An Ayurvedic treatment protocol in the management of Vataja Prathishyaya...

[Full title: An Ayurvedic treatment protocol in the management of Vataja Prathishyaya w.s.r. to Allergic Rhinitis - A Case Report]

[Find the meaning and references behind the names: Swathi, Red, Pasha, Ritu]

CASE REPORT July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 358 An Ayurvedic treatment protocol in the management of Vataja Prathishyaya w.s.r. to Allergic Rhinitis - A Case Report Swathi 1 , SM Pasha 2 . 1 Post Graduate Scholar, Dept. of PG Studies in Shalakya Tantra, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India. 2 HOD, Dept. of PG Studies in Shalakya Tantra, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India. I NTRODUCTION Rhinitis is the condition in which the mucous membrane of the nose is inflamed. Allergic Rhinitis is an immunoglobulin IgE mediated type 1 hypersensitivity inflammatory disease. It is a type of Address for correspondence: Dr. Swathi Post Graduate Scholar, Dept. of PG Studies in Shalakya Tantra, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India. E-mail: swathikulal 321@gmail.com Submission Date: 17/07/2021 Accepted Date: 11/08/2021 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA inflammation in the nasal mucosa, paranasal sinuses and sometimes mucosa of the lower respiratory tract which occurs when the immune system overreacts to allergens in the air. When an allergen such as pollen or dust is inhaled by an individual with a sensitized immune system, triggering antibody production. These antibodies often bind to histamine-containing mast cells. When the mast cells are stimulated by pollen and dust, histamine (and other chemicals) is released. This causes running nose, sneezing, red, itchy, and watery eyes, and swelling around the eyes. Allergic Rhinitis is an acute, recurrent and episodic disease [1] Worldwide it affects between 10-25% of the population and in India 20- 30% of population suffer from this disease. This is one such condition extensively prevailing and disturbing the individual’s routine life and certainly lowering the quality of life A B S T R A C T Introduction: Prathishyaya is one among 31 Nasagatha Roga explained by Sushrutha Acharya . Vata and Kapha are said to be the predominant Doshas involved in the manifestation of this condition. Vataja prathishyaya is one among 5 types of Prathishyaya . It is a common disorder characterized by Anaddha Pihita Nasa , Tanusrava, Shosha in Gala Taalu and Oshta , pain in Shankapradesha and Swaropaghatha . It is correlated to allergic rhinitis. This is a disorder in which there are episodes of nasal congestion, watery nasal discharge sneezing and redness and itching in eyes and nose. Allergic Rhinitis is due to an immediate hypersensitivity reaction to nasal mucosa. According to ayurvedic perspective allergy is scientifically explained under Asatmyaja Vyadhi and is mainly caused due hereditary factor, Viruddhahara, Dushivisha & Ritu Sandhi . This is the case report of 20 years old male patient complaints of continuous episodes of sneezing, running nose, itching in eyes and nose since 3 years. Materials and Methods : The subject who approached Shalakya Tantra OPD of Government Ayurveda Medical College, Bengaluru with symptoms of episodes of sneezing, running nose, itching in eyes and nose since 3 years was systematically reviewed and treatment modalities like Nirgundi Taila Nasya and internally Guda Maricha yoga is advised. Results: The subject showed marked improvement symptomatically and marked changes are seen in haematological investigations Discussion: Vataja Prathishyaya is affecting the Urdhwajatru especially Nasa and hampering the lifestyle of the patient. It is mainly vata and kaphaja vyadhi. Nasya and Abhyantara yoga advised are Vata - Kaphara in nature, having anti-inflammatory and antiallergic property hence it has shown marked improvement. Key words: Vataja Prathishyaya, Allergic Rhinitis, Nirgundi Taila Nasya, Guda Maricha Yoga

