From

Narayanan N, B.A.M.S

Preliminary MD (Ayu) Scholar,

Dept of PG Studies in Manasaroga,

SDMCollege of Ayurveda & Hospital,

P.Box No. 164, Hassan – 573 201.

To

THE REGISTRAR,

RajivGandhiUniversity of Health Sciences,

Bangalore,

Karnataka.

Through:

The Principal and Head of the Dept of PG Studies in Manasaroga

SDMCollege of Ayurveda & Hospital,

Hassan- 573201.

Respected Sir,

Subject: Submission of completed Proforma for registration of subject for dissertation.

I request you to kindly register the below mentioned subject against my name for the submission of dissertation to Rajiv Gandhi University of Health Sciences, Bangalore for partial fulfillment of MD (Ayurveda).

Title of the dissertation

“ROLE OF MANASIKA BHAVAS IN AETIOPATHOGENESIS AND MANAGEMENT OF ADHIMANTHA (GLAUCOMA)”

Herewith I am enclosing completed Proforma of synopsis for registration of subject for dissertation

Thanking you,

Yours faithfully,

Place: Hassan

Date:Narayanan N

.

RajivGandhiuniversity of Health Sciences

Bangalore, Karnataka.

ANNEXURE – II

completed proforma for Registration of

subject for dissertation.

1. Name of the Candidate:

And address

/

Dr NARAYANAN. N

Dept of PG Studies in Manasaroga

S.D.M.College of Ayurveda and Hospital,
P.Box No. 164, Hassan – 573 201.
S/O n nARAYANAN namboothiri,
nelliakattu mana,
kizhakombu, KOOTHATTUKULAM p.o,
ERNAKULAM (DT),
KERALA.
PIN-686662.

2. Name of the Institute

/ S.D.M.College of Ayurveda and Hospital

Hassan – 573 201.

3. Course of study in Subject / M.D. (Ayurveda) –Manasaroga
4. Date of Admission to
The Course / 1st JUNE, 2007.
5. Title of the dissertation / “Role of manasikabhavas in aetiopathogenesisand management of adhimantha (glaucoma)”

6. BRIEF RESUME OF THE INTENDED WORK

6.1NEED FOR STUDY:

Life is a complex union of Body, Senses, Mind and Soul.1 Human body is a tripod having three pillars, Satva (Mind), Atma (Soul) and Shareera (Body).2 Sense organs receive specific stimulation from the environment, lacking in meaning and functioning only in the pursuit, so that it gives a meaning to the organism and it is the task of Manas to take the information, process it.

Manas is considered as Jnanendriya as well as Karmendriya which is at a super sensual level (Ateendriya) in the body,3 an instrument of Atma, seat of all feelings like pleasure, sorrows and a mediator in knowledge gaining process,Manas activates Indriya towards objects – thought, consideration, hypothesis, attention, determination etc .Functions of Manas are Indriyabhigraha (direction to the indriyas), Swasyanigraha (control over itself), Ooha (reasoning or logical thinking), Vichara(abstract thinking) .4

Manasika Bhavas are the emotional factors exhibited by the person due to various external stimuli. Caraka has given explanation of Manasa Bhavas in Vimana Sthana, Mano-Artha (avyabhicharena) -By perception of specific objects even in the presence of all other senses along with their respective objects.

Vijnana-(Vyavasayena) -By proper reaction activities.

Rajah - (Sangena) - By attachment.

Moha- (Avijyanena)-By lack of understanding.

Krodha-(Abhidrohena)-By revengeful disposition.

Shoka-(Dainyena)-By sorrowful disposition.

Harsha-(Amodena)-By happiness.

Priti-(Toshena) - By satisfaction which is reflected by joyful appearance of face etc.

Bhaya-(Vishadena)-By apprehension.

Dhairya-(Avishadena)-By fearlessness.

Virya-(Utthanena)-By initiation of action.

Avasthana-(Avibhramena)-By stability of mind.

Shraddha-(Abhiprayena)-By request or quests.

Medha-(Grahanena)-By the power of comprehension.

