A Comparative Clinical Study to evaluate the efficacy of Tarpana with Mahatriphaladi Ghrita and Nasya with Abhijita Taila in the management of Timira w.s.r. to Astigmatism

Vachana S Devappa; Sujathamma K

doi:10.21760/jaims.9.7.1

E-ISSN:2456-3110

Research Article

Mahatriphaladi Ghrita

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY

Publisher

www.maharshicharaka.in

A Comparative Clinical Study to evaluate the efficacy of Tarpana with Mahatriphaladi Ghrita and Nasya with Abhijita Taila in the management of Timira w.s.r. to Astigmatism

Devappa VS^1*, Sujathamma K²

DOI:10.21760/jaims.9.7.1

^1* Vachana S Devappa, Assistant Professor, Dept of Shalakya Tantra, She S Ayurvedic Medical College, Bhavsarnagar Kalaburagi, Karnataka, India.

² Sujathamma K, Guide and HOD, Dept of Shalakya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College and Research Centre Vijaynagar, Bengaluru, Karnataka, India.

Background: Astigmatism has the potential to influence normal visual development and its incidence has been increasing due to the excessive usage of display screens and decrease in nutritional values. 13% of the refractive errors of the eye include Astigmatism. In Ayurveda, Astigmatism can be related to Prathama Patalagata Timira based on its Lakshanas.

Methods: 20 patients of Astigmatism in each group were selected from the OPD and IPD of the Shalakya Tantra department of SKAMCH, Bengaluru. Patients of Group A were given Tarpana with Mahatriphaladi Ghrita for 7 days and patients of group B were given Nasya with Abhijita Taila for 7 days.

Results: Overall the effect of treatment was statistically highly significant for both Tarpana and Nasya on all the parameters. Within the group analysis on comparing the t- values, Group A has shown better results on all the parameters. Though both groups showed highly significant differences within the group analysis; in between the groups, effect of treatment on Avyakta Darshana and eye strain showed significant differences, visual acuity and dioptric value showed highly significant difference and non-significant difference on headache.

Interpretation and Conclusion: The clinical study statistically proved that Tarpana with Mahatriphaladi Ghrita was more effective in comparison to Nasya. Tarpana provides increased tissue contact time and bioavailability of the medicines. By virtue of its procedural effect, medicines effect and the pressure exerted; it improves the visual acuity and dioptric power of the cornea.

Keywords: Timira, Astigmatism, Mahatriphaladi Ghrita, Abhijita Taila, Nasya, Tarpana

Corresponding Author	How to Cite this Article	To Browse
Vachana S Devappa, Assistant Professor, Dept of Shalakya Tantra, She S Ayurvedic Medical College, Bhavsarnagar Kalaburagi, Karnataka, India. Email:	Devappa VS, Sujathamma K, A Comparative Clinical Study to evaluate the efficacy of Tarpana with Mahatriphaladi Ghrita and Nasya with Abhijita Taila in the management of Timira w.s.r. to Astigmatism. J Ayu Int Med Sci. 2024;9(7):1-9. Available From https://jaims.in/jaims/article/view/3346

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2024-05-07	2024-10-23	2024-06-08	2024-06-13	2024-06-19
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
None	Nil	Yes	13.19

© 2024by Devappa VS, Sujathamma Kand 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].

J Ayu Int Med Sci 2024;9(7)1

Download PDF Back To Article Introduction Objectives of
the study Materials and
Methods Observations Results Discussion Conclusion References

Vachana SD et al. Management of Timira w.s.r. to Astigmatism

Introduction

Astigmatism is a type of refractive error wherein refraction varies in different meridian of eye eventually leading to blurring of vision. The asymmetrical surface of cornea in astigmatism leads to blurred vision, difficulty in focusing of words and lines, eye strain and headache. Astigmatism is a common refractive error, which is about 13 per cent of refractive errors of human eye.^[1]

Astigmatism occurs when incident light rays do not converge at a single focal point. Normally, due to the uniform curvature of entire surface of cornea, it has same refractive power all over its surface. In some individuals, however, the cornea is not uniform and the curvature is greater in one meridian (plane) than another. Hence the light rays of such cornea will not fall on a single point focus resulting in blurred retinal images of both distant and near objects. These might appear as widened or elongated.^[2]

In 1990 papers published from India highlighted the fact that uncorrected refractive error was a significant cause of blindness and the major cause of impaired vision.^[3] If Astigmatism is left untreated it leads to Amblyopia, Squint eyes etc. In modern, only glasses or contact lenses are available and surgery can cure limited amount of which are highly expensive and complicated therapies.

