Nasya (नस्यम्)

Nasya means instillation of medicine through nostrils or Errhine therapy. It is one of the popular panchakarma treatments for management of diseases pertaining to head-neck region. There is instillation of medicated oil, liquid or churna (powder) in nostrils through a controlled procedure which expels the doshas situated in head-neck region through nasal pathway. Even though it is a prime treatment modality in diseases pertaining to neck and above organs and kapha doshas mainly, there are broad spectrum advantages of this therapy including preventive aspect. Nasya karma is one of the important routines in dinacharya (दिनचर्या daily regimen).

निरुक्तिः ॥ Nirukti

नासिकायै हितं तत्र भवो वा यत् नसादेशः । १ नासिकाभवे २ तद्धिते च ३ सुश्रुतोक्ते नासिकाहिते क्रियाभेदे ॥ (Vach.)

Nasa or Nasika is the samskrit term for the organ Nose. Thus meaning of the term Nasya can be understood with the help of word Nasa or nasika. According to Vachspatyam, Nasya means,

• The one that is beneficial for Nasa/Nasika
• The one that originates in Nasa/Nasika

Nasya therapy in Ayurveda is beneficial for and administered in Nasa/Nasika thus called Nasya.

परिभाषा ॥ Definition

Ayurveda Samhitas have defined the term Nasya used in Ayurveda as below,

• औषधमौषधसिद्धो वा स्नेहो नासिकाभ्यां दीयत इति नस्यम् | (Sush. Samh. 40.21)

A therapy wherein medicated oil is instilled through nostrils is nasya karma.

• नासायां प्रणीयमानमोउषधं नस्यम्| (Asht. Sang. 29.3)

Administration of medicated oil through nasal pathway is nasya karma.

This process eliminates the morbid doshas through nasal route.

नस्यलाभाः॥ Benefits of Nasya therapy

Acharya Sushruta has described the benefits of preventive and therapeutic Nasya karma as below,

नस्येन रोगाः शाम्यन्ति नराणामूर्ध्वजत्रुजाः | इन्द्रियाणां च वैमल्यं कुर्यादास्यं सुगन्धि च ॥ हनुदन्तशिरोग्रीवात्रिकबाहूरसां बलम् | वलीपलितखालित्यव्यङ्गानां चाप्यसम्भवम् |॥ (Sush. Samh. 40.54-55)

Nasya therapy helps

• To alleviate the head-neck diseases
• Refreshes and energizes all the sensory faculties
• To refresh the mouth /oral cavity
• Strenghthens JAw, teeth, head, neck. shoulders and arms
• Daily nasyam included under Dinacharya helps to prevent skin wrinkles, greying of hair, baldness and blemishes or discoloration on face

नस्यभेदाः ॥ Classification

Nasya karma being a part of panchakarma therapy it performs shodhana (purification) type of chikitsa karma, also does shamana (pacification) of doshas. There are few types of nasya karma which are classified based on their action modality, form of the medicine administered etc.

1.   Navana nasya (नावन नस्यम्)– In this, Sneha i.e some type of oil or ghee or milk is used as medicine for nasal instillation depending upon the pathology.

2.   Shodhana nasya (शोधन नस्यम्) – This type of nasya is given specifically to facilitate expulsion of morbid doshas situated in head-neck region. Since the doshas have to be removed or drained, the ingredients selected for this type of nasya include specific herbs that have potential to perform shodhana (purification or detox) activity. The quantity of the drug is also speicific.

3.   Avapeedana nasya (अवपीडन नस्यम्) – The juice of fresh herbs is extracted and instilled according to vitiated doshas in avapeedana type of nasya.

4.   Pradhamana nasya (प्रधमन नस्यम्)- A very fine churna or powder of drugs is used as nasya medication in pradhamana nasya.

5.   Dhuma nasya (धूम नस्यम्) – In this type of a nasya, medicated smoke (smoke emerging from burning of herbal mixture) is inhaled through nose.

6.   Marsha-pratimarsha nasya (मर्श-प्रतिमर्श नस्यम्)– These are the 2 different types of the nasya based on the quantity of the drug used for nasal instillation. In Marsha the quantity is large, varies upon the multiple factors and in Pratimarsha the quantity is small and mostly fixed or limited to 1-2 drops only.

