A Successfull Case Study of Kranastarava in Terms of Nidan, Samprapati, Samprapti Ghatak and Samanya And Vishesh Chikitsa with Rakshoghna Dravya Karna Dhupan Karma and Internal Medications. Case Study Full Article: A study on the Efficacy of Rakshoghna Dravya Dhupana in the managment of Karnastrav. https://medicaljournals.stmjournals.in/index.php/JoAYUSH/article/view/3337 Publication: Journal Of AYUSH: Ayurveda, Yoga, Unani, Siddha and homeopathy.

1. RAKSHOGHNA DRAVYA DHUPANA IN
MANAGEMENT OF KARNA STRAV (ACUTE
SUPPURATIVE OTITIS MEDIA) – A CASE STUDY
By :
Sejal D. Gamit
Assistant Prof./ Consultant
Shalakya Tantra Department
Sumandeep Ayurved Medical College & Hospital.

2. Frame work:
 Astang Ayurved
 Shalakya tantra Disease Classification
 Ear Anatomy Superficial
 Karnastrav Disease Treatment Ayurved
 Acute Suppurative Otitis Media Disease - treatment: Superficial
 Case Report
 Publication

3. AYURVED
SHALYA
SHALAKYA
KAYA
CHIKITSA
BHUT
VIDHYA
KAUMAR
BHRITYA
AGAD
TANTRA
RASAYAN
TANTRA
VANJI
KARAN
सू.सू.1/7

4. Acc. To Acharya Shushrut
SHALAKYA
NETRA 76
NASA 31
KARNA 28
SHIRO 11
MUKH 65

5. Ear:
 External Ear
 Pinna
 External Auditory Canal
 Tympanic Membrane
 Middle Ear
 Middle ear cavity
 Eustachian Tube
 Inner Ear
 Semicircular canal
 Cochlea

6. Tympanic Membrane:
 Synonyms: Ear drum, Myringa
 Definition: A thin membrane that separates the external ear from the middle
ear.
 Site: Located at medial end of the external auditory canal, separating it from the
middle ear cavity
 Position: At an angle of 55° to the horizontal to the floor and directed
downward, forward and laterally. It is horizontal in newborns.
 Shape: Oval Concave laterally (towards external auditory canal) and slightly
drawn inwards at its center – the umbo, where the handle of malleus is attached.
 Size:
 Length: 9-10 mm
 Width: 8-9 mm
 Thickness: 0.1 mm
 Structure:
 Outer epithelial/cutaneous layer
 Middle fibrous layer
 Inner mucosal layer
 Color:
 Pars tensa: pearly white/grey
 Pars flaccida: pinkish

8. Karna roga - 28
1. Karnashul
2. Karnanada
3. Karna Badhirya
4. Karna Shweda
5. Karnastrav
6. Karnakandu
7. Karnavarcha
8. Krumikarna
9. Karna Pratinaha
10. Karnapaka
12. Nija Karna Vidradhi
13. Agantuj Karna
Vidradhi
14. Vataj Karna Arsha
15. Pittaj Karna Arsha
16. Kaphaj Karna Arsha
17. Tridoshaj Karna
Arsha
18. Vataj Karna Arbud
19. Pittaj Karna Arbud
20. Kaphaj Karna Arbud
21. Raktaja Karna Arbud
22. Tridoshaj Vataj
Karna Arbud
23. Mansaja Karna
Arbud
24. Medoj Karna Arbud
25. Vataj Karna Sopha
26. Pittaj Karna Sopha
27. Kaphaj Karna Sopha
28. Tridoshaj Karna
Sopha

9. KARNASTRAVA NIDANA:
शिरोशिघातादथवा शिमज्जतो जले प्रपाकादथवाऽशप शवद्रधेेः |
स्रवेत्तु पूयं श्रवणोऽशिलावृतेः स कणणसंस्राव इशत प्रकीशतणतेः ||
- सु.उ. 20/10

