|Year : 2017 | Volume
| Issue : 3 | Page : 335-339
Clinical evaluation of Nasya Karma in cervical spondylosis: Case series
Sangeeta R Tanwar1, Anup B Thakar1, Rajkala Ramteke2
1 Department of Panchakarma, IPGT and RA, GAU, Jamnagar, Gujarat, India
2 Department of Central Ayurveda Research Institute for Cardiovascular Diseases, New Delhi, India
|Date of Web Publication||5-Sep-2017|
Sangeeta R Tanwar
Department of Panchakarma, IPGt and RA, GAU, Jamnagar, Gujarat
Source of Support: None, Conflict of Interest: None
Introduction: Cervical spondylosis is one of the most common degenerative, neurological conditions of the cervical spine by which a major part of population is affected. In today's mobile era, for higher achievements and ambitions, man is moving faster to Mars life and is more prone to degenerative disorders. Apart from age, other risk factors for cervical spondylosis include occupations that may cause more stress on neck, certain neck injuries, incorrect posture while sitting or walking, smoking, sedentary lifestyle and genetic factors. Modern therapies such as analgesics, muscle relaxants, steroids, physiotherapies, and even operative procedures are not fulfilling the patients' goal of healthy life.
Materials and Methods: In Ayurveda, Degenerative disorders come under the broad umbrella of Vata Vyadhi and Nasya (Nasal Medication) is specifically indicated in Urdhvajatrugata Vikaras. Keeping this view and the increasing incidence of the disease in modern society, a study was conducted on five clinically diagnosed cases of cervical spondylosis, selected from Outpatient / Inpatient departments of Panchakarma Department. The patients were treated with Anu taila Nasya for first 3 days followed by Avartita Kshirabala Taila Nasya for the next 4 days.
Results: Satisfactory relief was seen in symptoms with improved quality of life after treatment and follow up.
Conclusion: Nasya Karma can be considered as an effective management of cervical spondylosis
Keywords: Cervical spondylosis, lifestyle disorders, Nasya, Panchakarma, Urdhvajatrugata Vikara, Vata Vyadhi
|How to cite this article:|
Tanwar SR, Thakar AB, Ramteke R. Clinical evaluation of Nasya Karma in cervical spondylosis: Case series. Indian J Health Sci Biomed Res 2017;10:335-9
|How to cite this URL:|
Tanwar SR, Thakar AB, Ramteke R. Clinical evaluation of Nasya Karma in cervical spondylosis: Case series. Indian J Health Sci Biomed Res [serial online] 2017 [cited 2019 Aug 24];10:335-9. Available from: http://www.ijournalhs.org/text.asp?2017/10/3/335/213990
| Introduction|| |
Cervical spondylosis is a degenerative condition of the cervical spine. There is degeneration of the intervertebral disc with its protrusion and bony overgrowth of adjacent vertebrae, causing narrowing of the cervical canal and intervertebral foramina with resultant compression of nerve roots, cords, or both. It is one of the most common degenerative, neurological condition by which the major population has been affected., Apart from age, occupational overstress on neck region, traumatic blunt or sharp injury, improper sitting posture, excessive smoking, sedentary lifestyle, and genetic factors may induce the occurrence of cervical spondylosis.
In Ayurvedic context, the disease cannot be correlated exactly as whole with any single disease or condition, but some features of the cervical spondylosis can be correlated nowadays with various conditions described in Ayurveda such as Griva Hundana, Manyastambha, Sandhi Gata Vata,  and Asthigata Vata.
Nasya is mainly indicated in the management of Urdhvajatrugata Vikaras in classics. Acharya Charaka has indicated Nasya therapy exclusively for the management of Manyastambha. Furthermore, it is stated that symptoms such as Gaurava ( Heaviness ), Supti (Numbness), Stambha (Stiffness), and Shirashula (Headache) should be treated with Shirovirechana type of Nasya Karma with appropriate drug to demolish the pathology.
