HTML Full Text

Introduction

Nowadays many modern drugs have better systemic bioavailability through nasal route as compared to oral or systemic administration. Many researches show that there is better absorption of drug in CSF through nasal route than any other route.1 Orally administered drugs significantly degraded in the gastrointestinal tract or considerably metabolized by first pass effect in the liver.2 Intranasal drug delivery offers a promising alternative route for administration of such drugs. Nasal drug delivery system is also suitable for restricting and obstacles blood brain barrier so that drug can be delivered in the biophase of CNS. Intranasal route for therapeutic purposes arises from the anatomical, physiological and histological characteristics of the nasal cavity, which provides rapid systemic drug absorption and quick onset of action.

              Intranasal therapy has been an accepted form of treatment in the Ayurvedic system of Indian medicine, in Ayurveda special procedure called Nasya has been mentioned. The Acharyas have also said “Nasa Hi Shiraso Dvaram”.3 Because nose is indirectly connected with the brain centers in the head. This indicates there is a very close relationship between the nose and Brain. Acharya Charaka 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). The Munja structure can be thought for an olfactory bulb and the Ishika for the numerous neurons join together to form the olfactory tract.4  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.5 Acharya Charaka says the Sneha Pradhana Navana drug (lipid processed herbal drug), gets absorbed in the Shringataka region. That means lipid soluble drugs are much more efficiently absorbed by nasal mucosa. Nasya Karma is used both to manage the local and general disorders. The aim of this study was to explore the mode of action of Brahmi Ghrita Nasya and to prove the effect of Nasya of Brahmi Ghrita on memory enhancing in healthy volunteers

Aims & Objectives

1.To evaluate the efficacy of nasal (Nasya) and oral administration of Brahmi Ghrita as memory enhancer and cognitive enhancer in healthy volunteers.

2.To compare the effects of Brahmi Ghrita when administrated nasally (Nasya) and orally.

Materials and methods: Total 101 healthy volunteers were registered and randomly divided into 3 groups. In Group A (Brahmi Ghrita Nasya) 33 healthy volunteers were completed the treatment. In Group B (Brahmi Ghrita Snehapana) 34 healthy volunteers were completed the treatment and In Group C (cow ghee Nasya) 33 healthy volunteers were completed the treatment and 1 healthy volunteers left before completion of treatment. The dose of Nasya was 16 Bindu (8 ml) in each nostril once in the morning for a period of 7 days. Three sittings of nasya were carried out in each patient with an interval of 7 days (total duration 35 days) same dose and duration was use for Snehapana. Observation regarding the demographic data of the healthy volunteers and assessment was done by PGI memory Scale6 after Nasya & Snehapana.

Criteria for Selection of the Volunteers

• Healthy Volunteers between age group of 20 years to 60 years were selected.

Exclusion Criteria:

• Healthy Volunteer having age less than 20 years & above 60 years.

• Classical Nasya Karma Ayogya and Abhyantar Snehapana Ayogya volunteers. Diabetes, any cardiovascular diseases, renal diseases or any other disease effecting multiple body systems and pregnant women.

CLINICAL OBSERVATIONS AND RESULTS

Among observations it was found that, maximum healthy volunteers i.e. 54.45 % were from the age group 20-30, 70.29 % healthy volunteers belonged to middle class, 63.73 % healthy volunteers were observed as vegetarian and 36.63% healthy volunteers were taking both veg. and non-veg. food. The dominance of Rasa in the diet of the healthy volunteers was sweet i.e. 95.04 %. 67.32% healthy volunteer’s diet timing was regular. 90.09% healthy volunteers were having Sitting nature of work. 18.81% healthy volunteers were having most of the standing work. 89.11 % were taking sound sleep. Maximum numbers of healthy volunteers of this study i.e. 66.33 % were of Madhyam Koshtha. 46.53 % healthy volunteers were of Kapha-Vata Prakriti, 70.29 % healthy volunteers were of Rajas tama Prakriti, 69.3% of healthy volunteers were having Samagni and 86.14 % healthy volunteers were having Madhyama Vyayam Shakti (table 1-34).

