RoleofShirodharainBodyMind% … Upakarma%(complementary%treatment)%of%Ayurveda % Classicalliterature...

Role of Shirodhara in Body-‐‑Mind Healing –An Evidence Based Report

Anupama Kizhakkeveettil, BAMS, MAOM, LAc, PhD © Associate Professor

Program Director Ayurveda Southern California University of Health Sciences

Board member California Association of Ayurvedic Medicine Board member of Council of Ayurvedic Research

Founding member of Council of Ayurvedic Credentialing Action Board Member , American Public Health Association

President Athreya Ayurvedic Products

Document provided to and used by NAMA with permission from Anupama KizhakkeveeFil

Shirodhara •  What is shirodhara?

o  Oil/water/bu3ermilk/decoc7on dripping on the forehead in a steady stream or flow.

o  Shira-‐ Head, Dhara – Flow o  Widely prac7ced treatment in Ayurveda o  Upakarma (complementary treatment) of Ayurveda

Classical literature Siraseka or dara is special type of treatment prac7ced for disease of the head. Siraseka, or dhara is the process in which medicated oil, milk, or bu3ermilk is poured in a con7nuous stream on the head, especially on the forehead in a specific manner.

Classical literature

Classical literature Ashtanga-‐ Sutrasthana-‐31 •  म"ध$त&ल( पuन,तuध- िभ01-‐अ3य5गः पiरषeकः iपचuब$ि?तiरiत| यथोBर( 1 बिलनः| तCा3य5गो EFकGड"मलाiदषu JयuKय1| पiरषeकLवE~ ंiषकािशर?तोददाहपाकQणeषu| Sशशात?फuटनध"पनWC?तXYषu iपचuः| बि?त?तu Jसu[LयiदतराiCजागiरतनासा?यशोषiतिमरवा^स5_षu चाiतदा`णeषu| 1aव3य5गादयः Jiसb?वEपाः||१०||

•  तCा3य5गः Jयो^तeयो रौgयकGड"मलाiदषu| अE~ ंiषकािशर?तोददाहपाकQणeषu च| पiरषeकः iपचuः Sशशात?फuटनध"पW

Classical literature •  Charaka explained Moordni taila

o  Shroabhyanga o  Shiripich o  Shirobas7 o  Shirodara

•  Dalhana commendatory on Sushrutha suthrasthan 45/113 explained Parisheka. Parisheka can be considered as shirodhara

Traditional Procedure •  Pa7ent is made to lie down in wooden table (Panchakarma

table) •  Head massage with suitable medicated oil •  Head rests in a slightly elevated posi7on preferably on pillow. •  All body abhyanga should be done gently •  Oil should be medicated according to the nature of the

diseases •  Two a3endants are needed-‐ one for suppor7ng the vessel

containing oil drip on forehead of the pa7ents and the other for collec7ng the liquid that falls from the head of the pa7ent and returning it back to the vessel

Traditional Procedure •  A wide mouthed earthen pot of a capacity of three prasthas is

used. There should be a hole at the bo3om of the vessel. •  The pot should be hung by means of suitable cord either from

roof of the room or other supports so that the end of the end of the fiber wick hanging from its bo3om will be four finger spaces from forehead of the pa7ent.

•  The liquid chosen to suit the case is then poured into the vessel and is made to flow on to upper part of his forehead.

•  The vessel is kept refilled with dripping oil collected.

Traditional Procedure •  This process is con7nued for one and half hrs. •  The pa7ent is to remain in the lying posture . •  This treatment is done for a period of 7 days or 14 days. •  Generally done in the morning hrs

Types Main types

•  Tailadhara •  Takradhara •  Ksheeradhara

•  Jala Shirodhara, Patrarasa dhara and Kashaya shirodhara is also prac7ced

Takra dhara Takra Prepara7on:

•  Forty palam of amalaki pulp is boiled with nine prasthas of pure water 7ll reduced to a decoc7on of one and half prasthas.

•  To this add equal quan7ty of bu3er milk made from cows milk

Takra dhara

Takra dhara Takra prepara7on: •  Two prasthas of cows milk is diluted with 8 prasthas of water

and is boiled with 2 palam of musta 7ed in a cloth, 7ll it is reduced to the original quan7ty of milk taken .

•  This is then removed from the fire, cloth with herb should be squeezed.

•  When cool, milk is fermented by addi7on of a li3le sour bu3er milk over night.

•  Next morning curd is churned, sprinkling over one prastha of decoc7on derived by boiling and reducing 4 prasthas of water and 4 palam of dry amalaki pulp,

•  Churning should be done 7ll all bu3er is removed.

Benefit of Takra dhara •  Premature grey hair •  Fa7gue, emacia7on •  Head ache, lack of vitality, pricking pain of palm and sole,

diabetes, lack of proper func7oning of limb joints •  Pain in the chest, heart diseases, indiges7ons, disease of eyes,

nose, throat and ears •  Derangement of 3 doshas and improves the power of sensory

organs

Kshira Dhara •  This is generally used for insanity, sleeplessness, burning

sensa7on of the head and head ache Prepara7on of milk: •  Two prasthas of cows milk is diluted with 8 prasthas of water •  Add 1 pala each of the bala root and shatavari 7ed in a cloth . •  Boil this 7ll quan7ty is educed to the bulk of milk originally

taken. •  When cool, take out the herbs and squeeze. •  Add equal quan7ty of fresh coconut water Some 7mes it is used without coconut water

Taila dhara •  Indicated in chronic headache and various sorts of disease of

head due to vi7ated vata Prepara7on Taila:

o  Prepare a decoc7on with 16 palas of the root of Bala crushed and boiled in 16 prasthas of water and reduced 4.

o  This decoc7on is strained well and to this is 4 tolas of paste of bala root and one prastha of pure sesame oil.

o  Boil this mixture over a slow fire and 7ll the residue or kalka acquire a semisolid condi7on.

