E-ISSN:2456-3110

Case Report

Allergic Rhinitis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Exploring Ayurvedic potential in the management of Jirna Pratishaya (Allergic Rhinitis): A Single Case Report

Holkar P1*, Jogad S2
DOI:10.21760/jaims.9.8.42

1* Priti Holkar, Post Graduate Scholar, Department of Swasthavritta and Yoga, Government Ayurvedic College, Nagpur, Maharashtra, India.

2 Sumeeta Jogad, HOD and Guide, Department of Swasthavritta and Yoga, Government Ayurvedic College, Nagpur, Maharashtra, India.

The present era is characterized by chaos, stress, and strain due to lifestyle modifications, dietary changes, urbanization, and industrialization, leading to increased pollution and antibiotic resistance. This has resulted in a rise in diseases, notably Jirna Pratishaya (chronic allergic rhinitis). In India, the prevalence of allergic rhinitis in children is approximately 21.99% and continues to increase. Repeated attacks and inadequate management often escalate the condition to a chronic phase. Additionally, Ajirna (indigestion) can cause Aam (toxins) accumulation, contributing to various disorders. This study evaluates the efficacy of Ayurvedic management - including Shamana Chikitsa (palliative treatment), dietary adjustments, and lifestyle modifications - for Jirna Pratishaya. It focuses on a 13-year-old boy diagnosed with allergic rhinitis for four years, who presented with symptoms aligning with Jirna Pratishaya. Treated at an Ayurvedic hospital, he received Shamana Chikitsa comprising Tribhuvan Kirti Ras, Shwas Kuthar Ras, Gokshuradi Guggul, and Ashtang Lavan Churna, alongside dietary and lifestyle changes over three months. Symptomatic assessments were performed every 15 days, revealing significant improvement in the patient's overall quality of life and a notable reduction in inhaler usage. The therapy provided effective symptomatic relief and highlights the potential of Ayurvedic interventions in managing chronic allergic conditions. This study underscores the importance of a holistic approach to treatment, addressing both physical symptoms and underlying lifestyle factors.

Keywords: Pratishaya, Allergy, Ajirna Janya Pratishaya, Shaman Chikitsa, Ayurveda

Corresponding Author How to Cite this Article To Browse
Priti Holkar, Post Graduate Scholar, Department of Swasthavritta and Yoga, Government Ayurvedic College, Nagpur, Maharashtra, India.
Email: 		Holkar P, Jogad S, Exploring Ayurvedic potential in the management of Jirna Pratishaya (Allergic Rhinitis): A Single Case Report. J Ayu Int Med Sci. 2024;9(8):274-279.
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https://jaims.in/jaims/article/view/3746

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-12 2024-07-22 2024-08-02 2024-08-12 2024-08-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 11.31

© 2024by Holkar P, Jogad Sand 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].

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Introduction

The Present era is full of Chaos, stress and Strain due to lifestyle modification, changes in dietary habits, urbanisation, and industrialisation lead to increased pollution and increase resistance to the antibiotics are responsible for prevalence of many diseases The most common upsurge of diseases is Jirna Pratishaya.[1]

In India, the prevalence of allergic rhinitis in children is 21.99% and it increasing day by day due to change in life style.[2] Repeated attack, improper management or negligence of the acute stage leads the disease to chronic phase. Ama, Asatmya, Virudh Aahara and allergens, etc. mainly involves in allergic conditions. Pratishaya characterized with symptoms of sneezing, heaviness, fever, and coughing, etc.[3] Ajirna i.e., indigestion is one of the possible causes for Aam in Body which always leads to various disorders. Long term Ajirna converted into Jirna Pratishaya. Allergic Rhinitis can be correlated with Ayurvedic terminology i.e., Kaphaja Pratishaya.[4]

Pratishaya is diseases of Nasa and Shiras associated with respiratory system. Pratishaya is Kapha-Vata predominating disease which also involves vitiation of Pranavaha and Rasavaha Srotas. There are different stages of disease depending upon pathological progression of disease namely Amavastha and Pakwavastha. The untreated condition turned to the chronic and advance stage which described as Ajirna Pratishaya difficult to treat. Samanya Chikitsa, Pakwa Peenasa Chikitsa, and consideration of concepts of Pathya- Apathya play important for treating Pratishaya.[5]

Aim and Objectives

To study the role of Ayurvedic medication along with Yoga and lifestyle modification in Jirna Pratishaya i.e., Allergic Rhinitis.

Case Report

A 13-year-old male patient was diagnosed with Allergic Rhinitis by a private practitioner with complaints of

  • Nasal congestion
  • Sneezing and runny nose, Headache (Shiroshul)
  • Sinus pressure with periorbital edema (Netra Shoth)
  • General weakness (Daurbalya),
  • Other associated symptoms like trouble breathing

These symptoms were occurring on and off from past 3-4 year.

