REVIEW OF NASYA KARMA

Introduction:

            Nasa has been considered as the gateway of Shirah and to uproot the deep seated morbid doshas Nasya therapy has been recommended by almost all the Acharyas^1,2. Urdhvajatrugata Rogas and their management have a special place in Ayurveda. Shirah being the prime seat of knowledge and also the prime controller of the entire body has been termed as Uttamanga. Hence, the diseases occurring in the Urdhvajatru have been very clearly highlighted in the Ayurvedic classics along with their management. Nasa is considered to be that Indriya, whose functions are not only limited to respiration but is also considered as a pathway for drug administration. In Ayurveda, special procedure called Nasya has been mentioned.

            Hence, in the present study Mukhadooshika, which is one of the Urdhvajatrugata Roga has been selected and for its management Nasya Karma with Apamarga Taila in the form of Shodhana Nasya has been planned.

Description of Nasa

Historical background of Nasa:

Atharvaveda

            In Atharvaveda the description of nine chidras & indriya has been mentioned & description of Netra, Nasa & Dantakrimi with its Mantras3^,4.

Bhagwata Gita

            In Bhagwata Gita the description of Indriya has been mentioned5.

Ayurvedic Review

Etymology:

                        The word ‘NASA’ is derived from the root ‘Nasru’. With addition of suitable suffix, the word Nasa is formed.

Definition & Synonyms:

                        Nasa is described as the seat of Ghranendriya i.e. sense of smell6.

            Amarkosha mentioned the synonyms of Nasa as Nasika, Ghranam, Gandhavaha, Ghrana.

Embryology:

            Acharya Charaka while explaining the embryology of organs in a pregnant woman states that Sarva Indriyas are developed during the third month of Garbhavastha7.                  In Garbhopnishada it is mentioned that Mukha (oral cavity), Nasa (nose), Akshi (eyes) and Shrotra (ears) are developed in sixth month of pregnancy8.

Anatomy:

            In Ayurvedic literature, there is no detailed description of Nasa Sharira at one place like the anatomical description of other organs, whereas Nasa is included among the five Gyanendriya.

            Acharya Sushruta has considered Nasa as Pratyanga. Similarly while enumerating the external orifices of the body; he has also considered two nostrils among the main nine external orifices.

Nasa is comprised of,

ü  Bones - 3

ü  Peshi - 2

ü  Dhamani - 2

ü  Siras - 24

ü  Marmas – 2

            Acharya Sushruta has mentioned the length of Nasika as 2-1/3 Angulas9. Acharya Dalhana the commentator of Sushruta Samhita clarifying about the length of each nostril as Tribhag Angulas i.e. 1-1/3 (inches). Angulas in length as far as horizontal plain is concerned1⁰.

            Acharya Sushruta told that 2 Dhamanis are present in the nose, which is responsible for Gandhajnana. This may be the Olfactory nerve pair, which is the sensory Cranial nerve responsible for Olfaction1¹.

            Sushruta, while explaining the 24 Siras classified them into four groups of six each as Vatavaha, Pittavaha, Kaphavaha and Raktavaha1².

            Acharya Charaka has given only short description of Nasa Sharira. He has mentioned only one nasal bone. Further he has also described Nasa as a sense organ13.

Indriya Panch Panchkam 14

ü  Indriya: Ghranendriya

ü  Indriya Dravya: Prithvi

ü  Indriya Adhisthana : Nasa

ü  Indriya Artha: Gandha

ü  Indriya Buddhi: Ghrana Buddhi

ü  Marmas: Acharya Vagbhata has stated that the two Marmas are situated in Nasika15.

ü  Phana: These are the Marmas which perform the olfactory function.

ü  Shringataka: These are Sadhyapranahara Marmas associated with Nasa, which also used to explain various diseases like Kshavathu, Brishakshava etc.

ü  Matruka: These are Sira Marmas associated with Nasa.

NASYA KARMA

Historical background of Nasya:

Rigveda

            Although it is very difficult to say that the procedure of Nasya karma therapy was in practice during Vedic period. But the few Mantras of Rigaveda indirectly refer towards the Karmas which are included under Panchakarma measures. There is a Mantra of Rigveda, in which eradication of Roga from the routes of Nasa (Nostrils), Chibuka (Chin), Shira (Head), Karna (ear) & Rasana (tongue) are mentioned. Thus one can think that the references of eradication of disease from the above mentioned routes most probably refer towards Nasa (nose) or Shirovirechana.

Ramayana

            A reference regarding the use of “Sanjivani” for Nasya karma is available in Valmiki Ramayana when Lakshmana became Unconscious drug was blown by Meghnada to make him conscious.

Ayurvedic Classics

            The subject of Nasya therapy has been elaborately described in Charaka and Sushruta Samhitas. During 6th century A. D. Vagbhatta, Vriddha Vagbhatta wrote Ashtanga Hridaya and Ashtanga Samgraha respectively and has elaborately dealt with the subject in their works. Chakrapani (11th Century A. D.) and Yogaratnakar have also contributed to the subject. Nasya karma has been used for Pumsavan Vidhi since Aacharya Charaka16.

Etymology of Nasya:

            The word nasya is derived from ‘Nasa’ Dhatu which conveys the sense of Gatimotion and Vyapti means pervasion. In Ayurvedic texts; the Nasa Dhatu is inferred in the sense of nose.

            According to Vachaspatyam, the word “Nastah” means being in the nose or the things beneficial to the nose¹⁷.

Definition of nasya:

            In Ayurveda, the word Nasya has been taken specifically to mention the root of administration of the drugs.

Sushruta Samhita18

            As stated by Sushruta medicines or medicated oil administered through the nose is known as Nasya.

