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Chapter 59 – Netra roga Nidanam

The 59th Chapter of Madhava Nidana is Netra roga Nidana which deals with Diseases of the Eye.

General Etiological Factors

उष्णाभितप्तस्य जले प्रवेशाद् दूरेक्षणात् स्वप्न विपर्ययाच्च |
स्वेदाद्रजो – धूमनिषेवणाच्च च्छर्देर्विघाताद् वमनातियोगात् || १ ||
द्रवात्तथा अन्नान्निशि सेविताच्च विण्मूत्र – वातक्रमनिग्रहाच्च |
प्रसक्तसंरोदन – कोप – शोकाच्छिरो अभिघातादतिमध्यपानात् || २ ||
तथा ऋतूनां च विपर्ययेण क्लेशाभिघातादतिमैथुनाच्च |
बाष्पग्रहात् सूक्ष्मनिरीक्षणाच्च नेत्रे विकाराञ्जनयन्ति दोषाः || ३ ||

uṣṇābhitaptasya jalē pravēśād dūrēkṣaṇāt svapna viparyayācca |
svēdādrajō – dhūmaniṣēvaṇācca cchardērvighātād vamanātiyōgāt || 1 ||
dravāttathā annānniśi sēvitācca viṇmūtra – vātakramanigrahācca |
prasaktasanrōdana – kōpa – śōkācchirō abhighātādatimadhyapānāt || 2 ||
tathā r̥tūnāṁ ca viparyayēṇa klēśābhighātādatimaithunācca |
bāṣpagrahāt sūkṣmanirīkṣaṇācca nētrē vikārāñjanayanti dōṣāḥ || 3 ||

Various eye disorders emerge due to the following factors that vitiate the doshas:

  1. taking bath in cold water immediately after exposure to heat,
  2. seeing objects which are far away,
  3. keeping awake without having a proper sleep
  4. exposure to dust and smoke,
  5. suppressing the urge of vomiting or frequent vomiting
  6. heavy perspiration
  7. taking water based items at night
  8. suppressing the call of nature
  9. indulging in the emotions of weeping, anger and grief
  10. injury to the head
  11. excessive intake of the alcoholic drinks,
  12. abnormal seasonal changes,
  13. exhaustion by physical exercise,
  14. sexual act and the like,
  15. controlling of the tears and seeing minute objects for long periods of  time and other identical activities. 1-3
Abhishyanda (Conjunctivitis)

वातात् पित्तात् कफाद्रक्तादभिष्यन्दः चतुर्विधः |
प्रायेण जायते घोरः सर्वनेत्रामयाकरः || ४ ||

vātāt pittāt kaphādraktādabhiṣyandaḥ caturvidhaḥ |
prāyēṇa jāyatē ghōraḥ sarvanētrāmayākaraḥ || 4 ||

Vitiation of Vata, Pitta and kapha or rakta gives rise to abhisyanda. Abhisyanda is of four types – Vataja, Pittaja, Kaphaja, and Raktaja. It is a very distressing disease leading to all kinds of eye disorders. 4

Vatabhisyanda (? Sub acute catarrhal conjunctivitis)

निस्तोदन – स्तम्भन – रोमहर्ष – संघर्ष – पारुष्य – शिरो अभितापाः |
विशुष्कभावः शिशिराश्रुता च वाताभिपन्ने नयने भवन्ति || ५ ||

nistōdana – stambhana – rōmaharṣa – saṅgharṣa – pāruṣya – śirō abhitāpāḥ |
viśuṣkabhāvaḥ śiśirāśrutā ca vātābhipannē nayanē bhavanti || 5 ||

The following are the features of abhishyanda that is generated by vitiation of Vata:

  • Pricking pain and
  • Loss or restricted movement,
  • Horripilation
  • irritation, and
  • roughness inside the eyes
  • headache,
  • absence of excretions in the eyes and cold tears. 5
Pittabhisyanda (Purulent conjunctivitis)

दाह – प्रपाकौ शिशिराभिनन्दा धूमायनं बाष्पसमुच्छ्रयश्च |
उष्णाश्रुतो पीतकनेत्रता च पित्ताभिपन्ने नयने भवन्ति || ६ ||

dāha – prapākau śiśirābhinandā dhūmāyanaṁ bāṣpasamucchrayaśca |
uṣṇāśrutō pītakanētratā ca pittābhipannē nayanē bhavanti || 6 ||

The features of Abhisyanda that are generated by pitta include the following:

  • Burning sensation
  • Severe inflammation
  • Longing for cold applications,
  • a feeling as if smoke is coming out of the eye
  • Excessive watering

Warm lacrimation and

  • Yellow discolouration of the eye. 6
Kaphabhisyanda (? Allergic conjunctivitis, spring catarrh)

उष्णाभिनन्दा गुरुता अक्षिशोथः कण्डु उपदेहावतिशीतता च |
स्रावो मृदुः पिच्छिल एव चापि कफाभिपन्ने नयने भवन्ति || ७ ||

uṣṇābhinandā gurutā akṣiśōthaḥ kaṇḍu upadēhāvatiśītatā ca |
srāvō mr̥duḥ picchila ēva cāpi kaphābhipannē nayanē bhavanti || 7 ||

The following are the features of abhisyanda that is generated by growth of kapha:

  • Desire for warm comforts,
  • sense of heaviness,
  • Swelling,
  • severe itching,
  • accumulation of dirty excrections
  • very cold and sticky tears flowing out frequently. 7
Raktabhisyanda ( ? Acute mucopurulent conjunctivitis)

ताम्राश्रुता लोहितनेत्रता च नाल्यः समन्ताlदतिलोहिताश्च |
पित्तस्य लिङ्गानि च यानि तानि रक्ताभिपन्ने नयने भवन्ति || ८ ||

tāmrāśrutā lōhitanētratā ca nālyaḥ samantāldatilōhitāśca |
pittasya liṅgāni ca yāni tāni raktābhipannē nayanē bhavanti || 8 ||

An affliction of the eye with vitiated rakta would reflect the following features:

  • Copper coloured tears
  • red colour of the eyes
  • absence of the network of arteries and
  • And presence of the features of provoked pitta.

These symptoms are present there in cases of Abhisyanda produced due to growth of blood. Moreover, there are deep red vascular markings in this morbidity in addition to the presence of all the features described regarding the pittabhisyanda. 8

Adhimantha (Glaucoma)
Pathogenesis

वृद्धैरेतैरभिष्यन्दैर्नराणामक्रियावताम् |
तावन्तस्त्वधिमन्थाः स्युर्नयने तीव्रवेदनाः || ९ ||

vr̥ddhairētairabhiṣyandairnarāṇāmakriyāvatām |
tāvantastvadhimanthāḥ syurnayanē tīvravēdanāḥ || 9 ||

Any of the above types of abhisyanda, if not treated at the proper time, would lead to the ailment named Adhimantha that generates severe pain in the eyes. 9

General Features

उत्पात्यत् इवात्यर्थं नेत्रं निर्मथ्यते तथा |
शिरसो अर्धं तं विध्यादधिमन्थं स्वलक्षणैः || १० ||

utpātyat ivātyarthaṁ nētraṁ nirmathyatē tathā |
śirasō ardhaṁ taṁ vidhyādadhimanthaṁ svalakṣaṇaiḥ || 10 ||

The symptoms of adhimantha include

  • Severe pain as though the eye is being pulled out by force or
  • being squeezed inside and
  • there is severe pain in half portion of the head,
  • in addition to the other features of the predominant doshas involved in context. 10
Sequela

हन्याद् दृष्टिं श्लैष्मिकः सप्तरात्रादधीमन्थो रक्तजः पञ्चरात्रात् |
षड्रात्राद्वै मारुतोत्थो निहन्यान्मिथ्याचारात् पैत्तिकः सध्य एव || ११ ||

hanyād dr̥ṣṭiṁ ślaiṣmikaḥ saptarātrādadhīmanthō raktajaḥ pañcarātrāt |
ṣaḍrātrādvai mārutōtthō nihanyānmithyācārāt paittikaḥ sadhya ēva || 11 ||

Adhimantha, if not treated quickly, will destroy the vision. If it is the

  • kaphaja type  – within seven days
  • raktaja type — 5 days
  • Vataja type — 6 days
  • Pittaja — 3 days. 11
Aama Stage of eye diseases

उदीर्णवेदनं नेत्रं राग – शोथसमन्वितम् |
घर्ष – निस्तोद – शूलाश्रुयुक्तमामान्वितं विदुः || १२ ||

udīrṇavēdanaṁ nētraṁ rāga – śōthasamanvitam |
gharṣa – nistōda – śūlāśruyuktamāmānvitaṁ viduḥ || 12 ||

