Pratimarsha sw02 has

A STUDY ON PRATIMARSHA NASYA IN PREVENTION OF

PRATISHYAYA

by

Shivakumar

Dissertation Submitted to the

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE.

In partial fulfilment of the requirements for the degree of

AYURVEDA VACHASPATI

(M.D. AYURVEDA)

in

SWASTHAVRITHA

Under the guidance of

Dr. Sajitha K.

DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHA VRITHA

S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL,

HASSAN

2005

Ayurmitra

TAyComprehended

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation / thesis entitled “A study on Pratimarsha

Nasya in Prevention Of Pratishyaya” is a bonafide and genuine research work

carried out by me under the guidance of Dr. Sajitha K., Asst. Professor, Department

of Post Graduate Studies In Swastha Vritta, S. D. M. College of Ayurveda and

Hospital, Hassan – 573 201.

15.02.2005 Signature of the candidate Hassan

Shivakumar


S. D. M. COLLEGE OF AYURVEDA & HOSPITAL, HASSAN – 573 201.

(Affiliated to Rajiv Gandhi University Of Health Sciences, Bangalore, Karnataka)

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A study on Pratimarsha Nasya in

Prevention Of Pratishyaya” is a bonafide research work done by “Shivakumar.” in

partial fulfilment for the degree of Ayurveda Vachaspati (M.D. Ayurveda) in

Swastha Vritha.

Date: Signature of the guide Hassan Dr. Sajitha K. Asst. Professor P G Studies in Swastha Vritha.

S D M College of Ayurveda, Hassan.


S. D. M. COLLEGE OF AYURVEDA & HOSPITAL, HASSAN – 573 201

(Affiliated to Rajiv Gandhi University Of Health Sciences, Bangalore, Karnataka)

ENDORSEMENT BY THE H O D, PRINCIPAL / HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “A study on Pratimarsha Nasya in

Prevention Of Pratishyaya” is a bonafide research work done by “Shivakumar”

under the guidance of Dr. Sajitha K, Asst. Professor, Department of Post Graduate

Studies In Swastha Vritta, S.D.M. College of Ayurveda, Hassan – 573201.

Seal & Signature of the H O D Seal & Signature of the Principal Dr. G.V.Ramana Dr. Prasanna N Rao Professor and Head Principal P G Studies in Swastha Vritta, S D M College of Ayurveda, S D M College of Ayurveda, Hassan. Hassan.

COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall

have the rights to preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic / research purpose.

15.02.2005 Signature of the candidate Hassan Shivakumar

© Rajiv Gandhi University of Health Sciences, Karnataka.

Acknowledgment

I take this opportunity to record my gratitude to all the individuals who have

helped me in the completion of this dissertation work. While it is not possible to list

all of them.

I record my indebtedness to my beloved parents Shri B.M. Rudra Shetty and

Smt. Basamma for their untiring support and out lasting affection.

It gives me immense pleasure to thank Sri Dr. Veerendra Heggade, President,

S D M Educational society (R), Ujire.

I pay my respectfull gratitude to my principal Dr. Prasanna N Rao M. S. Ph D

(Ayu), S D M College of Ayurveda, Hassan

Words are not enough to express my heartiest gratitude to my teacher and

guide Asst, Professor Dr. Sajita K M D department of P G studies in Swastha vritha

S D M C A & H, Hassan for his untiring help and constant attention.

I am grateful to Prof. Dr. G.V. Ramana, Head of the department Swastha

vritha , for his support.

and Dr. Dhingari Laxmanachari, HOD Department of P G studies in

Shalakya tantra and Dr.Kiran Goud for their timely advise.

I express my formal gratitude and cordial thanks to all my classmates, seniors

and juniors for providing great support to my dissertation work.

I extend my heart full thanks to my patients for their co-operation.

I am also thankful to one and all for their help to me for completing this work

successfully.

I owe my special thanks to SANSAR for all their support and help.

Date:

Place: Hassan Shivakumar

LIST OF TABLES

TABLE. NO.

LIST OF TABLES P. NO.

1 Showing Classification of Pratishyaya 16

2 Showing Nidana of Pratishyaya 18 3 Aharaja Nidanas Explained By Different Authors 19 4 Showing Viharaja Nidanas 19 5 Showing porva roopa mentioned by different authors 23 6 Vataja Pratishyaya Lakshanas According To Different Acharyas 23 7 Showing Lakhanas of Different types of Pratishyaya 31 8 Showing the Differential diagnosis of Allergic rhinitis 32 9 Showing the Chikitsa of Vataja Pratishyaya 34 10 Showingbenefits Of Pratimarsha Nasya With Justification 63 11 Difference Between Marsha Nasya And Prathimarsha Nasya 63 12 Showing Benefits of Anutaila 64 13 Showing Drugs mentioned for Anutaila by different authors 65 14 Showing pharmacological action of drugs mentioned for Anutaila 66 15 Showing the Age wise distribution of incidences 75 16 Showing the sex wise distribution of incidences 75 17 Showing the occupation wise distribution of incidences 75 18 Showing the habitat wise distribution of incidences 77 19 Showing the religion wise distribution of incidences 77 20 Showing distribution of incidences as per the socio economic

status 77

21 Showing the involvement of family history among incidences 77 22 Showing the Satva wise distribution of incidences 79 23 Showing the diet wise distribution of incidences 79 24 Showing the Prakruti wise distribution of incidences 79 25 Showing the marital status wise distribution of incidences 79 26 Showing the total no patients having different Nidana 81 27 Showing the Improvement in the symptom Kshvathu 81 28 Showing the Improvement in the symptom Tanusrava 81 29 Showing the Improvement in the symptom Anaddha 81 30 Showing the Improvement in the symptom Shirashoola 82 31 Showing the Improvement in the symptom Galashosha 82

32 Showing the Improvement in the symptom Swarabheda 82 33 Showing the Improvement in the symptom Nistoda Shanka 82 34 Showing Total Leucocyte Count values 82 35 Showing Absolute.Eosinophil Count values 83 36 Showing neutrophil values 83 37 Showing lymphocyte values 83 38 Showing lymphocyte values 83 39 Showing no of patients getting benefits of Anutaila 83 40 Showing total number of patients getting relief from Kshavatu 84 41 Showing total number of patients getting relief from Tanusrava 84 42 Showing total number of patients getting relief from Anaddha 84 43 Showing total number of patients getting relief from Shirashoola 85 44 Showing total number of patients getting relief from Galashosha 85 45 Showing total number of patients getting relief from Swarabheda 85 46 Showing total number of patients getting relief from Nistoda

shankha 86

47 Showing over all effect of therapy 86

List Of Illustrations

List Of Illustrations P.No.1 Showing the Age wise distribution of incidences 76 2 Showing the sex wise distribution of incidences 76 3 Showing the occupation wise distribution of incidences 76 4 Showing the habitat wise distribution of incidences 78 5 Showing the religion wise distribution of incidences 78 6 Showing distribution of incidences as per the socio economic status 78 7 Showing the involvement of family history among incidences 78 8 Showing the Satva wise distribution of incidences 80 9 Showing the diet wise distribution of incidences 80 10 Showing the Prakruti wise distribution of incidences 80 11 Showing the marital status wise distribution of incidences 80

LIST OF ABBREVIATIONS

A.H. - Astanga Hridaya

A.S. - Astanga Sangraha

Bl. - Bhela Samhita

B.P. - Bhava Prakash

B.R. - Bhaishyaja Rathanavali

Cha. - Charaka Samhita

Chi - Chikitsa Sthana

C.D. - Chakradatta

G.N. - Gada Nigraha

I - Indriya Sthana

Ka. - Kashyapa Samhita

Khi - Khila Sthana

M.N. - Madhava Nidana

Mk. - Madhyama Khanda

Ni. - Nidana Sthana

Pk. - Purva Khanda

Sha. - Shareera Sthana

Sha. Sa. - Sharangadhara Samhita

Si. - Siddi Sthana

Su. - Sushruta Samhita

Su. - Sutrasthana

Tk. - Tritiya Khanda

U - Uttara tantra

Y.R. - Yoga Ratnakara

H.P.M. - Harrison’s Principles Of Internal Medicine

H.Y.P - Hatha Yoga Pradipika

CONTENTS

1. Introduction 1

2. REVIEW OF LITERATURE

Historical Review 2

Discription Of Nasa 5

Vataja Pratishyaya 16

Allergy 37

Allergic Rhinitis 39

Pratimarsha Nasya 57

Anutaila 64

Drug Review 66

Prevention Of Allergic Rhinitis 68

3. MATERIAL & METHODS 71

4. OBSERVATION & RESULTS 75

5. DISCUSSION 87

6. CONCLUSION 94

7. SUMMARY 95

8. REFFERENCES AND BIBLIOGRAPHY 96

9. ANNEXURES I-VII

1

INTRODUCTION

It is nice to imagine a world without diseases. The imagination may become a

reality by incorporating healthy principles of Ayurveda in daily life. The prime

intention of Ayurveda is preserving the health of an individual rather than treatment.

Swasthavritta is such contribution, which aims at individual and social health.

Modification in daily life due to technological advances and busy life schedule

does not permit a person in indulging some basic health preservatory procedures.

Increased levels of environmental pollutions combined with decreased

immunity have subjected the man to innumerable modern health hazards. One such

condition is Vataja Pratishyaya with a similar clinical entity with that of Allergic

Rhinitis.

Its incidence is reported all over the world and increasing day by day. The

immediate hypersensitivity reaction of nasal mucosa to allergens like pollen dust

strong perfume and cold dry climate.

Ayurveda offers scope in the form of Pratimarsha Nasya, which is explained

as a procedure for resisting such disorders.

Hassan is a place, which has fulfilled all the criteria for supporting vitiating

factors for the causation of allergic rhinitis. Consequently more number of cases are

reporting at the hospital out patient units in search of solution.

Pratimarsha Nasya with Anutaila is explained as a procedure in Dinacharya

for prevention of Nasagata Rogas in particular and Urdhwajatrugata Vikara in

general.

Considering the simple nature of the procedure, cost effectiveness and

unassociated adversities a trial is planned to study the efficacy of Anutaila

Pratimarsha Nasya in prevention of Vataja Pratishyaya.

Review Of Literature 2

HISTORICAL REVIEW

History is the methodical records of the past events. The recording of the past

is an art and it becomes base for latest science. Without past any science cannot take

its stride towards progress. Hence to understand the disease Vataja Pratishyaya we

have to look back into the history.

The history of the said disease Vataja Pratishyaya from Vedic period to 20th

Century has been discussed in this chapter.

The history of Vataja Pratishyaya can be reviewed under the following chronological

periods.

1. Pre-Vedic and Vedic period

2. Samhita Kala

3. Sangraha Kala

4. Adhunika Kala

1. Pre-Vedic and Vedic period: In pre-Vedic period not much literature is available

on Vataja Pratishyaya but in Vedic period. Among four Vedas, we find reference of

Pratishyaya in Atharvana Veda, which is regarded to be the authentic source of

Ayurveda. In Atharvana Veda words like

Vekelandu

Vilohitha

Devakosha

Were available1

Meaning of Vekelandu – relates to Pratishyaya2

Meaning of Vilohitha – relates to a type of Nasa roga3 And meaning of Devakosha

relates to Shiras4

In Rig-Veda and Atharvana Veda also description of Urdhvajatru Rogas and

its treatment is available. The treatment descriptions like Snehana, Swedana, and

Nasya are also available in this regard.

A study on Pratimarsha Nasya in Prevention of Pratishyaya


2. Samhita period: Samhita period is an important period during which, several

prominent Ayurvedic texts were written, they include Charaka samhita, Sushruta

samhita, Bhela samhita and Hareetha Samhita. And all of them have described Vataja

Pratishyaya.

In Trimarmiya Adhyaya of chikitsa sthana in Charak Samhita5, Charaka

explains 5 types of pratishyaya namely Vataja, Pittaja, Kaphaja, Sannipataja and

Dusta Pratishyaya. Detailed clinical features and therapeutics have been mentioned in

the same chapter.

Apart from this at various places mention of Pratishyaya can be found.

Pratishyaya is mentioned as Poorva Roopa in Rajayakshma, as Laxana in diseases like

Arshas, Anaha, Udavartha, Krimi, Grahini, Jwara (Kaphaja, Vatakaphaja) Shwasa

rogas. It is explained as Upadrava in the disease Prameha and As Asadhya laxana in

Apachi and Gulma.

Acharya Sushruta the great authority on Shalya and Shalakya Tantra has

explained Pratishyaya and Peenasa, while explaing 31 varieties of Nasarogas. A

detail description of Nidana, Samprapti and Chikitsa of Vataja Pratishyaya is found in

the 24th Chapter of Uttaratantra6. Classification is done as Vataja, Pittaja, Kaphaja,

Tridoshaja and Raktaja. In Bhela Samhita explanation is available in Shirovirechana

adhyaya. And in Haritha Samhita7 it is explained in 42nd Chapter of Trithia Sthana.

3. Sangraha kala: Astanga Sangraha 8, Astanga Hridaya Madhava Nidana are

important treatises of this period, which have dealt about vataja pratishyaya in detail.

Vagbhata in his Astanga Hridaya9 mentions 6 varieties of Pratishyaya. They

are Vataja, Pittaja, Kaphaja, Sannipataja, Raktaja and Dustha Pratishyaya. It is

mentioned in 19th and 20th Chapter of Uttaratantra.

In Madhava Nidana10 the Author has mentioned Nidana aspect of Vataja

Pratishyaya. The description is identical to that of Sushruta Samhita. In Gada

Nigraha11 the explanation of Pratishyaya is available.

4. Adhunika kala: Sharangadhara Samhita12, Bhavaprakasha13, Yogaratnakara14 and

Bhaisajya Ratnavali15 are important texts of this period. In Sharangadhara Samhita

description related to Vataja Pratishyaya are scattered in different chapters. In Bhava

Prakasha the description is found in Madhyama Khanda in Nasa Rogadhikara. In

Yogaratnakara the description of Nasarogas and their treatment is identical to that of


Review Of Literature


4

Sushruta Samhita. Many prescriptions are seen for the Chikitsa of Vataja Pratishyaya

in Nasa Roga prakarana of Bhaishajya Ratnavali.

By reviewing the chronological development details about Nasarogas in

general and Vataja pratishyaya in particular, can be appreciated. It is evident that

Ayurvedic Scholars have achieved some mastery in medical treatment of

urdhvajatrugata vikara.


DESCRIPTION OF THE NASA

Etymology: The word ‘NASA’ is derived from the root Nasal, which becomes Nasru

by the principle “Nonah” and with the addition of suitable suffix the root gets the

position of Hal & thus word Nasa is derived which means to sound.16

Definition: Nasa is described as the seat of Ghranaendriya i.e. sense of smell.17

Synonyms: Nasa, Nasika, Ghranam, Gandhavaha, Ghrana 18(Amarkosa).

Embryology: Acharya Charaka states that Sarvanga are developed during the third

month of Garbhavastha. 19

In Garbhopnishada it is mentioned that Mukha (oral cavity), Nasa (nose),

Akshi (eyes) and Shrotra (ears) are developed in sixth month of pregnancy. Sushruta

has not clearly mentioned the embryological formation of NASA.

Anatomy: In Ayurvedic literature, there is no detail description of Nasa Sharira at

one place like the anatomical description of other organs, whereas Nasa is included

among the five Indriya as a site of Granendriya.

Sushruta has considered Nasa as Pratyanga i.e. secondary organ of the body.

Similarly while enumerating the external orifices of the body, Sushruta has considered

two nostrils among the main nine external orifices.

Nasa is comprised of: - 20

3 Bones,

2 Pesi,

2 Dhamani,

2 Marmas &

24 Siras

Sushruta mentions the length of Nasika as 2, 1/3 Angulas.21

Sushruta while explaining the 24 Siras classified them into four groups of six

each as Vatavaha, Pittavaha, Kaphavaha and Raktavaha.



INDRIYA PANCH PANCHKAM: 22

Indriya: Granendriya

Indriya Dravya: Prithvi

Indriya Adhisthana: Nasa

Indriya Artha: Gandha

Indriya Buddhi: Ghrana Buddhi

The sense faculties perceive only such objects, which are dominated by the

Mahabhutas specially constituting those respective faculties. This is so,

because the particular Mahabhuta determines the very nature of sense

faculties, it is specially made of.

All the sense faculties are made of all the five Mahabhutas which when

grouped together and transformed into a definite form constitute the

concomitant cause of the former.

But in spite of the fact that all five Mahabhutas are present in all the same

faculties, each sense one respective Mahabhuta dominates faculty.

Importance of Indriyas:

Indriyas are considered as evolved from the Atma directly, which confer

Jnana, Vijnana, Sukha, Dukha, Vivechanas and Ayu etc.

ANATOMY OF NOSE 23

External Nose:

External nose has a bony and cartilaginous structure. The bony framework is

formed by a pair of nasal bones, the frontal processes of maxillae and the nasal spine

of the frontal bone. The cartilages of the Nose are:

i) Paired upper lateral nasal cartilages.

ii) Paired lower nasal cartilages (greater alar cartilage).

iii) Accessory alar cartilages.

iv) Septal cartilage.



Nasal Cavities:

The interior of the nasal cavity is divided into two halves by a central septum.

The anterior and posterior apertures of the nose are called the anterior and posterior

concha respectively. The nasal cavity has a roof, floor and medial and lateral walls.

The floor is formed by the palatine processes of maxillae and horizontal plates

of the two palatine bones.

The roof is made of nasal bones, under surface of the nasal spine of the frontal

bone. Cribiform plate of the ethmoid and undersurface of the body of sphenoid bone.

The medial wall of the nasal cavity is formed by the nasal septum.

The lateral wall of the nose has ridges and depressions. The ridges are formed

by turbinate. There are three turbinate – Superior, middle and inferior. While the

inferior turbinate is a separate bone, the middle and superior turbinate are parts of the

ethmoid bone.

The anterior part of the lateral wall is formed by the inner aspect of the nasal

bone, anterior part of the body of maxilla, frontal process of the maxilla and a portion

of the inferior turbinate. The middle part of the lateral wall is formed by the medial

surface of the ethmoid labyrinth, superior and middle turbinates and the pterygoid

plates. In the upper part is the sphenopalatine formation.

The area below the turbinates is called the meatus. Each meatus is named after

the turbinate is named after the turbinate under which it lies, that is, superior meatus,

middle meatus and inferior meatus.

In the inferior meatus opens the nasolacrimal duct.

The following sinuses open in the middle meatus: -

i) Anterior ethmoidal cells and the frontal sinus opening the anterior part of

the meatus.

ii) Middle ethmoidal cells open above the bulla ethmoidalis or hiatus

semilunaris.

iii) Maxillary sinuses opening the posterior part of the hiatus semilunaris.



The area above the middle turbinate is the superior meatus. In this area open the

posterior ethmoid cells. Above and behind the superior turbinate is a small depression

called, the sphenoethmoidal recess in which the sphenoid sinus opens.

Nasal Septum:

The nasal septum has cartilaginous and bony parts. The following forms the

bony parts of the septum.

1) Posteroinferiorly by the vomer.

