Cervical spondylosis is a chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral discs of the neck as well as the contents of the spinal canal. In later stages, spondylotic changes may result in stenosis of the spinal canal and foramina. Recent researches showed that middle aged population shows increased incidence of degenerative disc changes. It is also a natural aging phenomenon because it usually occurs in people of age 50 or older. Cervical spondylosis in the general population has incidence rate of 83 per 100000 populations and prevalence of 3.3 cases per 1000 people and occurs mostly in fourth and fifth decades of life. The etiology of cervical spondylosis is associated with the ageing process of life. In a report on radiographic evidence, prevalence in male was 13% in 3rd decade and increases to 100% by the age of 70 years. But in female it ranges from 5% in 4th decade to 96% by the age of 70years. According to Ayurveda in parihani awastha vata influence is more and surplus Vata leads to dhatu kshaya. It may be said that the acceleration of the degenerative process takes place, which ultimately leads to many more problems of spinal origin. Ayurveda understands the cervical spine disorders in terms of vishwachi, apabahuka, manyasthambha and these are the disorders that mainly affect the urdhwa jatru. The clinical signs and symptoms of these disorders have certain similarities to cervical spondylosis as explained in contemporary system of medicine. Most of the times, patients of cervical spondylosis present with varied degree of signs and symptoms such as neck pain, stiffness, weakness etc. which are required to be alleviated by the administration of shamana chikitsa. Further in order to overcome the root pathology involved in manifestation of cervical spondylosis, Brimhana chikitsa occupies the prime seat in its line of treatment. Nasya karma is considered as a unique line of treatment in urdhwa jatru vikara. Cervical spondylosis is considered as one among the Urdhwa jatrugata vikara.
To gather information on the disease and the nasya treatment -Charaka Samhita was the main reference material. Search was conducted in the form of identifying the verses where these aspects have been discussed. The search was mainly focused on verses given in Sutrashtan, Siddhisthana and Chikithsasthana. The collected information was analyzed to understand both ‘bhavartha’ and ‘goodartha’ in the context of the existing knowledge and on clinical experience of the author’s team. Information related to Cervical spondylosis was collected from the information given in Harrisons Text Book of Medicine. Based on the information the following inference was drawn:
Cervical spondylosis is caused by chronic wear and tear on the cervical spine. This includes the discs or cushions between the neck vertebrae and the joints between the bones of the cervical spine. There may be abnormal growths or spurs on the bones of the spine (vertebrae). Over time these changes can compress one or more of the nerve roots. In advanced cases, the spinal cord becomes involved. This can affect not just the arms, but the legs as well. Everyday wear and tear may start these changes. People who are very active at work or in sports may be more likely to have them.
The major risk factor is aging. By age 60, most persons show signs of cervical spondylosis on x-ray. Other factors that can make a person more likely to develop spondylosis are:
Ø Being overweight and not exercising
Ø Having a job that requires heavy lifting or a lot of bending and twisting
Ø Past neck injury (often several years before)
Ø Past spine surgery
Ø Ruptured or slipped disc
Ø Severe arthritis
Ø Small fractures to the spine from osteoporosis
According to Acharya Charaka, vata gets aggravated by intake of non-unctuous, cold, scanty, light food, excessive sexual indulgence, lack of night sleep, inappropriate therapeutic measures administration of therapies which cause excessive elimination of doshas & blood, swimming in excess, langhana, resorting to wayfaring, exercise and other physical activities in excess, loss of dhatu, excessive emaciation because of worry grief and affliction by disease, sleeping over uncomfortable beds and seats, anger, sleep during day time, fear & suppression of natural urges, formation of ama suffering from trauma abstinence from food, injuries to marmas and riding over elephant, camel, horse or fast moving vehicles and falling down from the seats on these animal and vehicles.
Various etiological factors cause vata vitiations and vitiation of vata occurs in different parts of body and cause rukshata (dryness) parushata, kharata in strotasa gets sthanasamshraya at sandhi pradesh and cause sandhigata vata.
