“A CLINICAL STUDY TO EVALUATE THE EFFECT OF NASYA KARMA IN CERVICAL SPONDYLOSIS”
By
Dr. VIGNESH HOBLIDAR B.A.M.S
Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment
Of the requirements for the degree of
AYURVEDA VACHASPATI DOCTOR OF MEDICINE (Ayu)
in
PANCHAKARMA
Under the guidance of
Dr. NIRANJAN RAO M. D.
Professor (Ayu)
Department of Panchakarma,SDMCA Udupi.
Co-Guide
Dr. SHREEKANTH U. M.D. (Ayu) Former Dean, Professor & H O D
P.G.Studies in Department of Panchakarma, SDMCA Udupi.
Department of P.G. Studies in Panchakarma. S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI
2011-12
I
Rajiv Gandhi University of Health Sciences
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “ A CLINICAL STUDY TO
EVALUATE THE EFFECT OF NASYA KARMA IN CERVICAL
SPONDYLOSIS ” is a bonafide and genuine research work carried out by me under
the guidance of Dr. NIRANJAN RAO M.D. (Ayu), Professor, Department of
Panchakarma and co-guidance of Dr. SHREEKANTH U. M.D. (Ayu), Former
Dean, Professor and H.O.D., Department of Panchakarma.
Date: Signature of the candidate
Place: Udupi Dr. VIGNESH HOBLIDAR
II
Rajiv Gandhi University of Health Sciences
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A CLINICAL STUDY TO
EVALUATE THE EFFECT OF NASYA KARMA IN CERVICAL
SPONDYLOSIS ” is a bonafide research work done by Dr. VIGNESH
HOBLIDAR under my guidance and the co-guidance of Dr. SHREEKANTH U.
M.D. (Ayu), Former Dean, Professor and H.O.D., Department of Panchakarma in
partial fulfillment of the requirement for the degree of DOCTOR OF MEDICINE
(Ayu)
Date: Signature of the Guide
Place: Udupi Dr. NIRANJAN RAO M.D. (Ayu)
Professor, Department of Panchakarma
III
Rajiv Gandhi University of Health Sciences
This is to certify that the dissertation entitled “A CLINICAL STUDY TO
EVALUATE THE EFFECT OF NASYA KARMA IN CERVICAL
SPONDYLOSIS” is a bonafide research work done by Dr. VIGNESH HOBLIDAR
under the Guidance of Dr. NIRANJAN RAO M.D. (Ayu), Professor, Department of
Panchakarma and Co-guidance of Dr. SHREEKANTH U. M.D. (Ayu), Former
Dean, Professor and H.O.D., Department of Panchakarma.
ENDORSEMENT BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION
Signature of the H.O.D Signature of the Principal Dr. Shreekanth U. M.D. (Ayu) Dr. U.N. Prasad M.D (Ayu)
Date: Date: Place: Udupi Place: Udupi
IV
© COPYRIGHT
I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation / thesis in print or
electronic format for academic / research purpose.
Date: Signature of the Candidate Place: Udupi Dr. VIGNESH HOBLIDAR
Declaration by the Candidate
© Rajiv Gandhi University of Health Sciences, Karnataka
ACKNOWLEDGEMENT
I offer my salutation to the almighty for his blessings that
made me accomplish this dissertation work and to my parents
(Rathnakar Hoblidar & D. K Malathi ) for their everlasting
support.
It is the sacred time to avail opportunity by extending my
deepest sense of indebtedness to Dr. Gopinadh Raju , former
principal of Dr. N .R .S Govt. Ayurvedic College, Vijayawada
whose paternal affection, inspiring teaching, valuable guidance,
timely remarks & helpful suggestions made me to successfully
complete this work.
I am short of words to express my gratefulness towards
Dr.Veerendra Heggade for providing me with an opportunity to
study in this esteemed institution.
I am ever grateful to Dr. U.N Prasad, Principal for his
encouragement and support.
It is a matter of privilege and honor for me to say that
Dr. Niranjan Rao, Professor, Department of Panchakarma, SDM
College of Ayurveda, Udupi,has guided me for this dissertation
work and I am sincerely grateful to him for his expert guidance and
constant encouragement.
I express my deepest gratitude and respect to Co-Guide and
HOD Dr. Dr. Shreekanth U, Ex-Dean, Professor and HOD,
Department of Panchakarma, SDM College of Ayurveda, Udupi,
whose valuable guidance and support has been with me throughout
this dissertation work.
I am thankful to Dr. Rajalaxmi , for their valuable guidance
for the completion of my thesis.
I remember with gratitude the patients of the hospital for
their co-operation and furnishing valuable information for
compilation of data required for this study.
I also thank my beloved friend Dr. Mithun Ramaraju,
whose moral support was always there with me throughout my
study.
I also take this opportunity to thank my seniors, Dr. Girija ,
Dr. Rahul Dr. Prakash, Dr. Greeshma Dr. Riaz, Dr. Nikhil and
for their guidance, my colleagues Dr. Vishwanath, Dr .Raksha,
Dr. Varun, Dr. Shankar for their help and my juniors, Dr. Ambika,
Dr. Karthikeya, Dr. Abishek, Dr. Basavarajeshwari, , Dr. nagraj,
Dr. Murgesh, Dr. Amrith, Dr. Teena Nargotra for their support.
I also thank Dr. Joel Antony, Dr. Sudeep, Dr. Sunil,
Dr. Nishanth, Dr. Veeraj, Dr. Ashok, Dr. Vivek, Dr. Anand,
and Likith S.V, Sampark Xerox, Udupi for their support .
I offer my earnest gratitude to Dr. Kalyan Chakravarthy
for his hearty support
I would like to thank my uncle D. K Ganesh and my elder
brother for his encouraging words and support during my study.
I would like to thank all my teachers, who inspired and
supported me immensely throughout the studies.
I also thank all Panchakarma staff for their timely support .
In the end I would like to say that I thank and seek
forgiveness if I have not mentioned any names which have directly
or indirectly been a part of this study.
Date: Vignesh Hoblidar
Place:
List of Abbreviations
LIST OF ABBREVIATIONS USED
(in alphabetical order)
LIST OF ABBREVIATIONS
A.Di. Ayurveda Dipika A.Hr. Ashtanga Hridaya A.Sa. Ashtanga Sangraha AT After Treatment A.V. AtharvaVeda BT Before Treatment Bh.Pr. BhavaPrakasha Bhe.Sa. Bhela Samhita C.D. ChakraDatta C.S. Cervical Spondylosis Ch. Chaturtha Sthana Chi. Chikitsa Sthana Chi.Kal. Chikitsa Kalika Ch.Sa. Charaka Samhita Dw. Dwiteeya Bhaga Esi Esinophils ESR Erythrocyte Sedimentation Rate G.N. GadaNigraha gms grams Hb Heamoglobin H.S. Harita Samhita Ka. Kalpa Sthana Ka.Sa. Kashyapa Samhita Khi. Khila Sthana Lym Lymphocytes M.N. Madhava Nidana M.S. ManuSmruti Ma. Madhyama Khanda Mon Monocytes N Number of patients Neu Neutrophils Ni. Nidana Sthana
Ni.Sa. Nibandha Sangraha Pr. Prathama Bhaga Pu. Purva Khanda
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
List of Abbreviations
RBS Random Blood Sugar R.V. RigVeda SD Standard Deviation Sh. Shareera Sthana Sha.Sa. Sharangadhara Samhita Si. Siddhi Sthana Su. Sutra Sthana Sub. Substitute Su.Sa. Sushruta Samhita
TC Total Count Tr. Truteeya Sthana Ut. Uttara Khanda Vi. Vimana Sthana V.M. VrundaMadhava V.S. Vangasena Samhita Y.R. YogaRatnakara Y.T. YogaTarangini
ABSRACT
Today is the era of modernization and fast life. Everybody is busy and living stressful life. Changing of life style of modern human being has created several disharmonies inhis biological system. Advancement of busy, professional and social life, improper sittingposture in offices, continuous work in one posture and overexertion, jerking movements during travelling and sports – all these factors create undue pressure and stress injury to the spine and play an important role in producing disease like cervical spondylosis.
Nasya karma is considered as a prime line of treatment in urdhwa jatru vikaras. The phenomenon of cervical spondylosis is affecting the neck.
The prime line of treatment in such urdhwa jatru vikara is Nasya karma.
Design - This is a single blind clinical study with pre and post test design
Source of data - 30 patients suffering from Cervical spondylosis of either sex in an age
limit between 30-70 years were selected from O.P.D and I.P.D of S.D.M.Ayurveda
hospital,Udupi and randomly selected for the study.
Intervention - These 30 patients were administered with Ketakyadi taila nasya karma
for initial 7 days .Therapeutic effect of the procedures will be assessed by the parameters
and result will be analized statistically.
Observation – Among 30 patients of Cervical spondylosis studied in this work,43.33%
patients belonged to the age group of 41-50 years,70% were males,86.66% were
Hindus,80% were married, 43.33% were agriculturist ,43.33% were of vata pittaja
prakruti.
Result - Statistically significant improvement was observed in all the criteria of
assessment.
Conclusion – The Ketakyadi taila Nasya karma performed is therapeutically effective in
patients suffering from Cervical spondylosis
Key words : Cervical spondylosis, Nasya etc..
TABLE OF CONTENTS
Chapter
No. Title Page No.
1 INTRODUCTION 1-3
2 OBJECTIVES 4
3 REVIEW OF LITERATURE 5-75
4 METHODOLOGY 76-84
5 OBSERVATION & RESULTS 85-134
6 DISCUSSION 135-152
7 CONCLUSION 153
8 SUMMARY 154-155
9 BIBLIOGRAPHY 156-175
10 ANNEXURES 176-191
LIST OF TABLES
No. Topic Page no.
1 Various Timings for Pratimarsha Nasya 31
2 Nasya karma yogyas 34
3 Nasya karma ayogyas 37
4 Time schedule in different seasons should be as below 39
5 Showing time schedule of nasya in Doshaja vikaras 40
6 Dose of nasya 41
7 Shamayak Yoga Lakshana 46
8 Ayoga Lakshana 47
9 Atiyoga Lakshana 48
10 Management of ayoga and atiyoga of nasya karma 49
11 Age group wise distribution: 85
12 Sex wise distribution of patients: 86
13 Religion wise distribution of patients: 86
14 Educational Status of patients: 87
15 Marital status of patients 87
16 Socio economic status of patients 88
17 Occupation wise distribution of patients 88
18 Distribution of patients according to their Desha: 89
19 Distribution of pts according to the associated diseases 89
20 Distribution of pts according to their diet: 90
21 Distribution of patients on the basis of Rasa Pradhanya 90
22 Distribution of patients according to their Diet habit: 91
23 Distribution of patients according to their habit of Nidra: 91
24 Classification of patients based on Bowel & Bladder 92
habits:
25 Classification of patients according to their habits: 92
26 Classification of patients on the basis of prakruti: 93
27 Classification of patients on the basis of their satwa: 93
28 Classification of patients on the basis of samhanana: 94
29 Classification of patients on the basis of satmya: 94
30 Classification of patients on the basis of Ahara shakti: 95
31 Classification of pts on the basis of their vyayama shakti: 95
32 Classification of patients on the basis of Vaya: 96
33 Classification of patients on the basis of their Koshta: 96
34 Classification of patients on the basis of Neck pain 97
35 Classification of patients on the basis of Radiation of pain 97
36 Classification of patients on the basis of Radiating side 98
37 Classification of patients on the basis of Stiffness 98
38 Classification of patients on the basis of Neck movements 99
39 Classification of patients on the basis of Weakness 99
40 Classification of patients on the basis of Parasthesia 100
41 Classification of patients on the basis of Sensory loss 100
42 Classification of patients on the basis of Clumpsy finger
movements
101
43 Classification of patients on the basis of Vertigo 101
44 Classification of patients on the basis of Duration of
complaints
102
45 Classification of patients on the basis of Mode of onset 102
46 Classification of patients on the basis of Nature of pain 103
47 Classification of patients on the basis of Course of pain 103
48 Classification of patients on the basis of Family history 104
49 Classification of patients on the basis of Treatment history 104
50 Classification of patients on the basis of Neurological
deficit
105
51 Classification of patients on the basis of Neck disability
index
105
52 Samyak nasya laxana in the patients 106
53 Effect of treatment on neck pain 107
54 Effect of treatment on Radiation of pain 108
55 Effect of stiffness 109
56 Effect of treatment on Weakness 110
57 Effect of treatment on Parasthesia 111
58 Effect of treatment on Clumpsy finger movement 112
59 Effect of treatment on Vertigo 113
60 Effect of treatment on - Tenderness 114
61 Effect of treatment on–Movements of neck 115
62 Effect of treatment on - sensory loss 116
63 Effect of treatment on–Neurological deficit 117
64 Effect of treatment on -Neck disability index 118
65 Effect of treatment on Power w.s.r. movements . Shoulder
Abduction
119
66 Effect of treatment on -Power w.s.r. movements .
Shoulder, Flexion
120
67 Effect of treatment on - Power w.s.r. movements .
Shoulder Extension
121
68 Effect of treatment on - Power w.s.r. movements . Elbow .
Flexion
122
69 Effect of treatment on - Power w.s.r. movements . Elbow 123
Extension
70 Effect of treatment on Power w.s.r. movements . Wrist . Flexion 124
71 Effect of treatment on Power w.s.r. movements . Wrist . Extension -
125
72 Effect of treatment on Power w.s.r. movements . Forearm . supination
126
73 Effect of treatment on Power w.s.r. movements Forearm Pronation
127
74 Effect of treatment on Power w.s.r. movements . Metacarpophalangeal and interphalangeal . Flexion
128
75 Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal. Extension
129
76 Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Abduction
130
77 Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Adduction
131
78 Effect of treatment on - Reflex. Biceps 132
79 Effect of treatment on-- Reflex. Triceps 133
80 Effect of treatment on Reflex. Supinator 134
LIST OF FLOWCHARTS
NO.
TOPIC PAGE NO.
1. CARAKA’S CLASSIFICATION OF NASYAKARMA 21
2. SUSHRUTA’S CLASSIFICATION OF
NASYAKARMA
22
3. VAGBHATA’S CLASSIFICATION OF
NASYAKARMA
22
4. KASHYAPA’S CLASSIFICATION OF NASYAKARM 23 5. BHELA’S CLASSIFICATION OF NASYAKARMA 23
6. SHARANGADHARA’S CLASSIFICATION OF
NASYAKARMA
23
7. BHOJA’S CLASSIFICATION OF NASYAKARMA 23
8. VIDEHA’S CLASSIFICATION OF NASYAKARMA 24
LIST OF FIGURES
NO. TOPIC
PAGE NO.
1. Age group wise distribution: 85
2 Sex wise distribution of patients: 86
3. Religion wise distribution of patients:
86
4. Educational Status of patients: 87
5 Table depicting marital status of patients
87
6 socio economic status of patients 88
7 Occupation wise distribution of patients 88
8 distribution of patients according to their Desha: 89
9 Distribution of pts according to the associated diseases
89
10 Distribution of pts according to their diet:
90
11 Distribution of patients on the basis of Rasa Pradhanya
90
12 Distribution of patients according to their Diet habit:
91
13 Distribution of patients according to their habit of Nidra:
91
14 Classification of patients based on Bowel & Bladder habits:
92
15 Classification of patients according to their habits:
92
16 Classification of patients on the basis of prakruti:
93
17 Classification of patients on the basis of their satwa:
93
18 Classification of patients on the basis of samhanana:
94
19 Classification of patients on the basis of satmya:
94
20 Classification of patients on the basis of Ahara shakti:
95
21 Classification of pts on the basis of their vyayama shakti: 95
22 Classification of patients on the basis of Vaya:
96
23 Classification of patients on the basis of their Koshta:
96
24 Classification of patients on the basis of Neck pain
97
25 Classification of patients on the basis of Radiation of pain
97
26 Classification of patients on the basis of Radiating side
98
27 Classification of patients on the basis of Stiffness
98
28 Classification of patients on the basis of Neck movements
99
29 Classification of patients on the basis of Weakness
99
30 Classification of patients on the basis of Parasthesia
100
31 Classification of patients on the basis of Sensory loss
100
32 Classification of patients on the basis of Clumpsy finger movements
101
33 Classification of patients on the basis of Vertigo
101
34 Classification of patients on the basis of Duration of complaints
102
35 Classification of patients on the basis of Mode of onset
102
36 Classification of patients on the basis of Nature of pain
103
37 Classification of patients on the basis of Course of pain
103
38 Classification of patients on the basis of Family history
104
39 Classification of patients on the basis of Treatment history
104
40 Classification of patients on the basis of Neurological deficit
105
41 Classification of patients on the basis of Neck disability index
105
42 Samyak nasya laxana in the patients 106
43 Effect of treatment on neck pain 107
44 Effect of treatment on Radiation of pain 108
45 Effect of stiffness
109
46 Effect of treatment on Weakness 110
47 Effect of treatment on Parasthesia 111
48 Effect of treatment on Clumpsy finger movement 112
49 Effect of treatment on Vertigo
113
50 Effect of treatment on - Tenderness 114
51 Effect of treatment on–Movements of neck 115
52 Effect of treatment on - sensory loss 116
53 Effect of treatment on–Neurological deficit 117
54 Effect of treatment on -Neck disability index
118
55 Effect of treatment on Power w.s.r. movements . Shoulder Abduction
119
56 Effect of treatment on -- Power w.s.r. movements . Shoulder, Flexion
120
57 Effect of treatment on - Power w.s.r. movements . Shoulder Extension
121
58 Effect of treatment on - Power w.s.r. movements . Elbow . Flexion
122
59 Effect of treatment on - Power w.s.r. movements . Elbow Extension
123
60 Effect of treatment on Power w.s.r. movements . Wrist . Flexion
124
61 Effect of treatment on Power w.s.r. movements . Wrist . Extension -
125
62 Effect of treatment on Power w.s.r. movements . Forearm . supination
126
63 Effect of treatment on Power w.s.r. movements Forearm Pronation
127
64 Effect of treatment on Power w.s.r. movements . Metacarpophalangeal and interphalangeal . Flexion
128
65 Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal. Extension
129
66 Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Abduction
130
67 Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Adduction
131
68 Effect of treatment on - Reflex .Biceps 132
69 Effect of treatment on-- Reflex. Triceps 133
70 Effect of treatment on Reflex .Supinator 134
Chapter - 1
Introduction
Introduction
1
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
INTRODUCTION
In God’s creation, the evolution of man is considered supreme. According to Indian
tradition, the highest purpose of humanlife is the fourfold realization Dharma, Artha,
Kama and Moksha. For the accomplishment of these purposes, health of a person must
be maintained. Since the birth, decay and death are always co-existed with the life, the
study of abnormal healthstatus and their management has also been studied with the
dawn of the human intellect.
Today is the era of modernization and fast life. Everybody is busy and living stressfullife.
Changing of life style of modern human being has created several disharmonies inhis
biological system. Advancement of busy, professional and social life, improper
sittingposture in offices, continuous work in one posture and overexertion, jerking
movements during travelling and sports – all these factors create undue pressure and
stress injury tothe spine and play an important role in producing disease like cervical
spondylosis.
Faulty dietetic habits and irregular life style is responsible for early degenerative changes
in bodily tissue and play a vital role in the manifestation of such degenerative disorder.
Inthis way, this disease is now becoming a significant threat to the working population.
Prevalance:
60-70% women and 85% of men may show changes related with cervical
spondylosis by the age 45, rhontgenologically1
The prevalence of cervical spondylotic myelopathy ranges between 96-100%, by the age
70 years in females and males respectively. Radiographic changes are more severe in
men then in women
.
23.6% patients presenting with non traumatic myelopathic symptoms have
cervical spondylosis. This is the cause for non traumatic spastic paraparesis and
quadriparesis.
1
Introduction
2
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Cervical spondylosis is a degenerative disease of cervical spine. The main pathology is
found in the cervical spine; primarily in the intervertrabral discs and vertebral bodies. It
leads to pain and stiffness in neck, radiating pain into arm, headache,vertigo, giddiness,
paraesthesia, numbness etc. It disturbs the daily routine and overalllife of the patient.
Though it is not fatal instantly but it causes more severe complicationin later stage. It
cripples the patient, makes him burden to others. Person can’t perform the day to day
work properly due to severity of pain and this way it does not cut the yearsof life but life
of the years.Modern medical science provides various types of medical and surgical
therapy but none of the therapy is satisfactory in cervical spondylosis. All the treatments
are just for symptomatic relief. Due to more untowards effect of pain relieving drugs e.g.
NSAID,Steroids and surgical procedure, alternative medical systems like Ayurveda are
nowcoming into focus to find out better remedy for this condition.
Ayurveda is one among the most ancient medical sciences of the world. It conceives and
describes the basis & applied aspect of life process, health, disease & its managementin
terms of its own principles & approaches. There is no exact clinical entity mentioned in
classics like Cervical Spondylosis but it can be compared with apabahuka, vishwachi,
Manya graham, Manya stambha, Griva stambha , Shiro graham, greevahundanum . .How
ever description available regarding these conditions are very concised, so precise
interpretation with Cervical Spondylosis can not be established.
In such disorders core pathogenesis is – 1) degeneration of bone tissue and 2) vitiation
of Vata. Moreover,such degenerative type of condition with clinical manifestation can
also be consideredunder the broad umbrella of Vata Vyadhi.
“Urdhwa Jatru Vikareshu Visheshaat Nasyamishyate”2
The prime line of treatment in such urdhwa jatru vikara is Nasya karma. Ketakyadi taila
mentioned in the text is useful in such disorders
Nasya karma is considered as a prime line of treatment in urdhwa jatru vikaras. The
phenomenon of cervical spondylosis is affecting the neck.
3,4,5,6,7,8
Introduction
3
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Nasya Karma is one among very important treatment modality in Panchkarma
In the present study an attempt is made to assess the effect of nasya karma on Cervical
spondylosis . Here Nasya karma was performed for 7 days and was effective in the
condition and Statistically significant results were obtained in terms of Power with
respect to neck pain, radiation of pain , stiffness ,weakness parasthesia ,clumpsy
finger movement , vertigo ,tenderness , movements of neck, sensory loss , neurological
deficit ,neck disability index ,power w.s.r. movements . Shoulder, Abduction, flexion
,extension , power w.s.r. movements . Elbow , Flexion, Extension power w.s.r.
movements . Wrist , Flexion , Extension Power w.s.r. movements , Forearm ,
supination, Pronation, power w.s.r. movements. metacarpophalangeal and
interphalangeal . Flexion , Extension, Abduction , Adduction reflex .Biceps , Triceps,
Supinator . And all the patients showed samyak nasya laxana.
Previous Research Works Done:
1. Shaligram, Asthimajja vata with special reference to cervical spondylosis , and role
of snehana and nasya karma in it’s management. Gujarat Ayurveda University ,
Jamnagar 1998
2. Sulochana Rathi – Management of Greeva sthamba vis-à-vis cervical spondylosis ,
UTKAL University, Puri, Orissa 1997
3. Andanagoud S Patil – the effect of Ketakyadi taila as katibasti in katishoola, RGUHS
University ,Bangalore 2000.
Chapter - 2
Aims & Objectives
Objectives
4
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
OBJECTIVES
• To study the effect of Ketakyadi taila Nasya karma in the management of Cervical
Spondylosis.
• To study Conceptual aspect of Nasya Karma and cervical Spondylosis
Chapter - 3
Review of Literature
Conceptual Study
5
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
CONCEPTUAL STUDY HISTORICAL REVIEW OF NASYA KARMA :
Indian culture starts from vedic time. Some mantras of vedas denote the presence of
Ayurveda during that time . Although it is very difficult to say that the procedure of
nasya karma therapy was in practice in vedic period , but the few mantras of rigveda
indirectly refer towards the karma which are included under panchakarma measures .
Before seeking in to the details of NasyaKarma,it is necessary to know the organ
involved its relevance in literatures.
Description of Nasa
“lÉÉxÉÉ ÌWû ÍvÉUxÉÉã ²ÉUqÉç|”
9
ETYMOLOGY:
lÉÉxÉiÉã vÉoSÉrÉiÉã CÌiÉ| lÉÉxÉ vÉoSã + “aÉÑUÉãgcÉ WûsÉ:”|
The word ‘NASA’ is derived from the root lÉÉxÉÉ and bÉgÉç mÉëirÉrÉ which means ‘to sound’.
‘Nasa’ plays an important role in the process of Nasyakarma. Also called as Nasika,
Ghranendriya, Gandhendriya which is predominant of Prithvi Mahabhuta is not only a
organ of smell but also a respiratory passage. 10
Nasa, it has got wider communications with various parts of head through many
channels that communicate with nasal cavity either directly or indirectly.
Rigveda
This can be considered as a earliest picture of Nasya karma . In a mantra there is
mentioning of the worrd “Nasa” and reference stating erradication of rogas through the
routes of nasa, chibuka, shira, Karna
A.Hr.Su.20/1
11
Atarva veda
Description of nine chidras and indriya has been given
We get reference of Nasa during the description of Indriyas.
12
Yajurveda
13
Conceptual Study
6
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Atarva veda
Description of nine chidras and indriya has been given.14
MANUSMRUTI:
The names of 10 Indriyas have been mentioned. (M.S. 2/90)15
BHAGVADGITA:
Nasa is also mentioned while describing the Indriyas & Navadwaras.16
DEFINITION:
lÉÉxÉÉrÉÉ ÌuÉÍzɹ LMüSåzÉÉå bÉëÉhÉãÇÌSìrÉ AÍkɸÉlÉqÉçç| A.Hr.Sh.3/3,Arunadatta17
It is explained that nasa is seat of Granendriya .
SYNONYMS: The synonyms of Nasa as per Amarakosha are as follows -
Nasika ,Nasa, Ghona, Ghranendriya Ghranam, Ghrana, Gandhavaha, 18
EMBRYOLOGY:
Acharya Sushruta has described that Sarvanga are developed during the fourth month of
Garbhavastha (Su.Sh.3/18)19.
According to Charaka the Nasa is developed during the third month of Garbhavastha
(Ch.Sh.4/11-12). 20
In Garbhopanishad, it is mentioned that Mukha (oral cavity), Nasa (nose), Akshi (eyes)
and Shrotra (ears) are developed in sixth month of pregnancy.
Indriyas are considered as evolved from Atma21. So, Nasa is considered as Atmaja
Bhava.
