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Gla Coma

The article discusses glaucoma from an Ayurvedic perspective, comparing it to the condition Adhimantha, which signifies excessive pain. It highlights the prevalence of glaucoma, its symptoms, and various Ayurvedic treatments such as Virechana and Raktamokshana, aimed at managing the disease. The authors emphasize the importance of early detection and treatment to prevent irreversible blindness associated with glaucoma.

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0% found this document useful (0 votes)
64 views6 pages

Gla Coma

The article discusses glaucoma from an Ayurvedic perspective, comparing it to the condition Adhimantha, which signifies excessive pain. It highlights the prevalence of glaucoma, its symptoms, and various Ayurvedic treatments such as Virechana and Raktamokshana, aimed at managing the disease. The authors emphasize the importance of early detection and treatment to prevent irreversible blindness associated with glaucoma.

Uploaded by

Ayur Green
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ISSN: 2322 - 0902 (P)

ISSN: 2322 - 0910 (O)


International Journal of Ayurveda
and Pharma Research

Review Article

AN AYURVEDIC PERSPECTIVE ON GLAUCOMA


P.Ramya Kumari1*, Ch.Ramadevi2, K.Anasuya3
*1PG Scholar, 2Professor and H.O.D., Dept. of Shalakya Tantra, 3Principal, Dr B R K R Govt. Ayurveda College,
Hyderabad, Telangana, India.
Article info ABSTRACT
Article History: The word Adhimantha indicates excessive churning type of pain. Adhimantha is compared
Received: 22-06-2023
with glaucoma in modern science to some extent. Clinical features of this disease vary
Revised: 12-07-2023
depending upon Doshas involvement 4 types of Adhimantha was mentioned by our Acharyas.
Accepted: 30-07-2023
Glaucoma affects 2-3% of people over the age of 40 years 50% may be undiagnosed. primary
KEYWORDS: open angle glaucoma (POAG) is the most common form, the disease is insidious and usually
Adhimantha, asymptomatic until it has caused a significant loss of visual field hence it is called as “silent
Glaucoma, thief of sight”.
Virechana, Glaucoma is a neurodegenerative condition that affects mainly nervous coat of eye and is
Raktamokshana,
associated with increased intraocular pressure when left untreated patients may gradually
Kriyakalpa.
experience visual field loss and even lose their sight completely. It is the second leading cause
of blindness around worldwide. It cannot be treated completely but it can be managed with
Ayurvedic therapeutics to some extent by giving Sodhana chikista like Virechana and
Raktomokshana, Kriyakalpas like Akshitarpan, Seka, Anjana, Aschyotana, Pindi, Bidalaka,
Chakshsuya drugs and Mutrala drugs (diuretics) etc.

INTRODUCTION
“सर्वेन्द्रियानाम नयनं प्रधानं!!” i.e., eye is Glaucoma is second main cause of blindness. In
Pradhana among all sense organs to see and perceive India about 12 million people are affected and
knowledge [1] Sincere efforts should be made by every contribute to 12.8% of total blindness. It is a leading
individual to protect the eyes throughout the life. cause of irreversible blindness.
Acharya Susruta has mentioned 76 Netra rogas among Definition
them Adhimantha comes under Sarvagata rogas[2]. As Glaucoma is characterized by a progressive
per all Acharyas Abhisyanda is the root cause of all optic neuropathy resulting in a characteristic
types of Netra rogas. In which if Abhisyanda is not appearance of optic disc and a specific pattern of
treated in time leads to many diseases, Adhimantha is irreversible visual field defects, raised IOP is the most
one among them. common factor[4] (Normal IOP is 16-21mm of Hg).
Adhimantha is compared with glaucoma in Etiological Factors
modern science. Severe pain (Tivra Vedana) in the eye
Following are some of the causative factors which are
is the common feature of all types of Adhimanta.
responsible for Glaucoma
Clinical feature of this disease vary depending upon
Dosha involvement 4 types of Adhimantha was 1) Age over 40 years
mentioned by our Acharyas i.e., Vataja, Pittaja, Kaphaja 2) Myopic patients are more prone than the
and Raktaja all these are Vyadhana sadhya vyadhi[3] emmetropes
considering Hatadhimantha as Asadhya vyadhi. 3) Family history (hereditary): three many types of
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IJAPR | July 2023 | Vol 11 | Issue 7 90