History of present illness

After taking a detailed medical history of the patient, it was found that he was suffering from Allergic Rhinitis from the past 3-4 years, for which she received symptomatic allopathy treatment from a Private allopathic institute. He was suffering from Nasal congestion, Shiroshul, Netra Shoth, from last 15 Days. So, he approached Ayurvedic Hospital and was diagnosed with Jirna Pratishaya, and treatment was started on OPD Basis.

Past Medical History

  • Known case of asthma from 4 Years
  • No surgical history
  • Patient using Bronchodilator inhaler frequently

Family History

  • No history of asthma in family.
  • No history of any Lung disorder.

Ashtavidaha Pariksha

  • Nadi: 88/min
  • Mala: Unsatisfactory bowel
  • Mutra: Samyak
  • Jivha: Saam
  • Shabda: Spashta
  • Sparsha: Samsheetushna
  • Drik: Samyak
  • Akriti: Krusha

General examination

Blood Pressure: 110/70mm of hg 

Pulse Rate: 88/min

Weight: 28kg   

Height: 148cm

BMI: 23 Kg/m

Temperature: 37° Celsius 

Systemic Examination did not reveal any abnormality.


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Laboratory Investigations
Hematological

Hb: 12.2gm%   

TLC: 9300/cu mm

DLC: P-54%, L- 38%, E+M-08%

ESR: 18mm/hr.

Platelet Count: 2.77 lac/cu mm

Personal History

  • Wake up timming: 7am
  • Bowel Habits: Unsatisfactory
  • Exercise: Never
  • Food: Vegetarian and non-vegetarian food
  • Water intake: Early in the morning in an empty stomach, during and just after food 2-3 glasses of water.
  • Breakfast: Poha, Upama, Fried rice.
  • Junk food: Frequently
  • Bed Time: 11 pm
  • Dinner: 9pm
  • Nishapana (Water intake before going to Bed): 1 glass

Samprapti

The entity Pratishaya is a respiratory disease which covers a broad spectrum of nasal and para nasal mucosal inflammation. One of the conditions of Pratishaya which is having pathological background of allergy to respiratory mucosa is consider here as a disease condition. Studying the Nidanas (etiology) of Pratishaya, allergic conditions are due to the Agni-Mandhyakara Nidanas and Santarpanotta Nidanas, which is responsible for Ammotpatti at Rasavaha Srotas and Pranavaha Srotas leading to allergic condition of respiratory system.[6]

Samprapti Ghatak

  • Nidan: Kapha Vata Prakopak Ahara Vihara
  • Dosha: Kapha Vata Pradhana, Alpa Pitta, Rakta.
  • Dushya: Rasa and
  • Agni: Jatharagni, Rasadhatwagni.
  • Srotas: Pranavaha, Rasavaha, Raktavaha.
  • Srotodushti: Sanga, Vimargagamana, Atipravruthi.
  • Adhisthana: Nasa, Shiras.

Principle of Management

Pratishaya is Amashaya Udabhava Vyadhi, So correction and production of Prakrut Rasa Dhatu is main treatment. In this case, Jirna Pratishaya was diagnosed as Ajirna and Rasa Dhatu Dushti.[7] Treatment was given specially on Agni, Rasa Dhatu along with dietary changes and Yoga Practice. These drugs help to improve Digestion and Metabolic activities of body.

Intervention Details

SNTreatmentDrug of ChoiceDuration
1.Shaman Chikitsa- LanghanWarm water, Lahya,
Murmure (Puffed Rice), futane		1 week
2.Aushadhi Chikitsa Tribhuvan Kirti Ras-1-bd
Ashtang Lavan-3gm-bd- before meal
Shwaskuthar Ras-1-bd
Gokshuradi Guggul-2-bd		2 Week
3.Dietary Advicei) Diet Chart
ii) Wholesome - Unwholesome diet		1 Month
3 Month
4.Yoga (Exercise)Suryanamaskar
Bhujangasan
Omkar Chanting
Dirgha Shwasan (Deep Breathing)		1 Month

Follow-Up Medicine: for next 15 days

  • Arjun + Ashwagandha Ksheerpak - OD (Rasayankale) i.e., empty stomach - Strengthen Heart Capacity and Immunity.
  • Avipattikar Churna - 3gm – BD - Apanee., before meal - For correction Proper Drava Pitta and Anuloman.
  • Tribhuvan Kirti Ras - 1 - BD

