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Title, disease, patient age, diagnostic method, symptoms,signs, treatment protocol, procedure,oral medication,result

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Case Study: Bidalaka Prayoga in Puyalasa (Acute Dacryocystitis)

Published in: International Journal of Pharmaceutical Research and Applications, Vol. 8, Issue 1, Jan-Feb 2023, pp. 2391-2393

Title

Bidalaka Prayoga in Puyalasa (Acute Dacryocystitis)
  • Puyalasa = Ayurvedic term for suppurating swelling at the inner canthus (KaneenakaSandhi)
  • Modern correlation: Acute Dacryocystitis (inflammation of the lacrimal sac)

Disease

  • Puyalasa / Acute Dacryocystitis
  • Suppurating swelling at the inner canthus with thick discharge and foul-smelling pus
  • Three stages: (1) Cellulitis - painful, red, hot, tender swelling; (2) Lacrimal abscess - pus collected in sac with large fluctuant swelling; (3) Fistula formation - sac discharged forming external fistula

Patient Age

  • 60-year-old female
  • Name: Sumitabai W/o Devkaran
  • OPD No.: 17467
  • Institution: Shalakya Tantra OPD, SSAMC, Bhatinda, Punjab

Diagnostic Method

ParameterFinding
Visual Acuity (RE)6/24
Visual Acuity (LE)PL{(+)} with NV-N36
Corneal ExaminationWhitish patch over cornea (corneal opacity, diagnosed 8 months prior in general hospital)
Corneal vascularizationPresent
Local ExaminationInner canthus swelling (+++), tenderness, red discoloration, suppurated area, no pus point formed

Symptoms

  • Pain and swelling in eyebrow, orbital area, and inner canthus
  • Watering of eyes (epiphora) - Left Eye
  • Duration: 3 days
  • History of fertilizers/pesticides sprayed in eyes 8 months prior

Signs

  • Inner canthus swelling (+++)
  • Tenderness at lacrimal sac region
  • Red discoloration
  • Suppurated area (no pus point formed at presentation)
  • Corneal opacity (whitish patch)
  • Corneal vascularization
  • Watering of eyes

Treatment Protocol

Procedure (External/Local Treatment)

  1. Bidalaka - Triphala + Yastimadhu Choorna mixed with madhu (honey), applied as a thick medicated paste over closed eyelids (except eyelashes)
  2. Seka (Triphalachashya + Haridra) with madhu - irrigation over closed eyes from 4 directions (angulas) for 5 days
  3. Pratisaarana - done on Day 2 with Saindhavalavana + madhu (application of medicament directly)

Oral Medications

MedicationDoseDuration
Tab. TriphalaGuggulu1-1-15 days
Tab. GandhakaRasayana1-1-15 days

Follow-Up Medication

  • HaridraKhanda 3 gms at night with milk - given for 5 days

Observation Table (Day-wise Progress)

DateSymptomsTreatment Given
18/07/2022Swelling+++, Pain++++, Redness++, Watering++BidalakaSeka, Tab. TriphalaGuggulu, Tab. GandhakaRasayana
19/07/2022Swelling+++, Pain+++, Redness++, Watering++BidalakaSeka, Pratisaarana, Tab. TriphalaGuggulu, Tab. GandhakaRasayana
20/07/2022Swelling++, Pain++, Redness+, Watering+BidalakaSeka, Tab. TriphalaGuggulu, Tab. GandhakaRasayana
21/07/2022Swelling+, Pain+, Redness-, Watering- AbsentBidalakaSeka, Tab. TriphalaGuggulu, Tab. GandhakaRasayana
22/07/2022All symptoms reducedBidalakaSeka, Tab. TriphalaGuggulu, Tab. GandhakaRasayana

Result

  • 90% significant improvement was seen after the 5th day of treatment
  • No adverse effects were found during or after treatment
  • Patient was relieved and satisfied with the treatment
  • No complications during the treatment course

Summary of Drug Actions

DrugAction
Triphala ChoornaAntioxidant, vranashodaka, reduces swelling, redness, pain, watering
YastimadhuImproves digestion, controls pitta, reduces ama formation
HaridraRelieves blockage in cells, anti-inflammatory, clears toxins
Saindhava LavanaChakshushya, relieves infection (contains NaCl - ion exchange through eyelid skin)
GandhakaRasayanaTridoshashamaka, antibacterial, antiviral, antimicrobial, raktashodhaka
HaridraKhandaFollow-up anti-inflammatory, controls systemic ama
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