2) Posterosuperiorly by the perpendicular plate of ethmoid.

3) The nasal spine of the frontal bone joins the ethmoid plate.

4) Rostrum of sphenoid between the vomer and ethmoidal plate.

5) Nasal crests of the two maxillae and palatine bones.

A quadrilateral cartilage forms cartilaginous part of nasal septum. It is

attached to the perpendicular plate of the ethmoid bone posterosuperiorly, to the

anterior border of vomer posteriorly, to the intranasal crest superiorly, and to the nasal

crest of the maxilla and anterior nasal spine inferiorly.

The upper nasal cartilages are attached to the anterosuperior border of the

septal cartilage.

Membranous septum is formed by the juxtaposition of two mucocutaneous

flaps.

Mucosa of Nose:

1. The anterior vestibular region has stratified squamous epithelium it ends at

the mucocutaneous junction.

2. Respiratory portion of the nasalmucsoa is lined by pseudostratified

columnar ciliated epithelium. The mucosa is firmly adherent to the

perichondrium and periosteum.

3. Olfactory mucosa: This part of the mucosa occupies the olfactory portion

of the nose, which extends over the upper part of septum and adjacent

lateral wall up to the superior turbinate. This mucosa has a yellowish color

and consists of olfactory receptor cells among basal cells and supporting

cells.



Para nasal Sinuses:

Maxillary sinus: This is a pyramidal cavity in the maxilla. The sinus cavity may be

divided into small spaces by bony septam. The roof of the sinus lies about 1cm. below

the level of the nasal cavity in adults and is formed by the alveolar process of maxilla.

The anteriolateral wall is formed by the anterior part of the body of maxilla. It

contains the anterior superior dental vessels and nerves. The medial wall is formed by

the nasal surface of maxilla, the perpendicular plate of palatine bone, maxillary

process of inferior turbinate and the uncinate process of ethmoid. The posterior wall is

formed by the posterior surface of maxilla. The opening of the maxillary sinus is in

the posterior part of the hiatus semilunaris between bulla ethmoidalis and the uncinate

process of the ethmoid bone, on the lateral wall of the nose below the middle

turbinate. The capacity of sinus varies between 15 ml to 30 ml.

The roots of the premolar and molar teeth may project into the sinus cavity.

The marrow containing bone may be present up to 18 months of age and therefore,

Osteomyelitis of the maxilla may occur during this period. The postrosuperior dental

vessels and nerve supply the sinus mucosa.

Frontal Sinus: Frontal sinuses are two in number and develop in the frontal bone.

The two sinuses are usually unequal in size. The anterior wall and floor of the sinus

have marrow-containing bone; hence, Osteomyelitis can develop in this region at any

age. The floor of the sinus forms parts of the root of orbit. The posterior wall forms

the anterior boundary of the anterior cranial fossa; hence infection of the sinus can

travel to the anterior cranial fossa and orbit. The frontal sinus is drained by the

frontonosal duct, which opens in the anterior part of the middle meatus. The average

capacity of the sinus is about 7ml. in adult. The supraorbital nerve and vessels supply

the sinus.

Ethmoid Sinuses: These are multiple air-containing cells situated in the ethmoidal

labyrinth. These are arranged in three main groups. Anterior group, middle group and

the posterior group.

The anterior group of cells drains into the anterior part of the middle meatus.

The middle ethmoidal cells drain in the middle meatus on the ethmoid bulla or above

it while the posterior ethmoid cells drain into the superior meatus.



The ethmoidal air cells are related laterally to the orbit and are separated from

it by a thin bone lamina papyracea. Posteriorly the ethmoids are related to the optic

foramina. Superiorly the ethmoid air cells may reach to a level above the cribriform

palate. The anterior and posterior ethmoid nerves and vessels supply these sinuses.

The Sphenoid Sinus: Sphenoid sinuses develop in the body of the sphenoid bone.

The two sinuses are unequally divided by a septum. Superiorly the sinus is related to

the frontal and olfactory tracts. Above and posteriorly lies the pituitary gland in the

sella turcica. Laterally the sinus is related to the optic nerve and cavernous sinus. The

sinus opens through the anterior wall in the sphenoethmoidal recess.

Blood Supply:

i) The main supply is by the sphenopalatine artery, a branch of the internal

maxillary artery, which divides into lateral nasal branches, and a long

septal branch.

ii) Anterior and posterior ethmoidal arteries, branches of the ophthalmic

artery supply the upper part of the lateral wall and upper posterior part of

the septum.

iii) The greeter palatine artery enters through the incisive canal into the nose

and supplies the anteroinferior part if the septum and adjacent areas of the

floor and lateral wall.

Lymphatic Drainage:

Submandibular lymph nodes collect lymph from the external and

anterior parts of the nasal cavity. Upper deep cervical nodes drain the rest of the nasal

cavity either directly or through the retropharyngeal nodes.

Nerve Supply:

i) Anterior ethmoidal branch of the nasociliary nerve, supplying the upper

part of the lateral wall and the septum.

ii) Sphenopalatine nerves (long and short), branches from the

sphenopalatine ganglion.

iii) Greater palatine nerve.

iv) Anterior superior dental nerve.



Sympathetic supply: The preganglionic fibres arise from the first and second

thoracic segments of the spinal cord and end in the corresponding sympathetic

ganglia.

Parasympathetic supply: The preganglionic fibers arise in the superior

salivary nucleons in the brainstem and pass in the nerves intermedins to the

gemiiculate ganglion. The fires from this ganglion pass in the greater

superficial petrosal nerve.

PHYSIOLOGY:

The nose forms the gateway of the respiratory system and serves the following

important functions.

1) Respiratory passage: Normally, breathing takes place through the nose. The

inspired air passes upwards is a narrow stream medial to the middle turbinate and then

downward and backwards in the form of an arc, and thus respiratory air a currents are

restricted to the central part of the nasal chambers.

2) Filtration: The nose serves as an effective filter for the inspired air:

a) Vibrissae (nasal hair) in the nasal vestibule arrest large particulate

matter of the inspired air.

b) The fine particulate matter and bacterial are deposited on the mucus

blanket, which covers the nasal mucosa. The mucus contains various enzymes

like lysozymes having antibacterial properties.

c) The mucus with the particulate matter is carried by the ciliary

movements posterior to the oropharynx, to be swallowed.

3) Air conditioning and humidification: The highly vascular mucosa of the nose

maintains constancy of temperature of air and thus prevents the delicate mucosa of the

respiratory tract from any damage duet to temperature variations. The humidified air

is necessary for proper functioning and integrity of the ciliated epithelium.

4) Vocal resonance: The nose and Para nasal sinuses serve as vocal resonators and

nasal passages are concerned with production of nasal consonants like ‘M’ and ‘N’.

5) Nasal reflex functions: The receptive fields of various reflexes lie in the nose.

These include sneezing and nasopulmonary, nasobronchial and olfactory reflexes.



These protect the mucosa and regulate the vasomotor tone of the blood vessels.

Olfactory reflexes influence salivary, gastric and pancreatic glands.

6) The nasal cavity serves as an outlet for lacrimal and sinus secretions.

7) Olfaction: This function of the nose is less developed in human beings. This

sensation plays the most important role in behavior and reflex responses of lower

animals.

The olfactory mucosa is located in roof of nasal cavity and adjacent area of

superior turbinate and upper part of septum. The olfactory cells are distributed in the

olfactory mucosa.

The mechanism of olfactory stimulation is uncertain. Various theories have

been propagated. The odoriferous substance reaches the olfactory cells by air,

probably by diffusion. The olfactory sensitivity differs in individuals and is influenced

by many physiological factors and pathological changes in the nose.

Functions of The Para nasal Sinuses:

The Para nasal sinuses are thought to serve the following functions:

1) Warming and moistening of inspired air may be partly done by the large mucosal

surfaces of these adjacent sinuses.

2) The air filled sinus cavities probably add resonance to the laryngeal voice.

3) The temperature buffers: It is regarded that these chambers of cranial fossae from

the intranasal temperature variations.

4) Probably sinus formation in the cranial bones helps in reducing the weight of the

facial bones.

5) The sinus mucosa may act as a donar site for reconstructive procedures.

6) They act as shock buffers.



Examination of Nose: A detailed history of symptoms with special regard to their

onset, duration, progression, severity should be asked.

Nasal examination includes:

1. Examination of external nose.

2. Examination of vestibule.

3. Anterior rhinoscopy.

4. Posterior rhinoscopy.

5. Functional examination of nose.

1. External nose: Examine the skin and osteocartilaginous framework of nose

both by inspection and palpation.

2. Vestibule: It is the anterior skin-lined part of nasal cavity having vibrissae and

can be easily examined by tilting the tip of nose upwards. It is examined for a

furuncle, a fissure (chronic rhinitis), crusting, dislocated caudal end of the

septum, and tumors (cyst, papilloma or carcinoma)

3. Anterior Rhinoscopy: Patient is seated facing the examiner. A Thudicum or

Vienna type of speculums used to open the vestibule. The speculums held in

the left hand by a right-handed person. It should be fully closed while

introducing and partially open when removing form the nose to avoid catching

the hair. Light is focused at different sites in the nose to examine the nasal

septum, roof, floor and the lateral wall. For this, patient’s head may need to be

tilted in different directions. Look for the following points:

Nasal Passage: Narrow (septal deviation or hypertrophy of turbinates,

growth) and wide (atrophic rhinitis).

Septum: Deviation or spur, ulcer, perforation, swelling (haematoma or

abscess), growth (rhinosporidiosis, haemangioma).

Floor of nose: Defect (cleft palate or fistula), swelling (dental cyst),

neoplasm (haemangioma), or granulations (foreign body or osteitis).

Roof: Usually not seen except in cases of atrophic rhinitis.



Lateral wall: Look at the turbinates and meatuses. Only the inferior and

middle turbinates and their corresponding meatuses can be visualized.

Examine the colour of mucosa (congested in inflammations and pale in

allergy), size of turbinates (enlarged and swollen in hypertrophic

rhinitis, small and rudimentary in atrophic rhinitis), discharge

(discharge in the middle meatus indicates infection of maxillary,

frontal or anterior ethmoidal sinuses), mass (polyp, rhinosporidiosis,

carcinoma). A probe test should be done to feel the consistency of the

mass, its attachment and mobility.

4. Posterior Rhinoscopy: Patient sits facing the examiner, opens his mouth and

breathes quietly from the mouth. The examiner depresses the tongue with a

tongue depressor and introduces posterior rhinoscopic mirror, which has been

warmed and tested on the back of hand. The mirror is held like a pen and

carried behind the soft palate, without touching it on the posterior third of

tongue to avoid gag reflex. Light form the head mirror is focused on the

rhinoscopic mirror, which further illuminates the part to be examined.

Patient’s relaxation is important so that soft palate does not contract.

Look for the following:

Choanal polyp or atresia.

Hypertrophy of posterior ends of inferior turbintes.

Discharge in the middle meatus. It is seen in infections of maxillary,

frontal or ethmoidal sinuses. Discharge above the middle turbinate

indicates infection of the posterior ethmoid or the sphenoid sinuses.

5. Functional Examination of Nose: Test for patency of the nose and sense of

smell.

Patency of nose:

(i) Spatula test: A clean cold tongue depressor is held below the nostrils to look for

the area of mist formation when patient exhales. The two sides are compared.

(ii) Cotton-wool test: A fluff of cotton is held against each nostril and its movements

are noticed when patient inhales or exhales.



Sense of smell: A simple test is to ask the patient to identify the smell of a solitonor

substance held before the nostrils while keeping the eyes closed. Each nostril is tested

separately. Common substances used are the clove oil, peppermint, coffee, and

essence of rose.



VATAJA PRATISHYAYA

Acharya Charaka has mentioned three vital organs in the body, which are

basti, Hridaya and shira. In disease of different parts of shira, Pratishyaya is very

important among the Nasa roga because it give rise to other diseases of head.

Pratishyaya is also present in many Urdhwajatru roga and Pranavaha Sroto

vikara. It is also mentioned as a premonitory as well as one of the symptoms in

Rajayakshma 24. But it is mentioned as a separate disease by Acharyas.

Classification:

According to various Acharyas Pratishyaya is classified as

Table No: 1 showing Classification of Pratishyaya

Authors Vataja Pittaja Kaphaja Raktaja Sannipataja Charaka + + + - + Sushruta + + + + + Kasyapa + + + - +

The Vataja Pratishyaya lakshanas mentioned in the classics are very much

comparable to Allergic rhinitis.

In this chapter various aspects of pratishyaya is dealt in detail.

The term Pratishyaya can be split into PRATI + SHYAYA.

“PRATI”: - is the prefix, meaning Abhimukha i.e., towards or in the direction of.

“SHYAYA”: - is derived from the root Pratisya Gatwa. This means moving or

flowing.

The combined word Pratishyaya is explained in Vigraha Vakya as

“Prathikshanam Shatheithi Pratishyaya”. In vakya sudha vyakhya commentary on

Amarakosha of Amar Simha the term Pratishyaya is described, as when almost

continuous secretion is present from nose is known as pratishyaya.



Shabda Kalpadruma is in concurrence with the vakya sudha, while explaining

the terms Pratishyaya and Peenasa. Commentaries.

PARIBHASHA: - If Continuous secretion is present through nose then, is known as

Pratishyaya

Secretion produced from nose due to the derangement of Kaphadeenam (i.e.,

Kapha, Vata, Pitta, or Rakta or any combination of these Doshas) flows downwards

against the inspired air (SU – Dalahan-Com 24)

In Charaka Samhita Pratishyaya is defined as follows: Kapha, Pitta, Rakta

which are present in ghrana moola, combines with Vata resulting in the secretion

which flows against the inspired air is called Pratishyaya25 The above definitions can

be combined together in brief as follows:

The condition where the secretion produced due to the derangement of the

Kapha and other Doshas, at the root of the nose, which flows down through the nose

(nasamarga) against the inspired air is called as Pratishyaya.

NIDANA:

Nidana is defined as ‘Vyadhi utpatti hetu nidanam’. That is the main cause for

the occurrence of the disease. This helps us to ascertain or to confirm the diagnosis,

and to know the prognosis of the disease. Nidana also helps in planning proper

treatment. Nidana parivarjana is one of the important measures in chikitsa.

This chapter includes those causative factors, which are responsible for the

causation of the disease Vataja Pratishyaya. As such there is no separate nidanas

explained for the occurrence of Vataja Pratishyaya. However the nidanas for the

occurrence of Pratishyaya are the nidanas for Vataja Pratishyaya26

The nidanas mentioned can be separately dealt as Aharaja nidana, Viharaja

nidana, and manasika nidanas.



In Bhavaprakasha27 and Yogaratnakara nidanas are mentioned as Sadyojanaka

nidanas and Kalantarajanaka nidanas.

Different nidhanas explained by different authors:

Table No 2 Showing Nidana of Pratishyaya

Sl. No. NIDANAS Ch Su A.H. 1 Sandharana + + -- 2 Ajeerna + -- + 3 Rajo sevana + + -- 4 Atibhashana + -- + 5 Krodha + -- -- 6 Rutu vaishamya + -- -- 7 Shirobhitapa + + -- 8 Jagarana -- + + 9 Atisheetambu pana + -- -- 10 Avashyaya + -- + 11 Bhaspa + -- + 12 Dhoopasevana + + -- 13 Pratap -- + -- 14 Anila sevana -- -- + 15 Neechastyuchcha upadhana -- -- + 16. Athiswapna -- -- + 17. Peetenanyena varina -- -- + 18. Atyambu pana -- -- + 19. Ramana (Sheetala Avagaha) -- -- + 20. Ati Maithuna + + --

The causative factors are divided under two headings namely

1. Aharaja

2. Viharaja.



Table No 3 Showing Aharaja Nidanas Explained By Different Authors:

Sl.No Aharajanya Nidanas Ca Su A.H KA 1 Ati Ambupana -- -- + -- 2 Ati Guru Ahara + + -- + 3 Ati Madhura Ahara -- -- -- + 4 Ati Rooksha Ahara -- -- -- + 5 Ati Sheetala Ahara -- -- -- + 6 Vishama Bhojana -- -- -- + 7 Ajeerna + -- -- + 8 Sheetala Jalapana + -- -- --

Table No 4 Showing Viharaja Nidanas:

Sl.No Viharaja Nidana Cha Su A.H 1 Ati Bhashana + -- + 2 Ati Maithuna + + -- 3 Ati swapna + -- + 4 Ati pratapa -- + -- 5 Sandarana + + -- 6 Rajo Dhooma sevana + -- -- 7 Jagarana -- -- -- 8 Avashyaya + -- + 9 Sheeta vayu sevana -- + -- 10 Chardi Nigraha -- -- + 11 Bhaspa -- -- + 12 Sheetala Avagaha -- -- + 13 Krodha + -- -- 14 Rutu vaishamya + -- --

In Ayurveda Acharyas explained two ways of nidanas for Prtishyaya. They are

Sadhyojanaka nidana (Ashukari) and Kalantarajanaka nidana.

1.SADHYOJANAKA NIDANAS: -28

These are the ashukari nidanas, which produce the diseases with acute onset.

The causative factors such as Dhooma, raja, Sheetala vayu etc will irritate the nasa

kala by vitiating the tridosha. As a result there will be ‘shopha’ of mucus membrane.

In such condition in the absence of immunity Pratishyaya will manifest immediately.

Further indulgence in these nidanas, and this condition if not treated may lead to the

disease Dustha Prtishyaya.



2. KALANTARA JANAKA NIDANAS: - 29

By constant indulging in nidanas like Vegadharana, Ajeerana, Rutu vaishamya

Jagarana, Sheetala jala sevana. Avashyaya (walking in mist) etc, are the causes for

sanchaya, prakopavastha of doshas, hence leads to Pratishyaya.

Apart from these nidanas Vagbhatacharya includes nidanas like neecha

upadana, Atucha upadana, Anyajalapana, Atyambupana, Ualabhigamana, Chardhi

nigrahara Bhaspa nigrahana etc.

As said above nidanas are classified in to ahara as nidana and vihara as nidana

individual causative factors of each category can be visualized in the causation of

Vataja Pratishyaya.

A. AHARA AS NIDANA: -

SHEETALAJALAPANA AND ATIAMBUPANA:

Excessive intake of cold water reduces the agni in amashaya and ushnaguna in

the body. The reduction of ushnaguna means reduction of pitta. These together

leading to Agni mandya and results in ajeerna. Which give rise to ama. These in turn

vitiate the excess kapha and causes Pratishyaya

ATI AMBU PANA:

By drinking of water in excess, ambuvaha Srotas gets vitiated and kleda will

increase in Sleshma Pakala of nasa and produces Pratishyaya.

ATI GURU AHARA:

The food articles having guru guna when consumed in excess increases guru

guna by which kapha is increased. By the systematic increase of kapha in the nasal

region produces Pratishyaya.

MADHURA AHARA SEVANA:

Foodstuffs having sweet quality or madhura ahara increases the kapha. So by

taking madhura ahara, kapha is increased and they’re by causes imbalance of

tridoshas and thus produces Prtishyaya.



