Clinical efficacy of Tila Taila Paada Abhyanga and Eye Exercises in the management of Timira w.s.r. to Simple Myopia

Zeba Afroz MB; Mallikarjun S. Yalagond; Asha V. Karki

doi:http://dx.doi.org/10.21760/jaims.7.9.8

2020

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Afroz Z et al: Tila Taila Paada Abhyanga Eye Exercises Timira w.s.r. Simple Myopia

Introduction

Ayurveda, the Upaveda of Atharvaveda is an oldest healing science, well known for its holistic system of medicine and aims at promoting good health, preventing diseases and curing ill-health.^[1] According to Ayuveda “Chakshuhu Pradhaanam Sarveshaam Indriyaanaam.”^[2] Eyes are the most important organs among the five Jnanendriyas. Explaining the importance of eyes, Aachaarya Vaagbhata states “A person who desires for a long life must take care of his eyes throughout his life, as for a blind man there is no difference between day & night. Hence forth even though he has wealth, he will be poor.”^[3] Timira, one among the Drishtigata Rogas, presents with improper vision and various other symptoms based on the involved Patala. Doshas affecting the Prathama Patala lead to Prathama Patalagata Timira characterized by Avyakta Darshana i.e., blurring of vision.^[4] and hence, ‘Prathama Patalagata Timira’ can merely be taken as ‘Simple Myopia’, a subtype of Myopia. Myopia or Short Sightedness is one of the errors of refraction characterized by poor/ blurring of distant vision. Simple myopia, the most common form of myopia, described as physiological error, develops in childhood and almost always increases in severity until middle to late teenage years. Individuals with myopia also present with asthenopic symptoms. Dinacharya is a concept in Ayurveda to design one’s daily diet and regimen necessary for the maintenance of health of an individual. Abhyanga is one of the procedures mentioned in the context of Dinacharya and Abhyanga of Shira, Karna and Paada is specifically mentioned owing to its multiple benefits.^[5] Paada Abhyanga is said to be Drishti Prasaadaka by the Acharyas.^[6] The hectic computerised life style, faulty food habits, and negligence in following daily and seasonal regimen provoke many eye problems. Paada Abhyanga is an easy and effective therapy for Drishtiprasaadana. According to Yogaratnakara “The person who massaged his/her feet regularly before sleeping, diseases never goes to that person just like a snake which does not approach eagles.^[7] Eye Exercises nourishes the ciliary muscles, aqueous and vitreous humour; improving accommodating and focusing power of the eyes thereby correcting the refractive errors.^[8] Myopia is always associated with strain to see at distance. It is stated that the abnormal action of external muscles of eyeball is accompanied by a strain or effort to see and with the relief

of this strain the action of muscles become normal and all errors of refraction disappear.^[9]There are a number of eye exercises which helps in relieving them. This exercise aids to relieve the muscle strain and strengthen the ocular muscles. As they are simple and easy to practice, they can be advised to all age groups.

Aims and Objectives

To study the Combined effect of Tila Taila Paada Abhyanga and Eye Exercises in Timira w.s.r. to Simple Myopia.

Materials and Methods

The volunteers were selected irrespective of their Gender, Religion, Occupation, Qualification etc. Total 15 volunteers were recruited for the study from R.K.M. Ayurved Medical College, Hospital and P.G. Research Centre; Vijayapura. An elaborative case taking proforma was specially designed for the purpose of incorporating all aspects of the disease on Ayurvedic and Modern parlance.

Informed and written consent were taken from all the registered patients for the trial.

Diagnostic Criteria

Based on the chief complaint i.e., blurred distant vision (Avyakta Darshana)
Snellen’s distant vision chart reading
Autorefractometer reading

Inclusion Criteria

Patients presenting with clinical features of Prathama Patalagata Timiras.r. to Simple Myopia.
Patients with refractive error less than or equal to - 6D.
Patients aged between 08 to 40 years of age.

Exclusion Criteria

Patients presenting with clinical features of Dwitiya, Tritiya and Chathurtha Patalagata Timira.
Other types of Myopia – Congenital Myopia, Progressive Myopia, Acquired Myopia.
Patients of Myopia with diagnosed systemic illnesses like uncontrolled Hypertension, Diabetes Mellitus; T.B. etc.
Other forms of Ametropia.

Journal of Ayurveda and Integrated Medical Sciences 2022;7(9)58

Afroz Z et al: Tila Taila Paada Abhyanga Eye Exercises Timira w.s.r. Simple Myopia

Study Design: 15 patients were randomly selected on the basis of signs and symptoms of Prathama Patalagata Timira w.s.r. to Simple Myopia. Paada Abhyanga and Eye Exercises were done morning and night for 20 days

Posology

Medicine - Tila Taila
Quantity - As per the requirement, which approximates upto 30 to 40 ml for each use
Time - Pada Abhyanga of both feet for 10 mins

Eye Exercises: Eye exercises adopted in this study are Eye Wash, Palming, Blinking, Sideways viewing, Front and Sideways viewing, Up and Down Viewing, Rotational Viewing, Nose tip Gazing, Near and Distant Viewing.

