“STUDY ON THE IMPACT OF PRAKRITI IN CHILDREN WITH ACADEMIC STRESS AND EVALUATION OF ANTISTRESS EFFECT OF SARASWAT CHURNA” presented in Kochi International seminar.

1. “STUDY ON THE IMPACT OF PRAKRITI IN CHILDREN WITH ACADEMIC
STRESS AND EVALUATION OF ANTISTRESS EFFECT OF SARASWAT CHURNA”
*Dr. Sumod Suresh Khedekar **Dr.Atika Madhukar
***Dr. Nisha Kumari Ojha ****Dr. Abhimanyu Kumar
INTRODUCTION
Fast pace of life, highly competitive school environment and parental pressure brought child life
cumbersome and full of stress and anxiety. These lead to maladjustment in different spheres of
life such as home, social, health, emotion and educational problems. Childhood stress can be
caused by any situation that requires a person to adapt or change. The situation often produces
anxiety. Stress may be caused by positive changes, such as starting a new activity, but it is most
commonly linked with negative changes such as illness or death in the family. Stress that is
prolonged and managed poorly can result in negative physical, mental, and cognitive outcomes
for children and youth. [Steinberg, L. (2005). Adolescence (7th Ed.)] New York, NY: McGraw-
Hill] 1 Changes in our society have put new pressures and stresses on elementary children. Many
children are now starting to feel the pressures of our society and are beginning to show higher
signs of stress and anxiety. Muris, Meesters, Merckelbach, Sermon, and Zwakhalen (1988)
reported that nearly 70% of elementary school children have everyday worries and anxiety, and
5% of elementary school children exhibit signs of extreme worry and anxiety.Studies suggested
that the negative impact of stress is more profound on children who are younger than age 10,
have a genetic temperament that is "slow-to-warm-up" or "difficult," were born premature, are
male, have limited cognitive capacity, or have experienced prenatal stress [Monk et al., 2000]2.
Stress related to school pressure and family finances has a greater impact on young people than
parents believe, according to the American Psychological Association's (APA) 2009 Stress in
America survey. According to the survey, many parents don't realize how stressed their children
are. Nearly half (45 percent) of teens ages 13-17 said that they worried more this year, but only
28 percent of parents think their teen's stress increased. And while a quarter (26 percent) of teens
ages 8-12 said they worried more this year, only 17 percent of parents believed their teen’s stress
had increased. The only treatment of GAD in modern medicine is anxiolytics or antidepressant
etc. while the basic cause of GAD or any psychological disorders is the physiological pathways
that connect the mind and body demonstrating a strong relationship between them and emphasize
the mind’s effect on the body.
Thus at this level Ayurveda holds a holistic approach in management of any disease by
modification of diet, drug and lifestyle, specifically according to Prakriti of the individual may
provide better results. There are so many somatic diseases in which psychological symptoms
have been described whereas in the description of manasika roga, somatic characters are also
mentioned. In Ayurveda, avoidance of the causative factors is described as the first line of

2. treatment of any disease whether it is manasika or saririka roga. The Medhya rasayana drugs
described in Ayurveda have better and less adverse effect on the mind and body which helps to
alleviate the symptoms of stress and increase academic performance and cognitive functions.
AIMS & OBJECTIVES
1. To offer relief from the problem associated with academic stress.
2. To establish the relationship between Prakriti and academic stress.
3. To improve school performance.
MATERIAL &METHODS
A randomized double blind placebo control study was conducted in children. The study was
conducted in two portions which include
A. Impact of Prakriti on Academic Stress
a. A questionnaire was prepared to assess the Prakriti of children.
b. Study on the impact of Prakriti on Academic stress- this was done in children,
screened out from the OPD of the Bal-roga department and various schools.
B. Clinical evaluation: Randomized clinical trial was done.
SELECTION OF CASES
 Source - Children for the present study were screened out from OPD of National Institute
of Ayurveda, Jaipur and from various schools, situated in Jaipur by survey method.
 Age group - Children between 10 to 16 years were considered for study.
 Number of cases- 72 children were registered out of which 12 children discontinued the
treatment.
 Grouping of patients- Selected children were randomly divided into three groups keeping
in mind that all the three groups had children from various grades (classes), schools &
socio economic strata.
Group A – This group of 20 children were given the Ayurvedic
compound Saraswat Churna (SC-I granules).
Group B – This group of 20 children were given shirodhara (ksheerdhara)
Group C – This group of 20 children were given only placebo.

