International Journal of Current Research and Review Case Report

DOI: http://dx.doi.org/10.31782/IJCRR.2020.12135

An Ayurvedic Protocol to Manage Retinitis

Pigmentosa - A Case Report
IJCRR
Section: Healthcare Narayanan Namboothiri Narayanan1, Aravind Kumar2, Krishnendu Sukumaran2,
Sci. Journal Impact Agaja Peethambaran Leena3
Factor: 6.1 (2018)
ICV: 90.90 (2018) 1
Chief Physician and President, Sreedhareeyam Ayurvedic Research and Development Institute Nelliakkattu Mana, Kizhakombu Koothattuku-
lam, 686662, Ernakulam Dt., Kerala, India; 2Research Coordinator, Sreedhareeyam Ayurvedic Research and Development Institute Nelliakkattu
Mana, Kizhakombu Koothattukulam, 686662, Ernakulam Dt., Kerala, India; 3Junior Medical Officer, Sreedhareeyam Ayurvedic Research and
Development Institute Nelliakkattu Mana, Kizhakombu Koothattukulam, 686662, Ernakulam Dt., Kerala, India.

ABSTRACT
Introduction: Retinitis pigmentosa (RP) is a clinically and genetically heterogeneous group of inherited retinal disorders that
almost invariably occur in both eyes and often result in blindness in the middle-age and advanced age groups. According to
Ayurveda, the cardinal symptoms of night blindness and diminished vision seen in RP may be correlated with Kapha-Vidagdha
Drishti, a Drishtigata Roga or disease of vision.
Case: A 38-year-old male presenting with blurring of vision since 2017 and diminished night vision since childhood is presented
here.
Intervention: The patient underwent two courses of in-patient Ayurvedic management consisting of Panchakarma (bio-purifica-
tion) therapy, oral medicines, and external therapies for the eyes and head.
Results: Assessment showed improvement in both unaided distant visual acuity (DVA) and visual field analysis.
Conclusion: The main aim of management was to preserve and give a better quality of vision for the patient. The results indicate
the potential of Ayurvedic treatments to manage and maintain vision in retinitis pigmentosa.
Key Words: Case report, Retinitis pigmentosa, Kriyakalpa, Panchakarma therapy

INTRODUCTION METHODOLOGY
Retinitis pigmentosa is a genetically pre-determined retinal The efficacy of an Ayurvedic treatment protocol to manage
dystrophy characterized by progressive degeneration of rod a case of RP was assessed in this report. It was prepared ac-
photoreceptors, cone photoreceptors, and retinal pigment cording to the Case Report (CARE) guidelines to ensure
epithelium in that order. Inflammation, implied by the term transparency and effectiveness in reporting4. Although in-
is not a part of its pathophysiology. The prevalence of RP stitutional ethical clearance was not required for this study,
amounts to one case in every 4000 persons.1 A search on written informed consent was obtained from the patient be-
RP in PubMed amounted to 7000 references and was char- fore detailing his case.
acterized by desirability for both experimental and clinical
research.2 Occurrence may be either isolated or either au-
tosomal dominant, autosomal recessive, or X-linked by in- CASE PRESENTATION
heritance. Apart from genetic predisposition, there are no
other known risk factors.3 RP’s primary symptom is night A 38-year-old non-diabetic and non-hypertensive male pre-
blindness, with advanced cases presenting with a ring-like sented to the OPD of Sreedhareeyam Ayurvedic Eye Hospi-
scotoma in the visual field that gradually progresses to “tun- tal and Research Center, with blurring of vision since 2017
nel” vision. As there is no definite cure for RP in allopathic and difficulty in night vision since childhood. He was born to
medicine, alternative management options may be explored. non-consanguineous parents and his mother had a full-term,
normal delivery (FTND) with no postpartum complications.

