Shuklagata Rogas , Introduction,Armapptx
- 1. शुक्लगतरोग Dr sharada Major SD Singh University Farrukhabad
- 2. INTRODUCTION • Shukla mandala is the visible white portion of the eye. (Sukla= white coloured,Mandalam = circle). • It stretches fromVartma mandala to Krsna mandala. • Sukla mandala is normally white in colour. But the entry of vitiated dosas during the stage of Garbh vakranti ā (embryological development) will produce several congenital discolorations.
- 4. तदेव वातानुगतं विकृतरुक्षारुणाक्षम्। पित्तानुगतं पिङ्गाक्षम् । श्लेष्मानुगतं शुक्लाक्षम्रक् रक्तानुगतं रक्ताक्षम् इति। (अ.सं.शा. 2/53)
- 5. ’ दोष s Effect on शुक्लमण्डल वात विकृत, रुक्ष, अरुण पित्त पिंगल कफ शुक्ल रक्त रक्त पित्त and कफ (together) हरित/पिंगल रक्त and कफ (together) कपोत/निल
- 6. ROLE OF KAPHA • Shukla mandala, is the derivative of kapha. • It is a pitrja bh va ā . तथा कफ रक्तवाहिनां स्रोतसां महाभूतानां च प्रसादादिन्द्रियाण (अं.सं.शा. 5/49) सितं जलात्। (सु.उ. 1/11) • The qualities of kapha, viz., Snigdha, Sita, Guru, Manda, Ślaksna, Mrtsna and Sthira, take part is the formation of Sukla mandala.
- 7. CLASSIFICATION OF शुक्लगतरोग • The diseases of sukla mandala are classified into 11 types. प्रस्तारि शुक्ल क्षतजाधिमांस स्नाय्वर्मसंज्ञाः खलु पञ्च रोगा:। स्युः शुक्तिकाचार्जुन पिष्टकौ च जालं सिराणां पिडकाश्च याः स्युः। रोगा बलासग्रथितेन सार्धं एकादशाक्ष्णो खलु शुक्लभागे। (सु.उ. 4/3-4) • AcaryaVagbhata has observed symptoms of sirotpata and siraharsa in Suklamandala and included both of them in this group.
- 8. According to sushruta Vagbhata 01. Prastari arma Prastari arma 02. Shukla arma Shukla arma 03. Ksataja arma Shonita arma 04. Adhimamsa arma Adhimamsa arma 05. Snayu arma Snavarma 06. Suktika Suktika 07. Arjuna Arjuna 08. pistaka Pistaka 09. Sira jaala Sira jaala 10. Sira pidaka Sira(sira pitaka &sira chippita) 11. Balasa grathita Balasa grathita 12. — Sirotpata
- 9. CLASSIFCATION BASED ON DOSHA DOMINANCE No. Of diseases Names 1. Vataja 0 2. Pittaja 1 Suktika 3. Kaphaja 3 Shuklaarma, Pishtaka, Balasa grathita 4. Raktaja 3 Kshatajaarma,Arjuna, Sirajaala 5. Sannipataja 4 Prastaryarma Adhimamsarma,
- 10. CLASSIFICATION BASED ON PRESENTING SYMPTOM Features No. Names 1. Growing membrane 5 5 types of Arma 2. Nodular growth 4 Suktika, Sirapidaka, pishtaka and Balasagrathitha 3. Patch like 1 Arjuna 4. Increased blood vessels 1 Sirajaala
- 11. CLASSIFICATION BASED ON SHASTRA KARMA Shastra karma No. Names 1. Chedya/lekhya 7 5 types of Arma, sirajaala, sirapidika 2. Ashastrakrta 4 Suktika,Arjuna, Pishtaka, Balasagrathita
- 12. CLASSIFICATION BASED ON SADYA ASADYATA •Sadhya : all •Asadhya: nill
- 13. ARMA • Arma is characterised by a fleshy tissue in Sukla mandala • It is derived from the Sanskrit root (ऋ) with the meaning of regularly growing • Types : • Prastari arma • Sukla arma • Lohita (Ksataja) arma • Adhimamsa arma • Snayu arma
- 14. 1.PRASTARI ARMA Dominance :Tridosa Cikits : Cedana Sadhya ā The word Prastari has meanings like: • प्रस्तरणशीलं (दीपिका) – Growing continuosly • प्रसरयुक्तं (आतंकदर्पण) – Spreading • उत्सन्न – विस्तृतं Elevated and broad based.
