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Management of Recurrent Nasal Vestibular Furunculosis by Jalaukāvacaraṇa and

Palliative Treatment

Article  in  Ancient Science of Life · April 2017

DOI: 10.4103/asl.ASL_190_15

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Amol Kadu Dhirajsingh Rajput

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Case Report

Management of Recurrent Nasal Vestibular Furunculosis by

Jalaukāvacaraṇa and Palliative Treatment

Abstract Amol Sudhakar

Nasal vestibular furunculosis is a common bacterial skin infection among the general population Kadu,
mostly affecting adults and children.It is characterized by acute localized infection of hair follicle in Dhirajsingh
the skin lining of the nasal vestibule caused by Staphylococcus aureus.Immunodeficiency also plays
an important role in recurrent skin and soft tissue infections  (SSTI) including Nasal furunculosis. Sumersingh
Though, the lesion is small, it is extremely painful and tender. Treatment is mostly conservative which Rajput1,
consists of warm compresses, analgesics to relieve pain, topical and systemic antibiotics directed Sourabh G
against staphylococcus. With rapidly increasing resistance to antibacterial agents, management of Deshmukh2
these bacterial infections is becoming increasingly difficult. In Ayurveda, it can be correlated with Department of Agadtantra and
Nāsāruṇaśikhā  (Nasal furunculosis). Morphologically, it appears like pīḍikā  (Furuncle) which is Vyavahar Ayurveda, National
characterized by Rāgayuktaśotha  (inflammation with reddening. Jalaukāvacaraṇa  (Leech therapy) Institute of Ayurveda Jaipur,
is one of the ancient and important parasurgical procedures described in Ayurveda for treatment of 1
Rasashastra and Bhaishajya
various diseases. In this case, a leech has been applied at the affected area. After leech treatment, Kalpana and 2Kayachikitsa,
throbbing pain was reduced in its intensity followed by gradual reduction in swelling and reddening MGACH and RC, Wardha,
in two days.This case suggests the utility of leech application in Nasal vestibular furunculosis. Maharashtra, India

Keywords: Immunodeficiency, jalaukāvacaraṇa, nasaarunshika, nasal furunculosis

Introduction Treatment is mostly conservative which

Skin and soft tissue infections  (SSTI)
are one of the most common infections
encountered in every age group which
are caused by Staphylococcus  aureus and
Streptococcus, with occasional involvement
of Gram‑negative organisms.[1] Given
the variable presentation of SSTIs, an
assessment of their incidence and prevalence
has been difficult. The estimated incidence
rate of SSTIs is 24.6 per 1000 person/years.
There is an increased prevalence among
men (60% to 70% of all cases) and patients
between 45 and 64 years of age.[2,3]
Nasal vestibular furunculosis is a common
bacterial skin infection among the general
population mostly affecting adults and
children.It is characterized by acute
localized infection of hair follicle in the
skin lining of the nasal vestibule caused by
Staphylococcus aureus.[4] Immunodeficiency
also plays an important role for recurrent
SSTI including Nasal furunculosis.[5]
Though, the lesion is small, it is extremely
painful and tender. This being a bacterial
infection it has long‑term morbid effects.[1]
consists of warm compresses, analgesics to
relieve pain, topical and systemic antibiotics
directed against staphylococcus.[6] With
rapidly increasing resistance to antibacterial
agents, management of these bacterial
infections is becoming increasingly difficult.[7]
Raktamokṣaṇa, i.e. blood letting is one of the
ancient and important parasurgical procedures
described in Ayurveda for treatment of
various diseases. Jalaukāvacaraṇa or leech
therapy has gained greater attention globally,
because of its medicinal values. The saliva of
leech contains biologically active substances,
which have anti‑inflammatory as well as
anesthetic properties. Address for correspondence:
Dr. Amol Sudhakar Kadu,
Present case report is of a patient with Department of Agadtantra and
recurrent Nasal furunculosis who was not Vyavahar Ayurveda, MGACH
and RC, Wardha, Maharashtra,
responding to antibiotics and was treated India.
with Jalaukāvacaraṇa and (Śamana cikitsā) E‑mail: dramolkaduayu@
palliative treatment and the treatment gmail.com
was found to be effective in reducing the
symptoms.
Access this article online
Case Report Website:
www.ancientscienceoflife.org
On June 18, 2015 a 60‑year‑old male patient
DOI: 10.4103/asl.ASL_190_15
reported to O.P.D. with complaints of severe
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This is an open access article distributed under the terms of the How to cite this article: Kadu AS, Rajput DS,
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Deshmukh SG. Management of recurrent nasal
License, which allows others to remix, tweak, and build upon the
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new creations are licensed under the identical terms. palliative treatment. Ancient Sci Life 2017;36:220-4.

