CASE PRESENTATION

TIMIRA
DEPT- SHALAKYA TANTRA
GUIDED BY-
Dr Sanjeev Padhan (Reader in SKT)
Dr Ashutosh Kar(Lecturer in SKT)
MADE BY: Arijit Kumar Ashe
(Internee 2024-25
P-2666)
 PATIENT DETAILS
• Name : Mr. Rukmana Patra

• Age & sex : 20 yr / male

• Occupation : Student

• Religion : Hindu

• Marital status : UN-Married

• Opd no : 7860/306286

• Address : AT- KUMIR , PS- JAGDALPUR

DIST- BARGARH
 CHIEF COMPLAINT & DURATION
• Blurring of vision for distance in both eye since 6 months.
• Occasional headache

ASSOCIATE COMPLAIN
• Dryness of eyes.
• Difficulty to look distant objects (since 6 months)
 HISTORY OF PRESENT ILLNESS
• Patient was apparently well before 6 months, then gradually he started to
face difficulty in looking at distant objects.
• Defective distance vision & strain in both eye for 6 months.

HISTORY OF PAST ILLNESS

• No such relevant past history found

TREATMENT HISTORY
• No such relevant drug / surgical history found

FAMILY HISTORY
• No such relevant family history found
 PERSONAL HISTORY

• Mala pravruti : 2 times a day

• Mutra pravruti : 5 to 6 times a day & once at night

• Nidra : irregular

• Kshudha : Reduced

• Ahara : Mixed diet

• Abhyasa : no such addiction

 SARVADAEHIKA PAREEKSHA

• Pallor : absent • Built : normal

• Icterus : absent • Diet : mixed diet

• Cyanosis : absent • BP : 120/80 mmhg

• Clubbing : absent • PR : 80 bpm

• Lymphadenopathy : absent • RR : 20/min

• Edema : absent
 SAMSTHANIKA PAREEKSHA

• Cardio Vascular System : normal heart sound S1 & S2 audible.

• Respiratory System : bilaterally symmetrical

• Central Nervous System : conscious and well oriented

• ABDOMINAL EXAM : no tenderness & no organomegaly found.

 TRIVIDHA PARIKSHA

• DARSHANA : Lusterless eyes upon observation.

• SPARSHANA : Slight warm upon palpation on eye.

• PRASHNA : Continuous headache & difficulty to look at distant objects.

 ASHTAVIDHA PAREEKSHA

• NADI- Vata kapha • SHABDA- Spashta

• MALA- Samhata • SPARSHA- Ushna

• MUTRA-Samyaka • DRUK- Blurring of vision

• JIVHA- Saama • AKRUTI - Madhyama

 STHANIKA PAREEKSHA

• PAKSHMA MANDALA - Normal

• VARTMA MANDALA - Normal

• SHUKLA MANDALA – Lusterless

• KRISHNA MANDALA – Normal

• DRUSHTI MANDALA – Reduced vision in both eyes.

 VISUAL ACUITY
RIGHT EYE LEFT EYE
V/A 6/12(P) 6/9(P)

P/H 6/9(P) 6/6(P)

NEAR VISION N/6 N/6

 EYE EXAMINATIONS
LACRIMAL
SLIT LAMP EXAM APPARATUS FUNDOSCOPIC EXAM
• No deformity found in • Punctum clear • Normal fundal glow of
eyelids, eye lashes. • Regurgitation test both eye.
• No sub conjunctival negative
hemorrhage.
 NIDANA PANCHAKA
• NIDANA – exposure to vata kapha vardhaka aahara and vihara
• POORVAROOPA – blurry vision, upon looking at distant objects.
• ROOPA – lusterless in eye.
• SAMPRAPTI – Nidana Vata kapha( ) moves to netra sthana
samsraya produce symptoms
• UPASHAYA – Vata kapha shamaka upchara
 SAMPRAPTI GHATAKA

• DOSHA- Vata kapha • SROTOS- Rasa vaha & Rakta vaha

• DUSHYA- Rasa Rakta • SROTO DUSTI- Sanga

• AGNI- Mandagni • UDBHAVA STHANA- Netra

• AGNI DUSTI- Mandagni • VYAKTA STHANA- Netra

• AAMA- Saama • ROGA MARGA- Abhyantara

 VYADHI VYAVACHHEDHAKA
NIDANA/DIFFERENTIAL
DIAGNOSIS
• Prathama patalagata Timira

• Dwitiya patalagata Timira.

• Tritiya patalagata Timira.

• Suska Akshipaka

• Netra Srava.
VYADHI NISCHAYA / FINAL DIAGNOSIS
PRATHAMA
PATALAGAT
ATIMIRA
SADHYASADHYATA: SADHYA
 CHIKITSA / TREATMENT

PRESCRIPTION
Rx:-
1. SAPTAMRITA LAUHA – 2 TAB BD A/F
2. ASHWAGANDHA RASAYANA - 5gm BD A/F
3. SUNETRA REGULAR EYE DROP – 2 DROPS THRICE A DAY.
4. TARPANA with JEEVANTYADI GHRITA (7 DAYS)
 TARPANA PROCEDURE
(KRIYA KALPA)
• “tarpana netra truptikaram param” [Sha Utt 13/38]

PROCEDURE
Akshi Tarpan, is a procedure of pouring a medicated ghee or
other substances upon the eyes, where a frame of black gram paste
is firmly fixed. The eye is made to open and close several times.
When the specified duration is over, ghee is removed.