The following are the features of the immature (ama) stage of eye afflictions:

  • Pain that increases progressively,
  • Redness of the eyeballs
  • Swelling,
  • Irritation and
  • Pricking pain and flow of tears. 12

Pakva Stage of Eye diseases

मन्दवेदनता कण्डुः संरम्भाश्रुप्रशान्तता |
प्रशस्तवर्णता चाक्ष्णोः संपक्वं दोषमादिशेत् || १३ ||

mandavēdanatā kaṇḍuḥ sanrambhāśrupraśāntatā |
praśastavarṇatā cākṣṇōḥ sampakvaṁ dōṣamādiśēt || 13 ||

The following are the features that are manifested during the ripened (pakva) stage of eye diseases:

  • Reduction on the degree of pain,
  • irritation
  • Swelling, and
  • the amount of tears as well as the colour of the eyes returning to normalcy. 13

Panophthalmitis and Non Inflammatory atrophy of the globe

कण्डुपदेहाश्रुयुतः पक्वोदुम्बरसन्निभः |
संरम्भी पच्यते यस्तु नेत्रपाकः सशोथजः |
शोथहीनानि लिङ्गानि नेत्रपाके त्वशोथजे || १४ ||

kaṇḍupadēhāśruyutaḥ pakvōdumbarasannibhaḥ |
sanrambhī pacyatē yastu nētrapākaḥ saśōthajaḥ |
śōthahīnāni liṅgāni nētrapākē tvaśōthajē || 14 ||


Sashotha Netrapaaka (pus formation and ulceration) is that condition when there is itching and stickiness associated with lacrimation in the eye. The eye looks like a fruit of a ripe country fig (Udumbara) and the inflammation goes on to suppuration. Sometimes this condition appears without swelling. This is known as Asotha Netrapaaka. The asothaja netrapaaka (non inflammatory atrophy of the globe) has all the above mentioned features except inflammation. 14

Hataadhimantha (Atrophic Bulbi following acute congestive glaucoma)

उपेक्षणादक्षि यदा अधिमन्थो वातात्मकः सादयति प्रसह्य |
रुजाभिरुग्राभिरसाध्य एष हताधिमन्थः खलु नाम रोगः || १५ ||


upēkṣaṇādakṣi yadā adhimanthō vātātmakaḥ sādayati prasahya |
rujābhirugrābhirasādhya ēṣa hatādhimanthaḥ khalu nāma rōgaḥ || 15 ||


One should not neglect Vataja adhimantha because it might other wise culminate into Hataadhimantha that is an incurable disease with severe pain. 15

Vataparyaya (Ocular Neuralgia)

वारं वारं च पर्येति भ्रुवौ नेत्रे च मारुतः |
रुजश्च विविधास्तीव्राः स ज्ञेयो वातपर्ययः || १६ ||


vāraṁ vāraṁ ca paryēti bhruvau nētrē ca mārutaḥ |
rujaśca vividhāstīvrāḥ sa jñēyō vātaparyayaḥ || 16 ||


The disease Vataparyaya has been identified with the condition when vata is in upsurge. It generates severe and frequently intense pain in the eyebrows, and surrounding areas. 16

Sushka Akshipaaka (Xerophthalmia)

यत् कूणितं दारुण – रुक्षवर्त्म सन्दह्यते चाविलदर्शनं यत् |
सुदारुणं यत् प्रतिबोधने च शुष्काक्षिपाकोपहतं तदक्षि || १७ ||


yat kūṇitaṁ dāruṇa – rukṣavartma sandahyatē cāviladarśanaṁ yat |
sudāruṇaṁ yat pratibōdhanē ca śuṣkākṣipākōpahataṁ tadakṣi || 17 ||


The following are the symptoms of Sushka Akshipaaka:

1. The eyelids when closed become rough and dry. It has a burning sensation. In this condition, the eyes remain full of dirty excretions and one finds it very difficult to open the lids. 17

Anyatovaata (Referred pain in the eye)

यस्यावटु – कर्ण – शिरो – हनुस्थो मन्यागतो वा अप्यनिलो अन्यतो वा |
कुर्याद् रुजं वै भ्रुवि लोचने च तमन्यतोवातमुदाहरन्ति || १८ ||


yasyāvaṭu – karṇa – śirō – hanusthō manyāgatō vā apyanilō anyatō vā |
kuryād rujaṁ vai bhruvi lōcanē ca tamanyatōvātamudāharanti || 18 ||


On occassions, a patients vata functioning in the nape of the neck, ears, head, lower jaw, and sides of the neck undergoes upsurge and generates pain in the surrounding areas including the eyebrows and eyes. This disorder is known as Anyatovata. 18

Amlaadhyushita (Chemosis)

श्यावं लोहितपर्यन्तं सर्वं चाक्षि प्रपच्यते |
सदाह – शोथं सास्रावमम्लाध्युषितमम्लतः || १९ ||


śyāvaṁ lōhitaparyantaṁ sarvaṁ cākṣi prapacyatē |
sadāha – śōthaṁ sāsrāvamamlādhyuṣitamamlataḥ || 19 ||


The disease Amlaadhyushita is caused when pitta undergoes vitiation due to heavy intake of sour vegetables. It is characterized by the eyes having ulcers, turning blue in complexion with reddish borders all over. Moreover, there is a burning sensation, edema, and excessive flow of tears. 19

Sirotpaata (Episcleritis)

अवेदना वा अपि सवेदना वा यस्याक्षिराज्यो हि भवन्ति ताम्राः |
मुहुर्विज्यन्ति च याः स ताद्रुग्व्याधिः सिरोत्पात इति प्रदिष्टः || २० ||


avēdanā vā api savēdanā vā yasyākṣirājyō hi bhavanti tāmrāḥ |
muhurvijyanti ca yāḥ sa tādrugvyādhiḥ sirōtpāta iti pradiṣṭaḥ || 20 ||


When the eye becomes full with veins that are coppery red the condition is known as Sirotpata. This condition is painless or painful. It disappears on its own at times. 20

Sirapraharsha (Advanced episcleritis)

मोहात् सिरोत्पात उपेक्षितस्तु जायेत रोगस्तु सिराप्रहर्षः |
ताम्राभमस्रं स्रवति प्रगाढं तथा न शक्नोत्यभिवीक्षितुं च || २१ ||


mōhāt sirōtpāta upēkṣitastu jāyēta rōgastu sirāpraharṣaḥ |
tāmrābhamasraṁ sravati pragāḍhaṁ tathā na śaknōtyabhivīkṣituṁ ca || 21 ||


Due to indifference, if Sirotpaata is neglected, another disease Sirapraharsha would develop. In that case, there is a discharge of red blood in large quantity and the patient is unable to see. 21

Diseases of Krshna Mandala (Cornea)

Savrana Shukla (Corneal Ulcer)

निमग्नरूपं तु भवेद्दि कृष्णो सूच्येव विद्धं प्रतिभाति यद्वै |
स्रावं स्रवेदुष्णमतीव यच्च तत् सव्रणं शुक्ल (क्र) मुदाहरन्ति || २२ || 

nimagnarūpaṁ tu bhavēddi kr̥ṣṇō sūcyēva viddhaṁ pratibhāti yadvai |
srāvaṁ sravēduṣṇamatīva yacca tat savraṇaṁ śukla (kra) mudāharanti || 22 ||

The following are the features of Savrana Shukla:

  • retraction of the eye ball,
  • pain in the cornea as if it is being pierced by a needle with a profuse warm discharge.

