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Ayurvedic Management in Case of Depression W.S.R. to Kapahaj Unmad A Case Study

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This case study examines the Ayurvedic management of depression in a 27-year-old female patient presenting with symptoms for 2 years. The patient was treated with a combination of Panchakarma therapies including Shirodhara and Nasya along with oral medications like Saraswatharishta and Brahmi vati. Yoga practices like pranayama and meditation were also included. Assessment scales before and after treatment showed improvements in symptoms, appetite, sleep, mood, and weight. The Hamilton Depression Rating Scale score decreased from 21 to 10, and the Insomnia Severity Index score decreased from 16 to 5, indicating reduced clinically significant insomnia. The combined Ayurvedic treatment approach was found to effectively manage

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International Journal of Trend in Scientific Research and Development (IJTSRD)
Volume 7 Issue 4, July-August 2023 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470
@ IJTSRD | Unique Paper ID – IJTSRD59736 | Volume – 7 | Issue – 4 | Jul-Aug 2023 Page 861
Ayurvedic Management in Case of Depression
W.S.R. to Kapahaj Unmad - A Case Study
Dr. Kavita1, Dr. Shikha Pandey2, Dr. Gyanendra Datta Shukla3
1
PG Scholar, 2
Assistant Professor, 3
Associate Professor,
1,2,3
Panchkarma Department, Gurukul Campus, Haridwar,
Uttarakhand Ayurveda University, Dehradun, Uttarakhand, India
ABSTRACT
Ayurveda gives a prime importance to positive mental health. In the
present era, the rate of depression is raised to the alarming extent so
that it becomes the disorder of major public health importance, in
terms of prevalence, suffering and morbidity due to modified and
stressful lifestyle. Depression would be the second leading cause of
disability-adjusted life years (DALYs). Kapahaj Unmada can be
equated to Depression. Material and Methods: In this study, a
patient of 27 years old presented with complaints of disturbed sleep,
headache, anger issues, lack of concentration, involuntarily redundant
thinking on any point, suicidal thoughts and increased cry spells since
last 2 years. In this present study, an attempt is made to study the
efficacy of combined therapy of Shirodhara and Nasya along with
Yoga and internal administration of Saraswthaarishta and Brahmi
vati. Result and Conclusion: Result were assessed by the
improvement in patient’s symptoms based on Hamilton’s Depression
Rating Scale. During and after the treatment, no adverse events were
observed.
KEYWORDS: Stress, Kapahaj Unmada, Shirodhara
How to cite this paper: Dr. Kavita | Dr.
Shikha Pandey | Dr. Gyanendra Datta
Shukla "Ayurvedic Management in Case
of Depression W.S.R. to Kapahaj
Unmad - A Case Study" Published in
International
Journal of Trend in
Scientific Research
and Development
(ijtsrd), ISSN:
2456-6470,
Volume-7 | Issue-4,
August 2023,
pp.861-865, URL:
www.ijtsrd.com/papers/ijtsrd59736.pdf
Copyright © 2023 by author (s) and
International Journal of Trend in
Scientific Research and Development
Journal. This is an
Open Access article
distributed under the
terms of the Creative Commons
Attribution License (CC BY 4.0)
(http://creativecommons.org/licenses/by/4.0)
INTRODUCTION
Depression/ Major Depressive Disorder or clinical
depression is an episodic or constant disorder which
cause a major impact on person’s physical, mental,
emotional and social life. It is the second leading
cause of disease burden1
. Depression is a common
illness worldwide, with more than 264 million people
affected. Considering the impact of depression, the
World Health Organization declared slogan of world
health day 2017 as “ Depression -Let’s talk”.2
Depression is caused by multifactorial combination of
genetic and environmental factors and can be defined
as depressed mood on a daily basis for a minimum
duration of 2 weeks3
. The global pooled period
prevalence of mood disorders was 5.4%4
,and its
prevalence in WHO-World Mental Health Survey
ranged from 0.8% to 9.6% across countries5
. The
lifetime prevalence of DD was relatively high in 40–
49 age group (7.47%) and marginally more in females
(5.72%) when compared with males (4.75%).5
A
meta-analysis found that the lifetime prevalence of
suicide attempts was 31% and one year prevalence
was 8% in MDD patients6
.
Somatic symptoms associated with anxiety and
depression:
General – fatigue
Feeling restless
Psychological – Atypical anger
Irritability
Cognitive – Poor attention
Poor concentration
Impaired memory
Slow thinking
Musculoskeletal- muscle ache
Headache
Gastrointestinal – Dry mouth, chocking, nausea,
vomiting.
Genitourinary – Loss of libido
IJTSRD59736
International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Paper ID – IJTSRD59736 | Volume – 7 | Issue – 4 | Jul-Aug 2023 Page 862
Vishada and Avsada represents minor depressive
disorder and MDD can related with Unmada.
