ArticlePDF Available

A Critical Evaluation of the Concept of "Nasa Hi Shiraso Dwaram" (Nasal Route Entry for the Cranial Cavity)

Authors:

Abstract and Figures

The development of alternative methods of drug administration has improved the ability of physicians to manage specific problems. The nasal route of administration has been used for different therapeutic and prophylactic purposes for millennia. The drugs, which are administered through the nose, act locally as well as systemically. The dose of drugs required is very minimal. The metabolism of the drug is not required through first passage and the action of the drug is faster and effective. (Keywords: nasal drug delivery, nasya, nasal cavity, Ayurveda, traditional Indian medicine)
Content may be subject to copyright.
A Critical Evaluation of the Concept of “Nasa Hi Shiraso Dwaram”
(Nasal Route Entry for the Cranial Cavity).
Dr. H.J. Sangeeta, M.D. (Ayu)1 and Dr. Hemant D. Toshikhane, M.S.(Ayu) 2
1Department of Panchakarma, K.L.E’ BMK Ayurveda College, Belgaum, Karnataka, Inida.
2Department of Shalayatanra (Surgery). KLE BMK Ayurveda Mahavidtyalaya Shapur, Belgaum
Karnataka, India.
E-mail: drhemantt@gmail.com
ABSTRACT
The development of alternative methods of drug
administration has improved the ability of
physicians to manage specific problems. The
nasal route of administration has been used for
different therapeutic and prophylactic purposes
for millennia. The drugs, which are administered
through the nose, act locally as well as
systemically. The dose of drugs required is very
minimal. The metabolism of the drug is not
required through first passage and the action of
the drug is faster and effective.
(Keywords: nasal drug delivery, nasya, nasal cavity,
Ayurveda, traditional Indian medicine)
INTRODUCTION
This article attempts to reveal a better scientific
explanation to the concept of the administration of
drugs through the nasal route as it has been well
practiced by Acharyas. This route of
administration was well developed in early days,
and has been recognized and practiced by
modern physicians since at least the past 20
years. Modern medical science has accomplished
advances in the administration of drugs through
the nasal route by inhalation of vaporized,
nebulized, powdered, or aerosolized drug, as well
as by direct instillation.
To understand the relevancy of the mode of
action/mechanism of Nasya, a gross
understanding of the relative anatomy of the
nasal cavity is very important. The nasal cavity is
bounded by floor, roof, medical and lateral walls.
Important anatomical structures for consideration
are mainly the floor and the roof.
1) Floor is formed by the horizontal process of
the Palatine bone.
2) Roof is very narrow and formed by:
a) Nasal and frontal bones, anteriorly,
b) Cribriform plate of ethmoid bone in
the middle, and,
c) Body of sphenoid, posteriorly.
The roof of Nasal cavity is formed with the
superior turbinate and cribriform plate. This is a
specific plate which forms the floor of the anterior
cranial fossa, having small pores in it. This is the
specific area of olfaction formed by the superior
turbinate constituted with special mucous
membrane; which is called as olfactory
membrane.
This olfactory epithelium, where olfactory
receptors are located, is also called as olfactory
area. The total area of olfaction on each side is
about 250mm2.
The olfactory area (epithelium) is composed of
mainly the following types of cells:
1) Supporting (Substentacular cells)
2) Receptor cells and,
3) Basal cells
Supporting cells are columnar cells which secrete
mucous. The Receptor cells are those where one
end forms into Axon and the another end facing
mucous layer, forms into cilia which perceive the
object (i.e., smell). These axons join together to
form the olfactory tract and the olfactory bulb.
The Pacific Journal of Science and Technology 338
http://www.akamaiuniversity.us/PJST.htm Volume 10. Number 1. May 2009 (Spring)
Figure 1: Coronal Section Through the Nasal Cavity and the Maxillary Air Sinuses.
Figure 1: Representation of the Olfactory System.
