Unit 1 — Śarīra & Nidāna Pañcaka of Netraroga

Unit 1 — Śarīra & Nidāna Pañcaka of Netraroga

This chapter builds the base for ophthalmology in Ayurveda. You will learn definitions, Ayurvedic anatomy and physiology of the eye, common causes, prodromal signs, pathogenesis, sāma–nirāma features, and the classical classification of eye diseases—tailored for BAMS examinations.

A) Paribhāṣā of Shālākya Tantra

Shālākya Tantra is the branch of Āyurveda dealing with Ūrdhvajatrugata (above-clavicle) disorders—karṇa (ear), nāsā (nose), akṣi/netra (eye), mukha–kaṇṭha (oral–throat)—with a strong procedural core (kriyā-kalpa), including añjana, aścyotana, tarpana, putapāka, seka, and instrument-aided work (from which the word śālākya, “probe/rod-based,” gains its name). In the Uttaratantra of Suśruta, ophthalmology is laid out systematically across early adhyāyas, beginning with netra śarīra and roga-vijñānīya.

For exams, remember (mnemonic “KNaAM”): Karṇa, Nasā, Akṣi, Mukha (head-neck complex) = Shālākya scope.

B) Netra Racanāśarīra (Anatomy of Eye)

1) Maṇḍala–Sandhi–Pāṭala: the structural triad

Suśruta enumerates the macro-regions (maṇḍala), their junctions (sandhi), and layers (pāṭala) of the eye in one sweep:

मण्डलानि च सन्धींश्च पटलानि च लोचने |
यथाक्रमं विजानीयात् पञ्च षट् च षडेव च ॥ (सु.उ. 1/14)

Meaning: In the eye there are 5 maṇḍalas, 6 sandhis, and 6 pāṭalas.

• Five Maṇḍala (concentric/encircling parts)
  Suśruta names them: पक्ष्मवर्त्मश्वेतकृष्णदृष्टीनां मण्डलानि तु |
  अनुपूर्वं तु ते मध्याश्चत्वारोऽन्त्या यथोत्तरम् ॥ (सु.उ. 1/15)
  Maṇḍala What it denotes (Ayurveda) Broad modern correlate* Pakṣma Eyelashes margin Cilia line Vartma Eyelids Palpebrae Śveta White part Conjunctiva–sclera complex Kṛṣṇa “Black” ring Clinically corneal zone (iris influence) Dṛṣṭi Visual core Pupil/visual axis complex *Correlations are conventional for study use; Ayurveda uses functional–regional descriptions.
• Six Sandhi (junctions) पक्ष्मवर्त्मगतः सन्धिर्वर्त्मशुक्लगतोऽपरः |
  शुक्लकृष्णगतस्त्वन्यः कृष्णदृष्टिगतोऽपरः ।
  ततः कनीनकगतः षष्ठश्चापाङ्गगः स्मृतः ॥ (सु.उ. 1/16)
  Sandhi Junction 1 Pakṣma–Vartma 2 Vartma–Śveta 3 Śveta–Kṛṣṇa 4 Kṛṣṇa–Dṛṣṭi 5 Kanīnika (inner canthus) 6 Apāṅga (outer canthus)
• Six Pāṭala (layers/coats)
  Two are in Vartma, four in the eye proper: द्वे वर्त्मपटले विद्याच्चत्वार्यन्यानि चाक्षिणि |
  जायते तिमिरं येषु व्याधिः परमदारुणः ॥ (सु.उ. 1/17)
  Clinical pearl: Timira (early visual obscurations) arises when inner pāṭalas are involved.

2) Other structural points worth quoting

• Dṛṣṭi size & centrality: Dr̥ṣṭi occupies a fraction of Kṛṣṇa-maṇḍala and is the seat of vision; (see Su. Saṃ. Uttara 1 opening description for measurements and five-element constitution).
• Pañca-bhūta contribution: Pṛthvī → mām̐sa; Agni/Tejas → rakta; Vāyu → kṛṣṇa-bhāga dynamics; Jala → śveta/lucid parts; Ākāśa → āśru-mārga (channels).

C) Netra Kriyāśarīra (Physiology of Eye)

Ayurveda explains vision as a tridoṣa-sāmyak function with specific sub-doṣas:

• Pitta — Ālocaka Pitta (seat: dr̥ṣṭi): Enables darśana (seeing), discrimination of forms and colours; functionally comparable (conceptually) to light-processing in the visual axis.
• Kapha — Tarpaka Kapha (ocular nourishment): Unctuousness, tear film stability, comfort, netra-tarpana target.
• Vāta — Prāṇa/Vyāna sub-doṣa roles: Nimeṣa–Unmeṣa (blink-open cycles), extra-ocular movements, pupillary dynamics (via doṣic balance).