For reprints contact: reprints@medknow.com Received: October, 2015. Accepted: October, 2017.

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Kadu, et al.: Recurrent nasal vestibular furunculosis management by jalukavacharan

pain in left nostril since four days which was recurring from As per the classical texts of Ayurveda, observed symptoms
past six months.Severity of pain prevented him from his which are presented in this case can be correlated
routine activity.Patient had taken medical treatment which with Nasārunaśikhā.[8] It was treated on the basis of
included varieties of antibiotics, analgesics, anti‑inflammatory treatment principles explained by Vāgbhaṭa in context
medicines and topical antibiotics for six months; but felt only of Jalaukāvacaraṇa. According to Vāgbhaṭa, pain and
temporary relief. Recurrence of the Nasal furunculosis was redness at the site of inflammation decreases radically
observed after discontinuation of medication. followed by Jalaukāvacaraṇa due to letting out of
vitiated rakta  (blood).[9] In this case, after single setting of
On examination of nose  [Table  1] external appearance of
Jalaukāvacaraṇa, severe throbbing pain and redness in left
nose didn’t reveal any pathology.The internal examination
nostrils due to nasal furunculosis was reduced. Later, patient
of nostrils revealed localized, inflamedred suppurated
pus forming furuncle associated with throbbing pain in was advised oral administration of Triphalā Guggulu[10]
left nostril [Figure  1] while the right nostril was within 250 mg, Kaiśora Guggulu[11] 250 mg and SūkṣmaTriphalā[12]
normal limit.Routine hematological tests  (Hemoglobin, 250  mg with Mahmañjiṣṭhādi Kvātha[13] 40  ml twice a day
TotalLeucocytesCount, Differential Leucocytes Count, after lunch and dinner with Avipattikara Cūrṇa[14] 5 g twice
Erythrocyte sedimentationrate, and Absolute eosinophil a day before food for one month [Table 2].
count, Blood sugar fasting and Postprandial) werewithin Method of Leech Application
normal limits. Vitals  –  pulse 72/min., regular, full volume,
BP 130/80  mmHg  (right arm sitting), Temperature 98.8 F, As per standard protocol, a single leech was applied over
and Respiratory rate  –  20/min. No significant abnormality nasal alae of left nostrils internally with due precautions,
of the nervous system, cardio‑vascular system, and precision and all required care was taken to ensure patients
respiratory system were found. Per abdomen examination safety.
was also normal.
Observations and Results
Table 1: Local examination of nose The patient was photographed before,  [Figure  1] during
External Observation and after leech application  [Figures  2 and 3]. Photographs
examination were taken with the same camera, magnification, lighting,
Shape Normal angle, and film exposure.In this case, one leech was applied
Size Normal at the affected area. After leech application, throbbing
Color Light brown andno skin change pain reduced immediately despite swelling and reddening.
Nasal bridge Straight These then gradually resolved in the next two days. The
Root of nose Normal patient was advised to avoid diet which is predominant of
Vestibules Furuncle present in left vestibular area kaṭu  (pungent), amla  (sour), lavaṇa  (salty) tastes as they
Internal Right Left side would, vitiate rakta and pitta.
examination of side
Nasal cavity Discussion
Nasal cavity Right side Left side
Nasal Furunculosis is a quite common clinical entity
Nasal mucosa Normal Congested
affecting people of every age group especially in old age
Turbinates ‑ Inferior turbinate hypertrophy
and children. Nose picking, plucking of the nasal hair with
Nasal septum Normal