P.Ramya Kumari, Ch.Ramadevi, K.Anasuya. An Ayurvedic Perspective on Glaucoma
Pathophysiology of Glaucoma
Raised intraocular pressure causes mechanical Primary Angle Closure Glaucoma
stretch on the lamina cribrosa leading to axonal It is a type of Glaucoma in which rise in intraocular
deformation and ischaemia by altering capillary blood pressure occurs due to blockage of aqueous humour
flow. As a result of this neurotrophins (growth factors) outflow by closure of a narrow angle of anterior
are not able to reach the retinal ganglion cell bodies, chamber
due to deficiency of this growth factors cause death of
Symptoms Signs
RGC associated with a loss of retinal nerve fibre. Loss
of ganglion cells is related to the level of IOP but other Severe pain in eyes Lids become inflamed
factors may also play a role. Impairment of vision Conjunctiva-chemosed and
Causes of raised IOP include congested
1) Due to failure of aqueous outflow pump Redness and Cornea-cloudy, oedematous
mechanism as a result of trabecular meshwork lacrimation and insensitive
stiffening and apposition of schlem’s canal wall
there will be decreased aqueous outflow Photophobia Anterior chamber-very
shallow, flares present
2) Thickening and sclerosis of trabecular meshwork
with faulty collagen tissue Nausea, vomiting IOP elevated between 40 and
3) Narrowing of intertrabecular spaces 70mm of Hg
4) Deposition of toxic material in juxtacanalicular Optic disc is congested and
space inflamed
The retina and optic nerve share a peculiar Normal Tension Glaucoma
mechanism of autoregulation of blood flow with rest of It is characterised by progressive retinal
the central nervous system. Once the autoregulatory ganglion cell death and glaucomatous visual field loss
mechanisms are compromised, blood flow may not be associated with an intraocular pressure constantly
adequate beyond some critical range of IOP below 21mm of Hg
Progressive optic neuropathy occurs due to Secondary Glaucoma
toxic factors such as glutamate (excitatory toxin), It occurs as a result of another disease within
oxygen free radicals, or nitric oxide which are released the eye such as infections, inflammation, secondary
when RGCs undergo death which results in cataract, tumour, hypertension, diabetes etc.
characteristic optic disc appearance and visual field
Investigations[7]
defects[5]
1) Visual acuity test
Classification[6]
2) Diurnal variation test is especially useful in
A. Congenital and Developmental Glaucoma
detection of early cases
1. Primary Congenital Glaucoma
3) Gonioscopy- To examine the angle of anterior
2. Developmental Glaucoma
chamber.
B. Primary Adult Glaucoma
4) Tonometry- Measure IOP
1. Primary Open Angle Glaucoma (POAG)
5) Optical coherence test- To examine the thickness
2. Primary Angle Closure Glaucoma (PACG)
of retinal nerve fibre layer and ganglion’cell layer
C. Secondary Glaucoma
6) Slit-lamp - examination of anterior segment
The two main types of glaucoma
7) Perimetry- To detect the visual field defects
Primary Open Angle Glaucoma
8) Nerve fibre layer analyzer (NFLA)
It is characterized by slowly progressive raised
9) Opthalmoscopy- To examine the optic disc
intraocular pressure associated with optic disc cupping
and visual field defects 10) Pachymetry-It is used for measuring the
thickness of cornea
Symptoms Signs
11) Water drinking test
Develops gradually with harmful Optic disc cupping Medical Management
effects but usually asymptomatic (more than 0.4)
 Anti-glaucomatic drug like prostaglandin analogues,
Mild headache and orbital pain Visual field defects cholinergics agonist like pilocarpine, adrenergic
Visual field defects noticed Thinning of neuro agonist like brimonidine, carbonic anhydrase
(occasionally) retinal rim inhibitor, beta blockers etc.
 Surgical procedures like Iridectomy, Cyclocryo
Difficulty in reading and close
therapy, Goniotomy, Trabeculotomy, YAG laser etc.
work