Observation of Samyak Lakshans of Nasya karma

In Group A maximum 87.88% healthy volunteers in 1st sitting treated with Brahmi Ghrita Nasya experienced Urolaghuta (Feeling of lightness in chest) on second and third day however in Group C maximum 100 % healthy volunteers in 1st sitting treated with Cow ghee Nasya experienced Urolaghuta on first and second day. In Group A maximum 81.81 % healthy volunteers in 1st sitting treated with Brahmi Ghrita Nasya experienced Shirolaghuta (Feeling of lightness in head) on second and third day however In Group C maximum 96.96 % healthy volunteers in 1st sitting treated with Cow ghee Nasya experienced Shirolaghuta on second and third day. In Group A maximum 69.39 % healthy volunteers in 1st sitting treated with Brahmi Ghrita Nasya experienced Netralaghuta (Feeling of lightness in eyes) on second and third day however in Group C maximum 84.84 % healthy volunteers in 1st sitting treated with Cow ghee Nasya experienced Netralaghuta on second day. Srotovishuddhi (cleansing of channels) symptoms appear more frequently in all sittings  of Brahmi Ghrita Nasya than Cow ghee Nasya group. Svaravishuddhi (sweetness of vice) was found more on  4th, 5th  and 6th day of Nasya in third sitting (Table 39). Sweetness in vice was experience more by Cow ghee Nasya group but symptoms lasted longer in Brahmi Ghrita Nasya group. Vaktravishuddhi (cleansing of mouth) symptom was also found more frequently in Brahmi Ghrita Nasya than Cow ghee Nasya group (Netratejavriddhi (improvement in eyesight) was observed mostly on 6th and 7th day of Nasya in both group. Indriyaprasad (sensorial happiness) and Chittaprasada (mind happiness) symptom was more oftenly seen. In both groups maximum volunteers experience Chittaprasada 5th, 6th and 7th day of Nasya Vikaropshama (Improvement in disease condition/better feeling) was mostly found on 6ih and 7th days Nasya Svapnaprabodhana (good sleep and awakening) was experience by 100 % healthy volunteers in 1st sitting treated with Brahmi Ghrita on sixth and seventh day in 2nd sitting on fifth, sixth and seventh day and in 3rd sitting on fourth, fifth, sixth and seventh day. In Group C 100 % healthy volunteers in 1st sitting treated with Cow ghee Nasya experienced Svapnaprabodhana on sixth and seventh day, In 2nd sitting on fifth, sixth and seventh day and in 3rd sitting on sixth day. In Group A maximum 9.09 % healthy volunteers in 1st sitting treated with Brahmi Ghrita Nasya observed Atiyoga lakashana on fourth day and 6.06 % on sixth day.  3.03% healthy volunteers in 2nd sitting observed Atiyoga lakashana on first, third and fourth day and 9.09% on seventh day. 3.03 % healthy volunteers in 3rd sitting observed Atiyoga lakashana on sixth day. In Group C 3.03% healthy volunteers in 1st sitting and in 3rd sitting treated with Cow ghee Nasya observed Atiyoga lakashana on sixth day and in 2nd sitting 6.06% on 7th day.

tables

tables

tables

Effect of the therapy on Remote memory was found almost negligible however 14.14 % improvement was found in remote memory in group A, in Recent memory no change was found in treatment groups because all the volunteers got the full score before and after treatment. So, there was no chance at all for improvement. While assessing 16.93 % improvement was found in mental balance in group A, 9.67 % in group B and 17.25 % in group C. Maximum 28.28 % improvement was found in attention and concentration in group A, 21.26 % in group B and 17.57 % in group C. Statistically highly significant results P<0.001 were found in attention and concentration in all treatment groups. Statistically highly significant results P<0.001 were found in delayed recall in all treatment groups and 28.88 % improvement was found in delayed recall in group A, 15.43 % in group B and 12.83 % in group C. Maximum 35.53 % improvement was found in immediate recall in group A, 26.10 % in group B and 17.88 % in group C. Statistically highly significant results (P<0.001) were found in immediate recall in all treatment groups. 44.86 % improvement was found in  retention for dissimilar pairs group A, 23.63 % in group B and 33.33 % in group C. Statistically highly  significant results (P<0.001) were found in retention for dissimilar pairs in all treatment groups. . 24.4 % improvement was found in  visual retention pairs group A, 13.42% in group B and 14.39 % in group C. Statistically highly  significant results (P<0.001) were found in retention for visual retention  in all treatment groups. 15.9 % improvement was found in  visual retention pairs group A, 6.33 % in group B and 9.27  % in group C. Statistically highly significant results (P<0.001) were found in visual retention  in all treatment groups. Maximum 22.78 % improvement was found in total score of PGI memory scale group A, 14.70% in group B and 14.37 % in group C. Statistically highly significant results (P<0.001) were found in total score of PGI memory scale in all treatment groups.

In the PGI memory scale, on comparing all treatment groups statistically significant improvement was found in parameters like Attention and Concentration (p<0.05), Delayed recall (p<0.001), Immediate recall (p<0.01), Retention for Dissimilar pairs (p<0.05) and Visual retention (p<0.05). In Brahmi Ghrita Nasya when compared to Cow ghee Nasya, confirmed added and superior effect of Brahmi on these parameters. 

