“a clinical study to evaluate the effect of nasya …

“A CLINICAL STUDY TO EVALUATE THE EFFECT OF NASYA KARMA IN CERVICAL SPONDYLOSIS”

By

Dr. VIGNESH HOBLIDAR B.A.M.S

Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment

Of the requirements for the degree of

AYURVEDA VACHASPATI DOCTOR OF MEDICINE (Ayu)

in

PANCHAKARMA

Under the guidance of

Dr. NIRANJAN RAO M. D.

Professor (Ayu)

Department of Panchakarma,SDMCA Udupi.

Co-Guide

Dr. SHREEKANTH U. M.D. (Ayu) Former Dean, Professor & H O D

P.G.Studies in Department of Panchakarma, SDMCA Udupi.

Department of P.G. Studies in Panchakarma. S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI

2011-12

I

Rajiv Gandhi University of Health Sciences

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “ A CLINICAL STUDY TO

EVALUATE THE EFFECT OF NASYA KARMA IN CERVICAL

SPONDYLOSIS ” is a bonafide and genuine research work carried out by me under

the guidance of Dr. NIRANJAN RAO M.D. (Ayu), Professor, Department of

Panchakarma and co-guidance of Dr. SHREEKANTH U. M.D. (Ayu), Former

Dean, Professor and H.O.D., Department of Panchakarma.

Date: Signature of the candidate

Place: Udupi Dr. VIGNESH HOBLIDAR

II


CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A CLINICAL STUDY TO


SPONDYLOSIS ” is a bonafide research work done by Dr. VIGNESH

HOBLIDAR under my guidance and the co-guidance of Dr. SHREEKANTH U.

M.D. (Ayu), Former Dean, Professor and H.O.D., Department of Panchakarma in

partial fulfillment of the requirement for the degree of DOCTOR OF MEDICINE

(Ayu)

Date: Signature of the Guide

Place: Udupi Dr. NIRANJAN RAO M.D. (Ayu)

Professor, Department of Panchakarma

III


This is to certify that the dissertation entitled “A CLINICAL STUDY TO


SPONDYLOSIS” is a bonafide research work done by Dr. VIGNESH HOBLIDAR

under the Guidance of Dr. NIRANJAN RAO M.D. (Ayu), Professor, Department of

Panchakarma and Co-guidance of Dr. SHREEKANTH U. M.D. (Ayu), Former

Dean, Professor and H.O.D., Department of Panchakarma.

ENDORSEMENT BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION

Signature of the H.O.D Signature of the Principal Dr. Shreekanth U. M.D. (Ayu) Dr. U.N. Prasad M.D (Ayu)

Date: Date: Place: Udupi Place: Udupi

IV

© COPYRIGHT

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall

have the rights to preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic / research purpose.

Date: Signature of the Candidate Place: Udupi Dr. VIGNESH HOBLIDAR

Declaration by the Candidate

© Rajiv Gandhi University of Health Sciences, Karnataka

ACKNOWLEDGEMENT

I offer my salutation to the almighty for his blessings that

made me accomplish this dissertation work and to my parents

(Rathnakar Hoblidar & D. K Malathi ) for their everlasting

support.

It is the sacred time to avail opportunity by extending my

deepest sense of indebtedness to Dr. Gopinadh Raju , former

principal of Dr. N .R .S Govt. Ayurvedic College, Vijayawada

whose paternal affection, inspiring teaching, valuable guidance,

timely remarks & helpful suggestions made me to successfully

complete this work.

I am short of words to express my gratefulness towards

Dr.Veerendra Heggade for providing me with an opportunity to

study in this esteemed institution.

I am ever grateful to Dr. U.N Prasad, Principal for his

encouragement and support.

It is a matter of privilege and honor for me to say that

Dr. Niranjan Rao, Professor, Department of Panchakarma, SDM

College of Ayurveda, Udupi,has guided me for this dissertation

work and I am sincerely grateful to him for his expert guidance and

constant encouragement.

I express my deepest gratitude and respect to Co-Guide and

HOD Dr. Dr. Shreekanth U, Ex-Dean, Professor and HOD,

Department of Panchakarma, SDM College of Ayurveda, Udupi,

whose valuable guidance and support has been with me throughout

this dissertation work.

I am thankful to Dr. Rajalaxmi , for their valuable guidance

for the completion of my thesis.

I remember with gratitude the patients of the hospital for

their co-operation and furnishing valuable information for

compilation of data required for this study.

I also thank my beloved friend Dr. Mithun Ramaraju,

whose moral support was always there with me throughout my

study.

I also take this opportunity to thank my seniors, Dr. Girija ,

Dr. Rahul Dr. Prakash, Dr. Greeshma Dr. Riaz, Dr. Nikhil and

for their guidance, my colleagues Dr. Vishwanath, Dr .Raksha,

Dr. Varun, Dr. Shankar for their help and my juniors, Dr. Ambika,

Dr. Karthikeya, Dr. Abishek, Dr. Basavarajeshwari, , Dr. nagraj,

Dr. Murgesh, Dr. Amrith, Dr. Teena Nargotra for their support.

I also thank Dr. Joel Antony, Dr. Sudeep, Dr. Sunil,

Dr. Nishanth, Dr. Veeraj, Dr. Ashok, Dr. Vivek, Dr. Anand,

and Likith S.V, Sampark Xerox, Udupi for their support .

I offer my earnest gratitude to Dr. Kalyan Chakravarthy

for his hearty support

I would like to thank my uncle D. K Ganesh and my elder

brother for his encouraging words and support during my study.

I would like to thank all my teachers, who inspired and

supported me immensely throughout the studies.

I also thank all Panchakarma staff for their timely support .

In the end I would like to say that I thank and seek

forgiveness if I have not mentioned any names which have directly

or indirectly been a part of this study.

Date: Vignesh Hoblidar

Place:

List of Abbreviations

LIST OF ABBREVIATIONS USED

(in alphabetical order)

LIST OF ABBREVIATIONS

A.Di. Ayurveda Dipika A.Hr. Ashtanga Hridaya A.Sa. Ashtanga Sangraha AT After Treatment A.V. AtharvaVeda BT Before Treatment Bh.Pr. BhavaPrakasha Bhe.Sa. Bhela Samhita C.D. ChakraDatta C.S. Cervical Spondylosis Ch. Chaturtha Sthana Chi. Chikitsa Sthana Chi.Kal. Chikitsa Kalika Ch.Sa. Charaka Samhita Dw. Dwiteeya Bhaga Esi Esinophils ESR Erythrocyte Sedimentation Rate G.N. GadaNigraha gms grams Hb Heamoglobin H.S. Harita Samhita Ka. Kalpa Sthana Ka.Sa. Kashyapa Samhita Khi. Khila Sthana Lym Lymphocytes M.N. Madhava Nidana M.S. ManuSmruti Ma. Madhyama Khanda Mon Monocytes N Number of patients Neu Neutrophils Ni. Nidana Sthana

Ni.Sa. Nibandha Sangraha Pr. Prathama Bhaga Pu. Purva Khanda

“A Clinical Study to evaluate the effect of Nasya Karma in Cervical Spondylosis ”

List of Abbreviations

RBS Random Blood Sugar R.V. RigVeda SD Standard Deviation Sh. Shareera Sthana Sha.Sa. Sharangadhara Samhita Si. Siddhi Sthana Su. Sutra Sthana Sub. Substitute Su.Sa. Sushruta Samhita

TC Total Count Tr. Truteeya Sthana Ut. Uttara Khanda Vi. Vimana Sthana V.M. VrundaMadhava V.S. Vangasena Samhita Y.R. YogaRatnakara Y.T. YogaTarangini

ABSRACT

Today is the era of modernization and fast life. Everybody is busy and living stressful life. Changing of life style of modern human being has created several disharmonies inhis biological system. Advancement of busy, professional and social life, improper sittingposture in offices, continuous work in one posture and overexertion, jerking movements during travelling and sports – all these factors create undue pressure and stress injury to the spine and play an important role in producing disease like cervical spondylosis.

Nasya karma is considered as a prime line of treatment in urdhwa jatru vikaras. The phenomenon of cervical spondylosis is affecting the neck.

The prime line of treatment in such urdhwa jatru vikara is Nasya karma.

Design - This is a single blind clinical study with pre and post test design

Source of data - 30 patients suffering from Cervical spondylosis of either sex in an age

limit between 30-70 years were selected from O.P.D and I.P.D of S.D.M.Ayurveda

hospital,Udupi and randomly selected for the study.

Intervention - These 30 patients were administered with Ketakyadi taila nasya karma

for initial 7 days .Therapeutic effect of the procedures will be assessed by the parameters

and result will be analized statistically.

Observation – Among 30 patients of Cervical spondylosis studied in this work,43.33%

patients belonged to the age group of 41-50 years,70% were males,86.66% were

Hindus,80% were married, 43.33% were agriculturist ,43.33% were of vata pittaja

prakruti.

Result - Statistically significant improvement was observed in all the criteria of

assessment.

Conclusion – The Ketakyadi taila Nasya karma performed is therapeutically effective in

patients suffering from Cervical spondylosis

Key words : Cervical spondylosis, Nasya etc..

TABLE OF CONTENTS

Chapter

No. Title Page No.

1 INTRODUCTION 1-3

2 OBJECTIVES 4

3 REVIEW OF LITERATURE 5-75

4 METHODOLOGY 76-84

5 OBSERVATION & RESULTS 85-134

6 DISCUSSION 135-152

7 CONCLUSION 153

8 SUMMARY 154-155

9 BIBLIOGRAPHY 156-175

10 ANNEXURES 176-191

LIST OF TABLES

No. Topic Page no.

1 Various Timings for Pratimarsha Nasya 31

2 Nasya karma yogyas 34

3 Nasya karma ayogyas 37

4 Time schedule in different seasons should be as below 39

5 Showing time schedule of nasya in Doshaja vikaras 40

6 Dose of nasya 41

7 Shamayak Yoga Lakshana 46

8 Ayoga Lakshana 47

9 Atiyoga Lakshana 48

10 Management of ayoga and atiyoga of nasya karma 49

11 Age group wise distribution: 85

12 Sex wise distribution of patients: 86

13 Religion wise distribution of patients: 86

14 Educational Status of patients: 87

15 Marital status of patients 87

16 Socio economic status of patients 88

17 Occupation wise distribution of patients 88

18 Distribution of patients according to their Desha: 89

19 Distribution of pts according to the associated diseases 89

20 Distribution of pts according to their diet: 90

21 Distribution of patients on the basis of Rasa Pradhanya 90

22 Distribution of patients according to their Diet habit: 91

23 Distribution of patients according to their habit of Nidra: 91

24 Classification of patients based on Bowel & Bladder 92

habits:

25 Classification of patients according to their habits: 92

26 Classification of patients on the basis of prakruti: 93

27 Classification of patients on the basis of their satwa: 93

28 Classification of patients on the basis of samhanana: 94

29 Classification of patients on the basis of satmya: 94

30 Classification of patients on the basis of Ahara shakti: 95

31 Classification of pts on the basis of their vyayama shakti: 95

32 Classification of patients on the basis of Vaya: 96

33 Classification of patients on the basis of their Koshta: 96

34 Classification of patients on the basis of Neck pain 97

35 Classification of patients on the basis of Radiation of pain 97

36 Classification of patients on the basis of Radiating side 98

37 Classification of patients on the basis of Stiffness 98

38 Classification of patients on the basis of Neck movements 99

39 Classification of patients on the basis of Weakness 99

40 Classification of patients on the basis of Parasthesia 100

41 Classification of patients on the basis of Sensory loss 100

42 Classification of patients on the basis of Clumpsy finger

movements

101

43 Classification of patients on the basis of Vertigo 101

44 Classification of patients on the basis of Duration of

complaints

102

45 Classification of patients on the basis of Mode of onset 102

46 Classification of patients on the basis of Nature of pain 103

47 Classification of patients on the basis of Course of pain 103

48 Classification of patients on the basis of Family history 104

49 Classification of patients on the basis of Treatment history 104

50 Classification of patients on the basis of Neurological

deficit

105

51 Classification of patients on the basis of Neck disability

index

105

52 Samyak nasya laxana in the patients 106

53 Effect of treatment on neck pain 107

54 Effect of treatment on Radiation of pain 108

55 Effect of stiffness 109

56 Effect of treatment on Weakness 110

57 Effect of treatment on Parasthesia 111

58 Effect of treatment on Clumpsy finger movement 112

59 Effect of treatment on Vertigo 113

60 Effect of treatment on - Tenderness 114

61 Effect of treatment on–Movements of neck 115

62 Effect of treatment on - sensory loss 116

63 Effect of treatment on–Neurological deficit 117

64 Effect of treatment on -Neck disability index 118

65 Effect of treatment on Power w.s.r. movements . Shoulder

Abduction

119

66 Effect of treatment on -Power w.s.r. movements .

Shoulder, Flexion

120

67 Effect of treatment on - Power w.s.r. movements .

Shoulder Extension

121

68 Effect of treatment on - Power w.s.r. movements . Elbow .

Flexion

122

69 Effect of treatment on - Power w.s.r. movements . Elbow 123

Extension

70 Effect of treatment on Power w.s.r. movements . Wrist . Flexion 124

71 Effect of treatment on Power w.s.r. movements . Wrist . Extension -

125

72 Effect of treatment on Power w.s.r. movements . Forearm . supination

126

73 Effect of treatment on Power w.s.r. movements Forearm Pronation

127

74 Effect of treatment on Power w.s.r. movements . Metacarpophalangeal and interphalangeal . Flexion

128

75 Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal. Extension

129

76 Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Abduction

130

77 Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Adduction

131

78 Effect of treatment on - Reflex. Biceps 132

79 Effect of treatment on-- Reflex. Triceps 133

80 Effect of treatment on Reflex. Supinator 134

LIST OF FLOWCHARTS

NO.

TOPIC PAGE NO.

1. CARAKA’S CLASSIFICATION OF NASYAKARMA 21

2. SUSHRUTA’S CLASSIFICATION OF

NASYAKARMA

22

3. VAGBHATA’S CLASSIFICATION OF

NASYAKARMA

22

4. KASHYAPA’S CLASSIFICATION OF NASYAKARM 23 5. BHELA’S CLASSIFICATION OF NASYAKARMA 23

6. SHARANGADHARA’S CLASSIFICATION OF

NASYAKARMA

23

7. BHOJA’S CLASSIFICATION OF NASYAKARMA 23

8. VIDEHA’S CLASSIFICATION OF NASYAKARMA 24

LIST OF FIGURES

NO. TOPIC

PAGE NO.

1. Age group wise distribution: 85

2 Sex wise distribution of patients: 86

3. Religion wise distribution of patients:

86

4. Educational Status of patients: 87

5 Table depicting marital status of patients

87

6 socio economic status of patients 88

7 Occupation wise distribution of patients 88

8 distribution of patients according to their Desha: 89

9 Distribution of pts according to the associated diseases

89

10 Distribution of pts according to their diet:

90

11 Distribution of patients on the basis of Rasa Pradhanya

90

12 Distribution of patients according to their Diet habit:

91

13 Distribution of patients according to their habit of Nidra:

91

14 Classification of patients based on Bowel & Bladder habits:

92

15 Classification of patients according to their habits:

92

16 Classification of patients on the basis of prakruti:

93

17 Classification of patients on the basis of their satwa:

93

18 Classification of patients on the basis of samhanana:

94

19 Classification of patients on the basis of satmya:

94

20 Classification of patients on the basis of Ahara shakti:

95

21 Classification of pts on the basis of their vyayama shakti: 95

22 Classification of patients on the basis of Vaya:

96

23 Classification of patients on the basis of their Koshta:

96

24 Classification of patients on the basis of Neck pain

97

25 Classification of patients on the basis of Radiation of pain

97

26 Classification of patients on the basis of Radiating side

98

27 Classification of patients on the basis of Stiffness

98

28 Classification of patients on the basis of Neck movements

99

29 Classification of patients on the basis of Weakness

99

30 Classification of patients on the basis of Parasthesia

100

31 Classification of patients on the basis of Sensory loss

100

32 Classification of patients on the basis of Clumpsy finger movements

101

33 Classification of patients on the basis of Vertigo

101

34 Classification of patients on the basis of Duration of complaints

102

35 Classification of patients on the basis of Mode of onset

102

36 Classification of patients on the basis of Nature of pain

103

37 Classification of patients on the basis of Course of pain

103

38 Classification of patients on the basis of Family history

104

39 Classification of patients on the basis of Treatment history

104

40 Classification of patients on the basis of Neurological deficit

105

41 Classification of patients on the basis of Neck disability index

105

42 Samyak nasya laxana in the patients 106

43 Effect of treatment on neck pain 107

44 Effect of treatment on Radiation of pain 108

45 Effect of stiffness

109

46 Effect of treatment on Weakness 110

47 Effect of treatment on Parasthesia 111

48 Effect of treatment on Clumpsy finger movement 112

49 Effect of treatment on Vertigo

113

50 Effect of treatment on - Tenderness 114

51 Effect of treatment on–Movements of neck 115

52 Effect of treatment on - sensory loss 116

53 Effect of treatment on–Neurological deficit 117

54 Effect of treatment on -Neck disability index

118

55 Effect of treatment on Power w.s.r. movements . Shoulder Abduction

119

56 Effect of treatment on -- Power w.s.r. movements . Shoulder, Flexion

120

57 Effect of treatment on - Power w.s.r. movements . Shoulder Extension

121

58 Effect of treatment on - Power w.s.r. movements . Elbow . Flexion

122

59 Effect of treatment on - Power w.s.r. movements . Elbow Extension

123

60 Effect of treatment on Power w.s.r. movements . Wrist . Flexion

124

61 Effect of treatment on Power w.s.r. movements . Wrist . Extension -

125

62 Effect of treatment on Power w.s.r. movements . Forearm . supination

126

63 Effect of treatment on Power w.s.r. movements Forearm Pronation

127

64 Effect of treatment on Power w.s.r. movements . Metacarpophalangeal and interphalangeal . Flexion

128

65 Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal. Extension

129

66 Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Abduction

130

67 Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Adduction

131

68 Effect of treatment on - Reflex .Biceps 132

69 Effect of treatment on-- Reflex. Triceps 133

70 Effect of treatment on Reflex .Supinator 134

Chapter - 1

Introduction

Introduction

1


INTRODUCTION

In God’s creation, the evolution of man is considered supreme. According to Indian

tradition, the highest purpose of humanlife is the fourfold realization Dharma, Artha,

Kama and Moksha. For the accomplishment of these purposes, health of a person must

be maintained. Since the birth, decay and death are always co-existed with the life, the

study of abnormal healthstatus and their management has also been studied with the

dawn of the human intellect.

Today is the era of modernization and fast life. Everybody is busy and living stressfullife.

Changing of life style of modern human being has created several disharmonies inhis

biological system. Advancement of busy, professional and social life, improper

sittingposture in offices, continuous work in one posture and overexertion, jerking

movements during travelling and sports – all these factors create undue pressure and

stress injury tothe spine and play an important role in producing disease like cervical

spondylosis.

Faulty dietetic habits and irregular life style is responsible for early degenerative changes

in bodily tissue and play a vital role in the manifestation of such degenerative disorder.

Inthis way, this disease is now becoming a significant threat to the working population.

Prevalance:

60-70% women and 85% of men may show changes related with cervical

spondylosis by the age 45, rhontgenologically1

The prevalence of cervical spondylotic myelopathy ranges between 96-100%, by the age

70 years in females and males respectively. Radiographic changes are more severe in

men then in women

.

23.6% patients presenting with non traumatic myelopathic symptoms have

cervical spondylosis. This is the cause for non traumatic spastic paraparesis and

quadriparesis.

1

Introduction

2


Cervical spondylosis is a degenerative disease of cervical spine. The main pathology is

found in the cervical spine; primarily in the intervertrabral discs and vertebral bodies. It

leads to pain and stiffness in neck, radiating pain into arm, headache,vertigo, giddiness,

paraesthesia, numbness etc. It disturbs the daily routine and overalllife of the patient.

Though it is not fatal instantly but it causes more severe complicationin later stage. It

cripples the patient, makes him burden to others. Person can’t perform the day to day

work properly due to severity of pain and this way it does not cut the yearsof life but life

of the years.Modern medical science provides various types of medical and surgical

therapy but none of the therapy is satisfactory in cervical spondylosis. All the treatments

are just for symptomatic relief. Due to more untowards effect of pain relieving drugs e.g.

NSAID,Steroids and surgical procedure, alternative medical systems like Ayurveda are

nowcoming into focus to find out better remedy for this condition.

Ayurveda is one among the most ancient medical sciences of the world. It conceives and

describes the basis & applied aspect of life process, health, disease & its managementin

terms of its own principles & approaches. There is no exact clinical entity mentioned in

classics like Cervical Spondylosis but it can be compared with apabahuka, vishwachi,

Manya graham, Manya stambha, Griva stambha , Shiro graham, greevahundanum . .How

ever description available regarding these conditions are very concised, so precise

interpretation with Cervical Spondylosis can not be established.

In such disorders core pathogenesis is – 1) degeneration of bone tissue and 2) vitiation

of Vata. Moreover,such degenerative type of condition with clinical manifestation can

also be consideredunder the broad umbrella of Vata Vyadhi.

“Urdhwa Jatru Vikareshu Visheshaat Nasyamishyate”2

The prime line of treatment in such urdhwa jatru vikara is Nasya karma. Ketakyadi taila

mentioned in the text is useful in such disorders

Nasya karma is considered as a prime line of treatment in urdhwa jatru vikaras. The

phenomenon of cervical spondylosis is affecting the neck.

3,4,5,6,7,8

Introduction

3


Nasya Karma is one among very important treatment modality in Panchkarma

In the present study an attempt is made to assess the effect of nasya karma on Cervical

spondylosis . Here Nasya karma was performed for 7 days and was effective in the

condition and Statistically significant results were obtained in terms of Power with

respect to neck pain, radiation of pain , stiffness ,weakness parasthesia ,clumpsy

finger movement , vertigo ,tenderness , movements of neck, sensory loss , neurological

deficit ,neck disability index ,power w.s.r. movements . Shoulder, Abduction, flexion

,extension , power w.s.r. movements . Elbow , Flexion, Extension power w.s.r.

movements . Wrist , Flexion , Extension Power w.s.r. movements , Forearm ,

supination, Pronation, power w.s.r. movements. metacarpophalangeal and

interphalangeal . Flexion , Extension, Abduction , Adduction reflex .Biceps , Triceps,

Supinator . And all the patients showed samyak nasya laxana.

Previous Research Works Done:

1. Shaligram, Asthimajja vata with special reference to cervical spondylosis , and role

of snehana and nasya karma in it’s management. Gujarat Ayurveda University ,

Jamnagar 1998

2. Sulochana Rathi – Management of Greeva sthamba vis-à-vis cervical spondylosis ,

UTKAL University, Puri, Orissa 1997

3. Andanagoud S Patil – the effect of Ketakyadi taila as katibasti in katishoola, RGUHS

University ,Bangalore 2000.

Chapter - 2

Aims & Objectives

Objectives

4


OBJECTIVES

• To study the effect of Ketakyadi taila Nasya karma in the management of Cervical

Spondylosis.

• To study Conceptual aspect of Nasya Karma and cervical Spondylosis

Chapter - 3

Review of Literature

Conceptual Study

5


CONCEPTUAL STUDY HISTORICAL REVIEW OF NASYA KARMA :

Indian culture starts from vedic time. Some mantras of vedas denote the presence of

Ayurveda during that time . Although it is very difficult to say that the procedure of

nasya karma therapy was in practice in vedic period , but the few mantras of rigveda

indirectly refer towards the karma which are included under panchakarma measures .

Before seeking in to the details of NasyaKarma,it is necessary to know the organ

involved its relevance in literatures.

Description of Nasa

“lÉÉxÉÉ ÌWû ÍvÉUxÉÉã ²ÉUqÉç|”

9

ETYMOLOGY:

lÉÉxÉiÉã vÉoSÉrÉiÉã CÌiÉ| lÉÉxÉ vÉoSã + “aÉÑUÉãgcÉ WûsÉ:”|

The word ‘NASA’ is derived from the root lÉÉxÉÉ and bÉgÉç mÉëirÉrÉ which means ‘to sound’.

‘Nasa’ plays an important role in the process of Nasyakarma. Also called as Nasika,

Ghranendriya, Gandhendriya which is predominant of Prithvi Mahabhuta is not only a

organ of smell but also a respiratory passage. 10

Nasa, it has got wider communications with various parts of head through many

channels that communicate with nasal cavity either directly or indirectly.

Rigveda

This can be considered as a earliest picture of Nasya karma . In a mantra there is

mentioning of the worrd “Nasa” and reference stating erradication of rogas through the

routes of nasa, chibuka, shira, Karna

A.Hr.Su.20/1

11

Atarva veda

Description of nine chidras and indriya has been given

We get reference of Nasa during the description of Indriyas.

12

Yajurveda

13

Conceptual Study

6


Atarva veda

Description of nine chidras and indriya has been given.14

MANUSMRUTI:

The names of 10 Indriyas have been mentioned. (M.S. 2/90)15

BHAGVADGITA:

Nasa is also mentioned while describing the Indriyas & Navadwaras.16

DEFINITION:

lÉÉxÉÉrÉÉ ÌuÉÍzÉ¹ LMüSåzÉÉå bÉëÉhÉãÇÌSìrÉ AÍkÉ¸ÉlÉqÉçç| A.Hr.Sh.3/3,Arunadatta17

It is explained that nasa is seat of Granendriya .

SYNONYMS: The synonyms of Nasa as per Amarakosha are as follows -

Nasika ,Nasa, Ghona, Ghranendriya Ghranam, Ghrana, Gandhavaha, 18

EMBRYOLOGY:

Acharya Sushruta has described that Sarvanga are developed during the fourth month of

Garbhavastha (Su.Sh.3/18)19.

According to Charaka the Nasa is developed during the third month of Garbhavastha

(Ch.Sh.4/11-12). 20

In Garbhopanishad, it is mentioned that Mukha (oral cavity), Nasa (nose), Akshi (eyes)

and Shrotra (ears) are developed in sixth month of pregnancy.

Indriyas are considered as evolved from Atma21. So, Nasa is considered as Atmaja

Bhava.

Predominent Panchamahabutha22

Prithvi

NASA SHAREERA :

In Ayurvedic literature , there is no detail desciption of nasa sharira .at one place like the

anatomical description of other organs, whereras Nasa is included among the five

indriyas as a site of Ghranendriya .

Conceptual Study

7


Sushruta has considered two nostrils among the nine external orifices while enumerating

the external orifices of the body23

Nasa is comprised of:23

3 Asthi

2 Pesi

2 Dhamani

2 Bahya Srotas

2 Phana Marmas

Phana marmas are sira marmas, vaikalyakara in nature, ardha angula in pramana, if

damaged causes loss of smell sensation.(Su.Sh.6/27)

1 Srungataka Marma –It nourishes the nose & if damaged causes immediate death.

(Su.Sh.6/27)

24 Siras

INDRIYA PANCHAPANCHKAM:

Indriya : Ghranendriya

Indriya Dravya : Prithvi

Indriya Adhisthana : Nasa

Indriya Artha : Gandha

Indriya Buddhi : Ghrana Buddhi

IMPORTANCE OF SHIRAS:

mÉëÉhÉÉ: mÉëÉhÉpÉ×iÉÉÇ rÉ§ÉÉÍ´ÉiÉÉ: xÉuÉãïÎlSìrÉÉÍhÉ cÉ|

rÉSÒ¨ÉqÉÉXçaÉqÉXçaÉÉlÉÉÇ ÍvÉUxiÉSÍpÉkÉÏrÉiÉã|| Ch.Su.17/12

In a living being , the head is the place where prana of all the sense faculties reside and

hence termed as Uttamanga .24

Shirah has been compared with sun. Shiras is the vital organ of senses, sensory channels

and channels carrying the vital impulse of Prana, as Sun is the navigator of its rays.25

It is the controlling centre of PranaVata, AlochakaPitta and TarpakaSleshma.

Conceptual Study

8


Vagbhata has mentioned “lÉÉxÉÉ ÌWû ÍvÉUxÉÉã ²ÉUqÉç|”2

NASYA KARMA

i.e., Nose as the gateway of Head and is

the only one route through which medicines can be administered to Shiras. So,

NasyaKarma is superior and can be considered as ‘Uttama’ as it deals with Uttama

Anga, the Shiras.

