N idranasha ksheeradhara_nasya-pk027_gdg

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THE EFFECT OF YASTI KSHEERA DHARA AND SARPI NASYA IN NIDRANASHA - A COMPARATIVE CLINICAL STUDY” BY G.DEEPAK Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.

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N idranasha ksheeradhara_nasya-pk027_gdg

  1. 1. “THE EFFECT OF YASTI KSHEERA DHARA AND SARPI NASYA IN NIDRANASHA - A COMPARATIVE CLINICAL STUDY” BY G.DEEPAK Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfilment of the degree of AYURVEDA VACHASPATI IN PANCHAKARMA Under the guidance of DR. SURESH BABU. S M.D. (AYU), FRAV (GOI, Delhi) Professor P.G. Dept. of Panchakarma And co-guidance of DR. SANTOSH N. BELAVADI M.D. (Ayu) Asst. Professor P.G. Dept. of Panchakarma POST GRADUATE DEPARTMENT OF PANCHAKARMA, D.G M.AYURVEDIC MEDICAL COLLEGE AND RESEARCH CENTER, GADAG – 582103. 2007-2010“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  2. 2. DECLARATION BY THE CANDITATEI hereby declare that this dissertation / thesis entitled “The Effect of Yasti KsheeraDhara and Sarpi Nasya in Nidranasha - A Comparative Clinical Study” is a bonafideand genuine research work carried out by me under the guidance of Dr. Suresh Babu. SM.D. (Ayu), FRAV (GOI, Delhi) Professor and the co-guidance of Dr. Santosh N. BelavadiM.D(Ayu), Asst.Professor, Post Graduate Department of Panchakarma, ShriD.G.M.Ayurvedic Medical College, Gadag.Date: Signature of the CandidatePlace: Gadag (G.Deepak) “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  3. 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “The Effect of Yasti KsheeraDhara and Sarpi Nasya in Nidranasha - A Comparative Clinical Study” is a bonafideresearch work done by G.Deepak in partial fulfillment of the requirement for the degreeof Ayurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the GuidePlace: Gadag Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi) Professor P.G. Dept of Panchakarma Shri.D.G.M. Ayurvedic Medical College, Gadag. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  4. 4. CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “The Effect of YastiKsheera Dhara and Sarpi Nasya in Nidranasha - A Comparative Clinical Study” isa bonafide research work done by G.Deepak in partial fulfillment of the requirement forthe degree of Ayurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the Co-GuidePlace: Gadag Dr. Santosh N. Belavadi M.D. (Ayu). Ast. Professor P.G. Dept of Panchakarma D.G.M Ayurvedic Medical College, Gadag. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  5. 5. J.S.V.V. SAMSTHE’S SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST GRADUATE DEPARTMENT OF PANCHAKARMA ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “The Effect of Yasti Ksheera Dhara and Sarpi Nasya in Nidranasha - A Comparative Clinical Study” is a bonafide research work done by G.Deepak under the guidance of Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi) Professor, and co-guidance of Dr. Santosh N. Belavadi M.D. (Ayu) , Asst. Professor, Post Graduate Department of Panchakarma, Shri. D.G.M.A.M.C, Gadag and contributed good values to the Ayurvedic research. Dr. Sivaramudu M.D. (Ayu), M.A (San), M.A (Psy) Dr. G. B. Patil Prof. and H.O.D. Principal, P.G. Dept of Panchakarma Shri. D.G.M. Ayurvedic Medical College,Shri. D.G.M. Ayurvedic Medical College, Gadag Gadag.Date: Date:Place: Gadag Place: Gadag “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  6. 6. COPYRIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation / thesis in print orelectronic format for academic / research purpose.Date: Signature of the CandidatePlace: Gadag. G.Deepak © Rajiv Gandhi University of Health Sciences, Karnataka. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  7. 7. Acknowledgement ACKNOWLEDGEMENT At this happiest juncture of successful completion of this research work, Iprostrate to the lotus feet of “Lord Dhanvantri”, with whose showering of blessings thistask was ventured without any hindrances. I express my deep sense of gratitude to his great holiness Jagadguru ShriAbhinava Shivananda Mahaswamiji, for their divine blessings. Next I pay my obeisance to my Late Grand Father Dr.P.Kesava pillai Ex C.C.I.Mmember and N.Velayuda pillai, I pay respect to my Father Dr.K.Gopakumar M.D (Sid),my Mother V.Sreekala, for taking pain to bringing up me to this position. I thank mysister Dr.G.Divya BAMS who supported in my entire career and continuousencouragement. I grab the opportunity to express my deep sense of gratitude to my guideProfessor Dr.Suresh Babu.S M.D (Ayu), FARV (GOI, Delhi), whose sympathetic,compassionate and commendable nature gave me considerable boost, always providedme enough courage to cope up with each and every task during my P.G. studies. At such an auspicious moment, it is my pleasing privilege to express my respecttowards my co-guide, Dr.Santosh N. Belavadi M.D (Ayu) his inspiration, guidance andencouragement at every step of my work. I am extremely grateful and obliged to Professor Dr.P.Sivaramudu M.D (Ayu),HOD, Dept of Panchakarma for his affection, experience and intelligence guidance. I am sincerely thankful to Professor Dr.G.Purushothamacharyulu M.D (Ayu),who was former H.O.D. of the department, for his scholarly guidance. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  8. 8. Acknowledgement I sincerely convey my thanks to beloved principal Dr.G.B.Patil for his all timesupport and providing all necessary facilities for this research work. I express my sincere thanks to Dr. Rajashekar C.V M.D (Ayu), who was formerteacher in the department, for his valuable suggestions. I am deeply indebted and sincerely thankful to Dr.Jairaj Basarigidad M.D (Ayu),Dr. Yasmeen Phaniband M.D (Ayu), for their precious suggestion and co-operationthroughout the study. I am grateful to all the PG teachers Dr.K.S.R.Prasad, Dr.M.C.Patil, Dr.Mulugund,Dr.G.S.Hiremath, Dr.R.V.Shettar, Dr.Girish Danappa Goudar, Dr.Jagadeesh Mitti,Dr.Kuber Sankh, Dr.Shashikanth Nidugundi, Dr.B.M.Mulkipatil and Dr.M.D.Samudri,for their valuable inputs and suggestions. I extend my immense gratitude to Dr.V.M.Sajjan, Dr.Purad, Dr.SuvarnaNidugundi, Dr. Shakuntala and other teaching staffs who helped during my study. I express my sincere thanks to Sri.Nandakumar, for his help in statistical analysisof results. I take the privilege to thank Sri.Mundinamani, Librarian. I also extend mythanks to assistant librarians Mr.Shyavi and Mr.Keroor who provided me all thenecessary books and time for my literary work. I extend my thanks to Sri Kulakarni, SriNabi, Smt. Sunanda and Smt Renuka for their timely help in my clinical trail. I express my thanks to Dr.Ratnakumar and Dr.Udaykumar for their sincere words,which made me to join in this Institution. I feel extremely thankful to my seniorsDr.Ashok.M.G, Dr.Prasanna V.Joshi, Dr.Sanjeev Chaudary, Dr.Sathish, Dr.Subin,Dr.Febin, Dr.Madhushree, Dr.Prasanna Kumar, Dr.Siba Prasad, Dr.Payappa Gowdar, “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  9. 9. AcknowledgementDr.Devandrappa Budi, Dr.Nataraj, Dr.Udaya Ganesha, Dr.Adarsh, Dr.Shailej, Dr.MuktaHiremath and others for valuable suggestions. I pay sincere regards to my fellow colleagues Dr.Sabareesh, Dr.Rajesh,Dr.Jayasankar, Dr.Sanath kumar D.G, Dr.Ishwar Patil, Dr.Praveen Nayak, Dr.Bodke,Dr.Kanti, Dr.Shakunthala, Dr.Asha, Dr.C.C.Hiremath, Dr.Rotti, Dr.Bupesh, Dr.Gorpade,Dr.Deepa, Dr.Jadav, Dr.Mahantesh Swami Hiremath and Dr.Praveen Palyed for theirtruly help and co-operation. I thank my juniors Dr.Joshi Goerge, Dr.Anish, Dr.Vishwajith, Dr.Renukaraj,Dr.Sangamesh, Dr.Jayakar, Dr.Sathish, Dr.Raghavendrachar, Dr.Jagadeesh, Dr.Maneesh,Dr.Paresh, Dr.Shilpa, Dr.Bhaghyesh and Dr.Vijay Mahanthesh for their support. I pay sincere regards to my fellow colleagues in the other colleges,Dr.T.V.Dhanvanthari, Dr.Shivakumar and Dr.Girish for their support. Iam also very much thankful to Mr. Shakthi (Local Guardian) andDr.K.S.R.Prasad who made my stay comfort through out my P.G. carrier. I pay sincere regards to my UG friends Dr.Nepoleon, Dr.Kavas anand,Dr.S.E.Sivakumar, Dr.Seejith warrier, Dr.Vijith Nangelil, Dr.Surej, Dr.Sundar andDr.Sriram of SJSAC, Chennai, for their indirect support for my entire PG career. Lastly but not least I express my thanks to each and every person who have giventheir Support in accomplishing this task without any blemishes.Date :Place : Gadag Dr. G.Deepak “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  10. 10. AbbreviationsLIST OF ABBREVIATIONS USED: A.H – Ashtanga Hrudaya A.S – Ashtanga Samgraha B.P – Bhavaprakasha B.S – Bhela Samhita C.S – Charaka Samhita M.N – Madhava Nidana S.S – Sushruta Samhita V.S – Vangasena Y.R – Yogaratnakara “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  11. 11. Abstract ABSTRACT Nidranasha is one among the eighty Nanatmaja Vata Vikaras described byAcharya Charaka. Acharya Vagbhata indicated Brhmana Nasya for the treatment ofNidranasha. In the context of Murdhini taila, Shirodhara is also advised in the treatmentof Nidranasha. Hence, an attempt had been done to evaluate the effect of theseprocedures by undertaking the research work with the title “The Effect of Sarpi Nasyaand Yastiksheera Dhara in Nidranasha – A Comparative Clinical study”.Objectives of the study:(1) To evaluate the efficacy of Nasya karma in Nidranasha.