Chittodwega ksheeradhara pk026_gdg

“EVALUATION OF THE EFFICACY OF KSHEERABALA TAILA

NASYA AND AMALAKI SIDDA KSHEERA DHARA IN

CHITTODVEGA W.S.R.T. GENERALIZED ANXIETY DISORDER”

BY

RAJESH A.R.

Dissertation Submitted to the Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka.

In partial f ment oulfil f the degree of

AAYYUURR TTII

PANCHAKARMA

Dr.P.SIVARAMUDU yu), M.A(san), M.A(psy)

.G. Dept. of Panchakarma

And co-guidance of

DR. SAM.D. (Ayu)

a

POST GRADUAT F PANCHAKARMA D.G M.AYURVEDIC MEDICA E AN RESEARCH CENTER

GADAG – 582103 2007-2010

VVEEDDAA VVAACCHHAASSPPAA IN

U th a nder e guid nce of

M.D(A

Proff & H.O.DP

NTOSH N. BELAVADI

Ast. Professor P.G. Dept. of Panchakarm

E DEP OARTMENTL COLLEG D

DECLARATION BY THE CANDITATE

I hereby declare that this dissertation / thesis entitled “Evaluation of the efficacy

of ksheerabala taila nasya and amalaki siddha ksheera dhara in chittodvega w.s.r.t.

Generalized anxiety disorder” is a bonafide and genuine research work carried out by

me under the guidance of Dr. P. Sivaramadu M.D. (Ayu) M.A (San) M.A (Psy), Professor & H.O.D

and the co-guidance of Dr. Santosh N. Belavadi M.D(Ayu), Ast. Professor, Post Graduate

Department of Panchakarma, Shri D.G.M.Ayurvedic Medical College, Gadag.

Date: Signature of the Candidate

Place: Gadag (Rajesh. A.R)

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “Evaluation of the efficacy of

ksheerabala taila nasya and amalaki siddha ksheera dhara in chittodvega w.s.r.t.

Generalized anxiety disorder” is a bonafide research work done by Rajesh A.R in

partial fulfillment of the requirement for the degree of Ayurveda Vachaspathi. M.D.

(Panchakarma).

Date: Signature of the Guide

Place: Gadag

Dr. P. Sivaramadu M.D. M.(Ayu) M.A (San) M.A (Psy), Professor & H.O.D

P.G. Dept of Panchakarma Shri.D.G.M. Ayurvedic Medical College,

Gadag.

CERTIFICATE BY THE CO-GUIDE

This is to certify that the dissertation entitled “Evaluation of the efficacy


Generalized anxiety disorder” is a bonafide research work done by Rajesh A.R in

partial fulfillment of the requirement for the degree of Ayurveda Vachaspathi. M.D.

(Panchakarma).

Date: Signature of the Co-Guide Place: Gadag

Dr. Santosh N. Belavadi D. (Ayu).

P.G. Dept of Panchakarma D.G.M Ayurvedic Medical College,

Gadag.

M.Ast. Professor

J.S.V.V. SAMSTHE’S

SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST

GRADUATE DEPARTMENT OF PANCHAKARMA

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF

THE INSTITUTION

This is to certify that the dissertation entitled “Evaluation of the efficacy


Generalized anxiety disorder” is a bonafide research work done by Rajesh A.R under

the guidance of Dr. P. Sivaramadu M.D. M.(Ayu) M.A (San) M.A (Psy), Professor & H.O.D and the

co-guidance of Dr. Santosh N. Belavadi M.D(Ayu), Ast. Professor, Post Graduate

Department of Panchakarma, Shri D.G.M.Ayurvedic Medical College, Gadag. and

contributed good values to the Ayurvedic research.

Dr. G. B. Patil Principal,

Shri. D.G.M. Ayurvedic Medical College,Gadag

Date: Place: Gadag

Dr. Sivaramadu. M.D. (Ayu), M.A (San), M.A (Psy) Prof. and H.O.D. P.G. Dept of Panchakarma Shri. D.G.M. Ayurvedic Medical College, Gadag. Date: Place: Gadag

COPYRIGHT

Declaration by the Candidate

I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic / research purpose.

Date: Signature of the Candidate

Place: Gadag. Rajesh A.R

© Rajiv Gandhi University of Health Sciences, Karnataka.

ACKNOWLEDGEMENT

All human efforts have to be blessed by the Almighty to become complete and

fruitful. This is especially so in case of the Medical profession- in that both the patient

and the doctor have to be lucky to get the best results of the treatment. I pray to the

Almighty, the first physician in the universe to bless all mankind for the alleviation of

their sufferings.

I deserve my respectful greetings in the lotus feet of Jagadguru Shri.

Abhinava Shivanandmahaswamiji to his holiness and divine blessings.

I dedicate this work to my, respected parents Shri.K.Rajendran &

Smt.K.Vasanthakumari and my sister Smt.Remya.V.R. Who are the prime sources for all

my success.

My most earnest acknowledgment must go to my advisor& guide

Dr. P. Shivaramudu M.D.(Ayu), Prof. & H.O.D P.G. Department of Panchakarma,

P.G.S & R.C,D.G.M.A.M.C, Gadag, who has been instrumental in ensuring my

academic, professional, and moral well being ever since. I could not have imagined

having a better advisor for my P.G. He helped me come up with the thesis topic and

guided me over almost 2 years of development. And during the most difficult times when

writing this thesis, he gave me the moral support and the freedom I needed to move on.

During the 3 years of my P.G, I have seen in him an excellent advisor who can bring the

best out from his students, an outstanding researcher who can constructively criticize

research, and a nice human being who is honest, fair and helpful to others.

In particular, I would like to thank my respected co-guide Dr. Santosh. N.

Belavadi, MD (AYU) Ast. Professor, P.G. Department of Panchakarma, P.G.S &

R.C, D.G.M.A.M.C, for discussions and guidance, who has not only been a source for

academic progression, but has also, provided a friendship and understanding throughout

my research. . His discerning command over a vast range of literature in Ayurveda, and

management systems was an invaluable resource for me.

I express my obligation to, Dr.Suresh Babu, Prof and HOD, Department of

Kayachikitsa, P.G.S & R.C, D.G.M.A.M.C, Gadag, for his tremendous encouragement

and thought provoking advices throughout my P.G.curriculam.

I express my deep gratitude to Dr. G. B. Patil, Principal, D.G.M.A.M.C,

Gadag, for his encouragement as well as providing all necessary facilities for this

research work.

I express my sincere gratitude to Dr. G. Purushothamacharyulu Professor,

Dr.Santosh. N. Belavadi Ast. Professor, Dr.Yasmeen A Phaniband Lecturer Dr.

Jayaraj Basarigidad Lecturer, and Dr. C.V. Rajshekar Lecturer P.G. Department of

Panchakarma, P.G.S. & R.C, D.G.M.A.M.C, Gadag for their valuable guidelines and

suggestions throughout my post graduate carrier.

I express my sincere gratitude to Dr. M. C. Patil, Dr. Mulgund, Dr. K. S. R.

Prasad, Dr. R.V. Shetter, Dr. Girish. Danappagoudar, Dr.M.D.Samudri, Dr.

G.J.Mitti, Dr. S.Nidgundi, Dr. B.G.Swamy , all PG & UG staff for their constant

encouragement.

I am thankful to Shri. Nanda kumar (Statistician), Shri. V.M. Mundinamani

(Librarian), Shri. Kerur, Shri. Shravy, Shri kulakarni, Shri Nabhi, and other

hospital and office staff for their kind support in my study.

I ought to be immensely grateful to those individuals who have helped me in this

exciting venture. Their number will easily run into the hundreds. Among them are friends

and colleagues, and others with whom I have interacted during the course of my P.G. I

will try to record my appreciation of their help by naming some of them here are

Dr.Natraj, Mr. Shakti, Dr. Shyama Krishnan, Dr. Vasu, Dr. Sanjeev Chowdhry,

Dr.Ashok, Mr.Riaz, Dr. Madhushree, Dr. Shailej Dr. Adarsh, Dr. Mukta, Dr. Prasanna

Joshy, Late Dr. Shivakumar, Dr. Sanath, Dr. Jayashankar, Dr. Deepak, Dr. Sabareesh Dr.

C.C.Hirmath,, Dr. Bodke, Dr. Shakunthala, Dr. Vasanth, Dr. Rajasekar, Dr.Satheesh, Dr.

Deepa, Dr. Asha, Dr. Praveen, Dr. Aneesh, Dr. Renukaraj, Dr. Sangamesh, Dr. Biswajit,

Dr. Joshy George,Dr. Bhagyesh, Dr.Vijay Mahantesh, Dr.Vinod, Dr. Sateesh, Dr. Surej,

Dr. Jayaker, Dr. Baba, Dr. Ragavendra, Dr. Vijay, Dr. Jagadeesh, Dr. Manish, Dr.

Paresh. Dr. Shilpa, Dr. Eshwar, Smt. Lalita, Dr. Khanti, Dr. Ghorapade. Dr. Jadhav, Dr,

srikanth, Dr. Anoop.R, Dr. Adarsh.P, Dr.Praveen.R, Dr. Vishal Kannan, Dr. Jiji Prasad,

Dr. Sreeni.M, Dr. Arun Pratap, Dr.Arun S. Kumar, Dr. Hrishikesh, Dr. Purushothaman,

Dr. Sreekanth.Reddy, Dr. Soorya Vamsi, Dr. Kishore Kumar.

Date :

Place : Dr. Rajesh.A.R

ABBREVIATIONS USED:

A.H – Ashtanga Hrudaya

A.S – Ashtanga Samgraha

B.P – Bhavaprakasha

B.S – Bhela Samhita

C.S – Charaka Samhita

M.N – Madhava Nidana

S.S – Sushruta Samhita,

V.S – Vangasena

Y.R – Yogaratnakara

ABSTRACT

Chittodvega is commonest among psychic disorders. Anxiety disorder is

becoming so common in today’s life style and is having one-year prevalence rate 2-4%

globally. Incidence rate of Anxiety disorders is increasing day by day, which has created

major problem to modern society. Chittodvega is a disease of mind caused due to

Manasika dosas rajas and tamas along with the sharirika dosas mainly vata Pradhana

The treatment for mental disease nasya and dhara plays major role as mind is situated in

the Shiras (Shiro hrudaya). So here in this “Evaluation of the efficacy of ksheerabala

taila nasya and Amalaki siddha ksheera dhara in chittodvega w.s.r.t generalized

anxiety disorder” was taken.

Objective of the Study:

1. Evaluation of Effect of nasya in chittodvega.

2. Evaluation of effect of ksheerabala taila in chittodvega

3. Evaluation of effect of dhara karma in chittodvega

4. Evaluation of effect of amalaki siddha ksheera dhara in chittodvega

Study Design:

It was a simple randomized single clinical observational study with a pre and post

test design in 30 patients, were diagnosed as chittodvega and fulfilling the criteria of

Undergoing the process of nasya karma and dhara karma were selected. Patients were

Subjected to sthanika Abhyanga and Swedana before the nasya karma.

After the Pradhana karma with ksheera bala taila nasya in the morning by

adopting the brumhana Sneha nasya matra i.e. 8 drops in each nostril for 7 days as

Paschat karma dhoomapana and gandoosha were performed.

after the completion of nasya karma amalaki siddha ksheera dhara was administered for

seven consecutive days in the morning hours between 7:30 am -8:30 am the duration of

the dhara was taken in the arohana krama for the first 4 days with a specific time of 5

mins and on the 5th day on wards reduce the duration by the same. After that rasnadi

choorna was performed as Paschat karma over the scalp. The assessment criteria were

noted before the treatment and after the parihara kala, for that chief complaints Viz.

restlessness, fatigue and difficulty in concentration ,associated complaints like irritability,

muscle tension, and sleep disturbance , criteria’s like Hamilton anxiety scale , Zung self

rated anxiety scale ,MAAS, GHQ-28 were used

Results: • 26 (87 %) patients manifested with symptoms of chittodvega got complete relief or

best responded when assessing the criteria’s like HAS, Zung self rated anxiety scale,

MAAS, GHQ-28 and clinical symptoms.

• 04 (13%) got responded with the treatment adopted with minimum clinical symptoms

present.

• Not even a single patient left with not responded by the trial.

• The assessment of the overall effect of the treatment revealed that the treatment

adopted here is highly significant in the management of chittodvega

Key Words: chittodvega, generalized anxiety disorder, nasya karma, dhara karma

TABLE OF CONTENTS

SI. No. Contents Page No.

01 Introduction 1

02 Objectives 9

03 Review of Literature 15

04 Materials and Methodology 102

05 Observations and Results 122

06 Discussion 151

07 Conclusion 168

08 Summary 171

09 Bibliography 174

10 Annexures 190

List of tables

Si. No:

Tables Page no:

1. Showing the Sneha nasya matra 21

2. Showing the Shodhana Nasya matra 22

3. Showing the Avapeedana Nasya matra 23

4. Showing the Contra Indications of Nasya 26

5. Showing Nasya Matra. 29

6. Showing the Samyak Yoga Lakshanas of Nasya 34

7. Showing the Ayoga Lakshanas of Nasya. 35

8. Showing the Atiyoga Lakshanas of Nasya 36

9. Showing the Roopa 0f Chittodvega 112

10. Showing Hamilton Anxiety Rating Scale: 114

11. Showing Zung Self-Rated Anxiety Scale. 115

12. Showing the General Health Questionnaire-GHQ28. 116-118

13. Showing the Mindfulness Attention Awareness Scale (MAAS). 119

14. Showing the Ayurveda health assessment. 120

15. Showing the distribution of patients by sex. 122

16. Showing the distribution of patients by Age. 122

17. Showing the distribution of patients by Religion. 123

18. Showing the distribution of patients by occupation. 123

19. Showing the distribution of patient’s by Economic status. 124

20. Showing the distribution of patients by marital status. 124

21. Showing the distribution of patients by Ahara. 125

22. showing the distribution of patients by vihara 125

23. Showing the distribution of patients by Agni. 126

24. Showing the distribution of patients by Koshta. 127

25. Showing the distribution of patients by Nidra. 127

26. Showing the distribution of patients by Vyasana. 128

27. Showing the distribution of patients by sharirika prakruti. 128

28. Showing the distribution of patients by Manasika Prakruti. 129

29. Showing the distribution of Patients by satva. 129

30 Showing the distribution of Patients by Nidana. 130

31. Showing the distribution of patients by Roopa of chittodvega. 130

32. Showing the distribution of patients by Chronicity. 131

33. Showing the distribution of patients by Sheela. 132

34. Showing the distribution of patients by Chesta. 132

35 Showing the distribution of patients by Achara. 133

36. Showing the distribution of patients by Manaha. 134

37. Showing distribution of patients by Buddhi. 134

38. Showing distribution of patients by Buddhi. 135

39. Showing distribution of patients by Sajnajnanam. 136

40. Showing distribution of patients by Bhakthi. 136

41. Showing distribution of patients by HAS (Hamilton Anxiety Scale). 137

42. Showing distribution of patients by Zung self rated anxiety scale. 138

43. Showing distribution of patients by MAAS. 138

44. Showing distribution of patients by GHQ- 28. 139

45. Showing distribution of patients by Overall assessment of the result. 140

46. Showing the Roopa of Chittodvega. 141

47. Showing the Personal History. 142

48. Showing the Nidana of Chittodvega. 143

49. Showing the Demographical Data. 144

50. Showing the Hamilton Anxiety Rating Scale. 145

51. Showing the Zung Anxiety Rating Scale. 146

52. Showing the Mindfulness Attention Awareness Scale (MAAS). 147

53. Showing the GHQ-28. 148

54. Showing the Statistical Study of the Trial. 149

LIST OF FIGURES

Si. No:

igures Page no:

1. Showing the classification of nasya according to Charaka. 19 2. Showing the classification of nasya according to Sushruta. 20 3. Showing the classification of nasya according to Vagbhata. 20 4. Showing the Samprapti of Cittodvega. 79 5. Showing the 5 Functional neuro anatomy of GAD. 87 6. Showing the drug Bala. 88 7. Showing the drug Amalaki. 90 8. Showing the drugs used and the procedure. 121 9. Showing the showing the distribution of patients by sex. 122 10 Showing the showing the distribution patients by Age. 123 11. Showing the distribution of patient’s Religion. 123 12. Showing the distribution of the distribution by occupation. 124 13. Showing distribution of patients by Economical status. 124 14. Showing the distribution of patients by marital status. 125 15 Showing distribution of patients by Ahara. 125 16. Showing distribution of patients by Vihara. 126 17. Showing distribution of patients by Jataragni. 126 18. Showing distribution of patients by Koshta. 127 19. Showing distribution of patients by Koshta. 127 20. Showing distribution of patients by Vyasana. 128 21. Showing the distribution of patients by sharirika prakruti. 128 22. Showing the distribution of patients by Manasika Prakruti. 129 23. Showing the distribution of Patients by satva. 129 24. Showing the distribution of Patients by Nidana. 130 25. Showing the distribution of patients by Roopa of chittodvega. 131 26. Showing the distribution of patients by Chronicity. 131 27. Showing the distribution of patients by Sheela. 132 28. Showing the distribution of patients by Chesta. 133 29. Showing the distribution of patients by Achara. 133 30. Showing the distribution of patients by Manaha. 134 31. Showing the distribution of patients by Buddhi. 135 32. Showing the distribution of patients by Smrithi. 135 33. Showing the distribution of patients by Sajnajnanam. 136 34. Showing the distribution of patients by Bhakthi. 137 35. Showing the distribution of patients by HAS . 137 36. Showing the distribution of patients by Zung self rated anxiety scale. 138 37. Showing the distribution of patients by MAAS. 139 38. Showing the distribution of patients by GHQ- 28. 139 39. Showing the distribution of patients by Overall assessment of the result. 140

Introduction

INTRODUCTION

The most beautiful thing we can experience is the mysterious. It is the Source of all true

art and science.

—Albert Einstein (1930)

In today’s convulsively changing world, scientific advances, political mutations,

Profit maximizations, social interventions, and human interpretations are producing new,

and often confusing, perceptions of health and disease, to the extent that one wonders if

such primary human aspirations as equity, well-being, and freedom from suffering are

being forgotten. What are often forgotten are the fundamental principles of the World

Health Organization, “The struggle against human suppression is the struggle between

memory and forgetfulness?”

Health and disease, at once humanity’s happiness and yoke, have marched With

history and marked time with it. They have molded and, it turns, have been Influenced by

the degree of social and intellectual development in any given Space or time. Yet

whatever the flux, humankind has constantly pursued disease as its target and health as its

goal.

Human beings face unprecedented challenges as we approach the next

millennium. We are seeking new ways to meet the demands of modern life as its

unrelenting flow of information demands our attention. Although in many ways, we have

“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 1

Introduction

greater opportunities for a rich and fulfilling life than ever before, it is clear that we need

to evolve new strategies if we are to survive and thrive as individuals and as species.

Ayurveda, the extra-ordinary mind-body medicine, cognized by the great seers of

India, willingly offer us a wealth of practical knowledge on how to live a healthy and

meaningful life.

According to Ayurveda, Sattva, Atma, and Sharira are the three tripods of life,

where the mind (Sattva) occupies the first place, due to its importance in connecting the

sentient soul with non-sentient body. Human life is considered as an invaluable

opportunity to achieve the prime goals of life viz., Dharma, Artha, Kama, and Moksa. To

achieve these aims one needs a healthy and calm life. Whole ancient society tried to

achieve all four prime goals of life, so that they had a smooth, sound, safe, assured,

steady, and healthy lifestyle. But on the other hand, today’s life style has drastically

changed.

As James C. Colem said, “the 17th century was the age of enlighten, the 18th age

of reasoning, the 19th age of progress, and the 20th age of Anxiety which is the seed of

many psychological disorders, the 21st century has become the age of communication,

where the world become shortened to global village, by which whole world stressful

events are affecting the individuals apart from their own, leading to emotional

disturbances and incapacitating more people than any other health problems.” Today,

every one is trying to gain good financial status and to fulfill all the physical desires;

therefore today’s fast modern society is facing unsteady, weakened, hard, and everyday

changing lifestyle. The gift of this lifestyle is that, almost every one appears to be

stressed and confused. These reflections can lead to mental disabilities.


Introduction

Anxiety disorder is becoming so common in today’s life style and is having one-

year prevalence rate 2-4% globally (Kessler et. al.1994). Incidence rate of Anxiety

disorders is increasing day by day, which has created major problem to modern society.

The World Health Organization (2008)1 estimates that 450 million People worldwide

currently experience ‘mental, neurological or behavioral Problems’. In the United States

alone, almost 44 million people –Approximately one in six of the population – are

affected by a mental Illness in any given year (United States Department of Health and

Human Services 2006). As per the WHO predictions, at 2020 anxiety disorders and

depressive disorders will be in the top rank order of Disease Burden for 18 leading

Countries (The Global Burden Of Disease – WHO 2001); which are related to lifestyle

and behavioral patterns.

Purpose of Study:

Acharya Vagbhata gave the brief description of Manasaroga in the beginning

verse of his work, ‘Astanga Hrudaya’ as well as ‘Astanga Samgraha’ as Ragadirogan

Satatanushaktan….. Apoorvavaidyaya Namostu Tasmai Ii

This shows the importance of mental disorders according to the time factor. Even

though, Acharya Charaka and Susruta described many mental disorders, they gave prime

importance to the promotion of health and then they dealt with diseases. But, Vagbhata

by mentioning “ragadi roga” highlighted the importance of diseases prevailing during his

period, which holds well till today.

One side man is enjoying the fruits of modernization but on the other hand he is

paying price for the same. In this most modernized world due to sedentary life style and

food habits man is caught up with lot of diseases, this leads to early ageing, debility, loss


Introduction

of immunity, which in turn is producing more number of disease like insomnia, anxiety,

depression etc. in that GAD is one of the most common disease in the present era.

The generalized anxiety state is here closely comparing with chittodvega2 which is

mentioned by Acharya Charaka in the vimana sthana but the detailed description of the

disease is not available in the classics hence scattered terms used in Ayurveda similar to

this condition is also taken into account like anavastita chitta, chittanasha, chittakshobha,

asvasthachitta etc….

In Chittodvega, when the mind is afflicted with anxiety, fear, agitation etc.this

leads to worry apprehension, depression, psychological arousal as anger, irritability and

ultimately lead to disturbance in personal, familial and social harmony.

Anxiety disorders are among the most prevalent psychiatric condition in the

world. Further, studies have persistently shown that they produce inordinate morbidity,

utilization of health care services, and functional impairment. Recent studies also suggest

that chronic anxiety disorder may increase the rate of cardiovascular-related mortality.

Hence, clinicians in psychiatry and other specialties must make the proper anxiety

disorder diagnosis rapidly and initiate treatment.

In people with GAD, the worry often is unrealistic or out of proportion for the

situation. Daily life becomes a constant state of worry, fear, and dread. Eventually, the

anxiety so dominates the person's thinking that it interferes with daily functioning,

including work, school, social activities, and relationships The usual age of onset is

variable - from childhood to late adulthood. Women are two to three times more likely to

suffer from generalized anxiety disorder than men and more and more medicines also


Introduction

prove to be ineffective as they do not reach the site of the disease. So in this context

Ayurveda plays a major role because it eliminates the disease from its root.

In this present study shata paka ksheerabala taila which is mentioned in the classics

having the properties of brumhana, indriyaprsada and ksheera dhara which is mentioned

in keraliya Panchakarma having significant role in treating the manasa vikaras are taken

to evaluate its effectiveness in chittodvega.

Lacunae in Current Knowledge:

Mental diseases are generated by the non-fulfillment of desired objects and by

succumbing to the hated. As a social being we are unable to fulfill all our desires and

we are compelled to accept things that we dislike. Both these cause frustration and mental

stress and are conducive to mental diseases.

According to Ayurveda, improper union of time, objects and actions is the cause of

all the diseases. Thus improper union of mind with its object, namely 'the thinkable'

and improper action of mind are conducive to mental diseases. From a slightly

different perspective, etiology can be classified into three viz. contact of objects that

cannot be assimilated (ASAATMYA), error of consciousness and transformation. Error of

consciousness (PRAJN'AAPARAADHA) is the term used for erroneous actions prompted by

the lapse of intellect (BUDDHI), will power (DHR'TI) and memory (SMR'TI) that

produce bad result. In fact, most of the etiological factors will come under this head.

Mind-Body relation in the disease process in such a way that every disease is

psychosomatic, with varying predominance of psychic or somatic involvement.


Introduction

Relaxation is the voluntary letting go of tension. This tension can be physical

tension in the muscles, or it can be mental or psychological tension. When we relax

physically, certain impulses are sent to brain, which in turn bring about a general feeling

of calm, both physically and mentally.

Psychotherapy is one of the main management for anxiety in modern medicine, but our

satvavajaya chikitsa also plays equal role in the management of chittodvega The best

measure to achieve the goal of satvavachaya chikitsa is to restrain mind from desire from

unwholesome objects, its through jnana, vijnana, dhairya, smrithi and Samadhi according

to Charaka.

The Pharmacological study of the drug also establishes it as anxiolytic anti

depressant and nootropic drug. It is hoped that this piece of work will make a significant

contribution in the field of Manasaroga to find out an eco friendly, toxicity free and cost

effective ayurvedic herbal remedy for the management of such common disease

Chittodvega w.s.r. to Generalized Anxiety Disorder.

Although many people with GAD cannot be cured and symptoms can return from

time to time, most people gain substantial relief from their symptoms with proper

treatment. Previously, almost more than 20 research work have been carried out from

different P.G. Research centers on chittodvega w.s.r.t Anxiety disorders all over India by

taking trail work with Rasayana drugs and single drugs like Aswagangandha,

Mandukaparni, sankapushpi and classical preparations with Shodhana procedures like

dhara, kseera dhara and nasya. No doubt that an extensive research and research thought

has been done on Chittodvega and it shows the chronic, miserable life conditions to cope

up with this condition and still research work is undergoing in different institutes to


Introduction

invent an effective, less cost and more beneficial treatment and at the same time they

tried clinical research should help to getting rid of worry, irritable and anxiety condition.

Hypothesis:

In the pathogenesis of the disease the vulnerability in the form of positive family

history, Vataja and Rajas a prakruti, Heena Satva, fear prone personality, indulgence in

the misuse of Sadvritta, vitiated Dosa play an important role in predisposing to

Chittodvega.

Anxiety is always associated with some stressful events and some times stressful

situations may precipitate the anxiety disorders. So, it is always necessary to differentiate

pathological anxiety from normal response. Normal feeling of anxiety is an advantageous

response to a threatening situation. But, the pathological anxiety by contrast is an

inappropriate response to a given stimulus, by virtue of either its intensity or duration.

The feeling is characterized by autonomic symptoms such as headache, insomnia,

perspiration, difficulty in inhaling, palpitation, etc.

In the management of Anxiety common problems and clinical considerations

Over the course of therapy, a variety of pitfalls may occur. Such as-

• Poor Compliance with Home Assignments

• Low Motivation to Participate in Treatment

• Practical Problems Completing Home Assignments

• Fear that Homework Will Increase Anxiety and Worry

• Problems in the Therapeutic Relationship

• Common Problems Associated with Specific CBT Strategies

• Relaxation Strategies


Introduction

• Cognitive Strategies

• Behavior Therapy and Exposure Techniques

• Therapy Termination and Relapse Prevention

• Review of Client Progress and Essential Information

• Continued Practice of Therapy Skills and Coping Responses

• Written Relapse Prevention Plans

• Early Termination of Therapy

By keeping above discussed points and after observing the number of clinical trials

With different medicines and therapeutic procedures of Panchakarma previously done,

I have chosen to make clinical trial with Ksheera bala taila nasya and Amalaki siddha

ksheera dhara to evaluate the combined effect of both of these treatments in the each

patient of clinical trial.

The effects of the treatment, if properly done, are many. If done in the correct

manner, nasya stimulates vital centers, nourishing the tissues, clearing the channels,

removes the congestion and correcting the neuron-vascular anomalies. The hypothesis of

this clinical trail is also to bring the effects of nasya to get the benefit to the patients that

it relieves tension and cleanses the pathogenic srotasas there by nourishes the tissues and

brings the relaxation, calmness of mind.

Amalaki siddha ksheera dhara is scheduled in chittodvega because as amalaki is

having the actions like antioxidant, anabolic and dhara treatment helps in alleviating the

fatigue, worry, head-ache and lack of vitality.


Objectives

OBJECTIVES

The process of being scientific does not consist of finding objective truths. It

consists of negotiating a shared perception of truths in respectful dialogue.

—Robert Beavers

The entire concept of manas or mind is psychological in nature. Its neurophysiologic

attributes have not been described vividly in Ayurveda. According to Ayurveda mental

health is a state of sensorial, mental and spiritual well being. The mental ill health is brought

about essentially as a result of unwholesome interaction between the individual and his

environment.

In this present era, anxiety is one of the major problems the world has to deal with

due to its increased incidence and global distribution because of the modern life style and

sedentary habits. In that GAD is one of the most common psychological condition seen in the

contemporary system of medicine. Anxiety is a problem that ranges from mild uneasiness to

distress in physical, mental & emotional setup.

The data suggest that in Anxiety Disorders Clinics approximately 12% of the

individuals suffer with Generalized Anxiety Disorder. (Mental Illness in General Health

Care; Ustün & Sartorius, 2007). The national co morbidity survey found that the majority of

individuals with GAD also reported prominent complications which include: substantial

interference with their lives (49%), high probability of seeking professional help for GAD

symptoms (66%) & taking medications for GAD (44%). About 30 - 40% of patients will

develop other major psychiatric illness in their later life.


Objectives

Ayurveda follows psychosomatic approach of health. According to Ayurveda Psychic

factors are involved in almost all the disease processes along with physical disturbance as

both are interdependent.

While describing psychological disorders Acharya Charaka has quoted word

Chittodvega along with Kama, Krodha, Moha etc.Chittodvega is more applicable term to

illustrate whole anxious state.

In this study the term ‘Chittodvega’ is compared with Generalized Anxiety Disorder

DSM-IV, Chittodvega can exists as a separate disease or can be an etiological factor for

other psychic and psychosomatic diseases.

Generalized anxiety disorder (GAD) is a chronic anxiety condition

characterized by excessive and uncontrollable worry and associated somatic symptoms.

Unlike other anxiety disorders, GAD involves diffuse anxiety in the absence of a specific

feared object, class of stimuli, or situation. Individuals suffering from GAD instead fear

and avoid an array of subtle internal and external stimuli.

