E-ISSN:2456-3110

Review Article

Computer Vision Syndrome

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 6 June
Publisherwww.maharshicharaka.in

A conceptual view on Computer Vision Syndrome through an Ayurveda Prospective

Sharma S.1*, Kumar Sharma M.2
DOI: http://dx.doi.org/10.21760/jaims.8.6.29

1* Sakshi Sharma, Assistant Professor, Department of Swasthavritta & Yoga, SBLD Ayurveda Vishwa Bharti, Sardarshahar, Rajasthan, India.

2 Mahendra Kumar Sharma, Director/Principal, Post Graduate Institute of Ayurved, Dr. S.R Rajasthan Ayurved University, Jodhpur, Rajasthan, India.

Acharya Vagbhat quotes that loss of vision is a loss of life. Vision is our primary connection with this world. With the help of eyes, we can interact with our surroundings in more than a million ways every second. Computer, the knowledge bank of modern life, has emerged as a profession causing vision-related discomfort, ocular fatigue, and systemic effects. Computer Vision Syndrome (CVS) is the new nomenclature to the visual, ocular, and systemic symptoms arising due to the long time and improper working on the computer and is emerging as a pandemic in the 21st century. Approximately 60 million people suffer from Computer Vision Syndrome globally, which leads to a decrease in productivity at work and Quality of life. Ayurved being an ancient system of medicine has millions of remedies in it, which is useful for all types of disease, whether it is stated directly or not. Ayurved classics quote that if a physician is not able to get a direct description of the disease in Samhitas, he should not feel guilty about that and should treat the condition based on the involvement of Doshas in it. Hence, here an attempt has been made to provide an explanation of Dosha, Dushya & Samprapti of Computer vision syndrome according to Ayurveda.

Keywords: Computer Vision Syndrome, Emerging Pandemic, Quality of Life, Dosha, Dushya, Samprapti

Corresponding Author How to Cite this Article To Browse
Sakshi Sharma, Assistant Professor, Department of Swasthavritta & Yoga, SBLD Ayurveda Vishwa Bharti, Sardarshahar, Rajasthan, India.
Email: 		Sakshi Sharma, Mahendra Kumar Sharma, A conceptual view on Computer Vision Syndrome through an Ayurveda Prospective. J Ayu Int Med Sci. 2023;8(6):184-191.
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https://jaims.in/jaims/article/view/2467

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-04-24 2023-04-26 2023-05-17 2023-05-10 2023-05-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Sakshi Sharma, Mahendra Kumar Sharmaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Eye holds a special status among all the sense organs. Eyes are the most precious gift of God to the living beings. Today, in the 21st century, where we are living in a highly sophisticated environment, computer is one of the most developed technologies which are used regularly by the children, the young and the old. Improper use of sense organs, violating the moral code of conduct, and the effect of the time are the three basic causative factors behind all the health problems.

More and more men are sitting in front of the computer for longer hours, which is a highly vision demanding task which is leading to ocular and systemic discomfort coined as Computer Vision Syndrome (CVS).

Studies indicate that eye-related symptoms occur in 50-90% of VDT workers, while a study released by NIOSH stated that 22% of computer workers have musculoskeletal problems.

Ayurveda, the first systematic health system on this planet, has kept the doors open to prospective/undescribed health problems to be incorporated in the system on the fundamental grounds.

On critical analysis of the symptoms of CVS on Tridoshika theory of Ayurveda, as per the road map given by Acharya Charaka, it seems to be a Vata-Pittaja ocular cum systemic disease which needs systemic as well as topical treatment approach.This article verifies the hypothesis that CVS in Ayurvedic perspective is a Vata-Pittaja disease affecting mainly eyes and body as a whole.

Aim and Objectives

The main aim behind working in this article was to create an Ayurvedic understanding of computer vision syndrome to know about the Dosha Dushya Samurcharna & Samprapti Ghatak of computer vision syndrome.

To justify the quotes of Acharya Charak which postulate that it is not mandatory to have names of all the diseases, and even it is not a matter to be ashamed. Diseases can be classified innumerably according to Dosha & Dushya, involvement, and place of origin of the disease.

Materials and Methods

Samhitas like Charak Samhita, Susrut Samhita, Astang Hridaya, Astang Sangraha etc. & various modern books related to ophthalmology were used as main source materials while working on this article. Apart from this, various websites, articles, and various other literary works were considered and searched thoroughly for this review article.

