A CASE REPORT ON AYURVEDIC MANAGEMENT OF APEENASA i.e. ATROPHIC RHINITIS. SHDABINDU TAILA NASYA AND TRIKATU DHOOMAPANA WAS USED TO TREAT THE CONDITION. THE RESULT ARE ELABORATED WITH THE PROBABLE MODE OF ACTION.

1. Dr.Tarun Kumar Dwibedi,
PG SCHOLAR, DEPT. SHALAKYA TANTRA,
SJG AMC & H KOPPAL,KARNATAKA

2. 1. ATROPHIC RHINITIS
2. Etiology
3. Pathology
4. Clinical features
5. Prognosis
6. Treatment
7. CASE REPORT
8. General examination
9. Local examination
10. Differential diagnosis
11. Diagnosis
12. Treatment
13. Result
14. Mode of action
15. CONCLUSION
16. BIBLOGRAPHY
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

3.  Chronic Inflammation Of nasal cavity
 Atrophy of nasal mucosa & turbinates
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

4. • H E R N I A
• Hereditary
• Endocrinal Disturbances
• Racial Factor
• Nutritional Deficiency
• Infective
• Autoimmune Process
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

5.  Ciliated Columnar Cells Are Lost
 Replaced By Stratified Sq. Cell
 Atrophy Of Seromucinous Gland, venous Blood Sinusoids
& Nerve Elements
 Obliterative Endartritis In Bones, Mucosa, Periosteum.
 Turbinates Under Goes Resorption Roomy Nose
 PNS Are Small Due To Their Arrested Developed
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

6.  Dry nose
 Foul smell from nose
 Nasal Obstruction
 Anosmia
 Crusting in nasal cavity
 Epistaxis
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

7.  Persists For Years
 Tendency To Recover At Mid Age
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

8.  Maintenance Of Nasal Hygiene
 Removal Of Crust
 Nasal Irrigation  Alkaline /Normal Saline
 Local Antibiotics
 Oestradeol Spray
 Systemic Antibiotic Streptomycin
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

9. • Name:- R. Pati, 38/HF
• House Wife
• Bhubaneswar, Odisha
C/O
• Running nose and some times dryness of nose
since 15 yrs.
• Mild Headache all over the day since 5 years
• Loss of smell since 2 years
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

10. ASSO. COMPLAINs:-
 frequent sneeze & nasal blockage in morning and
evening
 Husband complaining Foul smell from patients nose .
 General weakness since 1.5 years
 laziness since 1 year
H/o present illness:-
Patient was said to be normal before 15 yrs. Then gradually
she developed with running nose at morning and evening
with nasal obstruction in the left nostril. She lost her smell
sensation 2 years back and suffering from headache with
general weakness since 1.5years.
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

11. Treatment History
• She Has Taken Antiallergics (Chlorpheniramine,
Cetrizine, Levocetrizine, Montellucast), Antibiotics (
Ofloxacine, Ciprofloxacin, Azithromycin)
FAMILY HISTORY
• Her father is suffering from the same condition
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

12. PERSONAL HISTORY
 SLEEP – Deep, Irregular
 ADDICTION – Tea, She Liked To Smell The Fume Of
Lantern In Childhood
 APPETITE – Irregular.
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

13. General Examination:-
System Properties
—CVS
S1, S2
Heard
—CNS
conscious
&
Oriented
—RS NVBS
P/A
Soft Non
Tender,
BS ++
Vitals Properties
—BP
—114/76
mmHg
—PR —86/Min
—RR —20/Min
—Pallor —mild
—Icterus —No
—Clubbing —No
—Cyanosi —No
Lymphadenopathy—No
—Oedema —No
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

14. LOCAL EXAM
EAR- NAD
NOSE 
 Ext. NOSE –Nasal Crease
Ant. Rhinoscopy- Grey Nasal Mucosa C Foul Smell
 Hypertrophic Middle Turbinate
Post. Rhiniscopy
 Hypertrophic Superior Turbinate.
PNS- Moderate Tenderness In Frontal Sinus
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

15. DIFFERENTIAL DIAGNOSIS
• Dusthapratishya
• Apeenasa
• Kaphaja pratishyaya
• Sinusitis
• Atrophic rhinitis
• Allergic rhinitis
DIAGNOSIS
Apeenasa
• प्रक्लिद्यते
• शुष्यतत
• न बेति गन्धं 7
Atrophic Rhinitis
• Foul smell
• Nasal Obstruction
• Anosmia
• Crusting 8
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

