“A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF NASYA WITH KARPASASTHYADI TAILA AND NAGARA TAILA IN THE MANAGEMENT OF AVABAHUKA”

Introdution
The Effect of Nasya with Karpasasthyadi Taila & Nagara Taila in The Management of Avabahuka
1. INTRODUCTION
Ayurveda is the rich storehouse of time-tested and effective recipes for the
treatment of several obstinate and otherwise incurable diseases. More important than
these recipes are the specialised therapies, which while curing such diseases
strengthen the immune system in the body and help in the preservation of positive
health. These specialised therapies in Ayurveda are called as Panchakarmas. It is no
wonder that the scientists and physicians in India and abroad are evincing deep
interest in the classical form of Ayurvedic treatment. Panchakarma therapy primarily
aims at cleansing the body of its accumulated impurities and nourishing the tissues.
Once this is achieved, it becomes very easy to rejuvenate the tissues and prevent the
process of ageing. This helps the individual to lead a disease free old age and
becomes capable of serving the society with accumulated experience without any
mental disability and physical decay.
It is necessary at this state to make it clear that these Panchakarmas do not
imply simple administration of emesis, purgation, enema or nasal drops as is
conventionally understood. Elaborate methods are described for the preparation of
these therapies, their administration, preparation of the individual prior to the
administration of these and the management of the patient after the therapy is
administered.
Nasya is an important therapeutic procedure as many of the courses of
Ayurvedic treatment. It comes under the Panchashodhanakarmas. Nasya Karma is
one of the important Panchakarma mainly for Urdhwajatrugata Vikaras . It is
more or less essential in all Urdhwajathru Vikaras. Nasya is effective not only for
inducing immediate results but also serves as a permanent cure.

Introdution
The present day, world is full of stress and strain due to change in life style,
sedentary work, increasing competitions in all walks of life. This has lead to many
diseases which though does not kill a person, but hamper his day-to-day life. Vata
among three humors is considered to be superior most in all aspects, for every action
or movement, strongest in its ability to produce diseases and worst mortality. Vata
which is motivating factor of other two doshas gets easily aggravated in this fast
paced life. Contradictory approaches to pacify this vitiated state have to be resorted to
maintain the equilibrium.
Economy of country relies on its work force. Avabahuka is one of such
disease which hampers the day to day activity of an individual. In classics two disease
have been mentioned ie Bahushosha and Avabahuka. Bahushosha is due to
Kevalavataja and Avabahuka due to Vata and Kaphaja involvement (Avarana).In
Avabahuka Shoola during movement and Bahupraspanda Hara (Stabdhatha) are
manifested.
Considering these facts an attempt is made to study the disease Avabahuka in
detail and to counter act the disease process by adopting suitable therapies.
Avabahuka can be relieved by therapies like Nasya , Sneha Paana,Abhyanga,Swedana
etc according to the classics. In the present study Nasya is selected because this
procedure is more effective in different Vyadhyavasthaas of Avabahuka.
Karpasasthyadi Taila described in Vatavyadhi Adhikara of Sahasrayoga is
generally practiced in the treatment of Avabahuka. By considering the Samprapti of
Avabahuka, the Taila Yoga which is processed with the property of the drugs which
are having Vata Kaphahara nature would be affective. Nagara is a drug having Vata
Kaphahara property which is easily available and economical compared to
Karpasasthyadi Taila. Hence an attempt is made to compare the effect of
Karpasasthyadi Taila Nasya and Nagara Taila Nasya in the management of
Avabahuka, this study is undertaken.

Introdution
This dissertation is a sincere effort to study the Nidana Pancaka as well as
Chikitsa of Avabahuka with special reference to the therapeutic efficacy of Nasya
with Karpasasthyadi Taila and Nagara Taila. This dissertation consists of:
Conceptual Study.
Clinical Study.
Discussion.
Conclusion and Summary.
Conceptual study begins with the historical review and description of
Avabahuka, definition, etymological derivation, anatomical understanding of shoulder
joint in Ayurvedic and modern perspective, Nidana Panchankas, modern perpetuation
of the disease Avabahuka, Chikitsa and Pathyapathya. There after historical review
and description of Nasya Karma is decribed, followed by description of
Karpasasthyadi Taila and Nagara Taila in the drug review.
Clinical study starts with the materials and methods of the present work with
complete description of the assessment criteria and descriptive statistical analysis of
the sample taken for the study is methodically elaborated. Finally observations, results
and their statistical analysis are presented in order along with tables and graphs.
Discussion includes the critical conceptual analysis, observation and results
obtained in the present study.
The whole thesis work is summarized with conclusive points under the
headings of Conclusion and Summary.

Objectives
2. OBJECTIVES
Avabahuka occurs in Urdhwajatru Pradesha. Nasyakarma is one of the
important procedures in Panchakarma and it is the treatment of choice for
Urdwajatrugata vikara “Nasahi shiraso dwaram” i.e Nose is the gate way to head.
The ingredients of Karpasasthyadi Taila and Nagara Taila are having Ushna
Veerya, Snigdha Guna, Madhura Vipaka, Vatakapha Hara properties and having
Karmukata as ,Snehana and Brumhana .
In modern science, Adhesive Capsulitis or Frozen shoulder is a disease
having similar clinical features as Avabahuka. Frozen shoulder is a condition that
causes restricted range of active and passive glenohumeral motion in the shoulder
joint.
Adhesive Capsulitis or Frozen shoulder is not having much effective medicine
or therapy in contemporary system of medicine. Anti-inflammatory, analgesics are the
drugs of choice in contemporary system of medicine. Surgery occasionally is
performed. Unfortunately all the analgesics are prone to many side effects particularly
in prolonged usage. Ayurvedic approach to the Avabahuka is to retard the
degeneration process and strengthening the dhatus pacifying the Vata Dosha has
special importance in the management of any degenerative phenomenon. As
Avabahuka is one of the Urdhwajatrugata Vikara and especially Dhatukshayajanya
Vataroga Brumhana Nasya and Snehana, Swedana are more beneficial.
Ayurvedic scientists at various centers with an aim to study Avabahuka and to
evolve safer and economical medicaments for it have carried out several experimental
and clinical studies. The works are successful to some extent to relieve common

Objectives
complaints like pain and stiffness of this condition.
George P.J: Classical management of Avabahuka, 1981 Kerala University,
Thiruvananthapuram.
Philomina P.J: Avabahuka and its management, 1988 Government Ayurveda
Medical College, Mysore.
Shukla Niranjan: Effect of Nasya and Abhyanga on Avabahuka w.s.r to Masha
Taila, 1997 Gopabandhu Ayurveda Mahavidyalaya, Puri.
Naveen C.J: A study on Avabahuka and its management through Nasya
Karma and Vatagajankusha Rasa, 2004 Dr B.N.M Rural Ayurvedic Medical College,
Bijapur.
Only few works were carried out related to the present topic. In the
degenerative diseases, Brumhana Nasya and Vatashamaka Chikitsa are more effective
(A.S.Su. 29/16).
In the classics the line of treatament described as Nasya and Snehapana
(A.H.Chi. 21/44). No studies seem to have been conducted to evaluate the effect of
Karpasasthyadi Taila Nasya and Nagara Taila Nasya in Avabahuka. Hence it is
intended to evaluate the efficacy of these procedures in case of Avabahuka. So the
present study, “A comparative clinical study on the effect of Nasya with
Karpasasthyadi Taila and Nagara Taila in the management of Avabahuka” is under
taken.
Objectives of the study are -
1. To evaluate the efficacy of Karpasasthyadi Taila Nasya in Avabahuka.
2. To evaluate the efficacy of Nagara Taila Nasya in Avabahuka.
3. To compare efficacy of Karpasasthyadi Taila Nasya and Nagara Taila
Nasya in Avabahuka.

Review of Literature
3. REVIEW OF LITRATURE
DISEASE REVIEW
AVABAHUKA
HISTORICAL REVIEW
History is a part of description of any object. In this way before going in detail
about the Avabahuka, an attempt has been made to trace the reference regarding
Avabahuka in particular and Vatavyadhi in general available till now beginning right
from Vedic period. For the total coverage of historical aspect, it has been divided into
four sections viz.
• Vedic Period and Pauranika period
• Samhita Period
• Sangraha Period
VEDIC PERIOD AND PAURANIKA PERIOD
The Vedas are considered as the oldest recorded knowledge in our culture.
Avabahuka is not mentioned in any form of Vedas. However, in the Atharvaveda, the
word ‘Vatikrita’ is mentioned. Here, ‘Vatikrita’ word denotes Vata Vyadhi. In same
Pippali (Ath. 6/109/3) and Visanika (Ath. 6/44/3) have been claimed as ‘Vatikritasya’
Bhesaja and Vatikritanashini respectively.
Many Vatika disorders pertaining to voluntary movement of limbs are told in
Vedic Literature under the terms Viskanda, though clear description of Avabahuka is
not found. Though the term Vishkanda mainly used in Atharva Veda (Atha-2/4; 3/9)
and Taitireeya Samhita (TS-7/3; 2/1). Viskanda was mentioned along with Visra

which means crushing the limbs and Abhisochana (burning sensation) (Atha-2/4/2).
Vyamsa was mentioned in Rig Veda which indicates the disorders which hamper the
movement or Gati.
In Yajur Veda , Thaittireeya Yajur Brahmana,second Ashtaka,6th chapter,4rth
Anuvaka,Vata and Vata Vyadhi is told.
On the basis of above Vedic descriptions it appears that many types of Vata
disorders were prevalent during Vedic period which impair the movement of the
limbs resulted due to description of muscles and joints leading to disability and appear
to be considered under the name Vishkanda and Vyamsa.
More attention was paid on Vata in Upanishads normal functions, etiological
factors of its disorders, its alleviations etc., have been described in Upanishads in
detail. Upanishads are the books which treat of spiritual matters apart from
ceremonials or belongs to the Jnaana-Kaanda. Their dates cannot be fixed with
certainty, only it is certain that they are older than the Buddhist movement. Puraanas
are the next literatures which deals more on Bhakti though it deals history and
cosmology, dates unknown. There are elaborate description of the functions and types
of Vata, its locations, qualities etc.
Kenopanishads have given the meaning of Vayu as one, which is always in
motion and continued efforts (Keno.3/10)
Ishopanishad (Ishavaasyopanishad) also described it in a similar fashion.
Chandogyopanishad has highlighted the Cala property of Vayu and described its
association with body and movements. (Cando.4/16/1 & 4/3/1).

