AYURVEDIC TREATMENT OF CATARACT

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Ayurveda, the ancient holistic healing system of India, is a complete approach to health and lifestyle management. This system incorporates diet, exercise, life activity routines, psychotherapeutic practices, massage and, of course, botanical medicine, which is the foundation of Ayurvedic therapeutics.

Therapy in Ayurveda is based on an understanding of the underlying concepts of energetics inherent in the Ayurvedic world view. Ayurveda assigns all matter/energy interactions in the world to a scheme of five primal elements (metaphorical concepts which describe physiological processes and environmental interactions): earth, water, fire, air and ether.

For ease of conceptualizing the actions of these energies, and for therapeutic application in diagnosis and treatment, the five elements, as they manifest in the body, are further condensed into three primal metabolic forces, called "doshas," as follows:

Ayurveda predicts physiological effect by the intrinsic biochemical makeup of the botanical, which can be identified by taste. Ayurveda recognizes six tastes, with the following properties:

Etiology
Cataract, the opacification of the lens or its capsule, is called "timira" or "linga nasha" in Sanskrit. Eye conditions, particularly cataract, are quite complex, and can arise from many possible variations of multi-dosha imbalance.

Pitta, if allowed to become excessive, leads to inflammation in the body. Since pitta regulates the overall function of the eyes, anti-pitta botanicals may have a generally beneficial effect.

Cataracts caused by pitta will produce visual symptoms of images which are bright and circular, vibrating and with rainbow-hued emanations.

Kapha is responsible for the production, deposition, and accumulation of all gooey, sticky, tissue clogging wastes, especially lipids. Thus, the actual material on the lens could be considered an accumulation of excess kapha, and treated with anti-kapha therapies. Diabetes is the prime example of a kapha condition. Diabetic cataracts should be treated with anti-kapha botanicals and diet.

Cataracts caused by kapha will produce visual symptoms of images which are white, greasy-looking, enlarged, wet looking, as if underwater, and resemble puffy clouds. Primarily, however, timira is regarded as an aggravation of vata. A fundamental property of vata is to cause dryness in tissues. Ayurveda considers the loss of lubrication and softness of the lens and its capsule to be a result of this accrued vata in the eye (Dash, 1980, p. 25).

Vata predominates in the nervous system generally, so the eyes, as part of that system, are subject to vata derangement. Cataracts caused by vata will produce visual symptoms of images which are unsteady, dusty, reddish and irregular.

Diseases of the eye, ear, nose, and throat, primarily problems of vata, can be caused by rapid changes in environmental temperature, such as a cold bath after hot sun, overuse of the eyes at a particular focal point, such as long distance, exposure of the eyes to atmospheric contaminants, suppression of natural urges, such as urination, emotional excesses, sexual overindulgence, or staring at close distance (Devaraj, 120).

Treatment Herbs for the eye
Triphala, the combination of the fruits of amla (Emblica officinalis), haritaki (Terminalia chebula), and bibhitaki (Terminalia belerica) is the premier general tri-dosha tonic of Ayurveda. Triphala nourishes the eyeball, and strengthens the nerves and other tissues (Dash, 1995, p.84). The dose is 500 mg. to 2 grams per day, as a general tonic, possibly for a lifetime.

Amla, a strong rejuvenative and the primary anti-pitta medicine in Ayurveda, is the most frequently used cataract medicine. Amla generally benefits the eyes, and is known to improve eyesight (Lad and Frawley, 158) Amla is a potent inhibitor of free radicals, which are one cause of cataracts (Sharma, 94). The fruit is the richest known source of naturally occurring vitamin C which accounts for its antioxidant effects, containing 20 times more vitamin C than orange juice at 600 mg. per 100 grams (Kapoor, 175). The dose is 250 mg. to 1 gram per day for one to two years or as needed.

Haritaki is the main anti-vata medicine of Ayurveda, and is called the "King of Medicines" in Tibetan medicine. Haritaki nourishes the nervous system and promotes vision. The dose is 250 mg. to 500 mg. per day.

Bibhitaki, a myrobalan fruit, regulates kapha. Like amla and haritaki, which are also myrobalans, it improves the vision. The dose is 250 mg. to 500 mg. per day.

Mahasudarshan (literally "the great formula for good vision") contains bitter herbs which cool and cleanse the eyes (Frawley, 246). The formula contains chiretta (Swertia chiratata), guduchi (Tinospora cordifolia), barberry (Berberis spp.), black pepper (Piper nigrum), long pepper (Piper longum), ginger root (Zingiber officinale) and the triphala combination.