In Ayurvedic classics, applied aspects of Nasa
have been specified for than their anatomical
aspect (i.e., classics have given the importance of
jnanendria (cognitive sense organs)). Charaka
has mentioned sense faculties for Nasa as below;
(Cha. Su.8/ 6-12)
Indria—Ghranendria (Sense faculty for smell)
Indria Artha—Gandha (Sense objects)
Indria Dravya—Prithvi (Material constituents
of sense faculty)
Indria buddhi—Gandha jnana (Smell
Perception)
Indria adhishthana-- Nasa (Sense organ for
smell)
Acharya Sushruta (Ancient Ayurvedic scholar and
authoer of text Sushruta Samhita) while telling the
importance of Indriya pancha panchaka (Sensory
System), Panchaabhibhuta Dhamanis have been
told, (i.e.; the sense faculties perceive objects
which are dominated by Particular Material
Constituents). This phenomenon tells about
Gandha jnana (the perception of smell), when
Gandha Artha (object for smell) is perceived by
Nasa Indriya (nose) through Panchaabhibhuta
dhamanis. These dhamanis (neurons) are
specific, referred to by the above scholar, which
can be considered for olfactory
receptors/neurons necessary for the smell. These
dhamanis are porous structures, which perceive
the objects (Ref; Su.Sha.9/ 10). These can be
considered for the ciliary bed/the transneural
area of the Nasal mucosa where absorption of
the drug takes place.
It is stated in Ayurvedic classics that, there is a
very close relationship between the Nasa and
Shiras (Brain). Even modern science accepts this
concept because the nasal mucosa is the only
location in the body that provides a direct
The Pacific Journal of Science and Technology 339
http://www.akamaiuniversity.us/PJST.htm Volume 10. Number 1. May 2009 (Spring)
connection between central nervous system
(CNS) and the atmosphere. Drugs administered to
the nasal cavity rapidly traverse through the
Cribriform plate into the CNS by 3 routes.
1) Directly by olfactory neurons,
2) Through supporting cells and the
surrounding capillary bed; and
3) Directly into the cerebrospinal fluid
(CSF).
Acharya Charaka (Scholar) has mentioned one
specific anatomical structure named Munja-,
which is like type of grass which acts like Ishika
(i.e., like a painter’s brush). This “painter’s brush”
when instilled in the paint, absorbs the paint; in
the same way the Munja structure attracts the
doshas when stimulated by the particular drug
(Ref; Cha.Si. 2/ 22). The Munja structure can be
thought for an olfactory bulb and the Ishika for the
numerous neurons join together to form the
olfactory tract. These two scholars tried to explain
the functional aspects of anatomy of the nose,
which simulates with the modern system.
PURVA KARMA (PRE-PROCEDURAL
MEASURES)
Importance of the Purva karma in Nasya karma is
to facilitate for drug absorption through Nasal
neurons and paranasal sinuses. In this, the
repeated Paanitaapa swedana (fomentation by
rubbing of palms) causes an impact on blood
circulation to head. The Vasodilator action over
superficial surface of the face facilitates for drug
absorption. The second aspect of Purva karma;
the posture giving during Nasya karma has its
relevancy in two ways:
1) It creates the patency in channels of nasal
cavity and Naso-pharynx;
2) The drug administered, reaches the upper
part of the Nasal cavity and stimulates the
olfactory neurons.
PRADHANA KARMA (MAIN-PROCEDURAL
MEASURES)
Where the actual drug is administered should
remain for momentary retention of the drug in
Nasal cavity. The provisions created by Purva
karma help in the Pradhana karma, so that the
drug has a greater chance of adsorption in the air
sinuses. As well as providing sufficient time for
stimulating olfactory neurons.
During this explanation, classics have mentioned
one more structure; the Shringataka Marma
(anatomical area) where there is an association
of Ghrana (nasal), Akshi (visual), Shrotra
(auditory), and Jiwha (lingual) Siras (nerves and
vessels) are present (Ref; Su.Sha.6/27). Acharya
Charaka says the sneha pradhana Navana Drug
(lipid processed herbal drug), gets absorbed in
the Shringataka region (Ref; Cha.Chi.26). The
above reference by the scholar says lipid soluble
drugs are much more efficiently absorbed by
nasal mucosa.