If the disease Savrana shukla (kra) has not occured near the pupil, is neither deep nor discharging, is painless, and if the bud produced by it is not two or more in number the disease is curable. 22

दृष्टेः समीपे न भवेत्तु यच्च न चावगाद्दं न च संस्रवेद्धि |
अवेदनं वा न च युग्मशुक्लं तत् सिद्धिमायाति कदाचिदेव || २३ ||


dr̥ṣṭēḥ samīpē na bhavēttu yacca na cāvagāddaṁ na ca sansravēddhi |
avēdanaṁ vā na ca yugmaśuklaṁ tat siddhimāyāti kadācidēva || 23 ||


The ulcer that is not very near to the pupil, not very deep rooted, not having too much of discharge, that is painful or only slightly painful and that is not affecting both the eyes together, respond to treatment rarely whereas others will not be healed altogether. 23

Avrana Shukla

स्यन्दात्मकं कृष्णगतं सचोषं शङ्खेन्दु – कुन्दप्रतिमावभासम् |
वैहायसाभ्रप्रतनुप्रकाशमथाव्रणं साध्यतमं वदन्ति || २४ ||


syandātmakaṁ kr̥ṣṇagataṁ sacōṣaṁ śaṅkhēndu – kundapratimāvabhāsam | vaihāyasābhrapratanuprakāśamathāvraṇaṁ sādhyatamaṁ vadanti || 24 ||

The following are the features of Avrana Shukla:

* The eye having fluid discharge,
* Localized burning sensation in the cornea,
* the sclera resembling the color of conch, moon, lily flower, and waterless cloud up in the sky (all these are clearly white). This type of symptom (Avrana shukla) is easily curable. 24

गम्भीरजातं बहुलं च शुक्लं चिरोत्थितं चापि वदन्ति कृच्छ्रं |
विच्छिन्नमध्यं पिशितावृतं वा चलं सिरासूक्ष्ममदृष्टिकृच्च |
द्वित्वगतं लोहितमन्ततश्च चिरोत्थितं चापि विवर्जनीयं || २५ ||


gambhīrajātaṁ bahulaṁ ca śuklaṁ cirōtthitaṁ cāpi vadanti kr̥cchraṁ |
vicchinnamadhyaṁ piśitāvr̥taṁ vā calaṁ sirāsūkṣmamadr̥ṣṭikr̥cca |
dvitvagataṁ lōhitamantataśca cirōtthitaṁ cāpi vivarjanīyaṁ || 25 ||

Other Incurable Corneal Opacities

उष्णाश्रुपातः पिडका च नेत्रे यस्मिन् भवेन्मुद्गनिभं च शुक्लम् |
तदप्यसाध्यं प्रवदन्ति केचिदन्यच्च यत्तित्तिरिपक्षतुल्यम् || २६ || 

uṣṇāśrupātaḥ piḍakā ca nētrē yasmin bhavēnmudganibhaṁ ca śuklam |
tadapyasādhyaṁ pravadanti kēcidanyacca yattittiripakṣatulyam || 26 ||

There is another condition of Avrana Shukla that is considered difficult to cure. This kind of Avrana shukla develops from deep inside, it turns the sclera thick and morbidity continues for a long period. On the other hand, there are situations when the sclera develops a tear, and is covered by muscle.

Additionally, it also faces a movable thin network of veins that interfere with vision. This morbidity involves the two layers of the eyes; there also develop ulcers having reddish edges. This condition if persisting for long time is to be refused treatment as incurable.

Identically, another condition of avrana shukla which is marked with warm tears, appearance of white nodules of the size of green gram and which subsequently assumes the features of a feather of Tittiri bird (grey partridge) is also considered as incurable. 25-26

Akshipakaatyaya (Hypopion)

श्वेतः समाक्रामति सर्वतो हि दोषेण यस्यसितमण्डलं च |
तमक्षिपाकात्ययमक्षिरोगं सर्वात्मकं वर्जयितव्यमाहुः || २७ ||

śvētaḥ samākrāmati sarvatō hi dōṣēṇa yasyasitamaṇḍalaṁ ca |
tamakṣipākātyayamakṣirōgaṁ sarvātmakaṁ varjayitavyamāhuḥ || 27 ||

The eye disease in which a whitish opacity covers the whole of the cornea due to the action of all the three doshas undergoing vitiation has been identified as an eye disease known as Akshipakatyaya. It should be discarded from treatment as incurable. 27

Ajakajaata (Prolapse Iris or Anterior Staphy staphyloma)

अजापुरिषप्रतिमो रुजावान् सलोहितो लोहितपिच्छिलास्रः |
विगृह्य कृष्णं प्रचयो अभ्युपैति तच्चाजकाजातमिति व्यवस्येत् || २८ ||

ajāpuriṣapratimō rujāvān salōhitō lōhitapicchilāsraḥ |
vigr̥hya kr̥ṣṇaṁ pracayō abhyupaiti taccājakājātamiti vyavasyēt || 28 ||

A condition of eye disorders known as Ajakaajaata arises when there is a slightly red, painful cyst on the cornea resembling a dried pellet of excreta of a goat, exuding reddish, sticky fluid, and growing slowly in size. 28

Diseases of Drshti Mandala

Six type of Timira

प्रथमे पटले दोषा यस्य दृष्ट्यां व्यवस्तिथाः |
अव्यक्तानि स रूपाणि कदाचिदथ पश्यति || २९ ||

prathamē paṭalē dōṣā yasya dr̥ṣṭyāṁ vyavastithāḥ |
avyaktāni sa rūpāṇi kadācidatha paśyati || 29 ||

If the vitiated doshas are localised in the first patala (layer) of the drsthimandala, the person does not see the objects before his eyes clearly. He often sees all objects as blurred. 29

Clinical Features of the Second Patala affliction

दृष्तिर्भृशं विह्वलति द्वितीयं पटलं गते |
मक्षिका – मशकांश्चापि जालकानि च पश्यति || ३० ||
मण्डलानि पताकांश्च मरीचीन् कुण्डलानि च |
परिप्लवांश्च विविधान् वर्षमभ्रं तमांसि च || ३१ ||
दूरस्थानि च रूपाणि मन्यते स समीपतः |
समीपस्थानि दूरे च दृष्तेर्गोचरविभ्रमात् || ३२ ||
यत्नवानपि चात्यर्थं सूचीपाशं न पश्यति |

dr̥ṣtirbhr̥śaṁ vihvalati dvitīyaṁ paṭalaṁ gatē |
makṣikā – maśakānścāpi jālakāni ca paśyati || 30 ||
maṇḍalāni patākānśca marīcīn kuṇḍalāni ca |
pariplavānśca vividhān varṣamabhraṁ tamānsi ca || 31 ||
dūrasthāni ca rūpāṇi manyatē sa samīpataḥ |
samīpasthāni dūrē ca dr̥ṣtērgōcaravibhramāt || 32 ||
yatnavānapi cātyarthaṁ sūcīpāśaṁ na paśyati |

When the second patala is afflicted, the vision of patient turns distorted, he sees flies, mosquitoes, webs, saucers, flags, rays, circular objects, flying objects, rain, sky, darkness etc., which are not actually present, the patients see things which are at a distance to be very near and nearby things as being far away. The patient is unable to locate the eye of a needle even after great efforts. 30-32

ऊर्ध्वं पश्यति नाधस्तात्तृतियं पटलं गते || ३३ ||
महान्त्यपि च रूपाणि छादितानीव चाम्बरैः |
कर्ण – नासाक्षिहीनानि विकृतानीव पश्यति || ३४ ||
यथादोषं च रज्येत दृष्तिर्दोषे बलीयसि |

ūrdhvaṁ paśyati nādhastāttr̥tiyaṁ paṭalaṁ gatē || 33 ||
mahāntyapi ca rūpāṇi chāditānīva cāmbaraiḥ |
karṇa – nāsākṣihīnāni vikr̥tānīva paśyati || 34 ||
yathādōṣaṁ ca rajyēta dr̥ṣtirdōṣē balīyasi |

When the third patala or the third layer of the eye is afflicted due to vitiation of doshas, the person could be able to see objects which are at the top but he would not be able to visualize objects which are at the bottom. Even large objects appear to him as though covered by cloth; face of the others appears to him as though devoid of ears, nose or eyes.

Depending on the doshas which has become predominant, corresponding colours also could be seen by him. Even if he sees the large objects, they appear before him as covered by a piece of cloth. He sees human beings and other things in a deformed shape. Moreover, his vision turns as if it is coated with the colour of dosha that has been instrumental in producing the disease. 33-34

Clinical Features of the Third Patala Affliction (Timira)

अधःस्थिते समीपस्थं दूरस्थं चोपरिस्थिते ||३५ ||
पार्श्वस्थिते तथा दोषे पार्श्वस्थं नैव पश्यति |
समन्ततः स्थिते दोषे सङ्कुलानीव पश्यति || ३६ ||
दृष्तिमध्यस्थिते दोषे महद्ध्रस्वं च पश्यति |
द्विधा स्थिते द्विधा पश्येद्बहुधा चानवस्थिते || ३७ ||
दोषे दृष्ट्याश्रिते तिर्यक् स एकं मन्यते द्विधा |

adhaḥsthitē samīpasthaṁ dūrasthaṁ cōparisthitē ||35 ||
pārśvasthitē tathā dōṣē pārśvasthaṁ naiva paśyati |
samantataḥ sthitē dōṣē saṅkulānīva paśyati || 36 ||
dr̥ṣtimadhyasthitē dōṣē mahaddhrasvaṁ ca paśyati |
dvidhā sthitē dvidhā paśyēdbahudhā cānavasthitē || 37 ||
dōṣē dr̥ṣṭyāśritē tiryak sa ēkaṁ manyatē dvidha |

If doshas are localized in the lower portion of the layer inside the third netra patala, objects that are nearby is not seen. If doshas are present there at the upper portion, objects, which are a bit far not seen. If doshas are present at the sides of third netra patala the objects which are on the sides will not be seen. If doshas are spread all over, objects could be seen as mixed up.

