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TO STUDY THE EFFICACY OF ANJAN OF RAJANIDARU
SIDDHA GHRITA IN ‘SHUSHKAKSHIPAAK’ WITH
SPECIAL REFERENCE TO ‘DRY EYE’
THE DISSERTATION TO BE SUBMITTED TO
BHARATI VIDYAPEETH DEEMED UNIVERSITY
FOR THE DEGREE OF
AYURVED DHANWANTARI (M.S.) INSHALAKYA TANTRA
YEAR 2009
BYVd. HEMANG CHHOTALAL SHAH
B.A.M.S.
GUIDE
DR. R.G. DOLEREADER, M.S. (SHALAKYA TANTRA)SHALAKYA TANTRA DEPARTMENT
BHARATI VIDYAPEETH DEEMED UNIVERSITYCOLLEGE OF AYURVED
PUNE – 411046
INSTITUTE
BHARATI VIDYAPEETH DEEMED UNIVERSITY
COLLEGE OF AYURVED
KATRAJ
PUNE – 411046
DEPT. OF POST GRADUATE STUDIES IN SHALAKYA TANTRA,
BHARATI VIDYAPEETH UNIVERSITY,
COLLEGE OF AYURVED,
KATRAJ-DHANKAWDI,
PUNE – 43.
CERTIFICATEThis is to certify that Vd. HEMANG CHHOTALAL SHAH is P. G.
student in the dept. of Shalakya Tantra of this institute, has written the
dissertation on the subject " T o S t u d y T h e E f f i c a c y O f
A n j a n O f R a j a n i d a r u S i d d h a G h r i t a I n
‘ S h u s h k a k s h i p a a k ’ W i t h S p e c i a l R e f e r e n c e T o
‘ D r y E y e ’ . " under my general supervision and guidance.
The candidate has presented his topic in pre M. S. seminar on
date 26/11/2008, suggestions given by the subject experts in the
seminar and the remarks given by the experts in assessment of the
synopsis are all incorporated in this dissertation.
The candidate has put up hard work after making an intensive
study of the subject with theoretical studies, clinical and practical
observations as well as originally of thought expressions.
I recommended the same for being submitted to the adjudicator.
Place – PuneDate - /01/2009.
Guide
Dr. R. G. DOLE.M. S. (Shalakya Tantra)READER, Shalakya Tantra,Bharati Vidyapeeth, AyurvedRugnalaya,Katraj-Dhankawdi, Pune – 43.
DEPT. OF POST GRADUATE STUDIES IN SHALAKYA TANTRA,
BHARATI VIDYAPEETH UNIVERSITY,
COLLEGE OF AYURVED,
KATRAJ-DHANKAWDI,
PUNE – 43.
CERTIFICATEThis is to certify that Vd. HEMANG CHHOTALAL SHAH is P. G.
student in the dept. of Shalakya Tantra of this institute has written the
dissertation on the subject "T o S t u d y T h e E f f i c a c y O f
A n j a n O f R a j a n i d a r u S i d d h a G h r i t a I n
‘ S h u s h k a k s h i p a a k ’ W i t h S p e c i a l R e f e r e n c e T o
‘ D r y E y e ’ . " Under the guidance of Dr. R. G. DOLE.
I recommended the same for being submitted to Bharati
Vidyapeeth University, Pune.
Guide
Dr. R. G. Dole.M. S. (Shalakya Tantra)Reader, Shalakya Tantra Vibhag,Bharati Vidyapeeth, Ayurved Rugnalaya,Katraj-Dhankawdi, Pune – 43.
H.O.D.
Dr. D. B. KadamM. S. (Shalakya Tantra)Reader, Shalakya Tantra Vibhag,Bharati Vidyapeeth, Ayurved Rugnalaya,Katraj-Dhankawdi, Pune – 43.
Principal
Dr, A. V. JoshiM.D.,Ph.D.College Of AyurvedBharati Vidyapeeth,Katraj-Dhankawdi, Pune – 43.
ACKNOWLEDGEMENTAt this juncture of submission of my dissertation, I feel the
blessings and sense of reverence, in my mind and heart towards
Bhagwan Dhanwantari.
I am highly indebted to Hon. Dr. Patangrao Kadam Founder and
Chancellor of Bharati Vidyapeeth University, Dr. Shivajirao Kadam,
Vice chancellor B.V.U. Pune for giving me the opportunity to fulfill my
ambition.
I express sincere gratitude to our Principal Dr. A.V. Joshi and Vice
Principal Dr. Bhalsing and Dr. Vedpathak who urge me to complete my
thesis satisfactory.
I am extremely thankful to my Honorable guide, DR. R.G. DOLE
for his valuable guidance, constant motivation and kind support.
I am extremely thankful to staff of Shalakya Tantra Dept., H.O.D.
Dr D. B. Kadam, Dr Mulik, Dr Diwan sir, Dr Shiralkar of Bharati
Ayurveda College, Pune, for their constant encouragement and timely
help.
I am very much thankful to Dr. D L Shinde Sir, for giving
blessings, moral support, confidence to tackle situations and valuable
suggestions, which helped in the enrichment of research work.
I am also thankful to our library staff for their valuable help.
I am very much thankful to Mr. Abhay Joshi for his valuable help
regarding statistical analysis of data. I would like to thank all the
departmental staff that rendered their help in every possible way.
I feel great pleasure to thank to all my friends, well-wishers and
relatives whose direct or indirect support was with me at every moment
till the completion of this work.
I am very grateful to all my colleagues and juniors Dr. Abhijit,
Dr.Vikram, Dr. Raju, Dr. Hemang, Dr. Baviskar, Dr. Nilesh, Dr. Yuvraj,
Dr Mahesh, Dr Mayuresh, Dr Lalit, Dr Manoj, Dr Gajanan, Dr Barghe,
Dr Vaishali, Dr for their continuous help and support.
I have no adequate words to express my feeling towards my
family members and my friends for their immense love, confidence and
blessings, which helped me a lot.
At last, I would like to endow with my special thanks to Vd.
Hemakant Baviskar Sir, whose work and teaching of Ayurved fascinated
me and continuously stimulated me to explore this field for mankind.
Dr. Hemang Chhotalal Shah.
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
CONTENTS
CONTENTS
INTRODUCTION ______________________________________________ 1
AIMS AND OBJECTIVE__________________________________________ 4
REVIEW OF LITERATURE________________________________________ 5
Applied anatomy and physiology of eye: _____________________________________ 5
Eye lids ________________________________________________________________ 5
Conjunctiva_____________________________________________________________ 6
Cornea_________________________________________________________________ 7
Lacrimal Apparatus ______________________________________________________ 7
Tear film _______________________________________________________________ 8
Layers of Precorneal Tear Film _____________________________________________ 9
Dynamics of tear film formation ___________________________________________ 10
DISEASE REVIEW_____________________________________________11
Review of disease DRY EYE According to modern science _______________________ 11
Definition___________________________________________________________________ 11
Classification ________________________________________________________________ 11
Causes Of Dry Eye ____________________________________________________________ 14
Signs And Symptoms__________________________________________________________ 16
Diagnosis ___________________________________________________________________ 16
Treatment Of Dry Eye _________________________________________________________ 20
Review of disease SHUSHKAKSHIPAAK According to Ayurved ___________________ 23
Definition___________________________________________________________________ 23
Nidan (Causes)_______________________________________________________________ 24
POORVARUPA (Premonitory Symptoms) __________________________________________ 25
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
ROOP (Signs And Symptoms) ___________________________________________________ 26
SAMPRAPTI (Pathology Of Disease) ______________________________________________ 27
SADHYASADHYATWA (Prognosis)________________________________________________ 27
CHIKITSA (Treatment) _________________________________________________________ 27
DRUG REVIEW ______________________________________________ 29
Review of drug HPMC [Hydroxy Propyl Methyl Cellulose] According to modern science
_____________________________________________________________________ 29
Review of drug according to ayurveda ______________________________________ 32
KRIYA KALPAS: _________________________________________________________ 32
ANJANA KARMA________________________________________________________ 33
Definition___________________________________________________________________ 33
Classification ________________________________________________________________ 33
Anjana Shalaka ______________________________________________________________ 36
Anjan kaal __________________________________________________________________ 37
ANJANA VIDHI _______________________________________________________________ 38
Anjan yogya (indication) _______________________________________________________ 38
ANJAN NISHEDHA(Contraindication of Anjana) _____________________________________ 39
Haridra _______________________________________________________________ 40
Daru haridra ___________________________________________________________ 49
Saindhava _____________________________________________________________ 53
Ghee (Cow Ghee) _______________________________________________________ 55
Go Dugdha (Cow Milk) ___________________________________________________ 58
Trial Drug action and samprapti ___________________________________________ 60
Previous work done _____________________________________________________ 63
MATERIALS AND METHODS____________________________________ 64
MATERIALS _________________________________________________ 64PREPARATION OF DRUG _______________________________________________________ 66
CONTROL DRUG _____________________________________________________________ 66
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
Prepared drug _______________________________________________________________ 67
METHODOLOGY _____________________________________________68Selection Of The Patients – _____________________________________________________ 68
Inclusion Criteria: ____________________________________________________________ 68
Exclusion Criteria: ____________________________________________________________ 68
Type Of Study: _______________________________________________________________ 69
Source Of Data: ______________________________________________________________ 69
Details of Study Subjects and Controls:___________________________________________ 69
Drugs Used: _________________________________________________________________ 69
Plan of Study __________________________________________________________ 70
Slit lamp examination: ___________________________________________________ 70
Schirmer’s Test 1 _______________________________________________________ 71
Tear film Break Up Time ( T.F.B.U.T.) _______________________________________ 74
OBSERVATION AND STATISTICAL ANALYSIS _______________________ 77
Statistical analysis _____________________________________________________ 103
DISCUSSION _______________________________________________ 104
CONCLUSION ______________________________________________ 106
BIBLIOGRAPHY _____________________________________________107
CASE REPORT FORM_________________________________________109
CONSENT FORM ____________________________________________112
TRIAL DRUG MASTER CHART __________________________________113
CONTROL DRUG MASTER CHART_______________________________113
AUTHENTICATION LETTER ____________________________________113
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
INTR
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INTRODUCTION
In modern days due to advancement of technologies many
important improvement in area of ophthalmology came in existence.
This enables easy and detailed diagnosis of eye diseases in very less time.
Many effective medicines and surgeries have also evolved, due to
continue exchange of information with an aim to progress.
In present work I have dealt with the most common problem of the eye
- Dry Eye Syndrome. It is usually caused by a problem with the
quality/quantity of the tear film that lubricates the eyes.
If the condition is left untreated it can damage eye tissues and can
cause scar formation on the cornea leading to visual impairment.
According to modern science Dry eye is an umbrella term used to
describe a heterogenous group of diseases resulting from inadequate
wetting of the cornea and conjunctiva by the pre-corneal tear film.
Millions of people worldwide suffer from dry eye. The vast majority of
patients have symptoms that are mild to moderate in severity. Although
these patients suffer with discomfort of dry eye, frequently they fail to
receive adequate attention and treatment.
For years, there has been a lack of consensus on the classification of dry
eye and the appropriate tests to diagnose it, & to treat the disease with
ayurvedic drugs. To address this issue, I have chosen to perform clinical
trials in dry eye with ayurvedic drug. The classification study group
identified two major practical types of cause-based dry eye – Tear
Deficient Dry Eye and Evaporative Dry Eye. Based on this classification
a diagnostic algorithm was developed that helps to identify the
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
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disorders that cause dry eye and the underlying pathophysiology. In
clinical practice, menopause, aging and RA-associated Sjogren’s
syndrome are the commonest causes of dry eye. As in today’s era we see
dryness of eyes due to exposure to wind, smoke, heat, allergens. various
other factors like food habits, daily regimen, seasonal regimen, if not
followed properly can cause devaststing effects in eyes and cause dry
eye.
Due to over exposure to smoke and wind, while travelling on bike,
motor, bus can cause dryness of eyes.
Also people who are working with over exposure to heat, hot climates,
are also getting affected with dryness of eyes.
