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nasal polyp ,ayurvedic view

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nasal polyp ,ayurvedic view

  1. 1. P a g e | 1 INTRODUCTION नास is one of the most important organ of ऊर्ध्वजत्रु & is the gateway for शिरस् & respiratory tract. It is one of the पञ्चेन्द्रिया & is responsible for गन्धज्ञान. The nose performs two functions. It is a respiratory passage. It is also the organ of smell. नासािवस् is one among the 31 नासगत रोगा mentioned in सुश्रुत संशिता,is one among the 17 नासगत रोगा mentioned in चरक संशिता ,is one among the 18 नासगत रोगा mentioned in अष्टाङ्ग हृदय & अष्टाङ्ग संग्रि,is one among 34 नासगत रोगा mentioned by भावशिश्र & योगरत्नाकर. “अिोर्ुवदाशन शवभजेदोषालङ्गै यवथाय़थि् ।“ The दोषा vitiating the त्वक् , िांस & िेद produce िांसाङ् कु रा of different shapes called अिवस्. अिवस् & अर्ुवद should be understood by the characteristic symptoms of the दोषा. Usually नासािवस् is co-related with nasal polyps. Nasal polypi are non-neoplastic masses of oedematous nasal or sinus mucosa.
  2. 2. P a g e | 2 ANATOMY OF NOSE Nose is primarily meant for breathing. The lower 2/3rd part of nasal cavity is wider & lined by a thick, vascular respiratory mucosa. Odours are air borne, the olfactory receptors are placed in the upper 1/3rd of the nasal cavity which is narrow & lined by the thin, pale olfactory mucosa. RESPIRATORY MUCOSA  The mucosa of the nose traps the foreign particles in the inspired air. The vascularity of the mucosa helps in warming & moistening the inspired air.  Thus nose acts as an air conditioner where the inspired air is warmed, moistened & cleansed before it is passed on to the delicate lungs. OLFACTORY MUCOSA It lines 1/3rd (upper) of the nasal cavity including the roof (cribriform plate) & the walls up to superior concha. It is thin & less vascular. Beneath epithelium, there are serous nasal glands (Bowman’s gland) which are rich in enzymes & open on to the surface. The gases responsible for odours responsible for odours dissolve in the fluid secretion of glands & stimulate olfactory hairs. RESPIRATORY MUCOSA lined by COLUMNAR CILIATED EPITHELIUM containing NUMEROUS GOBLET CELLS Beneath epithelium Fibrous layer infiltrated with lymphocytes Deep to this Mucous & serous glands present Opens on to the surface
  3. 3. P a g e | 3 EXTERNAL NOSE It is a surface projection on face. It is pyramidal in shape with its root up & the base directed downwards. SKELETAL FRAMEWORK / OSTEO CARTILAGINOUS FRAMEWORK PARTLYBONES NASAL BONES (bridge of nose) NASAL NOTCH OF FRONTAL BONE FRONTAL PROCESS OF MAXILLAE PARTLYCARILAGE ALAR CARTILAGE UPPER LATERAL CARTILAGE LESSER ALAR/ SESAMOID CARTILAGE SEPTAL CARTILAGE
  4. 4. P a g e | 4 BONY PART Formed by  Perpendicular plate of ethmoid bone – antero superiorly.  Vomer – postero inferiorly.  Nasal spine of Frontal crest formed by two nasal bones - from front & above.  Sphenoidal crest from behind. Nasal crest formed by palatine processes of two maxillae & horizontal processes of two palatine bones below. CARTILAGINOUS PART Septal cartilage: septal process of lower nasal cartilage. On each side of it is covered by mucous membrane except the lower part which is covered by skin. In the upper part mucous membrane is lined by olfactory epithelium in rest areas by respiratory epithelium. Upper lateral cartilage: they extend from the under surface of the nasal bone above, to the alar cartilage below. They fuse with each other & with the upper border of the septal cartilage in the midline anteriorly. The lower free edge of upper lateral cartilage is seen internasally as limen vestibule or nasal valve on each side. Lesser alar (or sesamoid) cartilage: two or more in number. They lie above & lateral to alar cartilages. The various cartilage are connected with one another & with the adjoining bones by perichondrium & periosteum. Most of the free margin of nostril is formed of fibrofatty tissue & not the alar cartilage. Lower lateral cartilage: each alar cartilage is U shaped. It has a lateral crus which forms the ala & a medial crus which runs in the columella. Lateral crus overlaps lower edge of upper lateral cartilage on each side.