Corresponding Author:
Dr. Aravind Kumar, M.S. (Ay), Sreedhareeyam Ayurvedic Research and Development Institute Nelliakkattu Mana, Kizhakombu Koothat-
tukulam, Ernakulam Dt., Kerala, 686662; Phone:9400630608; Email: [email protected]
ISSN: 2231-2196 (Print) ISSN: 0975-5241 (Online)
Received: 02.05.2020 Revised: 05.06.2020 Accepted: 18.06.2020 Published: 05.07.2020

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 Narayanan et al.: Management of retinitis pigmentosa through Ayurveda

He started to gradually develop difficulty in night vision cation through the nasal route), Anjana, Sirodhara (thera-
around the age of 3, for which he was prescribed vitamin peutic streaming over the head), Ascyotana (eye drops),
A tablets. He developed pain in distant vision around the Siro-veshtanam (application of paste over the head on a
age of 7, for which he was diagnosed with myopia and pre- Cora cloth), Bandhana (bandaging), Mukha Dhanya Pinda
scribed corrective spectacles. The glass power progressively Sveda (facial sudation by applying poultice made from sour
increased over time, for which he was prescribed cylindri- grains), Drishti Prasadana (massage over the eyelids using
cal lenses in 2014. In 2018, he was diagnosed with retinitis ghee), and Netra Tarpana (lubrication of the eye) (Table 4)
pigmentosa after a complete ophthalmic and genetic exami- were prescribed during the two courses of treatment.
nation. He was advised to protect his eyes from ultraviolet
During Snehapana, the patient was advised to observe strict
radiation, avoid smoking, and take plenty of fruits, vegeta-
rest and abstain from consuming oily and fried foods. A total
bles, and foods rich in omega-3 fatty acids. Genetic coun-
of 5 Vegas (urges) were noted between 6:30am and 11:30am
seling was also recommended. He had his first consultation
during Virecana, after which, Peya (thin gruel of rice) was
at Sreedhareeyam Eye Hospital in September 2018.
administered as Samsarjana Krama (post-therapy dietetic
His sister also suffered from night blindness. His bowel, ap- regimen for revival).
petite, and micturition were normal and his sleep was sound.
All medicines, except Septillin tablet, were manufactured
He occasionally consumes alcohol. Review of systems and
at Sreedhareeyam Farmherbs India, Pvt. Ltd., the hospital’s
vital signs were normal. He weighed 90kg and was 172cm
GMP-certified drug manufacturing unit. Septillin Tablet was
tall. His Dasavidha Pariksha (ten parameters of examina-
manufactured by The Himalaya Company, based in Bengal-
tion)5 findings are listed in Table 1.
uru, Karnataka, India.
Unaided distant visual acuity (DVA) was LogMAR 0.602 in
both eyes (OU). Aided DVA was LogMAR 0.477 in the right
eye (OD) and LogMAR 0.301 in the left eye (OS), which RESULT
was improvable to LogMAR 0.301 OU with a cylindrical
lens of 1 diopter OD and 1.25 diopter OS. Near vision was DVA was LogMAR 0.477 OU, which was improvable to