SHEETAL AHARA SEVANA:

Sheeta is the guna of both vata and kapha. By taking sheeta guna ahara the

sheeta guna is increased in the body. This in turn increases both kapha and vata and

causes imbalance of tridoshas thus causing Pratishyaya.

AJEERNA:

It means improper digestion of food. This semi-digested food cannot be

properly metabolized in the body, resulting in ama. This ama causes imbalance in

tridoshas. The imbalance of doshas in the nasal region produces shopha of nasal

mucous membrane causing Pratishyaya.

VISHAMA AHARA SEVANA:

Irregular food habits and consumption of unwholesome food leads to improper

secretion of digestive juices. Because of this improper secretion and quantity of

digestive juices, the digestion becomes improper causing ajeerna and ajeerna causes

Pratishyaya as explained above.

B. VIHARA AS NIDANAS: -

DHOOMA SEVANA:

Excessive inhalation of polluted dhuma etc. when comes in contact with

sleshmadhara kala of nasa brings about kshobha and irritation resulting in morbid

affection of those sthanas, thus resulting in Pratishyaya.

RAJO SEVANA:

Here air polluted with dust particles originated from mud, coal , cement , and

even pollen grains, Cotton , husks etc. when enters the respiratory passage through

nasa marga brings about similar effect as that of Dhooma and causes Pratishyaya.

ATI PRATAPA:

Constant exposure to excessive heat of sunrays falling upon the twacha and

influencing the Bhrajaka pitta through the above qualities results in vitiation of

raktadhatu also, thus leading to vascular disturbances. These changes give rise to

disturbance in equilibrium of jataragni, which in turn produces annarasa rich in



pittagunas. This rise during circulation results in prakopa in Pranavaha srothas. Their

Pratishyaya originates roga.

SHEETAL AVAGAHA:

Brings about vitiation of vayu, due to sheeta guna. There is also possibility of

entering jala into nasa Srotas. This results in stambhana of accumulated water in

sinuses. Then Pratishyaya will occur.

AVASHYAYA:

Exposure to mist results in the accumulation of kapha in the frontal and para

nasal sinuses. That accumulated kapha will obstruct vayu due to increased sheeta

guna, which in turn leads to the manifestation of Pratishyaya.

VEGA DHARANA:

Suppression of natural urges may cause vata prakopajanya disorders. In fact

the author of Bhela samhitha points out that the possibility of pratishyaya is due to

suppression of adhovata. “Shakrut pindikodveshta pratishyaya shirorujan”.30

JAGARANA:

Ratri jagarana (keeping awake during night time) increases the vata dosha.

Thus imbalance of tridosha takes place. There will be vitiation of Prana vayu, which

control manas and indriyas. Hence indriyas pradoshaja vikaras occurs.

ATI MAITHUNA AND ATI BHASHANA:

These increase vata in the body causing pratishyaya.

KRODHA:

Pittadosha gets vitiated due to krodha. Due to the impairment of pitta dosha,

that is Pachakagni, food will not be properly digested and results in ama. This ama

causes vaigunya of tridoshas and causes Pratishyaya. (Ref. Krohat Pittam prakopa

yathe)



POORVA ROOPA:

Poorva roopa of Vataja Pratishyaya have not been directly mentioned. So

Pratishyaya purva roopa itself is the Poorva roopa of Vataja Pratishyaya. But in

general, Poorva roopa of Pratishyaya has been told by susruthacharya as follows:

Shiro gurutva

Kshavathu

Angamarda

Parihrista romatha 31

Videha mentions some more Poorvaroopa like

Ghrana dhomayana

Kshavathu

Talu Dharana

Kanthadwamsa

Mukha srava

Shiropunotha

Table No 5 shows porva roopa mentioned by different authors:

Poorva Roopa Su Y.R. Vi

Shiro guruta + + +

Kshavathu + + +

Parihrista Romata + +

Ghrana Dhoomayana +

Kantadwamsa +

Mukha srava +

ROOPA:

The knowledge of roopa is very essential to diagnose the disease. Symptoms,

which are the characteristic manifestations of the disease developed during the course

of disease, are known as Roopa. In other words lakshanas commence from the

vyaktavastha.

Roopa helps not only to diagnose the disease, but also to know the prognosis

of the disease. Then only proper treatment can be ascertained. Different authors and

Ayurvedic texts describe SpecificVataja Pratishyaya lakshanas. 32



Table No 6 Vataja Pratishyaya Lakshanas According To Different Acharyas

Sl.No. LAKSHANA AH Ch Su YR BP

1 Anaddha + + + + +

2 Tanu srava + + + + +

3 Gala shosha - - + + +

4 Talu shosha - - + + +

5 Oshta shosha - - + + +

6 Nistoda shanka + + + + +

7 Swropaghata + + + + +

8 Mukha shosha + - - - -

9 Ghrana toda + + + + +

10 Kshavathu + + + + +

11 Shira shoola + + + + +

12 Danta toda + + + + +

13 Chira paka - - + + +

UPASHAYA AND ANUPASHAYA

These are the factors that passify or aggravate the condition respectively. The

factors responsible in Vataja Pratishyaya are,

Upashaya

1. Oral intake of Ghrita, (warm) containing sour ingredients.

2. Various kinds of Swedana & Vamana.

3. Nasya with the squeezed juices at appropriate time.

4. Dhumapana & Gandusha performed depending upon the types of Dosha

involved.

5. Snigdha, Ushna, Lavana & Amla Padartha Sevana.

Anupashaya

1. Excessive intake of Guru, Madhura, Sheeta substance.

2. Excessive intake of Shita Jala.

3. Rajah Sevana.

4. Ati Drava Sevana after meal.

5. Vishamashana. 33



SAMPRAPTI (Etio-Pathogenesis)

The treatment of a disease depends upon a true understanding of the

phenomena of its pathogenesis. All the classical texts have described the Samprapti of

Pratishyaya,there is no separate Samprapti mentioned for Vataja pratishyaya so

pratishyaya Samprapti can be considered which is as follow :

1) According to Charaka:

Charaka says that, due to indulgence in vataprakopaka Nidanas (causative

factors), Vata Dosha gets vitiated, and aggravated Vayu, gives rise to Pratishyaya.

|Cha chi 26/10|

2) According to Sushruta:

While describing Samprapti Sushruta says that, Vata and other Doshas, either

alone or in combination and with or without the association of Rakta gradually

accumulates in the head and when further vitiated by their respective exciting causes,

produce Pratishyaya. 34

3) According to Vagbhata:

Vagbhata says that, when the vitiated Vatpradhana Doshas, get localized in the

nasal cavities gives rise to Pratishyaya. If not treated properly, the increased Dosha

may lead to Kshaya.35

4) According to Kashyapa:

These instincts (likes and dislikes) and acts accordingly, the Doshas will come

back to their normal condition. On the other hands, if they are not Kashyapa has

mentioned that, due to Nidana, Mandagni and Vishamashana, the aggravated Vata

vitiates upper ashaya (seat) of Kapha and thus vitiating the channels situated in

Nasikamula causes Pratishyaya. In this disease the patients always excretes out the

secretion continuously Pitta or Rakta, so it is called Pratishyaya.36

The above given brief description of pathogenesis of Pratishyaya may

further be elaborated on the basis of Shad Kriyakala given by Sushruta.37



Shad Kriyakala:

1. Sanchaya:

During this stage one or more of the Doshas undergo increase in their chief site

i.e. Vata in Pakvasaya (large intestine), Pitta in Pachyamasaya (small intestine) and

Kapha in Uras (chest). This accumulation of Dosha produces mild symptoms in the

form of Iccha and Dvesa (like and dislikes) for certain foods, activities etc. Liking or

desire is for those which possess qualities opposite to those of the increased Dosha

(Viparita Guna Iccha) and dislike or aversion is for those which causes the increases

of the Dosha. If the person recognizes recognized and the person continues to indulge

in causative factors like unhealthy foods, the Doshas undergo increase further.

Acharya Dalhana clarifies phenomena of each Doshas in the head

region. Accordingly, Prana Vata has its field of activity in the head. Among Pittas,

Alochaka and Bhrajaka can be considered and Tarpaka Kapha’s site in the head is

well known. Sonita circulating through Siras also gets accumulated in the head.

2. Prakopa:

The second stage is known as Prakopa (vitiation). The further increased Dosha

leads to vitiation (Prakopa) state. He can easily get over this abnormality by suitable

adjustment in foods, activities and simple drugs and remedial measures by consulting

a physician. Negligence of appropriate action leads to the next stage of Prasara.

3. Prasara:

The third stage of Kriyakala is known as Prasara (spreading to large areas). The

Doshas undergo further increase an invade the sites of other Doshas in addition to

their own; Vata to the sites of Pitta or Kapaha, Pitta to sites of Vata or Kapha, Kapha

to sites of Vata or Pitta. If effective treatment is taken, the Doshas will come back to

normal. If the person continues to indulge in unhealthy foods etc., or if the treatment

is ineffective, the abnormality continues further to the onset of the fourth stage.

During the first three stages, the unhealthy foods and activities not only bring

about increase of the Doshas but at the same time, also bring about mild abnormalities

in the Kosthagni (digestive activity in the alimentary tract), the Dhatus (tissues), the

Srotas (pores, channels of the Dhatus, cell pores, ducts.) and the Ojas (the vital fluid



material present in every Dhatu and responsible for its strength vis-à-vis the strength

of the body).

The Kosthagni, which digests the food, becomes abnormal (Agni Vaisamya) by

the action of the unhealthy foods etc. and also by the increase of the Doshas. Increase

of Vata causes Visamagni (irregular, unpredictable, erratic) making digestion of food

variable from time to time, day-to-day etc. Increase of Pitta causes Tiksnagni

(excessively keen, strong) making digestion unusually quick and changing of food

materials and increase of Kapha causes Mandagni (weak, poor) making inadequate,

and delayed digestion of food. In all these abnormal states, the food does not undergo

perfect digestion and undigested materials - Ama - (improperly processed, over

processed or inadequately processed intermediary products of digestion) remain over

in the Ahara Rasa (essence of food). The quantity of such materials is more incase of

Mandagni, moderate in case of Visamagni and very little in case of Tiksangni.

In Prasara Avastha the vitiated Dosha through Rasa and Raktavaha Channels

circulates through out the body.

Besides all the said general symptoms, the local symptom in the nasal passages

will be ‘Kaphotklesh’.

4.Sthana Samsraya:

The circulating Doshas mixed with the circulating Rasa Dhatu, now tend to settle

at certain place in the Dhatus (Sthana Samsraya) and bring about abnormalities there,

especially the Srotas (pores, channels of cells of tissues)

The Dhatus (tissues) may not fall on easy prey to the onslaught of the Dosha.

They have their defense, in a fluid material known as Ojas which is responsible for

their Bala (strength), to carryout their functions (Karya Sakti) and to prevent diseases

(Vyadhi Utpada-Pratibandhakatva). As long as the Ojas is normal in its Pramana

(quantity) and Gunas (qualities), the Doshas cannot vitiate the Dhatus or the Srotas.

The ojas undergoes Kshaya (decrease) due to many causes such as lack of food,

physical strain, injury to vital organs, excess indulgence in alcohol and such other

substances of poisonous nature; anger, grief, worry and other mental emotions; loss of

blood, semen and other tissues etc. The decrease of Ojas makes the Dhatus poor in

strength and suceptable to the bad effect of the increased Doshas.



The Srotas may undergo following four kinds of abnormal changes (Sroto Dushti

or Khavaigunya).

(a) Atipravriti – increased functioning.

(b) Sanga or Rodha – obstruction, blockage, decreased functioning and

consequent increase in size.

(c) Granthi – growths, thickening, etc.

(d) Vimargagamana – movement of material in wrong direction, passage or

place.

The place or site (organ) where one or more of these Srotodusti/ Khavaigunya has

taken place, becomes the site of origin of the disease.

The Ama, which was formed by Mandagni accumulates in the Rasa Dhatu and

brings about changes in it. Its normal Tanutva (thinness) changes to Bahalatva

(thickness), Visadatva (non-sticky nature) to Pichilatva (sticky, slimy) and normal

Pramana (quantity) to increased quantity (Vriddhi). This kind of Sama Rasa (Rasa

mixed with Ama) circulating all over the body finds difficulty in entering into the

minute Srotas, which have also become abnormal by this time. Sama Rasa blocks the

Srotas, accumulates outside the Dhatu Pramanas (tissue cells) and makes for Dhatu

Vriddhi.

Every Dhatu has its own specific kind of Agni anologus to the Kosthagni

(digestive activity in the alimentary tract); these Dhatvagnis derive strength from the

Kosthagni and work similarly. They also become Tikshna (strong) and the latter

causes Vriddhi (increase) or Kshaya (decrease) of the Dhatus have been considered as

Vaishamya (abnormalities). Even the four kinds of Srotodushti also form part of

Dhatu Vaisamya; hence Dhatu Vaisamya itself is termed as the disease.

Thus, in the fourth stage, important abnormalities occurring inside the body are

further increase of the Doshas, their localization at certain place, (Sthanasamshraya),

decrease of Ojas (Ojas Kshaya), vitiation of Srotas (Srotodushti, Khavaigunya),

accumulation of Ama (Ama Sanchaya) and union of abnormal Doshas and Dushyas

(Dosha-Dushya Sammurchana); all these act as essential prerequisites for the onset of

the disease. This Kriyakala is the stage of actual commencement of the disease. It is

characterized by appearing of Purvarupa/Pragrupa (premonitory, prodromal

symptoms), which are produced by each one of the above said abnormalities.

This Prana, Kapha, Pitta Avritta Udana Vata gets lodged in the Pranavaha Srotasa,

especially in Nasa, where Khavaigunya is available. The premonitory symptoms of



the disease can be demonstrated in this stage. In this stage patient gets following

premonitory symptoms of Pratishyaya.

(i) Shirogurutvam(Heaviness of the head).

(ii) Kshavathu (Sneezing).

(iii) Parihrishtaromata (Generalized horripilation).

5.Vyaktavastha:

This is the fifth Kriyakala and characterized by the full manifestation of the

disease (Vyadhivyakti) with all its symptoms and signs (Rupa). Each one of the

aforesaid abnormalities contributes to its own symptoms and signs, which are clearly

recognizable. They vary in number and strength from one patient to the other,

depending upon the age, sex, constitution, strength of the causes and many other

factors. The diseases are given specific names based on the chief symptom/sign or the

organ affected and many other factors. They are even classified as arising for many

one of the Dosha (Ekadoshaja), two of them together (Dvidoshaja, Dvandvaja, or

Samsargaja) or by all the three of them together (Tridoshaja, Sannipataja). The

abnormalities, though profound, can be brought to normal easily when effective

treatment and all other favorable factors are present and with difficulty in the presence

of unfavorable factors. Some times the disease is uncontrollable and progresses

further to the sixth and final stage.

In the process of Vyaktavastha the following symptoms of Pratishyaya may be

present.

- Shirashula,

- Kaphotklesha,

- Ghrana Viplava,

- Nasa Avarodha,

- Svarabheda etc.

6. Bhedavastha

During the sixth Kriyakala all the abnormalities become still more profound and

irreversible. In spite of the best treatment, they continue to persist and make the

patient very debilitated, by loss or depletion of the Dhatus, give rise to one or more

Upadrava (complications). Some times even Arista Laksnasa (signs and symptoms



which herald death) might also manifest. All these grave symptoms and signs

differentiate this person from others. Hence, this stage is called as Bheda.

In case of the disease Pratishyaya, one can easily conclude that the disease is

either chronic or complicated on the symptomatology of anemia, deafness etc. It may

lead to production of, Dushta Pratishyaya and Kasa, Svasa, Kshya also.

Hence the concept of Shada Kriyakala in references to the disease Pratishyaya

seems to be more scientific both from the understanding of the disease process. As

well as it’s treatment viewpoint. Su.Su.21/36

SAMPRAPTI GHATAKA:

- Nidana

- Dosha

- Dushya

- Srotas

- Srotodushti

- Agni

- Dosha Marga

- Roga Marga

- Udbhava Stahna

- Adhistana

- Pratyatma Lakshana

- Kapha, Vata Prakopaka Nidana

- Kapha, Vata, Alpa Pitta

- Rasa, Rakta

- Rasavaha,Raktavaha,Pranavaha

- Sanga,Vimarga Gamana,Ati Pravriti

- Jatharagni – Mandya

- Dhatwagni – Mandya

- Shakha

- Bahya

- Amapkwashaya

- Nasa

- Shirah

- Kphotklesha

- Ghrana Viplava

- Shirah Shoola,

- Nasa Avarodha,

- Swara Bheda etc.



Sadhyasadhyata (Prognosis)

Ayurveda gives a detailed general description of the prognosis as well as

Sadhya, Krichra Sadhya, Yapya and Asadhya stages of the diseases. The authorities

of Ayurveda mention that neglected case or improperly treated cases of Pratishyaya

may take the shape of Dushta Pratishyaya, which is Asadhya 38

Differential Diagnosis

The disease Vataja Pratishyaya has symptoms, which are found in other

nasagata roga. But it has some particular symptoms, which help in differentiating it

from other disorders mentioned in the table

Table No 7 Showing Lakhanas of Different types of Pratishyaya

Sl.No Lakshna PeenasaApeenasaVatajaPittajaKaphajaSannipatajaRaktaja

1 Nasa srava + + + + + + +

2 Anaddha - - + - - - -

3 Kshavathu - - + - - + -

4 Swaropaghata - - + - - - -

5 Shota - - - - + - -

6 Shirashula + - + - + + -

7 Danta toda - - + - - - -

8 Vedana + + - - - - -

9 Durgadha swasa - - - - - - +

10 Kandu - - + - + + -



Table No 8 Showing the Differential diagnosis of Allergic rhinitis

NON INFECTIVE INFECTIVE Findings Allergic Vasomotor Infective

Age at Onset Childhood Adulthood Childhood

Symptoms

Congestion Moderate Moderate Severe

Sneezing Frequent Rare Uncommon

Itching Usual Uncommon Itching

Rhinorrhea Profuse Profuse Profuse

Sore throat Slight Moderate Slight

Postnasal discharge Moderate Marked Marked

Anosmia Occasional Rare Rare

Physical Examination factors

Swollen turbinates Moderate to marked Moderate Marked

Character of secretions Watery Watery Thick viscid

Polyps Occasional Rare Frequent

Allergy Tests Usually positive Negative Negative

Associated Findings

Predominant cell in

secretions

Many esinophils Few neutrophils Few

Infection Occasional Rare Frequent

Rhinorrhea, itching, post-nasal discharge, congestion, etc. are common in all

the rhinitis, but by seeing the above factors we can differentiate AR from others by

below mentioned points.

Nasal secretion us watery

Bacteriological examination of fluid is rich in eosinophils

Blood examination show increased values of Absolute Eosinophil

count.

Marked foreign body sensation, congestion and Rhinorrhea are

found in Allergic Rhinitis.



CHIKITSA:

For a physician the ultimate goal of understanding and studying a disease is to

give treatment or to prevent it. The Chikitsa procedure brings the Dosha, Dhatu and

Mala homoeostasis making the patient symptom free. The Chikitsa breaks the

Samprapti and reduces the pain. Considering different aspects Chikitsa are of different

types.