  5. 5. P a g e | 5 INTERNAL NOSE It is divided into right & left nasal cavities by nasal septum. Each nasal cavity communicates with the exterior through posterior nasal aperture or the choana. Each nasal cavity consists of a skin lined portion – the vestibule & a mucous lined portion, the nasal cavity proper. VESTIBULE OF NOSE Anterior & inferior part of nasal cavity is called VESTIBULE. It is lined by skin & contains sebaceous glands, hair follicles & the hair called vibrissae. Its upper limit on the lateral wall is marked by limen nasi (also called nasal valve) 1. NASAL VALVE It is bounded laterally by the lower border of upper lateral cartilage & fibrofatty tissue & anterior end of inferior turbinate; medially by the cartilaginous nasal septum, & caudally by the floor of pyriform aperture. The angle between the nasal septum & lower border of upper lateral cartilage is nearly 3o degree. 2. NASAL VALVE AREA It is cross sectional area bounded by the structures forming the valve. It is the least cross sectional area of nose & regulates airflow & resistance on inspiration. NASAL CAVITY PROPER Each nasal cavity has a lateral wall, medial wall, a roof & a floor. LATERAL WALL OF NASAL CAVITY A.BONY PART, Formed by Nasal, Frontal process of maxilla, Lacrimal, Labyrinth of ethmoid with superior & middle conchae, Inferior conchae, Medial pterygoid plate, Perpendicular plate of palatine bone B.CARTILAGENOUS PART-The upper & nasal cartilages & alar cartilage C. FIBROFATTY TISSUE-It is formed with covering skin in the lower part
  6. 6. P a g e | 6 FEATURES OF LATERAL WALL 1. NASAL CONCHAE These are shelf like projection of curved plate of bones directed downwards & medially. There are 3 conchae’s, they are:- a) Superior conchae b) Middle conchae c) Inferior conchae 2. MEATUSES OF THE NOSE These are spaces which lie below & beneath the conchae i. Superior meatus It lies below superior nasal conchae. It is the short among all. It receives opening of posterior ethmoidal sinuses. ii. Middle meatus Lies below the middle nasal concha. It has the following features: a) Bulla ethmoidalis A rounded bony bulging in the lateral wall due to middle ethmoidal air sinuses b) Hiatus semilunaris It is a deep semilunar groove or sulcus below the bulla c) Infundibulum It is a short passage at the anterior end of the hiatus. Openings-maxillary air sinus, frontal sinus, anterior ethmoidal sinus & middle ethmoidal sinus. d) Atrium of the middle meatus It is a shallow depression just in front of the middle meatus & above the vestibule of nose. e) Agger nasi It is a mucous ridge limiting the upper part of atrium f) Vestibule of the nose Depression in the anterior & lower part of the lateral wall deep to the ala iii. Inferior meatus Lies below the inferior nasal concha. It is the largest among the all meatus. Openings- naso lacrimal duct at the anterior part, opening guarded by lacrimal fold or Hasner’s valve.
  7. 7. P a g e | 7 MEDIAL WALL OF NASAL CAVITY Nasal septum forms the medial wall. Nasal septum consists of three parts. 1. COLUMELLAR SEPTUM It is formed of columella containing the medial crura of alar cartilage united together by fibrous tissue & covered on either side by skin. 2. MEMBRANOUS SEPTUM It consists of double layer of skin with no bony or cartilaginous support. It lies between the columella & the caudal border of septal cartilage. Both columellar & membranous parts are freely movable from side to side. 3. SEPTUM PROPER It consists of osteocartilaginous framework, covered with nasal mucus membrane. Its principal constituents are i. The perpendicular plate of ethmoid ii. The Vomer iii. A large (quadrilateral) septal cartilage wedged between the above two bones anteriorly. Other bones which make minor contributions at the periphery are crest of nasal bone, nasal spine of frontal bone, rostum of sphenoid, crest of palatine bones & the crest maxilla, & the anterior nasal Spine of maxilla. ROOF OF NASAL CAVITY It slopes in front & behind & middle part is horizontal. Anterior slope-is formed by nasal part of frontal, nasal bone, & cartilage. Middle-by cribriform plate of ethmoid bone, is thin & delicate. It is the highest part of roof which is pierced by olfactory nerve & ethmoid vessels. Posterior slope-is formed by inferior surface of body of sphenoid bone.
