E-ISSN:2456-3110

Research Article

Asthenopia

Journal of Ayurveda and Integrated Medical Sciences

8 Volume 5 Number 2023 May
Publisherwww.maharshicharaka.in

A single arm clinical study to evaluate the efficacy of Ela Anjana and Paadaabhyanga in Prathama Patalagata Timira with special reference to Asthenopia

Chandana R.1*, Naveen B.2
DOI: http://dx.doi.org/10.21760/jaims.8.5.1

1* R. Chandana, 4th year BAMS Scholar, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India.

2 BS Naveen, Professor and HOD, Department of PG Studies in Shalakya Tantra, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India.

Asthenopia is a broad term used to describe various symptoms under the umbrella of eye strain, which could be due to continuous reading, computer work or fine needle works. Asthenopia refers to mild eye ache, headache and tiredness of the eyes. It is a feature of extra ocular muscle imbalance and uncorrected mild refractive errors especially Astigmatism.[1] It’s been a common problem worldwide and is progressively increasing on the rising Covid-19. Stress and nutritional factors also contribute to improper vision. This symptom is mentioned in Ayurveda classics as Animitta Avyaktha Darshana in Prathama Patalagata Timira, a stage of Timira described under Drushtigata Rogas.[2] Anjana is one among the Kriyakalpa procedures administered in Netrarogas. According to Acharya Sushruta and Acharya Vagbhata, Anjana is of three types, namely Lekhana, Ropana and Prasadana. Paadaabhyanga is said to be Dristiprasadaka and stimulates the sensory peripheral nerves thus improving the sight. Ela Anjana[3] which is indicated in Timira Roga is explained by Acharya Charaka in Trimarmiya Chikita Adhyaya. Use of Ela Anjana also provides a nourishing effect to the eyes and improves visual activity. The study was carried out for a period of 30 days where in the intervention was for 7 days with two follow ups of seven days consecutively. Study yielded promising results in Asthenopic features, suggesting simple intervention in the form of Anjana and Paadaabhyanga can effectively help in managing Asthenopia.

Keywords: Asthenopia, Ela Anjana, Paadaabhyanga

Corresponding Author How to Cite this Article To Browse
R. Chandana, 4th year BAMS Scholar, , Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India.
Email: 		R. Chandana, BS Naveen, A single arm clinical study to evaluate the efficacy of Ela Anjana and Paadaabhyanga in Prathama Patalagata Timira with special reference to Asthenopia. J Ayu Int Med Sci. 8;5(2023):1-6.
Available From
https://jaims.in/jaims/article/view/2428

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-04-01 2023-04-03 2023-04-10 2023-04-17 2023-04-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Yes 16%

© 8by R. Chandana, BS Naveenand 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].

Journal of Ayurveda and Integrated Medical Sciences 8;5(2023)1
Chandana R et al: Ela Anjana and Paadaabhyanga in Prathama Patalagata Timira

Introduction

Ayurveda which is considered as ‘Science of life’ gives importance to both preventive and curative measures with respect to disease.

Sense organs serve as a media between the external world and the internal environment.

The eye is considered as the living optic object. It is considered as the superior and the important sense organ among five senses. Hence, eye should be protected and taken care.

Ayurveda has used and advocated use of Several methods for protecting eyes like Seka, Aschyotana, Tarpana, Anjana etc. not only for beautification and maintenance of eye health, but also to prevent and treat many disorders of eye.

There are many diseases, disorders and age-related changes that may affect the eyes and surrounding structures. While there are many changes in the non-diseased eye, the most functionally important changes seem to be reduction in power of accommodation or focusing capability.

Eye strain, also known as Asthenopia is a common eye condition that manifests through non-specific symptoms such as fatigue, pain in or around the eyes, blurred vision, headache, and occasional double vision.

