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A Critical Review of Netra Sharir of Ayurveda in the Modern Perspective

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 Scholars International Journal of Traditional and Complementary Medicine
Abbreviated Key Title: Sch Int J Tradit Complement Med
ISSN 2616-8634 (Print) |ISSN 2617-3891 (Online)
Scholars Middle East Publishers, Dubai, United Arab Emirates
Journal homepage: https://saudijournals.com/sijtcm

Review Article

A Critical Review of Netra Sharir of Ayurveda in the Modern Perspective

Dr. Mula Ram Suthar1, Dr. Rakesh Roushan2*
1
M.D. Scholar, Kriya Sharir, CBPACS, New Delhi India
2
Assistant Professor, Kriya Sharir, CBPACS, New Delhi India

DOI: 10.36348/sijtcm.2020.v03i03.002 | Received: 21.02.2020 | Accepted: 01.03.2020 | Published: 07.03.2020

*Corresponding author: Dr. Rakesh Roushan

Abstract
The Indian system of Ayurvedic medicine has described three basic physiological constituents of human body, viz.,
dosha, dhatu and mala. Acharya Sushruta was a great surgeon in ancient India known today as the “Father of Shalya
Tantra (Surgery)” for inventing and developing surgical procedures. Acharya Sushruta has elaborately described the
defining characteristic of Shalakya tantra. It comprises of the disease of shalakya tantra as narrated by king of Videha
(the author of Nimi Tantra). Acharya Sushruta first ever has described the anatomy of eye in relation to their shape, size
of various anatomical components. Acharya Sushruta has also described the Netra roga in a very systematic manner. In
the Uttara tantram, Sushruta recites an elaborated classification of eye disease complete with signs, symptoms, prognosis
and medically surgical interventions. In the foetus, the parts of eye are originated from akasha, vayu, agni, apa
and prithvi mahabhuta. Acharya Sushruta has described all anatomical structures of the eye in terms of madala, patala,
sandhis, peshi, marma, sira and Dristi. Susruta delineated fine anatomical divisions mandala of eye. Different Acharyas
have their own view in the utpatti (origin) of Netra during garbhawastha kala. Increased demand of Ayurveda science in
the present society is required to understand the depth of Ayurvedic principle in an easy mode. Hence an effort has been
made to ascertain and establish the knowledge regarding anatomical structure of netra sharir.
Keywords: Ayurveda, Netra, Field of vision, Mandala, Patala, Sandhi.
Copyright @ 2020: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted
use, distribution, and reproduction in any medium for non-commercial use (NonCommercial, or CC-BY-NC) provided the original author and source
are credited.

