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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
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Contents
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
COMPARATIVE STUDY OF AMRUTHA GUGGULU AND PATADI TAILA
PRATIMARSHA NASYA IN THE MANAGEMENT OF PRATISHYAYA
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Contents
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Contents
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
35 Disease aggravating and comfort features of Pratishyaya - data of Group
– B (Patadi Taila – Pratimarsha Nasya) [as described in case sheet]
101
36 Disease aggravating and comfort features of Pratishyaya - data of Group
– 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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Contents
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
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
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Introduction
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Introduction
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
enumerated with the instrumental objective parameters.
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
enumerated with the instrumental objective parameters.
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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Literary Review
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
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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:
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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.
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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.
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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”.
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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 + + + - +
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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
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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
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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.
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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)
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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) - + +
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Table No. - 4
Symptoms of Pittaja Pratishyaya
Lakshana Ch. Su. Va.
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
Lakshana Ch. Su. Va.
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) - + -
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Literary Review
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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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Literary Review
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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
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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
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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).
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(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)
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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
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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
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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
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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 +
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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 + + +
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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)
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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.
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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
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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
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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
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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.
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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.
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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.
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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
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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
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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
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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
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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.
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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
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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
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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.
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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.
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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
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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
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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
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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
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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 -
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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
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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
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Prabhava Shothahara, Vedana sthapaka, Vrana shodhana ropana,
Chakshushya
Doshagnata Kapha Pitta hara
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
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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
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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 anti- bacterial 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.
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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
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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
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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
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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
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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
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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
Doshagnata Kapha Pitta hara
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
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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.
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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
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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
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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.
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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
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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
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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.
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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),
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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.
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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.
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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
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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
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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.
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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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
Gender Age Religion Occupation Economical Condition
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,
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
86
Table –14 Demographic Data of Group – C (Amrutha Guggulu and Patadi taila – Pratimarsha Nasya)
SNo OPD No
Gender Age Religion Occupation Economical Condition
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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%
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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%
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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%
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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.
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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 +
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
105
Table - 39 Data of Group – C (Amrutha Guggulu and 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 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 + + +
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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Table - 42 Data of Group – C (Amrutha Guggulu and 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 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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
Erythrocytes sedimentation rate
3.133 2.445 0.631 4.965 <0.001 HS
Absolute Eosinophilic count
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
HS = Highly Significant, NS = Not Significant
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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%
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
118
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.
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
Ghrana Toda Arti 2.066 0.883 0.228 9.061 <0.001 H.S
Kshavathu (Sankhya) 3.0 1.069 0.276 10.869 <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
HS = Highly Significant, NS = Not Significant
Table – 54 Objective parameters Statistical study of individual Group – B
(Patadi taila – Pratimarsha Nasya)
Objective parameters Mean SD SE t-Value p-Value Remark
Erythrocytes sedimentation rate
4.733 3.825 0.987 4.795 <0.001 HS
Absolute Eosinophilic count
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
HS = Highly Significant, NS = Not Significant
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
Moderately Responded
13%
Cured13.33%
Well Responded
73.33%
Not Responded
0%
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
Ghrana Toda Arti 2.466 0.833 0.215 11.469 <0.001 H.S
Kshavathu (Sankhya) 2.333 1.046 0.2702 8.634 <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
HS = Highly Significant, NS = Not Significant
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
HS = Highly Significant, NS = Not Significant
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
objective parameters and statistically highly significant.
Results of Group -C
Moderately Responded
0%Cured
46.67%
Well Responded
53.33%
Not Responded
0%
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Results
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
Moderately Responded
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
Moderately Responded
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:
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Discussion
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Discussion
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Discussion
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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Discussion
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Discussion
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Discussion
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.
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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Discussion
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
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.
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.
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Conclusion
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Conclusion
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Conclusion
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
parameters and statistically highly significant.
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
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.
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
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10-2-32, 12-4-5, 7) Satya Narayan Shastri, Charka Samhita Chikitsa 26/105-6, 7th ed. 1991,
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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,
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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
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Bibliographic References
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Bibliographic References
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Bibliographic References
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Bibliographic References
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 êÀ 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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Case sheet
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Case sheet
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 /
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Case sheet
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Case sheet
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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Case sheet
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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
Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Case sheet
7
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)