Clinical Study of MustadiYogNasya, Tarpana and Basti in TritiyaChaturthapatalagataDoshadushtiw.s.r to Age Related Macular Degeneration (ARMD)

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1 Clinical Study of MustadiYogNasya, Tarpana and Basti in TritiyaChaturthapatalagataDoshadushtiw.s.r to Age Related Macular Degeneration (ARMD) Minal B. Sardar* 1, Madhukar Lahankar 2, Sarala G. Dudhat 3 1. P. G. Scholar, 2. Associate Professor and H. O. D., Department of Shalakyatantra, drmadhulahankar@gmail.com; mob.no Asst. Professor Department of Shalakyatantra, sarala.dudhat@gmail.com mob no *Corresponding Author: dr.minalsardar@gmail.com mob no Abstract: To Evaluate the effect of MustadiyogaNasya, Tarpana, Basti in Tritiyachaturthapatalagatadoshadushti w.s.r. to Age related macular degeneration. For this study we defined the aim and objects are study effect of new Ayurvedic regimen on Age related macular degeneration, re-evaluate the ayurvedic principles innetraroga and to suggest an effective remedy to treat Tritiyachaturthapatalagatadoshadushtiw.s.r to Age related macular degeneration. [1]ss ARMD is degenerative disease associated with aging that affects the macula and causes gradual loss of central vision due to which person is unable to do his day to day work like reading,writing,driving or recognizing person.modern science doesn t have anyeffective and definite treatment on this disease.while searching solution for ARMDin Ayurvedathere is no direct reference but some diseases liketritiyachaturthapatalagatadoshadushtis hows some of the symptoms of ARMD.There are many formulations mentioned in samhitasin the form of kriyakalpas in the mananagement of drishtigatarogas like Tarpana, Putpaka, Anjanaandpanchakarmaprocedure like Nasya, Virechana,Basti keeping this view in mind an attempt has been made to conquer the situation by Ayurvedic remedy Related Macular Degeneration (ARMD)1

2 i.emustadiyoga in the form of Nasya, Tarpana,Bastion ARMD. Mustadi yoga Nasya,Tarpana,Bastiin ARMD. We got significant result in dimness of vision and distorted vision after completion of MustadiyogaNasya,Tarpana,Basti treatment. Keywords: ARMD,Tritiyachaturthapatalagatadoshadus hti, Mustadiyoga, Nasya, Tarpana, Basti. Introduction: ARMD as the name suggest is a age related degenerative disorder. Mustadiyoga contains Musta and other drugs of [3] CharkoktVaysthapakganai.eHaritaki, Aamalaki, Guduchi, Shatavari,Jivanti,Rasna,Shaliparni,Manduk parni, Punarnava, Aparajita.Musta is chosen as it is shreshthadipan and pachan drug and Vaysthapakagana as the name suggest all the drugs are shreshtha in controlling aging and it s disorder and has rejuvenating property. Since ARMD is degenerative disorder and occurring due to Dhatukshayaso Brihannasya in the form of Mustadiyogaghrita is chosen. For topical drug delivarytarpanawas chosen because it is directly indicated in vatapitta disorders. ARMD is disease of old age which is the period of vatadosha. As it is the disease of Tritiyachaturthapatala which is called AsthyashritandBastiis main treatment of Vatadosha,Asthi and degenerative disorders so Bastiis preferably chosen for internal route. Keeping this in mind the present study was planned to evaluate the effect of Material & method: Study design: post study design. Clinical study with pre & Patients: Patients with classical signs & symptoms were selected by preset inclusion and exclusion criteria from the OPD and IPD of ShalakyatantraDept. of Podar college worli Mumbai. Trial drug: The ingrediants of study drug were purchased from local market. All the herbs were identified,authentified. Diagnostic criteria: Diagnosis was established on the basis of history and symptoms mentioned in classical texts and by objective parameters / investigations mentioned in contemporary texts. Inclusion criteria: Patients between age group Both sexes Controlled DM and HTN Immature cataract Related Macular Degeneration (ARMD)2

3 Cataract operated Mustadiyogakalka- 1part Exclusion criteria: Age < 40 and >80 Cataract Glucoma HBsAg and HIV Familial dominant drusen Other retinopathies like DRetc. Pts having infective&inflammatory disease Laboratory investigations: Blood Hb%, C.B.C., ESR,Lipid Profile, LFT, RFT, BSL-Fasting & P.P. Urine- Routine &microscopic, HIV, HBsAg etc. Treatment Group:-10 patients were selected for study purpose. Procedure: 1) MustadiyogaGhrit-As mentioned insharangdharasamhita,madhyamak handa [6] 2/9 siddha ghrit prepared byfollowing method. Goghrit-4part Mustadiyoga kwath-16part Raw material mixed in above proportion and with the help of heat reduced upto level of quantity of ghrita. 2) MustadiyogaBasti-preparedas per the kshirbasti procedure stated in [4] Charaksamhitasiddhisthan 12/15-1.Kwath is prepared by bharaddravyas of Mustadiyoga each 20 gm and 1 litre water is put in itand remained ¼ of itthen 200ml of godugdhais added in kwatha and heated upto godugdhare mained. Madhu,saindshava,kalka, ghrita are mixed one by one in separate jar and above mentioned kwatha siddha godugdha is added in this mixture and given to the patient in 250ml quantity. Process Content Dose Duration Cycles Nasya Mustadiyogaghrit 6 drops in each nostrils Tarpana Mustadiyogaghrit Starting from 100 matra increasing 50matra/day 7 Days 1st 2nd 3 rd 7 Days 1st 2nd 3 rd Related Macular Degeneration (ARMD)3