  8. 8. P a g e | 8 FLOOR OF NASAL CAVITY It is flat & almost horizontal & concave side to side, formed by upper surface of hard palate. LITTLE’S AREA/ KIESSELBACH’S PLEXUS This is the vascular area in the anteroinferior part of nasal septum just above the vestibule. Anterior ethmoidal, sphenopalatine, greater palatine, & septal branch of superior labial arteries & their corresponding veins forms an anastomosis here. ARTERIAL SUPPLY 1. Antero-superior quadrant is supplied by anterior ethmoidal artery assisted by the posterior ethmoidal & facial arteries. 2. Antero-inferior quadrant is supplied by branches from facial & greater palatine arteries. 3. Postero-superior quadrant is supplied by sphenopalatine artery 4. Postero-inferior quadrant is supplied by branches from greater palatine artery which pierce the perpendicular plate of palatine bone. VENOUS DRAINAGE Anteriorly drains into facial vein, posteriorly into the pharyngeal plexus of veins & from middle part to the pterygoid plexus of veins. NERVE SUPPLY 1. Antero-superior quadrant is supplied by anterior ethmoidal nerve 2. Antero-inferior quadrant is supplied by Antero-superior alveolar nerve 3. Postero-superior quadrant is supplied by posterior superior lateral nasal branches from pterygopalatine ganglion 4. Postero-inferior quadrant is supplied by anterior palatine branch from pterygopalatine ganglion
  9. 9. P a g e | 9 नासरोग नाम संख्या ACCORDING TO सुश्रुत अपीनसः पूशतनस्यं नासापाकस्तथैव च । तथा िोशितशपत्तं च पूयिोशितिेव च । क्षवथुर्भ्रंिथुदीप्तो नासानािः पररस्रवः । नासािोषेि सशिता दिैकाश्चेररता गदाः । चत्वायविांशस चत्वारः िोफाः सप्तार्ुवदाशन । प्रशतश्यायाश्च ये पञ्च वक्ष्यन्ते सशचशकत्सताः । एकशत्रंिन्द्रितास्ते तु नासरोगाः प्रकीशतवताः । अपीनसः क्षवथु िोशितशपत्तं नासानाि पूशतनस्यं र्भ्रंिथु पूयिोशित पररस्रवः नासापाक दीप्त नासािोष चत्वारः िोफाः प्रशतश्याया(5types) सप्तार्ुवदाशन चत्वायविांशस ACCORDING TO अष्टाङ्ग हृदय प्रशतश्याया(5types) नासानाि पूशतनास पुटक दुष्टप्रशतश्याया घ्रािपाक पूयरक्त अिवस् & अर्ुवद पक्व प्रशतश्याय घ्रािस्राव नासािोष दीन्द्रप्त भृिक्षव अपीनस
  10. 10. P a g e | 10 नासरोग सामान्य ननदान ACCORDING TO सुश्रुत नारीप्रसङ्ग शिरसो अशभतापो धूिो रजः िातिशतप्रतापः । संधारिं िूत्रपुरीषयोश्च सद्यः प्रशतश्यायशनदानिुक्ति् । Indulgence in women (copulation), injury to head, assault by smoke, sunlight, dust etc.; too much of cold (exposure to mist, fog, rain etc.), suppression of urges of urine & faeces are the immediate causes of नासरोग ACCORDING TO अष्टाङ्ग हृदय अवश्यायशनलरजोभाष्याशतस्वप्नजागरैः ।नीचात्युच्चोपधानेन पीतेनान्येन वाररिा । अत्यम्बुपनरििच्छशदवर्ाष्पग्रिाशदशभः ।क्रु ध्दा वातोल्बिा दोषा नासायां स्त्यानतां गताः । Exposure to dew(mist, fog), breeze & dust, too much of speaking, sleeping & keeping the pillow either very low or very high under the head, drinking more quantity of water, indulging more in water sports, suppression of vomiting & tears etc. नासरोग सम्प्राप्ति चयां गतां िूशधवशन िारुतादयः पृथक् सिस्ताश्च तथैव िोशिति् । प्रकोप्यिािा शवशवधैः प्रकोपिैनृविां प्रशतश्यायकरा भवन्द्रन्त शि । वात &other दोष either individually or in combination & also with रक्त getting aggravated by exciting causes accumulate in the head & produce नासरोग वाताशद दोष, रक्त Vitiated Accumulate in the िूधव नासरोग