(2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha.(3) To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya in NidranashaMaterials and Methods: A total of 30 patients were selected from O.P.D and I.P.D of D.G.M.A.M.C & Hafter fulfilling the inclusion and exclusion criteria randomly. They were divided in to twogroups Group A and Group B. 15 patients of Group A underwent Sarpi Nasya for sevendays. Group B patients underwent Yastiksheera Dhara for seven days. Assessment of results was done by considering the base line data of subjective andobjective parameters to pre and post medication and was compared for assessment of theresults. All the results were analyzed statistically for “P” value using Un-paired t-test.Subjective Parameters: Anganmarda, Shirogaurava, Jrumbha, Sleeplessness, Difficultyin Initiating Sleep, Sleep Quality, Performance of Daily Activities, Vitality AfterMorning Awakening, “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  12. 12. AbstractObjective parameters: Total Sleep time, Wakefulness during Sleep, Sleep HistoryQuestionResults:The overall results of the study were as follows;Group A: 02 (13.33%) shown Good response to the treatment. 10 (66.66%) were shownModerate response and 03 (20.00%) patients shown Poor response.Group B: 12 (80.00%) were shown Good response to the treatment and 03 (20.00%)patients shown Moderate response. From the statistical analyses, all parameters shows non-significant (as P>0.05).i.e., the mean affects of treatment same in all the parameters. All the parameters showshighly significant in both the Groups as P<0.05.Comparative efficacy: Overall the group B (Yastiksheera Dhara) is more effective thangroup A (Sarpi Nasya) in almost all the parameters. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  13. 13. Contents Contents Contents Page number 1. Introduction 1-2 2. Objectives 3-7 3. Literary review 8 - 92 4. Materials and methods 93 - 106 5. Observations and results 108 - 164 6. Discussion 165 - 180 7. Conclusion 181 8. Summary 182 - 186 9. Bibliography 187 - 203 10. Annexure 204 - 213“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 46
  14. 14. List of Tables & Figures LIST OF TABLES Table no. and content PageNo.Table no.01 showing the Time of Administraion 16Table no. 02 showing the Time schedule for Nasya karma in Rogi 23Table no. 03 showing the Probable Drug Dosage for Nasyakarma 24Table no.04 showing the Synonyms of Anidra 46Table no.05 showing the Nidana of Nidranasha 47Table no.06 showing the Rupa 57Table no.07 showing the Ekamulika prayoga in Nidranasha 64Table no.08 showing the variability between NREM & REM 70Table no.09 showing the Hours of Sleep according to Age 74Table no.10 showing the Drugs used for Ghrita murchana 88Table no.11 showing the Properties of Yastimadhu 90Table no.12 Showing the Therapeutic Actions of Yastimadhu 91Table no.13 showing the ksheera properties 91Table no.14 Showing the Milk Composition Analysis 92Table no.15 showing the Sleep history Questioner 102Table no16 showing the distribution of patient’s age group 108Table no.17 showing the distribution of patients according to sex 109Table no.18 showing the distribution of patients by Occupation 110Table no19 showing distribution of patients by Economical status 111Table no.20. Showing distribution of patients by Marital Status 111Table no 21 showing distribution of patients by Pradhana Vedana 112Table no 22. Showing distribution of patients by Anubanda vedana 113Table no 23. Showing distribution of patients by Mode of Onset 114Table no 24. Showing distribution of patients by Kula vruttanta 115Table 25 Showing distribution of patients by Occupational History 116Table no 26. Showing distribution of patients by Vihara 116Table no 27. Showing distribution of patients by Vyasana 117Table no 28 Showing distribution of patients by Satva 118Table no 29 Showing distribution of patients by Vyayama Shakti 118Table no 30 Showing distribution of patients by Vaya 119Table no 31 Showing distribution of patients by Aharaja hetu 120Table no 32 Showing distribution of patients by Viharaja hetu 121Table no 33 Showing distribution of patients by Manasika Hetu 122Table no 34: Showing the History Questionaire before treatment 123Table no 35: Showing the History Questionaire after treatment 124Table no 36: Showing the Angamarda before treatment 125Table no 37 Showing the Angamarda after treatment 126Table no 38 Showing the Shirogaurava before treatment 126Table no 39 Showing the Shirogaurava after treatment 127Table no 40 Showing the Jrumbha before treatment 128Table no 41 Showing the Jrumbha after treatment 128Table no 42 Showing the Sleeplessness before treatment 129 “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 46
  15. 15. List of Tables & FiguresTable no 43 Showing Sleeplessness after treatment 130Table no 44 Showing the Difficulty in Initiating Sleep before 131treatmentTable no 45 Showing the distribution of patients by different grades 132of Difficulty in Initiating Sleep after treatmentTable no 46 Showing the Sleep Quality before treatment 133Table no 47 Showing the Sleep Quality after treatment 134Table no 48 Showing the Performance of daily activities before 135treatmentTable no 49 Showing the Performance of daily activities after 136treatmentTable no 50 Showing the Vitality after Morning Awakening before 137treatmentTable no 51 Showing the Vitality after Morning Awakening after 138treatmentTable no 52 Showing the Total Sleep Time before treatment 139Table no 53 Showing the Total Sleep Time after treatment 140Table no 54 Showing the Wakefulness During Sleep before 141treatmentTable no 55 Showing the Wakefulness During Sleep after treatment 142Table no 56 Showing the Overall Response to the treatment 143Table no 57 showing the Comparative Study of Group A and 144Group B after treatmentTable no 58 showing Individual study of group-A 145Table no 59 showing Individual study of group-B 145Table no 60 Showing Demographical Data 147Table no 61 Showing Demographical Data 148Table no 62 Showing Demographical Data 149Table no 63 Showing Demographical Data 150Table no 64 Showing Demographical Data 151Table no 65 Showing Demographical Data 152Table no 66 Showing Demographical Data 153Table no 67 Showing Demographical Data 154Table no 68 Showing Demographical Data 155Table no 69 Showing Demographical Data 156Table no 70 Showing Demographical Data 157Table no 71 Showing Demographical Data 158Table no 72 Showing Subjective Parameter of Group A 159Table no 73 Showing Subjective Parameter of Group B 160Table no 74 Showing Objective parameter Group – B 161Table no 75 Showing Objective parameter Group – B 162Table no 76 Showing Sleep Questioner of Group A 163Table no 77 Showing Sleep Questioner of Group B 164 “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 47
  16. 16. List of Tables & Figures LIST OF FIGURE Figure PageNoFigure no.01 Showing the States and Stages of Sleep 69Fig No 02 showing the distribution of patient’s age group 109Fig No 03: showing the distribution of patient’s sex group 110Figure 04 showing distribution of patients by occupation 110Figure 05 showing distribution of patients by Economical status 111Figure 06 showing distribution of patients by Marital Status 112Figure 07 showing distribution of patients by Pradhana Vedana 113Figure 08 showing distribution of patients by Anubanda vedana 114Figure 09 showing distribution of patients by Mode of Onset 114Figure 10 showing distribution of patients by Kula vruttanta 115Figure 11 showing distribution of patients by Occupational History 116Figure 12. Showing distribution of patients by Vihara 117Figure 13 showing distribution of patients by Vyasana 118Figure 14 showing distribution of patients by Satva 118Figure 15 showing distribution of patients by Vyayama Shakti 119Figure 16 showing distribution of patients by Vaya 120Figure 17 showing distribution of patients by Aharaja Hetu 121Figure 18 showing distribution of patients by Viharaja hetu 122Figure 19 showing distribution of patients by Manasika Hetu 123Figure 20 showing Sleep History Questionaire before treatment 124Figure 21 showing Sleep History Questionaire after treatment 125Figure 22 showing Angamarda before treatment 125Figure 23 showing Angamarda after treatment 126Figure 24 showing Shirogaurava before treatment 127Figure 25 showing Shirogaurava after treatment 127Figure 26 showing Jrumbha before treatment 128Figure 27 showing Jrumbha after treatment 129Figure 28 showing Sleeplessness before treatment 130Figure 29 showing Sleeplessness after treatment 131Figure 30 showing Difficulty in Initiating Sleep before treatment 132Figure 31 showing Difficulty in Initiating Sleep after treatment 133Figure 32 showing Sleep Quality before treatment 134Figure 33 showing Sleep Quality after treatment 135Figure 34 showing Performance of daily activities before treatment 136Figure 35 showing Performance of daily activities after treatment 137Figure 36 showing Vitality Morning Awakening before treatment 138Figure 37 showing Vitality Morning Awakening after treatment 139Figure 38 showing Total Sleep Time before treatment 140Figure 39 showing Total Sleep Time after treatment 141Figure 40 showing Wakefulness During Sleep before treatment 142Figure 41 showing Wakefulness During Sleep after treatment 143Figure 42 showing Overall Response to the treatment 144 “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 48