Lifestyle changes have known to be causing dry eye as people are
unable to follow proper nutritious and seasonal diet. The dry and cold
foods if taken in large quantity or for long period continuously can
cause the disease. E.g. drinking cold water in cold season in the
morning. Food without oily substance, like ghee and oil can also bring
dryness.
It has been many times noted that people who don’t follow the daily
regimen and seasonal regimen can also get affected from dry eye.
Bathing with cold water in cold season, with wetting the head and hair.
Then avoid hair oil in scalp, avoiding nasya and karnapuran with oil.
These factors can bring more dryness in body which can bring early
symptoms of dryness as stated in various ayurvedic texts.
Stress and environment changes can bring many ailments. Stress for
long time can cause sunkened eyeballs, dark circles around eyes and
also dryness of ocular surface.
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
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Today millions of people are using computers everyday at offices and at
home. Daily computer users are suffering from the symptoms like visual
stress, burning of eyes, blurred vision, redness, dryness of eyes. This
discomfort may cause confusion, reduce productivity, lost of work time
and reduces the job satisfaction.
Common treatment for dry eye syndrome includes the frequent use of
artificial tears or punctal occlusion. But there is no satisfactory
treatment for Dry eyes at present.
In Ayurvedic samhitas different types of advices and procedures
are suggested, also eye care medicaments are prescribed to preserve the
vision and power of eyes and to cure the eye diseases known as
‘Chakshyushya’.
So I have selected this topic in order to study the effect of ‘rajani-daru
siddha ghrita’ as anjana in shushkaakshipaak with special reference to
dry eye. As haridra, daruharidra, saindhava lavana, go dugdha (cow
milk), ghee these all dravya are stated as pathyakar and chakshushya.
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
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AIMS AND OBJECTIVE
To study the dry eye syndrome according to modern medical
science in detail.
To study the shushkakshipaaka mentioned in Ayurveda having
correlation with dry eye syndrome in detail
To study the Rajani Daru Siddha Ghrita in detail.
To study the efficacy of Rajani Daru Siddha Ghrita
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REVIEW OF LITERATURE
Applied anatomy and physiology of eye:
Introduction
In this study, only those structures which are important from the view
point of study of Dry Eye are discussed.
Viz, Eyelids, Conjunctiva, Cornea and Lacrimal apparatus.
Eye lids
First line protection of eye balls are eye lids. The eyelids are two
movable folds of tissue, which cover the eyeball in front. The free age of
each lid carries eyelashes. The eye lid consists of a thin covering of skin,
three muscles, the orbicularis occuli, L.P-S and muller’s muscle and
three glands meibomian glands, glands of Zeis, glands of moll.
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Conjunctiva
This is thin membrane like mucus membrane, which lines the posterior
surface of the eyelids and anterior aspect of the eyeball. To protect the
in 1st line of defence.
It has following three parts:
Palpebral conjunctiva
Bulbar conjunctiva and
Conjunctival fornix.
Again Histologically, conjunctiva consists of three layers:
Epithelium
Adenoid layer and
Fibrous layer.
Further Conjunctiva contains two types of glands.
1) Mucin secretary glands.
Types: - Goblet cells in epithelium
The Crypts of Henle are present in tarsal conjunctiva and
Glands of Manz are present in limbal conjunctiva
Functions: - These glands secrete mucus which is essential for
wetting the cornea and conjunctiva. Thus eyelids move over smoothly.
2) Accessory lacrimal glands –
Glands of Krause – are present in subconjunctival connective
tissue of fornix. They are 42 in upper and 8 in lower fornix.
Glands of wolfring – are present in the tarsus.
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Cornea
The cornea is a transparent, avascular, watch – glass like structure.
Histologically, the cornea consists of five distinct layers. From anterior
to posterior these are as Epithelium, Bowman’s membrane, substantia
propria (stroma), Descemets membrane and endothelium.
Lacrimal Apparatus
i) Main lacrimal gland -
It is main tear secreting gland in the eye. It is situated at the upper outer
angle of the orbit in the fossa. It consists an upper orbital and lower
palpebral part separated by apponeurosis of LPS muscle. Each Lacrimal
gland has 12 ducts which open into the superior temporal fornix.
ii) Accessory lacrimal glands
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iii) Lacrimal passage – which includes puncta, canaliculi, lacrimal sac
and Nasolacrimal duct (NLD). All lacrimal glands are serous acinus
similar in structure to the salivary glands.
Secretion of tears
Tears to protect anterior ocular surface, are continuously secreted
throughout the day by accessory (basal secretion) & main (reflux
secretion) lacrimal glands. Reflex secretion (due to irritation) is in
response to sensations from the cornea & conjunctiva, probably
produced by evaporation & break up of tear film.
Elimination of tears
Tears flow downwards & medially across the surface of eyeball to
reach the lower fornix then towards the inner canthus, from where are
drained by lacrimal passages into the nasal cavity.
Tear film
The optical integrity and normal function of the eye depends on
an adequate supply of a thin, fluid film – the pre-ocular tear film.
This serves –
1. An antibacterial function by lysozyme and beta-lysin.
2. An optical function by maintaining an optically uniform corneal
surface.
3. A corneal nutritional function – affecting O2 & CO2 transport
4. A mechanical function by flushing cellular debris and foreign
matter from the cornea and conjunctival sac and by lubricating the
surface.
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Layers of Precorneal Tear Film
Tear Film Composition
Meibomian Glands → LIPID LAYER
Waxy & Cholestrol Esters
Lacrimal Glands → AQUEOUS LAYER
Water
Electrolytes Na, K, Cl, Ca Electrolytes
Lysozymes Lactoferin Lysozyme, lactoferin, lipocain, EGF, AlbuminProteins and enzymes
IGA IgG, IgA Immunoglobulins
Proteins
Metabolites – glucose, lactate, urea
Conjunctival Goblets Cells → MUCIN LAYER
Glycoproteins
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Dynamics of tear film formation
Here we discuss about tear film. Which is a dynamic structure and its
formation is a complex event, Where in normal lid function and
anatomy are absolutely necessary. With each blink, mucin is distributed
over the precorneal surface and also aqueous tears and lipid are
allowed to spread, creating a three layered tear film. As the tear film is
decreased by evaporation between blinks, the oily superficial layer
becomes admixed with the mucinous film recreating the hydrophobic
state of the corneal epithelium and favouring the breakup of the tear
film and forms the so called dry spots. Thus each blink aids in
maintaining normal wetting of the cornea by spreading the mucin
layer. The time period between the blink and the first dry spot in
normal eyes, the tear film break up time (T.F.B.U.T.), is usually greater
than the time interval between two consecutive blinks and no corneal
drying occurs. Accelerated or excessive lipid contamination may cause
the premature rupture of the tear film and results in dry eye state.
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
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DISEASE REVIEW
Review of disease DRY EYE According to modern science
Definition
Dry eye is defined as a disorder of the tear film due to tear deficiency or
excessive evaporation, which causes damage to the ocular surface & is
associated with symptoms of ocular discomfort.
It is the condition that occurs as a result of inadequate & ineffective
wetting & lubrication of the eyes.
Occurrence
Dry eyes is a common condition with a prevalence of 11% -17% in the
general population & rates of up to 29% in clinical optometry practices.
The majority of patients – 65% - 89% have mild dry eye,
12% - 33% have moderate dry eye,
0% - 2% have severe dry eye.
Classification
Classification based on clinical severity
Ascertaining the clinical severity of dry eye based on symptoms
experienced by the patients is another simple and practical way to
classify the condition. Categorizing the patients’ response to the
question “How often do you experience the symptoms?” will help to
decide the level of dryness. the four possible answers are :
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
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Classification:
Never - Non (No Dry Eye)
Sometimes/periodically - Mild Dry Eye
Frequently - Moderate Dry Eye
Always - Severe Dry Eye
Classification based on clinical symptoms
Symptoms may appear only under certain overexposure conditions
such as contact lens usage, exposure to windy weather; an open car
window or air conditioning.
A classification based on clinical symptoms and signs of dry eye takes
into account the complaints of the patient and examination findings of
the pathoalmologist. in this manner, dry eye can be classified as:
Symptoms when overexposed - Mild Dry Eye
Symptoms + reversible signs
(e.g. epithelial erosions) - Moderate Dry Eye
Symptoms + permanent signs
(e.g. cornel ulcers) - Sever Dry Eye
Symptoms + permanent signs
subnormal vision - Disabling Dry Eye
Classification according to damaged glands and tissue
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
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From a clinical point of view, and in order to establish a treatment, the
etiologic classification must be completed with the evaluation of the
participation of the different parts that from the lacrimal basin, i.e., the
anatomic space between the ocular surfaces, posterior surface of the
lids, and lid rim, where the mixture of the lacrimal sea is poured.
These components of the tear may be simplified as produced by three
basic types of dacryoglands-aqueo-serous, lipid, and mucinic-with an
important component of the epithelium, mainly the corneal one. The
affected parts of the lacrimal basin may be summarized in this
histopathologic classification expressed with the acronym ALMEN, in
which the A indicates the aqueo-serous deficiency; L, the lipid
deficiency; M, the mucin deficiency; E, the epithelial deficiency; and N,
the nondacryologic exocrinic deficiencies.
The aqueo-serous deficiency is basically produced by the damage
of the main and accessory lacrimal glands. The aqueo-serous
production may be measured by the Schirmer test, tear clearance,
volumetry of the lacrimal menisci (cisterna and rivi lacrimales),
lactoferrin, and other tests of controversial value but increasing
efficacy. Some of these tests such as BUT (breakup time) or
osmolarimetry do not establish the aqueo-deficiency but only a tear film
deficiency in which other deficiencies, such as lipd or mucinic, can
participate or be the primary cause.
The lipo-deficiency is mainly due to the abnormality of the
meibomian lipid glands, and to a lesser extent of the Zeis’ glands, the
pilosebaceous glands of the eyelashes, and the fatty component of the
Moll’s glands, which participate in the anterior antievaporative lipid
phase of the lacrimal film.
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
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The mucin deficiency is produced mainly by the damage of the
goblet cells of the conjunctiva, and the epithelial glycocalix, and also by
lacrimal gland participation. The most aprtical determination is not
only by impression cytology of the ocular surface, BUT, and vital
staining of the ocular surface epithelium.
The corneo-conjunctival epitheliopathy is sometimes primary,
but is more frequently secondary to the other glandular deficiencies.
Primary epitheliopathies with respect to dry eye are those is which a
corneal problem not relate with the tear production alters the
epithelium and causes problems in the formation of the tear film.
Examples are Meesmann epithelial dystrophy, amiodarone
thesaurismosis, stromal mucopolysaccharide deposits, Fuchs endo-
epitheliopathy, and corneal endothelium decompensation. Secondary
epitheliopathies produced by dry eye are those in which an aquo-
serous, lipid, or mucinic deficiency due to any dysfunction of the
dacryoglands damages the normal corneal epithelium, increasing the
problem of the eye dryness.
The affected dacryogland may be initially of one, two, or of all
types, it depends on the type of etiology. In any case, all dacryoglands
and the lacrimal basin are usually finally implicated in a vicious circle
that with different intensities affects all of them. For instance, an age-
related dry eye produces directly and with a certain synchrony a
general affection of all dacryoglands. But the extirpation or radiation of
the main lacrimal gland initially only affects the aqueo-serous
secretion, and little by little secondarily affects all other ocular surface
dacryoglands and the epithelium of the ocular surface.
Causes Of Dry Eye
Aqueous tear deficiency
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It is also known as Keratoconjunctivitis Sicca. It is seen in Sjogren
syndrome, paralytic hyposecretion, surgical removal of lacrimal gland
& as a part of natural aging process. It may be drug induced like
antihistamines.
Mucin deficiency
It occurs when goblet cells are damaged as in hypovitaminosis – A.
(Xerophthalmia), and conjunctival scaring diseases such as trachoma,
chemical burns & ocular pemphigoid.
Lipid deficiency & abnormalities
Lipid deficiency is extremely rare & is seen in congenital absence of
meibomian glands. Lipid abnormalities are common in various types of
blepharitis including meibomianitis.