well as text books of modern science have been referred

INTRODUCTION for better understanding of the concept and its
Acharya Susruta has described urdhva- comparison with modern science.
jatrugata roga elaborately which deals with the causes,
diagnosis and curative procedures of the diseases Field of Vision
pertaining to the body above the clavicles, i.e., ear, eye, According to Astang-Hridaya Samhita the
mouth, nose. Acharya Susruta has described gross eyes of kaphaj prakriti people are red at the angle,
ocular anatomy in first chapter of uttara-tantra. In this unctuous, wide, long with well-designed white and
article we intended to identify the anatomical black spheres (sclera and cornea) with more eyelashes.
considerations of the eye are described in many topics Acharya Susruta has mentioned the eyes of kaphaj
like Netra utpatti (embryology development of the prakriti people are red at the angle, white eyes. In the
eye), Netra –sharir (anatomical considerations of the classical text of Ayurveda it has been mentioned there
eye), Panchbhautika concept of embryogenesis of the are different types of eyes based on the dominance of
eye, Measurements and appearance of the eyeball, dosha in the prakriti like small eye, big eye, round eye,
Sources of origin of its constituents the eyeball, Colors elongated eye, sunken eye, rough eye, steady gaze eye,
of eye and Effect of Tejo dhatu on eye, Mandala, unsteady gaze eye, normal and healthy eye and these
Sandhi (junctional area), Patala (layer of eyeball), are the factors which can influence the field of vision.
concept of Dristi and Akshi Bandhana (contents of orbit
that binds the eyeball). So, there is a need of proper The field of vision is the visual area seen by an
understanding the anatomy in modern prospective. It eye at a given instant [1]. Visual field testing is a
cannot be characterized by a single entity at all the time common procedure in almost every eye practice. The
because Ayurveda is the science based on the concept of visual field is a three-dimensional area of a subject’s
structure and functional understanding. For this study, surroundings that can be seen at any one time around an
the basic materials have been collected from the object of fixation. The visual field can be divided into
Ayurvedic classics with the available commentaries, as
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central and peripheral field. The extent of normal visual various organs Punarvasu Atreya concluded that all the
field with a 5mm white color object is superiorly 50º, sense organs are developed simultaneously [5]. Both
nasally 60º, inferiorly 70º, and temporally 90º. The field Charaka and Sushruta consider Indriyas as Atmaja
for blue and yellow is roughly 10º less and that for red bhava. The clearness of senses (Indriya prasada) is
and green color is about 20º less than that for white. attributing of Satmyaja bhava.
The part of the external world visible to one eye when a
person fixes his gaze on one point is called the field of Acharyas Vagbhata opined Indriyas are
vision for that eye. To diagnose blindness in specific developed from the essence part of kapha, raktavaha
portions of the retina, one charts the field of vision for srotas and mahabhutas, after the digestion of its own
each eye with an instrument called Lister perimetry. agni. Vagbhata explained in detail about the
The process of charting the monocular field of vision is embryological development of each part of the eye,
called Perimetry. It is employed for the diagnosis of Shukla Mandala is developed from the essence of
various lesions of the visual pathways [2]. All visual Kapha and it is Pitraja Bhava, Krishna Mandala
fields are designed to measure the entire peripheral developed from Rakta and it is Matraja Bhava. Dristhti
vision. In fact, most commonly ordered visual fields Mandala is developed from both kapha and rakta and it
only test the central portion of a patient's field of vision. has both pitrija and matrija bhavas [6].
The amount of the field tested depends on which test
you perform. Panchbhautika Concept of Embryogenesis of
the Eye: The anatomy of the eye is described on the
NETRA UTPATTI (Embryology Development of the basis of panchabhautika composition like,
Eye) netrabudbuda (eyeball), pala (muscles of eye) are made
In the foetus, the parts originated from akasha of prathivi, rakta (blood) is made of agni, krashna
mahabhuta are- sound, auditory sensation, lightness, (black portion or cornea) is made of vayu, sita (white
fineness and space; the parts from vayu mahabhuta are portion or sclera) is made of jala, asrumarga (channels
– tangibility, sense of touch, roughness, impulsion, of tears or lacrimal ducts) is made of akasha
structuring of body tissues and maintaining of mahabhutas[7].
movements of the body and dosha; the parts belonging
to agni mahabhuta are visible form, vision, brightness, NETRA –SHARIR (Anatomical Considerations of
digestion and heat; those belonging to apa the Eye)
mahabhuta are taste, sense of taste, coldness, softness, Acharya Sushruta first ever has described the
unctuousness and moisture; those belonging anatomy of eye in relation to their shape, size of various
to prithvi mahabhuta are odour, sensation of smell, anatomical components. Sushruta has explained
heaviness, steadiness and material form[3]. seventy-six different kind of eye diseases and their
treatment in uttara tantra of Sushruta Samhita in 2nd
Acharya Sushruta has explained the subtle AD.
form of all the Indriyas is present during the formation
of Garbha. Eleven indriyas are originated from the Situation: Shira (head) is chief among all
vaikarika ahamkara with all its qualities with the help organs. It is the region of the body where vital centres
of taijas ahamkara. These eleven indriyas are as and all senses (indriya) of a living-being are located.
follows: ear, skin, eye, tongue, nose, speech organ, Acharyas have considered it is the principal organ
hand, sex organ, rectum, feet and mind. The former five among all organs and organelles. Two eye orbits are
are the organ of perception the next five are effector positioned in the head, which accommodate two Netras,
organ and the mind are common to both. The five one Chakshurindriya. Two ocular openings are present
tanmatras are created out of bhootadi ahamkara with over the head among the nine external openings of the
all its qualities with the help of tejas ahamkara. These body which communicate with the external world.
tanmatras are as follows; sabda, sparsh, rupa, ras and
gandha tanmatra. These tanmatra possess special Shape: Acharya Sushruta has described the
qualities of sound, touch, vision, taste and odour. From shape and dimension of Nayana Budbudam (eye ball)
these tanmatras the bhutas like akash, vayu, agni, jal as Suvrittam and Gostanakaram. Suvrittam means
and prithvi respectively are originated. Netras are agni spherical from all sides. Gostanakaram means shaped
predominant sense organ [4]. All the indriyas become like that teat of the cow (oval shape).
unambiguous during the third month. Charaka and
Kashyap has opined the same that the genesis of all Measurements of Eyeball- Acharya Sushruta
sense organs including eyes and organogenesis occurs has given the term Nayana budbuda for eye ball.
in third month of intrauterine life. According to Janaka Sushruta has explained the dimension of eyeball in
of Videha, sense organs existence the seat of senses is terms of angula and one angula is equivalent to the
first formed. After discussion with the various expert of central part of the patient’s own thumb. Two angula is
Ayurveda on the topic of formation of embryo, detailing the antero-posterior diameter of the eyeball. Vertical
the manner in which the foetus is formed in the uterus and horizontal diameter is two and half angula. Shape
of the mother and the mode of manifestation of its of the eyeball resembles with the teat of a cow and