  17. 17. Introduction INTRODUCTION “A good laugh and long sleep are the best cures in the doctor’s book” Ayurveda the holistic science believes mainly on preventing from diseases andcuring the diseases. According to Ayurveda Life sustains on three basic pillars – ahara,nidra and brahmacharya. This dictum of charaka clearly illustrates the importance ofNidra. The necessity of sleep is demonstrated by experiments in which animals deprivedof sleep die within a few weeks. Humans deprived of sleep for 60 to 200 hours begins todemonstrate a breakdown in concentration, motor skills, self care, attention, judgmentand eventually communication, debilitated appearance, skin lesions, increased foodintake, decreased body temperature and death. Hallucination and illusions may appear. There is however, a wide variation in the requirements for sleep, which isdetermined by genetic factors, habits formed early in life and particular physical andemotional states. This shows that if a person is deprived of good sleep will suffer frommany health problems as stated above with good sleep many physiological changes occurin respiration, cardiac function, muscle tone, temperature, hormone secretion and bloodpressure. More over good sleep serves a restorative, homeostatic function and appears tobe crucial for normal thermoregulation and energy conservation which are disturbed inthe sleep disorders like Nidranasha (Insomnia). Our Ayurveda Acharyas have visualized this scenario century’s ago. Prescribed anatural and refreshing line of approach to this lack of sleep problem – Nidranasha.Acharya charaka has mentioned Nidranasha as one among the vataja Nanathmaja vyadhi.Nidra is induced due to kapha and thamobhava. The symptoms of Nidranasha areAngamarda, Shirogaurava, Jrumbha, Jadya, Glani, Bhrama. Acharya charaka has “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 1
  18. 18. Introductionexplained Sukha, Dukha, Sthoola, Krusha, Bala and even Marana depends on the nidra.Nidranasha is also one of the important lakshana in many diseases. Nidranasha can be co-related with Insomnia. Insomnia is the condition ofinadequate quantity or quality of sleep. It may be a symptom of a depressive illness,anxiety disorder or other psychiatric condition. Even though there is an effective line of management for Insomnia which is thenear equivalent term for Nidranasha, but ultimately it may cause addiction. That is why asearch for an alternative line of treatment is carried out. Lot of unique therapeuticmodalities has been mentioned in Ayurveda, one of such modalities is Nasya karmawhich is the component of Panchakarma. While searching for such alternative treatment Ifound Brhmana Nasya with Sarpi indicated in Nidranasha. Since nidranasha is aurdhwajathrugata vikara nasya appears to be perfect line of treatment. As per dictum“Naasa hi Shiraso Dwaram”1a,b. Vagbhata2 a indicated the brhmana nasya in Nidranasha,basing on this apthavachana Sarpi has been taken for the trial as it is a Brhmana Dravyaand is taken as Group - A. Another procedure which is said to be effective and refreshing one is Shirodhara,which is indicated in Nidranasha is also selected for another group of patients calledGroup – B. In this way a comparative study “The Effect of Sarpi Nasya and YastiksheeraDhara in Nidranasha – A Comparative Clinical Study” has been designed with thefollowing aims as (1) To evaluate the efficacy of Nasya karma in Nidranasha. (2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 2
  19. 19. Introduction (3) To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya inNidranasha and conducted as per the Research protocols on 30 subjects (patients)2 b. Thefinal results are evaluated clinically and statistically and decreased in the relevantchapter. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 3
  20. 20. Objectives OBJECTIVES Ayurveda, the holistic science believes mainly in preventing diseases and curingthe diseases. Various unique therapeutic modalities have been mentioned in Ayurveda,one such modality is Panchakarma therapy. Acharya Charaka has mentioned Nidranashaas one among the Vataja Nanathmaja Vyadhi. Nidra is induced due to Kapha andThamobhava. The symptoms of Nidranasha are Angamarda, Shirogaurava, Jrumbha,Jadya, Glani, Bhrama. Acharya Charaka has explained Sukha, Dukha, Sthoola, Krusha,Bala, and even Marana depends on the Nidra. Nidranasha is the common and the most widely recognized sleep disorder.Nidranasha can be co-related with Insomnia. Insomnia is the condition of inadequatequantity (or) quality of sleep. It may be a symptom of a depressive illness, anxietydisorder (or) other Psychiatric condition. Sleep problems are common across all age groups, although the prevalence ofparticular kinds of problems may vary with factors, such as age, lifestyle, shift work,comorbid disease states, etc. 73% of the individuals surveyed complained of a nocturnalsleep problem and 9% had severe insomnia.The prevalence of severe insomnia rangedfrom 4% to 22%. Patients attending general practice clinics have a high prevalence ofinsomnia, and physicians must be on the lookout for these sleep disturbances so that theycan offer appropriate treatment. The importance of adequate knowledge of insomniacannot be overemphasized so that clinicians can efficiently manage this common healthproblem in primary care3. About one-third of adults reported at least one sleep complaint or problem (e.g.,difficulty falling asleep or staying asleep, or early morning awakening). The prevalence “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 3
  21. 21. Objectivesof sleep problems increases with age and is higher for women than for men. Whereasprevalence estimates of insomnia in childhood and adolescents do not appear to differbetween boys and girls, and gender differences are small or nonexistent between persons20–40 years old, investigations spanning the age range from 18–79 years indicate thatwomen, compared with men, are about 1.3 times more likely to report insomnia-likesleep problems4. Use of prescription medication in patients with sleep difficulty was reported by20% of men and 29% of women. Doctors have a lot of influence on patients use ofhypnotics and need to give proper information and advice to their patients whenhypnotics are prescribed. Adolescents and young adults (12-25 years) are at high risk forproblem sleepiness with particularly serious consequences3. About a third, adults experience some type of sleep disorder during their lifetimes.Over half of persons with Nidranasha do not seek medical advice at any time. But thesehypnotic or sedative drugs are not so effective and pose increased risk of psychologicalbehaviour. Keeping behind the limitations of drug therapy in other popular remedialsciences, research activities in Ayurveda for diseases like Nidranasha become intensive inthe recent years. Some studies have already been conducted in the management of Nidranasha withvarious Panchakarma Therapies are as follows,(1) Nirmal Dhamini:- A Role of Manas Bhavas in Anidra and its management withcertain indigenous drugs and shiro dhara, Department of Manasa Roga, 2004, Jamnagar.(2) Puja Muralidhar:- The Effect of Shiro Basti in the mangement of Nidranasha W.S.Rto primary Insomnia, Department of Kaya Chikitsa, 1999, Govt. Ayurvedic Medicalcollege, Mysore, RGUHS Bangalore, Karnataka. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 4
  22. 22. Objectives(3) Todkar Swati:- A study of the effect of Abhyanga Karma in Nidranasha, Departmentof Swastha Vritha, 2005, Pune.(4) Chaudhari (Ms) Rupali T:- Analytical study of Nidra in Shleshmala Prakriti, 2005,Department of Shareera kriya, M.A.M.S.S.B Ayurvedic Mahavidyalaya, Hadaspar, Pune,Pune University, Pune.(5) Nisha N.T:- Care of Nidra in Old- A natural approach through Abhyanga and Yoga,2003, Department of swasthavritha, Govt. Ayurvedic College, Kerala University,Thiruvananthapuram.Aims and Objectives of the Study:(1) To evaluate the efficacy of Nasya karma in Nidranasha: The Nasya is one among the Panchakarma which is especially indicated forUrdhwajathrugata vikaras1a. Acharya’s like Charaka5, Sushrutha6, Vagbhata,Sharangadara7, Kashyapa8 have mentioned detailed description of Nasyakarma. Different types of Nasya have been mentioned in classics, among these byVagbhata Brhmana Nasya is specially indicated for inducing sleep2. For this BrhmanaNasya - Murchitha Gritha (mahisha gritha) is used. Mahisha gritha specially described asNidrajanaka agent9. Gritha itself is a Brhmana dravya and having the properties of madhura vipakaand sheeta virya, which acts as brimhana, after administered through nasal route.Murchita Mahishagritha reduces the doshas like Vata and Pitta and has the propery ofNidrajanaka. Gritha also contains 4-5% Linoleic acid & essential fatty acid, which promotesproper growth of human body. The Lipophilic action of gritha facilitates transportation to “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 5
