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1 Impact factor: 3.958/ICV: 4.10 ISSN: Pharma Science Monitor 8(4), Oct-Dec 2017 PHARMA SCIENCE MONITOR AN INTERNATIONAL JOURNAL OF PHARMACEUTICAL SCIENCES Journal home page: ALLERGIC CONJUNCTIVITIS IN THE LIGHT OF AYURVEDA W.S.R TO NETRABHISHANDHYA: CONCEPTUAL STUDY Vedika Ade* 1 D.B. Vaghela 2 1 MD Scholar, Department Of Shalakya Tantra, Institute For Post Graduate Teaching & Research In Ayurveda, GAU, Jamnagar Gujarat Associate Professor, Department Of Shalakya Tantra, Institute For Post Graduate Teaching & Research In Ayurveda, GAU, Jamnagar Gujarat ABSTRACT Conjunctivitis refers to any inflammatory condition of the membrane that lines the eyelids and covers the exposed surface of the sclera. It is the most common cause of Red eye. Allergic Conjunctivitis is a type of Conjunctivitis. Allergic conjunctivitis is the most common type of and is widely experienced by the global population. The incidence appears to be increased, possibly due to air pollution and allergens worldwide. Clinical picture of Abhishyanda nearly simulate with the term of Conjunctivitis mentioned in modern terminology.abhishyanda is one among the Sarvagata Netra Rogas, which affects all parts of the eye, having good prognosis. Signs and symptoms of allergic conjunctivitis like redness, itching, watering, burning, F.B sensation, photophobia and ropy discharge, which simulates with signs and symptoms of Abhishyanda explained in our classics. This is an attempt to study the Allergic Conjunctivitis through ayurvedic point of view. KEYWORDS: Ayurveda, Netrabhishandya, Allergic Conjunctivitis. INTRODUCTION The term Abhishyanda is used extensively in Ayurvedic literature in different contexts. In the context of Sarvagata Roga Acharya Sushrut mentioned that Abhishaynda is root cause of all eye disease [1]. Abhishyanda or Netra Abhishyanda is classified as the eye disease affecting all parts of the eye. Acharya Sushruta has enumerated it under communicable diseases [2]. Adhimantha (Acute congestive glaucoma/acute uveitis), an eye disease has direct origin from Abhishyanda if not treated properly or neglected. To avoid such complications, Acharya Sushruta has stressed on the importance of immediate need of treatment in this disease. Clinical picture of Abhishyanda nearly replicate with the term of Conjunctivitis mentioned in modern terminology. A Conjunctivitis or Red eye is a common eye infection, which is contagious and may present as a seasonal epidemic. Simple Viral and bacterial conjunctivitis may affect one or both eyes. Both are very contagious and cause epidemics. In ophthalmic clinical practice, ocular allergy represents one of the most ordinary ocular