Opinions differ between Charaka and Sushruta in the principle of treatment of

Pratishyaya. Sushruta has considered Pakwavastha and Apakwavastha in the

treatment of Pratishyaya and in the beginning he had mentioned various Upakrama for

the Pachana of Ama Dosha. But Charaka has given more emphasis on the Srotas

affected rather than Ama. He mentioned Shad vidha upakrama according to the Gati

of Dosha in the treatment of Pratishyaya. Sushruta also not neglected the theory of

Shad upakrama. Later on he also advised the necessity of Shad upakrama for the

purpose of Ama pachana karma. Generally it is seen that in certain conditions of

Pratishyaya there is prominence of Vata and Kapha along with Ama, there he advises

Shad vidha upakrama for the intention of Ama pachana karma.

From the treatment point of view the disease Pratishyaya is basically a

Santarpanotha vikara as Ama production and Kapha vikaras are inevitable part of its

Samprapti. Vata Dosha is an important factor in this disease pathology. So Brumhana

is also unavoidable in its treatment. The disease Pratishyaya is primarily originated

from Madhyama Roga marga as Murdha Roga comes under this category. But its

origin can also happen from Abhyantara Roga marga, because most of the diseases of

Pranavaha Srotas are originating from Abhyantara Roga marga. The treatment of this

disease should be bidirectional as indicated by its Dosha predominance as Kapha

Vata. Keeping all these points in mind we should systematize the treatment of

Pratishyaya



Table No 9 Showing the Chikitsa of Vataja Pratishyaya

Upakramas Charaka Sushruta Vagbhatta Chakradatta Ghritapana + + + + ShiroVirechana (Nasya)

+ + + +

Snigdha Dugdhapana + - - - Mamsarasa + - - - Dhumrapana + - - - Panisweda + - - - Upanaha + - - - Sankara Sweda + + + + Niruha Basti + - - -

During the treatment of Vataja Pratishyaya 391the Rogi – Roga bala has to be

taken in to special consideration. Pratishyaya associated with Rajayakshma will also

come under this category. Some of the powerful treatments like Virechana and

Vamana are not indicated, instead mild Shodhana therapies like Basti, Nasya and

Dhumapana should be given due importance. The chances of secondary immuno

deficiency are associated with Vataja Pratishyaya. So the Brumhana preparations like

Mamsa rasa gains special concentration.

Upadrava (Complications)

Upadrava is a disorder itself, big or small manifesting in the later period of a

disease and rooted in the same Dosha. Upadrava is so named because it appears after

manifestation of the disease. Thus disease is primary while complication is secondary.

The later is often pacified when the main disease is pacified. At it appears later it

becomes more afflicting because of the patient being already suffering from the

disease. Hence, one should overcome the complication quickly.

By going through the above references it may be concluded that,

Upadrava is produced from the main vitiated Doshas causing Pradhana

Vyadhi.

After some period, the Upadrava may become an independent disease and

pose more problems to the patient.

Generally the Upadrava will subside after the subsidence of Mula Vyadhi. In

some case separate treatment will be adopted to Upadravas.



All varieties of Pratishyaya, if not treated at the proper time, will ultimately

lead on to the incurable Dushta Pratishyaya. Later on white, smooth and minute

worms (maggots or other micro organisms) may appear in nose and the patient may

develop all the symptoms of Krimija Shiro roga 40

Sushruta says that all types of Pratishyaya may lead to the following

complications:

Badhirya (Deafness)

Andhata (Blindness)

Ghora nayana amaya (Severe eye diseases)

Kasa (cough)

Agnisada (Poor digestion)

Shopha (Swelling of the body)

PATHYA AND APATHYA

The food what we eat has effect on body in maintenance of health and causing

diseases. Medicine taken for any disease without following Pathya is of no use.

Pratishyaya too has specific Pathya and Apathya mentioned as follows.41

PATHYA

Snehana

Swedana

Shiro abhyanga

Purana yava

Purana Shali

Kulatha yusha

Mudga yusha

Gramya mamsa rasa

Jangala mamsa rasa

Vartaka

Kulaka

Shigru

Karkota

Balamulaka

Lashuna



Dadhi

Taptambu

Varuni jala

Trikatu

Katu,Amla, lavana,snigdha,ushna rasa

Laghu bhojana.

APATHYA

Snana

Krodha

Vegadharana (mala, mutra, adhovata)

Ati drava ahara

Bhumi shayya



ALLERGY

The word allergy was applied originally by Von Pirquest to any

alteration in the state of reactivity of an organism, due to contact with any organic

substance. Among other terms used to describe this condition are lethargy, atopy,

anaphylaxis, hypersensitivity and idiosyncrasy.

“Allergy” is an individual‘s sensitivity to a foreign substance that is usually

harmless. This substance, called an allergen or antigen, is introduced the immune

system by a number of different routes; either by ingestion, inhalation, injection, or

simply by touch. Allergy is the most personalized of diseases and can occur at any

point in an individuals; lifetime. Once an allergic individual’s immune system has

identified an antigen, it sets to work producing antibodies to defend itself. Normal

individuals produce immunoglobin G to ward off invaders. It does not cause an

allergic reaction. Allergic individuals also produce immunoglobin G. but – in addition

–they produce immunoglobin E, an antibody with a “memory” for specific substance.

Histamine, and related substances, cause allergic symptoms to occur. This is a vastly

simplified expansion of allergic reaction. There are many chemicals that become part

of the allergy chain.

An allergic reaction can occur almost anywhere in body. The

symptoms of the reaction often occur at the site of the reaction. Hence, the sneezing

and stuffy nose of allergic rhinitis, the stomach cramps of food allergy and the itching

rash of poison ivy. At other times, however, the symptoms may occur in a separate

part of the body. Allergic reactions to insect stings can cause hives, dizziness and

other symptoms. And any type of severe allergic reaction can cause systemic

symptoms that can be life threatening.

Diagnosing allergies is, at times, easy, and at other times, all but

impossible. A patient’s history and a physical examination, may suggest certain

allergies, which can usually be verified by testing. Other allergies, notably food

allergies are sometimes diagnosed by blood testing. Still others may require more

extensive diagnostic efforts. Skin tests are performed by injecting a small amount of

an allergen just under the skin. This test is no more painful than a mosquito bite, and

will usually give an indication within twenty minutes of application. Skin testing is

the most accurate type of diagnosis for most allergies.



Many allergic disorders go undiagnosed and untreated. While

physiological mechanizations of allergy are so deeply complex that modern day

medicine is still unlocking its secrets. We do have a basic and ever broadening

understanding of its workings, which enhances our methods of treatment.

Primary concern is successfully treating the allergy, once it is detected.

In principle, the best way to treat an allergy is to remove the cause. Sometimes this is

a practical solution and sometimes it is not. If the allergy is caused by a pet, down

pillow, wool sweater, or certain food, removal of the allergen will eliminate the

symptoms.

We may not wish to remove certain allergy-provokers, and others may

be impossible to eliminate from one’s environment. Limiting exposure will at best

reduce symptoms. Sometimes there is no better option than immunotherapy to reduce

or eliminate the misery of hay fever and other manifestations of allergy.

Immunotherapy – also known as “hypo sensitization” and “allergy

shots” – is helpful in most cases. Measured amounts of the identified allergens are

actually introduced into the patient’s system over a period of time through a series of

weekly injections. Though carefully measured doses, enough of the allergen is

injected to build immunity, but not enough to cause an unfavorable reaction to occur.

Doses are increased gradually, until a “maintenance” level is reached.

Immunotherapy is not a quick fix. It may take months – or even longer

– for decreasing sensitivity appreciably. In the meantime, there are medicines that

provide symptomatic relief. Antihistamines, decongestants, bronchodilators,

cortisone, and other drugs are prescribed as appropriate.

Allergies are hereditary, though the tendency to become allergic may

skip a generation, and go from grandparent to child. While in most individuals’

allergies first appear in the childhood years, and can wait until later stages of life.



ALLERGIC RHINITS

Allergic Rhinitis must be regarded as a serious condition, because it

can impact negatively on the quality of life of suffers not only by producing severe

symptoms but also by producing complications.

School and work related dysfunction is common. Since allergic rhinitis

occurs commonly and is still regarded by many as a trivial illness, it was considered

that management guidelines should be formulated to elevate the status of Rhinitis and

thereby to counteract it.

Definition:

Allergic Rhinitis is an inflammation of the nasal passages caused by

allergic reaction to airborne substances.42

Classification:

Allergic Rhinitis is often classified into two types; viz; Seasonal, perennial.

SEASONAL ALLERGIC RHINITIS:

Symptoms are usually precipitated through contact with seasonal wind-

borne pollens, e.g. grass and tree pollens or fungal spores. These symptoms usually

occur in spring, early summer and with the change of season.

PERENNIAL ALLERGIC RHINITIS:

Symptoms are due to sensitivity to and contact with allergens which

are present in the environment throughout the year. It is usually caused by home or

workplace airborne pollutants, while symptoms of perennial AR worst after spending

time indoors. These are usually indoor allergens such as hones – dust mites, animal

dander, feathers, fungal spares and cockroaches.

Other potential causes of perennial Allergic Rhinitis are:

Cigarette smoke,

Perfume,

Cleansers,

Copier chemicals,



Industrial chemicals, and

Construction material, gases etc.

Pathophysiology:

Like all allergic reactions, Allergic Rhinitis involves a special set of

cells in the immune system known as mast cells. Mast cells, found in the lining of the

nasal passages and eyelids, display a special type of antibody, called immunoglobulin

type E (IgE), on their surface. Inside, mast cells store reactive chemicals in small

packets, called granules.

After initial exposure to an antigen, antigen –processing cells

(macrophages) present the processed peptides to T –helper cells. Upon subsequent

exposure to the same antigen, these cells are stimulated to differentiate into either

more T helper cells or B cells. The B cells may further differentiate into plasma cells

and produce immunoglobulin E (IgE) specific to that antigen. Allergen- specific IgE

molecules then bind to the surface of mast cells, sensitizing them.

Further exposures resulting in bridging of 2 adjacent IgE molecules,

leads to the release of preformed mediators from mast cell granules. These mediators

(i.e. histamine, leukotrienes, kinins) cause early phase symptoms such as sneezing,

rhinorrhea and congestion. Late-phase reactions begin 2-4 hours later and are caused

by newly arrived inflammatory cells. Mediators released by these cells prolong the

earlier reactions and lead to chronic inflammations.

Aetiology :

(1) Age: Usually it affects young adults from the age of 15 years onwards,

and tends to recede after the age of 40 to50 years. It may affect young

children also.

(2) Sex: Both sexes are affected.

(3) Predisposing Factors:

i) Heredity: It may run in families. If both parents are allergic, there is a

high incidence of the disease occurs in children.

ii) Hormonal: Since the disease often begins at puberty and increases

during pregnancy, a hormonal basis is possible.

iii) Climate: Change in humidity, and atmospheric pollution may make the

nose more susceptible to allergy.



iv) Emotional: Psychological factors may affect the nose. This factor is

more likely in cases of vasomotor rhinitis.

(4) Precipitating Factors (Allergens):

The allergens are exogenous or endogenous:

(a) Exogenous (External agents):

(i) Inhalants (The commonest allergens) : Dust, pollens animal

Odour, feathers, moulds, house dust and mites.

(ii) Ingestants: Foods like eggs, fish, milk, citrus fruits.

(iii) Contactants like cosmetics and powders

(iv) Irritants like fumes and smoke.

(v) Drugs: Aspirin, hypotensive drugs, iodides and nasal drops.

(vi) Infection : Bacterial and products of inflammation may cause

allergy, or they may be secondary invaders.

(b) Endogenous (Within the body):

Intestinal helminthes, tissue proteins in transudates and exudates.

CLINICAL FEATURES

The diagnosis of allergic rhinitis is usually not difficult, in fact it is

often made by the patient or by the parents of the allergic child.

Allergic History :

For the physician who treats patients with allergic rhinitis, nothing is

more crucial than the allergic history, it is important not only in identifying an allergy

but also in guiding the treatment plan.

In assessing the relative importance of different allergens in patients

with allergic rhinitis, it is essential first to take a detailed environmental history,

which includes:

- A clear definition of the geographical location of the patient.

- Whether or not the patient has moved.

- Place of birth.

- Home environment, such as:

Carpeting,

Pets,



Smoking,

Trees, plants, grass,

Hobbies.

- Seasonality of symptoms

- Relationship of symptoms to:

Working conditions,

Diet

Indoors V. outdoors

Family History :

Children of individual with allergies have been shown to have a higher

incidence of allergies than that of other children.

If both parents have allergies, their child has a 50% chance of having the same

problem.

As Allergic Rhinitis commonly occurs in families, it is important to determine

a family background of rhinitis or of the other allergic conditions (asthma,

eczema, urticaria).

Past Medical History:

In children, a history of recurrent otitis media, upper respiratory tract

infection, asthma, chronic rashes and formula intolerance are suggestive

of allergies.

Other pertinent medical problems (e.g. asthma, aspirin hypersensitivity) and

the use of medications (e.g. beta-blockers, tranquilizers) that could interfere

with the treatment for allergies should be evaluated,

Inquire about the results of previous allergy tests and treatment.

General Symptoms :

- Coughing

- Headache

- Itching of the nose, mouth, eyes, throat, skin

- Runny nose (Rhinitis)

- Smell, impaired

- Sneezing , may be frequent



- Stuffy nose (Nasal congestion)

- Tearing, increased

- Throat, sore

- Wheezing.

The dominant complaints of allergic rhinitis are itching, frequent

explosive sneezing, profuse watery nasal discharge (runny nose or postnasal drip) and

nasal blockage.

Nasal obstruction is often a factor of the later stages of allergic

rhinitis, but is more commonly a result of other obstructing factors

within the nose, e.g. adenoidal hypertrophy in association with

allergic rhinitis.

Nasal blockage leads to a variety of other problems, Patients often

mention that they use a whole box of tissues every day

Patients with a chronically blocked nose uncommonly sneeze, they

may complain t very often hat their chronic symptoms improve due

to regression in sneezing and running nose

Itching can be intense, affecting the soft palate and the external

auditory canals. The palatal itch often causes sufferers to make

'clicking' noises as they attempt to rub the palate with the tongue.

including:

- recurrent sinusitis

- headaches

- disturbed sleep patterns with tiredness and irritability

- mouth breathing - children are often thirsty at night as a result of

mouth breathing, which causes drying of the lips and buccal mucous

membranes.

- Allergic conjunctivitis with itchy, watery eyes and photophobia usually

accompanies the nasal symptoms. In perennial Allergic Rhinitis, eye symptoms

and itch do not usually occur.



EXAMINATIONS

Face: Patients with Allergic Rhinitis do not have the so-called 'allergic facies' -

rather, they often have red, puffy faces with reddened, watery eyes. Their

conjunctivae are hyperaemic and granular.

Mouth breathing - many of these patients are constant mouth

breathers, sometimes displaying the so-called 'allergic gape'.

Patients can develop rather long, mournful faces. The palate is often high-

arched and narrow in these patients and dental crowding is common,

especially in young children. These features form the long-face syndrome.

Patients often pull their faces in various ways, often like rabbits, in

an attempt to open up their nasal passages.

Patients with Allergic Rhinitis frequently grimace and twitch their face, in

general, and nose, in particular, because of itchy mucus membranes.

Chronic mouth breathing secondary to nasal congestion can result in the

typical adenoid facies.

Eyes:

Patients may have injected conjunctiva; increased lacrimation; and long,

silky eyelashes.

Dennie-Morgan lines (creases in the lower eyelid skin) and allergic shiners

(dark discoloration below the lower eyelids) caused by venous stasis may

be present.

Ears:

Ears frequently are unremarkable.

Eczematoid otitis externa and middle ear effusion may be present.

Nose:

Nose - often appears swollen, reddened and shiny from constant

rubbing.

Nasal mucosa - examination of the nasal passages usually shows

severe swelling of the nasal mucous membrane and lower

turbinates with profuse secretions which range from clear to thick

mucoid:

Some textbooks often describe the colour of the mucous

membranes as grey or greyish-pink but this is extremely variable.



In many cases there is long-standing chronic inflammation of these

Mucous membranes, and the color is often dark red.

It is not unusual for the swollen anterior turbinate to obstruct the

nostril completely.

The 'allergic salute' may also be characterized by a side wards

rubbing of the nose.

Younger children cannot complain about their early symptoms, they

frequently present with later sequelae such as otitis media with effusion. It

is consequently important to recognise the presence of allergy at this age.

Very young allergic children are often seen rubbing their noses on sheets

and their mother's shoulders, even before the hands can find their way to

the nose.

Mouth :

A high arched palate, narrow premaxilla, and receding chin may be present

secondary to long-term mouth breathing.

Throat :

usually appears reddened with prominent lymphoid follicles on the

posterior pharyngeal wall.

Speech :may have a nasal quality and there may be loss of taste and smell.

INVESTIGATIONS

Skin Test :

Skin testing generally is considered to be the criterion standard of allergy workup.

The classic wheal-and-flare responses result from the interaction between the

antigen and sensitized mast cells in the skin.

In general, the acute phase starts within 2-4 minutes and reaches a maximum in

10-20 minutes. It may be followed by a late phase 4-6 hours later.

A number of factors affect the responses; these include the following:

Volume and potency of the antigen

Reactivity of the skin

Age and race of the patient

Area of body tested

Distance between the injections and time of day of testing



Medications (eg, antihistamines and tricyclic antidepressants)

Because of these variables, positive and negative controls must be used

to ensure the validity of the results.

In addition, patients receiving beta-blocker therapy are at risk for

severe

Reactions, and the drugs should be switched to another class of

Medication before testing is initiated.

Currently, 3 types of skin tests are in use.

1) Prick testing is rapid and safe, and scores are graded from 0-4 according to

both wheal and flare responses. However, low-grade sensitivities can be

missed. Therefore, the test often is used as a screening tool, which is followed

by intradermal testing if necessary.

It tests for immediate hypersensitivity and demonstrates an IgE-

mediated allergic reaction.

Certain factors such as drugs, age and the season may influence

the results.

In performing an SPT, the use of a large number of allergens is

expensive, time-consuming and usually not necessary. SPT

should initially be limited to the common aero-allergens in the

patient's environment.

2) Single-dilution intradermal testing involves injecting 0.01-0.05 ml. of antigen into

the epidermis. The resulting wheal and flare are measured after 10-20 minutes and

graded as in prick testing. This test can be used to detect most low-degree atopies if a

1:500 concentration is used. However, as with prick testing, it does not permit

accurate quantitation of the sensitivity to the antigen involved.

3) Progressive-dilution intradermal testing (skin endpoint titration) involves a series

of 5-fold dilutions, starting with a concentration that is sufficiently dilute to be non -

reactive. Progressively stronger concentrations are injected until a wheal forms. The

endpoint is confirmed when the wheal with the next stronger dilution is 2 mm larger

than the previous wheal. This endpoint indicates the relative sensitivity of the patient



to the allergen and designates the starting point for immunotherapy. This method

allows both qualitative and quantitative assessment of sensitivity to the antigen in

question.