Figure 1: Nasal furunculosis before treatment Figure 2: Leech application in Nasal furunculosis

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Kadu, et al.: Recurrent nasal vestibular furunculosis management by jalukavacharan

Table 2: Ayurvedic palliative treatment given for a case of recurrent nasal furunculosis
Name of the drug used Composition Dose Anupāna Days of
orally treatment
Triphalā Guggulu Triphalā (Combination of Terminaliachebula, 250 mg Mahāmañjiṣṭhād 1 month
Terminalia bellerica and Emblica officinalis), Twice a day Kvātha
Guggulu (Commiphoramukul), Pippalī (Piper longum)
After meal
Sūkṣma Triphalā Triphalā in equal proportion with very small quantity 250 mg Mahāmañjiṣṭhād 1 month
of kajjalī Twice a day Kvātha
After meal
Kaiśora Guggulu Triphalā, Guggulu, Trikaṭu (Combination of Zingiber 250 mg Mahāmañjiṣṭhādi 1 month
officinale (Rosc.) Twice a day Kvātha
Piper nigrum Linn After meal
Piper longum Linn), Viḍaṅga (Embeliaribes)
Trivṛt (Operculinaturpethum L.),
Dantī (Baliospermummontanum)
Avipattikara Cūrṇa Triphalā, Trikaṭu, Mustā (Cyperusrotundus), 5g Lukewarm water 1 month
Trivṛt (Operculina turpethum L.) Twice a day
Before food

and reddening at furuncle site due to vitiation of vāta and

Figure 3: Nasal furunculosis after treatment
tweezers or trimming of the nasal hairs with nasal trimmers
may also lead to Nasal Furunculosis. Many of these
patients are chronic carriers of Staph. aureus in the nasal
vestibule.[5] The initial symptom is focal pain in the tissues
overlying the nasal vestibule which later on increases and
causes significant difficulty affecting the daily activities of
the patients.
The continuously increasing rates of infectious diseases
have led to a higher usage of the commercially available
antibiotics, which has resulted in resistance to antimicrobial
agents.[15] In this case, the patient had taken higher
antibiotics from different ENT specialists which may have
resulted in developing antibiotic resistance.
Nasal Furunculosis is very well correlated with nasal disease
Nāsāruṇaśikhā in Ayurveda. Though it is only described
by Caraka in brief. According to Caraka it is Pākavantī
Pīḍikā  (Suppurated furuncle) caused due to vitiation of
vāta and pitta.[8] In present case, patient had throbbing pain
pitta.As per treatment principle mentioned by Vāgbhaṭa
in the context of Jalaukāvacaraṇa, we decided to apply a
leech at the affected site.[16] After a single setting of leech
therapy, patient experienced complete relief from throbbing
pain followed by complete shrinkage of furuncle within
two days.
The saliva of leech contains numerous biologically
active substances, which have anti inflammatory as
well as anesthetic properties. It also contains anesthetic
substances which help to decrease the symptoms such as
pain and tenderness. It contains various anti‑inflammatory
substances such as Bdellins and Eglins which are helpful
in reduction of inflammation by reducing inflammatory
components.[17] Salivary gland secretion obtained
from the tropical leech H.  manillensiswas found to
have wide spectrum antibacterial activity against both
Gram‑positive  (S.aureus) and Gram‑negative (Sal. Typhi
and E.  coli) bacterial strains confirming its antibacterial
activity.[18] Leech saliva also contains hirudin‑, calin‑, and
destabilase‑like substances which increase microcirculation
by decreasing the blood viscosity. Corboxypeptidase
A inhibitor increases the inflow of blood at the site of
bite.Histamine‑like substances are also present in leech
saliva which act as vasodilators.[19] It sucks the blood at
superficial level from capillaries or extra‑cellular spaces
and hence the blood may be more impure than other body
channels.[20] Various substances of leech saliva increase
the microcirculation, decrease the inflammation as well
as tenderness at furuncle site. Leech saliva promotes the
increasing of local immunity as well.[21]
Following Jalaukāvacaraṇa, Śamana Cikitsā  (Palliative
treatment) was prescribed. Sūkṣma Triphalā, Triphalā
Guggulu and Kaiśora Guggulu had been advised with
Mahāmañjiṣṭhādi kvātha along with Avipattikara cūrṇa