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Swathi et al. Management of Vataja Prathishyaya w.s.r. to Allergic Rhinitis - A Case Report ISSN: 2456-3110 CASE REPORT July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 359 due to its more prevalence in all different age groups and in both the sexes. In conventional system of medicines antihistamines, decongestants and corticosteroids are advised. According to ayurvedic perspective it is corelated to Vataja Prathishyaya . Vata and Kapha are said to be the predominant Doshas involved in the manifestation of this condition. Clinical manifestations of the allergic rhinitis are same as Vataja Prathishyaya. It is a common disorder characterized by Anaddha Pihita Nasa, Tanusrava, Shosha in Gala Taalu and Oshta , pain in Shankapradesha and Swaropaghatha. [2] The treatment modalities which are adopted in this case study is Nasya which is helpful in restoring the normalcy of nasal mucosa and internal medicine gives Rasayana effect so helps in preventing the reoccurrence of the disease. O BJECTIVES 1 To understand the pathophysiology of Vataja Prathishyaya with respective to allergic rhinitis. 2 To find better and satisfying ayurvedic approach in Vataja Prathishyaya . C ASE R EPORT Basic information of the patient Age: 20 years Gender: male Religion: Hindu Occupation: Student Socioeconomic status: Middle class Chief complaints Complaints of continuous episodes of sneezing, watering and itching in eyes and running nose since 3 years. History of present illness Patient was apparently normal 3 years back then he developed continuous episodes of sneezing, blockage in nose, sometimes watery discharge in eyes and nose and itching in eyes and nose for these complaints he approached allopathic hospitals but never felt any kind of relief so he then approached our hospital for better management. History of past illness Nothing specific. Treatment history Cetirizine - 5 mg bd. Personal History Appetite: Patient had taken a mixed type of diet, Madhur rasa dominance, and moderate appetite. Koshta: Madhyama Koshta . Micturition: regular and normal Bowel habits: irregular. Sleep: disturbed sometimes. Vitals ▪ Respiratory rate: 24/min ▪ Regular Temperature: 98.6 F ▪ Blood pressure: 120/90 mm of Hg ▪ Pulse: 104/min Physical Examination ▪ Weight: 46 kg ▪ Height: 150 cm ▪ Pallor: No pallor ▪ Lymphadenopathy: No lymphadenopathy Examination of Eye No conjunctival infection, frequent rubbing of the eyes, irritability and mucous discharge. Itching and watering of eyes present. Examination of Nose [3] 1 Inspection: Swelling of the nasal mucosa, thin secretions. 2 Anterior Rhinoscopy: Lower and anterior part of septum, middle turbinate appears red, floor of the nose becomes red, mucosa red, septum normal.

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

Swathi et al. Management of Vataja Prathishyaya w.s.r. to Allergic Rhinitis - A Case Report ISSN: 2456-3110 CASE REPORT July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 360 3 Obstruction of nose/ Nasal Patency: No nasal polyps Examination of Ear a) EAC: Normal b) Tympanic Membrane: Normal Examination of sinus: Facial tenderness on palpation of the sinuses. Examination of throat: Posterior oropharynx is moist, mucous accumulation in the back of the nose and throat, no sign of inflammation Laboratory ▪ Hb% - 14.5 gm% ▪ TLC – 5800/cu mm ▪ Neutrophils - 63%, Lymphocytes - 29%, Monocytes - 3 %, Eosinophil - 5, Basophils ▪ ESR – 30 mm/hour ▪ Absolute Eosinophil count – 595 /cu.mm Instrumentation [6] Symptoms Score Nasavarodha (Nasal Obstruction) No Obstruction 0 Partially Occasional & Unilateral 1 Partially Occasional & Bilateral 2 Complete, Frequently & Unilateral 3 Always Complete & Bilateral 4 Kshavathu (Sneezing) No 0 1-5 bouts per day 1 6-10 bouts per day 2 11-20 bouts per day 3 More than 21 bouts per day 4 Shirashoola (Headache) No 0 Occasional 1 Intermittent 2 Continuous 3 Intolerable 4 Anterior Rhinoscopic Findings (Color of mucosa) Pink (Normal) 0 Red (Inflamed) 1 Cherry Red / Blue (Blood stained) 2 Tanu Srava (Watery discharge) No discharge 0 Negligible discharge 1 Intermittent discharge 2 Continuous discharge 3 Profuse discharge 4 Swarbhedha (Hoarseness of voice) No change of voice 0 Occasional hoarseness of voice 1 Frequent hoarseness of voice in morning hours 2 Frequent hoarseness of voice throughout the day 3 Cannot speak due to hoarseness of voice 4 Post Nasal Discharge Not Present 0 Occasional Present 1 Frequent Discharge 2 Continuous Discharge 3 Continuous Heavy Discharge 4

[Find the meaning and references behind the names: Bala, Karma, Vega, Kala]

