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.
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
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
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