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REVIEW ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 56-60

Role of Gambhari, Amalaki, and Haritaki Aschyotana in Shuktika with specific reference (W.S.R.) to conjunctival xerosis


1 Department of Shalakya Tantra, Abhilashi Ayurvedic College and Research Institute, Mandi, Himachal Pradesh, India
2 Department of Panchakarma, Abhilashi Ayurvedic College and Research Institute, Mandi, Himachal Pradesh, India
3 Department of Rasashastra and Bhaishajya Kalpana, Abhilashi Ayurvedic College and Research Institute, Mandi, Himachal Pradesh, India
4 Department of Kaumarbhritya, Abhilashi Ayurvedic College and Research Institute, Mandi, Himachal Pradesh, India

Date of Submission29-Jan-2020
Date of Acceptance09-Apr-2020
Date of Web Publication12-Jul-2020

Correspondence Address:
Dr. Abhinav Rathore
Department of Panchakarma, Abhilashi Ayurvedic College and Research Institute, Chail Chowk, Mandi, Himachal Pradesh
India
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DOI: 10.4103/bijo.bijo_6_18

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  Abstract 


The xerosis of the conjunctiva is a symptomatic condition in which the conjunctiva becomes dry, lusterless, and nonwettable. These patches almost always involve the interpalpebral area of the temporal quadrants and often nasal quadrants as well. Typical xerosis may be associated with conjunctival thickening, wrinkling, and pigmentation. Xerosis is correlated with Shuktika as the per Ayurvedic reference. In this disease, a small elevated blackish spot resembling shell appears in Shukla mandala. There are various noninvasive as well as safe treatment modalities mentioned in Ayurvedic classics for the treatment of Shuktika. Gambhari, Amalaki, and Haritaki Aschyotana are some of the medicines mentioned in Sushruta Samhita in the management of Shuktika. Hence, an attempt has been made in this regard to review the role of these drugs, i.e. topical instillation of Gambhari, Amalaki, and Haritaki eye drops in Shuktika. Ashchyotana is one among the seven Netra kriya kalpa. Gambhari, Amalaki, and Haritaki are found useful in treating Shuktika, i.e. conjunctival xerosis. As per Sushruta Samhita, the causative dosha in Shuktika is Pitta, and hence, the treatment involves in mitigating the Pitta dosha. It is told in Sushruta Samhita that the causative dosha should be eliminated. Gambhari, Amalaki, and Haritaki Ashchyotana have properties to eliminate Pitta dosha. The medicines mentioned in the present review are Pittahara and are considered best for the eyes. Gambhari, Amalaki, and Haritaki Ashchyotana are cost-effective, safe, and easy procedures which can be done by the patient himself/herself in their own homes.

Keywords: Amlaki, conjunctival xerosis, Gambhari, Haritaki, Shuktika


How to cite this article:
Rahul, Rathore A, Nigam R, Sharma B. Role of Gambhari, Amalaki, and Haritaki Aschyotana in Shuktika with specific reference (W.S.R.) to conjunctival xerosis. Albasar Int J Ophthalmol 2018;5:56-60

How to cite this URL:
Rahul, Rathore A, Nigam R, Sharma B. Role of Gambhari, Amalaki, and Haritaki Aschyotana in Shuktika with specific reference (W.S.R.) to conjunctival xerosis. Albasar Int J Ophthalmol [serial online] 2018 [cited 2021 May 12];5:56-60. Available from: https://www.bijojournal.org/text.asp?2018/5/2/56/289600




  Introduction Top


Shalakya is an important branch of Ayurveda which deals with disease manifesting above the clavicular region. Acharya Nimi is considered as the supreme authority in Shalakya tantra, but it was Acharya Sushruta who explained the subject in a systematic manner in Uttaratantra of Sushruta samhitha.

The xerosis of the conjunctiva is a symptomatic condition in which the conjunctiva becomes dry, lusterless, and nonwettable. These patches almost always involve the interpalpabral area of the temporal quadrants and often nasal quadrants as well. Typical xerosis may be associated with conjunctival thickening, wrinkling, and pigmentation.[1] It occurs in two groups of cases: (i) as a sequel of a local ocular affection and (ii) associated with general disease.

