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| ORIGINAL ARTICLE |
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| Year : 2014 | Volume
: 34
| Issue : 2 | Page : 100-102 |
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Development of a Nasya fitness form for clinical practice
BS Prasad1, Deepa Patil1, LG Pardeep1, Veerayya Hiremath2, CR Shreelakshmi1
1 Department of Panchakarma, Karnataka Lingayat Education University, Shri BMK Ayurveda Mahavidyalaya, Belgaum, Karnataka, India
2 Department Shalakya, Karnataka Lingayat Education University, Shri BMK Ayurveda Mahavidyalaya, Belgaum, Karnataka, India
| Date of Web Publication | 18-Mar-2015 |
Correspondence Address:
Deepa Patil
Department of Panchakarma, KLE University, Shri BMK Ayurveda Mahavidyalaya, Belgaum, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0257-7941.153470
Introduction: Nasya karma is prime treatment modality for ūrdhvajatrugata vikāra. Though classics clearly mention yogya (arha), ayogya (anarha) criteria for Nasya karma some complications were noticed while practicing. In KLEUS Shri BMK Ayurveda Hospital Belgaum, out of 2867 patients 58 (0.58%) cases reported various complications during and after Nasya karma in the year of 2011 even after taking utmost care in selection of patients as well as drugs. This gave rise to need to develop quick screening criteria to minimize errors.
Objective: To develop Nasya fitness form for clinical practice to further minimize unusual complications and thus obtain the maximum result.
Materials and Methods: Literature pertaining to Nasya karma, Nāsa śarīra with anatomy of nose, vasculature, innervation, examination of the nose and various anatomical pathologies were considered to develop the fitness form.
Results: On the basis of examination of external nose, nasal cavity, concha, nasopharynx and paranasal sinus by anterior and posterior rhinoscopic examination fitness form was developed.
Conclusion: Present fitness format will not only help to assess the nasal pathologies, which are obstacles for drug delivery, but also will help to attain optimum results and avoid unusual complications. Keywords: Nasya fitness, Nasya fitness form, Nasya karma
How to cite this article:
Prasad B S, Patil D, Pardeep L G, Hiremath V, Shreelakshmi C R. Development of a Nasya fitness form for clinical practice. Ancient Sci Life 2014;34:100-2 |
| Introduction | |  |
During any disease process, unbalanced doṣas get lodged in the weak parts of the channels of circulation and produce symptoms of the disease. If the channels of circulation are unobstructed and healthy, even the aggravated doṣas cannot accumulate anywhere and lead to disease. To treat the disease, Ayurveda adopts two principles of management: (i) Śodhana (purification therapy) and (ii) Śamana (pacificatory therapy). [2] Śodhana is a unique feature of Ayurveda aimed at the complete expulsion of the unbalanced Doṣas and the purification of the channels of circulation. Śodhana includes karmas such as Vamana, Virecana, Basti, Nasya, Raktamokṣaṇa, as therapeutic procedures.
Nasya (intranasal drug administration) is one of the therapeutic procedures part of Paρcakarma which acts both at local and systemic levels. It is the practitioner's prime duty to consider the patient's fitness prior to any Paρcakarma treatment, as these treatments are similar to any operative procedures used in allopathic medicine. Preanesthetic fitness is a must to avoid complications in surgery and in the same manner prefitness for Paρcakarma procedures has to be considered for imporvement in efficacy and to avoid complications.
The present data collected on Nasya will clearly indicate the need for an approach using a fitness form in the patient's clinical assessment leading up to the Nasya procedure. The database of KLE'U Shri BMK Ayurveda Hospital Belgaum, Karnataka, India documents that 2867 Nasya karmas have been performed in Paρcakarma Department in 2011. [3] These were different types of Nasya like śodhana, śamana and bṛhmaṇa. Despite performing the Nasya karma with due precautions the retrospective data analysis showed the following complications [4] [Table 1]. | Table 1: Complications documented following Nasya treatment in 2867 patients
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In order to minimize such complications and to achieve optimum results one has to rule out any existing nasal pathologies by proper examination before administering the procedure. This led to the development of a Nasya fitness form for clinical practice in order to further minimize complications.
| Objective | | |
To develop Nasya fitness form for clinical practice to further minimize unusual complications and thus obtain maximum result.
| Materials and Methods | | |
Literary sources
This includes study of:
- Ayurvedic classics: Includes literature of Nasya karma, Nāsa śarīra, etc
- Anatomy of nose, examination of nose and various anatomical pathologies.