Unmada lakshana include dearrangement of
Mana(mind), Buddhi(intellect), Bhakti(aspiration),
Sheela(constitution), Chesta (psychomotor activity)
and Achara (conduct) components. These characters
are more prevalent in Avara satwa.7
Tushnibhava (low tone voice)
Sthanamekdeshe, alpchankraman, manda (feeling of
fatigue)
Amarsha (irritability)
Arochakta (Anorexia)
Bibhatswa (Death glare)
Swapannityta (poor concentration)
Rhaskamta (poor attention)
Sttamniyatnam ch giramutsarg (increased cry spells)
Unmatchitta (obsessive thoughts)7
MATERIALS AND METHODS
A. Particulars of Patient:
Gender =female
Age = 27 years
Place = Panchkarma O.P.D. of Gurukul campus,
Haridwar
OPD No.= 1235/23177
Religion = Hindu
Marital status = Unmarried
D.O.A. = 31/10/2022
D.O.D. = 10/11/2022
B. Chief complaints - Disturbed sleep, headache,
anger issues, lack of concentration, involuntarily
redundant thinking on any point, suicidal thoughts
and increased cry spells since last 2 years.
C. History of Present Illness: According to the
patient, she was quite asymptomatic before 2
years. After that, patient gradually started eliciting
symptoms like anorexia, amenorrhea and
suddenly started attaining weight. Patient
symptoms are associated with low tone voice,
pessimistic mood, loss of social activities,
frequent waking during nighttime, loss of appetite
and reluctance in doing activities. Day by day
symptoms became worsen and patient became
badly aggressive. The onset of symptoms was
gradual. During initial phase, she was treated by
selective serotonin inhibitors (SSRIs) along with
counselling sessions. Patient took treatment and
found mild significant relief. After that, patient
approached towards Ayurvedic treatment with her
mother. So, she came to UAU, Gurukul Campus
Haridwar for further investigation and
management.
D. History of Past illness: No history
E. Family history: Not any relevant family history
F. Menstrual history: presence of amenorrhea since
1 year
G. Obstetric history: NAD
H. Personal history –
General condition – dull
Appetite – Decreased
Bowel – Clear
Urine – Normal
Sleep – Decreased
Diet – Vegetarian
Patient was teetotaller, non- smoker, non- diabetic
and non- hypertensive.
I. Examination at the time of admission:
Modern parameters -
BP = 126/84mm Hg
Pulse = 78/ min
RR = 18/min.
Weight = 61 kg
Ayurvedic Parameters –
Astvidha pareeksha =
Nadi- Vaat-pittaj, 78/min, Regular
Mala – Yellowish in colour having normal
consistency
Mutra – Pale yellowish in colour with frequency of 6-
7 times per day
Jihva – Coated
Shabd – Spast
Sparsh –Ushna and ruksha sparsh
Drik – Samanya (vision 6/6, clear conjunctiva)
Akriti – obese (BMI = 26.4)
Dashvidha pareeksha =
Prakriti – Vaat-pitta (having features like dry skin,
poor physical strength, bahubhuja, alpa nidra etc.)
Vikriti – Prakriti sam samvet
Sara – Madhyam
Sanhanan – madhyam (BMI= 26.4, devoid of any
structural deformity)
Aahar – Aalp (Abhyavarana shakti=less than 2-3
meals per day, Jaran shakti=not presence of all Jirna
Ahar lakshan upto 5 hrs.after meal intake)
Satmya – Deepan-pachan dravya
Satva – Aalp
Vyay – madhyam (27 yrs.)
Vyayam – Aalp
Pramana – madhyam (Body weight =61 kg, Height =
152cm)
J. Diagnostic Assessment
During the reporting time at our hospital, the findings
of the patient were as follows as per the diagnostic
criteria –
Hamilton Depression Rating Scale = 21
Insomnia Severity index = 16
International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Paper ID – IJTSRD59736 | Volume – 7 | Issue – 4 | Jul-Aug 2023 Page 863
K. Therapeutic intervention
After taking informed and written consent of the
patient and following international conference of
Harmonization-Good clinical practice Guidelines
(ICH- GCP) patient made to undergo following
intervention.
A) Therapy procedure: Depression comes under
Unmada category of Ayurveda. Two Panchkarma
procedures are adopted to this patient. Shirodhara
with Tila taila for 10 days and Nasya karma with Anu
taila for 10 days were administered {Table 1}. Along
with Panchkarma procedure combinations of oral
medications such as Tab. Manasmitravatak (MMV) 1
bd (two times) after meals. Tab. Brahmi vati 2 bd
with Saraswatharishta 20 ml (with normal water)
daily two times after meals {Table 2}. These oral
medications were continued in following 2 months
after completion of Panchkarma interventions.