Taila Dhara o One prastha of pure cows milk is now added and the boiling con7nued 7ll kalka acquires the consistency of loose grains or sand

o  The vessel is now removed from fire and oil is immediately separated from filtra7on.

o When it is cold this is used for dhara on head. o  In certain cases pure cows ghee is used in place of sesame oil for preparing the oil.

Indication of Dhara •  Body mind relaxa7on •  Relaxes the nervous system •  Relaxes the brain •  Insomnia •  Hypertension •  Stress/Anxiety/Psychiatric disorders •  Neurological disorders

Procedure •  Generally sesame oil or coconut oil processed with various

herbs have been used •  Warm milk cooked with herbs, water, bu3ermilk, coconut

milk can be also used •  Treatment last between 20-‐30 minutes •  Simple method

o  Plas7c body wrap is placed to cover the top quarter of the treatment table, falls over the top of the table

o  Its end tucked into large bowl o  Bath towel rolled will be placed below the neck o  Pa7ent has to lie in supine posi7on, head at the top of the treatment table o  Pa7ent body is covered with blanket o  Massage the face and neck to relax the pa7ent

Procedure •  To posi7ons pa7ents head, a small pillow or rolled towel is

placed under the pa7ents head in such a way that the head 7ps back slightly.

•  An eye pillow can be placed over the pa7ents eye or leg uncovered

•  Oil should be heated and a thermometer can be used to test the temperature ( 100 F-‐104 F is the advisable).

•  It is then poured into the vessel with tap which helps to control the flow. The vessel should be posi7oned over the pa7ent’s head and adjusted to appropriate height

Procedure •  Open the tap and make sure that oil flow is thin and even.

Here you can use small cup under the vessel, 7ll you adjust the flow.

•  Then inform the pa7ent that you will be star7ng the flow.

Stream of flow can be moved backward and forward in pendular mo7on across the forehead. Movement should be steady and even.

•  Another vessel can be used to collect the oil from the bo3om

vessel and reheat again and repeat the same procedure

Procedure •  Before ending the treatment place a cup under the stream of

oil and turn off the tap on the vessel. •  It is important that oil is allowed to spu3er out and drip

unevenly on client’s head. •  Atmosphere should be silent •  Remove the rolled hand towel from underneath the client’s

head and eye pillow from eyelids •  Neck, scalp, shoulder massaged with gentle stroke •  Oil should be removed from the head •  Use towel to wipe the head •  Advice shower ager the treatment

Instruments

Ayurclinic.com

Instruments

What is evidence based •  The conscien7ous, explicit and judicious use of current best

evidence in making decisions about the care of the individual pa7ent. It means integra7ng individual clinical exper7se with the best available external clinical evidence from systema7c research.” (Sacke3 D, 1996)

•  Sacke&, D., Rosenberg, W., Muir Gray, J., Haynes, R. Richardson, W. (1996). Evidencebased medicine: what it is and what it isn't. BriIsh Medical Journal, 312, 71-‐72.

Why it is important •  EBP is the integra7on of clinical exper7se, pa7ent values, and

the best research evidence into the decision making process for pa7ent care.

•  It helps to support pa7ent care process •  When evidence is used to define best prac7ces, pa7ent care

keeps the pace with the latest technological advances and takes advantage of knew knowledge developments

•  Healthcare policy-‐ Evidence based prac7ce important

Need of EBP in Ayurveda •  Ayurveda as an ancient science of life has a long history (5000

years old) and it basic principles valid even today •  However , essence of any science is a con7nuous quest for

new knowledge through research, development and newer applica7ons

•  Mode of manifesta7on of diseases, geo-‐clima7c environment, plants animals and microbes have changes

•  Human behavior, lifestyle, gene7cs have changes •  Con7nuous research on safety, quality and efficacy of

ayurvedic herbs and procedures needed

Evidence base for Ayurvedic Medicine

•  Important to review available evidence in the right perspec7ve

•  In Ayurveda evidence can be drawn from two main sources:

o  Evidence based on historical, classical and present nature of clinical prac5ce

o  Evidence based on scien5fic research to support theory, medicine and procedures used in ayurveda

Current Literature •  Literature search has been conducted using search engine-‐

Pubmed, Ebscohost and Google scholar •  Search term shirodhara, oil dripping, taila dhara, takradhara,

ksheera dhara, •  No language restric7ons applied •  Ar7cles which are published 7ll 2015 were retrieved. •  Total of 13 ar7cles were iden7fied

Medhya rasayana and shirodhara in the

management of Essential Hypertension

•  Tanna I, Patel D, Chandola HM. Evalua7on of Medhya rasayana and shirodhara in the management of Essen7al Hypertension-‐ Indian journal of ancient Medicine and yoga. 2013;6(2).