Vagbhata compares human body to a tree with UrdhwaMoola(Shiras) and If root is

protected, the tree survives. Hence if Shiras is properly treated, the diseases can be easily

cured .

RIGVEDA:

This can be considered as a primitive picture of Nasya Karma.

There is a Mantra in Rigveda which gives information about the eradication of Roga from

the routes of Nasa(Nostrils), Chibuka(Chin), Shiras(Head), Karna (Ear) and Rasana

(Tongue)26.

KRISHNA YAJURVEDA, UPANISHAD: 27

In these texts, the term Nasya Karma has been frequently used.

RAMAYANA:28

In Valmiki Ramayana, use of sanjeevani for nasya karma is found.

BOUDDHA KAALA

1) In Shirahshoola, he prescribed Nasya Karma to the wife of a Shreshthi of Saketa

Nagar using medicated Ghrita.

29

“Jeevaka” the famous Vaidya of Bouddha Kaala had utilized Nasya Karma in many

cases such as

2) Jeevaka administered Virechana to Lord Buddha by making him to smell a purgative

Aushadhi. This refers to Ghreya Virechana which is done through nasal route.

Conceptual Study

9


SAMHITA KAALA:

In all the Samhitas, NasyaKarma has been elaborately described especially in Charaka

Samhita, Sushruta Samhita, Ashtanga Sangraha, Ashtanga Hridaya, Sharangadhara

Samhita.

THE REFERENCE OF NASYA IN ASHTANGA SANGRAHAASHTANGA SANGRAHA

30

STHANA/ADHYAYA REFERENCE SUTRA

3.Dinacharya A.Sa.Su.3/15 4.Rutucharya A.Sa.Su.4/13 8.Annaraksha A.Sa.Su.8/36,37 13.Agryasangrahaniya A.Sa.Su.13/2 14.Sodanadigansangraha A.Sa.Su.14/6 24.Dwividopakramaniya A.Sa.Su.24/6 29.NasyaVidhi A.Sa.Su.29

SHAREERA 1.Putrakamiya A.Sa.Sh.1/58 CHIKITSA 2.JeernaJwara A.Sa.Chi.2/30 3.Raktapitta A.Sa.Chi.3/34 6.ShwasaHidhma A.Sa.Chi.6/25 7.Rajayakshma A.Sa.Chi.7/26,43 8.ChardiHridrogaTrusna A.Sa.Chi.8/21,39 9.Madatyaya A.Sa.Chi.9/55 22.SwitraKrimi A.Sa.Chi.22/28 23.VataVyadhi A.Sa.Chi.23/13,

14,17,25,26,28,37

KALPA 8.Bheshajakalpa A.Sa.Ka.8/18 UTTARA 6.Pratyekagrahpratiseda A.Sa.Ut.6/6 8.Bhutapratisheda A.Sa.Ut.8/4-23 9.Unmadapratisheda A.Sa.Ut.9/13-28 10.Apasmarapratisheda A.Sa.Ut.10/9,20 12.Vartmarogpratisheda A.Sa.Ut.12/5, 6,

10,13

14.SandiSitaAsitaRoga A.Sa.Ut.14/23,32 16.Timirapratisheda A.Sa.Ut.16/10-19 19.Abhisyandapratiseda A.Sa.Ut.19/8,40

Conceptual Study

10


20.AksipakaPillapratised A.Sa.Ut.20/2,3 22.KarnaRogapratisheda A.Sa.Ut.22/12,22

24.NasaRogapratisheda A.Sa.Ut.24/5,11,

19,20,28,29,31,33

26.MukhaRogapratiseda A.Sa.Ut.26/3,4,10

27, 29, 33

28.ShiroRogapratisheda A.Sa.Ut.28/3,7,13 18,19,21,27,28,29

35.GrantyArbudaSlipadaApachi

NadiPratisheda

A.Sa.Ut.35/2,

18,19

37.Kshudrarogapratiseda A.Sa.Ut.37/20 40.Vishapratisheda A.Sa.Ut.40/38 42.Sarpavishapratisheda A.Sa.Ut.42/25,29 43.Kitavishapratisheda A.Sa.Ut.43/35,59 44.Lutapratisheda A.Sa.Ut.44/33,36 46.Musikalarkapratiseda A.Sa.Ut.46/19,53 47.Vishopadravaprtiseda A.Sa.Ut.47/14,17 48.Vishopayogiya A.Sa.Ut.48/12,40,

A.Sa.Ut.48/41,42

THE REFERENCE OF NASYA IN ASHTANGA HRIDAYA

ASHTANGA HRIDAYA31

STHANA/ADHYAYA REFERENCE SUTRA

2.Dinacharya A.Hr.Su.2/6 3.Rutucharya A.Hr.Su.3/19 7.Annaraksha A.Hr.Su.7/26 14.Dwividopakramaniya A.Hr.Su.14/5 15.Sodanadigansangraha A.Hr.Su.15/4 20.NasyaVidhi A.Hr.Su.20

SHAREERA 1.Garbhavakranti A.Hr.Sh.1/40

CHIKITSA 1.Jwara A.Hr.Chi.1/125,

126, 150, 161

Conceptual Study

11


2.Raktapitta A.Hr.Chi.2/47,48 4.ShwasaHidhma A.Hr.Chi.4/46-50 5.Rajayakshma A.Hr.Chi.5/35,37,

41, 42, 69 6.ChardiHridrogaTrusna A.Hr.Chi.6/27,

A.Hr.Chi.6/66, 74

7.Madatyayadi A.Hr.Chi.7/104 A.Hr.Chi.7/110

20.SwitraKrimi A.Hr.Chi20/28,33 21.VataVyadhi A.Hr.Chi.21/3,

26-31,43, 44, 62 KALPA 6.DravyaKalpa A.Hr.Ka.6/21

UTTARA 5.Bhutapratisheda A.Hr.Ut.5/9,17,

A.Hr.Ut.5/30-47

6.Unmadapratisheda A.Hr.Ut.6/19,20 7.Apasmarapratisheda A.Hr.Ut.7/29,32 9.Vartmarogapratisheda A.Hr.Ut.9/1,8,19,

23, 39

11.SandiSitaAsitaRoga A.Hr.Ut.11/57 13.Timirapratisheda A.Hr.Ut.13/46,53,

69,75,76,93,95

16.Sarvakshirogpratised A.Hr.Ut.16/1,28 18.KarnaRogapratisheda A.Hr.Ut18/9-46 20.NasaRogapratisheda A.Hr.Ut.20/12-23 22.Mukharogapratisheda A.Hr.Ut.22/2,8,25

28,36,39,42,59,71

24.ShiroRogapratisheda A.Hr.Ut.24/4-7,

16, 33-36,48

30.GrantyArbudaSlipadaApachiNadiPratisheda A.Hr.Ut.30/20, 21,

26, 27

Conceptual Study

12


32.Kshudrarogapratiseda A.Hr.Ut.32/3,

27-30, 33

35.Vishapratisheda A.Hr.Ut.35/18 36.Sarpavishapratisheda A.Hr.Ut.36/72 38.Mushikalarkavisha A.Hr.Ut.38/24,32

THE REFERENCE OF NASYA IN SUSHRUTA SAMHITA SUSHRUTA SAMHITA

STHANA

32

REFERENCE SUTRA

12.Agnikarmavidhi Su.Su.12/36 27.Shalyapanayaniyam Su.Su.27/4,5,22

39.Samsodansamsamana Su.Su.39/6 43.VamanadravyaVikalp-aVijnaniyam Su.Su.43/9

44.VirechanadravyaVika-lpaVijnaniyam Su.Su.44/85

SHAREERA 2.ShukraShonitaSuddhi Su.Sh.2/32

CHIKITSA 1.Dwivraniya Su.Chi.1/8, 9, 125, 126

2.SadyoVrana Su.Chi.2/43 3.Bhagna 4.VataVyadhi Su.Chi.4/18,22 5.MahaVataVyadhi Su.Chi5/18,20-22 9.Kushta Su.Chi.9/43 14.Udara Su.Chi.14/11 18.GrantyApachiArbuda-

GalagandaChikitsitam

Su.Chi.18/22, 23,

Su.Chi.18/50

19.Vridyupadamslipada Su.Chi.19/15 20.Kshudraroga Su.Chi.20/30 22.Mukharoga Su.Chi.22/4,7,12,

Conceptual Study

13


31.Snehopayougika Su.Chi.31/3 32.Swedavacharaniya Su.Chi.32/17 34.Vamanvirecanvyapat Su.Chi.34/12,19 36.Netrabastivyapat Su.Chi.36/13 37.Anuvasanottarabasti Su.Chi.37/7 40.DhumaNasyaKavalaGraha

Chikitsitam

Su.Chi.40/20-57

KALPA 1.AnnapanarakshaKalpa Su.Ka.1/27, ,65

Su.Ka.1/35, 77 2.Stavaravishavijnaniya Su.Ka.2/41 5.SarpadashtaVishaChik-itsitamKalpa Su.Ka.5/21,23,27,

29,42,43,80

7.MushikaKalpa Su.Ka.7/37 8.KeetaKalpa Su.Ka.8/102,134 UTTARA 9.Vatabisyandapratiseda Su.Ut.9/4,10,22 10.Pittabisyandpratiseda Su.Ut.10/3,6 11.Slesmabisyandpratiseda Su.Ut.11/3 12.Raktabisyandpratised Su.Ut12/5,6,39,47 16.Paksmakopapratiseda Su.Ut.16/16 17.Dristigatrogapratised Su.Ut.17/5,32,41 18.KriyaKalpa Su.Ut.18/16, 78

Su.Ut.18/71 19.Nayanabigatapratiseda Su.Ut.19/3 21.Karnagatarogpratised Su.Ut.21/12,33,40 23.Nasagatarogpratiseda Su.Ut23/4,6,10,11 24.Pratisyayapratiseda Su.Ut.24/18-41 26.Shirorogapratiseda Su.Ut.26/7,10,15,

25,27,30,32,38-42

39.JwaraPratisheda 41.ShoshaPratisheda Su.Ut.41/33

Conceptual Study

14


45.RaktapittaPratisheda Su.Ut.45/28,37 46.MurchaPratisheda Su.Ut.46/18 50.HikkaPratisheda Su.Ut.50/16-18 52.KasaPratisheda Su.Ut.52/28 53.Swarabhedapratiseda Su.Ut.53/8 54.Krimirogapratisheda Su.Ut.54/34-36 55.UdavartaPratisheda Su.Ut.55/29 57.ArochakaPratisheda Su.Ut.57/13 60.Amanushopasargaprati Su.Ut.60/40,51 61.ApasmaraPratisheda Su.Ut.61/25 62.UnmadaPratisheda Su.Ut.62/14,16,32 64.Swsthavrutta Su.Ut.64/39

THE REFERENCE OF NASYA IN CHARAKA SAMHITA

CHARAKA SAMHITA

STHANA/

33

REFERENCE SUTRA

1.Deerghanjivitiy Ch.Su.1/79,85

Ch.Su.1/87,91

2.Apamargatanduliya Ch.Su.2/3-6 4.Sadvirecanasatasritiya Ch.Su.4/13 5.Matrashitiya Ch.Su.5/46-48

Ch.Su.5/56-70 7.NaVegandharaniya Ch.Su.7/17 13.Snehadhyaya Ch.Su.13/24 20.MahaRogadhyaya Ch.Su.20/13,19 21.Astouninditiya Ch.Su.21/55 22.LanghanaBrimhaniya Ch.Su.22/18 24.VidhiShonitiya Ch.Su.24/47,54 25.Yajjahpurushiya Ch.Su.25/40 28.Vividhashitapitiya Ch.Su.28/27 NIDANA 1. Jwara Ch.Ni.1/36 VIMANA

Conceptual Study

15


7.Vyadhitarupiya Ch.Vi.7/20 8.Rogabhishagjitiya Ch.Vi.8/151 SHAREERA 8.Jatisutriya Ch.Sh.8/19

CHIKITSA 3.Jwara Ch.Chi3/254,255

Ch.Chi.3/305 4.RaktaPitta Ch.Chi.4/97-101 7.Kushta Ch.Chi.7/48 8.Rajayakshma Ch.Chi.8/81-82

Ch.Chi.8/91 9.Unmada Ch.Chi.9/27,64 10.Apasmara Ch.Chi.10/14

Ch.Chi.10/41-45 12.Shwayathu Ch.Chi.12/17,80 17.HikkaShwasa Chchi17/130,134 18.Kasa Ch.Chi.18/142 22.Trushna Ch.Chi.22/33 23.Visha Ch.Chi.23/35

Ch.Chi23/68,181 26.Trimarmiya Ch.Chi.26/138-140,144-145,

151, 158,176-187, 262

28.VataVyadhi Ch.Chi.28/88 Ch.Chi.28/98,99 Ch.Chi.28/193

KALPA 1.Madana Ch.Ka.1/19 3.Ikshwaku Ch.Ka.3/11 4.Dhamargava Ch.Ka.4/10 10.Sudha Ch.Ka.10/17 12.DantiDravanti Ch.Ka.12/104

Conceptual Study

16


SIDDHI 1.Kalpana Ch.Si.1/50-55 2.Panchakarmiya Ch.Si.2/20-23 7.BastiVyapat Ch.Si.7/38,46 9.Trimarmiya Ch.Si.9/8, 16-17,

73, 77, 83, 87

Ch.Si.9/88-117

12.UttaraBasti Ch.Si.12/14

TABLE NO.12 SHOWING REFERENCE OF NASYA IN SHARANGDARA

SHARANGADHARA SAMHITAKHANDA/AD

34

REFERENCE POORVA

6.Aharadigati Sha.Sa.Po.6/18 Sha.Sa.Po.6/19

MADHYAMA 9.SnehaKalpana Sha.Sa.Ma.9/17

UTTARA

8. Nasyavidhi Sha.Sa.Ut.8

TABLE NO.13 SHOWING THE REFERENCE OF NASYA IN

BHAVAPRAKASHAPOORVA

35

REFERENCE PRATHAMA

4.Bala

Bh.Pr.Po.Pr.4/41 5.Dinacharyadi

Bh.Pr.Po.5/47 DWITIYA

2.Bheshajavidh

Bh.Pr.Po.Dw.2/65 5.PanchaKarm

Bh.Pr.Po.Dw.5/189-250 MADHYAMK

Conceptual Study

17


THE REFERENCE OF NASYA IN KASHYAPA SAMHITA

KASHYAPA SAMHITA

STHANA/ADHYAYA

36

REFERENCE SHAREERA Jatisutriya Ka.Sh.Jat/8

SIDDHI 2.Trilaxana Ka.Si.2 4.Nastahkarmiya Ka.Si.4 7.Panchakarmiya Ka.Si.7

KALPA Lashunakalpa Ka.Ka.Las/33

Ka.Ka.Las/78 Shatkalpa Ka.Ka.Shat/36 ShatapuspaShatavari Ka.Ka.SS/25 Visheshakalpa Ka.Ka.Vishesha

KHILA 1.Visamajwaranirdesiya Ka.Khi.1/93 7.Samsuddhivishesaniya Ka.Khi.7/59

THE REFERENCE OF NASYA IN BHELA SAMHITA

BHELA SAMHITA

STHANA/ADHYAYA

37

REFERENCE

SUTRA

6.NaVegandharaniya Bhe.Su.6/21-24

CHIKITSA

6.Kushta Bhe.Chi.6/46

8.Unmada Bhe.Chi.8/29

12.Ardita Bhe.Chi.12

23.Shiroroga Bhe.Chi.23

Conceptual Study

18


25.Nidradi Bhe.Chi.25

26.VataVyadhi Bhe.Chi.26

28.Apatantraka Bhe.Chi.28/10

KALPA

4.Dhamargava Bhe.Ka.4/14-16

SIDDHI

2.ShiroVirechana Bhe.Si.2

ETYMOLOGY OF NASYA:

The term ‘Nasya’ is derived from “Nasa” dhatu which conveys two meanings Gati or the

motion (Nasa Gatau) and Vyapti means pervasion (Nasa Vyaptau)

In Ayurvedic classics, the “Nasa” dhatu is inferred in the sense of nose (Nasa

Nasikayam).

In Vachaspatyam, 38the word “Nasata” means that which is beneficial for nose and the

word “Nasya” has been defined as the one which is administered through the nose.

According to Monier Williams39, the meaning of ‘Nasya’ is belonging to Nose or being

in the Nose; application of sternutatory; errhine.

Thus, the beneficial things pertaining to Nose or a conducive thing administered through

Nose is known as “Nasya”.

In Shabhakalpadruma, 40

lÉÉÍxÉMüÉrÉÉrÉæÈ ÌWûiÉÇ CÌiÉ lÉxrÉÈ |

The one which is good for nose is called as Nasya.

lÉÉÍxÉMüÉSãrÉcÉÔhÉÉïÌS| 41

Nasya is elaborately mentioned by including churnas in Shadbdakalpadruma

It is further explained,

lÉÉxÉÉ²ÉUÉ SãrÉÉæwÉkÉÌuÉvÉãwÉ| 42

The medicine which is administered through Nasa in particular is known as “Nasya”.

Conceptual Study

19


DEFINITION OF NASYA:

As per Acharya Sushruta, 43

AÉæwÉkÉqÉÉæwÉkÉÍxÉ®Éã uÉÉ xlÉãWûÉã lÉÉÍxÉMüÉprÉÉÇ SÏrÉiÉ CÌiÉ lÉxrÉqÉç| Su.Chi.40/21

The administration of medicine or medicated sneha through the nose is known as

NasyaKarma.

According to Vagbhata 44 and Hemadri, 45

lÉÉxÉÉrÉÉÇ mÉëhÉÏrÉqÉÉlÉqÉÉæwÉkÉÇ lÉxrÉqÉç| A.Sa.Su.29/2

According to Arunadatta, 46

lÉÉxÉÉrÉÉÇ pÉuÉÇ lÉxrÉqÉç| A.Hr.Su.20/1

lÉÉxÉÉrÉÉÇ Ì¢ürÉiÉ CìÌiÉ lÉxrÉqÉç| A.Hr.Su.20/1

According to Bhavamishra, 47

lÉÉÍxÉMüÉrÉÉÇ MüqÉï ÍcÉÌMüixÉÉ rÉãlÉ iÉSè lÉxrÉMüqÉï|| Bh.Pr.2/5/189

It is known as NasyaKarma as the treatment is done through Nasika.

Nasya means the administration of various drugs through the nasal route.

SYNONYMS:

Shirovireka

Shirovirechana

Navana

Murdhavirechana

Nastah Pracchardana

NastahKarma

SukshmaKarma48

Elimination of morbid Doshas from the body is Virechana. Hence Shirovirechana or

Murdhavirechana indicates the main function i.e. elimination of morbid Doshas from the

Murdha or parts situated above the clavicle.

Sushruta has specified the word Shirovirechana to describe a particular variety of Nasya

Karma49.

Conceptual Study

20


Navana Karma and Nastha karma means the measures that are beneficial to nose or

region of the nose.

Nastah and Navana denote the site or route of administration of medicine. Nastah Karma

Charaka has used the term “Nastah Pracchardana” 50for Nasya.

According to Chakrapani,

lÉxiÉ: mÉëcNûSïlÉ CÌiÉ ÍvÉUÉãÌuÉUãcÉlÉã| Ch.Su.1/85, A.Di. This denotes Shodhana done by Nasya.

CLASSIFICATION OF NASYAKARMA:

Sl.NO. NAME OF ACHARYA NO. REFERENCE CLASSIFICATION

1. Charaka 3

5

7

Ch.Si. 9/92

Ch.Si. 9/89

Ch.Vi. 8/151

According to the pharmacological action-

Rechana, Tarpana, Shamana

According to the method of administration –

Navana,Avapida,Dhmapana,Dhuma,Pratimarsha

According to parts of drug used –

Phala, Patra, Mula, Kanda,Pushpa,Niryasa, Twak

2.

3.

4.

5.

Sushruta

Vangasena

Vrunda

Chakrapani

2

5

Su.Chi.40/21

V.S.86/1,3

V.M.78/1

C.D.Nasya/1

NasyaKarma is mainly of 2 Types:

Shirovirechana and Snehana.

It is further classified into 5 Types: Nasya,

Shirovirechana,Pratimarsha,Avapida,Pradhamana

6. Vagbhata 3 A.Hr.Su.20/2 Virechana, Brimhana, Shamana 7. Kashyapa 2 Ka.Si. 2 & 4 Brimhana(Poorana), Karshana(Shodhana) 8. Bhela 4 Bhe.Si.2 Avapeeda, Anuvasa, Dhuma, Pradhamana 9.

10.

11.

Sharangadhara

Bhavamishra

Trimallabatta

2

Sha.Ut.8/2

Bh.Pr.Po.Dw.5/190

Y.T.9/2

Rechana, Snehana;

Avapida & Pradhamana are 2 types of Rechana

Marsha & Pratimarsha are 2 types of Snehana

12. Bhoja 2 Su.Chi.40/28Ni.Sa. Prayogika, Snaihika 13. Videha 2 Su.Chi.40/45Ni.Sa. SangnaPrabodhana, Stambhana 14. Shodala 3

6

G.N.10/5/2 Virechana, Brimhana, Shamana

Above 3 +Marsha, Dhmana, Avapida

Conceptual Study

21


Chart No. 1CARAKA’S CLASSIFICATION OF NASYAKARMA

Nasya

51

Navana Avapeedana Dmapana Dhuma Prathimarsha

Snehana Shodana Prayogika Snaihika Vairechanika

Shodana Sthambana

Snehana Virechana

According to the mode of action of Nasya Karma

Recana Tarpana

Shamana

According to various parts of the drugs utilized in Nasya Karma

Phala Patra Mula Kanda Pushpa Niryasa Twak

Accoding to action of nasya karma

Rechana Tarpana Shamana

According to various parts of the drugs utilized in Nasya therapy

Phala Patra Mula Khanda Pushpa Niryasa Twak

Conceptual Study

22


Chart No. 2 SUSHRUTA’S CLASSIFICATION OF NASYAKARMA

Nasya

52

According to Sushruta, Nasya is of 2 types viz. Shirovirechana and Snehana.

These are further classified into 5 groups viz.

Shirovirecana Snehana

Shirovirecana Pradhamana Avapida Nasya Pratimarsha

Chart No. 03 VAGBHATA’S CLASSIFICATION OF NASYAKARMA

53

Ashtanga Sangrahakara has classified Nasya mainly into 3 varieties based on its effect

viz. Virechana, Brimhana and Shamana.

Snehana or Brimhana Nasya is further subdivided into two types on the basis of dose i.e.,

Marsha and Pratimarsha.

Avapida Nasya can be administered for both Virechana and Shamana purpose, whereas

Pradhamana Nasya is employed only for Shirovirechana.

Ashtanga Hridayakarta has mainly classified Nasya into 3 types viz.

Virechana, Brimhana and Shamana.

Nasya

Virecana Brumhana Shamana

Pradhamana Murdha-virecana Sneha Nasya (according to dose)

Pratimarsha Marsha Avapida

Conceptual Study

23


Chart No. 04 KASHYAPA’S CLASSIFICATION OF NASYAKARMA

Nasya

Brumhana Karshana

(Purana) (Shodhana)

Chart No.5 BHELA’S CLASSIFICATION OF NASYAKARMA

54

According to Kashyapa Samhita, Nasya is classified into two groups,viz. Brimhana and

Karshana which are also known as Poorana and Shodhana Nasya respectively.

Nasya

55

Bhela classifies NasyaKarma into 4 types, viz., &

Avapida, Anuvasa Dhuma Pradhamana.

Chart No.6 SHARANGADHARA’S CLASSIFICATION OF NASYAKARMA

Nasya

56

Recana Snehana

Avapida Padhamana Marsha Pratimarsha

Chart No.7 BHOJA’S CLASSIFICATION OF NASYAKARMA

Nasya

Prayogika Snaihika

57

Conceptual Study

24


Chart No.8 VIDEHA’S CLASSIFICATION OF NASYAKARMA

Nasya

Sajnaprabodhaka Stambhana

From the above discriptions it can be said that there are two types of classification of

Nasya Karma that has been explained in Āyurvedic literature.

1. Based on the pharmacological actions

ex: Recana,Tarpana etc.

2. Based on the preparation of drug and the method of its application.

e.x. Avapīda Nasya (Extracted Juice is used)

Dhmāpana Nasya (Powder is blowed)

Dhūma Nasya (inhalation through nose) etc.

Classification of NasyaKarma according to Preparation

Classification of Nasya by Caraka into Nāvana, Avapīda, Dhmāpana, Dhūma and

Pratimarsha while by Sushruta into Nasya, Shirovirecana, Pratimarsha , Avapīda and

Pradhamana seems to be based on the type of preparation used or the way in which it is

administered.

Marsha and prathimarsha explained by vagbata was mainly on the basis of difference in

the dose to be instilled into the nostrils

Taking the Caraka’s classification as the basis, all the above mentioned types of Nasya

are being described here seperately

1. NAVANA NASYA:

Navana is one of the well applicable therapies of Nasyakarma.

58

59

Conceptual Study

25


Method:

Nāvana is administered by instilling the drops of a medicated Taila or Ghrita into the

nostril.Most of the time the medicines will be in the form of sneha

Types – Depending upon the therapeutic action, it is further classified into 2 types a)

Snehana Navana b) Shodhana Navana60

a) Snehana Navana: The snehana nasya suggests , It is employed to bring about

Snehana effect . It provides strength to all the Dhatus and is used as Dhatuposhaka.

Drug –.

Sarpi, Taila, Vasa & Majja processed either singly or in combination with appropraite

drugs. Generally, Sneha should be processed in VataPittahara Dravyas. 61

Dose – The following is the dosage schedule for Sneha Nasya.

According to Sushruta,62 the general dosage schedule for Snehana Nasya is

Hina Matra – 8 Bindu in each nostril (In total 16 Bindus).

Madhyama Matra – 1 Shukti Pramana(In total 32 Bindu)i.e., 16 Bindu in each nostril.

Uttama Matra – 1 Panishukti Pramana(In total 64 Bindu)i.e., 32 Bindu in each nostril.

According to Gayadasa & Bhoja,63

Prayogika Nasya) – 8 Bindu in each nostril.

Snaihika Nasya – (16 Bindu in each nostril).

Types – According to Vagbhata, Sneha Nasya is further classified into 2 types based on

dose:

i) Marsha ii) Pratimarsha

Indications 64– Sneha Nasya can be given in the following conditions :

Vātika Shirahshūla, Keshapāta,Dantapāta, Shmashrupāta, Karnashūla, Karnakshweda,

Timira, Nāsaroga, Mukhashosha, Avabāhuka, Akālaja Valita, Akālaja Palita,

Dārunaprabodha and Vātapittaja Mukharoga.

b) Shodhana Navana Sushruta’s Shirovirechana type refers to Shodhana type of Navana

Nasya.

Conceptual Study

26


Drug – In this type of Nasya, oil prepared by Shirovirecana Dravyā’s like Pippali,

Shigru etc. can be selected

Dose 65–The general dosage schedule for Shodhana Nasya is

Hina Matra – 4 Bindu in each nostril.

Madhyama Matra – 6 Bindu in each nostril.

Uttama Matra – 8 Bindu in each nostril.

Indications 66– Aruci, Shirogaurava, Shūla, Pīnasa, Ardhāvabhedaka, Krimi,

Pratishyāya, Apasmāra, Gandhajnānanāsha, Ūrdhvajatrugata Kapharōga’s

Nāvana Nasya vis-à-vis rtu in healthy persons.

67

Season Nasya given at -

Shīta Kala : Noon

Sharad and Vasanta : Morning

Grishma Rtu : Evening

arsha Rtu : Only when sun is visible.

Nāvana Nasya vis-a-vis dosha and kāla

68,69

Kaphaja Roga : Fore noon

In Pittaja Roga : Noon

In Vataja Roga : After Noon

2. AVAPIDA NASYA:70

Definition:

The word Avapīda means to extract juice of leaves or paste (kalka) of required

medicine.71

It is one such variety of Nasyakarma which is commonly employed in emergency

conditions.

According to Sushruta, it is considered as the Vikalpa of Shirovirechana.72

Method Medicines required for nasya are pounded into a paste form and then are

squeezed to extract the juice . This is dropped into the nostrils .This process of

administering the medicines is known as Avapida nasya

This type of Nasya may also be given with Kalka (paste) etc.