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arising from all the bhutas (akasha, vayu, agni, jala, combines with rakta, pitta, kapha or vayu. When tejo
prathivi) with their attributes. In modern perspective, dhatu goes to the visual apparatus with the rakta, the
dimension of an adult eyeball is as follows- child would have raktaksha (red eyes); if it goes with
anteroposterior diameter 24mm, horizontal diameter pitta, then pingaksha (yellow eyes); if with kapha then
23.5mm, vertical diameter 23mm, circumference shuklaksha (white eyes); and if with vata then the eyes
75mm, volume 6.5ml and weight 7gm [8]. would be vikrutaksha (deformed eye)[9].

Colors of Eye and Effect of Tejo Dhatu on In Upanishada period, ocular anatomy was
Eye- In fetal life, tejo dhatu is responsible for vision if depicted in philosophical manner. In Brihad Aranyaka
tejo dhatu doesn’t reach the drashti bhag (visual Upanishada different structures of eyeball were said to
apparatus), the child is congenitally blind (amblyopia). be evolved from different Gods as follows.
Color of the eye is depending, whether, tejo dhatu

Table-3: Shows different structures of eyeball evolved from different goddesses [10].
S.No. God Name Part of Netra Part of eyeball
1. Rudra Reddish part of eye ball Blood vessels
2. Parajanya Liquid portion Aqueous & Vitreous humour
3. Aditya Kaninika, Ashrumarga Lacrimal apparatus
4. Agni Blackish portion Cornea and iris
5. Indra Whitish part Conjunctiva and sclera
6. Prithvi Adho Vartma Lower eyelid
7. Akasha Urdhva Vartma Upper eyelid

Mandala ii. The subcutaneous areolar tissue

Acharya Sushruta has enumerated the iii. The layer of striated muscle
anatomical parts of the eye consists of mandals are five iv. Submuscular areolar tissue
in number and sandhi and patala are six in number. v. Fibrous layer
1. Pakshma Mandala: This is the first and outermost vi. Layer of non-striated muscle fibres
mandala of the eye formed by the pakshma or vii. Conjunctiva
eyelashes. Pakshmani means chakshua achadana
romani[11]. Pakshma are situated in lid margins 3. Shukla Mandala: This mandala is present exactly
called pakshmashaya or pakshma sadana. Paksma inside of the vartam mandala and beyond the
is a form of kesa and considered as upadhatu of krishna mandala. The shukla mandala appears
majja and mala of asthi. It serves to heighten the white in color. The shukla mandala can be allied
protection of the eye from dust and foreign bodies. with the scleral part of the external fibrous coat of
the eyeball. Sclera forms the posterior five-sixth
2. Vartma Mandala: The Upper and Lower eyelids opaque part of the exterior fibrous tunic of the
together form a circular structure in front of the eyeball. Its entire outer surface is covered by
eyeball called as vartma mandala. The eyelids are Tenon's capsule. In the anterior part it is also
mobile tissues curtains placed in front of the covered by bulbar conjunctiva. Thickness of sclera
eyeballs. Vartma Mandala is also known as Aksi varies considerably in dissimilar individuals and
Kosha considering its protective function. There with the age of the person. It is normally thinner in
are two tarunasthi in the eye lids [12]. It is of children than the adults and in females than the
elliptical space between the upper and lower males. Sclera is thickest posteriorly (1mm) and
eyelids. The eyelids feature a row of eyelashes progressively becomes thin when traced anteriorly.
along the eyelid margin. The two eyelids meet each Lamina cribrosa is a sieve-like sclera from which
other at medial and lateral angles (two sandhis as fibres of optic nerve pass. Sclera consists of
kaninika and apanga). The nimesha-unmesha following three layers:
function (blinking) is controlled by vyana I. Episcleral tissue
vayu[13]. The moement of the vartma (nimesha- II. Sclera proper
unmesha) is regulated by motor nerves are facial III. Lamina fusca
(orbicularis muscle), oculomotor (levator palpebrae
superioris muscle) and sympathetic fibers. Sensory 4. Krishna Mandala: The krishana mandala of eye
nerve supply is derived from branches of (cornea) is forms one-third of the transverse extent
trigeminal nerve such as lacrimal, supraorbital and of the eyeball. In modern perspective, cornea is
supra ocular nerves for upper lid and infraorbital forms anterior one-sixth of the outer fibrous coat of
nerve with infra- trochlear branch for lower lid. the eyeball. The krishna mandala can be similar
Each eyelid consists (from anterior to posterior) of with the cornea; seems as blackish because of the
following many layers: iris. Cornea is a transparent, avascular, watch-glass
i. The skin like structure. The uveal tissue constitutes the

