Nasal Polyp (Nasa Arsha) Management Through Ayurveda: A Single Case Study

Copyright © 2019 by author(s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/ by/4.0) ABSTRACT Nasal polyp is a chronic inflammatory disease affecting about 1–4% of the general population.1 Nasal polyps are fleshy benign growth that develop in the mucosal lining of the nasal passage and paranasal sinuses. Polyps vary in size and having shining pink colour and shaped like tear drops.2,3 The exact etiology remains unclear but it is known to have associations with allergy, asthma, infection, cystic fibrosis and aspirin sensitivity. The common features of the disease are nasal obstruction, anosmia, rhinorrhoea, post nasal drip and less commonly facial pain.4 In Ayurveda; it is closely related to nasa arsha. Nasa arsha is a Kapha-vata vyadhi located in Urdhwanga which is a kapha sthan.5 In this study, a single case 55 years old male patient presented with frequent episodes of nasal obstruction, anosmia mouth breathing and sometimes headache since six months was taken for study. An approach was made to treat the patient by sodhana, shamana and sthanika chikitsa with a positive clinical response. Local therapy was the application of Gunja lepa over polyps. This study aimed at introducing a new treatment modality with new formulation.


INTRODUCTION
Nasal polyps are soft, painless, benign growths arising from the mucosa on the lining of nasal passages or sinuses. They hang down like teardrops or grapes. Nasal polyps are traditionally divided into two types-Antrochoanal polyp and Ethmoidal polyps. Although having an uncertain etiology, they result from chronic manifestation of Rhinosinusitis, Cystic fibrosis, Allergic fungal sinusitis, Samter's triad (triad of nasal polyp, asthma and aspirin intolerance), Young's syndrome, Churg-Strauss syndrome, Nasal mastocytosis and Neoplasms. 6 Small nasal polyps may not cause symptoms. Larger growths or groups of nasal polyps can block the nasal passages and lead to breathing problems, a lost sense of smell and taste, facial pain or headache, a sense of pressure over forehead and face, frequent infections and Snoring. 7 Nasal polyps can affect anyone, but they are more common in male adults with male-female ratio of 4:1. Polyps can be graded into four stages according to their size 8 : ➢ Stage I: Limited to the extent of middle turbinate. ➢ Stage II: Extending beyond the limit of middle turbinate. ➢ Stage III: Approaching to inferior turbinate. ➢ Stage IV: Going up to the floor of nose.
Management of nasal polyp forms a large part of the workload for the otolaryngologist. Medical management is the choice for Ethmoidal Polyps. 9 Medications can help to shrink or eliminate nasal polyps, but surgery is sometimes needed to remove them. Even after successful treatment, recurrence rate is high.
In Ayurveda, it is closely related to Nasa arsha. This is a condition where patient feels nasal blockage. Sushruta had explained 4 types of nasarsha: Vataja, Pittaja, Kaphaja and Sannipataja as well as 4 types of treatments-Aushadhi, Ksharkarma, Agnikarma and Shastrakarma. 10 In this study aushadha karma had been followed to treat Nasa arsha.
Gunja (A brief introduction): 11 Gunja (Abrus precatorius Linn.), a well known plant of Ayurveda under Upavisha group (sub/semi poisonous group), is being used extensively in different formulations with great therapeutic significance and is being advocated to use in various diseases like Indralupta (alopecia), Shotha (edema), Krimi (helianthus), Kustha (skin diseases), Kandu (itching), Prameha (urinary disorders) etc. After proper samaskar known as shodhana (purification). Glycyrrhizin, Triterpene glycosides, pinitol and alkaloids such as abrine, hepaphotine, choline and precatorine are the principle chemical constituents of the plants. Among all varieties, Sweta Gunja was taken for study and purified by putting it into hot milk for 24 hours. Then paste was prepared by rubbing the seeds on stone. That paste was applied over the nasal polyp.

Consent:
Informed consent was taken prior to case study.

Investigations:
➢ Routine haematological and urine investigations were carried out and findings were not of any pathological significance. ➢ Endoscopic and mobile camera image of the polyp before and after treatment in the minor OT were taken.

nd Day:
➢ Sadhyovireachana with Nimbamritadi Erand taila 60ml followed by Triphala kashaya 100ml was given on empty stomach at 8 a.m. ➢ Sips of hot water and Jeera jala were also given. ➢ Sthanika avagundana was given at 4 p.m.
➢ Marsha nasya with Shikhari taila 12-12 drops in each nostril followed by haridra and ghrita dhumapana in the morning on empty stomach. ➢ Sthanika Avagundana was given in the afternoon. ➢ Purified Sweta Gunja Lepa over the polyp inside right nostrils on alternate day was applied. ➢ Internal medication like tab. Laghu Sutsekhsar Vati 1 BD, Haridrakhanda 1 tsf BD with hot water and Pippalyasava 3 tsf BD after food with water were given. These regimens were continued for 7days. Results: Significant changes in signs and symptoms were noticed before treatment and after treatment with short course duration of 10 days. Patient felt good response after 2 nd day application of Gunja lepa. On the day of discharge-10th day, he was happy and feeling better. On regular follow up the The combination of both sodhana and shamana therapies as well as local gunja lepa was acted synergistically to combat against the vitiated tridoshas in pathology of Nasa arsha. Conclusion: Nasal polyp i.e. Nasa arsha is a chronic inflammatory disease. Ayurveda believes in cleansing the body and pacifying the tridoshas from the roots by using unique treatment modalities such as sodhana, shamana and sthanika chikitsa. These treatment approaches create a balanced physiology which regress the size of nasal polyps and thus making the patient symptom free by non invasive method. Ayurveda creates a new hope for treatment of nasal polyps (Nasa arsha) for this era.