73

74

Conceptual Study

27


It may also be instilled by diping the Pichu into the Shruta or Shrutashīta, Swarasa of the

required drug. 75

Though Sushruta recommends it only for Shirovirecana,Sharkara and Ikshurasa have

been recommended for Stambhana in the disease like Raktapitta.

a. Shodhana Avapida Nasya

76

Types – According to Charaka, it is mainly of 2 types

b. Stambhana Avapida Nasya

c. Drugs

d. For Shodhana nasya Kalka of Tīkshna dravyas like Saindhava, Pippali etc. have

been mentioned.

e. For Shodhana nasya Kalka of Tīkshna dravyas like Saindhava, Pippali

etc. have been mentioned as Avapīda Nasya and for Stambhana purpose Stambhana

drugs have been mentioned77

According to Chakrapani, Avapida Nasya is of 3 types. viz.,

a) Shodhana Avapida Nasya

78

b) Stambhana Avapida Nasya

c) Shamana Avapida Nasya

According to Videha,

a) Sangnaprabodhana Avapida

it is of 2 types.viz.,

b) Stambhana Avapida

Sangnaprobodhana Nasya is a kind of Shodhana Avapida Nasya79

Dose – Like Shirovirecana, Avapīda Nasya should be given in the following dose 8

0

Hīna Mātra - 4 drops

Madhyama Mātra - 6 drops

Uttama Mātra - 8 drops

Indications: In Krusha, Durbala, Bhīru then Shrutha or Kalaka has to be used

accordingly.

It is also indicated in

81Sanyāsa, Mūrcha, Vishābhighāta, Mōha, Apatantraka, Mada,

Apasmāra, Kāma, Atichinta, Krodha, Bhaya, Mānasaroga.

Conceptual Study

28


Sārňgdhara has told the Avapīda Nasya for the patients suffering from Galaroga,

Vishamajwara, Manovikara and Krimi. 82

Sangnaprabodhaka and Shodhana & varities of Avapida Nasya are indicated in

Abhishyanna (MedaKaphabhivyapta Shiras), Sarpadashta Visanjna(loss of consciousness

due to snake-bite), Vishabhighata, Sanyasa, Murcha, Moha, Apatantraka, Mada,

Apasmara, Kaamarti, Chinta, Krodha, Bhaya, etc. and other Manasa Rogas like

MudaChetas, VyakulaChetas.

Stambhana Avapida is indicated in Nasagata Raktapitta, Krusha, Durbala, Bheeru,

Sukumara, Yoshita(Stri).(Su.Chi.40/44)

Dhmāpana Nasya :

Dhmāpana or Pradhamana is a specific Shodhana Nasya.

Definition:

Here the Nasya is instilled with chūrna specifically for Shirovirecana. Dhmāpana is a

word mentioned by Caraka83 and Pradhamana 84is been described by Sushruta.

According to Sushruta, it is considered as the Vikalpa of Shirovirechana.

Definition 85– cÉÔhÉïxrÉÉkqÉÉmÉlÉÇ iÉÌ® SãWûxÉëÉãiÉÉãÌuÉvÉÉãkÉlÉqÉç| Ch.Si.9/91

The procedure in which the fine powder of medicinal drugs are blown into the nostrils is

known as Dhmapana Nasya. It cleanses the DehaSrotas by eliminating the morbid dosha.

Method –1. Nadi method 86– mÉëkqÉÉmÉlÉxrÉ iÉÑ| iÉiÉç wÉQûÇaÉÑsÉrÉÉ lÉÉQèrÉÉ kÉqÉãccÉÔhÉïÇ qÉÑZÉãlÉ iÉÑ|

Ch.Si.9/107

wÉQûÇaÉÑsÉÉ Ì²uÉY§ÉÉ rÉÉ lÉÉQûÏ cÉÔhÉïÇ iÉrÉÉ kÉqÉãiÉç| iÉÏ¤hÉÇ MüÉãsÉÍqÉiÉÇ uÉY§ÉuÉÉiÉæ: mÉëkÉqÉlÉÇ ÌWû

iÉiÉç|| 87Sha.Sa.Ut.8/13

Here according to reference stated the fine powder of drugs is blown into the nostils with

the help of Naadi Yantra , which is six anguli in length . The fine powder of drugs is

taken at one end and air is blown from the other end , so that the medicine enters into the

nostrils

2nd

Here the fine herbal powder is wrapped in a pottali made of a thin cloth and is kept at the

opening of the nostrils and is made to inhale by the patient

method –By Videha.

88

Conceptual Study

29


Dose:

According to Videha the dose of Dhmāpana Nasya is three Mucuti (3 pinch)88

Indications89 AirÉliÉÉãiMüOûSÉãwÉãwÉÑ ÌuÉxÉÇ¥ÉãwÉÑ cÉ SÏrÉiÉã| cÉÔhÉïÇ mÉëkÉqÉlÉÇ kÉÏUæxiÉÌ® iÉÏ¤hÉiÉUÇ rÉiÉ:

|| Sha.Sa.Ut.8/17

It is indicated in patients afflicted with Krumi, Visha, Manasa Roga like Unmada,

Apasmara, etc. SangnyaNasha and in other conditions presenting with grave doshik

vitiation.

4. DHUMA NASYA:

Instrument: required for the dhuma nasya

A special Dhūmanādi (smoking pipe) has been mentioned by caraka to inhale smoke. Its

length should be of 24 Aňgula and breadth of measuring one’s own finger

90

Definition –iÉãlÉ mÉëÉrÉÉãÌaÉMüxlÉæÌWûMüuÉæUãcÉÌlÉMü kÉÔqÉÉlÉÉÇ lÉÉxÉÉSÏrÉqÉÉlÉÉÍqÉWû aÉëWûhÉqÉç,

qÉÑZÉmÉãrÉxiÉÑ kÉÔqÉÉã lÉ lÉxrÉqÉç| Ch.Si.9/9-92, A.Di.

It is defined as medicated fumes taken through nostrils and eliminated through oral

cavity. Acharya Sushruta has not described Dhuma Nasya as a type of Nasya.

Dhūma Nasya are of the following types :

91. This

measurement is for Virechana type. 32 Aňgula is the length mentioned for Snaihika

Dhūma where as 36 Aňgula length for Prāyogika Dhūma isbeen mentioned .91

Method of administration

Patient is asked to the inhale the smoke that is emitted out from burning the herbs .

While breathing in in one nostril, the other nostril is closed with a finger . The smoke is

then made to escape through the mouth

92

Prāyogika

Snaihika

Vairechanika

Conceptual Study

30


Drug – kÉÔqÉÇ cÉ xÉuÉïaÉlkÉÉlÉÉÇ MÑü¸Ç cÉæuÉÌuÉuÉÎeÉïiÉqÉç| Bhe.Si.293

All the Gandha dravyas can be used. But, Kushta and Tagara should never be used.

Indications –

Is indicated in Shiroroga, Nasaroga, Akshiroga 94

5. MARSHA & PRATIMARSHA NASYA:

Both Marsha and Pratimarsha type of Nasya consists of introducing the oil through the

nostrils.95 And it is stated that the prathimarsha variety of nasya is described as the most

convenient form of Nasya as it does not lead to any discomfort or complications.96

Definition – The procedure where in the medicated Sneha is dropped into the nostrils in a

specified dosage is called as Marsha-Pratimarsha Nasya.

PRATIMARSHA NASYA –97

Definition97–mÉëÌiÉqÉvÉÉãï pÉuÉãiÉç xlÉãWûÉã ÌlÉSÉãïwÉ EpÉrÉÉjÉïM×üiÉç| Ch.Si.9/92

mÉëÌiÉqÉvÉïxiÉÑ lÉxrÉÉjÉïÇ MüUÉãÌiÉ lÉ cÉ SÉãwÉuÉÉlÉç| Ch.Si.9/116

Medicated Sneha when administered into the nostrils in a small and specific dose is

known as Pratimarsha Nasya. It is described as the most convenient form of Nasya as it

does not has any complications.97

Types – It is of 2 types viz.,

a) Snehana

97

b) Virechana

Method – The index finger is dipped in the required sneha and then the sneha is instilled

into the nostrils , making sure that it does not reachthe kanta pradesha I,e the quantity

should be minimum 98.

Even a healthy person can use this for promoting the strength & stability to Indriyas &

organs in the head.

Dose – 2 Bindu in each nostril is the dose mentioned by Sharangadhara .99

Vagbhata100 &

Conceptual Study

31


Indications

It can be administered in any season,even in the season which is not suitable for the

nasya karma like varsha and durdina 101

Contraindications

It is contraindicated in dusta prathishyaya, bahudosha,bahudosha,durbala shrotra, udirna

doshas 102

It is contraindicated in such person because as the sneha matra is insufficient to eliminate

doshas or may aggrevate the dosha which is already vitiated 103

Pratimarsha can be given in

- Any age

- Any season

- Even in not suitable time & season i.e. in Varsha and

Durdina

- Bala - Vriddha

- Bhiru - Sukumara

- Weak patients - Kshtakshama

- Trishna Pidita - Mukhashosha

- Valita and Palita

Pratimarsha Pranidana Kaala –Sharangadhara104 Sushruta 105

N

o

and have described

fourteen suitable times for the administration of Pratimarsha Nasya, while Vagbhata has

mentioned fifteen such Kaala.

Sushruta & Vagbhata have even enumerated the benefits of Pratimarsha performed in

each Kaala.

Table no 1 showing Various Timings for Pratimarsha Nasya

Time for Pratimarsha Nasya Su. As. H. Sha.

1 After leaving the bed in morning + + +

Conceptual Study

32


2 After cleaning the teeth (with

Dantadhavana)

+ + +

3 Before going outside + - +

4 After exercise + + +

5 After sexual intercourse + + +

6 After walking + + +

7 After urination + + +

8 After passing Apanavayu + - -

9 After Kavala + + +

10 After Anjana + + +

11 After meal + + +

12 After sneezing + - -

13 After sleeping in the noon + + +

14 In the evening + + +

15 After vomiting - + +

16 After Shirobhyanga - + -

17 After defaecation - + +

18 After laughing - + -

MARSHA NASYA106 – The only difference between Pratimarsha & Marsha is the

dosage. Pratimarsha.

Nasya is administered in lesser dosage when compared with Marsha,

6-1o drops of sneha is instilled to each nostril , this is known as marsha nasya 107

Dose – Vagbhata 108& Sharangadhara109have mentioned different dosage pattern:

According to Vagbhata, Hina Matra – 6 Bindu in each nostril.

Madhyama Matra – 8 Bindu in each nostril.

Uttama Matra – 10 Bindu in each nostril.

According to Sharangadhara, Hina Matra –1 Shaana (8 Bindu)

Madhyama Matra – 4 Shaana (32 Bindu)

Uttama Matra – 8 Shaana (64 Bindu)

Conceptual Study

33


Classification of Nasya according the Pharmacological action: 110

On the basis of Pharmacological action, Charaka and Vagbhata have classified Nasya

Karma into 3 types viz., 1) Rechana (Virechana)

2) Tarpana (Brimhana)

3) Shamana means Palliative

Sushruta and Sharangdhara have excluded Shamana from their classification and divided

Nasyakarma into only two groups, viz; Shirovirechana111 and Snehana

Kashyapa considered Brimhana and Karshana types of Nasya112.

Further Videha explained two types of Nasyakarma according to their pharmacological

action i.e. Sangnyaprabodhana and Stambhana. 113

Nasya classification accoding to pharmacological action

Rechana (shodana ) Brimhana Shamana

Samjnaprabodana Krimigna Stambana Karshana

Rakthastambana Doshasthambana

1. RECHANA NASYA(VIRECHANA NASYA): 114, 115, 116

Definition – Rechana Nasya can be defined as that which eliminates the vitiated doshas

from urdhwajatru

Drugs – Drugs like Apamarga, Pippali, Maricha etc. may be used 117 mentioned in

Rogabhishakjitiya Adyaya 118

It may also be administered with Tikshna Sneha, Kwatha, Churna or Swarasa of

Shirovirechana drugs or by dissolving these drugs in Madya, Madhu, Saindhava, Asava,

Pitta and Mutra or mixed with the drugs specified to treat the respective

diseases(As.Sa.Su.29/5).119

Indications – xiÉqpÉxÉÑÎmiÉaÉÑÂiuÉÉ±É: vsÉæÎwqÉMüÉ rÉã ÍvÉUÉãaÉSÉ:| Ch.Si.9/13

hiroroga like Stambha, Supti and Guruta of Shira where the Kapha Dosha is primarily

involved 120

Conceptual Study

34


vÉÉãTüÉÅmÉxqÉÉUMÑü¸ãwÉÑ lÉxrÉÇ uÉæUãcÉlÉÇ ÌWûiÉqÉç| Sha.Sa.Ut.8/14,15

Rechana Nasya prepared out of sneha particularly indicated to the Bayabheeta, Kleeba

stree Durbala , Krusha and Sukumara. The patient suffering from Sannipataja Jwara,

Galaroga Atinidra, Manovikara, Krimi, Vishabhipanna, Abhishyanda and

SarpadashtaVisangna may be given Shirovirechana Nasya using Kalka, Churna and

Svarasa also. Choorna is advisable if immediate effect is required,. 121(As.Sa.Su.29/6).

2. TARPANA NASYA:122

Synonyms

Snehana nasya

Brimhana nasya

Drugs – The Sneha prepared of Madhura Skandha drugs or snigda and Madura drugs

may be employed. According to Vagbhata, Sneha prepared with Snigdha and Madhura

drugs or with the drugs described useful for that particular disease should be used.

Medicinal tree’s niryasa , mamsa rasa , raktha may also administered123

Indications – rÉã cÉ uÉÉiÉÉiqÉMüÉ UÉãaÉÉ: ÍvÉU:MüqmÉÉÌSïiÉÉSrÉ:| Ch.Si.9/13

It is used in diseases like shirakampa and arditha 124

3. SHAMANA NASYA

Definition –Type of Nasya which is administeread which is for the alleviation of

aggravated Dosha situated in JatrurdhwaBhaga.

Indications – Nasagata rakthapitta125

Nasya karma yogya

Sl.No.

126

Table : 2 Showing nasya karma yogyas

NasyaKarma Yogya Charaka Sushruta Vagbhata

1 Shiroroga + + +

2 Dantaroga + +

3 Manyastambha +

Conceptual Study

35


4 Galagraha +

5 Hanugraha +

6 Peenasa + + +

7 Galasundika +

8 Galashaluka +

9 Sukra +

10 Timira + +

11 Vartmaroga +

12 Vyanga + +

13 Upajihwika +

14 Ardhavabhedaka + +

15 GreevaSkandaRoga +

16 Amsaroga +

17 Asyaroga +

18 Nasikaroga + +

19 Karnaroga +

20 Akshiroga + +

21 Murdharoga +

22 Kaphalaroga +

23 Shirahkampa +

24 Ardita +

25 Apatantraka +

26 Apatanaka +

27 Galaganda +

28 Dantashula +

Conceptual Study

36


29 Dantaharsha +

30 Dantachala +

31 Akshiraaji + + +

32 Akshiarbuda +

33 Swarabheda + + +

34 Vakgraha + +

35 GadgadaKathanadi + + +

36 UrdwajatrugataVatadiRoga +

37 Vatabhibhutashiras +

38 Kesha smashruprapata +

39 DarunaKarnashoola +

40 Karnakshweda +

41 Asyashosha + +

42 Avabahuka + +

43 Akalajavalipalita +

44 Vatapittaja Shiroroga +

45 GreevaskandaUrasamcha

balajananartha

+

46 Drushtiprasadajananartha +

47 SleshmanabhivyaptaTaalu +

48 SleshmanabhivyaptaKanta +

49 SleshmanabhivyaptaShiras +

50 Arochaka +

51 Shirogourava +

52 Krumi + +

Conceptual Study

37


53 Pratishyaya +

54 Apasmara + +

55 Gandha Ajnana +

56 Shunyashirasa +

57 ShiraJaadya +

58 Galamaya +

59 Shopha +

60 Ganda +

61 Suryavarta +

62 Nasashosha +

63 Keshadosha +

Nasya Karma Ayogya The person for those nasya karma is contraindicated for the

nasya karma is mentioned by Caraka127 Sushrutha 128 and Vagbata

Sl.No.

129

Table No : 3 showing nasya karma ayogyas

NasyaKarma

Ayogya

Charaka Sushruta Vagbhatta

1 Bhuktabhakta + + +

2 Ajirni + + -

3 Peeta Sneha + + +

4 Peeta Madya + + +

5 Peeta Toya + + +

6 Snehadi Patukamah + - +

7 Snatah Shirah + - +

8 Snatukamah + + +

9 Kshudharta + - +

Conceptual Study

38


10 Shramarta + + -

11 Matta + - -

12 Murcchita + - -

13 Shastradandahrita + - -

14 Vyavayaklanta + - -

15 Vyayamaklanta + +(Shranta) -

16 Panaklanta + - -

17 Navajwara Pidita + - -

18 Shokabhitapta + + -

19 Virikta + - +(Shuddha)

20 Anuvasita + +(Datta Basti) +(Datta Basti)

21 Garbhini + + +

22 Navapratishyayarta + - -

23 Apatarpita - + +(Shuddha)

24 Peetadravah - + +

25 Trishnarta + + -

26 Gararta - + +

27 Kruddha - + -

28 Bala - + -

29 Vriddha - + -

30 Vegavarodhitah - + +

(Vegarta)

31 Raktasravita - - +

32 Sutika - - +

33 Shvasapidita - - +

34 Kasapidita - - +

Conceptual Study

39


If nasya karma is performed In Ajīrna or Bhuktabhakta then there will be obstruction to

the Ūrdhvavaha srotas leading to Kāsa, Shvāsa, Chardi and Pratishyāya

If nasya karma is performed after consuming Sneha, Madhya, and Toya then it leads to

Nāsa Srāva, Akshiupadeha, Timira, and Shiroroga.

If nasya karma is performed after Snāna or if Snāna done after Nasyakarma leads to

Pratishyāya.

If nasya karma is performed in Kshudhita Vātaprakopa takes place

If nasya karma is performed to a Trushni it further aggravates the Trushna leading to

Mukhashosha.

If nasya karma is performed In Shramita, Mattha, Mūrchita leads to Lakshanā’s as found

in the Niruha Basti Vyāpath.

The pain increases if Nasya is done to a person who has the got beaten by the Shastra and

Danda.

If nasya karma is performed to a patient who is fatigue due to Vyavāya, Vyāyāma and

Madhyapāna.may lead to pain in the shira , skhanda and netra

If nasya karma is performed to a person with Navajwara, Shoka, it leads to aggravation

of the Ūshma leading to Timira and there is further increase in the Jwara.

If nasya karma is performed to a person who has undergone Virecana leads to

Indriyaupaghāta and for Anuvāsita leads to Kaphaprakopa, Shirogurutha, Kandu, Krimi.

If nasya karma is performed in Garbhini leads to Garbha Sthambha, leading to Kuni,

Pakshahata.

In Navapratishyāya leads to Vikruthi in Srotas

In Akāla and Durdina due to Shīta Dosha it leads to Pūtinasya and Shiroroga.

NASYA PRANIDANA YOGYA KAALA

Generally Nasya should be given in Pravrit, Sharad and Vasanta Rtu.

130

131 By providing

artificial conditions of the above-mentioned seasons Nasya can be given in any season in

emergency. For example in summer, Nasya can be given in cold places and in cold

season it can be given in hot places.

Table no 4 – Showing Time schedule in different seasons should be as below.

132

133

Conceptual Study

40


Rtu Nasya given at

Grīshma Rtu - Pūrvahna

Shīta Rtu Madyāhna

Varsha Rtu Adurdina

Sharad + Vasanta In the morning

Shishira + Hemanta Madyāhna

Grīshma + Varsha Aparāhna

Sushrutha advised nasya karma to be performed in the empty stomach for healthy

individual 134

In rogi the time schedule is

Doshaja Vikāra

135

Table no 5 showing time schedule of nasya in Doshaja vikaras

Nasya given at

Kaphaja Vikāra Purvāhna

Pittaja Vikāra Madhyāhna

Vātaja Vikāra Aparāhna

The time schedule mentioned for the administration of nasya by Vagbata is same as that

of Sushrutha 136

Sharangadhara opines same as sushrutha in this aspect . He adds that if the patient is

suffering from lalasrva , supthi, pralapa , putimukha, arditha , karnanaadi, trushna,

shiroroga and such other condition with excessive vitiated doshas nasya can be

administered even in night . 137

NASYA KARMA COURSE :

According to Astanga Sansgaha Nasya should be given for 3 days, 5 days , 7 days and 8

days or till the samyak nasya laxana is attained 138

Caraka has not told specific duration of the nasya karma , but suggested to give according

to the severity of the disease .

Conceptual Study

41


Nasya can be administered on alternate days,once in 2 days for seven sittings or twenty –

one sittings. Two sittings may also be done in a day138

According to bhela he has smentioned not to perform nasya karmamore than nine days as

it leads to satmya to the body 139

Nasyakarma may be given for seven consecutive days . In condition like vata dosha in

shira, Manyasthamba, Swarabhramsha etc nasya karma may be done twice a day 140

Dose in Nasya Karma:

Acharya Caraka has not mentioned prescribed the exact dose of nasya . The dose of

Nasya drug depends upon the variety of the therapy and drug utilized for it . Sushruta and

Vāgbhata have explained the dose in form of Bindus (drops). Here one Bindu means the

drop that is formed after dipping the two phalanges of Pradeshini (index finger) in oil.

No.

141

Table no 6 showing dose of nasya

Type of Nasya Hrasva

Matra

Madhyama

Matra Uttam Matra

1 Shamana Nasya 8 drops 16 drops 32 drops

2 Shodhana Nasya 4 drops 6 drops 8 drops

3 Marsha Nasya 6 drops 8 drops 10 drops

4 Avapīda Nasya (Kalka

Nasya)

2 drops 2 drops 2 drops

5 Pratimarsha Nasya 2 drops 2 drops 2 drops

Dose of nasya accordin to Videha142

The common dose for Pradhamana Nasya is 3 Mucuti (the quantity of Churna that is held

inbetween Index finger and thumb =one Mucuti) Depending upon the variety of materials

used Shārňgdhara 143

has described the following dosage schedule for Nasyakarma.

Tīkshnaushadhi Churna - 1 Shāna (4 Māsha) (24 Ratti)

Conceptual Study

42


Hiňgu – 1 Yava (½ Ratti)

Saindhava – 1 Māsha (6 Ratti)

Dugdha – 8 Shāna (64 Drops)

Jala (Aushadha Siddha) – 3 Karsha (3 Tola)

Madhura Dravya – 1 Karsha (1 Tola)

if the quantity is less than the prescribed dose The vitiated Doshā’s does not get

eliminated completely , if practiced may lead to Gaurava, Aruchi, Praseka, Pīnasa,

Cchardi, Kantaroga etc symptoms of Atiyoga is found if the Snehana Nasya is

administered in the excessive dose.

Purva Karma (Pre-measures)

144

ADMINISTRATION OF NASYA

The procedure of Nasya karma may be classified under following headings :

Pradhana Karma (Chief measure)

Pashchata Karma (Post-measures)

Purva Karma (Pre-measure)

It is advisable that all materials, drugs and equipments like napkin, utensils necessary for

Nasya karma are collected in sufficient quantity prior to Nasya karma.

A special room “Nasya Bhavana” free from atmospheric effects like direct blow of aiand

dust, etc. and lighted appropriately145

A chair for sitting purpose

should be selected. The following articles should be

kept in the room:

Nasya Asana : It should be placed in Nasya room. It consists of -

cot for lying purpose

Nasya Aushadhi Drugs required for the induction and management of shirovirechana

should be collected in rhe form of kalka, churna, kwatha, kshira,udaka, sneha , asava,

Dhuma etc in sufficient quantity .

Nasya Yantra : It should be collected according to the types of Nasya such as :

Conceptual Study

43


A dropper or Pichu : For Snehana, Avapida, Marsha and Pratimarsha

Nasya.

Shadangula Nadi : For Pradhmana Nasya

Dhuma Yantra : For Dhuma Nasya

Besides this one needs efficient assistant , dressing material, spitting pots, bowl, napkins

and towels also

Selection of The Patient : The patient should be selected according to the indications

and contra-indications of Nasya described in classics.

Preparation of The Patient : To prepare the patient for the Nasya karma following

matter should be considered according to Acharya Sushruta.

Patient should have passed his natural urges like urine and stool.

He should have completed his routine activities.

Light breakfast prior (1 hour) to Nasya karma is advised.

Now the patient Patient is advised to lie down comfortably relaxed on a cot in supine

position, hands and legs stretched straight. His body is draped up to the neck. Eyes are

covered with a cloth to avoid any spilling of medicine. Mrudu Abhyaňga is done on

scalp, forehead, face and neck146

Mrudu Swedana in the form of Tāpasweda using cloth dipped in hot water for is done

after Abhyaňga over Lalāta, Mukha, Nāsa, Manya, Grīva and Kantha region.

Pradhāna Karma:

Sushruta 147 Vāgbhat148 Caraka, 149

Shira or the head is made to be “Pralambita” (lowered / hanging down) and foot end

is slightly raised.

and has explained the procedure Nasyakarma as

follow:

(a) Position of the Patient

Patient is advised to lie down in a comfortable supine position on Nasya table.

Head should neither be excessively flexed nor extended.

(b) Administration of medicine – 150

Conceptual Study

44


E¨ÉÉlÉvÉÉÌrÉlÉã mÉëxÉÉËUiÉMüUcÉUhÉÉrÉ ÌMüÇÍcÉiÉç mÉëÌuÉsÉÎqoÉiÉÍvÉUxÉã uÉx§ÉÉcNûÉÌSiÉlÉã§ÉÉrÉ

uÉÉqÉWûxiÉmÉëSãÍvÉlrÉaÉëÉã³ÉÉÍqÉiÉ lÉÉxÉÉaÉëÉrÉ ÌuÉvÉÑ®xÉëÉãiÉÍxÉ SÍ¤ÉhÉWûxiÉãlÉ xlÉãWûqÉÑwhÉÉqoÉÑlÉÉ mÉëiÉmiÉÇ

UeÉiÉxÉÑuÉhÉïiÉÉqÉëqÉÍhÉqÉ×imÉÉ§ÉvÉÑÌ£ülÉÉÇ AlrÉiÉqÉxjÉÇ vÉÑYirÉÉ ÌmÉcÉÑlÉÉ uÉÉ xÉÑZÉÉãwhÉÇ

xlÉãWûqÉSìÓiÉqÉÉÍxÉÇcÉãSurÉuÉÎcNû³ÉkÉÉUÇ rÉjÉÉ lÉã§ÉÇ lÉ mÉëÉmlÉÉãÌiÉ| Su.Chi.40/25

After covering of eyes with a clean cloth, the tip of patients nose should be drawn

upward by the left thumb of the Vaidya. At the same time with the right hand Vaidya

should instill lukewarm medicine in both the nostrils,151

The drug should be in a proper quantity i.e., it should neither be less nor more in the

dose.

alternately, with the help of

proper instrument like pichu, dropper, shadangula nadi etc. according the type of

Nasya

It should be Luke warm.

The patients should remain relaxed at the time of administration of nasya and he

should avoid speech, anger, sneezing, laughing and shaking his head

(c) Immediate measures after administration of Nasya – Mardana(Massage) should be

done over palms, soles, shoulders, ears.

152

Paschāt Karma: Sushruta

Then the patient should be told to draw the

medicine to the throat and spit it out on either side (right & left side on to Spitting pot

kept on either side)

(d) Observation of the Patient – for Samyak, Ayoga, Atiyoga Lakshana and Vyapads.

Appropriate treatment should be adopted if any Ayoga, Atiyoga & Vyapads are noticed.

153 Caraka ,154 Ashtāňga Hrudaya 155 and Shārňgdhara 156

Patient in lying position is asked to count up to 100 matra i.e. approximately 2

minutes. Then these regimen should be followed

has advised for the following regimen.

a. Snehana

b. Swedana

c. Dhūmapāna

Conceptual Study

45


Gandusha

(d) Ahara

(e) Parihara Vishaya

Mrudu Abhyaňga and Swedana over Gala, Kapola, lalāta, Mardana over shoulder, feet

and hands is done.157,158

Dhumapana

SL.NO

159,160,161

Inhalation of smoke for the therapeutic purposes is known as dhumapana.The kapha

dosha that is accumulated in the head is best cleared by this procedure.This is done as

Paschat karma after vamana and nasya karma.

