Chronic Sinusitis (Waram-e-Tajaweef-e- Anf Muzmin)

Introduction

Chronic Sinusitis (Waram-e-Tajaweef-e- Anf Muzmin) is defined as the chronic inflammation of paranasal sinuses (PNS) most commonly involving maxillary sinus; the next most common sites are the ethmoid, frontal, and sphenoid sinuses.

Rhino-sinusitis is a term commonly used synonymously, which means inflammation of paranasal sinuses (PNS) along with nasal mucosa.

Chronic Sinusitis (Waram-e-Tajaweef-e- Anf Muzmin) is one of the commonest allergic manifestations all around the world which affects all types of population. Among Indians this disease is more widespread than asthma, diabetes or coronary heart disease. One in every eight Indians suffer from chronic sinusitis. In a survey by The National Institute of Allergy and Infectious Diseases (NIAID) it has been estimated that 134 million Indians suffer from chronic sinusitis.

As per Unani medicine philosophy it is caused by cold morbid temperament (Su-e- Mizaaj Baarid) of brain as a result of various external factors e.g. exposure to cold air, cold water etc.. It may also occur by collection of putrified matter (Khilt-e- Afin) in and around the olfactory organs. The predisposing factors include cold temperament of an individual, old age and cold season.

It is characterized by heaviness (Tamaddud) of face, forehead and head, nasal discharge, nazala-e- halaqi (post nasal drip), nasal obstruction (sudda-e- anf), nasal voice (Ghunna), Hyposmia/ Anosmia (Nuqsan wa butlan-e- Hiss-e- Shamm), irritation (Daghdagha), diminished taste and cough.

In the treatises of eminent Unani physicians, Iltehaab-e- Tajaweef-e- Anf or Waram-e-Tajaweef-e- Anf (Chronic sinusitis) has not been mentioned as a disease. However signs and symptoms of Nazla-e- Baarid Muzmin have been described in details in their treatises, which closely resemble the symptoms of chronic sinusitis. In addition, when we go through classical Unani literature regarding the present concept of sinusitis, we find that symptoms and signs of sinusitis have been described under the disease “Nazla”.

Causes (Asbaab)

Sour phlegm (Tursh wa Hamiz Balgham), population with Phlegmatic temperament (Balghami mizaj) is more prone to develop the disease
Environmental conditions like immoderate hot and wet condition, excessive hot and dry, undue cold and dry conditions
Coldness like Cold water, Ice, Cold eatables and Hail or exposure to cold and humid environment.
Local irritant like pollens, cotton, fur, feathers, dust, grit and soil particles
Specific coldness of the brain which aggravates abnormally by some exogenic factors, e.g., toxic substances and use of cold temperament drugs, cold waves, sadness and psychological stress.
Nasal bstruction (Sudda-e- anf)
Sudden alternate exposure to heat and cold and weakness of body.
Infection (T’adiya) by microbes like bacteria, viruses, fungi etc.
Su-e- Mizaj-e- Dimagh: There may be four types of Su-e- Mizaj due to congestion of any of the body humours (Akhlaat) i.e. Dam, Balgham, Safra, and Sawda. This condition arises in response to congestion due to evaporation of the affected Khilt (Humour) towards brain. As a result, liquefaction starts from brain, which affects nasal passage and nostrils.

Symptoms and Signs (Asbaab wa A’lamaat)

Nasal congestion
Nasal obstruction
Whitish, thick and viscid nasal discharge
Burning, irritation, redness and itching in the nose, eye and throat
Sneezing
Lacrimation
Decreased sense of smell
Nasal speech
Mild headache
Feeling of pressure and fullness in nose and forehead
Excessive thirst
Fatigue and lethargy condition
Nabz (Pulse): Azeem, Saree’ wa Mutawatir
Yellowish Urine (Qarura ka zard hona)

Principles of Treatment (Usuool-e- Ilaj)

Izala-e- sabab (Elimination of the cause)
To warm the head (Taskheen-e- Raas)
To make the causative matter suitable for evacuation (Nuzj-e- Mawaad)
To remove the obstruction (Tafteeh-e- Sudda)
To remove the causative matter (Tanqiya-e- mawaad)
To tone up the brain (Tqwiyat-e- Dimaagh)

Pharmacotherapy (Ilaj Bil Dawa)

