Research Article International Ayurvedic Medical Journal ISSN:2320 5091

EFFECT OF SHANKHADI RASAKRIYA ANJANA IN THE MANAGEMENT OF

AVRANA SHUKLA WITH SPECIAL REFERENCE TO CORNEAL OPACITY
3
Akhil Jain1, Nidhi Garg2, Suman Lata
1
Assistant Professor in Shalakya Tantra Dept., 2Assistant Professor in Agad Tantra Dept., Assistant
Professor in Rasa Shastra Dept., Ch. Devi Lal College of Ayurveda and Hospital,
Jagadhri, Haryana, India
ABSTRACT
Avrana Shukla is a disease of Krishna Mandala exhibits whitish dots or patches on cornea
due to scarring or clouding of the corneal tissue which decreases vision. It can be correlated to Cor-
neal Opacity or non ulcerative keratitis. The incidence is very common in economically backward
and skilled laborers of rock cutting trade, among persons employed in various processes of thrashing,
husking and pounding of paddy and also highly prevalent among the working class. Corneal opacity
is one of the major causes of blindness. Out of total blind people 1.52% is blind only because of cor-
neal opacity. Any opacity in the refractive media causes blurriness of vision to blindness and cosmet-
ic problem. Cornea being the first refractive media of eye has greater importance in refraction. The
affection and complications of cornea and vision depends upon the site, spread and density of corneal
scars. Here a prompt clinical effort is carried out to establish the efficacy of Shankhadi Rasakriya
Anjana in management of Avrana Shukla. In Avrana Shukla mild pain, mild discharge and visual
impairment are cardinal features due to formation of white patches on Krishna Mandala by vitiation
of Kapha and Rakta. Shankhadi Rasakriya Anjana contains Shankha Bhasma, Shukti Bhasma, Yash-
timadhu Churna, Kataka Beeja, Draksha and Madhu. The contents of drug are Lekhana, Chakshu-
shya and Ropaka in action. The Kataka Beeja, Shukti Bhasma, Yashtimadhu, Draksha and honey are
Pitta Rakta Shamaka, Shoola and Shothahara, Chakshushya and Kandughana.Therefore the drug
was selected for this study. 40 patients of Avrana Shukla were treated by randomly dividing them
into two groups. SA group patients were subjected to Shankhadi Rasakriya Anjana and MA group
patients were applied with Madhu Anjana once daily in the morning on the affected eye for 15 days.
Shankhadi Rasakriya Anjana showed better result in clinical study.
Key words: Avrana Shukla, Krishna Mandala, Anjana, Lekhana, Chakshushya, Corneal opacity

