Lecture Note: “Approach to Ayurveda Treatment”(Part-3) by Prof. Muralidhara Sharma

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Approach to Ayurveda Treatment
(Part-3)

Prof. Muralidhar Sharma
based on the lecture available atApproach to Ayurvedic Practice

Rhinitis with post nasal drip [II] – Kshavathu
The presence of thicker and more profuse discharge may be present when patients visit after two to three days. In some patients, these symptoms may be present from the beginning itself.  You can see the nasal discharge in the provided image. Patients tend to have more persistent sneezing and the number of sneezes may be 10, 20, or more in number. In these conditions, you may get Vataja Lakshan, many times Vata Pittaja, or Vata Kaphaj Lakshan. Depending upon the clinical presentation you have to use the medicine for a longer duration. If the patient is more febrile then I would prefer Mritunjay Rasa, Tribhuvankirti, and Amrutarishta.   

If the patient has a comparatively lesser fever but more sneezing and nasal discharge are more I would prefer Mrityunjaya Rasa, Laghusoota shekhara Rasa, and Amritarishta. The duration of treatment would be of two weeks. Because in these conditions you won’t expect the results in three or four days. If you will advise the patient to continue these medicines for two weeks, definitely the patient will follow the treatment because at this stage Acetaminophen (Paracetamol) and Chlorpheniramine (CPM) won’t help at all. That’s the limitation. Either patient would have already tried Acetaminophen (Paracetamol), Chlorpheniramine (CPM), or sometimes patients come in the beginning stages. An important issue is to predict the duration of treatment and give the correct advice.

घ्राणाश्रिते मर्मणि सम्प्रदुष्टे यस्यानिलो नासिकया निरेति ||
कफानुयातो बहुशः सशब्दस्तं रोगमाहुः क्षवथुं विधिज्ञाः |
Su.Ut.22/11,12

आनद्धा पिहिता नासा तनुस्रावप्रवर्तिनी |
गलताल्वोष्ठशोषश्च निस्तोदः शङ्खयोस्तथा |
स्वरोपघातश्च भवेत् प्रतिश्यायेऽनिलात्मके |
Su.Ut.24/6,7

Treatment:

Mrityunjaya Rasa 1BD
Tribhuvana keerthi Rasa 1BD
OR
Laghusoota shikhara rasa 1BD
Amritarishta 2 tsf BD  2 weeks

Dosha -VATAKAPHA

Chronic rhinitis /Sinusitis:

Patients with chronic rhinitis or sinusitis who tried medicine of contemporary medicine but have not obtained satisfactory results often visit Ayurveda consultants. When the condition becomes more chronic, the patient would have thick and more discharges. You can see the discharge over the nasal area continuously and even there could be involvement of systemic features. Patients may have reduced appetite, lethargy, or complication of the febrile condition. These are the patients where it’s an Ayurvedic treatment that has an upper edge over contemporary medicine. Contemporary medicine prescription includes phenylephrine drops that give immediate relief but the congestion continued. With continuous use of phenylephrine, patients have relief for a transient period but in due course of time discharge becomes hard and consolidated. Afterward, patients would become patent patients for ayurvedic medicine. My prescription would be Mrityunjaya Rasa Sootashekhara Rasa and Pippalyasava or Somasava. I prefer Somasava when patients tend to have lower respiratory tract infections.

This is the stage where the Nasya would help. I always prefer Anutaila Nasya.  Any other Nasya would help. The use of Nasya in the initial stages of fever aggravates the condition. I don’t recommend Nasya in the initial stages but only when discharge tends to become thicker along with predominant symptoms of Pitta or Vata. When the color of discharge becomes yellowish and thicker similar to the Ghrita the condition indicated for Nasya. Most of the time patients may feel worse if Nasya is used in earlier stages. Nasya would not harm the patient in long run but in the short duration, patients would not be convinced about the treatment. The patients may not continue with the treatment prescribed by you.

उष्णः सपीतकः स्रावो घ्राणात् स्रवति पैत्तिके ||
कृशोऽतिपाण्डुः सन्तप्तो भवत्तृष्णानि(भि)पीडितः |
सधूमं सहसा वह्निं वमतीव च मानवः ||
Su. Ut. 24/ 7,8

Treatment:

Mrityunjaya Rasa 1BD
Sootashekhara Rasa 1 BD
Pippalyasava / Somasava 2 tsf BD
Anutaila Nasya  3 weeks

Dosha –PITTAVATA,  TRIDOSHA
Chronic sinusitis – Bhramshathu

प्रभ्रश्यते नासिकयैव यश्च  सान्द्रो विदग्धो लवणः कफस्तु ||
प्राक् सञ्चितो मूर्धनि पित्ततप्तस्तं भ्रंशथुं व्याधिमुदाहरन्ति |
Su. Ut.22/13,14