•  Objec7ve: to evaluate the efficacy of medhya rasayana and

ksheeradhara in the management of essen7al hypertension

Methods •  Inclusion criteria

o  20 Pa7ents of essen7al hypertension diagnosed per joint na7onal commi3ee

o  Who were already taking allopathic medicine and BP was not under control

•  Exclusion criteria o  Pa7ent suffering from Atherosclerosis, aor7c regurgita7on, arterio-‐

venous fistula, renal and adrenal pathologies, prostate enlargement, toxemia of pregnancy, neurogenic and iatrogenic condi7ons were excluded

Methods •  Group A-‐ Medhya Rasayana

o  Shankapushpi, Brahmi, Aswagandha, jatamamasi and parasika yavani o  Dose 9 gm/day o  Dura7on-‐ 2 months

•  Group B-‐ Kshiradhara o  Milk o  Dose-‐ 2 lit /day o  Dura7on – 45 minutes daily for 21 days

Methods •  Outcome measures

o  Systolic and Diastolic blood pressure o  Cardinal symptoms including Manasika Bhavas (headache, insomnia,

7redness, swea7ng, burning sensa7on in the eyes, feeling of tension, palpita7on, tachycardia, Anger, sadness, fear, thinking and courage)

o  Brief Psychiatry ra7ng scale

Results o  Both the therapies were highly significant reduc7on in both systolic and diastolic blood pressure but kshiradhara reduced it in more pronounced way.

o  Both therapies were equally effec7ve as Marked improvements (75% and above relief) was reported in 20% and moderate improvement ( 50% -‐ <75% relief) in 80% of par7cipants

Conclusion •  Con7nuous poring of milk over the forehead is an effec7ve

treatment for reducing stress and expanding one's consciousness

•  Re-‐estabilishes the func7onal integrity between prana, vyana vata and sadhaka pi3a

•  Sahasrara chakra is seat of pitutary gland and hypothalamus •  Ksheeradhara s7mulates this glands an helps to achieve

hormonal balance.

Conclusion •  Shirodhara relaxes the nervous system, improve the func7on

of brain, enhances metabolic system and induces alpha wave of brain

•  During this process nervous system is deeply calmed down and brain waves slow down.

•  When brain is calm, cerebral circula7on is enhanced and as a results the brain func7ons be3er stabilize the mood and reduc7on in the stress

Conclusion •  According to modern theory, ointment applica7on pass

through the stratum cornium into blood vessels and reach the organ, similarly milk pored reaches the brain cortex

•  In essen7al hypertension-‐ Vata affected •  Milk is having sheeta, snigdha and vatapitha raktha shamaka

proper7es

Shirodhara-‐‑ A Psycho-‐‑Physical profile in healthy volunteers

•  Dhuri K, Bodhe P, Vaidya A. Shirodhara-‐ A Psycho-‐Physical profile in healthy volunteers, Journal of Ayurveda and integraIve medicine. 2013, 4 (1).

•  Objec7ve: To evaluate the psychological and physiological effects of shirodhara in healthy volunteers by monitoring the ra7ng of mood, stress levels, ECG, EEG and selected biochemical markers of stress.

Methods •  Inclusion criteria:

o  Human subjects of the age group 30-‐60 years weighing 45-‐90 kg with normal blood pressure and no illness within last 3 months were studied

o  Subjects didn’t take any medica7on during study

Methods •  Sample size was 16 human subjects (10 males and 6 females) •  Whole body massage with refined sesame oil (50ml) for 15

minute •  Shirodhara oil is prepared with Ashwagandha, Brahmi and

Jatamamsi with sesame oil-‐ 45 minute

Methods •  Outcome measures:

o  BP, Pulse rate o  ECG, EEG o  Salivary cor7sol and urinary catecholamine were assessed by ELISA

method and flurometry o  Urinary crea7nine and other biochemical /hematological markers o  VAS (Visual Analogue Scale) and MAS (Mood Assessments Scale)

Results •  Significant reduc7on in the respiratory rate •  Significant reduc7on in mean diastolic pressure •  Significant reduc7on in the pulse rate •  ECG confirmed heart rate reduc7on and increase in the alfa

rhythm ager shirodhara •  ECG changes similar to those observed ager deep medita7on

and alert relaxa7on •  Significant changes in VAS score and MAS score for stress and

mood changes

Results •  Mean value of salivary cor7sol post –shirodhara was not

significantly different from that of pre shirodhara, Individual values showed decreasing trend

•  The mean of pre and post shirodhara urinary crea7nine levels didn’t differ significantly (Epinephrine and non epinephrine levels were not significantly different).

Conclusion •  Relaxing and calming effects mediated by the brain wave

coherence, alfa waves and a down regula7on of sympathe7c outlow

•  S7mula7on at the center of forehead-‐ pineal gland •  Adding abhyanga provide muscle relaxa7on and calming

effects •  Oil dripping on forehead provide inputs to the cerebral cortex

leading to tranquilizing effects •  Shirodhara seems to induce the relaxa7on response without

medita7on •  Shirodhara with medita7on may provide much be3er results

for stress

Manasamitra vataka with shirodhara for anxiety disorder

•  Tubaki BR, Chandrashekar CR, Sudhakar D, Prabha TN, Lavekar GS and Ku3y BM. Clinical efficacy of Manasamitra vataka on generalized anxiety disorder with comorbid generalized social phobia: A RCT study. J Alt Complementary Medicine. 2012; 18 (6).

