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\title{Role of Triphala Parishek in Lid Concretion : A Case Study}
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             \author[1]{Dr. Pratibha  Upadhyay}

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\date{\small \em Received: 16 December 2016 Accepted: 3 January 2017 Published: 15 January 2017}

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\begin{abstract}
        


Concretions are small white or yellowish dots, usually less than 1mm in diameter, commonly seen on the undersides of the eyelids. They contain cell debris and calcium. They may be the result of past inflammation. Occasionally they cause irritation. If concretions are causing symptoms, the opthalmologist intend to remove them. After using anaesthetic drop, concretions can usually be teased out with the tip of a hypodermic needle. In the case chosen in our study the patient has been suffering from ocular discomfort BE since 5 yrs gradually that patients complaint has been increasing in spite of using all the allopathic medicines as prescribed by the doctor. So here in our study triphala parishek is tried for 10 days in three sittings with gap of 10 days and patient got complete and gradual relief from the symptoms in duration of 2 months.

\end{abstract}


\keywords{vartma sharkara, conjunctival concretions, netra parisheka, rasayana.}

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\let\tabcellsep& 	 	 		 
\section[{I. Introduction}]{I. Introduction}\par
onjunctival concretions are of common occurrence and appear as minute hard yellow or white spots in the palpebral conjunctiva. They represent the inspissated degenerative products of leucocytes that wandered from epithelium and of cast off epithelial cells. Usually they cause no symptoms., however, they give rise to irritation and a foreign body sensation in eye. In ayurvedic texts there is immense description regarding various lid disorders of eye under the vartamagata roga in susruta uttar tantra. 
\section[{C}]{C}\par
© 2017 Global Journals Inc. (US) should be removed by hypodermic needle under topical anaesthesia. This concretion removal by hypodermal needle almost all the time causes conjunctival damage and bleeding. Thus this study was planned to overcome this problem and to evolve a sustainable treatment modality to treat conjunctival concretions \hyperref[b4]{5,}\hyperref[b5]{6,} {\ref 7,}\hyperref[b6]{8,} {\ref 9} . 
\section[{a) Aim of the study}]{a) Aim of the study}\par
To develop a successful, safe and sustainable line of treatment in the management of conjunctival concretion according to the principles of Ayurveda. 
\section[{II. Material and Methods}]{II. Material and Methods}\par
A Male patient having age 60yrs attended to eye OPD in the National Institute of Ayurveda, Jaipur, Rajasthan, with conjunctival concretion were selected as per the inclusion and exclusion criterias. 
\section[{a) Inclusion Criteria}]{a) Inclusion Criteria}\par
Patient with conjunctival concretions who complained of eye discomfort or eye irritation, lacrimation and foreign body sensation and who was willing to participate was selected for the present study irrespective of their age, race, religion, sex, caste and socio-economic status. 
\section[{b) Exclusion Criteria}]{b) Exclusion Criteria}\par
Patients having asymptomatic conjunctival concretion was excluded. 
\section[{c) Diagnosis Criteria}]{c) Diagnosis Criteria}\par
Patients were diagnosed by using diffuse torch light and findings were further verified by the slit lamp examination. 
\section[{d) Assessment Criteria}]{d) Assessment Criteria}\par
