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A riveting case study on retinitis pigmentosa through ayurvedic management

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Journal name: Ayushdhara
Original article title: A riveting case study on retinitis pigmentosa through ayurvedic management
AYUSHDHARA is an international peer-reviewed journal. It focuses on research in Ayurveda, Yoga, Unani, Siddha, Homeopathy, Allopathy, and Pharmaceutical Sciences.
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Author(s):

Prakruthi.G*
PG Scholar, Sri Kalabyraveshwara swami Ayurvedic Medical College and Research Centre, Vijayanagar, Bangalore, Karnataka
Hamsaveni.V
Guide and Professor, Sri Kalabyraveshwara swami Ayurvedic Medical College and Research Centre, Vijayanagar, Bangalore, Karnataka


Ayushdhara:

(A peer-reviewed, bi-monthly open-access journal)

Full text available for: A riveting case study on retinitis pigmentosa through ayurvedic management

Year: 2017

Copyright (license): CC BY-NC-SA 4.0


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Summary of article contents:

Introduction

Retinitis pigmentosa (RP) is a heterogeneous group of retinal dystrophies characterized primarily by the degeneration of rod photoreceptor cells, leading to progressive vision loss and potentially resulting in blindness by middle age. It manifests early in life, often starting with night blindness (nyctalopia) and subsequently affecting peripheral vision and color perception. The prevalence of this condition is about 1 in 5,000 people globally. Diagnosis typically involves a combination of visual acuity tests and fundoscopic examination, which usually reveals signs such as attenuated blood vessels and retinal bone spicule pigmentation.

The Ayurvedic Perspective on Retinitis Pigmentosa

In Ayurvedic medicine, RP is likened to the condition termed "Kaphavidagdha drushti," which reflects an imbalance in the body's Kapha dosha affecting vision. The management involves comprehensive treatment protocols based on ancient Ayurvedic texts. This includes therapies aimed at detoxification (Kaya shodhana), cleansing the head area (Shirashaodhana), and rejuvenating treatments (Rasayana pratyogas). Key Ayurvedic practices applied in this case included deepana and pachana (appetizers and digestives), snehapana (oleation), and various ocular therapies like Tarpana and Anjana that nourish and clean the eyes, utilizing specific herbal formulations that are believed to possess healing properties for the ocular region.

Traditional Treatment Approaches

The treatment protocol incorporated a series of Ayurvedic treatments to restore balanced doshas and improve visual function. The patient underwent shodhana therapies, including virechana (purging) and nasya (nasal administration of oils), designed to expel accumulated impurities from the body. Additional steps involved Tarpana, a therapeutic eye procedure using medicated ghee to rejuvenate the ocular tissues, and Kanadi putapaka, which further strengthened visual acuity. These treatments were complemented with dietary plans focusing on nourishing foods such as Amalaki payasa. The success of these treatments was monitored through visual acuity assessments that showed notable improvement after the therapeutic regimen.

Conclusion

This case study illustrates the potential of Ayurvedic interventions in managing conditions traditionally deemed untreatable by modern medical standards, such as retinitis pigmentosa. Through a holistic approach targeting both the physical and metabolic aspects of the patient’s health, significant improvements in visual acuity and quality of life were observed. The findings support the therapeutic efficacy of Ayurvedic principles in restoring and enhancing chakshurendriya functioning and underline the importance of integrating traditional practices into contemporary healthcare for specific chronic conditions.

FAQ section (important questions/answers):

What is the condition discussed in the case study?

The case study discusses Retinitis pigmentosa (RP), a hereditary eye disease that leads to progressive vision loss due to the degeneration of retinal photoreceptor cells, primarily affecting night vision and peripheral sight.

How was the patient treated for Retinitis pigmentosa?

The patient received Ayurvedic treatment involving Kaya shodhana and Shira shodhana therapies, Kriyakalpas like Tarpana, and Rasayana proyogas. The treatment aimed to restore vision and improve overall quality of life.

What results were observed after the Ayurvedic treatment?

