E-ISSN:2456-3110

Case Report

Timira

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 10 OCTOBER
Publisherwww.maharshicharaka.in

Efficacy of Ayurvedic management of Timira w.s.r. to Simple Myopia - A Single Case Study

Sanfi APM1*, Mahala P2, Fiaz S3
DOI:10.21760/jaims.9.10.43

1* Sanfi APM, Post Graduate Scholar, Dept of Shalakya Tantra, National Institute of Ayurveda, Jaipur, Rajasthan, India.

2 Pramila Mahala, Post Graduate Scholar, Dept of Shalakya Tantra, National Institute of Ayurveda, Jaipur, Rajasthan, India.

3 Shamsa Fiaz, Professor and HOD, Dept of Shalakya Tantra, National Institute of Ayurveda, Jaipur, Rajasthan, India.

Introduction: It is the most common refractive error of the eye common in children and young adults. Factors such as increased near-work activities (like computer use and reading), reduced time spend outdoors, and genetic predisposition are thought to contribute to the rising rates of Myopia. On the basis of symptoms Myopia can be correlated to Vatika Timira, for which treatment modalities have been mentioned and Ayurvedic treatments was done for the management of the case.

Materials and Methods: A fully conscious male patient age of 26 yrs had visited Shalakya Tantra OPD, National Institute of Ayurveda, Jaipur, with chief complaints of defective distant vision in both eyes which was gradual painless and persistent since 3 years. He also complained of frequent dryness of bilateral eyes. The patient was treated with Internal medicines which are Chakshushya and Vathahara and Therapies like Parisheka, Nasya and Tarpana in sittings. Along with this Eye exercises are also advised. The treatments suggested for 3 months.

Results: At the end of the study, there got significant improvement in visual acuity in both eyes and he got relief from dryness of bilateral eyes.

Conclusion: Thus, it can be concluded that Ayurvedic approaches are helpful to control Simple Myopia.

Keywords: Simple myopia, Parisheka, Nasya, Tarpana, Timira

Corresponding Author How to Cite this Article To Browse
Sanfi APM, Post Graduate Scholar, Dept of Shalakya Tantra, National Institute of Ayurveda, Jaipur, Rajasthan, India.
Email: 		Sanfi APM, Mahala P, Fiaz S, Efficacy of Ayurvedic management of Timira w.s.r. to Simple Myopia - A Single Case Study. J Ayu Int Med Sci. 2024;9(10):261-265.
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https://jaims.in/jaims/article/view/3552

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-09-12 2024-09-24 2024-10-04 2024-10-14 2024-10-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.65

© 2024by Sanfi APM, Mahala P, Fiaz Sand 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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Introduction

Simple Myopia, or nearsightedness, has indeed become increasingly prevalent among children and young adults worldwide. This trend has raised significant concerns among healthcare professionals and researchers. Factors such as increased near-work activities (like computer use and reading), reduced time spent outdoors, and genetic predisposition are thought to contribute to the rising rates of Myopia. If left uncorrected, Myopia can lead to more serious eye conditions later in life. Therefore, early detection and appropriate management are crucial in addressing this growing public health issue.

Understanding these factors helps in developing strategies for prevention and management of Myopia. Encouraging healthy lifestyle practices, regular eye check-ups, and addressing any underlying health conditions are essential in minimizing the impact of Myopia in the population.

According to Acharya Vagbhata, Nayanam (organ of sight) is the most important sense organ among the five sense organs. All our efforts should be directed to protect the eyes throughout life; for the man who is blind this world is useless, the day and night are the same even though he may have wealth.[1] Seldom many Myopia leads to retinal damage and blindness, and also separation, degeneration, and tears. Most of the time, it is not a fatal eye condition. It costs billions of dollars annually to have this ailment surgically treated, not to mention the cost of contacts and glasses. Although immensely popular, surgical intervention is unsuccessful for everyone, and issues like glare at night and dry eyes could arise.[2] In Ayurveda, only Drishtigata Rogas has the clinical characteristics associated with vision problems. Therefore, all cases of visual disturbances can be grouped together under the general Timira-Kacha-Linganasha category, with complete blindness occurring in the final stage. Myopia is associated with Timira in Ayurveda; the name Timira denotes gloom. Conditions that cause progressive visual loss and blindness is considered as Timira, the story of Timira is also told in phases, with the Doshas vitiating the Patalas, or layers of eyeballs, arranged one behind the other. when the outermost, or initial, Patala, gets impacted. It is mildest in nature, and when it gradually affects the inner Patalas, it might cause major eye diseases.

Pratama Patala Gatha Timira, is when the vitiated Dosas, move or gets Sthana Samshraya towards eyes, first reach the Prathma Patala of the eye. The patient will have blurred vision. This is explained as Avyaktha Darshana by Sushrutha, Animittha Avyaktha Roopa Darshana by Acharya Vagbhata and Kadachith Roopa Darshana by Acharya Madhava[3] if untreated will encroach the second Patala.