General tips given before performing Eye Exercises:

To take off glasses or contact lenses.
To intensely concentrate on eyes while performing the exercises.
Perform each exercise for 10 cycles.
Repeat palming after each exercise.
Perform Shavasana for a period of 5-10 minutes at the end of all the exercises.

Assessment Criteria: Effect of the therapies was assessed by the relief found in the signs and symptoms before, during and after treatment. It was on the basis of the self - formulated scoring scale according to the signs and symptoms.

BT (Before Treatment) - 0^th day or on the day of enrollment
DT (During Treatment) - On the 10^th day of the treatment
AT (After Treatment) - On 20^th (last day of treatment) and 31^st day (follow up)

Parameters

Subjective Parameters: Poor Distant Vision, Headache, Eye Strain, Watering of Eyes, Burning Sensation in Eyes.

Objective Parameters: Visual Acuity (Right Eye), Visual Acuity (Left Eye), Visual Acuity (Both Eyes), Clinical Refraction (Right Eye), Clinical Refraction (Left Eye).

Gradation Index: To give some objectivity to the symptoms for the statistical analysis grading was assigned as shown in table.

Table 1: Subjective Parameters

Symptom	Grading
1. Poor Distant Vision	No poor distant vision – 0
	Mild (Occasional) – 1
	Moderate (Intermittent adjust with squeezing eyes) – 2
	Severe (Tolerable with refractive aids) – 3
2. Headache	No headache – 0
	Mild (Occasional dull aching pain) – 1
	Moderate (off and on headache that interferes with routine work, but bearable) – 2
	Severe (experienced often and requires analgesics) – 3
3. Eye Strain	No strain – 0
	Mild (occasional eye strain on reading) – 1
	Moderate (off and on eye strain on reading) – 2
	Severe (continuous eye strain even without reading) – 3
4. Watering from Eyes	No watering of eyes – 0
	Mild (Slight watering of eyes on strain) – 1
	Moderate (Off and on watering of eye even without any strain, needs handkerchief at the interval of 3 or more hours) – 2
	Severe (Excess irritable watering of eye, requires frequent use of handkerchief) – 3
5. Burning sensation in the Eyes	No burning sensation in the eyes – 0
	Mild (Slight burning sensation in the eyes on strain) - 1
	Moderate (Off and on burning sensation in the eyes even without any strain)
	Severe (Excess burning sensation in the eyes , interfering with the daily routine)

Table 2: Objective Parameter

Snellen’s Distant Vision Chart Reading	0 – 6/6
	1 – 6/6p
	2 – 6/9
	3 – 6/9p
	4 – 6/12
	5 – 6/12p
	6 – 6/18
	7 – 6/18p
	8 – 6/24
	9 – 6/24p
	10 – 6/36
	11 – 6/36p
	12 – 6/60
	13 – 6/60p
	14 – 5/60 and less

Statistical Analysis of the Result: Effect of therapies is assessed on the basis of values obtained before & after treatment and in follow up. The results having P value < 0.05 were considered as statistically significant in this study.

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Afroz Z et al: Tila Taila Paada Abhyanga Eye Exercises Timira w.s.r. Simple Myopia

Result

Subjective Parameters

Parameters	Mean		Friedman Test Value	% Effect	p Value	Result
Parameters	BT	AT	Friedman Test Value	% Effect	p Value	Result
1. Poor Distant Vision	3	3	NA
2. Headache	1.33	0.13	30.6	90	0.001	Sig
3. Eye Strain	1.4	0.27	29.667	81	0.001	Sig
4. Watering of Eyes	0.87	0.13	22.594	85	0.001	Sig
5. Burning Sensation in Eyes	1.13	0.2	24.750	82	0.001	Sig

*Sig – Statistically Significant

Objective Parameters

Parameters	Mean		ANOVA Test Value	% Effect	p Value	Result
Parameters	BT	AT	ANOVA Test Value	% Effect	p Value	Result
1. Visual Acuity (Right Eye)	7.93	6.67	33.490	16	0.001	Sig
2. Visual Acuity (Left Eye)	9.13	8.67	9.400	5	0.02	Sig
3. Visual Acuity (Both Eyes)	7.67	6.07	34.981	26	0.001	Sig
4. Clinical Refraction (Right Eye)	-1.93	-1.73	7.200	12	0.066	NS
5. Clinical Refraction (Left Eye)	-2.13	-2	4.714	6.5	0.194	NS

