Approach to Ayurveda Treatment
(Part-4)
Prof. Muralidhar Sharma
based on the lecture available at–Approach to Ayurvedic Practice
There could be a simple common cold that immediately turns out bleeding. I have given a name to this condition as hemorrhagic rhinitis. In contemporary medicine, it is mentioned as one of the complications the rhinitis rather than in a special category. Patients may appear with clinical presentation of hemorrhage I consider this condition Raktaja Pratishyaya where bleeding is one of the features. My prescription would be Sootashekhara Rasa, Kamadudha, Draksharishta / Usheerasava, and Anutaila Nasya. This is one of the areas where we can have definite change. Anutaila Nasya has to be used only after the bleeding has stopped. Usually, the bleeding subsides within 2-3 days of starting the treatment. Anutaila Nasya can be used for a prolonged period and it prevents complications definitely.
रक्तजे तु प्रतिश्याये रक्तास्रावः प्रवर्तते |
ताम्राक्षश्च भवेज्जन्तुरुरोघातप्रपीडितः ||
दुर्गन्धोच्छ्वासवदनस्तथा गन्धान्न वेत्ति च |
मूर्च्छन्ति चात्र कृमयः श्वेताः स्निग्धास्तथाऽणवः ||
कृमिमूर्धविकारेण समानं चास्य लक्षणम् |
Su.Ut 24/12,13,14
Treatment
Sootashekhara Rasa 1 BD
Kamadugha [Plain] 1BD
Draksharishta / Usheerasava 2 tsf BD
Anutaila Nasya 3 weeks
Atrophic rhinitis
If the condition remain persistent for a prolonged duration and patient visits late to the physician then it may result in atrophic changes. This is one of the areas where there is a severe limitation and prognosis is poor. Neither contemporary system nor allopathic system produces any satisfactory relief but still patients may continue with Ayurvedic management.
Some of the patients may continue their management for one or two months then go to another doctor and so on. So they will be having experience with many doctors and they tend to be eternal patients. Usually when a patient of an atrophic rhinitis comes to me, I sent the patient to the ENT Specialist. When contemporary medication does not provide satisfactory results, patient return to Ayurveda physician. While dealing with atrophic rhinitis patients your communication ability to convince the patient is one issue and your management is another issue.
Virechan is one of the procedure which can often produce a significant changes. It could be a chance factor. Many times repeated Virechan produce significant changes. Sushruta has very clearly mentioned changes that could be observed in atrophic rhinitis while explaining ‘Dushtapratishyay’ or ‘Aanah’ and also mentioned about poor prognosis.
प्रक्लिद्यतिपुनर्नासा पुनश्च परिशुष्यति ||
मुहुरानह्यते चापि मुहुर्विव्रियते तथा |
निःश्वासोच्छ्वासदौर्गन्ध्यं तथा गन्धान्न वेत्ति च ||
एवं दुष्टप्रतिश्यायं जानीयात् कृच्छ्रसाधनम् |
Su. Ut24/14.15,16
Treatment:
Poor prognosis
Mritytunjaya Rasa
Soota shekhara rasa
Godanti+Avipathikara Choorna
Virechana
Nasal polyp formations
Patient having allergic tendency may end up either with atrophic changes or with the polyp formation. When polyp formation occurs we consider it as Tridoshaja variety or Nasarsha where a typical standard polyp would be visible, shapes of the polyp could be any it could be a non pedunculated bulging or pedunculated hanging sort of bulging
दोषैस्त्रिभिस्तैः पृथगेकशश्च ब्रूयात्तथाऽर्शांसि तथैव शोफान् ||
शालाक्यसिद्धान्तमवेक्ष्य चापि सर्वात्मकं सप्तममर्बुदं तु |
Su.Ut 22/18.19
When polyp develops after middle age or above 40 years age, it need to have surgical exploration in the form of biopsy is needed. Chances of having a malignant growth are higher. Most of time malignancy cannot be predicted simply by visual perception. Usually we have some conventional feeling regarding malignancy like surface is fragile and so on. But the actual presentation may be quiet misleading. Therefore it is always safer to have confirmation whether patient is having tumour pathology or not. If it is malignant growth then our treatment would not be helpful as it is considered to be incurable (Asadhya).
If patient comes to us at terminal stage then approach to the management will be different. If you have proved case of non-malignant condition then Mrityunjaya Rasa,Triphala Guggulu,Amritarishta ,Anutaila Nasya may help to the patient.In case of children chances of malignancy are rare but in case elderly patient its better to rule out malignancy.
