Last month, we looked at easily curable conditions of prana vaha srotas as well as those curable with difficulty. This month, we will look at chronic (yapya) conditions of prana vaha srotas and also mention briefly how to be aware of potentially fatal conditions.
One extremely common yapya respiratory condition is chronic rhinitis, affecting as many as 40% of the US population. One of the world's most common chronic disorders, rhinitis affects the entire spectrum of life from infancy to old age (1). Sushrut discusses thirty-one diseases of the nose, including Apinasa (rhinitis) and pratishaya (nasal catarrh)(2). Apinasa is classified as a disease of vata and kapha (2). Pratishaya with dryness, hoarsenss, temporal headache and nasal obstruction arises from Vata (3), with thirst, yellowish nasal discharge and a feeling of hot smoky breath, pitta is involved (4) and with thick white or yellowish catarrh, swollen eyes, heaviness and itchy throat and palate, kapha is implicated.
From a modern standpoint, classification of rhinitis is less based on clinical presentation and more on etiology. Rhinitis is either allergic or non-allergic. Allergic rhinitis results from IgE reactivity to both outdoor, seasonal allergens such as pollens and indoor allergens including moulds, house dust and animal dander. It is often associated with another chronic condition of prana vaha srotas, asthma. (See http://www.alandiashram.org/school/school_html/reviews/bronchial_asthma.html for a previous Vine discussion of asthma). While allergic rhinitis is common in infants, children and young adults (5), non-allergic rhinitis becomes increasingly prevalent in older adults and is more common in women (1). Although there are many etiologies of non-allergic rhinitis, some of the most common include chronic sinusitis, allergic fungal sinusitis, eosinophilic nasal polyps (6) and deviated nasal septum. For an in depth treatment of chronic sinusitis and allergic fungal sinusitis see archived Vine article http://www.alandiashram.org/school/school_html/reviews/chronic_sinusitis.html. Irritants such as dust, smoking and household cleaning agents can cause or contribute to rhinitis, as expressed by both Madhava and current medicine (7, 8). Hormonal causes of non-allergic rhinitis include pregnancy, menstruation, puberty and hormone replacement therapy as well as hypothroidism (8).
As we review the various ways of classifying rhinitis, we can see that the Western medicine classifications are more useful in terms of Western treatments. For example, allergic rhinitis would respond to anti-histamines whereas other kinds will not. By the same token, Sushrut's symptom based classification is more useful for Ayurvedic treatment since it points to the dosha involved and hence to the appropriate therapies.
Patients with chronic rhinitis frequently present for Ayurvedic treatment as an alternative to steroidal and non-steroidal nasal sprays and systemic antihistamines. Indeed, the persistent nature of this condition has led doctors, as well as patients, to look 'outside the box' for adjuvant therapies. As an example, a friend of mine recently visited National Jewish Hospital in Denver, one of the premier respiratory hospitals, only to be told to increase his use of the nasal rinse cup from once to twice a day! A number of studies have been done, demonstrating the effect of jala neti or saline irrigation using a nasal rinse cup. As one abstract puts it, "The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions. It is often prescribed as an adjunct to other treatments such as intranasal steroids or antibiotics. ...This review summarises the evidence for the effect of saline irrigations in the management of the symptoms of chronic rhinosinusitis. There is evidence that they relieve symptoms, help as an adjunct to treatment and are well tolerated by the majority of patients. While there is no evidence that saline is a replacement for standard therapies, the addition of topical nasal saline is likely to improve symptom control in patients with persistent sino-nasal disease....There are no significant side-effects reported in trials." ( 9)
An earlier study also indicated that "Endonasal irrigations with salt solutions are effective in the treatment of chronic sinusitis," (10) and an Australian study investigating nasal irrigation showed that neti, also known as nasal douche, was more effective than nasal sprays or nebulizers and effectively reached the maxillary sinuses and frontal recesses. The sphenoidal and frontal sinuses are not easily reached by irrigation methods. (11).
While local use of oils and herbs in the form of nasya have not been investigated to the same extent, some recent studies published by Gujerat Ayurved University indicate that nasya therapies are effective in both allergic and atropic rhinitis. Local (nasal) administration of herb via nasya was effective in giving immediate relief of signs and symptoms of allergic rhinitis and can best be paired with longer acting systemic herbs such as turmeric. (12). Nasya is also effective in atropic (non-allergic ) rhinitis (13).
Similarly, in terms of asthma, there has been a search for adjuvant therapies for this chronic condition. Steam inhalation, using natural mineral saline is one valuable adjuvant. The Ayurvedic use of steam and herbal smokes for administering medicines directly to the lungs is the precursor of today's asthma inhalers (14). Yoga therapy is also valuable in managing asthma. "Forty six young asthmatics with a history of childhood asthma were admitted for yoga training. Effects of training on resting pulmonary functions, exercise capacity, and exercise-induced bronchial lability index were measured. Yoga training resulted in a significant increase in pulmonary function and exercise capacity. A follow-up study spanning two years showed a good response with reduced symptom score and drug requirements in these subjects. It is concluded that yoga training is beneficial for young asthmatics." (15).
