Liquid discharge from the eye other than tears, with or without burning and itching, is found in many eye conditions and can also be due to environmental pollutants. Mostly, eye discharge is a common symptom in the inflammatory and allergic conditions of the eye. In viral conjunctivitis, the eye becomes red or bloodshot and irritation causes discharge but this condition does not last more than 10 days or so, if uncomplicated and proper hygienic care is taken. Bacterial conjunctivitis is not common, but when it develops as thick eye discharge of white, yellow or greenish colour; it is advisable to seek medical advice.

Cigarette smoke, chlorine in swimming pool water and chemicals in make-up materials are some of the uncommon causes of eye discharge. In such cases, eye discharge and other associated symptoms appear on contact with the irritant and do not last long. Specific medication is not required but the cause of eye irritation should be avoided.

Thin watery discharge coupled with itching and burning in the eyes is due to allergy and it is sometimes very uncomfortable. This condition necessitates determination of the cause of allergy. For eye discharge, the simple principle of treatment recommended in Ayurvedic literature is to avoid the causative factor and palliate the symptom with medicines having antagonistic properties. Triphala decoction is one such medicine which is widely popular and considered to be quite effective in alleviating various eye symptoms including discharge, inflammation and irritation.

Triphala decoction

Fruits of three myrobalans are collectively designated as Triphala in Ayurveda, meaning the three specific fruits put together. This formulation is included in the Ayurvedic Formulary of India and the ingredients are described in Ayurvedic pharmacopoeia. It finds vivid description in Ayurveda literature and is frequently used by practitioners inter alia in the treatment of eye diseases, particularly conjunctivitis and vision disorders. Both Kvatha (decoction) and Churna (powder) of Triphala are indicated respectively for external and internal use in eye disorders.

Triphala decoction is mainly used for washing inflamed eyes with purulent discharge or as eye drops in controlling conjunctivitis. Apart from providing relief in inflammation-induced eye symptoms with its decongestant, anti-inflammatory and soothing effects, instillation of Triphala decoction in eyes is proven to have prophylactic value for preventing viral conjunctivitis during epidemics.

Composition

Decoction of Triphala is prepared by boiling together in water the coarse powder of dried fruits of the following three medicinal plants.

Local Name	Latin Name	English Name	Family	Parts Used
Haritaki	Terminalia chebula Retz.	Chebulic myrobalan	Combretaceae	Fruit
Bibhitaki	Terminalia belerica Roxb.	Belliric myrobalan	Combretaceae	Fruit
Amalaki	Phyllanthus emblica Linn.	Emblic myrobalan	Euphorbiaceae	Fruit

Main chemical constituents

Triphala as a whole is rich in vitamin C, gallic acid and tannins. Ingredient-wise the main chemical constituents are:

• Haritaki: Tannins, anthraquinones and polyphenolic compounds.
• Bibhitaki: Gallic acid, tannic acid and glycosides.
• Amalaki: Vitamin C, carotene, nicotinic acid, riboflavin and tannins.

Quality standards

Simple quality parameters for selection of raw materials could be followed for having desired efficacy from Triphala decoction.

Ingredient	Foreign Matter	Total Ash	Acid Soluble Ash	Alcohol Soluble Ash	Water Soluble Extractives
Haritaki	Not more than 1%	Not more than 5%	Not more than 5%	Not less than 40%	Not less than 60%
Bibhitaki	Not more than 2%	Not more than 7%	Not more than 1%	Not less than 8%	Not less than 35%
Amalaki	Not more than 3%	Not more than 7%	Not more than 2%	Not less than 40%	Not less than 50%

Method of preparation

Triphala decoction for cleansing eyes is prepared the following way:

• (1) Clean the dried fruits and remove the seeds.
• (2) Take the required amount of each ingredient that is sufficient for the course of treatment. For 15 days’ treatment, 500 grams of each ingredient is needed.
• (3) Make coarse powder separately of the three dried fruits.
• (4) Mix together the three powders in equal amounts to form a uniform mixture.
• (5) Take 10 to 50 grams of the mixture for one application and soak it for about an hour in 16 times water. Then boil till half of the water remains. Filter the decoction through fine cotton cloth and keep in a clean bowl or jug. Slightly warm decoction should be used for washing eyes at the earliest after its preparation.
• (6) For use in children and sensitive individuals, soak 50 grams of powdered Triphala in 200 milliliters of hot water for half an hour, filter and use it lukewarm.