N6 OU. Anterior segment examination was normal OU. Di- LogMAR 0.176 OU with cylindrical lenses of -1.25D OD
rect and consensual pupillary reflexes were normal OU. and -0.5D OS after the first course of treatment on October
15th, 2018. NVA was maintained at N6 OU. The same visual
Posterior segment examination by direct ophthalmoscopy acuity was maintained at admission to, and at discharge af-
showed a slightly cloudy foveal reflex OU, pale optic disc ter, the second course of treatment. Refraction at discharge
OU, normal macula OU, and some bony corpuscles in the after the second course of treatment demonstrated LogMAR
peripheral retina OU. Visual field analysis OU showed 0 OU with cylinder lenses of -1.25D OD and -0.5D OS.
marked constriction in the peripheral visual fields (Figures Fundus examination by ophthalmoscopy showed no further
1 and 2). The findings were suggestive of RP. progression in the attenuated blood vessels and bony corpus-
The intervention adopted reflected the treatment for Timira cles. Visual field analysis showed markedly wider peripheral
and Kacha according to Vagbhata, viz., administrations of visual fields OU (Figures 3 and 4).
Snehana (therapeutic oleation), Asra-visravana (blood-let- A timeline of events for this case is provided in Table 5.
ting), Reka (purgation), Nasya (medication through the na-
sal route), Anjana(collyrium), Murdha-basti (retention of oil
over the head region), Basti Kriya (therapeutic enema), Tar- DISCUSSION
pana (lubrication of the eye), Lepa (anointment), and Seka
(ocular therapy by streaming).6 Ayurveda explains that genetic diseases, which are a result
of abnormalities in the Bija (sperm or ovum) brought about
The patient’s first round of treatment was from 25/09/2018
by improper activities of the parents and divine providence,
- 15/10/2018, and his second round of treatment was from
increase all the Doshas and the resultant condition, as well
12/08/2019 - 22/08/2019. Oral medicines such as Kvatha
as all hereditary conditions, is Asadhya (incurable).12 Heredi-
(decoction), Ghrta (clarified butter), and tablets (Table 2);
tary defects in an organ happen when it is vitiated due to the
Panchakarma therapies such as Snehapana (therapeutic
part of the Bija responsible for the formation of that organ
oleation), Svedana (sudation therapy), Virecana (therapeutic
becoming vitiated itself.13 In this patient, a genetic defect
purgation), and Marsa Nasya (high dose medication through
resulting in retinitis pigmentosa occurred despite a normal
the nose) (Table 3); and external therapies for the eye (Netra
pregnancy and delivery course.
Kriyakalpa) and head such as Netradhara (ocular therapy
by streaming), Hasta Pada Abhyanga (therapeutic massage Kapha Vidagdha Drishti occurs when the person perceives
over the hands and feet), Pratimarsa Nasya (low-dose medi- objects as white due to the Doshas lodging in the first and

