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EVALUATION OF THE EFFICACY OF KSHEERABALA TAILA NASYA AND AMALAKI SIDDA KSHEERA DHARA IN CHITTODVEGA W.S.R.T. GENERALIZED ANXIETY DISORDER” BY RAJESH A.R. Department of Panchkarma, D.G.M. Ayurvedic ...

EVALUATION OF THE EFFICACY OF KSHEERABALA TAILA NASYA AND AMALAKI SIDDA KSHEERA DHARA IN CHITTODVEGA W.S.R.T. GENERALIZED ANXIETY DISORDER” BY RAJESH A.R. Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.

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Chittodwega ksheeradhara pk026_gdg Chittodwega ksheeradhara pk026_gdg Document Transcript

  • “EVALUATION OF THE EFFICACY OF KSHEERABALA TAILA NASYA AND AMALAKI SIDDA KSHEERA DHARA INCHITTODVEGA W.S.R.T. GENERALIZED ANXIETY DISORDER” BY RAJESH A.R. Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfilment of the degree of AYURVEDA VACHASPATI IN PANCHAKARMA Under the guidance of Dr.P.SIVARAMUDU M.D(Ayu), M.A(san), M.A(psy) Proff & H.O.D P.G. Dept. of Panchakarma And co-guidance of DR. SANTOSH N. BELAVADI M.D. (Ayu) Ast. Professor P.G. Dept. of Panchakarma POST GRADUATE DEPARTMENT OF PANCHAKARMAD.G M.AYURVEDIC MEDICAL COLLEGE AND RESEARCH CENTER GADAG – 582103 2007-2010
  • DECLARATION BY THE CANDITATE I hereby declare that this dissertation / thesis entitled “Evaluation of the efficacyof ksheerabala taila nasya and amalaki siddha ksheera dhara in chittodvega w.s.r.t.Generalized anxiety disorder” is a bonafide and genuine research work carried out byme under the guidance of Dr. P. Sivaramadu M.D. (Ayu) M.A (San) M.A (Psy), Professor & H.O.Dand the co-guidance of Dr. Santosh N. Belavadi M.D(Ayu), Ast. Professor, Post GraduateDepartment of Panchakarma, Shri D.G.M.Ayurvedic Medical College, Gadag.Date: Signature of the CandidatePlace: Gadag (Rajesh. A.R)
  • CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Evaluation of the efficacy ofksheerabala taila nasya and amalaki siddha ksheera dhara in chittodvega w.s.r.t.Generalized anxiety disorder” is a bonafide research work done by Rajesh A.R inpartial fulfillment of the requirement for the degree of Ayurveda Vachaspathi. M.D.(Panchakarma).Date: Signature of the GuidePlace: Gadag Dr. P. Sivaramadu M.D. M.(Ayu) M.A (San) M.A (Psy), Professor & H.O.D P.G. Dept of Panchakarma Shri.D.G.M. Ayurvedic Medical College, Gadag.
  • CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “Evaluation of the efficacyof ksheerabala taila nasya and amalaki siddha ksheera dhara in chittodvega w.s.r.t.Generalized anxiety disorder” is a bonafide research work done by Rajesh A.R inpartial fulfillment of the requirement for the degree of Ayurveda Vachaspathi. M.D.(Panchakarma).Date: Signature of the Co-GuidePlace: Gadag Dr. Santosh N. Belavadi M.D. (Ayu). Ast. Professor P.G. Dept of Panchakarma D.G.M Ayurvedic Medical College, Gadag.
  • J.S.V.V. SAMSTHE’S SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST GRADUATE DEPARTMENT OF PANCHAKARMA ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Evaluation of the efficacy of ksheerabala taila nasya and amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” is a bonafide research work done by Rajesh A.R under the guidance of Dr. P. Sivaramadu M.D. M.(Ayu) M.A (San) M.A (Psy), Professor & H.O.D and the co-guidance of Dr. Santosh N. Belavadi M.D(Ayu), Ast. Professor, Post Graduate Department of Panchakarma, Shri D.G.M.Ayurvedic Medical College, Gadag. and contributed good values to the Ayurvedic research. Dr. Sivaramadu. M.D. (Ayu), M.A (San), M.A (Psy) Dr. G. B. Patil Prof. and H.O.D. Principal, P.G. Dept of Panchakarma Shri. D.G.M. Ayurvedic Medical College,Shri. D.G.M. Ayurvedic Medical College, Gadag Gadag.Date: Date:Place: Gadag Place: Gadag
  • COPYRIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation / thesis in print orelectronic format for academic / research purpose.Date: Signature of the CandidatePlace: Gadag. Rajesh A.R © Rajiv Gandhi University of Health Sciences, Karnataka.
  • ACKNOWLEDGEMENT All human efforts have to be blessed by the Almighty to become complete andfruitful. This is especially so in case of the Medical profession- in that both the patientand the doctor have to be lucky to get the best results of the treatment. I pray to theAlmighty, the first physician in the universe to bless all mankind for the alleviation oftheir sufferings. I deserve my respectful greetings in the lotus feet of Jagadguru Shri.Abhinava Shivanandmahaswamiji to his holiness and divine blessings. I dedicate this work to my, respected parents Shri.K.Rajendran &Smt.K.Vasanthakumari and my sister Smt.Remya.V.R. Who are the prime sources for allmy success. My most earnest acknowledgment must go to my advisor& guideDr. P. Shivaramudu M.D.(Ayu), Prof. & H.O.D P.G. Department of Panchakarma,P.G.S & R.C,D.G.M.A.M.C, Gadag, who has been instrumental in ensuring myacademic, professional, and moral well being ever since. I could not have imaginedhaving a better advisor for my P.G. He helped me come up with the thesis topic andguided me over almost 2 years of development. And during the most difficult times whenwriting this thesis, he gave me the moral support and the freedom I needed to move on.During the 3 years of my P.G, I have seen in him an excellent advisor who can bring thebest out from his students, an outstanding researcher who can constructively criticizeresearch, and a nice human being who is honest, fair and helpful to others.
  • In particular, I would like to thank my respected co-guide Dr. Santosh. N.Belavadi, MD (AYU) Ast. Professor, P.G. Department of Panchakarma, P.G.S &R.C, D.G.M.A.M.C, for discussions and guidance, who has not only been a source foracademic progression, but has also, provided a friendship and understanding throughoutmy research. . His discerning command over a vast range of literature in Ayurveda, andmanagement systems was an invaluable resource for me. I express my obligation to, Dr.Suresh Babu, Prof and HOD, Department ofKayachikitsa, P.G.S & R.C, D.G.M.A.M.C, Gadag, for his tremendous encouragementand thought provoking advices throughout my P.G.curriculam. I express my deep gratitude to Dr. G. B. Patil, Principal, D.G.M.A.M.C,Gadag, for his encouragement as well as providing all necessary facilities for thisresearch work. I express my sincere gratitude to Dr. G. Purushothamacharyulu Professor,Dr.Santosh. N. Belavadi Ast. Professor, Dr.Yasmeen A Phaniband Lecturer Dr.Jayaraj Basarigidad Lecturer, and Dr. C.V. Rajshekar Lecturer P.G. Department ofPanchakarma, P.G.S. & R.C, D.G.M.A.M.C, Gadag for their valuable guidelines andsuggestions throughout my post graduate carrier. I express my sincere gratitude to Dr. M. C. Patil, Dr. Mulgund, Dr. K. S. R.Prasad, Dr. R.V. Shetter, Dr. Girish. Danappagoudar, Dr.M.D.Samudri, Dr.G.J.Mitti, Dr. S.Nidgundi, Dr. B.G.Swamy , all PG & UG staff for their constantencouragement. I am thankful to Shri. Nanda kumar (Statistician), Shri. V.M. Mundinamani
  • (Librarian), Shri. Kerur, Shri. Shravy, Shri kulakarni, Shri Nabhi, and otherhospital and office staff for their kind support in my study. I ought to be immensely grateful to those individuals who have helped me in thisexciting venture. Their number will easily run into the hundreds. Among them are friendsand colleagues, and others with whom I have interacted during the course of my P.G. Iwill try to record my appreciation of their help by naming some of them here areDr.Natraj, Mr. Shakti, Dr. Shyama Krishnan, Dr. Vasu, Dr. Sanjeev Chowdhry,Dr.Ashok, Mr.Riaz, Dr. Madhushree, Dr. Shailej Dr. Adarsh, Dr. Mukta, Dr. PrasannaJoshy, Late Dr. Shivakumar, Dr. Sanath, Dr. Jayashankar, Dr. Deepak, Dr. Sabareesh Dr.C.C.Hirmath,, Dr. Bodke, Dr. Shakunthala, Dr. Vasanth, Dr. Rajasekar, Dr.Satheesh, Dr.Deepa, Dr. Asha, Dr. Praveen, Dr. Aneesh, Dr. Renukaraj, Dr. Sangamesh, Dr. Biswajit,Dr. Joshy George,Dr. Bhagyesh, Dr.Vijay Mahantesh, Dr.Vinod, Dr. Sateesh, Dr. Surej,Dr. Jayaker, Dr. Baba, Dr. Ragavendra, Dr. Vijay, Dr. Jagadeesh, Dr. Manish, Dr.Paresh. Dr. Shilpa, Dr. Eshwar, Smt. Lalita, Dr. Khanti, Dr. Ghorapade. Dr. Jadhav, Dr,srikanth, Dr. Anoop.R, Dr. Adarsh.P, Dr.Praveen.R, Dr. Vishal Kannan, Dr. Jiji Prasad,Dr. Sreeni.M, Dr. Arun Pratap, Dr.Arun S. Kumar, Dr. Hrishikesh, Dr. Purushothaman,Dr. Sreekanth.Reddy, Dr. Soorya Vamsi, Dr. Kishore Kumar.Date :Place : Dr. Rajesh.A.R
  • ABBREVIATIONS USED:A.H – Ashtanga HrudayaA.S – Ashtanga SamgrahaB.P – BhavaprakashaB.S – Bhela SamhitaC.S – Charaka SamhitaM.N – Madhava NidanaS.S – Sushruta Samhita,V.S – VangasenaY.R – Yogaratnakara
  • ABSTRACT Chittodvega is commonest among psychic disorders. Anxiety disorder isbecoming so common in today’s life style and is having one-year prevalence rate 2-4%globally. Incidence rate of Anxiety disorders is increasing day by day, which has createdmajor problem to modern society. Chittodvega is a disease of mind caused due toManasika dosas rajas and tamas along with the sharirika dosas mainly vata PradhanaThe treatment for mental disease nasya and dhara plays major role as mind is situated inthe Shiras (Shiro hrudaya). So here in this “Evaluation of the efficacy of ksheerabalataila nasya and Amalaki siddha ksheera dhara in chittodvega w.s.r.t generalizedanxiety disorder” was taken.Objective of the Study:1. Evaluation of Effect of nasya in chittodvega.2. Evaluation of effect of ksheerabala taila in chittodvega3. Evaluation of effect of dhara karma in chittodvega4. Evaluation of effect of amalaki siddha ksheera dhara in chittodvegaStudy Design: It was a simple randomized single clinical observational study with a pre and posttest design in 30 patients, were diagnosed as chittodvega and fulfilling the criteria ofUndergoing the process of nasya karma and dhara karma were selected. Patients wereSubjected to sthanika Abhyanga and Swedana before the nasya karma. After the Pradhana karma with ksheera bala taila nasya in the morning byadopting the brumhana Sneha nasya matra i.e. 8 drops in each nostril for 7 days asPaschat karma dhoomapana and gandoosha were performed.
  • after the completion of nasya karma amalaki siddha ksheera dhara was administered forseven consecutive days in the morning hours between 7:30 am -8:30 am the duration ofthe dhara was taken in the arohana krama for the first 4 days with a specific time of 5mins and on the 5th day on wards reduce the duration by the same. After that rasnadichoorna was performed as Paschat karma over the scalp. The assessment criteria werenoted before the treatment and after the parihara kala, for that chief complaints Viz.restlessness, fatigue and difficulty in concentration ,associated complaints like irritability,muscle tension, and sleep disturbance , criteria’s like Hamilton anxiety scale , Zung selfrated anxiety scale ,MAAS, GHQ-28 were usedResults:• 26 (87 %) patients manifested with symptoms of chittodvega got complete relief or best responded when assessing the criteria’s like HAS, Zung self rated anxiety scale, MAAS, GHQ-28 and clinical symptoms.• 04 (13%) got responded with the treatment adopted with minimum clinical symptoms present.• Not even a single patient left with not responded by the trial.• The assessment of the overall effect of the treatment revealed that the treatment adopted here is highly significant in the management of chittodvegaKey Words: chittodvega, generalized anxiety disorder, nasya karma, dhara karma
  • TABLE OF CONTENTSSI. No. Contents Page No. 01 Introduction 1 02 Objectives 9 03 Review of Literature 15 04 Materials and Methodology 102 05 Observations and Results 122 06 Discussion 151 07 Conclusion 168 08 Summary 171 09 Bibliography 174 10 Annexures 190
  • List of tablesSi. Tables Page no:No:1. Showing the Sneha nasya matra 212. Showing the Shodhana Nasya matra 223. Showing the Avapeedana Nasya matra 234. Showing the Contra Indications of Nasya 265. Showing Nasya Matra. 296. Showing the Samyak Yoga Lakshanas of Nasya 347. Showing the Ayoga Lakshanas of Nasya. 358. Showing the Atiyoga Lakshanas of Nasya 369. Showing the Roopa 0f Chittodvega 11210. Showing Hamilton Anxiety Rating Scale: 11411. Showing Zung Self-Rated Anxiety Scale. 11512. Showing the General Health Questionnaire-GHQ28. 116-11813. Showing the Mindfulness Attention Awareness Scale (MAAS). 11914. Showing the Ayurveda health assessment. 12015. Showing the distribution of patients by sex. 12216. Showing the distribution of patients by Age. 12217. Showing the distribution of patients by Religion. 12318. Showing the distribution of patients by occupation. 12319. Showing the distribution of patient’s by Economic status. 12420. Showing the distribution of patients by marital status. 12421. Showing the distribution of patients by Ahara. 12522. showing the distribution of patients by vihara 12523. Showing the distribution of patients by Agni. 12624. Showing the distribution of patients by Koshta. 12725. Showing the distribution of patients by Nidra. 12726. Showing the distribution of patients by Vyasana. 12827. Showing the distribution of patients by sharirika prakruti. 128
  • 28. Showing the distribution of patients by Manasika Prakruti. 12929. Showing the distribution of Patients by satva. 12930 Showing the distribution of Patients by Nidana. 13031. Showing the distribution of patients by Roopa of chittodvega. 13032. Showing the distribution of patients by Chronicity. 13133. Showing the distribution of patients by Sheela. 13234. Showing the distribution of patients by Chesta. 13235 Showing the distribution of patients by Achara. 13336. Showing the distribution of patients by Manaha. 13437. Showing distribution of patients by Buddhi. 13438. Showing distribution of patients by Buddhi. 13539. Showing distribution of patients by Sajnajnanam. 13640. Showing distribution of patients by Bhakthi. 13641. Showing distribution of patients by HAS (Hamilton Anxiety Scale). 13742. Showing distribution of patients by Zung self rated anxiety scale. 13843. Showing distribution of patients by MAAS. 13844. Showing distribution of patients by GHQ- 28. 13945. Showing distribution of patients by Overall assessment of the result. 14046. Showing the Roopa of Chittodvega. 14147. Showing the Personal History. 14248. Showing the Nidana of Chittodvega. 14349. Showing the Demographical Data. 14450. Showing the Hamilton Anxiety Rating Scale. 14551. Showing the Zung Anxiety Rating Scale. 14652. Showing the Mindfulness Attention Awareness Scale (MAAS). 14753. Showing the GHQ-28. 14854. Showing the Statistical Study of the Trial. 149
  • LIST OF FIGURESSi. igures PageNo: no:1. Showing the classification of nasya according to Charaka. 192. Showing the classification of nasya according to Sushruta. 203. Showing the classification of nasya according to Vagbhata. 204. Showing the Samprapti of Cittodvega. 795. Showing the 5 Functional neuro anatomy of GAD. 876. Showing the drug Bala. 887. Showing the drug Amalaki. 908. Showing the drugs used and the procedure. 1219. Showing the showing the distribution of patients by sex. 12210 Showing the showing the distribution patients by Age. 12311. Showing the distribution of patient’s Religion. 12312. Showing the distribution of the distribution by occupation. 12413. Showing distribution of patients by Economical status. 12414. Showing the distribution of patients by marital status. 12515 Showing distribution of patients by Ahara. 12516. Showing distribution of patients by Vihara. 12617. Showing distribution of patients by Jataragni. 12618. Showing distribution of patients by Koshta. 12719. Showing distribution of patients by Koshta. 12720. Showing distribution of patients by Vyasana. 12821. Showing the distribution of patients by sharirika prakruti. 12822. Showing the distribution of patients by Manasika Prakruti. 12923. Showing the distribution of Patients by satva. 12924. Showing the distribution of Patients by Nidana. 13025. Showing the distribution of patients by Roopa of chittodvega. 13126. Showing the distribution of patients by Chronicity. 13127. Showing the distribution of patients by Sheela. 13228. Showing the distribution of patients by Chesta. 13329. Showing the distribution of patients by Achara. 13330. Showing the distribution of patients by Manaha. 13431. Showing the distribution of patients by Buddhi. 13532. Showing the distribution of patients by Smrithi. 13533. Showing the distribution of patients by Sajnajnanam. 13634. Showing the distribution of patients by Bhakthi. 13735. Showing the distribution of patients by HAS . 13736. Showing the distribution of patients by Zung self rated anxiety scale. 13837. Showing the distribution of patients by MAAS. 13938. Showing the distribution of patients by GHQ- 28. 13939. Showing the distribution of patients by Overall assessment of the result. 140
  • Introduction INTRODUCTIONThe most beautiful thing we can experience is the mysterious. It is the Source of all trueart and science. —Albert Einstein (1930) In today’s convulsively changing world, scientific advances, political mutations,Profit maximizations, social interventions, and human interpretations are producing new,and often confusing, perceptions of health and disease, to the extent that one wonders ifsuch primary human aspirations as equity, well-being, and freedom from suffering arebeing forgotten. What are often forgotten are the fundamental principles of the WorldHealth Organization, “The struggle against human suppression is the struggle betweenmemory and forgetfulness?” Health and disease, at once humanity’s happiness and yoke, have marched Withhistory and marked time with it. They have molded and, it turns, have been Influenced bythe degree of social and intellectual development in any given Space or time. Yetwhatever the flux, humankind has constantly pursued disease as its target and health as itsgoal. Human beings face unprecedented challenges as we approach the nextmillennium. We are seeking new ways to meet the demands of modern life as itsunrelenting flow of information demands our attention. Although in many ways, we have “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 1
  • Introductiongreater opportunities for a rich and fulfilling life than ever before, it is clear that we needto evolve new strategies if we are to survive and thrive as individuals and as species. Ayurveda, the extra-ordinary mind-body medicine, cognized by the great seers ofIndia, willingly offer us a wealth of practical knowledge on how to live a healthy andmeaningful life. According to Ayurveda, Sattva, Atma, and Sharira are the three tripods of life,where the mind (Sattva) occupies the first place, due to its importance in connecting thesentient soul with non-sentient body. Human life is considered as an invaluableopportunity to achieve the prime goals of life viz., Dharma, Artha, Kama, and Moksa. Toachieve these aims one needs a healthy and calm life. Whole ancient society tried toachieve all four prime goals of life, so that they had a smooth, sound, safe, assured,steady, and healthy lifestyle. But on the other hand, today’s life style has drasticallychanged. As James C. Colem said, “the 17th century was the age of enlighten, the 18th ageof reasoning, the 19th age of progress, and the 20th age of Anxiety which is the seed ofmany psychological disorders, the 21st century has become the age of communication,where the world become shortened to global village, by which whole world stressfulevents are affecting the individuals apart from their own, leading to emotionaldisturbances and incapacitating more people than any other health problems.” Today,every one is trying to gain good financial status and to fulfill all the physical desires;therefore today’s fast modern society is facing unsteady, weakened, hard, and everydaychanging lifestyle. The gift of this lifestyle is that, almost every one appears to bestressed and confused. These reflections can lead to mental disabilities. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 2
  • Introduction Anxiety disorder is becoming so common in today’s life style and is having one-year prevalence rate 2-4% globally (Kessler et. al.1994). Incidence rate of Anxietydisorders is increasing day by day, which has created major problem to modern society.The World Health Organization (2008)1 estimates that 450 million People worldwidecurrently experience ‘mental, neurological or behavioral Problems’. In the United Statesalone, almost 44 million people –Approximately one in six of the population – areaffected by a mental Illness in any given year (United States Department of Health andHuman Services 2006). As per the WHO predictions, at 2020 anxiety disorders anddepressive disorders will be in the top rank order of Disease Burden for 18 leadingCountries (The Global Burden Of Disease – WHO 2001); which are related to lifestyleand behavioral patterns.Purpose of Study: Acharya Vagbhata gave the brief description of Manasaroga in the beginningverse of his work, ‘Astanga Hrudaya’ as well as ‘Astanga Samgraha’ as RagadiroganSatatanushaktan….. Apoorvavaidyaya Namostu Tasmai Ii This shows the importance of mental disorders according to the time factor. Eventhough, Acharya Charaka and Susruta described many mental disorders, they gave primeimportance to the promotion of health and then they dealt with diseases. But, Vagbhataby mentioning “ragadi roga” highlighted the importance of diseases prevailing during hisperiod, which holds well till today. One side man is enjoying the fruits of modernization but on the other hand he ispaying price for the same. In this most modernized world due to sedentary life style andfood habits man is caught up with lot of diseases, this leads to early ageing, debility, loss “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 3
  • Introductionof immunity, which in turn is producing more number of disease like insomnia, anxiety,depression etc. in that GAD is one of the most common disease in the present era.The generalized anxiety state is here closely comparing with chittodvega2 which ismentioned by Acharya Charaka in the vimana sthana but the detailed description of thedisease is not available in the classics hence scattered terms used in Ayurveda similar tothis condition is also taken into account like anavastita chitta, chittanasha, chittakshobha,asvasthachitta etc…. In Chittodvega, when the mind is afflicted with anxiety, fear, agitation etc.thisleads to worry apprehension, depression, psychological arousal as anger, irritability andultimately lead to disturbance in personal, familial and social harmony. Anxiety disorders are among the most prevalent psychiatric condition in theworld. Further, studies have persistently shown that they produce inordinate morbidity,utilization of health care services, and functional impairment. Recent studies also suggestthat chronic anxiety disorder may increase the rate of cardiovascular-related mortality.Hence, clinicians in psychiatry and other specialties must make the proper anxietydisorder diagnosis rapidly and initiate treatment. In people with GAD, the worry often is unrealistic or out of proportion for thesituation. Daily life becomes a constant state of worry, fear, and dread. Eventually, theanxiety so dominates the persons thinking that it interferes with daily functioning,including work, school, social activities, and relationships The usual age of onset isvariable - from childhood to late adulthood. Women are two to three times more likely tosuffer from generalized anxiety disorder than men and more and more medicines also “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 4
  • Introductionprove to be ineffective as they do not reach the site of the disease. So in this contextAyurveda plays a major role because it eliminates the disease from its root. In this present study shata paka ksheerabala taila which is mentioned in the classicshaving the properties of brumhana, indriyaprsada and ksheera dhara which is mentionedin keraliya Panchakarma having significant role in treating the manasa vikaras are takento evaluate its effectiveness in chittodvega.Lacunae in Current Knowledge: Mental diseases are generated by the non-fulfillment of desired objects and bysuccumbing to the hated. As a social being we are unable to fulfill all our desires andwe are compelled to accept things that we dislike. Both these cause frustration and mentalstress and are conducive to mental diseases.According to Ayurveda, improper union of time, objects and actions is the cause ofall the diseases. Thus improper union of mind with its object, namely the thinkableand improper action of mind are conducive to mental diseases. From a slightlydifferent perspective, etiology can be classified into three viz. contact of objects thatcannot be assimilated (ASAATMYA), error of consciousness and transformation. Error ofconsciousness (PRAJNAAPARAADHA) is the term used for erroneous actions prompted bythe lapse of intellect (BUDDHI), will power (DHRTI) and memory ( SMRTI ) thatproduce bad result. In fact, most of the etiological factors will come under this head. Mind-Body relation in the disease process in such a way that every disease ispsychosomatic, with varying predominance of psychic or somatic involvement. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 5
  • Introduction Relaxation is the voluntary letting go of tension. This tension can be physicaltension in the muscles, or it can be mental or psychological tension. When we relaxphysically, certain impulses are sent to brain, which in turn bring about a general feelingof calm, both physically and mentally.Psychotherapy is one of the main management for anxiety in modern medicine, but oursatvavajaya chikitsa also plays equal role in the management of chittodvega The bestmeasure to achieve the goal of satvavachaya chikitsa is to restrain mind from desire fromunwholesome objects, its through jnana, vijnana, dhairya, smrithi and Samadhi accordingto Charaka. The Pharmacological study of the drug also establishes it as anxiolytic antidepressant and nootropic drug. It is hoped that this piece of work will make a significantcontribution in the field of Manasaroga to find out an eco friendly, toxicity free and costeffective ayurvedic herbal remedy for the management of such common diseaseChittodvega w.s.r. to Generalized Anxiety Disorder. Although many people with GAD cannot be cured and symptoms can return fromtime to time, most people gain substantial relief from their symptoms with propertreatment. Previously, almost more than 20 research work have been carried out fromdifferent P.G. Research centers on chittodvega w.s.r.t Anxiety disorders all over India bytaking trail work with Rasayana drugs and single drugs like Aswagangandha,Mandukaparni, sankapushpi and classical preparations with Shodhana procedures likedhara, kseera dhara and nasya. No doubt that an extensive research and research thoughthas been done on Chittodvega and it shows the chronic, miserable life conditions to copeup with this condition and still research work is undergoing in different institutes to “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 6
  • Introductioninvent an effective, less cost and more beneficial treatment and at the same time theytried clinical research should help to getting rid of worry, irritable and anxiety condition.Hypothesis: In the pathogenesis of the disease the vulnerability in the form of positive familyhistory, Vataja and Rajas a prakruti, Heena Satva, fear prone personality, indulgence inthe misuse of Sadvritta, vitiated Dosa play an important role in predisposing toChittodvega. Anxiety is always associated with some stressful events and some times stressfulsituations may precipitate the anxiety disorders. So, it is always necessary to differentiatepathological anxiety from normal response. Normal feeling of anxiety is an advantageousresponse to a threatening situation. But, the pathological anxiety by contrast is aninappropriate response to a given stimulus, by virtue of either its intensity or duration.The feeling is characterized by autonomic symptoms such as headache, insomnia,perspiration, difficulty in inhaling, palpitation, etc. In the management of Anxiety common problems and clinical considerationsOver the course of therapy, a variety of pitfalls may occur. Such as- • Poor Compliance with Home Assignments • Low Motivation to Participate in Treatment • Practical Problems Completing Home Assignments • Fear that Homework Will Increase Anxiety and Worry • Problems in the Therapeutic Relationship • Common Problems Associated with Specific CBT Strategies • Relaxation Strategies “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 7
  • Introduction • Cognitive Strategies • Behavior Therapy and Exposure Techniques • Therapy Termination and Relapse Prevention • Review of Client Progress and Essential Information • Continued Practice of Therapy Skills and Coping Responses • Written Relapse Prevention Plans • Early Termination of Therapy By keeping above discussed points and after observing the number of clinical trialsWith different medicines and therapeutic procedures of Panchakarma previously done,I have chosen to make clinical trial with Ksheera bala taila nasya and Amalaki siddhaksheera dhara to evaluate the combined effect of both of these treatments in the eachpatient of clinical trial. The effects of the treatment, if properly done, are many. If done in the correctmanner, nasya stimulates vital centers, nourishing the tissues, clearing the channels,removes the congestion and correcting the neuron-vascular anomalies. The hypothesis ofthis clinical trail is also to bring the effects of nasya to get the benefit to the patients thatit relieves tension and cleanses the pathogenic srotasas there by nourishes the tissues andbrings the relaxation, calmness of mind. Amalaki siddha ksheera dhara is scheduled in chittodvega because as amalaki ishaving the actions like antioxidant, anabolic and dhara treatment helps in alleviating thefatigue, worry, head-ache and lack of vitality. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 8
  • ObjectivesOBJECTIVES The process of being scientific does not consist of finding objective truths. Itconsists of negotiating a shared perception of truths in respectful dialogue. —Robert Beavers The entire concept of manas or mind is psychological in nature. Its neurophysiologicattributes have not been described vividly in Ayurveda. According to Ayurveda mentalhealth is a state of sensorial, mental and spiritual well being. The mental ill health is broughtabout essentially as a result of unwholesome interaction between the individual and hisenvironment. In this present era, anxiety is one of the major problems the world has to deal withdue to its increased incidence and global distribution because of the modern life style andsedentary habits. In that GAD is one of the most common psychological condition seen in thecontemporary system of medicine. Anxiety is a problem that ranges from mild uneasiness todistress in physical, mental & emotional setup. The data suggest that in Anxiety Disorders Clinics approximately 12% of theindividuals suffer with Generalized Anxiety Disorder. (Mental Illness in General HealthCare; Ustün & Sartorius, 2007). The national co morbidity survey found that the majority ofindividuals with GAD also reported prominent complications which include: substantialinterference with their lives (49%), high probability of seeking professional help for GADsymptoms (66%) & taking medications for GAD (44%). About 30 - 40% of patients willdevelop other major psychiatric illness in their later life. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 9
  • Objectives Ayurveda follows psychosomatic approach of health. According to Ayurveda Psychic factors are involved in almost all the disease processes along with physical disturbance as both are interdependent. While describing psychological disorders Acharya Charaka has quoted word Chittodvega along with Kama, Krodha, Moha etc.Chittodvega is more applicable term to illustrate whole anxious state. In this study the term ‘Chittodvega’ is compared with Generalized Anxiety Disorder DSM-IV, Chittodvega can exists as a separate disease or can be an etiological factor for other psychic and psychosomatic diseases. Generalized anxiety disorder (GAD) is a chronic anxiety condition characterized by excessive and uncontrollable worry and associated somatic symptoms. Unlike other anxiety disorders, GAD involves diffuse anxiety in the absence of a specific feared object, class of stimuli, or situation. Individuals suffering from GAD instead fear and avoid an array of subtle internal and external stimuli. In Modern psychiatry, an extensive research has been done on general anxiety disorder with the approaches like- Cognitive-Behavioral and Pharmacological Treatment Research, Pharmacotherapy, Comparisons between CBT and Pharmacological Treatments, Comparisons between Applied Relaxation and Cognitive Therapy. The combination of psycho education, applied relaxation training, cognitive therapy, and behavioral and imaginable exposure treatment components consistently has helped individuals suffering from this difficult to treat anxiety disorder.“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 10
  • Objectives The following types of information should be considered when developing a treatment plan: idiosyncratic clinical features, interpersonal Problems and social support, medical problems and conditions, and the nature of any associated disability, impairment, and quality of life interference. By considering the above aspects and treatment protocols, in the present study an attempt is made to find suitable remedy for chittodvega keeping the cardinal symptoms of chittodvega and GAD i.e., Irritability, worry, initial insomnia, fatigue, muscle tension, the present study intended and selected the following yogas for Nasya karma with Ksheerabala Taila mentioned by Astanga hrudaya and Amalaki Siddha Ksheera dhara In this regard the objects proposed in the study are: 1. To evaluate the effect of nasya karma in chittodvega 2. To evaluate the effect of ksheerabala taila in chittodvega 3. To evaluate the effect of dhara karma in chittodvega 4. To evaluate the effect of Amalaki Siddha ksheera dhara in chittodvegaI. To evaluate the effect of nasya karma in chittodvega At the biological level Vata is the Niyanta i.e. Controller and Praneta i.e.Motivator of the mind 3 So that, any dysfunction of vata is responsible for dysfunction ofIndriyas and Mental pertandubance giving rise to Bhaya, Shoka, Moha, Dainya andPralapa 4; also further leads to Nidranasha, Karshya, Bhrama, Dinata, Kampa, Anaha 5.The above symptoms are commonly seen in anxiety disorders, so it can be said that therole of Vata in the manifestation of Cittodvega is very important. Nasya, one of the main Panchakarma used in the management of urdvajathrugatarogas and some Manasika diseases like Unmada, Apasmara etc. are taken in this trail to “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 11
  • Objectivesevaluate its action in chittodvega, because Nasa is the easiest route or way to convey themedicines into the shiras and Acharya Bhela has also opined that mind is situated inbetween shiras and thalu and according to the modern pharmacology the drug conveyedthrough nose are absorbed rapidly through the mucus membrane and it will give bothlocal as well as systemic effect. 6 Scientist of the institute of medical sciences Delhi have proved after experiments thatthe drug administered through nose shows effective action on the brain, so it can be saidthat there is very close relation between Shirah and Nasa (nose).Thus to understand thepathways of Nasya drug (classical errhine) acting on the central nervous system andmode of action of nasya is- stimulation of vital centers, nourishing the tissues, clearingthe channels, Removes the congestion and correcting the neuro-vascular anomalies, sogiven nasya treatment will help in removing the morbid doshas in shiras and controlsimbalances in vata dosha thereby helpful in motivating the mind.II. To evaluate the effect of ksheerabala taila in chittodvega As chittodvega is a Vata Pradhana Manasika vikara, ksheerabala which ismentioned in Ashtanga hrudaya having the qualities of vatahara, brumhana, and indriyaprasadana was taken to evaluate its efficacy in this study, ksheera bala taila (101)wasused and also to prove its cost effectiveness in the management of chittodvega with outany side effects.III. To evaluate the effect of dhara karma in chittodvega Dhara is one of the main procedures in keraliya Panchakarma7 which ispredominantly used in Manasika vikaras, Anidra, hyper tension etc is taken in this studyto see its effect on chittodvega as it is also a Manasika vikara and also to evaluate the “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 12