The following herbs are generally beneficial to vision and can be applied according to energetic indications:

Yashti madhu (licorice) (Glycyrrhiza glabra) (sweet, bitter —
VP?K?) — root
Chandana (sandalwood) (Santalum album)
(bitter, sweet, astringent — PV?K?) — wood
Ashwaganda (winter cherry) (Withania somnifera)
(bitter, astringent, sweet — VK?P?) — root
Bhringaraj (Eclipta alba) (bitter, astringent, sweet — VPK)
— herb
Sevanti (Chrysanthemum indicum)
(bitter, sweet — PK?V?) — flower
Cataract treatment
The foremost objective is to control vata, by moistening, warming, mobilizing and detoxifying the affected tissue. Ghee, or clarified butter, controls vata, and is considered the most important remedy for the eyes. The older the ghee, the more therapeutic the effect (Heyn, 112). The dose is 1-2 tsp. twice daily (Frawley, 245).

Ghrita, medicated ghee, is used in cataracts. The preparation Maha triphala ghrita, which includes ghee and triphala, among other ingredients, is used in the early stages of cataracts. The medicated ghee is used at a dose of 2 teaspoons twice daily, one hour before meals, with a cup of warm milk.

Shigru leaf (Moringa oleifera) is prophylactic for those at risk of cataracts. The dose is 5 grams per day.

Anise seed (Pimpinella anisum), Coriander seed (Coriandrum satavum), and almonds are used together to benefit cataracts (Hameed, 54).

Clinically, it is obvious that a cataract can be treated successfully. George Dever, O.D., an eye specialist in Seattle, Washington, who uses Ayurveda herbs extensively, demonstrates 85% clinical results in normalizing cataracts non-surgically. His clientele consists mainly of geriatric cases that have been referred for cataract surgery. Dr. Dever uses primarily amla, triphala and general detoxification for mature cataracts. The average time necessary to improve this condition sufficiently to reverse the need for surgery is six months.

Topical treatments Eye washes
Eye washes are popular in Ayurvedic ophthalmology. Several herbs are administered in this manner:

Triphala water — add 1 tablespoon
triphala powder to 10 oz. water.
Cover and let sit for 12 hours. Filter and apply with an
eyedropper or eye cup (Dash, 1995, p. 84). A cold infusion
of amla only may be substituted (Dash, 1993, p. 57).
Shigru juice (Moringa oleifera) — Mix with honey
and apply to the eyes daily. Shigru leaf is rich in
vitamin A (Devaraj, 121), as well as vitamin C (Kapoor, 234).
Eyewashes can also be made from infusions of chamomile flowers, chrysanthemum flowers, or rose petals (Frawley, 245).

Applications to the head
Ayurveda uses herbal pastes applied to the entire head to balance the doshas in that area. A typical formula for the paste includes mung bean flour, minced fresh ginger, raw cream, ghee, sesame oil, mustard oil, and water (Tiwari, 136).

Amla fruit decoction mixed with buttermilk may be poured on the forehead in a thin, continuous stream (Dash, 1992, p. 68).

Diabetic Cataract
Hyperglycemia promotes cataract formation. Research has shown that diabetics have altered vitamin C uptake, causing glucose to be converted to sorbitol. This excessive sorbitol builds up in the lens, causing premature cataract (Sorbinil Retinopathy Trial Research Group, 1234). Vitamin C supplementation reduces this accumulated sorbitol in the blood (Cunningham, et al., 334), which probably accounts for the overwhelming recommendation by Ayurvedic authorities for the use of amla fruit in cataract. In the case of diabetic cataract, it is essential to lower and stabilize blood sugar.

This process of the buildup of a thick, sweet, accumulated waste product that does not get eliminated is a good example of the Ayurvedic concept of "ama" (Lonsdorf, et al, 144), essentially a concentration of unmetabolized kapha byproducts, in this case, advanced glycosylation end products, or AGE's, which stick to the surface of the lens and cross link the proteins, binding them into a web-like formation.