  23. 23. Objectivesa target organ and final delivery inside the cell, because cell membranes also containLipid. Gritha being Yogavahi can be used in other Ayurvedic preparations. In the processof evaluating the activities of natural compounds, it has been found by means ofsophisticated research that when herbs are mixed with ghrita, their activity and utility ispotentiated many times. So, the murchitha gritha is used in this study can be includedunder Brimhana nasya and hence Sarpi Nasya is taken for the management ofNidranasha.(2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha: Nidranasha leads to the both physical and mental disturbances and even alters themetabolism. Use of anti-depressants and sedatives will lead to lot of adverse effects10.Hence in the present scenario, there is no effective treatment available in other systems ofmedicine. Sleep is one of the essential factors for sustainance of life, hence it has beenincluded under Thrayopasthamba11. Shirodhara is advised for the treatment ofNidranasha, in the context of Murdhini taila which is mentioned by Vagbhata12. Ksheeradhara is commonly practicing procedure for inducing sleep. Yastimadhu drug having the properties of sheeta virya and madhura vipaka, alsoVata and Pitta shamaka13. It is Rasayana, balya, Vrishya, Kanthya, Medhya, Mridurechana Mutrala, Varnya, Jivaniya, Sandhaniya, Chakshushya, Dahashamaka andKeshya. Mahisha ksheera is also specially indicated for Nidranasha by Vagbhata14a, b. Ksheerahaving the properties as Madhura Rasa, Guru, Snigdha, Sara Guna, Sheeta Virya, “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 6
  24. 24. ObjectivesMadhura Vipaka, Vata-pitta Shamaka and Karma as Mana Prasadaka, Medhya,Rasayana, Vrishya, Jivaniyam and Nidrajanaka. Continuous pouring (Dhara) of yastiksheera on forehead for particular period of timeinduces sleep and gives tranquilizing effect. This comfort can be compared to theCradling of a mother to her child15. According to modern view, the medicine may passthrough the stratum cornium into the blood vessels or may absorbed on the forehead andreach the brain cortex. The ksheera when penetrates or enters into the circulation acts asvatahara. Hence Dhara karma provides activation to cells by its medhya effect withoutany irritation or harmful effects. By understanding the properties and action of both yastimadhu and mahishaksheera we can conclude that, they are specially indicated for the treatment of Nidranashaand hence Yastiksheera Dhara is taken for the management of Nidranasha.(3) To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya inNidranasha. A Comparative Clinical Observational Study of Sarpi Nasya and YastiksheeraDhara has been taken up to study the clinical effect in Nidranasha. Thus the trial iscompared at the clinical efficacy with respect to the subjective and objective parameterschosen. At this attempt the group-A and group-B designated with respective therapies ofSarpi Nasya and Yastiksheera dhara respectively, are observed for the efficacy ofNidrajanaka prabhavam. Keeping this in background the study was done to compare “THE EFFECT OFYASTI KSHEERA DHARA AND SARPI NASYA IN NIDRANASHA”. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 7
  25. 25. Review of Nasyakarma NASYAKARMAHistorical review:Atharvaveda: “A¹cÉ¢ü lÉuɲÉU .................” (Atharvaveda.10-2-32). Nasa is describedamong nine Chidras and Indriyas.Rigveda: Some Mantras of Rigveda indirectly refers,for the eradication of the rogafrom the routes of Nasa, Chibuka, Shira, Karna and Rasana. (Rigveda.10-16-4).Yajurveda: Nasa is described among the Indriyas, while mentioning of two Netra,two Karna, Nasika Chhidras and Jihva.Bhagavad Gita: “lÉuɲÉU mÉÔuÉÉïSåÌWû lÉåuÉÉ ..................” (Bhagavad Gita 5/13). Nasa isdescribed among the Indriyas.Ramayana: In Valmiki Ramayana, when Laxmana became unconscious by the blowof Meghanada, their Vaidya Sushena administered the juice of Sanjivani throughnasal route and was back to consciousness, instantaneously.Introduction: Nasya or Shirovirechana is considered as the best and the specific Shodhanaprocedure for diseases of the head or the Sira “FkuÉïeɧÉÑÌuÉMüÉUåwÉÑ ÌuÉzÉåwÉɳÉxrÉÍqÉwrÉiÉå” 1.Nasya is a method, where - the medicated Taila or Churna, etc., is instilled in the noseto reach the shiras. Arunadatta16 has defined the word Nasya as “lÉÉxÉÉrÉÉÇ mÉëhÉÏrÉqÉÉlÉqÉÉæwÉkÉÇlÉxrÉqÉç”, it is derived from the root Nas. The word Nas is derived from the Nas dhatu.The Nas is also meant as Nasyakarma. Nasya is very useful in the diseases of upper part of the neck as the Nose isconsidered as the portals of the Head or the Sira- “lÉÉxÉÉÌWû ÍzÉUxÉÉå ²ÉUÇ”1. The medicineapplied through the nose will reach the shiras and mitigate the vitiated doshas. In “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 8
  26. 26. Review of NasyakarmaSushrutha samhitha, the word Shirovirechana is used for a Snehana type of Nasya17.As Nasya produces Shodhana of doshas, Virechana shabda is used here. Charaka hasused the word Nastha prachardana18, but Chakrapani views Nastha prachardana asShirovirechana. According to Bhavaprakasha also all drugs and measures that can beadministered through the nasal passage are called Nasya – “iɲÉËU lÉÉxÉÉ mÉårÉqÉç”19.‘Nasya’ also means ‘beneficial to nose’.Etymology of Nasyakarma:In Ayurveda, the word Nasya means the route of administration of the drugs. Nasyakarma as stated by Charaka (Cha.Si.9/88) the nose is the gateway of thehead, by the administration of the drugs through the nose is called Nasyakarma. As stated by Sushrutha (Su.Chi.40/21) the medicines which administeredthrough the nose is Nasyakama. As stated by Arunadatta (AH.Su.20/1) the nose is the gateway of the head andthe administered through the nose is Nasyakama.Also according to Sharangadhara (Sha.Utt.8/1) and Bhavaprakasha (BP.Pur.5/189)stated, the administered through the nose is Nasyakama. (Ayurvedia Shabdakosha)Synonyms: Shirovirechana Shirovireka Murdhavirechana Nastha prachardana “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 9
  27. 27. Review of NasyakarmaClassification of NasyakarmaAccording to various Aachaarya: Nasyakarma has been classified in to several types by different Aachaarya.Some are based on the mode of action; some are on the form of administration andsome on the source of the drugs used for the procedure.Charaka’s Classification of Nasya: According to Charaka the Nasya is of five type’s viz. Navana, Avapida,Dhmapana, Dhuma and Pratimarasa20. Navana is further divided in to Snehana and Shodhana, Avapidana into Shodhana and Stambhana, Dhuma into Prayogika, Vairechanika and Sneihika while Pratimarsha is divided into Snehana and Shodhana. Snehana Navana Shodhana Shodhana Avapidana StambhanaNasya Dhmapana Prayogika Dhuma Sneihika Vairechanika Snehana Pratimarsha Virechana “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 10
  28. 28. Review of Nasyakarma1. Naavana Nasya: Administration of Sneha into both the nostrils with the help of cotton ordropper is called “Navana nasya”. It is of two types as Snehana & Shodhana20.It gives strength to the Greeva (Neck), Skanda (Shoulder) and Uras (Chest). Itproduces Prasaada of drishti (improves eye sight) 21.Dosage: 22 32 drops - Uttama matra 16 drops - Madyama matra 8 drops - Hraswa matra in each nostril2. Avapidana Nasya: The process of nasal administration by means of fresh juice obtained byexpressing the leaves containing Tikshana Guna is known as “Avapidana Nasya”23.According to Dalhana24, it is of two types as 1. Stambhana and 2. Shodhana Sushrutha explains the Virechana nasya is mainly used for the purpose ofproducing Shodhana in the head. It is useful in Murcha, Sanyasa, Moha, Apatantraka,Apasmara and other Psychic disorder. In other conditions of Pitta diseases, theSthambha variety of nasya is used with Sharkara (sugar), Ikshu rasa (sugarcane juice),Ksheera (milk), Ghritha (ghee) and Mamsa rasa (meat soup).Dosage: 8 drops - Uttama matra 6 drops - Madyama matra 4 drops - Hraswa matra in each nostril3. Dhmapana Nasya or Pradhamana Nasya: 25 a, b Blowing medicated powders into the nostrils with the help of a tube. For this 6angula length tube is used, in which the choorna will be filled and the same choornawill be made to get into the nose by blowing. It is useful in Unmada, Apasmara, Atatwabhinivesa etc. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 11
  29. 29. Review of Nasyakarma Dalhana has suggested the use of fine powder taken in a thin cloth in aquantity of Sukti pramana (2 tolas) and tie it in the form of a Potali (bolus) and thesmell should be inhaled.Dosage: Is 3 Muchyuti i.e., approximately one Gunja (the quantity that is being takenwith the help of index finger) 4 rathi - Uttama matra 3 rathi - Madyama matra 2 rathi - Hraswa matra in each nostril.4. Dhuma Nasya: 20 The process of inhaling medicated fumes through the nostrils and expellingthrough mouth with the help of a Dhuma Yantra is known as “Dhuma Nasya”.It is of 3 types 1. Prayogika, 2. Vairechanika and 3. Snehika dhuma 26 aAccording to Chakradatta Dhuma nasya is used in Shiroroga, Nasa roga, Akshiroga.According to Vagbhatta26 b has suggested the use of dhuma through the nose first incase of Utklishta (aggravated doshas in the head) and the dhooma must be taken onlyfrom the mouth. When there is no Utklishta of doshas either in the nose or in the head,then if they are to cause aggravation then make the patient to inhale the dhumathrough the mouth and then through the nose.Dhuma Yantra: Consists of 2 parts are (a) Dhuma Netra (b) Dhuma Varti “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 12