  • Objectivesaction of dhara and to decide its cost effectiveness in the management of chittodvega without any side effects The shirodhara therapy is extensively used for the alleviation of many ailments,especially in psychic ailments but used in some of the somatic ailments too. Thoughclinical efficacy of Shirodhara is proved, the nature of its action is very complex.Therefore, to understand the mode of action of Shirodhara is a difficult task. The mind, body and spirit are intimately connected, and shirodhara by calmingthe stressful mind, relaxes the entire physiology. Imbalance of Prana, Udana and VyanaVayu, Sadhaka Pitta and Tarpaka Kapha can produce stress and tension. Siro dhara re-establishes the functional integrity between these three subtypes of Dosha through itsmechanical effect. Sahasrara Chakra is known to be the seat of pituitary and pineal gland.As we know, the pituitary gland is one of the main glands of the endocrine system. Sirodhara stimulates the pituitary gland by its penetrating effect, which helps in bring thehormonal balance. The procedural effect of Shirodhara itself seems to produce a relaxation responseirrespective of the medicament used. In almost all the methods of relaxation like yoga,meditation etc. similar general principles prevail. One involves efforts and concentrationfocusing attention upon a particular object or sensation and the other a simplewatchfulness and observation allowing fine flow of perception.IV. To evaluate the effect of Amalaki Siddha ksheera dhara in chittodvega Ksheera which is having the property of brumhana, jeevaneeya, and balyaproperty is taken as base and along with that amalaki which is having the properties like “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 13
  • Objectivestridoshahara, vrishya is taken as ingredient for dhara in this clinical trail to evaluate itseffect in case of anxiety disorders and also the amalaki is having the anxiolytic activityaccording to modern and is also a proven drug in case of depression and anxietymanagement. The Pharmacological studies of the drug also establish it as anxiolytic antidepressant and neuro tropic drug. The study is a simple randomized pre-post test single group clinical observationTrial where the effect of Ksheerabala Taila Nasya and Amalaki Siddha Ksheera Dhara isadministered to pacify the doshas in Chittodvega is combined. In this attempt the patientsare administered the designated medicaments and therapeutic procedures for 27 days andMuscle tension, Fatigue, worry, Insomnia etc., are observed up to 27 days. Thus thecombined effect of Nasya Karma and Ksheera dhara are established by Subjective andobjective parameters. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 14
  • Review of nasyaLITERATURE This chapter deals with historical aspects, Nidana, Purva roopa, Roopa, Samprapti,Chikitsa of chittodvega from different classics under two headings.1. Historical review2. Disease reviewHistorical Review of nasya and Dhara (A) Historical review of Nasya:DESCRIPTION OF NASA IN VEDA Rigveda: There is indication of a word Nasa in a Mantra “Yen Ygnasta yala sapla …………..” Yajurveda: While describing the Indriyas, there is mention of two Netra, two Karna, two Nasika Chhidra and Jihva. Atharvaveda: Nasa is described among nine chhidras and Indriya. “Ashtachakra, Navadwara…….” “Shirshaklima shirshamayana ………..” Bhagvad Gita: While describing Indriyas, the Nasa is mentioned. “Navadvara Purva dehi neva …….” “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 15
  • Review of nasyaDESCRIPTION OF NASYA IN ANCIENT TEXTSRigveda: There is a mantra in Rigveda in which eradication of Roga is mentioned byroutes of Nasa (Nostrils), Chibuka (Chin), Shira (Head), Karna (Ear), and Rasna(Tongue). This can be considered as a primitive picture of Nasya Karma.Krishna Yajurveda, Shatpatha Brahmana, and Upanishad: In these texts, the termNasya Karma has been used frequently.Ramayana: In Valmiki Ramayana, when Laxman became unconscious by the blow ofMeghanada, Vaidya Sushena administered the juice of Sanjivani through nasal routeBringing him to consciousness instantaneously.Bauddha Kala: “Jeevaka” the famous Vaidya of Bauddha kala had utilized Nasyakarma in many cases such as1) In Shirahshoola, he prescribed Nasya of medicated ghrita to the wife of Shreshthiof Saketa Nagar.2) Once, when Jeevak wanted to give Virechana to Lord Buddha, he gave himAushadhi by nasya for Virechana.Vinaya Pitika : In this book, it is mentioned that one utpala hasta of Nasya has potencyto induce 10 Vegas of Virechana.Samhita Kala: Literature written during this period is the heart of ayurvedic literature.In all the Samhita, Nasya karma has been elaborately described especially in CharakaSamhita, Sushruta Samhita and Ashtanga Samgraha. The research conducted on thistherapy was at such a height that it was used to achieve expected sex of foetus. Nasyakarma is utilized in treatment of many diseases in Brihattrayi such as in Charaka, inchikitsa of Jwara, Raktapitta, Kustha, Rajyakshama, Unmada, Apasmara, Shwayathu, “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 16
  • Review of nasyaHikka, Shvasa, Kasa, Visha, Trimarmiya, Vata vyadhi, Trimarmiya siddhi etc,. InSushruta Samhita, in Chiktisa of Dwivraniya, Sadyovrana, Bhagandar, Vata Vyadhi,Mahavata Vyadhi, Kustha, Udara, Granthi, Apachi, Arbuda ganda, Vriddhi, Upadamsha,Shlipada, Kshudra Roga, Mukha Roga etc, . In Ashtanga Hridaya, in Chikitsa of Jwara,Raktapitta, Shvasa Hikka, Rajyakshama, Chhardi, Hridaroga, Trishna, Madatyaya,Shvitra, Krimi, Vata Vyadhi etc,Nasya:Etymology of nasya: • The word Nasya is derived from ‘Nasa’ Dhatu. In Ayurvedic texts, Nasa Dhatu is used in the sense of nose. • In Sanskrit language each word is derived from a specific dhatu and each dhatubears an inherent meaning which is the crux of the word. The derivation of the word Nasya is from “Nasa” dhatu. It conveys the sense ofGati – motion. Vyapti bears the meaning pervasion. Here, the Nasa dhatu is inferred insense of nose. According to Vachaspatyam word “Nasata” means beneficial for nose. In context of Ayurveda, the word Nasya suggests the nasal route foradministration of various drugs. As per Acharya Sushruta, administration of medicine ormedicated oils through the nose is known as Nasya. Arunadatta and Bhavaprakashaopines that all drugs that are administered through the nasal passage are called Nasya.Sarangadhara and Vagbhata also hold the same view.Synonyms:• Prachchardana• Shirovirechana “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 17
  • Review of nasya• Shirovireka• Murdhavirechana• Navana• Nastaha Karma Amongst the various synonyms of Nasya karma Shirovirechana, Shirovireka andMurdhavirechana are suggestive of elimination of Doshas from the Shira or parts situatedabove the clavicle i.e. Prachchardana, whereas the terms Nastaha and Navana indicatessite of administration.DEFINITION OF NASYA: In Ayurveda, the word Nasya has been taken specifically to mention the route ofadministration of drugs. All these synonyms indicate that this is a procedure whicheliminates vitiated humors from ShirasCLASSIFICATION OF NASYA: Nasya is classified in various ways by different Acharya. It is mainly classifiedaccording to its mode of action i.e. Shodhana, Shamana, etc and on the basis ofVarious forms of drugs preparation utilized for the Nasyakarma e.g. Churna, Sneha etc. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 18
  • Review of nasyaClassification According To CharakaFigure no: 1. showing the classification of nasya according to Charaka NASYANavana Avapidana Dhmapana Dhuma PratimarshaSnehana shodhana Prayogika Sneihika Virechanika Shodhana sthambana Snehana virechanaThe above mentioned five types of Nasya are regrouped according to their functioninto three groups viz. – Rechana, Tarpana and Shamana.8Charaka has also mentioned 7 types of Nasya according to partsof the drugs to beused in Nasyakarmna via – Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twaka.9Classification of Nasya according to Sushruta:According to Sushruta Nasya is also of 5 types Viz. Nasya, Avapida, Pradhamana,Shirovirechana and Pratimarsha. These 5 types of Nasya are further classifiedaccording to their functions into two groups’ viz. Shirovirechana and Snehana.Shirovirechana, Avapida and Pradhamana are used for the elimination of morbidDosha from Shira, Pratimarsha and Nasya type may be used for Snehana.10 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 19
  • Review of nasyaFigure no: 2. showing the classification of nasya according to Sushruta: Nasya Shirovirechana snehanaShirovirechana Pradhamana Avapida Nasya PratimarshaCLASSIFICATION ACCORDING TO VAGBHATA Ashtanga Samgraha has mainly classified Nasya into three types depending up ontheir function viz. Virechana, Brimhana and Shamana. Snehana and Brimhana Nasyahave been further subdivided according to the doses into two groups i.e. Marsha andPratimarsha.Figure no: 3. showing the classification of nasya according to Vagbhata NASYA Virechana Brimhana Shamana Pradhamana Murdha Pratimarsha Marsha Avapida VirechanaCLASSIFICATIONS ACCORDING TO KASHYAPA According to Kashaya Samhita Nasya has classified into two groups i.e. Brimhanaand Karshana. These two types are also known as (1) Shodhana and (2) Purana Nasya. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 20
  • Review of nasyaCLASSIFICATION OF NASYA ACCORDING TO SHARANGADHARA: Sharangdhara11, 12, 13 has also classified Nasya according to the functions into twogroup’s viz. Rechana and Snehana. Rechana Nasya is further subdivided into Avapidaand Pradhamana. Snehana Nasya is subdivided into Marsha and Pratimarsha.Bhoja has classified two types of Nasya, Viz - Prayogika and Sneihika.14Classification of Nasya according to preparations1. Navana Nasya:Nasya Karma. Nasya which is administered by instilling the drops of medicated oilor Ghrita in the nose. Charaka15 has described Pranadi (pippet or dropper) for itNavana is generally the Sneha Nasya and is known as Nasya in general. It can bemainly classified into Snehana and Shodhana Nasya.Navana is again classified into two snehana and shodhanaSnehana nasya: As the word Sneha suggests, Snehana Nasya gives strength to allthe Dhatus and is used as Dhatuposhaka SNEHA NASYA MATRATable No.1 Showing the Sneha nasya Matra.Hina Matra 8 drops in each nostrilMadhyama Matra 16 drops in each nostrilUttama Matra 32 drops in each nostrilBenefits of Sneha Nasya It is used for the oiling in the feeling of head lightness. It gives strength to neck,Shoulder and chest and increases eye sight. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 21
  • Review of nasyaShodhana Nasya: Sushruta’s Shirovirechana type is included in Shodhana type of NavanaNasya. It eliminates the vitiated Doshas. In this type of Nasya, oil prepared byShirovirechana Dravyas like Pippali, Shigru etc. can be selected.Matra: It can be given in following dosage schedule according to Sushruta 16. Shodhana Nasya MatraTable No.2 Showing the Shodhana Nasya matra Uttama matra 8 drops Madhyama matra 6 drops Hina matra 4 dropsTime schedule:Navana Nasya should be administered according to the following timeSchedule. 17(i) In Kaphaja Roga: Fore noon(ii) In Pittaja Roga: Noon(iii) In Vataja Roga: After NoonTime schedule of nasya according to different RutusIn healthy persons Navana Nasya should be given according to the following Ritu(i) Shita Kala: Noon(ii) Sharad and Vasanta: Morning(iii) Grishma Rutu: Evening “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 22
  • Review of nasya(iv) Varsha Rutu: Only when sun is visible.2. AVAPIDA NASYA: 18The which is Nasya given by expressed juice of leaves or paste (kalka) ofrequired medicine (Chakrapani).Avapeedana nasya matraTable No.3 Showing the Avapeedana Nasya matra Uttama matra 8 drops Madhyama matra 6 drops Hina matra 4 drops3. DHMAPANA NASYA:The nasya in which choorna is inhaled by nasal passage with the help of nadi yantraThe Choorna (fine powder) of required drug is kept at one end, and air is blown fromthe other end, so that the medicine may enter into the nostrils19.Matra of Dhmapana nasya:According to Videha the matra of Dhmapana Nasya is three Muchuti (3 pinch).For the Pottali method Churna should be at least 2 Tolas i.e. 20 gms. GenerallyTikshna Dravyas are used for this type of Nasya. Hence cautions should be takenduring its administration.4. DHUMA NASYA:The nasya in which the medicated fumes are inhaled through nasal route andeliminated by oral route 20. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 23
  • Review of nasyaMatra • Habitual smoking twice • Once for Snaihika Dhuma (Unctuous • Three to four times for the Vairechanic Dhuma. • For Prayogika Dhuma drugs like Priyangu, Ushira etc. should be used. • For Snaihika Dhuma Vasa, Ghrita etc. • ForVirechanic Dhuma, drugs like Aparajita, Apamarga etc. should be used.215. MARSHA – PRATIMARSHA NASYA Introduction of oils into the nostril is in case of Marsha and pratimarsha but themain difference between them is the matra. In Pratimarsha Nasya 1-2 drops are givenwhile in Marsha Nasya the dose is 6 to 10 DropsPratimarsha Nasya: Pratimarsha Nasya can be given daily irrespective of the season and it can begiven in morning and evening it is given by dipping the finger in the required Sneha andthen dropping it in the nostrils.Marsha:It is also installing of medicated sneha into the nostril only difference is in the case ofMatra, in this 6 to 10 drops of Sneha will be instilled into the nostril. And it is more 22Effective than pratimarsha .Classification of Nasya according the action:Charaka and Vagbhata have classified Nasya into 3 groups according to theirPharmacological action, viz.(i) Rechana (Virechana) means purificatory, “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 24
  • Review of nasya(ii) Tarpana (Brimhana) means nourishing and(iii) Shamana (retraining) 23 24Sushruta and Sharangdhara have omitted Shamana from this classification and dividedNasyakarma into only two groups, Viz; Shirovirechana and Snehana.Kashyapa stated Brimhana and Karshana types of Nasya and Acharya Videha describedtwo types of Nasyakarma according to their pharmacological action i.e.Sangyaprabodhana and Stambhana. All these types can be included into the Classificationof Charaka.Rechana nasya:The Rechana Nasya denotes to eliminations of vitiated Doshas from Shiras. Choornasor the sneha prepared with Shiro virechaneya drug are commonly used for this25.It can also be given with Tikshana, Sneha, Kwatha or Svarasa of Shirovirechanadrugs or by dissolving these drugs in Madhya, Madhu, Saindhava, Asava, Pitta andMutra or mixed with the drugs specific for that diseases.2. TARPANA NASYA:Acharya Charaka explained tharpana nasya, acharya susrutha and sarangadharaexplained snehana, bramhana nasya by Acharya Vagbhata all these can be consideredas the synonyms of each other. The Sneha prepared out of Vatapittahara drugs shouldbe used and the drugs of Madhura Skandha 26 27may also be employedAccording to Vagbhata, Sneha prepared with Snigdha and Madhura drugs or withthe drugs described useful for that particular disease should be used. Exudations ofcertain trees, meat soup and blood also may be administered. 28 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 25
  • Review of nasya3. SHAMANA NASYA: It is used for the alleviation of Dosha situated in Shirah (head). Shamana Nasyahas been described by Charaka and Vagbhata only. It may be correlated with Snehanaand Marsha-Pratimarsha. The Sneha prepared with the beneficial drugs may be used forShamana NasyaTable No.4 Showing the Contra Indications of NasyaSi.no: Nasya anarhas Charaka Sushruta Vagbhata1 Bhuktabhakta + + +2 Ajirni + + -3 Pita Sneha + + +4 Pita Madhya + + +5 Pita Toya + + +6 Snehadi Patukamah + - +7 Snatah Shirah + - +8 Snatukamah + + +9 Kshudarta + - +10 Shramarta + + -11 Matta + - -12 Murcchita + - -13 Shastradandahrita + - -14 Vyavayaklanta + - -15 Vyayamaklanta + + -16 Panaklanta + - -17 Navajvara Pidita + - - “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 26
  • Review of nasya18 Shokabhitapta + - -19 Virikta + - +20 Anuvasita + + +21 Garbhini + + +22 Navapratishyayarta + - -23 Apatarpita - + +24 Pitadravah - + +25 Trishnarta + + +-26 Gararta - + +27 Kruddha - + -28 Bala - + -29 Vriddha - + -30 Vegavarodhitah - + +31 Raktasravita - - +32 Sutika - - +33 Shvasapidita - - +34 Kasapidita - - +Indications of Nasya: Nasya therapy may be given in all diseases except in the conditions mentionedearlier. The specific indications of Tarpana Nasya, Shodhana Nasya, Shamana Nasya,Shirovirechana, Navana, Avapida, Dhmapana and Dhuma Nasya etc. have alreadybeen discussed in the classification of Nasya, but Charaka had described the followinggeneral indications where Nasya therapy should be used. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 27
  • Review of nasya1. Shirostambha 18. Mukharoga2. Manyastambha 19. Karnashula3. Danta Stambha 20. Nasa Shula4. Danta Shula 21. Akshi Shula5. Hanugraha 22. Shirahshula6. Pinasa 23. Ardita7. Galashundika 24. Apatantraka8. Galashaluka 25. Apatanaka9. Shukra Roga-Netragata 26. Galaganda10. Timira 27. Danta Harsha11. Vartmaroga 28. Danta Chala12. Vyanga 29. Raji-Netra Roga13. Upajihvika 30. Arbuda14. Ardhavabhedaka 31. Svarabheda15. Griva roga 32. Vaggraha16. Skandharoga 33. Gadgadatva17. Ansashula 34. Krathana …etc.Course of Nasya Karma :Nasya Karma may be given for seven consecutive days. In conditions like Vata Dosha inhead, hiccough, torticolitis, loss of voice etc. it may be done twice a day (in morning andevening 29 The use of Nasya on 3rd, 5th, 7th and 8th day or till the patient shows thesymptoms of Samyak Nasya as stated in Ashtanga Samgraha30 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 28
  • Review of nasya Bhoja says that if Nasya is given continuously beyond nine days then it willbecomes Satmya (adaptable) to patients and if given further, it neither benefits nor harmto the Patients. According to Sushruta, Nasya may be given repeatedly at the interval of 1, 2, 7and 21 days depending upon the condition of the patient and the diseases he suffer 31 Charaka has not mentioned specific duration of the Nasya therapy, but suggestedto give according to the severity of disease.Dose of Nasya Karma: The dose of Nasya drug is depends upon the drug utilized for it and the variety ofthe Therapy. Charaka has not prescribed the dose of the Nasya. Sushruta and Vagbhatahave mentioned the dose in form of Bindus, here one Bindu means the drop which isformed after dipping the two phalanges of Pradeshini finger.32Drops in each nostrilTable No.5.Showing Nasya Matra. Si.no: TYPES OF NASYA Hrasva Madhyama Uttama Matra Matra Matra 1. Shamana Nasya 8 16 32 2. Shodhana Nasya 4 6 8 3. Marsha Nasya 6 8 10 4. Avapida Nasya 2 2 2 5. Pratimarsha Nasya 2 2 2 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 29
  • Review of nasyaAccording to Videha: The common dose for Pradhamana Nasya is 3 Muchuti (here one Muchuti = theChoorna which may come in between Index finger and thumb = 2.4 Ratti.)Sharangdhara33 described the following dosage schedule for Nasya Karma.• Tikshnaushadhi Choorna - 1 Shana (4 masha) (24 Ratti)• Hingu – 1 Yava (½ Ratti)• Saindhava – 1 Masha (6 Ratti)• Dugdha – 8 Shana (64 Drops)• Jala (Aushadha Siddha) – 3 Karsha (3 Tola)• Madhura Dravya – 1 Karsha (1 Tola)Administration of Nasya:The procedure of giving Nasya therapy may be classified into the following threeheadings:1. Purvakarma (Pre-measures)2. Pradhanakarma (Nasya therapy)3. Paschatkarma (Post measures)Purvakarma: Before giving Nasya, prior arrangement of the material and equipmentsshould be done. There should be a special room “Nasya Bhavana” free from direct blow 34of air and dust; and lighted appropriately . In it the following articles should becollected.(i) Nasya Asana – (a) A chair for sitting purpose. (b) A cot for lying purpose.(ii) Nasya Aushadhi – Drugs required for the nasya karma should be collected “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 30
  • Review of nasyain the form of Kalka, Choorna, Kwatha, Kshira, Udaka, Sneha, Asava, Dhuma etc.insufficient quantity.(iii) Nasya Yantra - For Snehana, Avapida, Marsha and Pratimarsha Nasya, thereshould be a dropper or Pichu. For Pradhamana Nasya Shadangula Nadi and specififDhuma yantra for Dhuma Nasya are required. Besides this one needs efficient assistant,Dressing material, spitting pots, bowl, napkins and towels also. • Selection of the patient: The patient should be selected according to the indications and contraindications of Nasya described in classics. • Preparation of patient: According to Sushruta’s description following regimens are given to the patient to prepare him for Nasya Karma. Diet should be given to the patient who has passed his natural urges like urine,stool etc. After some time tooth brush (and other routine daily activities like bath, prayer,light breakfast (not feel hungry) etc.) Should be done. Now the patient gets ready forNasya karma. He should lie down on Nasya Shayya. Before Nasya, Mridu AbhyangaShould be done on scalp, forehead, face and neck for 3 to 5 minutes by medicated oillike Bala Taila, Panchaguna Taila etc.34 35 Snehapana should not be given immediately before Nasyakarma According toAyurvedic texts Svedana is contra indicated in Shiras. Mrudu Svedana may be given forelimination of Doshas and liquefaction of Doshas. Tapa Sveda may be given on Shira, Mukha, Nasa, Manya, Griva and Kantharegion. Cloth dipped in hot water may be useful for Mrudu Sveda. After Svedana smoothmassage should be applied on regions of Gala, Kapola and Lalata. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 31
  • Review of nasya 36 37 382) Pradhana Karma : As described by Charaka Vagbhata and Sushruta thefollowing procedure should be adopted for performing the nasya karma.Nasya Karma. The patient should lie down in supine position with ease and head should belowered i.e. hanging down slightly and foot part is to be slightly raised. Head should notbe excessively flexed or extended. If the head is not lowered, the nasal medication maynot reach to the desired distinction and if it is lowered too much, there may be the dangerof getting the medication to be lodged in brain. After covering the eyes with clean cottoncloth, the physician should raise the tip of the patient’s nose with his left thumb and withthe right hand the luke warm medicine (Sukhoshna drug) should be dropped in both thenostrils in proper way.39.The drug should be neither less nor more in the dose i.e. it should be in the properquantity. It should also be neither very hot nor very cold. i.e. it should be luke warm.The patient should remain relaxed while taking Nasya. He should avoid speech,anger, sneezing, laughing and head shaking during Nasya Karma. 403) Paschat Karma: 41 42 43 As described by Charaka Ashtanga Hridaya and Sushruta followingregimen should be followed. After administration of medication through nasal passagepatient should lie supine (Uttana) for about 2 minute time interval consumable for “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 32
  • Review of nasyacounting numbers upto 100. After the administration of Nasya feets, shoulders, palms and 44ears should be massaged . The head, cheek and neck should be again subjected tosudation. The patient should avoid swallowing of Nasya Aushadhi. The oil that has beendropped in the nose may be repeatedly drained out together with the morbid Doshas,specially mucous; should be eliminated by the patient by sneezing slowly and care shouldbe taken that no portion of the medicated oil is left behind 45.Patient should spit out theexcessive medicine which have come into the oropharynx 46.Medicated Dhoomapana and Gandusha are advocated to expel out the residue mucouslodged in gullet (Kantha) and Shringataka. Patient should stay at windless place. Light 47meal (Laghu Aahara) and luke warm water (Sukhoshna Jala) is allowed . One shouldavoid dust, smoke, sunshine, alcohol, hot 48bath, riding, anger, excess fat and liquid diet . Day sleeping and cold water for anypurpose like Pana, Snana etc. should be avoided after Nasya Karma 49.SAMYAKA YOGA, AYOGA AND ATIYOGA OF NASYA KARMA: After Nasya Karma the symptoms of its Samyaka yoga, Ayoga and Atiyogashould be observed, which are being described here after.Samyaka Yoga : The symptoms of adequate Nasya according to Charaka, are Urah-shiro-laghavaIndriyavishuddhi and Srotovishuddhi50. In addition, Sushruta has described.Sukhasvapna-prabodhana , Chitta-Indriyaprasannata (mental and sensorial happiness) andVikaropashama (Improvement). Besides these proper respiration and sneezing have beendescribed by Vaghbhatta 51 as the general symptoms of Samyaka Yoga of Nasya Karma. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 33
  • Review of nasyaTable No.6 Showing the Samyak Yoga Lakshanas of NasyaSi.no Symptoms Cha. Su.Chi A.H.S Sa.U.K B.P Ka. Bh1. Urah Laghuta + - - - + - -2. Shiro Laghuta + + - - - - -3. Netra Laghuta - - + + - + -4. Laghuta + + - + - -5. Srotovishuddhi + + - + + + -6. Svaravishuddhi - + + - - - -7. Vaktravishuddhi - - + - - - -8. Indriyaachchta- + + - + + + + prasada9. Netrateja - + + - - - Vriddhi10. Chitta Prasada - + - + + + +11. Vikaropashama - + - + + - +12. Sukha Svapna - + + - - - - Prabodha13. Sukhachchvasa - + - - - - -14. Arati - - - - - - +15. Medha - - - - - - +16. Bala - - - - - - +Ayoga: If Nasya is not administered properly or if the dose is less in proper way or thedose is less, then it will cause certain complications. The Acharya has mentioned thefollowing general complications. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 34
  • Review of nasyaTable No.7 Showing the Ayoga Lakshanas of Nasya. Symptoms Cha. Su.Ch A.H.S Sa.U. B.P Ka. Bh Si1 Shirogaurava & + - - + + + + Dehagaurava2 Galopalepa + - - - - - +3 Nishthivana + - - - - - +4 Kandu - + + + + - -5 Kaphapraseka - - - - - - -6 Upadeha + - + + - - -7 Rukshata + - - + + + -8 Vata Vaigunya + - - - - - -9 Srotoriktata - - - - + - -10 Srotasam + - - + + + - kaphasrava11 Nasa shosha - + - - - -12 Asyashosha - + - - - - -13 Akshistabdhata - + - - - - -14 Shiroshunyata - + - - - - -15 Vyadhi Vridhdh - - - - - + -Atiyoga :Atiyoga of nasya also caused due to the improper administration .it is mainly due tothe ati matra of the drug or excessive potency of the medicine. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 35
  • Review of nasyaTable No.8 Showing the Atiyoga Lakshanas of Nasya Symptoms Cha. Su.Ci A.H.S Sa.U. B.P Ka. Bh Si u K1. Shirogaurava - + + + + - -2. Shiroshunyata - + - + + - -3. Shirovedana + - - - - + -4. Netra Vedana + - - - - - -5. Shankhavedana + - - - - - -6. Suchitodavata + - - - - - - Pida7. Indriya - + - + + + - Vibhrama8. Mastulungaaga - + - - - - - ma9. Snehapurna - - - - + - - Srotasa10. Karna Talu - - - - - - - Upadeha11. Vata Vriddhi + - - - - + +12. Kandu - + - - - - -13. Praseka - + + + - - -14. Pinasa - + - - - - -15. Aruchi - - + - - - -16. Deha Daurbalya - - - - - + - “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 36
  • Review of nasya17. Unmada - - - - - - +18. Pitta Vriddhi - - - - - - +19. Hridaya Shula - - - - - - +20. Suryavarta - - - - - - + Roga21. Atripti - - - - - - +Vyapada (Complications): The patients after taking the Nasyakarma if does not follow the regimen givenabove then the Prakopa of Dosha may again occur leading to many complications whichmay be known as Vyapada 52. Many complications of Nasya Karma may occur due to(i)administration of Nasya when it is contraindicated and (ii) due to technical failure.These complications occur through following two modes.(a) Doshotklesh which can be, managed by Shodhana and Shamana Chikitsa and(b) Dosha Kshaya which has to be managed byBrimhana Chikitsa 53 If Nasya is given in the contraindicated conditions like Ajirna, Bhuktabhakta,Jalapita etc. or in season or time where Nasyakarma is contraindicated e.g. cloudyatmosphere, then there is possibility of production of Kapha Rogas like asthama, cough,sinusitis and indigestion etc. In such conditions, the treatment should be done withKapha-nashaka Upachara like use of Ushna and Tikshna Aushadha andKarma 54.Mode of action of Nasya Karma : The clear description regarding the mode of action of the Nasya Karma is notavailable in Ayurvedic classics. According to Charaka, Nasa is the portal (gate way) “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 37
  • Review of nasyaof Shirah 55. The drug administered through nose as Nasya reaches to thebrain and eliminates only the morbid Doshas responsible for producing the disease. InAshtanga Samgraha it is explained that Nasa being the gate way to Shira (heard), thedrug administered through nostrils, reaches Shringataka (a Sira Marma by Nasa Srotaand spreads in the Murdha (Brain)) taking route of Netra (eye), Shrotra (ear), Kantha(throat), Siramukhas (opening of the vessels) etc. and scratches the morbiddoshas in supra clavicular region and extracts them from the Uttamanga56. Sushruta has clarified Shringataka Marma as a Sira Marma formed by the unionof Siras (blood vessels) supplying to nose, ear, eyeand tongue. It has been furtherpointed out that injury to this Marma maybe fatal immediately 57. Commentator Indu of Ashtanga Samgraha opined Shringataka as the inner side ofmiddle part of the head i.e. Shiraso Antarmadhyam.Under the complications of NasyaKarma Sushruta noted that the excessive eliminative errhine may cause Mastulunga(Cerebro spinal fluid) to flow out to the nose 58. According to all Acharya Nasa is said to be the portal of Shira. It does not meanthat any anatomical channel connects directly to the brain but it might be connectedPharmacodynamically through blood vessels or through nervous system (olfactorynerve etc.) It is an experimentally proved fact that where any type of irritation takesplace in any part of the body, the local blood circulation is always increased. This isthe result of natural protection function of the body. Something happens whenProvocation of Doshas takes place in Shirah due to irritating effect of administereddrug resulting an increase of the blood circulation of brain. So extra accumulatedmorbid Doshas are expelled out from small blood vessels and ultimately these morbid “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 38
  • Review of nasyaDoshas are thrown out by the nasal discharge, tears and by salivation. The anatomical point of view there is no such direct pharmacodynamicconsiderations between nose and cranial organs. Moreover blood brain barrier is a strictsecurity system that human brain has. The nose is used as a route of drug administrationfor inhalation of Anesthetic materials and certain decongestants for Para nasal sinusitis.Anterior Pituitary hormone nasal spray is in practice with modern medical system. Nasaladministrations of leutinising hormone and calcitonin are found to be equally effective asintravenous infusions in maintaining blood concentrations. Michael Russell (1977) hasobserved that perspired scent that has been painted on the upper lips has caused thesynchronization of the menstrual cycle in female volunteers by contact smelling. An LRHagonist nasal administration for 3-6 months was observed effective in inhibitingovulation as a contraceptive measure .The drugs are mostly believed in these Cases to beabsorbed through nasal and pharyngeal mucosa. Anand (1979) has also attemptedcontraceptive opined that the route is beneficial than systemic. Samgraha opined Shringataka as the inner side of middle part of the head i.e.Shiraso Antarmadhyam. Under the complications of Nasya Karma Sushruta noted thatthe excessive eliminative errhine may cause Mastulunga (cerebro spinal fluid) to flow outTo the nose. According to all Acharya Nasa is said to be the portal of Shira. It does notmean that any anatomical channel connects directly to the brain but it might be connectedpharmacodynamically through blood vessels or through nervous system It is an experimentally proved fact that where any type of irritation takes place inany part of the body, the local blood circulation is always increased. This is the result ofnatural protection functions of the body. Something happens when provocation of “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 39
  • Review of nasyaDoshas takes place in Shirah due to irritating effect of administered drug resulting anincrease of the blood circulation of brain. So extra accumulated morbid Doshas areexpelled out from small blood vessels and ultimately these morbid Doshas are thrownout by the nasal discharge, tears and by salivation. The anatomical point of view thereis no such direct pharmacodynamic consideration between nose and cranial organs.Moreover blood brain barrier is a strict security system that human brain has. Thenose is used as a route of drug administration for inhalation of anesthetic materialsand certain decongestants for paranasal sinusitis. Anterior pituitary hormone nasalsprays are in practice with modern medical system. Nasal administrations of leutinisinghormone and calcitonin are found to be equally effective as intravenous infusions inmaintaining blood concentrations. Michael Russell (1977) has observed that perspired scent that has been painted onthe upper lips has caused the synchronization of the menstrual cycle in female volunteersby contact smelling. An LRH agonist nasal administration for 3-6 months wasobserved effective in inhibiting ovulation as a contraceptive measure. The drugs aremostly believed in these cases to be absorbed through nasal and pharyngeal mucosa.Anand (1979) has also attempted contraceptive opined that the route is beneficial thansystemic administration. It was claimed that the concentration of drug in C.S.F was veryhigh to that when administered intravenously. An experimental study on the inhibiting effect of Jasmine flowers on lactationwas also carried out by fragrance inhalation method proving beneficial on rats (Abraham1979). Reduction in gland activity and reduction in serum prolactin was also noted.Hypoglycaemic effects of insulin and hyperglycaemic effects of glucagons hormone “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 40
  • Review of nasyaare confirmed by intranasal administration in normal and in diabetic patients .Intranasalgonadotropin hormone releasing hormone has been therapeutically recommended instimulating leutinising hormone secretion in cryptorchid boys. i.e. having undescendedtestis. Scientist of the institute of medical sciences Delhi have proved after experimentsthat the drug administered through nose shows effective action on the brain, so it can besaid that there is very close relation between Shirah and Nasa (nose).Thus to understandthe pathways of Nasya drug (classical errhine) acting on the central nervous system, it isimportant to go in details of the modus operandi of Nasyakarma. On the basis offractional stages of the Nasya karma procedures, we can draw certain rational issuethat are as follows :Effect on drug absorption and Transportation : Keeping the head in lowered position and retention of medicine in nasopharynxhelp in providing sufficient time for local drug absorption. Any liquid soluble substancehas greater chance for passive absorption directly through the cell of lining membrane.On other hand, massage and local fomentation also enhances the drug absorption (Fingl.1980).The later course of drug transportation can occur in two ways.(i) By systemiccirculation (ii) Direct pooling into the intracranial region. The second way is more ofinterest in our present study. This direct transportation can be assumed again in twopaths, viz.(a) By vascular path, (b) Lymphatic path. Vascular path transportation is possible through the pooling of nasal veinal bloodto the facial rein, which naturally occurs. Just of the opposite entrance the inferior “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 41
