REVIEW ON EFFECT OF AYURVEDICTREATMENT IN THE MANAGEMENT

OF DIABETIC RETINOPATHY

Krishna Kumar V 1

Prof. Manjusha R.2

1. 1st year Ph.D.scholar, Dept. of Shalakya Thantra, I.P.G.T. & R.A. Jamnagar

2. Professor & H.O.D, Dept. of Shalakya Thantra, I.P.G.T. & R.A. Jamnagar

INTRODUCTION

• Diabetic retinopathy (DR), the leading cause of visual disability in diabetics, is an important complication of diabetes mellitus (DM)

• Prevalence in India ranges from 17.6% to 28.2%.

• Conventional treatment -LASER Photocoagulation-side effects

• Intravitreal pharmacotherapies -heavy cost

• DM incorporated in the Vatika stage of Prameha -Madhumeha

• Netra Prakashika -Shri Pujyapada Mahamuni, description of Timira as a cause/complication of Meha (Madhumeha)

• DR- Madhumehajanya Timira

Healthy Retina Diabetic Retinopathy

MATERIALS AND METHODS

• All the theses works have been collected from Department of Shalakya Thantra of respective universities

• The procured theses were studied in detail and scientific review was done.

I.P.G.T& R.A

• Trial 1-A Clinical study to evaluate the role of holistic Ayurvedic treatment in PremehajaTimira w.s.r Background Diabetic Retinopathy (2013) Priyanka rani, K.S.Dhiman, ManjushaR, Anup Thakar, Hitesh Vyas et al

• Group A: (Trial Group) - 15 Patients

• Group B: (Control Group) - 15 Patients-Diagnosed patients-DM-observation

• Trial Group

• deepana pachana- Trikatu

• Snehapana- Triphala ghrita

• Swedana

• Virechana- Triphala, Trivrita and Katuki Powder in a ratio of 2:1:1

• Takra Shirodhara- Takra+Amalaki

• Pratimarsa nasya- Anutaila

• Oral medication (anubhuta rasayan yoga)

Group No of eyes Mean BT Mean AT % of relief 'p' value

Diminished

vision

A

B

15

15

1.500

1.500

0.933

0.933

37.80

37.80

<0.001

<0.001

Frequent change

in presbyopic

glass

A

B

02

01

0.133

0.066

0.000

0.000

100.00

100.00

<0.05

>0.05

Perception of

flashes

A

B

01

01

0.133

0.066

0.066

0.066

50.15

00.00

>0.05

>0.05

Floaters A

B

04

01

0.267

0.133

0.522

0.133

74.90

00.00

<0.05

>0.05

Problem for

dark adaptation

A

B

08

04

0.733

0.333

0.000

0.333

100.00

00.000

<0.001

>0.05

Microaneurysm A

B

08

12

0.433

0.900

0.300

0.867

30.71

3.7

<0.05

>0.05

Haemorrhage A

B

14

14

1.000

2.00

0.967

1.00

3.33

50.00

>0.05

<0.001

Exudates A

B

10

13

1.033

0.900

0.833

0.833

19.36

4.25

<0.05

>0.05

BCVA A

B

79.333

82.000

86.000

87.000

8.40

6.09

<0.001

<0.001

FBS A

B

186.067

176.667

137.133

149.733

26.29

15.24

<0.001

<0.05

PPBS A

B

260.867

246.267

222.000

209.400

14.89

14.97

<0.01

0.010

HbA1c A

B

7.787

7.619

6.933

7.325

10.96

3.84

<0.05

<0.05

Serum

cholesterol

A

B

220.267

229.73

198.667

210.333

9.80

8.44

<0.01

<0.05

Urine sugar A

B

2.000

2.250

1.167

0.500

41.65

77.73

<0.05

<0.001

I.P.G.T& R.A

• Trial-2 Further Clinical Study on Pramehajanya Timira (Background Diabetic Retinopathy) & its Ayurvedic Management-: (2015) Haripriya. H, K. S. Dhiman, Hitesh Vyaset al

