|Year : 2022 | Volume
| Issue : 3 | Page : 108-111
A case report on the management of lingual papilitis through Ayurveda
Narayan Bavalatti1, Manjusha Rajagopala1, Anjali Dabas2
1 Department of Shalakya Tantra, All India Institute of Ayurveda, New Delhi, India
2 Ishan Ayurvedic Medical College and Research Centre, Greater Noida, Uttar Pradesh, India
|Date of Submission||02-Aug-2021|
|Date of Acceptance||18-Aug-2022|
|Date of Web Publication||03-Oct-2022|
Dr. Anjali Dabas
Department of Shalakya, Ishan Ayurvedic Medical College and Research Centre, Knowledge Park -1, Greater Noida, Uttar Pradesh - 201310
Source of Support: None, Conflict of Interest: None
Transient lingual papilitis is a common inflammatory hyperplasia of one or multiple fungiform lingual papillae that has acute onset. It is painful and transient. Based on the clinical features, the condition can be compared with Pittaja jihvakantaka. In the present case report, a 35-year-old male patient presented with a chief complaint of nodular growth on the dorsal surface of his tongue for 4 months. The growth persisted even after intake of systemic steroids and even after avoiding possible mechanical stimuli. Considering the pathology and symptomatology, Triphala guggulu, Kamadudha rasa, Sutashekhara rasa, Ajamodadi churna, and Haridra khanda were prescribed. Anu taila and Yashtyadi taila were given for Pratimarsha nasya (~low-dose medication through nasal route). After about four months of treatment, the associated symptoms subsided to a significant level. No adverse events were noted during the treatment and follow-up period of about three months. This case report sets an example that Ayurveda has an effective and safe treatment for conditions such as lingual papilitis. This case also becomes evidence and base for further research works with a larger sample size.
Keywords: Mukha roga, Nasya, Pittaja Jihvakantaka, Triphala guggulu
|How to cite this article:|
Bavalatti N, Rajagopala M, Dabas A. A case report on the management of lingual papilitis through Ayurveda. J Ayurveda Case Rep 2022;5:108-11
|How to cite this URL:|
Bavalatti N, Rajagopala M, Dabas A. A case report on the management of lingual papilitis through Ayurveda. J Ayurveda Case Rep [serial online] 2022 [cited 2022 Dec 9];5:108-11. Available from: http://www.ayucare.org/text.asp?2022/5/3/108/357787
| Introduction|| |
“Lingual papilitis” is a common inflammatory condition that affects the tongue, specifically the fungiform papillae. The inflamed papillae become painful and dysphagia manifestation. Transient lingual papilitis may be caused due to several causative factors, including infection, chronic trauma, heat injury, or eating spicy or acidic foods. Associated symptoms present are burning, tingling, or itching sensation of the tongue, sensitivity to hot foods, difficulty in eating spicy or high-acidic foods, altered taste, and dryness in mouth.
Based on the similarity of clinical features, i.e., Peeta (~yellowish-colored tongue), Paridaha (~burning sensation), and having Rakta-kantaka (~reddish color papillae), the disease may be compared with Pittaja jihvakantaka. In the present case, the multimodal Ayurveda treatment approach, i.e., Anu taila nasya along with internal administration of Triphala guggulu, Kamadudha rasa, Sutashekhara rasa, Haridra khanda, and Ajamodadi churna showed recovery from the signs and symptoms.
| Patient Information|| |
A 35-year-old male patient presented to the outpatient department with the chief complaints of pain and multiple nodular growths on the dorsal surface of the tongue since June 2019 [Figure 1]. Pain and nodular growth on the tongue had developed 3–4 weeks ago when the patient was having sea-food. He felt a burning and pricking sensation and an increased soreness on the tongue along with some small elevated visible growths on the dorsal surface of the tongue for about three weeks. The patient had no significant medical or surgical history. No history of hypertension, diabetes, stomatitis, rhinitis, or blood disorders was observed. He had no significant family history of such disease. The patient had previously consulted ENT specialist and was prescribed systemic standard allopathic treatment. However, after using it for some time, the patient discontinued the allopathic treatment as he was not getting much relief from these medicines. Further, he approached to Ayurveda treatment on August 21, 2020, for possible management.
| Clinical findings|| |
Intraoral examination revealed multiple small visible growths measuring approximately 1–2 mm in diameter on the dorsal surface of the tongue. The nodules were pinkish in color, round in shape, solitary in nature, and dispersed throughout the dorsal surface of the tongue. On palpation, the nodules were slightly tender and no discharge was seen upon applying pressure. No congestion was present in the throat. Tonsils and buccal mucosa were also normal in appearance, and no abnormality was noticed. On extraoral examination, no lymph node involvement was found. Complete blood count was within normal limits. Serologic tests for the human immunodeficiency virus also revealed negative findings. Serum iron study and total iron-binding capacity were within the normal limits.
