International Journal of Innovative Pharmaceutical Sciences and Research

Transcription

1 International Journal of Innovative Pharmaceutical Sciences and Research AYURVEDIC SIGHT OF PHARMACODYNAMICS OF KARNAPOORANA - A TREATMENT MODALITY FOR EAR DISORDERS 1 Dr.C.M.Gulhane*, 2 Dr.Vivek Dhongdi, 3 Sharayu Gajapure, 4 Pradip Randive, 5 Dr.Avinash Karambhe 1 MD,Ph.D. IPGTRA, Gujrat, INDIA 2 Assistant Professor, Dept. of Swashthvrutta, INDIA 3 MD(Sch) Dept. of Swashthvrutta, INDIA 4,5 Dept. of Kaumarbhrutya, B. M. Ayurveda Mahavidyalaya, Nagpur, INDIA Abstract The whole of Ayurveda is divided into eight different branches, the branch which deals with the diseases manifesting above clavicle region (disease of eye, nose, ear, throat and head) is called Shalakya Tantra, while describing treatment of Ear disease, Aacharya Sushruta has explained about procedure like Karnapoorna, Nasya, Kaval, gandusha and Karnadhoopana. Karnapoorana is a method of filling or dropping the medication into the external ear. The use of Sneha especially Taila helps to subside Vata Dosha and clears the Srotas of the Karna. Karnapoorna with oil alevate the vitiated vata. Karnapoorana is useful in many ear diseases like Karnanada, Karnaksweda, Karnastrava, Karnashoola, Badhirya. In modern medical science also topical ear composition are commonly used as a therapeutic agents for disease of tympanic membrane, middle and inner ear. In this review article attempt has be made to clarify probable mode of action of Karnapoorana. Keywords: Karnapoorana, Karna roga, Karnashoola, Badhirya, Karnanada. Corresponding Author: Dr.C.M.Gulhane Ayurdent Clinic, Mira Road, Thane, INDIA drchetanayu@gmail.com Phone: Available online: February Issue 52

2 INTRODUCTION Karnapoorana means filling the ears with luke warm Taila, Swarasa, Snehadravya or Gomutra [1]. An Ayurvedic treatment prescribed for ear ailments like otorrhoea, tinnitus, and hearing impairment due to infection or injuries to the ear. Acharya Charaka included this procedure as a one of the Sneha Pravicharana (different modes of administration of oil/fats) [2]. Acharya Charaka and Acharya Sushruta have not described the procedure But Acharya Vagbhatta and Sharangadhara have described the procedure of Karnapoorana [3]. While describing daily routine, Acharya Charaka and Vagbhata have described importance of regular practice of Karnapoorana, which helps in prevention of disease of ear. Acharya Charaka has mentioned that daily practice of Karna Tarpana may prevent Vata Roga of Karna,Manyahanugraha, Ucchai Shruti, and Badhirya [4]. Acharya Sushruta has also mentioned that Snehana should be done in Manya, Shira, and Karna daily, which may prevent Vata Roga of Karna [5]. In modern medical science topical ear composition are commonly use as a therapeutic agents for disease of tympanic membrane, middle and inner ear for the purpose of reducing the inflammation of ear tissues, providing pain relief, and introducing agents with antimicrobial activity to combat infection. The composition reduces swelling of the lining membranes of the middle and inner ear, prevent the destructive effects of inflammation, inhibit the production of prostaglandins, reduce symptoms of tinnitus and vertigo, improve and prevent paralysis of the facial nerve, relieve labyrinthitis, and prevent hearing loss. Anatomical view regarding Karna All panchamahabhutas are involved in structure of Karna with dominance of Akash mahabhuta. It is also adhisthan of shabda tanmatra. In the third month of garbhavastha, there is division of head by neck, after which various parts of head are expressed in miniature form. According to sushruta each of ganda, karna and shanka has one asthi. Karna also has tarunasthi in it. Karnapoorana procedure [6] The entire procedure of Karnapoorana broadly can be divided into 3 steps. 1) Purva Karma Patient should be made to lie down on right or left lateral depending on the affected side. Gentle massage with lukewarm oil around the ear for a short period should be done. Mild hot fomentation around the ear should be done. Available online: February Issue 53

