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COMPARATIVE STUDY OF AMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHA NASYA IN THE MANAGEMENT OF PRATISHYAYA By Shreekrishna Hanumantappa Jigaloor, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

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Pratishyaya kc036 gdg

  1. 1. COMPARATIVE STUDY OF AMRUTHA GUGGULUAND 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 KayachikitsaPost Graduate Studies & Research CentreD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2004-2007
  2. 2. D.G.M.AYURVEDIC MEDICAL COLLEGEPOST GRADUATE STUDIES AND RESEARCH CENTRE GADAG - 582 103 This is to certify that the dissertation entitled “COMPARATIVE STUDY OFAMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHA NASYA IN THEMANAGEMENT OF PRATISHYAYA” is a bonafide research work done by SHREEKRISHNAHANUMANTAPPA JIGALOOR in partial fulfilment of the requirement for the post graduationdegree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University ofHealth Sciences, Bangalore, Karnataka. Date: Dr. SHIVA RAMA PRASAD KETHAMAKKA Place: Gadag M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)] Guide READER IN KAYACHIKITSA DGMAMC, PGS&RC, Gadag
  3. 3. 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. V. Varada charyulu) (Dr. G. B. Patil) Professor & HOD Principal, Dept. of Kayachikitsa DGM Ayurvedic Medical College, PGS&RC Gadag Date: Date: Place: Gadag Place:
  4. 4. Declaration by the candidate I here by declare that this dissertation / thesis entitled “COMPARATIVESTUDY OF AMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHANASYA IN THE MANAGEMENT OF PRATISHYAYA” is a bonafide andgenuine research work carried out by me under the guidance of Dr. SHIVARAMA PRASAD KETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D(Jyotish)], Reader in Kayachikitsa, DGMAMC, PGS&RC, Gadag.DatePlace (SHREEKRISHNA HANUMANTAPPA JIGALOOR)
  5. 5. 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 thisdissertation/ thesis in print or electronic format for the academic / researchpurpose.DatePlace (SHREEKRISHNA HANUMANTAPPA JIGALOOR) © Rajiv Gandhi University of Health Sciences, Karnataka
  6. 6. Contents ofCOMPARATIVE 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 KethamakkaChapter 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 & 1 Amrutha Guggulu in Pratishyaya – Contents
  7. 7. Figures of COMPARATIVE STUDY OF AMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHA NASYA IN THE MANAGEMENT OF PRATISHYAYASN Title of figures Page Number1 Schematic Samprapti of Pratishyaya 342 Procedure of Pratimarsha Nasya 413 Contents of Amrutha Guggulu 554 Contents of Patadi Taila 68 Graphs of COMPARATIVE STUDY OF AMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHA NASYA IN THE MANAGEMENT OF PRATISHYAYASN Title of graphs Page Number1 Pictorial Distribution of patients by age in all Groups 872 Distribution of patients by gender in Pratishyaya 883 Result Distribution of patients by gender in Pratishyaya 894 Distribution of patients by religion in Pratishyaya 905 Distribution of patients by occupation 916 Result of patients by occupation in Pratishyaya 927 Distribution of patients by economic status 938 Distribution of patients by diet in Pratishyaya 949 Pictorial Distribution of Results Group –A 11710 Pictorial Distribution of Results Group –B 11911 Pictorial Distribution of Results Group –C 12112 Pictorial Distribution of cumulative Results of trial 122 Patadi Taila Pratimarsha Nasya & 2 Amrutha Guggulu in Pratishyaya – Contents
  8. 8. Tables of COMPARATIVE STUDY OF AMRUTHA GUGGULU AND PATADI TAILA PRATIMARSHA NASYA IN THE MANAGEMENT OF PRATISHYAYAS Title of Table PageN Number1 Classification of Pratishyaya 212 Nidana of Pratishyaya 23 Symptoms of vataja Pratishyaya 264 Symptoms of pittaja Pratishyaya 275 Symptoms of kaphaja Pratishyaya 276 Symptoms of raktaja Pratishyaya 287 Samprapti ghataka 298 Sapeksha Nidana 359 Showing Pratishyaya as a lakshana in various diseases 3610 Showing the upadravas of Pratishyaya 3711 Pathya & Apathya in Pratishyaya 4612 Demographic data of Group – A (Amrutha Guggulu) 8513 Demographic data of Group – B (Patadi Taila – Pratimarsha Nasya) 8514 Demographic data of Group – C (Amrutha Guggulu and Patadi Taila – 86 Pratimarsha Nasya)15 Distribution of patients by age in Group –A, B, C 8616 Results of patients by age in Group – A (Amrutha Guggulu) 8717 Distribution of patients by gender in Pratishyaya 8818 Distribution of patients by religion in Pratishyaya 8919 Result of patients by religion in Pratishyaya 9020 Distribution of patients by occupation 9121 Distribution of patients by economic status 9222 Distribution of patients by diet in Pratishyaya 9323 Chief & associated complaints of Group – A (Amrutha Guggulu) 9424 Chief & associated complaints of Group – B (Patadi Taila Pratimarsha 95 Nasya) Patadi Taila Pratimarsha Nasya & 3 Amrutha Guggulu in Pratishyaya – Contents
  9. 9. 25 Chief & associated complaints of Group – C (Amrutha Guggulu and 95 Patadi Taila – Pratimarsha Nasya)26 Chief complaint & associated complaints of Group- A, B, C 9627 Subjective statistical assessment data of Group – A (Amrutha Guggulu) 9728 Subjective statistical assessment data of Group – B (Patadi Taila – 97 Pratimarsha Nasya)29 Subjective statistical assessment data of Group – C (Amrutha Guggulu 98 and Patadi Taila – Pratimarsha Nasya)30 Data of Group – A (Amrutha Guggulu) [as described in case sheet] 9831 Data of Group – B (Patadi Taila – Pratimarsha Nasya) 9932 Data of Group – C (Amrutha Guggulu & Patadi Taila Pratimarsha 99 Nasya)33 Chief complaint details of Group- A, B, C 10034 Disease aggravating and comfort features of Pratishyaya - data of Group 101 – A (Amrutha Guggulu) [as described in case sheet]35 Disease aggravating and comfort features of Pratishyaya - data of Group 101 – B (Patadi Taila – Pratimarsha Nasya) [as described in case sheet]36 Disease aggravating and comfort features of Pratishyaya - data of Group 102 – C (Amrutha Guggulu and Patadi Taila – Pratimarsha Nasya)37 Pathogenic factors of Pratishyaya data of Group – A (Amrutha Guggulu) 103 [as described in case sheet]38 Pathogenic factors of Pratishyaya data of Group – B (Patadi Taila – 104 Pratimarsha Nasya) [as described in case sheet]39 Pathogenic factors of Pratishyaya data of Group – C (Amrutha Guggulu 105 and Patadi Taila – Pratimarsha Nasya) [as described in case sheet]40 Etiological factors of Pratishyaya data of Group – A (Amrutha Guggulu) 10741 Etiological factors of Pratishyaya data of Group – B (Patadi Taila – 108 Pratimarsha Nasya) [as described in case sheet]42 Etiological factors of Pratishyaya data of Group – C (Amrutha Guggulu 109 and Patadi Taila – Pratimarsha Nasya) [as described in case sheet] Patadi Taila Pratimarsha Nasya & 4 Amrutha Guggulu in Pratishyaya – Contents