Dashavidha pariksha (~ten-fold examination)
Prakruti (~physical constitution) of the patient was found to be Pittakaphaja. Vikruti (~morbidity) was noticed to be in Raktavaha strotas. The patient was Asthi sara (~essence of Dhatus) and of Madhya samhanana (~compactness or tissues or organs), Sharira pramana (~measurement of body constituents) was 5 feet 11 inch, and weight was 76 kg. His Satmya (~homologation), Satwa (~psychic condition), Ahara shakti (~power of intake and digestion of food), and Vyayama shakti (~power of performing exercise) were Madhyama (~moderate).
Asthasthana pariksha (~eight-fold examination)
On examination, Naadi (~examination of pulse) was observed to be Vata pittaja, Mala (~examination of the excreta) was associated with Ama (~mucus), and Jihva (~examination of the tongue) showed hypertrophy of numerous papilla, and it was Ruksha (~dry) in appearance. Based on the overall examination, the patient was diagnosed with lingual papilitis and correlated with Pittaja jihvakantaka described in Ayurveda.
| Timeline|| |
The timeline for the treatment and follow-up of this case is depicted in [Flowchart 1].
| Therapeutic interventions|| |
The involvement of Vata and Pitta doshas was confirmed by the clinical signs and symptoms such as Shoola (~pain), Daha (~burning sensation), and other characteristic features presented. Vitiated Vata-Pitta doshas and Ama (~metabolic toxins) were found involved in the pathological progress. The internal and external medications were prescribed as per the treatment of Pittaja jihvakantaka explained in the classics. The details of prescribed medicines are mentioned in [Flowchart 1].
| Follow-up and outcomes|| |
By the end of the treatment, the intensity of the signs and symptoms of lingual papilitis was found reduced to a maximum [Figure 2]. The internal medicines were continued for the next 45 days. No recurrence of symptoms was observed. No adverse events were noted during the treatment period or during the follow-up period.
| Discussion|| |
Sixty-five different forms of Mukha rogas are mentioned in classical literature. These diseases manifest in seven different locations, i.e., the lips, the gums, teeth, tongue, palate, throat, and the entire oral cavity. The five diseases that affect the tongue are described as three types of Jihvakantakas (i.e., Vataja, Pittaja, and Kaphaja), Alasa, and Upa-jihvika. In Pittaja jihvakantaka, the tongue is filled with Ankuras (~reddish papillae) and has a burning sensation (due to Pitta).
Based on the clinical features, the disease is compared with Pittaja Jihvakantaka. In the present case, the treatment protocol has been adopted as per the Ayurvedic Samprapti and attempts have been made to treat the condition with Pittashamaka chikitsa and Nasya (~nasal therapy).
Sutashekhara rasa and Kamadudha rasa are having Pittashamaka properties and are used in the management of Pitta vitiation. Sutashekhara rasa is indicated in Mukha rogas and in Pitta vikara. Kamadudha rasa contains Mukta bhasma, Pravala bhasma, Muktashukti bhasma, Kapardika bhasma, Shankha bhasma, Swarna gairika, and Guduchi satwa, all in equal proportion. It is Pittashamaka and Rakta prasadana in action and reduces inflammation.
Guggulu (Commiphora mukul Hook. Ex Stocks) is very effective in the treatment of chronic inflammatory conditions., It also has anti-infective and antibacterial properties. Triphala guggulu helps in relieving pain, redness, and inflammation through its anti-inflammatory and antioxidant properties. All the internal medicines worked together through the possible synergistic way to target different pathways involved in the pathological process and found effective in treating the pathophysiology. The internal medications ultimately led to Samprapti vighatana (~correction of pathophysiology) by creating a balance between the Doshas.
Triphala guggulu is also mentioned in Sotha chikitsa. Various studies have documented the anti-inflammatory and scrapping action of Triphala guggulu. As Pittaja Jihvakantaka presents as bumpy elevations on the dorsal surface of the tongue, so the scraping action of the drugs is found beneficial in elevating this disease condition. Haridra khanda is used for the treatment of urticaria, Kandu (~itching), and abscess. Ajamodadi Churna is a polyherbal Ayurvedic formulation having anti-inflammatory action. It is also mentioned in Sotha (~swelling), Kapha, and Ama rogas.