   Frequent use of vasoconstrictor drops causes consolidation of discharge. This condition is described by Sushruta as Bhramshathu. In this condition, discharge is more and patients often may feel the salty taste of discharge in the throat.  A patient giving a history of salty discharge coming through which we say is ‘Post Nasal Drip’ causing irritation at that area. Patients may have pain in the sinuses, mostly in the frontal sinus and later in the maxillary sinus. Slight variations in the clinical presentation do occur. Some patients may present with pain in the maxillary sinus from the beginning itself. In this condition, secretion gets hardened and the duration of treatment has to be enhanced. I prefer the same prescription discussed earlier for two months. At this stage, contemporary medicine does not help at all. Only potent analgesic Tramadol Hydrochloride (Ultracet) may help in relieving symptoms. A patient would not able to continue with treatment and one or other day patients come to an Ayurveda practitioner for taking treatment. Particularly those who have used antibiotics, in the beginning, reach this quite early. In viral condition antibiotic should not be prescribed in the initial period. But this kind of practice does exist very commonly. Plenty of patients of this category visit Ayurveda practitioners because of other systems’ of malpractice.

Treatment

Mrityunjaya Rasa 1BD
Sootashekhara Rasa 1 BD
Pippalyasava / Somasava  2 tsf BD
Anutaila Nasya   8 weeks
Dosha – Kaphapitta,  Tridosha

प्रभ्रश्यते  नासिकयैव यश्च  सान्द्रो विदग्धो लवणः कफस्तु ||
प्राक् सञ्चितो मूर्धनि पित्ततप्तस्तं भ्रंशथुं व्याधिमुदाहरन्ति |
Su.Ut22/13,14

Allergic rhinitis:

भूत्वा भूत्वा प्रतिश्यायो योऽकस्माद्विनिवर्तते ||
सम्पक्वो वाऽप्यपक्वो वा स सर्वप्रभवः स्मृतः |
लिङ्गानि चैव सर्वेषां पीनसानां च सर्वजे ||
Su.Ut24/10,11

When condition became more chronic and patients have persistent symptoms, presentation is similar to that of allergic rhinitis. Sushruta has been described three different types of clinical presentation.  The first type of presentation include recurrent episodes of the nasal discharge, patients may have episodes of respiratory infection for a few days, relief with usual treatment, and episode tend to occur repeatedly.  As the condition progresses the interval between episodes gets shorter. The duration of episodes continues to increase.

कफः कफकृते घ्राणाच्छुक्लः शीतः स्रवेन्मुहुः |
शुक्लावभासः शूनाक्षो भवेद्गुरुशिरोमुखः ||
शिरोगलौष्ठतालूनां कण्डूयनमतीव च |
Su.Ut24/9,10

The second type of presentation includes systemic involvement in the form of itching and rashes seen over the body. You may also get severe nasal congestion.

अजस्रमच्छं सलिलप्रकाशं यस्याविवर्णं स्रवतीह नासा ||
रात्रौ विशेषेण हि तं विकारं नासापरिस्रावमिति व्यवस्येत् |
Su.Ut 22/16,17

The third type of presentation includes persistent continuous discharge, where a patient would be using two or three handkerchiefs as an essential part of routine life. Patients may present with any of the three conditions. Sushruta has identified these three conditions separately. In contemporary medicine anti-allergic, membrane stabilizing drugs are used instead of chlorpheniramine maleate. Reduction in space of turbinate is one of the important criteria. It may tend to develop a polyp but does not establish a polyp.

My choice of drugs would be Mrityunjaya Rasa, Laghusoota Shekhar, Amritarishta, and Anutaila Nasya. There could be some patients who are resistant to usual medical treatment. You may require procedures like Virechan or Vamana in certain patients or prolong treatment for years with Haridrakhanda, and Chyavanaprasha to prevent a recurrence. In case of severe nasal congestion with distress, I prefer Makaradwaja as the second-line treatment.  I do prefer mixing Makaradwaja 1gm/week with 25 gm Laghusootshekhar. Prolonged treatment along with dietary restriction is necessary.

 Basic management

Mrityunjaya Rasa 1BD
Laghusoota shikhara 1BD
Amritarishta 4 tsf BD
Anutaila Nasya                                              3 months

Specific management

1] Tridoshaja – Virechana /Vamana
2]Kaphaja – Haridrakhanda, Chyavanaprasha
3] Nasa parisrava – Makaradwaja 1gm/week

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