Case History

A fully conscious male patient age of 26 yrs had visited Shalakya Tantra OPD, National Institute of Ayurveda, Jaipur, with chief complaints of defective distant vision in both eyes which was gradual painless and persistent since 3 years. He also complained of frequent dryness of bilateral eyes.

History of present illness

The subject was apparently normal 3 years ago and he gradually developed defective distant vision. It was associated with frequent dryness of both eyes. The patient was not using spectacles.

History of past illness

No history of Systemic diseases like Asthma, Hypertension, Diabetis.

Family history: Nothing relevant

Surgical history: Not relevant

Personal history: Patient was vegetarian

Appetite - Normal
Bowel - Satisfactory
Micturition - Normal
Sleep - Sound

Ashtasthana Pareeksha

Nadi70bpm
MuthraPrakrutha
MalaPrakrutha
JihwaAnupaliptha
Shabdha Prakrutha
Sparsha Prakrutha
DrukDosha in Drushti
AkruthiPrakrutha

Vitals

Pulse rate - 76/min
Respiratory rate - 24/min


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Temp - 98.6°F
BP - 120/80 mm of Hg

Systemic Examinations

All the Systemic examination revealed no abnormalities

Ophthalmic examinations

On torch light and Slit lamp examination, eye brows, eye lashes, eye lids, conjunctiva, cornea pupil and lens were found normal in bilateral eyes.

Table 1: Visual acuity

Right EyeBTLeft EyeBT
DV Unaided6/24DV Unaided6/36
Pinhole6/9Pinhole6/9
BCVA-1.00/-0.25x600 - 6/6BCVA-0.50/-1.255X140 0-6/6
Near VisionN/6Near VisionN/6

Dilated Fundoscopy

Optic Disc

Size, shape, margin, colour - B/L normal

CDR - 0.2-0.3(B/L)

Macula

Fundal Glow - Bilaterally normal
General background - Bilaterally Normal
Diagnosis - Vatika Timira

Treatments

Shamana medicines and therapies suggested to the patient

Internal medicines

1. Sapthamrutha Lauha - 250 mg

Mahathriphala Ghrtha - 3 ml
Honey - 2 ml 
Anupana as milk in morning and evening after food for 3 months.

2. Amalaki Churna - 2 gm

Gokshura Churna - 1 gm
Guduchi Churna - 1 gm
Morning and evening with milk for 3 months .

3. Mahanarayana Taila for Paadabhyanga at bed time for 3 months.

4. Eye drop Isotine 1 drop / 4 times a day for 1 month.

Therapies

Nethra Parisheka with Kwatha of Thriphala Churna, Yashti Churna and Lodhra for 3 days.

Marsha Nasya with Anuthaila 8 drops for 3 days

Tarpana with Jeevanthyadi Ghrta for 7 days

2 sittings of 10 days therapies with an interval of 14 days were done.

Near and far focus, Blinking and palming exercise are also advised to the patient along with internal medicines and therapies.

Results

Total treatment duration was 3 months.

Visual acuity assessed with 1 month interval

Table 2

BTAfter 1st SittingAfter 2nd SittingFollow-Up
Right eye
DV6/246/126/96/9
PH6/96/66/66/6
BCVA-1.00/-0.25x600 - 6/6-0.75/-0.25x600-6/6-0.50Ds 6/6-0.50Ds-6/6
Left eye
DV6/366/246/186/12
PH6/96/66/66/6
BCVA-0.50/-1.255X140 0-6/6-1.25x1300- 6/6-1.25Ds-6/6-1.00Ds-6/6

Discussion

The present case was Vatika Timira and the treatment given was mainly aimed to pacify Vata. The management of Timira includes Snehana, Rakthamoksha, Virechana, Nasya, Anjana, Shirobasthi, Basthi, Tarpana, Lepa, Seka which are to be followed repeatedly.[4] Here Seka, Nasya and Tarpana were followed in this patient. The symptoms and signs of Myopia can be correlated to Vatika Timira.

Sapthamrutha Lauha[5] consists of seven combinations of herbal medications including iron. In combination of this drug with Mahathriphala Ghruta and Honey collectively works to balance the Vata Pradhana Tridosha, support, nourish and potentially improve the visual function. Mahathriphala Ghruta[6] is Vata Pitta Shamaka and Chakshushya.


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Ghee is best mind calming and stress relieving medicine. From the combination of Amalaki Gokshura Guduchi Churna, Amalaki protect the eye from oxidative stress, support eye health and coverup any nutritional deficiency to eye. It alleviates Vata by its Madhura Amla Rasa and breaks the Abhishyandhathwa of the Srothas. The phyto chemical constituents like Vit A, C helps in reformation of cells in tear film. Guduchi contains beta sitosterole which helps to reduce inflammation. Gokshura enhance the overall eye health by improving circulation and nutrient delivery to eyes. It protects the eyes from oxidative stress potentially reduces the progression of Myopia. Mahanarayana Taila is Vatahara and Padabhyanga gives improving eye sight. According to Vagbata, 4 nerves which connect the eyes and it helps in relieving eye strain and maintain good vision. The medicine along with the procedure reduce the Rukshatha of Vata.

