Vasomotor Rhinitis – Kshavathu – Meaning, Causes, Symptoms, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Kshavathu means sneezing. Kshavathu is thus a nasal disorder in which the patient suffers from too much sneezing. Master Vagbhata has used the term ‘Bhrsham Kshavah’ in place of Kshavathu. Bhrsham = repeated, Kshavah = sneezing.
Read – Why You Should Not Suppress Sneezing: Effect, Treatment

Causes

  • Tikshna ghranopayoga – inhalation of strong and irritating things
  • Arka rashmisu – getting exposed to intense heat of the sun for longer duration
  • Sutra trnadibhih – the nasal passage being irritated by inserting thread or grass / stick etc (often inserted to cleanse the nose)
  • Vata kopaka karana – exposure to or consumption of other factors which cause aggravation of vata

Pathogenesis

Due to the above said causes the cartilages in the nose gets irritated. Due to this, vata gets vitiated. This vitiated vata when gets obstructed in the nose changes its course moves upwards and irritates the shrngataka marma located in the head. After striking the srngataka marma, vata reverts back and comes down towards the nasal orifices and causes plenty of sneezes frequently. This is called as Bhrsham Kshavah.
Read – Allergic Rhinitis: Causes, Remedies, Ayurvedic treatment, Herbs

Symptoms

Repeated sneezing is the predominant symptom of Bhrsham Kshavah.

Types of Kshavathu

In Mahava Nidana, quoting Sushruta, the author describes two kinds of Kshavathu.

1. Nija / Doshaja Kshavathu – Vata which gets vitiated in the marma located within the nasal passage gets admixed with kapha therein gets eliminated from the nose frequently producing sounds. This condition is called as Kshavathu.

Here we can see that the external factors are not involved and pathogenesis takes place due to the vitiated doshas, mainly vata getting vitiated in the marma. Vitiation of vata and irritation of marma is the chief process in the causation of frequent sneezing. The term marma here corresponds to srngataka marma.
Read – Importance Of Marma: Need for study

2. Agantuja Kshavathu – Agantuja means that which is caused by external factors. Due to consumption of strong and irritating foods and also inhaling things of the same nature, getting exposed to heat of the sun for long duration or irritation of the phana marma located in the cartilages of the nasal passage or the cartilages of the nose or the shrngataka marma plenty of sneezes are caused frequently. This is called as Agantuja Kshavathu.

According to Master Charaka – ‘The vayu located in the head when takes an abnormal course and touches the marma located in the nasal passage, it causes severe and frequent sneezing. This condition is called kshavathu’.
Read – 4 Remedies For Morning Sneezing With Turmeric, Black Pepper, Tulsi

Sanskrit verses

Treatment of Kshavathu

Principles of treatment

  • Pradhamana Nasya – snuffing medicated powders is beneficial. Alternatively the powders are filled in tubes and blown into the nostrils of the patient by the physician.
  • Vataghna Sweda – sudation / fomentation with vata mitigating herbs is given over the head.
  • Snigdha Dhuma – unctuous fumigation is useful.

Useful formulations

Shuntyadi Ghrta or Taila – Ghee or oil prepared with the paste of the below mentioned herbs shall be used as oral medicines or as nasal drops –

  • Ginger
  • Kushta – Saussurea lappa
  • Pippali – Piper longum
  • Vidanga – Embelia ribes
  • Raisins

Sikthakadi Dhuma – Smoke emitted from burning together on fire the combination of Siktha – wax, Guggulu – Commiphora mukul and Ghee is useful.

Probable modern correlation

Kshavathu or Bhrsham Kshavah is compared to Vasomotor Rhinitis associated with Rhinorrhea explained in the modern texts due to closer resemblance of symptoms in both conditions.

Introduction

Rhinitis and Rhinorrhea are the terms used for running nose. While rhinorrhea is a clear watery discharge from the nose, rhinitis is the inflammation of nasal tissues and membranes probably caused by irritants or allergen. Rhinitis can lead to rhinorrhea. Therefore rhinorrhea may often be a symptom of rhinitis.

Vasomotor rhinitis – Many times there is no specific cause like irritant or allergen for inflammation. Such rhinitis is called as vasomotor rhinitis. It is also called as non-allergic rhinitis or idiopathic rhinitis. The symptoms of this condition can be uncomfortable but are not serious. It is more common after 20 years of age but can also affect children and adults.

Non-allergic rhinitis involves chronic sneezing or congested and running nose with no apparent cause. Though the symptoms resemble those of allergic rhinitis, evidence of allergy or allergic reaction is not present in this condition.
Read – Chronic Sinusitis: causes, symptoms, Ayurvedic treatment

Causes of vasomotor rhinitis

Vasomotor rhinitis is caused due to dilatation of blood vessels located in the nose. Dilatation of blood vessels consequently produces swelling leading to congestion and drainage of mucus from the nose. The other cause may be the hypersensitiveness or hyper-responsiveness of the nerve endings in the nose.

