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CLINICAL EVALUATION OF EFFICACY OF MAHATRIPHALADYA GHRITAIN MANAGEMENT OF DRY EYE SYNDROME (SHUSHKAKSHIPAKA)
1 MS(Ayu), Assistant Proffesor, Dept of Shalakya Tantra, Sri Jagadguru Gavisiddeshwara Ayuveda college
2 MS(Ayu), Assistant Proffesor, Dept of Shalakya Tantra,
INTRODUCTION Shushkakshipaka1 is one among
“Sarvagata Netra Rogas”2 mentioned by Sushruta as well as Vagbhata under Vyadhis, caused by Vata and Pitta Doshashaving symptoms of Gharsha, Toda, Bheda, Upadeha, Krichronmeelan, Vishushkata, Rooksha Daruna Vartma3 etc.,
Among many eye diseases, which have been identified by the ancient classics of Ayurveda as well as modern medicine,
Research Article International Ayurvedic Medical Journal ISSN:2320 5091
Background & Objectives:and Netra roga vigyana is its sub division. Sarvagatha Netra rogas characterized by shana (Blurred vision), Toda (Pricking type of pain), (Congestion). All these symptoms can be correlated to the symptoms of Dry Eye Syndrome.jective of the present study was to evaluate an observatioTarpana in the management of Dry Eye Syndrome (fulfilling the inclusion criteria Dry Eye Syndrome were randomly selected and subjected to the trail. Source of patients: Patients tantra, S.D.M. Ayurvedic College, Hassan. Clinical signs and symptoms were given with suitble scores according to their severity and results having P value less than < 0.001 were considered as statistically significant in this study.Results: Complete remission (100% relief) was seen in 12%, Marked Improvement in 32%Moderate Improvement in 34%, MildConclusion: Mahatriphaladya GrithaShushkakshipaka with maximum of 92% and minimum of 36 %.Key words: Ayurveda, Shalakya, shipaka, Dry Eye Syndrome
CLINICAL EVALUATION OF EFFICACY OF MAHATRIPHALADYA GHRITAIN MANAGEMENT OF DRY EYE SYNDROME (SHUSHKAKSHIPAKA)
Ashwini B N1, Siva Balaji K2
Assistant Proffesor, Dept of Shalakya Tantra, Sri Jagadguru Gavisiddeshwara Ayuveda college Koppal, Karnataka, India
Assistant Proffesor, Dept of Shalakya Tantra, Amrita school of Ayurveda, Kollam, Kerala, India
is one among mentioned by under Sadhya Pitta Doshas
Gharsha, Toda, Bheda, Upadeha, Krichronmeelan, Vishushkata,
Among many eye diseases, which have been identified by the ancient classics of Ayurveda as well as modern medicine,
the Shushkakshipaka, which has been consdered as on par with ‘Dry eyes’ in modern medicine, is a major one.
Dry eye conditions4
of disorders with ranging from mild eye strain to Foreign Body Sensation, Pain, Burning, with sight threatening comtions. Patients can have considerable dicomfort with this affliction, which can intefere with normal routine functioning.
Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACTBackground & Objectives: Shalakya Tantra is one of the branches of Astanga Ayurveda
is its sub division. Shushkakshipaka (Dry Eye Syndrome)characterized by Gharsha (Irritation), Kunita (Photophob
(Pricking type of pain), Daha (Burning sensation) and (Congestion). All these symptoms can be correlated to the symptoms of Dry Eye Syndrome.jective of the present study was to evaluate an observational study of Mahatriphaladya Gritha
in the management of Dry Eye Syndrome (Shushkakshipaka). Methodsfulfilling the inclusion criteria Dry Eye Syndrome were randomly selected and subjected to the
Patients were selected randomly from O.P.D and I.P.D of Shalakya tantra, S.D.M. Ayurvedic College, Hassan. Clinical signs and symptoms were given with suitble scores according to their severity and assessment was based on relief after treatment. The
P value less than < 0.001 were considered as statistically significant in this study.Complete remission (100% relief) was seen in 12%, Marked Improvement in 32%
%, Mild Improvement was seen in 18% patients. InterpretaMahatriphaladya Gritha showed significant result in relieving all the symptoms of
with maximum of 92% and minimum of 36 %.Shalakya, Mahatriphaladya Ghrita,Tarpana,Shamana Sneha, Shushka
CLINICAL EVALUATION OF EFFICACY OF MAHATRIPHALADYA GHRITAIN MANAGEMENT OF DRY EYE SYNDROME (SHUSHKAKSHIPAKA)
Assistant Proffesor, Dept of Shalakya Tantra, Sri Jagadguru Gavisiddeshwara Ayur-
Amrita school of Ayurveda,
, which has been consi-dered as on par with ‘Dry eyes’ in modern
4 are a spectrum of disorders with ranging from mild eye strain to Foreign Body Sensation, Pain, Burning, with sight threatening complica-tions. Patients can have considerable dis-comfort with this affliction, which can inter-fere with normal routine functioning.
