Ardhita navana-pk

“A COMPARATIVE CLINICAL TRIAL ON TWO DIFFERENT

NAVANA YOGAS IN CHARAKOKTA ARDITA.”

BY Dr. VIJAYA V.VYEVHARE, B.A.M.S

Dissertation submitted to the Rajiv Gandhi University of Health

Sciences, Bangalore, for the partial fulfillment of Degree

AYURVEDA VACHASPATI

DOCTOR OF MEDICINE (AYURVEDA)

IN

PANCHAKARMA

Under the guidance of

Dr. SHYLAJAKUMARI R. MD (Ayu.)

Asst. Professor

Department of Post Graduate Studies in Panchakarma,

Government Ayurvedic Medical College Bangalore

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA

GOVERNMENT AYURVEDIC MEDICAL COLLEGE

DHANWANTARI ROAD, BANGALORE – 560009

2010-2011

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “A Comparative

clinical trial on two different Navana yogas in Charakokta Ardita” is a

bonafide and genuine research work carried out by me under the

guidance of Dr.Shylajakumari R.,Asst. Professor, Dept of PG studies in

Panchakarma, Government Ayurvedic Medical College, Bangalore.

Date: Signature of the candidate Place: (Dr. Vijaya V.Vyevhare)

Department of Post Graduate Studies in Panchakarma

Government Ayurvedic Medical College

Bangalore - 560009

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A Comparative clinical trial

on two different Navana yogas in Charakokta Ardita” is a bonafide

research work done by Dr. Vijaya V.Vyevhare. in partial fulfilment of the

requirement for the degree of “AYURVEDA VACHASPATI” – MD (Ayurveda)

in Panchakarma of the Rajiv Gandhi University of Health Sciences,

Bangalore.

I recommend this dissertation for the above degree to the University for

Assessment and approval.

Dr. Shylajakumari R.M.D (Ayu)

Asst. Professor, Dept. of PG studies in Panchakarma

GAMC, Bangalore - 09

Department of Post Graduate Studies in Panchakarma

Government Ayurvedic Medical College

Bangalore - 560009

ENDORSEMENT BY HOD & PRINCIPAL

This is to certify that the dissertation entitled “A Comparative clinical trial

on two different navana yogas in Charakokta Ardita” is a bonafide

research work done by Dr.Vijaya V.Vyevhare. in partial fulfilment of the

requirement for the degree of “AYURVEDA VACHASPATI” – MD

(Ayurveda) in Panchakarma under the guidance of Dr. Shylajakumari R.,

Asst.Prof., Dept of PG studies in Panchakarma, Government Ayurvedic

Medical College, Bangalore.

Dr. Shalini C. Eli, MD (Ayu.) D.N.Y. Principal

Prof. & Head of the Department, Govt. Ayurvedic Medical College,

Department of P.G. Studies In Panchakarma, Bangalore.

Govt. Ayurvedic Medical College,

Bangalore.

COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences,

Karnataka, Bangalore, shall have the rights to preserve, use and

disseminate this dissertation in print or electronic format for Academic /

Research purpose.

Date: Signature of the Candidate Place: (Dr.Vijaya V.Vyevhare.)

© Rajiv Gandhi University of Health Sciences, Karnataka.

ACKNOWLEDGEMENT Beyond all worldly things, there is a supernatural power which harmonize all

worldly interactions. I express my deep hearted reverence to that divine source. I bow

my head to the lotus feet of “Lord Dhanvantri” with whose showering of blessings this

task was ventured without any hindrances.

It’s my great pleasure to express my deep gratitude towards

Dr.Shaylaja Kumari R., Asst. Professor, my preceptor and guide whose erudite

expositions, benevolent teaching & critical suggestions had given me a propitious

direction to accomplish this work in all aspects.

I am also thankful to my H.O.D, Dr. Shalini C. Eli, for being a

supporting hand in my work.I am also thankful to Dr. Shridhara B. S. former.H.O.D.for

his constant encouragement.

I express my deep gratitude to Principals of G.A.M.C, Bangalore during

my study Dr .S.G.Mangalgi.

I am especially thankful to teachers of “Department of Panchakarma”

Dr.Janaki Y.S., Dr.Santhosh.L.Y., Dr.V.M.Hugar, Dr.Shaila Gurappa, whose constant

encouragement and useful suggestions helped me throughout the study period.

I am highly indebted to my Parents Shri Vishwanath vyevhare and

Smt.Sunanda played a key role in molding my thoughts towards higher studies.

I pay my obeisance to my all family members, especially my beloved

husband Dr.Kailash Sonmankar for taking pain in bringing me up to this position.

Also I would like to thank my elder sister Mrs.Tejaswini and brother Mr.Ravindra

,beloved friend Dr.Basavjyoti and Miss.Alaka for giving me constant & unending

support .

I am very much thankful to my seniors Dr.Usha,Dr.Ashwini Kulkarni,

Dr.Rajani Ramesh, Dr.Divya, Dr.Salma, Dr.Smina, Dr.Sandeep, Dr.Somnath & My

special thanks to my department colleagues and friends, Dr.Pooja

Dr,Basavjyoti,Dr.Sumit,Dr.Ravikumar,Dr.Srinivas,and also thankful to my juniors

Dr.Rashmi,Dr.Vanishri,Dr.Manjunath,Dr.Shridhar,Dr.Nandakishore,Dr.Mukund

Dr.Kamlesh and all other post graduate scholars for their needful support to fulfil this

task.

I thank library, hospital & office staff, R.M.O. Dr. Nagraj, Physicians, and all

my patients for their kind support during my study.

I take this opportunity to appreciate the generous co operation offered by my

patients by being highly obdient during my study period .

I take all my effort to laud Dr. Raghavendra, Statistician, without whose help

whole of my work would have looked meaningless. I am extremely grateful to my printer

Mr.Arvind who has printed and bounded my work legibly and neatly.

Last but not least, I express my thanks to each and every person who have helped

me directly & indirectly in accomplishing this task without any blemishes, with apologies

for my inability to identify them individually.

Dr.Vijaya V.Vyevhare

ABSTRACT

Charkokta Ardita is the manifestation of the condition involving weakness of

either half of face or along with half of the body. The disese is mentioned in maharoga

from the point of prognosis – difficult to cure. This vatavyaadhi can be correlated with

cerebrovascular accidents which is a global health problem of present era and a major

cause of disability.

In its management Nasya is the first line of treatment for Ardita in charaka

samhita. With this classical background, in the present study an attempt is made to

understand the separate & comparative efficacy of Karpasasthyadi taila nasya and

Rasnaputika taila nasya in the management of Charakokta Ardita.

Objectives of the study:

i] To evaluate the efficacy of Karpasasthyadi taila nasya in the management

of Charkokta Ardita.

ii] To evaluate the efficacy of Rasnaputika taila nasya in the management of

Charkokta Ardita.

Study Design: 30 patients presentng with classical symptoms of Charkokta Ardita

were randomly recruited in 2 groups. The Group A patients received 2 course of nasya

with Karpasasthyadi taila while Group B patients received 2 course of nasya with

Rasnaputika taila.

Results: Comparision of both the groups shown that in group B there is significant

improvement after first course in finger movement,loss of speech, pain and handgrip

power,whereas in group A there is significant results found in after second course.

Key Words: Ardita, Nasya,

TABLE OF CONTENTS

SL. NO CHAPTER PAGE

NUMBER 1 INTRODUCTION 1-2

2 REVIEW OF LITERATURE

a) PROCEDURE REVIEW 3-33

b) DISEASE REVIEW 34-83

c) DRUG REVIEW 84-92

3 MATERIALS AND METHODS 93-102

4 OBSERVATIONS AND RESULTS 103-140

5 DISCUSSION 141-155

6 CONCLUSION 156

7 SUMMARY 157-158

8 BIBLIOGRAPHY -

9 ANNEXURE ---

LIST OF ABBREVIATIONS

A.H. – Ashtanga Hridaya.

A.S. – Ashtanga Sangraha.

A.V. _ Atharvana veda

Aru. – Arunadatta.

B.P. – Bhavaprakasha.

B.R. – BhaishajyaRatnavali.

Bha.Ni. – BhavaprakashNighantu.

Bhel.S. – BhelaSamhita

Ch.Dt – ChakraDatta.

Ch. – CharakaSamhita Chi. – ChikitsaSthana

Dal. – Dalhana.

G.N. – GadaNigraha.

Ha. – HaritaSamhita.

Kal. – KalpaSthana

Ka.Sam. – KashyapaSamhita.

M.N. – MadhavaNidana

Ni. – NidanaSthana

Pur. - Purvakhanda.

Si. – SiddhiSthana

Sha.S – Sharangadhara Samhita

Su.S. – SushrutaSamhita

Su. – SutraSthana

Van.S. – VangasenSamhita.

Vi. – VimanaSthana

Utt. – Uttarkhanda.

Y.R. – YogaRatnakara

LIST OF TABLES

Sl.no Title pg.no

1 Table showing references in Charaka Samhita 4 2 Table showing Nasya references in Sushruta Samhita. 5 3 Table showing Nasya references in Astanga Hrudaya 5 4 Table showing Classification of Nasya according to Various Acharya 8 5 Table showing Dose of Nasya. 14 6 Table showing Indications Avapida Nasya 15 7 Table showing Contra Indications of Nasya mentioned in Brihatrayiee 17 8 Table showing Nasya Time schedule according to different seasons 18 9 Table showing Nasya Time schedule in DoshajaVikara 18 10 Table showing Courses in day of Nasya karma according to different

acharyas 18

11 Table showing Dosage of various types Nasya Karma 20 12 Table showing Nasya Yantra 21 13 Table showing Nasya Samyaka Yoga Lakshana 23 14 Table showing Nasya Ayoga Lakshana 24 15 Table showing Nasya Atiyoga Lakshana 24 16 Table showing Site of Ardita according to different acharyas 38 17 Table showing Dosha involved in Ardita according to different acharyas 38 18 Table showing Nidana of Ardita according to different acharyas 38 19 Table showing Rupa of Ardita according to different acharyas 45 20 Table showing Vataja doshanubandhi lakshanas found in Ardita 46 21 Table showing Pittaja doshanubandhi lakshanas found in Ardita 46 22 Table showing Kaphaja doshanubandhi lakshanas found in Ardita 47 23 Table Showing the Pathyapathya in Vatavyadhi 54 24 Table Differentating between three common causes of Hemiplegia 60 25 Table Showing Etiological factors according to onset of Hemipegia 61 26 Table Showing The Ingredients of Karpasasthyadi taila 85 27 Table Showing The Ingredients of Rasna putika taila2 88 28 Table showing Incidance of age 103 29 Table showing Incidance of Sex 104 30 Table Showing Education wise distribution 104 31 Table showing Incidance of Occupation 105 32 Table showing Incidance of Socioeconomic Status 105 33 Table showing Incidance of Marital Status 106 34 Table showing Incidance of Family history of stroke 106 35 Table showing Incidance of Food habit 106 36 Table showing Incidance of Sharira Prakruti 107 37 Table showing Incidance of Manasa Prakruti 108 38 Table showing Incidance of Sara 108

39 Table showing Incidance of Agni 108 40 Table showing Incidance of Koshta 109 41 Table showing Incidance of Onset of stroke 110 42 Table showing Incidance of Right/Left half of the body affected 110 43 Table showing Incidance of Duration 111 44 Table showing Incidance of Aharaja nidana 111 45 Table showing Incidance of Viharaja nidana 112 46 Table showing Incidance of Manasika nidana 113 47 Table showing Incidance of Past history of hypertension 113 48 Table showing Incidance of Nature of Sleep 114 49 Table showing Incidance of Vyasana 114 50 Table showing Incidance of Nasya karmukata 115 51 Table showing Incidance of Overall response 115

LIST OF GRAPHS

Sl.no Title Pg.no

1 Graph showing Incidance of age 104 2 Graph showing Incidance of Sex 104 3 Graph Showing Education wise distribution 105 4 Graph showing Incidance of Occupation 105 5 Graph showing Incidance of Socioeconomic Status 105 6 Graph showing Incidance of Marital Status 106 7 Graph showing Incidance of Family history of stroke 106 8 Graph showing Incidance of Food habit 107 9 Graph showing Incidance of Sharira Prakruti 107 10 Graph showing Incidance of Manasa Prakruti 108 11 Graph showing Incidance of Sara 108 12 Graph showing Incidance of Agni 109 13 Graph showing Incidance of Koshta 109 14 Graph showing Incidance of Onset of stroke 110 15 Graph showing Incidance of Right/Left half of the body affected 110 16 Graph showing Incidance of Duration 111 17 Graph showing Incidance of Aharaja nidana 112 18 Graph showing Incidance of Viharaja nidana 112 19 Graph showing Incidance of Manasika nidana 113 20 Graph showing Incidance of Past history of hypertension 113 21 Graph showing Incidance of Nature of Sleep 114 22 Graph showing Incidance of Vyasana 115 23 Graph showing Incidance of Nasya karmukata 115 24 Graph showing Incidance of Overall response in group A 116 25 Graph showing Incidance of Overall response in group B 116 26 Graph showing changes in Housebrackman scale 118 27 Graph showing changes in Finger movement 120 28 Graph showing changes in Lifting of Arm 122 29 Graph showing changes in Sitting from laying down 123 30 Graph showing changes in Standing from sitting 125 31 Graph showing changes in Drooping of wrist 127 32 Graph showing changes in Loss of Speech 129 33 Graph showing changes in Pain 131 34 Graph showing changes in Muscle Power 133 35 Graph showing changes in Hand grip Power 135

36 Graph showing changes in Muscle tone 136 37 Graph showing changes in Increase in walking Capacity 138 38 Graph showing changes in Reflexes 140

LIST OF FLOWCHARTS

Sl no Headings Page no

1 Showing Charaka’s classification of Nasya Karma 9

2 Showing Charaka’s classification of Nasya Karma according to action 9

3 Showing Charaka’s classification of Nasya Karma according to various parts of the drugs utilized 9

4 Showing Sushruta’s classification of Nasya Karma 10 5 Showing Vagbhata’s classification of Nasya Karma 11 6 Showing Kashyapa’s classification of Nasya Karma 11 7 Showing Sharangadhara’s classification of Nasya

K12

8 Showing Videha’s classification of Nasya Karma 12 9 Schematic representation of the Samprapti of Ardita 42

LIST OF FIGURES Sl. No.

Headings Pg. no

1 Figure Showing The Olfactory System

31

2 Figure showing The Internal Capsule 72

3 Figure Showing Olfactory pathway 145

Introduction

“A Comparitive clinical trial on two different navana yogas in Charakokta Ardita” Dept.Of P.G.Studies In Panchakarma-G.A.M.C.Bangalore-09 1

INTRODUCTION

Ayurveda is an eternal science of life which is based on the principles of

tridosha theory. Tridoshas are eternally present and support the body as ‘vital

forces’ in their normalcy ,import development ,strngth ,complexion,and

cheerfulness to the body.All the activities of the body both external and internal

are essentially depend on vata and due to its quality of motivation it keeps kapha,

pitta,dhatus and malas in motion,which are incapable of independent motion1

Ardita is one among the vata vyadhis mentioned by many acharyas

where charaka has given different opinion regarding the disease. According to him in

Ardita not only half of the face,but involvement of half of the body ,is also noticed.

The condition as described in charaka samhita, makes the person more

difficult to perform his routine activity and disability to communicate also.

Greater the incidence of atherosclerosis and hypertension which are

the principal etiological factors of the cerebrovascular catastrophe and which are on

flare in today’s era. Stroke is currently the second leading cause of death in the

Western world, ranking after heart disease and before cancer, and causes 10% of

deaths worldwide.2 Prognosis for patient with stroke is worse than many forms of

cancer, with half of all patients dead or dependent on others after 1 year.

The impairment in the functions of indriyas (both jnanendriyas and

karmendriyas) resulting in vaksanga (Aphasia),Akarmanyata (loss of function in half

of the body mainly involving upper and lower limbs).

Considering all the above points one can safely conclude that the

adhistana for vata prakopa is in shiras where in all the vital centers including manas

http://en.wikipedia.org/wiki/Western_world

Introduction


are situated. Aradita is a severe blow to the sufferer’s life. It makes the patient

cursed creature so far his activities are concerned. The patient not only suffers from

bodily illness but also go through a severe mental depression on account of inability

to attend such duties as are essential for personal hygiene and maintenance of his

own cleanliness and attire. Such persons irrespective of religion, age, sex or

socioeconomic status, face a very miserable and dependent life. This disease not

makes the person only crippled but also makes him/her burden to the family. If he

or she is the only earning member in the family, the family has to face endless

problems.

Nasa has been mentioned as outlet of shiras.3 The drug administered

by nasya works upon the vitiated doshas and dushyas and expel the doshas situated

in urdhwajatrugata pradesha through nasa4 .Ardita is also one of the disease of

urdhwajatrugata pradesha and having shiras as its adhishatana, so nasya is preferred.

Taking the above points into mind, its poor prognosis and nature of inertia

the disease was selected, to find a measure that could help in restoring quality of life in

paralyzed patients. The present study has been designed with 2 groups:

1) Group-A--- Received Nasya with Karpasasthyadi Taila5 .

2) Group-B--- Received Nasya Rasnaputika taila6.

The present study is an effort to rule out an effect of Rasnaputika Taila and evaluate

the comparison between two formulations.

Procedure review


NASYA KARMA

Historical Review of Nasya:

Rigveda

There is a Mantra of Rigveda, in which eradication of Roga from the routes

of Nasa (Nostrils), Chibuka (Chin), Shiras (Head), Karna (ear) & Rasana (tongue) are

mentioned.1 This shows that the reference of eradication of disease from the above

mentioned routes most probably refers towards Nasa (nose) or Shirovirechana.

Ramayana

Valmiki Ramayana gives reference regarding Nasyakarma is when Lakshmana

became unconscious; drug named Sanjeevini brought by Lord Hanuman was used by

Vaidya Sushena to make him conscious.2

Baudha Kala

In Buddha period there are Jataka stories about the famous vaidya “Jeevaka”.

He has utilized many times Nasya Karma such as –

1. Administration of medicated Ghruta for the treatment of Shirah Shoola in the form

of Nasya Karma to the wife of Sreshthi of Saketa Nagar.3

2. Lord Buddha was given virechana by nasya in the total dose of three Utpala Hasta.4

Vinaya Pitaka

The book Vinaya-Pitaka states that the use of one Utpala Hasta of Nasya was

sufficient for ten Virechana.5

Ayurvedic Classics

After Buddha period, Charaka Samhita & Sushruta Samhita became famous

accomplishments where the specification in the Nasya karma had reached to such an

extent of perfectness that it was also being used as one of the methods, for changing

the fetal sex. 6

Procedure review

“A Comparitive clinical trial on two different navana yogas in Charakokta Ardita”

Nasya karma is mentioned as a treatment in several diseases in Brihatrayi.

References are given below-

Charaka Samhita 7-19

Table no. 1:- Nasya references in Charaka Samhita.

Name of Adhyaya References of Nasya Karma

1. Jwara Chikitsa Ch.Chi. 3/254, 255

2. Raktapitta Chikitsa Ch.Chi. 4/97-140

Ch.Chi. 7/48, 49 3. Kustha Chikitsa

4. Rajayakshama Chikitsa Ch.Chi. 8/34, 35

5. Unmada Chikitsa Ch.Chi. 9/35,56-58,65,71-79,81-82

6. Apasmara Chikitsa Ch.Chi. 10/40-45

7. Kshawathu Chikitsa Ch.Chi. 12/17

Ch.Chi. 17/129-134 8. Hikka, Shwasa Chikitsa

9. Kasa Chikitsa Ch.Chi. 18/142

10. Visha Chikitsa Ch.Chi.23/54-60,190,193,-196 ,213

11. Trimarmiya Chikitsa Ch.Chi.26/137,151-159,174,176,178,180,

183-185

12. Vata Vyadhi Chikitsa Ch.Chi. 28/78,88,98,99,124,125-128,194

13. Trimarmiya Siddhi Ch.Si. 9-73,75,82,83,87,97

Dept.Of P.G.Studies In Panchakarma-G.A.M.C.Bangalore-09 4

Procedure review


SUSHRUTA SAMHITA 20-26

Table no. 2 :- Nasya references in Sushruta Samhita.

Name of Adhyaya References of Nasya Karma

1. Dwivraniyam Chikitsa Su.Chi. 1/8,9,125,126

2. Sadyovraniya Chikitsa Su.Chi. 2/43

3 . Bhagandar Chikitsa Su.Chi. 3/40,54,64,68

5. Mahavata Vyadhi Chikitsa Su.Chi. 9/3

6. Kustha Chikitsa Su.Chi. 14/11

7. Udara Chikitsa Su.Chi. 18/22,23,50

8. Granthi-Apachi-Arbuda Ganda Chi.

Su.Chi. 19/15 9. Vruddhi,Upadamsha, Shlipada Chi. Su.Chi. 20/30

10. Kshudra Roga Chikitsa Su.Chi.22/4,7,12-17,21,25,35,38,39,40,45,48,59,63,67

11. Mukha Roga Chikitsa Su.Chi. 31/3

12. Snehaupayogika Chikitsa Su.Chi. 32/17

13. Swedavacharniya Chikitsa Su.Chi. 34/12,19

14.Vamana-Virechana Chikitsa Su.Chi. 36/13

15. Netra basti Vyapad Chikitsa Su.Chi. 37/7

16. Anuvasana Uttar basti Chikitsa Su.Chi. 40/1,2,20-26,28-56

ASTANGA HRIDAYA 37-44

Table no. 3 :- Nasya references in Astanga Hrudaya.