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middle vascular coat of eyeball. From anterior to lid margin is about 2-mm broad and is divided into
posterior it can be separated into three parts, two parts by the punctum. The medial, lacrimal
namely, iris, ciliary body and choroid. Iris is the portion is rounded and destitute of lashes or glands.
anterior most part of uveal tract. Iris is a tenuos The lateral, ciliary portion consists of a rounded
circular disc corresponding to the diaphragm of a anterior border, a sharp posterior border (placed
camera. The definitive color of iris be contingent against the globe) and an inter-marginal strip
on the anterior limiting layer. In blue iris this layer (between the two borders). The grey line (which
is thin and contains few pigment cells. While in marks junction of skin and conjunctiva) divides the
brown iris it is thick and compactly pigmented. inter-marginal strip into an anterior strip bearing 2-
3 rows of lashes and a posterior strip on which
The physical basis of eye color is openings of meibomian glands are settled in a row.
determined by the distribution and content of
melanocyte cells in the uveal tract of the eye. The 2. Vartma-Shukla gata Sandhi: The junction of
iris consists of several layers: the anterior limiting vartma mandala (eyelids) and shukla mandala
layer and its underlying stroma are the most (sclera) is known as Vartma-shukla gata sandhi. It
important for appearance of the eye color [14]. The is considered as conjunctiva fornix. Conjunctival
two primary physiological functions of the cornea. fornix conjoins the bulbar conjunctiva with the
first, functions of the cornea are to act as a major palpebral conjunctiva. It can be subdivided into
refracting medium; and Second, functions of the superior, inferior, medial and lateral fornixes. The
cornea to protect the intraocular contents. The conjunctiva contains Mucin secretory glands like
stroma of the iris contains collagenous fiber, goblet cells, crypts of Henle, glands of manz.
pigment cells, sphincter pupillae muscle and dilator These glands secrete mucus which is important for
pupillae muscle. wetting the cornea and conjunctiva. Accessory
lacrimal glands like glands of Krause, glands of
5. Drishti Mandala: The drishti mandala can be Wolfring.
similar with the pupil and lens. Acharya Susruta
has described the diameter of drishti mandala 3. Shukla – Krishna gata Sandhi: The junction of
(pupil) of eye is one-seventh and one-ninth part of Shukla mandala (cornea) and Krishna mandala
krashna mandala (cornea) and the distance (sclera) is known as Shukla-krishna gata sandhi.
between right and left drishti mandala (inter- This junctional area can be considered as the
pupillary) are four fingers[15]. corneoscleral junction and limbus. A 3-mm ridge
of bulbar conjunctiva round the cornea is called
Concept of drishti limbal conjunctiva. In the area of limbus, the
As Timira is one among the Drishti gata roga, conjunctiva, Tenon's capsule and the episcleral
it is quite essential to know more about drishti. tissue are merged into a dense tissue which is
strongly adherent to the underlying corneoscleral
Definition of Drasti (area of sight/vision)- The junction. At the limbus, the epithelium of
drashti is of the size of a cotyledon of the lentil, conjunctiva becomes continuous with that of
composed of the finest parts of panchmahabhutas, cornea.
gleaming like a glow-worm or a spark, covered by the
external coat of the eye and appearing like a hole[16]. 4. Krishna - Drishti gata Sandhi: The junction of
krishna and drishti mandala is known as Krishna-
The concept of Drishti by Acharya Sushruta is drishti gata Sandhi. This junctional area can be
little different and all the description of Drishti given by similar with the iris part in krishna mandala, this
him points to the pupil i.e. Sandhi can be explained and the central free
 Masura dala matra [size of a Masura dala] margin of the iris, which rests on the anterior
 Prasada of Panchamahaboota capsule of the lens, can be considered as the
 Covered by the external Patala Krishna-drishti gata Sandhi. The peripheral border
 Sparkle like glow worm (Khadyotavisfulingabha) or root of the iris attaches to the ciliary body while
 Constantly irrigated by the cold aqueous its central or free margin forms the rim of the pupil.
 Shape resembles a hole (Vivirakritim)
5. Kaneenika Sandhi: Dalhana describes this Sandhi
 Benefited with cold things
and it can be taken as the inner or nasal canthus of
the eye. The Canthus is either corner of the
SANDHI (JUNCTIONAL AREAS)
Sandhi is the “Junctional Areas” between two eye where the upper and lower
eyelids adjoin. More specifically, the inner and
Mandalas. The Sandhi are 6 in number. They are-
outer canthus is respectively, the medial and lateral
1. Pakshma-Vartma gata Sandhi: The junction of
ends of the palpebral fissure. The palpebral
pakshma mandala (eyelashes) and vartma mandala
fissure is the elliptic space amid the medial and
(eyelids) is called as the Pakshma-vartma gata
lateral canthi of the two open lids. The inner
sandhi and it is considered as the lid margin. The