In Ayurveda, Timira indicates darkness and the conditions with gradual loss of vision leading to blindness are considered as Timira. Astigmatism can be compared with Prathama Patalagata Timira based on the Lakshanas i.e., Avyakta Rupa Darshana. If treatment is not given in time, the Doshas spread to fourth Patala and cause Linganaasha i.e., total blindness. As Krishnamandala is predominant in Vayu Mahabhuta, so change in corneal curvature is seen due to vitiated Vata and Snehana is the best treatment to subside Vata.

Further Tarpana is the best topical treatment in pacifying Vata Dosha and at the same time it improves the Drushti. Also, Chakradatta has described Abhijita Taila for the management of Timira which restores the vision even in blind person.^[4] The present study was conducted to evaluate the efficacy of Tarpana with Mahatriphaladi Ghrita and Nasya with Abhijita Taila in the management of Timira w.s.r to Astigmatism.

Objectives of the study

The present study was carried out with the following aims and objectives:

1. To evaluate the clinical efficacy of Tarpana with Mahatriphaladi Ghrita in Timira S.R. to Astigmatism.
2. To evaluate the clinical efficacy of Nasya with Abhijit Taila in Timira S.R. to Astigmatism.
3. To compare and evaluate clinical efficacy of both the groups.

Materials and Methods

A total of 40 patients of either gender approaching the OPD and IPD of Sri Kalabyraveshwara Ayurvedic Medical College Hospital and Research Centre, Bengaluru diagnosed as Timira w.s.r. Astigmatism were selected for this randomised, active, double arm, open label study. They were assigned into two groups i.e. Group A and Group B, each comprising minimum of 20 patients.

The sample collection was initiated with post approval from the Institutional Ethics Committee.

Diagnostic criteria

1. Lakshanas of Prathama Patalagata Timira.
2. Clinical features of Astigmatism.
3. Diminished visual acuity confirmed through Snellen's visual acuity chart for distant vision.

Inclusion criteria

1. Patients of either gender from 10-25years.
2. Patients able to read 6/9 of visual acuity or less than that.
3. Patients with the Lakshanas of Prathama Patalagata Timira.
4. Patients presenting with signs and symptoms of Astigmatism.
5. Patients of best corrected vision with cylindrical lens with dioptric value up to -2D.
6. Nasya Arha.
7. Tarpana Arha.

Exclusion criteria

1. Patients with the history of any systemic disorder that may interfere with the course of the study.
2. Patients with high myopia.
3. Astigmatism with any other ocular pathology.
4. Patients who have underwent any of the refractive surgery.

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Intervention

1. The study was intervened in two phases
2. Treatment phase

Follow up phase

Treatment phase

Table 1: Showing treatment phase

Group	Procedure	Dose and duration
Group A	Tarpana with Mahatriphaladi Ghrita Time: in the morning	700 Maatrakaala 7 days
Group B	Nasya with Abhijita Taila Time: in the morning	8 drops each nostril 7 days

Follow-up phase

One follow up was done after 7 days of completion of the treatment.

Study duration

The total duration of the study in both the groups was 15 days.

Method of preparation of medicaments required for the study

The medicines required for the study were

Abhijita Taila for Nasya
Mahatriphaladi Ghrita for Tarpana

Abhijita Taila

Table 2: Ingredients required for the preparation of Abhijita Taila

SN	Name	Quantity
1.	Tila Taila	500ml
2.	Yashtimadhu Kalka	125gms
3.	Amalaki Swarasa	2 and ½ ltr
4.	Godugdha	2 ltrs

Method of preparation

Pre-preparatory procedure

All the necessary utensils and vessels required for the procedure were cleaned and kept ready.
Preparation of Yashtimadhu Kalka: Yashtimadhu Twak was coarsely powdered and sufficient water was added to make
Preparation of Amalaki Swarasa: Fresh juice of Amalaki Swarasa
was prepared using fresh Amalaki
Dugdha and Tila Taila were transferred to clean vessels separately.

