Efficacy of Nirgundi Patra Swarasa Nasya in Suryavarta with Special Reference to Frontal Sinusitis- A Case Study

Introduction

Suryavarta is one of the Shiro rogas mentioned by Brihatrayis. The cardinal features of Suryavarta are pain and pulsation around the eyes, eyebrows, and temples (Shanka, Akshi, Bru, Lalata Ruja, and Spandana) commencing mildly at sunrise and increasing slowly along with the movement of the sun and subsiding by sunset.¹ Suryavarta produces Pitta and Vata as per Acharya Sushruta who mentioned that it is “Sarvatmakam Kastatamam Vikaram” (Difficulty to cure).

According to him, Bhaskaravarta is the synonym for the disease. According to Charaka, Suryavarta is a Vata-Raktaja Vyadhi. As per Dhridhabala, due to the heat of the sun, Mastulunga gets melted which causes pain. At midday, melting takes place with severe intensity and the headache becomes intolerable. Post noon, as the intensity of the sun reduces, the severity of the headache also reduces.

As per Nimi, night time is cold and predominant in Tamoguna and Kapha. This Kapha gets accumulated in the Srotas of Shiras and blocks them. This leads to the obstruction of easy movement of Vata, thus resulting in Vata Prakopa causing headaches.

This condition has become more prevalent because of some common Nidanas such as Rajo Dhuma Sevana (dust, smoke), Atapa Sevana (sunlight), Tushara (snow, mist), Purovata Sevana (heavy breeze), Ambukrida (water sports), Sheeta Annapana (cold food items), and Vegadharana (suppressing urges), etc.

Most of its clinical features can be correlated to the features of frontal sinusitis which is also known as vacuum headache or office headache, as it affects routine and day-to-day activities of the people. Frontal sinusitis has symptoms like pain above the eye, showing characteristic periodicity i.e., it begins on waking, gradually increases and reaches its peak by mid-day, and then starts subsiding. Tenderness over the frontal sinus, edema of the upper eyelid, and nasal discharge are the other features.² Sinusitis is the most common disease affecting 30% of the whole population. It is estimated that 1 among 8 Indians are hit by chronic sinusitis.³

In Ayurveda, Nasya, Siravyadha, Lepas, etc. are the treatment options for Suryavarta.⁴ Nasya is considered an important line of treatment in all types of Shirorogas. By Nasya Karma, the elimination of the accumulated Dosas happens quickly and cures the ailment from its roots. Nirgundi possesses Vedanasthapana, Vata Kaphahara, and Sophahara properties and Saindhava has Tridoshahara and Vibandhatwahara properties. Ghrita also possesses Tridoshahara properties. Therefore, in this present study, an effort has been made to evaluate the efficacy of Nasya with Nirgundi Patra Swarasa added with Ghrita Saindhava in Suryavarta.

Case Presentation

A 27-year-old female patient came to the outpatient department (OPD) with complaints of frontal headache, nasal blockage, and heaviness of the head for the past 3 years and it was aggravated 2 weeks back. The complaints got aggravated by exposure to cold weather, cold wind, hunger, and intake of any cold food items. The patient used nasal decongestants, whenever she had a nasal block, but got only temporary relief so the patient came to the hospital for further management.

Detail history of the patient was taken and examined thoroughly. On examination tenderness over the bilateral frontal sinus was noted and on anterior rhinoscopy, mild inferior turbinate hypertrophy was also seen.

She was given the treatment of Nasya with Nirgundipatra Swarasa added with Ghrita and Saindhava for 7 days (Table 1).

Treatment Plan:

Nasya Karma Procedure

After a thorough examination, the patient was made to lie on the bed in a supine position.