Name of Adhyaya References

1. Jwara Chikitsa As.H.Chi. 1/125,126,150,161

2. Raktapitta Chikitsa As.H.Chi. 2/47

3 Shwasa Hikka Chikitsa As.H.Chi. 4/46-50

4. Rajayakshama Chikitsa As.H.Chi. 5/34,37,41,42,69

5. Chhardi, Hridroga, Trishna Chikitsa As.H.Chi. 6/27,74

6. Madatyaya Chikitsa As.H.Chi. 7/104,108,110,111

7. Shwitra krimi Chikitsa As.H.Chi. 20/28,33

Procedure review


ETYMOLOGY OF NASYA:

It is derived from “Nasa” dhatu which is inferred in sense of nose. According

to Vachaspatyam word “Nasata” means beneficial for nose.

As per Acharya Sushruta, administration of medicine or medicated oils

through the nose is known as Nasya . According to charaka also it means the same

“ lÉÉxÉÉ²ÉUålÉ pÉåwÉeÉ SÉlÉqÉç | ” 45

Arunadatta and Bhavaprakasha opine that all drugs that are administered

through the nasal passage are called Nasya.46 Sharangadhara and Vagbhata 47 also hold

the same view.

DEFINATION OF NASYA:

According to shabda kalpa druma:

“lÉÉÍxÉMüÉrÉÉrÉæÈ ÌWûiÉqÉç CÌiÉ lÉxrÉÈ’’

That which is good for nose is called as nasya.

According to Charaka 48

“ lÉxiÉ: MüqÉï cÉ MÑüuÉÏïiÉ ÍzÉUÉåUÉåaÉåwÉÑzÉÉx§ÉÌuÉiÉç |

²ÉUqÉç ÌWû ÍzÉUxÉÉå lÉÉxÉÉ iÉålÉ iÉSèurÉÉmrÉ WûÎliÉ iÉÉlÉç || ”

According to Sushruta

“AÉæwÉkÉÇ, AÉæwÉkÉ ÍxÉ®Éã uÉÉ xlÉãWûÉã lÉÉÍxÉMüÉprÉÉqÉç

SÏrÉiÉå CÌiÉ lÉxrÉÇ|” 49

A medicine or medicated oushadhi with Sneha administered through nasal route is

Nasya.

“iÉ§É rÉ: xlÉãWûlÉÉjÉïÇ vÉÑlrÉ ÍvÉUxÉÉÇ

aÉëÏuÉÉxMülkÉÉãUxÉÉÇ cÉ oÉsÉeÉlÉlÉÉjÉïÇ ..... uÉÉ xlÉãWûÉã

ÌuÉkÉÏrÉiÉã

Procedure review


... lÉxrÉ vÉoS:|” 50

This definition refers for the importance of Nasya.

“lÉÉxÉÉrÉÉqÉç pÉuÉÇ lÉxrÉÇ| ” 51

“lÉÉxÉÉrÉÉqÉç mÉëhÉÏrÉqÉÉlÉqÉÉæwÉkÉÇ lÉxrÉÇ|”52

“lÉÉxÉrÉÉ ÍvÉUÍxÉ mÉëhÉÏrÉqÉÉlÉqÉÉæwÉkÉÇ lÉxrÉ xÉÇ¥ÉÉÇ

sÉpÉiÉã|” 53

That medicine which is put through nose is called as nasya

“AÉæwÉkÉÇ YuÉÉjÉxuÉUxÉ xlÉãWûÉÌS , lÉxrÉÍqÉÌiÉ lÉÉxÉÉrÉÉ

SÏrÉiÉã CÌiÉ lÉxrÉÇ|” 54

Medicines to be administered through Nasal route may be in the form of Kwatha,

swarasa, kalka, Sneha etc

Synonyms :

• Prachchardana (ch.su.1/85)

• Shirovirechana (su.)

• Shirovireka

• Murdhavirechana

• Navana

• Nastaha Karma

Among the various synonyms of Nasya karma Shirovirechana, Shirovireka

and Murdhavirechana are suggestive of elimination of Doshas from the Shira or parts

situated above the clavicle i.e. Prachchardana, whereas the terms Nastaha and Navana

indicates site of administration.

CLASSIFICATION OF NASYA KARMA :

Procedure review


Nasya is classified in various ways by different Acharya. Each

classification has its own salient features and each is done with different angles.

Classification according to various Acharya is described in a tabular form as below.

Table No.4 Showing Classification of Nasya according to Various Acharya

No Name of Acharya Classification

1 Charaka 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 Sushruta Shirovirechana, Pradhamana, Avapida, Nasya, Pratimarsha

3 Vagbhata Virechana, Brimhana,

Shamana

4 Kashyapa Brimhana, Karshana

5 Sharangadhara Rechana, Snehana

6 Bhoja Prayogika, Snaihika

7 Videha Samgya Prabodhaka,

Stambhana,

CHARAKA’S CLASSIFICATION OF NASYA :

“ lÉÉuÉlÉqÉç AuÉmÉÏQûlÉqÉç kqÉÉmÉlÉqÉç kÉÔqÉ LãuÉ cÉ ||

mÉëÌiÉqÉvÉïxiÉÑ ÌuÉelÉãrÉÈ lÉxiÉÈ MüqÉï iÉÑ mÉlcÉkÉÉ ||

xlÉãWûlÉÇ vÉÉãkÉlÉqÉç cÉæ� Ì²ÌuÉkÉÇ lÉÉuÉlÉqÉç xqÉëiÉqÉç ||

vÉÉãkÉlÉÇ xiÉqpÉlÉ¶É xrÉÉiÉç AuÉmÉÏ��ã Ì²kÉÉ qÉiÉÈ ||

cÉÔhÉïxrÉÉkqÉÉmÉlÉqÉç iÉÌ® SãWûxÉëÉãiÉÉã ÌuÉvÉÉãÍkÉlÉqÉç ||

ÌuÉelÉãrÉÎx§ÉÌuÉkÉÉã kÉÔqÉÈ mÉëÉaÉÑ£üÈ vÉqÉlÉÉÌSMü ||

mÉëÌiÉqÉvÉÉãï pÉuÉixlÉãWûÉã ÌlÉSÉãïwÉ EpÉrÉÉjÉïMÚüiÉç ||

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Procedure review


Acharya Charaka have classified Nasya in five types viz. Navana, Avapidana,

Dhmapana, Dhuma and Pratimarsha.55

Navana is further divided in to Snehana and Shodhana, Avapidana into

Shodhana and Stambhana, Dhuma into Prayogika, Vairechanika and Snaihika while

Pratimarsha is divided into Snehana and Virechana.

The above-mentioned five types of Nasya are regrouped according to their

pharmacological action into three groups viz. – Rechana, Tarpana and Shamana.56

Charaka has also mentioned 7 types of Nasya according to parts of the drugs to

be used in Nasya karma viz. – Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twak.57

Chart no.1

Nasya

Navana Avapidana Dhmapana Dhuma Pratimarsha

Snehana Shodhana Prayogika Snaihika Vairechanika

Shodhana Stambhana Snehana Virechana

Chart no. 2 According to the action of Nasya therapy:

Tarpana Shamana Rechana

Chart no. 3 According to various parts of the drugs utilized in Nasya

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Procedure review


Phala Patra Mula Kanda Pushpa Niryasa Twaka


Procedure review


CLASSIFICATION OF NASYA ACCORDING TO SUSHRUTA:

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According to Sushruta, Nasya is of 5 types viz. Nasya, Avapida, Pradhamana,

Shirovirechana and Pratimarsha. These 5 types of Nasya are further classified

according to their functions into two groups viz. Shirovirechana and Snehana 58

Shirovirechana, Avapida and Pradhamana are used for Shirovirechana purpose.

i.e. for the elemination of morbid Dosha from Shira while Pratimarsha and Nasya may

be used for Snehana.59

Chart no.4 Classification according to Sushruta:

Nasya

Shirovirechana Snehana

Shirovirechana Pradhmana Avapida Nasya Pratimarsha

VAGBHATTA’S CLASSIFICATION OF NASYA:

Ashtanga Samgraha & Hridaya has mainly classified Nasya according to its effect viz.

Virechana, Brimhana and Shamana. Snehana and Brimhana Nasya have been further

subdivided according to the doses into two groups i.e. Marsha and Pratimarsha.60

Ashtanga Hridaya has mainly classified Nasya in 3 types viz. Rechana,

Brimhana and Shamana61.


Procedure review


Chart No.5 Classification According to Karma (Pharmacological Action)


Rechana Brimhana Shaman

Samgyaprabodhana (Shodhana)

Krimighna Stambhana Karshana

Raktastambhan Doshastambhan

KASHYAPA’S CLASSIFICATION OF NASYA

According to Kashyapa Samhita, Nasya has been classified into two

groups i.e. Brimhana and Karshana. These two types are also known as Shodhana and

Purana Nasya 62.

Chart no.6 Classification according to Kashyapa:

Karshana (Shodhana)

Brimhana (Purana)

Nasya

SHARANGADHARA’S CLASSIFICATION OF NASYA

Sharangdhara has also classified Nasya according to their functions into two groups

viz. Rechana and Snehana. Rechana Nasya is further subdivied into Avapida and

Pradhamana while Snehana Nasya is subdivided into Marsha and Pratimarsha. 63abc

Procedure review


Chart no.7 Classification according to Sharangadhara :

Nasya

Rechana Snehana

Pradhmana Marsha Avapida Pratimarsha

VIDEHA’S CLASSIFICATION OF NASYA

Videha has stated two types i.e. Sanjyaprabodhaka and Stamabhana 64

Chart no.8 Classification according to Videha :

Stambhana

Nasya

Sagnya Prabodhaka

It is clear from the above description 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)

Apart from classification on above basis other criteria are also described as follows :

♦ Classification according to preparation e.g. Avapida nasya which indicates the

use of expressed juice:

♦ Classification according to the dose to be dropped into the nostrils e.g. Marsha

and Pratimarsha described by Acharya Vagbhata.


Procedure review


A) 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 Vagbhata in its properties

and actions.

Drugs: Drugs of Madhura skandha and Sneha prepared with Vata-Pittahara drugs are

used for above type. 65 Exudation of certain trees, meat soups and blood may also be

administered.

Indications:

Vatika Shiroroga, Dantapata, Keshapatana, Darunaka and other Vata-Pittaja

diseases. Sushruta advises Sneha Nasya for increasing general strength and to improve

the vision and its acuity. It is also used for curing the Shirah kampa and Ardita.66

Shodhana Nasya

Shodhana nasya eliminates excessive vitiated doshas in urdhwajatrugata

pradesha. Generally Avapidana, Dhmapana, Vairechanika are classified in Shodhana

nasya. Rechana, are the synonyms of Shodhana nasya. Sushruta’s Shirovirechana type

is included in Shodhana type of Navana Nasya. If Rechana Nasya is to be given in

patients of weak will power then Sneha preparation of Rechana dravya is applied.

Drugs :

Apamarga, Pippali, Maricha, vidanga , Shirisha etc. are drugs of choice that can

be used for Rechana Nasya.67In this type of Nasya, oil prepared by above

Shirovirechana Dravyas are selected. Kwatha, Swarasa or Tikshna sneha of above

drugs may also be utilized for the same.

Dose :It can be given in following dosage schedule according to Sushruta.

Procedure review


Table No. 5. Dose of Nasya. 68

1 Uttama 8 drops

2 Madhyama 6 drops

3 Hina 4 drops

Indications :

It can be used in the following conditions; Kaphapurna Talu and Shira, Aruchi,

Shirogaurava, Shula, Pinasa, Ardhavabhedaka, Krimi, Pratishyaya, Apasmara,

Gandhagyananasha and Urdhvajatrugata Kapharogas 69 and Urdhvajatrugata Shopha, Praseka,

Arbuda and Kotha.

Avapida Nasya

Definition:

The word Avapida means it is expressed juice of leaves or paste (kalka) of

required medicine. 70

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

nasya.71

It may also be given by dipping the swab (pichu) into the Kwatha (decoction)

or Sheeta (cold infusion) or Swarasa (juice) of the required drug. Though Acharya

Sushruta has categorized this under Shirovirechana, Avapida has also been used for

Procedure review


Stambhana purpose in treatment of Raktapitta where Sharkara and Ikshu rasa are

utilized for the same.72

Charaka has described two types of Avapida Nasya.

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) Samgya prabodhana : It is one type of shodhana nasya.

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

Indications :

Table No.6- Indications Avapida Nasya. 73

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 Krimi.

Procedure review


INDICATIONS OF NASYA

Charaka has described the following general indications, where Nasya therapy

should be used.74

Shirostambha Gadgadatwa

Ardhavabhedaka Vaggraha

Shirahshula Grivaroga

Akshishula Swarabheda

Shukla Roga-Netragata Galashundika

Raji Galashaluka

Timira Galaganda

Vartmaroga Upajihvika

Pinasa Manyastambha

Nasa Shula Ardita

Danta Stambha Apatantraka

Danta Shula Apatanaka

Danta Harsha Karnashula

Danta Chala Arbuda

Hanugraha Skandharoga

Mukharoga Amsashula

Procedure review


CONTRAINDICATION OF NASYA

Table No.7 Contra Indications of Nasya mentioned in Brihatrayiee have been

tabulated below :75,76,77

Sr. Nasya arha Charaka Sushruta Vagbhata 1 Bhuktabhakta + + + 2 Ajeerni + + - 3 Pita Sneha + + + 4 Pita Madya + + + 5 Pita Toya + + + 6 Snehadi Patukamah + - + 7 Snatah Shirah + - + 8 Snatukamah + + + 9 Kshudharta + - + 10 Shramarta + + - 11 Matta + - - 12 Murcchita + - - 13 Shastradandahrita + - - 14 Vyavayaklanta + - - 15 Vyayama klanta + +(Shranta) - 16 Pana klanta + - - 17 Navajwara Pidita + - - 18 Shokabhitapta + - - 19 Virikta + - +(Shuddha) 20 Anuvasita + +(DattaBasti) +(Datta Basti) 21 Garbhini + + + 22 Navapratishyaya arta + - - 23 Apatarpita - + +(Shuddha) 24 Pitadravah - + + 25 Trishnarta + + - 26 Gararta - + + 27 Kruddha - + - 28 Bala - + - 29 Vruddha - + - 30 Vegavarodhitah - + + (Vegarta) 31 Raktasravita - - + 32 Sutika - - + 33 Shwasapidita - - + 34 Kasapidita - - +

Procedure review


SUITABLE TIME FOR GIVING NASYA

Charaka have opined that generally Nasya should be given in Pravruta, Sharada

and Vasanta Rutu.78 But 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. 8.

Time schedule according to different seasons : 79

Slno 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

Table No. 9. Time schedule in DoshajaVikara should be as below. 80

Solano Doshaja Vikara Nasya to be given at 1 Kaphaja Vikara Morning 2 Pittaja Vikara Noon 3 Vataja Vikara Evening

Sharangadhara has followed the same as per Sushruta. He further states that – Nasya

can be given in night, if the patient is suffering from Lalasrava, Supti, Pralapa,

Putimukha, Ardita, Karnanada, Trushna, Shiroroga and such conditions like excessive

vitiated Doshas.81

TABLE No. 10 COURSE OF NASYA KARMA

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

Procedure review


Charaka

Charaka has suggested administering nasya according to the severity of

disease….

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 he suffers. 82

Vagbhata

Nasya Karma may be given for seven consecutive days. In conditions like Vata

Desha in head, hiccough, loss of voice, Manyastambha, Apatanaka etc. it may be done

twice a day (in morning and evening). 83

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 Samgraha.84

Bhoja ref. 85

Bhoja says that if Nasya is given continuously beyond nine days then it

becomes Stamya to patients and if given further, it neither benefits nor harms the

patients.

Age limit 86-87

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Nasya should not be administered in those who are less than 7 years & more than

80 years of age. Pratimarsha can be given throughout life just like matrabasti.

DOSE OF NASYA

Procedure review


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

Vagbhata have mentioned the dose in form of Bindu (drops), here one Bindu means

the drop which smears after dipping the two phalanges of Predestine (index) finger in

oil.88

Table. No.11 Showing The Dosage of Nasya Karma

Drops in each Nostril No.

Type of Nasya Rhaswa

Marta Madhyama Matra

Uttam Matra

1 Shamana Nasya 8 16 32 2 Shodhana Nasya 4 6 8 3 Marsha Nasya 6 8 10 4 Avapida Nasya (Kalka Nasya) 4 6 8 5. Pratimarsha Nasya 2 2 2

PROCEDURE:

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

Purva Karma

Pradhana Karma

Paschat Karma

Purva Karma :

Prior to Nasya karma, it is advisable that all materials, drugs and equipments

necessary for Nasya karma are collected in sufficient quantity.

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 properly. 89

Nasya Asana :

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

A chair for sitting purpose

Procedure review


A cot for lying purpose

Procedure review


Nasya Aushadhi :

Drug required for Nasya karma in the form of Kalka, Churna, Kwatha,

Ksheera, Udaka, Sneha, Asava etc. should be collected in sufficient quantity.

Table No. 12 Nasya Yantra : It should be collected according to the types of

Nasya such as :

A dropper or Pichu For Snehana, Avapida, Marsha and Pratimarsha Nasya.

Shadangula Nadi For Pradhamana 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 :

After passing natural urges,abhynga should be done to urdhava jatru pradesha

,followed by mrudu swedana.The eyes should be protected while doing swedana karm

by covering it with cotton cloth. Mrudu Svedana may be given for elimination of

Doshas and liquification of Doshas. Tapa sveda may be given on Shira, Mukha, Nasa,

Manya, Griva and Kantha region. Cloth dipped in hot water may be useful for Mrudu

Sveda.After Svedana smooth massage should be applied on regions of Gala, Kapola

and Lalata.

Pradhana Karma :

The procedure to be adopted for the Nasya karma is described here as per

the statements of Charaka, Vagbhata and Susrutha. 90abc

Procedure review


Posture of The Patient :

The patient should lie down in supine position with ease on Nasya table. Shira (head)

should be “Pralambita” and foot part is to be slightly raised. Head should not be

excessively flexed or extended. If the head is not lowered, the nasal medication may

not reach to the desired distinction and if it is lowered too much, there may be the

danger of getting the medication to be lodged in brain. After covering the eyes with

clean cotton cloth, 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

dropped in both the nostrils alternately, with the help of proper instrument like pichu,

dropper, shadangula nadi etc. according the type of Nasya. The drug should be proper

in dose and temperature.

The patients should remain relaxed at the time of administration of nasya and

should avoid speech, anger, sneezing, laughing and shaking his head.91

Pashchat Karma:

According to Brihatrayees following regimen should be followed after

administration of Nasya. Patient is asked to stay in same position till 100 matras i.e. 2

min approx. Later feet, shoulders, palms and ears should be massaged. Again mridu

tapa sweda should be done on forehead, cheeks and neck. For pacifying Vata dosha,

Rasna churna is rubbed on head.92,93

The patient is asked to expel out the drug which comes in oropharynx. Care

should be taken that no portion of medicated oil is left behind.

Medicated Dhumpana and Gandusha are advocated to expel out the residue

mucous lodged in Kantha.94.Laghu and sukhosna jala are advised.95. Patient is advised

not to expose to cold wind, dust, smoke, sunshine. He should avoid head bath, anger,

riding, excessive intake fat and liquid diet. 96A light meal and lukewarm water are

advised. Acharya Charaka further says that the patient should avoid day sleep and

should not use cold water for any purpose like pana, snana, etc.

Procedure review


SAMYAK YOGA, AYOGA AND ATIYOGA OF NASYA KARMA :

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) are considered as samyaka nasya laxanas. To

that, Sushruta includes Sukhaswapna-prabodhana (good sleep and awakening), Chitta-

Indriya-prasannata (mental and sensorial happiness) and Vikaropashama

(Improvement). Besides these Sukhochhvasa (proper respiration) and sneezing have

been described by Vagbhata .

Table.No.13 Showing Samyaka Yoga Lakshana 97-101

Symptoms Ch. Su. As. H. Sha. B. P. Ka. Urah Laghuta + - - - + - Shiro Laghuta + + - - - - Netra Laghuta - + + - + Laghuta - - - + - Srotovishuddhi + + - + + + Swaravishuddhi - + - - - Vaktravishuddhi - + - - - Indriya achchta-prasada + + - + + + Netrateja Vriddhi - + - - + Chitta Prasada - + - + + + Vikaropashama - + - + + - Sukha Swapna Prabod ha - + + - - - Sukhochhvasa - + - - - - Smruti - - - - - + Medha - - - - - + Bala - - - - - +

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 Nishthivana102 (excessive spitting). According to Sushruta, Kandu

(Itching), Upadeha (feeling of wetness), Guruta (heaviness), Srotasam Kapha Srava

(excess mucus secretion in channels) are the symptoms of Hina Shuddhi103. Vitiation

of Vata, dryness in Indriya, no relief in the symptoms of the disease 104, dryness in

mouth and nose are other symptoms of Ayoga of Nasya karma.

Procedure review


Table No. 14. Ayoga Lakshana 105-109

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 Srotasam kaphasrava + - - + + + 11 Navasota - + - - - - 12 Asyashosha - + - - - - 13 Akshistabdhata - + - - - - 14 Shiroshunyata - + - - - - 15 Vyadhi Vrudhi - - - - - +

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) 110. Kapha Srava (Salivation), Shirahshula (headache) and Indriya Vibhrama

(confusion) are the symptoms of Atiyoga of Nasya 111. Mastulungagamana,

Vatavriddhi, Indriyavibhrama and Shiroshunyata (emptiness of head) are also the symptoms of

Atiyoga of Shirovirechana

Table No. 15. Atiyoga Lakshana 112-116

Symptoms Ch. Su. As. H. Sha. B.P. Ka. Shirogaurava - + + + + - Shiroshunyata - + - + + - Shirovedana + - - - - + Netra Vedana + - - - - - Shankhavedana + - - - - - Suchitodavata Pida + - - - - - Indriya Vibhrama - + - + + + Mastulungagamana - + - - - - Snehapurna Srotasa - - - - + - Karna Talu Upadeha - - - - - - Vata Vriddhi + - - - - + Kandu - + - - - - Praseka - + + + - - Pinasa - + - - - - Aruchi - - + - - -

Procedure review


Deha Daurbalya - - - - - + Unmada - - - - - - Pitta Vriddhi - - - - - - Hridaya Shula - - - - - - Suryavarta Roga - - - - - - Atripti - - - - - -

Vyapada :

Nasya vyapada (complication) occurs due to:

♦ If patient breaches the protocol to be followed after Nasya karma.