In Modern psychiatry, an extensive research has been done on general anxiety

disorder with the approaches like- Cognitive-Behavioral and Pharmacological

Treatment Research, Pharmacotherapy, Comparisons between CBT and

Pharmacological Treatments, Comparisons between Applied Relaxation and

Cognitive Therapy. The combination of psycho education, applied relaxation training,

cognitive therapy, and behavioral and imaginable exposure treatment components

consistently has helped individuals suffering from this difficult to treat anxiety

disorder.


Objectives

The following types of information should be considered when developing a

treatment plan: idiosyncratic clinical features, interpersonal Problems and social

support, medical problems and conditions, and the nature of any associated disability,

impairment, and quality of life interference.

By considering the above aspects and treatment protocols, in the present study an

attempt is made to find suitable remedy for chittodvega keeping the cardinal

symptoms of chittodvega and GAD i.e., Irritability, worry, initial insomnia, fatigue,

muscle tension, the present study intended and selected the following yogas for Nasya

karma with Ksheerabala Taila mentioned by Astanga hrudaya and Amalaki Siddha

Ksheera dhara In this regard the objects proposed in the study are:

1. To evaluate the effect of nasya karma in chittodvega

2. To evaluate the effect of ksheerabala taila in chittodvega

3. To evaluate the effect of dhara karma in chittodvega

4. To evaluate the effect of Amalaki Siddha ksheera dhara in chittodvega

I. To evaluate the effect of nasya karma in chittodvega

At the biological level Vata is the Niyanta i.e. Controller and Praneta i.e.

Motivator of the mind 3 So that, any dysfunction of vata is responsible for dysfunction of

Indriyas and Mental pertandubance giving rise to Bhaya, Shoka, Moha, Dainya and

Pralapa 4; also further leads to Nidranasha, Karshya, Bhrama, Dinata, Kampa, Anaha 5.

The above symptoms are commonly seen in anxiety disorders, so it can be said that the

role of Vata in the manifestation of Cittodvega is very important.

Nasya, one of the main Panchakarma used in the management of urdvajathrugata

rogas and some Manasika diseases like Unmada, Apasmara etc. are taken in this trail to


Objectives

evaluate its action in chittodvega, because Nasa is the easiest route or way to convey the

medicines into the shiras and Acharya Bhela has also opined that mind is situated in

between shiras and thalu and according to the modern pharmacology the drug conveyed

through nose are absorbed rapidly through the mucus membrane and it will give both

local as well as systemic effect. 6

Scientist of the institute of medical sciences Delhi have proved after experiments that

the drug administered through nose shows effective action on the brain, so it can be said

that there is very close relation between Shirah and Nasa (nose).Thus to understand the

pathways of Nasya drug (classical errhine) acting on the central nervous system and

mode of action of nasya is- stimulation of vital centers, nourishing the tissues, clearing

the channels, Removes the congestion and correcting the neuro-vascular anomalies, so

given nasya treatment will help in removing the morbid doshas in shiras and controls

imbalances in vata dosha thereby helpful in motivating the mind.

II. To evaluate the effect of ksheerabala taila in chittodvega

As chittodvega is a Vata Pradhana Manasika vikara, ksheerabala which is

mentioned in Ashtanga hrudaya having the qualities of vatahara, brumhana, and indriya

prasadana was taken to evaluate its efficacy in this study, ksheera bala taila (101)was

used and also to prove its cost effectiveness in the management of chittodvega with out

any side effects.

III. To evaluate the effect of dhara karma in chittodvega

Dhara is one of the main procedures in keraliya Panchakarma7 which is

predominantly used in Manasika vikaras, Anidra, hyper tension etc is taken in this study

to see its effect on chittodvega as it is also a Manasika vikara and also to evaluate the


Objectives

action of dhara and to decide its cost effectiveness in the management of chittodvega with

out any side effects

The shirodhara therapy is extensively used for the alleviation of many ailments,

especially in psychic ailments but used in some of the somatic ailments too. Though

clinical efficacy of Shirodhara is proved, the nature of its action is very complex.

Therefore, to understand the mode of action of Shirodhara is a difficult task.

The mind, body and spirit are intimately connected, and shirodhara by calming

the stressful mind, relaxes the entire physiology. Imbalance of Prana, Udana and Vyana

Vayu, Sadhaka Pitta and Tarpaka Kapha can produce stress and tension. Siro dhara re-

establishes the functional integrity between these three subtypes of Dosha through its

mechanical effect. Sahasrara Chakra is known to be the seat of pituitary and pineal gland.

As we know, the pituitary gland is one of the main glands of the endocrine system. Siro

dhara stimulates the pituitary gland by its penetrating effect, which helps in bring the

hormonal balance.

The procedural effect of Shirodhara itself seems to produce a relaxation response

irrespective of the medicament used. In almost all the methods of relaxation like yoga,

meditation etc. similar general principles prevail. One involves efforts and concentration

focusing attention upon a particular object or sensation and the other a simple

watchfulness and observation allowing fine flow of perception.

IV. To evaluate the effect of Amalaki Siddha ksheera dhara in chittodvega

Ksheera which is having the property of brumhana, jeevaneeya, and balya

property is taken as base and along with that amalaki which is having the properties like


Objectives

tridoshahara, vrishya is taken as ingredient for dhara in this clinical trail to evaluate its

effect in case of anxiety disorders and also the amalaki is having the anxiolytic activity

according to modern and is also a proven drug in case of depression and anxiety

management. The Pharmacological studies of the drug also establish it as anxiolytic anti

depressant and neuro tropic drug.

The study is a simple randomized pre-post test single group clinical observation

Trial where the effect of Ksheerabala Taila Nasya and Amalaki Siddha Ksheera Dhara is

administered to pacify the doshas in Chittodvega is combined. In this attempt the patients

are administered the designated medicaments and therapeutic procedures for 27 days and

Muscle tension, Fatigue, worry, Insomnia etc., are observed up to 27 days. Thus the

combined effect of Nasya Karma and Ksheera dhara are established by Subjective and

objective parameters.


Review of nasya

LITERATURE

This chapter deals with historical aspects, Nidana, Purva roopa, Roopa, Samprapti,

Chikitsa of chittodvega from different classics under two headings.

1. Historical review

2. Disease review

Historical Review of nasya and Dhara

(A) Historical review of Nasya:

DESCRIPTION OF NASA IN VEDA

Rigveda: There is indication of a word Nasa in a Mantra

“Yen Ygnasta yala sapla …………..”

Yajurveda: While describing the Indriyas, there is mention of two Netra, two

Karna, two Nasika Chhidra and Jihva.

Atharvaveda: Nasa is described among nine chhidras and Indriya.

“Ashtachakra, Navadwara…….”

“Shirshaklima shirshamayana ………..”

Bhagvad Gita: While describing Indriyas, the Nasa is mentioned.

“Navadvara Purva dehi neva …….”


Review of nasya

DESCRIPTION OF NASYA IN ANCIENT TEXTS

Rigveda: There is a mantra in Rigveda in which eradication of Roga is mentioned by

routes of Nasa (Nostrils), Chibuka (Chin), Shira (Head), Karna (Ear), and Rasna

term

of

dministered the juice of Sanjivani through nasal route

Jeevaka” the famous Vaidya of Bauddha kala had utilized Nasya

asya of medicated ghrita to the wife of Shreshthi

ve Virechana to Lord Buddha, he gave him

y

.

ya

(Tongue). This can be considered as a primitive picture of Nasya Karma.

Krishna Yajurveda, Shatpatha Brahmana, and Upanishad: In these texts, the

Nasya Karma has been used frequently.

Ramayana: In Valmiki Ramayana, when Laxman became unconscious by the blow

Meghanada, Vaidya Sushena a

Bringing him to consciousness instantaneously.

Bauddha Kala: “

karma in many cases such as

1) In Shirahshoola, he prescribed N

of Saketa Nagar.

2) Once, when Jeevak wanted to gi

Aushadhi by nasya for Virechana.

Vinaya Pitika : In this book, it is mentioned that one utpala hasta of Nasya has potenc

to induce 10 Vegas of Virechana.

Samhita Kala: Literature written during this period is the heart of ayurvedic literature

In all the Samhita, Nasya karma has been elaborately described especially in Charaka

Samhita, Sushruta Samhita and Ashtanga Samgraha. The research conducted on this

therapy was at such a height that it was used to achieve expected sex of foetus. Nas

karma is utilized in treatment of many diseases in Brihattrayi such as in Charaka, in

chikitsa of Jwara, Raktapitta, Kustha, Rajyakshama, Unmada, Apasmara, Shwayathu,


Review of nasya

Hikka, Shvasa, Kasa, Visha, Trimarmiya, Vata vyadhi, Trimarmiya siddhi etc,. In

Sushruta Samhita, in Chiktisa of Dwivraniya, Sadyovrana, Bhagandar, Vata Vyadhi,

Granthi, Apachi, Arbuda ganda, Vriddhi, Upadamsha,

, Kshudra Roga, Mukha Roga etc, . In Ashtanga Hridaya, in Chikitsa of Jwara,

ka, Rajyakshama, Chhardi, Hridaroga, Trishna, Madatyaya,

Shv ,

Nasya: Ety l

Ayurvedic texts, Nasa Dhatu is

for

ruta, administration of medicine or

ils through the nose is known as Nasya. Arunadatta and Bhavaprakasha

gs that are administered through the nasal passage are called Nasya.

Vagbhata also hold the same view.

chana

Mahavata Vyadhi, Kustha, Udara,

Shlipada

Raktapitta, Shvasa Hik

itra Krimi, Vata Vyadhi etc,

mo ogy of nasya:

• The word Nasya is derived from ‘Nasa’ Dhatu. In

used in the sense of nose.

• In Sanskrit language each word is derived from a specific dhatu and each dhatu

bears an inherent meaning which is the crux of the word.

The derivation of the word Nasya is from “Nasa” dhatu. It conveys the sense of

Gati – motion. Vyapti bears the meaning pervasion. Here, the Nasa dhatu is inferred in

sense of nose. According to Vachaspatyam word “Nasata” means beneficial for nose.

In context of Ayurveda, the word Nasya suggests the nasal route

administration of various drugs. As per Acharya Sush

medicated o

opines that all dru

Sarangadhara and

Synonyms:

• Prachchardana

• Shirovire


Review of nasya

• Shirovireka

• Murd

rious synonyms of Nasya karma Shirovirechana, Shirovireka and

urdhavirechana are suggestive of elimination of Doshas from the Shira or parts situated

ardana, whereas the terms Nastaha and Navana indicates

site of a

In Ayurveda, the word Nasya has been taken specifically to mention the route of

synonyms indicate that this is a procedure which

elimina

Nasya is classified in various ways by different Acharya. It is mainly classified

ccording to its mode of action i.e. Shodhana, Shamana, etc and on the basis of

arious forms of drugs preparation utilized for the Nasyakarma e.g. Churna, Sneha etc.

havirechana

• Navana

• Nastaha Karma

Amongst the va

M

above the clavicle i.e. Prachch

dministration.

DEFINITION OF NASYA:

administration of drugs. All these

tes vitiated humors from Shiras

CLASSIFICATION OF NASYA:

a

V


Review of nasya

Classification According To Charaka Figure no: 1. showing the classification of nasya according to Charaka

NASYA

Navana Avapidana Dhmapana Dhuma Pratimarsha

ec ana

he above mentioned five types of Nasya are regrouped according to their function

ana.8

.9

mana,

Shirovirechana and Pratimarsha. These 5 types of Nasya are further classified

according to their functions into two groups’ viz. Shirovirechana and Snehana.

Shirovirechana, Avapida and Pradhamana are used for the elimination of morbid

Dosha from Shira, Pratimarsha and Nasya type may be used for Snehana.10

Snehana shodhana Prayogika Sneihika Virechanika

Shodhana sthambana Snehana vir h

T

into three groups viz. – Rechana, Tarpana and Sham

Charaka has also mentioned 7 types of Nasya according to partsof the drugs to be

used in Nasyakarmna via – Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twaka

Classification of Nasya according to Sushruta:

According to Sushruta Nasya is also of 5 types Viz. Nasya, Avapida, Pradha


Review of nasya

Figure no: 2. showing the classification of nasya according to Sushruta: Nasya

Shirovirechana snehana Shirovirechana Pradhamana Avapida Nasya Pratimarsha CLASSIFICATION ACCORDING TO VAGBHATA

Ashtanga Samgraha has mainly classified Nasya into three types depending up on

their function viz. Virechana, Brimhana and Shamana. Snehana and Brimhana Nasya

have been further subdivided according to the doses into two groups i.e. Marsha and

Pratimarsha.

Figure no: 3. showing the classification of nasya according to Vagbhata NASYA Virechana Brimhana Shamana Pradhamana Murdha Pratimarsha Marsha Avapida Virechana CLASSIFICATIONS ACCORDING TO KASHYAPA

According to Kashaya Samhita Nasya has classified into two groups i.e. Brimhana

and Karshana. These two types are also known as (1) Shodhana and (2) Purana Nasya.


Review of nasya

CLASSIFICATION OF NASYA ACCORDING TO SHARANGADHARA:

Sharangdhara11, 12, 13 has also classified Nasya according to the functions into two

group’s viz. Rechana and Snehana. Rechana Nasya is further subdivided into Avapida

and Pradhamana. Snehana Nasya is subdivided into Marsha and Pratimarsha.

Bhoja has classified two types of Nasya, Viz - Prayogika and Sneihika.14

Classification of Nasya according to preparations

1. Navana Nasya:

Nasya Karma. Nasya which is administered by instilling the drops of medicated oil

or Ghrita in the nose. Charaka15 has described Pranadi (pippet or dropper) for it

Navana is generally the Sneha Nasya and is known as Nasya in general. It can be

mainly classified into Snehana and Shodhana Nasya.

Navana is again classified into two snehana and shodhana

Snehana nasya: As the word Sneha suggests, Snehana Nasya gives strength to all

the Dhatus and is used as Dhatuposhaka

SNEHA NASYA MATRA Table No.1 Showing the Sneha nasya Matra. Hina Matra

8 drops in each nostril

Madhyama Matra


Uttama Matra


Benefits of Sneha Nasya

It is used for the oiling in the feeling of head lightness. It gives strength to neck,

Shoulder and chest and increases eye sight.


Review of nasya

Shodhana Nasya:

Sushruta’s Shirovirechana type is included in Shodhana type of Navana

Nasya. It eliminates the vitiated Doshas. In this type of Nasya, oil prepared by

Shirovirechana Dravyas like Pippali, Shigru etc. can be selected.

Matra: It can be given in following dosage schedule according to Sushruta 16.

Shodhana Nasya Matra Table No.2 Showing the Shodhana Nasya matra

Uttama matra 8 drops

Madhyama matra

6 drops

Hina matra

4 drops

Time schedule: Navana Nasya should be administered according to the following time

Schedule. 17

(i) In Kaphaja Roga: Fore noon

(ii) In Pittaja Roga: Noon

(iii) In Vataja Roga: After Noon

Time schedule of nasya according to different Rutus

In healthy persons Navana Nasya should be given according to the following Ritu

(i) Shita Kala: Noon

(ii) Sharad and Vasanta: Morning

(iii) Grishma Rutu: Evening


Review of nasya

(iv) Varsha Rutu: Only when sun is visible.

2. AVAPIDA NASYA: 18

The which is Nasya given by expressed juice of leaves or paste (kalka) of

required medicine (Chakrapani).

Avapeedana nasya matra Table No.3 Showing the Avapeedana Nasya matra

Uttama matra

8 drops

Madhyama matra

6 drops

Hina matra

4 drops

3. DHMAPANA NASYA:

The nasya in which choorna is inhaled by nasal passage with the help of nadi yantra

The Choorna (fine powder) of required drug is kept at one end, and air is blown from

the other end, so that the medicine may enter into the nostrils19.

Matra of Dhmapana nasya:

According to Videha the matra of Dhmapana Nasya is three Muchuti (3 pinch).

For the Pottali method Churna should be at least 2 Tolas i.e. 20 gms. Generally

Tikshna Dravyas are used for this type of Nasya. Hence cautions should be taken

during its administration.

4. DHUMA NASYA:

The nasya in which the medicated fumes are inhaled through nasal route and

eliminated by oral route 20.


Review of nasya

Matra

• Habitual smoking twice

• Once for Snaihika Dhuma (Unctuous

• Three to four times for the Vairechanic Dhuma.

• For Prayogika Dhuma drugs like Priyangu, Ushira etc. should be used.

• For Snaihika Dhuma Vasa, Ghrita etc.

• ForVirechanic Dhuma, drugs like Aparajita, Apamarga etc. should be used.21

5. MARSHA – PRATIMARSHA NASYA

Introduction of oils into the nostril is in case of Marsha and pratimarsha but the

main difference between them is the matra. In Pratimarsha Nasya 1-2 drops are given

while in Marsha Nasya the dose is 6 to 10 Drops

Pratimarsha Nasya:

Pratimarsha Nasya can be given daily irrespective of the season and it can be

given in morning and evening it is given by dipping the finger in the required Sneha and

then dropping it in the nostrils.

Marsha:

It is also installing of medicated sneha into the nostril only difference is in the case of

Matra, in this 6 to 10 drops of Sneha will be instilled into the nostril. And it is more

Effective than pratimarsha 22.

Classification of Nasya according the action:

Charaka and Vagbhata have classified Nasya into 3 groups according to their

Pharmacological action, viz.

(i) Rechana (Virechana) means purificatory,


Review of nasya

(ii) Tarpana (Brimhana) means nourishing and

(iii) Shamana (retraining) 23 24

Sushruta and Sharangdhara have omitted Shamana from this classification and divided

Nasyakarma into only two groups, Viz; Shirovirechana and Snehana.

Kashyapa stated Brimhana and Karshana types of Nasya and Acharya Videha described

two types of Nasyakarma according to their pharmacological action i.e.

Sangyaprabodhana and Stambhana. All these types can be included into the Classification

of Charaka.

Rechana nasya:

The Rechana Nasya denotes to eliminations of vitiated Doshas from Shiras. Choornas

or the sneha prepared with Shiro virechaneya drug are commonly used for this25.

It can also be given with Tikshana, Sneha, Kwatha or Svarasa of Shirovirechana

drugs or by dissolving these drugs in Madhya, Madhu, Saindhava, Asava, Pitta and

Mutra or mixed with the drugs specific for that diseases.

2. TARPANA NASYA:

Acharya Charaka explained tharpana nasya, acharya susrutha and sarangadhara

explained snehana, bramhana nasya by Acharya Vagbhata all these can be considered

as the synonyms of each other. The Sneha prepared out of Vatapittahara drugs should

be used and the drugs of Madhura Skandha 26 27may also be employed

According to Vagbhata, Sneha prepared with Snigdha and Madhura drugs or with

the drugs described useful for that particular disease should be used. Exudations of

certain trees, meat soup and blood also may be administered. 28


Review of nasya

3. SHAMANA NASYA:

It is used for the alleviation of Dosha situated in Shirah (head). Shamana Nasya

has been described by Charaka and Vagbhata only. It may be correlated with Snehana

and Marsha-Pratimarsha. The Sneha prepared with the beneficial drugs may be used for

Shamana Nasya

Table No.4 Showing the Contra Indications of Nasya

Si.no: Nasya anarhas Charaka Sushruta Vagbhata

1 Bhuktabhakta + + +

2 Ajirni + + -

3 Pita Sneha + + +

4 Pita Madhya + + +

5 Pita Toya + + +

6 Snehadi Patukamah + - +

7 Snatah Shirah + - +

8 Snatukamah + + +

9 Kshudarta + - +

10 Shramarta + + -

11 Matta + - -

12 Murcchita + - -

13 Shastradandahrita + - -

14 Vyavayaklanta + - -

15 Vyayamaklanta + + -

16 Panaklanta + - -

17 Navajvara Pidita + - -


Review of nasya

18 Shokabhitapta + - -

19 Virikta + - +

20 Anuvasita + + +

21 Garbhini + + +

22 Navapratishyayarta + - -

23 Apatarpita - + +

24 Pitadravah - + +

25 Trishnarta + + +-

26 Gararta - + +

27 Kruddha - + -

28 Bala - + -

29 Vriddha - + -

30 Vegavarodhitah - + +

31 Raktasravita - - +

32 Sutika - - +

33 Shvasapidita - - +

34 Kasapidita - - +

Indications of Nasya:

Nasya therapy may be given in all diseases except in the conditions mentioned

earlier. The specific indications of Tarpana Nasya, Shodhana Nasya, Shamana Nasya,

Shirovirechana, Navana, Avapida, Dhmapana and Dhuma Nasya etc. have already

been discussed in the classification of Nasya, but Charaka had described the following

general indications where Nasya therapy should be used.


Review of nasya

1. Shirostambha 18. Mukharoga

2. Manyastambha 19. Karnashula

3. Danta Stambha 20. Nasa Shula

4. Danta Shula 21. Akshi Shula

5. Hanugraha 22. Shirahshula

6. Pinasa 23. Ardita

7. Galashundika 24. Apatantraka

8. Galashaluka 25. Apatanaka

9. Shukra Roga-Netragata 26. Galaganda

10. Timira 27. Danta Harsha

11. Vartmaroga 28. Danta Chala

12. Vyanga 29. Raji-Netra Roga

13. Upajihvika 30. Arbuda

14. Ardhavabhedaka 31. Svarabheda

15. Griva roga 32. Vaggraha

16. Skandharoga 33. Gadgadatva

17. Ansashula 34. Krathana …etc.

Course of Nasya Karma :

Nasya Karma may be given for seven consecutive days. In conditions like Vata Dosha in

head, hiccough, torticolitis, loss of voice etc. it may be done twice a day (in morning and

evening 29

The use of Nasya on 3rd, 5th, 7th and 8th day or till the patient shows the

symptoms of Samyak Nasya as stated in Ashtanga Samgraha30


Review of nasya

Bhoja says that if Nasya is given continuously beyond nine days then it will

becomes Satmya (adaptable) to patients and if given further, it neither benefits nor harm

to the Patients.

According to Sushruta, Nasya may be given repeatedly at the interval of 1, 2, 7

and 21 days depending upon the condition of the patient and the diseases he suffer 31

Charaka has not mentioned specific duration of the Nasya therapy, but suggested

to give according to the severity of disease.

Dose of Nasya Karma:

The dose of Nasya drug is depends upon the drug utilized for it and the variety of

the Therapy.

Charaka has not prescribed the dose of the Nasya. Sushruta and Vagbhata

have mentioned the dose in form of Bindus, here one Bindu means the drop which is

formed after dipping the two phalanges of Pradeshini finger.32

Drops in each nostril Table No.5.Showing Nasya Matra.

Si.no: TYPES OF NASYA Hrasva Matra

Madhyama Matra

Uttama Matra

1.

Shamana Nasya

8

16

32

2.

Shodhana Nasya

4

6

8

3.

Marsha Nasya

6

8

10

4.

Avapida Nasya

2

2

2

5.

Pratimarsha Nasya

2

2

2


Review of nasya

According to Videha:

The common dose for Pradhamana Nasya is 3 Muchuti (here one Muchuti = the

Choorna which may come in between Index finger and thumb = 2.4 Ratti.)

Sharangdhara33 described the following dosage schedule for Nasya Karma.

• Tikshnaushadhi Choorna - 1 Shana (4 masha) (24 Ratti)

• Hingu – 1 Yava (½ Ratti)

• Saindhava – 1 Masha (6 Ratti)

• Dugdha – 8 Shana (64 Drops)

• Jala (Aushadha Siddha) – 3 Karsha (3 Tola)

• Madhura Dravya – 1 Karsha (1 Tola)

Administration of Nasya:

The procedure of giving Nasya therapy may be classified into the following three

headings:

1. Purvakarma (Pre-measures)

2. Pradhanakarma (Nasya therapy)

3. Paschatkarma (Post measures)

Purvakarma: Before giving Nasya, prior arrangement of the material and equipments

should be done. There should be a special room “Nasya Bhavana” free from direct blow

of air and dust; and lighted appropriately 34. In it the following articles should be

collected.

(i) Nasya Asana – (a) A chair for sitting purpose.

(b) A cot for lying purpose.

(ii) Nasya Aushadhi – Drugs required for the nasya karma should be collected


Review of nasya

in the form of Kalka, Choorna, Kwatha, Kshira, Udaka, Sneha, Asava, Dhuma etc.

insufficient quantity.

(iii) Nasya Yantra - For Snehana, Avapida, Marsha and Pratimarsha Nasya, there

should be a dropper or Pichu. For Pradhamana Nasya Shadangula Nadi and specifif

Dhuma yantra for Dhuma Nasya are required. Besides this one needs efficient assistant,

Dressing material, spitting pots, bowl, napkins and towels also.

• Selection of the patient: The patient should be selected according to the

indications and contraindications of Nasya described in classics.

• Preparation of patient: According to Sushruta’s description following regimens

are given to the patient to prepare him for Nasya Karma.

Diet should be given to the patient who has passed his natural urges like urine,

stool etc. After some time tooth brush (and other routine daily activities like bath, prayer,

light breakfast (not feel hungry) etc.) Should be done. Now the patient gets ready for

Nasya karma. He should lie down on Nasya Shayya. Before Nasya, Mridu Abhyanga

Should be done on scalp, forehead, face and neck for 3 to 5 minutes by medicated oil

like Bala Taila, Panchaguna Taila etc.34

Snehapana should not be given immediately before Nasyakarma 35 According to

Ayurvedic texts Svedana is contra indicated in Shiras. Mrudu Svedana may be given for

elimination of Doshas and liquefaction of Doshas.

Tapa Sveda may be given on Shira, Mukha, Nasa, Manya, Griva and Kantha

region. Cloth dipped in hot water may be useful for Mrudu Sveda. After Svedana smooth

massage should be applied on regions of Gala, Kapola and Lalata.


Review of nasya

2) Pradhana Karma : As described by Charaka 36 Vagbhata 37 and Sushruta 38 the

following procedure should be adopted for performing the nasya karma.

Nasya Karma.

The patient should lie down in supine position with ease and head should be

lowered i.e. hanging down slightly and foot part is to be slightly raised. Head should not

be excessively flexed or extended. If the head is not lowered, the nasal medication may

not reach to the desired distinction and if it is lowered too much, there may be the danger

cotton

ith

both the

either less nor more in the dose i.e. it should be in the proper

hould be followed. After administration of medication through nasal passage

patient should lie supine (Uttana) for about 2 minute time interval consumable for

of getting the medication to be lodged in brain. After covering the eyes with clean

cloth, the physician should raise the tip of the patient’s nose with his left thumb and w

the right hand the luke warm medicine (Sukhoshna drug) should be dropped in

nostrils in proper way.39.

The drug should be n

quantity. It should also be neither very hot nor very cold. i.e. it should be luke warm.

The patient should remain relaxed while taking Nasya. He should avoid speech,

anger, sneezing, laughing and head shaking during Nasya Karma. 40

3) Paschat Karma:

As described by Charaka 41 Ashtanga Hridaya 42 and Sushruta 43 following

regimen s


Review of nasya

countin

with the morbid Doshas,

re advocated to expel out the residue mucous

ed 47. One should

bath, r

a Karma 49.

A, AYOGA AND ATIYOGA OF NASYA KARMA:

sensorial happiness) and

p rovem si p sp n ez av n

ibe a 51 as the general symptoms of Sa aka Yo of N ya K a.

g numbers upto 100. After the administration of Nasya feets, shoulders, palms and

ears should be massaged 44. The head, cheek and neck should be again subjected to

sudation.

The patient should avoid swallowing of Nasya Aushadhi. The oil that has been

dropped in the nose may be repeatedly drained out together

specially mucous; should be eliminated by the patient by sneezing slowly and care should

be taken that no portion of the medicated oil is left behind 45.Patient should spit out the

excessive medicine which have come into the oropharynx 46.

Medicated Dhoomapana and Gandusha a

lodged in gullet (Kantha) and Shringataka. Patient should stay at windless place. Light

meal (Laghu Aahara) and luke warm water (Sukhoshna Jala) is allow

avoid dust, smoke, sunshine, alcohol, hot

iding, anger, excess fat and liquid diet 48. Day sleeping and cold water for any

purpose like Pana, Snana etc. should be avoided after Nasy

SAMYAKA YOG

After Nasya Karma the symptoms of its Samyaka yoga, Ayoga and Atiyoga

should be observed, which are being described here after.

Samyaka Yoga :

The symptoms of adequate Nasya according to Charaka, are Urah-shiro-laghava

Indriyavishuddhi and Srotovishuddhi50. In addition, Sushruta has described.

Sukhasvapna-prabodhana , Chitta-Indriyaprasannata (mental and

Vikaro ashama (Imp ent). Be des these roper re iration a d sne ing h e bee

descr d by Vaghbhatt my ga as arm


Review of nasya

Ta lb e N e Sa yak Yoga Lakshanas of Nasya

a. .Chi H.S .U.K P .

o.6 Showing th m

Si.no Symptoms Ch Su A. Sa B. Ka Bh

1. Urah Laghuta + -

-

-

+ -

-

2. Shiro Laghuta + + -

-

-

-

-

3. Netra Laghuta -

-

+ + - + -

4. Laghuta + + -

+ -

-

5. Srotovishuddhi + + -

+ + + -

6. Svaravishuddhi - + + - - - -

7. Vaktravishuddhi - + - - -

-

-

8. Indriyaachchta- + + + + + prasada

+ -

9. Netrateja Vriddhi

-

+ + -

-

-

10. Chitta Prasada -

+ -

+ + + +

11. Vikaropashama -

+ -

+ + -

+

12. Sukha Prabodha

Svapna -

+ + -

-

-

-

13. Sukhachchvasa -

+ -

-

-

-

-

14. Arati

+ - - - - - -

15. Medha -

-

-

-

-

-

+

16.

Bala - - - - - - +

Ayoga:

If Nasya is not administered properly or if the dose is less in proper way or the

ose is less, then it will cause certain complications. The Acharya has mentioned the

following general complications.

d


Review of nasya

Tab the oga L shana f Nasy

ymptoms Cha. u.Ch .H.S a.U. .P a. Bh

le No.7 Showing Ay ak s o a.

S Si

S A S

B K

1 Shirogaurava & urava

+ - + + + Dehaga

-

+

2 Galopalepa - - - +

+

-

-

3 Nishthivana

+ -

-

-

- -

+

4 Kandu - +

+

+ + -

-

5 Kaphapraseka - - -

-

-

-

-

6 Upadeha + -

+ +

-

-

-

7 Rukshata +

+ -

-

+

+ -

8 ya + -

-

-

-

Vata Vaigun

- -

9 Srotoriktata

-

-

-

- + -

-

10 Srotasam kaphasrava

+ - -

+ + + -

11 Nasa shosha

-

+ -

- -

-

12 Asyashosha - + -

-

-

-

-

13 Akshistabdhata

-

+ -

-

-

-

-

14 Shiroshunyata

-

+

-

-

-

-

-

15 Vyadhi Vridhdh - - - - - + -

Atiyoga :

Atiyoga of nasya also caused due to the improper administration .it is mainly due to

the ati matra of the drug or excessive potency of the medicine.