Name of the

Acharyas

No Reference Classification

1 Charaka 3 Ca.si.9/91 Prayogika,Vairechanika,

Snaihika dhumapana

2 Sushruta 5 Su.ci.40/4 Prayogika,Snaihika,Vairechanika

Kasaghna,Vamaniya dhumapana

3 Vagbhata 3 A.H.SU. 21/2 Snigdha,Madhyama,Tikshna

dhuma

4 Sharngdhara 5 Sh.U.KH.9/1 Shamana,Brmhana,Rechana,

Kasaha,Vamana,Vrana dhupana

Procedure:

Two to three puffs are to be taken through the mouth and exhaled through mouth itself

and never exhaled through the nose.

As purvakarma snehana and swedana are administering prior to nasya karma.By these

doshs vilayana happens in the srotas and it helps for easy expelsion of doshas.In most of

the time even after the administration of nasya karma there may be chance of

accumulation of some amount of doshas in the srotas.That retained kapha dosha cannot

be come out by nasya dravya and gets collected their itself and further leads to different

diseases.Hence to remove this ,dhumapana is administered.This will clears the srotas and

expels the remaining doshas.

Conceptual Study

46


Gandusha

• Snigdha gandusha

162

Procedure of holding the oil or decoction in the oral cavity for certain ttime period is

known as gandusha.

Classification

• Shamana gandusha

• Shodhana gandusha

• Ropana gandusha

After dumapana,Ushna jala gandusha has been explained.This removes the kapha present

in the oral cavity.

(d) Ahara Hita Ahara, Anabhishyandi Ahara, Laghu & Ushna Ahara

(e) Parihara Vishaya One should avoid exposure to Raja , Dhuma, Ātapa, Shira

Snāna, Atiyāna, Krodha and stay in a place which is devoid of direct blow of wind. 163

Samyak Yoga of nasya karma :

Urah-shiro-lāghava, Indriyavishuddhi and Srotovishuddhi 164 Sukhaswapna-prabodhana,

Chitta-Indriya- prasannata and Vikaropashama 165 proper respiration and sneezing 166

Symptoms

are

the general symptoms of Samyak Yoga of NasyaKarma.

Table no 7 showing Shamayak Yoga Lakshana

Ch. Si

1/51

Su.Chi.

40/32-33

As.H.Su.

20/24

Sha.Utt.

8/58

Bha.Pra. Kas. Bh.

1. Urah Laghuta + - - - + - -

2. Shiro Laghuta + + - - - - -

3. Netra Laghuta - + + - + -

6. Srotovishuddhi + + - + + + -

7. Swaravishuddhi - + - - - -

8. Vaktravishuddhi - + - - - -

9.Indriyācchta-prasāda + + - + + + +

10. Netrateja Vriddhi - + - - + -

11. Chitta Prasāda - + - + + + +

Conceptual Study

47


12. Vikāropashama - + - + + - +

13. Sukha Svapna Prabodha - + + - - - -

14. Sukhacchvasa - + - - - - -

15. Arati - - - - - - +

16. Medha - - - - - - +

17. Bala - - - - -

Ayoga

Ayoga of Nasya karma will be seen if Nasya is not given in proper way or if the dose is

less. Shirogaurava, Galopalepa and Nishthīvana167 Kandu, Upadeha, Guruta, Srotasam

Kapha Srāva168. Vitiation of Vāta, dryness in Indriya and no relief in the symptoms of the

diseases169 dryness in mouth and nose170

Symptoms

are the symptoms of Ayoga of Nasyakarma.

Table no 8 showing Ayoga Lakshana

Ch. Si

1/51

Su.Chi.

40/32-33

As.H.Su.

20/24

Sha.Utt

8/58

Bha.Pra. Kas. Bh.

1. Shirogaurava and

Dehagaurava

+ - - + + + +

2. Galopalepa + - - - - - +

3. Nishthīvana + - - - - - +

4. Kandu - + + + + - -

5. Kaphapraseka - - - - - - -

6. Upadeha + - + + - - -

7. Rūkshata + - - + + + -

8. Vāta Vaigunya + - - - - - -

9. Srotoriktata - - - - + - -

10.Srotasamkaphasrāva + - - + + + -

11. Nāsashosha - + - - - - -

12. Āsyashosha - + - - - - -

13. Akshistabdhata - + - - - - -

14. Shiroshūnyata - + - - - - -

15. Vyādhi Vriddhi - - - - - + -

Conceptual Study

48


Atiyoga:

Toda and Arati,171 Kapha Srāva, Shirahshūla and Indriya

Vibhrama 172Mastulungāgama, Vātavriddhi, Indriyavibhrama, and Shiroshunyata 173

Table no 9 showing Atiyoga Lakshana

are also

the symptoms of Atiyoga of Shirovirecana.

Symptoms

Ch. Si

1/51

Su.Chi.

40/32-33

As.H.Su.

20/24

Sha.Utt

8/58

Bha.Pra. Kas. Bh.

1. Shirogaurava - + + + + - -

2. Shira shunyata - + - + + - -

3. Shira vedana + - - - - + -

4. Netra Vedana + - - - - - -

5. Shankhavedana + - - - - - -

6. Sūchitodavat Pīda + - - - - - -

7. Indriya Vibhrama - + - + + + -

8. Mastulungāgama - + - - - - -

9. Snehapūrna Srotas - - - - + - -

10.Karna Tālu Upadeha - - - - - - -

11. Vāta Vruddhi + - - - - + +

12. Kandu - + - - - - -

13. Praseka - + + + - - -

14. Pīnasa - + - - - - -

15. Aruchi - - + - - - -

16. Deha Daurbalya - - - - - + -

17. Unmāda - - - - - - +

18. Pitta Vruddhi - - - - - - +

19. Hridaya Shūla - - - - - - +

20. Sūryāvarta Roga - - - - - - +

21. Atrupti - - - - - - +

Conceptual Study

49


Table no 10 showing management of ayoga and atiyoga of nasya karma174,17

5

NASYA/CHIKITSA AYOGA CHIKITSA ATIYOGA CHIKITSA

SHIROVIRECHANA

According to Charaka, after

Snehana & Swedana,

TeekshnaNasya should be

administered again.

According to Sushruta 175,

According to Charaka, Mrudu &

Drava Tarpana should be given.

According to Sushruta, Vagbhata,

Kashyapa, Sharangadhara, &

Bhavamishra, Vataghna Chikita

should be adopted.

Vagbhata, Kashyapa,

Sharangadhara & Bhavamishra,

175

SNEHANASYA

According to Sushruta,

According to Sushruta,175

Nasya should be administered

again.

175 Ruksha

Upachara should be adopted.

According to Sharangadhara and

Bhavamishra 174, Ruksha &

Anabhishyandi Ahara is advised.

VYAPAD OF NASYAKARMA :(COMPLICATIONS OF NASYAKARMA)

Comlications do occur if patients do not follow the regimen mentioned in the paschat

karma of nasya karma leading to dosha prakopaand again leading to many complications

and which is termed as Vyapad 176

The vyapad of nasya karma may occur due to

Dosha Utleshat (Dosha Nimitta) – due to aggravation of the Dosha which is commonly

encountered in Snaihika Nasya.

Dosha Kshayat 177–

By giving kaphagna upacharas like use of ushna and Tikshna Aushadi karma in these

conditions

due to diminution of the Dosha which is commonly encountered in

Shirovirechana.

Administration of nasya to the patients who are suffering from

Ajirna,Bhuktabhakta,Jalapeetha, or in the time or season like cloudy atmosphere , it

leads to production of kaphaja rogas

Management :

178

Conceptual Study

50


If administration of nasya is done to krasha shareera , virittha,Garbini,vyayama klantha

and Trushi it leads to vitiation of vata leading to vataja vikaras

Management

Vatanashaka procedures like snehana,Brimhana and Swedana should be done in above

conditions . The pregnant lady should specifically be treated with the use of ghritha and

kshira 179

During administration of nasya if the head of the patient is lowered more , if he sneezed

or the drug is less or in excess quantity , or it is given when it is contraindicated then it

may lead to trishna and Udgara

It cures the diseases of the urdwajatru .

180

Cold water has to be sprinkled over Lalata and Mukthapradesha if he faints during the

time of administration of Nasya

If nasya karma is administered to patients suffering from Jwara , Shokabeetha, and

Madyapeetha it may lead to Timira roga

Management

Ruksha , Shitha anjana, Lepa and Putapaka should be applied as treatment

BENEFITS OF NASYAKARMA

Removes the cloudening or dullness of the indriyas .

Imparts sweet aroma to the mouth & strength of the jaws, teeth, bones, head, neck,

Trika, arms & chest.

It protects against the attack of Vali, Palitya, Vyanga.

181

It nourishes & strengthens Griva, Asya, Skanda Vaksha and all indriyas ..

Practicing NasyaKarma at the proper time will keep his sense organs unimpaired.

182

He do not suffer from premature graying of hair & beard

It reduces hairfall.

It cures the diseases like Ardita, Shirahshula, Hanugraha, Manyastambha, Peenasa,

Ardhavabhedaka, Shirahkampa.

It strengthens vessels, joints, ligaments & tendons of head The face will become

cheerful and improves swara .

Conceptual Study

51


Sense organs will be strengthened.

Checks the disease of Urdhvajatrugata of the body.

It reduces effects of senility in aged individuals.

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 Shira

183

2.The drug

administered through nose as Nasya reaches the brain & eliminates only the morbid

Doshas responsible for producing the disease.

In Astanga Sangraha –

Nasa being the gateway to Shira

10

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.).

Scratches the morbid Doshas in supra clavicular region expels them from Uttamanga

(As.San29/2).

Sushruta 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. 6/27).

Indu in his commentary on Astanga Sangraha has opined shringhataka as the inner

side of middle part of the head i.e. Siraso Antarmadhyam. Under the complications

ofNasya karma Sushruta noted that the excessive eliminative errhine may cause

Mastulunga (cerebro spinal fluid) to flow out of the nose (Su. Ch. 40/40).

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 Shira. 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.

Conceptual Study

52


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 Shira 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 &

salivation.

The modern point of view –

There is no such direct Pharmacodynamic considerations between nose & no such

cranial organs.

More over blood, brain barrier is a strict security system that human brain has..

In the case of paranasal sinusitis certain agents used as decongestants.

Since quite a time anterior pituitary hormones, nasal spray is in practice with

modern medical system.

Nasal administrations or leutinising hormone (Fink G. et al 1973) & calcitonin

(Potiroli E.A. et al 1983) are found to be equally effective as intravenous

infusions in maintaining blood concentrations.

Intranasal gonadotropin hormone releasing hormone has been therapeutically

recommended in stimulating leutinising hormone secretion in cryptorchid boys

(undescended testis) (Raifer J. et al 1985).

Kumar Anand (1979) has attempted contraceptive drug administration per nasal

route & opined that the route is beneficial than systematic administration.

Reduction in the gland activity & reduction is sperm prolactin was also noted.

On the basis of the foregoing observations we can state that the procedures,

postures & conducts explained for Nasya karma are of vital importance in drug

absorption & transportation.

Conceptual Study

53


CERVICAL SPONDYLOSIS DEFINITION184

Cervical spondylosis is the term given to the occurrence of osteoarthritis in the cervical

spine . It is charecterised by the degeneration of the intervertebral discs and osteophyte

formation184

Dictionary meaning of ‘Cervical’ is region of Neck & ‘Spondylo’ is a Greek word

meaning Vertebra.

Cervical Spondylosis is defined as arthrosis of posterior intervertebral joints in the

cervical vertebrae.

In the past, this condition was called as osteoarthritis, cervical spondylitis, herniated disc,

chondroma etc, but the term ‘Spondylosis’ is preferable as it is a degenerative rather than

a neoplastic or inflammatory condition.

Before getting into its depth, it is very essential to know anatomy of cervical spine

Cervical region

The atlas is a ring of bone with anterior and posterior arches and large lateral masses. It

lacks a body and a spinous process . The superior surface of lateral masses, called

superior articular facets , are concave . They articulate with the occipital condyles of the

185

The bodies of cervical vertebra ( C1 –C7) are smaller than those of thorasic vertebrae .

Their vertebral arches , however, are larger

.All cervical vertebrae have three foramina; one vertebral foramina and two transverse

foramina, The vertebral foramina of cervical vertebra are the largest in the spinal

coloumn because they house the cervical enlargement of the spinal cord .

Each cervical transverse process contains a transverse foramen through which the

vertebral artery and its accompanying vei and nerve pass. The spinous process of C2

through C6are often bifid – I,e split into 2 parts

The first two cervical vertebrae differ considerably from the others .

The first cervical vertebrae (C1), the Atlas , supports the head and is named for the

mythological Atlas who supported the world on his shoulders

Conceptual Study

54


occipital bone to form the atlanto occipital joints . The articulation permit the movement

seen when moving the head to signify “Yes”

The inferior surfaces of the lateral masses, the inferior articular facets , articulate with

the second ervical vertebrae . The transverse processes and transverse foramina of the

atlas are quite large.

Muscle attachments 186; The superior oblique parts of longus colli are attached on each

side of the anterior tubercle . The anterior surface of lateral mass gives attachment to

rectus capitis anterior . Rectus capitis posterior minor is attached jus lateral to the

posterior tubercle . Rectus capitus lateralis is attached to the transverse process superiorly

, and obliquus capitis superior is located more posteriorly . Obliquus capitis inferior is

attached laterally on the apex , below which are slips of levator scapulae , splenius

cervicis and scalenus medius

The second cervical vertebrae (C2) ,the axis , does have the body . A peg like

process called the dens (= tooth)or odontoid process projects up through the anterior

portion of the vertebral foramen of the atlas . The dens makes a pivot on which the atlas

and the head rotate, as in moving the head to signify “No”. This arrangement permits side

to side rotation of the head .

The articulation formed between the anterior arch of the atlas and the dens of the axis

may be driven into the medulla oblongata of the brain .When whiplash injuries result in

death , this type of injury is the usual cause.185

Muscle attachments

The anterior surface of the body carries a deep depression on each side for the attachment

of the vertical part of longus colli . Levator scapulae , scalenus medius and spenius

cervicis are all attached to the tips of the transverse processes and the intertransverse

muscles are attached to their upper and lower surfaces . The lateral surfaces of the

spinous process give origin to obliquus capitis inferior , and rectus posterior major is

attached a like more posteriorly . The inferior concavity of the process receives

187

Conceptual Study

55


semispinalis and spinalis cervicis , multi fidus more deeply , and the interspinalis near the

apex .

Arterial supply

Small branches arise mainly from the vertebral artery at the level of the intervertebral

foramen for the third cervical nerve and form paired anterior and posterior longitudinal

channels , branches of which enter the dens near the base and near the apex . The anterior

channel also receives numerous twigs from nearby branches of the external carotid artery

via branches to longus colli and the ligaments of the apex , hence avascular necrosis

does not occur after the fracture of the base of the dens .

The third through sixrh cervical vertebrae (C3-C6) represented by vertebrae , correspond

to the structural pattern of the typical cervical vertebrae previously described99

The seventh cervical vertebrae (C7), called the vertebrae prominens, is somewhat

different .It has a single large spinous process that can be seen and felt at the base of the

neck.186

Muscle attachments

188

Trapezius , spinalis capitis ,semispinalis thoracis , multifidus and interspinales all attach

to the tubercle of the spinous process . The anterior border of the transverse process

receives the attachment of scalenus minimus ( pleuralis ) when present . The first pair of

levatorses costarumis attached to the transverse process

Conceptual Study

56


Conceptual Study

57


ETIOLOGY:

1. Age: It becomes more prominent as age progresses , after 50 years of age most

of the subjects are likely to present some Spondylosis changes in their spine.

Thus, it is the natural consequence of aging.

189

Etiology of the disease cervical spondylosis remains unknown, some associations are

well found. Such factors have an effect on the development of Cervical Spondylosis are:

2. Sex: It affects more male ratio . But the difference between male and female

sexes is very small. Possibly because males involved in doing heavy work .

3. Occupation: Gutenberg, in a survey found that in Miners there was high

incidence of Spondylosis. followed by factory workers.

4. Posture: Bad posture, use of cushy pillows & soft bed are also considered in the

etiological factors. Incorrect positioning of the head in bed especially while lying

on the tummy with the head turned to one side develops a stiff neck in some

patients. Fast mechanical life which is full of tension, lack of exercise etc. factors

can also be included under the etiological factor.

5. 5 Trauma: In causing the disease Cervical Spondylosis trauma in cervical region

play an important role . Regular traveling for long distances on bad roads,

strainful movements ,Exertion, etc. also cause trauma in cervical spine.

6. Genetic: Familial causes have been reported & it is known to be genetically

influenced. Research has shown that variations of the HLA-B gene, part of a

family of genes called Human Leukocyte Antigen.

AETIOPATHOGENESIS190

a) Disc degeneration with thinning and protrusion of the nucleus pulposus posteriorly or

lateral herniation through a tear in the fibrous annulus; posterior herniation tends to

produce compression of the spinal cord and lateral bulging produces compression of

roots.

b) Osteophytic spur formation on the posterior aspect of the vertebral body

(‘spondylotic bar’) resulting in compression of the anterior aspect of the cord. Root

compression is secondary to osteophytic extension of the bar laterally, associated

Conceptual Study

58


articulatory hypertrophic changes, or encroachment of the intervertebral neural

foramina by osteophytes developing from the rim of the foramina. Anterior

osteophytic spur formation is usually symptomless but occasionally produces

dysphagia.

c) Partial sublaxation of vertebrae causing impinging of osteophytes on the nerve roots

during movements of the neck.

d) Hypertrophy of the dorsal spinal ligament and facet articulation or buckling of the

dorsal spinal ligament particularly during extension of the neck. All these may cause

further narrowing of the sagittal diameters of a spinal canal which might have been

congenitally narrow.

e) Encroachment of the vertebral foramina producing compromise of the arterial lumen

and significant vertebro-basilar ischaemia, leading to brainstem signs like vertigo,

tinnitus, intermittent blurring of vision and occasionally episodes of retro-ocular

pain. Blood supply to the cord may also be affected.

f) Congenital spinal canal stenosis; although the radiographic findings of spondylosis

are fairly common, patients develop myelopathy or radiculopathy only if spondylotic

changes are associated with congenitally narrow canal or foramina. If the shortest AP

diameter is 13 mm or greater, it is unlikely that spondylotic changes are the cause of

cord compression.

CLINICAL FEATURES191

a) Spinal symptoms : Neck pain, medial scapular pain and shoulder pain probably

originate in the disc and spine.

b) Root compression (radiculopathy) : The range of movement is reduced, particularly

rotation and lateral movement of the head. Pain starts from the trapezius ridge (C4),

tips of the shoulder (C5), anterior part of the arm (C6), radial forearm (C6), and often

the thumb (C6) or all the fingers (C6, C7, C8). It worsens with movement of the neck,

coughing, sneezing or straining. The clinical signs are motor weakness and wasting of

muscles depending on the roots compressed. In addition, there is areflexia and

radicular sensory impairment.

Conceptual Study

59


112 PHYSICAL SIGNS IN CERVICAL ROOT COMPRESSION184

Root Muscle weakness Sensory loss

Reflex

loss

C5 Biceps, deltoid, spinati Upper lateral arm Biceps

C6 Brachioradialis Lower lateral arm, thumb, index

finger

Supinator

C7 Triceps, finger and wrist

extensors

Middle finger Triceps

Sometimes L’hermitte’s sign or ‘barber’s chair sign’ can be elicited; this consists of

tingling in all four limbs or electric shock-like feelings down the back on flexing the

neck. The roots most often affected, in order of frequency, are C5, C6, and C6 and

C7; C8 and D1 are infrequently affected. Occasionally, the shoulder-hand syndrome

or the so-called frozen shoulder ensues if symptoms are unattended.

c) Compressive cervical myelopathy is less frequenct than root syndromes. The patient

usually has a congenitally narrow canal (cervical canal stenosis) and presents with a

progressive spastic paraparesis; later, sensory impairment with a level, and bladder

and bowel involvement develop.

d) Combined root and cord compression : In a few cases, clinical features of both

radiculopathy and myelopathy are present. In such a combined lesion occurring at C5

level, the C5 root is compressed by lateral protrusion and the cord below this level is

compressed by medial lesion. The reflexes are asymmetrical, with classically absent

or decreased supinator and exaggerated triceps jerks; occasionally an inverted

supinator jerk is elicited when, on testing for supinator response, there is finger

flexion in the absence of the normal supinator response.

e) Vascular insufficiency : Vertebro-basilar insufficiency may produce intermittent or

perpetual vertigo. Neck movement may initiate or exacerbate vertigo with further

compression of the vertebral artery.

DIFFERENTIAL DIAGNOSIS:

Spastic quadriparesis may occur due to number of reasons and the age of onset ,

192

Conceptual Study

60


temporal profile of the disease and associated clinical symtoms and signs help to

differentiate cervical spondylotic myeloradiculopathy from other conditions .

Motor neuron disease develops in 5th or 6 th decade of life , is accompanied by

fasciculation or bulbar features , has no sensory features and sphincters are

characteristically spared .

Tumors of the spinal cord in the cervical region present with features of multiple tract

involvement and nuchal pain is not such a prominent feature .

Syringomyelia presents with lower motor neuron signs in upper limbs and upper

motor neuron in the lower limbs , displays characteristic dissociated sensory loss and

early splincter involve ment . It may be accompanied by Horner’s syndrome and inter

nuclear opthalmoplegia if ther is associated syringobulbia .

Craniovertebral anomalies present with shortneck and abnormal neck –body ratio and

often are accompanied by signs of high cervical lesion, like downbeat nystagmus and

Horner’s syndrome . Multiple sclerosis occurs at an earlier age , cerebellar signs are

prominent and wasting of the muscles is not a florid feature

INVESTIGATIONS

Of these two MRI is certainly the preffered alternative. MRI demonstrates the

192

X-ray of the cervical spine

This is helpful procedure .A lateral view shows the loss of normal lordosis,

diminution in the disc space and growth of osteophytes

Sometimes , canal stenosis can also be demonstraded. An oblique view shows the

protruding osteophytes into the intervertebral foramina. The antero posterior view , a

common prescription does not offer much in the diagnosis of cervical spondylosis .

Contrast myelogram

This shows the protrusion of the discs into the thecal sac as ‘’negative shadow ‘’ with

total extra dural obstruction in some cases .

CT Myelogram and MRI

Conceptual Study

61


indentation of the thecal sac , hardening of the intervertebral discs , evidenced by

altered MRI signal , foraminal narrowing and facet arthropathy . In more severe

severe cases , compression of the spinal cord may also be demonstrated .

Discography

The role is debatable . Typical pain is provoked on injection into the intervertebral

disc and relieved with local anaesthetics. This often helps in the precise identification

of the offending disc in a given case

TREATMENT:193,194,195.

Conservative treatment with analgesics and nonsteroidal anti-inflammatory agents,

supplemented by physiotherapy, is sufficient in a majority of cases. The latter includes

cervical traction, short-wave diathermy or ultrasonic irradiation, static and dynamic neck

exercises and cervical collar to reduce neck movements.

1. CONSERVATIVE TREATMENT –In Cervical Spondylosis it is much beneficial

. It consists of the following:

193

2. a) Rest – It is the cornerstone of the treatment as it allows soft parts to heal.

Occupational therapists can advice the ergonomics of the workplace if the

problem is work-related.

b) Analgesics & NSAID’s – once a day are usually preferred. After the pain

decreases, patients are encouraged to perform gradual graded isometric neck

exercises.

194

c) Physiotherapy- ultrasound, infrared rays– like short-wave diathermy. are

useful

d) Cervical Traction –Depending on the severity of the symptoms It could be

continuous or intermittent. Traction helps by reducing the muscle spasm,

increasing the disc space & reducing the tension on the nerve roots.

e) Neck Exercises It helps in gaining the mobility of the stiff neck & strengthen

the weakened neck muscles. Hence, the following two sets of exercises are

recommended:

Conceptual Study

62


1) Mobilisation Exercises – This consists of gradual active mobilization of the neck by

performing all the movements of the neck.

2) Strengthening Exercises – Here the patient is instructed to offer resistance by the

other hand to all active movements of the neck. These self-resistance exercises

strengthen the neck muscles. Both these exercises should be done for 15 to 20

minutes everyday.

f) Cervical Collar – This device discovered by HO Thomas is a very good

supportive form of treatment. It is indicated during acute exacerbation of chronic

Spondylosis & should be worn only for a short duration. If used for long, it

weakens the neck muscles, thereby nullifying the beneficial effects of neck

exercises.

Surgical decompression is generally advised in patients with progressive neurologic

dysfunction or a fixed deficit of less than 12 months' duration. The value of surgery,

however, is uncertain. Surgery may involve an anterior or posterior approach.

Surgical treatment includes posterolateral or anterolateral approaches, as well as

laminectomy, foraminotomy, and neurolysis, which may be combined with osteophyte

excision.

Posterior Approach

The posterior approach allows good visualization of affected nerve roots, facilitates

removal of any constricting material, and permits enlargement of the intervertebral

foramen. In patients with diffuse spinal stenosis, laminectomy is the preferred approach,

but it does not reduce any dynamic forces affecting the cord and may increase cervical

mobility, which is associated with an increased risk for neurologic complications. In a

few patients, increased radicular or cord deficits develop after surgery via the posterior

approach.

Anterior Approach

The anterior approach permits easier decompression of roots and cord and removal of

disc material. In patients with cervical spondylotic myelopathy, herniated discs and

osteophytic spurs are indications for surgery by this approach. Fusion is favored by some

Conceptual Study

63


surgeons, but the need for it is uncertain. Cord or root damage after surgery via the

anterior approach occurs in a few instances, and other complications have also been

described, including esophageal perforation, damage to various nerves (e.g., brachial

plexus, supe-rior laryngeal nerve, hypoglossal nerve, and sympathetic nerves), epidural

hemorrhage, and damage to major blood vessels.

The efficacy of various surgical approaches is difficult to determine because the natural

history of the disorder is unclear, methods of assessing outcome are not standardized, and

postoperative complications are often not stated.

The most optimistic figures suggest that between 15 and 30% of patients do not benefit

from surgery, and several older studies indicate that up to 25% of patients worsen after

laminectomy.

A summary of the literature suggests that between 25 and 75% of patients improve after

surgery and between 5 and 50% worsen after it. Given the uncertainties of the natural

history, it is not clear whether benefit is related to surgery or occurs despite it. Regardless

of the difficulty in determining its precise value, surgery is so widely accepted as a

therapeutic option that it is difficult to withhold it in patients who are deteriorating

despite conservative measures.

Measurement of cervical mobility is helpful in selecting patients who are more likely to

deteriorate because patients with spinal hypermobility are more prone to deteriorate

without surgery. Patients without major deficits or whose disorder is nonprogressive

should be treated conservatively and monitored over time. Those with a greater level of

disability when first seen are usually referred for surgical treatment, which is also

indicated to arrest a progressive course.

195

For the sake of clinical identification we can well corelate to followig disorders compared

with cervical spondylosis 196,197

The main symptom of cervical spondylosis, are pain in the neck, stiffness of the neck

muscles, radiation of pain to the arms and restricted movements of the neck.

Conceptual Study

64


In Ayurvedic texts, there are many other ailments, which are related to neck and

demonstrate the similar symptoms. So it is worthy to have a look on these manifestations.