Table 1. Panchkarma Interventions
Panchkarma
Procedure
Drugs Method of application
Days of
treatment
Shirodhara Ksheerbala taila
Ingredients: Balamoola (Sida
cordifolia), Tila taila (Sesame oil),
Ksheera (Cow’s milk)
Tila taila
Ingredients- Tilataila - sesame oil,
Manjishta Rubia cordifolia, Lodhra
Symplocos racemosa, Musta -
Nagaramotha Cyperus rotundus,
Amalaki (Emblica officinalis),
Haritaki Chebulic myrobalan,
Vibhitaki Belliric myrobalan etc.
The person undergoing Shirodhara
intervention is made to lie down on
the table. Then, Snehana (oleation
therapy) followed by swedana
(sudation therapy) to make the body
suitable for Shirodhara. Siro-
abhyanga with tila taila for approx. 5-
7 minutes followed by covering of
Patient’s eyes and ears with the help
of cotton. Afterwards, the process of
Shirodhara was done with Tila taila
by manual Shirodhara instrument for
40-45 minutes under pleasant
environment. After this process, the
oil is to be wiped off and the patient
is advised to take warm water bath
after an hour.
10 days
Nasya karma Anu taila
Ingredients- Jivanti (Leptadenia
reticulata), Devadaru (Cedrus
deodara), Twak (Cinnamon
Usheera) Daruharidra (Berberis
aristata), Prishnaparni (Uraria
picta), Vidanga (Embelia ribes),
Renuka (Vitex negundo) etc.
Massage with Ksheerbala taila over
face followed by Mridu Swedana. 2
Bindu of Anu Taila administered in
the form of a vichhinna Dhara in
each nostril followed by Dhoompana. 10 days
Table 2. Oral Medications
Name of the drugs Dose Anupana Days
Tab. Manasmitravatak
(MMV)
Tab. Brahmi vati
1 tablet (twice a day)
2 tablets (twice a day)
with Lukewarm
water after meal
with Lukewarm
water after meal
Two months from the
first day of admission
Saraswatharishta 20 ml (twice a day) with equal quantity
of normal water
Two months from the
first day of admission
Table 3. Yoga Chikitsa
Name of Yoga Duration Days
Brahmari Pranayama
TratakaPranayama Surya namaskar
10 min. twice a day
15 min. twice a day.
twice a day.
Two months from the first day of
admission
Table 4. Aahar Chikitsa
Aahar Advised (Pathya) Avoid (Apathya)
Diet Light (liquid or semisolid) oily, refrigerated and junk food
International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Paper ID – IJTSRD59736 | Volume – 7 | Issue – 4 | Jul-Aug 2023 Page 864
OBSERVATION AND RESULT
The observation found that after the combined therapeutic treatment of 10 days there was improvement in
patient. The difference observed before and after the whole treatment was observed accordingly and compared as
shown in the given tables.
Table 1. Comparison of Sign and Symptoms
Symptoms Before treatment After treatment
Appetite Poor (++) Improved (+)
Episodes of crying 5-6 times in whole day 1-2 times in a day
Social attitude Secluded behaviour Interactive behaviour
Sleep Frequent awakening (5-6 times/night) 1-2 times / night
Weight 48 kg 61 kg
Mood Pessimistic mood Optimistic mood
Heart rate 100-120/min. 70-80/min.
Table 2. Hamilton’s Depression Rating Scale before and after treatment
S. No. Symptoms BT AT
1. Depressed mood 2 1
2. Feeling of guilty 1 0
3. Suicide 2 1
4. Insomnia: in early hours of night 0 0
5. Insomnia: middle of night 1 0
6. Insomnia: late hours of night 1 1
7. Work and activities 2 1
8. Retardation 0 0
9. Agitation 2 1
10. Anxiety psychic 3 1
11. Anxiety somatic 1 0
12. Somatic symptoms gastrointestinal 1 1
13. General somatic symptoms 1 0
14. Genital (menstrual) symptoms 1 1
15. Hypochondriasis 2 1
16. Weight loss 0 0
17. Insight 1 1
Total 21 10
Table No. 3 Insomnia Severity Index
S. No. Symptoms BT AT
1. Difficulty falling asleep 2 0
2. Difficulty staying asleep 3 1
3. Problems waking up too early 0 0
4. How satisfied/ dissatisfied with our current sleep pattern? 3 1
5.
How noticeable to others do you think your sleep in terms
of impairing the quality of life?
3 1
6.
How worried / distressed are you about your current sleep
pattern?
3 1
7.
To what extent do you consider your sleep pattern
interfere with your daily functioning currently?