Similarly, if doshas are in the centre of the third netra patala, big objects appear small, if doshas are located in two places of the third netra patala all objects appear double. Moreover, if doshas are located at various places, a single object would appear to be several in eyes of the patient. If doshas are present at the periphery, the patient sees double image of a single object. 35-37 

Clinical Features of the Fourth Patala Affliction  (Linganaasha Cataract)

तिमिराख्याः स वै दोषश्चतुर्थं पटलं गतः || ३८ ||
रुणाद्धि सर्वतो दृष्टिं लिङ्गनाशमतः परम् |
अस्मिन्नपि तमोभूते नातिरूद्दे महागदे || ३९ ||
चन्द्रादित्यौ सनक्षत्रावन्तरीक्षे च विध्युतः |
निर्मलानि च तेजांसि भ्राजिष्णून्यथ पश्यति || ४० ||

timirākhyāḥ sa vai dōṣaścaturthaṁ paṭalaṁ gataḥ || 38 ||
ruṇāddhi sarvatō dr̥ṣṭiṁ liṅganāśamataḥ param |
asminnapi tamōbhūtē nātirūddē mahāgadē || 39 ||
candrādityau sanakṣatrāvantarīkṣē ca vidhyutaḥ |
nirmalāni ca tējānsi bhrājiṣṇūnyatha paśyati || 40 ||

When the doshas or the pathological process involves the fourth patala (layer) of eyes, they generate a disease called Timira or Linganasha. In this, vision is completely lost; nonetheless, even in this condition (blindness) if much time has not lapsed or the disease has not got very deep, the person could be able to see very bright objects such as moon, sun, stars and lightning in the sky and clear bright objects elsewhere too. This condition is known as Lingnasha. Some also call it Nilika or Kacha. 38 – 40 

स एव लिङ्गनाशस्तु नीलिका काच संज्ञिताः |

sa ēva liṅganāśastu nīlikā kāca sañjñitāḥ |

The ailment is also called as Nilika and Kacha as well.

Vataja Timira

वातेन चापि रूपाणि भ्रमन्तीव च पश्यति || ४१ ||
आविलान्यरुणाभानि व्याविद्धानीव मानवः |

vātēna cāpi rūpāṇi bhramantīva ca paśyati || 41 ||
āvilānyaruṇābhāni vyāviddhānīva mānavaḥ |

In cases of Linganasha, when Vata is noticed as predominant then the pateint sees the objects as if they are moving, hazy, slightly red in complexion and irregular or broken off. 41

Pittaja Timira

पित्तेनादित्य – खध्योत – शुक्रचाप – तडिद्गुणान् || ४२ ||
नृत्यतश्चैव शिखिनः सर्वं नीलं च पश्यति |

pittēnāditya – khadhyōta – śukracāpa – taḍidguṇān || 42 ||
nr̥tyataścaiva śikhinaḥ sarvaṁ nīlaṁ ca paśyati |

If pitta is predominant in the case, the patient sees the sun, glow worm, rainbow and sparks of fire and peacocks all dancing and blue in colour; 42

Kaphaja Timira

कफेन पश्येद्रुपाणि स्निग्धानि च सितानि च || ४३ ||

kaphēna paśyēdrupāṇi snigdhāni ca sitāni ca || 43 ||

If kapha is the predominant dosha, he see all objects as smooth, white in colour, without any movement or as if drenched with water. 43

Raktaja Timira

(गौरचामरगौराणि शवेताभ्रप्रतिमानि च | 
पश्येदसूक्ष्माण्यत्यर्थं व्यभ्रे चैवाभ्रसम्प्लवम् | )
सलिलप्लावितानीव परिजाद्यानि मानवः |
पश्येद्रक्तेन रक्तानि तमांसि विविधानि च || ४४ ||
स सितान्यापि कृष्णानि पीतान्यापि च मानवः |

(gauracāmaragaurāṇi śavētābhrapratimāni ca |
paśyēdasūkṣmāṇyatyarthaṁ vyabhrē caivābhrasamplavam | )
salilaplāvitānīva parijādyāni mānavaḥ |
paśyēdraktēna raktāni tamānsi vividhāni ca || 44 ||
sa sitānyāpi kr̥ṣṇāni pītānyāpi ca mānavaḥ |

If there is vitiation of rakta is the main cause of the disease, the patient sees all objects as red even though they are white, black, or yellow. 44

Sannipataja Timira

सन्निपातेन चित्राणि विप्लुतानीव पश्यति || ४५ ||
बहुधा च द्विधा चापि सर्वाण्येव समन्ततः |
हीनाधिकाङ्गन्यपि तु ज्योतींष्यपि च भूयसा || ४६ ||

sannipātēna citrāṇi viplutānīva paśyati || 45 ||
bahudhā ca dvidhā cāpi sarvāṇyēva samantataḥ |
hīnādhikāṅganyapi tu jyōtīnṣyapi ca bhūyasā || 46 ||

If all the three doshas are equally dominant in the given case, the pateint sees objects very differently, with several colours and irregularities. In that case, the pateint sees one object as severe or double and several objects as mingled togther. Besides, parts of his own body appear to be less or more in number to him and he sees them illuminated, too. 45-46 

Parimlaayi Timira

पित्तं कुर्यात् परिम्लायि मूर्च्छितं पित्ततेजसा |
पीता दिशस्तु खध्योतान् भास्करं चापि पश्यति || ४७ ||
विकीर्यमाणान् खध्योतैर्वृक्षांस्तेजोभिरेव वा |

pittaṁ kuryāt parimlāyi mūrcchitaṁ pittatējasā |
pītā diśastu khadhyōtān bhāskaraṁ cāpi paśyati || 47 ||
vikīryamāṇān khadhyōtairvr̥kṣānstējōbhirēva vā |

Pitta generates another kind of linganasha known as Parimlaayin (or kacha or timira), in which the patient sees the landscapes as yellow and visualizes glow worms and the sun even when they are not there. The trees appear before him as though surrounded by glow worms or fire. 47

Colours in the six types of Linganaasha

वक्ष्यामि षड्विधं रागैर्लिङ्गनाशमतः परम् || ४८ ||

vakṣyāmi ṣaḍvidhaṁ rāgairliṅganāśamataḥ param || 48 ||

I will describe further on, six types of Linganashas according to their (different) colours. 48

रागो अरुणो मारुतजः प्रदिष्टो म्लायि च नीलश्च तथैव पित्तात् |
कफात् सितः शोणितजः सरक्तः समस्तदोषप्रभवो विचित्रः || ४९ ||

rāgō aruṇō mārutajaḥ pradiṣṭō mlāyi ca nīlaśca tathaiva pittāt |
kaphāt sitaḥ śōṇitajaḥ saraktaḥ samastadōṣaprabhavō vicitraḥ || 49 ||

  • In the linganasha generated by the vitiated vata, the lens turns to be red and the patient sees all objects as appearing as filmed with crimson red.
  • In the linganasha generated by pitta, all objects will appear yellow or blue.
  • Similarly, in cases of the linganasha generated by vitiated kapha all objects would appear in white colour.
  • In the linganasha generated by the vitiated rakta, the lens turns to be blood red and the patient sees all objects as appearing as coated in that colour.

In the cases of linganasha generated by the vitiation of all the three doshas, the patient would see several or variegated colours. 49

अरुणं मण्डलं दृष्ट्यां स्थूल काचारुणप्रभम् |

aruṇaṁ maṇḍalaṁ dr̥ṣṭyāṁ sthūla kācāruṇaprabham |

The crimson red colour described (for vataja linganasha) could be like a thick red glass.