  30. 30. Review of Nasyakarma(a) Dhuma Netra: Dhuma Netra can be prepared with the same metals which are indicated forthe preparation of Vasti Netra like Gold, Silver, Copper etc27. Dhuma Netra has thecircumference of a thumb and little finger at the base and tip respectively, the holenear the tip is of the size of a pea.The length of Prayogika Dhuma netra - 48 inches Snehika Dhuma netra - 32 inches & Vairechinika Dhuma netra - 24 inches (AS.Su.29)Preparation of Dhuma Varti: 28Dhuma nasya can be classified into 2 varieties, depending on the method of use.♦ Common method is, take any stick of herbal stem of 12 inches length and soak it in water over night. Then roll a cloth piece and apply the paste of any drugs eg., Eladigana drugs, according to the condition of the disease for about 9 inches and then dry it well. Again apply the same paste and dry. In this way paste is to be applied for 5 times. After that remove the stick from the cloth and the dhuma varti is ready. Then it should be arranged to Dhuma Netra and lit after applying ghee andmedicated fumes are to be inhaled through the nostril.♦ Other method is, the drugs mentioned for nasya are to be kept inside a tube and the tube must be lit with fire. In this type of nasya, the length of the netra Prayogika Dhuma netra - 36 inches Snehika Dhuma netra - 32 inches & Vairechinika Dhuma netra - 24 inches “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 13
  31. 31. Review of Nasyakarma The fumes inhaled through the nostrils should be expelled through the mouthand those inhaled through the mouth also should be expelled through mouth only. Thefumes should never be expelled through the nostrils, otherwise complication of theeye sight may arise 26 a, 29.5. Marsha or Pratimarsha: The Marsha and Pratimarsha nasya are to be conducted with the help of Sneha.The Marsha differs from pratimarsha in its high dose and they are to be differentiatedwith the help of dose schedule only20, 23. Pratimarsha nasya produces the dosha Saamyavastha, it won’t produce anycomplications. This is to be given twice in a day.This will not enhance the disease, butproduces Avarodhata in the body. The anguli of the patient must be dipped in sneha and should be dropped intothe nostril in the form of drops. This process is called Pratimarsha. As soon as Snehadropped into the nose it should be inhaled. This can be administered in all the seasonsof the year. The dose of Pratimarsha should be so much that the Sneha must reach thekanta from the nose, but Sneha should not produce any Sraava in the throat 30 a, b.Indication of Pratimarsha Nasya: 31 a, b Any age Any season Baala Vridhdha Bhiru Sukumara “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 14
  32. 32. Review of Nasyakarma Kshtakshama Trishna Pidita Mukhashosha Valita and PalitaContraindication of Pratimarsha: 32 a, b Dushta Pratishyaya Krimija Shiroroga Madhyapeeta Badhirya Bahudosha Utklishta DoshasIt is contraindicated, because the Sneha Matra is very less to eliminate Doshas and theaggravated Doshas may get vitiated further.Dose: 2 bindusMarsha: According to Vagbhata dropping of Sneha in the nostrils from 6 to 10 drops isknown as Marsha. Marsha Nasya gives quick result and it is more effective thanPratimarsha Nasya33Dose: 10 drops - Uttama matra 8 drops - Madyama matra 6 drops - Hraswa matra in each nostril “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 15
  33. 33. Review of Nasyakarma Table No.01 showing the Time of Administraion 34 a, b, c Ashtanga Sharang- Hridaya dharaNo Time for Pratimarsha Nasya Sushruta 1 After leaving the bed in morning + + + 2 After cleaning the teeth + + + 3 Before going outside + - + 4 After exercise + + + 5 After sexual intercourse + + + 6 After walking + + + 7 After urination + + + 8 After passing Apanavayu + - - 9 After Kavala + + +10 After Anjana + + +11 After meal + + +12 After sneezing + - -13 After sleeping in the noon + + +14 In the evening + + +15 After vomiting - + +16 After Shiroabhyanga - + -17 After defaecation - + +18 After laughing - + -Classification of Nasya according the Pharmacological action. 35 a, b Charaka and Vagbhata have classified the above mentioned five types ofNasya into 3 groups according to their pharmacological action, viz. (i) Rechana (Virechana) (ii) Tarpana (Brimhana) and (iii) Shamana “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 16
  34. 34. Review of Nasyakarma Rechana Mode of Action of Nasya Karma Tarpana Shamana1. Rechana Nasya (Virechana Nasya) The Rechana Nasya denotes to eliminations of vitiated Doshas fromUrdhvajatrugata part of the body. Mainly, Tailas and Kashayas are prepared withTikshna Dravyas like Pippali, Apamarga, Maricha, etc.,36 are used for VierechanaNasya. Also these Tikshna dravyas are administered by dissolving into Madya, Asava,Madhu, Saindhava, etc.,37 for the specific diseases.Indications: It is indicated specifically in Kaphaja type of Shiroroga like Manya Stambha,Abhishyanda, Swarabheda, Supti and Shirogaurava 38. Sushruta and Vagbhataindicated for Arochaka, Shoola, Shirogaurava, Pinasa, Pratishyaya, UrdhvajathrugataKaphaja Vikaras 39. Urdhvajathrugata Shopha, Praseka, Vairasya, Arbuda, Dadru andKotha 40. Virechana Nasya prepared in Sneha is particularly indicated for women, weakand delicate persons. Nasya which is prepared in Quatha and Kalka is specificallyindicated for Galaroga, Sannipataja Jwara, Atinidra, Manasika roga etc., If theintensity of the doshas are more in these disorders, then Churna should be usedbecause it enter completely into the nostrils and it mitigates the doshas. 41. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 17
  35. 35. Review of Nasyakarma2. Tarpana Nasya (Brhmana): In Brhmana Nasya, Snehas prepared with Snigdha and Madhura rasa dravyas42 a, b are administered. According to Vagbhata, Sneha prepared with Snigdha andMadhura drugs or with the drugs described useful for that particular disease should beused 41. Ghrita itself is a Brhmana dravya and if medicated ghrita with madhura andsheeta virya drugs administered through nasal route, it may acts as Brhmana drug. So,the Medhya Ghrita that is used in this study can be included under Brhmana nasya 41.It is mainly used in conditions like – Mukha sosha, Vaak sanga, Swaropaghata,Manya roga, Apataanaka, Apabahuka, Nidranasha and other diseases of Vata origin.Indications: It is specifically used for Suryavarta, Ardhavabhedaka, Krimi, Dantashoola, 43Karnashoola, Karnanada, Mukasosha, Nasasosha and other Vatapittaja Roga .Sushruta advised the use of Snehana Nasya for Timira, Akshi Samkocha andincreases the vision. It is also used for curing the Shirah kampa, Ardita and VatajaShiroroga 44.3. Shamana Nasya: The Shamana Nasya is defined as that which alleviates dushta doshas situatedin the Shiras and brings it to the normal. In Shamana Nasya the Taila, Ghrita,Swarasa, Ksheera, etc., can be used as per the condition of the patient. The Snehanaand Pratimarsha nasyas will comes under this Shamana Nasya.Indications: It is used to stop bleeding in Raktapitta.45. It is also indicated in Akala Palitaand Khalitya, Darunaka, Raktaraji, Vyanga and Nilika 46. Anutaila Nasya can be used “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 18
  36. 36. Review of Nasyakarmafor Svasthya person to promote the functions of eyes, ears and nose also, to preventKhalitya and PalityaClassification of Nasya according to various parts of the drugs: Charaka has mentioned 7 types of Nasya according to parts of the drugs to beused in Nasyakarma viz – Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twaka 47 as – Phala Patra Mula Various Parts of the Drug Kanda Pushpa Niryasa Twaka1. Phala Nasya: Friuts that are used like Apaamaarga, Pippali, Vidanga, Maricha, Shigru,Shireesha, Ajagandha, Ela, Peelu, Harenuka, etc.2. Patra Nasya : Leaves that are used like Tulasi, Saptaparna, Aragwadha, Moola, Sringaveera,Lashuna, Sarshapa, Taleesapatra, Tamalapatra, etc.3. Moola Nasya: Roots that are used like Arka, Vacha, Alarka, Kushta, Naagadanti, Bharangi,Braahmi, Ativisha, Karanja, Indrayava, etc.4. Kanda Nasya: Stems that are used like Haridra, Shunti, Lashuna, Moolaka, etc. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 19
  37. 37. Review of Nasyakarma5. Pushpa Nasya: Flowers that are used like Lodhra, Madhanaphala, Nimba, Saptaparna, Arka,etc.6. Niryasa Nasya: Swarasa (Juice) that are used like Devadaru, Hingu, Agaru, Sarala, Laaksha,Shallaki, etc.7. Twak Nasya: Bark that are used like Guduchi, Ingudi, Tejovati, Daalchini, etc.With the above drugs the Kalka, Choorna, Swarasa, Ksheera, Kwatha, Dhooma, Taila,and Ghritha, etc., can be prepared and used for nasya suitably.Classification of Nasya according to Sushruta : According to Sushruta Nasya is also of 5 types Viz. Nasya, Avapida,Pradhamana, Shirovirechana and Pratimarsha. These 5 types of Nasya are furtherclassified according to their functions into two groups viz. Shirovirechana andSnehana, but Shirovirechana and Avapeeda Nasya have been given separate entity. Shirovirechana is further divided in to Shirovirechana, Avapida andPradhamana, Snehana is further divided in to Pratimarsha and Nasya 48. Shirovirechana Shirovirechana Pradhamana Avapida Nasya Pratimarsha Snehana Nasya “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 20
