Eye patient has to be examined thoroughly for proper diagnosis so that appropriate management can be planned. What is healthy status or niramayata? How is disease generated? Charaka-Samhita, Sushruta-Samhita and Ashtanga-Hrudaya elaborated these points in their compendia. Some important points are discussed here:

3 Dosha, 7 Dhatu and 3 Mala should be maintained in homeostatic equilibrium for attaining healthy status. Their deviation on either side, vruddhi or kshaya, triggers genesis of disease. (Vruddhi means either aggrevation/vitiation or increase in one of the properties and kshaya means decrease in volume or one of the properties. Refer-S.Su.Ch.15, A.H.Su.Ch.1 & 11)

Etiological factors for vruddhi and kshaya of dosha:

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Vata Pitta Kapha
Prana vayu

When it conveys the Chakshurendriya buddhi/ visual impulses to mann and atma, then only images are perceived. Indriyadhruk and poorana/nourishment are its important functions.

2. Udana vayu

Bala and varnakruta are its functions. If vitiated causes chittabhransha and buddhibhransha (drushtibhransha), bluish, blackish discoloration and Urdhva – jatrugata vyadhi. It expresses various emotional feelings like pleasure, sorrow, anger, love, frustration etc on face. (Perhaps this is the reason behind calling eyes as mirror of emotions)

Vyana vayu – opening and closure of eyes, constriction and dilatation of pupil, circulation and propagation of rasa and rakta in all srotas are principle functions of this vayu. In presence of srotodushti it gets obstructed in srotas. It is vitiated by diseases of rasa, rakta, oja, and chetanadhatu; diarrhea, fever, aneamia; mental conditions like fear, sorrow, worry etc.

Samana vayu

Responsible for equilibrium of entire body functions. It gives strength to Jatharagni. It’s deviation from equilibrium causes eye diseases.

Apana vayu

Responsible for excreting the waste products. It has three properties namely yogavahi, vishada and daruna.

‘Vishada’-responsible for absorption of ‘kleda’ i.e. moisture causing dryness. Daruna-responsible for absorption of softness/ snigdhata causing hardness.

Pachaka pitta

Responsible for digestion of food material and segregation of dosha, rasadi dhatu, urine and stool. Disturbance of its equilibrium or it’s vitiation along with samana vayu and kledaka kapha, generates eye and other diseases.

Ranjaka pitta

It generates raktadhatu from rasadhatu. Its deficiency causes anemia resulting in Karana / indriya daurbalya.

Sadhaka pitta

Responsible for vigour i.e. sound physical and mental status; strong, healthy and well-nourished dhatus etc. It fulfills all wishes resulting in mental satisfaction. Its deficiency causes eye diseases due to weak and disturbed mental status as well as undernourished dhatus.

Alochaka pitta

Alochaka pitta/alochaka agni is responsible for visualizing objects. Its vitiation causes visual impairment.  

Digestion, body temperature, vision, hunger, thirst, appetite, luster, intelligence, bravery, patience, softness of body etc. are regulated by Pitta. It’s vrudhi or kshaya will cause disturbance in all these activities.

Kledaka kapha-

Homeostatic kledaka kapha, pachaka pitta and samana vayu are responsible for generating homeostatic Kapha which predominantly possesses madhura rasa.

-Unctuousness, healing, nurturing, nourishing, increasing strength, stability are the functions of this homeostatic kapha. Its deficiency causes faulty nourishment resulting in faulty functioning of various dnyanendriya, karmendriya etc.

-If madhura, amla and lavana rasa are ingested, kapha is nourished well whereas katu, tikta, kashaya rasa oppose genesis of prakruta kapha.

Tarpaka kapha

Shira i.e. brain is the location of tarpaka kapha. Minute centers of various dnyanendriya, karmendriya etc are situated in the shira. When sensory impulses are carried to mann and atma by pranavayu, then only various sensations are perceived. These impulses are again carried to brain / motor centres in brain for executing various activities.

