pratishyaya kc036 gdg

COMPARATIVE STUDY OF AMRUTHA GUGGULU

AND PATADI TAILA PRATIMARSHA NASYA IN

THE MANAGEMENT OF PRATISHYAYA By

Shreekrishna Hanumantappa Jigaloor

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfilment of the degree of

Ayurveda Vachaspati M.D. In

Kayachikitsa Under the Guidance of

Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)]

Department of Kayachikitsa Post Graduate Studies & Research Centre D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG

2004-2007

Ayurmitra

TAyComprehended

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG - 582 103

This is to certify that the dissertation entitled “COMPARATIVE STUDY OF

AMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHA NASYA IN THE

MANAGEMENT OF PRATISHYAYA” is a bonafide research work done by SHREEKRISHNA

HANUMANTAPPA JIGALOOR in partial fulfilment of the requirement for the post graduation

degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University of

Health Sciences, Bangalore, Karnataka.

Dr. SHIVA RAMA PRASAD KETHAMAKKAM.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)]

GuideREADER IN KAYACHIKITSADGMAMC, PGS&RC, Gadag

Date:

Place: Gadag

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE

GADAG, 582 103

Endorsement by the H.O.D, Principal/ head of the institution

This is to certify that the dissertation entitled “COMPARATIVE STUDY OF

AMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHA NASYA IN THE

MANAGEMENT OF PRATISHYAYA” is a bonafide research work done by

SHREEKRISHNA HANUMANTAPPA JIGALOOR under the guidance of Dr. SHIVA

RAMA PRASAD KETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D

(Jyotish)], Reader in Kayachikitsa, DGMAMC, PGS&RC, Gadag, in partial fulfilment

of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D.

(Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences, Bangalore,

Karnataka.

.

(Dr. G. B. Patil) Principal,

DGM Ayurvedic Medical College, Gadag

Date: Place:

(Dr. V. Varada charyulu) Professor & HOD

Dept. of Kayachikitsa PGS&RC

Date: Place: Gadag

Declaration by the candidate

I here by declare that this dissertation / thesis entitled “COMPARATIVE

STUDY OF AMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHA

NASYA IN THE MANAGEMENT OF PRATISHYAYA” is a bonafide and

genuine research work carried out by me under the guidance of Dr. SHIVA

RAMA PRASAD KETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D

(Jyotish)], Reader in Kayachikitsa, DGMAMC, PGS&RC, Gadag.

Date

Place

(SHREEKRISHNA HANUMANTAPPA JIGALOOR)

Copy right

Declaration by the candidate

I here by 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 the academic / research

purpose.

Date

Place

(SHREEKRISHNA HANUMANTAPPA JIGALOOR)

© Rajiv Gandhi University of Health Sciences, Karnataka

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Contents

1

Contents of

COMPARATIVE STUDY OF AMRUTHA GUGGULU AND

PATADI TAILA PRATIMARSHA NASYA IN THE

MANAGEMENT OF PRATISHYAYA

By

Shreekrishna Hanumantappa Jigaloor

Under the Guidance of

Dr. Shiva Rama Prasad Kethamakka

Chapter Content Pages

1 Introduction 1 to 3

2 Objectives 4 to 5

3 Literary review 6 to 71

4 Methods 72 to 83

5 Results 84 to 122

6 Discussion 123 to 130

7 Conclusion 131 to 134

8 Summary 135 to 136

9 Bibliographic References 1 to 5

10 Annex – Case sheet 1 to 7


2

Figures of

COMPARATIVE STUDY OF AMRUTHA GUGGULU AND PATADI TAILA

PRATIMARSHA NASYA IN THE MANAGEMENT OF PRATISHYAYA

SN Title of figures Page Number

1 Schematic Samprapti of Pratishyaya 34

2 Procedure of Pratimarsha Nasya 41

3 Contents of Amrutha Guggulu 55

4 Contents of Patadi Taila 68

Graphs of



SN Title of graphs Page Number

1 Pictorial Distribution of patients by age in all Groups 87

2 Distribution of patients by gender in Pratishyaya 88

3 Result Distribution of patients by gender in Pratishyaya 89

4 Distribution of patients by religion in Pratishyaya 90

5 Distribution of patients by occupation 91

6 Result of patients by occupation in Pratishyaya 92

7 Distribution of patients by economic status 93

8 Distribution of patients by diet in Pratishyaya 94

9 Pictorial Distribution of Results Group –A 117

10 Pictorial Distribution of Results Group –B 119

11 Pictorial Distribution of Results Group –C 121

12 Pictorial Distribution of cumulative Results of trial 122


3

Tables of COMPARATIVE STUDY OF AMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHA NASYA IN THE MANAGEMENT OF PRATISHYAYA

SN

Title of Table Page Number

1 Classification of Pratishyaya 21

2 Nidana of Pratishyaya 2

3 Symptoms of vataja Pratishyaya 26

4 Symptoms of pittaja Pratishyaya 27

5 Symptoms of kaphaja Pratishyaya 27

6 Symptoms of raktaja Pratishyaya 28

7 Samprapti ghataka 29

8 Sapeksha Nidana 35

9 Showing Pratishyaya as a lakshana in various diseases 36

10 Showing the upadravas of Pratishyaya 37

11 Pathya & Apathya in Pratishyaya 46

12 Demographic data of Group – A (Amrutha Guggulu) 85

13 Demographic data of Group – B (Patadi Taila – Pratimarsha Nasya) 85

14 Demographic data of Group – C (Amrutha Guggulu and Patadi Taila –

Pratimarsha Nasya)

86

15 Distribution of patients by age in Group –A, B, C 86

16 Results of patients by age in Group – A (Amrutha Guggulu) 87

17 Distribution of patients by gender in Pratishyaya 88

18 Distribution of patients by religion in Pratishyaya 89

19 Result of patients by religion in Pratishyaya 90

20 Distribution of patients by occupation 91

21 Distribution of patients by economic status 92

22 Distribution of patients by diet in Pratishyaya 93

23 Chief & associated complaints of Group – A (Amrutha Guggulu) 94

24 Chief & associated complaints of Group – B (Patadi Taila Pratimarsha

Nasya)

95


4

25 Chief & associated complaints of Group – C (Amrutha Guggulu and

Patadi Taila – Pratimarsha Nasya)

95

26 Chief complaint & associated complaints of Group- A, B, C 96

27 Subjective statistical assessment data of Group – A (Amrutha Guggulu) 97

28 Subjective statistical assessment data of Group – B (Patadi Taila –

Pratimarsha Nasya)

97

29 Subjective statistical assessment data of Group – C (Amrutha Guggulu

and Patadi Taila – Pratimarsha Nasya)

98

30 Data of Group – A (Amrutha Guggulu) [as described in case sheet] 98

31 Data of Group – B (Patadi Taila – Pratimarsha Nasya) 99

32 Data of Group – C (Amrutha Guggulu & Patadi Taila Pratimarsha

Nasya)

99

33 Chief complaint details of Group- A, B, C 100

34 Disease aggravating and comfort features of Pratishyaya - data of Group

– A (Amrutha Guggulu) [as described in case sheet]

101


– B (Patadi Taila – Pratimarsha Nasya) [as described in case sheet]

101


– C (Amrutha Guggulu and Patadi Taila – Pratimarsha Nasya)

102

37 Pathogenic factors of Pratishyaya data of Group – A (Amrutha Guggulu)

[as described in case sheet]

103

38 Pathogenic factors of Pratishyaya data of Group – B (Patadi Taila –

Pratimarsha Nasya) [as described in case sheet]

104

39 Pathogenic factors of Pratishyaya data of Group – C (Amrutha Guggulu

and Patadi Taila – Pratimarsha Nasya) [as described in case sheet]

105

40 Etiological factors of Pratishyaya data of Group – A (Amrutha Guggulu) 107

41 Etiological factors of Pratishyaya data of Group – B (Patadi Taila –

Pratimarsha Nasya) [as described in case sheet]

108

42 Etiological factors of Pratishyaya data of Group – C (Amrutha Guggulu

and Patadi Taila – Pratimarsha Nasya) [as described in case sheet]

109


5

43 Objective statistical assessment data of Group – A (Amrutha Guggulu) 111

44 Objective statistical assessment data of Group – B (Patadi Taila –

Pratimarsha Nasya)

111

45 Objective statistical assessment data of Group – C (Amrutha Guggulu and

Patadi Taila – Pratimarsha Nasya)

112

46 ANOVA table for the parameter erythrocyte sedimentation rate 113

47 ANOVA table for the parameter absolute Eosinophils count 114

48 ANOVA table for the parameter differential count (Eosinophils) 115

49 ANOVA table for the parameter total count 115

50 Subjective parameters statistical study of individual Group – A (Amrutha

Guggulu)

116

51 Objective parameters statistical study of individual Group – A (Amrutha

Guggulu)

116

52 Results of Group – A (Amrutha Guggulu) 117

53 Subjective parameters statistical study of individual Group – B (Patadi

Taila – Pratimarsha Nasya)

118

54 Objective parameters statistical study of individual Group – B

(Patadi Taila – Pratimarsha Nasya)

118

55 Results of Group – B (Patadi Taila – Pratimarsha Nasya) 119

56 Subjective parameters statistical study of individual Group – C

(Amrutha Guggulu and Patadi Taila – Pratimarsha Nasya)

120

57 Objective parameters statistical study of individual Group – C

(Amrutha Guggulu and Patadi Taila – Pratimarsha Nasya)

120

58 Results of Group – C (Amrutha Guggulu and Patadi Taila – Pratimarsha

Nasya)

121

59 Cumulative Results of the trial 122

I express my deep gratitude to my guide Dr. K. Shiva Rama Prasad, M.D. (Ay),

C.O.P (German) M.A.Ph.D. (Jy) for his timely advises and encouragement in every step of

my success. His ideologies have been exemplar to my further career.

I express my gratefulness to my professor H.O.D., Dr. V. Varadacharyulu, M.D.(Ayu),

Kayachikitsa, for their time to time help and critical suggestions associated with expert

guidance at the completion of this dissertation.

I express my thankfulness to beloved principal Dr. G. B. Patil, for his encouragement

as well as providing all necessary facilities for this research work.

I express my profound sense of acknowledgement to various departments H.O.D.s,

teachers and colleagues of sister concern departments along with the ministerial and sub

staff of the D.G.M. Ayurvedic Medical College & Hospital, Gadag.

I express my sincere thanks to and Dr R. V. Shettar, Dr. S.B. Sankadal, Dr.

G.Purushottamacharyulu, Dr. P. Shivaramudu, Dr. M.C. Patil, Dr. Danappagoudar, Dr.

Dhilip, Dr. Jagadeesh Mitti, Dr. Samudri, Dr. Mulugund, Dr. Kuber Sankh, Dr. Shashikant

Nidagundi, Dr. Mulkipatil, Dr. B.G. Swami, Dr. S.B. Govingappanavar Dr. Veena Kori, Dr.

Yasmeen, Dr. Yarigeri, Dr. G.S. Hiremath, Dr. S.A. Patil, Dr. B.S. Patil, Dr. Gacchinamath,

Dr. Bidanal, Dr. Soloman, Dr. Santhosh Belavadi Dr. Bheem Gopal Dr.Anil Bacha and Late

Dr. C.S. Sarangamath. I express my sincere thanks to Mr. Nandakumar for his help in

statistical analysis of results.

Behind my success, the pillars are my parents, Renuka Devi and Hanumantappa a

warm thanks to them on this regard.

I am extremely thankful and obliged to Sujata Devi, Rohini, Parameshwara,

Purushottama, Manjegoudar, Ashwatha Kumar, Chandanagouda, who always watched me

and shaped my career.

My sincere thanks to Dr. Ratna Kumar, Dr. Uday Kumar, Dr. Kalmat, Dr. Venkaraddi,

Dr. G.G. Patil, Dr. Sarvi, Dr. Umesh Kumbar, dr. H. Ananad, Dr. Ashok Akki, Dr. Meenakshi,

Dr. Shivaleela Kalyani, Dr. Kamalaxi Angadi, Dr. Sulochana, Dr. Ashok, Dr. Shekhar

Sharma, Dr. Neeraj, Dr. Sanjeev, Dr. Vijayalakshmi, Dr. Veena Jigalur, Dr. Triveni, Dr.

Bhanu, Dr. Shobha, Dr. Prashant Naik, Dr. Prasanna Joshi, Dr. Hadimani, Dr. B.Y. Ghanti,

Harun Kowshik and Jyothi - my friend of all times, with out of their support I am always

incomplete.

Last but not least, I am thankful to our JSVVS Chairman Sri S.V. Saunshi, for his

encouragement to join in to PG course.

At last my sincere thanks to the subjects who cooperated at my dissertation, with out

of them it would have been not a success.

Place:

Date: Shreekrishna Hanumantappa Jigaloor,

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Abstract



By: Shreekrishna Hanumantappa Jigaloor, Under the Guidance of: Dr. Shiva Rama Prasad Kethamakka

Keywords: Pratishyaya, Pratimarsha, Nasya, Immunity, IgE, Nasasrava,

The history reveals that the Pratishyaya exists from ages. Pratishyaya is considered

as a disease since 2500 BC, the classical age of Ayurveda. Pratishyaya is a complex disease

involving several symptoms and diversified pathogenesis. Pratishyaya is an IgE mediated

hypersensitivity disease of mucous membranes of the nasal airways. In Purvarupas of

Rajayakshama Pratishyaya can be seen. Pratishyaya is an acute disease of Pranavaha Srotas

and Nasa srava and Nasavarodha characterize it. Only Charaka and Kashyapa have

mentioned about the general symptoms of Pratishyaya. Samanya Chikitsa of Pratishyaya,

according to Chakrapani, five diseases viz. Netraroga, Kukshiroga, Pratishyaya, Vrana and

Jwara, are cured with Langhana Chikitsa within five days. Susruta has specifically

mentioned Vamana in Pratishyaya Chikitsa. Vyadhi kshamatwam and Vyadhi bala

virodhitwam are developed by the medicament and procedure. In this study three group’s

viz. Group A: Amrutha Guggulu internally, Group B: Nasya with Patadi taila and Group C:

15 patients will receive both Amrutha Guggulu internally and Nasya with Patadi taila.

The results of the Group –A as shown above exhibits the well responded patients 9

(60%) and Moderately responded patients 6 (40%) after the through examination of the

subjective and objective parameters and statistically highly significant. The results of the

Group –B as shown above exhibits the 2 (13.33%) patients cured, 11 (73.33%) well

responded patients and Moderately responded patients are 6 (40%) after the through

examination of the subjective and objective parameters and statistically highly significant.

The results of the Group –C as shown above exhibits the 7 (46.67%) patients cured and 8

(53.33%) well responded patients after the through examination of the subjective and

objective parameters and statistically highly significant. The cumulative results of the trial as

shown above exhibits the 9 (20%) patients cured, 28 (62.22%) well responded patients and 8

(17.8%) of moderately responded after the through examination of the subjective and

objective parameters and statistically highly significant.

Abstract

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Introduction

1

Chapter – 1

Introduction

“ fficient doctor treated common cold in seven days other wise it is cures in one

week” is the good olden saying. In spite of the development of health care systems in all

areas common minimum subjects are still for the discussion in the mob. One such condition

suffers the common man is “Pratishyaya” vis-à-vis common cold. Common is for every

body, may be the King or Worker.

As we observe the human development patterns the pollutant environment is the root

cause of the all-allergic manifestations, dealt in Ayurveda as Gramavasa Vyapannakruta

Vyadhi. Dusts, smoke, Pollen and other fine substances etc. play the role of irritants. The

modern lifestyle makes continuous and close relationships with the causes of nasal irritation

such as consumption of cold water, air – conditioned rooms, exposure to hot dusty climate,

vehicle Smoke, etc. leads to a higher chance of nasal problems.

Like many other diseases, the immunological factors also play a vital role in the

development, recurrence a well as in the curative aspect of the Pratishyaya. Identification of

aggravating factors of allergens is the first step of management as rightly said by the

Ayurveda as Nidana Parivarjanam. But on the aetio-pathological aspects of a critical study

on Ayurvedic parlance is important to offer better remedy for the poor patients.

Pratishyaya is a complex disease involving several symptoms and diversified

pathogenesis. It is a nuisance to the affected irrespective of age and sex. Description of this

disease is available in plenty while going through ancient classics and lexicons of Ayurveda.

A lot of modern disease entities can be included under the heading of Pratishyaya. Unless it


2

is not managed properly, can lead to several complications, which may be life threatening or

crippling in future. If it happens to a child or delicates the condition is more troublesome and

is a headache to both physician and attendants.

Pratishyaya although a mild disease, it can make patients externally uncomfortable

and can interfere with the routine activities. Pratishyaya is considered as a disease since

2500 BC, the classical age of Ayurveda. All major texts of Ayurveda have devoted their

attention to various aspects of the disease. Pratishyaya is an IgE mediated hypersensitivity

disease of mucous membranes of the nasal airways. It is a chronic disabling disorder

affecting at least over 10% of population. It is especially disturbing to notice that the spread

of the disease is on a steady rise in recent years. This can be a consequence of urbanization,

industrialization and subsequent pollution.

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 established by the

other researchers.

A simple common cold or Pratishyaya affects most of the population. Probably very

few people have been left untouched by these irksome disorders. However, if this is

neglected for a longer period, it may lead to more serious problem like Sinusitis, Bronchitis

or such other Upper respiratory tract infection. Even in Ayurveda it is said that Pratishyaya

let it be Ekadoshaja or Bahudoshaja, if not treated properly may lead to Dushta Pratishyaya

and later Kasa, or even Kshaya.

Pratishyaya as such is a disease situated in the Nasa 1, which is a pathway or gateway

of head and related organs. These organs are parts of the Shiras (head). Shiras, in fact is one


3

of the important organ of the body and given prominence by Charaka and Susruta. Shiras is

said to be Uttamanga 2, the superior most organ and compared to one of the Vital Tripods.

Charaka compares it with Sun. As sun reaches every corner of the earth by his powerful

rays, Shiras reaches to all parts of the body through its Vatanadis and controls all the

physiological functions. Hence Shiras has to be taken into consideration while discussing

the pathology and management of Dushta Pratishyaya.

For the present study Pratishyaya that is a very common disease affecting any age

group of both sex and prevalent worldwide has been noticed. It is well known for its

recurrence and chronic appearance. Recurrence of the disease occurs because the Doshas

have not been evacuated completely. Such Doshas reside in their latent stage (predisposing

stage) and give rise to the same disease when factors (aggravating factors) are favorable.

Even some times the Pratishyaya appears as a Rutu and Kapha sambandha Vyadhi. In this

way disease attains the Jeerna Avastha. Anurjita Pratishyaya (Allergic Rhinitis) is also

recurring frequently and attending the Jeerna Avastha, as per the Charaka for which Nasya is

the line of treatment 3.

Therefore Nasya has been selected as treatment modality for the present study.

Nasyas are of 5 types according to Charaka i.e. Navana, Avapidana, Dhmapana, Dhuma and

Pratimarsha 4. Ayurveda offers scope in the form of Pratimarsha Nasya, which is explained

as a procedure for resisting such disorders. Pratimarsha Nasya with Anutaila 5 is explained

as a procedure in Dina charya (daily routines) for prevention of Nasagata Rogas in particular

and Urdhwajatrugata Vikara in general.

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Objectives

4

Chapter – 2

Objectives

he present study intended to focus on the disease evaluation i.e., Pratishyaya vis-à-

vis. Allergic Rhinitis or Rhinorrhoea and the management with Amrutha Guggulu as

shamanaoushadi and Patadi Taila Pratimarsha Nasya as procedure for local action.

In this regard the objectives proposed in the study are discussed under the headings.

The proposed medicaments Amrutha Guggulu and Patadi taila has the remarkable actions

with the ingredients embedded in them. The actions observed from the individual drug

components categorized are –

• Over Dosha as - Kaphahara, Kapha Pitta vikara shamaka, Shiro Virechana, Sroto

vishodhaka, Anulomana,

• Over the disease condition as - Pratishyaya, Peenasa, Mukha Roga, Jwaraghna,

Swasahara, Kasahara,

• Over the symptoms of the disease as – Analgesic action in terms of Vedana sthapana,

Sweda prashamana, Shira Shoola hara, and anti spasmodic action as - Shoola

prashamana,

• Over the healing properties of the disease as -Shothahara, Dusta vrana Shodhaka

Ropaka, Anti-inflammatory,

• Over the invaders and supputrative phenomenon of disease as - Anti septic, anti

sappurative, Antibiotic and Anti bacterial actions as - Krimighna,

• Over the system as - Anti histamine, Anti mutagenic agents,

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Objectives

5

• Over the immune system as - Anti oxidative, Immuno stimulant, Rasayana and

Chakshushya,

The objectives are analyzed under the lime light of the material hypothetically and

experimentally available is as under.

1. To evaluate the efficacy of Amrutha Guggulu in Pratishyaya (Rhinitis)

The ingredients of the Amrutha Guggulu are highly significant with the individual

actions of the components as discussed. Such combination effect is evaluated here

methodically for the Dosha, Vyadhi and Lakshana mentioned in classical texts

enumerated with the instrumental objective parameters.

2. To evaluate the efficacy of Patadi tail Pratimarsha Nasya in Pratishyaya (Rhinitis)

As like the ingredients of Amrutha Guggulu the Patadi Taila also has the same efficacy

but said to act locally with the stimulant actions, which are highly significant with the

individual actions of the components as discussed. Such combination effect is evaluated

here methodically for the Dosha, Vyadhi and Lakshana mentioned in classical texts


3. To evaluate additive efficacy of Amrutha Guggulu and Patadi taila Pratimarsha Nasya in

Pratishyaya (Rhinitis).

Amrutha Guggulu the Patadi Taila also has the same efficacy but said to act systemic

and local respectively. Such combinations effect is evaluated cumulatively here in the

trial methodically for the Dosha, Vyadhi and Lakshana mentioned in classical texts


Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Literary Review

6

Chapter – 3

Literary review

here there is nose, there is cold and Pratishyaya persists. The history reveals that the

Pratishyaya exists from ages. We call it the “common cold” for good reason. There are over

one billion colds in the all over Globe each year. Generally all but children will probably

have more colds than any other type of illness. Many people continue getting cold

throughout life even. Parents often get them from the kids. It’s the most common reason that

children miss school and elders miss work.

For all its achievements, medical science does not have a cure for the common cold.

The common cold is a minor illness caused by one of as many as 200 different kinds of

viruses, including rhinovirus and adenovirus. These viruses can also cause laryngitis or

bronchitis by infecting either the larynx (the "voice box") or the bronchial tubes in the lungs.

Infections are spread from one person to another, by hand-to-hand contact, or by a cough or

sneeze that sprays many virus particles into the air. These viruses do not respond to

antibiotics. Severe infections, however, may require medical care and prescription

medication. If you develop a fever higher than 102 degrees Fahrenheit, have a history of

asthma, an ear infection, laryngitis or bronchitis, you should see you doctor as soon as

possible. If your symptoms last longer than five days, you should also see you doctor. If you

have a very high temperature and pains all over your body, you may have an influenza virus.

Many examples and notes are available at history.


7

Historical review of Pratishyaya

Pre-Vedic and Vedic period:

Much literature is not available on Pratishyaya in pre-Vedic period. In Vedic period,

among Vedas, we find reference in Atharvana Veda 6, authentic source of Ayurveda about

Pratishyaya. In Atharvana Veda words like Vekelandu, Vilohitha, Devakosha were

available.

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.

Samhita period:

Samhita period is an important period during which, Trimarmiya Adhyaya of Charka

Chikitsa 7 explains 5 types of Pratishyaya. Detailed clinical features and therapeutics have

been mentioned in the same chapter. Susruta the great authority on Shalya and Shalakya

Tantra has explained Pratishyaya and Peenasa, while explaining 31 varieties of Nasarogas 8.

Bhela Samhita explanations are available in Shirovirechana adhyaya 9. Even Haritha

Samhita 10 explained Pratishyaya in detail. Astanga Sangraha 11 and Astanga Hridaya 12 are

important treatises of this period, which have dealt Pratishyaya vivid. Vagbhata in his

Astanga Hridaya mentions 6 varieties of Pratishyaya.

Sangraha kala:

In Madhava Nidana 13 the Author has mentioned Nidana aspect of Pratishyaya. The

description is identical to that of Susruta Samhita. Gada Nigraha 14 explanations of

Pratishyaya are also available. Sharangadhara Samhita 15, Bhavaprakasha 16, Yogaratnakara

17 and Bhaisajya Ratnavali 18 are important texts of this period dealt Pratishyaya. In


8

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

Susruta Samhita. Many prescriptions are seen for the Chikitsa of Pratishyaya in Nasa Roga

prakarana of Bhaishajya Ratnavali is also found.

By reviewing the chronological development details about Nasa rogas in general and

Pratishyaya in particular, can be appreciated. It is evident that Ayurvedic Scholars have

achieved some mastery in medical treatment of urdhvajatrugata vikara.

Adhunika kala:

Colds were known in ancient Egypt; there were hieroglyphs representing the cough

and the common cold. The Greek physician Hippocrates gave a description of the disease in

the 5th century BC. Common cold was also known among the ancient American Indian

Aztec and Maya civilizations.

In the 18th century, John Wesley wrote a book about curing diseases; it advised

against cold baths, stating that chilling causes the common cold. The work was widely

reprinted in the 19th century. Another book by William Buchan in the 18th century also gave

wet feet and clothes as the cause of the common cold 19.

In 1904 Killan performed his external frontal sinus operation. Modern work on

allergy has changed much of the rhinologist to the nose and nasal sinuses.

1918 would go down as unforgettable year of suffering and death and yet of peace.