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Int. J. Ayur. Pharma Research, 2023;11(7):90-95
Ayurvedic Perspective 5) Aschyotana- Gambhari, Amalaki and Haritaki mixed
If Abhisyanda is not treated properly it leads to with water.
Adhimantha. In Adhimantha there is an intense feeling 6) Nasya karma- Gundradi ghrta[14]
as if the eye is being extracted (out of socket) and is 7) Anjana-
being churned up along with half of head in association a. Gulika anjana
with specific features of particular Dosha involved.
b. Samudraphena rubbed in Stanya and honey
Vataja Adhimantha used as colliyrium
Vataja Abhisyanda if not treated properly it c. Sallaki mixed with honey and sugar used as
may lead to Vataja Adimantha symptoms includes collyrium[14]
feeling as though eye is being plucked out, churned like
8) Bidalaka/pindi- Dhatri (Amalaka) or
Arani, blurring of vision, headache in one side,
Mahanimbhaphala
pricking, splitting, churning type of pain in eyeball,
increased pressure[8], ringing sound in the ears, 9) Tarpana
giddiness[9]. In this condition Rasa dhatu gets 10) Putapaka
decreased as a result of this occurs Karnanada, Bhrama 11) Internally should be given like Pittaja visarpa[14]
etc. i.e., Mahatiktaka ghruta.[15]
Treatment Kaphaja Adhimantha- There will be a swelling
1) Snehapana with Acha ghruta, Purana ghruta[10], associated with coldness, discharge, itching sensation,
Mesasrungi ghruta, Triphala ghruta, Sahacharadi heaviness, sliminess and horripilation, seeing objects
ghruta. with a difficulty associated with pain, headache and
2) Swedana- Salvana Upanaha, Bashpa swedana blockage in the nose.[16]
3) Basti- Sneha basti in Vata prakopa Treatment
4) Raktamokshana- it is done in Upanasika, Lalata 1) Apatarpana (Laghuahara should be taken for 3
and Apanga pradesha days) followed by intake of Tikta ghruta.
5) Virechana- Sneha viechana with Tilwak ghruta 2) Swedana- Fomentation with the leaves of Kupilu,
Kapitha, Arka etc.
6) Anjana[11]-
3) Sira mokshana- Siravyadhana
a) Madhukanjana: Madhuka, Rajani, Pathya and
Devadaru are macerated with Ajadugdha. 4) Avapidana nasya- Kaphahara drugs
b) Gaireekanjana: Gairika, Saindhava, Krsna and 5) Anjana- Haritaki, Haridra, Madhuyasti and
Nagara are macerated in water and used as Sauviranjana[17]
collyrium. 6) Dhumapana- Kapha hara drugs should be taken.
7) Nasya karma- Anutaila 7) Pariseka- Kwatha prepared with Nimba, Patola,
8) Pariseka : Decoction with Vatahara drugs Jatipatra made Sukoshna and poured over closed
9) Tarpana– Kashmarya, Madhuka, Kusta, Jatamansi, eyes.
Sariva dashamoola, Kaseru along with Paya 8) Bidalaka
(Kasmaryadi kshirapaka) a. Paste of fine powders of Kusta, Tagar,
10) Putapaka – Snehika type of Putapaka Daruharidra, Ela applied over eyelid,
11) Dhumpana- Snehika dhoompana b. Paste of Sunthi, Devadaru, Kustha and Balaka
12) Aschyotana- Hrebera, Tagara, Manjistha, bark of should be applied.
Udumbara along with Aja ksheera c. Application of paste with Barhista, Sunthi,
13) Ajadugdha boiled with Mula, Kanda and Patra of Devadaru and Kustha.[18]
Eranda used as eye drops[11] 9) Aschyotana – Eye drops made with Nagara, Nimba,
Pittaja Adhimantha Triphala, Vasa and Rodhra are used[19]
The symptoms includes eye ball looks like a 10) Ruksha aschyotana- Decoction prepared with
liver with a full of red streaks as if burnt by fire, Gomutra tilwaka, Lodhra, Aragwadha mula twak
perspiration, yellowish appearance of all objects, lid are used.
margin becomes swollen and inflamed[12] 11) Tarpana - Aja yakrit kshirapaka
Treatment: It should be treated like Pittaja 12) Putapaka- Prepared with Yakrit of Chaga, Agaru,
abhisyanda. Priyangu, Devadaru
1) Snehapana- Ghee mixed with Sarkara[13] 13) Kavalagraha -Teekshna dravyas
2) Raktamokshana- Siravyadha Raktaja Adhimantha
3) Sramsana- With the decoction of Triphala, Trivrut Redness of eye resembling like Bandhuka
4) Pariseka- Decoction of Lodhra, Yasthimadhu flower, tenderness, bleeding, pricking type of pain,

