Netra Pratisarana - Effective result with a simple procedure

[Find the meaning and references behind the names: Netra, Sri, Deep, Swamy, Shobha]

ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2017 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2017 | Vol. 2 | Issue 5 97 Netra Pratisarana - Effective result with a simple procedure Shobha CM., 1 Hamsaveni 2 1 Post Graduate Scholar, 2 Professor, Department of PG Studies in Shalakya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital And Research Centre, Vijayanagar, Bengaluru, Karnataka, India. I NTRODUCTION The reference of Pratisaarana Chikitsa is explained in almost all Samhitas . Pratisaarana is a “ Sthanika Chikitsa ” which means Pratisaaryate Gharshyate Aneneti Pratisaaranam , [1] Shanair Gharshanam Angulya Taduktam Pratisaaranam, [2],[3] Angulya Gharshanam , [4] a gentle massage on the teeth, tongue or buccal cavity with Choorna, Kalka, Avalehya with the finger for a shorter duration is called Pratisaarana [5] Address for correspondence: Dr. Shobha C. M. Post Graduate Scholar, Department of PG Studies in Shalakya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Centre, Vijayanagar, Bengaluru, Karnataka, India. E-mail: drshobha.cm 6@gmail.com Submission Date : 08/10/2017 Accepted Date: 28/10/2017 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.v 2 i 05.10263 Pratisaarana Chikitsa is a local treatment explained in the treatment principles of Mukha-Roga. The medicine is taken with the index finger and applied at the oral cavity. Here the word “ Gharshana ” is used for rubbing of medicine so that it exerts its action well. But Acharya Sushruta has described it as one of the Upakrama of Vrana [6] and also described in treatment of Netraroga as Pashchath Karma to remove the remnants of the lesion to clear the surface. In modern opthomology there is vast use of anti-biotic eye drops, steroids, mitomycin ointment to treat the condition and to avoid the reoccurrences of the conditions. Where as in Shalakya Tantra with the help of simple drug selection and Pratisarana procedure we can attain the similar result. Pratisarana is mainly carried out in Kapha Pradana Vyadhi with expected Lekhana effect, here with the help of Dravya there will be added effect of Lekhana . Hence this study is carried out to understand in depth regarding the procedure and its action. A B S T R A C T Pratisarana (rubbing) has been explained as Sthanika Chikitsa . Pratisarana is done, where Shastra Karma has a limitation to be used because of the sensitive surgical sight. “Hastameva Pradana Yantra”, Hasta (hand) has been used to carry out the procedure with various Lekhana Dravyas on such a delicate and sensitive structure with the expectation to cease the deep rooted / recurring / stubborn conditions. The importance of Pratisarana in Netra Roga as local ocular therapeutic/ surgery and its measures is immense into the present day in any chronic conditions as acute management due to its vast advantages, cost effect, availability of the drugs and procedure. In this area of presentation a brief overview on Pratisarana , its variants, Indications, clinical applications and rationality of the drugs used which are commonly available and probable mode of action will be convened to increase the confident level and make more ease to practice as an acute management to achieve success clinically. Key words: Pratisarana, Netra Rogas, Lekhana, Chronic Condition.

[Find the meaning and references behind the names: Kalpana, Guru, Madhu, Sha]