As noted in the Journal of the American Medical Association final edition of 1918: in

pockets across the globe, something erupted that seemed as benign as the common cold. The

influenza of that season, however, was far more than a cold. In the two years that this

scourge ravaged the earth, a fifth of the world's population was infected. The flu was most


9

deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza, which

is usually a killer of the elderly and young children.

The influenza pandemic of 1918-1919 killed more people than the Great War, known

today as World War I (WWI), at somewhere between 20 and 40 million people. It has been

cited as the most devastating epidemic in recorded world history. More people died of

influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347

to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global

disaster 20.

In 1980 - rhinology cold well, Luc Scanes spicer had independently devised the

modern radical operation on the maxillary antrum.

The idea that microscopic infectious agents cause disease arose in the second half of

the 19th century. Initially, bacteria were suspected to be the cause of the common cold, and

vaccines were produced based on this theory; these were still prescribed in the 1950s.

Viruses had been described beginning in the 1890s: infectious agents so small that

they could pass through all filters and could not be seen under a microscope. In 1914, Walter

Kruse, a professor in Leipzig, Germany, showed that viruses caused the common cold: nose

secretions of a cold sufferer were diluted, filtered, and introduced into the noses of

volunteers, producing colds in Common cold - Wikipedia, the free encyclopedia about half

of the cases 21.

These findings were not widely accepted, until Alphonse Dochez repeated them in

the 1920s, first in chimpanzees, and then in human volunteers using a double-blind setup.

Nevertheless, in 1932 a major textbook on the common cold by David Thomson still

presented bacteria as the most likely cause 21. In the United Kingdom, the civilian Medical


10

Research Council set up the Common Cold Unit in 1946. The unit worked with volunteers

who were infected with various viruses. The rhinovirus was discovered there. In the late

1950s, researchers were able to grow one of these cold viruses in a tissue culture, as it would

not grow in fertilized chicken eggs, the method used for many other viruses. In the 1970s,

the CCU demonstrated that treatment with interferon during the incubation phase of

rhinovirus infection protects somewhat against the disease, but no practical treatment could

be developed. The unit was closed in 1989, just two years after it demonstrated the benefit

of zinc gluconate lozenges in the prophylaxis and treatment of rhinovirus colds 22.

In 1927 U.S public health service noted that colds occur most frequently in children

and least in patients over 55 years of age. The children of early school age are more

susceptible to colds while immunity to droplet infection is gradually being acquired.

In 1931 Willia Duke studied another very interesting type of hypersensitiveness is

that to cold and heat. In 1945 Henry and Sigerist said that the common cold and its

complications do not kill people but they create more temporary disability than any other

diseases and we are still unable to prevent or cure them. In 1980-81 Mackenzie wrote one of

the first systemic treatise on disease of the nose and throat in establishing special hospitals

for such cases and insisting on the legitimate claims of the specialty.

History of Nasya

Vedic period

Few Mantras of Rigveda indirectly refer towards the Karmas, which are included

under Panchakarma measures, such as Nasya. A Mantra of Rigveda, in which eradication of

Roga from the routes of Nasa (Nostrils), Chibuka (Chin), Shira (Head), Karna (Ear) &

Rasana (Tongue) are mentioned (Ri.V. 10-16-4) refer towards Nasya or Shirovirechana. The


11

term Nasya Karma has been used many times in Krishna Yajurveda, Satapatha Brahmana &

Upanishatas.

“Sanjivani” for Nasya reference is available from Valmiki Ramayana while

Lakshmana became unconscious. Buddha period Jataka stories speak about the famous

vaidya “Jeevaka”, who has utilized several times Nasya Karma for Shirah shoola to treat the

wife of Shreshthi of Sakela Nagar and to Lord Buddha for his suffering - a Nasya for

Virechana in the total dose of three Utpala Hasta. Vinaya-Pitika of Bouddha literature

states that the use of one Utpala Hasta of Nasya (it was sufficient for 10 Virechana).

Samhita kala

Charaka, Susruta and Ashtanga Hridaya Vagbhata elaborately describe Nasya karma.

The specifications and procedures in the Nasya karma had reached to such an extent of

perfection and precision that it was also being used as one of the best methods of medicinal

administration, for transforming the intra uterine sex 23 Trans-nasal administrations are

admitted.

Contemporary knowledge of Nasya therapy

Other countries of the world did not contribute much of the subject Nasya. So it was

never developed as a special therapeutic measure with them. Occasionally some powders for

producing sneezing were utilized by Halen (1st century AD) and Hippocrates (4th century

AD). After and during the 17th century AD Barcon (1626) and Salva (1631) used powders

for administration through the nose.

Halen was the first to use the technical term ERRHINES meaning that like devices to

be used in to the nose. T.Johnson (1634) mentions about the dry errhines to be blown


12

through the pipe of quill in to the nose. Start (1680) and Eutler (1710) and A.T.Thomson

(1811) administered powder tobacco through nose to produce sneezing.

Definition of Nasa

Nasa is described as the seat of Ghranaendriya i.e. sense of smell 24.

Etymology of Nasa

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 25.

Synonyms of Nasa

Nasa, Nasika, Ghranam, Gandhavaha, Ghrana 26

Shareera (Surface Anatomy and Physiology)

NASA (nasal cavity)

The nose is one among the Pratyangas of body and is having due significance in

Ashtanga Ayurveda. Ayurvedic classics discuss “Nasa” with respect to several contexts,

such as- structural and functional (Shareera), general Medicine (Kayachikitsa), Surgery

(Shalya tantra), E.N.T (Shalakya tantra). But the disease Pratishyaya is concerned with

mainly Kayachikitsa and Shalakya considerations.

The nose as Ghranendriya is a door to access higher mental functions of the brain 27.

It is also having relation to the organs related to head and neck. So nose can be one portal

for the production of the diseases as well as means for the medicaments.

Nasa is important in Shalya tantras as Marma, Nasa bandhana, other traumatic

incidence are concerned or even for the nasal plastic surgery. The Marmas like Phanas,

Shringhataka, Matruka 28 are related with nose. It is very crucial for the Marma aspect the


13

Rakta moksha where care is under taken, where three Siras (arteries) are to be avoided

during this treatment.

An excellent knowledge of cosmetic plastic surgery was prevalent during the period

of Susruta and it is beautifully mentioned 29. Also Nasa is important in surgery with respect

to Raktamokshana for different diseases like Timira, Akshipaka 30 are concerned.

Ancient ENT practitioners knew a detailed morbid anatomical and physiological

knowledge. A crystal clear knowledge of Nasa sharira described along with lots of diseases

regarding nose. A relation of general body systemic homeostasis with Nasal diseases

[Trishna, Jwara, Gatragaurava] and interconnections between Nasa and other adjacent

organs like ear, throat 31 are discussed vivid.

The Ghranendriya are derived from Atmaja bhavas 32 and Nasa from Matruja as it is

Mrudu 33 and it is start to develop at third month of gestation 34, and fully manifest at the

month of six or seven 35. Susruta has considered Nasa as a Pratyanga i.e. secondary organ of

the body. Similarly while enumerating the external orifices of the body; Susruta has

considered two nostrils among the main nine external orifices.

Nasa is composed of

♦ 3 Asthis

♦ 2 Dhamanis

♦ 2 Pesis

♦ 2 Marmas

♦ 24 Siras

Susruta mentions the length of Nasika as 2 1/3 Angulas. Dalhana the commented as

tribhag angulas i.e. (1.1/3) inches angulas in length as far as horizontal plane is concerned.


14

Salient features of Nasal Anatomy & Physiology are 36–

The nose is the primary passageway for air entering the respiratory system. Air

normally enters the respiratory system through the paired external nares, or nostrils, which

open into the nasal cavity. The vestibule is the space contained within the flexible tissues of

the nose. The epithelium of the vestibule contains coarse hairs that extend across the

external nares. Large airborne particles, such as sand, sawdust, or even insects, are trapped

in these hairs and are thereby prevented from entering the nasal cavity.

The nasal septum divides the nasal cavity into left and right portions. The bony

portion of the nasal septum is formed by the fusion of the perpendicular plate of the ethmoid

bone and the plate of the vomer. The anterior portion of the nasal septum is formed of

hyaline cartilage. This cartilaginous plate supports the bridge, or dorsum nasi, and apex (tip)

of the nose.

The maxillary, nasal, frontal, ethmoid, and sphenoid bones form the lateral and

superior walls of the nasal cavity. The mucous secretions produced in the associated

paranasal sinuses, aided by the tears draining through the nasolacrimal ducts; help keep the

surfaces of the nasal cavity moist and clean. The olfactory region, or superior portion of the

nasal cavity, includes the areas lined by olfactory epithelium -

(1) The inferior surface of the cribriform plate,

(2) The superior portion of the nasal septum, and

(3) The superior nasal conchae. Receptors in the olfactory epithelium provide your

sense of smell.

The superior, middle, and inferior nasal conchae project toward the nasal septum

from the lateral walls of the nasal cavity. To pass from the vestibule to the internal nares, air


15

tends to flow between adjacent conchae, through the superior, middle, and inferior meatuses

(meatus, a passage). These are narrow grooves rather than open passageways, and the

incoming air bounces off the conchal surfaces and churns around like a stream flowing over

rapids. This turbulence serves a purpose: As the air eddies and swirls, small airborne

particles are likely to come into contact with the mucus that coats the lining of the nasal

cavity. In addition to promoting filtration, the turbulence allows extra time for warming and

humidifying the incoming air. It also creates eddy currents that bring olfactory stimuli to the

olfactory receptors.

A bony hard palate, formed by portions of the maxillary and palatine bones, forms

the floor of the nasal cavity and separates the oral and nasal cavities. A fleshy soft palate

extends posterior to the hard palate, marking the boundary between the superior

nasopharynx and the rest of the pharynx. The nasal cavity opens into the nasopharynx at the

internal nares.

The Nasal Mucosa

The mucosa of the nasal cavity prepares the air you breathe for arrival at your lower

respiratory system. Throughout much of the nasal cavity, the lamina propria contains an

abundance of arteries, veins, and capillaries that bring nutrients and water to the secretory

cells. The lamina propria of the nasal conchae also contains an extensive network of large

and highly expandable veins. This extensive vascularization provides a mechanism for

warming and humidifying the incoming air (as well as for cooling and dehumidifying the

outgoing air). As cool, dry air passes inward over the exposed surfaces of the nasal cavity,

the warm epithelium radiates heat and the water in the mucus evaporates. Air moving from

your nasal cavity to your lungs has been heated almost to body temperature, and it is nearly


16

saturated with water vapor. This mechanism protects more delicate respiratory surfaces from

chilling or drying out—two potentially disastrous events. Breathing through your mouth

eliminates much of the preliminary filtration, heating, and humidifying of the inspired air.

To avoid alveolar damage, patients breathing on a respirator, which utilizes a tube to provide

air directly into the trachea, must receive air that has been externally filtered and humidified.

As air moves out of the respiratory tract, it again passes across the epithelium of the nasal

cavity. This air is warmer and more humid than the air that enters; it warms the nasal

mucosa, and moisture condenses on the epithelial surfaces. Thus breathing through your

nose also helps prevent heat loss and water loss to your environment.

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

maxillary process of inferior turbinate and the uncinate process of ethmoid form the medial

wall. 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


17

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 as 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:


18

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.

Functional aspects of Upper Respiratory Tract

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: Vibrissae (nasal hair) in the

nasal vestibule arrest large particulate matter of the inspired air. 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. The ciliary

movements’ carry the mucus with the particulate matter 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.


19

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) 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.

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

Functions of the Para nasal Sinuses:

The Para nasal sinuses are thought to serve the following functions viz.

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.


20

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.

Etymology (Nirukti & Paryaya) of Pratishyaya

Prati + (root) shying + gatav = Pratishyaya

Shabda Ratnavali suggests that Pratishyaya evolved from ‘SHYENG’ Dhatu, which

means to move. This Dhatu when prefixed by ‘PRATI’ and suffixed by ‘GATAV’ gives rise

to the complete word Pratishyaya.

prati + syai + n = Pratishyaya

According to Shabdastam Mahanidhi, the word Pratishyaya is derivied from the root

“SYAI’ which when suffixed by ‘N’ Pratyay & prefixed by ‘PRATI’ Upsarga it becomes

Pratishyaya. It means the condition in which continuous (Prati Kshanam) flow (Shyayate) is

called as 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. The above etymological developments can be combined together in

brief as follows:

“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”.


21

Definition of Pratishyaya

Dalhana on Susruta Samhita has defined it as: The condition was in Kapha body

constituents’ follows the Vata for coming out of the body, is called as Pratishyaya. Other

wise understood as the 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 37. Charaka defined Pratishyaya is, Kapha, Pitta, Rakta

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

flows against the inspired air is called Pratishyaya 38.

Classification of Pratishyaya

Almost all authors except Charaka and Kashyapa are explaining five types of

Pratishyaya. Medieval period authors have followed Madhavakara, who himself has

followed Susruta. Charaka has classified Pratishyaya as “Swatantra” & “Paratantra”

Pratishyaya 39. Till the period of Susruta nobody framed the concept that Rakta as a ‘Dosha’.

This may be the one of the reason Charaka to exclude Raktaja Pratishyaya. However

Nasapaka, Nasa daurgandhya were described in the context of Dushta shonitaja Vikaras.

The many classifications are framed as table here.

Table – 1

Classification of Pratishyaya

Samhita Vata Pitta Kapha Rakta Sannipataja

Charaka + + + - +

Susruta + + + + +

Vagbhata + + + + +

Kashyapa + + + - +


22

Nidana of Pratishyaya

Etiological factors are the first modalities among the main 5 diagnostic methods

describes in Ayurveda Nidana. The importance of Nidana (Hetu) lies regarding with the

mitigation of disease as well as in Chikitsa of the disease. All the Nidana are classified into

three main group’s viz. Ahara, Vihara, Manasika and presented in this table.

Table No. – 2 Nidana of Pratishyaya

NIDANA Ch. Su. Va. Ka. Aharaja

Ajeerna + - - + Shita Ambu + + + + Ati Jalsevana - - + - Dvividha Dugdhapana - - - + Excessive intake of Guru, Madhura, Sheeta Padarthas - - - + Mandagni - - - + Vishmashana - - - +

Viharaja Vega Sandharana + + + + Raja Sevana + + + - Dhumra Sevana - + - + Bashpa Sevana - - + - Ati Sambhashana + - + - Ritu Vaishamya + - - - Ati Nariprasanga + + - - Shrio Abhitapa - + - + Improper size of pillow - - + - Excessively playing in water - - + - Ati Jagrana - - + +

Manasaja Ati Krodha + - - - 1) Aharaja:

Ama is a cause for Pratishyaya by the steps of Chaya, Prakopa, Prashara etc. On the

other hand if one eats more than his capacity he gets Ajeerna and this type of Ajeerna cause

the Pratishyaya. Many causes of Ajeerna are elucidated, out few is - Walking in night,

unneeded sleep, drinking more water after meals, taking bath after food etc. Foods


23

containing properties like Guru, Shita, and Madhura etc. cause the decrease of Agni; Ruksha

Guna makes the Agni Vaishmya similarly. Guru, Mahdura, Atidrava food intake and intake

of cold water may also cause Ama formation, which in turn makes the Pratishyaya.

(2) Viharaja :

By retention of urge for defecation, Vata is vitiated and it circulates all over the

body. Meanwhile in the head, it vitiates the Tarpakakapha. By the retention of Anya Vegas

like Chhardi, Mutra, Purisha, Pratishyaya may be produced. Commentators explained it as

day sleep by which Kapha Vriddhi, Mandagni, Ama production and nasal obstruction etc.

occur. Anila (Vayu) Sevana and Ati Jagarana may also produce Pratishyaya.

Taking bath in Ajeerna, causes Pratishyaya. The factors vitiating the Udanavata such

as by more talking has major role in the production of Pratishyaya. Over indulgence in

intercourse, cause Shukra Kshaya, Vata Prakopa as well as Ojo Kshaya, which may produce

to Pratishyaya. More play in water may lead to Pratishyaya; especially contaminated or

unexpected climate changes change homeostasis of body especially in Rutusandhi, which

later cause the Pratishyaya. But in this context, Shishira and Vasanta Sandhikala are

specified. Here the accumulation of Kapha in winter causes the Pratishyaya in spring season

is categorized in to a particular Hetu called Viprakrishta Hetu.

The smoke irritates the nasal mucosa to produce discharge and it affects all

respiratory tracts. These all cause the vitiation of Prana, Udanavata and Tarpakakapha to

produce Pratishyaya. Dust enters into the nostrils and is hindered by the local hairs there. It

causes irritant to the nasal mucosa and produces watering, which may stick into nasal

mucosa and cause of roughness. If dust level rises more than the certain level, it makes the


24

air impure by above-mentioned way and enhances the Vitiation of Prana and Udanavata.

Exposure to heat produces more heat in body and vitiates the Tarpaka Kapha of head.

(3) Manasika:

Any kind of stress, which provokes the Pitta Dosha, may lead to Pratishyaya.

Usually mental passions like anger cause the Pitta Prakopa. Vitiated Pitta affects,

Tarpakakapha in head, Udanavata and Pranavata in throat.

(4) Anya hetu (Miscellaneous):

There are few disease associations may cause or may associate with Pratishyaya at

different stages.

Pratishyaya has been described as a symptom in many categories of Jwara.

In Udavarta Pratishyaya has been mentioned as an Upadrava.

Pratishyaya is one of the Asadhya Lakshanas of Gulma.

Pratishyaya has been described as an iatrogenic complication of Raktapitta.

If the Rakta Srava is checked temporarily chances of Dushta Pratishyaya are

there owing to the vitiation of head by hindered Doshas.

In Purvarupas of Rajayakshama Pratishyaya can be seen. This has been

separately mentioned in cases of Vegadharanajanya, Dhatukshayajanya and

Vishamasanajanya types of Rajyakshama.

As Head is the Adhisthana for Shirorogas as well as Nasarogas, In Shirovedana

vitiated Vata by settling in the head, which naturally causes the vitiation of

Tarpakakapha.

In addition to all above the Pratishyaya may also occur in Ayoga condition of

Panchakarma viz. Vamana, Virechana etc.


25

Poorva Roopa

Purvaroopa (premonitory symptoms) are those signs and symptoms, which appear

prior to the actual manifestation of the disease and are not specifically assignable to the

Doshas as they are mile and few in number. Signs and symptoms, which with certainty are

suggestive of the future disease appearance, are termed as Purvaroopa. They can be either

Samanya (general) Purvarupa or Vishishtha (specific) Purvaroopa. The following are

Susruta 40 stated the Purvaroopa of Pratishyaya. Madhava Nidana and Bhavprakasha have

followed Susruta in describing the Purvaroopa of Pratishyaya.

They are as follows -

1. Shirogurutvam (Heaviness of the head)

2. Kshavathu (Sneezing)

3. Angamarda (Bodyache)

4. Parihristaromata (Generalised horripilaiton)

5. Stambha (Stiffness in nose)

Lakshana

Only Charaka and Kashyapa have mentioned about the general symptoms of

Pratishyaya. Charaka given following Samanya Lakshanas of Pratishyaya are as follows -

1. Shirahshoola (Headache)

2. Shirogaurav (Heviness in the head)

3. Ghranviplav (Loss of smell)

4. Jwara (Fever)

5. Kasa (Cough)

6. Kaphotklesh (Increase of mucous secretion)

7. Swarabheda (Hoarseness of voice)

8. Aruchi (Anorexia)

9. Klam (Fatigue)

10. Indriyanam Asamarthya (Asthenia of senses)


26

Kashyapa has mentioned the following general symptoms based upon the Dosha

involvement are -

Due to Vata: Head, face and nose become just as if obstructed and Feeling of tightness

Due to Pitta: Foul smell

Due to Kapha: Non clarity

Due to Rakta: Excess moisture

Further Kashyapa says that in this condition if patient takes more Ushna, Tikshna,

Amla, Lavana substances, Pitta Dosha is aggravated gives rise to Jwara (fever), Trishna

(thirst), Antardaha (burning sensation), Arati (anorexia) like symptoms seen in Pratishyaya.

Vishishta Lakshana (Specific Symptoms):

The specific symptoms of Pratishyaya according to its’ varieties of Vata, Pitta,

Kapha and Rakta are presented in the tabular form as below.

Table No.– 3

Symptoms of Vataja Pratishyaya

Lakshana Ch. Su. Va.

Ghranatoda (Pricking pain sensation in nose) + - -

Kshavathu (Sneezing) + - +

Jalabha Srava (Watery nasal discharge) + + +

Swarabheda (Hoarseness of voice) + + -

Gala-Talu-Oshta-Shosh (Dryness of throat, palate & lip) - + +

Nistoda Shankha (Pricking pain in temporal region) - + +

Mukha Shosha (Dryness of mouth) - - +

Shirahshula (Headache) - - +

Kitika ev Sarpanti (Ant moving like feeling) - - +

Chiratpaka (Late viscous secretion) - - +

Ghranoparodha (Obstruction of nose) - + +


27

Table No. - 4

Symptoms of Pittaja Pratishyaya


Nasagrapaka (Inflammation of tip of nose) + - +

Jwara (Fever) + + -

Vaktra Shosha (Dryness of mouth) and Trishna (Thirst) + + +

Ushna-Pita-Srava (Hot & yellow discharge from nose) + + +

Krishata (Weakness) - + -

Panduta (Pallor) - + -

Dhumra-Vahini Vamana (Vomiting) - + -

Bhrama (Giddiness) - - +

Ghrana Pitika (Abscess in nose) - - +

Table No.-5

Symptoms of Kaphaja Pratishyaya


Kasa (Cough) + - -

Aruchi (Anorexia) + - +

Ghana-Shveta-Shrava (Thick & whitish nasal -discharge) + + +

Kandu (Itching) + + +

Shuklavabhasa (Feeling of whiteness all around) - + -

Guru shiro-Mukha (Heaviness in head & face) Gatra-Gaurava (Heaviness in body)

- + +

Swasa (Breathlessness) - - +

Vamana (Vomiting) - - +

Mukha Madhurya (Sweetness in mouth) - - +

Shoonakshi (Swollen eyes) - + -


28

Table No. –6

Symptoms of Raktaja Pratishyaya

Lakshana Ch. Su.

Raktasrava (Bleeding from nose) + +

Tamrakshi (Copper colored eyes) + -

Durgandha Swasa-Vadana (Foul breath & face) + -

Gandha na Vetti (Loss of sense of smell) + -

Krimipatana (Worms fall from nose) + -

Nasagrapaka (Inflammation of tip of nose) - +

Trishna (Thirst) - +

Bhrama (Giddiness) - +

Ghrana Pitika (Nasal abscess) - +

Samprapti

Charaka enumerates that, due to indulgence in Nidana (causative factors), the Dosha

in the head accumulated aggravates Vata and gives raise Pratishyaya 41. While describing

Samprapti Susruta affirms that, Vata and other Doshas, either individually or in collectively

and with or without the association of Rakta gradually accumulate in the head and when

further vitiated by their respective exciting causes, produce Pratishyaya 42.

Vagbhata explains that, when the vitiated Vata pradhana Doshas, gets localized in

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

lead to Kshaya even 43.

Kashyapa has mentions are due to Nidana, Mandagni and Vishamashana, the

aggravated Vata vitiates seat of Kapha and this vitiates the channels situated near Nasika to

cause Pratishyaya. In this disease the patients always excretes out the secretions

continuously, so it is called Pratishyaya 44.


29

SAMPRAPTI GHATAKA Table - 7

Nidana Kapha, Vata Prakopaka Nidana

Dosha Kapha, Vata, Alpa Pitta

Dushya Rasa, Rakta

Srotas Rasavaha,Raktavaha,Pranavaha

Srotodushti Sanga,Vimarga Gamana,Ati Pravriti

Agni Jatharagni – Mandya Dhatwagni – Mandya

Dosha Marga Shakha

Roga Marga Bahya

Udbhava Stahna Amapkwashaya

Adhistana Nasa

Pratyatma Lakshana Shirah Kphotklesha Ghrana Viplava Shirah Shoola, Nasa Avarodha, Swara Bheda etc.

The above given brief description of pathogenesis of Pratishyaya may further be

elaborated on the basis of Shad Kriyakala given by Susruta.

Shad Kriyakala:

1. Sanchaya of Pratishyaya

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

Vata in Pakwashaya (large intestine), Pitta in Pachyamasaya (small intestine) and Kapha in

Urah Desha (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 these instincts (likes and dislikes) and acts accordingly, the Doshas will come


30

back to their normal condition. On the other hands, if they are not recognized and the person

continues to indulge in causative factors like unhealthy foods, the Doshas undergo increase

further.

Dalhana clarifies phenomena of each Doshas in the head region. Accordingly, Prana

Vata has its field of activity in the head. Among Pitta, Alochakapitta and Bhrajakapitta can

be considered and Tarpakakapha site in the head is well known. Rakta circulating through

head also gets accumulated in the head.

2. Prakopa of Pratishyaya

In the second stage Prakopa (vitiation), the further increased Dosha leads to vitiation

excitation 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 of Pratishyaya

The third stage of Kriyakala is known as Prasara where spreading to large areas takes

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

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

The Kosthagni, 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


31

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 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 of Pratishyaya

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 in the Srotas

(pores, channels of cells of tissues) especially. The Dhatus (tissues) may not fall on easy

prey to the onslaught of the Dosha. A fluid material known as Ojas, which is responsible for

the (Bala) strength of body to carryout its functions (Karya Sakti) and to prevent diseases

(Vyadhi Utpada-Pratibandhakatva) is a defence mechanism in the body. 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).


32

(a) Atipravriti – increased functioning – of nasal discharge

(b) Sanga or Rodha – obstruction, blockage, decreased normal functioning of the

upper respiratory tract and consequent increase in size of exudates

(c) Granthi – growths, thickening, accumulations etc. in the sinuses

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

to para-nasal sinuses.

