|
 |
| CASE STUDY |
|
| Year : 2015 | Volume
: 36
| Issue : 2 | Page : 177-179 |
|
|
Ayurvedic management of papilledema
Manjusha Rajagopala1, G Gopinathan2
1 Department of Shalakya, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
2 Department of Shalakya Tantra, School of Ayurveda, Amrita Vishwa Vidyapeetham, Amritapuri, Clappana, Kerala, India
| Date of Web Publication | 3-Feb-2016 |
Correspondence Address:
Dr. Manjusha Rajagopala
Associate Professor, Department of Shalakya, I.P.G.T. and R.A., Jamnagar - 361 008, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-8520.175545
 Abstract | | |
The term Shotha ordinarily means a swelling which may be because of inflammatory process in any part of the body or may be general, due to causes other than inflammatory. A diagnosed case of papilledema (Kapha-Pittaja Drishti Nadi Shotha) was treated on the lines of Shotha Chikitsa. The patient was given Dashamoola and Punarnavashtaka Kwatha internally and locally Nasya and Takradhara for 3 months. At the end of 3 months, papilledema completely regressed. Follow-up of the patient for more than 3 years, no recurrence has been reported. Keywords: Nasya, papilledema, Shotha, Takradhara
How to cite this article:
Rajagopala M, Gopinathan G. Ayurvedic management of papilledema. AYU 2015;36:177-9 |
| Introduction | |  |
The term Shotha ordinarily means a swelling which may be because of inflammatory process in any part of the body or may be general, due to causes other than inflammatory.[1]Shotha occurring any part of the body may occur as either Swatantra Vyadhi (primary) or Paratantra (secondary) condition. It may also occur as a symptom of other diseases. Keeping this concept of Shotha in view, papilledema can be considered Drishti Nadi Shotha which may be primary or secondary.
The term papilledema and disc edema look alike, and per se means swelling of the optic disc [2] However, arbitrarily, the term papilledema has been reserved for the passive disc swelling associated with increased intracranial pressure, which is almost always bilateral although it may be asymmetrical. If not treated in time, this condition can lead to optic atrophy and loss of vision that is Sannimitaja Linganasha,[3] due to Shiroabhitapa orraised intracranial pressure. In this case study, a female patient of papilledema presented with Kapha-Pitta predominant symptomsthat is, blurring of vision, heaviness in both eyes (BEs), mild pain in left eye, and signs of papilledema. Patient was diagnosed as bilateral papilledema, more in the right eye than the left eye. In ayurvedic parlance, this case had been diagnosed as Kapha-Pittaja Drishti Nadi Shotha.
| Case Report | | |
A female patient aged about 53 years visited outdoor patient Department of Shalakya Tantra, IPGT and RA Hospital, Jamnagar, presenting with complaints of blurring of vision, heaviness in the head and BEs throughout the day with associated complaints of mild pain in the left eye. For these complaints, patient had undergone treatment by an eye surgeon and was provisionally diagnosed as benign raised intracranial pressure with a normal report of magnetic resonance imaging - brain, presenting with bilateral papilledema (comparatively more in the right than left eye). Patient was on tablet Diamox 250 mg (acetazolamide twice a day), but patient complained generalized weakness after taking this tablet. Even after taking tablet Diamox, patient had persistent heaviness in head and mild pain in the left eye. Hence, patient wanted to discontinue it and thus, came for ayurvedic treatment. In the past history, it is a known case of hypertension since 8 years on antihypertensive (tablet Amlovas 50 mg once a day), and blood pressure was under control. Further suffering from diabetes mellitus since 6 years and on oral antihyperglycemic agent (tablet Glyciphage 500 mg), blood sugar level was - fasting 125 mg% and postprandial 151 mg%.
There was no history of severe headache or nausea or vomiting or neurological deficit.