3. DIAGNOSTIC CRITERIA
Pre-assessment screening of children with Academic stress was done according to Academic
Anxiety Scale for Children
A. Inclusion Criteria -Children aged between 10-16 years of either sex, diagnosed under stress.
B. Exclusion Criteria-Children below 10 years and above 16 years of age, with physical
disability, with any systemic disorder, with post-traumatic stress, with any genetic disorder, with
Obsessive compulsive disorder.
C. Discontinuation criteria -Any acute or severe illness, Parents not willing to continue the
treatment.
D. Assessment criteria-DSM- IV Criteria, Neuro feedback – HRV, BVP, Salivary Cortisol level
E. Side effect evaluation criteria
To rule out possible side effects of the study drugs, clinical criteria were adopted. It included the
documentation of information related to change in appetite, sleep, abdominal features,
drowsiness, irritability etc.
METHODS
1) Children from various schools were screened out for pre-assessment by an AASC
(Academic Anxiety Scale for children) questionnaire. The Performa contained 20
questions.
2) Screened out children were assessed for their IQ. For this purpose ‘Draw – A – Man’ test
for Indian children was adopted which is valid for children of age group 8-16 years.
Children with average or above average IQ were considered for further screening.
3) Children screened out by pre-assessment questionnaire and with average IQ or above
average IQ were screen by general symptoms of short term (23 symptoms ) & long term
symptoms of stress (11 symptom). Screened out children were given three tests
Generalized anxiety disorder DSM–IV, Salivary Cortisol level &HRV
4) Detailed information about the diagnosed children was recorded in Performa prepared on
the basis of Āyurvedic parameters as well as modern.

4. DRUG
A compound drug “Saraswat-Churna” (SC-1 granules) containing 13 herbs was selected for the
present study. The powder of dried useful parts of herbs were taken in proper quantity and were
processed in the pharmacy of National Institute of Ayurveda, Jaipur and was converted into
granule form in order to enhance its palatability of easy administration in children.
DOSE & DURATION
Doses were according to the body weight of the child (200 mg/ kg / day) in 2 divided doses with
milk for 2 months. Children were called for follow up every fortnightly.
PLACEBO
The placebo for the study was also in the form of granules with the same color and texture as
study drug (Granules) containing starch and sugar. Doses were similar to that of study drug.
OBSERVATIONS
Sr. No. Incidences Maximum Range
1 Age 15-16 Years. (57%)
2 Sex Females. (62%)
6 Educational status of father Graduated. (22%)
7 Type of diet Vegetarian. (52%)
9 Predominance of rasa in diet Lavana rasa. (37%)
10 Frequency of tea/coffee Three times per day. (43%)
11 Appetite Poor appetite. (52%)
12 Thirst Increased thirst. (53%)
13 Sleep pattern Moderate. (28%)

5. 14 Frequency micturition Increase in frequency. (50%)
15 Bowel habit Semisolid stool. (52%)
16 Academic performance Average. (40%)
17 Study time Study in home for two to four hour. (53%)
INCIDENCE OF SHARIKA PRAKRITI
Maximum numbers of children (39%) were of Vata-pitta Prakriti. 20% children were of pitta-
Vata Prakriti. Findings are consistent with the classics.
Majority of patients (33%) were of Rajasika-Tamsika Prakriti, followed by 25% patients of
Rajasika-Sattvika Prakriti, Maximum number of patient’s had Heena Satva (58%) followed by
Madhyama Satva in40%of patients.

