Mental Depression)

CLINO-COMPARATIVE TRIAL OF CHARKOKTAMEDHYARASAYAN AND SHIRODHARA IN PATIENTS OF MANSIKAVASAD (MENTAL DEPRESSION)

Dr. Shraddha Sharma* * Lecturer Department of Kayachikitsa. Pt. Khusilal Sharma Ayurveda Govt. Autonomous College and Institute Bhopal (M.P.)

ABSTRACT Depression is extremely common as a disorder. It is estimated that 20 to 25% of women and 12 to 15% of men will suffer from a major depression during their life. Depression is normal feature of our hard life. Depression is the most common disease of psychiatry as cough and cold is in dept. of medicine. MedhyaRasayanaYog is one of such drug which is said to be Medhahitam, Rasayana, Vrsya and acts as mood elevators and promotes the sense of well being. The present clinical trial was conducted to evaluate the efficacy of Medhyarasayana and Shirodhara in 45 patients having symptoms of Depression. The effect of therapy was assessed adopting “Hamilton’s depression rating scale”. MedhyaRasayana and Shirodhara showed significant (P<.001) improvement in all parameters of Hamilton’s Depression Rating scale. It was inferred that most of the contents of the formulation of MedhyaRasayana are Medhya, Balya, Dhatupushtikara, Brimhaniya, Jivaniya, and Agnivardhaka. The drugs may act as adoptogens, antioxidants, immunostimulents, antistress, nootrophics, antidepressants, or may have other geriatrics benefits. Hence it was concluded that MedhyaRasayanaYog can be used as an alternative treatment to manage depression.

Keywords: MedhyaRasayana, shirodhara, Stress.

INTRODUCTION Depression is grouped under mood disorders or affective disorders, in which the primary and dominant characteristic is a change in mood consisting of a feeling of sadness, which may vary from mild desponding to the most object despair, mood disorder , affects the whole organism , feelings , energy , thinking , drive , personality and interest and tends to influence every sphere of personal life .chronically depressed individuals are among the least productive citizens and heaviest users of the medical services and are thus major economic burden to society. Its effect extends in varying degrees to family, friends and co-workers. Moreover, influence of depression has a wide sphere as stated by Caraka that vishadorogvardhanam1 and Susruta mention this disease as a manasvyadhi2. Being an alarming problem, Avasada needs upmost care and susruta mentions this disease as a manasvyadhi. Being on alarming problem, avasada needs upmost care and effective treatment. Generally management of psychic disorders in modern medicine is limited up to tranquilizers and sedatives and long use of which bestows hazardous side effects and drug dependency. All the electric mesuresunnativeral obviously get refused to body, which proves complete failure of such an artificial attitude in eradication of root cause of avosada so, it is essential to evaluate safe, easily available and economical drug, which potentiate the medha with additional vrsya effect. MedhyaRasayana3is a one of such drug which is said to be Medhahitam4, Rasayana5, vrsya and acts as mood elevator and promotes the sense of well being. It is a unique combination of four drugs mandukaparni, sankhapuspi, mulathi and gudhuchi which is consider as medhya as it works as nervine and brain tonic.

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Shirodhara is purity of liquid over the forehead or scalp. It helps to manage depression by activating nervous system to increase the secretion of neurotransmitters such as serotonin and dopamine. Shirodhara was done by medhyarasayanakwatha. MEDHAYA RASAYANA YOG • Medhaya rasayana yog is one of such drug which is said to be medhahitam,rasayana,vrisya and acts as mood elevator and promotes the sense of well being • Description of medhya rasayana yog is available in charak samhita ,1st chapter rasayana (3rd pada,karpratichiya pada) • It acts as nervine and brain tonic. • It stimulates the neurotransmitters of our brain. SHIRODHARA  The name comes from the Sanskrit word shiro [head] and dhara [flow]. Shirodhara is an Ayurvedic method of treatment in which herbal oil, medicated milk or decoction is pored gently and steadily over fore head continuous stream a particular point from a definite height.  Unique form of ancient therapy  Specific height  Specific period  Continuously  Rythmatically

