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Year - 2023Volume - 1Issue - 2Pages - 1-9

Ayurvedic Treatment of Diabetic Retinopathy-A Single Case Study

 18 Nov 2023  211

About Author

Raut D1,Bhardwaj D2,Tundalwar D3,
1 PG Scholar,Shalakyatantra Department, Shri Ayurved Mahavidyalaya ,Nagpur , Shri Ayurved Mahavidyalaya ,Nagpur
2 PG Scholar,Shalakyatantra Department, Shri Ayurved Mahavidyalaya ,Nagpur , Shri Ayurved Mahavidyalaya ,Nagpur
3 Associate Professor, Shalakyatantra Department, Shri Ayurved Mahavidyalaya,Nagpur , Shri Ayurved Mahavidyalaya,Nagpur

Correspondence Address

Dr Priyanka Ashok Raut
PG Scholar,Shalakyatantra Department, Shri Ayurved Mahavidyalaya ,Nagpur

Contact No. : 9657595751, Email : priyankaraut102@gmail.com

Date of Acceptance : 14 Dec 2023

Date of Publication : 31 Dec 2023

Article ID : SD-IJAY_034

How to cite this article : http://doi.org/10.55552/SDNJAY.2023.1201

Abstract

Diabetic Retinopathy refers to a complication of diabetes that affects the eyes. That is nothing but damage to blood vessels in the tissue of retina. With increase in the life expectancy of diabetics, the incidence of Diabetic Retinopathy has increased.(1) Diabetic Retinopathy is leading cause of blindness. There are many treatment modalities mentioned in modern medicine but it have certain limitation. In Ayurveda, Diabetic Retinopathy can be compared with Madhumehajanya Timira. All the three doshas along with Rakta dosha and sapta dhatu with four internal Drishti patalas of eyes are affected in Madhumehajanya Timira in different stages of disease. In this current case of Madhumehajanya Timira, Ayurvedic treatment was done. In present case study a female patient of 58 years old visited the OPD of Shalakyatantra with complaining of defective distant and near vision since 6 months. Based upon the history and clinical features, Patient is K/C/O diabetes mellitus (type 2) since 8 years and is on regular medication. Patient is treated with Vasant Kusumakar Rasa 1OD  for 1 month ,Tab BGR-34 2BD  for 6 month, Tab Saptamrit Lauh 500 mg 1BD for 1 month and Triphala Ghrita 10 ml HS for 3 months duration. At the end of 6 months patient got significant relief.

Introduction

Diabetic Retinopathy the leading cause of visual disability in diabetics, is an important complication of diabetes mellitus (DM). Diabetic retinopathy is a chronic progressive, potentially sight -threatening disease of the retinal microvasculature associated with prolonged hyperglycemia. Diabetic Retinopathy is a microangiopathy involving the retinal precapillary arterioles, the capillary bed and the postcapillary venules. The pathogenesis of diabetic retinopathy includes both microvascular occlusion and leakage.(2)  Essentially ,it is a microangiopathy affecting retinal precapillary arterioles, capillaries and vesnules. Characteristics changes in capillaries include; damage to endothelial cells, there is loss of intramural pericytes which are normally present in the basement layers, basement membrane is thickened and fragmented. Microangiopathy results in microvascular occlusion, microaneurysm, capillary leakage and haemorrhages. This leads to retinal ischemia (retinal hypoxia) and retinal oedema. Retinal hypoxia in turn causes formation of hard exudates, arteriovenous shunt formation and neovascularisation.(3)

DR has been classified as-

  1. Non-proliferative diabetic retinopathy (NPDR)
  • Mild NPDR / Background NPDR
  • Moderate NPDR
  • Severe NPDR
  • Very Severe NPDR]
  1. Proliferative diabetic retinopathy (PDR)
  2. Diabetic Maculopathy
  3. Advance diabetic eye disease (ADED)

Ophthalmoscopic features of NPDR include microaneurysms, retinal hemorrhages both deep (dot and blot hemorrhages) and superficial   (flame shaped), retinal oedema, hard exudates, cotton wool spots, venous abnormalities (beading, looping and dilatation), IRMA. Occurrence of neovascularization over the changes of very severe NPDR is a hallmark of PDR. Diabetic maculopathy is associated with clinically significant macular oedema.

Pujyapada Muni in his work, “Netra Prakashika‟ explains Timir as the Upadrava of Madhumeha.(4) According to symptoms and complications of Diabetic Retinopathy it can be considered as Prameha / Madhumehajanya Timir. Avarana and Dhatu Kshaya too have important role in development of DR due to prolonged and uncontrolled hyperglycemia. Agnimandya related Ama formation has a role in pathology of DR which is quite similar to oxidative theory of DR explained in modern pathology.(5) DR possesses all the four features of Strotovaigunya i.e. Atipravritti, Sanga Siragranthi and Vimargagamana.(6) Sanga is manifested by the retinal vessels occlusion leading to hypoxic related ischaemia. Siragranthi is nothing other than development of microaneurysms. Vimargagamana is the retinal haemorrhages and Atipravritti can be correlated with neovascularization. Urdhwagata Raktapitta, OjasKshay , Raktavritta Vata, Pranavritta Vyana are other cause indevelopment of DR. All the Tridoshas and Dhatus are affected in successive stages and possess all the four features of Strotovaigunya. So as per etiopathological mechanism the first and foremost care should be given to prevent Madhumeha. Treatments like metabolic control of DM, intravitreal anti-VEGF therapy and intravitreal steroid laser photocoagulation surgical treatment i.e. Pars Plana Vitrectomy(PPV) given in modern science.