INTRODUCTION
A person who desires for a long life blind life is miserable hence advised to protect
must care of his eyes throughout the life, as the eyes from diseases and injuries. Due to
for a blind man there is no difference between Abhishyanda and other external causes, white
day and night. Hence even though he has opacities develop on the Krishna Mandala that
wealth he will be poor1. So protection of eye is known as Avrana Shukla or Shuddha Shuk-
sight is topmost priority of Shalakya Tantra la. It is characterized by Alpa Vedana and
since the loss of vision completely disables a Ashrusrava. In some cases it associates with
person. Avrana Shukla2 or Shuddha Shukla3 is visual impairment if Shukla arises at the
a disease of Krishna Mandala exhibits whitish Drishti Mandala. It can be correlated to cor-
dots or patches, single or multiple, stationary neal opacity, due to the similarity in Lakshnas,
or diffused spreads from Prathama Patala to Samprapti and stages of the disease. Non-
Tritya Patala and becomes complicated. The spreading, superficial lesion of Prathama Pa-
 Akhil Jain Et Al: Effect Of Shankhadi Rasakriya Anjana In The Management Of Avrana Shukla With Special Reference To Corneal
Opacity
tala is said to be curable. It can be correlated 2 The chronicity of the disease less than 5
to Corneal Opacity or non ulcerative keratitis. years.
Avrana Shukla is a disease affecting Krishna 3 Grade 1 & 2 corneal opacities.
Mandala which may ultimately lead to disfi- Exclusion criteria
gurement of cornea and blindness. Any opaci- 1 Savrana Shukla
ty in the refractive media causes blurriness of 2 Associated with diabetes, hypertension, ma-
vision to blindness and cosmetic problem. lignancy and acute specific infectious systemic
Cornea being the first refractive media of eye disease.
has greater importance in refraction. The af- 3 Anjana Anaraha.
fection and complications of cornea and vision 4 Corneal opacities with other complications
depends upon the site, spread and density of like adherent leucoma, corneal facet, kerecta-
corneal scars. Here a prompt clinical effort is sia and anterior staphyloma etc.
carried out to establish the efficacy of Shank- 5 Grade 3 corneal opacity.
hadi Rasakriya Anjana in management of Groups of treatment
Avrana Shukla. In this venture it is sincerely 40 patients of Avrana Shukla were randomly
hoped that present study will be a positive step selected and equally divided into the following
in providing a solution to a burning problem, two groups.
and will be a valuable contribution to the SA Group: The patients of this group were
scientific world. applied with Shankhadi Rasakriya Anjana,
Aims and objectives once a day in the morning for 15 days.
1 To study the efficacy of Shankhadi Rasa- MA Group: The patients of this group were
kriya Anjana in the management of Avrana applied with plain Madhu Anjana, once a day
Shukla. in the morning for a period of 15 days.
2 To study the efficacy of Madhu Anjana in Method of Application of Anjana: In the
the management of Avrana Shukla. morning hours the patient was advised to sit
3To compare the efficacy of Shankhadi Rasa- comfortably and 2 drops of Anjana was ap-
kriya Anjana and Madhu Anjana in the man- plied inside of lower eyelid with finger in af-
agement of Avrana Shukla. fected eye. Then the patient was asked to close
CLINICAL STUDY his eyes and rotate the eye balls for well dis-
MATERIAL AND METHODS tribution of the drug in eyes. When the lacri-
The Shankhadi Anjana was prepared in the mation stopped, the eye was washed with
Rasashastra department of SDM college of clean water and wiped with sterilized swab
Ayurveda and hospital, Hassan as per the fol- and patient was advised to take rest for a while
lowing method. Shankha Bhasma, Shukti and not to expose for dust, smoke and bright
Bhasma, Draksha, Yashtimadhu, and Kataka light etc. The patients were followed up at
Beeja were taken in equal quantity and made regular intervals of fifteen days after stopping
into a very fine powder form and was kept in the treatment for a period of two months.
an airtight container. On the day of Anjana the Assessment Criteria: Patients were assessed
powder was mixed with honey well and taken with subjective and objective parameters for-
in the dropper and put on the finger and then mulated for Avrana Shukla before and after
applied inside of lower lid in the form of Ra- treatment.
sakriya Anjana. Subjective Parameter
Patients with the classical features of Avrana 1. Lacrimation.
Shukla were selected from OPD and IPD of 2. Pain
Shalakya Tantra of SDM college of Ayurveda 3. Visual improvement
and hospital, Hassan. Objective Parameter:
Inclusion criteria 1. Size of the opacity measured in millimeter
1 Patients of 10-70 years of age were selected by slit lamp biomicroscope.
irrespective of sex, socioeconomic status and 2. Density of the opacity by transillumination
religion. test.
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 Akhil Jain Et Al: Effect Of Shankhadi Rasakriya Anjana In The Management Of Avrana Shukla With Special Reference To Corneal
Opacity
3. Pictorial presentation. Blood and urine routine tests were done ac-
Laboratory Investigations: cording to the need.
Grading of Sign and Symptoms for assessment of study
Subjective Srava or lacrimation: 0-No secretion
1-Mild secretion
2-Moderate secretion
3-Severe secretion
Vedana or pain: 0-No pain
1-Mild pain
2-Moderate pain
3-Severe pain
Objective Length and Breadth of Opacity in mm
Pictorial Representation
Visual Acuity or Visual improvement if papillary area is involved
Density of opacity : 1-Faint opacity
2-Semi dense/ whitish
3-Dense/white

