E-ISSN:2456-3110

Case Report

Retinitis Pigmentosa

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 4 April
Publisherwww.maharshicharaka.in

A case study on Doshantha (Retinitis Pigmentosa) with Ayurvedic management

Krishnan A.1*, Rathi S.2
DOI: http://dx.doi.org/10.21760/jaims.8.4.38

1* Arundhathi Krishnan, Post Graduate Scholar, Department of P.G studies in Shalakya Tantra, of P.G studies in Shalakya Tantra, Bengaluru, Karnataka, India.

2 S. Rathi, Professor, Department of P.G studies in Shalakya Tantra, of P.G studies in Shalakya Tantra, Bengaluru, Karnataka, India.

Retinitis pigmentosa (RP) is a group of hereditary disorders of the photoreceptors and retinal pigment epithelium (RPE) which gradually causes night blindness and progressive constriction of the visual field. RP is a leading cause of visual disability, with a worldwide pre-valence of 1:4000. RP typically manifests with night blindness in adolescence, followed by concentric visual field loss, reflecting the principal dysfunction of rod photoreceptors; central vision loss occurs later in life due to cone dysfunction. Symptoms may become manifest during childhood or adulthood, and include poor night vision (nyctalopia) and constriction of peripheral vision (visual field loss).[1] In Ayurveda, the signs and symptoms of this can be compared with the Lakshanas of Doshandha. The present paper discusses a case of retinitis pigmentosa and its Ayurvedic treatment.

Keywords: Retinitis Pigmentosa, Doshandha, Sleshmavidagda Drsti, Nakulandya

Corresponding Author How to Cite this Article To Browse
Arundhathi Krishnan, Post Graduate Scholar, Department of P.G studies in Shalakya Tantra, of P.G studies in Shalakya Tantra, Bengaluru, Karnataka, India.
Email: 		Arundhathi Krishnan, S. Rathi, A case study on Doshantha (Retinitis Pigmentosa) with Ayurvedic management. J Ayu Int Med Sci. 2023;8(4):226-229.
Available From
https://jaims.in/jaims/article/view/2270

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-02-18 2023-02-21 2023-02-28 2023-03-07 2023-03-14
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Arundhathi Krishnan, S. Rathiand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Krishnan A et al: Doshantha (Retinitis Pigmentosa) with Ayurvedic management

Introduction

Retinitis pigmentosa (RP) is a slowly progressive inherited retinal disease, and patients with RP have reduced visual function mainly because of degeneration of the rod and cone photoreceptors and retinal pigment epithelium (RPE). A clinical diagnosis of RP is made based on the family history, presence of nyctalopia, visual field constriction, characteristic pigmentary retinal changes, bone spicule pigmentation in the periphery, and reduction of the standard full-field electroretinograms (ERGs) consistent with rod-cone dystrophy. RP is one of the main causes of acquired blindness in developed countries.[2] The main treatment of retinitis pigmentosa is by using Low vision aids (LVA) and Genetic counselling.[3]

In Ayurveda the signs and symptoms of RP can be compared with Doshandha which is one among the Dristigata Rogas. It is considered as a diseased condition in which sunset will obliterate the Dristi Mandala and make the person blind at night time.[4] During morning hours the rising sunrays will disperse the accumulated Doshas from Dristi to clear vision.[5] This disease resembles Kaphajatimira in its pathogenesis, but the night blindness is the special feature.[6] After analysing the Nidana, Dosha, Dushyas of the disease the present case study was done.

Case Report

A female patient aged 21 years was apparently normal 7 years back. Gradually she developed difficulty in distant vision. Also, complaints of diminision of vision more during night time. There is no history of itching and pain. She complains of mild watering of eyes since few months. With these complaints she came to Shalakya OPD, GAMCB. After complete evaluation of the patient it was diagnosed as Doshanta (retinitis pigmentosa). For further investigations patient was referred to minto eye hospital and the reports came as described below.