Aruna Dutta & Bhava Prakash19

            According to them all drugs & measures that are, administered through the nasal passage are called Nasya. Sharangdhara & Vaghbhata20 are of same view.

Synonyms:                             

            Sirovirechana, Shirovireka, Murdhavirechana, Nstahkarma, Navana are the synonyms of Nasya Karma.

Shirovirechana, Shirovireka, Murdhavirechana:

            Sushruta specify the word Shirovirechana to describe a particular variety of Nasya karma21. The word Virechana means elimination of morbid Doshas from the body. This Shirovirechana or Murdhavirechana indicates its main function elimination of morbid Doshas particularly from the Shira or parts situated above the clavicle.

            Charaka has used the term “Nastah Pracchardana” for Nasya22, which denotes Shodhana done by Nasya23.

Nastah & Navana:

            The word Nastah & Navana denotes the site of administration. Nasta – Karma & Navana karma means the measures which are beneficial to nose, or region of the nose. On this basis it could be said that Nasya karma is a therapeutic measure where the drug (medicated oil or other) administered through Nasa mainly to eliminate the vitiated doshas situated in Shirah & its constituent parts, curing the diseases of those parts (Urdhvajatrugata Vikaras).

Classification of Nasya:

Table No. 1 Classification of Nasya

                        Nasya is classified in various ways by different Acharyas but ultimately all the procedures are same. Mainly classified according to its mode of action i.e. Shodhana, Shamana, etc & on the basis of various forms of drug preparation utilized for the Nasya karma e.g. Churna, Sneha, etc. The classifications according to various Acharyas are shown in table.

No.	Name of Acharya	No. of Types	Classification
1	Charaka24,25	3 5 7	According to mode of action -  Rechana, Tarpana, Shamana According to the method of administration – Navana, Avapidana, Dhmapana, Dhuma, Pratimarsha According to various parts of drugs utilized – Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twaka
2	Sushruta26	5	Shirovirechana, Pradhamana, Avapida, Nasya, Pratimarsha
3	Vagbhatta27	3	Virechana, Brimhana, Shamana
4	Kashyapa28	2	Brimhana, Karshana
5	Sharangadhara29	2	Rechana, Snehana
6	Bhoja30	2	Prayogika, Snaihika
7	Videha31	2	Sangya Prabodhaka, Stambhana,

            It is clear from the above discription that two types of classification of Nasya Karma are available in Ayurvedic literature. One is based on the pharmacological actions viz. Rechana, Tarpana etc. Other is based on the preparation of drug and the method of its application e.g.  Dhmapana (Powder is blowed) Avapida (Extracted Juice is used) Dhuma (Smoking through nose).

            It is clear from the above description that the types of classification of Nasya Karma are available in Ayurvedic literature. One is based on the pharmacological actions viz. Rechana, Tarpana etc. and the other is based on the preparation of drug and the method of its application e.g. Dhmapana (Powder is blowed), Avapida (Extracted Juice is used) and Dhuma (smoking through nose) etc. Also Classification according to the dose to be dropped into the nostrils e.g. marsha and pratimarsha described by Acharya Vagbhata.

            Taking the Charaka’s classification as the basis, all the above mentioned types of Nasya are being described here seperately.

1. Navana Nasya

            Navana is one of the important and well applicable therapies of Nasya Karma.

Method:

            Navana is administered by instilling the drops of a medicated oil or Ghrita in the nose.

Instrument:

            Charaka has described Pranadi (pippet or dropper) for it41. Navana is generally the Sneha Nasya and is known as Nasya in general42.

Classification:

            It can be mainly classified into Snehana and Shodhana Nasya.

1. a. Snehana Nasya

            As the word Sneha suggests, Snehana Nasya gives strength to all the Dhatus and is used as Dhatuposhaka.

Dose:

            The following is the dosage schedule for Sneha Nasya43.

Table No. 2 Dose of Sneha Nasya

1	Hina matra	8 drops in each nostril
2	Madhyama matra	16 drops in each nostril (Shukti Pramana)
3	Uttama matra	32 drops in each nostril (Panishukti Pramana)

Bhoja has mentioned: -

8 drops              Prayogika Sneha Nasya

16 drops            Sneihika Nasya.

According to Doshabala qauntity can be adjusted doubled or tripled.

Benefits of Sneha Nasya44:

            It is used for the oiling in the feeling of head lightness. It gives strength to neck, shoulder and chest and increases eye sight.

Indications of Sneha Nasya45:

            Sneha Nasya can be given in the following conditions:-

Vatika Shirahshula,     Keshapata,                  Dantapata,       Shmashrupata,

Tivrakarnashula,          Timira,                         Nasaroga,        Mukhashosha,

Avabahuka,                 Akalaja Valita,            Akalaja Palita,

Darunaprabodha  and             Vatapittaja Mukharoga.

1. b. Shodhana Nasya

            Sushruta’s Shirovirechana type is included in Shodhana type of Navana Nasya. It eliminates the vitiated Doshas.

Drugs:

            In this type of Nasya, oil prepared by Shirovirechana Dravya like Pippali, Vidanga, Shigru etc. is selected46.

Dose:

Table No. 3. Dosage schedule according to Sushruta47

1	Uttama	8 drops
2	Madhyama	6 drops
3	Hina	4 drops

Indications:

            It can be used in the following conditions:

            Kaphapurna Talu & Shira, Aruchi, Shirogaurava, Shula, Pinasa, Ardhavabhedaka, Krimi, Pratishyaya, Apasmara, Gandhagyananasha and Urdhvajatrugata Kapharogas48; and Urdhvajatrugata Shopha, Praseka, Arbuda and Kotha⁴⁹.

  In healthy persons Navana Nasya should be given according to the following seasonal schedule50.