Sanjna-(Namagrahena)-By recollection of names.

Smriti-(Smaranena)-By the power of retrieval.

Hriyam-(Apatratanena)-By bashfulness.

Shila-(Anushilene)-By habitual intake or following.

Dvesha-(Pratishedhena)-By disinclination.

Upadhi-(Anubendhena)-By subsequent manifestations.

Dhriti-(Alaulyene)-By firmness.

Vashyata-(Vidheyata)-By compliance with others.

To a certain degree every emotion finds some bodily expressions and exhibited through the eyes5. The perception is the meaningful organization of sensory data and their interpretations in the light of ones past experience. It is functionally selective as the old axiom goes“The eyes see what the mind does”6

Eye is an important sense organ for the active life of an individual, even where words fail to express, there the eyes finds the emotions. So, eye is that much important organ for the individual for a healthy life. Many of the Manasika Bhavas like Harsha, Krodha, Kama, Bhaya, Dainya etc are expressed through eye only. Suppression of tear is an Adharaniya Vega. This reaction is initiated and carried out by nervous system. Suppression of this leads to the disorders of the nervous system and leading to the production of many diseases. Suppression of tear will produce running nose, pain in the eyes, head and heart, stiffness of neck, loss of appetite, giddiness and tumors in the abdomen7.

Eye is the sense organ through which the perception of vision is taking place, “Atmendriyamanoarthanam Sannikarshath Pravarthathe, vyaktha tadathve yaa buddhi pratyaksham sa niruchchyathe”8.The combination of all these four factors gives the perception of vision.

The prevalence rate for all mental disorders was observed as 65.4 per thousand population.9 and for eye disorders due to emotional factors in general is 60-100/1000 population.10ThisStudy may help in finding the relationship between the emotional factors and eye disorders.

If we analyze the Nethraroga Nidana 11Swapna Viparyaya (irregular sleeping habit), Prasaktha Samrodhana (continuous crying), Kopa (anger), Shoka (grief) and Klesha (difficulties / the stressful activities) cause the vitiation of Raja and Tamo Dosha which in turn results in the prakopa of Pitta and Vata respectively. These Prakupita Doshas produce Indriya Durbalata, Moorcha, Alpanidrata along with other physical symptoms.

Adhimantha is Sarvagata Netra Vyadhi. It is of four types -Vataja adhimantha, Pittaja adhimantha, Kaphaja adhimantha and Rakthaja adhimantha.

No particular studies have been carried out for the involvement of Manasika Bhavas in Adhimantha in Ayurveda Research field. But it is very clear that involvement of Manasika Bhavas is very dominant in Adhimantha. Hence, clinicians in Psychiatry and Ophthalmology must make the proper evaluation of Manasika Bhavas in aetiopathogenesis of Adhimantha and initiate treatment. This study is intended to evaluate theManasika Bhavas like Kopa, Shoka, Vishada, Eersya, Bhaya, etc., in causation andaggravation of Adhimantha.

6.2Review of literature:

  • Acharya Sushruta in Netraroga Nidanam described about Prasaktha Samrodhana (continuous weeping), Shoka, Kopa, Klesha etc.
  • Vagbhata explained that the factors told in Sarvaroga Nidana is responsible for Netra Roga also.12
  • Sushrutha in Pittaja Adhimanda Lakshanas, described Lakshanas like Moorcha, Shirodaha which shows the psychological involvement.13
  • Vagbhata described Bhrama as one of the symptoms of Vaatadimanta.14
  • All Acharyas mentioned Rajas and Tamas as Manasika Dosas.15
  • Shankhapushpi is a Medhya Rasayana. Its properties are Rasa- Tikta; Guna- Snigdha,Picchila;Virya- Shita; Vipaka- Madhura; Karma- Tridoshaghna, Medhya, Svarya16
  • Ingredients of Jathimukuladi Varthi are Jathimukula, Laksha, Gairika and Chandana. It is Rakta Pitta Prasadana17