Mukhabhyanga was done with Murchita Tila Taila for 10 minutes followed by Nadisweda as Poorvakarma for 5min. After that patient was made to lie on the bed in a supine position with her head a little lower. Then 8 drops of the medicine were instilled into each nostril as a continuous stream. Soon after, a mild massage was given to the nose and the forehead region in an upward direction. After the expulsion of the morbid Dosha, Shesha Dosha Nirharanaardham, Dhumapana was given with Haridra Varti followed by Ushnajala Kavala. The patient was advised to avoid exposure to cold atmospheres and cold foods and to refrain from having milk and milk products.

Outcome:

The Nasya was given for 7 days. The patient got mild relief from Shirashoola and Nasavarodha after the first day itself. After 7 days of Nasya karma, a significant reduction in the symptoms was observed. On examination, a marked reduction of bilateral frontal sinus tenderness was noted (Table 2 and 3). 

Discussion

Ayurveda classics describe Shirashoola not only as a symptom but also as an independent disease. Shiro-Ruk as a separate disease is mentioned among eighty types of Vatavyadhi by Acharya Charaka. Many references concerning etiology, pathogenesis, clinical features, and their management are explained in both Brihatrayis and Laghutrayis. Suryavarta follows the course of the sun. Therefore, the severity of the disease depends upon the intensity of the sun rays. The onset of pain is characteristic, it begins during sunrise, reaches its peak in the noon and decreases as sun sets in the evening1 . Its features can be co-related with the that of frontal Sinusitis, also known as Office Headache as it affects the day-to-day activities of the people. The symptoms show characteristic periodicity i.e., it begins on waking, gradually increases and reaches its peak by mid-day and then starts subsiding.

In Ashtanga Sangraha, it is explained that Nasa is the doorway to Shiras. The drug administered through nostrils first reaches Shringataka Marma, then spread to the entire Murdhni Pradesha and eliminating through the Siramukhas of Netra, Shrotra, and Kantha. This whole process disintegrates the morbid Doshas in the Jatrurdhwa Desha and eliminates them just like the central part of a grass called Munja is removed, without hurting the surrounding structures.⁵

Provocation of Doshas takes place in the Shiras due to the irritating effect of the administered drug, increasing the Before treatment. The accumulated Doshas are expelled from the blood vessels and thrown out by the nasal discharge, tears, and saliva. The lowering of the head, the elevation of the lower extremities, and the fomentation of the face seem to have an impact on the blood circulation of the head and face.^6,7

PROBABLE MODE OF ACTION OF THE DRUG

The terpenoids and organic fatty acids present in Nirgundi have analgesic properties that could help in relieving Shirashoola.⁸ It also has Ushna Virya, Vedanasthapana guna. The anti-inflammatory, Kaphavataghna, Ushna, and Sothahara Guna of Nirgundi, Deepana, Pachana, and Vibandha Hara Guna of Saindhava helped in mucociliary clearance. These drugs helped in relieving mucosal edema and clearing nasal obstruction, thereby, causing free drainage of mucous from the sinuses. Nirgundi possesses analgesic, antipyretic, antihistaminic, antiallergic, antibacterial, antioxidant, and anti-phlegmatic action.⁹ Also, as a result of Nasya, the obstruction of the sinus Ostia is relieved and it facilitates normal drainage. This promotes mucociliary activity and prevents the collection of mucus in the sinus cavity and reduces tenderness. On the other way Vata Kaphahara, Shothahara property of Nirgundi and Lekhana and Sookshma Guna of Saindhava does Kapha Shamana and helps in draining out the mucus.

The etiology, pathology, and clinical features of Suryavarta and frontal Sinusitis are nearly similar. In the present study, an effort has been made to evaluate the efficacy of Nasya with Nirgundi Patra Swarasa added with Ghrita and Saindhava in the management of Suryavarta. After the course of the therapy, the subject got relief from all the symptoms and it was sustained till the follow-ups. If the patients fail in following advice regarding Nidana, then the combined effect of the Nasya with oral medications and external therapies like Lepa can be given to achieve sustenance of the results after treatment. No side effects were observed during the study period. 

Conflict of interest

None