Review of nasya

Table No.8 Showing the Atiyoga Lakshanas of Nasya

Symptoms Cha. Si

Su.Ci

A.H.Su

Sa.U.K

B.P Ka. Bh

1. Shirogaurava

-

+

+

+

+

-

-

2. Shiroshunyata

-

+

-

+

+

-

-

3. Shirovedana

+

-

-

-

-

+

-

4. Netra Vedana

+

-

-

-

-

-

-

5. Shankhavedana

+

-

-

-

-

-

-

6. Suchitodavata Pida

+

-

-

-

-

-

-

7. Indriya Vibhrama

-

+

-

+

+

+

-

8. Mastulungaagama

-

+

-

-

-

-

-

9. Snehapurna Srotasa

-

-

-

-

+

-

-

10. Karna Talu Upadeha

-

-

-

-

-

-

-

11. Vata Vriddhi

+

-

-

-

-

+

+

12. Kandu

-

+

-

-

-

-

-

13. Praseka

-

+

+

+

-

-

-

14. Pinasa

-

+

-

-

-

-

-

15. Aruchi

-

-

+

-

-

-

-

16. Deha Daurbalya

-

-

-

-

-

+

-


Review of nasya

17. Unmada

-

-

-

-

-

-

+

18. Pitta Vriddhi

-

-

-

-

-

-

+

19. Hridaya Shula

-

-

-

-

-

-

+

20. Suryavarta Roga

-

-

-

-

-

-

+

21.

Atripti

-

-

-

-

-

-

+

Vyapada (Complications):

The patients after taking the Nasyakarma if does not follow the regimen given

above then the Prakopa of Dosha may again occur leading to many complications which

may be known as Vyapada 52. Many complications of Nasya Karma may occur due to(i)

administration of Nasya when it is contraindicated and (ii) due to technical failure.

These complications occur through following two modes.

(a) Doshotklesh which can be, managed by Shodhana and Shamana Chikitsa and

(b) Dosha Kshaya which has to be managed byBrimhana Chikitsa 53

If Nasya is given in the contraindicated conditions like Ajirna, Bhuktabhakta,

Jalapita etc. or in season or time where Nasyakarma is contraindicated e.g. cloudy

atmosphere, then there is possibility of production of Kapha Rogas like asthama, cough,

sinusitis and indigestion etc. In such conditions, the treatment should be done with

Kapha-nashaka Upachara like use of Ushna and Tikshna Aushadha and

Karma 54.

Mode of action of Nasya Karma :

The clear description regarding the mode of action of the Nasya Karma is not

available in Ayurvedic classics. According to Charaka, Nasa is the portal (gate way)


Review of nasya

of Shirah 55. The drug administered through nose as Nasya reaches to the

brain and eliminates only the morbid Doshas responsible for producing the disease. In

Ashtanga Samgraha it is explained that Nasa being the gate way to Shira (heard), the

drug administered through nostrils, reaches Shringataka (a Sira Marma by Nasa Srota

and spreads in the Murdha (Brain)) taking route of Netra (eye), Shrotra (ear), Kantha

(throat), Siramukhas (opening of the vessels) etc. and scratches the morbid

doshas in supra clavicular region and extracts them from the Uttamanga56.

Sushruta has clarified Shringataka Marma as a Sira Marma formed by the union

of Siras (blood vessels) supplying to nose, ear, eyeand tongue. It has been further

pointed out that injury to this Marma maybe fatal immediately 57.

Commentator Indu of Ashtanga Samgraha opined Shringataka as the inner side of

middle part of the head i.e. Shiraso Antarmadhyam.Under the complications of Nasya

Karma Sushruta noted that the excessive eliminative errhine may cause Mastulunga

(Cerebro spinal fluid) to flow out to the nose 58.

According to all Acharya Nasa is said to be the portal of Shira. It does not mean

that any anatomical channel connects directly to the brain but it might be connected

Pharmacodynamically through blood vessels or through nervous system (olfactory

nerve etc.) It is an experimentally proved fact that where any type of irritation takes

place in any part of the body, the local blood circulation is always increased. This is

the result of natural protection function of the body. Something happens when

Provocation of Doshas takes place in Shirah due to irritating effect of administered

drug resulting an increase of the blood circulation of brain. So extra accumulated

morbid Doshas are expelled out from small blood vessels and ultimately these morbid


Review of nasya

Doshas are thrown out by the nasal discharge, tears and by salivation.

The anatomical point of view there is no such direct pharmacodynamic

considerations between nose and cranial organs. Moreover blood brain barrier is a strict

security system that human brain has. The nose is used as a route of drug administration

for inhalation of Anesthetic materials and certain decongestants for Para nasal sinusitis.

Anterior Pituitary hormone nasal spray is in practice with modern medical system. Nasal

administrations of leutinising hormone and calcitonin are found to be equally effective as

intravenous infusions in maintaining blood concentrations. Michael Russell (1977) has

observed that perspired scent that has been painted on the upper lips has caused the

synchronization of the menstrual cycle in female volunteers by contact smelling. An LRH

agonist nasal administration for 3-6 months was observed effective in inhibiting

ovulation as a contraceptive measure .The drugs are mostly believed in these Cases to be

absorbed through nasal and pharyngeal mucosa. Anand (1979) has also attempted

contraceptive opined that the route is beneficial than systemic.

Samgraha opined Shringataka as the inner side of middle part of the head i.e.

Shiraso Antarmadhyam. Under the complications of Nasya Karma Sushruta noted that

the excessive eliminative errhine may cause Mastulunga (cerebro spinal fluid) to flow out

To the nose. According to all Acharya Nasa is said to be the portal of Shira. It does not

mean that any anatomical channel connects directly to the brain but it might be connected

pharmacodynamically through blood vessels or through nervous system

It is an experimentally proved fact that where any type of irritation takes place in

any part of the body, the local blood circulation is always increased. This is the result of

natural protection functions of the body. Something happens when provocation of


Review of nasya

Doshas takes place in Shirah due to irritating effect of administered drug resulting an

increase of the blood circulation of brain. So extra accumulated morbid Doshas are

expelled out from small blood vessels and ultimately these morbid Doshas are thrown

out by the nasal discharge, tears and by salivation. The anatomical point of view there

is no such direct pharmacodynamic consideration between nose and cranial organs.

Moreover blood brain barrier is a strict security system that human brain has. The

nose is used as a route of drug administration for inhalation of anesthetic materials

and certain decongestants for paranasal sinusitis. Anterior pituitary hormone nasal

sprays are in practice with modern medical system. Nasal administrations of leutinising

hormone and calcitonin are found to be equally effective as intravenous infusions in

maintaining blood concentrations.

Michael Russell (1977) has observed that perspired scent that has been painted on

the upper lips has caused the synchronization of the menstrual cycle in female volunteers

by contact smelling. An LRH agonist nasal administration for 3-6 months was

observed effective in inhibiting ovulation as a contraceptive measure. The drugs are

mostly believed in these cases to be absorbed through nasal and pharyngeal mucosa.

Anand (1979) has also attempted contraceptive opined that the route is beneficial than

systemic administration. It was claimed that the concentration of drug in C.S.F was very

high to that when administered intravenously.

An experimental study on the inhibiting effect of Jasmine flowers on lactation

was also carried out by fragrance inhalation method proving beneficial on rats (Abraham

1979). Reduction in gland activity and reduction in serum prolactin was also noted.

Hypoglycaemic effects of insulin and hyperglycaemic effects of glucagons hormone


Review of nasya

are confirmed by intranasal administration in normal and in diabetic patients .Intranasal

gonadotropin hormone releasing hormone has been therapeutically recommended in

stimulating leutinising hormone secretion in cryptorchid boys. i.e. having undescended

testis. Scientist of the institute of medical sciences Delhi have proved after experiments

that the drug administered through nose shows effective action on the brain, so it can be

said that there is very close relation between Shirah and Nasa (nose).Thus to understand

the pathways of Nasya drug (classical errhine) acting on the central nervous system, it is

important to go in details of the modus operandi of Nasyakarma. On the basis of

fractional stages of the Nasya karma procedures, we can draw certain rational issue

that are as follows :

Effect on drug absorption and Transportation :

Keeping the head in lowered position and retention of medicine in nasopharynx

help in providing sufficient time for local drug absorption. Any liquid soluble substance

has greater chance for passive absorption directly through the cell of lining membrane.

On other hand, massage and local fomentation also enhances the drug absorption (Fingl.

1980).The later course of drug transportation can occur in two ways.(i) By systemic

circulation (ii) Direct pooling into the intracranial region. The second way is more of

interest in our present study. This direct transportation can be assumed again in two

paths, viz.

(a) By vascular path, (b) Lymphatic path.

Vascular path transportation is possible through the pooling of nasal veinal blood

to the facial rein, which naturally occurs. Just of the opposite entrance the inferior


Review of nasya

Ophthalmic veins also pool into the facial vein. Interestingly, both facial and

Ophthalmic veins have no venial valves in between. So that, blood may drain on

either side, that is to say the blood from facial vein can enter cavernous venous sinus

of the brain in reverse direction. Thus, such a pooling of blood from nasal veins to

Venous sinuses of the brain are more likely in the head lowered position due to gravity.

On this lines, the absorption of drug materials into meninges and related parts of

Intra cranial organs, is a worth considering point. Moreover the modern scholars have

noted that the infective throbosis of the facial vein may lead to infection of the

meninges easily through this path Pooling of blood from Para nasal sinuses also possible

in the same manner.

Vagbhata’s notation of Shringataka Srotas (anterior cranial fossa) seems to

relation with the above explanation. Drug transportation by lymphatic path, can reach

direct into the C.S.F. it is known that the arachnoid matter sleeve is extended to the sub

mucosal area of the nose along with olfactory nerve. Experiments have shown that the

dye injected to arachnoid matter has caused colouration of nasal mucosa within seconds

and vice versa also (Hamilton 1971).

Preliminary studies reported from AIMS. Laboratories clearly showed that

steroids enter the C.S.F. rapidly following their Administration as a nasal spray.

Surprisingly their levels in the C.S.F was found to be much higher as compared with

systemic injections

On the basis of the foregoing observations it can be stated that the procedures,

Postures and conducts explained for Nasya Karma are of vital importance in drug

absorption and transportation. The facts discussed here are also convincing about the


Review of nasya

Definite effect of Nasyakarma in the disorders of central nervous system, mental and

Some endocrinal disturbances also. Such type of description – mode of actions mentioned

only in Ayurveda, modern sciences try to use of Nasya Karma but in comparison of the

Ayurveda.

The effect of Nasya not found till today.Nasya Karma as per the opinion of

Ayurvedic texts, not only the treatment of the disease but, many types of Nasya Yoga

described in Ayurveda for maintenance of healthy life. Pratimarsha Nasya Karma can be

used in all age group, so one can assess the importance of the Nasya Karma.


Review of Dhara

Historical Review of Dhara:

Etymology:

The word Dhara is derived from the root ‘Dhru’ with the suffix ‘Nich + Ang + Tap’ and

is feminine gender.

Derivation of Dhara:

1) Dharyate Yaya

2) Dharyante Tatra Anaya

3) Ghatadi Chhidra Santatam Drava, Dravyasya Santatya Patane

(Shabdastoma Mahanidhi).

It means a continuous flow of liquid from the hole of the pot.

Synonyms:

•Dhara

•Seka

• Parisheka

•Avasheka

•Sechana – Sinchana

•Prasechana

SHIRODHARA

Shiro dhara otherwise called murdha dhara is one of the special type of treatment

and is also known as component of keraliya Panchakarma.In classics there is not much

references regarding Shiro dhara only casual references are available the detailed

description of dhara karma is mentioned in Dharakalpa a book on keraliya Panchakarma

but the original authorship of which is not known. The manuscript first available in


Review of Dhara

Malayalam published through ayurvediya granthamala of Bombay rewriting it in

Sanskrit. the same is republished with hindi commentary of shukla j.p (1980) through

sudhanidhi granthavali. The same verse of dhara karma is also available in sahasrayoga.

Pouring of a liquid on the forehead or scalp is known as the Shirodhara, it can be done by

different medicaments like Taila, Takra, Kshira, Kwatha, etc Gunaprada When it done

with ksheera it is called ksheera dhara, with jala it is called jala dhara and with thakra it is

Called thakra dhara’. When it is done with medicated Ghee or Taila, it is called Taila

Dhara This Taila Dhara is included in the varieties of Murdha Taila, which are

Abhyanga, Seka, Pichu and Basti. They are told ‘Uttarottar. Dhara is not only used in

Psychic disease but also used in psychosomatic diseases like IBS (Irritable Bowel

Syndrome), psoriasis etc.

INDICATIONS

Shirodhara is one of the allied Panchakarma procedures. It can be applied to

rejuvenate body and mind alleviating Chintadi Manasika Bhavas, which induce

psychosomatic disorder. Shirodhara calms the mind and relaxes entire physiology thus,

helps to alleviate Stress, strain, anxiety etc. By drug specific shirodhara, various diseases

can be dealt with effectively. In the pathophysiology of chittodvega, Vata Dosha is

mainly affected and the Kshira is having Shita, Snigdha and Vata-Pitta-Rakta shamaka

properties59. Acharya Charaka has also mentioned Kshira as Shita, Snigdha and Vata-

Pitta shamaka60. Moreover, Kshiradhara is also indicated in “Dharakalpa” for psychic

conditions like Anidra. Therefore, shirodhara with milk i.e. Kshiradhara has been

selected for present Study.


Review of Dhara

PURVA KARMA:

Purva Karma is related with the preparation of the patient. First it should be

confirmed that the patient is fit for Shirodhara or not. Following equipments should be

prepared.

• Droni (Dhara Table)

• Sharawa (Dhara Patra)

• Other requirements like cloth piece, cotton, pot etc.

It is advisable for the better results that the hair of the patient on the scalp should be

removed if the patient permits. The patient should pass stool and urine. Then patients

Pulse, temperature and blood pressure should be recorded.

Position of the Patient:

Proper posture of the patient for Shirodhara is supine position and Dhara Patra

should be brought 4 inches above his head. The eyes and ears should be covered with

cotton so that Liquid may not enter in eyes. His head rests in slightly elevated position,

preferably on Wooden piece.

Droni:

For Shirodhara a special type of table is used and it is known as Droni (vessel).

The table is made up of wood with raised edges in all the four side so that the oil may not

flow out. In this table arrangement are made at the head end so that the oil poured may be

collected in another vessel and may be reused.


Review of Dhara

Dimension of Droni:

The construction of Droni is explained here by converting the ancient

measurements into Contemporary one. The length of Droni may be 7 feet breadth 2½

feet, the height 2½ feet. On all the sides of the table, 3 inches elevated boundary is

constructed towards the side of the head, 2½ feet one horizontal midline strip of wood

may be constructed, by which Table is divided into 2 parts. This small portion of the table

towards the head end is used for Shirodhara. In the middle 3 inches from the horizontal

line a circular metallic plate of having 6 inches diameter with a central hole may be fixed.

This arrangement may be the made to collect the oil in a vessel for its reuse. Above

Shirodhara portion of the table, the Dhara Patra should be suspended with the help of a

strong wire to enable liquid to fall from the proper distance.

Dhara Patra:61

Dhara Patra is a vessel in which liquids used for Shirodhara are put in. It is

prepared from Brass, steel, clay etc. The mouth of the vessel should be wide and sides are

tapering gradually to a ventral point in the bottom. At this point a hole may be made

approximately of little finger size. The depth of vessel may be 5 to 6 inches. The

Capacity of the vessel may be 2 Prastha. Inside the vessel a small wooden bowl having a

Central hole should be put inversely so as to both holes of the vessel come in the medial

line. In this small vessel a wick should be entered passing through the both holes and

hanging down from the big vessel so as to maintain a continuous flow of liquid.

The length of the wick outside the vessel should be 4 inches. The upper end of the

wick should have knot to prevent slipping from the vessel. The Dhara Patra should be

hanged just above the forehead of the patient. The end of the wick should be 4 fingers


Review of Dhara

(3inches) above the forehead of the patient. The vessel is kept refilled with the

recollected liquid. On the upper edge of the vessel, 3 holes should be made to hang it in a

horizontal plane to avoid spillage.

Aushadha (Drug): 62

The drug should be selected according to the disease. The quantity required is

above 1 to 2 kg.

Sneha mentioned according to the condition of Doshas.

Vata Dosha: Tila Taila, Vataghna liquid

Pitta Dosha: Ghrita, cold water

Kapha Dosha: Tila Taila, not very hot, not very cold water

Rakta Dosha : Ghrita with cold water

Vata + Pitta + Rakta: Ghrita + Taila in equal proportion

Vata + Kapha + Rakta: ½ part Ghrita + 1 part Tila Taila

PRADHANA KARMA

The selected liquid should be kept in the vessel and should be poured

continuously and slowly on the forehead of the patient. A mild oscillation should be

given. So as to maintain the flow all over the forehead. This liquid gets collected in the

vessel, which is kept below the table, when the liquid in the vessel gets emptied, and then

it is replaced from the lower vessel.

Dharakalpa: 63

The patient having dryness and Pittayukta Vata, the period is 2½ Prahara or 2

Prahara and in Snigdha Kaphayukta Vata it is one Prahara, or it should be up to

perspiration Initiate. The patient has to remain in the laying posture on his back.


Review of Dhara

The treatment may be carried on daily for a period of 7 to 14 days, according to

the nature of the disease and the physical condition of the patient. Generally treatment is

done in the morning hours preferably between 7 to 10 p.m.

Period for Changing The Liquid : 64

When milk is used for Parisechana it should be changed every day. When

Dhanyamla is used, it can be used up to 3 days. Oil also should be changed at 3 days. In

the first 3 days; half of the oil used, for next 3 days later half of its used and on the 7th

day all the first and second half are mixed together, then it should be discarded

Temperature of the Sneha:

It should be Sukhoshna near about to body temperature.65

PASHCHAT KARMA

After completing Shirodhara the oil from the head should be removed by a piece

of cloth. Then the patient may be advised to drink ghee or medicated ghee according to

disease. His eyes should be washed with cold water, he should remove cough. He should

take mild wind. He should rest for sometime. Then remaining oil of the Dhara should be

massaged on the body. Then he should take bath with hot water. Then he should take

Perfume and light diet and he should drink water, which is Siddha with Vatanashaka

Aushadhi. He should take the hot meal. He should take Pathya up to 7 days. He should

not worry about his physical and mental condition.

For drinking purpose warm water boiled with Dhanyajiraka, ginger and cumine

seeds may be used. For washing and ablating purposes only warm water should be used.


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Pariharyani:

The patient should abstain from sexual intercourse as well as from any thought or

deed that may excite sexual desire, avoid physical exertions, mental excitement such as

anger, grief etc. and exposure to cold, sun, dew, wind, smoke or dust should also be

avoided. Riding on elephants or horses, walking, speaking too long or too loud and such

acting that may give any strain to the system must be avoided. Sleeping during daytime

and standing continuously for long period must also be avoided. It is also advisable to use

a pillow which is neither very high nor very low, during sleep at night

During the course of the treatment, the patient should be cheerful and happy and

should avoid wearisome exertions, distasteful diet or excessive indulgence in tasty foods.

He should wear clean and dry cloths and may have ‘Lepans’ of Sandal wood paste. 66

Pariharakala:

He should take Pathya and remain as Jitendriya up to the period which is taken for the

Completion of Dharakarma

Dhara Dosha:

If Dhara is done from more height, very early or very slowly then it may produce

burning in body, pain in all joints, bleeding tendency, Jwara, Kotha etc.For the treatment

of Dhara Dosha, following measures may be adopted.

1) Gandusha

2) Nasya

3) Kashayapana with Sunthi

4) Light diet at evening, Yusha with black pepper.

5) On the third day Basti should be given in which Saindhava is mixed.


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Histrocal Review of Disease:

The term chittodvega comprise of two words i.e. chit and udvega

Citta: It is derived from root “Cit” which denotes the following meanings:

To perceive, fix the mind upon, attend to, and be attentive, to observe, take notice of,

to aim at, intend, to be anxious about, care for, to resolve, to understand, comprehend,

know, make attentive, remind of, 67

Addition of “Kta” Pratyaya to Cit i.e. Cit + Kta leads to Citta, which has

Following meanings according to the two Sanskrit - English dictionaries:

- observed, perceived

- considered, reflected or meditated upon

- resolved

- intended, wished, desired

- visible, perceptible

2) According to the dictionary of Sir Monier Williams:

- thinking, reflecting, imagining, thought

- intention, aim, wish

- the heart, mind

- memory, intelligence, reason

Udvega68: It is derived from root “Ud” which has following meanings –

- superiority in place, rank or power, up, upwards, upon, on, over, above

- separation, disjunction, out off

- motion upwards

- publicity


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- wonder, anxiety

- liberation

- blowing expanding, opening

- acquisition, gain

Addition of “Vin” Pratyaya to “Ud” i.e. Ud + Vin leads to Udvega, which has the

following meanings:

- going swiftly, an express messenger, a runner, courier

- steady, composed, tranquil

- ascending, mounting, going up or upward

- trembling, waving, shaking

- agitation, anxiety

- regreat, fear, distress

- admiration, astonishment

Terms References;

Ayurvedic classics has mentioned many words related to mental status, which are as

follows:

Terms

Cittavibhramsha (mental decadence) 69, 70, 71

Cittavibhrama (mental perturbation) 72

Cittanasha (loss of conscious) 73

Cittakshobha (mental agitation) 74, 75

Cittaviparyaya (misapprehension of mind) 76

Cittavilobhana (mental seduction) 77


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Cittopaplava (mental adversity) 78, 79

Asvastha Citta (mental discomfortness) 80, 81

Anavasthita Citta (unstable mind) 82

Tapta Citta (anger mind) 83 84

Unmat Citta (furoreous mind) 85 86

Bhrant Citta (confused mind) 87 88

Abhihat Citta (strucked mind) 89 90

Upahat Cetas (afflicted mind) 91 92

Vipluta Cetas (dispersed mind) 93 94 95.

Pranasta Cetas (perished mind) 96.

Cittodvega (anxious mind) 1.

References about Udvega-in Ayurvedic texts:

Garbha lakshana 97

Katu Rasatiyoga 98

Stambhana Atiyoga 99

Andhaputana graha 100

Bala graha 101 102

Bhutabhisangaj Jvara 103 104

Rasagata Jvara 105

Mukhamandita graha 106

Pishaca graha 107

Putana graha 108

Sheeta putana graha 109


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Skanda graham 110 111

Unmada Poorvarupa 112,113

Unmada arista 114

It is evident from the forgoing references that the Acarya knew different forms of mental

status. Among all these terms, only Cittakshobha, Asvastha Citta, Anavasthita Citta, and

Cittodvega are indirectly towards the meaning of anxious status. However, Cittodvega is

more applicable term to illustrate whole anxious status.

Cittavibhramsa (mental decadence)

Vagbhata has explained chitta vibhrama while explaining the trishna samanya

lakshana and susrutha in jwara pratisheda while explaining about kamaja jwara.

Cittanasa (loss of conscious)

Acharya susrutha has explained about chittanasha while explaining about the

apasmara.

Cittakshobha (mental agitation)

Acharya vagbhata has mentiond while explaining about the madathyaya chikitsa.

Cittaviparyaya (misapprehension of mind)

Acharaya susrutha has explained about the chittaviparyaya while explaining about

the arochaka chikitsa.

Cittavilobhana (mental seduction)

Acharya vagbhata has mentiond while explaining about the madathyaya chikitsa.

Cittopaplava (mental adversity)

Acharya vagbhata has explained about chitta plava while describing the guna of

Madhya.


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Asvastha Citta (mental discomfortness)

Acahraya vagbhata has explained about asvasta chtta while explaining about the

lakshanas of paishaja graham in bhoota vijnaneeya and susrutha while explaining the

unmada chikitsa.

Anavasthita Citta (unstable mind)

Acahrya charaka while explaining about Vataja vikaras in maharoga adhyaya.

Tapta Citta (anger mind)

Acarya charaka described about tapa chitta while explaining about jwara.

Unmat Citta (furoreous mind)

Acharya charaka explained unmatta chitta while describing the poorvaroopa of

unmada.

Bharant Citta (confused mind)

Achraya susrutha has explained about the bhranta citta while explained about

apasmara poorvaroopa and acahrya charaka in madathyaya chikitsa.

Abhihat Chitta (strucked mind)

Acahraya susrutha has explained about the upahata chetas while explaining about the

nidana of apasmara.

Uphat Chetas (afflicated mind)

Acahraya charaka while explaining about the unmade nidana and in pandu roga

chikitsa.

Vipluta Cetas (dispersed mind)

Acahraya vagbhata has explained about vipluta manas while explaining the unmada

pratisheda and Acharya susrutha while explaining about arochaka .


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Pranasta Cetas (perished mind)

Acharaya charaka explained pranashta cheats wile explaining about the hikka

chikitsa.

Manovikshobha (mental agitation)

Acahraya vagbhata has explained about manovikshoba while explaining the

madathyaya chikitsa.

Manokshata (mental impairment)

Acahraya susrutha has explained about the mano vikshobha while explaining about

the unmada.

Manoabhighata (affected mind)

Acarya charaka has explained manoabhighata while explaining about the unmada

nidana.

Cittodvega (anxious mind)

Acarya charaka has mentioned the word chittodvega while explaining about the

manasa doshas rajas and thamas in roganeekam vamanam.

It is evident from the forgoing references that the Acaryas knew different forms of

mental status. Among all these terms, only Cittakshobha, Asvastha Citta, Anavasthita

Citta, Tapta Citta, Manvikshobha and Cittodvega are indirectly towards the meaning of

anxious status. However, Cittodvega is more applicable term to illustrate whole anxious

status. So in this study the term ‘Cittodvega’ is compared with General anxiety disorders.


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Disease Review:

The brain and the mind

When thinking about the brain we have in mind an organ made up of nerve cells

(the neurons), synapses (connections between neurons), chemical messengers

communicating information between neurons (neurotransmitters), receptors, multiple

inter neuronal connections, and circuits. When we talk about the brain we use the precise

specialist language of the basic sciences—mathematics, chemistry and physics,

molecules, proteins, electrical potentials—the world of matter which can be manipulated,

cut, separated into pieces, and analyzed.

For hundreds of years we have had a clear-cut separation of these two concepts,

that of the brain or matter occupying space and time, and the other of the mind or spirit

occupying time and being only individually experienced and therefore unique.115

The brain is no longer viewed in such coarse terms of simple matter as conceived in the

eighteenth century. Today we know that the brain is a continually changing organ, in its

structure as well as its function. But what about the mind in this constant flow of

information in the brain? Is it that the brain and its activity produce or cause what we call

mind? Mind does not exist in the sense of being a real entity or global concept capturing

a static or permanent thing. ‘Mind is the neural tissue sewn with the threads of time

Needless to say, for most neuroscientists mind is not a spiritual, immaterial entity, nor a


Review of Disease

product emerging or caused by the brain and different from the brain. Mind is the activity

of the brain itself—nothing more, nothing less.

In this process of evolution of the human brain, the most spectacular part has

been, without any doubt, the extraordinary development of those parts of the brain called

the association areas. These brain areas, not directly related to sensory or motor control,

seem to develop in parallel to the acquisition of mental capacities. During evolution these

areas of the cerebral cortex—prefrontal and parietotemporal cortices—have selectively

increased in volume and in the number of neurons (the so-called extra-neurons, damage

to which does not affect sensory or motor processes). It has been estimated that in such

areas, through evolution, the chimpanzee has accumulated 3.4 billion neurons, the

australopithecines 4.1 billion neurons, Homo habilis 5.5 billion neurons, Homo erectus

7.0 billion neurons, and Homo sapiens 8.5 billion neurons. How then can we not think

that there is an intimate relationship between brain and mind?

Each person is different from another because of his discriminatory, creative and

intuitive mind. Mind is a special gift to mankind, which is very complex in nature. It has

potentiality to act mainly as dual nature. It is creative as well as destructive, positive as

well as negative, active as well as dull, happy as well as sad. All these entities are well

balanced by mind knowingly or unknowingly to people in their life. But this balancing

nature of mind nowadays is getting deprived under the influence of growing stress and

strains in life. Intellect, thinking power, memory, temperament, behavior, socia1 attitude,

etc., of an individual depends upon mental faculties.

Acharya Vagbhata indicated these stressors of psyche and soma by using the term

‘Ādhi’. Along with various morbid conditions of mind Ādhijonmada is also explained by


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Vagbhata as Ādhi is explained ‘Dhanakanthadi nasena’. Emotional and behavioral

symptoms may occur in response to stressful life events. Stressors may be single such as

a divorce, or the loss of a job, or multiple such as the death of an important person

occurring at the same time as once own physical illness and loss of a job. Stressors may

be recurrent such as seasonal business difficulty or continuous, such as chronic illness, or

living in poverty. Specific developmental stages such as- beginning school, leaving

home, getting married, becoming a parent, failing to achieve occupational goal and

retiring etc. are often stressors which may manifest in the form of any stress related

disorder.

SHIRAH (HEAD) - THE SUPREME ORGAN

The Shirah is the supreme of all the organs because it is considered as uttamanga

i.e. supreme, important and major part of the body.116 It is that part of the body where the

life along with sense faculties resides. In the head are set, as rays in the sun, the sense

organs and the channels carrying the sensory and vital impulses.117

As regards the vital organs situated in the trunk, Shirah is considered as one of the

three important vital organs i.e. since the existence of the body is dependent upon

them.118Sankhya and Kumarshira Bharadwaja emphasized that head of the foetus

develops first, because it is the site of all important indriyas (faculties).

Injury to Shirah may lead to death of the patient 6 or it may lead to Rigidity of the

sides of the neck, facial paralysis, agitation of the eyes, stupefaction and constricting pain

in the head, loss of movement, cough, dyspnoea, trismus, dumbness, stuttering speech,

closed condition of the eye-lids, twitching of the cheeks, yawning fits, ptyalism, aphasia

and facial asymmetry 119


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Vagbhata has compared the human being with a tree with the roots at the top and

branches, below and defined head as a site where all senses along with the vital breath

(Prana) reside. Thus it is supreme of all organs, as consciousness is present in it. Hence, it

requires prime protection.