Shobha CM. et.al. Netra Pratisarana - Effective result with a simple procedure ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2017 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2017 | Vol. 2 | Issue 5 98 Types of Pratisaarana Table 1: Showing Types of Pratisaarana Types of Pratisaara na Su. [ 7] A.H. [ 8] A.S. [ 9] B.P. [1 0] Sha. [1 1] YR. [1 2] Kalka + + + + + + Rasakriya + + + - - - Kshaudra + - - - - - Churna + + + + + + Avaleha - - - + + + Avaleha is a synonym of Rasakriya , Acharya Sushruta and Vagbhata have not mentioned Avaleha instead they have mentioned Rasakriya , where as Bhavaprakasha , Yogaratnakara and Sharangadhara have mentioned Avaleha but not Rasakriya . Kalka being more Guru [13] and most potent [14] than Kashaya . Kalka can be used in severe condition as well in chronic conditions. Though Churna is one among Panchavidha Kashaya Kalpana , it can be considered as Upakalpana of Kalka , as Churna is a dry form of the drug. Churna chemical reaction in atmospheric condition is less in comparison to Rasakriya . Rasakriya can be considered as Upakalpana of Kashayaas , as 8 or 16 parts of water is boiled along with Dravya and reduced to one fourth of it. Kashaya being Laghu and least potent in comparison to Kwatha , Kalka , Swarasa , still we can extract all the water soluble principles of the drugs and preserve them for more days in comparison with Kashaya , Churna or any other primary preparations. Rasakriya can be prepared by seasonal as well unseasonal drugs. And also by doing Pratisarana with Rasakriya the drug bioavailability can be maximized. Kshaudra does Pitta Kapha Shamaka, Dipana, Medya, Srotoshodana, Rochana, Yogavahi Vibandha Hara, Daha Hara, Netramayahara. And also increases general metabolism. This can be used in absence or unavailability of the above mentioned form of preparations. Matra of Pratisaarana One Kola Matra is told in the context of Mukharoga , while in the treatment of Netra Roga we should use the required quantity depending upon the lesion. Following are the references from the classics regarding Pratisarana in various Netra Rogas . Roga Dravya used Savrana Shukra - Shukra Roga Nashana ▪ Shirisha Bija, Maricha, Pippali, Saindhava (Su. Ut, A. H. Ut., A.S.Ut., G.N.) Nimba along with above mentioned drugs (VS) ▪ Saindhava . (Su. Ut, Chakradatta, V.S.) ▪ Triphala Kwatha and Saindhava (A.H. Ut.) ▪ Dhatri, Phanjajkarasa, Kshara (A.H. Ut.) Shukra Vaivarnya Nashana ▪ Madhu (Su. Ut) As Pashyath Karma in Lekana Roga Chikitsa ▪ Manasheela, Kasisa, Trikatu, Saindava Lavana and Madhu (Su. Ut.) Lagana ▪ Gorochana, Yava Kshara, Tutta, Pippali, Madha (Su. Ut., B.R., Chakradatta, V.S., Y.R.) ▪ Manasheela, Ela, Saindhava,Tagara, Madhu (A. H. Ut) ▪ Gorochana, Kshara, Saindava, Pippali and Madhu(GN) Anjananamika ▪ Manasheela, Ela, Tagara,Saindava Lavana, Madhu (Su. Ut., A.S. Ut., Chakradatta, G.N., V.S., Y.R.) ▪ Rasanjana and Madha (Su. Ut., Chakradatta, G.N., V.S., Y.R.) ▪ Manashila,Ela, Saindhava and Madhu (B.R.)

[Find the meaning and references behind the names: Anjana, Tulsi, Sukha]

Shobha CM. et.al. Netra Pratisarana - Effective result with a simple procedure ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2017 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2017 | Vol. 2 | Issue 5 99 Krimigranthi Janthugranthi (Y.R.) ▪ Manasheela, Ela, Tagara, Saindava Lavana, Madhu (Su. Ut.) ▪ Rasanjana and Madha, (Su. Ut.) ▪ Triphaladyarasakriya (Su. Ut.) ▪ Triphala, Madhu, Kasisa, Saindhava (A.H. Ut) ▪ Kasisa, Saindhava, Triphala, Makshika (A.H. Ut.) ▪ Ela Churna (C.Ch.) ▪ Triphala, Tutta, Kasisa, Saindava and Rasanjana (B.R.) ▪ Triphala, Mutra, Kasisa, Saindhava and Rasanjana. (Chakradatta, G.N.) ▪ Triphala, Gomutra, Kasisa, Saindhava and Rasanjana.( V.S., Y.R.) Kaphajanya Upanaha ▪ Pippali, Madhu, Saindava Lavana (Su. Ut., A.S. Ut., B.R., Chakradatta) Arma ▪ Yavanala Churna, Trikatu, Lavana (Su. Ut.) ▪ Madhu, Vyosha, Saindhava ( A.H. Ut.) ▪ Saindhava Churna (A.S. Ut) ▪ Yavanala Bhasma (A.S. Ut) ▪ Plotha Shuddha Madhu (A.S. Ut) Sirajala ▪ Lekana Anjana Dravya (Su. Ut.) ▪ Yavanala Churna, Trikatu, Lavana (Su. Ut.) Sirapidaka ▪ Yavanala Churna, Trikatu, Lavana (Su. Ut.) Parvanika ▪ Saindava Lavana and Madhu (Su. Ut., A.H.Ut., A. S. Ut) Vartma Arsha ▪ Saindava Lavana, Kasisa, Pippali and Khara (Su. Ut.) Vartma Arbudha ▪ Saindava Lavana, Kasisa, Pippali (Su. Ut.) ▪ Khara (Su. Ut.) ▪ Tambula, Bakhuchi and Haritaki (A.S. Ut) Pakshma Kopa or Upapakshmamala ▪ Agni or Kshara if not treated then Patya Phala (Su. Ut.) ▪ Thovarakena (Su. Ut.) Kumbhika ▪ Saindava Lavana (A.H. Ut., A.S. Ut.) Vartma Lekahana ▪ Manasheela, Kasisa, Trikatu, Rasanjana, Saindava and Madhu (A.H.Ut.) Pothaki ▪ Shunti and Saindhava (A.H.Ut.) ▪ Shunti, Saindhava and Magadhi (Pippali). (A.S.Ut.) Kaphotklista ▪ Sukshma Saindava, Kasisa, Manasheela, Pippali, Rasanjana, Madhu (A.H. Ut., A.S. Ut.) Utsangini ▪ Tagara, Ela, Saindhava, Utpala (Manashila) and Madhu (A.S.Ut.) Bisavartma ▪ Saindhava (A.S.Ut.) Kukunaka ▪ Madhu, Saindhava and Rasanjana. (A.S.Ut.) Pakshmauparodha ▪ Tambula, Bakhuchi and Haritaki (A.S.Ut.) Sira shukla ▪ Manahashila and Rasanjana (A.S.Ut.) Pillaroga ▪ Haritala, Vaca, Devadaru and Tulsi Swarasa (Chakradatta) ▪ Tagara and Haritaki Kwatha (Chakradatta) ▪ Devadaru, Basti Mutra and Sasneha. (Chakradatta) Ajaka ▪ Gavasthi Twacya, Ushnodhaka (Y.R.) Characters of Samyakyoga Irrigation of Srava, Roga Haratwa (eliminating disease/ suppressing disease), Prakruta Stiti ( reobtaining its natural texture), Laghutwa (lightness), Sukha Prapti (feels comfortable).