2 1
Total
16 (Clinical
Insomnia)
5 (No Clinically
significant Insomnia)
DISCUSSION
In this case, combined therapy of Shamana Chikitsa,
Yoga Chikitsa along with Panchkama (Upkarma) has
been shown benefit.
As we all know acc. to Ayurveda, vata dosha is
responsible for all movements and activities of body
and brain.8
When there is imbalance of vata dosha in
body, the symptoms like bala-chesta nasha will be
found which is main characterstic feature of
International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Paper ID – IJTSRD59736 | Volume – 7 | Issue – 4 | Jul-Aug 2023 Page 865
depression8
. For Shamana of vata dosha, Snehan
therapy in the form of Shirodhara process was done8
.
Snehana – Swedana are the purvkarma of shirodhara
which helps in relaxation of body before shirodhara.
Snehana causes viscosity, softness and kleda in the
body as mentioned by Acharya Charaka. Swedana
causes vasodilation all over the body. In ayurvedic
classics Shirodhara can be correlated with
Shiroparisheka"9
. Shirodhara means pouring of either
taila, milk or takra gently over forehead in a
continuous stream at a particular point (Agya Chakra)
from a definite height (approx. 4-5 inches)10
.
Shirodhara has shown its anti-anxiety, anti-
hypertensive and sleep-inducing effects in few
studies. Effects of Shirodhara are found to be
responsible for reduction in catecholamine and an
increased serotonin uptake11
. This center of forehead
are believed to be linked with the pineal gland (often
called third eye) of the body12
which helps in
controlling circadian cycle of the sleep and
wakefulness by secretion of melatonin hormone.
Continuous pouring of Taila over forehead for a
specific period has a transquilizing effect and induce
sleep by reaching the brain cortex and correct
deficiency of certain neurotransmitters13
. As per
modern science, we all know that after local
application as an ointment a drug may pass through
the stratum corneum and into the blood vessels to
produce desirable effect at a remote target organ. Tila
taila possess anti vata dosha properties8
and its
snigdha property helps trpaka kapha of brain cells in
properly maintaining the connection of Indriyas and
Vishaya which may have been deranged by
aggravated Vata.
In Ashtanga Samgraha it is explained that Nasa being
the door way to Shira (heard), the drug administered
through nostrils, reaches Shringataka (a Sira Marma
by Nasa Srota and spreads in the Murdha (Brain)
taking route of Netra (eye), Shrotra (ear), Kantha
(throat), Siramukhas (opening of the vessels) etc. and
scratches the morbid Doshas in supra clavicular
region and extracts them from the Uttamanga14
Nasal
drops inserted in the nose during nasya process
induce inflammation in nasal epithelium causing
elimination of morbid materials15
These medicines used apart from Shirodhara like
Saraswataristha (anti-inflammatory, anti-anxiety,
memory enhancing, anti-oxidant) and Bramhi vati
(anti-oxidant, anti-inflammatory, antianxiety and
tranquilizer) are well established Medhya
Rasayan(brain tonic) in Ayurveda.
CONCLUSION
It may be concluded that Shirodhara is an effective
treatment in the management of Unmada. Shirodhara
along with these drugs helpful in decreasing
manifestations of vikriti of mana (chintya, vicharya,
uhaya, dheya and snkalpa), buddhi (abnormal
acumen power), smriti (not memorizing beautiful
memories), achar and chesta dusti (presence of
crying spells) etc.
Informed consent: Informed consent was taken from
the patient for this study.
REFERENCES
[1] Reddy MS. Depression: The Disorder and the
Burden. Indian J Psychol Med 2010; 32: 1–2.
[2] Farahzadi MH, Services H. Depression; Let’s
talk. 2017.
[3] O’Connor E, Whitlock E, Gaynes B, Beil T.
Screening for Depression in Adults and Older
Adults in Primary Care. Agency Healthc Res
Qual US 2009: 167.
[4] Steel Z, Marnane C, Iranpour C, Chey T,
Jackson JW, Patel V, et al. The global
prevalence of common mental disorders: A
systematic review and meta-analysis 1980-
2013. Int J Epidemiol 2014; 43: 476–93.
[5] Arvind BA, Gururaj G, Loganathan S,
Amudhan S, Varghese M, Benegal V, et al.
Prevalence and socioeconomic impact of
depressive disorders in India: Multisite
population-based cross-sectional study. BMJ
Open 2019; 9.
[6] Ye G, Li Z, Yue Y, Wu Y, Yang R, Wang H, et
al. Suicide attempt rate and the risk factors in
young, first-episode and drug-naïve Chinese
Han patients with major depressive disorder.
BMC Psychiatry BioMed Central; 2022; 22: 1–
10. Available from:
https://doi.org/10.1186/s12888-022-04254-x.
