|Section/Chapter/topic||Chikitsa / Panchakarma/ Nasya|
|Authors||Aneesh E.G., Deole Y.S.|
|Reviewed by||Basisht G.|
|Affiliations||Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar|
|Date of first publication:||December 15, 2020|
The term ‘nasya’ denotes ‘being in the nose’ or ‘belonging to nose’. It is one among the five purification procedures (panchakarma). In this procedure, the medicines are instilled through the nostrils. It is indicated in the diseases of head and associated structures.[A.Hr. Sutra Sthana 20/1] Considering the therapeutic efficacy, it is used to treat a wide spectrum of diseases ranging from headache to infertility.
- 1 Etymology and derivation
- 2 Synonyms
- 3 Classification
- 3.1 Based on the method of administration
- 3.1.1 Unctuous medicine (navana)
- 3.1.2 Herbal juice (avapeeda)
- 3.1.3 Medicinal powder (dhmapana)
- 3.1.4 Medicinal smoke inhalation (dhuma)
- 3.1.5 Low dose instillation (pratimarsha)
- 3.1.6 High dose instillation (marshanasya)
- 3.2 Types of nasya based on actions
- 3.3 Based on parts used to prepare the drug
- 3.1 Based on the method of administration
- 4 General indications of nasal instillation therapy
- 5 General Contraindications
- 6 Nasya procedure
- 7 Duration
- 8 Assessment of efficacy
- 9 Complications
- 10 Safety precautions
- 11 Importance in preservation of health and prevention
- 12 Importance in management of disease
- 13 Mode of action of nasya
- 14 Current researches
- 15 List of theses done
- 16 More information
- 17 Abbreviations
- 18 List of References
- 19 References
Etymology and derivation
The term ‘nasya’ is derived from the root word ‘nas’, which means ‘motion’ (nasagatau) or pervasion (nasavyapatau). The term ‘nastaha’ means ‘beneficial to nose’. Administration of any form of medicine into the nose is called nasya. [Su.Sa.Chikitsa Sthana 40/21]
Based on the method of administration
- Unctuous medicine (navana)
- Extracted herbal juice (avapeeda)
- Medicinal powder (dhmapana)
- Medicinal smoke (dhuma)
- Low dose (pratimarsha) and high dose(marsha) unctuous medicine[Cha.Sa.Siddhi Sthana 9/89-92]
This includes instillation of medicated oils or other unctuous materials.
Types based on purpose
A. Oleating (snehana)
B. Purificatory (shodhana)
Oleating (snehana) medicine
It provides unction, nourishment and strength to the chest, neck and shoulders.
Indications: It is especially indicated in diseases due to aggravation of vata dosha and associated pitta dosha in head and supraclavicular region. For ex. Hair fall, tooth disorders; pain in ear; tinnitus; frozen shoulder, premature graying of hair etc. [Su.Sa.Chikitsa Sthana 40/22]
The general dose of instillation of medicine is as below. In ancient times, the dose of nasal instillation medicine was measured in ‘bindu’ means drops. The amount of fluid that drips down after immersing the distal two interphalangeal joints of index finger of the patient in a liquid and taking the finger out is one bindu. [A.Hr. Sutra Sthana 20/9-10] One ‘bindu’ is standardized as 0.5ml for oil.