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canthus (medial palpebral commissure) is It plays a significant metabolic role by providing

prolonged for a short distance toward the nose, and substrates and by removing metabolites from the
the two eyelids are divided by a triangular space, avascular cornea and lens. The composition of
the lacus lacrimalis. The inner canthus has two aqueous humour in anterior chamber differs
structures- from that of the aqueous humour in posterior
i. Plica semilunaris-It is a pinkish chamber because of metabolic interchange. The
crescentic fold of conjunctiva, present in physiological processes concerned with the
the medial canthus. Its lateral free border dynamics of aqueous humour are its production,
is concave. It is a vestigial structure in drainage and maintenance of intraocular
human beings and represents the pressure.
nictitating membrane.
ii. Caruncle- The caruncle is a small, ovoid, iv. SECOND PATALA: The location of second
pinkish mass, situated in the inner canthus patala is inner side of the bahya patala. It is the
just medial to the plica semilunaris. In seat of pisita (muscles). The second patala can
really, it is a piece of modified skin and so be taken as ciliary body. Both iris and ciliary
is enclosed with stratified squamous body are mesodermal in origin and contain
epithelium and contains sweat glands, muscles tissue. The ciliary muscle is composed
sebaceous glands and hair follicles. of smooth muscle fibres oriented in longitudinal,
radial, and circular directions. Interweaving
6. Apanga Sandhi: Acharya Dalhana describes occurs between fibre bundles and from layer to
Apanga sandhi and it can be considered as the layer, such that various amounts of connective
outer canthus of the eye. It is one of the marma tissue are found among the muscle
points. The outer canthus (lateral bundles. The longitudinal muscle fibres (of
palpebral commissure) is more acute than the Brücke) lie adjacent to the supra ciliaris and
medial, and the eyelids here lie in close contact parallel to the sclera. Each muscle bundle looks
with the bulb of the eye. like a long narrow V, the base of which is at the
scleral spur, whereas the apex is in the choroid.
PATALA (Layers of Eyeball)
Acharya sushruta has described the patala are v. THIRD PATALA: This patala is seat of meda
most important structure of netra sharir. It can be (fat). The third patal can be appeared like as
appeared like as a layer of the eyeball or film or coating vitreous humour. The Vitreous humour is an
over the eyes. The two patala are present in the eyelids inert, transparent, jelly-like structure that fills
and the other four Patala in the internal eye ball. Out of the posterior four-fifth of the cavity of eyeball
them the first Patala (outermost) subsists in the tejas and is about 4 ml in volume. It is a hydrophilic
and jala, second Patala in the mansa (muscle), third gel that primarily serves the optical functions. In
Patala in the meda (fat), forth Patala in the asthi. Their addition, it mechanically stabilizes the volume
thickness of entire patal is equal to one-fifth of pupil. of the globe and is a pathway for nutrients to
The pathogenesis of Drishtigata roga, has delineate in attain the lens and retina. The vitreous body can
terms of involvement of successive patala. The be separated into two parts; the cortex and the
prognosis of the disease also depends upon the nucleus (the main vitreous body).
involvement of respective patala. Acharya Sushruta has
considered the different akshi patala and their vi. FOURTH PATALA: This patala is seat of asthi
constituting factors as shown below: (bone). The fourth patal can be appeared like as
crystalline lens and retina. The lens is a
I & ii. Patala (Two Vartama Patala): The upper and transparent, biconvex, crystalline structure
lower eyelids are divided by a horizontal furrow placed amid iris and the vitreous in a saucer
(sulcus) into an orbital and tarsal part. shaped depression the patellar fossa. The Retina,
iii. First Bahya Patala (Tejojalashrita): It is the the innermost tunic of the eyeball, is a thin,
outermost first patala, supported by tejas & jala. delicate and transparent membrane. It is the
The outermost patala can be appeared like as the almost highly-developed tissue of the eye. It
aqueous humour. Acharya Dalhana has seems purplish-red due to the visual purple of
described the outermost patala as tejojalashrita. the rods and underlying vascular choroid.
According to Dalhana, the word teja means
alochaka pitta and so siragata rakta can be Structure of the Lens-
occupied as teja. Jala, according to him implies 1. Lens capsule
rasa dhatu of skin. So, it can be considered that 2. Anterior epithelium
the first patala is the ashraya for rasa and rakta 3. Lens fibres
dhatus. The aqueous humour is a clear watery 4. Suspensory ligaments of lens
fluid filling in the anterior chamber (0.25 ml)
and posterior chamber (0.06 ml) of the eyeball.