*Sig – Statistically Significant, NS – Statistically Non Significant / Insignificant

Discussion

Netra and Paada are two extreme poles of our body and Siraas are the connectors between these two poles. Hence, any procedure or drug instilled at one pole shows its effects on other pole i.e., from feet to eyes. According to Aachaarya Vaagbhata there are 2 Siraas in the middle of each foot which are directly connected to the respective Eye. The effect of the Abhyangaadi procedures applied on Paada reaches Netra through these Siraas. Aachaarya Charaka too established this link between Paada and Netra when he states that “Paadatradhaarana” is Hitakara for Eyes (wearing footwear is wholesome for eyes). Commenting under the same verse Aachaarya Chakrapaanidutta mentions about the presence of “Paadasambaddhanetraposhikanaadi”, if these Naadis are harmed by not wearing footwear then the negative effect of it will be reflected on the Eyes. Aachaarya Sushruta mentions “Chakshushorupaghaatakrut” (injurious to eyes) as one of the ill effects of not wearing footwear and Chakshuhu Prasaadanam (strenghtening eyes) as one of the benefits of Paada Prakshaalana (washing of feet), thus establishing the same link between Paada and Netra as mentioned above. According to Yoga Shaastra, Gandhaari and Hastajihva Naadis are related to Left and Rigt Eyes respectively. Gandhaari Naadi extends from big toe of Left Paada and ends in Left Netra and Hastajihva Naadi extends from Big toe of Right Paada and ends in Right Netra. Paada Abhyanga stimutales these Naadis which inturn does the Drishti Prasaadana. Aachaarya Sushruta in Shaareera explains that out of the 4 Tiryakgata Dhamanis (oblique blood vessels), each divides gradually hundred and thousand times and thus become innumerable. These cover the entire body like a network and their openings are attached to Romakoopa. Through these the Veerya (potency) of Abhyanga enters into the body after undergoing Paaka with Bhraajaka Pitta in skin and shows its action. Paada Abhyanga nourishes Tiryakgata Dhamanis these inturn nourishes Adhogata (downward) and Oordwagata (upward) Dhamanis which reflects the positive effect on Netras. Aachaarya Sushruta further explains that the development of Paada and Netra both have same origin from Vaikaarika and Rajas Ahamkaara and both also develop in the same month in the Intra Uterine Life. Thus, because of their same origin, it can be inferred that any therapy on Paada can positively affect Netra.

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Afroz Z et al: Tila Taila Paada Abhyanga Eye Exercises Timira w.s.r. Simple Myopia

Sparshanendriyaa is known as Vyaapak Indriyaa as it is spread over all other Indriyaas and Vaata is found predominantly in Sparshanendriyaa. Paada Abhyanga through its Vaata ameliorating action is responsible for better functioning of all the Indriyaas including Chakshurindriyaa.

According to Modern View: Anatomically there exist no such vessels but can consider the Siraas as neurovascular bundles because sole of foot has very rich nerve anastomosis. Stimulation of this neurovascular bundle benefits the body as a whole and eyes especially by nourishing eye muscles and reduces the Eye Strain. According to Saamaanya Visheshaa Siddhaanta, by Paada Abhyanga ectodermal tissues of skin were nourished thereby nourishing its other derivatives in eye and improved the functions of eyes.

Abhyanga exhibits its actions basically on 3 systems of body – Blood Vascular System, Nervous System and Lymphatic System. By fine and crude touch, Abhyanga stimulates the Tactile receptors and Mechanoreceptors in the skin. The temperature in the skin increases, causing kinetic motion in the receptors by which the axons get activated and conduct stimulus through neurons to the sensory cortex in turn maintaining the normal homeostasis of the body by exhibiting neuronal action. In other view, as there is kinetic motion, this causes vasodilation in the sub cutaneous vessels by which the Veerya of the drug gets absorbed there by, improves circulation by increasing blood amino acids that is increasing plasma tryptophan which in turn increases neuro transmitter activation and causes the secretion of Serotonin. As there is improved blood circulation there will be parallel improvement occurring in lymphatic circulation which exhibits defense action and removes toxins via blood hence, maintaining the normal homeostasis.

Paada Abhyanga basically normalizes the important Neurotransmitter – Serotonin, which regulates a wide variety of Neuropsychological processes along with Sleep. Thus, it induces relaxation and Natural Sleep and impacts a positive effect on Eyes. According to physiology, by Paada Abhyanga the Somatic Sensory Area in Cortex may get stimulated and as areas of Feet and Eyes are same i.e., Area II of Cortex, its stimulant effect may go to the eyes and may act by improving the function of eyes by reducing the Eye Strain.