Based on a deficient serum retinol, there are more than 125 million preschool aged children with Vitamin A deficiency, among whom close to 4 million have an ocular manifestation of some kind, termed broadly as xerophthalmia. Management as per the modern medical science includes oral and intramuscular supplementation of Vitamin A.[2]

In children being treated for Vitamin A deficiency according to the protocols, transient bulging of fontanels occurs in 2% of infants and transient nausea, vomiting, and headache occur in 5% of preschoolers. Acute toxicity of Vitamin A can result in increased intracranial pressure, vertigo, diplopia, bulging fontanels in children, seizures, and exfoliative dermatitis; it may result in death.[2]

Xerosis is correlated with Shuktika as per the Ayurvedic reference. In this disease, a small elevated blackish spot resembling shell appears in Shukla mandala.[3] There are various noninvasive as well as safe treatment modalities told in Ayurvedic classics for the treatment of Shuktika. These can be done on the outpatient department level as well as by the patient himself/herself and are cheap and convenient.


  Materials and Methods Top


Aschyotana



Ashchyotana is one among these seven Netra kriya kalpa, which plays an important role in the treatment of eye diseases in general.

The patient should be comfortably lying down in the supine position in Kriyakalpa theater. The eye is opened by stretching and pressing apanga pradesa (lateral end) by the left hand. In the right hand, medicine is instilled to the open eye. These drugs can be held either in a conch shell, small vessels, or in a piece of cotton.[4]



Ashchyotana is to be done in day time only but not at nights, with the eye open, with drops of medicine being instilled from a height of two angulis.[5]





Eight drops for Lekhana action, ten drops for Snehana action, and 12 drops for Ropana action are the indicated doses. The medicine should be made warm during cold seasons and cold during hot season. This rule applies always.[6]



In disorders of Vata, the medicine should be bitter and oily. In Pitta disorders, it should be sweet and cold, and in Kapha disorders, warm and dry (viscid).[7]



Ashchyotana is to be retained for a period of one hundred syllables; the time required for one winking of the eyelids, the head going round the knee once, or uttering a long consonant is the unit called as one vakmatra.[8]



According to Sushruta, Aschyotana has three types viz. Lekhana, Snehana, and Ropana. Seven to eight drops for Lekhana, ten drops for Snehana, and 12 drops for Ropana are indicated.[9]

Shuktika

Shuktika is a disease of Netra, comes under the classification of Shukla Gata Roga according to Sushruta Samhita. Shuktika is corelated to “Conjunctival Xerosis”.

The symptoms are:

  1. Raised, silvery white, foamy, triangular patch of the keratinized epithelium, situated on the bulbar conjunctiva in the interpalpebral area[10]
  2. Multiple spots/dots resembling oyster shell (shukti) on sclera[11]
  3. Burning sensation in eyes[12]
  4. Pain in eyes[12]
  5. Diarrhea[12]
  6. Thirst[12]
  7. Fever.[12]


Drug review

A wide variety of yogas are described in Ayurveda to treat the various eye diseases. The formulations, i.e., Gambhari, amalaki, and haritaki Ashchyotana, selected in the clinical study to establish its therapeutic efficacy in treating Shuktika are from Sushruta Samhita Uttartantra and Pittabhishyanda pratishedham vyakhyasyama.

The ingredients of the above said formulation are easily available and moreover its mode of preparation and application is very easy. Further due to low cost, lower economic strata can also easily afford it.

Detailed descriptions of drugs are as follows:

Gambhari (fruit)[13]

Gambhari consists of dried fruit of Gmelina arborea Roxb. ( Family – Verbenaceae), an unarmed tree found scattered in deciduous forests throughout the greater part of the country up to an altitude of 500 m, planted in gardens and also as an avenue tree.

Synonyms

  • Sanskrit: Kashmari, Kashmarya, Pittakarohini, Shriparni, and Bhadraparni
  • Assamese: Gomari
  • Bengali: Gamargachha and Gambar
  • English: Beech Wood
  • Gujrati: Seevan
  • Hindi: Gambhari
  • Kannada: Seevani, Shivani, and Hannu
  • Malayalam: Kumbil, and Kumizhu
  • Marathi: Sivan
  • Oriya: Gambhari and Bhodroparnni
  • Punjabi: Khambhari
  • Tamil: Perunkurmizh and Komizhpazham
  • Telugu: Gumaditeku
  • Urdu: Gambhari.


Constituents

Butyric acid, tartaric acid, alkaloid, resin, and saccharine.

Properties and action

  • Rasa: Madhura, Amla, and Kshaya
  • Guna: Guru, Sara, and Snigdha
  • Virya: Shita
  • Vipaka: Madhura
  • Karma: Shukrala, Hrudya, Keshya, Medhya, Pittahara, Rasayana, Vatahara, and Brumhana.