6. RESULT-
Table No. 1 Statistical status of total effect of therapy on salivary cortisol
Groups
BT
Mean
AT
Mean
Mean
Diff.
S.D.
Diff.
S.E.
Diff.
%
‘t’
value
‘p’ Value REMARK
Group A 46.33 8.11 38.22 13.40 2.99 82.50 12.756 <0.001 HS
Group B 42.04 25.28 16.76 13.90 3.11 39.88 5.394 <0.001 HS
Group C 40.57 40.60 -0.024 13.04 2.92 0.058 0.0080 >0.05 IN
Statistically highly significant improvement in salivary cortisol was observed in groups A and B
(p<0.001) while group C showed insignificant result.
Table No. 2 Statistical status of total effect of therapy on HRV
Groups
AT
Mean
BT
Mean
Mean
Diff.
S.D.
Diff.
S.E
Diff.
‘t’ Value ‘p’ Value REMARK
Group A 18.42 11.74 6.68 3.35 0.75 8.914 <0.001 HS
Group B 17.10 11.96 5.14 2.78 0.62 8.276 <0.001 HS
Group C 11.22 13.02 -1.81 4.42 0.99 1.827 >0.05 IN
Highly significant (<0.001) improvement in HRV was observed by Paired t test in groups A and
B while group C showed insignificant result.

7. DISCUSSION
Study included the maximum numbers of female children (62%). The finding is consistent with
all studies that higher incidence of the disorder in females [Kashani et.al3. 1989; Weissman,
1988; Costello et.al. 20034]. Maximum number of patients (28%), showed proper & moderate
(28%) sleep pattern followed by 13% of patients with delayed sleep hours. 12% of patients had
disturbed sleep. 10% of patients had less sleep and only 9% of cases had excessive sleep. There
is accumulating evidence that anxiety or major depression are hallmark for disturbances in
circadian rhythms and sleep architecture [Chadi Touma et. al. 20095]
Majority of Patients (53%) showed average academic performance (marks between 40-55%),
followed by 30% of patients, showing poor academic performance as shown in Anxiety can be
seen as a cause and effect of poor school performance. Students can be overwhelmed which
causes anxiety, and then in turn their poor performance can produce more anxiety [Woolfolk,
20076]
Study included maximum number of cases (39%) with vata-pitta prakriti followed by 20%
children with pitta-vata Prakriti. The findings indicate some correlation between vata-pitta
prakriti and Academic stress. As all types of prakriti individual develops Academic stress due to
the reason that it affects all the systems of the body and the vitiation takes place in all the dosha
and produces the somatic. Since prakriti is the biological/ genetic constitution of an individual, it

8. can be concluded that vata & pitta prakriti predispose the child to the development of stress
rather than kapha prakriti.
Impact of Prakriti on stress: Physical and psychological Characters represented by Vata
dominant prakriti in context of stress showed 80% of patients in Group A, 75% in Group B and
66% in Group C had maximum Difficulty concentrating / mind going blank (Chala Dhriti,
Smriti, Buddhi). In Group A 45% patient and 50% each in both Group B & C showed maximum
symptoms of Poor short term memory (Alpa Smriti). 80% of patient in Group A 75% in B and
70% in C get easily fatigued maximum time. Incidence of Frequent colds/infections (Alpa Bala)
showed that 70%, 80%, & 90% patient in Group A, B and C had minimum episodes. 60% in
Group A showed maximum disturbance in sleep (Alpa Nidra) while 85% in Group A & 40 % in
Group C. In Group A and C 50 % of patient get irritable (Shighra Shobha)maximum time while
35% in Group C get irritable some time and 35% maximum time. 45% of patient in Group A,
40% in B and 50 % of patient in Group C had maximum lack of confidence (Nadridha). In group
A 70%, 55% in group B and 40% in C patient showed frequent anger (Krodhi) maximally. 40%,
50% and 45% of patients in Group A, B and C respectively had feeling out of control
(Najitendriya).
Symptoms represented by Pitta dominant prakriti in context of stress showed in Group A 55%
and 40% in Group C had maximum episodes of dry mouth or excessive thirst while 40 % patient
in Group B had moderate episodes of dry mouth (Kshut Pipasa). Episodes of excessive sweating
(Swedno) was minimum in all Groups (80% in A, 50% in B and 55% in C Group). 50% patient
in Group A 60% in B and 70% in Group C had minimum episodes of urge to urinate (Prabhuta
mutra). In Group A 85%, 75% in B and 95% in Group C had minimum episodes of functional
diarrhea (Prabhuta purisha). Over eating (Prabhuta asanpan) was minimum in all groups (80%
each in A and B and 90% in Group C) this suggests that stress is common in Vata dominant
Prakriti and to lesser extent in Pitta dominant Prakriti.
 Statistical analysis of the results obtained on the short term symptom of stress
The result of group A in which trial drug was given patients showed statistically highly
significant improvement (P<0.001) in symptoms of stress: episodes of dry mouth, fast heartbeat,
palpitation, functional dyspepsia, headache, tension in muscles, feeling out of control, frequent
anger, lack of confidence irritability loss of appetite, change in sleep and statistically mild
significant (<0.01) in episodes of rapid breathing, episodes of cold hands and feet, functional
heartburn, urge to urinate, lack of confidence in own judgment. Statistically significant
improvement (p<0.05) was observed in excessive sweating, nausea, functional diarrhoea, feeling
helpless, feeling of harming self, over eating.