Purva karma
• Preparation of the patient
• Preparation of the paste
• Making the frame around eyes
• Warming of the ghee
 Preparation of the patient :

• Patient should be subjected to different forms of sodhana procedures

like vamana, virecana and nasya karma earlier.

• Swasti vācana, the chanting of prayer.

• After the digestion of food or in the empty stomach patient is asked to

lie down on the treatment table.

• Mild massaging of eye lids with ghee and fomenting with wet cloth.
 Preparation of the paste:
About 200 grams of Masa charms (blackky floor is mixed with nearly 100 ml. of
clean water. It is beaten well to form a sticky paste This paste should be thick
enough to mould into any form

Making the frame around eyes:

Half of the paste is rolled into cyllindrical shape. Free ends of it is stuck
together to make a circular frame.This is placed around one of the eyes
touching the eye brow above nose medically, maxillary prominence below and
the lateral border of the orbit laterally

This is then properly stuck to the skin, which is subjected to massage and
fomentation. A small portion of the frame touching the skin is pressed against
the underlying skin with a finger. This forms a firm frame around the eyes,
Approximately two inch high (two angula) boundary is prepared around the
eyes.Care should be taken to avoid any weak point in the frame, so as to avoid
leakage of ghee during procedure.
Warming the ghee:
The medicated ghee is warmed in a water bath to make it similar to body
temperature.

Pradhana karma
Patient is asked to close his eye. The luke warm ghee is poured into the frame,
in the medial side (Kaninika Sandhi) of eye, with the help of a dropper spoon,
upto the level of eye lashes.
Patient is asked to gently open and close his eyes beneath the ghee. This is
continued for a specified period.
When the time is over, slowly separate the frame from the skin with the help of
a probe through lateral side (Apānga Sandhi) then the frame of gram floor is
also detached.
 Pascāt karma:
After Tarpana, mild fomentation should be done with warm paste of barley or
warm water.
Prayogika Dhumapana with Kaphahara dravya is done to elimirate accumulated
kapha.
Patient is advised to avoid seeing very bright objects or distant sky immedietly
after Tarpana.

In the evening and night, eyes should be packed with cooling jasmine flower
buds for at least 3 days.
To remove the debility and speed up the healing activity, putapaka is
recomonded. It induces laghutwa, visadatwa and suksmatwa to the eye.

Both eyes are treated with the same frame

Course of treatment
Patient was given treatment for 7 days.
 MODE OF ACTION
Administration of Tarpan in the eye

Fat soluble ingredients of drugs

absorbed through cornea

Transportation of drugs through

cornea to deeper tissues.

Lipids
Amino acids and protein
Vitamin A,D,E,K & Carotene
 Increases lubrication b/w Increase muscular power
lens fibers and ciliary muscles.

Helps in anaerobic oxidation Acts as antioxidant

Overall
improvement
in VISION
RESULT AFTER PROCEDURE
Data Before treatment After treatment

V.A P.H V.A P.H

Right eye 6/12(P) 6/9(P) 6/9(P) 6/6(P)

Left eye 6/6(P) 6/6(P) 6/6(P) 6/6(P)

 OTHER MEDICATIONS
1. PURANA GHRITA PANA
Old ghee preserved in iron vessel. Can be used for drinking, nasya, tarpana etc.
2. GO-SAKRUTA TAILA (NASYA)
Oil processed with decoction of cow-dung useful for nasya.

3. OIL PREPARED (NASYA)

-tila taila 1 ltr + sunti churna-125 gm + yasti churna-125 gm + bhringaraja rasa
4 ltr
{3-4 drops in each nostril relieve all types of patalarogas.}
4. Sukhavati varti- (Ca.Ci 26/256)
5. Dristiprada varti (Ca.Ci 26/257)
6. Chandrodaya varti (Sharangdhar Utt.
23/75-77)
7. Navasagara anjana.(Siddha Bheshaja
Manimala-netra 32)
 SOME MEDICATIONS A/C TO
BHAISAJA RATNAVALI
1. Nilotpaladyanjana
2. Patradyanjana
3. Shankhadyanjana
4. Haridradi vati
5. Saindhavanjana
6. Cinca patradyanjana
7. Kanadyanjana
8. Dhatyradyanjana
9. Kokila varti
 TRIPHALA
(Su Utt.17/30-32)
Triphala taken with Disease

Ghee Pittaja & raktaja timira

Taila Vataja timira

Honey Kaphaja timira

(A.Hr. Utt 13/17-18) (A. Sang Utt. 16/8)

Triphala taken
(Triphala + Yasti
internally WITH
madhu + Honey)
• Anupa mansa
taken at bed time
• Cowghee
for 1 month
• Grapes, sugar,
improves eyesight.
honey
 CONCLUSION
• Patient condition improved after using medications.

• NETRA TARPANA played an important role in improving the condition of the

patient.

• In just about 1 week time the following changes were seen.

• Right eye V/A changed from 6/12 to 6/9.

• Vision become relatively clear.

• Patient advised to continue medicines for 15 days.