  • Review of nasyaOphthalmic veins also pool into the facial vein. Interestingly, both facial andOphthalmic veins have no venial valves in between. So that, blood may drain oneither side, that is to say the blood from facial vein can enter cavernous venous sinusof the brain in reverse direction. Thus, such a pooling of blood from nasal veins toVenous sinuses of the brain are more likely in the head lowered position due to gravity.On this lines, the absorption of drug materials into meninges and related parts ofIntra cranial organs, is a worth considering point. Moreover the modern scholars havenoted that the infective throbosis of the facial vein may lead to infection of themeninges easily through this path Pooling of blood from Para nasal sinuses also possiblein the same manner. Vagbhata’s notation of Shringataka Srotas (anterior cranial fossa) seems torelation with the above explanation. Drug transportation by lymphatic path, can reachdirect into the C.S.F. it is known that the arachnoid matter sleeve is extended to the submucosal area of the nose along with olfactory nerve. Experiments have shown that thedye injected to arachnoid matter has caused colouration of nasal mucosa within secondsand vice versa also (Hamilton 1971). Preliminary studies reported from AIMS. Laboratories clearly showed thatsteroids enter the C.S.F. rapidly following their Administration as a nasal spray.Surprisingly their levels in the C.S.F was found to be much higher as compared withsystemic injections On the basis of the foregoing observations it can be stated that the procedures,Postures and conducts explained for Nasya Karma are of vital importance in drugabsorption and transportation. The facts discussed here are also convincing about the “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 42
  • Review of nasyaDefinite effect of Nasyakarma in the disorders of central nervous system, mental andSome endocrinal disturbances also. Such type of description – mode of actions mentionedonly in Ayurveda, modern sciences try to use of Nasya Karma but in comparison of theAyurveda. The effect of Nasya not found till today.Nasya Karma as per the opinion ofAyurvedic texts, not only the treatment of the disease but, many types of Nasya Yogadescribed in Ayurveda for maintenance of healthy life. Pratimarsha Nasya Karma can beused in all age group, so one can assess the importance of the Nasya Karma. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 43
  • Review of DharaHistorical Review of Dhara:Etymology:The word Dhara is derived from the root ‘Dhru’ with the suffix ‘Nich + Ang + Tap’ andis feminine gender.Derivation of Dhara:1) Dharyate Yaya2) Dharyante Tatra Anaya3) Ghatadi Chhidra Santatam Drava, Dravyasya Santatya Patane (Shabdastoma Mahanidhi).It means a continuous flow of liquid from the hole of the pot.Synonyms:•Dhara•Seka• Parisheka•Avasheka•Sechana – Sinchana•PrasechanaSHIRODHARA Shiro dhara otherwise called murdha dhara is one of the special type of treatmentand is also known as component of keraliya Panchakarma.In classics there is not muchreferences regarding Shiro dhara only casual references are available the detaileddescription of dhara karma is mentioned in Dharakalpa a book on keraliya Panchakarmabut the original authorship of which is not known. The manuscript first available in “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 44
  • Review of DharaMalayalam published through ayurvediya granthamala of Bombay rewriting it inSanskrit. the same is republished with hindi commentary of shukla j.p (1980) throughsudhanidhi granthavali. The same verse of dhara karma is also available in sahasrayoga.Pouring of a liquid on the forehead or scalp is known as the Shirodhara, it can be done bydifferent medicaments like Taila, Takra, Kshira, Kwatha, etc Gunaprada When it donewith ksheera it is called ksheera dhara, with jala it is called jala dhara and with thakra it isCalled thakra dhara’. When it is done with medicated Ghee or Taila, it is called TailaDhara This Taila Dhara is included in the varieties of Murdha Taila, which areAbhyanga, Seka, Pichu and Basti. They are told ‘Uttarottar. Dhara is not only used inPsychic disease but also used in psychosomatic diseases like IBS (Irritable BowelSyndrome), psoriasis etc.INDICATIONS Shirodhara is one of the allied Panchakarma procedures. It can be applied torejuvenate body and mind alleviating Chintadi Manasika Bhavas, which inducepsychosomatic disorder. Shirodhara calms the mind and relaxes entire physiology thus,helps to alleviate Stress, strain, anxiety etc. By drug specific shirodhara, various diseasescan be dealt with effectively. In the pathophysiology of chittodvega, Vata Dosha ismainly affected and the Kshira is having Shita, Snigdha and Vata-Pitta-Rakta shamakaproperties59. Acharya Charaka has also mentioned Kshira as Shita, Snigdha and Vata-Pitta shamaka60. Moreover, Kshiradhara is also indicated in “Dharakalpa” for psychicconditions like Anidra. Therefore, shirodhara with milk i.e. Kshiradhara has beenselected for present Study. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 45
  • Review of DharaPURVA KARMA: Purva Karma is related with the preparation of the patient. First it should beconfirmed that the patient is fit for Shirodhara or not. Following equipments should beprepared. • Droni (Dhara Table) • Sharawa (Dhara Patra) • Other requirements like cloth piece, cotton, pot etc.It is advisable for the better results that the hair of the patient on the scalp should beremoved if the patient permits. The patient should pass stool and urine. Then patientsPulse, temperature and blood pressure should be recorded.Position of the Patient: Proper posture of the patient for Shirodhara is supine position and Dhara Patrashould be brought 4 inches above his head. The eyes and ears should be covered withcotton so that Liquid may not enter in eyes. His head rests in slightly elevated position,preferably on Wooden piece.Droni: For Shirodhara a special type of table is used and it is known as Droni (vessel).The table is made up of wood with raised edges in all the four side so that the oil may notflow out. In this table arrangement are made at the head end so that the oil poured may becollected in another vessel and may be reused. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 46
  • Review of DharaDimension of Droni: The construction of Droni is explained here by converting the ancientmeasurements into Contemporary one. The length of Droni may be 7 feet breadth 2½feet, the height 2½ feet. On all the sides of the table, 3 inches elevated boundary isconstructed towards the side of the head, 2½ feet one horizontal midline strip of woodmay be constructed, by which Table is divided into 2 parts. This small portion of the tabletowards the head end is used for Shirodhara. In the middle 3 inches from the horizontalline a circular metallic plate of having 6 inches diameter with a central hole may be fixed.This arrangement may be the made to collect the oil in a vessel for its reuse. AboveShirodhara portion of the table, the Dhara Patra should be suspended with the help of astrong wire to enable liquid to fall from the proper distance.Dhara Patra:61 Dhara Patra is a vessel in which liquids used for Shirodhara are put in. It isprepared from Brass, steel, clay etc. The mouth of the vessel should be wide and sides aretapering gradually to a ventral point in the bottom. At this point a hole may be madeapproximately of little finger size. The depth of vessel may be 5 to 6 inches. TheCapacity of the vessel may be 2 Prastha. Inside the vessel a small wooden bowl having aCentral hole should be put inversely so as to both holes of the vessel come in the medialline. In this small vessel a wick should be entered passing through the both holes andhanging down from the big vessel so as to maintain a continuous flow of liquid. The length of the wick outside the vessel should be 4 inches. The upper end of thewick should have knot to prevent slipping from the vessel. The Dhara Patra should behanged just above the forehead of the patient. The end of the wick should be 4 fingers “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 47
  • Review of Dhara(3inches) above the forehead of the patient. The vessel is kept refilled with therecollected liquid. On the upper edge of the vessel, 3 holes should be made to hang it in ahorizontal plane to avoid spillage.Aushadha (Drug): 62 The drug should be selected according to the disease. The quantity required isabove 1 to 2 kg.Sneha mentioned according to the condition of Doshas.Vata Dosha: Tila Taila, Vataghna liquidPitta Dosha: Ghrita, cold waterKapha Dosha: Tila Taila, not very hot, not very cold waterRakta Dosha : Ghrita with cold waterVata + Pitta + Rakta: Ghrita + Taila in equal proportionVata + Kapha + Rakta: ½ part Ghrita + 1 part Tila TailaPRADHANA KARMA The selected liquid should be kept in the vessel and should be pouredcontinuously and slowly on the forehead of the patient. A mild oscillation should begiven. So as to maintain the flow all over the forehead. This liquid gets collected in thevessel, which is kept below the table, when the liquid in the vessel gets emptied, and thenit is replaced from the lower vessel.Dharakalpa: 63 The patient having dryness and Pittayukta Vata, the period is 2½ Prahara or 2Prahara and in Snigdha Kaphayukta Vata it is one Prahara, or it should be up toperspiration Initiate. The patient has to remain in the laying posture on his back. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 48
  • Review of Dhara The treatment may be carried on daily for a period of 7 to 14 days, according tothe nature of the disease and the physical condition of the patient. Generally treatment isdone in the morning hours preferably between 7 to 10 p.m.Period for Changing The Liquid : 64 When milk is used for Parisechana it should be changed every day. WhenDhanyamla is used, it can be used up to 3 days. Oil also should be changed at 3 days. Inthe first 3 days; half of the oil used, for next 3 days later half of its used and on the 7thday all the first and second half are mixed together, then it should be discardedTemperature of the Sneha:It should be Sukhoshna near about to body temperature.65PASHCHAT KARMA After completing Shirodhara the oil from the head should be removed by a pieceof cloth. Then the patient may be advised to drink ghee or medicated ghee according todisease. His eyes should be washed with cold water, he should remove cough. He shouldtake mild wind. He should rest for sometime. Then remaining oil of the Dhara should bemassaged on the body. Then he should take bath with hot water. Then he should takePerfume and light diet and he should drink water, which is Siddha with VatanashakaAushadhi. He should take the hot meal. He should take Pathya up to 7 days. He shouldnot worry about his physical and mental condition. For drinking purpose warm water boiled with Dhanyajiraka, ginger and cumineseeds may be used. For washing and ablating purposes only warm water should be used. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 49
  • Review of DharaPariharyani: The patient should abstain from sexual intercourse as well as from any thought ordeed that may excite sexual desire, avoid physical exertions, mental excitement such asanger, grief etc. and exposure to cold, sun, dew, wind, smoke or dust should also beavoided. Riding on elephants or horses, walking, speaking too long or too loud and suchacting that may give any strain to the system must be avoided. Sleeping during daytimeand standing continuously for long period must also be avoided. It is also advisable to usea pillow which is neither very high nor very low, during sleep at night During the course of the treatment, the patient should be cheerful and happy andshould avoid wearisome exertions, distasteful diet or excessive indulgence in tasty foods.He should wear clean and dry cloths and may have ‘Lepans’ of Sandal wood paste. 66Pariharakala:He should take Pathya and remain as Jitendriya up to the period which is taken for theCompletion of DharakarmaDhara Dosha: If Dhara is done from more height, very early or very slowly then it may produceburning in body, pain in all joints, bleeding tendency, Jwara, Kotha etc.For the treatmentof Dhara Dosha, following measures may be adopted.1) Gandusha2) Nasya3) Kashayapana with Sunthi4) Light diet at evening, Yusha with black pepper.5) On the third day Basti should be given in which Saindhava is mixed. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 50
  • Review of DharaPariharyani: The patient should abstain from sexual intercourse as well as from any thought ordeed that may excite sexual desire, avoid physical exertions, mental excitement such asanger, grief etc. and exposure to cold, sun, dew, wind, smoke or dust should also beavoided. Riding on elephants or horses, walking, speaking too long or too loud and suchacting that may give any strain to the system must be avoided. Sleeping during daytimeand standing continuously for long period must also be avoided. It is also advisable to usea pillow which is neither very high nor very low, during sleep at night During the course of the treatment, the patient should be cheerful and happy andshould avoid wearisome exertions, distasteful diet or excessive indulgence in tasty foods.He should wear clean and dry cloths and may have ‘Lepans’ of Sandal wood paste. 66Pariharakala:He should take Pathya and remain as Jitendriya up to the period which is taken for theCompletion of DharakarmaDhara Dosha: If Dhara is done from more height, very early or very slowly then it may produceburning in body, pain in all joints, bleeding tendency, Jwara, Kotha etc.For the treatmentof Dhara Dosha, following measures may be adopted.1) Gandusha2) Nasya3) Kashayapana with Sunthi4) Light diet at evening, Yusha with black pepper.5) On the third day Basti should be given in which Saindhava is mixed. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 51
  • Review of DiseaseHistrocal Review of Disease: The term chittodvega comprise of two words i.e. chit and udvegaCitta: It is derived from root “Cit” which denotes the following meanings:To perceive, fix the mind upon, attend to, and be attentive, to observe, take notice of,to aim at, intend, to be anxious about, care for, to resolve, to understand, comprehend,know, make attentive, remind of, 67Addition of “Kta” Pratyaya to Cit i.e. Cit + Kta leads to Citta, which hasFollowing meanings according to the two Sanskrit - English dictionaries:- observed, perceived- considered, reflected or meditated upon- resolved- intended, wished, desired- visible, perceptible2) According to the dictionary of Sir Monier Williams:- thinking, reflecting, imagining, thought- intention, aim, wish- the heart, mind- memory, intelligence, reasonUdvega68: It is derived from root “Ud” which has following meanings –- superiority in place, rank or power, up, upwards, upon, on, over, above- separation, disjunction, out off- motion upwards- publicity “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 52
  • Review of Disease- wonder, anxiety- liberation- blowing expanding, opening- acquisition, gainAddition of “Vin” Pratyaya to “Ud” i.e. Ud + Vin leads to Udvega, which has thefollowing meanings:- going swiftly, an express messenger, a runner, courier- steady, composed, tranquil- ascending, mounting, going up or upward- trembling, waving, shaking- agitation, anxiety- regreat, fear, distress- admiration, astonishmentTerms References;Ayurvedic classics has mentioned many words related to mental status, which are asfollows:TermsCittavibhramsha (mental decadence) 69, 70, 71Cittavibhrama (mental perturbation) 72Cittanasha (loss of conscious) 73Cittakshobha (mental agitation) 74, 75Cittaviparyaya (misapprehension of mind) 76Cittavilobhana (mental seduction) 77 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 53
  • Review of DiseaseCittopaplava (mental adversity) 78, 79Asvastha Citta (mental discomfortness) 80, 81Anavasthita Citta (unstable mind) 82Tapta Citta (anger mind) 83 84Unmat Citta (furoreous mind) 85 86Bhrant Citta (confused mind) 87 88Abhihat Citta (strucked mind) 89 90Upahat Cetas (afflicted mind) 91 92Vipluta Cetas (dispersed mind) 93 94 95.Pranasta Cetas (perished mind) 96.Cittodvega (anxious mind) 1.References about Udvega-in Ayurvedic texts:Garbha lakshana 97Katu Rasatiyoga 98Stambhana Atiyoga 99 100Andhaputana graha 101 102Bala grahaBhutabhisangaj Jvara 103 104Rasagata Jvara 105Mukhamandita graha 106 107Pishaca graha 108Putana grahaSheeta putana graha 109 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 54
  • Review of DiseaseSkanda graham 110 111Unmada Poorvarupa 112,113Unmada arista 114It is evident from the forgoing references that the Acarya knew different forms of mentalstatus. Among all these terms, only Cittakshobha, Asvastha Citta, Anavasthita Citta, andCittodvega are indirectly towards the meaning of anxious status. However, Cittodvega ismore applicable term to illustrate whole anxious status.Cittavibhramsa (mental decadence) Vagbhata has explained chitta vibhrama while explaining the trishna samanyalakshana and susrutha in jwara pratisheda while explaining about kamaja jwara.Cittanasa (loss of conscious) Acharya susrutha has explained about chittanasha while explaining about theapasmara.Cittakshobha (mental agitation) Acharya vagbhata has mentiond while explaining about the madathyaya chikitsa.Cittaviparyaya (misapprehension of mind) Acharaya susrutha has explained about the chittaviparyaya while explaining aboutthe arochaka chikitsa.Cittavilobhana (mental seduction) Acharya vagbhata has mentiond while explaining about the madathyaya chikitsa.Cittopaplava (mental adversity) Acharya vagbhata has explained about chitta plava while describing the guna ofMadhya. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 55
  • Review of DiseaseAsvastha Citta (mental discomfortness) Acahraya vagbhata has explained about asvasta chtta while explaining about thelakshanas of paishaja graham in bhoota vijnaneeya and susrutha while explaining theunmada chikitsa.Anavasthita Citta (unstable mind) Acahrya charaka while explaining about Vataja vikaras in maharoga adhyaya.Tapta Citta (anger mind) Acarya charaka described about tapa chitta while explaining about jwara.Unmat Citta (furoreous mind) Acharya charaka explained unmatta chitta while describing the poorvaroopa ofunmada.Bharant Citta (confused mind) Achraya susrutha has explained about the bhranta citta while explained aboutapasmara poorvaroopa and acahrya charaka in madathyaya chikitsa.Abhihat Chitta (strucked mind) Acahraya susrutha has explained about the upahata chetas while explaining about thenidana of apasmara.Uphat Chetas (afflicated mind) Acahraya charaka while explaining about the unmade nidana and in pandu rogachikitsa.Vipluta Cetas (dispersed mind) Acahraya vagbhata has explained about vipluta manas while explaining the unmadapratisheda and Acharya susrutha while explaining about arochaka . “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 56
  • Review of DiseasePranasta Cetas (perished mind) Acharaya charaka explained pranashta cheats wile explaining about the hikkachikitsa.Manovikshobha (mental agitation) Acahraya vagbhata has explained about manovikshoba while explaining themadathyaya chikitsa.Manokshata (mental impairment) Acahraya susrutha has explained about the mano vikshobha while explaining aboutthe unmada.Manoabhighata (affected mind) Acarya charaka has explained manoabhighata while explaining about the unmadanidana.Cittodvega (anxious mind) Acarya charaka has mentioned the word chittodvega while explaining about themanasa doshas rajas and thamas in roganeekam vamanam. It is evident from the forgoing references that the Acaryas knew different forms ofmental status. Among all these terms, only Cittakshobha, Asvastha Citta, AnavasthitaCitta, Tapta Citta, Manvikshobha and Cittodvega are indirectly towards the meaning ofanxious status. However, Cittodvega is more applicable term to illustrate whole anxiousstatus. So in this study the term ‘Cittodvega’ is compared with General anxiety disorders. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 57
  • Review of DiseaseDisease Review:The brain and the mind When thinking about the brain we have in mind an organ made up of nerve cells(the neurons), synapses (connections between neurons), chemical messengerscommunicating information between neurons (neurotransmitters), receptors, multipleinter neuronal connections, and circuits. When we talk about the brain we use the precisespecialist language of the basic sciences—mathematics, chemistry and physics,molecules, proteins, electrical potentials—the world of matter which can be manipulated,cut, separated into pieces, and analyzed. For hundreds of years we have had a clear-cut separation of these two concepts,that of the brain or matter occupying space and time, and the other of the mind or spiritoccupying time and being only individually experienced and therefore unique.115The brain is no longer viewed in such coarse terms of simple matter as conceived in theeighteenth century. Today we know that the brain is a continually changing organ, in itsstructure as well as its function. But what about the mind in this constant flow ofinformation in the brain? Is it that the brain and its activity produce or cause what we callmind? Mind does not exist in the sense of being a real entity or global concept capturinga static or permanent thing. ‘Mind is the neural tissue sewn with the threads of timeNeedless to say, for most neuroscientists mind is not a spiritual, immaterial entity, nor a “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 58
  • Review of Diseaseproduct emerging or caused by the brain and different from the brain. Mind is the activityof the brain itself—nothing more, nothing less. In this process of evolution of the human brain, the most spectacular part hasbeen, without any doubt, the extraordinary development of those parts of the brain calledthe association areas. These brain areas, not directly related to sensory or motor control,seem to develop in parallel to the acquisition of mental capacities. During evolution theseareas of the cerebral cortex—prefrontal and parietotemporal cortices—have selectivelyincreased in volume and in the number of neurons (the so-called extra-neurons, damageto which does not affect sensory or motor processes). It has been estimated that in suchareas, through evolution, the chimpanzee has accumulated 3.4 billion neurons, theaustralopithecines 4.1 billion neurons, Homo habilis 5.5 billion neurons, Homo erectus7.0 billion neurons, and Homo sapiens 8.5 billion neurons. How then can we not thinkthat there is an intimate relationship between brain and mind? Each person is different from another because of his discriminatory, creative andintuitive mind. Mind is a special gift to mankind, which is very complex in nature. It haspotentiality to act mainly as dual nature. It is creative as well as destructive, positive aswell as negative, active as well as dull, happy as well as sad. All these entities are wellbalanced by mind knowingly or unknowingly to people in their life. But this balancingnature of mind nowadays is getting deprived under the influence of growing stress andstrains in life. Intellect, thinking power, memory, temperament, behavior, socia1 attitude,etc., of an individual depends upon mental faculties. Acharya Vagbhata indicated these stressors of psyche and soma by using the term‘Ādhi’. Along with various morbid conditions of mind Ādhijonmada is also explained by “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 59
  • Review of DiseaseVagbhata as Ādhi is explained ‘Dhanakanthadi nasena’. Emotional and behavioralsymptoms may occur in response to stressful life events. Stressors may be single such asa divorce, or the loss of a job, or multiple such as the death of an important personoccurring at the same time as once own physical illness and loss of a job. Stressors maybe recurrent such as seasonal business difficulty or continuous, such as chronic illness, orliving in poverty. Specific developmental stages such as- beginning school, leavinghome, getting married, becoming a parent, failing to achieve occupational goal andretiring etc. are often stressors which may manifest in the form of any stress relateddisorder.SHIRAH (HEAD) - THE SUPREME ORGAN The Shirah is the supreme of all the organs because it is considered as uttamangai.e. supreme, important and major part of the body.116 It is that part of the body where thelife along with sense faculties resides. In the head are set, as rays in the sun, the senseorgans and the channels carrying the sensory and vital impulses.117 As regards the vital organs situated in the trunk, Shirah is considered as one of thethree important vital organs i.e. since the existence of the body is dependent uponthem.118Sankhya and Kumarshira Bharadwaja emphasized that head of the foetusdevelops first, because it is the site of all important indriyas (faculties). Injury to Shirah may lead to death of the patient 6 or it may lead to Rigidity of thesides of the neck, facial paralysis, agitation of the eyes, stupefaction and constricting painin the head, loss of movement, cough, dyspnoea, trismus, dumbness, stuttering speech,closed condition of the eye-lids, twitching of the cheeks, yawning fits, ptyalism, aphasiaand facial asymmetry 119 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 60
  • Review of DiseaseVagbhata has compared the human being with a tree with the roots at the top andbranches, below and defined head as a site where all senses along with the vital breath(Prana) reside. Thus it is supreme of all organs, as consciousness is present in it. Hence, itrequires prime protection.Aharya bhela has described that manas is situiated in between Shiras and talu.Manas: 120 121 122Synonyms of Manas: According to seat : Hridayam, Hrnmanasama According to function : Prajna(accommodator of super senses) Smriti (restores knowledge) Mahamati (super-most analyzer) Sattvam (express the presence of Atma) According to relation : Svantam (closely related to Atma) According to shape :Anangakam (non-morphological entity) According to action : Citta (thought process) Purvabdhikhyatih (carrier of previous deeds) Others : Eswarah (god, owner) Brahma (the soul)CHARACTERISTICS OF MANAS: Anutvamatha Caikatvam Dvau Gunau Manasah Smrtau 123 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 61
  • Review of DiseaseAnutvam (atomic dimension) and Ekatavam (uniqueness) are considered tobe the two characteristics of the Manas. These are very basic characters of the mind, if it were not so, all kindsof perceptions would have occurred at a time.Other characteristics or properties of manas are: Manas is said to be Suksma 124 Manas is Dravya It is Karana or instrument of Atma It is one of the 24 or 25 tattvas from which Purusa is derived. 125 It is one among the Adhyatma Dravya Samgraha 126 The three Mahaguna Sattva, Rajas, Tamas are said to be the guna of manas or they are imposed on Manas (Matsya Purana) It is Acetana but does functions by getting Cetana from Atma 127 It is dual faculty i.e. Ubhayendriya –both sensory and motor. Manas is considered as one of the Antahkarana Catustaya (Sharirikopnisada) Manas is considered as Atindriya, as it is subtle than Indriya and is considered to be superior than Indriya128 Cancalatva (unstability) is a characteristic of Manas (Bahopanisada) “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 62
  • Review of Disease Manas is AvyapakaFunctions of Manas: 129Indriyabhigrahah Karma Manasah Svasyanigrahah IUho Vicarasca …………………………………………IInIndriyabhigraha (control of sense organs), Svasyanigraha (self restraint),Uha (hypothesis) and Vicara (consideration) represent the functions of mind.1. Indriabhigraha: Manas send the impulses and inspirations to the cognitive senses and facilitatethem for the perception of objects.2. Svasyanigraha: Controlling of own functions or self-restrain is another function ofManas. As Manas is called Cancala130 it is necessary to have Svasyanigrahafor the perception of desired objects and retraction from those after thepurpose is fulfilled and from those unwanted.3. Uha: Chakrapani explained that Uha means, knowledge of perceived objects, whichproduced by complete analysis by mind.4. Vichara: Chakrapani stated that thinking upon perceived object for its reception(Upadeya) or rejection (Heya) is Vichara. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 63
  • Review of DiseaseOther than this, Manas stimulates the Karmendriya to perform theirfunctions. Also, to feel different types of emotions and their manifestationsover body is under the purview of Manas only.Manovaha Srotas: 131 132 133 134 Charaka has mentioned that, the channels of the whole body transportthe Tridosa, similarly Manas is transported through the same channels toprovide Chetana to all the living cells of the body and it is called ManovahaSrotas in Ayurvedic texts, but separate description regarding this topic is notavailable in texts. Chakrapani explains that Manovaha Srotas is spreaded all over thebody, but the main location of Srotas can be considered as Hridaya and tenDhamanis, which are related with Hridaya. In the context of Unmada andApasmara, Caraka has mentioned about Manovaha Srotas, but also in othercontexts like Mada, Murccha, and Sanyasa different other terms like“Cetanavahi Srotas,” “Samjnavahi Srotas” are used. These terms can betaken as synonyms for Manovaha Srotas. Generally, the functions of Manas are categorized under these aspects. 1. Cognitive Functions: To perceive the impulses and inspirations sent by the sensory faculties i.e. acquiring Knowledge. 2. Cognitive Functions: To stimulate the Karmendriya (Motor Faculties) to perform the desired functions i.e. Motor expressions “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 64
  • Review of Disease 3. Affective Functions: To feel various types of emotions and their bodily manifestations i.e. Manas Bhava. In mental disorders, these functions are disturbed or impaired or perverted,leading to various symptoms. When Cognitive functions are disturbed, there will besymptoms associated with higher mental functions. e.g. Memory loss, delirium, loss oforientation, etc. Impairment in cognitive functions leads to behavioral symptoms e.g. inappropriatelaughing, crying, dancing, singing, etc. In third category, impairment of the affective functions leads to emotionalsymptoms e.g. Blunted affect, incongruent mood, elation, depression, etc.Concept of Mind-Modern View Mind is the psyche, the faculty, or brain function, by which one is aware of hissurroundings and by which one experiences, feelings and desires and is able to attend,reason and make decisions 135. Though the modern science has a credit of invention of theory of mind, but theycould not conclude this. There were several changes even in fundamental, inpsychoanalysis by attempt of various eminent the founder of psychoanalysis was madeattempt to illustrate the basic concepts of mind and psychoanalysis:I. Topographic Model of the Mind: 136 The publication of “The Interpretation of Dreams” in 1900 heralded the Arrival ofFreud’s topographic model of the mind, in which he divided the mind into three regions:the conscious system, preconscious system and the unconscious system.Each system has its own unique characteristics “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 65
  • Review of Disease(1) The Conscious: 137 The conscious system is the part of the mind in which perceptions coming fromthe outside world or from within the body or mind are brought into awareness.Consciousness is a subjective phenomenon whose content can be communicated only byMeans of language or behavior.(2) The Preconscious: The preconscious system is composed of those mental events, process andcontents capable of being brought into conscious awareness by the act of focusingattention. The preconscious interfaces with both unconscious and conscious region of themind. To reach conscious awareness, contents of the unconscious must become linkedwith words and thus become preconscious. The preconscious also serves to maintain therepressive barrier and to censor unacceptable wishes and desires.(3) The Unconscious: 138 The Unconscious system is dynamic. Its mental contents and processes are keptfrom conscious awareness through the force of censorship or repression. The unconsciousis closely related to instinctual drives. The unconscious system is characterized by ‘Primary Process Thinking’, whichhas as its principal aim the facilitation of wish fulfillment and instinctual discharged. The content of the unconscious is limited to wishes seeking fulfillment theseWishes provide the motivation for dream and neurotic symptom formation.II. Instinct Theory: 139 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 66
  • Review of Disease After the development of the topographic model, Freud turned his attention to theinstinct theory. Instinct is a complex of unlearned responses characteristic of a species. InFreud view, an instinct has four principal characteristics: source, impetus, aim and object.Source: It refers to the part of the body from which the instinct arises.Impetus: It is the amount of force or intensity associated with the instinct.Aim: It refers to any action directed toward tension discharge or satisfaction.Object: It is the target for this action.Freud defined some instinct i.e. libido, ego, aggression, life and death instincts.III. Structural Theory of the Mind: The structural model of the psychic apparatus made by the three provinces – Id,Ego and Superego – are distinguished by their different function:1. Id: 140 Freud used this term to refer to a reservoir of unorganized instinctual drives.Operating under the domination of the primary process, the id lacks the capacity to delayor modify the instinctual drives with which an infant is born.2. Ego: 141 The ego spans all three topographic dimensions of conscious, preconscious andunconscious. Logical and abstract thinking and verbal expression are associated withconscious and preconscious function of ego. Defense mechanisms reside in theunconscious domain of the ego. The ego is the executive organ of psyche and controlsmotility, perception, contact with reality and through the mechanisms of defenseavailable to it, the delay and modulation of drive expression. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 67
  • Review of Disease3. Superego: 142 The third component of the tripartite structural model is the super ego. Itestablished and maintains an individual’s moral conscience based on a complex system ofideals and values internalized from parents. It then serves as an agency that providesongoing scrutiny of a person’s behavior, thoughts and feelings; makes comparisons withexpected standards of behavior and offers approval or disapproval. These activities occurlargely unconsciouslyIV. Theory of Anxiety: 143 After the development of structural model, Freud developed a new theory of asecond type of anxiety that he referred to as signal anxiety. In this model, anxietyoperates at an unconscious level and serves to mobilize the ego’s resources to avertdanger. Either external or internal sources of danger may produce such a signal that leadsthe ego to marshal specific defense mechanisms to guard against or reduce the degree ofinstinctual excitation.Genes, the brain, and the mind: In a recent review regarding genes, behavior, and the mind, Kandel has stated:There can be no changes in behavior that are not reflected in the nervous system and nopersistent changes in the nervous system that are not reflected in structural changes onsome level of resolution. Everyday sensory experience, sensory deprivation, and learningcan probably lead to a weakening of synaptic connections in some circumstances and astrengthening of connections in others.Nidana of chittodvega: “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 68