Aharya bhela has described that manas is situiated in between Shiras and talu.

Manas: 120 121 122

Synonyms of Manas:

According to seat : Hridayam, Hrnmanasama

According to function : Prajna(accommodator of super senses)

Smriti (restores knowledge)

Mahamati (super-most analyzer)

Sattvam (express the presence of Atma)

According to relation : Svantam (closely related to Atma)

According to shape :Anangakam (non-morphological entity)

According to action : Citta (thought process)

Purvabdhikhyatih

(carrier of previous deeds)

Others : Eswarah (god, owner)

Brahma (the soul)

CHARACTERISTICS OF MANAS:

Anutvamatha Caikatvam Dvau Gunau Manasah Smrtau 123


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Anutvam (atomic dimension) and Ekatavam (uniqueness) are considered to

be the two characteristics of the Manas.

These are very basic characters of the mind, if it were not so, all kinds

of perceptions would have occurred at a time.

Other characteristics or properties of manas are:

Manas is said to be Suksma

Manas is Dravya 124

It is Karana or instrument of Atma

It is one of the 24 or 25 tattvas from which Purusa is derived. 125

It is one among the Adhyatma Dravya Samgraha 126

The three Mahaguna Sattva, Rajas, Tamas are said to be the guna

of manas or they are imposed on Manas (Matsya Purana)

It is Acetana but does functions by getting Cetana from Atma 127

It is dual faculty i.e. Ubhayendriya –both sensory and motor.

Manas is considered as one of the Antahkarana Catustaya

(Sharirikopnisada)

Manas is considered as Atindriya, as it is subtle than Indriya and is considered

to be superior than Indriya128

Cancalatva (unstability) is a characteristic of Manas

(Bahopanisada)


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Manas is Avyapaka

Functions of Manas: 129

Indriyabhigrahah Karma Manasah Svasyanigrahah I

Uho Vicarasca …………………………………………IIn

Indriyabhigraha (control of sense organs), Svasyanigraha (self restraint),

Uha (hypothesis) and Vicara (consideration) represent the functions of mind.

1. Indriabhigraha:

Manas send the impulses and inspirations to the cognitive senses and facilitate

them for the perception of objects.

2. Svasyanigraha:

Controlling of own functions or self-restrain is another function of

Manas. As Manas is called Cancala130 it is necessary to have Svasyanigraha

for the perception of desired objects and retraction from those after the

purpose is fulfilled and from those unwanted.

3. Uha:

Chakrapani explained that Uha means, knowledge of perceived objects, which

produced by complete analysis by mind.

4. Vichara:

Chakrapani stated that thinking upon perceived object for its reception

(Upadeya) or rejection (Heya) is Vichara.


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Other than this, Manas stimulates the Karmendriya to perform their

functions. Also, to feel different types of emotions and their manifestations

over body is under the purview of Manas only.

Manovaha Srotas: 131 132 133 134

Charaka has mentioned that, the channels of the whole body transport

the Tridosa, similarly Manas is transported through the same channels to

provide Chetana to all the living cells of the body and it is called Manovaha

Srotas in Ayurvedic texts, but separate description regarding this topic is not

available in texts.

Chakrapani explains that Manovaha Srotas is spreaded all over the

body, but the main location of Srotas can be considered as Hridaya and ten

Dhamanis, which are related with Hridaya. In the context of Unmada and

Apasmara, Caraka has mentioned about Manovaha Srotas, but also in other

contexts like Mada, Murccha, and Sanyasa different other terms like

“Cetanavahi Srotas,” “Samjnavahi Srotas” are used. These terms can be

taken as synonyms for Manovaha Srotas.

Generally, the functions of Manas are categorized under these aspects.

1. Cognitive Functions: To perceive the impulses and inspirations sent by the

sensory faculties i.e. acquiring Knowledge.

2. Cognitive Functions: To stimulate the Karmendriya (Motor Faculties) to perform

the desired functions i.e. Motor expressions


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3. Affective Functions: To feel various types of emotions and their bodily

manifestations i.e. Manas Bhava.

In mental disorders, these functions are disturbed or impaired or perverted,

leading to various symptoms. When Cognitive functions are disturbed, there will be

symptoms associated with higher mental functions. e.g. Memory loss, delirium, loss of

orientation, etc.

Impairment in cognitive functions leads to behavioral symptoms e.g. inappropriate

laughing, crying, dancing, singing, etc.

In third category, impairment of the affective functions leads to emotional

symptoms e.g. Blunted affect, incongruent mood, elation, depression, etc.

Concept of Mind-Modern View

Mind is the psyche, the faculty, or brain function, by which one is aware of his

surroundings and by which one experiences, feelings and desires and is able to attend,

reason and make decisions 135.

Though the modern science has a credit of invention of theory of mind, but they

could not conclude this. There were several changes even in fundamental, in

psychoanalysis by attempt of various eminent the founder of psychoanalysis was made

attempt to illustrate the basic concepts of mind and psychoanalysis:

I. Topographic Model of the Mind: 136

The publication of “The Interpretation of Dreams” in 1900 heralded the Arrival of

Freud’s topographic model of the mind, in which he divided the mind into three regions:

the conscious system, preconscious system and the unconscious system.

Each system has its own unique characteristics


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(1) The Conscious: 137

The conscious system is the part of the mind in which perceptions coming from

the outside world or from within the body or mind are brought into awareness.

Consciousness is a subjective phenomenon whose content can be communicated only by

Means of language or behavior.

(2) The Preconscious:

The preconscious system is composed of those mental events, process and

contents capable of being brought into conscious awareness by the act of focusing

attention. The preconscious interfaces with both unconscious and conscious region of the

mind. To reach conscious awareness, contents of the unconscious must become linked

with words and thus become preconscious. The preconscious also serves to maintain the

repressive barrier and to censor unacceptable wishes and desires.

(3) The Unconscious: 138

The Unconscious system is dynamic. Its mental contents and processes are kept

from conscious awareness through the force of censorship or repression. The unconscious

is closely related to instinctual drives.

The unconscious system is characterized by ‘Primary Process Thinking’, which

has as its principal aim the facilitation of wish fulfillment and instinctual discharged.

The content of the unconscious is limited to wishes seeking fulfillment these

Wishes provide the motivation for dream and neurotic symptom formation.

II. Instinct Theory: 139


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After the development of the topographic model, Freud turned his attention to the

instinct theory. Instinct is a complex of unlearned responses characteristic of a species. In

Freud view, an instinct has four principal characteristics: source, impetus, aim and object.

Source: It refers to the part of the body from which the instinct arises.

Impetus: It is the amount of force or intensity associated with the instinct.

Aim: It refers to any action directed toward tension discharge or satisfaction.

Object: It is the target for this action.

Freud defined some instinct i.e. libido, ego, aggression, life and death instincts.

III. Structural Theory of the Mind:

The structural model of the psychic apparatus made by the three provinces – Id,

Ego and Superego – are distinguished by their different function:

1. Id: 140

Freud used this term to refer to a reservoir of unorganized instinctual drives.

Operating under the domination of the primary process, the id lacks the capacity to delay

or modify the instinctual drives with which an infant is born.

2. Ego: 141

The ego spans all three topographic dimensions of conscious, preconscious and

unconscious. Logical and abstract thinking and verbal expression are associated with

conscious and preconscious function of ego. Defense mechanisms reside in the

unconscious domain of the ego. The ego is the executive organ of psyche and controls

motility, perception, contact with reality and through the mechanisms of defense

available to it, the delay and modulation of drive expression.


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3. Superego: 142

The third component of the tripartite structural model is the super ego. It

established and maintains an individual’s moral conscience based on a complex system of

ideals and values internalized from parents. It then serves as an agency that provides

ongoing scrutiny of a person’s behavior, thoughts and feelings; makes comparisons with

expected standards of behavior and offers approval or disapproval. These activities occur

largely unconsciously

IV. Theory of Anxiety: 143

After the development of structural model, Freud developed a new theory of a

second type of anxiety that he referred to as signal anxiety. In this model, anxiety

operates at an unconscious level and serves to mobilize the ego’s resources to avert

danger. Either external or internal sources of danger may produce such a signal that leads

the ego to marshal specific defense mechanisms to guard against or reduce the degree of

instinctual excitation.

Genes, the brain, and the mind:

In a recent review regarding genes, behavior, and the mind, Kandel has stated:

There can be no changes in behavior that are not reflected in the nervous system and no

persistent changes in the nervous system that are not reflected in structural changes on

some level of resolution. Everyday sensory experience, sensory deprivation, and learning

can probably lead to a weakening of synaptic connections in some circumstances and a

strengthening of connections in others.

Nidana of chittodvega:


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The main Dosas of the Manasa are Rajas and Tamas144 Hence the Nidana, which

vitiate Rajas and Tamas, may be considered as etiological factors of Chittodvega.

Following three factors are responsible for the all physical and mental diseases

1. Asatmendriyarthasamyoga145 146

2. Prajnaparadha

3. Parinama

ASATMENDRIYAARTHA SAMYOGA: 147

Sensory perceptions which are not congenial with sensory organs called

asatmendriyartha Samyoga. In short it is called unwholesome contact with the objects.

They may be in the form of atiyoga (excessive or over utilization), ayoga (hypo

utilization or non utilization) and mithyayaoga (non judicial or wrong utilization).

Indulging in activity excessively (atiyoga), wrong utilization (mithyayoga), and non

utilization (ayoga) with regards to karma is also considered causes for the mental

disorders.

PRAGNAPARADHA148

An action carried out with non justifiable understading due to dhivibramsa

(impairment of intellect), dhritivibramsa (impairment of will) and smritivibramsa

(impairment of memory) is termed as prajnaparadha. Further due to involvement of rajah

and tamas dosha the emotional state like kama, krodha, bhaya, irshya etc. considered

under prajnaparadha become etiological factors for the mental disease.

It may be of three types

1. kayika (physical activites)-related to body.

2. vachika (speech)-related o speech


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3. manasika (mental activities)-related to manas/mind.

According to Charaka Dhivibramsa (impairment of intellect), Dhrtivibramsa

(impairment of will) and Smritivibramsa (impairment of memory) are the main causative

factors of the mental disorders, which lead to evil Karmas, this stage is defined as a

Prajnaparadha. It causes various types of physical and mental disorders. Some of the

examples of Manasika Prajnaparadha which leads to mental disorders are –over affliction

of mind by Kama, Krodha, Bhaya, Moha, Shoka, Cinta, and Udvega / Cittodvega149 150

To highlight the importance of Prajnaparadha, it is stated in the

context of Manasroga that neither the God, nor the Gandharva, nor Pishaca,

nor Raksasa afflict the person who himself is free from misdeeds 151.


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PARINAMA

Advent of the maturity of the results of Kala (time factor) and Karma (action) is

considered as the second cause of mental disorders. Ayurveda holds that results of all

misdeeds will mature in time and when time matures the person will be afflicted with

particular disorder. It is seen that all mental disorders have a phase of excitement,

remission, etc. and a relation between lunar phase and mental disorder is well

documented, but what about the mind? For perceptions, emotions, thoughts, memory,

consciousness, and self-consciousness we are concerned with intimate and subjective

entities that are elusive or difficult to grasp or measure. In this context we use a different

language, that of psychology.

Concept of Mind:

Ayurveda, the science of life, effectively explains about Manas and its functions

and lays emphasis on the need of overcoming the impediments like, Kama (Desire),

Krodha (Anger), etc. which are reflected in the form of psychological illnesses and also

prescribes methods to ward off them effectively.

In today’s metaphysical society, human life has become speedy, mechanized, less

effectious and more centered, which contribute to more production of Kama (Desire),

Krodha (anger), Lobha (greed), Bhaya (fear), Shoka (Grief), Cinta (Worry) and Irsa

(envy) etc. like Manas Vikara.

The symptoms of Ojoksaya described by Caraka like Bibheti, Durbala, Dhyana,

Vyathitendriya 152 are the common symptoms of anxiety. So the etiological factors for

Ojoksaya may be taken as causative factor for Cittodvega. Also some etiological factors


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for Jvara, giving rise to Vaicitya, Arati, Glani, Manastapa may be taken as Nidana for

Cittodvega 153

Likewise Preenana is the main function of Rasadhatu, Preeti is of the Majja, and

Shukra is responsible for Harsa and Dhairya, which are impaired in Cittodvega. This

gives the clue about the involvement of many Srotas in the pathogenesis of Cittodvega.

This different Srotodushti due to psychological factors is responsible for wide range of

symptoms of Cittodvega. e.g. excessive thinking leads to Rasavaha Srotodusti

(Cintyanam aticintanata). Other than this, different causative factors described for

Unmada may also responsible for genesis of Cittodvega. The Poorvarupa of Unmada

described by Caraka, gives clear idea about the symptoms of anxiety disorders or

Cittodvega

Etiology:

The cause for G.A.D is unknown, both biological and psychological factors will work

together.

Genetic factors-154 In a family study that used DSM-III criteria, GAD (but not other

anxiety disorders) was five times more prevalent (19.5 per cent versus 3.5 per cent)

among first-degree relatives of patients with GAD than among relatives of controls.

However, two twin studies using the same criteria found concordance rates for GAD

were no higher among monozygotic than dizygotic twins. Two subsequent studies that

used DSM-IIIR criteria found a shared heritability for GAD and mood disorders.


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At present, it appears that genetic factors play a modest role in the etiology of GAD, and

one that is more closely related to vulnerability for depression than for other anxiety

disorders generalized anxiety. The genetics of six neurotic disorders: a twin study.

The avoidance theory of worry outlined specific ways in which individuals with

GAD rely on worry as a cognitive avoidance strategy. Feared internal experiences, such

as aversive imagery, physiological arousal and intense emotion, are avoided in addition to

undesirable future outcomes. Building upon this theory, Mennin and colleagues (2004)

proposed that individuals with GAD suffer from deficits in emotion regulation skills and

therefore engage in such cognitive avoidance maneuvers to regulate their emotional

experience. Cholecystokinin neuropeptides (CCK-4 and CCK-8S) have been implicated

in the genesis of arousal and fear responses. It is unclear how those effects are mediated;

however cholecystokinin interacts with several neurotransmitters and systems believed to

be involved in anxiety responses, including the noradrenergic nervous system, the

hypothalamic–pituitary–adrenal axis, the benzodiazepine–GABA system, and serotonin.

Samprapti:

Acharya Vagbhata states that, the way in which the Dosa get vitiated and the

course it follows for the production of disease is called as the Samprapti. It is very

important in the treatment of disease because proper disintegration of Samprapti is called

as Chikitsa. There is no direct description of Samprapti of Chittodvega in Ayurvedic

texts, although it is included under Manovikara. Samprapti of Chittodvega may be traced

out by considering the general principles and multi factorial Nidana described earlier.


Review of Disease

In the pathogenesis of the disease the vulnerability in the form of positive family

history, Vataja and Rajas prakruti, Heena Sattva, fear prone personality, indulgence in the

misuse of Sadvritta, vitiated Dosa play an important role in predisposing to Cittodvega.

Emotions like Udvega, Chinta, Bhaya, Harsha, etc. are natural response to the viscitudes

of life, but persons having Sattvasarata or Pravara Sattva can resist the ill effects of such

emotions, due to the predominance of Sattva quality. On the other hand, persons having

Heena Sattva indulge in Prajnaparadha or are afflicted by Manobhighata of a recurrent

nature or is under stress, initiates the disease process by resulting an imbalance of

Manodohsa predominantly Rajas and also Sharirika dosha predominantly Vata. At this

stage, the patient exhibits an exaggerated response to emotional disturbances i.e. Udvega.

When the abnormality of manas dosa continues to exist for long duration, they

generate certain psychic symptoms such as Chinta (worry), Vyakulata (apprehension),

Bhaya (Fear), and Shoka (Grief). When this psychic response over ride a limit and

continues for a prolonged period, they start influencing the bodily dosha. At the

biological level, bodily Dosha especially Vata gets aggravated. On biological level, Vata

is the controller and promoter of mind, and Rajas the predominant manodohsa is having

direct relationship with Vata dosa. So at this stage bodily symptoms are predominantly

due to Vata dosha prakopa.

Out of the five subtypes of Vata, particularly Pranavata, Udanavata, and

Vyanavata get vitiated predominantly. Increased vitiation of Vata and Rajas leads to

Kapha kshaya and Sattva Guna Hrasa. In Cittodvega the main variety of kapha, which


Review of Disease

declines, is Tarpaka Kapha, resulting in the undernourishment of Indriyas. In Pitta dosa,

Sadhka Pitta gets vitiated, giving rise to symptoms such as Bhaya, Moha, Krodha, etc.

These vitiated Manodohsa and Sharirika Dosa move to Hridaya and vitiates it.

Due to Asraya- Asrayi Bhava, Manas also gets vitiated, as Hridaya is the site for Manas

(Cintadijustam Hridayam Pradusya-155 When this vitiation persists for longer duration, it

results in Ojoksaya, giving rise to the symptoms.

Dosha- Manasa- Rajah, Tamas

Sharirika - Vata-prana, udana, vyana.

Pitta-Sadhaka, Alochaka

Kapha-Tarpaka

Dusya - Mana, Sarvadhatu

Srotas- Especially manovaha srotas

Agni - ishamagni (Jatharangi)

Udbhavasthana- Manas (Hridaya)

Adhisthana - Shirohridaya

Vyakta sthana - Manah sarvasharira

Roga marga - Madhyam

Poorva roopa- Alpavyakta lakshana

Roopa- Udvega, Bhaya, kampa, Atisweda.etc.

Sadhya sadhyata- Kricchra sadhya

Updrava - Unmada


Review of Disease

Worry

Patients with panic disorder are worried about having a panic attack or the

consequences of experiencing certain bodily sensations. Their focus is on internal states.

What makes the differential diagnosis particularly confusing is that the worry

experienced by patients with GAD can lead to a panic attack. However, unlike patients

with panic disorder, patients with GAD are concerned primarily about some future event,

not having a panic attack or the symptoms of anxiety per se. Another distinction is the

course of onset of worry versus panic. Some patients with GAD are focused on the

physical symptoms of their anxiety, and this can lead one to think that the preoccupation

with bodily sensations is a sign of panic disorder. However, the onset of a panic attack is

sudden and its peak typically lasts for several minutes, whereas the onset and course of

GAD-related anxiety is usually longer and more stable.

Although the differentiation between obsessive-compulsive disorder (OCD) and

GAD seems obvious because of the behavioral rituals that are unique to OCD, there are

still some cases that can be extremely difficult to differentiate. This is especially true of

patients with OCD who do not have compulsions or have only mental rituals. The

differentiation can be made, however, by assessing the focus of concern.

Obsessions are focused on exaggerated or unrealistic expectations and are usually

short-lived (e.g., “If I don’t seal this envelope correctly, my kids will be injured on the

way home from school”). In addition, obsessions often take an “if-then” form (e.g., “If I

do/don’t do/think something, then something bad will happen”) or include vivid imagery

.Worry, on the other hand, is usually focused on future negative events that are not


Review of Disease

caused by the patient. According to non anxious subjects, worry lasts longer, is more

distracting, and usually consists of predominantly verbal thoughts as opposed to images.

The thought content of a worry may be specified in a “what if” fashion, without a

consequence being stated (“What if I get ill?”). Another difficult aspect of the

differentiation of GAD and OCD is the fact that patients with GAD may engage in

reassurance-seeking behaviors that can be somewhat ritualistic and superstitious. Patients

with GAD may report feeling compelled to act to neutralize this worry (e.g., to call one’s

wife at work to lessen a worry about something happening to her). However, these

behaviors are not as consistent, methodical, or ritualized as compulsive behaviors in

patients with OCD.

GAD may be common later in the lifespan as well. The original NCS

Epidemiological study found that GAD was most common among adults who were 45

years 45 years old or older and least common among respondents in the 15–24 year-old

age group.

In addition, GAD may co-occur with medical conditions, particularly those

involving the gastrointestinal system. Gastrointestinal problems such as ulcers and

stomach distress appear to accompany GAD more than other medical conditions.

Additional investigations have examined the link between GAD and irritable

bowel syndrome (IBS)Approximately 37% of a clinical GAD patients also met diagnostic

criteria for IBS (Tollefson, Pederson, Luxenberg, & Dunsmore 1991), and 34% of an IBS

patient sample had a lifetime history of GAD (Lydiard 1992).


Review of Disease

Neurobiological theories (e.g., Sinha, Mohlman, & Gorman 2004) have

implicated neuroanatomical structures including the amygdale and hippocampus as well

as neurochemical systems such as gamma-aminobutyric acid (GABA), norepinephrine

(NE), and serotonin (5-HT).

The neuropeptide cholecystokinin (CCK) and the limbic-hypothalamic-pituitary-

adrenal axis (LHPA axis) have been linked to normal anxiety and stress responses as well

as to pathological anxiety.

A wide array of neurobiological, cognitive, and behavioral factors have been

implicated in the etiology and maintenance of GAD. The integrative theoretical model

developed by Barlow and colleagues identifies general biological and psychological

vulnerabilities that may predispose and individual to an emotional disorder. Processes

specific to the development of GAD include fundamental beliefs that the world is

dangerous and that one is Unable to cope with adversity. Worry therefore becomes the

primary strategy to Cope with perceived threats as the individual attempts to gain control

over potential threats as well as spiraling tension and anxious arousal.

The diagnosis of Chittodvega is made only when symptoms become chronic and

enduring. Hence Alpavyakta lakshna, especially the mental symptoms such as Udvega,

Vyakulata, Bhaya, and Chinta without any obvious cause, can be considered as the

purvarupa of the disease.


Review of Disease

Samprapti – Pathogenesis of Cittodvega:

Vitiated Vatadi Dosa vitiates Jataragni, and afterwards Rasadi Dhatu. So the

combined effect of vitiated Sharirika and Manasika Dosa affect Hridaya, Manovaha

Srotas, and vulnerable Dhatu and Srotas resulting in the psychosomatic presentation of

the disease.

In Chittodvega multiple Srotas and almost all Dhatu seems to be affected. Hence,

the somatic symptoms of Chittodvega are numerous. When the symptoms become full

blown and attain chronicity, the disease becomes kricchrasadhya.

When the disease not treated promptly, it becomes chronic and disabling as Manodohsa

and Sharirika dosa potentiate each other in a vitiated state, resulting in a vicious cycle.

The poorvarupavastha of Unmada described by Charaka reflects the nature of the

symptoms of Cittodvega. So it can be said that, if Cittodvega not treated properly leads to

unmada.

In case of diagnosis and scheduling treatment the knowledge of samprapti plays

major role, as samprapti vighatana is the basic principle of all the treatment, for that the

knowledge of the factors that cause the pathogenesis is very important i.e. Nothing but

the samprapti ghatagas, but as such there is no direct mentioning of samprapti and

samprapti ghatagas in the classics for chittodvega here an attempt has been made to

mention the possible factors that take part in the pathogenesis of chittodvega.


Review of Disease

SAMPRAPTI GHATAKA

Figure no: 4. showing the Samprapti of Cittodvega Asatmyendriyarthasamyoga Prajnaparadha Parinama

Nidana Sevana

Predisposed Personality

Mano Dosa Prakopa Sharira Dosa Prakopa Rajas Tamas Vata Pitta Kapha (Calatva) (Gurutva) (Prana, Udana, (Sadhaka) (Tarpaka) Vyana)

Hridaya Dusti Agni Vikriti Rasadi Dhatudusti

Manovaha Srotodusti Rasadi Sarva Srotodusti

Manas Lakshana Uttpati Sharira Lakshana Uttpati

Chittodvega

Pathogenesis


Review of Disease

Worry is the major cognitive component of GAD. People who have GAD tend to

worry most of the day, nearly every day. However, worry in itself is not pathological. It is

an attempt to predict future danger and/or an attempt to gain control over events that

appear uncontrollable (and usually negative or dangerous).

However, it is clear that pathological worry is dysfunctional in that it is, by

definition, excessive and/or unrealistic and feels uncontrollable. Research supports the

idea that pathological worry has a functional role for people with GAD. Ironically, worry

inhibits autonomic arousal in patients with GAD when they are shown aversive imagery.

Worrying may cause the avoidance of aversive imagery, which is associated with an even

greater emotional arousal.

Neurobiology156

Multiple neuro chemicals and neurotransmitter systems have been implicated as

potential contributors to the development of GAD. These include the amino butyric acid

(GABA)–benzodiazepine (BZ) complex, serotonin (5-HT), nor epinephrine,

cholecystokinin, and corticotrophin-releasing factor, the hypothalamic pituitary-adrenal

axis, and neurosteriods.

A range of preclinical studies demonstrate that the 5-HT system plays an

important role in mediating anxiety. Patients with GAD have a decrease of 5-HT in the

cerebrospinal fluid (Brewerton et al. 1995) and reduced platelet paroxetine binding.


Review of Disease

Neurocircuitry and GAD: 157

The literature on the pathogenesis of GAD remains at an early stage. Nevertheless, a

number of themes have emerged. A first question is

Figure no: 5 Functional neuroanatomy of GAD: increased activity in amygdala and perhaps prefrontally

Whether the pathogenesis of GAD differs in any way from that of depression.

An influential twin study indicated that GAD and major depression (MD) shared

common genetic factors, but had substantially different non familial environment risk

factors with different kinds of life events predisposing to anxiety and mood disorders

indeed, preliminary brain imaging studies suggest that GAD is characterized by a number

of specific abnormalities. Thus, there may be increased amygdale volume and abnormal

benzodiazepine receptor binding in the temporal pole of GAD patients. An early

topographic electroencephalography study indicated differences between GAD and

normals in temporal regions and subsequent PET studies have also shown temporal

abnormalities in this disorder

Rupa:

Chittodvega is one of the Manasika Vikara mentioned in Ayurvedic literature.

The symptoms of this disease can be assumed mostly similar with the generalized anxiety

disorder (GAD). GAD is a disorder requires the presence of unrealistic or excessive


Review of Disease

anxiety and worry, accompanied by symptoms from three of four categories: (1) motor

tension, (2) autonomic hyperactivity, (3) vigilance and scanning, and (4) apprehensive

expectation. The anxious mood must continue for at least a month.

Chittodvega Vis a Vis Generalized anxiety disorder.

The diagnostic and statistical manual of mental disorders (DSM IV) defines

disorder as excessive anxiety and worry about several events or

Th otor tension, and autonomic hyper

acti y anxiety is excessive and interferes with other aspects

of People’s lives. .It includes both psychological as well as somatic symptoms.

Ps

pending disaster

ation

Som ti

generalized anxiety

activities for a majority of days during at least a 6 month period, the worry is difficult to

control and is associated with somatic symptoms such a muscle tension, irritability

difficulty in sleeping and restlessness.

Clinical features158

e primary symptoms of G.A.D are anxiety, m

vit and cognitive vigilance .the

ychological symptoms

• Apprehension

• Fear of im

• Irritability

• Depersonaliz

a c symptoms

• Tremor

• Sweating

• Palpitations

• Chest pain


Review of Disease

• Breathlessness

• Head ache

• Dizziness

• Diarrhoea

• Frequency of micturation

itial insomnia

or concentration

• In

• Po

Sym

l performance).

(B) T

(C) T e associated with three ( or more) of the following 6

sy or more days than not for the

p

eling keyed up or on edge

3) ing or mind going blank

, or restless

ptoms of Generalized Anxiety Disorder. DSM IV

(A) Excessive anxiety and worry (apprehensive expectation), occurring more days

than not for at least six months, about number of events or activities (such as

work or schoo

he person finds it difficult to control the worry.

he anxiety and worry ar

mptoms( with at least some symptoms present f

ast 6 months):

1) restlessness of fe

2) being easily fatigue

difficulty concentrat

4) irritability

5) muscle tension

6) sleep disturbance ( difficulty falling or staying asleep

unsatisfying sleep)


Review of Disease

The focus of anxiety and worry is not confined to the features of an Axis I

disorder. The anxiety worry or physical symptoms cause clinically significant distress or

ent in social, occupational or other important areas of functioning.

s not due to the direct physiological effects of a substance (e.g. a

drug of

starts in

dulthood, oftentimes a major stressor will exacerbate symptoms.

Researc

ring the course of a worry episode, both

atic sensations can be described as relatively persistent and

impairm

The disturbance i

abuse, a medication) or a general medical condition (e.g. hyperthyroidism) and

does not occur exclusively during a mood disorder, a psychotic disorder or a pervasive

developmental disorder.

GAD:

Associated Features159

GAD may be associated with significant comorbidity and morbidity. Early

authors did not see GAD as an independent entity, partly because comorbidity is so

common. Nevertheless, rates of comorbidity in GAD are no higher than those seen in

depression. Furthermore, community studies demonstrate that the disability associated

with GAD is as great as that associated with depression. Whereas GAD typically

childhood or early a

h (Wells 1994) and our clinical experience with GAD has led us to believe that

people with GAD are often driven toward being perfectionist, feel a greater need for

control in their environment, have difficulty tolerating ambiguity, and feel increased

personal responsibility for negative events that occur or are predicted to occur.

Somatic Symptoms

In addition to worry, patients with GAD experience unpleasant somatic

sensations. Although these usually increase du

the worry and the som


Review of Disease

pervasi

rders as well as making differential diagnoses. The primary

distinction between GAD and other anxiety disorders is the focus of the patient’s

concern. Patients with GAD experience uncontrollable worry about a number of different

areas in their life. In fact, they often worry about their worrying (known as metaworry).

In contrast, the focus of concern for patients with other anxiety disorders is specific to

their respective disorder.

rry for patients with GAD, they

are often found to have comorbid social phobia. However, some guidelines for

differentiating the two disorders can be made. The basic distinction is that GAD concerns

are more global, focused on a number of different areas that may include social

situations. In contrast, patients with social phobia are specifically concerned with being

evaluated, embarrassed, or humiliated in front of others.

ve. The most common somatic symptom reported by patients with GAD is muscle

tension. Patients may experience other symptoms often associated with worry and

tension, including irritability, restlessness, feeling keyed up or on edge, difficulty

sleeping, fatigue, and difficulty concentrating.

Differential diagnosis:

Differentiating GAD from other anxiety disorders can be complicated. First,

worry is a relatively generic feature of anxiety disorders (e.g., worry about panic attacks,

worry about embarrassing oneself). In addition, there is a high level of comorbidity

among the anxiety disorders and GAD in particular, which requires one to consider

diagnosing multiple diso

Panic Disorder:

Social Phobia

Because social concerns are a common area of wo


Review of Disease

Obsessive-Compulsive Disorder

Mood Disorders160

The final differentiation to be made is between GAD and mood disorders,

especially major depression and dysthymia. More often than not, anxiety symptoms occur

within the context of depression, and thus GAD is diagnosed as a separate disorder only

when the symptoms have occurred at least at some point independent of depression.

owever, regardless of DSM exclusionary criteria, the nature of cognitions associated

with each disorder can be distinguished: ruminations (common in depressive disorders)

tend to be negative thought patterns about past events, whereas worries (associated with

GAD)tend to be negative thought patterns about future events.

