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

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1 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 Shirodhara What is shirodhara? o Oil/water/bu8ermilk/decoc<on dripping on the forehead in a steady stream or flow. o Shira- Head, Dhara Flow o Widely prac<ced treatment in Ayurveda o Upakarma (complementary treatment) of Ayurveda Document provided to and used by NAMA with permission from Anupama KizhakkeveeFil Classical literature Classical literature Siraseka or dara is special type of treatment prac<ced for disease of the head. Siraseka, or dhara is the process in which medicated oil, milk, or bu8ermilk is poured in a con<nuous stream on the head, especially on the forehead in a specific manner. Classical literature Ashtanga- Sutrasthana- 31 म"ध$त&ल( पuन,तuध- भ01- अ3य5ग पiरषeक iपचuब$?तiरiत यथ Bर( 1 ब लन तC 3य5ग EFकGड"मल iदषu JयuKय1 पiरषeकLवE~ iषक शर?त दद हप कQणeषu Sशश त?फuटनध"पनWC?तXYषu iपचu ब?त?तu Jसu[Lयiदतर icज गiरतन स?यश षiत मरव ^स5_षu च iतद `णeषu 1aव3य5ग दय Jiसb?वEप १० तC 3य5ग Jय ^तeय र gयकgड"मल iदषu अE~ iषक शर?त दद हप कQणeषu च पiरषeक iपचu Sशश त?फuटनध"पW Classical literature Charaka explained Moordni taila o Shroabhyanga o Shiripich o Shirobas< o Shirodara Dalhana commendatory on Sushrutha suthrasthan 45/113 explained Parisheka. Parisheka can be considered as shirodhara 1

2 Traditional Procedure Pa<ent is made to lie down in wooden table (Panchakarma table) Head massage with suitable medicated oil Head rests in a slightly elevated posi<on preferably on pillow. All body abhyanga should be done gently Oil should be medicated according to the nature of the diseases Two a8endants are needed- one for suppor<ng the vessel containing oil drip on forehead of the pa<ents and the other for collec<ng the liquid that falls from the head of the pa<ent 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 bo8om 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 bo8om will be four finger spaces from forehead of the pa<ent. 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 con<nued for one and half hrs. The pa<ent 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 Main types Tailadhara Takradhara Ksheeradhara Types Jala Shirodhara, Patrarasa dhara and Kashaya shirodhara is also prac<ced Takra Prepara<on: Takra dhara Takra dhara Forty palam of amalaki pulp is boiled with nine prasthas of pure water <ll reduced to a decoc<on of one and half prasthas. To this add equal quan<ty of bu8er milk made from cows milk 2

3 Takra dhara Takra prepara<on: Two prasthas of cows milk is diluted with 8 prasthas of water and is boiled with 2 palam of musta <ed in a cloth, <ll it is reduced to the original quan<ty of milk taken. This is then removed from the fire, cloth with herb should be squeezed. When cool, milk is fermented by addi<on of a li8le sour bu8er milk over night. Next morning curd is churned, sprinkling over one prastha of decoc<on derived by boiling and reducing 4 prasthas of water and 4 palam of dry amalaki pulp, Churning should be done <ll all bu8er is removed. Benefit of Takra dhara Premature grey hair Fa<gue, emacia<on Head ache, lack of vitality, pricking pain of palm and sole, diabetes, lack of proper func<oning of limb joints Pain in the chest, heart diseases, indiges<ons, 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 sensa<on of the head and head ache Prepara<on of milk: Two prasthas of cows milk is diluted with 8 prasthas of water Add 1 pala each of the bala root and shatavari <ed in a cloth. Boil this <ll quan<ty is educed to the bulk of milk originally taken. When cool, take out the herbs and squeeze. Add equal quan<ty of fresh coconut water Taila dhara Indicated in chronic headache and various sorts of disease of head due to vi<ated vata Prepara<on Taila: o Prepare a decoc<on with 16 palas of the root of Bala crushed and boiled in 16 prasthas of water and reduced 4. o This decoc<on 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 <ll the residue or kalka acquire a semisolid condi<on. Some <mes it is used without coconut water Taila Dhara o One prastha of pure cows milk is now added and the boiling con<nued <ll kalka acquires the consistency of loose grains or sand o The vessel is now removed from fire and oil is immediately separated from filtra<on. 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 relaxa<on Relaxes the nervous system Relaxes the brain Insomnia Hypertension Stress/Anxiety/Psychiatric disorders Neurological disorders 3

