Can Virechana nasya and Vairechanika dhoomapana manage chronic sinusitis? An experience

Neethu Kesavan; EM Thrijil Krishnan; DB Vaghela

doi:10.4103/jacr.jacr_10_22

CASE REPORT

Year : 2022 | Volume : 5 | Issue : 4 | Page : 170-175

Can Virechana nasya and Vairechanika dhoomapana manage chronic sinusitis? An experience

Neethu Kesavan¹, EM Thrijil Krishnan², DB Vaghela³
¹ Central Ayurveda Research Institute, Patiala, Punjab, India
² Department of Rachna Sharir, All India Institute of Ayurveda, Goa, India
³ Department of Shalakya Tantra, ITRA, Jamnagar, Gujarat, India

Date of Submission	17-Feb-2022
Date of Acceptance	22-Nov-2022
Date of Web Publication	29-Dec-2022

Correspondence Address:
Dr. Neethu Kesavan
Research officer (Ay.), Central Ayurveda Research Institute, Opposite Govt. Ayurveda College, Patiala 147001, Punjab
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jacr.jacr_10_22

Abstract

Chronic sinusitis is a highly prevalent disease with a large social and economic burden. The pathophysiology of sinusitis is multifactorial. Environmental pollutants play a role in the inflammatory component of the disease process. When sinusitis persists for more than 12 weeks that can be considered chronic sinusitis. The main symptoms include nasal obstruction, nasal discharge, heaviness of the head, and dull headache. The symptoms of chronic sinusitis have proximity to that of Dushta pratishyaya in Ayurveda. A 32-year-old male patient has approached the outpatient department of Shalakya tantra with chief complaints of severe headache associated with heaviness of the head, postnasal dripping, nasal obstruction more toward evening, and mild hyposmia in the past 2 weeks. The symptoms were recurring for the past 3 years. He was managed with internal medicines, Shirovirechana nasya (~medication through the nose for cleansing), and Dhoomapana (~therapeutic smoking). After the treatment of 1 month, he got significant relief. Follow-up was done after 3 months and there was no recurrence of the symptoms inferring that Ayurveda treatment modalities are useful in the management of chronic sinusitis.

Keywords: Chitraka haritaki avaleha, Dushta pratishyaya, Saraladi varti, Vyaghri taila

How to cite this article:
Kesavan N, Thrijil Krishnan E M, Vaghela D B. Can Virechana nasya and Vairechanika dhoomapana manage chronic sinusitis? An experience. J Ayurveda Case Rep 2022;5:170-5

How to cite this URL:
Kesavan N, Thrijil Krishnan E M, Vaghela D B. Can Virechana nasya and Vairechanika dhoomapana manage chronic sinusitis? An experience. J Ayurveda Case Rep [serial online] 2022 [cited 2023 Jan 27];5:170-5. Available from: http://www.ayucare.org/text.asp?2022/5/4/170/365926

Introduction

Chronic sinusitis can be defined as the chronic inflammation of the mucosa lining of the nose and paranasal sinuses, which is characterized by postnasal drip, nasal congestion, nasal blockage, etc. If the acute infection is not managed in time, it further damages nasal mucosa. Studies reveal that sinusitis affects 1 out of every 7 adults in the United States and more than 30 million individuals are diagnosed each year. Approximately 0.5% of all respiratory tract infections are complicated by sinusitis. As per the National Institute of Allergy and Infectious Diseases, an estimated 134 million Indians suffer from chronic sinusitis.^[1] The incidence of acute sinusitis ranges from 15 to 40 episodes/1000 patients/year. Ayurveda, the science of healthy living, is the most rational and scientific among the ancient systems of medicine, which has the capacity to provide effective management for most diseases. All these features are synonymous with the description of Dushta pratishyaya (~chronic sinusitis).