Table No. 4 Indications of Nasya according to Season

Sl.No	Season	Nasya to be given at
1	Shita Kala	Noon
2	Sharada and Vasanta	Morning
3	Grishma Rutu	Evening
4	Varsha Rutu	Only when sun is visible

Time Schedule:

Table No.5. Navana Nasya Schedule51

Sl.No	Roga	Nasya to be given at
1	In Kaphaja Roga	Fore noon
2	In Pittaja Roga	Noon
3	In Vataja Roga	After Noon

2. Avapida Nasya

Definition:

            In Avapida Nasya, juice is expressed from paste or kalka of a drug. The word Avapida means it is expressed juice of leaves or paste (kalka) of required medicine52.

Method:

            The paste (kalka) of required medicine is placed in a white and clean cloth and thereafter it is squeezed to obtain the required quantity of juice, directly in the nostrils of the patients. The administration of the drug in this way is known as Avapida nasya53. This type of nasya may also be given with kalka (paste) etc.54

            It may also be given by dipping the swab (pichu) into the Kwatha (decoction) or Sheeta (cold infusion) or Swarasa (juice) of the required drug55. Though Acharya Sushruta has categorized this under Shirovirechana, Avapida has also been used for Stambhana purpose in treatment of Raktapitta where Sharkara and Ikshu rasa are utilized for the same56.

Charaka has described two types of Avapida Nasya57.

1.      Stambhana Nasya: For this type ikshu rasa, milk etc. are used.

2.      Shodhana Nasya: For this type Saindhava, Pippali etc. are used.

According to Chakrapani, Avapida nasya is of three types:

1.      Shodhana

2.      Stambhana

3.      Shamana

Videha has mentioned two types of Avapida Nasya.

1.      Sangya prabodhana: It is one type of shodhana nasya.

2.      Stambhana: It is one type of shamana nasya.

Table No.6. Dose of Shirovirechana, Avapida Nasya58

1	Hina Matra	4 drops
2	Madhyama Matra	6 drops
3	Uttama Matra	8 drops

Indications:

Table No.7. Indications of Avapida Nasya59

Manasaroga	Apasmara	Shirovedana
Apatantraka	Moha	Mada
Murchha	Sanyasa	Bhaya
Krodha	Bhiru	Sukumara
Krisharogi	Stri	Raktapitta
Vishabhighata	Chitta	Vyakulavastha

            Sharangdhara recommends the Avapida Nasya for the patients suffering from Galaroga, Vishamajwara Manovikara and Krimi60.

3. Dhmapana Nasya

            It is a specific Shodhana Nasya.

Synonym:

            Pradhmana Nasya

Definition:

            This type of nasya is instilled with Churna specifically for Shirovirechana. This nasya is mentioned as Dhmapana in Charaka Sam. and as Pradhamana in Sushruta Sam.

Instrument:

            In this type, fine powder of drug is administered through nasal passage. For this purpose specific Nadi yantra, a tube like instrument with length of 6 angulas and with open ends is utilized61.

Method:

            Fine powder of required drug is kept at one end and air is blown from the other end, so that the medicine gets puffed into the nostrils. Videha has advocated a different procedure in this context according to him, fine powder is kept in a pottali of thin cloth and then patient is asked to inhale deeply, so that the subtle particles of medicine enter into nostrils.

Dose:

            According to Videha62

ü  Three Muchuti (3 pinches) for method with Shadangula nadi.

ü  Two tolas i.e. 20 gms for pottali method.

ü  Drugs specifically mentioned for Pradhmana nasya.

ü  Rock salt, garlic, guggulu, maricha, vidanga etc.

ü  Here we observe that the drugs used in Pradhmana nasya are Tikshna (irritative) and it would be safe to remain cautious while executing this Nasya.

Indications:

            According to Sushruta63,

1.      Chetovikara

2.      Krimija shiroroga

3.      Vishabhipanna

4. Dhuma Nasya

            Inhalation of medicated Dhuma by nasal route and elimination of dosha by oral route is called Dhuma Nasya. Acharya Sushruta has remained aloof from description of this Nasya. According to Chakrapani, fume taken by mouth is known as Dhumapana and is not included in Nasya64.

Types and Instrument:

            Acharya Charaka has mentioned special Dhuma Nadi for Dhuma Nasya. The length of the Nadi depends upon the type of the Dhuma Nasya, details of which are as under65

Table No.8 Showing The Length of Dhuma Yantra Nadi

Sl.No	Type of Dhuma Nasya	Length of Nadi
1	Prayogika	36 angula
2	Vairechanika	24 angula
3	Snaihika	32 angula

                                               

            Breadth of the nadi should be as per measurement of one’s own angula.

Dose66:

ü  Two puffs are to be taken for Prayogika Dhuma.

ü  3 to 4 puffs are to be taken for Vairechanika Dhuma.

ü  A single puff is advised for snaihika Dhuma.

Table No.9. Drugs Used for Dhuma Nasya67

1	Prayogika Dhuma	Priyangu, Ushira, etc.
2	Vairechanika Dhuma	Aparajita, Apamarga etc
3	Snaihika Dhuma	Vasa, Ghrita etc

Indication of Dhuma Nasya:

            It is indicated for treatment of Shiroroga, Nasaroga and Akshiroga68.

5. Marsha – Pratimarsha Nasya

            The methods shared by both these types are common but the variation occurs in context of dose. In Pratimarsha Nasya 1 – 2 drops are administered while in Marsha the dose is of 6 to 10 drops.

5.a.Pratimarsha Nasya:

            Following method is employed for Pratimarsha Nasya. A finger is dipped in the appropriate sneha up to 2 phalanges and then oil is allowed to drop from it in both nostrils. Patient is advised to expel out the sneha, which comes in oral cavity.

