Case Series On Vataja Pratishyaya (allergic Rhinitis 2x68j
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Case series on Vataja Pratishyãya
(Chronic Allergic Rhinitis)
Dr.Kiran Mutnali Associate
Introduction • Nose - Exposed to atmosphere for smell sensation & respiration. • Prone to viral, bacterial, fungal infections, allergies and injuries. • Inhalation of Raja (dust), dhooma (smoke), vayu. • Sheeta Jala Pana, Avashyaya (Exposure to snow/moisture) • “Peetena anyeyna varinaa” & atyambu paana 1
Pratishyãya • Most common & important disease among Nasa Roga. • Vatam prati abhimukham shyayo gamanam kaphaadeenaam yatra sa pratishyaya” • Prati = in opposite direction • Shyaya = gamana of dosha • Vitiated Vatadi dosha either individually or together accummulate in shiras, then propagate to the nose leading to pratishyaya. 2
Case 1 (KR) Male, aged 22 yrs non HTN & DM Sneezing, Rhinorrhea, Nasal congestion, Oral breathing Allergic to dust and cold weather Repeated episodes at least once a month • Surgery twice for Septal deviation 2 years back (2012) • Hair Fall 3 • Since 5 years • • • • •
Case 2 (MP) • Female aged 53 years non HTN & DM • Rhinorrhea (Slightly thick) • Congestion • Headache • Sinusitis • Lumbago • Acidity
• Allergic to Dust, Smoke & Perfume • Underwent Surgery twice for Septal deviation. • Hemorrhoidectomy & Hysterectomy • Depressed
• Since 4 years 4
Case 3 (VK) • • • • • • •
Male aged 25 years non HTN & DM Engineering student Nasal Congestion Sinusitis Post Nasal Drip Cough Allergic to Dust and Cold - since 4
years • Hair Fall
5
Case 4 (AH) • • • • • • •
Male student aged 17 years Runny nose Sneezing Post Nasal Drip Nasal Congestion Cough Allergic to Dust & Cold
Since 5 years 6
Case 5 (VB) • • • • • • •
Male aged 39 years non HTN & DM Engineer by occupation Rhinorrhea (Slightly thick), Sneezing Sinusitis Cough & Wheeze Post Nasal drip since 4 years Reduced appetite, aruchi & constipation since 3 months 7
H/o Allergy H/o Allergy
Case 1
Case 2
Case 3
Case 4
Case 5
Dust
+
+
+
+
+
Cold Weather
+
-
+
+
+
Perfumes
-
+
-
-
-
Smoke
-
+
-
-
-
No h/o Smoking & Perennial Presentation 8
Symptoms Symptoms
Case 1
Case 2
Case 3
Case 4
Case 5
M, 22, 5 yrs
F, 53, 5 yrs
M, 25, 4 yrs
M, 17, 5 yrs
M, 39, 4 yrs
No H/o: HTN, DM, Koch’s Disease Sneezing
++
+
++
++
++
Rhinorrhea
+
+
-
++
+
Nasal congestion
+++
+++
+
+
-
Sinusitis
-
++
+
-
+
Headache
-
+++
-
-
-
Post Nasal Drip
-
-
+
+
++
Cough
-
-
+
+
+
Associated Conditions
Hair Fall
APD LBA
Hair Fall
--
Vibandha Wheezing 9
Clinical Examination • Vitals – WNL • Ama – Except one patient none had ama lakshana. • Local Examination – Nasal mucosa was pale – Hypertrophied inferior turbinate – No polyp, nasal crease
• Systemic Examination – Respiratory : Expiratory Wheeze in one of the patient (case 5). – MS System : Restricted ROM in LS Spine in case 2 10
Investigation Investigati on
Case 1
Case 2
Case 3
Case 4
Case 5
AEC cells/cu mm
1200
900
1200
600
900
11
Treatment History H/o Treatme nt Allopathic
Surgery
Case 1
Case 2
Case 3
Case 4
Case 5
Antihistamines & Decongestants, Inhalation of corticosteroids
Twice for Septal deviation
Twice for Septal deviation. Hemorrhoid ectomy Hysterecto my
--
--
--
12