Indu, the commentator for Ayurvedic epics,
mentioned the exact sthana of the Shringataka
Marma (i.e., Shiraso Antarmadhya Murdha)
which can be considered for the Middle Cephalic
Fossa. The Middle Cephalic fossa is the region,
which, in connection with ethmoid and sphenoidal
sinuses, consists of meningeal vessels, mainly
internal carotid artery, cranial nerves (3rd, 4th, 5th
and 6th). and also the optic nerve. The pituitary
gland can be approached through the sphenoidal
sinus by trasnsantral and transnasal routes. The
sphenoidal sinus is inferiorly in connection with
the Naso-pharynx and posteriorly with the brain
stem. The above show the Shringataka Marma
(structure consisting of four siras in connection
with four sense organs and the nerves and
vessels) can be related with the Middle Cephalic
fossa.
PASCHAT KARMA (POST-PROCEDURAL
MEASURES)
The absorption of the drug is also facilitated by
the Paschat karma followed during the
procedure. This starts with mardana (oil
massage) over the frontal, temporal, maxillary,
mastoid, and neck region. After administration of
the drug, when the drug reaches the distal ends
of the air ways, the patient is asked for the
Nishthivana Kriya (spitting out of the medicine).
The medicine should reach on the both sides of
the throat; otherwise the drug adsorption doesn’t
occur in the siras properly (Ref; As. Sa.Su.29).
The drug used for Navana/Marsha nasya (names
of different types of nasal drug administration) is
processed with sneha paka vidhi till Mrudu paka
The Pacific Journal of Science and Technology 340
http://www.akamaiuniversity.us/PJST.htm Volume 10. Number 1. May 2009 (Spring)
(preparation of the drug in lipid base) attains. This
also has the relevancy in facilitating the
stimulation as well as the absorption of the drug.
To achieve rapid diffusion through nasal mucosa
the lipid soluble drugs are preferred where the
mucosal cilia are lipophylic in action.
In humans small particals of size 0.5 to 1.0µm
tend to deposit in a naso pharyngeal part. So the
particles become finer than mentioned above on
undergoing Mrudu paka, which may facilitate the
drug absorption at the level of the Naso pharynx.
The duration of the Nasya karma course ranges
from 7-21 days. It differs for each classification of
Nasya karma. These many days are needed for
the action of the drug and to achieve required
symptoms. Because of the quantity of the drug,
very minimal and continuous stimulation to the
olfactory neurons should facilitate the stimulation
of the higher center (i.e., to the olfactory bulb).
Once this area is stimulated, then this stimulation
is continued to the parts of Amygdala,
Hypothalamus, to the parts of Basal Ganglia and
to the brain stem also. This whole system is called
the limbic system, which controls emotional
reactions, visceral somatic, behavioral changes,
motivation, biological rhythms, and respiratory,
circulatory, and endocrine changes.
CONCLUSION
All of these functions have been suggested in our
classics by describing the different types of
classification of Nasya karmas and these
classifications can be broadly understood under
two headings; 1) Shamana Nasya (Nasal
administration for subsiding the toxins) and 2)
Shodhana Nasya (administration for purificatory
purposes). The mechanism of both Nasya types is
different (i.e., the Shamana type, facilitates for
drug absorption while the Shodhana type, induces
stimulatory action). In the same way, the steps of
the procedure of Nasya karma have been
documented. On the basis of foregoing
observations, one can state that the procedures,
postures, and conducts explained for Nasya
karma are of vital importance to the drug
absorption and transportation.
So Nasya karma is used both to manage the
Sthanika (local) and Sarvadaihika (general)
anomalies and the relevancy of Nasa hi Shiraso
Dwaram can be proved thus (Nasal route is the
direct entry to the CNS).
REFERENCES
1. Choukhambha samskrita Samsthana. 1995.
“Charaka Samhita with Ayurveda deepika
Commentary”. Varanasi, 4th edition.
2. Bhaishajya Ratnavali –Govinda Das Ratna
prakashika commentary.
3. Shambhulingam, K. and Prema Shambhulingam.
2006. Essentials of Medical Physiology. 2nd
edition. Jaypee Brothers: New Delhi, India.
4. Sushruta Samhita. 2005. “Nibandha Sangraha by
Dalhana, Nyaya chandrika by Gaya Das
commentaries, Reprint”. Chowkhamba Sanskrita
Series: Varanasi, India.
5. WWW.Pubmed.com--- Dept .of Physiology and
Pharmacology, Denmark. n.einer- Jensen
@imbmed .sdu.dk.