|Minimum dose||4 ml (8 bindu or drops)|
|Moderate dose||8 ml (16 bindu or drops)|
|Maximum dose||16ml (32 bindu or drops)|
Purificatory (shodhana) medicine
The general dose of instillation of medicine is as below:
|Minimum dose||2ml (4 bindu)|
|Moderate dose||3ml (6 bindu)|
|Maximum dose||4ml (8 bindu)|
[Su.Sa.Chikitsa Sthana 40/36]
Herbal juice (avapeeda)
In this method, the juice extracted by pressing (peedana) fresh herbs or its paste is instilled in the nose.[Chakrapanai on Cha.Sa.Siddhi Sthana 9/90]
Unconsciousness, snake bite, diseases of throat, intermittent fever, psychological disorders, excessive sleep, [Su.Sa.Chikitsa Sthana 40/44-45] [Sha.Sa.Uttarakhanda 8/16] diseases of kapha dosha and adipose tissue (meda dhatu). [Dalhana on Su.Sa.Chikitsa Sthana 40/44-45]
- Purificatory (shodhana)
Nasal instillation with the medicines with purification properties (shirovirechana)
- Astringent (stambhana)
|Minimum dose||2ml (4 bindu)|
|Moderate dose||3ml (6 bindu)|
|Maximum dose||4ml (8 bindu)|
Medicinal powder (dhmapana)
In this method, the medicinal fine powder is blown into the nostrils. This clears body channels and is purificatory in action.[Chakrapani on Cha.Sa.Siddhi Sthana 9/91] Fine powder is filled inside a tube of approximately 12cm (6 angula) length and blown into the nostrils of the patient. It expels excess dosha.[A.Hr. Sutra Sthana 20/8-9]
Psychological disorders, person afflicted by poison, unconsciousness, epilepsy etc. [Su.Sa.Chikitsa Sthana 40/46] [Chakrapani on Cha.Sa.Siddhi Sthana 9/95] and conditions of severe aggravation of dosha. [Sha.Sa.Uttarakhanda 8/17]
|If procedure done using tube||3 pinch (3 muchudi) [Su.Sa.Chikitsa Sthana 40/46]|
|If a bolus is prepared with the medicine and is used for inhalation||24gm (1 shukti)|
|If medicine used is more potent||6 gm (1 kola) [Sha.Sa.Uttarakhanda 8/13]|
Medicinal smoke inhalation (dhuma)
- Therapeutic inhalation for prevention of disease (prayogika)
- Inhalation of smoke with unctuous substance (snaihika)
- Inhalation of smoke with purifying substance (vairechanika)
|Type of dhumanasya||Length of inhalation tube[Cha.sa.Sutra Sthana 5/49]||Dose [Cha.Sa.Sutra Sthana 5/36]|
|Prayogika||70cm (36 angula)||Twice in a day|
|Snaihika||62cm (32 angula)||Once in a day|
|Vairechanika||47cm (24 angula)||3 -4 times in a day|
Inhalation of smoke is done to remove mucus and clear the body channels. [Su.Sa.Chikitsa Sthana 40/25]
Low dose instillation (pratimarsha)
In this method, low dose of unctuous substance (sneha) is instilled in the nose (pratimarsha).[Chakrapani on Cha.Sa.Siddhi Sthana 9/117]
Time of administration
It can be administered in the morning after waking up from sleep, after brushing the teeth, before going outdoors, after being tired due to walking, exercise, sexual intercourse; after defecation and urination; after taking food, after vomiting and in evening. [Su.Sa.Chikitsa Sthana 40/51]
1ml (2 bindu) [A.Hr. Sutra Sthana.20/28-29]
Application of medicated oil in the inner wall of the nose with the finger dipped in the oil is also considered as pratimarsha. [Chakrapani on Cha.Sa.Siddhi Sthana 9/92]
High dose instillation (marshanasya)
Nasal instillation in higher dose is called ‘marshanasya’. The dosage forms are as below:
|Form of medicine used||Highest dose||Moderate dose||Least dose|
|Unctuous (oil/ghee)||5ml (10 bindu)||4ml (8 bindu)||3ml (6 bindu)|
|Paste||4ml (8 bindu)||3ml (6 bindu)||2ml (4 bindu)|
[A.Hr. Sutra Sthana 20/10]
Types of nasya based on actions
- Purificatory (rechana)
- Nourishing (tarpana)
- Pacifying (shamana)
Disorders of head due to kapha dosha, stiffness, numbness and heaviness of head; anorexia, headache, rhinitis, epilepsy and loss of smell. [Cha.Sa.Siddhi Sthana 9/93] [Su.Sa. Chikitsa Sthana 40/23]
Unctuous substance, paste, decoction, honey, salt or fermented preparations (asava) are used for purification errhine after processing with appropriate drugs.[A.Hr. Sutra Sthana 20/5]
Oil/ghee processed with medicated milk or decoction. [A.S. Sutra Sthana 29/8]
Based on parts used to prepare the drug
- Bark [Cha.Sa.Vimana Sthana8/154]
General indications of nasal instillation therapy
Nasal instillation is indicated in almost all diseases of head and supraclavicular region to remove the impurities.[Cha.Sa.Siddhi Sthana 2/22] As a part of purification regimen of panchakarma for preservation of health, nasya is indicated after therapeutic enema (basti).