Cardinal features like pain and stiffness denote involvement of Kapha and Vata Dosha in the disease phenomenon. As per the treatment protocol mentioned in Samhitas and based on clinical experiences, to get better effect, Shodhana therapy followed by Shamana therapy is taken as protocol for the present case series, i.e., “ Nasya with Anu Taila-followed by Brimhana Nasya with Kshirabala Taila.”
Five clinically diagnosed cases of cervical spondylosis were enrolled for this study and successfully treated by designed protocol. After completion of treatment course and follow-up of 1 week, all the five patients were assessed on the basis of subjective and objective parameters and encouraging results were found in reliving clinical sign and symptoms with improved quality of life.
Aim and objective
- To evaluate the efficacy of Nasya Karma in cervical spondylosis without the support of any oral medication.
| Materials and Methods|| |
- Five clinically diagnosed cases of cervical spondylosis (Irrespective of age and sex)
- Anu Taila
- 101 Avartita Kshirabala Taila
- Bala Taila
- Hot water pot
- Cotton swab
- Kidney tray/spitting vessel
A 30-year-old male patient was suffering from pain in the back of the neck with gradual onset which was radiating to bilateral shoulder joints and to the right arm up to hand since 3 years. Daily severe headache and occasionally, giddiness were also reported by the patient with the same duration of time. He was having a history of improper posture while sitting and sleeping. The aggravating factors were evening time and table work while some oil massage and hot fomentation were relieving factors in this case. On investigations, X-ray revealed normal study. He was diagnosed on clinical basis. No significant history or any addiction was reported by the patient.
A male patient aged 62 years, developed pain and stiffness at the cervical region gradually along with numbness and tingling sensation in both the hands for 1½ year. Painful cervical movements were also reported by the patient since the past 1 year. Pain was usually aggravating by lifting heavy weight objects, at evening time and was subsiding by rest. On investigations, X-ray of cervical spine revealed anterior and posterior osteophytes at the level of C5-C6, C6-C7, and decreased intervertebral disc space at C5-C6 and C6-C7 level.
A female patient, aged 32 years, presented with the chief complaints of pain in the back of the neck along with radiation in bilateral shoulder region(R>>L), right arm (sometimes bilateral) and occipital region since the past 5 years. The onset was sudden due to jerky movement while carrying heavy weight (Bucket full of water). Numbness and tingling sensation in bilateral hands, stiffness at the cervical region, limited range of motion at cervical spine and occasionally, giddiness were also present in this case since last 4 years. The pain was usually aggravating in the morning, after lifting heavy objects and reading even for 15–20 min and relieving by some hot fomentation and cervical exercises. MRI of Cervical Spine revealed posterior disc bulging at C3-C4, C4-C5, and C5-C6 levels without compressive elements with loss of lordosis.
A 60-year-old male patient was suffering with the complaints of gradual onset of pain at cervical region followed by radiating pain to bilateral shoulder joints, arms, forearms for 2 months. He was having painful cervical movements and restricted movements at bilateral shoulder joints, even not able to raise both arms above shoulder level due to severe pain. He also admitted history of occasional giddiness, numbness and tingling sensation in bilateral hands with the same duration of time. Pain was usually aggravating by movement attempted at cervical spine, elbow and shoulder joints and also on holding the objects firmly but there was no history of problem in gripping of objects, and it was subsiding by some oil massage and hot fomentation. X-ray cervical spine revealed marginal osteophytes at C5-C6 and C6-C7 levels.
A 62-year-old male patient presented with the complaints of gradual onset of pain and stiffness at the cervical region radiating to bilateral shoulder region since the past 3 years. He was also having occipital headache, giddiness (occasionally) and numbness and tingling sensation in bilateral arms up to hands with the same duration of time. Sleeplessness due to pain and stiffness and painful cervical movements since last 2 years were also reported by the patient. Night time, Pushing table or some other heavy object and also lifting some weight-bearing objects were the aggravating factors and only after intake of some analgesics and anti-inflammatory drugs, he used to get some relief in pain and stiffness. X-ray cervical spine revealed minimal degenerative changes in lower cervical vertebra.