[7] vidyotini teeka on charak samhita .pdf.
[8] Charaka Sootra Sthana Global .pdf.
[9] Sushrut Samhita -2 - Ambikadutta Shastri
(AyuTech).pdf.
[10] Rathod D m. Shirodhara With Oil.: 1–2.
[11] Divya Kajaria J. An Appraisal of The
Mechanism of Action of Shirodhara -. Ann
Ayurvedic Med 2013; 2: 114–7.
[12] Gaikwad A, More N, Wele A. International
Journal of Ayurveda and Pharma Research.
2015; 3: 2322–902.
[13] Dhuri KD, Bodhe P V., Vaidya AB.
Shirodhara : A psycho-physiological profile in
healthy volunteers. J Ayurveda Integr Med
2013; 4: 40–4.
[14] Astanga-Sangraha.pdf.
[15] Deepak VM, Suwarna VD, Pawan LS, Sunil
TG. Nasya Karma Karmukatva-a Review
Article. Available from: www.iamj.in.

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Ayurvedic Management in Case of Depression W.S.R. to Kapahaj Unmad A Case Study

  • 1. International Journal of Trend in Scientific Research and Development (IJTSRD) Volume 7 Issue 4, July-August 2023 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470 @ IJTSRD | Unique Paper ID – IJTSRD59736 | Volume – 7 | Issue – 4 | Jul-Aug 2023 Page 861 Ayurvedic Management in Case of Depression W.S.R. to Kapahaj Unmad - A Case Study Dr. Kavita1, Dr. Shikha Pandey2, Dr. Gyanendra Datta Shukla3 1 PG Scholar, 2 Assistant Professor, 3 Associate Professor, 1,2,3 Panchkarma Department, Gurukul Campus, Haridwar, Uttarakhand Ayurveda University, Dehradun, Uttarakhand, India ABSTRACT Ayurveda gives a prime importance to positive mental health. In the present era, the rate of depression is raised to the alarming extent so that it becomes the disorder of major public health importance, in terms of prevalence, suffering and morbidity due to modified and stressful lifestyle. Depression would be the second leading cause of disability-adjusted life years (DALYs). Kapahaj Unmada can be equated to Depression. Material and Methods: In this study, a patient of 27 years old presented with complaints of disturbed sleep, headache, anger issues, lack of concentration, involuntarily redundant thinking on any point, suicidal thoughts and increased cry spells since last 2 years. In this present study, an attempt is made to study the efficacy of combined therapy of Shirodhara and Nasya along with Yoga and internal administration of Saraswthaarishta and Brahmi vati. Result and Conclusion: Result were assessed by the improvement in patient’s symptoms based on Hamilton’s Depression Rating Scale. During and after the treatment, no adverse events were observed. KEYWORDS: Stress, Kapahaj Unmada, Shirodhara How to cite this paper: Dr. Kavita | Dr. Shikha Pandey | Dr. Gyanendra Datta Shukla "Ayurvedic Management in Case of Depression W.S.R. to Kapahaj Unmad - A Case Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-4, August 2023, pp.861-865, URL: www.ijtsrd.com/papers/ijtsrd59736.pdf Copyright © 2023 by author (s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0) INTRODUCTION Depression/ Major Depressive Disorder or clinical depression is an episodic or constant disorder which cause a major impact on person’s physical, mental, emotional and social life. It is the second leading cause of disease burden1 . Depression is a common illness worldwide, with more than 264 million people affected. Considering the impact of depression, the World Health Organization declared slogan of world health day 2017 as “ Depression -Let’s talk”.2 Depression is caused by multifactorial combination of genetic and environmental factors and can be defined as depressed mood on a daily basis for a minimum duration of 2 weeks3 . The global pooled period prevalence of mood disorders was 5.4%4 ,and its prevalence in WHO-World Mental Health Survey ranged from 0.8% to 9.6% across countries5 . The lifetime prevalence of DD was relatively high in 40– 49 age group (7.47%) and marginally more in females (5.72%) when compared with males (4.75%).5 A meta-analysis found that the lifetime prevalence of suicide attempts was 31% and one year prevalence was 8% in MDD patients6 . Somatic symptoms associated with anxiety and depression: General – fatigue Feeling restless Psychological – Atypical anger Irritability Cognitive – Poor attention Poor concentration Impaired memory Slow thinking Musculoskeletal- muscle ache Headache Gastrointestinal – Dry mouth, chocking, nausea, vomiting. Genitourinary – Loss of libido IJTSRD59736