4 Basti Mustadiyoga siddha kshirbasti 250 ml 14 Days 1st 2nd 3 rd 1-Dimness of vision Study duration:-3 months study was done. Follow up -followup after 15 days of each cycle. 2-Distorted vision Objective parameters: Ophthalmoscopic findings- Method of collection of data: The disease assessment and the response of therapy were assessed based on following subjective & objective parameters. Drusens. RPE (Retinal Pigment epithelium) changes Geographic atrophy of macula Subjective parameters Observation in tabular form:- Sr No. Sign and Symptom Observations 1 Visual acuity 2 Distorted vision (by Amsler grid) 3 Drusens 1st month 2nd month 3 rd month Assessment criteria SUBJECTIVE CRITERIA 1) DIMNESS OF VISION: It is recorded with help of Snellenschart.Distant vision recorded as aided vision DISTANT VISION Visual acuity Score 6/6 to 6/6p 1 6/9 to 6/9p 2 6/12 to 6/12p 3 6/18 to 6/18p 4 Related Macular Degeneration (ARMD)4

5 6/24 to 6/24p 5 6/36 to 6/36p 6 6/60 to 6/60p 7 2)DISTORTED VISION Distorted vision(this is assessed by using an Amsler s grid) Grade 0 Grade 1 Grade 2 Grade 3 No distorted vision Lines are crooked or bent Boxes appeared different in size and shape from each other Boxes and Lines are wavy, missing. OBJECTIVE CRITERIA 1) Drusen 2) Pigmentay changes 3) Geographicalatropy:- These are assessed by fundus photograph before and after treatment by improved or not improved criteria. 1) Drusen- ACCORDING TO AGE-RELATED EYE DISEASE STUDY FACULTY OF OPHTHALMOLOGY AMERICA Grade1 Grade 2 Grade 3 Grade 4 No drusen, or nonextensive small drusen only, in both eyes Extensive small drusen, nonextensive intermediate drusen, or pigment abnormalities at least in one eye. Large drusen, extensive intermediate drusen, or non-central geographic atrophy in at least one eye Geographical atrophy in at least one eye Grade 5 (Neo vascular) evidence suggesting CNVM or RPE detachment, (serous/haemorrhagic) in one eye. Total % of Sign & Symptoms Present in the Patients month wise Sign & symptom 1 st month 2 nd month 3 rd month Related Macular Degeneration (ARMD)5

6 DOV Distorted vision Drusens Result:-Gradation wise Improvement in Sign & Symptoms SN Symptoms Total BT Total AT Total Difference BT-AT Result BT-AT*100/BT 1 DOV % 2 Distorted vision % 3 Drusens % Discussion: We have selected the Mustadiyogaghrita having guna,rasa, veerya,vipak which are suggestive to break down the Samprati(aetiopathology) of Tritiya- Chaturthapatalgatadoshdushti.Ithas Chakshushyadrugs and alleviates vata, pitta and kaphadosha. The drug such as Sarpi, which got the main peculiarity like Sanskaranuvartana which not only alleviates Vayu but it also increases the symptoms of kapha.but, this kapha is kept in equilibrium(state) by kaphashamakaaction of drugs. Their combined karmuktwa only is responsible in destroying the doshadushti.astritiyapatala is MedashritGuduchi,Musta acts on Medodhatu also these drug haverasayana&chakshushya a properties. Chaturthapatala which is called AsthyashritandBastiis main treatment of Asthidhatu. The probable action of drug according to modern review can be described in the following way.drugs of Mustadiyoga are having Antidislipidemic, Rasayana, Antiinflammatory,Neuro Protective, Antioxidant And Antiplatelet activity properties according to chemical composition of drugnasya-either essence (Veerya) of the Nasya or NasyaDravyais reaching and acting on important centers controlling different Neurological, Endocrine and Circulatory functions and thus showing local & systemic effects.tarpanais the procedure for Snehana (Lubrication), truptior soothing of eye. This procedure has Related Macular Degeneration (ARMD)6