Procedure

Tila Taila was heated on Mandagni to which Amalaki Swarasa, Yashtimadhu Kalka and Dugdha were added.
The mixture was stirred intermittently so that it doesn’t stick to the vessel.
The mixture was kept standing overnight.

Next day, the heating was continued till the mixture attained Sneha Siddhi Lakshana like Gandha-Varna-Rasotpatti, Shabdahinata (no cracking sound), Phenodgama (appearance of froth) and Vartivat Kalka (rolling of paste of herbal drugs between fingers).

Post procedure

Once Mrudu Paka of Taila was attained, it was cooled down and filtered into a clean vessel and stored in airtight bottles.

Murchita Tila Taila and Mahatriphaladi Ghrita

In the present study, Murchita Taila was used for Mukha Abhyanga during Nasya Karma. And Mahatriphaladi Ghrita is used for Tarpana. Mahatriphaladi Ghrita was purchased from pentacare and dispensed from Sri Kalabyraveshwara Ayurvedic Medical College Hospital and Research Centre, Bengaluru.

Assessment criteria

Following were the subjective and objective parameters considered for the study.

Assessment Parameters

Subjective criteria

1. Avyakta Darshana
2. Eye strain
3. Headache
4. Visual acuity for distant vision using Snellen’s chart.

Objective criteria

Clinical Refraction using autorefractometer and trial method. The assessment was done on,

BT: Before Treatment (Day 1)
AT: After Treatment (Day 8) and
AF: At Follow Up i.e., on 15^th day.

The parameters considered for the study were scored for the purpose of statistical analysis.

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Scoring Index

Table 3: Scoring index for Avyakta Darshana (blurring of vision for distant objects)

Score	Criteria
0	No blurriness in distant vision
1	Occasional blurring
2	Regular blurring without disturbing work
3	Regular blurring disturbing day to day work

Table 4: Scoring index for Shirahshoola (headache)

Score	Criteria
0	No headache
1	Occasional mild headache on straining of eyes
2	Moderate headache on straining of eyes which inhibits work
3	Headache persists even after relieving from work

Table 5: Scoring index for Netrayasa (eye strain)

Score	Criteria
0	No eye strain
1	>4 hours of distant and near work
2	<4 hours of distant and near work
3	<2hrs of distant and near work

Table 6: Scoring index for Visual acuity for both eyes

Criteria
6/6
6/9
6/12
6/18
6/24
6/36
6/60

Table 7: Scoring index for Dioptric value for both eyes

Criteria
0
-0.25D
-0.5D
-0.75D
-1D
-1.25D
-1.5D
-1.75D
-2D

Statistical Analysis

For the statistical analysis the data obtained in both the groups were recorded, presented in tabulations and drawings.

The Statistic Mean, Standard Deviation (SD), Standard error of Mean (SEM) and Standard Error of difference between two means (SE) were employed for descriptive statistics.
To infer the clinical study and draw conclusion, students paired ‘t’ - test was applied for within the group analysis and unpaired ‘t’ - test was applied for between the group analysis.

Observations

Table 8: Observation on the different parameters

Parameters	Category	Value	%
Age	10-15	20	50%
	16-20	07	17.5%
	21-25	13	32.5%
Gender	Male	20	50%
Gender	Female	20	50%
Educational Status	School dropout	2	5%
	Below graduation	36	90%
	Graduate	2	5%
Occupation	Students	38	95%
	Others	2	5%
Family History	Present	16	40%
	Absent	24	60%
Chronicity	≤ 6months	13	32.5%
	>6months≤12 months	5	12.5%
	>12≤18months	6	15%
	>18≤24months	4	10%
	>24months	12	30%
Nidana	Atiyoga of Indriya	23	57.5%
	Sookshma Nireekshana	14	35%
	Doorekshanat	20	50%
Lakshanas	Avyakta Darshana	40	100%
	Eyestrain	17	42.5%
	Headache	21	52.5%
Visual Acuity	6/9	7	8.75%
	6/12	17	21.25%
	6/18	14	17.5%
	6/24	13	16.25%
	6/36	17	21.25%
	6/60	12	15%
Dioptric Value	-0.25D	1	1.25%
	-0.5D	22	27.5%
	-0.75D	11	13.75%
	-1D	16	20%
	-1.25D	5	6.25%
	-1.5D	11	13.75%
	-1.75D	9	11.25%
	-2D	5	6.25%