नस्यकर्म अर्हाः तथा अनर्हाः ॥ General indications and contraindications of nasya karma

Following are the conditions wherein nasya can be done under the proper guidance of a Vaidya.

नस्यकर्म अर्हाः ॥ Who are Fit for Nasya karma?

Arha means eligible. Like every Panchakarma, for Nasya therapy also eligibility, indications are clearly mentioned in Ayurveda literature. A vaidya assesses the patient on the basis of these along with other factors and only then advices Nasya therapy if suitable. Those who are suffering from any of the following disorders can be benefited from Nasya,

1. Shirosthamba (stiffness of head)
2. Dantasthamba (stiffnes in teeth)
3. Manyasthamba (neck stiffness)
4. Hanugraha (lockjaw/ jaw stiffness)
5. Peenasa (rhinitis/ common cold)
6. Galashundika (tonsilitis)
7. Timira (eye condition)
8. Vartma roga (disorders of eyelid)
9. Akshi roga(eye diseases)
10. Nasa roga (diseases pertaining with nose)
11. Ardhavabhedaka (migraine)
12. Ardita (facial palsy)
13. Shiro roga (diseases of head regien/ neurological conditions)
14. Apatanaka (convulsions)
15. Vak graha (speech disorders)
16. Swara bheda (hoarseness of voice)
17. Arbuda (tumours) Etc

नस्यकर्म अनर्हाः ॥ Who are Unfit for Nasya karma?

There are certain conditions where Nasya therapy is contraindicated. If Nasyam is given in these conditions without proper assessment then it could cause more harm than good to the patient. Thus Nasya should be avoided in following conditions,

1. Ajeerna (indigestion)
2. Bhuktabhakta (just after having food)
3. Peetasneha (the one who has ingested heavy amount of fatty substance)
4. Madyapana (alcoholic)
5. Snatshira (taken head bath)
6. Trishnaarta (thirsty)
7. Shramarta (exhausted)
8. Murchhita (unconscious)
9. Garbhini (pregnant lady)
10. Anuvasita (who has taken anuvasana basti)
11. Anrutu (unseasonal)
12. Durdine (cloudy weather) etc

नस्यार्थे समुचितः कालः ॥ Ideal time for Nasya therapy

Nasya therapy is indicated only in pravrut (प्रावृट् early or beggining of rainy season), sharad (शरद) and vasant (वसंत) rtu in classics, but nasya can be administered at certain other timings considering the requirements of patient. In summer season, it should be instilled in morning, in winter during noon time and in rainy season nasya is administered when sky is devoid of clouds.

नस्य कर्मम् ॥ Procedure

Nasya therapy which is done to treat certain medical conditions is performed in a specific manner. There are some pre and post procedure activities which are called as Purva and Pashchat karma respectively.

पुर्व कर्मम् ॥ Purva karma (Pre-procedure)

Every purva karma or pre procedure although being very basic in nature plays an important role in deciding the final outcome and success of the therapy.

Examination of patient – a Vaidya decides whether the patient is fit or unfit for nasya karma. Assessment of patient – Patient or individual is assessed based on various parameters like, Dashavidha pareeksha (दशविध परीक्षा) or 10-fold examination which includes assessment of prakrti (प्रकृतिः) of patient, aggravated doshas, balam (बलम् strength), Kala (time of the year and climate), age and many other aspects. Ashtavidha pareeksha (अष्टविध परीक्षा) or 8-fold examination which includes nadi (pulse), bowel, bladder movements etc. Few biochemical tests would be conducted if and when necessary.

Patient is well informed about the procedure in advance and is expected to have a good night’s sleep, clear bowel movements. Patient or individual must be in a positive and calm mood for ease of the overall procedure. Once Nasya therapy is finalized and patient given consent, other preparations are started.

Collection of materials –Before nasya karma, equipment and materials required for the therapy are kept ready. Nasya oil or churna etc, medicines for complications for emergency use etc are kept ready beforehand.

A special therapy bed in a well ventilated room is assigned for patient which is devoid of dust direct air and AC, with good amount of light arrangement.