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P.Ramya Kumari, Ch.Ramadevi, K.Anasuya. An Ayurvedic Perspective on Glaucoma
visualises flames in all directions, cornea looks like as 4) Pindi - Fried Lodhra mixed with Kanjika
if dipped in blood. [20]
5) Aschyotana- Churna of Kaseru and Madhuka are
According to Bhavprakasha, Krishna mandala is wrapped in cloth and soaked in rain water used as
compared with Raktabija. [21] eye drops.
According to Arundatta Krishna, Mandala looks like a 6) Bidalaka- Nilotapala, Usira, Kantakari,
fire and neem immersed in blood[22] Yasthimadhu, Musta, Lodhra, Padmaka mixed with
Treatment ghee applied around the eyes.[23]
It should be treated like Pittaja abhisyanda followed by 7) Nasyakarma
Sodhana chikistha like Sadyo virechana 8) Oral administration like - Vasadi kasaya, Patoladi
1) Snehapana- Tikta ghruta pana (Purana ghruta) kasaya, Phala trikadi kasaya, Brihat kushmanda
2) Rakta mokshana – Jalouka avaleha and Satavari paka should be given.
3) Anjana Hathadhimantha
a) Churna of Arjuna, Dhataki, Amalaki, Bilwa When Vataja Adhimantha is neglected it leads
flowers, Patali should be taken equal quantity to an Hatadhimantha, there will be severe pain
mixed with honey and used as colliyrium associated with shrinking of eyes.[24]
b) Candana, Kumuda, Kunkuma, Shilajatu, Treatment
Tamrabhasma, Lohabhasma, Tuttha, Vanga, It is incurable disease but general line of
Kamsyamala, Sauviranjana exudate of Nimba treatment like Vataja Abhisyanda and Vataja
are pounded with honey and use as collyrium[23] Adhimantha should be followed.
Prognosis of Disease
The four types of Adhimantha are said to be Sadhya if treated in time if ignored leads to vision loss
Types Sushruta[25] Astanga Hrudaya[26]
Vataja Adhimantha Loss of vision in 6 days Loss of vision in 5 days
Pittaja Adhimantha Loss of vision immediately Loss of vision immediately
Kaphaja Adhimantha Loss of vision in 7 days Loss of vision immediately
Raktaja Adhimantha Loss of vision in 5 days Loss of vision in 3 days
Correlation of Adhimantha to Glaucoma
Adhimantha is correlated with Glaucoma to some extent, like
Vataja Adhimantha Primary Angle Closure Glaucoma (PACG)
Pittaja Adhimantha Primary Angle closure Glaucoma (PCAG)
Kaphaja Adhimantha Primary Open Angle Glaucoma (POAG)
Raktaja Adhimantha Primary Angle Closure Glaucoma (PACG)
Hata Adhimantha Absolute Glaucoma
Pathya-Apathya[27]
Pathya (wholesome) Apathya (Uwholesome)
Ahara Shaka Vargas, Shastika Sali, Yava, Masha, Sura, Dadhi, Pinyaka, Hingu, Lavana,
Godhuma, Mudga, Go Ghrutam, Saindhva Panasa, Anoopa Mamsa, Kantakari, Phanita
Lavana, Madhu, Jangala Mamsa
Vihara Eye exercises, Pada Abyanga, Manasika Krodha, Atapa, Tejodarsana (viewing bright
Shanti, Padatradharana light), Divaswapnam, Ratri Jagarana, Sahasa,
Madyapana, Tamboola Sevana
Aushadi Shigru, Patola, Draksha, Kakamachi, Kadali,
varga Varthaka, Haritaki, Vibhitaki, Amalaka,
Puranaghrita
DISCUSSION
Glaucoma is the most common cause of visual field loss. It develops slowly and often without
irreversible blindness. Glaucoma is defined by the any symptoms. Various medicines and surgical
progressive loss of retinal ganglion cells and is procedures are mentioned in this condition but with
associated with a characteristic optic neuropathy and the above treatment also there is no permanent cure

