Role of Shirodhara in the Management of Madatyayajanya Anidra

: Insomnia ( anidra) is the complaint of inadequate sleep. Alcohol can interfere with sleep, despite the fact that many patients use it to relax and promote sleep. Although alcohol can increase drowsiness and shorten sleep latency, even moderate amounts of alcohol increases awakenings in the second half of the night most of times. Acharya Charak also describes the symptom nidranash or Prajagrana in madatyaya (Alcoholism). Shirodhara is a classical and a well-established Ayurveda procedure of slowly and steadily dripping medicated oil or other liquids on the forehead. This procedure promotes the release of sleep inducing neurotransmitters which causes a dynamic psycho-somatic balance results in quite sleep. This article reveals the effect of shirodhara procedure in insomnia associated with madatyaya (Alcoholism).


INTRODUCTION:
Ayurveda considered Nidra, among the three Upastambhas for the maintenance of the living organism 1 .While discussing about nidra and nidranasha in the context of Astaunindaniya Adhyaya, Charaka has stated that happiness & sorrow, growth & wasting, strength & weakness, virility & impotence, the knowledge & ignorance as well as existence of life and its cessation depend on the sleep.Moreover, Nidra is Pushtida and Jagarana or Nidranasha does the Karshana of the body 2 .Charaka has included the Asvapna (Insomnia) in Nanatmaja Vata Vikaras 3 .Acharya Sushruta explained the Vaikariki Nidra 4 which can be correlated to sleep disorders like madatyayajanya anidra in case of alcoholism.
The term shirodhara is derived from two Sanskrit words: shiro means head and dhara means to flow.It involves the rhythmic and consistent flow of lukewarm medicated oils on the forehead.This stimulates the chakra point just above and between the eyebrows and creates a blissful sensation.
Shirodhara improves blood circulation to the brain and stimulates the pituitary and pineal glands thus improving their functions.Shirodhara cures insomnia, stress, depression and memory loss.The procedure is also said to synchronize alpha brain waves.This procedure reduces fatigue and initiates a soothing effect on brain cells.It might be working due to the effect of a soothing sensation of poured liquids through peripheral nerves of the skin of the forehead and then they go to the brain with calming and soothing energies, which help to reduce stress and induce sleep.Due to constant flow of liquids over the head, shirodhara tranquilizes and stabilizes the mind, so the mind becomes serene and calmed.It is a form of restorative therapy for stress, anxiety and insomnia.

AIMS AND OBJECTIVE:
• To discuss, evaluate & elaboration of Insomnia with special references to madatyayajanya anidra.
• To discuss, evaluate & elaboration of effects of shirodhara procedure on madatyayajanya anidra.

MATERIAL AND METHODS:
This article is based on personal experiences & textual review.Material related to madatyayajanya anidra and effect of shirodhara procedure was collected from the Brihatrayi, Laghutrayi, Nighantu and available commentaries of those have reviewed.Modern Texts & various websites to collect information on the relevant topics were referred.

CONCEPTUAL STUDY:
Shirodhara is a titillating form of snehana treatment, whereby the oil or therapeutic substance methodically drips along a course thread onto the forehead.A metal or clay vessel, the dhara patra, is suspended directly above the forehead.This treatment involves pouring a stream of oil over the guest's forehead.Most commonly medicated sesame oil is used for this treatment.Traditionally, specifically prepared herbal medicated oils, milk, or buttermilk are used.The oil or other fluid is poured into the pot, and then seeps through a hole in the bottom of the pot and slides down a 4-inch-long thread, half of which hangs through the hole.The drops of oil from the thread drip directly onto the subject's third eye, or centre of the forehead.An ancient technique, shirodhara is meant to be maintained at a certain rhythmic speed while awakening the third eye.Vast and miraculous healing occurs when this technique is performed to perfection.The rhythm of the oil trickling onto the third eye or Sthapani Marma, which is the seat of our cognitive vision, evokes deep cognitive memories.Through the arousal of these memories, bodily tissues are transformed and good health is restored.Before shirodhara is administered, the preliminary procedure of abhyanga massage is performed.A soporific treat, shirodhara soothes and strengthen the senses as well as the mind.A total state of wellness is induced in the process.

Types of shirodhara:
Due to variation in liquids, its types are decided as follows: 1. Taila Dhara : Medicated oils are used in this type of dhara eg Brahmi taila , Ksheerbala taila .2. Takra Dhara : takra that is prepared with the curd of cow's milk is used as the main ingredient of pouring liquid.