10. SAMPRAPTI :
Nidana Sevan
Agnimandhya
Causing
Aamotpati
Vatolbana
Tridosha
Samuchay And
Prakop
Shiro Margen
Urdhvagaman
Nasastha
Dosha -
Pratishyaya
Karna
Srotorodha
Accumulation
Of Dosha &
Paka Due To
Pitta
Puyotpati and
strava from
Karna
Karna Strav

11. SAMPRAPTI GHATAK :
 Dosha: Vata pradhan Tridosha
 Dushya: Ras, Rakta, Mamsa
 Strotas: Ras, Rakta, Mamsa vaha
 Agni: Jathragnimandhya
 Udbhav sthan : Aamashaya
 Adhisthan: Karna
 Stroto dushti prakar: Vimargagaman paschat sanga

12. KARNAROGA SAMANYA CHIKITSA:
सामान्यं कणणरोधेषु घृतपािं रसायिम् |
अव्यायामोऽशिरेःस्नािं ब्रह्मचयणमकत्थिम् ||
- सू.उ.21/3
KARNASTRAV VISHESH CHIKITSA:
कणणस्रावे पूशतकणे तथैव क
ृ शमकणणक
े ||
समािं कमण क
ु वीत योगाि् वैिेशषकािशप |
- सु.उ. 21/39
शिरोशवरेचिं चैव धूपिं पूरणं तथा ||
प्रमाजणिं धाविं च वीक्ष्य वीक्ष्यावचारयेत् |
- सु.उ. 21/40

13.  In Karnastrav there is one type of Vran occurs in Tympanic membrane
and then discharge comes out.
 Achary Sushrut has described Sevral Dravya Dhupan for Karnastrava.
तो गुग्गुल्वगुरुसजणरसवचागौरसषणपचूणैलणवणशिम्बपत्रशवशमश्रैराज्ययुक्तैधूणपयेत् |
आज्यिेषेण चास्य प्राणाि् समालिेत ||
- सु.सू.5/18
 There is also a reference of Rakshoghna Dhup for Vrandhupan So if
Karnastrav taken as Vran in tympanic membrane, Rakshoghna Dhup
Drugs were taken for Karnadupan in Karnastrav.

14. ASOM
 Common infection affecting middle ear mucosa.
Stage of Tubal Occlusion
Stage of Pre-suppuration
Stage Of Suppuration
Stage Of Resolution
Stage Of Complication

15. MORDEN TREATMENT
 Antibacterial Therapy
 Decongestant Nasal Drops
 Oral Nasal Decongestants
 Analgesics & Antipyretics
 Ear Toilet Removal
 Dry Local Heat
 Myringotomy

16. CASE REPORT:
 Age : 44 Years
 Sex : Female
 Occupation : House
Wife
 Marital Status : Married
 Address : Jodhpur,
Ahmedabad
COMPLAINTS - DURATIONS:
S.N. Symptoms Durations
1 Karna Gauravata-Heaviness of Both Ears 1 month
2 Karna Shul-Mild Pain 1 month
3 Karnastrav-Ear Discharge 1 month
4 Karna Shravan Alpata-Hearing Loss 15–20 days
5 Karna Avidhyaman Dhvani Shruti-Tinitus 15–20 days
6 Karna Kandu-Itching 15–20 days
7 Nasa Strav-Nasal Discharge 1 yr (Recurrent)
8 Shiro Gauravta-Heaviness of Head 1 yr (Recurrent)

17. PAST HISTORY:
 Patient having Rhinitis and Heaviness of Head in recurrent condition since last
1 year.
 The patient received oral antibiotics and analgesics medications since 15 days
but only get relief as long as the effect of the medicines lasts and symptoms
occurs intermediately.
PERSONAL HISTORY :
 Diet : Mixed
 Appetite : Good
 Sleep : Disturbed
 Bowel : 2 times / day
 Micturition : 5-6 times /day

18. EXAMINATION:
• EAR:
External Auditory Canal - B/L Moderate Creamish Yellow Discharge present
• Moderate Pulsatile discharge
• Non-foul smelling
Tympanic Membrane – B/L Perforation
• Left :A small central perforation in the Antero inferior Quadrant.
• Right: Medium size central perforation.
• Hearing Test:
• Rinne test was negative.
• Weber test was lateralized to affected side and ABC was normal. Which shows Mild
Conductive Deafness.

