N idranasha ksheeradhara_nasya-pk027_gdg

“THE EFFECT OF YASTI KSHEERA DHARA AND SARPI NASYA IN NIDRANASHA - A COMPARATIVE

CLINICAL STUDY”

BY

GG..DDEEEEPPAAKK

Dissertation Submitted to the Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka.

In partial f ment oulfil f the degree of

AAYYUURR TTII

DR.D. (AYU), FRAV (GOI, Delhi)

P.G. Dept. of Panchakarma

And co-guidance of

DR. SM.D. (Ayu)

a

POST GRADUAT F PANCHAKARMA, D.G M.AYURVED GE AND RESEARCH

GADAG – 582103. 2007-2010

VVEEDDAA VVAACCHHAASSPPAA IN PANCHAKARMA Under the guidance of

. SURESH BABU. S

MProfessor

ANTOSH N. BELAVADI

Asst. ProfessorP.G. Dept. of Panchakarm

E DEPARTMENT OIC ME LLEDICAL CO

CENTER,

“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”

DECLARATION BY THE CANDITATE

I hereby declare that this dissertation / thesis entitled “The Effect of Yasti Ksheera

Dhara and Sarpi Nasya in Nidranasha - A Comparative Clinical Study” is a bonafide

and genuine research work carried out by me under the guidance of Dr. Suresh Babu. S

M.D. (Ayu), FRAV (GOI, Delhi) Professor and the co-guidance of Dr. Santosh N. Belavadi

M.D(Ayu), Asst.Professor, Post Graduate Department of Panchakarma, Shri

D.G.M.Ayurvedic Medical College, Gadag.

Date: Signature of the Candidate

Place: Gadag (G.Deepak)


CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “The Effect of Yasti Ksheera


research work done by G.Deepak in partial fulfillment of the requirement for the degree

of Ayurveda Vachaspathi. M.D. (Panchakarma).

Date: Signature of the Guide

Place: Gadag

Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi) Professor

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 “The Effect of Yasti

Ksheera Dhara and Sarpi Nasya in Nidranasha - A Comparative Clinical Study” is

a bonafide research work done by G.Deepak in partial fulfillment of the requirement for

the degree of Ayurveda Vachaspathi. M.D. (Panchakarma).

Date: Signature of the Co-Guide Place: Gadag

Dr. Santosh N. Belavadi D. (Ayu).

Ast. Professor P.G. Dept of Panchakarma D.G.M Ayurvedic Medical College,

Gadag.

M.


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 “The Effect of Yasti Ksheera


research work done by G.Deepak under the guidance of Dr. Suresh Babu. S M.D. (Ayu),

FRAV (GOI, Delhi) Professor, and co-guidance of Dr. Santosh N. Belavadi M.D. (Ayu), Asst.

Professor, Post Graduate Department of Panchakarma, Shri. D.G.M.A.M.C, Gadag and

contributed good values to the Ayurvedic research.

Dr. G. B. Patil Principal,

Shri. D.G.M. Ayurvedic Medical College, Gadag

Date: Place: Gadag

Dr. Sivaramudu M.D. (Ayu), M.A (San), M.A (Psy) Prof. and H.O.D. P.G. Dept of Panchakarma Shri. D.G.M. Ayurvedic Medical College, Gadag. Date: Place: Gadag


COPYRIGHT

Declaration by the Candidate

I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic / research purpose.

Date: Signature of the Candidate

Place: Gadag. G.Deepak

© Rajiv Gandhi University of Health Sciences, Karnataka.


Acknowledgement

ACKNOWLEDGEMENT

At this happiest juncture of successful completion of this research work, I

prostrate to the lotus feet of “Lord Dhanvantri”, with whose showering of blessings this

task was ventured without any hindrances.

I express my deep sense of gratitude to his great holiness Jagadguru Shri

Abhinava Shivananda Mahaswamiji, for their divine blessings.

Next I pay my obeisance to my Late Grand Father Dr.P.Kesava pillai Ex C.C.I.M

member and N.Velayuda pillai, I pay respect to my Father Dr.K.Gopakumar M.D (Sid),

my Mother V.Sreekala, for taking pain to bringing up me to this position. I thank my

sister Dr.G.Divya BAMS who supported in my entire career and continuous

encouragement.

I grab the opportunity to express my deep sense of gratitude to my guide

Professor Dr.Suresh Babu.S M.D (Ayu), FARV (GOI, Delhi), whose sympathetic,

compassionate and commendable nature gave me considerable boost, always provided

me enough courage to cope up with each and every task during my P.G. studies.

At such an auspicious moment, it is my pleasing privilege to express my respect

towards my co-guide, Dr.Santosh N. Belavadi M.D (Ayu) his inspiration, guidance and

encouragement at every step of my work.

I am extremely grateful and obliged to Professor Dr.P.Sivaramudu M.D (Ayu),

HOD, Dept of Panchakarma for his affection, experience and intelligence guidance.

I am sincerely thankful to Professor Dr.G.Purushothamacharyulu M.D (Ayu),

who was former H.O.D. of the department, for his scholarly guidance.


Acknowledgement

I sincerely convey my thanks to beloved principal Dr.G.B.Patil for his all time

support and providing all necessary facilities for this research work.

I express my sincere thanks to Dr. Rajashekar C.V M.D (Ayu), who was former

teacher in the department, for his valuable suggestions.

I am deeply indebted and sincerely thankful to Dr.Jairaj Basarigidad M.D (Ayu),

Dr. Yasmeen Phaniband M.D (Ayu), for their precious suggestion and co-operation

throughout the study.

I am grateful to all the PG teachers Dr.K.S.R.Prasad, Dr.M.C.Patil, Dr.Mulugund,

Dr.G.S.Hiremath, Dr.R.V.Shettar, Dr.Girish Danappa Goudar, Dr.Jagadeesh Mitti,

Dr.Kuber Sankh, Dr.Shashikanth Nidugundi, Dr.B.M.Mulkipatil and Dr.M.D.Samudri,

for their valuable inputs and suggestions.

I extend my immense gratitude to Dr.V.M.Sajjan, Dr.Purad, Dr.Suvarna

Nidugundi, Dr. Shakuntala and other teaching staffs who helped during my study.

I express my sincere thanks to Sri.Nandakumar, for his help in statistical analysis

of results. I take the privilege to thank Sri.Mundinamani, Librarian. I also extend my

thanks to assistant librarians Mr.Shyavi and Mr.Keroor who provided me all the

necessary books and time for my literary work. I extend my thanks to Sri Kulakarni, Sri

Nabi, Smt. Sunanda and Smt Renuka for their timely help in my clinical trail.

I express my thanks to Dr.Ratnakumar and Dr.Udaykumar for their sincere words,

which made me to join in this Institution. I feel extremely thankful to my seniors

Dr.Ashok.M.G, Dr.Prasanna V.Joshi, Dr.Sanjeev Chaudary, Dr.Sathish, Dr.Subin,

Dr.Febin, Dr.Madhushree, Dr.Prasanna Kumar, Dr.Siba Prasad, Dr.Payappa Gowdar,


Acknowledgement

Dr.Devandrappa Budi, Dr.Nataraj, Dr.Udaya Ganesha, Dr.Adarsh, Dr.Shailej, Dr.Mukta

Hiremath and others for valuable suggestions.

I pay sincere regards to my fellow colleagues Dr.Sabareesh, Dr.Rajesh,

Dr.Jayasankar, Dr.Sanath kumar D.G, Dr.Ishwar Patil, Dr.Praveen Nayak, Dr.Bodke,

Dr.Kanti, Dr.Shakunthala, Dr.Asha, Dr.C.C.Hiremath, Dr.Rotti, Dr.Bupesh, Dr.Gorpade,

Dr.Deepa, Dr.Jadav, Dr.Mahantesh Swami Hiremath and Dr.Praveen Palyed for their

truly help and co-operation.

I thank my juniors Dr.Joshi Goerge, Dr.Anish, Dr.Vishwajith, Dr.Renukaraj,

Dr.Sangamesh, Dr.Jayakar, Dr.Sathish, Dr.Raghavendrachar, Dr.Jagadeesh, Dr.Maneesh,

Dr.Paresh, Dr.Shilpa, Dr.Bhaghyesh and Dr.Vijay Mahanthesh for their support.

I pay sincere regards to my fellow colleagues in the other colleges,

Dr.T.V.Dhanvanthari, Dr.Shivakumar and Dr.Girish for their support.

Iam also very much thankful to Mr. Shakthi (Local Guardian) and

Dr.K.S.R.Prasad who made my stay comfort through out my P.G. carrier.

I pay sincere regards to my UG friends Dr.Nepoleon, Dr.Kavas anand,

Dr.S.E.Sivakumar, Dr.Seejith warrier, Dr.Vijith Nangelil, Dr.Surej, Dr.Sundar and

Dr.Sriram of SJSAC, Chennai, for their indirect support for my entire PG career.

Lastly but not least I express my thanks to each and every person who have given

their Support in accomplishing this task without any blemishes.

Date :

Place : Gadag Dr. G.Deepak


Abbreviations

LIST OF ABBREVIATIONS USED:

A.H – Ashtanga Hrudaya

A.S – Ashtanga Samgraha

B.P – Bhavaprakasha

B.S – Bhela Samhita

C.S – Charaka Samhita

M.N – Madhava Nidana

S.S – Sushruta Samhita

V.S – Vangasena

Y.R – Yogaratnakara


Abstract

ABSTRACT

Nidranasha is one among the eighty Nanatmaja Vata Vikaras described by

Acharya Charaka. Acharya Vagbhata indicated Brhmana Nasya for the treatment of

Nidranasha. In the context of Murdhini taila, Shirodhara is also advised in the treatment

of Nidranasha. Hence, an attempt had been done to evaluate the effect of these

procedures by undertaking the research work with the title “The Effect of Sarpi Nasya

and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study”.

Objectives of the study:

(1) To evaluate the efficacy of Nasya karma in Nidranasha.

(2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha.

(3) To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya in Nidranasha

Materials and Methods:

A total of 30 patients were selected from O.P.D and I.P.D of D.G.M.A.M.C & H

after fulfilling the inclusion and exclusion criteria randomly. They were divided in to two

groups Group A and Group B. 15 patients of Group A underwent Sarpi Nasya for seven

days. Group B patients underwent Yastiksheera Dhara for seven days.

Assessment of results was done by considering the base line data of subjective and

objective parameters to pre and post medication and was compared for assessment of the

results. All the results were analyzed statistically for “P” value using Un-paired t-test.

Subjective Parameters: Anganmarda, Shirogaurava, Jrumbha, Sleeplessness, Difficulty

in Initiating Sleep, Sleep Quality, Performance of Daily Activities, Vitality After

Morning Awakening,


Abstract

Objective parameters: Total Sleep time, Wakefulness during Sleep, Sleep History

Question

Results:

The overall results of the study were as follows;

Group A: 02 (13.33%) shown Good response to the treatment. 10 (66.66%) were shown

Moderate response and 03 (20.00%) patients shown Poor response.

Group B: 12 (80.00%) were shown Good response to the treatment and 03 (20.00%)

patients shown Moderate response.

From the statistical analyses, all parameters shows non-significant (as P>0.05).

i.e., the mean affects of treatment same in all the parameters. All the parameters shows

highly significant in both the Groups as P<0.05.

Comparative efficacy: Overall the group B (Yastiksheera Dhara) is more effective than

group A (Sarpi Nasya) in almost all the parameters.


Contents

Contents

Contents Page number

1. Introduction 1 - 2

2. Objectives 3 - 7

3. Literary review 8 - 92

4. Materials and methods 93 - 106

5. Observations and results 108 - 164

6. Discussion 165 - 180

7. Conclusion 181

8. Summary 182 - 186

9. Bibliography 187 - 203

10. Annexure 204 - 213


46

List of Tables & Figures

LIST OF TABLES

Table no. and content PageNo.Table no.01 showing the Time of Administraion 16 Table no. 02 showing the Time schedule for Nasya karma in Rogi 23 Table no. 03 showing the Probable Drug Dosage for Nasyakarma 24 Table no.04 showing the Synonyms of Anidra 46 Table no.05 showing the Nidana of Nidranasha 47 Table no.06 showing the Rupa 57 Table no.07 showing the Ekamulika prayoga in Nidranasha 64 Table no.08 showing the variability between NREM & REM 70 Table no.09 showing the Hours of Sleep according to Age 74 Table no.10 showing the Drugs used for Ghrita murchana 88 Table no.11 showing the Properties of Yastimadhu 90 Table no.12 Showing the Therapeutic Actions of Yastimadhu 91 Table no.13 showing the ksheera properties 91 Table no.14 Showing the Milk Composition Analysis 92 Table no.15 showing the Sleep history Questioner 102 Table no16 showing the distribution of patient’s age group 108 Table no.17 showing the distribution of patients according to sex 109 Table no.18 showing the distribution of patients by Occupation 110 Table no19 showing distribution of patients by Economical status 111 Table no.20. Showing distribution of patients by Marital Status 111 Table no 21 showing distribution of patients by Pradhana Vedana 112 Table no 22. Showing distribution of patients by Anubanda vedana 113 Table no 23. Showing distribution of patients by Mode of Onset 114 Table no 24. Showing distribution of patients by Kula vruttanta 115 Table 25 Showing distribution of patients by Occupational History 116 Table no 26. Showing distribution of patients by Vihara 116 Table no 27. Showing distribution of patients by Vyasana 117 Table no 28 Showing distribution of patients by Satva 118 Table no 29 Showing distribution of patients by Vyayama Shakti 118 Table no 30 Showing distribution of patients by Vaya 119 Table no 31 Showing distribution of patients by Aharaja hetu 120 Table no 32 Showing distribution of patients by Viharaja hetu 121 Table no 33 Showing distribution of patients by Manasika Hetu 122 Table no 34: Showing the History Questionaire before treatment 123 Table no 35: Showing the History Questionaire after treatment 124 Table no 36: Showing the Angamarda before treatment 125 Table no 37 Showing the Angamarda after treatment 126 Table no 38 Showing the Shirogaurava before treatment 126 Table no 39 Showing the Shirogaurava after treatment 127 Table no 40 Showing the Jrumbha before treatment 128 Table no 41 Showing the Jrumbha after treatment 128 Table no 42 Showing the Sleeplessness before treatment 129


46


Table no 43 Showing Sleeplessness after treatment 130 Table no 44 Showing the Difficulty in Initiating Sleep before treatment

131

Table no 45 Showing the distribution of patients by different grades of Difficulty in Initiating Sleep after treatment

132

Table no 46 Showing the Sleep Quality before treatment 133 Table no 47 Showing the Sleep Quality after treatment 134 Table no 48 Showing the Performance of daily activities before treatment

135

Table no 49 Showing the Performance of daily activities after treatment

136

Table no 50 Showing the Vitality after Morning Awakening before treatment

137

Table no 51 Showing the Vitality after Morning Awakening after treatment

138

Table no 52 Showing the Total Sleep Time before treatment 139 Table no 53 Showing the Total Sleep Time after treatment 140 Table no 54 Showing the Wakefulness During Sleep before treatment

141

Table no 55 Showing the Wakefulness During Sleep after treatment 142 Table no 56 Showing the Overall Response to the treatment 143 Table no 57 showing the Comparative Study of Group A and Group B after treatment

