A Case Study: Ayurvedic Management of Nasarsha w.s.r to Nasal Polyp

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[Find the meaning and references behind the names: Ramya]

Case Study This work is licensed under a CC BY 4.0 License International Research Journal of Ayurveda & Yoga Vol. 6 (2),17-21, Feb,2023 ISSN: 2581-785 X: https://irjay.com/ DOI: 10.47223/IRJAY.2023.6203 A Case Study: Ayurvedic Management of Nasarsha w.s.r to Nasal Polyp Ramya M 1 , Rathi.S 2 1.PG Scholar, Dept of P.G studies in Shalakya Tantra, G.A.M.C, Bangalore 2.Professor & HOD, Dept of Shalakya Tantra G.A.M.C Bangalore INTRODUCTION Nasal polyps are mucosal lesions of the nasal passage or paranasal sinuses that can result from a response to inflammatory or infection stimuli. They appears as smooth, round, semitranslucent masses that are most commonly found in the middle meatus and ethmoid sinuses and affect 1% to 4% of the population. Males are affected more than females and adults more than children. If it happens in childhood, mucociliary and immunodeficiency disease, patients with nasal polyps may present clinically with complaints of nasal obstruction, congestion, rhinorrhoea, hyposmia, headaches, post nasal drips, and snoring. Nasal polyps more commonly appear bilaterally they can also present unilaterally 1 . Nasal polyps are frequently associated intrinsic asthma, young’s syndrome, cystic fibrosis. Children 16 years or younger with nasal polyps should be evaluated for cystic fibrosis, and kartagener’s syndrome. Histologically, they classically have pseudo stratified ciliated columnar epithelium, thickening of the epithelial basement membrane, high stromal eosinophil count, mucin with neutral pH, few glands, and essentially no nerve endings. Cells consist of a mixture of Article Info Article history: Received on: 12-12-2022 Accepted on: 18-02-2023 Available online: 28-02-2023 Corresponding author- Ramya M, PG Scholar, Dept of P.G studies in Shalakya Tantra, G.A.M.C, Bangalore Email: ramyamahabala 3@gmail.com ABSTRACT: Nasa is the most important organ of Urdhwajatrugatabhaga and is the gateway for head as well as respiratory system. Nasarshas is one among the thirty-one Nasagata Rogas mentioned in our classics. Nasarshas can be correlated to nasal polyps. Nasal polyps are non-neoplastic masses of nasal or sinus mucosa. Prolonged use of antihistamines and antibiotics leads to drug resistance and decreases immunity, Fear of surgery, its complications and cost have restricted many patients from undergoing surgery and allopathic medicines. In this study a case of 31 years male Patient presented with difficulty in nasal breathing, mouth breathing especially at night, sneezing, nasal discharge, headache since 9 months was taken for study. Present case study is taken to evaluate the efficacy of Ksharakarma in the management of Nasarshas w.s.r to Nasal Polyp along with internal medications for improve immunity and to reduce its recurrence. Kshara is an excellent medicine in the management of Arsha , as it has Lekhana, Tridoshaghna , Teekshna and Ushna properties. Shirovirechana being one of the Shodhana Karma, hence Nasya with Apamarga Kshara Taila followed by Yava kshara prathisarana was planned. Internally, Chitrakadi Vati, Triphala Guggulu and Haridra khanda, Hamsapadi Kashaya was prescribed. There was significant improvement in patient’s complaints and marked reduction in polypoidal mass. Key words : Ksharakarma , Rasayana, Nasaarsha , Nasal Polyp

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[Find the meaning and references behind the names: Mala, Min, Good]