Dosage form

Slightly warm, dark-brownish coloured liquid.

Therapeutic properties

Anti-inflammatory, decongestant, soothing and wound healing properties.

Dose and mode of administration

Sufficient quantity of Triphala decoction, say about 100 to 200 milliliters, is required to wash eyes in one of the following ways:

• (1) Dip a small piece of sterilized cotton in slightly warm Triphala decoction and clean with it each eye 3-5 times from nasal side outwards; each time with separate cotton. Wipe the eyes with clean and sterilized cotton or soft cloth. Do this procedure two to three times a day.
• (2) Ask the patient to lie down on the back. Irrigate the open eyes, one by one, with Triphala decoction poured through a clean and sterilized dropper. The procedure may be done twice or thrice a day.
• (3) Akshi Tarpana: With patient lying down on back, first clean the eyes with cotton or soft cloth soaked in clean water and then make rings of wheat-flour dough around both eyes. Put Triphala decoction in the rings in such a way as it may not spill out. Keep this position for 5 to 10 minutes and ask the patient to blink eyes and move eye balls in between. This procedure should be done at least twice a day.

Indications and uses

Triphala decoction is used for washing eyes in acute and chronic infections and inflammatory diseases of eye including trachoma, where watery or purulent discharge is the main symptom. It is also recommended for oral use in various eye diseases.

Precautions and safety aspects

• (1) Due care must be taken to make and keep the decoction in a clean utensil. Do not keep the decoction uncovered and in an unhygienic place. Dipping fingers in the decoction to judge its temperature should be strictly avoided.
• (2) Too hot and too cold decoctions should not be used as they may not yield the desired results.
• (3) Frequency of eye wash should be determined on the basis of the severity of symptoms. It is advisable to wash the affected eye at least twice a day and for each application fresh decoction should be prepared.
• (4) Warm compresses should be applied to soften and remove crusts in the eyelids, before washing the eyes. Softened crusts can be removed with cotton.
• (5) Medical advice must be sought, if vision is decreased, the eye pain gets severe, the discharge is thick and frankly purulent or greenish or bloody and light sensitivity is intense.
• (6) Do not continue using Triphala decoction in case eye symptoms of itching, discharge, redness etc. worsen or do not improve in one to two weeks.
• (7) Haritaki, Bibhitaki and Amalaki fruits are traditionally considered safe in the prescribed doses and no adverse effects are reported in the literature.

References

• (1) India, Ministry of Health & Family Welfare. The Ayurvedic formulary of India. Part II. New Delhi: Department of Indian Systems of Medicine and Homeopathy, 2000. p. 72.
• (2) India, Ministry of Health & Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine and Homeopathy, 2001. p. 5, 26, 47.
• (3) India, Ministry of Health & Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine and Homeopathy, 2001. p. 48.
• (4) India, Ministry of Health & Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine and Homeopathy, 2001. p. 26.
• (5) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 14.
• (6) India, Ministry of Health & Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine and Homeopathy, 2001. p. 47.
• (7) India, Ministry of Health & Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine and Homeopathy, 2001. p. 26.
• (8) India, Ministry of Health & Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine and Homeopathy, 2001. p. 5.

Further reading

• (1) Juss SS. Triphala – the wonder drugs. Indian Med. Gaz., 1997.
• (2) Mehta BK, Shitut S, Wankhade H. In vitro antimicrobial efficacy of Triphala. Fitoterapia. 1993.
• (3) Mitra AK, Gupta AK, Debdas M. Clinical observations on an herbal eye drops preparation. Antiseptic. 1986.
• (4) Tambvekar NR. Ayurvedic drugs in common eye conditions. J. Nat. Integ. Med. Assoc., 1985.
• (5) Thakare RP. Studies on the anti-bacterial activity of some plant extracts. Indian Drugs. 1979-80.

Source: Traditional Herbal Remedies for Primary Health Care - WHO