Impaired eyelid function
It is seen in patients with lagophthalmos, symblepharon, & ectropion.
Epitheliopathies
Due to intimate relationship between the corneal surface & tear film,
alterations in corneal epithelium affect the stability of tear film.
Other causes
Constant staring at a particular object such as T.V., Computer etc.
Environment – dry, dusty, windy climate.
Medication – antihistamines, birth control pills.
Infection – systemic diseases such as lupus, rheumatoid arthritis or
Sjograen syndrome.
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Long-term use of contact lenses
Hormonal changes
Signs And Symptoms
symptoms
Itching
Burning sensation.
Blurred vision.
Dryness of eyes.
Redness of eyes.
Signs
Presence of excessive debris & mucus strands in the tear film.
Reduced or absence of marginal tear strip.
Lusterless ocular surface - xerosis.
Corneal changes as superficial punctate keratitis.
Diagnosis
Diagnosis of dry eye
We need to consider three important parameters that are :
Detailed history taking
Clinical examination
Clinical tests
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
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Many questionnaires have been devised by various authors of facilitate
relevant history taking in the patients. Schien et al. (1997) prepared a
7-point questionnaire that asks:
Feeling dry?
Any redness?
Any burning sensation?
Any gritty-sandy sensation?
Much crusting on eye lashes?
Eye get stuck in the morning
Constant ‘awareness’ about the eyes?
Additionally, one needs to take history regarding: dry mouth,
menopause, allergy/atopy, diurnal variation, oral and topical
medication, presence of dry systemic autoimmune disease, and
occupation and working environment. Following this, ocular evaluation
is carried out on a slit lamp to see:
If there is a reduced tear lake or low tear meniscus height; normal value
is 0.3 mm (seen with fluorescein)
IF the quality of the tear film is uniform with the ocular surface
If the lid margins have any abnormal meibomian gland openings
If there are any conjunctival changes such as:
Lustreless appearance
Desquamation and Bitot’s spot
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Keratinization
Tear film Breakup Time (TBUT)
TBUT (tear film breakup time)
A TBUT of less than 10 seconds in considered abnormal (this test is
considered invasive because of use of fluorescein dye.
Schirmer’s test
Most commonly done test is Schirmer’s test, which could be of three
types:
Schirmer’s I: tests basic and reflex secretion of tears and is most
commonly performed in OPD situations.
Jone’s Basic secretion test: tests for the basic secretion of tears after
using topical anesthesia.
Schirmer’s II: tests reflex secretion of tears after anesthetizing the ocular
surface and nasal mucosal stimulation.
Clinical application : In schirmer’s I test, a tear strip wetting more than
10 mm is considered to be normal. Less than 5 mm wetting is a
definitely dry eye, whereas values between 5 and 10 mm are considered
borderline dry eye.
Patients with symptoms suggestive of dry eye commonly will have
normal Schirmer’s test and vice-versa, patients with low values on this
test will have no complaints of dry eye. Experts believe that, since, there
is a large variation in the results, this test should be interpreted with
caution and used for clinical correlation to reach a diagnosis.
Occular surface staining
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Staining is a very useful tool to assess ocular surface. Dyes used in this
procedure are: fluorescein (2%), rose Bengal (1%) and lissamine green.
A normal ocular surface does not take up any of these dyes. Different
grading systems have been devised to quantify the ocular surface
staining.
Flourescein staining: Cornea is divided into 3 parts. Staining score is
given from 0 to 3, resulting in a cumulative score of 0 to 9; 0=no
staining and 9=total staining. In initial stages of dry eye the inter-
palpebral area is typically affected, whereas in superior limbic
keratoconjunctivitis, upper one third of the cornea is stained.
Experts’ Consensus On Treatment Of Dry Eye
Patients’ symptoms and slit lamp examination findings continue
to be main assessment parameters that guide us to treat dry eye.
Use of three tests, TBUT, Schirmer’s test, and ocular staining,
esttablish diagnosis and aid us devise a more specific and
accurate treatment plan.
Selection of tear substitute formulations should be based on the
severity and chronicity of the disease.
Gel formulation is a product of choice in patients with severe dry
eye because they provide an increased contact time and their
thixotropic properties are more comfortable to the patient. For
patients with mild-to-moderate dry eye, drop formulations are
more suitable.
Carbomers provide high viscosity when the eye is static but
shears thin during blinking. This is known as THIXOTROPIC
effect.
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Treatment Of Dry Eye
At present there is no permanent cure for the dry eye, but there
are some options available to relieve symptoms.
Preservations of existing tears.
i) Reduction of room temperature
ii) Humidifiers – e.g. swimmer’s goggles.
iii) Tarsorrhaphy – to prevent exposure keratitis.
iv) Punctal occlusion – Temporary: by solid gelatin rods, silicone
plugs, or heat-cautery.
Permanent: This is done by electro-cautery in severe cases of KCS.
Nutritional issues
Recent research shows that proper nutrition, including vitamins,
minerals and essential fatty acids, also may play a role in the
management of dry eye. Vitamins A, C, E and B6 are found in many oral
supplements to relieve dry eye symptoms and promote good eye health.
Specifically, vitamin A deficiency has been linked to loss of the mucin
layer of the tear film, resulting in dry eye and, in severe cases, corneal
damage. The primary sources of vitamin A are carotenoids, most
notably beta-carotene, with others including lutein, zeaxanthin and
lycopene. Although the majority of research with lutein and zeaxanthin
have been in the prevention of cataracts and macular degeneration,
they may be found in combination products to provide overall proper
eye care.15 Such minerals as magnesium, selenium, chromium and
zinc also may play a role in eye health and can be found in various
multivitamin products. Supplements may benefit those patients with an
inadequate dietary intake of essential vitamins and minerals.
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Tear substitutes:
Drops
Hypromellose 0.3%
Polyvinyl alcohol 1.4%
Sodium hyaluronate
Sodium chloride
Povidone
Gels
Viscotears or Gel tears are preferable to drops because they are instilled
less frequently.
Ointments
Petroleum mineral oil is used at bedtime.
Mucolytic Agent:
Acetyl cystine 5% eye drop 4 times help by dispersing the mucus
threads & decreasing tear viscosity.
Bandage soft contact lenses:
High hydrated bandage contact lenses occupy unique place in the
treatment of dry eye.
Treatment of associated problems:
It includes treatment of blepharitis, conjunctivitis, corneal ulcer,
symblepharon, etc.
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Review of disease SHUSHKAKSHIPAAK According to
Ayurved
As per Ayurvedic aspect Dry eye syndrome can be correlated with
‘Shushkakshipaak’ to some extent.
Definition
Signs and symptoms of disease according to ayurved:
Rukshta, sankosh in netra and vartma, aavil darshan, darun
pratibodhan, gharsha, toda, bheda, shula, upadeha, vikunan,
vishushkatvam, shiteccha etc.
Due to vitiation of vata and pitta dosha dosha in body or locally, they
reach to eye in its different parts via siras (by anusaran) and produce
disease. This shows above signs and symptoms.
Shushkakshipak is one of the Sarvagat Sadhya Vyadhi.
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Nidan (Causes)
The etiology of Shushkakshipak is not explicit in the classics. However,
Scholar of Ayurveda has explicit in the classics the common etiological
factors for all the netra rogas.
Ahara:
Vidahi annapana - Is the predominant cause. Vidahi means that which
produces fermentation
Asatmyahara - Foods that are inhabituated to body.
Viruddahara - Foods that have opposite gunas ,which are excessive
sheeta –kshara –amla –tikshna guru guna, excess in water will create
angnimandhya and indigestion and that causes vidahata.
Excessive intake of alcoholic preparation like shukta, aranala and
dhanyala.
Excessive intake of amala dravyas, kulatha (horsegram), masha
(blackgram)
Vihara:
Sudden plunging into cold water after exposing oneself to sun.
Looking at distant object for a prolonged period.
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Constant looking at minute object
Improper sleeping habits like sleeping during daytime, awakening in
the night, dropping of the head during sleep, or resting the head on big
pillows.
Suppression of physiological urges like vomiting, micturation, weeping
and flatus.
Atiyoga of sweda
Excessive physical exertion
Exposure to smoka, dust
Excessive smoking
Unpleasant environmental situations
Injuries to head and eyes
Manasika:
Excessive weeping, grief, worry, fatigue
Excessive stress and strain, emotions etc.
POORVARUPA (Premonitory Symptoms)
Symptoms of kapha vitiation such as itching, heaviness, hardness
etc.
Symptoms of pitta vitiation such as burning sensation, redness, pain;
Symptoms of vata vitiation such as pain, difficulty in lid moment are the
common premonitory symptoms of netra rogas.
The signs and symptoms are not manifested completely or
distinctly. Sometime patients may feel pain like the presence of sand,
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dust or paddy grains in eyes. The slight diminishion or impairment of
vision is the common prodromal symptoms of eye diseases.
ROOP (Signs And Symptoms)
When sthan samsraya of prakupita dosha takes place, then only
cardinal signs and symproms of the existing disease occurs.
Shushkakshipak presents with the following signs & symptoms.
Dirty eye with discharge.
Dryness of eyes.
Lid – Dry &Rough touch.
Burning Sensation.
Pricking Pain.
Foreign body Sensation.
Difficulty in opening & closing the lids.
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SAMPRAPTI (Pathology Of Disease)
Due to nidan sevan the vitiated doshas in the body (predominat vata &
pitta) move towards the head through the sira & get localized in all
parts of Akshi causing Shushkakshipak.
SADHYASADHYATWA (Prognosis)
Shushkakshipak is sadhya vyadhi.
CHIKITSA (Treatment)
Chikitsa:
SauYkxaiXapaakx icaikxtsaa
rjanaIdar]isaQdM vaa saOnQavaona samaayautama\ |
saipa-yau-taM stanyaGaRYTmaÉjanaM vaa mahaOYaQama\ ||
sauEa`uta saMihtaa {ttartan~a 9 ||23||
Explanation of treatment:
Contents of drug, Rajani – Haridra, Daru – Daruharidra, (Stanya –
woman’s milk) godugdha – instead of stanya cow milk will be taken,
Cow Ghee, Saindhav salt. The formation of drug is modified.
Take haridra, daru haridra churna and add very little salt. This is added
to ghrita and water and proper paak done. Till only ghrita remains. This
ghrita is to be stored. While its use as anjan it should be rubbed with
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women’s milk. Then to be applied into eyes in anjan form. The method
explained above will be modified in this study.
Name of the drug:
yadaOYaQaM tau paqamaM yasya yaaogasya kxqyatao |
SaaÈga-Qar saMihtaa pauva- KaMD paqamaaQyaaya | 36 |
Sharangdhara says, name of the drug (yog) is decided on basis of the
drug first explained/ named in shloka. So we have selected the name
Rajani-daru siddha ghrita, in case of drug name decision.
In ayurvedic classical texts of shalakyatantra we can see two types of
treatment i.e. Bahya or local & Abhyantar chikitsa.
a) Local Treatment:
Tarpan – Jeevaniya Ghrita.
Anjan – Snehanjan etc.
b) Systemic:
Shodhan & Shaman.
Snehan – Panchatikta or Jeevaniya Ghrita.
Swedan – Steam bath.
Raktamokshan – Jallauka., Siravedha
Bastikarma
Nasya – Anutail.
Ghritapan – Jeevaniya Ghrita.
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DRUG REVIEW
Review of drug HPMC [Hydroxy Propyl Methyl Cellulose]
According to modern scienceIntroduction
Lack of tears in patients with dry eye is compensated with the use of
artificial tears or rewetters.
The use of artificial tears has obvious limitation. Although, artificial
tears cannot completely substitute complex composition of natural
tears, continuous research promises to provide formulations that are
increasingly getting close to this goal.
Retention time, safety and wear-quality of these agents are important
clinical considerations. Essentially, artificial tears are available as drops,
gel or ointment.
These formulations can have conventional preservatives (chlorbutanol,
benzalkonium), transient preservatives (oxycholoro compounds,
sodium perborate) or no preservatives.