Parimlaayi Drsthi Mandala

परिम्लायिनि रोगे स्यान्म्लायि नीलं च मण्डलम् || ५० ||
दोषक्षयात् स्वयं तत्र कदाचित् स्यात्तु दर्शनम् |

parimlāyini rōgē syānmlāyi nīlaṁ ca maṇḍalam || 50 ||
dōṣakṣayāt svayaṁ tatra kadācit syāttu darśanam | |

In the case of parimlaayi sometimes, the person regains spontaneous recovery of vision due to subsidence of doshas and without any treatment with passage of time. 50

Features of Mandala in Linganaasha

अरुणं मण्डलं वाताच्चञ्चलं परुषं तथा || ५१ ||
पित्त्तान्मण्डलमानीलं कांस्याभं पीतमेव च |
श्लेष्मणा बहुलं पीतं शङ्खकुन्देन्दुपाण्डुरम् || ५२ ||
चलत्पद्मपलाशस्थः शुक्लो बिन्दुरिवाम्भसः |
मृज्यमाने च नयने मण्डलं तद्विसर्पति || ५३ ||
प्रवाल – पद्मपत्राभं मण्डलं शोणितात्मकम् |
दृष्तिरागो भवेच्चित्रो लिङ्गनाशे त्रिदोषजे |
यथास्वं दोषलिङ्गानि सर्वेष्वेव भवन्ति हि || ५४ ||

aruṇaṁ maṇḍalaṁ vātāccañcalaṁ paruṣaṁ tathā || 51 ||
pitttānmaṇḍalamānīlaṁ kānsyābhaṁ pītamēva ca |
ślēṣmaṇā bahulaṁ pītaṁ śaṅkhakundēndupāṇḍuram || 52 ||
calatpadmapalāśasthaḥ śuklō bindurivāmbhasaḥ |
mr̥jyamānē ca nayanē maṇḍalaṁ tadvisarpati || 53 ||
pravāla – padmapatrābhaṁ maṇḍalaṁ śōṇitātmakam |
dr̥ṣtirāgō bhavēccitrō liṅganāśē tridōṣajē |
yathāsvaṁ dōṣaliṅgāni sarvēṣvēva bhavanti hi || 54 ||

  • In vatika affliction, the netra mandala i.e., the rings that appear before the eyes, could turn to be reddish, unstable and irregular in case of the vitiation.
  • It might turn to be blue, yellow like bronze, or deep yellow in case of the instrumentality of vitiated pitta.
  • It might turn white, yellowish – white resembling a conch, lily, and moon in case of the instrumentality of vitiated kapha. In that case, the netra mandala moves like a drop of water moving on a lotus leaf when the person rubs his eyes.
  • On the other hand, if vitiated rakta is predominant in the given affliction, the rings of netra mandala could appear like coral or lotus petal in colour.
  • If all the three doshas are involved together, the netra mandala could be of mixed or variegated colours.

These are the characteristics features caused due to respective contirbution of the doshas producing the discolouration in cases of the linganasha. 51-54

The twelve Drshti diseases

षड् लिङ्गनाशाः षडिमे च रोगा दृष्ट्याश्रयाः षट् च षडेव वाच्याः |

ṣaḍ liṅganāśāḥ ṣaḍimē ca rōgā dr̥ṣṭyāśrayāḥ ṣaṭ ca ṣaḍēva vācyāḥ |

Thus, six types of the cases of linganasha have been described till now and six more types could be detailed further on.

Pitta Vidagdha Drshti

पित्तेन दुष्टेन सदा तु दृष्टिः पीता भवेद्यस्य नरस्य किञ्चित् || ५५ ||
पीतानि रूपाणि च तेन पश्येत् स वै नरः पित्त्तविदग्ध दृष्टिः |
प्राप्ते तृतीयं पटलं तु दोषे दिवा न पश्येन्निशि चेक्षते सः || ५६ ||
रात्रौ च शीतानुगृहीतदृष्टिः पित्ताल्पभावादपि तानि पश्येत् |

pittēna duṣṭēna sadā tu dr̥ṣṭiḥ pītā bhavēdyasya narasya kiñcit || 55 ||
pītāni rūpāṇi ca tēna paśyēt sa vai naraḥ pitttavidagdha dr̥ṣṭiḥ |
prāptē tr̥tīyaṁ paṭalaṁ tu dōṣē divā na paśyēnniśi cēkṣatē saḥ || 56 ||
rātrau ca śītānugr̥hītadr̥ṣṭiḥ pittālpabhāvādapi tāni paśyēt |

When the drstimandala of a person constantly appears somewhat yellow due to affliction with vitiated pitta, the pateint sees all the objects yellow in colour. If the affliction involves the third patala (layer of eye) he cannot see objects during day but can see at night. It is so as cold improves the vision and the power of pitta also is lessened in night. Naturally, this condition makes the eye comfortable. This condition is known as Pittavidagdha Drsthi (Or divaandhya that is blindness during the day). 55 – 56

Kapha Vidagdhaa Drshti (Night Blindness)

तथा नरः श्लेष्मविदग्धदृष्टिस्तान्येव शुक्लानि तु मन्यते सः || ५७ ||
त्रिषु स्थितो अल्पः पटलेषु दोषो नक्तान्ध्यमापादयति प्रसह्य |
दिवा स सूर्यानुगृहीतदृष्टिः पश्येत्तु रूपाणि कफाल्पभावात् || ५८ ||

tathā naraḥ ślēṣmavidagdhadr̥ṣṭistānyēva śuklāni tu manyatē saḥ || 57 ||
triṣu sthitō alpaḥ paṭalēṣu dōṣō naktāndhyamāpādayati prasahya |
divā sa sūryānugr̥hītadr̥ṣṭiḥ paśyēttu rūpāṇi kaphālpabhāvāt || 58 ||

On the other hand, when the person has a vitiation of kapha which is located in the first and second patalas, he sees all objects as coloured in white. When the kapha dosha reaches the third layer, the patient could become blind at night but can see objects during day because of the help of the heat of the sun and because of the fact that naturally there is lesser amount of kapha during diurnal hours. This condition is known as Kaphavidagdha Drshti (or naktaandhya that is night blindness). 57-58

Dhumadarshin (Haziness of Vision)

शोक – ज्वरायास शिरोभितापैरभ्यहता यस्य नरस्य दृष्टिः |
धूम्रांस्तथा पश्यति सर्वभावान् स धूमदर्शिति नरः प्रदिष्टः || ५९ ||

śōka – jvarāyāsa śirōbhitāpairabhyahatā yasya narasya dr̥ṣṭiḥ |
dhūmrānstathā paśyati sarvabhāvān sa dhūmadarśiti naraḥ pradiṣṭaḥ || 59 ||

Drstimandala is raised when a person, whose vision is affected by excessive grief, fever, exertion, injury to the head and the like. In this condition, the person sees everything as covered with smoke. This disease (and the patient as well) is called Dhumadarshi. 59

Hrsvajaadya (Retinitis pigmentosa/ central opacity of the lens)

यो ह्रुस्वजाड्यो दिवसेषु कृच्छ्राद्ध्रस्वानि रूपाणि च तेन पश्येत् |

yō hrusvajāḍyō divasēṣu kr̥cchrāddhrasvāni rūpāṇi ca tēna paśyēt |

The disease in which the person is able to see with difficulty during daytime and sees big objects as small even during the day is known as Hrsvajaadya.

Nakulaandhata (Maculopathy)

विध्योतते यस्य नरस्य दृष्तिर्दोषाभिपन्ना नकुलस्य यद्वत् || ६०||
चित्राणि रूपाणि दिवा स पश्येत् स वै विकारो नकुलान्ध्यसंज्ञः |

vidhyōtatē yasya narasya dr̥ṣtirdōṣābhipannā nakulasya yadvat || 60||
citrāṇi rūpāṇi divā sa paśyēt sa vai vikārō nakulāndhyasañjñaḥ |

The one whose vision (drshti) has got afflicted by doshas, sees objects in different colours other then the real ones during day just as the vision of a mongoose (nakula) remain illuminated (and as it sees things in unreal colours, probably). This condition is known as Nakulaandhya. 60

Gambhirikaa (? Acute iridocyclitis)

दृष्तिर्विरूपा शवसनोपसृष्टा सङ्कोचमभ्यन्तरतस्तु याति || ६१ ||
रुजावगाढा च तमक्षिरोगं गम्भीरिकेति प्रवदन्ति तज्ज्ञाः |

dr̥ṣtirvirūpā śavasanōpasr̥ṣṭā saṅkōcamabhyantaratastu yāti || 61 ||
rujāvagāḍhā ca tamakṣirōgaṁ gambhīrikēti pravadanti tajjñāḥ |

When the drshti is afflicted by Vata, one sees things in unnatural state and complains of difficulty in breathing, eye ball goes deep inside and creates an awful pain. This condition has been enumerated as the disease Gambhirika by experts. 61