Herbal therapies of course are also effective for asthma, including Boswellia (16) and kapi kacchu (17). Ayurvedic and yogic therapies including neti, nasya, steam inhalation herbal smokes, yoga therapy and oral herbs can be of tremendous use in enhancing quality of life for patients with chronic prana vaha srotas conditions and reducing the amount of medications they need to use.
With regard to fatal conditions of prana vaha srotas, lung cancer remains the leading cause of cancer-related death both in the United States and throughout the world (18). Ayurvedic practitioners as well as primary care physicians should be highly suspicious in the case of any person with a history of smoking who presents with cough, breathlessness or wheezing or simply fatigue and malaise. A pneumonia or bronchitis may be more than it seems as lung cancer may frequently present as pneumonia or bronchitis. Swift referral for chest X ray is vital to avoid overlooking cancer. Patients with a history of coal mining or working in or living near an asbestos plant should also be treated with great caution in the event of a history of cough as they too are susceptible to lung cancer. And of course, one should not forget spouses of chain smokers, who may have been exposed to a lifetime of carcinogenic second and third-hand smoke. Tridoshic disturbance of overall vikruti, of the lung pulse or of the rasa dahtu pulse can lead the Ayurvedic practitioner suspect lung cancer, although these same pulse findings may also hold good in chronic obstructive pulmonary disease (COPD).
To give some examples, some years ago a fifty-year-old woman presented with a non-specific complaint of "feeling unwell". She had never smoked cigarettes, although she was a marijuana smoker. However, her husband was a former chain-smoker. A few weeks later, she presented with cough and breathlessness and tridoshic disturbance in her lung pulse. Suspecting pneumonia, we referred her to her primary care practitioner, who diagnosed bronchitis and sent her home with antibiotics. Days later she was admitted to hospital with for pneumonia and within three months she had died of advanced pulmonary adenocarcinoma. This story serves to remind us of how nebulous the initial presentation of lung cancer may be.
A seventy five year old former smoker complained of chest pain during winter and was diagnosed with pneumonia and put on antibiotics. Bronchoscopy revealed Stage IV adenocarcinoma of the lungs and she presented for Ayurvedic adjuvant therapy alongside her chemotherapy. She went into remission for some time but recently, again in winter, developed cough and breathlessness and was found to have a pleural effusion, which may be malignant in origin. This case history too illustrates how difficult it is to diagnose lung cancer until a late stage of the condition and how closely its symptoms can mimic typical winter ailments.
Ayurvedic practitioners can facilitate considerable improvements in quality of life for patients suffering from chronic conditions of prana vaha srotas. When working with respiratory conditions, it is important to take note of lung cancer risk factors and to be aware that this condition can present as a typical winter chest infection.
1. John W. Georgitis Prevalence and differential diagnosis of chronic rhinitis Current Allergy and Asthma Reports Volume 1, Number 3 / May, 2001
2. Su. Uttarasthan, XXII
3 ibid XXIV 6
4 ibid v 7-8
5 Quoc A Nguyen, MD Allergic Rhinits http://emedicine.medscape.com/article/834281-overview
6. Maria Staevska and James N. Baraniuk Persistent nonallergic rhinosinusitis Current Allergy and Asthma Reports Volume 5, Number 3 / May, 2005
7. Madhava Nidhanam Ch 58 v 13-14
8. Vijay R Ramakrishnan, MD, Nonallergic Rhinitis http://emedicine.medscape.com/article/874171-overview
9. Nasal saline irrigations for the symptoms of chronic rhinosinusitis Otolaryngol Head Neck Surg. 2007 Oct;137(4):532-4.
10. G. Bachmann, Gerhard Hommel and Olaf Michel Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease European Archives of Oto-Rhino-Laryngology Volume 257, Number 10 / December, 2000
12. Neha j Modha ,V.D. Shukla, MS Baghel Clinical study of Anurjata Janita Pratishaya (allergic rhinitis) and comparative assessment of nasya karma Ayur-vol 30 No 1 2009 47-54
13. BV DHARMENDRASINH, K SINGH, KN PANSARA, et al A clinical study of Vyoshadivati and Pathadi Taila Nasya on Apinasa-Atrophic Rhinitis Ayu vol 30 No 4 2009 475-47
14. Mark Sanders Inhalation therapy: an historical review Primary Care Respiratory Journal (2007) 16(2): 71-81
15. S. C. Jain; L. Rai; A. Valecha; U. K. Jha; S. O. D. Bhatnagar; K. Ram Effect of Yoga Training on Exercise Tolerance in Adolescents with Childhood Asthma , Volume Issue December 1991 , pages 437 - 442
16. Gupta I, Gupta V, Parihar A, Gupta S, Lüdtke R, Safayhi H, Ammon HP.Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study Eur J Med Res. 1998 Nov 17;3(11):511-4
17. Mallaiah, GK | Thirupathi, K | Ganapaty, S | Rao, PT | Mohan, GK Phytochemical and AntimicrobialStudies on the Seeds of Mucuna Monosperma DC Current Trends in Biotechnology and Pharmacy. Vol. 2, no. 3, pp. 442-446. Jul 2008.
18. Syed Huq, http://emedicine.medscape.com/article/279960-overview