On examination
Visual status
- Distance vision acuity (DVA) - 6/6 BEs, Near Vision (NV) - N/6 BE
- Intraocular pressure (IOP) -15.9 mmHg BE
- Third, fourth, and sixth cranial nerve in BEs were normal
- Slit lamp examination - no keratitis, no iritis
- Pupil - no afferent pupillary defect.
Fundii disc
- Right eye - moderate papilledema
- Left eye - mild papilledema.
No papillitis/neuritis, retinal hemorrhage, retinal exudates, hypertensive retinopathy changes.
Looking into the above clinical picture, patient had been diagnosed as benign raised intracranial pressure leading to papilledema, which is painless swelling of the optic disc with hyperemia of the disc with engorged retinal vessels. From ayurvedic point of view, it was diagnosed as Kapha-Pittaja Shotha and treated on the line of Shotha Chikitsa.
The following treatment was administered:
- Dipana Pachana - Ama Pachana Vati – 2 tablet (each 500 mg) twice daily after meals for 7 days
- Koshta Shuddhi - Eranda Bhrishta Haritaki 6 g with lukewarm water at bedtime for 7 days
- Dosha Pratyanika Chikitsa:
- Dashamoola Kwatha[4]and Punarnavashtaka Kwatha[5] each 20 ml twice daily orally on empty stomach for 3 months
- Nisha Amalaki Churna[6] 6 g twice a day orally for 3 months
- Takradhara[7] - along with internal medication three sittings of Takradhara were given with 7 days gap between each sitting
- In between two sittings of Takradhara, one course of Nasya for 7 days with Ksheerabala Taila (101 Avartana)[8] was done.
Total duration of treatment was 3 months. The patient started feeling better in blurring of vision after 1 week of start of the treatment in right eye. Slight heaviness in the left eye persisted for 15 days; after this period, patient reported gradual improvement in the heaviness of the left eye. After 1 month of treatment, a decrease in papilledema was observed. Blood sugar level was normal (within biological limit). On follow-up of more than 3 years, patient was asymptomatic; on examination, papilledema of BEs completely regressed.
| Discussion | | |
As mentioned by Acharya Charaka in Vimana Sthana in the context of Anukta Vyadhi[9] that, for the management of diseases which are not named in the text, the physician should use his knowledge, intelligence and try to comprehend the vitiated Dosha and treat it accordingly.
Though there is no definite treatment protocol in the management of benign raised intracranial pressure presenting with papilledema, with the clinical experiences, an attempt was made to treat this clinical entity on lines of Shotha Chikitsa. Thus, the treatment aimed at reducing the Shotha by administering Shothahara preparations such as Dashamoola and Punarnavashtaka Kwatha. Along with internal medication, the local procedure Takradhara (Ruksha, Sheeta quality) to pacify Kapha and Pitta Dosha and to pacify Vata, Nasya with Ksheerabala Taila were planned. At the same time by giving due consideration to control diabetes, Nisha Amalaki Churna was administered. The patient responded well both subjectively and objectively to the treatment.
Drugs of Dashmoola Kwatha such as Agnimantha (Clerodendrum phlomidis Linn.),[10] Shyonaka (Oroxylum indicum Vent.),[11]Gambhari (Gmelina arborea Linn.),[12] and Bilwa (Aegle marmelos Corr.)[13] are proven to be best for their anti-inflammatory activity, and drugs of Punarnavashtaka Kwatha such as Punarnava (Boerhavia diffusa Linn.),[14] Haritaki (Terminalia chebula Retz.),[15] and Gomutra (cow urine)[16] are having antioxidant, diuretic, anti-inflammatory as well as antimicrobial properties. Nisha Amalaki Yoga is very commonly used drug for controlling blood sugar, and Harida (Curcuma longa Linn.),[17] as well as Amalaki (Emblica officinalis Gaertn.),[18] both are known for their free radical scavenging and antioxidant activity.