Symptoms often occur after long-term use of computers, digital devices, reading or other activities that involve extended visual tasks.[4]

This symptom is mentioned in Ayurveda classics as Animitta Avyakth Darshana in Prathama Patalagata Timira, a stage of Timira described under Drushtigata Roga.

Hence, Asthenopia can be correlated to Prathama Patalagata Timira.

The Prevalence of Asthenopia in India is 12.4% - 32.2% in individuals under 18 years and 57% among adults.

In this regard while exploring Ayurvedic classics, we come across few simple techniques and medicaments in the treatment of Prathama Patalagata Timira. Anjana is one among them. Ela Anjana is a preparation with easily available ingredients. Hence, this work is intended to ascertain the efficacy of Ela Anjana

with Tila Taila Paadaabhyanga in Prathama Patalagata Timira w.s.r. to Asthenopia

Aim and Objectives

Aim: Study to ascertain the efficacy of Ela Anjana with Tila Taila Paadaabhyanga in Prathama Patalagata Timira w.s.r. to Asthenopia.

Objectives

1. To evaluate the efficacy of Ela Anjana in management of Prathama Patalagata Timiras.r to Asthenopia.

2. To evaluate the efficacy of Tila Taila Paadaabhyanga in management of Prathama Patalagata Timiras.r to Asthenopia.

3. To evaluate the efficacy of Combined effect of Ela Anjana and Tila Taila Paadaabhyanga in management of Prathama Patalagata Timira w.s.r to Asthenopia.

Materials and Methods

Source of Data

a. Literary source: Literary data was collected from Ayurvedic Classical textbooks, textbooks of Modern Medical Science, Reputed Journals and Studies conducted on related works, Internet and other sources.

b. Sample source: Twenty subjects of either gender, fulfilling the diagnostic criteria were selected from OPD and IPD of our hospital.

c. Drug source: Raw drugs for the preparation of Ela Anjana was collected from authentic sources after proper identification. Medicine required for the treatment was prepared in the Teaching Pharmacy.

Methods of data collection

Study Design: A single arm clinical study.

Place of work: Department of PG Studies in Shalakya Tantra,

Collection of data: 20 subjects after considering the inclusion and exclusion criteria were taken up for the study.

Patient’s general and physical examinations were done.

Local examination was done to check the visual acuity, Intra ocular Pressure.


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Chandana R et al: Ela Anjana and Paadaabhyanga in Prathama Patalagata Timira

Inclusion Criteria

  • Age group - 18 to 25yrs.
  • Subjects irrespective of their gender, caste and religion
  • Subjects with clinically established condition of Asthenopia.

Exclusion Criteria

  • Pathological Myopia and High Myopia
  • Any of the systemic, endocrinal or nutritional disorders.
  • Underwent refractive surgeries.
  • Contra indicated for Anjana

Withdrawal Criteria

  • Subjects with acute systemic illness requiring emergency management during the study period.
  • Subjects who were not willing to continue the study.

Diagnostic Criteria

  • Blurred vision (Avyaktha Darshana)
  • Eye strain (Netra Glani)
  • Headache (Shira Shoola)
  • Watering of eyes (Netra Srava)

Assessment Criteria: For assessment, subjective and objective parameters were considered.

Subjective Parameters

1. Blurred vision

2. Eye strain

3. Watery eyes

4. Headache

Blurred vision (Avyaktha Darshana)

Scale Score Symptom
Absence 0 Nil
Mild 1 Occasional
Moderate 2 Intermittent- adjust with squeezing of eyes
Severe 3 Frequent- tolerable with refractive aids

Eye strain (Netra Glani)

Scale Score Symptom
Absence 0 Nil
Mild 1 Occasional
Moderate 2 Intermittent
Severe 3 Frequent

Headache (Shirashoola)

Scale Score Symptom
Absence 0 Nil
Mild 1 Occasional
Moderate 2 Intermittent
Severe 3 Frequent

Watering of eyes (Netra Srava)

Scale Score Symptom
Absence 0 Nil
Mild 1 Occasional
Moderate 2 Intermittent
Severe 3 Frequent

Objective Parameter
Assessment was done through Schirmer’s test.

