Introduction

According to Tielsch et al; in United States, the prevalence rate of Blindness attributed to Optic Atrophy was 0.8% and according to Munoz et al, the prevalence of visual impairment and blindness attributed to Optic Atrophy was 0.04% and 0.12% respectively. It is more prevalent in African Americans (0.3%) than in whites (0.05%). Optic Atrophy is seen in any age group. In this no sexual predisposition noted.4 Optic Atrophy refers to the death of the retinal ganglion cell axons that comprise the optic nerve with the resulting picture of pale optic nerve on fundoscopy.11 Optic atrophy is an end stage that arises from various causes of optic nerve damage anywhere along the path from retina to the lateral geniculate.5,6 Optic nerve transmit retinal inflammation to the brain, Optic Atrophy is associated with vision loss1 .Optic Atrophy is somewhat of implies disuse and optic nerve damage; it is better termed as Optic Neuropathy.1,3,6 In optic nerve atrophy there is loss of axons and shrinkage of myelin leading to gliosis and widening of the optic cup.7 Optic Nerve is not a true nerve but it is a continuation of central nervous system. Optic Atrophy is a disease which remains incurable in modern medicine. It is caused by various neurological, toxic, inflammatory and systemic disorder10. Many patients consult to ayurvedic hospitals; and seek ayurvedic treatment. While giving treatment for this disease on Ayurvedic principles; it is observed that Optic Atrophy can be correlated with Vataj Timir.  Acharya Sushrut, in Sushrut Samhita Uttartantra 7-18 and Acharya Vagbhat had mentioned in the shlok (va.utt. 12-8, 9/Su.utt.7-18 /Ashtang sangraha 15-6,9); that patient suffering from vataj timir visualize objects as blurred, irregular, distorted and flickering. The pathology, signs and symtoms etiological features purely suggest that primary optic atrophy is correlated with vataj dosha that is Vataj Timir.

• Samprapti- 10

Vaat Prakopak Aahar-Vihar

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Sarvadehik Dosh Vikruti

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Siranusaari Urdhvajatrugat

(Netragat Vaat Vigunata)

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Netragat Patal Doshdushti

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Kshayjanya Drushti Naadi Shirsh Shosh

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Vaataj Timir

In Samhitas; Samanya and vishesh chikitsa has been mentioned. Acharyas has mentioned vishesh chikitsa for Vataj Timir that is Sthanik and Sarvadehik Shodhan and Shaman.

Case study:

Patient name –XYZ

Age/Sex -56 years Male

Patient came in opd of our institute, having following complaints

1. Diminish of vision for both eyes for 2 years back
2. Headache for 2 years
3. Bilateral pain in both eyes

• Past history illness and investigations done –

K/c/o –Primary Optic Atrophy

Investigations- Had done MRI scan on (08/11/15)

Results mentioned were: -Bilateral optic nerves optic chiasma and tracts exhibit diffuse thinning and intraneural signal alteration with no extrinsic compressive pathology. Bilateral chronic optic nerve atrophy. Retinal Detachment in both eyes.MRI Brain +Optics on 22/10/20

Impression –chronic lacunar infracts

Fundus photograph taken on 18/12/22

Result both eye optic atrophy

Fundoscopy reveals optic nerve head palor ++

Patient diagnosed with Lebers congenital anamoly on 16/02/16

BOTH EYES Perimetry test done-Not following any specific pattern of Glaucoma.Patient come to Shalakya tantra opd for further treatment

INVESTIGATIONS-

HB-11.5(g/dl)

RBC-4.06 (10*6/uL)

WBC-7.49(10*3/uL)

NEUT-3.70(10*3/uL)

LYMPHOCYTES –2.81(10*3/uL)

MONOCYTES-0.48 (10*3/uL)

PLATELETS-257 (10*3/uL)

ESR-10 mm/hr

BLOOD SUGAR-

FASTING-90 MG/DL

POSTPRANDIAL-144 MG/dl

ETIOPATHOGENESIS-11,13

Causes like Injury, multiple sclerosis, retrobulbar neuritis(idiopathic), Leber’s, intracranial tumours, Toxic amblyopias and congenital anomalies.

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Degeneration or atrophy of axons by direct compression or toxic effect.

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Inflammation within or around the nerve.

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Ischemia by affecting blood supply.

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Disorder that produces swelling /oedema in and around the nerve.

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The optic nerve is affected.