Common causes or triggers which might produce a reaction which leads to dilatation of blood vessels in the nasal cavity –

  • Dust, smoke, smog, perfumes, strong odors, chemical fumes etc
  • Temperature / humidity changes often trigger the nasal membranes to swell and cause running nose. Dry weather to be precise is an important cause.  
  • Infections – Cold or flu and viral infections associated with these conditions
  • Hot or spice foods / drinks, drinking alcoholic beverages  
  • Excessive use of nasal decongestant sprays
  • Medications – aspirin, ibuprofen, beta-blockers, antidepressants, oral contraceptives, some sedatives
  • Hypothyroidism
  • Stress
  • Hormonal changes associated with menstruation and pregnancy
  • Sleeping on your back, sleep apnea and acid reflux (Read more)

Risk Factors

  • Exposure to irritants – smog, exhaust fumes, tobacco smoke etc
  • Being older than 20 years of age
  • Prolonged use of decongestant nasal drops or sprays
  • Being female – due to hormonal changes, nasal congestion gets worse often during menstrual cycles or pregnancy
  • Occupational exposure to fumes – like construction materials, solvents, chemicals and fumes from decomposing organic material (compost) etc
  • Certain health problems – Hypothyroidism, chronic fatigue syndrome etc may cause or worsen rhinitis
  • Stress – physical or emotional stress may trigger the condition in some people

Symptoms of Vasomotor Rhinitis

  • Runny nose
  • Stuffy nose
  • Postnasal drip
  • Mucus congestion in the throat
  • Sneeze
  • Cough

These symptoms may keep coming and going all through the year. They may also be constant or even last for many weeks.

Vasomotor rhinitis is typically marked by the absence of itching in the nose, eyes or throat and watering of eyes. On the contrary these symptoms are generally found in allergic rhinitis. This condition is caused by allergy and vasomotor rhinitis is not caused by allergy.
Read – Nose Bleed: Ayurvedic Understanding, Treatment

Complications

  • Nasal Polyps
  • Sinusitis
  • Middle ear infections
  • Interruption of daily activities – less productivity at work or school, sickness absenteeism etc

Diagnosis of Vasomotor Rhinitis

This condition can be diagnosed when other causes of the symptoms are ruled out. Tests for allergy will help to rule out allergy as a cause of rhinitis. A skin test to identify allergies or a blood test to check if the immune system is good enough or not will help in diagnosis and differential diagnosis of this condition. Nasal endoscope or CT scan of sinuses may help in checking if sinus problems are causing rhinitis. If no evident cause for rhinitis is found, vasomotor rhinitis may be diagnosed.
Read – Chronic Sinusitis: causes, symptoms, Ayurvedic treatment

Prevention

It is possible to prevent vasomotor rhinitis if the causes are identified.

Consult doctor in presence of severe symptoms. Doctor diagnoses the condition at the right time and identify the health problems that may be worsening the symptoms of the disease. Often the disease and its symptoms may be prevented, reduced or got rid of only after the disease has been diagnosed at the right time and treated promptly.

Avoid overusing nasal decongestants. They often tend to worsen the symptoms of the disease after having provided a short-term relief in the early part of their usage.

Studies suggest that children who consumed oily fish or certain polyunsaturated fatty acids are less prone to develop non-allergic or allergic rhinitis.

If you already have vasomotor rhinitis, you may take all steps which would reduce your symptoms, recurrences or flare-ups. These include –

Treatment of Vasomotor Rhinitis

Main principles of treating this condition includes –

  • Over the counter saline nasal sprays
  • Over the counter decongestants
  • Over the counter nasal sprays

Medications are given when symptoms are severe or if OTC medications produce side effects or no effects. Corticosteroids, antihistamine nasal sprays or anticholinergic nasal sprays or mix and match of these will come in for help to relieve the symptoms of vasomotor rhinitis. Surgery is rarely needed to treat the symptoms, especially if there are underlying health problems which intensify the symptoms inclusive of nasal polyps or a deviated nasal septum.
Read – 6 Simple Home Remedies To Stop Runny Nose

Home Remedies

Home remedies shall be tried only when milder symptoms persist, to relieve symptoms and discomfort.

Nasal Rinse – Bulb syringe, neti pot or specially designed squeeze bottles shall be used to irrigate your nasal passages. This can be done at home and is called as nasal lavage. It helps in keeping your nose free of irritants. You may use filtered, boiled and cooled or distilled water for this purpose. This helps in prevention of infection. Often clean and sterilize your equipment.
Read – Hatha Yoga and Shat Karmas: Benefits, Precautions

Nose Blowing – Blow your nose gently and regularly. This will help in clearing the mucus and irritants.

Humidification – Set up a humidifier at your work place or in your bed room if the air in your home or office is dry. Regularly cleanse your humidifier. Alternatively you may also breathe in the steam from a warm shower.

Hydration – Drink plenty of liquids, including water, juice and caffeine free tea. This will help in loosening the mucus in your nose. You may avoid caffeinated beverages.
Click to Consult Dr Raghuram Y.S. MD (Ayu) 

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