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| Standard Ancient Medications for the Treatment of Otalgia (Karnasula) | |||||||
| Paper Id :
17641 Submission Date :
14/05/2023 Acceptance Date :
22/05/2023 Publication Date :
25/05/2023
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| Abstract | In the present article we are going to learn about the otalgia. It is a major problem as no satisfactory treatment is available in the modern medicine. Only symptomatic management is done to alleviate the clinical features. Treatment of the cause is done which is totally temporary. Only analgesics, anti-inflammatory, antipyretic and antibiotic drugs which have long lasting side-effects of their own; are used for the condition. Otalgia is known as karnasula as per ayurvedic texts as seen from the symptoms and signs. Clinical features of Karnasula are mentioned in Sushruta (Su. Uttar. 20) and Astanga hrdayam (As. Hr. Uttarsthana 17) and its treatment in Sushruta (Su. Uttar. 20) and Astanga hrdayam (As. Hr. Uttarsthana 18). The treatment options for karnasula include oleation therapy, sudation through nadi sweda (steam inhalation) or fomentation which mitigates vata dosha and use of oily purgatives. Above therapy is useful for otalgia arising from kapha as well as vata dosha. Pinda sweda (fomentation) performed with fish, hen or lava bird or with thick (condensed) milk will also cure the otalgia. Leaves of asvatha prepared into bowel cup and filled with hot coal should be applied on the ears. This bowel cup will enter the ear canal and otalgia will get subsided. Vala taila is mentioned by Acharya Sushruta (Su. Uttar. 21/13) which is best oil for Murdha vasti (head purgation), Nasya karma (nasal medication), Sirodhara (pouring in the head), and as well as for oral application. It cures all the diseases arising from vata dosha. Next drug indicated by acharya is kukuta vasa purana and it is used for karnapurna (eardrops). Another important drug mentioned by Acharya Sushruta (Su. Uttar. 21/20-21), is dipika Taila, applied as karnapurna. For pittaj karnsula drugs that cure pitta dosha should be used to mitigate it. Kakolyadi gana (group) drugs are beneficial for it. Ghrit prepared with yastimadhu, candana, sugar and laxatives cure the otalgia of pittaj origin. In kaphaj karnasula, karnapurna with surasadi groups of dravyas is useful. Yusha (broth) prepared from tikta (bitter) aushadhis and kaphahar ruksa (dry) sweda (fomentation) are effective. The treatment for raktaj karnasula is same as mentioned for the pitta dosha. In the present research article Standard Ancient Medications for the treatment of otalgia (Karnasula) are looked for which will surely cure the condition from the grass- root level. | ||||||
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| Keywords | Karnasula, Oleation therapy, Nadisweda, Pinda sweda, Murdha vasti, Sirodhara, karnapurna, Tikta, Aushadhis, Ruksa, Prakopa. | ||||||
| Introduction |
The origin of term otalgia which means earache arise from ous, aus (genetitive otos) “ear” +algia “pain”; originated from the Greek word in 1650s.Otalgia is correlated with karnasula as mentioned in ayurvedic texts. No particular or specific treatment is prescribed for otalgia in modern texts, but lots of therapies are mentioned for otalgia (karnasula) in ancient texts. All the acharyas according to ayurvedic point have described same etiopathogenesis for karna rogas (ear diseases) which is also considered for the otalgia (karnasula) too. These include swimming, itching in ears, improper performance of surgical procedures as well as factors which aggravates vata dosha, leading to severe vata prakopa; which enters into the ear and head leading to karnarogas including karnasula. When we deal with causative factors of otalgia as per modern aspect, which include local causes, involving external ear, middle ear, referred