E-ISSN:2456-3110

Case Report

Ayurvedic management of Nasa

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 2 February
Publisherwww.maharshicharaka.in

Ayurvedic management of Nasa Arsha w.s.r. to Nasal Polyp - A Single Case Study

Devi P1*, Ashu2, Kumar M3
DOI:10.21760/jaims.9.2.45

1* Poonam Devi, Department of Shalakya Tantra, Institute for Ayurved Studies Research, Kurukshetra, Haryana, India.

2 Ashu, Professor HOD, Department of Shalakya Tantra, Institute for Ayurved Studies Research, Kurukshetra, Haryana, India.

3 Manoj Kumar, Associate Professor, Department of Shalakya Tantra, Institute for Ayurved Studies Research, Kurukshetra, Haryana, India.

Arshas is described as one of the Asta Mahagada Roga by Acharyas and is also explained as a fourfold treatment such as Bheshaja, Shastra, Kshara and Agni Karma. The Nasa Arshas means Arshas located in the nasal cavity causing nasal obstruction. The predominant Dosha is Kapha and Dushya is Twak, Mamsa and Medho Dhatus. Nasa Arshas can be correlated with nasal polyps. Nasal polyps are non-neoplastic masses of oedematous, prolapsed, pendenculated nasal or sinus mucosa. It can be treated by medical and surgical methods. Prolonged usage of anti-histaminics, steroids, antibiotics, nasal decongestants cause drug resistance, decreases the immunity, rebound congestion and there is a lot of chance for reoccurrence, even after the surgery especially in ethmoidal polyp. In Ayurveda, several treatment modalities have been planned for the treatment of Arsha as Shastra Karma (operative procedure), Kshara Karma (applying some alkaline drugs), Agni Karma (cauterization) and Bhaishaja (conservative/medical treatment). Here the present case study was planned to evaluate the efficacy of Anu Taila Nasya with Shamanaoushadhas.

Keywords: Arsha, Nasa Arsha, Anu Taila Nasya, Nasal Polyp

Corresponding Author How to Cite this Article To Browse
Poonam Devi, , Department of Shalakya Tantra, Institute for Ayurved Studies Research, Kurukshetra, Haryana, India.
Email: 		Devi P, Ashu, Kumar M, Ayurvedic management of Nasa Arsha w.s.r. to Nasal Polyp - A Single Case Study. J Ayu Int Med Sci. 2024;9(2):287-290.
Available From
https://jaims.in/jaims/article/view/3111

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-12-15 2023-12-25 2024-01-04 2024-01-14 2024-01-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 23.85

© 2024by Devi P, Ashu, Kumar Mand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2024;9(2)287
Poonam Devi et al. Ayurvedic management of Nasa Arsha w.s.r. to Nasal Polyp

Introduction

The term Arsas is defined as “Arivat Prana Shrunatiarsha” - The disease which tortures the person like enemy.[1] Nasa Arshas is mentioned in both Bhrihat Trayee and Laghutrayee. Acharya Sushrutha has explained total 4 types of Nasa Arsha: Vataja, Pittaja, Kaphaja and Sannipataja as well as explained fourfold treatments: Bhesaja, Shastra, Kshara and Agni Karma.[2]

Nasal polyps is defined as an inflammatory, collection of extracellular fluid and non-neoplastic masses of edematous, prolapsed nasal mucosa arise from the sinuses or the nasal cavity. The polyps are sessile in the beginning and later become pedunculated due to the effect of gravity and the excessive sneezing. The 2 most common clinical types are ethmoidal and antrochoanal.[3]

Nasal polyps can be associated with allergic or without allergic manifestation. Statistically in general population the overall prevalence rate of nasal polyposis ranges from 1-4%. It is more common in adults than in children under 10 years of age except when it is associated with cystic fibrosis. The association of nasal polyposis with asthma is well recognized ranging from 7-20%. The association of nasal polyposis, bronchial asthma, and aspirin sensitivity- Samter’s triad has also been found. Furthermore, the incidence of nasal polyps is higher in non-atopic asthmatics and rhinitis than atopic rhinitis and asthmatics.[4]