Criteria for the assessment of overall effect Statistical Evaluation of results- The ob-
of therapies tained data were analyzed statistically. The
Complete Remission: 100%improvement in values were expressed as percentage of Mean
signs and symptoms. reduction, SE, SD, t and P values. The data
Moderate Improvement: 51-99%improvement were analyzed by paired t test. The level of P
in signs and symptoms. between 0.10 to 0.001, and P<0.001 was con-
Mild Improvement: 1-50% improvement in sider as statistically significant and highly sig-
signs and symptoms. nificant respectively. P value more than 0.10
No Improvement: <1%improvement in signs results were taken as insignificant.
and symptoms.
Master charts
SA Group Vedana Lacrimation Density of Visual Acuity Length of Breadth of
opacity opacity opacity
Patient BT AT BT AT BT AT BT AT BT AT BT AT
1 0 0 0 0 2 1 11.1 10.9 5 4.8
2 1 0 0 0 2 1 3 2.8 2 1.8
3 2 1 1 0 2 1 5 4.8 2 1.8
4 1 0 1 0 2 1 6/36 6/24 8.3 8.1 8 7.9
5 1 0 1 0 2 1 6/60 6/60 8 7.9 5 4.8
6 0 0 0 0 2 0 6/60 6/60 10.9 10.7 10 9.8
7 1 0 1 0 2 1 6/60 6/36 4 3.8 4 3.8
8 1 0 2 0 2 0 6/60 6/60 10 9.8 10 9.8
9 1 0 1 0 2 1 3 2.9 2 1.8
10 1 0 2 0 2 1 6/24 6/18 7 6.8 8 7.8
11 0 0 0 0 2 1 6/12 6/9 5.1 4.9 5 4.8
12 2 0 1 0 2 1 6/60 6/60 3 2.9 3 2.9
13 1 0 1 0 2 0 6/60 6/60 7 6.8 9 8.8
14 1 0 0 0 2 1 6/60 6/36 5 4.8 5 4.8
15 1 0 1 0 2 1 6/60 6/36 7 6.8 6 5.9
16 1 0 1 0 2 1 6/60 6/60 4.5 4.3 5 4.8
17 1 0 1 0 2 1 2/60 3/60 4 3.8 3 2.8
18 1 0 1 0 2 0 6/60 6/60 7 6.8 6 5.8
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 Akhil Jain Et Al: Effect Of Shankhadi Rasakriya Anjana In The Management Of Avrana Shukla With Special Reference To Corneal
Opacity
19 1 0 1 0 2 1 4 3.9 1 0.9
20 2 1 1 0 2 1 2 1.9 3 3
MA Vedana Lacrimation Density of Visual Acuity Length of Breadth of
Group opacity opacity opacity
Patient BT AT BT AT BT AT BT AT BT AT BT AT
1 1 0 1 0 2 1 6/60 6/60 2.2 2.0 1 1.9
2 1 0 1 0 2 1 6/36 6/24 4 3.9 1 0.9
3 1 0 1 0 2 1 6/24 6/24 3.5 3.4 2 1.9
4 1 0 1 0 2 1 6/24 6/24 4 3.9 2 1.9
5 1 0 1 0 2 1 6/24 6/18 2.4 2.4 1 1
6 1 0 1 0 2 1 4 4 2 2
7 2 1 1 1 1 1 4 4 2 2
8 2 1 1 0 2 2 3 2.9 4 3.9
9 3 2 1 0 2 2 2 2 3 2.9
10 1 1 1 1 1 1 2 2 4 3.9
11 1 1 1 1 2 2 6/36 6/24 1 0.9 3 2.9
12 1 1 1 0 1 1 3.4 3.3 4 3.9
13 1 0 1 0 1 1 2 2 3 2.9
14 1 0 1 1 2 2 6/36 6/36 1 0.9 4 3.9
15 0 0 1 1 2 2 3.3 3.2 1 1
16 0 0 1 0 2 1 5 4.9 2 2
17 0 0 1 1 2 1 4 3.9 1 1
18 0 0 1 1 2 2 5.3 5.3 3 3
19 0 0 1 0 1 1 4 4 2 2
20 1 1 1 0 2 1 6/36 6/36 2 2 1 0.9
Results
Effects of Shankhadi Rasakriya Anjana on signs and symptoms of 20 patients of Avrana Shukla
SA Group Mean % of reduc- SD of SE of t P Val- Remarks
BT AT tion in mean mean mean Value ue
score
Length of opacity in 5.9 5.73 2.88 0.047 0.01 17 <0.001 Significant
mm
Breadth of opacity in 5.1 4.93 3.33 0.057 0.013 13.08 <0.001 Significant
mm
Visual acuity 6/48 6/41.36 13.83 10 2.67 2.48 <0.05 Significant
Density of opacity 2.0 1.2 40 0.41 0.09 8.89 <0.001 Significant
Lacrimation 0.85 0.25 70.59 0.6 0.13 4.6 <0.001 Significant
Vedana 1.0 0.45 55 0.51 0.11 5.0 <0.001 Significant