H


Review of Drug

Drug Review

“The plants that spread forth, those that are bushy, those that have a single sheath,

those that creep along, do I address; I call in thy behalf the plants that have shoots, those

that have stalks, those that divide their branches, those that are derived from all the gods,

the strong plants that furnish life to man. With the might that is yours, ye mighty ones,

with the power and strength that is yours, with that do ye, O plants, rescue this man from

this disease! I now prepare a remedy.”

—Hymn of Universal Remedy to All Magic and Medicinal Plants,

Atharvaveda

Classical Indian medicine has a long tradition in the diagnosis and classification

of disease, including psychiatric disorders (Vaidya 1997). In fact, the Ayurvedic

system identifies twenty categories of plants with specific CNS activity; among

these, there are eighteen categories of psychoneuro pharmacological herbs.

Ayurvedic herbs had significant influence on modern Western psychiatry and

Continue to be a source of inspiration and research. For example, Rauwolfia

serpentine(Rauvolfia root, Serpentine root, Candrika, Chotacard), Albizzia lebbeck

(Shirish, Shoedhanam, Sage-leaved alangium; family Mimosaceae), Asparagus

racemosus (Shatavari, Satavar, Satavara, Satavari), Bacopa monniera (Brahmi, Nira

brahm), Centella asiatica (Mandukaparni, Brahmamanduki), and Vitex negundo-has been

used traditionally to treat intestinal parasites, colds, rheumatism, headaches, and

convulsions, and anxious or nervous patients161

In this clinical study, Ksheera bala Taila is selected for Nasya and Amalaki choorna is

used in dhara treatment. Here the detail Properties of each drug is given below:


Review of Drug

For Nasya Purpose:

Bala

Ksheera

Tila Taila

Bala-Sida cordifolia Linn.

Family _ Malvaceae.

Habitat _ Throughout India in moist places.

Fig no: 6 showing the drug Bala

English - Country Mallow.

Ayurvedic - Balaa (yellow-flowered var.), Sumanganaa, Kharayashtikaa,

Balini, Bhadrabalaa, Bhadraudani, Vaatyaalikaa.

Unani - Bariyaara, Khirhati, Khireti, Kunayi.

Siddha/Tamil - Nilatutti.


Review of Drug

PROPERTIES

Rasa-Madhura

Guna-Laghu, Snigdha, Picchila

Veerya- Sheeta

Vipaka- Madhura

Prabhavam- Balya

Dosha karma- Vata pitta hara, balya, brumhana, vrishya

Karma- Balya, brumhana, vrishya

Rogaghnata- Raktapitta, Vata vyadhi, prameha, kshaya

Gana- Brumhana, prajasthapana, madhura skhanda (Ch.) Vatasamsamana (Su.)

Action: Juice of the plant—invigorating, spermatopoietic, used in spermatorrhoea.

Seeds—nervine tonic. Root—(official part in Indian medicine) used for the treatment of

rheumatism; neurological disorders (hemiplegia, facial paralysis, sciatica); polyuria,

dysuria, cystitis, strangury and hematuria; leucorrhoea and other uterine disorders; fevers

and general debility.

Leaves— demulcent, febrifuge; used in dysentery. Ephedrine and si-ephedrine are the

major alkaloids in the aerial parts. The total alkaloid content is reported

to be 0.085%, the seeds contain the maximum amount. In addition to alkaloids,

the seeds contain a fatty oil (3.23%), steroids, phytosterols, resin, resin acids, mucin and

potassium nitrate. The root contains alkaloids—ephedrine, si-ephedrine, beta-

phenethylamine, carboxylated tryptamines and hypaphorine, quinazoline alkaloids—

vasicinone, vasicine and vasicinol. Choline and betaine have also been isolated.


Review of Drug

A sitoindoside, isolated from the plant, has been reported to exhibit adaptogenic and

immunostimulatory activities. Alcoholic extract of the plant possesses antibacterial and

antipyretic propeptide. Ethanolic extract of the plant depresses blood pressure in cats and

dogs.

For Dhara Purpose:

Amalaki (dried) 350 gms

Ksheera 750 ml

Amalaki-Emblica officinalis Gaertn.

Synonym _ Phyllanthus emblica Linn..

Figure no: 7 showing the drug Amalaki.

Family - Euphorbiaceae.

Habitat - Native to tropical Southeast Asia; distributed throughout India;

alaka, Dhaatri, Kaayasthaa, Amoghaa,

la, Aaamalaa, Dhaatriphala, Vayasyaa, Vrshya, Shiva, Hattha.

also planted in public parks.

English -Emblic, Indian gooseberry.

Ayurvedic - Aaamalaki, Aaam

Amritaphala, Am


Review of Drug

Unani - Aamalaa, Amlaj.

ai, Nelli.

na varjita Pancha rasa

, Amlata

akadi (Su.)

gent,

nti haemorrhagic, antidiarrhoeal, diuretic, anti diabetic, carminative, antioxidant. Used

in jaundice, dyspepsia, bacillary dysentery, eye trouble and as a gastrointestinal tonic.

Juice with turmeric powder and honey is prescribed in diabetes insipidus.

Seed— antibilious, antiasthmatic. Used in bronchitis.

Bark— astringent. Leaf—juice is given in vomiting.

A decoction of powdered pericarp is prescribed for peptic ulcer.

Siddha/Tamil - Nellikka

PROPERTIES

Rasa- Lava

Guna- Ruksha, Laghu, Guru

Veerya- Sheeta

Vipaka- Madhura

Prabhavam- Rasayanam

Dosha Karma- Tridoshahara, Jaravyadhihara, Rasayana, Dhatuvruddhikara, Shramahara,

Daha hara

Karma- Medhya, Nadi balya, Indriya Shakti Vardhaka, Deepana, Rochana

nashaka, Sramsana, Rasayana.

Gana- Vayasthapana, Virechanopaga (Ch.) Triphala, Parush

Action: Fruit—anti anaemic, anabolic, anti emetic, bechic, astrin

A


Review of Drug

Key application: as an antacid. (Indian Herbal Pharmacopoeia.).

The fruit is an important source of vitamin C, minerals and amino acids. The edible fruit

tissue contains protein concentration threefold and vitamin C

(ascorbic acid) concentration 160-fold than those of apple. The fruit also contains

considerably higher concentration of most minerals and amino acids than apple.

The fruit gave cytokinine-like substances identified as zeatin, zeatin riboside

and zeatin nucleotide; suspension culture gave phyllembin. Phyllembin

exhibits CNS depressant and spasmolytic activity, potentiates action of adrenaline and

hypnotic action of Nembutal. The leaves contain gallic acid 10.8

mg/g dry basis), besides ascorbic and music acid. The methanol extract of

the leaves is found to be effective in rat paw inflammation. The bark contains tannin

identified as mixed type of proanthocyanidin. The fruit contains superoxide dismutase

482.14 units/g fresh weight and exhibits anti senescent (anti-aging) activity. Fruit, juice,

its sediment and residue are antioxidant due to gallic acid. Et OH (50%) extract—

antiviral. Aqueous extract of the fruit increases cardiac glycogen level and decreases

serum GOT, GPT and LDH in rats having induced myocardial necrosis. Preliminary

evidence suggests that the fruit and its juice may lower serum cholesterol, LDL,

triglycerides and phospholipids without affecting HDL levels and may have positive

effect on atherosclerosis.

An aqueous extract of the fruit has been reported to provide protection against

radiation-induced chromosomal damage in both pre-and post irradiation treatment. The

fruit is reported to enhance natural killer cell activity and antibody dependent cellular

cytotoxicity in mice bearing Dalton’s lymphoma ascites tumour. The extract of the fruit


Review of Drug

and ascorbic acid prevented hepatotoxic and nephrotoxic effects induced by lead and

aluminum. The toxicity could be counteracted to a great extent by the fruit extract than by

an amount of ascorbic acid alone equivalent to that contained in fruits. (The fruit can be

used as a dietary supplement to counteract prolonged exposure to metals in population in

Industrial areas.)

The fruits are reported to activate trypsin (proteolytic enzyme) activity. The fruits can be

used as coagulant in the treatment of water and can purify low turbidity water. The fruits

can be consumed safely all round the year.

Dosage - Fresh fruit—10–20g; pulp juice—5-10ml.


Review of Treatment

Review of Treatment

Chikitsa:

Psychotherapy is the treatment aimed to cure the emotional and behavioral

disturbances with the help of psychological techniques or methods. It has its roots in

man's everyday techniques for adapting himself to both his internal and external

environment. Though we have this rich treasure of insight in psychotherapy, very few

Ayurvedic physicians are practicing it. Practitioners now a day opt other branches of

Ayurveda rather than psychiatry.

Treatment of Manasika vikaras Mainly Ayurveda describes three methods of treatment principals viz daiva

vyapasraya, yukthi vyapsraya, satvavachaya

Daiva vyapasraya

Measures like mantra, Aushadhi, mani, mangala, bali, homa, upahara

niyamaetc…these are recommended in mental disorders caused due to aganthu factors

and administer the patient after considering the prakriti, desa, kala etc. factors

Yukthi vyapasraya

It includes Ahara, Aushadha and vihara, under Ahara food articles like ksheera,

Ghrita, draksha; panasa, manduka parni, brahmi, kushmanda, kapitha, mahisha mamsa,

kurma mamsa etc are recommended

Drug therapy includes dosha shodhana or srotoshodhana has to be done by adopting

various Shodhana measures after which rasayana Shamana Aushadha are given

management.


Review of Treatment

The keraleeya Panchakarma are widely used in the management of Manasika

vikaras like chittodvega, unmade, apasmara etc. the treatment procedures like Shiro

dhara, Tahlapothichil, Tahalam etc. are some of them.

Satvavachaya chikitsa:

These are adopted to get back the deranged manas. The aim of this therapy is to

retain mind from desire unwholesome objects. This is achieved by increasing satva to

subdue the exaggerated rajas and tamas emphasizing on the need of compassion and a

positive attitude towards the patient in administering the satvavachaya chikitsa. The best

measure to achieve the goal of satvavachaya chikitsa is to restrain mind from desire from

unwholesome objects, it’s through jnana, vijnana, dhairya, smrithi and Samadhi.

According to Charaka

Mental disorder caused by kama, shoka, bhaya, krodha, harsha, irsa, moha, should

be countered by inducing the opposite emotions in order to neutralize the causative ones

,certain other satvavachaya measures like calming down the patient with shock by

announcing the loss of something to holds dear or showing some surprising thing or

threatening have also been advocated. The fear of death which is the strongest of all fears

in order to provide insight to the patient to regain mental equipoise.162

Role of Achara Rasayana in the Management of Chittodvega:

Ayurveda stresses on the holistic concept of health and disease. It dose not call

health merely as absence of disease but something more positive and integrate. Achara

Rasayana described in this respect is very essential for the treatment of Cittodvega.


Review of Treatment

Achara Rasayana is a procedure of social and mental conduct, which can acquire

the Rasayana effect on body and mind. It is also suggested as a ‘Nitya Rasayana’ 163

this has direct effect on the potentiation of Sattva Guna of mind. The Achara Rasayana

described by Charaka are mentioned as below –

1. Satya Vadinam (truthful)

2. Akrodha (free from anger)

3. Nivrutam Madhya Maithunat (devoid of alcohol and sex)

4. Ahimsaka (do not indulge in violence)

5. Anayasa (do not indulge in exhaustion)

6. Prasantam Priya Vadinam (Peaceful and pleasing in speech)

7. Japa Saucaparam (Practice incantation and cleanness)

8. Dhiram (stable)

9. Nitya Dana (Regularly practicing charity)

10. Tapasvinam (Practicing penance)

11. Deva Go Bramhana Acarya Vriddha Arcana Ratam (regularly offer prayers to

God, cows, Bramhamanas, teachers, and old people)

12. Karuna Vedanam (compassionate)

13. Sama Jagarana Svapanam (regular period of awaking and sleep)

14. Ksira Grtasinam (habitually taking milk and ghee)

15. Desa Kala Pramana Jnanam (measurement of the country and the time)

16. Yuktijnam (Rational)

17. Anahmkrtam (free from ego)

18. Sastacaram (with good conduct)


Review of Treatment

19. Asamkirnam (not narrow minded)

20. Adhyatma Pravana Indriyam (loving spiritual knowledge)

21. Dharma Sastraparam (Regularly studying scriptures)

22. Upasitaram Vrddhanam, Astikanam Jetatmanam (having reverence for elders, Astikas

and persons having self control)

All these conducts are very necessary for the prevent or to treat the psychological

Conditions. Though modern psychotherapy play very important role to care anxiety

disorder, but Achara Rasayana are far better procedure then it. In this way, Ayurveda can

Open new horizon in treatment filed of Cittodvega (anxiety disorder).

TREATMENT: 164

There is evidence that both pharmacological and non-pharmacological procedures

and a combination of these strategies are effective in the treatment of GAD. The

pharmacological treatment of GAD includes benzodiazepines, azapirones and

antidepressants. Among psychotherapy, the cognitive-behavioural therapy has been

demonstrated to be effective in GAD treatment. Although in some cases of subsyndromal

anxiety one course of therapy might be sufficient, anxiety as a rule has a chronic course

and repeat interventions will be required. In general, the treatment of GAD should be

thought of as being intermittent.

Benzodiazepine (BDZs) - The effectiveness of benzodiazepine in generalized anxiety

has been well established. This class of drugs represents the treatment of choice for

limited. Generalized anxiety because of its rapid action and the effective reduction of

insomnia and somatic/adrenergic symptoms. There is evidence that BDZs may be more


Review of Treatment

effective on some specific symptoms, particularly the somatic symptoms of arousal

existing of autonomic deregulation.

Azapirones-Although the buspirone spectrum is not as broad as the BDZs, buspirone has

been shown to be effective in numerous patients suffering from current GAD. The first

results of drug action usually appear in the range of two to four weeks. Buspirone may be

seen as an effective anxiolytic in treatment of GAD. According to some authors,

buspirone may yield a slight antidepressant activity, making it probably a very valuable

option in those cases of GAD with depressive features or high levels of ‘‘psychic

symptoms’’, i.e. worry and ruminations.

Antidepressants- Imipramine was more effective than diazepam on psychic anxiety

symptoms, with the benefit of an additional significant antidepressant effect. Trazodone

was also found to be effective. It remains a little used, but potentially useful drug for

GAD. Its hypnotic properties may be welcome where Insomnia is a major problem. Other

antidepressants are being tested in GAD. There has been recent evidence in favour of the

effectiveness of venlafaxine in GAD.

Other Drugs- Abecarnil displays affinity for BDZ receptors and shows promising

anxiolytic effects in initial clinical studies. Although the data are encouraging, the

question remains whether, at well-tolerated doses that are unlikely to produce significant

withdrawal, the drug is clinically adequate in GAD (Connor and Davidson, 1998).

Psychotherapy- The aim of cognitive-behaviour therapy is to help the patient recognize

and alter patterns of distorted thinking and dysfunctional behaviour and, by these

processes, to alleviate the suffering and interference that the disorder causes. Cognitive-

behaviour treatment includes cognitive therapy, behaviour therapy and relaxation. A


Review of Treatment

range of relaxation techniques are available, among others Schultz’s autogenic training,

Jacobson’s progressive relaxation, Caycedian sophrology. Relaxation has to be presented

as a skill to be learned through repeated daily practice.

Use of complementary and alternative medicine has increased over the past

decade. A variety of studies have suggested that this use is greater in persons with

symptoms or diagnoses of anxiety and depression. Data support the effectiveness of some

popular herbal remedies and dietary supplements; in some of these products, particularly

kava, the potential for benefit seems greater than that for harm with short-term use in

patients with mild to moderate anxiety. Inositol has been found to have modest effects in

patients with panic disorder or obsessive-compulsive disorder. Physicians should not

encourage the use of St. John's wort, valerian, Sympathyl, or passionflower for the

treatment of anxiety based on small or inconsistent effects in small studies. Although the

evidence varies depending on the supplement and the anxiety disorder, physicians can

collaborate with patients in developing dietary supplement strategies that minimize risks

and maximize benefits.165

In this article, the supplements purported to ameliorate anxiety disorders are

divided into three groups: herbal supplements, nutritional supplements, and

neurotransmitter and hormonal precursors. These divisions are somewhat arbitrary in that

all of the products are taken orally, are available over the counter, are marketed with a

variety of health claims on the Internet, and are justified by their purported ultimate

effects on the neurotransmitter systems that mediate worry, stress, or fatigue symptoms in

patients with anxiety disorders.


Review of Treatment

Information on supplements that claim to be useful or commonly used for anxiety

disorders was obtained from several Internet sites, particularly 166 167 168

Medline via Ovid was used to search for clinical trials, guidelines, and meta-analyses that

tested or asserted the effectiveness of these preparations in the treatment of patients with

diagnosed anxiety disorders. Because use of herbal remedies is increasing, it is important

for family physicians to ask their patients about such use. Encouraging data support the

effectiveness of some of these products, particularly kava and, to a lesser degree, inositol.

Although none of these supplements or products are free of adverse effects, the potential

for benefit seems greater than the risk of harm.169

Management plan for GAD

Management strategies will always vary from one individual to the next depending on the

individual's particular problems. Generally, however, the management of GAD usually

involves:

1. Ongoing assessment of the disorder

2. Education about the nature of anxiety, tailored to each individual's needs. Some basic

information about anxiety is provided in Section 4.1 and includes:

* The nature of anxiety

* Management of the fight-or-flight response

* The role of hyperventilation in anxiety

3. Training in strategies for controlling anxiety and reducing stress:

* Relaxation methods and breathing control to reduce physical symptoms of anxiety

* Planning short-term activities which are relaxing or distracting (particularly those

activities that have been helpful in the past).


Review of Treatment

* Using structured problem solving to help individuals deal with stressors that may

contribute to worry (Section 4.6.3).

* If individuals avoid situations or activities because of anxiety, encourage them to

gradually confront the things they fear using graded exposure (Section 4.3.4).

* Regular physical activity or exercise is often helpful.

4. Individuals are to be encouraged to avoid using sedative medication or alcohol to

control their anxiety.

5. Referral or specialist consultation if symptoms persist for longer than three months

despite the above measures170


Methodology

Methodology Assessment and Treatment Planning:

If you are sure you understand everything that is going on, You are hopelessly confused.

—Walt The successful translation of a basic or clinical observation into a new treatment

of disease is rare in an investigator’s professional life, but when it occurs, the personal

thrill is exhilarating and the impact on society may be substantial. Progress in almost

every field of science depends on the contributions made by systematic research; thus

research is often viewed as the cornerstone of scientific progress. As defined by Kazdin

(1992, 2003), a recognized leader in the field of research, methodology refers to the

principles, procedures, and practices that govern research, whereas research design refers

to the plan used to examine the question of interest.

“Methodology” should be thought of as encompassing the entire process of

conducting research (i.e., planning and conducting the research study, drawing

conclusions, and disseminating the findings). By contrast, “research design” refers to the

many ways in which research can be conducted to answer the question being asked.

The Study of abnormal patterns of individual’s behavior, stress and anxieties has

interested psychologists as much as Psychiatrists and other scientific field workers.

Assessment of such behavior patterns by means of observation, interview and self-report

technique of inventory and questionnaire, has been very common in clinical Trials

Research Approach.

In the present study the investigators object is to study “Evaluation of the efficacy

of Ksheerabala taila nasya and Amalaki siddha ksheera dhara in chittodvega” The


Methodology

effect of therapies administered is determined by the finding out the difference between

the baseline data of the parameters of Subjective and objective to the after treatment data.

Study design

The study design selected for the present study is- A simple Randomized Pre-Post

test single clinical observational trial. In this Nasya and Ksheera dhara is given to the

trial group. Study is undertaken in single group.

Sample Size

In Sample size for the present Study were thirty Patients Suffering from

Chittodvega as per the pre set criteria. Patients were randomly selected.

Duration of the study

Both the treatments Nasya and Ksheera Dhara are administered after giving

sthanika Abhyanga with Ksheera bala taila is given for 12days observing the patient

closely and recording the events and data. After completion of Shodhana procedures and

a follow up period of 15 days were observed.

Source of Data

Patients suffering from chittodvega (GAD) were selected from the Post Graduate

Studies and Research Centre, Department Of Panchakarma, OPD and IPD of Shri

D.G.M.A.M.C. & Hospital, Gadag, Karnataka. Demographic data and disease specific

data are collected according to the case record form given in the appendix.

Selection Criteria

The cases were selected as per the pre set Inclusion and Exclusion criteria.

a) Inclusion Criteria

Patient aged above 10 years and above 60 years are included


Methodology

Patients with symptoms like restlessness or keyed up, easily fatigue,

difficulty in concentration, irritability, muscle tension, sleep

disturbance.

Patients who are fit for dhara and nasya karma.

b) Exclusion criteria

Patient aged below 10 years and above 60 years is excluded.

Patients with neurasthenia burn out, malaise and post viral syndrome.

Patients with other systemic diseases were excluded eg:

hyperthyroidism, cardiac disease.

Patients who are unfit for nasya and dhara karma

• Pregnant women

• Lactating mother.

Criteria for Diagnosis

The signs and symptoms of chittodvega mentioned in Ayurveda and signs and

symptoms mentioned in Generalized Anxiety Disorder were the main basis of diagnosis.

In addition, the criteria lay down for Anxiety disorders by Diagnostic and Stastical

manual of Mental Disorders (DSM IV) 171, ICD-10172 classification of mental and

behavioral Disorders F41-1, WHO, Geneva also followed. And another important

criteria’s included in this study are Hamilton Anxiety scale173, Zung174 Anxiety rating

scale, MAAS175 ((Mindfulness Attention Awareness Scale), General Health questionnaire

(GHQ-28) 176 and Ayurvedic Health Assessment (AHA) 177


Methodology

Parameters used for the diagnosis of the disease

DSM IV

ICD 10

The diagnostic and statistical manual of mental disorders (DSM IV)

(A) Excessive anxiety and worry (apprehensive expectation), occurring more days

than not for at least six months, about number of events or activities (such as

work or school performance).

(B) The person finds it difficult to control the worry.

(C) The anxiety and worry are associated with three ( or more) of the following 6

symptoms( with at least some symptoms present for more days than not for the

past 6 months):

1) restlessness of feeling keyed up or on edge

2) being easily fatigue

3) difficulty concentrating or mind going blank

4) irritability

5) muscle tension

6) sleep disturbance ( difficulty falling or staying asleep, or restless

unsatisfying sleep)

The focus of anxiety and worry is not confined to the features of an Axis I

disorder.

The anxiety worry or physical symptoms cause clinically significant distress or

impairment in social, occupational or other important areas of functioning.


Methodology

The disturbance is not due to the direct physiological effects of a substance (eg.

A drug of abuse, a medication) or a general medical condition (e.g.

hyperthyroidism) and does not occur exclusively during a mood disorder, a

psychotic disorder or a pervasive developmental disorder these symptoms are

considered for the diagnosis of the disease

ICD 10

(1) Palpitations or pounding heart, or accelerated heart rate.

(2) Sweating.

(3) Trembling or shaking.

(4) Dry mouth (not due to medication or dehydration).

(5) Difficulty breathing.

(6) Feeling of choking.

(7) Chest pain or discomfort.

(8) Nausea or abdominal distress (e.g. churning in stomach).

(9) Feeling dizzy, unsteady, faint or light-headed.

(10) Feelings that objects are unreal (derealization), or that one's self is distant

or "not really here" (depersonalization).

(11) Fear of losing control, going crazy, or passing out.

(12) Fear of dying.

(13) Hot flushes or cold chills.

(14) Numbness or tingling sensations.

(15) Muscle tension or aches and pains.

(16) Restlessness and inability to relax.

(17) Feeling keyed up, or on edge, or of mental tension.


Methodology

(18) A sensation of a lump in the throat, or difficulty with swallowing.

(19) Exaggerated response to minor surprises or being startled.

(20) Difficulty in concentrating, or mind going blank, because of worrying or anxiety.

(21) Persistent irritability.

(22) Difficulty getting to sleep because of worrying.

The international classification of diseases in that generalized anxiety disorder is

mentioned in F. 41 there are 24 symptoms mentioned out of any of the six or more

symptoms are present then the patient will fall under the criteria for this trial.

Data collection

A proforma was prepared incorporating all signs and symptoms of chittodvega

and GAD mentioned in Ayurvedic classics and modern literature. It also includes

Ashtasthana pareeksha, Nidana and Samprapti Ghatakas. At the outset, detailed clinical

history was taken and detailed physical examination was done on the basis of the

proforma.

Evaluation of Patient:

History and Physical Examination

Observations and Questions for the clinician to address:

1. Appearance, attitude and motor activity – dress, grooming, signs of

illness and behavior.

2. Mood and affect - range, liability appropriateness

3. Speech – quality

4. Thought – Content - Delusion, suicidal & homicidal ideations, obsessions


Methodology

5. Thought – Form- Circumstantiality, tangentiality, loosening of associations,

flight of ideas, derealization, depersonalization, dissociative events,

concreteness, grandiosity.

6. Perception - Hallucinations and illusions

7. Complete mental state examination 178

• Alertness

• Orientation to time, place, and person

• Concentration

• Recent and remote memory

• Language (e.g., naming objects, repeating phrases),

• Calculations

• Construction

• Insight and judgment

MENTAL AND EMOTIONAL STATE

Try to make some initial assessment of the patient's intelligence and mental and

emotional state, but recognize that this initial impression may be inaccurate. As well as

the history, observation is important in assessing the emotional state. Thus an anxious

person may be restless, with wide palpebral fissures and sweating palms. Is the anxiety

reasonable in the circumstances, or is the patient over anxious? In depression, the

lowered mood, inability to concentrate or make decisions, mental retardation, apathy or

even obvious misery may be clearly evident; however, these features may not be obvious,

although they are important and lead to physical symptoms179


Methodology

Administration of therapy:

Nasya karma- The materials used for Nasya:

1. Ksheera bala taila101

2. Ksheera bala taila plane

Ksheera bala taila Nasya: ksheerabala taila 101 and plane ksheerabala taila was

purchased from the market

Materials or tools for therapeutic intervention:

To administer nasya, electric vaporizer, gas stove, one big vessel, one small vessel, one

rubber dropper, kidney tray, , two cotton gauze, bandage cloth, and Ghrita were used.

Poorva karma:

All the patients were asked to be in the hospital with in 8 am. Every patient was

given Sthanika Abhyanga and Swedana just prior to the nasya karma, the abhyanga was

done with ksheerabala taila in the face, neck, and shoulders and Swedana with the help of

electric vaporizer after covering the eyes with wet cotton swab to the region where

abhyanga was done.

Pradhana karma:

Ksheera bala taila nasya was administered to all patients using rubber dropper,

after making the patient to lie in supine position and slightly bend his head backwards by

putting a pillow beneath his/her neck and administer the medicine by introducing the

nozzle of the dropper into the right nostril by closing the left nostril by the left hand of

the physician and slowly pour the medicine drop by drop, quantity of the medicine should

be 8 drops in each nostril and ask the patient to inhale the medicine gently same


Methodology

procedure was repeated in the left nostril also, and during this time rubbing of the palm

and foot of the patient should be done to avoid the shock, then after some time ask the

patient to spit the medicine along with sputum into a kidney tray that which accumulates

in his or her throat.

The same procedure was repeated for 7 days, the time of administration, and

Complications were noticed if any.

Paschat karma:

After nasya the patient should be administered Gandusha followed by

dhoomapana to remove the excessively accumulated Kapha. For Gandusha lavanodaka

which is slightly warm is used and for dhoomapana varti prepared out of triphaladi Ghrita

and haridra choorna is used. Patient was advised with all the pathyapathya to be

maintained in the nasya Pariharakala.

Amalaki Siddha ksheera dhara:

Saindhava

Amalaki kashaya.

Ksheera.

Haridra choorna

Rasnadi choorna

Materials or tools for therapeutic intervention:

Dhara table, gas stove, dhara pathi, dhara Patra, two big vessels, cloth piece, rasnadi

choorna


Methodology

Preparation of the medicine:

To prepare amalaki kashaya here followed the padavasesa method of preparation

for that 350gms of dried amalaki along with that 8 part water ,boiled and reduced to 1/4th

and that prepared kashaya is kept for cooling and after that mixed with 750ml of boiled

milk when it was in Luke warm.

Poorva karma:

All the patients were asked to be in the hospital with in 8A.M. It is advisable for

the better results that the hair of the patient on the scalp should be removed if the patient

permits. Gentile massage in the fore head and neck has been carried out with ksheerabala

taila Then ask the patient to lie in the supine position on the dhara pathi and Dhara Patra

should be brought 4 inches above his head. The eyes and ears should be covered with

cotton so that, Liquid may not enter in eyes. His head rests in slightly elevated position,

preferably on wooden piece. A minimum of two attenders were used to collect the

medicine and maintain the temperature by heating to prolong the treatment for prescribed

time.

Pradhana karma

In this allow the medicine to pour slowly into the forehead an uniform flow

should be maintained, along with that slowly move the dhara Patra in order to maintain a

circular flow of the medicine. The duration of the karma is in arohan karma starting with

30mins on the first day 35min,40mins and 45mins in the 2nd ,3rd and 4th day respectively,

then again reduce in the same frequency in which it is increased and comes to 30mins on

the final day i.e. 7th day.


Methodology

Paschat karma

After the completion of the dhara karma wrap the head and face with a cotton

cloth neatly and then apply the rasnadi choorna in the head in order to maintain the

temperature and advice the patient to follow the normal pathyapathya mentioned for

Panchakarma

The clinical study was taken up with the proper understanding of the classical

explanation observation and management of chittodvega. Among the causes of the

chittodvega more emphasis and the clinical symptoms of the chittodvega are taken into

consideration.

Assessment of clinical Response

Subjective and objective parameters were made out to assess the clinical response

in the total number of patients. All the grades declared for the assessment of subjective

and Objective parameters are clearly mentioned along with the case sheet in the annex.

