A Critical Review on The Nasya Karma (Shirovirechana)

In Ayurveda, the term Nasya has been taken particularly to describe the course of administration of the medications.  The medicine which is given through the nose is known as Nasya Krama.  It is the process of Shodhana which is used to remove the vitiated Doshas arranged in Shirah and its constituent parts, relieving the Urdhvajatrugata Vikaras. It is one of the important Panchakarma it is easy and short, but complicated procedure if not follow through correct ways. It is widely practiced as preventive, promotive and curative purposes. So, one should have to know about it.

The term Nasya is derived from ‘Nasa’ Dhatu. It brings the perception of Gati-motion (Nasa Gatau) & Vyapti implies pervasion (Nasa Vyaptau). The terminology Nasya karma is made up of 2 words i.e., Nasya and karma. In Ayurvedic classics, Nasa Dhatu is utilized in perception of nose (Nasa Nasikayam). As per Monier William - The word Nasya relates to Nose or being in the Nose, administration of sternulatory; errhine (inhalation) [1]. Sirovirechana, Shirovireka, Murdhavirechana, Nastahkarma, Navana and Nashta Prachardana are the synonyms of Nasya Karma [2]. In Ayurveda, the term Nasya has been taken particularly to describe the course of administration of the medications [3]. As stated by Sushruta, medicines or medicated oils given through the nose is known as Nasya.  Nasya karma is a restorative measure where the medication is given via Nasa mostly to remove the vitiated Doshas arranged in Shirah pradesh and its constituent parts, relieving the Urdhvajatrugata Vikaras [4]. It is the chief line of management for supraclavicular region. Moreover, it has some other advantages: a) Can be given in insensible individuals b) Promotion of health care as per Dincharya c) Instantly drug absorption through extremely vascularized mucosa membrane, avoiding the gastrointestinal region and first proceed metabolism d) Enhanced bioavailability e) Lower adverse effects [5].

Classification of Nasya Karma

Table 1: Classification as per Various Acharyas.

As Per Their Pharmacological Activity [6]

Rechana Nasya: The Rechana Nasya signifies the removal of vitiated Doshas from Urdhvajatrugata Pradesh. Churna or the Sneha prepared with shirovirechana dravyaslike Apamarga, Pippali and Maricha etc. may be utilized. It may too be given with Tikshna Sneha, Kwatha or Swarasa of Shirovirechana dravyas or by dissolving these medications in Madya, Madhu, Saindhava, Asava, Pitta and Mutra. Tarpana Nasya: The Sneha made with Vatapittahara medications need to be utilized and the medications of Madhura Skandha may too be utilized. As indicated by Vagbhata, Sneha made with Snigdha and Madhura dravyas or with the medications mentioned valuable for that specific vyadhi need to be utilized.

Shamana Nasya: It is utilized for the mitigation of Dosha sited in Urdhajatrugatasthana. It very well may be associated with Snehana and Marsha-Pratimarsha. The Sneha made with the essential medications may be utilized for Shamana Nasya.

According to Method of Administration [7]

Navana Nasya: The process of applying Sneha in nose is called as Navana. It is given by putting the drops of a medicated Taila or Ghrita in the nose. Charaka has detailed Pranadi (pippet or dropper) for it. Navana is for the most part the Sneha Nasya. It can be basically characterized into Snehana and Shodhana Nasya. Avapida Nasya: The term Avapida implies to extract the juice of leaves or paste (kalka). Herb is put in white and clean fabric and is crushed to get the necessary quantity of juice, put directly in the nostril of the individual. It may also be given by diping the pichu into the Shruta (decoction) or Shrutashita, Sheeta (cold imbuement), Swarasa (juice) of the desired drug. It is fundamentally of two kinds. (i) Stambhana Nasya (ii) Shodhana Nasya. Dhmapana Nasya/Pradhamana: It is a particular Shodhana Nasya. Churna is given by Nasal route with the assistance of Nadi Yantra (Shadangula Nadi both sides open ended). The Churna is kept toward one side and air is blown from the opposite end, so that the medication could go into the nostrils. Dhuma Nasya: It is characterized as medicated fumes taken by nose and expelled by mouth. Acharya Sushruta has not introduced it as a kind of Nasya. The smoking through oral route is known as Dhumapana and is excluded from Nasya. It is dangerous to vision (eye sight). Types: a) Prayogika b) Sneihika c) Vairechanic.