• Group A: (Trial Group) - 21 Patients

• Group B: (Control Group) - 21 Patients Diagnosed patients-DM-observation

• Trial group• Deepana pachana- Chitrakadi vati/ Trikatu

choorna• Kostha shodhana- Kwatha containing Draksha,

Taruni pushpa, Hareetaki and Aragwadhamajja• Sthanika sodhana- pippali and saindhava avapida

nasya• Marsha nasya /Pratimarsa- Drakshadi ghrita• Sirolepa -Mukkadi Bidalaka yoga• Oral Rasayana drug

RESULT

• Group A -significant effect on diminished vision ,floaters and dark adaptation problems than Group B.

• On frequent change in presbyopic glasses and perception of flashes of light none of the treatment was effective.

• Treatment on Group A -more effective in reducing microaneurysms, dot-blot haemorrhages, soft exudates and Intraretinal Microvascularabnormalities than Group B.

K.U.H.S

• Trial-3 Effectiveness of durva swarasapratimarsa nasya in retinal haemorrhages associated with Non-proliferative diabetic retinopathy(2015) Manu.v.k, S.Sunil Kumar, Kusumam Joseph et al

• Trial Group - 20 eyes- pratimarsa nasya-Durva swarasa

• Control Group - 20 eyes- pratimarsa nasya-Ksheerabala tailam 7 avarthi

RESULT

• Both the groups are equally significant from 21st day assessment onwards.

• Durva swarasa -having comparatively immediate action in controlling retinal haemorrhage than conventionally used Ksheerabala 7 avarthi.

K.U.H.S

• Trial-4 The efficacy of ayurvedic management in Proliferative diabetic retinopathy -A randomised controlled trial. Vinitha T V,Sreeja Sukesan, Kusumam Joseph, S. R. Krishnamoorthy et al (2013)

• Trial Group - 15 Patients

• Control Group - 15 Patients- Pan Retinal Photocoagulation

• Trial Group• Sthambana nasya - durva swarasa +equal

quantity of aja kseera• Talam - kseerabala tailam + kachooradi choornam• Sirolepa -Mukkadi purambada +Triphala kwatha• Sirodhara - mridweekadi kseera kashaya• Samana Snehapana -Mahatriphala gritha• Prathimarsa nasya – anutaila• Anjana -chandanadi varthi mixed with honey• Kshalana -yashti darvi kwatha

RESULT

• Overall % of improvement in vision -5.4 in trial group & 0 in control group

• Treatment protocol - more effective in reducing floaters and clearing fibrosis

• Both the therapies - equally effective in relieving erythropsia and controlling vitreous hemorrhage.

• Control group -more effective in treating pre retinal hemorrhage and regression of new vessel

R.U.H.S

• Trial-5 Management of diabetic retinopathy with doorvadya ghrita tarpana and internal administration of mahavasadi kwatha-(2010-2011) a comparative study AdoorVeeranagouda, Ramesh et al

• Group A: - 15 Patients- doorvadya ghritatarpana

• Group B: - 15 Patients-mahavasadi kwatha

• Group C: - 15 Patients-both

Group No of eyes Mean BT Mean AT % of relief 'p' value

Diminished

vision

A

B

C

19

24

24

1.033

1.287

1.155

0.733

0.891

0.594

29.00

31.00

49.00

<0.01

<0.001

<0.0001

Microaneurysm A

B

C

23

21

21

1.333

1.122

1.386

1.233

0.825

1.089

7.5

26.5

21.4

<0.05

<0.0001

<0.0001

Intraretinal

Haemorrhage

A

B

C

29

28

29

1.87

1.815

2.046

1.43

1.518

1.584

23.5

16.4

23

<0.001

<0.0001

<0.001

Exudates A

B

C

28

28

29

1.73

1.683

2.013

1.43

1.386

1.65

17.3

18

18

<0.01

<0.0001

<0.001

NVE A

B

C

07

09

12

0.467

0.433

0.7

0.4

0.367

0.633

14.3

15.5

10

>0.05

>0.05

>0.05

BCVA A

B

C

30

30

30

0.740

0.785

0.647

0.827

0.785

0.818

11.8

0

26.4

<0.05

>0.05

<0.01

Colour fundus

photograph

A

B

C

30

30

30

1.567

1.977

2.167

1.533

1.867

2.133

2.2

5.56

2

>0.05

<0.005

>0.05

R.U.H.S

• Trial-6 A comparative study on Takradharaand Vaasakadi kwatha orally in the management of Diabetic retinopathy (2012-2013) - Bhavya.B.M, Ramesh etal

