ocular therapeutics and kriyakalpa in ayurveda
TRANSCRIPT
Monday, May 1, 2023
Ocular Therapeutics (KRIYAKALPA)
in Ayurveda
Dr Prasanta Kumar SahooM.S (Ay) Shalakya, Netraroga. (NIA,Jaipur)
AMO, GAD, ADAVA
Monday, May 1, 2023
INTRODUCTIONKRIYA KALPA = KRIYA + KALPA
KRIYA/KARMA
कर्त�व्यस्य क्रिया कर्म� कर्म� नान्यदपेक्षरे्त |प्रयत्नादिद कर्म� चेष्टि�र्तर्मुच्यर्ते |Act/ Action/ Medical treatment/ Practice (MW dictionary)
KALPA – KALPANA/ YOJANA
कल्प्यरे्त व्यवस्थाप्यरे्त प्रयोगा अनेनेक्रिर्त कल्प ।प्रयोग पद्धक्रिर्तक्रिनर्मा�ण पद्धर्तीक्रिर्त कल्प एवेक्रिर्त कल्पना ॥Practicable / Idea/ Art of preparing medicine (MW dictionary)
KRIYAKALPA:
The unique branch of medicine which deals with specialized
topical ocular procedures/ methods of preparation for the
management of different diseases of eye and Adnexa.
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WHY KRIYA KALPA?Blood aqueous barrier
Blood retinal barrier
Less doses required for optimum therapeutic effect
Like skin, structures of Eye are exposed to outer
environment. Thus - to clean/remove surface pathogens
topical therapies are essential.
For diseases of lid and lacrimal apparatus …
No biodegradation of drugs.
Non surgical and cost effective.
Can be used as preventive as well as curative.
WHAT ARE THESE?TYPES
These are specifically designed according to the stage, severity and site of the diseases. Sushruta the father of Indian Ophthalmology mentioned five Kriyakalpas. TarpanaPutapakaSekaAschotanaAnjana ANDTwo more procedures added by Sharangadhara and Vagbhata. i.e. Pindi and Vidalaka.
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ASCHYOTANA
(आश्च्योतन) Instillation of the medicated solution into the conjunctival sac
when the eye is completely open and patient is in supine position.Indicated as first line of treatment in all ocular inflammatory conditions where Raga(congestion),Daha (burning pain), Ashrusrava (excessive lacrimation), Sopha (inflammaiton) and Toda (pricking pain) are present.Methods : Decoctions prepared with leaves, bark etc. The decoction should be neither concentrated nor diluted and it should not be too hot or too cold.Dose : 1-2 (Ghrita manda) / 7-8 /10/ 12 drops.Duration: 3 to 5 daysHolding time/ धारण काल: 100 वाक र्मात्रा (= 2.5 minutes)
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SEKA (सेक/ परिरसेक)
Pouring of thin stream of medicated solution into the closed eyes for a stipulated period.Indicated in acute and severe affections of the eye.Doses/ Procedure time: L/S/R- 200/400/600 वाक र्मात्रा (7/ 10/ 12 minutes)Duration – 3- 5 days.
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Drugs / Formulations used in Ashyotana / Seka
Bacterial / Viral conjuctivitis: Triphala + Lodhra+Yastimadu+ Musta decoctions.
Allergic conjuctivitis- Haridra / Daruharidra/ Yastimadhu/ Sirisha
VKC- Shigru Patra swarasa/juice. Dry eye- Milk+ Haridra+ Daruharidra+
saidhava lavana. Ocular injuries- Human milk.