General Examination

  • Pallor - Absent
  • Icterus - Absent
  • Cyanosis - Absent
  • Clubbing - Absent
  • Lymphadenopathy - Non palpable
  • Edema - Absent
  • BP - 120/80 mmhg.
  • Pulse - 74 bpm

Systemic Examination

CVS, CNS, RS, GIT - No abnormality.

Ophthalmic examination

  • Head posture: head is kept in straight and erect posture without any tilt of head.
  • Facial Symmetry: both eyebrows and eyelids are at the same level of Symmetrical nasolabial folds of Symmetrical angle of mouth on both sides
  • Occular posture: Visual axes of two eyes are parallel to each other in primary position and is maintained in all position of gaze.

Visual acuity (distant vision before treatment)

Both eyes 3/60
OD CF+(2m)
OS 3/60

Near vision (before treatment)

Both eyes N18(p)
OD N24
OS N18(p)
Eyelid Normal
Lacrimal apparatus Normal Skin over lacrimal sac - redness, swelling absent
Conjunctiva Congestion, Chemosis, Discolouration, Follicles, Papillaes, Pterygium, Pingecula - absent
Sclera Normal
Cornea No opacities, size and shape normal
Anterior chamber Normal
Iris Normal
Pupil 3mm RRR +
Lens Clear

Refraction

OD OS
-0.25DS -0.25DS

Fundus examination

Media : hazy

Vessels : articular attenuation

Foveal reflex : dull

Bony spicule appearance ++

RPE Mottling+


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Krishnan A et al: Doshantha (Retinitis Pigmentosa) with Ayurvedic management

Macular dystrophies +

CDR 0:3

A :V - 2:3

Treatment

Procedure Medicine Dose / Duration
1.        Nasya Anu Taila 8 drops, 7 days
2.        Tarpana Patoladi Ghrita 5 days
3.        Putapaka   3 days
Internal medicines Sapthamrutha Loha 2bd
  Kanapippali Anjana OD
  Mahavasakadi Kashaya 15ml bd
  Jeevanthyadi Ghrita 1tsp bd

Visual acuity (after 7 days of Nasya)

Both eyes 3/60
OD 3/60
OS 3/60

Near vision (after treatment)

Both eyes N18(P)
OD N18(P)
OS N18(P)

Discussion

In the present study Nasya with Anutaila is advised for first 7 days of the treatment. As in Ayurvedic Samhita Acharya Charaka, Sushruta and Vagbhata stated that nose is a gateway of the head (brain).[7] Nasal route is easily accessible, convenient and reliable with porous endothelial membrane and highly vascularized epithelium which provides rapid absorption of drug into systemic circulation avoiding hepatic first pass elimination.[8] Nasya with Anutaila helps to relieve the Sanga present. Olfactory nerve pathway is connected with limbic system and hypothalamus which have control of endocrine secretions. Thus, administration of drug through nasal route stimulates higher centers in brain which shows action of regulation of endocrine and nervous system.[9] Considering all points that are mentioned above Nasya therapy can be advised in retinitis pigmentosa to strengthen the retinal epithelium and maintain the existing vision.

After Nasya giving a 3 days gap Tarpana was started, Acharya Vagbhata stated that Tarpana Chikitsa is helpful in management of Vata-Pittaj Netrarogas as well as Ratrandhya i.e., night blindness.[10] Patoladi Ghrita has been used for Tarpana. The formulation Patoladi Ghrita

contains ingredients which have Tridoshahara and Kaphahara properties due to Tikta, Kashaya Rasa and Laghu, Ruksha Guna. The drug like Patola, Amalaki, Ghrita are assumed to have the chemical constituents like vit C, carotein, riboflavin, magnesium, potassium. This protects lens from free radical damage and help in lens metabolism support.