4 Procedure Generally sesame oil or coconut oil processed with various herbs have been used Warm milk cooked with herbs, water, bu8ermilk, coconut milk can be also used Treatment last between minutes Simple method o Plas<c 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 Pa<ent has to lie in supine posi<on, head at the top of the treatment table o Pa<ent body is covered with blanket o Massage the face and neck to relax the pa<ent Procedure To posi<ons pa<ents head, a small pillow or rolled towel is placed under the pa<ents head in such a way that the head <ps back slightly. An eye pillow can be placed over the pa<ents eye or leh 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 posi<oned over the pa<ent 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, <ll you adjust the flow. Then inform the pa<ent that you will be star<ng the flow. Stream of flow can be moved backward and forward in pendular mo<on across the forehead. Movement should be steady and even. Another vessel can be used to collect the oil from the bo8om 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 spu8er 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 aher the treatment Instruments Instruments Ayurclinic.com 4

5 What is evidence based The conscien<ous, explicit and judicious use of current best evidence in making decisions about the care of the individual pa<ent. It means integra<ng individual clinical exper<se with the best available external clinical evidence from systema<c research. (Sacke8 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, Why it is important EBP is the integra<on of clinical exper<se, pa<ent values, and the best research evidence into the decision making process for pa<ent care. It helps to support pa<ent care process When evidence is used to define best prac<ces, pa<ent care keeps the pace with the latest technological advances and takes advantage of knew knowledge developments Healthcare policy- Evidence based prac<ce 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 con<nuous quest for new knowledge through research, development and newer applica<ons Mode of manifesta<on of diseases, geo- clima<c environment, plants animals and microbes have changes Human behavior, lifestyle, gene<cs have changes Con<nuous 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 perspec<ve 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 restric<ons applied Ar<cles which are published <ll 2015 were retrieved. Total of 13 ar<cles were iden<fied Medhya rasayana and shirodhara in the management of Essential Hypertension Tanna I, Patel D, Chandola HM. Evalua<on of Medhya rasayana and shirodhara in the management of Essen<al Hypertension- Indian journal of ancient Medicine and yoga. 2013;6(2). Objec<ve: to evaluate the efficacy of medhya rasayana and ksheeradhara in the management of essen<al hypertension 5

6 Inclusion criteria o 20 Pa<ents of essen<al hypertension diagnosed per joint na<onal commi8ee o Who were already taking allopathic medicine and BP was not under control Exclusion criteria o Pa<ent suffering from Atherosclerosis, aor<c regurgita<on, arterio- venous fistula, renal and adrenal pathologies, prostate enlargement, toxemia of pregnancy, neurogenic and iatrogenic condi<ons were excluded Group A- Medhya Rasayana o Shankapushpi, Brahmi, Aswagandha, jatamamasi and parasika yavani o Dose 9 gm/day o Dura<on- 2 months Group B- Kshiradhara o Milk o Dose- 2 lit /day o Dura<on 45 minutes daily for 21 days Outcome measures o Systolic and Diastolic blood pressure o Cardinal symptoms including Manasika Bhavas (headache, insomnia, <redness, swea<ng, burning sensa<on in the eyes, feeling of tension, palpita<on, tachycardia, Anger, sadness, fear, thinking and courage) o Brief Psychiatry ra<ng scale o Both the therapies were highly significant reduc<on in both systolic and diastolic blood pressure but kshiradhara reduced it in more pronounced way. o Both therapies were equally effec<ve as Marked improvements (75% and above relief) was reported in 20% and moderate improvement ( 50% - <75% relief) in 80% of par<cipants Conclusion Con<nuous poring of milk over the forehead is an effec<ve treatment for reducing stress and expanding one's consciousness Re- estabilishes the func<onal integrity between prana, vyana vata and sadhaka pi8a Sahasrara chakra is seat of pitutary gland and hypothalamus Ksheeradhara s<mulates this glands an helps to achieve hormonal balance. Conclusion Shirodhara relaxes the nervous system, improve the func<on 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 circula<on is enhanced and as a results the brain func<ons be8er stabilize the mood and reduc<on in the stress 6