Total Serum IgE :

In normal subject, levels of IgE increase from birth to adolescence and then

decrease slowly to reach a plateau after the age of 20 – 30 years.

In contrast to total IgE, which has a poor clinical correlation, antigen-specific

IgE antibodies are important in the diagnosis of inhalant allergy.

Compared with skin testing, in vitro testing is more specific less sensitive than

skin testing, especially in regard to molds. Also, the results are not available

immediately and must be verified with skin testing before immunotherapy can

be started.

The original method for obtaining an IgE count, the radio allegro sorbent test

(RAST), has evolved from a radioimmunoassay to a test that involves

enzymatic or fluorometric processes (eg, enzyme-linked immunosorbent assay

[ELISA]).

Fadal and Nalebuff have modified the test to increase its sensitivity and to

improve the correlation of its findings to those obtained with the skin endpoint

titration method.

Scores do not necessarily correlate with the severity of the clinical symptoms.

Although they can be used to establish the starting dose for immunotherapy, a

vial test still is required before immunotherapy can be initiated.

Phadiatop Test :

The Phadiatop test is a screening test using several inhalant allergens on a

single solid phase and therefore will detect specific IgE in a single assay.

It has an efficiency of over 95%, defining those individuals who need more

detailed investigation.22

It is less useful in children under 3 years old, in whom the CAP RAST F x 5

(6-foods test) is generally more useful, particularly if combined with total

serum IgE.



CAP RAST :

This test is useful when SPT are not available, e.g. in young children.

Doctors are advised not to send blood for this test without specifying

which allergens they require and are appropriate for their region.

Laboratories offer an extremely wide range of CAP RAST tests, and

failure to specify can make the cost to the patient unnecessarily high.

Nasal Smears :

Nasal smears may differentiate between allergic and infective rhinitis.

Eosinophils are characteristic of allergic form and non-allergic rhinitis

eosinophilia (NARES) is with neutrophils, which imply bacterial infection.

Specialist advice can be sought.

Imaging Studies:

No radiological studies are necessary in the evaluation of patients with

allergies because the diagnosis is made on the basis of the history and

confirmed with relevant physical findings and test results.

Imaging findings, if available for other reasons, usually are nonspecific and

may be the same as those in other types of rhino sinusitis (eg. mucosal

thickening, turbinate hypertrophy).

Plain x-rays

Despite advances in imaging technology, plain films still have a limited role to

play.

They are of most value in detecting the presence of acute infective

Processes.

The main limitations of plain films lie in the poor visualization of the

ethmoidal air cells, and the difficulty in distinguishing between infection,

polyps and tumours in a completely opacified sinus.

The standard sub-mento vertical (Waters) view will clearly show an air/fluid

level as well as a complicated septal deviation.

The frontal and ethmoidal sinuses are more clearly shown in the postero-

anterior (Caldwell) view.

The density of the orbital cavity correlates with the normal frontal and



ethmoidal sinuses.

Problematic areas like the ostiomeatal complexes are not shown in any of

these views.

They are also not of use in very young children as the sinuses are not fully

aerated - 75% of children aged less than 1 year will therefore have opaque

maxillary sinuses.

The adenoidal fat pad is best visualized in the lateral view, but plain X-rays

are not adequate to assess the posterior nasal space.

CT Scanning

CT scanning should be reserved for complicated sinusitis and as part of surgical

planning.

It has become the imaging modality of choice for clearly viewing the

anatomical and pathological changes present in the sinuses.

The key area, the ostiomeatal complex, is clearly shown, as are all the other

changes in the sinuses if coronal views are requested.

Concern has been expressed about the radiation exposure during CT scanning.

Although the radiation dose to the lens of the eye is higher than that for plain

films, it is still well within safety limits.

Endoscopy of The Nose In Allergic Rhinitis:

Endoscopes can either be rigid or flexible. Most otolaryngology practices are

fitted out with either a rigid scope or a flexible scope.

Endoscopy is relatively easy in adults but is difficult in children, in whom its

use is therefore limited.

Endoscopy of the nose in allergic rhinitis not only helps to show the typical

mucosal findings but also allows determination of additional pathology, e.g.

polyps in the middle meatus or associated anatomical factors which may affect

the treatment of allergic rhinitis, e.g. septal deviation.



Cytotoxic Test :

Nasal cytological studies may be needed.

Nasal secretions are stained with hematoxylin and eosin.

In general, the presence of eosinophils and goblet cells is suggestive of

allergy, whereas the presence, and it is not affected by skin reactivity or

medications. It also has no risk of systemic reaction and is better tolerated,

because it is less traumatic. However, in vitro testing is of neutrophils and

bacteria is characteristic of infection.

Other Tests:

Many other alternative tests for allergies are available,

but they have not been fully validated yet.

o Basophilic histamine – release test.

o Leukocyte antibody test for related antigens.

PROGNOSIS

Most people with AR can achieve adequate relief with a combination

of preventive strategies and treatment. While allergies may improve over time, they

may also get worse or expand to include new allergens. Early treatment can help

prevent an increased sensitization to other allergens.

MEDICAL CARE

The 3 basic approaches for the treatment of allergies are (1) avoidance,

(2) pharmacotherapy, and (3) immunotherapy. Treatment should start with avoidance

of allergens and environmental controls. In almost all cases, however, some

pharmacotherapy is needed because the patient is either unwilling or unable to avoid

allergens and control occasional exacerbations of symptoms. For patients with a

severe allergy that is not responsive to environmental controls and pharmacotherapy

or for those who do not wish to use medication for a lifetime, immunotherapy may be

offered.



1)Avoidance of Allergens And Environmental Controls

Patients who have seasonal allergies should avoid outdoor activities when

allergens are in the air. The patient’s house and workplace should be kept as

clean as possible.

House dust mites thrive in warm humid conditions, and the antigen is found in

their feces. Control measures include removing reservoirs (eg, stuffed animals,

carpets, heavy drapes), covering bedding with dust-mite–proof covers, and

washing potential reservoirs in hot water. Frequent vacuuming with a high-

efficiency particulate-arresting (HEPA) vacuum and use of acaricides (eg,

benzyl benzoate) and products that denature dust mite antigen (eg, tannic acid)

are encouraged. In addition, lowering the relative humidity to less than 50% and

lowering the temperature to less than 70°F are helpful in controlling the dust

mite population.

If removing pets is not feasible, they should be kept outdoors or, at least, out of

the bedroom. Also, frequent vacuuming with an HEPA vacuum and washing the

animals are helpful in decreasing the allergen load.

Molds are present throughout the year in damp areas, both indoors and outdoors.

Attention should be paid to reservoirs such as refrigerator drip pans, areas

around air conditioner condensers and under sinks, indoor plants, and decaying

vegetation in the yard. The use of a dehumidifier and an HEPA air-filtration

system also is encouraged.

Prevention:

Reducing exposure to pollen may improve symptoms of seasonal AR.

Strategies include the following:

Stay indoors with windows closed during the morning hours, when pollen

levels are highest.

Keep car windows up while driving.

Use a surgical face mask when outside.

Avoid uncut fields.

Learn which trees are producing pollen in which seasons, and avoid forests

at the height of pollen season.



Wash clothes and hair after being outside.

Clean air conditioner filters in the home regularly.

Use electrostatic filters for central air conditioning.

Moving to a region with lower pollen levels is rarely effective, since

new allergies often develop.

Preventing perennial AR requires identification of the responsible

allergens.

Mold spores:

Keep the house dry through ventilation and use of dehumidifiers.

Use a disinfectant such as dilute bleach to clean surfaces such as bathroom

floors and walls.

Have ducts cleaned and disinfected.

Clean and disinfect air conditioners and coolers.

Throw out moldy or mildewed books, shoes, pillows, or furniture.

House dust :

Vacuum frequently, and change the bag regularly. Use a bag with small

pores to catch extra-fine particles.

Clean floors and walls with a damp mop.

Install electrostatic filters in heating and cooling ducts, and change all

filters regularly.

Animal dander:

Avoid contact if possible.

Wash hands after contact.

Vacuum frequently.

Keep pets out of the bedroom, and off furniture, rugs, and other dander-

catching surfaces.

Have your pets bathed and groomed frequently.



2)Pharmacotherapy

Antihistamines:

Antihistamines block the histamine receptors on nasal tissue,

decreasing the effect of histamine release by mast cells. They may be used after

symptoms appear, though they may be even more effective when used preventively,

before symptoms appear. A wide variety of antihistamines are available.

Older antihistamines often produce drowsiness as a major side effect.

Such antihistamines include the following:

Diphenhydramine (Benadryl and generics)

Chlorpheniramine (Chlor-trimeton and generics)

Brompheniramine (Dimetane and generics)

Clemastine (Tavist and generics).

Newer antihistamines that do not cause drowsiness are available by

prescription and include the following:

Astemizole (Hismanal)

Loratidine (Claritin)

Fexofenadine (Allegra)

Azelastin HCl (Astelin).

Hismanal has the potential to cause serious heart arrhythmias when

taken with the antibiotic erythromycin, the antifungal drugs ketoconazole and

itraconazole, or the anti malarial drug quinine. Taking more than the recommended

dose of Hismanal can also cause arrhythimas. Seldane (terfenadine), the original non-

drowsy antihistamine, was voluntarily withdrawn from the market by its

manufacturers in early 1998 because of this potential and because of the availability

of an equally effective, safer alternative drug, fexofenadine.

Decongestants:

Decongestants constrict blood vessels to counteract the effects of

histamine. Nasal sprays are available that can be applied directly to the nasal lining

and oral systemic preparations are available. Decongestants are stimulants and may

cause increased heart rate and blood pressure, headaches, and agitation. Use of topical

decongestants for longer than several days can cause loss of effectiveness and



rebound congestion, in which nasal passages become more severely swollen than

before treatment.

Topical corticosteroids:

Topical corticosteroids reduce mucous membrane inflammation and

are available by prescription. Allergies tend to become worse as the season progresses

because the immune system becomes sensitized to particular antigens and can

produce a faster, stronger response. Topical corticosteroids are especially effective at

reducing this seasonal sensitization because they work more slowly and last longer

than most other medication types. As a result, they are best started before allergy

season begins. Side effects are usually mild, but may include headaches, nosebleeds,

and unpleasant taste sensations.

Mast cell stabilizers :

Cromolyn sodium prevents the release of mast cell granules, thereby

preventing release of histamine and the other chemicals contained in them. It acts as a

preventive treatment if it is begun several weeks before the onset of the allergy

season. It can be used for perennial AR as well.

Alternative treatment :

Alternative treatments for AR often focus on modulation of the body's

immune response, and frequently center around diet and lifestyle adjustments.

Chinese herbal medicine can help rebalance a person's system, as can both acute and

constitutional homeopathic treatment. Vitamin C in substantial amounts can help

stabilize the mucous membrane response. For symptom relief, western herbal

remedies including eyebright (Euphrasia officinalis) and nettle (Urtica dioica) may be

helpful. Bee pollen may also be effective in alleviating or eliminating AR symptoms.

3) Immunotherapy

Immunotherapy, also known as desensitization or allergy shots, alters

the balance of antibody types in the body, thereby reducing the ability of IgE to cause

allergic reactions. Immunotherapy is preceded by allergy testing to determine the

precise allergens responsible. Injections involve very small but gradually increasing

amounts of allergen, over several weeks or months, with periodic boosters. Full

benefits may take up to several years to achieve and are not seen at all in about one in

five patients. Individuals receiving all shots will be monitored closely following each



shot because of the small risk of anaphylaxis, a condition that can result in difficulty

breathing and a sharp drop in blood pressure.

Immunotherapy is indicated in patients whose symptoms are not well

controlled with avoidance measures and pharmacotherapy. It also is

appropriate for those with symptoms lasting more than 1 season and

documented allergen-specific IgE antibodies.

Immunotherapy should be considered only in individuals who can comply

with weekly injections for approximately 3 years.

Immunotherapy should be avoided in those receiving beta-blockers and those

who have poorly controlled asthma, autoimmune disorders, or

immunodeficiency disorders.

During pregnancy, injections should not be initiated, and doses should not be

increased.

Although the exact mechanisms of immunotherapy are not known, they are

associated with decreased allergen-specific IgE levels and increased allergen-

specific immunoglobulin G (IgG) levels. These IgG molecules are thought to

be blocking antibodies that are important in impeding the allergic reaction.

Immunotherapy involves regular injections (every 5-7 d) of increasing

amounts of each reacting allergen until the symptoms are relieved or the

maximum tolerated dose is reached, at which time a maintenance dose is given

every 2-4 weeks. This dose is maintained until symptoms are controlled for 2-

3 seasons and then tapered.

Although systemic reactions are rare when immunotherapy is properly

administered, only qualified personnel should give injections, and resuscitative

equipment should be available.

Surgical Care:

Although Allergic Rhinitis is a medical condition, adjunctive surgery may be

offered to alleviate obstructive symptoms in appropriate individuals. Examples

are nasal polypectomy in the patients who have severe polyposis and various

inferior turbinate reduction maneuvers in patients who have nasal obstruction

caused by persistent turbinate hypertrophy that persists despite maximal

medical therapy.



Diet:

Food allergies can cause nasal symptoms similar to those caused by inhalant

allergies. Therefore, a workup for possible food allergies should be considered

if the patient has a history of food reactions, if findings of the inhalant allergy

evaluation are negative, and if appropriate treatments fail to yield

improvement.



PRATIMARSHA NASYA

Ayueveda is the only system of medicine, which proposes the need of undertaking the purification of biological system from gross channels upto molecular levels aiming to clear the entire body of vitiated factors, which render prevention of disease & promotion of health.

Nasya is one such purificatory procedure in order to prevent, control & cure,

the urdhwayatrugata rogas as nasa is the door to shiras. 43

Any medication administered through nose to get desired therapeutic effort is

known as nasal insufflation or nasya therapy. The medicaments used for nasya

includes oils (medicated), powders possessing irritant effect on nasal mucosa 44

Nasya is an important procedure explained under vaiyaktika Swasthavritta as

one of the cleaning process for channels in head and neck region.

Different types of nasya procedures are mentioned on the basis of its action,

and doses of medicine.

NASYA KARMA

The word Nasya karma is composed of two words (1) Nasya (2) Karma

Nasya : - “ Nas” is substituted for Nasa when it is followed by the suffix “Yath”

Nasika + Yath = Nasadeshancha

Nasika Yai hitam = Nasya

In vacharpathyam, the word Nasya has been defined as the one which is administered

through the nose 45

Nasya is a method by which either the medicated tail (oil) or churna (powder)

will be introduced through the nasa marga.

In shadbdakalpa druma the scope of nasya is elaborately mentioned by

including churnas etc. It is further explained, “the medicine which is administered

through nasa in particular is known as nasya”.



The medicine or medicated oils which are being employed through nose is

called nasya. Acharya Susrutha gives this version. Arunadatta in his commentary of

Sarvanga Sundari explains as “ Nasayam Kriyate Eti Nasyam” 46

Chakrapani explains that “ Nastha Prachardanam Eti Shirovirechanam”.47

Considering all the above said definitions Nasya can be defined as “ that

which is administered through the nose by using the medicines to alleviate Jatrurdhva

vikaras in particular.

Synonyms for Nasya: -

Following are the synonyms for Nasya.

Shiroverechana

Shirovireka

Moordhavireka

Navana

Nasthakarma

Nastham

Navanam

Prachardhanam

Shirovirechana

KARMA : -

The word karma is used in different contexts giving various meanings. These are

Denoting daiva or poorvadaihika karma

Dravya karya

Prayatna and

In the meaning of chikitsa



Karma (Na) is derived according to adhruchadi sootra by adding “manin”

pratyaya to “Kru” dhatu. The action done by Kartru according to his will is known as

Karma.

Synonyms of Karma : -48

Kriya

Karmayatna

Karya samarambha

Prayatna

The treatment of the disease done with nasya is called Nasya Karma here

karma is used in the meaning of Chikitsa

Classification of Nasya Karma : -

Nasya karma is classified in many ways by different authors. Based on the

forms of medicine used, the mode of action of the drugs or the Karmukata, and the

quantity of medicine used.

Classification according to CHARAKA 49

SHODHANA NAVANA NASYA

SNEHANA

AVAPEEDA NASYA SHODHANA

STAMBANA

DHMAPANA NASYA

PRAYOGIKA

VIRECHANKA DHOOMA NASYA

SNEHIKA

SNEHA PRATIMARSHA NASYA

VIRECHANA



Classification according to KARMUKATA

1.Rechana

2.Shamana

3.Tarpana

Classification according to SUSHRUTHA 50

Shirovirechana

Snehana

Further Classification on the basis of above said varieties :

Nasya

Shirovirechana

Pratmarsha

Avapeeda

Pradhamana

Classification According to VAGHBATA 51

Virechana

Brahmana

Shamana

Classification according to KASHYAPA 52

Brahmana

Karshana

Classification according to BHOJA

Prayogika

Snehika

Classification according to SHARANGADHARA 53

Rechana Or Karhsana

Snehana Or Brumhana



Classification according to VIDEHA

Sanjna Prabhodaka

Stambana

Classification according to Its MATRAS 54

Marsha

Pratimarsha

Among all the classifications, some words DENOTE the same meaning. For

example Rechana, Karshana, Shirovirechana and Virechanika does the same action of

“VIRECHANA NASYA “ and they can be taken as synonyms for Virechanana Nasya.

In the same manner Tarpana, Pratimarsha, Marsha, Seka as the synonyms of

BRIMHANA NASYA.

After going through all the above classifications that mentioned in Charaka

Samhita is considered as more appropriate

As this study is on pratimarsha nasya more attention is being paid on this procedure.

Nasya can be advised in a person for treatment as well as prevention of

diseases. Marshs nasya is usually preffered as treatment for many urdhvajatru Vikara,

where as pratimarsha nasya has significant role in the prevention of all those disorders

and promotion of health of sense organs.

Pratimarsha nasya is given importance in daily regimen in Swastha persons

|A. Ra on 2/6| advised to practice it in order to get protection from urdvajathru Vikara

apart from it, in improving oral hygiene, strengthening dentures and improving visual

perception etc.

Marsha & pratimarsha are classified only on the basis of sneha matra i.e

number of oil drops used for administration.

According to acharyas pratimarsha snehamatra is only two drops in each

nostril. Where as 10,8,6 drops in marsha as uttama, madhayama & Hina snehamatra

respectively.55



Pratimarsha & marsha nasya both have equal benefits, advantages and

disadvantages. There is no fear of Vyapat or adverse effects in pratimarsha nasya.

Mrasha nasya is fast acting in nature ,where as pratimrasha is slow in its action, there

is no increase of doshas in the pratimarsha nasya. Whereas marsha increase the doshas

which leads to certain complications if improperly practiced. 56

Pratimrasha nasya is ideal for the persons who are kshaama, kshata, trishna,

mukha shosha, vriddha, bala, bhiru, sukumara, in varsha rutu and durdina. It should

not be administered in persons suffering from dusta pratishyaya,in bahudosha,

affected with krimi in shiras, madyapita & who have weak hearing, because of sudden

increase of doshas in such people. 57

The benefits of pratimarsha nasya freshens the mouth, easy respiration, clarity

in sense organs perception, untimely graying of hair can be prevented by practicing it

everyday.