3 2) Pradhana Karma The medicated liquid (oil) should be gently warmed by keeping in luke warm water. The external auditory canal should be straightened by pulling the pinna backward and upwards. The liquid (oil) should be poured in drops till the ear canal is filled up. 3) Dharana kala Rasadi Dravya Before meal Tailadi Dravya After sunset The root of ear (Karnamula) should be gently massaged in order to potentiate the action of the drug. The medicated oil should be retained in same position for 100 Matras (5 minutes). 4) Indication of Dharana according to disease In Karnaroga 100 Matra In Kantharoga 500 Matra In Shiroroga 1000 Matra DISCUSSION In modern science ear drops have limited use for the external canal and tympanic membrane. Ear drop composition that uses penetration enhancers (absorption promoters or accelerants which penetrate into skin to reversibly decrease the barrier resistance.) to diffuse the therapeutic agents through the tympanic membrane into the middle and inner ear for the purpose of reducing the inflammation of ear tissues, providing pain relief, and introducing agents with antimicrobial activity to combat infection [7]. It is proved that there is evidence of systemic absorption of topical application of Gentamicin in the eternal ear that would ultimately be absorbed into the perilymph [8]. Researchers reported, ear drops provide better access to the middle ear, behind the ear drum, so more of the ear drops medicine reaches the infection, avoiding potential intestinal and blood absorption that occur with oral drug. Researchers discovered that the concentration at the infection can be a thousand fold greater than when oral or IV medication is used. In addition, because the drug is not distributed throughout the body, there is less chance of developing drug resistance [9]. Available online: February Issue 54

4 Ayurvedic Karnapoorana formations are mostly lipid base which have ability penetrate through ear epithelium and go to the circulations that s way we get desire effect on specific site of ear. It is hypothesized that Ayurvedic drugs helps in the absorption through epithelial tissue of external ear canal and tympanic membrane that can maintain normal function of hearing and equilibrium. According to Acharya Dalhana, oil spread in to the deeper tissues (Rasa & Rakta). Luke warm Karnapoorana improve the blood supply of ear first then drug spread through Kedarikulya Nyaya which corrects the microcirculation. As the result of Karnapoorana Kapha and Vata Shamana takes place which maintain the normal function of hearing and relieve the symptoms of ear diseases. In case of perforated tympanic membrane Karnapoorana promote healing though Vrana with Alpa Srava is an indication for Taila in Shashti Upakrama [10]. The pharmacokinetic of Ayurvedic formulations can be explain on the basis of liberation, absorption, distribution, metabolism and elimination of drugs. Liberation describes the release of the drug from its dosage form. Absorption refers to the movement of the drug from the site of administration to target site or the inner ear fluids. Distribution involves the processes by which the drug diffuses, into the various tissue compartments of the ear. Metabolism is the chemical conversion or transformation of drugs into active moieties or compounds which are easier to eliminate. Elimination describes the removal of the unchanged drug or metabolite from the ear (e.g. to blood, cerebrospinal fluid or the middle ear) [11]. Probable mode of action of Karnapoorana Drug administration is through Karnapoorana is the natural choice for the treatment of local ear disorders. It is good option for drug delivery because in lower dose it allows a rapid symptom of relief. A more detailed description regarding the mode of action of Karnapoorana is not available in Ayurvedic classics. But as Karna Tarpanana is mentioned as Sneha Pravicharana its mode of action can be understood as Sthanika Snehana, if Sneha Dravaya is used for it. Pharmacodynamics of Poorvakarma can be explain following way. 1) Abhayanga Before Karnapoorana, Abhyanga is specifically done in Murdha Pradesha which causes vasodilatation in the skin and muscles by stimulating receptors of the sympathetic nervous system. Vasodilatation increases blood flow and helps to remove the toxic products. Available online: February Issue 55

5 Dalhanahas explained in detail about absorption of Sneha. The Abhyang is done for sufficient time; the oil reaches to the different Dhatu. Hence it is clear that potency of drug used in oil is absorbed into the skin. Dalhana also mention that when Snehana reaches to the particular Dhatu it subsides the disease of that particular Dhatu [12]. So it is useful in the ear disease which caused by vitiated Vata. 2) Swedana Acharya Charaka has described mechanism of Swedana Karma as given below [13] It helps to dissolve Shleshma. It makes the channels soft, by which Vatadi Doshas and other contents can flow through in their normal directions. It increases the secretion of vitiated Shleshma thorough the channel. So, due to Ushna Guna of Swedana, Kapha Dosha gets liquefied. When lukewarm oil enters into the Shabdavaha Srotas, network of Srotas carry the Taila towards the desired sites and cleanses the channel. By its Shodhana property of its ingredients, probably it removes the Ama at the celluler level and pacifies the vitiated Vata and Kapha Dosha. Due to Stroto Shodhana and Vata Kapha Shamana, Avarana and Sanga of Vata & Kapha Dosha is removed and nutrition is brought to the respective sites. 3) Absorption of Drug Instilled medicine in ear canal gets absorbed by skin lining external auditory meatus and tympanic membrane and reaches systemic blood flow, according to Ayurveda drugs gets absorbed by Bhrajaka Pitta present in skin and shows its effects on body and local tissue [14]. Patient is asked to do chewing movements to facilitate more drug absorption. The drug instilled in form of alienation, urine etc. is used luke warm it helps in reliving inflammation thus it reduces ear ache, and by counter effect of heat it also relives pain of nearby structures like mandible or neck. As medicine for Karnapoorana is made by Snehapaka method all fat soluble active ingredients of drug get enclosed. Fat soluble active principle can be easily assimilated through nerve endings [15]. Ayurvedic properties of drug not only have beneficial effect on Vata but also remove Aavarana of Kapha. As a combine effect of all these Karnapoorana is useful in all ear disease. Available online: February Issue 56