• Group A: - 15 Patients- Takradhara

• Group B: - 15 Patients- Vaasakadi kwatha

• Group C: - 15 Patients- Tuvarakadi Anjana

Group No of eyes Mean BT Mean AT % of relief 'p' value

Blurred

vision

A

B

C

27

28

30

1.278

1.266

1.5

0.689

0.666

0.916

45.94

47.393

38.889

<0.0001

<0.0001

<0.0001

Microaneurysm A

B

C

29

26

24

1.206

1.233

1.233

0.896

0.6

0.85

25.71

51.338

31.081

0.0001

<0.0001

<0.0001

Intraretinal

Haemorrhage

A

B

C

29

30

30

1.379

1.23

1.4

0.896

0.65

1.266

35.003

47.154

9.524

<0.0001

<0.0001

<0.01

Exudates A

B

C

25

18

25

0.896

0.70

1

0.862

0.633

0.966

3.84

9.571

3.333

>0.10

<0.05

>0.05

IRMA A

B

C

09

06

06

0.310

0.20

0.2

0.310

0.20

0.2

0

0

0

>0.05

>0.05

>0.05

BCVA A

B

C

30

30

30

0.672

0.716

0.663

0.734

0.83

0.756

9.231

15.813

14.071

<0.0001

<0.0001

<0.0001

Colour fundus

photograph

A

B

C

30

30

30

1.344

1.266

1.4

1.206

0.766

1.3

10.256

39.476

7.143

<0.05

<0.0001

<0.10

Venous

abnormalities

A

B

C

02

04

10

0.068

0.133

0.333

0.068

0.133

0.3

0

0

9.99

>0.05

>0.05

>0.10

DISCUSSION

• Virechana -Kledaharana, Pitta shodhana, Rakta prasadana

• Anutaila Pratimarshanasya -srotoshodhanaand sense organ rejuvenating

• Takra Shirodhara -Pitta shaman and mental relaxant

• Rasayana yoga -chakshushya and Pramehahara

• Avapeeda nasya -urdhwa srota sodhana

• Drakshadi ghrita Marsa and Pratimarshanasya -srotoshodhana and sense organ rejuvenating

• Takra Shirolepa -Raktha sthambhaka,Kledaharana,Sophaharana and mental relaxant

• Durva swarasa -nasya in nasagata raktapittaby acharya Charaka..

• It has the qualities of sthambana dravya said by vaghbataacharya -kashaya tikta & madhura rasaas.

• Above rasas& laghu guna -kapha samana.

• Above rasas, sheeta veerya and madhuravipaka. - pitta-rakta samana

• Resolving retinal haemorrhages -rakthasthambhana property and preventing further haemorrhages -kapha-pitta samana property.

• Doorvadya ghrita -rakta-pittahara - augments the absorption of intra retinal hemorrhage. Chaksusya property of drugs helps in improvement of vision.

• Mahavasadi kwatha &Vasakaadi Kwatha -prameha samprapthi bhanga, also augments the absorption of intra retinal haemorrhages and exudates.

• Takra dhara accelerate the function of tarpakakapha, and may also bring in the specific action as demanded by the disease condition like blockage of channels by kapha which can be taken as micro vascular occlusion which is the basic pathological process seen in Diabetic retinopathy.

CONCLUSION

• Thus by these virtues the Ayurvedic approach is helpful in giving a complimentary treatment protocol for Diabetic retinopathy.

• Dilated eye examination of diabetics is important for early detection and prevention of DR

THANK YOU