-All these centers are located in majja dhatu in shira. Very unctuous, nourishing and nurturing Tarpaka kapha is essential for stabilizing these excessive vatika activities as well as for its smooth, regular and normal functioning.

-Homeostatic Kapha is essential for generating rasa, mansa, meda, majja and shukra in homeostatic conditions. Its deficiency or vitiation causes faulty generation of these dhatu.       

Marma in relation to Netra:

  1. Apanga marma– a sira marma, situated below the bhrupuchcha i.e. eyebrow, beyond the lateral corner of eye. Drushti gets destroyed in case of injury. It is vaikalyakara marma. (S.Sha. 6.28; A.H.Sha. 4.31,46,47 & 57)
  2. Avarta marma – situated deeply above eyebrows. When injured, dushti gets destroyed. (S.Sha. 6.28)


  1. Shrungataka marma

Joining of nourishing dhamanis of nose, ear, eye and tongue is termed as shrungataka marma. They are 4 in number and the ayama i.e. height is equal to ones palm. This is dhamani type of marma and in case of injury person dies on the spot. (C.Sha. 4.34,42,61; S.Sha. 6.28)

4.Sthapani marma – this marma is between two eyebrows. Foreign body in this location should not be extracted. If the place of introduction of foreign body gets inflamed and the body is discharged on its own due to inflammation, patient remains alive. If the foreign body is kept undisturbed, he can stay alive for rest of his life. On the contrary, if the surgeon attempts to extract the body, the patient dies.


Netra and dushya:

The effects of vruddhi and kshaya/dushti of various dushya on eye are elaborated in the following table.

Dushya Sara / strength features Vruddhi features Kshaya-dushti features
Rasa Prasanna i.e. satiated netra Gaurava Rukshta, shushkta, gauravata, margavarodha
Rakta Snigdha / glistening, reddish, pleasant eyes and other body parts. Reddish complexion, reddish eye, fullness of veins. Rukshta, sirasheithilya, visarpa (cellulitis), pidaka (furunculosis) , nilika (pigmented naevus), vidradhi, arsha, arbuda, raktapitta,  pittaja diseases.
Mansa Sthira, gauravata, well nourished and  strong         ————- Rouksha, toda, dhamani sheithilya, indriyadourbalya and general muscular weakness, arbuda, arsha, alaji.
Meda Especially snigdhata, bulky / obese. Anga-snigdhata i.e. glistening of body parts. Rouksha, granthi, arbuda
Majja Specifically snigdha / glistening eyes and other body parts; mahanetra / big sized eyes, strong. Netre and anga gauravata Bhrama (vertigo), timira darshana (darkness before eyes), murchcha (fainting),   abhishyanda.
Shukra Snigdha, pleasant kshirapurna-netra (glittering eyes); shweta danta, nails.      ——————          ——————–


Rasa, rakta, mansa, meda, majja and shukra along with Oja plays an important role in keeping the eye pleasant, satiated, lustrous, glittering, vigorous, healthy, strong and well nourished (Oja means bala i.e. strength).
Oja is considered as the supreme essence of all the tissues and its presence is necessary for all their vital i.e. anabolic activities. (Ancient Indian Surgery)
The kshaya or dushti of this dhatus and oja will generate various diseases/ disorders. Oja becomes catabolized in expressing various emotions as well as talking or doing various physical activities. Similarly mourning, anger, fear are also responsible for adverse effects on oja.
Note: cases where dosha in ayatana of indriya are vitiated, sense organs tend to be functionless.