  • Review of Disease The main Dosas of the Manasa are Rajas and Tamas144 Hence the Nidana, whichvitiate Rajas and Tamas, may be considered as etiological factors of Chittodvega.Following three factors are responsible for the all physical and mental diseases 1. Asatmendriyarthasamyoga145 146 2. Prajnaparadha 3. ParinamaASATMENDRIYAARTHA SAMYOGA: 147 Sensory perceptions which are not congenial with sensory organs calledasatmendriyartha Samyoga. In short it is called unwholesome contact with the objects.They may be in the form of atiyoga (excessive or over utilization), ayoga (hypoutilization or non utilization) and mithyayaoga (non judicial or wrong utilization).Indulging in activity excessively (atiyoga), wrong utilization (mithyayoga), and nonutilization (ayoga) with regards to karma is also considered causes for the mentaldisorders.PRAGNAPARADHA148 An action carried out with non justifiable understading due to dhivibramsa(impairment of intellect), dhritivibramsa (impairment of will) and smritivibramsa(impairment of memory) is termed as prajnaparadha. Further due to involvement of rajahand tamas dosha the emotional state like kama, krodha, bhaya, irshya etc. consideredunder prajnaparadha become etiological factors for the mental disease.It may be of three types1. kayika (physical activites)-related to body.2. vachika (speech)-related o speech “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 69
  • Review of Disease3. manasika (mental activities)-related to manas/mind. According to Charaka Dhivibramsa (impairment of intellect), Dhrtivibramsa(impairment of will) and Smritivibramsa (impairment of memory) are the main causativefactors of the mental disorders, which lead to evil Karmas, this stage is defined as aPrajnaparadha. It causes various types of physical and mental disorders. Some of theexamples of Manasika Prajnaparadha which leads to mental disorders are –over afflictionof mind by Kama, Krodha, Bhaya, Moha, Shoka, Cinta, and Udvega / Cittodvega149 150 To highlight the importance of Prajnaparadha, it is stated in thecontext of Manasroga that neither the God, nor the Gandharva, nor Pishaca,nor Raksasa afflict the person who himself is free from misdeeds 151. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 70
  • Review of DiseasePARINAMA Advent of the maturity of the results of Kala (time factor) and Karma (action) isconsidered as the second cause of mental disorders. Ayurveda holds that results of allmisdeeds will mature in time and when time matures the person will be afflicted withparticular disorder. It is seen that all mental disorders have a phase of excitement,remission, etc. and a relation between lunar phase and mental disorder is welldocumented, but what about the mind? For perceptions, emotions, thoughts, memory,consciousness, and self-consciousness we are concerned with intimate and subjectiveentities that are elusive or difficult to grasp or measure. In this context we use a differentlanguage, that of psychology.Concept of Mind: Ayurveda, the science of life, effectively explains about Manas and its functionsand lays emphasis on the need of overcoming the impediments like, Kama (Desire),Krodha (Anger), etc. which are reflected in the form of psychological illnesses and alsoprescribes methods to ward off them effectively. In today’s metaphysical society, human life has become speedy, mechanized, lesseffectious and more centered, which contribute to more production of Kama (Desire),Krodha (anger), Lobha (greed), Bhaya (fear), Shoka (Grief), Cinta (Worry) and Irsa(envy) etc. like Manas Vikara. The symptoms of Ojoksaya described by Caraka like Bibheti, Durbala, Dhyana, 152Vyathitendriya are the common symptoms of anxiety. So the etiological factors forOjoksaya may be taken as causative factor for Cittodvega. Also some etiological factors “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 71
  • Review of Diseasefor Jvara, giving rise to Vaicitya, Arati, Glani, Manastapa may be taken as Nidana forCittodvega 153 Likewise Preenana is the main function of Rasadhatu, Preeti is of the Majja, andShukra is responsible for Harsa and Dhairya, which are impaired in Cittodvega. Thisgives the clue about the involvement of many Srotas in the pathogenesis of Cittodvega.This different Srotodushti due to psychological factors is responsible for wide range ofsymptoms of Cittodvega. e.g. excessive thinking leads to Rasavaha Srotodusti(Cintyanam aticintanata). Other than this, different causative factors described forUnmada may also responsible for genesis of Cittodvega. The Poorvarupa of Unmadadescribed by Caraka, gives clear idea about the symptoms of anxiety disorders orCittodvegaEtiology:The cause for G.A.D is unknown, both biological and psychological factors will worktogether.Genetic factors-154 In a family study that used DSM-III criteria, GAD (but not otheranxiety disorders) was five times more prevalent (19.5 per cent versus 3.5 per cent)among first-degree relatives of patients with GAD than among relatives of controls.However, two twin studies using the same criteria found concordance rates for GADwere no higher among monozygotic than dizygotic twins. Two subsequent studies thatused DSM-IIIR criteria found a shared heritability for GAD and mood disorders. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 72
  • Review of DiseaseAt present, it appears that genetic factors play a modest role in the etiology of GAD, andone that is more closely related to vulnerability for depression than for other anxietydisorders generalized anxiety. The genetics of six neurotic disorders: a twin study. The avoidance theory of worry outlined specific ways in which individuals withGAD rely on worry as a cognitive avoidance strategy. Feared internal experiences, suchas aversive imagery, physiological arousal and intense emotion, are avoided in addition toundesirable future outcomes. Building upon this theory, Mennin and colleagues (2004)proposed that individuals with GAD suffer from deficits in emotion regulation skills andtherefore engage in such cognitive avoidance maneuvers to regulate their emotionalexperience. Cholecystokinin neuropeptides (CCK-4 and CCK-8S) have been implicatedin the genesis of arousal and fear responses. It is unclear how those effects are mediated;however cholecystokinin interacts with several neurotransmitters and systems believed tobe involved in anxiety responses, including the noradrenergic nervous system, thehypothalamic–pituitary–adrenal axis, the benzodiazepine–GABA system, and serotonin.Samprapti: Acharya Vagbhata states that, the way in which the Dosa get vitiated and thecourse it follows for the production of disease is called as the Samprapti. It is veryimportant in the treatment of disease because proper disintegration of Samprapti is calledas Chikitsa. There is no direct description of Samprapti of Chittodvega in Ayurvedictexts, although it is included under Manovikara. Samprapti of Chittodvega may be tracedout by considering the general principles and multi factorial Nidana described earlier. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 73
  • Review of Disease In the pathogenesis of the disease the vulnerability in the form of positive familyhistory, Vataja and Rajas prakruti, Heena Sattva, fear prone personality, indulgence in themisuse of Sadvritta, vitiated Dosa play an important role in predisposing to Cittodvega.Emotions like Udvega, Chinta, Bhaya, Harsha, etc. are natural response to the viscitudesof life, but persons having Sattvasarata or Pravara Sattva can resist the ill effects of suchemotions, due to the predominance of Sattva quality. On the other hand, persons havingHeena Sattva indulge in Prajnaparadha or are afflicted by Manobhighata of a recurrentnature or is under stress, initiates the disease process by resulting an imbalance ofManodohsa predominantly Rajas and also Sharirika dosha predominantly Vata. At thisstage, the patient exhibits an exaggerated response to emotional disturbances i.e. Udvega. When the abnormality of manas dosa continues to exist for long duration, theygenerate certain psychic symptoms such as Chinta (worry), Vyakulata (apprehension),Bhaya (Fear), and Shoka (Grief). When this psychic response over ride a limit andcontinues for a prolonged period, they start influencing the bodily dosha. At thebiological level, bodily Dosha especially Vata gets aggravated. On biological level, Vatais the controller and promoter of mind, and Rajas the predominant manodohsa is havingdirect relationship with Vata dosa. So at this stage bodily symptoms are predominantlydue to Vata dosha prakopa. Out of the five subtypes of Vata, particularly Pranavata, Udanavata, andVyanavata get vitiated predominantly. Increased vitiation of Vata and Rajas leads toKapha kshaya and Sattva Guna Hrasa. In Cittodvega the main variety of kapha, which “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 74
  • Review of Diseasedeclines, is Tarpaka Kapha, resulting in the undernourishment of Indriyas. In Pitta dosa,Sadhka Pitta gets vitiated, giving rise to symptoms such as Bhaya, Moha, Krodha, etc. These vitiated Manodohsa and Sharirika Dosa move to Hridaya and vitiates it.Due to Asraya- Asrayi Bhava, Manas also gets vitiated, as Hridaya is the site for Manas(Cintadijustam Hridayam Pradusya-155 When this vitiation persists for longer duration, itresults in Ojoksaya, giving rise to the symptoms.Dosha- Manasa- Rajah, TamasSharirika - Vata-prana, udana, vyana. Pitta-Sadhaka, Alochaka Kapha-TarpakaDusya - Mana, SarvadhatuSrotas- Especially manovaha srotasAgni - ishamagni (Jatharangi)Udbhavasthana- Manas (Hridaya)Adhisthana - ShirohridayaVyakta sthana - Manah sarvashariraRoga marga - MadhyamPoorva roopa- Alpavyakta lakshanaRoopa- Udvega, Bhaya, kampa, Atisweda.etc.Sadhya sadhyata- Kricchra sadhyaUpdrava - Unmada “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 75
  • Review of DiseaseWorry Patients with panic disorder are worried about having a panic attack or theconsequences of experiencing certain bodily sensations. Their focus is on internal states.What makes the differential diagnosis particularly confusing is that the worryexperienced by patients with GAD can lead to a panic attack. However, unlike patientswith panic disorder, patients with GAD are concerned primarily about some future event,not having a panic attack or the symptoms of anxiety per se. Another distinction is thecourse of onset of worry versus panic. Some patients with GAD are focused on thephysical symptoms of their anxiety, and this can lead one to think that the preoccupationwith bodily sensations is a sign of panic disorder. However, the onset of a panic attack issudden and its peak typically lasts for several minutes, whereas the onset and course ofGAD-related anxiety is usually longer and more stable. Although the differentiation between obsessive-compulsive disorder (OCD) andGAD seems obvious because of the behavioral rituals that are unique to OCD, there arestill some cases that can be extremely difficult to differentiate. This is especially true ofpatients with OCD who do not have compulsions or have only mental rituals. Thedifferentiation can be made, however, by assessing the focus of concern. Obsessions are focused on exaggerated or unrealistic expectations and are usuallyshort-lived (e.g., “If I don’t seal this envelope correctly, my kids will be injured on theway home from school”). In addition, obsessions often take an “if-then” form (e.g., “If Ido/don’t do/think something, then something bad will happen”) or include vivid imagery.Worry, on the other hand, is usually focused on future negative events that are not “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 76
  • Review of Diseasecaused by the patient. According to non anxious subjects, worry lasts longer, is moredistracting, and usually consists of predominantly verbal thoughts as opposed to images. The thought content of a worry may be specified in a “what if” fashion, without aconsequence being stated (“What if I get ill?”). Another difficult aspect of thedifferentiation of GAD and OCD is the fact that patients with GAD may engage inreassurance-seeking behaviors that can be somewhat ritualistic and superstitious. Patientswith GAD may report feeling compelled to act to neutralize this worry (e.g., to call one’swife at work to lessen a worry about something happening to her). However, thesebehaviors are not as consistent, methodical, or ritualized as compulsive behaviors inpatients with OCD. GAD may be common later in the lifespan as well. The original NCSEpidemiological study found that GAD was most common among adults who were 45years 45 years old or older and least common among respondents in the 15–24 year-oldage group. In addition, GAD may co-occur with medical conditions, particularly thoseinvolving the gastrointestinal system. Gastrointestinal problems such as ulcers andstomach distress appear to accompany GAD more than other medical conditions. Additional investigations have examined the link between GAD and irritablebowel syndrome (IBS)Approximately 37% of a clinical GAD patients also met diagnosticcriteria for IBS (Tollefson, Pederson, Luxenberg, & Dunsmore 1991), and 34% of an IBSpatient sample had a lifetime history of GAD (Lydiard 1992). “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 77
  • Review of Disease Neurobiological theories (e.g., Sinha, Mohlman, & Gorman 2004) haveimplicated neuroanatomical structures including the amygdale and hippocampus as wellas neurochemical systems such as gamma-aminobutyric acid (GABA), norepinephrine(NE), and serotonin (5-HT). The neuropeptide cholecystokinin (CCK) and the limbic-hypothalamic-pituitary-adrenal axis (LHPA axis) have been linked to normal anxiety and stress responses as wellas to pathological anxiety. A wide array of neurobiological, cognitive, and behavioral factors have beenimplicated in the etiology and maintenance of GAD. The integrative theoretical modeldeveloped by Barlow and colleagues identifies general biological and psychologicalvulnerabilities that may predispose and individual to an emotional disorder. Processesspecific to the development of GAD include fundamental beliefs that the world isdangerous and that one is Unable to cope with adversity. Worry therefore becomes theprimary strategy to Cope with perceived threats as the individual attempts to gain controlover potential threats as well as spiraling tension and anxious arousal. The diagnosis of Chittodvega is made only when symptoms become chronic andenduring. Hence Alpavyakta lakshna, especially the mental symptoms such as Udvega,Vyakulata, Bhaya, and Chinta without any obvious cause, can be considered as thepurvarupa of the disease. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 78
  • Review of DiseaseSamprapti – Pathogenesis of Cittodvega: Vitiated Vatadi Dosa vitiates Jataragni, and afterwards Rasadi Dhatu. So thecombined effect of vitiated Sharirika and Manasika Dosa affect Hridaya, ManovahaSrotas, and vulnerable Dhatu and Srotas resulting in the psychosomatic presentation ofthe disease. In Chittodvega multiple Srotas and almost all Dhatu seems to be affected. Hence,the somatic symptoms of Chittodvega are numerous. When the symptoms become fullblown and attain chronicity, the disease becomes kricchrasadhya.When the disease not treated promptly, it becomes chronic and disabling as Manodohsaand Sharirika dosa potentiate each other in a vitiated state, resulting in a vicious cycle.The poorvarupavastha of Unmada described by Charaka reflects the nature of thesymptoms of Cittodvega. So it can be said that, if Cittodvega not treated properly leads tounmada. In case of diagnosis and scheduling treatment the knowledge of samprapti playsmajor role, as samprapti vighatana is the basic principle of all the treatment, for that theknowledge of the factors that cause the pathogenesis is very important i.e. Nothing butthe samprapti ghatagas, but as such there is no direct mentioning of samprapti andsamprapti ghatagas in the classics for chittodvega here an attempt has been made tomention the possible factors that take part in the pathogenesis of chittodvega. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 79
  • Review of DiseaseSAMPRAPTI GHATAKAFigure no: 4. showing the Samprapti of CittodvegaAsatmyendriyarthasamyoga Prajnaparadha Parinama Nidana Sevana Predisposed Personality Mano Dosa Prakopa Sharira Dosa PrakopaRajas Tamas Vata Pitta Kapha(Calatva) (Gurutva) (Prana, Udana, (Sadhaka) (Tarpaka) Vyana) Hridaya Dusti Agni Vikriti Rasadi Dhatudusti Manovaha Srotodusti Rasadi Sarva Srotodusti Manas Lakshana Uttpati Sharira Lakshana Uttpati ChittodvegaPathogenesis “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 80
  • Review of Disease Worry is the major cognitive component of GAD. People who have GAD tend toworry most of the day, nearly every day. However, worry in itself is not pathological. It isan attempt to predict future danger and/or an attempt to gain control over events thatappear uncontrollable (and usually negative or dangerous). However, it is clear that pathological worry is dysfunctional in that it is, bydefinition, excessive and/or unrealistic and feels uncontrollable. Research supports theidea that pathological worry has a functional role for people with GAD. Ironically, worryinhibits autonomic arousal in patients with GAD when they are shown aversive imagery.Worrying may cause the avoidance of aversive imagery, which is associated with an evengreater emotional arousal.Neurobiology156 Multiple neuro chemicals and neurotransmitter systems have been implicated aspotential contributors to the development of GAD. These include the amino butyric acid(GABA)–benzodiazepine (BZ) complex, serotonin (5-HT), nor epinephrine,cholecystokinin, and corticotrophin-releasing factor, the hypothalamic pituitary-adrenalaxis, and neurosteriods. A range of preclinical studies demonstrate that the 5-HT system plays animportant role in mediating anxiety. Patients with GAD have a decrease of 5-HT in thecerebrospinal fluid (Brewerton et al. 1995) and reduced platelet paroxetine binding. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 81
  • Review of DiseaseNeurocircuitry and GAD: 157The literature on the pathogenesis of GAD remains at an early stage. Nevertheless, anumber of themes have emerged. A first question isFigure no: 5 Functional neuroanatomy of GAD: increased activity in amygdala and perhaps prefrontallyWhether the pathogenesis of GAD differs in any way from that of depression. An influential twin study indicated that GAD and major depression (MD) sharedcommon genetic factors, but had substantially different non familial environment riskfactors with different kinds of life events predisposing to anxiety and mood disordersindeed, preliminary brain imaging studies suggest that GAD is characterized by a numberof specific abnormalities. Thus, there may be increased amygdale volume and abnormalbenzodiazepine receptor binding in the temporal pole of GAD patients. An earlytopographic electroencephalography study indicated differences between GAD andnormals in temporal regions and subsequent PET studies have also shown temporalabnormalities in this disorderRupa: Chittodvega is one of the Manasika Vikara mentioned in Ayurvedic literature.The symptoms of this disease can be assumed mostly similar with the generalized anxietydisorder (GAD). GAD is a disorder requires the presence of unrealistic or excessive “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 82
  • Review of Diseaseanxiety and worry, accompanied by symptoms from three of four categories: (1) motortension, (2) autonomic hyperactivity, (3) vigilance and scanning, and (4) apprehensiveexpectation. The anxious mood must continue for at least a month.Chittodvega Vis a Vis Generalized anxiety disorder. The diagnostic and statistical manual of mental disorders (DSM IV) definesgeneralized anxiety disorder as excessive anxiety and worry about several events oractivities for a majority of days during at least a 6 month period, the worry is difficult tocontrol and is associated with somatic symptoms such a muscle tension, irritabilitydifficulty in sleeping and restlessness.Clinical features158The primary symptoms of G.A.D are anxiety, motor tension, and autonomic hyperactivity and cognitive vigilance .the anxiety is excessive and interferes with other aspectsof People’s lives. .It includes both psychological as well as somatic symptoms.Psychological symptoms • Apprehension • Fear of impending disaster • Irritability • DepersonalizationSomatic symptoms • Tremor • Sweating • Palpitations • Chest pain “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 83
  • Review of Disease • Breathlessness • Head ache • Dizziness • Diarrhoea • Frequency of micturation • Initial insomnia • Poor concentrationSymptoms of Generalized Anxiety Disorder. DSM IV (A) Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about number of events or activities (such as work or school performance). (B) The person finds it difficult to control the worry. (C) The anxiety and worry are associated with three ( or more) of the following 6 symptoms( with at least some symptoms present for more days than not for the past 6 months): 1) restlessness of feeling keyed up or on edge 2) being easily fatigue 3) difficulty concentrating or mind going blank 4) irritability 5) muscle tension 6) sleep disturbance ( difficulty falling or staying asleep, or restless unsatisfying sleep) “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 84
  • Review of Disease The focus of anxiety and worry is not confined to the features of an Axis Idisorder. The anxiety worry or physical symptoms cause clinically significant distress orimpairment in social, occupational or other important areas of functioning. The disturbance is not due to the direct physiological effects of a substance (e.g. adrug of abuse, a medication) or a general medical condition (e.g. hyperthyroidism) anddoes not occur exclusively during a mood disorder, a psychotic disorder or a pervasivedevelopmental disorder.GAD:Associated Features159 GAD may be associated with significant comorbidity and morbidity. Earlyauthors did not see GAD as an independent entity, partly because comorbidity is socommon. Nevertheless, rates of comorbidity in GAD are no higher than those seen indepression. Furthermore, community studies demonstrate that the disability associatedwith GAD is as great as that associated with depression. Whereas GAD typically starts inchildhood or early adulthood, oftentimes a major stressor will exacerbate symptoms.Research (Wells 1994) and our clinical experience with GAD has led us to believe thatpeople with GAD are often driven toward being perfectionist, feel a greater need forcontrol in their environment, have difficulty tolerating ambiguity, and feel increasedpersonal responsibility for negative events that occur or are predicted to occur.Somatic Symptoms In addition to worry, patients with GAD experience unpleasant somaticsensations. Although these usually increase during the course of a worry episode, boththe worry and the somatic sensations can be described as relatively persistent and “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 85
  • Review of Diseasepervasive. The most common somatic symptom reported by patients with GAD is muscletension. Patients may experience other symptoms often associated with worry andtension, including irritability, restlessness, feeling keyed up or on edge, difficultysleeping, fatigue, and difficulty concentrating.Differential diagnosis: Differentiating GAD from other anxiety disorders can be complicated. First,worry is a relatively generic feature of anxiety disorders (e.g., worry about panic attacks,worry about embarrassing oneself). In addition, there is a high level of comorbidityamong the anxiety disorders and GAD in particular, which requires one to considerdiagnosing multiple disorders as well as making differential diagnoses. The primarydistinction between GAD and other anxiety disorders is the focus of the patient’sconcern. Patients with GAD experience uncontrollable worry about a number of differentareas in their life. In fact, they often worry about their worrying (known as metaworry).In contrast, the focus of concern for patients with other anxiety disorders is specific totheir respective disorder.Panic Disorder:Social Phobia Because social concerns are a common area of worry for patients with GAD, theyare often found to have comorbid social phobia. However, some guidelines fordifferentiating the two disorders can be made. The basic distinction is that GAD concernsare more global, focused on a number of different areas that may include socialsituations. In contrast, patients with social phobia are specifically concerned with beingevaluated, embarrassed, or humiliated in front of others. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 86
  • Review of DiseaseObsessive-Compulsive DisorderMood Disorders160 The final differentiation to be made is between GAD and mood disorders,especially major depression and dysthymia. More often than not, anxiety symptoms occurwithin the context of depression, and thus GAD is diagnosed as a separate disorder onlywhen the symptoms have occurred at least at some point independent of depression.However, regardless of DSM exclusionary criteria, the nature of cognitions associatedwith each disorder can be distinguished: ruminations (common in depressive disorders)tend to be negative thought patterns about past events, whereas worries (associated withGAD)tend to be negative thought patterns about future events. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 87
  • Review of Drug Drug Review “The plants that spread forth, those that are bushy, those that have a single sheath,those that creep along, do I address; I call in thy behalf the plants that have shoots, thosethat have stalks, those that divide their branches, those that are derived from all the gods,the strong plants that furnish life to man. With the might that is yours, ye mighty ones,with the power and strength that is yours, with that do ye, O plants, rescue this man fromthis disease! I now prepare a remedy.” —Hymn of Universal Remedy to All Magic and Medicinal Plants, Atharvaveda Classical Indian medicine has a long tradition in the diagnosis and classificationof disease, including psychiatric disorders (Vaidya 1997). In fact, the Ayurvedicsystem identifies twenty categories of plants with specific CNS activity; amongthese, there are eighteen categories of psychoneuro pharmacological herbs. Ayurvedic herbs had significant influence on modern Western psychiatry andContinue to be a source of inspiration and research. For example, Rauwolfiaserpentine(Rauvolfia root, Serpentine root, Candrika, Chotacard), Albizzia lebbeck(Shirish, Shoedhanam, Sage-leaved alangium; family Mimosaceae), Asparagusracemosus (Shatavari, Satavar, Satavara, Satavari), Bacopa monniera (Brahmi, Nirabrahm), Centella asiatica (Mandukaparni, Brahmamanduki), and Vitex negundo-has beenused traditionally to treat intestinal parasites, colds, rheumatism, headaches, andconvulsions, and anxious or nervous patients161In this clinical study, Ksheera bala Taila is selected for Nasya and Amalaki choorna isused in dhara treatment. Here the detail Properties of each drug is given below: “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 88
  • Review of DrugFor Nasya Purpose: Bala Ksheera Tila TailaBala-Sida cordifolia Linn.Family _ Malvaceae.Habitat _ Throughout India in moist places. Fig no: 6 showing the drug BalaEnglish - Country Mallow.Ayurvedic - Balaa (yellow-flowered var.), Sumanganaa, Kharayashtikaa,Balini, Bhadrabalaa, Bhadraudani, Vaatyaalikaa.Unani - Bariyaara, Khirhati, Khireti, Kunayi.Siddha/Tamil - Nilatutti. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 89
  • Review of DrugPROPERTIESRasa-MadhuraGuna-Laghu, Snigdha, PicchilaVeerya- SheetaVipaka- MadhuraPrabhavam- BalyaDosha karma- Vata pitta hara, balya, brumhana, vrishyaKarma- Balya, brumhana, vrishyaRogaghnata- Raktapitta, Vata vyadhi, prameha, kshayaGana- Brumhana, prajasthapana, madhura skhanda (Ch.) Vatasamsamana (Su.)Action: Juice of the plant—invigorating, spermatopoietic, used in spermatorrhoea.Seeds—nervine tonic. Root—(official part in Indian medicine) used for the treatment ofrheumatism; neurological disorders (hemiplegia, facial paralysis, sciatica); polyuria,dysuria, cystitis, strangury and hematuria; leucorrhoea and other uterine disorders; feversand general debility.Leaves— demulcent, febrifuge; used in dysentery. Ephedrine and si-ephedrine are themajor alkaloids in the aerial parts. The total alkaloid content is reportedto be 0.085%, the seeds contain the maximum amount. In addition to alkaloids,the seeds contain a fatty oil (3.23%), steroids, phytosterols, resin, resin acids, mucin andpotassium nitrate. The root contains alkaloids—ephedrine, si-ephedrine, beta-phenethylamine, carboxylated tryptamines and hypaphorine, quinazoline alkaloids—vasicinone, vasicine and vasicinol. Choline and betaine have also been isolated. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 90
  • Review of DrugA sitoindoside, isolated from the plant, has been reported to exhibit adaptogenic andimmunostimulatory activities. Alcoholic extract of the plant possesses antibacterial andantipyretic propeptide. Ethanolic extract of the plant depresses blood pressure in cats anddogs.For Dhara Purpose: Amalaki (dried) 350 gms Ksheera 750 mlAmalaki-Emblica officinalis Gaertn.Synonym _ Phyllanthus emblica Linn..Figure no: 7 showing the drug Amalaki.Family - Euphorbiaceae.Habitat - Native to tropical Southeast Asia; distributed throughout India;also planted in public parks.English -Emblic, Indian gooseberry.Ayurvedic - Aaamalaki, Aaamalaka, Dhaatri, Kaayasthaa, Amoghaa,Amritaphala, Amla, Aaamalaa, Dhaatriphala, Vayasyaa, Vrshya, Shiva, Hattha. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 91
  • Review of DrugUnani - Aamalaa, Amlaj.Siddha/Tamil - Nellikkaai, Nelli.PROPERTIESRasa- Lavana varjita Pancha rasaGuna- Ruksha, Laghu, GuruVeerya- SheetaVipaka- MadhuraPrabhavam- RasayanamDosha Karma- Tridoshahara, Jaravyadhihara, Rasayana, Dhatuvruddhikara, Shramahara,Daha haraKarma- Medhya, Nadi balya, Indriya Shakti Vardhaka, Deepana, Rochana, Amlatanashaka, Sramsana, Rasayana.Gana- Vayasthapana, Virechanopaga (Ch.) Triphala, Parushakadi (Su.)Action: Fruit—anti anaemic, anabolic, anti emetic, bechic, astringent,Anti haemorrhagic, antidiarrhoeal, diuretic, anti diabetic, carminative, antioxidant. Usedin jaundice, dyspepsia, bacillary dysentery, eye trouble and as a gastrointestinal tonic.Juice with turmeric powder and honey is prescribed in diabetes insipidus. Seed— antibilious, antiasthmatic. Used in bronchitis. Bark— astringent. Leaf—juice is given in vomiting.A decoction of powdered pericarp is prescribed for peptic ulcer. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 92
  • Review of DrugKey application: as an antacid. (Indian Herbal Pharmacopoeia.).The fruit is an important source of vitamin C, minerals and amino acids. The edible fruittissue contains protein concentration threefold and vitamin C(ascorbic acid) concentration 160-fold than those of apple. The fruit also containsconsiderably higher concentration of most minerals and amino acids than apple.The fruit gave cytokinine-like substances identified as zeatin, zeatin ribosideand zeatin nucleotide; suspension culture gave phyllembin. Phyllembinexhibits CNS depressant and spasmolytic activity, potentiates action of adrenaline andhypnotic action of Nembutal. The leaves contain gallic acid 10.8mg/g dry basis), besides ascorbic and music acid. The methanol extract ofthe leaves is found to be effective in rat paw inflammation. The bark contains tanninidentified as mixed type of proanthocyanidin. The fruit contains superoxide dismutase482.14 units/g fresh weight and exhibits anti senescent (anti-aging) activity. Fruit, juice,its sediment and residue are antioxidant due to gallic acid. Et OH (50%) extract—antiviral. Aqueous extract of the fruit increases cardiac glycogen level and decreasesserum GOT, GPT and LDH in rats having induced myocardial necrosis. Preliminaryevidence suggests that the fruit and its juice may lower serum cholesterol, LDL,triglycerides and phospholipids without affecting HDL levels and may have positiveeffect on atherosclerosis. An aqueous extract of the fruit has been reported to provide protection againstradiation-induced chromosomal damage in both pre-and post irradiation treatment. Thefruit is reported to enhance natural killer cell activity and antibody dependent cellularcytotoxicity in mice bearing Dalton’s lymphoma ascites tumour. The extract of the fruit “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 93
  • Review of Drugand ascorbic acid prevented hepatotoxic and nephrotoxic effects induced by lead andaluminum. The toxicity could be counteracted to a great extent by the fruit extract than byan amount of ascorbic acid alone equivalent to that contained in fruits. (The fruit can beused as a dietary supplement to counteract prolonged exposure to metals in population inIndustrial areas.)The fruits are reported to activate trypsin (proteolytic enzyme) activity. The fruits can beused as coagulant in the treatment of water and can purify low turbidity water. The fruitscan be consumed safely all round the year.Dosage - Fresh fruit—10–20g; pulp juice—5-10ml. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 94
  • Review of TreatmentReview of TreatmentChikitsa: Psychotherapy is the treatment aimed to cure the emotional and behavioraldisturbances with the help of psychological techniques or methods. It has its roots inmans everyday techniques for adapting himself to both his internal and externalenvironment. Though we have this rich treasure of insight in psychotherapy, very fewAyurvedic physicians are practicing it. Practitioners now a day opt other branches ofAyurveda rather than psychiatry.Treatment of Manasika vikaras Mainly Ayurveda describes three methods of treatment principals viz daivavyapasraya, yukthi vyapsraya, satvavachayaDaiva vyapasraya Measures like mantra, Aushadhi, mani, mangala, bali, homa, upaharaniyamaetc…these are recommended in mental disorders caused due to aganthu factorsand administer the patient after considering the prakriti, desa, kala etc. factorsYukthi vyapasraya It includes Ahara, Aushadha and vihara, under Ahara food articles like ksheera,Ghrita, draksha; panasa, manduka parni, brahmi, kushmanda, kapitha, mahisha mamsa,kurma mamsa etc are recommendedDrug therapy includes dosha shodhana or srotoshodhana has to be done by adoptingvarious Shodhana measures after which rasayana Shamana Aushadha are givenmanagement. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 94
  • Review of Treatment The keraleeya Panchakarma are widely used in the management of Manasikavikaras like chittodvega, unmade, apasmara etc. the treatment procedures like Shirodhara, Tahlapothichil, Tahalam etc. are some of them.Satvavachaya chikitsa: These are adopted to get back the deranged manas. The aim of this therapy is toretain mind from desire unwholesome objects. This is achieved by increasing satva tosubdue the exaggerated rajas and tamas emphasizing on the need of compassion and apositive attitude towards the patient in administering the satvavachaya chikitsa. The bestmeasure to achieve the goal of satvavachaya chikitsa is to restrain mind from desire fromunwholesome objects, it’s through jnana, vijnana, dhairya, smrithi and Samadhi.According to Charaka Mental disorder caused by kama, shoka, bhaya, krodha, harsha, irsa, moha, shouldbe countered by inducing the opposite emotions in order to neutralize the causative ones,certain other satvavachaya measures like calming down the patient with shock byannouncing the loss of something to holds dear or showing some surprising thing orthreatening have also been advocated. The fear of death which is the strongest of all fearsin order to provide insight to the patient to regain mental equipoise.162Role of Achara Rasayana in the Management of Chittodvega: Ayurveda stresses on the holistic concept of health and disease. It dose not callhealth merely as absence of disease but something more positive and integrate. AcharaRasayana described in this respect is very essential for the treatment of Cittodvega. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 95
  • Review of Treatment Achara Rasayana is a procedure of social and mental conduct, which can acquirethe Rasayana effect on body and mind. It is also suggested as a ‘Nitya Rasayana’ 163this has direct effect on the potentiation of Sattva Guna of mind. The Achara Rasayanadescribed by Charaka are mentioned as below –1. Satya Vadinam (truthful)2. Akrodha (free from anger)3. Nivrutam Madhya Maithunat (devoid of alcohol and sex)4. Ahimsaka (do not indulge in violence)5. Anayasa (do not indulge in exhaustion)6. Prasantam Priya Vadinam (Peaceful and pleasing in speech)7. Japa Saucaparam (Practice incantation and cleanness)8. Dhiram (stable)9. Nitya Dana (Regularly practicing charity)10. Tapasvinam (Practicing penance)11. Deva Go Bramhana Acarya Vriddha Arcana Ratam (regularly offer prayers to God, cows, Bramhamanas, teachers, and old people)12. Karuna Vedanam (compassionate)13. Sama Jagarana Svapanam (regular period of awaking and sleep)14. Ksira Grtasinam (habitually taking milk and ghee)15. Desa Kala Pramana Jnanam (measurement of the country and the time)16. Yuktijnam (Rational)17. Anahmkrtam (free from ego)18. Sastacaram (with good conduct) “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 96