♦ On administration of Nasya in any contra-indicated condition.

♦ Due to technical failure by any means.

The complications occur through following two modes.

Doshotklesha : managed by Shodhana and Shamana chikitsa.

Doshakshaya : managed by Brimhana chikitsa.117

When Nasya is administered to the patient just after lunch or who is suffering

from indigestion then diseases like Kasa, Shwasa, Chhardi, Pratishyaya etc. may occur

due to obstruction of channels situated in upper part of body.

If Nasya is given in season in which it is contra-indicated for e.g. cloudy

atmosphere, then there is possibility of occurrence of Kapha roga like asthma.

Treatment :

In above-mentioned conditions treatment should be done with Kapha Nashaka

Upachara like Ushna, Tikshna Aushadha and Kapha Nashaka karma.

If Nasya is given in Krusha, Kshina (emaciated), Virikta (patient who had

taken virechana) Aura (anxious), Garbhini (pregnant lady), Vietnam kantar (exhausted

with exercise) and a thirsty person then vitiation of Vata dosha takes place which may

produce vata-vikara.

Procedure review


In this condition, Vatanashaka treatment like snehana, swedana, brumhana

should be specially done, pregnant lady should be treated with ghruta and milk 118.

If Nasya is administered in a madya pita, person having fever and in

shokabhitapta then timira roga may occur. For this ruksha, sheeta lepa and Putapaka

should be applied.

Vyapada Due To Technical Failure:

This can occur in following conditions -

1) If the drug used for Nasya is very hot or cold.

2) The dose is not proper i.e. very less or in excess quantity.

3) If the posture is not proper i.e. patient has lowered his head more during

Nasya. In such conditions complications like Trishna and Udgara occur. Treatment

should be done according to the disease. If the patient faints at the time of Nasya he

should be treated with sprinkling of water on Lalata and Mukha. 119

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.120

Procedure review


RACHANA SHARIRA

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

In Ayurvedic classics detailed explanation about Nasa is not available.

Sushruta has mentioned it as pratyanga and mentions 8 urdhwaga dhamanis among

which Gandhavaha dhamanis are included.126

Importance of Indriaya-Pancha-panchaka:

Acharya Charaka has specified mainly the functional aspect of nose than

Anatomical aspect i.e. showing the importance of Nasa as gnyanendria. Charaka has

mentioned sense faculties for Nasa as below 127

Indriya — Ghranendriya Indria Artha --- Gandha

Indria Dravya – Prithvi Indria Buddhi --- Gandha jnana

Indria Adhishthana – Nasa

Sushruta telling importance of Indriya – pancha-panchaka, Panchabhibhuta

dhamanis have been told, i.e. the sense faculties perceive objects which are dominated

by the Mahabhuta specially constituting those respective faculties128. This tells about

Gandha gnyana / buddhi occurs, when Gandha Artha is perceived by Nasa through

particular dhamanis. Sushruta perhaps referred about particular receptors necessary

for smell. These Dhamanis have fine porous structures like stem of lotus.

Siras associated with Nose:

Procedure review


While explaining about Siras, Sushruta has mentioned 124 Vatavaha Siras

for urdhwa jatrubhaga. Among these Vatavaha Siras, 6 Siras supply to Nasika 129.

The main function of these Vatavaha Siras is to perceive the impulses of particular

sense faculties to Manas and exact gnyana / Buddhi 5occurs. Even Ashtanga

Hridayakara claims in all 24 Siras are Nasashrita & these are Gandhavedini Siras 130.

Marmas associated with Nasa:131

Phana Marma: It is Sira marma located on both sides of Nasa srotomarga internally

which is responsible for Gandha gnyana. It is a Vaikalyakara Marma. Pramana-

Ardhangula.

Shringataka Marma: It is a sira Marma. This Marma is the association of Ghrana,

Akshi, Shrotra and Jiwha Siras. This is the Sadyopranahara Marma.

Applied Anatomy of Nose 132ab

The nasal cavity is bounded by floor, roof, medical and lateral walls.

Important anatomical structures for consideration are mainly the floor and the roof.

Floor is formed by the horizontal process of the Palatine bone.

Roof is very narrow and formed by:

Nasal and frontal bones, anteriorly,

Cribriform plate of ethmoid bone in the middle, and,

Body of sphenoid, posteriorly.

The roof of Nasal cavity is formed with the superior turbinate and cribriform

plate. This is a specific plate which forms the floor of the anterior cranial fossa, having

small pores in it. This is the specific area of olfaction formed by the superior turbinate

constituted with special mucous membrane; which is called as olfactory membrane.

Procedure review


This olfactory epithelium, where olfactory receptors are located, is also called

as olfactory area. The total area of olfaction on each side is about 250mm2.

The olfactory area (epithelium) is composed of mainly the following types of

cells: Supporting (Substentacular cells)

Receptor cells and,

Basal cells

Supporting cells are columnar cells which secrete mucous. The Receptor cells

are those where one end forms into Axon and another end facing mucous layer, forms

into cilia which perceive the object (i.e., smell). These axons join together to form the

olfactory tract and the olfactory bulb.

Character of the Nasal Epithelium:

While learning Nasya Karmukata it is important to understand the

character of nasal epithelium. Olfactory mucosa occupies the olfactory portion of the

nose which extends over the upper part of septum and adjacent lateral wall up to the

superior turbinate. In each nostril, the olfactory membrane has a surface area of about

2-4 cm2 . The receptor cells for the smell sensation are the olfactory cells; which are

actually bipolar nerve cells derived originally from the C.N.S itself. There are about

100 million of these cells in the olfactory epithelium interspersed among sustentacular

cells. The mucosal end of the olfactory cell forms a knob from which 6-12 olfactory

hairs project into mucous that coats the inner cavity of the nasal cavity. These cilia /

hairs react to odors in the air and stimulate the olfactory cells.

Procedure review


Stimulation of the olfactory cells:

The odorant substance coming in contact with olfactory surface first diffuses into

the mucous that covers cilia. Then it binds with a receptor protein that protrudes

through the ciliary membrane. This receptor is a long molecule that threads its way

through the membrane 7times, folding inward and outward. The odorant binds with

the portion of the receptor that fold to outside. The inside of the folding receptor, on

the other hand, is coupled to a so-called G-protein. This activates adenyle cyclase that

is attached to the inside of the ciliary membrane near the receptor cell body. This

activation in turn converts many molecules of intracellular adenosine triphosphate into

cyclic adenosine monophosphate (cAMP).This effects into a large number of sodium

ions to pour into the receptor cell cytoplasm. The sodium ions contribute positivity to

the inside of the cell membrane, thus exciting the olfactory neuron system and

transmitting action potentials into the C.N.S by way of an olfactory nerve. In addition

to the basic chemical mechanism by which the olfactory cells are stimulated, several

physical factors affect the degree of stimulation. First, only volatile substances that can

be sniffed into the nostrils can be smelled. Second, the stimulating substance must be

at least slightly water soluble, so that it can pass through the mucous to reach the

olfactory cells. And third, it is helpful to be at least slightly lipid-soluble, presumably

because the lipid constituents of the cilium membrane repel non-lipid-soluble odorants

from the membrane receptor proteins.

Procedure review


Figure no.1 Showing The Olfactory System:

Membrane Potentials and Action Potentials in Olfactory Cells:

The membrane potential of unstimulated olfactory cells, as measured by

microelectrodes, averages about -55millivolts.At this potential, most of the cells

generate continuous action potentials at a very slow rate, varying from once every

20seconds up to 2-3/ second. Most odorants cause depolarization of the olfactory cells

membrane, decreasing the –ve potential in the cell from -55 down to as low as -30

millivolts or even less. Along with this, the number of action potentials increases to

about 20 per second, which is a high rate for the minute, fraction of micrometer

olfactory nerve fibers.

Transmission of smell signals into the C.N.S:

The olfactory bulb, which is a cranial nerve 1, its an anterior outgrowth of

brain tissue from the base of the brain having a bulbous enlargement, the olfactory

bulb, at its end that lies over the cribriform plate separating the brain cavity from the


Procedure review


upper reaches of the nasal cavity. This plate has small multiple perforations through

which an equal number of small nerves pass upward from the olfactory bulb in the

cranial cavity. There is a close relationship between the olfactory cells in the olfactory

membrane and the olfactory bulb, with a short axons terminating in multiple globular

structures within the olfactory bulb called glomeruli. Through these axons olfactory

sensations transmit into C.N.S.

Mode of action of Nasya karma

According to Charaka Samhita, the drug administered through the nose enters

into the Uttamanga and eliminates the morbid Doshas residing there133.

According to Vruddha Vagbhata: 134

Drug administered through nose -the doorway to Shiras

Reaches the Shringataka marma of Head (Shiras) which is a sira marma and formed by

the Shiras of nose, eyes, kantha and shrotra

The drug spreads by the same route

Apakarshana of morbid Doshas of Urdhwajatru and expels them from the Uttamanga

Indu, the commentator of Ashtanga Samgraha, opined that Shringataka is the

inner side of middle part of head i.e. “Shiraso Antar Madhyam”.

In Charaka also while explaining the drug pathway through Nasa- has

mentioned the special structures Munja shara and Ishika. Dictionary meanings of these

words refer; Munja Shara – A sort of Grass and Ishika—A painters brush. Charaka

mentions morbid Doshas get attracted to these structures like paint instilled brush135.

In this context Sushruta has clarified that Shringataka marma is a Sira marma formed

by the union of Siras (blood vessels) supplying to nose, ear, eye and tongue . Thus we

can say that drug administered through Nasya may enter the above sira and purifies

them. Under the complications of Nasya karma, Sushruta has mentioned that


Procedure review


excessive eliminative errhine may cause Mastulunga Srava (flow of cerebrospinal

fluid out to the nose)136. Which suggest the direct relation of Nasal pathway to brain.

Drug Delivery: Nasal Route The nasal route is an attractive alternative to invasive administrations, and provides a

direct access to the systemic circulation. Certain drugs that are administered

intranasally are able to penetrate the nasal mucosa and enter the system. A rapid onset

of action is one advantage of the nasal route for the administration of systemically

acting,products.

The nose, or more precisely the nasal cavity, is the target of the

administration of a drug product. The anatomy and the physiology of the nose play a

decisive role in efficient drug administration. The nasal mucosa is much more

sensitive to external influences than the digestive mucosa in the stomach. Nasal

administration has several advantages. First, deposition of an active compound in the

nasal cavity results in avoidance of its degradation through the “first-pass”

metabolism. Second, enzymatic breakdown of the drug in the nose can be neglected.

Third, the onset of action of the drug is more rapid and even comparable to an invasive

route.

Drug review


DRUG REVIEW

The study involves two compound drugs which are explained here:-

⇒ Karpasasthyadi Taila 1

The Karpasasthyadi Taila is taken from Sahastrayoga.

⇒ Rasnaputika Taila2

The Rasnaputika taila is taken from Yogaratnakara mentioned in vatavyadhi

chikitsa

KARPASASTHYADI TAILA:

It has Karpasbeeja and Masha,Bala,Kulatha ingredients for kashaya prepararation ,

along with Ajaksheera and kalka dravyas.

Kalka dravyas:

Devdaru,Rasna,Kushta,Sarshapa,Nagara,Shatahva,Pipplimula,Chavya,Shigru,and

Punarnava.

Indications: Ardita, Apabahuka Pakshaghata,

Uses : Navana , Abhyanga , Pana.

Karpas 3:

MüÉmÉÉïÍxÉMüÉå sÉbÉÑ: MüÉåwhÉÉå qÉkÉÑUÉå uÉÉiÉlÉÉzÉlÉ:|

iÉiÉç mÉsÉÉzÉÇ xÉqÉÏUblÉÇ U£üMÚülqÉÔ§ÉuÉkÉïlÉqÉç |

iÉiÉç MühÉïÌmÉQMüÉAlÉÉW mÉÔrÉx§ÉÉuÉÌuÉlÉÉzÉlÉqÉ |

iÉiÉç oÉÏeÉqÉç xiÉlrÉSÇ uÉÚwrÉÇ ÎxlÉakÉqÉç MüTüMüUÇ aÉÑÂÇ|û ( pÉÉ.mÉë.)

Hemigosypol – seed, Oil – Cyryophyllene,pinene,Limonene

Drug review


Table no.26 Showing The Ingredients of Karpasasthyadi taila3-16

Si.no.

Name of the drug

Botanical Name Family Gana Parts

used Rasa Guna Virya Vipaka

Doshagnata

1 Karpasa

Gossypium

herbaceum Malvaceae Bruhaneeya,

Vatashamana Seed Katu Laghu, Tikshana Ushna Katu Vata

pittahara

2

Masha Phascolus mungo

Leguminosae,Papilionatate

Purishajanana Seed Madhra Guru snigdha Ushna Madh

ura

Vatahara,pitta

kaphavrdhaka

3 Bala

Sida cordifolia

Malvaceae Balya

,Brihaniya mula Madhur

a

Laghu snigdha sheet

Madhura

Vatapitthara

4

Kulattha Dolichos biflorus

Linn

Leguminoseae Ashmarighna seeds Kashay

a

Laghu,

Rooksha, Tikshna

Ushna Amla Kapha vata

shamaka

5

Devdaru Cedrus Deodara Conifereae

Katuka skanda,

stanyashodhana

kandasara Tikta Lagu.

snjgdha Ushna katu Kapha vata

shamaka

6 Rasna Pluchea

Lanceolata Composite

ae Anuvasanopa

ga Patra Tikta Guru Ushna Katu Kapha vata

shamaka 7

Kushta Saussurea luppa

Compositeae

Lekhaneeya,shukrashodhan

a, Roots

Tikta katu mada

Laghu RookshT

ikshna Ushna katu Kapha

vata hara

8 Sarshapa Brassica

campestris Cruciferae Kandughna Seed

Katu ,tikta

Laghu,Snigdha

Ushna

Katu

Kaphavatahara

9

Nagara Zingiber offiole

Zingibaeracae

Trptighna,shoola prashamana,

Rhizome Katu

Guru Ruksha, Tikshna

Ushna

Madhura

Kapha, Vata shaka

11 Shatahva

Anethum sowa Umbellifer

ae Asthapana Fruit Katu .Tikta

Laghu..ruksha,tik

shana Ushna katu

Kapha vata

shamaka 11 Pipplimu

la Piper

longum Piparacae Deepaneeya mula Laghu ,ruksha

Laghu, ruksha Ushna Katu Kapha

vatahara 12

Chavya Piparaceae

Piper chaba

shoolaprashamana kanda Katu

Laghu rooksha

Ushna

Katu

Kaphavatahara

13

Shigru

Moringa

ptyregosperma

Moringa ceae

Shirovirechana mula Katu

tikta

Laghu rooksha tikshna

Ushna katu

Kaphavatahara

14 Punarnav

a Borrhavia

diffusa

Nyctaginaceae

Swedopaga,vayasthapana,

Kasahara mula

Madhura tikta kashay

Laghu rooksha ushna katu Kaphava

tahara

Drug review

Ajaksheera:17

Rasa: Kashaya,Madhura

Veerya: Sheeta

Guna: Grahi,Laghu

Use: Raktapittatisara,Kshaya,Kasa,Jwara ,Sarvarogahara.

Rasnaputika Taila: Indications :

This can be used for nasya,shirobasti,pana in condition like

Ardita,Pakshaghata,Adhyavata,Padaharsha,Sarvagavata,Ekangavata,Pangu,Kalayakha

nja,Avabahuka,Jihvastambha,Hanustambha,Shirovata,Vishwachi,Vranayama.

Rasna:18

Botonical Name : Pluchea lanceolata

Family Name : Compositeae

Rasa : Tikta.

Veerya : Ushna.

Guna : Guru.

Dosha Karma : Kapha vata haram.

Parts used : Moola

Uses: : vata disorders. Amavata,Shotha,Udara.

Chemical composition: Proteins,quercetinn isorhamnetin,Pluchicin.

KARANJA19:

Karanja consists of dried root of Pongamia pinnata (Linn.)

Family :Fabaceae


Drug review

Gana:Kandughna,Ktuka skanda,

Rasa: Tikta.katu,kashaya

Guna: Laghu,Tikshna

Veerya: Ushna

Vipaka : Katu

Karma : Kaphavatahara,Shothahara,Bhedana

Part Used: Root bark,Stem bark,Leaves,Seeds,Seed oil.

Constituents - Karanjin, Kanugin, Demethoxy-kanugin, Pongachromene

Therapeutic uses - Krimiroga, Prameha, Yoniroga,

Dose - 1-2 g. of the drug in powder form.

Tila taila20

Botanical name : Sesamum indicum

Family : Pedaliaceae

English name : Sesamum

Part used : Seed

Synonyms : Teel oil, gingelly oil

Rasa : Madhura, Koshaya, Tikta

Guna : Guru, Snigdha

Virya : Ushna

Vipaka : Madhura

Doshaghnata : Tridoshaghna


Drug review


Actions and uses:

It is Balya, Keshya, Twachya, Dantya, Agniprada, Pachana, Vrinahar, Netrya,

Mamsadhatu pustika, Pramehahara etc

Table no.27 Showing The Ingredients of Rasna putika taila21-79

Si.no. Name of the drug


used Rasa Guna Virya

Vipaka

Doshagnata

1

Bilwa Aegle

marmelos corr.

Rutaceae

Shothahara, Arshaghna,

Asthapanapaga,Anuvasanopaga (Ch), Brihat Panchamoola

Root Kasha

ya, Tikta

Laghu, Ruksha

Ushna

K`atu

Kapha Vatasha

maka

2

Agnimanth

a

Premna Muronata

Verbernaceae

Shothahara; Shitaprashamana, Anuvasanopaga,

Root bark

Tikta, Katu, Kasha

ya, Madh

ur

Laghu, Ruksha

Ushna Katu

Kaphavatasham

aka.

3

Shonaka

Oroxylum Indian

Bignoniaceae

Shothahar,Shitaprashamna, Anuvasanopaga(ch)

Root bark

Madhur,

Tikta, Kasha

ya

Laghu, Ruksha

Ushna Katu

Kapha Vatasha

mak

4

Patala

Stereospermum

suavealens.

Bignoniaceae

Shothahara(Ch.)

