IJPHER

International Journal of Public Health and Epidemiology Research

Vol. 4(1), pp. 035-039, January, 2018. © www.premierpublishers.org. ISSN: 1406-089X

Case Study

Action of Elaneer Kulambu on Presbyopia- A Case Study

1
Preyadarsheni K, 2Swetha D, 3Anandhalakshmi D, 4Sasi S.K.
1,2,3
III year BSMS, Government Siddha Medical College, Chennai, India
4
Head of the Department (Noi Naadal), Government Siddha Medical College, Chennai, India
This was a case study conducted for the foremost reason of finding the most feasible and
affordable way of management of presbyopia. So as to make available, the most ancient and
concrete method of anjanam prescribed by siddhars to people’s usage. The study involved a
limited population of 10 subjects and “ELANEER KUAMBU” was given for a period of over 40
days. Jaeger’s test was used as study tool for the assessment of visual acuity. Results showed
that the elaneer kulambu had significantly reduced J value (jaegers’s chart value for near vision)
on about 50% of sample population. It had moderate impact on about 30% of sample population
and no significant change on 20% of sample population. By monitoring the regular usage of
Elaneer kulambu on a large scale population and for a long time, these results could be further
more productive.
Keywords: Elaneer kulambu, Anjanam, Presbyopia, External therapy, Siddha, Eye drops.

INTRODUCTION
World Health Organization in its bulletin (Oct 2015) has
said, “Uncorrected presbyopia is the most common cause
of visual impairment”. It is estimated that 108 million
people worldwide have impaired distance vision, while five
times as many (517 million) have impaired near vision. It
is estimated that over half of the one billion people affected
globally cannot afford the spectacles needed to correct
their eyesight. Worldwide in 2005 over 1.05 billion people
were reported to be presbyopic which is expected to rise
to 1.37 billion by 2020. An attempt has been made to find
the significant, ancient, affordable and feasible method for
management of presbyopia and its alarming
breakthrough.Presbyopia is an eye condition in which eye
slowly loses the ability to focus quickly on objects that are
close. Itis a disorder that affects during natural aging
process. The failure of accommodation becomes evident
gradually. The printed page becomes indistinct and letters
and words are confounded while reading. Sooner or later,
symptoms of eye strain appear. In ancient times, Siddhars
used anjanam for correcting refractive errors. According to
AGASTHIYAR NAYANA VITHI, a formulation called
“ELANEER KULAMBU” is prescribed for Presbyopia
(velleluthu).
LITERATURE REVIEW
A clinical study to evaluate the efficacy of pratka yoga krya
and eye exercises in management of timira (ammetropia
and presbyopia) by G. Gopinath et al., (2012) concludes
that eye exercise acts as adjuvant therapy hence one
should adopt pharmacological interventions (medical
management), lifestyle and diet modifications to get better
results in alarming refractive errors. A pharmacognostical
and physicochemical analysis of Elaneer kuzhambu- an
ayurvedic polyherbal formulation by Varma et al., (2013)
concluded that elaneer kuzhambu consists of prismatic
crystals of yashtimadhu and daruharidra, fragments of
mesocarp cells, sclereids, tannin of Haritaiki, starch grains
of naalikeera, mesocarp, oleo resin of karpura, fibres of
darvi, pH of 4.36, specific gravity of 1.39. A clinical study
on evaluation of anti-cataract effect of Triphaladi Ghana
vati and elaneer kuzhambuanjana in timira (immature
cataract) by Dr. Hitesh Bhati,(2015) concludes that the test
drugs can reduce and control the progress of cataract.

OBJECTIVE *Corresponding author: Preyadarsheni K. Krishnan,

To determine the effect of “ELANEER KULAMBU” on Government Siddha Medical College, Chennai, India.
presbyopia. Email: preyadarshenikrishnan@gmail.com

Action of Elaneer Kulambu on Presbyopia- A Case Study

Preyadarsheni et al. 036

MATERIALS AND METHODS
Among patients attending the IP department NOI NAADAL
(pathology), Aringar Anna Hospital, Government Siddha
Medical college, Chennai, with signs and symptoms (as
per siddha literature and Jaeger’s eye test) irrespective of
sex, religion, status, occupation, education, etc., a total of
10 volunteering patients were selected for the study. An
elaborate case proforma was particularly designed by
incorporating all aspects of the disease on Siddha and
modern basis. The formulated “ELANEER KULAMBU” as
per literature is procured from GMP certified company. A
case study is conducted for a period of 40 days by
administering eye drops to the selected volunteer patients
on an interval of 24 hours. Patients are well informed about
the study and consent is obtained from them after clear
explanation of pros and cons of the study. A pre and post
clinical assessment was done by BSMS students using
study tool over the period of 40 days.
The study is a case study and experimental in nature.
“ELANEER KULAMBU” drops is given at a 24 hour
interval.2-3 drops of the medicine should be administered
once a day. Eye checkup is done before and after the
administration of drops for consecutive 40 days.
Patients are requested not to sleep or roam in sunlight
immediately after administration of drops and to wipe out
tears (after dispensing drops for a while) using sterile cloth
soaked in hot water. According to AGATHIYAR NAYANA
VITHI, drops are not advised to be administered after oil
bath, during rainy days, menstruation, evening time and
while consuming alcohol.
INCLUSION CRITERIA: Both men & women above the
age of 40 are selected.
EXCLUSION CRITERIA: Patients with cataract, corneal
ulcer, surgery are excluded.
STUDY PERIOD: July 14 – August 25 2017
Elaneer kulambu is an eye care formula, specified in
Agathiyar Nayana Vidhi. It is used in treatment of corneal
ulcer, pterygium, early stage of cataract, presbyopia and
other eye related diseases. It is applied as a paste or eye
drops to the inner side of eye lids. It is sometimes used as
a collyrium. It balances Trithodam (Vadham - Pitham -
Kabham) in eyes.
It is prepared by following method,
• No.2 to No.6 in Table 1 (dry ingredients) are powdered,
filtered and soaked in Elaneer for three days.
• Fourth day, the mixture is boiled such that it is reduced
to one-fourth of total quantity.
• The mixture is kept aside to cool and filtered.
• The liquid is again boiled to one-fourth.
• Then, No.6 and No.7 are powdered and added.
• The liquid mixture and honey are grinded in kalvam.