- 15. प्रस्तारि प्रथितमिहार्म शुक्लभागे विस्तीर्णं तनु रुधिर प्रभं स नीलम्।। (सु.उ. 4/4) • Vistirnam : broad based. • Tanu: thin at the growing end. • Rudhiraprabham, sa nilam: reddish or bluish. • Prastari prathitamiharma sukla bhage: fleshy mass is seen in suklamandal and is called as prast ri ā arma AcaryaVagbhata have described prastari arma as grey or reddish muscular outgrowth produced by tridosa with following additional features: 1. Mridu: soft 2.Asu vriddhi: growing fast 3.Aruk: painless..
- 16. It is corelated with pterygium
- 17. 2. SHUKLA ARMA • Dominance: Kapha • Cikitsa: Cedana Sadhya • Suklärma, as the name indicates, is a white (sukla) fleshy growth, in Suklamandala. शुक्लाख्यं मृदु कथयन्ति शुक्लभागे, सश्वेतं सममिह वर्धते चिरेण । (सु.उ. 4/5) • Suklakhyam: Suklärma • Mridu kathayanti suklabhage: is soft outgrowth in suklamandala. • Sa swetam: whitish in appearance. • Samamiha vardhate cirena: uniform and grows slowly
- 18. •It is corelated to pterygium and pinguecula
- 19. 3. LOHITA ARMA • Dominance: Rakta • Cikitsa: Cedana Sadhya • As its appearance resembles blood it is called as rakta arma and Lohita arma • Ksataja ärma, indicates its traumatic origin. यन्मांसं प्रचयमुपैति शुक्लभागे पद्माभं तमुपदिशन्तिलोहितार्म (सु.उ. 4/5) • Yanmamsam pracayam upaiti sukla bhage: The muscular growth in shuklamandala. • Padmabham: Looking like a pink lotus in colour. • Tam upadisanti lohitarma: that is called as lohitarma
- 20. •It is compared with progressive pterygium, haemangioma, Symblepheron
- 21. 4.ADHIMAMSA ARMA • Dominance : Sannipätaja • Cikitsa: Cedana Sadhya विस्तीर्णं मृदु बहलं यकृत् प्रकाशं श्यावं वा तदधिक मांसजार्म विद्यात्। (सु.उ. 4/6) • Vistirnam: spreading in a wide area. • Mridu: soft. • Bahalam: thick. • Yakrit prakasam : looking like liver. • Syav m ā : or greyish in colour.
- 22. •It is corelated to pterygium or papilloma
- 23. 5.SNAYU ARMA • Dominance: Rakta • Cikitsä: Cedana Sadhya शुक्ले यत् पिशितमुपैति वृद्धिमेतत् स्नाय्वर्मेत्यभिपठितं खरं प्रपाण्डु (सु.उ. 4/6) • Yat sukle: in suklamandala. • Kharam: rough. • Prapandu: pale white coloured. • Pisitam upaiti vriddhim: muscular outgrowth. • Snayvarma iti abhipatitam : is mentioned as snayu arma. Snayu arma is a rough, pale dry muscular tissue resembling outgrowth of a tendon in Sukla mandala.
- 24. •It is compared to pterygium, pinguecula Or tumour of conjunctive
- 25. COMPLICATIONS OF ARMA Usually all the the five types of arma are painless.When this growth produce complications, then they should be excised. • असित प्राप्ति : Growth to reach Krsna mandala. • मांसावृतम् : Growth penetrating to deeper tissues like mämsa • स्नाव सिरावृतम् : Growth involving the blood vessels and tendons. • मांसवत् उच्छ्राय : Swelling that grow like a thick leather,Pressing underlying structures. • दृष्टि प्राप्ति : Growth extending Drsti mandala.
