A CASE STUDY ON THE THERAPEUTIC EFFECT OF MALLA SINDOOR AND SHRING BHASMA IN THE ELEVATED ABSOLUTE EOSINOPHIL COUNT

Bharati P.L. 1 , Agarwal Prateek 2 , Sharma Rashmi 3 , Subhose V. 4 and Jadhav A. D 5 . 1. Research Officer (S-2) Regional Ayurveda Research Institute for Drug Development, Aamkho, Gwalior (M.P.). 2. Research Officer-Ay Regional Ayurveda Research Institute for Drug Development, Aamkho, Gwalior (M.P.). 3. Senior Consultant Regional Ayurveda Research Institute for Drug Development, Aamkho, Gwalior (M.P.). 4. Assistant Director, Regional Ayurveda Research Institute for Drug Development, Aamkho, Gwalior (M.P.). 5. Ex-Assistant Director Regional Ayurveda Research Institute for Drug Development, Aamkho, Gwalior (M.P.). ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 5 (10), 1872-1875 1873 Introduction:-Allergic rhinitis patients are at risk of development of Asthma. These patients will have Bronchial hyper reactivity 1 . Bronchial hyper reactivity (BHR), one of the hallmarks of Bronchial Asthma, is a risk factor for the development of Asthma 2,3 . In non-atopic Asthma a relationship between the peripheral blood eosinophil count and the FEV1 has been observed and the Eosinophil count is considered useful in monitoring disease activity 4 . Various studies have attempted correlating Nasal Smear Eosinophilia (NSE) and Absolute Eosinophil Count (AEC) in peripheral blood in patients of allergic rhinitis, though very little is known about correlation of symptoms and severity of clinical score with NSE and peripheral blood AEC 5 .
Allergic rhinitis is seasonal or perennial. With an appropriate history and detailed examination, the diagnosis is usually not problematic. However, it is found that the common symptomatology of rhinitis congestion, sneezing, nasal itching, and rhinorrhea show significant overlap with non-allergic rhinitis (NAR) 6 . Treatment with inhaled sodium cromoglycate produces a small reduction in bronchial hyper reactivity 7. Remission of bronchial hyper reactivity occurred more frequently in subjects treated with intranasal corticosteroids 8,9,10 .
As per Ayurvedic context, Allergic rhinitis is compared with Vata-KaphajaPratishyay. The concept of Aama, Asatamya and ViruddhAahara also predict the allergic conditions. Ama is the product of impaired digestion and metabolism. It affects Rasa and RaktaDhatu leading to manifestation of Pratishyaya. Wrong food combinations (Viruddhaahara) having antagonist properties like fish with milk, fruit juice with milk, clarified butter with honey, ice cream after night meals, etc. leads to allergy 11 .
MallaSindoor is one of such medicament indicated mainly in diseases such as Shwasa, Kasa(respiratory disorders), and is thought to be an effective drug in combating Vedanaand Vatarogaharaproperty 12 .

Aim And Objective:-
To evaluate the therapeutic effect of MallaSindoorand ShringBhasmain the elevated Absolute Eosinophil Count

Material and Methods:-
The patient presented with clinical features indicative of allergic rhinitis was examined; a clinical diagnosis was made in the OPD of Regional Ayurveda Research Institute for Drug Development (RARIDD) Gwalior and then confirmed with the help of X-ray and pathological examination. After confirmation, patient having allergic rhinitis with increased Absolute Eosinophil Countwere considered for this case report. The demographic profile, associated allergic rhinitis symptoms such as rhinitis congestion, sneezing, nasal itching, dyspnoea and rhinorrhea were noted. Laboratory investigations like blood and radiological report were also documented. Purpose and effect of the Ayurvedic medicines were explained to the patient. MallaSindoorand ShringBhasmawere prescribed to the patient willing for medication. Patient outcomes were also analyzed.
Study Design:-MallaSindoor125 mg and ShringBhasma250 mg were prescribed to take orally thrice a day with honey for the duration of 2-3 weeks to the patient.
Case Report:-A 71 years old female having complaints of breathlessness, chest pain, cough, indigestion and weakness since 1 year. She had taken some modern medical treatment for the same problem and did not get relief for the same. She was interested to take Ayurvedic treatment for the same problem. Patient visited OPD of Regional Ayurveda Research Institute for Drug Development (RARIDD), Gwalior on 9 th Dec. 2016 vide registration no 3494. Initially some Ayurvedic medicines like Sitopaladichurna, Nardiyalaxmivilasras, Chandramritras, Swaskutharras, Haridrakhanda, Kanchnarguggulu etc. were prescribed. She was advised for CBC, ESR, RBS and X-ray chest PA view. Blood report shown normal values but X-ray report showed Pneumonitis in bilateral mid and lower lung zone. Same treatment was given for 15 days and observed her complaints but prescribed medicines were not responded significantly.