  10. 10. 43 Objective statistical assessment data of Group – A (Amrutha Guggulu) 11144 Objective statistical assessment data of Group – B (Patadi Taila – 111 Pratimarsha Nasya)45 Objective statistical assessment data of Group – C (Amrutha Guggulu and 112 Patadi Taila – Pratimarsha Nasya)46 ANOVA table for the parameter erythrocyte sedimentation rate 11347 ANOVA table for the parameter absolute Eosinophils count 11448 ANOVA table for the parameter differential count (Eosinophils) 11549 ANOVA table for the parameter total count 11550 Subjective parameters statistical study of individual Group – A (Amrutha 116 Guggulu)51 Objective parameters statistical study of individual Group – A (Amrutha 116 Guggulu)52 Results of Group – A (Amrutha Guggulu) 11753 Subjective parameters statistical study of individual Group – B (Patadi 118 Taila – Pratimarsha Nasya)54 Objective parameters statistical study of individual Group – B 118 (Patadi Taila – Pratimarsha Nasya)55 Results of Group – B (Patadi Taila – Pratimarsha Nasya) 11956 Subjective parameters statistical study of individual Group – C 120 (Amrutha Guggulu and Patadi Taila – Pratimarsha Nasya)57 Objective parameters statistical study of individual Group – C 120 (Amrutha Guggulu and Patadi Taila – Pratimarsha Nasya)58 Results of Group – C (Amrutha Guggulu and Patadi Taila – Pratimarsha 121 Nasya)59 Cumulative Results of the trial 122 Patadi Taila Pratimarsha Nasya & 5 Amrutha Guggulu in Pratishyaya – Contents
  11. 11. 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 ofmy 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 expertguidance at the completion of this dissertation. I express my thankfulness to beloved principal Dr. G. B. Patil, for his encouragementas 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 substaff 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. ShashikantNidagundi, 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 LateDr. C.S. Sarangamath. I express my sincere thanks to Mr. Nandakumar for his help instatistical analysis of results.
  12. 12. Behind my success, the pillars are my parents, Renuka Devi and Hanumantappa awarm 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 meand 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. ShekharSharma, 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 alwaysincomplete. Last but not least, I am thankful to our JSVVS Chairman Sri S.V. Saunshi, for hisencouragement to join in to PG course. At last my sincere thanks to the subjects who cooperated at my dissertation, with outof them it would have been not a success.Place:Date: Shreekrishna Hanumantappa Jigaloor,
  13. 13. 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 KethamakkaKeywords: Pratishyaya, Pratimarsha, Nasya, Immunity, IgE, Nasasrava, The history reveals that the Pratishyaya exists from ages. Pratishyaya is consideredas a disease since 2500 BC, the classical age of Ayurveda. Pratishyaya is a complex diseaseinvolving several symptoms and diversified pathogenesis. Pratishyaya is an IgE mediatedhypersensitivity disease of mucous membranes of the nasal airways. In Purvarupas ofRajayakshama Pratishyaya can be seen. Pratishyaya is an acute disease of Pranavaha Srotasand Nasa srava and Nasavarodha characterize it. Only Charaka and Kashyapa havementioned about the general symptoms of Pratishyaya. Samanya Chikitsa of Pratishyaya,according to Chakrapani, five diseases viz. Netraroga, Kukshiroga, Pratishyaya, Vrana andJwara, are cured with Langhana Chikitsa within five days. Susruta has specificallymentioned Vamana in Pratishyaya Chikitsa. Vyadhi kshamatwam and Vyadhi balavirodhitwam are developed by the medicament and procedure. In this study three group’sviz. 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 thesubjective and objective parameters and statistically highly significant. The results of theGroup –B as shown above exhibits the 2 (13.33%) patients cured, 11 (73.33%) wellresponded patients and Moderately responded patients are 6 (40%) after the throughexamination 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 andobjective parameters and statistically highly significant. The cumulative results of the trial asshown 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 andobjective parameters and statistically highly significant. Patadi Taila Pratimarsha Nasya & Amrutha Guggulu in Pratishyaya – Abstract
  14. 14. Chapter – 1 Introduction “ fficient doctor treated common cold in seven days other wise it is cures in oneweek” is the good olden saying. In spite of the development of health care systems in allareas common minimum subjects are still for the discussion in the mob. One such conditionsuffers the common man is “Pratishyaya” vis-à-vis common cold. Common is for everybody, may be the King or Worker. As we observe the human development patterns the pollutant environment is the rootcause of the all-allergic manifestations, dealt in Ayurveda as Gramavasa VyapannakrutaVyadhi. Dusts, smoke, Pollen and other fine substances etc. play the role of irritants. Themodern lifestyle makes continuous and close relationships with the causes of nasal irritationsuch 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 thedevelopment, recurrence a well as in the curative aspect of the Pratishyaya. Identification ofaggravating factors of allergens is the first step of management as rightly said by theAyurveda as Nidana Parivarjanam. But on the aetio-pathological aspects of a critical studyon Ayurvedic parlance is important to offer better remedy for the poor patients. Pratishyaya is a complex disease involving several symptoms and diversifiedpathogenesis. It is a nuisance to the affected irrespective of age and sex. Description of thisdisease 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 & 1 Amrutha Guggulu in Pratishyaya – Introduction
  15. 15. is not managed properly, can lead to several complications, which may be life threatening orcrippling in future. If it happens to a child or delicates the condition is more troublesome andis a headache to both physician and attendants. Pratishyaya although a mild disease, it can make patients externally uncomfortableand can interfere with the routine activities. Pratishyaya is considered as a disease since2500 BC, the classical age of Ayurveda. All major texts of Ayurveda have devoted theirattention to various aspects of the disease. Pratishyaya is an IgE mediated hypersensitivitydisease of mucous membranes of the nasal airways. It is a chronic disabling disorderaffecting at least over 10% of population. It is especially disturbing to notice that the spreadof 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 immunityhave subjected the man to innumerable modern health hazards. One such condition is VatajaPratishyaya with a similar clinical entity with that of Allergic Rhinitis established by theother researchers. A simple common cold or Pratishyaya affects most of the population. Probably veryfew people have been left untouched by these irksome disorders. However, if this isneglected for a longer period, it may lead to more serious problem like Sinusitis, Bronchitisor such other Upper respiratory tract infection. Even in Ayurveda it is said that Pratishyayalet it be Ekadoshaja or Bahudoshaja, if not treated properly may lead to Dushta Pratishyayaand later Kasa, or even Kshaya. Pratishyaya as such is a disease situated in the Nasa 1, which is a pathway or gatewayof head and related organs. These organs are parts of the Shiras (head). Shiras, in fact is one Patadi Taila Pratimarsha Nasya & 2 Amrutha Guggulu in Pratishyaya – Introduction
