International Journal of Trend in Scientific Research and Development (IJTSRD) Volume 5 Issue 6, September-October 2021 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470 @ IJTSRD | Unique Paper ID – IJTSRD47532 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1449 Nasya Karma an Emergency Therapy W.S.R. Visha Chiktsa Dr. Hari Krishna Shriwas 1 , Dr. L. C. Harjpal 2 , Dr. Rupendra Chandrakar 3 1Assistant Professor, 2Professor and HOD, 3Reader, 1Department of Samhita Siddhanta and Sanskrit, B. G. Garaiya Ayurvedic College, Rajkot, Gujarat, India 2,3Department of Maulik Siddhanta, Govt. Ayurvedic College, Raipur, Chhattisgarh, India ABSTRACT The Nasya Karma has been specifically indicated, when the poison reaches the head region (Shirogata Visha). As the medicines administered through Nasya directly enter the central nervous system, this treatment modality can be aptly used in such emergency medical conditions. The administration of Nasya doesn’t need any specific pre- therapeutic measures like Snehana (Oleation) or Swedana (Sudation) etc. which are compulsory before other starting other treatments like Vamana or Virechana. This makes it more suitable for its use in the emergency cases of poisoning. Moreover, the utilization of Nasya Karma has been observed right since the Vedic period and this extensive tradition of Nasya Karma gives lots of confidence about its safety and efficacy. Even certain researches in modern medical science have proved its utility, but still there is a greater need to explore and utilize this treatment option in a more scientific manner. Poisoning is always an emergency condition that doctor has to handle diligently and cautiously. Nasya karma (NK)- drug delivery through nasal passage is considered to be the best one among all the panchkarmas for all urdhwajatrugata (Organs above the adam’s apple) diseases. According to its practical application with minimum requirements, its accessibility is comparatively is easier. From 2016, CCIM has declared Agadatantra as a clinical subject. Agadatantra is the ayurvedic toxicological science which deals with the study of signs and symptoms of different types of poisons and its management. Among the twenty-four treatment modalities of vishachikitsa, nasya is one. But practicle application of drugs which are used for NK in poisoned cases were not available at first hand. KEY WORDS: Snehan, Antitoxic, Vishachikitsa, virechana How to cite this paper: Dr. Hari Krishna Shriwas | Dr. L. C. Harjpal | Dr. Rupendra Chandrakar "Nasya Karma an Emergency Therapy W.S.R. Visha Chiktsa" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456- 6470, Volume-5 | Issue-6, October 2021, pp.1449-1455, URL: www.ijtsrd.com/papers/ijtsrd47532.pdf Copyright © 2021 by author (s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0) INTRODUCTION: The concept of targeted drug delivery system has been originated from the perception of Paul Ehrlich, who proposed delivery of drug to be as a ‘Magic Bullet’. Nasal cavity has a large surface area and highly vascularized mucosa. Drugs are absorbed by the rich network of blood vessels and are passed through systemic circulation; thus, it avoids first pass metabolism. Despite the potential of the nasal route, a number of factors limit the intranasal absorption of drugs, especially the proteins and peptide drugs, these factors are the mucus and epithelial barrier, mucociliary clearance and enzymatic activity. Rapid mucociliary clearance of drug formulations that are administered through the nasal cavity is thought to be an important factor for the low bioavailability of drugs administered intranasally. Increasing the residence time of the drug formulation in the nasal cavity and thus prolonging the period of contact with the nasal mucosa may improve the drug absorption. The intranasal route of administration will probably have great future scope for the development of peptide preparations and other drugs those administered parenterally. Surface modification technology can be used as an excellent formulation strategy for nose to brain drug delivery. Out of all types of Panchakarma, Nasya Karma is the best therapy for Urdhvajatrugata Roga and especiallyfor Naasaagata Roga according to all Aayurvedic scholars and ancient literatures. Without Nasya karma, it is not