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Results

Table 9: Effect of treatment on symptoms within group A

Group A		Mean Diff	SD	SE	t- Value	P- Value	Re
Avyakta Darshana	BT-AT	1.2	0.52	0.11	10.25	<0.001	HS
Avyakta Darshana	BT-AF	1.25	0.55	0.12	10.16	<0.001	HS
Eye Strain	BT-AT	1.28	0.48	O.18	6.96	<0.001	HS
Eye Strain	BT-AF	1.28	0.48	0.18	6.99	<0.001	HS
Head Ache	BT-AT	1.27	0.46	0.14	9.03	<0.001	HS
Head Ache	BT-AF	1.27	0.46	0.14	9.03	<0.001	HS
Visual acuity	BT-AT	0.19	0.13	0.02	9.37	P<0.001	HS
Visual acuity	BT-AF	0.25	0.14	0.02	11.03	P<0.001	HS
Dioptric value	BT-AT	0.53	0.30	0.04	11.23	P<0.001	HS
Dioptric value	BT-AF	0.46	0.31	0.04	9.5	P<0.001	HS

Table 10: Effect of treatment within group B

Group B		Mean Diff	SD	SE	t- Value	P- Value	Re
Avyakta Darshana	BT-AT	0.8	0.61	0.13	5.81	<0.001	HS
Avyakta Darshana	BT-AF	0.85	0.61	0.13	5.83	<0.001	HS
Eye strain	BT-AT	0.7	0.48	0.15	4.58	<0.001	HS
Eye strain	BT-AF	0.8	0.42	0.13	5.99	<0.001	HS
Headache	BT-AT	1.5	0.70	0.22	6.70	<0.001	HS
Headache	BT-AF	1.6	0.69	0.22	7.23	<0.001	HS
Visual Acuity	BT-AT	0.17	0.16	0.02	6.68	<0.001	HS
Visual Acuity	BT-AF	0.20	0.16	0.02	7.8	<0.001	HS
Dioptric Value	BT-AT	0.39	0.30	0.04	8.18	P<0.001	HS
Dioptric Value	BT-AF	0.36	0.26	0.04	8.66	P<0.001	HS

Table 11: Effect of treatment on symptoms in between the groups

In B/W Group		PSE	t- Value	P- Value	Re
Avyakta Darshana	BT-AT	0.178	2.24	<0.05	S
Avyakta Darshana	BT-AF	0.184	2.44	<0.05	S
Eye strain	BT-AT	0.23	2.54	<0.05	S
Eye strain	BT-AF	0.21	2.24	<0.05	S
Headache	BT-AT	0.24	0.94	>0.05	NS
Headache	BT-AF	0.22	1.48	>0.05	NS
Visual acuity	BT-AT	0.07	19.63	<0.001	HS
Visual acuity	BT-AF	0.07	24.09	<0.001	HS
Dioptric value	BT-AT	0.04	3.59	<0.001	HS
Dioptric value	BT-AF	0.04	2.65	<0.001	HS

Graph 1: Effect of treatment in between the groups

Discussion

Astigmatism is a condition in which the refraction differs in different meridians of the eye which results in blurred vision. It occurs as a result of abnormalities of curvature of cornea.^[5] Avyakta Darshana is the cardinal feature of Prathama Patalagata Timira. Prathama Patala is Tejo Jala Ashrita which represents Tejas of Alochaka Pitta and Rasa Dhatu respectively.^[6] This Alochaka Teja Samashraya is seen in Jala which helps in Preenana i.e., by providing nutrition and nourishment to all the avascular structures. Cornea being an avascular structure derives nutrition from this Tejo Jala.