  16. 16. of the important organ of the body and given prominence by Charaka and Susruta. Shiras is 2,said to be Uttamanga 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 powerfulrays, Shiras reaches to all parts of the body through its Vatanadis and controls all thephysiological functions. Hence Shiras has to be taken into consideration while discussingthe pathology and management of Dushta Pratishyaya. For the present study Pratishyaya that is a very common disease affecting any agegroup of both sex and prevalent worldwide has been noticed. It is well known for itsrecurrence and chronic appearance. Recurrence of the disease occurs because the Doshashave not been evacuated completely. Such Doshas reside in their latent stage (predisposingstage) 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 thisway disease attains the Jeerna Avastha. Anurjita Pratishyaya (Allergic Rhinitis) is alsorecurring frequently and attending the Jeerna Avastha, as per the Charaka for which Nasya isthe 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 4.Pratimarsha Ayurveda offers scope in the form of Pratimarsha Nasya, which is explainedas a procedure for resisting such disorders. Pratimarsha Nasya with Anutaila 5 is explainedas a procedure in Dina charya (daily routines) for prevention of Nasagata Rogas in particularand Urdhwajatrugata Vikara in general. Patadi Taila Pratimarsha Nasya & 3 Amrutha Guggulu in Pratishyaya – Introduction
  17. 17. 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 asshamanaoushadi 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 actionswith the ingredients embedded in them. The actions observed from the individual drugcomponents 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 & 4 Amrutha Guggulu in Pratishyaya – Objectives
  18. 18. • Over the immune system as - Anti oxidative, Immuno stimulant, Rasayana and Chakshushya, The objectives are analyzed under the lime light of the material hypothetically andexperimentally 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 & 5 Amrutha Guggulu in Pratishyaya – Objectives
  19. 19. Chapter – 3 Literary review here there is nose, there is cold and Pratishyaya persists. The history reveals that thePratishyaya exists from ages. We call it the “common cold” for good reason. There are overone billion colds in the all over Globe each year. Generally all but children will probablyhave more colds than any other type of illness. Many people continue getting coldthroughout life even. Parents often get them from the kids. It’s the most common reason thatchildren 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 ofviruses, including rhinovirus and adenovirus. These viruses can also cause laryngitis orbronchitis 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 orsneeze that sprays many virus particles into the air. These viruses do not respond toantibiotics. Severe infections, however, may require medical care and prescriptionmedication. If you develop a fever higher than 102 degrees Fahrenheit, have a history ofasthma, an ear infection, laryngitis or bronchitis, you should see you doctor as soon aspossible. If your symptoms last longer than five days, you should also see you doctor. If youhave 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 & 6 Amrutha Guggulu in Pratishyaya – Literary Review
  20. 20. Historical review of PratishyayaPre-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 aboutPratishyaya. In Atharvana Veda words like Vekelandu, Vilohitha, Devakosha wereavailable. In Rig-Veda and Atharvana Veda also description of Urdhvajatru Rogas and itstreatment is available. The treatment descriptions like Snehana, Swedana, and Nasya arealso available in this regard.Samhita period: Samhita period is an important period during which, Trimarmiya Adhyaya of CharkaChikitsa 7 explains 5 types of Pratishyaya. Detailed clinical features and therapeutics havebeen mentioned in the same chapter. Susruta the great authority on Shalya and ShalakyaTantra has explained Pratishyaya and Peenasa, while explaining 31 varieties of Nasarogas 8. Bhela Samhita explanations are available in Shirovirechana adhyaya 9. Even Haritha 10 11 12Samhita explained Pratishyaya in detail. Astanga Sangraha and Astanga Hridaya areimportant treatises of this period, which have dealt Pratishyaya vivid. Vagbhata in hisAstanga Hridaya mentions 6 varieties of Pratishyaya.Sangraha kala: In Madhava Nidana 13 the Author has mentioned Nidana aspect of Pratishyaya. The 14description is identical to that of Susruta Samhita. Gada Nigraha explanations of 15,Pratishyaya are also available. Sharangadhara Samhita Bhavaprakasha 16, Yogaratnakara17 18 and Bhaisajya Ratnavali are important texts of this period dealt Pratishyaya. In Patadi Taila Pratimarsha Nasya & 7 Amrutha Guggulu in Pratishyaya – Literary Review
  21. 21. Yogaratnakara the description of Pratishyaya and their treatment is identical to that ofSusruta Samhita. Many prescriptions are seen for the Chikitsa of Pratishyaya in Nasa Rogaprakarana of Bhaishajya Ratnavali is also found. By reviewing the chronological development details about Nasa rogas in general andPratishyaya in particular, can be appreciated. It is evident that Ayurvedic Scholars haveachieved some mastery in medical treatment of urdhvajatrugata vikara.Adhunika kala: Colds were known in ancient Egypt; there were hieroglyphs representing the coughand the common cold. The Greek physician Hippocrates gave a description of the disease inthe 5th century BC. Common cold was also known among the ancient American IndianAztec and Maya civilizations. In the 18th century, John Wesley wrote a book about curing diseases; it advisedagainst cold baths, stating that chilling causes the common cold. The work was widelyreprinted in the 19th century. Another book by William Buchan in the 18th century also gavewet feet and clothes as the cause of the common cold 19. In 1904 Killan performed his external frontal sinus operation. Modern work onallergy 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: inpockets across the globe, something erupted that seemed as benign as the common cold. Theinfluenza of that season, however, was far more than a cold. In the two years that thisscourge ravaged the earth, a fifth of the worlds population was infected. The flu was most Patadi Taila Pratimarsha Nasya & 8 Amrutha Guggulu in Pratishyaya – Literary Review