Dose:

            2 drops, morning as well as in evening hours69. The sneha should be in such an amount that it reaches from nose to gullet but should not be enough to produce secretions in gullet.

Indications70:

            Pratimarsha can be given in

ü  Any age          

ü  Any season

ü  Even in not suitable time and season i.e. in Varsha and Durdina

ü  Bala                             - Vriddha

ü  Bhiru                           - Sukumara

ü  Weak patients                         - Kshtakshama

ü  Trishna Pidita              - Mukhashosha

ü  Valita and Palita 

Contraindications71:

            It is contraindicated in

ü  Dushta Pratishyaya     - Krimija Shiroroga

ü  Badhirya (deafness)    - Bahudosha

ü  Madhyapi (drunkers –habitual)

ü  Utklishta Doshas.

            It is contraindicated in such persons because the Sneha Matra is quite insufficient to eliminate Doshas or Kriminasha and already aggravated Doshas may get vitiated further. Sushruta and Sharangadhara have described 14 suitable times for Pratimarsha Nasya, while Vagbhatta has mentioned fifteen Kala.

Table No.10. Various Timings for Pratimarsha Nasya72

No	Time for Pratimarsha Nasya	Su.	As. H.	Sha.
1	After leaving the bed in morning	+	+	+
2	After cleaning the teeth (with Dantadhavana)	+	+	+
3	Before going outside	+	-	+
4	After exercise	+	+	+
5	After sexual intercourse	+	+	+
6	After walking	+	+	+
7	After urination	+	+	+
8	After passing Apanavayu	+	-	-
9	After Kavala	+	+	+
10	After Anjana	+	+	+
11	After meal	+	+	+
12	After sneezing	+	-	-
13	After sleeping in the noon	+	+	+
14	In the evening	+	+	+
15	After vomiting	-	+	+
16	After Shirobhyanga	-	+	-
17	After defaecation	-	+	+
18	After laughing	-	+	-

                                   

            Pratimarsha in Nasya is a very innocent procedure; it never produces any complication and by its virtue checks any disease process.

5.b Marsha Nasya

            The method of administration of Marsha Nasya resembles that of Pratimarsha but as said earlier the dose varies.

Dose:

            In Marsha Nasya, 6 to 10 drops of Sneha are administered.

Drugs:

            Though all Sneha dravya like oil, ghee, etc. can be utilized but use of oil is advisable because Shira is the place of Kapha and oil is inherently opposite to Kapha in properties.

            Marsha Nasya is quickly effective and more beneficial than its counterpart i.e. pratimarsha73.                                          

Classification Of Nasya According To Karma:

            This type of classification is given in Charaka Samhita as well as Ashtanga Hridaya74.

Rechana

Brimhana

Shamana

Sangyaprabodhana (Shodhana)

Krimighna

Stambhana

Karshana

Raktastambhana

Doshastambhana

Chart No.7 Classification According to Karma (Pharmacological Action)

      

            The types Rechana, Tarpana and Shamana are described by Acharya Charaka and Vagbhatta. Sushruta has not described the Shamana Nasya. He has given only two types viz. Shirovirechana and Snehana.

            Kashyapa has mentioned Brimhana and Karshana types of Nasya karma i.e. Sangya Prabodhana and Stambhana, according to their pharmacological action.

            All these types can be included into the classification of Charaka, as in previous pages. Details of each type of Nasya according to the Karma, is as under.

Rechana Nasya:

            The Nasya, which eliminates vitiated Doshas of Shira through the nasal route, is also called Rechana Nasya. It is also termed as Karshana Nasya.

Drugs75:

            Apamarga, Pippali, Maricha etc. are drugs of choice that can be used for Rechana Nasya. Kwatha, Swarasa or Tikshna sneha of above drugs may also be utilized for the same.

Indications:

            Stambha, Supti, Gaurava, Shiroroga etc76.

            According to Sushruta and Vagbhatta, it is used in Shleshma abhivypta like Talukantaka, Shirokrimi, Arochaka, Pinasa, Pratishyaya, Urdhvajatrugata Shopha, Praseka, Vairasya, Arbuda, Dadru and Kotha77.

Shirovirechana Nasya may be given with Kalka, Churna and Svarasa also, but if the immediate effects are required, Churna should be used78. If Rechana Nasya is to be given in patients of weak will power then Sneha preparation of Rechana dravya is applied.

Tarpana Nasya:

            Tarpana is that type of Nasya, which is specially indicated in a Dhatukshaya (degeneration). Tarpana Nasya resembles Snehana Nasya described by Sushruta and Sharangadhara and Brimhana Nasya mentioned by Acharya Vagbhatta in its properties and actions.

Drugs:

            Drugs of Madhura skandha and Sneha prepared with Vata-Pittahara drugs are used for above type79. Exudation of certain trees, meat soups and blood may also be administered80.

Indications:

            Vatika Shiroroga, Dantapata, Keshapata, Darunaka and other Vata-Pittaja roga. Sushruta advises Sneha Nasya for increasing general strength and to improve the vision power and its acquity. It is also used for curing the Shirah kampa and Ardita81.

Shamana Nasya:

            It is described by Charaka as well as Vagbhatta and Pratimarsha and Stambhana Nasya can be co-related with it.

Definition:

            The type of Nasya which is used for alleviation of Dosha of Shira is called Shamana Nasya.

Drugs:

            Usually drugs beneficial for particular diseases are chosen for this type and the carrier is a Sneha dravya.

Indication:

ü  It is indicated to check the bleeding occurring in the course of Raktapitta82.

ü  It is also indicated in Vali, Palita, Khalitya, Darunaka, Raktaraji, Vyanga and Nilika.