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Kadu, et al.: Recurrent nasal vestibular furunculosis management by jalukavacharan
twice a day before food for one month. Triphalā is
one of the important ingredients of above mentioned
medicine. Itstrengthens the different tissues of the body,
prevents ageing, and promotes health and immunity.
It correctsconstipation, cleanses and tonifies the
gastrointestinal tractand also detoxifies the whole body, and
improves digestion and assimilation[22] Triphalā exhibits
anti‑viral, anti‑bacterial, antifungal and anti‑allergic
properties.[23] Triphalā shows immunomodulatory properties
and helps in improving the body’s defense system.[24]
Kaiśora Guggulu has Antiallergic, antibacterial and blood
purifying properties which are used in skin diseases and
gout.[25] Sūkṣma Triphalā is found to be effective in various
infections like stye, decryocystitis, acnevulgaris and even
against some viral infections such as viral pharyngitis.[26]
Triphalā Guggulu has antimicrobial activity which has
been implemented in treatment of sinusitis, allergies,
boils, constipation, piles, high cholesterol, mal‑absorption
and as a purgative.[27] Both Guggulu formulations, mainly
consists of Guggulu  (Commiphoramukul) which is known
to have analgesic, anti‑inflammatory activity, antibacterial,
and antioxidant property etc.[28] Mahāmañjiṣṭhādi Kvātha
is one of the popular Ayurvedic preparations that is used
as a blood purifier and in treating various skin diseases
such as Acne vulgaris, Psoriasis etc., It promotes skin
health and complexion, Pacifies pitta, acts as immune
modulator.[29] Mañjiṣṭhā  (Rubiacordifolia Linn) which
is one of the important ingredient of Mahāmañjiṣṭhādi
kvātha acts as a potent blood purifier, antioxidant,
anti‑inflammatory, anti stress, antimicrobial which can
play important role to cure furuncle like skin infections
and improve skin health.[30,31] Avipattikara Cūrṇa
is indicated in all pitta vikāras. Pitta and rakta has
āśrayāśrayībhāva (inter relationship of doṣawith dhātu) if
pitta gets vitiated rakta also gets vitiated and this is the
root cause of Nasāruṇaśikhā. Avipattikara cūrṇa pacifies
pitta and ultimately pacify Rakta too.[32]
Application of leech, in the case of recurrent Nasal
furunculosis is not published previously. Rakta and pitta are
prime doṣas for causing Nāsāruṇashikhā  (Nasal furuncle).
There is no other doṣa involved in pathogenesis of
Nāsāruṇashikhā except vāta and pitta. Pitta vitiates rakta
which causes suppuration resulting in blockage of vāta.
Due to obstructed path of vāta doṣa by suppuration results
in throbbing pain at the affected site. Here removing the
blockage by Jalaukāvacaraṇa plays vital role in treatment
of Nāsāruṇashikhā. In this case, Leech therapy was found
to be effective not only in reducing the pain but also
subsiding progression of furuncle. During the follow‑up
period of two months, recurrence of Nasal furunculosis
was not seen. These observations and results indicate
effectiveness of Ayurvedic approach in management of
Nasal furunculosis.
Ancient Science of Life | Volume 36 | Issue 4 | April-June-2017
Conclusion
The present case suggests effectiveness of leech application
which significantly reduced throbbing pain, erythema,