  22. 22. deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza, whichis usually a killer of the elderly and young children. The influenza pandemic of 1918-1919 killed more people than the Great War, knowntoday as World War I (WWI), at somewhere between 20 and 40 million people. It has beencited as the most devastating epidemic in recorded world history. More people died ofinfluenza in a single year than in four-years of the Black Death Bubonic Plague from 1347to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a globaldisaster 20. In 1980 - rhinology cold well, Luc Scanes spicer had independently devised themodern radical operation on the maxillary antrum. The idea that microscopic infectious agents cause disease arose in the second half ofthe 19th century. Initially, bacteria were suspected to be the cause of the common cold, andvaccines 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 thatthey could pass through all filters and could not be seen under a microscope. In 1914, WalterKruse, a professor in Leipzig, Germany, showed that viruses caused the common cold: nosesecretions of a cold sufferer were diluted, filtered, and introduced into the noses ofvolunteers, producing colds in Common cold - Wikipedia, the free encyclopedia about halfof the cases 21. These findings were not widely accepted, until Alphonse Dochez repeated them inthe 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 stillpresented bacteria as the most likely cause 21. In the United Kingdom, the civilian Medical Patadi Taila Pratimarsha Nasya & 9 Amrutha Guggulu in Pratishyaya – Literary Review
  23. 23. Research Council set up the Common Cold Unit in 1946. The unit worked with volunteerswho were infected with various viruses. The rhinovirus was discovered there. In the late1950s, researchers were able to grow one of these cold viruses in a tissue culture, as it wouldnot 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 ofrhinovirus infection protects somewhat against the disease, but no practical treatment couldbe developed. The unit was closed in 1989, just two years after it demonstrated the benefitof 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 childrenand least in patients over 55 years of age. The children of early school age are moresusceptible to colds while immunity to droplet infection is gradually being acquired. In 1931 Willia Duke studied another very interesting type of hypersensitiveness isthat to cold and heat. In 1945 Henry and Sigerist said that the common cold and itscomplications do not kill people but they create more temporary disability than any otherdiseases and we are still unable to prevent or cure them. In 1980-81 Mackenzie wrote one ofthe first systemic treatise on disease of the nose and throat in establishing special hospitalsfor such cases and insisting on the legitimate claims of the specialty.History of NasyaVedic period Few Mantras of Rigveda indirectly refer towards the Karmas, which are includedunder Panchakarma measures, such as Nasya. A Mantra of Rigveda, in which eradication ofRoga 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 Patadi Taila Pratimarsha Nasya & 10 Amrutha Guggulu in Pratishyaya – Literary Review
  24. 24. term Nasya Karma has been used many times in Krishna Yajurveda, Satapatha Brahmana &Upanishatas. “Sanjivani” for Nasya reference is available from Valmiki Ramayana whileLakshmana became unconscious. Buddha period Jataka stories speak about the famousvaidya “Jeevaka”, who has utilized several times Nasya Karma for Shirah shoola to treat thewife of Shreshthi of Sakela Nagar and to Lord Buddha for his suffering - a Nasya forVirechana in the total dose of three Utpala Hasta. Vinaya-Pitika of Bouddha literaturestates 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 ofperfection and precision that it was also being used as one of the best methods of medicinal 23administration, for transforming the intra uterine sex Trans-nasal administrations areadmitted.Contemporary knowledge of Nasya therapy Other countries of the world did not contribute much of the subject Nasya. So it wasnever developed as a special therapeutic measure with them. Occasionally some powders forproducing sneezing were utilized by Halen (1st century AD) and Hippocrates (4th centuryAD). After and during the 17th century AD Barcon (1626) and Salva (1631) used powdersfor administration through the nose. Halen was the first to use the technical term ERRHINES meaning that like devices tobe used in to the nose. T.Johnson (1634) mentions about the dry errhines to be blown Patadi Taila Pratimarsha Nasya & 11 Amrutha Guggulu in Pratishyaya – Literary Review
  25. 25. 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 theprinciple “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 26Shareera (Surface Anatomy and Physiology)NASA (nasal cavity) The nose is one among the Pratyangas of body and is having due significance inAshtanga 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 withmainly 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 portalfor the production of the diseases as well as means for the medicaments. Nasa is important in Shalya tantras as Marma, Nasa bandhana, other traumaticincidence are concerned or even for the nasal plastic surgery. The Marmas like Phanas, 28Shringhataka, Matruka are related with nose. It is very crucial for the Marma aspect the Patadi Taila Pratimarsha Nasya & 12 Amrutha Guggulu in Pratishyaya – Literary Review
  26. 26. Rakta moksha where care is under taken, where three Siras (arteries) are to be avoidedduring this treatment. An excellent knowledge of cosmetic plastic surgery was prevalent during the periodof Susruta and it is beautifully mentioned 29. Also Nasa is important in surgery with respectto Raktamokshana for different diseases like Timira, Akshipaka 30 are concerned. Ancient ENT practitioners knew a detailed morbid anatomical and physiologicalknowledge. A crystal clear knowledge of Nasa sharira described along with lots of diseasesregarding nose. A relation of general body systemic homeostasis with Nasal diseases[Trishna, Jwara, Gatragaurava] and interconnections between Nasa and other adjacentorgans like ear, throat 31 are discussed vivid. The Ghranendriya are derived from Atmaja bhavas 32 and Nasa from Matruja as it is 33 34Mrudu and it is start to develop at third month of gestation , and fully manifest at themonth of six or seven 35. Susruta has considered Nasa as a Pratyanga i.e. secondary organ ofthe body. Similarly while enumerating the external orifices of the body; Susruta hasconsidered 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 astribhag angulas i.e. (1.1/3) inches angulas in length as far as horizontal plane is concerned. Patadi Taila Pratimarsha Nasya & 13 Amrutha Guggulu in Pratishyaya – Literary Review