Computer Vision Syndrome {CVS} is not directly mentioned in classical Ayurvedic text.

However, Acharya Charaka[1] describes that one should go through Nidana Panchaka, to understand the symptoms of CVS probable Nidana Panchaka[2] are discussed as follows -

A. Nidana: तत्र निदानं कारणमित्युक्तमग्रे |[3] Most of the symptoms of CVS are due to working on computers; moreover, Acharyas had described Hetu of all Netra Rogas in general as follows -

a. Bahya Hetus: The external factors causing Dosha Prakopa, prolonged working on computers screens or watching television for longer duration, gazing at fast-moving images and multiple colors frequently, non-uniform illumination of a workplace, an improper posture of sitting, etc. works as a Bahya Hetu or external factors for Computer Vision Syndrome.

b. Abhyantara Hetus: All internal factors leading to Prakopa of Tridosha due are known as internal factors or Abhyantara Hetus.[4]

उष्णाभितप्तस्य जलप्रवेशाद्दूरेक्षणात् स्वप्नविपर्ययाच्च द्यप्रसक्तसंरोदनकोपशोकक्लेशाभिघातादतिमैथुनाच्च ||

शुक्तारनालाम्लकुलत्थमाषनिषेवणाद्वेगविनिग्रहाच्च | स्वेदादथो धूमनिषेवणाच्च छर्देर्विघाताद्वमनातियोगात् |

बाष्पग्रहात् सूक्ष्मनिरीक्षणाच्च नेत्रे विकारान् जनयन्ति दोषाः द्यद्य ||[5]

Acharya has complied all the Nidanas so magnificently so the detailed description of this can be understood as follows -


  • उष्णाभितप्तस्य जलप्रवेशाद्र - Sudden deviation in the temperature can be the major reason for eye diseases, sudden drop in the body temperature leads to the vessels constrict & damage in the vasculature of eyes. This creates circulatory disturbances, which may affect the mechanism of nutrition & becomes the reason for eye diseases.

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  • दूरेक्षणात् - To see very distant objects constantly, result in eye strain which can later become the cause of eye disorders.
  • सूक्ष्म निरीक्षणाच्च - Viewing the minute things causes strain to the ciliary muscles and lens results in visual problems.
  • स्वप्नविपर्ययाच्च - Change in the pattern of sleep e.g., Diwaswapna results in Kapha vitiation, Ratrijagrana leads to Vata-Pitta Prakopa.
  • प्रसक्तसंरोदन - Continuous weeping; causes enhanced stimulation to the Lacrimal gland, by which the lacrimal gland secrets more fluid that washes away the nutrients and bacteriostatic activity of the conjunctival sac, which make it more prone to diseases.
  • कोपाभिघातादतिमैथुनाच्च - By indulging in excessive rage, Pitta vitiates and causes Pitta Vikaras in the eyes.
  • शोक - By excessive sorrow, Vata vitiates and roots Vataja Netra Vikara in the eyes.
  • क्लेश - Physical & Mental tiredness causes vitiation of Sharira and Manasik Doshas & leads to various eye diseases.
  • अभिघात - Minute injuries cause a significant loss to the eye; if proper care is not taken of such injuries this can results in blindness immediately.
  • अतिमैथुनाच्च - Indulgence in sexual activities causes Dhatukshaya and leads eye diseases.
  • शुक्तारनालाम्लकुलत्थमाषनिषेवणात - Sukta, Arnalae., food items which are sour in test consumed in excessive amount can lead to Netra Vikara because these types of food article consist the properties opposite to Ojas & their excess use can lead to Ojokshaya & causes eye diseases. For eg - Kulatha (Kashaya Rasa, Katu Vipaka) if consumed for a long time, vitiates, and leads to Raktaja Pittaja disorders of the eye, Masha (Guru, Madhura, Snigdha) if consumed for a long time, leads to Kaphaja disorders of the eye.
  • वेगविनिग्रहाच्च - छर्देर्विघात - Suppressing basic urges like passing urine, or defecating stools, the urge of vomiting causes, produces Udavartha Vyadhi (vitiation of Vata) & causes eye strain and other Vataja eye disorders.