7 Conclusion According to modern theory, ointment applica<on pass through the stratum cornium into blood vessels and reach the organ, similarly milk pored reaches the brain cortex In essen<al hypertension- Vata affected Milk is having sheeta, snigdha and vatapitha raktha shamaka proper<es 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). Objec<ve: To evaluate the psychological and physiological effects of shirodhara in healthy volunteers by monitoring the ra<ng of mood, stress levels, ECG, EEG and selected biochemical markers of stress. Inclusion criteria: o Human subjects of the age group years weighing kg with normal blood pressure and no illness within last 3 months were studied o Subjects didn t take any medica<on during study 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 Outcome measures: o BP, Pulse rate o ECG, EEG o Salivary cor<sol and urinary catecholamine were assessed by ELISA method and flurometry o Urinary crea<nine and other biochemical /hematological markers o VAS (Visual Analogue Scale) and MAS (Mood Assessments Scale) Significant reduc<on in the respiratory rate Significant reduc<on in mean diastolic pressure Significant reduc<on in the pulse rate ECG confirmed heart rate reduc<on and increase in the alfa rhythm aher shirodhara ECG changes similar to those observed aher deep medita<on and alert relaxa<on Significant changes in VAS score and MAS score for stress and mood changes 7

8 Mean value of salivary cor<sol post shirodhara was not significantly different from that of pre shirodhara, Individual values showed decreasing trend The mean of pre and post shirodhara urinary crea<nine 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 regula<on of sympathe<c outlow S<mula<on at the center of forehead- pineal gland Adding abhyanga provide muscle relaxa<on and calming effects Oil dripping on forehead provide inputs to the cerebral cortex leading to tranquilizing effects Shirodhara seems to induce the relaxa<on response without medita<on Shirodhara with medita<on may provide much be8er results for stress Manasamitra vataka with shirodhara for anxiety disorder Tubaki BR, Chandrashekar CR, Sudhakar D, Prabha TN, Lavekar GS and Ku8y 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). Objec<ve: To evaluate the effect of manasamithra vataka on GAD with comorbid generalized social phobia. Inclusion criteria: o Pa<ents between age years o Diagnosed with GAD with comorbid social phobia as per DSM IV TR criteria and Hamilton anxiety ra<ng scale les than 18 Exclusion criteria: o Pa<ent 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 Pa<ents with substance abuse, pregnant and lacta<ng women Blocked randomiza<ons Three groups (72 par<cipants) 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) Outcome measures o HARS and Beck Anxiety scale- Anxiety o Epworth Sleepiness scale- day <me sleepiness o World health organiza<on quality of life Assessment scale Quality of life o Clinical global impression scale to assess severity and changes associated with interven<on 8

9 All the groups showed significant reduc<on Improvements in Epworth sleepiness scale was observed only in group II Manasamithra vataka with shirodhara is effec<ve in management of GAD with comorbid generalized phobia Hypertension and its management by shirodhara and sarpagandha vati Kundu C, Shukla VD, Bha8 SNN. The role of psychic factors in pathogenesis of essen<al hypertension and its management by shirodhara and sarpagandha va<. AYU. 2010, 31 (4) Objec<ve: To evaluate the efficacy of shirodhara and sarpagandha va< in essen<al hypertension Reduced the anxiety, severity of diseases, stabilized the mood, decrease the sleep disturbance and day <me sleepiness, increased quality of life Inclusion criteria: o Pa<ent diagnosed with Essen<al Hypertension as per the defini<on 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 Pa<ents suffering from isolated systemic hypertension, conges<ve heart disease, coronary artery diseases, coarcta<on of the aorta, liver failure, endocrine disease, cerebral complica<ons, malignant hypertension Group A: Shirodhara using bala taila for 30 minutes for 7 days Group B: Sarpagndha Va< 250 mg twice daily Outcome measures: o Subjec<ve and objec<ve symptoms of stress (16 symptoms) o Manasa Pariksha bhava o Hamilton depression ra<ng scale In both the groups symptoms were reduced (sta<s<cally significant reduc<on in BP). But shirodhara helped to reduce systolic and diastolic pressure in more pronounced way. 9