  38. 38. Review of NasyakarmaClassification of Nasya according to Vagbhata: 49 a, bMentioned three types concentrating the action of the Nasya drugs. They are - 1. Virechana 2. Brumhana 3. Shamana Snehana and Brumhana Nasya are further divided in to two groups i.e. Marsha andPratimarsha (according to dose). Aachaarya mentioned ‘Avapeeda Nasya’ separately, which can be used both forShirovirechana and Shamana purposes and ‘Pradhamana Nasya’ which can be used only forthe Shirovirechana purpose. Ashtanga Hridaya50 has mainly classified Nasya in 3 types viz.Rechana, Brimhana and Shamana Pradhamana Virechana Shiro - virechana Pratimarsha Nasya Brumhana Marsha Shamana AvapidaClassification of Nasya according to Kashyapa: According to Kashyapa Samhita Nasya has been classified into two groupsi.e. Brimhana and Karshana. Also, Brihmana Nasya mentioned as Purana Nasya andKarshana Nasya mentioned as Shodhana Nasya 51 a, b “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 21
  39. 39. Review of Nasyakarma Brimhana Nasya KarshanaClassification of Nasya according to Sharangdhara: Sharangdhara has also classified Nasya into two groups viz. Rechana andSnehana according to their functions. Rechana Nasya are further divided in to two groups i.e. Avapida and Pradhamana Snehana Nasya are further divided in to two groups i.e. Marsha and Pratimarsha 52. Avapida Rechana Padhamana Nasya Marsha Snehana Pratimarsha Acharya Videha described two types of Nasyakarma according to theirpharmacological action i.e. Sangyaprabodhana and Stambhana. 53 Sangyaprabodhaka Nasya StmabhanaAll these types can be included into the classification of Charaka. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 22
  40. 40. Review of NasyakarmaAge limit for Nasyakarma:54 The Age limit mentioned in the classics is between 7 years and 80 years.Aachaarya advices many restriction regarding the Age, Time and Method ofadministration, because the way of drug administration is directly in to the Uttamanga(Head).Time of Nasyakarma:I. Based on Rutu55 Generally,the Nasya should be given in Pravrit, Sharad and Vasanta Rutu. Ifthere is any emergency, some changes can be made and given in other rutu also. If it is Greeshma, advised time is Purvahna (during the early hours of the dayto avoid the harsh Sunrays) arranging a comparatively cooler environment. In Hemanta, it is Madhyahna (in noontime when the temperature will warmup) providing a comparatively warm place for the treatment) and In Varsha Rutu, when there is proper Sunrays (Avoiding Durdina).II. Based on Dosha predominance Table no. 02 showing the Time schedule for Nasya karma in Rogi 56 a, b Dosha Predominance Time of Nasya Kaphaja Vikara Purvahna Pittaja Vikara Madhyahna Vataja Vikara AparahnaIII. Based on Roga Vagbhata has prescribed same timing as Sushruta has mentioned. Nasya canbe given daily in morning and evening in Vataja Shiroroga, Hikka, Apatanaka,Manyastambha and Swarabhramsha. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 23
  41. 41. Review of Nasyakarma According to Sharangadhara, if the patient is having Lalasrava, supti, pralapa,shiroroga etc. with excessively vitiated Dosha, Nasya can be administered even in thenight time also57, 56 b.Drug Dosage for Nasyakarma The drug dosage for Nasyakarma is based on the type of Nasya, which is to beadministered. Aachaarya mentioned different dosage patterns for different types ofNasya. Table no. 03 showing the Probable Drug Dosage for Nasyakarma Nasyakarma Dose for each Nostril Avara – 16 drops (8 each) Shamana Nasya Madhyama – 32 drops (16 each) Pravara – 64 drops (32 each) Avara – 8 drops (4 each) Shodhana Sneha Nasya Madhyama – 12 drops (6 each) Pravara – 16 drops (8 each) Avara – 4 drops Kalka Nasya Madhyama – 6 drops (Avapeeda Nasya) Pravara – 8 drops Avara – 2 ratti Pradhamana Nasya Madhyama – 3 ratti Pravara – 4 ratti Avara – 6 drops Marsha Nasya Madhyama – 8 drops Pravara – 10 drops Pratimarsha Nasya 2 drops Churna Nasya 3 pinch According to Videha, the dose for Pradhamana Nasya is 3 Muchut’i (1Muchut’i = the Churna which may come in between Index finger and thumb = 2.4Ratti.) Aachaarya Videha says four drops of Nasya dravya is the smallest dose forShirovirechana. The dose can be increased upto 6 drops, 8 drops, 10 drops or even 16drops also; it should be administered based on the strength of the Rogi and the Roga. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 24
  42. 42. Review of NasyakarmaCourse of Nasya Karma: 58 a, b, c According to Sushruta, Nasya can be given repeatedly at the interval of 1, 2, 7and 21 days depending upon the condition of the patient. According to Ashtaanga Samgraha, Nasya should be given for 3 days, 5 days,7 days and 8 consecutive days or till the patient shows the symptoms of Samyak yoga. According to Ashtanga Hridaya explained that one should not exceed morethan seven days. According to Bhoja, Nasyakarma should not perform for more than nine daysas it leads to Saatmyata in the body.Indication of Shirovirechana Nasya The conditions indicated for the administration of Shirovirechana Nasya is inthe diseases of Urdhwajathru gata (head and neck), kaphaja roga, swarakshaya,arochaka, pratishyaya, peenasa, shirah shoola, apasmara etc. According to Charaka59, the conditions like sthambha, supti and shlaishmikashiroroga and also diseases like shiro danta, manya stambha, gala hanu graha,peenasa, galashundika, gala shaluka, shukla roga, timira, vartma roga, vyanga, etc.and Urdhwajatru gata vatadi vikaras60. In Astanga Samgraha40 Aachaarya considered different forms of drugs andalso the condition of the patient while indicating the Shirovirechana Nasya. 1. Sneha Nasya - Bheeru, krisha and sukumara type of persons. 2. Kalka, Choorna, Kwatha, Aasava, Swarasa etc. - In Gala roga, sannipata jwara, atinidra, manovikara, krimi, vishaabhipanna, abhishanna, sarpadashta and visamjna. 3. Choorna – When dosha are excessively vitiated and need quick elimination. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 25
  43. 43. Review of NasyakarmaContra-indications for nasya karma:61 a, b, c Bhukta bhakta, ajeerna, peeta sneha, peeta madya, peeta toya, snehaadi peetakama, snata shira, snata kaama, kshudarta, shramarta, shastra danda hata, Vyavaayaklanta, vyayaama klanta, paana klanta, nawa jwara, shokabitapta, virikta, anuvasita,garbini, nava pratishyaya, apatarpita, peeta drava, trushnarta, gara hata, kruddha,Baala, vruddha, vegaavarodita, rakta sravita, sutika, swasa peedita, kasa peedita.Procedure of Nasya Karma: The whole procedure is divided into three stages- Purva karma Pradhana karma Paschat karmaPurva karma: This includes all the preparations and events that are to be done up to instillationof medicine. This stage is further divided into three steps ♦ Collection of materials ♦ Time for administration of Nasya karma ♦ Preparation of the patient♦ Collection of materials: 62 a, b, c, d A Special room should be considered with well ventilated roomwith adequate light for the administration of Nasyakarma and should be named as‘Nasya Gruha’. The Gruja should considered with things like -Nasya peeta or Nasyaasana, Nasya Aushadha, Cotton or Dropper for instillation, spittoon, cloth, attendants,etc. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 26
  44. 44. Review of Nasyakarma Nasya can be administered either in the Lying posture or in the Sitting posture.Hence Nasya Asana should be prepared. The main purpose should be to make thehead to lie down in supine position and to make the body in a little elevated posture.♦ Time of Administration: The time of administration of Nasya is to be decided after consideringthe prevailing season and dosha pradanata. For the administration of Nasya karmaSharad(autumn), Vasantha(spring) and Praavrita(Rainy) rutus are useful. The seasonshould not be too cold or too hot or cloudy, in greeshma rutu before madhyanha andin sheeta rutu during madhyanha nasya should be performed.♦ Preparation of the patient: Person to be administered with Nasya karma has to stay in nirvata pradesha,light food is given, after resting for a short duration dantadhavana and dhoomapanashould be done and he should comfortably lie down relaxed on a Nasya chair or cot insupine position, hands and legs stretched straight. Snehana and swedana to face isdone. Swedana is contraindicated to Shiras as it is a marma. Even than for vilayana ofdosha and to facilitate easy expulsion of dosha, mrudu swedana is performed overShiras, manya, nasa, greeva. Eyes are covered with a cloth.63.Pradhana karma: 63, 64 a, b It is of two steps- ♦  Administration of Nasya karma ♦ Precautions taken during administration♦  Administration of Nasya karma Head is slightly bent backwards by keeping a pillow below the shoulder thisfacilitates easy instillation of Nasya medicine. Oil is warmed, nose tip is raised withindex finger of left hand and one nostril is closed with another finger, using right handmedicine is instilled. Exact measured quantity of medicine to be administered is taken “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 27