2 Impact factor: 3.958/ICV: 4.10 ISSN: circumstances [3]. The terms "ocular allergy" and "allergic conjunctivitis" are used synonymously [4]. Allergic conjunctivitis is inflammation of the conjunctiva due to allergy [5]. It is a hypersensitivity reaction to specific airborne antigens. Common airborne antigens include pollen, grass, and weeds [6]. In allergic conjunctivitis, symptoms owe toward discharge of histamine and further vigorous substance by mast cells, which provoke dilation of blood vessels, aggravate nerve endings, and rise oozing of tears. Due to allergic conjunctivitis, serious sequels of corneal infection are rare, but painful signs and symptoms may cause excessive embarrassment to the patients, it can upset the patient's everyday life. Epidemiology: Allergic conjunctivitis occurs more frequently among those with allergic conditions, with the symptoms having a seasonal correlation [7]. Allergic conjunctivitis is estimated to affect 20 percent of the population on an annual basis and approximately one-half of these people have a personal or family history of atopy [8]. These variations may be attributed both to genetic and environmental factors (including warm dry climate and extent of pollution) [9]. In Ayurveda allergic conjunctivitis come under the Netrabhishandya, So this article compiles Ayurvedic methodology and modern sciences methodology on allergic conjunctivitis i.e Netrabhishandhya. Aims To understand the Allergic Conjunctivitis in the light of Ayurveda w.s.r to Netrabhishandhya Objective: To bring light the explanation work those is widespread to lots of the existing parameter Significantly look on conceptual study of other works on Netrabhishandhya and Allergic conjunctivitis. MATERIAL This review was done by compiling the classical Ayurveda literature, Ayurvedic Shalakya Tantra books, magazine, research journal as well as PUBMED, MEDLINE database. METHOD Based on the gathering information, logical interpretation has been done to review Netrabhishandhya and Allergic conjunctivitis. Nirukti: The word Abhishyanda is formed by two words-abhi and Shyandana, Abhi- profuse or more around Shyanda- discharge or secretion [10]. Shyanda is a clinical condition in which all supraclavicular channels gets Shyandatva due to Kledana of Dosha, Dhatu and Mala.

3 Impact factor: 3.958/ICV: 4.10 ISSN: When Shyandana takes place in Netravaha Srotas and get Sthanasamsraya in Netra and affecting all around the tissues lead to Abhishyanda with predominating feature of discharge from the eyes. Though in the classics there is no direct reference about or pathophysiology of Abhishyanda, it is understanding like patho-physiology as common Netra Rog. Classification: Allergic Conjunctivitis is one of the most ordinary non-traumatic additional ocular provocative circumstances and includes Seasonal Allergic Conjunctivitis (SAC)/ Vernal Keratoconjunctivitis (VKC) / Spring Catarrh, Perennial Allergic Conjunctivitis (PAC), Atopic Keratoconjunctivitis (AKC) and Drug Induced Allergic Conjunctivitis (DIAC) [11]. Likewise Ayurveda also classify Abhishandhya in Vataja Abhishandhya, Pittaja Abhishandhya, Kapkaja Abhishandhya and Raktaja Abhishandhya [12]. Causes/Nidana: Common signs of allergic disease such as hay fever, asthma and eczema. Allergens that cause conjunctivitis are Pollen from trees, grass, Animal skin and secretions such as saliva, Perfumes, Cosmetics, Skin medicines, Air pollution, Smoke, Dust mites. Special Nidanas for Abhishyanda are not mentioned in any classical texts so general Nidana for Netra Rogas can be considered as the Nidanas of Abhishyanda [13]. The Nidanas as follows- 1. Diving into water immediately after exposure to heat 2. Excessive looking at distant objects 3. Sleeping during day/awakening at night 4. Excessive weeping, Anger / grief 5. Injury to head 6. Suppression of natural urges specially vomiting 7. Suppressing tears 8. Change of seasons 9. Working in dusty surrounding. Pathology of Netrabhishandhya: Vitiated and previously accumulated Dosha in person, while irritated by the instant aggravating factors straight upsetting the ocular outside lead to additional vitiating of Rasa and Rakta (Siragata). These vitiated Rasa and Rakta by Vatadi-Doshs direct to the clinical features like diluted fulfill, itching, overcrowding etc. Acharya Charaka states that when humors obtain aggravated in the places of the sense organs, they reason also the injury or the pain of the senses disturbed [14]. For understanding of patho-physiology of Netrabhishandhya flow chart will be drown in this article.(figure 1)