144

Table no 58 showing Individual study of group-A 145 Table no 59 showing Individual study of group-B 145 Table no 60 Showing Demographical Data 147 Table no 61 Showing Demographical Data 148 Table no 62 Showing Demographical Data 149 Table no 63 Showing Demographical Data 150 Table no 64 Showing Demographical Data 151 Table no 65 Showing Demographical Data 152 Table no 66 Showing Demographical Data 153 Table no 67 Showing Demographical Data 154 Table no 68 Showing Demographical Data 155 Table no 69 Showing Demographical Data 156 Table no 70 Showing Demographical Data 157 Table no 71 Showing Demographical Data 158 Table no 72 Showing Subjective Parameter of Group A 159 Table no 73 Showing Subjective Parameter of Group B 160 Table no 74 Showing Objective parameter Group – B 161 Table no 75 Showing Objective parameter Group – B 162 Table no 76 Showing Sleep Questioner of Group A 163 Table no 77 Showing Sleep Questioner of Group B 164


47


LIST OF FIGURE Figure PageNo

Figure no.01 Showing the States and Stages of Sleep 69 Fig No 02 showing the distribution of patient’s age group 109 Fig No 03: showing the distribution of patient’s sex group 110 Figure 04 showing distribution of patients by occupation 110 Figure 05 showing distribution of patients by Economical status 111 Figure 06 showing distribution of patients by Marital Status 112 Figure 07 showing distribution of patients by Pradhana Vedana 113 Figure 08 showing distribution of patients by Anubanda vedana 114 Figure 09 showing distribution of patients by Mode of Onset 114 Figure 10 showing distribution of patients by Kula vruttanta 115 Figure 11 showing distribution of patients by Occupational History 116 Figure 12. Showing distribution of patients by Vihara 117 Figure 13 showing distribution of patients by Vyasana 118 Figure 14 showing distribution of patients by Satva 118 Figure 15 showing distribution of patients by Vyayama Shakti 119 Figure 16 showing distribution of patients by Vaya 120 Figure 17 showing distribution of patients by Aharaja Hetu 121 Figure 18 showing distribution of patients by Viharaja hetu 122 Figure 19 showing distribution of patients by Manasika Hetu 123 Figure 20 showing Sleep History Questionaire before treatment 124 Figure 21 showing Sleep History Questionaire after treatment 125 Figure 22 showing Angamarda before treatment 125 Figure 23 showing Angamarda after treatment 126 Figure 24 showing Shirogaurava before treatment 127 Figure 25 showing Shirogaurava after treatment 127 Figure 26 showing Jrumbha before treatment 128 Figure 27 showing Jrumbha after treatment 129 Figure 28 showing Sleeplessness before treatment 130 Figure 29 showing Sleeplessness after treatment 131 Figure 30 showing Difficulty in Initiating Sleep before treatment 132 Figure 31 showing Difficulty in Initiating Sleep after treatment 133 Figure 32 showing Sleep Quality before treatment 134 Figure 33 showing Sleep Quality after treatment 135 Figure 34 showing Performance of daily activities before treatment 136 Figure 35 showing Performance of daily activities after treatment 137 Figure 36 showing Vitality Morning Awakening before treatment 138 Figure 37 showing Vitality Morning Awakening after treatment 139 Figure 38 showing Total Sleep Time before treatment 140 Figure 39 showing Total Sleep Time after treatment 141 Figure 40 showing Wakefulness During Sleep before treatment 142 Figure 41 showing Wakefulness During Sleep after treatment 143 Figure 42 showing Overall Response to the treatment 144


48

Introduction

INTRODUCTION

“A good laugh and long sleep are the best cures in the doctor’s book”

Ayurveda the holistic science believes mainly on preventing from diseases and

curing the diseases. According to Ayurveda Life sustains on three basic pillars – ahara,

nidra and brahmacharya. This dictum of charaka clearly illustrates the importance of

Nidra. The necessity of sleep is demonstrated by experiments in which animals deprived

of sleep die within a few weeks. Humans deprived of sleep for 60 to 200 hours begins to

demonstrate a breakdown in concentration, motor skills, self care, attention, judgment

and eventually communication, debilitated appearance, skin lesions, increased food

intake, decreased body temperature and death. Hallucination and illusions may appear.

There is however, a wide variation in the requirements for sleep, which is

determined by genetic factors, habits formed early in life and particular physical and

emotional states. This shows that if a person is deprived of good sleep will suffer from

many health problems as stated above with good sleep many physiological changes occur

in respiration, cardiac function, muscle tone, temperature, hormone secretion and blood

pressure. More over good sleep serves a restorative, homeostatic function and appears to

be crucial for normal thermoregulation and energy conservation which are disturbed in

the sleep disorders like Nidranasha (Insomnia).

Our Ayurveda Acharyas have visualized this scenario century’s ago. Prescribed a

natural and refreshing line of approach to this lack of sleep problem – Nidranasha.

Acharya charaka has mentioned Nidranasha as one among the vataja Nanathmaja vyadhi.

Nidra is induced due to kapha and thamobhava. The symptoms of Nidranasha are

Angamarda, Shirogaurava, Jrumbha, Jadya, Glani, Bhrama. Acharya charaka has


1

Introduction

explained Sukha, Dukha, Sthoola, Krusha, Bala and even Marana depends on the nidra.

Nidranasha is also one of the important lakshana in many diseases.

Nidranasha can be co-related with Insomnia. Insomnia is the condition of

inadequate quantity or quality of sleep. It may be a symptom of a depressive illness,

anxiety disorder or other psychiatric condition.

Even though there is an effective line of management for Insomnia which is the

near equivalent term for Nidranasha, but ultimately it may cause addiction. That is why a

search for an alternative line of treatment is carried out. Lot of unique therapeutic

modalities has been mentioned in Ayurveda, one of such modalities is Nasya karma

which is the component of Panchakarma. While searching for such alternative treatment I

found Brhmana Nasya with Sarpi indicated in Nidranasha. Since nidranasha is a

urdhwajathrugata vikara nasya appears to be perfect line of treatment. As per dictum

“Naasa hi Shiraso Dwaram”1a,b. Vagbhata2 a indicated the brhmana nasya in Nidranasha,

basing on this apthavachana Sarpi has been taken for the trial as it is a Brhmana Dravya

and is taken as Group - A.

Another procedure which is said to be effective and refreshing one is Shirodhara,

which is indicated in Nidranasha is also selected for another group of patients called

Group – B.

In this way a comparative study “The Effect of Sarpi Nasya and Yastiksheera

Dhara in Nidranasha – A Comparative Clinical Study” has been designed with the

following aims as

(1) To evaluate the efficacy of Nasya karma in Nidranasha.

(2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha.


2

Introduction

(3) To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya in

Nidranasha and conducted as per the Research protocols on 30 subjects (patients)2 b. The

final results are evaluated clinically and statistically and decreased in the relevant

chapter.


3

Objectives

OBJECTIVES

Ayurveda, the holistic science believes mainly in preventing diseases and curing

the diseases. Various unique therapeutic modalities have been mentioned in Ayurveda,

one such modality is Panchakarma therapy. Acharya Charaka has mentioned Nidranasha

as one among the Vataja Nanathmaja Vyadhi. Nidra is induced due to Kapha and

Thamobhava. The symptoms of Nidranasha are Angamarda, Shirogaurava, Jrumbha,

Jadya, Glani, Bhrama. Acharya Charaka has explained Sukha, Dukha, Sthoola, Krusha,

Bala, and even Marana depends on the Nidra.

Nidranasha is the common and the most widely recognized sleep disorder.

Nidranasha can be co-related with Insomnia. Insomnia is the condition of inadequate

quantity (or) quality of sleep. It may be a symptom of a depressive illness, anxiety

disorder (or) other Psychiatric condition.

Sleep problems are common across all age groups, although the prevalence of

particular kinds of problems may vary with factors, such as age, lifestyle, shift work,

comorbid disease states, etc. 73% of the individuals surveyed complained of a nocturnal

sleep problem and 9% had severe insomnia.The prevalence of severe insomnia ranged

from 4% to 22%. Patients attending general practice clinics have a high prevalence of

insomnia, and physicians must be on the lookout for these sleep disturbances so that they

can offer appropriate treatment. The importance of adequate knowledge of insomnia

cannot be overemphasized so that clinicians can efficiently manage this common health

problem in primary care3.

About one-third of adults reported at least one sleep complaint or problem (e.g.,

difficulty falling asleep or staying asleep, or early morning awakening). The prevalence


3

Objectives

of sleep problems increases with age and is higher for women than for men. Whereas

prevalence estimates of insomnia in childhood and adolescents do not appear to differ

between boys and girls, and gender differences are small or nonexistent between persons

20–40 years old, investigations spanning the age range from 18–79 years indicate that

women, compared with men, are about 1.3 times more likely to report insomnia-like

sleep problems4.

Use of prescription medication in patients with sleep difficulty was reported by

20% of men and 29% of women. Doctors have a lot of influence on patients' use of

hypnotics and need to give proper information and advice to their patients when

hypnotics are prescribed. Adolescents and young adults (12-25 years) are at high risk for

problem sleepiness with particularly serious consequences3.

About a third, adults experience some type of sleep disorder during their lifetimes.

Over half of persons with Nidranasha do not seek medical advice at any time. But these

hypnotic or sedative drugs are not so effective and pose increased risk of psychological

behaviour. Keeping behind the limitations of drug therapy in other popular remedial

sciences, research activities in Ayurveda for diseases like Nidranasha become intensive in

the recent years.

Some studies have already been conducted in the management of Nidranasha with

various Panchakarma Therapies are as follows,

(1) Nirmal Dhamini:- A Role of Manas Bhavas in Anidra and its management with

certain indigenous drugs and shiro dhara, Department of Manasa Roga, 2004, Jamnagar.

(2) Puja Muralidhar:- The Effect of Shiro Basti in the mangement of Nidranasha W.S.R

to primary Insomnia, Department of Kaya Chikitsa, 1999, Govt. Ayurvedic Medical

college, Mysore, RGUHS Bangalore, Karnataka.


4

Objectives

(3) Todkar Swati:- A study of the effect of Abhyanga Karma in Nidranasha, Department

of Swastha Vritha, 2005, Pune.

(4) Chaudhari (Ms) Rupali T:- Analytical study of Nidra in Shleshmala Prakriti, 2005,

Department of Shareera kriya, M.A.M.S.S.B Ayurvedic Mahavidyalaya, Hadaspar, Pune,

Pune University, Pune.

(5) Nisha N.T:- Care of Nidra in Old- A natural approach through Abhyanga and Yoga,

2003, Department of swasthavritha, Govt. Ayurvedic College, Kerala University,

Thiruvananthapuram.

Aims and Objectives of the Study:

(1) To evaluate the efficacy of Nasya karma in Nidranasha:

The Nasya is one among the Panchakarma which is especially indicated for

Urdhwajathrugata vikaras1a. Acharya’s like Charaka5, Sushrutha6, Vagbhata,

Sharangadara7, Kashyapa8 have mentioned detailed description of Nasyakarma.

Different types of Nasya have been mentioned in classics, among these by

Vagbhata Brhmana Nasya is specially indicated for inducing sleep2. For this Brhmana

Nasya - Murchitha Gritha (mahisha gritha) is used. Mahisha gritha specially described as

Nidrajanaka agent9.

Gritha itself is a Brhmana dravya and having the properties of madhura vipaka

and sheeta virya, which acts as brimhana, after administered through nasal route.

Murchita Mahishagritha reduces the doshas like Vata and Pitta and has the propery of

Nidrajanaka.

Gritha also contains 4-5% Linoleic acid & essential fatty acid, which promotes

proper growth of human body. The Lipophilic action of gritha facilitates transportation to


5

Objectives

a target organ and final delivery inside the cell, because cell membranes also contain

Lipid. Gritha being Yogavahi can be used in other Ayurvedic preparations. In the process

of evaluating the activities of natural compounds, it has been found by means of

sophisticated research that when herbs are mixed with ghrita, their activity and utility is

potentiated many times. So, the murchitha gritha is used in this study can be included

under Brimhana nasya and hence Sarpi Nasya is taken for the management of

Nidranasha.

(2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha:

Nidranasha leads to the both physical and mental disturbances and even alters the

metabolism. Use of anti-depressants and sedatives will lead to lot of adverse effects10.

Hence in the present scenario, there is no effective treatment available in other systems of

medicine.

Sleep is one of the essential factors for sustainance of life, hence it has been

included under Thrayopasthamba11. Shirodhara is advised for the treatment of

Nidranasha, in the context of Murdhini taila which is mentioned by Vagbhata12. Ksheera

dhara is commonly practicing procedure for inducing sleep.

Yastimadhu drug having the properties of sheeta virya and madhura vipaka, also

Vata and Pitta shamaka13. It is Rasayana, balya, Vrishya, Kanthya, Medhya, Mridu

rechana Mutrala, Varnya, Jivaniya, Sandhaniya, Chakshushya, Dahashamaka and

Keshya.

Mahisha ksheera is also specially indicated for Nidranasha by Vagbhata14a, b. Ksheera

having the properties as Madhura Rasa, Guru, Snigdha, Sara Guna, Sheeta Virya,


6

Objectives

Madhura Vipaka, Vata-pitta Shamaka and Karma as Mana Prasadaka, Medhya,

Rasayana, Vrishya, Jivaniyam and Nidrajanaka.

Continuous pouring (Dhara) of yastiksheera on forehead for particular period of time

induces sleep and gives tranquilizing effect. This comfort can be compared to the

Cradling of a mother to her child15. According to modern view, the medicine may pass

through the stratum cornium into the blood vessels or may absorbed on the forehead and

reach the brain cortex. The ksheera when penetrates or enters into the circulation acts as

vatahara. Hence Dhara karma provides activation to cells by its medhya effect without

any irritation or harmful effects.

By understanding the properties and action of both yastimadhu and mahisha

ksheera we can conclude that, they are specially indicated for the treatment of Nidranasha

and hence Yastiksheera Dhara is taken for the management of Nidranasha.

(3) To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya in

Nidranasha.

A Comparative Clinical Observational Study of Sarpi Nasya and Yastiksheera

Dhara has been taken up to study the clinical effect in Nidranasha. Thus the trial is

compared at the clinical efficacy with respect to the subjective and objective parameters

chosen. At this attempt the group-A and group-B designated with respective therapies of

Sarpi Nasya and Yastiksheera dhara respectively, are observed for the efficacy of

Nidrajanaka prabhavam.

Keeping this in background the study was done to compare “THE EFFECT OF

YASTI KSHEERA DHARA AND SARPI NASYA IN NIDRANASHA”.


7

Review of Nasyakarma

NASYAKARMA Historical review:

Atharvaveda: “A¹cÉ¢ü lÉuÉ²ÉU .................” (Atharvaveda.10-2-32). Nasa is described

among nine Chidras and Indriyas.

Rigveda: Some Mantras of Rigveda indirectly refers,for the eradication of the roga

from the routes of Nasa, Chibuka, Shira, Karna and Rasana. (Rigveda.10-16-4).

Yajurveda: Nasa is described among the Indriyas, while mentioning of two Netra,

two Karna, Nasika Chhidras and Jihva.

Bhagavad Gita: “lÉuÉ²ÉU mÉÔuÉÉïSåÌWû lÉåuÉÉ ..................” (Bhagavad Gita 5/13). Nasa is

described among the Indriyas.

