Netra Tarpana-An Efficacious Rejuvenate Local Medication of Eye and Standardizing Samayak Tarpita lakshana of Netra with the Help of Questionnaire

Ayurved is one of the great gifts of the sages of ancient India to mankind. It is not only a system of medicine in the conventional sense of curing disease but also a way of life that teaches us how to maintain & protect health. Kriyakalp is the main therapeutic process for Netra rogas. Kriyakalp means the procedures in which various drugs are applied in & around the eye ball as a treatment modality. the importance of Ayurvedic treatment in the diseases of eyes cannot be ignored. There is a great need to find out an ocular procedure for prevention and treatment of eye diseases having no or least adverse effect. Tarpan karma is one of the local therapeutic procedures which if promptly used shows objective evidences of excellent responses. In this Article there is a review Review Article Nayak et al.; JPRI, 33(51A): 289-297, 2021; Article no.JPRI.75882 290 on Netra Tarpana Karma, their indications, contraindications and possible mode of action , Standardiging Samayak Tarpita Lakshan with the help of Questionnaire. Questionnaire is discussed with expert, we discussed action and we have finalized the Questionnaire with the Stalwarts of Shalakya Tantra.


INTRODUCTION
Ashtang Ayurved denotes eight different branches of Ayurved in which Shalakyatantra is one of the most important branch dealing with Urdhvajatrugat vikara. Netra is one of the most important Dynanendriya. Hence it is very essential to maintain the Swasthya of Chakshu Indriya. For this different therapeutics (Kriyakalpa) are mentioned in classics.

'Swasthasya swasthyarakshanam aturasya vikarprashaman ch'. [1]
Therapeutic is defined as the branch of medicine concerned with the treatment of disease and the action of remedial agents or a therapy, or drug.
Ayurvedic therapeutics (Kriyakalpa) helps in maintaining Swasthya and to cure diseases. Kriya = Therapeutic action Kalpa = specific formulation of medicines.
Eyes are the only organ in the body which receives separate Treatment modality like Kriyakalpa as a Bahyaparimarjan Chikitsa and no other organs are individually receives the treatment modalities like Kriyakalpa on eyes. Tarpana karma is one of the local therapeutic procedures which if promptly used shows objective evidences of excellent responses. Tarpana is usually practiced Kriya in Netra Chikitsa which is Brimhana (nourishing) in nature [2].
Kriyakalpa are numbered are as follows along with their references Classification of Kriyakalpa:

Sr. No.
Samhita Name

Reference
Adhyaya Name 1. Preparation of the patient:

Number of Kriyakalpa
• The parson is thoroughly examined.
• Explain the person about procedure.

Preparation for the treatment:
Materials:-Ghruta (medicated ghee) , Flour of black gram for the construction of Netra Tarpana  3. Preparing the flour ring or cabinet --Flour of black gram will be mixed thoroughly in a sterile vessel by adding water and little. The mixture is made into a bolus. From this, 2 small rings so as to fit around the eye socket are prepared. That means to tell that the inner circumference of the ring will fit on the boundary of the socket of the eye so as to enclose the eye within it. The height of the ring should be of 2 angula's [11] (1 angula=1.75 cm approximately). Small quantity of prepared flour should be kept in a small bowl. This would be useful to seal the junction of the ring with the socket of the eye so as to prevent leakage of medicaments.

Preparing the medicine -
The ghee which would be used for Netra Tarpanam shall be liquefied and kept lukewarm. For this, the required quantity of ghee is put in a small sterile bowl. The small bowl is placed in a big vessel having hot water. After the Ghrita gets melted its temperature should be checked (manually). The medicine should be administered lukewarm.

Fomentation -A gentle fomentation is given
to the eyes with cloth dipped in warm water before the treatment. The water shall be wiped off with a sterile cloth or cotton before constructing the Tarpana ring.

Pradhana Karma (Treatment proper) -[11]
After explaining the method of treatment to the patient in detail, he or she shall be taken to a place devoid of heavy breeze or air to conduct Akshi Tarpana treatment.