Hot fomentation (Takmid-e- haar) with wheat husk (Sabus) tied in cloth
Local application of paste of seeds of Brassica nigra Linn. (Khardal) and Saussurea lappa Clarke. (Qust) on forehead and head.
Hot fomentation (Takmid-e- Haar) with common salt and Jau Ras (Pennissetum glaucum R. Br.)
Oral administration of decoction of Asl-us- soos (Glycyrrhiza glabra Linn.) 7 gm., Gaozaban (Borago officinalis Linn.) 7 gm., Parsiyaoshan (Adiantum capillus- veneris Linn. and Bedd.) 7 gm., Mako (Solanum nigrum Linn.) 9 gm., Banafsha (Viola odorata Linn.) 9 gm. And Unnab (Zizyphus vulgaris Lamk.) 7 pieces with a compound Unani formulation Khamira Banafsha 48 gm.
Steaming (Inkibaab) of head with Turnip and Baboonah
Oral administration of powder of seeds of Nigella sativa Linn. (Shooneez) 1 gm., Curcuma zedoaria (Christm.) Roscoe (Zaranbad) 1 gm., Aril of Myristica fragrans Houtt. (Bisbasa) mixed with 24 ml of honey.
Oral administration of roasted seed of Linum usitatissimum Linn. (Tukhm-e- Alsi Biryan) mixed with honey and small amount of Piper nigrum Linn. (Filfil daradz)
Oral administration of powder of seed of Nepeta ruderalis Ham. (Tukhm-e- badaranjboya) 1.5 gm. And Lavandula steochas Linn. (Ustukhuddus) 2 gm. mixed with 12 ml of honey
Instillation with the combination of 3.5 gm of powdered of Lavandula steochas Linn. (Ustukhuddus) and suitable quantity of honey.
Oral administration of powder of Boswellia serrata Roxb. (Kundur) mixed with purified honey.
Chewing of almond, sugar and pine nuts.
Oral administration of Hareera prepared with wheat husk and almond oil.
Bakhur (Fumigation) with Shooneez (Seed of Nigella sativa Linn.)
Bakhoor (Fumigation) with Qust (Saussurea lappa Clarke.)
Inhalation with (Seed of Nigella sativa Linn.)
Inhalation with Qust (Saussurea lappa Clarke.)
Inhalation of nasal drops prepared with roasted seed of Nigella sativa Linn. (Shooneez biryaan) soaked in vinegar and mixed with olive oil.

Single Drugs

Behi Dana Cydona oblanga
Banafsha Violo odorata
Unnab Ziziphus jujuba
Gaozaban Borago officinalis
Sapistan Cardolia latifolia
Tukhm-e- Khashkhash Papaver somnifarem seeds
Khaksi Sismbrium irio
Zafran Crocus sativus
Tukhm-e- Khatmi Althaea officinalis
Neelofar Nymphea lotus

Compound Unani Drugs

Tiryaqe Nazla
Habbe Shifa
Sharbate Unnab
Sharbate khashkhash
Sharbate Banafsha
Laooqe Khashkhash
Khameere khashkhash
Habb-e- Ayaarij
Laooqe Sapistan
Sharbate Faryadris
Itrifal Muqawwi-e- Dimaagh
Sharbat-e- Zoofa
Roghan-e- Banafsha
Itrifal Ustukhuddoos
Sharbat-e- Ustukhuddoos
Itrifal Mulayyan
Itrifal Zamani
Majoon Falasfa
Qaoirooti Haar
Khameere Gaozaban

Regimenal Therapy (Ilaj Bil Tadbeer)

To produce irritation (Daghdagha) in the nostrils is beneficial
Takmeed (Fomentation) with warm cloth
Inkebaab (Steam inhalation) is advised
Fasd (Venesection) is advisable if damavi khilt (sanguine) is involved and it is followed by mushilat (Purgative drugs).
Induce sneezing with the help of luke warm shoneez and zeera is very effective
Intake of lukewarm water is very useful

Dietary recommendation

Aghziya Musakhkhinah
Ma-ul- Sha’eer
Aghziya Lateefa
Ma-ul- Asl

Dietary Restrictions

Aghziya Baarida (Cold food) are also restricted
Excessive food intake is restricted
Oily food is also restricted
Heavy food is also restricted

Tahaffuz (Prevention/ Precaution)

Avoid exposure to cold season
Avoid smoking
Avoid sleeping in the day time and intake of cold water

Health Tips

Use of warm clothes or apparels to protect scalp and body from cold wave exposure
Easily digestible food should be taken
Drinking of lukewarm water is useful in Chronic Sinusitis (Waram-e- Tajaweef-e- Anf Muzmin)

Investigations

CBC (Complete blood count)
ESR (Erythrocyte Sedimentation Rate)
X-ray PNS (Paranasal Sinuses)

Note: Unani drugs should be taken under the advice of the qualified Unani physician. The patients are required to follow strict Unani regimen for optimum results.

References