Polymers
From the use of salt solutions, oils, glycerin, Locke’s solution with
gelatin, the first major breakthrough was achieved with the
development of a semisynthetic cellulose ester, methylcellulose, by
Swan. Even today, semisynthetic cellulose ester, methylcellulose, by
Swan. Even today, semisynthetic cellulose remains a major constituent
of many tear substitutes. Of the available semisynthetic polymers,
carboxymethylcellulose and hydroxypropyl-methylcellulose are the
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most popular agents, these derivatives have found acceptability because
of their relative lack of toxicity, viscosity-enhancing quality and
beneficial effects on the tear film.
Synthetic polyvinyl polymers
Synthetic polymers are water soluble macromolecules with
predominantly mucomimetic properties. These molecules increase the
retention time by retaining the tears which have been secreated over a
long time. The surfactant activity of these polymers allows an even and
uniform spread over the whole of corneal surface. As a result these
polymers are absorbed better onto the epithelial surface, making it
hydrophilic. All these properties help to stabilise the tear film and
prolong the efficacy. Synthetic polymers also mimic the activity of
mucin layer.
Carbomers
Carbomers encompass a group of synthetic polymers that are further
classified based on the length of their molecular chain. Carbomer 980
polymer made by cross linking of polyacrylic acid has been a successful
introduction. It has properties of a typical gel that are non-greasy,
transparent and semisolid. These properties stabilize the tear film,
provide longer retention time (7 times longer than conventional tear
substitutes), and ensure fewer daily applications.
Formulation of tear substitutes
Formulation aspects of tear substitutes should be considered under:
pH : Viscosity : Tonicity : Electrolytes :
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HPMC
PROPERTIES OF HPMC
They work to coat the surface of the eyeball evenly with moisture,
provide protection from environmental irritants, increase the volume of
fluid in the eye and provide moisture to the cornea. Higher viscosity
and longer retention time may mean more benefit for those patients
with severe symptoms of dry eye and instillation of fewer eye drops per
day, though this may not be true in all cases.
Method to instill eye drops
1. Wash hands
2. Tilt head back
3. Pull lower eyelid down and away from eyeball to form a pocket
4. Place dropper over pocket, but avoid touching the tissues the eye
5. Release drop and close eye for 1-2 minutes
6. Gently apply pressure to the inner corner (tear duct) of the eye
7. Blot excess solution away eyes
8. close the bottle cap tightly and place in cool area.
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Review of drug according to ayurveda
KRIYA KALPAS:
Treatment of eye diseases consists of specific and important drug
administrative procedures called “kriya kalpa”. Different acharyas
explained different numbers of kriya kalpa.
1) As per Charaka 3 types of kriya kalpa,they are;
i. Bidalaka
ii. Aschyotana
iii. Anjana
2) Sushruta described five types of kriya kalpas they are as
follows.
i. Tarpana
ii. Aschothana
iii. Anjana
iv. Seka
v. Putapaka
3) According to Sharangadhara
i. Seka
ii. Tarpana
iii. Aschothana
iv. Putapaka
v. Pindi
vi. Anjana
vii. Bidalaka
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Classification of anjan shows the wide description not only in diseased
eye but also in the normal eyes to maintain the visual power properly.
The administrative process is very easy and it is practicing widely since
the origin of ayurveda. It can be administered even in unconscious
conditions also. Hence Among kriya kalpas anjan stands supreme.
Literally the word anjana means “medicine application to the internal
surface of the eye lid margin’’. Anjan karma is a process in which
specific medicines are pasted over the marginal conjunctiva in a
systematic way from kaneenika sandhi to apanga and apanga to
kaneenika sandhi. The description of anjana by Sushruta and Vagbhata
could be summed up as follows.
ANJANA KARMA
Definition
Application of medicine to the internal surface of lid margin from
Kaneenika sandhi to apanga sandhi, with anjan shalaka is known as
Anjan karma.
Classification
CLASSIFICATION OF ANJANA ACCORDING TO ACTION OF THE DRUG
1) Lekhana anjan: Used in Kapha predominent disorders, drug has to
prepare with all rasas except madhura rasa.
They should be selected according to the vitiated doshas i.e.
1) Vataja eye disease - Amla and lavana rasa dravyas
2) Pittaja disease - Thikta kashaya rasa dravyas and in
3) Kaphaja disease - Katu tikta kashaya rasa dravyas
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4) Raktaja diseases - Tikta kashaya rasa dravyas should be
selected.
Note: Anjan scrapes and expels the doshas from Netra, vartma, sira,
Netra Kosha and Ashru Vaha srotas, through the mouth, Nose and eye.
2) Ropana Anjan: The drug should be oily, with the predominance of
tiktha & kashaya rasa. It gives strength and complexion to the eyes.
3) Prasadan anjan: It is Prepared with madhura and sneha
predominance, medicines. it Is used for drusti prasadana (Improvement
of vision) and to remove the roughness of drusti (Drusti snehana)
Vriddha Vagbhata described one more type of anjana named as
snehana anjana, according to Sushrutha; this snehana type is included
in drishti prasadhana variety only.
CIassification of anjan according to akruti (nature of the drug)
1) gutika: is used In strengthy disorders (mahabala roga)
a. Lekhan gutika : 1 Harenu matra (dosage)
b. Ropana gutika : 1 to 1/2 harenu matra
c. prasadana gutika: 2 Harenu matra
2) RasKriya : is used in moderate type of diseases ( In madhyama
bala roga)
a. Lekhana Rasakriya 1 Harenu
b. Ropana Rasakriya 1 1/2 Harenu
c. Prasadana Rasakriya - 2 Hnrenu
3) Choorna : is used In Heenabala roga ( In minimal vitiation)
a. Lekhana choorna : 2 Shalaka
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b. Ropana choorna : 3 Shalaka
c. Prasadana choorna : 4 Shalaka
These forms are indicated in guru, madhyama and laghu doshas
respectively. Acharya Dalhana says that gutikanjana, rasakriyanjana
and choornanjana should be applied in severe, intermediate and mild
conditions of the diseases respectively.
Classification of Anjana according Karma to Potency of drug (Dravya
virya)
1) Mrudu anjan
a) Snehan
b) Ropana
C) Prasadana
2) Tikshna anjana
a) lekhana anjan
Classification of Anjana according to rasa (Drug taste)
1 ) Madhura anjana
2) AmIa anjana
3) Lavana Anjana
4) Katu anjana
5) Tiktha anjana
6) Kashaya anjana
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Anjana paatra (Vessel)
1) Swarna Paatra – madhura rasa
2) Roupya paatra – amla rasa
3) Mesha shrunga paatra – lavana rasa
4) Tamra or Loha paatra – kashaya rasa
5) Vydoorya paatra – katu rasa
6) Kamsya paatra – tiktha rasa
Anjana Shalaka
AMgaulaI Salaakxa
maRdutvaadMgaulaova paQaanama\ | Anta: sar]jao#iXNa saOva payaaojyaa | A. saM. {. 32 | 11
Shalaka should be prepared from following materials
1) for madura rasa anjana – shalaka of swarna
2) for Lekhana Karma – shalaka prepared with tamra
3) Ropana karma – shalaka prepared with loha
4) Prasadana karma – shalaka prepared with swarna
Although text describe of various types of shalaka, the anguli remains
first choice of shalaka. As it is easy to perform anjan procedure with
finger, then any other metal shalaka.
Anjan shalaka should be 10 Angulas length, the two ends. should be
blunt (should not sharp ) Like jasmine (flower ) , should be easy for
handling, and should not be rough, thin, hard, and breakable.
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Anjan kaal
AÉjana kxala
yaqaadaoYaM payaaojyaaina taaina raogaivaSaardO: | AÉjanaaina yaqaa@taaina paata:saayaMrai~aYau || sau. {. 18 | 57
In healthy persons collyrium should be applied daily morning
and evening on sunny days.
Lekhana type of collyrium should be applied at morning in Kaphadominant eye diseases.
Ropana type of collyrium should be applied in the evening in
Vaata dominant eye diseases.
Prasaadana type of collyrium should be applied at night in Pittadominant eye diseases.
prerequisites for application of anjan
I ) Body should be purified by siravyada, virechana, Nasya, vasti etc.
2) Aamaavasta should be eliminated.
3) The eye should be free from Aama and should exhibit normal
doshik symptoms, then only after Ashchyotan Anjana has to be done.
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ANJANA VIDHI
According to Sushrutha, before selecting the anjana karma we
have to consider, anjan yogya person [indication]
Anjan yogya (indication)
The vitiated doshas must be in niraamavastha, this can be assessed by
these symptoms.
a) Decreased pain
b) Mild oedema, lacrimation and redness,
c) Presence of itching sensation in the eyes.
PROCEDURE:
AÉjana kxma- ivaQaI
vaamaonaaiXa ivainaBau-jya hstaona sausamaaihta:| Salaakxyaa diXaNaona iXapaota\ kxanaInamaÉjanama\ ||
AapaaÈ\gyaM vaa yaqaayaaogaM kuxyaa-ccaaipa gataagatama \ | vatmaa-valaoipa vaa yattadAMgaulyaOva pa`yaaojayaota\ ||
AiXa naatyantayaaorÉjyaaWaQamaanaao#ipa vaa iBaYak\x| na caainavaa-ntadaoYao#iXNa QaavanaM saMpa`yaaojayaota\ ||
daoYa: paitainavaRtta: sana\ hnyaad\ dRYToba-laM taqaa | gatadaoYamapaotaaEau paSyaoVta\ samyagamBasaa ||
sau. {. 18 | 64 tao 68
These are the steps as per text:
1) Mangalacharana – prayer to god for successful and fruitful anjan
karma.
3) Then patient is asked to sit without fear and tension.
4) Doctor with his left hand, has to open the eyes of the patient, and
with his right hand he has to handle anjana shalaka and has to do
Anjana from Apanga sandhi to Kaneenika sandhi and vise a versa.
5) Anjan should not be more or less, hard or soft, tikshna or mrudu,
quick or delayed, if so can cause injury to eyes. i.e. uniformity should be
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maintained.
6) After anjana vidhi, by closing the eyes, eye ball should be rotated
gently, eyelids should be moved gently, by doing this the medicine
spreads easily on ocular surface area.
7) The doshas dissolves and comes out in the state of lacrimation.
8) The eyes should be cleaned, when discharge stops.
9) If required according to the condition prathyanjana has to be done.
Steps described to patient for anjan karma:
The patient is asked to sit without fear and tension,
With his left hand he is asked to open eye and apply the anjan
with right hand finger over lid margin from kaneenika sandhi to
apanga sandhi and vice versa.
After anjan vidhi he should close eyes, rotate gently and move eye
lids to spread the medicine in the eyes.
The doshas dissolve and comes out through lacrimation. The eye
discharge should be cleaned.
ANJAN NISHEDHA(Contraindication of Anjana)
Anjan vidhi is not advisable for the conditions or diseases like Jwara,
vomiting, Jagara, etc.
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Haridra
hirda kxaMÉcanaI paItaa inaSaa##Kyaa: varvaiNa-naI |kRximaGnaI hladI yaaoiYaitpa`yaa hT\TivalaaisanaI |hirda kxTukxa ita@taa r]XaaoYNaa kxfxipattanauta\ |vaNyaa- tvagdaoYamaohas~aSaaoqapaaNDuva`Naapaha ||
synonyms
Ranjani - Denotes dyeing- used for dyeing clothes, threads, body
etc.
Varna-datri - One, who gives colour, indicates its use as
enhancer of body complexion.
Dhirgha- rag - Lasting colour,
Hemaragi, Hemaragini Kanchini, Swarna-varna - Denote golden
colour, indicate if used by ladies their complexion become
golden.
Varangi - Varna means bridegroom, angi means put on – that
which is applied on bridegroom‘s
body before he leaves for the bridal house for the marriage, a
tradition that still persists.
Anestha - Denotes not offered in sacrifice or for homa
Bhadra - Denotes auspicious or lucky. In earlier days turmeric
was used as an amulet and regarded to ward off evil spirits.
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Mangal-prada,
mangala - Lucky, giving luck
Pavitra - Holy, it is regarded as a holy article
Subhagya - That which possesses good luck
Yoshit-priya, Yuvati - Favourite of young women, because it was
used for enhancing beauty and body complexion.