Amalaki (dried fruit)[14]

Amalaki consists of pericarp of dried mature fruits of Emblica officinalis Gaertn. Syn. Phyllanthus emblica Linn. ( Family – Euphorbiaceae), mostly collected in winter season after ripening and in Kashmir in summer, a small or medium sized tree, found both in a natural state in mixed deciduous forests of the country ascending to 1300 m on hills, and cultivated in gardens, homeyards, or grown as a roadside tree.

Synonyms

  • Sanskrit: Amritaphala, Amalaka, and Dhatriphala
  • Assamese: Amlakhi, Amlakhu, and Amlaku
  • Bengali: Amla, and Dhatri
  • English: Emblic Myrobalan
  • Gujrati: Ambala and Amala
  • Hindi: Amla and Aonla
  • Kannada: Nellikayi, Bela nelli, and Pottadenollikayi
  • Kashmiri: Amli and Embali
  • Malayalam: Nellikka
  • Marathi: Anvala and Avalkathi
  • Oriya: Ainla and Anala
  • Punjabi: Aula and amla
  • Tamil: Nellikkai and nelli
  • Telugu: Usirika
  • Urdu: Amla and Amlaj.


Constituents

Ascorbic acid and gallotannins.

Properties and action

  • Rasa: Madhura, Amla, Katu, Tikta, and Kshaya
  • Guna: Laghu and Ruksha
  • Virya: Shita
  • Vipaka: Madhura
  • Karma: Chakshushya, Rasayana, Tridoshajit, and Vrushya
  • DOSE – 3–6 g of the drug in powder form.


Haritaki (fruit)[15]

Harìtakì consists of the pericarp of mature fruits of Terminalia chebula Retz. ( Family – Combretaceae), a moderate sized or large tree found throughout India, chiefly in deciduous forests and areas of light rainfall, but occasionally also in slightly moist forests, up to about 1500 m elevation, throughout India, flowers appear from April to August and fruits ripen from October to January.

Synonyms

  • Sanskrit: Abhaya, Kayastha, Shiva, Pathya, and Vijaya
  • Assamese: Shilikha
  • Bengali: Haritaki
  • English: Myrobalan
  • Gujrati: Hirdo, Himaja, and Pulo-harda
  • Hindi: Harre, Harad, and Harar
  • Kannada: Alalekai
  • Kashmiri: Halela
  • Malayalam: Katukka
  • Marathi: Hirda, Haritaki, Harda, and Hireda
  • Oriya: Harida
  • Punjabi: Halela and Harar
  • Tamil: Kadukkai
  • Telugu: Karaka and Karakkaya
  • Urdu: Halela.


Constituents

Tannins, anthraquinones, and polyphenolic compounds.

Properties and action

  • Rasa: Madhura, Amla, Katu, Tikta, and Kashaya
  • Guna: Laghu and Ruksha
  • Virya: Ushna
  • Vipaka: Madhura
  • Karma: Chakshushya, Dipana, Hrudya, Medhya, Sarvadoshaprashamana, and Rasayana,
  • Anulomana
  • DOSE – 3–6 g of the drug in powder form.



  Discussion Top


Discussion on mode of action of Ashchyotana

In Ashchyotana, medicines are allowed to flow. This should be used in the initial stages and can be used in acute conditions. The medicine is poured in the required dosage at the inner canthus. The medicine thus used flows through the conjunctival sac and passes to the nose. The volume of the conjunctival sac is 7 μml and the volume of 1 drop is 50 μml. Obviously, the medicine is either wasted or reaches the nose for the transnasal absorption. Acharyas have described dharanakala of ashchyotana. These are 200 matras for snehana, 100 matras for lekhana, and 300 matras for Ropana. Eye drops cannot be retained, so this dharanakala means instilling appropriate. Now, if we consider 100 matra is equal to 1½ min as mentioned by Kasturishastri, the Lekhana drop should be used every 10–15 s into 8 times. In the same way, each drop every 18 s for 10 times for Snehana and each drop every 22–24s for Ropana is used.

Basically, the idea behind this procedure is to use medicine by the use of fat- and water-soluble extracts from the herbs and other ingredients and keep them in contact with the epithelium of conjunctiva and cornea, thereby transferring essential elements to them.

Discussion on action of medicine

As per Sushruta Samhita, the causative dosha in Shuktika is Pitta, and hence, the treatment involves mitigating this Pitta dosha. It is mentioned in Sushruta Samhita that the causative dosha should be eliminated. Gambhari, Amalaki, and Haritaki Ashchyotana have properties to eliminate Pitta dosha. The medicines mentioned in the present review are Pittahara and are considered best for the eyes.