•  Objec7ve: To evaluate the effect of manasamithra vataka on GAD with comorbid generalized social phobia.


o  Pa7ents between age 20-‐55 years o  Diagnosed with GAD with comorbid social phobia as per DSM IV TR criteria

and Hamilton anxiety ra7ng scale les than 18

•  Exclusion criteria: o  Pa7ent with significant depression (beck depression inventory score less than

17), medical disorders or taking psychotropic drugs 4 weeks prior to the study were excluded

o  Pa7ents with substance abuse, pregnant and lacta7ng women

Methods •  Blocked randomiza7ons •  Three groups (72 par7cipants)

o  Group 1-‐ Manasamithra vataka (100 mg twice daily for 30 days) o  Group II-‐ Manasamithravataka + Shirodharawith Brahmi oil for 45

minutes for 7 days o  Group III-‐ Clonazepam (0.75 mg/day for 30 days)


o  HARS and Beck Anxiety scale-‐ Anxiety o  Epworth Sleepiness scale-‐day 7me sleepiness o  World health organiza7on quality of life Assessment scale – Quality of

life o  Clinical global impression scale – to assess severity and changes

associated with interven7on

Results •  All the groups showed significant reduc7on

•  Improvements in Epworth sleepiness scale was observed only in group II

•  Manasamithra vataka with shirodhara is effec7ve in

management of GAD with comorbid generalized phobia •  Reduced the anxiety, severity of diseases, stabilized the

mood, decrease the sleep disturbance and day 7me sleepiness, increased quality of life

Hypertension and its management by shirodhara and sarpagandha vati

•  Kundu C, Shukla VD, Bha3 SNN. The role of psychic factors in pathogenesis of essen7al hypertension and its management by shirodhara and sarpagandha va7. AYU. 2010, 31 (4)

•  Objec7ve: To evaluate the efficacy of shirodhara and sarpagandha va7 in essen7al hypertension


o  Pa7ent diagnosed with Essen7al Hypertension as per the defini7on of WHO, JNC IV (Systolic blood pressure of 140 mm Hg or above and or diastolic blood pressure 90 mm Hg or above)

•  Exclusion Criteria: o  Pa7ents suffering from isolated systemic hypertension, conges7ve

heart disease, coronary artery diseases, coarcta7on of the aorta, liver failure, endocrine disease, cerebral complica7ons, malignant hypertension

Methods •  Group A: Shirodhara using bala taila for 30 minutes for 7 days •  Group B: Sarpagndha Va7 – 250 mg twice daily

Methods •  Outcome measures:

o  Subjec7ve and objec7ve symptoms of stress (16 symptoms) o  Manasa Pariksha bhava o  Hamilton depression ra7ng scale

Results •  In both the groups symptoms were reduced (sta7s7cally significant reduc7on in BP).

•  But shirodhara helped to reduce systolic and diastolic pressure in more pronounced way.

Results •  Bala taila poured on the forehead may be absorbed and

produce a tranquilizing effect by reaching brain cortex. •  This oil may have neurotransmi3er ac7on, when these reach

in cortex they correct deficiencies of certain neurotransmi3ers.

•  Bala taila is an7 vata proper7es. Ac7ve ingredients of bala taila penetrate into circula7on via forehead and produce vata hara proper7es. Bala taila also produces lubrica7on, nourishment and medhya effect ( A7bala has this quality)

Ayurvedic therapy for insomnia

•  Vinjamury S, Vinjamury M, Mar7rosian CD, Miller J. Ayurvedic therapy for insomnia: A Case series. Global adv health and Med. 2014. 3(1).

•  Objec7ve: To determine the feasibility of recurring and retaining par7cipants in clinical trial on shirodhara, ayurvedic oil dripping therapy for insomnia

Methods Inclusion Criteria: •  Par7cipants between age 18-‐75 years •  Dura7on of insomnia of at least 1 year •  Minimum score of 14 on insomnia severity index Exclusion criteria: •  People with comorbidi7es such as depression, or any other

psychological condi7on that require medica7ons , those who were on prescrip7on medica7on for insomnia

•  People with serious medical condi7on such as uncontrolled hypertension, uncontrolled diabetes or any other acute condi7on that disturb sleep

Methods •  Brahmi oil used for shirodhara for 40 minutes for five

consecu7ve days •  400-‐500ml oil is used •  oil changes every 3 days

Methods •  Outcome Measures

o  Insomnia severity index – nature, severity and impact of par7cipants insomnia

o  Adverse events form

Results •  Nine par7cipants completed the study •  Shirodhara with Brahmi oil for 45 minutes may be beneficial

for moderate to sever insomnia. •  All the par7cipants experienced improvements (percentage

varied from 3.85 to 69.57%) •  No adverse events reported

Results •  Effect of shirodhara in reducing anxiety could be a3ributed to the somato-‐autonomic reflex through thermosensors or pressure sensors in the skin or hair follicles via trigeminal cranial nerve.

Psychoneuroimmunology effects of Ayurvedic oil dripping Treatment

•  Uebaba K, Xu FH, Ogawa MS, Tatsuse T, Wang BH, Hisajima T, Venkatarama. Psychoneuroimmunology effects of Ayurvedic oil dripping Treatment. The journal of alternaIve and complementary Medicine. 2008. 4 (10).