Predominent Panchamahabutha22
Prithvi
NASA SHAREERA :
In Ayurvedic literature , there is no detail desciption of nasa sharira .at one place like the
anatomical description of other organs, whereras Nasa is included among the five
indriyas as a site of Ghranendriya .
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“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Sushruta has considered two nostrils among the nine external orifices while enumerating
the external orifices of the body23
Nasa is comprised of:23
3 Asthi
2 Pesi
2 Dhamani
2 Bahya Srotas
2 Phana Marmas
Phana marmas are sira marmas, vaikalyakara in nature, ardha angula in pramana, if
damaged causes loss of smell sensation.(Su.Sh.6/27)
1 Srungataka Marma –It nourishes the nose & if damaged causes immediate death.
(Su.Sh.6/27)
24 Siras
INDRIYA PANCHAPANCHKAM:
Indriya : Ghranendriya
Indriya Dravya : Prithvi
Indriya Adhisthana : Nasa
Indriya Artha : Gandha
Indriya Buddhi : Ghrana Buddhi
IMPORTANCE OF SHIRAS:
mÉëÉhÉÉ: mÉëÉhÉpÉ×iÉÉÇ rɧÉÉÍ´ÉiÉÉ: xÉuÉãïÎlSìrÉÉÍhÉ cÉ|
rÉSÒ¨ÉqÉÉXçaÉqÉXçaÉÉlÉÉÇ ÍvÉUxiÉSÍpÉkÉÏrÉiÉã|| Ch.Su.17/12
In a living being , the head is the place where prana of all the sense faculties reside and
hence termed as Uttamanga .24
Shirah has been compared with sun. Shiras is the vital organ of senses, sensory channels
and channels carrying the vital impulse of Prana, as Sun is the navigator of its rays.25
It is the controlling centre of PranaVata, AlochakaPitta and TarpakaSleshma.
Conceptual Study
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“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Vagbhata has mentioned “lÉÉxÉÉ ÌWû ÍvÉUxÉÉã ²ÉUqÉç|”2
NASYA KARMA
i.e., Nose as the gateway of Head and is
the only one route through which medicines can be administered to Shiras. So,
NasyaKarma is superior and can be considered as ‘Uttama’ as it deals with Uttama
Anga, the Shiras.
Vagbhata compares human body to a tree with UrdhwaMoola(Shiras) and If root is
protected, the tree survives. Hence if Shiras is properly treated, the diseases can be easily
cured .
RIGVEDA:
This can be considered as a primitive picture of Nasya Karma.
There is a Mantra in Rigveda which gives information about the eradication of Roga from
the routes of Nasa(Nostrils), Chibuka(Chin), Shiras(Head), Karna (Ear) and Rasana
(Tongue)26.
KRISHNA YAJURVEDA, UPANISHAD: 27
In these texts, the term Nasya Karma has been frequently used.
RAMAYANA:28
In Valmiki Ramayana, use of sanjeevani for nasya karma is found.
BOUDDHA KAALA
1) In Shirahshoola, he prescribed Nasya Karma to the wife of a Shreshthi of Saketa
Nagar using medicated Ghrita.
29
“Jeevaka” the famous Vaidya of Bouddha Kaala had utilized Nasya Karma in many
cases such as
2) Jeevaka administered Virechana to Lord Buddha by making him to smell a purgative
Aushadhi. This refers to Ghreya Virechana which is done through nasal route.
Conceptual Study
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“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
SAMHITA KAALA:
In all the Samhitas, NasyaKarma has been elaborately described especially in Charaka
Samhita, Sushruta Samhita, Ashtanga Sangraha, Ashtanga Hridaya, Sharangadhara
Samhita.
THE REFERENCE OF NASYA IN ASHTANGA SANGRAHAASHTANGA SANGRAHA
30
STHANA/ADHYAYA REFERENCE SUTRA
3.Dinacharya A.Sa.Su.3/15 4.Rutucharya A.Sa.Su.4/13 8.Annaraksha A.Sa.Su.8/36,37 13.Agryasangrahaniya A.Sa.Su.13/2 14.Sodanadigansangraha A.Sa.Su.14/6 24.Dwividopakramaniya A.Sa.Su.24/6 29.NasyaVidhi A.Sa.Su.29
SHAREERA 1.Putrakamiya A.Sa.Sh.1/58 CHIKITSA 2.JeernaJwara A.Sa.Chi.2/30 3.Raktapitta A.Sa.Chi.3/34 6.ShwasaHidhma A.Sa.Chi.6/25 7.Rajayakshma A.Sa.Chi.7/26,43 8.ChardiHridrogaTrusna A.Sa.Chi.8/21,39 9.Madatyaya A.Sa.Chi.9/55 22.SwitraKrimi A.Sa.Chi.22/28 23.VataVyadhi A.Sa.Chi.23/13,
14,17,25,26,28,37
KALPA 8.Bheshajakalpa A.Sa.Ka.8/18 UTTARA 6.Pratyekagrahpratiseda A.Sa.Ut.6/6 8.Bhutapratisheda A.Sa.Ut.8/4-23 9.Unmadapratisheda A.Sa.Ut.9/13-28 10.Apasmarapratisheda A.Sa.Ut.10/9,20 12.Vartmarogpratisheda A.Sa.Ut.12/5, 6,
10,13
14.SandiSitaAsitaRoga A.Sa.Ut.14/23,32 16.Timirapratisheda A.Sa.Ut.16/10-19 19.Abhisyandapratiseda A.Sa.Ut.19/8,40
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“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
20.AksipakaPillapratised A.Sa.Ut.20/2,3 22.KarnaRogapratisheda A.Sa.Ut.22/12,22
24.NasaRogapratisheda A.Sa.Ut.24/5,11,
19,20,28,29,31,33
26.MukhaRogapratiseda A.Sa.Ut.26/3,4,10
27, 29, 33
28.ShiroRogapratisheda A.Sa.Ut.28/3,7,13 18,19,21,27,28,29
35.GrantyArbudaSlipadaApachi
NadiPratisheda
A.Sa.Ut.35/2,
18,19
37.Kshudrarogapratiseda A.Sa.Ut.37/20 40.Vishapratisheda A.Sa.Ut.40/38 42.Sarpavishapratisheda A.Sa.Ut.42/25,29 43.Kitavishapratisheda A.Sa.Ut.43/35,59 44.Lutapratisheda A.Sa.Ut.44/33,36 46.Musikalarkapratiseda A.Sa.Ut.46/19,53 47.Vishopadravaprtiseda A.Sa.Ut.47/14,17 48.Vishopayogiya A.Sa.Ut.48/12,40,
A.Sa.Ut.48/41,42
THE REFERENCE OF NASYA IN ASHTANGA HRIDAYA
ASHTANGA HRIDAYA31
STHANA/ADHYAYA REFERENCE SUTRA
2.Dinacharya A.Hr.Su.2/6 3.Rutucharya A.Hr.Su.3/19 7.Annaraksha A.Hr.Su.7/26 14.Dwividopakramaniya A.Hr.Su.14/5 15.Sodanadigansangraha A.Hr.Su.15/4 20.NasyaVidhi A.Hr.Su.20
SHAREERA 1.Garbhavakranti A.Hr.Sh.1/40
CHIKITSA 1.Jwara A.Hr.Chi.1/125,
126, 150, 161
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2.Raktapitta A.Hr.Chi.2/47,48 4.ShwasaHidhma A.Hr.Chi.4/46-50 5.Rajayakshma A.Hr.Chi.5/35,37,
41, 42, 69 6.ChardiHridrogaTrusna A.Hr.Chi.6/27,
A.Hr.Chi.6/66, 74
7.Madatyayadi A.Hr.Chi.7/104 A.Hr.Chi.7/110
20.SwitraKrimi A.Hr.Chi20/28,33 21.VataVyadhi A.Hr.Chi.21/3,
26-31,43, 44, 62 KALPA 6.DravyaKalpa A.Hr.Ka.6/21
UTTARA 5.Bhutapratisheda A.Hr.Ut.5/9,17,
A.Hr.Ut.5/30-47
6.Unmadapratisheda A.Hr.Ut.6/19,20 7.Apasmarapratisheda A.Hr.Ut.7/29,32 9.Vartmarogapratisheda A.Hr.Ut.9/1,8,19,
23, 39
11.SandiSitaAsitaRoga A.Hr.Ut.11/57 13.Timirapratisheda A.Hr.Ut.13/46,53,
69,75,76,93,95
16.Sarvakshirogpratised A.Hr.Ut.16/1,28 18.KarnaRogapratisheda A.Hr.Ut18/9-46 20.NasaRogapratisheda A.Hr.Ut.20/12-23 22.Mukharogapratisheda A.Hr.Ut.22/2,8,25
28,36,39,42,59,71
24.ShiroRogapratisheda A.Hr.Ut.24/4-7,
16, 33-36,48
30.GrantyArbudaSlipadaApachiNadiPratisheda A.Hr.Ut.30/20, 21,
26, 27
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32.Kshudrarogapratiseda A.Hr.Ut.32/3,
27-30, 33
35.Vishapratisheda A.Hr.Ut.35/18 36.Sarpavishapratisheda A.Hr.Ut.36/72 38.Mushikalarkavisha A.Hr.Ut.38/24,32
THE REFERENCE OF NASYA IN SUSHRUTA SAMHITA SUSHRUTA SAMHITA
STHANA
32
REFERENCE SUTRA
12.Agnikarmavidhi Su.Su.12/36 27.Shalyapanayaniyam Su.Su.27/4,5,22
39.Samsodansamsamana Su.Su.39/6 43.VamanadravyaVikalp-aVijnaniyam Su.Su.43/9
44.VirechanadravyaVika-lpaVijnaniyam Su.Su.44/85
SHAREERA 2.ShukraShonitaSuddhi Su.Sh.2/32
CHIKITSA 1.Dwivraniya Su.Chi.1/8, 9, 125, 126
2.SadyoVrana Su.Chi.2/43 3.Bhagna 4.VataVyadhi Su.Chi.4/18,22 5.MahaVataVyadhi Su.Chi5/18,20-22 9.Kushta Su.Chi.9/43 14.Udara Su.Chi.14/11 18.GrantyApachiArbuda-
GalagandaChikitsitam
Su.Chi.18/22, 23,
Su.Chi.18/50
19.Vridyupadamslipada Su.Chi.19/15 20.Kshudraroga Su.Chi.20/30 22.Mukharoga Su.Chi.22/4,7,12,
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31.Snehopayougika Su.Chi.31/3 32.Swedavacharaniya Su.Chi.32/17 34.Vamanvirecanvyapat Su.Chi.34/12,19 36.Netrabastivyapat Su.Chi.36/13 37.Anuvasanottarabasti Su.Chi.37/7 40.DhumaNasyaKavalaGraha
Chikitsitam
Su.Chi.40/20-57
KALPA 1.AnnapanarakshaKalpa Su.Ka.1/27, ,65
Su.Ka.1/35, 77 2.Stavaravishavijnaniya Su.Ka.2/41 5.SarpadashtaVishaChik-itsitamKalpa Su.Ka.5/21,23,27,
29,42,43,80
7.MushikaKalpa Su.Ka.7/37 8.KeetaKalpa Su.Ka.8/102,134 UTTARA 9.Vatabisyandapratiseda Su.Ut.9/4,10,22 10.Pittabisyandpratiseda Su.Ut.10/3,6 11.Slesmabisyandpratiseda Su.Ut.11/3 12.Raktabisyandpratised Su.Ut12/5,6,39,47 16.Paksmakopapratiseda Su.Ut.16/16 17.Dristigatrogapratised Su.Ut.17/5,32,41 18.KriyaKalpa Su.Ut.18/16, 78
Su.Ut.18/71 19.Nayanabigatapratiseda Su.Ut.19/3 21.Karnagatarogpratised Su.Ut.21/12,33,40 23.Nasagatarogpratiseda Su.Ut23/4,6,10,11 24.Pratisyayapratiseda Su.Ut.24/18-41 26.Shirorogapratiseda Su.Ut.26/7,10,15,
25,27,30,32,38-42
39.JwaraPratisheda 41.ShoshaPratisheda Su.Ut.41/33
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45.RaktapittaPratisheda Su.Ut.45/28,37 46.MurchaPratisheda Su.Ut.46/18 50.HikkaPratisheda Su.Ut.50/16-18 52.KasaPratisheda Su.Ut.52/28 53.Swarabhedapratiseda Su.Ut.53/8 54.Krimirogapratisheda Su.Ut.54/34-36 55.UdavartaPratisheda Su.Ut.55/29 57.ArochakaPratisheda Su.Ut.57/13 60.Amanushopasargaprati Su.Ut.60/40,51 61.ApasmaraPratisheda Su.Ut.61/25 62.UnmadaPratisheda Su.Ut.62/14,16,32 64.Swsthavrutta Su.Ut.64/39
THE REFERENCE OF NASYA IN CHARAKA SAMHITA
CHARAKA SAMHITA
STHANA/
33
REFERENCE SUTRA
1.Deerghanjivitiy Ch.Su.1/79,85
Ch.Su.1/87,91
2.Apamargatanduliya Ch.Su.2/3-6 4.Sadvirecanasatasritiya Ch.Su.4/13 5.Matrashitiya Ch.Su.5/46-48
Ch.Su.5/56-70 7.NaVegandharaniya Ch.Su.7/17 13.Snehadhyaya Ch.Su.13/24 20.MahaRogadhyaya Ch.Su.20/13,19 21.Astouninditiya Ch.Su.21/55 22.LanghanaBrimhaniya Ch.Su.22/18 24.VidhiShonitiya Ch.Su.24/47,54 25.Yajjahpurushiya Ch.Su.25/40 28.Vividhashitapitiya Ch.Su.28/27 NIDANA 1. Jwara Ch.Ni.1/36 VIMANA
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7.Vyadhitarupiya Ch.Vi.7/20 8.Rogabhishagjitiya Ch.Vi.8/151 SHAREERA 8.Jatisutriya Ch.Sh.8/19
CHIKITSA 3.Jwara Ch.Chi3/254,255
Ch.Chi.3/305 4.RaktaPitta Ch.Chi.4/97-101 7.Kushta Ch.Chi.7/48 8.Rajayakshma Ch.Chi.8/81-82
Ch.Chi.8/91 9.Unmada Ch.Chi.9/27,64 10.Apasmara Ch.Chi.10/14
Ch.Chi.10/41-45 12.Shwayathu Ch.Chi.12/17,80 17.HikkaShwasa Chchi17/130,134 18.Kasa Ch.Chi.18/142 22.Trushna Ch.Chi.22/33 23.Visha Ch.Chi.23/35
Ch.Chi23/68,181 26.Trimarmiya Ch.Chi.26/138-140,144-145,
151, 158,176-187, 262
28.VataVyadhi Ch.Chi.28/88 Ch.Chi.28/98,99 Ch.Chi.28/193
KALPA 1.Madana Ch.Ka.1/19 3.Ikshwaku Ch.Ka.3/11 4.Dhamargava Ch.Ka.4/10 10.Sudha Ch.Ka.10/17 12.DantiDravanti Ch.Ka.12/104
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SIDDHI 1.Kalpana Ch.Si.1/50-55 2.Panchakarmiya Ch.Si.2/20-23 7.BastiVyapat Ch.Si.7/38,46 9.Trimarmiya Ch.Si.9/8, 16-17,
73, 77, 83, 87
Ch.Si.9/88-117
12.UttaraBasti Ch.Si.12/14
TABLE NO.12 SHOWING REFERENCE OF NASYA IN SHARANGDARA
SHARANGADHARA SAMHITAKHANDA/AD
34
REFERENCE POORVA
6.Aharadigati Sha.Sa.Po.6/18 Sha.Sa.Po.6/19
MADHYAMA 9.SnehaKalpana Sha.Sa.Ma.9/17
UTTARA
8. Nasyavidhi Sha.Sa.Ut.8
TABLE NO.13 SHOWING THE REFERENCE OF NASYA IN
BHAVAPRAKASHAPOORVA
35
REFERENCE PRATHAMA
4.Bala
Bh.Pr.Po.Pr.4/41 5.Dinacharyadi
Bh.Pr.Po.5/47 DWITIYA
2.Bheshajavidh
Bh.Pr.Po.Dw.2/65 5.PanchaKarm
Bh.Pr.Po.Dw.5/189-250 MADHYAMK
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THE REFERENCE OF NASYA IN KASHYAPA SAMHITA
KASHYAPA SAMHITA
STHANA/ADHYAYA
36
REFERENCE SHAREERA Jatisutriya Ka.Sh.Jat/8
SIDDHI 2.Trilaxana Ka.Si.2 4.Nastahkarmiya Ka.Si.4 7.Panchakarmiya Ka.Si.7
KALPA Lashunakalpa Ka.Ka.Las/33
Ka.Ka.Las/78 Shatkalpa Ka.Ka.Shat/36 ShatapuspaShatavari Ka.Ka.SS/25 Visheshakalpa Ka.Ka.Vishesha
KHILA 1.Visamajwaranirdesiya Ka.Khi.1/93 7.Samsuddhivishesaniya Ka.Khi.7/59
THE REFERENCE OF NASYA IN BHELA SAMHITA
BHELA SAMHITA
STHANA/ADHYAYA
37
REFERENCE
SUTRA
6.NaVegandharaniya Bhe.Su.6/21-24
CHIKITSA
6.Kushta Bhe.Chi.6/46
8.Unmada Bhe.Chi.8/29
12.Ardita Bhe.Chi.12
23.Shiroroga Bhe.Chi.23
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25.Nidradi Bhe.Chi.25
26.VataVyadhi Bhe.Chi.26
28.Apatantraka Bhe.Chi.28/10
KALPA
4.Dhamargava Bhe.Ka.4/14-16
SIDDHI
2.ShiroVirechana Bhe.Si.2
ETYMOLOGY OF NASYA:
The term ‘Nasya’ is derived from “Nasa” dhatu which conveys two meanings Gati or the
motion (Nasa Gatau) and Vyapti means pervasion (Nasa Vyaptau)
In Ayurvedic classics, the “Nasa” dhatu is inferred in the sense of nose (Nasa
Nasikayam).
In Vachaspatyam, 38the word “Nasata” means that which is beneficial for nose and the
word “Nasya” has been defined as the one which is administered through the nose.
According to Monier Williams39, the meaning of ‘Nasya’ is belonging to Nose or being
in the Nose; application of sternutatory; errhine.
Thus, the beneficial things pertaining to Nose or a conducive thing administered through
Nose is known as “Nasya”.
In Shabhakalpadruma, 40
lÉÉÍxÉMüÉrÉÉrÉæÈ ÌWûiÉÇ CÌiÉ lÉxrÉÈ |
The one which is good for nose is called as Nasya.
lÉÉÍxÉMüÉSãrÉcÉÔhÉÉïÌS| 41
Nasya is elaborately mentioned by including churnas in Shadbdakalpadruma
It is further explained,
lÉÉxÉɲÉUÉ SãrÉÉæwÉkÉÌuÉvÉãwÉ| 42
The medicine which is administered through Nasa in particular is known as “Nasya”.
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“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
DEFINITION OF NASYA:
As per Acharya Sushruta, 43
AÉæwÉkÉqÉÉæwÉkÉÍxÉ®Éã uÉÉ xlÉãWûÉã lÉÉÍxÉMüÉprÉÉÇ SÏrÉiÉ CÌiÉ lÉxrÉqÉç| Su.Chi.40/21
The administration of medicine or medicated sneha through the nose is known as
NasyaKarma.
According to Vagbhata 44 and Hemadri, 45
lÉÉxÉÉrÉÉÇ mÉëhÉÏrÉqÉÉlÉqÉÉæwÉkÉÇ lÉxrÉqÉç| A.Sa.Su.29/2
According to Arunadatta, 46
lÉÉxÉÉrÉÉÇ pÉuÉÇ lÉxrÉqÉç| A.Hr.Su.20/1
lÉÉxÉÉrÉÉÇ Ì¢ürÉiÉ CìÌiÉ lÉxrÉqÉç| A.Hr.Su.20/1
According to Bhavamishra, 47
lÉÉÍxÉMüÉrÉÉÇ MüqÉï ÍcÉÌMüixÉÉ rÉãlÉ iÉSè lÉxrÉMüqÉï|| Bh.Pr.2/5/189
It is known as NasyaKarma as the treatment is done through Nasika.
Nasya means the administration of various drugs through the nasal route.
SYNONYMS:
Shirovireka
Shirovirechana
Navana
Murdhavirechana
Nastah Pracchardana
NastahKarma
SukshmaKarma48
Elimination of morbid Doshas from the body is Virechana. Hence Shirovirechana or
Murdhavirechana indicates the main function i.e. elimination of morbid Doshas from the
Murdha or parts situated above the clavicle.
Sushruta has specified the word Shirovirechana to describe a particular variety of Nasya
Karma49.
Conceptual Study
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“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Navana Karma and Nastha karma means the measures that are beneficial to nose or
region of the nose.
Nastah and Navana denote the site or route of administration of medicine. Nastah Karma
Charaka has used the term “Nastah Pracchardana” 50for Nasya.
According to Chakrapani,
lÉxiÉ: mÉëcNûSïlÉ CÌiÉ ÍvÉUÉãÌuÉUãcÉlÉã| Ch.Su.1/85, A.Di. This denotes Shodhana done by Nasya.
CLASSIFICATION OF NASYAKARMA:
Sl.NO. NAME OF ACHARYA NO. REFERENCE CLASSIFICATION
1. Charaka 3
5
7
Ch.Si. 9/92
Ch.Si. 9/89
Ch.Vi. 8/151
According to the pharmacological action-
Rechana, Tarpana, Shamana
According to the method of administration –
Navana,Avapida,Dhmapana,Dhuma,Pratimarsha
According to parts of drug used –
Phala, Patra, Mula, Kanda,Pushpa,Niryasa, Twak
2.
3.
4.
5.
Sushruta
Vangasena
Vrunda
Chakrapani
2
5
Su.Chi.40/21
V.S.86/1,3
V.M.78/1
C.D.Nasya/1
NasyaKarma is mainly of 2 Types:
Shirovirechana and Snehana.
It is further classified into 5 Types: Nasya,
Shirovirechana,Pratimarsha,Avapida,Pradhamana
6. Vagbhata 3 A.Hr.Su.20/2 Virechana, Brimhana, Shamana 7. Kashyapa 2 Ka.Si. 2 & 4 Brimhana(Poorana), Karshana(Shodhana) 8. Bhela 4 Bhe.Si.2 Avapeeda, Anuvasa, Dhuma, Pradhamana 9.
10.
11.
Sharangadhara
Bhavamishra
Trimallabatta
2
Sha.Ut.8/2
Bh.Pr.Po.Dw.5/190
Y.T.9/2
Rechana, Snehana;
Avapida & Pradhamana are 2 types of Rechana
Marsha & Pratimarsha are 2 types of Snehana
12. Bhoja 2 Su.Chi.40/28Ni.Sa. Prayogika, Snaihika 13. Videha 2 Su.Chi.40/45Ni.Sa. SangnaPrabodhana, Stambhana 14. Shodala 3
6
G.N.10/5/2 Virechana, Brimhana, Shamana
Above 3 +Marsha, Dhmana, Avapida
Conceptual Study
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Chart No. 1CARAKA’S CLASSIFICATION OF NASYAKARMA
Nasya
51
Navana Avapeedana Dmapana Dhuma Prathimarsha
Snehana Shodana Prayogika Snaihika Vairechanika
Shodana Sthambana
Snehana Virechana
According to the mode of action of Nasya Karma
Recana Tarpana
Shamana
According to various parts of the drugs utilized in Nasya Karma
Phala Patra Mula Kanda Pushpa Niryasa Twak
Accoding to action of nasya karma
Rechana Tarpana Shamana
According to various parts of the drugs utilized in Nasya therapy
Phala Patra Mula Khanda Pushpa Niryasa Twak
Conceptual Study
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Chart No. 2 SUSHRUTA’S CLASSIFICATION OF NASYAKARMA
Nasya
52
According to Sushruta, Nasya is of 2 types viz. Shirovirechana and Snehana.
These are further classified into 5 groups viz.
Shirovirecana Snehana
Shirovirecana Pradhamana Avapida Nasya Pratimarsha
Chart No. 03 VAGBHATA’S CLASSIFICATION OF NASYAKARMA
53
Ashtanga Sangrahakara has classified Nasya mainly into 3 varieties based on its effect
viz. Virechana, Brimhana and Shamana.
Snehana or Brimhana Nasya is further subdivided into two types on the basis of dose i.e.,
Marsha and Pratimarsha.
Avapida Nasya can be administered for both Virechana and Shamana purpose, whereas
Pradhamana Nasya is employed only for Shirovirechana.
Ashtanga Hridayakarta has mainly classified Nasya into 3 types viz.
Virechana, Brimhana and Shamana.
Nasya
Virecana Brumhana Shamana
Pradhamana Murdha-virecana Sneha Nasya (according to dose)
Pratimarsha Marsha Avapida
Conceptual Study
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Chart No. 04 KASHYAPA’S CLASSIFICATION OF NASYAKARMA
Nasya
Brumhana Karshana
(Purana) (Shodhana)
Chart No.5 BHELA’S CLASSIFICATION OF NASYAKARMA
54
According to Kashyapa Samhita, Nasya is classified into two groups,viz. Brimhana and
Karshana which are also known as Poorana and Shodhana Nasya respectively.
Nasya
55
Bhela classifies NasyaKarma into 4 types, viz., &
Avapida, Anuvasa Dhuma Pradhamana.
Chart No.6 SHARANGADHARA’S CLASSIFICATION OF NASYAKARMA
Nasya
56
Recana Snehana
Avapida Padhamana Marsha Pratimarsha
Chart No.7 BHOJA’S CLASSIFICATION OF NASYAKARMA
Nasya
Prayogika Snaihika
57
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Chart No.8 VIDEHA’S CLASSIFICATION OF NASYAKARMA
Nasya
Sajnaprabodhaka Stambhana
From the above discriptions it can be said that there are two types of classification of
Nasya Karma that has been explained in Āyurvedic literature.
1. Based on the pharmacological actions
ex: Recana,Tarpana etc.
2. Based on the preparation of drug and the method of its application.
e.x. Avapīda Nasya (Extracted Juice is used)
Dhmāpana Nasya (Powder is blowed)
Dhūma Nasya (inhalation through nose) etc.
Classification of NasyaKarma according to Preparation
Classification of Nasya by Caraka into Nāvana, Avapīda, Dhmāpana, Dhūma and
Pratimarsha while by Sushruta into Nasya, Shirovirecana, Pratimarsha , Avapīda and
Pradhamana seems to be based on the type of preparation used or the way in which it is
administered.