Ramayana: In Valmiki Ramayana, when Laxmana became unconscious by the blow

of Meghanada, their Vaidya Sushena administered the juice of Sanjivani through

nasal route and was back to consciousness, instantaneously.

Introduction:

Nasya or Shirovirechana is considered as the best and the specific Shodhana

procedure for diseases of the head or the Sira “FkuÉïeÉ§ÉÑÌuÉMüÉUåwÉÑ ÌuÉzÉåwÉÉ³ÉxrÉÍqÉwrÉiÉå” 1.

Nasya is a method, where - the medicated Taila or Churna, etc., is instilled in the nose

to reach the shiras. Arunadatta16 has defined the word Nasya as “lÉÉxÉÉrÉÉÇ mÉëhÉÏrÉqÉÉlÉqÉÉæwÉkÉÇ

lÉxrÉqÉç”, it is derived from the root Nas. The word Nas is derived from the Nas dhatu.

The Nas is also meant as Nasyakarma.

Nasya is very useful in the diseases of upper part of the neck as the Nose is

considered as the portals of the Head or the Sira- “lÉÉxÉÉÌWû ÍzÉUxÉÉå ²ÉUÇ”1. The medicine

applied through the nose will reach the shiras and mitigate the vitiated doshas. In


8


Sushrutha samhitha, the word Shirovirechana is used for a Snehana type of Nasya17.

As Nasya produces Shodhana of doshas, Virechana shabda is used here. Charaka has

used the word Nastha prachardana18, but Chakrapani views Nastha prachardana as

Shirovirechana.

According to Bhavaprakasha also all drugs and measures that can be

administered through the nasal passage are called Nasya – “iÉ²ÉËU lÉÉxÉÉ mÉårÉqÉç”19.

‘Nasya’ also means ‘beneficial to nose’.

Etymology of Nasyakarma:

In Ayurveda, the word Nasya means the route of administration of the drugs.

Nasyakarma as stated by Charaka (Cha.Si.9/88) the nose is the gateway of the

head, by the administration of the drugs through the nose is called Nasyakarma.

As stated by Sushrutha (Su.Chi.40/21) the medicines which administered

through the nose is Nasyakama.

As stated by Arunadatta (AH.Su.20/1) the nose is the gateway of the head and

the administered through the nose is Nasyakama.

Also according to Sharangadhara (Sha.Utt.8/1) and Bhavaprakasha (BP.Pur.5/189)

stated, the administered through the nose is Nasyakama. (Ayurvedia Shabdakosha)

Synonyms:

Shirovirechana

Shirovireka

Murdhavirechana

Nastha prachardana


9


Classification of Nasyakarma

According to various Aachaarya:

Nasyakarma has been classified in to several types by different Aachaarya.

Some are based on the mode of action; some are on the form of administration and

some on the source of the drugs used for the procedure.

Charaka’s Classification of Nasya:

According to Charaka the Nasya is of five type’s viz. Navana, Avapida,

Dhmapana, Dhuma and Pratimarasa20.

Navana is further divided in to Snehana and Shodhana,

Avapidana into Shodhana and Stambhana,

Dhuma into Prayogika, Vairechanika and Sneihika while

Pratimarsha is divided into Snehana and Shodhana.

Snehana

Navana

Shodhana

Shodhana

Avapidana

Stambhana

Nasya Dhmapana Prayogika

Dhuma Sneihika

Vairechanika

Snehana

Pratimarsha

Virechana


10


1. Naavana Nasya:

Administration of Sneha into both the nostrils with the help of cotton or

dropper is called “Navana nasya”. It is of two types as Snehana & Shodhana20.

It gives strength to the Greeva (Neck), Skanda (Shoulder) and Uras (Chest). It

produces Prasaada of drishti (improves eye sight) 21.

Dosage: 22 32 drops - Uttama matra

16 drops - Madyama matra

8 drops - Hraswa matra in each nostril

2. Avapidana Nasya:

The process of nasal administration by means of fresh juice obtained by

expressing the leaves containing Tikshana Guna is known as “Avapidana Nasya”23.

According to Dalhana24, it is of two types as 1. Stambhana and 2. Shodhana

Sushrutha explains the Virechana nasya is mainly used for the purpose of

producing Shodhana in the head. It is useful in Murcha, Sanyasa, Moha, Apatantraka,

Apasmara and other Psychic disorder. In other conditions of Pitta diseases, the

Sthambha variety of nasya is used with Sharkara (sugar), Ikshu rasa (sugarcane juice),

Ksheera (milk), Ghritha (ghee) and Mamsa rasa (meat soup).

Dosage: 8 drops - Uttama matra



3. Dhmapana Nasya or Pradhamana Nasya: 25 a, b

Blowing medicated powders into the nostrils with the help of a tube. For this 6

angula length tube is used, in which the choorna will be filled and the same choorna

will be made to get into the nose by blowing.

It is useful in Unmada, Apasmara, Atatwabhinivesa etc.


11


Dalhana has suggested the use of fine powder taken in a thin cloth in a

quantity of Sukti pramana (2 tolas) and tie it in the form of a Potali (bolus) and the

smell should be inhaled.

Dosage:

Is 3 Muchyuti i.e., approximately one Gunja (the quantity that is being taken

with the help of index finger)

4 rathi - Uttama matra

3 rathi - Madyama matra

2 rathi - Hraswa matra in each nostril.

4. Dhuma Nasya: 20

The process of inhaling medicated fumes through the nostrils and expelling

through mouth with the help of a Dhuma Yantra is known as “Dhuma Nasya”.

It is of 3 types 1. Prayogika, 2. Vairechanika and 3. Snehika dhuma

According to Chakradatta 26 a Dhuma nasya is used in Shiroroga, Nasa roga, Akshi

roga.

According to Vagbhatta26 b has suggested the use of dhuma through the nose first in

case of Utklishta (aggravated doshas in the head) and the dhooma must be taken only

from the mouth. When there is no Utklishta of doshas either in the nose or in the head,

then if they are to cause aggravation then make the patient to inhale the dhuma

through the mouth and then through the nose.

Dhuma Yantra:

Consists of 2 parts are (a) Dhuma Netra

(b) Dhuma Varti


12


(a) Dhuma Netra:

Dhuma Netra can be prepared with the same metals which are indicated for

the preparation of Vasti Netra like Gold, Silver, Copper etc27. Dhuma Netra has the

circumference of a thumb and little finger at the base and tip respectively, the hole

near the tip is of the size of a pea.

The length of

Prayogika Dhuma netra - 48 inches

Snehika Dhuma netra - 32 inches &

Vairechinika Dhuma netra - 24 inches (AS.Su.29)

Preparation of Dhuma Varti: 28

Dhuma nasya can be classified into 2 varieties, depending on the method of use.

♦ Common method is, take any stick of herbal stem of 12 inches length and soak

it in water over night. Then roll a cloth piece and apply the paste of any drugs

eg., Eladigana drugs, according to the condition of the disease for about 9

inches and then dry it well. Again apply the same paste and dry. In this way

paste is to be applied for 5 times. After that remove the stick from the cloth

and the dhuma varti is ready.

Then it should be arranged to Dhuma Netra and lit after applying ghee and

medicated fumes are to be inhaled through the nostril.

♦ Other method is, the drugs mentioned for nasya are to be kept inside a tube

and the tube must be lit with fire. In this type of nasya, the length of the netra

Prayogika Dhuma netra - 36 inches

Snehika Dhuma netra - 32 inches &

Vairechinika Dhuma netra - 24 inches


13


The fumes inhaled through the nostrils should be expelled through the mouth

and those inhaled through the mouth also should be expelled through mouth only. The

fumes should never be expelled through the nostrils, otherwise complication of the

eye sight may arise 26 a, 29.

5. Marsha or Pratimarsha:

The Marsha and Pratimarsha nasya are to be conducted with the help of Sneha.

The Marsha differs from pratimarsha in its high dose and they are to be differentiated

with the help of dose schedule only20, 23.

Pratimarsha nasya produces the dosha Saamyavastha, it won’t produce any

complications. This is to be given twice in a day.This will not enhance the disease, but

produces Avarodhata in the body.

The anguli of the patient must be dipped in sneha and should be dropped into

the nostril in the form of drops. This process is called Pratimarsha. As soon as Sneha

dropped into the nose it should be inhaled. This can be administered in all the seasons

of the year.

The dose of Pratimarsha should be so much that the Sneha must reach the

kanta from the nose, but Sneha should not produce any Sraava in the throat 30 a, b.

Indication of Pratimarsha Nasya: 31 a, b

Any age

Any season

Baala

Vridhdha

Bhiru

Sukumara


14


Kshtakshama

Trishna Pidita

Mukhashosha

Valita and Palita

Contraindication of Pratimarsha: 32 a, b

Dushta Pratishyaya

Krimija Shiroroga

Madhyapeeta

Badhirya

Bahudosha

Utklishta Doshas

It is contraindicated, because the Sneha Matra is very less to eliminate Doshas and the

aggravated Doshas may get vitiated further.

Dose: 2 bindus

Marsha:

According to Vagbhata dropping of Sneha in the nostrils from 6 to 10 drops is

known as Marsha. Marsha Nasya gives quick result and it is more effective than

Pratimarsha Nasya33

Dose: 10 drops - Uttama matra




15


Table No.01 showing the Time of Administraion 34 a, b, c

No

Time for Pratimarsha Nasya

Sushruta

Ashtanga Hridaya

Sharang- dhara

1 After leaving the bed in morning + + +

2 After cleaning the teeth + + +

3 Before going outside + - +

4 After exercise + + +

5 After sexual intercourse + + +

6 After walking + + +

7 After urination + + +

8 After passing Apanavayu + - -

9 After Kavala + + +

10 After Anjana + + +

11 After meal + + +

12 After sneezing + - -

13 After sleeping in the noon + + +

14 In the evening + + +

15 After vomiting - + +

16 After Shiroabhyanga - + -

17 After defaecation - + +

18 After laughing - + -

Classification of Nasya according the Pharmacological action. 35 a, b

Charaka and Vagbhata have classified the above mentioned five types of

Nasya into 3 groups according to their pharmacological action, viz.

(i) Rechana (Virechana)

(ii) Tarpana (Brimhana) and

(iii) Shamana


16


Rechana

Mode of Action of Nasya Karma Tarpana

Shamana

1. Rechana Nasya (Virechana Nasya)

The Rechana Nasya denotes to eliminations of vitiated Doshas from

Urdhvajatrugata part of the body. Mainly, Tailas and Kashayas are prepared with

Tikshna Dravyas like Pippali, Apamarga, Maricha, etc.,36 are used for Vierechana

Nasya. Also these Tikshna dravyas are administered by dissolving into Madya, Asava,

Madhu, Saindhava, etc.,37 for the specific diseases.

Indications:

It is indicated specifically in Kaphaja type of Shiroroga like Manya Stambha,

Abhishyanda, Swarabheda, Supti and Shirogaurava 38. Sushruta and Vagbhata

indicated for Arochaka, Shoola, Shirogaurava, Pinasa, Pratishyaya, Urdhvajathrugata

Kaphaja Vikaras 39. Urdhvajathrugata Shopha, Praseka, Vairasya, Arbuda, Dadru and

Kotha 40.

Virechana Nasya prepared in Sneha is particularly indicated for women, weak

and delicate persons. Nasya which is prepared in Quatha and Kalka is specifically

indicated for Galaroga, Sannipataja Jwara, Atinidra, Manasika roga etc., If the

intensity of the doshas are more in these disorders, then Churna should be used

because it enter completely into the nostrils and it mitigates the doshas. 41.


17


2. Tarpana Nasya (Brhmana):

In Brhmana Nasya, Snehas prepared with Snigdha and Madhura rasa dravyas

42 a, b are administered. According to Vagbhata, Sneha prepared with Snigdha and

Madhura drugs or with the drugs described useful for that particular disease should be

used 41.

Ghrita itself is a Brhmana dravya and if medicated ghrita with madhura and

sheeta virya drugs administered through nasal route, it may acts as Brhmana drug. So,

the Medhya Ghrita that is used in this study can be included under Brhmana nasya 41.

It is mainly used in conditions like – Mukha sosha, Vaak sanga, Swaropaghata,

Manya roga, Apataanaka, Apabahuka, Nidranasha and other diseases of Vata origin.

Indications:

It is specifically used for Suryavarta, Ardhavabhedaka, Krimi, Dantashoola,

Karnashoola, Karnanada, Mukasosha, Nasasosha and other Vatapittaja Roga 43.

Sushruta advised the use of Snehana Nasya for Timira, Akshi Samkocha and

increases the vision. It is also used for curing the Shirah kampa, Ardita and Vataja

Shiroroga . 44

3. Shamana Nasya:

The Shamana Nasya is defined as that which alleviates dushta doshas situated

in the Shiras and brings it to the normal. In Shamana Nasya the Taila, Ghrita,

Swarasa, Ksheera, etc., can be used as per the condition of the patient. The Snehana

and Pratimarsha nasyas will comes under this Shamana Nasya.

Indications:

It is used to stop bleeding in Raktapitta.45. It is also indicated in Akala Palita

and Khalitya, Darunaka, Raktaraji, Vyanga and Nilika 46. Anutaila Nasya can be used


18


for Svasthya person to promote the functions of eyes, ears and nose also, to prevent

Khalitya and Palitya

Classification of Nasya according to various parts of the drugs:

Charaka has mentioned 7 types of Nasya according to parts of the drugs to be

used in Nasyakarma viz – Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twaka 47 as –

Phala

Patra Mula

Various Parts of the Drug Kanda Pushpa Niryasa Twaka 1. Phala Nasya:

Friuts that are used like Apaamaarga, Pippali, Vidanga, Maricha, Shigru,

Shireesha, Ajagandha, Ela, Peelu, Harenuka, etc.

2. Patra Nasya :

Leaves that are used like Tulasi, Saptaparna, Aragwadha, Moola, Sringaveera,

Lashuna, Sarshapa, Taleesapatra, Tamalapatra, etc.

3. Moola Nasya:

Roots that are used like Arka, Vacha, Alarka, Kushta, Naagadanti, Bharangi,

Braahmi, Ativisha, Karanja, Indrayava, etc.

4. Kanda Nasya:

Stems that are used like Haridra, Shunti, Lashuna, Moolaka, etc.


19


5. Pushpa Nasya:

Flowers that are used like Lodhra, Madhanaphala, Nimba, Saptaparna, Arka,

etc.

6. Niryasa Nasya:

Swarasa (Juice) that are used like Devadaru, Hingu, Agaru, Sarala, Laaksha,

Shallaki, etc.

7. Twak Nasya:

Bark that are used like Guduchi, Ingudi, Tejovati, Daalchini, etc.

With the above drugs the Kalka, Choorna, Swarasa, Ksheera, Kwatha, Dhooma, Taila,

and Ghritha, etc., can be prepared and used for nasya suitably.

Classification 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

classified according to their functions into two groups viz. Shirovirechana and

Snehana, but Shirovirechana and Avapeeda Nasya have been given separate entity.

Shirovirechana is further divided in to Shirovirechana, Avapida and

Pradhamana,

Snehana is further divided in to Pratimarsha and Nasya 48.