- If the patient is tired, worried, unconscious, while hungry or thirsty, pregnant ladies, soon after delivery, too old and too young
- Acute rhinitis, breathing difficulty, cough, acute fever etc.
- Immediately after purificatory procedures including purgation, enema, bloodletting, internal oleation etc.
- Immediately after head bath or just before head bath, immediately after intake of food or water[Cha.Sa.Siddhi Sthana 2/20][Su.Sa. Chikitsa Sthana40/47][A.Hr. Sutra Sthana 20/11-12]
Procedure of nasya in one session is done in three steps:
- Pre therapeutic (purvakarma)
- Therapeutic (pradhanakarma)
- Post therapeutic (pashchatkarma)
Pre therapeutic (purvakarma)
Nasya is done after passing natural urges, complete digestion of meals and when the patient is not too hungry.[A.S. Sutra Sthana 29/15] The patient is first asked to clean his face and mouth. Then he lies in supine position on a slanting table with inclination towards head end (head low position). [Su.Sa.Chikitsa Sthana 40/25] After that proper oleation and sudation is done on head, face and neck region. In some conditions, the patient is asked to inhale medicated smoke to clear channels.
Therapeutic procedure (pradhanakarma)
The suitable medicine for nasal instillation is made warm by placing in hot water. Eyes of the patient are covered with cloth and the tip of the nose is raised. Medicine is instilled in one nostril, while the other nostril is closed. Same procedure is repeated to instill medicine in both nostrils. If the medicine, comes to throat, the patient shall hold it without spitting for 5 -10 seconds. [Sha.Sa.Uttarakhanda 8/54] Slight rubbing or massage is done over face, palms and soles.[A.S. Sutra Sthana 29/18] After that, patient should inhale slowly and spit the contents coming to mouth till the entire medicine is expelled.
Post therapeutic (pashchatkarma)
Sudation is done over the face and neck region until the secretions are reduced. Smoke inhalation is done to reduce the kapha that is aggravated during nasya procedure and located in the channels of head.[Cha.Sa.Siddhi Sthana 9/106] Gargling with lukewarm water is advised to clear mouth.[A.H. Sutra Sthana 20/23]
Nasya can be done for 7 days.
Assessment of efficacy
Clinical features of optimal nasya
Feeling of lightness in head and chest region, clarity in body channels and proper functioning of sense organs [Cha.Sa.Siddhi Sthana 1/51], unobstructed inhalation and expiration, proper sleep and reduction in signs and symptoms of the disease [A.S. Sutra Sthana 29/19]
The following table shows clinical features of inadequate, optimal and excess administration of unctuous and purificatory nasal instillation.