Management Protocol Treatment Pachana Deepana Sthanika Abhyanga
Case 1
Case 2
Case 3
Case 4
Case 5
Triphala
--
Suddha Bala thaila Sweda : Mridu Bashpa Sweda
Nasya Karma
Dhūmapāna
Shadbindu Thaila 3 days Anu Thaila followed by Anu Thaila
Anu Thaila
Sahdbindu Thaila 3 days followed by Anu Thaila
Rasnadi followed by Haridra dhoomapana 13
Outcome after 21 days of Nasya Symptoms Case 1 Case 2 Case 3 Case 4
Case 5
M, 22, 5 yrs
F, 53, 5 yrs
M, 25, 4 yrs
M, 17, 5 yrs
M, 39, 4 yrs
Sneezing
++
+
++
++
++
Rhinorrhea
+
+
-
++
+
Nasal congestion
+++
+++
+
+
-
Sinusitis
-
++
+
-
+
Headache
-
+++
-
-
-
Post Nasal Drip
-
-
+
+
++
Cough
-
-
+
+
+
Associated Conditions
Hair Fall
APD LBA
Hair Fall
--
Vibandha Wheezing 14
Investigations Investigat ion
Case 1
Case 2
Case 3
Case 4
Case 5
1200
900
1200
600
900
550
400
640
400
500
AEC cells/cu mm
15
Medications & Rasayana • Haridra Khanda – 1tsf BD on empty stomach – Allergy
• Nayopaya Kashaya (Bala, Jeeraka & Nagara) – Pachana, Deepana, Vata hara -15 ml BD BF
• Naradeeya Lakshmi Vilasa Rasa with swarna – Kasa, Peenasa, Yakshma; Vajikarana 1 Tab BD AF
• Agastya Rasayana 1tsf BD AF • Pathya
16
Need of Rasayana • Body’s immune system becomes sensitized and over reacts to something in environment. • IgE antibodies attach to allergen & release inflammatory chemical histamine from mast cell. • “Pratishyayam vardhamaanam kshaya pradam” 17
Important Points Ascertain ama avastha Avoid Allergic factors Avoid nasya karma during rhinorrhea Determine dosha predominance and adopt medications • Treatment should focus on pacifying the dosha and in enhancing the immunity by use of rasayana medicines. • • • •
18
k n a h T u o Y
(Chronic Allergic Rhinitis)
Dr.Kiran Mutnali Associate
Introduction • Nose - Exposed to atmosphere for smell sensation & respiration. • Prone to viral, bacterial, fungal infections, allergies and injuries. • Inhalation of Raja (dust), dhooma (smoke), vayu. • Sheeta Jala Pana, Avashyaya (Exposure to snow/moisture) • “Peetena anyeyna varinaa” & atyambu paana 1
Pratishyãya • Most common & important disease among Nasa Roga. • Vatam prati abhimukham shyayo gamanam kaphaadeenaam yatra sa pratishyaya” • Prati = in opposite direction • Shyaya = gamana of dosha • Vitiated Vatadi dosha either individually or together accummulate in shiras, then propagate to the nose leading to pratishyaya. 2
Case 1 (KR) Male, aged 22 yrs non HTN & DM Sneezing, Rhinorrhea, Nasal congestion, Oral breathing Allergic to dust and cold weather Repeated episodes at least once a month • Surgery twice for Septal deviation 2 years back (2012) • Hair Fall 3 • Since 5 years • • • • •
Case 2 (MP) • Female aged 53 years non HTN & DM • Rhinorrhea (Slightly thick) • Congestion • Headache • Sinusitis • Lumbago • Acidity
• Allergic to Dust, Smoke & Perfume • Underwent Surgery twice for Septal deviation. • Hemorrhoidectomy & Hysterectomy • Depressed
• Since 4 years 4
Case 3 (VK) • • • • • • •
Male aged 25 years non HTN & DM Engineering student Nasal Congestion Sinusitis Post Nasal Drip Cough Allergic to Dust and Cold - since 4
years • Hair Fall
5
Case 4 (AH) • • • • • • •
Male student aged 17 years Runny nose Sneezing Post Nasal Drip Nasal Congestion Cough Allergic to Dust & Cold