Exam tip (AKTU): “Seat–Function” grid — Ālocaka–darśana, Tarpaka–tarpana/snehana, Prāṇa/Vyāna–nimeṣa/unmeṣa & saccades.

D) Sāmānya Hetu (Nija & Āgantuja) of Netraroga

Nija (endogenous) causes

Doṣa aggravation by āhāra–vihāra that directly strain ocular homeostasis:

• Āhāra: Excess amla/kaṭu/lavaṇa; śukta, āranāla (fermented gruels); māṣa, kulattha; adhyśana (overeating); ati-uṣṇa/ati-tīkṣṇa foods.
• Vihāra: Ati-dūra-darśana, sūkṣma-darśana (sustained fine work), divā-svapna, rātri-jāgaraṇa, ātapa–jalakeli alternation, śoka-krodha–śrama, suppression of tears, exposure to dhūma/rajaḥ. All these are explicitly listed in Suśruta’s opening chapter on eye diseases.

Āgantuja (exogenous/traumatic) causes

• Bāhya abhigāta: foreign body, blunt/penetrating trauma, burns, corrosives, caustic smoke. Suśruta keeps two traumatic entities distinct in overall counts.

Path note: These hetus vitiate doṣas ascending via śiras/srotas to the ocular site → local saṅga/srava/śotha → abhishyanda-ādi expressions.

E) Pūrvārūpa (Prodromal Signs) of Netraroga

Classically observed incubatory features include:

• Āvila-darśana (cloudy/blurred vision), dāha/toda/śūla (burning–prick–ache), āśru-srava (watering), piśita/śleṣma-sañcaya (mucus), gurutā/āyāsa (heaviness/fatigue), rakta-varṇa/aruṇa-varṇa changes; śūka-kaṇṭaka-vat sensation on lids in earlier vartma-inflammations.

Why care? Early recognition avoids deeper pāṭala-anubandha (e.g., timira → liṅganāśa sequence in dr̥ṣṭi-pāṭalas).

F) Samprāpti (Pathogenesis) of Netraroga

Canonical flow (write this exactly in exams):

1. Hetu-sevana (listed above) → doṣa-prakopa (vāta/pitta/kapha; often with rakta).
2. Ūrdhva-gati of doṣas through śiras–srotas to netra-sthāna (maṇḍala–sandhi–pāṭala specific lodgement).
3. Sthāna-saṃśraya → srotorodha/ati-pravṛtti → abhishyanda (foundational ocular inflammation) or localized vartma/sandhi/śveta/kṛṣṇa/dr̥ṣṭi-gatas.
4. According to depth: Timira (pāṭala-1…4) → kaċa → liṅganāśa (progressive obscuration to loss of functional vision), with doṣa-specific varṇa-viparyaya (colour–perception shifts) described by Suśruta in Dṛṣṭi-gataroga vijñānīya.

Schematic (remember: H–D–U–S–V): Hetu → Doṣa → Urdhva-gati → Sthāna-saṃśraya → Vikāra.

G) Sāma vs. Nirāma Lakṣaṇas in Netraroga

Sāma (with Āma involvement):

• General: ālasya, āvaraṇa-bhāva, mandāgni signs.
• Ocular: guru–rukṣa–staimitya (heaviness, sticky mucous), āśru-srava thick/stringy, dṛṣṭi-āvila, intolerance to light, relief with lāghava/laghu-pācana therapies (e.g., rukṣa-seka initially).
• On exam: conjunctival mala-sañcaya, lids feel kathina/bahala; benefits from dīpana–pācana before local kriyā-kalpa.

Nirāma:

• Cleaner tear film, less stickiness, pain localised/clear; patient tolerates gentle snehana–tarpana as per indication; signs align with śuddha doṣa-prakopa rather than āma-saṅga.

Exam handle: Start with āma-apakarṣaṇa if sāma features dominate; never jump to heavy snehana/tarpana in unmistakably sāma states.

H) Classification of Netraroga

1) By Doṣa (Suśruta) — total 76

• Vātaja 10, Pittaja 10, Kaphaja 13, Raktaja 16, Sannipātaja 25, Āgantuja (traumatic) 2.

2) By Site (Maṇḍala focus)

Suśruta totals 74 nija diseases distributed as: Vartma 21, Sandhi 9, Śveta 11, Kṛṣṇa 4, Dṛṣṭi 12, Sarvagata (entire eyeball) 17, plus 2 āgantuja → 76.

“इत्येते नयनगता … षट् च सप्ततिश्च” — Suśruta wraps the count of ocular diseases as 76 before detailing adhyāyas by location/prognosis.