  • Review of Treatment19. Asamkirnam (not narrow minded)20. Adhyatma Pravana Indriyam (loving spiritual knowledge)21. Dharma Sastraparam (Regularly studying scriptures)22. Upasitaram Vrddhanam, Astikanam Jetatmanam (having reverence for elders, Astikasand persons having self control) All these conducts are very necessary for the prevent or to treat the psychologicalConditions. Though modern psychotherapy play very important role to care anxietydisorder, but Achara Rasayana are far better procedure then it. In this way, Ayurveda canOpen new horizon in treatment filed of Cittodvega (anxiety disorder).TREATMENT: 164 There is evidence that both pharmacological and non-pharmacological proceduresand a combination of these strategies are effective in the treatment of GAD. Thepharmacological treatment of GAD includes benzodiazepines, azapirones andantidepressants. Among psychotherapy, the cognitive-behavioural therapy has beendemonstrated to be effective in GAD treatment. Although in some cases of subsyndromalanxiety one course of therapy might be sufficient, anxiety as a rule has a chronic courseand repeat interventions will be required. In general, the treatment of GAD should bethought of as being intermittent.Benzodiazepine (BDZs) - The effectiveness of benzodiazepine in generalized anxietyhas been well established. This class of drugs represents the treatment of choice forlimited. Generalized anxiety because of its rapid action and the effective reduction ofinsomnia and somatic/adrenergic symptoms. There is evidence that BDZs may be more “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 97
  • Review of Treatmenteffective on some specific symptoms, particularly the somatic symptoms of arousalexisting of autonomic deregulation.Azapirones-Although the buspirone spectrum is not as broad as the BDZs, buspirone hasbeen shown to be effective in numerous patients suffering from current GAD. The firstresults of drug action usually appear in the range of two to four weeks. Buspirone may beseen as an effective anxiolytic in treatment of GAD. According to some authors,buspirone may yield a slight antidepressant activity, making it probably a very valuableoption in those cases of GAD with depressive features or high levels of ‘‘psychicsymptoms’’, i.e. worry and ruminations.Antidepressants- Imipramine was more effective than diazepam on psychic anxietysymptoms, with the benefit of an additional significant antidepressant effect. Trazodonewas also found to be effective. It remains a little used, but potentially useful drug forGAD. Its hypnotic properties may be welcome where Insomnia is a major problem. Otherantidepressants are being tested in GAD. There has been recent evidence in favour of theeffectiveness of venlafaxine in GAD.Other Drugs- Abecarnil displays affinity for BDZ receptors and shows promisinganxiolytic effects in initial clinical studies. Although the data are encouraging, thequestion remains whether, at well-tolerated doses that are unlikely to produce significantwithdrawal, the drug is clinically adequate in GAD (Connor and Davidson, 1998).Psychotherapy- The aim of cognitive-behaviour therapy is to help the patient recognizeand alter patterns of distorted thinking and dysfunctional behaviour and, by theseprocesses, to alleviate the suffering and interference that the disorder causes. Cognitive-behaviour treatment includes cognitive therapy, behaviour therapy and relaxation. A “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 98
  • Review of Treatmentrange of relaxation techniques are available, among others Schultz’s autogenic training,Jacobson’s progressive relaxation, Caycedian sophrology. Relaxation has to be presentedas a skill to be learned through repeated daily practice. Use of complementary and alternative medicine has increased over the pastdecade. A variety of studies have suggested that this use is greater in persons withsymptoms or diagnoses of anxiety and depression. Data support the effectiveness of somepopular herbal remedies and dietary supplements; in some of these products, particularlykava, the potential for benefit seems greater than that for harm with short-term use inpatients with mild to moderate anxiety. Inositol has been found to have modest effects inpatients with panic disorder or obsessive-compulsive disorder. Physicians should notencourage the use of St. Johns wort, valerian, Sympathyl, or passionflower for thetreatment of anxiety based on small or inconsistent effects in small studies. Although theevidence varies depending on the supplement and the anxiety disorder, physicians cancollaborate with patients in developing dietary supplement strategies that minimize risksand maximize benefits.165 In this article, the supplements purported to ameliorate anxiety disorders aredivided into three groups: herbal supplements, nutritional supplements, andneurotransmitter and hormonal precursors. These divisions are somewhat arbitrary in thatall of the products are taken orally, are available over the counter, are marketed with avariety of health claims on the Internet, and are justified by their purported ultimateeffects on the neurotransmitter systems that mediate worry, stress, or fatigue symptoms inpatients with anxiety disorders. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 99
  • Review of Treatment Information on supplements that claim to be useful or commonly used for anxietydisorders was obtained from several Internet sites, particularly 166 167 168Medline via Ovid was used to search for clinical trials, guidelines, and meta-analyses thattested or asserted the effectiveness of these preparations in the treatment of patients withdiagnosed anxiety disorders. Because use of herbal remedies is increasing, it is importantfor family physicians to ask their patients about such use. Encouraging data support theeffectiveness of some of these products, particularly kava and, to a lesser degree, inositol.Although none of these supplements or products are free of adverse effects, the potentialfor benefit seems greater than the risk of harm.169Management plan for GADManagement strategies will always vary from one individual to the next depending on theindividuals particular problems. Generally, however, the management of GAD usuallyinvolves:1. Ongoing assessment of the disorder2. Education about the nature of anxiety, tailored to each individuals needs. Some basicinformation about anxiety is provided in Section 4.1 and includes:* The nature of anxiety* Management of the fight-or-flight response* The role of hyperventilation in anxiety3. Training in strategies for controlling anxiety and reducing stress:* Relaxation methods and breathing control to reduce physical symptoms of anxiety* Planning short-term activities which are relaxing or distracting (particularly thoseactivities that have been helpful in the past). “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 100
  • Review of Treatment* Using structured problem solving to help individuals deal with stressors that maycontribute to worry (Section 4.6.3).* If individuals avoid situations or activities because of anxiety, encourage them togradually confront the things they fear using graded exposure (Section 4.3.4).* Regular physical activity or exercise is often helpful.4. Individuals are to be encouraged to avoid using sedative medication or alcohol tocontrol their anxiety.5. Referral or specialist consultation if symptoms persist for longer than three monthsdespite the above measures170 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 101
  • MethodologyMethodologyAssessment and Treatment Planning: If you are sure you understand everything that is going on, You are hopelessly confused. —Walt The successful translation of a basic or clinical observation into a new treatmentof disease is rare in an investigator’s professional life, but when it occurs, the personalthrill is exhilarating and the impact on society may be substantial. Progress in almostevery field of science depends on the contributions made by systematic research; thusresearch is often viewed as the cornerstone of scientific progress. As defined by Kazdin(1992, 2003), a recognized leader in the field of research, methodology refers to theprinciples, procedures, and practices that govern research, whereas research design refersto the plan used to examine the question of interest. “Methodology” should be thought of as encompassing the entire process ofconducting research (i.e., planning and conducting the research study, drawingconclusions, and disseminating the findings). By contrast, “research design” refers to themany ways in which research can be conducted to answer the question being asked. The Study of abnormal patterns of individual’s behavior, stress and anxieties hasinterested psychologists as much as Psychiatrists and other scientific field workers.Assessment of such behavior patterns by means of observation, interview and self-reporttechnique of inventory and questionnaire, has been very common in clinical TrialsResearch Approach. In the present study the investigators object is to study “Evaluation of the efficacyof Ksheerabala taila nasya and Amalaki siddha ksheera dhara in chittodvega” The “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 102
  • Methodologyeffect of therapies administered is determined by the finding out the difference betweenthe baseline data of the parameters of Subjective and objective to the after treatment data.Study design The study design selected for the present study is- A simple Randomized Pre-Posttest single clinical observational trial. In this Nasya and Ksheera dhara is given to thetrial group. Study is undertaken in single group.Sample Size In Sample size for the present Study were thirty Patients Suffering fromChittodvega as per the pre set criteria. Patients were randomly selected.Duration of the study Both the treatments Nasya and Ksheera Dhara are administered after givingsthanika Abhyanga with Ksheera bala taila is given for 12days observing the patientclosely and recording the events and data. After completion of Shodhana procedures anda follow up period of 15 days were observed.Source of Data Patients suffering from chittodvega (GAD) were selected from the Post GraduateStudies and Research Centre, Department Of Panchakarma, OPD and IPD of ShriD.G.M.A.M.C. & Hospital, Gadag, Karnataka. Demographic data and disease specificdata are collected according to the case record form given in the appendix.Selection CriteriaThe cases were selected as per the pre set Inclusion and Exclusion criteria. a) Inclusion Criteria Patient aged above 10 years and above 60 years are included “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 103
  • Methodology Patients with symptoms like restlessness or keyed up, easily fatigue, difficulty in concentration, irritability, muscle tension, sleep disturbance. Patients who are fit for dhara and nasya karma. b) Exclusion criteria Patient aged below 10 years and above 60 years is excluded. Patients with neurasthenia burn out, malaise and post viral syndrome. Patients with other systemic diseases were excluded eg: hyperthyroidism, cardiac disease. Patients who are unfit for nasya and dhara karma • Pregnant women • Lactating mother.Criteria for Diagnosis The signs and symptoms of chittodvega mentioned in Ayurveda and signs andsymptoms mentioned in Generalized Anxiety Disorder were the main basis of diagnosis.In addition, the criteria lay down for Anxiety disorders by Diagnostic and Stastical 171manual of Mental Disorders (DSM IV) , ICD-10172 classification of mental andbehavioral Disorders F41-1, WHO, Geneva also followed. And another importantcriteria’s included in this study are Hamilton Anxiety scale173, Zung174 Anxiety ratingscale, MAAS175 ((Mindfulness Attention Awareness Scale), General Health questionnaire(GHQ-28) 176 and Ayurvedic Health Assessment (AHA) 177 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 104
  • MethodologyParameters used for the diagnosis of the disease DSM IV ICD 10The diagnostic and statistical manual of mental disorders (DSM IV) (A) Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about number of events or activities (such as work or school performance). (B) The person finds it difficult to control the worry. (C) The anxiety and worry are associated with three ( or more) of the following 6 symptoms( with at least some symptoms present for more days than not for the past 6 months): 1) restlessness of feeling keyed up or on edge 2) being easily fatigue 3) difficulty concentrating or mind going blank 4) irritability 5) muscle tension 6) sleep disturbance ( difficulty falling or staying asleep, or restless unsatisfying sleep) The focus of anxiety and worry is not confined to the features of an Axis I disorder. The anxiety worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 105
  • Methodology The disturbance is not due to the direct physiological effects of a substance (eg. A drug of abuse, a medication) or a general medical condition (e.g. hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder or a pervasive developmental disorder these symptoms are considered for the diagnosis of the diseaseICD 10(1) Palpitations or pounding heart, or accelerated heart rate.(2) Sweating.(3) Trembling or shaking.(4) Dry mouth (not due to medication or dehydration).(5) Difficulty breathing.(6) Feeling of choking.(7) Chest pain or discomfort.(8) Nausea or abdominal distress (e.g. churning in stomach).(9) Feeling dizzy, unsteady, faint or light-headed.(10) Feelings that objects are unreal (derealization), or that ones self is distant or "not really here" (depersonalization).(11) Fear of losing control, going crazy, or passing out.(12) Fear of dying.(13) Hot flushes or cold chills.(14) Numbness or tingling sensations.(15) Muscle tension or aches and pains.(16) Restlessness and inability to relax.(17) Feeling keyed up, or on edge, or of mental tension. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 106
  • Methodology(18) A sensation of a lump in the throat, or difficulty with swallowing.(19) Exaggerated response to minor surprises or being startled.(20) Difficulty in concentrating, or mind going blank, because of worrying or anxiety.(21) Persistent irritability.(22) Difficulty getting to sleep because of worrying. The international classification of diseases in that generalized anxiety disorder ismentioned in F. 41 there are 24 symptoms mentioned out of any of the six or moresymptoms are present then the patient will fall under the criteria for this trial.Data collection A proforma was prepared incorporating all signs and symptoms of chittodvegaand GAD mentioned in Ayurvedic classics and modern literature. It also includesAshtasthana pareeksha, Nidana and Samprapti Ghatakas. At the outset, detailed clinicalhistory was taken and detailed physical examination was done on the basis of theproforma.Evaluation of Patient: History and Physical ExaminationObservations and Questions for the clinician to address: 1. Appearance, attitude and motor activity – dress, grooming, signs of illness and behavior. 2. Mood and affect - range, liability appropriateness 3. Speech – quality 4. Thought – Content - Delusion, suicidal & homicidal ideations, obsessions “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 107
  • Methodology 5. Thought – Form- Circumstantiality, tangentiality, loosening of associations, flight of ideas, derealization, depersonalization, dissociative events, concreteness, grandiosity. 6. Perception - Hallucinations and illusions 7. Complete mental state examination 178 • Alertness • Orientation to time, place, and person • Concentration • Recent and remote memory • Language (e.g., naming objects, repeating phrases), • Calculations • Construction • Insight and judgmentMENTAL AND EMOTIONAL STATE Try to make some initial assessment of the patients intelligence and mental andemotional state, but recognize that this initial impression may be inaccurate. As well asthe history, observation is important in assessing the emotional state. Thus an anxiousperson may be restless, with wide palpebral fissures and sweating palms. Is the anxietyreasonable in the circumstances, or is the patient over anxious? In depression, thelowered mood, inability to concentrate or make decisions, mental retardation, apathy oreven obvious misery may be clearly evident; however, these features may not be obvious,although they are important and lead to physical symptoms179 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 108
  • MethodologyAdministration of therapy: Nasya karma- The materials used for Nasya: 1. Ksheera bala taila101 2. Ksheera bala taila planeKsheera bala taila Nasya: ksheerabala taila 101 and plane ksheerabala taila waspurchased from the marketMaterials or tools for therapeutic intervention:To administer nasya, electric vaporizer, gas stove, one big vessel, one small vessel, onerubber dropper, kidney tray, , two cotton gauze, bandage cloth, and Ghrita were used.Poorva karma: All the patients were asked to be in the hospital with in 8 am. Every patient wasgiven Sthanika Abhyanga and Swedana just prior to the nasya karma, the abhyanga wasdone with ksheerabala taila in the face, neck, and shoulders and Swedana with the help ofelectric vaporizer after covering the eyes with wet cotton swab to the region whereabhyanga was done.Pradhana karma: Ksheera bala taila nasya was administered to all patients using rubber dropper,after making the patient to lie in supine position and slightly bend his head backwards byputting a pillow beneath his/her neck and administer the medicine by introducing thenozzle of the dropper into the right nostril by closing the left nostril by the left hand ofthe physician and slowly pour the medicine drop by drop, quantity of the medicine shouldbe 8 drops in each nostril and ask the patient to inhale the medicine gently same “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 109
  • Methodologyprocedure was repeated in the left nostril also, and during this time rubbing of the palmand foot of the patient should be done to avoid the shock, then after some time ask thepatient to spit the medicine along with sputum into a kidney tray that which accumulatesin his or her throat.The same procedure was repeated for 7 days, the time of administration, andComplications were noticed if any.Paschat karma: After nasya the patient should be administered Gandusha followed bydhoomapana to remove the excessively accumulated Kapha. For Gandusha lavanodakawhich is slightly warm is used and for dhoomapana varti prepared out of triphaladi Ghritaand haridra choorna is used. Patient was advised with all the pathyapathya to bemaintained in the nasya Pariharakala. Amalaki Siddha ksheera dhara: Saindhava Amalaki kashaya. Ksheera. Haridra choorna Rasnadi choornaMaterials or tools for therapeutic intervention:Dhara table, gas stove, dhara pathi, dhara Patra, two big vessels, cloth piece, rasnadichoorna “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 110
  • MethodologyPreparation of the medicine: To prepare amalaki kashaya here followed the padavasesa method of preparationfor that 350gms of dried amalaki along with that 8 part water ,boiled and reduced to 1/4thand that prepared kashaya is kept for cooling and after that mixed with 750ml of boiledmilk when it was in Luke warm.Poorva karma: All the patients were asked to be in the hospital with in 8A.M. It is advisable forthe better results that the hair of the patient on the scalp should be removed if the patientpermits. Gentile massage in the fore head and neck has been carried out with ksheerabalataila Then ask the patient to lie in the supine position on the dhara pathi and Dhara Patrashould be brought 4 inches above his head. The eyes and ears should be covered withcotton so that, Liquid may not enter in eyes. His head rests in slightly elevated position,preferably on wooden piece. A minimum of two attenders were used to collect themedicine and maintain the temperature by heating to prolong the treatment for prescribedtime.Pradhana karma In this allow the medicine to pour slowly into the forehead an uniform flowshould be maintained, along with that slowly move the dhara Patra in order to maintain acircular flow of the medicine. The duration of the karma is in arohan karma starting with30mins on the first day 35min,40mins and 45mins in the 2nd ,3rd and 4th day respectively,then again reduce in the same frequency in which it is increased and comes to 30mins onthe final day i.e. 7th day. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 111
  • MethodologyPaschat karma After the completion of the dhara karma wrap the head and face with a cottoncloth neatly and then apply the rasnadi choorna in the head in order to maintain thetemperature and advice the patient to follow the normal pathyapathya mentioned forPanchakarma The clinical study was taken up with the proper understanding of the classicalexplanation observation and management of chittodvega. Among the causes of thechittodvega more emphasis and the clinical symptoms of the chittodvega are taken intoconsideration.Assessment of clinical Response Subjective and objective parameters were made out to assess the clinical responsein the total number of patients. All the grades declared for the assessment of subjectiveand Objective parameters are clearly mentioned along with the case sheet in the annex.1. Subjective Parameters: Certain gradations and declarations are made about thedata, which are as follows- Table No: 9 Showing the Roopa 0f ChittodvegaSl.No Roopa of chittodvega BT AT AF1. Restlessness or feeling keyed up or on the edge.2. Being easily fatigue3. Difficulty in concentration.4. Irritability.5. Muscle tension6. Sleep disturbance 0- None 1- Mild 2- Moderate 3- Severe “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 112
  • MethodologyIn this the roopa of chittodvega is taken and each roopa is given grading 0-3 dependingon the severity of the symptoms and it is calculated before treatment, after treatment andafter follow up.2. Objective Parameters 1. Hamilton anxiety rating scale 2. Zung anxiety rating scale 3. GHQ-28(General health questionnaire) 4. MAAS (Mindfulness Attention Awareness Scale) 5. Ayurveda mental health assessment. 1. Hamilton anxiety rating scale The HAM-A (Hamilton Anxiety Scale)is a widely used interview scale thatmeasures the severity of a patients anxiety, based on 14 parameters, including anxiousmood, tension, fears, insomnia, somatic complaints and behavior at the interview is takenin this trial to evaluate the effect of the treatment and also to assess the prognosis of thedisease, for that grading is given for all the 14 parameters like grade 0 is given if any ofthe symptoms are absent in a particular parameter,grade1if mild symptoms are presentthen grade 1, grade 2 if moderate symptoms are present, grade 3 if symptoms are severe,grade 4 if the symptoms are very severe and grossly disabling and finally the total scorewas calculated by computing the scores of a all the 14 parameters, if it is 18 then thepatient will be having mild anxiety, if it is 25 or below then moderate anxiety ,and 30 if itis severe anxiety “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 113
  • Methodology Table No: 10 Showing Hamilton Anxiety Rating Scale:No. Item BT AF01. Anxious mood: Worries, anticipation of the worst, fearful anticipation, irritability.02. Tension: Feeling of tension, fatigability, startle response, moved to tear easily, trembling, restlessness, inability to relax.03. Fears: Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.04. Insomnia: Difficulty in falling a sleep, broken sleep, unsatisfying sleep, fatigue on waking, dreams, nightmares, night terrors.05. Intellectual (Cognitive): Difficulty in concentration, poor memory.06. Depressed mood: Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.07 Somatic (Muscular): Pain and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone08. Somatic (Sensory): Tinnitus, blurring of vision, hot and cold flushes, feeling of weakness, picking sensation.09. Cardiovascular Symptoms: Tachycardia, palpitation, pain in chest, throbbing of vessels, fainting feelings, missing beat.10. Respiratory Symptoms: Pressure or constriction in chest, choking feeling, sighing, dyspnea.11. Gastrointestinal Symptoms: Difficulty in swallowing, wind, abdominal pain, burning sensation, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.12. Genitourinary Symptoms: Frequency of maturation, Urgency of micturation, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.13. Autonomic Symptoms: Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, rising of hair.14. Behavior at interview: Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, belching, brisk tendon jerks, dilated pupils, exophthalmoses.Signs and symptoms mentioned in Hamilton scale were assessed byadopting the following scoring system.Degree of anxiety &Pathological condition Scoring None 0 Mild 1 Moderate 2 Severe 3 Severe, grossly disabling 4 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 114
  • Methodology Table No: 11 Showing Zung Self-Rated Anxiety ScaleSl.No STATEMENT None Some A A BT AF or a of the good good little time of the part of the time of the time time1. I feel more nervous and anxious than 1 2 3 4 usual.2. I feel afraid for no reason at all. 1 2 3 43. I get upset easily or feel panicky. 1 2 3 44. I feel like Im falling apart and going 1 2 3 4 to pieces.5. I feel that everything is all right and 1 2 3 4 nothing bad will happen.6. My arms and legs shake and tremble. 1 2 3 47. I am bothered by headaches neck and 1 2 3 4 back pain.8. I feel weak and get tired easily. 1 2 3 49. I feel calm and can sit still easily. 1 2 3 410. I can feel my heart beating fast. 1 2 3 411. I am bothered by dizzy spells. 1 2 3 412. I have fainting spells or feel like it. 1 2 3 413. I can breathe in and out easily. 1 2 3 414. I get feelings of numbness and tingling 1 2 3 4 in my fingers and toes.15. I am bothered by stomach ache or 1 2 3 4 indigestion.16. I have to empty my bladder often. 1 2 3 417. My hands are usually dry and warm. 1 2 3 418. My face gets hot and blushes. 1 2 3 419. I fall asleep easily and get a good 1 2 3 4 nights rest.20. I have nightmares. 1 2 3 4 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 115
  • Methodology Zung anxiety scale is also a scale that is widely used to assess the anxiety in which there are 20 parameters and for each parameter there is a grading starting from 1 to 4 is used after grading the individual parameters the values of all the 20 parameters are computed to assess the severity of the patient, if its comes less than 50 then it is with in the normal range, if between 50-59 considered to be indicative of a person suffering from mild to moderate anxiety levels, if between 60-74 considered to be indicative of a person suffering from marked to severe anxiety levels and if the value is grater than 74 are considered to be indicative of a person suffering from extreme anxiety levels Table No: 12 Showing the General Health Questionnaire-GHQ28Sl. Have you recently Conditions B ANo T FAl Been feeling perfectly well and Better Same as Worse Much in than usual than usual worse than Good health? usual usualA2 Been feeling in need of a good Not at No than Rather Much tonic? all usual more than more than more usual usualA3 Been feeling run down and out Not at No than Rather Much of all usual more than more than Sorts? more usual usualA4 Felt that you are ill? Not at No than Rather Much all usual more than more than more usual usualA5 Been getting any pains in your Not at No than Rather Much all usual more than more than head? more usual usualA6 Been or pressure in your head? Not at No than Rather Much getting a feeling of tightness all usual more than more than more usual usualA7 Been having hot or cold spells? Not at No than Rather Much all usual more than more than more usual usual “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 116
  • MethodologySl. Have you recently Conditions B ANo T FB1 Lost much sleep over worry? Not at No than Rather Much all usual more than more than more usual usualB2 Had difficulty in staying asleep Not at No than Rather Much once you are off? all usual more than more than more usual usualB3 Felt constantly under strain? Not at No than Rather Much all usual more than more than more usual usualB4 Been getting edgy and bad- Not at No than Rather Much all usual more than more than tempered? more usual usualB5 Been getting scared or panicky Not at No than Rather Much all usual more than more than for no good reason? more usual usualB6 Found everything getting on top Not at No than Rather Much of you? all usual more than more than more usual usualB7 Been feeling nervous and Not at No than Rather Much strung-up all the time? all usual more than more than more usual usualSl. Have you recently Conditions B ANo T FC1 Been managing to keep yourself More so Same as Rather Much less busy and occupied? than usual less than than usual usual usualC2 Been taking longer over the Quicker Same as Longer Much things you do? than usual than usual longer usual than usualC3 Felt on the whole you were Better About Less well Much less doing things well? than Same as than usual well usual usualC4 Been satisfied with the way More About Less Much less satisfied Same as satisfied satisfied youve carried out your task? usual than usualC5 Felt that you are playing a useful More so Same as Less Much less than usual useful useful part in things? usual than usualC6 Felt capable of making decisions More so Same as Less so Much less about things? than usual than usual capable usualC7 Been able to enjoy your normal More so Same as Less so Much less day-to-day activities? usual usual than usual than usual “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 117
  • Methodology Sl. Have you recently Conditions B A No T F D1 Been thinking of yourself as a Not at No than Rather Much worthless person? all usual more than more than more usual usual D2 Felt that life is entirely Not at No than Rather Much hopeless? all usual more than more than more usual usual D3 Felt that life isnt worth living? Not at No than Rather Much all usual more than more than more usual usual D4 Thought of the possibility that Definite I dont Has Definitely you might make away with ly not think so crossed have yourself? my mind D5 Found at times you couldnt do Not at No than Rather Much anything because your nerves all usual more than more than were too bad? more usual usual D6 Found yourself wishing you Not at No than Rather Much were dead and away from it all? all usual more than more than more usual usual D7 Found that the idea of taking Definite I dont Has Definitely your own life kept coming into ly not think so crossed has your mind? my mind BT A- B- C- D- Total- AF A- B- C- D- Total- The general health questioner was used to assess the general healthcondition of the patient in that there is 4 sets of questions each set is having 7questions and that should be evaluated individually if it is 3 or below it isconsidered to be normal, if it is between 3-4 is considered to be having mild generalhealth problem, if it is above 4 is considered to be having severe general healthproblem. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 118
  • MethodologyTable No: 13 Showing the Mindfulness Attention Awareness Scale (MAAS) 1 2 3 4 5 6 Almost Very Somewhat Somewhat Very Almost Always frequently Frequently Infrequently Infrequently Never Sl.No Questionnaires BT AF 1. I could be experiencing some emotion and not be conscious of it until some time later. 2. I break or spill things because of carelessness, not paying attention, or thinking of something else. 3. I find it difficult to stay focused on whats happening in the present. 4. I tend to walk quickly to get where Im going without paying attention to what I experience along the way. 5. I tend not to notice feelings of physical tension or discomfort until they really grab my attention. 6. I forget a persons name almost as soon as Ive been told it for the first time. 7. It seems I am "running on automatic," without much awareness of what Im doing. 8. I rush through activities without being really attentive to them 9. I get so focused on the goal I want to achieve that I lose touch with what Im doing right now to get there 10. I do jobs or tasks automatically, without being aware of what Im doing. 11. I find myself listening to someone with one ear, doing something else at the same time 12. I drive places on "automatic pilot" and then wonder why I went there. 13. I find myself preoccupied with the future or the past. 14. I find myself doing things without paying attention. 15. I snack without being aware that Im eating. The mindfulness attention awareness scale is also a set of questioners used in this study to evaluate the mental condition of the patient it contains 15 questioners with grading starting from 1 to 6 to assess the mental condition, each item should be graded separately and the scoring has been done by simply computing the mean of 15 items, And higher score reflects the higher levels of dispositional. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 119
  • Methodology5. Ayurveda health assessment In this the sheela, chesta, achara, manah, buddhi, smrithi, Sajnajnanam, bhakthiare evaluated separately by counting the total no of patients comes under each groupbefore the treatment and after the follow up. For each group there are four grades Vizintact, moderately changed, grossly changed, and cannot be tested, this serve asdiagnostic as well as the prognostic tool.Table No: 14 showing the Ayurveda health assessmentGRADE No. of patients BT No. of patients AFIntact - -Moderately changed - _Grossly changed - -Cannot be tested - -Overall Assessment of the treatment (Improvement Criteria):Overall effect of the intervention was estimated in the following 3 categories:1. Best Responded- score below 18Hamilton Anxiety Scale, normal range of Zunganxiety scale, total absence of clinical symptoms with return to normal activities.2. Respondent- scores between 18-25Hamilton Anxiety Scale, score of 50-59 of Zungself rated Anxiety scale, marked improvement in clinical symptoms with return to normalactivities3. Not responded- Hamilton Anxiety Scale and Zung-anxiety scale being same orminimum improvement, with the presence of clinical symptoms and much difficulty toreturn to normal activities. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 120
  • Methodology“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 121
  • Master chartsOBSERVATION AND RESULTS Total 33patients were registered for this study. Out of this 3 patients wereexcluded, so their data has not been included here. The remaining 30 patients ofChittodvega fulfilling the criteria for diagnosis were treated in single group.Demographic DataTable No: 15 showing the distribution of patients by sex.Si.no Sex No of Patients Percentage1 Male 15 50%2 Female 15 50% Total 30 100%`Among 30 patients Distribution of sex was; male 15(50%) and females were 17 (50%)Figure no: 9. showing the showing the distribution of patients by sex 15 Age 10 5 Female 0Table No:16 showing the distribution of patients by AgeSi.no Sex No of Patients Percentage1 10-19 0 0%2 20-29 12 40%3 30-39 7 23%4 40-49 10 33%5 50-59 1 3.33%Among 30 patients, 12 (40%) were 2 in the age group 10-19, 7 (23%) were in the agegroup 30-39 ,10 (33%) were in the age group 40-49 and one(3.33%) patient were in agegroup 50-59 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 122