7 been widely used in the various types of eye disorders showing satisfactory resultsto prevent the progress of such diseases also protect the eyes from the occurrences of diseases and strengthen all layers of eyes. It is also helpful to improve muscle strength and visual acuity by accommodation. Sukshmguna (Micro properties) in snehacan reach uptosukshmastrotasas (Micro channels that includes vessels, vacuoles and at cellular level) and perceive its subject i.e. Roopgraham(Ability to see the object). But the role and mechanism of its action is still not clear and existing science techniques are unable to predict the mechanism. According to modern science, anatomically anterior cilliary veins opens into Schlem s canal. The medicated ghrita may get absorbed through anterior cilliary vessels into Schlem s canal and through which; it may enter in anterior chamber then passes into posterior chamber and may get absorbed into retina. It relieves tiredness and also improves eyesight. Tarpanaa, putapaka are usually lipid based medicaments to enable easy, faster and far penetrating effect into the posterior segment of eyes. The main chemical composition of Mustadiyogaghrita,chebulagic acid, chebulinic acid & vitamin A. vitamin A in ghrita is very useful in forming visual purple in the retina.bastiprayoga may have Anti-oxidant, Rasayan,Bruhana property and hence it plays an important role in ARMD. Thus we have tried to explain the action of Mustadiyogaghrita in ARMD. Mustadiyoga Nasya, Tarpana & Bastihas significant relief in visual acuity & Distorted vision but there is no improvement in drusen,pigmentary changes & Geographic Atrophy. It maytake more period to show changes in fundus as it is degenerative process & 3 Month is not a sufficient period to improve these changes.positive point is that no patient had worsenthesymotoms.as ARMD is an progressive disease controlling its further progression is also a big achievement. Probable Correlation:- The condition ARMD has no definite comparision in Ayurvedictexts.InAyurveda the clinical features related to visual disturbances are seen only in drishtigataroga.a part of the clinical features of Related Macular Degeneration (ARMD)7

8 TritiyaChaturthaPatalagataDoshadushtican be correlated with ARMD.In ARMD there is gradual loss of central vision due to which patient can t recognize the face of person this symptom can be co relate with TritiyaChaturthaPatalagataTimirasymptom of [5] Karna Nasa Akshi Viparitani Vikshate. means when person looks at face of somebody he can t recognize his ears,eyes & nose properly or he seems to be without ear,nose &eyes. Certain lakshanas of TritiyaPatalagathTimiramentioned by our Acharya s like: 1) loss of vision in a particular region, according to location of dosha in patala. Lakshanas of Chaturthapatal mentioned by Aacharya are 1) Runadhisarvatodrushtilingnashasauchyate here drushtimeans Macula so all macular disorders can be correlated with ChaturthaPatala. Conclusion:- Due to similarity in clinical features disease Tritiya Chaturtha Patalagata Doshadushtican be correlated with ARMD. MustadiyogaNasya, Tarpana, Basti showed significant results in Dimness of vision and Reference:- Distorted vision after statistical analysis. Although there is no improvement in drusens in fundus photograph as disease is age related and degenerative and 3 month period may not be sufficient to show fundus changes.it may require more period upto 1 year. No any adverse reaction were observed in patients 1. Parsons Diseases of the Eye, Editted by Ramanjit Sihota & RadhikaTandon, Elviser Publishers 21th Edition,20 th Chapter p Clinical Opthalmology.Jack J Kanski& Brad Bowling, Elviser Publisher 7 th Edition 14 th Chapter p Agnivesha, Charak Samhita,.Editted By AcharyaVidyadharshukla&prof.Ravi duttatripathi, sutra Sthana,Chapter 4,Chaukhambha SurbhartiPrakashan2007.(ch.su.4/8-50) 4. Agnivesha, CharakSamhita,.Editted By AcharyaVidyadharshukla&prof.Ravi duttatripathi, siddhi Sthana,Chapter 8,Chaukhambha SurbhartiPrakashan2007.(ch.si.12/15-1) Related Macular Degeneration (ARMD)8

9 5. AacharyaSushruta SushrutaSamhita Edited ByKavirajaAmbikaduttashastri, Uttartantra Chapter 7, Chaukhambha Sanskrit SansthanPrakashan.(su.u 7/12) 6. Sharangdharacharya SharangdharaSamhita JivanpradaS 7. avimarsha Hindi VyakhyaSamhita, Edited By Dr. ShrimatiShailajaShrivastav,Chaukha mbhaorientaliyaprakashan 2011.Madhyamakhanda 9 snehaprakaran Related Macular Degeneration (ARMD)9

10 Related Macular Degeneration (ARMD)10

11 . Cite this article: Minal B. Sardar, Madhukar Lahankar, Sarala G. Dudhat Clinical Study of MustadiYogNasya, Tarpana and Basti in TritiyaChaturthapatalagataDoshadushtiw.s.r to Age Related Macular Degeneration (ARMD) -2014; 3(2): 1-11 Related Macular Degeneration (ARMD)11