  11. 11. P a g e | 11 नासरोग पूर्वरूप शिरोगुरुत्वं क्षवथोः प्रवतवनं तथा अङ्गिदवः पररिष्टरोिता । उपद्रवाश्चाप्यपरे पृथन्द्रिधा नृिां प्रशतश्यायपुरःसराः स्मृताः ।  Feeling of heaviness of head, Sneezing, Body ache  Horripilation, Many secondary disease (such as fever, loss of taste etc.) नासरोग साध्या-असाध्यता अष्टादिानाशित्येषां यापयेदुष्टपीनसि् । A.H ;Among the 18 नासरोग दुष्टप्रशतश्याया is to be treated for long period. (All the others are curable) नासार्वस् लक्षण अष्टाङ्ग हृदय & अष्टाङ्ग संग्रि अिो अर्ुवदाशन शवभजेदोषशलङ्गै यवथायथि् । सवेषु कृ च्छर ोच्छ्वसनं पीनसः प्रततं क्षुशतः । सानुनाशसकवशदत्वं पूशतनासः शिरोव्यथा । अिवस् & अर्ुवद should be understood by the characteristic symptoms of the –  Difficulty in breathing  Running nose  Continuous sneezing  Nasal voice  Foul smell from nose, Head ache
  12. 12. P a g e | 12 ACCORDING TO सुश्रुत संशिता त एवोर्ध्विागताः श्रोत्राशक्षघ्रािवदनेष्विोस्युपशनववतवयन्द्रन्त, तत्र किवजेषु र्ाशधयं िूलं पूशतकिवता च, नेत्रजेषु वर्त्ाववरोधो वेदना स्रावो दिवननािश्च, घ्रािजेषु प्रशतश्यायो अशतिात्रं क्षवथुः कृ च्छर ोच्छ्वासता पूशतनस्यं सानुनाशसकवाक्यत्वं शिरोदुःखं च,वक्रजेषु कण्ठौष्ठतालुनािन्यतिन्द्रस्मस्तैगवद्रदवाक्यता रसाज्ञानं िुखरोगांश्च भवन्द्रन्त । दोष reaching to the upper part, get localised in ears, eyes, nose, mouth or face & produce sprouts in these organs; those in the ears give rise to deafness, pain, exudation & blindness; those in the nose produce nasal catarrh, too many sneezes, difficulty for breathing, bad smell from the nose, nasal voice while speaking & headache; those developing in the mouth, throat, lips, palate & any other place nearby, give rise to stammering, loss of sensation of taste & diseases of the mouth. नासार्वस् निनित्सा ACCORDING TO अष्टाङ्ग संग्रि अिांशस शवशधवत् क्षारेिाशिना वा दिेत् । स्थूलाशन तु िस्त्रेि दािानन्तरं िीतां शक्रयां योजयेत् । The following is the treatment done for नासािवस्. If नासािवस् is small, it should be burnt either by क्षार or अशि & larger one should be excised by scalpel, cold applications are done after cauterizing the spot. वशतं च नासायां कु म्बशनकु म्ब अशिकसैन्धवशपप्पली िनशिलाकल्क िधु घृत प्रशदग्धाि् ।
  13. 13. P a g e | 13 कल्क Of following drugs such as कु म्ब, शनकु म्ब दन्ती, अशिक, सैन्धव, शपप्पली, िनशिला, आल added with honey & ghee is smeared on a cotton wick & inserted into the nose तुवररकाशवभीतक िररद्रालोध्र शप्रयङ् गु करशिकाकल्क गुडोदकशवपक्वं तैलं नावनि् । करिकलोध्रोत्पलिधुकशतन्दुकान्द्रस्थ शत्रफलाखशदरसार शवपक्वं वा । Oil processed with the paste of तुवररक, शवभीतक, िररद्रा, लोध्र, शप्रयङ् गु, करशिक added with jaggery water administered as nasal drops; or the oil cooked with करि, लोध्र, उत्पल, िधुक, शतन्दुक, अन्द्रस्थ, शत्रफल, खशदर सार should be administered as nasal drops. यथादोषं च स्निविनशवरेकादीन् प्रशिदध्यात् । स्नेिन, विन, शवरेचन therapies etc. Which are suitable are administered depending on the predominance of दोषा. ACCORDING TO योगरत्नाकर क्षारो अर्वद अिविांसे च शक्रयः िेषे अप्यवेश्क्ष्क्ष्य च । न्द्रस्थशतशनवावतशनलये प्रगाढोष्णीषधारिि् । गण्डू षो लङ्गनं नस्यं धूिच्छशदवः शिरव्यधः । Cautery with क्षार in the cases of tumour & polyps & other therapies to the condition should be administered. The patient should be kept in a house free from direct wind & he should wear a tight turbun on his head. Gargles, fasting, nasal administration, smoking, emesis, & bloodletting are beneficial. ACCORDING TO भावप्रकाि रक्तशपत्ताशन िोथांश्च तथा अिावस्यर्ुवदाशन च । नाशसकयां स्युिेषां स्वं स्वं कु यावशचशकन्द्रत्सति् ।