|Administration||Unctuous instillation||Purificatory instillation|
|Optimal||Clarity and normal functions of sense organs, mental wellbeing, lightness of head, unobstructed breathing and reduction in symptoms of disease [Su.Sa. Chikitsa Sthana 40/33]||Clarity and lightness of sense organs, clarity of mind, clarity of voice and proper functioning of sense organs [Su.Sa. Chikitsa Sthana 40/38] [A.Hr. Sutra Sthana 20/25]|
|Inadequate||Dryness of sense organs especially nose and mouth, feeling of emptiness of head and abnormal functioning of vata dosha [A.Hr. Sutra Sthana 20/24] [Su.Sa. Chikitsa Sthana 40/35]||Heaviness, coating, itching in body channels, oozing of kapha through channels, heaviness of head and aggravation of disease [Su.Sa. Chikitsa Sthana 40/39] [Cha.Sa.Siddhi Sthana 1/52]|
|Excess||Heaviness of head, excessive discharge of kapha, itching, anorexia, rhinitis, improper functioning of sense organs and other diseases due to aggravation of kapha [Su.Sa. Chikitsa Sthana 40/33] [A.Hr. Sutra Sthana 20/24]||Pain in head, eyes, ears and temples; aggravation of vata dosha, abnormality of senses organs, emptiness of head and fainting [Cha.Sa.Siddhi Sthana 1/52] [Su.Sa. Chikitsa Sthana 40/40]|
Complications due to improper administration:
- If nasya medication is instilled quickly (atidrutam), it will make a negative impact over the micro channels and leads to the obstruction of vital air (prana). It results in cough, dyspnea, hiccups etc. [Ka.Sa.Siddhi Sthana 4/3]
- If nasya medication is excessively hot, that results in burns, ulceration, epistaxis, headache, vision complaints and fainting. [A.S. Sutra Sthana 29/18]
- Administration of medication which is too cold, results in blockage in the channels which results in non evacuation of dosha. [Ka.Sa.Siddhi Sthana 4/3] [A.S. Sutra Sthana 29/18]
- If the quantity of nasal medication is more, it will get easily expelled and may cause disorders due to excessive expulsion of dosha. [Ka.Sa.Siddhi Sthana 4/3] [A.S. Sutra Sthana 29/18]
- If the amount of nasal medication is low, that results in aggravation of dosha and the person may experience heaviness, anorexia, cough, coryza, vomiting etc. [A.S. Sutra Sthana 29/18]
- If the potency of medicine is more, that may cause aggravation of vata dosha which results in psychic disorders. [Ka.Sa.Siddhi Sthana 4/3]
- If the instillation is done by keeping the head in elevated position, the medicine won’t reach at its target sites. [A.S. Sutra Sthana 29/18]
- If nasya is done by keeping the head in too low position will results in fainting, burning sensation and fever. [A.S. Sutra Sthana 29/18]
- If the patient engulfed the medication, loss of appetite and aggravation of dosha may happen. [A.S. Sutra Sthana 29/18]
Doing nasya in contraindicated conditions will results in complications.
Proper selection of patient and drug is essential in order to make a procedure effective and safe. Educate the person properly about the complete procedure and about the do’s and don’ts. The person should always stay in warmer environment during nasya and even after that. Prior to nasya proper oleation and fomentation must be done. The medicine should be moderately warm while instillation and ask the patient to inhale through mouth. After the instillation, remaining medicine present in the channels must be eliminated through fomentation etc. techniques. During the course of this treatment, advice the patient to avoid head bath and to consume warm food and drinks.
Importance in preservation of health and prevention
Nasya with Anu taila (a medicated oil) is advised as a part of seasonal regimen of preservation of health during pre-rainy season, autumn and spring. This keeps sight, smell and hearing unimpaired. It nourishes and gives greater strength to the blood vessels, joints, ligaments and tendons of cranium. It also prevents the diseases related to head and neck. [Cha.Sa.Sutra Sthana 5/56-63] Pratimarsha nasya is advised in daily regimen. This provides more strength to sense organs and prevents the diseases of head.[Sha.Sa.Uttarakhanda 8/45]
Importance in management of disease
Nasya is indicated in many diseases pertaining to head like stiffness of head and teeth, torticollis, spasm of throat, lock jaw, migraine, facial paralysis etc.[Cha.Sa.Siddhi Sthana 2/22]
Mode of action of nasya
The medicines instilled into the nose moves through the micro channels and reach the vital point ‘shringatakamarma’ and then spread throughout the head, eyes, ears, throat etc. Thus, it cures the diseases of head and neck by removing the accumulation of the dosha. [A.S. Sutra Sthana 29/3] In anatomical perspective, ‘shringatakamarma’ is considered as the middle cephalic fossa. It includes nerves, paranasal sinuses and meningeal vessels. The nasal cavity directly opens into the paranasal sinuses. The drug administered through the nose reaches the paranasal sinuses having abundant blood supply. It may stimulate the nerves and a portion might get absorbed into the blood supply and reaches the brain.