Ayurvedic herbs which can assist in this process include the following, all of which have primarily anti-kapha and anti-ama action:

Bitter melon (Momordica charantia) — 2 ounces. of fresh
juice, per day, or the equivalent
Gurmar herb ("Killer of sweet") (Gymnema sylvestre)
— 10 grams per day
Asana bark (Pterocarpus marsupium) — 3-6 grams per day
(Welihinda, et al, 277) (Shanmugrasundram, et al, 281)
Tulsi herb (holy basil) (Ocimum sanctum) — 10 grams per day
Ginger root (Zingiber officinale) — 5 grams per day
Neem leaf (Azadirachta indica) — 5 grams per day
Guggul gum (Commiphora mukul) — 3-10 grams per day
Kutki (Picrorhiza Kurroa) — 5 grams per day
Diet
The dietary strategy should be based on the primary underlying dosha imbalance, usually vata. If vata is the dosha to be controlled, the diet should be warming, moisturizing, nourishing, easy to digest, and primarily consist of cooked foods.

Specific foods which benefit cataract are cow's ghee, milk (warm with digestive spices such as clove and cinnamon), butter, rice, wheat, mung bean, banana, spinach, okra, grapes, pomegranates, apples, and oranges.

Pungent, bitter, sour, and salty foods promote cataract and should be minimized (Dash and Kashyap, 4).

Miscellaneous considerations
The patient should be monitored for constipation, which is, in itself, a sign of vata derangement. Triphala and ghee both loosen the stool.

Minimize exposure to excessive heat and sun. Anxiety, worry and anger aggravate vata and pitta and are to be avoided.

Elements Dosha Characteristics Actions
Earth and Water Kapha Cold, wet, heavy Stability,
solidity,
lubrication
Water and Fire Pitta Hot, wet, light Metabolism,
body heat,
glandular
secretion
Air and Ether Vata Cold, dry, light Movement,
nerve
regulation
Taste Characteristics Action or Doshas
Sweet Cold, wet, heavy PV?K?
Sour Hot, wet, light V?PK?
Salty Hot, wet, heavy V?PK?
Pungent Hot, dry, light K?VP?
Bitter Cold, Dry, Light PK?V?
Astringent Cold, Dry, Heavy PK?V?
References
Cunningham, J.J., Mearkle, P.L., Brown, R.G. Vitamin C: An aldose reductase inhibitor that normalizes erythrocyte sorbitol in insulin-dependent diabetes mellitus. J. Am. College of Nutrition 13 (1994): 344-50

Dash, Bhagwan, and Kashyap, Lalitesh. Materia Medica of Ayurveda. Concept: New Delhi, 1979

Dash, Bhagwan. Ayurvedic Cures for Common Diseases. Hind Pocket: Delhi. 1995

Dash, Bhagwan. Fundamentals of Ayurvedic Medicine. Bansal: Delhi, 1980

Dash, Bhagwan. High Blood Pressure and Sleeplessness. Jain: New Delhi, 1993

Dash, Bhagwan. Massage Therapy in Ayurveda. Concept: New Delhi, 1992

Devaraj, T.L. Speaking of Ayurvedic Remedies for Common Diseases. Sterling: New Delhi, 1985

Frawley, David. Ayurvedic Healing. Passage: Salt Lake City, 1989

Hameed, H. Abdul. Complete Book of Home Remedies, The. Orient: Delhi, 1982

Heyn, Birgit. Ayurvedic Medicine. Thorsons: Wellingborough, 1987

Kapoor, L.D. CRC Handbook of Ayurvedic Medicinal Plants. CRC Press: New York, 1989

Lad, V., and Frawley, D. Yoga of Herbs, The. Lotus: Santa Fe. 1986

Lonsdorf, Nancy, Butler, Veronica, and Brown, Melanie. Woman's Best Medicine, A. Tarcher: New York, 1993

Sharma, Hari. Freedom from Disease. Veda: Toronto. 1993

Shanmugrasundram, E.R.B., et al. Use of Gymnema sylvestre leaf extract in the control of blood glucose in insulin-dependent diabetes mellitus. J. Ethnopharmacol 30 (1990): 281-94

Sorbinil Retinopathy Trial Research Group. A randomized trial of Sorbinil, an aldose reductase inhibitor in diabetic retinopathy. Archives of Ophthalmology 108 (1990): 1234-44

Tiwari, Maya. Ayurveda: Secrets of Healing. Lotus: Twin Lakes, 1995

Welihinda, J., et al. Effect of Momordica charantia on the glucose tolerance in maturity onset diabetes. J. Ethnopharmacol 17 (1986): 277-82

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By Karta Purkh Singh Khalsa, CN, AHG.

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