Shirovirechana Shirovirechana Pradhamana

Avapida

Nasya Pratimarsha

Snehana

Nasya


20


Classification of Nasya according to Vagbhata: 49 a, b

Mentioned three types concentrating the action of the Nasya drugs. They are -

1. Virechana

2. Brumhana

3. Shamana

Snehana and Brumhana Nasya are further divided in to two groups i.e. Marsha and

Pratimarsha (according to dose).

Aachaarya mentioned ‘Avapeeda Nasya’ separately, which can be used both for

Shirovirechana and Shamana purposes and ‘Pradhamana Nasya’ which can be used only for

the Shirovirechana purpose. Ashtanga Hridaya50 has mainly classified Nasya in 3 types viz.

Rechana, Brimhana and Shamana

Pradhamana Virechana

Shiro - virechana

Pratimarsha

Nasya Brumhana

Marsha

Shamana Avapida Classification of Nasya according to Kashyapa:

According to Kashyapa Samhita Nasya has been classified into two groups

i.e. Brimhana and Karshana. Also, Brihmana Nasya mentioned as Purana Nasya and

Karshana Nasya mentioned as Shodhana Nasya 51 a, b


21


Brimhana

Nasya

Karshana

Classification of Nasya according to Sharangdhara: Sharangdhara has also classified Nasya into two groups viz. Rechana and

Snehana according to their functions.

Rechana Nasya are further divided in to two groups i.e. Avapida and Pradhamana

Snehana Nasya are further divided in to two groups i.e. Marsha and Pratimarsha 52.

Avapida

Rechana

Padhamana

Nasya

Marsha

Snehana

Pratimarsha

Acharya Videha described two types of Nasyakarma according to their

pharmacological action i.e. Sangyaprabodhana and Stambhana. 53

Sangyaprabodhaka

Nasya

Stmabhana

All these types can be included into the classification of Charaka.


22


Age limit for Nasyakarma:54

The Age limit mentioned in the classics is between 7 years and 80 years.

Aachaarya advices many restriction regarding the Age, Time and Method of

administration, because the way of drug administration is directly in to the Uttamanga

(Head).

Time of Nasyakarma:

I. Based on Rutu55

Generally,the Nasya should be given in Pravrit, Sharad and Vasanta Rutu. If

there is any emergency, some changes can be made and given in other rutu also.

If it is Greeshma, advised time is Purvahna (during the early hours of the day

to avoid the harsh Sunrays) arranging a comparatively cooler environment.

In Hemanta, it is Madhyahna (in noontime when the temperature will warm

up) providing a comparatively warm place for the treatment) and

In Varsha Rutu, when there is proper Sunrays (Avoiding Durdina).

II. Based on Dosha predominance

Table no. 02 showing the Time schedule for Nasya karma in Rogi 56 a, b

Dosha Predominance Time of Nasya

Kaphaja Vikara Purvahna

Pittaja Vikara Madhyahna

Vataja Vikara Aparahna

III. Based on Roga

Vagbhata has prescribed same timing as Sushruta has mentioned. Nasya can

be given daily in morning and evening in Vataja Shiroroga, Hikka, Apatanaka,

Manyastambha and Swarabhramsha.


23


According to Sharangadhara, if the patient is having Lalasrava, supti, pralapa,

shiroroga etc. with excessively vitiated Dosha, Nasya can be administered even in the

night time also57, 56 b.

Drug Dosage for Nasyakarma

The drug dosage for Nasyakarma is based on the type of Nasya, which is to be

administered. Aachaarya mentioned different dosage patterns for different types of

Nasya.

Table no. 03 showing the Probable Drug Dosage for Nasyakarma

Nasyakarma Dose for each Nostril Shamana Nasya

Avara – 16 drops (8 each) Madhyama – 32 drops (16 each) Pravara – 64 drops (32 each)

Shodhana Sneha Nasya

Avara – 8 drops (4 each) Madhyama – 12 drops (6 each) Pravara – 16 drops (8 each)

Kalka Nasya (Avapeeda Nasya)

Avara – 4 drops Madhyama – 6 drops Pravara – 8 drops

Pradhamana Nasya

Avara – 2 ratti Madhyama – 3 ratti Pravara – 4 ratti

Marsha Nasya

Avara – 6 drops Madhyama – 8 drops Pravara – 10 drops

Pratimarsha Nasya 2 drops

Churna Nasya 3 pinch

According to Videha, the dose for Pradhamana Nasya is 3 Muchut’i (1

Muchut’i = the Churna which may come in between Index finger and thumb = 2.4

Ratti.)

Aachaarya Videha says four drops of Nasya dravya is the smallest dose for

Shirovirechana. The dose can be increased upto 6 drops, 8 drops, 10 drops or even 16

drops also; it should be administered based on the strength of the Rogi and the Roga.


24


Course of Nasya Karma: 58 a, b, c

According to Sushruta, Nasya can be given repeatedly at the interval of 1, 2, 7

and 21 days depending upon the condition of the patient.

According to Ashtaanga Samgraha, Nasya should be given for 3 days, 5 days,

7 days and 8 consecutive days or till the patient shows the symptoms of Samyak yoga.

According to Ashtanga Hridaya explained that one should not exceed more

than seven days.

According to Bhoja, Nasyakarma should not perform for more than nine days

as it leads to Saatmyata in the body.

Indication of Shirovirechana Nasya

The conditions indicated for the administration of Shirovirechana Nasya is in

the diseases of Urdhwajathru gata (head and neck), kaphaja roga, swarakshaya,

arochaka, pratishyaya, peenasa, shirah shoola, apasmara etc.

According to Charaka59, the conditions like sthambha, supti and shlaishmika

shiroroga and also diseases like shiro danta, manya stambha, gala hanu graha,

peenasa, galashundika, gala shaluka, shukla roga, timira, vartma roga, vyanga, etc.

and Urdhwajatru gata vatadi vikaras60.

In Astanga Samgraha40 Aachaarya considered different forms of drugs and

also the condition of the patient while indicating the Shirovirechana Nasya.

1. Sneha Nasya - Bheeru, krisha and sukumara type of persons.

2. Kalka, Choorna, Kwatha, Aasava, Swarasa etc. - In Gala roga, sannipata

jwara, atinidra, manovikara, krimi, vishaabhipanna, abhishanna, sarpadashta

and visamjna.

3. Choorna – When dosha are excessively vitiated and need quick elimination.


25


Contra-indications for nasya karma:61 a, b, c

Bhukta bhakta, ajeerna, peeta sneha, peeta madya, peeta toya, snehaadi peeta

kama, snata shira, snata kaama, kshudarta, shramarta, shastra danda hata, Vyavaaya

klanta, vyayaama klanta, paana klanta, nawa jwara, shokabitapta, virikta, anuvasita,

garbini, nava pratishyaya, apatarpita, peeta drava, trushnarta, gara hata, kruddha,

Baala, vruddha, vegaavarodita, rakta sravita, sutika, swasa peedita, kasa peedita.

Procedure of Nasya Karma:

The whole procedure is divided into three stages-

Purva karma

Pradhana karma

Paschat karma

Purva karma:

This includes all the preparations and events that are to be done up to instillation

of medicine. This stage is further divided into three steps

♦ Collection of materials

♦ Time for administration of Nasya karma

♦ Preparation of the patient

♦ Collection of materials: 62 a, b, c, d

A Special room should be considered with well ventilated room

with adequate light for the administration of Nasyakarma and should be named as

‘Nasya Gruha’. The Gruja should considered with things like -Nasya peeta or Nasya

asana, Nasya Aushadha, Cotton or Dropper for instillation, spittoon, cloth, attendants,

etc.


26


Nasya can be administered either in the Lying posture or in the Sitting posture.

Hence Nasya Asana should be prepared. The main purpose should be to make the

head to lie down in supine position and to make the body in a little elevated posture.

♦ Time of Administration:

The time of administration of Nasya is to be decided after considering

the prevailing season and dosha pradanata. For the administration of Nasya karma

Sharad(autumn), Vasantha(spring) and Praavrita(Rainy) rutus are useful. The season

should not be too cold or too hot or cloudy, in greeshma rutu before madhyanha and

in sheeta rutu during madhyanha nasya should be performed.

♦ Preparation of the patient:

Person to be administered with Nasya karma has to stay in nirvata pradesha,

light food is given, after resting for a short duration dantadhavana and dhoomapana

should be done and he should comfortably lie down relaxed on a Nasya chair or cot in

supine position, hands and legs stretched straight. Snehana and swedana to face is

done. Swedana is contraindicated to Shiras as it is a marma. Even than for vilayana of

dosha and to facilitate easy expulsion of dosha, mrudu swedana is performed over

Shiras, manya, nasa, greeva. Eyes are covered with a cloth.63.

Pradhana karma: 63, 64 a, b

It is of two steps-

♦ Administration of Nasya karma

♦ Precautions taken during administration

♦ Administration of Nasya karma

Head is slightly bent backwards by keeping a pillow below the shoulder this

facilitates easy instillation of Nasya medicine. Oil is warmed, nose tip is raised with

index finger of left hand and one nostril is closed with another finger, using right hand

medicine is instilled. Exact measured quantity of medicine to be administered is taken


27


in a spoon of gold, silver, shell, wood or even administered using a pad of cotton or

cloth or a dropper and dropped in a continues flow into each nostrils one after the

other. This method is meant to use only either Sneha or Swarasa or Kwatha.

If Churna is used for nasya, then it must be introduced into the nose through 6

angula netra. From the other end, the powder is blown with the help of mouth.

♦ Precautions taken during administration-

Quantity of medicine should be exact neither more nor less, it should not be

poured all of a sudden, it should not be too warm or too cold, patients head should be

stretched down neither too much nor elevated and he should lie relaxed.

During administration of Nasya karma if the quantity of medicine is very less, it

will only excite the doshas, it will not expel doshas out and causes feeling of

heaviness, loss of taste, cough, excessive salivation, rhinitis, vomiting and diseases of

kanta i.e., Ayoga features. More quantity of medicine will give rise to complications

i.e. Atiyoga features. Pouring the entire quantity at once will force the medicine to

enter in to the wrong routes causing diseases of head, pratishyaya, ghrana kleda,

obstruction to expiration. If the medicine is very warm it causes burning sensation,

formation of ulcers, fever, bleeding through nose, head ache, blurring of vision. If it is

very cold it will cause ayoga features. Medicine instilled in an improperly stretched

position of the head too gives ayoga features as the medicine fails to spread all over

the head uniformly. If the head is stretched too much, the medicine spreads to a long

route causes moorcha, jaadya, kandu, daaha, jwara. Nasya administered in an un-

relaxed person causes increase in doshas as it is unable to spread all over the shiras,

along with pain or stiffness64 a. If the head is not stretched than medicine fails to enter

inside shiras and if stretched too much than the entered medicine fails to come back65.


28


Paschat karma: 66 a, b, c, d

The patient should avoid swallowing of Nasya aushadhi. Patient should spit

out the excessive medicine which has come into the oropharynx. One should avoid

dust, smoke, sunshine, alcohol, hot bath, riding, anger, excess fat and liquid diet67.

Day sleeping and cold water for any purpose like Pana, Snana etc. should be avoided

after Nasya Karma68.

This has following steps-

♦ Snehana and Swedana

♦ Dhumapana and Gandusha

♦ Assessing the Samyak yoga lakshanas

♦ Complications if any and measures to be adopted

♦ Snehana and Swedana

Mrudu abhyanga and swedana over gala, kapola, lalaata, mardana over

shoulder, feet and hands is done. Patient is instructed not to swallow but to spit the

expectoration as it contains doshas69. Patient should lie still in same position for 100

matra kala, should not shake his head, talk, laugh, sneeze, yawn as these prevent the

medicine reaching the expected place and even kasa, pratishyaya, shiro akshi rogas

may occur especially if the medicine doesn't reach Shringataka marma and thereby

mastulunga67, 70. Dhumapana, Kavalagraha and Ushna jala gandusha should be done

for kanta shuddi 66 d, 71.

♦ Dhumapaana66 c:

Snehana and swedana are nasya purvakarma, by these the srotas becomes soft

and doshas in them gets loosened. Administration of nasya easily expels them out but

the nasya dravya being a sneha and sneha by nature increases kapha due to its sheeta

guna. This retains a portion of kapha, which was liquefied due to snehana and


29


swedana. And so retained kapha can't be expelled out by nasya dravya and gets

collected in karna,manya and causes different diseases. To remove this, dhumapana is

administered. Dhuma by virtue of its ushna and teekshna guna clears the dosha70.

Inhalation of dhuma is indicated in the disorders of shira72 in general and in

particular prayogika dhuma is indicated after nasya karma73.

Two to three inhalations are to be taken through nose and exhaled through

mouth only. If the dhuma is done through the mouth, the fumes should be let off

through the nose only. By this lightness of head, sense organs, heart occurs, dosha

shamana takes and throat becomes clear74 a, b.

Gandusha:75

After dhumapana, ushna jala gandusha is to be done. This removes the kapha present

in the oral cavity and also increases the taste

♦ Samyak yoga lakshanas:76

Laghavata (lightness in the body), Nidra (good sleep), Shirolaghuta (lightness

in the head), Sroto shuddhi (cleansing of srotus), Indriya prasannata, Mana prasannata

and Roga shamana are the samyak yoga lakshanas

Due to Atiyoga - Kaphasraava, Shiro gaurava and Vibrama are lakshanas.

Due to Ayoga – Indriya rukshata, Roga aprashamana, Kandu, Anga gaurava

and nasa,netra, mukha srava are the lakshanas.

♦ Complications if any and measures to be adopted

Complications will occur when Nasya is administered in odd times and also to

unfit patients. When the complication occurs due to the utklesha of doshas, they must

be treated with Shodhana and Shamana chikitsa. When the complication occurs due to

kshaya, they must be treated with Brhmana chikitsa77.


30


Importance of Post Nasya Massage:

Post nasya massage, recommended by ancient acharya is as important as

massage before nasya. The texts have recommended post nasya massage on the

frontal, temporal, maxillary, mastoid and neck (manya) region. A comfortable

massage on the above regions may help to subside the irritation of the somatic

constriction due to heat stimulation and may also help in removing the slush created

in these regions.

According to Sushruta, manya is a marma existing in neck on either side of

trachea78, which likely corresponds to the carotid sinus of neck on the bifurcation of

common carotid artery. The receptors called baroreceptors are situated here and

manipulation on it may have a buffering action on cerebral arterial pressure. (Best and

Taylor, 1988). Pressure applied on the baroreceptors is also found to normalize the

deranged cerebral arterial pressure. - (Hejmadi S. 1985).

Probable Mode of Action of Nasya Karma

Ayurvedic Point of View:

In Ayurvedic classics, the mode of action of nasya karma is explained very

briefly. To understand the mode of action of nasya karma, the following points should

be kept in view “lÉÉxÉÉÌWû ÍzÉUxÉÉå ²ÉUÇ” 79

• Shringataka marma is a Shiramarma formed by the union of siras (blood

vessels) supplying to Ghrana (Nose), Srotra, Akshi (Eye), and Jihva (Tongue),

and injury to this marma will be immediately fatal.80

• Indu81 has opined that Shringataka is the inner side of middle part of the head

i.e."ÍzÉUxÉÉå AliÉqÉïkrÉqÉç".