Extrinsic Diseases

Nimittaja and Animittaja Diseases

बाह्यौ पुनर्द्वाविह संप्रदिष्टौ निमित्ततश्चाप्यनिमित्ततश्च || ६२ ||
निमित्ततस्तत्र शिरो अभितापाज्ज्ञेयस्त्वभिष्यन्दनिदर्शनः सः |
सुरर्षि – गन्धर्व – महोरगाणां संदर्शनेनापि च भास्करस्य || ६३ ||
हन्येत दृष्तिर्मनुजस्य यस्य स लिङ्गनाशस्त्वनिमित्तसंज्ञः |
तत्राक्षि विस्पष्टमिवावभाति वैदूर्यवर्णा विमला च दृष्टिः || ६४ ||

bāhyau punardvāviha sampradiṣṭau nimittataścāpyanimittataśca || 62 ||
nimittatastatra śirō abhitāpājjñēyastvabhiṣyandanidarśanaḥ saḥ |
surarṣi – gandharva – mahōragāṇāṁ sandarśanēnāpi ca bhāskarasya || 63 ||
hanyēta dr̥ṣtirmanujasya yasya sa liṅganāśastvanimittasañjñaḥ |
tatrākṣi vispaṣṭamivāvabhāti vaidūryavarṇā vimalā ca dr̥ṣṭiḥ || 64 ||

Further, of the two (linganasha) diseases due to external causes, which have been described to be nimittaja (specific) and animittija ( non specific), the Nimittaja is due to injury to the head and will have the features identical to that of abhisyanda; Animittaja as due to the unusual (sudden) sight of gods, sages, gandharvas, divine serpents or the sun. In this condition, the eye appears to be normal while the drshti (vision) remains clear like the complexion of a cat’s eye gem. 62-64

Diseases of Shukla Mandala (sclera)

Prastari Arma ( Pterigium)

प्रस्तार्यर्म तनु स्तीर्णं श्यावं रक्तनिभं सिते |

prastāryarma tanu stīrṇaṁ śyāvaṁ raktanibhaṁ sitē |

Prastari Arma is the condition in which there is a thin, broad, black or slightly blackish mass of tissue on the sita mandala (sclera).

Shukla Arma (Pinguecula)

सश्वेतं मृदु शुक्लार्म शुक्ले तद्वर्धते चिरात् || ६५ ||

saśvētaṁ mr̥du śuklārma śuklē tadvardhatē cirāt || 65 ||

Shukla Arma signifies a white soft mass, developing slowly on the white portion of the eye. 65

Rakta Arma 

पद्माभं मृदु रक्तार्म यन्मांसं चीयते सिते |

padmābhaṁ mr̥du raktārma yanmānsaṁ cīyatē sitē |

Rakta arma signifies a growth of muscle tissue that looks like a lotus petal on the sclera. It is produced due to vitiation of the blood (rakta).

Adhimamsa Arma

पृथु मृद्विधिमांसार्म बहलं च यकृन्निभम् ||

pr̥thu mr̥dvidhimānsārma bahalaṁ ca yakr̥nnibham ||

On occasions, there is growth of muscle tissue on the sclera. It is produced due to vitiation of the blood (rakta). It is soft but thick in shape and it resembles to piece of a liver. This condition has been identified with the name Adhimamsa Arma.

Snayu Arma

स्थिरं प्रस्तारि मांसाद्ध्यं शुष्कं स्नाय्वर्म पञ्चमम् || ६६ ||

sthiraṁ prastāri mānsāddhyaṁ śuṣkaṁ snāyvarma pañcamam || 66 ||

Appearance of immovable, widespread, dry, abundant fleshy tissue is marked with the fifth kind of diseases of sclera known as Snayu Arma. 66

Shukti (Xerosis of the eye ball)

श्यावाः स्युः पिशितनिभाश्च बिन्दवो ये
शुक्त्याभाः सितनियताः स शुक्तिसंज्ञः |

śyāvāḥ syuḥ piśitanibhāśca bindavō yē śuktyābhāḥ sitaniyatāḥ sa śuktisañjñaḥ |

The eye problem called Shukti is manifested through white dots on the sclera reflecting blackish, flesh like and pearl shell like shape (Shukti).

Arjuna (? Sub – conjunctival haemorrhage or Haemangioma)

एको यः शशरुधिरोपमश्च बिन्दुः
शुक्लस्थो भवति तमर्जुनं वदन्ति || ६७ ||

ēkō yaḥ śaśarudhirōpamaśca binduḥ śuklasthō bhavati tamarjunaṁ vadanti || 67 ||

Blue coloured papule, identical to that of a muscle, but resembling a shell of a pearl on the sclera is known as Shuktika; on the other hand, a single dot situated in the white portion of the eye resembling the blood of a rabbit (deep red in colour) is known as Arjuna. 67

Pistaka (? Lymphangioma)

श्लेष्ममारुतकोपेन शुक्ले पिष्टं समुन्नतम् |
पिष्तवत् पिष्टकं विद्धि मलाक्तादर्शसन्निभम् || ६८ ||

ślēṣmamārutakōpēna śuklē piṣṭaṁ samunnatam |
piṣtavat piṣṭakaṁ viddhi malāktādarśasannibham || 68 ||

An elevated growth in the white portion of the eye due to vitiation of Kapha and Vata makes the sclera dirty as though it has been smeared with a white paste resembling a dust laden mirror. This condition has been called Pistaka. 68

Siraajaala (? Haemangioma)

जालाभः कठिनसिरो महान् सरक्तः
सन्तानः स्मृत इह जालसञ्ज्ञितस्तु |

jālābhaḥ kaṭhinasirō mahān saraktaḥ
santānaḥ smr̥ta iha jālasañjñitastu |

An extensive, branched network of veins, hard, thick, slightly red, covering the sclera is known as the symptom named Sirajala.

Siraapidaka (Phlyctenular or limbal nodule)

शुक्लस्थाः सितपिडकाः सिरावृता यास्ता ब्रूयादसितसमीपजाः सिराजाः |

śuklasthāḥ sitapiḍakāḥ sirāvr̥tā yāstā brūyādasitasamīpajāḥ sirājāḥ |

The morbid condition marked with white nodules covered with veins, developing very near to the cornea but on the sclera is known as Siraja Pidaka.

Balasagrathita (Conjuctival cyst)

कांस्याभो अमृदुरथ वारिबिन्दुकल्पो विज्ञेयो नयनसिते बलाससंज्ञः || ६९ ||

kānsyābhō amr̥duratha vāribindukalpō vijñēyō nayanasitē balāsasañjñaḥ || 69 ||

A lesion appearing like a water bubble, coloured like bronze, hard to touch, developing on the white portion of  the eyeball has been named as Balasa. 69

Diseases of Sandhi (Junctional Areas) 

Puyaalasa (Acute dacryocystitis)

पक्वः शोथः सन्धिजो यः सतोदः स्रवेत् पूयं पूति पूयलासाख्यः |

pakvaḥ śōthaḥ sandhijō yaḥ satōdaḥ sravēt pūyaṁ pūti pūyalāsākhyaḥ |

Puyalasa is characterized by inflammation and suppuration in the inner corner of the eyes, with a swollen, painful shape and discharge of pus with foul smelling.

Upanaaha (Lacrymal Cyst)

ग्रन्थिर्नाल्पो दृष्तिसन्धावपाकी कण्डुप्रायो नीरुजस्तूपनाहः || ७० ||

granthirnālpō dr̥ṣtisandhāvapākī kaṇḍuprāyō nīrujastūpanāhaḥ || 70 ||

Upanaaha is a kind of big size cyst, affecting the junctio of cornea with the pupil. It does not form pus, but it is itching. Sometime it is slightly painful and sometimes is painless. 70

Srava of four types

गत्वा सन्धीनश्रुमार्गेण दोषाः कुर्युः स्रावान् लक्षणैः स्वैरुपेतान् |
तं हि स्रावं नेत्रनालीति चैके तस्या लिङ्गं कीर्तयिष्ये चतुर्धा || ७१ ||

gatvā sandhīnaśrumārgēṇa dōṣāḥ kuryuḥ srāvān lakṣaṇaiḥ svairupētān |
taṁ hi srāvaṁ nētranālīti caikē tasyā liṅgaṁ kīrtayiṣyē caturdhā || 71 ||

The doshas, undergoing vitiation and invading all the joints of the eye through the channel of the tears, discharge of morbid fluids that manifest corresponding features. These dischearges are regarded as netranaadi also by some. Features of the four types of discharges would now be described below. 71

Puyaasraava (Purulent dacrycystitis)

पाकात् सन्धौ संस्र्वेध्यस्तु पूयं पूयास्रावो असौ गदः सर्वजस्तु |

pākāt sandhau sansrvēdhyastu pūyaṁ pūyāsrāvō asau gadaḥ sarvajastu |

Shleshma Srava (Chronic Dacryocystitis or mucocoele) 

श्वेतं सान्द्रं पिच्छिलं यः स्रवेत्तु श्लेष्मस्रावो असौ विकारो मतस्तु || ७२ ||

śvētaṁ sāndraṁ picchilaṁ yaḥ sravēttu ślēṣmasrāvō asau vikārō matastu || 72 ||

This morbidity produces from eyes a discharge that is white in complexion, thick and sticky in shape. Therefore, it has been named as Shleshmaja or Kaphaja Srava. 72

Raktasrava (Haemorrhagic dacryocystitis)

रक्तस्रावः शोणितोत्थो विकारः स्रवेद्दुष्टं तत्र रक्तं प्रभूतम् |

raktasrāvaḥ śōṇitōtthō vikāraḥ sravēdduṣṭaṁ tatra raktaṁ prabhūtam |

In another type of ailment, there is discharge of morbid blood from the eyes. This condition is produced through vitiation of blood. Therefore, it has been named as Raktaja or Kaphaja Srava.