TREATMENT-

• Sarvadehik- SHODHAN

SHAMAN

1) Shodhan chikitsa –After Aam Paachan done with Oral medication we conduct,

• Virechan karma with Ichchabhedi rasa by snehapan Mahatiktaka ghrut.
• 4 sittings of

1. Mustadi Yapan Bast

Contents-

Musta –Cyperus rotundus

Patha-Cissampelos Pareira

Amruta- Tinosporia Cordifolia

Bala –Sida cordifolia

Arand –Ricinus Communis

Rasna –Pluchea lanceolata

Punarnava – Boerhavia diffusa

Manjishta –Rubia cordifolia

Aragwadh –Cassia fistula

Usheer –Vetiveria ziazanioidis

Trayman –Gentiana kurroa

Bibhitak- Terminalia Bellirica

Kutki- Picorhiza kurroa

Shaliparni –Desmodium gangeticum

Bruhati- Solanum indicum

Kantakari- Solanum surratence

Gokshur –Tribulus terrestris

Madanphala –Randia spinosa

Kalka dravya –

Yashtimadhu –Glycyrhhiza glabra

Shatpushpa- Anethum sowa

Gavhala –Prunus mahaleb

Indrayava –Holarrhena antidysentrica

Rasanjana

Sarpi

Madhu and Saindhav

Dose -80ml (Basti prepared as per Ashtang Hriday Smhita )

Deepan pachan were given before administration of basti, with help of oral medications.

Time of Administration –After meal

Period of Administration-

4 sittings of Mustadi Yapan of 16 days was given as follows-

• First basti was given by Teel taila (40 ml)
• Sendly 14 consecutive Mustadi yapan basti (80ml) was given
• Then 16th basti was given by Teel taila (40ml)

Discussion

As discussed earlier the pathogenesis (samprapti)occurred in patient was sarvadehik followed by sathanik. So firstly, we decided for shodhan karma. As mentioned in ayurvedic text that sarvadehika doshprakopa is definitely responsible for netragat vyadhi Keeping above in mind,patient posted for virechan karma .For this snehapan with Mahatikta ghrut having tikta rasatmak dravyas was given.The rakt viguntva was corrected by titkta ras.   We decided to do snehapan with Mahatikta Ghrut (which contains-Saptaparna, ativisha,shampaka,Tiktarohini,Patha,Musta,Ushira, Triphala, Patola, Neem, Parpataka, Dhanvayasa, Chandan, Pippali,Gajapippali,Padmaka,Haridra, Daruharidra, Ugragandha, Vishaka, Shatavari, Sariva,  Vatsakabija, Vasa, Murva, Amruta, Kiratatikta, Yashtimadhu, Trayamana, Amalaki phala, Ghrita) (Bhaishajya Ratnavali Kushta Adhikara 118-124) and Virechan karma with icchabhedi rasa.

After virechan karma,sansarjan krama strictly followed.

Mustadi Yapan Basti given for 16 days.

The following are the properties of dravyas in Mustadi yapan basti –

Arand, Bala,rasna,punarnava ,laghupanchmula –are Vatashamak

Madanphal,manjishtha,Argwadh,usher,laghupanchmula – are Pittashamak

Trayman,Behada,patha,Muta,Madanphal –Kaphashamak

Yashti,Rasanjana –Chakshushya

Amruta,Manjishtha –Rasa –rakt prasadak

Amruta,bala –Rasayana

Mansaras,Ghrita – Bruhaniya

In such type of condition, firstly it Is necessary to treat vitiated Vata at its own territory. The drugs like Madnphal,Argawadh,trayman,arand does srotoshodhan and corrects the kha –vaigunya.Here we can see tha all six rasa  are present in this combination along with Mansrasa,Ghrita,Taila,Guda and Madhu to show a cumulative effect of whole formulation of Yapan Karma is related with Dharan,Poshan and Rogshaman. The Sanga or Obstruction is removed because of Katu Tikta Rasa,but excessive use of these Rasa would cause Vata prakop and hence madhur,amla,lavan yukt dravyas will controls  vikrut Vata and will give effect as vaat shaman , gives bal to netrapatalas,and netranadi shirsha.

The given treatment corrects the dushit doshas, thus giving nourishment to the saptadhatu,as netra is essence of saptadhatu.

Mustadi yapan basti has jeevaniya,rasanaya,balya,doshghna  and chakushya karma ,hence due to it patient got improvement in visual aquity.Also he got relief from asthenopic symptoms .Also patient got improvement in height and complexion

ORAL MEDICATION-

1.Saptamrut loha vati 2 tabs BD with triphala ghrut (5ml) and Madhu (2.5 ml)

2. Gandharva Haritaki choorna 1 tsp with lukewarm water HS.

Triphala contain in triphala ghrut has Nitya Virechan karma, as Netra is pittaj avayav; hence nitya virechan is Pathya for Netra.

But Triphala as ruksha gunn,so with Jeshthamadh sinagdhata gunn ,it gets balanced; hence  ruksh gunn doesn’t get raised.

Loha Bhasma controls and increase and stabilize rakt dhatu and combination of Ghrut and Madhu as anupaan of Saptamrut loha acts as Rasayan karma and also create shukshma gamitva. Hence decrease the Netrapatalgat Doshdushti.

Conclusion

As discussed above about Primary Optic Atrophy and its treatment; as per ayurvedic and modern view; the disease can be treated with ayurvedic medication. We can disrupt the pathophysiology (samprapti bhang) of disease. We can save the visual acuity of patient. Hence preventing from worsen condition that is Blindness.