| Section/Chapter/topic | Chikitsa / Panchakarma/ Nasya |
|---|---|
| Authors | Aneesh E.G., Deole Y.S. |
| Reviewed by | Basisht G. |
| Affiliations | Charak Samhita Research, Training and Development Centre, I.P.G.T.& R.A., Jamnagar |
| Correspondence email: | carakasamhita@gmail.com |
| Date of first publication: | December 15, 2020 |
| DOI | Under process |
The term ‘nasya’ denotes ‘being in the nose’ or ‘belonging to nose’.[1] It is one among the five purification procedures (panchakarma). In this procedure, the medicines are instilled through the nostrils. It is indicated in the diseases of head and associated structures.[A.Hr. Sutra Sthana 20/1][2] Considering the therapeutic efficacy, it is used to treat a wide spectrum of diseases ranging from headache to infertility.
Etymology and derivation
The term ‘nasya’ is derived from the root word ‘nas’, which means ‘motion’(nasagatau) or pervasion (nasavyapatau).[3] The term ‘nastaha’ means ‘beneficial to nose’.[4] Administration of any form of medicine into the nose is called nasya. [Su.Sa.Chikitsa Sthana 40/21][5]
Synonyms
Navana,nastakarma [A.S. Sutra Sthana 29/2][6], nasyakarma [Sha.Sa.Uttarakhanda 8/1][7], nastaha prachardana[Cha.Sa.Sutra Sthana 1/85], shirovireka, murdhavirechana.
Classification
Based on the method of administration
- Unctuous medicine (navana)
- Extracted herbal juice (avapeeda)
- Medicinal powder (dhmapana)
- Medicinal smoke (dhuma)
- Low dose (pratimarsha) and high dose(marsha) unctuous medicine[Cha.Sa.Siddhi Sthana 9/89-92]
This includes instillation of medicated oils or other unctuous materials.
Types based on purpose
A. Oleating (snehana)
B. Purificatory (shodhana)
Oleating medicine
It provides unction, nourishment and strength to the chest, neck and shoulders.
=Indications=
It is especially indicated in diseases due to aggravation of vata dosha and associated pitta dosha in head and supraclavicular region. For ex. Hair fall, tooth disorders; pain in ear; tinnitus; frozen shoulder, premature graying of hair etc. [Su.Sa.Chikitsa Sthana 40/22][5]
The general dose of instillation of medicine is as below. In ancient times, the dose of nasal instillation medicine was measured in ‘bindu’ means drops. The amount of fluid that drips down after immersing the distal two interphalangeal joints of index finger of the patient in a liquid and taking the finger out is one bindu. [A.Hr. Sutra Sthana 20/9-10][2] One ‘bindu’ is standardized as 0.5ml for oil.[8]
| Minimum dose | 4 ml (8 bindu or drops) |
| Moderate dose | 8 ml (16 bindu or drops) |
| Maximum dose | 16ml (32 bindu or drops) |
Purificatory (shodhana) medicine
It is indicated in disorders due to aggravation of kapha dosha in the head and throat like heaviness of head, tastelessness, loss of smell, epilepsy, migraine etc. [Su.Sa.Chikitsa Sthana 40/36][5]
The general dose of instillation of medicine is as below:
| Minimum dose | 2ml (4 bindu) |
| Moderate dose | 3ml (6 bindu) |
| Maximum dose | 4ml (8 bindu) |
[Su.Sa.Chikitsa Sthana 40/36][5]
Herbal juice (avapeeda)
In this method, the juice extracted by pressing (peedana) fresh herbs or its paste is instilled in the nose.[Chakrapanai on Cha.Sa.Siddhi Sthana 9/90]
Indications
Unconsciousness, snake bite, diseases of throat, intermittent fever, psychological disorders, excessive sleep, [Su.Sa.Chikitsa Sthana 40/44-45][5] [Sha.Sa.Uttarakhanda 8/16][7] diseases of kapha dosha and adipose tissue (meda). [Dalhana on Su.Sa.Chikitsa Sthana 40/44-45][5]
Types
- Purificatory (shodhana)
Nasal instillation with the medicines with purification properties (shirovirechana)
- Astringent (stambhana)
Nasal instillation with the medicines with astringent properties like jaggery, milk, ghee, meat soup etc. [Su.Sa.Chikitsa Sthana 40/44-45][5] [Cha.Sa.Siddhi Sthana 9/90]
| Minimum dose | 2ml (4 bindu) |
| Moderate dose | 3ml (6 bindu) |
| Maximum dose | 4ml (8 bindu) |
Medicinal powder (dhmapana)
In this method, the medicinal fine powder is blown into the nostrils. This clears body channels and is purificatory in action.[Chakrapani on Cha.Sa.Siddhi Sthana 9/91] Fine powder is filled inside a tube of approximately 12cm (6 angula) length and blown into the nostrils of the patient. It expels excess dosha.[A.Hr. Sutra Sthana 20/8-9][2]
Indications
Psychological disorders, person afflicted by poison, unconsciousness, epilepsy etc. [Su.Sa.Chikitsa Sthana 40/46][5] [Chakrapani on Cha.Sa.Siddhi Sthana 9/95],conditions of severe aggravation of dosha. [Sha.Sa.Uttarakhanda 8/17][7]
| If procedure done using tube | 3 pinch (3 muchudi) [Su.Sa.Chikitsa Sthana 40/46][5] |
| If a bolus is prepared with the medicine and is used for inhalation | 24gm (1 shukti) |
| If medicine used is more potent | 6 gm (1 kola) [Sha.Sa.Uttarakhanda 8/13][7] |
Medicinal smoke inhalation (dhuma)
In case, the vitiated dosha is present in head, nose or eyes, medicinal smoke is inhaled through nose and exhaled through mouth.[Cha.Sa.Sutra Sthana 5/46-47] This is done through a smoking pipe.