Root bark

Tikta, Kasha

ya

Laghu, Ruksha

Ushna Katu

Tridoshashama

ka

5 Gambhari

Gmelina arborea

Verbenaceae

Shothahara, Virechanopaga, Dahaprashana

Root Tikta, Kasha

ya, Guru Ushn

a Katu Tridoshashama

ka 6 Brihat

i Solonum indicum

Solonaceae

Laghu, Ruksha, Tikshna

Root Fruit

Katu. Tikta


Ushna Katu

Kapha vatashamaka

7 Kantakari

Solonum Xanthaca

rpun, Solanum

Surattense

Solanaceae

Kasahara, Kanthya,

Hikkanigrahana

Root, Panchanga

Tikta, Katu


Ushna Katu

Kaphavatasham

aka

8

Gokshura

Tribulus terestris

Zygophylaceae

Mutravirechaniya, Shothahara,

Krimighana, Anuvasanopag

Fruit and

Root

Madhur

Guru, Snigdha Shita Mad

hura

Vatapittashama

ka

9 Shaliparni

Desmodium

gangetium

Leguminoceae

Papilionatae

Angamardaprashamana,Balya

panchanga

Madhura,Ti

kta

Guru,Snigdha

Ushna

Madhur

Tridoshashama

ka

10 Prishniparni

Uraria picta

Leguminoceae

Papilionatae

Shothahara.Sandhaniya,Anga

mardaprashamana

Root Madhura,Ti

kta

Lghu,Snigdha

Ushna

Madhur

Tridoshashama

ka

Drug review





Vipaka

Doshagnata

11 Shunti Zingiber

officinale zingibara

ceae

Trptighna,shoola prashamana, Deepaneeya

Rhizome Katu

Guru Ruksha, Tikshna

Ushna

Madhura

Kapha, Vata shaka

12 Maric

ha Piper

Nigrum. Piperacea

e

Shirovirechana, shoola prashamana, Deepaneeya

Fruit Katu Laghu.tikshana

Ushna Katu

Kapha vata

shamaka

13 Pippal

i Piper

longum Piperacea

e

Shirovirechana, shoola prashamana, Deepaneeya

Fruit Katu

Laghu.Snigdha,tikshan

a

Anushna

sheet

Madhura

Kapha vata

shamaka

14 Ajamoda

Carum roxburgh

ianum

Umbellifrae

shoola prashamana, Deepaneeya

Fruit Katu Laghu..ruksha,tikshana

Ushna katu

Kapha vata

shamaka

15 Shatapuspa

Anethum sowa Umbellif

ereae Asthapana Fruit Katu .Tikta

Laghu..ruksha,tikshana

Ushna katu

Kapha vata hara

16 Vidanga

Embelia Ribes Burm

Myrsinaceae

Krimighna,Trptighna, shoola

prashamna

Fruit Katu Laghu..ruksha,tikshna

Ushna katu

Kapha vata

shamaka

17

Yava Trachi

spermum Lini

Umbeliferae

Sheetprashamana Seed Katu

tikta. Laghu ruksha

Ushna katu

Kapha vata

shamaka

18

Vacha areceae Acorus calamus

Sajnasthapana,lekhaneeya,

Sheetprashamana

Bark Katu.tikta

Laghu.tikshna,s

ara

Ushana katu

Kapha vata

shamaka

19 Kusht

am Saussurea luppa

Compositeae

Lekhaneeya,shukrashodhana, Roots

Tikta katu madhura

Laghu Rooksh

a, Tikshna

Ushna katu

Kapha vata

shamaka

20 Devda

ru Cedrus

Deodara Conifere

ae Katuka skanda, stanyashodhana

kandasara Tikta Lagu.

snjgdha Ushn

a katu

Kapha vata

shamaka

21 Kulatt

ha

Dolichos biflorus

Linn

Leguminoseae Ashmarighna Seeds Kasha

ya

Laghu, Rooksha, Tikshna

Ushna

Amla

Kapha vata

shamaka

22

Kola Zizyphus sativus

Rhamnus

Depana

Kanda, phala majja

Amla, Madhura,

Kashyaya

Guru,

Snigdha, Pichila

Sheet

Madhur

Kapha pitta

shamak

24 Erand

a

Ricinus communi

s

Euphorbiaceae

Bhedaniya,swedopaga,Angamardaprashaman

a

Seeds

Madhur,katu,kash

aya

Snigdha,tikshana,sooks

hma

ushana

Madhur

Kaphavatahara

25

punaranava

Borrhavia diffusa

Nyctaginaceae

Swedopaga,vayasthapana,Kasa

hara Mula

Madhura tikta

kashay

Laghu rooksha

ushna katu Kaphav

atahara

Drug review





Vipaka

Doshagnata

26 Nirgundi

Vitex negundo

Verbenaceae

Vishaghna,Krimighna Patra katu Laghu

rooksha ushn

a katu Kaphavatahara

27

Ashwagand

ha

Withanaia

somnifera

Solanaceae

Balya ,Brihaniya Mula

Katu tikta

kashay

Sningdha

laghu

Ushna katu

Kaphavatahara

28 Varuna

Crataev a nurvala

Capparidaceae

Vatashmarinashana

,kaphashamarinashana

Mula Tikta kasha

y

Laghu rooksha

ushna katu

Kapha vatahar

a

29 Bala

Sida cordifolia

Malvaceae

Balya ,Brihaniya Mula

Madhura

Laghu snigdha sheet

Madhura

Vatapitthara

30

Shighru

Moringa ptyregosperma

Moringa ceae

Shirovirechana Mula Katu

tikta

Laghu rooksha tikshna

Ushna

katu Kaphavatahara

31

Jatamansi

Nordostayhcus

jatamannsi

Valerianaceae Sajnyasthapana Mula

Tikta kasha

y madhura

Laghu snigdha

Sheet

Katu

Tridoshahara

31 Vishatinduk

a

Strychnus nux

vomica

Loganiaceae Akshepajanana Beeja

Katu tikta

Laghu

Ushna

Katu

Kaphavatahara

32 Chavya

Pipera chaba

Piperaceae

shoolaprashamana Kanda Katu

Laghu rooksha

Ushna

Katu

Kaphavatahara

33 Manji

sta

Rubia cardifolia

Rubiaceae

Vishaghna,Jwarahara

Mula

Madhura tikta

Guru rooksha

Ushna

Katu

Kaphavatahara

34 Champak

Michelia champaka

Mangoliaceae

Pushpadi varga Twak, tikta

Laghu rooksha

Shet katu

Kaphavatahara

35 Hingu

Ferula narthex

Umbrllifareae

Sajnyasthapana,Deepaneeya

Niryasa

Katu

Laghu snigdha

Ushna

katu

Kaphavatahara

36 Shach

ara

Barleria prionitis

Acanthaceae

Vatasamshaman Moola

Tikta madhura

Laghu

Ushna

Katu

Kaphavatahara

37 Chandana

Santalum album

Santalaceae

Dahaparshamana,Vishaghna,Angamardpras

hamana

Kandasara,ta

ila

Tikta madhura

Laghu rooksha

Sheet

Katu

Kapha pittahar

a

Drug review





Vipaka

Doshagnata

38 Sarshapa

Brassica campestri

s

Cruciferae Kandughna Seed

Katu ,tikta

Laghu,Snigdha

Ushna

Katu

Kaphavatahara

39 Shata

vari

Asparaus recemosu

s Liliaceae Balya,vayastha

pana Moola

Madhur

,tikta

Guru ,snigdh

a

Sheet Katu

Kaphavatahara

40 Chitra

ka mula

Plumbago

zeylanica

plumbaginaceae

Dipaneeya,soolaprashamana,le

khaneeya, arshoghna

Root bark

Katu

Laghu ,ruksha,tikshan

a

Ushna

Katu

Vata kaphah

ara

41 Jatiphala

Myristica fragrans

Myristicaceae

Aoushadi varga

Seed,seed coat

Tikta katu

Laghu ,tikshan

a

Ushna

Katu

Kaphavatahar

42 Ushira

Vetiveria zizinoide

s

Graminae

Varnya,dahaprashamana

Root

Tikta ,madh

ur

Laghu ,rooksh

a

Sheet

Katu

Kaphapittahara

43

Badar

Ziziphus mauritina

Rhamnaceae

Hrudya,virechnopaga

Root ,leaf,fr

uit

Madhur

Amla

Guru snigdha

Sheet

Madhur /aml

a

Vata pittahar

a

44

Tagar

Valeriana wallichill

valerianaceae

Sheetprashama

na

Root

Tikta Katu, kasha

ya

Laghu snigdha

Ushana

Katu

Kapha vatahar

a

45 Haritaki

Terminalia

chebula

Combretaceae

Shothahara, vedana,

sthapana, anulomana

Phala

Kashaya

pradhana

Laghu,ruksha

Ushana

Madhur

Tridoshahara

46

Amalaki

Embelia officinali

s

Euphorbiaceae Vayasthapana Phala

Pancharasa

except Lavan

a

Guru,ruksha,sni

gdha

Sheeta

Madhur

Tridoshghna

47 Bhibhitaki

Terminalia

bellirica

Combrataceae Jwarahara Phala Kasha

ya Ruksha,

laghu Ushn

a Madhur

Tridoshara

48 Ankola

Alangium

lamarckii thwaites

Alangiaceae Krimighna Mula

Katu ,kasha

ya

TikshaSnigdha

Ushna Katu Kapapit

tahara

49 Mulaka

Raphanus sativus

Cruciferae

Moolakadi varga Kanda katu Ruksha

Ushn

a Katu Tridoshakar

50 Patha

Cissampelos

pareira

Minispermaceae

Jwarahara,Stanyashodhana Mula Tikta Laghu.

Tikshna Ushn

a Katu Kapapittahara

51 Yashtika

Glycyrrhiza glabra

Leguminoceae

Sandhaneeya jeevaneeya Mula Madh

ur Guru

snigdha sheet

a Madhur

Vatapittahar

52 Chitraka

Plumbago

zeylanica

Plumbaginaceae

Deepneeya Lekhaneeya

Mulatwaka

Katu

Laghu.ruksha,

Tikshna

Ushna katu

Kapha Vatahar

a

Drug review





Vipaka

Doshagnata

53 Duralabha

Trushnanigrahana

Fagonia cretica Zygophylaceae Panch

ang

Kashaya,tikta,mad

hr

Laghu,snigdha

Ushna

Katu

Vatapittahar

54 Twak Cinnamomum zeylanicum

Lauraceae

Trijataka Twak

Tikta, Madhura

Laghu, Ruksha, Teekshna

Ushna

Katu Vata and

Pitta

55 Ela Elettaria cardamomum

Zingiberaceae Shiro virechana Seed

Katu,Madhura

Laghu, Ruksha

sheet Madhur

Tridoshahara

56 Patra Cinnamomum tamala

Lauraceae Trijataka Patra

Tikta, Madhura

Laghu,Tikshana

Ushna

Katu Kapha Vatahar

a

57 Nagkesara Mesua

ferrea Guttiferae. Chaturjata

Stamens

(Kesara)

Kashaya,tikta

Laghu, Ruksha

Ushna

Katu Kaphapittashamaka

58 Guggulu

Commiphara Mukul

Burseraceae Sangya

Sthapana Gum Resin

Tikta, Katu

Laghu, RukshaTikshan Sukshma

Ushna

Katu Tridoshahara

Materials and methods


MATERIALS AND METHODS

Clinical trial is a way of research and is the best method to evaluate therapy

involved in the line of treatment. In todays scenario the Ayurvedic therapeutic

approach needed to be explained on rational lines.

The present study was a comparative study where the efficacy of

Karpasasthyadi taila nasya was compared with the efficacy of Rasnaputika taila

nasya.

SOURCE OF DATA:

The patients attending the OPD and IPD of S.J.I.I.M., Hospital, Bangalore who

fulfilled all the inclusion criteria were randomly selected for the study.

DIAGNOSTIC CRITERIA:

Patients with classical signs and symptoms of Charkokta Ardita with presenting main

features like-

1) Mukhardha vakrata : Dakshina/Vama

2) Sharira ardha affected : Dakshina/Vama

3) Vaksanga

INCLUSION CRITERIA:

Patients of both the sexes in the age group of 12-80 yrs. who fulfill the diagnostic

criteria were included in the study.

EXCLUSION CRITERIA:

1. Chronicity of the disease more than 1 year.

2. Pateints with occurrance of Ardita of other systemic disorders..

3. Ardita due to head injury and lesion (brain stem).

4. Ardita of infectious cause.



RESEARCH DESIGN:

After the diagnosis of Charakokta Ardita based on the above parameters, the

selected patients were subjected for the Randomised Comparative Clinical Trial as

follows-

SAMPLE SIZE AND GROUPING:

A minimum sample of 30 patients with signs and symptoms of Charkokta

Ardita were selected for the study, and they were randomly distributed into 2 groups

of 15 patients

Group A: (Standard Group) 15 patients were subjected to Karpasasthyadi Taila

Nasya.

Group B: (Trial Group) 15 patients were subjected to Rasna putika Taila Nasya

STUDY DESIGN:

Total Study duration: 28 days

Group A: Patients of this Group received nasya with Karpasasthyadi taila for 7

days. A rest of 7 days was given followed by second course for another 7 days and

follwup after seven days.

Group B: Patients of this Group received nasya with Rasnaputika taila for 7 days. A

rest of 7 days was given followed by second course for another 7 days and follwup

after seven days.

Materials required for study for each sitting:

1) Tila Taila for abhyanga

2) A dropper or pichu for Nasya.

3) A cotton strip to cover the eyes



4) spitting pit or a kidney tray

5) Hot water

6) Nasya dravya

7) Nasya table

8) Towel

Preparation of the Drugs:

Karpasasthyadi taila manufactured by Nagarjuna Pharmacy,kerala.was used for

nasya. Rasna putika taila prepared at Sanjeevini Pharmaceuticals, Kengeri-

Bangalore, after procuring the raw drugs from authentic wholesale dealer.

PREPARATION OF RASNA PUTIKA TAILA:

Kashaya:

Dashmoola,bala,davdaru,ashwagandha,shatavari,varuna,eranda,nirgundi,shigru,shacha

ra,chitramoola,ankolamoola,poonarnava,bhupilu,yava,jivanti,vishatinduka,eranada,jata

mansi,kulatha all these drugs were taken in equal quantity. Rasna is taken in same

quantity as that of total of these drugs Karanja is taken equal to sum of all the above

drugs. All the drugs collected for kashaya are boiled in 16 times of water It was

reduced up to 1/8th part of it.Later the kashaya is filtered and kept aside.

Tila taila was taken equal to One fourth part of the kashaya.It was kept

in a container and heated. After allowing it to cool, the above kashaya was added to

taila. The kalka was prepared with guggulu tagar, jatamansi, pippali,

maricha,Triphala,Chaturjataka,kachoor,vidanga,hingu,rasna,vacha,kutaki,patha,yashti,

chitraka,priyangu,pippalimula,chandana,chavya,champaka,kushta,manjishta,shatapush

pa,sarshapa,jatiphala,usheera was also added to taila. The quantity of kalka is 1/16 th

part of tila taila.



The taila with kashaya,kalka, was then heated on mild fire. The

mixture was constantly stirred, Aja Ksheera was added and heating was continued.

Constant stirring of the ingredients was maintained to prevent charring of the contents.

The process of heating was continued till the watery portion evaporated and

phenodgamana (formation of froth) was observed and the kalka formed a varti when

rolled between the fingers and did not stick to the finger. After confirming that the

madhyamapaka lakshanas of Tailapaka was achieved the heating was stopped and the

oil was filtered through cloth. The oil was filtered again and allowed to cool. After

cooling it was stored in a clean air tight container.

METHODOLOGY OF STUDY:

PROCEDURE FOR NASYA KARMA:-

The procedure of Nasya karma is classified under following heading:

Purva Karma

Pradhana Karma

Paschat Karma

Purva Karma :

All materials, drugs and equipments like napkin, utensils necessary for Nasya karma

were collected in sufficient quantity prior to Nasya karma. Nasya was performed in

‘Nasya room’ located in Panchakarma theater,place having sufficient day light & is

devoid of direct atmospheric influences like dust, wind, etc.

Nasya Asana: A cot for lying purpose was kept in special room.

Nasya Aushadhi Nasya taila was taken in sufficient quantity.



Preparation of the Patient:

Patient was advised to attend the natural urges. Patients were asked to be

seated on ‘Nasya pitha’ comfortably for Snehana purpose. Then snehana i.e. Mrudu

abhyanga with Tila taila was done on scalp, forehead and particularly over neck region

for 3 to 5 minutes. After Abhyanga, sthanika Swedana i.e. was done on Shira,

Mukha, Nasa, Manya, Greeva and Kantha pradesha.

Pradhana Karma:

Patient was advised to lie down in supine position on Nasya table. The

head of the patient was lowered (Pravilambita) & was not excessively extended. After

covering the eyes with a clean cloth, the tip of patient’s nose was drawn upward by

left thumb. At the same time with the right hand 8 drops of koshna nasya taila was

administered in both the nostrils alternately. The patient was advised to remain relaxed

at the time of administration of nasya.

Pashchat Karma:

Patient was asked to stay in the same position till 100 matras i.e.

approx. 2 min. Later feet, shoulders, palms and ears were massaged. Again mrudu

tapa sweda was done on forehead, cheeks and neck. The patient was asked to expel out

the drug which comes in oropharynx. Gandusha with koshna jala was advocated to

expel out the residue mucous lodged in Kantha.

Special advise was given to all patients regarding the diet, i.e. –

a. Patients were advised to take light meal and lukewarm water.

b. To avoid cold food & drinks.

c. Prohibition of intake of salad.

d. curd should be excluded completely from the diet.



Vihara :

Advise was given to all patients regarding vihara

a) Avoid exposure to cold wind, dust, smoke, sunshine.

b) Patient was advised not to take head bath, and to avoid riding, excessive

c) talking, anger, sneezing, laughing and shaking his/her head.

d) Advised to always cover their ears & head.

e) Minimum 6 hrs. of sleep was advised.

f) Day sleep was prohibited.

Pathyapathya:

The patients were advised to follow the general Pathypathya for Ardita.

ASSESSMENT CRITERIA:

The assessment of the disease were done by scoring method. The patients were

assessed on the first day (before starting the treatment) & after completion of the first

course of treatment,before initiation and after completion of second corse and follow

up in both the groups.

Grade Definitation.

I. Normal Symmetrical function in all areas.

II. Slight weakness: noticeable only on close inspection.

- Compelte eye closure with minimal effort.

- Slight asymmetry of smile with maximal effort.

- Synkinesis barcly noticeable, contracture or

spasm absent.



III. obvious weakness, but not disfiguring

- may not be able to lift eyebrow.

- complete eye closure and strong but

asymmetrical mouth movement with a maximal

effort.

- Obvious, but not disfiguring synkinesis, mass

movement or spasm.

IV. Obivous - Inability to lift eye brow.

disfiguring - incomplete eye closure and

weakness asymmetry of mouth with maximal

effort.

- Severe synkinesis, mass movement, spasm.

V. Motion barely perceptible.

- Incomplete eye closure, slight movement corner of mouth .

- Synkinesis, contracture and spasm usually

absent.

VI. No movement Loss of tone, no synkinesis, contracture or spasm.

- may not be able to lift eyebrow.


CRITERIA FOR ASSESSMENT :

1. House Brackmann grading scale

BT AT BT 2 AT 2 AF Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6

2.Finger Movement

Score BT AT BT 2 AT 2 AF No 4 Slight 3 Unable to hold object 2 Able to hold with less power 1 Normal 0 3.Lifting of Arm at Shoulder

Score BT AT BT 2 AT 2 AF No 4 Up to 45 3 Up to 90 2 Up to 135 1 Up to 180 0

4. Sitting From Lying Down

Score BT AT BT 2 AT 2 AF Unable 2 With support 1 Without support 0 5.Standing From Sitting

Score BT AT BT 2 AT 2 AF Unable 2 With support 1 Without support 0



6. Drooping wrist Score BT AT BT 2 AT 2 AF Full 3 Moderate 2 Slight 1 No 0 7. Associated Signs And Symptoms (a) Loss of Speech Score BT AT BT 2 AT 2 AF Aphasia 4 Utter voice 3 Speak few words 2 Speak with difficulty 1 Normal 0 (b) Pain

Score BT AT BT 2 AT 2 AF Frequent mild type 2 After exertion 1 No pain 0

8.Muscle Tone Score BT AT BT 2 AT 2 AF Severe rigidity 3 Moderate rigidity 2 Mild rigity 1 Normal 0 9.Loss of Muscle Power

Score BT AT BT 2 AT 2 AF No active contraction 0

Visible contraction without active movement

1

Movement possible when gravity eliminated

2

Movement possible againest gravity 3 Movement possible against gravity & resistant but weaker than normal

4

Normal 5



10.Handgrip Power

Score BT AT BT 2

AT 2 AF

0 – 10 mm Hg 3 10 – 20 mm Hg 2 20 -30 mm Hg 1 30 -40 mm Hg 0

11. Increase In Walking Capacity :

BT AT BT 2 AT 2 AF Before treatment 2 times than before 3 times than before 4 times than before 5 times than before

12. Reflexes

Score BT AT BT 2 AT 2 AF Very brisk 2 Brisk 1 Normal 0

For measuring handgrip power calf of B.P. apparatus was inflated upto 20

mmHg. This was counted as 0 mmHg. After that the rise in pressure was measured.

For measuring walking capacity patient was asked to walk the possible distance in a

stipulated time of 5 minutes. It was further counted and evaluated by any increase in it.

TOTAL RESPONSE TO THE TREATMENT:

1. Marked improvement relief of >75%

2. Moderate improvement 51-75% relief

3. Mild improvement 25-50% of relief

4. No Change 0% relief


Observations


OBSERVATIONS

A total of 40 patients were screened for the study, out of which 33 patients met

the inclusion criteria. Among these 33 patients 3 patients did not apt for the study due

to various reasons. A total of 33 patients were registered for the present study. 16

patients were registered in group A, 1 patient dropped out in the middle, while 17

patients were registered in Group B, and 2 patients dropped out in the middle. The data

of 3 patients who dropped out of the study have not been included here.

All the patients were examined before and after the treatment according to the

case sheet format given in the appendix. The data recorded are presented here under

the following heading:–

I. Demographic data

II. Data related to the disease

III. Data related to over all response to the treatment

DEMOGRAPHIC DATA

Table No. 28 showing age wise distribution

No. of patients Age group Group A

Group B Total %

31-40 2 2 4 13.33 41-50 2 4 6 20 51-60 6 7 13 43.33 61-70 3 1 4 13.33 71-80 2 1 3 10


Observations


Graph No. 1

0

10

20

30

40

50

Group A Group B Total %

31-4041-5051-6061-7071-80

AGE: Age groups of 31-40, and 61-70 have 13.33 patients each, while the age group

41-50 yrs had 20% ,and the age group of 51-60 yrs had 43.33% of patients, ,in 71-80

age group 10 % patients were there.

Table No. 29 Graph No. 2 Showing Sex wise distribution

01020304050607080

1st Qtr Gr. A Gr. B Total %

Male

Female

Majority of the patients (70%) were males and only 30% were females.

No. of patients Sex Group A Group B Total %

Male 8 13 21 70

Female 7 2 9 30

Table No. 30 Showing Education wise distribution

No. of patients Education Group A Group B Total %

Illiterate 3 4 7 23.3 Primary 4 3 7 23.3 High school 6 6 12 40 Graduate 1 2 3 10 Post Graduate 1 0 1 3.3


Observations


Graph No. 3

0

5

10

15

20

25

30

35

40


Illi

P

H

G

PG

Majority of the patients (40%) could read and write, while 23.33% of patients

were from primary educated group ,23.33 % patients were illetrate and 1 patient

(3.3%) was Post Graduate.

Table No. 31 Showing Occupation wise distribution Graph No. 4

0

5

10

15

20

25

30

35

GROUPA

GROUPB

TOTAL %

PL

HW

DW

FW

Majority of patients 33% were occupied with Physical labor, while 30% of

the patients were house wives, and 26% of the patients were occupied with desk.10%

of patient from field work group.

No. of patients Occupation Group A

Group B

Total

%

Physical labor

4 6 10 33

House wife 7 2 9 30Desk work 3 5 8 26Field work 1 2 3 10

Table No. 32 Showing Socio economic status Graph no 5

No. of patients Socio

economic status

Group A

Group B Total %

0

10

20

30

40

50

60

Group A GroupB Total %

UM

M

LM

P

Upper middle class 1 2 3 10

Middle 2 3 5 16.6 Lower middle class 9 9 18 60

Poor 3 1 4 13.3


Observations


The above table shows distribution of patients across society with 10% from

Upper middle class, 16.6% from middle class ,Majority of patients were from 60%

from Lower middle class & 13.3% from the poor class.