All the routine hematological, biochemical investigations such as complete blood count, blood sugar level, liver function test, renal function test, and urine investigations were carried out in all the patients to rule out any possible associated disorder, but they were found within normal limits.
- Subjective criteria
Clinical symptoms of cervical spondylosis were assessed on the basis of grading of each symptom such as pain, stiffness, giddiness, numbness, tingling sensation, and headache
- Objective criteria
Following scales were used for the assessment of objective parameters:
- Visual analog scale (VAS)
- Neck disability index (NDI)
- Range of movement.
Intervention: Nasya Karma
- Local Abhyanga
Face and neck of the patient were anointed with lukewarm Bala Taila and then massaged by specific maneuvers like linear thumb movements over Forehead, Nose, Chin, and Maxillary area and circular movements of palm over Cheek and Temporal.
- Mridu Sweda
The towel was soaked in boiling water and after squeezing the water, towel was waved, touched, and pressed on the face and neck.
- Positioning of the patient
Supine position (Uttanasya Shyanasya) by bending the head for about 45°(Pralambita Shirsah Kinchit).
- Administration of medicine
- Lukewarm oil was poured with instrument “ Gokarna” in each nostril one by one by closing the other nostril and patient was asked to sniff the medicine so that it reaches deep inside the nose
- Duration-7 days (Anutaila for first 3 days + 101 Avartita Kshirabala Tail for next 4 days)
- Dose-6 drops (1 drop-0.05 ml) in each nostril.
- The patient was asked to spit out medicine that reaches the throat in beside kidney tray/spitting vessel
- Kavala (Gargling) with lukewarm water was advised just after the procedure.
| Observations and Results|| |
After completion of treatment, relief in numbness (75%), pain (73.68%), stiffness (66.67%), giddiness (60%), tingling sensation (50%), and headache (18%) was noticed [Table 1]. VAS and NDI were reduced by 76.92% and 75.45%, respectively [Table 2]. The range of movements were also improved considerably, namely, complete relief in neck flexion and lateral rotation was found along with 90% improvement in right lateral flexion, 88.89% in left lateral flexion, and 60% in extension [Table 2].
| Discussion|| |
Cervical spondylosis is a degenerative disorder, and all such disorders can be considered under the broad umbrella of Vata Vyadhi. As per classics Vata Prakopa, occurs by two types of Samprapties, i.e., Margasyaavaranajanya and Dhatukshayajanya. Pain and stiffness are the primary symptoms of the disease which reflect the association of Kapha along with Vata. On the other hand, as Urdhwanga is concerned, the involvement of Kapha is defined by Acharyas.
Acharya Charaka has used the term, “Nastah Pracchardana” for Nasya, which denotes Shodhana done by Nasya. It is the best method to eliminate and alleviate the vitiated Doshas of Urdhvanga. Taila has been mentioned fo r Nasya Karma in Kapha-Vata Dosha Pradhana condition. The best treatment modality for any kind of disorder is Shodhana therapy followed by Shamana Therapy. Hence, this treatment protocol was adopted here.
Majority of the ingredients of Anu Taila possess Laghu-Teekshana guna, Ushna veerya, and Katu vipaka which facilitate Srotoshodhaka (cleansing) effect of Anu Taila and due to Sukshma Srotogami (rapidly penetrating into microchannels) property, it is imbibed at the cellular level by entering microcirculation and causing profuse secretions by irritating the nasal mucosa. Hence, it mobilizes the Kaphadi Doshas and then expels them out from the nearest outlet and simultaneously strengthens the indriyas. Thereby, it removes the Avarana caused by Kapha Dosha over Vata.
After the pacification of Kapha dosha by Anu Taila Nasya, the disease remains Keval Vatika for which Brimhana type of Nasya with Kshirabala Taila was used. In Sahasrayogam, it is said to pacify all the eighty Nanatmaja Vata Vyadhies. Acharya Charaka and Vagbhatta have also mentioned the same preparation, but with different names, i.e., Shatapaka or Sahasrapaka Bala Taila and its effects as best Vatashamaka, Jeevanam, and Brimhana have been described there. The Sneha used as Nasya reaches the Srotasas and imparts tone to the nerves and muscles of the neck, shoulders, and chest.