  14. 14. P a g e | 14 रक्तशपत्त, िोथ, अिवस्, अर्ुवद occurring in the nose should be treated with therapies as described in their respective chapters. ACCORDING TO वृन्दिाधव, सुश्रुत िेषािां तु शवकारािां स्वं स्वं कायं शचशकन्द्रत्सति् । वीक्ष्यदोषर्लं सम्यन्द्रिषजां शवशधवेशदना । An expert physician should treat the remaining disease individually according to the condition of the दोषा. िेषान् रोगान् घ्रािजान् सन्द्रन्तयच्छे दुक्तं तेषां यद्यथा संशवधानि् । चतुशववधो अिवसां साधनोपायः ।तद्यथा-भेषजं क्षारो अशिः िस्त्रशिशत । तत्र अशचरकालजातान्यल्पदोषशलङ्गोपद्रवाशि भेषजसाध्याशन, िृदुप्रसृतावगाढान्युन्द्रच्छर ताशन क्षारेि, ककव िन्द्रस्थरपृथुकशिनान्यशिना, तनुिूलान्युन्द्रच्छर ताशन क्लेदवन्द्रन्त च िस्त्रेि ।तत्र भेषजसाध्यानाििवसािद्यश्यानां च भेषजं भवशत, क्षाराशििस्त्रसाध्यानां तु शवधानिुच्यिानिुपधारय । अशचरकालजाशन-अवत्सरािी पृथूशन-शविालाशन कशिनाशन-अकोिलाशन Methods of treatment of अिवस् are four; such as भेषज, क्षार, अशि, िस्त्र  अिवस् which are not chronic, having mild aggrevation of दोषा, symptoms & complications(secondary diseases) are treatable with medicines.  Those who are soft, broad, deep & bulged up are to be treated with क्षार.  Those which are rough, immovable, big & hard require the use of fire
  15. 15. P a g e | 15  Those which have thin root, bulged up & exuding(fluids) are to be treated with sharp instruments  For अिवस् treatable medicines & for those which are invisible, medicinal treatment alone is sufficient. ACCORDING TO अष्टाङ्ग हृदय दग्धेष्विोर्ुवदेषु च ।शनकु म्भकु म्भशसन्घूत्थ िनोह्वालकिाशिकै ः । कन्द्रल्कतैघृवतिर्ध्क्तां घ्रािे वशतं प्रवेियेत् ।शिग्र्वाशद नावनं चात्र पूशतनासोशदतं भजेत् । अिवस् & अर्ुवद Should burnt first & after that a cotton wick smeared with the paste of शनकु म्भ, कु म्भ, शसन्घूत्थ, िनशिल, आल, किा, अशि added with ghee & honey should be introduced into the nose. Nasal drops with शिग्रु & other drugs mentioned in the treatment of पूशतनास should be resorted to. DIFFERENT औषघयोगा USEFUL IN नासार्वस् 1) नासार्ाांनस गृहधूमानद तैलम् नर्खरर तैलम् गृिधूिकिादारुक्षार नक्ताह्वसैन्घवैः । शसध्दं शसखररर्ीजैश्च तैलं नासािवसे शिति् । The oil cooked with domestic soot, किा, दारु, क्षार, नताह्व, सैन्धव & the seeds of शिखरर is beneficial in the cases of nasal polyps. 2) नासार्वसे रक्तिरर्ीरपुष्पानद तैलम् रक्तकरवीरपुष्पं जात्यं वा तथा िन्द्रिकायाः ।एतैः सिं शतलतैलं नासािोनािनं परिि् । The oil cooked with equal quantity of the flowers of रक्तकरवीर, जाशत, िन्द्रिका is an excellent remedy of nasal polyp
  16. 16. P a g e | 16 3) नहङ्ग् वानद तैलम् शिङ् गुव्योषशवडङ्ग कट्फलवचा रुक्तीक्ष्िगन्धयुवतैलावक्ष । श्वेतपुननववाभ्दकु टजैः पुष्पोभ्दवैः सोरसैः । इत्येशभः कटुतैलिेतदनले िन्दे सिुत्रं श्रृतं । पीतं नाशसकया यथाशवशध भवेन्नासािशयभ्यो शिति् । Oil should be cooked with (कल्क of) शिङ् गु, व्योष, शवडङ्ग, कट्फल, वचा, रुक् , तीक्ष्िगन्ध, लाक्षा, श्वेतपुननवव, अभ्द, कु टज & flowers of सुरस along with cow urine on low fire. This oil taken methodically through nose, is beneficial in all the nasal diseases. 4) नित्रि तैलम् शचत्रकचशवकादीप्यक शनशदग्धकाकरिलविाके ।गोिूत्रयुक्तं शसध्दं तैलं नासािवसां शवशिति् । Oil cooked with (कल्क of) शचत्रक, चशवका, दीप्यक, शनशदग्धक, करि, लविा, अकव along with गोिूत्र is beneficial for नासािवस्. नस्य can be performed using this तैलि् 5) नित्रिहरीतिी शचत्रकस्यािलक्याश्च गुडू च्या दििूलजि् ।