  • स्वेदात - वमनातियोग - Excessive Swedana Karma may lead to Pittaja Raktaja disorder of the eye so it is contraindicated to the eye if necessary, Mrudu Sweda is suggested with caution. Indulging in frequent Vamana therapy produces side effects like protrusion of the eye and Retinal or subconjunctival hemorrhage of the eye.
  • धूमनिषेवणाच्च - Smoking is very harmful to eyes, according to Ayurveda. As per Ayurveda, smoking will vitiate Pitta and Vata by increasing in Tikshna and Ruksha Gunas.
  • बाष्पग्रहात - Suppressing the tears flow can produce Ashruja Udavarta where Doshas get obstructed in the Ashruvahasrotas and lead to eye disease.

Vishesha Nidan[6]

The Vishesha Nidana consists of Asatmendriyartha Samyoga, Pragyaparadha, Parinama these can be explained as follows in respect to Chakshurendriya in the case of “Computer Vision Syndrome”

1. Asatmendriyartha Samyoga: The incomplete correlation of sense with their objects which might happen either accidentally, inevitably, or intentionally is known as Asatmendriyartha Samyoga.

Examples for such improper contacts w.r.t. Chakshurendriya is as follows-

a. Atiyoga: Seeing very bright light or bright objects for a longer duration like in reference of CVS it is constantly looking at the computer screen without blinking is Atiyoga of Chaksuindriya. The glare of the screen is the main pathogenic factor of CVS.

b. Heenayoga: Characters displayed on VDT’s are made up of numerous small dots or pixels. Pixelated characters are brightest in the center, with the brightness decreasing towards the outer edges. Seeing this is a type of character

c. Mithyayoga: Concentrating on the small letters over the screen, viewing objects from a distance of fewer than six inches, or working on the monitor of not appropriate height, observing much brighter computer screens is considered as the Mithyayoga of Chakshurendriya in reference of Computer Vision Syndrome.



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2. Pragyaparadha: Doing work without proper Dhi, Buddhi, Dhriti & Smriti is known as this action in future leads to Dosha Vaishmya and produces disease. In the context of CVS use of a computer for a huge amount of time despite trouble in the eye in an indiscipline manner can be termed as Pragyaparadha. Due to depressed surroundings and a lack of Sattva Guna and an increase in Raja and Tama Guna, a person spends significant time on social network sites which also working as aggravating factor for CVS nowadays.

3. Parinama: Parinama refers to Kala. Excess, mild, and altered appearance of their characteristics in any particular Ritu refer to Ati Yoga. Hina Yoga and Mithya Yoga. However, in the context of CVS, we did not find any relation of Parinama.

B. Poorvaroopa

पूर्वरूपं प्रागुत्पत्ति लक्षणं व्याधेः ||[7] - Poorvaroopa are the prodromal symptoms that occur before the disease is felt by the patient. Moreover, prodromal signs are observed by the physician.

तत्राविलं ससंरम्भमश्रुकण्डूपदेहवत् द्यगुरूषातोदरागाद्यैर्जुष्टं, चाव्यक्तलक्षणैः |

सशूलं वर्त्मकोषेषु शूकपूर्णाभमेव च | विहन्यमानं रूपे वा क्रियास्वक्षि यथा पुरा |

दृष्ट्वैव धीमान् बुध्येत दोषेणाधिष्ठितं तु तत् ||

Acharyas had described Poorvroopa of all Netra Roga in general in as[8]-

1. Avilata - Dirty eyes with discharges (Malayuktam) in reference to Computer vision syndrome the symptom can be taken as blurring of vision

2. Samrambha - Angry looks in reference to Computer vision syndrome it is the foreign body sensations or atypical discomfort in the eye.

3. Ashru - excessive watery discharge from the eyes.

4. Kandu - Itching can occur because of eye strain.

5. Upadeha - Stickiness in eyes due to continuous watery discharge of eyes.

6. Guruta - Heaviness is due to eye fatigue in CVS.

7. Usha - Burning sensation in eyes.

8. Toda - Pricking pain in eyes.

9. Raga - Redness in eyes.

10. Vartma Kosha Shoola - Pain in the fornices.

11. Vartma Kosha Shookapurnabha - Foreign body sensation in the fornices a typical symptom perceived by a CVS patient.

12. Vihanyaamana Rupa - Visual disturbances

13. Vihanyaamana Kriya - Subnormal functions of the eye.

14. Kriyaswakshi Yathapura - Reduced activities / movements, e.g., blinking

C. Roopa[9]

प्रादुर्भूतलक्षणं पुनर्लिङ्गमं - Roopa are the typical signs and symptoms by which a disease is diagnosed.