Cervical spondylosis involves the inflammatory pathology of the cervical spine; the anti-inflammatory effect of Kshirabala Taila marks its importance as a Nasya dravya in such cases. Studies reported the anti-inflammatory effect of Kshira Bala Taila, which was comparatively more in Mridu and Madhyama paka and was equally effective as Diclofenac and NSAIDS.
Aggravation of Doshas takes place in Shirah (Head) due to irritating effect of administered drug, which results in an increased blood circulation to the brain due to vasodilator effect of histamine released in response to irritation caused by the Nasya drug. The facial vein has a direct connection to the ophthalmic vein and then to deep venous sinus within the cranial cavity the cavernous sinus. Facial vein does not possess any valve in its course, and the cavernous plexus stands for arteriovenous communication of the nasal cavity. Therefore, there is the possibility of reverse circulation of Nasya Dravya, reached to the brain circulation after being absorbed by highly vascular mucous membrane of nasal cavity. Hence, accumulated morbid Doshas are expelled out from small blood vessels and ultimately they are eliminated through the nasal discharge and by salivation. Moreover, pre- and post-procedure massage and fomentation at supraclavicular and posterior part of neck help to improve the local circulation, enhancing the absorption of the drug and also relieves local stiffness.
| Conclusion|| |
Cervical spondylosis is a Kapha-Vata dominant condition, Nasya with Anu Taila pacifying Kapha by profuse secretions followed by Avartita Kshirabala Taila pacifying Vata Dosha through Brimhana is proved effective in its management. Hence, Nasya can be considered as an effective management of cervical spondylosis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Singhal BS. Neurology. In: Sainani GS, editor. API Textbook of Medicine. 6th
ed., Sec. 12. Mumbai: Association of Physicians of India; 1999. p. 28, 829.
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Back pain & neck pain. Harisons Principles of Internal Medicine. Pain. 16th
ed., Vol. 1, Ch. 15, Sec. 1. New Delhi: McGraw- Hill Medical Publishing Division; 2005. p. 102.
Sainani GS, editor. Osteoarthritis. API Textbook of Medicine. AN Chandrasekaran. Rheumatology. Osteoarthritis. 9th
ed., Vol. 2, Ch. 4, Sec. 24. Mumbai: Association of Physicians of India; 2012. p. 1819-20.
Acharya JT, editor. Vatavyadhi chikitsa. Charaka Samhita of Charaka, Chikitsa Sthana. Reprint 2011. Ch. 28, Ver. 22. Varanasi: Chaukhambha Orientalia; 2011. p. 617.
Acharya JT, editor. Vatavyadhi nidana. Sushruta Samhita of Sushruta, Nidana Sthana. Reprint 2014. Ch. 1, Ver. 67. Varanasi: Chaukhambha Orientalia; 2014. p. 267.
Acharya JT, editor. Vatavyadhi chikitsa. Charaka Samhita of Charaka, Chikitsa Sthana. Reprint 2011. Ch. 28, Ver. 37. Varanasi: Chaukhambha Orientalia; 2011. p. 618.
Acharya JT, editor. Vatavyadhi chikitsa. Charaka Samhita of Charaka, Chikitsa Sthana. Reprint 2011. Ch. 28, Ver. 33. Varanasi: Chaukhambha Orientalia; 2011. p. 617.
Paradakara HS, editor. Ashtang Hridaya of Vagbhatta, Sutra Sthana, Nasyavidhimadhyaya. Reprint 2014. Ch. 20, Ver. 1. Varanasi: Chaukhamba Sanskrit Sansthana; 2014. p. 287.
Acharya JT, editor. Matrashitiya adhyaya. Charaka Samhita of Charaka, Sutra Sthana. Reprint 2011. Ch. 5, Ver. 59. Varanasi: Chaukhambha Orientalia; 2011. p. 41.
Dwivedy RN, editor. Tripathi I, Commentator, Chakradatta of Chakrapanidatta, Nasyadhikara. Reprint 2014. Ch. 74, Ver. 14. Varanasi: Chaukhambha Sanskrit Bhavan; 2014. p. 457.