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

taken place, becomes the site of origin of 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 Srotas,

especially in Nasa, where Khavaigunya is already imparted. The Poorvaroopa i.e.

premonitory symptoms of the disease can be demonstrated in this stage. In this stage patient

gets following premonitory symptoms of Pratishyaya.

1. Shirogurutvam(Heaviness of the head)

2. Kshavathu (Sneezing)

3. Parihrishtaromata (Generalized horripilation)


33

5) Vyaktavastha of Pratishyaya

The fifth Kriyakala is characterized by the full manifestation of the disease

(Vyadhivyakti) with all its full bloom symptoms and signs (Roopa). Each one of the

described abnormalities contributes to their 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 (Dwidoshaja, Dwandvaja, 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.

1. Shirashula,

2. Kaphotklesha,

3. Ghrana Viplava,

4. Nasa Avarodha,

5. Svarabheda etc.

6) Bhedavastha of Pratishyaya

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


34

Lakshana of Pratishyaya

(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 aneamia, 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.

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

its pathogenesis. All the classical texts have described the Samprapti schematic diagram of

Pratishyaya, is as follow:

Figure – 1

Schematic Samprapti of Pratishyaya

Rasa –Rakta Srotodushti

Prasara in whole body

Sthana-Samshrya of Dosha in Nasa Vimargagamana of Rasa

Nidana Sevana

Sanchaya & Prakopa of Dosha

Nasa Khavaigunya


35

Sapeksha Nidana (Differential Diagnosis)

Sapeksha Nidana lies in the establishing the exact identity of the disease. Identical

signs and symptoms make the chances of misguidance. Arriving at a true diagnosis is indeed

great. In Ayurvedic literature, Pratishyaya is mentioned as a symptom of many diseases and

also described as Hetu (causative factor) of some diseases. Hence, differential diagnosis of

Pratishyaya is put forth here.

Table – 8

Sapeksha Nidana

PRATISHYAYA VATA KAPHAJA JVARA

• Independent disease

• Shiro Gaurava

• Shirah Shoola

• Nasa Srava

• As a symptom

• Sarvanga Gaurava

• Shirograha

• Shirah Manasantap

PRATISHYAYA KAPHAJA KASA

• Nasa Srava

• Kasa Cured with Pratishyaya

• Kapha Nisthivana

• Kasa still exist after the cure of

Pratishyaya

PRATISHYAYA TAMAKA SHVASA

• No relief while sitting

• No relief after Nasasrava

• No difference would be observed

• Relief while Sitting

• Feeling of Relief after Kapha

Nisthivana

• Increased severity at early hours

and wet seasons

PRATISHYAYA RAJYAKSHAMA

• Ashukari

• Affected part Nasa- Shirah

• Not related with Dhatukshaya

• Chirakari

• Mainly Both the Lungs

• Related with Dhatukshaya


36

Sadhyasadhyata (Prognosis)

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

Krichha Sadhya, Yapya and Asadhya stages of the diseases. Susruta mentions that

neglected case or improperly treated cases of Pratishyaya may take the shape of Dushta

condition of Pratishyaya, which is Asadhya 45.

Upadrava (Complications)

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

Table - 9

Showing Pratishyaya as a Lakshana in various diseases

Diseases Ch Su Vag

Kaphaja Jwara + + +

Vatasleshmajwara + + +

Rajayakshma +

Kaphaja Ajeerna +

Kaphaja Grahance + +

Kaphaja Arsha + +

Tamaka Swasha + +

Kaphaja kasa +

Kaphaja Gulma +

Udavartha +

Adhavabedaka +

Krimi +


37

being already suffering from the disease. Hence, one should overcome the complication

quickly.

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

lead on to the incurable Dushta Partishyaya. 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 Shiroroga.

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

complications:

1. Badhirya (Deafness)

2. Andhata (Blindness)

3. Ghor nayanamayan (Severe eye diseases)

4. Kasa (cough)

5. Agnisada (Poor digestion)

6. Shopha (Swelling of the body)

Table -10

Showing the Upadravas of Pratishyaya

Su. M.N. Basava

Bhadirya + + +

Andya + + +

Agratwa + + +

Netraroga + + +

Kasa + + +

Angimandya + + +

Shotha + + +


38

To the above list Susruta further adds other systemic symptom like, Angasada,

Chardi, Gourava arathi, Jwara, Arochaka, Atisara etc. as upadravas 46, while Madhavakara

opines Arbudha, Arshas, Ahotha and Raktapitta as also some of the complications of

Pratishyaya 47.

• Kashyapa mentions that Pratishyaya is not treated leads to Bala Agni and

Varna Shamana 48. These can be later effects of the disease. Contemporary

science opines that pathological changes associated with Rhinitis may lead to

obstruction of the Eustachian tube with dysfunction and middle ear effusion.

• Prolonged Allergin Rhinitis may be complicated by secondary infection,

polyposis or sinusitis.

• Allergic rhinits and bronchial asthma are said to coexist frequently.

• Perennial Allergic Rhinitis may also be accompanied by secondary

symptoms including loss of smell, loss of taste etc 49-50.

• The other complications include epistaxis, Naso pharyngeal lymphoid, hyper

plasia, decreased pulmonary functions etc.

• The signs of Allergic Rhinitis like Dark circles under eyes, transverse nasal

crease

Chikitsa of Pratishyaya

Chikitsa can be defined as the measure, which brings about the homeostasis of the

Dosha. Chikitsa of Sannipatika Pratishyaya is classified under two headings -

1) Samanya Chikitsa (General treatment)

2) Vishesh Chikitsa (Specific treatment)


39

Samanya Chikitsa

Samanya Chikitsa of Pratishyaya, according to Chakrapani, five diseases viz.

Netraroga, Kukshiroga, Pratishyaya, Vrana and Jwara, are cured with Langhana chikitsa

within five days. Thus, five days of Langhana is advised in Pratishyaya before going for

further treatments. All types of Pratishyaya except Nava Pratishyaya i.e. of recent origin

should be treated by the following measures:

1) Ghritapana

2) Sweda

3) Vamana

4) Avapida Nasya

Pratishyaya Chikitsa Sutra

On the basis of the above description we can constitute the following Chikitsa Sutra –

1. Langhana

2. Ghritapana

3. Swedana

4. Vamana

5. Avapida Nasaya

Apakva Pratishyaya Chikitsa

Susruta has given following line of treatment for Ama stage of Pratishyaya. In

Apakva Pratishyaya, following treatment for Pachana is to be prescribed. But Charaka said,

Dhuma Sevana by Mallaka Samput made of Sattu mixed with Ghrita is beneficial in

Pratishyaya.

1) Swedana

2) Intake of warm food containing sour (Amlarasa)

3) Ginger should be taken with milk or with sugarcane preparation for Pachana.


40

Pakva Pratishyaya Chikitsa

According to Susruta the pakwa (mature), dense and suspended Doshas

should be expelled out. Susruta has specifically mentioned Vamana in Pratishyaya Chikitsa.

Vamana should treat an adult patient with Pinasa having excessive liquid secretion due to

Vata and Kapha. By the use of following measures Pratishyaya is pacified -

1) Shirovirechana

2) Virechana

3) Asthapana

4) Dhumpana

5) Kavalagraha

6) Haritaki Sevana

Bhavaprakasha slightly differ and offers treatment as -

• Maricha Churna mixed with Guda and Dadhi and

• Katuphaladi Churna is beneficial for this condition.

Chakrapani explained that the intake of Sheet Jala in its full quantity before going to

bed is beneficial in Pratishyaya. Chakradatta has also mentioned the following measures for

managing Pratishyaya.

1) Panchmula siddha Ghrita

2) Chitraka Haritaki

3) Sarpi Guda

4) Shadanga Yusha

5) Vyoshadi Churna

6) Nasya by Pathadi Taila & Shadbindu Taila


41

Vishesh Chikitsa of Pratishyaya

Susruta has mentioned treatment of Pratishyaya as under:

1) Katu –Tikta Dravya Siddha Ghrita

2) Tikshana Dhooma

3) Katu Bheshaja

4) Nasya by the oil processed with Rasanjana, Ativisha, Musta and Devadaru and

Siddha Ghrtia

5) Kaval by Musta, Patha, Katphala, Katuka, Vacha etc. Siddha Kashaya

6) Shiro- Virechana

7) The measures involving the use of Mutra and Pitta

8) Krimighna Aushadha for the Yapana Chikitsa

Pratishyaya Nivarana

Some authors advise warm water through Nasa in early morning regularly is

beneficial in Pratishyaya 51.

Nasya & Pratimarsha Nasya in Pratishyaya (Colds) 52

In general indications of Nasya, Pratishyaya has been mentioned by Acharyas.

However the actual stage of the disease at which Nasya can be applicable is mentioned by

these references. Whenever Pratishyaya has progressed to a stage where the sputum is

ghana, it is called as Pakwavastha (purulent). For every disease there are three methods of

approach for its cure viz Apakarshana, prakriti vighata, and nidana parivarjana. Each ranks

equal importance in the therapy.

In Pratishyaya Nasya (Apakarshana) can contribute 33.33% of total therapy. This is

true in real sense so far as Virechana Nasya is concerned. In conditions like chronic sinusitis


42

this aspect has to be thought in prima facie. Nasya is well to do with Vatika Pratishyaya if

we analyze the disease with proper Doshic discrimination (Amshamsha kalpana). In most of

the Nasyas, which are indicated in Pratishyaya Chikitsa, should be in Taila (oil) form ideally

- though Ghrita is also mentioned. Of all Tailas, Tila Taila (sesame oil) is thought to be

ideal, as it possesses Srotosodhaka property. Inspite of Vatika Pratishyaya, Nasya is also

indicated in Sannipatika, Kaphaja and Paittika Pratishyaya. Nasya in Pratishyaya can be

either Vairechanika or Snaihika as far as pediatric age group is concerned. It is a quite

common symptom that dryness of the mouth and pharynx is probably due to Nasal

obstruction (Sringhatak sosha). In Nasya Therapy in Pratishyaya (Colds) such conditions

Nasya is indicated while dealing with the Pratishyaya in Charaka Samhita Chikitsa.

One of the principal uses of Nasal drops in the conditions like coryza, vasomotor

rhinitis, and sinusitis is nothing but decongestions. The decongestive effect may be bringing

down by vasoconstriction. Most of our Nasya drugs if it is in Taila media medicated with

Mrudu Dravyas will satisfy following conditions, which are needed for a decongestant.

1. It prompts reliable action.

2. A secondary or rebound congestion should not occur.

3. Side effects due to systemic absorption should be minimal.

4. The duration of action should be fairly long so that frequent application doesn’t

become necessary.

5. The solution or preparation applied should not be irritant or harmful to the cilia.

Second method of Nasal decongestion in clinical practice is provision of

humidification in Nasal passage according to Harry Beckman pharmacological

principle. No doubt Nasya with medicated oil will serve the same purpose for


43

relieving the feeling of fullness in the head by proper breath in an atmosphere

saturated with moisture.

6. From the different studies (Potiroli, E. A. etal 1983 and Berquist et-al 1979) it is well

Nasya Therapy in Pratishyaya (Colds) proved that systemic absorption can happen

even through the mucous membrane of the nose. If the Nasya is given in oil media

the absorption rate can be improved as mucous membrane is much more lipophilic

but here absorption of active ingredients of test drugs is still debatable.

History of modern medicine in relation to Nasya therapy

Other countries of the world did not contribute much of the subject. So it never

developed as a special therapeutic measure with them. Some powders for producing

sneezing usage are available from Halen (1st century AD) and Hippocrates (4th century AD)

writings. After and during the 17th century AD Barcon (1626) and Salva (1631) used

powders for administration through the nose. Halen was the first to use the technical term

ERRHINES meaning that like devices to be used in to the nose. T.Johnson (1634) mentions

about the dry errhines to be blown through the pipe of quill in to the nose. Start (1680) and

Eutler (1710) and A.T.Thomson (1811) administered powder tobacco through nose to

produce sneezing.

In 1927 U.S public health service noted that colds occur most frequently in

children and least in patients over 55 years of age. The children of early school

age are more susceptible to colds while immunity to droplet infection is

gradually being acquired.

In 1931 Willia Duke studied another very interesting type of hypersensitiveness

is that to cold and heat.


44

In 1945 Henry and Sigerist said that the common cold and its complications do

not kill people but they create more temporary disability than any other diseases

and we are still unable to prevent or cure them.

In 1980-81 Mackenzie wrote one of the first systemic treatise on disease of the

nose and throat in establishing special hospitals for such cases and insisting on

the legitimate claims of the specialty.

Intravenous infusions and Nasal administrations of leutinising hormone (Fink G.

et al 1973) and calcitonin (Potiroli E.A. et al 1983) are found to be equally the

effective in maintaining blood concentrations.

Confirmation was done by the intranasal administration of Hypoglyceamic

effects of insulin and hyperglyceamic effects of glucagons hormone in normal

and in diabetic patients (Patiroli E.A. et al 1983)

In undescended testis (cryptorchid boys) intranasal gonadotropin hormone

releasing hormone has been therapeutically recommended in stimulating

leutinising hormone secretion (Raifer J. et al 1985).

As a contraceptive measure, an LRH agonist nasal administration for 3-6 months

was observed effective in inhibiting ovulation (Berquist et al 1979). The drugs

are mostly believed to be absorbed through nasal and pharyngeal mucosa in these

cases.

The nasal route of administration of the contraceptive drugs has more beneficial

effects than systematic administration. (Kumar Anand (1979))

It was also claimed that the concentration of drug in C.S.F. was very high when

compared to that of intravenous administration.


45

The study also revealed that there was reduction in the gland activity and

reduction in the sperm prolactin.

In female volunteers Micheal Russel (1977) had observed that perspired scent

that had been painted onto the upper lips has caused the synchronization of the

menstrual cycle by constant smelling.

After experiments Scientists of the institute of medical sciences Delhi have

proved that drug administered through nose shows effective action in the brain.

Thus it can be said that there is a very close relation between Shira and Nasa.

Direct Pharmacodynamic considerations between nose and such cranial organs

are not present in contemporary literature.

The blood, brain barrier is a strict security system that the human brain has. A

route of administration for inhalation of anesthetic materials is the nose.

Certain agents are used as decongestants in the case of para-nasal sinusitis.

Anterior pituitary hormones nasal spray is in practice in the modern medical

system. Few of the nasal therapy such as the Vasopression or Antidiuretic

hormone are already in the market.

Pathya and Apathya in Pratishyaya

Pathya & Apathya

The patient of Pratishyaya should be made to lie, sit or work in a place free from

direct wind, wear a heavy and warm cloth and wrap around the head. The use of dry and

barley meal is advised. The patient of Pratishyaya should keep away from cold, sexual

intercourse, immersion-bath in cold water, worries, excessively dry food, suppression of

natural urges, grief and freshly prepared intoxicates.


46

Table – 11

Pathya & Apathya in Pratishyaya 53

Pathya Apathya

Ahara Vihara Ahara Vihara

Katu Amala Lavana rasa

Sneha Drava Ahara Snana

Gramya Jangala rasa Sweda Krodha

Purana Yava shali Shiro Abhyanga Veganigrahana

Laghu Bhojana Bhoomi Shayana

Kulutha

Kulakam

Swigru

Karkata

Lashuna

Purana Dadhi (Amla)

Tapayambu

Varuni

Katu Traya


47

Rhinitis and its

Management from contemporary

Origin of Rhinitis

[rhin- + G. -itis, inflammation] (Stedman)

Types of rhinitis

1. Acute rhinitis

2. Allergic rhinitis

3. Atrophic rhinitis

4. Atrophic rhinitis of swine

5. Rhinitis caseosa

6. Chronic rhinitis

7. Gangrenous rhinitis

8. Hypertrophic rhinitis

9. Inclusion body rhinitis

10. Rhinitis medicamentosa

11. Necrotic rhinitis of pigs

12. Rhinitis nervosa

13. Scrofulous rhinitis

14. Rhinitis sicca

15. Vasomotor rhinitis

Allergic Rhinitis is a symptom complex characterized by paroxysms of sneezing;

itching of the eyes, nose, and palate; rhinorrhea; and nasal obstruction. It is often associated

with postnasal drip, cough, irritability, and fatigue. Symptoms develop when persons inhale


48

airborne antigens (allergens) to which they have been previously exposed and have made

IgE antibodies.

These IgE antibodies bind to IgE receptors on mast cells in the respiratory mucosa

and to basophils in the peripheral blood. When IgE molecules on their surface are bridged

by allergen, mast cells release pre-formed and granule-associated chemical mediators. They

also generate other mediators and cytokines that lead to nasal inflammation and, with

continued allergen exposure, chronic symptoms 54. Other wise said as inflammation of the

nasal mucous membrane with Synonym as nasal catarrh 55.

Allergic Rhinitis affects approximately 10 per cent of the population and may be

seasonal or perennial. The condition is usually accompanied by conjunctivitis and is

characterized by sneezing, nasal congestion interspersed with profuse watery rhinorrhoea,

pharyngeal and conjunctival pruritus, and lacrimation. Inspection of the nasal passages

usually reveals a pale mucosa with swollen turbinates and the conjunctiva is often reddened

and oedematous.

Clinical manifestations, which are due to IgE-mediated degranulation of mast cells

and basophils, often present before the fourth decade and decrease gradually with ageing.

Grass, tree, and weed pollens are usually responsible for seasonal rhinitis and may be

predicted by pollination calendars, although published pollen counts usually follow the

event. In Britain, tree pollens peak from March to May, grass pollens follow in June and

July, and weed pollens peak in late July and early August.

House-dust mite antigens and animal salivary protein allergens are associated with

perennial symptoms. Allergenic particles of 10 to 100 & nbsp; & mgrm in diameter are

particularly prone to nasal trapping. Not uncommonly, atopic individuals may suffer from


49

perennial symptoms with seasonal exacerbations due to multiple allergies. In severe cases,

swelling may be sufficient to obstruct the sinus ostia and eustachian tubes, resulting in

secondary bacterial infection with associated purulent nasal discharges.

Nasal polyps may accompany the mucosal oedema of; in particular, perennial rhinitis

and so increase the nasal blockage. They are semitransparent mucosal sacs of grape-like

appearance that contain oedema fluid, mast cells, and eosinophils. Nasal polyps challenged

with specific allergen are able to release histamine, leucotrienes, and peptides chemotactic

for eosinophils. Vasomotor or non-allergic rhinitis has many of the clinical symptoms of

perennial allergic rhinitis but occurs in non-atopic individuals. Nasal polyposis and

eosinophilia may also accompany this non-allergic condition.

A diagnosis of allergic rhinitis requires a convincing clinical history and

examination, evidence of specific IgE by skin-prick testing or the presence of specific serum

IgE in laboratory assays, and is usually accompanied by a positive family history of allergic

diseases 56.

Sneezing; rhinorrhea; obstruction of the nasal passages; conjunctival, nasal, and

pharyngeal itching; and lacrimation, all occurring in a temporal relationship to allergen

exposure, characterize allergic rhinitis.

Although commonly seasonal due to elicitation by airborne pollens, it can be

perennial in an environment of chronic exposure. The incidence of allergic Rhinitis is with

the peak occurring in childhood and adolescence 57.

Mechanisms of allergic reactions

The expression of allergic diseases reflects an autosomal dominant pattern of

inheritance with incomplete penetrance. This is manifested as a propensity to respond to


50

inhalant allergen exposure by producing high levels of allergen-specific IgE. The IgE

response appears to be controlled by immune response genes located within the major

histocompatibility complex (MHC) on chromosome 6. The immunologic mechanisms for

atopy have been studied in murine models and in humans and appear to center on the

expression of a repertoire of responses associated with the Th2 type T-helper lymphocyte

summarized below 58.

Mechanisms of nasal allergic reactions

Under normal conditions, the nose accounts for nearly 50% of the resistance to

airflow in the airway. It is lined by pseudostratified epithelium resting on a basement

membrane, separating it from deeper submucosal layers. The submucosa contains mucous,

seromucous, and serous glands.

The small arteries, arterioles, and arteriovenous anastomoses determine regional

blood flow. Capacitance vessels, consisting of veins and cavernous sinusoids, determine

nasal patency. The cavernous sinusoids lie beneath the capillaries and venules, are most

dense in the inferior and middle turbinates, and contain smooth muscle cells controlled by

the sympathetic nervous system. Withdrawal of sympathetic tone or, to a lesser degree,

cholinergic stimulation causes this sinusoidal erectile tissue to become engorged.

Cholinergic stimulation causes arterial dilation and promotes the passive diffusion of

plasma protein into glands and the active secretion by mucous glands in cells. Novel

neurotransmitters, including substance P, calcitonin gene-related peptide, and

vasointestinal peptide, have been detected in nasal secretions after nasal allergen challenge

of patients with allergic rhinitis. Because they can produce changes in regional blood flow

and glandular secretion, their role in rhinitis may be important 59.


51

Immediate and late nasal reactions

Exposing the nasal mucosa to ragweed in ragweed-sensitive subjects (nasal

challenge) provokes the immediate onset of sneezing and nasal itching associated with

significantly increased concentrations of inflammatory mediators. Histamine, PGD2, the

kininogen product tosylarginine-methylester (TAME-esterase), tryptase, kinins, and

sulfidopeptide leukotrienes are present in nasal washes. After about half an hour, PGD2

and histamine levels return to baseline, whereas TAME-esterase concentrations remain

elevated. Sneezing is correlated with the appearance of measurable histamine, TAME-

esterase, and PGD2 in nasal washes, etc. Biopsy specimens of the nasal mucosa at this

time show an increased number of degranulated mast cells.

Two to 6 hours after the initial allergen challenge, symptoms recur with a second

release of mast cell mediators at the time of maximum mast cell cytokine production. This

late-phase nasal allergic reaction occurs in approximately 50% of patients with seasonal

rhinitis undergoing nasal challenge with allergen. This is associated with elevated levels of

the same mediators noted in the immediate reaction except that PGD2 is not detected.

Thus, basophils appear partly responsible for such late-phase reactions because histamine

is generated by both mast cells and basophils, whereas only mast cells can produce PGD2.

In support of this, a marked basophil influx into the nasal mucosa has been noted 3 to 11

hours after allergen challenge. Large numbers of neutrophils, mononuclear cells, and

eosinophils also migrate into the nasal mucosa at this time. This inflammatory response is

thought to cause the recurrence of symptoms and to induce chronic ones.

After allergen challenge, lymphocytes remain the predominant cells in the nasal

mucosa. These cells actively transcribe messages for IL-3, IL-4, IL-5, and GM-CSF and


52

have increased expression of the IL-2 receptor. Interleukins 1 through 5 and GM-CSF have

been recovered from nasal washes after allergen challenge 60.

Patho-physiology and manifestations of Rhinitis

Episodic rhinorrhea, sneezing, obstruction of the nasal passages with lacrimation,

and pruritus of the conjunctiva, nasal mucosa, and oropharynx are the hallmarks of allergic

rhinitis. The nasal mucosa is pale and boggy, the conjunctiva congested and edematous, and

the pharynx is generally unremarkable. Swelling of the turbinates and mucous membranes

with obstruction of the sinus ostia and eustachian tubes precipitates secondary infections of

the sinuses and middle ear, respectively, commonly in perennial but rarely in seasonal

disease. Nasal polyps, representing mucosal protrusions containing edema fluid with

variable numbers of eosinophils, arise concurrently with edema and/or infection within the

sinuses and increase obstructive symptoms.

The nose presents a large mucosal surface area through the folds of the turbinates

and serves to adjust the temperature and moisture content of inhaled air and to filter out

particulate materials above 10 um in size by impingement in a mucous blanket; ciliary

action moves the entrapped particles toward the pharynx. Entrapment of pollen and

digestion of the outer coat by mucosal enzymes such as lysozymes release protein allergens

generally of 10,000 to 40,000 molecular weight. The initial interaction occurs between the

allergen and intraepithelial mast cells and then proceeds to involve deeper perivenular mast

cells, both of which are sensitized with specific IgE. During the symptomatic season when

the mucosae are already swollen and hyperemic, there is enhanced adverse reactivity to the

seasonal pollen as well as to antigenically unrelated pollens for which there is underlying

hypersensitivity due to improved penetration of the allergens. Biopsy specimens of nasal


53

mucosa during seasonal rhinitis show submucosal edema with infiltration by eosinophils,

along with some basophils and neutrophils.

The mucosal surface fluid contains IgA that is present because of its secretory piece

and also IgE, which apparently arrives by diffusion from plasma cells in proximity to

mucosal surfaces. IgE fixes to mucosal and submucosal mast cells, and the intensity of the

clinical response to inhaled allergens is quantitatively related to the naturally occurring

pollen dose. Specific IgE is distributed also to circulating basophilic leukocytes; patients

with more severe clinical disease have basophils that release histamine in response to lesser

concentrations of allergen in vitro than do cells from patients with milder disease. In

sensitive individuals, the introduction of allergen into the nose is associated with sneezing,

"stuffiness," and discharge, and the fluid contains histamine, PGD2, and leukotrienes. Thus

the mast cells of the nasal mucosa and submucosa generate and release mediators through

IgE-dependent reactions that are capable of producing tissue edema and eosinophilic

infiltration 61.

Prevention of Rhinitis

Avoidance of exposure to the offending allergen is the most effective means of

controlling allergic diseases; removal of pets from the home to avoid animal danders,

utilization of air filtration devices to minimize the concentrations of airborne pollens,

elimination of cockroach-derived proteins by chemical destruction of the pest and careful

food storage, travel to nonpollinating areas during the critical periods, and even a change of

domicile to eliminate a mold spore problem may be necessary. Control of dust mites by

allergen avoidance includes use of plastic-lined covers for mattresses, pillows, and

comforters, and elimination of carpets and drapes 62.