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Shobha CM. et.al. Netra Pratisarana - Effective result with a simple procedure ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2017 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2017 | Vol. 2 | Issue 5 100 Characters of Hinayoga Kaphotklishta (increase Kapha Dosha ), stickiness of lid margin, heaviness of lid. Characters of Atiyoga Varthma Sushkata (dryness of lids), Klama (fatigue), Daha (burning sensation) Shoola (pain) Rakta Srava (bleeds), difficulty in Varthma Kriya. Mode of action of Pratisaarana The word meaning of Pratisarana is Garshana which means rubbing gentle. Rubbing of the eye lid and lid margin with very fine powder of the medicinal drugs promotes:- ▪ Local raise in temperature: Initiates function of brajaka pitta, influence twak prasadana. ▪ Vilayana of Dosha’s (liquefying the vitiated impurities): Clears Kapha Dosha due to Garshana . ▪ Increase in blood circulation : Blood vessels gets dilate which increases blood circulation and promotes healing. ▪ Srothomukha Vishodhana i.e., opening up the vessels: Does evacuation and cleansing of the secretary passages. ▪ Increase in the rate of absorption: By this procedure where the drugs come in contact with ocular tissue enters Srotomukha (like in Vartma Arbudha, Arshas, Utsangini ) and Romakupa ( Krimigranti , Pakshma Kopa ) further gets absorbed through Swedavaha Srotas ( Kumbika , Pilla Roga ). ▪ Hence this therapy removes the eyelid debris, which can be colonized by bacteria, reduces the bacterial load mechanically and stabilizes the tear film by releasing oily secretions from the meibomian glands. Ointment are of two types, i.e., Water soluble and fat soluble, this is as similar as Water soluble - Kalka , Rasakriya , Kshaudra and Churna and fat soluble as Avaleha . An ointment is a preparation of a medication for topical use that contains an oil base - essentially a preparation of water in oil. This is a semi-solid preparation. ▪ Site specific action. ▪ Occlusive effect enhances penetration of active drug and improves efficacy (especially in thickened, lichenified skin). CONCLUSION Even though in spite of using Antibiotic, Steroid and surgical procedure like excision, the recurrences rate of some ocular diseases is more. So patients are diverting towards alternative treatment. In Ayurveda, Pratisarana is type of procedure indicated in those diseases where there is need to use Anushatra’s at sensitive structures like eyes. This is one of the methods of achieving therapeutic drug concentration on the eye and surrounding structures. The affected tissue is targeted directly than from the systemic absorption and always give quick results. As the tissue contact time and bio availability of the drugs is more, Pratisarana with appropriate drugs based on Dosha’s involved in the disease, can help in scraping off the morbid cells from the site so that the reoccurrence can be avoided. Also is cost effective and avoid the anxiousness of the patient for surgical intervention. REFERENCES 1 Sharangadhara, Sharangadhara samhita commentary Adhamalla’s Dipika and Kasirama’s Gudharatha - Dipika, Re print edition 2012. Varanasi: Chowakambha Orientalia (Jai.Krishnadas Ayurvedaseries), Utharakhanda Chapter 10, verse 13-18 commentary PP. 398 Pg.354. 2 Yoga ratnakara with Vidyotini, hindi commentary by Vaidya Lakshmipati Sastri edidted by B.B. Sastri, Reprint 2015, Chaukhambha Prakashan, Mukha roga chikitsa PP. 298. 3 Bhava Prakasha of Sri Bhavamishra commentary by Dr. Bulusu Sitaram part-2, Chaukhambha Orientalia 1 st edition 2010, Reprint 2014, Chapter 66, verse 19, PP.656, pg.770