  • Master charts Figure no: 10. showing the showing the distribution patients by Age40% 10-19 yrs35%30% 20-29 yrs25%20% 30-39 yrs15% 40-49 yrs10% 5% 50-59 yrs 0% Among 30 patents none of them were from 10-19 age group, 12 (40%) from20-29 age group, 07 (23%) from30-39age group,10 (33%) from 40-49 and 1 (3.33%) from 50-59 age group Table No: 17 showing the distribution of patients by Religion S.L. No Sex No of Patients Percentage 1 Hindu 28 93.33% 2 Muslim 2 6.67% 3 Christian 0 0% 4 Others 0 0% Total 30 100% Among 30 patients, Hindus were 28 (93.33%), were Muslims were 02 (6.67%), and none were from other category among 30 patients Fig No 11: showing the distribution of patient’s Religion:30 Hindu2520 Muslim1510 5 Christian 0 Table No: 18 showing the distribution of patients by occupation S.L. No Occupation No of Patients Percentage 1 Laborer 01 3.33% 2 Student 10 33.33% 3 Executive 10 33.33% 4 Sedentary 09 30% Total 30 100% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 123
  • Master chartsAmong 30 patients, only 01(3.33) patient is labour, 10 (33.33%),were students,10(33.33%) executive and 09 (20%) were belonging to sedentary category this signifies thatthe incidence is more in working peopleFig No 12: showing the distribution of the distribution by occupation Labour 10 8 Student 6 4 Executive 2 0 Sedentar yTable No: 19 showing the distribution of patient’s by Economic statusSi.no Economic Status No. of Patients Percentage1 Poor 01 3.332 Lower middle class 09 303 Upper middle class 20 66.674 Rich 0 0Among 30 patients, 01 (3.33%) were poor, 09 (30%) Lower middle class, 20(66.67%)was Upper middle class and none were belonging to Rich categoryFig No 13: showing distribution of patients by Economical status:20 Poor15 Lower middle class10 Upper middle class 5 Rich 0Table No: 20 showing the distribution of patients by marital statusSi.no Marital status No of Patients Percentage1 Married 16 53.33%2 Unmarried 14 46.67% Total 30 100% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 124
  • Master chartsAmong 30 patients, 06 (53.33%) were married, 14 (46.67%), and 20(46.67%) wereUnmarriedFig No 14: showing the distribution of patients by marital status 16 Married 15 14 Un married 13Table No: 21 showing the distribution of patients by Ahara S.L. No AHARA No of Patients Percentage 1 Vegetarian 08 26.67 2 Mixed 22 73.33 Total 30 100Among 30 patients 08(26.67%) were vegetarian, 22(73.33%) were having mixed dietaryhabitFig No 15: showing distribution of patients by Ahara: 25 Vegetarian 20 15 10 Mixed 5 0Table No: 22 showing the distribution of patients by vihara S.L. No VIHARA No of Patients Percentage 1 Hard O2 6.67 2 Moderate 25 83.33 3 Sedentary 03 10 Total 30 100 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 125
  • Master charts Among 30 patients O2 (06.67%) were hard working, 25(83.33%) were moderately working and 3 (10%) were having sedentary life life habits Fig No 16: showing distribution of patients by Vihara:100.00% Hard80.00%60.00% Moderate40.00%20.00% Sedentary 0.00% Table No: 23 showing the distribution of patients by Agni S.L. No AGNI No of Patients Percentage 1 Samagni O5 16.67 2 Mandagni 23 76.67 3 Visamagni 01 3.33 4 Teekshnagni 01 3.33 Total 30 100 Among thirty patients 05(16.67%) were having Sama agni, 23 (76.67%) were having manda agni, 01 (3.33.66%) patient is having vishama agni and 01 (76.66%) having theekshna agni Fig No 17: showing distribution of patients by Jataragni: Samagni 80.00% Mandagni 60.00% 40.00% Visamagni 20.00% Theekshnagni 0.00% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 126
  • Master chartsTable No: 24 showing the distribution of patients by KoshtaS.L. No KOSHTA No of Patients Percentage1 Mrudu 02 6.672 Madhyama 28 93.333 Krura 00 00 Total 30 100Among thirty patients 02(6.67%) were having Mrudu Koshta, 28 (93.33%) were havingMadhyama Koshta, and none were having Krura Koshta.Fig No 18: showing distribution of patients by Koshta: 100.00% Mrudu 80.00% 60.00% Madhyama 40.00% 20.00% Krura 0.00%Table No: 25 showing the distribution of patients by NidraS.L. No NIDRA No of Patients Percentage1 Prakruta 00 00%2 Alpa 29 96.67%3 Ati 00 00%4 Diwaswapna 01 3.33% Total 30 100%Among thirty patients 00(00%) were having Prakrutha nidra, 29 (96.67%) were havingAlpa nidra, 01 patient having Diwaswapna and none were having Ati nidra.Fig No 19: showing distribution of patients by Koshta: 100.00% Prakruta 80.00% Alpa 60.00% Ati 40.00% 20.00% Diwasvapna 0.00% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 127
  • Master charts Table No: 26 showing the distribution of patients by Vyasana S.L. No Vyasana No of Patients Percentage 1 Tobacco 02 6.67% 2 Smoking O6 20% 3 Alcohol 03 10% 4 None 19 63.33% Total 30 100% Among 30 patients 02 (06.67%) were having Tobacco chewing habit, 06 (20%) were having smoking habit, 03 (10%) were having alcohol drinking habit Fig No 20: showing distribution of patients by Vyasana: Tobaco 80.00% 60.00% Smoking 40.00% Alcohol 20.00% 0.00% None Table No: 27 showing the distribution of patients by sharirika prakruti S.L. No Prakruti No of Patients Percentage 1 Vata pitta 25 83.33% 2 Vata kapha 05 16.67% 3 Kapha pitta 00 0% Total 30 100% Among 30 patients 25 (83.33%) were having vata pitta prakruti, 05(16.67%) were having vata kapha prakruti and none were having kapha pitta prakruti Fig No 21: showing the distribution of patients by sharirika prakruti100.00% Vata pitta80.00%60.00% Vata kapha40.00%20.00% Kapha pitta 0.00% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 128
  • Master chartsTable No: 28 showing the distribution of patients by Manasika PrakrutiS.L. No Prakruti No of Patients Percentage1 Satva - -2 Rajasika 22 73.33%3 Tamasika 08 26.67% Total 30 100%Among 30 patients no one is having satvika prakruti, 22(73.33%) patients were havingrajasika prakruti and 08(26.67%)of them were having tamasika prakrutiFig No 22: showing the distribution of patients by Manasika Prakruti 80.00% Thamasika 60.00% Rajasika 40.00% 20.00% Tamasika 0.00%Table No: 29 showing the distribution of Patients by satvaS.L. No Satva No of Patients Percentage1 Pravara 04 13.33%2 Madhyamaha 21 70%3 Avara 05 16.67% Total 30 100%Among 30 patients 04(13.33%) patients were having pravara satva, 21(70%) were havingMadhyama satva and o5 (16.67%) were having avara satvaFig No 23: showing the distribution of Patients by satva Pravara 80.00% 60.00% Madhyama 40.00% 20.00% Avara 0.00% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 129
  • Master charts Table No: 30 showing the distribution of Patients by Nidana S.L. No Nidana No of Patients Percentage 1 Bhaya 30 100% 2 Krodha 30 100% 3 Udvega 30 100% 4 shoka 30 100% 5 Chinta 30 100% 6 Dhana nasha 18 60% 7 Bhandhu nasha 10 33% Among the 30 patients all were having the nidana of Bhaya, Krodha, udvega, shoka and chinta i.e. (100%) and 18 patients is having the nidana of dhana nasha (60%) and 10 patients were having the nidana of bandhu nasha (33%) Fig No 24 showing the distribution of Patients by Nidana 100.00% Bhaya Krodha 80.00% Udvega 60.00% Shoka 40.00% Chinta Dhana nasha 20.00% Bandhu nasha 0.00%Table No: 31 showing the distribution of patients by Roopa of chittodvega S.L. No Roopa of No of %BT No of patients % AF chittodvega Patients BT AF 1 Restlessness 30 100% 03 10% 2 Fatigue 30 100% 00 00% 3 Difficulty in 30 100% 02 07% concentration 4 Irritability 30 100% 02 07% 5 Muscle tension 21 70% 01 03% 6 Sleep disturbance 30 100% 02 00% Among the 30 patients all were having the symptoms restlessness, fatigue, difficulty in concentration, and sleep disturbance before treatment and 21 patients were having muscle “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 130
  • Master charts tension, but after the completion of treatment only 03 (10%) patient were having the symptoms like restlessness,02 (07%) were. Having the symptom of difficulty in concentration, 02 (07%) patients were having the symptom of irritability and 01 (03%) patient was having the symptom of muscle tension; this shows the effectiveness of the treatment.Fig No 25 showing the distribution of patients by Roopa of chittodvega Restlessness 100.00% Fatigue 80.00% Poor concentration 60.00% Irritability 40.00% Muscle tension 20.00% 0.00% Sleep disturbance Table No: 32 showing the distribution of patients by Chronicity S.L. No Chronicity No of Patients Percentage 1 Up to 1 year 20 67% 2 1yrs-2yrs 09 30% 3 2yrs-3yrs 01 03% Total 30 100% Among the 30 patients 20 (67%) were having the chronocity up to 1 year,09 (30%) patients were having 1-2yrs and 1 (03%) patient were having 2-3yrs . The chronicity shows that majority of the patient seek medical attention after long duration this signifies that the GAD is not that serious a disease like depression were even the daily activities get disturbed or hampered Fig No 26 showing the distribution of patients by Chronicity 80.00% up to 1 yrs 60.00% 1yrs-2yrs 40.00% 20.00% 2yrs-3yrs 0.00% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 131
  • Master charts Table No: 33 showing the distribution of patients by Sheela S.L. No Sheela No of %BT No of patients % AF Patients BT AF 1 Intact 00 00% 28 93% 2 Moderately 26 87% 02 07% changed 3 Grossly changed 04 13% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment no body is having the sheela intact, 26 were moderately changed, 04 grossly changed and no body were cannot be tested. After the treatment 28 patients sheela become intact, 02 patients comes under moderately change. Fig No. 27 showing the distribution of patients by Sheela 100.00% Intact 80.00% Moderately changed 60.00% 40.00% Grossly changed 20.00% Cannot be tested 0.00%Table No: 34 showing the distribution of patients by Chesta S.L. No Chesta No of %BT No of patients % AF Patients AF BT 1 Intact 04 13% 28 93% 2 Moderately changed 24 80% 02 07% 3 Grossly changed 02 7% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 04 were having the chesta intact, 24 were moderately changed, 02grossly changed and no body were cannot be tested. After the treatment 28 patients chesta become intact, 02 patients comes under moderately change “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 132
  • Master chartsFig No 28 showing the distribution of patients by Chesta100.00% Intact80.00% Moderately changed60.00%40.00% Grossly changed20.00% Cannot be tested 0.00%Table No: 35 showing the distribution of patients by AcharaS.L. No Achara No of %BT No of patients % AF Patients BT AF1 Intact 16 53% 27 90%2 Moderately 13 43% 03 03% changed3 Grossly changed 01 3% 00 00%4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100%Among the 30 patients before treatment 16 were having the achara intact, 13 weremoderately changed, 01grossly changed and no body were cannot be tested. After thetreatment 27 patients achara become intact, 03 patients comes under moderately change.Fig No 29 showing the distribution of patients by Achara100.00% Intact 80.00% Moderately changed 60.00% 40.00% Grossly changed 20.00% Cannot be tested 0.00% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 133
  • Master chartsTable No: 36 showing the distribution of patients by Manaha S.L. No Manaha No of %BT No of % AF Patients BT patients AF 1 Intact 01 03% 27 90% 2 Moderately changed 27 90% 03 03% 3 Grossly changed 02 07% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 01 were having the Manaha intact, 27were moderately changed, 02grossly changed and no body were cannot be tested. After the treatment 27 patients Manaha become intact, 03 patients comes under moderately change. Fig No 30 showing the distribution of patients by Manaha Intact 100.00% 80.00% Moderately changed 60.00% 40.00% Grossly changed 20.00% Cannot be tested 0.00% Table No: 37 showing distribution of patients by Buddhi S.L. No Buddhi No of %BT No of % AF Patients BT patients AF 1 Intact 15 50% 26 87% 2 Moderately changed 13 43% 04 13% 3 Grossly changed 02 07% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 15 were having the buddhi intact, 13 were moderately changed, 02grossly changed and no body were cannot be tested. After the treatment 26 patients buddhi become intact, 04 patients comes under moderately change. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 134
  • Master charts Fig No 31 showing the distribution of patients by Buddhi100.00% Intact80.00% Moderately changed60.00%40.00% Grossly changed20.00% Cannot be tested 0.00% Table No: 38 showing distribution of patients by Buddhi S.L. No Smrithi No of %BT No of % AF Patients BT patients AF 1 Intact 17 57% 29 97% 2 Moderately changed 13 43% 01 03% 3 Grossly changed 00 00% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 17 were having the smrithi intact, 13 were moderately changed, 02grossly changed and no body were cannot be tested. After the treatment 29 patients smrithi become intact, 01 patient comes under moderately change. Fig No 32 showing the distribution of patients by Smrithi. 100.00% Intact 80.00% Moderately changed 60.00% 40.00% Grossly changed 20.00% Cannot be tested 0.00% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 135
  • Master charts Table No: 39 showing distribution of patients by Sajnajnanam S.L. No Sajnajnanam No of %BT No of patients % AF Patients BT AF 1 Intact 02 07% 27 90% 2 Moderately changed 27 90% 03 10% 3 Grossly changed 01 03% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 02 were having the Sajnajnanam intact, 27 were moderately changed, 01grossly changed and no body were cannot be tested. After the treatment 27 patients Sajnajnanam become intact, 03 patients comes under moderately change. Fig No 33 showing the distribution of patients by Sajnajnanam100.00% Intact80.00%60.00% Moderately changed40.00% Grossly changed20.00% Cannot be tested 0.00% Table No: 40 showing distribution of patients by Bhakthi S.L. No Bhakthi No of %BT No of patients % AF Patients BT AF 1 Intact 01 03% 28 93% 2 Moderately 19 63% 02 07% changed 3 Grossly changed 10 33% 00 00% 4 Cannot be tested 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 01 were having the bhakthi intact, 19 were moderately changed, 10 grossly changed and no body were cannot be tested. After the treatment 28 patients bhakthi become intact, 02 patients comes under moderately change “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 136
  • Master charts Fig No 34 showing the distribution of patients by Bhakthi100.00% Intact80.00% Moderately changed60.00% Grossly changed40.00%20.00% Cannot be tested 0.00% Table No: 41 showing distribution of patients by HAS (Hamilton Anxiety Scale) S.L. No HAS No of Patients %BT No of patients % AF BT AF 1 Normal 00 00% 30 100% 2 Mild anxiety 10 33% 00 00% 3 Severe anxiety 20 67% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment none of them were in normal range of HAS, 10 were having mild anxiety, 20 were having severe anxiety but after the follow up all the patients comes with in the normal. Fig No 35 showing the distribution of patients by HAS (Hamilton Anxiety Scale) 100.00% Normal 80.00% 60.00% Mild anxiety 40.00% 20.00% Severe anxiety 0.00% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 137
  • Master charts Table No: 42 showing distribution of patients by Zung self rated anxiety scale S.L. No Zung No of %BT No of patients % AF Patients BT AF 1 Normal 19 63% 30 100% 2 Moderate anxiety 07 23% 00 00% 3 Severe anxiety 04 13% 00 00% 4 Extreme 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment 19 were in normal range of Zung self rated anxiety scale, 07 were having moderate anxiety, 04 were having severe anxiety and none were having extreme anxiety but after the follow up all the 30 patients comes with in the normal Fig No: 36 showing the distribution of patients by Zung self rated anxiety scale100.00% Normal80.00% Moderate anxiety60.00%40.00% Severe anxiety20.00% Extereme anxiety 0.00% Table No: 43 showing distribution of patients by MAAS S.L. No MAAS No of % BT No of patients % AF Patients BT AF 1 Bad 30 100% 00 00% 2 Moderately good 00 00% 01 03% 3 Good 00 00% 28 93% 4 Extremely good 00 00% 01 03% Total 30 100% 30 100% Among the 30 patients before treatment all were in bad range of MAAS, but after the treatment 01 patient were in moderately good, 28 were good and 01 were extremely good. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 138
  • Master charts Fig No: 37 showing the distribution of patients by MAAS 100.00% Bad 80.00% Moderately good 60.00% 40.00% Good 20.00% Extremely good 0.00% Table No: 44 showing distribution of patients by GHQ- 28 S.L. No GHQ-28 No of Patients % BT No of patients % AF BT AF 1 Normal 06 20% 26 87% 2 Moderately bad 16 53% 04 13% 3 Severe 08 27% 00 00% 4 Grossly severe 00 00% 00 00% Total 30 100% 30 100% Among the 30 patients before treatment O6 were in normal range of GHQ-28, 14 were having moderate bad, 08 were having severe problem and none were having gross problem but after the follow up all the 30 patients comes with in the normal Fig No: 38 showing the distribution of patients by GHQ- 28100.00% Normal80.00%60.00% Moderately bad40.00% Severe20.00% Grossly severe 0.00% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 139
  • Master chartsTable No: 45 showing distribution of patients by Overall assessment of the resultS.L. No Results No. of patients % of the result1 Best responded 26 87%2 Respondent 04 13%3 Not responded 00 00%4 Total 30 100%The overall treatment result of 30 patient’s shows best responded in 26 patients,respondent in 04 and none of them were not respondedFig No: 39showing the distribution of patients by Overall assessment of the result100.00% Best responded 80.00% Respondent 60.00% 40.00% Not responded 20.00% 0.00% “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 140
  • Master charts Table no: 46 Showing the Roopa of ChittodvegaSl. OPD No Restlessness or Being easily Difficulty in Irritability Muscle Tension Sleep distuNo felling keyed up fatigue concentration BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT1 4341 2 1 0 2 1 0 3 1 0 2 0 0 2 0 0 3 12 5822 3 1 0 2 1 0 2 1 0 2 0 0 1 0 0 3 13 6463 3 1 0 2 1 0 3 1 0 2 1 0 2 1 0 3 14 765 3 1 0 2 1 0 3 1 0 3 2 0 1 0 0 3 25 3193 3 1 0 2 1 0 3 1 0 2 1 0 0 0 0 3 16 3218 3 1 0 2 1 0 3 1 0 1 0 0 2 1 0 3 17 3349 3 1 0 2 1 0 3 1 0 3 1 1 2 1 0 3 18 3411 3 1 0 3 1 0 2 0 1 3 1 0 1 0 0 3 19 8981 2 1 0 2 1 0 3 2 0 3 2 0 1 0 0 3 110 8982 3 1 1 2 1 0 3 1 0 2 1 0 1 0 0 3 111 10608 3 1 0 2 1 0 3 2 0 3 2 0 2 1 0 3 112 10613 2 1 0 3 1 0 2 0 0 3 1 0 2 1 0 3 113 10611 3 1 0 3 1 0 3 1 0 2 1 0 2 1 1 3 114 14330 3 1 0 2 1 0 3 1 0 2 0 0 3 1 0 3 215 14760 3 1 1 2 1 0 3 1 1 2 0 0 0 0 0 3 116 14749 2 1 0 2 0 0 3 1 0 2 0 0 0 0 0 3 017 14769 3 1 0 3 1 0 3 2 0 3 2 0 3 0 0 3 118 15087 3 2 0 3 1 0 3 1 0 2 0 0 0 0 0 3 119 15086 3 1 0 3 1 0 3 0 0 2 0 0 1 0 0 3 120 17023 3 2 0 2 0 0 3 1 0 2 1 0 0 0 0 2 121 18228 3 1 0 2 1 0 3 1 0 3 1 0 0 0 0 3 222 18203 3 1 0 2 1 0 3 2 0 3 2 0 1 0 0 3 123 19055 3 1 0 2 1 0 2 1 0 3 2 0 0 0 0 3 124 3829 3 1 0 2 0 0 3 1 0 3 1 1 0 0 0 2 125 19510 3 1 0 2 1 0 3 1 0 3 1 0 0 0 0 3 226 20196 3 2 1 3 1 0 3 1 0 2 1 0 1 0 0 3 127 23773 3 1 0 2 1 0 3 1 0 3 1 1 2 1 0 3 128 23771 2 1 0 3 1 0 2 1 0 2 1 0 1 0 0 3 129 24778 3 1 0 2 0 0 2 1 0 2 1 0 1 0 0 3 030 24780 3 2 0 2 0 0 2 1 0 2 0 0 1 0 0 2 1 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 141
  • Master charts Table no: 47 Showing the Personal HistoryS.L. OPD AHARA VIHARA AGNI KOSHTA NIDRA VYASANANo No V M H M S Sa Ma Th Vi Mr Md Kr P Al At` Dw Nn Tob Smk Alc 1 4341 - + - + - - - - + + - - - + - - + - - - 2 5822 - + - + - - + - - - + - - + - - + - - - 3 6463 - + - + - - + - - - + - - + - - + - - - 4 765 - + - + - + - - - - + - - + - - + - - - 5 3193 - + + - - - + - - + - - - + - - + - - - 6 3218 + - - + - + - - - - + - - + - - + - - - 7 3349 - + - + - + - - - - + - - + - - + - - - 8 3411 - + - + - + - - - - + - - + - - + - - - 9 8981 - + - + - - + - - - + - - + - - - - + - 10 8982 - + + - - + - - - + - - + - - - - - +11 10608 - + - + - - + - - - + - - + - - + - -12 10613 + - - + - - + - - - + - - + - - - + - -13 10611 + - - + - - + - - - + - - + - - + - -14 14330 - + - - + - + - - - + - - + - - - + + +15 14760 - + - - + - + - - - + - - + - - + - - -16 14749 - + - + - + - - - + - - + - - + - - -17 14764 - + - - + - + - - - + - - + - - + - - -18 15087 - + - + - - + - - - + - - + - - + - - -19 15086 - + - + - - + - - - + - - + - - + - - -20 17023 + + - + - - + - - - + - - + - - + - - -21 18228 + - - + - - + - - - + - - - - + - - + -22 18203 - + - + - - + - - - + - - + - - - - + +23 19055 - + - + - - + - - - + - - + - - + - - -24 3829 + - - + - - + - - - + - - + - - - - - -25 19510 + - - + - - + - - - + - - + - - + - - -26 20196 - + - + - - + - - - + - - + - - - - + -27 23773 - + - + - - + - - - + - - + - - - - + -28 23771 + - - + - - + - - - + - - + - - + - - -29 24778 - + - + - + - - - + - - + - - + - - -30 24780 - + - + - - - + - - - + - + - - - - - + “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 142
  • Master charts Table no: 48 Showing the Nidana of Chittodvega. S.L. OPD Nidana No No Bhaya Krodha Udvega Soka Chinta 1 4341 + + + + + 2 5822 + + + + + 3 6463 + + + + + 4 765 + + + + + 5 3193 + + + + + 6 3218 + + + + + 7 3349 + + + + + 8 3411 + + + + + 9 8981 + + + + + 10 8982 + + + + + 11 10608 + + + + + 12 10613 + + + + + 13 10611 + + + + + 14 14330 + + + + + 15 14760 + + + + + 16 14749 + + + + + 17 14764 + + + + + 18 15087 + + + + + 19 15086 + + + + + 20 17023 + + + + + 21 18228 + + + + + 22 18203 + + + + + 23 19055 + + + + + 24 3829 + + + + + 25 19510 + + + + + 26 20196 + + + + + 27 23773 + + + + + 28 23771 + + + + + 29 24778 + + + + + 30 24780 + + + + +“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 143
  • Master charts Table no: 49 Showing the Demographical Data.SL OPD Age in Sex Religion Occupation Economical SNo No Yrs M F H M C O L ST EX SE P LM U1. 4341 33 - + - + - - - - + - - - +2. 5822 25 + - + - - - - + - - - - +3. 6463 22 + - + - - - - + - - - - +4. 765 31 + - + - - - - + - - - - +5. 3193 34 - + + - - - + - - - + -6. 3218 25 + - + - - - - + - - - - +7. 3349 21 + - + - - - - + - - - +8. 3411 45 - + + - - - - - - + - +9. 8981 24 + - + - - - - - + - - +10. 8982 29 + - + - - - - - + - - +11. 10608 33 - + + - - - - - - + - +12. 10613 52 - + + - - - - - - + - - +13. 10611 33 - + + - - - - - + - - - +14. 14330 40 + - + - - - - - + - - +15. 14760 41 - + + - - - - - - + - +16. 14749 46 - + + - - - - - - + - - +17. 14764 41 - + - + - - - - - + - +18. 15087 32 - + + - - - - - - + - - +19. 15086 25 + - + - - - - + - - - - +20. 17023 48 - + + - - - - - + - - - +21. 18228 23 + - + - - - - + - - +22. 18203 28 + - + - - - - - + - - - +23. 19055 36 + - + - - - - - + - - +24. 3829 48 - + + - - - - - - + - +25. 19510 46 - + + - - - - - - + - +26. 20196 40 - + + - - - - - + - - - +27. 23773 42 + - + - - - - - + - - - +28. 23771 22 - + + - - - - + - - - - +29. 24778 28 + - + - - - - + - - - - +30. 24780 24 + - + - - - - + - - - - + “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 144
  • Master charts Table no: 50 Showing the Hamilton Anxiety Rating ScaleSl.No OPD No Total Scoring BT AF 1 4341 36 03 2 5822 21 03 3 6463 19 02 4 765 21 02 5 3193 19 02 6 3218 18 02 7 3349 31 04 8 3411 27 03 9 8981 23 02 10 8982 38 03 11 10608 18 02 12 10613 42 04 13 10611 43 05 14 14330 40 03 15 14760 48 05 16 14749 46 03 17 14764 40 03 18 15087 40 03 19 15086 18 02 20 17023 39 02 21 18228 39 05 22 18203 43 05 23 19055 44 05 24 3829 42 03 25 19510 34 04 26 20196 33 03 27 23773 18 01 28 23771 37 03 29 24778 27 03 30 24780 19 02“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 145
  • Master charts Table no: 51 Showing the Zung Anxiety Rating Scale Sl.No OPD No Total Scoring BT AF 1 4341 46 23 2 5822 38 22 3 6463 47 20 4 765 37 20 5 3193 33 20 6 3218 35 22 7 3349 39 22 8 3411 43 22 9 8981 42 24 10 8982 36 23 11 10608 35 23 12 10613 56 23 13 10611 63 24 14 14330 49 24 15 14760 60 29 16 14749 61 24 17 14764 53 27 18 15087 53 22 19 15086 32 23 20 17023 53 27 21 18228 60 28 22 18203 55 27 23 19055 50 29 24 3829 57 29 25 19510 53 26 26 20196 45 22 27 23773 37 20 28 23771 34 22 29 24778 43 22 30 24780 35 23“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 146
  • Master chartsTable no: 52 Showing the Mindfulness Attention Awareness Scale (MAAS) Sl.No OPD No Total Scoring Mean BT AF BT AF 1 4341 39 90 2.60 6.00 2 5822 30 72 2.00 4.80 3 6463 27 77 1.80 5.13 4 765 25 88 1.67 5.87 5 3193 29 87 1.97 5.80 6 3218 31 83 2.07 5.53 7 3349 38 83 2.53 5.53 8 3411 25 88 1.67 5.87 9 8981 21 84 1.40 5.60 10 8982 36 82 2.40 5.47 11 10608 30 82 2.00 5.47 12 10613 35 85 2.33 5.67 13 10611 35 78 2.33 5.20 14 14330 32 86 2.13 5.73 15 14760 46 84 3.07 5.60 16 14749 29 87 1.97 5.80 17 14764 37 86 2.47 5.73 18 15087 46 88 3.07 5.87 19 15086 29 84 1.97 5.60 20 17023 35 86 2.33 5.73 21 18228 33 82 2.20 5.47 22 18203 24 83 1.60 5.57 23 19055 30 85 2.00 5.67 24 3829 33 85 2.20 5.67 25 19510 28 81 1.87 5.40 26 20196 27 85 1.80 5.67 27 23773 28 88 1.87 5.87 28 23771 36 81 2.40 5.40 29 24778 33 84 2.20 5.60 30 24780 27 84 1.80 5.60 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 147
  • Master charts Table no: 53 Showing the GHQ-28Sl.No OPD No A B C D BT AF BT AF BT AF BT AF 1 4341 3 1 7 2 5 2 3 1 2 5822 3 1 5 2 4 2 3 1 3 6463 2 1 4 3 5 2 4 0 4 765 2 1 5 2 5 2 4 1 5 3193 3 1 5 3 4 2 3 1 6 3218 4 1 7 4 5 3 4 0 7 3349 3 1 6 3 5 3 3 0 8 3411 2 0 6 3 5 3 3 0 9 8981 3 1 4 2 4 2 2 0 10 8982 3 1 6 2 5 3 2 0 11 10608 3 1 5 2 4 3 2 0 12 10613 3 0 5 2 4 2 2 1 13 10611 3 0 5 2 5 2 2 2 14 14330 1 0 5 2 5 2 2 2 15 14760 3 1 6 3 5 2 2 1 16 14749 2 0 6 2 4 2 2 1 17 14764 3 1 5 2 3 2 3 1 18 15087 3 0 6 3 5 2 3 1 19 15086 3 1 5 2 3 2 5 1 20 17023 4 1 6 2 4 2 3 0 21 18228 2 0 4 1 3 2 3 1 22 18203 2 0 4 1 3 2 3 0 23 19055 4 2 7 4 4 3 3 0 24 3829 4 0 5 2 4 2 3 1 25 19510 3 0 5 2 3 1 3 0 26 20196 4 1 6 3 3 1 3 0 27 23773 4 1 6 3 3 1 3 2 28 23771 3 0 4 2 4 1 3 0 29 24778 3 0 5 1 3 1 2 0 30 24780 2 0 4 0 2 1 1 0“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 148
  • Results Table no: 54 Showing the Statistical Study of the TrialSl.No Parameters Mean Net SD SE T- P- Re Mea value value marks BT AT n 1. Restlessness or 2.833 0.366 2.466 0.5074 0.0926 26.63 <0.001* HS feeling keyed up 2. Being easily 2.266 0.0333 2.233 0.430 0.0785 28.44 <0.001* HS Fatigue 3. Difficulty in 2.766 0.3 2.466 0.507 0.092 26.80 <0.001* HS concentration 4. Irritation 2.4 0.2 2.2 0.550 0.1005 21.89 <0.001* HS 5. Muscle tension 1.1 0.033 1.06 0.907 0.165 6.424 <0.001* HS 6. Sleep 2.9 0.233 2.66 0.479 0.087 30.57 <0.001* HS disturbance 7. HAS 32.1 3.066 29.03 9.49 1.734 16.74 <0.001* HS 8. Zung self rated 46.0 23.733 22.26 8.098 1.478 15.06 <0.001* HS anxiety scale 9. MAAS 31.8 83.93 52.13 6.621 1.208 43.15 <0.001* HS 10. GHQ-28-A 2.9 0.6 2.3 0.702 0.128 17.96 <0.001* HS 11. GHQ-28-B 5.3 2.23 3.066 0.739 0.135 22.71 <0.001* HS 12. GHQ-28-C 4.033 2.0 2.033 0.718 0.131 15.51 <0.001* HS 13. GHQ-28-D 2.8 0.6 2.2 1.06 0.194 11.34 <0.001* HS* = More highly significant To know on which parameters the combined efficacy of treatment procedure ismore effective, the statistical analyses is done by using paired t-test, by assuming that thetreatment procedure is same in all the parameters.From the analyses all parameters shows more highly significant as P<0.001.The priority wise treatment procedure is most highly significant in MAAS, Sleepdisturbance, Being easily fatigue, difficulty in concentration, Restlessness or feelingkeyed up, GHQ-28-B, Irritation, GHQ-28-A, Hamilton Anxiety Rating Scale (HAS), “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 149
  • ResultsGHQ-28-C, Zung Self Rated Anxiety Scale, GHQ-28-D and Muscle tension respectively(By comparing t-value).Conclusion: The study shows this treatment procedure is not more effective on Muscletension and rest of all the parameters the procedure shows most effective (By comparing t-value). The further study can be conducted from the samples who wereworking under severe stress or any other work pressure. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 150
  • Discussion DISCUSSION Every research is having one aim or progress, to share that knowledge with the fruitfuland unselfish way, discussion is very important or a key part of the research. There is no exception; it is very important to every researcher that the methodsadopted, clinical data collection, observation and declaring the results is too presentedsystematically in the Discussion. In my clinical study “Evaluation of theEfficacy of ksheerabala taila nasya and amalaki siddha ksheera dhara in chittodvegaw.s.r.t generalized anxiety disorder” the following is discussed-Conceptual study: • Probable mode of action of Nasya karma and Dhara karma Nasya karma Chittodvega is a Vata Pradhana Manasika vyadhis, nasya is chosen for clinicaltrial because Nasa is the easiest route to administer the medicine into the head andAcharya are also stated that the mind is situated in the head. In the clinical trial, selectingthe nasya procedure and its role in chittodvega chikitsa is stated and discussed inobjective chapter.Discussion on Nasya drug:Avarthita thailamThe literal meaning of avarthi thaila is to rotate, or repeat. As in Rasa shastra there isconcept of “mardhana guna vardhanam” being there particularly more efficacious, thesame is true for avarthi in take in thaila kalpana. in general the entire procedure of snehaKapha involves three components Viz oil, decoction and paste of herbs. The basic aim ofthe procedure being to acquire the liquid soluble essence in to the oil while preparing the “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 151
  • Discussiondecoction most of the volatile oil gets evaporates and only water soluble active principlescomes into the final product. The decoction inters acts with the oil and emulsion likestage is reached when the complex alkaloids get enlarged with the glycoside Easters ofthe fatty acids. The paste comes directly in contact with the oil. The fat-solublecomponents of herbs and even some volatile oils mixed in to oils. The essentialcomponents coming in contact of per unit oil is more and the oil is thus formed is moreconcentrated in case of reprocessingDiscussion on mode of action of nasya drug: The absorption of the drugs is carried out in three media they are by general bloodcirculation, after absorption through mucous membrane. The direct pooling into Venussinus of brain via inferior ophthalmic veins and next one absorption directly in to thecerebra spinal fluid. Apart from the small emissary veins entering cavernous sinuses ofthe brain, a pair of venous branch emerging from alliance will drain into facial vein. Inaddition neither the facial vein nor the ophthalmic veins have any venial values so thereare more chances of blood draining from facial vein into the cavernous sinus in thelowered head position. The nasal cavity directly opens with the frontal maxillary and sphenoid air sinusepithelial layer is also continuous through out then the momentary retention of drug innaso pharynx. Medicine causes oozing as drug material enters into air sinus, which arerich with blood vessels entering the brain and remaining through the existing foramens inthe bones there are better chances of drug transportation in this path.The drug administered enters the Para nasal sinus especially frontal and sphenoid sinusi.e., Shringataka where the ophthalmic veins and the other veins spread the sphenoid “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 152
  • Discussionsinus are in close relation with intra-cranial structures. Thus there may be a so farundetected route between air sinuses and cavernous sinuses enabling the transudation offluids. As a whole, the mentioning of the Shringataka in this context seems to be morereasonable.Discussion on Nasya Procedure: Ksheera bala taila (101) which is mentioned in the in Ashtanga hrudaya which ishaving the properties of balya rasayana, medhya and Vata shamaka property. For nasyamadhyama matra of brumhana nasya is used in this trial ie.8 drops in each nostril for themaximum of seven days. The time schedule of nasya is fixed in the morning because all the stress andanxiety related hormones are at their peek in the morning hours between 7 to 8 am.Nasya-Poorva Karma Before performing the nasya karma, ksheerabala taila is used for the Sthanikaabhyanga and nadi sveda is done. After the nasya karma, dhoomapana by the vartiprepared out of haridra choorna and go Ghrita and gandoosha by ushna lavanambu aregiven to prevent the excessive accumulation of kapha.Abhyanga: Mode of action The Abhyanga is acting over the skin, which is a seat of Vata. The skin is not onlya seat of Vata but also for Lasika (lymph). Thus the lymphatic drainage will be the primeeffect of Abhyanga. Lymph possesses a relatively large amount of the amino acidtryptophan, especially when compared with the dietary intake. It likewise has a largeamount of albumin (protein), glucose and histaminase (breaks down histamine).Hypothetically, blood amino acids like tryptophan increase after massage. An increase in “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 153
  • Discussionplasma tryptophan subsequently causes a parallel increase in the neurotransmitter(chemical between nerve endings) at motor end plates, and serotonin, which is made fromtryptophan. Serotonin has been implicated in several psychiatric diseases with low levelsof metabolite found by researchers in depression and schizophrenia. Giving albuminbound protein tryptophan to the brain with proper diet and massage should theoreticallyincrease brain serotonin. In practice the abhyanga relieves systems like those caused byserotonin depletion, anxiety, irritability, etc. Swedana: Mode of actionMechanism of action of Swedana will be discussed under the following headings: • Application of heat, • Physical effect of massage and • Therapeutic effects of medicaments used. Application of heat- The effects of any kind of thermal therapy are due to the increase in the circulation and local metabolic process with the relaxation of the musculature. Application of heat causes relaxation of muscles and tendons, improves the blood supply and activates the local metabolic processes. Physical effect of the massage: - It stimulates the sensory nerve endings thereby producing relaxation. It produces a hyperemic effect causing the arterioles to dilatate and thereby achieving more circulation. Also, the venous and lymphatic return is assisted. Massage causes movements of the muscles thereby accelerating the blood supply. Therapeutic effects of the medicaments used: - Drugs in oils and other lipid soluble carriers can penetrate the epidermis. The movement is slow, particularly. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 154
  • Discussion through the layers of cell membranes in the stratum corneum. But once the drug reaches the underlying tissues it will be absorbed into the circulation. Placing a drug in a solvent that is lipid soluble can assist its movement through the lipid barriers Dhara: Dhara is one among the moordhini taila and it is one of the main treatment inkeraleeya Panchakarma, and it is also widely practicing in the management of themanasika vyadhis, like unmada, chittodvega, ,Anidra etc. In the clinical trial, selectingthe dhara procedure and its role in chittodvega chikitsa is stated and discussed inobjective chapter.Discussion on Dhara-Drug Amalaki kashaya is taken along with the ksheera for dhara treatment , .amalaki ishaving the property of tridosha shamaka mainly vata shamaka and the fruit gavecytokinine-like substances identified as zeatin, zeatin riboside and zeatin nucleotide;suspension culture gave phyllembin. Phyllembin exhibits CNS depressant andspasmolytic activity, potentiates action of adrenaline and hypnotic action of Nembutal.Discussion on Procedure of Dhara: The time schedule of dhara is fixed in the morning hours as the hormonesresponsible for the anxiety and stress are at their peek in morning hours , the action ofdhara can be of two ways one is due to the absorption and the other theory is due to itsmechanical effect. Sthanika abhyanga is given with Ksheera bala taila in the fore head to increase theblood circulation and after the dhara karma rasnadi choorna is applied over the scalp to “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 155
