ARYA AYURVEDIC PANCHAKARMA CENTRE

SINUSITIS
Sinusitis also known as rhinosinusitis is an inflammation of the mucous membrane lining
the nasal passages and sinuses, usually caused by an infection.
The sinuses are hollow air filled cavity in the skull. They help to maintain pressure, air
circulation and serve as a shock absorber for the internal organs of the skull. Sinuses are
lined with membrane which secretes mucus that traps any germs or bacteria and drains
out, in exchange air is filled. But when the sinuses opening into the nose are blocked,
excess mucus is produced which leads to inflammation.
There are four sinuses located within the skull:
1. Frontal sinuses - above the eyes in the eyebrows
2. Ethmoid sinuses - between the eyes and behind the nose bridges
3. Maxillary sinuses - in both cheekbones
4. Sphenoid sinuses - behind the ethmoid in the upper nose and behind the eyes

Causes for sinusitis

Exposure to environment pollution, dust, chemical irritant, etc.
Recent upper respiratory tract infection like common cold
Exposure to allergens like pollens
Sudden changes in environment temperature
Low physical exertion
Any structural change in the nasal passage due to nasal polyp, deviated nasal septum, etc.
Recent contact with mould or fungus
Tobacco smoking
Weak immune system

Copyright Dr.Niveedha Bhadran, ARYA AYURVEDIC PANCHAKARMA CENTRE

ARYA AYURVEDIC PANCHAKARMA CENTRE

Cystic fibrosis
Dental infection
Blockage in Eustachian tube
Genetic factor
Obesity
Increased antibiotic resistance
In children

• Contact with other children with the illness in day care centre
• Pacifiers
• Allergies to soft toys with fur
• Environmental smoke
Types
Based on chronological
1. Acute sinusitis: most common type and lasts up to 1 to 4 weeks
2. Recurrent acute sinusitis: repeated attack at smaller intervals
3. Sub-acute sinusitis: symptoms longer than the normal acute period for
between 4 and 12 weeks
4. Chronic sinusitis: symptoms may persists or continually return after 12
weeks
Based on location
1. Maxillary sinusitis: pain or pressure in the cheek area e.g. toothache
2. Frontal sinusitis: pain or pressure above the eyes, headache particularly in
the forehead
3. Ethmoidal sinusitis: can cause pain between/behind the eyes, sides or
upper part of the nose, headache
4. Sphenoid sinusitis: pain or pressure behind the eyes, often felt at the top of
the head, over the mastoid process (behind the ear) or back of the head.
Signs and Symptoms

• Pain or pressure on the sinuses

• Nasal congestion or blocked nose
• Post nasal drip i.e. overproduction of the mucous that flows to the
throat that leads to Irritated or sore throat
• Thick whitish or yellowish mucous or watery nasal discharge
• Irritated or throat
• Cough, sneezing
• aggravated headache whenever the head is tilted forward
• Reduced sense of smell

Copyright Dr.Niveedha Bhadran, ARYA AYURVEDIC PANCHAKARMA CENTRE

ARYA AYURVEDIC PANCHAKARMA CENTRE

• Halitosis or bad breath

• Itching in the eyes which is similar to allergies
• Fatigue
• Toothache
• Ear ache
• Mild fever
Complication

• Abscess
• Meningitis
• Vision problems
• Deafness
• Coma
Diagnosis
- Physical examination- by taking the proper case history and palpating the sinuses,
examining the nasal passage, etc.
- X ray of the sinuses
- Ct scan or MRI
- Rhinoscopy
Treatment

• Antibiotics for bacterial infections

• Antifungal for fungal infections
• Nasal decongestant sprays
• Analgesics
• Surgery
Prevention

• Wash the hands regularly

• Avoid exposure to allergens, pollens etc.
• Avoid smoking and passive smoke
• Keep vaccination up to date
• Stay away from people with cold and other respiratory tract infection
• Keep the air-condition filter clean to prevent the mould build up

SINUSITIS IN AYURVEDA
According to Ayurveda the main site of kapha dosha is head and the nose is the gateway
of the head. Hence similar symptoms of sinusitis are mentioned under Nasa roga (disease
of nose) and Shiro roga (disease of head). It can be correlated as Kaphaja siroroga and
Suryaavartha under Siroroga and also as Dushtapratishyaya in Nasa roga.