In reference to CVS sign and symptoms has not been mentioned directly anywhere in Ayurvedic texts but here an effort has been made to understand symptomatology of CVS by considering the main symptoms of CVS which is found in majority of patients with the help of classical Ayurvedic references -

a. Eyestrain - According to Acharya Sushruta, the second Patala of Netra has Akunchana and Prasarana properties which resembles the work of muscle fiber, and therefore considered it as Mansa Ashrita Patala based on its functional capacity, continuous work load on this Mansa Ashrita Patala can cause Aayasa or eye strain. In a person working for prolonged hours on a computer they generally cross this limit which causes Shrama, e., Apakarshana, which ultimately leads to a decrease in Kapha & increase Vata and Pitta.

b. Blurred vision - Accommodative spasm of the ciliary body leads to blurred vision. Prolonged working on VDT’s leads to Vata vitiation as which gives rise to the blurring of vision like symptoms in patients.

c. Dry eye - In Ayurvedic texts, dry eye is mentioned in various ways, i.e., Visushakbhava,[10] Visushaktav, and Sushakalpa are Vatapitta symbolizing terms; hence Vata and Pitta are responsible for dry eye symptoms. Inadequate blinking while working on a computer also decreases tear film reconstruction and results in dry eye.

d. Headache - According to Ayurveda,[11] its pathophysiology can be described as prolonged working on computer monitor leads to eye fatigue,


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which leads to an aggravation of Vata and Pitta and results in Shirotapa and

e. Neck / Shoulder / Back Pain - According to Ayurved Ativyayama of muscles leads to such symptoms, which vitiates Vata and Pitta, which leads to neck/shoulder/back and finger pain.

D. Upshyaya[12] - Upshyaya is the medicines, food items, and activities that give feelings of wellbeing to the patient after consumes them. In the patient of computer vision syndrome Upshyaya may include sound sleep, eye rest, vitamin C & A rich food, Tarpana Karma, fresh air, ocular and head massage, and soothing Netra Bindu.

Computer Vision Syndrome in Ayurved Prospective

Acharya Charka[13] opens a broad way by stating that it is not mandatory to have names of all the diseases, and even it is not a matter to be ashamed. Diseases can be classified innumerably according to Dosha & Dushya, involvement, and place of origin of the disease. So, by considering Prakariti, Adhisthana & Samuthana of Dosha will understand any disease and can lay down a treatment protocol accordingly. Acharya Charaka[14] states that Prataksha, Anumama & Aptopodesh are the three tools by which we can know about any disease. Among all these, Aptopodesh occupies the top list because of other sources like Prataksha, Anumama, Pramana, Aagama, etc.

  • Acharya Charak[15] has explained 13 tools to describe an ‘Anukta Vyadhi’ they are described as follows -

1. Evam Prakopanam: Prakopanam indicates to Hetu. In CVS, constantly staring at the computer screen with wide-open eyes causes three main changes in the eye i.e.

a. Widely open eyes will evaporate the moisture present on the anterior surface.

b. Concentrating on the screen with a decreased blinking rate decreases the tear secretions from the lacrimal gland.

c. Viewing small fonts or pixelated characters for a long time may lead to fatigue in the extraocular muscles of the eyes.

General causative factors like Nidana & Vishesh Nidana discussed above are also considered as causes of aggravation of Doshas.

2. Evam Yonim: Yoni symbolizes Moolbhoota Karana of the disease. It is a Vatadi Dosha dominating disease in Ayurved. It can be correlated to Vatta Pitta Pradhana Tridoshaja disease.

a. Red eyes[16] - पित्त - पितोष्णं रागः

b. Itching[17] - कफ - कण्डूपदेहाश्रुयुतः

c. Eyestrain[18] - वात्त - शड्खक्षिभ्रूललाटस्य तोदस्फुरणभेदनम

d. Blurred near and distant vision[19] - वात्त - धूमाविलां धूमदर्शा दृशं कुर्युःस धूमर

e. Double vision[20] - वात्त - एकं मन्यते द्विधा

f. Head, neck, shoulder, and back pain[21] - वात्त - पित्त - मन्याक्षिशड्खतो वायुरन्यतो वा प्रबर्तयेत

3. Evam Utthanam: Understanding the involvement of Doshas in the occurrence of the disease is called Utthana. The causative factors mentioned above are due to the vitiation of the Doshas. Sthanasamshraya of the vitiated Pitta occurs by the Khiavaigunya at the Pitta predominant area of the eye. Vegodeerana means continuously working with no relaxation of eyes, constantly staring at the VDT’s causes less blinking in the eyes pathology of CVS starts even causing accommodative insufficiency and convergence Insufficiency like symptoms. Vata and Pitta Dosha Prakopa causes Sthanasamshraya by Khavaigunya at the Vata dominant areas like Krishna Mandala etc. Hence all the processes mentioned above increasingly cause the manifestation of symptoms of “Computer Vision Syndrome.”