Marsha and prathimarsha explained by vagbata was mainly on the basis of difference in
the dose to be instilled into the nostrils
Taking the Caraka’s classification as the basis, all the above mentioned types of Nasya
are being described here seperately
1. NAVANA NASYA:
Navana is one of the well applicable therapies of Nasyakarma.
58
59
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Method:
Nāvana is administered by instilling the drops of a medicated Taila or Ghrita into the
nostril.Most of the time the medicines will be in the form of sneha
Types – Depending upon the therapeutic action, it is further classified into 2 types a)
Snehana Navana b) Shodhana Navana60
a) Snehana Navana: The snehana nasya suggests , It is employed to bring about
Snehana effect . It provides strength to all the Dhatus and is used as Dhatuposhaka.
Drug –.
Sarpi, Taila, Vasa & Majja processed either singly or in combination with appropraite
drugs. Generally, Sneha should be processed in VataPittahara Dravyas. 61
Dose – The following is the dosage schedule for Sneha Nasya.
According to Sushruta,62 the general dosage schedule for Snehana Nasya is
Hina Matra – 8 Bindu in each nostril (In total 16 Bindus).
Madhyama Matra – 1 Shukti Pramana(In total 32 Bindu)i.e., 16 Bindu in each nostril.
Uttama Matra – 1 Panishukti Pramana(In total 64 Bindu)i.e., 32 Bindu in each nostril.
According to Gayadasa & Bhoja,63
Prayogika Nasya) – 8 Bindu in each nostril.
Snaihika Nasya – (16 Bindu in each nostril).
Types – According to Vagbhata, Sneha Nasya is further classified into 2 types based on
dose:
i) Marsha ii) Pratimarsha
Indications 64– Sneha Nasya can be given in the following conditions :
Vātika Shirahshūla, Keshapāta,Dantapāta, Shmashrupāta, Karnashūla, Karnakshweda,
Timira, Nāsaroga, Mukhashosha, Avabāhuka, Akālaja Valita, Akālaja Palita,
Dārunaprabodha and Vātapittaja Mukharoga.
b) Shodhana Navana Sushruta’s Shirovirechana type refers to Shodhana type of Navana
Nasya.
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Drug – In this type of Nasya, oil prepared by Shirovirecana Dravyā’s like Pippali,
Shigru etc. can be selected
Dose 65–The general dosage schedule for Shodhana Nasya is
Hina Matra – 4 Bindu in each nostril.
Madhyama Matra – 6 Bindu in each nostril.
Uttama Matra – 8 Bindu in each nostril.
Indications 66– Aruci, Shirogaurava, Shūla, Pīnasa, Ardhāvabhedaka, Krimi,
Pratishyāya, Apasmāra, Gandhajnānanāsha, Ūrdhvajatrugata Kapharōga’s
Nāvana Nasya vis-à-vis rtu in healthy persons.
67
Season Nasya given at -
Shīta Kala : Noon
Sharad and Vasanta : Morning
Grishma Rtu : Evening
arsha Rtu : Only when sun is visible.
Nāvana Nasya vis-a-vis dosha and kāla
68,69
Kaphaja Roga : Fore noon
In Pittaja Roga : Noon
In Vataja Roga : After Noon
2. AVAPIDA NASYA:70
Definition:
The word Avapīda means to extract juice of leaves or paste (kalka) of required
medicine.71
It is one such variety of Nasyakarma which is commonly employed in emergency
conditions.
According to Sushruta, it is considered as the Vikalpa of Shirovirechana.72
Method Medicines required for nasya are pounded into a paste form and then are
squeezed to extract the juice . This is dropped into the nostrils .This process of
administering the medicines is known as Avapida nasya
This type of Nasya may also be given with Kalka (paste) etc.
73
74
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It may also be instilled by diping the Pichu into the Shruta or Shrutashīta, Swarasa of the
required drug. 75
Though Sushruta recommends it only for Shirovirecana,Sharkara and Ikshurasa have
been recommended for Stambhana in the disease like Raktapitta.
a. Shodhana Avapida Nasya
76
Types – According to Charaka, it is mainly of 2 types
b. Stambhana Avapida Nasya
c. Drugs
d. For Shodhana nasya Kalka of Tīkshna dravyas like Saindhava, Pippali etc. have
been mentioned.
e. For Shodhana nasya Kalka of Tīkshna dravyas like Saindhava, Pippali
etc. have been mentioned as Avapīda Nasya and for Stambhana purpose Stambhana
drugs have been mentioned77
According to Chakrapani, Avapida Nasya is of 3 types. viz.,
a) Shodhana Avapida Nasya
78
b) Stambhana Avapida Nasya
c) Shamana Avapida Nasya
According to Videha,
a) Sangnaprabodhana Avapida
it is of 2 types.viz.,
b) Stambhana Avapida
Sangnaprobodhana Nasya is a kind of Shodhana Avapida Nasya79
Dose – Like Shirovirecana, Avapīda Nasya should be given in the following dose 8
0
Hīna Mātra - 4 drops
Madhyama Mātra - 6 drops
Uttama Mātra - 8 drops
Indications: In Krusha, Durbala, Bhīru then Shrutha or Kalaka has to be used
accordingly.
It is also indicated in
81Sanyāsa, Mūrcha, Vishābhighāta, Mōha, Apatantraka, Mada,
Apasmāra, Kāma, Atichinta, Krodha, Bhaya, Mānasaroga.
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Sārňgdhara has told the Avapīda Nasya for the patients suffering from Galaroga,
Vishamajwara, Manovikara and Krimi. 82
Sangnaprabodhaka and Shodhana & varities of Avapida Nasya are indicated in
Abhishyanna (MedaKaphabhivyapta Shiras), Sarpadashta Visanjna(loss of consciousness
due to snake-bite), Vishabhighata, Sanyasa, Murcha, Moha, Apatantraka, Mada,
Apasmara, Kaamarti, Chinta, Krodha, Bhaya, etc. and other Manasa Rogas like
MudaChetas, VyakulaChetas.
Stambhana Avapida is indicated in Nasagata Raktapitta, Krusha, Durbala, Bheeru,
Sukumara, Yoshita(Stri).(Su.Chi.40/44)
Dhmāpana Nasya :
Dhmāpana or Pradhamana is a specific Shodhana Nasya.
Definition:
Here the Nasya is instilled with chūrna specifically for Shirovirecana. Dhmāpana is a
word mentioned by Caraka83 and Pradhamana 84is been described by Sushruta.
According to Sushruta, it is considered as the Vikalpa of Shirovirechana.
Definition 85– cÉÔhÉïxrÉÉkqÉÉmÉlÉÇ iÉÌ® SãWûxÉëÉãiÉÉãÌuÉvÉÉãkÉlÉqÉç| Ch.Si.9/91
The procedure in which the fine powder of medicinal drugs are blown into the nostrils is
known as Dhmapana Nasya. It cleanses the DehaSrotas by eliminating the morbid dosha.
Method –1. Nadi method 86– mÉëkqÉÉmÉlÉxrÉ iÉÑ| iÉiÉç wÉQûÇaÉÑsÉrÉÉ lÉÉQèrÉÉ kÉqÉãccÉÔhÉïÇ qÉÑZÉãlÉ iÉÑ|
Ch.Si.9/107
wÉQûÇaÉÑsÉÉ Ì²uÉY§ÉÉ rÉÉ lÉÉQûÏ cÉÔhÉïÇ iÉrÉÉ kÉqÉãiÉç| iÉϤhÉÇ MüÉãsÉÍqÉiÉÇ uÉY§ÉuÉÉiÉæ: mÉëkÉqÉlÉÇ ÌWû
iÉiÉç|| 87Sha.Sa.Ut.8/13
Here according to reference stated the fine powder of drugs is blown into the nostils with
the help of Naadi Yantra , which is six anguli in length . The fine powder of drugs is
taken at one end and air is blown from the other end , so that the medicine enters into the
nostrils
2nd
Here the fine herbal powder is wrapped in a pottali made of a thin cloth and is kept at the
opening of the nostrils and is made to inhale by the patient
method –By Videha.
88
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Dose:
According to Videha the dose of Dhmāpana Nasya is three Mucuti (3 pinch)88
Indications89 AirÉliÉÉãiMüOûSÉãwÉãwÉÑ ÌuÉxÉÇ¥ÉãwÉÑ cÉ SÏrÉiÉã| cÉÔhÉïÇ mÉëkÉqÉlÉÇ kÉÏUæxiÉÌ® iÉϤhÉiÉUÇ rÉiÉ:
|| Sha.Sa.Ut.8/17
It is indicated in patients afflicted with Krumi, Visha, Manasa Roga like Unmada,
Apasmara, etc. SangnyaNasha and in other conditions presenting with grave doshik
vitiation.
4. DHUMA NASYA:
Instrument: required for the dhuma nasya
A special Dhūmanādi (smoking pipe) has been mentioned by caraka to inhale smoke. Its
length should be of 24 Aňgula and breadth of measuring one’s own finger
90
Definition –iÉãlÉ mÉëÉrÉÉãÌaÉMüxlÉæÌWûMüuÉæUãcÉÌlÉMü kÉÔqÉÉlÉÉÇ lÉÉxÉÉSÏrÉqÉÉlÉÉÍqÉWû aÉëWûhÉqÉç,
qÉÑZÉmÉãrÉxiÉÑ kÉÔqÉÉã lÉ lÉxrÉqÉç| Ch.Si.9/9-92, A.Di.
It is defined as medicated fumes taken through nostrils and eliminated through oral
cavity. Acharya Sushruta has not described Dhuma Nasya as a type of Nasya.
Dhūma Nasya are of the following types :
91. This
measurement is for Virechana type. 32 Aňgula is the length mentioned for Snaihika
Dhūma where as 36 Aňgula length for Prāyogika Dhūma isbeen mentioned .91
Method of administration
Patient is asked to the inhale the smoke that is emitted out from burning the herbs .
While breathing in in one nostril, the other nostril is closed with a finger . The smoke is
then made to escape through the mouth
92
Prāyogika
Snaihika
Vairechanika
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Drug – kÉÔqÉÇ cÉ xÉuÉïaÉlkÉÉlÉÉÇ MÑü¸Ç cÉæuÉÌuÉuÉÎeÉïiÉqÉç| Bhe.Si.293
All the Gandha dravyas can be used. But, Kushta and Tagara should never be used.
Indications –
Is indicated in Shiroroga, Nasaroga, Akshiroga 94
5. MARSHA & PRATIMARSHA NASYA:
Both Marsha and Pratimarsha type of Nasya consists of introducing the oil through the
nostrils.95 And it is stated that the prathimarsha variety of nasya is described as the most
convenient form of Nasya as it does not lead to any discomfort or complications.96
Definition – The procedure where in the medicated Sneha is dropped into the nostrils in a
specified dosage is called as Marsha-Pratimarsha Nasya.
PRATIMARSHA NASYA –97
Definition97–mÉëÌiÉqÉvÉÉãï pÉuÉãiÉç xlÉãWûÉã ÌlÉSÉãïwÉ EpÉrÉÉjÉïM×üiÉç| Ch.Si.9/92
mÉëÌiÉqÉvÉïxiÉÑ lÉxrÉÉjÉïÇ MüUÉãÌiÉ lÉ cÉ SÉãwÉuÉÉlÉç| Ch.Si.9/116
Medicated Sneha when administered into the nostrils in a small and specific dose is
known as Pratimarsha Nasya. It is described as the most convenient form of Nasya as it
does not has any complications.97
Types – It is of 2 types viz.,
a) Snehana
97
b) Virechana
Method – The index finger is dipped in the required sneha and then the sneha is instilled
into the nostrils , making sure that it does not reachthe kanta pradesha I,e the quantity
should be minimum 98.
Even a healthy person can use this for promoting the strength & stability to Indriyas &
organs in the head.
Dose – 2 Bindu in each nostril is the dose mentioned by Sharangadhara .99
Vagbhata100 &
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Indications
It can be administered in any season,even in the season which is not suitable for the
nasya karma like varsha and durdina 101
Contraindications
It is contraindicated in dusta prathishyaya, bahudosha,bahudosha,durbala shrotra, udirna
doshas 102
It is contraindicated in such person because as the sneha matra is insufficient to eliminate
doshas or may aggrevate the dosha which is already vitiated 103
Pratimarsha can be given in
- Any age
- Any season
- Even in not suitable time & season i.e. in Varsha and
Durdina
- Bala - Vriddha
- Bhiru - Sukumara
- Weak patients - Kshtakshama
- Trishna Pidita - Mukhashosha
- Valita and Palita
Pratimarsha Pranidana Kaala –Sharangadhara104 Sushruta 105
N
o
and have described
fourteen suitable times for the administration of Pratimarsha Nasya, while Vagbhata has
mentioned fifteen such Kaala.
Sushruta & Vagbhata have even enumerated the benefits of Pratimarsha performed in
each Kaala.
Table no 1 showing Various Timings for Pratimarsha Nasya
Time for Pratimarsha Nasya Su. As. H. Sha.
1 After leaving the bed in morning + + +
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2 After cleaning the teeth (with
Dantadhavana)
+ + +
3 Before going outside + - +
4 After exercise + + +
5 After sexual intercourse + + +
6 After walking + + +
7 After urination + + +
8 After passing Apanavayu + - -
9 After Kavala + + +
10 After Anjana + + +
11 After meal + + +
12 After sneezing + - -
13 After sleeping in the noon + + +
14 In the evening + + +
15 After vomiting - + +
16 After Shirobhyanga - + -
17 After defaecation - + +
18 After laughing - + -
MARSHA NASYA106 – The only difference between Pratimarsha & Marsha is the
dosage. Pratimarsha.
Nasya is administered in lesser dosage when compared with Marsha,
6-1o drops of sneha is instilled to each nostril , this is known as marsha nasya 107
Dose – Vagbhata 108& Sharangadhara109have mentioned different dosage pattern:
According to Vagbhata, Hina Matra – 6 Bindu in each nostril.
Madhyama Matra – 8 Bindu in each nostril.
Uttama Matra – 10 Bindu in each nostril.
According to Sharangadhara, Hina Matra –1 Shaana (8 Bindu)
Madhyama Matra – 4 Shaana (32 Bindu)
Uttama Matra – 8 Shaana (64 Bindu)
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Classification of Nasya according the Pharmacological action: 110
On the basis of Pharmacological action, Charaka and Vagbhata have classified Nasya
Karma into 3 types viz., 1) Rechana (Virechana)
2) Tarpana (Brimhana)
3) Shamana means Palliative
Sushruta and Sharangdhara have excluded Shamana from their classification and divided
Nasyakarma into only two groups, viz; Shirovirechana111 and Snehana
Kashyapa considered Brimhana and Karshana types of Nasya112.
Further Videha explained two types of Nasyakarma according to their pharmacological
action i.e. Sangnyaprabodhana and Stambhana. 113
Nasya classification accoding to pharmacological action
Rechana (shodana ) Brimhana Shamana
Samjnaprabodana Krimigna Stambana Karshana
Rakthastambana Doshasthambana
1. RECHANA NASYA(VIRECHANA NASYA): 114, 115, 116
Definition – Rechana Nasya can be defined as that which eliminates the vitiated doshas
from urdhwajatru
Drugs – Drugs like Apamarga, Pippali, Maricha etc. may be used 117 mentioned in
Rogabhishakjitiya Adyaya 118
It may also be administered with Tikshna Sneha, Kwatha, Churna or Swarasa of
Shirovirechana drugs or by dissolving these drugs in Madya, Madhu, Saindhava, Asava,
Pitta and Mutra or mixed with the drugs specified to treat the respective
diseases(As.Sa.Su.29/5).119
Indications – xiÉqpÉxÉÑÎmiÉaÉÑÂiuÉɱÉ: vsÉæÎwqÉMüÉ rÉã ÍvÉUÉãaÉSÉ:| Ch.Si.9/13
hiroroga like Stambha, Supti and Guruta of Shira where the Kapha Dosha is primarily
involved 120
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vÉÉãTüÉÅmÉxqÉÉUMÑü¸ãwÉÑ lÉxrÉÇ uÉæUãcÉlÉÇ ÌWûiÉqÉç| Sha.Sa.Ut.8/14,15
Rechana Nasya prepared out of sneha particularly indicated to the Bayabheeta, Kleeba
stree Durbala , Krusha and Sukumara. The patient suffering from Sannipataja Jwara,
Galaroga Atinidra, Manovikara, Krimi, Vishabhipanna, Abhishyanda and
SarpadashtaVisangna may be given Shirovirechana Nasya using Kalka, Churna and
Svarasa also. Choorna is advisable if immediate effect is required,. 121(As.Sa.Su.29/6).
2. TARPANA NASYA:122
Synonyms
Snehana nasya
Brimhana nasya
Drugs – The Sneha prepared of Madhura Skandha drugs or snigda and Madura drugs
may be employed. According to Vagbhata, Sneha prepared with Snigdha and Madhura
drugs or with the drugs described useful for that particular disease should be used.
Medicinal tree’s niryasa , mamsa rasa , raktha may also administered123
Indications – rÉã cÉ uÉÉiÉÉiqÉMüÉ UÉãaÉÉ: ÍvÉU:MüqmÉÉÌSïiÉÉSrÉ:| Ch.Si.9/13
It is used in diseases like shirakampa and arditha 124
3. SHAMANA NASYA
Definition –Type of Nasya which is administeread which is for the alleviation of
aggravated Dosha situated in JatrurdhwaBhaga.
Indications – Nasagata rakthapitta125
Nasya karma yogya
Sl.No.
126
Table : 2 Showing nasya karma yogyas
NasyaKarma Yogya Charaka Sushruta Vagbhata
1 Shiroroga + + +
2 Dantaroga + +
3 Manyastambha +
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4 Galagraha +
5 Hanugraha +
6 Peenasa + + +
7 Galasundika +
8 Galashaluka +
9 Sukra +
10 Timira + +
11 Vartmaroga +
12 Vyanga + +
13 Upajihwika +
14 Ardhavabhedaka + +
15 GreevaSkandaRoga +
16 Amsaroga +
17 Asyaroga +
18 Nasikaroga + +
19 Karnaroga +
20 Akshiroga + +
21 Murdharoga +
22 Kaphalaroga +
23 Shirahkampa +
24 Ardita +
25 Apatantraka +
26 Apatanaka +
27 Galaganda +
28 Dantashula +
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29 Dantaharsha +
30 Dantachala +
31 Akshiraaji + + +
32 Akshiarbuda +
33 Swarabheda + + +
34 Vakgraha + +
35 GadgadaKathanadi + + +
36 UrdwajatrugataVatadiRoga +
37 Vatabhibhutashiras +
38 Kesha smashruprapata +
39 DarunaKarnashoola +
40 Karnakshweda +
41 Asyashosha + +
42 Avabahuka + +
43 Akalajavalipalita +
44 Vatapittaja Shiroroga +
45 GreevaskandaUrasamcha
balajananartha
+
46 Drushtiprasadajananartha +
47 SleshmanabhivyaptaTaalu +
48 SleshmanabhivyaptaKanta +
49 SleshmanabhivyaptaShiras +
50 Arochaka +
51 Shirogourava +
52 Krumi + +
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53 Pratishyaya +
54 Apasmara + +
55 Gandha Ajnana +
56 Shunyashirasa +
57 ShiraJaadya +
58 Galamaya +
59 Shopha +
60 Ganda +
61 Suryavarta +
62 Nasashosha +
63 Keshadosha +
Nasya Karma Ayogya The person for those nasya karma is contraindicated for the
nasya karma is mentioned by Caraka127 Sushrutha 128 and Vagbata
Sl.No.
129
Table No : 3 showing nasya karma ayogyas
NasyaKarma
Ayogya
Charaka Sushruta Vagbhatta
1 Bhuktabhakta + + +
2 Ajirni + + -
3 Peeta Sneha + + +
4 Peeta Madya + + +
5 Peeta Toya + + +
6 Snehadi Patukamah + - +
7 Snatah Shirah + - +
8 Snatukamah + + +
9 Kshudharta + - +
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10 Shramarta + + -
11 Matta + - -
12 Murcchita + - -
13 Shastradandahrita + - -
14 Vyavayaklanta + - -
15 Vyayamaklanta + +(Shranta) -
16 Panaklanta + - -
17 Navajwara Pidita + - -
18 Shokabhitapta + + -
19 Virikta + - +(Shuddha)
20 Anuvasita + +(Datta Basti) +(Datta Basti)
21 Garbhini + + +
22 Navapratishyayarta + - -
23 Apatarpita - + +(Shuddha)
24 Peetadravah - + +
25 Trishnarta + + -
26 Gararta - + +
27 Kruddha - + -
28 Bala - + -
29 Vriddha - + -
30 Vegavarodhitah - + +
(Vegarta)
31 Raktasravita - - +
32 Sutika - - +
33 Shvasapidita - - +
34 Kasapidita - - +
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If nasya karma is performed In Ajīrna or Bhuktabhakta then there will be obstruction to
the Ūrdhvavaha srotas leading to Kāsa, Shvāsa, Chardi and Pratishyāya
If nasya karma is performed after consuming Sneha, Madhya, and Toya then it leads to
Nāsa Srāva, Akshiupadeha, Timira, and Shiroroga.
If nasya karma is performed after Snāna or if Snāna done after Nasyakarma leads to
Pratishyāya.
If nasya karma is performed in Kshudhita Vātaprakopa takes place
If nasya karma is performed to a Trushni it further aggravates the Trushna leading to
Mukhashosha.
If nasya karma is performed In Shramita, Mattha, Mūrchita leads to Lakshanā’s as found
in the Niruha Basti Vyāpath.
The pain increases if Nasya is done to a person who has the got beaten by the Shastra and
Danda.
If nasya karma is performed to a patient who is fatigue due to Vyavāya, Vyāyāma and
Madhyapāna.may lead to pain in the shira , skhanda and netra
If nasya karma is performed to a person with Navajwara, Shoka, it leads to aggravation
of the Ūshma leading to Timira and there is further increase in the Jwara.
If nasya karma is performed to a person who has undergone Virecana leads to
Indriyaupaghāta and for Anuvāsita leads to Kaphaprakopa, Shirogurutha, Kandu, Krimi.
If nasya karma is performed in Garbhini leads to Garbha Sthambha, leading to Kuni,
Pakshahata.
In Navapratishyāya leads to Vikruthi in Srotas
In Akāla and Durdina due to Shīta Dosha it leads to Pūtinasya and Shiroroga.
NASYA PRANIDANA YOGYA KAALA
Generally Nasya should be given in Pravrit, Sharad and Vasanta Rtu.
130
131 By providing
artificial conditions of the above-mentioned seasons Nasya can be given in any season in
emergency. For example in summer, Nasya can be given in cold places and in cold
season it can be given in hot places.
Table no 4 – Showing Time schedule in different seasons should be as below.
132
133
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Rtu Nasya given at
Grīshma Rtu - Pūrvahna
Shīta Rtu Madyāhna
Varsha Rtu Adurdina
Sharad + Vasanta In the morning
Shishira + Hemanta Madyāhna
Grīshma + Varsha Aparāhna
Sushrutha advised nasya karma to be performed in the empty stomach for healthy
individual 134
In rogi the time schedule is
Doshaja Vikāra
135
Table no 5 showing time schedule of nasya in Doshaja vikaras
Nasya given at
Kaphaja Vikāra Purvāhna
Pittaja Vikāra Madhyāhna
Vātaja Vikāra Aparāhna
The time schedule mentioned for the administration of nasya by Vagbata is same as that
of Sushrutha 136
Sharangadhara opines same as sushrutha in this aspect . He adds that if the patient is
suffering from lalasrva , supthi, pralapa , putimukha, arditha , karnanaadi, trushna,
shiroroga and such other condition with excessive vitiated doshas nasya can be
administered even in night . 137
NASYA KARMA COURSE :
According to Astanga Sansgaha Nasya should be given for 3 days, 5 days , 7 days and 8
days or till the samyak nasya laxana is attained 138
Caraka has not told specific duration of the nasya karma , but suggested to give according
to the severity of the disease .
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Nasya can be administered on alternate days,once in 2 days for seven sittings or twenty –
one sittings. Two sittings may also be done in a day138
According to bhela he has smentioned not to perform nasya karmamore than nine days as
it leads to satmya to the body 139
Nasyakarma may be given for seven consecutive days . In condition like vata dosha in
shira, Manyasthamba, Swarabhramsha etc nasya karma may be done twice a day 140
Dose in Nasya Karma:
Acharya Caraka has not mentioned prescribed the exact dose of nasya . The dose of
Nasya drug depends upon the variety of the therapy and drug utilized for it . Sushruta and
Vāgbhata have explained the dose in form of Bindus (drops). Here one Bindu means the
drop that is formed after dipping the two phalanges of Pradeshini (index finger) in oil.
No.
141
Table no 6 showing dose of nasya
Type of Nasya Hrasva
Matra
Madhyama
Matra Uttam Matra
1 Shamana Nasya 8 drops 16 drops 32 drops
2 Shodhana Nasya 4 drops 6 drops 8 drops
3 Marsha Nasya 6 drops 8 drops 10 drops
4 Avapīda Nasya (Kalka
Nasya)
2 drops 2 drops 2 drops
5 Pratimarsha Nasya 2 drops 2 drops 2 drops
Dose of nasya accordin to Videha142
The common dose for Pradhamana Nasya is 3 Mucuti (the quantity of Churna that is held
inbetween Index finger and thumb =one Mucuti) Depending upon the variety of materials
used Shārňgdhara 143
has described the following dosage schedule for Nasyakarma.
Tīkshnaushadhi Churna - 1 Shāna (4 Māsha) (24 Ratti)
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Hiňgu – 1 Yava (½ Ratti)
Saindhava – 1 Māsha (6 Ratti)
Dugdha – 8 Shāna (64 Drops)
Jala (Aushadha Siddha) – 3 Karsha (3 Tola)
Madhura Dravya – 1 Karsha (1 Tola)
if the quantity is less than the prescribed dose The vitiated Doshā’s does not get
eliminated completely , if practiced may lead to Gaurava, Aruchi, Praseka, Pīnasa,
Cchardi, Kantaroga etc symptoms of Atiyoga is found if the Snehana Nasya is
administered in the excessive dose.
