🔘 kshavathu ( Vasomotor rhinitis)

Kshavathu (vasomotor rhinitis)

👉🏻 Definition :- 

Kshavathu means sneezing. Kshavathu is thus a nasal disorder in which the patient suffers from too much sneezing. Master Vagbhata has used the term ‘Bhrsham Kshavah’ in place of Kshavathu. Bhrsham = repeated, Kshavah = sneezing.

👉🏻  Causes :- 

1. Tikshna ghranopayoga – inhalation of strong and irritating things.

2. Arka rashmisu – getting exposed to intense heat of the sun for longer duration.

3. Sutra trnadibhih – the nasal passage being irritated by inserting thread or grass / stick etc (often inserted to cleanse the nose).

4 . Vata kopaka karana - exposure to or consumption of other factors which cause aggravation of vata.

👉🏻 Pathogenesis :- 

Due to the above said causes the cartilages in the nose gets irritated. Due to this, vata gets vitiated. This vitiated vata when gets obstructed in the nose changes its course moves upwards and irritates the shrngataka marma located in the head. After striking the srngataka marma, vata reverts back and comes down towards the nasal orifices and causes plenty of sneezes frequently. This is called as Bhrsham Kshavthu.

👉🏻 Symptoms :- 

Repeated sneezing is the predominant symptom of Bhrsham Kshavah.

👉🏻 Types of Kshavathu :- 

In Mahava Nidana, quoting Sushruta, the author describes two kinds of Kshavathu.

1. Nija / Doshaja Kshavathu – 

Vata which gets vitiated in the marma located within the nasal passage gets admixed with kapha therein gets eliminated from the nose frequently producing sounds. This condition is called as Kshavathu.

Here we can see that the external factors are not involved and pathogenesis takes place due to the vitiated doshas, mainly vata getting vitiated in the marma. Vitiation of vata and irritation of marma is the chief process in the causation of frequent sneezing. The term marma here corresponds to srngataka marma.

2. Agantuja Kshavathu –

 Agantuja means that which is caused by external factors. Due to consumption of strong and irritating foods and also inhaling things of the same nature, getting exposed to heat of the sun for long duration or irritation of the phana marma located in the cartilages of the nasal passage or the cartilages of the nose or the shrngataka marma plenty of sneezes are caused frequently. This is called as Agantuja Kshavathu.

👉🏻 According to Acharya Charaka – 

‘The vayu located in the head when takes an abnormal course and touches the marma located in the nasal passage, it causes severe and frequent sneezing. This condition is called kshavathu.

👉🏻 Treatment of Kshavathu Principles of treatment :-

1. Pradhamana Nasya –

 snuffing medicated powders is beneficial. Alternatively the powders are filled in tubes and blown into the nostrils of the patient by the physician.

2 . Vataghna Sweda –

 sudation / fomentation with vata mitigating herbs is given over the head.

3. Snigdha Dhuma – unctuous fumigation is useful.

Useful formulations

4. Shuntyadi Ghrta or Taila – Ghee or oil prepared with the paste of the below mentioned herbs shall be used as oral medicines or as nasal drops –

5. Ginger

Kushta – Saussurea lappa

Pippali – Piper longum

Vidanga – Embelia ribes Raisins.

6. Sikthakadi Dhuma – 

Smoke emitted from burning together on fire the combination of Siktha – wax, Guggulu – Commiphora mukul and Ghee is useful.

👉🏻 According to modern : Vasomotor Rhinitis 

Kshavathu or Bhrsham Kshavah is compared to Vasomotor Rhinitis associated with Rhinorrhea explained in the modern texts due to closer resemblance of symptoms in both conditions.

👉🏻 Introduction :- 

Rhinitis and Rhinorrhea are the terms used for running nose. While rhinorrhea is a clear watery discharge from the nose, rhinitis is the inflammation of nasal tissues and membranes probably caused by irritants or allergen. Rhinitis can lead to rhinorrhea. Therefore rhinorrhea may often be a symptom of rhinitis.

👉🏻 Vasomotor rhinitis: 

 Many times there is no specific cause like irritant or allergen for inflammation. Such rhinitis is called as vasomotor rhinitis. It is also called as non-allergic rhinitis or idiopathic rhinitis. 

The symptoms of this condition can be uncomfortable but are not serious. It is more common after 20 years of age but can also affect children and adults.

Non-allergic rhinitis involves chronic sneezing or congested and running nose with no apparent cause. Though the symptoms resemble those of allergic rhinitis, evidence of allergy or allergic reaction is not present in this condition.

👉🏻 Causes of vasomotor rhinitis:- 

Vasomotor rhinitis is caused due to dilatation of blood vessels located in the nose. Dilatation of blood vessels consequently produces swelling leading to congestion and drainage of mucus from the nose. The other cause may be the hypersensitiveness or hyper-responsiveness of the nerve endings in the nose.