IJAPR | July 2023 | Vol 11 | Issue 7 93


Int. J. Ayur. Pharma Research, 2023;11(7):90-95
so as preventive and curative aspect Ayurvedic 2. Kaviraja Ambhikadutta Shastri, Sushruta Samhita
therapeutics are very much helpful. Adhimantha has a published by Chaukhambha Sanskrit sansthan
similar symptoms with that of glaucoma like blurring Varanasi 2021 vol-3, Sarvagataroga vijnaniya
of vision, eye pain, half sided headache, nausea, adhyaya, slok no-3 Uttara sthana Hindi
vomiting etc Shodhana chikista like Virechana, commentary pg no:33
Nasyakarma, Raktamoksana are explained in 3. Kaviraja Ambhikadutta Shastri, Sushruta Samhita
Ayurvedic texts. According to Bhela samhita Alochaka published by chaukhambha Sanskrit sansthan
pitta is of 2 types. They are Chakshur vaisheshika and Varanasi 2021 vol-3, Chikistha Pravibhaga
Buddhi vaisheshika mainly Pitta gets vitiated in eye vijnaniya, slok no-9 Uttara sthana Hindi
diseases. Due to Virechana karma the vitiated Dosas commentary pg no-49
and waste products of metabolism in the Kosta are 4. AK Khurana comprehensive ophthalmology by
eliminated. Nasya helps in removing all the vitiated Jaypee brothers medical publisher- 2019 pg no-
Doshas, Kriyakalpas like Ascyotana, Anjana, 231
Akshitarpana, Putapaka etc has more contact time and
5. Nitin Nema textbook of ophthalmology, by Jaypee
higher bioavailability so the drug absorption is more in
brother medical publisher 2008 edt: 5 pg no-216
topical route than the oral route. Raktamokshana like
Siravyadhana, Jaloukavacharan etc are indicated in 6. AK Khurana comprehensive ophthalmology by
Adhimanta. Jalouka having an anticoagulant, Jaypee brothers medical publisher- 2019 pg no-
vasodilation, analgesic, anti-cholinergic agents as it 232
reduces the pain and pressure inside the eyeball. 7. AK Khurana comprehensive ophthalmology by
Acharya Charaka has mentioned Mutra virechaniya Jaypee brothers medical publisher- 201 pg no-241,
dashemanis and included Gokshura, Vasuka 242
(Punarnava) etc has a Sothahara properties helps in 8. Kaviraja Ambhikadutta Shastri, Sushruta Samhita
reducing the oedema.[28] Internally administrating published by chaukhambha Sanskrit sansthan
Chakshusya ghrutas like Mahatriphala ghrutam, Varanasi 2021 vol-3 Sarvagata Roga Vijnaniya, slok
Jeevantyadi ghrutam etc. As these Ghrutas will reduce no-12, 13 Uttara sthana Hindi commentary pg no-
the sclerosis of trabecular meshwork with faulty 35
collagen tissue. Chakshuya dravyas like Triphala, 9. Prof. K R Srikantha murthy, Astanga hrdayam
Yasthimadhu, Bhrungaraja etc are given for vision published by chowkhambha Krishnadas Acadamy
improvement as the drugs mostly contain anti- Varanasi vol-3 Uttara sthana sarvaksiroga
inflammatory, antioxidants, Rasayana (rejuvenating) vijnaniya English translation edt-2017 pg no-137