Ramya et.al , “A Case Study: Ayurvedic Management of Nasarsha w.s.r to Nasal Polyp.” : 2023; 6 (2):17-21 18 lymphocytes, plasma cells and eosinophils. Polyps from patients with young’s syndrome, kartagener’s syndrome, and cystic fibrosis have predominately Neutrophils with insignificant Eosinophils. Mediators found in nasal polyps are as follows: histamine, serotonin, leukotrienes norepinephrine, kinin. There is more histamine in nasal polyps than in normal nasal mucosa, and norepinephrine is present in greater concentration in the base of nasal polyps than in normal mucosa. The concentrations of IgA and IgE and in some cases, IgG and IgM are greater in polyp fluid than in serum. IgE – mediated disease is not the cause of nasal polyps, but when present, may contribute to episodes of exacerbation. Despite medical or surgical management, a significant number of nasal polyps are recurrent. For treatment, systemic corticosteroid should be tried before surgical polypectomy. At the present, the pathogenesis of polyp formation is unknown 2 . In Ayurveda , nasal polyps are correlated to the Nasa Arsha . Acharya Sushruta has mentioned that the aggravated Dosha when moves upward it takes sthanasamshraya in ear, eye, nose, and mouth, then vitiates Mamsa, and Rakta of those parts and produces Arsha . Acharya Sushruta clearly mentioned that patients feel difficulty in nasal breathing, mouth breathing especially at night, foul smell, headache, constant sneezing, running nose are the common symptoms 3 . Acharya Sushruta has mentioned that it is one among thirty one nasagata rogas . Four type of Nasarsha are described by Acharya Sushruta – Vata, Pittaja, Kaphaja and Sannipataja 4 . Acharya Charaka has mentioned in Arsha chikitsa that the fleshy mass growth appear on many region of body like penis, vagina, throat, mouth, nose, eye, skin. These hypertrophied or fleshy growths are termed as Adhimamsa. The seat of these growth is Twak, Mamsa, and Meda 5 Hence the present case study is taken to evaluate the efficacy of Ksharakarma in the management of Nasarshas w.s.r to Nasal Polyp along with internal medications. Objects of the study are: 1. To evaluate the efficacy of Kshara Karma in the management of Nasarshas w.s.r to Nasal polyp. 2. To evaluate the effect of oral Ayurvedic Medicines in the management and prevention of recurrence of Nasarshas w.s.r. to Nasal polyp. MATERIALS AND METHOD Source of Data Patient were selected from the outpatient of Shalakya Tantra department from Government Ayurvedic Medical College, Bangalore, Karnataka. Drug selection is done according to the Classical reference CASE STUDY Chief Complaints & Associated Complaints A male patient of age 31 years presented with difficulty in nasal breathing, mouth breathing especially at night, headache, sneezing, nasal discharge since 1 year. History Of Present Illness A male patient of age 26 years was apparently healthy 9 months back. Gradually he started developing bilateral nasal obstruction on and off, recurrent sneezing on and off, rhinorrhea on and off, heaviness of head and headache. It was so recurrent that, the patient was feeling difficulty in breathing during the episodes and unable to concentrate on the routine activities. So, he consulted one of the allopathic doctor, where he diagnosed the case as Nasal polyp on examination and prescribed nasal decongestants and antiallergic drugs. The symptoms used to relieve for sometimes but was recurring. So, he was suggested to undergo surgery for nasal polyps. Patient was not willing to get surgery done, so he consulted our hospital for further management. History of Past Illness: History of allergy to pollens, dust, smoke. Family History : Nothing Specific Personal History : Appetite: Good Sleep: Sound Bowel: Twice a day Micturition: 5-6 times a day Diet: Mixed General Examination : Respiratory system: Normal vesicular breathin sound heard, no added sounds CVS: S 1 S 2 heard, no added sounds Per abdomen: On palpitation nothing specific. BP- 120/80 mm/hg Pulse rate: 71/ min Weight- 57 kg Height: 166 cm Ashtavidha Pareeksha Nadi – Kaphapittaja Mala - Prakruta Mutra – Prakruta Jihva - Prakruta Shabda – Prakruta Sparsha - Prakruta

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[Find the meaning and references behind the names: Guna, Medo, Nil, Market]