After treatment, the patient reported subjective improvements in vision, allowing him to perform daily activities independently. Night vision improved significantly, enabling him to recognize objects during nighttime.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “A riveting case study on retinitis pigmentosa through ayurvedic management�. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Dosha (Dosa):
Dosha in Ayurveda refers to the three fundamental bodily bio-elements, which are Vata, Pitta, and Kapha. These elements govern physiological and psychological processes in the body and mind. In this case study, an imbalance of these Doshas is involved in the disease mechanism of Retinitis Pigmentosa.

2) Madhyama:
'Madhyama' means moderate in Ayurveda. It can refer to the middle stage of progression or moderate capabilities. For example, the patient's Bala (strength), Sara (essence), and Satva (mental resilience) are assessed as 'Madhyama', indicating they are moderate.

3) Kapha:
Kapha is one of the three Doshas in Ayurveda, responsible for structure and lubrication. In Retinitis Pigmentosa, an imbalance of Kapha, along with other Doshas, affects the disease manifestation by contributing factors like 'Kapha vidagdha drushti'.

4) Tarpana:
Tarpana is an Ayurvedic ocular therapeutic procedure aimed at nourishing and rejuvenating the eyes. In this case, 'Mahatriphaladhyaghrita' was used for Tarpana, containing ingredients like Triphala and Guduchi, which are considered 'Chakshushyadravyas', beneficial for eye health.

5) Karma (Karman):
Karma in Ayurveda refers to the prescribed therapeutic actions or procedures. Different therapeutic Karmas like Nasya karma and Snehapana were employed in treating the patient, catering to Panchakarma and rejuvenation practices to improve vision and overall eye health.

6) Netra:
Netra means eye in Sanskrit. The term 'Netra Pariksha' refers to the ocular examination conducted in diagnosing conditions like Retinitis Pigmentosa. The treatment aimed at improving the 'Chakshurendriya', or eye faculty, through various Ayurvedic processes.

7) Pariksha (Pariksa):
Pariksha means examination or investigation. Different types of Pariksha, including Ashta sthana (eight types of examination) and Dashavidha Pariksha (tenfold examination), were used to assess the patient’s condition comprehensively.

8) Rasayana (Rasa-ayana):
Rasayana refers to rejuvenation therapy in Ayurveda. The treatment embraced 'Rasayana proyogas' to enhance the longevity and vitality of the tissues, including the eye tissues affected by Retinitis Pigmentosa. Ingredients like Guduchi were used for their Rasayana properties.

9) Patala:
Patala refers to the layers or membranes within the body. In the context of 'Kapha vidagdha drushti', the term Tritiya patala suggests the involvement of the third layer of the eye, leading to conditions like night blindness similar to Retinitis Pigmentosa.

10) Sira (Shira):
Shira means head in Sanskrit. 'Shiro shodana' refers to detoxification of the head. Therapies like Nasya were performed for Shiro shodana to clear the Doshas affecting the upper body, including the head and eyes.

11) Drug:
In this text, drug refers to herbal formulations used in Ayurvedic treatments. For instance, Mahatriphaladhya ghrita, Chitrakadi vati, and Triphala churna were part of the medication regimen. These drugs have specific properties that target the ocular system for therapeutic benefits.

12) Blindness:
Blindness in the context of Retinitis Pigmentosa refers to the progressive loss of vision due to degeneration of photoreceptor cells. Ayurvedic management aimed at improving the patient's vision and preventing further progression towards complete blindness.

13) Triphala (Tri-phala):
Triphala is a traditional Ayurvedic herbal remedy composed of three fruits: Amalaki, Bibhitaki, and Haritaki. It is known for its beneficial effects on the eyes and was used in various forms, such as Triphala ghrita for Shodhana and Rasayana treatments in this case.

14) Vidagdha:
Vidagdha in Ayurveda refers to a condition of burning or over-acidified state, often used to describe pathological states involving digestive fire (Agni) or Doshas. 'Kapha vidagdha drushti' describes an eye condition involving inflamed Kapha Dosha.

