E-ISSN:2456-3110

Review Article

Paksaghata

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

The Application of Nasya in Paksaghata

Lata S1*, Singh AP2, Tiwari SK3
DOI:10.21760/jaims.9.7.42

1* Suman Lata, Post Graduate Scholar, Department of Panchkarma, Government Ayurvedic College and Hospital, Patna, Bihar, India.

2 Akhilesh Prasad Singh, Associate Professor and Head, Department of Panchkarma, Government Ayurvedic College and Hospital, Patna, Bihar, India.

3 Satyendra Kumar Tiwari, Professor, Department of Panchkarma, Government Ayurvedic College and Hospital, Patna, Bihar, India.

The Vatavyadhis include Pakshaghata is one. That resembles the medical disease known as a stroke in the cerebrovascular area. Ruja, Vakstambha, and other Lakshanas are among them. There are two varieties: Pittanubandha and Kappanubandha. Though Pakshaghata is a Vata Vyadhi and, it is not a Shuddha Vataja condition, according to Charaka's Nanatmaja Vatajavikaras. Susrutha and Madhava Nidana speak of Samsarga of Pitta and Kapha in detail. The fundamental reason of the illness is evident in all of the previously given theories, which link Raktadushti to Vata Prakopa. Cerebrovascular accidents rank third in the world in terms of causes of death, with acute stroke accounting for one out of every ten deaths. Acute stroke symptoms can be mistaken for Pakshaghata, one of the 80 varieties of Nanatmaja Vata Vikaras, because Kevalavata Vyadhis are hard to treat. The patients' physical disabilities persist even after the treatment, demonstrating the global potential of Ayurveda. As Kevalavata Vyadhis are difficult to heal, signs and symptoms of acute stroke can be misinterpreted as Pakshaghata, one of 80 forms of Nanatmaja Vata Vikaras. Ayurveda is demonstrating its global potential as people continue to experience physical disability even after receiving the most recent treatment. Thus, an attempt is made to illustrate the part played by Avapeedana Nasya in the administration of Pakshaghta.

Keywords: Pakshaghta, Hemiplegia, Vatavyadhi, Nanatmaja Vata Vikaras, Avapeedana Nasya

Corresponding Author How to Cite this Article To Browse
Suman Lata, Post Graduate Scholar, Department of Panchkarma, Government Ayurvedic College and Hospital, Patna, Bihar, India.
Email: 		Lata S, Singh AP, Tiwari SK, The Application of Nasya in Paksaghata. J Ayu Int Med Sci. 2024;9(7):271-275.
Available From
https://jaims.in/jaims/article/view/3326

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-19 2024-05-25 2024-06-05 2024-06-15 2024-06-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.72

© 2024by Lata S, Singh AP, Tiwari SKand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2024;9(7)271
Suman Lata et al. The Application of Nasya in Paksaghata

Introduction

Paralysis of one half of the body is the meaning of the term Pakshaghta. The term Aghata, or paralysis, indicates the impairment of Karmendriya, Gyanendriya, and Manas, while Paksha indicates the right or left half of the body. Both Gyanendriya and Karmendriya are seen as components of the Sangnavaha Srotas (sensory system) and Cheshtavaha Srotas (motor system), respectively, with Manas is acting as their controller and guide.

In rural areas, the prevalence of stroke is 1.8%, while in urban areas, it is 9.4%. Every year, 15 million people have strokes worldwide; of those, one third pass away and one third become permanently crippled. When discussing the Chikitsa of Pakshaghta, Acharya Sushruta stated that it should be regarded as Aakshepaka, citing references to Teekshna Avapeedana Nasya has and Teekshna Avapeedana Nasya Dravyas found in Trimarmeeya Adhyaya of Charaka.

Hence, Nasya is the best treatment for preserving Urdhvajatru's health because it is the only Karma that has a position in both the most complex locations, such as Panchakarma, and in straight forward references, like Dinacharya. All Ayurvedic experts and ancient literatures agree that Nasya Karma is the most effective therapy out of all Karmas for Urdhvajatrugata Rogas, especially Nasagata Rogas (Ch. Chi. 30/294; Ch. Si. 9/93; Su. Chi. 40/23).

It is impossible to eradicate the vitiated Doshas, which are found in Nasa Pradesh or Shirah, without Nasya Karma. For the most part, Rogas medicinal oil is utilized in Urdhvajatrugata. The rationale is that it strengthens immunity against both Urdhvajatru and Nasa Pradesh in addition to shielding the nasal mucosa from external objects. The nose is an organ that serves both respiratory and olfactory purposes (B. D. Chaurasiya, Vol. 3/193).