Copyright Dr.Niveedha Bhadran, ARYA AYURVEDIC PANCHAKARMA CENTRE

ARYA AYURVEDIC PANCHAKARMA CENTRE

Nidana (Causative Factors)

 Ahara Nidana
o Atibhojana (excessive intake of food)
o Guru bhojana (excessive intake of food taking long time to digest)
o Ati snigda bhojana (excessive intake of oily food)
o Atyambupaana/sheethambupaana (excessive drinking of cold water)
 Vihara Nidana
o Aasya sukham (sedentary lifestyle)
o Svapna sukham (excessive sleep/daytime sleeping)
o Rajo, dhooma, sheetha vayu sevana (exposure to dust, smoke, cold breeze)
o Ritu vaishamya (sudden climate change)
o Vegodharana (suppression of urges especially chardi (vomiting) or tears)
o Use of too high or too low pillow

Samprapthi (Etiopathogenesis)

Vata dosha
circulates This
Nidanasevan
this ama all obstructs the
a (causative
leads to over the srothas causes nasa
factor)
formation of body and (channel) roga or
makes to
ama (toxins) gets localised and further siroroga
aggravate
in nasa vitiates the
kapha dosha
(nose) or kapha
siras (head)

Poorvaroopa (Premonitory symptoms)

o Nasal and eye irritation
o Sneezing
Lakshanas (Symptoms)
 Kaphaja Siroroga
 Kapha predominant disease
 Feeling of heaviness in head, headache
 Puffy face and eyelids
 Severe headache at night and minimum at daytime
 Postnasal drip
 Thick sputum
 Suryaavartha
 Tridoshaja/pitta predominant disease
 Pain in eyes, root of nose, frontal and sides of head
 Pain depends on intensity of the sunrays (starts at morning, increases at
noon and decreases at night
 Dushtapratishyaya

Copyright Dr.Niveedha Bhadran, ARYA AYURVEDIC PANCHAKARMA CENTRE

ARYA AYURVEDIC PANCHAKARMA CENTRE

 Pratishyaya (rhinitis) when untreated for long time leads to

Dushtapratishyaya, a complication of rhinitis
 Thick white sputum
 Fever, severe headache, cough, breathing trouble, malaise
 Nasal mucosa moist and dry alternately
 Reduced sense of smell
Upasaya (Pacifying Factors)
- Hot fomentation over the sinus
- Warm food and liquids
Anupasaya (non-pacifying factors)

• Exposure to cold wind, mist, smoke, etc.

• Intake of cold items like ice-cream
• Cold water shower
Treatment
The principle line of treatment is ama pachana (to breakdown toxins) by giving medicines
with deepana pachana (digestive) to increase Agni (digestive fire). Then to clear the
obstruction of the srothas (channels) teekshana Shodana (strong expulsion of aggravated)
to the nearest route i.e. nose by Nasya (one of the panchakarma) is given. Further to
enhance the immunity of the individual Rasayana is advised.
In all types of siroroga and nasaroga, nasya is the prime treatment to remove the
aggravated doshas. If the patient has more bala (strength) and aggravated doshas,
vamana is also recommended

There are 2 modalities of treatment

1. Shodana (Purificatory treatment)
 Deepanapachana (to increase Agni)
 Shadanga kashayam
 Trikatuchoornam
 Chitrakadi vati
 Sirovirechana
- Poorvakarma (pre-operative stage)
a) Abhyangam above shoulder region with Asana vilwadi/kumkumadi tailam
b) Followed by Swedana kriya (steam inhalation) with Dasamoola kashayam/Rasnadi
choornam and Karpooram (medicinal camphor)
- Pradhana karma (operative stage)