15) Putapaka (Puta-paka):
Putapaka is an Ayurvedic ocular therapy where a medicated paste is used to nourish and cleanse the eyes. In this case study, 'Kanadiputapaka' was used, focusing on alleviating symptoms akin to night blindness by delivering nutrient-rich medication directly to the eyes.

16) Sthana:
Sthana refers to the site or location in the body affected by a particular Dosha or disease. In Retinitis Pigmentosa, the 'Sthana samshraya' of Doshas is in the Tritiya patala of the Netra, leading to symptoms like night blindness.

17) Nasya (Nashya):
Nasya is one of the Panchakarma therapies used for administering medication through the nostrils. This method is effective for treating conditions affecting the head and sensory organs. In this case, Brhingarajataila was used for Nasya to clear accumulated Doshas and improve vision.

18) Blood:
Blood, or Rakta in Ayurveda, is one of the primary bodily tissues affected in various disorders. In this study, attenuated blood vessels are noted symptomatically in Retinitis Pigmentosa, and treatments aimed at improving Rakta (blood) circulation were utilized.

19) Shodhana (Sodhana):
Shodhana refers to the purification process in Ayurveda, aiming to expel the vitiated Doshas from the body. Procedures like Virechana (purgation) and Nasya were part of Shodhana therapy used in the treatment of Retinitis Pigmentosa to alleviate symptoms.

20) Shakti (Sakti):
Shakti means strength or power. In Ayurvedic assessment, various types of Shakti such as Aharashakti (digestive power), Vyayama shakti (physical strength), and Bala (overall strength) are evaluated to determine the patient’s ability to endure and respond to treatments.

21) Nidana:
Nidana refers to the etiological factors causing a disease. In Retinitis Pigmentosa, 'Bheejopaghata' (genetic cause) is recognized along with precipitating factors like diet and lifestyle contributing to the doshic imbalance. Correct identification of Nidana helps in targeting treatment effectively.

22) Family:
The term 'Family' refers to the patient's genetic and familial background. In this case study, a detailed family history was taken to understand any genetic predisposition towards Retinitis Pigmentosa, although the patient reported no familial incidence.

23) Shiras (Siras, Siro, Shirash):
Shiras refers to the head region in Ayurveda. Treatments like 'Shiro shodana' (cleansing of the head) are crucial for disorders affecting the head and sensory organs including the eyes. Nasya therapy is one such Shiro shodana procedure applied in the case study.

24) Mamsa (Mamsha):
Mamsa refers to the muscle tissue in Ayurveda. Along with Rasa (plasma), Rakta (blood), and Meda (fat), it is one of the primary body tissues (Dushyas) involved in disease processes.

25) Rakta:
Rakta means blood. In the context of Retinitis Pigmentosa, the disorder involves changes in retinal blood vessels. Ayurvedic treatments aimed at improving 'Rasa', 'Rakta', 'Mamsa', and 'Meda' can support overall ocular health.

26) Roga:
Roga means disease or disorder in Ayurveda. In this case study, the patient was diagnosed with Retinitis Pigmentosa, corresponding to 'Kapha vidagdha drushti'. The appropriate management involved assessing 'Rogi bala' (patient's strength) and 'Roga bala' (disease intensity).

27) Kaya:
Kaya refers to the body. 'Kaya shodhana' means body purification, which was adopted as part of the management plan for Retinitis Pigmentosa. Procedures like 'Virechana' (purgation) were used to detoxify the body and reduce symptoms.

28) Rasa (Rasha):
Rasa means plasma or the initial nutrient fluid formed after digestion. It is one of the 'Dushyas' affected in Retinitis Pigmentosa. Treatments aimed at balancing Rasadhatu (plasma tissue) were integral in managing the disorder.

29) Bala:
Bala refers to the strength or immunity of a patient. Assessments of 'Bala' are vital to determining the patient's ability to undergo intensive treatments like Panchakarma. The term 'Madhyama Bala' suggests moderate strength which was a factor in the outlined treatment.

30) Vata:
Vata is one of the three Doshas, governing movement and neurological functions. In Retinitis Pigmentosa, an imbalance in Vata, along with Kapha and Pitta, affects disease progression. Treatments addressed Vata disbalances to mitigate symptoms and improve eye health.