Nasal polyps
कफावृतो वायुरुदानसञ्ज्ञो यदा स्वमार्गे विगुणः स्थितः स्यात् ||
घ्राणं वृणोतीव तदा स रोगो नासाप्रतीनाह इति प्रदिष्टः |
Su. Ut 22/15,16
कफावृतो वायुरुदानसञ्ज्ञो यदा स्वमार्गे विगुणः स्थितः स्यात् ||
घ्राणं वृणोतीव तदा स रोगो नासाप्रतीनाह इति प्रदिष्टः |
Su. Ut. 22/15,16
Treatment:
Mrityunjaya Rasa
Triphala Guggulu
Amritarishta
Anutaila Nasya
Dosha – TRIDOSHAJA , Yapya
Mostly palliative management
Surgical intervention to rule out tumours
Vatakapahaja jvara – Tendency to involve lower respiratory tract?? Bronchitis
We are often referred to Jwara, certain other issues of variables of Jwara which we can have clinically are considered here with minimal academically theory. One of the common fever would be where the patient continued to have fever and nasal discharge might not significant but patient tends to develop lower respiratory tract involvement within a day or shorter duration. On the first day patient may have some feeling like cold. Second day patient may have pain in throat. Next day patient may have cough and wheezing and so on. In such condition I would start combination of Laghusoot Shekhar and Talisadi in the beginning itself so that next complications can be prevented. This presentation is similar to symptoms explained under Vata Kapha Jwara. In case of VataKaphaja Jwara where patient would have more sever systemic symptoms like joint pain, lethargy and cough developed within a day. Use of antibiotics found quiet frequent in this type of patients. Many times patient may some other systemic factors which made them susceptible for virulent infection. In that patient it could be safer to start with Laghusoot Mishran in the beginning itself before patient develops symptoms. In that condition instead of Amrutarishta I would prefer Pippalyasava / Kumari asava that would have more Pachan to help in resolution of cough.
स्तैमित्यं पर्वणां भेदो निद्रा गौरवमेव च ||
शिरोग्रहः प्रतिश्यायः कासः स्वेदप्रवर्तनम् |
सन्तापो मध्यवेगश्च वातश्लेष्मज्वराकृतिः ||
Su. Ut 39/48,49
Treatment
Mrityunjaya Rasa
Tribhuvanakeerthi Rasa
Laghusoota Mishrana
Pippalyasava / Kumari Asava
Septic and atrophic changes [Nasapaka]
Severe atrophic or septic changes in nasal mucosa could be complications of chronic rhinitis or sinusitis. In such conditions, nasal examination reveals lots of pus-like discharge and hardened calcification. This condition has been described by Sushruta as Nasapaka where typical pus formation occurs and the patient would have tenderness and visible swelling. According to Sushruta Nasapak is an incurable condition. The use of antibiotics would be necessary for this condition. Either refer the patient to others for prescription or you prescribe it. Most of the time it would be gram-positive infections. You can prescribe suitable antibiotics for gram-positive infection or you can refer the patient. Simply managing alone with Ayurveda treatment may not be possible because Sushruta described this condition as incurable. If any condition described in Samhita as incurable then I consider that as a limitation for Ayurvedic treatment. The number of patients suffering from this condition is lesser. My advice would be to refer a patient to contemporary medicine.
घ्राणाश्रितं पित्तमरूंषि कुर्याद्यस्मिन् विकारे बलवांश्च पाकः |
तं नासिकापाकमिति व्यवस्येद्विक्लेदकोथावपि यत्र दृष्टौ |
Su.Ut22/8,9
Rhinitis with purulent discharges [Pootinasa]
दोषैर्विदग्धैर्गलतालुमूले संवासितो यस्य समीरणस्तु ||
निरेति पूतिर्मुखनासिकाभ्यां तं पूतिनासं प्रवदन्ति रोगम् |
Su. Ut 22/7,8
Tridoshaja , Yapya or Asadhya condition.
Treatment
A course of antibiotics is necessary. Surgical exploration may be needed.
Pittaja jvara
वेगस्तीक्ष्णोऽतिसारश्च निद्राल्पत्वं तथा वमिः |
कण्ठौष्ठमुखनासानां पाकः स्वेदश्च जायते ||
प्रलापः कटुता वक्त्रे मूर्च्छा दाहो मदस्तृषा |
पीतविण्मूत्रनेत्रत्वं पैत्तिके भ्रम एव च ||
Su. Ut 39/31,32
In Pittaja Jwara patient may have yellowish discolouration of skin. I would consider viral hepatitis as Pittaj Jwara. If liver function tests are suggestive of obstructive pathology then it is another limitation for Ayurveda treatment. In non-obstructive condition even if bilirubin level is raised and at the same time transaminase levels are also raised (AST>1000) then Ayurveda treatment would definitely help. If AST levels are lowered upto 200 -300 and bilirubin level tends to rise then prognosis would be poor. Either refer the patient to someone else or go for further level of investigation as simple liver function test would not be enough. You have identify cause of obstruction and treatment would be more specific. In case of my treatment would be Mrityunjaya Rasa,Arogya vardhini rasa,Kumari asava. If it is viral hepatitis, we can manage the patient Ayurveda treatment as long as patient does not having altered sensorium or cerebral irritation signs. It is advisable to do serum electrolytes if patient has sever vomiting. It is not possible to manage patient alone with Ayurveda treatment if there is electrolyte imbalance. Electrolyte replacement may be needed therefore it is better to admit the patient and keep under observation. OPD level treatment may be risky because changes occur very rapidly. A patient who seems to be healthy now may become very sick in few hours, so it is better to keep patient under observation till the febrile condition is over. A simple causal regular practice may not possible in this situation still we can manage with Ayurvedic treatment alone. We have to give importance to investigation and investigations may have to be repeatedly seen and follow up has to be done. Depending upon patient’s status supplementation of electrolytes, vitamin K may require.
Investigations – Haemogram, Liver function tests
Mrityunjaya Rasa
Arogya vardhini Rasa
Kumari Asava
