An open labelled clinical trial to evaluate the combined effect of Apamarga Kshara Pratisarana with Vachadi Kwatha Kavala and Kaishora Guggulu in Tundikeri with special reference to chronic tonsillitis in children.”

The treatment principles of Ayurveda aim at eliminating the impurities. Kaumarabhritya, one among

the Ashtanga’s of Ayurveda exclusively deals with the child care both preventive and curative. As the

definition of Bala signifies, vulnerability of children to acquire disease is more when compared to an

adult.

A disease Tundikeri, explained by Ancient Ayurvedic classics under Mukhagata rogas lI7 and

Talugata Rogas |3455,71 appearing as a SthanikaShotha (local swelling) is one such disease in children,

caused due to an excess consumption of Guru, Snigdha, Amla and Abhishyandi Ahara’s leading to

Kapha, Pitta and Rakta Dusti. The Lakshanas of the disease Tundikeri mentioned in Ayurveda classics

are characterized by Sthoolashotha (hard swelling), Toda (pricking type of pain), Daha (burning

sensation), Prapaki (tend to undergo suppuration) and Avrodha (creates obstruction in throat for

respiration and deglutition) (SI. Acharya mentioned line of management of Tundikeri in Ayurveda similar

to that of Galashundika which include Shastra karma, Pratisarana, Kavala, Dhuma and use of Yushal°

According to Acharyas, common line of management of Kantharogas is also applicable to Tundikeri.

Thisinclude Kayshirovirechana, Vamana, Katu Tikta Kavala Graha, Raktavisravana, Kapharaktahara

Karma, Raktamokshana, Tikshna nasya, Pratisarana or Kavala, Lepana(101

Immunological protection of a newborn will be done by maternal antibodies and developed naturally

later in life through infection or artificially by immunization. Their inherent immunity diminishes within

months After birth. Whenever there is an infection in the oral cavity or respiratory tract, the tonsils act as

sentinels to guard against foreign intruders like viruses, bacteria and other antigens coming into contact

through inhalation and ingestion (’"I

Chronic tonsillitis in children may be described as a sore throat for 3 months or more, associated

with inflammation of the tonsils, presenting with features like chronic sore throat, halitosis, a foreign

body sensation in the throat, or a history of expelling smelly foul-tasting cheesy lumps 11Z. It profoundly

affects the child’s quality of life, having an impact on their ability to work, sleep, and enjoy daily

activities, leading to an inevitable school absence.If medicinal treatments are unsuccessful, then the final

option is to undergo a tonsillectomy surgery in those patients who have had sequelae, such as

peritonsillar abscess, lemierre syndrome, minimum frequency of sore throat episodes 7 or more in the

preceding year, cervical lymphadenopathy, tonsillar exudates, sleep apnea due to tonsillar hypertrophy

[13)

When considering tonsillectomy surgery, the surgery is associated with risks, can potentially pose

serious risks to a child’s health. The persistent inflammation and infection of the tonsils can lead to

complications that could become life threatening if not addressed. acute respiratory infections are a major

cause of children in India. Outpatient attendance attributed to acute respiratory infections is as high as

2040% of all outpatients and 12-35% of in patients.

Hence, an effective line of management intending to scrape out the inflamed cells with the retention

of surrounding normal tissues in chronic tonsillitis is a need of hour, so that the faster healing with less

or no recurrence of incidences will be achieved by the following treatment. Treatment with oral medication like Kaishora Guggulu along with various local drug application

methods like Apamarga Kshara Pratisarana, and Gargling with Vachadi Kwatha Kavala.

As Apamarga Kshara, known for its ushna (hot) and Tikshna (sharp) properties, plays a crucial role

in managing Tundikeri. It readily burns inflamed cells, aids wound cleansing, and accelerates healing by

promoting both vrana shodhana (cleansing of wounds) and Ropana (healing) (14)

Additionally, Vachadi Kwatha Kavala is effective in treating GalashundikaRoga which is similar to

Tundikeri within the context of Taluroga Chikitsal’5). Furthermore, Kaishora Guggulu is beneficial for

addressing conditions such as Mandagni, Kasa, Shwasa, and Shothall

Therefore, the present study is planned to evaluate the combined effect of Apamarga Kshara

Pratisarana with VachadiKwatha Kavala and Kaishora Guggulu in Tundikeri w.s.r to chronic Tonsillitis

in children.