19. • NOSE:
Nasal Mucosa – Mild inflamed
Left side Nasal septum Deviation
• THROAT:
Ant. And Post. Pillar – Mild Congested
P.P.W- Mild Congested

20. S.N. Type of Drug Drug Dose Anupana/Sahpana
1. Compound Drug Sitopaladi Churna–3 gm
Haridra Churna–2 gm
Trikatu Churna–500 mg
5 gm Twice a day After Meal Honey
2 Single Drug Yastimadhu Ghanvati 3–4 Tab. in whole day for
Chusanarthe.
-----
3 Single Drug Sarivadi Vati 2 tab. Twice a day After Meal Ushnodaka
4 Single Drug Gandhak Rasayan Tab. 2 tab. Twice a day After Meal -----
5 Karna Dhupan
(Ear Fumigation)
Guggalu, Sarjras, Agru,
Vacha, Lavan Nimb Patra,
Gaur Sarshap, Ghrit.
Twice a day ------
TREATMENT:

21. PATHYAPATHYA CHART :
Pathya Apathya
Aahara
• Grains: One Year Old Grains, Kulatha
• Pulses: Mung, Urad
• Vegetables: Kankoda, Sarsav, Mulak, Lahsun,
• Green Vegetables: Spinach, Fenugreek, Suva,Matla
• Fruits: Badar, Dadim, Kele, Mosambi, Amla, Nimbu, Harde.
• Milk Dish: Cow Ghee–Milk, Butter
• Others: Saindhav, Puran Madhu, Marich
• Pulses: Chickpeas, Peas, Samo
• Contraindicated food–All sour fruits with Milk–Meat–Onion–
Garlic–Radish–Carrot–Jaggery– With Basil, Ginger, Curd
with–Radish, Sesame, Garlic, Urad, Milk, Jaggery with–Sesame,
Banana,With Ghee Equal Parts Honey
• Other: Curd, Fish, Sour–Spicy Food
Vihara
• Drink cow's ghee mixed with fresh milk.
• Keeping silence
• Rest
• Karna Abhyanga: Massaging the ears withLuke warm oil.
• Consumption of dew point
• Bathe by dipping/pouring water on the head.
• Ear bud put In the ear
• Cleaning teeth with Dantun
• Anger, grief
• Anxiety
• Cool water/atmosphere
• Fasting
• More exercise
• Alcohol consumption

22. Gradations
Grades
Features
0 1 2 3
Ear Discharge Absent
Mild–scanty
secretion near the
tympanic membrane
Moderate–secretion irritating in
the ear canal
Profuse–secretion coming outof
ear canal
Pain Absent Not continuous
Continuous but not hamper
normal activity
Continuous throughout and
hamper normal activity
Itching Absent Occasional Continuous Mild Continues Sever
Hearing Loss Absent
Unable to hear the
whispering voice
Unable to hear normal voice Unable to hear a loud voice
Tinitus Absent Present ------------ ------------
Heaviness Absent Present ------------ ------------
Nasal
Discharge
Absent Present ------------ ------------

23. RESULT:
Complaints B.T 7 days 15 days 1 Month 3 Months
Karna Gauravata-Heaviness of Both Ears 1 1 0 0 0
Karna Shul - Pain 3 2 1 0 0
Karna Strav-Ear Discharge 3 2 1 0 0
Karna Kandu-Itching 2 1 0 0 0
Karna Shravan Alpata-Hearing Loss 2 1 1 1 1
Karna Avidhyaman Dhvani Shruti-Tinitus 1 1 1 1 1
Nasa Strav-Nasal Discharge 1 1 0 0 0
Shiro Gauravta-Heaviness of Head 1 1 1 0 0

24. FOLLOW UP:
• The patient came regularly in interval of 7 days for 1 month.
• After completion of treatment there was no recurrence for 3 month, General
health of patient get improved by supporting treatment.