Bhrahmasutra has given importance of Vyana Vata as the one that resides in
the joints and it is responsible for the movements of the joint. The circulation is
considered as the function of Samaana. (B.S.1/5/3). In Garuda Puraana, Ayurveda
related subjects are described in details. In this treatise a separate chapter available as
Vaatavyaadhi Nidana.
Paanini has mentioned Vata Kopa as well as Vaaa Shamana. He has given the
term Vatiki for disorders of Vata.
SAMHITA PERIOD
Detailed description regarding Avabahuka is available in different Samhitas.
• Charaka Samhita (200 –300 B.C.): Charaka Samhita is one among the
Brihatrayees and has not mentioned directly about Avabahuka. But Charaka
explains regarding Bahushosha1
a condition resembling Avabahuka.
• Sushruta Samhita (600 BC to 400 BC): has discussed the Samprapti Lakshanas
of Avabahuka in Nidana Sthana 1st
Chapter and Chikitsa in 4th
Chapter of Chikitsa
Sthana.2
• Astanga Hridaya (5th
Century): explains about Avabahuka in Nidana Sthana 15th
Chapter and its Chikitsa is discussed in 21st
chapter of Chikitsa Sthana.3
• Astanga Sangraha (5th
Century): explains about Avabahuka, its Samprapti in
Nidana Sthana 15th
Chapter and its Chikilsa in Chikilsa Sthana.4
• Transitional Period: Many commentators of this period like Dalhana, Arundatta,
and Hemadri etc. have tried to Analyse Avabahuka.
SANGRAHA KALA :
Sangraha Kala - (100 A.D.-800AD): Different texts of Sangraha Kala contain

description regarding the disease Avabahuka.
• Madhava Nidan (7th
Century A.D.): In Madhava Nidan in Acharaya
Madhavakara has explained the Lakshana of Avabahuka. Madhavakara is the first
to differentiate Avabahuka from Bahu Shosha.5
• Chakradatta (12th
Century): In Chakradatta Acharya Chakrapanidatta
explained the treatment of Avabahuka.6
• Sharangdhara Samhita (13th
Century): In Sharangadhara Samhita Acharaya
Sharagadhara explained Avabahuka under one of the Nanatmaja Vata vyadhi.7
• Gada Nigraha (12th
Century): In Gad Nigraha Acharya Shodhya mentioned the
Lakshanas and Chikitsa elaborately.8
• Vangasena Samhita (12th
Century): In Vangasena Samhita, Lakshanas and
Chikitsa is mentioned.9
• Yogratnakara (17th
Century): In Yogratnakara Lakshanas and Chikitsa of
AVabahuka is been mentioned.10
• Bhaishajya Ratnavali (18th
Century): Treatment of Avabahuka is mentioned in
Vata Vyadhi Chikitsa Adhikar.11
• Sahasrayogam: It is complied by unknown author or authors containing
description of numerous preparations particularly used traditionally in Kerala.
While explaining the efficacy of Yogas he included Avabahuka. 12
NIRUKTI AND PARIBHASHA
Before proceeding to Avabahuka it is better to deal with the Nirukti and
Paribhasha of Vata Vyadhi as it is one of the Vata Vyadhi -

“Vikrita vata janito asadharana vyadhi vata vyadhi”
Extra- ordinary disease resulting from Vikrita Vata is known as Vata Vyadhi.
The word Avabahuka is formed by two components of words namely, Ava
and Bahuka.
Ava means:
• As per Sanskrit English dictionary edited by Vamana Shivaram Apte, Denotes
the meaning of Ava as away off or down.
• Ava as prefix to verbs and verbal nouns off, away down.13
Apa is used as alternate for ‘Ava’ in some like Astanga Sangraha and
Sharangdhar Samhita etc., which gives following meaning.
• Viyoga, Vikratau:14
Viyogou means Dysfunction.15
• Stiffness in the arm joint. 16
The usage of ‘Ava’ or ‘Apa’ change according to different regional
pronunciation. Thus in the present condition, the ‘Ava’ or ‘Apa’ can be taken as
Deterioration as Dysfunction.
Bahuka usually occurs at the end of a compound and is studied as follows:
a) Bahu – The shoulder.
b) Bahu – “Bahu Prabahu cha Koorparasyaurdhwadha bhagou iti” (Vishnupuran)
c) Bahu – Muscular Gender.
d) “Bahu (Pum) Badha Ku Dhashaha Bhuje Kakshyanguli Paryanthe avayave.
Bahu is structure from kaksha to anguli.”
Acharaya Sushruta has considered Bahu is a part between Amsa and Karpoora
Sandhi.

“Amsa Koorparantharam Prathyangamekam.”
Thus Avabahuka can be defined as Bahu Stambha Avabahuka.
Under Avabahuka Monires writes the meaning as spasm in the arm and refers
to Sushrutha Samhita with due respects to the Scholar, it may be said that “Spasm in
the arm” is not to be taken literally but to mean it something like “stiffness in the
arm” in the words.
To summarize the above discussion and considering the relevant clinical
features, the term Avabahuka and Avabahuka would mean dysfunction of the arm,
stiffness in the arm joint, disability of shoulder joint.
Paryayas: As such there are no Paryaya of Avabahuka mentioned in classics but
different words like Avabahuka and Apabahuka are used in different context. These
words may be considered as Paryaya of Avabahuka.
Paribhasha of Avabahuka: 17
Avabahuka is a disease characterized by aggravated Vata at Amsa Pradesa
,after constriction of Sira (Akuncana) causes the restricted movement(Bahupraspanda
Hara).
AMSA SANDHI RACHANA SHAREERA VIVEVACHANA:
This is a major joint of upper limb. This is one type of Chala18
and Ulookhala
Sandhi.19
This is formed by the combination of Pragandasthi, Akshakasthi and
Amsaphalakasthi.
Pratanavat types of snayus cover this Sandhi20

Shleshmadhara Kala is presents in this joint and secretes Shleshaka kapha.21
This acts as lubricant and helps in protection and movement of the Sandhi.22,23
Amsamarma is present near this Sandhi. A brief explanation of it can be done as
follows.
Acharaya Sushruta has described that the Rachana of Sandhi as like a wheel
having an axis. When the axis is lubricated by putting oil on it, the wheel can move
freely and friction does not occur. In the same way the bones or joints can move
freely in the presence of Shleshama.24
The word Amsa denotes a specific area of the shoulder. The Amsa Marma is
situated within the line of the area joining head (Murdha), neck (Greeva) and the arm
(Bahu). This is a Snayu Marma measuring to a length of half finger's width (1 cm) 25
This Marma is located on the Amsa that is formed by the union of Amsa
Peetha (glenoid) and the Skanda (acromio clavicular joint).
The physical matrix that are present in Amsa Marma are Mamsa, Sira, Snayu,
Sandhi and Asthi.26
But it is a Snayu Marma.27
As it is one of Vaikalyakara Marma, any trauma to this will produce disability
or deformity of the shoulder joint.28
NIDANA PANCHAKA OF AVABAHUKA
To understand the entire process of manifestation of disease, Acharyas have
explained the five means through which one can diagnose a disease correctly. These
five individually or collectively helps to diagnose the diseases. These five means are
called as Nidana Panchak.

Nidana of Avabahuka:
The knowledge of Nidana is important for the proper understanding of the
disease, for deciding the line of treatment to be adopted. It is also helpful in deciding
the Sadyaasadyata of the disease.29
One of the Nidana that has been mentioned for the causation of the Vatavyadhi is
Marmabhighata. Charaka and Sushrutha have identified 107 Marma in the body,
where Sushrutha has elaborated all the types. While going through the Lakshana
mentioned for the Marmabhighata, it is said that the Amsa Marmabhighata, where the
Bahu lose its function and becomes stiff which mimics the Rupa of the disease
Avabahuka. Hence it can be considered as one of the specific Nidana for this illness.
The following are considered as the Vishista Nidana as these are directly or
indirectly cause detrimental effect on Amsapradesha.
Abhighata: Any direct or indirect trauma that causes injury to the Amsapradesha or
Amsamarma will change the structural integrity and can cause Kriyahani of Bahu.
Vyayama: Those exercises which directly or indirectly influence the shoulder joint
are to be considered here.Vyayama in excess or violent exercises related with Bahu
provocates Vata, producing Shoshana and Sankocha of the Sira and ultimately causes
dysfunction of the joint.
Plavana: This if done in excess will be a cause of over exertion to the Sandhi causing
Vataprakopa and then manifesting the disease Avabahuka.
Bharavahana: Carrying heavy loads over shoulder will cause deformity in the joint
capsule which further leads to disease.

Balatwat Vigraha: Wrestling with a person who is stronger will cause Aghata to
Amsapradesha and Vataprakopa can takes place.
Dhukka Shayya: An improper posture that gives more pressure over the Amsasandhi
will disturb the muscular integrity and can vitiate Vata. This leads to the disease.
Even though a specific Nidana have not been mentioned for Avabahuka,
however the general factors told for Vata prakopa have to be analyzed and elicited.
According to Madhukosha Nidana may be classified into two groups;
1) Bahya Nidana – Bahya Nidana includes Ahara,Achara,kala etc, which include
the Manasika Bavas also.
2) Abhyantara Nidana – Doshas and Dushyas (Dhathus, Mala, Upadhathu,
Srotas) coming under Abhyanthara Nidana. Indulging in Vata Prakopaka
Nidanas leading to vitiation of Vata in that region.30
In regard to Nidanas Vatavyadhi only Acharya Charaka 31
and Bhavprakasha
have explained in detail. While in Sushruta Samhita, 32, 33
Astanga Sangraha34
and
Astanga Hridaya35
etc, generally have been mentioned.
Nidanas of Vata Vyadhi and Vata Prakopa vis a vis Avabahuka
Aharaja: The Nidana in the form of Aharaja or faulty diet is included under this
group and this can be divided into 8 subgroups as follows:
i. Dravyataha: All the food articles responsible for Vata Prakopa have been
included under this group.

ii. Gunataha: The quality of food articles like Ruksha, Shita etc. that lead to the
Prakopa of Vata have been included under this group.
iii. Rasataha: Excessive use of certain Rasa which leads to the prakopa of Vata has
been included in this group.
iv. Karmataha: Vata Prakopa can occur due to excessive use of Vishthambhi food
article and those are included under this heading.
v. Viryataha: Shita Virya Yukta Ahara may cause the Prakopa of Vata.
vi. Matrataha: Taking food in Alpamatra, Atimatra etc. comes under this heading.
vii. Kalataha: The Vata Prakopa occurs at the end of Ahara Jeerna Kala and in
Varsha Ritu which is included here.
viii. Mithyopayogatah: Violating the rules of Ahara Sevana can lead to Vata Prakopa.
B) Viharaja: The Nidana in the form of Vihara or factors related to the habit and
behavior of the patient is considered here.
Any of the following two can cause Vataprakopa and leads to disease.
(1) Mithyaprayogataha: The faulty habits or the improper use of Sharira that may lead
to the Prakopa of Vayu is included under this heading.
(2) Atiyogataha: The excessive use of the Karmendriya can cause vata prakopa.
C) Agantuja: Vata prakopa which occurs due to external factors like trauma, etc. is
included under this heading.

D) Manasika: The Manasika Nidana like Chinta, Bhaya, Shoka etc. are also
responsible for Vata Prakopa.
E) Anya Heuja: All the other Nidanas except above are included under this heading.
Table no.1 Showing Nidanas of Vata Vyadhi and Vata Prakopa vis a vis Avabauka
Nidana C.S.37,38,39
Su.S40,41
A.H42,43
A.S.44
M.N45
Aharaja
Rasa
Katu
Tikta
Kashaya
+
+
+
+
+
+
+
+
+
+
+
+
Gunas Ruksha
Laghu
Sheet
Vishad
Khara
Vaistambya
Darunak
+
+
+
+
+
-
+
+
+
+
+
-
+
-
+
+
+
-
+
-
-
+
+
-
+
+
-
-
+
+
+
-
-
-
-
Veerya Sheeta + - - - -
Dravya Adhaki
Chanaka
Kalaya
Masura
Mudga
Nispava
Shushkashaka
Tinduka
-
-
-
-
-
-
-
-
+
-
+
+
+
+
+
-
+
-
+
+
+
+
-
-
+
+
-
+
+
+
-
+
-
-
-
-
-
-
-
-
Matra Heen Abhojana
Alpabhojana
Vishamashan
+
-
-
+
+
+
-
+
-
-
-
+
+
-
-
Viharaj Ati Maithuna
Ati Jagaran
Ati Plavan
Ati vyayam
Ati Vichestam
Bhaya
+
+
+
+
+
+
-
-
+
+
-
-
-
-
-
+
-
+
-
-
-
+
-
+
+
+
+
+
-

Cinta
Krodha
Mada
Soka
Utkantha
+
+
-
+
-
-
-
-
-
-
-
-
+
-
+
+
-
-
+
+
Mityayoga Dukhshaya
Asanat
Vegadharan
Balvat Nigraha
Bhar Haron
+
+
-
-
-
+
+
+
-
+
-
+
-
+
+
+
-
-
-
-
Kalaj Aparatra - - + + -
Agantuj Abhighataj
Marmaghata
+
+
-
-
-
-
-
-
-
-
Bhavprakasha46
,Yogaratnakara etc is also having the same opinion regarding
Vatavyadhi.To summarize, the above said Nidanas mentioned under Vihara specially
involving Amasa Sandhi and Marmabhighata to Amsa leads to the development of
Avabahuka.
POORVA ROOPA OF AVABAHUKA
Poorva Roopa are indicators of impending diseases. They occur prior to
complete manifestation of disease to suggest the forthcoming illness. In parlance with
the Shadkriyakala this stage denotes the Sthanasamshraya Avastha.47
“Poorva roopameva Sthana samshraya lingam (Chakradatta)”
In this stage the provocated Doshas having extended to the other parts of the
body become localized and it marks the beginning of specific symptoms pertaining to
those structures.