Hridayavilasini - Giving delight to heart, charming, possibly
because in ancient India this was beauty aid to women folk and
application of turmeric gives out an aroma that is delighting.
Jwaranthika - Curing fever
Krimighni - Killing worms, Anti-microbial activity.
Mehaghni - Indicates the anti- Diabetic activity
Vishaghni - Curing poison or destroying poison
Kaveri - Possibly it was cultivated mainly on the banks of the
river Cauvery in Tamil Nadu.
Detail properties of haridra
Latin Name
Curcuma longa,
family
Zingiberaceae
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Effect on the Doshas (Three bio humors)
Vata: ↓Kapha: ↓
Bio energetics
Rasa(Taste)- Tikta(Bitter); Katu(Pungent)
Guna(Characteristics)- Ruksha(Rough); Laghu(Light); Tikshna(sharp)
Veerya(Potency)- Ushna (Warm)
Vipaka(Post digestion effect)- Katu(Bitter)
Actions according to Ayurveda
Kushthaghna- Useful in all types of skin diseases
Lekhaniya- That scrapes out the unnecessary fat and other toxins out of
the body
Kandughna- Alleviates itching
Vishghna- Alleviate toxic conditions
Shirovirechana- Useful in purification procedure for the body parts
above clavicle level
Varnya/ Deha varna vidhayini- Enhances complexion
Meha hara- Useful in urinary disorders including diabetes
Krimighna- Kills all types of Krimies(Infectiuous agents)
Shoshahara- Useful in emaciation, under nutrition and other similar
conditions
Pandu paha- Useful in anaemic conditions
Vranapaha- Good healer for wounds
Vishodhani- Purifies all the systems of the body
Peenasa nashini- Useful in cold, coryza and rhinitis
Aruchi nashini- Alleviates anorexia
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Useful Part
Rhizome
Doses
Powder- 2-4 gms
Juice of fresh Haridra Rhizome- 10-20 ml
Some special notes about Haridra
Eye Disorder:
Curcumin may prove to be as effective as corticosteroids in the
uveitis (inflammation of the uvea, the middle layer of the eye
between the sclera - white outer coat of the eye and the retina -
the back of the eye) the type of eye disorder.
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Burning sensation in the eyes
Boil water and add turmeric and cool it, wash your eyes in that
water.
According to Astanga Samgraha (One of the best books on
Ayurveda)Haridra is the best medication for Prameha(Urinary
disorders including Diabetes).
Understanding all these facts very imporatant it is a common
practice in India to use Haridra to prepare vegetables. It indicates
towards the life of a common Indian enriched with the treasure
of knowledge.
Anemia
Turmeric is a rich and ample source of iron. Have a teaspoon of
raw turmeric juice with a bit of honey, if suffering from anemia.
Cuts and burns
It should be
immediately applied
on cuts, bleeding or
burns. It is an
antiseptic and stops
bleeding and heals
the cut or burn.
For skin diseases and
itching Mix a spoon
of turmeric with
butter or coconut oil and massage on our skin.
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According to recent studies by modern science:
A decoction of the rhizome relieves the pain of purulent
ophthalmia. Oil of turmeric, distilled from the dried rhizomes,
has mild antiseptic properties. It has fluoride which is thought to
be essential for teeth.
National Institutes of Health has four clinical trials underway to
study curcumin treatment for pancreatic cancer, multiple
myeloma, Alzheimer's, and colorectal cancer.
A 2004 UCLA-Veterans Affairs study involving genetically altered
mice suggests that curcumin, the active ingredient in turmeric,
might inhibit the accumulation of destructive beta amyloids in
the brains of Alzheimer's disease patients and also break up
existing plaques.
A recent study involving mice has shown that turmeric slows the
spread of breast cancer into lungs and other body parts. Turmeric
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also enhances the effect of taxol in reducing metastasis of breast
cancer. It is an antacid and, in small doses, acts as a carminative,
appetizer and tonic. In large doses.
Curcumin protects against cataract formation in lenses
Age-related cataractogenesis is a significant health problem
worldwide. Oxidative stress has been suggested to be a common
underlying mechanism of cataractogenesis, and augmentation of
the antioxidant defenses of the ocular lens has been shown to
prevent or delay cataractogenesis. The results of these studies
showed that 4-HNE led to opacification of cultured lenses as
indicated by the measurements of transmitted light intensity
using digital image analysis. However, the lenses from curcumin-
treated rats were resistant to 4-HNE-induced opacification.
Curcumin treatment significantly induced the GST isozyme
rGST8-8 in rat lens epithelium. Because rGST8-8 utilizes 4-HNE
as a preferred substrate, we suggest that the protective effect of
curcumin may be mediated through the induction of this GST
isozyme. These studies suggest that curcumin may be an effective
protective agent against cataractogenesis induced by LPO.
In another study results suggest that curcumin is effective against
galactose-induced cataract only at very low amounts (0.002%) in
the diet. On the other hand, at and above a 0.01% level,
curcumin seems to not be beneficial under hyperglycemic
conditions, at least with the model of galactose-cataract.
Suryanarayana and coworkers (2005) reported that turmeric and
curcumin are effective against the development of diabetic
cataract in rats. Although, both curcumin and turmeric did not
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prevent streptozotocin-induced hyperglycemia, as assessed by
blood glucose and insulin levels, slit lamp microscope
observations indicated that these supplements delayed the
progression and maturation of cataract. The present studies
suggest that curcumin and turmeric treatment appear to have
countered the hyperglycemia-induced oxidative stress, because
there was a reversal of changes with respect to LPO, reduced
glutathione, protein carbonyl content, and activities of
antioxidant enzymes in a significant manner. Also, treatment
with turmeric or curcumin appears to have minimized osmotic
stress, as assessed by polyol pathway enzymes. Most important,
aggregation and insolubilization of lens proteins due to
hyperglycemia was prevented by turmeric and curcumin.
Padmaja’s group investigated that Wistar rat pups treated with
curcumin before being administered with selenium showed no
opacities in the lens. TheLPO, xanthine oxidase enzyme levels in
the lenses of curcumin, and selenium-cotreated animals were
significantly less when compared to selenium-treated animals.
The superoxidase dismutase and catalase enzyme activities of
curcumin and selenium-cotreated animal lenses showed an
enhancement. Curcumin cotreatment seems to prevent oxidative
damage and found to delay the development of cataract (Padmaja
et al., 2004).
Clinical experience with curcumin on human beings:
Lal et al. (1999) administered curcumin orally to patients
suffering from chronic anterior uveitis (CAU) at a dose of 375 mg
three times a day for 12 weeks. The patients in both the groups
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started improving after two weeks of treatment. All the patients
who received curcumin alone improved, hereas the group
receiving antitubercular therapy along with curcumin had a
response rate of 86%. 3 of 14 patients (21%) in the second group
lost their vision in the follow-up period because of various
complications, e.g., vitritis, macular edema, central venous block,
cataract formation, and glaucomatous optic nerve damage, etc.
None of the patients reported any side effects. The efficacy of
curcumin and recurrences following treatment are comparable to
corticosteroid therapy, which is at present considered the only
available standard treatment for this disease. The lack of side
effects with curcumin is its greatest advantage compared with
corticosteroids. A double blind multicenter clinical trial of this
drug for CAU is highly desirable to further validate the results of
the study.
Some useful combinations of Haridra
Haridra khanda
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Daru haridra
davaI- dar]hirda ca paja -nyaa paja-naIita ca |kxTÈkxTorI paItaa ca BavaotsaOva pacampacaa ||saOva kxalaIyakx: pa`ao@tastaqaa kxalaoyakxao#ipa ca || 201 ||paItaduEca hirduEcapaItadar]’ ca paItakxma\ |davaI- inaSaagauNaa ikxntau nao~a kxaNaa -syaraoganauta\ ||
synonyms
Sanskrit Name:Daruharidra- As it is yellow in texture as the Haridra
Kantakateri- Because of the presence of Kantkas (Thorns) on it
Panchapacha- As "Rasanjana" is prepared from it after heating itDetail propeties of daru haridraLatin Name:
Berberis aristata
family :
Berberidaceae
Bio energetics:
Rasa (Taste)- Tikta (Bitter); Kashaya (Astringent)
Guna (Characteristics)- Laghu (Light); Ruksha (Rough)
Veerya (Potency)- Ushna (Warm)
Vipaka (After digestion effect)- Katu (Pungent)
Effect on doshas (Three bio humors):
Pitta : ↓Kapha : ↓
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Actions according to Ayurveda:
Arshoghna- Useful in management of all types of hemorrhoids
Kandughna- Valued highly in management of all conditions where
there is itching over the skin
Lekhaniya- Scrapes out the toxins including unnecessary fat from the
body
Vrananut- A good healer for all types of ulcers
Mehanut- Useful in management of all types of urinary disorders
including Diabetes mellitus
Karna- netra- mukhodbhuta rujam nashayet- Useful in all conditions
which cause pain in ears, eyes and/or mouth
Netryo paramam hitam- Tonic for eyes
Vish vikaranut- Useful in all toxic conditions
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Chhedana- Having cutting action so useful in conditions where cutting
of extra material is necessary like opacities in lens of eyes
Useful part:
Root; Stem; Fruits
Doses:
Powder- 3-6gm; Decoction- 5-10gm; Rasanjana- 1-3 gm
Some special notes about Daruharidra :
A very valuable preparation called Rasaut is prepared from this
plant. It is mixed with butter and alum, or with opium and lime-
juice and is applied externally to the eyelids to cure ophthalmic
diseases and other eye diseases. It is also reported to be a mild
laxative, a tonic and is useful in curing ulcers and fevers.
Caraka has categorized daruharidra as stanyasodhana – lactode
purant, lekhana – a reducing herb, arsoghna – anti –
haemorrhoidal, kandughna – anti – haemorrhoidal, kandughna –
anti – pruritic and as svedala – promotes sweating, rasayana-
rejuvenative. Susruta have mentioned it as ropana – a wound
healer
In Berberis aristata the most active ingredient is Berberine.
It supports a healthy liver as well as a healthy immune system.
Berberine has marked antibacterial effects. Since it is not
appreciably absorbed by the body, it is used orally in the
treatment of various enteric infections, especially bacterial
dysentery. It is almost equal to quinine and Warburg's tincture. It
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does not produce any bad effects on the stomach, the bowels, the
brain and the organs of hearing (Watt, 1889). The stem is said to
be diaphoretic and laxative and useful in rheumatism.
The dried extract of the roots is used as an application in eyes. It
is also an excellent medication in the case of sun-blindness.
An Iowa State University website indicates Berberine has been
suggested to boost the immune system, as an anti-oxidant, and
even to help ward off cancer. Other reported uses include
assistance with digestive tract problems, staph infections, in AIDS
therapy, lowering cholesterol and blood sugar levels, and in
battling Alzheimers disease.