As many as 14 different periods in a day are mentioned for administration of

patrimarsha nasya which is depicted in the table. 58

The marsha Nasya is a lengthy procedure requiring Purva karma, Pradhana

karma, paschat karma which are to be performed in nivata sthana .Where as

pratimarsha nasya is a simple procedure which can be per formed by oneself without

restrictions and even parihara is also not required.

The quantity of oil applied to the nostrils which reaches the throat is said to be

considered as ideal dose, but does not require spitting 59

To summarize pratimarsha nasya it is just like matra basti which is suitable for

all, from birth to death, and bestows same benefits as those result from Marsha, if

implemented daily.



Table No 10 Showing Benefits Of Pratimarsha Nasya With Justification

Sl. No.

Indication/Time of nasya Benifit

1 Early morning Accumulated kapha(at night) gets cleard 2 After brushingthe teeth Teeth becomes strong and mouth becomes

fresh 3 While out from home Prevents dust and smoke allergy 4 After coitus Relieves tiredness and weakness 5 After tired needs due to

walking Relieves tiredness and weakness

6 After Kavala Graha Improves vision 7 After Anjana Improves Vision 8 After meals Sroto shuddhi 9 After Vamana Kapha shodhana,Improves taste 10 After sleeping in day time Prevents Kapha vruddhi,gives mental peace 11 In the evening Gives sound sleep at night 12 After exercise Relieves the tiredness and wakness 13 After urination Improves vision 14 After defecation Improves vision Table No 11 Difference Between Marsha Nasya And Prathimarsha Nasya

Sl.

No.

MARSHA NASYA PRATHIMARSHA NASYA

1 Sneha dravyas are used Sneha dravyas are used 2 Dose of the medicinal drug used

differs (Quantity differs) Dose of the medicinal drug used differs (Quantity differs)

3 Mode of administration same Mode of administration same 4 Shodhana Mode of action Shamana Mode of action 5 Does the action of snehana Does the action of snehana 6 6, 8, 12 Bindu prmana is advised

in Heena, Madhyama & Uttama matra respectively.

But here it is only 2 Bindus and no demarkations like Heena, Madhyama & Uttama matra.

7 Ashukari Chirakari 8. Sometimes complications may

arise. No complications

9. Is indicated in the patients who are strong and able to sustain.

It is advocated in ksheena, vriddha, bala, sukumara and stree, in any age group & in any seasons

10 Parihara is required Parihara is not required



ANU TAILA

Anu taila is indicated extensively in treating various ailments pertaining to

Urdvajathru pradesha. Apart from treatment of diseases, it also used daily in Pratimarsha nasya .

Anu taila when used in the form of Pratimarsha nasya for a long period has beneficial effects like keshya, kantya 60 etc. The word meaning of Anutaila tells that it reaches to minute channels of the body . Anati sukshmatvam gacchati…Shabdhakalpadruma

Anu taila contains over twenty-seven drugs processed in tila taila and ajaksira. The drugs and preparation of the oil is discussed in detail. PREPARATION

All the drugs mentioned are taken in prescribed quantity as per classics and subjected to sneha paka. Drugs 1 part Oil 2 parts Goats milk 6 parts Water 100 parts

The procedure is carried out as per sneha kalpana mentioned for Anu taila and the desired product is obtained 61| The beneficiary effects of Anutaila are mentioned in the table Table no 12 showing Benefits of Anutaila

Sl.No. Benefits Cha A.S A.H 1 Tridoshara (passifies tridosha) + + + 2 Indriyabalaprada(strengthens sense organs) + + + 3 Keshya (blackens the hair) + - + 4 Twachya(good for skin) - + + 5 Prinana (nourishes) - + + 6 Brimhana (nourishes) - + + 7 Asya (removes bad breath) - - + 8 Vakshya (strengthens shoulder region) - - + 9 Greevya (strengthens neck region) - - + 10 Kantya (good for throat ) - + -




65

Table no 13 showing Drugs mentioned for Anutaila by different authors

Sl.No Drugs A.H. A.S. Cha1 Jivanthi + + + 2 Jalada + - - 3 Devadaru + + - 4 Musta + + - 5 Twak + + + 6 Ushira + + - 7 Sariva + + + 8 Chandana + + + 9 Darvi + + + 10 Madhuka + + + 11 Agaru + + + 12 Haritaki + + + 13 Vibhitaki + + + 14 Amlaki + + + 15 Prapoundarika + + + 16 Bilva + + + 17 Utpala + + + 18 kantakari + + - 19 Shallaki + + + 20 Shalparni + + + 21 Prishnaparni + + + 22 Vidanga + + + 23 Patra + + + 24 Ela + - + 25 Nirgundi + - + 26 Padmakesara + + + 27 Bala + + + 28 Manjista - + - 29 Rishabaka - + - 30 Kakoli - + - 31 payasya - + - 32 Ananta - + - 33 Rasna - + - 34 Madhuparni - + - 35 Mundi - + - 36 Meda - + - 37 Kakanasha - + - 38 Sarala - + - 39 Sala - + - 40 Atibala - + + 41 Hribera - + + 42 Vanya - + + 43 Shatavari - - +


DRUG REVIEW Table No 14 Showing pharmacological action of drugs mentioned for Anutaila

Drugs Latin name Family Parts used

Doshagnata Rasa Guna Virya Vipaka Vishista karma

Rogagnata

1 Jeevanti Leptidenia reticulata

Asclepidaceae Mula Vatapitta shamaka

Madura Laghu snigdha

Shita Madura Chakshushya Daha Raktapitta

2 Jala Pavonia odorata

Malvaceae Mula Tridosha shamaka

Tikta Kasaya

Laghu Ruksa

Shita Madura Hridya Raktapitta

3 Devadaru Cedrus deodara

Pinaceae Kanda sara

Kaphapitta shamaka

Tikta Laghu Snigdha

Ushna Katu Shodana Vibhanda Adhmana

4 Musta Cyperus rotundus

Cyperaceae Kanda Kaphapitta Shamaka

Tikta Katu

Laghu Ruksha

Shita Katu Dipana Pachana

Jwara Trishna

5 Twak Cinnamonum zylanica

Lauraceae Twak Patra

Kaphapitta shamaka

Tikta Katu

Laghu Ruksha

Ushna Katu Sangrahi Pinasa Kasa

6 Ushira Vetveria ziziniodis

Graminae Mula Kaphavata shamaka

Tikta Madura

Laghu Ruksha

Shita Katu Rasayana Pachna

Daha Jwara

7 Chandana Santalam album

Santalaceae Twak Kaphapitta shamaka

Tikta Madura

Laghu Ruksha

Shita Katu Ahladakara Shosha Daha

8 Darvi Beberis Aristata

Berberidaceae Mula Kanda

Kaphapitta shamaka

Tikta Kasaya

Laghu Ruksha

Ushna Katu Chakshushya Vrana shodana

9 Madhuka Madhuka indica

Sapotaceae Puspa Bija

Vatapitta samaka

Madura Kasaya

Guru Snigdha

Shita Madura Balya Keshya

Daha Raktapitta

10 Agaru Aquilaria agallocha

Thymelaceae Kanda sara

Kaphavata shamaka

Tikta Katu

Laghu Ruksha

Ushna Katu Twachya Jwara Swasa

11 Sariva Hemidesmus indicus

Asclepidaceae Mula Kaphavata shamaka

Madura

Guru

Shita Madura Sangrahi Raktapitta

12 Haritaki Terminalia chebula

Combretaceae Phala Tridosha hara Pancharasa Laghu Ruksha

Ushna Madura Sangrahi rasayana

Pratishyaya Swarbheda

13 Vibhitaki Terminalia bellirica

Combretaceae Phala Tridosha hara Kasaya Laghu Ruksha

Ushna Madura Keshya chakshushya

Agnimandya

A study on Pratimarsha Nasya in Prevention of Pratishyaya 66



67

67

14 Amlaki Emblica officinalis

Euphorbiaceae Phala Tridosha hara Pancharasa Guru Ruksha

Shita Madura Keshya chakshushya

Meha

15 Pundra Nelumbo nucifera

Nymphaceae Puspa Kaphapitta shamaka

Kasaya madura

Laghu snigdha

Shita Madura Stambana Kasa

16 Bilva Aegle marmelos

Rutaceae Phala Mula

Kaphavata shamaka

Kasaya Tikta

Laghu Ruksha

Ushna Katu Rasayana Pratishyaya Swarbheda

17 Utpala Nymphaea nouchali

Nymphaceae Puspa bija

Kaphapitta shamaka

Kasaya madura

Laghu Snigdha

Shita Madura Sangrahi Raktapitta Atisara

18 kantakari Solanum Surmttence

Solanaceae Panch- -anga

Kaphavata shamaka

Tikta Katu

Laghu Ruksha

Ushna Katu Dipana Kasa shwasa

19 Shallaki Boswellia serrata

Burseraceae Twak Kaphapitta Shamaka

Kasaya Tikta

Laghu Ruksha

Ushna

Katu Medhya Grahi

Kasa shwasa

20 Shalparni Desmodium Gangiticum

Leguminosae Panch- Anga

Tridosha Hara

Madura Tikta

Guru Snigdha

Ushna Madura Brimhana Kasa shwasa

21 Prishnaparni Uraria picta Leguminosae Mula Tridosha Hara

Madura Tikta

Laghu Snigdha

Ushna Madura Sangrahi Vrishya

Kasa Shwasa

22 Vidanga Emblia ribes Myesinaceae Phala Kaphavata Shamaka

Katu Kasaya

Laghu Tiksna

Ushna Katu Krimigna Shula Adhmana

23 Patra Cinnamonum tamala

Lauraceae Twak Patra

Kaphapitta shamaka

Tikta Katu

Laghu Ruksha

Ushna Katu Sangrahi Pinasa Kasa

24 Ela Elattaria cardamom

Lauraceae Bija Tridosha Hara

Katu Madura

Laghu Ruksha

Shita Madura Rochana Pachna

Kasa shwasa

25 Nirgundi Vitex nigundo

Vebinaceae Bija Kaphavata Shamaka

Katu Tikta

Laghu Ruksha

Ushna Katu Dipana Kasa

26 Bala Sida cardifolia

Malvaceae Mula Vatapitta Shmaka

Madura Laghu Snigdha

Shita Madura Grahi Balya

Raktapitta Urasshata

27 Manjista Rubia cardifolia

Rubiaceae Mula Kaphapitta Shamaka

Tikta Kasaya

Guru Ruksha

Ushna Katu Varnya

Review of Literature 68

Prevention of Allergic rhinitis

Life without disease in present days is impossible for innumerable reasons.

But it is possible to prevent the occurrence of diseases if one inculcates the habit of

leading well disciplined life imbibing good principles of healthy living.

Prageva prati kurvanti rogebhyah sukha kamibihi |Rigveda|

Content of above verse that prevention is better than cure is the need of hour

Ayurveda is the science of life where it describes health as equilibrium of

physiological activities including social and spiritual well being of a person and not

mere absence of disease.62

The ultimate goal of life is to achieve moksha and the tool to achieve moksha

is health. To stay healthy and to prevent diseases one need to follow charya traya.63

Allergic rhinitis is one such disorder, which can be prevented easily with

principles of positive health mentioned in our science. The best way of prevention of

Allergic rhinitis is to avoid exposure to the factors. However it is not always possible

to take utmost prevention.

Dinacharya or daily regimen teaches us the way one should start and end the

day. If one follows the dinacharya he can develop strength to prevent disease

occurrence. Nasya is one such procedure explained in dinacharya to prevent the

diseases of the urdvajatru bhaga and to maintain the health of sense organs.

Pratimarsha nasya is a simple procedure which can be practiced by one by

himself, which consists of instilling of two drops of medicated oil into each nostril

everyday. If one practices this, gets protection from dust, smoke etc which causes

allergic rhinitis.

Everything in the cosmos starting from planets down to the minutest substance

undergoes changes in the atmosphere as per changes of climate. Seasons should

follow a definite order but now a days the manifestation of seasons are not very

regular and this forms the important cause of the diseases. So acharyas have stressed


Review of Literature 69

for periodical shodana and regimen to overcome the ill effects of seasons under

Ritucharya.64

Season surely has its influence in causing and aggravating .the seasonal

Allergic rhinitis which is precipitated through contact with seasonal wind born pollens

or fungal spores which is a common feature in Vasanta ritu. One can protect from

these agents by applying nasal drops everyday and indulging in such of the ahara

vihara which will not aggravate the condition.

Rasayana is that which provides optimum quality to the bodily tissues due to

which it provides both mental and physical health. Consuming of nitya sevaniya ahara

containing triphala, madhu etc may strengthen the body system against diseases by

removing free radicals because of their anti- oxidant property. Eg –Amalaki

Rasayana.

Alternative therapies for prevention

Pranayama & Allergic rhinitis

Pranayama 65 is nothing but control over the breath. By practicing it one can

regularize the breathing. Our body requires oxygen in varied quantity in different

conditions, which can be regulated by practicing pranayama. Regular practice of

pranayama has very good affect on nasal mucosa. It hyposensitizes the nasal mucosa

whenever foreign body comes in contact with it.

Different types of pranayama like kapalabhati, suryanulomaviloma,

chandraanulomaviloma, nadishuddi may prevent the Allergic rhinitis and effectively

over come the symptoms of the same.

Kriyas 66

Kriyas are cleansing practices. Yoga kriyas refer to special yoga techniques

developed by yogis to cleanse the body. They are totally six in number meant for

cleansing different channels of the body. Among them Neti is once such procedure

meant for strengthening and cleansing of nasal passages.

Neti is of 2 types :-

1. Jala Neti


Review of Literature


70

2. Sutra Neti.

Jala Neti is a process where in Luke warm water is made to pass from right

nostril to left nostril by using Neti pot. The process is repeated with left to right also.

Sutra Neti is a process in which soft rubber catheter or thread lubricated with

ghrita or taila is passed through each nostril separately pushed through the mouth to &

for movement in made.

If neti practiced regularly

Cleanses the nasal passages.

Desensitizes nasal mucosa to dust and pollution.

Hence one can prevent A.R by practicing Neti. Instillation of Ghee and milk

drops; honey mixed with water may also be used in different types of nasal allergic

disorders according to yogic scriptures.

Naturopathy and Allergic rhinitis

Naturopathy is a system of medicine in which diseased conditions are

prevented and treated by adopting principles of five elements available in nature.

Among five basic elements one is water by which hydrotherapy is given. To

prevent Allergic rhinitis one should undergo facial sauna once in a week. Facial sauna

is a procedure in which steam is inhaled through nostrils for a short period by which

nasal passage is cleared and adherings to the mucosa are removed.67

It is rightly said, “Prevention is better than Cure.” so allergic rhinitis also can

be prevented. The best way one can prevent Allergic rhinitis is by avoiding exposure

to the causative factors.

It is up to the people to adopt such principles in life by all possible ways to

live healthy. And prime duty of doctors is to create AWARENESS about it.

Material & Methods 71

MATERIAL & METHODS

Allergic rhinitis occurs due to immediate hypersensitivity reaction in nasal

mucosa to the antigen concerned in seasonal form like pollen of grass, dust etc.

Pratimarsha Nasya can be performed with anutaila daily by patient himself at home.

This study is planned to evaluate the role of anutaila administered in the form of

Pratimarsha Nasya in prevention of reoccurrence of allergic rhinitis.

Objectives Of The Study

1. To evaluate the role of Pratimarsha nasya as preventive procedure for

allergic rhinitis.

2. To study the overall effects of Anutaila Pratimarsha nasya in long-term

duration.

Hypothesis

Hypothesis for the study – Pratimarsha nasya with anutaila is effective in

allergic rhinitis.

Materials

Anutaila was procured from Kumar Ayurveda Ashram. Bangalore where it was

prepared as per classics.

Source Of Data

20 patients of recurrent rhinitis, who complained of watery nasal discharge,

increased sneezing, obstruction of nasal passages, were randomly selected irrespective

of religion, sex, race and socio-economical status from the OPD and IPD of

SDMCAH for the study. The patients having the history of allergy to dust, pollen

grains, and environmental variations were also included in the study.



Grouping

A single group consisting of 20 patients administered with anutaila

Pratimarsha nasya daily for a period of 2 months.

Study Design

It is a clinical study with pretest and post test design

Procedure of Pratimarsha nasya

The procedure of PN is very simple and patients were taught to instill two

drops of Anutaila everyday morning and evening to both nostrils and to spit the oil

when it reaches the throat.

Diagnostic criteria

- Repeated bouts of sneezing.

- Profuse watery nasal discharge.

- Careful history revealing patient allergic to specific allergens.

Inclusion Criteria.

- Patients who are already diagnosed of suffering with allergic rhinitis.

- Patients who are suffering with recurrent rhinitis for at least 1yr duration.

Exclusion Criteria

Patients below 17 years of age.

Allergic rhinitis associated with other systemic disorders.

Patients who require surgical intervention.

INVESTIGATIONS

TC. DC.

AEC

X -Ray where ever necessary



Assesment Criteria

Improvement was assessed once in 15 days with following subjective

parameters for two months, but efficacy was tested only after completion of treatment

i.e. after two months.

Subjective parameters – severity of symptoms was assessed by grading 0-3 for each

symptom as mentioned below

Kshavathu –

Absence 0

Once or twice in a day only on exposure to cold, dust 1

More than twice a day with or without exposure 2

Present throughout the day 3

Tanu srava -

Absence 0

Uses one or two pads per day 1

Uses more than two to five pads per day 2

Uses more than 5 pads per day 3

Anaddha -

Absence 0

Present only in the morning and evening 1

Present only during exposure 2

Present always 3

Shirashoola –

Absence 0

Present at the time of attack only 1

Present only for few hours 2


Gala shosha -

Absence 0


Present in between attacks 2



Material & Methods


74

Nistoda shanka –

Absence 0


Present in between attack 2


Swara bheda-

Absence 0


Present for few hours 2


Improvement in symptom Anaddha was considered as improvement in functions of

Ghranendriya.

Assessment of Anutaila benefits

Grading No. of benefits

No benefits -

Mild 1-3

Moderate 4-6

Maximum 7-10

Objective – done before and after study

TC, DC

AEC

Follow Up Study

After completion of two months medicine administration, patients were

followed up to one month period.

Observation and Results 75

OBSERVATIONS AND RESULTS

The clinical study was conducted in 20 patients. All patients were having complaints

of Vataja Pratishyaya. Each and every case was observed for prevalence according to

age, sex, religion, place, socio economic status, marital status, occupation, prakriti,

family history, diet pattern, Satva and the observations are presented in tables

Table no 15 showing the Age wise distribution of incidences

AGE TOTAL NO OF PATIENTS PERCENTAGE 17-27 7 35 28-37 7 35 38-47 3 15 48-57 3 15

Among 20 patients there were 7 in the age group between 17-27,7 in 28-37, 3 in 38-47 years and 3 patients in the age group 48-57. Table no 16 showing the sex wise distribution of incidences

SEX TOTAL NO OF PATIENTS PERCENTAGE MALE 11 55 FEMALE 9 45

Out of 20 patients 11 were males and 9 were females in the group Table no 17 showing the occupation wise distribution of incidences

OCCUPATION TOTAL NO OF PATIENTS PERCENTAGE STUDENT 5 25 LECTURER 2 10 HOUSE WIFE 7 35 AGRICULTURE 4 20 PREECHER 2 10

In this group there were 5 students, 2 lecturers, 7 house housewives, 4 agriculturists and 2 preachers among 20 patients.


