Role of Ayurvedic treatment modalities in the managment of Dusta Pratishyaya...

[Full title: Role of Ayurvedic treatment modalities in the managment of Dusta Pratishyaya w.s.r. to Rhinosinusitis]

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[Find the meaning and references behind the names: Maria, Sri, Swamy]

ISSN: 2456-3110 CASE REPORT Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 171 Role of Ayurvedic treatment modalities in the managment of Dusta Pratishyaya w.s.r. to Rhinosinusitis Dr. Tresa Maria Job, 1 Dr. Mamatha KV 2 1 Post Graduate Scholar, 2 Reader and Guide, Department of PG Studies in Shalakya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College Hospital and Research Centre, Bengaluru, Karnataka, INDIA. I NTRODUCTION Rhinosinusitis is an inflammation of nose and paranasal air sinuses. Its common causes include viral, bacterial and allergic. Patients who have complete recovery between the episodes of rhinosinusitis, which lasts for more than 7 days, are considered to have recurrent rhinosinusitis. Acute inflammation of Address for correspondence: Dr. Tresa Maria Job Post Graduate Scholar, Department of PG Studies in Shalakya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College Hospital and Research Centre, Bengaluru, Karnataka, INDIA. E-mail: tresamariajob 92@gmail.com Submission Date: 12/11/2018 Accepted Date: 19/12/2018 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.3.6.26 nasal mucosa causes hyperemia, exudation of fluid, outpouring of polymorphonuclear cells and increased activity of serous and mucuos glands. The exudate which is serous in beginning, becomes mucopurulent and causes destruction of mucosal lining. Failure of ostium to drain pus results in empyema of the sinus with destruction of its bony walls [4] The reasonable strategy for many patients is to treat symptomatically and recommend antibiotics only if symptoms do not begin to improve. When the body is exposed to a perceived threat, the mast cells secrete chemical mediators, such as histamine, interlukins, prostaglandins etc. These chemical messengers produce both local and systemic effects like inflammation, increased mucous production, congestion, sneezing. In this paper a case report of a 38 year old male patient with complaints of severe nasal discharge, sinusitis and allergic manifestations along with other associated symptoms was taken for the study. A B S T R A C T Nose is considered as the gateway of head according to Ayurveda and medicine instilled through the nose provides strength to the structures above neck. Nose being exposed more to the external environment gives rise to various infectious and allergic manifestations. In present era, global warming, industrialization and urbanization had paved the way to various health issues and Rhinitis or Pratishyaya being common among them. Increased pollution, exposure to dust and smoke, seasonal changes, exposure to allergens, changing lifestyle, improper food habits are the causes of Rhinitis or Pratishyaya . Ayurveda has explained the disease Pratishyaya under Nasagata Rogas and has classified it into five types, Dustapratishyaya being one among them. If the disease Pratishyaya is not treated properly in early stage and improper Ahara Vihara is continued to be taken, it leads to the more complicated stage of the disease named as Dustapratishyaya . Improper management causing repeated attacks, resistance to antibiotics leads the disease to chronic phase called Rhinosinusitis or Dustapratishyaya . Most cases of Rhinosinusitis are caused by allergies or infection. Ayurveda treatment modalities especially Nasya Karma and other local treatment procedures arefound effective in treating such cases of Dustapratishyaya . One such case was reported with the symptoms of severe nasal discharge, sneezing, allergic manifestations and sinusitis which was recurrent since last 6 years and successful outcome was observed. Key words: Dustapratishyaya, Rhinosinusitis, Shodhana Nasya, Kriya Kalpas, Dhoomapana.

