Site of manas is
both Hridaya and Mastiska
(Brain)
SampraptiGhataka:
1.
Dosha– Manasa– Raja, Tama
Sharira– Vata – Prana, Udana and Vyana;
Pitta – Sadhaka;
Kapha– Tarpaka;
2. Dusya– Mana, Rasadidhatu;
3. Agni–
Jatharagni – Manda, Visama;
4. Srotas– Manovaha, Sarvasrotodusti;
5. Udbhava Sthana- Hridaya; Mastishka
6. Vyakti Sthana – Mana; (Hridaya and Mastishka)
Sarva Sariravikara:
Acarya Charaka has explained three types of
therapies of physical and mental disorders:
1. Daivavyapasraya– Spiritual therapy
2. Yuktivyapasrya –
Physical therapy
3. Sattvavajaya – Psychological therapy.(Cha.Su. 11/54)
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This
is one of the most common mental disordersnow a day.
Patients with generalized anxiety disorder (GAD) have persistent, excessive,
and/or unrealistic worry associated with muscle tension, impaired
concentration, autonomic arousal, feeling "on edge" or restless, and
insomnia. Onset is usually before age 20, and a history of childhood fears and
social inhibition may be present. The lifetime prevalence of GAD is 5–6%; the
risk is higher in first-degree relatives of patients with the diagnosis.
Interestingly, family studies indicate that GAD and panic disorder segregate
independently. Patients with GAD worry excessively over minor matters, with
life-disrupting effects.
Generalized anxiety disorder:
URL of
this page: http://www.nlm.nih.gov/medlineplus/ency/article/000917.htm
Generalized
anxiety disorder (GAD) is a pattern of frequent, constant worry and anxietyanxiety over many different activities
and events.
Causes:
Causes
Generalized
anxiety disorder (GAD) is a common condition. Genes may play a role. Stressful
life situations or learned behaviour may also
contribute to the development of GAD.
The disorder
may start at any time in life, including childhood. Most people with the
disorder report that they have been anxious for as long as they can remember.
GAD occurs somewhat more often in women than in men.
Symptoms:
Symptoms
The
main symptom is the almost constant presence of worry or tension, even when
there is little or no cause. Worries seem to float from one problem to another,
such as family or relationship problems, work issues, money, health, and other
problems.
Even
when aware that their worries or fears are stronger than needed, a person with
GAD still has difficulty controlling them.
Other
symptoms include:
·
Difficulty concentrating
·
Fatigue
·
Irritability
·
Problems falling or staying asleep, and
sleep that is often restless and unsatisfying
·
Restlessness or feeling keyed up or
"on the edge," often becoming startled very easily
Along
with the worries and anxieties, a number of physical symptoms may also be
present, including muscle tension (shakiness, headaches).
Depression
and substance abuse may occur with an anxiety disorder
The
main Dosas of the Manasa
are Raja and Tama (Ca. su. 1/57), Hence the Nidnana, which vitiate Raja and Tama may be considered as
etiological factors of Chittodvega.
Keeping these points in view, shirodhara (ksheerabalataila) has been used in patients of chittodvega (Generalized anxiety disorder) for 14 days
PATIENTS AND METHODS:
19
patients of Chittodvega were selected from O.P.D. and
I.P.D. sections of Panchkarma department of Rishikul
Govt. Ay. P.G. College and Hospital, Haridwar (Uttarakhand). Detailed history and physical and mental
examinations were done on the basis of specialized proforma
prepared for this purpose. Pulse, respiration and blood pressure were checked
to assess the present condition of the disease. Routine blood, urine and stool
examinations were performed to exclude other pathogenesis. Diagnosis was done
on the basis of following criteria-
Criteria
for diagnosis:
DSM
IV (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria
for various anxiety disorders were primarily adapted.
DSM-IV
Diagnostic Criteria for Generalized Anxiety Disorder:
A.
Excessive anxiety and worry (apprehensive expectation), occurring more days
than not for at least 6 months, about a number of events of activities (such as
work or school performance).
B.
The person finds it difficult to control the worry.
C.
The anxiety and worries are associated with three (or more) of the following six symptoms (with at
least some symptoms present for more days than not for the past 6 months)
1.
Restlessness or feeling keyed up or on edge,
2.
Being easily fatigued,
3.
Difficulty concentrating or mind going blank,
4.
Irritability,
5.
Muscle tension,
6.
Sleep disturbance (difficulty falling or staying a sleep, or restless
unsatisfying sleep).
D.
The focus of the anxiety and worry is not confined to features of an Axis 1
disorder, e.g. the anxiety or worry is not about having a panic attack (as in
panic disorder), being embarrassed in public (as in social phobia), being
contaminated (as in obsessive – compulsive disorder), being away from home or
close relatives (as in separation anxiety disorder), gaining weight (as in
anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur
exclusively during posttraumatic stress disorder.
E.
The anxiety, worry or physical symptoms cause clinically significant distress
or impairment is social, occupational, or other important areas of functioning.
F.
The disturbance is not due to the direct physiological effects of a substance
(e.g. a drug of abuse, a medication) or a general medical condition (e.g. hypethyroidism), and does not occur exclusively during a
mood disorder, psychotic disorder, or pervasive development disorder.