Acharya JT, editor. Matrashitiya adhyaya. Charaka Samhita of Charaka, Sutra Sthana. Reprint 2011. Ch. 5, Ver. 63-70. Varanasi: Chaukhambha Orientalia; 2011. p. 41-2.
Prabhakara RG. Sahasrayogam Sanskrit Text with English Translation and Prabhakara Vyakhyanam. Taila Yoga Prakaranam, 123. 1st
ed., Ch. 18. New Delhi: Chaukhambha Sanskrit Sansthan; 2016. p. 559.
Acharya JT, editor. Trimarmiya adhyaya. Charaka Samhita of Charaka, Siddhi Sthana. Reprint 2011. Ch. 9, Ver. 99-100. Varanasi: Chaukhambha Orientalia; 2011. p. 723.
Yogeshwar RC, Chandaliya SS, Sane VN, Jadhav M. Standardization of Bindu for Nasya. Int J Adv Res 2016;4:895-901.
Acharya JT, editor. Vatavyadhi chikitsa. Charaka Samhita of Charaka, Chikitsa Sthana. Reprint 2011. Ch. 28, Ver. 59. Varanasi: Chaukhambha Orientalia; 2011. p. 619.
Acharya JT, editor. Dirghamjivitiya adhyaya. Charaka Samhita of Charaka, Sutra Sthana. Reprint 2011. Ch. 1, Ver. 85. Varanasi: Chaukhambha Orientalia; 2011. p. 21.
Acharya JT, editor. Dhumnasyakavalagrah chikitsa. Sushruta Samhita of Sushruta, Chikitsa Sthana. Reprint 2014. Ch. 40, Ver. 56. Varanasi: Chaukhambha Orientalia; 2014. p. 559.
Acharya JT, editor. Vyadhitarupiyavimana adhyaya. Charaka Samhita of Charaka, Vimana Sthana. Reprint 2011. Ch. 7, Ver. 30. Varanasi: Chaukhambha Orientalia; 2011. p. 261.
Jitesh T, Amit J. Management of Vataja Pratishyaya in children as per Ayurveda: A review. Eur J Biomed Pharm Sci 2016;3:134-6.
Acharya JT, editor. Matrashitiya adhyaya. Charaka Samhita of Charaka, Sutra Sthana. Reprint 2011. Ch. 5, Ver. 70. Varanasi: Chaukhambha Orientalia; 2011. p. 42.
Rao GP. Sahasrayogam Sanskrit Text with English Translation and Prabhakara Vyakhyanam. Taila Yoga Prakaranam 123. 1st
ed., Ch. 18. New Delhi: Chaukhambha Sanskrit Sansthan; 2016. p. 559.
Acharya JT, editor. Vatashonita chikitsa. Charaka Samhita of Charaka, Chikitsa Sthana. Reprint 2011. Ch. 29, Ver. 119-120. Varanasi: Chaukhambha Orientalia; 2011. p. 632.
Acharya JT, editor. Dhumnasyakavalgrah chikitsa. Sushruta Samhita of Sushruta, Chikitsa Sthana. Reprint 2014. Ch. 40, Ver. 22. Varanasi: Chaukhambha Orientalia; 2014. p. 555.
Nair CG, Geethesh RR, Honwad S, Mundugaru R. A comparative study on the anti-inflammatory effects of trividha paka of Ksheerabala taila. Int J Res Ayurveda Pharm 2015;6:692-5.
Guyton Arthur C. Local control of blood flow by the tissues and hormonal regulation. Textbook of Medical Physiology. 8th
ed., Ch. 17. Bangalore: PRISM Books Pvt. Ltd., W.B. Saunders Company; 1991. p. 192.
Kantikar P. Mechanism of Nasya. Mechanism of Panchakarma and its module of investigation. 1st
ed., Ch. 6, Part 1. Delhi: Chaukhamba Sanskrit Pratishthan; 2013. p. 115.
[Table 1], [Table 2]