Nasal route is a simple, convenient, noninvasive and safe for systemic administration of drugs. The advantages of nasal route for drug delivery are its large surface area for drug absorption, bypassing the hepatic first-pass metabolism and avoiding drug degradation in gastro intestinal tract. Apart from this the nasal route plays major role in the brain targeted drug delivery. It allows active principles of the drug to be delivered directly to the brain via neural pathways such as olfactory and trigeminal nerves. Through this pathway it also bypasses the blood brain barrier. Drugs cross the nasal mucosa through transcellular and paracellular pathways. Lipophilic molecules are usually transported through the transcellular pathway. The intra nasal combination of erythropoietin and IGF-1 (insulin like growth factor-1) significantly reduce the infarct in middle cerebral artery occlusion and improve neurological functions. Intra nasal delivery of recombinant human vascular endothelial growth factor shows reduction in infract volume, improved behavioral recovery and enhanced angiogenesis following middle cerebral artery occlusion (Xu et al., 2009).
In a study conducted on 36 patients, Nasya with Dhanwantaramtaila was found to be effective in reducing the signs and symptoms of cervical spondylosis especially pain, tenderness, numbness etc. Nose is a direct pathway to brain. The peripheral process of olfactory cells responds to volatile, water soluble and lipid soluble chemical substances. The medicine used for nasya possess these qualities. Nasya may stimulate the brain through this pathway and thus inducing the production of neuro peptides which act as pain relievers. Nasya may stimulate the areas like amygdela in the limbic system and thus activate the neuropeptide pathway.
Nasya with powder (trikatuchurna) in a comatose patient showed appreciable changes in Glasgow coma scale. Smell sensation projects to higher cortical area and to the limbic system. Drugs administered in powder form may stimulate the limbic system, hypothalamus and thalamus. This in turn may activate the reticular activating system which provokes higher degree of consciousness.
Nasya with trikatuchurna with triphalachurna is found to be effective in reducing the signs and symptoms of chronic sinusitis. Significant reduction is reported in nasal blockage, sneezing, post-nasal drip, headache, cough and fever. This study conducted on 110 patients also reported an insignificant reduction in some of the hematological parameters like C – reactive protein, ESR and Absolute eosinophil count (AEC) after nasya. It also suggests that the nasya with powder is effective in removing the vitiated kapha dosha quickly.
In a study conducted on 15 patients nasya with Laghumashataila was found effective in reducing the signs and symptoms of frozen shoulder through its anti-inflammatory and nutritive effects. A study on 20 patients, it was reported that nasya with Anutaila and Mashaditaila is effective in treating facial paralysis. In another study conducted on 21 patients of migraine, nasya with Bruhatdashamoolataila followed by pacifying therapy was found effective in reducing its signs and symptoms.
List of theses done
- Sushmita Saxena (2001): A comparative study on effect of Panchabhautika taila Nasya with Samvardhana Ghrita and Jyotishmati taila in management of Mandabuddhitva (mental retardation). Department of Kaumarabrithya, IPGT&RA Jamnagar
- Patel Ratna(2002): A comparative study on the role of Medhya Ghrita administered by Nasya and oral route in the management of Vatika Shirah-Shoola (tension headache). Department of Kayachikitsa, IPGT&RA Jamnagar
- Jyotishi Hetal R (2003): Role of Nasya and Shiro abhyanaga along with Narasimha Ghrita in the management of Khalitya: A comparative study. Department of Kayachikitsa, IPGT&RA Jamnagar
- Tank Neha G (2003): Clinical study of anurjatajanitapratishyaya (allergic rhinitis) and comparative assessment of nasya karma. Department of Kayachikitsa, IPGT&RA Jamnagar