54

Treatment of Rhinitis 63

The most effective treatment is allergen avoidance but this is often not practical.

Medical treatment with the combination of a long-acting, non-sedating H&sub1;-

antihistamine (terfenadine, loratidine, cetirizine) and a topical corticosteroid nose spray

(flunisolide or beclomethasone) is effective in most individuals. Topical vasoconstrictors are

not recommended for other than very short periods, owing to rebound chemical rhinitis. For

pharmacologically unresponsive, seasonal allergic rhinitis, immunotherapy involving

weekly injections of gradually increased doses of specific allergen was efficacious in some

patients. However, this practice is now unpopular in the United Kingdom because of the risk

of anaphylaxis with the currently licensed preparations. Atopic individuals frequently have

many clinically relevant allergens, which renders specific immunotherapy less feasible. The

underlying immunological mechanisms of successful allergen immunotherapy have not been

determined, although a good clinical outcome is associated with an eventual decrease in

specific IgE and an increase in specific IgG subclasses. The induction of peripheral T-cell

anergy to the allergen has been suggested and the outcome of research into new approaches

for immunotherapy is encouraging. Treatment with antihistamines and topical

corticosteroids is often also effective for symptoms of vasomotor rhinitis.


55

Trail drug

Amrutha Guggulu 64

S. No Sanskrit name Botanical name Proportion

1 Amrutha 65 Tinospora cordifolia 100 Pala

2 Dashamoola 66 Ten roots 100 Pala

3 Pata 67 Cissampelos pareira 10 Pala

4 Moorva 68 Sansevieria roxburghiana 10 Pala

5 Bala 69 Sida cordifolia 10 Pala

6 Katuki (Tikta) 70 Picrorrhiza kurrooa 10 Pala

7 Darvi (Daruharidra) 71 Berberis aristata 10 Pala

8 Gandharvahasta 72 Ricinus communis 10 Pala

9 Vibhitakai 73 Terminalia bellarica 100 nos

10 Haritaki 74 Terminalia chebula 200 nos

11 Amalaki 75 Emblica officinalis 200 nos

12 Guggulu 76 Balasmodendrom mukul 1 prasta

Prakshipta dravya

13 Guduchi satwa 77 Tinospora cordifolia 2 Pala

14 Shunti Churna 78 Zingiber officinale 2 Pala

15 Pippali Churna 79 Piper longum 2 Pala

1 Pala = 48 gms, 1 Prasta = 64 gms


56

1) Amrutha 80

Synonyms Amritalata, Amritavalli, Bhishakpriya, Guduchi,

Jivanthika, Madhuparni, Pittaghni

Prayojyanga Roots, stems

Rasa Madhura

Guna Laghu

Veerya Ushna

Vipaka Katu

Prabhava Rasayana

Doshagnata Tridhoshaghna

Action Alterative, antiperiodic, bitter tonic, diuretic, febrifuge

Uses Seminal weakness and urinary affections, Blood purifier,

valuable tonic, fever, gout, and jaundice, torpidity of the

liver, skin diseases, secondary syphilis, rheumatism,

constipation, tuberculosis, and leprosy.

Chemical consttiuents 3 crystalline substances (tinosporin, tinosponic acid and

tinosporal), 2 bitter principles (columbine chassmahthin

and Palmarin) and a neutral fatty alcohol, (Anon, 19701),

rich in protein and fairly rich in calcium and phospherus

Prepared Medicines Amrutharista, Amrutha swarasa, Amrutha prasha gritha,

Amruthadigritha, Amrutha Satwa


57

2) Dashamoola 81

SNo

Name & Latin name

Rasa Guna Veerya Vipaka Karma

1 Bilwa (Aegle marmelos)

Katu-Tikta-Kashaya

Snigdha Teekshna

Ushna Katu Grahi, Agnikrit, Pachaka, Shothahara,balya and vedanastapaka

2 Agnimantha (Premna mucronata)

Tikta-Katu Kashaya

Laghu-Ruksha

Ushna Katu Shothahara, Pandunashana, Agnikrit, Vibandha nashana

3 Shyonaka (Oroxylum indicum)

Madhura Tikta Kashaya

Laghu-Ruksha

Ushna Katu Vedana nashaka, Shothahara, Aruchinashaka, Grahi, Basthi rogahara

4 Patala (Stereospermum suaveoleus)

Tikta-Kashaya

Laghu-Ruksha

Ushna Katu Vedana Sthapaka, Chardi-Shwasa-Atisara nashaka, Sthothahara, Vranaropaka

5 Kashmari (Gmelia arborea)

Tikta-Madhura-Kashaya

Guru Ushna Katu Deepaka, Pachaka, Medhya, Shothahara, Amashoolahara, Jwara-Visha-Trishnashamaka,bhramanashini.

6 Shaliparni (Desmodium gangeticum)

Madhura-Tikta

Guru-Snigdha

Ushna Madhura Vedana Sthapaka, Vranaropaka, Shothahara, Chardi-shwasa-Atisaranashaka,vrsya,rasayani, Brumhana

7 Prishniparni (Uraria picta)

Madhura-Tikta

Laghu-Snigdha

Ushna Madhura Daha, Jwara, Shothahara, Vrishya Raktatisara nashaka

8 Gokshura (Tribulus terrestris)

Madhura Guru-Snigdha

Sheeta Madhura Balya, Mutrala, Vrishya, Ashmari hara, Vatarogahara,brumhana,sulahara,pustikaraka,srotovishodaka

9 Brihati (Solanum indicum)

Katu-Tikta

Laghu-Ruksha, Teekshna

Ushna Katu Kushta, shwasa, Jwara, Shula-Kasa-Agnimandya nashaka

10 Kanthakari (Solanum xanthocarpum)

Tikta-Katu

Laghu-Ruksha-Teekshna

Ushna Katu Vedana sthapaka, Shotha hara, Krimighna, Kasahara, Hikkanashaka,parswa peedahara


58

SNo Name & Latin name Useful parts Chemical

composition Doshaghnata

1 Bilwa (Aegle marmelos)

Fruit, Leaves, Roots

Xanthotoxin, Umbelliferon, Marmesin, Marmin

Kapha Vatahara

2 Agnimantha (Premna mucronata)

Leaves, Roots β-sitasterol, Aphelandrine, Premnine, Betulin, Premnenol

Kapha Vatahara

3 Shyonaka (Oroxylum indicum)

Roots, Barks Bicalein, Oroxindin, Tetulin

Kapha Vatahara

4 Patala (Stereospermum suaveoleus)

Root bark, Flower, seed, Leaf, Kshara

Crystalline bitter substances

Tridosha hara

5 Kashmari (Gmelia arborea)

Root, Fruit, Flowers, Leaves

β-sitasterol, Gmelinol, Butyric acid, Tartaric acid, Apigenin

Tridosha hara

6 Shaliparni (Desmodium gangeticum)

Whole Plant, Root

N.N-dimethyl tryptamine, Hypaphorine, Hordenine

Tridosha nashaka

7 Prishniparni (Uraria picta)

Root U.Lagopodioides, Flavanoids

Tridosha nashaka

8 Gokshura (Tribulus terrestris)

Root Campestrol, β-sitasterol, Stigmasterol, Neotigogenin

Vata-Pitta shamaka

9 Brihati (Solanum indicum)

Root, Fruit Solanine, Carotene, carpestrol, Solanocarpone

Kapha-Vata hara

10 Kanthakari (Solanum xanthocarpum)

Whole Plant, Root, Fruit

β-carotene, Diosgenin, Carpestrol, Solasodine

Kapha-Vatahara

3) Pata - Cissampelos pareira 82

Prayojyanga Moola, Kanda

Rasa Tikta

Guna Laghu, Teekshna


59

Veerya Ushna

Vipaka Katu

Prabhava Sthanya shpdhana

Doshagnata Kapha Pitta hara

Action Vrana ropana, Vishaghna, Kustaghna, Rakta shodhaka,

Shotha hara,

Uses Pitta rogahara, Dustavrana, Nadivrana, Kusta, Rakta

Vikara,

Chemical consttiuents Pelosine, Cycleinarnottii alkaline like S japonica

Prepared Medicines Shatdharana Yoga

4) Moorva - Sansevieria roxburghiana 83

Prayojyanga Moola

Rasa Madhura

Guna Snigdha, Picchila

Veerya Sheeta

Vipaka Madhura

Prabhava Kapha shodhana

Doshagnata Kapha hara

Action Anulomana, Kapha nissaraka, Mootrala, Jwaraghna, Balya

Uses Swasa hara, kapha vikara, kasa, Arsha, raja yaksham,

mootrakruchra

Chemical consttiuents -

Prepared Medicines -


60

5) Bala - Sida cordifolia 84-87

Synonyms Peetha pushpa, sahadevi, vatyalika

Prayojyanga Whole plant, Roots, leaves, seeds and stems

Rasa Amla, Madhura, Kashaya

Guna Guru, Snigdha, Pichchila

Veerya Sheeta

Vipaka Madhura

Prabhava Daha Prashamana, Vedana Stapana, sukrala

Doshagnata Vata pittaghna

Action Roots are diaphoretic, aphrodisiac and tonic, for

strengthening before and after, chemotherapy, for healing

tissues of convalescence,

Uses Daha, Swasa, Vata Vyadhi, Facial paralysis, arthritis,

asthma, bronchitis, cancer, chronic inflammation, cystitis,

dysentery, emaciation, exhaustion, fevers, heart disease,

insanity, joint diseases, leucorrhea, muscle cramps, nerve

pain, neuralgia and nerve inflammation numbness,

rheumatism, chronic sciatica, sexual debility, skin

disorders, stimulant, as a tumors ulcers and wounds

Chemical consttiuents Fatty oil, ephedrine, Ephedra, phytosterol, mucins,

potassium nitrate, resins, resin acids, no tannin or

glucoside

Prepared Medicines Balarishtam, chandanabala lakshadi Taila


61

6) Katuki (Tikta) Picrorrhiza kurrooa 88-90

Synonym Katuka, Tikta, Kandharuha, Chakrangi

Prayojyanga Dried rhizome

Rasa Tikta

Guna Ruksha, laghu

Veerya Sheeta

Vipaka Katu

Doshagnata Kapha pitta hara

Action In small doses, it is a bitter stomachic and laxative and in

large doses, a cathartic, It is reputed as an antiperiodic and

chalagogue.

Uses Aruchi, agnimandya, kamala, sthanya vikara, prameha

Chemical consttiuents picrorrhizin, a soluble bitter substances with an acid

reaction.

Prepared Medicines Arogyavardhini vati, katukadi loha, tiktadi kwatha

7) Darvi (Daruharidra) Berberis aristata 91

Prayojyanga Bark of roots

Rasa Tikta, Kashaya

Guna Laghu, Rooksha

Veerya Ushna

Vipaka Katu


62

Prabhava Shothahara, Vedana sthapaka, Vrana shodhana ropana,

Chakshushya


Action Cholagogue, hepatic, anti-emetic, bitter, laxative

Uses Diuretic, Antibilious, Refrigerant, Stomachic, Bitter tonic,

Antiperiodic, Alterative, Antipyretic. Used for the

treatment as an Antibiotic, Immune Stimulant, for treating

pinkeye, High blood pressure.

Chemical consttiuents Alkaloids of the isoquinoline type, Mainly berberine,

Berbamine and derivatives, Berberrubine, Bervulcine,

Columbamine, Isotetrandrine, Jatrorrhizine,

Magnoflorine, Oxycanthine and Vulvracine o

Miscellaneous, including Chelidonic acid, resin, tannin

etc.

Prepared Medicines Darviikwatha, Darviloha

8) Gandharvahasta - Ricinus communis – Euphorbiaceae 92-95

Synonyms grandhva hasthe, pancharguta, vardhaman, chitra

Prayojyanga Whole plant

Rasa Madhura, Katu, Kashaya

Guna Guru, Snigdha, pichila- Teekshna sookshma,

Veerya Ushna

Vipaka Madhura


63

Prabhava Shothahara, Vedana sthapaka, Angamarda Prashamana,

Amahara

Doshagnata Kapha vatagna

Action Hrudya, Mootra vishodhana, Vrushyam, Sthanya janaka,

Sukrashodhaka, Garbhashaya Shodhaka, Kustaghna,

Jwaraghna

Used in diseases Shoola, shotha, katu, Basthi, shirashoola, udara, jwara,

bradhna, anaha, kasa, Kushta

Chemical consttiuents Recinine, glycerides, and ricinoleie acid linoleum, stearic,

hydroxyl steam

Prepared Medicines Erandapaka, Eranda mooladi kwatha, rasnadhi kwatha

9) Vibhitakai Terminalia bellarica 96-99

Synonyms Kalidrum, Bhutavasa, Karsaphala

Prayojyanga Fruits

Rasa Kashaya

Guna Ruksha, Lagu

Veerya Ushna

Vipaka Madhura

Prabhava Kasahara, netra, keshya, madakaraka, Shothahara,

Vedanasthapana, Raktasthambhana, Krushni, Anulomana,

Deepana,

Doshagnata Tridoshahara

Action Astringent, tonic, expectorant, laxative, Anti microbial

activity


64

Uses Krimighna, Trushna Nigrahana, Chardi Nigrahana,

Vajikarana, Jwaraghna, Chakshushya

Chemical consttiuents 20 to 30% of tannin and 40 to 45% of water-soluble

extractive. Galic acid, ellagic acid, phyllemblen, ethyle

gallate and galloyl glucose

Prepared Medicines Triphalachiurna, phalatrikadi kwatha, lavangadivati,

Talisadichurna

10) Haritaki Terminalia chebula – Combertaceae 100-106

Synonyms Abhaya, Pathya, Vijaya, Bhishakpriya

Prayojyanga Phala

Rasa Kashaya Pradhana(lavanavarjita) Pancharasa

Guna Laghu, Ruksha

Veerya Ushana

Vipaka Madhura

Prabhava Shothahara, Vedanasthapaka, Vrana shodhana ropana,

Chakshushya, Deepana Pachana

Doshagnata Tridhoshahara

Action wide antibacterial and antifungal spectrum, and also

inhibits growth of E. coli, the most common organism

responsible for urinary tract infection

Uses Effective purgative, Rashayana, Swasa Kasa, Prameha,

Eye diseases, Kusta, Vruna, Chardi, Sopha, Vatarkata and

Cardiac diseases. Astringent, Stomachic, Netraroga,

Twakaroga Kamala, Grahani, Hikka, Pleeharoga, Gulma

Yakritrog, Asmari.


65

Chemical consttiuents Tannin and large amount of Gallic acid and Chebulic acid.

Tannic acid, gallic acid,Resin and a purgative principle

anthraquinone and sennoside

Prepared Medicines Triphala churna, Abhyadi modaka, Abhyarista, Agastya

Hareetaki

11) Amalaki Emblica officinalis 107-110

Synonyms Dhatriphala, sriphala, vayashya, Vrushya

Prayojyanga Phala

Rasa Amla pradhana lavana varjita pancharasa

Guna Ruksha Guru sheeta

Veerya Sheeta

Vipaka Madhura

Prabhava Dahaprashanmana, Chakshushya, Keshaya, Hrudya,

Sonita sthapana, Vrushya,

Doshagnata Tridosha hara

Action Anti hemorrhage, diarrhea and dysentery, anemia,

Jaundice and dyspepsia, cough.

Uses Raktapitta, daha, chardhi, prameha, Rasayana and shopa.

Antimutagenic and anti-carcinogenic Anti-oxidative

activity

Chemical consttiuents Vitamin C, 5% of tannin, Phosphorus, Iron calcium.

Prepared Medicines Chyavana prashavalehya, Dhatriloha, Dhatri Rasyana


66

12) Guggulu - Balasmodendrom mukul 111-112

Synonym Palnkash

Prayojyanga Resin / Gum

Rasa Tikta, Katu, Kashya

Guna Laghu, Snigdha

Veerya Ushana

Vipaka Katu

Prabhava Anti Obesity, reliever of nervous diseases, arthritis,

rheumatism, pertussis, pneumonia, pyelitis, pyorrhea,

scrofula, skin disorders, sore throat, spongy gums,

ulcerative pharyngitis,

Doshagnata Kapha hara, Vatahara

Action Analgesic, highly potent anti-inflammatory, rejuvenator,

aphrodisiac, diaphoretic, diuretic, astringent, demulcent,

alterative, carminative, appetizer, antispasmodic,

antisuppurative, antiseptic, enhances phagocytosis,

immuno-stimulant,

Uses Vedana stahapana, Akshepahara, Medhaya, thoulya hara

Chemical consttiuents Z-guggulsterone and E-guggulsterone, phytosterols

named guggulsterones, organic acids, aromatic acids,

diterpenes, lignans, sterols, steroids, esters and fatty acid

alcohols. Guggal 0.37% volatile oil consisting chiefly

myrcene, dimyrcene, gum resin & bitter principle.

Prepared Medicines Yogaraja Guggulu, Chandraprabhavati, Kaishora Guggulu


67

13) Shunti 113 Zingiber officinale

Prayojyanga Kanda

Rasa Katu

Guna Laghu, Snigdha

Veerya Ushna

Vipaka Madhura

Doshagnata Kapahavata shamaka

Action Sheeta prashamana, Rechana, deepana, vatanulomana,

Swasa hara, Ama Dosha hara

Uses Amavata, Vata roga, Aruchi, Agnimandya, Chardi

Chemical consttiuents Zingibarne, Zingiberol

Prepared Medicines Ardraka Khanda, Rasnadi Kwatha,

14) Pippali 114 Piper longum

Prayojyanga Phala, Moola

Rasa Katu

Guna Laghu, Snigdha, Teekshna

Veerya Anushna Sheeta

Vipaka Madhura

Doshagnata Pitta shamaka

Action Rakta utkleshaka, Shirovirechaka, Yakrutottejaka, Mrudu

Virechaka, Krimighna, Deepana


68

Uses Swasa, kasa, hikka, mootra roga, garhashaya sankochaka

Chemical consttiuents Piperine, piplartine, piplasterol,

Prepared Medicines Gudapippali, pippali khanda, pippalyasava

Patadi tailam 115-116

S. No Sanskrit name Botanical name

1 Pata Cissampelos pareira

2 Haridra Curcuma longa

3 Daruharidra Berberis aristata

4 Moorva Sansevieria roxburghiana

5 Pippali Piper longum

6 Jati pallava Jasminum grandiflorum

7 Danti Baliospermum montanum

8 Tila taila Sesame oil

All are in equal quantity

Patadi tailam ingredients discussed above are -

S. No Sanskrit name & Botanical name

1 Pata - Cissampelos pareira

2 Daruharidra - Berberis aristata

3 Moorva - Sansevieria roxburghiana

4 Pippali - Piper longum


69

1) Haridra 117 Curcuma longa

Synonyms Krumighna, Yostipreeya, Nisa, Yositpriya, Krmighni, Kancani, Gouri.

Prayojyanga Moola

Rasa Tikta, katu,

Guna Rooksha, Laghu.

Veerya Ushna

Vipaka Katu

Prabhava Raktashodhaka, Shothahara, Deepana,

Doshagnata Pittahara, Kaphagna, Vatahara

Action Pratishyaya, Peenasa, Krimi, Prameha, Kamala, Yakritvikara,

Paryayika jwara, Netrabhishanda, Kaphaghna, Pandu, Vrinaropaka,

Varnya, Twagdoshahara,, Grahi, Carminative and acts as vermicidal.

Uses Antibacterial (Basu, 1971), Anti-histamine or blockers, (Sinha et al.,

1972) Anti-inflammatory (Tripathi et al., 1973), (Katare, 1974)

Chemical constituents

1% of volatile oil, Resin, Curcumin, Turmeric oil, Curcumene,

Curcumenone, curcone, curdione, cineole, cineole, curzerenone,

epiprocurcumenol, eugenol, camphene, camphor, borneol,

procurcumadiol, procurcumenol, curumins, ukonan A,B and D, β-

sitosterol etc.

Prepared Medicines

Patadi Taila


70

2) Jati pallava 118 Jasminum grandiflorum Prayojyanga Moola, Patra, Pushpa

Rasa Kashaya, Tikta

Guna Laghu, Mrudu, Snigdha

Veerya Ushna

Vipaka Katu

Prabhava Mukharogahara, Raktadoshahara, Shoolaghna, Vranaghna

Doshagnata Kaphaghna, Pittaghna, Vataghna

Prepared Medicines Patadi Taila

3) Danti 119 Baliospermum montanum

Prayojyanga Moola, Beeja, Patra

Rasa Katu

Guna Guru, Teekshna

Veerya Ushna

Vipaka Katu

Prabhava Teekshna virechaka


Action Vedana sthapana, virechana, krimighna, swasahara, Rakta

shodhaka, deepana

Uses Shotha, vata vyadhi, udara, arsha, krimi,

Chemical consttiuents Starch, oil of laxative action

Prepared Medicines Dantyarista


71

4) Tila taila - Sesame oil - Seasum indicum – Pedaliaceae 120-121

Synonyms homadhanya, pavitra, papaghna

Prayojyanga Beeja, Taila

Rasa Madhura (Anurasa -Kashaya, Tikta)

Guna Guru, Snigdha,

Veerya Ushna

Vipaka Madhura

Prabhava Keshya, Swedanasthapana

Doshagnata Vatahara

Action Medhya, soola prasaman (pain-relieving property) Balya

Uses Mastishkya dourbalya, Grahani, Arsha

Chemical consttiuents Protein, carbohydrate, minerals, phosphorous; 70% of

liquid fats consisting of the glycerides of oleic and linoleic

acid

Prepared Medicines Tiladi Gutika

Preparation of Medicine: Amrutha Guggulu and Patadi taila ingredients are well identified

and collected from local areas. Good manufacturing practice will be followed for the

preparation. The vati is prepared with the additives as par the method described in the

classical texts. All the herbs collected are powered and made as tablet. The ready tablets are

preserved in glass containers and dispensed to the patient as par the schedule.

The taila preparation is done according to Samhita methods adding reduced Kashaya

to the oil and looking at mrudu paka of the oil put off the fire to get self-cooled. Later the oil

is preserved in the glass bottle and supplied patient according to the requirement.

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Methods

72

Chapter – 4

Methods

he clinical study is based on the classical explanations with scientific well-designed

research protocols, which enumerates the patient before to administrate the trial drug to after

effects in comparison.

Criteria for selecting drugs

1. The trial drugs are Amrutha Guggulu and Pataditaila for Pratimarsha Nasya.

2. The pharmacological actions of the individual drugs are Pratishyaya hara and

Peenasahara in their properties along with vedana shamaka and Dosha hara

properties.

3. The trial drugs, Amrutha Guggulu and Pataditaila are selected according to the

pharmacological action and properties of individual drugs.

4. Amrutha Guggulu and Pataditaila are purely herbal, they are cheaper and easily

available as in the local market

5. Amrutha Guggulu and Pataditaila are very easy to process and making

6. Amrutha Guggulu and Pataditaila are very easy to dispense.

7. Amrutha Guggulu and Pataditaila are selected in the study by considering the

following facts –

In different contexts the texts referred these group of herbs are potent

All of these are considered for multi dimensional actions


73

All these yields results not only to Pratishyaya but also to the shira shoola,

etc, which are associative of Pratishyaya

The said combination is hypothetically effective in reversal of Samprapti i.e.

the patho-physiological normalcy induction

Criteria for quantity of the drug

Amrutha Guggulu and Pataditaila are selected to act against Pratishyaya with

therapeutic effects and pharmacological actions, which are the potent to combat Pratishyaya

successfully.

Methods followed in trail

1) Method of Research design

The trail is an observational simple random sampling technique -

comparative clinical study.

2) Sample size and grouping: A minimum of 45 patients equally distributed in three

groups.

1. Group A: 15 patients will receive Amrutha Guggulu internally.

2. Group B: 15 patients will receive Nasya with Patadi taila.

3. Group C: 15 patients will receive both Amrutha Guggulu internally and Nasya

with Patadi taila

3) Posology of Trial drug 122

1) Internally: Amrutha Guggulu – 2 TDS (Each tablet of 500 mg) for 7 days

2) Externally: Pratimarsha Nasya with Patadi taila for 7 days

4) Anupana of Trial drug 123

Hot water - because it is pathya for Pratishyaya


74

5) Study duration of Trial drug

Amrutha Guggulu and Pataditaila are studied for 7 days. The Amrutha Guggulu was

dispensed for 2 days to all patients and advised to report for every alternative day’s interval,

asked to note the nature, frequency and other symptoms of their disease and noted during

their visits. Pataditaila Pratimarsha Nasya is done at our hospital under supervision even

though it can be done by patient him self.

6) Follow up of Trial drug

Amrutha Guggulu and Pataditaila are trail offered a further follow up 7 days. The

effect of Amrutha Guggulu and Pataditaila was analyzed according to clinical and functional

response before and after the treatment is compared to that of follow up data. In further the

final declaration of the trail drug effect and result is done on the basis of the follow up data.

7) Source of data of Trial drug

The data was collected from the patients suffering from Pratishyaya in the OPD of

post graduation and research center DGM Ayurvedic medical college Gadag. The method of

the present study consists of following headings.

a) Selection of the patient

b) Examination of the patient

c) Criteria of diagnosis

a) Selection of the patient

Patients of Pratishyaya (Allergic Rhinitis) fulfilling the criteria of diagnosis were

selected in the present study. Patients were distributed randomly for the study, based on

preset inclusion and exclusion criteria. Patients were excluded, as they are discontinuous at

the treatment or unable to fulfill the study design.


75

i) Inclusion criteria

1. Patients above 12 and below 60 years of age groups irrespective of sex are

included in the studies who are effectively tolerated the medicine and

procedure.

2. Patients fit for Nasya karma are included as the study included the

Pratimarsha Nasya.