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Cont..Corneal opacities (Sukra roga)- Amla+Nimba +
Kapitha Patra+ Yastimadhu+ Lodhra+
Khadira+Tila decoction (Y.R)
Cataract- Triphala decoction (Ch.D)
Pterygium- Karanja bija+Milk
Pothaki (Trachoma)- khadira+ shigru+ Adhaki
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PINDI (क्रिपन्डी) / Kavalika
In Pindi-mild sudation is applied over the eye by luke warm paste made out of different plant parts.Indications:Conjuctivitis, Glaucoma, Inflammatory conditions of eye Drugs used Eranda patra , moola, etc.Amla / mahanimbaShigru Triphala
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BIDALAKA (बि�डालक)In Bidalaka–paste of different drugs is applied over the closed eyelids leaving the eye lashes.Indications: it is indicated in mild inflammatory conditions of the eye.तरूण नेत्र रोग (prodormal conditions)अश्रुस्राव (Hyperlacrimation)वेदना (Pain)तोद (Pricking sensation)कनु्ड (Itching)शोथ (edema) Mostly in the diseases of eye lids and lacrimal apparatus- stye, blepharitis, lid abscess, trichiasis.Drugs used are- Manjistha, Chandana, Sariva.Like mukha lepa – Saindhavadi lepa – Saindhava lavana, Rasanjana, yastimadhu and daruharidra.
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TARPANA (तप"ण)
Concentric boundary is formed around the orbit and medicated ghee (clarified butter) and oils are filled for a stipulated period.Drug used: Ghee /medicated ghee. Indications: It is indicated in a variety of ocular disorders such as Jihyata (squinting)Tamyata (symptomatic visual disturbances)Rookshata (dryness) Adhimantha (Glaucoma)Average time prescribed is 20 minutes Quantity required 20ml for each eye For 3/ 5/ 7 days can be advised.
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Cont..
Jivantyadi Ghrita- ARMD, Optic atrophy and
degenarative disorders of retina.
Patoladighritha- Uveitis
Doorvadyaghrita- DR( NPDR)
Mahatriphalaghritha- Senile cataract, Refractive
disorders, RP
Triphalaghritha- Refractive disorders,
Tikthakaghritha- corneal opacity
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TARPANA (तप"ण)
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PUTAPAKA (पुटपाक)Topical application of extracts prepared out of plant drugs,
animal flesh, mineral drugs and fats, byn heating their
mixture (paste) in a closed chamber.
This extract is retained over the eyes as in Tarpana.
Compliance, disposal and tissue contact time are also same
as in Tarpana.
Pippalyadi Putapaka- Retinitis pigmentosa (RP)-
(Sleshmavidagdha dristi)
Krushnadi Putapaka- Lekhana (Scraping properties)-
Corneal opacity.
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ANJANA (अन्जन)(Application of Collyrium
Topical application of the drug in the form of powder/paste/
thick liquid into the conjuctival fornices with an applicator.
Anjana means which spreads or propagates‘Anakti anena
anjanam’.
According to its form Anjana is of 3 types i.e. Gutika,
Rasakriya and Churna.
Even though anjanas are meant for eye diseases it has wide
applications in systemic diseases too.
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Indications: Anjana is indicated when clinical features of doshas have
become manifested and localised in the eye and acute inflammatory
signs are subsided by the application of seka and aschotana.
Contra-indications: In acute inflammatory conditions.
Drug used: Compound drugs prepared of metals, minerals and herbs.
Generally antimony ,lead and tin compounds are frequently prescribed.
Dose: Harenu matra
Post Anjana Karma- Pratyanjana
Naktandhya (Night blindness)- maricha+ dahi anjan, pippalyadi
anjan.
Chandrodaya varti anjan- Arma (Pterygium)
Guduchi rasakriya anjan- vascular disorders of retina , optic nerve
diseases etc. Chandraprava varti anjana- degenerative conditions of
conjuctiva- pingeicula etc.