3) By Treatment Modality (operative logic)

Suśruta also divides by cedya (incision), lekhya (scarification), bhedya (excision), vyādhya (sirā-vyadha), yāpya (palliative), asādhyā etc., guiding surgical decision-making.

One-glance exam table

Assessment

A. Long Essay (answer any 1; 10 marks)

1. Describe Netra Racanā with Suśruta’s maṇḍala–sandhi–pāṭala scheme. Add a diagrammatic description and clinical correlations with Timira–Kaca–Liṅganāśa sequence.
2. Explain the Nidāna-Pañcaka of Netraroga: sāmānya hetu (nija & āgantuja), pūrvārūpa, rūpa, upaśaya-anuśaya, and samprāpti with a neat flowchart.

B. Short Essays (write any 3; 5 marks each)

1. Role of Ālocaka Pitta and Tarpaka Kapha in ocular physiology.
2. Sāma vs. Nirāma features in conjunctival inflammations (Abhishyanda-spectrum).
3. Suśruta’s site-wise classification—tabulate numbers and give two examples from each site.
4. Kriyā-kalpa as local therapeutics in the early pūrvārūpa stage—rationale and cautions.

C. Short Notes (any 4; 3 marks each)

• Kanīnika and Apāṅga sandhi
• Vartma-pāṭala versus Akṣi-pāṭala
• Doṣa-specific varṇa-viparyaya in Dṛṣṭi disorders
• Āgantuja netraroga—clinical approach
• Abhishyanda as mūla of netraroga

D. MCQs (5 × 1 = 5 marks)

1. Total maṇḍala–sandhi–pāṭala in netra are (respectively):
   a) 5-6-6 b) 6-5-6 c) 5-5-6 d) 6-6-5
2. Kanīnika refers to: a) outer canthus b) inner canthus c) pupil margin d) limbus
3. Total netrarogas (Suśruta): a) 72 b) 74 c) 76 d) 78
4. Traumatic (āgantuja) eye diseases (Suśruta): a) 2 b) 4 c) 6 d) 8
5. Doṣa-wise largest group: a) Vāta b) Pitta c) Kapha d) Sannipāta

Answer key: 1-a, 2-b, 3-c, 4-a, 5-d.

Quick Review (1-minute)

• 5/6/6 = Maṇḍala/Sandhi/Pāṭala.
• Pūrvārūpa = āvila-darśana, dāha, toda, āśru-srava, gurutā.
• Samprāpti = Hetu→Doṣa→Ūrdhva-gati→Sthāna-saṃśraya→Vikāra; Abhishyanda is foundational.
• Sāma eyes are sticky–heavy; nirāma allows śamana/snehana as indicated.
• 76 total (Suśruta): 74 nija by site + 2 traumatic.

Selected Ślokas to cite in answers

1. Structural triad & counts
   “मण्डलानि च सन्धींश्च पटलानि च लोचने | यथाक्रमं विजानीयात् पञ्च षट् च षडेव च ॥ (सु.उ. 1/14)”
2. List of five maṇḍalas
   “पक्ष्मवर्त्मश्वेतकृष्णदृष्टीनां मण्डलानि तु… (सु.उ. 1/15)”
3. Six sandhis
   “पक्ष्मवर्त्मगतः सन्धिर्वर्त्मशुक्लगतोऽपरः… कनीनक… अपाङ्ग… (सु.उ. 1/16)”
4. Pāṭala distribution (2 in vartma; 4 in akṣi)
   “द्वे वर्त्मपटले विद्याच्चत्वार्यन्यानि चाक्षिणि… (सु.उ. 1/17)”
5. Total disease count
   “इत्येते नयनगता … षट् च सप्ततिश्च” — total 76.

References (study use; cite in exam answers as text sources)

Classical

• Suśruta Saṃhitā, Uttara Tantra: Adhyāya 1 (Nayana-śarīra & netraroga overview), Adhyāya 3 (Vartmagata), Adhyāya 7 (Dṛṣṭigata roga vijñānīya, timira–kaca–liṅganāśa sequence).
• Aṣṭāṅga Hṛdaya, Sūtrasthāna (pañca-pitta including Ālocaka), Uttarasthāna (netraroga topics).

Standard modern/academic aids

• K.S. Dhiman — Śālākya Kriyā-Kalpa Vijñāna.
• Shiv Nath Khanna — Śālākya Tantra.
• Wisdomlib (Bhīṣagratna’s English translation of Suśruta Uttara-tantra) for distribution by site and treatment modalities.
• Conceptual papers on Ālocaka Pitta and Netra Śarīra (use judiciously for viva).