In some parameters like Delayed recall (p<0.05), Visual retention(p<0.01) and recognition(<0.05), significantly higher results were obtained, in Brahmi Ghrita Nasya as compared to Brahmi Ghrita Snehapana, proves the superiority of Nasyakarma over Snehapana in memory enhancing.

Overall effect of therapy on the basis of PGI Memory Scale

In group A (Brahmi Ghrita Nasya group) maximum i.e. 60.61% volunteers reported the mild improvement followed by 33.33% which found to be improved & 0.06% volunteers remained unchanged. In group B (Brahmi Ghrita Snehapana group) Maximum i.e. 70.59 % volunteers reported the mild improvement and 5.88 % which found to be improved. However, 23.52% volunteers remained unchanged. In group C (Cow ghee Nasya group) Maximum i.e. 75.76 % volunteers reported the mild improvement and 6.06 % which found to be improved. However, 18.18 % volunteers remained unchanged.

Discussion

Discussion part of the research a fruitful discussion has been done to give the possible reasoning based on the specific logic to explain and interpret the findings of the study to correlate the same with their causes. This section also has described in details the mode of action of Nasya karma and Brahmi Ghrita.

The results shown by Brahmi Ghrita was also discussed.  Brahmi has Tikta, Kashaya Rasa, with Laghu, Snigdha, Sara Guna, Sheeta Veerya, Madhura Vipaka and brain tonic effect by counteracting vitiated Vata and Kapha. Cow ghee has Madhura Rasa with Guru, Snigdha Guna, Sheeta Veerya, Madhura Vipaka and brain tonic and rejuvenative effect by pacifying all three vitiated Dosha. Tikta rasa has dominance of Aakasha and Vayu mahabhoota. This combination of Mahabhoota helps in highly penetrating capacity of drug molecules to reach the minute channels supplying nutrition to the Manovaha Srotas.17 Ghee has Samskaranuvartanum property the formulation of Brahmi Ghrita sheeta veerya drugs. Drugs having Sheeta Veerya nourish the neuronal matter of brain via Tarpaka & Avalambaka Kapha and improve Dharana. Brahmi works on chelation of metal ions, scavenging of free radicals, and enhanced antioxidative defense enzymes. Bacopa monnieri extract may be able to increase memory formation by the enzyme Tryptophan Hydroxylase (TPH2) and increasing the expression of the serotonin transporter (SERT). Brahmi possesses anti cholinesterase, antioxidant, antidepressant, neuro protective properties and it has memory enhancing activity and improves cognitive function.18

Acharya Charaka described that Nasa is the only gate way to Shirah. The medicine administrated through Nasya can easily spread to Shirah and get absorbed. The drug administrated through nostrils reaches Sringataka, a Sirahmarma by Nasa Srota and spreads in the Murdha (Brain), taking routes of Netra (eyes), Shrotra (ears), Kantha (throat) Sira Mukhas and scratches the morbid Doshas in Urdwajatru and extract them from Uttamanga(upper part of body). Modern science also accepts advantages of nasal drug delivery system in which through nasal route drug degradation is absent. Hepatic first – pass metabolism is absent. It has rapid drug absorption, quick onset of action. Better nasal bioavailability for smaller drug molecules. Drugs which cannot be absorbed orally may be delivered to the systemic circulation through nasal drug delivery system and nasal drug route is the convenient route when compared with parenteral route for long term therapy.

Conclusion

The Ayurvedic philosophy of Medha, Smriti, Mana and Buddhi played a important role in the processes of cognition and memory. The process of recollection takes place properly after the Buddhi, Medha and Smriti unites. In Cow ghee Nasya, the Samyaka Lakshanas were seen earlier than Brahmi Ghrita Nasya, but in Brahmi Ghrita Nasya the symptoms lasted longer than the Cow ghee Nasya and with the increase of sittings, the Samyaka Lakshanas improved durability.In the PGI memory scale, statistically significant improvement was found in parameters like Attention and Concentration, Delayed recall, immediate Recall, Retention for Dissimilar pairs and Visual retention. In Brahmi Ghrita Nasya when compared to Cow ghee Nasya, confirmed added and superior effect of Brahmi on these parameters. In some parameters like Delayed recall, Visual retention and Recognition, significantly higher results in Brahmi Ghrita Nasya as compared to Brahmi Ghrita Snehapana, proves the superiority of Nasyakarma over Snehapana in memory enhancing. Brahmi Ghrita Nasya, Brahmi Ghrita Snehapana and Cow ghee Nasya are all effective in memory enhancement and cognitive enhancement in the healthy volunteers. Comparatively, Brahmi Ghrita Nasya is more effective in memory enhancement and cognitive enhancement as compared to other therapies under trial.