Nasya karma is one among the panchakarma procedures which is a modality of choice in various Urdhwa jatrugata roga. Nasya therapy if carried out effectively, kapha related toxins from the para nasal sinuses are eliminated and the region nourished. Due to this the Patient feels great relief in the head and clarity of the sense organs. Breathing becomes completely unobstructed which gives sound sleep at night, olfactory improvement is also felt. Nasya is excellent for purana pratishaya and pinasa, sirashoola, urdhwajatruvikara, netravikara, apasmara and vishwachi.[5,6] According to Acharya Vagbhata the procedure of instilling medicine through the nasal orifice is called Nasya karma. The nasal orifices are believed to be entrance of the head. The medicine instilled through them easily penetrates the sringataka and spreads to the siraa (arterioles of head), eyes, ears (shrotra), throat, kantha and expels out the impurities. Acharya Charaka explains about the time and its benefits in dinacharya. Time of year one should undergo the Nasya karma with Anu tailam is in Praavrit, Sharad and Vasant ritu when the sky is free of clouds.
Anti-inflammatory, analgesic and disease modifying anti-rheumatic drugs are the drugs of choice for management of cervical spondylosis in contemporary system of medicine. Unfortunately, all the analgesics are liable to many side effects particularly by repeated and prolonged usage. The Ayurveda approach to the disease management of cervical spondylosis is to retard the degeneration or to strengthen the dhathu and pacifying the vata dosha. Nasya is described as having a significant role among Shodhana therapy as it does the important action shirah shodhana i.e clearing the channels of head by clearing the dosha samghata deep rooted in the channels of indriya situated.
Mode of action of Nasya karma
In Ayurveda classics the mode of action of Nasya karma is explained indirectly. According to Charaka Samhita, the drug administered through the nose -the doorway to shira, enters in the Uttamanga and eliminates the morbid doshas residing there. According to Vrudda Vagbhata drug administered through nose -the doorway to shira reaches the Shringataka marma of Head (Shira), which is a sira marma and formed by the siras of nose, eyes, kantha and shrotra:
The drug spreads by the same route attracts the morbid Doshas (Vata & kapha) of Urdhwa jatru and expels them from the Uttamanga. In this context Sushruta has clarified that Shringataka marma is a Sira marma formed by the union of Siras (blood vessels) supplying to nose, ear, eye and tongue. This can be given as an example of mechanisms described in Ayurveda to overcome the blood-brain barrier for the drug to reach its desired destination.
Thus, we can say that drug administered through nasya may enter the above sira and purifies them. Under the complications of nasya karma, Sushruta has mentioned that excessive eliminative errhine may cause mastulunga srava (flow of cerebrospinal fluid out to the nose). Which suggest the direct relation of nasal pathway to brain. All ancient Acharyas have considered Nasa as the gate way of Shira. It does not mean that any channel directly connects brain and nose, but it may be suggestive of any connection through blood vessels, lymphatics and nerve.
Probable mode of action of Nasya drug given through nasal route:
Gets in circulation through nasal venous blood.
Get pooled in facial vein and ophthalmic vein communicates with (especially in head lowered position due to gravity) cavernous sinus
Active principle of drug get absorbed and controls neurological and circulatory functions showing systemic effect
Due to changes in the life style and inappropriate habits at place of work there is significant increase in the incidence of cervical spondylosis. This condition is treated symptomatically by using of analgesics, anti-inflammatory and disease modifying anti-rheumatic drugs. These have the tendency of producing undesirable side effects. In contrast to this we have found that efficient treatment modality in the form of Nasya karma in Ayurveda. This prompted us to gather and analysis information related to the conditions and Nasya karma. The information obtained was analyzed and an attempt was made to explain different aspects. The information related to the pathogenesis was explained on the basis of vata dosha concept. This was followed by explaining the role of Nasya as shodhana therapy in this condition and probable mode of its action.
Based on the information gathered it can be concluded that with the above given hypothesis we can assume that Nasya karma can give significant relief in cervical spondylosis and is the apt measure to overcome the blood brain barrier.