Improvement
in all the signs and symptoms as per Hamilton’s anxiety rating scale was
assessed. Hamilton (1959) has described 14 types of clinical features of
anxiety status, the details of which are as follows:
HAMILTON
ANXIETY RATING SCALE:
01. Anxious mood: Worries, anticipation of the
worst, fearful anticipation, Irritability.
02. Tension: Feeling of tension, fatigability,
startles 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 asleep,
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, dyspnoea
11 Gastrointestinal
Symptoms: Difficulty in swallowing, wind, abdominal pain, burning
sensation, abdominal fullness, nausea, vomiting, 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 Behaviour 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 and Pathological condition Scoring:
None 0
Mild 1
Moderate
2
Severe
3
Severe,
grossly disabling 4
Out of 19 patients, observed % improvement
in anxiety was 76.6%, its p value was <.001, i.e. highly significant;
in irritability it was 75,61% and p value was <.001, i.e. highly
significant; in tension it was 73.81% and p value was <.001, i.e.
highly significant; in fear it
was 65.38% and p value was <.001, i.e. highly significant; in insomnia it
was 64.00% and p value was <.001, i.e. highly significant; in nightmares it was 44.68% and p
value was <.001, i.e. highly significant;
in memory it was 68.57% and p value was <.001, i.e. highly
significant; in lack of interest
it was 72.50% and p value was <.001, i.e. highly significant; in muscle tone it was 45.00% and p
value was <.001, i.e. highly significant;
in weakness it was 27.17% and p value was <.01, i.e. significant;
in palpitation it was 38.1% and p value was <.01, i.e.
significant; ; in tension headache it was 60.00% and p value was
<.001, i.e. highly significant; ; in GI disturbance it was 30.76% and p
value was <.01, i.e.
significant;
DISCUSSION:
Demographic profiles of these patients
didn’t show any relevancy because it is neither a community nor an age related
disorder; but it was more prominent in married, retired and housewives.
The therapeutic trial of shirodhara (ksheerabalataila)
showed beneficial effects on various symptoms as per
Hamilton’s Anxiety Rating Scale (HARS) as
shown in above mentioned table.
At the site of shirodharasthapanimarma is situated. Sthapanimarma
have anatomical structures like cavernous plexus, optic chiasmaand
thalamus. Ajna chakra is also situated at the site of
sthapanimarma. It has close relation with the
hypothalamus, limbic system andneighbouring region
with connections to pituitary gland. May be when shirodhara
performed it stimulated these structures and produce some effect on blood
pressure. The hypothalamus, major controls headquarter for limbic system. On
the stimulation of different areas of the hypothalamus can cause every known
type of neurogenic effect on cardiovascular system,
including increase arterial pressure, decrease arterial pressure, increase
heart rate and decrease heart rate. Stimulation in the posterior and
lateral hypothalamus increase the
arterial pressure and heart rate, whereas stimulation in the preoptic area (sthapanimarma) has
opposite effect, causing a decrease in both arterial pressure and heart rate
(Guyton and Hall medical physiology 10th edition). Probably such an
effect may relieve insomnia and provides mental calm, in addition to provide
cure of the above mentioned symptoms. Chittodvega
(Generalized Anxiety Disorder) is basically a vata
predominant disorder with the involvement of raja-tama manasdoshas;
ksheerabalataila has good vatashamak
effect as well as it mayprovide essential nutrition
to the underlying tissues. Shirodhara is done directly on the head, so it may be
considered as good for relieving the symptoms caused by stress and strain as
well as other mental factors. The nidranashahara, shirorukhara, bhramahara actions
shown by shirodhara indicate towards its shamaka i.e. tranquilizer effect and due to which it might
reduced the blood pressure of the patients and producecalm.
CONCLUSION:
Anxiety symptoms
are common in medically ill patients 5 to 20% of medical in patients and 4 to
14% of general medical out patients suffer from anxiety disorders, 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).
Chittodvega a minor psychiatric disorder has been mentioned by Charaka (Charak Vi. 6/5), which
is produced due to vitiation of Raja and Tama. In addition Prana,
Udana, Vyana Vayu; Sadhaka Pitta;
and Tarpaka Kapha are also provocated factors in it. Etymology of Chittodvega
i.e. anxious status of mind is similar to anxiety, somatic manifestation are
also same in both the condition.
Shirodhara therapy has been found as safe and effective treatment modalities
in anxiety, irritability, inability to relax, lack of concentration, disturbed
sleep, loss of memory, palpitation, headache, dryness of mouth, upset stomach
and restlessness. It is having tranquilizing and anxiolytic
effect resulting into a kind of relaxation response.
REFERENCES:
Charaka Samhita
Vol. 1 and 2 by Pt. Kashinath Pandey
and Dr. Gorakhnath Chaturvedi;
Panchkarma Therapy by Prof. R.H. Singh;
Astanga Hridayam
Vol 1,2,3 by Dr. K. R. Srikanth
Murthy;
Ayurveda Panchkarma
Vigyana by VD. Kasture;
Principles of Internal Medicine by
Harrison;
Kaplan and Sadock
(1998): Synopsis of Psychiatry, Behavioural Sciences
Clinical Psychiatry, 8th edition
Text Book of Medical Physiology by Guyton
and Hall.