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Retina consists of following ten layers (arranged perception takes place in this patala as dristi is seated
from outward to inward): in medas, kalakasthi remains outside meda.
1. Pigment epithelium
2. Layer of rods and cones Extra Ocular Muscles of the Eyes: The
3. External limiting membrane muscles of the globe can be divided into two groups:
4. Outer nuclear layer the involuntary intrinsic muscles and the voluntary
5. Outer plexiform layer extrinsic muscles. The intrinsic muscles- the ciliary
6. Inner nuclear layer muscle, the iris sphincter, and the iris dilator are located
7. Inner plexiform layer inside the eye; these muscles control the movement of
8. Ganglion cell layer internal ocular structures. The extrinsic muscles are six
9. Nerve fibre layer (stratum opticum) and extraocular muscles; it is attached to the sclera and
10. Internal limiting membrane. control movement of the globe. The Rectus muscles are
superior, inferior, medial and lateral. The oblique
This description can be considered as a muscles include superior and inferior. The extraocular
misunderstanding from Dalhana. Actually, he had muscles rotate the eyeball round vertical, horizontal and
misinterpreted the word abhyantara given by Sushruta antero-posterior axes. Medial and lateral rectus muscles
in the description of prathama patalagata timira and are virtually parallel to the optical axis of the eyeball,
considered the first patala as the abhyantara so, they have got only the main action. While superior
(innermost) patala. According to some other scholars, and inferior rectus muscles make an angle of 23 and
the patala can be taken as the layers of the cornea. reflected tendons of the superior and inferior oblique
There is one other view in which the patala are taken muscles of 51 with the optical axis in the primary
as different layers of the lens itself. To justify this, they position, so, they have subsidiary actions in addition to
say that the lens is the only structure where the changes the main action.
of the disease timira, kacha and linganasha are taking
place. They assume the anterior lens capsule as the first Sira (Veins, Arteries and Nerves)-
patala and nucleus as the fourth patala. Acharya Dalhana describes sira are plural
word and it means can be considered as the orbit has a
According to some other views, the patala can single ophthalmic artery but two ophthalmic veins.
be taken as different layers of retina. There is third
patala participation for the diseases pittavidagdha Sira (Veins): Acharya Susruta has descried
drishti and kaphavidagdha drishti. These are the both the eye have 38 siras[18]. Among them vata is
diseases where patients complain of day blindness and carried in eight sira, pitta, rakta and kapha are carried
night blindness respectively. As these diseases occur in ten sira each. Acharya vagbhatta has explained total
due to degeneration of rods and cones. The Patala can number of 56 siras present in the both eyes. Among
be taken as different layers of retina. But, by taking the them two siras each are responsible for lid movement
retina as patala, we cannot explain the clinical entity (nimesha-unmesha) and these six siras should not be
timira. However, there is another view that, all these opened during sira vyadha. The superior and inferior
patala are seated in dristi mandala. Their thickness is ophthalmic veins primarily drain into the cavernous
one fifth of dristi mandala. This will lead to concept of sinus. On its course the superior and inferior ophthalmic
dividing dristi mandala in to four distinct layers; each veins give off several side branches: central retinal vein,
layers of retina representing patala. anterior and posterior ethmoid veins, lacrimal vein,
superior and inferior vortex veins, anterior ciliary veins,
Contents of Orbit That Binds the Eye Ball (Akshi supraorbital and infraorbital vein, superior, inferior,
Bandhana)- lateral and medial muscular veins branches.
The both eyeballs are held in position by the
inherent properties of the sira (veins, arteries and Dhamani (Arteries): The two dhamanies helps
nerves), kandara (tendons and ligaments), meda (orbital in visual perception, two for the flow of tears [19]. The
fat), Kalkaasthi (fascia that is attached to the bony ophthalmic artery is a branch of the internal carotid
cavity) and Sleshma bandana (especially the eye ball is artery that supplies all structure in the orbit. The
supported by the orbital fat) kapha as well as by the ophthalmic artery orginate in the cavernous sinus,
lining mucous membrane along with its vessels next to enters the orbit via the optic canal, then turns medially
the cartilage. The vessels, ligaments, bones and joints if and continues along the medial wall of the orbit,
the living beings have strength because they are dividing at the medial end of the upper eyelid into
covered by the muscles [17]. terminal branches- supratrochlear artery and dorsal
nasal branches. On its course the ophthalmic
According to Sasilekha commentary of artery gives off several side branches: central
Acharya Indu, the first patala consists of sira guna, the retinal artery, lacrimal artery, ciliary arteries,
qualities of teja and jala are also seen here. The second supraorbital artery, anterior and posterior
Patala has kandara guna which is derivative of mamsa ethmoidal arteries, meningeal branch, medial
dhatu. The third Patala has meda guna; exact visual palpebral arteries and muscular branches. There are