possible to eliminate the vitiated Dosha, which are situated in Shira or Naasaa IJTSRD47532 International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47532 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1450 Pradesh. “Nasya” becomesa prime therapy for maintaining the health of “Urdhvajatru” region, because it is the only Karma, which finds a place in simple routine references like “Dinacharya” and also within the most sophisticated places like “Panchakarma”. DESCRIPTION OF NAASAA As per its etymology, the word ‘Naasaa’ is derived fromthe root word “Nastru” which means“the only gateway to head”. The Aayurvedic classics explained Naasaa as the only route to the head. Therefore, a lot of medicaments are advised to be introduced through nose, which can influence the head directly, especially in unconscious conditions as well as in fatal emergency conditions like Sanyaasa, Murchchhaa, Sarpadamsha etc. Historical Background of Nasya Karma – A review Since ancient times, India is very well known worldwide for its splendid civilization (culture) which had its own system of medicine i.e. Aayurveda. It is difficult to find its root; but glimpses point that, Indian culture origins from Vedic time. Therefore, we find the references of Naasaa (Nose) as an Indriya in ancient classic literature, like Yajurveda, Atharvaveda and Bhagawata Geeta. Although it is very difficult to say that the procedure of Nasya Karma therapy was in practice during Vedic period. But a few Mantras of Rigveda indirectly refer towards the Karmas which are included under Panchakarma measures. There is a Mantra of Rigveda, in which eradication of Roga from the routes of Naasaa (Nostrils), Chibuka (Chin), Shira (Head), Karna (Ear) & Rasana (Tongue) are mentioned. Thus, we can assume that this reference of eradication of diseases through the above mentioned routes probably refers towards Nasya Karma or Shirovirechana. However, the term “Nasya Karma” has been used many times in Krishna Yajurveda, Shatapatha Braahmana & Upanishada. In Bauddha period, there are some Jaataka stories about the famous Vaidya “Jeevaka”, who has reportedly utilizedNasya Karmaa several times such as – Nasya of medicated Ghritafor the treatment of Shirah Shoola and Nasya of Virechana Aushadha to Lord Buddha as well. The same reference about Nasya of Virechana Aushadha is mentioned in Vinaya Pitaka as well. Even in Vaalmiki Raamaayana, the famous reference regarding use of the herb “Sanjeevani” mentions the use of Nasya Karma.The drug “Sanjeevani”was blew by Sushena in the nose of Lakshmana to make him conscious. After Bauddha Kaala, Aayurvedic Classicslike Charaka Samhitaa, Sushruta Samhitaa and Ashtaanga Hridaya became famous, wherethe subject of Nasya Karma therapy is elaborately described. In Samhitaa period, the specification in Nasya Karma had reached to such an extent of perfectness that it was being used not only for the treatment of adult humans but also for the fetal health . Etymology according to Vaachaspatyam The literary meaning of the word “Nasya” is “being in the nose” or “the things beneficial to the Nose”. Vaachaspatyam also derives the word ‘Nastah’ which means “beneficial for the nose”. Definition of Nasya: As stated by Sushruta, administration of medicines or medicated oils through the nose is known as a Nasya Synonyms: Shirovirechana, Shirovireka, Murdhavirechana, Nastah Karma, Naavana are the synonyms of Nasya Karma. Table of classification of Nasya according to various Aachaarya Sr. No. Name of Aachaarya No. Reference Classification 1 Charaka 3 Ch.Si. 9/89, 92 Ch.Vi. 8/154 According to mode of action – Rechana, Tarpana, Shamana 5 #According to the method of administration – Naavana, Avapidana, Dhmaapana, Dhuma, Pratimarsha 7 According to various parts of drugs utilized - Phala, Patra, Mula, Kanda, Pushpa, Niryaas, Twak 2 Sushruta 5 Su.Chi.40/21 Shirovirechana, Pradhamana, Avapida, Nasya, Pratimarsha 3 Vaagbhata 3 A.H.Su.20 Virechana, Brimhana, Shamana 4 Kaashyapa 2 Ka.Si. 2 & 4 Brimhana, Karshana 5 Shaarangadhar 2 Sha.Utt.8/2,11,24 Rechana, Snehana 6 Dalhana 2 Su. Chi. Praayogika, Snaihika 7 Videha 3 40/31 Sangyaa Prabodhaka, Stambhaka International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47532 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1451 Charaka’s Classification