- Yadav Ramdev (2003): A clinical study on the Rasayana effect of Tuvarakataila nasya in the management of Dushta-pratishyaya. Department of Kayachikitsa, IPGT&RA Jamnagar
- Mann Raj (2005): A clinical study of Nasya Karma and Shamana yoga in the management of Vatika Shirashoola w.s.r to tension headache. Department of Kayachikitsa, IPGT&RA Jamnagar
- Sankhyadhar Deepika (2005): A clinical study on Nasya karma and indigenous drugs in the management of Jeerna-pratishyaya w.s.r to chronic rhinitis. Department of Kayachikitsa, IPGT&RA Jamnagar
- Rameshbhai C Patel (2013): A comparative clinical study between rasnaditaila nasya and pathyadikwatha administered orally in the management of vatika shirahshoola w.s.r to tension headache. Department of Panchakarma, IPGT&RA Jamnagar
- Sonam Dangi (2015): A comparative study of nasya karma with yashtimadhukadhyamtaila and chandanadhyamtaila in the management of khalitya (Hair fall). Department of Panchakarma, IPGT&RA Jamnagar
- Zala Divyaben Samatbhai (2017): A comparative clinical study of panchagavyaghrita nasya and sarasvatchoorna in the management of chittodvega w.s.r to generalized anxiety disorder. Department of Panchakarma, IPGT&RA Jamnagar
- Shrija Mavani (2018): A comparative clinical study to evaluate role of nasya and physiotherapy in the management of avabahuka w.s.r to frozen shoulder. Department of Panchakarma, IPGT&RA Jamnagar
Cha. = Charak, Su. = Sushruta, A. = Ashtanga, S. = Sangraha, Hr. = Hridayam, Sa. = Samhita, Sha. = Sharangadara, Ka. = Kashyapa
List of References
The list of references for Nasya in Charak Samhita can be seen here
- Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Nasya, Page 532
- Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.
- Sabdakalpadruma- vol 5, 3rd edition. Varanasi: Chowkhamba Sanskrit series office; 1961.nasya; p. 457:Col 1
- Mukundalal Dwivedi, Vaacaspatyam, Ayurvediya Pancakarma. Varanasi: Chaukhambha bharati academy; 1992, Chapter 11; p-936
- Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.
- Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.
- Sharangadhara. Sharangadhara Samhita. Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Chaukhambha orientalia;2016.
- C Radhika, G Vinodkumar et al. A randomized controlled clinical trial to assess the efficacy of Nasya in reducing the signs and symptoms of cervical spondylosis. Ayu. 2012 Jan;33(1):73-7. doi: 10.4103/0974-8520.100316.
- Kashyapa. Kashyapa Samhita. Edited by P. V. Tewari. Reprint. Varanasi: Chaukhambha vishvabharati;2008.
- B Das, Ravi M G, P K Mishra, G Bhuyan. A study on Apabahuka (frozen shoulder) and its management by Laghumasha taila nasya. Ayu. 2010 Oct;31(4):488-94. doi: 10.4103/0974-8520.82048.
- D Kim, Young HK, Soonjo K. Enhanced nasal drug delivery efficiency by increasing mechanical loading using hypergravity. Sci Rep. 2018 Jan 9;8(1):168. doi: 10.1038/s41598-017-18561-x.
- Franciska Erdo, Luca AB, Daniel F et al. Evaluation of intranasal delivery route of drug administration for brain targeting. Brain Res Bull. 2018 Oct;143:155-170. doi: 10.1016/j.brainresbull.2018.10.009. Epub 2018 Oct 25.
- Rajkala SR, PD Patil, AB Thakar. Efficacy of Nasya (nasal medication) in coma: A case study. Anc Sci Life. 2016 Apr-Jun;35(4):232-5. doi: 10.4103/0257-7941.188188.
- Chaudhari V, Rajagopala M, Mistry S, Vaghela DB. Role of Pradhamana Nasya and Trayodashanga Kwatha in the management of Dushta Pratishyaya with special reference to chronic sinusitis. Ayu. 2010;31(3):325-331. doi:10.4103/0974-8520.77165
- Thanki K H, Joshi N P, Shah N B. A comparative study of Anutaila and Mashaditaila Nasya on Adrita (Facial paralysis). Ayu. 2009:30(3):201-204
- Parekh H, Rajagopala M. A clinical study on the role of Brihat Dashamoola taila nasya and Laghu Sutashekhara rasa in the management of Ardhavabhedaka w.s.r to migraine. Ayu. 2009:30(1):29-33