1. Subjective Parameters: Certain gradations and declarations are made about the

data, which are as follows-

Table No: 9 Showing the Roopa 0f Chittodvega

Sl.No Roopa of chittodvega BT AT AF 1. Restlessness or feeling keyed up or on the edge. 2. Being easily fatigue 3. Difficulty in concentration. 4. Irritability. 5. Muscle tension 6. Sleep disturbance

0- None

1- Mild

2- Moderate

3- Severe


Methodology

In this the roopa of chittodvega is taken and each roopa is given grading 0-3 depending

on the severity of the symptoms and it is calculated before treatment, after treatment and

after follow up.

2. Objective Parameters

1. Hamilton anxiety rating scale

2. Zung anxiety rating scale

3. GHQ-28(General health questionnaire)

4. MAAS (Mindfulness Attention Awareness Scale)

5. Ayurveda mental health assessment.

1. Hamilton anxiety rating scale The HAM-A (Hamilton Anxiety Scale)is a widely used interview scale that

measures the severity of a patient's anxiety, based on 14 parameters, including anxious

mood, tension, fears, insomnia, somatic complaints and behavior at the interview is taken

in this trial to evaluate the effect of the treatment and also to assess the prognosis of the

disease, for that grading is given for all the 14 parameters like grade 0 is given if any of

the symptoms are absent in a particular parameter,grade1if mild symptoms are present

then grade 1, grade 2 if moderate symptoms are present, grade 3 if symptoms are severe,

grade 4 if the symptoms are very severe and grossly disabling and finally the total score

was calculated by computing the scores of a all the 14 parameters, if it is 18 then the

patient will be having mild anxiety, if it is 25 or below then moderate anxiety ,and 30 if it

is severe anxiety


Methodology

Table No: 10 Showing Hamilton Anxiety Rating Scale:

No. Item BT AF 01. Anxious mood: Worries, anticipation of the worst, fearful

anticipation, irritability.

02.

Tension: Feeling of tension, fatigability, startle response, moved to tear easily, trembling, restlessness, inability to relax.

03.

Fears: Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.

04.

Insomnia: Difficulty in falling a sleep, broken sleep, unsatisfying sleep, fatigue on waking, dreams, nightmares, night terrors.

05. Intellectual (Cognitive): Difficulty in concentration, poor memory. 06.

Depressed mood: Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.

07 Somatic (Muscular): Pain and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone

08.

Somatic (Sensory): Tinnitus, blurring of vision, hot and cold flushes, feeling of weakness, picking sensation.

09.

Cardiovascular Symptoms: Tachycardia, palpitation, pain in chest, throbbing of vessels, fainting feelings, missing beat.

10.

Respiratory Symptoms: Pressure or constriction in chest, choking feeling, sighing, dyspnea.

11.

Gastrointestinal Symptoms: Difficulty in swallowing, wind, abdominal pain, burning sensation, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.

12.

Genitourinary Symptoms: Frequency of maturation, Urgency of micturation, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.

13.

Autonomic Symptoms: Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, rising of hair.

14.

Behavior at interview: Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, belching, brisk tendon jerks, dilated pupils, exophthalmoses.

Signs and symptoms mentioned in Hamilton scale were assessed by adopting the following scoring system. Degree of anxiety &Pathological condition Scoring

None 0

Mild 1

Moderate 2

Severe 3

Severe, grossly disabling 4


Methodology

Table No: 11 Showing Zung Self-Rated Anxiety Scale

Sl.No STATEMENT None or a little of the time

Some of the time

A good of the time

A good part of the time

BT AF

1. I feel more nervous and anxious than usual.

1 2 3 4

2. I feel afraid for no reason at all. 1 2 3 4

3. I get upset easily or feel panicky. 1 2 3 4

4. I feel like I'm falling apart and going to pieces.

1 2 3 4

5. I feel that everything is all right and nothing bad will happen.

1 2 3 4

6. My arms and legs shake and tremble. 1 2 3 4

7. I am bothered by headaches neck and back pain.

1 2 3 4

8. I feel weak and get tired easily. 1 2 3 4

9. I feel calm and can sit still easily. 1 2 3 4

10. I can feel my heart beating fast. 1 2 3 4

11. I am bothered by dizzy spells. 1 2 3 4

12. I have fainting spells or feel like it. 1 2 3 4

13. I can breathe in and out easily. 1 2 3 4

14. I get feelings of numbness and tingling in my fingers and toes.

1 2 3 4

15. I am bothered by stomach ache or indigestion.

1 2 3 4

16. I have to empty my bladder often. 1 2 3 4

17. My hands are usually dry and warm. 1 2 3 4

18. My face gets hot and blushes. 1 2 3 4

19. I fall asleep easily and get a good night's rest.

1 2 3 4

20. I have nightmares. 1 2 3 4


Methodology

Zung anxiety scale is also a scale that is widely used to assess the anxiety in which there

are 20 parameters and for each parameter there is a grading starting from 1 to 4 is used

after grading the individual parameters the values of all the 20 parameters are computed

to assess the severity of the patient, if its comes less than 50 then it is with in the normal

range, if between 50-59 considered to be indicative of a person suffering from mild to

moderate anxiety levels, if between 60-74 considered to be indicative of a person

suffering from marked to severe anxiety levels and if the value is grater than 74 are

considered to be indicative of a person suffering from extreme anxiety levels

Table No: 12 Showing the General Health Questionnaire-GHQ28

Sl.No

Have you recently Conditions BT

AF

Al Been feeling perfectly well and in Good health?

Better than usual

Same as usual

Worse than usual

Much worse than usual

A2 Been feeling in need of a good tonic?

Not at all

No than usual more

Rather more than usual

Much more than usual

A3 Been feeling run down and out of Sorts?

Not at all

No than usual more



A4 Felt that you are ill? Not at all

No than usual more



A5 Been getting any pains in your

head?

Not at all

No than usual more



A6 Been or pressure in your head? getting a feeling of tightness

Not at all

No than usual more



A7 Been having hot or cold spells? Not at all

No than usual more




Methodology

Sl.No


AF

B1 Lost much sleep over worry? Not at all

No than usual more



B2 Had difficulty in staying asleep once you are off?

Not at all

No than usual more



B3 Felt constantly under strain? Not at all

No than usual more



B4 Been getting edgy and bad-

tempered?

Not at all

No than usual more



B5 Been getting scared or panicky

for no good reason?

Not at all

No than usual more



B6 Found everything getting on top of you?

Not at all

No than usual more



B7 Been feeling nervous and strung-up all the time?

Not at all

No than usual more



Sl.No


AF

C1 Been managing to keep yourself busy and occupied?

More so than usual

Same as usual

Rather less than usual

Much less than usual

C2 Been taking longer over the things you do?

Quicker than usual

Same as usual

Longer than usual

Much longer than usual

C3 Felt on the whole you were doing things well?

Better than usual

About Same as usual

Less well than usual

Much less well

C4 Been satisfied with the way

you've carried out your task?

More satisfied

About Same as usual

Less satisfied than usual

Much less satisfied

C5 Felt that you are playing a useful

part in things?

More so than usual

Same as usual

Less useful than usual

Much less useful

C6 Felt capable of making decisions about things?

More so than usual

Same as usual

Less so than usual

Much less capable

C7 Been able to enjoy your normal day-to-day activities?

More so usual

Same as usual

Less so than usual



Methodology

Sl.No


AF

D1 Been thinking of yourself as a worthless person?

Not at all

No than usual more



D2 Felt that life is entirely hopeless?

Not at all

No than usual more



D3 Felt that life isn't worth living? Not at all

No than usual more



D4 Thought of the possibility that you might make away with yourself?

Definitely not

I don't think so

Has crossed my mind

Definitely have

D5 Found at times you couldn't do anything because your nerves were too bad?

Not at all

No than usual more



D6 Found yourself wishing you were dead and away from it all?

Not at all

No than usual more



D7 Found that the idea of taking your own life kept coming into your mind?

Definitely not

I don't think so

Has crossed my mind

Definitely has

BT AF A-

A-

C-B-

C-B- D- Total-

D- Total-

The general health questioner was used to assess the general health

condition of the patient in that there is 4 sets of questions each set is having 7

questions and that should be evaluated individually if it is 3 or below it is

considered to be normal, if it is between 3-4 is considered to be having mild general

health problem, if it is above 4 is considered to be having severe general health

problem.


Methodology

Table No: 13 Showing the Mindfulness Attention Awareness Scale (MAAS) 1 2 3 4 5 6

Almost Always

Very frequently

Somewhat Frequently

Somewhat Infrequently

Very Infrequently

Almost Never

Sl.No Questionnaires BT AF1. I could be experiencing some emotion and not be conscious of it until

some time later.

2. I break or spill things because of carelessness, not paying attention, or thinking of something else.

3. I find it difficult to stay focused on what's happening in the present. 4. I tend to walk quickly to get where I'm going without paying attention to

what I experience along the way.

5. I tend not to notice feelings of physical tension or discomfort until they really grab my attention.

6. I forget a person's name almost as soon as I've been told it for the first time.

7. It seems I am "running on automatic," without much awareness of what I'm doing.

8. I rush through activities without being really attentive to them 9. I get so focused on the goal I want to achieve that I lose touch with what

I'm doing right now to get there

10. I do jobs or tasks automatically, without being aware of what I'm doing. 11. I find myself listening to someone with one ear, doing something else at

the same time

12. I drive places on "automatic pilot" and then wonder why I went there. 13. I find myself preoccupied with the future or the past. 14. I find myself doing things without paying attention. 15. I snack without being aware that I'm eating.

The mindfulness attention awareness scale is also a set of questioners used in this study

to evaluate the mental condition of the patient it contains 15 questioners with grading

starting from 1 to 6 to assess the mental condition, each item should be graded separately

and the scoring has been done by simply computing the mean of 15 items, And higher

score reflects the higher levels of dispositional.


Methodology

5. Ayurveda health assessment

In this the sheela, chesta, achara, manah, buddhi, smrithi, Sajnajnanam, bhakthi

are evaluated separately by counting the total no of patients comes under each group

before the treatment and after the follow up. For each group there are four grades Viz

intact, moderately changed, grossly changed, and cannot be tested, this serve as

diagnostic as well as the prognostic tool.

Table No: 14 showing the Ayurveda health assessment

GRADE No. of patients BT No. of patients AF Intact - - Moderately changed - _ Grossly changed - - Cannot be tested - -

Overall Assessment of the treatment (Improvement Criteria):

Overall effect of the intervention was estimated in the following 3 categories:

1. Best Responded- score below 18Hamilton Anxiety Scale, normal range of Zung

anxiety scale, total absence of clinical symptoms with return to normal activities.

2. Respondent- scores between 18-25Hamilton Anxiety Scale, score of 50-59 of Zung

self rated Anxiety scale, marked improvement in clinical symptoms with return to normal

activities

3. Not responded- Hamilton Anxiety Scale and Zung-anxiety scale being same or

minimum improvement, with the presence of clinical symptoms and much difficulty to

return to normal activities.


Methodology


Master charts

OBSERVATION AND RESULTS

Total 33patients were registered for this study. Out of this 3 patients were

excluded, so their data has not been included here. The remaining 30 patients of

Chittodvega fulfilling the criteria for diagnosis were treated in single group.

Demographic Data

Table No: 15 showing the distribution of patients by sex.

Si.no Sex No of Patients Percentage

1 Male 15 50% 2 Female 15 50% Total 30 100% ` Among 30 patients Distribution of sex was; male 15(50%) and females were 17 (50%) Figure no: 9. showing the showing the distribution of patients by sex

0

5

10

15Age

Female

Table No:16 showing the distribution of patients by Age

Si.no Sex No of Patients Percentage 1 10-19 0 0% 2 20-29 12 40% 3 30-39 7 23% 4 40-49 10 33% 5 50-59 1 3.33% Among 30 patients, 12 (40%) were 2 in the age group 10-19, 7 (23%) were in the age

group 30-39 ,10 (33%) were in the age group 40-49 and one(3.33%) patient were in age

group 50-59


Master charts

Figure no: 10. showing the showing the distribution patients by Age

0%5%

10%15%20%25%30%35%40% 10-19 yrs

20-29 yrs

30-39 yrs

40-49 yrs

50-59 yrs

Among 30 patents none of them were from 10-19 age group, 12 (40%) from20-29 age group,

07 (23%) from30-39age group,10 (33%) from 40-49 and 1 (3.33%) from 50-59 age group

Table No: 17 showing the distribution of patients by Religion

S.L. No Sex No of Patients Percentage 1 Hindu 28 93.33% 2 Muslim 2 6.67% 3 Christian 0 0% 4 Others 0 0% Total 30 100% Among 30 patients, Hindus were 28 (93.33%), were Muslims were 02 (6.67%), and none were from other category among 30 patients Fig No 11: showing the distribution of patient’s Religion:

05

10

15

20

25

30 Hindu

Muslim

Christian

Table No: 18 showing the distribution of patients by occupation

S.L. No Occupation No of Patients Percentage 1 Laborer 01 3.33% 2 Student 10 33.33% 3 Executive 10 33.33% 4 Sedentary 09 30% Total 30 100%


Master charts

Among 30 patients, only 01(3.33) patient is labour, 10 (33.33%),were students,10

(33.33%) executive and 09 (20%) were belonging to sedentary category this signifies that

the incidence is more in working people

Fig No 12: showing the distribution of the distribution by occupation

Table No: 19 showing the distribution of patient’s by Economic status

0

2

4

6

8

10Labour

Student

Executive

Sedentary

Si.no Economic Status No. of Patients Percentage 1 Poor 01 3.33 2 Lower middle class 09 30 3 Upper middle class 20 66.67 4 Rich 0 0 Among 30 patients, 01 (3.33%) were poor, 09 (30%) Lower middle class, 20(66.67%)

was Upper middle class and none were belonging to Rich category

Fig No 13: showing distribution of patients by Economical status:

0

5

Poor

Lower middle class

Upper middle class

Rich

20

15

10

Table No: 20 showing the distribution of patients by marital status

Si.no Marital status No of Patients Percentage 1 Married 16 53.33% 2 Unmarried 14 46.67% Total 30 100%


Master charts

Among 30 patients, 06 (53.33%) were married, 14 (46.67%), and 20(46.67%) were

Unmarried

Fig No 14: showing the distribution of patients by marital status

13

14

15

16Married

Un married

Table No: 21 showing the distribution of patients by Ahara

S.L. No AHARA No of Patients Percentage 1 Vegetarian 08 26.67 2 Mixed 22 73.33 Total 30 100

Among 30 patients 08(26.67%) were vegetarian, 22(73.33%) were having mixed dietary

habit

Fig No 15: showing distribution of patients by Ahara:

05

10152025

Vegetarian

Mixed

Table No: 22 showing the distribution of patients by vihara

S.L. No VIHARA No of Patients Percentage 1 Hard O2 6.67 2 Moderate 25 83.33 3 Sedentary 03 10 Total 30 100


Master charts

Among 30 patients O2 (06.67%) were hard working, 25(83.33%) were moderately

working and 3 (10%) were having sedentary life life habits

Fig No 16: showing distribution of patients by Vihara:

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%Hard

Moderate

Sedentary

Table No: 23 showing the distribution of patients by Agni S.L. No AGNI No of Patients Percentage 1 Samagni O5 16.67 2 Mandagni 23 76.67 3 Visamagni 01 3.33 4 Teekshnagni 01 3.33 Total 30 100 Among thirty patients 05(16.67%) were having Sama agni, 23 (76.67%) were having

manda agni, 01 (3.33.66%) patient is having vishama agni and 01 (76.66%) having

theekshna agni

Fig No 17: showing distribution of patients by Jataragni:

0.00%

20.00%

40.00%

60.00%

80.00%

Samagni

Mandagni

Visamagni

Theekshnagni


Master charts

Table No: 24 showing the distribution of patients by Koshta S.L. No KOSHTA No of Patients Percentage 1 Mrudu 02 6.67 2 Madhyama 28 93.33 3 Krura 00 00 Total 30 100

Among thirty patients 02(6.67%) were having Mrudu Koshta, 28 (93.33%) were having

Madhyama Koshta, and none were having Krura Koshta.

Fig No 18: showing distribution of patients by Koshta:

0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Mrudu

Madhyama

Krura

Table No: 25 showing the distribution of patients by Nidra

S.L. No NIDRA No of Patients Percentage 1 Prakruta 00 00% 2 Alpa 29 96.67% 3 Ati 00 00% 4 Diwaswapna 01 3.33% Total 30 100% Among thirty patients 00(00%) were having Prakrutha nidra, 29 (96.67%) were having

Alpa nidra, 01 patient having Diwaswapna and none were having Ati nidra.

Fig No 19: showing distribution of patients by Koshta:

0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Prakruta

Alpa

Ati

Diwasvapna


Master charts

Table No: 26 showing the distribution of patients by Vyasana S.L. No Vyasana No of Patients Percentage 1 Tobacco 02 6.67% 2 Smoking O6 20% 3 Alcohol 03 10% 4 None 19 63.33% Total 30 100% Among 30 patients 02 (06.67%) were having Tobacco chewing habit, 06 (20%) were

having smoking habit, 03 (10%) were having alcohol drinking habit

Fig No 20: showing distribution of patients by Vyasana:

0.00%

Tobaco

Smoking

Alcohol

None

Table No: 27 showing the distribution of patients by sharirika prakruti S.L. No Prakruti No of Patients Percentage 1 Vata pitta 25 83.33% 2 Vata kapha 05 16.67% 3 Kapha pitta 00 0% Total 30 100%

Among 30 patients 25 (83.33%) were having vata pitta prakruti, 05(16.67%) were having

vata kapha prakruti and none were having kapha pitta prakruti

Fig No 21: showing the distribution of patients by sharirika prakruti

20.00%

00%

00%

00%80.

40.

60.

0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Vata pitta

Vata kapha

Kapha pitta


Master charts

Table No: 28 showing the distribution of patients by Manasika Prakruti S.L. No Prakruti No of Patients Percentage 1 Satva - - 2 Rajasika 22 73.33% 3 Tamasika 08 26.67% Total 30 100%

Among 30 patients no one is having satvika prakruti, 22(73.33%) patients were having

rajasika prakruti and 08(26.67%)of them were having tamasika prakruti Fig No 22: showing the distribution of patients by Manasika Prakruti

0.00%

20.00%

40.00%

60.00%

80.00% Thamasika

Rajasika

Tamasika

Table No: 29 showing the distribution of Patients by satva S.L. No Satva No of Patients Percentage 1 Pravara 04 13.33% 2 Madhyamaha 21 70% 3 Avara 05 16.67% Total 30 100% Among 30 patients 04(13.33%) patients were having pravara satva, 21(70%) were having

Madhyama satva and o5 (16.67%) were having avara satva

Fig No 23: showing the distribution of Patients by satva

0.00%

20.00%

40.00%

60.00%

80.00%Pravara

Madhyama

Avara


Master charts

Table No: 30 showing the distribution of Patients by Nidana

S.L. No Nidana No of Patients Percentage 1 Bhaya 30 100% 2 Krodha 30 100% 3 Udvega 30 100% 4 shoka 30 100% 5 Chinta 30 100% 6 Dhana nasha 18 60% 7 Bhandhu nasha 10 33%

Among the 30 patients all were having the nidana of Bhaya, Krodha, udvega, shoka and

chinta i.e. (100%) and 18 patients is having the nidana of dhana nasha (60%) and 10

patients were having the nidana of bandhu nasha (33%)

Fig No 24 showing the distribution of Patients by Nidana

0.00%

20.00%

40.00%

60.00%

80.00%

100.00% BhayaKrodhaUdvegaShokaChintaDhana nashaBandhu nasha

Table No: 31 showing the distribution of patients by Roopa of chittodvega

S.L. No Roopa of

chittodvega No of Patients BT

%BT No of patients AF

% AF

1 Restlessness 30 100% 03 10% 2 Fatigue 30 100% 00 00% 3 Difficulty in

concentration 30 100% 02 07%

4 Irritability 30 100% 02 07%

5 Muscle tension 21 70% 01 03%

6 Sleep disturbance 30 100% 02 00%

Among the 30 patients all were having the symptoms restlessness, fatigue, difficulty in

concentration, and sleep disturbance before treatment and 21 patients were having muscle


Master charts

tension, but after the completion of treatment only 03 (10%) patient were having the

symptoms like restlessness,02 (07%) were. Having the symptom of difficulty in

concentration, 02 (07%) patients were having the symptom of irritability and 01 (03%)

patient was having the symptom of muscle tension; this shows the effectiveness of the

treatment.

Fig No 25 showing the distribution of patients by Roopa of chittodvega

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%RestlessnessFatiguePoor concentrationIrritabilityMuscle tensionSleep disturbance

Table No: 32 showing the distribution of patients by Chronicity S.L. No Chronicity No of Patients Percentage 1 Up to 1 year 20 67% 2 1yrs-2yrs 09 30% 3 2yrs-3yrs 01 03% Total 30 100%

Among the 30 patients 20 (67%) were having the chronocity up to 1 year,09 (30%)

patients were having 1-2yrs and 1 (03%) patient were having 2-3yrs . The chronicity

shows that majority of the patient seek medical attention after long duration this signifies

that the GAD is not that serious a disease like depression were even the daily activities

get disturbed or hampered

Fig No 26 showing the distribution of patients by Chronicity

0.00%

20.00%

40.00%

60.00%

80.00% up to 1 yrs

1yrs-2yrs

2yrs-3yrs


Master charts

Table No: 33 showing the distribution of patients by Sheela S.L. No Sheela No of

Patients BT %BT No of patients

AF % AF

1 Intact 00 00% 28 93%

2 Moderately changed

26 87% 02 07%

3 Grossly changed 04 13% 00 00%

4 Cannot be tested 00 00% 00 00%

Total 30 100% 30 100%

Among the 30 patients before treatment no body is having the sheela intact, 26 were

moderately changed, 04 grossly changed and no body were cannot be tested. After the

treatment 28 patients sheela become intact, 02 patients comes under moderately change.

Fig No. 27 showing the distribution of patients by Sheela

0.00%20.00%40.00%

60.00%80.00%

100.00% Intact

Moderately changed

Grossly changed

Cannot be tested

Table No: 34 showing the distribution of patients by Chesta

S.L. No Chesta No of

Patients BT


% AF

1 Intact 04 13% 28 93% 2 Moderately changed 24 80% 02 07% 3 Grossly changed 02 7% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 04 were having the chesta intact, 24 were

moderately changed, 02grossly changed and no body were cannot be tested. After the

treatment 28 patients chesta become intact, 02 patients comes under moderately change


Master charts

Fig No 28 showing the distribution of patients by Chesta

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%Intact

Moderately changed

Grossly changed

Cannot be tested

Table No: 35 showing the distribution of patients by Achara S.L. No Achara No of


AF % AF

1 Intact 16 53% 27 90% 2 Moderately

changed 13 43% 03 03%

3 Grossly changed 01 3% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100%

Among the 30 patients before treatment 16 were having the achara intact, 13 were


treatment 27 patients achara become intact, 03 patients comes under moderately change.

Fig No 29 showing the distribution of patients by Achara

0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Intact

Moderately changed

Grossly changed

Cannot be tested


Master charts

Table No: 36 showing the distribution of patients by Manaha

S.L. No Manaha No of Patients BT


% AF

1 Intact 01 03% 27 90% 2 Moderately changed 27 90% 03 03% 3 Grossly changed 02 07% 00 00%


Total 30 100% 30 100%

Among the 30 patients before treatment 01 were having the Manaha intact, 27were


treatment 27 patients Manaha become intact, 03 patients comes under moderately change.

Fig No 30 showing the distribution of patients by Manaha

0.00%

Intact

Moderately changed

Grossly changed

Cannot be tested

Table No: 37 showing distribution of patients by Buddhi

S.L. No Buddhi No of

Patients BT %BT No of

patients AF % AF

1 Intact 15 50% 26 87% 2 Moderately changed 13 43% 04 13% 3 Grossly changed 02 07% 00 00% 4 Cannot be tested 00 00% 00 00%

Total 30 100% 30 100%

Among the 30 patients before treatment 15 were having the buddhi intact, 13 were


treatment 26 patients buddhi become intact, 04 patients comes under moderately change.

20.00%

00%

00%

00%

100.00%

80.

60.

40.


Master charts

Fig No 31 showing the distribution of patients by Buddhi

0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Intact

Moderately changed

Grossly changed

Cannot be tested

Table No: 38 showing distribution of patients by Buddhi

S.L. No Smrithi No of

Patients BT %BT No of

patients AF % AF

1 Intact 17 57% 29 97% 2 Moderately changed 13 43% 01 03% 3 Grossly changed 00 00% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 17 were having the smrithi intact, 13 were


treatment 29 patients smrithi become intact, 01 patient comes under moderately change.

Fig No 32 showing the distribution of patients by Smrithi.

0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Intact

Moderately changed

Grossly changed

Cannot be tested


Master charts

Table No: 39 showing distribution of patients by Sajnajnanam

S.L. No Sajnajnanam No of Patients BT


% AF

1 Intact 02 07% 27 90% 2 Moderately changed 27 90% 03 10% 3 Grossly changed 01 03% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 02 were having the Sajnajnanam intact, 27 were


treatment 27 patients Sajnajnanam become intact, 03 patients comes under moderately

change.

Fig No 33 showing the distribution of patients by Sajnajnanam 0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Intact

Moderately changed

Grossly changed

Cannot be tested

Table No: 40 showing distribution of patients by Bhakthi

S.L. No Bhakthi No of Patients BT


% AF

1 Intact 01 03% 28 93%

2 Moderately changed

19 63% 02 07%

3 Grossly changed 10 33% 00 00%


Total 30 100% 30 100%

Among the 30 patients before treatment 01 were having the bhakthi intact, 19 were

moderately changed, 10 grossly changed and no body were cannot be tested. After the

treatment 28 patients bhakthi become intact, 02 patients comes under moderately change


Master charts

Fig No 34 showing the distribution of patients by Bhakthi 0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Intact

Moderately changed

Grossly changed

Cannot be tested

Table No: 41 showing distribution of patients by HAS (Hamilton Anxiety Scale) S.L. No HAS No of Patients

BT %BT No of patients

AF % AF

1 Normal 00 00% 30 100% 2 Mild anxiety 10 33% 00 00% 3 Severe anxiety 20 67% 00 00%

Total 30 100% 30 100%

Among the 30 patients before treatment none of them were in normal range of HAS, 10

were having mild anxiety, 20 were having severe anxiety but after the follow up all the

patients comes with in the normal.

Fig No 35 showing the distribution of patients by HAS (Hamilton Anxiety Scale) 0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Normal

Mild anxiety

Severe anxiety


Master charts

Table No: 42 showing distribution of patients by Zung self rated anxiety scale S.L. No Zung No of


AF % AF

1 Normal 19 63% 30 100% 2 Moderate anxiety 07 23% 00 00% 3 Severe anxiety 04 13% 00 00% 4 Extreme 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 19 were in normal range of Zung self rated

anxiety scale, 07 were having moderate anxiety, 04 were having severe anxiety and none

were having extreme anxiety but after the follow up all the 30 patients comes with in the

normal

Fig No: 36 showing the distribution of patients by Zung self rated anxiety scale 0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Normal

Moderate anxiety

Severe anxiety

Extereme anxiety

Table No: 43 showing distribution of patients by MAAS S.L. No MAAS No of

Patients BT % BT No of patients

AF % AF

1 Bad 30 100% 00 00% 2 Moderately good 00 00% 01 03% 3 Good 00 00% 28 93% 4 Extremely good 00 00% 01 03% Total 30 100% 30 100%

Among the 30 patients before treatment all were in bad range of MAAS, but after the

treatment 01 patient were in moderately good, 28 were good and 01 were extremely

good.


Master charts

Fig No: 37 showing the distribution of patients by MAAS

0.00%

Bad

Moderately good

Good

Extremely good

Table No: 44 showing distribution of patients by GHQ- 28

Among the 30 patients before treatment O6 were in normal range of GHQ-28, 14 were

having moderate bad, 08 were having severe problem and none were having gross

problem but after the follow up all the 30 patients comes with in the normal

Fig No: 38 showing the distribution of patients by GHQ- 28 \

S.L. No GHQ-28 No of Patients BT

% BT No of patients AF

% AF

1 Normal 06 20% 26 87% 2 Moderately bad 16 53% 04 13% 3 Severe 08 27% 00 00% 4 Grossly severe 00 00% 00 00% Total 30 100% 30 100%

20.00%

00%

00%

00%

100.00%

60.

80.

40.