In the present context Poorva Roopa of Avabahuka have not been mentioned
anywhere in the text. So for that reason we have to take Poorva Roopa of the Vata
Vyadhi which are told as
“Avyaktam lakshanam tesham Poorvaroopamiti Smrutham”.48
In case of Vata Vyadhi the face of Poorva Roopa will be in latent form. So the
patient will not appreciate them.
Chakrapanidatta commenting on the word “Avyakta” mentions that few mild
symptoms are to be taken as Poorva roopa.49
But Vijayrakshita the commentator of Madhava Nidana has given the clear
meaning of the term Avyakta.50
ie unclear symptoms.
It is clear from the above reference that Avyakta is Alpa Vyakta or less
manifested. So in Avabahuka also Poorva Roopa can be taken as minor symptom like
Alpa Shoola and Sthabdhatha produced before the actual manifestation of disease.
ROOPA:
Next to the Poorvaroopa in pathological conditions will be Roopa. Roopa
appears in the Vyakta Avastha. This is the unique stage of the illness, where in, it is
clearly recognizable as all its characteristics signs and symptoms manifest.51
Based on
these Lakshanas a particular disease can be diagnosed.
The features of Avabahuka are as follows.
• Bahupraspandanahara52
(Stabdatha)
• Shoola553.54
Thus practically speaking Stabdata ( Sthambha= Graha) and Shoola are the
Pradhan Lakshana that occurs in Avabahuka. The intensity and nature of the pain is
recommended only on the basis of patient’s description. Apart from these
Lakshanas, Sparshaasahatva is also one of the features observed.

UPASHAYA AND ANUPASHAYA
Upashaya are the medicines, diets and regimens which are similar to the
causative factors of disease or are dissimilar/opposite to the causative factors of
disease which gives relief to the patient55
.
Upashaya for Avabahuka has not been mentioned in the text. But we have seen
some factors which aggravate the disease and some factors which give relief to the
patient. For example, Physical excretion , lifting heavy weights, exercises
etc.Increases pain in patient. These are Anupashaya.
Taking rest , application of oil , not indulging in physical excertions, there is
relief in pain in patient . These are Upashaya.
In the same way, in Shaithya (cold climate), and in rainy season patient feels
discomfort. These are Anupashaya.
On the other hand, in summer season, Ushnata or exposing to hot gives a feeling of
relief in patient, called as Upashaya in Apvabahuka.
SAMPRAPTI:
The manner of Doshic vitiation and the course they follow, culminating in the
development of specific clinical manifestation is known by the name Samprapti. In
other words, it briefly reflects the state of affairs brought about by the factors vitiated
by different source of etiological factors and afflicting different parts of the body,
resulting in either structural on functional changes in the part, finally developing a
series of signs and symptoms.
The knowledge of Samprapti helps in the comprehension of the features of a
disease like Dosha, Dushya, Sroto Dusti etc. A proper understanding of Samprapti is
Vital in planning of the treatment of any disease, since Chikitsa enunciated in
Ayurvedic text is nothing but Samprapti Vighatana.

This chapter discusses about Samprapti of Avabahuka. In the classics, the
Samprpati of Avabahuka is told as follows.
1 ) Samanya Samprapti
It is due to the Snayugata Vata.In this condition the Vyana Vata vitiates the
Snayu and produce Sthabdhatha in the Amsa Predesha and produce Avabahuka.56
2)Vishesha Samprapthi
The Morbid Vata, which gets lodged in Amsa Moola, will cause the
Sirasankochana (constriction of the Sira) locally and produces Bahupraspandanahara
(restricted movement), manifesting Avabahuka.
3)Avaranajenya (Kaphaavrtha vyana)
In this condition Vyanavata combines with Sleshakakapha and leads to
Gatisanga (restricted movement) and produces Avabahuka57
.
The Samprapti Ghatakas of Avabahuka can be taken as:
Dosha - Vata Vyana Vata
Dushya - Sira, Snayu.
Rogamarga - Madhyam
Udbavasthan - Pakwashaya
Vyaktasthan - Bahu (Amsa)
Adhisthana - Amsa Pradesh

Illustration No. 1 Showing the Schematic Representation of Samprapti of
Avabahuka
Nidana
(Bharavahana ,Vyayama etc)
SADHYA ASADHAYATH
Acharya Charaka, in Chikitsa Sthana, has explained that if Vata vyadhi more
than 1 year or chronic is difficult to cure or considered as incurable for treatment
(Asadhya)
He further explains that, Vata vyadhi should be treated if they are in strong
patient, newly originated or less than 1 year and also free from complications
(upadrava). They are Sadhya for treatment 58
.
According to Acharya Charaka, if Vatavyadhi is connected with Sandhichuti,
Kunjanam, Kubjata, Ardita, Pakshaghata, Angasamshosha, Pangutva and those which
are Majja and Asthigata are usually cured with difficulty or even incurable for
treatment.
Provocation of
Vyana Vata
Vyaktasthana
(Amsa pradaesha Sira,Snayu)
Avabahuka
Sthana Samsharya,Vyaktha
Sanchaya, Prakopa,Prasara

UPADRAVA:
The occurrence of another disorder on the wake of primary disease is termed
as Upadrava59
. Acharya Sushruta says that if the patient of Vatavyadhi develops the
complications like Sunam (edema/inflammation), Suptatvacha (tactile senselessness),
Bhagna (Fracture), Kampa (tremors), Adhamana (distention of abdomen with
tenderness) and pain in internal organs, then he doesn’t survive 60
.
SAPKESHA NIDANA:
Sapeksha Nidana is the comparison of similar features, which are found in
many diseases. Once the Samprapti of a disease has been established, that diseased
condition should be differentiated from taking consideration of similar other
disorders. Vyavachedaka Nidana or differential diagnosis is the determination and
establishment of a diseased condition taking consideration of the various disorders.
The disorders are differentiated from one another on certain cardinal features.
Avabahuka should be differentiated with the following diseased conditions that affect
the upper limb.
1. Amsashosha61
2. Amavata62
3. Vata Raktha63
Table No.2 Showing Sapeksha / Vyavachedaka, Nidana of Avabahuka
Nidana
Panchaka
Avabahuka Amsashosha Amavata Vatarakta
Nidana Vatavridhikara
ahara-vihara
Vatavridhikara
ahara-vihara
Viruddha ahara,
Cheshta,
Mandagni,
Amla Lavana,
Madhura,Teeks
hna, Ushna,
Snigdha,
Viruddha,
Raktha

Prakopakara
Ahara, Vihara
Purvarupa Avyakta Lakshna Avyakta Lakshna Swedaatyartha
Karshnya,
Sparshgnatva,
Kshateatiruk,
Sandhi
Shitilyata
Gurutva
Vaivarnya,
Peedakodhbava
Rupa Bahuspraspandhar
a
vadana
Bahuspraspandhara
Shosha, Vadana
Rujam,
Shotham,Daurb
alya, Agni
mandhya,
Prasaka,
Aruchi,
Gauravam,Daha
m Vrischika
damshavat
Peeda.etc
Toda, Beda,
Shosha,Kandu,
Daha,
Spurana,Paka,
Teevra ruk,
Grathita-paki
Shvayathu
Spreads like
mooshikavisha
Starting from
Smaller joints
Samprapthi
1.Adhistana Amsasandhi Amsasandhi Hasta,Pada,
Janu Gulpha,
Trika, etc
Padhamoola,
Hasthamoola
2.Agni Dusti Samagni Samagni Mandagni Samagni
3.Rogamarg
a
Madyama Madyama Trividha roga
marga
Bahya,
Madyama
4.Dushya Sandhi, Snayu Sandhi, Snayu All Datus exept
shukra
All Datus exept
shukra
5.Dosha Vata Kapha Vata Vata, Kapha Vata, Rakta
Upashaya Ushna-Snigdha Ushna-Snigdha Ushna-rooksha Sheeta

In Vata Raktha specific feature like Ahara, Vihara etc are indicated as Nidana
but specific Nidana is not told for Avabahuka. With this we can differentiate
Avabahuka from Vata Raktha. Guru Ahara, Agnimandhya are major Nidana for
Amavata, these are not told in Avabahuka Nidana. Agnimandya in Amavata is a
major Nidana which differentiate Amavata and Avabahuka.
In Vata Raktha specific features are mentioned under the headings of
Purvarupa, whith these we can differentiate it from Avabahuka as there is no
Purvarupa told in Avabahuka, Amavata, Amsashosha.
Bahuspraspandhara and Shosha, are the Lakshanas seen in Amsashosha. In
Avabahuka Shosha is not seen. In Amavata and Vata Raktha many features can be
seen as Rupa with which we can differentiate them from Avabahuka.
In Samprapthi of AmaVata and Vataraktha the Dushyas involved are all
Dathus exept Shukra. In Avabahuka Sandhi and Snayu Affected. In Amsashosha
Sandhi and Mamsa are affected. In the Roga Marga of AmaVata, Trividha Rogamarga
can be seen. In Vataraktha, Bahya and Madhyama Rogamarga is affected. In
Avabahuka and Amsashosha the Rogamarga is Madyama. In the Samprapti Of
Amavata Mandagni Plays a major role. Apart from these the Adisthana of the Roga
that is Amsa Sandhi is clearly mentioned in Avabahuka. With these we can
Differentiate Avabahuka from other diseases.
The Upashaya in Vataraktha is Sheeta. In Amavata it is Usna Rooksha in Ama
condition and Sneha and Usna in Nirama condition. In Avabahuka the Upasaya is
Usna, Snigdha which differentiates it from Vata Raktha and AmaVata

CHIKITSA:
After the Diagnosis of a Disease, the Next will be its Management. In the
Present chapter, the management of Avabahuka is discussed.
The general line of treatment mentioned for Vata Vyadhi in Ayurvedic
classics include Snehana (Both external and internal), Swedena, Mrdusamshodhana,
Basti, Sirobasti etc.64
. Ayurvedic classics explain the chikitsa of Avabahuka as follows:
1. Nasya Karma has been mentioned by Vagbhata in Jatroordhava Vata Vikaras65
2. Astanga hrudhaya explains Nasya and Uttara Bhaktika Snehapana are useful
in the management of Avabahuka66
.
3. Sushruta Acharaya advice to follow Vata Vyadhi Chikitsa for Avabahuka
except Siravedh67
.
4. Astanga Sangraha explains Nasya for Avabahuka. It also explains
Uttarbhaktika Snehapana68
.
5. Vangasena advices Nasya Uttarabhaktika Snehapana and Sweda for the
treatment of Avabahuka 69
By considering the above references, this can be concluded as line of
treatment of Avabahuka.
• Abhyanga
• Swedana
• Uttarabhaktika Snehapana
• Nasya Karma
• Shamanaoushadi
• Pathya Apathya

1) Abyanga: .
The Veerya of the drug used for Abhyanga gets digested with the help of
Sthanika Bhrajaka Pitta and enters into the Srotas and start its action. Taila used for
Abhyanga after entering into the body nourishes the body tissues, gives strength70
.
2) Swedana:
“Stambha Gourava SheetaGunam Swedanum Swedakarakam” 71
.
The process which reduces stiffness, heaviness, reduces the Shetatha and
produce sweating is called Swedana. It does the dilation of the vessels thus by
improving blood circulation. Hence it is very much beneficial in conditions where
Shoola, Stambha and Sankocha are present.
In the context of Vatavyadhi Swedana Karma like Pinda Sweda, Nadi Sweda,
Avagaha Sweda are mentioned which alleviate Vata Dosha. It also helps in relieving
Stambha (stiffness), Gourava (Heaviness) and Sheeta (cold).
3) Uttarbhaktika Snehpana:
In classics Abhyantara Snehapana is divided into 2 types.
1) Shamana
2) Shodhana
Shamana and Shodana are used in case, when we need palliation and allivation
of the morbid Doshas from the body respectively. Brumhana Snehapana comes under
the Shamana Snehapana.
Brumhana is the one, which is done or used for the nourishment. In the
present context of Avabahuka the vitiated vata due to its Rookshadi qualities does the
Shoshana of Shleshaka Kapha that is present in the amsa Sandhi. To subside this
Rooksha quality and to normalize the Shleshaka kapha qualities, Brumhana

Snehapana is advisable, Bruhmana type of Snehapana is advised prior, middle and
after the intake of food, as explained by Hemadri72
Uttarbhaktika Snehapana i.e. Snehapana done after the intake of food is useful
in the disorders of Udana vata73
.
Uttarabhaktika Snehapana indicated in Avabahuka fulfills the need of
treatment required in case of Udana Vata disorder and also act as Brumhana. Here
Alpa Matra Snehapana should be used. Sneha used here should be Taila, because
Taila is best amongst Snehas in Vata Vyadhi74
.
4) Nasya Karma
The administration of either medicine (drug) on medicated oil through the
nose is known as Nasya Karma75
. Navan, Nastakarma are the words used for Nasya
Karma. It gives strength to neck shoulders chest and increase vision76
, thus Nasya is
useful in Avabahuka.
5) Shamanoushadi: Vata Vyadhis are very difficult to manage, in case of Shoola
Pradhan and Stambha Pradhana Vikaras. In such conditions along with Sthanika
procedures internal administration of Shamanaoushadi are essential.
6) Pathya – Apathya:
Pathya are the Ahara and Vihara that is congenial to the health both
in healthy and diseased where as the Ahara and Vihara that is quite opposite to the
above are named as Apathya.Specific Pathya and Apathya in regards to
Avabahuka is not mentioned in classics, so Pathya and Apathya told for the
Vatavyadhi in general are considered as Pathya and Apathya of Avabahuka.