ü  It can also be used to improve the power of eyes, ears and nose.

Indications of Nasya83:

            Nasya therapy may be given in all diseases except in the conditions mentioned earlier. The specific indications of Tarpana Nasya, Shodhana Nasya, Shamana Nasya, Shirovirechana, Navana, Avapida, Dhmapana and Dhuma Nasya etc. have already been discussed in the classification of Nasya, but Charaka has described the following general indications, where Nasya therapy should be used.

ü  Shirostambha                          Gadgadatva

ü  Ardhavabhedaka                     Vaggraha

ü  Shirahshula                              Grivaroga

ü  Akshishula                              Swarabheda

ü  Shukra Roga-Netragata          Galashundika

ü  Raji                                          Galashaluka

ü  Timira                                      Galaganda

ü  Vartmaroga                             Upajihvika

ü  Pinasa                                      Manyastambha

ü  Nasa Shula                              Ardita

ü  Danta Stambha                       Apatantraka

ü  Danta Shula                            Apatanaka

ü  Danta Harsha                          Karnashula

ü  Danta Chala                            Arbuda

ü  Hanugraha                               Skandharoga              

ü  Mukharoga                              Ansashula

            According to Ashtanga Samgraha if the Nasya is to be given as a part of performing the complete Panchakarma then, it should be given after Basti karma.

Contraindication of Nasya:

            In our classics - Brihattrayi some special conditions have been mentioned where Nasya should not be administered, otherwise various complications may occur. In general, in all patients Nasya should not be administered on Durdina (Rainy day) or in Anrutu (Viparita Kala).

Table No.11. Contra Indications Of Nasya Mentioned In Brihattrayi:

Sr.	Anasyarha	Charaka	Sushruta	Vagbhatta
1	Bhuktabhakta	+	+	+
2	Ajirni	+	+	-
3	Pitta Sneha	+	+	+
4	Pitta Mad	+	+	+
5	Pitta Toya	+	+	+
6	Snehadi Patukamah	+	-	+
7	Snatah Shirah	+	-	+
8	Snatukamah	+	+	+
9	Kshudharta	+	-	+
10	Shramarta	+	+	-
11	Matta	+	-	-
12	Murcchita	+	-	-
13	Shastradandahrita	+	-	-
14	Vyavayaklanta	+	-	-
15	Vyayamaklanta	+	+(Shranta)	-
16	Panaklanta	+	-	-
17	Navajwara Pidita	+	-	-
18	Shokabhitapta	+	-	-
19	Virikta	+	-	+(Shuddha)
20	Anuvasita	+	+(Datta Basti)	+(Datta Basti)
21	Garbhini	+	+	+
22	Navapratishyayarta	+	-	-
23	Apatarpita	-	+	+(Shuddha)
24	Pittadravah	-	+	+
25	Trishnarta	+	+	-
26	Gararta	-	+	+
27	Kruddha	-	+	-
28	Bala	-	+	-
29	Vriddha	-	+	-
30	Vegavarodhitah	-	+	+ (Vegarta)
31	Raktasravita	-	-	+
32	Sutika	-	-	+
33	Shvasapidita	-	-	+
34	Kasapidita	-	-	+

Suitable time for giving Nasya:

            According to Charaka generally Nasya should be given in Pravrita, Sharada and Vasant Rutu. However in emergency it can be given in any season by providing artificial conditions of the above mentioned seasons, for example in summer, Nasya can be given in cold places and in cold season, it can be given in hot places.

Table No.12. Time Schedule of Nasya in Different Seasons84

SL.No	Rutu	Nasya to be given at
1	Grishma Rutu	Morning
2	Shita Rutu	Noon
3	Varsha Rutu	When day is clear
4	Sharada + Vasanta	Morning
5	Shishira + Hemanta	Noon
6	Grishma + Varsha	Evening

            According to Sushruta in normal condition Nasya should be given on empty stomach.

Table No.12. Time Schedule of in Doshaja Vikaras85

SL.No	Doshaja Vikara	Nasya to be given at
1	Kaphaja Vikara	Morning
2	Pittaja Vikara	Noon
3	Vataja Vikara	Evening

                                   

            Vagbhatta has prescribed same timings as Sushruta has mentioned. According to Doshaja Vikara he has suggested some more important points.

            Sharangadhara has described same time schedule for different seasons as Sushruta has mentioned. He further states that – Nasya can be given in night, if the patient is suffering from Lalasrava, Supti, Pralapa, Putimukha, Ardita, Karnanadi, Trishna, Shiroroga and such conditions like excessive vitiated Doshas.

Course of Nasya Karma:

Vagbhata

            Nasya Karma may be given for seven consecutive days. In conditions like Vata Dosha in head, hiccough, loss of voice, Manyasthamba, Apatanaka etc. it may be done twice a day (in morning and evening)86.

            Nasya should be given for 3 days, 5 days, 7 days and 8 days or till the patient shows the symptoms of Samyaka Nasya as stated in Ashtanga Samgraha87.

Bhoja

            Bhoja says that if Nasya is given continuously beyond nine days then it becomes Satmya to patients and if given further, it neither benefits nor harms the patients.

Sushruta

            According to Sushruta, Nasya may be given repeatedly at the interval of 1, 2, 7 or 21 days depending upon the condition of the patient and the disease him suffer88.

Charaka

            Charaka has not mentioned specific duration of the Nasya therapy, but instead suggested to give it according to the severity of disease.