Purva Karma (Pre-measures)
144
ADMINISTRATION OF NASYA
The procedure of Nasya karma may be classified under following headings :
Pradhana Karma (Chief measure)
Pashchata Karma (Post-measures)
Purva Karma (Pre-measure)
It is advisable that all materials, drugs and equipments like napkin, utensils necessary for
Nasya karma are collected in sufficient quantity prior to Nasya karma.
A special room “Nasya Bhavana” free from atmospheric effects like direct blow of aiand
dust, etc. and lighted appropriately145
A chair for sitting purpose
should be selected. The following articles should be
kept in the room:
Nasya Asana : It should be placed in Nasya room. It consists of -
cot for lying purpose
Nasya Aushadhi Drugs required for the induction and management of shirovirechana
should be collected in rhe form of kalka, churna, kwatha, kshira,udaka, sneha , asava,
Dhuma etc in sufficient quantity .
Nasya Yantra : It should be collected according to the types of Nasya such as :
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A dropper or Pichu : For Snehana, Avapida, Marsha and Pratimarsha
Nasya.
Shadangula Nadi : For Pradhmana Nasya
Dhuma Yantra : For Dhuma Nasya
Besides this one needs efficient assistant , dressing material, spitting pots, bowl, napkins
and towels also
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 : To prepare the patient for the Nasya karma following
matter should be considered according to Acharya Sushruta.
Patient should have passed his natural urges like urine and stool.
He should have completed his routine activities.
Light breakfast prior (1 hour) to Nasya karma is advised.
Now the patient Patient is advised to lie down comfortably relaxed on a cot in supine
position, hands and legs stretched straight. His body is draped up to the neck. Eyes are
covered with a cloth to avoid any spilling of medicine. Mrudu Abhyaňga is done on
scalp, forehead, face and neck146
Mrudu Swedana in the form of Tāpasweda using cloth dipped in hot water for is done
after Abhyaňga over Lalāta, Mukha, Nāsa, Manya, Grīva and Kantha region.
Pradhāna Karma:
Sushruta 147 Vāgbhat148 Caraka, 149
Shira or the head is made to be “Pralambita” (lowered / hanging down) and foot end
is slightly raised.
and has explained the procedure Nasyakarma as
follow:
(a) Position of the Patient
Patient is advised to lie down in a comfortable supine position on Nasya table.
Head should neither be excessively flexed nor extended.
(b) Administration of medicine – 150
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E¨ÉÉlÉvÉÉÌrÉlÉã mÉëxÉÉËUiÉMüUcÉUhÉÉrÉ ÌMüÇÍcÉiÉç mÉëÌuÉsÉÎqoÉiÉÍvÉUxÉã uÉx§ÉÉcNûÉÌSiÉlÉã§ÉÉrÉ
uÉÉqÉWûxiÉmÉëSãÍvÉlrÉaÉëÉã³ÉÉÍqÉiÉ lÉÉxÉÉaÉëÉrÉ ÌuÉvÉÑ®xÉëÉãiÉÍxÉ SͤÉhÉWûxiÉãlÉ xlÉãWûqÉÑwhÉÉqoÉÑlÉÉ mÉëiÉmiÉÇ
UeÉiÉxÉÑuÉhÉïiÉÉqÉëqÉÍhÉqÉ×imÉɧÉvÉÑÌ£ülÉÉÇ AlrÉiÉqÉxjÉÇ vÉÑYirÉÉ ÌmÉcÉÑlÉÉ uÉÉ xÉÑZÉÉãwhÉÇ
xlÉãWûqÉSìÓiÉqÉÉÍxÉÇcÉãSurÉuÉÎcNû³ÉkÉÉUÇ rÉjÉÉ lÉã§ÉÇ lÉ mÉëÉmlÉÉãÌiÉ| Su.Chi.40/25
After covering of eyes with a clean cloth, the tip of patients nose should be drawn
upward by the left thumb of the Vaidya. At the same time with the right hand Vaidya
should instill lukewarm medicine in both the nostrils,151
The drug should be in a proper quantity i.e., it should neither be less nor more in the
dose.
alternately, with the help of
proper instrument like pichu, dropper, shadangula nadi etc. according the type of
Nasya
It should be Luke warm.
The patients should remain relaxed at the time of administration of nasya and he
should avoid speech, anger, sneezing, laughing and shaking his head
(c) Immediate measures after administration of Nasya – Mardana(Massage) should be
done over palms, soles, shoulders, ears.
152
Paschāt Karma: Sushruta
Then the patient should be told to draw the
medicine to the throat and spit it out on either side (right & left side on to Spitting pot
kept on either side)
(d) Observation of the Patient – for Samyak, Ayoga, Atiyoga Lakshana and Vyapads.
Appropriate treatment should be adopted if any Ayoga, Atiyoga & Vyapads are noticed.
153 Caraka ,154 Ashtāňga Hrudaya 155 and Shārňgdhara 156
Patient in lying position is asked to count up to 100 matra i.e. approximately 2
minutes. Then these regimen should be followed
has advised for the following regimen.
a. Snehana
b. Swedana
c. Dhūmapāna
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Gandusha
(d) Ahara
(e) Parihara Vishaya
Mrudu Abhyaňga and Swedana over Gala, Kapola, lalāta, Mardana over shoulder, feet
and hands is done.157,158
Dhumapana
SL.NO
159,160,161
Inhalation of smoke for the therapeutic purposes is known as dhumapana.The kapha
dosha that is accumulated in the head is best cleared by this procedure.This is done as
Paschat karma after vamana and nasya karma.
Name of the
Acharyas
No Reference Classification
1 Charaka 3 Ca.si.9/91 Prayogika,Vairechanika,
Snaihika dhumapana
2 Sushruta 5 Su.ci.40/4 Prayogika,Snaihika,Vairechanika
Kasaghna,Vamaniya dhumapana
3 Vagbhata 3 A.H.SU. 21/2 Snigdha,Madhyama,Tikshna
dhuma
4 Sharngdhara 5 Sh.U.KH.9/1 Shamana,Brmhana,Rechana,
Kasaha,Vamana,Vrana dhupana
Procedure:
Two to three puffs are to be taken through the mouth and exhaled through mouth itself
and never exhaled through the nose.
As purvakarma snehana and swedana are administering prior to nasya karma.By these
doshs vilayana happens in the srotas and it helps for easy expelsion of doshas.In most of
the time even after the administration of nasya karma there may be chance of
accumulation of some amount of doshas in the srotas.That retained kapha dosha cannot
be come out by nasya dravya and gets collected their itself and further leads to different
diseases.Hence to remove this ,dhumapana is administered.This will clears the srotas and
expels the remaining doshas.
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Gandusha
• Snigdha gandusha
162
Procedure of holding the oil or decoction in the oral cavity for certain ttime period is
known as gandusha.
Classification
• Shamana gandusha
• Shodhana gandusha
• Ropana gandusha
After dumapana,Ushna jala gandusha has been explained.This removes the kapha present
in the oral cavity.
(d) Ahara Hita Ahara, Anabhishyandi Ahara, Laghu & Ushna Ahara
(e) Parihara Vishaya One should avoid exposure to Raja , Dhuma, Ātapa, Shira
Snāna, Atiyāna, Krodha and stay in a place which is devoid of direct blow of wind. 163
Samyak Yoga of nasya karma :
Urah-shiro-lāghava, Indriyavishuddhi and Srotovishuddhi 164 Sukhaswapna-prabodhana,
Chitta-Indriya- prasannata and Vikaropashama 165 proper respiration and sneezing 166
Symptoms
are
the general symptoms of Samyak Yoga of NasyaKarma.
Table no 7 showing Shamayak Yoga Lakshana
Ch. Si
1/51
Su.Chi.
40/32-33
As.H.Su.
20/24
Sha.Utt.
8/58
Bha.Pra. Kas. Bh.
1. Urah Laghuta + - - - + - -
2. Shiro Laghuta + + - - - - -
3. Netra Laghuta - + + - + -
6. Srotovishuddhi + + - + + + -
7. Swaravishuddhi - + - - - -
8. Vaktravishuddhi - + - - - -
9.Indriyācchta-prasāda + + - + + + +
10. Netrateja Vriddhi - + - - + -
11. Chitta Prasāda - + - + + + +
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12. Vikāropashama - + - + + - +
13. Sukha Svapna Prabodha - + + - - - -
14. Sukhacchvasa - + - - - - -
15. Arati - - - - - - +
16. Medha - - - - - - +
17. Bala - - - - -
Ayoga
Ayoga of Nasya karma will be seen if Nasya is not given in proper way or if the dose is
less. Shirogaurava, Galopalepa and Nishthīvana167 Kandu, Upadeha, Guruta, Srotasam
Kapha Srāva168. Vitiation of Vāta, dryness in Indriya and no relief in the symptoms of the
diseases169 dryness in mouth and nose170
Symptoms
are the symptoms of Ayoga of Nasyakarma.
Table no 8 showing Ayoga Lakshana
Ch. Si
1/51
Su.Chi.
40/32-33
As.H.Su.
20/24
Sha.Utt
8/58
Bha.Pra. Kas. Bh.
1. Shirogaurava and
Dehagaurava
+ - - + + + +
2. Galopalepa + - - - - - +
3. Nishthīvana + - - - - - +
4. Kandu - + + + + - -
5. Kaphapraseka - - - - - - -
6. Upadeha + - + + - - -
7. Rūkshata + - - + + + -
8. Vāta Vaigunya + - - - - - -
9. Srotoriktata - - - - + - -
10.Srotasamkaphasrāva + - - + + + -
11. Nāsashosha - + - - - - -
12. Āsyashosha - + - - - - -
13. Akshistabdhata - + - - - - -
14. Shiroshūnyata - + - - - - -
15. Vyādhi Vriddhi - - - - - + -
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Atiyoga:
Toda and Arati,171 Kapha Srāva, Shirahshūla and Indriya
Vibhrama 172Mastulungāgama, Vātavriddhi, Indriyavibhrama, and Shiroshunyata 173
Table no 9 showing Atiyoga Lakshana
are also
the symptoms of Atiyoga of Shirovirecana.
Symptoms
Ch. Si
1/51
Su.Chi.
40/32-33
As.H.Su.
20/24
Sha.Utt
8/58
Bha.Pra. Kas. Bh.
1. Shirogaurava - + + + + - -
2. Shira shunyata - + - + + - -
3. Shira vedana + - - - - + -
4. Netra Vedana + - - - - - -
5. Shankhavedana + - - - - - -
6. Sūchitodavat Pīda + - - - - - -
7. Indriya Vibhrama - + - + + + -
8. Mastulungāgama - + - - - - -
9. Snehapūrna Srotas - - - - + - -
10.Karna Tālu Upadeha - - - - - - -
11. Vāta Vruddhi + - - - - + +
12. Kandu - + - - - - -
13. Praseka - + + + - - -
14. Pīnasa - + - - - - -
15. Aruchi - - + - - - -
16. Deha Daurbalya - - - - - + -
17. Unmāda - - - - - - +
18. Pitta Vruddhi - - - - - - +
19. Hridaya Shūla - - - - - - +
20. Sūryāvarta Roga - - - - - - +
21. Atrupti - - - - - - +
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Table no 10 showing management of ayoga and atiyoga of nasya karma174,17
5
NASYA/CHIKITSA AYOGA CHIKITSA ATIYOGA CHIKITSA
SHIROVIRECHANA
According to Charaka, after
Snehana & Swedana,
TeekshnaNasya should be
administered again.
According to Sushruta 175,
According to Charaka, Mrudu &
Drava Tarpana should be given.
According to Sushruta, Vagbhata,
Kashyapa, Sharangadhara, &
Bhavamishra, Vataghna Chikita
should be adopted.
Vagbhata, Kashyapa,
Sharangadhara & Bhavamishra,
175
SNEHANASYA
According to Sushruta,
According to Sushruta,175
Nasya should be administered
again.
175 Ruksha
Upachara should be adopted.
According to Sharangadhara and
Bhavamishra 174, Ruksha &
Anabhishyandi Ahara is advised.
VYAPAD OF NASYAKARMA :(COMPLICATIONS OF NASYAKARMA)
Comlications do occur if patients do not follow the regimen mentioned in the paschat
karma of nasya karma leading to dosha prakopaand again leading to many complications
and which is termed as Vyapad 176
The vyapad of nasya karma may occur due to
Dosha Utleshat (Dosha Nimitta) – due to aggravation of the Dosha which is commonly
encountered in Snaihika Nasya.
Dosha Kshayat 177–
By giving kaphagna upacharas like use of ushna and Tikshna Aushadi karma in these
conditions
due to diminution of the Dosha which is commonly encountered in
Shirovirechana.
Administration of nasya to the patients who are suffering from
Ajirna,Bhuktabhakta,Jalapeetha, or in the time or season like cloudy atmosphere , it
leads to production of kaphaja rogas
Management :
178
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If administration of nasya is done to krasha shareera , virittha,Garbini,vyayama klantha
and Trushi it leads to vitiation of vata leading to vataja vikaras
Management
Vatanashaka procedures like snehana,Brimhana and Swedana should be done in above
conditions . The pregnant lady should specifically be treated with the use of ghritha and
kshira 179
During administration of nasya if the head of the patient is lowered more , if he sneezed
or the drug is less or in excess quantity , or it is given when it is contraindicated then it
may lead to trishna and Udgara
It cures the diseases of the urdwajatru .
180
Cold water has to be sprinkled over Lalata and Mukthapradesha if he faints during the
time of administration of Nasya
If nasya karma is administered to patients suffering from Jwara , Shokabeetha, and
Madyapeetha it may lead to Timira roga
Management
Ruksha , Shitha anjana, Lepa and Putapaka should be applied as treatment
BENEFITS OF NASYAKARMA
Removes the cloudening or dullness of the indriyas .
Imparts sweet aroma to the mouth & strength of the jaws, teeth, bones, head, neck,
Trika, arms & chest.
It protects against the attack of Vali, Palitya, Vyanga.
181
It nourishes & strengthens Griva, Asya, Skanda Vaksha and all indriyas ..
Practicing NasyaKarma at the proper time will keep his sense organs unimpaired.
182
He do not suffer from premature graying of hair & beard
It reduces hairfall.
It cures the diseases like Ardita, Shirahshula, Hanugraha, Manyastambha, Peenasa,
Ardhavabhedaka, Shirahkampa.
It strengthens vessels, joints, ligaments & tendons of head The face will become
cheerful and improves swara .
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Sense organs will be strengthened.
Checks the disease of Urdhvajatrugata of the body.
It reduces effects of senility in aged individuals.
Mode of action of Nasya Karma
The clear description regarding the mode of action of the Nasya karma is not available in
Ayurvedic classics. According to Charaka Nasa is the gate way of Shira
183
2.The drug
administered through nose as Nasya reaches the brain & eliminates only the morbid
Doshas responsible for producing the disease.
In Astanga Sangraha –
Nasa being the gateway to Shira
10
The drug administered through nostrils.
Reaches Shringataka (a Sira Marma by Nasa srota).
Spreads in the murdha (brain) taking marma of Netra (eye), Shrotra (ear), Kantha
(throat), Shiramukhas (opening of the vessels, etc.).
Scratches the morbid Doshas in supra clavicular region expels them from Uttamanga
(As.San29/2).
Sushruta has clarified shringataka Marma as a Sira Marma formed by the union of
siras (blood vessels) supplying to nose, ear, eye & tongue. He further points out that
injury to this marma will be immediately fatal (Su.Sha. 6/27).
Indu in his commentary on Astanga Sangraha has opined shringhataka as the inner
side of middle part of the head i.e. Siraso Antarmadhyam. Under the complications
ofNasya karma Sushruta noted that the excessive eliminative errhine may cause
Mastulunga (cerebro spinal fluid) to flow out of the nose (Su. Ch. 40/40).
In Sushruta, Astanga Hridaya, Bhavaprakasha, etc detailed descriptions are not found
about the mode of action of Nasya karma. According to all prominent Acharyas Nasa
is said to be the gateway of Shira. It does not mean that any channel connects
directly to the brain but they might be connected through blood vessels or through
nervous system(olfactory nerve, etc. )
It is an experimentally proved fact that –
Wherever any type of irritation takes place in any part of body.
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The local blood circulation is always increased.
This is the result of natural protective function of the body.
When provocation of Doshas takes place in Shira due to irritating effect of
administered drug resulting increase of the blood circulation of brain.
So extra accumulated morbid Doshas are expelled out from small blood vessels.
Ultimately these morbid Doshas are thrown out as nasal discharge, tear &
salivation.
The modern point of view –
There is no such direct Pharmacodynamic considerations between nose & no such
cranial organs.
More over blood, brain barrier is a strict security system that human brain has..
In the case of paranasal sinusitis certain agents used as decongestants.
Since quite a time anterior pituitary hormones, nasal spray is in practice with
modern medical system.
Nasal administrations or leutinising hormone (Fink G. et al 1973) & calcitonin
(Potiroli E.A. et al 1983) are found to be equally effective as intravenous
infusions in maintaining blood concentrations.
Intranasal gonadotropin hormone releasing hormone has been therapeutically
recommended in stimulating leutinising hormone secretion in cryptorchid boys
(undescended testis) (Raifer J. et al 1985).
Kumar Anand (1979) has attempted contraceptive drug administration per nasal
route & opined that the route is beneficial than systematic administration.
Reduction in the gland activity & reduction is sperm prolactin was also noted.
On the basis of the foregoing observations we can state that the procedures,
postures & conducts explained for Nasya karma are of vital importance in drug
absorption & transportation.
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CERVICAL SPONDYLOSIS DEFINITION184
Cervical spondylosis is the term given to the occurrence of osteoarthritis in the cervical
spine . It is charecterised by the degeneration of the intervertebral discs and osteophyte
formation184
Dictionary meaning of ‘Cervical’ is region of Neck & ‘Spondylo’ is a Greek word
meaning Vertebra.
Cervical Spondylosis is defined as arthrosis of posterior intervertebral joints in the
cervical vertebrae.
In the past, this condition was called as osteoarthritis, cervical spondylitis, herniated disc,
chondroma etc, but the term ‘Spondylosis’ is preferable as it is a degenerative rather than
a neoplastic or inflammatory condition.
Before getting into its depth, it is very essential to know anatomy of cervical spine
Cervical region
The atlas is a ring of bone with anterior and posterior arches and large lateral masses. It
lacks a body and a spinous process . The superior surface of lateral masses, called
superior articular facets , are concave . They articulate with the occipital condyles of the
185
The bodies of cervical vertebra ( C1 –C7) are smaller than those of thorasic vertebrae .
Their vertebral arches , however, are larger
.All cervical vertebrae have three foramina; one vertebral foramina and two transverse
foramina, The vertebral foramina of cervical vertebra are the largest in the spinal
coloumn because they house the cervical enlargement of the spinal cord .
Each cervical transverse process contains a transverse foramen through which the
vertebral artery and its accompanying vei and nerve pass. The spinous process of C2
through C6are often bifid – I,e split into 2 parts
The first two cervical vertebrae differ considerably from the others .
The first cervical vertebrae (C1), the Atlas , supports the head and is named for the
mythological Atlas who supported the world on his shoulders
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occipital bone to form the atlanto occipital joints . The articulation permit the movement
seen when moving the head to signify “Yes”
The inferior surfaces of the lateral masses, the inferior articular facets , articulate with
the second ervical vertebrae . The transverse processes and transverse foramina of the
atlas are quite large.
Muscle attachments 186; The superior oblique parts of longus colli are attached on each
side of the anterior tubercle . The anterior surface of lateral mass gives attachment to
rectus capitis anterior . Rectus capitis posterior minor is attached jus lateral to the
posterior tubercle . Rectus capitus lateralis is attached to the transverse process superiorly
, and obliquus capitis superior is located more posteriorly . Obliquus capitis inferior is
attached laterally on the apex , below which are slips of levator scapulae , splenius
cervicis and scalenus medius
The second cervical vertebrae (C2) ,the axis , does have the body . A peg like
process called the dens (= tooth)or odontoid process projects up through the anterior
portion of the vertebral foramen of the atlas . The dens makes a pivot on which the atlas
and the head rotate, as in moving the head to signify “No”. This arrangement permits side
to side rotation of the head .
The articulation formed between the anterior arch of the atlas and the dens of the axis
may be driven into the medulla oblongata of the brain .When whiplash injuries result in
death , this type of injury is the usual cause.185
Muscle attachments
The anterior surface of the body carries a deep depression on each side for the attachment
of the vertical part of longus colli . Levator scapulae , scalenus medius and spenius
cervicis are all attached to the tips of the transverse processes and the intertransverse
muscles are attached to their upper and lower surfaces . The lateral surfaces of the
spinous process give origin to obliquus capitis inferior , and rectus posterior major is
attached a like more posteriorly . The inferior concavity of the process receives
187
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semispinalis and spinalis cervicis , multi fidus more deeply , and the interspinalis near the
apex .
Arterial supply
Small branches arise mainly from the vertebral artery at the level of the intervertebral
foramen for the third cervical nerve and form paired anterior and posterior longitudinal
channels , branches of which enter the dens near the base and near the apex . The anterior
channel also receives numerous twigs from nearby branches of the external carotid artery
via branches to longus colli and the ligaments of the apex , hence avascular necrosis
does not occur after the fracture of the base of the dens .
The third through sixrh cervical vertebrae (C3-C6) represented by vertebrae , correspond
to the structural pattern of the typical cervical vertebrae previously described99
The seventh cervical vertebrae (C7), called the vertebrae prominens, is somewhat
different .It has a single large spinous process that can be seen and felt at the base of the
neck.186
Muscle attachments
188
Trapezius , spinalis capitis ,semispinalis thoracis , multifidus and interspinales all attach
to the tubercle of the spinous process . The anterior border of the transverse process
receives the attachment of scalenus minimus ( pleuralis ) when present . The first pair of
levatorses costarumis attached to the transverse process
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ETIOLOGY:
1. Age: It becomes more prominent as age progresses , after 50 years of age most
of the subjects are likely to present some Spondylosis changes in their spine.
Thus, it is the natural consequence of aging.
189
Etiology of the disease cervical spondylosis remains unknown, some associations are
well found. Such factors have an effect on the development of Cervical Spondylosis are:
2. Sex: It affects more male ratio . But the difference between male and female
sexes is very small. Possibly because males involved in doing heavy work .
3. Occupation: Gutenberg, in a survey found that in Miners there was high
incidence of Spondylosis. followed by factory workers.
4. Posture: Bad posture, use of cushy pillows & soft bed are also considered in the
etiological factors. Incorrect positioning of the head in bed especially while lying
on the tummy with the head turned to one side develops a stiff neck in some
patients. Fast mechanical life which is full of tension, lack of exercise etc. factors
can also be included under the etiological factor.
5. 5 Trauma: In causing the disease Cervical Spondylosis trauma in cervical region
play an important role . Regular traveling for long distances on bad roads,
strainful movements ,Exertion, etc. also cause trauma in cervical spine.
6. Genetic: Familial causes have been reported & it is known to be genetically
influenced. Research has shown that variations of the HLA-B gene, part of a
family of genes called Human Leukocyte Antigen.
AETIOPATHOGENESIS190
a) Disc degeneration with thinning and protrusion of the nucleus pulposus posteriorly or
lateral herniation through a tear in the fibrous annulus; posterior herniation tends to
produce compression of the spinal cord and lateral bulging produces compression of
roots.
b) Osteophytic spur formation on the posterior aspect of the vertebral body
(‘spondylotic bar’) resulting in compression of the anterior aspect of the cord. Root
compression is secondary to osteophytic extension of the bar laterally, associated
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articulatory hypertrophic changes, or encroachment of the intervertebral neural
foramina by osteophytes developing from the rim of the foramina. Anterior
osteophytic spur formation is usually symptomless but occasionally produces
dysphagia.
c) Partial sublaxation of vertebrae causing impinging of osteophytes on the nerve roots
during movements of the neck.
d) Hypertrophy of the dorsal spinal ligament and facet articulation or buckling of the
dorsal spinal ligament particularly during extension of the neck. All these may cause
further narrowing of the sagittal diameters of a spinal canal which might have been
congenitally narrow.
e) Encroachment of the vertebral foramina producing compromise of the arterial lumen
and significant vertebro-basilar ischaemia, leading to brainstem signs like vertigo,
tinnitus, intermittent blurring of vision and occasionally episodes of retro-ocular
pain. Blood supply to the cord may also be affected.
f) Congenital spinal canal stenosis; although the radiographic findings of spondylosis
are fairly common, patients develop myelopathy or radiculopathy only if spondylotic
changes are associated with congenitally narrow canal or foramina. If the shortest AP
diameter is 13 mm or greater, it is unlikely that spondylotic changes are the cause of
cord compression.
CLINICAL FEATURES191
a) Spinal symptoms : Neck pain, medial scapular pain and shoulder pain probably
originate in the disc and spine.
b) Root compression (radiculopathy) : The range of movement is reduced, particularly
rotation and lateral movement of the head. Pain starts from the trapezius ridge (C4),
tips of the shoulder (C5), anterior part of the arm (C6), radial forearm (C6), and often
the thumb (C6) or all the fingers (C6, C7, C8). It worsens with movement of the neck,
coughing, sneezing or straining. The clinical signs are motor weakness and wasting of
muscles depending on the roots compressed. In addition, there is areflexia and
radicular sensory impairment.
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112 PHYSICAL SIGNS IN CERVICAL ROOT COMPRESSION184
Root Muscle weakness Sensory loss
Reflex
loss
C5 Biceps, deltoid, spinati Upper lateral arm Biceps
C6 Brachioradialis Lower lateral arm, thumb, index
finger
Supinator
C7 Triceps, finger and wrist
extensors
Middle finger Triceps
Sometimes L’hermitte’s sign or ‘barber’s chair sign’ can be elicited; this consists of
tingling in all four limbs or electric shock-like feelings down the back on flexing the
neck. The roots most often affected, in order of frequency, are C5, C6, and C6 and
C7; C8 and D1 are infrequently affected. Occasionally, the shoulder-hand syndrome
or the so-called frozen shoulder ensues if symptoms are unattended.
c) Compressive cervical myelopathy is less frequenct than root syndromes. The patient
usually has a congenitally narrow canal (cervical canal stenosis) and presents with a
progressive spastic paraparesis; later, sensory impairment with a level, and bladder
and bowel involvement develop.
d) Combined root and cord compression : In a few cases, clinical features of both
radiculopathy and myelopathy are present. In such a combined lesion occurring at C5
level, the C5 root is compressed by lateral protrusion and the cord below this level is
compressed by medial lesion. The reflexes are asymmetrical, with classically absent
or decreased supinator and exaggerated triceps jerks; occasionally an inverted
supinator jerk is elicited when, on testing for supinator response, there is finger
flexion in the absence of the normal supinator response.
e) Vascular insufficiency : Vertebro-basilar insufficiency may produce intermittent or
perpetual vertigo. Neck movement may initiate or exacerbate vertigo with further
compression of the vertebral artery.