and psychogenic causes. External ear causes like furuncle, impacted wax, otitis externa, otomycosis, myringitis bullosa, neoplasms and herpes infections are responsible for otalgia. The middle ear causes of otalgia are otitis media, mastoiditis, eustachian tube obstruction and carcinoma of middle ear. While the referred causes are from Vth, IXth, Xth And C2 and C3 spinal nerves. Now coming to treatment of otalgia, it is considered to be a symptom and no specific treatment is available for it. In contrast in the ayurvedic texts general as well as specific treatment is mentioned for the management of otalgia. If we look at the chikitsa of karna rogas as well as otalgia (karnasula) include ingestion of ghrit, rasayana (rejuvenation therapy) sevana, avoiding physical exertion and bathing head, avoidance of over sexual indulgence and providing rest to talk. Lots of specific treatments have been mentioned in ancient texts for the management of otalgia. Acharya Sushruta have mentioned Murdha vasti, nasya karma, Sirodhara, kukuta vasa purana etc. for its management. Additionally, in Astanga hrdayam intake of ghrit, meat juice, fomentation, karnapurna, purgative therapy, nasya karma, vamana karma (emesis therapy), kavala dharna (gargles), sudation is equally useful for different types of karnasula. Yoga Ratnakara on page 1051 have described etiopathogenesis of karnasula which is similar to Sushruta Samhita and on Page 1055 have mentioned the treatment of karnasula with karnapurna like sringverras, arkankuradi yoga, arka svarasa, chaga mutra, syonaka taila and hingvadi taila all relieve the severe earache/otalgia. According to Cakradatta the chikitsa of karnasula is karnpurna with different combinations of dravyas, Samudraphena avacurna ( powder) is useful for the disease. Karnapurna with dipika taila, arkapatra svarasa, basta (goat) mutra use, vamsaneli taila, hingvadi taila, ksara taila are very effective in the condition. Thus, it is very clear from the above learning that there is lot of scope of management of otalgia in the ancient system of medicine; though the modern medicines are unable to treat the condition. |
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| Aim of study | 1. To compare karnasula with otalgia. 2. To find safe and effective medicines for otalgia from ancient texts. 3. To evaluate efficacy of ayurvedic drugs for the management of otalgia (karnasula). | ||||||
| Review of Literature | An article was published on karnashool on Dec 2017 by Dr. Punareesasha Rao P. In Oct, 2020 Suchalakshmi R and Rathi S 2 included the same topic in their study. Swarna Ranjita, Pasha SN and S Ahalya carried out the study on otalgia w.s.r to kaphaja karnashoola on dated 07- 2021. Dr. Prarbhaaklank chougule and Dr. Pravin R. Jagtap have done the study on karnashool with special reference to diffuse otitis media on may, 2017. But, it is felt that lot of more work has to be done on the present topic. Therefore, it has been selected as the choice of topic.
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| Methodology |
1. The material for karnasula topic has been collected from the ayuvedic granths, modern texts and reference books, internet and dictionary for upgrading the knowledge about karnasula (otalgia).
2. Ancient granths like Sushruta Samhita, Astanga hrdaya, Charak Samhita, Cakradatta -Cakrapani commentary on charak, laghutriya granths were studied for the correlation of otalgia with the diseased condition mentioned in these granths. Samprapti (pathology) and lakshans (clinical features) have been studied and treatment options including medicines and procedures are looked for treatment of otalgia.
3. Textbooks related to Dravyaguna vigyan, Ras-shastra, Shalya tantra as well as books related to ayurvedic as well as modern point of Shalakya tantra were reviewed to gain the knowledge about the existing topic.