  27. 27. Salient features of Nasal Anatomy & Physiology are 36– The nose is the primary passageway for air entering the respiratory system. Airnormally enters the respiratory system through the paired external nares, or nostrils, whichopen into the nasal cavity. The vestibule is the space contained within the flexible tissues ofthe nose. The epithelium of the vestibule contains coarse hairs that extend across theexternal nares. Large airborne particles, such as sand, sawdust, or even insects, are trappedin these hairs and are thereby prevented from entering the nasal cavity. The nasal septum divides the nasal cavity into left and right portions. The bonyportion of the nasal septum is formed by the fusion of the perpendicular plate of the ethmoidbone and the plate of the vomer. The anterior portion of the nasal septum is formed ofhyaline 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 andsuperior walls of the nasal cavity. The mucous secretions produced in the associatedparanasal sinuses, aided by the tears draining through the nasolacrimal ducts; help keep thesurfaces of the nasal cavity moist and clean. The olfactory region, or superior portion of thenasal 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 yoursense of smell. The superior, middle, and inferior nasal conchae project toward the nasal septumfrom the lateral walls of the nasal cavity. To pass from the vestibule to the internal nares, air Patadi Taila Pratimarsha Nasya & 14 Amrutha Guggulu in Pratishyaya – Literary Review
  28. 28. 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 theincoming air bounces off the conchal surfaces and churns around like a stream flowing overrapids. This turbulence serves a purpose: As the air eddies and swirls, small airborneparticles are likely to come into contact with the mucus that coats the lining of the nasalcavity. In addition to promoting filtration, the turbulence allows extra time for warming andhumidifying the incoming air. It also creates eddy currents that bring olfactory stimuli to theolfactory receptors. A bony hard palate, formed by portions of the maxillary and palatine bones, formsthe floor of the nasal cavity and separates the oral and nasal cavities. A fleshy soft palateextends posterior to the hard palate, marking the boundary between the superiornasopharynx and the rest of the pharynx. The nasal cavity opens into the nasopharynx at theinternal nares.The Nasal Mucosa The mucosa of the nasal cavity prepares the air you breathe for arrival at your lowerrespiratory system. Throughout much of the nasal cavity, the lamina propria contains anabundance of arteries, veins, and capillaries that bring nutrients and water to the secretorycells. The lamina propria of the nasal conchae also contains an extensive network of largeand highly expandable veins. This extensive vascularization provides a mechanism forwarming and humidifying the incoming air (as well as for cooling and dehumidifying theoutgoing 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 fromyour nasal cavity to your lungs has been heated almost to body temperature, and it is nearly Patadi Taila Pratimarsha Nasya & 15 Amrutha Guggulu in Pratishyaya – Literary Review
  29. 29. saturated with water vapor. This mechanism protects more delicate respiratory surfaces fromchilling or drying out—two potentially disastrous events. Breathing through your moutheliminates 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 provideair 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 nasalcavity. This air is warmer and more humid than the air that enters; it warms the nasalmucosa, and moisture condenses on the epithelial surfaces. Thus breathing through yournose 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 smallspaces by bony septam. The roof of the sinus lies about 1cm. below the level of the nasalcavity in adults and is formed by the alveolar process of maxilla. The anteriolateral wall isformed by the anterior part of the body of maxilla. It contains the anterior superior dentalvessels 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 medialwall. The posterior wall is formed by the posterior surface of maxilla. The opening of themaxillary sinus is in the posterior part of the hiatus semilunaris between bulla ethmoidalisand the uncinate process of the ethmoid bone, on the lateral wall of the nose below themiddle turbinate. The capacity of sinus varies between 15 ml to 30 ml. The roots of thepremolar and molar teeth may project into the sinus cavity. The marrow containing bonemay be present up to 18 months of age and therefore, Osteomyelitis of the maxilla may Patadi Taila Pratimarsha Nasya & 16 Amrutha Guggulu in Pratishyaya – Literary Review
  30. 30. occur during this period. The postrosuperior dental vessels and nerve supply the sinusmucosa.Frontal Sinus: Frontal sinuses are two in number and develop in the frontal bone. The two sinusesare usually unequal in size. The anterior wall and floor of the sinus have marrow-containingbone; hence, Osteomyelitis can develop in this region at any age. The floor of the sinusforms parts of the root of orbit. The posterior wall forms the anterior boundary of theanterior cranial fossa; hence infection of the sinus can travel to the anterior cranial fossa andorbit. The frontal sinus is drained by the frontonosal duct, which opens in the anterior part ofthe middle meatus. The average capacity of the sinus is about 7ml. in adult. The supraorbitalnerve and vessels supply the sinus.Ethmoid Sinuses: These are multiple air-containing cells situated in the ethmoidal labyrinth. These arearranged in three main groups as anterior group, middle group and the posterior group. Theanterior group of cells drains into the anterior part of the middle meatus. The middleethmoidal cells drain in the middle meatus on the ethmoid bulla or above it while theposterior ethmoid cells drain into the superior meatus. The ethmoidal air cells are relatedlaterally to the orbit and are separated from it by a thin bone lamina papyracea. Posteriorlythe ethmoids are related to the optic foramina. Superiorly the ethmoid air cells may reach toa level above the cribriform palate. The anterior and posterior ethmoid nerves and vesselssupply these sinuses.The Sphenoid Sinus: Patadi Taila Pratimarsha Nasya & 17 Amrutha Guggulu in Pratishyaya – Literary Review