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

Dr. Tresa Maria Job et.al. Role of Ayurvedic treatment modalities in the managment of Dusta Pratishyaya. ISSN: 2456-3110 CASE REPORT Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 172 The condition was correlated to Dustapratishyaya due to long standing nature of the disease and symptoms like Puyopamasrava from Nasa (watery discharge from nose), Punaschapraklinnanasa and Punaschaparisushyathi (nose gets moist and dry alternatively), Gandhannavethi (reduced perception of smell). To manage the condition of Dustapratishyaya , Nasya , Bidalaka , Seka , Sthanika Lepa on sinuses, Dhumapana were advised owing to its actions. Analysing the Nidana, Samprapti of the disease, Deepana, Pachana, Lekhana, Vata Kaphahara, Srotoshodhaka treatment was advised and improvement in the patient condition was appreciated. M ATERIALS AND M ETHODS Case Report A moderately built male patient aged about 38 years presented to the Shalakya Tantra OPD of SKAMCH & RC with chief complaints of watery nasal discharge, continuous sneezing, itching in eye, nose and throat since 6 months. He is having recurrent episodes of this attack for twice or thrice a year since 6 years. Complaint History The patient was not having any of these complaints before 6 years. Six month before patient started developing itching of eyes, nose, ear and throat, headache and continuous sneezing episodes followed by watery nasal discharge which later became purulent and nasal blockage with difficulty in breathing. The symptoms get aggravated during night time and after waking up in morning. He is having recurrent episodes of this attack for twice or thrice a year which lasts for 3 to 4 weeks for 6 years. There were recurrent attacks during cold seasons and on exposure to dust Occupational History The patient was army personnel and was working in snow fall areas for 8 years. During the time of snowfall and cold seasons he had severe presentations of the disease. Continuous nasal discharge persisting for more than four weeks and itching in face, eyes and throat was present Treatment History Two years before patient had taken allopathic treatment but found only symptomatic relief for few days. He also had undergone Homeopathic treatment for 6 months but no marked difference was noted. Since there was no relief in complaints and patient wanted to seek an alternative approach, he came to SKAMCH and RC, Bengaluru. C LINICAL F INDINGS Examination of nose Nasal mucosa - Pale Inferior Turbinates - Hypertrophied Septum - slightly deviated to left Functional examination of nose Patency - Cotton wool test - both nostrils patent Sense of smell - reduced Examination of paranasal sinuses Tenderness - in bilateral maxillary, frontal, ethmoidal sinuses. CT Paranasal Sinuses Bilateral Frontal, Ethmoidal, Maxillary and left sphenoid sinusitis. Right concha bullosa with conchal edema. Turbinates are hypertrophied. Hypertrophy / nasal mucosal polyposis. Mild Deviated nasal septum to left. Lab Investigations Immunoglobulin - E - 160.10 IU/ml Ocular Examination On slit lamp bio microscopy Right lower palpebral conjunctiva - Papillaes, Follicles present

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[Find the meaning and references behind the names: Raja, Vega, Rasa]

Dr. Tresa Maria Job et.al. Role of Ayurvedic treatment modalities in the managment of Dusta Pratishyaya. ISSN: 2456-3110 CASE REPORT Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 173 Left lower palpebral conjunctiva - Papillaes, Follicles present Congestion of vessels seen Probable Nidana Aharaja: Vishamashana, Kaphavataprakopakaahara. Viharaja : Raja Dhumasevana, Vega Sandharana, Rituvaishamya, Prajagarana and Diwaswapna . Probable Samprapti Due to the Nidana Sevana there is Vatadidoshakopa which accumulates in the Shiras and then combines with Rakta , takes Sthanasamsraya in Nasa causing Pratishyaya . According to Dalhana , Pranavayu which circulates in Mukha , Pitta settled in Twacha and Dristi , Tarpakakapha in Shiras and Rakta circulates all over the body these again vitiated by aggravated Doshas and causes Pratishyaya. [1] Pratishyaya when left untreated for long time leads to Dustapratishyaya. The disease is considered as Kruchrasadya or Yapya according to Ayurvedic classics. Probable Samprapti Ghatakas Dosha Vata Kapha Pradhana Tridosha Dushya Rasa, Rakta Agni Dhatvagnimandya Srotas Pranavaha , Rasavaha, Raktavaha Sroto Dusti Sanga, Atipravarthi, Vimargagamana Udhbhava Sthana Amashaya Vyaktasthana Nasa Adhistana Shiras, Nasa Sancharasthana Shiras Sadya Asadyata Kruchrasadhya or Yapya Treatment Course The patient was admitted in the hospital for about one and half month and further internal medications was continued in follow up on OPD basis. Shodhana Nasya (15/6/18 - 21/6/18) Gudanagara Nasya 8 drops each nostril for 7 days. Mukhaabhyanga with Moorchithathaila Kriyakalpa (16/6/18 - 6/7/18) Bidalaka with Triphala and Yastimadhu Choorna Seka with Eranda, Triphala, Lodhra Sthanika Chikitsa (16/6/18 – 6/7/18) Sthanikalepa with Maricha, Rasna, Kachoora, Shunti, Nimbuswarasa Lajjasakthu, Haridra, Eladhoomapana Sthanikaabhyanga, Patrapindasweda with Nirgunditaila, Karnadhupana with Haridra. Thalam with Rasna, Kachoora, wheat flour Kavala with Triphala Kashaya Jaloukacharana on left outer canthus on 3/7/18 Shamana Aushadhis After Shodhana Dashamoolakatutraya Kashaya - 3 tsp - 0 - 3 tsp with 6 tsp of warm water (b/f) Naradeeyalaxmivilasa Rasa - 1 - 0 - 1 Opthacare drops 1-1-1- 1 drop to each eye After first follow up (After 15 days) Balajeerakadi Kashaya - 3 tsp - 0 - 3 tsp with 6 tsp of warm water (b/f) Sinol drops 4 - 4 drops to each nostril T.A - fluo-cil Forte 1-0-1 (a/f) Haridra Khanda - 0 - 0 - 1 tsp at night with milk (a/f)