and inflammation in Nasal furunculosis. Jalaukāvacaraṇa
in this condition provided a safe and amenable treatment
option which is least expensive and is easy to be done.
Instant relief in painful condition of Nasal furunculosis
after Jalaukāvacaraṇa indicates its utility in other
inflammatory disorders. As vāta and pitta are only doṣa
causes of Nāsāruṇashikhā and there is no other type of this
disease is mentioned in classical texts, hence the present
treatment modality need to be studied at larger sample
sizes to establish its efficacy.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal. The
patients understand that their names and initials will not
be published and due efforts will be made to conceal their
identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Department of Agadtantra and Vyavahar Ayurveda and
Department of Kayachikitsa, MGACH and RC, Salod  (H)
Wardha.
Conflicts of interest
There are no conflicts of interest.
References
1. Palit  A, Inamadar  AC. Current concepts in the management of
bacterial skin infections in children. Indian J Dermatol Venereol
Leprol 2010;76:476‑88.
2. Ellis Simonsen  SM, van Orman  ER, Hatch  BE, Jones  SS,
Gren  LH, Hegmann  KT, et  al. Cellulitis incidence in a defined
population. Epidemiol Infect 2006;134:293‑9.
3. Eron  LJ, Lipsky  BA, Low  DE, Nathwani  D, Tice  AD,
Volturo  GA, et  al. Managing skin and soft tissue infections:
Expert panel recommendations on key decision points.
J Antimicrob Chemother 2003;52 Suppl 1:i3‑17.
4. Weston V. Scott Brown’s Text Book of Otorhinolaryngology and
Head and Neck Surgery. 7th ed., Vol. 17: London: Edward Arnold
Ltd; 2008, p. 196.
5. Das A, Borah H, Jamil MD, Hanifa A, Das KB. Unusually high
incidence and complications of nasal furunculosis at North East
region of Assam. Nation J Otorhinolaryngol Head Neck Surg
2014;2:20‑1.
6. Dhingra  PL, Dhingra  S, Dhingra  D. Diseases of Ear, Nose and
Throat & Head and Neck Surgery. 6th  ed. New Delhi: Elsevier
Publication; 2014. p. 145.
7. Sharma C, Singh C, Sharma LN, Purvia R, Adlakha M. Antibiotic
resistant organism: An emerging public health problem and role of
Ayurveda (an overview). Int J Ayurveda Pharm Res 2014;2:17‑29.
8. Sastri  K, Chaturvedi  GK. Caraka Samhita; Vidyotini Hindi
Commentary. Chikitsasthan 26/117. Vol. 2. Varanasi: Chaukumba
Bharti Academy; 2004. p. 740.
223
[Downloaded free from http://www.ancientscienceoflife.org on Saturday, July 18, 2020, IP: 49.35.57.202]
Kadu, et al.: Recurrent nasal vestibular furunculosis management by jalukavacharan
9. Gupta  A. Ashtanga Hridaya, Vidyotini Hindi Commentary,
Sutrasthan 26/47. Reprint ed. Delhi: Chaukhambha Sanskrit
Sansthan; 2005. p. 147.
10. Srivastav S. Sharangdhar Samhita Jiwanprada Hindi
Commentary, Madhyam Khandvatakkalpana‑Triphala Guggulu.
Varanasi: Choukhamba Orientalia: 1999; Ch. 7/82‑83. p. 205.
11. Dasaji  G, Shastri  A. Kaishorguggulu. Bhaishajya Ratnavali.
19th  ed., Ch. 27/98‑108. Varanasi: Chaukhamba Sanskrit
Sansthan; 2008. p. 598.
12. Date BB. Therapeutic Index, Formulation Sukshm Triphala;
Pune: Ayurvedrasashala: 2006. p. 34.
13. Srivastav S. Sharangdhar Samhita Jiwanprada Hindi
Commentary, Madhyam Khand Kwathkalpana, Mahamnjishtadi
Kwath; Ch. 2/139‑144. Varanasi: Choukhamba Orientalia: 1999.