0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Normal

Moderately bad

Severe

Grossly severe


Master charts

Table No: 45 showing distribution of patients by Overall assessment of the result S.L. No Results No. of patients % of the result 1 Best responded 26 87% 2 Respondent 04 13% 3 Not responded 00 00% 4 Total 30 100% The overall treatment result of 30 patient’s shows best responded in 26 patients,

respondent in 04 and none of them were not responded

Fig No: 39showing the distribution of patients by Overall assessment of the result

0.00%

20.00%

40.00%

60.00%

80.00%

100.00% Best responded

Respondent

Not responded


Master charts

Table no: 46 Showing the Roopa of Chittodvega

Restlessness or felling keyed up

Being easily fatigue

Difficulty in concentration

Irritability Muscle Tension Sleep distuSl. No

OPD No

BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT1 4341 2 1 0 2 1 0 3 1 0 2 0 0 2 0 0 3 1 2 5822 3 1 0 2 1 0 2 1 0 2 0 0 1 0 0 3 1 3 6463 3 1 0 2 1 0 3 1 0 2 1 0 2 1 0 3 1 4 765 3 1 0 2 1 0 3 1 0 3 2 0 1 0 0 3 2 5 3193 3 1 0 2 1 0 3 1 0 2 1 0 0 0 0 3 1 6 3218 3 1 0 2 1 0 3 1 0 1 0 0 2 1 0 3 1 7 3349 3 1 0 2 1 0 3 1 0 3 1 1 2 1 0 3 1 8 3411 3 1 0 3 1 0 2 0 1 3 1 0 1 0 0 3 1 9 8981 2 1 0 2 1 0 3 2 0 3 2 0 1 0 0 3 1

10 8982 3 1 1 2 1 0 3 1 0 2 1 0 1 0 0 3 1 11 10608 3 1 0 2 1 0 3 2 0 3 2 0 2 1 0 3 1 12 10613 2 1 0 3 1 0 2 0 0 3 1 0 2 1 0 3 1 13 10611 3 1 0 3 1 0 3 1 0 2 1 0 2 1 1 3 1 14 14330 3 1 0 2 1 0 3 1 0 2 0 0 3 1 0 3 2 15 14760 3 1 1 2 1 0 3 1 1 2 0 0 0 0 0 3 1 16 14749 2 1 0 2 0 0 3 1 0 2 0 0 0 0 0 3 0 17 14769 3 1 0 3 1 0 3 2 0 3 2 0 3 0 0 3 1 18 15087 3 2 0 3 1 0 3 1 0 2 0 0 0 0 0 3 1 19 15086 3 1 0 3 1 0 3 0 0 2 0 0 1 0 0 3 1 20 17023 3 2 0 2 0 0 3 1 0 2 1 0 0 0 0 2 1 21 18228 3 1 0 2 1 0 3 1 0 3 1 0 0 0 0 3 2 22 18203 3 1 0 2 1 0 3 2 0 3 2 0 1 0 0 3 1 23 19055 3 1 0 2 1 0 2 1 0 3 2 0 0 0 0 3 1 24 3829 3 1 0 2 0 0 3 1 0 3 1 1 0 0 0 2 1 25 19510 3 1 0 2 1 0 3 1 0 3 1 0 0 0 0 3 2 26 20196 3 2 1 3 1 0 3 1 0 2 1 0 1 0 0 3 1 27 23773 3 1 0 2 1 0 3 1 0 3 1 1 2 1 0 3 1 28 23771 2 1 0 3 1 0 2 1 0 2 1 0 1 0 0 3 1 29 24778 3 1 0 2 0 0 2 1 0 2 1 0 1 0 0 3 0 30 24780 3 2 0 2 0 0 2 1 0 2 0 0 1 0 0 2 1


Master charts


Table no: 47 Showing the Personal History

AHARA VIHARA AGNI KOSHTA NIDRA VYASANA S.L. No

OPD No V M H M S Sa Ma Th Vi Mr Md Kr P Al At` Dw Nn Tob Smk Alc

1 4341 - + - + - - - - + + - - - + - - + - - - 2 5822 - + - + - - + - - - + - - + - - + - - - 3 6463 - + - + - - + - - - + - - + - - + - - - 4 765 - + - + - + - - - - + - - + - - + - - - 5 3193 - + + - - - + - - + - - - + - - + - - - 6 3218 + - - + - + - - - - + - - + - - + - - - 7 3349 - + - + - + - - - - + - - + - - + - - - 8 3411 - + - + - + - - - - + - - + - - + - - - 9 8981 - + - + - - + - - - + - - + - - - - + -

10 8982 - + + - - + - - - + - - + - - - - - + 11 10608 - + - + - - + - - - + - - + - - + - - 12 10613 + - - + - - + - - - + - - + - - - + - - 13 10611 + - - + - - + - - - + - - + - - + - - 14 14330 - + - - + - + - - - + - - + - - - + + + 15 14760 - + - - + - + - - - + - - + - - + - - - 16 14749 - + - + - + - - - + - - + - - + - - - 17 14764 - + - - + - + - - - + - - + - - + - - - 18 15087 - + - + - - + - - - + - - + - - + - - - 19 15086 - + - + - - + - - - + - - + - - + - - - 20 17023 + + - + - - + - - - + - - + - - + - - - 21 18228 + - - + - - + - - - + - - - - + - - + - 22 18203 - + - + - - + - - - + - - + - - - - + + 23 19055 - + - + - - + - - - + - - + - - + - - - 24 3829 + - - + - - + - - - + - - + - - - - - - 25 19510 + - - + - - + - - - + - - + - - + - - - 26 20196 - + - + - - + - - - + - - + - - - - + - 27 23773 - + - + - - + - - - + - - + - - - - + - 28 23771 + - - + - - + - - - + - - + - - + - - - 29 24778 - + - + - + - - - + - - + - - + - - - 30 24780 - + - + - - - + - - - + - + - - - - - +

Master charts

Table no: 48 Showing the Nidana of Chittodvega. Nidana S.L.

No OPD No Bhaya Krodha Udvega Soka Chinta

1 4341 + + + + + 2 5822 + + + + + 3 6463 + + + + + 4 765 + + + + + 5 3193 + + + + + 6 3218 + + + + + 7 3349 + + + + + 8 3411 + + + + + 9 8981 + + + + +

10 8982 + + + + + 11 10608 + + + + + 12 10613 + + + + + 13 10611 + + + + + 14 14330 + + + + + 15 14760 + + + + + 16 14749 + + + + + 17 14764 + + + + + 18 15087 + + + + + 19 15086 + + + + + 20 17023 + + + + + 21 18228 + + + + + 22 18203 + + + + + 23 19055 + + + + + 24 3829 + + + + + 25 19510 + + + + + 26 20196 + + + + + 27 23773 + + + + + 28 23771 + + + + + 29 24778 + + + + + 30 24780 + + + + +


Master charts


Table no: 49 Showing the Demographical Data. Sex Religion

Occupation Economical SSL

No OPD No

Age in Yrs

M F H M C O L ST EX SE P LM U1. 4341 33 - + - + - - - - + - - - +2. 5822 25 + - + - - - - + - - - - +3. 6463 22 + - + - - - - + - - - - +4. 765 31 + - + - - - - + - - - - +5. 3193 34 - + + - - - + - - - + - 6. 3218 25 + - + - - - - + - - - - +7. 3349 21 + - + - - - - + - - - + 8. 3411 45 - + + - - - - - - + - +9. 8981 24 + - + - - - - - + - - + 10. 8982 29 + - + - - - - - + - - +11. 10608 33 - + + - - - - - - + - + 12. 10613 52 - + + - - - - - - + - - +13. 10611 33 - + + - - - - - + - - - +14. 14330 40 + - + - - - - - + - - + 15. 14760 41 - + + - - - - - - + - +

16. 14749 46 - + + - - - - - - + - - +17. 14764 41 - + - + - - - - - + - + 18. 15087 32 - + + - - - - - - + - - +19. 15086 25 + - + - - - - + - - - - +20. 17023 48 - + + - - - - - + - - - +21. 18228 23 + - + - - - - + - - + 22. 18203 28 + - + - - - - - + - - - +23. 19055 36 + - + - - - - - + - - +24. 3829 48 - + + - - - - - - + - + 25. 19510 46 - + + - - - - - - + - + 26. 20196 40 - + + - - - - - + - - - +27. 23773 42 + - + - - - - - + - - - +28. 23771 22 - + + - - - - + - - - - +29. 24778 28 + - + - - - - + - - - - +30. 24780 24 + - + - - - - + - - - - +

Master charts

Table no: 50 Showing the Hamilton Anxiety Rating Scale

Total Scoring Sl.No OPD No BT AF

1 4341 36 03

2 5822 21 03 3 6463 19 02

4 765 21 02 5 3193 19 02

6 3218 18 02 7 3349 31 04

8 3411 27 03 9 8981 23 02

10 8982 38 03 11 10608 18 02

12 10613 42 04 13 10611 43 05

14 14330 40 03 15 14760 48 05

16 14749 46 03

17 14764 40 03 18 15087 40 03

19 15086 18 02 20 17023 39 02

21 18228 39 05 22 18203 43 05

23 19055 44 05 24 3829 42 03

25 19510 34 04 26 20196 33 03

27 23773 18 01 28 23771 37 03

29 24778 27 03 30 24780 19 02


Master charts

Table no: 51 Showing the Zung Anxiety Rating Scale

Total Scoring Sl.No OPD No

BT AF 1 4341 46 23

2 5822 38 22 3 6463 47 20

4 765 37 20 5 3193 33 20

6 3218 35 22 7 3349 39 22

8 3411 43 22

9 8981 42 24 10 8982 36 23

11 10608 35 23 12 10613 56 23

13 10611 63 24 14 14330 49 24

15 14760 60 29 16 14749 61 24

17 14764 53 27 18 15087 53 22

19 15086 32 23 20 17023 53 27

21 18228 60 28 22 18203 55 27

23 19055 50 29 24 3829 57 29

25 19510 53 26

26 20196 45 22 27 23773 37 20

28 23771 34 22 29 24778 43 22

30 24780 35 23


Master charts

Table no: 52 Showing the Mindfulness Attention Awareness Scale (MAAS)

Total Scoring Mean Sl.No OPD No

BT AF BT AF 1 4341 39 90 2.60 6.00 2 5822 30 72 2.00 4.80

3 6463 27 77 1.80 5.13 4 765 25 88 1.67 5.87

5 3193 29 87 1.97 5.80 6 3218 31 83 2.07 5.53

7 3349 38 83 2.53 5.53 8 3411 25 88 1.67 5.87

9 8981 21 84 1.40 5.60 10 8982 36 82 2.40 5.47

11 10608 30 82 2.00 5.47 12 10613 35 85 2.33 5.67

13 10611 35 78 2.33 5.20 14 14330 32 86 2.13 5.73

15 14760 46 84 3.07 5.60

16 14749 29 87 1.97 5.80 17 14764 37 86 2.47 5.73

18 15087 46 88 3.07 5.87 19 15086 29 84 1.97 5.60

20 17023 35 86 2.33 5.73 21 18228 33 82 2.20 5.47

22 18203 24 83 1.60 5.57 23 19055 30 85 2.00 5.67

24 3829 33 85 2.20 5.67 25 19510 28 81 1.87 5.40

26 20196 27 85 1.80 5.67 27 23773 28 88 1.87 5.87

28 23771 36 81 2.40 5.40 29 24778 33 84 2.20 5.60

30 24780 27 84 1.80 5.60


Master charts

Table no: 53 Showing the GHQ-28

A B C D Sl.No OPD No BT AF BT AF BT AF BT AF

1 4341 3 1 7 2 5 2 3 1 2 5822 3 1 5 2 4 2 3 1 3 6463 2 1 4 3 5 2 4 0 4 765 2 1 5 2 5 2 4 1 5 3193 3 1 5 3 4 2 3 1 6 3218 4 1 7 4 5 3 4 0 7 3349 3 1 6 3 5 3 3 0 8 3411 2 0 6 3 5 3 3 0 9 8981 3 1 4 2 4 2 2 0

10 8982 3 1 6 2 5 3 2 0 11 10608 3 1 5 2 4 3 2 0 12 10613 3 0 5 2 4 2 2 1 13 10611 3 0 5 2 5 2 2 2 14 14330 1 0 5 2 5 2 2 2 15 14760 3 1 6 3 5 2 2 1 16 14749 2 0 6 2 4 2 2 1 17 14764 3 1 5 2 3 2 3 1 18 15087 3 0 6 3 5 2 3 1 19 15086 3 1 5 2 3 2 5 1 20 17023 4 1 6 2 4 2 3 0 21 18228 2 0 4 1 3 2 3 1 22 18203 2 0 4 1 3 2 3 0 23 19055 4 2 7 4 4 3 3 0 24 3829 4 0 5 2 4 2 3 1 25 19510 3 0 5 2 3 1 3 0 26 20196 4 1 6 3 3 1 3 0 27 23773 4 1 6 3 3 1 3 2 28 23771 3 0 4 2 4 1 3 0 29 24778 3 0 5 1 3 1 2 0 30 24780 2 0 4 0 2 1 1 0


Results

Table no: 54 Showing the Statistical Study of the Trial

Mean Sl.No Parameters

BT AT

Net Mea

n

SD SE T-value

P- value

Re marks

1. Restlessness or feeling keyed up

2.833 0.366 2.466 0.5074 0.0926 26.63 <0.001* HS

2. Being easily Fatigue

2.266 0.0333 2.233 0.430 0.0785 28.44 <0.001* HS

3. Difficulty in concentration

2.766 0.3 2.466 0.507 0.092 26.80 <0.001* HS

4. Irritation 2.4 0.2 2.2 0.550 0.1005 21.89 <0.001* HS

5. Muscle tension 1.1 0.033 1.06 0.907 0.165 6.424 <0.001* HS

6. Sleep disturbance

2.9 0.233 2.66 0.479 0.087 30.57 <0.001* HS

7. HAS 32.1 3.066 29.03 9.49 1.734 16.74 <0.001* HS

8. Zung self rated anxiety scale

46.0 23.733 22.26 8.098 1.478 15.06 <0.001* HS

9. MAAS 31.8 83.93 52.13 6.621 1.208 43.15 <0.001* HS

10. GHQ-28-A 2.9 0.6 2.3 0.702 0.128 17.96 <0.001* HS

11. GHQ-28-B 5.3 2.23 3.066 0.739 0.135 22.71 <0.001* HS

12. GHQ-28-C 4.033 2.0 2.033 0.718 0.131 15.51 <0.001* HS

13. GHQ-28-D 2.8 0.6 2.2 1.06 0.194 11.34 <0.001* HS

* = More highly significant

To know on which parameters the combined efficacy of treatment procedure is

more effective, the statistical analyses is done by using paired t-test, by assuming that the

treatment procedure is same in all the parameters.

From the analyses all parameters shows more highly significant as P<0.001.

The priority wise treatment procedure is most highly significant in MAAS, Sleep

disturbance, Being easily fatigue, difficulty in concentration, Restlessness or feeling

keyed up, GHQ-28-B, Irritation, GHQ-28-A, Hamilton Anxiety Rating Scale (HAS),


Results

GHQ-28-C, Zung Self Rated Anxiety Scale, GHQ-28-D and Muscle tension respectively

(By comparing t-value).

Conclusion: The study shows this treatment procedure is not more effective on Muscle

tension and rest of all the parameters the procedure shows most effective

(By comparing t-value). The further study can be conducted from the samples who were

working under severe stress or any other work pressure.


Discussion

DISCUSSION

Every research is having one aim or progress, to share that knowledge with the fruitful

and unselfish way, discussion is very important or a key part of the research.

There is no exception; it is very important to every researcher that the methods

adopted, clinical data collection, observation and declaring the results is too presented

systematically in the Discussion. In my clinical study “Evaluation of the

Efficacy of ksheerabala taila nasya and amalaki siddha ksheera dhara in chittodvega

w.s.r.t generalized anxiety disorder” the following is discussed-

Conceptual study:

• Probable mode of action of Nasya karma and Dhara karma

Nasya karma Chittodvega is a Vata Pradhana Manasika vyadhis, nasya is chosen for clinical

trial because Nasa is the easiest route to administer the medicine into the head and

Acharya are also stated that the mind is situated in the head. In the clinical trial, selecting

the nasya procedure and its role in chittodvega chikitsa is stated and discussed in

objective chapter.

Discussion on Nasya drug:

Avarthita thailam

The literal meaning of avarthi thaila is to rotate, or repeat. As in Rasa shastra there is

concept of “mardhana guna vardhanam” being there particularly more efficacious, the

same is true for avarthi in take in thaila kalpana. in general the entire procedure of sneha

Kapha involves three components Viz oil, decoction and paste of herbs. The basic aim of

the procedure being to acquire the liquid soluble essence in to the oil while preparing the


Discussion

decoction most of the volatile oil gets evaporates and only water soluble active principles

comes into the final product. The decoction inters acts with the oil and emulsion like

stage is reached when the complex alkaloids get enlarged with the glycoside Easters of

the fatty acids. The paste comes directly in contact with the oil. The fat-soluble

components of herbs and even some volatile oils mixed in to oils. The essential

components coming in contact of per unit oil is more and the oil is thus formed is more

concentrated in case of reprocessing

Discussion on mode of action of nasya drug:

The absorption of the drugs is carried out in three media they are by general blood

circulation, after absorption through mucous membrane. The direct pooling into Venus

sinus of brain via inferior ophthalmic veins and next one absorption directly in to the

cerebra spinal fluid. Apart from the small emissary veins entering cavernous sinuses of

the brain, a pair of venous branch emerging from alliance will drain into facial vein. In

addition neither the facial vein nor the ophthalmic veins have any venial values so there

are more chances of blood draining from facial vein into the cavernous sinus in the

lowered head position.

The nasal cavity directly opens with the frontal maxillary and sphenoid air sinus

epithelial layer is also continuous through out then the momentary retention of drug in

naso pharynx. Medicine causes oozing as drug material enters into air sinus, which are

rich with blood vessels entering the brain and remaining through the existing foramens in

the bones there are better chances of drug transportation in this path.

The drug administered enters the Para nasal sinus especially frontal and sphenoid sinus

i.e., Shringataka where the ophthalmic veins and the other veins spread the sphenoid


Discussion

sinus are in close relation with intra-cranial structures. Thus there may be a so far

undetected route between air sinuses and cavernous sinuses enabling the transudation of

fluids. As a whole, the mentioning of the Shringataka in this context seems to be more

reasonable.

Discussion on Nasya Procedure:

Ksheera bala taila (101) which is mentioned in the in Ashtanga hrudaya which is

having the properties of balya rasayana, medhya and Vata shamaka property. For nasya

madhyama matra of brumhana nasya is used in this trial ie.8 drops in each nostril for the

maximum of seven days.

The time schedule of nasya is fixed in the morning because all the stress and

anxiety related hormones are at their peek in the morning hours between 7 to 8 am.

Nasya-Poorva Karma

Before performing the nasya karma, ksheerabala taila is used for the Sthanika

abhyanga and nadi sveda is done. After the nasya karma, dhoomapana by the varti

prepared out of haridra choorna and go Ghrita and gandoosha by ushna lavanambu are

given to prevent the excessive accumulation of kapha.

Abhyanga: Mode of action

The Abhyanga is acting over the skin, which is a seat of Vata. The skin is not only

a seat of Vata but also for Lasika (lymph). Thus the lymphatic drainage will be the prime

effect of Abhyanga. Lymph possesses a relatively large amount of the amino acid

tryptophan, especially when compared with the dietary intake. It likewise has a large

amount of albumin (protein), glucose and histaminase (breaks down histamine).

Hypothetically, blood amino acids like tryptophan increase after massage. An increase in


Discussion

plasma tryptophan subsequently causes a parallel increase in the neurotransmitter

(chemical between nerve endings) at motor end plates, and serotonin, which is made from

tryptophan. Serotonin has been implicated in several psychiatric diseases with low levels

of metabolite found by researchers in depression and schizophrenia. Giving albumin

bound protein tryptophan to the brain with proper diet and massage should theoretically

increase brain serotonin. In practice the abhyanga relieves systems like those caused by

serotonin depletion, anxiety, irritability, etc.

Swedana: Mode of action

Mechanism of action of Swedana will be discussed under the following headings:

• Application of heat,

• Physical effect of massage and

• Therapeutic effects of medicaments used.

Application of heat- The effects of any kind of thermal therapy are due to the

increase in the circulation and local metabolic process with the relaxation of the

musculature. Application of heat causes relaxation of muscles and tendons,

improves the blood supply and activates the local metabolic processes.

Physical effect of the massage: - It stimulates the sensory nerve endings thereby

producing relaxation. It produces a hyperemic effect causing the arterioles to

dilatate and thereby achieving more circulation. Also, the venous and lymphatic

return is assisted. Massage causes movements of the muscles thereby

accelerating the blood supply.

Therapeutic effects of the medicaments used: - Drugs in oils and other lipid

soluble carriers can penetrate the epidermis. The movement is slow, particularly.


Discussion

through the layers of cell membranes in the stratum corneum. But once the drug

reaches the underlying tissues it will be absorbed into the circulation. Placing a

drug in a solvent that is lipid soluble can assist its movement through the lipid

barriers

Dhara:

Dhara is one among the moordhini taila and it is one of the main treatment in

keraleeya Panchakarma, and it is also widely practicing in the management of the

manasika vyadhis, like unmada, chittodvega, ,Anidra etc. In the clinical trial, selecting

the dhara procedure and its role in chittodvega chikitsa is stated and discussed in

objective chapter.

Discussion on Dhara-Drug

Amalaki kashaya is taken along with the ksheera for dhara treatment , .amalaki is

having the property of tridosha shamaka mainly vata shamaka and the fruit gave

cytokinine-like substances identified as zeatin, zeatin riboside and zeatin nucleotide;

suspension culture gave phyllembin. Phyllembin exhibits CNS depressant and

spasmolytic activity, potentiates action of adrenaline and hypnotic action of Nembutal.

Discussion on Procedure of Dhara:

The time schedule of dhara is fixed in the morning hours as the hormones

responsible for the anxiety and stress are at their peek in morning hours , the action of

dhara can be of two ways one is due to the absorption and the other theory is due to its

mechanical effect.

Sthanika abhyanga is given with Ksheera bala taila in the fore head to increase the

blood circulation and after the dhara karma rasnadi choorna is applied over the scalp to


Discussion

prevent the cold due to dhara procedure. The procedural effect of Shirodhara itself seems

to produce a relaxation response irrespective of the medicament used. In almost all the

methods of relaxation like yoga, meditation etc. similar general principles prevail.

Probable Mode of Action of Shirodhara:

The shirodhara therapy is extensively used for the alleviation of many ailments,

especially in psychic ailments but used in some of the somatic ailments too. Though

clinical efficacy of Shirodhara is proved, the nature of its action is very complex.

Therefore, to understand the mode of action of Shirodhara is a difficult task.

The mind, body and spirit are intimately connected, and shirodhara by calming

the stressful mind, relaxes the entire physiology. Imbalance of Prana, Udana and Vyana

Vayu, Sadhaka Pitta and Tarpaka Kapha can produce stress and tension. Siro dhara re-

establishes the functional integrity between these three subtypes of Dosha through its

mechanical effect. Sahasrara Chakra is known to be the seat of pituitary and pineal gland.

As we know, the pituitary gland is one of the main glands of the endocrine system. Siro

dhara stimulates the pituitary gland by its penetrating effect, which helps in bring the

hormonal balance.

The Shirodhara is effective in following two ways:

1) Therapeutic effect of medicaments

2) Procedural effect of the process

1. Therapeutic Effect of Medicaments: 180

The therapeutic effect is partially attributed to the medicaments viz. the medicated

oil, Ghrita, butter milk, Kwatha etc. which exchange through the fine pores present over


Discussion

the scalp and forehead. As it is said that the effect and potencies of the articles of

Abhyanga, Snana, Udvartana, etc. which are digested by the skin, enter into the internal

organism through the orifices present in the skin.

The concept of percutaneous absorption described in the modern physiology can be

summed up as follows:

There are three possible routes of absorption. The pilo sebaceous follicles play

some part in absorption of many compounds. The trans-follicular absorption, the route of

penetration is through the follicular pores to the follicles and then to the dermis via the

sebaceous gland. The permeability of the cells of the sebaceous gland is greater than that

of granular layer of the epidermis.

2. Procedural Effect of the Process:

The procedural effect of Shirodhara itself seems to produce a relaxation response

irrespective of the medicament used. In almost all the methods of relaxation like yoga,

meditation etc. similar general principles prevail. One involves efforts and concentration

focusing attention upon a particular object or sensation and the other a simple

watchfulness and observation allowing fine flow of perception.

In Shirodhara, patients feel relaxation both – physically as well as mentally.

Relaxation of the frontalis muscle tends to normalize the entire body and achieve a

decrease in activity of sympathetic nervous system with lowering of heart rate,

respiration, oxygen consumption, blood pressure, the brain cortisone and adrenaline level,

muscle tension and probably an increase in α - brain waves. It strengthens the mind and

spirit and this continues even after the relaxation. Corresponding to different levels and


Discussion

powers of consciousness there are different nerve plexuses and glands in human

organisms. Special stimulation of different nerve plexus, glands and brain cells

accompanies mental function of different type at different levels. Thus, the Hindu theory

of Chakras – center of consciousness – is based on this fact.

According to Ayurveda, the forehead and head are areas of many vital spots –

Marma, which have got very important place in the body. Marmas are very important

points where Soma (Jala/Kapha), Vata, Agni (Pitta), Raja, Satva, Tama and Bhutatma’s

are present.181 In some cases, even slight stimulation of such Marma may have beneficial

effect on the body, due to their connection with higher centers.

Shirodhara makes the patient to concentrate on this area, by which the stability

arrives in the mind function and the patient may feel more comfortable (relaxed). And

moreover, it is having tridoshahara effect. So, in Ayurveda out of the three types of

chikitsa Bahirparimarjana has also important place and many systemic diseases are cured

by using external methods of the therapy and Shirodhara carried out with takra is one of

them.

Shirodhara is done directly on the head, so it may be considered as good for

relieving the diseases caused by stress and strain as well as other mental factors.

According to yogic science among the seven charkas two are located in the head

i.e. Ajna chakra and Sahasrara chakra. It can be hypothesized that with Dhara therapy

these two charkas are getting stimulated and activating the hypothalamus.


Discussion

Discussion on the Disease Chittodvega-Vis-À-Vis GAD

Acharya Charaka has included Chittodvega as a separate Manovikara which

produced by two Manasa Dosha i.e. Raja and Tama. This is indicates that Chittodvega is

a minor psychic disorder with various type of somatic manifestation. In anxiety disorders,

there are various types of classification, which are presented many disorders related with

anxiety. All those disorders have various type of somatic manifestation. It indicates that

Chittodvega and anxiety disorder both have a similarity in this respect. Chittodvega can

manifest as a causative or aggregative emotional factor of various somatic disorders i.e.

Atisara. Anxiety disorders are also caused as well as aggravated by various emotional

disturbances.

In this regard Chittodvega can be presented any subtype of anxiety disorders.

Actually, all sub types of anxiety disorders are conversion of basic anxiety. Hence, in this

Study all subtypes of anxiety disorders are diagnosed according to DSM IV criteria.

Discussion on clinical study:

Source of Data

A total 30 patients suffering from chittodvega fulfilling the inclusion criteria

were studied. The observations and the results as well as statistical analysis of these are

mentioned below.

• Number of patients registered in study - 33

• Number of patients completed the study - 30

• Number of dropout - 03


Discussion

• Discussion on the observations:

Sex - Among the 30 patients of this study 50% patients were females; and 50% were

males this indicates that sex is having no significant role in this study as the ratio of

males and females are equally affected.

Age - Among 30 patents none of them were from 10-19 age group, 12 (40%) from20-

29 age group, 07 (23%) from30-39age group,10 (33%) from 40-49 and 1 (3.33%)

from 50-59 age group, from this we can say that middle age people are more affected

when compare to children’s and old age people because of their constant exposure to

stressful environment.

Religion - Among 30 patients of this study maximum 28 (93.33%) of patients were

belonged to Hindu community 02 (6.67%), from Muslim .. This may due to the

random selection of the samples.

Marital Status - Among the 30 patients maximum of 16 (53.33%) patients were

married and14 (46.67%) are unmarried people Higher incidence in married people

especially in females was noted may be due to possibility of conflicts in the family.

Socio-Economic Status - Maximum of 20 (66.67%) patients belongs to upper Middle

class, 01 (3.33%) from poor class, 09 (30%) from lower middle class. This shows

predominance of chittodvega in Upper middle class may be due to working group

facing events of financial loss or adjusting the needs in the family.

Occupation - Maximum of 10 (33.33%) patients were executive, 10 (33.33%) were

students, 01 (3.33%) patients were labours; and 09 (20%) were belongs to sedentary

habits. In the clinical study, occupation plays important role as the working


Discussion

executives and particularly working women gets a bad situations and atmosphere

around the place of working makes them to be prone to chittodvega.

Chronicity - Among the 30 patients 20 (67%) were having the chronocity up to 1

year,09 (30%) patients were having 1-2yrs and 1 (03%) patient were having 2-3yrs .

The chronicity shows that majority of the patient seek medical attention after long

duration this signifies that the GAD is not that serious a disease like depression were

even the daily activities get disturbed or hampered

Nidana182- Among the 30 (100%) patients, all patient is having the nidana of bhaya,

Krodha, udvega shoka and chinta, 18 (60%) patients were having the nidana of

dhananasha bandhunasha as nidana for 10 (33%) the dosas pertaining the mind rajas

and tamas, are responsible for the above said nidanas and Acharya Susruta also states

that Manasika disease are produced by these nidanas. Mental disease is generated by

the non fulfillment of the desired objects and by succumbing to the hated. As a social

being we are unable to fulfill our desires and we are compelled to accept things that

we dislike both these cause frustration and mental stress and are conducive to mental

disease. According to Ayurveda improper union of time, objects and action is the

cause of all the disease thus the improper union of the mind with its objects namely,

“the thinkable” and the improper action of the mind are conducive to the mental

diseases. From a slightly different perspective, etiology can be classified into 3 viz

contact of objects that cannot be assimilated, error of consciousness and

transformation. Error of consciousness is the term used for erroneous action prompted

by the lapse of intellect, will power and memory that produce bad result. In fact most

of the etiological factors will come under this head. In the context of the diseases


Discussion

especially those based in mind the .in that Bhaya it is generally known as fear it is

related to tamo guna and aggravates vata, Krodha is the feature of rajo guna produced

either due to vata or pitta dosa it is produced when one could not acquire the desired

one and sammoha follows it. Soka is caused due to rajas and tamas along with vata

and chinta is also vata Pradhana dosa caused due to rajas and tamas leads to various

psychological conditions. .( page 16-17 concept of mind)

Diet 183- Among 30 patients 08 (26.67%) were vegetarian, 22 (73.33%) were having

mixed dietary habit this also signifies that the disease is more predominant in non

vegetarians as this may be due to increase of rajasika guna and also use of more

katu, tikta, kashaya and amla rasas in their food and consumption of more spicy

things and use of animal mamsa. Dietary restriction becomes inevitable part of any

treatment it aims at framing a plan of advisable food stuffs those suits the disease and

treatment schedule here also no exception that means necessary modifications are

permitted according to treatments to be done, keeping a general plan of restricted diet

here are some list wholesome and un wholesome foods, cereals like green gram,

wheat, shashtika rice, vegetables like ash gourd ,snake gourd ,amaranth, fruits like

mango, grapes jack fruit and ghee, meat of tortoise fresh milk are wholesome foods

recommended and unwholesome foods like, black gram, bitter gourd, leafy

vegetables, fruits occurring in late summer, alcohol, bitter spicy food in compatible

food and meat. .

Vihara - Among 30 patients O2 (06.67%) were hard working, 25(83.33%) were

moderately working and 3 (10%) were having sedentary life habits . vihara plays

major role in mental disorders, vihara like sitting, sleeping, oil massage, inhalation of


Discussion

fumes cold daub etc are indicate in mental disease as these gives mental relaxation,

keeping awake at the night, starvation, suppression of thirst, physical exercise etc

should be avoided as these causes aggravation of vata.( page 193 concept of mind)

Agni - In the present study, maximum of 23(77%) patients were having manda agni

and01 (03%) patients were having vishama agni,1 (03%) having theekshna agni and 5

patients having sama agni The provocation of Vata leads to Visama Agni. Acarya

Caraka mentions various Manasa Bhava i.e. Cinta, Soka, Bhaya, Krodha etc. which

impacts on Agni and leads to Manda Agni (Ca. Vi. 2/9). The relation of type of agni

and its role in bringing changes in mental faculties in causing the mental disorders

need an extensive research, definitely manasika bhavas causes variation in types of

Agni level.