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 Mula Ram Suthar & Rakesh Roushan., Sch Int J Tradit Complement Med, March 2020; 3(3): 46-54

rupa vaha dhamani to transmit visual perception and lies posterior to the orbital septum and anterior to the
asruvaha dhamani for the flow of tears one in each eye. levator aponeurosis (upper eyelid) or the capsule-
palpebral fascia (lower eyelid). In the upper eyelid,
Cranial Nerve Innervation of Ocular Structure- there are two fat pouches: nasal and central. In the
The orbital structures are innervated by cranial nerves lower eyelid, there are three fat pockets: nasal, central,
optic nerve (II), oculomotor nerve (III), trochlear nerve and temporal. These pockets are surrounded by thin
(IV), trigeminal nerve (V), abducens nerve (VI), and fibrous sheaths that are forward continuations of the
facial nerve (VII). The Motor functions of the striated anterior orbito-septal system.
muscles are controlled by oculomotor nerve, trochlear
nerve, abducens nerve and facial nerve. The trigeminal Kalkaasthi of the Eyeball: The Kalkaasthi can
nerve transmits the sensory supply from the orbital be considered as tenon capsule. The Tenon capsule also
structures. The optic nerve carries visual information. known as the fascial sheath of the eyeball (fascia bulbi),
it is a thin membrane which envelops the eyeball from
Kandara (tendons and ligaments) of the the optic nerve to the corneal limbus, separating it from
Eyeball: The kandara can be considered as trochlea of the orbital fat and forming a socket in which it moves.
superior oblique and suspensory ligament of eyeball. The inner surface of the Tenon capsule is smooth and is
The trochlea of superior oblique is a pulley alike separated from the outer surface of the sclera by the
structure in the eye. The tendon of the trochlea of peri-scleral lymph space.
superior oblique passes through, it is situated on the
superior nasal aspect of the frontal bone, it is the only Marma (Vulnerable Area): There are three
cartilage found in the normal orbit. The suspensory marma related to eye i.e. Apanga, Aavarta and
ligament of eyeball (Lockwood's ligament) forms a Shringataka. The two apanga marma are situated on
hammock stretching below the eyeball between the the outer side of the orbit, below the lateral end the of
medial and lateral check ligaments and enwrapping the the eye-brows. The injury of apanga and avarta marma
inferior rectus and inferior oblique muscles of the eye. to them cause blindness or diminished vision. The
apanga marma and avarta marma is a type of shira
Snyau, Peshi: There is a snayu of prithu type marma and half angula in size. The Avarta marma is
in the eyes. Two peshi are situated in both eyes and above the end of the eyebrows. The Sringataka marma
which circular (Mandala) in shape. are the merging of vessels providing nutrition to sense
organs like nose, ear, eye and tongue. It is type of sira
Meda and Sleshma Bandana (Orbital fat) of marma and four angula in size and injury to this also
the Eyeball: The Meda and Sleshma Bandana can be results in immediate death.
considered as Orbital fat of both eyelids. The Orbital fat

Structure or Entities as per Ayurvedic text Correlation of Structure or Entities as per Modern text
Pakshma mandala Eyelashes.
Vartma mandala Upper and Lower eyelids.
Shukla mandala Sacral part of the external fibrous coat of eyeball.
Krishna mandala Cornea and iris.
Drishti mandala Pupil and lens.
Pakshma-Vartma gata Sandhi Lid margins of eyelashes
Vartma-Shukla gata Sandhi conjunctiva fornix
Shukla – Krishna gata Sandhi Corneoscleral junction and limbus.
Krishna - Drishti gata Sandhi central free margin of the iris, the anterior capsule of the lens.
Kaneenika Sandhi Inner canthus of the eye, Plica semilunaris and caruncle.
Apanga Sandhi outer canthus of the eye.
Two Vartama Patala Orbital and tarsal part of the eyelids.
Tejojala-ashrita Patala Aqueous humour
Mamsa-ashrita Patala Ciliary body, choroid
Medoa-ashrita Patala Vitreous humour
Asthi-ashrita Patala Crystalline lens and retina