Tab BGR-34 (Blood Glucose Regulator) is an Ayurvedic derived product that is sold in India as an over-the-counter pill for the management of diabetes. Tab BGR-34 was co-developed by two national government owned laboratories. National Botanical Research Institute (NBRI) and Central Institute for Medicinal and Aromatic Plants (CIAMP) under the patronage of the Council of Scientific and Industrial Research (CSIR). It was developed in 2015 and launched commercially in 2016. CSIR has claimed BGR-34 to be the first Indian Ayurvedic anti-diabetic drug and the laboratories were awarded the CSIR Technology Award in 2016 in the Life Sciences category. According to Rasendra Sar Sangraha, Saptamrit Lauh is called as Timirhar Lauh. Primary indication of Saptamrit Lauh is vision loss, which is broad term. It includes several eye disorders one of them is DR.(7) Vasant Kusumakar Rasa  ayurvedic herbomineral formulation marketed worldwide for diabetes and associated symptoms.(8) Triphala Ghrit has strong therapeutic action on eye disorders. Following ingredients along with the part used

in formulation of tablets and Ghrita.

.

BGR 34

Sr No

Contents

1

Daruharidra   (Stem)

2

Vijaysar(Heart wood),

3

Gudmar   (Leaf)

4

Manjeeshtha (Root),

5

Methika   (Seed)

6

Giloy (Stem).

Triphala Ghrit

Sr . No.

Contents

1

Triphala

2

Trikatu

3

Draksha

4

Yashtimadhu

5

Kutakrohini

6

Padmakashta

7

Ela

8

Vidang

9

Nagkeshar

10

Neelkamal

11

Sariva

12

Shwetachandan

13

Haridra

14

Daruharidra

15

Ghrita

16

Milk

17

Triphala Kwath

     

Vasant Kusumakar Ras

Sr No.

Contents

1

Swarna Bhasma

2

Rajat Bhasma

3

Vanga bhasma

4

Kantaloha bhasma

5

Parad bhasma

6

Abhrak bhasma

7

Praval and pishti

8

Rasasindhur

     

SaptamritaLauh

Sr. No.

Contents

1

AamlaChurna

2

BehadaChurna

3

Haritakichurna

4

YashtimadhuChurna

5

Lohabhasma

6

Ghrita

7

Madhu (honey)

The present article deals with single case study regarding the Ayurvedic approach to the Mild /Background NPDR as Madhumehajanya Timir.

AIMS AND OBJECTIVE         

To evaluate  the effect of Vasant Kusumakar Rasa, Tab BGR-34 along with Tab Saptamrit Lauh and Triphala Ghrita in Background NPDR.

MATERIAL AND METHODS

Case Report:

Patient Name –XYZ  Age/Sex- 58 years/Female OPD No.-5357

Place- Nagpur

Occupation-Housewife

Date of registration-11/02/2022

 

Chief complaints – Blurring of vision since 6 months

H/O Present illness-

Patient had history of high blood glucose level before 2 years. After taking anti diabetic treatment for 3 months her blood glucose level is under control. But she experienced gradually blurring of vision. Since 6 months she complaints of increase in intensity of blurring of vision so she came to OPD of Shalakyatantra department of Shri Ayurved Mahavidyalaya, Nagpur.

 

Past History-

 

K/C/O-Diabetes mellitus since 8 years

On medication-Tab Vildader 50 mg OD (morning) Tab Glimp-M2 OD (afternoon)

K/C/O-Hypertension since 5 years

On medication-Tab Telvilite-AM 40mg OD(morning)

Family History-

 

No relevant history found

 

On ocular examination-

Sr.No

Examination

Findings

1.

Visual acuity (Aided)

RE-6/9

LE-6/9 (P)

2.

Eyelid

Normal

3.

Conjunctiva

No congestion

4.

Cornea

Clear

5.

Anterior chamber

Normal depth

6.

Iris

Colour pattern normal

7.

Pupil

NSRTL

8.

Lens

In situ

9.

Fundus examination

RE- Disc - normal  

       Macula- Soft Exudates

                   Microaneurysm

                Dot Haemorrhages    

LE- Disc- normal

      Macula-Soft exudates

BE-Signs of Background NPDR

Treatment Protocol

    1. Tab BGR-34 twice a day for 6 month duration.

Two tablet twice a day should be taken 30 minutes before meal.

    1. Vasant Kusumakar Rasa once a day for 1 month duration.
    2. Tab  Saptamrit Lauh 500 mg twice a day for 3 months after meal
    3. Triphala Ghrita 10 ml once a day at bed time

        Patient is given following medication and follow up is taken after 6 months.