31


• Under the complications of nasya karma Sushruta noted that the excessive

eliminative errhine might cause Mastulunga Srava (flow of CSF out of the

nose) 82. This suggests the direct relation of Nasal pathway to brain.

Considering above points, the mode of action of Nasya karma can be understood as follows83.

Drug

Through nasal route (i.e. gate way to shiras)

Reaches the Shringataka Marma (Shiro Antarmadhyam)

Spreads through the Shira of nose, ear, eye and tongue

Reaches Shiras

Enhances the strength of dhatus and tarpana of Shirah

Tarpana or Brumhana Nasya

Modern Point of View: 84

According to modern science, there is no direct pharmacodynamic

consideration between nose and cranial organs.

Human brain has strict security system i.e. blood brain barrier (BBB) the nose

is used mainly as a route of administration for inhalation of anesthetics material.

Inspite of this also, the intra-nasal route for administration of drugs is

preferred by modern science, which is found to be very effective.


32


A Modern Concept:

To understand the pathways of Nasya drug (classical errhine) acting on

(central nervous system) it is important to go in details of the modus operandi of

Nasya karma.

On the basis of fractional stages of Nasya karma procedures, we can draw

certain rational issues that are as follows.

A) Effect on neuro-vascular junction:

Specific posture during Nasya karma, like the lowering of the head elevation

of lower extremities, fomentation of face seems to have an impact on blood

circulation of the head and face.

The efferent vasodilator nerves, which are spread out on the superficial surface

of face, receive stimulation by fomentation and may increase the blood flow to the

brain i.e. momentary hyperemia.

According to Chatterjee, approximately 22% of total dilatation of cerebral

capillaries, caused by facial efferent stimulation will lead to 150% blood inflow

(Chatterjee 1980)

Considering above description the effect of nasya on neuro-vascular junction

can be understood as follows mainly by Cushing's reaction.

So, it can be stated that the modus operandi of nasya karmas has a definite

impact on central neurovascular system and likely to lower the blood brain barrier,

which makes possible the absorption of certain drugs in the brain tissue.

B) Effect ct at neuro-psychological levels:

Effect of nasya at neuro-psychological levels stand upon the facts discussed

previously that the terminal adjacent nerves running along with the olfactory

nerves are connected with limbic system of brain including hypothalamus.


33


♦ Certain drug administered through nose may have an impact on immediate

psychological behavior by acting on limbic system through olfactory nerves as

the limbic system is also concerned with behavioral aspects of human beings,

besides control over endocrine secretions.

♦ Cowley, 1975 has also highlighted such phenomenon in his study. The work

was carried out by exposing people to known pheromone for a short time

period. The result showed subjects reacting differently, in a assessing men and

women in comparison with the control state; the judgment of people can also

be influenced by exposure to a mixture of short chain fatty acids.

These things certainly support the recommendation of Nasya by ayurvedic

scholars for mental disorders like Apasmara, unmada and Nidranasha.

Absorption and transportation of the drug administered by nasal pathway:

Ways for the proper absorption of drug, which is given by nasal route, are as

follows.

♦ Keeping the head in lowering position and retention of medicine in

nasopharynx help in providing sufficient time for local drug absorption.

♦ Lipid soluble substance has great chance for passive absorption through the

cell of lining membrane.

♦ The drug absorption can also be enhanced by massage and local fomentation.

The absorption and transportation of drug, which is promoted by local

massage and fomentation, can occur in two ways.

♦ Along with olfactory nerve, the arachnoid matter sleeve is extended to sub

mucosal area of the nose. Correlation between them is established by the

Lymphatic path:

Drug can reach directly into the C.S.F. through lymphatic pathway.


34


experiment that the dye injected to arachnoid matter causes coloration of nasal

mucosa within seconds and vice versa also.

♦ Preliminary studies reported from AIMS laboratory's shows that steroids

which are administered as a nasal spray enter rapidly in C.S.F. surprisingly

their levels in the C.S.F. was found to be much higher as compared with

systemic injections. (Kumar et al, 1979)

♦ Here it is important to recall the statement of Sushruta that the excessive

administration of virechana nasya (eliminative errhine) may cause oozing of

mastulunga (C.S.F) into the nose.

On this basis, it can be stated that ancient scholars of Ayurveda were aware of

the role of lymphatic path in direct absorption into brain from nose.

On the basis of the foregoing discussion we can state that the procedures,

postures and conducts explained for Nasya karma are of vital importance in drug

absorption and transportation.


35

Review of ShiroDharakarma

SHIRODHARA 85, 86, 87

Shirodhara is one of the special types of treatment procedure. It is the process

in which medicated oils, milk, kwatha or buttermilk, is poured in a continuous stream

on the forehead, for the particular fixed time.

Acharya Charaka has defined snehana as the treatment, which produces

viscosity, softness, solubility and kleda in the body88. Snehana is one among the

shadvidhopakramas. There are two routes to administer the sneha viz. External and

Internal. External by Abhyanga, Murdha taila etc. and Internal by Pana, Basti, Nasya

etc. The Murdha Taila is having four varieties namely, Abhyanga, Seka, Pichu and

Basti. They are told uttrottara gunaprada89. Dhara can be administered in different

way like Shirodhara or Shiroseka (only on the head), Sarvangadhara (all over the

body) and Sthanikadhara (local). Dhara is not only used in psychic diseases, but also

used in psychosomatic diseases like psoriasis, Nidranasha. Dhara is done by using

different medicaments like taila, takra, kshira, kwatha etc.

Synonym of Dhara:

♦ Dhara

♦ Seka

♦ Parisheka

♦ Avasheka

♦ Sechana

♦ Prasechana


36


Indication: 90

Shirodhara is effective procedure which indicated in

♦ Nidranasha,

♦ Ardhavabhedaka,

♦ Suryavarta,

♦ Ardita,

♦ Pakshagata,

♦ Hanugraha,

♦ Akshisula,

♦ Shirogatavata,

♦ Shirahkampa

Contra-Indications

♦ Kaphaj Vikaras

♦ Shirodhara further increases Kapha, which makes the diseases difficult to cure.

Method of Pouring of Dhara:

The procedure of Dhara may be divided into three stages for the descriptive purpose:

1). Purvakarma

2). Pradhanakarma

3). Pashchatkarma

1). Purvakarma:

Purvakarma is the preparation of the patient. First, it should be confirmed that

the patient is fit for Shirodhara or not. Patients who are suffering from mental illness,

headache, peenasa, sankhaka, suryavarta, arumshika, pratishyaya, shiropaka,

shirovrana, anidra, timira, karnaroga, akshiroga, valita, palita, murcha etc. diseases are

fit for Shirodhara. It is advisable for the better results that the hairs of the patient on


37


the scalp should be removed, if the patient permits. The patient should pass stool and

urine. Then patient’s pulse, temperature, blood pressure should be recorded.

The patient is made to lie down in the wooden basin, specially prepared for

such kinds of treatment, after first anointing his head and body with suitably

medicated oils. His head rests in a slightly elevated position, preferably on a pillow.

The anointing of the oil is generally done, at first by the physician himself and then by

the attendants all over the body. The oils for the purpose should be medicated

according to the nature of the disease the patient is suffering from. The eyes and ears

should be covered with cotton so that, liquid may not enter in the eyes.

For the treatment two attendants are needed; one for supporting the vessel

containing the liquid to drip on to the forehead of the patient, and the other for

collecting the liquid that falls from the head of the patient and returning it back to the

vessel wherefrom the liquid is to drip.

Dharapati or Droni or Dhara table:

For Shirodhara a special type of table is used and it is known as Droni. The

table is made up of wood with raised edges in all the four sides so that the liquid/oil

may not flow out. The first one is the selection of suitable wood for making the

Dharapati. Many trees as Plaksha, Udumbara, Varana, Nyagrodha, Devadruma,

Punnaga, Kapitha, Bakula, Asoka, Amra, Vilwa, Nimba, Khadira or Arjuna. The ideal

wood universally accepted by the physician is Kupilu (Nuxvomica). In this table

arrangements are made at the head end so that, the liquid poured can be collected in

another vessel and can be re-used.

Dimension of Droni:

The construction of droni is explained here. It is better wrought from a single

piece of wood 11 feet 9 inches by 2 feet 9 inches by 9 inches. From either end mark


38


off a length of 9 inches and carve out the four rounded handles near the bottom at the

four corners, each having a diameter of two inches. Leaving a margin of one and half

inches width all round scoop out the whole surface of 10 feet by two feet 6 inches

until the margin around stands one and half inches above it everywhere. Then the

inner space is divided into two main compartments; the anterior compartment or the

head end having a space of 2 feet 6 inches (including a cross ridge) by 2 feet 6 inches

and the posterior compartment or the body portion having a space of 7 feet 6 inches

by 2 feet 6 inches. A partition ridge is made to separate the anterior compartment

from the posterior compartment and also for giving a comfortable seat for the neck of

the patient during the treatment.

The anterior compartment is again divided into two parts; one being a level

platform 11 inches wide at the farther end towards the head portion and the other

being a sloping plane of 1 foot 5 ½ inches wide from the bottom of the partition ridge

towards the head end platform. Here in the head end platform scoop out a circular

hemispherical sink of 10 inches diameter and 6 inches depth such that the sink

commences at a point 2 inches away from the bordering rim at the head end. The sink

should protrude 1 inch into the slopping part below the head end platform. This

projection facilitates an easy flow of the liquid coming down the slope to the sink

from the portion near the marginal cross-ridge which separates the head portion from

the body compartment. The space between the cross-ridge and the circular sink is

planed with a slight slope so that all the liquid drippings from the head of the patient

may drain into the sink.

The body compartment is scooped out gradually sloping towards the foot end

to a depth of 7 ½ inches at the farther end of the basin where an outlet is bored


39


through the marginal rim to let out wastes ad drippings that may accrue during the

treatment.

The anterior compartment and the posterior portion of the basin should be perfectly

smooth and comfortable for the patient. The partition ridge is also rounded off and

smoothened with a concave depression 6 inches long and ½ inch deep in the middle

for a comfortable neck rest.

Above Shirodhara portion of the table, dharapatra should be suspended with

the help of a strong wire to enable liquid to fall from the proper height.

Dhara Patra or Dhara chatti:

Dhara Patra is a vessel in which liquids used for Shirodhara is put in. It is

prepared from steel, glass, gold, silver, clay, or any of the woods recommended for

Droni. It is a shallow, about 5 or 6 inches in depth, wide-mouthed and curved

bottomed vessel of the capacity of not less than 2 prasthas or 64 ounces.

The vessel is to be suspended just over the head of the patient by means of

suitable cords tied round the rim of the vessel, taking care that the supporting cords

should never pass underneath the basin. A small hole- just sufficient to admit the tip

of the little finger of the patient- about ½ inch in diameter is to be bored neatly at the

center of the bottom of the vessel. A small hard hemispherical hollow wooden cup,

preferably a half of the hard endocarp of the coconut, having a similar corresponding

hole in its bottom at its center and corresponding to the hole in the basin and with

ridged edges is placed over the hole in the vessel with its mouth downwards. A string

of loose cotton threads is passed through the hole of the wooden cup with a free end

of about four finger (3 inches) coming out through the hole. The upper end of the

thread should have knot to prevent slipping from the vessel. The vessel is kept refilled

with the recollected liquid.


40


2). Pradhanakarma:

The selected liquid should be kept in the vessel and be poured continuously

and slowly on the upper part of the forehead of the patient. A mild oscillation should

be given so, as to maintain the flow to all over the forehead. The vessel is kept refilled

with the drippings collected from the sink in the wooden basin in which the patient

lies down.

Dharakala:

The process can be continued for one and half hours; but there are variations

about the time period among different acharyas. The maximum time for Shirodhara is

given as one Muhoortha91. The patient is to remain in the lying posture alone (on his

back) throughout the period. This treatment is carried on daily for a period of seven to

fourteen days, according to the disease and the physical condition of the patient.

Generally the treatment is done in the morning hours, preferably between 7 and 10

a.m.

Period for Changing the Liquid:

When Milk or Buttermilk is used, it should be changed everyday. When

Kashaya is used, it should be prepared everyday. When Dhanyamla is used, it can be

used up to 3 days. When Oil is used, it should be changed at 3 days. In the first 3

days, half of the oil is used, for next 3 days later half of its used and on the 7th day the

entire first and second half are mixed together, then it should be discarded

3). Paschatkarma:

At least five minutes before the completion of Dhara all attendants should be

particularly vigilant. Everything for the next step, like bath towel, etc., are to be kept

ready. Refilling of Dhara patra is to be stopped some seconds earlier before the exact

stopping time. At the exact time, stop Dhara by drawing the vessel back. Then wipe


41


the head with the towel. In Sarvangadhara the body is to be wiped well with the towel.

Then the patient may take bath as usual. To remove the oil from the body pasted

greengram, horsegram, etc, can be used. After bath wipe the head without delay. It

has to be done carefully so that no moisture is retained. After wiping, part the hair and

rub the medicated powder like Rasnadi choorna in Murdha pradesha, to prevent the

occurrence of Cold.

Pariharyani:

The patient should abstain from sexual intercourse as well as from any thought

or deed that may excite sexual desire, avoid physical exertions, mental excitement

such as anger, grief etc. and exposure to cold, sun, dew, wind, smoke and dust should

be avoided. Riding on elephants or horses, walking, speaking too long or too loud and

such other acting that may give any strain to the system must be avoided. Sleeping

during daytime and standing continuously for long period must also be avoided. It is

also advisable to use a pillow, which is neither very high nor very low, during sleep at

night.

During the course of the treatment, the patient should be also cheerful, happy

and should avoid wearisome exertions, distasteful diet or excessive indulgence in

tasty foods. He should wear clean and dry cloths and may have Lepana of

Sandalwood paste. For any reason or due to lack of attention, if any untoward effect is

observed, stop Dhara immediately. Then treat for those Dhara dosha. When such

troubles are relieved again start Dhara with due care.

Dhara-Dosha:

If Dhara is done from more height, very nearly or very slowly then it may

produce burning in the body, pain in the all joints, bleeding tendency, jwara, kotha,

headache, etc.


42


For the treatment of dhara-dosha following measures may be adopted:

i) Gandusha

ii) Nasya

iii) Kashayapana with Sunthi

iv) Light diet at evening, Yusha with black pepper

v) On the third day, Basti should be given in which saindhava is mixed.

After the Dhara for 7 days or 14 days, the restrictions are reduced gradually

and returning to the normal diet and conditions.85

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. Shiro

dhara re-establishes the functional integrity between these three subtypes of Dosha

through its mechanical effect. Sahasrara Cakra 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. Shiro dhara stimulates the pituitary gland by its penetrating effect,

which helps in bring the hormonal balance.

The Shirodhara is effective in following two ways:

♦ Therapeutic effect of medicaments

♦ Procedural effect of the process


43


Therapeutic Effect of Medicaments:

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 the scalp and forehead. As it is said that the effect and potencies of the

articles of Abhyanga, Snana, Udvartana, etc. which are digested by the skin, enter into

the internal organism through the orifices present in the skin92.

The concept of percutaneous absorption described in the modern physiology can be

summed up as follows:

There are three possible routes of absorption. The pilo sebaceous follicles play

some part in absorption of many compounds. The trans-follicular absorption, the route

of penetration is through the follicular pores to the follicles and then to the dermis via

the sebaceous gland. The permeability of the cells of the sebaceous gland is greater

than that of granular layer of the epidermis (Lovatt Evan’s Physiology, 11th edition).