Table 1: Ingredients required for preparation of elaneer kulambu

S/No Botanical Name Vernacular Name Parts used Quantity(in grams)

1 Cocos nucifera Elaneer Tender/unripe drupe water 1680

2 Terminalia chebula Kadukkaithol Pericarp 41
3 Phyllanthus Emblica Nellivatralthol Pericarp 41
4 Terminalia bellarica Thaandrikaai Pericarp 41
5 Cocsinumfenestratum Maramanjal Rhizome 41
6 Glycyrrizaglabra Athimadhuram Root & stolons 41
7 Sodium chloride impura Indhuppu - 2.1
8 Borneo camphor PachaiKapooram - 2.1
9 Honey Thaen - 2.1

Action of Elaneer Kulambu on Presbyopia- A Case Study

 Int. J. Public Health Epidemiol. Res. 037

OBSERVATIONS/RESULTS
Out of 10 subjects, 5 of the subject’s near vision has been
The Main tool used to measure the changes in visual observed to be reduced markedly, 3 of the subject’s near
acuity of presbyopic patients before and after the study is vision are observed to be reduced moderately and two of
“jaeger’s chart”in additionto siddha proforma. The results the subject’s near vision remains unchanged.The results
obtained from the respective 10 patients at the 41st day are are tabulated in percentage. (See Table 3)
listed below in Table 2.
Table 3: Percentage of changes in visual acuity (%)
Table 2: Observed changes in visual acuity of the S.NO CHANGES PERCENTAGE (%)
sample population. 1) Unchanged 20
2) Moderately changed 30
S.NO PRE- POST-CLINICAL CHANGES
CLINICAL RESULT OBSERVED 3) Markedly changed 50
RESULT
1) J5 J5 Unchanged The findings are represented in bar diagram. (See Table
2) J4 J3 Moderately changed 4)
3) J6 J3 Markedly changed
4) J4 J3 Moderately changed
5) J4 J4 Unchanged
6) J7 J4 Markedly changed
7) J5 J4 Moderately changed
8) J8 J5 Markedly changed
9) J4 J1 Markedly changed
10) J5 J1 Markedly changed

FINDINGS
5

4.5

3.5

2.5

2 RESULT

1.5

0.5

Unchanged
Moderately
changed Markedly changed

Table 4: Findings

Action of Elaneer Kulambu on Presbyopia- A Case Study

Preyadarsheni et al. 038

DISCUSSION acuity of the respective subjects. In that event, the

corresponding eye drop formulation “ELANEER
Quantitative variables are used. KULAMBU” is found to be beneficial, feasible, affordable
The difference between the pre and post clinical results and undeniably effective against presbyopia for the
(variables) are enumerated as, corresponding subjects. This case study establishes that
Unchanged -0, the formulated drug can reduce and manage the progress
Moderately changed-1, of presbyopia.
Markedly changed-2 (See Table 5)

Table 5: Enumeration of data for statistical analysis. LIMITATIONS

S/NO PRE-CLINICAL POST-CLINICAL DIFFERENCE
1 1 1 0 As this is a case study and involved only a limited
2 1 2 1 population in a limited time, it may not be applicable to the
3 1 3 2 whole population and varying age groups. But this case
4 1 2 1 study is so absolute that it can be applied to further
5 1 1 0 explorative researches.
6 1 3 2
7 1 2 1
8 1 3 2 ACKNOWLEDGEMENT
9 1 3 2
10 1 3 2 My sincere thanks to Dr. Kanagavalli. MD (S), the principal
of Government Siddha Medical College, Chennai for
NULL HYPOTHESIS: There is no significant difference permitting me access to IP department of Aringnar Anna
between the respective subjects’ near visual acuity before Siddha Hospital, Chennai. My heartfelt thanks to my guide
and after the clinical administration of eye drops. Dr.S.K.Sasi.MD(S) for her valuable guidance and moral
The t-paired test is used for the statistical analysis of the support throughout the case study. I extend my thanks to
raw data. According to the SAS (Statistical Analysis Dr. Vijayapushpam, Research Officer (ICMR) for her
System), the P value rests between 0.00037(one tail) and constructive and constant guidance in statistical analysis.
0.00074(two tail) but the t-stat value is 4.9934 (modulus) I also would like to thank Dr. R. Manickam, Scientist
which is greater than the P value. This concludes that the (ICMR), Dr. Shameem Fathima, (Research methodology
null hypothesis is rejected which paves the way for the Professor), Dr. S. Krishnan (Statistical officer) for helping
alternative hypothesis. me understand the basics of research. Finally, I extend my
whole hearted thanks to Vice-Principal, all professors of
Therefore, statistical analysis of the findings suggests our college, my family and friends for being my pillars of
that the eye drops have impact on visual acuity of the support throughout the case study.
subjects. The eye drops have beneficial impact on 50% of
the subjects; undeniable but moderate impact on 30% of
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Action of Elaneer Kulambu on Presbyopia- A Case Study