Improvement Seen in Sign and Symptoms of patients of Avrana Shukla in SA group

Unchanged Mild Moderate
Sign and Symptoms No. of patients % No. of patients % No. of patients %
Length of opacity in mm 00 00 20 100 00 00
Breadth of opacity in 01 05 19 95 00 00
mm
Visual Acuity 8 out of 14 57.14 06 out of 14 42.86 00 00
Density of opacity 04 20 16 80 00 00
Lacrimation 09 45 01 05 10 50
Vedana 11 55 02 10 07 35

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 Akhil Jain Et Al: Effect Of Shankhadi Rasakriya Anjana In The Management Of Avrana Shukla With Special Reference To Corneal
Opacity
Improvement Seen in Sign and Symptoms of patients of Avrana Shukla in MA group
Unchanged Mild Moderate
Sign and Symp- No. of % No. of pa- % No. of pa- %
toms patients tients tients
Length of opacity 09 45 11 55 00 00
in mm
Breadth of opacity 08 40 12 60 00 00
in mm
Visual Acuity 5 out of 62.50 03 out of 37.50 00 00
8 08
Density of opacity 11 55 09 45 00 00
Lacrimation 10 50 00 00 10 50
Vedana 13 65 01 05 06 30

Effects of Madhu Anjana on signs and symptoms of 20 patients of Avrana Shukla

MA GROUP BT AT % of re- S.D S.E of t value P val- Remarks
duction in of mean ue
mean mean
score
Length of opaci- 3.0 2.95 1.83 0.05 0.012 4.58 <0.001 Significant
ty in mm
Breadth of opac- 2.3 2.24 2.6 0.05 0.012 5 <0.001 Significant
ity in mm
Visual acuity 6/34.5 6/30.75 10.9 5.3 1.87 2.00 <0.10 Significant
Density of opac- 1.75 1.30 25.71 0.51 0.11 4.09 <0.001 Significant
ity
Lacrimation 1.0 0.5 50 0.51 0.11 4.54 <0.001 Significant
Vedana 0.95 0.6 37 0.47 0.11 3.18 <0.01 Significant

Overall improvement seen in sign and symptoms opacity of 40 patients of Avrana Shukla
SA Group MA Group
Unchanged 30% 55%
Mild 60% 35%
Moderate 10% 10%