3. Patients with clinical features of Pratishyaya as explained in classics are

included as the bases of disease diagnosis are symptoms mentioned in

classics.

ii) Exclusion criteria

1) Patients with infective Rhinorrhoea are excluded as the invasions of microbes

may give rise complications.

2) Under the age of 12 years are excluded as these are considered as “Baala” i.e.

children and not fit for the any experimental study.

3) Patients with Asadhya lakshanas as mentioned in Ayurvedic texts are

excluded, as the disease at that stage requires multi centric medicaments.

4) Patients with other systemic disorders are excluded as the symptoms can

misguide the study.

5) Pregnant women and lactating mothers are excluded at the suspicion of

medicine as placental barrier.

iii) Criteria of diagnosis:

The clinical features of Pratishyaya (allergic Rhinitis) mentioned in texts will be the

basis of diagnosis. Repeated bouts of sneezing, profuse watery nasal discharge and Careful


76

history revealing patient allergic to specific allergens makes the diagnosis. The classical

symptoms mentioned as subjective parameters and the instrumental diagnostic tools as

objective parameters are mentioned here for criteria of diagnosis.

Subjective parameters

Colour (Yellowish/ White/ Blood tinge)

Smell (No smell/ Purulent)

1 Nasa Srava

Discharge (Watery/ purulent / non purulent)

Unilateral/ Bilateral

Intermittent / Continuous

2 Nasavarodha

Day / Night/ All Time

3 Ghrana Toda Arti

4 Kshavathu (Sankhya)

5 Nisteeva (Non purulent / purulent)

6 Shirah Shoola

7 Shiro gurutwa

Objective parameters

Erythrocytes sedimentation rate

Absolute Eosinophilic count

Differential count of Eosinophils

Total count


77

8) Examination of the patient

Examination of Nose:

A detailed history of symptoms with special regard to their onset, duration,

progression, severity should be asked.

Functional Examination of Nose:

Test for patency of the nose and 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.

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.

Nasal examination includes:

1. Examination of external nose.

2. Examination of vestibule.

3. Anterior rhinoscopy.

4. Posterior rhinoscopy.

5. Functional examination of nose.

External nose:

Examine the skin and osteocartilaginous framework of nose both by inspection and

palpation.


78

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)

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:

1. Nasal Passage: Narrow (septal deviation or hypertrophy of turbinates, growth) and

wide (atrophic rhinitis).

2. Septum: Deviation or spur, ulcer, perforation, swelling (haematoma or abscess),

growth (rhinosporidiosis, haemangioma).

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

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

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

5. 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),


79

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.

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.

Grades for assessment

Subjective parameters

1) Nasa Srava has the sub divisions of examination are as follows.

A. Colour (White/ Yellowish/ Blood tinge) – as each of the category is having different

symptoms for examination based on the colour of the discharge white as 1, yellowish

as – 2 and blood tinge discharge as 3 points allotted.


80

B. Smell (No smell/ Purulent) as like the same as above here no smell is grades as 1 and

purulent smell as 2.

C. Discharge (Watery/ non purulent / purulent /) same rule applied even here for

convenience of assessment. If watery discharge as 1, non-purulent discharge as 2 and

purulent discharge as 3.

Summations of the numerical assessments are compared at the end, where normalcy

has taken as “0”.

2) Nasavarodha – for Nasavarodha assessment also same methods are followed.

• If Unilateral as 1, Bilateral as 2,

• Intermittent as 1, Continuous as 2,

• if either of day or Night as 1 and All Time considered as 2

• Cumulative assessments are applied for the final result.

3) Ghrana Toda Arti (1-6)

0 = Normal

1 = Unilateral

2 = Bilateral

3 = Intermediate

4 = day

5 =Night

6 = All time

4) Kshavathu (numerical)

• Absence as - “0”

• The actual number sneezes of different times in a day either on exposure to

cold or dusts are counted.


81

5) Nisteeva (Non purulent / purulent) (1-6)

• Absence 0

• Present at the time of attack only (non purulent) 1

• Present at the time of attack only (purulent) 2

• Present in between attack (non purulent) 3

• Present in between attack (purulent) 4

• Present throughout the day (non purulent) 5

• Present throughout the day (non purulent) 6

6) Shirah Shoola (1-5)

• Absence 0

• Present at the time of attack only 1

• Present only for few hours 2

• Present throughout the day 3

• Subsides with medication 4

• Not-Subsides with medication 5

7) Shiro gurutwa (1-5)

• Absence 0

• Present at the time of attack only 1

• Present only for few hours 2

• Present throughout the day 3

• Subsides with medication 4

• Not-Subsides with medication 5


82

Objective parameters

1) Erythrocytes sedimentation rate

Erythrocytes sedimentation rate 124 is measures in the graduated tubes under

Westergren’s method (pipette method). This facilitates to understand possible presence of

organic disease or to follow the course of the disease. It is universally accepted that it is a

good prognostic method in clinical laboratory.

Procedure:

Steps 1) draw the sufficient blood sample from patient vein

Step 2) add anti coagulant to the blood

Steps 3) suck the blood in to the ESR tube

Step 4) note the point of sedimentation on graduated tube

Absolute Eosinophilic count and Differential count of Eosinophils

Eosinophils attack objects that have already been coated with antibodies. They are

phagocytic cells and will engulf antibody-marked bacteria, protozoa, or cellular debris.

However, their primary mode of attack involves the exocytosis of toxic compounds,

including nitric oxide and cytotoxic enzymes, onto the surface of their targets. Eosinophils

are important in the defense against large multicellular parasites, such as flukes or parasitic

worms, and they increase in number dramatically during a parasitic infection. Because they

are also sensitive to circulating allergens (materials that trigger allergies), eosinophils

increase in number during allergic reactions as well. Eosinophils are also attracted to sites of

injury, where they release enzymes that reduce the degree of inflammation and control its

spread to adjacent tissues. This test is being done to all the patients before and after the


83

treatment. To study the effect of trial drug effect on Eosinophils, considering normal range

of Eosinophils in peripheral blood as up to 250 cells, the AEC examination is performed 125.

Total count

This test is being done to all the patients before and after the treatment. Effect of

trial drug on total count of the blood cells is studied which are protecting the over all heath.

Assessment of results:

Subjective and objective parameters of base line data to after treatment data

comparison are done for the assessment of results. The paired “t” test, unpaired “t” test and

non-parametric test are used to test the hypothesis. If “P” value is < 0.05, the test is highly

significant. Over all assessment of results are done considering the cumulative subjective

and objective parameters assessments. The grades of assessment made for the results

declaration after observing subjective parameters and objective parameters (11 parameters)

converted as percentages of values of cure in terms of relief. The numerical percentages of

11 parameters are 1100. Out of the percentages of different result categories are as follows -

1. Cured – if the value is 700 or above

2. Well responded – if the value is between 700 to 500

3. Moderately responded – if the value is between 500 to 300

4. Not responded- if the value is less than 300.

5. The samples that are discontinued at the trial are not included in the study.

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results

84

Chapter – 5

Results

resent study registers 45 patients, out of 65 approached patients. Out of this, no

patients were discontinued hence their data has not been included in the assessment. The

remaining 45 patients of Pratishyaya viz. coryza defined as a Rhinitis in an allergic

individual due to the presence of an agent to which he is hypersensitive, fulfilling the criteria

of diagnosis and inclusive criteria were included in the study, fewer than three groups as

discussed in the Methodology, distributed patients in Group-A are 15 (Amrutha Guggulu),

Group-B (Patadi taila – Pratimarsha Nasya) are 15 and Group-C (Amrutha Guggulu and

Patadi taila – Pratimarsha Nasya) are 15.

All the patients were examined before and after the trail, according to the case sheet

format given in the annex. Both the subjective and objective criteria were recorded. The data

recorded are presented under the following headings.

A. Demographic data

B. Evaluating disease Data and

C. Result of the Amrutha Guggulu and Patadi taila – Pratimarsha Nasya as distributed

group wise are dealt at every event.

A) Demographic data:

The details of Age, Gender, Religion, and Occupation etc. of the 15 patients in each

group are as follows.


85

Table –12 Demographic Data of Group – A (Amrutha Guggulu)

SNo OPD No

Gender Age Religion Occupation Economical Condition

Result

Ma Fe H M C O S A L P Md Hg Hc 1 3808 + 23 + + + Well 2 4565 + 34 + + + Well 3 4576 + 27 + + + Well 4 4621 + 23 + + + Well 5 4750 + 17 + + + Well 6 4765 + 28 + + + Mod 7 4785 + 28 + + + Mod 8 4812 + 21 + + + Mod 9 4830 + 20 + + + Well 10 4845 + 23 + + + Well 11 4856 + 28 + + + Well 12 4900 + 26 + + + Mod 13 4912 + 19 + + + Mod 14 4930 + 27 + + + Well 15 4934 + 23 + + + Mod Total 10 5 13 2 0 0 2 12 1 1 11 2 1

Table –13 Demographic Data of Group – B (Patadi taila – Pratimarsha Nasya)

SNo OPD No


Result

Ma Fe H M C O S A L P Md Hg Hc 1 2438 + 21 + + + Cured 2 3595 + 40 + + + Mod 3 3806 + 18 + + + Well 4 3807 + 19 + + + Well 5 4210 + 36 + + + Well 6 4220 + 38 + + + Well 7 4238 + 29 + + + Well 8 4254 + 30 + + + Well 9 4263 + 24 + + + Well 10 4269 + 32 + + + Mod 11 4283 + 28 + + + Cured 12 4290 + 35 + + + Well 13 4295 + 36 + + + Well 14 4358 + 15 + + + Well 15 4364 + 23 + + + Well Total 11 4 14 1 0 0 5 10 0 1 11 2 1

Ma= Male, Fe = Female, H = Hindu, Mu = Muslim, C = Christian, O = Others, S = Sedentary, A = Active, L = Labour, P = Poor, Md = Middle class, Hg = Higher Middle Class, Hc = Higher Class,


86

Table –14 Demographic Data of Group – C (Amrutha Guggulu and Patadi taila – Pratimarsha Nasya)

SNo OPD No


Result

Ma Fe H M C O S A L P Md Hg Hc 1 3644 + 33 + + + Cured 2 3810 + 29 + + + Well 3 3968 + 20 + + + Well 4 3976 + 21 + + + Well 5 3992 + 18 + + + Well 6 4149 + 18 + + + Well 7 5117 + 19 + + + Well 8 5617 + 45 + + + Cured 9 5812 + 27 + + + Cured 10 5861 + 22 + + + Cured 11 5884 + 36 + + + Cured 12 5896 + 23 + + + Well 13 5911 + 34 + + + Well 14 5914 + 33 + + + Cured 15 5924 + 26 + + + Cured Total 4 11 13 1 1 0 9 5 1 1 9 3 2

A1) distribution of patients by Age

An interval of 10 has considered from the ages 15 to 55 as discussed in the methods.

In the study it is revealed that allergy is continued from the ages of 15 and even lesser age

groups and as age advances the samples are affected with external atmosphere exposure. A

wide distribution of the disease observed is tabulated as below.

Table- 15 Distribution of patients by Age in Group –A, B, C

Group –A Group -B Group -C Total

Age

dist

ri

buti

o

Patients % Patients % Patients % Patients %

15 to 24 8 53.33 6 40 7 46.66 21 46.67

25 to 34 7 46.67 4 26.66 6 40 17 37.78

35 to 44 0 0 5 33.34 1 6.66 6 13.33

45 to 54 0 0 0 0 1 6.66 1 2.22

Total 15 100 15 100 15 100 45 100


87

Graph – 1

Pictorial distribution of patients by Age in all groups

Table- 16 Results of Patients by Age in Group – A (Amrutha Guggulu)

Patients

Occupation

A B C T

Cur

ed

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% N

ot

Res

pond

ed

%

15 to 24 8 6 8 22 2 4.44 17 37.8 3 6.66 0 0

25 to 34 7 4 5 16 5 11.1 7 15.5 4 8.88 0 0

35 to 44 0 5 1 6 1 2.22 4 8.88 1 2.22 0 0

45 to 54 0 0 1 1 1 2.22 0 0 0 0 0 0

Total 15 15 15 45 9 19.9 28 62.2 8 17.8 0 0

The Results of the trial encourage and 9 cured are distributed among 5 (11.11%) are

from the 25-34 age group. From the well responded category 17 (37.3%) out of 28 are at the

ages of 15 to 24 range. Moderate response rated maximum observed from 25-34 range only

as 4 (8.88%).

Distribution of patients by Age

768

6

4

71

5

0

02468

10121416

45 to 5435 to 4425 to 3415 to 24


88

A2) Distribution of patients by Gender

Table- 17

Distribution of patients by Gender in Pratishyaya

Gender

Tot

al n

o of

pa

tien

ts

% C

ured

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% N

ot

Res

pond

ed

%

Male 25 55.56 4 8.88 16 35.55 5 11.1 0 0

Female 20 44.44 5 11.11 12 26.66 3 6.7 0 0

Total 45 100 9 19.99 28 62.21 8 17.8 0 0

The male female ratio in the study is approximately 4:5 patients. The percentage of

the distribution does not show any gender differentiation to get this para-nasal disease in

specific, except a small lean towards male population. The observations are 25 Patients i.e.

(55.56%) male and 20 patients i.e. (44.44%) were female. Pictorial representation is as

follows.

Graph - 2 Distribution of patients by Gender in Pratishyaya

Distribution of patients by Gender in Pratishyaya

Male55.56%Female

44.44%


89

Graph -3

Result Distribution of patients by Gender in Pratishyaya

A3) distribution of patients by Religion

Table- 18

Distribution of patients by Religion in Pratishyaya

Group –A Group -B Group -C Total Religion

Patients % Patients % Patients % Patients %

Hindu 13 86.67 14 93.33 13 86.66 40 88.89

Muslim 2 13.33 1 6.67 1 6.67 4 8.89

Christian 0 0 0 0 1 6.67 1 2.22

Others 0 0 0 0 0 0 0 0

Total 15 100 15 100 15 100 45 100

Result of patients by Gender in Pratishyaya

4

5

16

12

5

3

0

0

0 2 4 6 8 10 12 14 16 18

Male

Female

Not Responded

Moderate Responded

Well Responded

Cured


90

Graph – 4

Distribution of patients by religion in Pratishyaya

Table – 19 –

Result of patients by religion in Pratishyaya

Patients

Religion

A B C T

Cur

ed

% Wel

l R

espo

nded

%

Mod

erat

ely

Res

pond

ed

% N

ot

Res

pond

ed

%

Hindu 13 14 13 40 8 17.7 25 55.5 7 15.5 0 0

Muslim 2 1 1 4 1 2.22 2 4.44 1 2.22 0 0

Christian 0 0 1 1 0 0 1 2.22 0 0 0 0

Others 0 0 0 0 0 0 0 0 0 0 0 0

Total 15 15 15 45 9 19.9 28 62.2 8 17.8 0 0

Distribution of patients by religion in Pratishyaya

Christian 2.22%

Hindu88.89%

Muslim8.89%

Others0.00%


91

Hindu dominant area of registering patients show marked Hindu population in the

trial are 40 (88.89%) out of 45 samples. Out of rest 1 Christian (2.22%) and 4 Muslims

(8.89%) are observed. The results of these cumulatively distributed are tabulated as above.

A4) Distribution of patients by Occupation

Table- 20

Distribution of patients by occupation

Patients

Occupation

A B C T C

ured

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% N

ot

Res

pond

ed

%

Sedentary 2 5 9 16 3 6.60 12 26.6 1 2.22 0 0

Active 12 10 5 27 5 11.1 16 35.5 6 13.4 0 0

Labour 1 0 1 2 1 2.2 0 0 1 2.22 0 0

Total 15 15 15 45 9 19.9 28 62.2 8 17.9 0 0

Graph - 5 DISTRIBUTION OF PATIENTS BY OCCUPATION

PATIENTS BY OCCUPATIONActive

60.00%

Sedentary35.56%

Labour4.44%


92

Out of the recorded patients a maximum i.e. 27 (60%) are of actively occupational

and 16 (35.56%) are sedentary. The labour getting Pratishyaya are minimal i.e. 2 (4.44%)

out of 45. The pictorial representation is as follows.

Graph – 6 Result of patients by occupation in Pratishyaya

A5) Distribution of patients by economic status

Table- 21 Distribution of patients by Economic status

Patients

Economic

status

A B C T

Cur

ed

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% N

ot

Res

pond

ed

%

Poor 1 1 1 3 1 2.22 1 2.22 1 2.3 0 0

Middle Class

11 11 9 31 4 8.88 21 46.6 6 13.3 0 0

Higher Middle

2 2 3 7 3 6.66 3 6.66 1 2.3 0 0

Higher Class

1 1 2 4 1 2.22 3 6.66 0 0 0 0

Total 15 15 15 45 9 19.9 28 62.2 8 17.9 0

Result of patients by occupation in Pratishyaya

2

12

1

5

10

0

9

5

1

0 2 4 6 8 10 12 14

Sedentary

Active

Labour

Group_C

Group_B

Group_A


93

The economic status observed here are maximum 31 patients of middle class and

another 7 at higher middle class. The poor and higher are minimal 3 and 4 respectively. Out

of 31 of middle class 21 patients are well responded and 4 are cured in stipulated time.

Graph- 7

DISTRIBUTION OF PATIENTS BY ECONOMIC STATUS

A6) Distribution of patients by diet

Table- 22 Distribution of patients by diet in Pratishyaya

Patients

Diet

A B C T

Cur

ed

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% N

ot

Res

pond

ed

%

Vegetarian 13 8 8 29 4 8.8 18 40 7 15.5 0 0

Mixed diet 2 7 7 16 5 11.1 10 22.2 1 2.22 0 0

Total 15 15 15 45 9 19.9 28 62.2 8 17.7

2 0

Diet is important in the life and disease. Here an attempt made to understand the

food importance is observed as 29 vegetarians and 16 mixed diet practitioners of study show

good response as shown in the table and graph.

1

11

2

11

11

2

11

9

3

2

0

2

4

6

8

10

12

Poor Middle Higher Middle Higher

Result by economical statusPatients


94

Graph - 8 Distribution of patients by diet in Pratishyaya

B) Evaluating disease Data

B1) Chief & Associated complaints

Table -23 Chief & Associated complaints of Group – A (Amrutha Guggulu)

Chief complaints Associated SNo OPD

No Nas

aSra

va

Nas

a A

varo

dha

Ghr

ana

Tod

a A

rti

Ksh

avat

hu

Nis

tee

va

S_h

Sh

oola

S_g

urut

wa

Sw

ara

kshe

e

Dow

rba

lya

Aru

chi M

and

ajw

ara

Gal

a S

osha

Tal

u so

sha

Ost

a so

sha

Vak

tra

Vai

ras

ya

1 3808 3 7 + + + + + + 2 4565 4 5 + + + + + + 3 4576 5 4 + + + + 4 4621 7 6 + + + + + 5 4750 5 4 + + + + + + 6 4765 3 7 + + + + + 7 4785 3 3 + + + + + 8 4812 7 5 + + + + + 9 4830 3 7 + + + + 10 4845 3 5 + + + + 11 4856 6 4 + + + + 12 4900 3 6 + + + + + 13 4912 3 5 + + + + 14 4930 7 5 + + + + + 15 4934 4 5 + + + + + Total 4 11 12 13 0 14 13 6 0 0 0 0

Patients by diet in Pratishyaya

13

2

8

7

8

7

0 2 4 6 8 10 12 14

Vegetarian

Mixed diet

Group_C

Group_B

Group_A


95

Table - 24 Chief & Associated complaints of Group – B (Patadi taila – Pratimarsha Nasya)

Chief complaints Associated SNo OPD

No Nas

aSr

ava

Nas

a A

varo

dha

Ghr

ana

Tod

a A

rti

Ksh

ava

thu

Nis

teev

a

S_h

Sho

ola

S_g

urut

wa

Sw

arak

shee

na

Dow

rba

lya

Aru

chi

Man

daj

war

a

Gal

a S

osha

Tal

u so

sha

Ost

a so

sha

Vak

tra

Vai

rasy

a

1 2438 6 3 + + + + 2 3595 7 5 + + + 3 3806 3 7 + + + + + 4 3807 6 3 + + + + + + + + 5 4210 3 4 + + + 6 4220 3 5 + + + + + 7 4238 3 3 + + 8 4254 7 6 + + + + + + 9 4263 4 5 + + + + + + + 10 4269 3 3 + + + + 11 4283 3 4 + + + + + 12 4290 7 6 + + + + + 13 4295 7 4 + + 14 4358 6 7 + + + + + + 15 4364 3 5 + + + + + + Total 4 9 9 10 1 15 11 8 2 2 0 0

Table - 25 Chief & Associated complaints of Group – C (Amrutha Guggulu and Patadi taila – Pratimarsha Nasya) Chief complaints Associated

SNo OPD No

Nas

aSra

va

Nas

a A

varo

dh

Ghr

ana

Tod

a A

tiK

shav

athu

Nis

teev

a

S_h

Sho

ola

S_g

urut

wa

Sw

arak

she

ena

Dow

rbal

ya Aru

chi

Man

daj

war

a

Gal

a S

osha

Tal

u so

sha

Ost

a so

sha

Vak

tra

Vai

rasy

a

1 3644 3 3 + + + + + + 2 3810 6 3 + + + + + + 3 3968 3 5 + + + + + 4 3976 3 6 + + + + + + 5 3992 8 6 + + + + + + 6 4149 3 5 + + + + + 7 5117 8 6 + + + + + 8 5617 4 6 + + + + + + + 9 5812 5 7 + + + + + 10 5861 6 4 + + + + + + 11 5884 3 6 + + + + + + 12 5896 3 4 + + + + + 13 5911 7 7 + + + + 14 5914 6 5 + + + + + + + 15 5924 3 5 + + + + + Total 7 12 14 14 0 15 15 7 0 0 0 0


96

Table – 26

Chief complaint & Associated Complaints of Group- A, B, C Chief complaint Group -

A Group –

B Group –

C Total %

1 Nasa Srava 15 15 15 45 100

2 Nasavarodha 15 15 15 45 100

3 Ghrana Toda Arti 4 4 7 15 33.33

4 Kshavathu 11 9 12 32 71.11

5 Nisteeva 0 0 0 0 0

6 Shirah Shoola 12 9 14 35 77.77

7 Shiro gurutwa 13 10 14 37 82.22

Associated Complaints

1 Swaraksheena 0 1 0 1 2.22

2 Dowrbalya 14 15 15 44 97.77

3 Aruchi 13 11 15 40 88.88

4 Mandajwara 6 8 7 21 46.66

5 Gala sosha 0 2 0 2 4.44

6 Talu sosha 0 2 0 2 4.44

7 Osta sosha 0 0 0 0 0

8 Vaktra Vairasya 0 0 0 0 0

It is observed in the study that all 45 (100%) patients exhibit the Nasa srava and

Nasavarodha. 44 (97.77%) patients observed with Dourbalya. 40 (88.88%) patients express

Aruchi and 37 (82.22%) and 35 (77.77%) patients with Shiroguruta and Shirashoola

respectively. Kshavathu that is pratyatma niyata lakshana is observed in 32 - (71.11%)

patients. Manda jwara is witnessed in 21 (46.66%) patients. Ghrana toda and Arti is seen in

15 (33.33%) of patients. The other associated symptoms Gala sosha and Talu sosha are

observed each of two (4.44%) patients. Swara ksheena is looked in one (2.22%) patient

only. The observations made in disease analysis are assessed statistically from each group

individually and compared with the final assessments. The data of statistical evaluation is as

follows.