         Features of sara – C.V. 8-103 to 110; S.Su. 35-16

         Vruddhi features – S.Su. 15-18; A.H Su.11-7 to 11

         Kshaya features –S.Su.15-13; A.H.Su.11-17

         Dushti features –S.Su.24-8; A.H.Su.11-7 to 11


Netra and mala

The white and dense waste product generated through eyes is called as netradushika, which is a mala of mansa dhatu. Majjamala, which is snigdha, is excreted through eyes as well as through sweda, mutra, and purish; as a consequence, any obstruction to these waste products leads to diseases of eyes. Bhru/eyebrows are entitled as Asthimala which protect eyes from sweat from forehead (A.H.Sh. 6-63).
Netra and srotas:
Annavaha – these are 2 in number. The mulasthanaamashaya and annavaha dhamanis; Injury to them leads to total or partial blindness. Vitiation of jatharagni leads to vitiation of dosha. This vitiation of Agni and dosha leads to the generation of various eye diseases, ultimately precipitating total or partial blindness. (S.Sh. 9-12.)
Raktavaha – these are 2 in number. The mulasthanayakrut and pleeha and raktavaha dhamanis; injury to them leads to red eyes ( S.Sh.9-12.)
Padagata srotas – A.H. suggests 2 large siras reach eyes from feet. The virya of oils etc and paste applied to feet reach the eyes. Hence feet should be protected with footwear; should be kept clean and such medicinal applications are made on feet for better health of eyes (A.H. U. 16-65, 66).



External environmental acquaintance with the living body is executed by five sense organs namely netra (eye), karna (ear), nasa (nose), jivha (taste buds), and twak (skin)- S.Sh.1-15.

All dnyanendriyas i.e. sense organs are panchbhautic in composition. In spite of this fact, every indriya or sense organ perceives object/tanmatra of that mahabhuta from which it is originated or one which is predominant. For example, the eye is originated from teja mahabhuta and hence perceives the object of teja mahabhuta only i.e. it is capable of performing ‘rupagrahana’, i.e. visual perception only. An eye is not capable of perceiving senses like audio, tactile etc. Virtual dnyanendriyas or sense organs or centers of perception are minute and are located in brain and organs perceiving them like the eye, ear etc. are the instrumental sense organs or ‘adhishthana’ (Charaka Sh.1-138).

Charaka in Sutrasthana Ch. 8 has explained the functioning of Dnyanendriya. He has laid down panch-panchaka concept for this. It includes pancha dnyanendriya, predominant mahabhoota originating them, adhishthana, artha i.e. sense objects and buddhi i.e. interpreting brain center of that sense organ. It is as follows in case of Netra.


Sense organ Chakshurindriya
Mahabhuta Teja mahabhuta
Dnyanendriya adhishthana Netra (Eye)
Artha/ sense object Roopa tanmatra/sight i.e. perception of size, shape, colour etc. of an object.
Indriya buddhi / Visual centres. It is created by togetherness of Chakshurindriya buddhi i.e. visual centres in occipital cortex, mann (mind) and atma (soul)


Perception of an image is the function of drushti which is the location of Alochaka pitta. This sensation is conveyed through dhamanis to mann and atma through pranavayu and the sequence is responsible for the perception of an object. In this way the external object is perceived when atma unites/linked with mann; Mann unites with indriyabuddhi; Indriyabuddhi unites with tanmatra; Tanmatra unites with adhishthana; Adhishthana unites with mahabhuta; and Mahabhuta unites with minute virtual dnyanendriya located in the brain. In this process of perception of an object by eye, pranavayu and kapha located in shira play an important role. Healthy status of all sense organs depends upon homeostatic i.e. physiological conditions especially of pranavayu and tarpaka kapha. Once the above sequence is completed, then the image of a particular object is interpreted and perceived.

Role of Dosha-Dhatu-Mala

The living body is sustained by 3 dosha, 7 dhatu, and 3 mala. All body functions are controlled by dnyanendriya, karmendriya, mann, and atma (S.Su 15-3). Dosha-dhatu-mala has to stay in equilibrium, their deviation either from physiology or towards pathology; triggers genesis of diseases. Following passages will explain how homeostatic conditions of dosha-dhatu-mala become responsible for normal functioning of dnyanendriya like Netra.


Before considering the Samprapti of Netraroga, I would like to highlight the following important points.