9. In group B in which shirodhara was given statistically analysis showed highly significant
improvement (P<0.001) symptoms of stress: rapid breathing, dry mouth, cold hands and feet, fast
heartbeat, palpitation, functional dyspepsia, headache, tension in muscles, feeling out of control,
frequent anger, feeling helpless, irritability, loss of appetite, change in sleeping. Statistically mild
significant (<0.01) was observed in symptoms of episodes of excessive sweating, functional
heartburn, urge to urinate, lack of confidence, lack of confidence in own judgment and
statistically significant (<0.05) nausea, functional diarrhea, feeling harming self, over eating.
Statistically analysis showed significant improvement (P<0.05) in symptoms of stress in
group C (placebo group): rapid breathing, dry mouth, functional dyspepsia, functional, diarrhoea,
headache, feeling harming self, irritability. And statistically (>0.05) insignificant cold hands and
feet, excessive sweating , fast heartbeat, palpitation, nausea, functional heartburn, tension in
muscles, urge to urinate, feeling out of control, lack of confidence, lack of confidence in own
judgment, over eating, loss of appetite, change in sleeping.
 Statistical analysis of the results obtained on the long-term symptom of stress
Statistically highly significant improvement (P<0.001) in long-term symptoms of stress
in Group A (trial group) was obtained in easily fatigued, insomnia, social withdrawal, repetitive
habits, poor short term memory, difficulty concentrating/ mind going blank and statistically
(P<0.01) moderately significant in weight loss, frequent colds/infections, and significant (<0.05)
in symptoms of weight gain, constipation, diarrhea.
In group B statistically highly significant improvement (P<0.001) was observed in weight
loss, easily fatigued, social withdrawal, repetitive habits, poor short term memory, difficulty
concentrating/ mind going blank; mild significant (<0.01) in frequent cold or infection. And
statistically significant (<0.05) in symptoms of weight gain, constipation, diarrhea, insomnia.
In group C statistically analysis showed significant improvement (P<0.05) in long-term
symptoms of stress: constipation, repetitive habits. And statistically insignificant (>0.05) was
observed in symptoms of weight loss, weight gain, diarrhea, frequent colds/infections, being
easily fatigued, insomnia, social withdrawal, poor short term memory, difficulty concentrating/
mind going blank.

10.  Statistical analysis of the results obtained on Generalized Anxiety Disorder according to
DSM IV
Statistically highly significant improvement (P<0.001) in all symptoms of Generalized Anxiety
Disorder: restlessness or feeling keyed up or on edge, being easily fatigue, difficulty
concentrating or mind going blank, irritability, muscle tension, sleep disturbance was observed in
group A
In group B (shirodhara group) statistically highly significant improvement (P<0.001) was
observed in all symptoms of Generalized Anxiety Disorder: restlessness or feeling keyed up or
on edge, being easily fatigue, difficulty concentrating or mind going blank, irritability, muscle
tension, sleep disturbance.
On statistical analysis of symptoms of Generalized Anxiety Disorder in group C (placebo group)
it showed statistically significant improvement (P<0.05) was observed by Wilcoxon test in
restlessness or feeling keyed up or on edge only and irritability. Statistically insignificant in
symptoms of being easily fatigue, difficulty concentrating or muscle tension, sleep disturbance.
CONCLUSION
Both drug and shirodhara were effective in alleviating the symptoms of Academic stress.
Counseling based on prakriti proved effective in overcoming the symptoms of Academic stress.
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