10 Bala taila poured on the forehead may be absorbed and produce a tranquilizing effect by reaching brain cortex. This oil may have neurotransmi8er ac<on, when these reach in cortex they correct deficiencies of certain neurotransmi8ers. Bala taila is an< vata proper<es. Ac<ve ingredients of bala taila penetrate into circula<on via forehead and produce vata hara proper<es. Bala taila also produces lubrica<on, nourishment and medhya effect ( A<bala has this quality) Ayurvedic therapy for insomnia Vinjamury S, Vinjamury M, Mar<rosian CD, Miller J. Ayurvedic therapy for insomnia: A Case series. Global adv health and Med (1). Objec<ve: To determine the feasibility of recurring and retaining par<cipants in clinical trial on shirodhara, ayurvedic oil dripping therapy for insomnia Inclusion Criteria: Par<cipants between age years Dura<on of insomnia of at least 1 year Minimum score of 14 on insomnia severity index Exclusion criteria: People with comorbidi<es such as depression, or any other psychological condi<on that require medica<ons, those who were on prescrip<on medica<on for insomnia People with serious medical condi<on such as uncontrolled hypertension, uncontrolled diabetes or any other acute condi<on that disturb sleep Brahmi oil used for shirodhara for 40 minutes for five consecu<ve days ml oil is used oil changes every 3 days Outcome Measures o Insomnia severity index nature, severity and impact of par<cipants insomnia o Adverse events form Nine par<cipants completed the study Shirodhara with Brahmi oil for 45 minutes may be beneficial for moderate to sever insomnia. All the par<cipants experienced improvements (percentage varied from 3.85 to 69.57%) No adverse events reported 10

11 Effect of shirodhara in reducing anxiety could be a8ributed 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 (10). Objec<ve: To assess the psychoneuroimunologic effects of ayurvedic oil dripping and to find out the safest condi<ons for conduc<ng shirodhara For determining the most appropriate condi<ons for opera<ng shirodhara - 16 healthy females who are physically and psychologically healthy To inves<gate about the psychoimmunologic changes- Another 16 healthy females par<cipated in the second experiment. Oil sesame oil In order to compare the comfort levels o Oil temperature C, 37 0 C, 39 0 C and 41 0 C at the nozzle o 3 oil flow rates- (1.8, 2.3 and 2.8 L/min) o Four different dura<ons (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 Pa8ern of dripping temple, horizontal, and ver<cal movements involving two repe<<ons each 5 minutes movements Outcome measures o VAS scale for comfort o Anxiety was assessed using state- Trait Anxiety Inventory o Physical examina<ons- skin temperature of the dorsal side of the right hand and foot was monitored with thermocouple sensors. Measured every 10 seconds o Neuroimmunologic examina<ons- Serum thyrotropin releasing hormone by radioimmunoassay, natural killer cell ac<vity, plasma catecholamine ( adrenaline, noradrenaline and dopamine by high- performance liquid chromatography) and urinary serotonin by urinary crea<nine concentra<on The most comfortable and safest condi<ons were 30- minute dura<on at 39 0 C at a oil flow rate of 2.3 l/min. The diameter of dripping oil nozzle was 8x8 mm. 11