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Absolute Eosinophil Count was advised to the patient and report was 1.32 thou/mm 3 (Normal 0.02-0.50 thou/mm 3 ). As per report above medicines were stopped and new prescription consisting of MallaSindoor125 mg and ShringBhasma250 mg were given to take orally thrice a day with honey for 10 days to the patient. Patient purchased the medicines from local chemist shop as per prescription. After 10 days patient reported with significant relief in breathlessness, chest pain, cough and indigestion. The medicines were further continued for 7 days. Patient reported 95% relief in her complaints due to treatment by MallaSindoor and ShringBhasma. After follow up repeat Absolute Eosinophil Count was done and report was found to be in normal range (0.50 thou/mm 3 ).

Discussion:-
The present study showed the relationship between peripheral blood eosinophilia and bronchial hyper reactivity in allergic rhinitis and also revealed a strong association between allergic rhinitis and lower airway dysfunction. Allergic rhinitis is a frequent inflammatory chronic disease induced by an IgE-mediated reaction after allergen exposure in the nasal mucosa. It is now clear from a large number of cross-sectional studies that allergic rhinitis is strongly associated with Asthma and BHR 15 .The mean value of blood AEC was below the standard normal value with 307.6 in patients having only nasal symptoms and 460 in patients having nasal with respiratory symptoms. Hence, blood AEC tends to be more in the respiratory system 5 . Similar finding was observed by Jagdeeshwaret al. 16 but with a little highervalue of AEC which was 416.26 in patients having only nasal symptoms and 683.76 in patients having nasal and respiratory systems. ShringaBhasma is an Ayurvedic medicine prescribed mainly for asthma.ShringaBhasma is aodourless dull white powder with chalk like taste. Qualitative inorganic analysis showed the presence of Carbonates, Sulphates, Chlorides, Potassium, Calcium and Magnesium. The organic contents like tannins and proteins were also identified 19 .

Malla-Sindoor is a mineral formulation of Ayurveda and contains
ShringaBhasma is used in respiratory disorders accompanied with a productive cough, wheezing, chest congestion, chest tightness, chest pain and fever. ShringaBhasma helps clearing the lungs and airways. It is used when there is a need to regulate mucous secretion. ShringaBhasma has bacteriostatic action, which most likely to appear in tuberculosis. It inhibits the growth of Mycobacterium tubercle. Though, ShringaBhasma plays a supportive role in Tuberculosis and the main medicine is Swarna Bhasma. 20,21 Ushna, Tikshna, Kapha-Amasanshodhana, purgative, stimulant, antibacterial and antiviral properties of MallaSindoor and kaphaghna, soothing, bacteriostatic properties of ShringBhasma might have reduced elevated Absolute Eosinophil Count in patient and provided relief from the sign & symptoms of allergic rhinitis.

Conclusion:-
MallaSindoor 125 mg and ShringBhasma, 250 mg administered together orally with honey thrice a day provided relief in sign and symptoms of patient of allergic rhinitis with increased absolute eosinophil count. The treatment 1875 was found very effective and safe. The findings of this case report may be helpful for treatment of allergic rhinitis with increased absolute eosinophil count and the effect of the drugs may be further confirmed in clinical study employing more number of patients of allergic rhinitis with increased absolute eosinophil count.