Ramya et.al , “A Case Study: Ayurvedic Management of Nasarsha w.s.r to Nasal Polyp.” : 2023; 6 (2):17-21 19 Drik – Prakruta Akruthi – Madhyama Nasal Examination Inspection - Nothing Specific Palpation - Nothing specific Anterior Rhinoscopy - Round, soft, glossy, greyish swelling in the middle meatus is seen which does not bleed on touch when examined through Jobson’s probe. Posterior Rhinoscopy - Nothing specific Examination of Paranasal Sinus - Maxillary & Frontal Sinus Tenderness Present Investigations : AEC - 450 cells/microliter of blood Samprapti Ghatakas Dosha – Kaphavata Dushya - Mamsa, Meda, Asthi Agni - Jatharagni Udbhava Sthana – Urdhwajatru Sanchara Sthana - Urdhwajatru Vyakta Sthana - Nasa Srotas – Pranavaha Srotodushti – Sanga Rogamarga – Bahya Sadhyasadhyata – Kricchrasadhya Diagnosis: Nasarshas (Nasal Polyp) Treatment: Table no-1(Treatment given) OBSERVATIONS AND RESULT : Table 2:( Observation- Before and after the treatment) AEC was reduced to 230 cells/microliter of blood Assessment Scale Grading : All the subjective parameters were assessed based on Self- Grading Scale. DISCUSSION Shirovirechana being one of the Shodhana karma 6 for the diseases of Urdhwajatru where it helps in evacuating the accumulated Doshas from the Shiras. Hence Nasya with Apamarga Kshara Taila for 7 days has been administered. Apamarga Kshara Taila is Teekshna, Ushna and has Ksharana property and is indicated in Nasarshas 7 . Kshara is an excellent Anusastra in the management of Arsha , because it has Lekhana, Tridoshaghna , Teekshna and Ushna properties. In Nasarsha the Doshic predominance is Kaphapradhana Tridosha , and Dushya is Mamsa and Medo Dhatu, as the Kshara has Ushna Guna and Lekhana properties. It can reduce the vitiated Mamsankura . Ksharakarma is specifically indicated in Nasarshas . Yava Kshara is having Ushna , Teekshna, Lekshana properties and can be easily prepared and available in the market. Hence Yava Kshara is used for the Ksharakarma 8 . Internally Chitrakadi Vati , Triphala Guggulu , Haridra Khanda , Hamsapadi Kashaya . Chitrakadi Vati 9 is prescribed to increase the Agni as patient is having Agnimandya and is the basic factor for manifestation of any disease. Chitraka is also having Kshareeya property and is acts as remedy for Nasarshas . Triphala Guggulu 10 is also one of the antiinflammatory and Kaphamedohara in nature and helpful in relieving the pain, nasal blockage. Haridra Khanda is indicated in all allergic conditions and it has kaphahara property and agnimandyahara. Hamsapadadi Kashaya which contains Tripadi, Pippali and Guduchi acts on Mamsa and Medo Dhatu is helpful maintaining the respective Dhatwagni. CONCLUSION Nasal polyp is one of the major surgical disease in nasal disorder, there is chance of recurrence after surgery as per allopathic science. We can cure it by Ayurvedic line of treatment easily and more effectively. There is no chance of recurrence of disease where Kshara karma is done. There was significant result just after the Nasya Karma, where he got half relief of the symptoms of Nasal Polyp. Overall, there was significant improvement in the condition. Hence there is need to implement Ayurvedic medicines in larger samples of the disease to draw a conclusion. Acknowledgments- Nil Conflicts Of Interest- Nil Source of finance & support – Nil ORCID Ramya M , https://orcid.org/ 0000-0002-1783-981 X REFERENCES 1 The Epidemiology and Clinical aspect of nasal polyps https://www.ncbi.nlm.nih.gov/PMC 3846212 10/11/22 . 2 Nasal polyps, epidemiology/pathology/treatment. https://www.journals.sagepub.com by GA setti pane - 1987.10/11/22

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[Find the meaning and references behind the names: Shri, Sharma, Deepika, Rao, Prakashan]