Paranasal sinuses are a group of four paired air-filled spaces surrounding the nasal cavity.^[2] Those are lined with mucus membrane, which is a continuation of the nasal mucous membrane. Inflammation of nasal mucosa by infection, allergic reaction, etc., will lead to inflammation of the paranasal sinuses due to the continuation of the mucosa. Symptoms of chronic sinusitis may include any combination of these symptoms: nasal congestion, facial pain, headache, night-time coughing, an increase in previously minor or controlled asthma symptoms, general malaise, thick green or yellow discharge, feeling of facial “fullness” or “tightness” that may worsen when bending over, dizziness, aching teeth, and/or bad breath.^[3] As Dushtapratishyaya is a chronic condition of Dosha accumulation in Nasa (~nasal cavity) and Shira (~head), which happens mainly due to Srotosanga (~obstruction in the pathway of body channel); administration of Snehavirechana nasya (~medication through the nose for cleansing) with Vyaghri taila was selected for Dosha sravana (~elimination of Dosha) and Srotosudhdhi (~clearance of channels). On the other hand, if the immunity is less in the diseases, recurrences are very common. According to Ayurveda, Rasayana (~rejuvenation therapy) is to be used to improve immunity. Many Rasayana preparations are described in various texts, out of which Chitraka haritaki avaleha was selected as internal medication in this case, as it is indicated in Pratishyaya (~chronic rhinitis) and also considering its Rasayana and anti-inflammatory properties. Dhoomapana (~therapeutic smoking), another therapeutic procedure is indicated in Vata kaphaja urdhva jatrugata vikara (~disorders of part of the body above the clavicle).^[4]

Patient Information

A 37-year-old male patient, an IT professional has approached the outpatient department of Shalakya tantra on August 31, 2021, with chief complaints of severe headache associated with heaviness in the head, postnasal dripping, nasal obstruction more toward evening, and mild hyposmia for the past 2 weeks. The symptoms were recurring for the past 3 years. The headache he experienced was sometimes severe with the heaviness of the whole head which was increasing on bending or stooping down along with facial pain. The nature of postnasal drip was thick jelly-like mild yellowish and occasionally foul smelling. The symptoms were aggravated by the intake of cold drinks, and sweets, and exposure to cold and dust. The patient has taken several courses of modern conventional management during the past 3 years. The patient used to get relief from the symptoms temporarily after taking the medications but relapses were noticed. The patient used to get some relief on steam inhalation.

Clinical Findings

The patient was afebrile. The pulse was 78 beats/min. The blood pressure was 128/74 mmHg. No relevant abnormalities were noted in the functioning of the respiratory, circulatory, and digestive systems. On an anterior rhinoscopy, it was noted that the nasal mucosa was congested, and the septum was deviated toward the right. The inferior turbinate hypertrophied bilaterally. On sinus examination, tenderness over the bilateral frontal floor, frontal wall, maxillary sinus, and ethmoidal sinuses was noted.

Assessment criteria

The assessment of symptoms was done on the basis of scoring developed in the department from previous works on chronic sinusitis.^[5] [Table 1].

Table 1: Scoring pattern of symptoms and signs of chronic sinusitis*

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Time Line

The patient had a severe headache with heaviness and rhinitis in December 2017. Recurrent attack of the previous symptoms on exposure to cold and dust occurred in 2018. The patient experienced severe headache with a yellowish postnasal drip for 3 weeks and got relief on allopathic medication in October 2019. Since February 2021, he is under Ayurvedic treatment, the details of which is given in the therapeutic intervention section.

Diagnostic Focus and Assessment

The hemogram (hemoglobin – 14.5 g%, erythrocyte sedimentation rate –40 mm/h, and absolute eosinophil count –248/Ul), random blood sugar (99 mg/dl), and urine analysis were in normal limits before starting the treatment. On nasal endoscopy, on the first pass, the nasal mucosa was congested, on the third pass, thick yellowish discharge was seen in the bilateral middle meatus and the osteomeatal unit was partially obstructed with thick discharge and mucosal swelling. X-ray of paranasal sinuses showed partial haziness over bilateral frontal and maxillary sinuses. Nasal endoscopy and X-ray of paranasal sinuses confirmed the diagnosis of chronic sinusitis.