16.  NASYA shadvindu taila 8 drops following the classical
procedure
 Followed by Trikatuadi dhoomapana
 Same dhoomapana at before bed-time
 Tab. Aswagandha 1 tab BD
 Haridrakhanda 1TSF BD
Nasya & Dhoomapana = 3 sittings
Gap=15 days between each sitting
Study Duration = 51 days
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

17. AFTER FIRST
SITTING
• Mild of head ache &
nasal obstruction
• in foul smell from
nose
• Anosmia persists
SECOND SITTING
• no fresh complaints
• feeling better
• Nasal obstruction
markedly.
• Headache & foul smell
absent
• perceive smell for
some extent.
THIRD SITTING
• patient got marked
improvement
• able to perceive smell.
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

18. Deepana Pachana Oushadhi
Agni modulate the digestive power that renders the pakwa state
of morbid doshas, so that later it may be expelled easily by nasya
karma.
Mukhaabhyanga
Blood circulation  mobilization of the
• doshas from the site of morbidity to the site
• of elimination.
Swedana
• eliminate doshas from the effected
• part of nose and removed by the
• Nasya karma
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

19. SODHANA TYPE OF NASYA
• Sneha Dravyas of nasya Drava, sukshma, Sara, snigdha
and guru.  absorbed in nasal mucosa  remove doshas.
• Causes santarpana of tissues, makes the tissues snehakrut,
mardavakrut and balakrut .
• Thus rejuvenate the nasal mucosa proper action of the
olfactory epithelium and nerve endings.
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

20. Pathway Of Nasya Drug
• Nasal cavity olfactory epithelium Olfactory Bulb
Through Cribriform Plate Ant. Craneal fossa Med.
And lat. Area of cerebral cortex.
• Nasya Chemical impulse neuronal impulse  influencing
on cerebral cortex area  stimulatory effect  evacuation of
doshas.
• Nasya dravya  nutrient and rejuvenate the olfactory nerve
Proper function.
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

21. Rasayana Oushadhi
• Aswagandha having the property of rasayana karma rejuvenate
the nasal mucosa as well as provides strength to the body.
Paschat Karma
• Varti (Trikatu + yasti + haridra +
• kheerabala Taila)  Removal of
• residual Kapha after nasya karma.
• Kavala after dhoomapana causes vasodilation and by this the
remaining doshas expelled out from the mukha and also causes
better absorption of oushadhi dravyas.
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

22. Apeenasa is a disease which causes impairment of smell
sense, which may cause ostracization, crusting inside nasal
cavity, nasal bleeding nasal obstruction and headache due
to vata and Kapha Dosha. In this condition the nasya
procedures helps in reducing the impairment, restored the
nasal dehydration which reduces the crusting and complete
reduction of foul smell of nose. The trikatu dhoomapana
completely reduces the head ache and Aswagandha along
with haridrakhanda modulate the action of shadbindu taila
and trikatu dhoomapana. The trikatu dhoomapana resists the
secondary infection. Thus the combination of this drug
therapy can be adopted for apeenasa or atrophic rhinitis.
Dr. Tarun kumar Dwibedi,SJG AMC &H,
dr.tarun52@gmail.com/9438790500

23. 1. Dhingra P L, Disease of Ear, nose And Throat, fifth edition, 2010, Elsevier,
New Delhi, P.170.
2. Dhingra P L, Disease of Ear, nose And Throat, fifth edition, 2010, Elsevier,
New Delhi, P.170.
3. Dhingra P L, Disease of Ear, nose And Throat, fifth edition, 2010, Elsevier,
New Delhi, P.170.
4. Dhingra P L, Disease of Ear, nose And Throat, fifth edition, 2010, Elsevier,
New Delhi, P.170.
5. Dhingra P L, Disease of Ear, nose And Throat, fifth edition, 2010, Elsevier,
New Delhi, P.170.
6. Dhingra P L, Disease of Ear, nose And Throat, fifth edition, 2010, Elsevier,
New Delhi, P.171.
7. Dr.Kebal krishna Thakral- Sushruta Samhita Nibandha Sangraha published by
Chaukhambha Orientalia, Baranasi; Reprint 2017,Uttara Tantra 22/6, P.155
8. Dhingra P L, Disease of Ear, nose And Throat, fifth edition, 2010, Elsevier,
New Delhi, P.170
Dr. Tarun Kumar Dwibedi, SJG AMC & H, dr.tarun52@gmail.com/9438790500

24. THANK
YOU