PRATISHYAYA

PARIBHASHHA (DEFINITION) OF PRATISHYAYA

• The term Pratishyaya is derived from the root "shii" meaning "to go down," and "prati" meaning "reverse" or "again", indicating the downward flow of morbid doshas into the nasal cavity.

• It is a disorder primarily affecting the Urdhvajatru Pradesh (region above the clavicle), manifesting as nasa srava (nasal discharge), nasavarodha (nasal blockage), and other related symptoms.

अतिस्रुतं यत् नासायां दोषाणां निःसरं भवेत्।
तच्च प्रातिश्ययं ज्ञेयं तद्वेद्यं बहुवैधकम्॥
(Aṣṭāṅgahṛdaya Uttarasthāna 19/1)

HETUS (ETIOLOGICAL FACTORS) OF PRATISHYAYA

• Exposure to cold wind, dust, smoke (sheeta vata, raja, dhuma)

• Suppression of natural urges (e.g., sneezing)

• Irregular food habits – intake of guru, abhishyandi ahara

• Cold, heavy, unctuous foods leading to kapha vitiation

• Environmental factors: seasonal variation, especially during vasanta and hemanta ritu

• Vega dharana, dukha shayya, ratrijagarana etc.

धूमराजोत्तरान् वातान् शीतांस्तैलाभिषेचनम्।
वेगधारणमत्यर्थं तदहेतोः स प्रातिश्ययः॥
(Suśruta Saṃhitā Uttara Tantra 25/4)

SAMPRAPTI (PATHOGENESIS) OF PRATISHYAYA

• Vitiated doshas (mainly Kapha) accumulate in nasa srotas

• Local strotorodha (obstruction in nasal channels)

• Subsequent involvement of vata leads to expulsion or stagnation of mucous

• If untreated, leads to chronic inflammation or associated complications

सर्वे दोषा गदं कुर्युः कफजं तत्र कारयेत्।
प्रातिश्ययं स पित्तेन रक्तेन च विशेषतः॥
(Aṣṭāṅgahṛdaya Uttarasthāna 19/2)

PURVARUPA (PRODROMAL SYMPTOMS) OF PRATISHYAYA

• Mild nasal discharge or blockage

• Heaviness in head

• Itching sensation in nasal mucosa

• Watering of eyes

• Frequent sneezing

• Loss of smell (ghrana nasha)

LAKSHANA (SYMPTOMS) OF PRATISHYAYA

VATAJA PRATISHYAYA

• Dryness of nasal mucosa

• Scanty discharge – thin, clear

• Headache, sneezing

• Whistling sound in the nose

पारुष्यमर्धसिरसा छिनत्ति शिरसा रजः।
हिन्धोलकं स्वरं कुर्याद्वातप्रातिश्ययं विदुः॥
(Aṣṭāṅgahṛdaya Uttarasthāna 19/5)

PITTAJA PRATISHYAYA

• Yellowish nasal discharge – warm and foul-smelling

• Burning sensation in nose and eyes

• Fever, bitter taste in mouth

पाक्यं स्रवति पीतं च विदह्यत्यग्निमेति च।
पित्तप्रातिश्ययं कुर्यात्तृष्णारुचिकरं तथा॥
(Aṣṭāṅgahṛdaya Uttarasthāna 19/6)

KAPHAJA PRATISHYAYA

• Profuse, white, thick nasal discharge

• Nasal heaviness and congestion

• Lethargy, cough

• Loss of appetite

प्रस्रवणं स गुरुकं श्लक्ष्णं बहलमेव च।
स्निग्धं मदं च जनयेत्कफप्रातिश्ययं बुधाः॥
(Aṣṭāṅgahṛdaya Uttarasthāna 19/7)

SANNIPATAJA PRATISHYAYA

• Mixed symptoms of all three doshas

• Severe nasal symptoms with systemic involvement

• Recurrent nature and resistance to treatment

प्रसक्तं बहुरूपं च बहुदोषसमुद्भवम्।
कठिनोपशमं चैव सान्निपातं विनिर्दिशेत्॥
(Aṣṭāṅgahṛdaya Uttarasthāna 19/8)

RAKTAJA PRATISHYAYA

• Bloody discharge from nose

• Burning and inflammation

• Associated with rakta dushti conditions

AMAJA PRATISHYAYA

• Due to ama dosha accumulation

• Foul-smelling, sticky nasal discharge

• Heaviness, indigestion, fatigue

PAKVAJA PRATISHYAYA

• Maturation of earlier ama stage

• Discharge becomes clear or purulent

• Mild to moderate fever, relief after sneezing

IMPORTANCE (SIGNIFICANCE IN RELATION TO OVERALL HEALTH)

• Pratishyaya is not just a local disease; it can lead to systemic disorders if neglected.

• Chronic pratishyaya can result in:

  • Dushta pratishyaya (chronic rhinitis)

  • Sinusitis

  • Nasal polyps

  • Hearing impairment (eustachian tube blockage)

  • Complications like Karna rogas and Netra rogas

• It also affects:

  • Sleep

  • Concentration

  • Smell perception

  • Quality of life

MODERN CORRELATION (WITH MODERN ENT VIEW)

• Acute Rhinitis / Common Cold

  • Viral origin (Rhinovirus, Coronavirus)

  • Sneezing, nasal obstruction, watery discharge, malaise

• Allergic Rhinitis

  • IgE-mediated response to allergens

  • Sneezing, nasal congestion, clear discharge, nasal itching

• Chronic Rhinosinusitis

  • Long-term inflammation of sinuses

  • Thick discharge, facial pain, anosmia

• Complications

  • Secondary bacterial infections

  • Otitis media, sinusitis, nasal polyps

  • Rarely: orbital cellulitis, intracranial spread

• Management includes:

  • Antihistamines

  • Decongestants

  • Nasal corticosteroids

  • Antibiotics (in bacterial cases)

  • Allergen avoidance and immunotherapy in allergic rhinitis

    
    

    CHIKITSA (TREATMENT) OF PRATISHYAYA

    
    

    • Vataja Pratishyaya:

      • Snehana (internal oleation)

      • Nasya with vatahara dravyas (e.g., Anu taila)

      • Rasayana (rejuvenators)

      • Diet: warm, nourishing

    • Pittaja Pratishyaya:

      • Tikta and Madhura rasa based herbs

      • Sheetala nasya (cooling nasal drops)

      • Avoid spicy, sour food

    • Kaphaja Pratishyaya:

      • Vamana karma (therapeutic emesis)

      • Pradhamana nasya (dry powder insufflation)

      • Laghu and ruksha ahara

    • Raktaja Pratishyaya:

      • Raktamokshana (bloodletting)

      • Pitta shamaka chikitsa

    • Chirakarita (Chronic):

      • Shodhana (virechana, nasya)

      • Rasayana and pathya-apathya regulation

    Common Formulations Used:

    • Vyaghri haritaki

    • Tribhuvanakirti rasa

    • Dashamoola katutrayadi kwatha

    • Sitopaladi churna

    • Anu taila for nasya

    • Shadbindu taila

    Modern Correlation and Treatment:

    • Acute Rhinitis: Antihistamines, decongestants, steam inhalation

    • Allergic Rhinitis: Antihistamines (Cetirizine, Loratadine), intranasal corticosteroids

    • Chronic Rhinitis/Sinusitis: Antibiotics, nasal sprays, surgery in resistant cases (FESS)