Pitta Srava (Subacute dacryocystitis)

हरिद्राभं पीतमुष्णं जलाभं पित्तात् स्रावः संस्रवेत् सन्धिमध्यात् || ७३ ||

haridrābhaṁ pītamuṣṇaṁ jalābhaṁ pittāt srāvaḥ sansravēt sandhimadhyāt || 73 ||

In pittasraava, a warm watery discharge yellowish in appearance like turmeric, comes out from the interior of the junctional areas that is inner canthus. 73

Parvani and Alaji (Limbal nodules)

ताम्रा तन्वी दाहशूलोपपन्ना रक्ताज्ज्ञेया पर्वणी वृत्तशोथा |
जाता सन्धौ कृष्णशुक्ले अलजि स्यात् तस्मिन्नैव ख्यापिता पूर्वलिङ्गैः || ७४ ||

tāmrā tanvī dāhaśūlōpapannā raktājjñēyā parvaṇī vr̥ttaśōthā |
jātā sandhau kr̥ṣṇaśuklē alaji syāt tasminnaiva khyāpitā pūrvaliṅgaiḥ || 74 ||

Parvani is a kind of coppery red, small round cyst, producing burning sensation and pain, developing at the junction of cornea and sclera, generated by vitiation of rakta; Another identical disease known as Alaji occuring at the same place could be having all features of the disease alaji described earlier (under the section of prameha pidaka). 74

Krimigranthi (Chronic blepharitis)

कृमिग्रन्थिर्वर्त्मनः पक्ष्मणश्च कण्डुम् कुर्युः क्रिमयः संधिजाताः |
नानारूपा वर्त्म – शुक्लान्तसन्धौ चरन्त्यन्तर्लोचनं दूषयन्तः || ७५ ||

kr̥migranthirvartmanaḥ pakṣmaṇaśca kaṇḍum kuryuḥ krimayaḥ sandhijātāḥ |
nānārūpā vartma – śuklāntasandhau carantyantarlōcanaṁ dūṣayantaḥ || 75 ||

Krimigranthi is a swelling in which the organisms are produced at the junction of the eyelids and the eyelashes that cause itching. Itching and such other features are caused when they begin to move from place to place inside. 75

Disease of Vartma (Eye – lids)

Utsanga Pidaka

अभ्यन्तरमुखी ताम्रा बाह्यतो वर्त्मनश्च या |
सोत्सङ्गोत्सङ्गपिडका सर्वजा स्थूल – कण्डुरा || ७६ ||

abhyantaramukhī tāmrā bāhyatō vartmanaśca yā |
sōtsaṅgōtsaṅgapiḍakā sarvajā sthūla – kaṇḍurā || 76 ||

Utsanga Pidaka is a kind of cyst on the eyelid that is coppery red, has its opening facing the eye, increasing in size upwards; and which produces severe itching. 76

Kumbhika (Multiple Styes)

वर्त्मान्ते पिडका ध्माता भिध्यन्ते च स्रवन्ति च |
कुम्भीकाबीजप्रतिमाः कुम्भीकाः सन्निपातजाः || ७७ ||

vartmāntē piḍakā dhmātā bhidhyantē ca sravanti ca |
kumbhīkābījapratimāḥ kumbhīkāḥ sannipātajāḥ || 77 ||

In cases of the ailment identified as the Kumbhika one can notice characteristic features like multiple papules of the size of seeds of Kumbhika inside the lids. They are filled with pus, bursting and discharging pus. The kumbhika is generated by the vitiation of all the three doshas together. 77

Pothaki (Trachoma)

स्राविण्यः कण्डुरा गुर्व्यो रक्तसर्षपसन्निभाः |
रुजावत्यश्च पिडकाः पोथक्य इति कीर्तिताः || ७८ ||

srāviṇyaḥ kaṇḍurā gurvyō raktasarṣapasannibhāḥ |
rujāvatyaśca piḍakāḥ pōthakya iti kīrtitāḥ || 78 ||

In cases of the disease Pothaki, one can notice several hard papules of the size of red mustard seeds inside the lids. These papules discharge pus and pain. They also produce itching sensation. 78

Vartma Sharkara (Granular form of trachoma)

पिडका या खरा स्थूला सूक्ष्माभिरभिसंवृता |
वर्त्मस्था शर्करा नाम स रोगो वर्त्मदूषकः ||७९ ||

piḍakā yā kharā sthūlā sūkṣmābhirabhisanvr̥tā |
vartmasthā śarkarā nāma sa rōgō vartmadūṣakaḥ ||79 ||

A big, hard, and rough papulem surrounded by smaller papules inside the lids, distorting it, is known as Vartmasharkara. This disease may lead to deformity of the eyelids. 79 

Arshovartman (Papillary form of trachoma)

एर्वारुबीजप्रतिमाः पिडका मन्दवेदनाः |
श्लक्ष्णाः खराश्च वर्त्मस्थास्तदर्शोवर्त्म कीर्त्यते || ८० ||

ērvārubījapratimāḥ piḍakā mandavēdanāḥ |
ślakṣṇāḥ kharāśca vartmasthāstadarśōvartma kīrtyatē || 80 ||

Arshovartma is a kind of papule, resembling seed of a melon, slightly painful, smooth but hard. It locates inside the lid. 80

Shushkaarsha (? Wart)

दीर्घाङ्कुरः खरः स्तब्धो दारुणो अभ्यन्तरोद्भवः |
व्याधिरेषो अभिविख्यातः शुष्कार्शो नाम नामतः || ८१ ||

Sushka Arsha are a kind of sprouts that are long, hard, immovable, and very troublesome. They arise from deep inside the lids of eyes. 81

Anjanaanaamika (Stye)

दाह – तोदवती ताम्रा पिडका वर्त्मसम्भवा |
मृद्वी मन्दरुजा सूक्ष्मा ज्ञेया सा अञ्जननामिका || ८२ ||

dāha – tōdavatī tāmrā piḍakā vartmasambhavā |
mr̥dvī mandarujā sūkṣmā jñēyā sā añjananāmikā || 82 ||

Anjanaa Namika is a kind of papule that produces a burning sensation, and pricking pain. It is red in colour, soft inside the lid and small. 82

Bahulavartman (Multiple chalazion)

वर्त्मोपचीयते यस्य पिडकाभिः समन्ततः |
सवर्णाभिः स्थिराभिश्च विध्याद् बहुलवर्त्म तत् || ८३ ||

vartmōpacīyatē yasya piḍakābhiḥ samantataḥ |
savarṇābhiḥ sthirābhiśca vidhyād bahulavartma tat || 83 ||

The cases of Bahula Vartma are manifest in the lids becoming thick by numerous static, hard, and coloured papules developing inside. 83

Vartmaavabandhaka (Allergic oedema to the lid)

कण्डूमता अल्पतोदेन वर्त्मशोथेन यो नरः |
न स संच्छादयेदक्षि यत्रासौ वर्त्मबन्धकः || ८४ ||

kaṇḍūmatā alpatōdēna vartmaśōthēna yō naraḥ |
na sa sañcchādayēdakṣi yatrāsau vartmabandhakaḥ || 84 ||

Vartma Bandhaka is an eye disease wherein one can notice the lids being swollen, and associated with itching and mild pain. The lids no longer remain able to cover the eye fully. 84

Klishtavartman (Palpebral type of spring catarrh)

मृद्वल्पवेदनम् ताम्रं यद्वर्त्म सममेव च |
अकस्माच्च भवेद्रक्तं क्लिष्टवर्त्मेति तद्विदुः || ८५ ||

mr̥dvalpavēdanam tāmraṁ yadvartma samamēva ca |
akasmācca bhavēdraktaṁ kliṣṭavartmēti tadviduḥ || 85 ||