Pratimarsha Nasya: Medicated Sneha when instilled into the nose in a specific and small dosage form, is known as Pratimarsha Nasya, it could be administered every day and in every one of the seasons in morning and night, without any adverse effects. It is given by dipping the finger in the desired Sneha and then afterword instilling it into the nose.

On the basis of Various Parts of Dravyas for Nasya [8].

Table 2: Various Parts of Dravyas.

According To Sushruta [9]

As per Sushruta, Nasya is additionally of 5 kinds. These are Nasya, Avapida, Pradhamana, Shirovirechana and Pratimarsha. They are additionally arranged by their actions into two varieties viz. Shirovirechana and Snehana.

According To Vaghbhata [10]

It has mainly grouped Nasya in 3 category - Rechana, Brimhana and Shamana

Virechana Nasya: Dravyas like Apamarga, Pippali and Maricha etc may be utilized particularly in Kaphaja kind of Shiroroga such as Stambha, Supti and Guruta of Shira.

BrimhanaNasya: Sneha made with Snigdha and Madhura dravyas are utilized for Vatika Shiroroga, Dantapata, Keshapata, Darunaka and other Vatapittaja Roga. 

Shamana: The Sneha made with the essential medications may be utilized for Shamana. It is used to cease the bleeding in Raktapitta. It is also given in AkalaValita, Palita and Khalitya, Darunaka, Raktaraji, Vyanga and Nilika.

On the basis of Dosage

Table 3: The Dosage of Nasya Karma.

Nasya karma Arha (Indications) - Anarha (Contrindications)

Table 4: Arha (Indications).

Table 5: Anarha (Contrindications).

Effect of Nasya if administered in contraindicated persons [11,12]

Table 6: Effect of Nasya if administered in contraindicated condition.

Nasya Vyapada (Complications) [13]

Table 7: VyapadaChikitsa of Nasya Karma.

Suitable Time for administrating Nasya [14,15]

Table 8: Time schedule in various seasons.

Table 9: Time Schedule in Doshaja Vikara.

Suitable Age and Duration of Nasya Karma [16,17]

As per Acharaya Vaghbhata, Nasya need not to be administrated before the age of 7 years and after the age of 80 years. But Pratimarsha Nasya may be given from birth to death. Acharaya Sharangadhara has also given the same view as Acharya Vaghbhata. Acharya Charaka has not explained the appropriate age.

Table 10: Duration of Nasya karma.

Nasya may be given for seven continuous days. In circumstances like Vata Dosha in head, hiccough, torticollis, loss of voice and so on, it may be done two times every day (in morning and night).

Nasyadana Vidhi (Method of Administrating Nasya) [18-21]

The method of administrating Nasya may be categorized into the following three headings: 

1. Purvakarma.
2. Pradhanakarma.
3. Paschatkarma.

Purva Karma

The following articles must be collected before Nasya:

Nasya Asana: (a) A sitting chair. b) A cot for relaxation c) Droni 

Nasya Aushadhi: Medicines should be collected in the form of Kalka, Churna, Kwatha, Kshira, Udaka, Sneha, Asava, Dhuma etc.

Nasya Yantra: For Snehana, Avapida, Marsha and Pratimarsha, Nasya must have Dropper or Pichu. Shadangula Nadi and Dumayantra specifically for Dhum Nasya are required for Pradhamana Nasya.

Preparation of the Patient

Patient need to have passed his normal urges like urine and faces. Patient need to rests on Nasya table. Prior to Nasya, Mridu Abhyanga (Massage) needs to be finished on scalp, temple, face and neck for 3 to 5 minutes by medicated oil like Bala Taila, Panchaguna Taila etc. Tapa sweda might be given on area of Shira, Mukha, Nasa, Manya, Griva and Kantha. Cotton cloth dipped in steaming hot water may be valuable for Mrudu Sweda. After Swedana smooth massage need to be applied on areas of Gala, Kapola and Lalata.