This will help in differential doagnosis and also in justification to the paralance with

these disease . Those diseases are:

1) Bahushirash-agataVata

2) Astyavruta Vata

3) Manya-stamba

4) Asthi Majja Gatavata

5) Greeva- stambha

6) Apabahuka

7) Vishwachi

8) Greeva Hundana

A).Bahushirash-agataVata

Nidana- uÉÉiÉmÉëMüÉåmÉMü

Samprapti -Aggravated vayu lodges in Bahu & Shiras

Lakshana- Clinical manifestation in Bahu & Shiras

Chikitsa Nasya- Pana(Sneha)

Features of Cervical spondylosis- Radiating pain to arm & head

B) Astyavruta Vata

Nidana -uÉÉiÉmÉëMüÉåmÉMü

Samprapti -Occlusion of vayu by asthi

Lakshana-EwhÉ xmÉzÉï mÉÏQûlÉÇ cÉ AÍpÉlÉlSÌiÉ, xÉÇpÉerÉiÉå xÉÏSÌiÉ xÉÔÍcÉÍpÉËUuÉ iÉÑ±iÉå

Chikitsa - MahaSneha given in different routes

Features of Cervical spondylosis- Neck pain, Parasthesia,

pins & needles or numbness, sensory impairment

C) Manya-stamba

Nidana - ÌSuÉÉxuÉmlÉ, ÌuÉM×üiÉ AÉxÉlÉ ÌuÉM×üiÉ xjÉÉlÉ, FkuÉïÌlÉUÏ¤ÉhÉ

Samprapti - zsÉåwqÉhÉÉuÉ×iÉ uÉÉiÉ

Lakshana - Charaka described along with Antarayama & Bahirayama

Conceptual Study

65


Chikitsa – Vatakapha -hara Nasya, Rukshasweda

Features of Cervical spondylosis - Neck Stiffness, Restricted & painful neck movements

D)Astimajja –gataVata

Nidana uÉÉiÉmÉëMüÉåmÉMü

Samprapti Aggravated vayu lodges in Asthi & Majja

Lakshana AÎxjÉmÉuÉïpÉåS, xÉÇÍkÉzÉÔsÉ, qÉÉÇxÉoÉsÉ¤ÉrÉ, AxuÉmlÉ, xÉÇiÉiÉÉ ÂMçü

Chikitsa - Bahya & Abhyantara Sneha

Features of Cervical spondylosis- Neck pain,

Motor weakness, Wasting of muscles

E) Greeva- stambha

Nidana - uÉÉiÉmÉëMüÉåmÉMü

Samprapti - AliÉ:mÉëuÉåzÉ:

Suggestive of structural deformity

Lakshana - xiÉqpÉ in the region of Neck

Chikitsa - Vatavyadhi Samanya Chikitsa

Features of Cervical spondylosis- Neck Stiffness, Restricted neck movements

F)Apabahuka


Samprapti - AÇxÉSåzÉÎxjÉiÉÉå uÉÉrÉÑ: ÍxÉUÉ AÉMÑÇücrÉ

Lakshana - zÉÉåwÉÌrÉiuÉÉ AÇxÉoÉlkÉlÉqÉç

Chikitsa – Rukshasweda Nasya

Features of Cervical spondylosis- Wasting of muscles, Weakness

G) Vishwachi


Conceptual Study

66


Samprapti - iÉsÉÇ mÉëirÉÇaÉÑsÉÏlÉÉÇ iÉÑ MühQûUÉ oÉÉWÒûmÉ×¸iÉ:

Lakshana - oÉÉÀûÉå: MüqÉï¤ÉrÉMüUÏ

Chikitsa - Siravyadha, Nasya

Features of Cervical spondylosis -Radiating pain, Motor weakness

- H) Greeva Hundana

- Nidana : uÉÉiÉmÉëMüÉåmÉMü

- Samprapti : AliÉ:mÉëuÉåzÉ

- Lakshana : xiÉqpÉ in the region of Neck

- Chikitsa Vatavyadhi Samanya Chikitsa

Features of Cervical spondylosis - Stiffness,

- Restricted neck movements

- and Ushna Jala Gandūsha should be done for Kanta Shuddi.

Drug Review

67


DRUG REVIEW

In Ayurveda the success of chikitsa depends totally upon chikitsa chatuspada . Among

these four basic factors of treatment , dravya has been awarded the second place . W.H.O

defines drug as “ a substance or product that is used or intended to be used to modify or

explore physiological system or pathological status for the benefit of the recipient “

The selection of a proper drug in the management of disease is very important . Therefore

sufficient thoughts should be given fot the selection of the drug .

In the present study ketakyadi taila is taken for the clinical study and references are

available in text books .

Kalka dravya: ketakyadi kalka

3,4,5,6,7,8

(Sahasrayoga)

AlÉsmÉuÉcÉlÉÉiÉç iÉ§É iÉÑsrÉã YuÉÉjÉiÉÑwÉÉãSMãü |

AMüsMüÉãÅÌmÉ pÉuÉãiÉç xlÉãWûÉã rÉ: xÉÉkrÉ: MãüuÉsÉã SìuÉã|

Sneha dravya:tila taila

Drava dravya: ketaki moola, bala, atibala kashaya and kanji

Procedure: Prepare taila with above drugs in specified quantity with kalka, sneha and drava dravyas taken.

KETAKI 198

Botanical name-Pandanus fascicularis

Syn. Pandanus ordoratissimus , Pandanus tectorius

Family-Pandanaceae

Classical name –Kataki

Sanskrit name –. Ketaka , Sucipushpa, Krakacchada , Trnasunya, Kancuki, Halimaka,

Karatrna, sugandha , Kakacatvaca, Jambuka

68


Regional names

Kevrha, Kebarha (hindi), Kiya(beng) , Kevarha(mar) , Kevarhi (Guj) Javanam chedi

(Tam) , Mogali chettu (tel), Umbrella tree ( eng)

Description

Gregarious , much branched, stem bent, sometimes upto 25 ft . high , but more often

shrubby, resting on strong aerial roots . Shrubby upto 6 meters high, rarely erect , often

bushy shrub, stem supported by aerial roots .

Leaves glaucous – green , 8-6 ft long , caudate –acuminate , usually withstrong spines on

edges and midrib

Syncarpium solitary , drooping , scarlet, drupes numerous (50-60) each consisting of 5-

12 carpels , the apex of each carpel distint more or less convex with a small variously –

lobulate stima

Distribution

Plant is cultivated in gardens for fragrant flowers . It often runs wild in vacant and waste

places ; southern India and coastal regions

Chemical composition

Flowers contain aromatic volatile oil

Pharmacodynamics

Rasa –Tiktha, Madura , katu

Guna-Lagu, snigdha,

Veerya-ushna

Vipaka-Katu

Doshakarma –kaphapittashamaka, tridoshahara

Properties and action

Karma –varnya, Vedanasthapana, soumanasyajanana, Aksepahara, keshya

Roga – Varnavikara, kusta

69


Therapeutic uses

Antiseptic , aromatic, cooling and stimulant .It is used in burning sensation, eye

diseases , headache, rheumatism, smallpox

The decoction of roots is useful is given in jaundice .

Drug plant is useful as diaphoretic, febrifuge , braintonic, cardiotonic ,

anticonvulsant and aromatic drug

Parts used

Flowers ,roots, fruit.

Dose

Arka -40-60 ml , panaka- 20-40 ml

Bala

Botanical name – Sida cordifolia

199

Family-Malvacea

Classical name –Bala

Sanskrit name – Bala , vaatyalika ,Kharayastika .

Regional name – Khirenti, Bariyaara,Brela, Bala, Kharaiti, Baryaal(Hindi),

Barelaa(Beng) , Chikana(Mar) , Nilatuthi(Tamil) , Chirubend(Tel),Country Mallow , Sida

(Eng)

Description

Shrubby, branched , softly hairy and with much stelatehair nearly all over and

subpersistent . Leaves 2.5-5cm , long ,cordate, ovate-oblong, crenate,obtuse or subacute;

not acuminate,petioles 1.2-3.8cm long; jointed much above the middle .Calyx 6-8 mm.

long lobes ovate, acute Corollaslightly exceeding the calyx, yellow . Fruits 6-8 mm dia ,

carpels 7-10; strongly reticulated

Flowering and fruitin time

July to December.Post – rainy season

70


Kinds and variety

There are four kinds of Balaa viz Balaa,Atibala, Mahabala,and Nagabala collectively

grouped under Balaa-catustaya incorporated in texts .Bala has also of two varieties based

on flower- colour such as white (sveta) and yellow (pita)

In general , the components of Balacatustaya and their main plant sources may be

considered as follows

1. Baala – Sida cordifolia

2. Atibala-Abutilon indicum

3. Mahabala-Sida rhombifolia

4. Nagabala – Grewia populifolia

Distribution

It is found in tropical and subtropical regions of both hemispheres .

Throughout the hotter parts of India ; and fairy common in various provinces in country

as a common weed ;U.P, M.PBihar, Aassam,HimachalPradesh, Jammuand Kashmir,

Tamilnadu,Andrapradesh.Karnataka,Kerala


Plant contains alkaloidal part 0.085 percent ; and seeds containing its highest content o.32

percent Ephedrine forms major part of alkaloidal contents . Besides , fatty acids ,

mucilaginous matter , potassium nitrateand resin .Plant has not yet shown presence of

tannin or glucoside.

Pharmacodynamics

Rasa –Madura

Guna-Guru, snigdha, picchila

Veerya-Sita

Vipaka-Madura

Doshakarma –Vatapittasamaka

71


Action and properties

Karma ; Balya –brnhana-ojovardhaka-kaantivardaka

Naadibalya-vatahara

Anulomana-snehana-grahi

Hradya-rakthapittasamaka

Sukrala-prajassthapana,Mutrala

Jvaraghna-visamajvarahara

Krimighna, Rasayana .

Therapeutic uses

The drug is sweet and slightly bitter ;it is tonic, astringent,emollient, aphrodisiac and

remoes vata and pitta ; it is good in coughas a pectoral and bechic.It is an antiarthritic ,

appetizer, ccardiac, conceptive , cooling, demulcent,alterative , diuretic , antihelmenthic

and antipyretic

The bark cures urinary troubles and discharges .

The kashaya is of the root with ginger is given in intermittent fever .It is also

administered in fever accompanied by shivering fits and strong heat of the body

The seeds are reckoned aphrodisiac , and are administered in gonorrhea .

The leaves with other cooling leaves are applied in opthalmia , the root juice is used to

promote the healing of the wounds

The roots are pounded and boiled in oil which is applied to rheumatism paralysis ,

nervous disorder and debility , it enters in recipes of oils prescribed in disorders of vata

and nervine complaints , and muscular troubles ‘

Parts used

Roots, seeds , leaves

Dose ;

Juice 20-40gms , powder 1-3gms

72


Groups

Balya, Brmhaniya ,prajasthpana, Maduraskanda(caraka), Vatasamsamana (Sushrutha)

ATIBALA

Botanical name-Abutilon indicum

200

Family-Malvacea

Classical name –Atibala

Sanskrit name –. Atibala,Rsyaproktha, Kankatika,

Regional name – Kanghi,Kakahiya(hindi), Paitasi, Jhanpi (Beng), Muda(Mar) ,

Khapada, Dabali, Kamsaki (guj)Tatti (Tami) Tutirechedru(Tel)

Description

A suffrutescent , erect , minutely, tomentose, woody, grey, velvety, shrubbyplant . Leaves

upto 9 by 5 cm . cordate , ovate acuminate , toothed ,rarely subtrilobate; petioles 3.8-

7.5cm long stipules 9mm .linear,acute,deflexed .Pedicles often 2.5 mm ong axillary

solitary jointed very near the top .Calyx 12.8 mm long . Crolla 2.5cm dia, yellow,

opening in the evening .Staminal tube hairy at the base ; filaments long .Carpels usually

15-20 . longer than the calyx, with a distinct small acute point hairy , ultimately shining ,

dark brown. Seeds brown black, densely and minutely scrobiculate

Flowering and fruiting time

Autum to winter seasons

Distributions

It is commonly found throughtout India and Pakistan specially tropical and temperature

regions;

73


Tropics

Kinds and varieties

The drug atibala belongs to Balacatustaya consisting of Bala, Atibala,Nagabala and

Mahabala in the classical texts of medicine .Occasionally other groups such as Baladvaya

and Balatraya –tritaya, consisting 2 0r 3 plant , also combine atibala


Leaves contain mucilaginous matter, tannin, organic acid ; little Asparaginand ash

(consisting alkaline sulphate , chloride magnesium phosphate , and calciumcarbonate );

roots also contain asparagin .

Pharmacodynamics

Rasa –Madura, tiktha-katu

Guna-Guru, snigdha,

VeeryaPicchila

Vipaka-Madura

Doshakarma –Vatapittasamaka

Action and properties

Karma : Balya- brmhana

Rasayana-ojovarhana, Krmigna

Dahaprasamana, Trsnanigrahana

Visagna, Kledasamana, Mutrala

Vayahsthapana, Vajikarana,Kasagna, Shothahara,

Vedanasthapana

Therapeutic uses

The bark has sharply bitter taste ; it is febrifuge , antihelmenthic, and alexeteric ,and it

allays vata and tridosha ;and counters thirst, vomiting and it lessens perspiration . The

roots cure uterine uterine haemorrage discharges .

The leaves are used in lumbago, toothache, piles and all kinds of inflammation .

74


The seeds are reckoned aphrodisiac and are used as a laxative in piles , and in the

treatment of coughs .

The roots are alternative and used as restorative . The are recommended to be taken

internally with water as rasayana .

Parts used : Roots , leaves , seeds

Dose : juice 12-24 gms . Powder 1-3 gms

Groups : Balya, Brmhaniya, Maduraskanda(caraka), Madura,Vatasamsamana

(Sushrutha)

KANJI

MÑüsqÉÉwÉkÉÉlrÉqÉhQûÉÌS xÉÇÍkÉiÉ

201

MüÉÎgeÉMüÇ ÌuÉSÒ:

vÉÉ.xÉ.qÉ.ZÉÇ 10,11

Liquor prepared with manda of half boiled kulmasa , dhanya is kanjika

Tila Taila :

The word “Taila” is derived from Sanskrit.

“Tilodbhavam” means, one which is derived from Tila-sesamum. But in general,

‘Taila’ is considered for all oils. Specifically, Tila taila means oil extracted from the

seeds of Sesamum indicum (Fam. Pedaliaceae), a herb which is widely cultivated in

India, Japan, China and many other tropical countries. This is an official oil mentioned in

the British Pharmacopoeial codex, British pharmacopoeia and in the European

pharmacopoeia.

Ayurvedic view 202,203 ,204

Rasa Pancaka :

Rasa - Madhura

Anurasa - Tikta, Kasaya

Guna - Tiksna, Vyavayi, Suksma, Usna, Visada, Guru, Sara,

Vikasi

Vipaka - Madhura

75


Dosaghnata - Vatakaphahara

Karmukata -

Brmhana/Lekhana,Prinana,Vrsya,Twakprasadana,Mardavakara, Sthairyakara, Balya

Bhagna sandhanakara, Medhavardhaka, Sulaprasamana, Ropaka

Rogaghnata-Vataroga, Bhagna, Yoni-karna-siroroga, Kesapata, Vrana

Modern view:Sesame oil is the most stable vegetable oil, ever used. The oil is extracted

from both the varieties of sesamum seeds Viz., black and white.It is a light yellow coloured

with a pleasant odour of typical character and bland taste. Its density may vary between

0.916-0.920. It solidifies at –5°C and forms a buttery mass.

The sesame oil is soluble in Ether, Chloroform, Pet-ether and Carbon disulphide

solutions. It is partially soluble in alcohol and insoluble in water.

Chemical composition:

In experimental studies, it has been observed that sesame oil is the most stable vegetable

oil against oxidation. The stability of sesame oil against oxidation is due to the lignans

such as sesamol, Sesaminol, phynoresinol and sesamolinol.

Tocopherol is another antioxidant, providing better results in tissue injuries.

Chemical constituents of sesame oil are shown in table -

1 Saturated fatty acids Palmitic acid

2 Non saturated fatty acids Linoleic acid, Oleic acid

3 Anti oxidant principle 7-Tocopherol 4 Lignans Sesamolin, Sesamol, Sesamolinol, Sesaminol,

Phynoresinol, Sesamin

Pharmaceutical Uses:

1. The oils are used as soothing agents or to allay inflammation and pain.

2. In modern pharmacy, it is limited to the preparation of ointments or medicated

Creams.

3.The conventional medical practitioners use them as demulcent and emollients as

Protective covering on injured surfaces.

Chapter - 4

Methodology

Materials & Methods

76


MATERIALS & METHODS Aims of the Study:

1. To study the effect of Ketakyadi taila Nasya karma in the management of cervical

Spondylosis.

Source of the Data:

The patients who attended the O.P.D. and I.P.D. of S.D.M. Ayurveda Hospital,

Kuthpady, Udupi, Karnataka having the signs and symptoms of cervical spondylosis

were screened. Among these 30 Patients who fulfilled the below mentioned criteria of

inclusion were taken for the study. While selecting these patients care was also taken to

see that there was no any factor in these patients listed in the exclusion criteria. The

selected patient’s detailed profile is prepared as per the detailed proforma designed for

the same purpose, which incorporates relevant data like symptomatology, physical signs,

laboratory investigation reports as well as assessment criteria.

INCLUSION CRITERIA

1. Patients of either sex and age between 30 to 70 years is taken.

2. Patients presenting with the signs and symptoms of cervical spondylosis is

selected.

3. Patients who are fit for nasya karma.

Exclusion Criteria

• Patients with traumatic injury of cervical spine.

• Patients suffering from neoplastic disorders.

Laboratory investigations

X ray cervical spine AP and Lateral(Before treatment).

Blood routine investigation. CR protein, RA factor

Design:

It is a single blind clinical study with a pre-test and post-test design. In this study 30

patients diagnosed as cervical spondylosis of either sex were subjected to clinical study.

Materials & Methods

77


PLAN OF TREATMENT:

Purva Karma – Abyanga of neck, face with ksheerabala taila, Taapa Sveda(mrudu) with

cloth dipped in hot water will be done for 10 minutes.

Pradhana Karma –

o Position of the Patient :- supine with head end lowered.

o Ketakyadi Taila is slightly warmed indirectly with the help of hot water bath.

o 8 drops of Ketakyadi Taila is instilled in each nostril.

o Soles, palms, neck and ears are massaged

o Secretions are spitted out.

Paschatkarma – Haridra dhumapana, kavala with sukhoshna jala.

Total Duration – 7 consecutive Days.

Follow up Study :

7 days after completion of Nasya karma.

ASSESSMENT CRITERIA

Subjective & Objective Parameters include the clinical grading and standard scoring

method of signs and symptoms of the condition. These data were collected before the

commencement of treatment & after the completion of 7 days of treatment.

Subjective Parameters:

Neck Pain: Grade 0 – No Pain

Grade 1 – Mild Pain occasional / intermittent

relieved on its own / rest

Grade 2 – Moderate Pain, frequent pain

relieved after taking painkillers

Grade 3 – Severe Pain, not tolerable,

not relieved fully even after taking painkillers

Radiation of Pain: Grade 0 – No radiation

Grade 1 – Radiation of pain from neck to arm

or neck to anyone extremity, occasionally present

Grade 2 – Radiation of pain from neck to arm

Materials & Methods

78


or neck to anyone extremity, continuously present

Grade 3 – Radiation of pain from neck to both arms

or both upper extremities, occasionally present

Grade 4 – Radiation of pain from neck to both arms

or both upper extremities, continuously present

Stiffness: Grade 0 – No Stiffness

Grade 1 – Mild Stiffness

Grade 2 – Moderate Stiffness

Grade 3 – Severe Stiffness

Weakness: Grade 0 – No weakness

Grade 1 – Weakness in anyone upper extremity

Grade 2 – Weakness present in both upper extremities

Parasthesia: Grade 0 – Absent

Grade 1 – Present

Clumsy Finger Movements:

Grade 0 – No Clumsy Finger Movements

Grade 1 – Clumsy Finger Movements in anyone upper extremity

Grade 2 – Clumsy Finger Movements in both upper extremities

Vertigo: Grade 0 – Absent

Grade 1 – Present on neck movements or occasionally present

Grade 2 – Present constantly

Objective Parameters:

Tenderness over Cervical region:

Grade 0 – No pain

Grade 1 – Patient complains of pain

Grade 2 – Patient complains of pain and winces

Grade 3 – Patient winces and withdraws the affected part

Grade 4 – Patient will not allow palpation of affected part

Reference: Orthopedic Physical Assessment by David J. Magee

Movements of Neck Painful or Restricted:

Grade 0 – All 6 movements are painless or not restricted

Materials & Methods

79


Grade 1 – Any 1 movement is painful or restricted

Grade 2 – Any 2 movements are painful or restricted




Grade 6 – All 6 movements are painful or restricted

Sensory Loss: Grade 0 – Normal Sensation

Grade 1 – Reduced Sensation

Grade 2 – No Sensation

Neurological Deficit: (Watkins’ Severity Scale for Neurological Deficit)

A Neurological deficit

Grade 1 – Unilateral arm numbness or dysesthesia;Loss of strength

Grade 2 – Bilateral upper extremity loss of motor & sensory

function

Grade 3 – Ipsilateral arm, leg & trunk loss of motor & sensory

function

Grade 4 – Transient quadriparesis (temporary sensory loss in all 4

Limbs)

Grade 5 – Transient quadriplegia (temporary motor loss in all 4

Limbs)

Score A: ____

B Time Symptoms Present

Grade 1 – Less than 5 minutes

Grade 2 – Less than 1 hour

Grade 3 – Less than 24 hours

Grade 4 – Less than 1 week

Grade 5 – Greater than 1 week

Materials & Methods

80


Score B: ____

Severity Score: A + B = _____

C Central Canal Diameter

Grade 1 – > 12 mm

Grade 2 – Between 10 to 12 mm

Grade 3 – 10 mm

Grade 4 – 8 to 10 mm

Grade 5 – < 8 mm

Score C: ____

Return to Activity Score: A + B + C = _____


Power:

Grade 0 – No muscle contraction visible

Grade 1 – Flicker of contraction but no movement

Grade 2 – Joint movement when effect of gravity eliminated

Grade 3 – Movement against gravity but not against resistance

Grade 4 – Movement against resistance but weaker than normal

Grade 5 – Normal Power

Reference: Medical Research Council Scale, Macleod’s Clinical Examination

Reflexes: Grade 0 – Absent (Areflexia)

Grade 1 – Diminished (Hyporeflexia)

Grade 2 – Average (Normal)

Grade 3 – Exaggerated (Brisk)

Grade 4 – Clonus, very brisk (Hyperreflexia)


Score (Out of 10 ) Severity ≤ 4 Mild Episode

4 - 7 Moderate Episode 8 - 10 Severe Episode

Score (Out of 15 ) Severity ≤ 6 Minimum Risk

6 - 10 Moderate Risk 10 - 15 Severe Risk

Materials & Methods

81


Neck Disability Index:

SECTION 1: Pain Intensity

A. I have no pain at the moment. (0)

B. The pain is very mild at the moment. (1)

C. The pain is moderate at the moment. (2)

D. The pain is fairly severe at the moment. (3)

E. The pain is very severe at the moment. (4)

F. The pain is the worst imaginable at the moment. (5)

SECTION 2: Personal Care (Washing, Dressing, etc.)

A. I can look after myself normally without causing extra pain. (0)

B. I can look after myself normally but it causes extra pain. (1)

C. It is painful to look after myself and I am slow & careful. (2)

D. I need some help but manage most of my personal care. (3)

E. I need help every day in most aspects of self-care. (4)

F. I do not get dressed; I wash with difficulty and stay in bed. (5)

SECTION 3: Lifting

A. I can lift heavy weights without extra pain. (0)

B. I can lift heavy weights but it gives extra pain. (1)

C. Pain prevents me from lifting heavy weights off the floor, but I can manage if they

are conveniently positioned, for example on a table. (2)

D. Pain prevents me from lifting heavy weights, but I can manage light to medium

weights if they are conveniently positioned. (3)

E. I can only lift very light weights. (4)

F. I cannot lift or carry anything at all. (5)

SECTION 4: Reading

A. I can read as much as I want to with no pain in my neck. (0)

B. I can read as much as I want to with slight pain in my neck. (1)

C. I can read as much as I want with moderate pain in my neck. (2)

D. I cannot read as much as I want because of moderate pain in my neck. (3)

E. I can hardly read at all because of severe pain in my neck. (4)

F. I cannot read at all. (5)

Materials & Methods

82


SECTION 5: Headaches

A. I have no headaches at all. (0)

B. I have slight headaches that come infrequently. (1)

C. I have moderate headaches which come infrequently. (2)

D. I have moderate headaches which come frequently. (3)

E. I have severe headaches which come frequently. (4)

F. I have headaches almost all the time. (5)

SECTION 6: Concentration

A. I can concentrate fully when I want to with no difficulty. (0)

B. I can concentrate fully when I want to with slight difficulty. (1)

C. I have a fair degree of difficulty in concentrating when I want to. (2)

D. I have a lot of difficulty in concentrating when I want to. (3)

E. I have a great deal of difficulty in concentrating when I want to. (4)

F. I cannot concentrate at all. (5)

SECTION 7: Work

A. I can do as much work as I want to. (0)

B. I can do my usual work, but no more. (1)

C. I can do most of my usual work, but no more. (2)

D. I cannot do my usual work. (3)

E. I can hardly do any work at all. (4)

F. I cannot do any work at all. (5)

SECTION 8: Driving

A. I can drive my car without any neck pain. (0)

B. I can drive my car as long as I want with slight pain in my neck. (1)

C. I can drive my car as long as I want with moderate pain in my neck. (2)

D. I cannot drive my car as long as I want because of moderate pain in neck. (3)

E. I can hardly drive at all because of severe pain in my neck. (4)

F. I cannot drive my car at all. (5)

SECTION 9: Sleeping

A. I have no trouble sleeping. (0)

B. My sleep is slightly disturbed (less than 1 hour sleepless). (1)

Materials & Methods

83


C. My sleep is mildly disturbed (1-2 hours sleepless). (2)

D. My sleep is moderately disturbed (2-3 hours sleepless). (3)

E. My sleep is greatly disturbed (3-5 hours sleepless). (4)

F. My sleep is completely disturbed (5-7 hours sleepless). (5)

SECTION 10: Recreation

A. I am able to engage in all my recreation activities with no neck pain at all (0)

B. I am able to engage in all my recreation activities with some pain in neck. (1)

C. I am able to engage in most, but not all, of my usual recreation activities

because of pain in my neck. (2)

D. I am able to engage in a few of my usual recreation activities because of

pain in my neck. (3)

E. I can hardly do any recreation activities because of pain in my neck. (4)

F. I cannot do any recreation activities at all. (5)

Scores (Out of 50 ) Level of Disability

0 - 4 No Disability

5 - 14 Mild Disability

15 - 24 Moderate Disability

25 - 34 Severe Disability

35 - 50 Complete Disability


Assessment of NasyaKarma: Samyak Yoga, Ayoga & Atiyoga Yoga Lakshanas of

NasyaKarma were assessed daily after the procedure.

TABLE NO.57 SHOWING THE ASSESSMENT OF NASYAKARMA SAMYAK LAKSHANAS Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

UroLaghava ShiroLaghava IndriyaAcchyam(Prasada) SrotoVishuddhi ManahSukham(Prasada) AkshiLaghuta Vaktra Vishuddhi Swara Vishuddhi Sukhochwaasa Sukha Swapna

Materials & Methods

84


Sukha Prabhodana Vikaropashamah Pramoda Smruti Medha Aapti Bala Aapti Agni Aapti

AYOGA LAKSHANAS Day 1 Day 2 Day 3 Day 4 Day 5 Day

Day 7 Galopalepa ShirasoGurutwa Moordha Shoonyata Nishteewana KaphaSramsana Vata Vaigunya Indriya Rookshata Akshi Stabdata Akshi Rukshata Nasa Shosha Asya Shosha Kandu Upadeha Gadodreka

ATIYOGA LAKSHANAS Day 1 Day 2 Day 3 Day 4 Day 5 Day

Day 7 Shiro Arti / Toda Akshi Arti / Toda Shankha Arti / Toda Shravana Arti / Toda Timira Pashyet Kapha Praseka Shiro Gurutwa Shirasah Shoonyata Indriya Vibhrama Mastulungagama VataVruddhi Kandu Aruchi Peenasa Kshaamata Unmada Hridrava

X ‐

Reduction

Growth

Ray Cerv

n in the disc sp

of Osteophyt

vical Spin

pace

es

ne (AP)

X

Reduction

‐ Ray Ce

(L

n in the disc s

ervical Sp

LAT)

pace

pine

Requirem

Cloth Dipped

ents for Na

d in Hot Wate

asya Karma

M

er for Swedan

Mukha Abh

a

hyanga

Swe

Nasya Aasa

edana Over Fa

ana

ace

Nasyya Pranidana

Gandusha

Indireect Heating of

Dho

f Ketakyadi Ta

oomapana

aila

Chapter – 5

Observations & Results

Observation

85


OBSERVATION

A total of 30 patients suffering from cervical spondylosis ,fulfilling the inclusion

criteria were taken for the study.