 - Common causes or triggers which might produce a reaction which leads to dilatation of blood vessels in the nasal cavity –

- Dust, smoke, smog, perfumes, strong odors, chemical fumes etc

Temperature / humidity changes often trigger the nasal membranes to swell and cause running nose. Dry weather to be precise is an important cause.

- Infections – Cold or flu and viral infections associated with these conditions.

- Hot or spice foods / drinks, drinking alcoholic beverages.

- Excessive use of nasal decongestant sprays

Medications – aspirin, ibuprofen, beta-blockers, antidepressants, oral contraceptives, some sedatives.

-Hypothyroidism

-Stress

-Hormonal changes associated with menstruation and pregnancy.

- Sleeping on your back, sleep apnea and acid reflux .

👉🏻 Risk Factors :-

Exposure to irritants – smog, exhaust fumes, tobacco smoke etc

Being older than 20 years of age

Prolonged use of decongestant nasal drops or sprays.

Being female – due to hormonal changes, nasal congestion gets worse often during menstrual cycles or pregnancy.

Occupational exposure to fumes – like construction materials, solvents, chemicals and fumes from decomposing organic material (compost) etc.

Certain health problems – Hypothyroidism, chronic fatigue syndrome etc may cause or worsen rhinitis.

Stress – physical or emotional stress may trigger the condition in some people.

👉🏻 Symptoms of Vasomotor Rhinitis :-

- Rhinitis

- Runny nose

- Stuffy nose

- Postnasal drip

- Mucus congestion in     the throat

- Sneeze

- Cough

These symptoms may keep coming and going all through the year. They may also be constant or even last for many weeks.

Vasomotor rhinitis is typically marked by the absence of itching in the nose, eyes or throat and watering of eyes. On the contrary these symptoms are generally found in allergic rhinitis. This condition is caused by allergy and vasomotor rhinitis is not caused by allergy.

👉🏻 Complications :-

- Nasal Polyps

- Sinusitis

- Middle ear infections

- Interruption of daily activities – less productivity at work or school, sickness,  absenteeism etc

👉🏻 Diagnosis of Vasomotor Rhinitis:-

This condition can be diagnosed when other causes of the symptoms are ruled out. Tests for allergy will help to rule out allergy as a cause of rhinitis. A skin test to identify allergies or a blood test to check if the immune system is good enough or not will help in diagnosis and differential diagnosis of this condition. Nasal endoscope or CT scan of sinuses may help in checking if sinus problems are causing rhinitis. If no evident cause for rhinitis is found, vasomotor rhinitis may be diagnosed.

👉🏻  Prevention  :- 

It is possible to prevent vasomotor rhinitis if the causes are identified.

Avoid overusing nasal decongestants. They often tend to worsen thesymptoms of the disease after having provided a short-term relief in the early part of their usage.

Studies suggest that children who consumed oily fish or certain polyunsaturated fatty acids are less prone to develop non-allergic or allergic rhinitis.

👉🏻 If you already have vasomotor rhinitis, you may take all steps which would reduce your symptoms, recurrences or flare-ups. These include –

- Avoid triggers

- Not overusing nasal - decongestants

👉🏻 Main principles of treating this condition includes –

- Over the counter saline nasal sprays

- Over the counter decongestants

- Over the counter nasal sprays

- Medications are given when symptoms are severe or if OTC medications produce side effects or no effects. Corticosteroids, antihistamine nasal sprays or anticholinergic nasal sprays or mix and match of these will come in for help to relieve the symptoms of vasomotor rhinitis.

 Surgery is rarely needed to treat the symptoms, especially if there are underlying health problems which intensify the symptoms inclusive of nasal polyps or a deviated nasal septum.

👉🏻 Home Remedies:- 

Home remedies shall be tried only when milder symptoms persist, to relieve symptoms and discomfort.

1. Nasal Rinse – Bulb syringe, neti pot or specially designed squeeze bottles shall be used to irrigate your nasal passages. This can be done at home and is called as nasal lavage. It helps in keeping your nose free of irritants. You may use filtered, boiled and cooled or distilled water for this purpose. This helps in prevention of infection. Often clean and sterilize your equipment.

2 . Nose Blowing – Blow your nose gently and regularly. This will help in clearing the mucus and irritants.

3. Humidification – Set up a humidifier at your work place or in your bed room if the air in your home or office is dry. Regularly cleanse your humidifier. Alternatively you may also breathe in the steam from a warm shower.

4. Hydration – Drink plenty of liquids, including water, juice and caffeine free tea. This will help in loosening the mucus in your nose. You may avoid caffeinated beverages.