Types
- Therapeutic inhalation for prevention of disease (prayogika)
- Inhalation of smoke with unctuous substance (snaihika)
- Inhalation of smoke with purifying substance (vairechanika)
| Type of dhumanasya | Length of inhalation tube[Cha.sa.Sutra Sthana 5/49] | Dose [Cha.Sa.Sutra Sthana 5/36] |
|---|---|---|
| Prayogika | 70cm (36 angula) | Twice in a day |
| Snaihika | 62cm (32 angula) | Once in a day |
| Vairechanika | 47cm (24 angula) | 3 -4 times in a day |
Benefits
Inhalation of smoke is done to remove mucus and clear the body channels. [Su.Sa.Chikitsa Sthana 40/25][5]
Low dose instillation (pratimarsha)
In this method, low dose of unctuous substance (sneha) is instilled in the nose (pratimarsha).[Chakrapani on Cha.Sa.Siddhi Sthana 9/117]
Indications
It is indicated in old persons, children, debilitated, injured, coward and for those who can’t withstand adversities. [A.Hr. Sutra Sthana 20/26][2] [A.S. Sutra Sthana 29/20][6]
Contraindications
In case of excessively aggravated dosha, alcoholism, rhinitis. [A.Hr. Sutra Sthana 20/26-27][2]
Health benefits
It provides strength to cranial structures, prevents premature ageing and graying of hair. [Cha.Sa.Siddhi Sthana 9/116] [Sha.Sa.Uttarakhanda 8/45-46][7]
Time of administration
It can be administered in the morning after waking up from sleep, after brushing the teeth, before going outdoors, after being tired due to walking, exercise, sexual intercourse; after defecation and urination; after taking food, after vomiting and in evening. [Su.Sa.Chikitsa Sthana 40/51][5]
Dose
1ml (2 bindu) [A.Hr. Sutra Sthana.20/28-29][2]
Application of medicated oil in the inner wall of the nose with the finger dipped in the oil is also considered as pratimarsha. [Chakrapani on Cha.Sa.[[Siddhi Sthana 9/92]
High dose instillation (marshanasya)
Nasal instillation in higher dose is called ‘marshanasya’. The dosage forms are as below:
| Form of medicine used | Highest dose | Moderate dose | Least dose |
| Unctuous (oil/ghee) | 5ml (10 bindu) | 4ml (8 bindu) | 3ml (6 bindu) |
| Paste | 4ml (8 bindu) | 3ml (6 bindu) | 2ml (4 bindu) |
[A.Hr. Sutra Sthana 20/10][2]
Types of nasya based on actions
- Purificatory (rechana)
- Nourishing (tarpana)
- Pacifying (shamana)
Purificatory instillation
Indications
Disorders of head due to kapha dosha, stiffness, numbness and heaviness of head; anorexia, headache, rhinitis, epilepsy and loss of smell. [Cha.Sa.Siddhi Sthana 9/93] [Su.Sa. Chikitsa Sthana 40/23][5]
Drugs used
Unctuous substance, paste, decoction, honey, salt or fermented preparations (asava) are used for purification errhine after processing with appropriate drugs.[A.Hr. Sutra Sthana 20/5][2]
Nourishing instillation
Indications
Disorders of head due to vata dosha, facial palsy, tremors in head, severe earache, frozen shoulder, premature graying of hair. [Cha.Sa.Siddhi Sthana 9/94] [Su.Sa. Chikitsa Sthana 40/22][5]
Drugs used
Oil/ghee processed with vata and pitta subsiding drugs, meat soup, blood etc. are used. [A.S. Sutra Sthana 29/7][6]
Pacifying instillation
Indication
It is used in bleeding disorders. It can also be used in condition like facial melanosis. [Cha.Sa.Siddhi Sthana 9/95] [A.Hr. Sutra Sthana 20/4][2]
Drugs used
Oil/ghee processed with medicated milk or decoction. [A.S. Sutra Sthana 29/8][6]
Based on parts used to prepare the drug
- Fruit
- Leaf
- Root
- Stem
- Flower
- Resin
- Bark [Cha.Sa.Vimana Sthana8/154]
General indications of nasal instillation therapy
Nasal instillation is indicated in almost all diseases of head and supraclavicular region to remove the impurities.[Cha.Sa.Siddhi Sthana 2/22] As a part of purification regimen of panchakarma for preservation of health, nasya is indicated after therapeutic enema (basti).