  • 2. International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD59736 | Volume – 7 | Issue – 4 | Jul-Aug 2023 Page 862 Vishada and Avsada represents minor depressive disorder and MDD can related with Unmada. Unmada lakshana include dearrangement of Mana(mind), Buddhi(intellect), Bhakti(aspiration), Sheela(constitution), Chesta (psychomotor activity) and Achara (conduct) components. These characters are more prevalent in Avara satwa.7 Tushnibhava (low tone voice) Sthanamekdeshe, alpchankraman, manda (feeling of fatigue) Amarsha (irritability) Arochakta (Anorexia) Bibhatswa (Death glare) Swapannityta (poor concentration) Rhaskamta (poor attention) Sttamniyatnam ch giramutsarg (increased cry spells) Unmatchitta (obsessive thoughts)7 MATERIALS AND METHODS A. Particulars of Patient: Gender =female Age = 27 years Place = Panchkarma O.P.D. of Gurukul campus, Haridwar OPD No.= 1235/23177 Religion = Hindu Marital status = Unmarried D.O.A. = 31/10/2022 D.O.D. = 10/11/2022 B. Chief complaints - Disturbed sleep, headache, anger issues, lack of concentration, involuntarily redundant thinking on any point, suicidal thoughts and increased cry spells since last 2 years. C. History of Present Illness: According to the patient, she was quite asymptomatic before 2 years. After that, patient gradually started eliciting symptoms like anorexia, amenorrhea and suddenly started attaining weight. Patient symptoms are associated with low tone voice, pessimistic mood, loss of social activities, frequent waking during nighttime, loss of appetite and reluctance in doing activities. Day by day symptoms became worsen and patient became badly aggressive. The onset of symptoms was gradual. During initial phase, she was treated by selective serotonin inhibitors (SSRIs) along with counselling sessions. Patient took treatment and found mild significant relief. After that, patient approached towards Ayurvedic treatment with her mother. So, she came to UAU, Gurukul Campus Haridwar for further investigation and management. D. History of Past illness: No history E. Family history: Not any relevant family history F. Menstrual history: presence of amenorrhea since 1 year G. Obstetric history: NAD H. Personal history – General condition – dull Appetite – Decreased Bowel – Clear Urine – Normal Sleep – Decreased Diet – Vegetarian Patient was teetotaller, non- smoker, non- diabetic and non- hypertensive. I. Examination at the time of admission: Modern parameters - BP = 126/84mm Hg Pulse = 78/ min RR = 18/min. Weight = 61 kg Ayurvedic Parameters – Astvidha pareeksha = Nadi- Vaat-pittaj, 78/min, Regular Mala – Yellowish in colour having normal consistency Mutra – Pale yellowish in colour with frequency of 6- 7 times per day Jihva – Coated Shabd – Spast Sparsh –Ushna and ruksha sparsh Drik – Samanya (vision 6/6, clear conjunctiva) Akriti – obese (BMI = 26.4) Dashvidha pareeksha = Prakriti – Vaat-pitta (having features like dry skin, poor physical strength, bahubhuja, alpa nidra etc.) Vikriti – Prakriti sam samvet Sara – Madhyam Sanhanan – madhyam (BMI= 26.4, devoid of any structural deformity) Aahar – Aalp (Abhyavarana shakti=less than 2-3 meals per day, Jaran shakti=not presence of all Jirna Ahar lakshan upto 5 hrs.after meal intake) Satmya – Deepan-pachan dravya Satva – Aalp Vyay – madhyam (27 yrs.) Vyayam – Aalp Pramana – madhyam (Body weight =61 kg, Height = 152cm) J. Diagnostic Assessment During the reporting time at our hospital, the findings of the patient were as follows as per the diagnostic criteria – Hamilton Depression Rating Scale = 21 Insomnia Severity index = 16
  • 3. International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD59736 | Volume – 7 | Issue – 4 | Jul-Aug 2023 Page 863 K. Therapeutic intervention After taking informed and written consent of the patient and following international conference of Harmonization-Good clinical practice Guidelines (ICH- GCP) patient made to undergo following intervention. A) Therapy procedure: Depression comes under Unmada category of Ayurveda. Two Panchkarma procedures are adopted to this patient. Shirodhara with Tila taila for 10 days and Nasya karma with Anu taila for 10 days were administered {Table 1}. Along with Panchkarma procedure combinations of oral medications such as Tab. Manasmitravatak (MMV) 1 bd (two times) after meals. Tab. Brahmi vati 2 bd with Saraswatharishta 20 ml (with normal water) daily two times after meals {Table 2}. These oral medications were continued in following 2 months after completion of Panchkarma interventions. Table 1. Panchkarma Interventions Panchkarma Procedure Drugs Method of application Days of treatment Shirodhara Ksheerbala taila Ingredients: Balamoola (Sida cordifolia), Tila taila (Sesame oil), Ksheera (Cow’s milk) Tila taila Ingredients- Tilataila - sesame oil, Manjishta Rubia cordifolia, Lodhra Symplocos racemosa, Musta - Nagaramotha Cyperus rotundus, Amalaki (Emblica officinalis), Haritaki Chebulic myrobalan, Vibhitaki Belliric myrobalan etc. The person undergoing Shirodhara intervention is made to lie down on the table. Then, Snehana (oleation therapy) followed by swedana (sudation therapy) to make the body suitable for Shirodhara. Siro- abhyanga with tila taila for approx. 