Clinical Study of MustadiYogNasya, Tarpana and Basti in ... · Vatadosha,Asthi and degenerative disorders so Bastiis preferably chosen for internal route. Keeping this in mind the

ISBN 978-93-5173-179-3 ISSN 2320-7329

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Clinical Study of MustadiYogNasya, Tarpana and Basti in TritiyaChaturthapatalagataDoshadushtiw.s.r to Age

Related Macular Degeneration (ARMD)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,

Email: [email protected]; mob.no. 9223378878

3. Asst. Professor Department of Shalakyatantra,

Email:[email protected] mob no. 9869021885

*Corresponding Author: Email:[email protected] mob no. 7303083575

__________________________________________________________________

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]ssARMD 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

mailto:[email protected]

mailto:[email protected]

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i.eMustadiyoga in the form of Nasya,

Tarpana,Bastion 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

Mustadi yoga Nasya,Tarpana,Bastiin

ARMD.

Material & method:

Study design: Clinical study with pre &

post study design.

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 40-80

Both sexes

Controlled DM and HTN

Immature cataract

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Cataract operated

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.

Mustadiyogakalka- 1part

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

7 Days 1st 2nd 3rd

Tarpana Mustadiyogaghrit Starting from 100

matra increasing

50matra/day

7 Days 1st 2nd 3rd

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Basti Mustadiyoga siddha

kshirbasti

250 ml 14 Days 1st 2nd 3rd

Study duration:-3 months study was done.

Follow up -followup after 15 days of each

cycle.

Method of collection of data:

The disease assessment and the response of

therapy were assessed based on following

subjective & objective parameters.

Subjective parameters

1-Dimness of vision

2-Distorted vision

Objective parameters:

Ophthalmoscopic findings-

Drusens.

RPE (Retinal Pigment epithelium)

changes

Geographic atrophy of macula

Observation in tabular form:-

Sr No. Sign and Symptom Observations

1st month 2nd month 3rd

month

1 Visual acuity

2 Distorted vision (by Amsler grid)

3 Drusens

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

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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 No distorted vision

Grade 1 Lines are crooked or bent

Grade 2 Boxes appeared different in size and shape from each other

Grade 3 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 No drusen, or nonextensive small drusen only, in both eyes

Grade 2 Extensive small drusen, nonextensive intermediate drusen, or pigment

abnormalities at least in one eye.

Grade 3 Large drusen, extensive intermediate drusen, or non-central geographic atrophy

in at least one eye

Grade 4 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 1st month 2

nd month 3

rd month

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Result:-Gradation wise Improvement in Sign & Symptoms

Discussion:

We have selected the “Mustadiyogaghrita”

having guna,rasa, veerya,vipak which are

suggestive to break down the

Samprati(aetiopathology) of Tritiya-

Chaturthapatalgatadoshdushti.Ithas a

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 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, Anti-

inflammatory,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

DOV

Distorted vision

Drusens

SN Symptoms Total

BT

Total

AT

Total Difference

BT-AT

Result

BT-AT*100/BT

1 DOV 76 45 31 40.78%

2 Distorted vision 23 7 16 69.56%

3 Drusens 14 14 0 0%

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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

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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

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

Reference:-

1. Parsons‟ Diseases of the Eye, Editted

by Ramanjit Sihota &

RadhikaTandon, Elviser Publishers

21th Edition,20th

Chapter p.319

2. Clinical Opthalmology.Jack J

Kanski& Brad Bowling, Elviser

Publisher 7th

Edition 14th

Chapter

p.611-616

3. 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)

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5. AacharyaSushruta„„SushrutaSamhita

”Edited

ByKavirajaAmbikaduttashastri,

Uttartantra Chapter 7, Chaukhambha

Sanskrit SansthanPrakashan.(su.u

7/12)

6. Sharangdharacharya

„SharangdharaSamhita‟‟JivanpradaS

avimarsha Hindi VyakhyaSamhita,

Edited By Dr.

ShrimatiShailajaShrivastav,Chaukha

mbhaOrientaliyaPrakashan

2011.Madhyamakhanda 9

snehaprakaran

7.

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ISBN 978-93-5173-179-3 ISSN 2320-7329





.

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)

Ayurlog: National Journal of Research in Ayurved Science-2014; 3(2): 1-11

Documents

Clinical Study of MustadiYogNasya, Tarpana and Basti in ... · Vatadosha,Asthi and degenerative disorders so Bastiis preferably chosen for internal route. Keeping this in mind the