Int J Cur Res Rev | Vol 12 • Issue 13 • July 2020 26

 Narayanan et al.: Management of retinitis pigmentosa through Ayurveda

second Patalas (layers of the eyeball). When the Doshas ad- maintain vision and prolonging further progression of the
vance to the 3rd Patala, the person sees during the day and not disease. The results obtained in this case may be validated
at night because of Kapha Dosha.14 and analyzed by large-scale studies and trials.
Snehapana was done as a Samana Cikitsa (pacifying treat-
ment) for this patient, with 30mL of ghee administered each Abbreviations:
day so as to not increase Kapha further. Avipattikara Yoga RP: retinitis pigmentosa
was selected for Virecana as it is apt for all Pitta (Dosha DVA: distant visual acuity
responsible for regulating body temperature and metabolic NVA: near visual acuity
activities) conditions. The ingredients of Jivantyadi Taila OD: oculus dexter
pacified Vata and Pitta. Saptamrta Lauha is Tridosha Prasa-
mana (pacifies the Tridosha), Rakta Prasadana (enhancing OS: oculus sinister
the quality of blood tissue), Rasayana (rejuvenative), and OU: oculus uterque
Cakshushya (Dravya or intervention good for eyesight).
Asvagandha is Kapha-Vata Samana (pacifies Kapha and
Vata), Balya (strength, stamina, and immunity promoter), ACKNOWLEDGMENT
Rakta Prasadana, and Rasayana. These medicines enhanced
The authors thank Sreedhareeyam Ayurvedic Eye Hospital
blood quality, relieved Tridosha, and prolonged the retinal
and Research Center, and Sreedhareeyam Farmherbs India
dystrophy by revitalizing the tissue. Bharngyadi Kvatha is
Pvt. Ltd., for their help in preparing this case report. The
Vata-Kapha Samana, Dipana, and Srotosodhana (cleansing
authors acknowledge the immense help received from the
the structural or functional channels). Dasamula Katutraya
scholars whose articles are cited and included in references
Kvatha is Vata-Kapha Samana, Dipana, and Lekhana (thera-
of this manuscript. The authors are also grateful to the au-
peutic scraping). Sudarsanam Tablet, the tablet form of the
thors/editors/publishers of all those articles, journals, and
original Curna, is Tridosa Prasamana, Amapacana (enhanc-
books from where the literature for this article has been re-
ing digestion). The combined effect of these three medicines
viewed and discussed.
helped to enhance digestion, reduce Doshas, and make avail-
able essential nutrients by clearing the channels. Local exter- Conflicts of Interest: None declared
nal treatments enabled efficient absorption and transport of
Sources of Funding: None declared
the medicines to the target tissue, the retina, by obviating the
blood-aqueous, blood-vitreous, and blood-retinal barriers.
Siroveshtanam is a variant of Sirolepa in which the paste is REFERENCES
applied to the head in a Cora cloth and tied in the following
1. Hamel C, Retinitis pigmentosa, Orphanet Journal of Rare Dis-
manner: One end is placed over the right ear, the cloth is eases, 2006, Vol. 40, pg. 2
wrapped over the forehead and towards the left ear, taken 2. Parmeggiani F, Clinics, Epidemiology, and Genetics of Retinitis
over the back of the head toward the occiput, and brought Pigmentosa, Current Genomics, June 2011, Vol. 12, Issue 4, pgs.
over the head towards the right ear. Drishtiprasadanam is a 236-237
procedure in which lukewarm Sneha is taken and massaged 3. Lim IJ, Akkara JD, Epley D, Shah VA, Carrera W, 2019, Reti-
nitis Pigmentosa, Retrieved from https://eyewiki.aao.org/Retini-
over the forehead and eyelids while applying pressure to tis_Pigmentosa
the forehead, inner and outer canthus, and the supraorbital 4. Gagnier J, Kienle G, Altman DG, Moher D, Sox H, Riley DS,
notch. Kasyapam Kvatha and Saptamrta Kvatha are indi- CARE group, The CARE guidelines: Consensus-based clini-
cated in all Netra Rogas (eye diseases). Timiranjana, Naku- cal case-reporting guideline development, Global Advances in
lanjana, and Nayanamrtam are Sita Virya (potency of cold- Health and Medicine, 2013, Vol. 2, Issue 5, pgs. 38-43
5. Byadgi PS, Ayurvediya Vikrti Vijnana and Roga Vijnana, Vol. 1,
ness) and Ropana (healing) by nature. Sasanka Taila is Sita Chaukhambha Orientalia, Varanasi, 2004, pg. 300
Virya by nature, and pacifies Pitta Dosha. Vinayakanjana is 6. Murthy KRS., Ashtangahrdaya of Vagbhata: Text, English
Ropana and is indicated in all Netra Roga. Jatavedha Ghrta Translation, Notes, Appendices, and Index, Vol. III, Uttara Stha-
and Ananta Ghrta are excellent for Netra Tarpana (lubrica- na, Krishnadas Academy, Varanasi, Reprint 2000, pg. 121
tion of the eye). 7. Krishnan Vaidyan KV, Gopala Pillai S, Sahasrayogam: Sujanap-
riya Commentary, Vidyarambham Publishers, Alappuzha, 2006,
pg. 34
8. Murthy PHC, Sarngadhara Samhita: Text with English Transla-
CONCLUSION tion, Chaukhambha Orientalia, Varanasi, 2010, pg. 156
The main challenge, in this case, was maintenance of vi- 9. Murthy KRS., Ashtangahrdaya of Vagbhata: Text, English Trans-
lation, Notes, Appendices, and Index, Vol. II, Nidana, Cikitsa, and
sion and prolonging the dystrophy. However, positive results Kalpa-Siddhi Sthana, Krishnadas Academy, Varanasi, Reprint
were obtained in both fields after two courses of Ayurvedic 2000, pg. 540
treatment. Repeated courses of treatment may aid to at least