97

Table - 27 Subjective statistical Assessment Data of Group – A (Amrutha Guggulu)

S.No OPD Nasa Srava

Nasarodha Ghrana Toda-Arti

Kshavathu Nisteevana Shira Shoola

Shiro Gourava

B A B A B A B A B A B A B A 1 3808 4 2 4 2 4 2 3 2 4 2 4 1 4 2 2 4565 2 1 3 1 2 1 2 1 3 1 4 2 3 2 3 4576 5 1 4 3 5 2 3 2 3 1 3 2 3 1 4 4621 6 2 3 5 4 2 4 1 6 2 2 1 3 1 5 4750 5 3 4 2 4 2 3 1 5 3 5 3 4 1 6 4765 6 4 4 2 5 1 3 1 5 2 2 3 4 3 7 4785 5 1 4 2 4 3 4 2 4 3 3 3 5 2 8 4812 5 3 3 5 3 1 3 2 5 2 3 2 4 1 9 4830 2 2 5 4 2 2 2 2 2 3 4 1 5 1 10 4845 5 2 3 5 4 2 3 1 5 2 5 2 4 2 11 4856 6 3 5 3 3 2 4 2 5 2 4 2 3 2 12 4900 5 3 4 1 4 2 3 4 4 2 4 3 3 2 13 4912 6 5 4 2 3 2 2 3 5 2 3 1 3 2 14 4930 5 3 3 4 4 1 4 2 5 2 2 1 3 1 15 4934 4 6 4 5 3 1 4 6 4 2 3 2 2 1 71 41 57 46 54 26 47 32 65 31 51 29 53 24

Table - 28 Subjective statistical Assessment Data of Group – B (Patadi taila – Pratimarsha Nasya)

S.No OPD Nasa Srava

Nasarodha Ghrana Toda-Arti

Kshavathu Nisteevana Shira Shoola

Shiro Gourava

B A B A B A B A B A B A B A 1 2438 4 1 4 2 4 1 4 1 5 2 4 2 4 3 2 3595 3 2 3 1 2 1 3 2 6 2 4 2 5 2 3 3806 5 2 4 3 5 2 5 2 5 2 3 1 4 2 4 3807 6 1 3 5 4 1 5 2 4 2 2 1 3 2 5 4210 5 1 4 2 4 1 4 2 5 1 3 2 3 2 6 4220 6 2 4 2 5 2 4 2 5 2 4 2 5 2 7 4238 5 2 4 2 4 2 5 2 5 1 5 3 4 3 8 4254 5 2 3 1 3 2 4 2 4 2 5 2 5 2 9 4263 5 2 5 2 3 1 4 1 4 2 4 2 5 3 10 4269 5 2 3 2 3 2 4 1 4 3 4 2 4 2 11 4283 5 1 4 2 3 1 5 1 4 1 4 2 4 1 12 4290 5 2 4 2 3 2 6 1 4 2 5 2 5 2 13 4295 4 2 3 1 4 1 5 2 4 2 5 3 5 3 14 4358 5 2 4 1 3 2 5 2 5 2 5 2 4 3 15 4364 6 2 4 2 4 2 6 1 5 2 4 3 3 2 74 26 56 30 54 23 69 24 69 28 61 31 63 34


98

Table - 29 Subjective statistical Assessment Data of Group – C (Amrutha Guggulu and Patadi taila – Pratimarsha Nasya) S.No OPD Nasa

Srava Nasarodha Ghrana

TodaArti Kshavathu Nisteevana Shira

Shoola Shiro Gourava

B A B A B A B A B A B A B A 1 3644 6 2 5 1 5 2 4 2 4 1 5 2 5 2 2 3810 5 3 4 2 5 1 5 2 4 2 4 2 5 1 3 3968 4 1 5 1 4 2 4 3 5 2 4 1 4 2 4 3976 5 2 4 2 4 3 5 2 5 1 4 1 3 2 5 3992 6 1 4 2 4 2 5 1 4 2 4 2 4 2 6 4149 6 2 4 1 4 1 3 2 4 1 4 2 5 2 7 5117 5 2 5 2 4 2 4 2 4 2 5 2 5 2 8 5617 5 3 3 2 5 2 4 1 4 2 5 1 4 2 9 5812 4 1 4 1 5 2 4 2 4 1 5 2 4 1 10 5861 5 2 5 2 5 2 5 2 5 3 5 1 5 2 11 5884 4 2 4 2 4 2 3 2 5 2 4 2 5 1 12 5896 4 2 3 1 4 1 3 2 3 2 4 2 5 2 13 5911 4 2 5 3 3 2 5 1 3 1 3 2 4 2 14 5914 5 2 5 2 4 2 4 2 5 3 3 1 3 1 15 5924 4 1 4 2 4 1 4 1 5 1 5 2 5 1 72 28 64 26 64 27 62 27 64 26 64 25 66 25

The statistical opine discussed at the end along with results.

B2) Disease Developmental Features of Pratishyaya Table - 30

Data of Group – A (Amrutha Guggulu) [as described in case sheet]

SNo OPD Mode onset Course Frequency Duration Progress Periodicity 1 2 3 4 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 3808 + + + + + + 2 4565 + + + + + + 3 4576 + + + + + + 4 4621 + + + + + + 5 4750 + + + + + 6 4765 + + + + + + 7 4785 + + + + + + 8 4812 + + + + + + 9 4830 + + + + + 10 4845 + + + + + 11 4856 + + + + + + 12 4900 + + + + + + 13 4912 + + + + + + 14 4930 + + + + + + 15 4934 + + + + + + Total 2 12 1 0 4 7 4 0 10 4 4 4 6 1 6 7 7 4 4


99

Table – 31

Data of Group – B (Patadi taila – Pratimarsha Nasya) [as described in case sheet]

SNo OPD Mode onset Course Frequency Duration Progress Periodicity

1 2 3 4 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 2438 + + + + + + 2 3595 + + + + + + + 3 3806 + + + + + + 4 3807 + + + + + + 5 4210 + + + + + + 6 4220 + + + + + + 7 4238 + + + + + + 8 4254 + + + + + + 9 4263 + + + + + + 10 4269 + + + + + + 11 4283 + + + + + + 12 4290 + + + + + + 13 4295 + + + + + + 14 4358 + + + + + + + 15 4364 + + + + + Total 5 10 8 4 3 6 5 4 6 0 10 3 5 7 8 3 4

Table - 32 Data of Group – C (Amrutha Guggulu and Patadi taila – Pratimarsha Nasya) [as described in case sheet]

SNo OPD Mode onset Course Frequency Duration Progress Periodicity

1 2 3 4 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 3644 + + + + + + 2 3810 + + + + + + 3 3968 + + + + + + 4 3976 + + + + + + 5 3992 + + + + + + 6 4149 + + + + + + 7 5117 + + + + + + 8 5617 + + + + + + 9 5812 + + + + + + 10 5861 + + + + + + 11 5884 + + + + + + 12 5896 + + + + + + 13 5911 + + + + + + 14 5914 + + + + + + 15 5924 + + + + + + Total 5 9 1 0 6 7 2 5 5 5 0 9 6 5 5 5 9 4 2


100

The features of the disease development discussed here are Mode onset, Course,

Frequency, Duration, Progress and Periodicity. These features are summarized table is as

follows.

Table - 33 Chief complaint details Group -

A Group –

B Group –

C Total %

Sudden 2 5 5 12 26.66 Gradual 12 10 9 31 68.88 Insidious 1 0 1 2 4.44

1 Mode of onset

Sub-acute 0 0 0 0 0 Episodic 4 8 6 18 40

Continuous 7 4 7 18 40 2 Course

Initially episodic

4 3 2 9 20

few hours 0 6 5 11 24.44 few days 10 5 5 20 44.44

3 Frequency

few weeks 4 4 5 13 28.88 Continuous 4 6 0 10 22.22 Intermittent 4 0 9 13 28.88

4 Duration

Subsides with

medication

6 10 6 22 48.88

Typical 1 3 5 9 20 Rapid 6 5 5 16 35.55

5 Progress

Long time non progressive

7 7 5 19 42.22

Seasonal 7 8 9 24 53.33 Irregular 4 3 4 11 24.44

6 Periodicity

Perennial 4 4 2 10 22.22

At the mode of onset 31 patients (68.88%) of patients are with gradual in onset and

12 (26.66%) patients are with sudden onset. As the course is observed episodic and

continuous are with 18 (40%) patients each and the rest are initially episodic. Frequency of

the disease observed 20 patients as few days. The duration in maximum 22 (48.88%) is

subsides with medication and reappears. The progress is long time non-progressive mode for

19 (42.22%) and Rapid in 16 (435.55%). 24 (53.33%) patients seen with seasonal

periodicity. The rest of the observations with the percentage in table are self-explanatory.


101

B3) Disease Aggravating and comfort Features of Pratishyaya

Table - 34 Data of Group – A (Amrutha Guggulu) [as described in case sheet]

SNo OPD Preceded by Aggravating Comfort posture Food 1 2 3 1 2 3 4 5 6 1 2 3 4 V M

1 3808 + + + + + + + + 2 4565 + + + + + + + 3 4576 + + + + + + + 4 4621 + + + + + + + 5 4750 + + + + + + + 6 4765 + + + + + + + + 7 4785 + + + + + + + + + 8 4812 + + + + + + + + + 9 4830 + + + + + + + + + 10 4845 + + + + + + 11 4856 + + + + + + + 12 4900 + + + + + + + + + + 13 4912 + + + + + + + 14 4930 + + + + + + + + 15 4934 + + + + + + Total 9 4 2 13 6 13 4 10 10 4 6 11 8 13 2

Table - 35 Data of Group – B (Patadi taila – Pratimarsha Nasya) [as described in case sheet]

SNo OPD Preceded by Aggravating Comfort posture Food 1 2 3 1 2 3 4 5 6 1 2 3 4 V M

1 2438 + + + + + + + + 2 3595 + + + + + + + 3 3806 + + + + + + + 4 3807 + + + + + + + + 5 4210 + + + + + + + + + 6 4220 + + + + + + + + 7 4238 + + + + + + + 8 4254 + + + + + + + + + 9 4263 + + + + + + + + 10 4269 + + + + + + + + 11 4283 + + + + + + + 12 4290 + + + + + + + 13 4295 + + + + + + + + + 14 4358 + + + + + + + + + 15 4364 + + + + + + + Total 7 3 5 10 10 11 2 13 6 9 6 10 11 8 7


102

Table - 36

Data of Group – C (Amrutha Guggulu and Patadi taila – Pratimarsha Nasya) [as described in case sheet] SNo OPD Preceded by Aggravating Comfort posture Food 1 2 3 1 2 3 4 5 6 1 2 3 4 V M

1 3644 + + + + + + + + 2 3810 + + + + + + + + + 3 3968 + + + + + + + + + 4 3976 + + + + + + + + 5 3992 + + + + + + + 6 4149 + + + + + + + + + 7 5117 + + + + + + + + + + 8 5617 + + + + + + + 9 5812 + + + + + 10 5861 + + + + + + + + 11 5884 + + + + + + 12 5896 + + + + + + + 13 5911 + + + + + + 14 5914 + + + + + + + + 15 5924 + + + + + + + + + Total 7 6 2 10 7 12 1 13 5 14 6 11 7 8 7 The numerical representations made in the table are explained as under.

Disease Preceded by 1) Sneezing 2) nasal irritation 3) cough

Disease Aggravating factors 1) dust 2) food 3) smoke

4) Pets 5) pollens 6) Stress

Disease Comfort posture at attack 1) sitting 2) lying 3) standing 4) Forward bending

Disease precedence is observed high with 23 patients sneezing followed by 13

patients of nasal irritation. Cough is minimal with 9 patients. As par the allergic factors

concerned pollen and smoke hurt maximum i.e. 36 patients along with 33 patients who has

the exposure to smoke. 23 patients recorded with food allergy and 21 say it is with stress.

Only 7 patients complained of pets as the cause and aggravation. The postures of comfort is

elicited here as Upashaya. 32 patients expressed standing if good for them. 27 patients said it

as sitting and as many as 26 patients expressed comfort with forward bending. 18 patients

express lying is the best for them.


103

B4) Pathogenic factors of Pratishyaya Table – 37- Data of Group – A (Amrutha Guggulu) [as described in case sheet]

SNo - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

OPD No 3808 4565 4576 4621 4750 4765 4785 4812 4830 4845 4856 4900 4912 4930 4934

Sama + + + + + Manda + + + + + + + Vishama + + + A

gni

Teekshna Tobacco + + + + Alcohol +

Add

ict

ions

Drugs + Vata + Pitta Kapha + + + + + Vata Pitta Vata Kapha + + + + + + Pitta Kapha +

Pra

krut

i

Tridoshaja + Atisrustam + + + Kupitam Alpalpa + + Ati badhdama Abheekhnam P

rana

vaha

sr

otas

Sashoolam + + + + Shirogurutwam + + + + + + + + Angamarda + + + + + + + + + + Jwara + + + + + + + + + Shirashoola + + + + + + + + + + + + + + Netra kandu + + + + + + + + + + + Nasa daha + + + + Talu shushkata + + + + + Kshavathu + + + + + + + + + + + + + Romaharsha + + + + + + + + + + Aruchi + + + + + + + + + + + + + Ashru srava + + + + + + Nasa kandu + + + +

Poo

rvar

oopa

Lalasrava + + + + + + + + + +

Vata +

Pitta + +

Kapha + + + + + + + + +

Sannipata + + +

Rakta

Pra

tish

yaya

Bhe

da

Dusta


104

Table - 38 Data of Group – B (Patadi taila – Pratimarsha Nasya) [as described in case sheet]

SNo - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

OPD No 2438 3595 3806 3807 4210 4220 4238 4254 4263 4269 4283 4290 4295 4358 4364

Sama + + + + Manda + + + + + + + Vishama + + + + A

gni

Teekshna Tobacco + + + Alcohol +

Add

ict

ions

Drugs Vata + Pitta + + Kapha + + + + + Vata Pitta Vata Kapha + + + + + Pitta Kapha

Pra

krut

i

Tridoshaja + + Atisrustam + + + + Kupitam + Alpalpa + + + + + + Ati badhdama Abheekhnam P

rana

vaha

sr

otas

Sashoolam + + + Shirogurutwam + + + + + + + + + + + Angamarda + + + + + + + + + + Jwara + + + + Shirashoola + + + + + + + + + Netra kandu + + + + + + + + Nasa daha + + + + Talu shushkata + + + + + Kshavathu + + + + + + + + + Romaharsha + + + + + Aruchi + + + + + + + + + + + Ashru srava + + + + + + + + Nasa kandu + + + + + +

Poo

rvar

oopa

Lalasrava + + + + + + + + Vata

Pitta + +

Kapha + + + + + + + + + +

Sannipata + +

Rakta

Pra

tish

yaya

Bhe

da

Dusta +


105


SNo - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

OPD No 3644 3810 3968 3976 3992 4149 5117 5617 5812 5861 5884 5896 5911 5914 5924

Sama + + + + Manda + + + + Vishama + + + + + + + A

gni

Teekshna Tobacco Alcohol

Add

ict

ions

Drugs Vata + + Pitta + Kapha + + + + + + + Vata Pitta Vata Kapha + + + + Pitta Kapha

Pra

krut

i

Tridoshaja + Atisrustam Kupitam Alpalpa + + Ati badhdama Abheekhnam P

rana

vaha

sr

otas

Sashoolam + + Shirogurutwam + + + + + + + Angamarda + + + + + + + + + Jwara + + + + Shirashoola + Netra kandu + + + + + Nasa daha + Talu shushkata + + + + Kshavathu + + + + + + Romaharsha + + + + + Aruchi + + + + + + Ashru srava + Nasa kandu + + + + + + +

Poo

rvar

oopa

Lalasrava + + + + + + + + Vata + +

Pitta +

Kapha + + + + + + + + +

Sannipata

Rakta

Pra

tish

yaya

Bhe

da

Dusta + + +


106

Checking the Agni predominance is first and far most necessity as the medicine has

to follow oral route and Jatharagnipaka and Dhtwagnipaka to act on the Dosha Dooshya

sammurchana vighatana. Thus the Agni observed here show 14 patients of Vishamagni and

18 patients of Mandagni. The rest show Samaagni.

As addictions are seen very few are habituated as 7 tobaccos, 2 alcohols and one

dependent medicine more.

The Prakruti assessment is done here to evaluate the disease manifestation in somatic

body. It is observed that a major portion of 17 patients of Kapha Prakruti and 15 belongs to

Vata Kapha Prakruti. Thus the Kapha dominance is noticed.

The disease is manifested at the Pranavaha srotas, thus the dusti Lakshana are

observed. Alpalpa Swasa is seen in 10 patients along with Atisrusta Swasa in 7 patients.

Sashoola Swasa is seen in 9 patients.

Poorva Roopa is not witnessed as the disease precipitates. As a routine enquiry past

experiences are noted here. Most of the patients as 30 – 20 patients exhibit the Annvaha

sroto dusti Lakshana and 15 – 25 patients Pranavaha sroto dusti Lakshana. Almost all

patients show the Poorva Roopa told in Samhita.

Bheda Avasta of the Pratishyaya explains the medicament efficacy. As it is observed

the Pratishyaya here out of 45 patients 28 (62.22%) exhibit the Kaphaja Pratishyaya, 5

(11.11%) patients in each of Pittaja Pratishyaya and Sannipataja Pratishyaya. Lastly 4

(8.88%) patients of Dusta Pratishyaya and 3 (6.66%) of Vataja Pratishyaya are noticed. The

table expressed above group wise is self-explanatory.

B5) Etiological factors of Pratishyaya The Etiological factors of Pratishyaya are dealt as under.


107

Table- 40 Data of Group – A (Amrutha Guggulu) [as described in case sheet]

SNo - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

OPD No 3808 4565 4576 4621 4750 4765 4785 4812 4830 4845 4856 4900 4912 4930 4934

Ajeerna + + + + + + + + + + + Agnimandya + + + + + + + + Sheetambupana + + + + + + Dustambu pana + + + + + + + + + + Kaphaprakopa + + + + + + + + + + + + +

Aha

ra

Vataprakopa ahara + + + + Jalakreeda + + + + + + + Dustajala kreeda + + + + + + + + Avashyaya Atimaidhuna Nishi jagarana + + + + + + + Diwaswapna + + + + + + + + + Ucchira Bhashana + + + + + Ati bhashya + U.shira shayana + + + Ne. shira shayana Pravasa + + + + + + Ati Vyayama + + + + Inh. Poison smell + + Inh. Vidahi Dravya Inh.Tekshna Dravya + Dhooma sevana + + + + + + Rajo sevana + + + + + + + + + +

Vih

ara

Bhashpa sevana + + + + + + + + + + + Krimi Vegavarodha + + Rutu Viparyaya + + + + + + + + + + + Shirobhitapa + + + + + Pralapa + + + + Krodha + + + shoka + Nasal picking Nasal foreign body Samsargaja vyadhi Abhighata Beeja Dosha Vata Vyadhi Malnutrition A

nya

vya

dhi A

vast

ha s

amba

ndha

Hypo vitaminosis


108

Table -41 Data of Group – B (Patadi taila – Pratimarsha Nasya) [as described in case sheet]

SNo - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

OPD No 2438 3595 3806 3807 4210 4220 4238 4254 4263 4269 4283 4290 4295 4358 4364

Ajeerna + + + + + + + + + + + + + + Agnimandya + + + + + + + + + + + Sheetambupana + + + + Dustambu pana + + + + + + + Kaphaprakopa + + + + + + + + + + + +

Aha

ra

Vataprakopa ahara + + + + Jalakreeda + + + + + + + + + Dustajala kreeda + + Avashyaya Atimaidhuna Nishi jagarana + + + + + + + + + + + + Diwaswapna + + + + + + + Ucchira Bhashana + + + + Ati bhashya U.shira shayana Ne. shira shayana Pravasa + Ati Vyayama Inh. Poison smell + + + + + + + + + Inh. Vidahi Dravya Inh.Tekshna Dravya Dhooma sevana + + + + + + + + + + + + Rajo sevana + + + + + + + + + + + + + + +

Vih

ara

Bhashpa sevana + + + + + + + + + + + + Krimi Vegavarodha + + + + + + + + + + + Rutu Viparyaya + + + + Shirobhitapa + + + + Pralapa + Krodha + + + shoka + + + + + + Nasal picking Nasal foreign body Samsargaja vyadhi Abhighata Beeja Dosha Vata Vyadhi Malnutrition A

nya

vya

dhi A

vast

ha s

amba

ndha

Hypo vitaminosis


109


SNo - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

OPD No 3644 3810 3968 3976 3992 4149 5117 5617 5812 5861 5884 5896 5911 5914 5924

Ajeerna + + + + + + + + + + + Agnimandya + + + + + + + + + + + Sheetambupana + + + + + + + Dustambu pana + + + + Kaphaprakopa + + + + + + + + + + + + + + +

Aha

ra

Vataprakopa ahara + + + + Jalakreeda + + + + Dustajala kreeda + + + Avashyaya Atimaidhuna Nishi jagarana + + + + + + + Diwaswapna + + + + + + + + Ucchira Bhashana + + + Ati bhashya U.shira shayana Ne. shira shayana Pravasa + + + + Ati Vyayama Inh. Poison smell Inh. Vidahi Dravya Inh.Tekshna Dravya + + + + + + + + + + + Dhooma sevana + + + + + + + + + + + + + + + Rajo sevana + + + + + + + + + + + + + +

Vih

ara

Bhashpa sevana + + + + + + + + Krimi Vegavarodha + + + + + + + + + + + Rutu Viparyaya + + + + Shirobhitapa + + + + Pralapa + + + Krodha + + + + shoka Nasal picking + + + + + Nasal foreign body Samsargaja vyadhi Abhighata Beeja Dosha Vata Vyadhi Malnutrition A

nya

vya

dhi A

vast

ha s

amba

ndha

Hypo vitaminosis


110

The Nidana is important to notice the prototypes of disease. Thus the Nidana

classified under three headings viz. Ahara, Vihara and Anya sambandhi are emphasized

here.

Ahara Nidana as observed as many as 40 (almost all) patients with Kaphakara ahara

along with 12 patients with Vatakara ahara. 36 patients complain Ajeerna, 30 patients

Agnimandya which are of Annavaha srota Lakshana. Sheetambu pana and dustambu pana

observed in 17 and 21 patients respectively.

At the vihara, no Avashyaya, Atimaidhuna, Neecha shira shayana, and Inhalation of

Vidahi Dravya are observed. Maximum patients i.e. 26 are seen with nishi jagarana and 24

with divaswapna in the trial. Compulsory causatives such as Dhooma sevana, Rajo sevana

and Bhashpa sevana are 33, 39 and 31 patients respectively. Out of the other Jalakreeda

either sujala or dusta observed as 20 and 13 respectively. The rest of the factors observed are

with minimal importance.

Hypo vitaminosis and Krimi are said as Anya Avastha sambandha Nidana. But these

two are not observed in the study, where as 24 patients claimed vegavarodha as the cause of

Pratishyaya in the study. . 19 specify it as rutu viparyaya and 10+8 specify this is even with

Manasika karana such as Krodha and Shoka.

The data on the disease is so important to understand the disease patterns and the

results obtained in the trial. So the tabulations of the entire observations are put forth here in

table forms. The tabulations include the entire cases sheet information obtained from the

patients in the trial. The salient features of observations are brought in to notice. The result

of the study is based upon the subjective and objective assessments. The subjective

assessments are shown above. The objective assessments are as follows.


111

Table - 43 Objective Statistical Assessment Data of Group – A (Amrutha Guggulu)

S.No OPD ESR AEC Diff Eosinophils TC B A B A B A B A 1 3808 30 20 450 450 8 9 5880 5900 2 4565 10 10 500 450 4 2 6050 6010 3 4576 25 28 600 600 4 4 5950 5950 4 4621 28 27 450 550 4 5 5800 5860 5 4750 27 30 650 650 6 6 6670 6690 6 4765 19 18 500 500 8 6 5690 5650 7 4785 20 24 500 500 6 7 6560 6560 8 4812 25 28 550 600 7 8 6380 6300 9 4830 25 29 650 700 9 9 6500 6500 10 4845 20 24 600 650 4 4 6700 6700 11 4856 25 26 550 550 6 6 6800 6800 12 4900 26 30 500 550 6 6 6500 6500 13 4912 12 12 500 500 5 5 6680 6680 14 4930 30 35 550 600 6 6 6800 6800 15 4934 18 20 500 500 5 5 7600 7600 340 361 8050 8350 88 88 96560 96500

Table -44 Objective Statistical Assessment Data of Group – B (Patadi taila – Pratimarsha Nasya)

S.No OPD ESR AEC Diff Eosinophils TC B A B A B A B A 1 2438 10 5 550 500 6 6 5750 5760 2 3595 19 19 550 500 7 8 5650 5650 3 3806 17 15 600 550 7 8 6750 6750 4 3807 10 10 450 450 4 4 6560 6560 5 4210 35 25 650 600 6 6 7065 7065 6 4220 25 20 650 600 7 5 5664 5670 7 4238 24 20 550 500 8 8 6480 6480 8 4254 28 20 650 600 7 8 7450 7450 9 4263 30 25 650 600 8 7 6850 6860 10 4269 26 20 660 650 7 8 7250 7260 11 4283 25 25 550 500 6 6 6160 6180 12 4290 28 25 550 500 8 8 6200 6220 13 4295 22 18 550 500 0 4 5450 5455 14 4358 25 20 600 550 0 2 6700 6700 15 4364 24 10 550 500 8 8 6200 6200 348 277 8760 8100 89 96 96179 96260


112

Table -45

Objective Statistical Assessment Data of Group – C (Amrutha Guggulu and Patadi taila – Pratimarsha Nasya)

S.No OPD ESR AEC Diff Eosinophils TC B A B A B A B A 1 3644 25 15 650 400 16 16 8800 8800 2 3810 24 20 550 450 8 8 6770 6775 3 3968 15 9 550 440 4 5 5500 5550 4 3976 10 7 460 340 4 8 5250 5250 5 3992 12 10 540 440 2 6 5450 5490 6 4149 15 13 540 340 3 4 6050 6050 7 5117 15 10 650 440 4 7 4800 4840 8 5617 20 12 540 400 6 6 6560 6560 9 5812 15 9 550 400 7 8 6055 6055 10 5861 20 10 540 400 6 6 7060 7060 11 5884 20 8 460 300 3 3 5565 5565 12 5896 15 10 500 430 6 6 6755 6755 13 5911 18 10 560 440 7 9 6550 6555 14 5914 15 6 500 360 5 4 6750 6750 15 5924 17 10 540 400 9 7 5950 5955 256 159 8130 5980 90 103 93865 94010 Statistical analysis

To compare the mean effect three groups after the treatment the analysis is done by

completely randomized design (CRD) of ANOVA. Here we assumed that mean effect of

three groups is same after the treatment. If p<0.05 the treatment is highly significant.

Least significance difference = L.S.D = t0.05 √2S2/K

S2 = Error mean sum of squares

K = number of observations in which groups under comparison

t0.05 = t – table value for error degrees of freedom at 5% level of significance


113

Table -46

ANOVA table for the parameter Erythrocyte Sedimentation Rate

Source of variation

Degrees of freedom

Sum of squares

Mean sum of squares

F – value

F – table value

P – value

Remarks

Treatment 2 1372.97 686.485 21.29 3.23 <0.05 High significance

Error 42 1354.26 32.24

Total 44 2727.24

Here L.S.D. = 4.188

Group Mean Difference from Group – A

Difference from Group – B

A 24.06 0 0

B 18.466 5.594 0

C 10.6 13.46 7.866 ⊗

⊗ Significant

The parameter ESR shows high significance. To know which of the treatments differ

significance, we used least significant difference, and the conclusion can be drawn from

table above as below.