31) Atipravritti (Atipravrtti, Ati-pravritti):
Atipravritti refers to excessive flow or activity within the body's channels (Srotas). In the pathogenesis of Retinitis Pigmentosa, Atipravritti may contribute to the disease’s progression, requiring treatments that manage and stabilize the disease pathways.

32) Nasyakarman (Nasyakarma, Nasya-karma):
'Nasya-karma' is a procedure involving the instillation of medicinal oils or powders through the nostrils, used in treating ailments of the head and sensory organs. It was part of the therapeutic approach in this case study, with 'Brhingarajatailanasya' being administered.

33) Shleshmala (Slesmala):
Shleshmala refers to substances or conditions producing Kapha or mucus. In Ayurveda, 'Shleshmala ahara' like Dadhi (curd) and Masha (black gram) can aggravate Kapha. Dietary control of these foods is essential in managing Kapha-related disorders like Retinitis Pigmentosa.

34) Karnataka:
Karnataka is the state in India where the Ayurvedic treatment of this case was conducted. Specifically, the Sri Kalabyraveshwara swami Ayurvedic Medical College and Research Centre in Bangalore, Karnataka, played a role in the detailed management of the patient’s condition.

35) Abhyanga (Abhyamga):
Abhyanga refers to the Ayurvedic practice of full-body massage with herbal oils. In the case study, 'Sarvanga Abhyanga' using Dhanwantaram taila was performed to promote circulation and facilitate the removal of toxins before the purgation therapy (Virechana).

36) Pradhana:
Pradhana means chief or main. 'Pradhana vedana' refers to the chief complaints or main symptoms presented by the patient. In this case, the patient's primary complaint was the progressive diminution of vision due to Retinitis Pigmentosa.

37) Snehana:
Snehana refers to the process of oleation, a preparatory procedure in Panchakarma therapies involving the administration of medicated ghee or oil. Mahatriphaladhya ghrita was used for 'Snehapana' to achieve internal oleation which helps in detoxifying the body.

38) Trivrit (Tri-vrit, Trivrt):
Trivrit is the botanical name for Operculina turpethum, a herb used in 'Virechana karma' (purgation therapy) due to its strong purgative properties. In this study, Trivrit lehya was used to expel the vitiated Doshas from the patient's body.

39) Dusita (Dushita):
Dushita refers to the contaminated or vitiated state, particularly of the Doshas. In the context of Retinitis Pigmentosa, the term 'Dushita kapha' describes an impure form of Kapha contributing to the disease process by entering the Tritiya Patala of the eye.

40) Vimarga:
Vimarga means deviated path in Ayurveda, referring to the displacement or wrong route taken by Doshas or bodily fluids. 'Vimarga gamana' is mentioned in the case study in the context of disturbed flow causing disease pathogenesis.

41) Nostril:
Nostril refers to the nasal passage through which Nasya therapy is administered. In this study, medicated oil drops were instilled into the nostrils as part of 'Nasya-karma' to reach and detoxify the head region, thereby alleviating symptoms.

42) Gamana:
Gamana means movement or migration. 'Vimarga gamana' refers to abnormal or deviant movement of Doshas within the body, contributing to disease mechanisms like those seen in Retinitis Pigmentosa.

43) Vedana:
Vedana means pain or sensation. 'Vedana vruttanta' refers to the history of present illness, particularly the symptoms experienced by the patient. In this case study, the chief complaint was progressive diminution of vision which was thoroughly documented.

44) Dushya (Dusya):
Dushya refers to the tissues or components of the body that are afflicted or affected by disease. In Retinitis Pigmentosa, the primary Dushyas involved are Rasa, Rakta, Mamsa, and Meda, which need to be targeted in treatment.

45) Anjana (Amjana):
Anjana refers to Ayurvedic collyrium applied to the eyes. 'Kanadi anjana', containing ingredients like Kana and Ajaksheera, was used in the treatment to enhance eye health and clear accumulated Doshas from the Netra.