•  Objec7ve: To assess the psychoneuroimunologic effects of ayurvedic oil dripping and to find out the safest condi7ons for conduc7ng shirodhara

• 

Methods •  For determining the most appropriate condi7ons for

opera7ng shirodhara -‐ 16 healthy females who are physically and psychologically healthy

•  To inves7gate about the psychoimmunologic changes-‐

Another 16 healthy females par7cipated in the second experiment.

•  Oil –sesame oil

Methods •  In order to compare the comfort levels –

o  Oil temperature -‐ 350C, 370C, 390C and 410C at the nozzle o  3 oil flow rates-‐ (1.8, 2.3 and 2.8 L/min) o  Four different dura7ons (9, 19, 29, and 39 minutes) o  Moving speed of dripping nozzle was 1.5 cm /sec o  Nozzle height was set at 20cm o  Pa3ern of dripping –temple, horizontal, and ver7cal movements

involving two repe77ons each 5 minutes movements


o  VAS scale for comfort o  Anxiety was assessed using state-‐Trait Anxiety Inventory o  Physical examina7ons-‐ skin temperature of the dorsal side of the right

hand and foot was monitored with thermocouple sensors. Measured every 10 seconds

o  Neuroimmunologic examina7ons-‐ Serum thyrotropin releasing hormone by radioimmunoassay, natural killer cell ac7vity, plasma catecholamine ( adrenaline, noradrenaline and dopamine by high-‐performance liquid chromatography) and urinary serotonin by urinary crea7nine concentra7on

Results •  The most comfortable and safest condi7ons were 30-‐ minute dura7on at 390 C at a oil flow rate of 2.3 l/min.

•  The diameter of dripping oil nozzle was 8x8 mm.

Results •  The subjects receiving shirodhara showed lowered levels of

state anxiety and higher levels of ASC than those in control posi7on.

•  Plasma noradrenaline and urinary serotonin excre7on decreased significantly more ager Shirodhara

•  Changes in NK cell ac7vity decreased significantly in control condi7ons and PMN/lymphocyte ra7o decreased significantly on shirodhara treatment

•  Increased in foot skin temperature ager shirodhara than in control group

Results •  Warm plain sesame oil starts the ac7on from tac7le

s7mula7on of the skin in-‐nervated by the first branch of the trigeminal nerve.

•  It is possible that impulses are transmi3ed to the thalamus through the principal nucleus and forwarded to the cerebral cortex. The impulses from the forehead cause a somato autonomic reflex and changes in the levels of various neurotransmi3ers including, serotonin, TRH, and catecholamine, resul7ng sympathe7c suppression and pysioimmunologic changes of peripheral circula7on and NK cell ac7vity

Conclusions •  Shirodhara has anxioly7c and ASC inducing effects and it

promotes a decrease of noradrenaline and exhibits a sympatholy7c effect, resul7ng in the ac7va7on of peripheral foot skin circula7on and immunopoten7a7on

Evaluation of Insomrid tablet and

shirodhara in the management of anidra

•  Evalua7on of Insomrid tablet and shirodhara in the management of anidra. Pokharel S, Sharma AK. AYU. 2010. 31 (1).

•  Objec7ve: Evalua7on of the efficacy of shirodhara and Tab.

Insomrid in the management of Anidra.


o  Individuals between age 16-‐60 years of both sexes of having insomnia of minimum one month dura7on

o  Pa7ents of insomnia with mild hypertension, mild anxiety and mild depression without any complica7ons of any other diseases

•  Exclusion Criteria: o  Pa7ents below 16 years and above 60 years of age o  Pa7ents with major psychiatric illness o  Pa7ents with alcohol dependency or drug dependency o  Pa7ents with chronic illness o  Pa7ents with acute illness

Methods •  Group 1-‐ 10 pa7ents-‐Dose of Insomrid – 2 tab (500mg each)

in the morning ager breakfast and night ager the dinner with luke warm milk for 30 days

•  Group II – Shirodhara with luke warm milk (temperature of

milk was 380C-‐ 400C) for 15 days •  Group III-‐ Insomrid 9 (Ashwagandha, Sarpagnadha,

Jatamamsi, Tagara and Parasika Yavani) + Shirodhara

Methods • Outcome Measures

o Symptom Ra7ng Scale o Sleep Diary Assessment

Results •  Ager the comple7on of treatments, marked improvement in the feeling of well being , physical and mental fitness in all the three groups.

•  Group III showed significant improvements •  No adverse effects were noted

Results •  In shirodhara, pressure and vibra7on from oil dripping is

created over forehead. •  This vibra7on is amplified by the hollow sinus present in the

frontal bone. •  The vibra7on is then transmi3ed inwards through the fluid

medium of cerebrospinal fluid. •  The vibra7on along with li3le temperature may ac7vate the

func7ons of thalamus and the basal fore brain which then brings the amount of serotonin and catecholamine to the normal stage inducing sleep

Results •  In modern texts: Pressure has an effect on impulse

conduc7on through tac7le and thermo receptors. •  Prolonged pressure is applied to the nerve, impulse

conduc7on in interrupted and part of the body may go to the rest.