1. Treatments of three groups are not alike.

2. If choice is made between B and C which differ significantly the

treatment is to be performed since the average gain effect due to

treatment C is more than due to the treatment B and A. all over

possible combination of treatments passer are alike.


114

Table –47

ANOVA table for the parameter Absolute Eosinophils Count

Source of variation

Degrees of freedom

Sum of squares

Mean sum of squares

F – value

F – table value

P – value

Remarks

Treatment 2 226084.44 113042.22 30.848 3.23 <0.05 High significance

Error 42 153906.66 3664.44

Total 44 37999.10

Here L.S.D. = 44.65

Group Mean Difference from Group – A

Difference from Group – B

A 556.66 0 0

B 540.00 16.66 0

C 398.66 18.0 141.34 ⊗

⊗ Significant

The parameter AEC is highly significant by using least significant difference, the

conclusions can be drawn from the above tables as –

1) Treatments of three groups are not alike.

2) If choice is made between B and C which differ significantly the

treatment is to be performed since the average gain effect due to

treatment C is more than due to the treatment B and A. all over

possible combination of treatments passer are alike.


115

Table –48

ANOVA table for the parameter Differential Count (Eosinophils)

Source of variation

Degrees of freedom

Sum of squares

Mean sum of squares

F – value F – table value

P – value Remarks

Treatment 2 7.511 3.75 0.682 3.23 >0.05 Not significant

Error 42 231.06 5.501

Total 44 238.57

Table –49

ANOVA table for the parameter Total Count

Source of variation

Degrees of freedom

Sum of squares

Mean sum of squares

F – value

F – table value

P – value

Remarks

Treatment 2 215295.6 107647.8 0.199 3.23 >0.05 Not significant

Error 42 2689495.6 540226.08

Total 44 22904791.2

The parameters DC and TC are not significant as p >0.05 from above tables.

To compare the groups of treatment individually the analysis is done by using paired

t-test by assessing the trial drug is not responsible for changes in the observations before and

after the treatments. If p <0.05, the test is significant.

Over all objective parameter ESR, AEC and Eosinophils DC, in the group C shows

more high significance than Group B and A. but in the parameter TC the Group B shows

more high significance than Group A. (From tables as p <0.05). On Group C the same

parameter of C shows no significance.


116

In subjective parameters shiro Gourava and Shira shoola, Ghrana toda / Arti is more

high significance in Group C than A and B. but the parameter Nisteeva, Kshavathu, Nasa

Rodha and Nasa Srava are more highly significant in Group-B than A and C. over all in

subjective parameters in Group C shows more high significance than Group B and A. (by

comparing p value, t value from tables).

Table – 50 Subjective parameters Statistical study of individual Group – A (Amrutha Guggulu)

Subjective parameters Mean SD SE t-Value p-Value Remark

Nasa Srava 2.266 1.162 0.3 7.55 <0.001 HS

Nasavarodha 1.8 0.566 0.144 12.5 <0.001 H.S

Ghrana Toda Arti 1.866 0.99 0.255 7.31 <0.001 H.S

Kshavathu (Sankhya) 1.533 0.743 0.191 8.026 <0.001 H.S

Nisteeva (Non purulent / purulent)

2.4 0.828 0.213 11.267 <0.001 H.S

Shirah Shoola 1.6 0.91 0.235 6.808 <0.001 H.S

Shiro gurutwa 1.933 0.961 0.248 7.794 <0.001 H.S

HS = Highly Significant, NS = Not Significant

Table – 51 Objective parameters Statistical study of individual Group – A (Amrutha Guggulu)

Objective parameters Mean SD SE t-Value p-Value Remark


3.133 2.445 0.631 4.965 <0.001 HS


26.66 31.99 8.261 3.22 <0.01 H.S

Eosinophils Differential count

0.666 0.975 0.251 2.655 <0.05 H.S

Total count 16.733 25.58 6.604 2.533 <0.05 H.S



117

Table - 52

Results of Group – A (Amrutha Guggulu)

Result Group –A %

Cured 0 0

Well Responded 9 60

Moderately Responded 6 40

Not Responded 0 0

Total 15 100

Graph –9

Pictorial distribution of Results GROUP -A

Results of Group -A

Moderately Responded

40%

Cured0.00%

Well Responded

60.00%

Not Responded

0%


118



subjective and objective parameters and statistically highly significant.

Table – 53 Subjective parameters Statistical study of individual Group – B

(Patadi taila – Pratimarsha Nasya)

Subjective parameters Mean SD SE t-Value p-Value Remark

Nasa Srava 3.133 0.833 0.215 14.57 <0.001 HS

Nasavarodha 2.00 0.534 0.138 14.49 <0.001 H.S



Nisteeva (Non purulent /

purulent)

2.733 0.883 0.228 11.986 <0.001 H.S

Shirah Shoola 2.0 0.654 0.169 11.834 <0.001 H.S

Shiro gurutwa 1.933 0.883 0.228 8.478 <0.001 H.S


Table – 54 Objective parameters Statistical study of individual Group – B

(Patadi taila – Pratimarsha Nasya)

Objective parameters Mean SD SE t-Value p-Value Remark


4.733 3.825 0.987 4.795 <0.001 HS


44.0 15.94 4.11 10.705 <0.001 H.S

Eosinophils Differential count

0.866 1.125 0.2905 2.981 <0.02 H.S

Total count 6.733 7.932 2.048 3.282 <0.01 H.S



119

Table - 55

Results of Group – B (Patadi taila – Pratimarsha Nasya)

Result Group –B %

Cured 2 13.33

Well Responded 11 73.34

Moderately Responded 2 13.33

Not Responded 0 0

Total 15 100

Graph –10

Pictorial distribution of Results GROUP -B

The results of the Group –B as shown above exhibits the 2 (13.33%) patients cured,

11 (73.33%) well responded patients and Moderately responded patients are 6 (40%) after

Results of Group -B


13%

Cured13.33%

Well Responded

73.33%

Not Responded

0%


120

the through examination of the subjective and objective parameters and statistically highly

significant.

Table –56 Subjective parameters Statistical study of individual Group – C

(Amrutha Guggulu and Patadi taila – Pratimarsha Nasya)

Subjective parameters Mean SD SE t-Value p-Value

Rem

ark

Nasa Srava 2.933 0.883 0.228 12.86 <0.001 HS

Nasavarodha 2.533 0.833 0.215 11.78 <0.001 H.S



Nisteeva (Non purulent /

purulent)

2.533 0.833 0.215 11.78 <0.001 H.S

Shirah Shoola 2.6 0.828 0.213 12.206 <0.001 H.S

Shiro gurutwa 2.733 0.883 0.228 11.986 <0.01 H.S


Table –57 Objective parameters Statistical study of individual Group – C

(Amrutha Guggulu and Patadi taila – Pratimarsha Nasya)

Objective parameters Mean SD SE t-Value p-Value

Rem ark

Erythrocytes

sedimentation rate

6.333 3.287 0.848 7.464 <0.001 HS

Absolute Eosinophilic

count

143.33 46.85 12.09 11.85 <0.001 H.S

Eosinophils Differential

count

1.266 1.437 0.371 3.41 <0.01 H.S

Total count 9.666 17.674 4.563 2.118 >0.05 NS



121

Table - 58

Results of Group – C (Amrutha Guggulu and Patadi taila – Pratimarsha Nasya)

Result Group –C %

Cured 7 53.33

Well Responded 8 46.67

Moderately Responded 0 0

Not Responded 0 0

Total 15 100

Graph –11

Pictorial distribution of Results GROUP -C

The results of the Group –C as shown above exhibits the 7 (46.67%) patients cured

and 8 (53.33%) well responded patients after the through examination of the subjective and


Results of Group -C


0%Cured

46.67%

Well Responded

53.33%

Not Responded

0%


122

Table –59

Cumulative Results of the trial

Result Group –A

% Group –B

% Group –C

% Total %

Cured 0 0 2 13.33 7 53.33 9 20

Well Responded 9 60 11 73.34 8 46.67 28 62.2


6 40 2 13.33 0 0 8 17.8

Not Responded 0 0 0 0 0 0 0 0

Total 15 100 15 100 15 100 45 100

Graph –12

Pictorial distribution of cumulative Results of trial

The cumulative results of the trial as shown above exhibits the 9 (20%) patients

cured, 28 (62.22%) well responded patients and 8 (17.8%) of moderately responded after the

through examination of the subjective and objective parameters and statistically highly

significant.

Cumulative Results of the trial


18%Cured

20.00%

Well Responded

62.22%

Not Responded

0%

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Discussion

123

Chapter- 6

Discussion

ratishyaya is an acute disease of Pranavaha Srotas and Nasa srava and Nasavarodha

characterize it. The main villain of the piece behind diseases relating to the nose is the

common cold i.e. Pratishyaya. Coryza or catarrh of the nose is a common condition found in

cold climates and during the change of season in countries like India. This is an irritating

condition, which is not fatal, but if neglected for a long time, it can create complications best

avoided by timely attention. The common cold is generally treated lightly both by patients

and physicians as is clear from the old adage: If you take medicine for a cold, it cures in a

week, otherwise it takes seven days 126.

At the ICD-9, the Pratishyaya i.e. Rhinitis in general technically termed and

classified under 460 Acute nasopharyngitis is as follows 127-128.

460 Acute nasopharyngitis [common cold]

Coryza (acute)

Nasal catarrh, acute

Nasopharyngitis:

NOS

Acute

Infective NOS

Rhinitis:

Acute

Infective

Excludes:

nasopharyngitis, chronic (472.2)

pharyngitis:


124

Acute or unspecified (462)

Chronic (472.1)

rhinitis:

Allergic (477.0-477.9)

Chronic or unspecified (472.0)

Sore throat:

Acute or unspecified (462)

Chronic (472.1)

A common cold is an infection of your upper respiratory tract. It's relatively harmless

— but it usually doesn't feel that way. If it's not a runny nose, sore throat and cough, it's

watery eyes, sneezing and congestion, or may be all of the above. In fact, because any one of

more than 200 viruses can cause a common cold, symptoms tend to vary greatly 129.

The discharge from nose may become thicker and yellow or green in color as a

common cold runs its course. What makes a cold different from other viral infections is that

you generally won't have a high fever. Patients are also unlikely to experience any

significant fatigue from a common cold 130. Discussion improves the knowledge and

discussion with science becomes base establishment of the concept. Thus discussion is the

most essential phase of any research work. Keeping this in view, the facts, which have

emerged from the study, are studied in five folds. They are -

1. Discussion on demographic data

2. Discussion on disease Pratishyaya

3. Discussion on probable mode of action of Trial Drug

4. Assessment of Trail Drug at Trial

5. Limitations of the study

6. Recommendations


125

Discussion on demographic data

As we observe the data of the trial is specific to the disease is as follows.

Age:

The age groups as we classified at the 10 class intervals starts with the 15years of

ages. The ages of early are said as the Kapha predominance ages in Ayurveda. The

Pratishyaya is more prevalent in the children and early ages. Thus as the observations at the

trial suggests that the 15 to 25 ages groups show much insidious to the precipitation of

Pratishyaya, which is 21 (46.66%) of the whole trial. This age is said to have the

development of the dhatu in the body along with the Ojus, which protects the body as

“Balam” in terms we can compare to the immunity. The other ages that show the high

incidence in the trial is successive group to the above is 25 to 35 ages. The disease

prevalence in this group is by the exposure to the causatives much and more.

The results assessed assume that the medicament is capable of developing lacks and

breaches of the immune developments. These age groups are supportive to the immune

development and development of immune resistance in the body. Out of the 15 to 25 ages as

discussed, Vyadhi kshamatwam and Vyadhi bala virodhitwam are developed by the

medicament and procedure, offers the 28 (62.2%) of well responded and 19.9% of cured

patients. These results are strongly suggestive of restoration of immune suppression in the

body.

The Dosha predominance at the age relations are very specific in Ayurveda need the

study and discussion. The ages of early are said to be Kapha predominance and these are

prone to get the diseases relevant to Kapha Dosha. The observations refer to the Kapha


126

involvement in the early ages to get the Pratishyaya, which is a Kapha predominant disease.

The Kapha vitiation leads to the Vyadhi bala kshamatwam and Vyadhi bala virodhitwam

and there by the external atmosphere exposures offers the invasion of the external stimuli or

the internal environment changes. Thus the age relations’ study is very important in the

disease Pratishyaya.

Here in this study out of the observed patients 28 are well responded, where the

medicament choose is capable of promoting the Vyadhi kshamatwam and there by

increasing the immunity in the body.

Gender:

The gender is not specific here in this trial. But still few points draw attention of us.

The ratio is 4:5 between female to male. The 19 females those are reported stay at home but

have an exposure to that of dust, etc as the male exposed to the traffic pollution and winds.

The result are offered good response at the both groups individually and also at the

comparison. Out of the 26 male patients 4 cured and 17 well responded. In the same way at

female population out of 19 5 cured and 11 well responded. Thus it is clear and evidential

that the medicine doesn’t have any gender specificity.

Religion

The area as Hindu dominant there is no discussion here. But the results are as

observed in the study revels that out of 40 Hindu patients 8 cured and 25 well responded.

Out of 4 Muslims patients 1 cured and 2 well responded. No community has shown any no

response category.


127

Occupation

The occupations groups of sedentary consists 16 and active groups 27 patients,

which are major groups of observation. Here the more are less the distribution is 2:3 to the

sedentary to active patients. A discussion is required for the female populations in these

groups.

Occupation is one of the important factors of discussion. Usually exposure to the

cold or dust and extreme nasal irritant subjects makes one’s to prone to get the Pratishyaya.

Here an attempt is made to understand the active group occupations. Many are exposed to

dust and habituated to go for cold beverages. This dietetic habit of consuming cold

immediately after work or when strained makes one’s Dosha alterations, may be an AEC

here in this concern. Miraculously the labor group is very small here. Probable reason

behind is that these people with repeated attacks of Pratishyaya developed the resistance to

it. The results as observed the active group responded well even with 5 cured and 16 well

responded out of 27. The sedentary group scored 3 cured and 12 well responded out of 16.

The labor group got in to 1 in each cured and moderately responded.

Economical status

Out of any disease when it is subjected for clinical trial the middle class is more.

Here in this study 31 out of 45 are middle class. As usually they responded well with 4

cures, 21 well responded and 6 moderately responded. At no level of economic status not

responded is observed.

Diet

Diet, usually has much relations to the disease. The vegetarian and mixed diets

classification may not be suitable to comment any. Individually exposures to the foods and


128

beverages are discussed separately under the heading of Nidana. Exposure to the allergens is

possible in both groups.

Chief complaints

The complaints are evaluated as per the case sheet tagged at the annex. The

symptoms, which are told in Ayurvedic texts, are observed and out of which Nasa srava,

Nasavarodha, shira Shoola and shiro gourava are predominant along with the aruchi and

dourbalya.

The mode of onset is observed as gradual in maximum number of cases. The course

of the disease is continuous and episodic in nature. The frequency felt as few days for the

Pratishyaya. The durations are continuous, intermittent and subsided with medication. The

disease progress is long time non-progressive and the periodicity is of seasonal.

The numerical representations are made to assess the Disease Preceded by, Disease

Aggravating factors and Disease Comfort posture at attack as discussed in the result chapter.

The Sneezing, nasal irritation and cough are assessed in preceding factors of Pratishyaya.

Dust, food, Pets, pollens, Stress and smoke are look for the aggravating factors of

Pratishyaya. Lastly positions of comfort are look forward through the questioner by asking

which of the positions of sitting, lying, standing or forward bending are comfortable.

Bheda Avasta of the Pratishyaya explains the medicament efficacy. As it is observed

the Pratishyaya here out of 45 patients 28 (62.22%) exhibit the Kaphaja Pratishyaya, 5

(11.11%) patients in each of Pittaja Pratishyaya and Sannipataja Pratishyaya. Lastly 4

(8.88%) patients of Dusta Pratishyaya and 3 (6.66%) of Vataja Pratishyaya are noticed.

Checking the Agni predominance is first and far most necessity as the medicine has

to follow oral route and Jatharagnipaka and Dhtwagnipaka to act on the Dosha Dooshya


129

sammurchana vighatana. Thus the Agni observed here show 14 patients of Vishamagni and

18 patients of Mandagni. The rest show Samaagni. Even though the medicament in built

capacity of nullifying the Ama and Agni developing character made the Pratishyaya to treat

comfortably.

The disease is manifested at the Pranavaha srotas, thus the dusti Lakshana are

observed. Alpalpa Swasa is seen in 10 patients along with Atisrusta Swasa in 7 patients.

Sashoola Swasa is seen in 9 patients.

The Prakruti assessment is done here to evaluate the disease manifestation in somatic

body. It is observed that a major portion of 17 patients of Kapha Prakruti and 15 belongs to

Vata Kapha Prakruti. Thus the Kapha dominance is noticed.

The data on the disease is so important to understand the disease patterns and the

results obtained in the trial. So the tabulations of the entire observations are put forth in

Result chapter in table forms. The tabulations include the entire cases sheet information

obtained from the patients in the trial. The salient features of observations are brought in to

notice. The result of the study is based upon the subjective and objective assessments.

Results

To compare the mean effect three groups after the treatment the analysis is done by

completely randomized design (CRD) of ANOVA. Here we assumed that mean effect of

three groups is same after the treatment. If p<0.05 the treatment is highly significant.



subjective and objective parameters and statistically highly significant.


130

The results of the Group –B as shown above exhibits the 2 (13.33%) patients cured,

11 (73.33%) well responded patients and Moderately responded patients are 6 (40%) after

the through examination of the subjective and objective parameters and statistically highly

significant.

The results of the Group –C as shown above exhibits the 7 (46.67%) patients cured

and 8 (53.33%) well responded patients after the through examination of the subjective and


The cumulative results of the trial as shown above exhibits the 9 (20%) patients

cured, 28 (62.22%) well responded patients and 8 (17.8%) of moderately responded after the

through examination of the subjective and objective parameters and statistically highly

significant.

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Conclusion

131

Chapter - 7

Conclusion • here there is nose, there is cold and Pratishyaya persists. The history reveals

that the Pratishyaya exists from ages.

• Like many other diseases, the immunological factors also play a vital role in the

development, recurrence a well as in the curative aspect of the Pratishyaya.

• Pratishyaya is a complex disease involving several symptoms and diversified

pathogenesis.

• A lot of modern disease entities can be included under the heading of

Pratishyaya.

• Pratishyaya although a mild disease, it can make patients externally

uncomfortable and can interfere with the routine activities. Pratishyaya is

considered as a disease since 2500 BC, the classical age of Ayurveda.

• All major texts of Ayurveda have devoted their attention to various aspects of the

disease.

• Pratishyaya is an IgE mediated hypersensitivity disease of mucous membranes of

the nasal airways. A simple common cold or Pratishyaya affects most of the

population.

• Ayurveda said that Pratishyaya let it be Ekadoshaja or Bahudoshaja, if not treated

properly may lead to Dushta Pratishyaya and later Kasa, or even Kshaya.


132

• Charaka compares it with Sun. For the present study Pratishyaya that is a very

common disease affecting any age group of both sex and prevalent worldwide

has been noticed.

• Anurjita Pratishyaya (Allergic Rhinitis) is also recurring frequently and attending

the Jeerna Avastha, as per the Charaka for which Nasya is the line of treatment.

• The proposed medicaments Amrutha Guggulu and Patadi taila has the

remarkable actions with the ingredients embedded in them.

• The actions observed from the individual drug components categorized are –

Over the invaders and supputrative phenomenon of disease as - Anti septic, anti

sappurative, Antibiotic and Anti bacterial actions as – Krimighna.

• There is few disease associations may cause or may associate with Pratishyaya at

different stages.

• In Udavarta Pratishyaya has been mentioned as an Upadrava.

• In Purvarupas of Rajayakshama Pratishyaya can be seen.

• Only Charaka and Kashyapa have mentioned about the general symptoms of

Pratishyaya.

• Vagbhata explains that, when the vitiated Vata pradhana Doshas, gets localized

in the nasal cavities, gives rise to Pratishyaya.

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

will be ‘Kaphotklesh’.

• Atipravriti is observed as increased functioning – of nasal discharge


133

• Samanya Chikitsa of Pratishyaya, according to Chakrapani, five diseases viz.

Netraroga, Kukshiroga, Pratishyaya, Vrana and Jwara, are cured with Langhana

Chikitsa within five days.

• Susruta has given following line of treatment for Ama stage of Pratishyaya.

• Susruta has specifically mentioned Vamana in Pratishyaya Chikitsa.

• Exposing the nasal mucosa to ragweed in ragweed-sensitive subjects (nasal

challenge) provokes the immediate onset of sneezing and nasal itching associated

with significantly increased concentrations of inflammatory mediators. Biopsy

specimens of the nasal mucosa at this time show an increased number of

degranulated mast cells.

• To compare the mean effect three groups after the treatment the analysis is done

by completely randomized design (CRD) of ANOVA. Here we assumed that

mean effect of three groups is same after the treatment. If p<0.05 the treatment is

highly significant.

• Group A: 15 patients will receive Amrutha Guggulu internally.

• The results of the Group –A as shown above exhibits the well responded patients

9 (60%) and Moderately responded patients 6 (40%) after the through

examination of the subjective and objective parameters and statistically highly

significant.

• Group B: 15 patients will receive Nasya with Patadi taila.

• The results of the Group –B as shown above exhibits the 2 (13.33%) patients

cured, 11 (73.33%) well responded patients and Moderately responded patients


134

are 6 (40%) after the through examination of the subjective and objective

parameters and statistically highly significant.

• Group C: 15 patients will receive both Amrutha Guggulu internally and Nasya

with Patadi taila

• The results of the Group –C as shown above exhibits the 7 (46.67%) patients

cured and 8 (53.33%) well responded patients after the through examination of

the subjective and objective parameters and statistically highly significant.

• Patients of Pratishyaya (Allergic Rhinitis) fulfilling the criteria of diagnosis were

selected in the present study.

• The cumulative results of the trial as shown above exhibits the 9 (20%) patients

cured, 28 (62.22%) well responded patients and 8 (17.8%) of moderately

responded after the through examination of the subjective and objective


Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Summary

135

Chapter – 8

Summary

• he history reveals that the Pratishyaya exists from ages.

• Pratishyaya is a complex disease involving several symptoms and diversified

pathogenesis.

• Pratishyaya is considered as a disease since 2500 BC, the classical age of Ayurveda.

• Pratishyaya is an IgE mediated hypersensitivity disease of mucous membranes of the

nasal airways.

• In Udavarta Pratishyaya has been mentioned as an Upadrava.

• In Purvarupas of Rajayakshama Pratishyaya can be seen.

• Pratishyaya is an acute disease of Pranavaha Srotas and Nasa srava and Nasavarodha

characterize it.

• Only Charaka and Kashyapa have mentioned about the general symptoms of

Pratishyaya.

• Samanya Chikitsa of Pratishyaya, according to Chakrapani, five diseases viz.

Netraroga, Kukshiroga, Pratishyaya, Vrana and Jwara, are cured with Langhana

Chikitsa within five days.

• Susruta has specifically mentioned Vamana in Pratishyaya Chikitsa.

• The ages of early are said as the Kapha predominance ages in Ayurveda.

• Vyadhi kshamatwam and Vyadhi bala virodhitwam are developed by the

medicament and procedure

• Group A: 15 patients will receive Amrutha Guggulu internally.

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Summary

136

• Group B: 15 patients will receive Nasya with Patadi taila.

• Group C: 15 patients will receive both Amrutha Guggulu internally and Nasya

with Patadi taila

• The results of the Group –A as shown above exhibits the well responded patients

9 (60%) and Moderately responded patients 6 (40%) after the through

examination of the subjective and objective parameters and statistically highly

significant.

• The results of the Group –B as shown above exhibits the 2 (13.33%) patients

cured, 11 (73.33%) well responded patients and Moderately responded patients

are 6 (40%) after the through examination of the subjective and objective


• The results of the Group –C as shown above exhibits the 7 (46.67%) patients

cured and 8 (53.33%) well responded patients after the through examination of

the subjective and objective parameters and statistically highly significant.