Swathi et al. Management of Vataja Prathishyaya w.s.r. to Allergic Rhinitis - A Case Report ISSN: 2456-3110 CASE REPORT July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 361 Treatment Adopted The patient was treated in the OPD of the Shalakya Department of GAMC Bengaluru and treatment was planned considering involved Dosha and Dushya . Nasya was planned for 14 days with the gap of 7 days along with the internal medicine. Following treatment was administered: ▪ Shodhana done with Trivritth Lehya - 40 gms was administered for a day 8 Vegas was observed and 1 day Parihara Kala with the intake of light food ▪ Snehana - Mridu Abhyanga with Ksheerbala Taila [ Ashtanga Hridaya , Vatarakta Chikitsa Adhyaya 22/44] ( Bala , Ksheera , Tila Taila ) was done on scalp, forehead and over neck regions for 3-5 minutes ▪ Swedan - Bhashpa Swedan for 2-3 minutes. ▪ Nasya Karma - Shodhana Nasya with Nirgundi Taila . 4-6 drops of lukewarm Nirgundi Taila Taila (4) was administered to each nostril in the morning for 14 days with the gap of 7 days in between ▪ Oral Medication - Guda Maricha Yoga [5] - Guda and Maricha both are taken in equal quantity and Choorna is prepared. This Choorna is given 3 gms bd. O BSERVATIONS & R ESULTS After completion of 21 days of treatment and follow up for 1 month’s clinical assessments were made from the interrogation with patient and assessment of objective parameters. The outcome observed was a drastic change in the parameters as: Symptoms BT AT (After first sitting of nasya) AT (After second sitting of nasya) Follow up (After 30 days) Nasavarodha (Nasal Obstruction) 2 1 1 1 Tanu Srava (Watery 2 1 1 0 discharge) Kshavathu (Sneezing) 3 1 1 1 Swarbhedha (Hoarseness of voice) 2 0 0 0 Shirashoola (Headache) 1 0 0 0 Post Nasal Discharge 2 2 1 1 Anterior Rhinoscopic Findings (Colour of mucosa) 1 1 0 0 Haematological investigations Before treatment After treatment ESR 30 mm/hour 15 mm/hour AEC 590/cu. Mm 400/cu.mm DISCUSSION Allergic Rhinitis is a disease which hampers the quality of life and disturbs the daily activities of the person. The incidence rate of this disease is increasing day by day due to the increased environmental pollution, stressful life and decreased immunity of the person. At this stage, if Allergic Rhinitis is not treated, it may lead to infection resulting in various complications. Allergic Rhinitis is caused due to smoke, dust, allergy, atmospheric pollution, Change in humidity and psychological factors. The features of Allergic Rhinitis mentioned in Allopathic Science are Sneezing, Nasal Obstruction, Watery Nasal Discharge, Change in Voice, Headache, Dryness of throat and lips. Vataja Pratishyaya is a Nasagata Roga described in detail in Ayurvedic classics in which there is vitiation of Vata and Kapha Doshas resulting in Kshawathu (profuse sneezing), Nasaavarodha (nasal obstruction), Jalaja Nasa Srava (watery nasal discharge), Gala Talu Shushkata (dryness of the throat and lips), Swaropaghata (change in voice ), Shirashoola