•  In shirodhara, prolonged and con7nuous pressure due to

pouring of the medicated liquid may cause tranquility of mind and induce natural sleep

Conclusions •  Insomrid tablet and shirodhara with milk are very safe and effec7ve treatment and can be used in the management of Anidra

Role of Ayurvedic treatment along with Shirodhara in Ardit Roge

•  Tripathi SV, Dwivedi HS, Bala S. Role of Ayurvedic treatment along with Shirodhara in Ardit Roge. 1990, 25 (3).

•  Objec7ve: To evaluate the effec7veness of Ayurvedic treatments for Ardit roge.

Methods •  16 pa7ents selected for the study

o  10 pa7ents facial paralysis and 6 were facial paralysis with hemiplegia. o  Facial paralysis-‐ 10 pa7ents o  Facial paralysis with hemiplegia-‐6 pa7ents

•  Shirodhara-‐ Warm medicated oil-‐ 20-‐30 minutes dura7on-‐10 days in a month. Some cases 3-‐5 courses of shirodhara

•  Herbo-‐mineral compounds-‐ Brihat vatachitamani, Ras Raj rasa with

Ashwagandha and Amalaki choornam-‐ 3 months-‐ 1 year

•  Herbo-‐mineral compound with gold-‐ 3 months-‐ 1 year

•  Dura7on of treatments-‐ 1-‐12 months

Methods •  Shirodhara + Herbo-‐mineral compound with gold-‐ 12 pa7ents •  Shirodhara+ Herbo-‐mineral compound without gold-‐ 4

pa7ents

Results •  In facial paralysis, almost all the symptoms of diseases have

been disappeared except con7nuous twinkling of the eye for few seconds without any control.

•  In Hemiplegia disease along with facial paralysis all symptoms of disease have also been disappeared except the fully movement of affected upper extremity.

•  11-‐ pa7ents completely cured •  4 pa7ents-‐ Par7ally relieved •  1pa7ent no relive of symptoms

Ayurvedic approach for improving reaction time of

aFention deficit hyperactivity disorder

•  Singhal H, Kumar A, Rai M. Ayurvedic approach for improving reac7on 7me of a3en7on deficit hyperac7vity disorder affected children. Ayu. 2010. 31 (3):338-‐342.

•  Objec7ve: To examine the efficacy of an ayurvedic treatments in decreasing reac7on 7me in ADHS affected children, using the Vernier Chronoscope test

Methods •  Group A-‐ 17 children-‐ Ayurvedic compound I •  Group B-‐ 14 children-‐ Ayurvedic compound I and Shirodhara •  Group C-‐ 12 children-‐ placebo syrup-‐ Ayurvedic compound II

•  Age-‐ 8-‐14 years

Methods •  Compound I-‐ Brahmi, Ashwagandha, Tagara-‐ mixed with sixteen

7mes of water and allowed to soak overnight. Ager this it is boiled on an electric heater 7ll it was reduced 1/8 of its original volume. Sugar added and boiled for 30 minutes. Ager cooling coloring agents and preserva7ve were added. Dose of the drug was 1.0ml/kg body weight. Dura7on of treatment was 3 months

•  Compound II-‐ without any herb sugar syrup

•  Shirodhara-‐ cow milk-‐ poured on forehead from a height of 3.14 inches (Sharakalpam in sahshrayoga)-‐ 45 minutes/day-‐2 weeks

Methods •  Outcome measures-‐

o  Vernier chronoscope-‐ to measure reac7on 7me in response to visual or auditory s7mulus.

Results •  43 children completed the study •  Herbs and shirodhara together were effec7ve in improving

reac7on 7me of ADHD affected children. Sta7s7cally significant.

•  Group B showed sta7s7cally significant with maximum gain percentage in total reac7on 7me of ADHD.

Conclusion •  Herb alone or herb with shirodhara were both effec7ve in

reducing reac7on 7me in ADHD and thus improve the a3en7on span.

•  The herb + shirodhara was more effec7ve in reducing reac7on 7me than either herb or placebo.

Using a healing robot for scientific study of shirodhara

•  Uebaba K, Xu FH, Asakura R, Itou T, Ta7sue Ttaguchi Y, Ogawa

H, Shimbayashi M, Hisajima AT. Using a healing robot for scien7fic study of shirodhara. IEEE Engineering in medicine and biology. 2005. 24 (2).

•  Objec7ve: to assess the impact of shirodhara on pa7ents state of well being and to assess factors in the therapy that altered the pa7ents' state.

Methods •  Experiment 1-‐ Physiological changes of both subjects and

technicians during manual shirodhara •  16 females •  Healthy individuals (no mental diseases and nor

neuropsychological disorders) •  Shirodhara-‐ warm sesame oil-‐ 20 minutes, flow rate 2.1-‐2.6 L/

min and temperature was 39 ±10C Outcome measures

o  Blood pressure o  Electrocardiogram o  Expired gas analysis o  Cardiography

Methods •  Experiments 2-‐ Standardiza5on of oil weight between the

manual and robo5c shirodhara o  The weight of dripped oil was measured at the forehead by a scale using heights of

dripping nozzle and various flow rates.

•  Experiment 3-‐ Physio-‐psychological changes during shirodhara in rela5on to Anxiety and altered states of consciousness o  57 healthy volunteers par7cipated o  Temperature of the oil was 39 ±0.5 C and flow Sesame oil rate was 2.3 ± 0.2 L/min o  Skin temperature of right neck, right hand and right foot was monitored o  Psychological changes were assessed by psychometric studies using State Trait Anxiety

Inventory before and ager shirodhara.