It is an indicative of amount of moisture content in eye whose normal value ≥ 10mm.

Grade 0 = 0mm - 5mm

Grade 1 = 6mm - 10mm

Grade 2 = 11mm - 15mm

Grade 3 = 16mm - 20mm

Method of preparation: 300gms of cleaned Ela was taken and soaked in Aja Mutra for a period of three days. It was then filtered through a clean Cora cloth. The filtered seeds were collected and dried completely under the shade. Later it was pounded to obtain coarse powder (Churna).

The Churna was spread over the Cora cloth (muslin cloth). It was wrapped and Wicks / Varti were prepared. Later wicks were smeared with few drops of oil and was lit under flame. The sooth particles formed over the plate were collected and packed in closed bottles.

Method of application

Anjana: Anjana is a topical application. It is applied with fingertip to the lower lid of both the eyes from the Kaninika Sandhi to Apanga Sandhi and vice versa.

Timings: Every morning for a period of 7 days.

Paadaabhyanga: It was advised for the patients to gently massage their soles for 5 min with Tila Taila every day for a period of 7 days.

Observation and Results

Observation: In the present study, a total of Twenty subjects were screened and enrolled


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Chandana R et al: Ela Anjana and Paadaabhyanga in Prathama Patalagata Timira

fulfilling the diagnostic and inclusion criteria of Pratama Patalagata Timira. The following observation were made in the study on 0th day, 8th day, 15th day, 30th day.

Observation on Subjective Parameters

Percentage reduction on Asthenopic Symptoms

SN Symptoms Grade BT (%) AT (%) F1 (%) F2 (%)
RE LE RE LE RE LE RE LE
1. Blurred vision 0 20 25 35 45 40 35 45 50
1 40 40 35 30 30 40 35 35
2 25 30 15 20 25 25 15 15
3 15 5 15 5 5 0 5 0
2. Eye strain 0 15 20 55 60 55 60 65 70
1 50 45 30 25 30 25 25 20
2 25 25 10 10 15 15 10 10
3 10 10 5 5 0 0 0 0
3. Watery eyes 0 45 50 80 80 85 85 75 85
1 40 35 10 10 10 10 25 15
2 15 15 10 10 5 5 0 0
3 0 0 0 0 0 0 0 0
4. Headache 0 35 60 75 85
1 35 30 15 10
2 25 10 10 5
3 5 0 0 0

*BT – Before Treatment, AT – After Treatment, RE – Right Eye, LE – Left Eye

Observation on Objective Parameter

Percentage reduction on Asthenopic Symptoms

SN Test Grade BT(%) AT(%)
RE LE RE LE
1. Schirmer’s Test 0 40 45 25 30
1 40 40 40 40
2 10 5 20 15
3 10 10 15 15

*Grade 0 = 0mm-5mm, Grade 1=6mm-10mm, Grade 2=11mm-15mm, Grade 3=16mm-20mm

Statistical Analysis

Symptoms BT – AT (8th day) BT - F1 (15th day) BT - F2 (30th day)
R2 Sig. F Change Pearson’s Correlation R2 Sig. F Change Pearson’s Correlation R2 Sig. F Change Pearson’s Correlation
Blurred vision RE 0.740 0.000 0.860 0.655 0.000 0.809 0.545 0.000b 0.738
LE 0.644 0.000 0.802 0.598 0.000 0.773 0.422 0.002b 0.650
Eye strain RE 0.275 0.017 0.842 0.576 0.000 0.759 0.419 0.002b 0.648
LE 0.301 0.012 0.851 0.577 0.000 0.758 0.462 0.001b 0.680
Watery eyes RE 0.709 0.000 0.525 0.333 0.008 0.577 0.059 0.303b 0.243
LE 0.725 0.000 0.548 0.353 0.006 0.594 0.041 0.392b 0.202
Headache 0.370 0.004 0.609 0.468 0.001 0.684 0.018 0.574b -0.136

*R2 - Co-efficient of determination, Sig. F - Significant ANOVA values, BT - Before treatment, AT - After treatment, F1 - Follow-up 1, F2 - Follow up 2

Discussion

Timira is a disease, which is included under Drishtigata Vikaras which may get prognosed to Kacha & Linganasha if untreated. The main aim of treatment is to prevent the prognosis and to reduce the symptoms of Timira.