Cornea which is considered as Krishna Mandala is of Vata Sthana in Chakshu Indriya.^[7] Hence Vata when afflicts the Patalas of Krishna Mandala, cause changes like Jihmata by affecting the corneal meridians. The proper refraction of light rays in the eye is again held to be responsible by Vata. Hence both the Sthanika and Agantuja Dosha being Vata, affects the refraction leading to Avyakta Darshana/blurring of vision.

Tarpana and Nasyakarma are chosen for the study. Tarpana is one of the Netra Kriyakalpas which is indicated for Tamo Darshana and Vakrata. Krishna Mandala being of Vata origin needs Preenana, which is fulfilled by Tarpana using Sneha. Tarpana acts by the virtue of its procedural, pressure effect and its medicinal effect. The tissue contact time and bioavailability of the medicines is well achieved in Tarpana.

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And the sustained effect with 700 Matrakalas for Krishnagata Roga for 7days of duration, as said by Acharya Sushruta, helps in nourishing the whole Krishna Mandala. Due to the direct pressure applied over the cornea, Tarpana can help bring about the changes in the curvature of cornea leading to improved refractive power.

Mahatriphaladi Ghrita having ghee as a lipid base allows the drugs to penetrate into the corneal layers. The ghee which is processed by various Kashayas is amphiphilic. From the studies it is evident that lipophilic and hydrophilic properties of the medicines pass through cornea easily via trans-corneal route and para-cellular route respectively.^[8] Also Ghrita which is best among the Snehas, carries all the properties of other drugs to the target organ without leaving its properties, due to the Sanskaranuvartana Guna.

Poor nutrition of the cornea may also lead to reduced corneal rigidity which results in increased corneal astigmatism due to pressure from the upper eyelid that flattens cornea in the horizontal meridian and makes steeper the vertical.^[9] Ghrita having all such nutritional values help to promote the nutritional status of the cornea.

By virtue of the Swaroopa of different Gunas, they pacify Vata and impart Bala. This occurs at the level of extraocular muscles also which brings about muscular strength and improved flexibility and at the level of cornea by changing the curvature and hence improving the refractive power.

Acc to Sushruta, Samyak Tarpana helps in achieving Kriya Laghavata of Netra i.e., normal functioning of eye in all aspects.^[10] The restrictions during and after Tarpana, like complete restraints from reading, staring at any display screens also gives relief from the eyestrain. Hence Tarpana has the potential to change the curvature of the cornea allowing the proper convergence of light and therefore improves the visual acuity and dioptric power of the cornea in that meridian.

According to Bhaisajya Ratnavali, Abhijita Taila is indicated in Timira which restores the sight even in blind.^[11] It induces the properties of Rasayana and Preenana.

According to Sushruta Samhita, Acharya has indicated Snehana type of Nasya in Timira, it is considered as Drushtiprasadaka and gives Bala.^[12]

Bruhmana Nasya is chosen for the present clinical study as Acharya Charaka explains that Brumhana Chikitsa is adopted where Kaalantara Santarpana is required. And Snehadis can be given for the same.^[13] Here Vata afflicting the Krishna Mandala needs Bruhmana Chikitsa. Hence Nasya with Abhijita Taila was chosen.

According to Astanga Hrudaya, Nasa being the gateway of Shiras (head),^[14] the drug administered through nostrils reach Shringataka - a Sira Marma present in the middle of the junction of Siras supplying nourishment to the Nasa, Karna, Netra etc. From the studies, it can be understood that the Shringataka Marma is where the ophthalmic vein and the other veins spread out, i.e., the medicines used in Nasya reaches Netra by direct pooling into the venous sinuses of the brain via the inferior ophthalmic veins and by direct absorption into the cerebrospinal fluid.

Lipid soluble substances have greater affinity for passive absorption through the cell walls of nasal mucosa. The cilia of the olfactory cells and the portions of the body of the olfactory cells contain relatively large quantities of lipid materials.^[15] Hence the Snehana type of Nasya is effective in pacifying Vata and does Preenana.

Bruhmana Nasya administered relieves the eye fatigue. The medicines present in Abhijita Taila does Bruhmana, Preenana and promote Bala and flexibility to the ocular muscles.