Nasya is told to be the treatment of choice in Urdhvajatrugata rogas (~supraclavicular disorders), and it is also the main line of treatment of Pittaja jihvakantaka. Anu taila contains more than 25 herbs cooked in Tila taila and Aja dugdha.
| Conclusion|| |
The chronic inflammatory and autoimmune nature of lingual papilitis needs a comprehensive treatment approach for its cure. In the present case, Ayurveda treatment showed promising results in the treatment of lingual papilitis. The Ayurvedic approaches proved to be safe, cost-effective, and easy to follow. The patient was followed up for 45 days, and there were no recurrences of symptoms. No adverse events were noted with the treatment. Ayurvedic treatment can be an effective and safe solution for lingual papilitis. However, to further prove the efficacy of this treatment, well-designed and planned study on large sample size is required.
Declaration of patient consent
Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bryan WS, Krupa JJ, Singh BB. Transient lingual papillitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 1996;82:441-5.
Singhal GD, editor. Sushruta Samhita. Nidaan Sthana. Vol. I, Ch. 37, Ver. 16. Delhi: Chaukhamba Sanskrit Pratishthan; 2005. p. 616.
Mondal A, Kumar P. Transient lingual papillitis: A retrospective study of 11 cases and review of literature. J Clin Exp Dent 2017;9:e157-62.
Sharma PV, editor. Commentary Nibandha Sangraha of Dalhanacharya on Sushruta Samhita of Sushruta. Vol. II, Ch. 16. Varanasi: Chaukhamba Vishwabharti Oriental Publishers and Distributors; Reprint 2005. p. 103.
Sharma PV, editor. Commentary Nibandha Sangraha of Dalhanacharya on Sushruta Samhita of Sushruta. Vol. II, Ch. 16. Varanasi: Chaukhamba Vishwabharti Oriental Publishers and Distributors; Reprint 2005. p. 103-4.
Sharma PV, editor. Commentary Nibandha Sangraha of Dalhanacharya on Sushruta Samhita of Sushruta. Vol. II, Ch. 16. Varanasi: Chaukhamba Vishwabharti Oriental Publishers and Distributors; Reprint 2005. p. 107.
Sharma PV, editor. Commentary Nibandha Sangraha of Dalhanacharya on Sushruta Samhita of Sushruta. Vol. II, Ch. 16. Varanasi: Chaukhamba Vishwabharti Oriental Publishers and Distributors; Reprint 2005. p. 108.
Maurya S, Arka G, Yadav A, Kumar D, Singh A. Kamadudha rasa an effective ayurvedic formulation for peptic ulcer: A review. Glob J Res Med Plants Indigen Med 2014;3:24-32.
Krushnanandji M, editor. Rasa Tantra Saara Evam Siddha Prayoga Sangraha, Part 1; Amlapitta Chikitsa. 25th
ed., Ver. 159. Ajmer: Krushna Gopal Ayurved Bhavan; Reprint 2015.
Shailja S, editor, Sarangdhara Samhita of Sarangdhara, Purva Khanda. Ch. 4, Ver. 16-17. Varanasi: Chaukhamba Orientalia; Reprint 2009. p. 42.
Verma P, Singh B, Kumar A, Sharma R. In-vitro
anti-inflammatory and anti-oxidant potential of Triphala guggul
tablets. J Med Herbs Ethnomed 2020;6:45-7.
Shailja S, editor. Sarangdhara Samhita of Sarangdhara, Madhyam Khanda. Ch. 7, Ver. 82-83. Varanasi: Chaukhamba Orientalia; Reprint 2009. p. 198.
The Ayurvedic Formulary of India. Part I. New Delhi: Ministry of Health and Family Welfare, Government of India; 1979.
Ram HN, Sriwastava N, Makhija IK, Shreedhara CS. Anti-inflammatory activity of Ajamodadi churna
extract against acute inflammation in rats. J Ayurveda Integr Med 2012;3:33-7.
Shailja S, editor. Sarangdhara Samhita, Madhyam Khanda. Ch. 6, Ver. 115-9. Varanasi: Chaukhamba Orientalia; Reprint 2009. p. 188.
Tripathi B, editor. Ashtanga Hridaya, Sutra Sthana. Ch. 1, Ver. 20. Varanasi: Chaukhamba Sanskrit Pratishthan; Reprint 2015. p. 244.
Sharma PV, editor. Commentary Nibandha Sangraha of Dalhanacharya on Sushruta Samhita of Sushruta. Chikitsa Sthana. Vol. I, Ch. 22, Ver. 45. Varanasi: Chaukhamba Vishwabharti Oriental Publishers and Distributors; Reprint 2005. p. 100.
Yadav T, Rao N, editors. Charak Samhita, Sutra Sthana. Ch. 5, Ver. 63-5. Varanasi: Chaukhamba Surbharati Prakashan; Reprint 2000. p. 41.
[Figure 1], [Figure 2]