4. Evam Atmanam: Atmana refers to Swarupa or clinical manifestations of the disease.

The sign and symptoms of CVS are Red-eye, burning of eyes, Itching, Eyestrain, blurred near and distant vision, Difficulty in focusing, Double vision, Squinting,

Headache, Neck / back / shoulder pain and Fatigue.

5. Evam Adhisthanam: It refers to Ashraya, Vitiated Vata and Pitta Dosha will take Sthanasamshraya at Netra Patala and further causes lead to progression of the symptoms of CVS. Among Dushya Rasa, Rakta, Mamsa & Asthi Dhatu are involved after the Prakopana of Vata and Pitta Dosha.

6. Evam Vedanam: The word “Vedanam” signifies knowledge.


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Here the word can be described in clinical features and various diagnostic tests done in CVS. In Computer vision syndrome, not any particular diagnostic tools are described, but by using the Schirmer test, Dominant eye test, and visual acuity, we can rule out the condition like CVS.

7. Evam Samsthanam: The clinical manifestation of the disease is known as Samsthana. The signs and symptoms of CVS have been described above.

8. Evam Upadravam: Upadrava is the disease after the occurrence of the main disease and it is dependent on the main disease. Regarding Upadravas they are Shushkakshipaka (Dry eye), Avsada (Depression), and musculoskeletal disorder.

9. Evam Vriddhi, Sthana, Kshaya: The aggravating factor for the disease i.e., the Upshayas and relieving factors for the disease i.e., Anupshayas. For this particular disease following can be considered as Upshaya are, diet containing all the good nutrients, working with proper rest and proper blinking of an eye, good workplace ergonomics, uniform illumination.

Anupashaya means a combination of the above-mentioned subject which aggravates the symptoms which are dry eye condition prolong working hour, reduced blinking, disturbed sleep pattern, excessive screen glare.

10. Evam Udarkam: After a complete treatment protocol, the residual conditions of any disease which is not relieved by the specific treatment is called Udarka it leads to secondary diseases or complications with the progression of time. CVS is a lifestyle disease that causes no fatality but may reduce the quality of life. There is no evidence that it causes permanent damage to the eyes.

11. Evam Naman:  According to the above discussion it has been concluded that Computer Vision Syndrome is an “Anyukta Vyadhi.” Acharya Charak in Sutrasthana has stated that a physician should always diagnosis an Anyukta Vyadhi based on the presences of Dosha & Dushya in it so here we have made a try to describe Computer Vision Syndrome and in the similar sequence we would name Computer Vision Syndrome as ‘Vata Pitta Pradhana Tridoshaja Netra Roga’

12. Evam Yogam: As it is very clear from the above discussion that Computer Vision Syndrome is the diseases which is not directly mentioned

in Ayurved classics therefore any direct protocol has also not mentioned for this particular Vyadhi but Acharyas have always mentioned that success of any treatment depends upon the Yukti of Vaidhya.

E. Samprapti Ghataka

Dosha - Vata, Pitta Pradhana Tridoshaja Netra Roga

Dushya - Rasa Dhatu, Rakta Dhatu, Mamsa Dhatu, Majja Dhatu,

Agni - Jatharagni, Rasa Dhatwagni, Rakta Dhatwagni, Majja Dhatwagni, Mamsa Dhatwagni

Srotas - Roopavaha Srotas

Srotodushti Prakara - Vimargagamana and Sanga

Adhishthana - Netra (lids, conjunctiva, cornea & lacrimal glands)

Vyaktasthana - Netra

Sadhyasadhyata - Sadhya Rog

jaims_2467_01.JPG

Reference

1. Agnivesha, Charaka Samhita, Comm. Chakrapanidatta Ed. Pandit Kashinath Shastri & Dr. Gorakhnath Chaturvedi, Chaukhamba Sanskrit Sansthan, Varanasi, edition 2013; Sutrasthana18/ 44 – 47.

2. Agnivesha, Charaka Samhita, Comm. Chakrapanidatta Ed. Pandit Kashinath Shastri & Dr. Gorakhnath Chaturvedi, Chaukhamba Sanskrit Sansthan, Varanasi, edition 2013; Nidanasthana 1/6.