DISCUSSION corneal opacity in the comparison to Madhu

Effect on pain: Shankhadi Rasakriya Anjana Anjana group.
provided significant relief (p<0.001) in pain of Effect on Srava: Shankhadi Rasakriya Anjana
55% after 15 days of treatment. In this group provided significant relief (p<0.001) in Srava
35% patients got moderate relief and 10% pa- of 70.59% after 15 days of treatment. In this
tients got mild relief in pain. On the other group 50% patients got moderate relief and
hand Madhu Anjana provided significant 05% patients got mild relief in Srava. On the
(p<.0.01) relief in pain of 37% after 15 days of other hand Madhu Anjana provided significant
treatment. In this group 30% patients got (p<0.001) relief in Srava of 50% after 15 days
moderate relief and 5% patients got mild relief of treatment. In this group 50% patients got
in pain. On the basis of above results it can be moderate relief. On the basis of above results
said that effect of Shankhadi Rasakriya Anja- it can be said that effect of Shankhadi Rasa-
na was better in relieving pain in patients of kriya Anjana was better in relieving Srava in
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 Akhil Jain Et Al: Effect Of Shankhadi Rasakriya Anjana In The Management Of Avrana Shukla With Special Reference To Corneal
Opacity
patients of corneal opacity in the comparison 25.71% after 15 days of treatment and 45%
to Madhu Anjana group. patients got mild relief in density of opacity
Effect on length of corneal opacity: Shank- .On the basis of above results it can be said
hadi Rasakriya Anjana provided significant that effect of Shankhadi Rasakriya Anjana
relief (p<0.001) on length of corneal opacity was better in improving density of opacity in
of 2.88% after 15 days of treatment. and 100% the comparison to Madhu Anjana group.
patients got mild relief in length of corneal Overall relief: Among 20 patients after 15
opacity .On the other hand Madhu Anjana days of Anjana therapy in SA group 60% pa-
provided significant (p<.0.001) relief in length tients got mild relief 10% patients got mod-
of corneal opacity of 1.83% after 15 days of erate relief. Among the 20 patients after 15
treatment and 55% patients got mild relief in days of Anjana therapy in MA group 35% pa-
length of corneal opacity. On the basis of tients got mild relief 10% patients got mod-
above results it can be said that effect of erate relief.
Shankhadi Rasakriya Anjana was better in re- Follow up: In SA group after completion of
lieving length of corneal opacity in the com- follow up study (60 days) all patients showed
parison to Madhu Anjana group. sustained relief. No recurrence was observed.
Effect on breadth of corneal opacity: In MA group after completion of follow up
Shankhadi Rasakriya Anjana provided signifi- study (60 days) all patients showed sustained
cant relief (p<0.001) on breadth of corneal relief. No recurrence was observed.
opacity of 2.88% after 15 days of treatment. Comparison of the effects:
and 100% patients got mild relief in breadth of On the basis of above results it can be said that
corneal opacity .On the other hand Madhu An- effect of Shankhadi Rasakriya Anjana were
jana provided significant (p<.0.001) relief in more significant in relieving the signs and
breadth of corneal opacity of 2.60% after 15 symptoms of corneal opacity in comparison to
days of treatment and 60% patients got mild Madhu Anjana group.
relief in breadth of corneal opacity .On the ba- Drug Action
sis of above results it can be said that effect of The treatment principles of Avrana Shukla is
Shankhadi Rasakriya Anjana was better in re- divided into two groups
lieving breadth of corneal opacity in the com- 1 Sthanic Shodhana 2 Sarvadaihika Shod-
parison to Madhu Anjana group. hana
Effect on Visual acuity: Shankhadi Rasakriya In Sthanic Shodhana Seka, Ashchyotana,
Anjana provided significant relief (p<0.05) on Gharshana and Lekhana Anjana are ex-
Visual acuity of 13.83% after 15 days of plained. Among them Gharshana and Lekha-
treatment. and 42.86% patients got mild relief na Anjana are given utmost importance. In
in Visual acuity .On the other hand Madhu Sarvadaihika Shodhana Virechana and Nasya
Anjana provided significant (p<.0.10) relief in is given utmost importance. The treatment
Visual acuity of 10.9% after 15 days of treat- principle of Avrana Shukla is Lekhana, Ghar-
ment and 37.50% patients got mild relief in shana or Pratisarana, especially in the form
Visual acuity. On the basis of above results it of Anjana. The drug should possess Lekhana,
can be said that effect of Shankhadi Rasakriya Kaphahara, Chakshushya, Shothahara, Kan-
Anjana was better in improving Visual acuity duhara and Vedanashamaka efficacy.
in the comparison to Madhu Anjana group. The Shankhadi Anjana is very good
Effect on density of opacity: Shankhadi Ra- Lekhana Drug due to containing drugs like
sakriya Anjana provided significant relief Shankha Bhasma, Shukti Bhasma, Yashtimad-
(p<0.001) on density of opacity of 40% after hu and Madhu. This Lekhana Anjana with its
15 days of treatment. and 80% patients got efficacy scrapes the vitiated Kapha of Krishna
mild relief in density of opacity. On the other Mandala by which the vitiation of Krishna
hand Madhu Anjana provided significant Mandala gets corrected. These contain Mad-
(p<.0.001) relief in density of opacity of hura, Tikta, Kashaya Rasa, Madhura Vipaka,