Procedural Effect of the Process:

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. One involves efforts and

concentration focusing attention upon a particular object or sensation and the other a

simple watchfulness 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 a

decrease 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 and spirit and this continues even after the relaxation. Corresponding to


44


different levels and powers of consciousness there are different nerve plexuses and

glands in human organisms. Special stimulation of different nerve plexus, glands and

brain cells accompanies mental function of different type at different levels. Thus, the

Hindu theory of 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

important points where Soma (Jala/Kapha), Vata, Agni (Pitta), Raja, Satva, Tama and

Bhutatma’s are present93. In some cases, even slight stimulation of such Marma may

have beneficial effect on the body, due to their connection with higher centers.

Shirodhara makes the patient to concentrate on this area, by which the stability arrives

in the mind function and the patient may feel more comfortable (relaxed). And

moreover, it is having tridoshahara effect.

So, in Ayurveda out of the three types of chikitsa Bahirparimarjana has also

important place and many systemic diseases are cured by using external methods of

the therapy and Shirodhara carried out with takra is one of them. Shirodhara is done

directly on the head, so it may be considered as good for relieving 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 head i.e. Ajna chakra and Sahasrara chakra. It can be hypothesized that with

Dhara therapy these two charkas are getting stimulated and activating the

hypothalamus.


45

Disease Review

DISEASE REVIEW

Historical Review:

Vaidika Kala:

In Atharva veda Shaunakeeya shakha, the reference of Nidrajanana given as

Karma, while explaining the Maulika siddhanta in Dravyaguna.

Upanishads:

Four levels of consciousness of the life is stated as

Jagratavastha (waking consciousness)

Svapnavastha (Dreaming)

Susuptavastha (Dreamless sleep)

Turiyavastha (Conscious dreamless sleep)

(Brhadaranyaka Upanishad, Chandayoga Upanishad and Mandukya Upanishad)

Ayurvedic Texts:

Samhitha Kala:

In Samhitha kala Charaka94, Sushruta95, Bhela and Kashyapa Samhitha96,

given descriptions related to Nidra and Nidranasha. Charaka and Sushruta have not

described Nidranasha separately. But Bhela97 and Hareeta98 have mentioned special

chapters on Nidra, in this context they explained about the nidana and chikitsa of

Nidranasha.

In Kashyapa Samhitha, Nidranasha is explained as the lakshana of some

diseases and also, as Grahadusta lakshana. Various Aushadhis are also mentioned for

the Chikitsa of Nidranasha.


46

Disease Review

Sangraha Kala:

In Astanga Sangraha and Astanga Hridaya the Nidana & Chikitsa of

Nidranasha are available. Madhavakara also mentioned Nidranasha as lakshana of

some diseases.

Adhunika Kala:

In Bhavaprakash and Yogaratnakara have described Nidana and Chikitsa of

Nidranasha and also explained it as lakshana of some diseases.

Also in Bhaishajyaratnavali describes some single drugs and various

Aushadha yogas for the chikitsa of Nidranasha. In Sharangadhara Samhitha,

explained about the Murdhini taila.

Etymology: (Shabda Kalpa Druma)

Derivation of the word ‘Nidra’

♦ Root Ni + dra + rak + ta = Nidra ( Amarakosa)

Ni + dra for blem (Panini Unadi 2.17)

The word Nidra is formed by the prefix Ni + dra + rak + ta. It is always used in

feminine gender. Sleep is a state of unconsciousness of the person.

Review of Nidra:

Impotance of Nidra:

♦ The Acharya of Ayurveda consider the Nidra as one among the three pillars of life

i.e Ahara, Nidra and Brahmacharya99 and also as one among the thirteen Adharaneeya

Vegas100.

♦ Acharya Vagbhatta explained as one among the three pillars which gives support

and strength to the life.101a, b

♦ Nidra is a Swabhava bala pravrtta roga i.e., natural phenomenon102 a, b


47

Disease Review

♦ The happiness, nourishment, strength, virility, knowledge and life depends on the

proper or adequate sleep103.

♦ Charaka has called the Nidra as Bhuta Dhatri i.e., which occurred by nature of

night, that nourishes all the living beings104.

♦ Sushrutha terms as Vaishnavi i.e., derived word from Lord Mahavishnu, which as

restorative property both physically and mentally105.

♦ Like Ahara the adequate sleep is essential for maintenance of the body106.

♦ The Characteristic of a healthy individual is proper sleep time and awakening107

♦ Bhavaprakasha has described importance of sleep in fetal life. He has emphasized

that the fetus in the womb enjoys better rest and comfort when the mother sleeps

during pregnancy108.

Definition of Nidra:

♦ Nidra is the state of life where, gnanendriyas and karmendriyas are not doing their

functions109.

♦ Sharngadhara mentions that Nidra is a state where predominance of Kapha and

Tamas is seen110.

♦ Dalhana states that Nidra is the state of combination of mind and intellectual in

which the person feels happy (Dalhana on 1st Chapter).

♦ According to Haritha samhitha the Nidra is a state of the body at rest111

♦ According to the Patanjali yoga sutra, Sleep is a state of unconciousness. (1/10).

♦ Nidra is the state of life where Jnanendriaya and Karmendriaya are not doing their

functions (Sabdastoma Mahanidhi).


48

Disease Review

Ayurvedic Concepts:

The three concepts which explained the phenomenon of Nidra by our

Acharyas are as follows,

(1) Tamoguna theory:

♦ Sushruta explains phenomenon of nidra by giving importance to Hridaya which is

considered as Chetana Sthana. Tamas predominates during the night and is

responsible for the induction of sleep. When Chetana Sthana is Hridaya and if it is

over come or enveloped by Tamas, the person goes to sleep112.

♦ Vagbhata states that at night, Tamas being predominance and the higher psychic

centers being over powered by it, and then the sleep initiates113.

♦ According to Kashyapa the Satvaguna is Prakashaka (brightening), Raja guna is

Pravartaka (promoter) and Tama guna is Niyamaka (controller). So predominance of

Tamoguna than Satva and Raja is the prime cause for sleep114.

♦ Harita has stated that the center of sleep is in the upper half part of nasal region, i.e.,

in between the two eye brows and when the Tamas reaches to this particular center

the knowledge and the activity get diminished and sleep initiates.115.

(2) Kapha Dosa Theory:

♦ Sushruta mentions that when the Sanjavaha srotas are filled with Kapha and

Indriyas are deprived from their respective objects of senses, the person goes to

sleep116.

♦ Sushrutha also mentions the role of Kapha and Tamo bhava for Nidra.117.

♦ Astanga Hridaya describes that whenever the sensation conveying the channels of

the body are blocked or filled up by the Shleshma and when it is over saturated with

the Tamasika quality the living being gets sleep.118


49

Disease Review

♦ Bhela explains that Kapha situated in Hridaya is augmented during the process of

digestion of food, during day time and when covers the Chakshuvaha and Srotovaha

Srotas, it leads to sleep119.

(3) Fatigue theory:

♦ Charaka states that due to exhaustion of the mind, sensory and motor organs will

cause inactive and the person goes to sleep109.

♦ Vagbhata gives importance to the Kapha Dosha and Shrama of the Indriya and

Manas in the normal onset of sleep120.

(4) Swabhava:

♦ Charaka and Sushruta have mentioned as sleep is a nature instinct, the night serves

as a causative factor for sleep109, 116.

Types of Sleep:

Broadly, sleep can classified into 2 types as

(1) Svabhavika Nidra – which comes regularly and naturally at night.

(2) Asvabhavika Nidra – which comes due to some other causes.

Various Acharyas have given various opinions regarding the types of sleep. Other

types of sleep according to different Acharyas are as follows:

(1) According to Acharya Charaka 121

(a) Tamobhava

(b) Shleshmasamudbhava

(c) Manasika Shrama Sambhava

(d) Shareerika Shrama Sambhava

(e) Agantuki

(f) Vyadhyanuvartini

(g) Ratri swabhava


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Disease Review

(2) Acharya Sushruta classifies as follows:116

(a) Tamasi

(b) Swabhavika / Vaishnavi

(c) Vaikarika

(3) Vagbhata’s classification of sleep is similar with Charaka’s classification but

the names differ.122

(a) Tamobhava

(b) Kaphabhava

(c) Chittakhedaja

(d) Dehakhedaja

(e) Agantuki

(f) Kalasvabhava

(g) Amayaja

♦ Vyadhyanuvartini

In some diseases due to severe weakness the patient falls asleep called

Vyadhyanuvartini e.g., Sannipataja Jvara.

♦ Agantuki

Chakrapani and Gangadhar commented as Agantuki Nidra is indicative of bad

prognosis which leading to definite death (Arista lakshana) 121.


51

Disease Review

CONCEPT OF NIDRANASHA (INSOMNIA):

Ayurvedic Review

Nidra is not only an important to our life but also an essential phenomenon of

life, which affects the body and mind equally in a favorable way when it is enjoyed in

a rightful manner. But it affects adversely, if it is not enjoyed in an appropriate

manner and at appropriate time.

The ancient Acharyas of Ayurveda considered Nidra – among the three

Upastabhas for the maintenance of the living organism123. While discussing about

Nidra and Nidranasha in the context of Astauninditiya Adhyaya, Acharya Charaka has

stated that happiness and sorrow, growth and wasting, strength and weakness, virility

and impotence, the knowledge and ignorance as well as existence of life and its

cessation depend on the sleep. According to him, Nidra is Pushtida and Jagarana

(Nidranasha) does the Karshana of the body. Untimely and excessive sleep and

prolonged vigil take away both happiness and longevity, like the night of

destructions124.

Charaka included the Asvapna in 80 Nanatmaja Vata Vikaras125. Acharya

Sushruta126 explained this under the chapter Garbha Vyakarana Shariram, might be

because of Nidra plays a role of nutrition and development of the body. He also

explained the Vaikariki Nidra in the same chapter, which can be correlated to sleep

disorders.

Acharya Vagbhatta in Ashtanga Sangraha127 mentioned this in Viruddhanna-

vignaniya Adhyaya, where he explained the Trayopastambhas. Here he considered

Manda Nidra due to Vata, but used Asvapna term in Vataja Nanatmaja Vikaras.


52

Disease Review

In Ashtanga Hridaya128, Nidra, Nidra Vikaras and its Chikitsa are mentioned

under Anna-rakshadhyaya, where Trayopastambhas are explained.

Acharya Sharangadhara129, concerted the Anidra in Vataja Nanatmaja Vikara,

Alpa nidra in Pittaja Nanatmaja Vikara and Atinidra under Kaphaja Nanatmaja

Vikara.

By observing these descriptions regarding Nidra and Anidra, it can be

concluded that all Acharyas considered the importance of Nidra, hence Nidranasha

are explained along with physiology of Nidra only. Anidra or Alpa Nidra is seen in

many diseases as a Lakshana and it may be Upadrava or Arishta Lakshana also.

Hence, the Nidana, Samprapti and Chikitsa are explained regarding Asvapna, the

Acharyas considered its independent manifestation too as a disease.

The Deprivation of Word Anidra:

It is composed of two words ‘A’ + ‘Nidra’. The suffix ‘A’ provides negative

meaning to the act of Nidra.

Anidra means less or no sleep.

Ayurvediya Vishvakosha part I explains Anidra as Nidranasha.

In Ayurvedic texts the term “Anidra” is used indicating a pathological

condition in which patient is devoid of sleep.

Definition of Nidranasha:

The word Nidranasha is composed of two words, Nidra and Nasha. The

definition of Nidra is as follows,


53

Nidana

Nasha in other words being lost, elimination, disappearance, annihilation,

destruction.

Based on the above descriptions, the term Nidranasha can be broadly defined as

the Loss of sleep or Absence of sleep or Destruction of sleep or Derangement in the

quantity and quality of sleep.

Synonyms of Anidra:

Table no.04 showing the Synonyms of Anidra

Asvapna Alpanidra

Anidra Akala Nidra

Avyavahita Nidra Nidra Nasha

Nidra Kshaya Nidra bhanga

Nidra pranasha Nidraghata

Nidra viparyaya Nastha Nidra

Nidra alpata Manda Nidra

Nidana 130 a, b, c, d, e, f

The causation of Nidranasha are predominantly Vata vitiating factors. Regarding

causative factors for Nidranasha, there is no direct reference.Broadly, the etiological

factors of Anidra can be categorized in two headings, viz. Shareerika and Manasika

♦ Shareerika Dosha – Vata bahula, Pitta and Kasheena Sleshma

♦ Manasika Dosha – Satwodarya, Rajas and Tamas

Acharyas explained some other causative factors due to Ahara, Vihara, Manasa,

Upachara, Vyadhi, etc are shown in this table


54

Nidana

Table no.05 showing the Nidana of Nidranasha

Ahara Vihara Manasa Upachara Vyadhi / Anya

Rukshanna Sheetanna Athyashana Vishamashana

Ati Vyayama Adyasana Plavana Atyadhwa Pradhavana Pratarana Atyuchabhashana Balavadvigraha Vegodeerana Abhigata Bharaharana Dukhashayya Sheegrhayana Prapeedana Prajagarana Atiadhyayana Ati vyavaya Vegadharana Vishamopachara Shrama Upavasa/Langhana Divasvapna Pavanatapa Himatapa

Chinta Shoka Krodha Bhaya

Atiyoga of Vamana Virechana Nasya Raktamokshana Dhuma Swedana

Dhatu kshaya Abhighata Kshaya Kala

♦ Acharya Charaka Specifically mentioned the cause for Manasa Vyadhis as 131

is caused by non-fulfilment of desires and facing of undesired.

♦ Acharya Vagbhatta has mentioned the mental cause for Anidra. In Ashtanga

Hridaya, he stated that due to excess of Kama, Nidrakshaya occurs132.

Besides this, certain specific causes for Anidra are also mentioned 133 Purgation,

evacuation of head, emesis, fear, anxiety, anger, smoking, physical exercise (excessive),

blood-letting (excessive), fasting, uncomfortable bed, predominance of Satva and


55

Nidana

suppression of Tamasa – These check the unwholesome and excessive occurrence of

sleep.

These factors may be taken as causes of Nidranasha, along with over work, time,

disorder (Vatika), constitution (Vatika) and aggravation of Vata itself.

♦ According to Acharya Sushruta, Nidranasha is caused by aggravated conditions

of the bodily Vayu and Pitta, as aggrieved state of the mind, wasting of Dhatus and

trauma (physical or mental).134

The loss of sleep is not found in all Vata rogas, but it is found in those diseases

where the Shula (pain) exists, viz. Pindikodveshtana (cramps), Gridhrasi (sciatica),

Udavarta (flatulence in stomach), Akshepaka (convulsions).

From Manastapa – all the psychic conditions – like worry, anger, mania etc. can

be taken.

♦ According Vagbhatta in both Ashtanga Hridaya135 and Sangraha136 added some

factors as

The excessive hunger, thirst, mental and physical misery, excessive happiness, sadness,

coitus, fearness, anger, worry, eagerness and excessive use of moisture, less dietetics are

the extra causes mentioned for sleeplessness. The Vata and Pitta provoking Ahara and

Vihara also cause sleeplessness. In Ashtanga Hridaya, the edge of Tikshna Anjan and

Dwadashavidha Langhana are also mentioned as the causes for Anidra.