Table No.3 Pathyaapathyas in Vatavyadhi77,78
Factors Pathyas Apathyas
Sneha Sarpi, Vasa, Taila, Majja, -
Shaka and Phala Vargas Kulatha, Masha, Godhuma,
Raktashali,Patola,Vartaka,
Dadima,Parushaka,Badara,
Lashuna and Draksha.
Chanaka, Kalaya, Shyamaka,
Kuravinda, Mudga,
Rajamasha, Guda, Jambuka,
Kramuka, Mrinala, Nishpava,
Taalaphala, Shimbi, Shaka,
Mamsa varga Chataka, Kukkuta, Tittira,
Shilindhra, Nakra, Gargars,
Khudisha, Bileshaya
All Jangala Mamsa Varga.
Rasa Pradhana Madhura, Amla, Lavana Kashaya, Katu, Tikta
Manasika Sukha Chinta, Prajagara
Vihara Snehana, Swedana, Snehapana,
Snana, Abhyanga, Rechana,
Mardana, Basti,Avagahana,
Samvahana, Agni Karma,
Upanaha, Tailadroni,
Shirobasti, Nasya, Santarpana
Vyavaya, Ativyayama, Basti,
Ashva Yana, Chankramana,
Vegadharana, Chardhi,
Shrama,

MODERN REWIEW
Figure 1.Anatomy of the Shoulder Joint: 79,80
This is a synovial joint of ball and socket variety.
Articular Surface: The joint is formed by articulation of scapula and head of the
humerus. Therefore, it is also known as Gleno Humeral articulation.
Structurally it is a weak joint; because Glenoid cavity is too small and shallow to hold
the head of the humorous in the place (the head is four times larger than the size of the
glenoid cavity). However this arrangement permits great mobility, stability of the
joint is maintained by the following factors.
1) The coracoacromial arch or secondary socket for the head of the humorous.
2) The musculotendinous cuff of the shoulder
3) The Glenoid labrum helps in deepening the Glenoid fossa. Stability is also
provided by the muscle attaching the humorous to the pectoral girdle, the long
head of the biceps, the long head of the triceps and atmospheric pressure.

Ligaments of the Joint:
The capsular ligament: It is very loose and permits free movements. It is least
supported inferiorly where dislocation may damage the closely related axillary nerve.
The Coracohurmeral Ligament: It extends from the root of the coracoid process to
the neck of the humerus opposite to the greater tubercle. It gives strength to the
capsule.
Transverse humeral ligament: It bridges the upper part of the bicipital groove of the
humerus (between the greater and lesser tubercle). The tendon of the long head of the
biceps brachi, passes deep to the ligament.
The Glenoidal Labrum: It is a fibro cartilaginous rim, which covers the margins of
the glenoid cavity, thus increasing the depth of the cavity.
Figure 2.Bursae Related to the Shoulder Joint:
1) The sub acromial (sub deltoid) bursa.
2) The Sub Scapularis bursa, communicates with the joint cavity.
3) The infraspinatus bursa, may communicate with joint cavity.
4) Several other bursae related to the coroco brachialis, teres major, long head of
the triceps, latissimus dorsi, and the coracoid process are present.

Relations:
Superiorly: Coracoarcomial arch, sub acromial bursa, supraspinatus and deltoid.
Inferiorly: Long head of the triceps.
Anteriorly: Sub Scapularis, corcao brachialis, short head of biceps and deltoid.
Posteriorly: Infraspinatus, teres minor and deltoid within the joint tendon of the
long head of biceps brachii.
Blood Supply:
Anterior circumflex humeral artery
Posterior circumflex humeral artery
Subscapular artery
Suprascapular artery.
Nerve Supply:
Axillary Nerve
Musculocutaneous Nerve
Suprascapular Nerve
Movements at the Shoulder Joint:
The shoulder joint enjoys great freedom of mobility at the cost of stability.
There is no other joint in the body which is more mobile than the shoulder. This wide
range of mobility is due to laxity of its fibrous capsule, and large size of the head of
the humorous as compared with the shallow glenoid cavity. The range of movements
is further increased by concurrent movements of the shoulder girdle.
Movements of shoulder joint are analyzed as follows.

1. Flexion and Extension: During flexion the arm moves forwards and medially and
during extension the arm moves backwards and laterally. The flexion and
extension take place in a plane parallel to the surface of the Glenoid cavity.
2. Abduction and Adduction: This takes place at right angles to the plane of flexion
and extension (i.e.-approximately midway between the saggital and coronal
plane). In Abduction, the arm moves antero-laterally away from the trunk. This
movement is in the same plane as that of the body of scapula.
3. Medial and lateral Rotation are best demonstrated with mid-flexed elbow. In this
position the hand is moved laterally in lateral rotation of the shoulder joint. And
hand moved medially is medial rotation.
4. Circumduction is the combination of different movements as a result of which the
hand moves along the circle.
5. Elevation: Elevation is an upward movement of a part of the body. Here arm is
taken upwards.
The Range of any movement depends on the availability of an area of free
articular surface on the head of the humorous. It may be noted that the articular area
on the head of the humorous is four times larger than that of the Glenoid cavity.
Table No.4 Muscles acting on Shoulder Girdle.
Muscles Origin Insertion Action on Shoulder
Pectoralis major Clavicle medial
2/3, sternum and
costal cartilages 1-
6.
Humorous, crest of
greater tubercle
Flexion and medial
rotation. Adduction
and medial rotation.
Lattisimus dorsi Lower ribs, iliac
crest.
Humorous inter
tubercular groove.
Adduction, medial
rotation, extension if
flexed.

Deltoid Clavicle lat.1/3,
acromion spine of
scapula.
Deltoid tuberosity of
humerous.
Abduction, extension,
and lat. Rotation.
Biceps brachii
Short head
Long head
Coracoid process
Supraglenoid
tubercle
Radius
Radius
Flexion
Stabilization
Coracobrachialis Coracoid process Humerous middle
body
Flexion
Teres major Inf. 1/3 margin of
scapula
Crest of lesser
tubercle humerous
Adduction, medial
rotation.
Teres minor Scapula, superior
2/3 lat. Margin
Humerous greater
tubercle post.
Surface
Lateral rotation,
stabilization
Supraspinatus Scapula, supra
spinous fossa
Humerous greater
tubercle sup. Surface
Abduction,
stabilization
Infraspinatus Scapula, infra
spinous fossa
Humerous greater
tubercle post.surface
Lat.rotation,
stabilization
Subscapularis Scapula,
subscapularis fossa
Humerous lesser
tubercle.
Med.rotation,
stabilization
Analysis of abduction at the shoulder occurs through 90 degrees. The
movement takes place partly at the shoulder joint and partly at the shoulder girdle
(forward rotation of scapula round the chest wall). The humorous and scapula move
in the ratio 2:1 throughout abduction, for every 15 degree of elevation, 10 degrees
occur at the shoulder joint and 5 degrees are due to movement of the scapula is
facilitated by movements at the sterno-clavicular and acromio-clavicular joint.
The articular surface of the head of the humorous permits abduction of the arm
only up to 90 degrees. At the limit of this movement there is lateral rotation of the
humorous and the head of the bone comes to lie deep to the coraco-acroial arch.

Abduction is initiated by the supraspinatus, but the deltoid is the main abductor. The
scapula is rotated by combined action of the trapezium and serratus anterior.
MODERN REVIEW OF DISEASE:
In modern science, Avabahuka can be compared with
Periarthritis or Adhesive Capsulitis or Frozen shoulder81,82
:
Frozen shoulder is a condition that causes restricted range of active and
passive glenohumeral motion in the shoulder joint. The cause of the frozen shoulder is
not well understood, but it often occurs for no known reason. Frozen shoulder causes
the capsule surrounding the shoulder joint to contract and form scar tissue called
adhesions. The contraction of the capsule and the formation of the adhesions cause the
frozen shoulder to become stiff and cause movements, more painful. There is also
lack of synovial fluid, which normally lubricates the gab between arm bone and
socket to help shoulder joint move.
In this condition pain and stiffness of the shoulder joint are the cardinal
symptom leading to inability of affected upper limb.
Painful / Freezing stage
Frozen stage
Thawing stage
a) Painful / Freezing Stage: This is the most painful stage of the frozen shoulder
motion is restricted, but the shoulder is not as stiff as the frozen stage. This
painful stage typically lasts 6-12 weeks.
b) Frozen Stage: During frozen stage, the pain usually eases up, but the stiffness
worsens. The frozen stage can last for 4-6 months.

c) Thawing Stage: The Thawing stage is gradual and motion steadily improves
over a lengthy period of time. The thawing stage can last more than a year.
The patient gives the history of having noticed a catch in the region of the
shoulder joint and upper arm with dull aging pain since several months. Gradually
becoming aware of the inability to perform certain tasks because of stiffness of the
arm, night pain, often awakening him after he has fallen asleep, is a common
complaint.
Figure 3.Exercises for frozen shoulder.
PROCEDURE REVIEW
NASYA KARMA
Nasa is considered to be that Indriya, whose functions are not only limited to
respiration but is also considered as a pathway for drug administration. In Ayurveda,
special procedure called Nasya has been mentioned.

HISTORICAL REVIEW
VEDA K LA: (PRE-SAMHITA PERIOD, 10,000 B.C. TO 500 B.C.)
In Puranas Nastam Kurut sentence meaning treat Nasagata roga is available,
the same sentence is not available in the Samhita Granthas but the very nearest
term Nasyakarma with the similar meaning treating the diseases of Nose is available.
Reference from Buddhist and Jaina traditions says that Jeevaka
administered Nasya karma. Buddha with a purgative drug sprinkled on lotus which
exerted its effect on smelling and 30 Vegas were observed.83
In Buddha period
procedure like Dantadhavana, Paadaprakshalana, Nasyakarma, Abhyanga, Vyayama,
Snana are mentioned. In Koushika sutra of Vedic times application of Jalauka and
administration of Nasyakarma is mentioned84
.
The reference regarding usage of Panchakarma is available in Jaina
period indicating the usage of Nasya karma.
In the same context while mentioning the different Chikitsa sutras, it is said
that Ghrita for Paana and Nasya Karma should be done to treat Dhanurvata, Anga
Kampa, Shareera Bhaga, etc. Vata Rogas85
In Ramayana86
, Lakshmana was given Nasyakarma by Vaidya Sushena
using Sanjeevini brought by Hanuman from Himalaya after which he regained
consciousness.
Reference about Pumsavana Karma where in medicated drops were instilled
into right nostril of a pregnant woman is explained widely by Charaka87
,
Sushruta88
and Vagbhata89
.