Pradhana Karma

Patient need to rest in supine position effortlessly on Nasya Droni (table). Shira (head) needs to be “Pralambita” (bringing down or head down position) and feet somewhat raised.  Head need not to be extremely flexed or extended. After covering the eyes with clean cotton cloth, the doctor needs to raise the tip of the patient's nose with his left thumb and with the right hand the Luke warm medication need to be dropped in both the nostrils on the other hand in appropriate manner. The medication needs to be neither less nor more in proper amount. The patient needs to stay calm while taking Nasya.

Paschat Karma

After Nasya, feet, shoulders, palms and ears need to be rubbed. The head, cheek and neck need to be again exposed to sudation. If feasible snuffing of Rasana churna for Vata Prashamana need to be done. The patient needs to try not to swallow of Nasya Aushadhi. Patient needs to spit out the excessive medication which has come into the throat region. Medicated Dhumapana and Gandusha are recommended to remove the remaining mucus collected in Kantha and Shringataka. 

Pathya - Apathya after Nasya Karma

Pathya: Laghu Ahara, Sukhoshna Jala.

Apathya: Rajo, Dhuma, Sneha, Atopa, Madya, Dravapana, Shirasnana, Atiyana, Krodha, and Dhivaswapana.

Samyaka Yoga, Ayoga and Atiyoga of Nasya Karma [22-25]

Samyaka Yoga: The Lakshana of Samyaka yoga as per Charaka, are Urah-Shiro Laghava, Indriyavishuddhi and Srotovishuddhi. Aditionlly, Sushruta has detailed Sukhaswapna-prabodhana, Chittaindriya-prasannata and Vikaropashama In addition, this appropiate respiration and sneezing have been detailed by Vagbhatta as the general Lakshana of Samyaka yoga. Ayoga: If Nasya is administered in an improper way or the dose is less, the accompanying features appear like Shirogaurava, Galoplepa and Nisthivana. As per Sushruta, Kandu Upadeha, Guruta, Srotasam kapha srava are the Lakshana of Hina shuddhi. Dryness in mouth and nose are too the lakshana of Ayoga. Atiyoga: The common features of extreme Nasya are feeling of Arti and Toda (pricking like pain in the head, eyes, temporal region and ears). Kapha srava, Shirahshula and Indriya vibhrama are the other lakshana of Atiyoga. Mastulunga agama, Vatavriddhi, Indriyavibhrama and Shirah shunyata are too the lakshana of Atiyoga of Shirovirechana.

Mode of Action of Nasya Karma 

In our classics, the mode of activity of Nasya Karma is not referenced directly. As per Charaka Samhita, the drug given through the nose goes into in the Uttamanga and removes the morbid Doshas occupying there. (Ch.Si.2/22).

Flow Chart: Mode of Action of Nasya Karma.

Nasya Phala (Benefits of Nasya Karma)

1. Prasannata of Indriyas
2. Khanata and Prasannata of Twaka, Skanda, Greeva, Greeva, Asya, Vaksha
3. Indriya Vimalata
4. Urdhwajatrugata Vyadhi Shamana
5. Asya Sugandham
6. Snigdha Niswana
7. Prevents Vali, Khalitya, Palitya, Vyanga
8. Bala in Greeva, Trika, Hanu, Shira, Bahu, Uras

The Nasya Karma is broadly described in the our samhitas. It is done by instillation of dravyas through nasal cavity and used either local or systemic diseases of Urdhvajatrugata. All eminent Acharyas described that Nasa is the gateway of Shirah. Thus, Nasal is the gateway of the head region. It is highly beneficial in alleviating a number of diseases pertaining to the head, if it is done properly.  It opens and cleanse the channels of the head region, in this way refining the progression of Prana to the brain, which has a direct effect on the physiological activity of the brain.  The Process of evacuation of morbid doshas from urdhvajatrugata pradesh is performed by Nasya Karma via its Laghu, Ushana and Tikshna gunas of dravyas. It is widely practiced as preventive, promotive and curative purposes. So, a skillful administration of Nasya Karma is highly needed to achieve efficient therapeutic results of Nasya karma.