ितं ितं रसं दत्वा पथ्याचूिावढकं गुडात् ।ितं पचेध्दशनभूते पलं द्वादिकं शक्षपेत् ।व्योषशत्रजातयोः क्षारात् पलाध्दविपरे अिशन ।प्रस्थाध्दं िधुनो दर्ध्ा यथाग्न्यद्यादतन्द्रितः ।वृध्दये अिेः क्षयं कासं पीनसं दुस्तरं शक्रशिन् गुल्मोदावतवदुनाविश्वासान् िन्द्रन्त रसायनि् । 100 पला juice/decoction each of शचत्रक, आिलकी, दििूल, one अढक चूिव पथ्या & 100 पल jaggery should be cooked together, when cooked to thick consistency, 12 पल of व्योष, शत्रजात & पला यवक्षार should be added to it. The next day प्रस्थ honey should be mixed with it & given to eat according to the patient’s digestive capacity. It is appetizing, cures phthisis, cough, & chronic coryza; difficult to be cured otherwise,
  17. 17. P a g e | 17 maggots, gulma, and upward movement of abdominal gases, piles & dyspnoea. It is also a रसायन. 6) िासीसानद तैलम् कासीसंलाङ्गलीकु ष्ठं िुण्ठीकृ ष्णासैन्धवि् ।िनशिलाश्विारश्च शवडङ्गशचत्रकद्रुिः । दन्तीकोिातकी र्ीजं िेिाह्वा िररतालकि् ।कल्कै ः कषवशितैरेतैस्तैलपृस्थं शवपाचयेत् । स्नुह्याकव पयसी दध्यात् पृथन्द्रवद्वपलसंशिते ।चतुगविं गवां िूत्रं दत्वा सम्यक्प्रसाधयेते । कशथतं खरनादेन तैलििोशवनािनि् ।क्षारवत्पातयत्येतदिशंस्यभ्यङ्गतो भृिि् । वशलनव दू षयत्येतत्क्षारकिवकरं स्मृति् । कासीस(ferrous sulphate), लाङ्गली(Gloriosa superba), कु ष्ठ(Saussurea lappa), िुण्ठी(dry ginger),कृ ष्णा(long pepper),सैन्धव(rock salt),िनशिला(Real gar),अश्विार(Nerium odorum),शवडङ्ग(Embelia ribes),शचत्रक(Plumbago zeylanica),द्रुि(Hollarhena antidysentrica),दन्ती(Baliospermum montanum),कोिौतकी र्ीज(seeds of Luffa acutangula),िेिाह्व(Argemon Mexicana),िररतालक(yellow arsenic sulphate) are taken in the quantity of 1 कषव(10gm) each & made into a bolus which is put in 1 प्रस्थ(640gm) of sesame oil, 2 पला(80ml) of each of the latex from स्नुिी (Euphorbia tirucalli)& अकव (Calotropis gigantia) & 4 times of cows urine & boiled to oil consistency. This preparation which is called कासीसाशद तैलि् unfolded by KHARANADA, is useful in destroying अिवस्. अिवस् are fallen by application of this as in the case of application of क्षार.
  18. 18. P a g e | 18 नासारोग पथ्या-अपथ्या योगरत्नाकर पथ्या स्नेिः स्नेदः शिरोभ्यङ्गः पुरािा यविालयः ।कु लत्थिुद्गयोयूवषो ग्राम्या जाङ्गलजा रसा । वातावकं कु लकं शिग्रु ककोटं र्ालिूलकि् ।लिूनं दशध तप्ताम्बु वारुिी च कटुत्रयि् । कट्वम्ललविं शस्नग्धिुष्णं च लघु भोजनि् ।नासारोगो पीनसादो सेव्यिेतद्यथािलि् ।  पथ्या-शविार - स्नेिन, स्नेदन, शिरोभ्यङ्गः  पथ्या-आिार - पुरािा यव, पुरािा िाली यूष prepared using कु लत्थ, िुद्ग िांसरसा of ग्राम्य जाङ्गलदेि(domestic & wild creatures) वातावकं , लिूनं, दशध, तप्ताम्बु(उष्णजल), वारुिी(िद्य), कटुत्रयि्(शपप्पली, िरीच, िुण्ठी) कटु, अम्ल, लवि, शस्नग्ध, उष्ण, लघु भोजन अपथ्या स्नानं क्रोधं िकृ िूत्रवातवेगाञ्शुचं द्रवि् । भूशििय्ां च यत्नेन नासारोगी पररत्यजेत् ।  अपथ्या-शविार स्नानि्, क्रोधि्, िोकि्, भूशििय्ा, िलिुत्रवेगों का रोकना  अपथ्या-आिार द्रव पदाथों का भोजन्