These are some of the scattered references available in different periods
indicating the usage of Nasyakarma for different purposes.
SAMHITA PERIOD
Charaka Samhita: (200 –300 B.C):
In Samhitas Nasyakarma has been described in detail. Charaka in Sutrasthana
first chapter has given the synonyms of Nasyakarma, in Siddhisthana has
classified Nasyakarma depending on the medicines used and on the pharamacological
action and also has stated indications and contraindications for Nasyakarma.90
He has
explained the procedure along with complications and Samyak and Asamyak
Yoga features. In Vimanasthana he mentions different types of Nasyakarma
depending on the parts of a plant used.91
Sushruta Samhita: (600 BC to 400 BC):
Sushruta has defined Nasyakarma as instillation of medicine through
Nose in Chikitsasthana. He has given the classification of Nasyakarma, even
the timing of administration based on rutu and doshas. He has also given the
indications and contraindications, procedure, Samyak, Heena and Atiyoga features,
complications and the things to be followed after Nasyakarma is being stated by
him.92
Astanga Hridaya: (5th
century):
Vagbhata mentioned Nasya Karma elaborately in Sutra Sthana93
and advised
in various diseases like Jwara, Raktapitta, Swasa, Hikka and Vata Vyadhi Chikitsa
etc.

Astanga Sangraha (5th
century)
Sangrahakara has also given extensive explanations regarding Nasyakarma,
the drugs to be used, indications and contraindications, procedure of Nasyakarma. He
has explained the Nasyakarma karmukata by using the terms shrungataka marma and
nasa as Shirodwara.Thus, Nasyakarma is being explained by all authors by
giving special importance to it.94
Sharangdhara Samhita (13th
century):
In Sharangadhara Samhita Acharaya Sharagadhara explained Nasya Vidhi in
Uttara Khanda.95
Adunika period
Recent text like Vangasena Samhitha, Yogaratnakara, Sahasrayaogam etc
mentioned the Nasya treatment in different diseases.
Etymology of Nasya Karma
In Sanskrit language each word is derived from a specific Dhatu and each
Dhatu bears an inherent meaning which is the crux of the word. The derivation of the
word Nasya is from “Nasa” Dhatu. It conveys the sense of Gati – motion. Vyapti
bears the meaning pervasion. Here, the Nasa Dhatu is inferred in sense of nose.
According to Vachaspatyam word “Nasata” means beneficial for nose.
Nasya is the term applied generally to medicines or medicated oil
administered through the nasal passage96
. Arunadatta states Nasayam Bhavam
Nasyam. According to Bhavaprakasha medicines administered through nose is termed
as Nasya97
.

Nasya karma is considered to be the most specific procedure for diseases of
the head or the diseases of Urdhwajatrugata region.Because, as stated by Vagbhata
the nasal passage is considered as the gateway of shirus (head) and the drugs
introduced through the nose spread throughout the head and its constituent
parts, accordingly influencing the dosha and the diseases situated in those parts.98
Shiras in brief:
In a living being, the head is the place where Prana of all sense faculties reside
and hence rightly called as Uttamanga99
.
Sushruta while enumerating Snayu has totally mentioned 900 out of which 70
are present in Greeva and Shiras100
. Among the types of Snayu, Prutula Snayu is
present in Shirus, Uras, Parshwa and Prusta101
. Out of 500 Peshis, 34 are present in
Shirus and Greeva102
.
Among the different Marmas present in Shirus, Shringataka Marma is
explained in direct relation to Nasya Karma. This Marma is the place of collection of
Siras of Shrotra, Netra, Kanta-adi. Ghrana or Nasa, being a Jnanedriya does Gandha
Grahana and is said to be the door of Shirus. Nasya instilled through Nose enters
Shrungataka Marma and gets distributed all over, through the siras103
.
Synonyms of Nasya :
• Navana
• Nastah karma
• Shirovirechana
• Shirovireka

• Murdha virechana , are the terms used synonymously.
Charaka has used the term Nastah Pracchardanam. Literally Pracchardanam is
a synonym of Vamana. Thus the term Nasya being used in relevance to terms
Virechana (Shirovirechana) and Vamana (Pracchardana) clearly appears to be a type
of Shodhana Karma administered through Nose. However, it comprises different
types and the purpose of all the procedures is one and the same.
Classification of Nasya karma
Nasya is classified in various ways by different Acharya. Each classification
has its own silent features and each is done with different angles. Classification
according to various Acharya is described in a tabular form as below
Table No 5 Showing Classification of Nasya according to Various Acharya
Sl No Name of
Acharya
Classification
1 Charaka According to mode of action -Rechana, Tarpana, Shamana
According to the methodof administration —
Navana, Avapeeda, Dhmapana, Dhooma, Pratimarsha
According to various parts of drugs utilized - Phala, Patra,
Moola, Kanda, Pushpa, Niryasa, and Twak Phala, Patra,
Moola, Kanda, Pushpa, Niryasa, Twak
2 Sushruta Shirovirechana, Pradhamana, Avapeeda, Nasya, Pratimarsha
3 Vagbhata Virechana, Brumhana, Shamana
4 Kashyapa Brumhana, Karshana
5 Sharangadhara Rechana, Snehana
6 Bhoja Prayogika, Snaihika
7 Videha Sanjya Prabodhaka, Stambhana,

Charaka’s classification of Nasya:
According to Charaka the Nasya is of five type’s viz. Navana,
Avapeeda, Dhmapana, Dhooma and Pratimarsha104
.
Navana is further divided in to Snehana and Shodhana, Avapeeda into
Shodhana and Stambhana, Dhooma into Prayogika, Vairechanika and Snaihika. While
Pratimarsha is divided into Snehana and Virechana.
The above-mentioned five types of Nasya are regrouped according to
their pharmacological action into three groups viz. — Rechana, Tarpana and
Shamana105
.
Charaka has also mentioned 7 types of Nasya according to parts of the drugs
to be used in Nasya karma viz. — Phala, Patra, Moola, Kanda, Pushpa, Niryasa, and
Twak106
.
Illustration No 2 Nasya according to Charaka
NASYA

!
Illustration No.3 Nasya According to the action
NASYA
Illustration No.4 According to various parts of the drugs utilized in Nasya therapy
NASYA
Classification of Nasya according to Sushruta :
According to Sushruta, Nasya is of 5 types viz. Nasya, Avapeeda,
Pradhamana, Shirovirechana and Pratimarsha. These 5 types of Nasya are further
classified according to their functions into two groups viz. Shirovirechana and
Snehana107
.
Shirovirechana, Avapeeda and Pradhamana are used for Shirovirechana
purpose, i.e. for the elemination of morbid Dosha from Shirus while Pratimarsha and
Nasya may be used for Snehana.

"
Illustration No.5 Classification of Nasya according to Sushruta
Vagbhata’s Classification of Nasya108
Ashtanga Sangraha has mainly classified Nasya according to its effect
viz. Virechana, Brumhana and Shamana. Snehana and Brumhana Nasya have been
further subdevided according to the doses into two groups i.e. Marsha and
Pratimarsha109
.
Avapeeda Nasya may be given for both Virechana and Shamana while
Pradhamana Nasya is given only for Shirovirechana.
Ashtanga Hrudaya has mainly classified Nasya in 3 types viz. Rechana,
Brumhana and Shamana.
Illustration No.6 Classification of Nasya according to Vagbhata

Kashyapa’s Classification of Nasya110
According to Kashyapa Samhita, Nasya has been classified into two groups
i.e. Brumhana and Karshana. These two types are also known as Shodhana and
Purana Nasya.
Illustration No.7 Classification of Nasya according to Kashyapa
Sharangadhara’s Classification of Nasya
Sharangadhara has also classified Nasya according to their functions into
twogroups viz. Rechana and Snehana. Rechana Nasya is further subdevied into
Avapeeda and Pradhamana while Snehana Nasya is subdevided into Marsha and
Pratimarsha111abc
.
Illustration No.8 Classification of Nasya according to Sharangadhara
"
# $ # $
!

Videha’s Classification of Nasya
Videha has stated two types i.e. Samnja prabodhaka and Stamabhana
Illustration No.9 Classification of Nasya according to Videha
It is clear from the above discription that two types of classification of Nasya
Karma are available in Ayurvedic literature. One is based on the pharmacological
actions viz. Rechana, Tarpana etc. Other is based on the preparation of drug and the
method of its application e.g. Dhmapana (Powder is blowed) Avapeeda (Extracted
Juice is used) Dhooma (Smoking through nose).
Navana Nasya:
This is one of the important types of Nasya. It is further classified into
Snehana and Shodhana. Navana is instillation of the drops of medicated oil into the
Nose. Navana is generally a Sneha Nasya and is synonymously used for Nasyakarma
in general.
Avapeeda Nasya:
Avapeeda Nasya is the Nasya consisting of the Swarasa of a drug administered
through nasal passage. It is of two types-Stambhana Nasya and Shodhana Nasya
Dhmapana or Pradhamana Nasya:
%

In Pradhamana Nasya, powder of drugs is blown or inhaled through nasal
passage. Its dose as mentioned by Videha as 3 munchuti (3 pinches).
Dhooma Nasya:
Dhooma Nasya is inhalation of medicated fumes through nasal route and
exhalation by oral route. It is of 3 types-
1. Prayogika
2. Snaihika
3. Vairechanika
Marsha-Pratimarsha Nasya:
Both consist of introduction of sneha through the nostrils. Marsha-Pratimarsha
is in the same principles but they have following distinctions-
Table No 6 Marsha-Pratimarsha Nasya
PRATIMARSHA MARSHA
*Never disturbs dosha
*Dose- 2drops morning and
evening
*Indicated in all seasons
*No complications
*Slow acting and less potent
*To all persons including
Swastha
*May disturb dosha
*Dose-
10 drops - uttama matra
8 drops - madhyam matra
6 drops - heena matra
*Seasons and age are to be considered
*May produce complications
*Quick effective and highly potent in action

Indication for Nasyakarma
Shirastambha, Manyastambha, Dantastambha, Dantashoola, Hanugraha,
Peenasa, Galashaluka, Galashundika, Shukraghataroga, Timira, Vartma roga, Vyanga,
Upajihwika, Ardhavabhedaka, Greevaroga, Skandaroga, Amsashoola, Mukharoga,
Nasashoola, Karna shoola, Akshishoola, Shirashoola, Ardita, Apatantraka,
Apatanaka, Galaganda, Danta shoola, Danta harsha, Arbuda, Swarabheda, Vakgraha,
Gadgadatwa.
Table No 7 Showing the indications of Shodhana Nasya
Si.
No
Vyadhi C. S.112
S.S.
113
A.H. 114
A.S115
1 Shirogourava + + - +
2 Stambha + - - +
3 Supti + - - +
4 Shirah sheeta - + + -
5 Jadya - - + -
6 Soudnyaheena - - + -
7 Amaya - - + -
8 Shopha - - + +
9 Ganda - - + -
10 Krimi - + + +
11 Ghranti - - + +
12 Kushta - - + -
13 Apasmara - + + +
14 Peenasa - + + +
15 Upadeha - - - +
16 Kandu - - - +
17 Abhishyanda - - - +
18 Paka - - - +
19 Praseka - - - +

20 Asyavairasya - - - +
21 Arochaka - + - +
22 Svarabheda - - - +
23 Gandalaji - + - +
24 Arbhuda - - - +
25 Dadru - - - +
26 Kotha - - - +
27 Ardhavabhedak - + - -
Table No 8 showing the indications for Brumhana Nasya:
Si.
No
Vyadhi C. S.116
S.S.117
A.H 118
A.S119
.
1 Shirakampa + - - -
2 Ardhita + - - -
3 Shirashool (vataja) - + + +
4 Suryavarta - - + +
5 Swarakshaya - + + +
6 Nasa shosha - + + +
7 Asya shosha - + + +
8 Vaksanga - - + +
9 Krichrabhoda - + + +
10 Avabahuka - + + +
11 Ardhavbhedak - - - +
12 Krimi shiroroga - - - +
13 Akshi sankocha - - - +
14 Spanda - - - +