Table No. 33

Showing marital status Graph No. 6

0

20

40

60

80

100

GROUPA

GROUP TOTAL %

UM

M

No. of patients Group A

Group B

Total %

Married 15 14 29 96.6

Unmarried 0 1 1 3.3

Among 30 patients 96.6% of the patients were married and 3.3% were

unmarried.

Table No. 34 Showing Family history of STROKE Graph No. 7

020

406080

100120

A B TOTAL %

PRESENT

ABSENT

3.3% of the patients gave family history of Stroke while majority of the patients


(67%) had no family history of Stroke. Table No. 35 Showing Food habit wise distribution

No. of patients Family History

Group A

Group B

Total %

Present 1 0 1 3.3 Absent 14 15 29 96.6

No. of patients Food habit Group A

Group B

Total %

Vegetarian 4 3 7 23.3Mixed 11 12 23 76.6

Observations


Graph No. 8

0

1020

30

40

5060

70

80

A B TOTAL %

VEG

MIXED

Majority ( 76.6% )of the patients were having mixed food habits and 23.3%

were vegetarians.

Table No. 36 showing Shareerika prakruti wise distribution

No. of patients Shareerika Prakruti Group A Group B Total % Vata Kapha 5 5 10 33.33 Vata Pitta 6 6 12 40 Kapha Pitta 1 1 2 6.66 Pitta Kapha 3 3 6 20

Graph No. 9

0

5

10

15

20

25

30

35

40

GROUP A GROUP B TOTAL %

KP

VK

VP

PK

Majority of the patients (40%) belonged to Vata pitta prakruti, 33.33% patients

belonged to Vata Kapha prakruti, while 20% patients belonged to Pittakaphaja

prakruti and 6.6% Kaphapitta prakruti .


Observations


Table No. 37

Showing Manasika Prakruti wise distribution Graph No. 10

0

10

20

30

40

50

60

70


S

R

T

Majority of the patients (63%) belonged to Rajasika Prakruti and 13.33% of the

patients belonged to Satvika prakruti, while 23% patient belonged to Tamasika

prakruti.

No. of patients Manasika Prakruti Group

A Group B

Total %

Satvika 2 2 4 13.3Rajasika 9 10 19 63.3Tamasika 4 3 7 23.3

Table No. 38 Showing Sara wise distribution Graph No. 11

0

10

20

30

40

50

60

70

A B TOTAL %

Pravara

Madhyama

Avara

Majority of the patients (70%) belonged to Madhyama Sara while 26% of the

patients belonged to Avara Sara and 3.3% belonged to Pravara Sara category.

No. of patients Sara Group

A Group B

Total %

Pravara 1 0 1 3.3

Madhyama 11 10 21 70

Avara 3 5 8 26

Table No. 39 Showing Agni wise distribution

No. of patients Agni Group

A Group B

Total %

Sama 1 2 3 10 Manda 2 1 3 10 Vishama 7 6 13 43.33Teekshna 5 6 11 36.6


Observations


Graph No. 12

0

10

20

30

40

50

A B TOTAL %

Sama

Manda

Vishama

Teekshna

10% of the patients had Samagni,and Mandagni and 43.33% patients had Vishamagni

and 36.6% of the patients had Teekshnagni.

Table No. 40 Showing Koshta wise distribution

No. of patients Koshta Group

A Group B

Total %

Madhyama 7 8 15 50Mrudu 3 0 3 10Krura 5 7 12 40

Graph No. 13

0

10

20

30

40

50

60

A B TOTAL %

Madhyama

Mrudu

Krura

50% of the patients had Madhyama koshta, 40% of the patients had Krura

koshta and 10% of the patients had Mrudu koshta.


Observations


DATA RELATED TO DISEASE

Table No. 41 Showing no. of Incidence of Onset of stroke

No. of patients Incidence of

Onset of stroke Group A Group B Total % Sudden onset 12 14 26 86.6 Gradual onset 3 1 4 13.3

Graph No. 14

0

20

40

60

80

100

A B TOTAL %

sudden

Gradual

There were major no of ( 86.66% ) patients with sudden onset of stroke, 13.33% of the

patients suffered from stroke with gradual onset.

Table No. 42 Showing no. of Right/Left half of the body affected


Graph No. 15

0

10

20

30

40

50

60

A B TOTAL %

RIGHT

LEFT

No. of patients Half of the body affected Group A Group B Total % Right 4 8 12 40Left 11 7 18 60

Observations


A Total of 12 patients (40%) suffered from Loss of function of Right side of

the body, while 18 patients (60%) suffered from Loss of function of Left side of the

body.

Table No. 43

Showing duration of illness wise distribution


No. of patients Duration of Illness Group A Group B Total % 0-1Month 3 3 6 20 1–3Months 2 1 3 10 3- 6Months 6 5 11 36.67 6M -1 year 4 6 10 33.33

Graph No. 16

0

510

1520

25

3035

40

A B TOTAL %

0‐1Month

1‐3Months

3‐6Months

6M‐ 1year

Total 3 patients (10%) were having1-3 months of history of illness, while 11

patients (36.67%) had 3-6 Months history of illness and, 10 patients (33.33%) had

history of 6M -1 year and 20% patients were having 0-1 month of history of illness.

Table No. 44 showing Aharaja Nidana

60% of the patient consumed Rooksha ahara, 13.33% of the patients consumed

Sheeta ahara, 30% of the patients consumed Alpa ahara and 53.33% of the patients

consumed Laghu ahara. The pattern clearly shows that majority of the patients

consumed Vata Vardhaka ahara.

No. of patients Aharaja Nidana Group A Group B Total % Rooksha ahara 11 7 18 60 Sheeta ahara 2 2 4 13.33 Laghu ahara 10 6 16 53.33 Alpa ahara 5 4 9 30

Observations


Graph No. 17

0

10

20

30

40

50

60

A B TOTAL %

Ruksha

Sheeta

Laghu

Alpa

Table No. 45 showing Viharaja Nidana

No. of patients Viharaja Nidana Group A Group B Total % Ati vyayama 4 10 14 46.6 Ati adhva 2 5 7 23.33Ati prajagara 7 8 15 53.33Abhighata 2 1 3 10 Ati langhana 1 1 2 6.66 Bhojanottar chesta 2 4 6 20 Diva svapna 4 3 7 23.33Ati yana 2 4 6 20 Vega sandharana 3 4 7 23.33

Graph no.18

0

10

20

30

40

50

60

Group A GroupB Total %

Ati vyayama

Ati adhva

Ati prajagara

Abhighata

Ati langhana

Bhojanottar chesta

Diva svapna

Ati yana

Vega sandharana


Observations


Majority of patients are having Atiprajagarana 53.33%, Ativyayama is seen in

46.66% ,Bhojanottar chesta and Atiyana are seen in 20% patients. Vega sandharana

and Diwaswapna 23.33%,Abhighata 10% ,Atilanghana is seen in 6.66% pf patients.

Table No. 46 showing Manasika Nidanas Graph no. 19

No. of patients Manasika Nidana and other Nidana Group A Group B Total % Chinta 10 7 17 56.66 Shoka 3 0 3 10 Krodha 6 6 12 40 Bhaya 0 1 1 3.33

0

10

20

30

40

50

60


Chinta

Shoka

Krodha

Bhaya

In 40% of the patients Krodha was observed, while 56.66% of the patients had

Chinta, and in 10% of patients shoka as manasika nidana was observed. Bhaya was

observed in 3.33% of the patients.

Table No. 47 showing Presenting history of hypertension Graph no.20

No. of patients History of hypertension Group

A Group B

Total %

Present 12 9 21 70Absent 3 6 9 30

0

10

20

30

40

50

60

70


Present

Absent


Observations


In 70% of the patients history of hypertension was observed, while 30% of the

patients were not having such history of hypertension.

Table No. 48 showing Presenting nature of sleep in stroke patients

No. of patients Nature of sleep Group

A Group B

Total %

Good 3 4 7 23.33 Disturbed 12 11 23 76.66

Graph no.21

0

10

20

30

40

50

60

70

80


Good

Disturbed

The nature of sleep was disturbed in 76.66% in stroke patients.while in 23.33% were

having good sleep.

Table No. 49 showing Presenting vysana as etiological factors in stroke patients

No. of patients Type of

vyaasana Group A

Group B

Total %

Alcohol 4 7 11 36.66Smoking 2 3 5 16.66Betel 2 3 5 16.66Tobacco 3 4 7 23.33


Observations


Graph no.22

05

10152025303540

GROUP GROUP B TOTAL %

Alcohol

Smoking

Betel

Tobacco

In majority of patients Alcohol consumption(36.66%) was seen,Betel and Smoking

habits were seen in 16.66% patients each. Where in 23.33% patients Tobacco habit

was seen.

Table No. 50 Showing analysis of Nasyakarmukata Graph no.23

0

10

20

30

40

50

60

70

80

A B TOTAL %

Sukhauchvasa

Sukhaswapan

Sukha Bodha

Akshipatavam

Parameter A B Total %

Sukhauchvasa 12 8 20 66.66

Sukhaswapan 13 10 23 76.66

Sukha Bodha 10 11 21 70

Akshipatavam 8 6 14 46.66

Sukhaswapanam is in majority of patients (76.66%), Sukhauchvasam in (66.66%)

patients, Sukha Bodha 70% and Akshipatavam is seen in 46.66 % of patients.

Table No. 51 showing overall response for the treatment

Response Marked improvement

Moderate improvement

Mild improvement No Change Group

No. of patients % No. of

patients % No. of patients % No. of

patients %

Group A 01 6.66 04 26.67 07 46.66 03 20


Observations


Group B 01 6.66 04 26.67 08 53.33 02 13.33

In Group A out of 15 patients 1 patient (6.66%) showed marked improvement, 4

patients (26.67%) showed moderate improvement, 7 patients (46.66%) showed mild

improvement, and 3 patients registered no change.

Graph no. 24 over all response in group A:

0

10

20

30

40

50

% No.of Pt.

Marked

Moderate

Mild

No change

In Group B out of 15 patients 1 patient (6.66%) showed marked improvement, 4

patients (26.67%) showed moderate improvement, 8 patients (53.33%) showed mild

improvement, and a total of 2 patients (13.33%) registered no change.

Graph no. 25 Over all response in group B

0

10

20

30

40

50

60

% Total no.pt.

Marked

Moderate

Mild

No.Change

By comparing the overall response for the treatment it can be concluded that Group B

patients responded better than the Group A in case of mild improvement. In case of

marked and moderate improvement no. of patients are same in both the groups.


Results

RESULTS

1) HOUSEBRACKMAN SCALE :

a) Within group: Group 1(Karpasasthyadi taila):

Wilcoxons test was applied for within group comparision. There was no

significant improvement after first course (Z = 0.00, p=1.000), compared to

base line .There was significant improvement in Housebrackman scale after

second course (Z = -2.828, p=0.005) and at follow up (Z = -3.00, p=0.003)

compared to baseline within karpasasthyadi group.There was also a significant

reduction after follow up compared to second course.(p= 0.002)


a.The sum of negative ranks equals sum of positive rankas

H AT - BT H AT 2 - BT HAF - BT

Z 0.000a -2.828b -3.000b

Asymp. Sig. (2-tailed) 1.000 .005 .003

b.based on positive ranks

Group 2 (Rasnaputika taila): Wilcoxons test was applied for within group comparision. There was no

significant improvement in finger movement after first course (Z = .000,

p=1.000),There was significant improvement after second course (Z = -2.236,

p=0.025) and at follow up (Z = -2.236, p=0.025) compared to baseline within

Rasnaputika taila group.

H AT - BT H AT 2 - BT H AF - BT

Z .000a -2.236b -2.236b

Asymp. Sig. (2-tailed) 1.000 .025 .025



Results

b) Between the group: Graph no.26

Comparison of mean scores of Housebrackman scale before and after treatment and

follow up between Karpasasthyadi taila and Rasnaputika taila groups.

Group H BT H AT H BT 2 H AT 2 H AF HATCHN HAT2CHN HATFCHN

Karpasasthyadi thaila N=15 Mean ±SD

2.13±0.51 2.13±0.51 2.13±0.52 1.60±0.50 1.53±0.52 0.00±0.00 0.53±0.52 0.60±0.51

Rasnaputika taila N=15 Mean ±SD

2.20±0.41 2.20±0.41 2.20±0.41 1.87±0.52 1.87±0.52 0.00±0.00 0.33±0.49 0.33±0.49

0

0.5

1

1.5

2

2.5

H BT H AT H BT 2 H AT 2 H AF

GROUP A

GROUP B

HATCHN HAT2CHN HATFCHN Mann-Whitney U 112.500 90.000 82.500

Wilcoxon W 232.500 210.000 202.500

Z .000 -1.087 -1.439

Asymp. Sig. (2-tailed) 1.000 .277 .150 b.grouping variable group

There was no significant improvement in between groups after treatment and

after follow up on Mann Whitney test.

2 ) FINGER MOVEMENT :

a) Within group: Group 1(Karpasasthyadi taila):


significant improvement following first course (Z = -1.000, p=0.357)

compared to base line There was highly significant improvement in finger

movement score after second course (Z = -3.606, p=0.<001) which was


Results

maintained even after follow up (Z = -3.500, p=<0.001) compared to baseline

within karpasasthyadi group.

F AT - BT F AT 2 - BT F AF - BT

Z -1.000b -3.606b -3.500b

Asymp. Sig. (2-tailed) .317 .<001 .<001



b.based on positive rank

Group 2(Rasnaputika taila): Wilcoxons test was applied for within group comparision. There was

significant improvement in finger movement following first course (Z = -

2.449, p=0.014).There was highly significant improvement after second

course (Z = -3.494, p=<0.000) and which was maintained after follow up (Z

= -3.494, p=<0.000) compared to baseline within Rasnaputika taila group.

F AT - BT F AT 2 - BT F AF - BT

Z -2.449b -3.494b -3.494b

Asymp. Sig. (2-tailed) .014 <0.001 <0.001



b) Between groups : Comparison of mean scores of finger movement before

and after treatment and follow up between Karpasasthyadi taila and

Rasnaputika taila groups.

Group F BT F AT F BT 2 F AT2 F AF FTCHN FTCHN2 FTCHNFP


3.07±0.89 3.00±0.86 2.87±0.91 2.20±0.78 2.13±0.83 0.07±0.26 0.87±0.35 0.93±0.46


3.13±0.91 2.73±1.03 2.73±1.03 2.00±1.00 2.00±1.00 0.40±0.51 1.13±0.52 1.13±0.51

Results

Graph no.27

0

0.5

1

1.5

2

2.5

3

3.5

F BT F AT F BT2 F AT2 F AF

GROUP A

GROUP B

There was significant improvement in finger movement between groups after first

treatment(Z=-2.122 p= 0.034) and no significant improvement after second treatment

and followup on Mann Whitney test compred to baseline.

Test Statisticsb

FTCHN FTCHN2 FTCHNFP

Mann-Whitney U 75.000 85.500 92.500 Wilcoxon W 195.000 205.500 212.500 Z -2.122 -1.606 -1.122 Asymp. Sig. (2-tailed) .034 .108 .262

b.grouping variable group

3) LIFTING OF ARM:

Within group: Group 1(Karpasasthyadi taila):


significant improvement following first course (Z = -1.414, p=0.157),

compared to base line.There was highly significant improvement after second

course (Z = -3.464, p<0.001) and which was maintained even after follow up

(Z = -3.357, p< 0.001) compared to baseline within karpasasthyadi group.


Results




Group 2(Rasnaputika taila): Wilcoxons test was applied for within group comparision. There was

significant improvement in following first course (Z = -2.236, p=0.025

compared to base line.and highly significant improvement after second course

(Z = -3.176, p=<0.001) and which was maintained even after follow up (Z =

-3.176, p=<0.001) compared to baseline within Rasnaputika taila group.



a) Between groups : Comparison of mean scores of lifting of arm before and

after treatment and follow up between Karpasasthyadi taila and


LA AT - BT LA AT 2 - BT LA AF – BT

Z -1.414b -3.464b -3.357b

Asymp. Sig. (2-tailed) .157 .001 .001

LA AT - BT LA AT 2 - BT LA AF – BT

Z -2.236b -3.176b -3.176b

Asymp. Sig. (2-tailed) .025 .001 .001

Group LA BT L A AT LA BT2 L A AT2 LA AF LABTCHN LABTCHN2 LABTCHNFP


3.67±0.49 3.53±0.51 3.47±0.64 2.87±0.64 2.80±0.68 0.13±0.35 0.80±0.41 0.87±0.52


3.73±0.46 3.40±0.63 3.27±0.79 2.67±0.90 2.67±0.90 0.33±0.49 1.07±0.70 1.07±0.70

Results

Graph no.28

0

0.5

1

1.5

2

2.5

3

3.5

4

LA BT LA AT LA BT 2 LA AT2 LA AF

GROUP A

GROUP B

There was no significant improvement in lifting of arm between groups after first

course of treatment and second course of treatment and after followup on Mann

Whitney test.

Test statisticsb

LABTCHN LABTCHN2 LABTCHNFP

Mann-Whitney U 90.000 88.500 94.500

Wilcoxon W 210.000 208.500 214.500

Z -1.273 -1.195 -.871

Asymp. Sig. (2-tailed) .203 .232 .384


4 ) SITTING FROM LAYING DOWN :

a) Within group:

Wilcoxons test was applied for within group comparison. There was no

significant improvement following first course (Z = 0.00 p=1.00) and after second

course (Z = -1.633, p=0.102) and even after follow up (Z = -1.633, p=0.102)

compared to baseline within karpasasthyadi group.

Si AT - BT Si AT 2 - BT Si AF - BT

Z .000a -1.633b -1.633b

Asymp. Sig. (2-tailed) 1.000 .102 .102




Results

Group 2(Rasnaputika taila): Wilcoxons test was applied for within group comparision. There was no

significant improvement following first course (Z = -1.414 p=0.157).After

second course there was significant improvement (Z = -2.449, p=0.014) and

at follow up (Z = -2.449, p=0.014) compared to baseline within Rasnaputika

taila group.

Si AT - BT Si AT 2 - BT Si AF - BT

Z -1.414b -2.449b -2.449b

Asymp. Sig. (2-tailed) .157 .014 .014



b) Between the group:

Comparison of mean scores of capacity of sitting from laying down before and

after treatment and follow up between Karpasasthyadi taila and Rasnaputika

taila groups.

Group SI BT SI AT SI BT2 SI AT2 SI AF SICHN SICHN2 SICHNFPKarpasasthyadi thaila N=15 Mean ±SD

0.73±0.79 0.73±0.79 0.67±0.72 0.47±0.64 0.47±0.64 0.00±0.00 0.27±0.59 0.27±0.59


0.73±0.70 0.60±0.63 0.60±0.63 0.33±0.49 0.33±0.49 0.13±0.35 0.40±0.50 0.40±0.50

Graph no.29

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

SI BT SI AT SI BT 2 SI AT2 SI AF

GROUP A

GROUP B


Results

There was no significant improvement in sitting from laying down between groups

before and after treatment and after followup on Mann Whitney test.

SICHN SICHN2 SICHNFP

Mann-Whitney U 97.500 100.500 100.500

Wilcoxon W 217.500 220.500 220.500

Z -1.439 -.580 -.580

Asymp. Sig. (2-tailed) .150 .562 .562


5) STANDING FROM SITTING:

a) Within group:

Group 1(Karpasasthyadi taila):


significant improvement following first course (Z = -1.000, p=0.317)

compared to base line There was highly significant improvement after

second course (Z = 2.449, p=0.014) which was maintained even after follow

up (Z = -2.449, p=0.014) compared to baseline within karpasasthyadi group.

St AT - BT St AT 2 - BT St AF - BT

Z -1.000b -2.449b -2.449b

Asymp. Sig. (2-tailed) 0.317 0.014 0.014




Results

Group 2(Rasnaputika taila): Wilcoxons test was applied for within group comparision. There was no

significant improvement following first course (Z = 0.00, p=1.000), There

was significant improvement after second course (Z = -2.236, p=0.025) and at

follow up (Z = -2.236, p=0.025) compared to baseline within Rasnaputika taila

group.

St AT - BT St AT 2 - BT St AF - BT

Z .000a -2.236b -2.236b

Asymp. Sig. (2-tailed) 1.000 .025 .025



b)Between the group:

Comparison of mean scores of standing from sitting before and after treatment and


Group St BT St AT St BT2 StA T2 St AF STCHN STCHN2 STCHNFP

Karpasasthyadi thaila

N=15

Mean ±SD

0.87±0.64 0.80±0.56 0.80±0.56 0.47±0.51 0.47±0.51 0.07±0.26 0.40±0.51 0.40±0.51

Rasnaputika taila

N=15

Mean ±SD

0.87±0.83 0.87±0.83 0.87±0.83 0.53±0.52 0.53±0.52 0.00±0.00 0.33±0.49 0.33±0.49

Graph no.30

0

0.2

0.4

0.6

0.8

1

St. BT St AT St BT 2 St AT 2 StAF

GROUP A

GROUP B



Results

There was no significant improvement between groups after treatment and after

followup on Mann Whitney test.

STCHN STCHN2 STCHNFP

Mann-Whitney U 105.000 105.000 105.000

Wilcoxon W 225.000 225.000 225.000

Z -1.000 -.372 -.372

Asymp. Sig. (2-tailed) .317 .710 .710


6) DROOPING OF WRIST :

a)Within group:


Wilcoxons test was applied for within group comparision. There was no significant

improvement in drooping of wrist following first course (Z = 0.00,p=1.000 )compared

to base line There was significant improvement in finger movement after second

course (Z = -2.828, p=0.005) which was maintained even after follow up (Z = -

2.828, p=0.005) compared to baseline within karpasasthyadi group.