56

Purvarupa & Rupa

Purvarupa:

Purvarupa of Anidra is not mentioned in any Ayurvedic classics. As Charaka

included the Nidranasha in 80 Nanatmaja Vata Vikaras, we can consider

“AurÉ£Çü sÉ¤ÉhÉ iÉåwÉÉÇ mÉÔuÉïÂmÉÍqÉÌiÉxqÉ×iÉqÉç |”137

Charaka has mentioned that Avyakta lakshana are the purvarupa of vatavyadhi.

Rupa: In Ayurvedic classics some symptoms are mentioned as.

Table no.06 showing the Rupa

Rupa Charaka Sushrutha Ashtanga Hrudhaya

Ashtanga Sangraha

Jrumbha + + + + Angamarda + + + + Tandra + + + + Shiroroga + - - - Shirogaurava - + + + Akshigaurava + + - - Jadya - - + + Glani - - + + Bhrama - - + + Apakti - - + + Vataroga - - + +

Charaka has described the following symptoms.138

By suppression of sleep, yawning, body ache, drowsiness, head disorders and heaviness

in eyes are caused.


57

Samprapti

Sushruta has described following symptoms due to restraint of sleep: 139

Yawning, body ache, stiffness in the body, head and eyes and drowsiness are the

symptoms caused by restraint of sleep.

Vagbhatta has mentioned that due to Nidranasha140 a, b – malaise, heaviness in

head, yawning, laziness, languor, giddiness, indigestion, stupor and Vatajanya rogas will

be manifested.

Samprapti:

Nidranasha is not explained as a separate disease in Ayurveda. On the basis of

Dosha, Dushya, etc. involvement, Samprapti can be constructed. Nidranasha is explained

as Vataja Nanatmaja Vikara.

Relation of various Manasika Bhavas regarding the body humors is well known.

Hence, Acharya Charaka141 mentioned it as, the interplay between the body and mind is

the core of Samprapti of every Manasa roga. Even though, it is Vataja Vikara, in the

pathogenesis of Anidra, the Manasika dosha plays an important role.

The etiological factors of Anidra can be categorized in two headings, viz.

Shareerika and Manasika. The former category comprises Shodhana Atiyoga, Vyayama,

Upavasa, dietary articles and routine activities causing Vata-pitta vitiation etc. Gunas like

Ruksha and Laghuguna causes vata predominant, Ushna and Teekshna causes pitta

predominant. On account of mental dispositions such as Chinta, Krodha, Bhaya and

Shoka, Vata Prakopa takes place in addition to the physical factors. The Vata vitiation

occurs, due to both kinds of etiological factors. So the vitiation of these factors leads to

the condition of Nidranasha.


58

Samprapti

Nidranasha Nidana

Aharaja, Viharaja and Anya

Manasika

Vata ↑

Pitta ↑

Kapha ↓

Satva ↑

Raja ↑

Tama ↓

Kaphakshaya Tamakshaya

Lack of Sleshma or Tama avarana to Chetanasthana Hridaya or Samjavaha srotas

Nidranasha


59

Samprapti

Types of Samprapti:

Sankhya: According to our ancient Acharyas, Asvapna is of two types viz.,

Nidranasha due to Vataprakopa and Nidralpata due to Pittaprakopa142. So Sankhya

Samprapti of Anidra can be two in number.

Vikalpa: In Anidra, mainly Vata Prakopa occurs and its Chala and Laghu Guna

vitiate, which keeps the mind active, causing Anidra.

Pradhanya: In Pradhanya Samprapti, the predominance of morbid humors are

described in terms of the comparative and superlative degrees but here as Anidra is a

Vataja Nanatmaja Vyadhi, vitiation of Vata only takes place. So there would not be

Pradhanya Samprapti in the case of Anidra.

Bala: Bala of Asvapna can be determined by the strength of manifestation of its

symptoms, severity, duration etc.

Kala: It is an important factor, while considering Nidra as well Anidra. As

Acharya Charaka has mentioned Kala under the causative factors of Anidra, which

indicates that Kala – time factor has an influential effect on it.

Samprapti Ghataka

Dosha : Vata & Pitta (Vriddhi),

Dushya : Rasa

Agni : Jatharagni

Srotasa : Manovaha, Rasavaha

Srotodushti Prakara : Atipravritti

Adhisthana : Hridaya

Udbhavasthana : Hridaya


60

Samprapti

♦ Dosha: Dosha involvement in Anidra are Vata, Pitta and Kapha. But the deviation from

the normal level is to be considered with due importance. Vata and Pitta are in increased

state, while in case of Kapha, the Kshaya is usually observed.

♦ Dushya: Rasa Dhatu, has its role in the Dhatu level of Samprapti. Because it provides

Tushti, Prinana – both functions are evaluated by Acharyas in the psychic level.

♦ Agni: Here, vitiation of Jatharagni takes place, because Nidra is said to enhance the

Agni 143. Apakti – one symptom of Nidranasha also indicates its vitiation.

♦ Srotasa: The role of Manovaha Srotasa can be understood without any controversy.

Rasavaha Srotasa, in this context, too have a pivotal role in the pathogenesis. Root of

Manovaha Srotasa is Hridaya and Hridaya is substantiating to the seat of Mana.

Moreover, etiological factor, responsible for Rasavaha Dushti, includes mental cause

such as Chintyanam Chatichintanat.

♦ Srotodushti Prakara: The main mode of vitiation is Atipravritti. Since, the over

indulgence of Manasa is a common feature of the disease.

♦ Adhisthana and Udbhavasthana: Hridaya is the abode for these two factors. It is the

plate form where the whole Samprapti process is supposed to be eventualised. As seen

earlier, Hridaya is the bed rock for Mana and its role in Anidra is already defined by

Acharyas.


61

Upashaya & Anupashaya

UPASHAYA & ANUPASHAYA:

Upashaya and Anupashaya are not available in Ayurvedic texts, can be evolved as,

Upashaya - Mamsarasa, Madya, Ksheera and Ksheeravikaras, Abhyanga,

Utsadana, Tarpana and Snehasevana, etc. can be considered as Upashaya of Nidranasha

Anupashaya - Rukshanna, Yavanna, Dhoomapana, Krodha, Shoka, etc. can be

considered as its Anupashaya.

Upadrava:

In Ashtanga Sangraha, it is mentioned that increased Vayu due to Nidranasha produces

Kaphakshaya, this decreased and dried Kapha sticks in the walls of Dhamanis and causes

Srotorodha. This, results in so much exhaustion that eyes of the patient remain wide open

and watery secretion from eyes. This dangerous exhaustion is Sadhya up to three days,

and then becomes Asadhya144.

Chikitsa: 145

The Chikitsa of any disease in simple word is: The giving up of the causative

factors. In the treatment of Anidra, one should depend upon the measures having

Vatashamaka, Vedanashamaka and Roga Nivaraka effects as well as pacifying effects on

mental activities. The treatments which are described for Anidra in Ayurvedic Samhitas

are mostly same. The management modalities according to various classics can be

classified as


62

Chikitsa

♦ Bahya upachara

♦ Ahara upachara

♦ Manasika upachara

♦ Anya upachara are as follows,

Bahya Upacharas for Nidranasha

Charaka mentioned Abhyanga,Utsadana,Samvahana, Abhyanga, Akshitarpana, Shiro

Lepa, Karna Purana, Shiro Basti, Shirodhara, Moordhni Taila as bahya upacharas.

Manasika Upacharas for Nidranasha

Charaka mentioned Manonukula vishaya grahana, Manonukula sabda

granaha, Manonukula gandha granaha, as manasika upacharas

Aahara Upacharas for Nidranasha

Charaka mentioned Gramya mamsa rasa, Anupa mamsa rasa, Jaleeya mamsa

rasa, Mahisha ksheera, Peeyusha, Morata as manasika upacharas

Anya upachara

Some other measures, which can be advised to the patient of Nidranasha, though

are not mentioned in Ayurvedic texts, are as follows:

• Maintaining regular time for going to bed.

• Avoid smoking, tea, coffee or alcohol at night before going to sleep.

• Not indulge in any type of work or reading till late night.

• Should devoid of thoughts tensions before going to bed.

• Hearing soft music or favorite songs also induces sleep.

• 5-10 minutes mediation before going for sleep.

• Offering prayer before sleep.


63

Chikitsa

• Washing of hand, feet and face before goes to sleep.

• Avoiding a divaswapna

• Proper evacuation of stool and urine.

• Avoid mosquito bites.

• Maintenance of adequate privacy and free from disturbance.

Ekamulika prayoga:

Table no.07 showing the Ekamulika prayoga in Nidranasha

Brahmi

Aswagandha

Drakshya

Bhanga

Shankapuspi

Jatamamsi

Katu tumbi

Jatiphala

Apamarga moola

Khas khas

Kupilu

Tagara

Raja sarshapa, etc

Kusmanda

Yamini

Pippali moola

Sarpagandha

Punarnava

Karpura

Parasika yavani

Other Yogas:

• Brahmi powder or mixed with the sweet drink form

• Sankhapushpi powder or in the sweet drink form

• Ashwagandha powder 3gm + Pippalimula powder 3gm. Mixture of these to be

given twice a day with milk.

• Ashwagandha powder 2gm + Pippalimula powder 2gm + Parasikayavani powder

2gm mixed and to be given with milk or water at night before sleep.

• Loknath Rasa (Sh.Sam.)

• Ashwagandha Churna with Sharkara & Ghee (Vangasena)

• Decoction of Jeevaniya Gana with milk (A.S)


64

Pathya & Apathya

• Pippali Moola Churna with Jaggery (B.P.)

• Roasted Vijaya powder with honey (B.P.)

• Sarpagandha powder – 2gm with milk twice/thrice daily

• Decoction of root and bark of Kakamachi with Jaggery (B.P.)

• Nidrodaya Rasa (Rasatarangini)

• Kalyanaka Guda (Ch.Kal.7)

Some external treatment are also described as

• The bandanging of the root of Kakamachi or Kakajangha or Apamarga or

Kokilaksha or suparnika (Bakuchi) with hair (Ha.Sam.& B.P.)

• Maharshi Harita has stated that sleep is induced by the moving wind with the help

of cloth, Bamboo-chip (fan) or use of bronze vessel and the use of banana leaf

(Ha.Sam.).

• He also mentioned that the sleep can be achieved by hearing the sounds produced

by the animals like ox, horse etc. and by viewing dance and by hearing humorous

words (Ha.Sam.).

Pathya – Apathya:

Pathya is the wholesome regimen which does not impair the body system and

which is pleasant to the mind146. If one follows certain principles and controls the

activities and makes changes in the regimen, as mentioned earlier in the form of Ahara

and Vihara management, he can get a sound, normal and good sleep.

Apathya – those which adversely affect the body and mind are considered to be

unwholesome (Apathya). It may be said that etiological factors of Anidra are Apathya in

the disease, because they increase the disease.


65

Modern Review of Insomnia

Concept of Sleep: Introduction: Shakespeare described sleep as “Chief nourisher in life’s feast”

Sleep is a fundamental aspect of all human life. Sleep comprises approximately

one-third of our lives. The alternating pattern of waking in the daytime and sleeping

during the darkness of night is so ingrained in human experience that we barely have a

perspective on it. Sleep is a state of control and complexity. An excellent night of sleep

can make a person feel wonderful and productive.

We do not know why we sleep, just as we don’t know why we are awake.

Reasons typically given for sleep include - conservation of energy, the restoration of

important bodily functions, and the repair of damaged tissues. For example, some

hormones are secreted mainly during sleep. Such theories are attractive, but all of these

functions could be met by simply resting and having whatever hormones are secreted

during sleep secreted during rest, not necessarily having the brain go into an unconscious

state. A poor night of sleep or insufficient sleep leaves a person feeling exhausted and

nonproductive; he or she may even pose a danger to others. If people do not sleep the

right amount, they feel rotten the next day, their brains do not work properly, and they

might be quite mentally impaired and unable to perform complex tasks.

Definition of Sleep:

♦ A state of unconsciousness from which the person can be aroused by sensory or other

stimuli147.

♦ A state of consciousness that differs from alert wakefulness by loss of critical reactivity

to events in the environment with a profound alteration in the function of brain148.


66


♦ Sleep is a reversible behavioral state of perceptual disengagement form and

unresponsiveness to the environment149.

♦ Dr. Robert MacNish wrote in Philosophy of Sleep in 1830 describes sleep as,

“Sleep is the intermediate state between wakefulness and death: wakefulness is regarded

as the active state of all the animal and intellectual functions and death as that of their

total suspension.”

♦ A condition of the body and mind, such as that which normally recurs for several hours

every night in which the nervous system is inactive, the eyes closed, the postural muscles

relaxed and consciousness partially suspended150.

♦ A state of natural unconsciousness during which the brain’s activity is not apparent, but

can be detected by means of an electroencephalogram. (Medical dictionary)

♦ Insomnia is defined as repeated difficulty with the initiation, duration, maintenance, or

quality of sleep that occurs despite adequate time and opportunity for sleep that results in

some form of daytime151.

A turning point occurred in the twentieth century, when it became apparent that

the brain was indeed active during sleep. In 1928, a German doctor, Hans Berger,

successfully measured and recorded electrical activity from the sleeping brain through

electrodes placed on the scalp. This was the first EEG (electroencephalogram). Soon

techniques were devised to measure the millionths of volts of electrical energy put out by

the human brain during sleep to provide a more accurate picture of the brain’s activity.

In 1953 at the University of Chicago, Nathaniel Kleitman and his student, Eugene

Aserinsky, measured the EEG and eye movements in babies. They described became

known as rapid eye movement (REM) sleep. Scientists then realized that there were three


67


states of being: non-REM sleep, REM sleep, and wakefulness. It was soon discovered

that REM sleep is the time when one is most likely to experience vivid dream imagery.

Further studies then ascertained that there were actually several types or stages of

sleep. Using brainwaves and other measures, non-REM sleep was divided into four

stages. Typically, as one goes from stage one to four, brainwaves become progressively

slower and the size of the brainwaves become increasingly bigger and sleep is deeper and

deeper. Stages three and four are frequently combined and called slow-wave sleep, deep

sleep, or even delta sleep. Consequently, a more detailed picture of the brain’s electrical

activity during sleep emerged - one that represented the states and stages of sleep during

the sleep cycle.

States and Stages of Sleep

Sleep is defined electroencephalographically and behaviorally by two states: non-

rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. NREM sleep

is characterized by four sleep stages (1–4), with increasing arousal thresholds correlating

with successive sleep stages. Brain activity as measured by the electroencephalogram

(EEG) demonstrates relatively slow synchronous waveforms1, and predominance of

stages 2, 3 and 4, usually called slow-wave sleep (SWS) or NREM. REM sleep, by

contrast, is identified in activation by EEG criteria, relative muscle atonia and episodic

bursts of rapid eye movements. REM sleep tends to cycle every 90 to 120 min throughout

the night becoming more prominent in the early morning hours1,2. The abundance of

theories about the nature of sleep and especially about its function is the best evidence of

how little we know about sleep–wake mechanisms.


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Figure no.01 Showing the States and Stages of Sleep

People are most likely to have heart attacks during their sleep early in the

morning. Systemic arterial blood pressure falls by about 5–16% during NREM and

significantly fluctuates in REM sleep. Cutaneous, muscular and mesenteric blood flow

show little change during NREM but have profound vasodilatation in REM sleep.