15 Timira - + - +
16 Dantashoola - - - +
17 Karna shoola - + - +
18 Karnanada - + - +
19 Manya roga + + - +
20 Apatanaka - - - +
21 Valipalitya - + - -
Contraindications of Nasya:
In Bruhatrayi some special conditions have been mentioned where Nasya
should not be administered, otherwise various complications may occur. In general,
in all patients Nasya should not be given on Durdina (Rainy day) or in Anritu
(Viparita Kala).
Table No 9 Contraindication of Nasya
Nasya Anarha Ch120
Su121
Va122
1.Bhuktabhakta + + +
2.Ajeerna + + -
3.Peeta Sneha + + +
4.Peeta Madhya + + +
5.Peetatoya + + +
6.Snehadi Patukamah + - +
7.Snatah Shirah + - +
8.Snatukamah + + +
9.Kshudharta + - +
10. Shramarta + + -
11.Matta + - -

12.Murchita + - -
13.Shastradandahrita + - -
14.Vyavayaklanta + - -
15.Vyayamaklanta Shranta) + + -
16.Panaklanta + - -
17.Navajwara Pidita + - -
18.Shokabhitapta + - -
19.Virikta + - +
20.Anuvasita + + +
21.Garbhini + + +
22.Navapratishyayarta + - -
23.Apatarpita - + +
24.Peetadravah - + +
25.Trishnarta + + -
26.Gararta - + +
27.Kruddha - + -
28.Bala - + -
29.Vruddha - + -
30.Vegavarodhitah (Vegarta) - + +
31.Raktasravita - - +
32.Sootika - - +
33.Shvasapidita - - +
34.Kasapidita - - +
Suitable time for giving Nasya:
According to Charaka generally Nasya should be given in Pravrit, Sharad and
Vasant Rutu. However in emergency it can be given in any season by
providing artificial conditions of the above mentioned seasons, for example in
summer Nasya can be given in cold places and in cold season it can be given in hot
places.

Nasya karma according to Rutus123
Grishma Rutu - ----- Before noon (morning)
Sheeta Rutu ---------- Noon
Varsha Rutu - ------- Day should be clear
Sharad + Vasanta - In the morning (Vagbhata) Shishira + Hemanta - Noon
Grishma + Varsha — Evening
According to Sushruta in normal conditions Nasya should be given in empty
stomach, at the time when the person usually takes his meal.
Nasya karma according to Doshas 124
Kaphaja Vikara — Poorvahna
Pittaja Vikara - Madhyahna
Vataja Vikara - Aparahna
Vagbhata has prescribed same timing as Sushruta has mentioned. According
to Doshaja Vikara it has suggested some more important points also. Nasya should be
given daily in morning and evening in Vataja Shiroroga, Hikka, Apatanaka,
Manyastambha and Swarabhramsha. Sharangadhara has described same time
schedule for different seasons as Sushruta has mentioned. He further states that —
Nasya can be given in night, if the patient is suffering from Lalasrava, Supti,
Pralapa, Putimukha, Ardita, Karnanada, Trushna, Shiroroga and such conditions
like excessive vitiated Doshas (Sha. Ut. 8I3)125

Table No 10 Course of Nasya Karma:
No. Name of Acharaya Days
1 Sushruta 1,2,7,21
2 Bhoja 9
3 Vagbhata 3,5,7,8
Nasya Karma may be given for seven consecutive days. In conditions like
Vata Dosha in head, Hikka, Manyastambha, Swarabheda. it may be done twice a day
(in morning and evening). (As. H. Su. 20I16).
Nasya should be given for 3 days, 5 days, 7 days & 8 days or till the patient
shows the symptoms of Samyak Nasya as stated in Ashtanga Samgraha126
.
Bhoja says that if Nasya is given continuously beyond nine days then it
becomes Satmya (adaptable) to patients and if given further, it neither benefits nor
harms the patients.
According to Sushruta127
, Nasya may be given repeatedly at the interval of 1,
2, 7 and 21 days depending upon the condition of the patient and the diseases he
suffers.
Charaka has not mentioned specific duration of the Nasya therapy, but
suggested to give according to the severity of disease.
Dose of Nasya:
The dose of Nasya drug depends upon the drugs utilized for it and the variety
of the therapy. Charaka has not prescribed the dose of the Nasya. Sushruta and

Vagbhata have mentioned the dose in the form of Bindus (drops), here one Bindu
means the drop which is formed after dipping the two phalanges of Pradeshini (index)
finger 128
.
Table No 11 showing the dosage of Nasya Karma:
Drops in each NostriiSi
No. Type of Nasya Hrasva Matra Madhyama
Matra
Uttama Matra
1 Shamana Nasya 8 16 32
2 Shodhana Nasya 4 6 8
3 Marsha Nasya 6 8 10
4 Avapeeda Nasya (Kalka Nasya) 2 2 2
5 Pratimarsha Nasya 2 2 2
According to Videha:
The common dose for Pradhamana Nasya is 3 Munchuti (here one Munchuti =
the quantity of Churna which may come in between Index finger and thumb = 2.4
Ratti.) Sharangadhara (Sha. Ut. 8I9, 10) has described the following dosage schedule
for Nasya Karma according to the variety of material used.
• Tikshnaushadhi Churna - 1 Shana (4 Masha) (24 Ratti)
• Hingu — 1 Yava (S Ratti)

• Saindhava — 1 Masha (6 Ratti)
• Dugdha — 8 Shana (64 Drops)
• Jala (Aushadha Siddha) — 3 Karsha (3 Tola)
• Madhura Dravya — 1 Karsha (1 Tola)
If the Nasya is given less than the prescribed dose then it does not eliminate
the Doshas completely and cause heaviness, loss of appetite, cough, salivation,
coryza, vomiting and disorders of the throat etc. If the Snehana Nasya is
administered in the excessive dose it may produce the symptoms of Atiyoga (As. San.
Su. 29/6) Danta Chala, Arbuda, Hanugraha, Skandharoga, Mukharoga, Amsashula.
According to Ashtanga Sangraha if the Nasya is to be given as the part
of performing the complete Panchakarma then, it should be given after Bastikarma.
Procedure of Nasya Karma:
The whole procedure is divided into three stages-
* Poorva karma
* Pradhana karma
* Paschat karma
Poorva karma:
This includes all the preparations and events that are to be done up to
instillation of medicine. This stage is further divided into three steps
• Collection of materials

• Deciding the exact time for the procedure
• Preparation of the patient
Collection of materiais:
A separate well ventilated room with adequate light is to be sellected131
. It
should flourish following needy things-Nasya Peeta or Nasya Shayya, Nasya
medicine, Nasya Yantra i.e. Gokarna Yantra, cotton or dropper for instillation,
spittoon, cloth, attainders, etc.
Ideal Time:
After considering the prevailing season and Dosha Pradhanyata, the time of
administration should be decided. In general Pravrut, Sharat,Vasanta Rutu are good.
In Varsha Rutu un-cloudy day, in Greeshma Rutu before Madhyanha and in Sheeta
Rutu during Madhyanha Nasya should be performed.
Preparation of 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 Dhoomapana
should be done and he should comfortably lie down relaxed on a cot in supine
position, hands and legs stretched straight. Snehana and Swedana to face is done.
Swedana is contraindicated to Shiras as it is a Marma. Even then for liquifaction of
Dosha and to facilitate easy expulsion of them Mrudu Swedana is performed over
Shira, Manya, Nasa, Greeva. Eyes are covered with a cloth to avoid any spilling of
medicine 129
.

Pradhana karma130
Head is slightly bent backwards by keeping a pillow below the shoulder
this facilitates easy instillation of Nasya medicine. Oil is warmed, nose tip is raised
with index finger of left hand and one nostril is closed with another finger, using right
hand medicine is instilled. Exact measured quantity of medicine is taken in a Gokarna
or even administered using a pad of cotton or cloth or a dropper and dropped in a
continues flow into each nostril one after the other.
Precautions to be taken before instiiiation:
Quantity of medicine should be exact neither more nor less, it should not be
poured all of a sudden, it should not be too warm or too cold, patients head should
neither be stretched down too much nor elevated and should lie relaxed.
Very little quantity of medicine will only excite the doshas but will not expel
them out and causes feeling of heaviness, loss of taste, cough, excessive salivation,
rhinitis, vomiting and diseases of kantha. More quantity of medicine will give
rise to complications i.e. atiyoga features. Pouring the entire quantity at once will
force the medicine to enter into the wrong routes causing diseases of head,
Pratishyaya, Ghrana Kleda, obstruction to expiration. If the medicine is too warm it
causes burning sensation, formation of ulcers, fever, bleeding through nose, headache,
blurring of vision. If it is very cold it will cause Ayoga features.
Medicine instilled in an improperly stretched position of the head too gives
Ayoga features as the medicine fails to spread all over the head uniformly. If the
head is stretched too much, the medicine traversing a long route causes Moorcha,
Jaadya, Kandu, Daha, Jwara. Nasya administered in an un-relaxed person causes

increase in Doshas as it is unable to spread all over, along with pain or stiffness131
. If
the head is not stretched then medicine fails to enter inside Shirus and if stretched too
much then the entered medicine fails to come back. Patient should be observed for
any complications, if present then necessary steps are to be taken accordingly.
Paschat karma :
This has following steps-
• Snehana and swedana
• Dhoomapana and Gandusha
• Assessing the yoga Ayoga lakshanas
• Complications if any and measures to be adopted
• Ahaara and Vihara
Mrudu Abhyanga and Swedana over Gala, Kapola, Lalata, Mardana over
shoulder, feet and hands done. Patient is instructed not to swallow but to spit the
expectoration as it contains doshas134
. Patient should lie still in same position for 100
Matra Kala133
, should not shake his head, talk, laugh, sneeze, yawn as these prevent
the medicine reaching the expected place and even Kasa, Pratishyaya, Shiro Akshi
rogas may occur especially if the medicine doesn’t reach Shrungataka Marma134
.
Dhoomapana and ushna jala gandusha should be done for kantha shuddi135
.
Dhoomapana136
Inhalation of Dhooma is indicated in the disorders of shiras, in general and in
particular Prayogika dhooma is indicated after Nasya karma137
.
Two to three puffs are to be taken through mouth and exhaled through mouth
only138
. By this lightness of head, sense organs, heart, Dosha Shamana takes place and

throat becomes clear139
.
Snehana and Swedana are Poorva Karma of Nasya, by these the Srotas
becomes soft and Doshas in them gets loosened. Administration of Nasya easily
expels them out but the Nasya dravya being a Sneha and Sneha by nature increases
Kapha due to its Sheeta Guna.
This retains a portion of Kapha, which was liquefied due to Snehana and
Swedana. And so retained Kapha can’t be expelled out by Nasya Dravya and gets
collected in Karna, Manya and causes different diseases. To remove this, dhoomapana
is administered140
. Dhooma by virtue of its ushna and teekshna Guna clears the dosha.
Gandusha:
After dhoomapana, Ushna jala gandusha is to be done. This removes the
Kapha present in the oral cavity and also increases the taste.141
Samyak Yoga, Ayoga and Atiyoga of Nasya Karma:
After Nasya Karma the symptoms of its Samyakyoga , Ayoga, Atiyoga should
be observed.
Samyak yoga:
Samyak yoga mentioned according to different Acharyas.
Table No 12 Showing Samyak Yoga Lakshana
Si. No Symptoms C. S142
a S. S142
b A. H142
c Sh. S142
d
1. Uraha Laghuta + - - +
2. Shiro Laghuta + + - +

3. Netra Laghuta - - + -
4. Shareera Laghuta - + - +
5. Srotovishuddhi + + - +
6. Swaravishuddhi - - + -
7. Urdwajatrugata Vikaropashaman - - - +
8. Prakruta Indriyaschesta + + - +
9. Netrateja Vruddhi - - + -
10. Chitta Prasada - + - +
11. Vikaropashamana - + - +
12. Sukha Svapna Prabodha - + + -
Ayoga:
Ayoga is mentioned according to different acharya as follows.
Table No 13 Showing Ayoga Lakshana
a S. S143
b A. H143
c Sh. S143
d
1. Shirogaurava, Dehagaurava + + - +
2. Galopalepa + - - -
3. Nishtheevana + - - -
4. Kandu - + - +
5. Kaphapraseka - + - -
6. Upadeha + - + +
7. Rukshata + - - +
8. Vata Vaigunya + - - -
9. Srotoriktata - + - -
10. Srotasamkaphasrava + - - +
11. Nasashosha - + + -