Article International Ayurvedic Medical Journal ISSN:2320 5091
Astanga Ayurveda(Dry Eye Syndrome) is one of the
(Photophobia), Avila Dar-(Burning sensation) and Raktharaji
(Congestion). All these symptoms can be correlated to the symptoms of Dry Eye Syndrome. Ob-Mahatriphaladya Gritha
Methods: 50 patients fulfilling the inclusion criteria Dry Eye Syndrome were randomly selected and subjected to the
were selected randomly from O.P.D and I.P.D of Shalakya tantra, S.D.M. Ayurvedic College, Hassan. Clinical signs and symptoms were given with suita-
was based on relief after treatment. The P value less than < 0.001 were considered as statistically significant in this study.
Complete remission (100% relief) was seen in 12%, Marked Improvement in 32%, Interpretation &
showed significant result in relieving all the symptoms of
Ghrita,Tarpana,Shamana Sneha, Shushkak-
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye Syndrome (Shushkakshipaka)
330 www.iamj.in IAMJ: Volume 3; Issue 2; February- 2015
Tarpana5 is one among the all im-portant Kriyakalpas which gives nourish-ment to the eyes and cures the Vata Pittadisease6. It is very much essential in the management of Shushkakshipaka. Mahatri-phaladya Ghrita7 is the important formula-tions which is indicated in Netrarogas be-cause of its Chakshushya and Rasayanaproperties. In the present study, it is used for Tarpana and as Shamana Snehana8. AIM OF THE STUDY To evaluate the effect of Mahatripha-ladya Gritha Tarpana and Mahatriphaladya Gritha as Shamana Snehana in Shushkakshipaka.Source of data: Patients were selected from outpatient department and in patient department of Shalakya Tantra, SDM col-lege of Ayurveda and Hospital, Hassan. 1. Preparatory Phase Day 1 and 2 (Dipana): Hingvashtaka Chur-na9 3-5 gm before meal twice a day with lukewarm water Day 3 and 4 (Snehapana): Go Gritha10 30ml early morning in empty stomach Day 5(Virechana): Gandarvahastadi taila11
30 ml early morning in empty stomach2. Treatment phase: Mahatriphaladya Tar-pana and as Shamana Sneha.Shamana Sneha:Dose : 15 ml twice daily Anupana : Luke warm water Method of preparation of Maha Tripha-ladya Ghrita: Mahatriphaladya Ghrita is prepared as per the classical preparation of Ghrita. Inclusion criteria: Patients of either sex aged between 35-
70 years
Patient presenting with the symptoms su-gesstive of Dry Eye Syndrome like irrita-tion, foreign body sensation(sandy), feeling of dryness, itching, ocular discomfort, etc.
Tear film break up time less than 10 secs
Schirmer’s 1 test positive <10 mm.
Rose Bengal staining showing devitalized epithelium of conjunctiva and mucus pla-ques on the cornea
Exclusion criteria: Severe cases of Dry Eye Syndrome with
complications like perforated Corneal ulc-er, Uveitis, Glaucoma.
Inflammatory conditions like Acute Con-junctivitis
Systemic diseases causing Dry Eye Syn-drome
Follow up: The follow up was done for 16 weeks for once every two weeks.
ASSESSMENT OF RESULTS:Effect of the therapies was compared
before and after the treatment on the basis of Visual Analogue Scale for the subjective parameters and objective parameters.Subjective Parameters Feeling of dryness
Burning sensation
Foreign body sensation
Pricking pain
Rough lids/ mucoid discharge/blepheritis
Stuck lids
Blurred vision
Inflammation / redness
Narrowing palpebral apertureObjective Parameters 01. Schirmer’s Test 112. 02. Tear filmBreak up Time13
OBSERVATIONS
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye
331 www.iamj.in
RESULTS
020406080
10098 100
Percent
Severity of the overall Symptoms of Dry Eye
020406080
100
14th Day
34
Percent
Improvement in Feeling of Dryness
020406080
100
14th Day
37
Percent
Improvement in Burning sensation
020406080
100
14th Day
38
Percent
Improvement in Foreign Body sensation
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye Syndrome (Shushkakshipaka)
IAMJ: Volume 3; Issue 2; February- 2015
100 96 88
3721 35
10 2
Severity of the overall Symptoms of Dry Eye
28th Day 42nd Day 56th Day 70th Day 84th Day
55 68 72 80 84
Improvement in Feeling of Dryness
28th Day 42nd Day 56th Day 70th Day 84th Day
5367
10085 92
Improvement in Burning sensation
28th Day 42nd Day 56th Day 70th Day 84th Day
63 6376 83 81
Improvement in Foreign Body sensation
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye
Severity of the overall Symptoms of Dry Eye
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye
332 www.iamj.in
020406080
100
14th Day
41
Percent
Improvement in Pricking Pain
020406080
100
14th Day
68Percent
Improvement in Rough lids/ Mucoid Discharge
020406080
100
14th Day
37
Percent
0
50
100
14th Day
63Percent
Improvement in Blurred Vision
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye Syndrome (Shushkakshipaka)
IAMJ: Volume 3; Issue 2; February- 2015
