Brief Resume of Intended Work: (A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF SHIGRU ARKA ASCHYOTANA AND TRIPHALA ARKA ASCHYOTANA IN SHUSHKAKSHIPAKA w.r.t COMPUTER VISION SYNDROME)

Eyes are the main link between man and his environment. Eighty percent of what we perceive comes through our sense of sight.¹ Computers and other mobile devices (tablets, e-readers, cell phones etc.) are an innovative and revolutionary inventions. Their multidimensional over usage compel us to spend more and more hours before their contrasts, flickering and glaring screens. This constantly strains the smooth eye muscles leading to Computer vision syndrome (CVS). 

According to American Optometric Association (AOA), “Computer vision syndrome, also referred to as Digital Eye Strain, describes a group of eye and vision related problems that result from prolonged computer, tablet, e-reader and cell phone use”.² This newly found condition, frequently described in the lay press and World Wide Web has now been accepted in medical literature.³

Most studies indicate that computer operators who view their video display terminals (VDT) report more eye related problems than non VDT office workers. NIOSH Survey (National Institute of Occupational Safety and Health) has reported that visual symptoms occur in 75-90% of VDT workers as opposed to 22% of musculoskeletal disorders (carpel tunnel syndrome) in computer users.⁴ According to ‘National Institute of Occupational Safety and Health’, CVS affects people who spend 3 hours or more in front of computer per day.⁵

   Personal mobile devices (i.e. smart phones) are so advanced that they are more like hand-held computers. Given the substantial number of hours being devoted to the viewing of electronic devices, it is concerning that the frequency of occurrence and magnitude of ophthalmologic symptoms is significantly higher. Ocular complaints such as eye strain, irritation and blurred vision experienced by electronic-device users as now known, universally as ‘Computer Vision Syndrome’.⁶

Computer vision syndrome has no direct reference in Ayurvedic classics. However, it can be largely correlated to the symptoms of Shushkakshipaka of Sarvakshiroga,⁷ as dryness is its main symptom. Nidana and Samprapti can be understood by trividha hetus (asatmya indriya artha samyoga, pragnaparadha and parinama) related to chakshurendriya (eye)⁸. Constant viewing at the computer screens for longer time with reduced blinking rate is one among the prominant causes of Dry eye syndrome⁹, which is a proven classical correlation of Shushkakshipaka. Hence Computer vision syndrome can be considered as an entity of Shushkakshipaka.

Treatment of CVS in contemporary systems of medicine is purely symptomatic and lacks rejuvenation, improvement in eye sight and a permanent solution. Considering the alarming severity and high prevalence of ‘CVS’, there is an urgent need to come out with an effective and restorative treatment method.

CVS and its symptoms are apparently because of the vitiated vata – pitta pradhana tridosha at chakshurendriya. Acharya Sushruta has advocated the use of Ghritapana, Tarpana, Nasya along with Parisheka. ¹⁰  Whereas, Acharya Vagbhata has mentioned about Anjana and Snigdha Dhumapana¹¹ in the treatment of Shushkakshipaka.

Considering the dosha involvement and based on the symptoms, Ayurvedic remedies can be used to effectively treat it. Therapies like ‘netra tarpana’, ‘netra dhara’, ‘aschyotana’, ‘ghrita pana’, ‘nasya’, ‘anjana’ and ‘triphala prayoga’^12,13 are classically indicated. Whereas ‘shiro pichu’, ‘virechana’, ‘padabhyanga’, ‘asanas’, ‘pranayama’ and ‘chakshushya’ – ‘rasayana shamanoushadhis’ can be indicated based on symptoms and dosha predominance.

‘Shigru’ is counted as ‘chakshushya dravya’ by Acharya Sushrutha and Bhavaprakasha. It is a significant herbal drug indicated in almost all Netra rogas. ‘Shigru patra’ by virtue of its ‘madhura rasa’ and ‘sheeta guna’ (as per Kaiyyadeva Nighantu) is going to be beneficial here in the treatment of CVS.

 Furthermore, ‘Shigru’ is mentioned as ‘tridosha-shamaka’ (mitigates all three doshas); it also acts as ‘rasayana’ (rejuvenator); it is indicated in ‘shiroroga’; and it exhibits ‘Shothahara’ (antiinflammatory) and ‘Shulahara’ (analgesic) properies. All these specific inherent properties of the ‘Shigru’ will be indeed useful in the management of CVS.   

‘Triphala’ (haritaki, vibhitaki and amalaki) is a well-known and commonly used formulation for both local and internal administration in many forms, for the treatment of ‘Netra roga’. It is also a known Rasayana (rejuvenator) and Chakshushya dravya¹⁵.

 Aschyotana has been explained as a ‘Prime Local Therapy’ in all the diseases of Eye especially in the conditions which present with ama-lakshanas like irritation, redness, burning sensation, etc¹⁶. Since the symptoms seen in CVS are similar to them, Aschyotana seem to counter the disease successfully as the application in the form of eye drops makes the drug available for immediate action and most convenient method of topical application, especially for daytime use.

Arka is a unique preparation in which water soluble active principles and essential oils from the herbal drugs are extracted through drugs soaked in water using Arkayantra or any convenient modern distillation apparatus ¹⁷.  Triphala Arka¹⁸ and Shigru Arka¹⁹ are the formulations explained in ‘Arka Prakasha’ and are indicated in Netra Roga.