of Nasya According to Aachaarya Charaka, Nasya is of five types viz. Naavana, Avapida, Dhmaapana, Dhuma and Pratimarsha [7]. Naavana is further divided into Snehana and Shodhana; Avapidana into Shodhana and Stambhana; Dhuma into Praayogika, Vairechanika and Snaihika; while Pratimarsha is divided into Snehana and Shodhana. Charaka Samhitaa has also mentioned 7 types of Nasya according to parts of the drugs to be used in Nasya Karma viz – Phala, Patra, Mula. It is clear from the above description that, two types of classification of Nasya Karma are available in Aayurvedic literature: One is based on the pharmacological actions viz. Rechana, Tarpana, Shamana. Other is based on the preparation of drug and the method of its application. e.g. - Dhmaapana (Powder is blown), Avapida (Extracted juice is used), Dhuma (Smoking through nose) etc. Nasya Karma has been mentioned as a treatment modality in Visha Chikitsaa . In this perspective, Nasya can be defined as the procedure in which the medication given through the nasal route removes the poison as well as the vitiated Dosha from the head and neck region. It also stimulates the centers in the brain which are affected by the Madakaari Guna of Visha and helps to regain the consciousness of patient immediately. Therefore, in the context of Visha Chikitsaa (Treatment of Poisoning), the following three types of Nasya are more important - 1. Avapida Nasya- The word Avapida means the juice expressed from leaves or paste (Kalka) of required medicine (Chakrapaani). (Sha. Utt. 8/12)- method of Avapida nasya Rationale:Avapida Nasya is specifically indicated in Vishaabhighaata. Drugs: For Shodhana purpose, Kalka of Tikshna Dravya like Saindhava, Pippali etc. has been mentioned as Avapida Nasya. Dose: Like Shirovirechana, Avapida Nasya should be given in the following dose – Hina Maatraa - 4 drops Madhyama Maatraa - 6 drops Uttama Maatraa - 8 drops 2. Dhmaapana Nasya- Dhmaapana or Pradhamana is specifically a Shodhana Nasya. Definition: This type of Nasya is instilled using medicated Churna (Powder) for Shirovirechana. It is mentioned as Dhmaapana in Charaka Samhitaa and Pradhamana in Sushruta Samhitaa. Rationale: Pradhamana is described on the 13th rank among the Chaturvinshati Upakrama used for the treatment of poisoning. Principle: When the medicated powder is blown into the nose, itgets spread through the respiratory passage into the body, by which the spreading of poison is reduced and this is one of the preventive measures to reduce spread of poison. International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47532 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1452 Drugs: The powders of medicines like Katukaa, Katabhi, Katphala should be blown up into the persons nostrils to reduce the spreading of the poison. Method: In Pradhamana Nasya, Churna (Powder of drugs) is administered (Inhaled) by Nasal passage with the help of Naadi Yantra (6 Angula Naadi, open ended on both sides). The Churna (Fine powder) of required drug is kept at one end and air is blown from the other end, so that the medicine could enter into the nostrils. Videha: Aachaarya Videha has described another method for Pradhamana, in which fine powder of drug is kept in a Pottali made of a thin cloth and is used to inhale, so that smallest particles of the medicine enter into the nostrils. Dose: According to Videha, the dose of Dhmaapana Nasya is three Muchuti (3 pinch). For the Pottali method, Churna should be at least 2 Tola i.e. 20 gms. Drugs: Generally Tikshna drugs like Rock salt, Garlic,Guggulu, Maricha,Vidanga, etc. are used for this type of Nasya. Hence, caution should be taken during its administration. 