DIFFERENTIAL DIAGNOSIS:
Spastic quadriparesis may occur due to number of reasons and the age of onset ,
192
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temporal profile of the disease and associated clinical symtoms and signs help to
differentiate cervical spondylotic myeloradiculopathy from other conditions .
Motor neuron disease develops in 5th or 6 th decade of life , is accompanied by
fasciculation or bulbar features , has no sensory features and sphincters are
characteristically spared .
Tumors of the spinal cord in the cervical region present with features of multiple tract
involvement and nuchal pain is not such a prominent feature .
Syringomyelia presents with lower motor neuron signs in upper limbs and upper
motor neuron in the lower limbs , displays characteristic dissociated sensory loss and
early splincter involve ment . It may be accompanied by Horner’s syndrome and inter
nuclear opthalmoplegia if ther is associated syringobulbia .
Craniovertebral anomalies present with shortneck and abnormal neck –body ratio and
often are accompanied by signs of high cervical lesion, like downbeat nystagmus and
Horner’s syndrome . Multiple sclerosis occurs at an earlier age , cerebellar signs are
prominent and wasting of the muscles is not a florid feature
INVESTIGATIONS
Of these two MRI is certainly the preffered alternative. MRI demonstrates the
192
X-ray of the cervical spine
This is helpful procedure .A lateral view shows the loss of normal lordosis,
diminution in the disc space and growth of osteophytes
Sometimes , canal stenosis can also be demonstraded. An oblique view shows the
protruding osteophytes into the intervertebral foramina. The antero posterior view , a
common prescription does not offer much in the diagnosis of cervical spondylosis .
Contrast myelogram
This shows the protrusion of the discs into the thecal sac as ‘’negative shadow ‘’ with
total extra dural obstruction in some cases .
CT Myelogram and MRI
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indentation of the thecal sac , hardening of the intervertebral discs , evidenced by
altered MRI signal , foraminal narrowing and facet arthropathy . In more severe
severe cases , compression of the spinal cord may also be demonstrated .
Discography
The role is debatable . Typical pain is provoked on injection into the intervertebral
disc and relieved with local anaesthetics. This often helps in the precise identification
of the offending disc in a given case
TREATMENT:193,194,195.
Conservative treatment with analgesics and nonsteroidal anti-inflammatory agents,
supplemented by physiotherapy, is sufficient in a majority of cases. The latter includes
cervical traction, short-wave diathermy or ultrasonic irradiation, static and dynamic neck
exercises and cervical collar to reduce neck movements.
1. CONSERVATIVE TREATMENT –In Cervical Spondylosis it is much beneficial
. It consists of the following:
193
2. a) Rest – It is the cornerstone of the treatment as it allows soft parts to heal.
Occupational therapists can advice the ergonomics of the workplace if the
problem is work-related.
b) Analgesics & NSAID’s – once a day are usually preferred. After the pain
decreases, patients are encouraged to perform gradual graded isometric neck
exercises.
194
c) Physiotherapy- ultrasound, infrared rays– like short-wave diathermy. are
useful
d) Cervical Traction –Depending on the severity of the symptoms It could be
continuous or intermittent. Traction helps by reducing the muscle spasm,
increasing the disc space & reducing the tension on the nerve roots.
e) Neck Exercises It helps in gaining the mobility of the stiff neck & strengthen
the weakened neck muscles. Hence, the following two sets of exercises are
recommended:
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1) Mobilisation Exercises – This consists of gradual active mobilization of the neck by
performing all the movements of the neck.
2) Strengthening Exercises – Here the patient is instructed to offer resistance by the
other hand to all active movements of the neck. These self-resistance exercises
strengthen the neck muscles. Both these exercises should be done for 15 to 20
minutes everyday.
f) Cervical Collar – This device discovered by HO Thomas is a very good
supportive form of treatment. It is indicated during acute exacerbation of chronic
Spondylosis & should be worn only for a short duration. If used for long, it
weakens the neck muscles, thereby nullifying the beneficial effects of neck
exercises.
Surgical decompression is generally advised in patients with progressive neurologic
dysfunction or a fixed deficit of less than 12 months' duration. The value of surgery,
however, is uncertain. Surgery may involve an anterior or posterior approach.
Surgical treatment includes posterolateral or anterolateral approaches, as well as
laminectomy, foraminotomy, and neurolysis, which may be combined with osteophyte
excision.
Posterior Approach
The posterior approach allows good visualization of affected nerve roots, facilitates
removal of any constricting material, and permits enlargement of the intervertebral
foramen. In patients with diffuse spinal stenosis, laminectomy is the preferred approach,
but it does not reduce any dynamic forces affecting the cord and may increase cervical
mobility, which is associated with an increased risk for neurologic complications. In a
few patients, increased radicular or cord deficits develop after surgery via the posterior
approach.
Anterior Approach
The anterior approach permits easier decompression of roots and cord and removal of
disc material. In patients with cervical spondylotic myelopathy, herniated discs and
osteophytic spurs are indications for surgery by this approach. Fusion is favored by some
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surgeons, but the need for it is uncertain. Cord or root damage after surgery via the
anterior approach occurs in a few instances, and other complications have also been
described, including esophageal perforation, damage to various nerves (e.g., brachial
plexus, supe-rior laryngeal nerve, hypoglossal nerve, and sympathetic nerves), epidural
hemorrhage, and damage to major blood vessels.
The efficacy of various surgical approaches is difficult to determine because the natural
history of the disorder is unclear, methods of assessing outcome are not standardized, and
postoperative complications are often not stated.
The most optimistic figures suggest that between 15 and 30% of patients do not benefit
from surgery, and several older studies indicate that up to 25% of patients worsen after
laminectomy.
A summary of the literature suggests that between 25 and 75% of patients improve after
surgery and between 5 and 50% worsen after it. Given the uncertainties of the natural
history, it is not clear whether benefit is related to surgery or occurs despite it. Regardless
of the difficulty in determining its precise value, surgery is so widely accepted as a
therapeutic option that it is difficult to withhold it in patients who are deteriorating
despite conservative measures.
Measurement of cervical mobility is helpful in selecting patients who are more likely to
deteriorate because patients with spinal hypermobility are more prone to deteriorate
without surgery. Patients without major deficits or whose disorder is nonprogressive
should be treated conservatively and monitored over time. Those with a greater level of
disability when first seen are usually referred for surgical treatment, which is also
indicated to arrest a progressive course.
195
For the sake of clinical identification we can well corelate to followig disorders compared
with cervical spondylosis 196,197
The main symptom of cervical spondylosis, are pain in the neck, stiffness of the neck
muscles, radiation of pain to the arms and restricted movements of the neck.
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In Ayurvedic texts, there are many other ailments, which are related to neck and
demonstrate the similar symptoms. So it is worthy to have a look on these manifestations.
This will help in differential doagnosis and also in justification to the paralance with
these disease . Those diseases are:
1) Bahushirash-agataVata
2) Astyavruta Vata
3) Manya-stamba
4) Asthi Majja Gatavata
5) Greeva- stambha
6) Apabahuka
7) Vishwachi
8) Greeva Hundana
A).Bahushirash-agataVata
Nidana- uÉÉiÉmÉëMüÉåmÉMü
Samprapti -Aggravated vayu lodges in Bahu & Shiras
Lakshana- Clinical manifestation in Bahu & Shiras
Chikitsa Nasya- Pana(Sneha)
Features of Cervical spondylosis- Radiating pain to arm & head
B) Astyavruta Vata
Nidana -uÉÉiÉmÉëMüÉåmÉMü
Samprapti -Occlusion of vayu by asthi
Lakshana-EwhÉ xmÉzÉï mÉÏQûlÉÇ cÉ AÍpÉlÉlSÌiÉ, xÉÇpÉerÉiÉå xÉÏSÌiÉ xÉÔÍcÉÍpÉËUuÉ iÉѱiÉå
Chikitsa - MahaSneha given in different routes
Features of Cervical spondylosis- Neck pain, Parasthesia,
pins & needles or numbness, sensory impairment
C) Manya-stamba
Nidana - ÌSuÉÉxuÉmlÉ, ÌuÉM×üiÉ AÉxÉlÉ ÌuÉM×üiÉ xjÉÉlÉ, FkuÉïÌlÉUϤÉhÉ
Samprapti - zsÉåwqÉhÉÉuÉ×iÉ uÉÉiÉ
Lakshana - Charaka described along with Antarayama & Bahirayama
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Chikitsa – Vatakapha -hara Nasya, Rukshasweda
Features of Cervical spondylosis - Neck Stiffness, Restricted & painful neck movements
D)Astimajja –gataVata
Nidana uÉÉiÉmÉëMüÉåmÉMü
Samprapti Aggravated vayu lodges in Asthi & Majja
Lakshana AÎxjÉmÉuÉïpÉåS, xÉÇÍkÉzÉÔsÉ, qÉÉÇxÉoÉsɤÉrÉ, AxuÉmlÉ, xÉÇiÉiÉÉ ÂMçü
Chikitsa - Bahya & Abhyantara Sneha
Features of Cervical spondylosis- Neck pain,
Motor weakness, Wasting of muscles
E) Greeva- stambha
Nidana - uÉÉiÉmÉëMüÉåmÉMü
Samprapti - AliÉ:mÉëuÉåzÉ:
Suggestive of structural deformity
Lakshana - xiÉqpÉ in the region of Neck
Chikitsa - Vatavyadhi Samanya Chikitsa
Features of Cervical spondylosis- Neck Stiffness, Restricted neck movements
F)Apabahuka
Nidana - uÉÉiÉmÉëMüÉåmÉMü
Samprapti - AÇxÉSåzÉÎxjÉiÉÉå uÉÉrÉÑ: ÍxÉUÉ AÉMÑÇücrÉ
Lakshana - zÉÉåwÉÌrÉiuÉÉ AÇxÉoÉlkÉlÉqÉç
Chikitsa – Rukshasweda Nasya
Features of Cervical spondylosis- Wasting of muscles, Weakness
G) Vishwachi
Nidana - uÉÉiÉmÉëMüÉåmÉMü
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Samprapti - iÉsÉÇ mÉëirÉÇaÉÑsÉÏlÉÉÇ iÉÑ MühQûUÉ oÉÉWÒûmÉ׸iÉ:
Lakshana - oÉÉÀûÉå: MüqÉï¤ÉrÉMüUÏ
Chikitsa - Siravyadha, Nasya
Features of Cervical spondylosis -Radiating pain, Motor weakness
- H) Greeva Hundana
- Nidana : uÉÉiÉmÉëMüÉåmÉMü
- Samprapti : AliÉ:mÉëuÉåzÉ
- Lakshana : xiÉqpÉ in the region of Neck
- Chikitsa Vatavyadhi Samanya Chikitsa
Features of Cervical spondylosis - Stiffness,
- Restricted neck movements
- and Ushna Jala Gandūsha should be done for Kanta Shuddi.
Drug Review
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DRUG REVIEW
In Ayurveda the success of chikitsa depends totally upon chikitsa chatuspada . Among
these four basic factors of treatment , dravya has been awarded the second place . W.H.O
defines drug as “ a substance or product that is used or intended to be used to modify or
explore physiological system or pathological status for the benefit of the recipient “
The selection of a proper drug in the management of disease is very important . Therefore
sufficient thoughts should be given fot the selection of the drug .
In the present study ketakyadi taila is taken for the clinical study and references are
available in text books .
Kalka dravya: ketakyadi kalka
3,4,5,6,7,8
(Sahasrayoga)
AlÉsmÉuÉcÉlÉÉiÉç iÉ§É iÉÑsrÉã YuÉÉjÉiÉÑwÉÉãSMãü |
AMüsMüÉãÅÌmÉ pÉuÉãiÉç xlÉãWûÉã rÉ: xÉÉkrÉ: MãüuÉsÉã SìuÉã|
Sneha dravya:tila taila
Drava dravya: ketaki moola, bala, atibala kashaya and kanji
Procedure: Prepare taila with above drugs in specified quantity with kalka, sneha and drava dravyas taken.
KETAKI 198
Botanical name-Pandanus fascicularis
Syn. Pandanus ordoratissimus , Pandanus tectorius
Family-Pandanaceae
Classical name –Kataki
Sanskrit name –. Ketaka , Sucipushpa, Krakacchada , Trnasunya, Kancuki, Halimaka,
Karatrna, sugandha , Kakacatvaca, Jambuka
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Regional names
Kevrha, Kebarha (hindi), Kiya(beng) , Kevarha(mar) , Kevarhi (Guj) Javanam chedi
(Tam) , Mogali chettu (tel), Umbrella tree ( eng)
Description
Gregarious , much branched, stem bent, sometimes upto 25 ft . high , but more often
shrubby, resting on strong aerial roots . Shrubby upto 6 meters high, rarely erect , often
bushy shrub, stem supported by aerial roots .
Leaves glaucous – green , 8-6 ft long , caudate –acuminate , usually withstrong spines on
edges and midrib
Syncarpium solitary , drooping , scarlet, drupes numerous (50-60) each consisting of 5-
12 carpels , the apex of each carpel distint more or less convex with a small variously –
lobulate stima
Distribution
Plant is cultivated in gardens for fragrant flowers . It often runs wild in vacant and waste
places ; southern India and coastal regions
Chemical composition
Flowers contain aromatic volatile oil
Pharmacodynamics
Rasa –Tiktha, Madura , katu
Guna-Lagu, snigdha,
Veerya-ushna
Vipaka-Katu
Doshakarma –kaphapittashamaka, tridoshahara
Properties and action
Karma –varnya, Vedanasthapana, soumanasyajanana, Aksepahara, keshya
Roga – Varnavikara, kusta
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Therapeutic uses
Antiseptic , aromatic, cooling and stimulant .It is used in burning sensation, eye
diseases , headache, rheumatism, smallpox
The decoction of roots is useful is given in jaundice .
Drug plant is useful as diaphoretic, febrifuge , braintonic, cardiotonic ,
anticonvulsant and aromatic drug
Parts used
Flowers ,roots, fruit.
Dose
Arka -40-60 ml , panaka- 20-40 ml
Bala
Botanical name – Sida cordifolia
199
Family-Malvacea
Classical name –Bala
Sanskrit name – Bala , vaatyalika ,Kharayastika .
Regional name – Khirenti, Bariyaara,Brela, Bala, Kharaiti, Baryaal(Hindi),
Barelaa(Beng) , Chikana(Mar) , Nilatuthi(Tamil) , Chirubend(Tel),Country Mallow , Sida
(Eng)
Description
Shrubby, branched , softly hairy and with much stelatehair nearly all over and
subpersistent . Leaves 2.5-5cm , long ,cordate, ovate-oblong, crenate,obtuse or subacute;
not acuminate,petioles 1.2-3.8cm long; jointed much above the middle .Calyx 6-8 mm.
long lobes ovate, acute Corollaslightly exceeding the calyx, yellow . Fruits 6-8 mm dia ,
carpels 7-10; strongly reticulated
Flowering and fruitin time
July to December.Post – rainy season
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Kinds and variety
There are four kinds of Balaa viz Balaa,Atibala, Mahabala,and Nagabala collectively
grouped under Balaa-catustaya incorporated in texts .Bala has also of two varieties based
on flower- colour such as white (sveta) and yellow (pita)
In general , the components of Balacatustaya and their main plant sources may be
considered as follows
1. Baala – Sida cordifolia
2. Atibala-Abutilon indicum
3. Mahabala-Sida rhombifolia
4. Nagabala – Grewia populifolia
Distribution
It is found in tropical and subtropical regions of both hemispheres .
Throughout the hotter parts of India ; and fairy common in various provinces in country
as a common weed ;U.P, M.PBihar, Aassam,HimachalPradesh, Jammuand Kashmir,
Tamilnadu,Andrapradesh.Karnataka,Kerala
Chemical composition
Plant contains alkaloidal part 0.085 percent ; and seeds containing its highest content o.32
percent Ephedrine forms major part of alkaloidal contents . Besides , fatty acids ,
mucilaginous matter , potassium nitrateand resin .Plant has not yet shown presence of
tannin or glucoside.
Pharmacodynamics
Rasa –Madura
Guna-Guru, snigdha, picchila
Veerya-Sita
Vipaka-Madura
Doshakarma –Vatapittasamaka
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Action and properties
Karma ; Balya –brnhana-ojovardhaka-kaantivardaka
Naadibalya-vatahara
Anulomana-snehana-grahi
Hradya-rakthapittasamaka
Sukrala-prajassthapana,Mutrala
Jvaraghna-visamajvarahara
Krimighna, Rasayana .
Therapeutic uses
The drug is sweet and slightly bitter ;it is tonic, astringent,emollient, aphrodisiac and
remoes vata and pitta ; it is good in coughas a pectoral and bechic.It is an antiarthritic ,
appetizer, ccardiac, conceptive , cooling, demulcent,alterative , diuretic , antihelmenthic
and antipyretic
The bark cures urinary troubles and discharges .
The kashaya is of the root with ginger is given in intermittent fever .It is also
administered in fever accompanied by shivering fits and strong heat of the body
The seeds are reckoned aphrodisiac , and are administered in gonorrhea .
The leaves with other cooling leaves are applied in opthalmia , the root juice is used to
promote the healing of the wounds
The roots are pounded and boiled in oil which is applied to rheumatism paralysis ,
nervous disorder and debility , it enters in recipes of oils prescribed in disorders of vata
and nervine complaints , and muscular troubles ‘
Parts used
Roots, seeds , leaves
Dose ;
Juice 20-40gms , powder 1-3gms
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Groups
Balya, Brmhaniya ,prajasthpana, Maduraskanda(caraka), Vatasamsamana (Sushrutha)
ATIBALA
Botanical name-Abutilon indicum
200
Family-Malvacea
Classical name –Atibala
Sanskrit name –. Atibala,Rsyaproktha, Kankatika,
Regional name – Kanghi,Kakahiya(hindi), Paitasi, Jhanpi (Beng), Muda(Mar) ,
Khapada, Dabali, Kamsaki (guj)Tatti (Tami) Tutirechedru(Tel)
Description
A suffrutescent , erect , minutely, tomentose, woody, grey, velvety, shrubbyplant . Leaves
upto 9 by 5 cm . cordate , ovate acuminate , toothed ,rarely subtrilobate; petioles 3.8-
7.5cm long stipules 9mm .linear,acute,deflexed .Pedicles often 2.5 mm ong axillary
solitary jointed very near the top .Calyx 12.8 mm long . Crolla 2.5cm dia, yellow,
opening in the evening .Staminal tube hairy at the base ; filaments long .Carpels usually
15-20 . longer than the calyx, with a distinct small acute point hairy , ultimately shining ,
dark brown. Seeds brown black, densely and minutely scrobiculate
Flowering and fruiting time
Autum to winter seasons
Distributions
It is commonly found throughtout India and Pakistan specially tropical and temperature
regions;
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Tropics
Kinds and varieties
The drug atibala belongs to Balacatustaya consisting of Bala, Atibala,Nagabala and
Mahabala in the classical texts of medicine .Occasionally other groups such as Baladvaya
and Balatraya –tritaya, consisting 2 0r 3 plant , also combine atibala
Chemical composition
Leaves contain mucilaginous matter, tannin, organic acid ; little Asparaginand ash
(consisting alkaline sulphate , chloride magnesium phosphate , and calciumcarbonate );
roots also contain asparagin .
Pharmacodynamics
Rasa –Madura, tiktha-katu
Guna-Guru, snigdha,
VeeryaPicchila
Vipaka-Madura
Doshakarma –Vatapittasamaka
Action and properties
Karma : Balya- brmhana
Rasayana-ojovarhana, Krmigna
Dahaprasamana, Trsnanigrahana
Visagna, Kledasamana, Mutrala
Vayahsthapana, Vajikarana,Kasagna, Shothahara,
Vedanasthapana
Therapeutic uses
The bark has sharply bitter taste ; it is febrifuge , antihelmenthic, and alexeteric ,and it
allays vata and tridosha ;and counters thirst, vomiting and it lessens perspiration . The
roots cure uterine uterine haemorrage discharges .
The leaves are used in lumbago, toothache, piles and all kinds of inflammation .
74
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
The seeds are reckoned aphrodisiac and are used as a laxative in piles , and in the
treatment of coughs .
The roots are alternative and used as restorative . The are recommended to be taken
internally with water as rasayana .
Parts used : Roots , leaves , seeds
Dose : juice 12-24 gms . Powder 1-3 gms
Groups : Balya, Brmhaniya, Maduraskanda(caraka), Madura,Vatasamsamana
(Sushrutha)
KANJI
MÑüsqÉÉwÉkÉÉlrÉqÉhQûÉÌS xÉÇÍkÉiÉ
201
MüÉÎgeÉMüÇ ÌuÉSÒ:
vÉÉ.xÉ.qÉ.ZÉÇ 10,11
Liquor prepared with manda of half boiled kulmasa , dhanya is kanjika
Tila Taila :
The word “Taila” is derived from Sanskrit.
“Tilodbhavam” means, one which is derived from Tila-sesamum. But in general,
‘Taila’ is considered for all oils. Specifically, Tila taila means oil extracted from the
seeds of Sesamum indicum (Fam. Pedaliaceae), a herb which is widely cultivated in
India, Japan, China and many other tropical countries. This is an official oil mentioned in
the British Pharmacopoeial codex, British pharmacopoeia and in the European
pharmacopoeia.
Ayurvedic view 202,203 ,204
Rasa Pancaka :
Rasa - Madhura
Anurasa - Tikta, Kasaya
Guna - Tiksna, Vyavayi, Suksma, Usna, Visada, Guru, Sara,
Vikasi
Vipaka - Madhura
75
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Dosaghnata - Vatakaphahara
Karmukata -
Brmhana/Lekhana,Prinana,Vrsya,Twakprasadana,Mardavakara, Sthairyakara, Balya
Bhagna sandhanakara, Medhavardhaka, Sulaprasamana, Ropaka
Rogaghnata-Vataroga, Bhagna, Yoni-karna-siroroga, Kesapata, Vrana
Modern view:Sesame oil is the most stable vegetable oil, ever used. The oil is extracted
from both the varieties of sesamum seeds Viz., black and white.It is a light yellow coloured
with a pleasant odour of typical character and bland taste. Its density may vary between
0.916-0.920. It solidifies at –5°C and forms a buttery mass.
The sesame oil is soluble in Ether, Chloroform, Pet-ether and Carbon disulphide
solutions. It is partially soluble in alcohol and insoluble in water.
Chemical composition:
In experimental studies, it has been observed that sesame oil is the most stable vegetable
oil against oxidation. The stability of sesame oil against oxidation is due to the lignans
such as sesamol, Sesaminol, phynoresinol and sesamolinol.
Tocopherol is another antioxidant, providing better results in tissue injuries.
Chemical constituents of sesame oil are shown in table -
1 Saturated fatty acids Palmitic acid
2 Non saturated fatty acids Linoleic acid, Oleic acid
3 Anti oxidant principle 7-Tocopherol 4 Lignans Sesamolin, Sesamol, Sesamolinol, Sesaminol,
Phynoresinol, Sesamin
Pharmaceutical Uses:
1. The oils are used as soothing agents or to allay inflammation and pain.
2. In modern pharmacy, it is limited to the preparation of ointments or medicated
Creams.
3.The conventional medical practitioners use them as demulcent and emollients as
Protective covering on injured surfaces.
Chapter - 4
Methodology
Materials & Methods
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“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
MATERIALS & METHODS Aims of the Study:
1. To study the effect of Ketakyadi taila Nasya karma in the management of cervical
Spondylosis.
Source of the Data:
The patients who attended the O.P.D. and I.P.D. of S.D.M. Ayurveda Hospital,
Kuthpady, Udupi, Karnataka having the signs and symptoms of cervical spondylosis
were screened. Among these 30 Patients who fulfilled the below mentioned criteria of
inclusion were taken for the study. While selecting these patients care was also taken to
see that there was no any factor in these patients listed in the exclusion criteria. The
selected patient’s detailed profile is prepared as per the detailed proforma designed for
the same purpose, which incorporates relevant data like symptomatology, physical signs,
laboratory investigation reports as well as assessment criteria.
INCLUSION CRITERIA
1. Patients of either sex and age between 30 to 70 years is taken.
2. Patients presenting with the signs and symptoms of cervical spondylosis is
selected.
3. Patients who are fit for nasya karma.
Exclusion Criteria
• Patients with traumatic injury of cervical spine.
• Patients suffering from neoplastic disorders.
Laboratory investigations
X ray cervical spine AP and Lateral(Before treatment).
Blood routine investigation. CR protein, RA factor
Design:
It is a single blind clinical study with a pre-test and post-test design. In this study 30
patients diagnosed as cervical spondylosis of either sex were subjected to clinical study.
Materials & Methods
77
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
PLAN OF TREATMENT:
Purva Karma – Abyanga of neck, face with ksheerabala taila, Taapa Sveda(mrudu) with
cloth dipped in hot water will be done for 10 minutes.
Pradhana Karma –
o Position of the Patient :- supine with head end lowered.
o Ketakyadi Taila is slightly warmed indirectly with the help of hot water bath.
o 8 drops of Ketakyadi Taila is instilled in each nostril.
o Soles, palms, neck and ears are massaged
o Secretions are spitted out.
Paschatkarma – Haridra dhumapana, kavala with sukhoshna jala.
Total Duration – 7 consecutive Days.
Follow up Study :
7 days after completion of Nasya karma.
ASSESSMENT CRITERIA
Subjective & Objective Parameters include the clinical grading and standard scoring
method of signs and symptoms of the condition. These data were collected before the
commencement of treatment & after the completion of 7 days of treatment.