  19. 19. P a g e | 19 भैषज्य रत्नावली पथ्या न्द्रस्थशतशनवावतशनलये प्रगाढोष्णीषधारिि् ।गण्डू षा लङ्गनं नस्यं धूिछशदवः शिराव्यधः । कटुचुिं नासारन्ध्रे शनशक्षप्यान्तः प्रवेशिति् ।स्नेिः स्नेदः शिरोभ्यङ्गः पुरािा यविालयः । कु लत्थिुद्गयोयूवषो ग्राम्या जाङ्गलजा रसा ।वातावकं कु लकं शिग्रु ककोटं र्ालिूलकि् । लिूनं दशध तप्ताम्बु वारुिी च कटुत्रयि् ।कट्वम्ललविं शस्नग्धिुष्णं च लघु भोजनि् । नासारोगो पीनसादो सेव्यिेतद्यथािलि् ।  Dwell in वायु रशित स्थान  To wear heavy blankets  गण्डू षा, लङ्गनं, नस्यं, धूिछशदवः, शिराव्यधः अपथ्या शवरुध्दाशन शदवास्वप्निशभष्यन्द्रन्द गुरूशि च । स्नानं क्रोधं िकृ िूत्रवातवेगाञ्शुचं द्रवि् । भूशििय्ां च यत्नेन नासारोगी पररत्यजेत् ।  Consumption of शवरुध्दािार, अशभष्यन्द्रन्द गुरूशि आिार  शदवास्वप्न ACCORDING TO वङ्गसेन िीताम्बुयोशषन्द्रच्छरसावगािि् शचन्ताशतरूक्षािनवेगरोधन् । िोकं च िद्याशन नवानी चैव शववजवयेत पीनसरोगजुष्टः ।
  20. 20. P a g e | 20 NASAL POLYPI Nasal polypi are non-neoplastic masses of oedematous nasal or sinus mucosa. They are divided into two main varieties: i. Bilateral ethmoidal polypi ii. Antrochoanal polyp 1. BILATERAL ETHMOIDAL POLYPI AETIOLOGY  Very complex & not well understood  They may arise in inflammatory conditions of nasal mucosa(rhino sinusitis), disorders of ciliary motility or abnormal composition of nasal mucus(cystic fibrosis)  Various diseases associated with the formation of nasal polypi are chronic rhino sinusitis, Asthma, Aspirin intolerance, Cystic fibrosis, Allergic fungal sinusitis, Kartagener syndrome, Young syndrome, Churg-strauss syndrome. PATHOGENESIS Nasal mucosa, particularly in the region of middle meatus & turbinate, becomes oedematous due to collection of extracellular fluid causing polypoidal change. Polypi which are sessile in the beginning become pedunculated due to gravity & excessive sneezing. PATHOLOGY In early stages, surface of nasal polypi covered by ciliated columnar epithelium like that of normal nasal mucosa but later it undergoes a metaplastic change to transitional & squamous type on exposure to atmospheric irritation. Sub mucosa shows large intercellular spaces filled with serous fluid. There is also infiltration with eosinophil’s & round cells.
  21. 21. P a g e | 21 SITE OF ORIGIN Multiple nasal polypi always arise from the lateral wall of nose, usually from the middle meatus. Common sites are uncinated process, bulla ethmoidalis, ostia of sinuses, medial surface & edge of middle turbinate. Allergic nasal polypi almost never arise from the septum or the floor of nose. SYMPTOMS  Multiple polypi can occur at any age but are mostly seen in adults  Nasal stiffness leading to total nasal obstruction may be the presenting symptom, Head ache due to associated sinusitis  Partial or total loss of sense of smell, Sneezing & watery nasal discharge due to associated allergy, Mass protruding from the nostril SIGNS  On anterior rhinoscopy, polypi appear as smooth, glistening grape like masses often pale in colour. They may be sessile or pedunculated, insensitive to probing & do not bleed on touch, Often they are multiple & bilateral  Long standing cases present with broadening of nose & increased intercanthel distance  A polyp may protrude from the nostril & appear pink & vascular simulating neoplasm. Nasal cavity may show purulent discharge due to associated sinusitis DIAGNOSIS Diagnosis can be easily made on clinical examination. Computed tomography (CT) scan of paranasal sinus is essential to exclude the bony erosion & expansion suggestive of neoplasia. Simple nasal polypi may sometimes be associated with malignancy underneath, especially in people above 40 yrs. & this must be excluded by histological examination of the suspected tissue. CT scan also helps to plan surgery.