D AT - BT D AT 2 - BT D AF - BT

Z .000a -2.828b -2.828b

Asymp. Sig.

(2-tailed) 1.000 .005


.005



Group 2(Rasnaputika taila):


improvement in drooping of wrist following first course (Z = -1.414, p=0.157),

There was significant improvement in finger movement after second course (Z = -

Results

2.00, p=0.046) which was maintained even after follow up (Z = -2.00, p=0.046)

compared to baseline within Rasnaputika taila group.

D AT - BT D AT 2 - BT D AF - BT

Z -1.414b -2.000b -2.00b

a.The sum of negative ranks equals sum of positive

rankas Asymp. Sig.

(2-tailed) 0.157 0.046 0.046


b) Between groups :

Comparison of means scores of drooping of wrist before and after treatment and


Group D BT D AT D BT2 D AT2 D AF DROPCHN DROPCHN2 DROPCHNFP


1.80±0.78 1.80±0.78 1.73±0.78 1.27±0.79 1.27±0.79 0.00±0.00 0.53±0.51 0.53±0.51


2.20±0.78 2.07±0.96 2.07±0.96 1.93±0.96 1.93±0.96 0.13±0.35 0.27±0.46 0.27±0.46

Graph no.31

0

0.5

1

1.5

2

2.5

D BT D AT D BT 2 D AT 2 D AF

GROUP A

GROUP B

There was no significant improvement in drooping of wrist between groups

after treatment and after followup on Mann Whitney test.


Results

Test statisticsb

DROPCHN DROPCHN2 DROPCHNFP Mann-Whitney U 97.500 82.500 82.500

Wilcoxon W 217.500 202.500 202.500 Z -1.439 -1.466 -1.466 Asymp. Sig. (2-tailed) .150 .143 .143


7 )LOSS OF SPECH :

a) Within group:



improvement in loss of speech following first course (Z = -1.000, p=0.317), There

was significant improvement after second course (Z = -2.029, p=0.042) and at follow

up (Z = -2.029, p=0.042) compared to baseline within karpasasthyadi group.

LS AT - BT LS AT 2 - BT LS AF - MP BT

Z -1.000b -2.029b -2.029b

Asymp. Sig. (2-tailed) .317 .042 .042





Wilcoxons test was applied for within group comparision. There was

significant improvement in loss of speech following first course (Z = -2.449,

p=0.014),second course (Z = -2.972, p=0.003) and at follow up (Z = -3.127,

p=0.002) compared to baseline within Rasnaputika taila group.

LS AT - BT LS AT 2 - BT LS AF - MP BT Z -2.449b -2.972b -3.127b Asymp. Sig. (2-

tailed) .014 .003 .002



Results

b) Between groups :

Comparison of mean scores of loss of speech before and after treatment and


Group LS BT LS AT LS BT2 LS AT2 LS AF LSCHN LSCHN2 LSCHNFP


Graph no.32

0

0.5

1

1.5

2

2.5

LS BT LS AT LS BT 2 LS AT 2 LS AF

GROUP A

GROUP B

There was significant improvement in loss of speech between groups after first

course of treatment . But there was no significant improvement after second

treatment and followup copared to first course in between groups on Mann

Whitney test. Test statisticsb


2.00±1.13 1.93±1.03 1.93±1.03 1.40±0.74 1.40±0.74 0.07±0.26 0.60±0.985 0.60±0.985


1.93±1.10 1.53±0.74 1.53±0.74 1.13±0.64 1.07±0.70 0.40±0.51 0.80±0.68 0.87±0.64

LS CHN LS CHN2 LS CHN F Mann-Whitney U 75.000 109.000 103.000 Wilcoxon W 195.000 229.000 223.000 Z -2.122 -.165 -.459

Asymp.Sig.(2-tailed) .034 .869 .646

Results

7b ) PAIN a) Within group:



improvement in pain following first course (Z = -1.414, p<0.157), After second

course there was highly significant improvement (Z = -3.317, p<0.001) and which

was maintained at follow up (Z = -3.317, p<0.001) compared to baseline within

karpasasthyadi group.





Wilcoxons test was applied for within group comparision. There was significant

improvement in pain following first course (Z = -2.00, p=0.046) and after second

course (Z = -3.162, p=0.002) and at follow up (Z = -3.162, p=0.002) compared to

baseline within Rasnaputika taila group.



b)Between groups :

Comparison of mean score of pain before and after treatment and follow up

between Karpasasthyadi taila and Rasnaputika taila groups.

PAIN AT - BT PAIN AT 2 - BT PAIN AF - BT Z -1.414b -3.317b -3.317b

Asymp. Sig. (2-tailed) .157 .001 .001

PAIN AT - BT PAIN AT 2 - BT PAIN AF - BT

Z -2.000b -3.162b -3.162b

Asymp. Sig. (2-tailed) .046 .002 .002

Results

Group PAIN BT PAIN AT

PAIN BT2

PAIN AT2

PAIN AF

PAINCHN

PAINCHN2

PAINCHNFP


Graph no.33

0

0.5

1

1.5

2

PAIN BT PAIN AT PAIN BT 2 PAIN AT 2 PAIN AF

GROUPA

GROUP B


There was no significant improvement in pain between groups after treatment and

after follow up on Mann Whitney test.

8) MUSCLE POWER :

a) Within group :

Group 1 (Karpasasthydi taila)


improvement in muscle power following first course (Z = -1.00, p=0.317), There


1.47±0.83 1.33±0.82

1.20±0.78

0.73±0.46

0.73±0.46

0.13±0.35

0.73±0.46

0.73±0.46


1.80±0.41 1.53±0.52

1.47±0.52

1.13±0.52

1.13±0.52

0.27±0.46

0.67±0.49

0.67±0.49

Test Statisticsb

PAINCHN PAINCHN2 PAINCHNFP

Mann-Whitney U 97.500 105.000 105.000

Wilcoxon W 217.500 225.000 225.000

Z -.898 -.392 -.392

Asymp. Sig. (2-tailed) .369 .695 .695

Results


was highly significant improvement after second course (Z = -3.606, p=<0.001) and

at follow up (Z = -3.500, p=<0.001) compared to baseline within karpasasthyadi

group.

MP AT - BT MP AT 2 - BT MP AF - BT

Z -1.000c -3.606c -3.500c

Asymp. Sig. (2-tailed) .317 P<0.001 P<0.001



c. Based on negative ranks.

d. Wilcoxon Signed Ranks Test



improvement in muscle power following first course (Z = -1.342, p=0.180), There

was highly significant improvement after second course (Z = -3.274, p=0.001) and

at follow up (Z = -3.274, p=0.001) compared to baseline within Rasnaputika taila

group.

MP AT - BT MP AT 2 - BT MP AF - MP BT

Z -1.342c -3.274c -3.274c

Asymp. Sig. (2-tailed) .180 P<0.001 P<0.001



B) Between groups : Comparison of mean scores of Muscle power before and after

treatment and follow up between Karpasasthyadi taila and Rasnaputika taila

groups.

Results

Group MP BT MP AT MP BT 2 MP AT 2 MP AF MPCHN MPCHN2 MPCHNFP

1.47±0.99 1.53±0.99 1.67±1.04 2.33±0.98 2.40±0.99 -.07±0.26 -.87±0.35 -.93±0.46 Karpasasthyadi thaila

N=15 Mean ±SD

1.07±1.03 1.27±0.96 1.27±096 2.07±0.96 2.07±0.96


Graph no.34

0

0.5

1

1.5

2

2.5

3

MP BT MP AT MP BT 2 MP AT 2 MP AF

GROUP A

GROUP B

There was no significant improvement in muscle power between groups after

treatment and after followup on Mann Whitney test.

-.20±0.56 -1±.0.76 -1.00±0.76Rasnaputika taila

N=15 Mean ±SD

Test Statisticsb

MPCHN MPCHN2 MPCHNFP Mann-Whitney U 104.500 107.000 112.500

Wilcoxon W 224.500 227.000 232.500

Z -.637 -.309 .000

Asymp. Sig. (2-tailed) .524 .757 1.000

9 ) HAND GRIP POWER :

a) Within group:



improvement in hand grip power following first course (Z = -1.00, p=0.357), There

Results

was highly significant improvement after second course (Z = -3.317, p=0.001) and

at follow up (Z = -3.317, p=0.001) compared to baseline within karpasasthyadi group.

HG AT - BT HG AT 2 - BT HG AF - BT

Z -1.000b -3.317b -3.317b

Asymp. Sig. (2-

tailed) .317 .001 .001





improvement in hand grip power following first course (Z = -2.00, p=0.046) and

second course (Z = -2.714, p=0.007) and at follow up (Z = -2.714, p=0.007)

compared to baseline within Rasnaputika taila group

b) Between groups :

Comparison of mean scores of Increase in Hand grip power before, and after

treatment and follow up between Karpasasthyadi taila and Rasnaputika

taila groups.

Group HGP BT HGP AT HGP BT

2


HGP AT 2

HGP AF

HGPCHN

HGPCHN2

HGPCHNFP


2.93±026

2.8± 0.352

2.87±0.352

2.20±.0.561

2.20± 0.561

.067± 0.26

.73±0.457 .73±0.457


2.53± 0.743

2.27±0.78

2.20±0.78

1.93± 0.884

1.93±0.884

.267± 0.457

.60±0.632 .60±0.632

HG AT - BT HG AT 2 - BT HG AF - BT

Z -2.000b -2.714b -2.714b

Asymp. Sig. (2-tailed) .046 .007 .007

Results

Graph no. 35

0

0.5

1

1.5

2

2.5

3

3.5

HGP BT HGP AT HGP BT2 HGP AT 2 HGP AF

GROUP A

GROUP B

There was no significant improvement in hand grip power between groups after treatment and after followup on Mann Whitney test.

Test Statisticsb

HGPCHN HGPCHN2 HGPCHNFP Mann-Whitney U 90.000 95.500 95.500 Wilcoxon W 210.000 215.500 215.500 Z -1.445 -.822 -.822

Asymp. Sig. (2-tailed) .148 .411 .411



10) MUSCLE TONE :

a)Within group:



improvement in Muscle tone following first course (Z = -1.342, p=0.180),There was

highly significant improvement after second course (Z = -3.274, p=0.001) and which

was maintained after follow up (Z = -3.274, p=0.001) compared to baseline within


MT AT - BT MT AT 2 - BT MT AF - MP BT Z -1.342c -3.274c -3.274c

Asymp. Sig.

(2-tailed) .180 P<0.001 P<0.001



Results



improvement in Muscle tone following first course (Z = -1.00, p=0.317), There was

highly significant improvement after second course (Z = -3.606, p=<0.001) and

which was maintained after follow up (Z = -3.500, p=<0.001) compared to baseline

within Rasnaputika taila group



a) Between groups : Comparison of mean score of Muscle tone before, and

after treatment and follow up between Karpasasthyadi taila and

Rasnaputika taila groups.

Group MT BT MT AT MT BT 2

MT AT - BT MT AT 2 - BT MT AF - BT Z -1.000c -3.606c -3.500c

Asymp. Sig. (2-tailed)


MT AT 2 MT AF MTCHN MTCHN2 MTCHNFP


1.47± 0.74

1.40± 0.63 1.40±0.63 1.27±0.46 1.27±0.46 0.06±0.26 0.20±0.41 0.20±0.41


1.67±0.61 1.67±0.61 1.67±0.61 1.67±0.61 1.67±0.61 0.00±0.00 0.00±0.00 0.00±0.00

Graph no.36

0

0.5

1

1.5

2

MT BT MT AT MT BT 2 MT AT2 MT AF

GROUP A

GROUP B

There was no significant improvement in between groups after treatment and

after followup on Mann Whitney test.

.317 P<0.001 P<0.001

Results

Test Statisticsb

MTCHN MTCHN2 MTCHNFPMann-Whitney U 105.000 90.000 90.000 Wilcoxon W 225.000 210.000 210.000 Z -1.000 -1.795 -1.795 Asymp. Sig. (2-tailed) .317 .073 .073


11) INCREASE IN WALKING CAPACITY:

a) Within groups:

Group 1 (karpasasthyadi taila):


improvement in increase in walking capacity following first course (Z = -1.414,

p=0.157), There was significant improvement after second course (Z = -2.53,

p=0.011) and at follow up (Z = -2.53, p=0.011) compared to baseline within


IWC AT - IWC BT IWC AT 2 - IWC BT IWC AF - IWC BT

Z -1.414b -2.530b -2.530b





Group 2 (Rasnaputika taila):


improvement in increase in walking capacity following first course (Z = -1.732,

p=0.083),second course (Z = -2.646, p=0.008) and at follow up (Z = -2,646, p=0.008)

compared to baseline within Rasnaputika taila group.

.157 .011 .011

Results

IWC AT - IWC BT IWC AT 2 - IWC BT IWC AF - IWC BT Z -1.732b -2.646b -2.646b



a)Between group:

Comparison of mean scores of Increase in walking capacity (grades) before and after

treatment and at follow up between Karpasasthyadi taila and Rasnaputika taila

groups.

Group IWC BT IWC AT IWC BT 2



IWC AT 2 IWC AF IWCCHN IWCCHN2 IWCCHNFP


4.00±0.00 3.87±0.4 3.87±0.4 3.47±0.64 3.47±0.64 0.13±0.35 0.53±0.63 0.53±0.63


4.00±0.00 3.80±0.41 3.80±0.41 3.53±0.51 3.53±0.51 0.20±0.41 0.47±0.51 0.47±0.51

There was no significant improvement in reflexes between groups after treatment and

after followup on Mann Whitney test.

Graph no.37

3.23.33.43.53.63.73.83.94

4.1

IWC BT IWC AT IWC BT 2 IWC AT 2 IWC AF

GROUP A

GROUP B

.083 .008 .008

Results

12) REFLEXES:

a) Within Groups:

Group 1 (Karpasasthydi taila):


improvement in reflexes following first course (Z = 0.00, p=1.00),second course (Z

= -1.414, p=0.157) and at follow up (Z = -1.414, p=0.157) compared to baseline

within karpasasthyadi group.


Group2((Rasnaputika taila) :


improvement in reflexes following first course (Z = 0.00, p=1.00),second course (Z

= -1.00, p=0.317) and at follow up (Z = -1.00, p=0.317) compared to baseline within


R AT - R BT R AT 2 - R BT R AF - R BT

Z .000a -1.000b -1.000b

Asymp. Sig. (2-

tailed) 1.000 .317 .317

a. The sum of negative ranks equals the sum of positive ranks. b. Based on positive ranks.

R AT - R BT R AT 2 - R BT R AF - R BT

Z .000a -1.414b -1.414b

Asymp. Sig. (2-

tailed) 1.000 .157 .157

a. The sum of negative ranks equals the sum of positive ranks.

b. Based on positive ranks.

Results

b ) Between groups

Graph no.38

1.6

1.7

1.8

1.9

2

R BT R AT R BT2 R AT2 R AF

GROUP A

GROUP B

Group R BT R AT R AT 2 R AF R BT 2 RBTCHN RBTCHN2 RBTCHNFP

Karpasasthyadi thaila

N=15

Mean ±SD

1.93±0.26 1.93±0.26 1.8±0.41 1.8±0.41 1.93±0.26 0.93±0.35 .13±0.35 .13±0.35

Rasnaputika taila

N=15

Mean ±SD

1.8±0.41 1.8±0.41 1.73±0.46 1.73±0.46 0.7 ±0.26 1.8±0.41 .07±0.26 .07±0.26

There was no significant improvement in reflexes between groups after treatment and

after followup on MannWhitney test.


Test Statisticsb

RBTCHN RBTCHN2 RBTCHNFP

Mann-Whitney U 112.500 105.000 105.000 Wilcoxon W 232.500

225.000 225.000

Z .000

-.598 -.598 Asymp. Sig. (2-tailed) 1.000

.550 .550

b. Grouping Variable: Group

Discussion


DISCUSSION

Any hypothesis or principle, if to be proved must be discussed thoroughly

from all angles, which has been clearly stated by Charaka long back. After the

formation of a hypothesis, it has to be tested and observed by various methods and

eventually the results are obtained. All these should be well supported by proper

reasoning or logic and finally concluded. A hypothesis gets established as a principle

if the reasoning given is satisfactory, otherwise it remains as it is. Charka has very

precisely said that, even the truth may not be accepted, as it is without the logical

interpretation.

Discussion improves the knowledge and discussion with science becomes base

establishment of the concept. Thus discussion is the most essential phase of any

research work. Keeping this in view, the facts which have emerged from the study can

be studied in 4 main headings.

• Discussion on Review of literature

• Discussion on Materials and Methods

• Discussion on Observation

• Discussion on Results

Discussion on Nasya Procedure:

According to Ayurvedic Classics, Nasya therapy is the most favourable in the

diseases of urdhwajatru pradesha and first line of treatment in Ardita according to

charaka samhita.As the adhishthana of Ardita is shiras ,Nasya is considered to be

beneficial.Charak told two tupes of Navana Nasya that are Snehana and Shodhana

Discussion


Nasya .Here both the Nasya yogas are shodhana type of Nasya. Both the yogas are

mainly prepared with ushna veerya ,katu rasa pradhana dravyas.

Samprapti of vata vyaadhi is of two types , Upastambhita and Nirupastambhita.In

Upastambhita there is obstruction of Vata gati due to srotorodha. Nirupastambhita

vata vyadhis are those where there is dhatukshaya janya vata prakopa.

The incidence of cerebrovascular thrombotic lesion have involvement of vata

kapha. The incidence of cerebrovascular thrombosis is also reported to be maximum

among CVA

Among the embolic one also ,in many cases the source of embolus is

broken in pieces of atheroma which can be considered among kaphapradhana

vyadhi..Thus in majority of cases with thrombosis ,embolism,the line of treatment

should be vatakaphaghna. So,considering above said aspect,we can do Shodhana

nasya in such cases of CVA.

Discussion on Disese review:

Ardita is described in Nanatmaja vata vyadhis .Accordig to Charaka either half of face

or half of the face along with half of the body is considerd.

Sushrutachrya told only half of face.Different opinion is given by Vagbhatacharya

that is along with half of body and face, he has included adharanga also.

The Condition with involvement of half of the face along with half of the body is

worse than only half of face. Because in this condition not only speech but the routine

activity of the patient is hampered and patient becomes dependent on others for it.This

can be taken as a hemiplegic condition where the lesion is in internal capsule.The

fibers converge at this level and hence a lesion in this area causes complete hemipegia

Discussion


on the opposite side with involvement of face,commonly happened due to

embolism,thrombosis and haemorrhage.

Where in Bell’s palsy which is commonly correlated with Ardita ( Involvement of

half of face ) ,where there is the damage of 7th cranial nerve. Recovery of 7th nerve is

more likely to occur when it happens with apoplexy .This can be justified to the

chakrapani commentary where he narrated the paroxysms nature of Ardita i.e. ‘Ardito

vegitaya bhavati’

Discussion on Drug review:

Rasna vataharanam as mentioned by charaka in Agrya sangraha Rasna is shreshta

dravya for vatavyadhi.Keeping this in mind the yoga Rasnaputika taila told

vatavyadhi chiktsa in Yogaratnakara is taken for the study where the ingredients are

mainly kaphaghna ,ushna virya,katu rasa,katu vipaka properties.are used for shodhana

nasya. Karpasasthyadi taila is also used in vatavyadhis,told in sahasrayoga.

Compairing the ingredients of both the drugs we can elicit that All

ingredients of Karpasasthyadi taila are found in Rasnaputika taila except karpasa and

masha.while in Rasnaputika taila we can find more ingredients which are having

vatakaphaghna properties.

Discussion on Materials and Methods :

This is a comparative clinical study conducted on Charakokta Ardita.As per the

inclusion and exclusion criterias, patients were selected randomly. A total of 30

patients, 15 in each group with 3 dropouts were registered for the study.

Patients of Group A underwent two course of nasya with Karpasasthyadi taila,

while the patients of Group B received two course of nasya with Rasnaputika

Discussion


taila,Then both the groups were observed before and after every course of nasya.Total

duration of 28 days for completion of the treatment.

Probable Mode of action :-

Any medicine administered through the nasal route is called as Nasya according to

Ayurveda.

“ lÉÉxÉÉrÉÉÇ pÉuÉqÉç lÉxrÉqÉç | ” ( A.¾Òû. xÉÔ.

20/1 )

“lÉÉxÉÉrÉÉqÉçmÉëhÉÏrÉqÉÉlÉqÉÉæwÉkÉÇlÉxrÉÇ|”(A.xÉÇ.xÉÑ.29/2)

PURVA KARMA :

Importance of the Purva karma in Nasya karma is to facilitate drug absorption through

Nasal neurons and paranasal sinuses. In this, urdhwajatruga abhyanga causes an

impact on local blood circulation.swedana causes the dosha utklesha ,which are

further expelled by nasya procedure. The Vasodilator action over superficial surface

of the face facilitates for drug absorption. The second aspect of Purva karma; the

posture given during Nasya karma ( Pravilambita Shiras) has its relevancy in two

ways:

It creates the patency in channels of nasal cavity and Naso-pharynx,

The drug administered, reaches the upper part of the Nasal cavity and

stimulates the olfactory neuron where the actual drug is administered should remain

for momentary retention of the drug in Nasal cavity.

PRADHANA KARMA :- The provisions created by Purva karma help in the

Pradhana karma, so that the drug has a greater chance of absorption in the air sinuses.

As well as providing sufficient time for stimulating olfactory neurons.