Subjective Parameters:
Neck Pain: Grade 0 – No Pain
Grade 1 – Mild Pain occasional / intermittent
relieved on its own / rest
Grade 2 – Moderate Pain, frequent pain
relieved after taking painkillers
Grade 3 – Severe Pain, not tolerable,
not relieved fully even after taking painkillers
Radiation of Pain: Grade 0 – No radiation
Grade 1 – Radiation of pain from neck to arm
or neck to anyone extremity, occasionally present
Grade 2 – Radiation of pain from neck to arm
Materials & Methods
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“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
or neck to anyone extremity, continuously present
Grade 3 – Radiation of pain from neck to both arms
or both upper extremities, occasionally present
Grade 4 – Radiation of pain from neck to both arms
or both upper extremities, continuously present
Stiffness: Grade 0 – No Stiffness
Grade 1 – Mild Stiffness
Grade 2 – Moderate Stiffness
Grade 3 – Severe Stiffness
Weakness: Grade 0 – No weakness
Grade 1 – Weakness in anyone upper extremity
Grade 2 – Weakness present in both upper extremities
Parasthesia: Grade 0 – Absent
Grade 1 – Present
Clumsy Finger Movements:
Grade 0 – No Clumsy Finger Movements
Grade 1 – Clumsy Finger Movements in anyone upper extremity
Grade 2 – Clumsy Finger Movements in both upper extremities
Vertigo: Grade 0 – Absent
Grade 1 – Present on neck movements or occasionally present
Grade 2 – Present constantly
Objective Parameters:
Tenderness over Cervical region:
Grade 0 – No pain
Grade 1 – Patient complains of pain
Grade 2 – Patient complains of pain and winces
Grade 3 – Patient winces and withdraws the affected part
Grade 4 – Patient will not allow palpation of affected part
Reference: Orthopedic Physical Assessment by David J. Magee
Movements of Neck Painful or Restricted:
Grade 0 – All 6 movements are painless or not restricted
Materials & Methods
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“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Grade 1 – Any 1 movement is painful or restricted
Grade 2 – Any 2 movements are painful or restricted
Grade 3 – Any 3 movements are painful or restricted
Grade 4 – Any 4 movements are painful or restricted
Grade 5 – Any 5 movements are painful or restricted
Grade 6 – All 6 movements are painful or restricted
Sensory Loss: Grade 0 – Normal Sensation
Grade 1 – Reduced Sensation
Grade 2 – No Sensation
Neurological Deficit: (Watkins’ Severity Scale for Neurological Deficit)
A Neurological deficit
Grade 1 – Unilateral arm numbness or dysesthesia;Loss of strength
Grade 2 – Bilateral upper extremity loss of motor & sensory
function
Grade 3 – Ipsilateral arm, leg & trunk loss of motor & sensory
function
Grade 4 – Transient quadriparesis (temporary sensory loss in all 4
Limbs)
Grade 5 – Transient quadriplegia (temporary motor loss in all 4
Limbs)
Score A: ____
B Time Symptoms Present
Grade 1 – Less than 5 minutes
Grade 2 – Less than 1 hour
Grade 3 – Less than 24 hours
Grade 4 – Less than 1 week
Grade 5 – Greater than 1 week
Materials & Methods
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“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Score B: ____
Severity Score: A + B = _____
C Central Canal Diameter
Grade 1 – > 12 mm
Grade 2 – Between 10 to 12 mm
Grade 3 – 10 mm
Grade 4 – 8 to 10 mm
Grade 5 – < 8 mm
Score C: ____
Return to Activity Score: A + B + C = _____
Reference: Orthopedic Physical Assessment by David J. Magee
Power:
Grade 0 – No muscle contraction visible
Grade 1 – Flicker of contraction but no movement
Grade 2 – Joint movement when effect of gravity eliminated
Grade 3 – Movement against gravity but not against resistance
Grade 4 – Movement against resistance but weaker than normal
Grade 5 – Normal Power
Reference: Medical Research Council Scale, Macleod’s Clinical Examination
Reflexes: Grade 0 – Absent (Areflexia)
Grade 1 – Diminished (Hyporeflexia)
Grade 2 – Average (Normal)
Grade 3 – Exaggerated (Brisk)
Grade 4 – Clonus, very brisk (Hyperreflexia)
Reference: Orthopedic Physical Assessment by David J. Magee
Score (Out of 10 ) Severity ≤ 4 Mild Episode
4 - 7 Moderate Episode 8 - 10 Severe Episode
Score (Out of 15 ) Severity ≤ 6 Minimum Risk
6 - 10 Moderate Risk 10 - 15 Severe Risk
Materials & Methods
81
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Neck Disability Index:
SECTION 1: Pain Intensity
A. I have no pain at the moment. (0)
B. The pain is very mild at the moment. (1)
C. The pain is moderate at the moment. (2)
D. The pain is fairly severe at the moment. (3)
E. The pain is very severe at the moment. (4)
F. The pain is the worst imaginable at the moment. (5)
SECTION 2: Personal Care (Washing, Dressing, etc.)
A. I can look after myself normally without causing extra pain. (0)
B. I can look after myself normally but it causes extra pain. (1)
C. It is painful to look after myself and I am slow & careful. (2)
D. I need some help but manage most of my personal care. (3)
E. I need help every day in most aspects of self-care. (4)
F. I do not get dressed; I wash with difficulty and stay in bed. (5)
SECTION 3: Lifting
A. I can lift heavy weights without extra pain. (0)
B. I can lift heavy weights but it gives extra pain. (1)
C. Pain prevents me from lifting heavy weights off the floor, but I can manage if they
are conveniently positioned, for example on a table. (2)
D. Pain prevents me from lifting heavy weights, but I can manage light to medium
weights if they are conveniently positioned. (3)
E. I can only lift very light weights. (4)
F. I cannot lift or carry anything at all. (5)
SECTION 4: Reading
A. I can read as much as I want to with no pain in my neck. (0)
B. I can read as much as I want to with slight pain in my neck. (1)
C. I can read as much as I want with moderate pain in my neck. (2)
D. I cannot read as much as I want because of moderate pain in my neck. (3)
E. I can hardly read at all because of severe pain in my neck. (4)
F. I cannot read at all. (5)
Materials & Methods
82
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
SECTION 5: Headaches
A. I have no headaches at all. (0)
B. I have slight headaches that come infrequently. (1)
C. I have moderate headaches which come infrequently. (2)
D. I have moderate headaches which come frequently. (3)
E. I have severe headaches which come frequently. (4)
F. I have headaches almost all the time. (5)
SECTION 6: Concentration
A. I can concentrate fully when I want to with no difficulty. (0)
B. I can concentrate fully when I want to with slight difficulty. (1)
C. I have a fair degree of difficulty in concentrating when I want to. (2)
D. I have a lot of difficulty in concentrating when I want to. (3)
E. I have a great deal of difficulty in concentrating when I want to. (4)
F. I cannot concentrate at all. (5)
SECTION 7: Work
A. I can do as much work as I want to. (0)
B. I can do my usual work, but no more. (1)
C. I can do most of my usual work, but no more. (2)
D. I cannot do my usual work. (3)
E. I can hardly do any work at all. (4)
F. I cannot do any work at all. (5)
SECTION 8: Driving
A. I can drive my car without any neck pain. (0)
B. I can drive my car as long as I want with slight pain in my neck. (1)
C. I can drive my car as long as I want with moderate pain in my neck. (2)
D. I cannot drive my car as long as I want because of moderate pain in neck. (3)
E. I can hardly drive at all because of severe pain in my neck. (4)
F. I cannot drive my car at all. (5)
SECTION 9: Sleeping
A. I have no trouble sleeping. (0)
B. My sleep is slightly disturbed (less than 1 hour sleepless). (1)
Materials & Methods
83
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
C. My sleep is mildly disturbed (1-2 hours sleepless). (2)
D. My sleep is moderately disturbed (2-3 hours sleepless). (3)
E. My sleep is greatly disturbed (3-5 hours sleepless). (4)
F. My sleep is completely disturbed (5-7 hours sleepless). (5)
SECTION 10: Recreation
A. I am able to engage in all my recreation activities with no neck pain at all (0)
B. I am able to engage in all my recreation activities with some pain in neck. (1)
C. I am able to engage in most, but not all, of my usual recreation activities
because of pain in my neck. (2)
D. I am able to engage in a few of my usual recreation activities because of
pain in my neck. (3)
E. I can hardly do any recreation activities because of pain in my neck. (4)
F. I cannot do any recreation activities at all. (5)
Scores (Out of 50 ) Level of Disability
0 - 4 No Disability
5 - 14 Mild Disability
15 - 24 Moderate Disability
25 - 34 Severe Disability
35 - 50 Complete Disability
Reference: Orthopedic Physical Assessment by David J. Magee
Assessment of NasyaKarma: Samyak Yoga, Ayoga & Atiyoga Yoga Lakshanas of
NasyaKarma were assessed daily after the procedure.
TABLE NO.57 SHOWING THE ASSESSMENT OF NASYAKARMA SAMYAK LAKSHANAS Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
UroLaghava ShiroLaghava IndriyaAcchyam(Prasada) SrotoVishuddhi ManahSukham(Prasada) AkshiLaghuta Vaktra Vishuddhi Swara Vishuddhi Sukhochwaasa Sukha Swapna
Materials & Methods
84
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Sukha Prabhodana Vikaropashamah Pramoda Smruti Medha Aapti Bala Aapti Agni Aapti
AYOGA LAKSHANAS Day 1 Day 2 Day 3 Day 4 Day 5 Day
Day 7 Galopalepa ShirasoGurutwa Moordha Shoonyata Nishteewana KaphaSramsana Vata Vaigunya Indriya Rookshata Akshi Stabdata Akshi Rukshata Nasa Shosha Asya Shosha Kandu Upadeha Gadodreka
ATIYOGA LAKSHANAS Day 1 Day 2 Day 3 Day 4 Day 5 Day
Day 7 Shiro Arti / Toda Akshi Arti / Toda Shankha Arti / Toda Shravana Arti / Toda Timira Pashyet Kapha Praseka Shiro Gurutwa Shirasah Shoonyata Indriya Vibhrama Mastulungagama VataVruddhi Kandu Aruchi Peenasa Kshaamata Unmada Hridrava
X ‐
Reduction
Growth
Ray Cerv
n in the disc sp
of Osteophyt
vical Spin
pace
es
ne (AP)
X
Reduction
‐ Ray Ce
(L
n in the disc s
ervical Sp
LAT)
pace
pine
Requirem
Cloth Dipped
ents for Na
d in Hot Wate
asya Karma
M
er for Swedan
Mukha Abh
a
hyanga
Swe
Nasya Aasa
edana Over Fa
ana
ace
Nasyya Pranidana
Gandusha
Indireect Heating of
Dho
f Ketakyadi Ta
oomapana
aila
Chapter – 5
Observations & Results
Observation
85
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
OBSERVATION
A total of 30 patients suffering from cervical spondylosis ,fulfilling the inclusion
criteria were taken for the study.
Observations as well as results of the therapy are analyzed below. Observations were
made before and after treatment.
No. of patients registered for the study –30
No. of patients completed the study – 30
No. of drop out - 0
TABLE NUMBER 11 :
Table showing Age group wise distribution:
FIGURE NO.3
Age The minimum age of the patient of this study was 30years & maximum was 70 years.
Table shows that nature of distribution of patients in every 4-years age group. The
maximum percentage of patients i.e. (43.33%) was between 41-50 age groups and
minimum 10% was between 30-40 age groups. And 10 (i,e 33.33%) were between
51-60 years of age and 13.33% were between the age group of 61-70
0%
10%
20%
30%
40%
50%
30-40 41-50 51-60 61-70
Age-Yrs No. of Pts %
30---40 03 10%
41---50 13 43.33%
51-60 10 33.33%
61-70 04 13.33%
Observation
86
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 12:
Table showing sex wise distribution of patients:
FIGURE NO.4
According to sex wise distribution of the patients showed that maximum number i.e.
70% of the patients was male and 30% were female.
TABLE NUMBER 13:
Table showing religion wise distribution of patients: FIGURE NO.5
Among 30 patients of these series maximum patients 86.66% belonged to the Hindu
community, whereas 6.66% were Muslim &6.66% belonged to Christian
community.
05
10152025
Male Female
0
5
10
15
20
25
30
Hindu Christian Muslim
Sex No. of Pts %
Male 21 70%
Female 9 30%
Religion No.of.Pts %
Hindu 26 86.66%
Christian 2 6.66%
Muslim 2 6.66%
Observation
87
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 14:
Table showing Educational Status of patients:
FIGURE NO.6
Among all the 30 patients taken for this study, the maximum 40% of patients had
studied up to graduation; where as 30% of patients had studied up to the level of
Higher primary education and 16.66% had studied till the level of Primary school
and 13.33% were Middle primary .
TABLE NUMBER 15:
Table depicting marital status of patients
FIGURE NO.7
Among the 30 patients of cervical spondylosis taken for this study, a maximum of
80% patients were married where as 6.66% patients were widow and 13.33%
unmarried.
0
2
4
6
8
10
12
UE MP Gra
0
5
10
15
20
25
M UM W
Education No. of Pts
%
Uneducated 0
Primary 5 16.66%
Middle primary 4 13.33%
Higher primary 9 30%
Graduates 12 40%
Marital
Status
No. of
Pts
%
Married 24 80%
Unmarried 04 13.33%
Widow 02 6.66%
Observation
88
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 16:
Table showing socio economic status of patients
FIGURE NO.8
Most of the patients included in this study belonged to middle class (36.66%), 26%
patient’s belonged to lower middle class and 2 patient belonged to Very poor class
(16.65%). Remaining data is shown in the table.
TABLE NUMBER 17:
Table showing Occupation wise distribution of patients
FIGURE NO 9
Present study includes following category of occupations:-
0
10
20
30
40
50
VP P LM M HM
0
2
4
6
8
10
12
14
L HW B S A
Socioeconomic Status
No. of Pts
%
Very poor 02 6.66%
Poor 04 13.33%
Lower middle 08 26.66%
Middle 11 36.66%
Higher middle 05 16.66%
Occupation No. of Pts.
%
Labours 02 6.66%
House wife 09 30%
Business 1 3.33%
Service 05 16.66%
Agriculture 13 43.33%
Observation
89
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
9 patients were house wife (30%), 1 patients were in business (3.33%), 2 each were
Labours (6.66%) and Service class (16.66%), and 13 patients were Agriculturist i,e
(43.33%)
TABLE NUMBER 18:
Table showing distribution of patients according to their Desha: FIGURE NO.10
The present study shows that all the patients hailed from Anupa desha(100 %)
TABLE NUMBER 19 :
Distribution of pts according to the associated diseases: FIGURE NO 11
Most of the patients included in the study had no associated disease.i,e( 46%) . 6
patients i,e (20%) had Hypertensive + Diabetes milletus. and 16.66 % each were
suffering from Diabetes Mellitus and Hypertension.
0
20
40
60
80
100
Anupa Sadhara
0
10
20
30
40
50
HTN HTN+DM DM None
Desha No. of Pts %
Anupa 30 100
Sadharana 0 0
Associated Diseases No. of
Pts
%
Hypertension 5 16.66%
Hypertension +DM 6 20%
Diabetes 5 16.66%
None 14 46.66%
Observation
90
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 20:
Table showing distribution of pts according to their diet: FIGURE NO.12
The present study shows that maximum No. of Patients in the study had mixed diet
habit (70%) where as (30%) of them had Vegetarian diet.
TABLE NUMBER 21:
Table showing distribution of patients on the basis of Rasa Pradhanya
FIGURE NO.13
The present study shows that maximum No. of Pts in the study had the habit of
consuming more of Katu rasa pradhana dravya (50%), 33.33% patients had the habit
of consuming more of Lavana rasa pradhanya dravya and 16.66% patients had the
habit of consuming more of Tikta rasa pradhanya food.
0
20
40
60
80
VEG MIXED
0
10
20
30
40
50
Tikta Lavana Katu
Diet No. of Pts %
Vegetarian 09 30%
Mixed 21 70%
Rasa No. of Pts %
Tikta 05 16.66%
Lavana 10 33.33%
Katu 15 50%
Observation
91
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 22:
Table showing distribution of patients according to their Diet habit:
FIGURE NO.14
The above table shows that 20patients in the study had the habit of Akalabhojana
(66.66%) and 5Patients each had the habit of Kala Bhojana(16.66%) and followed
by Abhojana (16.66%).
TABLE NUMBER 23:
Distribution of patients according to their habit of Nidra:
FIGURE NO.15
The study shows that 70% of patients had sound sleep. 30% had from disturbed &
delayed sleep.
0
10
20
30
40
50
60
KALA AKALA ABHOJANA
010203040506070
DISTURBED SOUND
Diet Habit No. of
Pts
%
Kala 05 16.66%
Akala 20 66.66%
Abhojana 05 16.66%
Nidra No. of
Pts
%
Disturbed
& Delayed
09 30%
Sound 21 70%
Observation
92
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 24: Classification of patients based on Bowel & Bladder habits:
FIGURE NO.16
In the study 73.33% of patients had regular bowel movements and 8% complained of
irregular bowel habits .73.33% of patients had regular Bladder habits where as 8% of
patients complained of increased frequency of urine.
TABLE NUMBER 25:
Table showing Classification of patients according to their habits: FIGURE NO.17
0102030405060708090
Bowel Bladder
REGULAR
IRREGULAR
0
10
20
30
40
50
60
70
B G C A N
Bowel No. of Pts % Bladder No. of Pts %
Regular 22 73.33% Regular 22 73.33%
Irregular 08 26.66% Increased frequency
08 26.66%
Habits No. of Pts %
Beedi 02 6.66%
Gutka 01 3.33%
Cigarette 04 13.33%
Alcohol 03 10%
None 20 66.66%
Observation
93
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
The study shows that 66.66% patients had no habbits . 13.33% patients had
habit of smoking . 10% of patients had the habit of consuming Alcohol, and 6.66%
of patients had habit of smoking beedi .
TABLE NUMBER 26:
Table showing Classification of patients on the basis of prakruti:
FIGURE NO.18
The study shows that majority of the patients belonged to Vata-pitta Prakruti
(43.33%), 11 Patients belonged to Pitta-kapha (36.66%), 6 patients belonged to Vata-
Kapha prakruti(20%).
TABLE NUMBER 27:
Table showing Classification of patients on the basis of their satwa:
FIGURE NO.19
0
10
20
30
40
50
VP PK VK
0
20
40
60
80
100
P M A
Prakruti No. of Pts %
Vata-pitta 13 43.33%
Pitta-kapha 11 36.66%
Vata-kapha 06 20%
Satwa No. of Pts %
Pravara 03 10%
Madhyama 25 83.33%
Avara 02 6.66%
Observation
94
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
The study shows that most of patients in the study had Madhyama satwa (83.33%),
while (10%) of them had Pravara satwa and (6.66%) had Avara satva .
TABLE NUMBER 28:
Table showing Classification of patients on the basis of samhanana: FIGURE NO.20
The study shows that 10 patients had madhyama samhanana (76%) and 3 patients had
avara samhanana (12%) and Pravara samhanana (12%) respectively.
TABLE NUMBER 29:
Table showing Classification of patients on the basis of satmya: FIGURE NO.21
The study shows that 23 patients had Madhyama satmya (76 .66%) whereas 04 of
them had Pravara satmya(13.33%)and 03 patients had Avara satmya.
0
20
40
60
80
P M A
0
20
40
60
80
P M A
Samhanana No. of Pts %
Pravara 04 13.33%
Madhyama 20 66.66%
Avara 06 20%
Satmya No. of Pts %
Pravara 04 13.33%
Madhyama 23 76.66%
Avara 03 10%
Observation
95
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 30:
Table of Classification of patients on the basis of Ahara shakti:
Abhyavaran
shakti
No. of
Pts
% Jarana
Shakti
No. of Pts %
Pravara 07 23.33% Pravara 07 23.33%
Madhyama 15 50% Madhyama 14 46.66%
Avara 08 26.66% Avara 09 30%
FIGURE NO.22
Maximum patients were having Madhyama Abhyavarana (50%) and Jarana shakti
(46.66%).
TABLE NUMBER 31:
Classification of pts on the basis of their vyayama shakti: Poorvakalina FIGURE NO.23
0
10
20
30
40
50
ABH.SH JAR.SH
0
20
40
60
80
P M A
Vyayama Shakti No. of Pts %
Pravara 02 6.66%
Madyama 20 66.66%
Avara 08 26.66%
Observation
96
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
66.66% of patients had madyama vyama shakthi and 26.66% patients had madhyama
vyayama shakti 6.66% patients had Avara vyayama shakti.
TABLE NUMBER 32:
Table showing Classification of patients on the basis of Vaya: FIGURE NO.24
In the present study 86.66% of pts belonged to Madhyama vaya and remaining
13.33% were Vriddha.
TABLE NUMBER 33:
Table showing Classification of patients on the basis of their Koshta:
FIGURE NO.25
13.33%of patients had Mrudu koshta, where as 70% had Madhyama koshta, and
remaining 16.66% of patients krura koshta.
0
20
40
60
80
100
MADHYAM VRUDDHA
010203040506070
MRUDU MADHY KRURA
Vaya No. of Pts %
Madhyama 26 86.66%
Vruddha 04 13.33%
Koshta No. of Pts %
Mrudu 04 13.33%
Madhyama 21 70%
Krura 05 16.66%
Observation
97
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 34:
Table showing Classification of patients on the basis of Neck pain
FIGURE NO.26
In all the 30 patients neck pain was present .
TABLE NUMBER 35:
Table showing Classification of patients on the basis of Radiation of pain
FIGURE NO.27
In all the 30 patients radiation of pain was present.
05
1015202530
Present Absent
05
1015202530
Present Absent
Neck
pain
No. of Pts %
Present 30 100%
Absent 0 -
Radiation
of pain
No. of Pts %
Present 30 100%
Absent 0 -
Observation
98
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 36:
Table showing Classification of patients on the basis of Radiating side
FIGURE NO.28
Most of patients showed radtaion of pain on both the upper limbs (33.33%) more in
left upper limb (36.67%).
TABLE NUMBER 37:
Table showing Classification of patients on the basis of Stiffness
FIGURE NO.29
Maximum number of patients 86.66%presented with the stiffness .
0
10
20
30
40
Rt UL Lft UL Both limb No radiation
0
20
40
60
80
100
Present Absent
Radiating side
No. of Pts %
Rt UL 9 30
Lft UL 11 36.67
Both limb
10 33.33
No radiation
0
Stiffness No. of Pts %
Present 26 86.66
Absent 4 13.34
Observation
99
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 38:
Table showing Classification of patients on the basis of Neck movements
FIGURE NO.30
Maximum number of patients presented painfull neck movements (83.33%)
TABLE NUMBER 39:
Table showing Classification of patients on the basis of Weakness
FIGURE NO.31
Maximum number of patients presented weakness (86.67%)
020406080
100
Painful Painful restric
Not painful
0
20
40
60
80
100
Present Absent
Neck movements
No. of Pts %
Painful 25 83.33
Painful restricted
5 16.67
Not painful
0
Weakness No. of Pts %
Present 26 86.67
Absent 04 13.33
Observation
100
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 40:
Table showing Classification of patients on the basis of Parasthesia
FIGURE NO.32
70% of the patients presented with
paraasthesia and 30% patients had no parsthesia .
TABLE NUMBER 41:
Table showing Classification of patients on the basis of Sensory loss
FIGURE NO.33
In the clinical study 60% of the patient had sensory loss.
010203040506070
Present Absent
0102030405060
Present Absent
Parasthes
ia
No. of Pts %
Present 21 70
Absent 9 30
Sensory
loss
No. of Pts %
Present 18 60
Absent 12 40
Observation
101
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 42:
Table showing Classification of patients on the basis of Clumpsy finger movements
FIGURE NO.34
26 patients presented with clumpsy finger movements .
TABLE NUMBER 43:
Table showing Classification of patients on the basis of Vertigo
FIGURE NO.35
22 patients (73.33%) presented with vertigo.
0
20
40
60
80
100
Present Absent
01020304050607080
Present Absent
Clumpsy finger movements
No. of Pts %
Present 26 86.67
Absent 04 13.33
Vertigo No. of Pts %
Present 22 73.33
Absent 08 26.67
Observation
102
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 44:
Table showing Classification of patients on the basis of Duration of complaints
FIGURE NO.36
Among 30 patients 14 patients had duration of complaints since from 6months -1 year
(46.67%), 10 patients from 1-2 years and (33.33%) 6 patients < 6 months .
TABLE NUMBER 45:
Table showing Classification of patients on the basis of Mode of onset
FIGURE NO.37
In this study 50% of the patient had sudden
onset and rest had gradual onset .
0
10
20
30
40
50
< 6mon 6-1yr 1-2yr
02468
10121416
Sudden Gradual
Duration of complaints
No. of Pts
%
< 6 months 6 20
6 months – 1 year
14 46.67
1- 2 years
10 33.33
Mode of
onset
No. of Pts %
Sudden 15 50
Gradual 15 50
Observation
103
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 46:
Table showing Classification of patients on the basis of Nature of pain
FIGURE NO.38
0
5
10
15
20
25
30
35
40
Dra DA Sh Pri Sta Burning
Maximum no of patients had pricking type of pain. Followed by 36.67% had
shooting type of pain . Remaining data is shown in the table .
TABLE NUMBER 47:
Table showing Classification of patients on the basis of Course of pain
FIGURE NO.39
0
20
40
60
80
Intermittent Continuous
Nature of pain
No. of Pts %
Dragging 2 6.67
Deep Aching
2 6.67
Shooting 11 36.67
Pricking 12 40
Stabbing 2 6.67
Burning 1 3.34
Course of
pain
No. of Pts %
Intermittent 20 66.67
Continuous 10 33.33
Observation
104
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Among 30 patients 66.67% patients had intermittent course of pain and 10 patients
had continuous course of pain.
TABLE NUMBER 48:
Table showing Classification of patients on the basis of Family history
FIGURE NO.40
0
20
40
60
80
100
Present Absent
Among 3o patients 5 patients had familial history of cervical spondylosis .
TABLE NUMBER 49:
Table showing Classification of patients on the basis of Treatment history
FIGURE NO.41
0
10
20
30
40
50
Al Ay Phy Al+Phy Ay+PhyNo prev
Family history
No. of Pts %
Present 5 16.67
Absent 25 83.33
Treatment history
No. of Pts
%
Allopathic 15 50
Ayurvedic 4 13.33
Physiotherapy 2 6.67
Allopathy+Physiotherapy
3 10
Ayurveda+Physiotherapy
0
No previous treatment
06 20
Observation
105
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Among 30 patients registered in the study 15 patients had treatmental history of
Allopathy.And 20% patients had no previous treatment history . Remaining data is
shown in the table .
TABLE NUMBER 50:
Table showing Classification of patients on the basis of Neurological deficit
FIGURE NO.42
0102030405060
Mildepisode
Moderateepisode
Severeepisode
Among 30 patients 18 patients have Mild episode of Neurological deficit.