Effect of Shirodhara on Tridosha: Stress and tension causes imbalance of Prana, Udana and Vyana
Vayu; Sadhaka Pitta and Tarpaka Kapha.Shirodhara reestablishes the functional integrity between these three subtypes of dosha through its positive effect 6 .

Therapeutic effect of the medicament used for Shirodhara:
The maximum absorption of drug is in the skin of scalp and oil is better absorbed compare water 7 .It suggests that the medicament used for dhara is definitely absorbed.

Effect of Shirodhara as per Yogic science:
Shirodhara is performed in Savasana position, which is used for relaxation in Yogic science.During Shirodhara patients concentrate where dhara is poured on the forehead.As the Patient concentrates on a particular place, the thought process decreases and thus entire psycho-physiology relaxes 8 .

Effect of Shirodhara on Shada Chakra:
Dhara poured on Agyaa Chakra (space between two eyebrows), is the seat of pituitary and pineal gland.Shirodhara regulates their stimulation and helps to bring hormonal balance 9 .It also nor-malised elevated cortisone & adrenaline, synchronizes the brain wave (alpha waves), strengthens the mind and this continues even after the relaxation 10 .

Effect of Shirodhara as per Marma science:
In forehead region, mainly Sthapani, Utkshep and Avarta Marma are located.As mentioned earlier it is also a place of Agyaa Chakra.According to Acharya Bhela, the location of Chitta (Mana) is Bhru madhya and same is place of Sthapani Marma 11 .Shirodhara makes the patient concentrate on this area by which the stability arrives in the functions of mind.

DISSCUSSION:
Most of the classics have mentioned role of Tama, Shleshma, and inactivity of mind in the initiation of sleep.According to Acharya Charaka when mana (mind) as well as indriyan gets exhausted or becomes inactive and the sensory and motor organs become inactive then the individual gets sleep 12 .Heart is the seat of the mana and indriyan, while madya having entered into the heart counteracts the ten properties of ojas with its corresponding ten properties and thus upsets the mana and indriyan results to anidra 13 (Insomnia).Shirodhara is a well-established upakarma procedure for centuries.It is widely practiced in India and also in Panchakarma centers abroad.Besides its therapeutic usage and its shamana karma, its general relaxing and calming effects are well-known and worth exploring with modern tools.To explain how shirodhara affects madatyayjanya anidra, shirodhara re-establishes the functional integrity between doshas subtypes like prana vayu, and tarpaka kapha both having seat of shirha Pradesh and helps to induce sleep.Shirodhara procedure stimulate the Agyachakra -seat of vital part (Marma) also and thus help in regulating the neuro-endocrine system to maintain the hormones, neurotransmitters etc. related to Hypothalamus, Pituitary, Pineal gland etc, to have proper relaxation & tranquility.Moreover, supine position in shirodhara also helps in providing further relaxation.In the procedure of shirodhara, particular pressure and vibration is created over the forehead.The vibration is amplified by the hollow sinus present in the frontal bone.The vibration is then transmitted inwards through the fluid medium of cerebrospinal fluid (CSF).This vibration along with little temperature may activate the functions of thalamus and the basal fore-brain which then brings the amount of serotonin and catecholamine to the normal stage inducing the sleep.

CONCLUSION:
Modern sedatives, hypnotics, tranquillizers and psychotropic drugs which are generally used for sleep related disorders have their own limitation due to its hazardous & withdrawal effects.Shirodhara is very effective procedure for madatyayjanya anidra by the action of soothes, nourishes and pacifies the doshas through the application of the liquid to the forehead, scalp and nervous system.

Dugadha Dhara / Ksheer Dhara) :
5. Kwatha Dhara: Decoctions made from various herbs as per condition and bodily defect or dosha of the person are used in kwatha dhara eg Dashmool kwatha, brahmi kwatha etc. 4. Cow's milk mixed with some medicinal herbs such as Sida cordifolia or Asparagus rasemosus is used as the main ingredient in shirodhara is called dugadha dhara.shirodharawithluke-warm milk have potent effect on the management of Anidra (Insomnia).Shirodhara may have sedative effect on hyperactive limbic system, caused by stress.It leads to facilitate the inhibitory pre-synaptic action of GABA and also reduces high level of nor-adrenaline, which are found high in anxious state of mind5.
The milk used for the shirodhara has madhura rasa, snigdha guna, sheeta veerya and madhura vipaka which subside Vata and Pitta doshas and increases the Kapha dosha.It also increases Tamoguna in the Shirah pradesha.Hence it helps to induce sleep. 5. Jala Dhara: Coconut water or plain water is used in cases of ailments due to excess heat in the body or Pitta diseases.Indications of shirodhara: Shirodhara is beneficial in all diseases of forehead, head or nervous system.