• The cumulative results of the trial as shown above exhibits the 9 (20%) patients

cured, 28 (62.22%) well responded patients and 8 (17.8%) of moderately

responded after the through examination of the subjective and objective


Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Bibliographic References

1

Bibliographic

References

1) K.R. Sriknta Murty Ed, Astanga Hridaya Sutra, 20/1, 3rd Ed, 1996, Krishnadas Academy, Chaukhambha Sanskrita Series office, Varanasi, pp 255-63

2) Satya Narayan Shastri, Charka Samhita Sutra 17/3, 10th ed. 1982, Choukumbha Bharati Academy, Varanasi, pp 332-3

3) Ibid, 5/56-62, pp 123-4 4) Satya Narayan Shastri, Charka Samhita Siddhi 9/89, 7th ed. 1991, Choukumbha

Bharati Academy, Varanasi, pp 1070 5) Satya Narayan Shastri, Charka Samhita Sutra 5/63-70, 10th ed. 1982, Choukumbha

Bharati Academy, Varanasi, pp 123-124 6) W.D. Whitney Ed, Sayana Bhasya Atharva Veda – vol 1, 2004, 9/8/1, A. V-12-4-4,

10-2-32, 12-4-5, 7) Satya Narayan Shastri, Charka Samhita Chikitsa 26/105-6, 7th ed. 1991,

Choukumbha Bharati Academy, Varanasi, pp 736-37 8) Ambika Datta Shastri, Susruta Samhita Uttara 22/3-5, reprint, 2004, Choukumbha

Sanskrit Samsthana, Varnasi, p 102-111 9) K.R. Sriknta Murty Ed, Astanga Hridaya Sutra, 20/2, 3rd Ed, 1996, Krishnadas

Academy, Chaukhambha Sanskrita Series office, Varanasi, pp 255 10) Ramavalamba Shastri, Harita Samhita, ch-42, 1st ed, 1985, Prachya Prakashan,

Varanasi, pp 379-90 11) K.R. Sriknta Murty Ed, Astanga Sangraha Uttara, part-3, 23 & 24 ch, 1st Ed, 1997,

Chaukhambha Orientalia, Varanasi, pp 201-212 12) K.R. Sriknta Murty Ed, Astanga Hridaya Uttara, 19 & 20 ch, 3rd Ed, 1996,

Krishnadas Academy, Chaukhambha Sanskrita Series office, Varanasi, pp 173-183 13) K.R. Sriknta Murty Ed, Madhava Nidana 58/1-2, 6th Ed, 2004, Chaukhambha

Orientalia, Varanasi, pp 197 14) Indradev Tripathi, Gada Nigraha part-2, 1st ed, 1969, Choukumbha Sanskrit

Samsthana, Varnasi, pp 181 15) K.R. Sriknta Murty Ed, Sharanghara Samhita Uttara, 8/1-63, Chaukhambha

Orientalia, Varanasi, pp 223-229 16) Brahma Shankara Mishra, Bhavaprakasha part-2, 65/16, 6th ed, 1988, Choukumbha

Samskruta samsthan, Varanasi, pp 693 17) Brahma Shankara Shastri, Yogaratnakara, 16/1-33 sl, 1st ed, 1998, Choukumbha

Sanskrit samsthan, Varanasi, pp 164 18) Ambikadatta Shastri, Govindadas, Bhaishajya Ratnavali 63/1-63, 18th ed, 2005,

Choukumbha Samskrut Samsthan, Varanasi, pp 985-989 19) http://en.wikipedia.org/wiki/Common_cold (11 of 16)10/21/2006 4:51:07 PM 20) http://virus.stanford.edu/uda/ (1 of 6)10/21/2006 5:06:48 PM 21) http://en.wikipedia.org/wiki/Common_cold (11 of 16)10/21/2006 4:51:07 PM


2

22) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3440773&query_hl=17&itool=pubmed_DocSum

23) Satya Narayan Shastri, Charka Samhita Shareera 8/19, 10th ed. 1982, Choukumbha Bharati Academy, Varanasi, pp 926-27

24) K.R. Sriknta Murty Ed, Astanga Hridaya Shareera, 3/108-9, 3rd Ed, 1996, Krishnadas Academy, Chaukhambha Sanskrita Series office, Varanasi, pp 419-20

25) Varada Prasad, Shabda Kalpa Druma, part-2, 3rd ed, 1967, Chaukhambha Sanskrita Series office, Varanasi, pp 873

26) Amarakosha 27) K.R. Sriknta Murty Ed, Astanga Hridaya Chikitsa, 7/110, 3rd Ed, 1996, Krishnadas

Academy, Chaukhambha Sanskrita Series office, Varanasi, pp 304 28) Ibid, Shareera 4/28-30, pp 426-27 29) Ambika Datta Shastri, Susruta Samhita Sutra 16/49-53, reprint, 2005, Choukumbha

Sanskrit Samsthana, Varnasi, pp 69-70 30) Ibis, Shareera, 8/17, pp 66 31) Ibid, Uttara, 25/16-17, pp 129-30 32) K.R. Sriknta Murty Ed, Astanga Hridaya Shareera, 3/5, 3rd Ed, 1996, Krishnadas

Academy, Chaukhambha Sanskrita Series office, Varanasi, pp 392-93 33) Ibid, 3/3-4, pp 392 34) Satya Narayan Shastri, Charka Samhita Shareera 4/11, 10th ed. 1982, Choukumbha

Bharati Academy, Varanasi, pp 870 35) K.R. Sriknta Murty Ed, Astanga Hridaya Shareera, 1/57, 3rd Ed, 1996, Krishnadas

Academy, Chaukhambha Sanskrita Series office, Varanasi, pp 370 36) Martini, Fundamentals of anatomy and physiology, 4th ed, 1998, Prentice Hall Inc,

New Jersey, pp 818-19 37) Ambika Datta Shastri, Susruta Samhita Uttara 24/2-23, 4th ed, 1980, Choukumbha

Sanskrit Samsthana, Varnasi, pp 650-51 38) Satya Narayan Shastri, Charka Samhita Chikitsa 26/104, 7th ed. 1991, Choukumbha

Bharati Academy, Varanasi, pp 736 39) Ibid, 26/108, pp 737-38 40) Ambika Datta Shastri, Susruta Samhita Uttara 25/5, reprint, 2004, Choukumbha

Sanskrit Samsthana, Varnasi, pp 124 41) Satya Narayan Shastri, Charka Samhita Chikitsa 26/104, 7th ed. 1991, Choukumbha

Bharati Academy, Varanasi, pp 736 42) Ambika Datta Shastri, Susruta Samhita Uttara 24/4, reprint, 2004, Choukumbha

Sanskrit Samsthana, Varnasi, pp 116 43) K.R. Sriknta Murty Ed, Astanga Hridaya uttara, 9/1-2, 2nd Ed, 1997, Krishnadas

Academy, Chaukhambha Sanskrita Series office, Varanasi, pp 173 44) Pt. Heamaraj Sharma, Kashyapa Samhita, Chikitsa 1/1-14, 2nd ed, 1976,

Chaukhambha Sanskrita samsthana, Varanasi, pp 130-132 45) Ambika Datta Shastri, Susruta Samhita Uttara 24/16, reprint, 2004, Choukumbha

Sanskrit Samsthana, Varnasi, pp 116-117 46) Ibid, 24/ 23, pp 120-21 47) K.R. Sriknta Murty Ed, Madhava Nidana 58/28, 6th Ed, 2004, Chaukhambha

Orientalia, Varanasi, pp 263


3

48) Pt. Heamaraj Sharma, Kashyapa Samhita, Chikitsa 1/1-14, 2nd ed, 1976, Chaukhambha Sanskrita samsthana, Varanasi, pp 130-132

49) Scott Brown Rhinology Vol. 4 - Scott Brown’s Otolaryngology, 6th Edition, Rhinology, Volume 4, p.4/6/1/ - 4/6/15, 4/91/1 - 4/9/15.

50) Ranjeeth Raj Desai Nidana Chikitsa Hastamalaka, Vol. 3, (1980), Sri. Baidhyanath Ayurveda Bhavan Limited, Nagpur, pp. 448-612 – check in

51) Brahma Shankara Mishra, Bhavaprakasha, 65 ch, 5th ed, 1988, Choukumbha Sanskrita samsthana, Varanasi, pp 699

52) http://www.ayurvedahc.com/articlelive/articles/230/1/Nasya-Therapy-in-Pratishyaya-Colds/Page1.html (2 of 4) 10/21/2006 5:16:56 PM

53) Indradeva Tripathi, Yoga Ratnakara, Nasaroga Nidana Chikitsa, 1st ed, 1998, Krishnadas Academy, Varanasi, pp 846-47

54) Cecils TBM, part XIX diseases of the Immune system, 225 allergic rhinitis, pp 55) Stedman’s medical dictionary V 4, 22nd ed, 1974, Williams Wilkins co, Baltimore, 56) Oxford Textbook of Medicine on CD ROM, Version 1.10, September 16 1996,

17:10:02, Oxford University Press & Electronic publishing B.V., chapter 5.2, Immune mechanisms in health and disease

57) Petersdorf R.G editor, Harison principles of internal medicine, Vol-2, 252 ch. 14th ed. India: Mcgraw Hill, New York, 1998.p 106

58) Cecil Textbook of Medicine, 20th edition, part XIX diseases of the Immune system, 225 allergic rhinitis, version 3.1a, 1992-1994, SoftArt. Inc. and Linguistic software products. Inc.

59) Idid 60) Ibid 61) Petersdorf R.G editor, Harison principles of internal medicine, Vol-2, 252 ch. 14th

ed. India: Mcgraw Hill, New York, 1998.p 107 62) Ibid 63) Oxford Textbook of Medicine on CD ROM, Version 1.10, September 16 1996,

17:10:02, Oxford University Press & Electronic publishing B.V., chapter 5.2, Immune mechanisms in health and disease

64) Ambikadatta Shastri edited, Bhaishajya Ratnavali, 54/ 222-227, published by Chaukhambha Sanskrit Samstan, Varanasi, 15th edition 2002, PP 632

65) K.M.Nadkarni, Indian Materia Medica, 2nd edition, 1982, Published by Popular Prakashan Bombay, PP 1017

66) Ibid, PP 430 67) Ibid, PP 333 68) Ibid, PP 1098 69) Ibid, PP 1134 70) Ibid, PP 953 71) Ibid, PP 187 72) Ibid, PP 1065 73) Ibid, PP 1202 74) Ibid, PP 1205 75) Ibid, PP 480 76) Ibid, PP 167 77) Ibid, PP 1017


4

78) Ibid, PP 1308 79) Ibid, PP 965 80) Ibid, PP 101 Guduchi satwa (PP 1017) and also as prakshipta Dravya 81) Ibid, PP 430 Ten roots 82) Ibid, PP 333 83) Ibid, PP 1098 84) Ibid,PP 1134 85) Nambiar P.K.K, Indian medicinal plant Orient Longman Chennai 1995.p. 141. 86) Shastry.J.L.N Dravyaguna vijnana vol 2. 1st ed. Varanasi Chaukhambha Orientalia;

2004.p. 88. 87) Dhanukar. S.A Indian Journal of Pharmacology of Medicinal plants and Natural

products; 2000. p. 81-84 . 88) K.M.Nadkarni, Indian Materia Medica, 2nd edition, 1982, Published by Popular

Prakashan Bombay, PP 953 89) Pharmacognosy, Page No.206 90) Indian Medicinal plants, Page No.1825 91) K.M.Nadkarni, Indian Materia Medica, 2nd edition, 1982, Published by Popular

Prakashan Bombay, PP 187 92) Ibid, PP 1065 93) Nambiar P.K.K, Indian medicinal plant Orient Longman Chennai 1995.p. 3. 94) Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan;

1976. p. 1065. 95) Shastry.J.L.N Dravyaguna vijnana vol 2. 1st ed. Varanasi Chaukhambha Orientalia;

2004.p.483. 96) K.M.Nadkarni, Indian Materia Medica, 2nd edition, 1982, Published by Popular

Prakashan Bombay, PP 1202 97) AAMRA Vol 1st Issue 3rd Oct, Dec 1997, Page No 76 98) Dravyaguna Vijnana by P.V. Sharma Choukambha Bharathi Academy,

Varanasi1991. 99) Dravyaguna vignana 2nd part Page No.758

100) K.M.Nadkarni, Indian Materia Medica, 2nd edition, 1982, Published by Popular Prakashan Bombay, PP 1205

101) Indian Medicinal Plants, by Kirtikar & Basu, Vol 1 - 3 2nd edition 1975, page No 1204

102) AAMRA volume 2 Issue 1& 2 1998 Page No 24 103) Bhava Prakash Nighantu by Dr. Gangasahaya Pandeya Choukhambha Bharati

Academy Varanasi –221001, 1974 Page No 38 To 41 104) Tripathi, V. N. et. al.: sachitra Ayurveda, 740, (1983) 105) Inamdar, M. C. et. al.: 1,d. J. pharm., 21: 333 (1959). 106) Singh, P,. H. et. al.: j. Res. ind. Med., 92 (1974). 107) K.M.Nadkarni, Indian Materia Medica, 2nd edition, 1982, Published by Popular

Prakashan Bombay, PP 480 108) Pharmacognosy, 12th edition, Nirli Prakashana by C.K.Kokate A.P.Purohit,

S.B.Gokhale July 1999. , Page No.225 109) Medicinal and Aromatic plants abstract, National Institute of Science

Communication C.S.I.R New-Delhi vol 24/No.1 2002 Page No.16


5

110) AAMRA vol 1st Issue 3rd Oct-Dec 1997 Page No.76,92, 111) K.M.Nadkarni, Indian Materia Medica, 2nd edition, 1982, Published by Popular

Prakashan Bombay, PP 167 112) http://www.ayuherbal.com/Medicinal Plant of India.htm (1-4) dt 14/7/2006 113) K.M.Nadkarni, Indian Materia Medica, 2nd edition, 1982, Published by Popular

Prakashan Bombay, PP 1308 114) Ibid, PP 965 115) Yadavji Trikamji Acharya edited, Charaka Samhita Chikitsa, 26/ 146, Chakrapani

Ayurveda deepika, Chaukhambha Ayurvijnana Grandhamala - 34, published by Chaukhambha Surabharathi Prakashan, Varanasi, reprint 1992, (ch. Chi. 26/145),

116) Bh. Ra – 63/24) 117) K.M.Nadkarni, Indian Materia Medica, 2nd edition, 1982, Published by Popular

Prakashan Bombay, PP 333 118) Ibid, PP 701 119) Ibid, PP 116 120) Nambiar P.K.K, Indian medicinal plant Orient Longman Chennai 1995.p. 107. 121) Shastry.J.L.N Dravyaguna vijnana vol 2. 1st ed. Varanasi Chaukhambha Orientalia;

2004. p.882. 122) Srikanta Murthy edited, Sharangadhara Samhita Madhyama Khanda, 8/ 38,

Jaikrishnadas Ayurved Series - 58, published by Chaukhambha Orientalia, Varanasi, 4th edition 2001, pp 227

123) Ambika Datta Shastri, Susruta Samhita Uttara 45/39-40, 15th edition, 2002, Choukumbha Sanskrit Samsthana, Varnasi, p 171

124) Ramnik Sood, Medical Lab Technology, 4th ed, 1994, Jaypee Brothers, New Delhi, pp 194-95

125) Ibid, pp 234 126) http://www.indiangyan.com/books/ayurvedabooks/ayurvedic_cures/Diseases_respira

tory_organs.shtml (1 of 18)10/21/2006 5:16:31 PM 127) http://icd9.chrisendres.com/index.php?action=alpha 128) http://en.wikipedia.org/wiki/ICD 129) http://www.mayoclinic.com/health/common-cold/DS00056 130) http://www.mayoclinic.com/health/common-cold/DS00056/DSECTION=2

Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Case sheet

1

SPECIAL CASE SHEET FOR THE COMPARATIVE STUDY OF AMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHA NASYA IN THE MANAGEMENT OF PRATISHYAYA

POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA) SHRI. D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG

Guide: Dr. K. Shiva Rama Prasad

Scholar: Shreekrishna H. Jigaloor

1) Name of the Patient Sl.No

2) Sex Male Female OPD No

3) Age Years IPD No

4) Religion Hindu Muslim Christian Other

5) Occupation Sedentary Active Labor

6) Economical status Poor Middle Higher middle Higher class

7) Address

Pin

8) Birth data Place of Birth

AM Date Month Year Time

Hours Minutes PM

9) Selection Included Excluded Group

10) Schedule dates Initiation Completion

11) Result Cured Well

Responded

Moderately

responded

Not

responded

INFORMED CONSENT I Son/Daughter/Wife of

am exercising my free will, to participate in above study as a subject. I have been informed to

my satisfaction, by the attending physician the purpose of the clinical evaluation and nature of

the drug treatment. I am also aware of my right to opt out of the treatment schedule, at any

time during the course of the treatment. EzÀ Ä £Á£À Ä ²æ Ã/²æ ÃªÀ Ä w _________________________________________________ £À £À ß ̧ À é EZÀ Ñ ¬ÄAzÀ PÉÆqÀ Ä ªÀ aQvÁì ̧À ªÀ Ä äw. ¥À æ ¸À Ä Û vÀ £À qÉ¢gÀ Ä ªÀ

aQvÁì ¥À zÀ Þ w0iÀ Ä §UÉ Î £À £À UÉ aQvÀ ìPÀ jAzÀ ̧ À A¥À Çtð ªÀ iÁ»w zÉÆ gÉwzÀ Ä Ý ªÀ Ä vÀ Ä Û 0iÀ iÁªÁUÁzÀ Ä gÀ Ä aQvÀ ì¬Ä AzÀ »AwgÀ Ä UÀ ® Ä ̧Áé vÀ AvÀ æ ÷ å «zÉ JAzÀ Ä w½ ¢gÀ Ä vÀ Û £É .

gÉ Æ V0iÀ Ä gÀ Ä dÄ / Patient's Signature

Group A = Oral Amruta Guggulu, Group B = Patadi Taila Pratimarsha Nasya, Group C = Both A & B

A B C


2

12) CHIEF COMPLAINTS WITH DURATION (Subjective Parameters) Complaints Duration Remarks

Colour (Yellowish/ White/ Blood tinge) Smell(No smell/ Purulent)

1 Nasa Srava

Discharge (Watery/ purulent / non purulent) Unilateral/ Bilateral Intermittent / Continuous

2 Nasavarodha

Day / Night/ All Time 3 Ghrana Toda Arti 4 Kshavathu (Sankhya) 5 Nisteeva (Non purulent / purulent) 6 Shirah Shoola 7 Shiro gurutwa 13) ASSOCIATED COMPLAINTS Associated Complaints Duration Remarks

1 Swaraksheena (Swaropaghata)

2 Dowrbalya

3 Aruchi 4 Mandajwara

5 Gala sosha 6 Talu sosha 7 Osta sosha 8 Vaktra Vairasya

14) HISTORY OF PRESENT ILLNESS Mode of onset - sudden / Gradual/ Insidious / Sub-acute

Course episodic/ continuous/ initially episodic Frequency of attack few hours / few days / few weeks Duration of attack Continuous / intermittent / subsides with medication Mode of progress Typical / Rapid / Long time non progressive

Periodicity Seasonal / irregular / perennial

Preceded by Sneezing / nasal irritation/ cough/ Aggravating factors dust/ food/ smoke/ pets / pollens/ Stress Comfort posture at attack sitting/ lying/ standing/ forward bending

15) Occupational History if any


3

16) PERSONAL HISTORY Food habits Vegetarian Mixed diet Taste preferred Sweet Sour Salty Pungent Bitter Astringent

Agni Sama Vishama Manda Teekshna

Kosta Mrudu Madhyama Krura

Nidra Day Night Sound Disturbed

Addictions Tobacco Alcohol Drugs

Bowel habits Normal Loose Constipated

Menstrual History Regular Irregular Amenorrhea Menopause

Family history – Specify if any has the same disease

Other system medications Bronchodialtors Treatment history Cortico steroids Other medicines RS Since how long

History of past illness

17) EXAMINATION (a) Vitals

Temperature ºF Pulse / min Respiration rate / min

Height Cms Weight Kg Blood pressure mmHg

(b) Respiratory system Chest

Shape Normal / Kyphosis / Scoliosis/ Flattening/ over inflation Movement Normal / Reduced Resp. Rhythm Normal / Abnormal Respiration Thoracic/ Abdominal / Thoraco abdominal Accessory muscles Not involved / Involved / Inter coastal spaces Normal / Abnormal Visible veins Absent / present

Dar

shan

a

Venous pulses Normal / Raised Tracheal position Centrally placed / Deviated Pain / Tenderness Absent / present Swelling Absent / present Vocal fremitus Absent / present Shape Symmetrical / Asymmetrical Sp

arsh

ana

Lymph nodes Not palpable / palpable at Akotana Normal / Resonant / Hyper Resonant / Dull

Type of breath Broncho-vesicular/ Vesicular / Bronchial Vocal resonance Normal / Increased/ Decreased/ Absent

Shra

vana

Resp. Sound Rales/ Ronchi/ Crepitating/ Plural Rub /


4

(c)Nasal Examination Pina (Well developed)

Apina (Ill developed)

Ruju (straight & Normal)

Vakra (deformed)

Subaddha (well joined)

Abaddha (Il joined)

Mahadwara (Well defined orifices)

Dwara baddhata (reduced nasal air way)

Shape

Deergha (long nose) Hraswa (Reduced & drooping nasal tip)

Vamsha sampanna (No deformity)

Saddle deformity

deviated nasal septum

septal abscess

septum hematoma syphilitic septum

Bridge of the Nose

traumatic deformity Ardra (moist) Sushka (Dry) Samanya Rakta varna (Normal Redness)

Asamanya Rakta varna ( Abnormal Redness)

Non- Congestion Congestion

Mucosa

Non- Oedematous Oedematous Atrophy

Nisrava (No Nasal discharge)

Sasrava (with Nasal discharge)

Samanya Gandha jnana

Gandha nasha

Inspection

General appearance

cellulites Tenderness Present Absent swelling Present Absent expansion Present Absent

Nasal

bony depression Present Absent Tenderness Present Absent swelling Present Absent expansion Present Absent

Para nasal

bony depression Present Absent Frontal Normal Inflammatory Ethmoidal Normal Inflammatory

Palpation

Sinus

Maxillary Normal Inflammatory Nasal mucosa Normal Inflammatory obstructive material Present Absent rhinorrhoea Present Absent ambient humidity Present Absent temperature Normal Abnormal dryness Present Absent

Anterior

nasal polyps Present Absent Inflammations Not seen Inflammatory polyps Not seen Present

Rhinoscopy observations

Post nasal space

hypertrophy Not seen Observed


5

(d) Ayurvedic methods of Examination Desham (Deha) Bhumi Jangala Anupa Sadharana

Vata B A Pitta B A Kapha B A

Karshya Peeta mootrata Agni sadana

Karshnya Peetanetra Praseka

Ushna kamitwa Peetavi t Alasya

Kampa Peetatwak Swetangata

Anaha Adhikshudha Sheetangata

Shakrudgraha Adhidaha Gowrava

Balabhrmsha Slathangata

Nidrabhramsha Swasa

Pralapa Kasa

(a) Dosha Vruddhi

Bhrama At in idra

Vata B A Pitta B A Kapha B A

Angasada Mandagni Bhrama Alpabhashite

ahitam Shareera sheetatwam Urah

shoonyata

Chesta heenata Prabha hani Shira soonyata

Vyamoha Hridrava

(b) Dosha Kshaya

Sleshma vruddhi Sandhi saidhi lya

Nadi V P K VP VK PK VPK

Prakruti V P K VP VK PK VPK Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya

Nadi Dosha Pravrutti Gati Varna Purnata Gandha Spandana Kathinya

Mutra

Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa

Mala

Shabda Sparsha Sheeta Ushna

Ast

asth

ana

Drik Akruti


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(e) Srotas Before After Before After Pranavaha Atisrustam Ati badhdama Kupitam Abheekhnam Alpalpa Sashoolam 18) Pratishyaya Nidana

Ajeerna Sheetambupana Kaphaprakopa ahara

Aha

ra

Agnimandya Dustambu pana Vataprakopa ahara Jalakreeda Ucchira Bhashana Inhaling poisonous

smell

Dustajala kreeda Ati bhashya Inhaling Vidahi Dravya

Avashyaya Ucchita shira shayana Inhaling Teekshna Dravya

Atimaidhuna Neecha shira shayana Dhooma sevana Nishi jagarana Pravasa Rajo sevana

Viha

ra

Diwaswapna Ati Vyayama Bhashpa sevana Krimi Krodha Abhighata Vegavarodha shoka Beeja Dosha Rutu Viparyaya Nasal picking Vata Vyadhi Shirobhitapa Nasal foreign body Malnutrition

Anya

Vyad

hi

Avas

ta

sam

band

ha

Pralapa Samsargaja vyadhi Hypo vitaminosis 19) Pratishyaya Poorvaroopa

Shiro gurutwam Kshavathu Angamarda Romaharsha Jwara Aruchi Shirashoola Ashru srava Netra kandu Nasa kandu Nasa daha Lalasrava Talu shushkata 20) Pratishyaya Bheda

Nasavaraodha Tanu srava Nistoda Gala Shosha Talu Shosha Osta Shosha

Vata

Shankayostoda Swarabhanga Nasa Ushnata Peeta Sravam Dowrbalyata Pandu varna Ushna Kamitwam Trushna

Pitta

Nasa Dhoomayanam Mukha Dhoomayanam Sukla ghranam Sheeta sravam Sweta varnam Shuklavabhasa Soonaksho Mukha gowrava

Kapha

Shiro gowrava Shiro Talu kandu Osta Talu kandu Sannipata Punah punah

Pratishyaya Pakwa- Apakwa

Pratishyaya Sarwa lakshanam

Rakta srava Rakta/ Tamra Akshi Uroghata Lakshana Rakta Mukha durgandhata Gandh Ajnanata Nasa Krimi Nasa praklinnata Nasa shushkata Nasa baddhata Dusta Swasa durgandhata Gandha Ajnanata


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21) Objective parameters (INVESTIGATIONS) Objective parameters Before After Difference Haemoglobin % Gm% Gm% Gm% Erythrocytes sedimentation rate mm/1st Hour mm/1st Hour mm/1st Hour Absolute Eosinophilic count /cumm /cumm /cumm Total count /cumm /cumm /cumm

Polymorphs Lymphocytes Eosinophils Monocytes

Diff

eren

tial

coun

t

Basophills 22) Subjective parameters (Symptoms) Subjective parameters Before treatment After treatment

Colour (Yellowish/ White/ Blood tinge) Smell(No smell/ Purulent)

1 Nasa Srava

Discharge (Watery/ purulent / non purulent)

Unilateral/ Bilateral Intermittent / Continuous

2 Nasavarodha

Day / Night/ All Time 3 Ghrana Toda Arti 4 Kshavathu (Sankhya) 5 Nisteeva (Non purulent / purulent) 6 Shirah Shoola 7 Shiro gurutwa 23) Treatment schedule of “Amrutha guggulu & Patadi taila Pratimarsha Nasya in the management of Pratishyaya” Schedule Investigator’s observation

Day 1

Day 3

Day 5

Day 7

Day 14 (Final Follow up)

Investigators Note:

Signature of Guide

(Dr. K. Shiva Rama Prasad)

Signature of Scholar

(Shreekrishna H. Jigaloor)

pratishyaya kc036 gdg

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