6.3Objectives of the study

1. Assessment of Manasika Bhavas as cause and effect of Adhimantha

2. To evaluate, effect of Medhya Rasayana (Shankhapushpi Choorna) in the management of Manasika Bhavas in Adhimandha

3. To evaluate the effect of Jathi mukuladi Varthi Anjana in the management of Adhimandha.

4. To evaluate the combined effect of Medhya Rasayana(Shankhapushpi Choorna)and Jathi mukuladi Varthi Anjana in the management of Adhimandha

7. Materials and methods

  1. Source of data:-

Two Hundredpatients suffering from Adhimandha will be selected from the O.P.D and I.P.D of S.D.M.College of Ayurveda and Hospital, Hassan and SreedhareeyamAyurvedaeye hospital, Koothattukulam, Kerala.

  1. Methods of the collections of data:

a) Assessment study will be conducted on two hundred patients.

b) Evaluation will be done by using standard scales, objective and subjective parameters.

b) Inclusion criteria:

  • Patients between the age of 20 & 80 years will be selected irrespective of sex, occupation, religion and socio economic status.
  • 200 Patients having the classical Lakshanas of Adhimantha will be selected for the evaluation of Manasika Bhavas

c) Exclusion criteria: .

  • Patients not having the classical Lakshanas of Adhimantha.

d)Diagnostic criteria

  • Adhimantha lakshanas- Karnayohonadam, Bhrama, Mardanavat peedana in Bhru, Lalata, Akshi, Burning sensation in Eyes, Excess salivation, Foreign body sensation in eyes, Eye pain, Reddish discoloration etc.
  • Specific signs and symptoms of Glaucoma-Raised IOP, Cupping of disc, visual field defects etc.
  • Manasika Bhavas pertaining to Adhimantha..

e)ASSESSMENT CRITERIA:

Patients will be assessed with subjective and objective parameters formulated for the assessment of Manasika Bhavas in Adhimantha.

  • Subjective Parameter:

Mental Status examination

Self scored scale for Assessment of Manasika Bhavas

  • Objective Parameter:

Routine eye examination

Visual Acquity

Fundoscopy

Tonometry

Visual Field

Slit lamp Examination

Parameter’s as per requirement.

Treatement plan-200 patients of Adhimantha will be selected randomly for the assessment of Manasika Bhavas in atiopathogenesis. Out of these, those patients willing to undergo for Ayurvedic management will be again randomly divide into three groups each comprising of 20 patients.

  1. Group I (Medhya Rasayana group)- Patients of this group will be given orally Shankhapushpi powder only in the dose of 3gms twice daily with warm milk for one month, to evaluate whether improvement in Manasika Bhava provides relief in Adhimantha
  2. Group II (Jatimukuladi Varti Anjana Group)- Patients of this group will be treated with Jatimukuladi Varthi Anjana, applied over eyes 2 times a day for one month.
  3. Group III (Combined group) - Patients of this group will be treated simultaneously with Medhya Rasayana and Jatimukuladi Varthi Anjana to evaluate the efficacy of combined therapy.

f) Statistical Analysis- After compiling the data statistical analysis will be done by using Student’s t test and f test.

7.3LABORATORY INVESTIGATIONS:

  • Routine laboratory investigations, EEG, CT Scan, MRI, Evoked Potentials, as and when required.

7.4 Has the Ethical Clearance been obtained from your Institution?

Yes.

8.0List of References:

  1. Agnivesha’s Charaka Samhitha – Chakrapanidutta’s Ayurveda Dipika,commentary transalated by – Dr.Ram Karan Sharma and Vaidya Bhagwan Dash, Vol-1, Published by – Chaukambha Sanskrit series office – Varanasi, Reprint – 2006, Sutrasthanam –1/56, Page No – 41 .
  2. Ibid,Sutrasthanam –1/42, Page No – 25 .
  3. Ibid, Sutrasthanam –8/4, Page No – 164 .
  4. Agnivesha’s Charaka Samhitha – Edited by Prof.P.V.Sharma, Published by – Chaukhambha Orientalia, Varanasi, 1st Edition, 1983, Shareerasthana – 1/21, Page No- 379.
  5. Ibid, Vimanasthana – 4/8, Page No- 316.
  6. V.M.D.Namboothiri – A concise text book of Psychiatry – 2nd edition, Published by – Elsevier a division of Read Elsevier Pvt. Ltd , 2005 @ Elsevier – 3rd Chapter, Page No – 47.
  7. Vagbhata’s Astanga Sangraham transalated by Prof .K.R.Sreekantha Murthy published by Chaukhambha orentalia Varanasi, Suthrastana fifth chapter,Sloka No 17 ,P.No.74.
  8. Agnivesha’s Charaka Samhitha – Chakrapanidutta’s Ayurveda Dipika, By – Dr.Ram Karan Sharma and Vaidya Bhagwan Dash, Vol-1, Published by – Chaukambha Sanskrit series office – Varanasi, Reprint – 2006, Sutrasthanam –11/20, Page No – 211 .
  9. Indian journal of Community medicine 2001 October – December; 26(4): 198-200.
  10. 10.Dr.M.S.Bhatia – Short Textbook of Psychiatry, 5th edition, edited by – Dr.M.S.Bhatia, Published by – CBS Publishers and distributers, New Delhi, Chapter – 1, Page No- 3.
  11. Sushruta : Sushruta Samhita with Dalhana Acharya, Nibandha Sangraha and Gayadas Acharya Nyaya Chandrika, Panjika Commentary edited by Vaidya Yadavji Trivikramamtajen Acharya, Krishnadas Academy, Varanasi,6th Edition reprint - 2003, Uttaratantra First Chapter – Sloka – 21,
  12. Vagbhata’s Ashtanga Hridayam –Edited with Nirmala Hindi Commentary along with special delebration Etc., By Dr. Brahmanandha Tripati, Published by – Chaukambha Sanskrit Pratisthan, Delhi-7, Uttarasthanam -8th Chapter, Sloka – 1, Page No- 935.
  13. Sushruta : Sushruta Samhita with Dalhana Acharya, Nibandha Sangraha and Gayadas Acharya Nyaya Chandrika, Panjika Commentary edited by Vaidya Yadavji Trivikramamtajen Acharya, Krishnadas Academy, Varanasi.

Sixth Edition reprint - 2003, Uttaratantra,6thChapter – sloka 14.

  1. Vagbhata’s Ashtanga Hridayam –Edited with Nirmala Hindi Commentary along with special delebration Etc., By Dr. Brahmanandha Tripati, Published by – Chaukambha Sanskrit Pratisthan, Delhi-7, Uttarasthanam - 15th Chapter, Sloka – 4, Page No -974.
  2. Ibid,Sutrasthanam– 1stChapter, Sloka – 21, Page No -27.
  3. Prof. P. V. Sharma – Dravyaguyna Vijnana Vol- II- Published by ChaukambhaBharatiAcademy, Varanasi-1993, 1st Chapter, Page No.-9
  4. Sahasrayogam, Sujana priya ccommentary- Edited by K.V.Krishnan Vaidyar and S. Gopala Pillai – 26 edition Feb. 2006- published by Vidhyarthimithram publication , Alappuzha- Netraroga Chikitsa, Page no . 386.
  1. Signature of the Candidate:
  1. Remarks of Guide:
  1. Name and Designation of

(IN BLOCK LETTERS)

11.1Guide:Dr. NARAYANA PRAKASH, M.D (Ayu)

PROFESSOR and H.O.D,

DEPT. OF P.G STUDIES IN

MANASA ROGA,

S.D.M.C.A & H, HASSAN.

11.2Signature:

11.3Co – guide:Dr.SUHAS KUMAR SHETTYM.D (Ayu)

ASST.PROFESSOR,

DEPT. OF P.G STUDIES IN

MANASA ROGA,

11.4Signature:

11.5Head of the department:Dr. NARAYANA PRAKASH, M.D (Ayu)

H.O.D, DEPT. OF P.G STUDIES IN

MANASA ROGA,

S.D.M.C.A & H, HASSAN.

11.6Signature:

12.

12.1Remarks of the Chairman:

And Principal

12.2Signature:

1