12 The subjects receiving shirodhara showed lowered levels of state anxiety and higher levels of ASC than those in control posi<on. Plasma noradrenaline and urinary serotonin excre<on decreased significantly more aher Shirodhara Changes in NK cell ac<vity decreased significantly in control condi<ons and PMN/lymphocyte ra<o decreased significantly on shirodhara treatment Increased in foot skin temperature aher shirodhara than in control group Warm plain sesame oil starts the ac<on from tac<le s<mula<on of the skin in- nervated by the first branch of the trigeminal nerve. It is possible that impulses are transmi8ed 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 neurotransmi8ers including, serotonin, TRH, and catecholamine, resul<ng sympathe<c suppression and pysioimmunologic changes of peripheral circula<on and NK cell ac<vity Conclusions Shirodhara has anxioly<c and ASC inducing effects and it promotes a decrease of noradrenaline and exhibits a sympatholy<c effect, resul<ng in the ac<va<on of peripheral foot skin circula<on and immunopoten<a<on Evaluation of Insomrid tablet and shirodhara in the management of anidra Evalua<on of Insomrid tablet and shirodhara in the management of anidra. Pokharel S, Sharma AK. AYU (1). Objec<ve: Evalua<on of the efficacy of shirodhara and Tab. Insomrid in the management of Anidra. Inclusion criteria: o Individuals between age years of both sexes of having insomnia of minimum one month dura<on o Pa<ents of insomnia with mild hypertension, mild anxiety and mild depression without any complica<ons of any other diseases Exclusion Criteria: o Pa<ents below 16 years and above 60 years of age o Pa<ents with major psychiatric illness o Pa<ents with alcohol dependency or drug dependency o Pa<ents with chronic illness o Pa<ents with acute illness Group 1-10 pa<ents- Dose of Insomrid 2 tab (500mg each) in the morning aher breakfast and night aher the dinner with luke warm milk for 30 days Group II Shirodhara with luke warm milk (temperature of milk was 38 0 C C) for 15 days Group III- Insomrid 9 (Ashwagandha, Sarpagnadha, Jatamamsi, Tagara and Parasika Yavani) + Shirodhara 12

13 Outcome Measures o Symptom Ra<ng Scale o Sleep Diary Assessment Aher the comple<on 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 In shirodhara, pressure and vibra<on from oil dripping is created over forehead. This vibra<on is amplified by the hollow sinus present in the frontal bone. The vibra<on is then transmi8ed inwards through the fluid medium of cerebrospinal fluid. The vibra<on along with li8le temperature may ac<vate the func<ons of thalamus and the basal fore brain which then brings the amount of serotonin and catecholamine to the normal stage inducing sleep In modern texts: Pressure has an effect on impulse conduc<on through tac<le and thermo receptors. Prolonged pressure is applied to the nerve, impulse conduc<on in interrupted and part of the body may go to the rest. In shirodhara, prolonged and con<nuous 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 effec<ve 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). Objec<ve: To evaluate the effec<veness of Ayurvedic treatments for Ardit roge. 13

14 16 pa<ents selected for the study o 10 pa<ents facial paralysis and 6 were facial paralysis with hemiplegia. o Facial paralysis- 10 pa<ents o Facial paralysis with hemiplegia- 6 pa<ents Shirodhara- Warm medicated oil minutes dura<on- 10 days in a month. Some cases 3-5 courses of shirodhara Shirodhara + Herbo- mineral compound with gold- 12 pa<ents Shirodhara+ Herbo- mineral compound without gold- 4 pa<ents 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 Dura<on of treatments months In facial paralysis, almost all the symptoms of diseases have been disappeared except con<nuous 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- pa<ents completely cured 4 pa<ents- Par<ally relieved 1pa<ent 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 reac<on <me of a8en<on deficit hyperac<vity disorder affected children. Ayu (3): Objec<ve: To examine the efficacy of an ayurvedic treatments in decreasing reac<on <me in ADHS affected children, using the Vernier Chronoscope test 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 years Compound I- Brahmi, Ashwagandha, Tagara- mixed with sixteen <mes of water and allowed to soak overnight. Aher this it is boiled on an electric heater <ll it was reduced 1/8 of its original volume. Sugar added and boiled for 30 minutes. Aher cooling coloring agents and preserva<ve were added. Dose of the drug was 1.0ml/ kg body weight. Dura<on 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 14