  • Discussion prevent the cold due to dhara procedure. The procedural effect of Shirodhara itself seems to produce a relaxation response irrespective of the medicament used. In almost all the methods of relaxation like yoga, meditation etc. similar general principles prevail. Probable Mode of Action of Shirodhara: The shirodhara therapy is extensively used for the alleviation of many ailments, especially in psychic ailments but used in some of the somatic ailments too. Though clinical efficacy of Shirodhara is proved, the nature of its action is very complex. Therefore, to understand the mode of action of Shirodhara is a difficult task. The mind, body and spirit are intimately connected, and shirodhara by calming the stressful mind, relaxes the entire physiology. Imbalance of Prana, Udana and Vyana Vayu, Sadhaka Pitta and Tarpaka Kapha can produce stress and tension. Siro dhara re- establishes the functional integrity between these three subtypes of Dosha through its mechanical effect. Sahasrara Chakra is known to be the seat of pituitary and pineal gland. As we know, the pituitary gland is one of the main glands of the endocrine system. Siro dhara stimulates the pituitary gland by its penetrating effect, which helps in bring the hormonal balance. The Shirodhara is effective in following two ways: 1) Therapeutic effect of medicaments 2) Procedural effect of the process1. Therapeutic Effect of Medicaments: 180 The therapeutic effect is partially attributed to the medicaments viz. the medicated oil, Ghrita, butter milk, Kwatha etc. which exchange through the fine pores present over “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 156
  • Discussionthe scalp and forehead. As it is said that the effect and potencies of the articles ofAbhyanga, Snana, Udvartana, etc. which are digested by the skin, enter into the internalorganism through the orifices present in the skin.The concept of percutaneous absorption described in the modern physiology can besummed up as follows: There are three possible routes of absorption. The pilo sebaceous follicles playsome part in absorption of many compounds. The trans-follicular absorption, the route ofpenetration is through the follicular pores to the follicles and then to the dermis via thesebaceous gland. The permeability of the cells of the sebaceous gland is greater than thatof granular layer of the epidermis. 2. Procedural Effect of the Process: The procedural effect of Shirodhara itself seems to produce a relaxation responseirrespective of the medicament used. In almost all the methods of relaxation like yoga,meditation etc. similar general principles prevail. One involves efforts and concentrationfocusing attention upon a particular object or sensation and the other a simplewatchfulness and observation allowing fine flow of perception. In Shirodhara, patients feel relaxation both – physically as well as mentally.Relaxation of the frontalis muscle tends to normalize the entire body and achieve adecrease in activity of sympathetic nervous system with lowering of heart rate,respiration, oxygen consumption, blood pressure, the brain cortisone and adrenaline level,muscle tension and probably an increase in α - brain waves. It strengthens the mind andspirit and this continues even after the relaxation. Corresponding to different levels and “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 157
  • Discussionpowers of consciousness there are different nerve plexuses and glands in humanorganisms. Special stimulation of different nerve plexus, glands and brain cellsaccompanies mental function of different type at different levels. Thus, the Hindu theoryof Chakras – center of consciousness – is based on this fact. According to Ayurveda, the forehead and head are areas of many vital spots –Marma, which have got very important place in the body. Marmas are very importantpoints where Soma (Jala/Kapha), Vata, Agni (Pitta), Raja, Satva, Tama and Bhutatma’sare present.181 In some cases, even slight stimulation of such Marma may have beneficialeffect on the body, due to their connection with higher centers. Shirodhara makes the patient to concentrate on this area, by which the stabilityarrives in the mind function and the patient may feel more comfortable (relaxed). Andmoreover, it is having tridoshahara effect. So, in Ayurveda out of the three types ofchikitsa Bahirparimarjana has also important place and many systemic diseases are curedby using external methods of the therapy and Shirodhara carried out with takra is one ofthem. Shirodhara is done directly on the head, so it may be considered as good forrelieving the diseases caused by stress and strain as well as other mental factors. According to yogic science among the seven charkas two are located in the headi.e. Ajna chakra and Sahasrara chakra. It can be hypothesized that with Dhara therapythese two charkas are getting stimulated and activating the hypothalamus. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 158
  • DiscussionDiscussion on the Disease Chittodvega-Vis-À-Vis GAD Acharya Charaka has included Chittodvega as a separate Manovikara whichproduced by two Manasa Dosha i.e. Raja and Tama. This is indicates that Chittodvega isa minor psychic disorder with various type of somatic manifestation. In anxiety disorders,there are various types of classification, which are presented many disorders related withanxiety. All those disorders have various type of somatic manifestation. It indicates thatChittodvega and anxiety disorder both have a similarity in this respect. Chittodvega canmanifest as a causative or aggregative emotional factor of various somatic disorders i.e.Atisara. Anxiety disorders are also caused as well as aggravated by various emotionaldisturbances. In this regard Chittodvega can be presented any subtype of anxiety disorders.Actually, all sub types of anxiety disorders are conversion of basic anxiety. Hence, in thisStudy all subtypes of anxiety disorders are diagnosed according to DSM IV criteria.Discussion on clinical study: Source of Data A total 30 patients suffering from chittodvega fulfilling the inclusion criteriawere studied. The observations and the results as well as statistical analysis of these arementioned below.• Number of patients registered in study - 33• Number of patients completed the study - 30• Number of dropout - 03 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 159
  • Discussion • Discussion on the observations: Sex - Among the 30 patients of this study 50% patients were females; and 50% were males this indicates that sex is having no significant role in this study as the ratio of males and females are equally affected. Age - Among 30 patents none of them were from 10-19 age group, 12 (40%) from20- 29 age group, 07 (23%) from30-39age group,10 (33%) from 40-49 and 1 (3.33%) from 50-59 age group, from this we can say that middle age people are more affected when compare to children’s and old age people because of their constant exposure to stressful environment. Religion - Among 30 patients of this study maximum 28 (93.33%) of patients were belonged to Hindu community 02 (6.67%), from Muslim .. This may due to the random selection of the samples. Marital Status - Among the 30 patients maximum of 16 (53.33%) patients were married and14 (46.67%) are unmarried people Higher incidence in married people especially in females was noted may be due to possibility of conflicts in the family. Socio-Economic Status - Maximum of 20 (66.67%) patients belongs to upper Middle class, 01 (3.33%) from poor class, 09 (30%) from lower middle class. This shows predominance of chittodvega in Upper middle class may be due to working group facing events of financial loss or adjusting the needs in the family. Occupation - Maximum of 10 (33.33%) patients were executive, 10 (33.33%) were students, 01 (3.33%) patients were labours; and 09 (20%) were belongs to sedentary habits. In the clinical study, occupation plays important role as the working“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 160
  • Discussion executives and particularly working women gets a bad situations and atmosphere around the place of working makes them to be prone to chittodvega. Chronicity - Among the 30 patients 20 (67%) were having the chronocity up to 1 year,09 (30%) patients were having 1-2yrs and 1 (03%) patient were having 2-3yrs . The chronicity shows that majority of the patient seek medical attention after long duration this signifies that the GAD is not that serious a disease like depression were even the daily activities get disturbed or hampered Nidana182- Among the 30 (100%) patients, all patient is having the nidana of bhaya, Krodha, udvega shoka and chinta, 18 (60%) patients were having the nidana of dhananasha bandhunasha as nidana for 10 (33%) the dosas pertaining the mind rajas and tamas, are responsible for the above said nidanas and Acharya Susruta also states that Manasika disease are produced by these nidanas. Mental disease is generated by the non fulfillment of the desired objects and by succumbing to the hated. As a social being we are unable to fulfill our desires and we are compelled to accept things that we dislike both these cause frustration and mental stress and are conducive to mental disease. According to Ayurveda improper union of time, objects and action is the cause of all the disease thus the improper union of the mind with its objects namely, “the thinkable” and the improper action of the mind are conducive to the mental diseases. From a slightly different perspective, etiology can be classified into 3 viz contact of objects that cannot be assimilated, error of consciousness and transformation. Error of consciousness is the term used for erroneous action prompted by the lapse of intellect, will power and memory that produce bad result. In fact most of the etiological factors will come under this head. In the context of the diseases“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 161
  • Discussion especially those based in mind the .in that Bhaya it is generally known as fear it is related to tamo guna and aggravates vata, Krodha is the feature of rajo guna produced either due to vata or pitta dosa it is produced when one could not acquire the desired one and sammoha follows it. Soka is caused due to rajas and tamas along with vata and chinta is also vata Pradhana dosa caused due to rajas and tamas leads to various psychological conditions. .( page 16-17 concept of mind) 183 Diet - Among 30 patients 08 (26.67%) were vegetarian, 22 (73.33%) were having mixed dietary habit this also signifies that the disease is more predominant in non vegetarians as this may be due to increase of rajasika guna and also use of more katu, tikta, kashaya and amla rasas in their food and consumption of more spicy things and use of animal mamsa. Dietary restriction becomes inevitable part of any treatment it aims at framing a plan of advisable food stuffs those suits the disease and treatment schedule here also no exception that means necessary modifications are permitted according to treatments to be done, keeping a general plan of restricted diet here are some list wholesome and un wholesome foods, cereals like green gram, wheat, shashtika rice, vegetables like ash gourd ,snake gourd ,amaranth, fruits like mango, grapes jack fruit and ghee, meat of tortoise fresh milk are wholesome foods recommended and unwholesome foods like, black gram, bitter gourd, leafy vegetables, fruits occurring in late summer, alcohol, bitter spicy food in compatible food and meat. . Vihara - Among 30 patients O2 (06.67%) were hard working, 25(83.33%) were moderately working and 3 (10%) were having sedentary life habits . vihara plays major role in mental disorders, vihara like sitting, sleeping, oil massage, inhalation of“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 162
  • Discussion fumes cold daub etc are indicate in mental disease as these gives mental relaxation, keeping awake at the night, starvation, suppression of thirst, physical exercise etc should be avoided as these causes aggravation of vata.( page 193 concept of mind) Agni - In the present study, maximum of 23(77%) patients were having manda agni and01 (03%) patients were having vishama agni,1 (03%) having theekshna agni and 5 patients having sama agni The provocation of Vata leads to Visama Agni. Acarya Caraka mentions various Manasa Bhava i.e. Cinta, Soka, Bhaya, Krodha etc. which impacts on Agni and leads to Manda Agni (Ca. Vi. 2/9). The relation of type of agni and its role in bringing changes in mental faculties in causing the mental disorders need an extensive research, definitely manasika bhavas causes variation in types of Agni level. Nidra - Among thirty patients 00(00%) were having Prakrutha nidra, 29 (96.67%) were having Alpa nidra, 01 (03%) patient having Diwaswapna and none were having Ati nidra. Nidra is mainly caused by tamo guna and sleshma, apart from that due to mental exertion, physical exhaustion and in some diseases. Anidra is caused due bhaya, Krodha, shoka, chinta, udvega etc.this disorder is characterized by frequent awakening or early morning awakening and the patient may have felling or not having rested properly , it will not cause severe problem in GAD as compared to other serious mental conditions like depression, anxiety neurosis etc .where the REM is more severe .Among my patients most of them were working in shifts .Shift workers in particular appear more prone to digestive ailments, constipation, obesity, anxiety, depression etc disorders and during the waking hours such individuals may“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 163
  • Discussion suffer fatigue, reduced alertness, anxious mood, irritability etc. the main symptoms of GAD. Vyasana - Among 30 patients 02 (06.67%) were having Tobacco chewing habit, 06 (20%) were having smoking habit, 03 (10%) were having alcohol drinking habit and 19 (63.33%) of them had no habits this signifies that vyasan is not having much influence in causing the chittodvega in this study but the vyasan like alcohol and smoking plays significant role in causing the disease. Manasika Prakruti - Among 30 patients no one is having satvika prakruti , 22(73.33%)patients were having rajasika prakruti and 08(26.67%)of them were having tamasika prakruti this suggests that the persons with rajasika prakruti are more prone to this disease as chittodvega is disease caused due to rajas and tamas Satva - Among 30 patients 04(13.33%) patients were having pravara satva, 21(70%) were having Madhyama satva and 05 (16.67%) were having Avara satva When Alpa satva (inadequate mental make up or personality) person indulges in or is afflicted by manobhighata and Pragnaparadh , it results in the imbalance of manas dosha rajah and tama leading to the vitiation at bodily level by affecting dosas , along with the vitiation of Agni & depletion of Ojas which present the Psychosomatic presentation of disease. Discussion on Clinical Parameters: The effect of the Ksheerabala taila (101) nasya and amalaki Siddha ksheera dhara shows significant results in all the parameters used - Effect on restlessness - In case of restlessness highly significant relief on symptom of restlessness the p value is <0.001 and 87% improvement clinically. In case of 30“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 164
  • Discussion patients all the patient possess with the symptoms of restlessness before the treatment but after the treatment the symptom persist with only 3 patients Effect on Fatigue - In case of fatigue before the treatment all the 30 patients possess with this symptom but the treatment shows highly significant relief on the symptom of fatigue the p value is <0.001 and 98% improvement clinically. After the treatment none of the patient persists with the symptom. Effect on Difficulty in concentration - In case of difficulty in concentration the study shows statistically highly significant with p value <0.001 and 88% improvement clinically. In case of 30 patients all the patient possess with the symptoms of difficulty in concentration before the treatment but after the treatment only 3 patient were having the symptom. Effect on Irritability - In case of Irritability the study shows statistically highly significant with p value <0.001 and 92% improvement clinically. In case of 30 patients all possesses with the symptoms of difficulty in concentration before the treatment but after the treatment only 3 patients were having the symptom. Effect on Muscle tension- In case of muscle tension the statistical value shows highly significant with p value <0.001 and 97% improvement clinically In case of 30 patients all the patient possess with the symptoms of muscle tension before the treatment but after the treatment symptom persist only in 1 patient. Effect on Sleep disturbance - In case of sleep disturbance the statistical value shows highly significant with p value <0.001 and 92% improvement clinically In case of 30 patients all the patient possess with the symptoms of Sleep disturbance but after the treatment the symptom persist only in 2 patients.“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 165
  • Discussion Effect on HAS - In case of HAS the statistical value shows highly significant with p value <0.001 and 90% improvement clinically 30 patients of clinical trial comes under normal range of Hamilton Anxiety Scale. Effect on Zung self rated anxiety scale - In case of Zung self rated anxiety scale the statistical value shows highly significant with p value <0.001 and 48% improvement clinically. Effect on MAAS - In case of MAAS the statistical value shows highly significant with p value <0.001 and 62% improvement clinically Effect on GHQ-28 - In case of GHQ-28 the statistical value shows highly significant with p value <0.001 and 64 % improvement clinically.Discussion on the 0verall assessment of the resultThe overall assessment will be calculated by considering the following three grading • Best responded • Respondent • Not respondedBest Responded- score below 18 Hamilton Anxiety Scale, normal range of Zung anxietyscale, total absence of clinical symptoms with return to normal activities.Respondent- scores between 18-25Hamilton Anxiety Scale, score of 50-59 of Zung selfrated Anxiety scale, marked improvement in clinical symptoms with return to normalactivitiesNot responded- Hamilton Anxiety Scale and Zung-anxiety scale being same orminimum improvement, with the presence of clinical symptoms and much difficulty toreturn to normal activities “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 166
  • Discussion• In case of Hamilton anxiety scale before the treatment there were no patients below the range of 18, between 18-25 range 10 (33%) patients are there and 20 (67%) patients are above the level of 30• In case of Zung anxiety self rated scale before the treatment 19 (63%) patients were with in the normal range i.e. below 50, 07 (23%) patients between the range of 50-59 i.e. with moderate anxiety, 04 (13%) patients with in the range between 60-74 and no patients above the range of 74 i.e. Severe anxiety• In case of clinical symptoms all the 30 patients were having symptoms like restlessness, fatigue, irritability, difficulty in concentration, sleep disturbance and 21 (70%) patients were having the symptom muscle tension.• After the treatment all the 30 patients comes under the normal range of HAS and Zung self rated anxiety scale where as in case of clinical symptoms only 26 (87%) patient got complete relief ,04 (13%) patients were responded well and none were not responded.• The criteria taken for the assessment of the result Hamilton anxiety scale and Zung self rated anxiety scale shows differed reading before treatment but after the treatment the value are almost equal this may be due to the difference in the application of the two scales when we compare both the criteria’s .• General observation- Maximum patients were good at personal care as GAD is a minor psychic disease. There was not much disturbance in the higher mental functions. Attitude of most of the patients was found co-operative in order to hope for the better solution of their condition. Most of the patients were watching TV, which indicate that television was not providing proper mental relaxation. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 167
  • ConclusionCONCLUSION From the detailed conceptual compilation, critical review, clinical observations and discussions the following conclusions can be drawn-1. Chittodvega is a diseased condition related to mind caused due to rajas and tamas.2. Among various psychological disorders described in Ayurveda, Chittodvega is the one which can be correlated clinically to Generalized Anxiety Disorder.3. Generalized anxiety disorder is the most common health problem in the present world due to the stress, life style, sedentary habits, excessive worry, fear etc. It not only affects the patient mentally but physically also.4. Anxiety and anxiety disorder have been discussed with up to date modern Perspective. Generalized anxiety disorder is studied with special reference to Chittodvega. Various theories regarding etiology of Generalized Anxiety Disorder, its pathogenesis, symptoms and differential diagnosis are discussed in details. Various psychotherapy and drugs used at present are also described.5. The disease does not show any severe problems in the beginning, due to this the patients will be less bothered or give less attention to the symptoms of the disease and that itself leads to more complication in the latter stage because it may occur as a manifestation of a primary psychiatric disorder or secondarily to either the medical illness or the medications prescribed for treatment (Harrison).6. Chittodvega or GAD is that common a disease that all most every individual will meet or experience at least once in their life either in severe or minor forms, but if it persist for a long time then patient should seek for medical attention because if it “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 168
  • Conclusion persist for more duration it will lead to several disabling mental conditions such as, anxiety neurosis, depression etc.7. The scales used Hamilton anxiety scale, Zung self rated anxiety scale, MAAS, etc plays significant role for the diagnosis of the disease as well as to assess the therapeutic effect.8. The incidence of the disease is noted high in the population age group between 20- 40 years in this trial that shows the disease is more associated with working people and those who were more exposed to the stress full conditions.9. The therapies used in this trial brumhana nasya with ksheera bala taila(101) and amalaki Siddha ksheera dhara shows significant results in the management of the disease.10. Observation and analysis of the30 patients has been presented and the results obtained from Patients who complete the course of therapy, have been presented in Tabular form projecting the effect of therapy on sign and symptoms of Generalized Anxiety Disorder effect on Hamilton Anxiety Rating Scale, Brief Psychiatry rating Scale and effect on various Manasbhava are also summarized11. The therapies used in this trial along with counseling plays major role in the present study in case of the management of the disease chittodvega..12. The further research is necessary to establish this treatment modality adopted here in this trial and also should be more concentrated on the areas where the occupational stress, sedentary life styles etc factors that influence the disease. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 169
  • Conclusion13. Since the study was carried out with limited budget and time, the results of this study provides enough scope to future research scholars in the field of Ayurveda in general and Manasaroga in particular to work in this direction.14. Cognitive behavior therapy plays important role in the management of anxiety disorders according to modern psychiatry where as in Ayurveda , Achara Rasayana, Daivavyapasraya chikitsa is also indicated in manasika vikaras like chittodvega, apasmara, unmade etc. but rationality of these treatment modalities need to applied and put forth for research makes to understand their value. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 170
  • SummarySUMMARY Chittodvega is a disease of mind caused due to rajas and tamas the generalizedanxiety state is here closely comparing with chittodvega which is mentioned by AcharyaCharaka in the vimana sthana As per the WHO predictions, at 2020 anxiety disorders and depressivedisorders will be in the top rank order of Disease Burden for 18 leading Countries (TheGlobal Burden Of Disease – WHO 2001); which are related to lifestyle and behavioralpatterns. In Chittodvega, when the mind is afflicted with anxiety, fear, agitation etc.thisleads to worry apprehension, depression, psychological arousal as anger, irritability andultimately lead to disturbance in personal, familial and social harmony.Anxiety disorders are one among the most prevalent psychiatric condition in the worldThe thesis entitled the “Evaluation of the efficacy of ksheerabala taila nasya andAmalaki siddha ksheera dhara in chittodvega w.s.r.t Generalized anxiety disorder”consists of seven parts.• Introduction• Objectives• Review of Literature• Methodology• Observation and Results• Discussion• Conclusion and summary “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 171
  • SummaryIntroduction: This part consists of the general description of health and relevance ofChittodvega and generalized anxiety disorders. In this part, discussion on chittodvega iscovered briefly and selection of samshodhana for this study is discussed. This part is alsoConsists of discussion about lacuna in current Knowledge and Proposed or formulatedHypothesis of this study is discussed briefly.Objectives: This part consists of brief description of types of life style which causesChittodvega, before the putforthing the objectives. After considering the clinicalparameters, four objectives were discussed.Review of Literature: Historical review deals with the historical aspects relatedto nasya karma. Etymology and definition of nasya, indication and Contra indicationsexplained in a glimpse on utility of nasya karma- nasya karma in various conditionsobtained from several texts. Dhara karma was studied as procedure, observation during procedure and brieflydiscussed about a review on current physiology. Conceptual study of chittodvega includes Etymology, definitions, Nidana,Lakshana, Samprapti, Upadrava, Upashayanupashaya, Pathyapathya and Psychologicalcorrelation to generalized anxiety disorders at appropriate context. Drug review explainsthe properties of drugs used for nasya (bala) and dhara (amalaki)Methodology: The materials and methods adapted for the study are described here.This chapter deals with the• Protocol of the study Vs objective of the study• Inclusion and exclusion criteria for the patients• Method of administration of nasya karma “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 172
  • Summary• Method of administration of dhara karma.• Intervention and criteria of assessmentObservations and Results: The observation made on demographic incidence of age, sex, habits etc arePresented in the form of Tables and Graphs. The results of the clinical study arePresented with master charts and statistical analysis in the form of tables with briefnarrations.Discussion: The conceptual part of nasya karma and dhara karma and its effect onChittodvega are explained. Clinical data is discussed in detail. The result obtained inClinical study, as well as observations in it is discussed with relevant arguments.Conclusion and Summary: The conclusion of whole clinical study and the effect ofnasya and dhara in this study are explained in this chapter. Limitation of study and furtherscope for study is also discussed briefly.This humble effort is just a curtain raiser for more valuable and deep studiesIn summary, summarized the whole thesis. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 173
  • BibliographyBibliography1) www.who.com http://www.generalized/anxiety/disorders.asp.2) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Vimana Sthana, Chapter 6, Sloka-5,Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 2543) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 12, Sloka-8, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 79.4) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 12, Sloka-7, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 79.5) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Sutra Sthana Chapter 11, Sloka-6, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 183.6) Laurence.L.Brunton Edited Pharmacological Basis Of Therapeutics By Goodman And Gillman chapter 1, Eleventh Edition Reprint 2006 Pub:Mc Graw Hill Medical Publications. New Delhi Page No:77) Ashta Vaidyan Vayaskara N.S. Mooss Edited, Ayurvedic treatments of Kerala dhara kalpa, edition reprint 1946, Pub: Vaidyasarathy Kottayam, PP- 40.8) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 09, Sloka-89-92,Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 722.9) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Vimana Sthana, Chapter 8, Sloka-151,Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 286.10) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 21-22, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 554-555.11) Pt. Parasurama Sastri Vidyasagar Edited Sarangadhara Samhita Uttara Khanta Chapter 8 Sloka-2 Third Edition 1983Pub: Orientalia. Post Box No.32 Gokul Bhawan, K-37/109 Gopal Mandir Lane, Varanasi 221001 Page No- 339 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 174
  • Bibliography12) Pt. Parasurama Sastri Vidyasagar Edited Sarangadhara Samhita Uttara Khanta Chapter 8 Sloka-11 Third Edition 1983Pub: Orientalia. Post Box No.32 Gokul Bhawan, K-37/109 Gopal Mandir Lane, Varanasi 221001 Page No-34113) Pt. Parasurama Sastri Vidyasagar Edited Sarangadhara Samhita Uttara Khanta Chapter 8 Sloka-24 Third Edition 1983Pub: Orientalia. Post Box No.32 Gokul Bhawan, K-37/109 Gopal Mandir Lane, Varanasi 221001 Page No- 34214) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 31, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 554-55615) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 5, Sloka- 68, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 4216) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka-36, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 55617) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 24, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 55518) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-90, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72219) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-107, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72320) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 5, Sloka-49, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 4121) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 5, Sloka- 20-26, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 3922) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Sutra Sthana Chapter 20, Sloka-24, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 292. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 175
  • Bibliography23) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-92, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72224) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Sutra Sthana Chapter 20, Sloka-2, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No-287.25) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-96-97, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72326) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Vimana Sthana, Chapter , Sloka-5,Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 28227) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-97, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72328) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Sutra Sthana, Chapter 29, Sloka- 6 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-22329) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Sutra Sthana Chapter 20, Sloka-16, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 29030) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Sutra Sthana, Chapter 29, Sloka- 16 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-22531) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 43, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 55632) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Sutra Sthana Chapter 20, Sloka-9, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 289. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 176
  • Bibliography33) Pt. Parasurama Sastri Vidyasagar Edited Sarangadhara Samhita Uttara Khanta Chapter 9 Sloka-10 Third Edition 1983Pub: Orientalia. Post Box No.32 Gokul Bhawan, K-37/109 Gopal Mandir Lane, Varanasi 221001 Page No- 34834) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 25, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 55535) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Sutra Sthana Chapter 20, Sloka-21, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 291.36) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-104, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 723.37) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Sutra Sthana Chapter 20, Sloka-18-20, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 290.38) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 21-22, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 55539) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-98, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72340) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Sutra Sthana, Chapter 29, Sloka- 16 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-22641) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-106-108, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72342) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Sutra Sthana Chapter20, Sloka-22, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 291.43) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Chikitsa Sthana Chapter 40, Sloka- 21 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 554 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 177
  • Bibliography44) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Sutra Sthana Chapter20, Sloka-19-20, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 290.45) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-103, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72346) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 30, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 55647) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-108, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72348) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 31, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 55649) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-106, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72350) Vaidya Jadvaji Jrikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 1, Sloka-51, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 68551) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Sutra Sthana, Chapter 29, Sloka- 18 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-22652) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-109-110, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 72353) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 49-50, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 55754) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-111-112, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 723 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 178
  • Bibliography55) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 2, Sloka-22, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 69056) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Sutra Sthana, Chapter 29, Sloka- 2 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-22357) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 21-22, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 554-55558) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Chikitsa Sthana, Chapter 40, Sloka- 40, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 55659) Sri Brahma Sankara Misra edited Bhavaprakasa, Poorva khanda, Chapter 14, Sloka- 8 edition reprint 2004, Pub: Chaukambha Sanskrit Sansthan Varanasi, PP-89860) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 1, Sloka-108-113, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 43.61) Vaidya Haridasa Sridhar Kasture Edited Ayurveda Panchakarma Vignana Chapter 2 Sloka 196(Dharakalpa) Eleventh Edition 2008 Pub:Shri Baidyanath Ayurveda Bhavan Ltd. Naomi Allahabad. Page no: 13062) Vaidya Haridasa Sridar Kasture Edited Ayurveda Panchakarma Vignana Chapter 2 Sloka 197(Dharakalpa) Eleventh Edition 2008 Pub: Shri Baidyanath Ayurveda Bhavan Ltd. Naomi Allahabad. Page no: 13063) K.V Krishnana Vaidyan and S Gopalapilla Edited Sahasrayogam ( Malayalam ) Dhara kalpam Chapter Sloka- 18 , Twenty sixth Edition 2006Pub: Vidyarambham Publishers Mullakkal Alappuzha, Kerala Page No: 47864) K.V Krishnana Vaidyan and S Gopalapilla Edited Sahasrayogam ( Malayalam ) Dhara kalpam Chapter Sloka- 22 , Twenty sixth Edition 2006Pub: Vidyarambham Publishers Mullakkal Alappuzha, Kerala Page No: 47965) Vaidya Haridasa Sridar Kasture Edited Ayurveda Panchakarma Vignana Chapter 2 sloka 198(Dharakalpa) Eleventh Edition 2008 Pub:Shri Baidyanath Ayurveda Bhavan Ltd. Naomi Allahabad. Page no:13066) K.V Krishnana Vaidyan and S Gopalapilla Edited Sahasrayogam ( Malayalam ) Dhara kalpam Chapter Sloka- 13 , Twenty sixth Edition 2006Pub: Vidyarambham Publishers Mullakkal Alappuzha, Kerala Page No: 476 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 179