4. Textbooks of Pharmacology were studied in detail to establish mode of action of the therapies mentioned in ayurvedic granths. |
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| Result and Discussion |
Figure 1- Definition of Otalgia Figure 2- Referred Otalgia
Figure 3- Causes of Otalgia Figure 4- Symptoms of Otalgia Regarding
correlating Otalgia with Karnasula Correlation of
otalgia is done in the present study due to the following factors- 1. According to
Acharya Sushruta nidana (etiology), lakshans (signs and symptoms), samprapti
(pathology) of karnasula shows that all these matches with otalgia as explained
in modern texts as well as on internet. 2. As per Acharya
Vagbhatta, the information indicates karnasula is otalgia and nothing else. 3. According to
modern textbooks and other sources like internet have mentioned otalgia as pain
arising from the auricle, external meatus, middle ear or mastoid. It may also
be referred from other sources as discussed earlier. The incidence of otalgia
indicates it to be karnasula. 4. The etiology,
causes and pathophysiology show otalgia as karnasula as per the information as
well as knowledge gained above. Regarding
Management of otalgia (karnasula) Methods of administration It has been
indicated in the ancient texts for the management of all types karnaroga
including otalgia (karnasula) intake of ghrit, rasayana (rejuvenation therapy)
sevana, avoiding physical exertion and bathing head, avoidance of over sexual
indulgence and providing rest to talk. Mode of Action These different
types of administration like ghrit intake, rejuvenation therapy will provide
relief in otalgia as these methods are considered as best for healing and early
recovery of the condition. Whereas, avoiding physical exertion and bathing
head, avoidance of over sexual indulgence and providing rest to talk will
provide relief of otalgia as these will preserve energy. Moreover, synergistic
potentiated effect will lead to early recovery from the otalgia. Acharya
Sushruta Murdha vasti Method of administration After sodhana
(purification) of the patient’s body, suitable treatment according to the
disease is given to patient. In the evening, patient is asked to sit straight.
Afterwards a cap like receptacle to hold the liquid is strongly tied by a rope
on the patient’s head. Then prepared decoction and ghrit should be filled in
the receptacle. Patient has to retain the decoction and ghrit for the time
mentioned in texts. Mode of Action Murdha vasti is
helpful in the treatment of otalgia as the medicated dravyas will remain in
contact for long time in urdhvajatru gata parts (above the clavicle) and thus
providing relief for the karnasula. Nasya karma- Method of administration Application of
medicated nasal drops after abhyanga (massage) with ghrit, instilled in nose
will reach the ear and will have its beneficial effect in otalgia. Mode of Action It will be
effective for otalgia (karnsula) as ear is connected with nose through
eustachian tube Thus, application of nasya karma will provide the nutrition to
different structures of ear like pinna, external auditory canal, tympanic
membrane, mastoid and as well as to middle ear. Sirodhara Method of administration Application of
medicated dravyas like takra (butter milk), narikela (coconut) or milk as per
season; for 45 minutes will alleviate oltagia of different
doshas. Mode of Action Sirodhara will
be helpful in the management of treatment of otalgia as the medicated dravyas will
remain in contact for prolonged time will provide relief in otalgia. Ghrit and meat
juice. Method of administration Intake of ghrit
and meat juice for ingestion. Mode of Action Ingestion of
ghrit and meat juice will act as rejuvenation therapy and will provide relief
from otalgia. Fomentation Method of
administration Local
application as upnaha/pralepa (poultice). Mode of Action Fomentation
will reduce the pain and swelling of otalgia when applied in the form of
poultice. Purgative
therapy Method of administration It should be
taken with water or fruit juice along with the dravyas recommended by the
physician. Mode of Action A hydrophilic or osmotic action will retain the water and electrolytes content in the lumen of intestine which will increase the volume of content of colon resulting in easy propel of the doshas. Vamana karma
(emesis therapy) Method of administration Oral
application (15 to 30 ml). Repetition
of the procedure is done if vamana does not occur within half an hour; with 15ml another dose. Mode of Action Vamana dravyas
cause gastric irritation and stimulate CNS chemoreceptor zone or both of these.