Discussion


According to Ashtanga Samgraha Su. 29/3,

“ iÉ§ÉÉuÉxÉåÍcÉiÉqÉÉæwÉkÉqÉÇ x§ÉÉåiÉ: zÉÚÇaÉÉOûMüqÉç mÉëÉmrÉ

urÉÉmrÉ qÉÑÎklÉïÇlÉå§É´ÉÉå§ÉMülPûÉÌSÍxÉUÉqÉÑZÉÉÌlÉcÉ

qÉÑÇeÉÉSÏÌwÉMüÉÍqÉuÉÉxÉ£üÉÇ EkuÉïeÉ§ÉÑaÉiÉqÉç

uÉæMüÉËUMüqÉç xÉÑ¤qÉåzÉÑ

SÉåwÉxÉÇWûÌiÉqÉÑ¨ÉqÉÉÇaÉÉSÉmÉMüÍ¶ÉÌiÉ: |

Acharya Charaka has mentioned one specific anatomical structure named

Munja-, which is like type of grass which acts like Ishika (i.e., like a painter’s brush).

This “painter’s brush” when instilled in the paint, absorbs the paint; in the same way

the Munja structure attracts the doshas when stimulated by the particular drug (Ref.

Cha.Si. 2/ 22). The Munja structure can be thought for an olfactory bulb and the

Ishika for the numerous neurons join together to form the olfactory tract.

Indu, the commentator of Astangha Sangraha mentioned the exact sthana of the

Shringataka Marma (i.e., Shiraso Antarmadhya Murdha) which can be considered for


Discussion


the Middle Cephalic Fossa. The Middle Cephalic fossa is the region, which, in

connection with ethmoid and sphenoidal sinuses, consists of meningeal vessels,

mainly internal carotid artery, cranial nerves (3rd, 4th, 5th and 6th) and also the optic

nerve. The sphenoidal sinus is inferiorly in connection with the Naso-pharynx and

posteriorly with the brain stem. The above show the Shringataka Marma (structure

consisting of four siras in connection with four sense organs and the nerves and

vessels) can be related with the Middle Cephalic fossa. vatahara properties of the

drugs are useful to pacify the vitiated Vata, the drug spreads by the same root and

scratches the morbid doshas of Urdhwajatru and removes them from Khavaighunya &

cures the diseases.

Recently, the nasal route of administration has gained increasing consideration for

obtaining systemic absorption or brain uptake of drugs , due to the high

vascularization of the nasal mucosa . In the nasal cavity the respiratory region has the

highest degree of vascularity. The olfactory region is located in the top of the nasal

cavity and it is the only site of the body where the CNS is in contact with the external

environment. By this way drugs can be absorbed into the blood stream across the

nasal membrane of the respiratory region. Lipophilic molecules are easily transported

via a transcellular mechanism. On the other hand, polar or hydrophilic molecules pass

the nasal membrane via a paracellular mechanism that is dramatically less efficient

than the transcellular pathway.

Structure/solubility relationships (prodrugs)

The usual non-invasive approach, to improve the brain drug delivery, is to “lipidize”

the drug: the polar functional groups on the drug are masked with non-polar groups,

converting a water-soluble druginto a lipophilic “prodrug”.

Discussion


From above discussion again we can elicit that nasya plays a major role in the

management of urdhwa jatrugata diseases.

Discussion


PASCHAT KARMA :-

The absorption of the drug is also facilitated by the Paschat karma followed during the

procedure. This starts with mardana (oil massage) over the frontal, temporal,

maxillary, mastoid, and neck region. After administration of the drug, when the drug

reaches the distal ends of the air ways, the patient is asked for the Nishthivana Kriya

(spitting out of the medicine). The medicine should reach on the both sides of the

throat; otherwise the drug adsorption doesn’t occur in the siras properly (Ref; As.

Sa.Su.29). Also the light massage will produce pressure on barro receptors & may

soothen the excited nerve endings

Discussion on demographic data :

Age –

In the present study, majority of patients were from the age group of 51-60 yrs i.e.

43.33% .In 31-40 yrs of age group and 61-70 yrs group were having 13.33% each.

Least patients were seen in the age group of 71-80 years i.e. 10% only. As stroke is

seen after fourth decade of age it is evident but in this study more prevalence is seen

between 6th decade.It may be due to small sample size.

Sex:

Men are 25% more likely to suffer than women in case of evidence of stroke. The sex

wise distribution of patients reveals the same. Among 30 patients 70% of male

patients and 30 % of female patients observed.

Education:

Majority of the patients (40%) could read and write, while 23.33% of patients were

from primary educated group ,23.33 % patients were illiterate and 1 patient (3%) was

Post Graduate.

Discussion


Occupation –

Maximum patients taken up for this study were having physical labour

Occupation plays major role in the manifestation of disease. It is known fact that

persons having professions like farmers, labourers, are prone to suffer from this

disease due to excess of work which may lead to vitiation of vata. The present data

also supports these facts.

Economical status:-

In the present clinical study, among the 30 patients selected, distribution of

patients across society with 10% from Upper middle class, 16.6% from middle class

,Majority of patients were from 60% from Lower middle class & 13.3% from the poor

class. This might be due to random sampling of the patients.

Agni:

Among the 30 patients selected, 13 were having vishama agni (43.33%), 11

patients were having teekshna agni (36.6%), 3 manda agni ( 10%) & 3 ( 10%) having

samagni. So it is evident that majority of patients were having vishama agni, reveals

the involvement of the vata dosha.

Koshtha:-

In the present clinical study, among the 30 patients selected, 10% were having

mrudu koshtha , 50% madhyama koshtha & 40 having kroora koshtha (53.3%).

Duration:-

For the present clinical study, among the 30 patients selected, 6 patients

(20%) had history of 0- 1Month of illness, 3 patients (10%) had 1-3 months of

history of illness, while 11 patients (36.67%) had 3-6 Months history of illness and,

Discussion


10 patients (33.33%) had history of 6M -1 year . So it is clear that, patients suffering

since 3-6 months were seen more in duration.

Discussion on vyasana :

In majority of patients Alcohol consumption(36.66%) was seen,Betel and Smoking

habits were seen in 16.66% patients each.In 23.33% patients Tobacco habit was seen.

Alcohol in excess (more than 2 drinks a day) can contribute to hypertension

that we all know contributes directly to stroke. Alcohol can cause certain heart

problems which will contribute to stroke ( e.g.atrial fibrillation, cardiomyopathy)

There is also evidence that alcohol can inhibit coagulation and this might explain

why alcohol tends to directly relate to hemorrhagic stroke ( e.g.intracerebral

hemorrhage).

Aaharaja nidana :

60% of the patient consumed Rooksha ahara, 13.33% of the patients

consumed Sheeta ahara, 30% of the patients consumed Alpa ahara and 53.33% of

the patients consumed Laghu ahara. The pattern clearly shows that majority of the

patients consumed Vata Vardhaka ahara.

Diet Found To Be Protective In Cases of Stroke:

Diet adequate in Potassium levels is considered to be protective against stroke.

People with less Potassium are ten times more prone to Stroke (www.nalap.org).

Two tomatoes and Spinach every day gives enough Potassium.

Magnesium and high fiber diet are also found to be protective against stroke Persons

having low concentration of vitamin C are 2.4 times more prone to the development

of stroke. (www.hsph.harward.edu).

Discussion


Diet deficient in Mg has been correlated with increased incidence of stroke cases.

Anashana Ruksha ahara can be considered as those deficient in micro nutrients.The

vatavyadhi nidana told in our classics resemble the same.

Viharajanya Nidana:

Majority of patients are having Atiprajagarana 53.33%, Ativyayama is seen in

46.66% ,Bhojanottar chesta and Atiyana are seen in 20% patients. Vega sandharana

and Diwaswapna 23.33%,Abhighata 10% ,Atilanghana is seen in 6.66% pf

patients.All these nidana are vataprakopaka nidana found play a role in manifestation

of the disease.

Ati Vyayama : Excessive exercise induces damage to mitochondria and DNA of

muscle cells. Ativyayama is considered as one of the nidana of vata vyadhi. Such a

condition may predispose some or many muscle groups of a person who is already

prone to stroke.

Relation of Atmosphere and Stroke :

More cases of stroke are reported when there is drop in temperature five days

previously (www.healthandage.do). Higher air pressure and humidity are also risk

factors for stroke.All these findings strengthen the Ayurvedic concept that Sheeta kala

is the precipitating factor of Vata vyadhi and Ushna kala prevents it.

Onset :

There were major no of ( 86.66% ) patients with sudden onset of stroke, 13.33% of

the patients suffered from stroke with gradual onset.Sudden onset is seen in case of

embolism,thrombosis,cerebral haemorrhage.In case of gradual onset the causes are

tumours,meningitis,encephalitis,congenital defects.

Discussion


Manasika nidana:

In 40% of the patients Krodha was observed, while 56.66% of the patients had Chinta, and Bhaya was observed in 3.33% of the patients. Manasika nidana have a

a role in manifestation of vatavyadhi, which can be compared as like below:

Autonomic and neuro endocrine mechanisms also may underlie the relation between

anger expression and stroke risk. Prior research has shown that anger and hostility are

associated with excessive autonomic and neuroendocrine activation, especially under

conditions of stress, and in individuals who experience frequent episodes of anger. The

men who reported high levels of outwardly expressed anger also showed greater SBP

responses in anticipation of an exercise stress test, which is reflective of exaggerated

sympathetic arousal. These men also experienced a greater frequency of anger, as

indicated by higher hostility scores, and reported more stressful working conditions, as

indicated by higher scores on a measure of job demands. However, taken together,

available evidence suggests that excessive sympathetic arousal and associated

neuroendocrine activation in response to stress and frequently experienced angry

outbursts also could underlie the observed association between anger expression and

incident stroke. These and related hypotheses await additional research.

Histroy of Hypertension:

In 70% of the patients history of hypertension was observed, while 30% of the pa

tients were not having such history.Hypertension accounts for 35-50% of stroke risk.

Epidemiological studies suggest that even a small blood pressure reduction (5 to 6

mmHg systolic, 2 to 3 mmHg diastolic) would result in 40% fewer strokes. Lowering

blood pressure has been conclusively shown to prevent both ischemic and

hemorrhagic strokes. It is equally important in secondary prevention.

http://en.wikipedia.org/wiki/Hypertension

http://en.wikipedia.org/wiki/Epidemiological

Discussion


Nature of Sleep:

The nature of sleep was disturbed in 76.66% in stroke patients.while in 23.33% were

having good sleep.Atiprajagarana leads to rukshata in the body.Thus it causes

vitiation of vata.

Effect of Nasya:

Sukhaswapanam is in majority of patients (76.66%), Sukhauchvasam in (66.66%)

patients, Sukha Bodha 70% and Akshipatavam is seen in 46.66 % of patients.

Many nerve endings which are arranged in the peripheral surface of mucous

membrane, olfactory, trigeminal etc will be stimulated by Nasyadravya (the medicine

used to give nasya) and impulses are transmitted to the central nervous system. This

results in better circulation and nourishment of the organs

Over all improvement:

In Group A out of 15 patients 1 patient (6.66%) showed marked improvement,

4 patients (26.67%) showed moderate improvement, 7 patients (46.66%) showed mild

improvement, and 3 patients registered no change.

In Group B out of 15 patients 1 patient (6.66%) showed marked improvement,

4 patients (26.67%) showed moderate improvement, 8 patients (53.33%) showed mild

improvement, and a total of 2 patients (13.33%) registered no change.

Discussion on results :

The statistical analysis was done by applying Shapiro wilks test to find out

whether all the parameters were following the normal distribution or not. As all the

parameters were not following normal distribution, non parametric Mann Whitney

test is applied for between group analysis and Wilcoxons signed rank test for within

group analysis were followed.

Discussion


1.Housebrackman scale :

Both Nasya yogas showed no significant results in first course of treatment. There

was significant difference observed in group A(p=0.05) and group B (p=0.025) after

second course and follow up.This indicates the necessity of two courses of nasya for

better results.

2.Finger movement :

There was no significant difference observed in group A (p=0.317) after first course

of nasya ,but in group B (p=0.014) there was significant improvement in first course

only. Both the groups shown significant improvement after second course and follow

up.

3.Lifting of Arm :


of nasya ,but in group B (p=0.025) there was significant improvement in first course

only. Both the groups shown highly significant improvement (p=0.001) after second

course and follow up.

4.Sitting from laying down:

There was no significant difference observed in group A . In group B there was no

difference found. But after second course and follow up the results are found to be

significant with p value =0.014.

5.Standing from sitting :

There was no significant difference observed after first course of treatment in both

groups. In group B after second course and follow up the results are found to be

significant with p value 0.025 but,group A is found to be more effective as

compared to group B after second course and follow up the results are found to with

p value=0.014 which suggest more significance.

Discussion


6.Drooping of Wrist:


groups. In group B after second course and follow up the results are found to be

significant with p value 0.046 but,group A is found is more effective as compared to

group B after second course and follow up the results are found to with p

value=0.005.

7.Associated complaints :

a) Loss of Speech:


of nasya ,but in group B (p=0.014) there was significant improvement in first course.

Group A shown significant improvement (p=0.042) after second course and which

was maintained even after follow up. Group B shown more improvement after second

course and follow up ( p=0.002) .The nasya dravya acts by reaching 'Sringataka

marma' a main vital point situated on the surface of the brain corresponding to the

nerve centres, which consisting of nerve cells and fibres responsible for the function

of speech-Broca's Centre.

b) Pain :


of nasya, but there was significant improvement was observed. in group B (p=0.046)

Comparision of results of second course and follow up in both the groups reveals that

group A is highly significant (p=0.001),group B shows slightly less significant results

with p value = 0.002

Discussion


8.Muscle Power:

Both the groups shown the same results.There was no significant difference observed

after first course of treatment in both groups. After second course and follow up the

results are found to be highly significant with same p value = 0.001.

9.Hand grip Power:


of nasya, there was significant improvement was observed in group B (p=0.046)

Highly significant results was seen in group A p=0.001,where in group B p=0.007

which is significant but comparatively less than group A

10.Muscle tone :


groups.(group A p=0.18 & group B p=0.317). Results are highly significant in both

the groups after second course and follow up (p<.001)

11. Increase in walking capacity:

There was no significant improvement observed after first course of nasya in group

A(p=0.157),where in group B significant improvement observed after first course,

Second course and follow up in group B (p=0.083).In group A there was also

significant improvement observed after Second course and follow up (p=0.01)

12.Reflexes:

There was no significant improvement observed after first course, Second course

and follow up in both group.

Conclusion


CONCLUSION

The conclusion drawn from the present clinical study are as follows :

• Charakokta Ardita is defined in two terms by charkacharya as involvement of

only half of the face and with half of the body.

• The disease leads more disability to the sufferer’s in day to day activity and

hampering quality of life.

• The characteristic features of patients and disease studied shown that the disese

is more prevalent in males ,mostly affects in the later period of life,when vata

dosha is dominant.

• The complete recovery from the illness is rare ,but result of nasya showed that

it is useful to improve the functional ability add quality of living of disabled

patients.

• Here a comparative study of two navana yogas was done and found to be

effective.There was significant improvement seen in both the groups in all

parameters except in case of reflexes.

• Comparision of both the groups shown that in group B there is significant

improvement after first course in finger movement,loss of speech, pain

,handgrip power,where in group A there is significant results found in after

second course.

• The nasya treatment in both the groups was well tolerated by the patients

studied.

Suggestions for the future study:-

Study should be done on a large sample size.

A clinical study can be done with Rasnaputika taila in different indicated

disorders of this yoga.

Summary


SUMMARY

The present clinical study was undertaken to evaluate the efficacy of

Karpasasthyadin taila Nasya & Rasnaputika taila nasya in the management of

Charkokta Ardita.The present work is distributed in two sections. The first section

deals with review of literature available for Nasya procedures, disease Ardita and

Drug Review.

Procedure review covers the historical background for Nasya classification

according various Acharyas, Indications and contraindications, Schedule, Dosage,

Administration of which includes,Purva karma, Pradhana karma and Paschat karma,

Samyka yoga, atiyoga, ayoga, Vyapada and Chikitsa .

Disease review includes, Historical review Nirukti, Paribhasha, and,

Nidana, Samprapti, Roopa, Bheda, Sadhya-asadyata, Chikitsa and Pathya-pathya for

Ardita . A brief discussion based on available Modern literature was also done with

reference to the above subjects.

The second section is related to clinical trials.The clinical trial includes

materials and methodology, the clinical observations, results and discussion. The

clinical study was done on 30 patients of both sexes, between the age group of 31-70

years were selected. The patients were divided into 2 groups namely Group A and

Group B. In group A Karpasasthyadi taila Nasya & in group B Rasnaputika taila nasya

was given .Both the groups were given similar poorva & paschat karmas.

Both Nasya karma was initiated with Mrudu abhyanga with tila taila to

urdhawa jatrugata pradesha followed by swedana the pradhana karma. Koshna jala

gandoosha was given as paschat karma to both the groups.

Summary


The dosage of Nasya was followed according to Shodhana Nasya i.e. 8

drops. The assessment was done before the day of initiation of treatment and at the end

of each course and at follow-up. Thus total study duration was of 28 days.

The observations and results were tabulated and statistically analyzed with

relevant parameters like, Housebrackmann scale,muscle power,finger movement,pain &

reflexes. Both nasya yogas Showed significant improvement in Ardita except reflexes.

Statistically efficacy of group B was found superior to group A.

List of References

“A Comparitive clinical trial on two different navana yogas in Charakokta Ardita” Dept.Of P.G.Studies In Panchakarma-G.A.M.C.Bangalore-09

RFERENCES

Introduction:-

1) Sh.S.Prathama khanda 5/25

2) http;//.wikipaedia.org /Nurology

3) A.S.Su.29/3

4) A.S.Su.29/3

5) Sahastrayoga P. no.252

6) Y.R.Vatavyadhi chikitsa P.541

Procedure Review:-

1) R.V.10-16-4.

2) Valmiki Ramayana Yuddha Kanda 6/102.

3) Ayurveda ka Bruhat Itihas pp. 68

4) Ayurveda ka Bruhat Itihas pp.105-106.

5) Vinaya Pitika 6/1/1-9.

6) Cha. Sha. 8/19.

7) Cha. Chi. 3/254,255

8) Cha. Chi. 4/97-104

9) Cha. Chi. 7/48/49

10) Cha. Chi. 8/34,35

11) Cha. Chi. 9/35,56-58,65,71-79,81-82

12) Cha. Chi. 10/40-45

13) Cha. Chi. 12/17

14) Cha. Chi. 17/129-134

15) Cha. Chi. 18/142

16) Cha. Chi. 23/54-60,190,193-196,213

17) Cha. Chi. 26/137,1151-159,174,176,178,180,183-185

18) Cha. Chi. 28/78,88.98,99,124,125-128,194.

19) Cha. Chi. 9/73,75,82,83,87,97.

20) Su. Chi. 1/8,9,125,126

21) Su. Chi. 2/43

22) Su. Chi. 3/40,54,64,68

http://www.wikipaedia.org/

List of References


23) Su. Chi. 4/18,22

24) Su. Chi. 5/18,20,21,22

25) Su. Chi. 9/3

26) Su. Chi. 14/11

27) Su. Chi. 18/22,23,50

28) Su. Chi. 19/15

29) Su. Chi. 20/30

30) Su. Chi. 22/4,7,12-17,21,25,35,38,39,40,45,48.59,63,67.

31) Su. Chi. 31/3.

32) Su. Chi. 32/17

33) Su. Chi. 34/12,19.

34) Su. Chi. 36/13.

35) Su. Chi. 37/7

36) Su. Chi. 40/1,2,20-26,28-56

37) A. H. Chi. 1/125,126,150,161.

38) A. H. Chi. 2/47

39) A. H. Chi. 4/46-50

40) A. H. Chi. 5/34,37,41,42,69.

41) A. H. Chi. 6/27,74.

42) A. H. Chi. 7/104,108,110,111.

43) A. H. Chi. 20/28,33.

44) A. H. Chi. 21/17,26,30,43,44,62,63.

45) Cha.Su. 5/57.

46) Su. Chi. 40/21

47) A.S.Su.29/1

48) Cha.Si. 9/8

49) Su. Chi. 40/21

50) Su. Chi. 40/22

51) A.H. Su.20/1

52) A.S. Su. 29/2

53) A.S. Su. 29/5

54) Sha. U.K. 8/1

55) Cha.Si. 9/89-92

List of References


56) Cha.Si. 9/92

57) Cha.Vi. 8/151

58) Su. Chi. 40/21

59) Su. Chi. 40/21,22

60) A.S. Su. 29/2

61) A.H. Su.20/2

62) Ka. Si. 4/2

63) a) Sha. U.K. 8/2

b) Sha. U.K. 8/11

c) Sha. U.K. 8/24

64) Su. Chi. 40/31

65) Cha.Si. 9/97

66) Cha.Si. 9/94

67) Su. Chi. 40/23

68) Su..Su. 40/36

69) Su. Chi. 40/23,24

70) A.S. Su. 29/7

71) Sha. U.K. 8/12

72) Su. Chi. 40/44

73) Su. Chi. 40/44

74) Cha.Si. 2/22

75) Cha.Si. 2/20,21

76) Su. Chi. 40/47

77) A.H. Su. 20/11,12,13.

78) Cha. Si. 2/23

79) Cha. Si. 2/23

80) Su. Chi. 40/24

81) Sha. U.K. 8/3

82) Su. Chi. 40/42

83) A.H. Su. 20/15,16.

84) A.S. Su. 29/16

85) Su. Chi. 40/22 Bhoja Tika

86) A.H. Su. 20/30

List of References


87) A.H. Su. 20/32

88) A.H. Su. 20/9

89) Su. Chi. 40/25

90) a) Cha.Si. 9/98-104

b) Su. Chi. 40/25,26

c) A.H. Su. 20/17,22.