Table No. 14. Course of Nasya Karma

No.	Name of Acharaya	Days
1	Sushruta	1,2,7,21
2	Bhoja	9
3	Vagbhatta	3,5,7,8

Dose of Nasya:

            The dose of Nasya drug depends upon the drug utilized for it and the variety of the therapy. Charaka has not prescribed the dose of the Nasya. Sushruta and Vagbhatta have mentioned the dose in form of Bindu (drops), here one Bindu means the drop which smears after dipping the two phalanges of Pradeshini (index) finger in oil89.

Table. No.15. Showing the Dosage of Nasya Karma

		Drops in Each Nostril
No.	Type of Nasya	Hrasva Matra	Madhyam Matra	Uttam Matra
1	Shamana Nasya	8	16	32
2	Shodhana Nasya	4	6	8
3	Marsha Nasya	6	8	10
4	Avapida Nasya	4	6	8
5.	Pratimarsha Nasya	2	2	2

Dose According to Videha:

            The common dose for Pradhamana Nasya is 3 Muchuti (here one Muchuti = the quantity of Churna which may come in between index finger and thumb = 2.4 Ratti.)

Dose According to Sharangadhara90:

            Sharangadhara has described the following dosage schedule for Nasya Karma depending upon the variety of material used.

ü  Tikshnaushadhi Churna - 1 Shana (4 Masha)/(24 Ratti)

ü  Hingu – 1 Yava (½ Ratti)

ü  Saindhava – 1 Masha (6 Ratti)

ü  Dugdha – 8 Shana (64 Drops)

ü  Jala (Aushadha Siddha) – 3 Karsha (3 Tola)

ü  Madhura Dravya – 1 Karsha (1 Tola)

            If the Nasya is given in less quantity than the prescribed dose then it does not eliminate the Doshas completely and cause heaviness, loss of appetite, cough, salivation, coryza, vomiting and disorders of the throat etc. If the Snehana Nasya is administered in the excessive dose it may produce the symptoms of Atiyoga

Nasyavidhi:

The procedure of Nasya karma may be classified under following headings:

ü  Purva Karma (Pre-measures)

ü  Pradhana Karma (Chief measure)

ü  Pashchata Karma (Post-measures)

Purva Karma (Pre-measure):

            It is advisable that all materials, drugs and equipments like napkin, utensils necessary for Nasya karma are collected in sufficient quantity prior to Nasya karma.

            Patient should be prepared for Nasya karma. It can be described in detail as under. Special room for Nasya should be prepared which should be free from atmospheric effects like direct blow of air or dust and it should be lighted properly91.

Nasya Asana:

            It should be placed in Nasya room. It consists of -

ü  A chair for sitting purpose

ü  A cot for lying purpose

Nasya Aushadhi:

            Drug required for Nasya karma in the form of Kalka, Churna, Kwatha, Kshira, Udaka, Sneha, Asava etc. should be collected in sufficient quantity.

            Drug for counter acting any complications during or after the nasya should also be kept ready.

Table No. 16. Nasya Yantra : It should be collected according to the types of Nasya

A dropper or Pichu	For Snehana, Avapida, Marsha and Pratimarsha Nasya.
Shadangula Nadi	For Pradhmana Nasya
Dhuma Yantra	For Dhuma Nasya

            Besides it is also necessary that a stove, bowl, napkins, spitting pits and an efficient assistant are kept handy.

Selection of the Patient:

            The patient should be selected according to the indications and contra-indications of Nasya described in classics.

Preparation of the Patient:

            The following things should be looked carefully to prepare the patient for Nasya Karma.

ü  Patient should have passed his natural urges like urine & stool.

ü  Should have completed his routine activities like tooth brushing, bath, etc.

ü  Mridu Abhyanga (massage) should be done on scalp, forehead, face and neck for 3 to 5 minutes by medicated oil92.

ü  Nadi sweda or tapa sweda can be done93.

ü  Eyes should be bandaged with a clean gauze piece after placing lotus petals and cotton pads over the closed eyelids for protect the eyes from swedana.

ü  Patient is made to lie in supine position with slightly elevated legs and head extended backwards94.

Pradhana Karma (Chief measure):

            The procedure to be adopted for the Nasya karma is described here as per the statements of Charaka, Vagbhata and susrutha.

Posture of the Patient:

ü  The medicine should mildly warmed over a water bath (Ushnambu taptha)

ü  After covering the eyes with clean cotton cloth95, the physician should raise the tip of the patient’s nose with his left thumb and with the right hand the luke warm medicine (Sukhoshna drug) should be poured by a Pranadi (gokarna) in both the nostrils alternately in a continuous single stream.

ü  Immediately after installation of medicine mild massage is done over pani, pada, greeva and skanda96.

ü  The patient should asked to inhale the medicine in moderate force and to split it out through the mouth turning the head to either side alternatively without rising from the cot97.

Pashchata Karma (Post-measure):

            The following regimen should be followed after administration of Nasya.

ü  The patient is made to lie in the same position for 100 mathra kalas (3-5 minutes)98.

ü  Medicated Dhumapana and Gandusha are advocated to expel out the residue mucus lodged in Kantha i.e.for kantha sudhi99.

ü  Patient should stay at windless place. Light meal (Laghu Aahara) and luke warm water (Sukhoshna Jala) is allowed100.

ü  One should avoid dust, smoke, sunshine, alcohol, hot bath, riding, anger, excess fat and liquid diet101.

ü  Day sleep and cold water for any purpose like Pana, Snana etc. should be avoided after NasyaKarma102.

Precautions:

ü  While positioning the patient for nasya, if the head is not sufficiently bend the nasya dravya will not enter shiras and if head is more bent dravyas may enter to masthulunga and causes complications like headache, dizziness etc.

ü  The patient should avoid swallowing of Nasya Aushadhi. If the medicine is swallowed and the split is not done properly then it will causes Kaphotklesha, agneemandya and aggravation of the disease.