- 26. TREATMENT OF ARMA As 'arma' is an abonormal growth in the Suklamandala, it should be removed.But a clever physician should try with medicines before going for surgery. Hence clinical classification should be done as : 1. Lekhana Sadhya and 2. Cedya arma. Features of Lekhana sadhya arma: • अर्मं चाल्पं दधिनिभं नीलं रक्तमथापि वा। धूसरं तनु यच्चाणि शुक्रवत्तदुपाचरेत्।। (सु.उ. 15/17) • अर्मोक्तं पञ्चधा तत्र तनु धूमाविलं च यत्। रक्तं दधिनिभं यच्च शुक्रवत्तस्य भेषजम्।। (अ.हृ.उ. 11/13)
- 27. • दधिभिम् : Looking like curds-śukl rma ā • नीलं: Bluish-Prasthari. • रक्तं: Reddish-Rakt rma. ā • धूसर: Greyish-Snayu Arma. • तनु: Thin. Indications for Lekhana añjanas: 1. Alpa – very small growth 2. Tanu – thin growth. 3. Without complications (as listed earlier )
- 28. MedicalTreatment क्रिया शुक्लामये कार्या पित्ताभिष्यन्दजिच्छुया (यो.र. -नेत्र) Treatment of krsnagata rogas and pittaja abhisyanda are useful in arma. तच्छुक्लवत् कायशिरो विरेक लेखनाञ्जनैरुपाचरेत्।। (अ.सं.उ. 14/9) Further, virecana and nasyakarma will expel dosas from eye, there facilitating complete cure in addition to lekhana anjanas. Oral drugs : guggulu, vasakadi kwatha, maha triphalaadi gritha, lohadi guuggulu etc. Lepana: Marichadi lepa Putapaka Or Anjana: Krshnadi putapaka, pippalyadi gutikanjana.
- 29. Shastra karma: Indications of surgery: चर्माभं बहलं यत्तु स्नायुमांस घनावृत्तम्। (सिरावृतम्) छेद्यमेव तदर्म स्यात् कृष्ण मण्डलगं च यत्।। (सु.उ. 15/18) दृष्टि प्राप्तं तु वर्जयेत्। (अ.सं.उ. 13 / 25) • Very thick like extra skin (Charmabha) • Highly elevated (Bahala) • Fleshy growth covered densely with fibrous tissues (Snayu-Mamsa avrita) • Encroaching krsna mandala (Krishna mandalaga) • Visible blood vessels in arma However, if arma is already encroached the drsti mandala, it is a sign of incurability and surgery should be avoided in such cases.
- 30. 6.SHUKTIKA Dominance: Pitta Cikitsä: Sädhya The word Suktika literally mean a shell. In this disease, a small elevated blackish spot resembling shell appears in sukla mandala. Suktika is characterised by: श्यावाः स्युः पिशितनिभाञ्च बिन्दवो ये। शुक्त्याभाः सितनयने स शुक्ति संज्ञः।। (सु.3.4/7) Syavah pisitanibhasca bindavo syuh : greyish flesh like dots. Ye suktyabhah: having the lustre of a pearl shell.
- 31. • Suktika is compared to xerosis Or xeropthalmia
- 32. TREATMENT • The disease Suktika is a pittaja vyadhi. Hence local and systemic measures to relieve pitta, mentioned in the pittabhisyanda prati eda (Su.Ut. 11) and ș pittajavisarpa are useful. • But SiraVyadhana is contraindicated in this disease. Seka,Aścyotana, lepa and Nasya are specially beneficial. • After dosas are eliminated from the body by virecana, cooling anjana like samudra phena rubbed with breast milk and honey should be applied. • Palasyadi, mustadi, amalakyadi, lodhradi anjanas mentioned in pittaja abhisyanda are also indicated for suktika. • Gh ta P na:Triphala ghrta,Tilvaka Gh ta (10 year old) Purana Gh ta, ṛ ā ṛ ṛ • Vaidurya anjana
- 33. 7.ARJUNA • Dominance : Rakta • Cikitsä: Sädhya एको यः शशरुधिरोपमस्तु बिन्दुः शुक्लस्थो भवति समर्जुनं वदन्ति (सु.उ. 4/7) • Eko yah sasa rudiropamastu binduh: a single red dot resembling rabbits blood. • Suklastho bhavati: in sukla mandala. • Tam arjunam vadanti: is called as arjuna. • The single dot situated in suklamandala which appears like a rabbits blood in colour is called as arjuna.