Since 5 years 6
Case 5 (VB) • • • • • • •
Male aged 39 years non HTN & DM Engineer by occupation Rhinorrhea (Slightly thick), Sneezing Sinusitis Cough & Wheeze Post Nasal drip since 4 years Reduced appetite, aruchi & constipation since 3 months 7
H/o Allergy H/o Allergy
Case 1
Case 2
Case 3
Case 4
Case 5
Dust
+
+
+
+
+
Cold Weather
+
-
+
+
+
Perfumes
-
+
-
-
-
Smoke
-
+
-
-
-
No h/o Smoking & Perennial Presentation 8
Symptoms Symptoms
Case 1
Case 2
Case 3
Case 4
Case 5
M, 22, 5 yrs
F, 53, 5 yrs
M, 25, 4 yrs
M, 17, 5 yrs
M, 39, 4 yrs
No H/o: HTN, DM, Koch’s Disease Sneezing
++
+
++
++
++
Rhinorrhea
+
+
-
++
+
Nasal congestion
+++
+++
+
+
-
Sinusitis
-
++
+
-
+
Headache
-
+++
-
-
-
Post Nasal Drip
-
-
+
+
++
Cough
-
-
+
+
+
Associated Conditions
Hair Fall
APD LBA
Hair Fall
--
Vibandha Wheezing 9
Clinical Examination • Vitals – WNL • Ama – Except one patient none had ama lakshana. • Local Examination – Nasal mucosa was pale – Hypertrophied inferior turbinate – No polyp, nasal crease
• Systemic Examination – Respiratory : Expiratory Wheeze in one of the patient (case 5). – MS System : Restricted ROM in LS Spine in case 2 10
Investigation Investigati on
Case 1
Case 2
Case 3
Case 4
Case 5
AEC cells/cu mm
1200
900
1200
600
900
11
Treatment History H/o Treatme nt Allopathic
Surgery
Case 1
Case 2
Case 3
Case 4
Case 5
Antihistamines & Decongestants, Inhalation of corticosteroids
Twice for Septal deviation
Twice for Septal deviation. Hemorrhoid ectomy Hysterecto my
--
--
--
12
Management Protocol Treatment Pachana Deepana Sthanika Abhyanga
Case 1
Case 2
Case 3
Case 4
Case 5
Triphala
--
Suddha Bala thaila Sweda : Mridu Bashpa Sweda
Nasya Karma
Dhūmapāna
Shadbindu Thaila 3 days Anu Thaila followed by Anu Thaila
Anu Thaila
Sahdbindu Thaila 3 days followed by Anu Thaila
Rasnadi followed by Haridra dhoomapana 13
Outcome after 21 days of Nasya Symptoms Case 1 Case 2 Case 3 Case 4
Case 5
M, 22, 5 yrs
F, 53, 5 yrs
M, 25, 4 yrs
M, 17, 5 yrs
M, 39, 4 yrs
Sneezing
++
+
++
++
++
Rhinorrhea
+
+
-
++
+
Nasal congestion
+++
+++
+
+
-
Sinusitis
-
++
+
-
+
Headache
-
+++
-
-
-
Post Nasal Drip
-
-
+
+
++
Cough
-
-
+
+
+
Associated Conditions
Hair Fall
APD LBA
Hair Fall
--
Vibandha Wheezing 14
Investigations Investigat ion
Case 1
Case 2
Case 3
Case 4
Case 5
1200
900
1200
600
900
550
400
640
400
500
AEC cells/cu mm
15
Medications & Rasayana • Haridra Khanda – 1tsf BD on empty stomach – Allergy
• Nayopaya Kashaya (Bala, Jeeraka & Nagara) – Pachana, Deepana, Vata hara -15 ml BD BF
• Naradeeya Lakshmi Vilasa Rasa with swarna – Kasa, Peenasa, Yakshma; Vajikarana 1 Tab BD AF
• Agastya Rasayana 1tsf BD AF • Pathya
16
Need of Rasayana • Body’s immune system becomes sensitized and over reacts to something in environment. • IgE antibodies attach to allergen & release inflammatory chemical histamine from mast cell. • “Pratishyayam vardhamaanam kshaya pradam” 17
Important Points Ascertain ama avastha Avoid Allergic factors Avoid nasya karma during rhinorrhea Determine dosha predominance and adopt medications • Treatment should focus on pacifying the dosha and in enhancing the immunity by use of rasayana medicines. • • • •
18
k n a h T u o Y
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