NETRA TARPANA.pptx

Netra Tarpana procedure in detail, dose and duration and its mode of action in detail.

1. TARPANA/ NETRA BASTI- An ocular therapy Dr. Shraddha Joshi Ph.D. Scholar Shalakya Tantra Dept. ITRA, Jamnagar

2. Netra Tarpana acts as both preventive and curative therapy for maintaining healthy condition of eyes . Netra means eyes and T arpana means nourishment. Netra T arpana is a procedure where in lukewarm medicated ghee is made to stay stagnant in the eyes for a speculated time in a specific formed frame. Dr. Shraddha Joshi 2 Cont ….

3. This procedure is useful in healthy as well as diseased person. It cools, lubricates and rejuvenates the eyes. It helps in the clarity of the eyes as it expelled out the impurities. This procedure strengthens eye sight and increases the blood circulation. The medicines having the quality to get into minute channels of the body, when applied to the eyes enters deeper into the layers of eyes . Dr. Shraddha Joshi 3 Cont ….

4. Indications ( Tarpana sadhya vyadhi ) Netra shushkata (Dryness of eyes) Prakashasahata (Photophobia) Ati darun , shirna pakshma (Stiff eyelashes) Netrabhighata (trauma) Vata -pitta dosha predominance Kricchonminmilan (Difficulty in closing of eyelids) Sirotpata (Hyperaemia of eye) Arjuna ( Subconjunctival haemorrhage) Abhishyanda (Conjunctivitis) Adhimantha (Glaucoma) etc. Dr. Shraddha Joshi 4

5. Contra-Indications ( Tarpana ayogya awastha ) Durdina (cloudy day) Ati-Ushna or A tishita K ala (extreme sunny day, cold season) Patient having C hinta , B hrama (worry, anxiety) In the conditions of acute pain. Complicated ocular disease. Dr. Shraddha Joshi 5

6. Tarpana Vidhi This procedure is divided into three parts a ) Purvakarma b ) Pradhanakarma c ) Paschatkarma Purvakarma Dr. Shraddha Joshi 6

7. 7 Dr. Shraddha Joshi Position of Patient

8. 8 Dr. Shraddha Joshi Masha (Horse gram) dough Liquefy the Ghrita

9. Pradhana karma Akshi Tarpana should be carried out in the forenoon or in the afternoon on an auspicious day after the food (taken by the patient) has been digested and after the head and the whole body of the patient have been treated with purification measures properly. Patient is made to lay in supine position in a good lighted , ventilated room free from dust and smoke. Than the eyes are encircled with firm, compact leak proof Pali (wall) made up of paste of powdered Masha . Dr. Shraddha Joshi 9

10. The patient is asked to close the eyes and over the closed eyes, Ghrita processed with appropriate drugs and liquefied in lukewarm water should be poured to the orbit, till the level of tip of eyelashes. Patient is asked to open and close the eye intermittently and steadily. Dr. Shraddha Joshi 10

11. Modification in Procedure of Tarpana Nowadays a new technique was developed. A swimming goggle can be taken and its upper glasses can be removed for pouring medicine. There is no chance of leaking of the medicine in this method. This gives best results and more comfort to the patient in less time. 11 Dr. Shraddha Joshi

12. Paschata karma After retaining of Ghrita for a stipulated period, the Ghrita is drained out through a hole made at the bottom of dough wall, near the outer canthus of the eye and the eye is irrigated with lukewarm water fomentation . The Kapha which has already been stimulated by the potency of Ghrita , should be eliminated by Shirovirechana ( Nasya ), and medicated smoking ( Dhoompana ) with the Kapha suppressive drugs. Patient is instructed to keep away from exposure to bright lights, wind, sky, mirrors and luminous bodies. Dr. Shraddha Joshi 12

13. Period of retention of ghrita According to vitiated Doshas : ( Su.Sha .) Dosha Bheda Duration Healthy eye 500 Matra (~15 min.) Kapha Prakopa 600 Matra (~15-20 min) Pitta Prakopa 800 Matra (~25 min) Vata Prakopa 1000 Matra (~25-30min) According to site of disease : ( Su.Sha .) Site Duration Sandhigata (Diseases of junctional areas) 300 Matra (~10 min) Vartmagata (Eyelid diseases) 100 Matra (~3 min) Shuklagata (Diseases of Sclera) 500 Matra (~15 min) Krishnagata (Diseases of Cornea & Iris) 700 Matra (~20 min) Drishtigata (Diseases occurring in the visual field or retina, lens) 800/1000 Matra (~25-30 min) Sarvagata (Diseases occurring all over eye) 1000 Matra (~25-30min) Dr. Shraddha Joshi 13

14. Tarpana Avadhi (Days of Procedure) This process is done for 1 day 3 days or 5 days as per the requirement. Dosha Bheda Days Vataja Vyadhi Daily Pittaja Vyadhi Alternate day Kaphaja Vyadhi At the interval of 2 days Healthy person At the interval of 2 days Dr. Shraddha Joshi 14

15. Samyaka Tarpita Lakshana (Signs of Properly done Tarpana ) Sukhaswapana - good (sound) sleep Avbodhatva - blissful awakening Vaishadhya - clearness of the eyes Varnapatava - discernment of individual colours Nivriti - feeling of comfort Vyadhividhvansa - cure of the disease Kriya L aghvama - easiness in closing and opening the eyes Prakash K shamta - ability to withstand bright light Dr. Shraddha Joshi 15