According to Sushruta, Samyak Nasya yields in Shiro Laghavata, Indriya Shuddhi, Vikaropashamah.^[16]

Yashtimadhu is Chakshushya and promotes Bala (here it imparts Bala to the Peshis of the Netra). Prathama Patalagata Timira mainly afflicts rasa and Rakta Dhatu. Yashtimadhu, Kakoli, Ksheerakakoli being Jeevaniya Gana Dravyas strengthen and provide nourishment the tissues of the eye by their direct action on Rasa Dhatu. According to Bhava Prakasha, Shatavari is said to be Netrya, Balya and relieves Nayanaamaya. Kaideva Nighantu has said it as Chakshushya and Akshirogaghni. Kaideva Nighantu and Bhava Prakasha considers Bhringaraja as Akshirogahara, as is Chakshushya according to Raja Nighantu, and it acts on Rasa and Rakta Dhatu. Guduchi is Chakshushya and Balya. Also, Draksha is Chakshushya according to Kaiyadeva Nighantu.

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Haritaki is Chakshushya, Srotovishodhini, Yogavaahini, Sarva Dosha Prashamani, Bruhmana and Vibhitaki is Netrahita, relieves the Doshas from Rasa, Rakta Mamsa and Meda, Amalaki is Chakshushya, Sarvadoshaghna. Go Ghrita is Chakshushya, alleviates Vata Dosha, imparts Brumhana action and is Indriya Bala Vruddhikara.

Most of the drugs have Madhura Rasa. The Madhura Skanda Dravyas are Sapta Dhatu Vardhaka, are Indriya Prasadaka, Balya and promote Preenana, Jeevana and Brihmana Gunas. They possess Snigdha Gunas.

Snigdha Gunas by virtue of its Swaroopa, brings about Mruduta and pacifies Vata and imparts Bala. The drugs which are Balya promote strength to the extraocular muscles.

Similarly, the drugs present in Abhijita Taila like Amalaki, Yashtimadhu provide Bruhmana action. Ksheera present in it pacifies Vata Dosha owing to its Guru, Snigdha Guna and Madhura Rasa. Tila Taila is best Vatahara and due to its Vyavayi Vikasi Gunas it helps drugs penetrate into the minute channels.

Due to all the above properties of both the formulations, they act on Timira by their yoga Prabhava.

Conclusion

Going through the observations and results of Group A and B it can be concluded that patients of Group A who were treated with Tarpana revealed better results on overall assessment. In both the groups, within the group analysis, the effect of treatment was statistically highly significant in all the parameters i.e., Avyakta Darshana, eyestrain, headache, visual acuity and dioptric value. Though both groups showed highly significant differences within the group analysis; in between the groups, effect of treatment on Avyakta Darshana and eye strain showed significant differences, visual acuity and dioptric value showed highly significant difference and non-significant difference on headache.

References

1. Read, S.A., Collins, M.J. and Carney, L.G. A review of astigmatism and its possible genesis. Clinical and Experimental Optometry, 2007 90(1): 5-19.

2. Dieudonne Kaimbo Wa Kaimbo, Astigmatism – Definition, Etiology, Classification, Diagnosis and Non-Surgical Treatment, Astigmatism - Optics, Physiology and Management, Dr. Michael Goggin (Ed.).

3. Pizzarello L et al. VISION 2020: The Right to Sight: A global initiative to eliminate avoidable blindness. Arch Ophthalmol, 2004, 122; 615 – 20.

4. Chakrapanidatta-Chakradatta (chikitsasangraha) of chakrapaanidatta, sanskrit text with english translation, english translation, chaukamba orientalia, first edition 2014 by Dr. G Prabhakar rao, 59th chapter, verse-198-199, pg-585, pp-825.

5. A K Khurana, Comprehensive Opthalmology, Jaypee Brothers Medical Publishers (P) Limited, 6th edition 2015, Section 2, Chapter-4, Pg-42, Pp- 623.

6. Sushruta Samhita with Nibandha Sangraha commentary of Sri Dalhanaacharya and the Nyayachandrika Panjika of Sri Gayadasacharya on nidanasthana. Edited by Vaidya jadavji Trikamji Acharya and Narayan Ram Acharya ‘Kavyatirtha’, New ed. Varanasi: haukambha orientalia; 2014, Uttaratantra, Chapter 1, Verse 18, Pg-596, Pp-824.