Ramya et.al , “A Case Study: Ayurvedic Management of Nasarsha w.s.r to Nasal Polyp.” : 2023; 6 (2):17-21 20 3 Sharma A.R Sushruta Samhita Uttartantra, Chap -22, ckaukhambha surbharati prakashan Varanasi - 2001.pp.170. 4 Sharma A.R Sushruta Samhita Uttartantra, Chap -22, ckaukhambha surbharati prakashan Varanasi - 2001.pp.164. 5 Kushwaha H.C, Charaka Samhita second part , Chikitsa sthana chaukhambha Orientalia, Varanasi-2012.pp.341. 6 Moreshwar A, Acharya Laghu Vagbhata, Ashtanga Hridayam, Sarvaanga Sundara & Ayurveda Raasayana Commentry, Edited by Bhishagacharya Harishastri Paradakarya Vaidya, Chaukhambha Publications, 10 th Edition, 2011, 287 p. 7 Shastry AD, Bhaishajya Ratnavali, Vidyotini Commentry Edited by Shri Rajeshwardatta Shastri, Chaukhambha Publications, 2019.pp.979 8 Chunekar K, Acharya Bhavamishra, Bhavaprakasha Nighantu,Hindi translation Poorva Khanda, Mishraprakarana, Harithakyadi Varga,Shloka no-252-254. Chaukhambha Publications, 2019 9 Chunekar K, Acharya Bhavamishra, Bhavaprakasha Nighantu,Hindi translation Poorva Khanda, Mishraprakarana, Harithakyadi Varga,Shloka no-252-254. Chaukhambha Publications, 2019 10 Rao K.L, Pandit Sharangdharacharya, Sharangadhara Samhita, Adhamalla Deepika & Gudartha Deepika commentaries,2009. How to cite this article: Ramya M, Rathi. S “A Case Study: Ayurvedic Management Of Nasarsha W.S.R To Nasal Polyp” IRJAY. [online]2023;6(1);17-21 Available from: https://irjay.com DOI linkhttps://doi.org/ 1 0.47223/IRJAY.2023.6203

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Ramya et.al , “A Case Study: Ayurvedic Management of Nasarsha w.s.r to Nasal Polyp.” : 2023; 6 (2):17-21 21 Table no-1(Treatment given) SL NO TREATMENT MEDICINES MODE OF ADMINISTRATION DURATION 1 Marsha Nasya Apamarga Kshara Taila 4-4 Drops Each Nostrils 7 days 2 Kshara Prathisarana Yava Kshara Application 5 Sittings( Once In 5 Days) 5 sittings 3 INTERNALLY Chitrakadi Vati 1-0-1(b/f) 30 days Triphala Guggulu 2-0-2 (a/f) 30 days Haridra Khanda 1 tsp-0-1 tsp(warm water) 30 days Hamsapadyadi Kashaya 15 ml-0-15 ml (a/f) 30 days Table 2:( Observation- Before and after the treatment) Assessment criteria Before treatment (1 st day) After Nasya (8 th day) After Kshara Karma (33 rd day) During Followup (40 th day) Nasal Blockage 3 2 0 0 Sneezing 2 1 1 0 Rhinnorhea 2 1 0 0 Frontal Headache 3 1 0 0 Heaviness of the head 3 2 1 0 Table 3 All the subjective parameters were assessed based on Self- Grading Scale. Assessment Criteria’s GRADINGS No Symptoms Mild Moderate Severe Nasal Blockage 0 - No nasal blockage 1 - Occasional nasal blockage 2 - Intermittent nasal blockag 3 - Continuous nasal blockage Sneezing 0 - No Sneezing 1 - Occasional sneezing 2 - Intermittent sneezing 3 - Severe sneezing Rhinorrhea 0 - No Rhinorrhea 1 - Occasional Rhinorrhea 2 - Intermittent Rhinorrhea 3-Continuo us Rhinorrhea Frontal Headache 0 - No frontal Headache 1 - Occasional frontal Headache 2 - Intermittent frontal Headache 3 - Persistent frontal Headache Heaviness of head 0 - No heaviness of head 1 - Occasional heaviness of head 2 - Intermittent heaviness of head 3 - Persistent heaviness of head Pictogram of Nasal Polyp before and after treatment: Before treatment After treatment

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