5- 7 minutes followed by covering of Patient’s eyes and ears with the help of cotton. Afterwards, the process of Shirodhara was done with Tila taila by manual Shirodhara instrument for 40-45 minutes under pleasant environment. After this process, the oil is to be wiped off and the patient is advised to take warm water bath after an hour. 10 days Nasya karma Anu taila Ingredients- Jivanti (Leptadenia reticulata), Devadaru (Cedrus deodara), Twak (Cinnamon Usheera) Daruharidra (Berberis aristata), Prishnaparni (Uraria picta), Vidanga (Embelia ribes), Renuka (Vitex negundo) etc. Massage with Ksheerbala taila over face followed by Mridu Swedana. 2 Bindu of Anu Taila administered in the form of a vichhinna Dhara in each nostril followed by Dhoompana. 10 days Table 2. Oral Medications Name of the drugs Dose Anupana Days Tab. Manasmitravatak (MMV) Tab. Brahmi vati 1 tablet (twice a day) 2 tablets (twice a day) with Lukewarm water after meal with Lukewarm water after meal Two months from the first day of admission Saraswatharishta 20 ml (twice a day) with equal quantity of normal water Two months from the first day of admission Table 3. Yoga Chikitsa Name of Yoga Duration Days Brahmari Pranayama TratakaPranayama Surya namaskar 10 min. twice a day 15 min. twice a day. twice a day. Two months from the first day of admission Table 4. Aahar Chikitsa Aahar Advised (Pathya) Avoid (Apathya) Diet Light (liquid or semisolid) oily, refrigerated and junk food
  • 4. International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD59736 | Volume – 7 | Issue – 4 | Jul-Aug 2023 Page 864 OBSERVATION AND RESULT The observation found that after the combined therapeutic treatment of 10 days there was improvement in patient. The difference observed before and after the whole treatment was observed accordingly and compared as shown in the given tables. Table 1. Comparison of Sign and Symptoms Symptoms Before treatment After treatment Appetite Poor (++) Improved (+) Episodes of crying 5-6 times in whole day 1-2 times in a day Social attitude Secluded behaviour Interactive behaviour Sleep Frequent awakening (5-6 times/night) 1-2 times / night Weight 48 kg 61 kg Mood Pessimistic mood Optimistic mood Heart rate 100-120/min. 70-80/min. Table 2. Hamilton’s Depression Rating Scale before and after treatment S. No. Symptoms BT AT 1. Depressed mood 2 1 2. Feeling of guilty 1 0 3. Suicide 2 1 4. Insomnia: in early hours of night 0 0 5. Insomnia: middle of night 1 0 6. Insomnia: late hours of night 1 1 7. Work and activities 2 1 8. Retardation 0 0 9. Agitation 2 1 10. Anxiety psychic 3 1 11. Anxiety somatic 1 0 12. Somatic symptoms gastrointestinal 1 1 13. General somatic symptoms 1 0 14. Genital (menstrual) symptoms 1 1 15. Hypochondriasis 2 1 16. Weight loss 0 0 17. Insight 1 1 Total 21 10 Table No. 3 Insomnia Severity Index S. No. Symptoms BT AT 1. Difficulty falling asleep 2 0 2. Difficulty staying asleep 3 1 3. Problems waking up too early 0 0 4. How satisfied/ dissatisfied with our current sleep pattern? 3 1 5. How noticeable to others do you think your sleep in terms of impairing the quality of life? 3 1 6. How worried / distressed are you about your current sleep pattern? 3 1 7. To what extent do you consider your sleep pattern interfere with your daily functioning currently? 2 1 Total 16 (Clinical Insomnia) 5 (No Clinically significant Insomnia) DISCUSSION In this case, combined therapy of Shamana Chikitsa, Yoga Chikitsa along with Panchkama (Upkarma) has been shown benefit. As we all know acc. to Ayurveda, vata dosha is responsible for all movements and activities of body and brain.8 When there is imbalance of vata dosha in body, the symptoms like bala-chesta nasha will be found which is main characterstic feature of