28th Day 42nd Day 56th Day 70th Day 84th Day
49 6074 81 80
Improvement in Pricking Pain
28th Day 42th Day 56th Day 70th Day 84th Day
9276
92 97 100
Improvement in Rough lids/ Mucoid Discharge
28th Day 42nd Day 56th Day 70th Day 84th Day
8963
84100 100
Improvement in Stuck Lids
28th Day 42nd Day 56th Day 70th Day 84th Day
84100 100 97.36 100
Improvement in Blurred Vision
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye
84th Day
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye
333 www.iamj.in
0
50
100
14th Day
40
Percent
Improvement inInflammation
0
50
100
14th Day
100Percent
Relief in Narrowing of Palpebral Aperture
020406080
100
14th Day
14
Percent
Improvement in Tear Film Break Up Time
020406080
100
14th Day
19
Percent
Improvement in Schirmer's Test
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye Syndrome (Shushkakshipaka)
IAMJ: Volume 3; Issue 2; February- 2015
14th Day 28th Day 42nd Day 56th Day 70th day 84th day
80100 100
80100
Improvement inInflammation
28th Day 42nd Day 56th Day 70th Day 84th Day
100 100 100 100 100
Relief in Narrowing of Palpebral Aperture
28th Day 42th Day 56th Day 70th Day 84th Day
17 22 30 32 36
Improvement in Tear Film Break Up Time- LE
28th Day 42th Day 56th Day 70th Day 84th Day
4128 35 38 41
Improvement in Schirmer's Test-LE
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye
84th day
Relief in Narrowing of Palpebral Aperture
84th Day
LE
84th Day
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye
334 www.iamj.in
DISCUSSION Mahariphaladya Gritha
best immunomodulator, it confers anti flammatory activity and in dry eye sydrome thereby prevents T – cells from rleasing cytokines (primarily interleukin that incite the inflammatory component of dry eye.
Contemporary tear substilate the cell surface glyocoproteins that maintain ocular hydration and mucoadhesive property due to lipid content in it. The degree of contact time with the ocular surface of tear substitutes generally ranges from 1.5mL pas (Pascal seconds, a of measurement for viscosity) to 15 mL pas, with an average of 5.0 mL pas which are available in markets. Compared to these artificial tear products, as Triphala Gritha is rich in lipid content which reflects mucoadhesive properties and therefore the degree of contact time with the ocular surface is greater. Hence, the effect of Tarpana is better as it has got contact time more than 20 minutes. Tarpana stimulates the reconstruction of the tear film and the ShothaharaMahatriphaladya Grita reduces the inflamatory changes due to Shushkakshipaka
CONCLUSION
0255075
100
complete remission
12
Percent
Overall Effect of Mahatriphaladya Gritha on
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye Syndrome (Shushkakshipaka)
IAMJ: Volume 3; Issue 2; February- 2015
as being the best immunomodulator, it confers anti – in-flammatory activity and in dry eye syn-
cells from re-leasing cytokines (primarily interleukin - 6) that incite the inflammatory component of
Contemporary tear substitutes stimu-late the cell surface glyocoproteins that maintain ocular hydration and mucoadhesive property due to lipid content in it. The degree of contact time with the ocular surface of tear substitutes generally ranges from 1.5mL pas (Pascal seconds, a standard of measurement for viscosity) to 15 mL pas, with an average of 5.0 mL pas which are
Compared to these artificial tear products, as is rich in lipid content
which reflects mucoadhesive properties and the degree of contact time with the
ocular surface is greater. Hence, the effect of is better as it has got contact time
uction of the property of
reduces the inflam-Shushkakshipaka.
Thus, Mahatriphaladya Gritatrols the inflammation, reconstructs the tear film, thereby producing optimal hydration in the eye offering a promise of long lasting relief to patients with moderate to severe dry eye symptoms.
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complete remission
marked moderate mild unchanged
12 32 34 18 4
Overall Effect of Mahatriphaladya Gritha on Dry Eye Syndrome
Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye
Mahatriphaladya Grita con-
trols the inflammation, reconstructs the tear film, thereby producing optimal hydration in the eye offering a promise of long lasting
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Ashwini B N Ms Siva & Balaji K Ms : Clinical Evaluation Of Efficacy Of Mahatriphaladya Ghritain Management Of Dry Eye Syndrome (Shushkakshipaka)
335 www.iamj.in IAMJ: Volume 3; Issue 2; February- 2015
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CORRESPONDING AUTHORDr. Ashwini B N MS(Ayu),Assistant Professor, Dept of Shalakya Tan-tra, Koppal, Karnataka, IndiaEmail: [email protected]
Source of support: NilConflict of interest: None Declared