Diet Chart

EventsTimeAdvice
Wake up time5-6 amAvoid unnecessary water Intake
Yoga6-7amSuryanamaskar, Bhujangasan, Omkar Chanting,
Dirgha Shwasan (Deep Breathing)
First Meal8 amUpma / Soji / green gram soup + Hing + Ghrut / Fruit OR
3 fulke +1 bowl Varan + half bowl rice (Puran Shali) + Salad (Beet + Corriander + Carrot + Raddish + Tomato + Cucumber) + Awala Chutney/ Javsachi chutney Vegetables: Bitter gourd (Karla), Ridge gourd (Dodka), Drumstick (Shevga), Sankegourd (Patol). Bottle gourd (Doodhi bhopla/lauki), Dhemas, Lady's finger (bhendi), Brinjal (vangi), Fenugreek (methi), Spinach (palak), Horse gram (kulith) etc.
Lunch12 pmGoghrut + Sugar with Fulke / Fulke + one bowl vegetable + one bowl green gram Dal + buttermilk (Takra)
Last Meal (Dinner)5 pmBhakri (Nachni/Jwari) + (Green gram) Mugache varan 1 bowl + Vegetables (Bhaji)
Sleep10 pmAvoid unnecessary water Intake

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Pathya: Apathya

Pathya: It is advised to take light and Kapha Nashaka foods, lukewarm water sometimes can be used to relieve symptoms of diseases. Cereals which include barley, pulses like green gram, fruits are advised. Vegetables such as pointed gourd, bitter gourd, white gourd melon are advised. Legumes, soups, and freshly cooked hot food stuffs are considered good for respiratory problems.

Apathya: One should avoid heavy & fermented food, food causing congestion also need to be avoided. Cold, soar and excessively sweets foods; curd, yogurt, ice creams and yellow grams, etc. are restricted in such types of diseased conditions.

Lifestyle related guideline for Pratishaya

  • Avoid Cold Exposure: Steer clear of excessively cold climates, as they can exacerbate respiratory issues.
  • Keep Essential Medications Handy: Always have cloves, black pepper, and other recommended medications on hand for those susceptible to acute respiratory distress.
  • Limit Allergen Exposure: Avoid contact with common allergens such as pollen, dust, silicates, and harmful chemicals or gases.
  • Manage Physical Activity: Refrain from daytime sleeping, excessive physical exertion, and smoking, as these can strain respiratory system.
  • Respect Natural Urges: Do not suppress natural urges, as doing so can lead to toxin accumulation in body.
  • Avoid Self-Medication: Do not self-medicate with steroids or antibiotics unless prescribed by a physician.

Reports
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Discussion

  • Treatment of any disease changes according to its Hetu and In the pathogenesis of Pratishyaya, predisposing factor was Kapha vitiated due to Ahara &
  • Prime factor was Rasadhatwagni Mandyata which can be corrected through
  • They also have function like Kaphasaman & Lekhan (depletive).
  • Ras Aushadhi (Parad containing medicine) are fast acting.
  • It nourishes whole body and has tonic, aphrodisiac, rejuvenates, anti-aging, wound-healer, and antimicrobial effect.

Effects of Chikitsa protocol

A) Adravyabhut Chikitsa: No drug treatment

Langhana

By focusing on improving digestion, metabolism, and detoxification, Langhana helps address the root causes of the condition, ultimately promoting better health and alleviating symptoms.

Benefits of Laghana

Improves Digestive Power (Agni): By enhancing Agni, Laghana helps ensure that nutrients are absorbed efficiently, reducing the likelihood of allergic reactions triggered by improperly digested foods.

Rectifies Metabolism: Langhana aids in normalizing metabolic processes, which can become dysregulated in individuals with Pratishaya. A balanced metabolism can help the body process allergens more effectively, reducing the severity of allergic symptoms.


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Regresses Initial Pathological Processes: By promoting a lighter and more balanced state in the body, Langhana can help reverse early pathological changes associated with Pratishaya. This may include reducing inflammation and mucus production in the nasal passages.

Strotoshodhak: Langhana is known for its ability to cleanse and rejuvenate the channels (Srotas) of the body. This detoxifying action can help remove accumulated toxins (Ama) that contribute to allergic reactions, promoting better respiratory health.

Vyayama

By increasing energy levels, improving circulation, and strengthening the cardiovascular system, exercise can significantly alleviate the symptoms of allergic rhinitis and enhance overall well-being.