DISCUSSION influences eyes in terms of size, shape of eyes,

In this literary study we collected various data appearance of eyes, dryness or roughness of eyes, color
from the Ayurvedic classics with the available of eyes, lashes of eyes, movement of eyes and some
commentaries, as well as text books of modern medical specific features of eye. These relates to the
sciences, various articles for better understanding of the constitutional variations of the individuals. Acharya
netra sharir and its comparison with contemporary Sushruta has described “Sarvendriyaanam
science. Acharyas have explained prakriti also Nayanampradhanam[20]”. Acharya Sushruta first ever

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 Mula Ram Suthar & Rakesh Roushan., Sch Int J Tradit Complement Med, March 2020; 3(3): 46-54

has described the anatomy of eye in relation to their edition. (pp.). Varanasi, India: Chaukhamba
shape, size of various anatomical components. Sushruta Sanskrit Sansthan; 1-10.
has explained seventy-six different kinds of eye 5. Chakrapanidatta. (2009). Sharir Sthana, Sharira
diseases and their treatment in uttara tantra. The Netra Vichaya Sharira adhyaya. In: Kushwaha HC (Eds.),
execute both physiological functions roopagrahana and Ayurveda deepika on Charaka Samhita: Revised
buddhigrahana as it is the seat of Alochaka pitta. It is edition. Varanasi, India: Chaukambha Orientalia,
predominant of tejo mahabhuta so, there is always 824-844
dread of kapha to eye. 6. Vaghbhatta. (2016). Sharir Sthana, Angavibhaga
Sharir Adhyaya. In: Gupta AD, (Eds.), Astanga
The shape of netra is like suvrittam means Sangraha. Revised edition. Varanasi, India:
spherical from all sides and gostanakara means shaped Chaukambha Krishnadas Academy, 297-308
like that teat of the cow (oval shape). Acharya Sushruta 7. Sushrut. (2016). Uttara tantram, Aupadravikah
described the anatomical parts of the eye consists of adhyaya. In: Shastri A.D. (Eds.), Ayurved
mandals are five in number and sandhi and patala are Tatvasandipika on Susruta Samhita: Revised
six in number [21]. Sandhi is the “Junctional Areas” edition. Varanasi, India: Chaukhamba Sanskrit
between two Mandalas. The Sandhi are 6 in number. Sansthan, 1-17
Acharya sushruta has described the patala are most 8. Khurana AK. (Aug 31. 2015). Anatomy and
important structure of netra sharir. The first patala is development of the eye. In: Khurana AK. &
the seat of tejas and jala and it can be taken as cornea Khurana B. (Eds.), Comprehensive Ophthalmology
and aqueous humour; the second patala is the seat of with Supplementary Book Review of
mamsa and it can be taken as iris and ciliary body. The Ophthalmology. 5th edition. New Delhi, India: New
third patala is the seat of medo and it can be taken as Age International (P) Limited, Publishers, 1-11
vitreous humour, it is a jelly like structure which 9. Sushrut. Sharir Sthana, Sukrasonitasuddhi
resembles medas. The fourth patala is the seat of asthi Shariradhyaya. In: Shastri A.D. (Eds.), Ayurved
and it can be taken as lens and retina, as it is the seat for Tatvasandipika on Susruta Samhita: Revised
linganasha. edition. Varanasi, India: Chaukhamba Sanskrit
Sansthan; 11-36.
These are the parts where doshas get localized 10. Madhukar, L., & Nivrutti, B. (2018). An
and produce various types of netra rogas. When doshas Imperative Review Study on Concept of
invade gradually deeper in the patala it causes timira, Ophthalmology in Ayurveda in the Purview of
Kacha and Linganasa. Netra also consists of Akshi Rachana Sharir (Human Anatomy). World Journal
bandhana, sira, pesi, dhamani, marma, snayu and other of Pharmaceutical Research, 7(08), 140–151.
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snayu completes the netra sharira. on Sushrut Samhita. Revised edition. Varanasi,
India: Chaukhamba Sanskrit Sansthan; 139-148
To conclude, we can say that Patala were 12. Dalhan. (2009). Sharir Sthana, Dhamanivyakarana
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severity of the diseases when they involve deeper Sangraha on Sushrut Samhita. Revised edition.
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