The assessment was done before treatment and after treatment. Also the follow up was done after one month after the treatment. The signs and symptoms were assessed by self-designed scoring system, described in the table No.1 Vartma Sharkara is among Vartmagata Roga (disorders in eyelids) that is explained among the twenty one types of Vartma Rogas described in Susruta Samhitha 1 .All the three Doshas are involved in this disease (Sannipataja) \hyperref[b1]{2} and is curable by Lekhana Karma (scraping procedures). Vartma Sharkara is characterized by a hard large Pidaka 3 (eruption) with surrounding small densely arranged number of Pidakas inside the eyelid. As per Vagbhata 4 , Vartma Sharkara is described as Sikata Vartma. He described Sikata Vartma as Pidaka (eruptions) which are hard, rough, dry and resembling sand appearing inside the lids. Thus it can be said that it is a kind of small, hard, whitish or yellowish brown (resembling sand-Sikata eruptions in the posterior surface of the eyelids without any discharge. artificial tears during day time and lubricating eye ointments at bedtime are prescribed. Whereas  It is responsible for the purification action and pacifying of Kapaha Dosha. Maximum of them have Madhura Vipaka which is important for pacifying Pitta Dosha \hyperref[b15]{19} . All of the ingredients contain Chakshushya property and Kashaya rasa. 
\section[{III. Discussion}]{III. Discussion}\par
According to the signs and symptoms mentioned in Ayurvedic classics Vartma Sharkara or Sikara Varma can be correlated with conjunctival concretion which is a degenerative condition of the conjunctiva. Old age and anterior segment chronic inflammations are the main causative factors of concretion. The present study also confirmed those factors and another etiological factors also i.e. exposure to heat or sunlight frequently and long term exposure to near work which are the causative factors of eye diseases mentioned in Ayurvedic authentic texts. Concretions are more common in upper lids and present study also confirmed it.\par
Treatments are not essential if it is asymptomatic. However if it is present with symptoms should be removed by hypodermic needle under topical anaesthesia. The concretion removal by hypodermal needle almost all the time causes conjunctival damages with bleeding and most of the time it may be a cause for following conjunctival inflammations unless treated with a topical antibiotic. Ayurveda also advised to perform Lekhana Karma or remove by scraping. Triphaladi Netra Parisheka with lukewarm decoction was performed to better purification of the eye. It was also helpful for the eliminating the irritation or foreign body sensation. Also it increases blood circulation inside the lids which increases drug absorption. Further Triphaladi Netra Parisheka consists with Chakshushya properties which are beneficial for the healthy maintenance of eye and has anti inflammatory and antimicrobial properties too. 
\section[{IV. Conclusion}]{IV. Conclusion}\par
Hence it can be concluded that the above mentioned line of treatment is ideal remedy for the management of Varma Sharkara or conjunctival concretion because it completely cure almost all the signs and symptoms without any adverse effects. It was further proved that the treatment had a sustained effect even after one month of follow up period. This study can be evaluated on a large sample size to effectively access the treatment.\begin{figure}[htbp]
\noindent\textbf{No1} \par 
\begin{longtable}{P{0.26591743119266054\textwidth}P{0.06472477064220183\textwidth}P{0.2308256880733945\textwidth}P{0.11775229357798166\textwidth}P{0.007798165137614679\textwidth}P{0.004678899082568807\textwidth}P{0.14894495412844036\textwidth}P{0.009357798165137614\textwidth}}
Symptom\tabcellsep 1. Absent\tabcellsep \multicolumn{4}{l}{Scoring System 2. Mild 3. Moderate}\tabcellsep 4. Severe\\
1. Foreign body sensation of the\tabcellsep No foreign body\tabcellsep Occasionally\tabcellsep \multicolumn{2}{l}{Frequently}\tabcellsep \tabcellsep Present\\
eye\tabcellsep sensation\tabcellsep present and not\tabcellsep \multicolumn{2}{l}{present}\tabcellsep and\tabcellsep continuously\\
\tabcellsep \tabcellsep disturbing daily\tabcellsep \multicolumn{3}{l}{disturbing daily}\tabcellsep disturbing daily\\
\tabcellsep \tabcellsep routine\tabcellsep routine\tabcellsep \tabcellsep \tabcellsep routine\\