Benefits of Vyayam in treating Pratishaya

  • Increases Energy Levels and Delivers Oxygen and Nutrients to the Whole Body: Regular exercise enhances lung capacity and efficiency, improving oxygen intake. This is particularly beneficial for individuals with Pratishaya, as proper oxygenation supports respiratory health and overall vitality.
  • Strengthening Heart Muscles and Improving Circulation: Exercise strengthens the heart muscles, leading to improved cardiovascular health. Improved circulation helps in detoxifying the body by facilitating the removal of waste products and toxins, including those that may contribute to allergic reactions.
  • Enhances Immunity: Regular physical activity can strengthen the immune system, making the body more resilient to allergens. A well-functioning immune system is crucial for managing conditions like

Lifestyle Modification

Avoiding Excess Water Consumption:

Aam Utapatti: In Ayurveda, excess consumption of water can lead to the formation of "Ama," or toxins, which are often implicated in various health issues, including allergies. By limiting water intake, especially during meals, individuals can enhance digestion and reduce the likelihood of Ama accumulation. This can help minimize the severity of allergic symptoms and support overall digestive health.

Consuming Dinner Before Sunset:

Improved Digestion: Eating dinner before sunset aligns with our natural circadian rhythms, promoting better digestion. This practice allows the body to process food while it is still light outside, facilitating optimal digestive function. Eating earlier can help prevent indigestion and support the body’s natural detoxification processes overnight, which can be beneficial for managing allergies.

B) Dravyabhut Chikitsa - Drug Treatment (Aushadhi)

Correcting Rasadhatwagni Mandyata using Rasoaushadhi like Tribhuvan Kirti and Shwaskuthar Ras, etc.

Discussion on Medication

Rasa Aushadhi given with corrected Dinacharya with proper and added Yog provides more accuracy in Samprapti Bhanga i.e., Chikitsa

SNName of MedicineEffect
1.Tribhuvan Kirti Ras[8]Kapha-Vataghna, Jwarghna, Swedajanana
2Ashtang Lavan[9]Deepana, Pachana[10] and Kaphahara properties along with Shroto Shodhan (cleansing of micro channels of the body).
3Shwaskuthar Ras[11]Shwasghna (Improve respiration), Kapha-Vataghna
4Gokshuradi Guggul[12]Laghu, Dipana, Pachana, Strotovishodhako, Kledahara

Conclusion

In this Case, Atyambupana (excessive water intake) and Mithya Ahar Vihar (incorrect diet) is the main etiological factor to Aam production leading to Ajirna then finally leading to Pratishaya. Treatment of Aam Ajirna i.e., Laghana, Deepana, Pachan along with Dietary changes, Yoga gives more effective results in Jirna Pratishaya.

Correction of Little Daily routine things can make the huge difference in life and make u free from Suffocative Inhalers. Ayurvedic modalities like Dincharya, Rutucharya and Yoga played a crucial role in diseases like Pratishaya. To effectively manage allergic rhinitis in Ayurveda, a holistic approach is recommended, focusing on diet, lifestyle changes, and herbal treatments tailored to individual needs.


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References

1. Sushruta Samhita, Dalhana Commentary Nibandhasangraha, Choukhamba Orientalia, Varanasi, 2009, Uttara tantra 24/16- 17.
2. Dara PK, Kumari P, Meena H, Sharma BS. Prevalence of various oculo-respiratory allergic conditions and their comorbid association: A cross-sectional observational study in children (6–18 years) from Jaipur. Indian J Allergy Asthma Immunol 2018;32: 15-9.
3. Ashtanga Hridaya - Sarvanga Sundari Commentary Arunadatta, Choukhambha Krishna Das Academy, Varanasi, 2000, Uttara Sthana 19/1-2
4. Ayurvedalankara Shrisatyapal Bhishagacharya, Pratishaya Chikitsadhyaya, Kashyapa Samhita Chikitsastan; Choukhambha Sanskurt Sanstan, Varanasi; Ninth Edition; 2004, page 132.
5. K. Sharma, Bhagawandas, Agnivesha, Charaka Samhita, Commentary Chakrapanidatta Chowkhamba Sanskrita Series, Varanasi, 1984, Chikitsa Sthana 26/104
6. Sunil B. Patil & Rakesh Sharma: A Review Of Jirna Pratishyaya And Its Ayurvedic Management. International Ayurvedic Medical Journal {online} 2021 {cited February, 2021}
7. Patil, Sunil B. and Rakesh Sharma. “A Review of Jirna Pratishyaya and its Ayurvedic Management.”February 2021(2021): n. pag.
8. Yadav, Yadevendra. (2022). Pharmacological Activity of Constituents of Tribhuvan Kirti Rasa: A Review. International Journal of Research in Ayurveda and Pharmacy. 13. 2022. 10.7897/2277-4343.1304107.
9. Kumar Shetty, Suhas & Prakash, Bhat & H P, Savitha & KN, Sunil Kumar & Ravishankar, Basavaiah. (2013). Standardization of Astanga Lavana -A Herbo-Mineral Ayurvedic Compound. Global Journal of Research in Medicinal Plants & Indigenous Medicine 2275-4289. 2. 589-598.


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