Classical Ayurvedic Preparations
Darvyadi kavatha; Darvyadi leha; Darvyadi taila ;Rasanjana ; Darvyadi;
kwatha; Darvyadi Leha; Darvyadi Tail;
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Saindhava
saOnQavaao#s~aI SaItaiSavaM maiNamanqaÉca isanQaujama \ |saOnQavaM lavaNaM svaadu dIpanaM paacanaM laGau |isnagQaM r]cyaM ihmaM vaRYyaM saUcamaM nao~yaM i~adaoYa=ta\ ||241||
saindhava synonyms
Detail propeties of saindhava [rock salt]
Latin Name:
Sodii chloridium
Bio energetics:
Rasa (Taste)- lavan ( salt ); swadu ( sweet )
Guna (Characteristics)- Laghu (Light); snigdha( unctuous )
Veerya (Potency)- sheeta ( cold )
Vipaka (After digestion effect)- swadu ( sweet )
Effect on doshas (Three bio humors):
Vata: ↓ Pitta : ↓ Kapha : ↓
Actions according to Ayurveda:
Deepan – increases agni
Pachan – helps to digest the food material
Vrushya – increases vitality
Netrya – tonic for eyes or good for eyes
Tridosh shamak – pacifies all 3 doshas
Aruchi nashak- Alleviates anorexia
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Some special notes about saindhava :
Chemical analysis of rock salt before process
Water insoluble impurities 6.895±2.46%
Moisture 0.121±0.006%
Sulfur as sulfite (SO3) 1.302±0.003%
Calcium as calcium oxide (CaO) 1.655±0.039%
Magnesium as magnesium oxide (MgO) 0.053±0.002%
Chloride (Cl-) 54.402±0.340%
Sodium (Na+) 33.906±0.879%
Potassium (K+) 1.583±0.252%
Total 99.917%
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Ghee (Cow Ghee)
GaRtamaajyaM hiva: saipa-: kxqyantao tad\gauNaa Aqa |GaRtaM rsaayanaM svaadu catauByaM vainhdIpanama\ ||1||SaItavaIya- ivaYaalaXmaIpaapaipattaainalaapahma\ |AlpaaiBaYyaind kxansyaaojastaojaaolaavaNyavaRiQdkRxta\ ||svarsmaRitakxrM maoQyamaayauYyaM balakRxd\gaur] |{davata-jvaraonmaadSaUlaanaahvaNaana\ hrota\ |isnagQaM kxfxkxrM Xata:XayavaIsapa-r{>xnauta\ || 3 ||
gavyaM GaRtaM ivaSaoYaoNa catauYyaM vaRYyamaignakRxta\ |svaadupaakxkxrM SaItaM vaataipattakxfxapahma\ || 4 ||maoGaalaavaNyakxanyaaojastaojaaovaRiQdkxrM parma\ |AlaXmaIpaaparXaaoGnaM vayasa: sqaapakMx gaur] || 5 ||balyaM paiva~amaayauYyaM saumaÈgalyaM rsaayanama\ |sauganQaM raocanaM caar] savaa-jyaoYau gauNaaiQakxma \ || 6 ||
Ghee is said to be rasayana ( rejuvenator ), vanhi deepan ( increases
digestive fire ), sheeta virya ( cold potency ), destroys visha ( poison ),
alaxmi , papa ( bad sins ), diminishes pitta and vata, alpabhishyanda (
causes mild abhishyand ), brings more kanti , teja, lavanya, smriti
(memory), swara (makes voice powerful), medhya, ayushya (brings
life), balakara (increases strength), it is used in udavarta, jwara,
unmade, shoola, aanaha, vrana, it brings more snigdha ( unctuousness)
in body, and increases kapha, so used in kshata (wound), kshaya
(emaciation), visarpa.
Cow ghee specifically used to increase vrushyata (vigor and vitality),
agni (increases digestive fire), it is having madhur vipaka, sheeta ( cold)
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potency, pacifies vata, pitta and kapha. It brings more medha
(memory), lavanya, kanti, teja, oja. It destroys papa (bad sin), alakshmi,
causes raksha (secures life), vaya sthapak (maintains life or brings
down ageing process). It is guru, balya, pavitra, ayushya vardhak,
sumangalya, rasayan, sugandhi, rochan, charu. Its best amongst all
types of ghee.
synonyms
Sanskrit Name:
ajya –
Havi –
Sarpi -
Detail propeties of daru haridra
Bio energetics:
Rasa (Taste) - madura ( sweet )
Guna (Characteristics) - guru ( heavy ); snigdha ( unctuous )
Veerya (Potency) - sheeta ( cold )
Vipaka (After digestion effect) – madhur ( sweet)
Effect on doshas (Three bio humors):
Vata: ↓ Pitta : ↓Kapha : ↑
Actions according to Ayurveda:
Vanhi deepan
Rasayana
Vaya sthapak
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Ayushya vardhak
Destroys visha, alakshami, paapa,
Brings smriti, medha, bala, kanti, teja, oja,
Shoola and vrana nashak
Some special notes about Ghee:
The serum total cholesterol level showed a significant rise in the
experimental group at 4 wk; the rise persisted at 8 wk. A similar rise
was also seen in HDL cholesterol. Hence the total cholesterol/HDL
cholesterol ratio did not show any significant change. In the control
group, there was a trend towards a fall in LDL cholesterol but the
change was not significant. The study does not indicate any adverse
effect of ghee on lipoprotein profile.
Go Ghrita ( Ghee )
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Go Dugdha (Cow Milk)gaavyaM dugQaM ivaSaoYaoNa maQaurM rsapaakxyaao: |daoYaQaataumalas~aaota:ikxiÉcat@laodkxrM gaur] || 7 ||SaItalaM stanyakRxitsnagQaM vaataipattaas~anaaSanama\ |jarasamastaraogaaNaaM SaaintakRxta\ saoivanaaM sada ||
Go Dugdha
The cow milk especially has madhura rasa and vipak. It brings mild
kleda in to the dosha, dhatu, mala srotas areas. It is guru (heavy),
sheetal (cold potency), brings more stanya (milking in women), and is
snigdha (unctuous). It pacifies vata and pitta. It is highly indicated in
jara (ageing process), samast roga (almost every kind of disorder),
shantikar (brings peace), sevinam sadaa (can be consumed always any
time).
Detail propeties of go dugdha
Bio energetics:
Rasa (Taste) - madura ( sweet )
Guna (Characteristics) - guru ( heavy ); snigdha ( unctuous )
Veerya (Potency) - sheeta ( cold )
Vipaka (After digestion effect) – madhur ( sweet)
Effect on doshas (Three bio humors):
Vata: ↓ Pitta : ↓Kapha : ↑ (increases kleda)
Actions according to Ayurveda:
Kinchit kledakar – brings mild kleda at dosha, dhatu, mala srotas
Guru, snigdha, sheetal – heavy to digest, unctuous, cold potency
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Stanyakruta – bring milking in women
Jaranashak – slows ageing process and used in almost all kind of ageing
diseases
Sevinam sada – can be consumed by everybody at anytime.
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Trial Drug action and samprapti
Probable action of drug
Rajnidarusidha ghrita anjan is said to be the treatment of
Shushkakshipaak. On taking in to consideration the samprapti of the
Shushkakshipak, we have found that the hetu sevan triggers ruksha
guna of the vata dosha and bala of the netra decreases gradually.
Simultaneously the kapha and pitta vahini srotases gets obstructed.
Ruksha and laghu gunas of vata disturbs the flow of the kapha and pitta
leading to the lakshanas like daha etc. Due to vata aggravates rukshata
& netragata aavil darshan increases. Here the drugs like Rajni and daru
haridra which are ushna in veerya, katu in rasa and vipak. They have
vranapaha, shophhara and kandugna properties too. But as ushna is
anetrya, so to suppress this excessive ushna guna, dugdha which is
sheeta vata shamak pitta shamak anulomak snigdha is used. Saindhav
lavan aids to digest the milk due to is pachan guna. It opens the
channels (srotogami) that facilitates the absorption of the aushadh
along with netrya and trigoshdhana guna of other drugs.
The modern aspect of drug action: The necessary electrolytes for
tears are provided by saindhav lavan. The mucin, immunoglobulin,
proteins, glucose in various forms and peculiar enzymes etc. are derived
from ghrita (cow ghee) and dugdha (cow milk). The haridra and daru
haridra contains curcumin and berberin respectively which aid to
control inflammation of ocular tissue. And over all ghrita, dugdha and
saindhava which are vrushya, rasayan, act on ocular tissue to
regenerate good quality of tissue. There by it can be understood clearly
that all ingradients have vital role in healing dry eye syndrome.
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SAMPRAPTI CHARTHetu sevan
Increased rukshata (aggrevation of vata)
Obstruction of pitta and kapha dosha
Aggrevation of pitta and kapha dosha
Haridra = Vata: ↓,Kapha:↓; and daru haridra = Pitta :↓,Kapha :↓; ushna virya; katu rasa and vipak; Laghu (Light); Ruksha (Rough)(Lekhaniya, Shoshahara, Vranapaha, Kandughna, Shirovirechana, Vishodhani Kandughna,Lekhaniya, Vrananut, Karna- netra- mukhodbhuta rujam nashayet, Netryo paramam hitam,Chhedana)
Ghrita = Vata:↓,Pitta :↓,Kapha :↑ & Dugdha = Vata:↓,Pitta : ↓, Kapha :↑(increases kleda); shita virya, madhura rasa and vipakRasayana, Vaya sthapak, Ayushya vardhak, Destroys visha, Brings bala, kanti, teja, oja;Shoola and vrana nashak, Kinchit kledakar, Guru, snigdha, sheetal
Saindhav = Vata:↓Pitta:↓Kapha:↓; shita virya; lavan, madhur rasa and vipak; Laghu, snigdhaVrushya, Netrya, Tridosh shamak
(All Drugs Are Netrya, Pacify All 3 Doshas WhenTogether, Majority Vata And Pitta Shamak )
Drug prescribed: Rajanidaru siddha ghrita anjan once inevening daily with right hand finger for 28 days
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Previous work done
The work carried out at other institution or Universities related to this
project is as follows –
1) Role Of Kataka (Strychnus Potatorum) In Management Of
Dry Eye W.S.R. To Pothaki By A.K. Shrivastava In 2001 At
B.H.U.
2) A Clinical Study On The Effect Of Keshanjana And
Perisheka In Management Of Shushka-Akshi W.S.R. To Dry
Eye By Prabhakar Vardhan In 2005 At Paprola, Himachal
University.
3) The Efficacy Of ‘Triphala Yog’ In Dry Eye Syndrome Due
To Excessive Use Of Computer. By Dr. D B Kadam In 2007
At Bharati Vidyapetth University Pune.
4) To Study The Efficacy Of Rajanidarusidha Ksheerpak
Parisheka In The Management Of Shushkakshipak By Dr
Vikram Pokharkar In 2008 At Bharati Vidyapeeth
University Pune.
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MATERIALS AND METHODS
MATERIALS1. Collection – haridra, daru haridra, saindhava, dugdha, ghee
taken from reputed local Pune market.
2. Authentification & standardization – It is done at pune
vidyapeeth, Pune and Indian drug research laboratory pune.
3. Preparation – Rajani daru siddha ghrita was prepared by taking
all the ingredients. Ghee prepared according to ghritapaak vidhi.
Take haridra, daru haridra churna, add godugdha and add very little
salt. This is added to ghrita and proper paaka done. Till only ghrita
remains. This ghrita is to be stored and used for Anjan purpose.
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Materials:
Baagao #nau@tao tau saamyaM syaata\ |
SaaÈ-gaQar saMihtaa pauva- KaND paqama AaQyaaya | 50 |
Wherever matras of dravyas are not mentioned, take each of them in
same quantity.
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PREPARATION OF DRUG
GaRtapaatakx ivaiQa
kxlkxaccataugau-NaIkRxtya GaRtaM vaa taOlamaova vaa |
catauga-uNao dvaosaaQyaM tasya maa~aa palaaoinmataa ||
SaaÈ-gaQar saMihtaa maQyama KaMD |9||1à2||
Take haridra, daru haridra churna, add godugdha and add very little
salt. This is added to ghrita and proper paaka done. Till only ghrita
remains. This ghrita is to be stored and used for Anjan purpose.
CONTROL DRUG
Artificial tear drops containing hydroxyl propyl methyl cellulose
(hypromellose) 0.03% and preservative Benzylkonium chloride 0.01%
and aqueous base.
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Prepared drug
RAJANI-DARU SIDDHA GHRITA(Haridra, Daru haridra, Saindhav,
Godugdha siddha Ghrita)
ARTIFICIAL TEAR DROPS(Hydroxyl Propyl Methyl Cellulose
0.03%)
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METHODOLOGYEntire study is based on clinical findings and patients narrations.
Selection Of The Patients –
The patients suffering from Dry Eye syndrome were selected for the
project.
Inclusion Criteria:
The patients having signs and symptoms of dry eye like,
Dryness of eyes
Burning sensation
Blurring of vision
Itching
Redness
Irrespective of Age, Sex, Religion were selected for the project
Above 15 yrs and below 60 yrs of age
Exclusion Criteria:
Below 15 yrs and above 60 yrs of age
Congenital anomalies of eye
Abnormal structure and function of eyelid
Anjan ayogya
Severe cases of Dry eye
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Type Of Study:
Clinical prospective experimental comparative single blind study -
Entire study is based on clinical findings and patient’s narration.