Observations as well as results of the therapy are analyzed below. Observations were

made before and after treatment.

No. of patients registered for the study –30

No. of patients completed the study – 30

No. of drop out - 0

TABLE NUMBER 11 :

Table showing Age group wise distribution:

FIGURE NO.3

Age The minimum age of the patient of this study was 30years & maximum was 70 years.

Table shows that nature of distribution of patients in every 4-years age group. The

maximum percentage of patients i.e. (43.33%) was between 41-50 age groups and

minimum 10% was between 30-40 age groups. And 10 (i,e 33.33%) were between

51-60 years of age and 13.33% were between the age group of 61-70

0%

10%

20%

30%

40%

50%

30-40 41-50 51-60 61-70

Age-Yrs No. of Pts %

30---40 03 10%

41---50 13 43.33%

51-60 10 33.33%

61-70 04 13.33%

Observation

86


TABLE NUMBER 12:

Table showing sex wise distribution of patients:

FIGURE NO.4

According to sex wise distribution of the patients showed that maximum number i.e.

70% of the patients was male and 30% were female.

TABLE NUMBER 13:

Table showing religion wise distribution of patients: FIGURE NO.5

Among 30 patients of these series maximum patients 86.66% belonged to the Hindu

community, whereas 6.66% were Muslim &6.66% belonged to Christian

community.

05

10152025

Male Female

0

5

10

15

20

25

30

Hindu Christian Muslim

Sex No. of Pts %

Male 21 70%

Female 9 30%

Religion No.of.Pts %

Hindu 26 86.66%

Christian 2 6.66%

Muslim 2 6.66%

Observation

87


TABLE NUMBER 14:

Table showing Educational Status of patients:

FIGURE NO.6

Among all the 30 patients taken for this study, the maximum 40% of patients had

studied up to graduation; where as 30% of patients had studied up to the level of

Higher primary education and 16.66% had studied till the level of Primary school

and 13.33% were Middle primary .

TABLE NUMBER 15:

Table depicting marital status of patients

FIGURE NO.7

Among the 30 patients of cervical spondylosis taken for this study, a maximum of

80% patients were married where as 6.66% patients were widow and 13.33%

unmarried.

0

2

4

6

8

10

12

UE MP Gra

0

5

10

15

20

25

M UM W

Education No. of Pts

%

Uneducated 0

Primary 5 16.66%

Middle primary 4 13.33%

Higher primary 9 30%

Graduates 12 40%

Marital

Status

No. of

Pts

%

Married 24 80%

Unmarried 04 13.33%

Widow 02 6.66%

Observation

88


TABLE NUMBER 16:

Table showing socio economic status of patients

FIGURE NO.8

Most of the patients included in this study belonged to middle class (36.66%), 26%

patient’s belonged to lower middle class and 2 patient belonged to Very poor class

(16.65%). Remaining data is shown in the table.

TABLE NUMBER 17:

Table showing Occupation wise distribution of patients

FIGURE NO 9

Present study includes following category of occupations:-

0

10

20

30

40

50

VP P LM M HM

0

2

4

6

8

10

12

14

L HW B S A

Socioeconomic Status

No. of Pts

%

Very poor 02 6.66%

Poor 04 13.33%

Lower middle 08 26.66%

Middle 11 36.66%

Higher middle 05 16.66%

Occupation No. of Pts.

%

Labours 02 6.66%

House wife 09 30%

Business 1 3.33%

Service 05 16.66%

Agriculture 13 43.33%

Observation

89


9 patients were house wife (30%), 1 patients were in business (3.33%), 2 each were

Labours (6.66%) and Service class (16.66%), and 13 patients were Agriculturist i,e

(43.33%)

TABLE NUMBER 18:

Table showing distribution of patients according to their Desha: FIGURE NO.10

The present study shows that all the patients hailed from Anupa desha(100 %)

TABLE NUMBER 19 :

Distribution of pts according to the associated diseases: FIGURE NO 11

Most of the patients included in the study had no associated disease.i,e( 46%) . 6

patients i,e (20%) had Hypertensive + Diabetes milletus. and 16.66 % each were

suffering from Diabetes Mellitus and Hypertension.

0

20

40

60

80

100

Anupa Sadhara

0

10

20

30

40

50

HTN HTN+DM DM None

Desha No. of Pts %

Anupa 30 100

Sadharana 0 0

Associated Diseases No. of

Pts

%

Hypertension 5 16.66%

Hypertension +DM 6 20%

Diabetes 5 16.66%

None 14 46.66%

Observation

90


TABLE NUMBER 20:

Table showing distribution of pts according to their diet: FIGURE NO.12

The present study shows that maximum No. of Patients in the study had mixed diet

habit (70%) where as (30%) of them had Vegetarian diet.

TABLE NUMBER 21:

Table showing distribution of patients on the basis of Rasa Pradhanya

FIGURE NO.13

The present study shows that maximum No. of Pts in the study had the habit of

consuming more of Katu rasa pradhana dravya (50%), 33.33% patients had the habit

of consuming more of Lavana rasa pradhanya dravya and 16.66% patients had the

habit of consuming more of Tikta rasa pradhanya food.

0

20

40

60

80

VEG MIXED

0

10

20

30

40

50

Tikta Lavana Katu

Diet No. of Pts %

Vegetarian 09 30%

Mixed 21 70%

Rasa No. of Pts %

Tikta 05 16.66%

Lavana 10 33.33%

Katu 15 50%

Observation

91


TABLE NUMBER 22:

Table showing distribution of patients according to their Diet habit:

FIGURE NO.14

The above table shows that 20patients in the study had the habit of Akalabhojana

(66.66%) and 5Patients each had the habit of Kala Bhojana(16.66%) and followed

by Abhojana (16.66%).

TABLE NUMBER 23:

Distribution of patients according to their habit of Nidra:

FIGURE NO.15

The study shows that 70% of patients had sound sleep. 30% had from disturbed &

delayed sleep.

0

10

20

30

40

50

60

KALA AKALA ABHOJANA

010203040506070

DISTURBED SOUND

Diet Habit No. of

Pts

%

Kala 05 16.66%

Akala 20 66.66%

Abhojana 05 16.66%

Nidra No. of

Pts

%

Disturbed

& Delayed

09 30%

Sound 21 70%

Observation

92


TABLE NUMBER 24: Classification of patients based on Bowel & Bladder habits:

FIGURE NO.16

In the study 73.33% of patients had regular bowel movements and 8% complained of

irregular bowel habits .73.33% of patients had regular Bladder habits where as 8% of

patients complained of increased frequency of urine.

TABLE NUMBER 25:

Table showing Classification of patients according to their habits: FIGURE NO.17

0102030405060708090

Bowel Bladder

REGULAR

IRREGULAR

0

10

20

30

40

50

60

70

B G C A N

Bowel No. of Pts % Bladder No. of Pts %

Regular 22 73.33% Regular 22 73.33%

Irregular 08 26.66% Increased frequency

08 26.66%

Habits No. of Pts %

Beedi 02 6.66%

Gutka 01 3.33%

Cigarette 04 13.33%

Alcohol 03 10%

None 20 66.66%

Observation

93


The study shows that 66.66% patients had no habbits . 13.33% patients had

habit of smoking . 10% of patients had the habit of consuming Alcohol, and 6.66%

of patients had habit of smoking beedi .

TABLE NUMBER 26:

Table showing Classification of patients on the basis of prakruti:

FIGURE NO.18

The study shows that majority of the patients belonged to Vata-pitta Prakruti

(43.33%), 11 Patients belonged to Pitta-kapha (36.66%), 6 patients belonged to Vata-

Kapha prakruti(20%).

TABLE NUMBER 27:

Table showing Classification of patients on the basis of their satwa:

FIGURE NO.19

0

10

20

30

40

50

VP PK VK

0

20

40

60

80

100

P M A

Prakruti No. of Pts %

Vata-pitta 13 43.33%

Pitta-kapha 11 36.66%

Vata-kapha 06 20%

Satwa No. of Pts %

Pravara 03 10%

Madhyama 25 83.33%

Avara 02 6.66%

Observation

94


The study shows that most of patients in the study had Madhyama satwa (83.33%),

while (10%) of them had Pravara satwa and (6.66%) had Avara satva .

TABLE NUMBER 28:

Table showing Classification of patients on the basis of samhanana: FIGURE NO.20

The study shows that 10 patients had madhyama samhanana (76%) and 3 patients had

avara samhanana (12%) and Pravara samhanana (12%) respectively.

TABLE NUMBER 29:

Table showing Classification of patients on the basis of satmya: FIGURE NO.21

The study shows that 23 patients had Madhyama satmya (76 .66%) whereas 04 of

them had Pravara satmya(13.33%)and 03 patients had Avara satmya.

0

20

40

60

80

P M A

0

20

40

60

80

P M A

Samhanana No. of Pts %

Pravara 04 13.33%

Madhyama 20 66.66%

Avara 06 20%

Satmya No. of Pts %

Pravara 04 13.33%

Madhyama 23 76.66%

Avara 03 10%

Observation

95


TABLE NUMBER 30:

Table of Classification of patients on the basis of Ahara shakti:

Abhyavaran

shakti

No. of

Pts

% Jarana

Shakti

No. of Pts %

Pravara 07 23.33% Pravara 07 23.33%

Madhyama 15 50% Madhyama 14 46.66%

Avara 08 26.66% Avara 09 30%

FIGURE NO.22

Maximum patients were having Madhyama Abhyavarana (50%) and Jarana shakti

(46.66%).

TABLE NUMBER 31:

Classification of pts on the basis of their vyayama shakti: Poorvakalina FIGURE NO.23

0

10

20

30

40

50

ABH.SH JAR.SH

0

20

40

60

80

P M A

Vyayama Shakti No. of Pts %

Pravara 02 6.66%

Madyama 20 66.66%

Avara 08 26.66%

Observation

96


66.66% of patients had madyama vyama shakthi and 26.66% patients had madhyama

vyayama shakti 6.66% patients had Avara vyayama shakti.

TABLE NUMBER 32:

Table showing Classification of patients on the basis of Vaya: FIGURE NO.24

In the present study 86.66% of pts belonged to Madhyama vaya and remaining

13.33% were Vriddha.

TABLE NUMBER 33:

Table showing Classification of patients on the basis of their Koshta:

FIGURE NO.25

13.33%of patients had Mrudu koshta, where as 70% had Madhyama koshta, and

remaining 16.66% of patients krura koshta.

0

20

40

60

80

100

MADHYAM VRUDDHA

010203040506070

MRUDU MADHY KRURA

Vaya No. of Pts %

Madhyama 26 86.66%

Vruddha 04 13.33%

Koshta No. of Pts %

Mrudu 04 13.33%

Madhyama 21 70%

Krura 05 16.66%

Observation

97


TABLE NUMBER 34:

Table showing Classification of patients on the basis of Neck pain

FIGURE NO.26

In all the 30 patients neck pain was present .

TABLE NUMBER 35:

Table showing Classification of patients on the basis of Radiation of pain

FIGURE NO.27

In all the 30 patients radiation of pain was present.

05

1015202530

Present Absent

05

1015202530

Present Absent

Neck

pain

No. of Pts %

Present 30 100%

Absent 0 -

Radiation

of pain

No. of Pts %

Present 30 100%

Absent 0 -

Observation

98


TABLE NUMBER 36:

Table showing Classification of patients on the basis of Radiating side

FIGURE NO.28

Most of patients showed radtaion of pain on both the upper limbs (33.33%) more in

left upper limb (36.67%).

TABLE NUMBER 37:

Table showing Classification of patients on the basis of Stiffness

FIGURE NO.29

Maximum number of patients 86.66%presented with the stiffness .

0

10

20

30

40

Rt UL Lft UL Both limb No radiation

0

20

40

60

80

100

Present Absent

Radiating side

No. of Pts %

Rt UL 9 30

Lft UL 11 36.67

Both limb

10 33.33

No radiation

0

Stiffness No. of Pts %

Present 26 86.66

Absent 4 13.34

Observation

99


TABLE NUMBER 38:

Table showing Classification of patients on the basis of Neck movements

FIGURE NO.30

Maximum number of patients presented painfull neck movements (83.33%)

TABLE NUMBER 39:

Table showing Classification of patients on the basis of Weakness

FIGURE NO.31

Maximum number of patients presented weakness (86.67%)

020406080

100

Painful Painful restric

Not painful

0

20

40

60

80

100

Present Absent

Neck movements

No. of Pts %

Painful 25 83.33

Painful restricted

5 16.67

Not painful

0

Weakness No. of Pts %

Present 26 86.67

Absent 04 13.33

Observation

100


TABLE NUMBER 40:

Table showing Classification of patients on the basis of Parasthesia

FIGURE NO.32

70% of the patients presented with

paraasthesia and 30% patients had no parsthesia .

TABLE NUMBER 41:

Table showing Classification of patients on the basis of Sensory loss

FIGURE NO.33

In the clinical study 60% of the patient had sensory loss.

010203040506070

Present Absent

0102030405060

Present Absent

Parasthes

ia

No. of Pts %

Present 21 70

Absent 9 30

Sensory

loss

No. of Pts %

Present 18 60

Absent 12 40

Observation

101


TABLE NUMBER 42:

Table showing Classification of patients on the basis of Clumpsy finger movements

FIGURE NO.34

26 patients presented with clumpsy finger movements .

TABLE NUMBER 43:

Table showing Classification of patients on the basis of Vertigo

FIGURE NO.35

22 patients (73.33%) presented with vertigo.

0

20

40

60

80

100

Present Absent

01020304050607080

Present Absent

Clumpsy finger movements

No. of Pts %

Present 26 86.67

Absent 04 13.33

Vertigo No. of Pts %

Present 22 73.33

Absent 08 26.67

Observation

102


TABLE NUMBER 44:

Table showing Classification of patients on the basis of Duration of complaints

FIGURE NO.36

Among 30 patients 14 patients had duration of complaints since from 6months -1 year

(46.67%), 10 patients from 1-2 years and (33.33%) 6 patients < 6 months .

TABLE NUMBER 45:

Table showing Classification of patients on the basis of Mode of onset

FIGURE NO.37

In this study 50% of the patient had sudden

onset and rest had gradual onset .

0

10

20

30

40

50

< 6mon 6-1yr 1-2yr

02468

10121416

Sudden Gradual

Duration of complaints

No. of Pts

%

< 6 months 6 20

6 months – 1 year

14 46.67

1- 2 years

10 33.33

Mode of

onset

No. of Pts %

Sudden 15 50

Gradual 15 50

Observation

103


TABLE NUMBER 46:

Table showing Classification of patients on the basis of Nature of pain

FIGURE NO.38

0

5

10

15

20

25

30

35

40

Dra DA Sh Pri Sta Burning

Maximum no of patients had pricking type of pain. Followed by 36.67% had

shooting type of pain . Remaining data is shown in the table .

TABLE NUMBER 47:

Table showing Classification of patients on the basis of Course of pain

FIGURE NO.39

0

20

40

60

80

Intermittent Continuous

Nature of pain

No. of Pts %

Dragging 2 6.67

Deep Aching

2 6.67

Shooting 11 36.67

Pricking 12 40

Stabbing 2 6.67

Burning 1 3.34

Course of

pain

No. of Pts %

Intermittent 20 66.67

Continuous 10 33.33

Observation

104


Among 30 patients 66.67% patients had intermittent course of pain and 10 patients

had continuous course of pain.

TABLE NUMBER 48:

Table showing Classification of patients on the basis of Family history

FIGURE NO.40

0

20

40

60

80

100

Present Absent

Among 3o patients 5 patients had familial history of cervical spondylosis .

TABLE NUMBER 49:

Table showing Classification of patients on the basis of Treatment history

FIGURE NO.41

0

10

20

30

40

50

Al Ay Phy Al+Phy Ay+PhyNo prev

Family history

No. of Pts %

Present 5 16.67

Absent 25 83.33

Treatment history

No. of Pts

%

Allopathic 15 50

Ayurvedic 4 13.33

Physiotherapy 2 6.67

Allopathy+Physiotherapy

3 10

Ayurveda+Physiotherapy

0

No previous treatment

06 20

Observation

105


Among 30 patients registered in the study 15 patients had treatmental history of

Allopathy.And 20% patients had no previous treatment history . Remaining data is

shown in the table .

TABLE NUMBER 50:

Table showing Classification of patients on the basis of Neurological deficit

FIGURE NO.42

0102030405060

Mildepisode

Moderateepisode

Severeepisode

Among 30 patients 18 patients have Mild episode of Neurological deficit.

TABLE NUMBER 51: Table showing Classification of patients on the basis of Neck disability index

FIGURE NO.43

0

20

40

60

80

Nodisability

Moderatedisability

completedisability

Among 30 patients registered in the study 22 patients presented with the Neck

disability index .

Neurological deficit

No. of Pts %

Mild episode

18 60

Moderate episode

10 33.33

Sever episode

2 6.67

Neck disability index

No. of Pts %

No disability

04 13.33

Mild disability

22 73.33

Moderate disability

02 6.67

Severe disability

02 6.67

Complete disability

00

Observation

106


TABLE NUMBER 52:

Table showing samyak nasya laxana in the patients

Samyak Nasya Laxanas Number Of Patients Day

1 Day 2 Day

3 Day 4 Day

5 Day

6 Day

7 UroLaghava ShiroLaghava 3 5 7 6 3 3 3 IndriyaAcchyam(Prasada) 1 4 1 5 4 7 8 SrotoVishuddhi 0 0 0 10 7 8 5 ManahSukham(Prasada) 0 0 0 8 8 3 11 AkshiLaghuta 0 0 0 0 0 16 14 Vaktra Vishuddhi 2 5 3 2 6 4 8 Swara Vishuddhi 0 0 0 0 6 9 15 Sukhochwaasa 3 6 4 2 1 5 9 Sukha Swapna 0 2 1 5 5 1 16 Sukha Prabhodana 2 4 2 6 6 3 7 Vikaropashamah 0 0 3 2 1 10 14 Pramoda 1 6 8 3 3 4 5 Smruti Medha Aapti 0 0 0 0 13 15 2 Bala Aapti 0 0 0 0 0 15 15 Agni Aapti 1 2 0 0 2 15 10

In the present study maximum 7 patients attained shirolagava on Day 3,Indriya

Acchyam was seen on Day 7 , 10 patients had Srotho Vishuddi on Day 4 , and

maximum of 11 patients attained Manah sukham (Prasada) on Day 7 . Maximum of

15 patients attained Akshi Lagutha on Day 6, maximum of 8 patients attained Vakthra

and swara vishuddhi on Day 7 . maximum of 9 patients had sukhochwasa on Day 7 .

maximum of 16 patients attained sukha swapna on day 7 . maximum of 7 patients

attained Sukha prabhodana on day 7 . maximum of 14 patients had vikaropashama on

Day 7 . 8 patients attined Pramoda on Day 3 . maximum of 15 patients attained

Smruthi Meda Aapthi , Bala Aapthi and Agni Aapti on Day 6 .

Results

107


RESULTS

The analysis was done statistically using Sigma Stat version 3.5 software.

Paired t- test was used for comparing the results.

1. Effect On Neck Pain -

The effect over the symptom neck pain on 30 patients suffering from cervical spondylosis showed the mean score of 2.000 before the treatment was reduced to 1.133 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No 53 ., Effect of treatment on neck pain-

No. of

Patients

Mean Score Diff.in

means

% Paired ‘t’ test

30

BT AT S.D S.E.M. t value P value

2.000

(±0.144)

1.133

(±0.133)

0.867 43.85% 0.434 0.079 10.934 P=<0.001

Figure No. 44 , Effect of treatment on neck pain

00.20.40.60.8

11.21.41.61.8

2

BT AT

Mean score

BT

AT

Results

108


2. Effect On–Radiation of pain

The effect over radiation of pain pain on 30 patients suffering from cervical spondylosis showed the mean score of 2.43 before the treatment was reduced to 1.600 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No. 54 : Effect of treatment on Radiation of pain

No. of

patients

Mean Score Diff. in

means


30


2.43

(±0.190)

1.600

(±0.163)

0.833 34.28% 0.461 0.0842 9.898 P=<0.001

Figure No. 45 : Effect of treatment on – Radiation of pain

0

0.5

1

1.5

2

2.5

BT AT

Mean score

BT

AT

Results

109


3. Effect On stiffness

The effect over the symptom stiffness on 30 patients suffering from cervical spondylosis showed the mean score of 1.567 before the treatment was reduced to 0.900 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No. 55 : Effect of stiffness

No. of

Patient

s

Mean Score Diff.i

n

means


30

BT AT S.D S.E.M

.

t

value

P value

1.567

(±0.171

)

0.900

(±0.139

)

0.667 42.55

%

0.54

7

0.099 6.67

9

P=<0.00

1

Figure No :46 Effect of treatment on Stiffness –

0

0.5

1

1.5

2

BT AT

Mean score

BT

AT

Results

110


4. Effect On - Weakness

The effect over the symptom weakness on 30 patients suffering from cervical spondylosis showed the mean score of 1.167 before the treatment was reduced to 0.633 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No. 56 : Effect of treatment on Weakness

No. of

Patients

Mean Score Diff. in

means


30

BT AT S.D S.E.

M.

t value P value

1.167

(±0.118)

0.633

(±0.12)2

0.533 47.05

%

0.629 0.115 4.646 P=<0.001

Figure No. 47 : Effect of treatment on - Weakness

0

0.2

0.4

0.6

0.8

1

1.2

BT AT

Mean score

BT

AT

Results

111


5. Effect On - Parasthesia

The effect over the symptom parasthesia on 30 patients suffering from cervical spondylosis showed the mean score of 0.700 before the treatment was reduced to 0.300 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No. 57 : Effect of treatment on Parasthesia

No. of

Patients

Mean Score Difference

in means


30

BT AT S.D S.E.M. t

value

P value

0.700

(±0.0851)

0.300

(±0.0851)

0.400 60% 0.498 0.091 4.397 P=<0.001

Figure No. 48 : Effect of treatment on – Parasthesia

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

BT AT

Mean score

BT

AT

Results

112


6. Effect On Clumpsy finger movement

The effect over the symptom clumpsy finger movement on 30 patients suffering from cervical spondylosis showed the mean score of 1.300 before the treatment was reduced to 0.933 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No. 58 : Effect of treatment on Clumpsy finger movement

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

P value

1.300

(±0.128)

0.933

(±0.106)

0.367 27.027% 0.490 0.0895 4.097 P=<0.001

Figure No. 49 : Effect of treatment on – Clumpsy finger movement

0

0.2

0.4

0.6

0.8

1

1.2

1.4

BT AT

Mean score

BT

AT

Results

113


7. Effect On - Vertigo

The effect over the symptom vertigo on 30 patients suffering from cervical spondylosis showed the mean score of 1.067 before the treatment was reduced to 0.633 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.59: Effect of treatment on Vertigo

No. of

Patients


in means


30


1.067

(±0.143)

0.633

(±0.112)

0.433 40% 0.568

0.104 4.176

P=<0.001

Figure No.50 : Effect of treatment on - Vertigo

0

0.2

0.4

0.6

0.8

1

1.2

BT AT

Mean score

BT

AT

Results

114


8. Effect On - Tenderness

The effect over the symptom tenderness on 30 patients suffering from cervical spondylosis showed the mean score of 2.233 before the treatment was reduced to 1.167 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.60 : Effect of treatment on - Tenderness

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

2.233

(±0.164)

1.167

(±0.167)

1.067

47.76%

0.785 0.143 7.443 P=<0.001

Figure No 51 : Effect of treatment on– Tenderness

0

0.5

1

1.5

2

2.5

BT AT

Mean score

Results

115


9. Effect On - Movements of neck

The effect over movements of neck on 30 patients suffering from cervical spondylosis showed the mean score of 2.033 before the treatment was reduced to 1.500 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.61 : Effect of treatment on–Movements of neck

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

2.033

(±0.122)

1.500

(±0.150)

0.533 26.22% 0.507 0.092

5.757 P=<0.001

Figure No 52 : Effect of treatment on– Movements of neck

0

0.5

1

1.5

2

2.5

BT AT

Mean score

BT

AT

Results

116


10. Effect On - Sensory loss

The effect over sensory loss on 30 patients suffering from cervical spondylosis showed the mean score of 0.667 before the treatment was reduced to 0.267 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.62 : Effect of treatment on - sensory loss

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

0.667

(±0.111)

0.267

(±0.082)

0.400

60%

0.563 0.103

3.890 P=<0.001

Figure No 53 : Effect of treatment on– Sensory loss

00.10.20.30.40.50.60.7

BT AT

Mean score

BT

AT

Results

117


11. Effect On - Neurological deficit

The effect over Neurological deficit on 30 patients suffering from cervical spondylosis showed the mean score of 4.533 before the treatment was reduced to 3.867 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.63 : Effect of treatment on–Neurological deficit

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

4.533

(±0.298)

3.867

(±0.291)

0.667 14.70% 0.661 0.121

5.525 P=<0.001

Figure No 54 : Effect of treatment– Neurological deficit

3.4

3.6

3.8

4

4.2

4.4

4.6

BT AT

Mean score

BT

AT

Results

118


12. Effect of treatment on -Neck disability index

The effect of treatment on Neck disability index over 30 patients suffering from cervical spondylosis showed the mean score of 11.00 before the treatment and mean score of 10.167 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = 0.009)

Table No.64: Effect of treatment on -Neck disability index

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

11.00

(±1.163)

10.167

(±0.974)

0.833

6.94%

1.621 0.296

2.816 P=0.009

Figure No 55: Effect of treatment on --Neck disability index

9.6

9.8

10

10.2

10.4

10.6

10.8

11

BT AT

Mean score

BT

AT

Results

119


(Since in these parameters improvement over the basal values was

expected –At values were compared with Bt values)

13. Effect of treatment on Power w.s.r. movements . Shoulder Abduction

The effect on power w.s.r movements . shoulder Abduction on 30 patients suffering from cervical spondylosis showed the mean score of 3.400 before the treatment and mean score of 4.033 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.65 : Effect of treatment on Power w.s.r. movements . Shoulder

Abduction

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

3.400

(±0.261)

4.033

(±0.189)

0.633

18.62%

0.718 0.131

4.829 P=<0.001

Figure No56 : Effect of treatment on Power w.s.r. movements . Shoulder

Abduction

3

3.2

3.4

3.6

3.8

4

4.2

BT AT

Mean score

BT

AT

Results

120


14. Effect of treatment on -- Power w.s.r. movements . Shoulder, Flexion

The effect on power w.s.r movements . shoulder,flexion on 30 patients suffering from cervical spondylosis showed the mean score of 3.23 before the treatment and showed mean score of 3.867 jafter the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.66: Effect of treatment on -- Power w.s.r. movements . Shoulder, Flexion

No. of Patients

Mean Score Difference in means


30

BT AT S.D S.E.M. t value

p value

3.23

(±0.233)

3.867

(±0.202)

0.633 19.58% 0.669 0.122 5.188 P=<0.001

Figure No 57 : Effect of treatment on -- Power w.s.r. movements . Shoulder, Flexion

2.93

3.13.23.33.43.53.63.73.83.9

BT AT

Mean score

BT

AT

Results

121


15. Effect of treatment on Power w.s.r. movements . Shoulder Extension

The effect on power w.s.r movements . shoulder , extension on 30 patients suffering from cervical spondylosis showed the mean score of 2 .967 before the treatment and mean score 3.400 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.67 : Effect of treatment on - Power w.s.r. movements . Shoulder

Extension

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

2.967

(±0.227)

3.400

(±0.261)

0.433 14.60% 0.504 0.092

4.709 P=<0.001

Figure No 58 : Effect of treatment on time Power w.s.r. movements . Shoulder

Extension

2.7

2.8

2.9

3

3.1

3.2

3.3

3.4

BT AT

Mean score

BT

AT

Results

122


16 Effect of treatment on Power w.s.r. movements . Elbow . Flexion

The effect of treatment on power w. s.r movements . Elbow. Flexion on 30 patients suffering from cervical spondylosis showed the mean score of 3.233 before the treatment and mean score of 3.800 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.68 : Effect of treatment on - Power w.s.r. movements . Elbow . Flexion

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

3.233

(±0.190)

3.800

(±0.182)

0.567

17.52%

0.568 0.104

5.461 P=<0.001

Figure No 59 : Effect of treatment on Power w.s.r. movements . Elbow . Flexion

2.93

3.13.23.33.43.53.63.73.8

BT AT

Mean score

BT

AT

Results

123


17. Effect of treatment on Power w.s.r. movements . Elbow Extension

The effect on power w. s.r movements . Elbow.Extension on 30 patients suffering from cervical spondylosis showed the mean score of 2.033before the treatment and mean score of 1.500 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.69 : Effect of treatment on - Power w.s.r. movements . Elbow Extension

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

2.033

(±0.122)

1.500

(±0.150)

0.533

14.85%

0.507 0.0926

5.757 P=<0.001

Figure No60 : Effect of treatment on Power w.s.r. movements . Elbow Extension

0

0.5

1

1.5

2

2.5

BT AT

Mean score

BT

AT

Results

124


18. Effect of treatment on Power w.s.r. movements . Wrist . Flexion

The effect on power w. s.r movements . Wrist . Flexion on 30 patients suffering from cervical spondylosis showed the mean score of 3.233 before the treatment and mean score of 3.667 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No. 70: Effect of treatment on Power w.s.r. movements . Wrist . Flexion

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

3.233

(±0.202)

3.667

(±0.161)

0.433

12.76%

0.504 0.0920

4.709 P=<0.001

Figure No 61 : Effect of treatment on Power w.s.r. movements . Wrist . Flexion

3

3.1

3.2

3.3

3.4

3.5

3.6

3.7

BT AT

Mean score

BT

AT

Results

125


19. Effect of treatment on Power w.s.r. movements . Wrist . Extension

The effect on power w. s.r movements . Wrist. Extension on 30 patients suffering from cervical spondylosis showed the mean score of 3.100 before the treatment and mean score of 3.633 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No71.: Effect of treatment on Power w.s.r. movements . Wrist . Extension -

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

3.100

(±0.227)

3.633

(±0.182)

0.124

16.66%

0.681 0.124

4.287 P=<0.001

Figure No 62 : Effect of treatment on Power w.s.r. movements . Wrist .