Tila Taila is considered to be the best among all herbal oils and according to Aachaarya Sushruta and Bhaavaprakasha it is Tridosha Shaamaka hence, it becomes an apt selection for Timira as Timira is also Tridoshaja. Through its Ushna and Snigdha Guna it suppresses Vaata, Through Madhura Rasa and Madhura Vipaaka suppresses Pitta and Through its Teekshna and Ushna Gunas does Kapha Shamana. Alpha and beta tocopherols, and Sesamol present in it are having anti - oxidant and anti - ageing activity hence nourishing the eye muscles and increasing accommodating and focusing power of the eyes there by increasing the Visual Acuity.

Most of the time our daily routine and nature of work implies on particular disease. In the present study it was observed majority of the patients were having a habit of near or distant object gazing, and around 36% of patients were having stress. Eye exercises are the relaxing techniques, they help to break the staring habit, increasing the accommodating and focusing power of the eyes and tones up the eye muscles, in turn having an effect in restoration and improvement of the eye sight. W.H. Bates, an American Ophthalmologist developed the concept of Eye Exercises with an aim of correcting the action of eye muscles. He opined that eye strain is a result of abnormal action of external muscles of the eye and relief of this strain normalizes the muscle action and corrects all errors of refraction.

Conclusion

Simple Myopia, a condition affecting millions of people and which doesn’t have any alternative treatment other than using Correction Lenses or opting for LASIK Surgery which definitely cannot be afforded by the majority of the population, in such a scenario, Paada Abhyanga and Eye Exercises kind of cost effective, easy to perform and age friendly treatment modalities should definitely be adopted in its management and be made aware to the public about its potential benefits.

Statistically Significant Combined Effect of Tila Taila Paada Abhyanga and Eye Exercises was observed in Subjective and Objective Parameters. Simple Myopia characterized by Blurred Distant Vision can be compared with Prathama Patalagata Timira having Avyakta Darshana as its characteristic feature.

Journal of Ayurveda and Integrated Medical Sciences 2022;7(9)61

Afroz Z et al: Tila Taila Paada Abhyanga Eye Exercises Timira w.s.r. Simple Myopia

Paada Abhyanga, a Dinacharya Procedure is found to be Drishtiprasaadaka and hence, can be adopted in the management of Prathama Patalagata Timira. Tila Taila is the best Taila option for Paada Abhyanga in Timira as it is Chakshushya, Balya and Tridosha Shaamaka. Eye Exercises are the set of exercises mainly aimed at relieving strain of muscles of the eye, increasing the accommodating and focusing power of the eyes and can be seen widely practiced in management of refractive errors. Though there was no much improvement observed in the results of Objective Parameters of this study, it can be deduced that Paada Abhyanga with Eye Exercises when performed for longer duration of time or if adopted as a Life Style, has a potential to show much better and Statistically Significant Results in objective parameters as well.

Reference

1. Agnivesha. Caraka Samhita, with Ayurveda Dipika commentary of Chakrapanidatta, edited by Vaidya Yadavji Trikamji Acharya, Reprinted ed. Varanasi: Chaukambha Orientalia; 2011. p 187.

2. Agnivesha. Caraka Samhita, with Ayurveda Dipika commentary of Chakrapanidatta, edited by Vaidya Yadavji Trikamji Acharya, Reprinted ed. Varanasi: Chaukambha Orientalia; 2011. p 38.

3. Vagbhata. Astanga Hrdayam with Sarvangasundara commentary of Arunadatta and Ayurvedarasayana commentary of Hemadri, edited by Vaidya Harisastri Paradakara, Reprinted ed. Varanasi: Chaukambha Orientalia; 2014. p.825.

4. Sushrutha. Susruta Samhita with Nibandhasangraha commentary of Sri Dalhanacharya, edited by Vaidya Yadavji Trikamji Acharya, Reprinted ed. Varanasi: Chaukhamba Surbharati Prakashan; 2003. p 606.

5. Chandramouli Naikar S, Editor. Gheranda Samhita. Dharawad: Medha Publishers; 1995. p.5.

6. Chandramouli Naikar S, Editor. Gheranda Samhita. Dharawad: Medha Publishers; 1995. p.19.

7. World Health Organization. Universal eye health. A global action plan: 2014 – 2019. p.5.

8. A K Khurana. Comprehensive Ophthalmology, 5th ed. New Delhi: New Age International (P) Limited; 2012. p.32.

9. W H Bates. The Cure of Imperfect Sight by Treatment Without Glasses, 1st ed. New York City: Central Fixation Publishing Co; 1920. p.89.

Journal of Ayurveda and Integrated Medical Sciences 2022;7(9)62

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-08-30	2022-09-01	2022-09-08	2022-09-15	2022-09-22
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Research Article

Timira

Journal of Ayurveda and Integrated Medical Sciences