[Find the meaning and references behind the names: Nil, Med]

Shobha CM. et.al. Netra Pratisarana - Effective result with a simple procedure ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2017 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2017 | Vol. 2 | Issue 5 101 4 Ashtanga Hridaya with Sarvangasundara commentary of Arunadatta and Ayurvedarasayana of Hemadri. Chaukamba Orientalia 9 th edition.Varanasi (India), Sutra sthana , chapter 22, verse 13, p.p.956, pg. 300 5 Bhava Prakasha of Sri Bhavamishra edited with the Vidyotini hindi commentary part-2, Chaukhambha Sanskrit Bhavan 11 th edition 2010, Chapter 66, verse 19, PP.836, pg.703 6 Acharya JT. Susrutha Samhita with Nibandha Sangraha Commentary of Dalhana. Reprint ed. Varanasi (India): Chaukamba Sanskrit Sansthan; Chikithsa sthana, Chapter 1, Verse 8, commentary, p.p.824, pg.397. 7 Acharya JT. Susrutha Samhita with Nibandha Sangraha Commentary of Dalhana. Reprint ed. Varanasi (India): Chaukamba Sanskrit Sansthan; Chikithsa sthana, Chapter 40, Verse 69, commentary, p.p.824, pg.558. 8 Ashtanga Hridaya with Sarvangasundara commentary of Arunadatta and Ayurvedarasayana of Hemadri. Chaukamba Orientalia 9 th edition.Varanasi (India), Sutra sthana , chapter 22, verse 13, p.p.956, pg. 300 9 Ashtanga Sangraha of vagbhata Vol. 1 by Prof. K.R. Srikantamuthy.. Chaukamba Orientalia 9 th edition 2005, reprint 2007. Sutra sthana , chapter 31, verse 12, p.p.641, pg. 535 10 Bhava Prakasha of Sri Bhavamishra commentary by Dr. Bulusu Sitaram part-2, Chaukhambha Orientalia 1 st edition 2010, Reprint 2014, Chapter 66, verse 19, PP.656, pg.770 11 Sharangadhara, Sharangadhara samhita commentary Adhamalla’s Dipika and Kasirama’s Gudharatha - Dipika, Re print edition 2012. Varanasi: Chowakambha Orientalia (Jai.Krishnadas Ayurvedaseries), Utharakhanda Chapter 10, verse 17 commentary PP. 398 Pg.354. 12 Yoga Ratnakara with Vidyotini, hindi commentary by Vaidya Lakshmipati Sastri edidted by B.B. Sastri, Reprint 2015, Chaukhambha Prakashan, Mukha roga chikitsa PP. 298. 13 Sharangadhara, Sharangadhara samhita commentary Adhamalla’s Dipika and Kasirama’s Gudharatha - Dipika, Re print edition 2012. Varanasi: Chowakambha Orientalia (Jai.Krishnadas Ayurvedaseries), Madyama khanda Chapter 1, verse 1 commentary PP. 398 Pg.51. 14 Ashtanga Hridaya with Sarvangasundara commentary of Arunadatta and Ayurvedarasayana of Hemadri. Chaukamba Orientalia 9 th edition.Varanasi (India), kalpa sthana , chapter 6, verse 8, p.p.956, pg.771 ******************************* How to cite this article: Shobha CM., Hamsaveni. Netra Pratisarana - Effective result with a simple procedure. J Ayurveda Integr Med Sci 2017;5:97-101. http://dx.doi.org/10.21760/jaims.v 2 i 05.10263 Source of Support: Nil, Conflict of Interest: None declared.

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