12. Asyashosha - + - -
13. Akshistabdhata - + - -
14. Shiroshunyata - + + -
15. Vyadhi Vrudhdhi - - + -
Table no 14 showing Atiyoga lakshana
a S. S144
b A. H144
c Sh. S144
d
1. Shirogourava - + + +
2. Shiroshunyata - + - +
3. Shirovedana + - - -
4. Netra Vedana + - - -
5. Shankhavedana + - - -
6. Suchitodavat Peeda + - - -
7. Indriya Vibhrama - + - +
8. Mastulungagama - + - -
9. Snehapurna Srotasa - - - +
10. Karna Talu Upadeha - - + -
11. Vata Vruddhi + - - -
12. Kandu - + + -
13. Praseka - + + +
14. Peenasa - + - -
15. Aruchi - - + -
16. Deha Daurbalya - - + -
Complications of Nasya145
Complications occur due to 2 reasons

a. Administration in a contraindicated state b. Improper technique of
administration These two give rise to Dosha Utklesha or Dosha Kshaya features
respectively. Dosha Utklesha is to be managed by Shodhana and Dosha Kshaya by
Brumhana Chikitsa.
Table No 15 Complications of Nasya Karma and their management
Si.No Conditions where nasya
is contraindicated
Manifestations
occuring due to Nasya
Management
01. Ajeerna, bhukta bhakta
peeta toya, durdina
Kapha roga, shwasa,
peenasa, agnimandya
Kapha hara, teekshna,
ushna drugs
02. Krusha, virikta,
vyayaama
klanta, trushnarta, garbini
Vataja sula, angamarda,
mukashosha,garbastamba
Vatahara,snehana,
brumhana, in garbhini
milk and ghee is to be
given
03. Jwara,shokatapta,
Madyapeeta
Timira roga Rooksha, sheetala
anjana, lepa, putapaaka
Regimen to be followed after Nasya Karma-
After finishing Paschat Karma warm water is given to drink and light food is
given. One should avoid Abhishyandi Ahara, Sneha, Madya, Drava Pana, exposure to
Raja, Dhooma, Aatapa, Shira Snana, Atiyana, Krodha and should stay in Nirvata
Pradesha68. Cold water should not be used for drinking or for bathing only warm
water is to be used.146
The procedure may be conducted on alternative days or once in 3 days for
about 7 to 21 days or even until results are got. In Vata Vyadhi daily 2 times Nasya
can be given. But Vagbhata says that Nasya should not be conducted for more than 7
days147
.

Benefits of Nasya Karma:
Who regularly follows Nasya Karma will be free from diseases of eyes, Ears
and Nose. His hair and beard does not turn grey. His hair doesn’t falls but instead
grows fast. Diseases like common cold, migraine, headache, facial paralysis, etc. can
be alleviated. The joints, sinus, tendons and bones of his cranium acquires great
strength. His face becomes cheerful and plump and his voice becomes mallow, firm
and stentorian. Strength of all sense organs increases greatly. There will be no
sudden invasion of disease in the upper parts (Urdhvajatrugata) of the body. He
experiences the symptoms of old age later.
Disease of the supra clavicular region are cured in the person who practices
Nasya. He gets clarity of senses, good smell of mouth and the strength of jaw, teeth,
arms, chest, etc. He never suffers from the premature appearance of wrinkles,
premature hair falling and Vyanga.
Importance of Post Nasya Massage:
The texts have recommended light massage on the frontal, temporal,
maxillary, mastoid & on Manya region.
A comfortable massage on the above regions may help to subside the irritation of
somatic construction due to heat stimulation. It may also help in removing the slush
created in these regions
Pressure applied on the barroreceptors may bring the deranged cerebral arterial
pressure to normalcy (hejmadi s. 1985).
Guards against attack of baldness, Vyanga, premature appearance of wrinkles
or furrows.

Mode of action of Nasya Karma
The clear description regarding the mode of action of the Nasya karma is not
available in Ayurvedic classics. According to Charaka Nasa is the gate way of
Shirah.The drug administered through nose as Nasya reaches the brain & eliminates
only the morbidDoshas responsible for producing the disease.
Nasa being the gateway to Shiras, the drug administered through nostrils,
reaches Shringataka (a Sira Marma by Nasa Srota), spreads in the Murdha (brain)
taking Marma of Netra (eye), Shrotra (ear), Kantha (throat), Shiramukhas (opening of
the vessels, etc.) and scratches morbid Doshas in supra clavicular region and expels
them from Uttamanga (As.San.). Sushruta153
has clarified Shringataka Marma as a
Sira Marma formed by the union of Siras (blood vessels) supplying to nose, ear, eye
& tongue. He further points out that injury to this Marma will be immediately
fatal (Su. Sha. ). Indu in his commentary on Ashstanga Sangraha has opined
Shringhataka as the inner side of middle part of the head i.e. Siraso Antarmadhyam.
Under the complications of Nasya karma
Sushruta noted that the excessive eliminative errhine may cause Mastulunga
(cerebro spinal fluid) to flow out of the nose (Su. Ch. ).In Sushruta, Astanga Hridaya,
Bhavaprakasha, etc detailed descriptions are not found about the mode of action of
Nasya Karma. According to all prominent Acharyas Nasa is said to be the gateway of
Shirah. It does not mean that any channel connects directly to the brain but
they might be connected through blood vessels or through nervous system (olfactory
nerve, etc.).
It is an experimentally proved fact that wherever any type of irritation takes
place in any part of body, the local blood circulation is always increased. This is the

result of natural protective function of the body. When provocation of Doshas takes
place in Shirah due to irritating effect of administered drug resulting increase of the
blood circulation of brain. So extra accumulated morbid Doshas are expelled out
from small blood vessels.
Ultimately these morbid Doshas are thrown out as nasal discharge, tear and
salivation
NASA SHAREERA
In Ayurvedic literature there is no detailed description of Nasa Sharira is
available at a single context like the anatomical description of eye (Netra).By an
overall analysis of Ayurvedic classics we can see that a lot of terms are used by
different Acharyas which clearly indicate the anatomical parts of Nasa while
explaining the pathophysiology of Nasal diseases.Dalhana while commenting that the
Samyoga Sthala of Ghranendriya is called as Shringataka, injury to this causes death.
Nasa is one among the seat of Sukshma Jnanendriyas which is
dominant in Pruthwi Mahabhoota. Nasa is made up of Tarunasthi149
. The pramana of
Nasa puta is 4 anguli, Dalhana comments that it is pramana of one Nasaputa, others
opines that the pramana of one Nasaputa is 2I3 anguli, it is Bahirmukha Srotus and it
has two peshis.
According to Sushruta, Nasa has 24 siras they are 6 Vatavahini, 6 Pittavahini,
6 Kaphavahini and 6 Raktavahini siras150
. Nasa has 2 dhamanis.
Utpatti of Ghranendriya:
Acharya Charaka expained that development of Nasa occurs during the third
month of gestation.151
In the third month of pregnancy at that time Indriyas involves.

Nasa is the opening of Shiras, Hence in Urdwajatrugata Vikara mainly Nasya
Karma152
is advised. Ayurvedic classics explained Nasa as the only route to the head.
So any medicine which is applying through the Nose can influence the head directly.
A lot of medicaments are advised to introduce through nose in
unconsciousness conditions as well as in fatal conditions like Sanyasa, Murcha, and
Sarpadamsha etc. We can conclude the structure of the Nasa as follows:
It is composed of
• 3 Asthis
• 2 Peshi
• 2 Dhamani
• 3 Marmas and
• 24 Siras.
Indria Panchapanchaka153
:
Indriya — Ghranendriya
Indriya Dravya — Pruthvi
Indriya Adhisthana — Nasa
Indriya Artha — Gandha
Indriya Buddhi — Ghrana Buddhi
These faculties are responsible for the perception of smell.
Anatomy154
: External Nose:
It is having the shape of a triangular pyramid; the supporting frame work
consists of bony part and cartilaginous parts.

Bony parts:
Forms the upper part of external Nose it consists of anterior part of body of the
maxilla with its frontal process.
Cartilaginous part:
Area around the nose, vestibule and upper lip is dangerous as infection. From
these areas may drain into cavernous sinus, anterior facial and cellulites of the area
may be spreading of infection cavernous sinus.
Figure 4 showing anatomy of Nose
The Nasal cavity:
The nasal cavity is divided into right and left halves by the median septum and
extends from anterior nasal to the posterior nasal apertures where it communicates
with the nasopharynx.
Floor:
Floor is formed by the palatine process of the maxilla and palatine bone .
Roof:
Roof has anterior sloping and is formed by nasal bones, central part is
horizontal and is formed by cribriform plate of the ethmoid bone. The posterior

sloping part is formed by under surface of body of the sphenoid.
Medial wall: It is formed by the septum.
Lateral wall: It is formed by maxilla and ethmoid bone.
Olfactory area:
It is the upper part of the nasal cavity from the level of superior conchae. It is
bounded above by the cribriform plate. Laterally by lateral wall of the nasal cavity
above the level of the superior turbinate, medially by corresponding part of the nasal
septum. Nasal septum; -
Medial wall is the portion which divides the nasal cavity and lies in or near the
mid line; it consists of perpendicular plate of the ethmoid bone above and behind.
Vomer below and behind.Septal cartilage anterio- inferiorly.
Minor contribution by anterior nasal spine of the maxilla septal crest of
the maxillary and palatine bones, nasal spine of the frontal bone the sphenoidal crest.
DRUG REVIEW –
INTRODUCTION.
Dravya has a vital role in curing the diseases, so it is considered as one among
four in the Chiikitsa Chatushpada Without its knowledge, a physician cannot cure a
disease.
The main objective of the present clinical study is to evaluate the effect of
Nasya with Karpasasthyadi Taila and Nagara Taila respectively in the management
of Avabahuka. The properties of these drugs are summarized below.

PROPERTIES OF INGREDIENTS OF NAGARA TAILA.
Nagara ( Zingiber officinale Rosc) belonging to the family Zingiberaceae is a
herb. It is extensively grown in India, widely available, cheaper and non controversial
drug and is used as a household remedy. Besides a common drug and spice condiment
including vegetable or edible household item, the drug is used in wide range of
therapeutics, pharmaceuticals and also in dietetics.
Nagara is one among the drugs told in”Vatagana Gana” in Vata Vyadhi
Chikitsa Adhyaya of different classics155
. In all most 70% of yogas told in Vata
Vyadhi Chikitsa in classics Nagara is present. Charaka describe Nagara in
Shoolaprashamana Gana, and Deepaneeya Gana156
. Susruta and Vagbhatta have
described Nagara in Pipalyadi Gana.(SU.SU 38/22)157
. This drug is also used in case
of Vatavyadhi, Shoola158
, Shopha 159
and it is one of the ingredient in Masha taila,
Maharasnadi Kwatha which is used in Vatavyadhi (Avabahuka)160
.In Bhavaprakasha
it is mentioned in Haritakyadi varga161
it is also mentioned in Panchakola,
Sadusana162
. In Shodala Nigandu it is mentioned in Shatapuspadi Varga163
. Raja
Nighantu mentions Nagara in Pipalyadi Varga164
.
SYNONYMS.
Ardraka, Ardrika, Sunthi, Usna, Nagara, Visvabhesaja, Srngavera,
Mahousadha, Gulmamoola, Moolaja, Kandala, Varam, Anupaja, Apakshakaa,
Saiktastha, Ardrakya, Rahuchatra shaka, Ardra shaka, Schaaka.(danwantari nigantu
pipalyadi varga).