3. Dhoomapaana – Dhooma means medicated smoke, while Dhoomapaana means inhaling the medicated smoke through nostrils. Principle: Fumes or smoke arising from anti-toxic materials are used for detoxification. This anti-toxic medicated smoke enters the body & clears all the channels (Strotasa)of circulation from all kinds of obstructions.On entering the body, this fume also nullifies the toxic effect of the poison. Rationale: Dhooma is described on the 17th rank among the Chaturvinshati Upakrama used for the treatment of poisoning. Dhuma Nasya: It is defined as the medicated fume taken by nasal route and eliminated by oral route. Aachaarya Sushruta hasn’t described it as a type of Nasya. The smoking per mouth is known as Doomapaana and is not included in Nasya. It is harmful to the eye sight. Drugs:For Praayogika Dhuma, drugs like Priyangu, Ushira etc. should be used. For Snaihika Dhuma,drugs like Vaasaa, Ghrita etc. should be used. For Vairechanika Dhuma, drugs like Aparaajitaa, Apaamaarga etc. should be used. INDICATIONS OF NASYA (Nasal medication) IN POISONING In the cases of poisoning, various herbal drugs or drug formulations have been advised for use through nasal route in Aayurvedic texts. Moreover, the Nasya Karma has been indicated in many different types of poisoning conditions. It can be observed from the textual illustrations given as follows Sr. No. Drugs/Formulation used for Nasya Indication 1 Mrutasanjeevana Agada In all types of poisoning 2 Shirishapushpa Yoga Sarpa Damsha (Snake Bite) 3 Parama Agada Poisoning by Vishvambhara etc. (An insect) 4 Kshaaraagada In all types of poisoning 5 Moola (Roots) of Bandhujeeva,Bhaarangi and Krushna Tulasi Shirogata Visha (When effect of poison is seen in head), Unconsciousness due to Visha 6 Powder of Pippali, Hingu, Vrishchikaali, Manashilaa, Shirishabeeja, Apaamaarga, Lavana Shirogata Visha (When effect of poison is seen in head), Unconsciousness due to Visha 7 Pippali, Kshavaka, Ativishaa and Maricha [20] Shirogata Visha (When effect of poison is seen in head) 8 Kaakaanda and Shirisha Patra Swarasa [21] In 5th Vega of Sthaavara Visha 9 Nasya [22] Darveekara Sarpa Damsha (in 3rd Vega) 10 Tikshna Avapida Nasya Darveekara Sarpa Damsha (in 7thVega) 11 Avapida Nasya [24] Raajimaana Sarpa Damsha (in 6th Vega) 12 Vaartaaku, Beejapura, Jyotishmati etc. When obstruction occurs in nose, eye, ear,tongue and throat due to poisoning International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47532 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1453 13 Tikshna Pradhamana Nasya using Churna (Powdered drugs) [26] When the person is unconscious due to poisoning 14 Shyaamaa,Yavaphala, Faninjaka, Shirisha grinded with Vaartaaka juice or Sarpi Manda In Lootaa poisoning 15 Shirisha Phala Saara [28] In Mushaka Visha 16 Kutajaadi Pradhamana Nasya Vrishchika, Unduru, Lootaa, Sarpa, Gara Visha Administration of Nasya The procedure of giving Nasya therapy may be classified into the following three headings: 1. Purva Karma (Pre-measures)- Before giving Nasya, prior arrangement of the materials and equipments should be done. There should be a special room “Nasya Bhavana” free from atmospheric effects like direct blow of air and dust etc. and with appropriate light arrangement [30]. Following articles should be collected before Nasya.(i) Nasya Aasana- (a) A chair for sitting. (b) A cot for lying. (ii) Nasya Aushadhi– Drugs required for induction and management of Shirovirechana should be collected in the form of Kalka, Churna, Kwaatha, Kshira, Udaka, Sneha, Aasava, Dhuma etc. in sufficient quantity. (iii) Nasya Yantra- For Snehana, Avapida, Marsha and Pratimarsha Nasya, there should be a dropper or Pichu. For Pradhamana Nasya, 6 Angula Naadi and specific Dhumayantra for Dhuma Nasya are required.Besides these, one needs efficient assistant, dressing material, spitting pots, bowl, napkins and towels also. 2. Pradhaana Karma (Nasya therapy)- As described by the Bruhattrayi (3 Major Aachaarya), the following procedure should be adopted for performing the Nasya Karma . Patient should lie down in supine position with ease on Nasya table. Shira (Head) should be “Pralambita” (Lowering or head down position) and feet slightly raised. Head should not be excessively flexed or extended. If the head is not lowered, the nasal medication may not reach to the desired distinction and if it is lowered too much, there may be the danger of getting the medication to be lodged in brain. After covering the eyes with clean cotton cloth, the physician should raise the tip of the patient’s nose with his left thumb and with the right hand, lukewarm medicine (Sukhoshna Aushadha) should be dropped in both the nostrils alternately in proper way . The drug should neither be less nor more in the dose, it should be in the proper quantity. It should neither be very hot nor very cold i.e. it should be lukewarm. The patient should remain relaxed while taking Nasya. He should avoid speech, anger, sneezing, laughing and shaking of head during Nasya Karma . 