The clinical features explained by Acharya Sushruta, Acharya Vagbhatta and the Clinical Features mentioned in Modern Science areas follows:[5,6]

Symptoms of Nasa ArshasSymptoms of Nasal Polyps
Pratishaya AtimatramRunny nose
Nasa AvarodhaNasal obstruction (difficulty in breathing)
KshvathuSneezing, itchy nose- if associated with allergy
PutinasaHyposmia or anosmia depending on severity.
Saanunasika VakyamHyponasal voice
ShirovyathaHeadache
-Altered or reduced sensation of taste
-Post nasal drip

Staging[7]

Polyps can be staged based on the size

Stage I: Limited to the extent of middle meatus.

Stage II: Extending beyond the limit of Middle Turbinate.

Stage III: Approaching to inferior turbinate.

Stage IV: Going up to the floor of nose.

Management of nasal polyposis can be done by both conservative and surgical procedures. Early edematous polypoidal mucosal changes may revert to normal by using antihistamines, control of infection, and allergy. Prolonged usage of Anti antihistamines, oral corticosteroids, nasal decongestants causes drug resistance, decreases immunity and rebound congestion. Polyps that are not responding to medication are managed by Functional Endoscopic Sinus Surgery (FESS) By doing surgery nasal obstruction will be reduced but does not control the allergy, infection, and polyps may reoccur. Hence the present case study was planned to evaluate the efficacy of Anu taila nasya along with internal medication in the management of Nasaarshas w.s.r to nasal polyps.

Case Study

Chief Complaints with Duration

A female patient of age 58 years has been suffering from nasal blockage, sneezing, difficulty in nasal breathing, watery nose, and frontal headache on and off for 3-4 years.

History of Present Illness

The patient was asymptomatic for 3-4 years, gradually she developed difficulty in nasal breathing, sneezing, watery nose along with nasal blockage. She took conservative treatment but did not get relief. So patient came to our OPD for treatment purposes.

History of Past Illness

Medical History - seasonal allergy

Personal History

a) Appetite - Normal

b) Bowel - Regular

c) Micturation - Normal

d) Sleep - Normal

Family History - NAD


J Ayu Int Med Sci 2024;9(2)288
Poonam Devi et al. Ayurvedic management of Nasa Arsha w.s.r. to Nasal Polyp

Examination

Ashtasthana Pareeksha

Nadi: 78/min

Mala: Regular, twice a day

Mutra: 5-6 times/day

Jihwa: Anavrutta

Shabda: Prakruta

Sparsha: Prakrutha

Druk: Prakruta

Akruthi: Madhyama

Vitals

Pulse rate - 78/min, Respiratory rate - 22/min, BP - 126/84 mm of Hg, Temp. - Afebrile

Systemic examination

No specific abnormalities detected

Nasal Examination

Inspection - DNS towards Right side

Palpation - Examination of paranasal sinuses- tenderness present in maxillary, frontal sinus.

Anterior Rhinoscopy - Bilateral round, pale, glossy, polypoidal masses in the middle meatus is seen. Insensitive to probing, does not bleed on touch when examined by using Jobsons probe.

B/L Inferior turbinate hypertrophy.

Treatment Given

SNName of the medicineDoseTimeAnupana
1.Tab. Kaishore Guggulu2-x-2After foodLukewarm water
2.Dashmoola Kwath along with Pippali Churna30 mlEmpty stomachLukewarm water
3.Chitraka Haritaki Lehyam3g-x-3gAfter foodLukewarm milk
4.Tribhuvan Kirti Rasa2-x-2after foodLukewarm water
5.Cap. Nilsin1-x-1after foodLukewarm water
6.Anu Taila Nasya2 drops--------

(Nilsin capsule contains Mahasudarshan, Sunthi, Vach, Kosta Kulinjan and Sitopaladi as its key ingredients)

Anu Taila as Pratimarsha Nasya to lubricate the nasal passage and helps to decongest the sinuses.