Klishtavartma signifies a morbid condition in which the lids turn soft, slightly painful, coppery red in complexion, and even in the shape. However, lids assume angry red complexion occassionally without any apparent reason. 85 

Vartmakardama (Lid Inflammation)

क्लिष्टं पुनः पित्त्तयुतं शोणितं विदहेध्यदा |
ततः क्लिन्नत्वमापन्नमुच्यते वर्त्मकर्दमः || ८६ ||

kliṣṭaṁ punaḥ pitttayutaṁ śōṇitaṁ vidahēdhyadā |
tataḥ klinnatvamāpannamucyatē vartmakardamaḥ || 86 ||

The same Klishtavartma turns into Vartama Kardama, when there is a vitiation of pitta and rakta and the lids get soaked with moisture. 86

Shyava Vartman (Lid Haematoma/ Ecchymosis)

यद्वर्त्म बाह्यतो अन्तश्च श्यावं शूनं सवेदनम् |
तदाहुः श्याववर्त्मेति वर्त्मरोगविशारदाः || ८७ ||

yadvartma bāhyatō antaśca śyāvaṁ śūnaṁ savēdanam |
tadāhuḥ śyāvavartmēti vartmarōgaviśāradāḥ || 87 ||

The morbid condition, in which the eyelid appears black both inside and outside, is swollen and that remains painful has been identified by experts as Shyava Vartma. 87

Praklinna Vartma

अरुजं बाह्यतः शूनं वर्त्म यस्य नरस्य हि |
प्रक्लिन्नवर्त्म तद्विध्यात् क्लिन्नमत्यर्थमन्ततः || ८८ ||

arujaṁ bāhyataḥ śūnaṁ vartma yasya narasya hi |
praklinnavartma tadvidhyāt klinnamatyarthamantataḥ || 88 ||

Praklinna Vartma is the condition signified in the lids getting slightly painful (or painless), extremely swollen with too much of moisture underneath. 88

Akilnnavartma (Sticky eyelids)

यस्य धौतान्यधौतानि संबध्यन्ते पुनः पुनः |
वर्त्मान्यपरिपक्वानि विध्यादक्लिन्नवर्त्म तत् || ८९ ||

yasya dhautānyadhautāni sambadhyantē punaḥ punaḥ |
vartmānyaparipakvāni vidhyādaklinnavartma tat || 89 ||

The morbid condition in which the eyelids stick together frequently regardless of the fact they are washed or not. In addition, there are features of unripe state of disease. This symptom is known as Aklinna Vartma. 89

Vaatahata Vartmana (Lagophthalmos)

विमुक्तसन्धि निश्चेष्टं वर्त्म यस्य न मील्यते |
एतद् वातहतं वर्त्म जानीयादक्षिचिन्तकः || ९० ||

vimuktasandhi niścēṣṭaṁ vartma yasya na mīlyatē |
ētad vātahataṁ vartma jānīyādakṣicintakaḥ || 90 ||

The morbid condition when the lids are displaced from their joints and no longer able to close or open themselves has been identified as Vatahata Vartma by the specialists. 90

Vartmaarbuda (Polypus or papilloma of the lid)

वर्त्मान्तरस्थं विषमं ग्रन्थिभूतमवेदनम् |
आचक्षीतार्बुदमिति सरक्तमविलम्बितम् || ९१ ||

vartmāntarasthaṁ viṣamaṁ granthibhūtamavēdanam |
ācakṣītārbudamiti saraktamavilambitam || 91 ||

Vartmaarbuda is a kind of tumor developing from inside the lid, growing upwards, slightly painful (or painless) red in complexion, and growing quickly in size. 91

Nimesha

निमेषिणीः सिरा वायुः प्रविष्टः सन्धिसंश्रयाः |
प्रचालयति वर्त्मानि निमेषं नाम तद्विदुः || ९२ ||

nimēṣiṇīḥ sirā vāyuḥ praviṣṭaḥ sandhisanśrayāḥ |
pracālayati vartmāni nimēṣaṁ nāma tadviduḥ || 92 ||

When Vaayu, permeating the channels of the junctional areas responsible for closure and opening of the lids, causes frequent blinking movements, this morbid condition is identified as Nimesha. 92

Shonitaarshas (? Pappillomatous growth ? wart)

यः स्थितो वर्त्ममध्ये तु लोहितो म्रुदुरङ्कुरः |
तद्रक्तजं शोणितार्शशिच्छनं छिन्नं प्रवर्धते || ९३ ||

yaḥ sthitō vartmamadhyē tu lōhitō mruduraṅkuraḥ |
tadraktajaṁ śōṇitārśaśicchanaṁ chinnaṁ pravardhatē || 93 ||

Shonitaarshas is a kind of reddish sprout in the centre of the lid inside, soft and continously growing even after excision is performed. It is generated by vitiated rakta. 93

Lagana (Chalazion)

अपाकी कठिनः स्थूलो ग्रन्थिर्वर्त्मभवो अरुजः |
लगनो नाम स व्याधिर्लिङ्गतः परिकीर्तितः || ९४ ||

apākī kaṭhinaḥ sthūlō granthirvartmabhavō arujaḥ |
laganō nāma sa vyādhirliṅgataḥ parikīrtitaḥ || 94 ||

Lagana is a kind of non suppurating, hard, big, painless tumor, developing inside the lids. 94

Bisavartman (?Ulcerative conjunctivitis)

त्रयो दोषा बहिः शोथं कुर्युशिछिद्रानि वर्त्मनोः |
प्रस्रवन्त्यन्तरुदकं बिसवद् बिसवर्त्म तत् || ९५ ||

trayō dōṣā bahiḥ śōthaṁ kuryuśichidrāni vartmanōḥ |
prasravantyantarudakaṁ bisavad bisavartma tat || 95 ||

All the three doshas undergoing vitiation reproduce a swelling on the external surface of the lid and create holes therein through which watery discharge comes out just like the underground stem of lotus releases a watery discharge internally; this morbid condition is known as Bisavartma. 95

Kunchana (Blepharospasm)

वाताध्या वर्त्मसङ्कोचम् जनयन्ति मला यदा |
तदा द्रष्टुं न शक्नोति कुञ्चनं नाम तद्विदुः || ९६ ||

vātādhyā vartmasaṅkōcam janayanti malā yadā |
tadā draṣṭuṁ na śaknōti kuñcanaṁ nāma tadviduḥ || 96 ||

Kunchana Vata is a disease caused when all the three doshas undergoing vitiation together make for contractures on the lids and thus causing inability to see things. This morbidity turns the lids unable to open. 96

Pakshmakopa (Entropion/ Trichiasis)

प्रचालितानि वातेन पक्षमण्याक्षि विशन्ति हि |
घृष्यन्त्यक्षि मुहुस्तानि संरम्भं जनयन्ति च || ९७ ||
असिते सितभागे च मूलकोषात् पतन्त्यपि |
पक्ष्मकोपः स विज्ञेयो व्याधिः परमदारुणः || ९८ ||

pracālitāni vātēna pakṣamaṇyākṣi viśanti hi |
ghr̥ṣyantyakṣi muhustāni sanrambhaṁ janayanti ca || 97 ||
asitē sitabhāgē ca mūlakōṣāt patantyapi |
pakṣmakōpaḥ sa vijñēyō vyādhiḥ paramadāruṇaḥ || 98 ||

The eyelashes activated too much by vitiated vata turn inwards if one rubs the eyeball again and again. It leads to produce an inflammation of the black cornea as well as white sclera of the eye. The eyelashes also may fall off from thier roots. This dreadful disease is known as Pakshmakopa. 97-98

Pakshmashata (Madarosis/Blepharitis)

वर्त्मपक्ष्माशगतं पित्तं रोमाणि शातयेत् |
कण्दुं दाहं च कुरुते पक्ष्मशतं तमादिशेत् || ९९ ||

vartmapakṣmāśagataṁ pittaṁ rōmāṇi śātayēt |
kaṇduṁ dāhaṁ ca kurutē pakṣmaśataṁ tamādiśēt || 99 ||

Pakshmashata is a kind of disease wherein the pitta is found to be vitiated and affecting the lids.It makes the eyelashes to drop off, producing itching, and burning sensation locally. 99

इति श्रीमाधवकरविरचिते माधवनिदाने नेत्ररोगनिदानं समाप्तम् || ५९ ||

iti śrīmādhavakaraviracitē mādhavanidānē nētrarōganidānaṁ samāptam || 59 ||

Thus ends the chapter on Netra roga.