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 Akhil Jain Et Al: Effect Of Shankhadi Rasakriya Anjana In The Management Of Avrana Shukla With Special Reference To Corneal
Opacity
Sheeta Veerya and Tikshna Guna. Hence these porated in Shankhadi Anjana are having Ka-
are effective as Lekhana, Gharshana, and Pra- phapittahara, Shothahara, Ropaka, Lekhana
tisaraniya Dravya without harming peripheral and Chakshushya properties. Therefore the
or underlying tissues. drug is helpful in Samprapti Vigatana of
The Kataka Beeja, Shukti Bhasma, Avrana Shukla.
Yashtimadhu, Draksha and honey are Pitta- On the basis of all details it can be
rakta Shamaka, Shoola and Shothahara, concluded that both the therapies selected for
Chakshushya and Kandughana. The fine drugs this study provided significant relief in signs
have very good Lekhana efficacy without da- and symptoms of patients of Avrana Shukla.
maging the underlying tissue due to their But on comparison it was found that Shankha-
smoothening effect, anti-inflammatory effect di Rasakriya Anjana provided better relief to
and also imparts healing effect. patients of Avrana Shukla in comparison to
Shukti Bhasma is well known drug Anjana application done with Madhu.
used for external and internal usage especially
for Pitta and Rakta disorders. REFERENCES
Draksha has anti-inflammatory, anti- 1. Agnivesha , 1941, Charaka Samhita, chap-
allergic and smoothening activity. It is widely ter 19, ashtodariya adhyay, Edited by Ya-
used as one of the components in different davji Trikamji , Chakrapani Vyakhya
medicines of eye disorders. It has Madhura Samhita, Chaukhamba Sanskrit series of-
Rasa Sheeta Veerya and Madhura Vipaka, fice ,Varanasi, pp110
Daha Prashamana, Jwaraghana, Shothahara, 2. Agnivesha,1984,Charaka Samhita, Chikit-
Raktapittashamaka. So, it can be used safely sa sthana, chapter 17, shloka 67,
in management of eye diseases. Edited by R.K Sharma , Bhagwan Dass,
Shankha Bhasma is well known drug Edition 1, Chaukhamba Sanskrit Series,
commonly used as one of the components in Varanasi ,pp 134
different Lekhana Anjanas. It has Katu Rasa, 3. Amarasimha, 1976, Amarakosha,Tritya
Katu Vipaka, Ushna Veerya and Laghu, Ruk- kanda ,nanartha varga , 2nd edition,
sha, Tikshna Guna, Shothahara, Dahahara, Chaukhamba Sanskrit series office
Amlapitta Hara, Vranaropaka and Lekhana ,Varanasi, pp270.
efficacy. 4. Anonymous, Atharva Veda Samhita,2002,
Shankha Bhasma and Shukti Bhasma is shashtha kandam,akshiroga bheshaja suk-
a drug with natural calcium supplements ta,edited by Shriram Sharma Acharya,pp8
commonly used in most of Lekhana Anjana .
Yogas. It has Ruksha, Sheeta Guna and effica- CORRESPONDING AUTHOR
cy of Lekhana, Gharshana or Pratisarana. Dr. Akhil Jain
Madhu for having Madhu Kashaya Ra- Associate Professor in Shalakya Tantra Dept,
sa, Kaphahara efficacy enhances the potency Ch. Devi Lal Ayurvedic College and Hospital,
of compound. The application of medicine Jagadhri, Haryana, India
spreads to Netra Patala, Sira, Dhamani, Sro- Email: akhiljn11@gmail.com
tas disintegrates the vitiated Doshas of Krish-
na Mandala. The Doshas thus mitigated is Source of Support: Nil
removed through Ashru Srava and brings Conflict of Interest: None Declared
normalcy in ocular structures.
Avrana Shukla is caused by derange-
ment of Kapha Pitta Dosha. The drugs incor-

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