In Ayurveda, traditional Indian medicine, not only treatment but also prevention and daily regimen are explained in detail and emphasized. In classical medical texts, daily regimen is called Dinacary? and its effects are listed [1]. It is still practiced today, mainly in countries such as India and Sri Lanka where Ayurveda is widespread among the people. Among them, Oil Nasal Drops (so-called Nasya) is easy to do and is widely used as a disease prevention method. In fact, even during the COVID-19 pandemic, Nasya was recommended by the Ministry of AYUSH, as one way to boost immunity [2,3]. India government has a Ministry in charge of traditional medicine, that is described as the Ministry of AYUSH, an acronym for Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy. It has information departments in over 40 countries around the world, and an AYUSH Information Cell (AIC) was established in Japan in 2023.

In this study, we compared various indicators before and after one month of Nasya practice in healthy volunteers to verify the effectiveness of the Oil Nasal Drops (Nasya), which is easy to do on a daily basis among Dinacary. We have traditionally conducted a variety of clinical trials and research in the fields of integrative medicine and Ayurveda [4,5]. In the current study, we report the effects and efficacy of the method and discuss the possible effects of self-Nasya.

Dinacary is described in detail in the Caraka Samhit and Astñga Hrdayam [6], which are classical medical texts in Ayurveda. The list includes waking up early, brushing teeth and tongue, applying eye ointment, dropping oil into the nasal cavity, gargling with oil, oil massage (especially on the head, ears, and feet), exercise, bathing, cleaning the body, perfume, wearing jewelry, using a parasol, cutting hair, shaving, and cutting nails. These are all lifestyle habits that are easy to incorporate into modern daily life, which is why many people still practice them. There have been reports in the past that using sesame oil and Anu taila is also effective for respiratory diseases [7]. Among these, we have focused on and examined the daily practice of Oil Nasal Drops, called Pratimara nasya (Hereafter abbreviated as PN).

Twelve healthy volunteers were recruited, and after explaining the details of the test, consent was obtained. The average age was 48.3 years old, and all 12 were female.

The method was to inject two drops of sesame oil into the nose every morning, then inhale lightly and exhale. They continued this for one month, and a comparison was made of each item before and after one month of PN.

The following four items were examined:

1) Questionnaire on ordinary symptoms

2) Nasopharyngeal findings by nasopharyngeal fiber optic examination

3) Autonomic nerve function test

4) Organ evaluation test by measuring weak electrical resistance

Details of each item are described below.

1) Questionnaire On Subjective Symptoms

A questionnaire was conducted on the following 12 items that are easily noticed on a daily basis and are mainly related to the head and neck: stiff neck and shoulders, eye fatigue, discomfort in the throat, nose, ears, headache, snoring, teeth grinding, swollen gums, hot flashes of the face, difficulty falling asleep, and mental stress. Participants were asked to rate each of these 12 items on a 5-point scale, with 1: none, 2: feel a little, 3: feel it sometimes on a daily basis, 4: feel it relatively strongly, and 5: feel it strongly on a daily basis.

2) Nasopharyngeal Findings by Nasopharyngeal Fiber Optic Examination

The author (an otolaryngologist) performed a nasopharyngeal fiber optic examination to confirm the nasopharyngeal findings. The examination was performed twice, before and one month after PN. In addition, the nasopharyngitis was graded into four stages based on the fiber optic findings. The grade classification was conducted by Tanaka et al. and is shown below [8,9] (Figure. 1).

Grade 1: normal

Grade 2: chronic epipharyngitis (mild)

Grade 3: chronic epipharyngitis (moderate/mucosal swelling)

Grade 3: chronic epipharyngitis (moderate/nasal discharge)

Grade 4: chronic epipharyngitis (severe)

Figure 1: Nasopharyngeal grading based on fiberscopic findings.