p. 156.
14. Dasaji  G, Shastri  A. Avipattikar Churna. Bhaishajyaratnavali.
19th ed., Ch. 56/25‑29. Varanasi: Chaukhamba Sanskrit Sansthan;
2008. p. 922.
15. Tasiemski  A, Salzet  M. U.S. Patent No.  20,120,251,625. Use
of Extract of Leeches as Antibacterial Agent. WO 2011/045427
A1, 2011. Washington, DC: U.S. Patent and Trademark Office;
4 October, 2012.
16. Subhose  V, Srinivas  P, Narayana A. Biography of mădhavakara:
His scholarly contribution. Bull Indian Inst Hist Med Hyderabad
2005;35:113‑30.
17. Rai  PK, Singh AK, Singh  OP, Rai  NP, Dwivedi AK. Efficacy of
leech therapy in the management of osteoarthritis  (Sandhivata).
Ayu 2011;32:213‑7.
18. Abdualkader  AM, Merzouk  A, Ghawi  AM, Alaama  M. Some
biological activities of Malaysian leech saliva extract. Int Islamic
Univ Malaysia Eng J 2011;12:1‑9.
19. Michalsen A, Klotz S, Lüdtke R, Moebus S, Spahn G, Dobos GJ,
et al. Effectiveness of leech therapy in osteoarthritis of the knee:
A randomized, controlled trial. Ann Intern Med 2003;139:724‑30.
20. Raval H, Thakar A. Raktamokshana by Jalaukavacharana
& Shiravedhana‑Vicharchika (Eczema)‑MD Dissertation.
IPGT&RA, GAU, Jamnagar; 2010.
224
View publication stats
21. Bhagat  PJ, Raut  SY, Lakhapati  AM. Clinical efficacy of
jalaukawacharana  (leech application) in Thrombosed piles. Ayu
2012;33:261‑3.
22. Mehta BK, Shitut S, Wankhade H. In vitro antimicrobial efficacy
of Triphala. Fitoterapia 1993;64:371‑2.
23. Sumathi  P, Parvathi  A. Antibacterial potential of the three
medicinal fruits used in Triphala: An ayurvedic formulation.
J Med Plants Res 2010;4:1682‑5.
24. Naik GH, Priyadarsini KI, Bhagirathi RG, Mishra B, Mishra KP,
Banavalikar  MM, et  al. In vitro antioxidant studies and free
radical reactions of triphala, an ayurvedic formulation and its
constituents. Phytother Res 2005;19:582‑6.
25. Lather A, Gupta V, Bansal P, Sahu M, Sachdeva K, Ghaiye P. An
ayurvedic polyherbal formulation kaishore guggulu: A  review I.
Int J Pharm Biol Arch 2011;2:497‑503.
26. Dawane  JS, Pandit  VA, Borole  KD, Kulkarni  SD, Asalkar  MR.
Anti‑infective activities of Sookshma Triphala in abdominal
sepsis induced by cecal ligation in rats. Int J Pharm Biomed Res
2011;2:250‑3.
27. Itankar P, Nagulwar DB, Bhatlawande B. Physical, phytochemical
and chromatographic evaluation of triphala guggul tablets. E Int
J Pharm Phytopharmacol Res 2015;4:306-9.
28. Chander  R, Khanna  AK, Pratap  R. Antioxidant activity
of guggulsterone, the active principle of guggulipid from
Commipheramukul. J Med Aromat Plant Sci 2002;24:370.
29. Available from: http://www.bimbima.com/./mahamanjishthadi-
kwath‑for‑skin‑diseases.aspx.  [Last accessed on 2015  Sep
29;2:15 PM].
30. Available from: https://www.satveda.com/p/mahamanjishth
adikwathlast. [Last accessed on 2015 Sep 29;5:10 PM].
31. Meena  V, Chaudhary  AK. Manjistha  (Rubiacordifolia)  –  A
helping herb in cure of acne. J  Ayurveda Holist Med
2015;3:11‑7.
32. Gyawali  S, Khan  GM, Lamichane  S, Gautam  J, Ghimire  S,
Adhikari  R, et  al. Evaluation of anti‑secretory and
anti‑ulcerogenic activities of avipattikar churna on the peptic
ulcers in experimental rats. J Clin Diagn Res 2013;7:1135‑9.
Ancient Science of Life | Volume 36 | Issue 4 | April-June-2017