3. Paschaata Karma (Post measures) - After administration of medication through nasal passage, patient should lie supine (Uttaana) for about 2 minutes time interval &he should be asked to count the numbers up to 100. After administration of Nasya, feet, shoulders, palms and ears should be massaged. The head, neck andcheeks should again be subjected to sudation.If possible, snuffing of Rasna churna should be done for Vaata Prashamana. Mode of action of Nasya Karma A clear description regarding the mode of action of Nasya Karma is not available in Aayurvedic classics. According to Aachaarya Charaka, Naasaa is the gateway of Shira.The drug administered through nose as Nasya reaches the brain & eliminates the morbid Dosha responsible for producing the disease. According to Ashtaang Sangraha, Naasaa being the gateway to Shira,the drug administered through nostrils reaches Shringaataka (A Siraa Marma) by Naasaa Srotas. It spreads in the Murdhaa (Brain), Netra (Eyes), Shrotra (Ears), Kanthha (Throat), Siraamukha (Opening of the vessels, etc.) and scratches the morbid Dosha in supra-clavicular region, finally expelling them out from Uttamaanga. Aachaarya Sushruta has clarified Shringaataka Marma as a Siraa Marma formed by the union of Siraa (Blood vessels) supplying to nose, ears, eyes& tongue. He further points out that injury to this marma will be immediately fatal . Indu, in his commentary on Ashtaanga Sangraha, has opined Shringaataka as the inner side of middle part of the head i.e. Shiraso Antarmadhyama. According to all prominent Aachaarya, Naasaa is said to be the gateway of Shira. It doesn’t mean any channel which connects directly to the brain, but they might be connected through blood vessels or through nervous system (olfactory nerve etc.) There have been certain researches which have indicated that, the nasal route of administration of drug can prove to be a better option for drug delivery. Kumaar Aanand (1979) had attempted contraceptive drug administration by per nasal route & has opined International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47532 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1454 that the route is more beneficial than systemic administration. Micheal Russel (1977) has observed that the perspired scent, which has been painted on the upper lips, has caused the synchronization of menstrual cycle in female volunteers by constant smelling. Scientists of Institute of Medical Sciences, New Delhi have proved after experiments that, drug administered through nose shows effective action in the brain. So, it can be said that there is a very close relation between Shira & Naasaa. Thus, to understand the pathways used for action of Nasya drugs on central nervous system, it is important to explore the modus operandi of Nasya Karma. DISCUSSION: From the available data, it is observed that there are Sample drugs and agadas (anti toxic drugs) are mentioned for the NK in different types of poisoning. Almost in all types i.e. in Sthaavara (inanimate-plants, minerals, metals) and animate poisons (Snakes, scorpions, etc.) NK is indicated as a first aid treatment. So, this article may prove much helpful to researchers, UG, PG, scholars and scientist fraternity for innovative way of fast acting drug delivery system. Some latest researches are also mentioned supportive of the research question CONCLUSION Nasya Karma, being an important measure in Visha Chikitsaa, has been broadly mentioned in 24 treatment modalities by Aachaarya Charaka. It can be observed that Nasya Karma is not mentioned only as a single method, but three different types of Nasya Karma have been indicated for this purpose, namely Avapida Nasya, Dhmaapana Nasya and Dhuma Nasya. This is only because of the great utility of Nasya Upakrama in the cases of poisoning. Even though such a wide range of treatment options have been suggested in the cases of poisoning; however, every treatment modality out of the 24, cannot be used in all the types of poisons. Other treatments like Vamana (Emesis) or Virechana (Purgation) have been indicated in some types of poisoning, while they are contraindicated in certain other conditions. 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