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Selection of Kriyakalpa (Stage)
Status Therapy
Inflammatory conditions (Amma avastha)
Seka AschyotanaPindiBidalaka
Non inflammatory conditions(Nirama Avastha)
TarpanaPutapakaAnjana
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Cont.. SEGMENT THERAPY
ANTERIOR ASCHYOTANASEKATARPANAPUTAPAKAANJANA
POSTERIOR TARPANAPUTAPAKAANJANA
NASYA
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Cont..SURFACE LESIONS/ ADNEXA
LENSCILIARY BODY IRIS
RETINAOPTIC NERVE
VISUAL PATHWAY
TARPANA PUTAPAKA SEKA ASCHYOTANA ANJANA PINDI BIDALAKA
SEKAASCHYOTANA ANJANA TARPANA
TARPANA
PUTAPAKA
ANJANA
NASYA
TARPANA
PUTAPAKA
ANJANA
NASYA
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PHARMACOLOGICAL ACTIONKRIYAKALPA MODE OF ACTION &
DRUG DELEVERYAdvantage Disadvantage
Aschyotana Direct Diffusion Better complianceCommonly use
Less tissue contact time
Seka Direct Diffusion Removes surface pathogens
Drug excretion moreLess bioavailabity
Pindi Trans-cutaneous drug absorption and pressure effect e.g. in Glaucoma
Better compliance.Tissue contact time more
Transient effectNeeds repeatation- long term use.
Vidalaka Trans-cutaneous drug absorption
Better compliance.Tissue contact time more
Mostly limited to lids, adnexa and anterior segment eye diseases.
Tarpana Bothe precorneal and corneal drug absorptionBoth lipd and water soluble drugs absorbed
Tissue contact time moreEffective both in ant. And post. Segment.
After follow up little difficult.
Putapaka Drug ionisation, nano particles. Better absorption, bioavailability more
Tissue contact time moreVery effcetive in both ant. And post. Eye diseases
Very concentrated, Complications more
Anjana Solid drug deliveryBoth conjuctival , scleral.
Tissue contact time more.Prolong drug deliveryEffective both in ant. And post. Segment.
Patient compliance less.
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FACTORS RESPONSIBLE FOR OCULAR DRUG DELIVERY
Routes of drug administration- in case of Kriyakalpa mainly mocosal and cutaneous routes..Solubility and bioavailability- lipid soluble/ water soluble/ aqeous suspensions( medicated ghee/oils), tissue contact timePhysical state of the drug- colloids / crystalloids, concentrated tonicity/ pH, molecular weight, Absorption (Time and rate of absorption)Absorbing surface- surface areaVascularity of the surfaceCompliance and excretion of the drugs.Ionisation of the drug- non ionised drugs penetrate the lipid cellular layers. Microimulsions – oil+water- surfactants
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SUMMARY WHY KRIYAKALAPA?
WHAT ARE THESE?
HOW THESE ARE DONE?
WHICH CONDITIONS
PHARMACOLOGY AND OCULAR DRUG DELIVERY
ANALOGY AND COMPARISION BETWEEN MODERN
AND AYURVEDA OCULAR DRUG DELIVERY SYSTEM.
FUTURE PROSPECTIVES
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CONCLUSIONAncient medical shcolars were aware of the mechanism of blood aqueous barrier as well as ocular pharmacologyPutapaka is highly developed Nanoconcept which is been used since thousands of years.By Pindi and Bidalaka therapies, vasodilatation and drainage of toxins from the site of lesion is possible. In all the drug preparations of Kriyakalpa mostly herbal and natural excipients are used like -Honey- best natural preservative Antioxidant – Triphala Surfactant- Nirmali bijaViscosity – honey, ghee etcTonicity – saindhavalavana etc.ANIMAL STUDIES WITH CONTROL GROUPS ARE REQUIRED TO STANDARDISE THE PROTOCOLS FOR TREATMENT PURPOSES.
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TAKE HOME MESSAGE
NON SURGICAL NON INVASIVE
COST EFFECTIVE
BOTH PREVENTIVE AND CURATIVE
EFFECTIVE IN BOTH ANT. AND POIST.
SEGMENT DISEASES
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CONT..
चक्ष्युरक्षायां सव"कालं मनुष्यॆय"त्नः कत"व्यो जिजवीते यावदिदच्छा । व्यथ5 लोकोऽयं तुल्यराबित्रदिदवानां पुंसामन्धानां बिवद्दमानेऽबिप बिवते्त ॥ (A.H. U.13/97)
“All effort should be made by men to protect the
eyes, throughout the life; for the man who is blind
this world is useless, the day and night are the
same even though he may have wealth”.
(A.H.U.13/98)
Monday, May 1, 2023
Thank You