Ela Anjana is mentioned in the contest of Trimarmiya Chikitsa of Charaka Samhita,Chikitsa Sthana.

The drug is easily available and cost effective, thus it emphasizes the importance for treatment of Timira.

Ela having Madhura Rasa, Sheeta Veerya and Madhura Vipaka[5] is responsible for soothing effect which is effective in dry eye condition.

Aja Mutra having Tikta Rasa reduces inflammation and Snigdha Guna of Aja Mutra reduces the strain over the eyes.

Anti-Oxidant Property reduces inflammation of eye and protects ocular tissue from oxidative damage.

Presence of Vit B2, Vit B3 & Vit B6 in Ela promotes in preventing dryness of eyes.

Essential Oils present in the drug is responsible for soothing effect of eyes thus preventing dryness and eye strain.

Statistically, results showed that there was significant reduction in Asthenopic symptoms,

R2 change was found to be maximum for Blurred vision after treatment which slightly reduced in Follow up 1 and 2. But there was considerable improvement in Eye strain in Follow up 1.

Significant F change - Blurred vision, watery eyes and headache was significantly reduced after treatment, whereas in Follow up 1 and 2 there was significant reduction of Blurred vision and eye strain.

Karl Pearson’s correlation values were found to be maximum for blurred vision and eye strain. This clearly states that this treatment is effective in reducing blurred vision and eye strain.

Schirmer’s test values showed significant reduction in dryness of eyes.

There was a reduction in Headache and watery eyes


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Chandana R et al: Ela Anjana and Paadaabhyanga in Prathama Patalagata Timira

after treatment but didn’t considerably sustain post intervention i.e., Follow up 2.

Conclusion

Asthenopia is one of the most common complaints for which patients approach the Shalakya tantra OPD. Elanjana is a preparation with easily available ingredients. It is also very comfortable on application, and does not cause any discomfort to the eyes on application. When paired with the procedure of Paadaabhyanga, there is significant reduction in asthenopic symptoms, as evident in the study. In the present study, 20 subjects were given with Ela anjana and Tila Taila Paadaabhyanga. In the study, statistically there was much improvement in the results after treatment but failed to significantly sustain the results post intervention i.e. (F1 & F2). It would be better if the study is conducted in larger size and longer intervention.

Reference

1. Khurana A K, Theory and practice of optics and refraction, 4th edition. New delhi: RELX India (P) Limited; 2018. p.464.

2. Paraadakara shastri HS, editor, Ashtangahrdaya of Vagbhata with the commentaries of Sarvangasundara of Arunadatta and Ayurvedarasayana of Hemadri, Uttarasthana; Drishtiroga vijnaneeya: chapter 12, verse 1. Varanasi: Chaukhamba Sanskrit samsthan; 2018. p.816.

3. Acharya J.T, editor. Commentary Ayurveda Dipika of Chakrapanidutta on Charaka Samhita by Agnivesha, Chikitsa sthana; Trimarmiya Chikitsa: Chapter 26, Verse 249. Varanasi: Chaukhambha Orientalia; 2015; p.611.

4. Khurana A K, Comprehensive Opthalmology, Practical Opthalmology, Sec 6, Jaypee Brother Medical Publishers, 7th Edition; 2019. p.516.

5. Hegde P A, Textbook of Dravyaguna Vijnana, volume II, New Delhi: Chaukhambha Publications; 2019. p.277


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