ü  If the medicine is very less in quantity then it will excite the doshas but will not expel them out and so leads to feeling of heaviness, loss of taste, cough excessive salivation, Rhinitis, Vomiting and disease of throat.

ü  Large quantity of medicine will give rise complication of Atiyogas.

ü  Pouring the entire oil all of a sudden will make the oil enter in to wrong routes, diseases of head, Rhinitis, exudation from the nose, and obstruction of inspiration.

ü  If the medicine is very hot, that can lead to burning sensation, formation of ulcer, Jwara, bleeding through nostrils, headache, disturbance of vision, fainting and giddiness.

ü  Very cold medicine will cause ayoga lakshanas.

Samyak Yoga, Ayoga and Atiyoga of Nasya Karma:

            After Nasya karma the symptoms of its Samyaka yoga, Ayoga and Atiyoga should be observed, which are being described here as under.

Samyak Yoga:

            The symptoms of adequate, Nasya according to Charaka are Urah-shiro-laghava (Feeling of lightness in chest and head). Indriyavishuddhi (sensorial proficiency) and Srotovishuddhi (cleansing of channels). In addition, Sushruta has described Sukhaswapna-prabodhana (good sleep and awakening), Chitta-Indriya-prasannata (mental and sensorial happiness) and Vikaropashama (Improvement). Besides this proper respiration and sneezing have been described by Vagbhatta as general symptoms of Samyaka Yoga of Nasya Karma.

Table.No.17. Showing Samyaka Yoga Lakshana¹⁰³

Symptoms	Ch.	Su.	As. H.	Sha.	B. P.	Ka.
Urah Laghuta	+	-	-	-	+	-
Shiro Laghuta	+	+	-	-	-	-
Netra Laghuta	-		+	+	-	+
Laghuta	-		-	-	+	-
Srotovishuddhi	+	+	-	+	+	+
Swaravishuddhi	-		+	-	-	-
Vaktravishuddhi	-		+	-	-	-
Indriyaachchta-prasada	+	+	-	+	+	+
Netrateja Vriddhi	-		+	-	-	+
Chitta Prasada	-	+	-	+	+	+
Vikaropashama	-	+	-	+	+	-
Sukha Svapna Prabodha	-	+	+	-	-	-
Sukhachchvasa	-	+	-	-	-	-
Arati	-	-	-	-	-	-
Medha	-	-	-	-	-	-
Bala	-	-	-	-	-	-

Samyak yoga of Brumhana Nasya:

            Felling of lightness of head, good sleep and wakening, pacification of symptoms, clarity of sense organs and feeling of well being.

Samyak yoga of Virechana  Nasya:

            Lightness of head, Purity of channels, Cure of the disease, pleasant mind and sense organs.

Ayoga:

            If Nasya is not given in proper way or the dose is less, features of inadequate Nasya arise which are Shirogaurava (heaviness in head), Galopalepa (throat coated with mucus) and Nishthivana (excessive spitting104). According to Sushruta, Kandu (Itching), Upadeha (feeling of wetness), Guruta (heaviness), Srotasam Kapha Srava (excess mucus secretion in channels) are the symptoms of Hina Shuddhi105. Vitiation of Vata, dryness in Indriya, no relief in the symptoms of the disease106, dryness in mouth and nose are other symptoms of Ayoga of Nasya karma.

Table No. 18. Ayoga Lakshana107

Sl.No	Symptoms	Ch.	Su.	As. H.	Sha.	B.P.	Ka.
1	Shirogaurava and  Dehagaurava	+	-	-	+	+	+
2	Galopalepa	+	-	-	-	-	-
3	Nishthivana	+	-	-	-	-	-
4	Kandu	-	+	+	+	+	-
5	Kaphapraseka	-	-	-	-	-	-
6	Upadeha	+	-	+	+	-	-
7	Rukshata	+	-	-	+	+	+
8	Vata Vaigunya	+	-	-	-	-	-
9	Srotoriktata	-	-	-	-	+	-
10	Srotasamkaphasrava	+	-	-	+	+	+
11	Nasashosha	-	+	-	-	-	-
12	Asyashosha	-	+	-	-	-	-
13	Akshistabdhata	-	+	-	-	-	-
14	Shiroshunyata	-	+	-	-	-	-
15	Vyadhi Vridhdhi	-	-	-	-	-	+

Ayoga of Brumhana Nasya:

            Aggravation of vata, dryness of Indriyas, persistence of disease.

Ayoga of Virechana Nasya:

            Itching, feeling of coating in the body, heaviness, exudation of kapha.

Atiyoga:

            According to Charaka, the general features of excessive Nasya are, feeling of Arati (uneasiness) and Toda (pricking like pain in the head, eyes, temporal region and ears)108. Kapha Srava (Salivation), Shirahshula (headache) and Indriya Vibhrama (confusion) are the symptoms of Atiyoga of Nasya109. Mastulungagama, Vatavriddhi, Indriyavibhrama and Shiroshunyata (emptiness of head) are also the symptoms of Atiyoga of Shirovirechana.

Table No. 19. Atiyoga Lakshana110

Symptoms	Ch.	Su.	As. H.	Sha.	B.P.	Ka.
Shirogaurava	-	+	+	+	+	-
Shiroshunyata	-	+	-	+	+	-
Shirovedana	+	-	-	-	-	+
Netra Vedana	+	-	-	-	-	-
Shankhavedana	+	-	-	-	-	-
Suchitodavata Pida	+	-	-	-	-	-
Indriya Vibhrama	-	+	-	+	+	+
Mastulungagama	-	+	-	-	-	-
Snehapurna Srotasa	-	-	-	-	+	-
Karna Talu Upadeha	-	-	-	-	-	-
Vata Vriddhi	+	-	-	-	-	+
Kandu	-	+	-	-	-	-
Praseka	-	+	+	+	-	-
Pinasa	-	+	-	-	-	-
Aruchi	-	-	+	-	-	-
Deha Daurbalya	-	-	-	-	-	+
Unmada	-	-	-	-	-	-
Pitta Vriddhi	-	-	-	-	-	-
Hridaya Shula	-	-	-	-	-	-
Suryavarta Roga	-	-	-	-	-	-
Atripti	-	-	-	-	-	-

Atiyoga of Brumhana Nasya:

            Hyper salivation, Heaviness of head, indriya vibhrama.