6 Fig.1: Shows Mode of Action of karnapooran. CONCLUSION Karnapoorana is a method of filling or dropping the medication into the external ear. The use of Ayurvedic preparations especially Taila and Swarasa helps to subside Vata, Pitta and Kapha Dosha and clears the Srotas of the Karna. Karnapoorana is useful in many ear diseases like Karnanada, Karnaksweda, Karnastrava, Karnashoola and Badhirya. Mode of action is not much clear in Ayurvedic texts, but it can be understood on the basis of modern pharmacokinetic and pharmacodynamics of drug used. Source of support: Nil Conflict of interest : Nil REFERENCES 1. Sharangadhara, Sharngadhara Samhita, Commented by Adhamalla and Kashiram, 7 th Edition, Chaukhambha Orientalia, Varanasi, 2008, Uttara Khanda, Chap- 11/128, pg Agniveshaacharya, Charaka Samhita with the Ayurveda Deepika Comm.-Chakrapanidatta Chaukhambha Surbharati Prakashan Varanasi, reprint 2008; Sutrasthana 13/25, pg Vagbhataacharya, AshtangaHridaya SarvangaSundariComm. Arunadatta, Chaukhambha Surbharati Prakashan Varanasi, reprint 2007; Sutrasthana -22/32, 33, pg Agniveshaacharya, Charaka Samhitawith the Ayurveda Deepika Comm. Chakrapanidatta Chaukhambha Surbharati Prakashan Varanasi, reprint 2008; Sutrasthana 5/84, pg-42. Available online: February Issue 57

7 5. Acharya Sushruta, Sushruta Samhita with the Nibandha Sangraha Comm. Dalhana Chaukhambha Surbharati Prakashan Varanasi, reprint 2008; Chikitsasthana 24/29, pg Sharangadhara, Sharngadhara Samhita, Commented by Adhamalla and Kashiram, 7 th Edition, Chaukhambha Orientalia, Varanasi, 2008, Uttara Khanda, Chap- 11/128, pg Fust, Charles. "Composition for the prevention and treatment of inflammation of the ear." U.S. Patent Application No. 10/303, Lancaster, J. L., et al. "Systemic absorption of gentamicin in the management of active mucosal chronic otitis media." Clinical Otolaryngology & Allied Sciences 24.5 (1999): Antibiotic Ear Drops Favored Over Popular Oral Antibiotics For Ear Infections [cited on 26 jan 2015] 10. Vagbhata, Astang Samgrah, Edited by Kaviraj Atrideva Gupta, Vol 2, Uttar tantra, 30/28. Chowkhamba Krishnadas Academy, Varanasi, Salt, Alec N., and Stefan K. Plontke. "Principles of local drug delivery to the inner ear." Audiology and Neurotology 14.6 (2009): Sushruta,Samhita, NibandhaSangrahComm.-Dalhana Chikitsasthana24/30, Chaukhambha SurbharatiPrakashan, Varanasi, reprint Sushruta, Samhita, Nibandha Sangrah Comm.- Dalhana Chaukhambha Surbharati Prakashan, Varanasi, reprint 2008;Chikitsasthana24/ Vagbhata, Astang Samgrah, Edited by Kaviraj Atrideva Gupta, Vol 2, Sutra Sthana, 20/7. Chowkhamba Krishnadas Academy, Varanasi, DavidWright. Scott-Brown s Otolaryngology, Butterworth International 5 th Edition 1987, Volume-1, BasicSciences, pg 178. Available online: February Issue 58