NIDANA (ETIOLOGY) 6 According to acharya charak, susruta and vagbhata. • Rajja and tamma manas doshes and manas bhava (Kama, krodha, bhaya, glani etc) are responsible for manas roga. according to Ayurveda nidana is A) Aharaja • 1.Tamasik and rajjasik ahara • 2.Vatadoshakaraka ahara • 3.Kaphavridhikaraka ahara

B) Viharaja • 1.Tamasik and rajjasik karya • 2.Anavanchitta karya • 3.Asimitta karya

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• 4.Asamajik karya • 5.Vatadushtikaraka karya C) Rogaja • 1.Vatapradhana roga • 2.Kaphapropokapa roga • 3.Roga aggravates sadhaka pitta • 4.Chronic roga • 5.Manosararik raga D) Manasik • 1.Shoka,bhaya,krodha,dukha,ishya,chintta,diveysha,moha etc • 2.Mansik aghata • 3.Economic problem • 4.Family and social problems • 5.Sexual problems E) Others • Pragjyaappradha, purvajanam karya, disobeying of devta, rishi, gandharva, yaksa, guru, acharya etc. Modern etiology • 1.Genetic • 2.Biochemical • 3.Family problems • 4.Social

AIMS AND OBJECT  To evaluate the role of charkoktamedhyarasayana and shirodhara in mansikavasad  Evaluation of changes in psychological state after using medhayarasayanayog.  To provide a general observation of depressive patients

METHODOLOGY • A clinical study for 21 days duration was carried out with three groups of patients to fulfill the aims and objects of the study. A special research Performa was prepared and data was statistically analyzed. There are 45 patients were selected are divided into three groups.(15 patients in each group) Group A • Medhyarasayanayog was given 10gm two times with milk for 21 days. Group B • Shirodhara was done by medhyarasayanakwath for 21 days.

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Group C • Medhyarasayana and shirodhara both are given for 21 days.

SUBJECTIVE PARAMETERS A. PYSCHIC SYMPTOMS 1 Dukkhatvam 2 Anavastha Cittam 3 Glani 4 Asiddhi Bhaya 5 Visada 6 Atmana Asktata 7 Kheda 8 Alpa Nidra 9 Suicidal Tendencies 10 Ati chinta B. SOMATIC SYMPTOMS 1 Karmesu Apravritti 2 Aaruchi 3 Bharchinata 4 Mala avarodha 5 Swasa Karchichata OBJECTIVE PARAMETER 1 CBP with ESR 2 Sugar Test OTHERS 1 B.P. 2 Body weight 3 Pulse 4 Temperatures

Result and observation

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S.NO Effect of therapy Group A Group B Group C Pt. % Pt. % Pt. % 1 Markedly improved - - 2 13.32 3 20 2 Improved 9 60 9 60 10 67.67 3 Mildly improved 6 64 4 26.67 2 13.33 4 Not improved ------To 15 100 15 100 15 100 tally

Discussion  The effect of therapy in 45 patients are in three groups are mentioned as below  Group A  Out of 15 patients, 9 patients (i.e. 60/) are improved and 6 patients (40/) are mildly improved.  Group B  Out of 15 patient,2 patients(i,.e13.32/)are markedly improved and 9 patients(60/) are improved whereas  4 patients (i.e. 26.67/) are mildly improved.  Group C  Out of 15 patients, 3 patients (i.e. 20/) are markedly improved and 10 patients (i.e. 66.67) are improved whereas 2 patients (i.e. 13.33/) are mildly improved. MODE OF ACTION MEDHYA RASAYANA . Medhya rasayana yog is a combination of four drugs . Mandukaparni, mulathi, sankhapushpi and guduchi.

