CHRONIC RHINOSINUSITIS (CRS): NASYA, DHOOMAPANA, AND SHAMANA AS PRIMARY MANAGEMENT WITH FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS) RESERVED AS A LATE-STAGE/REFRACTORY INTERVENTION – AN AYURVEDIC REVIEW

Dr. Suchita Kanade*, Dr. Indrajeet S. Gadge, Dr. Sachin Umbardand

ABSTRACT

Background: Chronic Rhinosinusitis (CRS) is a persistent inflammatory condition of the nasal and paranasal sinus mucosa lasting more than 12 weeks, severely impacting breathing, olfaction, sleep quality, and overall well-being. Global prevalence ranges between 8–12%, with a high rate of recurrence despite repeated antibiotic and surgical interventions.[1] Ayurveda describes analogous conditions under Dushta Pratishyaya, Peenasa, and Kaphaja Shiroroga, emphasizing vitiation of Vata–Kapha, Srotorodha, and chronic inflammation of the Urdhwanga Srotas.[2],[3] Panchakarma modalities like Nasya and Dhoomapana along with Shamana aushadha provide an effective non-invasive approach. Aim and Objective: To evaluate Classical Ayurvedic recommendations and modern pathophysiological evidence supporting Nasya, Dhoomapana, and Shamana therapy as first-line treatment for CRS, placing FESS as a secondary option for refractory cases only. Methods: Narrative integrative review of classical Ayurvedic texts including Bruhatrayee, laghutrayee, Nighantu and therapeutic compendia alongside modern literature sourced from PubMed, Scopus, Google Scholar, Cochrane using keywords: Chronic Rhinosinusitis, Nasya, Dhoomapana, FESS, Ayurveda, Mucociliary clearance. Key Findings: Nasya improves mucociliary drainage, reduces biofilm formation, restores Prana Vayu flow and clears Srotorodha.[4],[5] Dhoomapana liquefies and expels stubborn Kapha, acts as topical anti-microbial and reduces oedema.[6] Shamana drugs (Trikatu, Haridra, Pippali, Dashmoola) provide systemic anti-inflammatory and immunomodulatory support.[7],[8] Surgery (FESS) is required only in structural deformity, complications or failure of medical therapy.[9] Conclusion: CRS management should prioritize Ayurveda-based non-invasive Nasya–Dhoomapana–Shamana therapy before considering surgical intervention. This approach demonstrates superior chronic disease control, mucosal remodelling, and recurrence reduction.

Keywords: Chronic Rhinosinusitis, Dushta Pratishyaya, Nasya, Dhoomapana, Shamana, FESS, Kapha-Vata dushti, mucociliary function.