In allergic rhinitis or “hay fever”, there are a number of factors that come together to cause various uncomfortable symptoms of the upper respiratory tract (throat, sinuses, nose) and eyes. Typical symptoms include nasal congestion, a clear runny nose, sneezing, nose and eye itching, and excess tear production in the eyes. Postnasal dripping of clear mucus frequently causes a cough. Loss of the sense of smell is common, and loss of taste sense occurs occasionally. Nose bleeding may occur if the condition is severe. Eye itching, redness, and excess tears in the eyes frequently accompany the nasal symptoms. The eye symptoms are referred to as “allergic conjunctivitis”. To understand this condition from an Ayurvedic point of view, we need to consider how Dosha, Dhatu and Mala are involved. We also need to consider the role of Agni and Ama.
Allergic Rhinitis is mainly a problem of Kapha Dosha Vriddhi (excess, aggravated Kapha) in Rasa Dhatu (the mucus membranes are part of Rasa, and mucus is the Mala of Rasa Dhatu). The condition could be classified as “Rasa Gata Kapha”. This is seen through the over-production of nasal mucus which can cause congestion and itching. In addition to this, there is often considerable swelling / inflammation which can also cause a narrowing of the breathing channels, itching and further congestion. So there is an excess of Kapha and sometimes Pitta present locally in the upper respiratory tract and eyes which are lubricated by Rasa Dhatu.
When we inhale air that contains airborne particles (dust, pollens, pollutants etc.) our nasal passages and sinuses act as a partial filter to these particles, trapping some of them in the thin layer of mucus that lines these mucus membranes. Other particles enter the lungs where they can become absorbed into the blood stream. Many airborne particles also find their way in to the body via what we eat and drink, providing a secondary potential route into the blood stream.
Irrespective of the way in (via the lungs or the digestive tract) airborne particles that enter our blood are identified as foreign, non-nutritive substances by our immune system (Prana Vayu governs the intelligence of the immune system). Once identified as foreign, absorbed pollutants are digested / neutralised (thanks to Rasa Dhatu Agni and the Pancha Bhuta Agnis) then eliminated via the normal routes (mainly Purisha and Mutra Malas). In healthy people, this process normally happens without us noticing anything out of the ordinary. However, when Prana Vayu is disturbed, or when Rasa Dhatu Agni is disturbed, this normal defence mechanism can go awry.
The main factor to consider when allergic rhinitis arises is inadequate Rasa Dhatu Agni due to Sama Dosha in Rasa Dhatu. If Rasa Dhatu Agni is insufficient, Rasa can become overwhelmed by undigested airborne particles. This often results in the body triggering an “emergency response” to cleanse Rasa more radically and to prevent further absorption of airborne particles – hence the first main symptom of most people’s allergies: a runny nose. Rasa is producing copious amounts of clear runny nasal mucus in the hope that more particles will be trapped then eliminated out of the nose and sinuses directly. This initial state of excess Bodhaka Kapha production can be thought of as a Vikriti since it is a sign that the body is no longer coping with airborne pollution in a controlled manner. A single short lived bout might not be a reason for concern, but if the runny nose and sneezing become chronic, allergic rhinitis should be considered as a Vikriti worth treating.
We can trace back the problem of Ama in Rasa Dhatu to its production in the digestive tract. We know that any of the three Doshas, once aggravated, can cause Ama to accumulate in their respective primary sites (stomach, small intestine, colon). If there is chronic Ama accumulation in the Anna Vaha Srotas, it will eventually infiltrate Rasa Dhatu via Rasa and Rakta Vaha Srotas. Ama spreading to Rasa Dhatu will weaken Rasa Dhatu Agni and predispose you to allergic rhinitis as well as numerous other problems.
Sometimes, this initial emergency reaction comes with other stronger symptoms such as severe itching, inflammation and congestion. This is a sign of an increased severity of the above pathology (more Ama in Rasa Dhatu) as well as a more pronounced measure of Dosha Vriddhi in Rasa Dhatu (both globally and locally at the sites of irritation). For example, we might have an underlying chronic state of Rasa Gata Pitta with Sama Pitta overflowing from Annavaha Srotas into Rasa Dhatu, eventually weakening Rasa Dhatu Agni and affecting the quality or Rasa Dhatu and its ability to protect the mucus membranes that lubricate the nasal passages and eyes. When the body kicks in the emergency action (as mentioned above) there will be too much Pitta mixed in with the emergency flooding of mucus (high Kapha) causing increased inflammation, heat, redness and itching.
Basically, the specific symptoms that accompany the general symptoms of increased Kapha/low Rasa Agni tend to tell us which Dosha is aggravated chronically (the underlying cause of the problem). For example, runny nose accompanied by:
- Dry eyes, itching and clear mucus means Vataja (caused by Vata)
- Inflammation, burning eyes, itching and perhaps yellowish mucus means Pittaja
- Itching and perhaps thicker (sometimes opaque) mucus means Kaphaja
So we can differentiate three internal chronic causes of rhinitis depending on the nature of the local symptoms. Other observations such as tongue coating, global Vikriti and pulse diagnosis can help to confirm or contradict our interpretation of the local symptoms.
Efforts can then be put into place to treat the causal Dosha, Agni and Ama, as well as managing the symptoms locally.
The above discussion deals with the internal cause of inadequate Rasa Dhatu Agni, most likely caused by Ama in Rasa Dhatu, and chronic damage to Rasa Dhatu by any of the three Doshas. It is also possible that the mucus membranes of the nasal passages and eyes have been damaged or weakened by stronger-than-average external factors which contribute to the making of the pathology. Some examples are people living and working in highly polluted environments such as in certain factories, commercial farms, wood mills, or in communities situated downwind from intensive livestock farms, or living in polluted urban environments etc. Even office workers where air conditioning units cause low humidity can be a common causal factor in Vata types (who are dry by nature). In such cases, irritation to the mucus membranes can arise despite adequate lubrication and health of Rasa Dhatu. Protection from (or removal from) the polluted environment is therefore sometimes necessary and of course the most intelligent preliminary treatment to pursue in all allergy cases. In this respect, the Ayurvedic daily hygiene practices including Jala Nati (saline nasal cleansing) and Nasya (nasal oleation) form very useful treatments that help to reduce the daily absorption of airborne particles into the bloodstream as well as promoting the healthy function of Prana Vayu and Bodhaka Kapha in the head.
In cases where the pathology is mild it may be sufficient to remove the cause and treat the causal Dosha, balance Jatharagni and remove Ama from Annavaha Srotas:
- Reduce exposure to pollutants (change environment and self-hygiene methods)
- Reduce Bodhaka Kapha (the “Local Dosha”)
- Balance the “Causal Dosha” (Vata, Pitta or Kapha)
- Balance Jatharagni and remove Sama Dosha from GI tract
These are mainly Langhana techniques. In severe cases, or long-term suffers need to consider a “deeper” treatment that comprises the above goals in addition to the following:
- Balance Prana Vayu
- Cleanse Rasa Dhatu of Ama then rejuvenate Rasa and correct Rasa Dhatu Agni
- Increase Ojas and immune function
These combine Langhana with Brimhana techniques.