General Contraindications
- If the patient is tired, worried, unconscious, while hungry or thirsty, pregnant ladies, soon after delivery, too old and too young
- Acute rhinitis, breathing difficulty, cough, acute fever etc.
- Immediately after purificatory procedures including purgation, enema, bloodletting, internal oleation etc.
- Immediately after head bath or just before head bath, immediately after intake of food or water[Cha.Sa.Siddhi Sthana 2/20][Su.Sa. Chikitsa Sthana40/47][5][A.Hr. Sutra Sthana 20/11-12][2]
Nasya procedure
Procedure of nasya in one session is done in three steps:
- Pre therapeutic (purvakarma)
- Therapeutic (pradhanakarma)
- Post therapeutic (pashchatkarma)
Pre therapeutic (purvakarma)
Nasya is done after passing natural urges, complete digestion of meals and when the patient is not too hungry.[A.S. Sutra Sthana 29/15][6] The patient is first asked to clean his face and mouth. Then he lies in supine position on a slanting table with inclination towards head end (head low position). [Su.Sa.Chikitsa Sthana 40/25][5] After that proper oleation and sudation is done on head, face and neck region. In some conditions, the patient is asked to inhale medicated smoke to clear channels.
Therapeutic procedure (pradhanakarma)
The suitable medicine for nasal instillation is made warm by placing in hot water. Eyes of the patient are covered with cloth and the tip of the nose is raised. Medicine is instilled in one nostril, while the other nostril is closed. Same procedure is repeated to instill medicine in both nostrils. If the medicine, comes to throat, the patient shall hold it without spitting for 5 -10 seconds. [Sha.Sa.Uttarakhanda 8/54][7] Slight rubbing or massage is done over face, palms and soles.[A.S. Sutra Sthana 29/18][6] After that, patient should inhale slowly and spit the contents coming to mouth till the entire medicine is expelled.
Post therapeutic (pashchatkarma)
Sudation is done over the face and neck region until the secretions are reduced. Smoke inhalation is done to reduce the kapha that is aggravated during nasya procedure and located in the channels of head.[Cha.Sa.Siddhi Sthana 9/106] Gargling with lukewarm water is advised to clear mouth.[A.H. Sutra Sthana 20/23][2]
Duration
Nasya can be done for 7 days.
Assessment of efficacy
Clinical features of optimal nasya
Feeling of lightness in head and chest region, clarity in body channels and proper functioning of sense organs [Cha.Sa.Siddhi Sthana 1/51], unobstructed inhalation and expiration, proper sleep and reduction in signs and symptoms of the disease [A.S. Sutra Sthana 29/19][6]
The following table shows clinical features of inadequate, optimal and excess administration of unctuous and purificatory nasal instillation.