  31. 31. Sphenoid sinuses develop in the body of the sphenoid bone. The two sinuses areunequally divided by a septum. Superiorly the sinus is related to the frontal and olfactorytracts. Above and posteriorly lies the pituitary gland in the sella turcica. Laterally the sinus isrelated to the optic nerve and cavernous sinus. The sinus opens through the anterior wall inthe sphenoethmoidal recess.Functional aspects of Upper Respiratory Tract1) Respiratory passage: Normally, breathing takes place through the nose. The inspired air passes upwards isa narrow stream medial to the middle turbinate and then downward and backwards in theform of an arc, and thus respiratory air a currents are restricted to the central part of the nasalchambers.2) Filtration: The nose serves as an effective filter for the inspired air: Vibrissae (nasal hair) in thenasal vestibule arrest large particulate matter of the inspired air. The fine particulate matterand bacterial are deposited on the mucus blanket, which covers the nasal mucosa. Themucus contains various enzymes like lysozymes having antibacterial properties. The ciliarymovements’ carry the mucus with the particulate matter posterior to the oropharynx, to beswallowed.3) Air conditioning and humidification: The highly vascular mucosa of the nose maintains constancy of temperature of airand thus prevents the delicate mucosa of the respiratory tract from any damage duet totemperature variations. The humidified air is necessary for proper functioning and integrityof the ciliated epithelium. Patadi Taila Pratimarsha Nasya & 18 Amrutha Guggulu in Pratishyaya – Literary Review
  32. 32. 4) Vocal resonance: The nose and Para nasal sinuses serve as vocal resonators and nasal passages areconcerned 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 andnasopulmonary, nasobronchial and olfactory reflexes. These protect the mucosa and regulatethe vasomotor tone of the blood vessels. Olfactory reflexes influence salivary, gastric andpancreatic glands.6) Olfaction: This function of the nose is less developed in human beings. This sensation plays themost important role in behavior and reflex responses of lower animals. The olfactorymucosa is located in roof of nasal cavity and adjacent area of superior turbinate and upperpart of septum. The olfactory cells are distributed in the olfactory mucosa. The mechanismof olfactory stimulation is uncertain. Various theories have been propagated. Theodoriferous substance reaches the olfactory cells by air, probably by diffusion. The olfactorysensitivity differs in individuals and is influenced by many physiological factors andpathological 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. Patadi Taila Pratimarsha Nasya & 19 Amrutha Guggulu in Pratishyaya – Literary Review
  33. 33. 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, whichmeans to move. This Dhatu when prefixed by ‘PRATI’ and suffixed by ‘GATAV’ gives riseto 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 becomesPratishyaya. It means the condition in which continuous (Prati Kshanam) flow (Shyayate) iscalled as Pratishyaya. In vakya sudha vyakhya commentary on Amarakosha of Amar Simhathe term Pratishyaya is described, as when almost continuous secretion is present from noseis known as Pratishyaya. The above etymological developments can be combined together inbrief 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 “PrathikshanamShatheithi Pratishyaya”. Patadi Taila Pratimarsha Nasya & 20 Amrutha Guggulu in Pratishyaya – Literary Review
  34. 34. Definition of Pratishyaya Dalhana on Susruta Samhita has defined it as: The condition was in Kapha bodyconstituents’ follows the Vata for coming out of the body, is called as Pratishyaya. Otherwise understood as the secretion produced from nose due to the derangement ofKaphadeenam (i.e., Kapha, Vata, Pitta, or Rakta or any combination of these Doshas) flows 37.downwards against the inspired air Charaka defined Pratishyaya is, Kapha, Pitta, Raktawhich are present in ghrana moola, combines with Vata resulting in the secretion whichflows against the inspired air is called Pratishyaya 38.Classification of Pratishyaya Almost all authors except Charaka and Kashyapa are explaining five types ofPratishyaya. Medieval period authors have followed Madhavakara, who himself hasfollowed 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. HoweverNasapaka, Nasa daurgandhya were described in the context of Dushta shonitaja Vikaras.The many classifications are framed as table here. Table – 1 Classification of PratishyayaSamhita Vata Pitta Kapha Rakta SannipatajaCharaka + + + - +Susruta + + + + +Vagbhata + + + + +Kashyapa + + + - + Patadi Taila Pratimarsha Nasya & 21 Amrutha Guggulu in Pratishyaya – Literary Review
  35. 35. Nidana of Pratishyaya Etiological factors are the first modalities among the main 5 diagnostic methodsdescribes in Ayurveda Nidana. The importance of Nidana (Hetu) lies regarding with themitigation of disease as well as in Chikitsa of the disease. All the Nidana are classified intothree main group’s viz. Ahara, Vihara, Manasika and presented in this table. Table No. – 2 Nidana of Pratishyaya NIDANA Ch. Su. Va. Ka. AharajaAjeerna + - - +Shita Ambu + + + +Ati Jalsevana - - + -Dvividha Dugdhapana - - - +Excessive intake of Guru, Madhura, Sheeta Padarthas - - - +Mandagni - - - +Vishmashana - - - + ViharajaVega 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 - - + + ManasajaAti Krodha + - - -1) Aharaja: Ama is a cause for Pratishyaya by the steps of Chaya, Prakopa, Prashara etc. On theother hand if one eats more than his capacity he gets Ajeerna and this type of Ajeerna causethe 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 Patadi Taila Pratimarsha Nasya & 22 Amrutha Guggulu in Pratishyaya – Literary Review
  36. 36. containing properties like Guru, Shita, and Madhura etc. cause the decrease of Agni; RukshaGuna makes the Agni Vaishmya similarly. Guru, Mahdura, Atidrava food intake and intakeof 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 thebody. Meanwhile in the head, it vitiates the Tarpakakapha. By the retention of Anya Vegaslike Chhardi, Mutra, Purisha, Pratishyaya may be produced. Commentators explained it asday 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 suchas by more talking has major role in the production of Pratishyaya. Over indulgence inintercourse, cause Shukra Kshaya, Vata Prakopa as well as Ojo Kshaya, which may produceto Pratishyaya. More play in water may lead to Pratishyaya; especially contaminated orunexpected climate changes change homeostasis of body especially in Rutusandhi, whichlater cause the Pratishyaya. But in this context, Shishira and Vasanta Sandhikala arespecified. Here the accumulation of Kapha in winter causes the Pratishyaya in spring seasonis categorized in to a particular Hetu called Viprakrishta Hetu. The smoke irritates the nasal mucosa to produce discharge and it affects allrespiratory tracts. These all cause the vitiation of Prana, Udanavata and Tarpakakapha toproduce Pratishyaya. Dust enters into the nostrils and is hindered by the local hairs there. Itcauses irritant to the nasal mucosa and produces watering, which may stick into nasalmucosa and cause of roughness. If dust level rises more than the certain level, it makes the Patadi Taila Pratimarsha Nasya & 23 Amrutha Guggulu in Pratishyaya – Literary Review
