ocular therapeutics and kriyakalpa in ayurveda

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Ocular Therapeutics (KRIYAKALPA) in Ayurveda Dr Prasanta Kumar Sahoo M.S (Ay) Shalakya, Netraroga. (NIA,Jaipur) AMO, GAD, ADAVA 6/12/22

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Page 1: OCULAR THERAPEUTICS AND KRIYAKALPA IN AYURVEDA

Monday, May 1, 2023

Ocular Therapeutics (KRIYAKALPA)

in Ayurveda

Dr Prasanta Kumar SahooM.S (Ay) Shalakya, Netraroga. (NIA,Jaipur)

AMO, GAD, ADAVA

Page 2: OCULAR THERAPEUTICS AND KRIYAKALPA IN AYURVEDA

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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.

Page 4: OCULAR THERAPEUTICS AND KRIYAKALPA IN AYURVEDA

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.

Page 18: OCULAR THERAPEUTICS AND KRIYAKALPA IN AYURVEDA

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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

Page 21: OCULAR THERAPEUTICS AND KRIYAKALPA IN AYURVEDA

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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.

Page 22: OCULAR THERAPEUTICS AND KRIYAKALPA IN AYURVEDA

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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

Page 23: OCULAR THERAPEUTICS AND KRIYAKALPA IN AYURVEDA

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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

Page 24: OCULAR THERAPEUTICS AND KRIYAKALPA IN AYURVEDA

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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)

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Thank You