SHUKTIKA - ARJUNA

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SHUKTIKA - ARJUNA

• Dr. Pranav Bhagwat
• Reader, dept. of Shalakyatantra,
• Gomantaka ayurveda college,
• Shiroda, Goa.

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SHUKTIKA
It is a Shuklagata, Pittaja, Sadhya Vyadhi.
Shyava syu pishitanibhashcha bindavo
ye/ Shuktyabha sitanayane sa shuktisaudnya//
(su ut 4/6)
Dalhana comments - shuktyabha  iti
jalashuktiriva kincit deerrgha shuklamandale ye
bindava 

• Colour
• Consistency
• Shape

• Shyava i.e. blackish white
• Mamsa-like
• Shell-like oblong or oval (Dalhana)

These are multiple spot-like structures .

• Gadanigraha (netra-66)
• Bhavaprakasha (Madhya 4/16)
• Yogaratnakara (netra-66)

• Sushrutas opinion

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According to Vagbhata-
Pittam kuryaat site bindoon asita-shyaava-peetakan
/ Malaaktaadarshatulyam vaa sarvam shuklam
adaaharuk/ Roga ayam shuktikaasandnya
sashakrudbhedtrudjwara// ( A.S.U. 13/12.)
Pittam kuryaat site bindoon asita-shyaava-peetakan
/ Malaaktaadarshatulyam vaa sarvam shuklam
adaaharuk/ Roga ayam shuktikaasandnya
sashakrudbhedtrudjwara// ( A.S.U. 13/12.)
INDU TIKA Pittam kruddham site bhaage
asitadivarnaan bindun tilakalakaan kuryaat/
athavaa sarvam shuklam malaliptadarpanasadrusham
kuryaat/ ubhayatraaapi daaharuk abhava/ etat
ubhayamapi shakrutbhedadiyogannaamna shuktika iti
rogo bhavati /
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Inference
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SUSHRUTA
VAGBHATA

• Can be corelated with Xerosis.

• Can be considered as part of systemic disease.
• pigmentary lesion of conjunctiva and sclera
• including malignant melanoma, primary acquired
  melanosis, naevus,
• Like a dirty mirror- xerosis.
• when we include general symptoms - viral
  hepatitis, liver disorders.

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XEROSIS

• Dry lustreless condition of conjunctiva due to
  deficiency of mucin.

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XEROSIS

• Types- two.
• 1) - as a sequel of local ocular disease
• 2) - associated with general condition.
• The first type occurs due to
• scarring of the conjunctival epithelium and
  glands following trachoma, burns, diphtheria,
  pemphigoid- starts as a spot and continue to
  affect whole conjunctiva or cornea.
• Prolonged exposure to air due to ectropion or
  proptosis.

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• Xerosis has nothing to do with lacrimal
  apparatus. It depends more on the secretory
  activity of conjunctiva. (Goblet cells )

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xerosis

• The second general type --a milder form,
• --
  usually found in children due to lack of vitamin
  A in diet and accompanied by night blindness.
• (vita. A daily requirement is 5000 I. u. /day-
• chief sources milk, egg, carrots.
• Stored in liver.).

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Character of xerosis

• A small triangular, white patch, little away from
  limbus in the horizontal meridian, usually on
  temporal side first.
• is covered with foamy substance due to gas
  produced by corynebacterium xerosis. (bitots
  spots).
• When patients looks towards affected side
  wrinkling of bulbar conjunctiva at the site.
• When the child is marasmic, disease associated
  with nyctalopia and keratomalacia.

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Treatment

• Prevention
• 1) vit A 2 lac U every 6 months from the age of 6
  months to 3 years
• 2)diet containing green leafy vegetables etc.
• Curative
• Vit A IM 1 lac U per day on alternate day for 3
  weeks.
• Oral vit. A
• Artificial tears
• Topical antibiotics
• Dark glasses