Methods •  Experiment 4-‐ Anxioly5c effect of Shirodhara

o  10 subjects with high score of State Trait Anxiety inventory par7cipated o  25 minutes/week for 4 7mes in a month o  Profile of Mood States score ( Tension, anxiety, depression, anger, and hos7lity, vitality,

exhaus7on and confusion ) was assessed before and ager shirodhara

•  Experiment 5-‐ Impact of different dripping media on experience of Shirodhara o  Warm water, warm cows milk, bath salt, bath with same viscosity has sesame oil, bath

salt prepared from hyaluronic acid and collagen o  3 healthy female subjects par7cipated o  Five different media in same 7me of the day for every 4 days o  Like/dislike and visual analog scale o  Viscosity was measured by viscometer

Results •  Standardiza7on of shirodhara

o  In manual method Oil weight was 16 g at the forehead from nozzle at 20 cm high. Same weight of oil was obtained at 20 cm high in the flow of 2.3 l/min. The diameter of nozzle was 8x8 mm.

•  Physiological examina7on o  Heart rate decreased significantly 5 minutes ager star7ng shirodhara o  Carbon dioxide excre7on and 7dal volume also decreased o  LF/HF ra7o, alterna7ve index of cardiac sympathe7c ac7vity was suppressed during and

ager shirodhara o  EEG mapping -‐Alpha wave power dominance shiged from occipital region to the frontal

region during treatment o  The difference in heart rate, carbon dioxide excre7on, sympathe7c tone and EEG were

very similar to the findings responded in the medita7on study.

Results •  Psychological Examina7ons

o  State of anxiety was decreased abruptly (significant) o  EEG mapping – deep restulness with less anxiety o  81% of the par7cipants experienced some kind of altered state of consciousness (10

domains iden7fied for this-‐ Loss of space percep7on, loss of 7me percep7on, loss of speech sense, trance, no no7ce of any change in the surrounding, cosmic consciousness experience such as to have seen truth, passiveness, momentariness, loss of difference between subjec7vity and objec7vity. Loss of bodily sense)

o  The highest score were obtained in the domains of trance, passiveness, 7meless sensa7on, wordless sensa7on and concentra7on.

•  Anxioly7c effects of shirodhara o  Significant decrease in tension and anxiety

•  Based on subjects good experience, plain sesame oil was the best medium

Conclusions •  Shirodhara induced bradycardia and lowered 7dal volume

and carbon dioxide output •  During shirodhara-‐ sympathe7c nervous tone was suppressed •  EEG during shirodhara showed an increase of slow alpha

waves. Restul alertness in which the frontal lobe, limbic system and medulla oblongata were ac7vate

•  Reduced stress and anxiety. •  Deep restulness state •  Plain sesame oil had a be3er effect than other medium. The

effec7veness of shirodhara is not related to viscosity of the medium

Conclusions •  These finding indicated a change in the func7ons of frontal

lobe, limbic system, brain stem and autonomic nervous system.

•  Psycho physiological changes may be related tac7le s7mula7on of the skin or hair follicles innervated by the first branch of trigeminal nerve.

•  The impulse would be transmi3ed to the thalamus through the principal nucleus and forward to cerebral cortex or limbic system.

•  These routes would provide the subjects to experience relaxa7on and reduce anxiety

Conclusions •  Other routes from principal nucleus to re7cular forma7on and

posterior region of the thalamus, which is the center of autonomic nervous system.

•  This provide ra7onal for changes in sleep and autonomic nervous balances and skin temperature difference.

•  Shirodhara may manipulate cerebral circula7on, cerebral func7ons and state of consciousness

Clinical study on psycho-‐‑somatic management of shukraavrita vata with

rasayana yoga and shirodhara •  Cardozo B, Thakar AB, Skandha KP. Clinical study on psycho-‐

soma7c management of shukraavrita vata with rasayana yoga and shirodhara. Ayu. 2006. 27 (3).

•  Objec7ve: To evaluate the clinical efficacy of psychological

counseling, oral medica7on and shirodhara in premature ejacula7ons

Methods •  60 subjects par7cipated •  Inclusion criteria:

o  Diagnosed with Premature ejacula7on according to DSM –IV

•  Group I -‐ -‐ Placebo (roasted wheat tablets)+ counselling •  Group II-‐ Rasayana (Amalaki+ Guduchi+ Gokshura+ Jatamamsi

+Brahmi in ra7o 1:1 which were given 7 bhavanas of brahmi kwatha-‐ 6gm/day for 4 weeks) + counselling

•  Goup III-‐ Rasayana + counselling + Shirodhara (sesame oil for 7 days

•  Inves7ga7on-‐ o  Blood count o  Urine rou7ne o  Semen Analysis


o  Hamilton's anxiety ra7ng scale o  Modified scale for PE on the GRISS ques7onnaire for sexual sa7sfac7on o  Improvised scoring scale for Manasabhavas on psycho-‐sexual parlance

Results •  Sta7s7cally significant results in all groups •  Group III has be3er results compared to group II with regards

to voluntary control over ejacula7ons, pa7ents sa7sfac7on, performance anxiety and number of penile thrusts

Conclusions •  Rasayana yoga with shirodhara proved to be most effec7ve in

trea7ng Premature Ejacula7ons.