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Swathi et al. Management of Vataja Prathishyaya w.s.r. to Allergic Rhinitis - A Case Report ISSN: 2456-3110 CASE REPORT July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 362 (headache). It can be co-related with the disease Allergic Rhinitis mentioned in modern science. The allergens which are inhaled releases newly formed or preformed mediators, which leads to the causation of; 1 Increased vascular permeability and vasodilation followed by tissue oedema and nasal blockage. 2 Change in smooth muscle tone followed by Bronchospasm. 3 Hyperactivity of glands followed by increased secretion and rhinorrhoea. Nasya is one of the effective lines of treatment indicated in most of the Urdhwajatrugata Vikaras . This treatment is equally beneficial in treating Vataja Prathishyaya as it is one among the Nasagatharoga . Trans-nasal administration of medicated drugs plays an important role in treating the disease by preventing the contact of the allergens by forming barrier between the nasal mucosa which helps in preventing the reoccurrence of disease. In this present study, Nirgundi a best Vataharaand Prathishyayahara drug is used for Nasya in the form of Taila and along with that Guda Marichyoga will be used as Abhyantaraprayoga which is also Ushna, Snigdha and Vatakaphahara in nature. Taila Nasya helps in restoring the normal structural and functional integrity of nasal mucosa and internal medication will boost the immunity by its Rasayana effect. CONCLUSION Vataja Prathishyaya (Allergic Rhinitis) if untreated can lead to bronchial asthma, recurrent middle ear infections, sinusitis and chronic cough. The case study has revealed a remarkable efficacy in Vataja Prathishyaya with a significant result in most of the assessment criteria. The symptoms score did not worsen and was maintained. This was pilot study to evaluate the efficacy of Nasya Karma and oral medication in the management of Vataja Prathishyaya and the result produced was encouraging enough not only on the assessment parameters, but also helped to gain resistance against allergens, repeated attacks and promoted immunity, physical and mental health of the patient. REFERENCES 1 Joshua A. Boyce, K. Frank Austen. Harrison’s Principles of Internal Medicine. New York City, United States: McGraw Hill Education. 19 th Edition, April 2015;p 2121. 2 Acharya Sushruta. Sushruta Samhita with English translation of text and Dalhana’s commentary along with critical notes, Edited and translated in English by Priyavrat Sharma, Reprint. Varanasi: Chowkhamba Vishwabharathi. 2014;Vol III,p 256. 3 Mohan Bansal, Diseases of EAR, NOSE &THROAT with Head & Neck Surgery. First Edition. New Delhi. Jaypee Brothers Medical Publishers (P)Ltd. 2013;p 323. 4 Gyanendra Pandey. Dravya Guna Vijnana. Varanasi: Chowkhamba Krishnadas Academy. Part 2; page 719. 5 Narayan J Vidwansa. Shiro-Karna-Nasa and Mukha- Dantaroga Vignyan. Pune: Vimal Vision Publication; First Edition: Nasaroga Vignyan page 143. 6 Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA; et al. (2008). "The diagnosis and management of rhinitis: an updated practice parameter". J Allergy Clin Immunol. 122 (2 Suppl): S 1 – 84 ******************************* How to cite this article: Swathi, SM Pasha. An Ayurvedic treatment protocol in the management of Vataja Prathishyaya w.s.r. to Allergic Rhinitis - A Case Report. J Ayurveda Integr Med Sci 2021;4:358-362. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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Shodhana, Sushruta-samhita, Guda, Snehana, Nasya, Snigdha, Ushna, Viruddhahara, Maricha, Kshavathu, Ritusandhi, Nasasrava, Dushivisha, Nirgunditaila, Laboratory, Shalakyatantra, Pulse, Smoke, Dust, Allergy, Bronchial asthma, Increased secretion, Running nose, Dryness of throat, Vata and Kapha, Internal medicine, Physical examination, Headache, Internal medication, Chronic cough, Blood-pressure, Nasal obstruction, Personal history, Rasayana effect, Sneezing, Physical and mental health, Environmental pollution, Mucous discharge, Psychological factor, Assessment criteria, Madhyama koshta, Pilot study, Case report, Respiratory rate, Predominant dosha, Clinical assessment, Dosha and Dushya, Anti-inflammatory property, Swedan, Paranasal sinuses, Post nasal discharge, Ayurvedic treatment protocol, Objective parameter, Assessment parameter, Ksheerbala Taila, TLC, Urdhwajatru, Oral medication, Nasal blockage, Chief complaint, Eosinophil, Change in voice, Haematological investigation, Shirashoola, Allergic Rhinitis, Tympanic Membrane, Nasal Mucosa, Stressful life, Vatakaphahara, Lymphadenopathy, Symptoms Score, Vasodilation, Urdhwajatrugata Vikara, ESR, Increased Vascular Permeability, Nasavarodha, Anterior rhinoscopy, Lower respiratory tract, Sinusitis, Dravya Guna Vijnana, Mridu Abhyanga, Post Graduate Scholar, History of present illness, Conventional system of medicine, Bronchospasm, Neutrophil, Basophil, EAC, Nasal polyp, Antibody production, Parihara Kala, Type 1 hypersensitivity, Monocyte, Lymphocyte, Harrison's Principles of Internal Medicine, Rhinorrhoea, Middle ear infection, Creative Commons Attribution License, AEC, Episodic disease, Immediate hypersensitivity reaction, Choorna.