Fig. 1: Showing Agewise distribution of patients

35%

35%

15%

15%17-27

28-37

38-47

48-57

Fig.2: Showing the sexwise distribution of

Patients

MALE55%

FEMALE45% MALE

FEMALE

Fig.3:Occopationwise distribution of Patients

25%

10%

35%

20%

10% STUDENT

LECTURER

HOUSE WIFE

AGRICULTURE

PREECHER


Table no 18 showing the habitat wise distribution of incidences

PLACE TOTAL NO OF PATIENTS PERCENTAGE RURAL 4 20 URBAN 16 80

In group of 20 patients 4 were hailing from rural area where as 16 were from urban loality Table no 19 showing the religion wise distribution of incidences

RELIGION TOTAL NO OF PATIENTS PERCENTAGE HINDU 14 60 ISLAM 4 20 BUDDHIST 2 10

14 Hindus, 4 Islamic and 2 Buddhists were seen among 20 patients Table no 20 showing distribution of incidences as per the socio economic status

SES TOTAL NO OF

PATIENTS PERCENTAGE

POOR 2 10 MIDDLE CLASS 15 75 UPPER MIDDLE CLASS 3 15 In this group 2 patients belongs to poor class, 15 to middle class and 3 to upper middle class among 20 patients. Table no 21 showing the involvement of family history among incidences

FAMILY HISTORY TOTAL NO OF

PATIENTS PERCENTAGE

ATOPIC 13 65 NON ATOPIC 7 35 Out of 20 patients 13 were atopics and 7 were non atopic in the group.


Fig.4: Showing Placewise distribution of

Patients

RURAL20%

URBAN80%

RURAL

URBAN

Fig 5: Showing Religion wise distribution of patients

70%

20%

10%

HINDU

ISLAM

BUDDHIST

Fig. 6: Showing Socio economic statuswise distribution of patients

10%

75%

15%POOR

MIDDLE CLASS

UPPER MIDDLECLASS

Table no 21 showing the Satva wise distribution of incidences

Fig 7: Showing Distribution patients based on family history

65%

35%ATOPIC

NON ATOPIC


Table no 22 showing the Satva wise distribution of incidences

SATVA TOTAL NO OF PATIENTS PERCENTAGE AVARA 0 0 MADYAMA 17 85 PRAVARA 3 15

In the group of 20 patients 3 were having Pravara satva, 17 having Madyama satva and no Avara satva patient present.

Table no 23 showing the diet wise distribution of incidences

DIET TOTAL NO OF PATIENTS PERCENTAGE VEG 14 70

MIXED 6 30 14 vegetarians and 6 patients were habituated to mixed diet out of 20 patients Table no 24 showing the Prakruti wise distribution of incidences

PRAKRUTI TOTAL NO OF PATIENTS PERCENTAGE VATAPITTA 7 35

PITTAKAPHA 4 20 KAPHAVATA 9 45

Out of 20 patients 7, 4, and 9 patients belongs to Vatapitta, Pittakapha and Kaphavata Prakruti respectively. Table no 25 showing the marital status wise distribution of incidences

MARITAL STATUS TOTAL NO OF PATIENTS PERCENTAGE MARRIED 15 75

UNMARRIED 5 25 15 patients got married and 5 were unmarried in the group of 20 patients


Fig 8: Showing Distribution of the patients based on

Satwa

0%

85%

15%AVARA

MADYAMA

PRAVARA

F ig 9 : S h o w in g d ie tw is e d is tr ib u tio n o f p a tie n ts

7 0 %

3 0 %

V E G

M IX E D

Fig 10: Showing distributin of incidence based on Prakruti

35%

20%

45% VATAPITTA

PITTAKAPHA

KAPHAVATA

Fig 11: Showing distribution of patients based on marital status

75%

25%

MARRIED

UNMARRIED


Table No 26 Showing the total no patients having different nidanas

Nidana No of Patients % Vega dharana 9 45 Rajo sevana 20 100 Atibhashana 15 75 Krodha 11 55 Shiro abhitapa 10 50 Jagarana 11 55 Diva swapna 11 55 Avashyaya 14 60 Bhashpa 7 35 Dhuma sevana 7 35 When nidana sevana were assessed among 20 patients 45% of patient had Vega dharana, 100% had Rajo sevana, 75% had Atibhashana, 55% had Krodha, 50% had Shiro abhitapa 55% had Jagarana, 60% had Diva swapna, 35% did Avashyaya sevana, 35% Bhashpa sevana and 80% of patients had Dhuma sevana RESULTS LAKSHNAS Table no 27 showing the Improvement in the symptom Kshvathu X BT X AT X Diff % SD SE t value P value 2.9 1.05 1.85 63.79 0.933 0.2086 8.808 < 0.001

The mean of before treatment 2.9 and mean of after treatment 1.05 giving a mean difference of 1.85 which is highly significant at P level yielding 63.79 % relief which infers that Anutaila pratimarsha nasya is beneficial. Table no 28 showing the Improvement in the symptom Tanusrava X BT X AT X Diff % SD SE t value P value 2.8 0.85 1.95 69.64 0.8255 0.1846 10.56 < 0.001

The mean of before treatment 2.8 and mean of after treatment 0.85 giving a mean difference of 1.95 which is highly significant at < 0.001 yielding 69.64 % relief which infers that Anutaila pratimarsha nasya is beneficial.

Table no 29 showing the Improvement in the symptom Anaddha X BT X AT X Diff % SD SE t value P value 2.5 0.8 1.7 68 0.9787 0.2128 7.769 < 0.001

The mean of before treatment 2.5 and mean of after treatment 0.8 giving a mean difference of 1.7 which is highly significant at < 0.001 yielding 68 % relief in which infers that Anutaila pratimarsha nasya is beneficial.


Table no 30 showing the Improvement in the symptom Shirashoola X BT X AT X Diff % SD SE t value P value 1.6 0.6 1.0 62.50 0.7947 0.1777 5.62 < 0.001

The mean of before treatment 1.6 and mean of after treatment 0.06 giving a mean difference of 1.00 which is highly significant at < 0.001 yielding 62.50 % relief in which infers that Anutaila pratimarsha nasya is beneficial

Table no 31 showing the Improvement in the symptom Galashosha X BT X AT X Diff % SD SE t value P value 1.8 0.7 1.1 61 1.020 0.2282 4.820 < 0.001

The mean of before treatment 1.8 and mean of after treatment 0.07 giving a mean difference of 1.1 which is highly significant at < 0.001 yielding 61 % relief which infers that Anutaila pratimarsha nasya is beneficial Table no 32 showing the Improvement in the symptom Swarabheda X BT X AT X Diff % SD SE t value P value 2.0 0.65 1.35 69.23 0.8750 0.1956 6.90 < 0.001

The mean of before treatment 2.0 and mean of after treatment 1.35 giving a mean difference of 0.65 which is highly significant at < 0.001 yielding 69.23 % relief which infers that Anutaila pratimarsha nasya is beneficial

Table no 33 showing the Improvement in the symptom Nistoda Shanka X BT X AT X Diff % SD SE t value P value 1.95 0.6 1.35 69.23 0.8750 0.1956 6.90 < 0.001

The mean of before treatment 1.95 and mean of after treatment 1.35 giving a mean difference of 0.06 which is highly significant at < 0.001 yielding 69.23 % relief in which infers that Anutaila pratimarsha nasya is beneficial Table No 34 showing Total Leucocyte Count values X BT X AT X

Diff % SD SE t value P value

8865 8761 103.5 1.167 49.18 10.997 9.41 < 0.001 The mean of before treatment 8865 and mean of after treatment 8761 giving a mean difference of 103.5 which is highly significant at < 0.001 yielding 1.167 % relief in which infers that Anutaila pratimarsha nasya is beneficial


Table No 35 showing Absolute.Eosinophil Count values X BT X AT X Diff % SD SE t value P value 442.05 358.0 84.05 19.01 44.08 9.875 8.511 < 0.001

The mean of before treatment 442.05 and mean of after treatment 358.0 giving a mean difference of 0.06 which is highly significant at < 0.001 yielding 84.05 % relief in which infers that Anutaila pratimarsha nasya is beneficial. NEUTROPHILS Table No 36 showing neutrophil values

X BT X AT X Diff % SD SE t value P value 60.15 62.51 5.1 8.47 6.103 3.73 3.73 < 0.001

The mean of before treatment 60.15 and mean of after treatment 62.51 giving a mean difference of 5.1 which is highly significant at < 0.001 yielding 8.47 % relief in which infers that Anutaila pratimarsha nasya is beneficial LYMPHOCYTES Table No 37 showing lymphocyte values


The mean of before treatment is 33.5 and mean of after treatment 30.5 giving a mean difference of 3.0, which is insignificant. EOSINOPHILS Table No 38 showing eosinophil values


The mean of before treatment 6.2 and mean of after treatment 2.6 giving a mean difference of 3.60 which is highly significant at < 0.001 yielding 58.06 % relief which infers that Anutaila pratimarsha nasya is beneficial BENEFITS OF ANUTAILA

Table no 39 showing no of patients getting benefits of Anutaila

Benefits No .of Patients % No Benefits 0 0

Mild (1-3 Benefits)

4 20

Moderate (4-6 Benefits)

14 60

Maximum (7-10 Benefits)

2 10


When benefits of anutaila was assessed 4 patients got 1-3 benefits, 14 patients got 4-6

benefits and 2 patients got 7-10 benefits after the treatment.

Total no patients getting relief in individual symptom KSHAVATHU

Table no 40 showing total no of the patients getting relief from kshavathu

Improvement Total no of patients % No change 0 0

Mild 3 15Moderate 9 45Complete 8 40

At the end after 2 months of administration of Anutaila pratimarsha Nasya 3 patients

got mild relief. 9 patients got moderate relief and 8 patients got complete relief from

the symptom ksahvathu.

TANUSRAVA

Table no 41 showing total no of the patients getting relief from tanusrava





the symptom tanusrava.

ANADDHA

Table no 42 showing total no of the patients getting relief from anaddha





the symptom anaddha.

SHIRASHOOLA


Table no 43 showing total no of the patients getting relief from Shirashoola




got mild relief, 1 patient got moderate relief and 9 patients got complete relief from

the symptom shirashoola.

GALASHOSHA

Table no 44 showing total no of the patients getting relief from galashosha





the symptom galashosha.

SWARABHEDA

Table no 45 showing total no of the patients getting relief from swarabheda


Mild 11 55Moderate 1 5 Complete 8 45



the symptom swarabheda.


NISTODA SHANKHA

Table No 46 showing total no of the patients getting relief from nistoda shankha





the symptom nistoda shanka.

Table No 47 showing Overall effect therapy

Relief % of patientsComplete 41.43 Moderate 17.14

Mild 41.43 No 0

At end of two months of administration of Anutaila Pratimarsha Nasya it was

observed that 41% of the patients got complete relief, 17% of the patients got mild

relief and 41% patients got complete relief.

Discussion 87

Discussion

Pratishyaya is one of the most important diseases among Nasa roga. Among

different types of Pratishyaya, Vataja Pratishyaya occurs very commonly in people.

The disease Vataja pratishyaya is old as existence of human beings. The description

of the disease is available from vedic period till modern time.

As per nirukti continuous elimination of Kaphadi Doshas through nose

constitute pratishyaya disease.

Charaka, Sushruta, Vagbhata all Acharys have described Vataja Pratishyaya

elaborately. Apart from Brihartrayi Bhavaprakasha, Madhavakara and Yogaratnakara

also describe pratishyaya in detail.

The disease Vataja Pratishyaya and its lakshanas mentioned in the classics are

very much comparable to the disease Allergic rhinitis.

Allergic rhinitis is caused due to allergens like dust, pollen, smoke, cold air

etc. making nasa mucosa hypersensitive to it where as same factors are mentioned in

the classics as Nidana like Raja, Dhooma, Bashpa and Avashyaya Sevana.

The lakshanas of Vataja Pratishyaya like Anaddha, Tanusrava, Kshavatu are

also seen in Allergic rhinitis. So explanations hold good even today about Vataja

Pratishyaya mentioned by Acharyas to allergic rhinitis.

The best way to prevent Allergic rhinitis is avoidance of allergens many a time

it becomes difficult, as finding the allergens may not be easy. In Ayurveda also

“Nidana parivarjana” explains the same principle.

Discussions on age incidences

Usually rhinitis affects from childhood to adults, but Allergic rhinitis is more

common from 15 years and tends to reduce after the age of 50, probably during these

years the exposure to the allergens is very high. Is In this study selected patients


Discussion 88

were between 17 years to 52 years. Out of these 14 were below 40 years and only 6

patients were above 40. This observation supports the statement.

Discussion on Sex incidences

Generally bath sexes are affected by Allergic rhinitis. This study also shows

11 males and 9 females among the incidences.

Discussion on occupation incidences

Occupation plays a very important role where it predisposes a person to the

causative factors. In this category more number of patients were housewives. This

study shows more incidences among housewives as they are exposed to household

dust, cold environment and fumes etc, which are the prime factors for the disease.

Among the rest of the incidences 5 students, 4 agriculturists were seen. Incidence of

the disease is also reported in two individuals who are involved in atibhashana like

religion preaching and lecturers.

Discussion on habit incidence

The place where we live certainly has influence in causing the disease. In this

study four patients were from rural area constituting of agriculturists where they are

exposed to dust, smoke, cold air etc. but majority of the sample includes patients from

urban area who reside in comparatively higher polluted environment. Hence the

incidence is higher here. This factor needs data collection from a large sample.

Discussion on Socio-economic status incidence

Poor socio economic status influences, Disease patterns. However in this study

there were only two patients belonging to poor class and 15 patients from middle class

i.e. 75%. This may be due to Hassan is a place where study was conducted and more

number of patients visiting the hospital were from middle class.

Discussion on family history incidence

In this category there were 13 patients with positive family history of atopic

and seven negative. Usually allergy runs in families so the statement hold good in this

study.


Discussion 89

Discussion Satwa incidence

Satwa indicates psychological aspect of the person. Psychological factors are

very important in causing and aggravating the allergic diseases and recovery will be

greatly influenced by the status of satwa. There were 17 patients of Madhyama satwa

and Pravara satwa.

Discussion on diet incidence

Incompatibility to certain foods forms an important etiological factor in atopy.

Consuming certain foods like fish, eggs, soya protein and many other foods may

trigger aggravation of episodes. In present study there were 14 vegetarians and six of

mixed diet category but majority of them were avoiding such foods, which shows

strong involvement of this factor.

Discussion on Prakruti wise incidences

Prakruti influences the diseases occurrence and its prognosis. Vatavikaras

more commonly affects a vata prakruti person and easy or difficult treatment nature

depends upon its association with a Vyadhi. In this study 9 patients out of 20 cases

were of vatakapha prakriti and 7 belonged to vata-pitta prakruti. The involvement of

vata and Kapha Doshas here is more predominant in this disease.

Discussion on Nidana incidence

For pratishyaya on considering description of various Acharyas a set of about

10 common causative factors can be made, on studying these factors in 20 cases

studied, Raja sevana was found in 100%, Dhoomasevana in 80%, Atibhashana 75%,

Divaswapna 60% of patients. This observation signifies their close association in

causation of the disease.

Discussion on Pratimarsha Nasya

Different procedures and principles are explained for the treatment of nasal

diseases, among them Nasyakarma is given prime importance. Nasya is a procedure in

which medicine is given through the nose either in the form of liquid, powder, oils or

smoke, though Nasya appears to be simple procedure depending upon its utility it can

be used in different disorders.


Discussion 90

Nasagatavikara

Anya jatrurdhwagata vikara (Shoro, Karna, Netra, Mukha)

Anyasroto vikara

Specific to nasal disorders again it is used for,

1. Preventive purposes

2. Curative purposes

Navana, avapeedana, dhmapana and dhooma nasya, which are of teekshna

variety, are commonly used for curative aspect and pratimarsha Nasya is for

preventive aspect. The timings of pratimarsha nasya are explained in the context for

pacifying the effects of allergens at specific timings. Pratimarsha nasya is a safe easily

administrable type of Nasya. It can be given to anybody at anytime without having

any restriction. The dosage is very less (2 drops) and cannot produce any

complication hence it can be employed as the choice of preventive therapy

considering the long-term administration in reducing allergic conditions.

Pratimarsha nasya is Mrudu, Snehana, Tarpana, Bruhmana amd shamana in

natutre it is not having the effect of shodhana and shiro virechana. Hence it is widely

indicated in Vataja disorders to render the nasal mucosa oily and smooth. It

strengthens and maintains the normal mucosal barrier.

Discussion on Anutaila and its mode of action

Anutaila as the name indicates it is having the capacity to penetrate minute

channels. Anutaila is Shamana, Bruhmana and snehana in nature. It is prepared with

27 drugs processed in tilataila and ajaksheera.

It is having the qualities like tridoshahara indriyabalaprasada, hridya,.

chakshushya, grahi, rasayana, balya, keshya, twachya, medya, bruhmana, krimighna,

vrishya, deepana, pachana, pratishayahara, shirorogahara, manorogahara and

srotoshodhaka.

It is having tridoshsgna and pratishyayahara property.due to fillowing qualities of

Anutaila it becomes capable to arrest vataja pratishyaya or allergic rhinitis.


Discussion 91

The nature of the medicine is oleos by instilling it into the nose it creates an

oily coat on nasal mucosa thus the direct effect of allergen on nasal mucosa is

restricted.

Due to the medhya and rasayana efficacy promotes normal olfaction.

The Tarpana, Brumhana nasya qualities of the drug maintain the normal

ciliated columnar epithelium of nasal mucosa. Thus capable to prevent the

stagnation of nasal mucosa secretions.

Due to oily media created on the mucosa cavity its capable to prevent the

crust formation.

Due to snehana, shamana, vatahara, tridoshahara efficacy it is capable of

reducing Vataja Pratishyaya.

Due to the presence of drugs having deepana and pachana it can regularize

agni and there by cures pratishyaya caused by mandagni.

Among the drugs present in Anutaila most of the drugs are having the property

of tridoshagna and kaphavata shamana pacifying the predominant Doshas

causing Vataja pratishyaya.

Nasal pathology is corrected, local hygiene gets improved and allergic

reactions are controlled.

Crust formation, direct attack of allergen on nasal mucosa, stagnation of nasal

secretions, destruction of ciliated columnar epithelium of nasal mucosa,

irritation and dryness of mucosa, atrophic, hypertrophy exciting factors are

reduced due to drug instillation. Hence it can control and cure pratishyaya.