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[Find the meaning and references behind the names: Ana, Laxmi]

Dr. Tresa Maria Job et.al. Role of Ayurvedic treatment modalities in the managment of Dusta Pratishyaya. ISSN: 2456-3110 CASE REPORT Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 174 After second follow up (After 30 days) Dashamoolakatutraya Kashaya - 3 tsp - 0 - 3 tsp with 6 tsp of warm water (b/f) Chitraka Haritaki Lehya - 1 tsp in morning ( b/f) Sinol drops 4 - 4 drops to each nostril T.A-fluo-cil Forte 1-0-1 (a/f) After third follow up (After 45 days) Chitraka Haritaki Lehya - 1 tsp in morning ( b/f) Naradeeyalaxmivilasa Rasa - 1- 0 - 1 (a/f) Vyagradhi Kwatha - 0 - 0 -3 tsp with 6 tsp of warm water (b/f) Opthacare drops 1 - 1 -1 - 1 drop to each eye Cap step 2 - 0 - 2 (a/f) Treatment Protocol Treatment Medicines Durati on Justification Shodhana Nasya Guda and Nagara 7 days Lekhana, Graahi, Srotoshodhana . Bidalaka Triphala, Yastimadhucho orna 20 days Bidalaka reduces Kandu, Garsha, Raga. Yastimadhu alleviates Vata and Pitta Dosha and act as Srotoshodaka. Seka Eranda, Triphala, Lodhra 20 days Eranda is Kaphavatasha maka and have Sukshmaguna which enters Srotases . Lodhra is Vatapittahara and Raktaprasadan a Triphala is Tridoshahara and act as Chakshuya . Sthanikalep a Maricha, Rasna, Kachoora, Shunti, Nimbuswarasa 20 days Kaphavilayana, Vatakaphahara [3] Dhoomapan a Lajjasakthu, Haridra, Ela 20 days Shrotoshodhan a, Kandughana, Krimihara Kavala Triphalakashay a 20 days Kandhuhara, Tridoshashama ka Sthanika Abhyanga, Patrapinda Sweda Karnadhupa na Nirgunditaila Haridra 20 days Krimihara, Kanduhara Jaloukachar ana 1 day Raktashodaka, Shothahara Shamana Aushadhis Medicines Duration Justification Dashamoolakatutraya Kashaya 20 days Pacifies Vatakaphadosha and reduces nasal discharge, Deepana, Shothahara. Balajeerakadi Kashaya 15 days Pacifies Kaphadosha, Amapachana, Vataanulomana Vyaghradi Kashaya 15 days Vatakaphahara, Deepana, Pachana, Shrotoshodaka Naradeeya Laxmi Vilasa Rasa 20 days Rasayana, Balya, Agni vardhaka

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

Dr. Tresa Maria Job et.al. Role of Ayurvedic treatment modalities in the managment of Dusta Pratishyaya. ISSN: 2456-3110 CASE REPORT Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 175 Chitraka Haritaki Lehya 15 days Vatakaphahara, Aamapachaka, Rasayana, Vataanulomana. Haridra Khanda 15 days Vatakaphahara, Krimigha, Kandughna, clears Srotoavarodha Patient condition during the treatment course SN Phase Symptoms 1. After Shodhana Nasal discharge, Headache reduced, itching in nose, throat persisted. 2. After Sthanika Chikitsa Itching in nose, ear and throat reduced, sneezing controlled. 3. After First follow up Relieved from nasal discharge completely. 4. After Second follow up Completely relieved from itching, Mild headache present. DISCUSSION Dustapratishyaya being a Vatakaphajavyadhi , treatment modalities aimed at alleviating Vata and Kapha and to break the pathogenesis of the disease by controlling Vatadosha . Sodhana Nasya was first adopted as it does the Srotoshodhana . Later, various Kriyakalpas like Bidalaka, [7] Seka and other Sthanika Chikitsas were adopted for Pachana , Lekhana Karma and to cure various assosciated symptoms. Dhumapana clears excessive secretion, does the disinfection of nasal mucosa and maintains the patency of nostrils. When the medicaments are ignited, will release volatile substances which pass through the nostrils and absorption of the medicine occurs. Jaloukacharana helps in reducing the inflammation by improving blood circulation and reduces congestion by the action of enzymes like Hirudin, carboxypeptidase - A inhibitor, Destabilise, Calin. The enzyme Acetylcholine causes vasodilatation and increases blood circulation. Tryptase inhibitor inhibits proteolytic enzymes of host mast cells. Mast cell Tryptases are serine proteases in cell granules and their release causes inflammatory reactions. The oral medications selected in this study aimed at alleviating Ama , to do Agni Vardhana , Vataanulomana, Rasayana action. Various drugs used for the treatment like Triphala , Yastimadhu etc. are having anti inflammatory, immunomodulatory, antioxidant properties which aids to the cure of the disease. Haridra is proved to have antihistamine property that controls the symptoms produced by histamine which is released when allergen is inhaled. The anti oxidant property of Haridra scavenges free radicals and enhances body’s immunity against allergies and diseases. The active components of ginger comprises of gingerols and shagols which have the anti inflammatory and analgesic properties. Triphala posses antibacterial properties and act as a good immunomodulator as it contains flavonoids, alkaloids, tannines, saponines etc. CONCLUSION Dustapratishyaya is one of the major diseases of the present era which is induced due to inevitable pollution, sedentary lifestyle and climate variations [5] The reasonable strategy in treating rhinosinusitis is to treat symptomatically and to recommend antibiotics only if symptoms do not begin to improve. Increased resistance to antibiotics and less immunity in these days had lead to the recurrent attacks of the disease. Ayurveda has its own treatment modalities and Rasayana therapies to increase the immune power of the body and thus avoiding the recurrence of the disease. Early diagnosis and timely treatment along with proper Pathya , appropriate Shamana Oushadhis and avoiding Nidana Sevana will help in treating the disease and prevents its recurrence. If Dustapratishyaya is not treated timely it can lead to other secondary diseases like Rajayakshma or Sosha and may produce complications like Badhirya and other Nayanarogas. [6]