After 5 days of Tarpana, Putapaka was administered. Putapaka therapy has the efficacy of passing into minute channels. Ajamamsa is Balya and Triphala is Chakshushya; Ghrita is lipophilic in nature due to this property it crosses the corneal epithelium, Stromal layer of cornea irrespective of size of molecules. Thus, it helps in improving the strength of ocular structures.

Internally Sapthamrutha Loha was advised for 3 to 6 months. Since it is Drushtiprasadaka and Rasayana, it is helpful to preserve the eyesight and effective in night blindness.

Jeevanthyadi Ghrita was given internally since it possess Madhura Rasa, Laghu Guna, Sheeta Veerya, Madhura Vipaka thereby helping for rejuvenating action on retina and thus preventing degeneration of retina.

Acharya Sushruta and Vagbhata explained many Anjana Kalpas in Ratrandhya (night blindness) and Drishtigata Rogas, one among them is Kanapippali Anjana which is especially indicated in night blindness.

Conclusion

The main challenge in management of retinitis pigmentosa is to maintain the vision of patient as well as to delay the degeneration of retina. In allopathy science, therapies, or treatments available for RP are gene therapy, retinal transplants, stem cell therapy and vitamin therapy etc. these treatments are not satisfactory and much expensive for common people. The aim through Ayurveda is to arrest the degeneration, preserve your eyesight and delay the progress of the disease. In this manner, the patient is able to lead a normal life, with the support of treatment and medicines. Ayurvedic therapies are cost effective and have minimal side effects. However, positive results were obtained in both fields after two courses of Ayurvedic treatment. Repeated courses of treatment may aid to at least maintain vision and prolonging further progression of the disease.


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Reference

1. https://www.aao.org/eye-health/diseases/whatis-retinitis-pigmentosa American Academy of Ophthalmology.

2. Diagnostic imaging in patients with retinitis pigmentosa

3. Khurana A.K. Comprehensive Ophthalmology. 4 th edition. New delhi: New Age International, 2007;p.268

4. Shankar Uday, Textbook of Shalakya Tantra, Chowkhamba Vishwabharathi Series, Varanasi, Vol-1, Netra Roga, p.640.

5. Shankar Uday, Textbook of Shalakya Tantra, Chowkhamba Vishwabharathi Series, Varanasi, Vol-1, Netra Roga, p.640

6. Shankar Uday, Textbook of Shalakya Tantra, Chowkhamba Vishwabharathi Series, Varanasi, Vol-1, Netra Roga, p.595

7. Ganesh krishna Garde, Sartha Vagbhata, Sutrasthana, Adhyaya-20, Shloka, 1, Chaukhamba Surbharti publication, Varanasi, reprint-2009, page no.85.

8. Amod Kumar, Suryawanshi.C.S, review article on conceptual study of Nasya Karma in Panchakarma w.s.r to Brihatrayi, international Ayurvedic medical Journal, vol-2 issue-3, page.1-6

9. K.Y.Shrikanth, V. Krishnamurthy, review article on pharmacodynamics of Nasya Karma, international Journal of research in Ayurveda and pharmacy-2011, 2(1) page 24-26.

10. Ganesh krishna Garde, Sartha Vagbhata, Sutrasthana, Adhyaya-24, Shloka, 3-9, Chaukhamba Surbharti publication, Varanasi, reprint-2009, page no.94.

11. Amrut.S. Salunke, Sonali Sunil Tadasarkar, & Adarsh Ramkalap Sharma. (2021). Retinitis Pigmentosa and its Ayurvedic Management. International Journal of Ayurveda and Pharma Research, 9(5), 62-68. https://doi.org/10.47070/ijapr.v9i5.1919

12. Narayanan Namboothiri Narayanan, Aravind Kumar, Krishnendu Sukumaran, Agaja Peethambaran Leena, An Ayurvedic Protocol to Manage Retinitis Pigmentosa - A Case Report by Int J Cur Res Rev, Vol 12, Issue 13, July 2020;p25-32.


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