Management of the Diseases of Respiratory System
(Part-2)
Prof. Muralidhar Sharma
Based on the lecture available at–Management of the Diseases of Respiratory System
The incidence of complications of tonsillitis is not very high. But you may see that and in children particularly, this is very important. One of the important cautious issues is if there is unilateral tonsillitis. If one side of the tonsil is involved, you have certain potential risks. Most of the time incidence viesyou may not see many patients, but particularly in children below five years unilateral tonsillitis often can result in significant complications of tonsillar abscess later on. So it’s better to be more conscious. I don’t say that it is incurable, but it can result in some acute complications and it may go out of hand. So the decision to whether you continue with our treatment or whether you prefer an antibiotic treatment or have an opinion of the surgeons depends upon the patient’s condition. Unilateral tonsillitisis always a red signwhilebilateral tonsillitis is comparatively are comparatively safer.
One of the conditions which can result in serious complications is tonsillar abscess. In the clinical sense, particularly in children, when the child would have the rigidity of the neck when the neck is rigid and the swelling is seen on the exterior, that’s also a critical sign where the patient may have a complication. It is interesting to note that the incurable (Asadhya) condition ‘Balas’ described by Sushruta shows the same description as that of
peritonsillar abscess.
गलेतुशोफंकुरुतःप्रवृद्धौश्लेष्मानिलौश्वासरुजोपपन्नम् |
मर्मच्छिदंदुस्तरमेतदाहुर्बलाससञ्ज्ञंनिपुणाविकारम् ||(Su.Ni16/54)
Patients may have obvious rheumatic signs occasionally, but the incidence is rare. The rheumatic signs are more common in upper-class patients while lower-class patients may not have rheumatic signs.Though the number of patients from that category with tonsillitis is more, it is a very interesting issue that is good enough for objective studies reasons, etc. But my observation of such people may have more tonsillitis where they do not go into rheumatic complications frequently. Whereas the upper class more sophisticated people, may have a lesser incidence of tonsillitis comparatively but complications for rheumatism are more.So, you have to be cautious about rheumatic signs. Tachycardia is one of the dangersigns, once the patient has a significant tachycardia, you have to be cautious. In acute rheumatism phase, it may not be possible to manage with our medicines. But once the acute phaseis over orchronic rheumatism develops then it could be managed by Ayurvedic treatment. But acute rheumatism is always preferable to have a course of antibiotics.
Rheumatic signs
- Joint pain
- Fleeting pain
- Tachycardia
- Murmur
- Chorea
Certain the confusing conditions with tonsillitis
The incidents of such conditions are not many, but herpes is comparatively common. You may get at least 3 cases of the total if you see 100 tonsillitis,at least two-three would be of herpes. Herpetic tonsillitis is not significantly different from others, but only the difference is as you have herpes elsewhere, which could be small eruptions across a cavity. It’s not limited only to the tonsillar area, it could be seen in the oral mucosa, but patients may complain only about the pain in the throat. So complaints could be similar,and febrile conditions would be there.
If you identified that as herpetic conditions, the treatment is also easier comparatively. My treatment in that condition would be Kamdudha and Paripathadi Kadha. Incidence is not very high, comparatively lesser but still, it may occur. So you have to be alert that every patient presenting with the pain and swelling in the throat is not tonsillitis. So from that point of view, we have to be bothered about it.
Candidiasis also is another common condition seen in immune-compromised and diabetic patients. Particularly in diabetes, if they have throat pain then you have to be more cautious. Candidiasiswould be presenting with thick and yellowish exudates. This condition would be more chronic and usually resistant to the treatment. Most of the time there would be underlying pathology andhence the priority would be given to managing that underlying condition. Oral Candidiasis could be a flag sign in diabetes patients initially.
Many times incidence of undiagnosed leukemia, where other clinical symptoms were comparatively misleading. But the leukemia was suspected because of candidiasis and when progress along with the investigations, leukemia was confirmed. So when you have candidiasis, it’s not a simple straightforward case. Comparatively,the incidence is lesser, but you need to have detailed a workup about the underlying cause. If the underlying cause is identified, then the whole treatment will be cording to that underlying pathology. If it’s along with that underlying management of the underlying pathology, I would prefer Gandhak Rasayan, Khadhirarishta, and Triphala gargles. Triphala gargles would also help.
One of the very important categories of patients undergoing chemotherapy or radiation candidiasis is quite a common complication. Use of any other antibiotic or antifungal drugs often can result in more complications and in that condition Triphala kwatha gargling alone would be quite significantly useful. Patients undergoing chemotherapy is one of our strong areas which we can recommend, we may not intervene with the chemotherapy, need not give any internal medicine, Triphala kwatha gargling alone can help in the significant resolution of the symptoms. Of course, tonsillar carcinoma is a rare phenomenon, still, occasionally it may occur. So only the thing is, you should be alert. So every swollen tonsil is not tonsillitis.
Herpangina
Treatment:
Kamadudha
Paripathadikadha
Candidiasis
Treatment:
GandhakaRasayana
Khadirarishta
Triphalagargling
Carcinoma
Laryngitis
Now, when you descend from the tonsillitis next area where usually the clinical presentation is laryngitis. Identification of the laryngitis is by a dry cough and the hoarseness of the voice.