  37. 37. 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 atdifferent 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. Patadi Taila Pratimarsha Nasya & 24 Amrutha Guggulu in Pratishyaya – Literary Review
  38. 38. Poorva Roopa Purvaroopa (premonitory symptoms) are those signs and symptoms, which appearprior to the actual manifestation of the disease and are not specifically assignable to theDoshas as they are mile and few in number. Signs and symptoms, which with certainty aresuggestive of the future disease appearance, are termed as Purvaroopa. They can be eitherSamanya (general) Purvarupa or Vishishtha (specific) Purvaroopa. The following are 40Susruta stated the Purvaroopa of Pratishyaya. Madhava Nidana and Bhavprakasha havefollowed 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 ofPratishyaya. 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) Patadi Taila Pratimarsha Nasya & 25 Amrutha Guggulu in Pratishyaya – Literary Review
  39. 39. Kashyapa has mentioned the following general symptoms based upon the Doshainvolvement 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 PratishyayaLakshana 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) - + + Patadi Taila Pratimarsha Nasya & 26 Amrutha Guggulu in Pratishyaya – Literary Review
  40. 40. Table No. - 4 Symptoms of Pittaja PratishyayaLakshana 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 PratishyayaLakshana 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 & 27 Amrutha Guggulu in Pratishyaya – Literary Review
  41. 41. Table No. –6 Symptoms of Raktaja PratishyayaLakshana 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 41in the head accumulated aggravates Vata and gives raise Pratishyaya . While describingSamprapti Susruta affirms that, Vata and other Doshas, either individually or in collectivelyand with or without the association of Rakta gradually accumulate in the head and whenfurther vitiated by their respective exciting causes, produce Pratishyaya 42. Vagbhata explains that, when the vitiated Vata pradhana Doshas, gets localized inthe nasal cavities, gives rise to Pratishyaya. If not treated properly, the increased Dosha maylead to Kshaya even 43. Kashyapa has mentions are due to Nidana, Mandagni and Vishamashana, theaggravated Vata vitiates seat of Kapha and this vitiates the channels situated near Nasika tocause Pratishyaya. In this disease the patients always excretes out the secretionscontinuously, so it is called Pratishyaya 44. Patadi Taila Pratimarsha Nasya & 28 Amrutha Guggulu in Pratishyaya – Literary Review
  42. 42. 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 beelaborated 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 inUrah Desha (chest). This accumulation of Dosha produces mild symptoms in the form ofIccha and Dvesa (like and dislikes) for certain foods, activities etc. Liking or desire is forthose 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 personrecognizes these instincts (likes and dislikes) and acts accordingly, the Doshas will come Patadi Taila Pratimarsha Nasya & 29 Amrutha Guggulu in Pratishyaya – Literary Review
  43. 43. back to their normal condition. On the other hands, if they are not recognized and the personcontinues to indulge in causative factors like unhealthy foods, the Doshas undergo increasefurther. Dalhana clarifies phenomena of each Doshas in the head region. Accordingly, PranaVata has its field of activity in the head. Among Pitta, Alochakapitta and Bhrajakapitta canbe considered and Tarpakakapha site in the head is well known. Rakta circulating throughhead also gets accumulated in the head.2. Prakopa of Pratishyaya In the second stage Prakopa (vitiation), the further increased Dosha leads to vitiationexcitation 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 ofappropriate 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 takesplace. The Doshas undergo further increase an invade the sites of other Doshas in addition totheir own; Vata to the sites of Pitta or Kapha, Pitta to sites of Vata or Kapha, Kapha to sitesof Vata or Pitta. If effective treatment is taken, the Doshas will come back to normal. If theperson continues to indulge in unhealthy foods etc., or if the treatment is ineffective, theabnormality continues further to the onset of the fourth stage. The Kosthagni, becomes abnormal (Agni Vaisamya) by the action of the unhealthyfoods 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 today etc. Increase of Pitta causes Tiksnagni (excessively keen, strong) making digestion Patadi Taila Pratimarsha Nasya & 30 Amrutha Guggulu in Pratishyaya – Literary Review
  44. 44. 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 - (improperlyprocessed, over processed or inadequately processed intermediary products of digestion)remain over in the Ahara Rasa (essence of food). The quantity of such materials is moreincase of Mandagni, moderate in case of Visamagni and very little in case of Tiksangni. InPrasara the vitiated Dosha through Rasa and Raktavaha Channels circulates through out thebody. 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 atcertain 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 easyprey to the onslaught of the Dosha. A fluid material known as Ojas, which is responsible forthe (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 Ojasis normal in its Pramana (quantity) and Gunas (qualities), the Doshas cannot vitiate theDhatus or the Srotas. The ojas undergoes Kshaya (decrease) due to many causes such aslack of food, physical strain, injury to vital organs, excess indulgence in alcohol and suchother substances of poisonous nature; anger, grief, worry and other mental emotions; loss ofblood, semen and other tissues etc. The decrease of Ojas makes the Dhatus poor in strengthand suceptable to the bad effect of the increased Doshas. The Srotas may undergo followingfour kinds of abnormal changes (Sroto Dushti or Khavaigunya). Patadi Taila Pratimarsha Nasya & 31 Amrutha Guggulu in Pratishyaya – Literary Review
