INTRODUCTION:

In this present era due to the ambitious nature as well as luxurious life of man, it has made man busy all time which leads to disease aggravating cause root factors like stress, strain and mental disturbances. And it’s a real fact that a healthy mind is the main cause for a healthy body. And such factors leads to different types of diseases, among which shiro roga is one of them. All types of shiro shoola have been described under the heading of â€˜Shiroroga’, which are further divided into eleven types according to Sushruta . Ardhavabhedaka one of the important typ e of Shiroroga.

Panchakarma includes five main karma among which Nasya is one of them. Nasya is classified into five types,i.e, Navana, Avapida, Dhmapana, Dhooma and Pratimarsha. According to acharya Charaka, Nasya is specially indicated in Ardhavabhedak according to acharya   Charak.   Currently,    conventional    medicine     has    no    effective    treatment for Ardhavabhedaka. But in Ayurveda, Nasya is specially indicated in Ardhavabhedaka.

Jala neti is one among the shatkarma which helps in eliminating the morbit kapha dosha from the sinuses . Jala neti is a yogic technique to clean your sinuses and is indicated in shiro roga.

Need of study:

Migraine was identified to be more common in the rural population, with its prevalence ranging between 1.37% and 72%.According to International headache society, migraine have influence on 16% of the primary headache. In today’s era, 10-20% of general populationsuffer from migraine. It is three times more common in women than men (3:1) in India more than 10 million cases per year.

Conventional treatment modalities includes Analgesics and Vasodilators.Classical Ayurvedic texts have described various yogas of Nasya and also jala neti in the management of Ardhavabhedaka, in which Jala neti is much cheaper than nasya karma. Now a days jala neti is not being clinically practiced regularly .So here is an attempt to compare the efficacy of Brihat Dashamoola taila nasya (Group A) and Jala Neti(Group B) in the management of Ardhavabhedaka.

REVIEW OF LITERATURE:

 Classical Ayurvedic literature, contemporary texts, journals and website about the disease , drug and procedure will be reviewed documented for the intended study.

RESEARCH QUESTION:

1.      Whether Nasya karma with brihatdasmoola taila 2 bindu in each nostrils for 7days ismore effective than jala-neti karma with lavanodaka for 7 days in management of Ardhavbhedakaa?

 AIM AND OBJJECTIVES:

 AIM:

“ A RANDOMIZED COMPARATIVE CLINICAL TRIAL TO EVALUATE THE EFFICACY OF NASYA KARMA WITH BRIHATDASHMOOLA TAILA AND YOGIC NETIKARMA IN THE MANAGEMENT OF ARDHAVBHEDAKA”

OBJECTIVES:

1.      To determine the effect of Nasya karma with Brihatdashmoola taila in themanagement of Ardhavbhedaka.

2.       To determine the effects of jala neti in the management of Ardhavbhedaka

3.      To determine the comparative effect of nasya karma with Brihatdashmoola tailand jala neti in the management of Ardhavbhedaka.

 Null Hypothesis (H₀):

(H0) â€“ Neither Nasya karma with Brihatdashmoola Taila nor Jal-neti effective in management of Ardhavbhedaka.

Alternate Hypothesis:

(H₁) â€“ Nasya Karma with Brihatdashmoola tail is more effective than Jal-neti in the management of Ardhavbhedaka.

(H₂) – Jala neti is more effective than Nasya karma with Brihatdashmoola tail in the management of Ardhavbhedaka.

(H₃) – Both Nasya karma with Brihatdashmoola tail and Jal-neti are equally effective in the management of Ardhavbhedaka

MATERIALS & METHODS:

 1 .Source of data:

 i.        Literary source: All the available literature regarding, Arthavabhedaka, Brihatdhamula, Nasya and Jala Neti in classical treatises and contemporary texts including journals and online sources will be reviewed and documented for the study.

ii.       Pharmaceutical source:

 a.       Medicine will be prepared in the GMP certified Teaching Pharmacy ofParul Institute of Ayurved.

DRUG SOURCE

1.      Raw drugs required for preparation of Brihatdashmoola taila will be procured from standard suppliers and identification and authentication of it will be done in   Dravyaguna Department Parul Institute of Ayurveda.

Brihatdashmoola taila ( for Pratimarsh Nasya) will be prepared in GMP Certified pharmacy of  Parul Institute of Ayurveda following classical guidelines as mentionedin Bhaishjya ratnavali.

 Drugs:

1.     Bilva

2.     Shyonaka

3.     Agnimantha

4.     Gambhari

5.     Patla

6.     Shalparni

7.     Prushniparni

8.     Brihati

9.     Kantakari

10.  Gokshura

11.  Nirgundi swarasa

12.  Adarak swarasa

13.  Taila

14.  Saindhava

15.  Pippali

16.  Chavya

17.  Chitraka

18.  Sunthi

19.  Maricha

20.  Sveta jirak

21.  Krishna jirak

22.  Sarsapa

23.  Nisotha

24.  Haridra

25.  Daruharidra

26.  Yavakshara

Method of collection of data:

A. Sample size:

A minimum of 40 patients diagnosed with Ardhavbhedaka fulfilling the diagnostic and inclusion criteria irrespective of gender, caste will be randomly selected and grouped into two i.e. Group A and Group B for the study.

Group A : Nasya with Bhrihatdashmool taila will be administered on 20 patients for 7 days.