Owing to its close interaction with the outside world, it is subjected to several airborne microbes and contaminants. Today's hectic lives and rising environmental pollutants have made rhinoitis a frequent illness. Meaning and Origin Derived from Nasa Dhatu, which means Gati, comes the word Nasya. The Gati is now oriented toward the head proper, nasal accessories, and nose.

Definitions Here are a few well-known definitions of Nasya from various Ayurvedic classics. According to Sushrut, "Shringataka Marma" refers to Sira Marma that is present in the midst of a Sira's confluence and feeds the tongue, ears, eyes, and nose. One of the Panchakarma prescribed in Ayurveda is Nasya. Nasya Karma is a medical practice in which medications are given through the nose in a particular way to treat various systemic disorders. Since the nose is the entrance to the head, the therapy purifies and opens the channels in the head, enhancing the process of oxygenation (Prana), which directly affects how the brain functions. Since Nasa is referred to as the gateway to the Shira, it is seen as one of the Panchaganandriya, whose functions extend beyond breathing and smell to include acting as a conduit for the introduction of drugs.

Review of Literature

History of Nasaya

Rigveda

While it is highly unlikely that Nasya Karma therapy was in use during the Vedic era, a few Mantras in the Rigveda allude inadvertently to the Karmas that fall under the purview of Panchakarma remedies. The Rigvedic Mantra (Ri.V. 10-16-4) mentions the removal of Roga from the paths of Nasa (Nostrils), Chibuka (Chin), Shira (Head), Karna (Ear), and Rasana (Tongue). Therefore, it stands to reason that any allusions to the removal of sickness from the aforementioned routes most likely allude to either Shirovirechana or Nasa (nose). Yajurveda Krishna. The Upanishada, Satapatha Brahmana, and Krishna Yajurveda all make frequent references to Nasya Karma.

Ramayana

The Valmiki Ramayana contains a reference to the usage of Sanjivani for Nasya Karma. Sushana Vaidhya blew a drug into Lakshmana's comatose state to bring him back to consciousness.

Bauddha Kala

There are certain anecdotes (Jataka stories) from the Buddha period concerning the well-known Vaidya named "Jeevaka." He has used Nasya Karma on multiple occasions, including: 1. He gave the wife of Shreshthi of Sakela Nagar medicine Ghrita as Nasya Karma to heal Shirah Shool. 2.


J Ayu Int Med Sci 2024;9(7)272
Suman Lata et al. The Application of Nasya in Paksaghata

When the Buddha was in pain, Jeevaka administered him Virechana. He administered to him the entire dosage of three Utpala Hasta, Aushadha by Nasya for Virechana.

Vinaya Pitika

According to the book Vinaya-Pitika, one Utpala Hasta of Nasya was used (it was adequate for 10 Virechana).

Ayurvedic classics

The Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya detail Nasyakarma treatment in great detail. The Nasyakarma specification had become so excellent that it was also being employed as a means of altering sex of fetus (Ch. Sha.8/19).

Nasya's classification

Various ancient Acharyas have classed Nasya in different ways. Even while each classification has unique characteristics and is approached from various perspectives, the procedures are essentially all the same in the end. Below are the classifications of Nasya based on various Acharyas.Nasya's classification by Charaka based on the administration technique (Cha.Si.9/89-92) Pratimarsha, Nasya, Navana, Aavapidana, Dhmapana, Dhuma, Snehana, Shodhana, Shodhana, Stambhana, Virechana, Snehana, Prayogika, Vairechanika, Sneihika.

An appropriate moment to give Nasya

Acharya Charaka states that Nasya should normally be given in Pravrit, Sharada, and Vasanta Rutu. Nasya can, however, be administered in any season in an emergency by creating fake conditions for the previously stated seasons; for instance, it should be administered in cold locations during the summer and in hot places during the winter. In classics, suitable time schedule for Nasya is mentioned as below According to seasons (Ch.Si.2/23) Vagbhatta Grishma + Varsha - Evening.

According to Doshaja - Kaphaja Vikara – Morning, Pittaja Vikara - Noon (Su.Chi.40/24), Vataja Vikara - Evening.

According to Sushruta (Su.Chi.40/24). In normal condition - Empty stomach (at the time of meal). Vataja Shiroroga, Hikka, Apatanaka, Manyastambha, Swarabhramsha, (Vagbhata) Daily morning and evening.

According to certain diseases (A.H.20/16) (Sha.Utt.8/3) Lalasrava, Supti, Pralapa, Putimukha; Ardita; Karnanadi, Trishna, Shiroroga, excessive vitiated Doshas (Sha.) Can be administered in night also. According to Panchkarma Schedule (A.S.) As a part of complete Panchkarma. After Basti Karma.