3) Autonomic Nerve Function Test

For the measurement of autonomic nerve function, we used TAS 9 view (Paras Analyzer Plus View TAS 9 VIEW, Tokyo, Japan) (Figure 2). This device captures changes in peripheral blood vessel volume as pulse waves (PPG) and converts them into accelerated plethysmograms (APG) to perform peripheral blood circulation analysis (degree of vascular aging), and also extracts pulse rates with high accuracy from the peak intervals between pulse wave heights and analyzes the changes to perform autonomic nerve analysis (heart rate variability, HRV). The subjects were measured using this device before and one month after the start of PN. Considering the location of the autonomic nerve measurement and its diurnal variation, all measurements were performed in the morning at the clinic. Autonomic nervous function is quantified from +100 to -100, with the larger the positive value, the more the sympathetic nervous system dominates, and the larger the negative value, the more the parasympathetic nervous system dominates. Basically, the closer the value is to 0, the better the autonomic nervous system balance is.

Figure 2: Medical opparatus of TAS 9 view This device allows evaluation of autonomic nervous function.

4) Organ evaluation test by measuring weak electrical resistance

For the purpose of the evaluation of each organ condition, we used the QRM health analyzer. Weak electrical signals and electrical resistance from the human body are collected by a grip-type sensor, the values are amplified by the main unit, and after computer processing, they are compared with the standard values in the device based on health and nutritional guidance, and the corresponding values are displayed on the monitor. Among these, three were used: adrenal function, internal oxidation level, and airway immunity index. In this test, the condition of each item is quantified from 1 to 4, with the lower the number, the better the condition.

1) Questionnaire on Subjective Symptoms

The results of the questionnaire on subjective symptoms of the 12 subjects are shown (Figure 3). The numbers on the vertical axis indicate the average value for each questionnaire item.

Subjective symptom scores decreased for all items. In particular, more than 6 out of 12 subjects (50%) answered that they had improved in seven items: stiff neck and shoulders, eye fatigue, nasal discomfort, headache, teeth grinding, difficulty falling asleep, and mental stress. Among these, the improvement in subjective symptom scores was most notable for stiff neck and shoulders, eye fatigue, nasal discomfort, difficulty falling asleep, and mental stress.

Figure 3: Changes in symptoms by Pre- and Post 1M- PN.

Subjective symptom scores decreased for all items. In particular, more than 6 out of 12 subjects (50%) answered that they had improved in seven items: stiff neck and shoulders, eye fatigue, nasal discomfort, headache, teeth grinding, difficulty falling asleep, and mental stress. Among these, the improvement in subjective symptom scores was most notable for stiff neck and shoulders, eye fatigue, nasal discomfort, difficulty falling asleep, and mental stress.

2) Nasopharyngeal Findings by Nasopharyngeal Fiber Optic Examination

The change in nasopharyngeal grade classification before and after the verification is shown (Figure 4).
At the start of the verification, only one of the 12 cases had no grade 1 findings, and the remaining 11 cases had findings of nasopharyngitis on endoscopic findings. Of the 12 cases, five (41.6%) showed no change, six (50%) showed improvement, and one case showed worsening.

Figure 4: The change in nasopharyngeal grade classification Pre- and Post 1M- PN.

3) Autonomic Nerve Function Test

The results of the autonomic nervous function test before and after the verification are shown (Figure 5).
One case was excluded due to a large fluctuation range, and 11 cases were examined. Four of the 11 cases (36.4%) showed changes that normalized autonomic nervous function, and the other four showed no change. The remaining three cases (27.3%) showed changes that favored the sympathetic nervous system. Measurements were performed at the same place and time, but the effects of these must be taken into consideration, especially in autonomic nervous function tests.

Figure 5: The change of autonomic nervous function test Pre- and Post 1M- PN

4) Organ Evaluation Test by Measuring Weak Electrical Resistance

 The results of this test before and after verification are shown (Figure 6).

The average values for 12 cases are shown, and in particular, the average value for adrenal function showed a tendency to improve after verification, with improvement in 11 of 12 cases (91.7%).

Figure 6: The change of Organ evaluation test Pre- and Post 1M- PN.