Abhyanga (अभ्यङ्‍गम्) and swedana (स्वेदनम्)– This means oil massage and steam inhalation.Patient is made to lie down on nasya table comfortably and mild abhyanga is done to face and neck region for about 15 min with medicated oil. This is followed by swedana or steam therapy which is very mild and limited to face and neck only. Alternatively a towel is dipped in hot water and patted mildly over face in patients who are not indicated for swedana (steam therapy).

प्रधान कर्मम् ॥ Pradhana Karma (Nasya procedure)

The main procedure of Nasal instillation in Nasya karma includes some steps. Those are as follows

Patient is advised to lie down comfortably on therapy bed and the head is slightly turned back to make sure it remains a level lower than that of body to facilitate easy administration of medicine. Head low position can be given.

Patient's eyes are covered with soft cotton cloth or cotton only.

Tip of the patient’s nose is raised a little and medicated oil is inserted drop by drop in both nostrils as instructed by Vaidya. A nasya yantra (equipment used to administer nasya medicine) or a dropper. is used for oil instillation. When the nasya drug is in the form of powder or medicated smoke the same procedure is followed but only the method of drug administration differs slightly.

Temperature of the oil is controlled and so do the dose specific to the patient.

Patient is advised to remain relaxed during the whole procedure. Also, talking, getting angry, laughing are to be avoided during nasya drops instillation.

After the whole procedure patient is kept under observation. This is mandatory for assessment of level of evacuation of doshas and deciding the next plan of action.

पश्चात कर्मम् ॥ Pashchat Karma

After nasya karma, patient is advised to rest in the lying down position. Feet, palms, shoulders of patient are gently massaged/rubbed. Hot fomentation can also be given once again.,

Patient is advised to spilt out excessive medicine that might have come into throat and avoid swallowing the same.

Dhumapana (धूमपानम्) and Gandusha (गण्डूष) – Dhumapana meaning medicated smoke is given to patient after nasya karma to eliminate any excess kapha dosha lodged locally. Gandusha meaning gargle with medicated decoction is given for cleansing of mouth and throat, and to remove any remnant morbid doshas locally. These procedures help in expulsion of doshas completely and to keep the oral cavity and nasal cavity clean and non-sticky.

Restrictions – Patient should avoid getting exposed to heavy winds, excess dust, sunlight. Any contact with cold water should be avoided, sleep during daytime is contraindicated.

Diet – Excessive fatty or liquid diet is to be avoided; light meal is advised after nasya karma. Drinking warm water is advised post Nasyam. Cold, refrigerated water must be strictly avoided.

Any kind of complication if at all arises during or after procedure it is treated with apt medicines.

नस्य कार्मुकता ॥ Mode of action

According to ayurvedic classics,

ऊर्ध्वजत्रुविकारेषु विशेषान्नस्यमिष्यते | नासा हि शिरसो द्वारं तेन तद्व्याप्य हन्ति तान् ॥ (Asht. Hrud. 20.1)

तत्रावसेचितमोउषधं स्रोतः शृङ्गाटकं प्राप्य व्याप्य च मूर्धानं नेत्रश्रोत्रकण्ठादि- सिरामुख़ानि च मुञ्जादिषीकामविसक्तामूर्ध्वजत्रुगतांकारिकीमशेषामाशु दोषसंहतिमुत्तमाङ्गादपकर्षति॥ (Asht. Sang. 29.3)

Nasa or nostrils are the pathway to shiras (brain). Thus, when medicine is administered through nostrils it reaches shrungataka marma (शृङ्गाटक मर्म | a point in brain where energies are concentrated). From here on the medicine gets distributed further by opening of channels which are blood vessels of eye, throat and ears. Thus, due to presence of active ingredients in the medicines the morbid doshas get eliminated just like removing grass from its roots. Precisely, when the medicated oil or churna etc enters nose, the active compounds eradicate the morbid doshas completely from the system.

From western medicine point of view there is no direct pharmacodynamic correlation between nose and cranial organs. Moreover, there is a strong security system of blood brain barrier system present in the body. But the fact cannot be denied that whenever there is any irritation in the body, there is increased circulation and permeability of the blood vessels. When it comes to absorption of drug, the position of head helps retention of medicine in nasopharynx, on the other hand, local massage and fomentation will enhance the drug absorption.