16. Ati-Tarpita Lakshana (Excessive Tarpana ) Netragaurava - heaviness in eyes Avilta - indistinct vision Atisnigdhata - excessive oiliness Ashru Srava - lacrimation Kandu - itching Upadeha - stickiness Dosha Samutklishta - aggravation of Dosha Dr. Shraddha Joshi 16

17. Heena Tarpita Lakshana (Inadequate Tarpana ) Netrarukshata - dryness of eye Avilta - indistinct vision Ashrusrava - lacrimation Asahyam Roopdarshana - difficulty in vision Vyadhivridhi - aggravation of disease 17 Dr. Shraddha Joshi

18. Treatment of Inadequate and Excessive Tarpana Dhoompana , Nasya , Anjana , Seka either Ruksha or Snighdha are to be done for treating both inadequate and excessive Tarpana conditions according to predominance of Dosha . Snighdha Seka in disease of Vata predominance Dosha . Ruksha Seka in Kapha predominance Dosha. Sheeta Seka in Pitta predominance Dosha . 18 Dr. Shraddha Joshi

19. Factors affecting absorption of drug in body Route of administration Solubility and bioavailability of the drug Physical state of drug Time of absorption Patient and drug compliance Absorbing surface Excretion of drug 19 Dr. Shraddha Joshi

20. 20 Dr. Shraddha Joshi MODE OF ACTION* *Dr. Arun Gupta N. et.al., Anticipated mode of action of Netra Tarpana ; WJPS, 2020, Vol. 6, issue 7, pg. no. 263-270.

21. Ghrita is used primarily for Tarpana . Effective in subsiding Pittaja & Vataja disorders. It improves Dhatus . Overall booster for improving Ojas . Possess quality of trespassing into minutest channels of body. Possess Sanskaranuvartana (Easily imbibes the properties of other drugs) quality. Possess Balya (strengthening), Brihana (nourishing), Rasayana (rejuvenator) property. Contains mainly omega-3 & 6 fatty acids, Vit . A, E, K & antioxidants. 21 Dr. Shraddha Joshi

22. Tarpana can also be considered as a route of ocular drug delivery through topical administration. Most of the topically applied drugs, the site of action is usually different layers of the cornea, conjunctiva, sclera, and the other tissues of eye. Mucin present in tear film plays a protective role by forming a hydrophilic layer and it also clears the debris and pathogens. However, tear film displays a rapid restoration time of 2-3 min, and topically administered solutions are washed away within 15-30 s after instillation. And so more amount of drug with more contact time is required for increased bioavailability. 22 Dr. Shraddha Joshi

23. In case of Tarpana the volume of drug retained over ocular surface is much higher. Thus mucin itself may get diluted by the Ghrita or any other Tarpana drug removing the hydrophilic layer barrier and provides more drug for absorption. In addition to tear film, various layers of the cornea, conjunctiva and sclera play an important role in drug permeation. 23 Dr. Shraddha Joshi

24. Epithelium- Lipophilic in nature Stroma - Hydrophilic in nature Endothelium- Lipophilic in nature 24 Dr. Shraddha Joshi

25. Tarpana is mostly done with lipophilic drugs in the form of Ghrita , thus it can be well absorbed through lipoidal membrane. Used Lukewarm: May dilate the tight junctional complexes thus allowing paracellular drug penetration. Endothelial junctions are leaky and facilitate the passage of macromolecules between the aqueous humor and stroma . So, it is vital to understand that the permeant should have an amphi p athic nature in order to permeate through these layers. 25 Dr. Shraddha Joshi

26. Tarpana when did with Siddha Ghrita , it contains more small chain fatty acids having small molecular radius than the long chain fatty acids. Thus, they may get readily absorbed. 26 Dr. Shraddha Joshi

27. Exerts extraocular pressure to the lens thus increasing its axial length- Improves the accommodation. Ghrita preparation used in Tarpana are in the form of suspension containing different particles of the drugs and the particles donot leave the eye as quick as solution. So, Tarpana has proven to be the most efficacious Netra Kriyakalpa in various disease. 27 Dr. Shraddha Joshi

28. Mechanism of Cow Ghee in Akshi Tarpana 28 Dr. Shraddha Joshi In cornea the epithelium & endothelium is lipid permeable i.e. Lipophilic Hence lipophilic drugs are effectively delivered to Cornea The ghee is used in Tarpana procedure is lipophilic Ghee has quality of passing into minute channels of body Intraocular drug absorption to ant. Lens capsule, ciliary muscles and other tissues. Due to to more contact time of ghee in Tarpana procedure, the absorption will be more to cure disease. Desired therapeutic action Relief in symptoms

29. 29 Dr. Shraddha Joshi Administration of Tarpana in the eye Absorption of the drug through various layers of eye Activation of Chakshuvaisheshika Pitta Spread of the drug in to the deeper tissues through Rupavaha Siras Activation of Alochaka Pitta Ghrita - Rasayana, Balya, Chakshushya property Activation of Buddhivaisheshika Pitta Increased power of Drishti Nadi (Optic nerve) Activation of Visual centre in brain (Occipital lobe) Overall improvement in visual status

30. 30 Dr. Shraddha Joshi 30 Administration of Tarpana in the eye Fat soluble ingredients of Drugs absorbed through cornea Lipids (Phospholipids-Glycerides) Vitamin A,D,E,K & Carotene Transportation of drugs through cornea to deeper tissues Amino acids & proteins Increases lubrication b/w lens fibers Increases muscular power of ciliary muscles Overall improvement in visual status Helps in anaerobic oxidation Acts as antioxidant Prevents cornea & lens from oxidative injuries

31. 31 Dr. Shraddha Joshi