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[Find the meaning and references behind the names: Deepika, Mohan, Nil, Med, Prakashan]

Dr. Tresa Maria Job et.al. Role of Ayurvedic treatment modalities in the managment of Dusta Pratishyaya. ISSN: 2456-3110 CASE REPORT Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 176 REFERENCES 1 Sushruta, Sushruta Samhita Uttaratantra, Dalhanatika by Vaidyajadavji Trikamjiacharya, Chowkhamba Prakashan Varanasi, reprint-2014, th chapter, shloka- 4, pg-651 pp-824. 2 Vaghbhata: Ashtanga Hridaya with commentaries Sarvangasundara of Arunadatta and Ayurveda Rasayana of Hemadri, Chaukhambha Orientalia Varanasi, Reprint Ninth Edition- 2005, Sutrasthana, 20 th chapter, verse 1, Pp- 956, Pg-287 3 Dr. J.L.N.Sastry, Dravyaguna Vijnana , Chaukamba Orientalia, Varanasi, reprint-2014, pp-134 4 Mohan Bansal, Diseases of Ear, Nose and Throat, Jaypee Publishers, First edition 2013,pp – 661,Pg – 300 5 PL Dhingra, Diseases of Ear, Nose and Throat, Elsevier publications, 5 th edition,pp– 486,Pg - 169 6 Sushruta, Sushruta Samhita Uttaratantra, Dalhanatika by Vaidyajadavji Trikamjiacharya, Chowkhamba prakashan, Varanasi, reprint-2014, th chapter, shloka- 17, pg-652 pp-824. 7 Agnivesha, Charaka Samhita, Ayurveda Deepika Commentary of Chakrapani, edited by; Vaidya Yadavji Trikramji Acharya, Choukambha Surabharati Prakashan, Varanasi, reprint-2014, Chikitsasthana, chapter 26 th, Verse 231, Pp: 738, Page no 610. ******************************* How to cite this article: Dr. Tresa Maria Job, Dr. Mamatha KV. Role of Ayurvedic treatment modalities in the managment of Dusta Pratishyaya w.s.r. to Rhinosinusitis. J Ayurveda Integr Med Sci 2018;6:171- 176. http://dx.doi.org/10.21760/jaims.3.6.26 Source of Support: Nil, Conflict of Interest: None declared.

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Dosha, Nidana, Pathya, Samprapti, Pratishyaya, Kriyakalpa, Nasyakarman, Antibiotic, Sense of smell, External environment, Treatment modalities, Internal medication, Early diagnosis, Aharaja, Ayurveda treatment, Symptomatic relief, Nidana Sevana, Ayurvedic treatment modalities, Dhoomapana, Shamana Aushadhi, Ayurveda treatment modalities, Viharaja, Nasal Discharge, Vata-Kaphahara, Oral medication, Nasal blockage, Sthanika Chikitsa, Treatment Course, Shodhana Nasya, Nasal Mucosa, Patient Condition, Rhinosinusitis, Sthanika Lepa, Clinical finding, Allergic manifestation.