Hence the drug Anutaila can be a drug of choice to reduce the disease and to

prevent the recurrence.

Discussion on results

Discussion on symptom kshavatu

The effect of anu taila pratimarsha nasya on kshavatu is found to be significant

with 63.79% relief at p<0.001 after 2 months.

At the end of 2 months it is observed that out of 20 patients 3 got mild relief, 9 got

moderate relief and 8 got complete relief.


Discussion 92

Discussion on symptom tanusrava

After 2 months of administration of anu taila pratimarsha nasya is found to be

significant giving 69.64% of relief at p<0.001.



Discussion on symptom anaddha

Two months of administration of anu taila pratimarsha nasya is found to be

significant with 68% of relief at p<0.001.



Discussion on symptom shirashoola

The study after two months of administration of anu taila pratimarsha nasya is

found to be significant with 62.50% of relief at p<0.001.



Discussion on symptom galasosha

The study after two months of administration of anu taila pratimarsha nasya is

found to be significant with 61% of relief at p<0.001.



Discussion on symptom swarabedha

Two months of administration of anu taila pratimarsha nasya is found to be

significant with 69.23% of relief at p<0.001.



Discussion on symptom nistoda shanka

After 2 months of administration of Anutaila pratimarsha Nasya is found to be

significant giving 69.23% of relief at p<0.001.


Discussion


93

At the end of 2 months it is observed that out of 20 patients 8 got mild relief, 4

got moderate relief and 8 got complete relief.

Discussion on benefits of Anutaila

In the study benefits gained by Anutaila was significant .4 patients got mild

benefits , 14 patients got moderate benefits and 2patients got all the benefits which is

encouraging.

Discussion on frequency and duration of attack

During the course of treatment at the end of 15th, 30th and 45th day assessments

were made to note about number of attacks during the intermediate period and the

duration of individual attacks. There were encouraging results observed maximum

during the third interval period and minimal changes in the first interval period which

shows that, with prolonged practice of Anutaila Pratimarsha Nasya the beneficiary

effects are higher but test of significance was undertaken at the end of study period.

After one month of follow up there reported 12 patients where no relapses of allergic

attacks were found.

Discussion on investigations

In the total count of WBC the effect of Anutaila pratimarsha Nasya is found to

be significant with 1.67% increase in leukocyte count at <0.001, which indicate the

improvement of immunological status.

In absolute eosinophil count which is one of the important criteria to diagnose

Allergic Rhinitis. The study is found to be significant with 19.01% decrease of count

with <0.001, showing Anutaila Pratimarsha Nasya has a significant role in reducing

influence of allergens.

As far as differential count is considered there was not much significance that

was found.

Discussion on over all effect of therapy

At the end of two months of study when over all efficacy was analyzed by

cumulating improvement of individual factors it is found that 41% of the patients Got

complete relief, 17% of the patients got moderate relief and 41 % of the patients got

mild relief, hence Anutaila pratimarsha nasya is found to be highly significant in

vataja pratishyaya.

Conclusion 94

CONCLUSION In the present study the effect of anu taila pratimarsha nasya was found beneficial. The causative factors mentioned for Vataja pratishaya were very much appreciated among the sample taken for study. Among the nidanas dhuma, raja, sevana, atibhashana was present in majority of the cases substantiating the classics. Patients show improvement in reduction signs and symptoms and at the end result was encouraging. As allergy is atopic many patients shown positive family history in the study. Majority of the cases were avoiding such food and activities which will aggravate the condition. Majority of the patients were hailing from urban area where environment is polluted Which is a predisposing factor The partimarsha nasya is very simple procedure which is cost effective and can be employed easily by the people. Partimarsha nasya is aid to prevent the occurrence of urdvajatrugata vikara. Studies involving large samples is necessary to observe and followup the cases for relapses. The age old practice of anutailapartimrasha nasya holds good even today in prevention of vatajapartishyaya.


Summary 95

SUMMARY

The present study entitled “A clinical study on Pratimarsha nasya in

prevention of Pratishyaya” was aimed to study the efficacy of Anutaila to reduce the

incidences of Vataja Pratishyaya.

The lakshanas of Vataja Pratishyaya closely resemble the features of Allergic

rhinitis and the same was considered for the selection of cases. Among the many

etiological factors exposure to dhooma, rajah, atibhashana and diwaswapnaconstitute

the important factors.

The drug Anutaila was selected considering its properties like tridoshahara and

rasayana. Its explanation under dinacharya as one of the daily employed procedure for

strengthening nasal mucosa also support the view.

Among the etiological factors explained for the disease the maximum

involvement for dhooma, raja sevana , diwa swapna and atibhashana were

predominant. Due to its vata shamana. Tridoshahara, snehana, bruhmana and rasayana

effects, Anutaila is highly effective in sensitizing the local mucosa resistant towards

the allergens.

The clinical study was conducted in 20 patients that administration of Anutaila

was practiced for two months. The patients were subjected to improvement

assessment at the end of two months in terms of reduction in signs and symptoms.

Gradation were given to assess the severity, the results were subjected to statistical

analysis in respect of improvement the over all efficacy of the treatment shows 41%

complete relief, 17% moderate relief and 42% mild relief. This assessment was based

on cumulating the individual assessment factors considered for the study. All the

assessment parameters are highly significant.

Thus the present research work supports the age-old practice Anutaila Nasya

for preventing Vataja Pratishyaya. Though results are encouraging further studies

involving large samples is necessary to observe and to follow up the cases for

relapses. It is also necessary to document other beneficial effects explained for

Anutaila Pratimarsha Nasya.


References & Bibliography 96

List of Reference

1. A. V-12/4/5 2. A. V. It. Page No. 56 3. A. V-9/8/1, A. V-12/4/4 4. A.V-10/2/32 5. Cha. Chi. 26th Chapter 6. Su.Ut 24 chapter 7. Ha. Sa. 42 chapter 8. A.Sa. Ut 9. A.H.Ut. 19& 20 chapter 10. M. Ni. Ut. 58 11. G.N. page 181 12. Sha.Ut. 19 13. B.P.Ut. 65 14. Y.R. 16 15. B.R. Chi. 63 16. S.K.B. page 871 17. A.H.Sha 3/108 18. A.K. 89 19. Cha. Sha. 4/11 20. Su.Sha. 5/21,7/7,9/5 21. Su. Su. 35/12 22. Cha.sha. 1/27 23. Gray’s Anatomy 24. Cha. Chi.8/33 25. Cha.Chi. 26/104 26. Cha chi 26/10, A.H Ut.16/1-2, Su.Ut 24 27. B.P. Ut 65/16 28. Y.R.nasaroga adikara 16 29. Y.R. nasaroga adikara 17 30. A.H.Su. 4/3 31. Su.Ut.24/5 32. Su Ut 24/6 33. Su. Ut. 24/21 34. Su Ut 24/5 35. A.H U.19/1 36. Ka.Sa. 12/3 37. Su.Su.21/36 38. Su. Ut. 24/ 16 39. C.D. 18/25 40. Su.Ut.24/16-17 41. Y.R. nasarogadikara 85/88 42. H. P.M. 43. A.H. Su 20/1 44. Su .chi 40/21 45. Vachaspatyam page 4006. 46. A.H. Su 20/1 47. Cha.Su 1/85 48. A.K. page 408


References & Bibliography


97

49. Cha.Si 9/ 89- 90 50. Su.Ut 4O/21 51. A.H.Su 20/2 52. Ka.Sa.Si 2 53. Sha.Ut. 8/2 54. A.H. Su 20/8 55. A .H. Su 20/9,10, 56. A.H. Su 20/34,35, 36 57. A.H. Su 20/26 58. A.H. Su 29/18 59. Sha Ut .8/44 60. Cha. Su.5/63-70 61. A.H.Su 20/37 62. Su.Su.15/48 63. B.P. Pu.5 64. A.S.Su. 15 65. H.Y.P 76 66. H.Y.P 29. 67. Nature cure page 11


BIBILIOGRAPHY

1. Agnivesha-Charka samhita with Ayurveda dipika commentary by

Chakrapanidatta Chikitsa shtana 26/107,8,9.page no. 604,chaukamba Sanskrit Samsthana Varanasi 4th edition.

2. API textbook of Medicine, C.S. Sainani 6th edition, page no. 279, published

by – Association of Physicians of India, Mumbai

3. Banvarilala mishra, Dravyaguna Hastamalaka, III edition, Sharan Book depot

4. Bhavamishra, shri Shankar misra shastry, Bhavaprakasha uttarardha, 8th

edition, 2003 Choukabha publications page 693.

5. Davidson’s principles and Practice of medicine, 18th edition page no. 381-82,

published by Churchill-Livingston.

6. Dr. Ravichandra Choudhari, Sachitra Salakya Vignana, 1999, 13th edition,

Choukambha orientalia, Varanasi.page 45.

7. Hall and Collmans Diseases of ENT, XV edition, B.I. Churchil Livingston pvt.

Ltd. Delhi,page No 41.

8. Hara govinda shastri Vyakhyakara , Amarakosha 1984, Choukambha Sanskrit series, Page – 217, 408

9. Harrison’s principles of internal medicine, 15th edition, Volume II, Page no. 1920,21 published by Mc-Graw company.

10. Indian medicinal Plants, Orient Longmann, Chennai.

11. Indradeva tripathi commentary, Gada nigraha part III, II edition, 1999,

Choukabha Sanskrit sansthan. Varanasi Page. No. 181.

12. J.L.N. Shastri Dravyaguna Vignana, I edition, Krishnadas academy, Varanasi.

13. K.K. Ramalingam, B. Shreeram Murthy, Ravi Ram II edition, AIPD Chennai,

Page. No. 200

14. Kshema raja sri Krishna dasa, Harita samhita, IInd edition, 1984, sri venkateshwara printers Mumbai, .



15. K.V. Bhargav, S.K. Bhargav, T.M. Shah, A short text book of ENT VI edition, Usha publications, Mumbai, page no. 154.

16. Lakshmipati shastry, Yoga ratnakara, 7th edition Choukabha Sanskrit sansthan.

Varanasi Page. No 320

17. Mohd . Maqbul, Text book of ENT, 1993, Jaypee brothers

18. P.D. Mishra – Beenamishra, Nature Cure, I edition, B.I. Churchil Livingston pvt. Ltd. Delhi,page No. 115

19. P.V. Sharma, Chakradatta, 17th edition, Choukamba Sanskrit series, 1998,

page no. 480.

20. P.L. Dingara, Diseases of Ear, Nose, Throat, II edition, B.I. Churchil Livingston pvt. Ltd. Delhi,page No 200.

21. Proff, K.R. Shrikanthamurthy, Sharangadhara Samhita, translation,

Choukambha orientalia, Varanasi.page 222

22. Proff. K.R. Shrikanthamurthy, Asthanga samgraha of Vaghbata, translation Vol I, III edition 2000, Choukambha orientalia, Varanasi.page 57.

23. P . Ramanjaneyalu, Diseases of ENT, 3rd edition, 2002, Paras Publications,

page 207

24. P.V. Sharma, Dravyaguna Vignana, Choukambha orientalia, Varanasi

25. P.V. Tiwari, Kashyapa Samhita, text with English translation and commentary, Ist edition, Choukamba Vishwabharati, Varanasi, page 221

26. Raja Radha Kantha deva ,Shabdha kalpa dhruma, Raja Radha Kantha deva,

Part II, IIIrd edition, the Choukambha Sanskrit series, Varanasi, page no. 845, 871

27. Samson Hale, Bernard H Colman, 13th edition, ELBS, B.I. Churchil

Livingston pvt. Ltd. U.K ,page No.204.

28. Scott-Brown’s Otolaryngology, VI edition, Vol IV rhinology, International Edition, Mumbai. Page no. 125

29. Sushruta -Sushruta samhita with Dalhana Acharya’s Nibhanda Sangraha

commentary Uttara tantra 24/3,6 page no. 651, publisher Chaukambha orientalia, 6th edition.

30. Swami Devananda, Hatha Yoga Pradeepika, IV edition, 1999, Motilal

Banarasidas Publishers, Delhi, Page. No. 67


References & Bibliography


100

31. Taranath tarka vachaspathi ,Vachaspatyam, Taranath tarka vachaspathi, 3rd edition volume 2, Choukambha Sanskrit series Varanasi page no, 4006

32. Vagbhata-Ashtanga hrudaya with sarvanga sundari commentary of Arunadatta, Ayurveda rasayana of Hemadri, , Uttara tantra 19/1, 3, Page No. 841-842.publisher Krishnadas Academy, Varanasi

i

Annexure I

DEPARTMENT OF POST - GRADUATE STUDIES IN SWASTHAVRITHA

S.D.M COLLEGE OF AYURVEDA – HASSAN

CASE PROFORMA FOR CLINICAL STUDY

A STUDY ON PRATIMARSHANASYA IN PREVENTION OF PRATISHYAYA

Name: Date: Age: Serial No.: Sex: OPD No.: Religion: IPD No.: Address: D.O.A: Occupation: D.O.D: Socio – economic status:

A. Chief complaints with duration:

B. History of present illness Nil mild moderate severess

KSHAVATHU TANUSRAVA ANADDHA SHIRASHOOLA SWARABHEDA GALASHOSHA TALUSHOSHA NISTODASHANKA GRANATODA GANDAGNANA

C. Associated complaints

D. Family history

ii

E. Treatment history

F. Personal history Appetite: Bowel: Sleep: Micturation: Habits: Diet: Veg: mixed:

G. Vihara Vegadharana Rojosevana Atibhashana Krodha Shirogurutva Jagarana Divaswspna Avashyaya Bashpa Dhumasevana

H. Dashavida pariksha Prakruti Vikruti Sara Satva Satmya Samhanana Desha Kala Aharashakti Vyayama shakti

I. Systemic examination: C.N.S.: C.V.S.: R.S: G.I.T.: Locomotory system

iii

J. Examination of the nose EXTERNAL EXAMINATION OF NOSE B. Palpation A. Inspection ANTERIOR RHINOSCOPY Mucosa Septum

Turbinates Nasal cavity

Laboratory examinations

Blood a. Total WBC count b. Differential WBC count

i. Neutrophils ii. Monocytes

iii. Lymphocytes iv. Eosinophils v. Basophils

c. Erythrocyte sedimentation rate: d. Absolute eosinophil count:

K. Treatment

iv

L. Assessment chart Sl.No Symptoms 0

day15th day

30th day

45th day

60th day

1 KSHAVATHU

2 TANUSRAVA

3 ANADDHA

4 SHIRASHOOLA

5 SWARABHEDA

6 GALASHOSHA

7 NISTODASHANKA

Signature of Student Signature of Guide / H.O.D

v

Annexure II Sl.No Name Age Sex O.P.D. Occuptn place Religion SES Fml Hst Satva Habits Diet Prakruti

1 Veena. P 26 F 92137 H.W R H M.C N M Coffee Mixed VP 2 Stanzian 17 F 88977 Student U B M.C N M Tea Veg VK 3 Kavita.M.B 27 F 254 Lecturer U H M.C P P C/T Veg VP 4 Tashi 22 M 92226 Monk U B M.C N M Tea Mixed VK 5 Alamara 30 F 91279 H.W U I M.C N M Coffee Mixed PK 6 Md.Jaffer 35 M 90764 H.W U I M.C N P Coffee Mixed VK 7 Indira 50 F 59015 H.W U H M.C N M Coffee Veg VK 8 Mastan 30 M 158 Student U I M.C P M Coffee Mixed VP 9 shashikala 23 F 91347 Lecturer U I M.C N M Coffee Mixed VP

10 Samudri 28 F 154 Student U I M.C P M Tea Mixed VP 11 erajamma 50 F 81438 H.W U H M.C N M Coffee Veg VK 12 Vijay 52 M 91978 Agri R H U.M N M Coffee Veg VK 13 Radhika 32 F 91992 H.W U H U.M N M Coffee Mixed PK 14 Savithri 38 F 90646 H.W U H M.C P M Coffee Mixed VK

15Ranga swamy 32 M 90787 Agri U H M.C P P A,S,C Mixed VK

16 Puneet 19 M 91052 Student U H M.C N M alcohol Mixed VK 17 Ravi 40 M 80735 Agri R H Poor P M A,S,C Mixed PK 18 Lalitha 36 F 85487 H.W U H M.C P M Coffee Veg PK 19 Shivanna 42 M 90569 Agri R H Poor N M A,S,C Mixed VP 20 Ravi kumar 23 M 87118 Agri U H U.M N M A,S,C Mixed VP

Master Chart

vi

Table no showing the distribution of incidences of nidanas

NIDANA

Sl.No.Vega dharana

Rajo sevana

Atibhashana Krodha Shiro abhitapa

Jagarana Diva swapna

Avashyaya Bhashpa Dhuma sevana

1 + + + + - + + - - + 2 + + + - - + - + + + 3 + + + - + + - + + + 4 + + + - - - + + + + 5 - + - - - - + + + + 6 + + + + + + - + - + 7 + + + + - + - - - + 8 - + + - + + - + - + 9 - + + + - - + - - + 10 - + + - + - - + + - 11 - + - - - + - + + + 12 + + + - + - + + - + 13 - + + + - - + + - + 14 - + + + - + + - - + 15 + + + + + + - + + + 16 - + + - + + + - - + 17 - + + + - - + - - + 18 - + + + + - + + - - 19 - + + + + - + + - - 20 + + + - + + - + - -

vii

LAKSHNAS

Sl No

Kshvathu Tanusrava Anaddha Shirasoola Galashosha Swarabheda Nistoda shanka

BT AT BT AT BT AT BT AT BT AT BT AT BT AT1 3 0 3 0 2 0 1 0 1 0 1 0 1 0 2 3 0 3 0 3 0 1 1 3 0 3 0 1 0 3 3 0 3 0 2 1 1 0 0 0 1 0 2 0 4 3 0 3 2 2 0 1 0 2 0 2 0 2 0 5 3 2 2 0 1 0 2 0 1 0 1 1 2 0 6 3 0 3 2 3 0 3 1 3 1 3 1 3 1 7 2 0 2 0 3 1 1 0 2 0 3 1 2 1 8 3 0 3 0 3 0 2 0 1 1 1 1 3 1 9 3 2 3 0 3 0 2 0 2 1 2 1 2 1 10 3 0 3 0 3 0 1 0 2 1 2 0 2 0 11 3 2 3 2 3 1 3 1 3 1 3 0 3 0 12 2 1 3 1 2 1 1 1 2 0 2 0 1 0 13 3 2 3 1 3 2 1 1 3 0 3 0 3 0 14 3 2 3 1 2 2 2 1 2 1 2 2 2 1 15 3 2 3 1 2 1 2 1 2 2 2 1 2 1 16 3 2 2 1 3 1 1 1 1 1 2 1 1 1 17 3 1 2 1 2 1 2 0 1 1 2 1 2 2 18 3 1 3 2 3 1 2 1 1 1 1 1 1 1 19 3 2 3 1 3 2 1 1 2 1 2 1 2 1 20 3 2 3 2 2 2 2 2 2 2 2 1 2 1

Pratimarsha sw02 has

Documents

Transcript of Pratimarsha sw02 has