Importance of equilibrium of Dosha-
The homeostatic condition of Dosha, Dhatu, and Mala is essential for maintaining the normal functioning of various Dnyanendriya, Karmendriya, Mann (mind) and Atma (soul). Their deviation either from physiology or towards pathology triggers genesis of disease (A.H.Su.1-20).

Six stages of Samprapti / Pathogenesis-
According to Sushruta( S. Su. 21-36), 6 stages are necessary for generating disease of a particular structure. They are Chaya (accumulation), Prakopa (excitation), Prasara (spread), Sthanasanshraya (localization), Vyakta and Bheda (complete manifestation of disease).

Importance of Srotovaigunya i.e. Abnormality-
The spreading vitiated Dosha get localized / settled / lodged wherever Kavaigunya / Srotovaigunya i.e. abnormality is present (S. Su. 24-10).

General Samprapti of Netraroga-
Dosha vitiated by various etiological factors; especially the ones specifically acting on eyes (caused by unwholesome diet and injudicious activities); when passes upwards through sira; occupy different structures like Vartma, Sandhi, Shukla, Krushna, Drushti and Sarva / all parts of eye; and then precipitate diseases of that particular structure only if Srotovaigunya is present there (S.U. 1-20, 21 and A.H.U. 8-1, 2; A.H.Ni.1-12).

In very few diseases Sushruta described some specific Samprapti e.g. Srava, Savrana Shukra, Ajakajata, Timira, etc. Timira, Kacha, and Linganasha are 3 main diseases of Drushtigata Roga causing partial or total blindness if not treated properly and promptly. Hence their specific Samprapti is described here.
Specific Samprapti / Pathogenesis of Timira / Kacha / Linganasha
Dosha, vitiated by various etiological factors / specifically some Timira generating dosha (Dalhana), when enters the Eye through sira and get lodged in the First Patala i.e. Tejojalashrita (due to pre-existing Srotovaigunya); generate pathology there i.e. Timira. If neglected / untreated, these Dosha become more and more intensified / aggravated and invade 2nd, 3rd, and 4th Patala and precipitate Kacha and Linganasha. The mild blurring of vision in the affliction of 1st Patala gradually increases leading to the visual loss in the 4th Patala.

Thus derangement of the environment in the vicinity of Tejojala i.e. aqueous humor is responsible for the development of Timira / Kacha / Linganasha. If the environment remains within the physiological limits, vitiated dosha shall not be able to get settled in the 1st Patala.


  1. Turbidity/avilata, oedematous look of eye/sasarambhata, frequent watering of eye, itching, profuse secretions/upadeha, heaviness/guruta indicates Kapha vitiation.
  2. Burning sensation indicates Pitta vitiation.
  3. Redness indicates Rakta vitiation.
  4. Pricking sensation/toda, Foreign body sensation/bristle like movements with some pain in fornix indicates Vata vitiation. (S. U. 1-21 to 23)

Being Prodromal features, these are not clearly expressed or visualized. But in such conditions also if there is visual impairment or impaired lid movements, then the wise clinician should understand that the Eye is occupied by various Vitiated Dosha.

Indriya-Aayatan Dosha / Disorders of sense organs

When the sense organs are unable to perceive/interpret or interpret the received sensations in a twisted manner, the condition is called as Indriya-Aayatan Dosha i.e. Disorders of sense organs. (S. Su.24-9)

[Karana daurbalya i.e. weakness of sense organ, mentioned in Charaka Su. 11-8, is also responsible for improper functioning of sense organ.]

Vitiation of Dosha is the main etiological factor for Eye diseases along with some anatomical / structural defects; physiological i.e. functional anomalies; adibala pravrutta, janmabala pravrutta etc. (S. Su. 24-5); Asatmendriyartha sanyoga, Pradnyaparadha and Parinama (C. Su. 11-43). Besides these some specific etiological factors for eye diseases are also mentioned in S. U. 1-26, 27; A.H.U.8-1, 2 and Madhava Nidana Uttarardha-page 690. All these etiological factors are listed in a tabulation form as under- Continue Reading