  • Bibliography67) Sir Monier Williams Edited Sanskrit English Dictionary Edition Reprint 1993 Pub: Motilal Banarsidass Publishers Pvt. Ltd New Delhi Page No: 395.68) Sir Monier Williams Edited Sanskrit English Dictionary Edition Reprint 1993 Pub: Motilal Banarsidass Publishers Pvt. Ltd New Delhi Page No: 192.69) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Uttara Tantra, Chapter 39, Sloka- 77 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 666.70) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Nidana Sthana, , Chapter 5, Sloka- 43 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-377.71) Ah .Ni. 5/4971 Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Nidana Sthana Chapter 5, Sloka-49, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 484.72) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Nidana Sthana, , Chapter 6, Sloka- 15 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-380.73) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Uttara Tantra, Chapter 61, Sloka- 3 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 799.74) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Nidana Sthana Chapter 7, Sloka78, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 63875) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Nidana Sthana, , Chapter 8, Sloka- 9 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-386.76) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Uttara Tantra, Chapter 57, Sloka- 3 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 784.77) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Nidana Sthana Chapter 7, Sloka-79, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 638. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 180
  • Bibliography78) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Nidana Sthana Chapter 6, Sloka-2, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 485.79) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Nidana Sthana, , Chapter 6, Sloka- 3 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-378.80) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 9, Sloka-20, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 46981) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Uttara Sthana Chapter 4, Sloka-30, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 792.82) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 20, Sloka-11, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 113.83) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Nidana Sthana, Chapter 1, Sloka-35, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 20284) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Nidana Sthana, , Chapter 5, Sloka- 31 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-376.85) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Nidana Siddhi Sthana, Chapter 7, Sloka-6, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 22386) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Uttara Tantra, , Chapter 9, Sloka- 5 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-676.87) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 24, Sloka-105, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 58788) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Uttara Tantra, Chapter 61, Sloka- 8 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 800. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 181
  • Bibliography89) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Uttara Tantra, Chapter 61, Sloka- 6 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 799.90) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Uttara Tantra, Chapter 10, Sloka- 2 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-681.91) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Nidana Sthana, Chapter 8, Sloka-4, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 22692) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 16, Sloka-9, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 52793) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 11, Sloka-45, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 76.94) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Uttara Tantra, Chapter 40, Sloka- 21-22, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 78495) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Uttara Tantra Chapter 6, Sloka-52, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 800.96) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 17, Sloka-30, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 53497) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha Sharera Sthana, Chapter 3, Sloka- 15, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 39298) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Sutra Sthana Chapter 61, Sloka- 3 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 185.99) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 22, Sloka-40, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 124 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 182
  • Bibliography100) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Nidana Sthana Chapter 3, Sloka-25, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No-787-788.101) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Sharera Sthana Chapter 10, Sloka- 51 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 392.102) Prof. Yadunandana Upadhyaya Edited Madhava Nidana Vol 2 Chapter 68 Sloka 7, Thirtieth Edition 2001 Pub: Chaukambha Sanskrit Sansthan K-37/116, Gopal Mandir Lane Post Box No.1160, Varanasi- 221001 Page No- 384103) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Uttara Tantra Chapter 39, Sloka- 80 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 677.104) Prof. Yadunandana Upadhyaya Edited Madhava Nidana Vol- 1 Chapter 2 Sloka 30, Thirtyth Edition 2000 Pub: Chaukambha Sanskrit Sansthan K-37/116, Gopal Mandir Lane Post Box No.1160, Varanasi- 221001 Page No- 105105) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 3, Sloka-76, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 405106) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Uttara Tantra Chapter 27, Sloka-15 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 660107) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Uttara Tantra Chapter 60, Sloka- 15 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 795.108) Prof.Yadunandana Upadhyaya Edited Madhava Nidana Vol 2 Chapter 68 Sloka 25, Thirtieth Edition 2001 Pub:Chaukambha Sanskrit Sansthan K-37/116, Gopal Mandir Lane Post Box No.1160, Varanasi- 221001 Page No- 392109) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Uttara Tantra Chapter 27, Sloka- 14 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 660.110) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Uttara Tantra Chapter 27, Sloka- 8 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 659 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 183
  • Bibliography111) Hari Sadasiva Sastri Paradakara Bhisagacarya Edited Astanga Hrudaya Uttara Sthana Chapter 3, Sloka-8, Edition Reprint 2007 Pub: Chaukambha Surbharati Prakashan, K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 786-787.112) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 7, Sloka-6, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 223113) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Uttara Tantra Chapter 62, Sloka- 6 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 803.114) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Indriya Sthana, Chapter 5, Sloka-18, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 362115) Beakley, B. and Ludlow, Edited The philosophy of mind. Classical problems/contemporary issues. Edition Reprint 1995 Pub: MIT Press, Cambridge, Alianza, Madrid.116) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 17, Sloka-12, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 99117) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-4, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 716118) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-3, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 716119) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Siddhi Sthana, Chapter 9, Sloka-6, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 717120) Vaidya Jadvaji Jrikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 8, Sloka-4, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 45121) Dr. Shiva Prasad Sharma Edited Astanga Samgraha Sharera Sthana, , Chapter 5, Sloka- 22 , Edition Reprint 2008 Pub: Chaukambha Sanskrit Series K-37/99, Gopal Mandir Lane Post Box No.1008, Varanasi- 221001 Page No-301. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 184
  • Bibliography122) Pt. Hara Govinda Sastri Edited Amarakosha Pradhama Khanda, Varga-4, Sloka-3, Edition Reprint 2006 Pub: Pub:Chaukambha Sanskrit Sansthan K-37/116, Gopal Mandir Lane Post Box No.1139, Varanasi- 221001123) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sharera Sthana, Chapter1, Sloka-19, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 288124) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 1, Sloka-42, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 8125) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sharera Sthana, Chapter 1, Sloka-17, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 288126) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 8, Sloka-13, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 57127) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sharera Sthana, Chapter 1, Sloka-75, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 294128) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sharera Sthana, Chapter 1, Sloka-14, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 289129) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sharera Sthana, Chapter 1, Sloka-20, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 288130) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sharera Sthana, Chapter 3, Sloka-21, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 315131) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 24, Sloka- 25, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 125132) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Nidana Sthana, Chapter 7, Sloka-4, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 222 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 185
  • Bibliography133) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 9, Sloka-5, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 468134) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Uttara Tantra Chapter 39, Sloka- 80 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 800.135) Dorland Edited Medical Dictionary ,Edition Reprinted 2004 Pub: Elsevier, A Division Of Reed Elsevier Pvt. Ltd,17-A/I,Main Ring Road, Lajpat Nagar-IV New Delhi-110 024 Page No- 519136) Harold.I.Kaplan & Benjamin.J.Sadock Edited Synopsis of Psychiatry Edition Reprint 1998 Pub: B.I.Waverly Pvt. Ltd. New Delhi Page No.211137) Harold.I.Kaplan & Benjamin.J.Sadock Edited Synopsis of Psychiatry Edition Reprint 1998 Pub: B.I.Waverly Pvt. Ltd. New Delhi Page No.211138) Harold.I.Kaplan & Benjamin.J.Sadock Edited Synopsis of Psychiatry Edition Reprint 1998 Pub: B.I.Waverly Pvt. Ltd. New Delhi Page No.212139) Harold.I.Kaplan & Benjamin.J.Sadock Edited Synopsis of Psychiatry Edition Reprint 1998 Pub: B.I.Waverly Pvt. Ltd. New Delhi Page No.212140) Harold.I.Kaplan & Benjamin.J.Sadock Edited Synopsis of Psychiatry Edition Reprint 1998 Pub: B.I.Waverly Pvt. Ltd. New Delhi Page No.217141) Harold.I.Kaplan & Benjamin.J.Sadock Edited Synopsis of Psychiatry Edition Reprint 1998 Pub: B.I.Waverly Pvt. Ltd. New Delhi Page No.217142) Harold.I.Kaplan & Benjamin.J.Sadock Edited Synopsis of Psychiatry Edition Reprint 1998 Pub: B.I.Waverly Pvt. Ltd. New Delhi Page No.217143) Harold.I.Kaplan & Benjamin.J.Sadock Edited Synopsis of Psychiatry Edition Reprint 1998 Pub: B.I.Waverly Pvt. Ltd. New Delhi Page No.218.144) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 1, Sloka- 57, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 16145) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 1, Sloka- 54, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 14 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 186
  • Bibliography146) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 11, Sloka-37, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 74.147) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sharera Sthana, Chapter 1, Sloka-128, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 298148) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sharera Sthana, Chapter 1, Sloka-102-108, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 297149) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Nidana Sthana, Chapter 7, Sloka-4, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 222150) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 11, Sloka- 31, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 73151) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Nidana Sthana, Chapter 7, Sloka-19, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 225.152) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 24, Sloka-36, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 584153) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 3, Sloka-36, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 401154) Brewrton T.D Lydiard, R.B Johnson Edited Biological Psychiatry Research Abstract Chapter 36 Edition 1995 Pub: American Psychiatric Association Page No: 281-291155) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 9, Sloka-9, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 468156) Dan J. Stein Edited Clinical Manual Anxiety Disorders Edition 1995 Pub: American Psychiatric Publishing, Inc, Wilson Boulevard Arlington, VA 22209-3901157) Dan J. Stein Edited Serotonergic Neurocircuitry in mood and anxiety disorders MRC Unit of Anxiety Disorders University of Stellenbosch, Cape Town, South Africa© 2003Martin Dunitz Ltd, a member of the Taylor & Francis. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 187
  • Bibliography158) Nicholas.A.Boon Edited Davidson’s Principles and Practice of Medicine Chapter 10, 20th Edition Pub: Churchill Livingston, Elsevier sciences India. PP-231.159) Dan J. Stein Edited Clinical Manual Anxiety Disorders Edition 1995 Pub: American Psychiatric Publishing, Inc, Wilson Boulevard Arlington, VA 22209-3901 Page No: 149-155160) Dan J. Stein Edited Serotonergic neurocircuitry in mood and anxiety disorders MRC Unit of Anxiety Disorders University of Stellenbosch, Cape Town, South Africa© 2003Martin Dunitz Ltd, a member of the Taylor & Francis.161) Dr. Stefanie Schwartz, Edited Psychoactive Herbs In Veterinary Behavior Medicine© 2005 Pub: Blackwell Publishing Professional2121 State Avenue, Ames, Iowa 50014, USA Page No-187-192162) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Sutra Sthana, Chapter 11, Sloka- 54, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 77.163) Vaidya Jadavji Trikamji Acharya Edited Charaka Samhitha Chikitsa Sthana, Chapter 1, Sloka-4-34, Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 376-378.164) E. J. L. Griez, C. Faravelli, D. Nutt and D. Zohar. Edited Anxiety Disorders- An Introduction to Clinical Anxiety Disorders- An Introduction to Clinical Management and Research Copyright © 2001 Pub: John Wiley & Sons Ltd Page No-197-200165) Am Fam Physician 2007; 76: 549-556. Copyright © 2007 American Academy of Family Physicians.166) http://www.revolutionhealth.com/drugs-treatments167) http://www.healthyplace.com/Communities/Anxiety/treatment/alternative_treatment. asp168) http://www.naturaldatabase.com.169) Ref: Copyright © 2007 by the American Academy of Family Physicians., August 15, 2007170) Gavin Andrews MD Edited Management of Mental Disorders, published by World Health Organization, Sydney. Editions in Australia, Canada, China, Italy, New Zealand and the United Kingdom, UNSW, 2007, ©2009-2010 Pages No. 266-269.171) www.psyweb.com “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 188
  • Bibliography172) http://www.who.int/classification/apps/icd/icd10/online/173) http://www.fpnotebook.com/psy86-htm174) www.psychology.com.inc175) mhtml:file://EAnxietySTD Questionnaires Self-Regulation Questionnaires Religion.mht.176) http://www.hcc.bcu.ac.uk/craig_jackson/general%20health%20questionaire%2028 pdf.177) M.G Ramu & B.S Venkataram Edited An Approach To Mental Examination Based On The Ayurvedic Concepts Edition Reprint 1981 Pub: CCRAS Monograph No-12 New Delhi.178) American Psychiatric Association: www.psych.org)171179) Michael Swash Edited Hutchison’s clinical Methods-An Integrated Approach to Clinical Practice Chapter 2 , 22nd Edition Pub: Elsevier Ltd. Page No.15180) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Uttara Tantra Chapter 9, Sloka- 9 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K-37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 803.181) Vaidya Jadavji Trikamji Acharya Edited Susruta Samhitha, Sharera Sthana Chapter 6, Sloka- 46 , Edition Reprint 2008 Pub: Chaukambha Surbharati Prakashan,K- 37/117, Gopal Mandir Lane Post Box No.1129, Varanasi- 221001 Page No- 803.182) Dr. C.R Agnives Edited Concept Of Mind Edition 2001 Section-I Concept Of Mind In Ayurveda Pub: Department Of Samhitas & Siddhantas, Vaidyaratnam P.S Varier Ayurveda College Kottakkal Kerala Page no:16-17.183) Dr. C.R Agnives Edited Concept Of Mind Edition 2001 Section-IV Concept Of Physical Ayurvedic Treatment In Mental Diseases Ayurveda Pub: Department Of Samhitas & Siddhantas, Vaidyaratnam P.S Varier Ayurveda College Kottakkal Kerala Page no:193. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 189
  • Annexure SPECIAL CASE SHEET FOR CHITODVEGA Post Graduate Research and Studies Center (Panchakarma)Shree DGM Ayurvedic Medical College, Gadag. GUIDE : DR. P. SIVARAMUDU, PG SCHOLAR: RAJESH.A.R. MD (Ayu). M.A. (San), M.A. (Psy) Co-Guide: Dr. Santosh. N. Belavadi MD (Ayu).1. Name of the patient : ____________________ SL.No O.P.D. No2. Father’s / Husband’s Name : ____________________ I.P.D. No3. Age _______ yrs. Place of Birth __________________4. Sex M F Education __________________5. Marital Status Married ( ) Unmarried ( )6. Religion Hindu ( ) / Muslim ( ) / Christian ( ) / Others ( )7. Occupation Labour ( ) Student ( ) Executive ( ) Sedentary ( )8. Economical Status Poor ( )/ Lower Middle ( ) / Upper Middle ( )/ Rich ( )9. Address _______________________ E-mail ID _____________ _______________________ Phone No _____________ _______________________ Pin __________________ D M Y D M Y10. Date of Schedule Initiation Completion11. Result: CONSENTI am fully educated with the disease and treatment there by I got satisfied. I accept formedical trial on me happily. “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 190
  • AnnexureInvestigator’s Signature Signature of Patient 1. CHIEF COMPLAINTS: Duration: a) restlessness or feeling keyed up or on edge b) Being easily fatigue c) Difficulty in concentration2. ASSOCIATED COMPLAINTS: a) Irritability b) Muscle tension c) Sleep disturbance3. HISTORY OF PRESENT ILLNESS:4. HISTORY OF PAST ILLNESS: a) No of episodes b) Post traumatic c) Phobias d) Working condition5. FAMILY HISTORY: Yes No6. OCCUPATIONAL HISTORY: “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 191
  • Annexure7. TREATMENT HISTORY:8. PERSONAL HISTORY:1 Ahara Vegetarian ( ) Mixed ( )2 Vihara Nature of work : Hard ( ) Moderate ( ) Sedentary ( )3 Agni Samagni ( ) Mandagni ( ) Teekeshnagni ( ) Vishamagni ( )4 Kostha Mrudu ( ) Madhyama ( ) Krura ( )5 Nidra Prakruta ( ) Alpa ( ) Ati ( ) Diwaswapna ( )6 Vyasana None ( ) Tobacco ( ) Smoking ( ) Alcohol ( )7 Artava Regular ( ) Irregular ( ) Menopause ( )Menstrual History a) Menstrual cycle b) Use of contraceptives c) Abortions9. SAMANYA PAREEKSHA: A. Asta sthana Pareeksha : B. Vital examination : 1. Nadi /Min 1. Heart rate /Min 2 Mala 2 Resp rate /Min 3 Mootra 3 Blood pressure mm of Hg 4 Jihwa 4 Body Temp /F 5 Shabda 5 Body weight Kgs 6 Sparsha 7 Druk 8 Akruti10. SROTO PAREEKSHA: 1. Manovaha srotas 2. Pranavaha srotas “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 192
  • Annexure 3. Annavaha srotas 4. Rasavaha srotas11. NIDAANA 1. Prajnaparadha 2. Parinama 3. Asatmendriyarthasamyogaa.) Mithya / Atiyoga karmanamb.) Mithya / Atiyoga IndriyarthamSi.no Nidana Present Absent Si.no Nidana Present Absent1. Kama 8. Moha2. Krodha 9. Cinta3. Bhaya 10. Irsa4. Udvega 11. Raga5. Soka 12. Dvesa6. Lobha 13. Dhananasa7. Harsa 14. Bandhavanasa8. Moha 15. Hina Sattava9. Cinta 16. Pujyapujavyatikrama12. ROOPA OF CHITODVEGAS.No Roopa of Chitodvega BT AT AF1 Restlessness or feeling keyed up or on edge2 Being easily fatigue3 Difficulty in concentration4 Irritability5 Muscle tension6 Sleep disturbance ` “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 193
  • Annexure HAMILTON ANXIETY RATING SCALE:No. Item Scoring BT AF01. Anxious mood: Worries, anticipation of the worst, fearful anticipation, irritability.02. Tension: Feeling of tension, fatigability, startle response, moved to tear easily, trembling, restlessness, inability to relax.03. Fears: Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.04. Insomnia: Difficulty in falling a sleep, broken sleep, unsatisfying sleep, fatigue on waking, dreams, nightmares, night terrors.05. Intellectual (Cognitive): Difficulty in concentration, poor memory.06. Depressed mood: Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.07. Somatic (Muscular): Pain and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.08. Somatic (Sensory): Tinnitus, blurring of vision, hot and cold flushes, feeling of weakness, picking sensation.09. Cardiovascular Symptoms: Tachycardia, palpitation, pain in chest, throbbing of vessels, fainting feelings, missing beat.10. Respiratory Symptoms: Pressure or constriction in chest, choking feeling, sighing, dyspnea.11. Gastrointestinal Symptoms: Difficulty in swallowing, wind, abdominal pain, burning sensation, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.12. Genitourinary Symptoms: Frequency of maturation, Urgency of micturation, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.13. Autonomic Symptoms: Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.14. Behavior at interview: Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, belching, brisk tendon jerks, dilated pupils, exophthalmos. Signs and symptoms mentioned in Hamilton scale were assessed by adopting the following scoring system. Degree of anxiety &Pathological condition Scoring None 0 Mild 1 Moderate 2 Severe 3 Severe, grossly disabling 4 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 194
  • Annexure Table No: 11 Showing Zung Self-Rated Anxiety ScaleSl.No STATEMENT None Some A A BT AF or a of the good good little time of the part of the time of the time time1. I feel more nervous and anxious than 1 2 3 4 usual.2. I feel afraid for no reason at all. 1 2 3 43. I get upset easily or feel panicky. 1 2 3 44. I feel like Im falling apart and going 1 2 3 4 to pieces.5. I feel that everything is all right and 1 2 3 4 nothing bad will happen.6. My arms and legs shake and tremble. 1 2 3 47. I am bothered by headaches neck and 1 2 3 4 back pain.8. I feel weak and get tired easily. 1 2 3 49. I feel calm and can sit still easily. 1 2 3 410. I can feel my heart beating fast. 1 2 3 411. I am bothered by dizzy spells. 1 2 3 412. I have fainting spells or feel like it. 1 2 3 413. I can breathe in and out easily. 1 2 3 414. I get feelings of numbness and tingling 1 2 3 4 in my fingers and toes.15. I am bothered by stomach ache or 1 2 3 4 indigestion.16. I have to empty my bladder often. 1 2 3 417. My hands are usually dry and warm. 1 2 3 418. My face gets hot and blushes. 1 2 3 419. I fall asleep easily and get a good 1 2 3 4 nights rest.20. I have nightmares. 1 2 3 4 “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 195
  • Annexure Table No: 12 Showing the General Health Questionnaire-GHQ28Sl. Have you recently Conditions B ANo T FAl Been feeling perfectly well and Better Same as Worse Much in than usual than usual worse than Good health? usual usualA2 Been feeling in need of a good Not at No than Rather Much tonic? all usual more than more than more usual usualA3 Been feeling run down and out Not at No than Rather Much of all usual more than more than Sorts? more usual usualA4 Felt that you are ill? Not at No than Rather Much all usual more than more than more usual usualA5 Been getting any pains in your Not at No than Rather Much all usual more than more than head? more usual usualA6 Been or pressure in your head? Not at No than Rather Much getting a feeling of tightness all usual more than more than more usual usualA7 Been having hot or cold spells? Not at No than Rather Much all usual more than more than more usual usualSl. Have you recently Conditions B ANo T FB1 Lost much sleep over worry? Not at No than Rather Much all usual more than more than more usual usualB2 Had difficulty in staying asleep Not at No than Rather Much once you are off? all usual more than more than more usual usualB3 Felt constantly under strain? Not at No than Rather Much all usual more than more than more usual usualB4 Been getting edgy and bad- Not at No than Rather Much all usual more than more than tempered? more usual usualB5 Been getting scared or panicky Not at No than Rather Much all usual more than more than for no good reason? more usual usualB6 Found everything getting on top Not at No than Rather Much of you? all usual more than more than more usual usualB7 Been feeling nervous and strung- Not at No than Rather Much up all the time? all usual more than more than more usual usual “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 196
  • AnnexureSl. Have you recently Conditions B ANo T FC1 Been managing to keep yourself More so Same as Rather Much less busy and occupied? than usual less than than usual usual usualC2 Been taking longer over the Quicker Same as Longer Much things you do? than usual than usual longer usual than usualC3 Felt on the whole you were Better About Less well Much less doing things well? than Same as than usual well usual usualC4 Been satisfied with the way More About Less Much less satisfied Same as satisfied satisfied youve carried out your task? usual than usualC5 Felt that you are playing a useful More so Same as Less Much less than usual useful useful part in things? usual than usualC6 Felt capable of making decisions More so Same as Less so Much less about things? than usual than usual capable usualC7 Been able to enjoy your normal More so Same as Less so Much less day-to-day activities? usual usual than usual than usualSl. Have you recently Conditions B ANo T FD1 Been thinking of yourself as a Not at No than Rather Much worthless person? all usual more than more than more usual usualD2 Felt that life is entirely hopeless? Not at No than Rather Much all usual more than more than more usual usualD3 Felt that life isnt worth living? Not at No than Rather Much all usual more than more than more usual usualD4 Thought of the possibility that Definitel I dont Has Definitely you might make away with y not think so crossed have yourself? my mindD5 Found at times you couldnt do Not at No than Rather Much anything because your nerves all usual more than more than were too bad? more usual usualD6 Found yourself wishing you Not at No than Rather Much were dead and away from it all? all usual more than more than more usual usualD7 Found that the idea of taking Definitel I dont Has Definitely your own life kept coming into y not think so crossed has your mind? my mind A- B- C- D- Total- BT A- B- C- D- Total- AF “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 197
  • AnnexureMindfulness Attention Awareness Scale (MAAS)1 2 3 4 5 6Almost Very Somewhat Somewhat Very Almost NeverAlways frequently Frequently Infrequently InfrequentlySl.No Questionnaires BT AF1. I could be experiencing some emotion and not be conscious of it until some time later.2. I break or spill things because of carelessness, not paying attention, or thinking of something else.3. I find it difficult to stay focused on whats happening in the present.4. I tend to walk quickly to get where Im going without paying attention to what I experience along the way.5. I tend not to notice feelings of physical tension or discomfort until they really grab my attention.6. I forget a persons name almost as soon as Ive been told it for the first time.7. It seems I am "running on automatic," without much awareness of what Im doing.8. I rush through activities without being really attentive to them9. I get so focused on the goal I want to achieve that I lose touch with what Im doing right now to get there10. I do jobs or tasks automatically, without being aware of what Im doing.11. I find myself listening to someone with one ear, doing something else at the same time12. I drive places on "automatic pilot" and then wonder why I went there.13. I find myself preoccupied with the future or the past.14. I find myself doing things without paying attention.15. I snack without being aware that Im eating.The mindfulness attention awareness scale is also a set of questioners used in this studyto evaluate the mental condition of the patient it contains 15 questioners with gradingstarting from 1 to 6 to assess the mental condition, each item should be graded separatelyand the scoring has been done by simply computing the mean of 15 items, And higherscore reflects the higher levels of dispositional “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 198
  • AnnexureAYURVEDA MENTAL EXAMINATIONI) SHEELAA) Habits B.T 1. Vinidra Present/Absent 2. Swapnanityata Present/Absent 3. Rahaskamata Present/Absent 4. Abheekshanam asthane hasanam Present/Absent 5. Abheeksham asthane rodanam Present/Absent 6. Arochakam Present/Absent 7. Charadi Present/Absent 8. Alpaharam Present/Absent 9. Bahubhuk Present/Absent 10. Bhunkte balam Present/Absent 11. Jeerne balam Present/Absent 12. Ratrau bhrisham bhavati Present/AbsentB) Temperament 1. Krodhaha Present/Absent 2. Santarjanam Present/AbsentC) Physiological functions 1. Swedabahulaha Present/Absent 2. Tritabahulaha Present/Absent 3. Shwasaturaha Present/Absent 4. Kasaha Present/Absent 5. Nareepriyata Present/Absent 6. Sadanam Present/AbsentD) Personal Care 1. Matopadigdhakshata Present/Absent 2. Lalosravaha Present/Absent 3. Asyat phenagamanam Present/Absent 4. Singhanaka sravaha Present/Absent 5. Analankarikairalankaranam Present/Absent “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 199
  • AnnexureII) CHESTAA) General motor activity B.TA.F 1. Abheekshanam asthane nartanam Present/Absent 2. Abheekshnam asthane vadanam Present/Absent 3. Abheekshnam asthane gayanam Present/Absent 4. Ajasram parisaranam Present/Absent 5. Akasmadanjavikshepanam Present/Absent 6. Abhidravanam Present/Absent 7. Asthane samrambhaha Present/Absent 8. Asthane akroshaha Present/Absent 9. Paresham abhihananam Present/Absent 10. Manda chesta Present/AbsentB) Speech 1. Satatam giramutsargaha Present/Absent 2. Aniyatam giramutsargaha Present/Absent 3. Parushavak Present/Absent 4. Vakmanda Present/AbsentC) Facial expression and postures 1. Shwayathuschanane Present/Absent 2. Sthimitakshata Present/Absent 3. Utpinditakshata Present/Absent 4. Samrabdhakshata Present/Absent 5. Aruna/tamra/Haridra/Haritakshata Present/Absent 6. Nakhadi shouklyam Present/Absent 7. Peetacha bha Present/Absent 8. Rukshachhavihi Present/Absent 9. Dhamaneetataha Present/Absent 10. Karshyam Present/Absent 11. Sphurita sandhihi Present/Absent 12. Sthanamekadeshe Present/Absent “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 200
  • AnnexureIII) ACHARAHAA) Personal standards 1. Shoucha dweshaha / Bheebhatsatwam Present/AbsentB) Social standards 1. Vinagnabhabaha Present/AbsentIV) MANAHA1) Indriyabhigrahaha i. Cannot be tested because of non-cooperation Present/Absent ii. Disturbed because of peripheral factors Present/Absent iii. Disturbed mild /Moderate/Severe Present/Absent iv. Indriyasapekshayatharthajnanam a. Astya jwaladi darshanam Present/Absent2) Manonigarahaha Present/Occasionally Absent/Frequently Absent3) Ooha Intact/Partly impaired Grossly impaired4) Vicharaha Intact/Mildly Impaired/ Moderately Impaired/ Grossly Impairedi. Discriminative ability Intact/Mildly Impaired/ Moderately Impaired/ Grossly Impaired a. Ativelam santapaha Present/Absent b. Ayanairyanam Present/Absentii. Indriyanirapekshayathara thajnanam Present/Absent a. Himambunichayepi cha vahnishanki Present/Absent b. Aushnyam Present/Absent “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 201
  • AnnexureV) BUDDHIHI 1. Vividha shabdanukaranam Present/Absent 2. Sweshamabhihananam Present/Absent 3. Atpamatihi Present/AbsentVI) SMRITHI - Intact/Mildly impaired/Grossly impaired /Cannot be testedVII) SANJNAJNANAM - Intact/Mildly impaired/Grossly impaired /Cannot be tested 1. Orientation to place Intact/Mildly impaired/ Moderately impaired/ Grossly impaired 2. Orientation to time Intact/Mildly impaired/ Moderately impaired/ Grossly impaired 3. Orientation to person Intact/Mildly impaired/ Moderately impaired/ Grossly impaired 4. Responsiveness Intact/Mildly impaired/ Moderately impaired/ Grossly impairedVIII) BHAKTHI - Intact/Mildly impaired/Grossly impaired /cannot be tested i. Physiological desires ii. Desires in relation to attireiii. Desires in relation to entertainment 1. Ushnasevee Present/Absent 2. Sheetabhilasee Present/Absent 3. Alabdheshu abhyavaharyeshu lobhaha Present/Absent 4. Labdheshu abhyavaharyeshu teevra matsaryam Present/AbsentIX) 1. Prakrithi i. Shareera ii. ManasaX) SATWAM – Pravaraha/Madhyamaha/Avaraha “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 202
  • AnnexureSPECIAL WORK SHEET FOR CHITODVEGA1. Name of the patient : ____________________ Sl.No O.P.D. No2. Age _______ yrs. Place of Birth __________________ I.P.D. No3. Sex M F Education __________________During Nasya karmaDays Heart Rate Pulse Rate Blood Pressure1st day /min /min mm of Hg2nd day3rd day4th day5th day6th day7th day “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 203
  • AnnexureDuring Dhara karmaDays Heart Rate Pulse Rate Blood Pressure8th day /min /min mm of Hg9th day10th day11th day12th day13th day14th day “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 204
  • AnnexureNASYAKARMAABHYANGA with ksheerabala tailaNASYA Ksheera bala taila (101) 8 drops in each nostril for –7 daysTime of administration – Morning 7.30 am- 8.30 amInitiation Date: Completion Date:Days Time of administration Matra Nireekshana1234567Samyak Nasya LakshanaSl. No. Nasya phala APPEARNCE OF SIGNS AND SYMPTOMS1 EUÈ sÉÉbÉuÉ2 ÇÍzÉUÉå sÉÉbÉuÉ3 CÇÎlSìrÉ sÉÉbÉuÉ4 xÉëÉåiÉÉåzÉÑÎ®È “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 205
  • AnnexureDHARAKARMADHARA Amalaki siddha ksheera for -7 daysTime of administration – between 7.30 to 8.30 amInitiation Date: Completion Date:Days Time of administration Duration Nireekshana1234567Bahya Sneha Lakshanas:Sl.No. Sneha Phala APPEARNCE OF SIGNS AND SYMPTOMS1 SØ̹mÉëxÉÉS2 mÉÑ̹3 xuÉmlÉ4 xÉÑiuÉMçüSÉRûrÉïM×üiÉçOther observation:Signature of Guide Signature of Scholar(Dr. P. SIVARAMUDU) (RAJESH.A.R.) “Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 206
  • Annexure“Evaluation of The efficacy of Ksheerabala taila Nasya & Amalaki siddha ksheera dhara in chittodvega w.s.r.t. Generalized anxiety disorder” 207