Source Of Data:
Department of Shalakya OPD and IPD, Bharati Vidyapeeth Ayurved
Hospital, Katraj, Pune - 411046.
Details of Study Subjects and Controls:
Number of patients' selected - total 60 patients will be selected having
above signs and symptoms.
Group A – 30 patients – they will receive Rajani-daru siddha ghrita for
Anjan.
Dosage and time: evening time, once daily, for 28 days, with finger.
Group B – 30 patients – they will receive Artificial tear drops
containing methyl cellulose 0.03% and preservative Benzylkonium
chloride 0.01% and aqueous base.
Dosage and time: one drop three times daily for 28 days
Drugs Used:
Patients will be given rajani-daru siddha ghrita in sterile form, after
proper authentification and standardization and sterilization.
The drugs will be prepared according to ghrita paak vidhi and will be
packed in sterile form to use as medication purpose.
Follow Up –
Follow up was done on 7th, 14th and 21st and 28th day and
observations were recorded in tabular form.
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Plan of Study
Flow chart: with arrow markings
A detailed history was taken in each case, followed by thorough
general and systemic examination and ocular examination as per the
proforma attached subsequently. As the ‘dry eye’ is defined as being
either a quantitative or qualitative dysfunction of the tear film, I
submitted all the patients of both group with Dry eye to slit lamp
examination and performed two specific tests in each case:
Slit lamp examination
Schirmer’s Test -1.
Tear film Break Up Time Test.
Slit lamp examination:
Inspection of the marginal tear strip to see irregular width of the strip
or frank discontinuation, which strongly suggests aqueous tear
deficiency or lipid abnormality.
To see for increased debris floating in the pre-corneal tear film
representing desquamated epithelium.
To observe for viscous mucin threads in the inferior fornix which
indicate increased lipid contamination of the mucus layer facilitated by
decreased tear flow.
Inspection of the fornices for symblepharon etc.
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Schirmer’s Test 1
In Schirmer’s 1 Test, the patient was seated comfortably in a dimly light
room in chair with head straight. It was ensured that no fan was on in
the room at the time of carrying out this test.
The test was then performed by No.41 Whatman filter paper strips
5mm wide and 30mm long partially folded 5mm from one end at 90o.
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The folded short end was gently placed in the lower conjunctival fornix
at the junction of middle and lateral one-third of lower lid and the
patient was advised to look straight ahead and to keep eyes open.
Blinking was permitted. At the end of the five minutes, the strips were
removed and two minutes later the amount of wetting of the strips from
the folded ends was measured with a millimeter scale. If tear fluid failed
to diffuse over the lid margin along the strip within 2 minutes, it was
moved to another site within the sac and time was recorded. This is a
modification of the Schirmer’s 1 test, to obviate false positive results. If
one or both strips were completely wetted before five minutes passed,
they were replaced by new strips.
The Schirmer’s test was used to determine the quantitative tear
formation. Normal range is wetting of 10 to 25 mm. Below 10 mm and
upto 5 mm it is border line and less than 5mm wetting definitely
abnormal.
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A dry spot caused by tear film break up –
Green colored strip is Fluorescein strip for T.F.B.U.T. and white coloredStrip (containing measurement in m.m.) is for shirmer’s test.
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Tear film Break Up Time ( T.F.B.U.T.)
Tear film B.U.T. was used to measure the quality of the tear film. This
test was done as follow.
A moistened fluorescein strip was applied to the inferior temporal
bulbar conjunctiva. Patients were instructed to blink several times to
facilitate an even distribution of fluorescein. The patient was then
positioned for slit lamp examination and asked to stare directly ahead
without blinking or holding the lids after one complete blink. The tear
film was then scanned through a cobalt blue filtered light by
magnification and broad vertical beam. A stopwatch was used to
measure the interval between the last complete blink and the first
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appearance of a randomly distributed dry spot, the tear film B.U.T.
Three consecutive readings were taken in each eye and the mean value
of these readings were considered above 10 seconds as normal and less
than 10 seconds as cases of dry eyes.
Observation Tables
Observation Table – 1
Symptoms Day 1 Day 7 Day 14 Day 21 Day 28
Rukshta – dryness
Daaha – burning sensation
Aavil darshan - decreasedvisual acuity
Daarun pratibodhan - unableto open and close eyes withease
Toda – Pain
Sankoch
Shiteccha
Observations were noted in tabulated form according to signs and
symptoms with gradations as follows:
O – Normal, + - Mild
++ - Moderate, +++ - Severe
Observation Table – 2.
Sr.No.
Test. 0th 7th 14th 21st
1. Tear Film Breakup time
2. Schirmer’s Test 1
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Observation parameters and measures -
Type Gradation Numbering Shirmer’s test Tear film breakup time (TFBUT)
Normal 0 0 > 10 mm > 10 sec
Mild + 1 > 8 mm and< 10 mm
> 8 sec and <10 sec
Moderate ++ 2 > 5 mm and< 8 mm
> 5 sec and < 8sec
Severe +++ 3 > 5 mm > 5 sec
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OBSERVATION AND STATISTICAL ANALYSISTable 1
Classification of patients as per age
Sr. No. Age
Group
Trial Gr.
No. of Pt.
Control
Gr. No. of
Pt.
Total %
1. 15 – 30 11 13 24 40
2. 30 – 45 15 14 29 48.33
3. 45 – 60 4 3 7 11.66
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Chart for table 1
Interpretation
Agewise classification shows total 24 person between15 to 30 yrs of
age, in control group were 13 and trial group were 11 involved. Total
29 person between30 to 45 yrs of age, in control group were 14 and
trial group were 15 persons involved. Total 7 person between46 to 60
yrs of age, in control group were 3 and trial group were 4 involved in
the project. Thus maximum patients were from 30 – 45 yrs age group.
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Table 2
Classification of patients as per gender
Sr. No. Gender Trial Gr.
No. of Pt.
Control
Gr. No. of
Pt.
Total %
1. Male 16 11 27 53.3
2. Female 14 19 33 46.6
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Chart for table 2
Interpretation
sexwise classification shows total 27 male involved of which in control
group were 11 and trial group were 16 involved. Total 33 female
involved in control group were 19 and trial group were 14 involved.
Thus its seen that out of total 60 patients 33 were female patients i.e.
53% appx.
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Table 3
Classification of patients according to occupation
Occupation
WiseGroup A Group B Both Group %
Service 10 14 24 40
Student 11 5 16 26.66
Business 4 5 9 15
House wife 5 6 11 18.33
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Chart for table 3
Interpretation
Occupationwise distribution shows 24 patients from service sector of
which 10 patients were in trial group while 14 were in control group.
In students group 16 patients were included of which 11 were in trial
group while 5 were in control group. In business group total 9 patients
were included of which 5 were in trial group while control group
contains 4 patients. At last in house wife group total 11 patients were
included of which 5 were in trial group and 4 patients were in control
group. Conclusively out of 60 patients 24 patients i.e. 40% were from
service sector, while 16 patients i.e. 26% were in students group.
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Table 4
Classification of patients according to symptom dryness
Gradation Trial Group Control Group
B. T. % A. T. % B. T. % A. T. %
No. ofPt.
No. ofPt.
No. ofPt.
No. ofPt.
0 0 0 22 73.33 0 0 6 20
1 10 33.33 8 26.66 14 46.66 20 66.66
2 20 66.66 0 0 16 53.33 4 13.33
3 0 0 0 0 0 0 0 0
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Chart for table 4
Interpretation
In trial group 10 pt had mild grade and 20 had moderate grade of
dryness ( rukshata) noted. After treatment 8 were symptom less and 22
had mild form of dryness persistent. While in control group 14 patients
had mild form and 16 had moderate form of dryness present. After
treatment of control cases only 6 cases had relief in symptom while 24
had persistent dryness.
Thus By comparing both groups rukshata (dryness) symptom is relived
in more no. of pts. in Trial Group as compared to Control Group.
TRIAL GROUP B.T.
TRIAL GROUP A.T.
CONTROL GROUP B.T.
CONTROL GROUP A.T.
0
5
10
15
20
25
01
23
0
10
20
0
8
22
00
0
14 16
0
6
20
4
0
Rukshata (dryness)
TRIAL GROUP B.T. TRIAL GROUP A.T. CONTROL GROUP B.T. CONTROL GROUP A.T.
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Table 5
Classification of patients according to symptom daaha –
burning sensation
Gradation Trial Group Control Group
B. T. % A. T. % B. T. % A. T. %
No. of
Pt.
No. of
Pt.
No. of
Pt.
No. of
Pt.
0 0 0 17 56.66 0 0 9 30
1 10 33.33 13 43.33 14 46.66 16 53.33
2 20 66.66 0 0 16 53.33 5 16.66
3 0 0 0 0 0 0 0 0
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CHART FOR TABLE 5
Interpretation
In both groups number of patients in moderate Burning Sensation are
more. In Trial Group Burning Sensation is relived completely in 56%
cases & mild relived in 43% cases. in control group it shows 30% relief
and 53% mild relief.
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Table 6
Classification of patient according to symptom aavil
darshan – decreased visual acuity
Gradation
Trial Group Control Group
B. T. % A. T. % B. T. % A. T. %
No. of
Pt.
No. of
Pt.
No. of
Pt.
No. of
Pt.
0 22 73.33 28 93.33 21 70 21 70
1 8 26.66 2 6.66 9 30 9 30
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
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Interpretation
26% i.e. 8 patients had mild degree aavil darshan in trial group and 9
pts. had mild degree of aavil darshan in control Group. 6% cases i.e. 2
patients had no Blurring at the end of treatment. But in Control Group
there is very minimal relief.
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Table 7
Classification of patient as per symptom daarun
pratibodhan – foreign body sensation
Gradation
Trial Group Control Group
B. T. % A. T. % B. T. % A. T. %
No. of
Pt.
No. of
Pt.
No. of
Pt.
No. of
Pt.
0 10 33.33 24 80 7 23.33 12 40
1 10 33.33 8 26.66 15 50 14 46.66
2 10 33.33 0 0 8 26.66 4 13.33
3 0 0 0 0 0 0 0 0
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Chart for table 7
Interpretation
In Trial Group fb sensation found in 10 pts. (33%) in mild degree & in
10 (33%) pts. moderate degree. After treatment 24 (80%) pts had relief
while 8 pt (26%) had mild fb sensation. While In control Group fb
sensation found in 15 pts. (50%) in mild degree & in 8 (26%) pts.
moderate degree. After treatment 12 (40%) pts had relief while 14 pt
(46%) had mild fb sensation and 4 pts i.e. (13%) had moderate dryness.
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Table 8
Classification of symptom as per symptom toda – pain
Gradation
Trial Group Control Group
B. T. % A. T. % B. T. % A. T. %
No. of
Pt.
No. of
Pt.
No. of
Pt.
No. of
Pt.
0 30 100 30 100 30 100 30 100
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
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Chart for table 8
Interpretation
As the study included only mild and moderate form of dry eye subjects,
pts did not show any kind of toda or gharsh.
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Table 9
Classification of symptom upadehavat
Gradation
Trial Group Control Group
B. T. % A. T. % B. T. % A. T. %
No. of
Pt.
No. of
Pt.
No. of
Pt.
No. of
Pt.
0 30 100 30 100 30 100 30 100
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
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Chart for table 9
Interpretation
As the study included only mild and moderate form of dry eye subjects,
pts did not show any kind of updehavat symptom.
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Table 10
Classification of patient as per symptom – sankocha
Gradation
Trial Group Control Group
B. T. % A. T. % B. T. % A. T. %
No. of
Pt.
No. of
Pt.
No. of
Pt.
No. of
Pt.
0 30 100 30 100 30 100 30 100
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
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Chart for table 10
Interpretation
As the study included only mild and moderate form of dry eye subjects,
pts did not show any kind of sankoch symptom.