  • 5. International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD59736 | Volume – 7 | Issue – 4 | Jul-Aug 2023 Page 865 depression8 . For Shamana of vata dosha, Snehan therapy in the form of Shirodhara process was done8 . Snehana – Swedana are the purvkarma of shirodhara which helps in relaxation of body before shirodhara. Snehana causes viscosity, softness and kleda in the body as mentioned by Acharya Charaka. Swedana causes vasodilation all over the body. In ayurvedic classics Shirodhara can be correlated with Shiroparisheka"9 . Shirodhara means pouring of either taila, milk or takra gently over forehead in a continuous stream at a particular point (Agya Chakra) from a definite height (approx. 4-5 inches)10 . Shirodhara has shown its anti-anxiety, anti- hypertensive and sleep-inducing effects in few studies. Effects of Shirodhara are found to be responsible for reduction in catecholamine and an increased serotonin uptake11 . This center of forehead are believed to be linked with the pineal gland (often called third eye) of the body12 which helps in controlling circadian cycle of the sleep and wakefulness by secretion of melatonin hormone. Continuous pouring of Taila over forehead for a specific period has a transquilizing effect and induce sleep by reaching the brain cortex and correct deficiency of certain neurotransmitters13 . As per modern science, we all know that after local application as an ointment a drug may pass through the stratum corneum and into the blood vessels to produce desirable effect at a remote target organ. Tila taila possess anti vata dosha properties8 and its snigdha property helps trpaka kapha of brain cells in properly maintaining the connection of Indriyas and Vishaya which may have been deranged by aggravated Vata. In Ashtanga Samgraha it is explained that Nasa being the door way to Shira (heard), the drug administered through nostrils, reaches Shringataka (a Sira Marma by Nasa Srota and spreads in the Murdha (Brain) taking route of Netra (eye), Shrotra (ear), Kantha (throat), Siramukhas (opening of the vessels) etc. and scratches the morbid Doshas in supra clavicular region and extracts them from the Uttamanga14 Nasal drops inserted in the nose during nasya process induce inflammation in nasal epithelium causing elimination of morbid materials15 These medicines used apart from Shirodhara like Saraswataristha (anti-inflammatory, anti-anxiety, memory enhancing, anti-oxidant) and Bramhi vati (anti-oxidant, anti-inflammatory, antianxiety and tranquilizer) are well established Medhya Rasayan(brain tonic) in Ayurveda. CONCLUSION It may be concluded that Shirodhara is an effective treatment in the management of Unmada. Shirodhara along with these drugs helpful in decreasing manifestations of vikriti of mana (chintya, vicharya, uhaya, dheya and snkalpa), buddhi (abnormal acumen power), smriti (not memorizing beautiful memories), achar and chesta dusti (presence of crying spells) etc. Informed consent: Informed consent was taken from the patient for this study. REFERENCES [1] Reddy MS. Depression: The Disorder and the Burden. Indian J Psychol Med 2010; 32: 1–2. [2] Farahzadi MH, Services H. Depression; Let’s talk. 2017. [3] O’Connor E, Whitlock E, Gaynes B, Beil T. Screening for Depression in Adults and Older Adults in Primary Care. Agency Healthc Res Qual US 2009: 167. [4] Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et al. The global prevalence of common mental disorders: A systematic review and meta-analysis 1980- 2013. Int J Epidemiol 2014; 43: 476–93. [5] Arvind BA, Gururaj G, Loganathan S, Amudhan S, Varghese M, Benegal V, et al. Prevalence and socioeconomic impact of depressive disorders in India: Multisite population-based cross-sectional study. BMJ Open 2019; 9. [6] Ye G, Li Z, Yue Y, Wu Y, Yang R, Wang H, et al. Suicide attempt rate and the risk factors in young, first-episode and drug-naïve Chinese Han patients with major depressive disorder. BMC Psychiatry BioMed Central; 2022; 22: 1– 10. Available from: https://doi.org/10.1186/s12888-022-04254-x. [7] vidyotini teeka on charak samhita .pdf. [8] Charaka Sootra Sthana Global .pdf. [9] Sushrut Samhita -2 - Ambikadutta Shastri (AyuTech).pdf. [10] Rathod D m. Shirodhara With Oil.: 1–2. [11] Divya Kajaria J. An Appraisal of The Mechanism of Action of Shirodhara -. Ann Ayurvedic Med 2013; 2: 114–7. [12] Gaikwad A, More N, Wele A. International Journal of Ayurveda and Pharma Research. 2015; 3: 2322–902. [13] Dhuri KD, Bodhe P V., Vaidya AB. Shirodhara : A psycho-physiological profile in healthy volunteers. J Ayurveda Integr Med 2013; 4: 40–4. [14] Astanga-Sangraha.pdf. [15] Deepak VM, Suwarna VD, Pawan LS, Sunil TG. Nasya Karma Karmukatva-a Review Article. Available from: www.iamj.in.