3. Agnivesha, Charaka Samhita, Comm. Chakrapanidatta Ed. Pandit Kashinath Shastri & Dr. Gorakhnath Chaturvedi, Chaukhamba Sanskrit Sansthan, Varanasi, edition 2013; Nidanasthana 1/7.


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4. Management of Computer Vision Syndrome through Ayurvedic principle by Dr. Upadhyay Arvind Kumar.

5. Sushruta. Sushruta Samhita Dalhana Comm. - Nibandhasangraha, Chowkhambha Orientalia Varanasi, 2002, Uttaratantra 1/26-27.

6. Agnivesha, Charaka Samhita, Comm. Chakrapanidatta Ed. Pandit Kashinath Shastri & Dr. Gorakhnath Chaturvedi, Chaukhamba Sanskrit Sansthan, Varanasi, edition 2013; Nidanasthana 1/3.

7. Agnivesha, Charaka Samhita, Comm. Chakrapanidatta Ed. Pandit Kashinath Shastri & Dr. Gorakhnath Chaturvedi, Chaukhamba Sanskrit Sansthan, Varanasi, edition 2013; Nidanasthana 1/8.

8. Sushruta. Sushruta Samhita Dalhana Comm. - Nibandhasangraha, Chowkhambha Orientalia Varanasi, 2002, Uttaratantra 1/21-23.

9. Agnivesha, Charaka Samhita, Comm. Chakrapanidatta Ed. Pandit Kashinath Shastri & Dr. Gorakhnath Chaturvedi, Chaukhamba Sanskrit Sansthan, Varanasi, edition 2013; Nidanasthana 1/9.

10. Sushruta. Sushruta Samhita Dalhana Comm. - Nibandhasangraha, Chowkhambha Orientalia Varanasi, 2002, Uttaratantra 6/6.

11. Sushruta. Sushruta Samhita Dalhana Comm. - Nibandhasangraha, Chowkhambha Orientalia Varanasi, 2002, Uttaratantra 6/27.

12. Agnivesha, Charaka Samhita, Comm. Chakrapanidatta Ed. Pandit Kashinath Shastri & Dr. Gorakhnath Chaturvedi, Chaukhamba Sanskrit Sansthan, Varanasi, edition 2013; Nidanasthana 1/10.

13. Agnivesha, Charaka Samhita, Comm. Chakrapanidatta Ed. Pandit Kashinath Shastri & Dr. Gorakhnath Chaturvedi, Chaukhamba Sanskrit Sansthan, Varanasi, edition 2013; Sutrasthana 18/44-47.

14. Agnivesha, Charaka Samhita, Comm. Chakrapanidatta Ed. Pandit Kashinath Shastri & Dr. Gorakhnath Chaturvedi, Chaukhamba Sanskrit Sansthan, Varanasi, edition 2013; Vimanasthana 4/3.


15. Agnivesha, Charaka Samhita, Comm. Chakrapanidatta Ed. Pandit Kashinath Shastri & Dr. Gorakhnath Chaturvedi, Chaukhamba Sanskrit Sansthan, Varanasi, edition 2013; Sutrasthana 18/44.

16. Vrddha Vagbhata, Ashtanga Samgraha - Sasilekha Comm. Indu, Chaukhambha Krishna Das Academy, Varanasi, 2000; Uttarsthana 15/8.

17. Sushruta. Sushruta Samhita Dalhana Comm. - Nibandhasangraha, Chowkhambha Orientalia Varanasi, 2002, Uttartantra 6/21.

18. Vrddha Vagbhata, Ashtanga Samgraha - Sasilekha Comm. Indu, Chaukhambha Krishna Das Academy, Varanasi, 2000; Sutrasthana 15/9.

19. Ashtanga Hridaya - Sarvanga Sundari Comm. Arunadatta, Ed. Dr. Brahmanand Tripathi, Chaukhambha Krishna Das Academy, Varanasi, 2000; Sutrasthana 12/29.

20. Sushruta. Sushruta Samhita Dalhana Comm. - Nibandhasangraha, Chowkhambha Orientalia Varanasi, 2002, Uttartantra 7/14.

21. Ashtanga Hridaya - Sarvanga Sundari Comm. Arunadatta, Ed. Dr. Brahmanand Tripathi, Chaukhambha Krishna Das Academy, Varanasi, 2000; Uttartantra 15/6.


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