2. Eye discomfort or irritation\tabcellsep No discomfort or\tabcellsep Occasionally\tabcellsep \multicolumn{2}{l}{Frequently}\tabcellsep \tabcellsep Present\\
\tabcellsep irritation\tabcellsep present and not\tabcellsep \multicolumn{2}{l}{present}\tabcellsep and\tabcellsep throughout the\\
\tabcellsep \tabcellsep disturbing daily\tabcellsep \multicolumn{3}{l}{disturbing daily}\tabcellsep day\tabcellsep and\\
\tabcellsep \tabcellsep routine\tabcellsep routine\tabcellsep \tabcellsep \tabcellsep disturbing daily\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep routine\\
3. Excessive lacrimation\tabcellsep No lacrimation excessive\tabcellsep Occasionally present, need to wipe no with\tabcellsep \multicolumn{3}{l}{Frequently present, needs to wipe with handkerchief and}\tabcellsep Present throughout the day, needs to wipe with\tabcellsep Year 2017\\
\tabcellsep \tabcellsep handkerchief\tabcellsep not\tabcellsep \multicolumn{2}{l}{disturbing}\tabcellsep handkerchief\\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{daily routine}\tabcellsep \tabcellsep disturbing daily\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep routine\\
\multicolumn{2}{l}{Treatments: Thriphal?di Netra Parisheka contains equal}\tabcellsep \multicolumn{5}{l}{Symplocos racemosa (Lodhra) which is a commonly}\\
\multicolumn{2}{l}{quantity of powder of Terminalia berelica (Vibhitaka),}\tabcellsep \multicolumn{5}{l}{used formula in eye OPD of the National Institute of}\\
\multicolumn{2}{l}{Terminalia chebula (Haritaki), Phyllanthus embilica}\tabcellsep Ayurveda.\tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{2}{l}{(?mla), Glycyrrhiza glabra (Yashtimadhu) and}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{2}{l}{e) Data analyzing and Statistical methods}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep D D D D ) F\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep (\end{longtable} \par
  {\small\itshape [Note: Author ? ? ?: Phd scholar, Asso. Proff \& Head, NIA, Jaipur. e-mail: dr.pratibha5685@gmail.com Volume XVII Issue 1 Version I]} 
\caption{\label{tab_0}Table No . 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{No3} \par 
\begin{longtable}{P{0.2833333333333333\textwidth}P{0.08220164609053499\textwidth}P{0.09269547325102881\textwidth}P{0.04722222222222222\textwidth}P{0.06646090534979424\textwidth}P{0.2780864197530864\textwidth}}
Name of the drug\tabcellsep Rasa\tabcellsep Guna\tabcellsep Virya\tabcellsep Vipaka\tabcellsep Dosha karma\\
Terminalia chebula (Haritaki)\tabcellsep Pancha rasa\tabcellsep Laghu\tabcellsep Ushna\tabcellsep Madhura\tabcellsep Chakshushya,\\
\tabcellsep \tabcellsep Ruksha\tabcellsep \tabcellsep \tabcellsep Rasayana\\
Terminalia berelica (Vibhitaka)\tabcellsep Kashaya\tabcellsep Laghu\tabcellsep Ushna\tabcellsep Madhura\tabcellsep Chakshushya,\\
\tabcellsep \tabcellsep Ruksha\tabcellsep \tabcellsep \tabcellsep Kapha-pitta\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep Nashaka\\
Phyllanthus embilica (?mla)\tabcellsep Pancha rasa\tabcellsep Laghu\tabcellsep Sita\tabcellsep Madhura\tabcellsep Chakshushya,\\
\tabcellsep \tabcellsep Ruksha\tabcellsep \tabcellsep \tabcellsep Rasayana\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep Thridoshajit\\
Glycyrrhiza glabra (Yashtimadhu)\tabcellsep Madhura\tabcellsep Guru\tabcellsep Sita\tabcellsep Madhura\tabcellsep Chakshushya,\\
\tabcellsep \tabcellsep Snigdha\tabcellsep \tabcellsep \tabcellsep Balya\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep Vata-pittajit\\
Symplocos racemosa (Lodhra)\tabcellsep Kashaya\tabcellsep Laghu\tabcellsep Sita\tabcellsep Katu\tabcellsep Chakshushya\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep Kapha-pitta\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep nashaka, Grahi\end{longtable} \par
 
\caption{\label{tab_1}Table No . 3 :}\end{figure}
 			\footnote{© 2017 Global Journals Inc. (US)} 		 		\backmatter  			  				\begin{bibitemlist}{1}
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\end{document}