Dasha vidhapareeksha (~Tenfold examination)

The Deha prakriti (~somatic constitution) of the patient was Vatakaphaja. Vikriti (~morbidity) was Kaphavata pradhana along with Rasa dushti (~vitiation of the primary product of digested food). Satwa (~psychic condition), Sara (~excellence of tissue elements), Samhanana (~compactness of organs), Ahara shakti (~power of intake and digestion of food), Vyayama shakti (~power of performing exercise), Satmya (~homologation), and Pramana (~measurement of body constituents) of the patient were of Madhyama (~medium) level.

Therapeutic Interventions

For initial 5 days, Amapachana vati (1 g) twice a day in divided doses was given. This was followed by Vairechanika nasya with Vyaghri taila (6 bindu) in each nostril and Dhoomapana with Saraladi dhoomavarti as three sittings; each sitting with a duration of 7 days with a gap of 3 days in between. Internally, Chitrakaharitaki avaleha (5 g) twice a day after food with lukewarm water was given. During the treatment, the patient was strictly restricted from consuming Dugdha (~milk), Dadhi (~curd), sweets, oil-fried items, and junk food. Exposure to wind, cold, and sunlight was also avoided. The patient was advised to take a diet that digests easily along with soup of freshly available vegetables and soup of green gram with turmeric, ginger, and black pepper.

Follow-Up and Outcome

After 1 month of treatment, sinus examination and nasal endoscopy were done. There was no tenderness over the sinuses. Changes in the symptoms with the treatment are mentioned in [Table 2]. Nasal endoscopy revealed that nasal mucosa was mildly congested (Grade 1) with no discharge, no edema, and no mucosal obstruction of the osteomeatal unit (Grade 0). Follow-up was done after 1 month of completion of treatment. X-ray of paranasal sinuses was taken and it was found to be clear. Another follow-up was done after 6 months to inquire about the status of the disease and the patient was found to be normal. No fresh complaints were noted and there was no recurrence complaint by the patient during this period. The patient was advised to practice Pranayama (~breathing exercises) and nasal administration of two drops of Anutaila in the morning as a daily regimen [Figure 1], [Figure 2], [Figure 3], [Figure 4].

Table 2: Assessment of symptoms and signs before and after the treatment

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Figure 1: Endoscopy (before treatment) showing middle meatus filled with mucus

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Figure 2: Endoscopy (after treatment) showing clear middle meatus

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Figure 3: X-ray PNS (before treatment) showing hazy frontal, maxillary, and sphenoidal sinuses. PNS: Paranasal sinus

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Figure 4: X-ray PNS (after treatment) showing mild haziness in frontal and maxillary, and clear sphenoid sinus. PNS: Paranasal sinus

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Discussion

By analyzing the Samprapti (~pathogenesis) of Pratishyaya, it is clear that there is the involvement of Tridosha with a predominance of Vata and Kapha. It is clearly explained that if Pratishyaya is not treated properly leads to Kshaya (~emaciation) or Sosha (~emaciation). Thus, the treatment of Dushta pratishyaya should be done like the treatment of Rajayakshma. Hence, there is a need for a Rasayana which is Agnivardhaka and Vyadhi shamaka.^[6] Hence, as the best option here Chitraka haritaki avaleha was selected. Chitraka haritaki avaleha is indicated in Agni mandya (~iminution of agni), Kshaya (~emaciation), Kasa (~cough), Peenasa (~catarrh), Swasa (~difficulty in breathing), etc., It is the drug that helps in the management of conditions where Kapha and Vata are deranged. As the drug is explained as Rasayana, it is definitely having the properties such as Srotoshodhana (~clearance of Srota) and Rasa dhatu prasadana (~clarity of primary product of digested food).