Atiyoga of Virechana Nasya:

            Exudation of Masthulunga, Vata vrudhi, Indriya vibhrama, feeling of emptiness of head.

Treatment principle of Heenasudhi and Atisudhi:

            In case of heene sudhi kaphahara chikitsa can be done and in atisudhi vata hara chikitsa should be done.

Vyapada:

            After completion of the Nasya Karma, if patient does not follow the regimen mentioned previously then the Prakopa of Dosha may again occur leading to many Vyapada110. Generally complications arise by two ways one is from Doshotklesha and the other from Doshakshaya. The complications, which are produced by provocation of Doshas, the treatment should be done on the line of Shodhana therapy and if complications are arise from Doshakashaya, then the treatment to be given on the line of Brimhana therapy112.

            If Nasya is given in the contra-indicated conditions like Ajirna, Bhuktabhakta, Jalapitta etc. or in season or time e.g. cloudy atmosphere in which Nasya Karma is contra indicted, then there is possibility of production of Kapha rogas like asthama, cough, sinusitis and indigestion etc. In such conditions, the treatment should be done with Kaphanashaka Upachara like use of Ushna and Tikshna Aushadha and Karma113.

            If Nasya is given in Krishasharira (emaciated), Virikta (patient who had taken Virechana), Garbhini (pregnant lady), Vyayama klanta (exhausted with exercise) and in Thirsty person then vitiation of vata takes place and may lead to Vataj vikara. In all the above conditions, Vatanashaka procedures like Snehana, Brimhana and Swedana should be done. The pregnant lady should specifically be treated with the use of Ghrita and Milk114. The conditions like fever, Shokabhitapta and in Madyapita, if Nasya is performed then Timiraroga may occure. Ruksha, Sheeta Anjana, Lepa and Putapaka should be applied for the treatment of these conditions115.

            For Nasya if the drug used is very hot or cold or given in less or in excess quantity or during administration of Nasya the patient has lowered his head more or sneezed or Nasya is given during the time when it is contra- indicated then it may lead to the complications like Trishna and Udgara116.

            If Patient gets Murccha during Nasya, he should be treated with the pouring of cold water on Lalata and Kapala117.

Benefits of Nasya:

            Patient who regularly observes Nasya Karma does not become victim of diseases of eyes, ears and nose. His hair and beard does not turn gray. His hair doesn’t falls but instead grows fast. Diseases like common cold, migraine, headache, facial paralysis, etc. can be alleviated. The joints, sinus, tendons and bones of his cranium acquire great strength. His face becomes cheerful and plump and his voice becomes mallow, firm and stentorian. Strength of all sense organs increases greatly. There will be no sudden invasion of disease in the upper parts (Urdhvajatrugata) of the body. He experiences the symptoms of old age later.

            Disease of the supra clavicular region are cured in the person who practices Nasya. He gets clarity of senses, good smell of mouth and the strength of jaw, teeth, arms, chest, etc. He never suffers from the premature appearance of wrinkles, premature hair falling and Vyanga.

Mode of Action of Nasya Karma:

            The clear description regarding the mode of the Nasya Karma is not available in Ayurvedic classics. According to Charaka, Nasa is the portal (gateway) of Shirah118. The drug administered through nose as Nasya reaches to the brain and elininates only the morbid Doshas responsible for producing the disease. In Ashtanga samgraha, it is explained that Nasa being the door way to Shira (head), the drug administered through nostrils, reaches Shringataka (a Sira Marma by Nasa Srota) and spreads in the Murdha (Brain) taking route of Netra (eye), Shrota (ear), Kantha (throat), Siramukhas (opening of the vessels) etc. and scratches the morbid Doshas in supra clavicular region and extracts them from the Uttamanga119.

            Sushruta has clarified Shringataka Marma as a Sira Marma formed by the union of Siras (blood vessels) supplying to nose, ear, eye and tongue120. Commentator Indu of Ashtanga Samgraha opined Shringataka as the inner side of middle part of the head i.e. Shiraso Antarmadhyam. Under the complications of Nasya Karma Sushruta noted that the excessive eliminative errhine might cause Mastulunga to flow out to the nose121.

            According to all Acharyas, Nasa or nose to be the gateway of Shira. It does not mean that any anatomical channel connects directly to the brain but it might be connected through blood vessels or through nervous system (olfactory nerve etc.)

            It is an experimentally proven fact that where any type of irritation takes place in any part of the body, the local blood circulation is always increased. This is the result of natural protection function of the body. Something happens when provocation of Doshas takes place in Shirah due to irritating effect of administered drug, which resulting an increase of the blood circulation of brain. So extra accumulated morbid Dosha are expelled out from small blood vessels and ultimately these morbid Doshas are thrown out by the nasal discharge, tears and by salivation.

According to Vrudda Vagbhata:

Drug administered through nose -the doorway to sheera

Reaches the Shringataka marma of Head (Sheera), which is a sira marma and formed by the siras of nose, eyes, kantha and shrotra

The drug spreads by the same route

Scratches the morbid Doshas of Urdhwajatru and extracts them from the Uttamanga