•  The line of treatment should evolve around control of vata and mana (Psychotropic and reduce performance anxiety) and improve agni and thereby dehabala and satvabala rasayana yogas which worked on the psychobiological components proved to be effec7ve

•  Psychological components of the disease is very strong there fore psychosexual counseling is a must

•  When pychoneurobiological components of disease is strong then shirodhara proved to be very effec7ve

Stress induced insomnia and its management with

Tagaradi kwatha and mahishi Dugdha Shirodhara

•  Bina V, Chandoola HM. Clinical study on psychic traits in stress induced insomnia and its management with Tagaradi kwatha and mahishi Dugdha Shirodhara. Ayu, 29 (3)

•  Objec7ve: To evaluate the efficacy of Tagaradi kwatha and Mahishi dugdha shirodhara in Anidra

Methods •  27 pa7ents par7cipated •  Stress induced insomnia •  Diagnosed according to DSM –IV

Outcome measures •  Hamilton's anxiety, depression ra7ng scale and brief

psychiatry ra7ng scale •  Manasabhava Pariksha

Methods •  Group I-‐ 21 pa7ents-‐ Tgaradi kwatha-‐ Jatamamsi,

shankapushpi, Ashwagandha, tagar, Brahmi, Draksha, Katuki, Parpataka, Dahamula, Mushta, Rakthachandana and Amaltas used for kwatha-‐ Dose 40 gm/day-‐ 6 weeks

•  Group II-‐12 pa7ents-‐ Mahishai Dugdha Shirodhara-‐ Buffalow milk – 21 days

Results •  Tagaradi kwatha provided significant relief on sleeplessness,

sleep 7me and freshness ager awakening •  Shirodhara-‐highly significant relief on sleeplessness, sleep

7me, sleep quality and freshness ager awakening •  Relief on mental stress has been observed in both the groups

Results •  Shirodhara leads to the relaxa7on of the frontalis muscle to

achieve decreased ac7vity of central and autonomic nervous system with lowering of brain cor7sone and adrenaline level. It also synchronize the brain wave alpha waves resul7ng inducing sleep

•  Efficacy of shirodhara may vary depending upon density and temperature of materials used.

•  Medhya herbs with shirodhara help to reduce stress and

induce normal sleep to lead healthy and happy life

PharmacoPhysioPsychologic effect of shirodhara using an

essential oil from Lavendula Angustifolia •  PharmacoPhysioPsychologic effect of shirodhara using an

essen7al oil from Lavendula Angus7folia

•  Objec7ve: To evaluate pharmaco-‐physio-‐psychologic effect of shirodhara

Methods •  16 women par7cipated •  Each par7cipants received 3 kinds of treatments: shirodhara

with sesame oil, lavender sesame oil and control supine posi7on

•  Shirodhara – with robo7c system-‐ •  Flow rate-‐ 2.3l/min, for 30 minutes •  Moving speed of dripping nozzle was 1.5 cm/sec •  Pa3ern of dripping – on temple region, horizontal, and

ver7cal movements involving two repe77on each 5 minute movements

•  Nozzle height was set at 20cm


o  Anxiety was assessed with State Trait Anxiety Inventory o  Anxylosis was calculated percentage change between pre and post

treatment assessments o  Altered state of consciousness -‐Psychometric instrument o  Skin temperature of the dorsal aspects of right hands and feet – every

5 minutes by two thermocouple sensors o  Physiological examina7on-‐ HRV (common method to evaluate

autonomic nervous changes) es7mated by ECG

Results •  Plain and lavender shirodhara had similar anxyoly7c ac7on

•  Lavender shirodhara was correlated with more Altered state of consciousness than plain shirodhara

•  Lavender shirodhara induced largest increase in foot skin temperature

Results •  Mechanism of ac7on :

o  Relaxing ac7on of lavender oil mediated by olfactory nerves. Impulses may transmi3ed to the hypothalamus to sooth the mood ager autonomic nervous balance

o  Pharmacologic ac7on: Linalool, the main cons7tuent of lavender oil , may also be absorbed through the skin or mucosa of the respiratory tract. Linalool, once reach in to the body, it binds to GABA receptors in the central nervous system, inducing relaxed state

Conclusion •  Tradi7onal literature showed that:

o  Takra dhara is effec7ve in management of : Premature grey hair, Fa7gue, emacia7on, Head ache, lack of vitality, pricking pain of palm and sole, diabetes, lack of proper func7oning of limb joints, Pain in the chest, heart diseases, indiges7ons, disease of eyes, nose, throat and ears, derangement of 3 doshas and improves the power of sensory organs

o  Ksheera Dhara is effec7ve in management of : insanity, sleeplessness, burning sensa7on of the head and head ache

o  Taila dara is effec7ve in management of : chronic headache and various sorts of disease of head due to vi7ated vata

Conclusion •  Evidence from the modern literature showed the role of

shirodhara on management of: o  insomnia o  stress and anxiety o  generalized anxiety disorders with comorbid generalized social phobia o  hypertension o  facial paralysis, facial paralysis with hemiplegia o  premature ejacula7on o  improving reac7on 7me in a3en7on deficit hyperac7vity disorders

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