Virechana Nasya is another procedure adopted in this case along with Tikshna Dhoomapana (~medicated smoking of high strength). Nasa is said to be the gateway to Siras.^[7] The drug is administered through the nose as Nasya reaches the Shiras and helps in pacifying the vitiated Doshas that are responsible in disease manifestation. Vyaghri taila was indicated in the condition of Putinasa (~putrified rhinitis).^[8] All the ingredients in Vyaghri taila are mentioned under Shirovirechana gana which are useful in Pratishyaya.

The individual properties of each drug add up to form Vata kaphahara action with Ruksha (~dryness) and Tikshnaguna (~sharpness) altogether. These properties help in the easy assimilation of the drug facilitating easy expulsion of Dushta kapha further leading to Vatanulomana (~proper elimination of flatus, feces, urine, etc.).

Svedana (~sudation therapy) has a mucolytic effect and also causes vasodilation which in turn increases the permeability of blood vessels. It liquefies the Utklishta kapha (~vitiated Kapha) and facilitates its expulsion out of the Srotas (~structural or functional channels). This further supports faster absorption of the drug, spreading it to Netra (~eyes), Srotra, and Kanthadi siramukhani (~microchannels in Kantha).

Dhoomapana is another important procedure enumerated while describing Chikitsa (~treatment) of Uthamanga (~head), especially in diseases of the nose and respiratory pathway, particularly of vitiated Vata and Kapha.^[9] Dushta pratishyaya (~chronic sinusitis) is a disease, where there is excessive accumulation of Kapha that causes obstruction to Gati of Vata. Hence, attaining the clearance of the Srotas (~channels) and Vata Anulomana (~proper functioning of Vayu) should be the aim of treatment. The drugs of Saraladi dhoomavarti.^[10] (Trivrit [Operculinum turpethum Silva manso], Apamarga [Achyranthus aspera Linn.], Danti [Baliospermum montanum Muel-Arg.], Devadaru [Cedrus deodara Roxb.], and Ingudi [Balanites aegyptiaca (L.) Delile.]) are also the drugs mentioned for Vairechanika dhoomapana. Most drugs have anti-inflammatory,^{[11],[12],[13],[14],[15]} anti-allergic,^[16],[17] analgesic,^{[14],[15],[18],[19],[20]} and bronchodilator activities.^[21],[22]

Most of the drugs of the formulation have Katu, Tikta rasa, Ushna virya, Katuvipaka, and Kapha vatahara properties. The therapeutic fumes coming from these drugs will be Tikshna (~sharpness), Sukshma (~micro), Laghu (~lightness), and Ruksha guna (~dryness). This causes Kapha nirharana (~elimination of Kapha), Lekhana (~scraping), and Chedana (~detachment of vitiated doṣa) of Kapha dosha and Soshana (~drying) of Srava (~discharge) with its Ruksha guna. Katu Rasa facilitates Ghranam asravyati (~nasal discharge), Margan vivrinoti (~clearing the passages), and Sleshma shamyati (~pacifies Kapha). Tikta rasa also helps the functions of Katu rasa. Laghu guna helps in the easy absorption of medicated fumes into the mucosa. The Sukshma guna of drugs used for Dhoomapana helps in opening the smallest channels. The Ushna and Tikshna guna liquefy and eliminate the vitiated Dosha.

The nasal cavity is covered by a thin mucosa that is well vascular. The fumes from the Dhoomavarti stimulate the mucosa, further facilitating blood supply to the area and easy absorption of volatile drugs. This helps in reducing the inflammation and swelling of the respiratory mucosa and clearing the sinus ostia. Thus, Dhoomapana is the most useful way for treating nasal pathologies quickly way.

Conclusion

The case report demonstrates the clinical improvement in Dushta pratishyaya with Ayurveda approaches. Headache with the heaviness of the head, postnasal dripping, and nasal obstruction was reduced with the adopted therapeutic approaches. There was no recurrence of symptoms after 6 months of follow-up. The treatment used here is found to be effective, simple, and economical. Thus, can be followed in the cases of Dushta pratishyaya.

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

Nil.

Conflicts of interest

There are no conflicts of interest.

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