27 Int J Cur Res Rev | Vol 12 • Issue 13 • July 2020

 Narayanan et al.: Management of retinitis pigmentosa through Ayurveda

10. Krishnan Vaidyan KV, Gopala Pillai S, Sahasrayogam: Sujanap- 13. Sharma RK, Dash B, Caraka Samhita: Text with English Trans-
riya Commentary, Vidyarambham Publishers, Alappuzha, 2006, lation and Critical Exposition based on Cakrapani Datta’s
pg. 286 Ayurveda Dipika, Vol. II, Nidana, Vimana, Sarira, and Indriya
11. Murthy KRS., Ashtangahrdaya of Vagbhata: Text, English Sthanas, Chaukhambha Krishnadas Academy, Varanasi, Reprint
Translation, Notes, Appendices, and Index, Vol. I, Sutra and 2005, pg. 382
Sarira Sthana, Krishnadas Academy, Varanasi, Reprint 2000, pg. 14. Sharma PV, Susruta Samhita: With English Translation of Text
12. Murthy KRS., Ashtangahrdaya of Vagbhata: Text, English and Dalhana’s Commentary alongwith Critical Notes Vol. III:
Translation, Notes, Appendices, and Index, Vol. II, Nidana, Kalpasthana and Uttara Tantra, Chaukhambha Vishwabharati,
Cikitsa, and Kalpa-Siddhi Sthana, Krishnadas Academy, Vara- Varanasi, Reprint 2010, pg. 145
nasi, Reprint 2000, pg. 67

Table 1: Dasavidha Pariksha

Parameter Findings
Prakrti (somatic constitution) Kapha-Vata
Vikrti (pathological factors) Dosha (humor): Sannipata (three Doshas)
Dushya: (tissues): Rasa (lymph)
Sara (essence of tissues) Rakta (blood)
Samhanana (compactness) Madhyama (medum)
Pramana (measurement) Sama (equal)
Sattva (psyche) Madhyama
Satmya (homologation) Madhyama
Ahara Sakti (power of intake and digestion of food) Pravara (optimum)
Vyayama Sakti (power of physical strength) Madhyama
Vayah (age) Madhyama

Table 2: Oral Medicines

Si. Medicine Dosage Anupana Time Duration
No.
1 Netraraksha Kvatha* 60mL Warm water Twice a day before 25/09/2018 - 03/10/2018, 05/10/2018 -
food 15/10/2018
16/08/2019 - 26/08/2019
2 Saptamrta Lauha 7
1 tablet Netraraksha Twice a day before 25/09/2018 - 03/10/2018, 05/10/2018 -
Kvatha* food 15/10/2018
3 Asvagandha Tablet 1 tablet Warm water Twice a day after food 25/09/2018 - 03/10/2018,
05/10/2018 - 15/10/2018
4 Saptamrta Kvatha* 60mL Warm water Twice a day before 06/10/2018 - 15/10/2018
food
5 Bharngyadi Kvatha 60mL Warm water Twice a day before 13/08/2019 - 15/08/2019
food
6 Dasamula Katutrayam 60mL Warm water Twice a day before 13/08/2019 - 15/08/2019
Kvatha food
7 Sudarsanam Gutika8 2 tablets Warm water Twice a day after food 13/08/2019 - 26/08/2019
8 Septillin Tablet^ 1 tablet Warm water Twice a day after food 13/08/2019 - 26/08/2019

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 Narayanan et al.: Management of retinitis pigmentosa through Ayurveda

Table 3: Panchakarma Procedures

Treatment Medicine Procedure Duration
Snehapana Vainateya Ghrta* 30mL of ghee was administered at 6am in the morn- 27/09/2018 - 02/10/2018
ing on an empty stomach.
Svedana Satapaka Taila* A full-body massage was done using the oil. The 03/10/2018
patient was asked to take bath with hot water.
Virecana Trvrt Lehya9 and 20g of Lehya and 60mL of Kvatha were administered 04/10/2018
Triphala Kvatha in the morning. The urges were recorded
Marsa Nasya Jivantyadi Taila* Abhyanga was done with Kshirabala Taila. Then, 05/10/2018 - 07/10/2018
8 drops of Jivantyadi Taila were instilled into each
nostril. 19/08/2019