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Table 11
Classification of patient as per symptom – shitechha
Gradation
Trial Group Control Group
B. T. % A. T. % B. T. % A. T. %
No. of
Pt.
No. of
Pt.
No. of
Pt.
No. of
Pt.
0 30 100 30 100 30 100 30 100
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
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Chart for table 11
Interpretation
As the study included only mild and moderate form of dry eye subjects,
pts did not show any kind of shiteccha symptom.
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Table 12
Classification of patient based on shirmer’s test type 1
Gradation
Trial Group Control Group
B. T. % A. T. % B. T. % A. T. %
No. of
Pt.
No. of
Pt.
No. of
Pt.
No. of
Pt.
0 22 73.33 30 100 23 76.66 27 90
1 8 26.66 0 0 7 23.33 3 10
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
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Chart for table 12
Interpretation
While performing shirmer’s test 8 cases were found to have mild grade
i.e. 8 to 10 mm of strips reading. After treatment none of the cases had
mild grade of shirmaers test readings i.e. between 8 to 10 mm in trial
group. While in control group 7 cases had mild grade of shirmers test
readings but after treatment 3 cases had mild grade shirmers test
readings.
So it is seen that trial drug performance is good over control group, as
seen here.
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Table 13
Classification of patient based on tear film breakup time
test (TBUT)
Gradation
Trial Group Control Group
B. T. % A. T. % B. T. % A. T. %
No. of
Pt.
No. of
Pt.
No. of
Pt.
No. of
Pt.
0 22 73.33 28 93.33 29 96.66 29 96.66
1 8 26.66 2 6.66 1 3.33 1 3.33
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
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Chart for table 13
Interpretation
Trial group subjects show 8 patients had TFBUT between 8 to 10 sec
while after treatment 2 cases remain between this range. In control
group 1 cases was in range between 8 to 10 sec while after treatment it
did not show any change.
So it is well understood here that there is much improvement in trial
group as compared to control group.
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Statistical analysis
Trial Control Trial Control Trial Control
Dryness Dryness Burning Burning
FB
Sensation
FB
Sensation
D Mean 1.4 0.6 1.23 0.6 0.8 0.3
Sd2 (Var) 0.58 0.25 0.35 0.51 0.69 0.21
T-Cal
Paired 9.99 6.54 11.30 4.56 5.26 3.56
T-Cal
Unpaired 5.31 3.99 2.99
Day 1
Mean 1.66 1.53 1.66 1.46 1 1.03
Day Last
Mean 0.266 0.93 0.433 0.86 0.2 0.73
we reject Ho. i.e. there is significant difference in symptom level
in post test of two groups and is less in trial group.
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
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DISCUSSION
Dry eye syndrome cannot be co-related exactly with any single
disease explained in various classics by our Acharya’s. Some of the
lakshanas of Shushkakshipak appears to be similar to that in Dry eye, so
the attempt is made to co-relate the lakshanas of Shushkakshipak with
Dry eye syndrome.
Age & Occupation - The incidence of Dry eye was observed
higher in the age group of 30 to 45 years & minimum in the patient
above the 45 years. It is probably because computer is widely used,
pollution, nutritional factors playing hostile situation since last decade.
Dryness (rukshata) - In trial group 10 pt had mild grade and 20
had moderate grade of dryness ( rukshata) noted. After treatment 8
were symptom less and 22 had mild form of dryness persistent. While
in control group 14 patients had mild form and 16 had moderate form
of dryness present. After treatment of control cases only 6 cases had
relief in symptom while 24 had persistent dryness.
This may be due to snigdha and kinchit kledkar guna of ghrita
and snigdha and netrya property of saindhava lavan.
Burning & Redness - In both groups number of patients in
moderate Burning Sensation are more. In Trial Group Burning
Sensation is relived completely in 56% cases & mild relived in 43%
cases. in control group it shows 30% relief and 53% mild relief.
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The shita guna of ghrita go dugdha and saindhava has possible
role in this. So burning sensation may have relieved.
Foreign body sensation in eyes - In Trial Group fb sensation
found in 10 pts. (33%) in mild degree & in 10 (33%) pts. moderate
degree. After treatment 24 (80%) pts had relief while 8 pt (26%) had
mild fb sensation. While In control Group fb sensation found in 15 pts.
(50%) in mild degree & in 8 (26%) pts. moderate degree. After
treatment 12 (40%) pts had relief while 14 pt (46%) had mild fb
sensation and 4 pts i.e. (13%) had moderate dryness.
As haridra and daru-haridra which have shoshahara, vranapaha
and kandugna property they must be controlling this symptom. While
ghrita and dugdha have rasayan and sheetal property which are able to
heal the surface and bring smoothness.
Blurring of vision - 26% i.e. 8 patients had mild degree aavil
darshan in trial group and 9 pts. had mild degree of aavil darshan in
control Group. 6% cases i.e. 2 patients had no Blurring at the end of
treatment. But in Control Group there is very minimal relief.
Due to Rasayan & Balya property of ghrita and dugdha the
symptom blurring of vision is reduced significantly in trial group as
compared to control group.
In present study, trial drug is not much effective T.F.B.U.T. & S.T.
1 tests in both the groups.
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
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CONCLUSION The clinical features of Shushkakshipaak are closely related
to dry eye syndrome.
The incidence of Shushkakshipaak was observed higher in
age group 30 to 45 years (around 50%)
A higher prevalence seen in service sector of occupation
(40 %)
During the treatment signs and symptoms of
Shushkakshipaak seen to reduce in both group, but significantly
in trial group
Rajnidarusiddha ghrita anjan is beneficial as its marked
relief over symptoms and the ingredients of this preparation are
easily available, cost effective.
By Rajnidarusiddha ghrita anjan it is proved that
Shushkakshipaak can be managed with conservative line of
treatment in the initial stages.
The effect of rajani-daru siddha ghrita anjan on T.F.B.U.T.
& S. T. 1 is not much effective.
Thus early diagnosis and adequate treatment of
Shushkakshipaak definitely relives the symptoms.
Clinical trials showed very encouraging results, but More
study is necessary on large scale.
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BIBLIOGRAPHY
Charak Samhitha with Vidyotini Tika edited in Hindi by
Rajeshwaradatta Shastri Vol. 1 and Vol. 2, 22nd Edition Varanasi,
Choukambha Vishwabharati, 1996.
Bhaishajya Ratnavali by Govinda Das, Edited in Hindi by Kaviraj
Sri. Ambika Dutta Sashtri, 2nd Edition;Chaukambha Sanskrit
Series.
Madhav Nidan with Madhukosha Tika Edited in Hindi by
Srikanta Dutta and Vijayarakshita, 28th Edition. Varanasi;
Choukambha sanskrita Sansthan: 1999.
Nimi tantra Edited in Hindi by Ramanath
Dwivedi.Varanasi,Chaukambha Sanskrit Series. 2003.
Shalakya Vignyana by Ravindra Choudhari. 13th Edition,
Varanasi.Choukambha Orientalia. 1999.
Sharangadhara Samhita. Text with English translation by
Prof.K.R.Srikanta Murthi, 3rd Edition. Varanasi. Choukambha
Orientalia. 1999.
Yogratnakar with Vidyotini Tika by Vd. Lakshmipati Shastri
Choukambha Sanskrit Sansthan, Varanasi, 7th Edition.
Nighantu Ratnakar, P. Dattaramen Virachit, Gangavishnu; 1st
Edition.
To Study The Efficacy Of Anjan Of Rajanidaru Siddha Ghrita In ‘Shushkakshipaak’ With Special Reference To ‘Dry Eye’
BIBL
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Y
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Bhavprakash Nighantu by Dr. Chunekar, Dr. Pandaya,
Choukambha Bharati Academy Varanasi; 10th Edition.
Abhinav Netra Chikatsa Vignyan by Vishwanath Dwivedi
Choukambha Sanskrit Sansthan, Varanasi, 2nd Edition. 1991.
Ashtang Hridyam Shri Lalchandra Vaidya Motilal Banarasidas
2nd Edition.
Modern Ophthalmology by L. C. Dutta, Jaypee Brothers Medical
Publishers Pvt. Ltd. 2nd Edition; New Delhi, 1994.
Clinical Ophthalmology by Jack J. Kanski, Butter Worth
Heinemen Ltd. 4th International Edition; 1994.
G. N. Seal’s Text book of Ophthalmology by S.K.Seal, Current
Books International, 5th Edition, Kolkata.
Parson’s Diseases of Eye by Stephen M. J. H. Churchill Living
Stone Publishers; 19th Edition. 2004.
Ophthalmology by A. K. Khurana, New Age International
Publishers; 3rd Edition. New Delhi.
Essentials of Ophthalmology by Samar K. Basak, Current Books
International, 2nd Edition, Kolkata.
Clinical Ophthalmology by Shashikapoor; S. P. Publishers, 1st
Edition; Bombay
“To study the efficacy of Anjan of rajani-daru siddha ghrita insushkakshipaak with special reference to dry eye”
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CASE REPORT FORMShalakya tantra department, Bharati Vidyapeeth Ayurved Hospital
Katraj, Pune – 411046.
Name of patient - Age - Sex -
Address - Date - Time -
O.P.D. Case number - Occupation -
Patient group code - Patient study code -
Diagnosis –
Chief complaints – vedana vishesh -
History of present illness – vartaman vyadhi vruttant –
History of past illness – purva vyadhi vruttant -
“To study the efficacy of Anjan of rajani-daru siddha ghrita insushkakshipaak with special reference to dry eye”
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Netra parikshana Rt eye Lt eye
Vartma mandal –
Shukla mandal –
Krushna mandal –
Vision -
Sandhi parikshana
Apanga
Kaninika
Pakshma vartma gata
Vartma shukla gata
Shukla krushna gata
Discharge
Other examination for dry eye
Shirmer’s test type 1
Tear film break-up time
Roga nidan
Chikitsa
Patient advice
“To study the efficacy of Anjan of rajani-daru siddha ghrita insushkakshipaak with special reference to dry eye”
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Follow up
Symptoms Day 1 Day 7 Day 14 Day 21 Day 28
Rukshta – dryness
Daaha – burning sensation
Aavil darshan - decreasedvisual acuity
Daarun pratibodhan - unableto open and close eyes withease
Toda - Pain
Sankoch
Shiteccha
Observations - recorded in tabular form according to sign and symptomsgradation.
Subjective Gradation - 0 - Normal
+ - Mild
++ - Moderate
+++ - Severe
“To study the efficacy of Anjan of rajani-daru siddha ghrita insushkakshipaak with special reference to dry eye”
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CONSENT FORMI .....................................................................................
.....................................................................................
Stating here giving in written that, I am involving in the Study of ‘E f f i c a c y O f
A n j a n O f R a j a n i d a r u S i d d h a G h r i t a I n ‘ S h u s h k a k s h i p a a k ’
W i t h S p e c i a l R e f e r e n c e T o ‘ D r y E y e ’ by my own responsibility. This
study will be carried out in Bharati Ayurveda Hospital.
All the criteria in this consent form are duly explained to me. I am aware of the possible
complications in this study. Permission regarding all the tests and treatments has been takenfrom me and I am undergoing with my own interest.
1) I am aware that doctor is going to examine me.2) I will follow all the orders and information given by the concerned doctor, also I agree
to undergo all the investigations and treatments.3) Some eye examinations will be required for my treatment, I am explained regarding the
diagnostic modalities.4) Doctor from Bharati Ayurveda Hospital will be permitted to do treatment on me.5) Patients will be divided in two groups. One group will be treated with study drug and
another group with some given drug or treatment. I may be involved in any group so Imay or may not receive the study medicine.
6) There are so many treatments on dry eye and it is one of them. I know that I may notget the total relief.
7) All the conclusions of this study will be kept secret and is used only during the study.The person signing below, doctor has explained about the study and answered all my
queries.
The consent form has been duly read and understood by me. I am aware of thisstudy and I am involving with my own interest. All the empty spaces in this consent paper
has been previously filled before my signature.
In this study I am involving with my own interest and signing consent paper.
Doctor Patient
Name, Sign, Date Name, Sign, Date
Witness
Name, Sign, Date