6. Krishna Kumar, CD. 2005. “Pharmacological and
Clinical Aspects of External Application of Fats
and Oils”. Lead paper for Intellectual Conclave.
May 29, 2005.
ABOUT THE AUTHORS
Dr. H.J. Sangeeta, M.D. (Ayu), is an Assistant
Professor in the Department of Panchakarma,
K.L.E’ BMK Ayurveda College, Belgaum,
Karnataka, India. His research interests are in
Ayurveda and linkages between traditional Indian
medicine and western medicine.
Dr. Hemant D. Toshikhane, M.S.(Ayu), is a
Professor in the Department of Shalayatanra
(Surgery), KLE BMK Ayurveda Mahavidtyalaya
Shapur Belgaum Karnataka, India. His research
nterests are in Ayurveda and linkages between
raditional Indian medicine and western medicine.
i
t
SUGGESTED CITATION
Sangeeta, H.J. and H.D. Toshikhane. 2009. “A
Critical Evaluation of the Concept of “Nasa Hi
Shiraso Dwaram” (Nasal Route Entry for the
Cranial Cavity)”. Pacific Journal of Science and
Technology. 10(1):338-341.
Pacific Journal of Science and Technology
The Pacific Journal of Science and Technology 341
http://www.akamaiuniversity.us/PJST.htm Volume 10. Number 1. May 2009 (Spring)
... [41] Nose is the gateway to the head. [42] Drugs given through the nasal route helps in direct absorption of the molecules through trigeminal and olfactory pathways, thus facilitating direct entry to the brain. Nasya acts on higher centers of brain controlling different neurological functions. ...
Article
Full-text available
Huntington's disease (HD) is a rare autosomal dominant neurodegenerative disorder. It is caused due to trinucleotide cytosine-adenine-guanine (CAG) repeat expansion on chromosome 4. The greater the CAG repeat size, the earlier the onset of the disease. It is characterized by motor, cognitive, and psychiatric symptoms. The onset of Juvenile HD occurs before the age of 21 and is rarer compared to adult-onset HD. A 30-year-old female, diagnosed with HD by molecular genetic analysis and magnetic resonance imaging, presented to Ayurveda hospital with chief complaints of abnormal involuntary movements in both the limbs bilaterally, difficulty in walking without support, difficulty in speech, swallowing, episodes of anger outbursts, and hard stools. The Ayurvedic treatment protocol was planned with a course of Nasya (~medication through nasal route), Basti (~medicated enema), and Abhyanga (~therapeutic oleation). Shashtika Shali Pinda Sweda (~sudation by application of poultice with rice), Shiropichu (~therapeutic procedure of placing tampon with oil over head region), and Karnapurana (~filling of ear with medicated liquid) along with internal medications which had Balya (~strength promoting), Brimhana (~restorative measures), Agni balavardhana (~enhancing digestive fire), Rechana (~cleansing), Rasayana (~rejuvenation therapy), and Vatahara (~Vata pacifying) actions were also adopted. By the completion of treatment, improvement was noticed in terms of reduced involuntary movements, better balance while standing, and reduced frequency of falls. Assessment by Abnormal Involuntary Movements Scale showed a reduction from score 30 to 18 after treatment, inferring that Ayurvedic therapies can help in betterment of patients affected with HD. Keywords: Abhyanga, Basti, Nasya, Shashtika shali pinda sweda, Shiropichu
... [33] • Aparasanga: Tampon soaked with oil prepared with Madanphala (Randia spinosa Poir.), Shatapuspa (Anethum sowa Kurz.) and so on is recommended. [ • Nasal administration of medicated oil that reaches to Shringataka Marma (a vital anatomical point of head exactly in middle cephalic fossa) [49] eliminates morbid Dosha and ultimately stimulation of Hypothalamic-pitutary-ovarian axis promotes the normal physiological function of ovarian hormones. [50] Thus it helps in achieving conception and preventing recurrent miscarriage or abortion. ...
... Parenteral preparations cover a broad spectrum of drug formulations useful in a variety of conditions however requirement of a trained personnel for drug administration along with strict adherence to aseptic procedures and pain on site of injection leaves room for an effective as well as patient friendly drug delivery approach. Nasal therapy is being practiced since ages and has been a perceived mode of therapeutics in the Ayurveda system of medicine going by the name "nasaya karma" [3]. The nasal route for drug delivery avoids first pass effect in liver related to the oral delivery. ...