91) A.S. Su. 29/17

92) Cha.Si. 9/98-104

93) Su. Chi. 40/31

94) Sha. U.K. 8/47-53

95) Cha.Si. 9/108

96) Su. Chi. 40/32

97) Cha.Si. 1/51

98) Su. Chi. 40/32-33

99) A.H. Su. 20/23

100) Sha. U.K. 8/58

101) Ka. Si. 2

102) Cha.Si. 1/52

103) Su. Chi. 40/39

104) Su. Chi. 40/39

105) Cha.Si. 1/52

106) Su. Chi. 40/35

107) A.H. Su. 20/25

108) Sha. U.K. 8/59

109) Ka. Si. 2

110) Cha.Si. 1/52

111) Su. Chi. 40/34

112) Cha.Si. 1/52

113) Su. Chi. 40/34

114) A.H. Su. 20/24

115) Sha. U.K. 8/60

116) Ka. Si. 2

117) Su. Chi. 40/49

List of References


118) Cha.Si. 9/113-115

119) A.H. Su. 20/21

120) Cha.Si. 5/57-62

121) Chakradatta Vatavyadhi Adhikara sl. 23,24

122) Yogaratnakara Vatavyadhi Adhikara sl.1,2.

123) Bh. Ratnavali 26/71-72

124) G. Ni. 2nd 19/117,118

125) Sha. U.K. 8/36,37

126) Su. Sha. 9/5

127) Cha. Su.8/8-12

128) Su. Sha. 9/11

129) Su. Sha. 7/8

130) A.H. Sha. 4/30

131) Su. Sha. 6/28

132) a)Guyton book of physiology ch.41 pp no. 516

b) The Pacific Journal of Science and Technology –338–

http://www.akamaiuniversity.us/PJST.htm

133) Cha. Si. 9/88

134) A.S.Su. 29/3

135) Cha. Si. 2/22

136) Su. Chi. 40/40

Disease Review:

1) R.V.10/2/13

2) A.V.6/109/3,A.V.6/44/33

3) Ayurved ka praamanika Itihasa, page 88

4) Ch.Su. 20/11

5) Ch.su.11/63

6) Ch.chi.28/36-40

7) Ch. chi.28/98

8) Bh.S. chi.10/1

9) Bh.S/.Chi. 27/26-3

List of References


10) Ha.Trutiya sthana-23

11)Su. Ni.1/68-73

12)Su.Chi.5/22

13)Su.Ni.1/68-72 Haranachandra commentary

14)A.S.Ni 15/32

15)A.S.Chi.32/2-10

16) A.H.Ni.16/19-20

17)K.S.Su.27-28

18)K.S.Su.23/22

19)Sh.S.Pur.7/103

20)Su.S. Utt. 8/36-37

21)Bh.P.Madhyama khanada 24/60-72

22)The student’s sanskrit english dicitionary by V.S. Apte

23)Ch. Chi.28/64

24)Su.Ni.1/69

25)A.S.Ni.15/24

26)A.H.Ni.15/36

27)Bh.P.Ma. Vatavyadhi Chi.23/63

28)M.N.22

29)Y.R.Vatavyaadhi Chikitsa

30)Ha.Trutiyasthana 20/40

31)Bhel.10/1

32)Ch.Chi.28/38

33)Su.Ni.1/69

34)A.S.15/24

35)A.H.15/33

36)Bh.P.23/63

List of References


37)M.N. Vatavyaadhi 22

38)Y.R.Vatavyadhi nidanam

39) Ha.Trutiyasthana 20/43

40) Bhel.10/10

41) Ch. Chi.28/15 -18, Su.Ni.1/67-68, Ka.Vatavyadhi/12, A.H.Ni.15/32,

B.P.Vaatavyadi/60-61, Y.R.Vatavyadhi Nidana/Ardita prakarana

42) Ch. Chi. 28/38-39

43) Su. Ni. 1/68-70

44) A H. Ni. 15/32-31

45) Y.R.Vatvyadhinidana 3/5

46) Bhela.Chi. 27/27-28

47) Su.Ni.1/68

48) A.H.Ni.15/32

49) M.Ni.22

50) B.P.Vatavyadhi 23

51) A.H.Ni.15/32

52) Ch. Ni. 1/8

53) A.H. Ni.1/3

54) Su. Ni. 1/71

55) Ch. Chi. 28/38-39

56) Su. Ni.1/68-70

57) Y.R.Vatavyahi 3-5

58) Bhela S.10/10

59) Ch.Su.11/49

60) Ch.Chi.28/39-42

61) Su.Ni.1/70-72

List of References


62) A.S.Ni.15/24

63) A.H. 15/34-36

64) B.P.23 Vatavyadhi adhikara

66) Y.R. Vatavyadhi /16

67) Bhel.10/1

68) Ha.Trutiya sthana 20/40

69) B.P.23/64,

70) Y.R.Vatavyadhi/9

71) Ha.S. Trutiya stahana 20/41

72) B.P.23/65,



75) B.P.23/66,



78) Bhel S.10/10-11

79) Chakrapani commentry on Ch.Chi.28/42

80) Su.Su.33/4

81) A.H.Ni.8/30

82) Su.Ni.1/73

83) Su.Chi.5/22

84) Ch.Chi.28/99

85) A.H.Chi.21/42

86) A.S.Chi.23/23

87) B.P,23/68

88) Sh.S.Utt.8/37

89) Ch.Dt.Vatavyadhi chikitsa 17,18.

List of References


90) How to examine a patient p.431.

91) Harrison’s Pricipals of Internal Medicine Vol.2 p.1934-1940. Drug review:

1) Sahastra yoga p.252

2) Yogartnaka vatavyadhi p.541

3) D.V.Vol.2 p.630

4) D.V.Vol.2 p.393

5) D.V.Vol.2 p.734

6) Bha.Ni. p.640

7) D.V.Vol.2 p.75

8) D.V.Vol.2 p.39

9) D.V.Vol.2 p.572

10) D.V.Vol.2 p.152

11) D.V.Vol.2 p.331

12) D.V.Vol.2 p.403

13) D.V.Vol.2 p.275

14) D.V.Vol.2 p.335

15) D.V.Vol.2 p.111

16) D.V.Vol.2 p.630

17) Bha.Ni.Dugdhavarga,p.760

18) D.V.Vol.2 p.39

19) D.V.Vol.2 p. 144,Bh.Ni.p.349

20) Bha.Ni.Vol.2 p.779

21) D.V.Vol.2 p.455

22) D.V.Vol.2 p.221

23) D.V.Vol.2 p.469

24) D.V.Vol.2 p.223

25) D.V.Vol.2 p.225

26) D.V.Vol.2 p.282

27) D.V.Vol.2 p.280

28) D.V.Vol.2 p.632

29) D.V.Vol.2 p.820

List of References


30) D.V.Vol.2 p.822

31) D.V.Vol.2 p.331

32) D.V.Vol.2 p.362

33) D.V.Vol.2 p.275

34) D.V.Vol.2 p.497

35) D.V.Vol.2 p.403

36) D.V.Vol.2 p.503

37) Bha.Ni.p.640

38) D.V.Vol.2 p.28

39) D.V.Vol.2 p.572

40) D.V.Vol.2 p.75

41) Bha.Ni.p.640

42) Bha.Ni.571

43) D.V.Vol.2 p.743

44) D.V.Vol.2 p.58

45) D.V.Vol.2 p.630

46) D.V.Vol.2 p.66

47) D.V.Vol.2 p.763

48) D.V.Vol.2 p.652

49) D.V.Vol.2 p.732

50) D.V.Vol.p.111

51) D.V.Vol.2 p.31

52) D.V.Vol.2 p.83

53) D.V.Vol.2 p.335

54) D.V.Vol.2 p.800

55) D.V.Vol.2 p.721

56) D.V.Vol.2 p.350

57) D.V.Vol.2 p.185

58) D.V.Vol.2 p.715

59) D.V.Vol.2 p.152

60) D.V.Vol.2 p.562

61) J.L.N.Shastry p.314


List of References





66) D.V.Vol.2 p.753s

67) D.V.Vol.2 p. 758

68) D.V.Vol.2 p.239

69) Bh.Ni.p.365

70) Bh.Ni.p.696

71) Bh.Ni.p.394

72) D.V.Vol.2 p.253

73) D.V.Vol.2 p.359

74) D.V.Vol.2 p.319

75) D.V.Vol.2 p.250

76) D.V.p.719

77) D.V.Vol.3 p.704

78) D.V.Vol.2 p.783

79) D.V.Vol.2 p.54

Bibliography


BIBLIOGRAPAHY 1. Agnivesha. Charakasamhita, 4th edition. Varanasi: Chaukhamba Sanskrit

sansthan; 2005. (kasisanskrit series) 2. Sushruta. Sushruta Samhita, Editor Kaviraja Ambikadutta Shastri, 14th ed.Varanasi: Chaukhambha Sanskrit Sansthan; 2003. 3. Dalhana. Nibanda samgraha teeka on Sushruthasamhitha Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51). 4. Madatraya Maharshi Hareetamuni. Samvadarupa Vaidya Granth, Harita Samhita

Edited by Khemraj Shrikrishnadas, Bombay: Swakiya Venkateshwar Mudranlaya; 1984.

5. Ashtangasangraha. Prof.K.R.Srikhantamurthy, editor.Varanasi: Chaukhambha Orientalia; 1996 (Jaikrishnadas Ayurvedic series 79) 6. Vagabhatta. Astangasamgraha with sasilekha teeka, Rudra parasava 1st ed. Varanasi: Chaukhamba Krishnadas Academy; 2006. 7. Vagabhatta. Astanga hrudaya, 8th ed. Edited by Vaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia; 1998.

8. Arunadatta. Sarvangasundari teeka on Ashtangahridaya, Varanasi: Krishnadas

Academy; 1982. (Krishnadas Academic series 4).

9. Vrudhajeevaka. kashyapasamhita siddisthan,4th ed. Varanasi: Chowkambha Sanskrit sansthan; 1988.

10. Bhelasamhita, Girijadayal Shukla editor. Varanasi: Chaukhambha Vidyabhavan; 1959. 11. Madhavakara. Madhavanidana, Varanasi: Chaukhambha Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana Granthamala 46). 12. Sharangadhara. Sharangadhara samhita, 6th ed. Varanasi: Chowakambha Orientalia; 2005. (Jai. Krishnadas Ayurveda series) 13. Bhavamishra. Bhavaprakasha Purvakanda, 5th ed. Varanasi: Chaukhamba Sanskrit series ;130,1988.

Bibliography


14. Yogaratnakar with vidyatini Hindi commentary edited by Vd.Sri Laxmipati Shastri Chaukambha Sanskrit Samsthan 7th edition 1999. 15 Sahastra yoga translated by Dr.Panditrao P.V. edited by Vaidya Mahendrapal Sinha Arya, New delhi, Kendriya Ayurveda Evam AnusandhamParishad,1990. 16. Raja Radhakantha Deva Bahadur. Shabdakalpadruma,

3rded.Varanasi:Chaukambha Sanskrit Series;Chaukambha Samskrita Granthamala-93.

17. Kasture VG. Ayurvediyapanchakarmavigyan, 6th ed. Nagpur: Shree

Baidyanath Ayurved Bhavan Ltd.; 1998.

18. B.D Chaurasia Human Anatomy 3rd ed. Vol-3. New Delhi: CBS publishers and distributors; 1995. 19. Harrisons’s principles of internal medicineVol-2.; McGraw Hill book company 11th edition 1987. 20. Peter. L. Williams. Grays Anatomy, 38th ed. Philadelphia: Churchill Living Stone; 2000. 21. Bhavamishra. Bhavaprakash Nighantu, Reprinted. Varanasi: Choukhambha Bharati Academy; 1999. 22. Shastry J.L.N. Dravyaguna Vijanam vol 2, 2nd edition. Varanasi: Chaukhamba Orientalia; 2005. 23. P.V.Sharma, Dravyaguna Vijanam vol 2, Reprinted. Varanasi: Choukhambha Bharati Academy; 2003.

24. Clinical examination , 7th Edition edited by John Macleod and John Munro English language book society, Churchill Livingstone, 1988. 25. Atridev Vidyalankar. Ayurvedasya Bruhat Itihas, 1st ed. U.P. Prakashan Shakha; 1960. 26. Sri Taranath Taraka Vachaspati. Vachaspatyam, Re-edited, Varanasi: Chowkhambha Sanskrit Series office; 2003. 27. Shastri Ramgopal. Vedon mein Ayurveda, Delhi: Madan Mohanlal Ayurveda Anusandhan trust; 1956.

Bibliography


28. Martini.F.H. Fundamentals of Anatomy and Physiology, 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. 29. Williams Monier Monier Sir. Sanskrit English Dictionary, cognate Indo-European

languages. New Delhi: Motilal Banarasi Das; 1970. 30. Davidson’s Principles and Practice of Medicine 20th Edition. 31. Atmakari Vinayakumar .Ayuredic Clinical Medicine:1st Edition1997. Mcnino desouza, How to examine a patient,Varghese Publishing House 5th

Edition;1982. 32. Pachakarma Treatment of Ayurveda :Sri Sadguru Publication,First edition2002 33. www.stroke-info.com 34. www.stroke.ahajournals.org 35. www.wemove.org 36. www.brainattacks.net 37. www.strokecenter.org/trails 38. www.righthealth.com 39. www.mdpi.org/molecules 40. www.ninds.nih.gov 41. Ayurveda-foryou-com/panchakarma/nasya,html 42. stroke.ahajournals.org/cgi/content/full/strokeaha;30/3/523

Annexure


Dept.Of P.G.Studies In Panchakarma-G.A.M.C.Bangalore-09.

DEPARTMENT OF PG STUDIES IN PANCHAKAMA GOVERNMENT AYURVEDIC MEDICALCOLLEGE,BANGALORE - 09

CASE SHEET PROFOMA FOR “ COMPARATIVE CLINICAL TRIAL ON TWO DIFFERENT NAVANA YOGAS IN CHARAKOKTA ARDITA” P.G.SCHOLAR : Dr.Vijaya v. GUIDE NAME:Dr.Shylaja kumari R. Name of patient: Sl no: Age: OPD No:

Sex: M/F IPD No: Religion: H/M/C/O Bed No: Educational status: Group : Economical status: Poor/Middle/Upper middle/high Marital status: Married/Unmarried/Widow/Widower Occupation: Address: Phone No: Chief complaints: - Duration:- 1) Mukhardha vakrata : Dakshina/Vama 2) The Sharirardha affected : Dakshina/Vama 3) Vaksanga :

Annexure



Associated complaints: - Duration:- History of present illness:- Onset : History of past illness:- Family History:- Treatment History:- Case:- Fresh/Treated/Under treatment /Untreated Previous medication:-Allopathic/Ayurveda/Other Response :- No response /Mild / Moderate / Good

Annexure



Personal History:- Diet: - Type:-Veg/Nonveg/Mixed Time of intake of food:-Regular/ Irregular Quantity of food:-Less/ Moderate/More

Rasa dominance:-Madhura/Amla/Lavana/Katu/ Kashaya/Tikta

Bowel: - Frequency:- Consistency:- Micturition: - Frequency:- Sleep: - Sound/ disturbed /Divaswapna / Ratrijagarana

Habits: - Coffee/ Tea/ Smoking/ Tobacco/Betel chewing/ Drugs/ Alcohol/ Soft drinks/ Snuffing/ None Duration: Occasional/Regular/Reduced/Stopped Emotional Status: - Anxiety/ Tension/Depression/ Irritation/Anger/Fear/ Calm Type of Koshta:- Mrudu/Madhyama/Krura Type of Agni :- Mandagni/Vishamagni/Tikshnagni/Samagni Menstrual History:- Manarche ….yrs Menstrual cycle….days Regular / Iregular Menopause…. Other details:-Menorrhagia / Metrorrhagia/ Dysmenorrhea Leucorrhoea Obstetric History:- No. of delivaries….Nornal /Surgical Last delivery……..yrs back

Annexure



General Examination : - Weight -

Height - Built - Odema - Cyanosis - Clubbing - Temp - B.P - Pulse - Respiration rate -

Systemic Examination:- Respiratory System:- Cardio vascular System:- Gastro intestinal System:- Central nervous System:-

a) Higher mental functions

b) Cranial nerves :

I Olfactory : sense of olfaction II Optic : seight Field of vision Colour sense III Occulomotor : eye movements IV Trochler : ptosis Nystagmus Diplopia V Trigeminal : mandibular movements Deglutition & mastication Sensibility of face

Annexure



VI : Abducent : corneal reflex VII : Facial : Ability to close eyes Ability to raise eyebrows speech whistling test mouth inflation test

sense of taste in anterior 2/3 rd of tounge blowing test VIII Auditory : hearing vertigo

IX Glossopharngeal : pharyngeal & larengeal movements X Vagus : swalloing Voice XI Spinal accessory : elevation of shoulder XII Hypoglossal : tongue movement

c) Motor system : Nutrition of the muscles-

Mascular tone – Power of muscles – Coordination – Abnormal movements – Gait – d ) Sensory system : e ) Reflexes :

Annexure



Dashavidha pareeksha : Atura Bhoomi Desha Pareeksha:-

Jangala Desha Anoopa desha Sadharana desha

Jatha

Samvridha

Vyadhita

Atura Deha Pareeksha Prakrititaha:- Shareerika Prakriti:- Manasika Prakriti:- Sarataha:- Pravara/ Madhyama/ Avara Samhananataha:-Susamhata/ Madhyama/ Asamhata Pramanataha:-Sama/ Adhika/ Heena Satmyataha;-Ekarasa/ sarvarasa/Vyamishra Satvataha;-Pravara/ Avara/ Madhyama Ahara Shakti;-Abhyavarana :-Pravara/ Madhyama/ Avara Jarana Shakti:-Pravara/ Madhyama/ Avara Vyayama Shakti:-Pravara/ Madhyama/ Avara Vayataha;- Balya/yuva/vruddha Vikrititaha:- Hetu: :- Ahara;- Vihara:- Manasika:- Anya:- Dosha:

Annexure



Dushya: Prakruti:

Desha:

Kala:

Bala ASHTASTHANA PAREEKSHA: Nadi:vata/pitta/kapha.

Jihwa:liptata/aliptata; . Mala:badda/abadda; saama/nirama Mootra:prakruta/vikruta. Shabdha:prakruta/aprakruta. Sparsha:mrudu/khara. Druk:prakruta/vikrut Aakruti:sthula/madhyama/heena Laboratory Investigation: - Blood Investigation

Hb% T C DC ESR R B S

Urine Analysis;- Albumin

Microscopic Others if necessary

Annexure Chikitsa : 1) Group-A--- Nasya with formulation with Karpasathyadi Taila .

2) Group-B--- Nasya with formulation with Rasnaputika taila.

Group Date of initiation Date of completion 1st course 2nd course

Samyak Yoga Lakshana :

Symptoms 1st course 2nd course

Swaravishuddhi

Vikaropashama

Sukha Svapna Prabodha

Sukhochvasa

CRITERIA FOR ASSESSMENT :

1. Housebrackman scale:

House Brackmann grading scale

BT AT BT 2 AT 2

Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6



Annexure 2.Finger Movement

Score BT AT BT 2 AT 2 No 4 Slight 3 Unable to hold object 2 Able to hold with less power 1 Normal 0

3.Lifting of Arm At Shoulder

Score BT AT BT 2 AT 2 No 4 Up to 45 3 Up to 90 2 Up to 135 1 Up to 180 0

4.Sitting From Lying Down

Score BT AT BT 2 AT 2 Unable 2 With support 1 Without support 0

5.Standing From Sitting

Score BT AT BT 2 AT 2 Unable 2 With support 1 Without support 0



Annexure 6.Drooping wrist

Score BT AT BT 2 AT 2 Full 3 Moderate 2 Slight 1 No 0 7. Associated Signs And Symptoms (a) Loss of Speech

Score BT AT BT 2 AT 2 Aphasia 4 Utter voice 3 Speak few words 2 Speak with difficulty 1 Normal 0 (b) Pain

Score BT AT BT 2 AT 2 Frequent mild type 2 After exertion 1 No pain 0

8.Muscle Tone

Score BT AT BT 2 AT 2 Severe rigidity 3 Moderate rigidity 2 Mild rigity 1 Normal 0



Annexure 9. Muscle Power Gradation

Score BT AT BT 2 AT 2 No active contraction 0

Visible contraction without active movement

1

Movement which is possible when gravity is eliminated

2

Movement which is possible against gravity

3

Movement which is possible against gravity and resistance but it is weaker than normal.

4

Normal 5

10.Handgrip Power

Score BT AT BT 2 AT 2 0 – 10 mm Hg 3 10 – 20 mm Hg 2 20 -30 mm Hg 1 30 -40 mm Hg 0 11.Increase In Walking Capacity :

BT AT BT 2 AT 2 Before treatment 2 times than before 3 times than before 4 times than before 5 times than before



Annexure

12.Reflexes

Results :

Score BT AT BT 2 AT 2 Very brisk 2 Brisk 1 Normal 0

1. Marked improvement relief of >75%

2. Moderate improvement 51-75% relief

3. Mild improvement 25-50% of relief

4. No Change 0% relief

Signature of the investigator Signature of the Guide



Annexure



Voluntary Consent Form I ____________________________, hereby willingly agree to participate in this

dissertation study titled,“A comparative clinical trial on two different navana yogas in

Charakokta Ardita”. I affirm that there has been no compulsion or monetary inducement

in my agreeing to be volunteer for this study which I do on my free will. I have been

explained the general purpose of the study. I am convinced that it is for the benefit of

science and mankind. I have been told about the risks involved which I am convinced. I

have also been told that I have to undergo following procedures during the study.

1. Collection of Blood samples

2. To remain under observation

I can opt out of this study at any time.

Signature of PG Scholar Signature of Volunteer

ABHYANGA

SWEDANA

NASYA

Documents

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