Classical Schedule of Nasya Karma

Charaka

The length of the Nasya therapy has not been specified by Charaka; instead, it is suggested to be administered based on the severity of the ailment. An overview of the Nasya Karma schedule is provided below:

SNName of AcharyaDurations (Days)
1.Vagbhata3,5,7,8
2.Bhoja9
3.SushrutaInterval of 1, 2,7,21
4.CharakaAccording to disease

Dose of Nasya Drugs

The dose of Nasya drugs depends upon the drug utilized for it and the variety of the therapy as well as Aturabala & Doshabala (Su.Chi.40/28,36).

Acharya Charaka has not mentioned the dose of the Nasya drugs. Sushruta and Vagbhata have described the dose inform of Bindus (Drops).

Classically, one Bindu means the drop, which is formed after dipping the two phalanges of Pradeshini (Index) finger. (A.H.Su.20/9).

The dose of Nasya drugs according to different types of Nasya can be summarized as under.

Type of Nasya drops in each nostril

Hrasva Matra, Madhyama Matra, Uttama Matra

1.Shamana Nasya8, 16, 32
2.Shodhana Nasya (Su.Chi. 40)4, 6, 8
3.Marsha Nasya (A.H.Su.27/9)6, 8, 10
4.Avapida Nasya (Su.Chi.40)2, 2, 2
5.Pratamarsha Nasya (Cha.Si.9/117)2, 2, 2
6.Sneha Nasya (Su.Chi.40)8, 32, 64

Drugs

Medications according to Charaka in Avapeedana Nasya Dravyas, the medications administered for Avapeedana Nasya were Tulasi, Shunti, Maricha, Pippali (Trikatu), Yastimadhu, and Dugdha.


J Ayu Int Med Sci 2024;9(7)273
Suman Lata et al. The Application of Nasya in Paksaghata

Mechanism of Nasya through Modern Anatomical and Physiological Studies

1. Neurological Pathway: Drug-induced olfactory stimulation comes first. Bipolar olfactory receptor axons pass through ethamoid bone's cribriform plate and enter olfactory bulb. Axons and mitral cell dendrites synapses in this location. Mitral cell axons exit olfactory bulb and form olfactory tract. Olfactory tract now enters brain and splits into two paths.
2. Brain's medial olfactory region is made up of a collection of nuclei situated in midbrain, right in front of hypothalamus. The most noticeable are septal nuclei. Olfactory bulb, hippocampus, amygdala, hypothalamus, habenula, thalamus, cingulate gyrus, and midbrain all provide connections to it.
3. Brain's lateral olfactory region, which is primarily made up of prepyriform and pyriform cortex. Additionally, amygdoloid nucleus' cortical region.

Functions

Hippocampus: Long-term memory and emotional center.

Amygdala: Involved in scent, it gets information from cortex and olfactory bulb. Particularly, bed nuclei (BNST) of Stria terminalis serve as a conduit for communication between amygdale and hypothalamus as well as hypothalamus and pituitary gland. It is a part of limbic system responsible for emotions and motivation.

Hypothalamus: through pituitary gland, it connects neurological and endocrine systems. The sympathetic and parasympathetic brain stem and spinal cord nuclei are reached via axons of hypothalamus. Therefore, ANS is in charge of controlling heart rate, body temperature, and water balance, as well as uterine contractility, GIT, and food patterns.

Habenular nuclei: primarily connected to smell.

Thalamus: perception, sleep, and awareness.

The Cingulated Gyrus is a limbic system region that is involved in emotion processing, memory, learning, and processing.

Midbrain: Arousal (alertness), sleep/awake, hearing, vision, and motor control Thus, above-mentioned brain regions and functions are indirectly stimulated by olfactory stimulation.

The Vascular Route The septum's Kiesselbach's plexus, also known as the Littles region, empties directly into the facial vein in the front and the pterigoid plexus in the back. Additionally, the facial veins drain directly into the jugular vein and have strong links to the cavernous sinus, pterygoid plexus, supraorbital and superior ophthalmic veins, and these veins.

Drug Diffusion: The nasal mucosa's cell wall is more receptive to passive absorption of lipid-soluble compounds. Large lipid materials are found in the cilia and body of olfactory cells, which is why lipid-soluble substances significantly stimulate olfactory cells. Non-polar hydrophobic molecules enter and exit cells through the lipid layer of the plasma membrane. Oxygen, carbon dioxide, nitrogen gases, fatty acids, steroids, and fat-soluble vitamins are examples of such molecules.