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Pigmentory lesions of conjunctiva
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PIGMENTARY LESIONS OF CONJUNCTIVADIFFERENTIAL
DIAGNOSIS OFMELANOCYTIC LESIONS
NEVUS RACIAL MELANOSIS OCULAR MELANOCYTOSIS PRIMARY ACQUIRED MELANOSIS (PAM) MALIGNANT MELANOMA
Onset First 2 decades. Can show changes during puberty Congenital, dark individuals Congenital,Can be associated with Naevus of Ota 40-50 yrs, in fair skins, high chances of conversion to Ca. gt50 yrs (but can be any age)
Location Interpalpebral area Limbusgtbulbargtpalpebral conjunctiva Bulbar conjunctiva Anywhere (usually bulbar conjuctiva) Anywhere
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NEVUS RACIAL MELANOSIS OCULAR MELANOCYTOSIS PRIMARY ACQUIRED MELANOSIS (PAM) MALIGNANT MELANOMA
Colour Brown or yellow Brown gray Brown Brown or pink
Depth Substantia propria Epithelium Episclera/scleral Epithelium/substantia propria Substantia propria
Cyst Present 50 None None None Vascular nodule
Margins Well defined Ill defined Ill defined Illdefined well defined
Laterally Unilateral Bilateral Usually unilateral unliateral Unilateral
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Conclusion

• Pigmented lesions of the conjunctiva comprise a
  large and varied
• spectrum of conditions that include benign
  and malignant melanocytic lesions.
• 2. Whilst conjunctival nevi are the most common
• Melanocytic lesions, the clinical features
  of these pigmented
• conditions occasionally overlap and cause
  diagnostic confusion.
• 3. Clinical inspection and photodocumentation on
  regular intervals
• is utilized to monitor pigmented lesions.
• 4. A conjunctival biopsy can confirm diagnosis.

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Treatment
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TREATMENT OF SHUKTIKA ACCORDING TO AYURVEDA

• Sushruta-
• Doshhaiadhastaat shuktikaayaam apaaste
  sheetairdravyairanjanan kaaryamaashu//
• 
  (Su.u.11/14)
• Dalhana says
• Adhastaat apaaste doshaihi virechanena iti/
• Anjana of vaidurya, sphatika, pravala,mukta,shankh
  a,raupya,suvarna along with sharkara and honey.

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Conclusion.

• Sushruta has understood the degenerative
  condition of conjunctiva and hence used
  ratnas,upratnas and superior dhatus for anjana.
• The advocacy of virechana also points towards
  involvement of yakruta (raktavaha srotas ) here
  the point should be noted that virechana cannot
  be given in Vagbhatas Shuktika as it already has
  shakruta bheda.

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Vagbhata (A.S.U.14/6)

• says- shuktikaam pittaabhishhyandavat saadhayet
  //
• Treatment of pittabhishandhya includes (
  A.S.U.19)
• 1)ghruta pana with sharkara or tiktaka
  ghruta/mahatiktaka ghruta/guggula tiktaka ghruta.
• 2) aschotana-kashaya of poundarika,
  amalaka,darbha,dashamula,shatavari,manjistha,
  talispatra,yasthi,darvi along with sugar and
  stanya.
• 3)seka-lepa- described here are anti inflammatory
  which are not useful in this condition.

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• 4) anjanas described here are also rujaghna
  dahraghna and hence not useful in this condition
• 5) rasakriya of 50 parts of darvi and 1 part of
  sariva, yasthi, kakoli, nisha,draksha,
  manjistha,lodhra, usher,chandana, kashmari,
  sunishannaka. This is useful in all pittarogas.
• 6)nasya- kalka of sarivasharkarakashmari
  swarasa, nasya-yashti kalka triturated in ikshu
  rasa .
• 7)Tarpana and putapaka similar to savrana
  shukla-cream should be taken from kshirapaka of
  mamsa of jaangala animals, pigeons, hens etc.
  along with sheeta, jevaniya drugs and this cream
  is subjected to kshirpaka with kalka of
  chandana, madhu etc. For putapaka veshavar of
  kukkuta along with sheeta, jeevaniya drugs, honey
  and ghee should be used.
• 8) Siravedha. saarvadehika pittadushti.

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Conclusion.

• The treatment described by Vagbhata has the
  action of raktaprasadana along with pitta
  shamana. This imparts arrest of transformation in
  nature of tissues- metaplasia -which is useful in
  acquired melanosis.
• Fat soluble contents.
• Jeevaneeya action.

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Chakradatta (59/195)

• Recommends following treatment-
• koumbha-sarpi(puraana ghrita) paana .-
  chakshushya
• Virechana.
• Alepa.
• parisheka by madhura sheeta dravyas .
• anjana same as Sushruta with addition of
  chandana.
• Vrunda madhava, Bhaishajya Ratnavali, Gadanigraha
  follow Chakradatta.

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Conclusion-

• Sushruta, Chakradatta and others Xerosis.
• Vagbhata- Xerosis pigmentations.