BINOMIAL NOMENCLATURE165
NOMENCLATURE
Kingdom : Plantae
Division : Angiosperma
Class : Monocotyledoneae.
Order : Sciataminaea
Family : Zingiberaceae
Subfamily : Zingiberoideae
Genus : Zingiber
Species : Officinale
Botanical Name : Zingiber officinale.
REGIONAL NAMES
Hindi: Adarak, Malayalam: Inchi, Tamil: Ardrakamu, Kanada: Hasisunti
DESCRIPTION OF THE DRUG
A slender, perennial rhizomatous herb, leaves are linear, sessile, glabrous,
flowers yellowish green in oblong, cylindrical spikes, ensheathed in few scarious,
glabrous bracts, fruits oblong capsules. The rhizomes are white to yellowish brown in
colour, irregularly branched, somewhat annulated and laterally flattened. The growing
tips are covered over by scales. The surface of the rhizome is smooth and if broken a
few fibrous elements of vascular bundles project out from the cut ends.

HABITAT OF THE DRUG
Cultivated throughout India, run wild in some places in the Western ghats
THERAPEUTICALLY USED PART
Rhizomes (raw as well as dry)
Table No.16 Properties of Nagara
ACTION OF DRUG166
Doshaghna Karma – Kaphavatasamaka
Vyadhighna Karma – Triptighna-Rochana-Dipana-Pachana, Vatanulomana-
Sulaprasamanam, Arsoghna, Pittasamaka, Rakthasodhaka, Hridya, Shothahara,
Kaphaghana, Swasahara, Kasaghna, Svarya, Vrsya, Uttejaka. Jwaraghna,
Sitaprasamna, Balya, Vedanasthapana, Nadyuttejaka.
INDICATIONS
Abyantara
Vatavyadhi, Aruchi,Hrllasa, Chardhi, Mukhavairasya, Agnimandya, Ajirna,
Adhmananaha, Udararoga, Sula, Kosthabaddhata, Arsa, Pandu, Kamala,
DRUG LATIN NAME RASA GUNA VEERYA VIPAKA DOSHAKARMA
Nagara Zingiber officinale
Rosc
Katu Laghu,
Snigdha
Tikshna
Usna Madhura Kaphavatasamaka

Hrddourbalya, Hrcchula, Sotha, AmaVata, Slipada, Sitapitta, Kasa, Swasa, Hikka,
Pratisaya, Jwara.
Bahya
Amavata, Sandhisotha, Karnashoola, Shirasjoola
CHEMICAL COMPOSITION
Rhizome contain volatile oil 1-5%, gingerol, gingerin (oily resinous substance
main active principle), gingerenone, ginger glycolipids A, B, & C, citronellol,
geraniol, starch and other contents.
TILA TAILA:167
The base of Nagara Taila is Tila taila. The properties of Tila are
Table No 17: Showing Guna-Karma of Tila:
S.No Tila
01 Latin name Sesamum indicum Linn.
02 Family Sesamum
03 Sanskrit Tila
04 Rasa Madhura
05 Anurasa Kashaya-Tikta
06 Guna Guru, Snigda
07 Veerya Ushna
08 Vipaka Madhura
09 Doshakarma Tridosha Shamaka
10 Composition
(Beeja)
Moisture – 4.1-6.5%
Oil – 43-56.8%
Protein – 16.6-26.4%

Fibers – 2.9-8.6%
Carbohydrate – 9.1-25.2%
Minerals – 4.1-7.4%
Calcium – 1.06-1.45%
Phosphorus – 0.47-0.62%
11 Parts used Beeja, Taila
Tila Taila Murchana:
Moorchita tila taila was prepared in the department of Rasashastra and
Bhaishajya kalpana, K V G A M C, Sullia. And taila paka was done according to
Sharngdhara Samhita14
.
Tila taila Murchana procedure168
:
For the taila Murchana 1/16th
part of Manjistha, 1/64th
part of Haritaki
,Vibhitaki, Amalaki, Mustha, Haridra, Lodra, Vatankura, Hrivera, Nalika,
Ketakipushpa,1 part of Tila taila, and 4 parts of jala was taken and done paka in
mandagni till Taila paka siddhi lakshana
NAGARA TAILA PREPARATION
Ingredients of Nagara Taila
(1) Kalka & Swarasa prepared out Nagara (Zingiber officinale Rosc)
(2) Tila Taila.
Taila will be prepared according to Mrdu Taila Paaka Vidhi mentioned in
ayurvedic classics169
.

Drugs were taken in the following proportion,
Nagara Swarasa- 8 litres (16 parts)
Nagara Kalka –250 gms(1/8 parts)
Tila Taila – 2 litres (4 parts)
Rhizomes (fresh) of Nagara was collected (30 kg) from surrounding areas
(locally) and cleaned properly. Then it was chopped into small pieces and taken in a
vessel. It was grinded and made into paste. The paste was squeezed through a cloth to
take the Swarasa. This Swarasa (8 litters) was added to 2 liters of Tila Taila and kept
over mild flame. Nagara Kalaka (250 gms) was also added to it and was kept over
mild flame till it attained Mrdu Paka Lakshana.
The Taila paka Lakshanas are170
Phenotgama in Taila, Vartivat shape Kalka will be got, when a small quantity
of Kalka is taken from the boiling Taila and is rolled in between the fingers., Shabdha
Heena, when it is thrown on fire.
Then it is cooled, measured and stored in a dry, air tight container.
PROPERTIES OF INGREDIENTS OF KARPASASTHYAD TAILA.
Karpasasthyadi Taila described in Tailayoga Adhikara of Sahasrayoga is
generally practiced in the treatment of Avabahuka171
. The ingredients of
Karpasasthyadi Taila are.
Table 18: Kasaya Dravyas of Karpasasthyadi Taila 172,173.
.
DRUG LATIN NAME RASA GUNA VEERYA VIPAKA DOSHA
KARMA
Karpasa Gossypium
Herbaceum
Madhura
(Seed)
Laghu,
Teekshna
Anushna Katu Vata Pitta
Shamaka

Rasna Sida
Rhombifolia
Madhura Guru,
Snigdha,
Pichila
Sheeta Madhura Vata
Pitta
Shamaka.
Masha Vigna Mungo Madhura Guru,
Snigdha
Ushna Madhura Vata
Shamaka,
Pitta
Kapha
Kara
Kulattha Macrotyloma
Uniflorum
Kashaya,
Madhura
Laghu,
Teekshna,
Ushna
Ushna Katu Vata
Kapha
Hara
Table 19: Kalka Dravyas of Karpasasthyadi Taila.
DRUG LATIN
NAME
RASA GUNA VEERYA VIPAKA DOSHAKA
RMA
Devadaru Cedrus
Deodara
Tikta,
Katu
Laghu,
Snigdha
Ushna Katu Kapha
Vatahara
Bala Sida
cordifolia
Madhura Guru,Snigd
ha, Picchila
Sita Madhura Vata Pitta
Shamaka
Rasna Alpinia
Galanga
Tikta Guru Ushna Katu Kapha Vata
Shamaka
Kustha Sausseria
Lappa
Tikta,
Katu,
Madhura
Laghu,
Rooksha,
Teekshna
Ushna Katu Kapha.
Vata
Shamaka
Sarshapa Brassica
Juncea
Katu,
Tikta
Teekshna,
Ruksha,
Snigdha
Ushna Kapha Vata
Nashaka,
Pitta
Vardhaka

Nagara Zingiber
Officinale
Katu
Tikta
Laghu
Snigdha
Ushna Madhura Kapha Vata
Shamaka
Shatapus
hpa
Anethum
Graveolens
Katu,
Tikta
Laghu,
Ruksha,
Teekshna
Ushna Katu Kapha Vata
Shamaka
Pippali
Moola
Piper
Longum
Katu Laghu,
Rooksha
Ushna Katu Vata Kapha
Shamaka,
Pitta
Vardhaka
Chavya Piper
Brachystachy
cum
Katu Laghu,
Rooksha
Shamaka
Shigru Moringa
Olifera
Katu,
Tikta
Laghu,
Rooksha,
Teekshna
Shamaka
Punarnav
a
Boerhaavia
Diffusa
MadhuraT
ikta,
Kashaya
Laghu,
Rooksha
Ushna Madhura Tridoshahar
a
Aja
Ksheera
- Madhura Drava,
Pichila,
Sara,
Manta,
Sukshma,
Teekshna
Ushna Madhura Vata
Pittagna
Tila Taila Seasamum
indicum Linn
Madhura Guru,
Drava,
Pichila,
Sara,
Manta,
Sukshma,
Teekshna
Ushna Madhura Vata
Pittagna

Method of preparation of Karpasasthyadi Taila:
Drugs for Kasaya – Karpasa Beeja – 500 mg
Bala - 500 mg
Masha - 500 mg
Kulattha - 500 mg
Quantity of Kasaya – 8 ltrs
Kalka Dravyas - Devadaru – 5 grms
Bala - 5 grms
Rasna - 5 grms
Kusta - 5 grms
Sarshapa - 5 grms
Nagara - 5 grms
Shatapushpa- 5 grms
Pippalimoola- 5 grms
Chavya - 5 grms
Shigru - 5 grms
Punarnava - 5 grms
Taila for preparation – Tila Taila - 2 ltrs
Ksheera - 2 ltrs
Kasaya was prepared by adding 3.2ltrs of water reduced to 800 ml after adding
the Kasaya Dravyas. Moorchita Tila Taila was prepared.To this, Kasaya was added
and boiled over mild fire.The Kalka Dravyas are prepared by making a paste and
added to the oil. Ksheera is added to the boiling oil and stirred thoroughly over mild
fire till the Paaka Siddhi Lakshanas are obtained. Then cooled and filtered into air
tight container and stored.

Materials and Methodology
4. MATERIALS AND METHODOLOGY
CLINICAL STUDY
Methodological approach is the backbone of research. Utmost care is taken in
designing a methodology for conducting a research. Clinical research involves the
experimentation of a drug/therapy on a population and recording the feedback based
on which postulations are made regarding the usefulness of the drug/therapy in the
disease. Hence, in this section, the researchers put forward the systemic procedures,
which are followed by the researcher’s right from the identification of the problem to
the final conclusion.
Research Approach
In this clinical study, the objective was to. The “A comparative clinical study
on the effect of Nasya with Karpasasthyadi Taila and Nagara Taila in the management
of Avabahuka ”. Efficacy of this was determined by finding of base line data of the
parameters before and after the treatment of Nasya Karma with Karpasasthyadi Taila
and Nagara Taila.
Materials and Methods
Study Design
It is a comparative clinical study. Total patients were made in to two Groups
A and B. Group A had received Nasya with Karpasasthyadi Taila and Group B
received Nasya with Nagara Taila.

Materials and Methodology
a). Source of Data
Patients:- Patients with classical features of Avabahuka had been
selected from OPD/IPD dept in KVG Ayurvedic Medical College &
Hospital, Sullia.
b). Literary ;-literary aspect of the study had been collected from
classical Ayurvedic texts, recent medical journals and internet
c). Therapy:
Nasya Karma –with Karpasasthyadi Taila
Nasya Karma –with Nagara Taila.
d). “Selection of drug”- the trial drug collected from the surrounding
area and local market after being properly identified.
e). Preparation of medicine:-according to Sneha Paka mentioned in
classics. Medicine was prepared in K.V.G Ayurveda pharmacy,
Sullia
1. Karpasasthyadi Taila
Karpasasthyadi Taila is used for Nasya in group A.
Contents of Karpasasthyadi Taila.
Drugs for Kasaya - Karpasa Beeja, Bala, Masha, Kulattha.
Kalka Dravyas - Devadaru, Bala, Rasna, Kusta, Sarshapa, Nagara,Shatapushpa,
Chavya, Shigru, Punarnava. Ksheera.
Tila Taila

“A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF NASYA WITH KARPASASTHYADI TAILA AND NAGARA TAILA IN THE MANAGEMENT OF AVABAHUKA”

“A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF NASYA WITH KARPASASTHYADI TAILA AND NAGARA TAILA IN THE MANAGEMENT OF AVABAHUKA”

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“A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF NASYA WITH KARPASASTHYADI TAILA AND NAGARA TAILA IN THE MANAGEMENT OF AVABAHUKA”