MANAGEMENT OF NASAL POLYPS WITH AN AYURVEDIC MINI SURGERY I.E JALOUKAVACHRANA

Ayurved is science of life. From ancient Indian surgery, it has been observed that various operations successfully performed in those days also. In ancient period Acharya were doing surgery in Ayurveda. Sushrut is father of modern surgery. It is common man’s thinking that there is no surgical treatment for disease in the science of Ayuvred. After the turn over the pages of sushrut Samhita, one will understand that sushrut has laid done the basic concept of the present surgery. Nasal polyps are growth of soft tissues on the lining of the nasal passage or sinus. In Ayurvedic samhita, nasal polyps are referred to as Nasarsha. Jaloukavacharana is best mini surgery in this nasal polyp. 14 years old children suffering from Nasal block (Nasa-avarodha), breathing difficulty (Ayasen swasa), running nose (Nasa strav), snoring since last 3 years. One-time application of jaloukavacharana give him excellent results. The present article is Management of Nasal polyps with an Ayurvedic mini surgery i.e jaloukavachrana.


Introduction
In this modern era all filed developing rapidly, medical filed also not optional for that. variety of research in instruments, medicine and concepts occurs in modern science, still its fail at some stage. While same time Ayurveda still stand to test to the time, with its unique unchanged concepts. This case study is one of the example that proved Ayurvedic mini-surgery i.e jaloukavachrana still effective as in past. Http://www.granthaalayah.com ©International Journal of Research -GRANTHAALAYAH [222] Due to industrialization and all air pollution increased rapidly. This air pollutions induced variety of respiratory diseases. Nasal polyps are soft jelly like overgrowth of the lining of sinus. This look like grapes on the end of stalk.it is noncancerous growth within the nose or sinus.
[1] Trouble in the breathing through the nose, loss of smell, decreased taste, post nasal drip and running nose are symptoms of nasal polyps. Steroid, nasal spray, surgery and antihistamines are modern treatment of nasal polyps. In Ayurveda, nasal polyps can be named as Nasarsha. [2] Hypothesis

Aims and Objectives
• To study a pathophysiology of Nasarsha (nasal polyps).
• To study effect of Jaloukavacharana in Nasarsha.
• To study and observe correct indication for effect of Jaloukavacharana in Nasarsha.

Case Study
14 years old children suffering from Nasal block (Nasa-avarodha), breathing difficulty (Krucha swasa), running nose (Nasa strav), snoring since last 3 years. There are no satisfactory relief with all types of internal modern medicine. Patient fear for operations. sushruta advised jaloka in raktamokshan is children. [3] For an Ayurvedic treatment patient came to Nakshtra Ayurved Panchkarma Clinic & Research Center, Mumbai. Within one application of jalouka he got good relief in all symptoms.
Method: Jaloukawachra done as per described in samhita. [4] Normal blood investigation like BT-CT, CBC done before jaloukavachrana. Informed consent of children with sign of his father taken on letter pad of clinic. As this is single case study there is no involvement of ethics committee. I give proper information of procedure to patient's relative and give consent from them.

Purva-Karma:
After the diagnosing the patient suffering from a nasal polyps which requires the application of leeches, the site of polyps examined. Mark outer side of polyps. Marked area rubbed with dry cotton. Then the leeches should be taken out from bottle and sprinkled over with water saturated with mustard seed and pasted turmeric. Then for a moment (Muhurta) they should be kept in pot or tank full of water, after they regained their natural vivacity and freshness (Vigataklama) and free from natural urges (Muktapurisha). Jaloka should be applied to marked part i.e outer side of polyps.

Pradhana-Karma
Jaloka should be held with small, white, wet cloth, gauze or cotton by covering its mouth.in this case I used empty syringe for holding jaloka. If Jaloka is not able to stick to the desired spot, the affected part should be sprinkled over with drop of milk or blood or ghee or butter or slight incision should be made into the lesion. After all efforts, if Jaloka does not hold at the desired spot, other fresh leech should be applied. After application of Jaloka, their body should be covered with a piece of thin and wet linen or with a piece of white cotton.
Features of Jaloka Sticking: That the leeches should be taken to the affected part may be inferred from the mouth of leeches assuming the shape of a horse shoe and the raised and arched position made after attached to the seat of the disease. (Aswakhuravata Ananam, Unnabhya Va Skandham).
While sucking, the leeches should be covered with a piece of linen and should be constantly sprinkled over with cold water. Jaloka looks like a breathing rhythm of little child and observe continue pulsation. jaloka expels vitiated blood only same as a tit of swan drinking milk not water.
A sensation of itching and pain at the seat of the application indicates that fresh blood is being sucked, so the leeches should be removed.
If leeches refusing to fall off over after the production of the desired affect or sticking to the affected part out of their fondness for the smell of blood or due to their covetous (Laulya) or eagerness should be prickled with the Haridra powder.