4 Impact factor: 3.958/ICV: 4.10 ISSN: Symptom of Netrabhishyanda: Netrabhishyanda is four types depending upon the predominant Dosha viz- Vataja, Pittaja, Kaphaja and Raktaja Abhishyanda. Each type of Abhishyanda symptoms [15] are described in Table No.1 Table 1: Dosha wise sign and Symptoms of Netrabhishandhya Dosha Symptoms Similar terminology 1. Vata Nistoda Pricking sensation Stambha Fixity Romharsha Horripilation Parushya Hardness Sangharsha Foreign body sensation Shoro Abhitap Headache Vishushka bhava Dryness Shishira Shruta Cold watery discharge 2. Pitta Daha Burning sensation Prapaka Severe inflammation Shishirabhinanda Longing for cold Dhumayan Smokiness in eye Ushnashruta Warm lacrimation Pitak netrata Yellow discoloration of eye 3. Kapha Ushnabhinanda Longing for hot Guruta Heaviness Akshi shopha Inflammation in eye Kandu Itching Sitata Whiteness Ati Shaityam Excessive cold Pichchil strava Slimy discharge 4. Rakta Tamrashruta Cpooery Discharge Lohit netrata Blood- red discoloration Samnta Dati Generalised deep red vascular margin Lohitashcha

5 Impact factor: 3.958/ICV: 4.10 ISSN: Figure 1: flow chart of patho-physiology of Abhishyanda Discussion: Netrabhishyanda is the origin source of almost all the eye disorders and treated as soon as possible; if not; its complications will be converted into rigorous and complicated to save the eyesight. If Abhishyanda takes a chronic course, it may lead to Vataja Adhimantha, Hatadimantha, Akshipakatyaya, Avranashukla, and so on. Vataja Abhishyanda is character rized by Toda (Pricking pain), Sangharsha (foreign body sensation), Achchashruta (watery discharge),

6 Impact factor: 3.958/ICV: 4.10 ISSN: Alpa Shopha (mild chemosis), Vishushka Bhava (feeling of dryness), Parushya (dryness), and so on, which are very similar to most of the signs and symptoms of Simple Allergic Conjunctivitis. Based on the similarities of signs and symptoms, Vataja Abhishyanda can be co-related with Simple Allergic Conjunctivitis. Simple allergic conjunctivitis is the most common form of ocular allergy. It is a hypersensitivity reaction to specific airborne antigens. Although serious sequels because of corneal involvement are rare, the distressing signs and symptoms may cause extreme discomfort to the patients, it can disturb the patient's routine life. A Conjunctivitis or Red eye is a common eye infection, which is contagious and may present as a seasonal epidemic. Simple measures such as regular hand washing, avoiding crowded areas and appropriate eye medication can help prevent the spread of conjunctivitis. Viral and bacterial conjunctivitis may affect one or both eyes. Both are very contagious and cause epidemics. It can affect both adults and children. The disease Abhishyanda is produced when the vitiated Doshas are situated in all parts of the eyes, particularly on the ocular surface. In classical texts, a clear explanation of signs and symptoms with a slight variation amongst different authors is available. It is Vedhya Sadhya Vyadhi and at the same time, various treatment protocols have been enumerated. Out of all the diseases described in Sarvagata Roga, the signs and symptoms like Achcha Ashruta, Alpa Dushika, Sangharsha, Shishirashruta, Ragata, Kandu, and Toda of Abhishyanda seems to be similar to the characteristic features of the disease Allergic Conjunctivitis viz. watery discharge, foreign body sensation, pricking pain, congestion, itching etc. In Ayurvedic texts one finds general causative factors of eye diseases in elaborate manner. No separate Nidanas are mentioned for the disease Abhishyanda. Hence general causative factors are to be taken as causative factors for Abhishyanda also. These Nidanas include Aaharaja, Viharaja as well as mental factors. In Ayurveda classical book sign and symptoms like Ragata, Kandu,Toda are similar to symptoms of allergic conjunctivitis. Therefore, Netrabhishandhya is analogous resembling to allergic conjunctivitis described in Ayurveda. Prevention of Conjunctivitis: Conjunctivitis spreads easily and quickly. Following steps should be carried out: 1. Do not touch or rub your eyes. If your eyes itch or burn, use a tissue to wipe drainage; put the used tissue in the trash, and clean your hands. 2. Clean your hands frequently with soap and water. Use a waterless, alcohol-based hand rub if hands are not visibly soiled. 3. Do not share towels or washcloths with others. Assign one towel and one washcloth to each family member, and launder frequently.