Group B: Jala neti karma will be observed on 20 patients for 7 days.

 B. Study design:

It is a Randomized Comparative Clinical trial study.

C. Duration of treatment: 7days

D. Follow up:

 

Follow up will be after 1st, 7th and 14thday.

E. Selection criteria:

• INCLUSION CRITERIA

• The diagnosis was made based on the criteria of Ardhavabhedaka

• Patients between the age group of 16- 60yrs of age.

• Patients who are fit for “Nasya karma”.

• Patients who are fit for ‘Jal neti’.

ʉۢ EXCLUSION CRITERIA

• Patient of Ardhavabhedaka who are under other treatment modalities.

• Patient who are contraindicated for Nasya.

 

• Patients who are contraindicated for Jala Neti.

• Patients suffering from other secondary types of headache like in brain tumors, meningitis, cervical-spondylitis, encephalitis, referred pain, refractive errors and glaucoma.

 Diagnostic Criteria for Ardhavabhedaka

Subjective parameters

1.     ARDHA SHIRASHOOLA

2.     MANYASHOOLA

3.     BHRAMA

4.     HRILLAS

5.     CHHARDI

6.     PRAKASHASHAHISNUTA

7.     SABDAASHAHISNUTA

PLAN OF TREATMENT:

 GROUP A-

SOP OF NASYA WITH BHRITDASMOOL TAILA

1. Introduction:

 It is a procedure followed in majority of nasaroga, karna roga, netra roga and shiroroga (innirama avastha) etc. in which the liquid medicine is instilled in the nostrils..

2. Requirement:

 a)  Manpower- Trained Senior Resident /Junior Resident Doctor,One Class D worker.

b)   Materials-

 â€¢  Sterile bowls, sterile dropper Oil for facial massage Liquid/oil/powdered medicine.

•  Preparation of the table.

3. Pre- operative:

•  Patient made to lie in supine position comfortably with a small pillow under the neck andshoulder maintaining the head low position.

•  Massaging of face, neck and forehead with necessary Oil Hot Fomentation with steam should be done after massage.

4.   Operative:

 The specific medicines is instilled inside the nostrils with the help of dropper.Massaging of face, neck, palm and soles.

The patient is advised to remain in supine position for 100 matrakala (approx. 2.5 min) andspit-out the medicine.

5.   Post-operative:

Gargling with lukewarm water. Inhaling the smoke of dried turmeric.

 6.   Safety precautions:

 Sterilisation of the materials.

 Light food after evacuation of urine and bowel before procedure.

 â€¢  Avoidance of exposure to breeze, direct sunrays, smoke and dust. Not to Wash Face with Cold Water immediately after the Procedure.Emergency management

•  These are very rare in this procedure. Still if happens patient has to inform the trained senior Resident doctor/junior Resident doctor who is on duty at that particular time. Senior Residentdoctor/junior Resident doctor should inform the Consultant in charge and get the suitable management. 

GROUP B

 SOP OF JALA NETI:-

             1.Neti is a technique to cleanse the nasal passages. It is a cleansing process related to theupper part of the respiratory system.

2.Although authentic references are not available for jala neti, it is most widely practiced.3.It is usually practiced with a neti pot filled with lukewarm saline water. The exact amount of salt is not mentioned in any traditional texts.

3.  Practically it is about 2.5 gfor 500 L of water. Based on clinical studies use of proper salt concentration (2e3.5%) has been recommended in nasal irrigation .

4.    Some authors mention about the use of ksheera (milk) and madhu (honey) instead oflukewarm water. It is ideally practiced in morning before asanas and pranayama.

5. This is named Neti by the Siddhas.

 

 

PROPHYLACTIC MANAGEMENT

 1.    After jala neti KAPAL BHATI should be done .

2.  Now a days 4 size rubber catheter is sterilized and used. Those suffering from chronic nasal bleeding, ear infections and nasal septum deviation should perform under proper guidance

REFERENCES:

1   Charaka Samhita, Dr. Bhramananda tripathi, Vol.1, Chaukhamba Surbharti Prakashan,

 

2  Sushruta samhita, Kaviraj Ambikadattashastri, Chaukhamba Sanskrita Sansthan, Varanasi,Reprint-2015, Uttar tantra- 26/31-35

 

3  Cakradatta, P. V. Sharma, Published by Chaukhambha Orientalia, Edition-2007, Shiro- rogs,

 

4  Yogaratnakara with Vidyaprabha Hindi Commentary, By Indradev Tripathi and Dr. Daya Shankar Tripathi, Chaukhamba Krishnadas Academy, Varanasi, Shirorogasya upachara-69, Pg.No.-763

 

5  Gadanigraha of Sri Vaidya Sodhala, By Sri Indradeva Tripathi, Edited by Sri Ganga Sahaya Pandeya Chaukhambha Sanskrit Sansthana, Reprint-2005, Part-3 Shalakyatantre Shirorogadhikara-1/59.Pg.No.-22

 

6  Charaka Samhita By Agnivesa. Edited by Vaidya Jadavaji Trikamji Acharya, Chaukhambha Orientalia, Varanasi, Edition-2009.Sutra sthana-4/18.

          7   Hath yog pradipika à¥¨/३०

8  Bhaisajya Ratnavali Of Shri Govi nd Dasji; Commented Upon By Shri Kaviraja Ambikadatta Shastri ,Ayurvedacharya Vol-3 ,shiroroga, Page NO-326.