Table 4: External Therapies

Therapy Medicine Procedure Time Duration
Netra Dhara° Kasyapam Kvatha* 30mL of the decoction was poured Morning 27/09/2018 - 03/10/2018,
over the eyes with the patient being and After- 05/10/2018 - 06/10/2018
asked to blink. noon 12/08/2019 - 18/08/2019
Anjana° Timiranjana* 1 drop of the medicine were instilled Morning 25/09/2018 - 03/10/2018
Nakulanjana* into the eye at the inner canthus, and and After- 27/09/2018 - 06/10/2018
the patient was asked to roll the eyes noon
around while closed. 12/08/2019 - 18/08/2019
Nayanamrta* 12/08/2019 - 18/08/2019
Hasta Pada Abhyanga Dhanvantara Taila 10
30mL of oil was taken and slightly Morning 26/09/2018
Kshirabala Taila heated. This was then applied to the 13/08/2019 - 16/08/2019
hands and feet and massaged.
Sirodhara Kshirabala Taila A thin stream of oil was poured Morning 27/09/2018 - 02/10/2018
Sasanka Taila* through a coconut shell with a hole in
the center over the patient’s head. 17/08/2019 - 22/08/2019
Siroveshtanam° Bala, Vidari, Kacchuradi A paste was prepared from the ingre- Morning 13/08/2019 - 15/08/2019
Churna in Balasvagand- dients and smeared over a Cora cloth.
hadi Taila This was applied over the right ear,
around the forehead, over the left ear,
and over the occiput.
Mukha Dhanya Pinda Lukewarm grains were made into a Morning 20/08/2019 - 22/08/2019
Sveda poultice and gently applied over the
face.
Pratimarsa Nasya Anutaila11 3 drops of lukewarm oil were instilled Morning 27/09/2018 - 02/10/2018
into each nostril after massage over
the face. 16/08/2019 - 18/08/2019
Drshtiprasadana° Kshirabala 101 Avartana 5 drops of oil were taken and massage Morning 17/08/2019 - 19/08/2019
Taila was done over the forehead, upper
eyelid, and lower eyelid
Tarpana Ananta Ghrta* and Jata- A circular fence was constructed Afternoon 07/10/2018 - 15/10/2018
vedha Ghrta* around the orbits using Masha flour
and water. The medicine, made
lukewarm, was poured into the cavi-
ties. The patient was asked to blink 20/08/2019 - 26/08/2019
frequently.
Ascyotana and Band- One drop of medicine was instilled Morning 20/08/2019
hana into the inner canthus. Afterward,
Malati Pushpa was applied to the eyes
and bandaging was done for one hour.

*Patented medicines of Sreedhareeyam Ayurvedic Eye Hospital and Research Center

^Patented medicine of Himalaya Drug Company
°Treatment protocols of Sreedhareeyam Ayurvedic Eye Hospital and Research Center

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 Narayanan et al.: Management of retinitis pigmentosa through Ayurveda