7 Impact factor: 3.958/ICV: 4.10 ISSN: Launder your pillowcase every day. 5. Do not wear contact lenses while your eyes are red or draining. Discard contact lens solution used before or during your eye illness. Disinfect contact lenses before resuming use. 6. Do not share eye make-up, such as mascara or eyeliner. 7. Do not share eye drops, contact lens solution or any medications. 8. Stay home from school, childcare or work (especially if you are a healthcare worker or childcare provider) until the eye drainage has resolved. 9. Wear sunglasses if light bothers your eyes. 10. Do not operate machinery if your vision if blurred. 11. Avoid swimming in a pool if you have eye drainage. CONCLUSION Allergic conjunctivitis is the most common type of eye allergy and widely experienced by global population. Due to increase incidence of allergens world-wide and environmental pollution. Netrabhishyanda is affects all parts of the eye. Depending upon predominant Doshas involved, these are classified into four-type i.e Vataja, Pittaja, Kaphaja and Raktaja. Allergic conjunctivitis having Symptoms like redness, itching, watering, burning, F.B sensation, photophobia and ropy discharge which similar to symptoms of Abhishyanda. This article compiles conceptual study between Allergic conjunctivitis and Netrabhishandhya and its bridge between them. REFERENCES 1. Sushruta samhita,g.d Singhal, second edition 2007, Delhi: Chaukhamba Sansskrit Pratishthan, Uttara Tantra. chap-6/5, P Sushruta Samhita,Niband Sagraha commentary by Dalhan, Dr. Kewal Krushna Thakaral, first edition 2014, Varanasi: Chaukhamba Orientalia, Nidan Sthan. 5/33-34, page no Mario La Rosa, Elena Lionetti, Michele Reibaldi, Andrea Russo, Antonio Longo, Salvatore Leonardi, Stefania Tomarchio, Teresio Avitabile, Alfredo Reibaldi, Ital J Pediatr. 2013; 39: Published online 2013 Mar 14. doi: / asses on 3/09/ asses on 3/09/ asses on 3/09/17

8 Impact factor: 3.958/ICV: 4.10 ISSN: Conjunctivitis Epidemiology, Diagnoosis, Treatment and management. Encyclopedia state university.com. asses on 3/09/17 8. Conjunctivitis: Differentiating Allergic, Bacterial & Viral Conjunctivitis". conjunctivitis.blogspot.com. asses on 3/09/17 9. Abokyi.S, Koffuor.G.A, Ntodie.M, Kyei.S, Gyanfosu.L. Epidemiological profile and pharmacological management of allergicconjunctivitis: A study in Ghana, International Journal of Pharmaceutical and Biomedical research, 2012.p Agrawal Riju, Rani Manju, Dhiman K.S, A Clinical Study On The Effect Of Rasanjana (Extract of Berberis Aristata) Eye Drop In Treatment Of Netra Abhishyanda (Infective Conjunctivitis ), International Research Journal of Pharmacy, 2014,5 (3), Page No Salim. B, Rosaliz.P. Ocular Allergy: Diagnosis & treatment Ophthalmology Clinics of North America 2005.p Ibid Sushruta samhita, Uttara Tantra. chap-6/3-4, P Ibid Sushruta samhita, Uttara Tantra. chap-1/26-27, P Agnivesha,Charaka Samhita,Chakrapanidatta,edited by Vaidya Jadavaja Trikamji Acharya, edition 2008, Chaukhamba Surabharati Prakashan Varanasi, Sutra Sthana chapter 28 / 20 pg. 15. Ibid Sushruta samhita, Uttara Tantra. chap-6/6-9, P