Copyright Dr.Niveedha Bhadran, ARYA AYURVEDIC PANCHAKARMA CENTRE

ARYA AYURVEDIC PANCHAKARMA CENTRE

Make the patent lie on the flat surface and tilt the head backwards. Then instil the
medicinal drops (ANU TAILAM, GUDA NAGARA, etc.) and allow the medicine to flow into
the nasal passage by slight massage on the sides of nose.
- Pashchat karma (post-operative stage)
o Patient is asked to spit out the accumulated sputum
o Kavalagraha/Gandoosham: Lukewarm salt water is prepared and instruct the
patient to hold and gargle for 2-5 minutes and spit it out.
o Dhomapanam: Inhalation of smoke with medicine. Powders like Haridra
(curcuma), Ela (cardamom) powder, etc. is mixed with ghee and smeared on the
cotton cloth and is lit.
Dosage and the days of the nasya karma depend upon the severity of the disease and bala
of the person.
2. Shamana (Palliative treatment)
Herbal Formulations
o Decoctions: Dashamoolakatutrayam/Vyagradi kashayam/Dashamoolam
kashayam/ Pathyashadangam kashayam/Khadira and asana kashayam
o Tablets: Sudarshanamgulika/Laxmivilasarasam/Dushivishari
gulika/Shirashoolavajrarasa/Mahadhanwanthara gulika
o Choornam: Hinguvachadi choornam/Sitopaladi choornam/Talisapatradi
choornam
o Arishtam: Amruthaaraishtam/Dashamoolarishtam
o Lepanam (External application): Rasnadi choornam with lime
o Pratimarsha Nasyam (daily instillation of 2 drops in each nostril) Shatbindhu
tailam/Anutailam
3. Rasayanam
Vyaagriharitaki Avaleha/Agastaya rasyanam/Haridrakhandam
KEYDRUGS
- Kantakari (Solanam xanthocarpum)
- Tulsi (Ocimum sanctum)
- Haridra (Curcuma longa)
- Haritaki (Terminalia chebula)
- Amalaki (Embilica officinalis)
- Sunthi (Zingiber officinale)
- Maricha (Piper nigrum)
- Pippali (Piper longum)

Copyright Dr.Niveedha Bhadran, ARYA AYURVEDIC PANCHAKARMA CENTRE

ARYA AYURVEDIC PANCHAKARMA CENTRE

- Yashtimadhu (Glycyrrhiza glabra)

HOME REMEDIES

• Mix 1 tsp. Ginger juice with honey and take it 3-5 times daily
• Lime juice with honey
• 1tsp. cinnamon powder with honey
• Wheatgrass juice
• Tulasi tea
• Boil 4 glass of water with tulsi, 2 cloves, a few mint leaves, and a piece of ginger
and sip it throughout the day.
• Steam inhalation morning and evening with fresh tulasi leaves or camphor.
COMPLEMENTARY TREATMENT
Aromatherapy: A few drops of essential oils like Tea tree oil, Peppermint oil, Eucalyptus
oil, Lavender oil can be added to hot water for inhalation or bath. It can also be used
directly to the cloth or as in diffuser.
YOGA ASANAS

• Setubandhasanam
• Sarvaangasanam
• Janusheershasanam
• Haalasanam
• Pranayama

PATHYA APAHYA

Pathya (do`s) Apathya (don’ts)

• Warm food and hot water • Cold food items like ice-cream, juices, etc.
• Easily digestible food like • Sour and salty food
soups/porridge • Dairy products
• Buckwheat soup • Heavy, deep fried, processed or junk food
• Orange • Excess sweets/sugar
• Papaya • Refined flour
• Pears • Aubergine, tomato, banana
• Green leafy vegetables • coffee
• Garlic, onion and ginger • Day or excessive sleep
• Legumes • Cold water shower
• Spices (turmeric, cinnamon, black • Frequent head bath
pepper, clove, cumin seeds, mint) • Exposure to cold climate, air-condition
• Light exercise • Cigarette smoking
• Swimming in chlorinated pool