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. The medhya rasayana are known to be beneficial to improve the intellectual e.g. mandukparni swaras, yashtimadhu churna with ksheer, guduchi swaras and shankhapushpi kalka.medhya rasayana drugs are used for prevention and treatment of mental disorders of all the age groups. These drugs promote the Intellect (Dhi), Retention power (Dhriti), memory (smriti).  Unfortunately modern medicine based psychoactive drugs have met with limited success in treatment of various neurological and psychiatric disorders due to multi-factorial nature of these diseases. This review discusses about medhya rasayanas as great players for prevention and management of age related cognitive decline.

PROBABLE MODE OF ACTION OF SHIRODHARA

1. TRANQUILIZING EFFECT Chemical constituent of medicated oil may acts as a neurotransmitter (for ex. serotonin) as deficiency of certain neurotransmitter can be checked hypothetically , if oil circulate into the brain cortex as explained by Johnson while treating the patient of angina by nitroglycerin.

2. EFFECT ON AUTONOMIC NERVOUS SYSTEM Shirodhara may also have alpha adrenergic blocking effect and can thus block certain actions of adrenaline and noradrenaline.shirodhara may also act on the adrenergic neuron. Probably produce their effects by modifying the synthesis storage and uptake mechanisms of noradrenalin 3. EFFECT ON ENDOCRINE SYSTEM Hypothalamus – main controller of endocrine secretions. Hypothalamic neurons secrete the regulatory hormones are themselves under the control of specialized monoaminergic,neurotransmitter neurons which arise in mid brain .these later release dopamine,noradrenaline and serotonin.inturn these mid brain nuclei are under the control of visceral brain and are responsive to stress and emotional disturbances. 4. REGULATION OF EMOTIONAL AND BEHAVIOURAL PATTERNS Together with limbic system hypothalamus regulates the feeling of rage, aggression, pain, pleasure and behavioral patterns. Shirodhara may be having some effect on hypothalamus resulting in decrease of most of the psychic and somatic disorders. 5. EFFECT ON TEMPERATURE Vibration along with little temperature may activate the function of thalamus and the basal for brain -brings the amount of serotonin and catecholamine’s to the normal. 6. EFFECT OF PRESSURE According to modern physiology Pressure has an effect on nerve impulse conduction Shirodhara produce a constant pressure and vibration which is amplified hollow sinus present in frontal bone. Vibration is then transmitted inwards through fluid medium of cerebrospinal fluid [CSF] Nerve ending stimulates-ANS stimulates –acetylcholine [inactive]-activates fall of blood pressure-leading to decrease activity of CNS resulting in tranquility of mind.

7. ACTION OF SHIRODHARA ON MARMA Marmas [vitals spots]-critical spots in our body 107 marmas. 37 are Shiras [head region] 15 are sadhyapranahara [injury of which result in instant death.] 5 are kalantara pranahara [injury of which result in delayed death.] 3vishalyagna [death after removing foreign body] 14 vaikalyakara [injury to which results in physical impairment] Most marma are Agni [fire] and vayu [air] mahabhuta pradhana. The site of sthapani marma-the site of pituitary gland and pineal gland exist at the same level. Function of pituitary gland is controlled by hormones or nerve signals. The gland activated whenever the stimuli from CNS or hormones. it has capacity to maintain all the endocrine system

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8. ACTION OF SHIRODHARA ON CHAKRA CONCEPT Chakras [nerve plexuses]-7 chakras located in our body. 1. Muladhara [pelvic plexus] 2. Swadistana [hypogastric plexus] 3. Manipura [solar plexus] 4. Anahata [cardiac plexus] 5. Vishuddha [pharyngeal plexus] 6. Ajna [the plexus of command between two eye brows] 7. Sahastrara [the thousand petals lotus, the upper cerebral centre]-it has capacity to control all other six chakras. Shiras [head] is the seat of both. Ajnya chakras [6th chakra] are located at the level of external point of the eye brow.