- 34. Arjuna can be compared to following conditons • Sub conjuctival haemorrhage • Haemangioma( abnormal growth of blood vessels ) • Mole Or melanoma
- 35. TREATMENT • Arjuna is one among the asastra krita vyadhis and surgery is strictly contraindicated. अर्जुनेषु रक्ताभिष्यन्दवत् प्रतिकुर्यात्। (अ.सं.उ. 14/8) पैत्तं विधिमशेषेण कुर्यादर्जुनशान्तये।। (सु.उ. 12/19) Rakta Abhisyanda Cikitsä, and Pittahara measures should be followed in the management of Arjuna. Following anjana yogas are advocated by AcaryaVägbha a: ț • Käsisa with human milk • Käsisa with honey
- 36. 8.PISHTAKA Pistaka literally mean a rice cake. • Dominance : Kapha (Su); Kapha,Vayu (V); • Cikitsä: Sädhya उत्सन्नः सलिलनिभोऽथ पिष्टशुक्लो बिन्दुर्यो भवति स पिष्टकः सुवृत्तः।। (सु.उ. 4/8) • Utsannah: elevated. • Salila nibho bindu: resembling water droplet. • Pista suklo: rice cake like white coloured. • Suvritta: perfectly round bubbles. • Suklo: in suklamandala. • Sa pistaka bhavati: is called as pistaka. An elevated circular dot, which looks like water drop and is as white as a rice cake is
- 37. • Pistaka is compared to pinguecula and lymphangioma (benign tumors of lymphatic system)
- 38. TREATMENT • Similar to Abhisyanda and Adhimantha. • Yogaratnakara has found Raktamokshana and the treatment of kaphabhisyanda useful in pistaka • Anjana: Mahoushaadhadi Anjana, Brihatyadi Anjana • Internal medicine: Netrasani rasa with ghee and honey for chronic case of pistaka
- 39. 9.SIRAJAALA • Dominance: Rakta • Cikitsa: Sadhya जालाभः कठिनसिरो महान् सरक्तः सन्तानः स्मृत इह जाल संज्ञितस्तु।। (सु.उ. 4/8) • Jalabhah santanah: an extensive network of • Katinasiro: rigid veins. • Mahan sa raktah: filled with blood. • Jalasamjnitah tu: is called as siräjäla. Siräjäla is known to be the condition in which there is an extensive branched net work of rigid veins filled with blood.
- 40. Sirajaala is seen as a symptom in Deep anterior scleritis, haemangioma, ciliary staphyloma
- 41. TREATMENT • Both medical and surgical treatment are advised in siräjäla depending upon the nature of siras. • Lekhana Añjanas: Smooth and fragile blood vessels should be treated with Lekhana Añjanas. • The kathina (stiff and hard) siras should be excised like arma. • The stiff blood vessels should be held with a hook (Badisa yantra) and excised with a circular knife (Mandalagra sastra). • Pratisarana with lekhana drugs as in arma and Abhisyanda should be done after surgery
- 42. 10. SIRA PIDAKA • Dominance:Tridosa • Cikitsa: Sadhya • Sira pidaka (sira = blood vessels; pidika = nodular swelling) is a condition in which white nodules covered by blood vessels are seen near krsna mandala. शुक्लस्थाः सित पिडकाः सिरावृता यास्ता विद्यादसित समीपजाः सिराजाः।। (सु.उ. 4/9) • Suklasth h sita pidikah ā : white nodules in suklamandala. • Asita samipaja: near krisnmandala. • Sira avrita: capped by blood vessels. • Sirajah vidyat: are called as siraja or sira pidika. • Sira pidika is a condition in which white nodules, covered by blood vessels, are seen in sukla mandala near krisna mandala.
- 43. Sira pidaka can be compared on the basis of clinical features with: • Episcleritis • Scleritis • Phylctenular conjunctivities • Limbal nodule (nodular lesion at limbus)
- 44. TREATMENT • Medical and surgical treatment similar to arma. • Sankhadi curnänjana • Lekhana karma is beneficial for very minute sirä pidikas. • Bigger pidikas are held with the tip of a needle and are excised.
- 45. 11.BALASA GRATHITA • Dominance:kapha • chikitsa:sadya कांस्याभो भवति सिते अम्बु बिन्दु तुल्यः । स ज्ञेयो अमृदुः अरुजो बलासकाख्यः ।। (सु.उ. 5/9) • Site ambu bindu tulyah: a water drop like swelling in sukla mandala. • Kamsyabho: resembling the colour of bell metal. • Amridu: hard. • Arujo: painless. • Balasak khyah ā : that disease is balasaka or balasa grathitha. • Balasa grathita is a condition in which a growth looking like a drop of water shining like bell metal occurs in suklamandala. It is neither soft nor painful.
- 46. • Balasa grathita resembels Episcleral Rheumatoid nodule and any cyst Or tumour of conjunctiva
- 47. TREATMENT • As the disease Baläsa grathita is produced by kapha, treatment of kaphaja Abhisyanda is to be undertaken, but without siravydha. बलासाहयपिष्टके कफाभिष्यन्दवन्मुक्त्वा सिराव्यधमुपाचरेत्।। (अ.हृ. उ. 11/7-8) • Ksarañjana is an exclusive remedy for Balasagrathita mentioned by both Susruta andVägbhata. • The two anjana yoga of vaghbhata are: 1.vyosa katphaladyanjana 2. Jati mukuladyanjana