Table 5: Timeline of Events

Date Event
1983 The patient gradually develops night blindness, for which he is prescribed vitamin A tablets
1990 Develops difficulty in distant vision, is diagnosed with myopia, and is prescribed corrective glasses
2018 Diagnosed with retinitis pigmentosa
September 25th, 2018 First consultation with Sreedhareeyam; advised inpatient management.
Uncorrected DVA: LogMAR 0.602 OU
Aided DVA: LogMAR 0.477 OD and LogMAR 0.301 OS
Refraction: LogMAR 0.301 OU with a -1D cylinder OD and -1.25D cylinder OS.
NVA: N6 OU
Visual Fields: Constricted peripheral fields OU
Oral medicines, viz., Netraraksha Kvatha*, Saptamrta Lauha, and Asvagandha Tablet are started.
Anjana^ with Timiranjana* is started.
September 26th, 2018 Hasta Pada Abhyanga with Dhanvantara Taila is done.
September 27 , 2018
th
Snehapana with a fixed dose of 30mL of Vainateya Ghrta* is started
Anjana^with Nakulanjana is started.
Netra Dhara^with Kasyapam Kvatha is started.
Pratimarsa Nasya with Anutaila is started.
Sirodhara with Kshirabala Taila and Sasanka Taila* is started.
October 3rd, 2018 Svedana is done by Sarvanga Abhyanga (full-body massage) with Satapaka Taila and hot-water bath.
Anjana^ with Timiranjana*and Netra Dhara^ are stopped.
Pratimarsa Nasya is stopped.
Sirodhara is stopped.
Oral medicines are stopped.
October 4th, 2018 Virecana is induced with Triphala Kvatha and Trvrt Lehya; a total of 5 urges are recorded
October 5 , 2018
th
Oral medicines are restarted.
Netra Dhara^is restarted.
Saptamrta Kvatha* is started.
October 6th, 2018 Netra Dhara is stopped.
Anjana with Nakulanjana* is stopped.
October 7th, 2018 Tarpana with Ananta Ghrta* and Jatavedha Ghrta* is started.
October 15th, 2018 All treatments are stopped.
Patient is discharged with instructions for regular follow-up.
Unaided DVA: 6/18 Snellen (LogMAR 0.477) OU
Aided DVA: 6/9 OU
Refraction: 6/6 OU with cylinder lenses of -1.25D OD and -0.5D OS.
NVA: N6 OU.
August 13th, 2019 Patient reports for the second course of treatment.
Unaided DVA: LogMAR 0.477 OU
Aided DVA: LogMAR 0.176 OU
Refraction: LogMAR 0 OU with cylinder lenses of -1.25D OD and -0.5D OS.
NVA: N6 OU
Oral medicines, viz., Bharngyadi Kvatha, Dasamula Katutrayam Kvatha, Sudarsanam Gutika, and
Septilin Tablet, are started.
Netra Dhara^with Kasyapam Kvatha is started.
Anjana^with Nakulanjana* and Nayanamrtam*are started.
Hasta Pada Abhyanga with Kshirabala Taila is started.
Siroveshtana^ with Bala, Vidari, and Kaccuradi Churna in Balasvagandhadi Taila is started.
August 15th, 2019 Bharngyadi Kvatha and Dasamula Katutrayam Kvatha are stopped.
Siroveshtana^is stopped.
August 16th, 2019 Netraraksha Kvatha* is started.
Pratimarsa Nasya is started.
Hasta Pada Abhyanga is stopped.
August 17th, 2019 Drishti Prasadana^ with Kshirabala 101 Avartana Taila is started.
August 18th, 2019 Anjana^ and Pratimarsa Nasya are stopped.

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 Narayanan et al.: Management of retinitis pigmentosa through Ayurveda

Table 5: (Continued)

Date Event
August 19th, 2019 Drishti Prasadana is stopped.
August 20 , 2019
th
Ascyotana with Ananta Ghrta* and Jatavedha Ghrta* is done, with Bandhana for 1 hour with jasmine
flowers.
Tarpana with Ananta Ghrta* and Jatavedha Ghrta* is started.
August 26th, 2019 All treatments and oral medicines are stopped.
Unaided DVA: 6/18 Snellen (LogMAR 0.477) OU
Aided DVA: LogMAR 0.176 OU
Refraction: LogMAR 0 OU with cylinder lenses of -1.25D OD and -0.5D OS.
NVA: N6 OU
Visual Fields: Widened peripheral fields OU

Figure 1: Visual field analysis OD at Admission before the

First Course of Treatment.
Figure 2: Visual field analysis OS at Admission before the
First Course of Treatment.

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 Narayanan et al.: Management of retinitis pigmentosa through Ayurveda

Figure 3: Visual field analysis OD at Dischargeafter the Sec-

ond Course of Treatment. Figure 4: Visual field analysis OS at Discharge after the Sec-
ond Course of Treatment.

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