Extension

2.82.9

33.13.23.33.43.53.63.7

BT AT

Mean score

BT

AT

Results

126


20 . Effect of treatment on Power w.s.r. movements . Forearm . supination

The effect on power w. s.r movements. Forearm . Supination on 30 patients suffering from cervical spondylosis showed the mean score of 3.133 before the treatment and mean score of 3.567 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.72 : Effect of treatment on Power w.s.r. movements . Forearm . supination

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

3.133

(±0.234)

3.567

(±0.190)

0.433

13.186%

0.504 0.0920

4.709 P=<0.001

Figure No63 : Effect of treatment on Power w.s.r. movements . Forearm .

supination -

2.9

3

3.1

3.2

3.3

3.4

3.5

3.6

BT AT

Mean score

BT

AT

Results

127


21. Effect of treatment on Power w.s.r. movements Forearm Pronation

The effect on power w. s.r movements. Forearm Ponation over the symptom neck pain on 30 patients suffering from cervical spondylosis showed the mean score of 3.967 before the treatment and mean score of 4.400 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.73 : Effect of treatment on Power w.s.r. movements Forearm

Pronation

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

3.967

(±0.140)

4.400

(±0.123)

0.433

10.34%

0.504 0.0920

4.709 P=<0.001

Figure No 64 : Effect of treatment on Power w.s.r. movements Forearm

Pronation -

3.7

3.8

3.9

4

4.1

4.2

4.3

4.4

BT AT

Mean score

BT

AT

Results

128


22. Effect of treatment on Power w.s.r. movements . Metacarpophalangeal and

interphalangeal . Flexion

The effect on power w. s.r movements Metacarpophalangeal and interphalangeal . Flexion on 30 patients suffering from cervical spondylosis showed the mean score of 3.933 before the treatment and mean score of 4.300 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) Table No.74 : Effect of treatment on Power w.s.r. movements . Metacarpophalangeal and interphalangeal . Flexion

No. of

Patients


in means


30

BT AT S.D S.E.M. t value p value

3.933

(±0.143)

4.300

(±0.119)

0.367

8.69%

0.490

0.0895

4.097

P=<0.001

Figure No 65 : Effect of treatment on Power w.s.r. movements .

Metacarpophalangeal and interphalangeal . Flexion

3.7

3.8

3.9

4

4.1

4.2

4.3

BT AT

Mean score

BT

AT

Results

129


23. Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal. Extension

The effect on on power w. s.r movements Metacarpophalangeal and interphalangeal. Extension on 30 patients suffering from cervical spondylosis showed the mean score of 4.133 before the treatment and mean score of 4.667 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) Table No.75: Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal. Extension

No. of Patients



30

BT AT S.D S.E.M. t value

p value

4.133

(±0.133)

4.667

(±0.0875)

0.533

12.39%

0.507 0.0926

-5.757

P=<0.001

Figure No 66 : Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal. Extension

-

3.83.9

44.14.24.34.44.54.64.7

BT AT

Mean score

BT

AT

Results

130


24. Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Abduction

The effecton on power w. s.r movements Metacarpophalangeal and interphalangeal. Abduction over the symptom neck pain on 30 patients suffering from cervical spondylosis showed the mean score of 4.200 before the treatment and mean score of 4.900 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.76 : Effect of treatment on - Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Abduction

No. of Patients



30

BT AT S.D S.E.M. t value p value 4.200

(±0.0884)

4.900 (±0.0557)

0.700 16.26%

0.466

0.0851

8.226 P=<0.001

Figure No 67 : Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and interphalangeal Abduction

3.8

4

4.2

4.4

4.6

4.8

5

BT AT

Mean score

BT

AT

Results

131


25. Effect of treatment on Power w.s.r. movements . . Metacarpophalangeal and

interphalangeal Adduction

The effect on power w. s.r movements Metacarpophalangeal and interphalangeal . Adduction over the symptom neck pain on 30 patients suffering from cervical spondylosis showed the mean score of 4.133 before the treatment 4.533 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No. 77: Effect of treatment on Power w.s.r. movements . .

Metacarpophalangeal and interphalangeal Adduction

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

4.133

(±0.142)

4.533

(±0.142)

0.400 9.09% 0.498 0.091

4.397 P=<0.001

Figure No68 : Effect of treatment on Power w.s.r. movements . .

Metacarpophalangeal and interphalangeal Adduction

3.9

4

4.1

4.2

4.3

4.4

4.5

4.6

BT AT

Mean score

BT

AT

Results

132


26. Effect of treatment on -Reflex .Biceps

The effect on Relex . Biceps over 30 patients suffering from cervical spondylosis showed the mean score of 1.700 before the treatment and mean score of 2.167 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.78: Effect of treatment on - Reflex .Biceps

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

1.700

(±0.160)

2.167

(±0.108)

0.467

26%

0.507 0.0926

5.037 P=<0.001

Figure No 69 : Effect of treatment on Reflex .Biceps -

0

0.5

1

1.5

2

2.5

BT AT

Mean score

BT

AT

Results

133


27. Effect of treatment on - Reflex. Triceps

The effect of treatment on reflex- Triceps over 30 patients suffering from cervical spondylosis showed the mean score of 2.033 before the treatment and mean score of 2.267 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = 0.006)

Table No.79 : Effect of treatment on-- Reflex. Triceps

No. of

Patients


in means


30

BT AT S.D S.E.M. t value p value

2.033

(±0.169)

2.267

(±0.135)

0.233 10% 0.430 0.0785

2.971 P=0.006

Figure No70 : Effect of treatment on - Reflex. Triceps

1.9

1.95

2

2.05

2.1

2.15

2.2

2.25

2.3

BT AT

Mean score

BT

AT

Results

134


28. Effect of treatment on Reflex .Supinator

The effect of treatment on Reflex. Supinator over 30 patients suffering from cervical spondylosis showed the mean score of 1.867 before the treatment 2.267 after the treatment. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.80 : Effect of treatment on Reflex .Supinator

No. of

Patients


in means


30

BT AT S.D S.E.M. t

value

p value

1.867

(±0.184)

2.267

(±0.135)

0.400 20% 0.498 0.0910

4.397 P=<0.001

Figure No 71 : Effect of treatment on Reflex .Supinator

0

0.5

1

1.5

2

2.5

BT AT

Mean score

BT

AT

Chapter - 6

Discussion

Discussion

135


DISCUSSION

Plan of study:

The patients for the study were selected from the OPD and IPD

section of SDMAH, Udupi. 30 patients fulfilling the inclusion criteria and

presented signs and symtoms of cervical spondylosis are selected

Total number of patients registered –30

Completed – 30

Drop out – 0

Clinical Study:

A single blind clinical study was conducted on Patients suffering from

Cervical Spondylosis . Patients were randomly selected and detailed

proforma was prepared by incorporating all the sign and symtoms of

cervical spondylosis and nasya karma with Ketakyadi taila was done

continuosly for 7 days. The followup was for 07 days after the

treatment. The following observations are made.

Observations and results:

Age:. The maximum percentage of patients i.e. (43.33%) was between 41-50

age groups and minimum 10% was between 30-40 age groups. And 10 (i,e

33.33%) were between 51-60 years of age

It is known that the incidence of the disease is common in third and fourth

decades of life.

Meanwhile another risk factor is ageing. 60-70% women and 85% of men

may show changes related with cervical spondylosis by the age 45,

rhontgenologically2 [Table number11 ].

Discussion

136


Sex: According to sex wise distribution of the patients showed that

maximum number i.e. 70% of the patients was male and 30% were female.

It is known that male are more prone compared to female ratio

[Table number 12].

Religion

Among 30 patients of these series maximum patients 86.66% belonged to

the Hindu community, whereas 6.66% were Muslim &6.66% belonged to

Christian community. This may be due to Hindu dominant population in this

area. [Table Numbe 13]

Educational status

The this study showed that majority of patients were graduates 40%,where

as 30% of patients had studied up to the level of Higher primary education

and 16.66% had studied till the level of Primary school and 13.33% were

Middle primary . [Table number 14 ].

Marital Status

In dis study of 80% patients were married where as 6.66% patients were

widow and 13.33% unmarried. [Table number 15 ].

Socioeconomic Status

In this study 36.66% belonged to middle class 26% patient’s belonged

to lower middle class and 2 patient belonged to Very poor class

(16.65%). [Table number 16 ].

Discussion

137


Occupation

9 patients were house wife (30%), 1 patients were in business (3.33%), 2

each were Labours (6.66%) and Service class (16.66%), and 13 patients

were Agriculturist i,e (43.33%)

Patients having occupation which involves more physical and mental

stress dominated the group. [Table number 17].

Desha

The present study shows that all the patients hailed from Anupa

desha(100 %) [Table number 18 ].

Associated Diseases

Most of the patients included in the study had no associated disease.i,e(

46%) . 6 patients i,e (20%) had Hypertensive + Diabetes milletus. and

16.66 % each were suffering from Diabetes Mellitus and Hypertension.

[Table number 19].

Diet

In the study 70% of the patients had habit of mixed diet where as

(30%) of them had Vegetarian diet. A dietary habit of patients in this group

does not exhibit much preponderance of either vegetarian or non-vegetarian

food habits in the causation of illness. As this study showed 70% of patients

had the habit of mixed diet, in comparison to 30% of patients restricted to

vegetarian dietary habits. [Table number 20].

Discussion

138


Rasa

The present study shows that maximum No. of Pts had the habit of

consuming more of Katu rasa pradhana dravya (50%), 33.33% patients had

the habit of consuming more of Lavana rasa pradhanya dravya and 16.66%

patients had the habit of consuming more of Tikta rasa pradhanya food.

[Table number 21].

Diet Habit

The study showed (66.66%) had habit of Akalabhojana and 5 Patients

each had the habit of Kala Bhojana(16.66%) and followed by Abhojana

(16.66%).[Table number 22].

Nidra

The study shows that 70% of patients had sound sleep. 30% had

disturbed & delayed sleep. [Table number 23].

Classification of patients based on Bowel & Bladder habits:

In the study 73.33% of patients had regular bowel movements and 8%

complained of irregular bowel habits .73.33% of patients had regular

Bladder habits where as 8% of patients complained of increased

frequency of urine. [Table number 24].

Habits

The study shows that 66.66% patients had no habbits . 13.33% patients had

habit of smoking . 10% of patients had the habit of consuming Alcohol, and

6.66% of patients had habit of smoking beedi

Discussion

139


only in 17% of patients who are addicted were registered in the study [Table

number 25].

Prakruti

The study shows that majority of the patients belonged to Vata-pitta

Prakruti (43.33%), 11 Patients belonged to Pitta-kapha (36.66%), 6

patients belonged to Vata-Kapha prakruti(20%). Dominance of Vata Pitta

Prakruti can be seen. observation support the theory of tendency of

Vātaja disorders like Vishvāci in persons having Vāta Prakruti [Table

number 26]

Satwa

The study shows that most of patients in the study had Madhyama satwa

(83.33%), while (10%) of them had Pravara satwa and (6.66%) had

Avara satva . [Table number 27]

Samhanana

10 patients had madhyama samhanana (76%) and 3 patients had avara

samhanana (12%) and Pravara samhanana (12%) respectively. [Table

number 28].

Satmya

23 patients had Madhyama satmya (76 .66%) whereas 04 of them had

Pravara satmya(13.33%)and 03 patients had Avara satmya. [Table

number 29].

Discussion

140


Abhyavaran shakti and Jarana Shakti

The study shows that maximum patients were having Madhyama

Abhyavarana (50%) and Jarana shakti (46.66%). [Table number 30].

Vyayama Shakti

66.66% of patients had madyama vyama shakthi and 26.66% patients had

madhyama vyayama shakti 6.66% patients had Avara vyayama shakti.

Table[ number 31].

Vaya:

In the present study 86.66% of pts belonged to Madhyama vaya and

remaining 13.33% were Vriddha. [Table number 32].

Koshta:

13.33%of patients had Mrudu koshta, where as 70% had Madhyama koshta,

and remaining 16.66% of patients krura koshta. [Table number 33].

Neck pain

In this study 30 patients neck pain was present . [Table number 34].

Radiation of pain

In this study all the 30 patients radiation of pain was present. [Table

number 35].

Discussion

141


Radiating side

In the study most of patients showed radiataion of pain on both the upper

limbs (33.33%) more in left upper limb (36.67%).[Table number 36].

Stiffness

In the study maximum number of patients 86.66%presented with the

stiffness . [Table number 37].

Neck movements

In the study (83.33%) of patients presented painfull neck movements

[Table number 38].

Weakness

In the study Maximum number of patients presented weakness (86.67%)

[Table number 39].

Parasthesia

In the study 70% of the patients presented with paraasthesia and 30%

patients had no parsthesia [Table number 40].

Sensory loss In the clinical study 60% of the patient had sensory loss. [Table number 41].

Clumpsy finger movements

In the study 26 patients presented with clumpsy finger movements .

[Table number42].

Discussion

142


Vertigo

In the study 22 patients (73.33%) presented with vertigo. [Table number43].

Duration of complaints

Among 30 patients 14 patients had duration of complaints since from

6months -1 year (46.67%), 10 patients from 1-2 years and (33.33%) 6

patients < 6 months . [Table number 44].

Mode of onset

In this study 50% of the patient had sudden onset and rest had gradual

onset . [Table number45]

Nature of pain

In the study Maximum no of patients had pricking type of pain.

Followed by 36.67% had shooting type of pain . Remaining data is

shown in the table . [Table number46].

Course of pain

Among 30 patients 66.67% patients had intermittent course of pain and

10 patients had continuous course of pain. [Table number47].

Family history

In the study Among 3o patients 5 patients had familial history of cervical

spondylosis . [Table number48].

Discussion

143


Treatment history

In the study Among 30 patients registered in the study 15 patients had

treatmental history of Allopathy.And 20% patients had no previous treatment

history . Remaining data is shown in the table . [Table number 49].


In the study Among 30 patients 18 patients have Mild episode of

Neurological deficit [Table number 50].


In the study Among 30 patients registered in the study 22 patients

presented with the Neck disability index . [Table number51].

samyak nasya laxana in the patients [Table number52].

In the study all the 30 patients attained samyak nasya laxanas and no one

in the study ended in ayoga or atiyoga of nasya karma

Effect OF THE TREATMENT

1. Effect On Neck Pain -

The effect on neck pain over 30 patients suffering from cervical

spondylosis showed the mean score of 2.000 before the treatment was

reduced to 1.133 after the treatment. The change that occurred with the

treatment is greater than would be expected by chance; there is a statistically

significant change (P = <0.001)

Discussion

144


2. Effect On–Radiation of pain

The effect on radiation of pain over pain on 30 patients suffering

from cervical spondylosis showed the mean score of 2.43 before the

treatment was reduced to 1.600 after the treatment. The change that

occurred with the treatment is greater than would be expected by chance;

there is a statistically significant change (P = <0.001)

3. Effect On stiffness

The effect on the symptom stiffness over 30 patients suffering from

cervical spondylosis showed the mean score of 1.567 before the treatment

was reduced to 0.900 after the treatment. The change that occurred with the



4. Effect On - Weakness

The effect over the symptom weakness on 30 patients suffering from





5. Effect On - Parasthesia

The effect over the symptom parasthesia on 30 patients suffering from





Discussion

145


6. Effect On Clumpsy finger movement

The effect over the symptom clumpsy finger movement on 30 patients

suffering from cervical spondylosis showed the mean score of 1.300

before the treatment was reduced to 0.933 after the treatment. The change

that occurred with the treatment is greater than would be expected by

chance; there is a statistically significant change (P = <0.001)

7. Effect On - Vertigo

The effect over the symptom vertigo on 30 patients suffering from





8. Effect On - Tenderness

The effect over the symptom tenderness on 30 patients suffering from





9. Effect On - Movements of neck

The effect over movements of neck on 30 patients suffering from



Discussion

146




10. Effect On - Sensory loss

The effect over sensory loss on 30 patients suffering from cervical

spondylosis showed the mean score of 0.667 before the treatment was

reduced to 0.267 after the treatment. The change that occurred with the



11. Effect On - Neurological deficit

The effect over Neurological deficit on 30 patients suffering from





12. Effect of treatment on -Neck disability index

The effect of treatment on Neck disability index over 30 patients suffering


treatment and mean score of 10.167 after the treatment. The change that

occurred with the treatment is greater than would be expected by chance;

there is a statistically significant change (P = 0.009)

Discussion

147


13. Effect of treatment on Power w.s.r. movements . Shoulder

Abduction

The effect on power w.s.r movements . shoulder Abduction on 30

patients suffering from cervical spondylosis showed the mean score of

3.400 before the treatment and mean score of 4.033 after the treatment.

The change that occurred with the treatment is greater than would be

expected by chance; there is a statistically significant change (P = <0.001)

14. Effect of treatment on -- Power w.s.r. movements . Shoulder,

Flexion

The effect on power w.s.r movements . shoulder,flexion on 30 patients


before the treatment and showed mean score of 3.867 after the

treatment. The change that occurred with the treatment is greater than would

be expected by chance; there is a statistically significant change (P =

<0.001)

15. Effect of treatment on Power w.s.r. movements . Shoulder Extension

The effect on power w.s.r movements. shoulder , extension on 30 patients

suffering from cervical spondylosis showed the mean score of 2 .967

before the treatment and mean score 3.400 after the treatment. The

change that occurred with the treatment is greater than would be expected by


Discussion

148


16 Effect of treatment on Power w.s.r. movements . Elbow . Flexion

The effect of treatment on power w. s.r movements . Elbow. Flexion on 30

patients suffering from cervical spondylosis showed the mean score of

3.233 before the treatment and mean score of 3.800 after the treatment.



17. Effect of treatment on Power w.s.r. movements . Elbow Extension

The effect on power w. s.r movements . Elbow.Extension on 30 patients

suffering from cervical spondylosis showed the mean score of

2.033before the treatment and mean score of 1.500 after the treatment.



18. Effect of treatment on Power w.s.r. movements . Wrist . Flexion

The effect on power w. s.r movements . Wrist . Flexion on 30 patients


before the treatment and mean score of 3.667 after the treatment. The



19. Effect of treatment on Power w.s.r. movements . Wrist . Extension

The effect on power w. s.r movements . Wrist. Extension on 30 patients



Discussion

149




20 . Effect of treatment on Power w.s.r. movements. Forearm .

supination

The effect on power w. s.r movements. Forearm . Supination on 30 patients





21. Effect of treatment on Power w.s.r. movements Forearm Pronation

The effect on power w. s.r movements. Forearm Ponation over the

symptom neck pain on 30 patients suffering from cervical spondylosis

showed the mean score of 3.967 before the treatment and mean score of

4.400 after the treatment. The change that occurred with the treatment is

greater than would be expected by chance; there is a statistically significant

change (P = <0.001)

22. Effect of treatment on Power w.s.r. movements .

Metacarpophalangeal and interphalangeal . Flexion

The effect on power w. s.r movements Metacarpophalangeal and

interphalangeal . Flexion on 30 patients suffering from cervical

spondylosis showed the mean score of 3.933 before the treatment and

mean score of 4.300 after the treatment. The change that occurred with the

Discussion

150





Metacarpophalangeal and interphalangeal. Extension

The effect on on power w. s.r movements Metacarpophalangeal and

interphalangeal. Extension on 30 patients suffering from cervical






Metacarpophalangeal and interphalangeal Abduction

The effecton on power w. s.r movements Metacarpophalangeal and

interphalangeal. Abduction over the symptom neck pain on 30 patients





25. Effect of treatment on Power w.s.r. movements.

.Metacarpophalangeal and interphalangeal Adduction

The effect on power w. s.r movements Metacarpophalangeal and

interphalangeal . Adduction over the symptom neck pain on 30 patients


Discussion

151


before the treatment 4.533 after the treatment. The change that occurred

with the treatment is greater than would be expected by chance; there is a

statistically significant change (P = <0.001)

26. Effect of treatment on -Reflex .Biceps

The effect on Relex. Biceps over 30 patients suffering from cervical





27. Effect of treatment on - Reflex. Triceps

The effect of treatment on reflex- Triceps over 30 patients suffering from


and mean score of 2.267 after the treatment. The change that occurred with

the treatment is greater than would be expected by chance; there is a

statistically significant change (P = 0.006)

28. Effect of treatment on Reflex .Supinator

The effect of treatment on Reflex. Supinator over 30 patients suffering


treatment 2.267 after the treatment. The change that occurred with the



Discussion

152


Significant results were seen in

Neck Pain -

Radiation of pain

stiffness

Weakness

Parasthesia

Clumpsy finger movement

Vertigo

Tenderness

Movements of neck

Sensory loss



Power w.s.r. movements . Shoulder, Abduction, flexion ,extension

Power w.s.r. movements . Elbow , Flexion, Extension

Power w.s.r. movements . Wrist , Flexion , Extension

Power w.s.r. movements , Forearm , supination, Pronation

Power w.s.r. movements . Metacarpophalangeal and

interphalangeal . Flexion , Extension, Abduction , Adduction

Reflex .Biceps , Triceps, Supinator

Chapter -7

Conclusion

Conclusion

153


CONCLUSION

• The maximum percentage of patients i.e. (43.33%) was between 41-50

age groups which is suggestive of risk factor is more on ageing

• Cervical spondylosis as a whole cannot be compared to any single

disease pathology Ayurvedic parlance. But what ever may be the

disease, it affects the well being of the person and make an impact on

nations economy.

• . It can be said that the present study shows significant remission in

signs and symptoms of illness Cervical spondylosis

• Therefore it is imperative that the nasya karma with ketakyadi taila

help in management of the disease Cervical spondylosis and mostly

affects the individuals with in the age between forty- sixty years. Sex,

martial status, religion, Social status, literature bear no relation in

causation of this disease.

• Nasya karma performed with ketakyadi taila taila helps to pacify the

Vataprakopa due to its Snehana and brimhana qualities. And increases

functional ability

• Moreover, the improvement following the treatment proved to be

statistically significant.

• The results of the follow up study showed that the relief provided by the

therapy did not show much benefit up to 7 days of follow up after

stopping the treatment.

Chapter - 8

Summary

Summary

154


SUMMARY

The dissertation entitled “A Clinical Study To Evaluate The Effect Of

Nasya Karma In Cervical Spondylosis” consists of 10 chapters , namely

Introduction, Objectives, Review of literature, Methodology, Observation

and Result, Discussion, Conclusion and summary, Bibliography and

Annexure

Chapter 1 – Introduction

Chapter 2-Where the aims and objectives of the study are specified.

Chapter 3-Review of litreature

1. References of Nasya in various litreatures including Veda,

Upanishads, Puraana, different samhitas,etc are mentioned.

2. Conceptual study of Nasya:Here Etymological derivation, definition

of Nasya are explained.It also includes Nasya classification, dosage of

Nasya etc. according to various texts.Procedure of Nasya Karma is

explained along with Samyaka,Ayoga,Atiyoga Lakshanas.Vtapats and

their respective treatment are explained.

3. Conceptual study of Cervical Spondylosis where definition anatomy

of cervical spine,etiology and ethiopathogenesis of the disease,clinical

features, differential diagnosis, investigations, treatment are

mentioned.

4. Drug review:Here detailed description of the drugs used in Nasya

Karma are explained.

Chapter 4-Methodology:It explains the design of the study.Method of

selection of patients, Inclusion and exclusion criteria, Intervention, Criteria

for assessment.

Summary

155


Chapter 5- Observation and results: The detailed description of the different

observations made during the study is explained. Statistical analysis of the

data on different parameters is explained in results.

Chapter 6- Discussion: Discussion about the conceptual part of Nasya and

Cervical Spondylosis, about the Clinical data is specified. Discussion about

different observations are also explained along with the comment.

Discussion about the effect of the therapy on different parameters are also

explained in detail.

Chapter 7- Conclusion: The conclusion drawn upon clinical study and

various other parts of the work is explained here.

Chapter 8- Summary: summarized the whole Dissertation work.

Chapter 9- Bibliography: This deals with author name, publication, edition,

page no. and total no. of pages of the books referred in this study.

Chapter 10- Annexure: This section deals with the details of case proforma.

Chapter - 9

Bibliography

Bibliography

156


BIBLIOGRAPHY 1. eMedicine from webMD, Medscape’s continually updated clinical

reference,Cervical spondylosis, Diagnosis and management, by Sandeep S Rana ,

MD, Clinical Associate Professor of Neurology, Drexel university/College of

medicine, updated 14th Aug 2009, cited 30th oct 2009,available

at http://emedicine.medscape.com/article/1144952-overview

2. Vagbhata, Astanga Hrudaya , commentaries of Sarvangasundara of Arunadatta

and Ayurvedrasayan of Hemadri, edited by Paradakara Hari Sadashiv Shastri,

Varanasi, Chaukamba Surbharti Prakashan,Print 2007, Pp: 956: Page no.287

3. Sahasrayogam; English translation by, Dr.Nishteshwar & Dr. R. Vidyanath; First

edition; Chaukamba Samskrit Series Office, Varanasi, 2006, Pp: 540: Page no 112.

4. Chakradatta of Shri Chakrapani datta with Vaidyaprabha hindi commentary by

Dr. Indradeva Tripathi, Editor Ramanath Dwivedi, Published by Chaukamba

Publications, 2005, Pp: 539: Page no. 145

5. Bharat Bhaishajya Ratnakara:Samgruhita- Shree Nagindas Chaganlal Shah,

Samalankrut- Gopinath Gupta, Samshodith- Nivaran Chandra Bhattacharya,

B.Jain Publishers Pvt Limited, Delhi, Reprint 1995, Pp:650: Page no.269

6. Shri Vaidya Shodala ,Gada nigraha; with Vidyotini hindi commentary by Dr.

Indradeva Tripathi, edited by Sri Gangashaya Pandeya Part II , Chaukamba

Samskrit Series Office, Varanasi , First edition 1969, Pp: 971: Page no.512

7. Vrndamadhava or Siddayoga , Edited and translated by Dr. Premavati Tiwari and

Dr. Asha Kumari; Chaukamba Bharati Academy, Varanasi, First edition 2006,

Part I ; Pp:560: Page no.340

8. Vangasena, Chikitsa Sara Sangraha, English translation by DR. Nirmal Saxena

Vol I Chaukamba Publications , Varanasi 2004; Pp: 669: Page no.400

9. ShabdaKalpadruma, RajaRadhakanthaDeva, Dwiteeya Khanda,

Published by Nag Pubhlishers, Delhi; Reprint-1988. Pp 926. Pg 871.