15 Outcome measures- o Vernier chronoscope- to measure reac<on <me in response to visual or auditory s<mulus. 43 children completed the study Herbs and shirodhara together were effec<ve in improving reac<on <me of ADHD affected children. Sta<s<cally significant. Group B showed sta<s<cally significant with maximum gain percentage in total reac<on <me of ADHD. Conclusion Herb alone or herb with shirodhara were both effec<ve in reducing reac<on <me in ADHD and thus improve the a8en<on span. The herb + shirodhara was more effec<ve in reducing reac<on <me than either herb or placebo. Using a healing robot for scientific study of shirodhara Uebaba K, Xu FH, Asakura R, Itou T, Ta<sue Ttaguchi Y, Ogawa H, Shimbayashi M, Hisajima AT. Using a healing robot for scien<fic study of shirodhara. IEEE Engineering in medicine and biology (2). Objec<ve: to assess the impact of shirodhara on pa<ents state of well being and to assess factors in the therapy that altered the pa<ents' state. 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 L/ min and temperature was 39 ±1 0 C Outcome measures o Blood pressure o Electrocardiogram o Expired gas analysis o Cardiography 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 par<cipated 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 aher shirodhara. 15

16 Experiment 4- Anxioly5c effect of Shirodhara o 10 subjects with high score of State Trait Anxiety inventory par<cipated o 25 minutes/week for 4 <mes in a month o Profile of Mood States score ( Tension, anxiety, depression, anger, and hos<lity, vitality, exhaus<on and confusion ) was assessed before and aher 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 par<cipated o Five different media in same <me of the day for every 4 days o Like/dislike and visual analog scale o Viscosity was measured by viscometer Standardiza<on 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 examina<on o Heart rate decreased significantly 5 minutes aher star<ng shirodhara o Carbon dioxide excre<on and <dal volume also decreased o LF/HF ra<o, alterna<ve index of cardiac sympathe<c ac<vity was suppressed during and aher shirodhara o EEG mapping - Alpha wave power dominance shihed from occipital region to the frontal region during treatment o The difference in heart rate, carbon dioxide excre<on, sympathe<c tone and EEG were very similar to the findings responded in the medita<on study. Psychological Examina<ons o State of anxiety was decreased abruptly (significant) o EEG mapping deep restulness with less anxiety o 81% of the par<cipants experienced some kind of altered state of consciousness (10 domains iden<fied for this- Loss of space percep<on, loss of <me percep<on, loss of speech sense, trance, no no<ce of any change in the surrounding, cosmic consciousness experience such as to have seen truth, passiveness, momentariness, loss of difference between subjec<vity and objec<vity. Loss of bodily sense) o The highest score were obtained in the domains of trance, passiveness, <meless sensa<on, wordless sensa<on and concentra<on. Anxioly<c 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 <dal volume and carbon dioxide output During shirodhara- sympathe<c 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 ac<vate Reduced stress and anxiety. Deep restulness state Plain sesame oil had a be8er effect than other medium. The effec<veness of shirodhara is not related to viscosity of the medium Conclusions These finding indicated a change in the func<ons of frontal lobe, limbic system, brain stem and autonomic nervous system. Psycho physiological changes may be related tac<le s<mula<on of the skin or hair follicles innervated by the first branch of trigeminal nerve. The impulse would be transmi8ed to the thalamus through the principal nucleus and forward to cerebral cortex or limbic system. These routes would provide the subjects to experience relaxa<on and reduce anxiety Conclusions Other routes from principal nucleus to re<cular forma<on and posterior region of the thalamus, which is the center of autonomic nervous system. This provide ra<onal for changes in sleep and autonomic nervous balances and skin temperature difference. Shirodhara may manipulate cerebral circula<on, cerebral func<ons and state of consciousness 16