 Ajna chakra corresponds to pineal gland and medulla oblongata in brain. It is consider as third eye because of its position.  Trigger point of concentration  Consider as centre of concentration or center of consciousness.  Centre of bodily systems and state of awareness are controlled.  Shirodhara treatment over ajna chakra.[pineal gland and medulla oblongata in brain].it will stimulates sahastrara chakra.  Pineal gland is responsible for rhythmic changes, sleep promotion and sexual behavior.  Medulla oblongata [brain stem]-equilibrium of body is controlled. Together both synergistically help to produce desired effect of shirodhara. 9. ACTION OF SHIRODHARA BASED ON ASANA Posture of shirodhara-shavasana [corpses pose] This is one of the complete relaxation posture mentioned in yogashastra [text of yoga] Present therapy may act as mechanical stimulus to the receptor which counterbalances the pain regulating centers [such as bradykinin, serotonin, histamine, potassium ions, acetylcholine etc.] Mechanical, thermal and chemical stimuli. Shavasana is one of the very important yogic practice, provides total relaxation. Some recent researches suggested that it is significantly reduces the subjective improvement in the symptoms like headaches, giddiness, nervousness, irritability and diminished sleep. 10. ACTION OF SHIRODHARA BASED ON MANOMAYA KOSHA Five koshas leads to manifestation of a progressive expression of life.  Annamaya [physical]  Pranamaya [vital]  Manomaya [mental]  Vigyanamaya [intellect]  Anandmaya [blissful]  Manomaya kosha refers to the emotional ,mental and spiritual aspects of human being collectively frame our subjective experience of being alive which is composed of manas [mind]

Conclusion Conclusion drawn from the clinical study is as follows • Medhyarasayanayog are very effective in treatment of mental depression due to its nervine and brain tonic actives. it stimulates the secretion of neurotransmitters. • Shirodhara done by medhyarasayanakwath were very effective in the treatment of mental depression. It stimulates nervous system .mode of action of shirodhara works through ajnachakra, sthapanimarma, temperature, pressure, manomaya kosha etc. • Medhyarasayana and shirodhara both are used together, it shows very good result.

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• This therapy provides significant relief in the symptoms of mansikavasad .no clinical side effects were noted during the study period of 21 days. The results of this trial are very encouraging and require further research on larger scale .further detailed experimental studies are required to assess the effects of medhyarasayanayog in mansikavasad.  Shiras is the seat of manas .manas has four purpose 1. Remembrance 2. Resonableness 3. Vision 4. Knowledge of bliss and ache based on responses from past deeds.  Body and mind both are innately interconnected hence healing process to mind indirectly heals the body also.  So dhara therapy hypothetically heals the mind in turn heals the body.

REFRENCES

1. Charak samhita 1stpart , of Agnivesa, elaborated by Charaka and Dridhabala, Edited with Charaka- Candrika Hindi commentary along with special deliberation by Dr. Brahmanand Tripathi, Chaukambha Surbharati Prakashan, Varanasi, 3rd Edition 1994 chapter 25/8

2. Sushruta samhita, Sutra Sthana. Susrutvimarshni Hindi commentary by Anantaram Sharma Subharati Prakashana, Varanasi 2004 chapter 1/33 3. Charak smahita 2nd part, of Agnivesa, elaborated by Charaka and Dridhabala, Edited with Charaka-Candrika Hindi commentary along with special deliberation by Dr. Brahmanand Tripathi, Chaukambha Surbharati Prakashan, Varanasi, 3rd Edition 1994

4. Astanga Sangraha of Vagbhata with Indu Vyakhya by D.V.Pandit, Vaidya Ayodhya Pandey,1st Edition, chapter 5/14 CCRAS, New Delhi, 1991 5. Charak samhita 1stpart , of Agnivesa, elaborated by Charaka and Dridhabala, Edited with Charaka- Candrika Hindi commentary along with special deliberation by Dr. Brahmanand Tripathi, Chaukambha Surbharati Prakashan, Varanasi, 3rd Edition 1994 chapter 1-3/30-31

6. Sushruta samhita, nidan Sthana. Susrutvimarshni Hindi commentary by Anantaram Sharma Subharati Prakashana, Varanasi 2004.

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