  45. 45. (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 hastaken place, becomes the site of origin of the disease. Thus, in the fourth stage, important abnormalities occurring inside the body arefurther 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 byappearing of Purvarupa/Pragrupa (premonitory, prodromal symptoms), which are producedby 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 patientgets following premonitory symptoms of Pratishyaya. 1. Shirogurutvam(Heaviness of the head) 2. Kshavathu (Sneezing) 3. Parihrishtaromata (Generalized horripilation) Patadi Taila Pratimarsha Nasya & 32 Amrutha Guggulu in Pratishyaya – Literary Review
  46. 46. 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 thedescribed abnormalities contributes to their own symptoms and signs, which are clearlyrecognizable. They vary in number and strength from one patient to the other, dependingupon the age, sex, constitution, strength of the causes and many other factors. The diseasesare given specific names based on the chief symptom/sign or the organ affected and manyother 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 themtogether (Tridoshaja, Sannipataja). The abnormalities, though profound, can be brought tonormal easily when effective treatment and all other favorable factors are present and withdifficulty in the presence of unfavorable factors. Some times the disease is uncontrollableand progresses further to the sixth and final stage. In the process of Vyaktavastha thefollowing 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 andirreversible. In spite of the best treatment, they continue to persist and make the patient verydebilitated, by loss or depletion of the Dhatus, give rise to one or more Upadrava Patadi Taila Pratimarsha Nasya & 33 Amrutha Guggulu in Pratishyaya – Literary Review
  47. 47. (complications). Some times even Arista Laksnasa (signs and symptoms which herald death)might also manifest. All these grave symptoms and signs differentiate this person fromothers. Hence, this stage is called as Bheda. In case of the disease Pratishyaya, one can easily conclude that the disease is eitherchronic or complicated on the symptomatology of aneamia, deafness etc. It may lead toproduction of, Dushta Pratishyaya and Kasa, Svasa, Kshya also. Hence the concept of ShadaKriyakala in references to the disease Pratishyaya seems to be more scientific both from theunderstanding of the disease process. As well as it’s treatment viewpoint. The treatment of a disease depends upon a true understanding of the phenomena ofits pathogenesis. All the classical texts have described the Samprapti schematic diagram ofPratishyaya, is as follow: Figure – 1 Schematic Samprapti of Pratishyaya Nidana Sevana Sanchaya & Prakopa Nasa Khavaigunya Rasa –Rakta of Dosha Srotodushti Prasara in whole body Sthana-Samshrya of Dosha in Nasa Vimargagamana of Rasa Lakshana of Pratishyaya Patadi Taila Pratimarsha Nasya & 34 Amrutha Guggulu in Pratishyaya – Literary Review
  48. 48. Sapeksha Nidana (Differential Diagnosis) Sapeksha Nidana lies in the establishing the exact identity of the disease. Identicalsigns and symptoms make the chances of misguidance. Arriving at a true diagnosis is indeedgreat. In Ayurvedic literature, Pratishyaya is mentioned as a symptom of many diseases andalso described as Hetu (causative factor) of some diseases. Hence, differential diagnosis ofPratishyaya is put forth here. Table – 8 Sapeksha Nidana PRATISHYAYA VATA KAPHAJA JVARA • Independent disease • As a symptom • Shiro Gaurava • Sarvanga Gaurava • Shirah Shoola • Shirograha • Nasa Srava • Shirah Manasantap PRATISHYAYA KAPHAJA KASA • Nasa Srava • Kapha Nisthivana • Kasa Cured with Pratishyaya • Kasa still exist after the cure of Pratishyaya PRATISHYAYA TAMAKA SHVASA • No relief while sitting • Relief while Sitting • No relief after Nasasrava • Feeling of Relief after Kapha • No difference would be observed Nisthivana • Increased severity at early hours and wet seasons PRATISHYAYA RAJYAKSHAMA • Ashukari • Chirakari • Affected part Nasa- Shirah • Mainly Both the Lungs • Not related with Dhatukshaya • Related with Dhatukshaya Patadi Taila Pratimarsha Nasya & 35 Amrutha Guggulu in Pratishyaya – Literary Review
  49. 49. 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 +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 thatneglected case or improperly treated cases of Pratishyaya may take the shape of Dushtacondition of Pratishyaya, which is Asadhya 45.Upadrava (Complications) Upadrava is so named because it appears after manifestation of the disease. Thusdisease is primary while complication is secondary. The later is often pacified when themain disease is pacified. At it appears later it becomes more afflicting because of the patient Patadi Taila Pratimarsha Nasya & 36 Amrutha Guggulu in Pratishyaya – Literary Review
  50. 50. being already suffering from the disease. Hence, one should overcome the complicationquickly. 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 + + + Patadi Taila Pratimarsha Nasya & 37 Amrutha Guggulu in Pratishyaya – Literary Review
  51. 51. To the above list Susruta further adds other systemic symptom like, Angasada, 46Chardi, Gourava arathi, Jwara, Arochaka, Atisara etc. as upadravas , while Madhavakaraopines Arbudha, Arshas, Ahotha and Raktapitta as also some of the complications ofPratishyaya 47. • Kashyapa mentions that Pratishyaya is not treated leads to Bala Agni and 48 Varna Shamana . 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 creaseChikitsa of Pratishyaya Chikitsa can be defined as the measure, which brings about the homeostasis of theDosha. Chikitsa of Sannipatika Pratishyaya is classified under two headings - 1) Samanya Chikitsa (General treatment) 2) Vishesh Chikitsa (Specific treatment) Patadi Taila Pratimarsha Nasya & 38 Amrutha Guggulu in Pratishyaya – Literary Review
  52. 52. Samanya Chikitsa Samanya Chikitsa of Pratishyaya, according to Chakrapani, five diseases viz.Netraroga, Kukshiroga, Pratishyaya, Vrana and Jwara, are cured with Langhana chikitsawithin five days. Thus, five days of Langhana is advised in Pratishyaya before going forfurther treatments. All types of Pratishyaya except Nava Pratishyaya i.e. of recent originshould be treated by the following measures: 1) Ghritapana 2) Sweda 3) Vamana 4) Avapida NasyaPratishyaya Chikitsa SutraOn the basis of the above description we can constitute the following Chikitsa Sutra – 1. Langhana 2. Ghritapana 3. Swedana 4. Vamana 5. Avapida NasayaApakva Pratishyaya Chikitsa Susruta has given following line of treatment for Ama stage of Pratishyaya. InApakva 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 inPratishyaya. 1) Swedana 2) Intake of warm food containing sour (Amlarasa) 3) Ginger should be taken with milk or with sugarcane preparation for Pachana. Patadi Taila Pratimarsha Nasya & 39 Amrutha Guggulu in Pratishyaya – Literary Review

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