| Administration | Unctuous instillation | Purificatory instillation |
|---|---|---|
| Optimal | Clarity and normal functions of sense organs, mental wellbeing, lightness of head, unobstructed breathing and reduction in symptoms of disease [Su.Sa. Chikitsa Sthana 40/33][5] | Clarity and lightness of sense organs, clarity of mind, clarity of voice and proper functioning of sense organs [Su.Sa. Chikitsa Sthana 40/38][5] [A.Hr. Sutra Sthana 20/25][2] |
| Inadequate | Dryness of sense organs especially nose and mouth, feeling of emptiness of head and abnormal functioning of vata dosha [A.Hr. Sutra Sthana 20/24][2] [Su.Sa. Chikitsa Sthana 40/35][5] | Heaviness, coating, itching in body channels, oozing of kapha through channels, heaviness of head and aggravation of disease [Su.Sa. Chikitsa Sthana 40/39][5] [Cha.Sa.Siddhi Sthana 1/52] |
| Excess | Heaviness of head, excessive discharge of kapha, itching, anorexia, rhinitis, improper functioning of sense organs and other diseases due to aggravation of kapha [Su.Sa. Chikitsa Sthana 40/33][5] [A.Hr. Sutra Sthana 20/24][2] | Pain in head, eyes, ears and temples; aggravation of vata dosha, abnormality of senses organs, emptiness of head and fainting [Cha.Sa.Siddhi Sthana 1/52] [Su.Sa. Chikitsa Sthana 40/40][5]
ComplicationsComplications due to improper administration:
Current researchesNasal route is a simple, convenient, noninvasive and safe for systemic administration of drugs. The advantages of nasal route for drug delivery are its large surface area for drug absorption, bypassing the hepatic first-pass metabolism and avoiding drug degradation in gastro intestinal tract. Apart from this the nasal route plays major role in the brain targeted drug delivery. It allows active principles of the drug to be delivered directly to the brain via neural pathways such as olfactory and trigeminal nerves. Through this pathway it also bypasses the blood brain barrier. Drugs cross the nasal mucosa through transcellular and paracellular pathways. Lipophilic molecules are usually transported through the transcellular pathway.[10] The intra nasal combination of erythropoietin and IGF-1 (insulin like growth factor-1) significantly reduce the infarct in middle cerebral artery occlusion and improve neurological functions. Intra nasal delivery of recombinant human vascular endothelial growth factor shows reduction in infract volume, improved behavioral recovery and enhanced angiogenesis following middle cerebral artery occlusion (Xu et al., 2009).[11] In a study conducted on 36 patients, Nasya with Dhanwantaramtaila was found to be effective in reducing the signs and symptoms of cervical spondylosis especially pain, tenderness, numbness etc. Nose is a direct pathway to brain. The peripheral process of olfactory cells responds to volatile, water soluble and lipid soluble chemical substances. The medicine used for nasya possess these qualities. Nasya may stimulate the brain through this pathway and thus inducing the production of neuro peptides which act as pain relievers. iv The nasya may stimulate the areas like amygdela in the limbic system and thus activate the neuropeptide pathway. (radhikatvm) Nasya with powder (trikatuchurna) in a comatose patient showed appreciable changes in Glasgow coma scale. Smell sensation projects to higher cortical area and to the limbic system. Drugs administered in powder form may stimulate the limbic system, hypothalamus and thalamus. This in turn may activate the reticular activating system which provokes higher degree of consciousness. Nasya with trikatuchurna with triphalachurna is found to be effective in reducing the signs and symptoms of chronic sinusitis. Significant reduction is reported in nasal blockage, sneezing, post-nasal drip, headache, cough and fever. This study conducted on 110 patients also reported an insignificant reduction in some of the hematological parameters like C – reactive protein, ESR and Absolute eosinophil count (AEC) after nasya. It also suggests that the nasya with powder is effective in removing the vitiated kapha dosha quickly. In a study conducted on 15 patients nasya with Laghumashataila was found effective in reducing the signs and symptoms of frozen shoulder through its anti-inflammatory and nutritive effects.vA study on 20 patients, it was reported that nasya with Anu taila and Mashaditaila is effective in treating Facial paralysis. In another study conducted on 21 patients of migraine, nasya with Bruhatdashamoolataila followed by pacifying therapy was found effective in reducing its signs and symptoms. |
- ↑ Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Nasya, Page 532
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.
- ↑ Sabdakalpadruma- vol 5, 3rd edition. Varanasi: Chowkhamba Sanskrit series office; 1961.nasya; p. 457:Col 1
- ↑ Mukundalal Dwivedi, Vaacaspatyam, Ayurvediya Pancakarma. Varanasi: Chaukhambha bharati academy; 1992, Chapter 11; p-936
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Sharangadhara. Sharangadhara Samhita. Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Chaukhambha orientalia;2016.
- ↑ C Radhika, G Vinodkumar et al. A randomized controlled clinical trial to assess the efficacy of Nasya in reducing the signs and symptoms of cervical spondylosis. Ayu. 2012 Jan;33(1):73-7. doi: 10.4103/0974-8520.100316.
- ↑ Kashyapa. Kashyapa Samhita. Edited by P. V. Tewari. Reprint. Varanasi: Chaukhambha vishvabharati;2008.
- ↑ D Kim, Young HK, Soonjo K. Enhanced nasal drug delivery efficiency by increasing mechanical loading using hypergravity. Sci Rep. 2018 Jan 9;8(1):168. doi: 10.1038/s41598-017-18561-x.
- ↑ Franciska Erdo, Luca AB, Daniel F et al. Evaluation of intranasal delivery route of drug administration for brain targeting. Brain Res Bull. 2018 Oct;143:155-170. doi: 10.1016/j.brainresbull.2018.10.009. Epub 2018 Oct 25.