Article
Full-text available
Background and Objective: Intranasal drug delivery, being non-invasive in nature has turned out to be a promising option for drug administration. It is particularly valuable for drugs having low oral bioavailability due to degradation in Gastrointestinal Tract (GIT). Nasal route provides a unique microenvironment due to absence of deactivating enzymes and abundant vascular tissues which bring about direct systemic display, along with these lines abstaining the first pass hepatic metabolism. Conclusion: The present article provides in-depth information about the physicochemical parameters associated with drug absorption in nasal mucosa and factors influencing it. The pathways and mechanisms associated with nasal drug uptake alongside current pharmaceutical applications are additionally summarized.
... t connection between central nervous system and the atmosphere. Drugs administered to the nasal cavity rapidly transfer to the cribriform plate and then to the central nervous system via three routes: @BULLET Directly via olfactory neurons @BULLET Via supporting cells and the surrounding capillary bed @BULLET Directly through cerebrospinal l fluid. [6] The surface area of the nasal cavity is about 160 cm 2 (0.96 m 2 if the microvilli are included). The olfactory region, however, is only about 5 cm 2 (0.3 m 2 when microvilli are included). There are six arterial branches that serve the nasal cavity, making this region, called as Little's area of nose, a very attractive route for drug a ...
Article
Full-text available
Nasya karma is prime treatment modality for ūrdhvajatrugata vikāra. Though classics clearly mention yogya (arha), ayogya (anarha) criteria for Nasya karma some complications were noticed while practicing. In KLEUS Shri BMK Ayurveda Hospital Belgaum, out of 2867 patients 58 (0.58%) cases reported various complications during and after Nasya karma in the year of 2011 even after taking utmost care in selection of patients as well as drugs. This gave rise to need to develop quick screening criteria to minimize errors. To develop Nasya fitness form for clinical practice to further minimize unusual complications and thus obtain the maximum result. Literature pertaining to Nasya karma, Nāsa śarīra with anatomy of nose, vasculature, innervation, examination of the nose and various anatomical pathologies were considered to develop the fitness form. On the basis of examination of external nose, nasal cavity, concha, nasopharynx and paranasal sinus by anterior and posterior rhinoscopic examination fitness form was developed. Present fitness format will not only help to assess the nasal pathologies, which are obstacles for drug delivery, but also will help to attain optimum results and avoid unusual complications.
Book
Salient Features • Thoroughly revised and fully updated with recent developments in the field of Physiology • Enriched with Boxes containing important facts particularly in applied physiology in addition to inclusion of more tables, flow charts and descriptive diagrams • Tables and flow charts formatted in new attractive style • Illustration of each chapter with beautiful colour diagrams and appropriate colour blends that are soothing to the eyes and appealing to the mind • List of topics given at the beginning of each chapter prepares the mind of the reader what to expect from that chapter and how to approach the chapter for better understanding • Probable questions given at the end of each section is the ultimate benefit for the student to assess himself/herself and approach the subject with clear idea • A real state-of-the-art book with approximately 600 colour diagrams • Useful text book not only for medical students but also for the dental, paramedical and allied health sciences students.
Pharmacological and Clinical Aspects of External Application of Fats and Oils". Lead paper for Intellectual Conclave
  • Krishna Kumar
Krishna Kumar, CD. 2005. "Pharmacological and Clinical Aspects of External Application of Fats and Oils". Lead paper for Intellectual Conclave. May 29, 2005.
Charaka Samhita with Ayurveda deepika Commentary
  • Samsthana Choukhambha Samskrita
Choukhambha samskrita Samsthana. 1995. "Charaka Samhita with Ayurveda deepika Commentary". Varanasi, 4th edition.
Nibandha Sangraha by Dalhana, Nyaya chandrika by Gaya Das commentaries, Reprint
  • Sushruta Samhita
Sushruta Samhita. 2005. "Nibandha Sangraha by Dalhana, Nyaya chandrika by Gaya Das commentaries, Reprint". Chowkhamba Sanskrita Series: Varanasi, India.