Ayurveda has been prevalent and evaluated across the world for years [10]. In India, Bachelor of Ayurveda, Medicine and Surgery (BAMS) are found more than 30,000 [11]. The authors have been involved in integrative medicine (IM) and the Ayurveda Society in Japan (ASJ) for many years [4,12]. In this report, autonomic nervous function could be quantified for clinical practice, and then it would be useful for judging the effectiveness of treatment for each patient. The questionnaire covered symptoms commonly encountered in daily life. Among them, many items related to the head and neck were selected, because people are prone to feeling unwell in this region. These items broadly cover age, gender, season, time of day, and so on, and are likely to be useful in assessing various physical conditions.

When observing the nasopharynx by fiberscope examination, many patients are found to have chronic inflammation even if they do not have any particular symptoms. Chronic inflammation is the cause of various diseases and has been proven to be harmful to anti-aging. In particular, the diagnosis and treatment of nasopharyngitis has recently attracted more attention than previous management of otitis media, sinusitis, and tonsillitis. Using non-invasive nasopharyngeal fiberoptic examination, evaluation of chronic inflammation will become more important in the future.

The autonomic nervous system may become the cause of various disorders, and visualization of autonomic nervous function has progressed using various devices [13]. In this study, the use of TAS9 has made it possible to quantify function, which is considered to be an advantage. A detailed examination of subjective symptoms showed that many patients had improvements in difficulty falling asleep and mental stress, suggesting that oil nasal drops have a regulating effect on autonomic nervous function.

Among the items with improvement by daily oil nasal drops, difficulty falling asleep and mental stress were noted. This may be related to the improvement of the nasal and nasopharynx environments. First, improving the nasal environment improves nasal breathing during sleep. Second, the nasopharynx is controlled by the autonomic nervous system. Then, improved balance of autonomic nervous function may have contributed to the improvement of falling asleep and mental stress [14].

According to classical Ayurvedic texts, the nose is described and emphasized as the entrance to the head. Since there are many cases where nasal discomfort has improved, it is highly likely that it triggered the improvement of other symptoms. Many patients visit otolaryngologists with discomfort in the nose and throat. However, there are lots of cases where several tests show no abnormality and it is not possible to determine how to deal with it. When patients visit the clinic with the main complaint of difficulty falling asleep or mental stress, they are often prescribed sleeping pills or anti-anxiety drugs [15]. This current clinical study will lead to the improvement of problems that have no solution and a reduction in the use of sleeping pills and anti-anxiety drugs.

For recent topics, chronic nasopharyngeal inflammation may be involved in the development of palmoplantar pustulosis and IgA nephropathy, and then diagnosis and treatment of chronic nasopharyngeal inflammation would be more important. The effectiveness of nasal oil drops has been suggested. Furthermore, epipharyngeal abrasive therapy (EAT) has also been proposed for the treatment of COVID-19 related problems [16]. Nasal oil drops may contribute to these responses.

As a result of weak electrical resistance measurements, improved tendency of adrenal function was found in 11 of 12 cases. We will investigate the possible correlation between the adrenal function and improved symptoms. In addition, chronic fatigue syndrome (CFS) may be involved in lower adrenal function [17], and then daily oil nasal sprays will be expected for providing clinical effects in the future.

Some limitation may be present in this report. In order to reduce the influence of environmental factors, all cases were tested in the same place within the clinic and at the same time. However, in order to evaluate only factor of regular oil nasal spray, no restrictions were placed on other lifestyle habits. In the future, it will be required to continue to evaluate daily autonomic nervous function and consider changes in autonomic nervous function due to long-term oil nasal spray [18].

In summary, current study showed clinical study of Oil Nasal Drops (Nasya) providing healthy volunteers. It included questionnaire, fiberscope examination, autonomic nerve function, and organ evaluation by measuring weak electrical resistance. The results showed the improvements of symptoms, mucous findings and adrenal function. This report will be hopefully useful reference for Ayuveda and IM in the future.

Conflict of interest: The authors declare no conflict of interest.

Funding: There was no funding received for this paper.

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