Drug Transfer Through the Brain-Blood Barrier: Drugs cannot ordinarily enter the brain from the blood circulation due to the blood-brain barrier's near total impermeability to passive diffusion. Nonetheless, medication transfer via the olfactory nerve can directly reach the brain and avoid the BBB. It is believed that smell travels into the brain through two different routes: either slowly via olfactory nerve cells inside the olfactory bulb, or more quickly via the perineural space surrounding the olfactory nerve cells in the CSF surrounding the olfactory bulb and brain.

The value of massage after Nasya following a Nasya massage, advised by traditional healers is just as crucial as a massage prior to Nasya. The frontal, temporal, maxillary, mastoid, and neck (Manya) regions should be massaged following Nasya, according to the literature.

A gentle massage in the aforementioned areas may assist reduce the somatic tightness caused by heat stimulation and aid in clearing the slush that has formed there. Sushruta states that Manya is a Marma that exists in the neck on either side of the trachea (Su.Sha.6/29), which most likely corresponds to the neck's carotid sinus on the common carotid artery's bifurcation.

This region contains the baroreceptor receptors, which can be manipulated to potentially lower cerebral artery pressure. It is also discovered that applying pressure to the baroreceptors restores the abnormal cerebral arterial pressure.


J Ayu Int Med Sci 2024;9(7)274
Suman Lata et al. The Application of Nasya in Paksaghata

Based on the previous explanation, we may conclude that the Nasya Karma methods, postures, and conducts are crucial for drug absorption and transportation.

Discussion

The patients' traditional protocols were not followed when giving Nasya to because the condition was an emergency and the patients would not cooperate. Every time new Nasya Dravya is produced and administered, it is done flawlessly. The maximum duration for administering Nasya Dravya was 21 days, with repeat administrations occurring after a 15-day interval and as needed. When a patient is having another Shodhana procedure, Nasya is not given. There were no noted problems during the administration. Nasya Dravyas are affordable and easily accessible for patients. The impact of the Nasya was noted on the sensory system in the greatest number of patients on the third day. As well as how the Nasya persisted, their impact on motor functions was observed. Avapeedana Nasya in conjunction with contemporary medicine proved to be more efficacious than modern treatment by it.

Conclusion

In the present day, Pakshaghata is a concerning illness. The fundamental characteristic of Pakshaghta is the presence of Karma Kshaya, Balakshaya, Vaksangha, Manasikachesta Hani, Santapa, Tandra, and Alasya in one half of the body. Avapeedana Nasya is one of the Ashulabhakari Upayas mentioned by Acharya Sushruta and Charaka for the aforementioned condition. We have seen that doing Avapeedana Nasya in folkloric practices yields noteworthy outcomes. Avapeedana Nasya is an affordable and simple medication to use. Ushna Teeksha, one of the Dravyas utilized in Avapeedana Nasya, aids in the relief of obstruction and Yastimadhu acts as Vruna Ropaka thereby reducing the symptoms. Every single one of the six patients responded favorably to the Nasya.

References

1. Vaidya Harishchandra singh kushawaha edited, Charaka samhita, chikitsa sthana, 28/53-54,1stedition 2009, Published by Chaukamba sanskrit sansthana. Varanasi. Page no. 740.

2. http;//www.strokeforum.com./stroke–backround/epidemiology.html

3. Kaviraja Ambikadutta shastri edited, Sushruta samhita chikitsa sthana, 5/18, Volume 1, reprint 2012, Published by Chaukamba Sanskrit sansthana. Varanasi. Page no. 32.

4. Vaidya Harishchandra singh kushawaha edited, Charaka samhita, chikitsa sthana, 26/152,1st edition 2009, Published by Chaukamba sanskrit sansthana. Varanasi. Page no. 699.

5. L.N. Sastry edited, Dravayaguna vijnana, volume –2, reprint edition 2010, Published by Chaukamba orientalia, Varanasi. Page no. 871.

6. L.N.Sastry edited, Dravayaguna vijnana, volume-2, reprint edition 2010,Published by Chaukamba orientalia, Varanasi. Page no. 448.

7. 7. L.N.Sastry edited, Dravayaguna vijnana, volume-2, reprint edition 2010,Published by Chaukamba orientalia, Varanasi. Page no. 452.

8. L.N.Sastry edited, Dravayaguna vijnana, volume –2, reprint edition 2010, Published by Chaukamba orientalia, Varanasi. Page no. 152.

9. L.N.Sastry edited, Dravayaguna vijnana, volume-2, reprint edition 2010,Published by Chaukamba orientalia, Varanasi. Page no. 430.

10. Shah,Vanclay, F.cooper,V. (1989) Improving the sensitivity of Barthel index for stroke rehabilitation, Journal of clinical epidemiology, page no 42,703-709


J Ayu Int Med Sci 2024;9(7)275