clinical evaluation of efficacy of mahatriphaladya … · clinical evaluation of efficacy of...

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


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


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


IAMJ: Volume 3; Issue 2; February- 2015

100 96 88

3721 35

10 2


28th Day 42nd Day 56th Day 70th Day 84th Day

55 68 72 80 84

Improvement in Feeling of Dryness


5367

10085 92

Improvement in Burning sensation


63 6376 83 81

Improvement in Foreign Body sensation




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




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


8963

84100 100

Improvement in Stuck Lids


84100 100 97.36 100

Improvement in Blurred Vision


84th Day


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



14th Day 28th Day 42nd Day 56th Day 70th day 84th day

80100 100

80100

Improvement inInflammation


100 100 100 100 100



17 22 30 32 36

Improvement in Tear Film Break Up Time- LE


4128 35 38 41

Improvement in Schirmer's Test-LE


84th day


84th Day

LE

84th Day


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



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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hita of Susrutha with English translation and commemtary.2002 reprinted. Varnasi: Chaukhambaorientalia:2002.p. 137

2. Srikanthamurthy KR(ed). Susrutha Sahita of Susrutha with English translation and commemtary.2002 reprinted. Varnasi: Chaukhambaorientalia:2002.p. 137

3. Srikanthamurthy KR(ed). Susrutha Sahita of Susrutha with English translation and commemtary.2002 reprinted. Varnasi: Chaukhambaorientalia:2002.

4. Khurana AK, Choudhary R, Ahluwalia BK, Gupta S. Hospital epidemiology of dry eye.

Indian J Ophthalmol 1991;39:555. Sushruta Samhita, Uttara Tantra of M

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6. Srikanthamurthy KR(ed). Susrutha Sahita of Susrutha with English translation

complete remission

marked moderate mild unchanged

12 32 34 18 4

Overall Effect of Mahatriphaladya Gritha on Dry Eye Syndrome


Mahatriphaladya Grita con-

trols the inflammation, reconstructs the tear film, thereby producing optimal hydration in the eye offering a promise of long lasting

patients with moderate to severe dry

Srikanthamurthy KR(ed). Susrutha Sam-hita of Susrutha with English translation and commemtary.2002 reprinted. Vara-

ntalia:2002.p. 137Srikanthamurthy KR(ed). Susrutha Sam-

of Susrutha with English translation and commemtary.2002 reprinted. Vara-nasi: Chaukhambaorientalia:2002.p. 137Srikanthamurthy KR(ed). Susrutha Sam-hita of Susrutha with English translation and commemtary.2002 reprinted. Vara-

ntalia:2002.p. 137Khurana AK, Choudhary R, Ahluwalia BK, Gupta S. Hospital epidemiology of

Indian J Ophthalmol 1991;39:55-8Sushruta Samhita, Uttara Tantra of Ma-harshi Sushruta, Edited with Ayurvedic Tatwa Sandipika. By Kavira-ja Ambikadutta Shahtri Part II . Vara-

ntalia:2004.p.149Srikanthamurthy KR(ed). Susrutha Sam-hita of Susrutha with English translation

Overall Effect of Mahatriphaladya Gritha on


335 www.iamj.in IAMJ: Volume 3; Issue 2; February- 2015

and commemtary.2002 reprinted. Vara-nasi: Chaukhambaorientalia:2002.p. 149

7. The Ayurvedic Formulary of In-dia.departement of indian system of medicine & homoeopathy part I.Delhi : The controller of publication civil lines :p.75



10. Sharma R K, Dash B (ed). Charaka Samhita of Agnivesa with Ayurveda Di-pika of Cakrapanidatta.2007 reprinted. Varanasi: Chaukhambaorienta-lia:2007.p.160

11. Dry eye and Ocular surface disorders editor Suresh k Pandey, pub by jaypee brothers medical publishers(P) Ltd.

12. Dry eye and Ocular surface disorders editor Suresh k Pandey, pub by jaypee brothers medical publishers(P) Ltd.

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

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