properties and also prevent further damage of RGC. 10. Prof. K R Srikantha murthy, Astanga hrdayam
CONCLUSION published by chowkhambha Krishnadas Acadamy
Glaucoma damages the optic nerve, which is Varanasi vol-3 Uttara sthanaa sarvaksiroga
responsible for transmitting visual information from vijnaniya English translation edt-2017 pg no-145
the eye to the brain. This damage is often caused by 11. Kaviraja Ambhikadutta Shastri, Sushruta Samhita
increased intraocular pressure (IOP). In our classics it published by chaukhambha Sanskrit sansthan
is mentioned that Adhimantha occurs due to the Varanasi 2017 vol-3,Vatabhisyanda pratisheda,
negligence of Abhisyanda. It is Vyadhana type of Sadhya slok no-11, 14, 15 Uttara sthana Hindi commentary
vyadhi, churning type of pain is the main symptom of pg no-52
Adhimantha with the help of Ayurvedic principles 12. Kaviraja ambhikadutta shastri, Sushruta Samhita
explained for Adhimantha can be applied to Glaucoma published by chaukhambha Sanskrit sansthan
and are helpful in restoring the deterioration of vision Varanasi 2021 vol- 3, sarvaroga vijnaniya, slok no-
and ultimately blindness ensues. According to 14, 15 Uttara sthana Hindi commentary, pg no-36
Ayurveda texts mentioned Pathya ahara vihara, 13. Prof K R Srikantha Murthy, Astanga Hrdayam
Rutucharya and Dincharya can be followed and helps published by chowkhambha Krishnadas Academy
in prevention of progression of disease. These natural Varanasi vol-3 Uttara stagna sarvaksiroga
approaches, when combined with conventional vijnaniya English translation edt-2017 pg no-145
medical treatments, may provide a holistic approach to
14. Kavaraja ambhikadutta shastri, Sushruta Samhita
promote healthy eye and support the management of
published by Chaukhambha Sanskrit sansthan
glaucoma.
Varanasi 2021 vol-3, Pittabhisyanda pratisedha,
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22. Dr Anna moreswar kunte and krisne ramchandra commentary, vol-1 edt:2021 pg no-59
Astanga Hridaya commentaries of arundatta and

*Address for correspondence


Cite this article as:
Dr. P. Ramya Kumari
P.Ramya Kumari, Ch.Ramadevi, K.Anasuya. An Ayurvedic Perspective on Glaucoma.
PG Scholar,
International Journal of Ayurveda and Pharma Research. 2023;11(7):90-95.
Department of Shalakya Tantra,
https://doi.org/10.47070/ijapr.v11i7.2881 Dr B R K R Govt. Ayurveda College,
Source of support: Nil, Conflict of interest: None Declared Hyderabad, Telangana.
Email:
[email protected]
Disclaimer: IJAPR is solely owned by Mahadev Publications - dedicated to publish quality research, while every effort has been taken to verify the
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IJAPR | July 2023 | Vol 11 | Issue 7 95

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