  22. 22. P a g e | 22 2. ANTROCHOANAL POLYP (SYN.KILLIAN’S POLYP) This polyp arises from the mucosa of maxillary antrum near its necessary ostium, comes out of it & grows in the choana & nasal cavity. Thus it has three parts. 1) Antral,which is a thin stalk 2) Choanal,which is round & globular 3) Nasal, which is flat from side to side AETIOLOGY Exact cause is unknown. Nasal allergy coupled with sinus infection is incriminated. Antrochoanal polypi are seen in children & young adults. Usually they are single & unilateral. SYMPTOMS Unilateral nasal obstruction is the presenting symptom. Obstruction may become bilateral when polyp grows into nasopharynx & starts obstructing the opposite choana. Voice may become thick & dull due to hypo nasality. Nasal discharge, mostly mucoid, may be seen on one or both sides. SIGNS As an Antrochoanal polyp grows posteriorly, it may be missed on anterior rhinoscopy. When large, a smooth greyish mass covered with nasal discharge may be seen. It is soft & can be moved up & down with a probe. A large polyp may protrude from the nostril & show a pink congested look on its exposed part. Posterior rhinoscopy may reveal a globular mass filling with choana or the nasopharynx. A large polyp may hang down behind the soft palate& present in the oropharynx. Examination of the nose with an endoscope may reveal a choanal or Antrochoanal polyp hidden posteriorly in the nasal cavity.
  23. 23. P a g e | 23 DIFFERENTIAL DIAGNOSIS (A)Antrochoanal polyp seen hanging in the oropharynx from behind the soft palate on the right side of uvula. (B) Polyp after removal
  24. 24. P a g e | 24 1. A blob of mucosa often looks like a polypus but it would disappear on blowing the nose 2. Hypertrophoid middle turbinate is differentiated by its pink appearance & hard feel of bone on probe testing 3. Angiofibroma has history of profuse recurrent epistaxis. It is firm in consistency & easily bleeds on probing 4. Other neoplasms may be differentiated by their fleshy pink appearance, friable nature & their tendency to bleed DIFFERENCE BETWEEN ANTROCHOANAL & ETHMOIDAL POLYPI ANTROCHOANAL POLYPI ETHMOIDAL POLYPI AGE Common in children Common in adults AETIOLOGY infection Allergy or multifactorial NUMBER Solitary Multiple LATERALITY Unilateral Bilateral ORIGIN Maxillary sinus near the ostium Ethmoidal sinuses, uncinated process, middle turbinate & middle meatus GROWTH Grows backwards to the choana; may hang down behind the soft palate Mostly grow anteriorly & may present at the nares SIZE & SHAPE Trilobed with antral, nasal & choanal parts. Choanal part may protrude through the choana & fill the nasopharynx obstructing both sides. Usually small & grape like masses RECURRENCE Uncommon, if removed completely Common TREATMENT Polypectomy; endoscopic removal or Caldwell-Luc operation if recurrent Polypectomy. Endoscopic surgery or ethmoidectomy.
  25. 25. P a g e | 25 TREATMENT BILATERAL ETHMOIDAL POLYPI CONSERVATIVE 1) Early polypoidal changes with oedematous mucosa may revert to normal with anti-histamines & control of allergy 2) A short course of steroids may prove useful in case of people who cannot tolerate anti histamines &/or in those with asthma & polypoidal nasal mucosa. They may also be used to prevent recurrence after surgery. Contraindications to use of steroids, e.g; hypertension, peptic ulcer, diabetes, pregnancy & tuberculosis should be excluded. SURGICAL 1) POLYPECTOMY One or two polyps which are pedunculated can be removed with snare. Multiple & sessile polypi require special forceps. 2) INTERNASAL ETHMOIDECTOMY When polypi are multiple & sessile, they require uncapping of the ethmoidal air cells by internasal route, a procedure called internasal ethmoidectomy 3) EXTRANASAL ETHMOIDECTOMY This is indicated when polypi recur after internasal procedures & surgical landmarks are ill defined due to previous surgery. Approach is through the medial wall of the orbit by an external incision, medial to medial canthus. 4) TRANSANTRAL ETHMOIDECTOMY This is indicated when infection & polypoidal changes are also seen in the maxillary antrum. In this case, antrum is opened by Caldwell-Luc approach & the ethmoidal air cell approached through the medial wall of the antrum. This procedure is also superceded by endoscopic sinus surgery.
  26. 26. P a g e | 26 5) ENDOSCOPIC SINUS SURGERY These days, ethmoidal polypi are removed by endoscopic sinus surgery more popularly called functional endoscopic sinus surgery (FESS). It is done with various endoscopes of 0 degree, 30 degree, 70 degree angulation. Polypi can be removed more accurately when ethmoid cells are removed & drainage & ventilation provided to the other involved sinuses such as maxillary, Sphenoidal or frontal. TREATMENT ANTROCHOANAL POLYP (SYN.KILLIAN’S POLYP) An Antrochoanal polyp is easily removed by avulsion either through the nasal or oral route. Recurrence is uncommon after complete removal. In cases which do recur, Caldwell-Luc operation may be required to remove the polyp completely from the site of its origin & to deal with co existent maxillary sinusitis. These days, endoscopic sinus surgery has superceded other modes of polyp removal. Caldwell-Luc operation is avoided.
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nasal polyp treatment in ayurveda science

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