Development of format
The above mentioned points from classics and nasal anatomy with its examination were considered for the development of present form to rule out any nasal pathology. They include the examination of external nose, nasal cavity, concha, nasopharynx and paranasal sinus by anterior and posterior rhinoscopic examinations. [4] and this led to the development of a form as seen in [Table 2].
| Results | | |
On the basis of examination of external nose, nasal cavity, concha, nasopharynx and paranasal sinus by anterior and posterior rhinoscopic examination fitness form was
developed.
| Discussion | | |
It is well established in Ayurveda classics, that there is a close relationship between the nāsā (nose) and śiras (brain). nāsā is one among the paρcajρānendriyas (five sense organs) whose function is not limited to olfaction and respiration but is also the pathway to śiras. The medicine administered through the nostrils reach up to śṛṅgāṭaka marma, spreads all over ūrdhvajatru and eliminates the deep seated doṣas. [5]
Recent trends in modern science are emphasizing the use of transnasal route for administration of drugs as the nasal mucosa constitute the only site in the body that provides a direct connection between central nervous system and the atmosphere. Drugs administered to the nasal cavity rapidly transfer to the cribriform plate and then to the central nervous system via three routes:
- Directly via olfactory neurons
- Via supporting cells and the surrounding capillary bed
- Directly through cerebrospinal l fluid. [6]
The surface area of the nasal cavity is about 160 cm 2 (0.96 m 2 if the microvilli are included). The olfactory region, however, is only about 5 cm 2 (0.3 m 2 when microvilli are included). There are six arterial branches that serve the nasal cavity, making this region, called as Little's area of nose, a very attractive route for drug administration. In particular, the blood flowing in this region is get slightly more reabsorbed in the nasal vein, with any excess draining into the lymph vessels, making this region a very attractive route for drug delivery. [7] The same pathway though may spread any infections directly to the brain if performed without considering safety issues of nasal fitness. The same pathway is also the cause of spreading infection from external to internal parts. Many a time, the administration of Nasya Dravyas (Drugs) without considering the internal existing pathologies such as infected concha etc., will worsen the condition and cause untoward effects. An understanding of the anatomical and histological structure of the nasal cavity is essential and important for nasal drug delivery system and these factors were considered in the development the present fitness form.
The above considerations in ruling out the structural pathology hindering the pathway of a drug administered through the nasal route are better understood by the following example. There was a case diagnosed as Apabāhuka (frozen shoulder) [8] and a nasal examination revealed "S" shaped deviated nasal septum (DNS) with middle turbinate hypertrophy. Though the patient with Apabāhuka is indicated for Nasya karma with Sneha Dravya Prayoga (oil based intranasal drug usage), his DNS makes him unfit for the procedure. With the DNS as a physical obstacle for drug delivery the Nasya karma, if performed will not fully serve its purpose. In addition to this, there is a higher risk of complications in the form of infection like rhinitis and headache in the patient.
Present fitness format will not only help to assess fractures of nasal bones, obstructions like DNS, turbinate hypertrophies, polyps and paranasal sinuses etc., which are obstacles for drug delivery, but also will help to attain optimum results and avoid unusual complications.
| Acknowledgements | | |
I would like to thank all the Staff members and PG scholars of Depatartment of Panchakarma, KLEU's Shri BMK Ayurveda Mahavidyalaya, Belgaum for their support and for their direct and indirect help.
| References | | |
| 1. | Trikamaji AJ, Editor. 13 th Adhyaya Sutrasthana, Charaka Samhita. 5 th ed. Varanasi; Chaukhamba Sanskrit Sansthana; 2006.  |
| 2. | Paradakara HS, editor. 14 Adhyaya, Sutrasthana, Astanga Hridaya. 5 th ed. Varanasi: Chaukhamba Surbharati Prakashan; 2010. |
| 3. | KLEU's Shri BMK Ayurveda Hospital, Belgaum Karnataka. Department of Panchakarma Statastics in year 2011. |
| 4. | Chaursiya BD. Human Anatomy. 3 rd ed., Vol. 3. CBS Publishers; 2003. p. 213. |
| 5. | Trikamji AJ, editor. "25 th Adhyaya" Chikisthasthana. Charaka Samhita. 5 th ed. Varanasi: Chaukhamba Sanskrit Sansthan; 2006. |
| 6. | Sangeeta HJ, Toshikhane HD. A critical evaluation of the concept of "Nasa Hi Shiraso Dwaram" (Nasal Route Entry for the Cranial Cavity). Pac J Sci Technol 2009;10:338-41. |
| 7. | Gizurarson S. Anatomical and histological factors affecting intranasal drug and vaccine delivery. Curr Drug Deliv 2012;9:566-82. |
| 8. | Das B, Ganesh RM, Mishra PK, Bhuyan G. A study on Apabahuka (frozen shoulder) and its management by Laghumasha taila Nasya. Ayu 2010;31:488-94. [ PUBMED]  |
[Table 1], [Table 2]
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