10. Vagbhata, Ashtanga Hridaya, Edited by HariSastri Paradakara Vaidya, 9th

Edition, Published by Choukhambha Orientalia, Varanasi; Reprint-2005. Pp 956.

Pg 287.

http://emedicine.medscape.com/article/1144952-overview�

Bibliography

157


11. RigVeda Samhita, Published by Nityagnihotri Somayaji

V.R.Laxmikanth Sharma Dwivedi, Kumbhakonam,Tamilnadu; 1979. Pp

978. Pg 757.

12. . The Atharvaveda, English Translation by Devi Chand M.A.,

Published by Munshiram Manoharlal Publishers Pvt Ltd, New Delhi;

1997. Pp 939. Pg 57, 434, 788.

13. ShuklaYajurvedaKanvaSamhita with Sayana Bhashya(Uttara

Vimshati), Edited by Pt.Cintamani Misra Sarma, 1st

14. The Atharvaveda, English Translation by Devi Chand M.A., Published

by Munshiram Manoharlal Publishers Pvt Ltd, New Delhi; 1997. Pp

939. Pg 57, 434, 788.

Edition, 1978,

Published by Sampurnanand Sanskrit Vishvavidyalaya, Varanasi; Pp

385. Pg 161.

15. Manusmruti, Edited with Maniprabha Hindi commentary by

Pt.Haragovinda Sastri, Revised Edition2009,Published by Choukhamba

Sanskrit Bhawan, Varanasi; Pp766. Pg 58.

16. BhagavadGita - As it is, English Translation by A.C.Bhaktivedanta

Swami Prabhupada, 19th

17. Vagbhata, Ashtanga Hridaya, Edited by HariSastri Paradakara Vaidya, 9

print 2002,Published by The Bhaktivedanta

Book Trust,Mumbai. Pp 904.Pg 286, 303. th

18. AmaraSimha, AmaraKosha, Edited by Pt. HaraGovinda Shastri,

Choukhambha Sanskrit Sansthana, Varanasi; Reprint-2006. Pp 668. Pg 300.


Pg 385.

19. Sushruta, Sushruta Samhita, Edited by Vaidya Jadavaji Trikamji Acharya &

Narayan Ram Acharya, 9th Edition, 2007, Published by Chaukhambha Orientalia,

Varanasi; Pp 824. Pg 352.

20. Agnivesha, Charaka Samhita, Edited by Vaidya Jadavaji Trikamji Acharya,

Published by Chaukhambha Orientalia, Varanasi; Reprint-2007. Pp 738. Pg 318.

Bibliography

158


21. Vruddha Vagbhata, Ashtanga Sangraha with Shashilekha commentary, Edited by

Dr.Shivprasad Sharma, 2nd


Dr.Shivprasad Sharma, 2

Edition, 2008, Published by Chowkhamba Sanskrit

Series Office, Varanasi; Pp 965. Pg 300.

nd



Varanasi; Pp 824. Pg 366, 368, 384, 364, 374, 377.







26. RigVeda Samhita, Published by Nityagnihotri Somayaji

V.R.Laxmikanth Sharma Dwivedi, Kumbhakonam,Tamilnadu; 1979. Pp

978. Pg 757.

27. Atridev Vidyalankar, Ayurved Ka Brihat Itihas, 1st

28. SrimadValmeekeeya Ramayana, Dwiteeya Bhaga (YuddhaKanda),

Published by Geeta Press, Gorakhpur; Pp 831. Pg 331.

Edition, 1960,

Published by Bhargav Bhushan Press, Varanasi; Pp 704. Pg 15, 29-31,

63-67, 69-71.

29. Atridev Vidyalankar, Ayurved Ka Brihat Itihas, 1st


Dr.Shivprasad Sharma, 2

Edition, 1960,

Published by Bhargav Bhushan Press, Varanasi. Pp 704. Pg 101, 105-

106.

nd



Series Office, Varanasi; Pp 965. Pg 18-908. th


Pg 25-922.

Bibliography

159




Varanasi; Pp 824. Pg 54-811.


Published by Chaukhambha Orientalia, Varanasi; Reprint-2007. Pp 738. Pg 20-

731.

34. Sharangadhara, Sharangadhara Samhita, Edited by Pt.Parashurama Shastri, 1st

Edition, 2006, Published by Chaukhambha Surbharati Prakashan, Varanasi; Pp

398. Pg 72, 214, 338-346.

35. Bhavamishra, BhavaPrakasha, Volume-1, Edited by Pt.Brahma Shankara Misra,

11th

36. Vruddha Jivaka, The Kashyapa Samhita or VruddhaJivakiyaTantra, Vidyotini

Hindi Commentary by Sri Satyapala Bhisagacharya, Edition Reprint-2006,

Published by Chaukhambha Sanskrit Sansthan, Varanasi; Pp 364. Pg 81, 150,

151, 159-162, 166-167, 176, 179, 185, 187, 219, 234, 274.

Edition, 2007, Published by Chaukhambha Sanskrit Bhawan, Varanasi; Pp

959. Pg 101, 112, 821, 882-888.

37. Bhela, Bhela Samhita, Edited by Girijadayalu Suklah, Published by

Chaukhambha Bharati Academy, Varanasi; Reprint-1999. Pp 285. Pg 8, 151, 160,

169, 206, 210, 215-220, 223, 241, 257-259.

38. Vachaspatyam, compiled by Sri Taranatha Tarkavachaspati, Volume-5, 3rd

39. Sir Monier Monier-Williams, A Sanskrit-English Dictionary, Published

by Motilal Banarsidas Publishers Private Limited, Delhi; Reprint-2005.

Pp 1333. Pg 532.

Edition, 1970, Published by Chaukhambha Sanskrit Series Office, Varanasi; Pp

5442. Pg 4006, 4007.


Published by Nag Pubhlishers, Delhi; Reprint-1988. Pp 926. Pg 844,

845.



845

Bibliography

160




845.








Series Office, Varanasi; Pp 965. Pg 223. th



Pg 287. th

47. Bhavamishra, BhavaPrakasha, Volume-1, Edited by Pt.Brahma Shankara Misra,

11


Pg 287.

th

48. Trimalla Bhatta, Yogatarangini, English Translation by Dr.Nirmal Saxena, 1

Edition, 2007, Published by Chaukhambha Sanskrit Bhawan, Varanasi; Pp

959. Pg 882. rd




Edition, 2007, Published by Chaukhambha Sanskrit Bhawan, Varanasi; Pp 514.

Pg 30, 59-62.




Published by Chaukhambha Orientalia, Varanasi; Reprint-2007. Pp 738. Pg 722,

286.

Bibliography

161








Published by Chaukhambha Sanskrit Sansthan, Varanasi; Pp 364. Pg 159-162.


Pg 287.


Chaukhambha Bharati Academy, Varanasi; Reprint-1999. Pp 285. Pg 257-259.



398. Pg 339, 342.



Varanasi; Pp 824. Pg 555, 556.



Varanasi; Pp 824. Pg 555, 556





same







Bibliography

162














67. Vagbata,Astanga Hradaya,Edited by Pt.Hari Sadashiva Shastri Paradakara,

Published by Chaukambha Sanskrit Samsthan ,Varanasi ,Reprint 2010,Pp 956.Pg

290

68. Sushrutha, Sushrutha Samhitha,Edited by Vaidya Jadvji Trikamji

Acharya&Narayan Ram Acharya Kavyatirtha, Published by Chaukambha

Sanskrit Samsthan ,Varanasi,Reprint 2010,P p824.Pg 555



290



71. Agnivesha,Caraka Samhitha, Revised by Caraka and Dradabala with Ayurveda

Dipika . Commentory of Cakrapanidutta, Edited by Jadavaji Trikamji Acharya,

Published by Chaukhambha Orientalia, Varanasi , Reprint 2011,Pp-738. Pg 722




Bibliography

163


73. Sharangadhara,Sharangadara Samhitha , Edited by Pandith Parashuram Shasthri,

Published by Chaukhambha Orientalia,Varanasi , 7th



289

Edition -2008. Pp398. Pg

341























Published by Chaukhambha Orientalia,Varanasi , 7th Edition -2008. Pp398. Pg

341

Bibliography

164














398. Pg 341.




89. . Sharangadhara, Sharangadhara Samhita, Edited by Pt.Parashurama Shastri, 1st


398. Pg 341.










Chaukhambha Bharati Academy, Varanasi; Reprint-1999. Pp 285. Pg 257-259.

Bibliography

165







288




97. . Agnivesha, Charaka Samhita, Edited by Vaidya Jadavaji Trikamji Acharya,

Published by Chaukhambha Orientalia, Varanasi; Reprint-2007. Pp 738. Pg 722-

724.






398. Pg 344


101. Vrudha Vagbata, Astanga Sansraha , Edited by DrShivprasad Sharma, Published

by Choukambha Sanskrit Series Office , Varanasi , 2


Pg 288-294.

nd



289

edition 2008, Pp-965,

Pg-226 .


by Choukambha Sanskrit Series Office , Varanasi , 2nd


Pg-226 .

Bibliography

166








557




288


Pg 288-294.




398. Pg 344.


Pg 288-294.




Narayan Ram Acharya, 9th Edition, 2007, Published by Chaukhambha

Orientalia, Varanasi; Pp 824. Pg 554.



Published by Chaukhambha Sanskrit Sansthan, Varanasi; Pp 364. Pg 151-152.






Bibliography

167





398. Pg 341.


Pg 287.



118. . Agnivesha, Charaka Samhita, Edited by Vaidya Jadavaji Trikamji Acharya,

























Bibliography

168










289





















290

Bibliography

169








339






290



289







by Choukambha Sanskrit Series Office , Varanasi , 2


340

nd





Pg-225 .




Bibliography

170







290




150. . Sushruta, Sushruta Samhita, Edited by Vaidya Jadavaji Trikamji Acharya &


Orientalia, Varanasi; Pp 824. Pg 555-557.










Pg-225 .






291


Published by Chaukhambha Orientalia,Varanasi , 7th Edition -2008. Pp398. Pg

344

Bibliography

171







291

159. Chakrapani, Charaka Samhita , Chaukambha Sanskrit sansthana, 2001,

Varanasi, Pp-738,Page no.723

160. Susruta, Susruta Samhita, Acharya Jadavji Trikamji, Choukambha Orientalia

2003 Varanasi. Pp824, Page no.558

161. Vagbatacharya , Astanga Hrudaya, Pandith Bhisagacharya Harishastri paradkar

vaidya, Nirnay Sagar Press , 2002, Varanasi , Pp-956. Page no 288

162. Susruta, Susruta Samhita, Acharya Jadavji Trikamji, Choukambha Orientalia

2003 Varanasi. Pp824, Page no.558.



Orientalia, Varanasi; Pp 824. Pg 555-557.













Pg-226 .

Bibliography

172










292












398. Pg 345-346.



Orientalia, Varanasi; Pp 824. Pg 556, 557.







Bibliography

173











181. 186. Sushruta, Sushruta Samhita, Edited by Vaidya Jadavaji Trikamji Acharya &







Pg 294.

184. Davidson’s Principles and practice of medicine, Edited by Nicki R. Colledgge,

Brian R. Walker , Stuart H. Ralston 21th

185. Grabowkski Sandra Reynolds, Tartora Gerard ,Principles of Anatomy and

Physiology , 10

edition, Reprinted 2010, Publisher’s

Libreary of Congress Cataloging in Publication data, Pp :1360:Pp1360. Page

no.1221

th

186. Gray, Gray’s anatomy , 40

edition , 2003, published by John wiley and sons ,Inc . Pp1140.

Pg 205,206 th


edition , 2008,edited by Standring Susan . Published

by Churchill LivingstoneElsevier .Pp1550. pg 719,720 th


edition , 2008,edited by Standring Susan . Published

by Churchill LivingstoneElsevier .Pp1550. pg,721 th edition , 2008,edited by Standring Susan . Published

by Churchill LivingstoneElsevier .Pp1550. pg,721

Bibliography

174


189. http://www.indiadivine.org/audarya/ayurveda/443619-cervical-spondylitis-

ayurveda.html.

190. Shyamal Sen, API Text of Medicine, 6th

191. Shyamal Sen, API Text of Medicine, 6

Edition, 1999, Edited by Sainani G.S.,

Published by Association of Physicians of India, Mumbai; Pp 1444. Pg 829. th

192. Kalyan B. Bhattacharyya, API Text of Medicine, 7



193. Shyamal Sen, API Text of Medicine, 6

Edition, 2003, Edited by

Siddharth N.Shah, Published by the Association of Physicians of India, Mumbai;

Pp 1511. Pg 886.,887 th

194. . Kumar & Clarke, Clinical Medicine, 6



195. Cecil Medicine, Volume-2, 23

Edition, 2005, Reprinted 2006, Edited

by Prof.Parveen Kumar & Dr.Michael Clarke, Published by Elservier. Pp 1508.

Pg 536. rd


Published by Chaukhambha Orientalia, Varanasi; Reprint-2007. Pp 738. Pg 617,

113, 40, 619, 621.

Edition,2007, Edited by Lee Goldman & Dennis

Ausiello, Published by Elservier; Pp 3078, Pg 2658-2659.

197. . Sushruta, Sushruta Samhita, Edited by Vaidya Jadavaji Trikamji Acharya &


Orientalia, Varanasi; Pp 824. Pg 267, 268.

198. Gyanendra Pandey, Dravyaguna Vijnana Part 2 , Chowkamba Krishnadas

Academy, Varanasi , Reprint 2004 , Pp-824, Pg 232-237







398. Pg 345-235

http://www.indiadivine.org/audarya/ayurveda/443619-cervical-spondylitis-ayurveda.html.�

http://www.indiadivine.org/audarya/ayurveda/443619-cervical-spondylitis-ayurveda.html.�

Bibliography

175




203. Susruta, Susruta Samhita, Acharya Jadavji Trikamji, Choukambha Sanskrit

Sansthan 2002 Varanasi. Pp824, Page no: 205

204. Vagbhatacharya, Ashtanga Hridaya, Late. Dr. Anna Moreswara Kunte at el,

Chaukhambha Publication, Varanasi, 2002, Pp 956, Page no.77

Chapter - 10

Annexure

176

“A Clinical Study to evaluate the effect of Nasya Karma in Cervical S d l i ”

Department of Post Graduate Studies in Panchakarma, Kuthpady, Udupi

Title of Dissertation

“A CLINICAL STUDY TO EVALUATE THE EFFECT OF NASYA KARMA IN

CERVICAL SPONDYLOSIS"

Guide: Dr. Niranjan Rao M.D (Ayu) Candidate :- Dr. Vignesh Hoblidar

Professor

Patient name : Date :

CLINICAL CASE PROFORMA

Age : Sl. No :

Sex : OPD No :

Religion : IPD No :

Occupation : D.O.A :

Educational Status : D.O.D :

Economical Status : L/M/UM/H

Habitat :

Address :

Date of commencement :

Date of completion :

Follow up :

Results :

Chief Complaints

:

Duration

177


Pain : Localized / Diffuse

Radiate to / Rt / Lt

Occiput

Frontal

Shoulder down one arm

Shoulder down both arms

Other areas

Referred

To one finger

To more than one fingers

Tingling

Burning

Numbness

Weakness :

Wasting of muscles :

Morements of neck : Painful / Painful Restricted/ Restricted/Stiffness

Painful movements / Holding

Sensory loss :

Clumsy finger movements :

Associated complaints

Vertigo :

:

Flushing :

Tinnitus :

Visual Blurring :

Dysphagia :

Loss of bladder / Bowel control :

Groins involved : Rt It

Neck :

Arm :

178


Forearms :

Fingers :

Leg :

History of present illness:

Mode of onset:

Nature of Pain:

Course:

Aggravating Factors:

Family history :

Relieving Factors

No of children : Male

Female

Previous history :

Work :

Disease :

Operative procedure :

Major spinal operations :

Others :

Whiplash injury :

Trauma :

Motor vehicle accident :

Fall :

Sports :

179


Diving :

Other :

Nature of job : Standing Profession

Occupational History:

Sitting Laborious

Administrative

Clerical

Duration of job Other

Treatment History: Taken allopathic treatment

Taken Ayurvedic treatment

Taken physio theraphy

Taken any other Treatment

Gynecological history :

History of associated symptoms :

History of complications :

Marital Status :

Personal History:

Married / Unmarried / Widow

No of Children : Male : Female :

Occupation :

Nature of Job :

Environment of Job :

Education :

Educated / Uneducated

Addiction :

Alcohol : Quantity Frequency Duration

Smoking :

Cigarettes : Numbers Frequency Duration

Beedies : Numbers Frequency Duration

180


Tobacco chewing :

Gutkha : Quantity Frequency Duration

Others’s :

Ahara :

Veg / Non-veg / Mixed

Rasa :

Sarvagraha

Parigraha – M/ A/ L/ K/T/KS

Time : Regular / Irregular

Type :-

Samashana

Adyashana

Vishamashana

Anashana

Vihara : sleep : Normal / Excessive / Less / Disturbed / Loss

Duration : Day time

Night time

Sports :

Habit :

Tea : Quantity Frequency Duration

Coffee : Quantity Frequency Duration

Others : Quantity Frequency Duration

Appetite (Agni) :

Sama / Manda / Vishama / Teekshna

Bowel :

Regular / Irregular / Constipated / Other

Bhaya / Shoka / Chinta / Krodha

Manasika Pareeksha :

181


Contraceptive History:

Nadi :

General Examination

Mootra :

Mala :

Jiwha :

Shabda :

Sparsha :

Drik :

Akruthi :

B.P :

Temp :

Heart rate :

Resp rate :

Weight :

Height :

x-ray (AP & Lateral views of cervical spine )

Investigations :

Blood investigations: E.S.R

R.A

V.D.R.L

Examination of cervical spine:

Specific Examination:

Movements of Neck:

Flexion Rt lateral Flexion

Extension Left Lateral Flexion

Rt. Lateral rotation

Ieft Lateral rotation

182


Motor function :

Nutrition : Atrophy

Hypertrophy

Upper limb : Rt Left

Tone

Power

Lower limb :

Tone

Power

Involuntary movements if any :

Sensory functions :

Superficial or exteroceptive

1. Pain

2. Touch

3. Thermal - Hot

Cold

Deep reflexes Rt Lt

Biceps (c5, c6

Supinator (c

)

5, c6

Triceps (c

)

7, c8)

1. Prukruti

Dasha Vidha Parecksha:

2. Vikruti

3. Sara

4. Samahanan

5. Pramana

6. Seatmya

7. Satura

8. Ahara

9. Vyayama sakthi

10. Vaya

183


BT Subjective parameters AT

Neck pain

Radiation of pain

Stiffness

Weakness

Parasthesia

Clumsy finger movements

Vertigo

Objective Parameters BT AT

Tenderness

Movements of Neck

Flexion

Extension

Right Lateral Flexion

Left Lateral Flexion

Right Lateral Rotation

Left Lateral Rotation

Sensory Loss

Neurological Deficit

Power w.s.r. Movements

Shoulder:Abduction

Flexion

Extension

Elbow: Flexion

Extension

Wrist: Flexion

Extension

184


Forearm :Supination

Pronation

Metocarpophalangeal and

Interphalangeal: Flexion

Extension

Abduction

Adduction

Reflex

Biceps

Triceps

Supinator

Neck Disability Index

BT AT

Assessment of nasya karma :

Samyak Nasya

Lakshana

Day1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

UroLaghava

ShiroLaghava

Indriya Acchyam

(Prasada)

Sroto vishudhi

Manah Sukham

(Prasada)

Akshi Laghuta

185


Vaktra Vishudhi

Swara Vishudhi

Sukhochwaasa

Sukha swapna

Sukha

Prabhodana

Vikaropashamah

Pramoda

Smruthi Medha

Aapti

Bala Aapti

Agni Aapti

Ayoga Nasya Laxanas Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Galopalepa

ShirasoGurutwa

Moordha Shoonyata

Nishteewana

KaphaSramsana

Vata vaigunya

Indriya Rookshata

Akshi Stabdata

Akshi Rookshata

Nasa Shosha

Asya shosha

Kandu

Upadeha

Gadodreka

186


Atiyoga Nasya Laxana Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Shiro Arti /Toda

Akshi Arti/ Toda

Shankha Arti/Toda

Shravana Arti/ Toda

Timira Pashyet

Kapha Praseka

Shiro Guruthwa

Shirasah shoonyata

Indriya Vibrama

Mastulungagama

Vata Vrudhi

Kandu

Aruchi

Peenasa

Kshaamatha

Unmada

Hridrava

Signature of Guide

Signature of Co-Guide Signature of scholar

187


Grading:

Subjective Parameters :

Neck pain : Grade 0 – No pain

Grade1 –Mild painoccasional/Intermittent Relieved on its own/ rest Grade2-Moderate pain,frequent pain Relieved after taking pain killers Grade 3-Severe pain, not tolerable, not relieved fully even after taking pain killers Radiation of Pain : Grade 0 –No radiation Grade1 –Radiation of pain from neck to arm or neck to any one extremity, occasionally present Grade 2- Radiation of pain from neck to arm or neck to any one extremity, continuously present Grade3-Radiation of pain from neck to both arms or both upper extremities, occasionally present Grade 4-Radiation of pain from neck to both arms or both upper extremities , continuously present Stiffness: Grade 0-No stiffness Grade 1-Mild stiffness Grade2-Moderate stiffness Grade 3- Severe stiffness Weakness: Grade 0-No weakness Grade1-Weakness in any one upper extremity Grade 2-Weakness present in both the extremities Parasthesia : Grade0-Absent Grade 1-Present Clumsy Finger movements : Grade0- No clumsy finger movements Grade 1- clumsy finger movements in any one upper extremities Grade 2- Clumsy finger movements in both upper extremities Vertigo: Grade 0 –Absent Grade 1- Present on neck movements or occasionally present Grade 2- Present constantly

188


Objective parameters :

Tenderness over cervical region : Grade 0- No pain Grade 1- Patient complains of pain Grade 2- Patient complains of pain and winces

Grade 3- Patient winces and withdraws the affected part Grade 4- Patient will not allow palpation of affected part

Reference : Orthopedic Physical Assessment by David J.Magee

Movements of neck painful or restricted : Grade 0- All 6movements are painless or not restricted Grade1- Any 1 movements is painful or restricted Grade 2-Any 2 movements is painful or restricted Grade 3-Any 3 movements is painful or restricted Grade 4- Any 4 movements is painful or restricted Grade 5-Any5 movements is painful or restricted Grade 6-All 6 movements is painful or restricted Sensory Loss : Grade 0- Normal sensation Grade 1- Reduced sensation Grade 2 – No sensation Neurological Deficit: ( Watkin’s Severity scale for Neurological Deficit ) A Neurological Deficit Grade 1- Unilateral arm numbness or dysesthesia ;Loss of strength

Grade 2- Bilateral upper extremity loss of motor and sensory function Grade 3- Ipsilateral arm, leg &trunk loss of motor & sensory function Grade 4- Transient quadriparesis (temporary sensory loss in all 4 limbs) Grade 5- Transient quadriplegia ( temporary motor loss in all 4 limbs) Score A : B Time symptoms present Grade 1- Less than 5 minutes

Grade 2 - Less than 1 hour Grade 3- Less than 24 hours Grade 4- Less than 1 week Grade 5 – Greater than 1 week Score B:- Severity score : A+B = Score (out of 10) Severity ≤4 Mild episode 4-7 Moderate episode 8-10 Severe episode

189


C Grade 1- >12mm

Central canal diameter

Grade 2- Between 10 to 12mm Grade 3- 10mm Grade 4- 8 to 10mm Grade 5 - <8mm Score C : __ Return to activity score A +B+C = Score (out of 10) Minimum risk 6-10 Moderate risk 10-15 Severe risk Reference : Orthopedic physical Assessment by David J. Magee Power : Grade 0 – No muscle contraction visible Grade 1-Flicker of contraction but no movement Grade 2 – Joint movement when effect of gravity eliminated Grade 3 – Movement against gravity but not against resistance Grade 4 – Movement against resistance but weaker than normal Grade 5 – Normal power Reference : Medical research Council Scale, Macleod’s Clinical examination Reflexes: Grade 0- Absent Grade 1- Diminished Grade 2- Average Grade 3 – Exaggerated Grade 4 – Clonus , very brisk Reference : Orthopedic Physical Assessment by David J . Magee Neck Disability Index : SECTION 1 : Pain Intensity A. I have nompain at the moment .( 0) B. The pain is very mild at the moment . ( 1) C. The pain is moderate at the moment ( 2) D. The pain is fairely severe at the moment( 3) E. The pain is very severe at the moment (4) F. The pain is the worst imaginable at the moment (5)

190


SECTION 2: Personal Care (Washing , Dresing , etc ) A. I can look after myself normally without causing extra pain (0) B. I can look after myself normally but it causes extra pain (1) C. It is painful to look after myself and I am slow and careful ( 2) D. I ned some help but manage most of my personal care ( 3) E. I need help every day in most aspect s of my personal care F. I do not get dressed ; I wash with difficulty and stay in bed ( 5) SECTION 3: Lifting A. I can lift heavy weights without extra pain . (0) B. I can lift heavy weights but it gives extra pain . (1) C . Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned , for example on the table . ( 2) D. Pain prevents me from lifting heavy weights , but I can manage light to medium weights if they are conveniently positioned . ( 3) E. I can only lift very light weights . ( 4) F . I cannot lift or carry anything at all . ( 5) SECTION 4 : Reading A. I can read as much as I want to with no pain in my neck . ( 0) B. I can read as much as I want to with slight pain in my neck . (1) C. I can read as much as I want with moderate pain in my neck . (2) D. I cannot read as much as I want because of moderate pain in my neck . (3) E. I can hardly read at all because of severe pain in my neck . (4) F. I cannot read at all . ( 5) SECTION 5 : Headaches A. I have no headaches at all . ( 0) B. I have slight headaches that come in frequently .(1) C. I have moderate headaches which come infrequently (2) D. I have moderate headaches which come frequently (3) E. I have severe headaches which come frequently . (4) F. I have headaches almost all the time . (5) SECTION 6 : Concentration A.I can concentrate fully when I want to with no difficulty . (0) B.I can concentrate fully when I want to with slight difficulty .(1) C.I have a fair degree of difficulty in concentration when I want to (2) D.I have a lot of difficulty in concentrating when I want to (3) E.I have a great deal of difficulty in concentrating when I want to (4) F.I cannot concentrate at all (5)

191


SECTION 7 : Work A.I can do as much work as I want to .(0) B.I can do my usual work , but no more .(1) C.I can do most of my usual work , bit no more . (2) D.I can do my usual work . (3) E. I can hardly do any work at all (4) F. I cannot do any work at all . (5) SECTION 8 : Driving A.I can drive my car without any neck pain . (0) B.I can drive my car as long as I want with slight pain in my neck (1) C.I can drive my car as long as I want with moderate pain in my neck (2) D. want because of moderate pain in neck . (3) E.I can hardly drive at all because of severe pain in my neck .(4) F.I can not drive my car at all . (5) SECTION 9: Sleeping A.I have no trouble sleeping . (0). B.My sleep is slightly disturbed (less than 1 hour sleepless ).(1) C.My sleep is mildly disturbed (1-2 hours sleepless ).(2) D.My sleep is moderately disturbed (2-3hours sleepless ). (3) E.My sleep is greatly disturbed (3-5hours sleepless ). (4) F.My sleep is completely disturbed (5-7hours sleepless ).(5) SECTION 10 : Recreation A.I am able to engage in all my recreation activities with no pain at all (0) B.I am able to engage in all my recreation activities with some pain in neck . (1) C.I am able to engage in most , but not all , of my usual recreation activities because of pain in my neck . (3) D.I am able to engage in a few of my usual recreation activities because of pain in my neck (3) E.I can hardly do any recreation activities because of pain in my neck (4) F.I cannot do any recreation activities at all . (5) Scores (out of 50 ) Level of disability 0-4 No disability 5-14 Mild disability 15-24 Moderate disability 25-34 Severe disability 35-50 Complete disability Reference : Orthopedic Physical assessment by David J. Magee

“a clinical study to evaluate the effect of nasya …

Documents