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ARJUNA.
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ARJUNA-

• This is a shuklagata vyadhi,
• Raktaja, saadhya.
• Sushruta says- ( Su. U. 4/7)
• Eko ya shasharudhiropamastu bindu
  shuklastho bhavati tam arjunam vadanti/
• Gadanigraha (3/netraroga/66) , yogaratnakara-
  (netraroga/67), follow Sushruta.
• Vagbhata says-(A.S.U.13/20)
• Neeruk shlakshno arjuno bindu shashalohit
  lohita/
• Vagbhata has added painless lesion as an
  additional feature.

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SUBCONJUNCTIVAL ECCHYMOSIS
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• Site- bulbarC. Since it is liable to injuries and
  also loose connective tissues are there.
• Colour bright red, then blackish red.

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Causes-

• direct trauma to the eye- posterior limit is
  visible.
• Injury to orbit/head injury- appears within 12-24
  hrs after injury. Since the bleeding is from
  inside the orbit, therefore the posterior limit
  of the hemorrhage is not visible.
• Marked congestion of neck veins- whooping cough
  in children, severe compression of chest/neck
• Blood diseases- leukaemia, haemophilia, purpura.
• HT/ aneurysm of local arterioles.
• Acute inflammation of conjunctiva- -pneumococcal,
  herpes simplex, leptospirosis, viral epidemic
  K-Citis.

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• Acute febrile systemic infections- measles,
  yellow fever, subacute bacterial endocarditis,
  meningococcal septicaemia.
• Endometriosis.
• Elderly people
• idiopathic

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DIFFERENTIAL DIAGNOSIS

• Kaposis sarcoma (in AIDS cases, bluish red
  tumour, may be with similar lesion on eyelid and
  face)

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TREATMENT

• Trivial condition
• Hardly any treatment required.
• Blood absorbs within 2-3 wks. Faster with hot
  compresses
• Astringent drops as placebo.

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AYURVEDOKTA CHIKITSA
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• According to Sushruta
• (Su. U. 12/19-27)
• Paittam vidhim ashshhena kuryaat arjunashantaye/
• The vidhi of pittaabhishhyanda should be follwed.
• Parisheka with ikshu, honey, sugar, stanya,
  darvi, yashti, saindhava
• Anjana with same
• Ashcyotana- Amla drugs. Also with sugar water,
  yashti, mastu, honey, amla, saindhava,
  beejapooraka, kola, dadimamla.

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• Anjana-
• 1)sphatika, pravala, shankha, yashti, honey or
  2)shankha, honey, sugar, samudraphena or
  3)saindhava, honey, kataka or
• 4) rasanjana with honey or
• 5) kasis with honey.
• Lekhyanjana- lohadi dhatu, avasadana gana, 5
  lavanas, etc.
• Putapaka at last.

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According to Vagbhata (A.S.U.14/8)

• Raktaabhishyandavat pratikuryaat/
• Ashchyotana- matulungarassugar or mastu
• Anjana- 1)shankhanaabhi makshika or
  2)samudraphena with sita or 3)sphatika, keshara,
  shankhanabhi, yashti, honey or 4)rasanjana with
  honey or 5) kasis with honey.
• From raktabhishyanda chikitsa
• If required siravyadha
• Nasya- sharkara, stanya,neelotpala.

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According to Vrundamaadhava (Netraroga/226/7/8)

• 1. Pittabhishyandavat.
• 2. Anjanas with
• shankha with honey.
• kataka with saindhava.
• samudraphena with sugar.
• 3. Purana with sita, honey tentu, mastu, yashti,
  saindhava.

Follow anjanas of Vrunda
ChakradattaGadanigrahaYogaratnakaraBhaishajyara
tnavali
Yogaratnakara advises aschyotana with sugar,
mastu and honey.
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Discussion Conclusion
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• Basic treatment principle- early absorption of
  extravasated blood to reduce anxiety of patient
  and further prevention of recurrence.
• yogas containing CaCO3, sugar, honey, kashaya
  dravyas are used.
• Here,. the question can be raised regarding use
  of amla rasaa for ashchyotana and not kashaya
  rasa, though amla rasa is raktapittaprakopakara.

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• The answer is- The amla rasa - ushna so drugs
  when instilled in eye get entry into capillaries
  and veinules and dilate them causing resorption
  of blood.(anumaana) The similar use of amla
  dravyas are found for lepa in raktapitta chikitsa
  and pittaja jwara chikitsa..(aapptopadesha.)
• Lekhyanjana should be reserved for intractable
  cases and generally not required.

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• The topic is open for discussion.
• -dr. Pranav Bhagwat.