Thus, will lead to removal of doshas from the urdhva marga leading to sodhana. kavala dharna Method of administration Local
application as gargles which are sanchari (movable) in mouth. Mode of Action As ear is
interconnected with mouth through oropharynx, the effect of medicated kavala
will reach the ear and will remove the causes and clinical features of otalgia. Sudation
therapy Method of administration Application of
warm temperatures leading to Perspiration (sweating). Mode of Action Sudation
therapy is useful for karnasula as sudation (sweating) will lead to alleviate
the doshas of otalgia through skin and pores of the body. Karnapurna All acharyas have mentioned that one of the
best therapies for otalgia (karnasula) is karnapurna. Method of administration Filling of
svarasa (expressed juice) of dravyas in the ear should be done before meals and
if medicated oils are used for the same purpose, it should be carried out in
the evening before sunset. Six drops of medicated dravyas should be instilled
in each ear. Yogas for
Karnapurna Leaves of
Asvatha as karnapurna, Vala taila, Kukuta vasa purana, Dipika Taila, Kakolyadi
gana (group) drugs, surasadi group of dravyas applied as karnapurna as told by
Acharya Sushruta will provide relief from otalgia. Astanga hrdya have also
described karnapurna as most useful for the management of otalgia. Yoga Ratnakara
described karnapurna like sringverras, arkankuradi yoga, arka svarasa, chaga
mutra, syonaka taila and hingvadi taila all relieve the severe earache/otalgia.
According to Cakradatta the chikitsa of karnasula is karnpurna with different
combinations of dravyas, Samudraphena avacurna
is useful for the disease. Karnapurna with dipika taila, arkapatra
svarasa, basta (goat) mutra use, vamsaneli taila, hingvadi taila, ksara taila
are very effective in the condition.
According to Acharya Cakradutta in chapter 57 many
of yoga for karnapurna like Dipika taila, Arkapatra svarasa, Bastmutra prayoga,
Vamsaneli taila, Hingavadi taila and Ksara taila are mentioned for karnapurna. Mode of Action Karnapurna
remains in contact with structures of the ear for prolonged time and through
synergistic effect of combination of dravyas will cure the otalgia. Moreover,
rejuvenation therapy will help to clear the clinical features as well as
pathology of otalgia.
Thus, it is
very clear from the above learning that there is lot of scope of management of
otalgia in the ancient system of medicine. Though the modern medicines only
provide symptomatic and temporary relief for brief time. |
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| Conclusion | 1. It is clear from the above discussion that otalgia and karnasula have similar signs and symptoms. The clinical features of these two rogas are similar. Thus, otagia and karnasula can be correlated with each other and it is concluded through the present study that the two rogas on the basis of clinical features, pathology and mode of action of different dravyas, the rogas otalgia and karnasula are same. 2. For the treatment of otalgia, the most effective as mentioned by different Acharyas is karnpurna and for which yogas are explained by them. 3. Ingestion of ghrit, rasayana (rejuvenation therapy) sevana, avoiding physical exertion and bathing head, avoidance of over sexual indulgence and providing rest to talk are effective in all the karnarogas as mentioned in Bhritriya granths and same is true for karnasula (otagia). These therapies will provide relief in the condition by early healing and recovery. 4. As mentioned by Acharya Sushruta Murdha vasti is helpful for the treatment of otalgia as the medicated dravyas will remain in contact for long time in urdhvajatru gata parts (above the clavicle) and thus providing relief for the karnasula. Therefore, Sirovasti also known as Murdha vasti will definitely cure the otalgia. 5. Instillation of nasal drops after massage of local area, applied in nose will reach the ear and will have its beneficial effect in otalgia. It will be effective for otalgia (karnsula) as ear is connected with nose through eustachian tube. 6. Sirodhara will be helpful in the management of otalgia as the medicated dravyas will remain in contact for prolonged time with the structures related to ear and will provide relief in otalgia. 7. Fomentation will reduce the inflammatory condition of otalgia when applied in the form of poultice. 8. Purgative therapy and Vamana karma- These will be absolutely beneficial for urdhva as well as adho srotas and will help to throw out doshas from the body thus curing the disease. 9. kavala dharna- The fact that ear is has connection with mouth through oropharynx, the effect of medicated kavala will reach the ear and will remove the causes and clinical features of otalgia. 10. Sudation therapy (sweating)- It have the effectiveness to relieve the clinical features of the all kinds of inflammation. Therefore, it is going to be very effective in case of otalgia (karnasula) too. | ||||||
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