Nidra - Among thirty patients 00(00%) were having Prakrutha nidra, 29 (96.67%)

were having Alpa nidra, 01 (03%) patient having Diwaswapna and none were having

Ati nidra. Nidra is mainly caused by tamo guna and sleshma, apart from that due to

mental exertion, physical exhaustion and in some diseases. Anidra is caused due

bhaya, Krodha, shoka, chinta, udvega etc.this disorder is characterized by frequent

awakening or early morning awakening and the patient may have felling or not

having rested properly , it will not cause severe problem in GAD as compared to

other serious mental conditions like depression, anxiety neurosis etc .where the REM

is more severe .Among my patients most of them were working in shifts .Shift

workers in particular appear more prone to digestive ailments, constipation, obesity,

anxiety, depression etc disorders and during the waking hours such individuals may


Discussion

suffer fatigue, reduced alertness, anxious mood, irritability etc. the main symptoms of

GAD.

Vyasana - Among 30 patients 02 (06.67%) were having Tobacco chewing habit, 06

(20%) were having smoking habit, 03 (10%) were having alcohol drinking habit and

19 (63.33%) of them had no habits this signifies that vyasan is not having much

influence in causing the chittodvega in this study but the vyasan like alcohol and

smoking plays significant role in causing the disease.

Manasika Prakruti - Among 30 patients no one is having satvika prakruti ,

22(73.33%)patients were having rajasika prakruti and 08(26.67%)of them were

having tamasika prakruti this suggests that the persons with rajasika prakruti are

more prone to this disease as chittodvega is disease caused due to rajas and tamas

Satva - Among 30 patients 04(13.33%) patients were having pravara satva, 21(70%)

were having Madhyama satva and 05 (16.67%) were having Avara satva When Alpa

satva (inadequate mental make up or personality) person indulges in or is afflicted by

manobhighata and Pragnaparadh , it results in the imbalance of manas dosha rajah

and tama leading to the vitiation at bodily level by affecting dosas , along with the

vitiation of Agni & depletion of Ojas which present the Psychosomatic presentation

of disease.

Discussion on Clinical Parameters:

The effect of the Ksheerabala taila (101) nasya and amalaki Siddha ksheera dhara

shows significant results in all the parameters used -

Effect on restlessness - In case of restlessness highly significant relief on symptom

of restlessness the p value is <0.001 and 87% improvement clinically. In case of 30


Discussion

patients all the patient possess with the symptoms of restlessness before the treatment

but after the treatment the symptom persist with only 3 patients

Effect on Fatigue - In case of fatigue before the treatment all the 30 patients possess

with this symptom but the treatment shows highly significant relief on the symptom

of fatigue the p value is <0.001 and 98% improvement clinically. After the treatment

none of the patient persists with the symptom.

Effect on Difficulty in concentration - In case of difficulty in concentration the

study shows statistically highly significant with p value <0.001 and 88%

improvement clinically. In case of 30 patients all the patient possess with the

symptoms of difficulty in concentration before the treatment but after the treatment

only 3 patient were having the symptom.

Effect on Irritability - In case of Irritability the study shows statistically highly

significant with p value <0.001 and 92% improvement clinically. In case of 30

patients all possesses with the symptoms of difficulty in concentration before the

treatment but after the treatment only 3 patients were having the symptom.

Effect on Muscle tension- In case of muscle tension the statistical value shows

highly significant with p value <0.001 and 97% improvement clinically In case of 30

patients all the patient possess with the symptoms of muscle tension before the

treatment but after the treatment symptom persist only in 1 patient.

Effect on Sleep disturbance - In case of sleep disturbance the statistical value shows

highly significant with p value <0.001 and 92% improvement clinically In case of 30

patients all the patient possess with the symptoms of Sleep disturbance but after the

treatment the symptom persist only in 2 patients.


Discussion

Effect on HAS - In case of HAS the statistical value shows highly significant with p

value <0.001 and 90% improvement clinically 30 patients of clinical trial comes

under normal range of Hamilton Anxiety Scale.

Effect on Zung self rated anxiety scale - In case of Zung self rated anxiety scale the

statistical value shows highly significant with p value <0.001 and 48% improvement

clinically.

Effect on MAAS - In case of MAAS the statistical value shows highly significant

with p value <0.001 and 62% improvement clinically

Effect on GHQ-28 - In case of GHQ-28 the statistical value shows highly significant

with p value <0.001 and 64 % improvement clinically.

Discussion on the 0verall assessment of the result

The overall assessment will be calculated by considering the following three grading

• Best responded

• Respondent

• Not responded

Best Responded- score below 18 Hamilton Anxiety Scale, normal range of Zung anxiety

scale, total absence of clinical symptoms with return to normal activities.

Respondent- scores between 18-25Hamilton Anxiety Scale, score of 50-59 of Zung self

rated Anxiety scale, marked improvement in clinical symptoms with return to normal

activities

Not responded- Hamilton Anxiety Scale and Zung-anxiety scale being same or

minimum improvement, with the presence of clinical symptoms and much difficulty to

return to normal activities


Discussion

• In case of Hamilton anxiety scale before the treatment there were no patients below the

range of 18, between 18-25 range 10 (33%) patients are there and 20 (67%) patients are

above the level of 30

• In case of Zung anxiety self rated scale before the treatment 19 (63%) patients were with

in the normal range i.e. below 50, 07 (23%) patients between the range of 50-59 i.e. with

moderate anxiety, 04 (13%) patients with in the range between 60-74 and no patients

above the range of 74 i.e. Severe anxiety

• In case of clinical symptoms all the 30 patients were having symptoms like restlessness,

fatigue, irritability, difficulty in concentration, sleep disturbance and 21 (70%) patients

were having the symptom muscle tension.

• After the treatment all the 30 patients comes under the normal range of HAS and Zung

self rated anxiety scale where as in case of clinical symptoms only 26 (87%) patient got

complete relief ,04 (13%) patients were responded well and none were not responded.

• The criteria taken for the assessment of the result Hamilton anxiety scale and Zung self

rated anxiety scale shows differed reading before treatment but after the treatment the

value are almost equal this may be due to the difference in the application of the two

scales when we compare both the criteria’s .

• General observation-

Maximum patients were good at personal care as GAD is a minor psychic disease. There

was not much disturbance in the higher mental functions. Attitude of most of the patients

was found co-operative in order to hope for the better solution of their condition. Most of

the patients were watching TV, which indicate that television was not providing proper

mental relaxation.


Conclusion

CONCLUSION

From the detailed conceptual compilation, critical review, clinical observations

and discussions the following conclusions can be drawn-

1. Chittodvega is a diseased condition related to mind caused due to rajas and tamas.

2. Among various psychological disorders described in Ayurveda, Chittodvega is the

one which can be correlated clinically to Generalized Anxiety Disorder.

3. Generalized anxiety disorder is the most common health problem in the present world

due to the stress, life style, sedentary habits, excessive worry, fear etc. It not only

affects the patient mentally but physically also.

4. Anxiety and anxiety disorder have been discussed with up to date modern

Perspective. Generalized anxiety disorder is studied with special reference to

Chittodvega. Various theories regarding etiology of Generalized Anxiety Disorder, its

pathogenesis, symptoms and differential diagnosis are discussed in details. Various

psychotherapy and drugs used at present are also described.

5. The disease does not show any severe problems in the beginning, due to this the

patients will be less bothered or give less attention to the symptoms of the disease and

that itself leads to more complication in the latter stage because it may occur as a

manifestation of a primary psychiatric disorder or secondarily to either the medical

illness or the medications prescribed for treatment (Harrison).

6. Chittodvega or GAD is that common a disease that all most every individual will

meet or experience at least once in their life either in severe or minor forms, but if it

persist for a long time then patient should seek for medical attention because if it


Conclusion

persist for more duration it will lead to several disabling mental conditions such as,

anxiety neurosis, depression etc.

7. The scales used Hamilton anxiety scale, Zung self rated anxiety scale, MAAS, etc

plays significant role for the diagnosis of the disease as well as to assess the

therapeutic effect.

8. The incidence of the disease is noted high in the population age group between 20- 40

years in this trial that shows the disease is more associated with working people and

those who were more exposed to the stress full conditions.

9. The therapies used in this trial brumhana nasya with ksheera bala taila(101) and

amalaki Siddha ksheera dhara shows significant results in the management of the

disease.

10. Observation and analysis of the30 patients has been presented and the results

obtained from Patients who complete the course of therapy, have been presented in

Tabular form projecting the effect of therapy on sign and symptoms of Generalized

Anxiety Disorder effect on Hamilton Anxiety Rating Scale, Brief Psychiatry rating

Scale and effect on various Manasbhava are also summarized

11. The therapies used in this trial along with counseling plays major role in the present

study in case of the management of the disease chittodvega..

12. The further research is necessary to establish this treatment modality adopted here in

this trial and also should be more concentrated on the areas where the occupational

stress, sedentary life styles etc factors that influence the disease.


Conclusion

13. Since the study was carried out with limited budget and time, the results of this study

provides enough scope to future research scholars in the field of Ayurveda in general

and Manasaroga in particular to work in this direction.

14. Cognitive behavior therapy plays important role in the management of anxiety

disorders according to modern psychiatry where as in Ayurveda , Achara Rasayana,

Daivavyapasraya chikitsa is also indicated in manasika vikaras like chittodvega,

apasmara, unmade etc. but rationality of these treatment modalities need to applied

and put forth for research makes to understand their value.


Summary

SUMMARY

Chittodvega is a disease of mind caused due to rajas and tamas the generalized

anxiety state is here closely comparing with chittodvega which is mentioned by Acharya

Charaka in the vimana sthana

As per the WHO predictions, at 2020 anxiety disorders and depressive

disorders will be in the top rank order of Disease Burden for 18 leading Countries (The

Global Burden Of Disease – WHO 2001); which are related to lifestyle and behavioral

patterns.

In Chittodvega, when the mind is afflicted with anxiety, fear, agitation etc.this

leads to worry apprehension, depression, psychological arousal as anger, irritability and

ultimately lead to disturbance in personal, familial and social harmony.

Anxiety disorders are one among the most prevalent psychiatric condition in the world

The thesis entitled the “Evaluation of the efficacy of ksheerabala taila nasya and

Amalaki siddha ksheera dhara in chittodvega w.s.r.t Generalized anxiety disorder”

consists of seven parts.

• Introduction

• Objectives

• Review of Literature

• Methodology

• Observation and Results

• Discussion

• Conclusion and summary


Summary

Introduction: This part consists of the general description of health and relevance of

Chittodvega and generalized anxiety disorders. In this part, discussion on chittodvega is

covered briefly and selection of samshodhana for this study is discussed. This part is also

Consists of discussion about lacuna in current Knowledge and Proposed or formulated

Hypothesis of this study is discussed briefly.

Objectives: This part consists of brief description of types of life style which causes

Chittodvega, before the putforthing the objectives. After considering the clinical

parameters, four objectives were discussed.

Review of Literature: Historical review deals with the historical aspects related

to nasya karma. Etymology and definition of nasya, indication and Contra indications

explained in a glimpse on utility of nasya karma- nasya karma in various conditions

obtained from several texts.

Dhara karma was studied as procedure, observation during procedure and briefly

discussed about a review on current physiology.

Conceptual study of chittodvega includes Etymology, definitions, Nidana,

Lakshana, Samprapti, Upadrava, Upashayanupashaya, Pathyapathya and Psychological

correlation to generalized anxiety disorders at appropriate context. Drug review explains

the properties of drugs used for nasya (bala) and dhara (amalaki)

Methodology: The materials and methods adapted for the study are described here.

This chapter deals with the

• Protocol of the study Vs objective of the study

• Inclusion and exclusion criteria for the patients

• Method of administration of nasya karma


Summary

• Method of administration of dhara karma.

• Intervention and criteria of assessment

Observations and Results:

The observation made on demographic incidence of age, sex, habits etc are

Presented in the form of Tables and Graphs. The results of the clinical study are

Presented with master charts and statistical analysis in the form of tables with brief

narrations.

Discussion: The conceptual part of nasya karma and dhara karma and its effect on

Chittodvega are explained. Clinical data is discussed in detail. The result obtained in

Clinical study, as well as observations in it is discussed with relevant arguments.

Conclusion and Summary: The conclusion of whole clinical study and the effect of

nasya and dhara in this study are explained in this chapter. Limitation of study and further

scope for study is also discussed briefly.

This humble effort is just a curtain raiser for more valuable and deep studies In summary, summarized the whole thesis.


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31) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 43, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 556

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34) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 25, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 555

35) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Sutra Sthana





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41) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-106-108, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 723


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57) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 21-22, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 554-555



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66) K.V Krishnana Vaidyan and S Gopalapilla Edited Sahasrayogam ( Malayalam )

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77) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Nidana



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80) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter


81) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Uttara Sthana




83) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Nidana Sthana, Chapter




85) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Nidana Siddhi Sthana,

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Annexure


SPECIAL CASE SHEET FOR CHITODVEGA

Post Graduate Research and Studies Center (Panchakarma) Shree DGM Ayurvedic Medical College, Gadag. GUIDE : DR. P. SIVARAMUDU, PG SCHOLAR: RAJESH.

A.R.

MD (Ayu). M.A. (San), M.A. (Psy) Co-Guide: Dr. Santosh. N. Belavadi MD (Ayu).

1. Name of the patient : ____________________ 2. Father’s / Husband’s Name : ____________________ 3. Age _______ yrs. Place of Birth __________________ 4. Sex Education __________________ 5. Marital Status Married ( ) Unmarried ( ) 6. Religion Hindu ( ) / Muslim ( ) / Christian ( ) / Others ( ) 7. Occupation Labour ( ) Student ( ) Executive ( ) Sedentary ( ) 8. Economical Status Poor ( )/ Lower Middle ( ) / Upper Middle ( )/ Rich ( ) 9. Address _______________________ E-mail ID _____________

_______________________ Phone No _____________

_______________________ Pin __________________

D M Y D M Y 10. Date of Schedule Initiation Completion

11. Result:

CONSENT

I am fully educated with the disease and treatment there by I got satisfied. I accept for

medical trial on me happily.

M

SL.No O.P.D. No I.P.D. No

F

Annexure

Investigator’s Signature Signature of Patient

1. CHIEF COMPLAINTS: Duration:

a) restlessness or feeling keyed up or on edge

b) Being easily fatigue

c) Difficulty in concentration

2. ASSOCIATED COMPLAINTS:

a) Irritability

b) Muscle tension

c) Sleep disturbance

3. HISTORY OF PRESENT ILLNESS: 4. HISTORY OF PAST ILLNESS:

a) No of episodes b) Post traumatic c) Phobias d) Working condition

5. FAMILY HISTORY:

Yes No 6. OCCUPATIONAL HISTORY:


Annexure


7. TREATMENT HISTORY:

8. PERSONAL HISTORY: 1 Ahara Vegetarian ( ) Mixed ( )

2 Vihara Nature of work : Hard ( ) Moderate ( ) Sedentary ( )

3 Agni Samagni ( ) Mandagni ( ) Teekeshnagni ( ) Vishamagni ( )

4 Kostha Mrudu ( ) Madhyama ( ) Krura ( )

5 Nidra Prakruta ( ) Alpa ( ) Ati ( ) Diwaswapna ( )

6 Vyasana None ( ) Tobacco ( ) Smoking ( ) Alcohol ( )

7 Artava Regular ( ) Irregular ( ) Menopause ( )

Menstrual History

a) Menstrual cycle

b) Use of contraceptives

c) Abortions

9. SAMANYA PAREEKSHA:

10. SROTO PAREEKSHA:

1. Manovaha srotas

2. Pranavaha srotas

A. Asta sthana Pareeksha :

1. Nadi /Min

2 Mala

3 Mootra

4 Jihwa

5 Shabda

6 Sparsha

7 Druk

8 Akruti

B. Vital examination :

1. Heart rate /Min

2 Resp rate /Min

3 Blood pressure mm of Hg

4 Body Temp /F

5 Body weight Kgs

Annexure

3. Annavaha srotas

4. Rasavaha srotas

11. NIDAANA

1. Prajnaparadha

2. Parinama

3. Asatmendriyarthasamyoga

a.) Mithya / Atiyoga karmanam

b.) Mithya / Atiyoga Indriyartham

Si.no Nidana Present Absent Si.no Nidana Present Absent

1. Kama 8. Moha

2. Krodha 9. Cinta

3. Bhaya 10. Irsa

4. Udvega 11. Raga

5. Soka 12. Dvesa

6. Lobha 13. Dhananasa

7. Harsa 14. Bandhavanasa

8. Moha 15. Hina Sattava

9. Cinta 16. Pujyapujavyatikrama

12. ROOPA OF CHITODVEGA S.No Roopa of Chitodvega BT AT AF 1 Restlessness or feeling keyed up or on edge 2 Being easily fatigue 3 Difficulty in concentration 4 Irritability 5 Muscle tension 6 Sleep disturbance

`


Annexure

HAMILTON ANXIETY RATING SCALE:

No. Item Scoring BT AF 01. Anxious mood: Worries, anticipation of the worst, fearful

anticipation, irritability.

02.

Tension: Feeling of tension, fatigability, startle response, moved to tear easily, trembling, restlessness, inability to relax.

03.

Fears: Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.

04.

Insomnia: Difficulty in falling a sleep, broken sleep, unsatisfying sleep, fatigue on waking, dreams, nightmares, night terrors.

05.

Intellectual (Cognitive): Difficulty in concentration, poor memory.

06. 07.

Depressed mood: Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing. Somatic (Muscular): Pain and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.

08.

Somatic (Sensory): Tinnitus, blurring of vision, hot and cold flushes, feeling of weakness, picking sensation.

09.

Cardiovascular Symptoms: Tachycardia, palpitation, pain in chest, throbbing of vessels, fainting feelings, missing beat.

10.

Respiratory Symptoms: Pressure or constriction in chest, choking feeling, sighing, dyspnea.

11.

Gastrointestinal Symptoms: Difficulty in swallowing, wind, abdominal pain, burning sensation, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.

12.

Genitourinary Symptoms: Frequency of maturation, Urgency of micturation, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.

13.

Autonomic Symptoms: Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.

14.

Behavior at interview: Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, belching, brisk tendon jerks, dilated pupils, exophthalmos.

Signs and symptoms mentioned in Hamilton scale were assessed by adopting the following scoring system. Degree of anxiety &Pathological condition Scoring

None 0

Mild 1

Moderate 2

Severe 3

Severe, grossly disabling 4


Annexure

Table No: 11 Showing Zung Self-Rated Anxiety Scale

Sl.No STATEMENT None or a little of the time

Some of the time

A good of the time

A good part of the time

BT AF

1. I feel more nervous and anxious than usual.

1 2 3 4

2. I feel afraid for no reason at all. 1 2 3 4

3. I get upset easily or feel panicky. 1 2 3 4

4. I feel like I'm falling apart and going to pieces.

1 2 3 4

5. I feel that everything is all right and nothing bad will happen.

1 2 3 4

6. My arms and legs shake and tremble. 1 2 3 4

7. I am bothered by headaches neck and back pain.

1 2 3 4

8. I feel weak and get tired easily. 1 2 3 4

9. I feel calm and can sit still easily. 1 2 3 4

10. I can feel my heart beating fast. 1 2 3 4

11. I am bothered by dizzy spells. 1 2 3 4

12. I have fainting spells or feel like it. 1 2 3 4

13. I can breathe in and out easily. 1 2 3 4

14. I get feelings of numbness and tingling in my fingers and toes.

1 2 3 4

15. I am bothered by stomach ache or indigestion.

1 2 3 4

16. I have to empty my bladder often. 1 2 3 4

17. My hands are usually dry and warm. 1 2 3 4

18. My face gets hot and blushes. 1 2 3 4

19. I fall asleep easily and get a good night's rest.

1 2 3 4

20. I have nightmares. 1 2 3 4


Annexure

Table No: 12 Showing the General Health Questionnaire-GHQ28 Sl.No


AF

Al Been feeling perfectly well and in Good health?

Better than usual

Same as usual

Worse than usual

Much worse than usual

A2 Been feeling in need of a good tonic?

Not at all

No than usual more



A3 Been feeling run down and out of Sorts?

Not at all

No than usual more



A4 Felt that you are ill? Not at all

No than usual more



A5 Been getting any pains in your

head?

Not at all

No than usual more



A6 Been or pressure in your head? getting a feeling of tightness

Not at all

No than usual more



A7 Been having hot or cold spells? Not at all

No than usual more



Sl.No


AF

B1 Lost much sleep over worry? Not at all

No than usual more



B2 Had difficulty in staying asleep once you are off?

Not at all

No than usual more



B3 Felt constantly under strain? Not at all

No than usual more



B4 Been getting edgy and bad-

tempered?

Not at all

No than usual more



B5 Been getting scared or panicky

for no good reason?

Not at all

No than usual more



B6 Found everything getting on top of you?

Not at all

No than usual more



B7 Been feeling nervous and strung-up all the time?

Not at all

No than usual more




Annexure


Sl.No


AF

C1 Been managing to keep yourself busy and occupied?

More so than usual

Same as usual

Rather less than usual


C2 Been taking longer over the things you do?

Quicker than usual

Same as usual

Longer than usual

Much longer than usual

C3 Felt on the whole you were doing things well?

Better than usual

About Same as usual

Less well than usual

Much less well

C4 Been satisfied with the way

you've carried out your task?

More satisfied

About Same as usual

Less satisfied than usual

Much less satisfied

C5 Felt that you are playing a useful

part in things?

More so than usual

Same as usual

Less useful than usual

Much less useful

C6 Felt capable of making decisions about things?

More so than usual

Same as usual

Less so than usual

Much less capable

C7 Been able to enjoy your normal day-to-day activities?

More so usual

Same as usual

Less so than usual


Sl.No


AF

D1 Been thinking of yourself as a worthless person?

Not at all

No than usual more



D2 Felt that life is entirely hopeless? Not at all

No than usual more



D3 Felt that life isn't worth living? Not at all

No than usual more



D4 Thought of the possibility that you might make away with yourself?

Definitely not

I don't think so

Has crossed my mind

Definitely have

D5 Found at times you couldn't do anything because your nerves were too bad?

Not at all

No than usual more



D6 Found yourself wishing you were dead and away from it all?

Not at all

No than usual more



D7 Found that the idea of taking your own life kept coming into your mind?

Definitely not

I don't think so

Has crossed my mind

Definitely has

BT

AF A-

A-

C-B-

C-B- D- Total-

D- Total-

Annexure

Mindfulness Attention Awareness Scale (MAAS) 1 2 3 4 5 6

Almost Always

Very frequently

Somewhat Frequently

Somewhat Infrequently

Very Infrequently Almost Never

The mindfulness attention awareness scale is also a set of questioners used in this study to evaluate the mental condition of the patient it contains 15 questioners with grading starting from 1 to 6 to assess the mental condition, each item should be graded separately and the scoring has been done by simply computing the mean of 15 items, And higher score reflects the higher levels of dispositional

Sl.No Questionnaires BT AF 1. I could be experiencing some emotion and not be conscious of it until

some time later.

2. I break or spill things because of carelessness, not paying attention, or thinking of something else.

3. I find it difficult to stay focused on what's happening in the present. 4. I tend to walk quickly to get where I'm going without paying attention to

what I experience along the way.

5. I tend not to notice feelings of physical tension or discomfort until they really grab my attention.

6. I forget a person's name almost as soon as I've been told it for the first time.

7. It seems I am "running on automatic," without much awareness of what I'm doing.

8. I rush through activities without being really attentive to them 9. I get so focused on the goal I want to achieve that I lose touch with what

I'm doing right now to get there

10. I do jobs or tasks automatically, without being aware of what I'm doing. 11. I find myself listening to someone with one ear, doing something else at

the same time

12. I drive places on "automatic pilot" and then wonder why I went there. 13. I find myself preoccupied with the future or the past. 14. I find myself doing things without paying attention. 15. I snack without being aware that I'm eating.


Annexure

AYURVEDA MENTAL EXAMINATION

I) SHEELA

A) Habits B.T

1. Vinidra Present/Absent

2. Swapnanityata Present/Absent

3. Rahaskamata Present/Absent

4. Abheekshanam asthane hasanam Present/Absent

5. Abheeksham asthane rodanam Present/Absent

6. Arochakam Present/Absent

7. Charadi Present/Absent

8. Alpaharam Present/Absent

9. Bahubhuk Present/Absent

10. Bhunkte balam Present/Absent

11. Jeerne balam Present/Absent

12. Ratrau bhrisham bhavati Present/Absent

B) Temperament

1. Krodhaha Present/Absent

2. Santarjanam Present/Absent

C) Physiological functions

1. Swedabahulaha Present/Absent

2. Tritabahulaha Present/Absent

3. Shwasaturaha Present/Absent

4. Kasaha Present/Absent

5. Nareepriyata Present/Absent

6. Sadanam Present/Absent

D) Personal Care

1. Matopadigdhakshata Present/Absent

2. Lalosravaha Present/Absent

3. Asyat phenagamanam Present/Absent

4. Singhanaka sravaha Present/Absent

5. Analankarikairalankaranam Present/Absent


Annexure

II) CHESTA

A) General motor activity B.T

A.F

1. Abheekshanam asthane nartanam Present/Absent

2. Abheekshnam asthane vadanam Present/Absent

3. Abheekshnam asthane gayanam Present/Absent

4. Ajasram parisaranam Present/Absent

5. Akasmadanjavikshepanam Present/Absent

6. Abhidravanam Present/Absent

7. Asthane samrambhaha Present/Absent

8. Asthane akroshaha Present/Absent

9. Paresham abhihananam Present/Absent

10. Manda chesta Present/Absent

B) Speech

1. Satatam giramutsargaha Present/Absent

2. Aniyatam giramutsargaha Present/Absent

3. Parushavak Present/Absent

4. Vakmanda Present/Absent

C) Facial expression and postures

1. Shwayathuschanane Present/Absent

2. Sthimitakshata Present/Absent

3. Utpinditakshata Present/Absent

4. Samrabdhakshata Present/Absent

5. Aruna/tamra/Haridra/Haritakshata Present/Absent

6. Nakhadi shouklyam Present/Absent

7. Peetacha bha Present/Absent

8. Rukshachhavihi Present/Absent

9. Dhamaneetataha Present/Absent

10. Karshyam Present/Absent

11. Sphurita sandhihi Present/Absent

12. Sthanamekadeshe Present/Absent


Annexure

III) ACHARAHA

A) Personal standards

1. Shoucha dweshaha / Bheebhatsatwam Present/Absent

B) Social standards

1. Vinagnabhabaha Present/Absent

IV) MANAHA

1) Indriyabhigrahaha

i. Cannot be tested because of non-cooperation Present/Absent

ii. Disturbed because of peripheral factors Present/Absent

iii. Disturbed mild /Moderate/Severe Present/Absent

iv. Indriyasapekshayatharthajnanam

a. Astya jwaladi darshanam Present/Absent

2) Manonigarahaha Present/Occasionally

Absent/Frequently

Absent

3) Ooha Intact/Partly impaired

Grossly impaired

4) Vicharaha Intact/Mildly

Impaired/ Moderately

Impaired/ Grossly

Impaired

i. Discriminative ability Intact/Mildly

Impaired/ Moderately

Impaired/ Grossly

Impaired

a. Ativelam santapaha Present/Absent

b. Ayanairyanam Present/Absent

ii. Indriyanirapekshayathara thajnanam Present/Absent

a. Himambunichayepi cha vahnishanki Present/Absent

b. Aushnyam Present/Absent


Annexure

V) BUDDHIHI

1. Vividha shabdanukaranam Present/Absent

2. Sweshamabhihananam Present/Absent

3. Atpamatihi Present/Absent

VI) SMRITHI - Intact/Mildly impaired/Grossly impaired /Cannot be tested

VII) SANJNAJNANAM - Intact/Mildly impaired/Grossly impaired /Cannot be tested

1. Orientation to place Intact/Mildly impaired/

Moderately impaired/

Grossly impaired

2. Orientation to time Intact/Mildly impaired/


Grossly impaired

3. Orientation to person Intact/Mildly impaired/


Grossly impaired

4. Responsiveness Intact/Mildly impaired/


Grossly impaired

VIII) BHAKTHI - Intact/Mildly impaired/Grossly impaired /cannot be tested

i. Physiological desires

ii. Desires in relation to attire

iii. Desires in relation to entertainment

1. Ushnasevee Present/Absent

2. Sheetabhilasee Present/Absent

3. Alabdheshu abhyavaharyeshu lobhaha Present/Absent

4. Labdheshu abhyavaharyeshu teevra matsaryam Present/Absent

IX)

1. Prakrithi

i. Shareera

ii. Manasa

X) SATWAM – Pravaraha/Madhyamaha/Avaraha


Annexure


SPECIAL WORK SHEET FOR CHITODVEGA

1. Name of the patient : ____________________ 2. Age _______ yrs. Place of Birth __________________ 3. Sex Education __________________

During Nasya karma

Days Heart Rate Pulse Rate Blood Pressure

1st day /min /min mm of Hg

2nd day

3rd day

4th day

5th day

6th day

7th day

M F

Sl.No O.P.D. No I.P.D. No

Annexure

During Dhara karma Days Heart Rate Pulse Rate Blood Pressure

8th day /min /min mm of Hg

9th day

10th day

11th day

12th day

13th day

14th day


Annexure


NASYAKARMA

ABHYANGA with ksheerabala taila

NASYA Ksheera bala taila (101) 8 drops in each nostril for –7 days

Time of administration – Morning 7.30 am- 8.30 am

Initiation Date: Date:

Days Time of administration Matra Nireekshana

Completion

1

2

3

4

5

6

7

Samyak Nasya Lakshana

Sl. No. Nasya phala APPEARNCE OF SIGNS AND

SYMPTOMS

1 EUÈ sÉÉbÉuÉ

2 ÇÍzÉUÉå sÉÉbÉuÉ

3 CÇÎlSìrÉ sÉÉbÉuÉ

4 xÉëÉåiÉÉåzÉÑÎ®È

Annexure


DHARAKARMA

DHARA Amalaki siddha ksheera for -7 days

Time of administration – between 7.30 to 8.30 am

Initiation Date: Date:

Days Time of administration Duration Nireekshana

Completion

1

2

3

4

5

6

7

Bahya Sneha Lakshanas:

Sl.No. Sneha Phala APPEARNCE OF SIGNS AND

SYMPTOMS

1 SØÌ¹mÉëxÉÉS

2 mÉÑÌ¹

3 xuÉmlÉ

4 xÉÑiuÉMçüSÉRûrÉïM×üiÉç

Other observation: Signature of Guide Signature of Scholar (Dr. P. SIVARAMUDU) (RAJESH.A.R.)

Annexure


Chittodwega ksheeradhara pk026_gdg

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