  45. 45. Review of Nasyakarmain a spoon of gold, silver, shell, wood or even administered using a pad of cotton orcloth or a dropper and dropped in a continues flow into each nostrils one after theother. This method is meant to use only either Sneha or Swarasa or Kwatha. If Churna is used for nasya, then it must be introduced into the nose through 6angula netra. From the other end, the powder is blown with the help of mouth.♦ Precautions taken during administration- Quantity of medicine should be exact neither more nor less, it should not bepoured all of a sudden, it should not be too warm or too cold, patients head should bestretched down neither too much nor elevated and he should lie relaxed. During administration of Nasya karma if the quantity of medicine is very less, itwill only excite the doshas, it will not expel doshas out and causes feeling ofheaviness, loss of taste, cough, excessive salivation, rhinitis, vomiting and diseases ofkanta i.e., Ayoga features. More quantity of medicine will give rise to complicationsi.e. Atiyoga features. Pouring the entire quantity at once will force the medicine toenter in to the wrong routes causing diseases of head, pratishyaya, ghrana kleda,obstruction to expiration. If the medicine is very warm it causes burning sensation,formation of ulcers, fever, bleeding through nose, head ache, blurring of vision. If it isvery cold it will cause ayoga features. Medicine instilled in an improperly stretchedposition of the head too gives ayoga features as the medicine fails to spread all overthe head uniformly. If the head is stretched too much, the medicine spreads to a longroute causes moorcha, jaadya, kandu, daaha, jwara. Nasya administered in an un-relaxed person causes increase in doshas as it is unable to spread all over the shiras,along with pain or stiffness64 a. If the head is not stretched than medicine fails to enterinside shiras and if stretched too much than the entered medicine fails to come back65. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 28
  46. 46. Review of NasyakarmaPaschat karma: 66 a, b, c, d The patient should avoid swallowing of Nasya aushadhi. Patient should spitout the excessive medicine which has come into the oropharynx. One should avoiddust, smoke, sunshine, alcohol, hot bath, riding, anger, excess fat and liquid diet67.Day sleeping and cold water for any purpose like Pana, Snana etc. should be avoidedafter Nasya Karma68.This has following steps- ♦ Snehana and Swedana ♦ Dhumapana and Gandusha ♦ Assessing the Samyak yoga lakshanas ♦ Complications if any and measures to be adopted♦ Snehana and Swedana Mrudu abhyanga and swedana over gala, kapola, lalaata, mardana overshoulder, feet and hands is done. Patient is instructed not to swallow but to spit theexpectoration as it contains doshas69. Patient should lie still in same position for 100matra kala, should not shake his head, talk, laugh, sneeze, yawn as these prevent themedicine reaching the expected place and even kasa, pratishyaya, shiro akshi rogasmay occur especially if the medicine doesnt reach Shringataka marma and therebymastulunga67, 70. Dhumapana, Kavalagraha and Ushna jala gandusha should be donefor kanta shuddi 66 d, 71.♦ Dhumapaana66 c: Snehana and swedana are nasya purvakarma, by these the srotas becomes softand doshas in them gets loosened. Administration of nasya easily expels them out butthe nasya dravya being a sneha and sneha by nature increases kapha due to its sheetaguna. This retains a portion of kapha, which was liquefied due to snehana and “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 29
  47. 47. Review of Nasyakarmaswedana. And so retained kapha cant be expelled out by nasya dravya and getscollected in karna,manya and causes different diseases. To remove this, dhumapana isadministered. Dhuma by virtue of its ushna and teekshna guna clears the dosha70. Inhalation of dhuma is indicated in the disorders of shira72 in general and inparticular prayogika dhuma is indicated after nasya karma73. Two to three inhalations are to be taken through nose and exhaled throughmouth only. If the dhuma is done through the mouth, the fumes should be let offthrough the nose only. By this lightness of head, sense organs, heart occurs, doshashamana takes and throat becomes clear74 a, b.Gandusha:75After dhumapana, ushna jala gandusha is to be done. This removes the kapha presentin the oral cavity and also increases the taste♦ Samyak yoga lakshanas:76 Laghavata (lightness in the body), Nidra (good sleep), Shirolaghuta (lightnessin the head), Sroto shuddhi (cleansing of srotus), Indriya prasannata, Mana prasannataand Roga shamana are the samyak yoga lakshanas Due to Atiyoga - Kaphasraava, Shiro gaurava and Vibrama are lakshanas. Due to Ayoga – Indriya rukshata, Roga aprashamana, Kandu, Anga gauravaand nasa,netra, mukha srava are the lakshanas.♦ Complications if any and measures to be adopted Complications will occur when Nasya is administered in odd times and also tounfit patients. When the complication occurs due to the utklesha of doshas, they mustbe treated with Shodhana and Shamana chikitsa. When the complication occurs due tokshaya, they must be treated with Brhmana chikitsa77. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 30
  48. 48. Review of NasyakarmaImportance of Post Nasya Massage: Post nasya massage, recommended by ancient acharya is as important asmassage before nasya. The texts have recommended post nasya massage on thefrontal, temporal, maxillary, mastoid and neck (manya) region. A comfortablemassage on the above regions may help to subside the irritation of the somaticconstriction due to heat stimulation and may also help in removing the slush createdin these regions. According to Sushruta, manya is a marma existing in neck on either side oftrachea78, which likely corresponds to the carotid sinus of neck on the bifurcation ofcommon carotid artery. The receptors called baroreceptors are situated here andmanipulation on it may have a buffering action on cerebral arterial pressure. (Best andTaylor, 1988). Pressure applied on the baroreceptors is also found to normalize thederanged cerebral arterial pressure. - (Hejmadi S. 1985).Probable Mode of Action of Nasya KarmaAyurvedic Point of View: In Ayurvedic classics, the mode of action of nasya karma is explained verybriefly. To understand the mode of action of nasya karma, the following points shouldbe kept in view “lÉÉxÉÉÌWû ÍzÉUxÉÉå ²ÉUÇ” 79• Shringataka marma is a Shiramarma formed by the union of siras (blood vessels) supplying to Ghrana (Nose), Srotra, Akshi (Eye), and Jihva (Tongue), and injury to this marma will be immediately fatal.80• Indu81 has opined that Shringataka is the inner side of middle part of the head i.e."ÍzÉUxÉÉå AliÉqÉïkrÉqÉç". “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 31
  49. 49. Review of Nasyakarma• Under the complications of nasya karma Sushruta noted that the excessive eliminative errhine might cause Mastulunga Srava (flow of CSF out of the nose) 82. This suggests the direct relation of Nasal pathway to brain. Considering above points, the mode of action of Nasya karma can beunderstood as follows83. Drug Through nasal route (i.e. gate way to shiras) Reaches the Shringataka Marma (Shiro Antarmadhyam) Spreads through the Shira of nose, ear, eye and tongue Reaches Shiras Enhances the strength of dhatus and tarpana of Shirah Tarpana or Brumhana Nasya 84Modern Point of View: According to modern science, there is no direct pharmacodynamicconsideration between nose and cranial organs. Human brain has strict security system i.e. blood brain barrier (BBB) the noseis used mainly as a route of administration for inhalation of anesthetics material. Inspite of this also, the intra-nasal route for administration of drugs ispreferred by modern science, which is found to be very effective. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 32
  50. 50. Review of NasyakarmaA Modern Concept: To understand the pathways of Nasya drug (classical errhine) acting on(central nervous system) it is important to go in details of the modus operandi ofNasya karma. On the basis of fractional stages of Nasya karma procedures, we can drawcertain rational issues that are as follows.A) Effect on neuro-vascular junction: Specific posture during Nasya karma, like the lowering of the head elevationof lower extremities, fomentation of face seems to have an impact on bloodcirculation of the head and face. The efferent vasodilator nerves, which are spread out on the superficial surfaceof face, receive stimulation by fomentation and may increase the blood flow to thebrain i.e. momentary hyperemia. According to Chatterjee, approximately 22% of total dilatation of cerebralcapillaries, caused by facial efferent stimulation will lead to 150% blood inflow(Chatterjee 1980) Considering above description the effect of nasya on neuro-vascular junctioncan be understood as follows mainly by Cushings reaction. So, it can be stated that the modus operandi of nasya karmas has a definiteimpact on central neurovascular system and likely to lower the blood brain barrier,which makes possible the absorption of certain drugs in the brain tissue. B) Effect ct at neuro-psychological levels: Effect of nasya at neuro-psychological levels stand upon the facts discussed previously that the terminal adjacent nerves running along with the olfactory nerves are connected with limbic system of brain including hypothalamus. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 33