Nethra Parishka (Seka) is more suggested to manage in Amavastha of eye diseases. It increase the circulation of eye. Main aim of Seka is to attain an effective absorption at site of action for sufficient period of time to elicit response. Nasya is the main Panchakarma which for treating entire diseases of Urdhwajathrugatha Roga.[7] Nasya done with Anuthaila[8] indicated in Urdhwajathrugatha Rogas and increase the efficacy of Indriya. It has Tridoshahara property. Tarpana was done with Jivanthyadi Ghrta,[9] mainly indicated in Vatika Timira. Considering the drugs in Jeevantyadi Grutha, It is Vata Pithahara and Brumhana action. Hence disintegrate the pathology of Timira. The lipophilic nature of Ghrita facilitates the entry of drugs into eye ball and penetrates through the corneal epithelium irrespective of their molecular surface. Tissue contact time and bioavailability is more and hence therapeutic concentration can be achieved by Akshi Tarpana. The medicine which put on eyes exert some direct pressure so that it will help to reduce the refractive index of the eyes.

Myopia prevalence in India is reported to be around 6.9%, and there are several factors that can influence its development:

1. Genetic Factors: Genetic predisposition plays a significant role in the development of Myopia. Various biochemical pathways influenced by genetic factors can affect the growth and development of the eye, leading to Myopia.

2. Structural Weakness of the Eye: Conditions where the sclera (the white outer layer of the eye) and cornea (the transparent front part of the eye) are weak or thinned out and can contribute to Myopia. These structural weaknesses can be influenced by genetic factors as well as other environmental factors Jeevanthyadi Tarpana, Mahathriphala Grita and eye exercises corrects the structural integrity of the eye .

3. Nutritional Deficiencies: Inadequate intake of certain nutrients may impact the general growth and development of the eye, potentially contributing to Myopia. Ensuring a balanced diet rich in essential nutrients is important for eye health. Generally, Sapthamrutha Lauha goes well with most of the dietary supplements and corrects the Rasa Dathu

4. Stress and Debilitating Diseases: Psychological stress and certain debilitating diseases can affect overall health, including the growth processes of the eye. Chronic stress or severe illnesses may impact the body's ability to maintain proper eye structure and function. Nasya provides Brumhana to Indriyas. Intake of ghee is Vata Pithahara so that it reduces the over stress of mind and eye.

5. Endocrine Disturbances: Hormonal imbalances or disturbances in the endocrine system can influence growth processes throughout the body, including the eyes. These disturbances may contribute to the development or progression of Myopia.

Conclusion

Here the therapies and internal medicines which mainly aimed to pacify the Vata Dosha from Urdhwajathrugatha areas are incorporated. Therapies like Parisheka, Nasya and Tarpana along with Internal medicines had shown significant improvement to decrease the power of spectacles. Around 60% cases of blurring vision are due to Simple Myopia presenting from simple eye strain to blurring of vision especially seen during the age group of 8 -22 years.

References

1. Ashtanga Hridayam Srikantha Murthy K.R. Uttar Tantra 31/98. Varanasi: Krishnadas Academy, 2002.130pp.


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2. http://www.bmj.com/content/324/7347/0.1.full?sid=3edf92c4-bb9a-4c3c-83a4-6beb647b8239
3. Shankar Udaya, Text book of Shalakya Tantra, Varanasi: Chaukhambha Vishva Bharathi; 2018.p561.
4. Harisadashiva Sastri Paradakara Bhisagacarya. Ashtanga Hrdaya. Reprint 2014.Chaukambha 2014. Uttarasthana; Timira Pratishedha, chapter 13/47.822pp.
5. Govind Das Sen, Bhaishajya Ratnavali. Netrarogachikitsa Prakaranam 64/232-234, commented by Ambikadutt Shastri. In: Rajeshwar Dutta Shastri., editor. 13th ed. Varanasi: Choukhambha Sanskrit Sansthan; 1997. p. 704.
6. Vagbhata, Brahmanand Tripathi, Ashtanga Hridayam Delhi: Chaukhambha Sanskrit Pratishthan; Suthrastana 20/37-8 7.
7. Ashtanga Hridayam, Upadhyaya YV, editors. Uttar Sthana 20/1 Varanasii: Chaukhambha Sanskrit Sansthana; 2003.Vidyotini Hindi Teeka; pp.127
8. Vagbhata, Brahmanand Tripathi, Ashtanga Hridayam Delhi: Chaukhambha Sanskrit Pratishthan; Uttar sthana 13/12
9. Vagbhata, Ashtanga Hridaya - Sarvanga Sundari Comm.02-03. Vol. 13. Varanasi: Chaukhambha Surbharti Prakashana; 2002. pp. 818–9.


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