Discussion

Diabetic Retinopathy the leading cause of visual disability in diabetics.So, an attempt has been made to study the complete aspect of disease and to find the best possible way for the betterment of mankind. In modern, drugs are not acceptable due their certain limitations, drug dependency and drug withdrawal syndrome. So Ayurvedic approach is needed, Treatment is all about correcting and preventing the etiopathological mechanism (Samprapti Vighatana). So as per etiopathological mechanisms described above, the first foremost care should be given to prevent madhumeha. The treatment of Diabetic Retinopathy revolves around treating the causes of madhumeha, prevention of dhatu kshay , prevention of agnimandya, prevetion of Ojo kshay, treatment of avarana. Vasant Kusumakar Rasa has Deepan and Pachan properties which reduce Agnimandya at tissue level i.e. Dhatwagnimandya and  improve metabolism that helps to control blood glucose levels. Madhumehajanya Timir mainly caused due to vitiation of Tridosha and Vasant Kusumakar Rasa has property of tridoshaghnta. Tab BGR-34 contains such herbs that are rich source of antioxidants preventing oxidative damage to vital organs. Tab BGR-34 restores carbohydrate metabolism by inhibiting various enzymes like inhibiting DPP-4 enzymes. It is an encouraging risk free drug regimen that effectively maintains normal carbohydrate metabolism while lowering the risk of long term complication. Hence, it acts as Neuroprotective, Rejuvenator, Anti-oxidant and Anti-diabetic drug. Saptamrit Lauh is Lauh kalpa which improves blood supply and thus the nutrition to the eye structures and tissues. And hence help to arrest the process of retinal hemorrhage absorption and prevent its recurrence. Which shows its importance in the treatment Diabetic Retinopathy. Triphala Ghrita rasayana for the eyes and Chakshyshya in nature, which helps in preservation of tissue and promotes the regeneration of tissue and prevents further degenerative changes of the retinal tissue. Hence useful in treatment of diabetic retinopathy .

Conclusion

Objective of the treatment of this case was restoration of structural and functional integrity in diabetic retinopathy. Ayurveda treatment principles help to arrest the progression of the disease and in this patient improvement were noticed. The present study shows the protective effect of an Ayurvedic herbo-mineral formulation, Vasant Kusumakar Rasa, tab BGR-34 along with Saptamrita lauh and Triphala Ghrita in Diabetic Retinopathy. In above case study, significant result was obtained in symptoms and signs after treatment. There is no adverse effect of drug. However, Vasant Kusumakar Rasa cannot be used for longer duration due to metallic formulation. Hence, Vasant Kusumakar Rasa and Tab BGR-34 along with Tab Saptamrita Lauh and Triphala Ghrita internally helps in management of Background NPDR.

References

  1. A K Khurana, Comprehensive Ophthalmology, chapter12, Diseases of Retina, Jaypee Health Science Publisher,New Delhi, 6th edition 2015, page no. 277
  2. Samar  K  Basak,  Essentials  of Ophthalmology, chapter 18, Diseases of Retina, Jaypee Health Science Publisher, New Delhi, 7th edition 2019, page no.353
  3. Renu Jogi ,Basic Ophthamology ,Chapter 13,The Retina ,Jaypee Brothers Medical Publishers, New Delhi , 4th edition 2009, page no. 317
  4. Pujyapada Mahamuni, Netraprakashika, chaturtha patala, first  edition, Kendriya Ayurved  and  Siddha Anusandhana Parishad, New Delhi,1999,12.
  5. Acharya  Agnivesha;  CharakaSamhita; redacted by Charaka and Dridabala with Ayurveda Dipika Commentary by Chakrapani Dutta; edited by Vaidya Yadavji Trikamji Acharya; 4thEdition; published by Chaukhambha Surabarathi Prakashana Varanasi, 2001:page no.231.
  6. Uday Shankar, ShalakyaTantra, 1stedition, Varanasi: Chaukhamba Sanskrit samsthana : 2012, page no. 634
  7. Nidhi Garg and Akhil Jain ; Ayurvedic Drug used in Eye disorder-A review international journal of recent Scientific research ; 2017 jan;vol.8 issue,1,pp.15225-15232
  8. Sridharan K.Mohan R.,Ramratnam S., Panneerselvam D.The Cochrane Library;2011.Ayurvedic treatments for diabetes mellitus [Google Scholar]
  9. Patel MP, Archana, Lalchand, Netam N, Parhate S.Vasant kusumakar Rasa-“A Best Antidiabetic Drug in Modern Era”:A review. International Ayurvedic Medical Journal; 2018 Oct;  6(10):2305-2311.
  10. Sashtri Brahmashankar, Commentary Vidyotini by Pt.Laxmipati Sashtri on Yogratnakar,Uttarardha,Prameha Chikitsa Adhyay, Chapter12, Verse1-4. Varanasi: Chaukhamba Prakashan, Edition10th;page no.94
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