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Introduction

Every person should make consistant efforts to protect his eyes throughout the life because for blind person day and night are equal.(1) If person possesses all other sense organs ,strength,beauty & so on but lacks eye sight he is as useless as an insect.(2) Shalakya Tantra is one among the eight branches of Ayurveda which deals with management of diseases above the clavicle.Pishtaka is one among Shuklagata Netraroga which is characterized by dots which are circular,elevated looks white like rice flour , clear like water droplet.It appears on white portion of the eye ie. Shuklamandala.It is described under kaphaja Shuklagata roga. In modern science it is correlated with Pinguecula.(3)

Pinguecula is extremely common degenerative condition of conjunctiva characterized by formation of yellowish white patch on bulbar conjunctiva near limbus.It is benign,idiopathic condition which is commonly found in people who are exposed to dust, wind,UV rays etc.It is seen on nasal and temporal limbal conjunctiva .When conjunctiva is congested it stands out as an avascular prominence.(4) Pinguecula is generally asymptomatic hence no treatment is required for it but when it is cosmetically unaccepted it may be excised.

Methodology:

Anjana Review:

Anjana is the procedure in which application of medicinal pastes or powders is done with the help of Shalaka or Fingers from Kanninika Sandhi ie.inner canthus to Apanga Sandhi ie. Outer canthus. Anjana has tremendous importance in both healthy as well as in person having ophthalmic diseases.Anjana should be applied after shodhana therapy & when the doshas localized in the eye and total elimination of Amavastha and appearance of Pakwavastha lakshana ie. reduced edema, itching, lacrimation etc.(5)

Indication of Anjana:

Pittaja,Kaphaja,Raktaja & mainly in Vataja netraroga.

Contraindication:

Insomnia, eye exposed to breeze,dust ,smoke ,in presence of eye injury & fatigued eye, thirsty patient,angry patient,emotionally upset patient ie.fear,grief,weeping,after emesis,purgation, meal,day sleep,nasyakarma in presence of indigestion,headache, extreme cold weather, immediately after headbath or before sunrise,suppression of natural urges,suffering from fever,shiroroga ,shopa ,kruchchronmilan,Timira etc.(6)

Types of Anjana:(7)

Anjana is of 3 types i.e. Gutika(Pills), Rasakriya(Semisolid) and Churna (powder). Acharya  Susruta  and  Vagbhata  mentioned  that  thestrength of Anjana increases in preceding order asGutika, Rasakriya and Churna.  However  Acharya  Bhavamishra mentioned that order somewhat differently as Rasakriya, VartiandChurna. Hence can be usedAnjanaaccording tothe severity of the disease as Gutika, Rasakriya and Churna for  the  most  severe,  moderate  and  mild  disorders respectively.

Application method of Anjana:(8)

Poorvakarma:

When doshas are localized in eye only

When doshas exibit symptoms of Niramavastha

Pradhan karma:

After selecting proper Anjana as per dosha,patient has to be lie in supine or sitting position .The learned physician should open the eyelids of patient with the help of left hand & application of Anjana is done with fingertip or Anjana Shalaka held in right hand from kanninka sandhi to Apanga sandhi or viceversa.After appliucation of anjana ,Patient is asked to rotate the eyeball slowly in all direction to disperse the anjana material uniformly.

Paschat karma:

Eye should be properly washed with water.

table 1

Table 2

Discussion

Lekhana anjana is indicated in kapha predominant vyadhi by Acharyas. As the drugs used for preparation of Saindhav –Eladi Anjana having properties like katu, Tikta, Kashaya rasa, Tikshna,Ruksha, Laghu Guna and Kaphahara doshghnata this Anjana may be helpful in Pishtaka as it is a kapha predominant roga.

Mode of Action of Lekhana Anjana:(16)

The vitiated dosha which are situated in vessels applying eye & eyelids srotas ie,Larima apparatus & also in Shrungataka marma are drained out through mouth,nostril & eye because of tirritant effect of Lekhana Anjana.

Mode action modern :

1. Bioavailability and Drug Delivery:
   1. Developing topical ocular drugs involves enhancing bioavailability and controlling the constant release of the drug.
   2. Factors such as precorneal barriers, anatomical structures, and systemic absorption significantly impact bioavailability.
2. Precorneal Factors:
   1. Solution Drainage: The tear film turnover rate affects the drainage of instilled solutions.
   2. Blinking: Each blink removes a small volume of fluid from the cul-de-sac.
   3. Tear Film: The tear film offers initial resistance due to its rapid restoration time.
3. Mucin and Protective Role:
   1. Mucin present in the tear film forms a hydrophilic layer over the glycocalyx of the ocular surface.
   2. It plays a protective role by clearing debris and pathogens, including ocular drugs.
4. Human Tear Volume:
   1. Human tear volume is estimated to be around 7 μl.
   2. The cul-de-sac can transiently contain approximately 30 μl of the administered eye drop.
   3. However, tear film restoration occurs rapidly (within 2-3 minutes).
5. Blinking and Drug Drainage:
   1. Blinking promotes the drainage of instilled ocular drugs through the nasolacrimal duct.
   2. Spontaneous tear flow results in the complete loss of instilled drugs from the cul-de-sac within about 5 minutes.
   3. Approximately 80% of the drug is lost through the nasolacrimal drainage.

Conclusion

Pishtaka is correlated with the Pinguecula in modern science.Pinguecula is usually asymptomatic and not requied any treatment but if it is cosmetically unaccepted to patient then the surgical removal of it is the only treatment option in modern science and to avoid the surgery it is important to find out an effective alternative treatment.

In ayurveda Anjana Kriyakalpa is indicated in Pishtaka which is safe and cost effective treatment. As per Acharyas,Lekhana Anjana is useful in Pishtaka & drugs in Saindhav –Eladi Anjana has Lekhana property which helps in reducing size of Pishtaka.