17 Clinical study on psycho- somatic management of shukraavrita vata with rasayana yoga and shirodhara Cardozo B, Thakar AB, Skandha KP. Clinical study on psycho- soma<c management of shukraavrita vata with rasayana yoga and shirodhara. Ayu (3). Objec<ve: To evaluate the clinical efficacy of psychological counseling, oral medica<on and shirodhara in premature ejacula<ons 60 subjects par<cipated Inclusion criteria: o Diagnosed with Premature ejacula<on according to DSM IV Group I - - Placebo (roasted wheat tablets)+ counselling Group II- Rasayana (Amalaki+ Guduchi+ Gokshura+ Jatamamsi +Brahmi in ra<o 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 Inves<ga<on- o Blood count o Urine rou<ne o Semen Analysis Outcome measures o Hamilton's anxiety ra<ng scale o Modified scale for PE on the GRISS ques<onnaire for sexual sa<sfac<on o Improvised scoring scale for Manasabhavas on psycho- sexual parlance Sta<s<cally significant results in all groups Group III has be8er results compared to group II with regards to voluntary control over ejacula<ons, pa<ents sa<sfac<on, performance anxiety and number of penile thrusts Conclusions Rasayana yoga with shirodhara proved to be most effec<ve in trea<ng Premature Ejacula<ons. 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 effec<ve 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 effec<ve 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) Objec<ve: To evaluate the efficacy of Tagaradi kwatha and Mahishi dugdha shirodhara in Anidra 17

18 27 pa<ents par<cipated Stress induced insomnia Diagnosed according to DSM IV Outcome measures Hamilton's anxiety, depression ra<ng scale and brief psychiatry ra<ng scale Manasabhava Pariksha Group I- 21 pa<ents- 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 pa<ents- Mahishai Dugdha Shirodhara- Buffalow milk 21 days Tagaradi kwatha provided significant relief on sleeplessness, sleep <me and freshness aher awakening Shirodhara- highly significant relief on sleeplessness, sleep <me, sleep quality and freshness aher awakening Relief on mental stress has been observed in both the groups Shirodhara leads to the relaxa<on of the frontalis muscle to achieve decreased ac<vity of central and autonomic nervous system with lowering of brain cor<sone and adrenaline level. It also synchronize the brain wave alpha waves resul<ng 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 essen<al oil from Lavendula Angus<folia Objec<ve: To evaluate pharmaco- physio- psychologic effect of shirodhara 16 women par<cipated Each par<cipants received 3 kinds of treatments: shirodhara with sesame oil, lavender sesame oil and control supine posi<on Shirodhara with robo<c system- Flow rate- 2.3l/min, for 30 minutes Moving speed of dripping nozzle was 1.5 cm/sec Pa8ern of dripping on temple region, horizontal, and ver<cal movements involving two repe<<on each 5 minute movements Nozzle height was set at 20cm 18

19 Outcome measures 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 examina<on- HRV (common method to evaluate autonomic nervous changes) es<mated by ECG Plain and lavender shirodhara had similar anxyoly<c ac<on Lavender shirodhara was correlated with more Altered state of consciousness than plain shirodhara Lavender shirodhara induced largest increase in foot skin temperature Mechanism of ac<on : o Relaxing ac<on of lavender oil mediated by olfactory nerves. Impulses may transmi8ed to the hypothalamus to sooth the mood aher autonomic nervous balance o Pharmacologic ac<on: Linalool, the main cons<tuent 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 Tradi<onal literature showed that: o Takra dhara is effec<ve in management of : Premature grey hair, Fa<gue, emacia<on, Head ache, lack of vitality, pricking pain of palm and sole, diabetes, lack of proper func<oning of limb joints, Pain in the chest, heart diseases, indiges<ons, disease of eyes, nose, throat and ears, derangement of 3 doshas and improves the power of sensory organs o Ksheera Dhara is effec<ve in management of : insanity, sleeplessness, burning sensa<on of the head and head ache o Taila dara is effec<ve in management of : chronic headache and various sorts of disease of head due to vi<ated vata Conclusion THANK YOU 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 ejacula<on o improving reac<on <me in a8en<on deficit hyperac<vity disorders 19