TABLE NUMBER 51: Table showing Classification of patients on the basis of Neck disability index
FIGURE NO.43
0
20
40
60
80
Nodisability
Moderatedisability
completedisability
Among 30 patients registered in the study 22 patients presented with the Neck
disability index .
Neurological deficit
No. of Pts %
Mild episode
18 60
Moderate episode
10 33.33
Sever episode
2 6.67
Neck disability index
No. of Pts %
No disability
04 13.33
Mild disability
22 73.33
Moderate disability
02 6.67
Severe disability
02 6.67
Complete disability
00
Observation
106
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
TABLE NUMBER 52:
Table showing samyak nasya laxana in the patients
Samyak Nasya Laxanas Number Of Patients Day
1 Day 2 Day
3 Day 4 Day
5 Day
6 Day
7 UroLaghava ShiroLaghava 3 5 7 6 3 3 3 IndriyaAcchyam(Prasada) 1 4 1 5 4 7 8 SrotoVishuddhi 0 0 0 10 7 8 5 ManahSukham(Prasada) 0 0 0 8 8 3 11 AkshiLaghuta 0 0 0 0 0 16 14 Vaktra Vishuddhi 2 5 3 2 6 4 8 Swara Vishuddhi 0 0 0 0 6 9 15 Sukhochwaasa 3 6 4 2 1 5 9 Sukha Swapna 0 2 1 5 5 1 16 Sukha Prabhodana 2 4 2 6 6 3 7 Vikaropashamah 0 0 3 2 1 10 14 Pramoda 1 6 8 3 3 4 5 Smruti Medha Aapti 0 0 0 0 13 15 2 Bala Aapti 0 0 0 0 0 15 15 Agni Aapti 1 2 0 0 2 15 10
In the present study maximum 7 patients attained shirolagava on Day 3,Indriya
Acchyam was seen on Day 7 , 10 patients had Srotho Vishuddi on Day 4 , and
maximum of 11 patients attained Manah sukham (Prasada) on Day 7 . Maximum of
15 patients attained Akshi Lagutha on Day 6, maximum of 8 patients attained Vakthra
and swara vishuddhi on Day 7 . maximum of 9 patients had sukhochwasa on Day 7 .
maximum of 16 patients attained sukha swapna on day 7 . maximum of 7 patients
attained Sukha prabhodana on day 7 . maximum of 14 patients had vikaropashama on
Day 7 . 8 patients attined Pramoda on Day 3 . maximum of 15 patients attained
Smruthi Meda Aapthi , Bala Aapthi and Agni Aapti on Day 6 .
Results
107
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
RESULTS
The analysis was done statistically using Sigma Stat version 3.5 software.
Paired t- test was used for comparing the results.
1. Effect On Neck Pain -
The effect over the symptom neck pain on 30 patients suffering from cervical spondylosis showed the mean score of 2.000 before the treatment was reduced to 1.133 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No 53 ., Effect of treatment on neck pain-
No. of
Patients
Mean Score Diff.in
means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t value P value
2.000
(±0.144)
1.133
(±0.133)
0.867 43.85% 0.434 0.079 10.934 P=<0.001
Figure No. 44 , Effect of treatment on neck pain
00.20.40.60.8
11.21.41.61.8
2
BT AT
Mean score
BT
AT
Results
108
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
2. Effect On–Radiation of pain
The effect over radiation of pain pain on 30 patients suffering from cervical spondylosis showed the mean score of 2.43 before the treatment was reduced to 1.600 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No. 54 : Effect of treatment on Radiation of pain
No. of
patients
Mean Score Diff. in
means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t value P value
2.43
(±0.190)
1.600
(±0.163)
0.833 34.28% 0.461 0.0842 9.898 P=<0.001
Figure No. 45 : Effect of treatment on – Radiation of pain
0
0.5
1
1.5
2
2.5
BT AT
Mean score
BT
AT
Results
109
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
3. Effect On stiffness
The effect over the symptom stiffness on 30 patients suffering from cervical spondylosis showed the mean score of 1.567 before the treatment was reduced to 0.900 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No. 55 : Effect of stiffness
No. of
Patient
s
Mean Score Diff.i
n
means
% Paired ‘t’ test
30
BT AT S.D S.E.M
.
t
value
P value
1.567
(±0.171
)
0.900
(±0.139
)
0.667 42.55
%
0.54
7
0.099 6.67
9
P=<0.00
1
Figure No :46 Effect of treatment on Stiffness –
0
0.5
1
1.5
2
BT AT
Mean score
BT
AT
Results
110
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
4. Effect On - Weakness
The effect over the symptom weakness on 30 patients suffering from cervical spondylosis showed the mean score of 1.167 before the treatment was reduced to 0.633 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No. 56 : Effect of treatment on Weakness
No. of
Patients
Mean Score Diff. in
means
% Paired ‘t’ test
30
BT AT S.D S.E.
M.
t value P value
1.167
(±0.118)
0.633
(±0.12)2
0.533 47.05
%
0.629 0.115 4.646 P=<0.001
Figure No. 47 : Effect of treatment on - Weakness
0
0.2
0.4
0.6
0.8
1
1.2
BT AT
Mean score
BT
AT
Results
111
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
5. Effect On - Parasthesia
The effect over the symptom parasthesia on 30 patients suffering from cervical spondylosis showed the mean score of 0.700 before the treatment was reduced to 0.300 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No. 57 : Effect of treatment on Parasthesia
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
P value
0.700
(±0.0851)
0.300
(±0.0851)
0.400 60% 0.498 0.091 4.397 P=<0.001
Figure No. 48 : Effect of treatment on – Parasthesia
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
BT AT
Mean score
BT
AT
Results
112
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
6. Effect On Clumpsy finger movement
The effect over the symptom clumpsy finger movement on 30 patients suffering from cervical spondylosis showed the mean score of 1.300 before the treatment was reduced to 0.933 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No. 58 : Effect of treatment on Clumpsy finger movement
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
P value
1.300
(±0.128)
0.933
(±0.106)
0.367 27.027% 0.490 0.0895 4.097 P=<0.001
Figure No. 49 : Effect of treatment on – Clumpsy finger movement
0
0.2
0.4
0.6
0.8
1
1.2
1.4
BT AT
Mean score
BT
AT
Results
113
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
7. Effect On - Vertigo
The effect over the symptom vertigo on 30 patients suffering from cervical spondylosis showed the mean score of 1.067 before the treatment was reduced to 0.633 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.59: Effect of treatment on Vertigo
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t value P value
1.067
(±0.143)
0.633
(±0.112)
0.433 40% 0.568
0.104 4.176
P=<0.001
Figure No.50 : Effect of treatment on - Vertigo
0
0.2
0.4
0.6
0.8
1
1.2
BT AT
Mean score
BT
AT
Results
114
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
8. Effect On - Tenderness
The effect over the symptom tenderness on 30 patients suffering from cervical spondylosis showed the mean score of 2.233 before the treatment was reduced to 1.167 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.60 : Effect of treatment on - Tenderness
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
2.233
(±0.164)
1.167
(±0.167)
1.067
47.76%
0.785 0.143 7.443 P=<0.001
Figure No 51 : Effect of treatment on– Tenderness
0
0.5
1
1.5
2
2.5
BT AT
Mean score
Results
115
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
9. Effect On - Movements of neck
The effect over movements of neck on 30 patients suffering from cervical spondylosis showed the mean score of 2.033 before the treatment was reduced to 1.500 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.61 : Effect of treatment on–Movements of neck
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
2.033
(±0.122)
1.500
(±0.150)
0.533 26.22% 0.507 0.092
5.757 P=<0.001
Figure No 52 : Effect of treatment on– Movements of neck
0
0.5
1
1.5
2
2.5
BT AT
Mean score
BT
AT
Results
116
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
10. Effect On - Sensory loss
The effect over sensory loss on 30 patients suffering from cervical spondylosis showed the mean score of 0.667 before the treatment was reduced to 0.267 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.62 : Effect of treatment on - sensory loss
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
0.667
(±0.111)
0.267
(±0.082)
0.400
60%
0.563 0.103
3.890 P=<0.001
Figure No 53 : Effect of treatment on– Sensory loss
00.10.20.30.40.50.60.7
BT AT
Mean score
BT
AT
Results
117
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
11. Effect On - Neurological deficit
The effect over Neurological deficit on 30 patients suffering from cervical spondylosis showed the mean score of 4.533 before the treatment was reduced to 3.867 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.63 : Effect of treatment on–Neurological deficit
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
4.533
(±0.298)
3.867
(±0.291)
0.667 14.70% 0.661 0.121
5.525 P=<0.001
Figure No 54 : Effect of treatment– Neurological deficit
3.4
3.6
3.8
4
4.2
4.4
4.6
BT AT
Mean score
BT
AT
Results
118
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
12. Effect of treatment on -Neck disability index
The effect of treatment on Neck disability index over 30 patients suffering from cervical spondylosis showed the mean score of 11.00 before the treatment and mean score of 10.167 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = 0.009)
Table No.64: Effect of treatment on -Neck disability index
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
11.00
(±1.163)
10.167
(±0.974)
0.833
6.94%
1.621 0.296
2.816 P=0.009
Figure No 55: Effect of treatment on --Neck disability index
9.6
9.8
10
10.2
10.4
10.6
10.8
11
BT AT
Mean score
BT
AT
Results
119
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
(Since in these parameters improvement over the basal values was
expected –At values were compared with Bt values)
13. Effect of treatment on Power w.s.r. movements . Shoulder Abduction
The effect on power w.s.r movements . shoulder Abduction on 30 patients suffering from cervical spondylosis showed the mean score of 3.400 before the treatment and mean score of 4.033 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.65 : Effect of treatment on Power w.s.r. movements . Shoulder
Abduction
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
3.400
(±0.261)
4.033
(±0.189)
0.633
18.62%
0.718 0.131
4.829 P=<0.001
Figure No56 : Effect of treatment on Power w.s.r. movements . Shoulder
Abduction
3
3.2
3.4
3.6
3.8
4
4.2
BT AT
Mean score
BT
AT
Results
120
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
14. Effect of treatment on -- Power w.s.r. movements . Shoulder, Flexion
The effect on power w.s.r movements . shoulder,flexion on 30 patients suffering from cervical spondylosis showed the mean score of 3.23 before the treatment and showed mean score of 3.867 jafter the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.66: Effect of treatment on -- Power w.s.r. movements . Shoulder, Flexion
No. of Patients
Mean Score Difference in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t value
p value
3.23
(±0.233)
3.867
(±0.202)
0.633 19.58% 0.669 0.122 5.188 P=<0.001
Figure No 57 : Effect of treatment on -- Power w.s.r. movements . Shoulder, Flexion
2.93
3.13.23.33.43.53.63.73.83.9
BT AT
Mean score
BT
AT
Results
121
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
15. Effect of treatment on Power w.s.r. movements . Shoulder Extension
The effect on power w.s.r movements . shoulder , extension on 30 patients suffering from cervical spondylosis showed the mean score of 2 .967 before the treatment and mean score 3.400 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.67 : Effect of treatment on - Power w.s.r. movements . Shoulder
Extension
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
2.967
(±0.227)
3.400
(±0.261)
0.433 14.60% 0.504 0.092
4.709 P=<0.001
Figure No 58 : Effect of treatment on time Power w.s.r. movements . Shoulder
Extension
2.7
2.8
2.9
3
3.1
3.2
3.3
3.4
BT AT
Mean score
BT
AT
Results
122
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
16 Effect of treatment on Power w.s.r. movements . Elbow . Flexion
The effect of treatment on power w. s.r movements . Elbow. Flexion on 30 patients suffering from cervical spondylosis showed the mean score of 3.233 before the treatment and mean score of 3.800 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.68 : Effect of treatment on - Power w.s.r. movements . Elbow . Flexion
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
3.233
(±0.190)
3.800
(±0.182)
0.567
17.52%
0.568 0.104
5.461 P=<0.001
Figure No 59 : Effect of treatment on Power w.s.r. movements . Elbow . Flexion
2.93
3.13.23.33.43.53.63.73.8
BT AT
Mean score
BT
AT
Results
123
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17. Effect of treatment on Power w.s.r. movements . Elbow Extension
The effect on power w. s.r movements . Elbow.Extension on 30 patients suffering from cervical spondylosis showed the mean score of 2.033before the treatment and mean score of 1.500 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.69 : Effect of treatment on - Power w.s.r. movements . Elbow Extension
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
2.033
(±0.122)
1.500
(±0.150)
0.533
14.85%
0.507 0.0926
5.757 P=<0.001
Figure No60 : Effect of treatment on Power w.s.r. movements . Elbow Extension
0
0.5
1
1.5
2
2.5
BT AT
Mean score
BT
AT
Results
124
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18. Effect of treatment on Power w.s.r. movements . Wrist . Flexion
The effect on power w. s.r movements . Wrist . Flexion on 30 patients suffering from cervical spondylosis showed the mean score of 3.233 before the treatment and mean score of 3.667 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No. 70: Effect of treatment on Power w.s.r. movements . Wrist . Flexion
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
3.233
(±0.202)
3.667
(±0.161)
0.433
12.76%
0.504 0.0920
4.709 P=<0.001
Figure No 61 : Effect of treatment on Power w.s.r. movements . Wrist . Flexion
3
3.1
3.2
3.3
3.4
3.5
3.6
3.7
BT AT
Mean score
BT
AT
Results
125
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19. Effect of treatment on Power w.s.r. movements . Wrist . Extension
The effect on power w. s.r movements . Wrist. Extension on 30 patients suffering from cervical spondylosis showed the mean score of 3.100 before the treatment and mean score of 3.633 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No71.: Effect of treatment on Power w.s.r. movements . Wrist . Extension -
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
3.100
(±0.227)
3.633
(±0.182)
0.124
16.66%
0.681 0.124
4.287 P=<0.001
Figure No 62 : Effect of treatment on Power w.s.r. movements . Wrist .
Extension
2.82.9
33.13.23.33.43.53.63.7
BT AT
Mean score
BT
AT
Results
126
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20 . Effect of treatment on Power w.s.r. movements . Forearm . supination
The effect on power w. s.r movements. Forearm . Supination on 30 patients suffering from cervical spondylosis showed the mean score of 3.133 before the treatment and mean score of 3.567 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.72 : Effect of treatment on Power w.s.r. movements . Forearm . supination
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
3.133
(±0.234)
3.567
(±0.190)
0.433
13.186%
0.504 0.0920
4.709 P=<0.001
Figure No63 : Effect of treatment on Power w.s.r. movements . Forearm .
supination -
2.9
3
3.1
3.2
3.3
3.4
3.5
3.6
BT AT
Mean score
BT
AT
Results
127
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21. Effect of treatment on Power w.s.r. movements Forearm Pronation
The effect on power w. s.r movements. Forearm Ponation over the symptom neck pain on 30 patients suffering from cervical spondylosis showed the mean score of 3.967 before the treatment and mean score of 4.400 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.73 : Effect of treatment on Power w.s.r. movements Forearm
Pronation
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
3.967
(±0.140)
4.400
(±0.123)
0.433
10.34%
0.504 0.0920
4.709 P=<0.001
Figure No 64 : Effect of treatment on Power w.s.r. movements Forearm
Pronation -
3.7
3.8
3.9
4
4.1
4.2
4.3
4.4
BT AT
Mean score
BT
AT
Results
128
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22. Effect of treatment on Power w.s.r. movements . Metacarpophalangeal and
interphalangeal . Flexion
The effect on power w. s.r movements Metacarpophalangeal and interphalangeal . Flexion on 30 patients suffering from cervical spondylosis showed the mean score of 3.933 before the treatment and mean score of 4.300 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) Table No.74 : Effect of treatment on Power w.s.r. movements . Metacarpophalangeal and interphalangeal . Flexion
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t value p value
3.933
(±0.143)
4.300
(±0.119)
0.367
8.69%
0.490
0.0895
4.097
P=<0.001
Figure No 65 : Effect of treatment on Power w.s.r. movements .
Metacarpophalangeal and interphalangeal . Flexion
3.7
3.8
3.9
4
4.1
4.2
4.3
BT AT
Mean score
BT
AT
Results
129
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23. Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal. Extension
The effect on on power w. s.r movements Metacarpophalangeal and interphalangeal. Extension on 30 patients suffering from cervical spondylosis showed the mean score of 4.133 before the treatment and mean score of 4.667 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) Table No.75: Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal. Extension
No. of Patients
Mean Score Difference in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t value
p value
4.133
(±0.133)
4.667
(±0.0875)
0.533
12.39%
0.507 0.0926
-5.757
P=<0.001
Figure No 66 : Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal. Extension
-
3.83.9
44.14.24.34.44.54.64.7
BT AT
Mean score
BT
AT
Results
130
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24. Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Abduction
The effecton on power w. s.r movements Metacarpophalangeal and interphalangeal. Abduction over the symptom neck pain on 30 patients suffering from cervical spondylosis showed the mean score of 4.200 before the treatment and mean score of 4.900 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.76 : Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Abduction
No. of Patients
Mean Score Difference in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t value p value 4.200
(±0.0884)
4.900 (±0.0557)
0.700 16.26%
0.466
0.0851
8.226 P=<0.001
Figure No 67 : Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Abduction
3.8
4
4.2
4.4
4.6
4.8
5
BT AT
Mean score
BT
AT
Results
131
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25. Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and
interphalangeal Adduction
The effect on power w. s.r movements Metacarpophalangeal and interphalangeal . Adduction over the symptom neck pain on 30 patients suffering from cervical spondylosis showed the mean score of 4.133 before the treatment 4.533 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No. 77: Effect of treatment on Power w.s.r. movements . .
Metacarpophalangeal and interphalangeal Adduction
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
4.133
(±0.142)
4.533
(±0.142)
0.400 9.09% 0.498 0.091
4.397 P=<0.001
Figure No68 : Effect of treatment on Power w.s.r. movements . .
Metacarpophalangeal and interphalangeal Adduction
3.9
4
4.1
4.2
4.3
4.4
4.5
4.6
BT AT
Mean score
BT
AT
Results
132
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26. Effect of treatment on -Reflex .Biceps
The effect on Relex . Biceps over 30 patients suffering from cervical spondylosis showed the mean score of 1.700 before the treatment and mean score of 2.167 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.78: Effect of treatment on - Reflex .Biceps
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
1.700
(±0.160)
2.167
(±0.108)
0.467
26%
0.507 0.0926
5.037 P=<0.001
Figure No 69 : Effect of treatment on Reflex .Biceps -
0
0.5
1
1.5
2
2.5
BT AT
Mean score
BT
AT
Results
133
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27. Effect of treatment on - Reflex. Triceps
The effect of treatment on reflex- Triceps over 30 patients suffering from cervical spondylosis showed the mean score of 2.033 before the treatment and mean score of 2.267 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = 0.006)
Table No.79 : Effect of treatment on-- Reflex. Triceps
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t value p value
2.033
(±0.169)
2.267
(±0.135)
0.233 10% 0.430 0.0785
2.971 P=0.006
Figure No70 : Effect of treatment on - Reflex. Triceps
1.9
1.95
2
2.05
2.1
2.15
2.2
2.25
2.3
BT AT
Mean score
BT
AT
Results
134
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28. Effect of treatment on Reflex .Supinator
The effect of treatment on Reflex. Supinator over 30 patients suffering from cervical spondylosis showed the mean score of 1.867 before the treatment 2.267 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.80 : Effect of treatment on Reflex .Supinator
No. of
Patients
Mean Score Difference
in means
% Paired ‘t’ test
30
BT AT S.D S.E.M. t
value
p value
1.867
(±0.184)
2.267
(±0.135)
0.400 20% 0.498 0.0910
4.397 P=<0.001
Figure No 71 : Effect of treatment on Reflex .Supinator
0
0.5
1
1.5
2
2.5
BT AT
Mean score
BT
AT
Chapter - 6
Discussion
Discussion
135
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
DISCUSSION
Plan of study:
The patients for the study were selected from the OPD and IPD
section of SDMAH, Udupi. 30 patients fulfilling the inclusion criteria and
presented signs and symtoms of cervical spondylosis are selected
Total number of patients registered –30
Completed – 30
Drop out – 0
Clinical Study:
A single blind clinical study was conducted on Patients suffering from
Cervical Spondylosis . Patients were randomly selected and detailed
proforma was prepared by incorporating all the sign and symtoms of
cervical spondylosis and nasya karma with Ketakyadi taila was done
continuosly for 7 days. The followup was for 07 days after the
treatment. The following observations are made.
Observations and results:
Age:. The maximum percentage of patients i.e. (43.33%) was between 41-50
age groups and minimum 10% was between 30-40 age groups. And 10 (i,e
33.33%) were between 51-60 years of age
It is known that the incidence of the disease is common in third and fourth
decades of life.
Meanwhile another risk factor is ageing. 60-70% women and 85% of men
may show changes related with cervical spondylosis by the age 45,
rhontgenologically2 [Table number11 ].
Discussion
136
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Sex: According to sex wise distribution of the patients showed that
maximum number i.e. 70% of the patients was male and 30% were female.
It is known that male are more prone compared to female ratio
[Table number 12].
Religion
Among 30 patients of these series maximum patients 86.66% belonged to
the Hindu community, whereas 6.66% were Muslim &6.66% belonged to
Christian community. This may be due to Hindu dominant population in this
area. [Table Numbe 13]
Educational status
The this study showed that majority of patients were graduates 40%,where
as 30% of patients had studied up to the level of Higher primary education
and 16.66% had studied till the level of Primary school and 13.33% were
Middle primary . [Table number 14 ].
Marital Status
In dis study of 80% patients were married where as 6.66% patients were
widow and 13.33% unmarried. [Table number 15 ].
Socioeconomic Status
In this study 36.66% belonged to middle class 26% patient’s belonged
to lower middle class and 2 patient belonged to Very poor class
(16.65%). [Table number 16 ].
Discussion
137
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Occupation
9 patients were house wife (30%), 1 patients were in business (3.33%), 2
each were Labours (6.66%) and Service class (16.66%), and 13 patients
were Agriculturist i,e (43.33%)
Patients having occupation which involves more physical and mental
stress dominated the group. [Table number 17].
Desha
The present study shows that all the patients hailed from Anupa
desha(100 %) [Table number 18 ].
Associated Diseases
Most of the patients included in the study had no associated disease.i,e(
46%) . 6 patients i,e (20%) had Hypertensive + Diabetes milletus. and
16.66 % each were suffering from Diabetes Mellitus and Hypertension.
[Table number 19].
Diet
In the study 70% of the patients had habit of mixed diet where as
(30%) of them had Vegetarian diet. A dietary habit of patients in this group
does not exhibit much preponderance of either vegetarian or non-vegetarian
food habits in the causation of illness. As this study showed 70% of patients
had the habit of mixed diet, in comparison to 30% of patients restricted to
vegetarian dietary habits. [Table number 20].
Discussion
138
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Rasa
The present study shows that maximum No. of Pts had the habit of
consuming more of Katu rasa pradhana dravya (50%), 33.33% patients had
the habit of consuming more of Lavana rasa pradhanya dravya and 16.66%
patients had the habit of consuming more of Tikta rasa pradhanya food.
[Table number 21].
Diet Habit
The study showed (66.66%) had habit of Akalabhojana and 5 Patients
each had the habit of Kala Bhojana(16.66%) and followed by Abhojana
(16.66%).[Table number 22].
Nidra
The study shows that 70% of patients had sound sleep. 30% had
disturbed & delayed sleep. [Table number 23].
Classification of patients based on Bowel & Bladder habits:
In the study 73.33% of patients had regular bowel movements and 8%
complained of irregular bowel habits .73.33% of patients had regular
Bladder habits where as 8% of patients complained of increased
frequency of urine. [Table number 24].
Habits
The study shows that 66.66% patients had no habbits . 13.33% patients had
habit of smoking . 10% of patients had the habit of consuming Alcohol, and
6.66% of patients had habit of smoking beedi
Discussion
139
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
only in 17% of patients who are addicted were registered in the study [Table
number 25].
Prakruti
The study shows that majority of the patients belonged to Vata-pitta
Prakruti (43.33%), 11 Patients belonged to Pitta-kapha (36.66%), 6
patients belonged to Vata-Kapha prakruti(20%). Dominance of Vata Pitta
Prakruti can be seen. observation support the theory of tendency of
Vātaja disorders like Vishvāci in persons having Vāta Prakruti [Table
number 26]
Satwa
The study shows that most of patients in the study had Madhyama satwa
(83.33%), while (10%) of them had Pravara satwa and (6.66%) had
Avara satva . [Table number 27]
Samhanana
10 patients had madhyama samhanana (76%) and 3 patients had avara
samhanana (12%) and Pravara samhanana (12%) respectively. [Table
number 28].
Satmya
23 patients had Madhyama satmya (76 .66%) whereas 04 of them had
Pravara satmya(13.33%)and 03 patients had Avara satmya. [Table
number 29].
Discussion
140
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Abhyavaran shakti and Jarana Shakti
The study shows that maximum patients were having Madhyama
Abhyavarana (50%) and Jarana shakti (46.66%). [Table number 30].
Vyayama Shakti
66.66% of patients had madyama vyama shakthi and 26.66% patients had
madhyama vyayama shakti 6.66% patients had Avara vyayama shakti.
Table[ number 31].
Vaya:
In the present study 86.66% of pts belonged to Madhyama vaya and
remaining 13.33% were Vriddha. [Table number 32].
Koshta:
13.33%of patients had Mrudu koshta, where as 70% had Madhyama koshta,
and remaining 16.66% of patients krura koshta. [Table number 33].
Neck pain
In this study 30 patients neck pain was present . [Table number 34].
Radiation of pain
In this study all the 30 patients radiation of pain was present. [Table
number 35].
Discussion
141
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Radiating side
In the study most of patients showed radiataion of pain on both the upper
limbs (33.33%) more in left upper limb (36.67%).[Table number 36].
Stiffness
In the study maximum number of patients 86.66%presented with the
stiffness . [Table number 37].
Neck movements
In the study (83.33%) of patients presented painfull neck movements
[Table number 38].
Weakness
In the study Maximum number of patients presented weakness (86.67%)
[Table number 39].
Parasthesia
In the study 70% of the patients presented with paraasthesia and 30%
patients had no parsthesia [Table number 40].
Sensory loss In the clinical study 60% of the patient had sensory loss. [Table number 41].
Clumpsy finger movements
In the study 26 patients presented with clumpsy finger movements .
[Table number42].
Discussion
142
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Vertigo
In the study 22 patients (73.33%) presented with vertigo. [Table number43].