Season and Time of Tarpana treatment:
The treatment shall be done in 'Sadharana Kala' i.e. in a season which is neither too hot nor too cold and when there is no rain or sky enveloped with clouds.
The treatment should be conducted either in the morning time or evening time or at both times if the condition of the disease demands an extra attention

Position of the patient:
The patient is made to sleep supine (on the back or facing the roof). He or she shall be given a neck support.

Construction of Netra Tarpana cabinet (ring) around the eye:
The rings of flour which were kept ready in the Purvakarma are inserted over the eye sockets, (one on each eye) such that the eyes are enclosed within their respective rings. The junctions of the rings with eye sockets are sealed with wet flour so that the medicament doesn't leak or escape during the process of the treatment.

Filling the Tarpana Ring with medicine -
The medicated ghee (ghrita) which was melted and kept warm in the Purvakarma is gently poured in the Netra Tarpana cabinets such that the eyes are dipped within the medicine. The patient is advised to close the eyes while dropping the medicine in the ring. Later he or she is instructed to open and close the eyes repeatedly so that the interior of eyes come into the contact of the medicines intermittently. The medicaments are left in place for a fixed duration of time. The patient might experience burning sensation during the process of the treatment but he or she should be intimated that it is quiet natural to happen. The irritation will come down once the medicines are removed. 1. Removing the medicine -The medicine is removed by creating a small hole in the lower portion of the wall of the flour ring at the outer angle of the eye and draining the contents in a bowl. Alternately, the wall of the ring is broken at the outer canthus (outer angle of the eye) and the contents are drained in a bowl.

Wiping the eyes and the surrounding area -
The medicines sticking to the eye and the sockets are swabbed out by wiping them off with the help of a sterile cotton pad or a tissue paper. Later the eyes can be wiped off gently with a sterile cloth dipped in warm water or the same cloth is used to give a gentle fomentation to the eyes.  Ruksham -dryness of the eye increases  Aavilam -increase of dirtiness of the eye  Asraadyam -excess of tearing of eye  Rupa darshanam asaham -inability of perceiving the objects of vision  Roga vriddhi -increase in disease and their symptoms

Tarpana therapy benefits: [21]
 Nayane Tamyati -Feeling of darkness in front of eyes (also due to irritation after exposure to light)  Stabdha netra -Feeling of stiffness or rigidity in the eyes  Netra shushkata -Extreme dryness of the eyes  Abhighata -Injury to the eye  Vata pittaja roga -Diseases of the eyes caused due to aggravation of Vata and Pitta  Jihma netram -abnormal deviation of eye ball

CONCLUSION
After reviewing various researches and available scientific data regarding Tarpana it can be concluded that, Tarpana is a superior therapy than merely using eye drops. Tarpana

QUESTIONNAIRE BEFORE & AFTER TARPANA
(Questionnaire is discussed with expert, we discussed action and we have finalized the Questionnaire with the Stalwarts of shalakya tantra. It is a subjective perametar differs person to person.) 1) When you wake up in the morning, do you feel (Sukhaswapana avbodhatva) Blissful awakening ?

□ Yes □ No
Discussion:-Sukhaswapana avbodhatvam word has 2 meaning 1. Sukhaswapana avbodhatvam means when you wake up you feel like blissful awakening. 2. Sukhaswapana avbodhatvam means person sleeps as soon as you go to bed.

□ Yes □ No
Discussion:-Vaishadya word has two meaning.
1. Vaishadya means clear vision ( person can see better than before) 2. Vaishadya means clear eye ( person not have mala in eye or near eyelids)

□ Yes □ No
Discussion:-Varnapatava word has two meaning:-1. Varnapatava means person can find perfect difference in each colour. 2. Varnapatava means person's sclera in it's normal colour.

□ Yes □ No
Discussion:-Kriya laghavama word has two meaning:-1. Kriya laghavama means person can blinking easily or eye movement are normal. 2. Kriya laghavama means person's vison process is normal.

□ Yes □ No
Discussion:-Prakash kshamta means person react normally to light or some rays of light.

□ Yes □ No
Discussion:-laghu lochanm means person fills lightness or stress free while reading books/watching TV