7. Sushruta Samhita with Nibandha Sangraha commentary of Sri Dalhanaacharya and the Nyayachandrika Panjika of Sri Gayadasacharya on nidanasthana. Edited by Vaidya jadavji Trikamji Acharya and Narayan Ram Acharya ‘Kavyatirtha’, New ed. Varanasi: Chaukambha orientalia; 2014, Uttaratantra, Chapter 1, Verse 11, Pg-596, Pp-824.

8. Yousef Al-ebini, Investigations into drug delivery to the eye: nanoparticle comparisons, January 2014

9. Sanjay Marasini, Pattern of astigmatism in a clinical setting in Maldives, Journal of Optometry, 2016 January-March; 9(1): 47-53.

10. Sushruta Samhita with Nibandha Sangraha commentary of Sri Dalhanaacharya and the Nyayachandrika Panjika of Sri Gayadasacharya on nidanasthana. Edited by Vaidya jadavji Trikamji Acharya and Narayan Ram Acharya ‘Kavyatirtha’, New ed. Varanasi: Chaukambha orientalia; 2014, Uttaratantra, Chapter 18, Verse 13, Pg-634, Pp-824.

11. Kaviraj Shri Govind Das Sen, Bhaisajya Ratnavali, English translation and Shri Ramana Prabhakara Commentary by Prabhakara Rao, Chaukambha Orientalia, first edition, 2014, volume 2, Chapter-64, Verse 274-275, Pg-503, Pp-933.

J Ayu Int Med Sci 2024;9(7)7

Vachana SD et al. Management of Timira w.s.r. to Astigmatism

12. Sushruta Samhita with Nibandha Sangraha commentary of Sri Dalhanaacharya and the Nyayachandrika Panjika of Sri Gayadasacharya on nidanasthana. Edited by Vaidya jadavji Trikamji Acharya and Narayan Ram Acharya ‘Kavyatirtha’, New ed. Varanasi: Chaukambha orientalia; 2014, Chikitsasthana, Chapter 40, Verse 22, Pg-555, Pp-824.

13. Agnivesha, Charaka samhitha- Revised by Charaka and Dridhabala with the Ayurveda dipika commentary of Chakrapanidatta- Edited by vaidya Jadavaji Trikamji Acharya, Chaukhambha orientalia, Varanasi, Reprint-2015, Sutrasthana, Chapter23, Verse 39, Pg-124, Pp-738.

14. Vagbhata, Astanga Hrudaya, with the commentaries (Sarvanga Sundara) of Arunadatta and (Ayurveda Rasayana) of Hemadri, edited by Bhisagacharya Harishastri Paraadakara Vaidya, Choukambha Surabharati Prakashan, Varanasi, Reprint-2014, Sutrasthana, Chapter 20, Verse-1, Pg-287, Pp-956.

15. K Y Shrikant et al, Pharmacodynamics of nasyakarma, IJRAP, 2011, 2(1), 24-26. Available from

16. Sushruta Samhita with Nibandha Sangraha commentary of Sri Dalhanaacharya and the Nyayachandrika Panjika of Sri Gayadasacharya on nidanasthana. Edited by Vaidya jadavji Trikamji Acharya and Narayan Ram Acharya ‘Kavyatirtha’, New ed. Varanasi: Chaukambha orientalia; 2014, Chikitsasthana, Chapter 40, Verse 38, Pg-556, Pp-824.

J Ayu Int Med Sci 2024;9(7)8

Research Article

Mahatriphaladi Ghrita

Journal of Ayurveda and Integrated Medical Sciences

A Comparative Clinical Study to evaluate the efficacy of Tarpana with Mahatriphaladi Ghrita and Nasya with Abhijita Taila in the management of Timira w.s.r. to Astigmatism

Devappa VS1*, Sujathamma K2

Introduction

Objectives of the study

Materials and Methods

Observations

Results

Discussion

Conclusion

References

Devappa VS^1*, Sujathamma K²