Gambhari, Amalaki, and Haritaki Ashchyotana are used in the treatment of eye diseases. Gambhari is a drug which is pittahara, hrudya and rasayana and Amalaki is tridoshahara, rasayana, and chakshushya. Haritaki is a drug mentioned in the treatment of eye diseases and has properties such as tridoshahara and chakshushya.


  Conclusion Top


  • Shuktika can be compared to conjunctival xerosis in which the conjunctiva becomes dry, lusterless, and nonwettable. These patches almost always involve the interpalpabral area of the temporal quadrants and often nasal quadrants as well. Typical xerosis may be associated with conjunctival thickening, wrinkling, and pigmentation accompanied by pain in the eyes, burning sensation in the eyes, diarrhea, thirst, and fever
  • Most common etiology of Shuktika is improper ahara and vihara causing chaya followed by prakopa and sthana samsraya of pitta dosha in the eyes. Etiological factors concerned with conjunctival xerosis are Vitamin A deficiency
  • In the present study, Shuktika was found to be more prevalent in preschool aged children, students, women in reproductive age, and alcoholics
  • Gambhari, Amalaki, and Haritaki Ashchyotana are cost-effective, safe, and easy procedures which can be done by the patient himself/herself in their own homes.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khurana AK. Comprehensive Ophthalmology. 4th ed. Daryaganj, New Delhi: New Age International (P) Limited Publishers; 2007. p. 434.  Back to cited text no. 1
    
2.
Fauci AS, et.al. Harrison's' Principles of Internal Medicine. Vol-1., 17th ed. New York City: McGraw Hill Medical Publishing Division; 2009. p. 447.  Back to cited text no. 2
    
3.
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4.
Yadunandan Upadhyaya VD, Vagbhata A. Ashtanga Hridaya with Vidyotini Hindi Teeka, Uttar Tantra. Ch. 23., Ver. 2-3. Varanasi: Chaukhamba Sanskrit Sansthana; 1980.  Back to cited text no. 4
    
5.
Sharngadhara, Sharngadhara Samhita, Uttara Khanda. Ch. 13., Ver. 12-13. Varanasi: Krishnadas Academy; 1985.  Back to cited text no. 5
    
6.
Sharngadhara, Sharngadhara Samhita, Uttara Khanda. Ch. 13., Ver. 13-14. Varanasi: Krishnadas Academy; 1985.  Back to cited text no. 6
    
7.
Sharngadhara, Sharngadhara Samhita, Uttara Khanda. Ch. 13., Ver. 14-15. Varanasi: Krishnadas Academy; 1985.  Back to cited text no. 7
    
8.
Sharngadhara, Sharngadhara Samhita, Uttara Khanda. Ch. 13., Ver. 15-17. Varanasi: Krishnadas Academy; 1985.  Back to cited text no. 8
    
9.
Shastri KA. Ayurveda Tatvasamdeepika Hindi Commentary on Sushruta Samhita of Sushruta, Uttara Tantra. Ch. 18., Ver 45-46., 10th ed. Varanasi: Chaukhamba Sanskrit Series; 1996.  Back to cited text no. 9
    
10.
Khurana AK. Comprehensive Ophthalmology. 4th ed. Daryaganj, New Delhi: New Age International (P) Limited Publishers; 2007. p. 434.  Back to cited text no. 10
    
11.
Kaviraj Ambikadatta Shastri, Ayurveda Tatvasamdeepika Hindi Commentary on Sushruta Samhita of Sushruta, Uttara Tantra. Ch. 4. Ver. 7., 10th ed. Varanasi: Chaukhamba Sanskrit Series; 1996.  Back to cited text no. 11
    
12.
Yadunandan Upadhyaya VD. Vagbhata, Ashtanga Hridaya with Vidyotini Hindi Teeka, Uttara Tantra. Ch. 10., Ver. 10-11. Varanasi: Chaukhamba Sanskrit Sansthana; 1980.  Back to cited text no. 12
    
13.
The Ayurvedic Pharmacopoeia of India, Part 1, Vol-II; Page 44 Government of India, Department of AYUSH; 1996.  Back to cited text no. 13
    
14.
The Ayurvedic Pharmacopoeia of India, Part 1, Vol-I; Page 5. Government of India, Department of AYUSH; 1999.  Back to cited text no. 14
    
15.
The Ayurvedic Pharmacopoeia of India, Part 1, Vol-I; Page 47. Government of India, Department of AYUSH; 1999.  Back to cited text no. 15
    




 

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