Clinical consensus statements on Marsha Nasya - A feasibility study towards developing clinical practice guidelines...

Modern pedagogical frameworks and recent advancements-such as quality accreditation and insurance coverage in Ayurveda-underscore the need for clear and practical guidelines for therapeutic procedures, particularly Panchakarma. The therapeutic procedures outlined in Ayurveda, notably Panchakarma, comprising five internal cleansing therapies (emesis, purgation, decoction enema, unctuous enema, and errhine therapy) currently lack published contemporary practice guidelines. Developing evidence-based, expert-endorsed clinical practice guidelines for these therapies would enhance their safety and effectiveness, ensuring their wider acceptance. Ayurveda classical texts describe Marsha Nasya (MN), a therapy in which medicines mainly having an oil base are instilled in the nose in a comparatively higher dose, as a Panchakarma treatment that targets a range of pathological conditions, particularly those affecting the head and neck area.

This study aimed to develop a comprehensive set of evidence-based, expert-endorsed Clinical Consensus Statements (CCSs) for MN therapy utilizing the RAND/UCLA Appropriateness Method (RAM).

Best Practice Statements (BPSs) were developed based on an extensive literature review, inputs from physicians, and a survey conducted across multiple healthcare facilities. Nine experts participated in rounds 1 and 2 of RAM. The panelists rated each of these statements, and the statements that were deemed appropriate statistically were included in the final set of recommendations. The study was prospectively registered in the Clinical Trial Registry of India (CTRI number: CTRI/2023/05/052422 dated May 09, 2023) and PREPARE (Practice Guideline Registration for Transparency), an international prospective register for clinical practice guidelines. (PREPARE-2024CN612).

A consensus was reached on 63 BPSs across six domains: the general domain, the preparatory procedures domain, the main therapeutic procedure domain, the post-therapy procedures domain, the dosage domain, and the quality assurance domain.

The detailed, expert - endorsed and evidence - based statements represent the important procedural aspects of MN and can be the basis for further clinical validation and practice of MN. The study may serve as a model for developing evidence-informed clinical practice guidelines for Panchakarma therapies and other therapeutic procedures in Ayurveda and can offer valuable guidance to clinicians, researchers, students, and policymakers.