| Conclusion | | |
New ocular disorders, for example, papilledema which is not described in ancient texts can be understood by following the guidelines given in the context of Anukta Vyadhi and can be successfully managed by analyzing the vitiated Doshas based on the signs and symptoms. The entity papilledema can be considered Kapha-Pitta predominant Drishti Nadi Shotha and managed by following the treatment prescribed for Shotha.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Acharya YT, editor. Charaka Samhita of Agnivesha, Sutrasthana. Reprint Edition. Ch. 18, Ver. 5. Varanasi: Chaukhambha Orientalia; 2011. p. 106.  |
| 2. | Khurana AK. Neuropthalmology. In: Comprehensive Ophthalmology. 4 th ed. New Delhi: New Age International (P) Limited Publication; 2007. p. 319-22. |
| 3. | Acharya JT, editor. Sushruta Samhita of Sushruta, Uttaratantra. 8 th ed., Ch. 7, Ver. 42. Varanasi: Chaukhambha Orientalia; 2005. p. 609. |
| 4. | Krishna KV, editor. Sahasrayoga, Kashaya Kalpana. 25 th ed. Alleppy: Vidyarmbha Publication; 2004. p. 34. |
| 5. | Vidyasagar PS, editor. Sarangdhara Samhita of Sarangdhara, Madhyama Khanda. Reprint Edition. Ch. 2, Ver. 76-7. Varanasi: Krishnadas Academy Publication; 2000. p. 154. |
| 6. | Paradakara HS, editor. Astanga Hridaya of Vaghbatta, Uttarasthana. 9 th ed. Ch. 40, Ver. 48. Varanasi: Chaukhambha Orientalia Publication; 2005. p. 943. |
| 7. | Krishna KV, editor. Sahasrayoga, Dhara Kalpa. 25 th ed. Alleppy: Vidyarmbha Publication; 2004. p. 475. |
| 8. | Krishna KV, editor. Sahasrayoga, Taila Yoga. 25 th ed. Alleppy: Vidyarmbha Publication; 2004. p. 315. |
| 9. | Acharya YT, editor. Charaka Samhita of Agnivesha, Vimanasthana. Reprint Edition. Ch. 4, Ver. 6. Varanasi: Chaukhambha Orientalia; 2013. p. 248. |
| 10. | Rathore RS, Prakash A, Singh PP. Premna integrefolia Linn., A preliminary study of anti-inflammatory activity. Rheumatism 1977;12:130-4. |
| 11. | Doshi K, Ilanchezhian R, Acharya R, Patel B R, Ravishankar B. Anti-inflammatory activity of root bark and stem bark of Shyonaka. J Ayurveda Integr Med 2012;3:194-7. [ PUBMED]  |
| 12. | Barik BR, Bhowmik T, Dey AK, Patra A, Chatterjee A, Joy SS. Premnazole an isoxazole alkaloid of Premna integrifolia and Gmelina arborea with anti-inflammatory activity. Fitoterapia 1992;63:295-9. |
| 13. | Pitre S, Srivastava SK. Pharmacological, Microbiological and phytochemical studies on the roots of Aegle mermelos. Fitoterapia 1987;58:194. |
| 14. | Awasthi LP, Verma HN. Boerhaavia diffusa – A wild herb with potent biological and antimicrobial properties. Asian Agrihist 2006;10:55-68. |
| 15. | Singh MP, Sharma CS. Wound healing activity of Terminalia chebula in experimentally induced diabetic rats. Int J Pharm Technol Res 2009;1:1267-70. |
| 16. | Edwin J, Edwin S, Tiwari V, Garg R, Emmanuel T. Antioxidant and antimicrobial activities of cow urine. Glob J Pharmacol 2008;2:20-2. |
| 17. | Sreejayan N, Rao MN. Free radical scavenging activity of curcuminoids. Arzneimittelforschung 1996;46:169-71. |
| 18. | Katiyar CK, Brindavanam NB, Tiwari P, Narayana DB. Immunomodulator products from Ayurveda: Current status and future perspective. In: Upadhyaya SN, editor. Immunomodulation. New Delhi: Narosa Publishing House; 1997. p. 163-87. |
|