25. RAKSHOGHNA DRAVYA PROPERTIES :
Sr. No Drug Rasa Guna Virya Vipak Doshghnata Remarks
1 Guggalu Katu,Tikta,
Kashay
Ruksha, Laghu Ushna Katu Vata - Kapha Bhagna Sandhan Krut
2 Sarjras Tikta Kashya Guru Shit Katu Vata – Pitta Vran Shodhak-Ropak,
Bhagna Sandhan Krut, Vedana
Sthapak
3 Agru Katu, Tikta Laghu, Tikshna Ushna Katu Kapha - Vata Karnaakshi Roga Nashak ,
Shitprashaman
4 Vacha Katu , Tikta Katu , Tikshna Ushna Katu Vata Shulaghni
5 Nimbpatra Tikta ,
Kashay
Laghu Shit Katu Kapha- Pitta Vran Shodhak – Ropak
6 Gaur Sarshap Katu , Tikta Tikshna , Ushna Ushna Katu Kapha – Vata Kandhu Nashak
7 Saindhav
Lavan
Lavan Laghu, Snigdha,
Sukhsma
Shit Madhur Tridosha Vran Shodhak – Ropak
8 Ghrit Madhur Saumya, Mrudu Shit Madhur Vata - Kapha Sarva Snehanam Uttamam,Alpa-
Kledkarak

26. • According to Ayurveda classics, Vata Dosha is responsible for
Karnastrav in which Strav is the main symptom.
• One of the most important features of Ruksha sweda (Dry heat) is
dryness.
• Hence in Karnastrav, Karna Dhupan is a choice of treatment because
it not only dries up the Strav but also creates the unfavorable
condition for the growth of microbes. The fumes of Dhupan may
bring out the sedative effect and dries up the Strav.
• Heat also helps in vasodilatation and increased blood circulation
thereby helping in better absorption of drugs and healing.
• This Rakshoghna Drvavya drugs also having Anti-Fungal, Anti-
Bacterial, Anti-Inflammatory, Anti- Septic and Anti-Spasmodic
properties that helps to pacify the Dosha of Karna and helps to
reduce discharge.
WHY KARNA DHUPAN ?

27. Mode of Actions of Internal medications:
Sitopaladi Churna
Haridra Churna
Trikatu Churna
Combine work on
Tridosha
Helps to reduce
Inflammation and
pain
Reduce Nasal
Discharge and
heaviness of Head.
Yastimadhu Ghanvati
Madhur Rasa, Guru and Snigdha
Guna,
Madhur Vipaka and Sheeta
Virya and Sandhaniya,
Kandughna Karma
Helps internally to treat
Nasastrav and Karna kandu.
Also having Anti-
inflammatory, Anti-Viral,
Anti Allergic, healing
properties which helps to
subside the Inflammation
and congestion of nose and
Throat
Sarivadi Vati
Acts on Vata, Pitta and
Kapha Doshas
Useful in tinnitus,
ear infection and
chronic respiratory
diseases
Gandhaka Rasayana
Kandughna Properties
and bestowed with
powerful healing
properties including
Analgesic that reduces
tenderness and pain of
soft tissues.

28. CONCLUSION:
 Karnastrava (ASOM) is disease which may lead to severe complications such as Putikarna,
CSOM and Cholestetoma.
 The results of the study on Rakshoghna Dravya Dhupan with internal medications For the
management of Karnastrav have been extremely encouraging.
 The study demonstrates that Rakshoghna Dravya Dhupan is an effective treatment for the
management of Karnastrav. Furthermore, it is easy to use and does not require any complicated
preparation.
 Considering all aspects of Karnastrav External Treatment and Internal formulation aid in the
management of Karnastrav, It has been observed that it helps in reducing the symptoms of the
discharge, perforation, and impaired hearing. It was also found to be helpful in improving the
overall quality of life of the patients suffering from this condition.
 The mode of treatment was found to be cost effective, safe and ease to implement.

29. PUBLICATION

30. Thank You
For
Listening