Dry eye 02 shlk

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


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


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


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


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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.


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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.


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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.


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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 :


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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


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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.


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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


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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 )


Vata: ↓ Pitta : ↓ Kapha : ↓


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)


Vata: ↓ Pitta : ↓Kapha : ↑


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)


Vata: ↓ Pitta : ↓Kapha : ↑ (increases kleda)


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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

80

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.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

81

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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

82

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.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

83

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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

84

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.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

85

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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

86

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.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

87

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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

88

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.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

89

Table 7

Classification of patient as per symptom daarun

pratibodhan – foreign body sensation

Gradation


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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

90

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.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

91

Table 8

Classification of symptom as per symptom toda – pain

Gradation


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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

92

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.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

93

Table 9

Classification of symptom upadehavat

Gradation


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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

94

Chart for table 9

Interpretation


pts did not show any kind of updehavat symptom.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

95

Table 10

Classification of patient as per symptom – sankocha

Gradation


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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

96

Chart for table 10

Interpretation


pts did not show any kind of sankoch symptom.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

97

Table 11

Classification of patient as per symptom – shitechha

Gradation


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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

98

Chart for table 11

Interpretation


pts did not show any kind of shiteccha symptom.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

99

Table 12

Classification of patient based on shirmer’s test type 1

Gradation


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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

100

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.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

101

Table 13

Classification of patient based on tear film breakup time

test (TBUT)

Gradation


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


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

102

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.


OBS

ERVA

TIO

NAN

DST

ATIS

TIC

ALAN

ALY

SIS

103

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.


DIS

CUSS

ION

104

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.


DIS

CUSS

ION

105

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.


CO

NCL

USI

ON

106

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.


BIBL

IOG

RAPH

Y

107

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.


BIBL

IOG

RAPH

Y

108

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”

CAS

ERE

PORT

FORM

109

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 -


CAS

ERE

PORT

FORM

110

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


CAS

ERE

PORT

FORM

111

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


CO

NSE

NT

FORM

112

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

Dry eye 02 shlk

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