46) Srotas (Shrotas):
Srotas are channels or pathways in the body that transport bodily fluids and nutrients. In the context of Retinitis Pigmentosa, Srotodushti (blockage) of Rasa, Rakta, Mamsa, and Medovaha Srotas is treated to restore proper flow and alleviate symptoms.

47) Pitta:
Pitta is another one of the three Doshas, governing metabolism and heat. An imbalance in Pitta, especially Alochaka Pitta which is associated with vision, contributes to eye diseases such as Retinitis Pigmentosa.

48) Dadhi:
Dadhi refers to curd in Ayurveda. 'Shleshmala ahara' like Dadhi can aggravate Kapha Dosha. Patients with Kapha-related eye conditions are advised to avoid Dadhi to prevent further aggravation.

49) Ahara:
Ahara means food in Sanskrit. In Ayurveda, dietary habits (Ahara) are crucial for maintaining Dosha balance. The patient's diet (mixed, non-veg) was documented to adjust based on the needs of mitigating Kapha and other Doshas in the treatment.

50) Masha (Masa, Ma-sha):
Masha is black gram, known for its Kapha-aggravating properties. Consumption of Masha should be minimized in conditions like Kapha vidagdha drushti to avoid exacerbating Kapha Dosha.

51) Sanga (Samga, Shanga, Shamga):
Sanga refers to the obstruction or blockage in the Ayurvedic system. In Retinitis Pigmentosa, there is an obstruction of Doshas in the Tritiya Patala of the eye, requiring treatments to clear the blockages and restore normal function.

52) Svamin (Swami, Svami, Swamin):
Swami can denote ownership or title; in this text, it is part of the name of the institution, Sri Kalabyraveshwara Swami Ayurvedic Medical College and Research Centre.

53) Medas (Meda, Medash):
Meda refers to fat tissue in Ayurveda, one of the primary tissues affected in many disorders. In Retinitis Pigmentosa, the 'Dushyas' include Meda among others, and therapies aimed at balancing Meda are essential for treatment.

54) Rogin (Rogi):
Rogi refers to a patient. Assessment of 'Rogi Bala' (patient strength) was crucial in determining the treatment regimen for Retinitis Pigmentosa, ensuring that therapies were appropriate for the patient's constitution and condition.

55) Guna:
Guna means quality or property in Ayurveda. Assessment of various Gunas (qualities) of the patient's body and mind is essential for diagnosing and treating disorders. For instance, the 'Chakshushyaguna' of Dhanwantaram taila is highlighted in the treatment.

56) Kana:
Kana, also known as Piper longum or long pepper, was used in 'Kanadi Anjana'. It has a Netrasodhana (eye-cleansing) property, which helps in removing accumulated Doshas from the eyes and improving vision.

57) Diet:
Diet in Ayurvedic practice is closely monitored to balance Doshas. The patient's diet, consisting of a mix of vegetarian and non-vegetarian foods, was modified, particularly reducing Kapha-aggravating substances like Masha and Dadhi.

58) Rice (Rce):
Rice is a common dietary staple used in various Ayurvedic post-treatment dietary regimens, such as 'Samsarjana karma', following purgation where thin and thick rice gruel gradually reintroduces regular diet.

59) Sthanasamshraya (Sthanasamsraya, Sthana-samshraya):
'Sthana-samshraya' refers to the stage of disease where the Doshas localize in specific body sites. In Retinitis Pigmentosa, Doshas accumulate in the Tritiya Patala of Netra, leading to symptoms like night blindness.

60) Vyayamashakti (Vyayamasakti, Vyayama-shakti):
'Vyayama-shakti' indicates the patient's physical strength and stamina. It's one of the tenfold examinations in Ayurveda, assessing how well a patient can endure physical activities and respond to treatment.

[Note: The above list is limited to 75. Total glossary definitions available: 139]

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Tarpana, Samprapti, Putapaka, Kriyakalpa, Snehapana, Virechana Karma, Urdhwajatru, Chakshurendriya, Retinitis Pigmentosa, Rogi and Roga bala.

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