Pathya to be followed are like staying in Nirvata Pradesha

, drinking hot water or boiled water by adding pinch of Shunti and Dhanya powder, Laghu Ahara, Pranayama.

Apathya to be avoided are eating freeze food, fast food, fried food, afternoon sleep, late night awakening, traveling, exposing to cool air.

Observations and Results

The condition of the patient improved gradually. After completion of 90 days of treatment, the patient has shown excellent improvement.

Discussion

Ayurveda creates new hope for the treatment of nasal polyps (Nasa Arsha) as it believes in treating the disease at its root cause. In the Samprapti of Nasa Arshas the predominant Dosha was Kapha along with Alpa Vata and Alpa Pitta, and Dushya is Twak, Mamsa, Medo, along with Jalabahulyata. So, to break the above pathogenesis Nasya with Shamana Chikitsa was given to the patient. Nasya Karma with Anu Taila was instilled into both nostrils and was expected to strengthen the vital functions of the sense organs by its unique mode of action through Shringataka Marma. Internally Kaishore Guggulu has Tridoshahara especially Kaphahara, Sotha Hara, Lekhana and Chedana at Mamsa and Medho level and is anti-inflammatory in nature. Chitraka Haritaki is prescribed to mainly increase the Agni and Vatakapha Shamana and it also has Kaphanissaraka and Lekhana property. Dashmoola Kwath along with Pipali Churna pacifies vitiated Tridoshas. Thus, internal medications also helped to pacify the vitiated Doshas and brought into an equilibrium state. The combination of both Nasya and Shamana Chikitsa acted synergistically to combat the vitiated Tri Doshas in the pathology of Nasa Arsha.

Conclusion

Nasal polyp i.e., Nasa Arsha is a chronic inflammatory disease. Ayurveda believes in cleansing the body and pacifying the Tridoshas from the roots by using unique treatment modalities such as Sodhana, Shamana and Sthanika Chikitsa. These treatment approaches create a balanced physiology which regress the size of nasal polyps and thus making the patient symptom free by non-invasive method.


J Ayu Int Med Sci 2024;9(2)289
Poonam Devi et al. Ayurvedic management of Nasa Arsha w.s.r. to Nasal Polyp

Before Treatment

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After treatment

jaims_3111_02.JPG

References

1. Schramm VL Jr., Effron MZ. Available from http://www.ncbi.nlm.nih.gov/pubmed/7401851

2. Acharya Sushruta, Sushruta Samhita, Edited by Vd. Yadavaji Trikamji Acharya and Narayanram Acharya Kavyatritha, Choukambha Sanskrit samsthan, Sanskrit teeka, 2014, P.649

3. Mohan Bhansal, Disease of Ear, Nose & Throat with Head & Neck Surgery. 3rd Edition. New Delhi;

Jaypee Brothers Medical Publishers(P), Ltd 2021, P 357

4. Online cited, www.worldallergy.org

5. Sashtri Ambika Dutta, Sushruta Samhita with Ayurveda Tattva Sandipika Hindi commentary, Nidana sthana, Volume I, Choukhamba Sanskrit Sansthan, Varanasi, 2017, P 305

6. Hazarika, Dr Nayak, R Balakrishnan, Textbook of Ear, Nose, Throat and Head - Neck Surgery Clinical and Practical, 4th edition, CBS Publishers & distributors Pvt Ltd, P 270

7. Mohan Bhansal, Disease of Ear, Nose & Throat with Head & Neck Surgery. 3rd Edition. New Delhi; Jaypee Brothers Medical Publishers (P), Ltd 2021, P 358


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