Characteristic hoarseness of the voice is a typical feature and usually,the fever will be low grade. Swarha is exact description described by Vagbhat. It is sort of the disease where you will get ‘Hataswar’ difficult feature is described. All that point is every such condition, every such variable clinical conditionis described in the text and there is a specific line of management, we might not be following.
श्लेष्मरुद्धाऽनिलगतिःशुष्ककण्ठोहतस्वरः|
ताम्यन्प्रसक्तंश्वसितियेनसस्वरहाऽनिलात्||A.H U 21/57
As far as the treatment is concerned, there is not much of a very significant issue, unless the condition is persisting for a long period. My guideline is if the patient has hoarseness of the voice that persists for more than three weeks, then laryngoscopy is a must. I do that laryngoscopy if it is persisting beyond three weeks. This is not a universal guideline, I have framed it for my practice alone. By that you can be saved in other ways misleading conditions, many critical conditions like you must tuberculosis can also present with the same symptoms occasionally and hence a laryngoscopy is a safer investigation. But usually, I prefer it only after three weeks. Incidences of such issues also are not very common, but you have one patient among hundreds also is significant enough. So same issue is to be considered as such.Chronic conditions when the patient has a history for a long duration are better to be safeguarded.
Laryngitis
Hoarseness of voice
Malaise
Treatment
Mrityunjaya Rasa
TriphalaGuggulu
Amritarishta
Khadiradivati /Lavangadivatifor chewing
Laryngoscopyis -a must if symptoms persist beyond 3 weeks
Tracheitis – Vataj/PittajKasa:
The next of course is the tracheitiswhich you can have further deeper down into the area. The patient would have typicalsubsternal chest pain is the characteristic feature of the tracheitis. Sputum also is comparatively lesser. This condition is exactly again described by Vagbhat as well as Charak asVatajand Pittajacomplication. So, when it is Vatajcomplication, characteristically the feature is a dry the sputum.
Also,Swarbheda is a common feature, but you will have sputum after efforts. The patient has to strain more and only after having straining, stressing a small amount of the sputum would be coming through. Whereas, if it isPittaj in that condition, a patient will have a burning sensation in the substernal area is common. This difference is not made out in the contemporary sciences. In contemporary science burning as well as sub-substernal is considered a common sign of tracheitis. But we are in a position to make out these two categories of the patients separately. Now management in that condition will be, when the patient has Vataj symptoms, my prescription would be Mrityunjaya Rasa,Sootashekhara Rasa,Laghusoota Mishrana,and Somasava. In case of Pittaja symptoms, my choice would be Sitopaladi choorna instead of the Sootashekhara,relatively Sheetveerya Dravyas than Ushnaveerya Dravyas.I also prefer Pippalyasava in this condition. Results would be usually satisfactory and comparatively the outcome is better than any of the other contemporary treatments. You will have a good number of patients who have visited other doctors and then come to you for Ayurvedic treatment. In tracheitis often the modern contemporary antibiotic treatment doesn’t help and virtually there is no such a specific treatment for tracheitis. Even the syrups that contain volatile substances often produce more irritation than really the resolution. This is our stronger area for treatment. So Tracheitis is our area for treatment.
Treatment
Mrityunjaya Rasa
Sootashikhara Rasa
LaghusootaMishrana / Sitopaladichoorna
Somasava / Pippalyasava
Next, as the inflammation goes down further is bronchitis, and bronchitis again in general, the clinical description of the bronchitis is the same where you’ll have thick sputum and a relatively low degree of fever. But for the clinical identification, and maybe from the point of view of clinical management, I categorize them into two categories. It’s my categorization may not be what you see in the text, I would say bronchitis is the usual initial feature that will be presented with the Kaphaj Kasa Lakshan. Exactly what Sushruta has said is the characteristic feature will be the patient would have reduced appetite and the pain will be more when the stomach is empty.
प्र(वि)लिप्यमानेनमुखेनसीदन्शिरोरुजार्तःकफपूर्णदेहः|
अभक्तरुग्गौरवसादयुक्तःकासेतनासान्द्रकफंकफेन||(Su. U 52/10)
Now with a patientwith bronchitis one of the important clinical symptoms which are not mentioned in the textbooks, some of the patients would say the cough is more after consuming the food. Another category of the patient group is cough would be more onan empty stomach, consumption of food reduces the cough. Now a consumption of the food reducing the cough and the pain being more or the discomfort being more onan empty stomach is a typical sign of the Kaphaj Kasa and this is not mentioned in the contemporary textbooks. None of the other textbooks would say, it’s about the Ayurvedatextbook and is an important categorization. In that condition, the drug of choice I prefer would be TribhuvanKirti. TribhuvanKirti is a more efficient drug in Kaphaj involvement.
Of course,MritunjayRas also is given if the patient is febrile and the same treatment. Steam inhalation is another very significantly beneficial management in case of bronchitis conditions. Usually, you take anX-ray and in that, you will have only minimal modeling as such. Now, the minimal modeling scene is a typical sign of Kaphaj Kasa one variety of bronchitis
Bronchitis
Fever
Thick and scanty expectoration
Crepitations
Treatment
Mrityunjaya Rasa
TribhuvanaKeerthi rasa
LaghusootaMishrana
Somasava
Steam inhalation
