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Introduction

Pratishyaya is most common health problem amongst Nasagata vikara, many patienst patients visit the doctor for the condition of pratishay. The condition in which Kapha, Pitta and Rakta move along with Vata in the same direction is termed as Pratishyaya. Acharyas has stated that  Pratishyaya is not only diseases of Nose it also one of the gateways of other disease like Jwar, Shirshool etc.  The disease in which Kaphadi doshas moves towards the direction of Vata dosha is called as Pratishyaya. Acharya Charaka said “Pratikshnam shyayati iti Pratishyaya” which means Kaphadi doshas are continuously eliminated out through Nose.1 Bhavamishra interprets Pratishyaya as a condition in which the vitiated Dosha get accumulated in Shira in every moment and hence called by the name.2 The etiological factors of Pratishyaya could broadly classified under Sadyojanaka Nidanas and Kalantarajanaka Nidana. Some etiological factors are immediate triggering factors like Mandagni, Ajeerna, Vishamashan, Atijalapana, Ati Sheeta Ambupana, Intake of Ati Shita Jala by persons of Shleshma Prakriti, Excessive intake of Guru, Shita, Madhura substance and some of them like Mandagni, Ajirna etc.3 As per modern view, Pratsishay can be corelated with rhinitis, it is defined as the inflammation of nasal mucous membrane owing to infection, allergy and trauma.4 Approximately 10% of the population suffers from recurrent nasal symptoms including rhinitis. The prevalence of non-allergic rhinitis is on an average about 40%.5

OBJECTIVES:

1. To review disease Pratishay in details from Ayurvedic point of view.
2. To interpret the importance of Shatkriyakal in pathogenesis of Pratishay.

METHODOLOGY:

Source of Data:

Literary and conceptual study was on the data compilation from the Brihatrayees, Laghutrayees, and other classical books including journals, published papers from national and international journals.

Method of the collection of the data:

Books, thesis, journals, internet materials, published papers were reviewed and analysed scientifically.

Pratishyaya secondary to other illness:

Jwara: Acharyas have stated that, Pratishyaya occurs in many types of Jwara like Shleshmika Jwara.6

Raktapitta: Though Pratishyaya has not been directly related to Raktapitta, Dushta Pratishyaya has been included in the diseases caused by sudden stoppage of blood in the Raktapitta.7

Gulma: Pratishyaya has been described as one of the important symptoms in the non-curable Gulma.8 Pratishyaya has been included in the Lakshanas of Kaphaja Gulma.9

Udavarta: Suppression of natural urges results in Pratishyaya, it is stated by all Acharyas. Vegasandharana can also cause Udavarta. It has been noted in all the diseases caused by suppression of natural urges in which aggravation of Vata.10  In Madhava Nidana, Pratishyaya has been mentioned as one of the main symptom in Amaja Anaha.11

Rajayakshma: In this disease an independent Samprapti of the Pratishyaya has been given.

Shiro Roga: Head is the seat of all the diseases of Nasa & Shirovedana, Vayu is main cause for pain & head is the place of Kapha. Vitiated Vayu vitiates Tarpaka Kapha & gets lodged in Shirahpradesha producing headache. This Vata & Kapha obstructing the Nasagata Srotas results in manifestation of Pratishyaya, when main symptom subsides, Pratishyaya will also subside.12

Chhardi: Suppression of vomiting can cause the disease Pratishyaya.  Its suppression causes vitiation of Vayu leading to Udavartajanya Samprapti of Pratishyaya. 13

RUPA: Rupa is the first appeared sign or symptom  of  the disease when the Samprapti Prakriya reaches the level of Vyaktavasta. Charaka and Kashyapa have mentioned general symptoms of Pratishyaya. Acharya Charaka has described the following cardinal features-14

1. Sirahsula
2. Sirogurutwa
3. Nasa viplava
4. Jwara
5. Kasa
6. Kaphotklesha
7. Swarabheda
8. Aruchi
9. Klama
10. Yakshma
11. Indriya asamarthatha

These descriptions are given in the context of Rajayakshma. So, the generalized somatic manifestations described here are to be considered in the light of the abundant vitiation of all the three Doshas taking place in Rajayakshma.

TREATMENT:

Regarding the treatment of Pratishyaya, the following are the considerations given by different Acharyas. In the management of Nava Pratishyaya, the protocol includes: 15

1. Swedana
2. Ushna Bhojana
3. Ardraka with milk
4. Ardraka with Ikshuvikaras

The common protocol which could be adopted in the management of all types of Pratishyaya except Nava Pratishyaya includes: 16

1. Sarpishah Pana
2. Different types of Swedas
3. Vamana
4. Nasya

Procedures to be adopted in Pakwa Pratishyaya include:17

• Nasya
• Virechana
• Asthapana
• Dhumapana
• Kabala

In the disease associated with complications like Chhardi, Angasada, Jwara, Gourava, Arochaka, Arati and Atisara the protocol consists of Langhana, Deepana and Pachana.18

If there is abundant vitiation of Vata and Kapha, if the patient is able to tolerate, he should be subjected for Vamana therapy after giving him large quantity of liquids.19  The complications should be taken care of with respective medicines particular for the conditions.

Upadrava (Complication)

If pratishay is not treated in particular time then it also creates some complications like Peenasa, Indriyavikara, Badhirya, Andhatva, Ghranavikara, Darunanetra, Kasa, Shotha.20 Acharaya Madhavakara said Pratishayaya if not treated lead to Kasa, and again leads to Kshaya.

Corelation of Pratishay and Rhinitis with reference to Clinical features:

Sneezing, Rhinorrhea, Nasal obstruction, Irritation in the Nose, Body ache, Fever, Headache, Yellow or greenish thick nasal discharge.21

Table 1: Showing Corelation of clinical features of Rhinitis:22

Discussion

Pratishay is very commonest form for which patient visit the doctor. Though it is not so fatal disease however it hampers the quality of life and sometimes also threatening in current situation like Covid-19 pandemic. In the management of pratsishay, appropriate Shodhana  alongwith appropriate  Shamana chikitsa cure the disease and can prevent the secondary complication in Pratishay.23 As Nidana-Parivarjana (Abstinence from etiological factors) should be first strategy to conquer over any disease, based on Dosha involvement Nidanparivarjan become essential in the treatment of Pratishay. Exposure to cold air, water brings about the disease by its Sheeta and Chala Guna whereas Ati Jagarana (excessive awakening) is responsible for the presentation of the ailment by the vitiation of Vata with enhanced Chala and Ruksha Guna. So far as Anya Varipaan i.e. intake of water from different sources is concerned, it brings about vitiation of Vata and Kapha because of Asatmyata (unsuitability). Atyambupaana i.e., drinking of more quantity of water leads to improper Rasa and Rakta Samvahan and brings about the disease.  These all factor with cumulative  effect result into samprapati of Pratishay. Allergic Rhinitis is not a life-threatening disease, it can significantly impair patient’s quality of life and productivity. Allergic rhinitis often coexists with asthma and may be associated with otitis media, Eustachian tube dysfunction, sinusitis, nasal polyps etc.24 However, with proper care, shaman chikitsa along any Panchakarma procedure like swedana, nasya, Dhumpan the pathology of Pratishay can be broken. Nidanparivarjan is foremost important in dealing with pratishay.

Conclusion

According to Ayurveda Acharya, Pratsihay is gateway for any disease like Rajkshayama, Jwar,  Kshay etc. Negligence in treatment or sometime self-medication by patients  may cause further complication. With appropriate Ayurved treatment and nidan parivarjan Pratishay can be cure effectively.