Copyright Dr.Niveedha Bhadran, ARYA AYURVEDIC PANCHAKARMA CENTRE

ARYA AYURVEDIC PANCHAKARMA CENTRE

CLINICAL EXPERIENCE
A female patient aged 35 years came to our centre with occasional headache associated
with blocked nose and loss of smell since 1 year. The condition worsens especially after
seasonal change and air travel.
Physical examination
Prakrithi (body constitution): Pittakapha
Vikrithi: Vatakapa
Agni (digestion): Mandagni (weak)
Diagnosis: Kaphaja Siroroga
Clinical Examination
Examination of nose: Nasal mucosa-inflammed, inferior turbinate-Hypertrophied,
Septum slightly deviated.
Examination of paranasal sinuses: Tenderness in bilateral frontal, ethmoidal and maxillary
sinuses.
Treatment
The treatment procedures for 14 days are given below:
Internal medication
- 1tsp Shadharana choornam in half glass of hot water in the afternoon before food
for 3 days
- Mahadhanwanthara gulika thrice daily after meals
- After 3 days Dashamoolakatutraya kashayam 20 ml in 40 ml luke warm water
External medication
- Udhwarthanam (powder massage) for 3 days to reduce body weight
- Shodana Nasya for 7 days
- Mukha abhyanga with Kumkumadi tailam
- Swedana-steam inhalation with Rasnadi choornam and Karpooram
- Nasyam with Anutailam 8 drops each nostril
- Gandoosham-with lukewarm salt water
- Dhoomapanam- Haridraadi choornam
Then on 11th day Virechanam with Avipathi choornam (20 g in 60 ml hot water)
Then till 12-14 days Pratimarsha Nasyam (2 drops in each nostril) after mukhabhyangam
and swedana.

Copyright Dr.Niveedha Bhadran, ARYA AYURVEDIC PANCHAKARMA CENTRE

ARYA AYURVEDIC PANCHAKARMA CENTRE

During the whole treatment course patient was asked to avoid morning walks and to
follow pathya.
Observation
- After udhwarthana patient lost 1Kg and felt lightness of body
- During shodhana nasya, for the first few days nose was completely blocked and it was
difficult for the drops to enter inside. Then after proper massage to nose bridge the
patient felt slightly relieved after spitting sputum
- After virechanam, the patient shed 3 more kilograms of body weight
- No tenderness over the sinuses by palpating as well as sense of smell was attained after
clearing the nasal passage.
Result
There was marked relief over the symptoms and patient gained normal appetite.
Advice given to patient on discharge
- Internal medication:
- Haridrakhandam- 10g with 30 ml hot water before bed
- Pathyashadangam kashayam-30 ml in 60 ml hot water before breakfast
- Nasyam with Anu tailam 2 drops in each nostril continuously for 7 days with an interval
of 7 days for 3 months
- Follow the pathya.
CONCLUSION
Even though sinuitis is categorized as kruchrasadhya/yapya (difficult to treat/control/
cure completely), Ayurveda medicines give a significant relief to the symptoms without
any side effects. Recurrence can occur due to unavoidable causes like climate change,
exposure to dusts, smoke, pollens etc. cause. However, in our clinical experience we
observed that those who have done regular panchakarma and followed the Rasayana
properly had a reduced recurrence.
References
1. The Shalakya tantra by Dr Dingari Laxmanacharya
2. Charaka Samhita, Chaukhamba Bharati Academy
3. Susruta Samhita Ayurveda Tatva Sandipika, Chaukhamba Bharati Academy
4. www.ayurveda journal.com
5. Ashtangahridayam
6. Mednet.com
7. Sahasrayogam
8. Chiktsa Manjari

Copyright Dr.Niveedha Bhadran, ARYA AYURVEDIC PANCHAKARMA CENTRE

ARYA AYURVEDIC PANCHAKARMA CENTRE

Copyright Dr.Niveedha Bhadran, ARYA AYURVEDIC PANCHAKARMA CENTRE