  51. 51. Review of Nasyakarma♦ Certain drug administered through nose may have an impact on immediate psychological behavior by acting on limbic system through olfactory nerves as the limbic system is also concerned with behavioral aspects of human beings, besides control over endocrine secretions.♦ Cowley, 1975 has also highlighted such phenomenon in his study. The work was carried out by exposing people to known pheromone for a short time period. The result showed subjects reacting differently, in a assessing men and women in comparison with the control state; the judgment of people can also be influenced by exposure to a mixture of short chain fatty acids. These things certainly support the recommendation of Nasya by ayurvedicscholars for mental disorders like Apasmara, unmada and Nidranasha.Absorption and transportation of the drug administered by nasal pathway: Ways for the proper absorption of drug, which is given by nasal route, are asfollows.♦ Keeping the head in lowering position and retention of medicine in nasopharynx help in providing sufficient time for local drug absorption.♦ Lipid soluble substance has great chance for passive absorption through the cell of lining membrane.♦ The drug absorption can also be enhanced by massage and local fomentation. The absorption and transportation of drug, which is promoted by localmassage and fomentation, can occur in two ways.Lymphatic path:Drug can reach directly into the C.S.F. through lymphatic pathway.♦ Along with olfactory nerve, the arachnoid matter sleeve is extended to sub mucosal area of the nose. Correlation between them is established by the “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 34
  52. 52. Review of Nasyakarma experiment that the dye injected to arachnoid matter causes coloration of nasal mucosa within seconds and vice versa also.♦ Preliminary studies reported from AIMS laboratorys shows that steroids which are administered as a nasal spray enter rapidly in C.S.F. surprisingly their levels in the C.S.F. was found to be much higher as compared with systemic injections. (Kumar et al, 1979)♦ Here it is important to recall the statement of Sushruta that the excessive administration of virechana nasya (eliminative errhine) may cause oozing of mastulunga (C.S.F) into the nose. On this basis, it can be stated that ancient scholars of Ayurveda were aware ofthe role of lymphatic path in direct absorption into brain from nose. On the basis of the foregoing discussion we can state that the procedures,postures and conducts explained for Nasya karma are of vital importance in drugabsorption and transportation. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 35
  53. 53. Review of ShiroDharakarma SHIRODHARA 85, 86, 87 Shirodhara is one of the special types of treatment procedure. It is the processin which medicated oils, milk, kwatha or buttermilk, is poured in a continuous streamon the forehead, for the particular fixed time. Acharya Charaka has defined snehana as the treatment, which producesviscosity, softness, solubility and kleda in the body88. Snehana is one among theshadvidhopakramas. There are two routes to administer the sneha viz. External andInternal. External by Abhyanga, Murdha taila etc. and Internal by Pana, Basti, Nasyaetc. The Murdha Taila is having four varieties namely, Abhyanga, Seka, Pichu andBasti. They are told uttrottara gunaprada89. Dhara can be administered in differentway like Shirodhara or Shiroseka (only on the head), Sarvangadhara (all over thebody) and Sthanikadhara (local). Dhara is not only used in psychic diseases, but alsoused in psychosomatic diseases like psoriasis, Nidranasha. Dhara is done by usingdifferent medicaments like taila, takra, kshira, kwatha etc.Synonym of Dhara: ♦ Dhara ♦ Seka ♦ Parisheka ♦ Avasheka ♦ Sechana ♦ Prasechana “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 36
  54. 54. Review of ShiroDharakarmaIndication: 90Shirodhara is effective procedure which indicated in ♦ Nidranasha, ♦ Ardhavabhedaka, ♦ Suryavarta, ♦ Ardita, ♦ Pakshagata, ♦ Hanugraha, ♦ Akshisula, ♦ Shirogatavata, ♦ ShirahkampaContra-Indications♦ Kaphaj Vikaras♦ Shirodhara further increases Kapha, which makes the diseases difficult to cure.Method of Pouring of Dhara:The procedure of Dhara may be divided into three stages for the descriptive purpose:1). Purvakarma2). Pradhanakarma3). Pashchatkarma1). Purvakarma: Purvakarma is the preparation of the patient. First, it should be confirmed thatthe patient is fit for Shirodhara or not. Patients who are suffering from mental illness,headache, peenasa, sankhaka, suryavarta, arumshika, pratishyaya, shiropaka,shirovrana, anidra, timira, karnaroga, akshiroga, valita, palita, murcha etc. diseases arefit for Shirodhara. It is advisable for the better results that the hairs of the patient on “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 37
  55. 55. Review of ShiroDharakarmathe scalp should be removed, if the patient permits. The patient should pass stool andurine. Then patient’s pulse, temperature, blood pressure should be recorded. The patient is made to lie down in the wooden basin, specially prepared forsuch kinds of treatment, after first anointing his head and body with suitablymedicated oils. His head rests in a slightly elevated position, preferably on a pillow.The anointing of the oil is generally done, at first by the physician himself and then bythe attendants all over the body. The oils for the purpose should be medicatedaccording to the nature of the disease the patient is suffering from. The eyes and earsshould be covered with cotton so that, liquid may not enter in the eyes. For the treatment two attendants are needed; one for supporting the vesselcontaining the liquid to drip on to the forehead of the patient, and the other forcollecting the liquid that falls from the head of the patient and returning it back to thevessel wherefrom the liquid is to drip.Dharapati or Droni or Dhara table: For Shirodhara a special type of table is used and it is known as Droni. Thetable is made up of wood with raised edges in all the four sides so that the liquid/oilmay not flow out. The first one is the selection of suitable wood for making theDharapati. Many trees as Plaksha, Udumbara, Varana, Nyagrodha, Devadruma,Punnaga, Kapitha, Bakula, Asoka, Amra, Vilwa, Nimba, Khadira or Arjuna. The idealwood universally accepted by the physician is Kupilu (Nuxvomica). In this tablearrangements are made at the head end so that, the liquid poured can be collected inanother vessel and can be re-used.Dimension of Droni: The construction of droni is explained here. It is better wrought from a singlepiece of wood 11 feet 9 inches by 2 feet 9 inches by 9 inches. From either end mark “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 38
  56. 56. Review of ShiroDharakarmaoff a length of 9 inches and carve out the four rounded handles near the bottom at thefour corners, each having a diameter of two inches. Leaving a margin of one and halfinches width all round scoop out the whole surface of 10 feet by two feet 6 inchesuntil the margin around stands one and half inches above it everywhere. Then theinner space is divided into two main compartments; the anterior compartment or thehead end having a space of 2 feet 6 inches (including a cross ridge) by 2 feet 6 inchesand the posterior compartment or the body portion having a space of 7 feet 6 inchesby 2 feet 6 inches. A partition ridge is made to separate the anterior compartmentfrom the posterior compartment and also for giving a comfortable seat for the neck ofthe patient during the treatment. The anterior compartment is again divided into two parts; one being a levelplatform 11 inches wide at the farther end towards the head portion and the otherbeing a sloping plane of 1 foot 5 ½ inches wide from the bottom of the partition ridgetowards the head end platform. Here in the head end platform scoop out a circularhemispherical sink of 10 inches diameter and 6 inches depth such that the sinkcommences at a point 2 inches away from the bordering rim at the head end. The sinkshould protrude 1 inch into the slopping part below the head end platform. Thisprojection facilitates an easy flow of the liquid coming down the slope to the sinkfrom the portion near the marginal cross-ridge which separates the head portion fromthe body compartment. The space between the cross-ridge and the circular sink isplaned with a slight slope so that all the liquid drippings from the head of the patientmay drain into the sink. The body compartment is scooped out gradually sloping towards the foot endto a depth of 7 ½ inches at the farther end of the basin where an outlet is bored “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 39

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