Duration of complaints
Among 30 patients 14 patients had duration of complaints since from
6months -1 year (46.67%), 10 patients from 1-2 years and (33.33%) 6
patients < 6 months . [Table number 44].
Mode of onset
In this study 50% of the patient had sudden onset and rest had gradual
onset . [Table number45]
Nature of pain
In the study Maximum no of patients had pricking type of pain.
Followed by 36.67% had shooting type of pain . Remaining data is
shown in the table . [Table number46].
Course of pain
Among 30 patients 66.67% patients had intermittent course of pain and
10 patients had continuous course of pain. [Table number47].
Family history
In the study Among 3o patients 5 patients had familial history of cervical
spondylosis . [Table number48].
Discussion
143
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Treatment history
In the study Among 30 patients registered in the study 15 patients had
treatmental history of Allopathy.And 20% patients had no previous treatment
history . Remaining data is shown in the table . [Table number 49].
Neurological deficit
In the study Among 30 patients 18 patients have Mild episode of
Neurological deficit [Table number 50].
Neck disability index
In the study Among 30 patients registered in the study 22 patients
presented with the Neck disability index . [Table number51].
samyak nasya laxana in the patients [Table number52].
In the study all the 30 patients attained samyak nasya laxanas and no one
in the study ended in ayoga or atiyoga of nasya karma
Effect OF THE TREATMENT
1. Effect On Neck Pain -
The effect on neck pain over 30 patients suffering from cervical
spondylosis showed the mean score of 2.000 before the treatment was
reduced to 1.133 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
Discussion
144
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
2. Effect On–Radiation of pain
The effect on radiation of pain over pain on 30 patients suffering
from cervical spondylosis showed the mean score of 2.43 before the
treatment was reduced to 1.600 after the treatment. The change that
occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001)
3. Effect On stiffness
The effect on the symptom stiffness over 30 patients suffering from
cervical spondylosis showed the mean score of 1.567 before the treatment
was reduced to 0.900 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
4. Effect On - Weakness
The effect over the symptom weakness on 30 patients suffering from
cervical spondylosis showed the mean score of 1.167 before the treatment
was reduced to 0.633 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
5. Effect On - Parasthesia
The effect over the symptom parasthesia on 30 patients suffering from
cervical spondylosis showed the mean score of 0.700 before the treatment
was reduced to 0.300 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
Discussion
145
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
6. Effect On Clumpsy finger movement
The effect over the symptom clumpsy finger movement on 30 patients
suffering from cervical spondylosis showed the mean score of 1.300
before the treatment was reduced to 0.933 after the treatment. The change
that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)
7. Effect On - Vertigo
The effect over the symptom vertigo on 30 patients suffering from
cervical spondylosis showed the mean score of 1.067 before the treatment
was reduced to 0.633 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
8. Effect On - Tenderness
The effect over the symptom tenderness on 30 patients suffering from
cervical spondylosis showed the mean score of 2.233 before the treatment
was reduced to 1.167 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
9. Effect On - Movements of neck
The effect over movements of neck on 30 patients suffering from
cervical spondylosis showed the mean score of 2.033 before the treatment
was reduced to 1.500 after the treatment. The change that occurred with the
Discussion
146
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
10. Effect On - Sensory loss
The effect over sensory loss on 30 patients suffering from cervical
spondylosis showed the mean score of 0.667 before the treatment was
reduced to 0.267 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
11. Effect On - Neurological deficit
The effect over Neurological deficit on 30 patients suffering from
cervical spondylosis showed the mean score of 4.533 before the treatment
was reduced to 3.867 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
12. Effect of treatment on -Neck disability index
The effect of treatment on Neck disability index over 30 patients suffering
from cervical spondylosis showed the mean score of 11.00 before the
treatment and mean score of 10.167 after the treatment. The change that
occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = 0.009)
Discussion
147
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
13. Effect of treatment on Power w.s.r. movements . Shoulder
Abduction
The effect on power w.s.r movements . shoulder Abduction on 30
patients suffering from cervical spondylosis showed the mean score of
3.400 before the treatment and mean score of 4.033 after the treatment.
The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = <0.001)
14. Effect of treatment on -- Power w.s.r. movements . Shoulder,
Flexion
The effect on power w.s.r movements . shoulder,flexion on 30 patients
suffering from cervical spondylosis showed the mean score of 3.23
before the treatment and showed mean score of 3.867 after the
treatment. The change that occurred with the treatment is greater than would
be expected by chance; there is a statistically significant change (P =
<0.001)
15. Effect of treatment on Power w.s.r. movements . Shoulder Extension
The effect on power w.s.r movements. shoulder , extension on 30 patients
suffering from cervical spondylosis showed the mean score of 2 .967
before the treatment and mean score 3.400 after the treatment. The
change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)
Discussion
148
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
16 Effect of treatment on Power w.s.r. movements . Elbow . Flexion
The effect of treatment on power w. s.r movements . Elbow. Flexion on 30
patients suffering from cervical spondylosis showed the mean score of
3.233 before the treatment and mean score of 3.800 after the treatment.
The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = <0.001)
17. Effect of treatment on Power w.s.r. movements . Elbow Extension
The effect on power w. s.r movements . Elbow.Extension on 30 patients
suffering from cervical spondylosis showed the mean score of
2.033before the treatment and mean score of 1.500 after the treatment.
The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = <0.001)
18. Effect of treatment on Power w.s.r. movements . Wrist . Flexion
The effect on power w. s.r movements . Wrist . Flexion on 30 patients
suffering from cervical spondylosis showed the mean score of 3.233
before the treatment and mean score of 3.667 after the treatment. The
change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)
19. Effect of treatment on Power w.s.r. movements . Wrist . Extension
The effect on power w. s.r movements . Wrist. Extension on 30 patients
suffering from cervical spondylosis showed the mean score of 3.100
before the treatment and mean score of 3.633 after the treatment. The
Discussion
149
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)
20 . Effect of treatment on Power w.s.r. movements. Forearm .
supination
The effect on power w. s.r movements. Forearm . Supination on 30 patients
suffering from cervical spondylosis showed the mean score of 3.133
before the treatment and mean score of 3.567 after the treatment. The
change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)
21. Effect of treatment on Power w.s.r. movements Forearm Pronation
The effect on power w. s.r movements. Forearm Ponation over the
symptom neck pain on 30 patients suffering from cervical spondylosis
showed the mean score of 3.967 before the treatment and mean score of
4.400 after the treatment. The change that occurred with the treatment is
greater than would be expected by chance; there is a statistically significant
change (P = <0.001)
22. Effect of treatment on Power w.s.r. movements .
Metacarpophalangeal and interphalangeal . Flexion
The effect on power w. s.r movements Metacarpophalangeal and
interphalangeal . Flexion on 30 patients suffering from cervical
spondylosis showed the mean score of 3.933 before the treatment and
mean score of 4.300 after the treatment. The change that occurred with the
Discussion
150
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
23. Effect of treatment on Power w.s.r. movements .
Metacarpophalangeal and interphalangeal. Extension
The effect on on power w. s.r movements Metacarpophalangeal and
interphalangeal. Extension on 30 patients suffering from cervical
spondylosis showed the mean score of 4.133 before the treatment and
mean score of 4.667 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
24. Effect of treatment on Power w.s.r. movements .
Metacarpophalangeal and interphalangeal Abduction
The effecton on power w. s.r movements Metacarpophalangeal and
interphalangeal. Abduction over the symptom neck pain on 30 patients
suffering from cervical spondylosis showed the mean score of 4.200
before the treatment and mean score of 4.900 after the treatment. The
change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)
25. Effect of treatment on Power w.s.r. movements.
.Metacarpophalangeal and interphalangeal Adduction
The effect on power w. s.r movements Metacarpophalangeal and
interphalangeal . Adduction over the symptom neck pain on 30 patients
suffering from cervical spondylosis showed the mean score of 4.133
Discussion
151
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
before the treatment 4.533 after the treatment. The change that occurred
with the treatment is greater than would be expected by chance; there is a
statistically significant change (P = <0.001)
26. Effect of treatment on -Reflex .Biceps
The effect on Relex. Biceps over 30 patients suffering from cervical
spondylosis showed the mean score of 1.700 before the treatment and
mean score of 2.167 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
27. Effect of treatment on - Reflex. Triceps
The effect of treatment on reflex- Triceps over 30 patients suffering from
cervical spondylosis showed the mean score of 2.033 before the treatment
and mean score of 2.267 after the treatment. The change that occurred with
the treatment is greater than would be expected by chance; there is a
statistically significant change (P = 0.006)
28. Effect of treatment on Reflex .Supinator
The effect of treatment on Reflex. Supinator over 30 patients suffering
from cervical spondylosis showed the mean score of 1.867 before the
treatment 2.267 after the treatment. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)
Discussion
152
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Significant results were seen in
Neck Pain -
Radiation of pain
stiffness
Weakness
Parasthesia
Clumpsy finger movement
Vertigo
Tenderness
Movements of neck
Sensory loss
Neurological deficit
Neck disability index
Power w.s.r. movements . Shoulder, Abduction, flexion ,extension
Power w.s.r. movements . Elbow , Flexion, Extension
Power w.s.r. movements . Wrist , Flexion , Extension
Power w.s.r. movements , Forearm , supination, Pronation
Power w.s.r. movements . Metacarpophalangeal and
interphalangeal . Flexion , Extension, Abduction , Adduction
Reflex .Biceps , Triceps, Supinator
Chapter -7
Conclusion
Conclusion
153
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
CONCLUSION
• The maximum percentage of patients i.e. (43.33%) was between 41-50
age groups which is suggestive of risk factor is more on ageing
• Cervical spondylosis as a whole cannot be compared to any single
disease pathology Ayurvedic parlance. But what ever may be the
disease, it affects the well being of the person and make an impact on
nations economy.
• . It can be said that the present study shows significant remission in
signs and symptoms of illness Cervical spondylosis
• Therefore it is imperative that the nasya karma with ketakyadi taila
help in management of the disease Cervical spondylosis and mostly
affects the individuals with in the age between forty- sixty years. Sex,
martial status, religion, Social status, literature bear no relation in
causation of this disease.
• Nasya karma performed with ketakyadi taila taila helps to pacify the
Vataprakopa due to its Snehana and brimhana qualities. And increases
functional ability
• Moreover, the improvement following the treatment proved to be
statistically significant.
• The results of the follow up study showed that the relief provided by the
therapy did not show much benefit up to 7 days of follow up after
stopping the treatment.
Chapter - 8
Summary
Summary
154
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
SUMMARY
The dissertation entitled “A Clinical Study To Evaluate The Effect Of
Nasya Karma In Cervical Spondylosis” consists of 10 chapters , namely
Introduction, Objectives, Review of literature, Methodology, Observation
and Result, Discussion, Conclusion and summary, Bibliography and
Annexure
Chapter 1 – Introduction
Chapter 2-Where the aims and objectives of the study are specified.
Chapter 3-Review of litreature
1. References of Nasya in various litreatures including Veda,
Upanishads, Puraana, different samhitas,etc are mentioned.
2. Conceptual study of Nasya:Here Etymological derivation, definition
of Nasya are explained.It also includes Nasya classification, dosage of
Nasya etc. according to various texts.Procedure of Nasya Karma is
explained along with Samyaka,Ayoga,Atiyoga Lakshanas.Vtapats and
their respective treatment are explained.
3. Conceptual study of Cervical Spondylosis where definition anatomy
of cervical spine,etiology and ethiopathogenesis of the disease,clinical
features, differential diagnosis, investigations, treatment are
mentioned.
4. Drug review:Here detailed description of the drugs used in Nasya
Karma are explained.
Chapter 4-Methodology:It explains the design of the study.Method of
selection of patients, Inclusion and exclusion criteria, Intervention, Criteria
for assessment.
Summary
155
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”
Chapter 5- Observation and results: The detailed description of the different
observations made during the study is explained. Statistical analysis of the
data on different parameters is explained in results.
Chapter 6- Discussion: Discussion about the conceptual part of Nasya and
Cervical Spondylosis, about the Clinical data is specified. Discussion about
different observations are also explained along with the comment.
Discussion about the effect of the therapy on different parameters are also
explained in detail.
Chapter 7- Conclusion: The conclusion drawn upon clinical study and
various other parts of the work is explained here.
Chapter 8- Summary: summarized the whole Dissertation work.
Chapter 9- Bibliography: This deals with author name, publication, edition,
page no. and total no. of pages of the books referred in this study.
Chapter 10- Annexure: This section deals with the details of case proforma.
Chapter - 9
Bibliography
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Chapter - 10
Annexure
176
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Department of Post Graduate Studies in Panchakarma, Kuthpady, Udupi
Title of Dissertation
“A CLINICAL STUDY TO EVALUATE THE EFFECT OF NASYA KARMA IN
CERVICAL SPONDYLOSIS"
Guide: Dr. Niranjan Rao M.D (Ayu) Candidate :- Dr. Vignesh Hoblidar
Professor
Patient name : Date :
CLINICAL CASE PROFORMA
Age : Sl. No :
Sex : OPD No :
Religion : IPD No :
Occupation : D.O.A :
Educational Status : D.O.D :
Economical Status : L/M/UM/H
Habitat :
Address :
Date of commencement :
Date of completion :
Follow up :
Results :
Chief Complaints
:
Duration
177
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Pain : Localized / Diffuse
Radiate to / Rt / Lt
Occiput
Frontal
Shoulder down one arm
Shoulder down both arms
Other areas
Referred
To one finger
To more than one fingers
Tingling
Burning
Numbness
Weakness :
Wasting of muscles :
Morements of neck : Painful / Painful Restricted/ Restricted/Stiffness
Painful movements / Holding
Sensory loss :
Clumsy finger movements :
Associated complaints
Vertigo :
:
Flushing :
Tinnitus :
Visual Blurring :
Dysphagia :
Loss of bladder / Bowel control :
Groins involved : Rt It
Neck :
Arm :
178
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Forearms :
Fingers :
Leg :
History of present illness:
Mode of onset:
Nature of Pain:
Course:
Aggravating Factors:
Family history :
Relieving Factors
No of children : Male
Female
Previous history :
Work :
Disease :
Operative procedure :
Major spinal operations :
Others :
Whiplash injury :
Trauma :
Motor vehicle accident :
Fall :
Sports :
179
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Diving :
Other :
Nature of job : Standing Profession
Occupational History:
Sitting Laborious
Administrative
Clerical
Duration of job Other
Treatment History: Taken allopathic treatment
Taken Ayurvedic treatment
Taken physio theraphy
Taken any other Treatment
Gynecological history :
History of associated symptoms :
History of complications :
Marital Status :
Personal History:
Married / Unmarried / Widow
No of Children : Male : Female :
Occupation :
Nature of Job :
Environment of Job :
Education :
Educated / Uneducated
Addiction :
Alcohol : Quantity Frequency Duration
Smoking :
Cigarettes : Numbers Frequency Duration
Beedies : Numbers Frequency Duration
180
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Tobacco chewing :
Gutkha : Quantity Frequency Duration
Others’s :
Ahara :
Veg / Non-veg / Mixed
Rasa :
Sarvagraha
Parigraha – M/ A/ L/ K/T/KS
Time : Regular / Irregular
Type :-
Samashana
Adyashana
Vishamashana
Anashana
Vihara : sleep : Normal / Excessive / Less / Disturbed / Loss
Duration : Day time
Night time
Sports :
Habit :
Tea : Quantity Frequency Duration
Coffee : Quantity Frequency Duration
Others : Quantity Frequency Duration
Appetite (Agni) :
Sama / Manda / Vishama / Teekshna
Bowel :
Regular / Irregular / Constipated / Other
Bhaya / Shoka / Chinta / Krodha
Manasika Pareeksha :
181
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Contraceptive History:
Nadi :
General Examination
Mootra :
Mala :
Jiwha :
Shabda :
Sparsha :
Drik :
Akruthi :
B.P :
Temp :
Heart rate :
Resp rate :
Weight :
Height :
x-ray (AP & Lateral views of cervical spine )
Investigations :
Blood investigations: E.S.R
R.A
V.D.R.L
Examination of cervical spine:
Specific Examination:
Movements of Neck:
Flexion Rt lateral Flexion
Extension Left Lateral Flexion
Rt. Lateral rotation
Ieft Lateral rotation
182
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Motor function :
Nutrition : Atrophy
Hypertrophy
Upper limb : Rt Left
Tone
Power
Lower limb :
Tone
Power
Involuntary movements if any :
Sensory functions :
Superficial or exteroceptive
1. Pain
2. Touch
3. Thermal - Hot
Cold
Deep reflexes Rt Lt
Biceps (c5, c6
Supinator (c
)
5, c6
Triceps (c
)
7, c8)
1. Prukruti
Dasha Vidha Parecksha:
2. Vikruti
3. Sara
4. Samahanan
5. Pramana
6. Seatmya
7. Satura
8. Ahara
9. Vyayama sakthi
10. Vaya
183
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
BT Subjective parameters AT
Neck pain
Radiation of pain
Stiffness
Weakness
Parasthesia
Clumsy finger movements
Vertigo
Objective Parameters BT AT
Tenderness
Movements of Neck
Flexion
Extension
Right Lateral Flexion
Left Lateral Flexion
Right Lateral Rotation
Left Lateral Rotation
Sensory Loss
Neurological Deficit
Power w.s.r. Movements
Shoulder:Abduction
Flexion
Extension
Elbow: Flexion
Extension
Wrist: Flexion
Extension
184
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Forearm :Supination
Pronation
Metocarpophalangeal and
Interphalangeal: Flexion
Extension
Abduction
Adduction
Reflex
Biceps
Triceps
Supinator
Neck Disability Index
BT AT
Assessment of nasya karma :
Samyak Nasya
Lakshana
Day1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
UroLaghava
ShiroLaghava
Indriya Acchyam
(Prasada)
Sroto vishudhi
Manah Sukham
(Prasada)
Akshi Laghuta
185
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Vaktra Vishudhi
Swara Vishudhi
Sukhochwaasa
Sukha swapna
Sukha
Prabhodana
Vikaropashamah
Pramoda
Smruthi Medha
Aapti
Bala Aapti
Agni Aapti
Ayoga Nasya Laxanas Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Galopalepa
ShirasoGurutwa
Moordha Shoonyata
Nishteewana
KaphaSramsana
Vata vaigunya
Indriya Rookshata
Akshi Stabdata
Akshi Rookshata
Nasa Shosha
Asya shosha
Kandu
Upadeha
Gadodreka
186
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Atiyoga Nasya Laxana Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Shiro Arti /Toda
Akshi Arti/ Toda
Shankha Arti/Toda
Shravana Arti/ Toda
Timira Pashyet
Kapha Praseka
Shiro Guruthwa
Shirasah shoonyata
Indriya Vibrama
Mastulungagama
Vata Vrudhi
Kandu
Aruchi
Peenasa
Kshaamatha
Unmada
Hridrava
Signature of Guide
Signature of Co-Guide Signature of scholar
187
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Grading:
Subjective Parameters :
Neck pain : Grade 0 – No pain
Grade1 –Mild painoccasional/Intermittent Relieved on its own/ rest Grade2-Moderate pain,frequent pain Relieved after taking pain killers Grade 3-Severe pain, not tolerable, not relieved fully even after taking pain killers Radiation of Pain : Grade 0 –No radiation Grade1 –Radiation of pain from neck to arm or neck to any one extremity, occasionally present Grade 2- Radiation of pain from neck to arm or neck to any one extremity, continuously present Grade3-Radiation of pain from neck to both arms or both upper extremities, occasionally present Grade 4-Radiation of pain from neck to both arms or both upper extremities , continuously present Stiffness: Grade 0-No stiffness Grade 1-Mild stiffness Grade2-Moderate stiffness Grade 3- Severe stiffness Weakness: Grade 0-No weakness Grade1-Weakness in any one upper extremity Grade 2-Weakness present in both the extremities Parasthesia : Grade0-Absent Grade 1-Present Clumsy Finger movements : Grade0- No clumsy finger movements Grade 1- clumsy finger movements in any one upper extremities Grade 2- Clumsy finger movements in both upper extremities Vertigo: Grade 0 –Absent Grade 1- Present on neck movements or occasionally present Grade 2- Present constantly
188
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
Objective parameters :
Tenderness over cervical region : Grade 0- No pain Grade 1- Patient complains of pain Grade 2- Patient complains of pain and winces
Grade 3- Patient winces and withdraws the affected part Grade 4- Patient will not allow palpation of affected part
Reference : Orthopedic Physical Assessment by David J.Magee
Movements of neck painful or restricted : Grade 0- All 6movements are painless or not restricted Grade1- Any 1 movements is painful or restricted Grade 2-Any 2 movements is painful or restricted Grade 3-Any 3 movements is painful or restricted Grade 4- Any 4 movements is painful or restricted Grade 5-Any5 movements is painful or restricted Grade 6-All 6 movements is painful or restricted Sensory Loss : Grade 0- Normal sensation Grade 1- Reduced sensation Grade 2 – No sensation Neurological Deficit: ( Watkin’s Severity scale for Neurological Deficit ) A Neurological Deficit Grade 1- Unilateral arm numbness or dysesthesia ;Loss of strength
Grade 2- Bilateral upper extremity loss of motor and sensory function Grade 3- Ipsilateral arm, leg &trunk loss of motor & sensory function Grade 4- Transient quadriparesis (temporary sensory loss in all 4 limbs) Grade 5- Transient quadriplegia ( temporary motor loss in all 4 limbs) Score A : B Time symptoms present Grade 1- Less than 5 minutes
Grade 2 - Less than 1 hour Grade 3- Less than 24 hours Grade 4- Less than 1 week Grade 5 – Greater than 1 week Score B:- Severity score : A+B = Score (out of 10) Severity ≤4 Mild episode 4-7 Moderate episode 8-10 Severe episode
189
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
C Grade 1- >12mm
Central canal diameter
Grade 2- Between 10 to 12mm Grade 3- 10mm Grade 4- 8 to 10mm Grade 5 - <8mm Score C : __ Return to activity score A +B+C = Score (out of 10) Minimum risk 6-10 Moderate risk 10-15 Severe risk Reference : Orthopedic physical Assessment by David J. Magee Power : Grade 0 – No muscle contraction visible Grade 1-Flicker of contraction but no movement Grade 2 – Joint movement when effect of gravity eliminated Grade 3 – Movement against gravity but not against resistance Grade 4 – Movement against resistance but weaker than normal Grade 5 – Normal power Reference : Medical research Council Scale, Macleod’s Clinical examination Reflexes: Grade 0- Absent Grade 1- Diminished Grade 2- Average Grade 3 – Exaggerated Grade 4 – Clonus , very brisk Reference : Orthopedic Physical Assessment by David J . Magee Neck Disability Index : SECTION 1 : Pain Intensity A. I have nompain at the moment .( 0) B. The pain is very mild at the moment . ( 1) C. The pain is moderate at the moment ( 2) D. The pain is fairely severe at the moment( 3) E. The pain is very severe at the moment (4) F. The pain is the worst imaginable at the moment (5)
190
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
SECTION 2: Personal Care (Washing , Dresing , etc ) A. I can look after myself normally without causing extra pain (0) B. I can look after myself normally but it causes extra pain (1) C. It is painful to look after myself and I am slow and careful ( 2) D. I ned some help but manage most of my personal care ( 3) E. I need help every day in most aspect s of my personal care F. I do not get dressed ; I wash with difficulty and stay in bed ( 5) SECTION 3: Lifting A. I can lift heavy weights without extra pain . (0) B. I can lift heavy weights but it gives extra pain . (1) C . Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned , for example on the table . ( 2) D. Pain prevents me from lifting heavy weights , but I can manage light to medium weights if they are conveniently positioned . ( 3) E. I can only lift very light weights . ( 4) F . I cannot lift or carry anything at all . ( 5) SECTION 4 : Reading A. I can read as much as I want to with no pain in my neck . ( 0) B. I can read as much as I want to with slight pain in my neck . (1) C. I can read as much as I want with moderate pain in my neck . (2) D. I cannot read as much as I want because of moderate pain in my neck . (3) E. I can hardly read at all because of severe pain in my neck . (4) F. I cannot read at all . ( 5) SECTION 5 : Headaches A. I have no headaches at all . ( 0) B. I have slight headaches that come in frequently .(1) C. I have moderate headaches which come infrequently (2) D. I have moderate headaches which come frequently (3) E. I have severe headaches which come frequently . (4) F. I have headaches almost all the time . (5) SECTION 6 : Concentration A.I can concentrate fully when I want to with no difficulty . (0) B.I can concentrate fully when I want to with slight difficulty .(1) C.I have a fair degree of difficulty in concentration when I want to (2) D.I have a lot of difficulty in concentrating when I want to (3) E.I have a great deal of difficulty in concentrating when I want to (4) F.I cannot concentrate at all (5)
191
“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”
SECTION 7 : Work A.I can do as much work as I want to .(0) B.I can do my usual work , but no more .(1) C.I can do most of my usual work , bit no more . (2) D.I can do my usual work . (3) E. I can hardly do any work at all (4) F. I cannot do any work at all . (5) SECTION 8 : Driving A.I can drive my car without any neck pain . (0) B.I can drive my car as long as I want with slight pain in my neck (1) C.I can drive my car as long as I want with moderate pain in my neck (2) D. want because of moderate pain in neck . (3) E.I can hardly drive at all because of severe pain in my neck .(4) F.I can not drive my car at all . (5) SECTION 9: Sleeping A.I have no trouble sleeping . (0). B.My sleep is slightly disturbed (less than 1 hour sleepless ).(1) C.My sleep is mildly disturbed (1-2 hours sleepless ).(2) D.My sleep is moderately disturbed (2-3hours sleepless ). (3) E.My sleep is greatly disturbed (3-5hours sleepless ). (4) F.My sleep is completely disturbed (5-7hours sleepless ).(5) SECTION 10 : Recreation A.I am able to engage in all my recreation activities with no pain at all (0) B.I am able to engage in all my recreation activities with some pain in neck . (1) C.I am able to engage in most , but not all , of my usual recreation activities because of pain in my neck . (3) D.I am able to engage in a few of my usual recreation activities because of pain in my neck (3) E.I can hardly do any recreation activities because of pain in my neck (4) F.I cannot do any recreation activities at all . (5) Scores (out of 50 ) Level of disability 0-4 No disability 5-14 Mild disability 15-24 Moderate disability 25-34 Severe disability 35-50 Complete disability Reference : Orthopedic Physical assessment by David J. Magee