Paschata-Karma
After falling off, the leeches should be keep in haridra powder. Dressing of wound at polyp area done by putting haridra and kakshi Powder on that area. Then jaloka which was kept in haridra powder they should be catches by a tail-end with the thumb and the fore finger of the left hand and their backs should be gently rubbed with the same finger of the right hand form tail upward to the mouth with a view to make them vomit or eject the full quantity of blood, they had sucked from the seat of disease. The process should be continued until they manifest the fullest symptom of the disgorging. Leeches that, had vomited the entire quantity of blood sucked as above, would briskly move in quest of food if placed in water, while the contrary should be inferred from their lying dull and inert. They should be made to disgorge again.
The leeches should then be put into a new bottle and treated as before laid down, after they had fully omitted the sucked blood. Used leech should be restricted for reuse at least 7 days.
Samprapti: Arsha is mainly disease of gudawali, but it can found in other place also like medhra, nabhi, etc. Increased kapha Dosha accumulates in the wall of blood vessels and surrounding muscular tissues and give rises to swelling known as Nasarsha or nasal polyps. Nasal block (Nasaavarodha), breathing difficulty (Krucha swasa), running nose (Nasa strav), snoring,shawathu are symptoms found in Nasarsha. [5] One time application of jalouka give relief in all symptoms as follow -

Action of jaloka (Acc.Mordern science)
Saliva of leech is play important role to cure or prevention of further diseases. More than 100 bioactive substances found in saliva of leech, which is found to be beneficial in various diseases. Hirudin is one of the important component found in leech saliva. Hirudin is one of the anticoagulation agent. Calin is one more component of leech saliva which inhibits blood coagulation. A component that dissolves fibrin clots as well as inhibits the formation of thrombus is known as destabilise. Leech saliva contains a Factor Xa inhibitor which restrains the coagulating effect of the coagulation Factor Xa. Leech saliva also has hyaluronidase that enhances the viscosity of the interstitial fluid. Saliva of leech connate acetylcholine and histamine-like substances as well as carboxypeptidase-A inhibitors which do vasodilation effect. Above three factor increase blood flow by dilating constricted vessels. These are action of some useful components found in leech saliva. [7] Those mentioned above all work together to decrease the viscosity of the blood, making its consistency thinner so as to promote better blood flow. Blood that has a thick consistency makes it prone to clot formation as well as increases the blood pressure of an individual. These clots can travel to different parts of the body and block a vessel, which could then cause a stroke or heart attack. Thick blood poses a risk that the distal extremities, especially the tips of the fingers and toes, will not receive adequate oxygenated blood and the nutrients they need. Therefore, the anticoagulation component in leech's saliva is vital as it naturally makes the blood thinner and works to inhibit platelet coagulation.
Due to best results of jalokawachrana, now day's jaloka have been centre of attraction for the researcher all over worlds. Reason to use empty syringe for holding jaloka is giving support to base of jaloka. As patient is child and area of polyps is less and sensitive to soft touch, so I used empty syringe for holding jaloka. Jaloka is best choice in rakata (blood) related disorder. [8] . Bheshaj, Shashtra, Kshar, Agnikarma is tenement for arsha vhyadhi. [9] Jaloka consider as one of anushastra. [10] Jalokavachrana is one of the indication of Nasarsha. [11] Limitation of Jalokavachrana in nasal polyps Contagious blood disorders, BT-CT problems will be some limitations in such type of treatment. This is single case study, to find out more limitations need to more cases data. Very soon, I will do study of that with many cases.

Conclusion
Due to easy, instant result, no need of internal medicine, safest, less chances of recurrence, jalokawacharna is one of the best choice for treatment of nasal polyps. Mini surgery i.e jalokawacharna is best treatment for nasal polyps. Although this is single case study so need more cases for further evaluations.