Cerebral blood flow and cerebral metabolic rate for glucose and oxygen decrease by 5–

23% in NREM but increase by up to 41% above waking levels during REM sleep


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Table no.08 showing the Physiological variability between NonRapid Eye Movement (NREM) and Rapid Eye Movement (REM) sleep

Functions NREM REM

Electroencephalogram Slow waves(theta and delta) Low amplitude; tooth waves Evoked potentials None Decreased amplitude Eye movements (electroolfactogram)

Slow, pendulum-like Rapid eye movements

Chin electromyogram Normal Significant decrease or absence

Mono-synaptic reflex Normal Weak Pupils Normal Myopic Babinski symptoms Apneas Disappear Intra-cerebral pressure Decreases Increases Body movements Typical Absent Brief finger movement Not typical Typical Arousal threshold Increases Decreases Type of thinking Realistic thoughts Emotional images Dreams Rare Frequent Sleep talking Understandable; long,

frequent Not understandable, brief, rare

Blood pressure

Decreased lowest during stages 3 and 4; reduced variability

Short increases possible (40 mmHg); magnitude of change greater in hypertensive patients

Heart rate

Decreased; breathing variablity

Increased variability; bursts of eye movements accompanied by brief tachycardia, followed by bradycardia

Cardiac activity

Reduce cardiac output; vasodilatation

Transient vasoconstrictions in skeletal muscle circulation; cardiac arrest (during sleep) more frequent during this stage

Cerebral blood flow

Twenty-five per cent reduction of flow to brainstem; 20% reduction to cerebral cortex

Significantly increased blood flow, especially to cochlear nuclei

Temperature Decreased brain and body temperature (rectal)

Increased brain temperature; absence of thermoregulation

Perspiration (except palms) Maximal Fluctuates by waves


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Fever Increased Decreased Palms perspiration Decreased Increases during REM

bursts Skin galvanic response (SGR)

Increases with body movements

Decreased

Seizure activity Increased Suppressed Respiration

Respiratory rate decreased upperairway muscles may be hypotonic; obstructing oxygen flow in patients with sleep apnea

Breathing rapid and may be irregular

Oxygen Metabolism Decreased Significantly increased Blood CO2 consumption Maximal Lowest Endocrine functions

Growth hormone and prolactin secretion increased

ACTH-cortisol rhythm increased (in the morning)

Renal function

Decreased urine volume, excretion of sodium, potassium, chloride and calcium

Variable

Pain Decreased receptor activity to noxious tactile stimuli

Decreased pain at level of tooth pulp

Different Theories of NREM/REM sleep regulation149:

The anatomic and physiological processes that control NREM and REM sleep are

not clearly understood. Currently, the regulatory mechanisms of NREM sleep are

believed to reside within diencephalic structures, while those regulating REM sleep

appear to reside mainly in the pontine brainstem.

Although the exact mechanisms controlling NREM and REM sleep are still not

clear, several theories of NREM and REM sleep regulation have been proposed.

♦ In the 1970s Jouvet proposed the monoaminergic theory of the sleep–wake cycle

based on pharmacological and brainstem transection studies. Jouvet’s theory suggested

that the catecholaminergic system of the brain plays the executive role in REM sleep. The

caudal two-thirds of the locus ceruleus (LC) complex (locus ceruleus, subceruleus and


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parabrochialis) act as the trigger for REM sleep. One-third of the LC complex controls

the total inhibition of muscle tone, whereas the medial third of the coeruleus complex is

responsible for pontogeniculo-occipital (PGO) activity and both phasic and tonic

components of REM sleep.

♦ The contemporary version of the monoaminergic theory is Hernandez-Peon’s

cholinergic theory of sleep–wake regulation. According to this theory, the sleep–wake

cycle is regulated by two antagonistic cholinergic systems: the sleep system and the

waking system. Recently Jouvet1 suggested that serotonin is the major neuromodulator of

sleep,

♦ Whereas Radulovacki presented data regarding the major role of adenosine in

sleep–wake regulation.

♦ In 1975 Hobson and colleagues offered a new explanation proposing a reciprocal

interaction model of sleep–wake cycle control in an attempt to explain the sleep–wake

cycle on a cellular level. This concept, based on the interaction of multiple and widely

distributed distinct groups of neurons, replaced the previous hypothesis of a single ‘sleep

center’.

A simplified version of the reciprocal interaction model may be explained as

follows: REM-ON cholinergic nuclei activate reticular formation neurons in a positive

feedback interaction to produce REM sleep. When REM sleep is ‘on’, this excites REM

‘off’ neurons in the raphe and locus ceruleus systems. As the REM-OFF neurons become

active at the end of REM sleep, they terminate REM and the NREM period starts, which

inhibits REM-OFF cells, owing to self-inhibiting feedback, and then the cycle repeats

itself.


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♦ One of the common features of the molecular and cellular theories is the idea of a

single form of NREM and a single form of REM. Alternative approaches to the single

NREM–REM model such as the sequential hypothesis of the sleep function were

described by Ambrozini and co-workers. They suggested that the functions of the

sleeping brain depend on the nature of the previous waking experience.

♦ Hernandez-Peon theory also considered NREM and REM as a unitary process.

Other interesting theories (see Drucker and Merchant) attempting to unite several states

of human experiences suggested that sleep after feeding, stress, coitus, fatigue or

infection, etc. is not the same sleep, meaning it is not triggered by the same brain

mechanisms.

Therefore, NREM and REM sleep may have different initiating and controlling

mechanisms, which may depend in part on the previous waking experience. There are

multiple excellent reviews describing in great detail a dozen sleep regulation theories.

There is currently no consensus or generally accepted theory explaining sleep–wake

cycle regulation, but all researchers agree on the fact that sleeping and waking are

intimately united. You cannot understand sleep without understanding wakefulness and

its mechanisms, and vice versa. Deep mechanisms of waking behavior are connected with

mechanisms of sleep.

Sleep Time

When we sleep, and how much deep sleep and dreaming sleep we need varies

with age. Thus, seven to nine hours of sleep, which is adequate for most adults, would

leave the average nine-year-old extremely sleepy during the daytime. Sleep requirements

for different ages. As you can see, there are ranges for each age group. The amount of


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sleep a woman needs is an individual characteristic just like her height. Each person

needs his or her own unique amount of sleep. The amount of sleep needed is that which

makes you wide awake and alert. Research has also shown a link between sleep time and

health.

Table no.09 showing the Hours of Sleep according to Age

Age A 24-hour period Napping Birth to 2 months 10 1⁄2 to 18 5 to 10 2 months to 12 months 14 to 15 2 1⁄2 to 5 12 months to 18 months 13 to 15 2 to 3 18 months to 3 years 12 to 14 1 1⁄2 to 2 1⁄2 3 years to 5 years 11 to 13 0 to 2 1⁄2 5 years to 12 years 9 to 11 ** Teenage years 8 to 10 ** Adult years 7 to 9 **

In general, the amount of sleep decreases with age. Babies spend an enormous

amount of time sleeping (although it may not feel that way to their sleep-deprived

parents); for the first few months of life, most infants sleep at any time during the twenty-

four-hour day. Finally and mercifully for the parents, they start to have long periods of

sleep mostly at night. Infants and toddlers nap. By the time children go to school, most

will no longer nap.

The amount of REM sleep also decreases with age. Newborns spend roughly half

their sleep time in REM sleep. In adults the amount of REM experienced during sleep

goes down to between 20 to 25 percent. The amount of slow-wave sleep is also much

higher in children; the time most people spend in slow-wave sleep decreases with aging.

Some elderly people may have no slow-wave sleep. This is the sleep state during which

most of the human growth hormone is secreted.


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Repeatedly that people who consistently sleep too much (more than ten hours a

night) or far too little (fewer than five hours a night) have a higher death rate. However,

the key issue is not the length of sleep. Rather we believe that such abnormal amounts of

sleep are a symptom of a sleep or medical disorder that may cause or result in death.

The Body Clock

In our brain, a place called the suprachiasmatic nucleus (SCN) is a collection of

cells that have the ability to keep time and function as a pacemaker for our sleep-wake

cycle which helps to know when it is time to go to sleep and to wake up. It turns out that

this pacemaker controls not only the times when we are sleepy or alert, but it also

controls the function of many systems in the body.

Most of the systems in the body have a pattern that varies over a twentyfour-

hour period. This is true for the secretion of many hormones, blood pressure, heart rate,

and other functions in the body. This natural, internal rhythm in function has been called

the circadian rhythm.

The word comes from circa meaning “about” and Diem meaning “day.” In other

words, the cir - cadian rhythm changes the way many systems in the body work over the

twenty-four-hour day so that the function of the systems matches what the body needs.

As a result, we usually don’t have to go to the bathroom and we don’t have hunger at

night. If you have traveled across time zones you know how discombobulated or out of

sync you can feel because of a disconnect between your own body clock and the time

where you happen to be.


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Circardian Rhythm Disorders:152

The DSM-IV establishes the following general diagnostic criteria and lists the

following four criteria for diagnosing circadian rhythm disorders:

(1) A persistent or recurrent pattern of sleep disruption occurs which leads to insomnia

and/or excessive daytime sleepiness secondary to a mismatch between the environment

and the individual’s circadian sleep - wake pattern.

(2) The sleep - wake disturbance causes clinically significant distress or impairment in

social, occupational or other important areas of functioning.

(3) The disturbance does not occur exclusively during the course of another sleep

disorder or mental disorder.

(4) The disturbance is not due to the direct physiological effects of a drug of abuse,

medication or other general medical condition.

Advanced sleep phase syndrome

Individuals are usually drowsy in the evening and awaken too early in the

morning. This type sometimes is seen among the elderly, who may experience sufficient

lifestyle impairment to warrant treatment. However, people with a strong ‘morning’

tendency may Shift work and circadian rhythm disorders be called ‘larks’ and not all

present with a phase advanced sleep–wake rhythm which interferes with daily life.

Delayed sleep phase syndrome

These individuals are more alert in the evening and night, tend to stay up much

later than usual, and have difficulty awakening in the morning. This is often seen in

adolescents and young adults, sometimes referred to as ‘owls’. If the desynchronize


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between internal sleep - wake rhythms and external demands of daily living is severe

enough, a diagnosis of phase delayed syndrome is made.

Jet lag

This is sleepiness and alertness experienced at an inappropriate time of day

relative to local time, occurring after travel across more than one time zone.

Shift work

Insomnia may occur during the major sleep period and excessive sleepiness

during the major awake period. It is associated with night shift work or frequently

changing shifts. A variety of factors affect the tolerability of shift work. These include the

fit between an individual’s assignment and his best time of day, the direction of rotation

and the speed of rotation.

As society has become more industrialized, an increasing number of individuals

are required to undertake shift work, estimates of the number of people thus engaged

ranging from 20 to 25% of the work force14. Many shift workers are chronically sleep

deprived and therefore suffer both sleep onset and maintenance insomnia. During the

major waking period, such individuals may suffer fatigue and reduced alertness. Poor

mood (irritable, depressed or anxious) may also result from sleep loss. Of perhaps

greatest importance is the fact that night shift workers are at increased risk of falling

asleep between about 3 and 5 a.m.

In general, shift workers obtain about 2 h less sleep per day than non-shift

workers, because if one is working nights, the physical and social environment makes it

more difficult to obtain good quality sleep during daylight hours. Under these

circumstances, circadian factors exert greater influence on the ability to sleep than do the


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homeostatic factors (prior sleep loss). Adaptability to night shift work can be enhanced

by the speed and direction of the rotation. Slower rotation used in the United States

permit a worker to gradually adjust his circadian rhythms over a period of 2 to 4 weeks.

Some authorities believe that the method reduces long-term damage to workers’ health.

Many hidden costs occur when shift work is assigned without regard for a worker’s

health, safety or family concerns.

Shift workers in particular appear more prone to digestive ailments, including

ulcers, constipation and obesity1. This is probably due, in part, to poor eating habits,

excess intake of caffeine and junk food and too little exercise. Improved health of shift

workers may be obtained by modifying diet (e.g. switch to low fat, high fiber) and

exercise routines. Of additional concern is the fact that most shift workers revert to the

conventional sleep–wake times on days off but often have long periods of compensatory

sleep. Thus, social and family obligations may be neglected during time off work.

Shift work and circadian rhythm disorders

Determinants of Daytime Sleepiness:

Not all daytime sleepiness is a result of inadequate amounts of total sleep time.

The human sleep–wake cycle is regulated by two primary processes, process S and

process C. Process S is the homeostatic drive to sleep. This drives increases during

wakefulness and decreases during sleep. If a sufficient amount of sleep is not achieved,

either through decreased total sleep time (sleep quantity) or sleep fragmentation (sleep

quality), our homeostatic drive for sleep increases and results in daytime sleepiness. The

amount of slow-wave sleep (stage 3 and 4) achieved is primarily linked to process S and

the duration of prior wakefulness. Process C is the circadian drive for sleep, which acts


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independently of sleeping and waking. This drive increases sleepiness and alertness

during different parts of the subjective day. Process C also controls our drive for REM

sleep. REM sleep propensity is circadian phase dependent and not altered by an

increasing homeostatic drive for sleep. Other factors in addition to homeostatic and

circadian influences may affect an individual’s drive for sleep or wakefulness.

Insomnia

Definition of Insomnia

Insomnia is defined as an inability to obtain adequate sleep. This statement is

sufficiently broad to permit classification of essential commonalities, which are

persistence of the complaint (i.e. more than a transient poor night of sleep), and the

subjective element as noted by the word adequate. The latter also highlights the fact that

individuals vary in their need for sleep.

Insomnia is a complex problem, and it is now widely recognized that there can be

multiple causes for sleep disruption, including conditions such as sleep apnea, delayed

sleep phase, periodic limb movements (PLMs), gastroesophageal reflux and drug

reactions. However, clinicians are more likely to treat insomnia that is the result of

anxiety, depression, conditioned arousal, stress and sleep - wake cycle disturbances.

Insomnia, difficulty in falling asleep and staying asleep, is a symptom and not

a disease. When a person has a problematic symptom such as insomnia, it is up to that

person to go to the doctor. It becomes the job of the doctor to determine the cause of the

symptom and then to treat the cause. The symptom of insomnia can be caused by many

different medical problems - a disturbance in sleep often indicates that there is something


79


else wrong in the body, and it might be serious. Disorders involving almost every single

organ system can cause problems with sleep, which makes it all the more amazing

that doctors have only been asking about their patients’ sleep for the past few years.

You name a chronic disease and it is probably associated with a sleep problem.

Diabetes, kidney failure, arthritis, Parkinson’s disease, heart failure, and cancer are some

of the commonly occurring medical conditions that can affect sleep and lead to sleep

complaints

Affective Disorders:

Sleep is much disrupted in depression and mania. Major depression usually

produces initial insomnia and sleep maintenance insomnia including early morning

awakening. Patients most often complain of the inability to return to sleep as easily as

usual. Individuals with atypical depressions and seasonal affective disorders more often

complain of hypersomnolence. A sleep laboratory recording may document specific

abnormalities associated with depression. These include early onset of rapid eye

movement (REM) sleep, increased number of eye movements, reduction in stage 3 and

stage 4 and poor sleep continuity. Several studies have now demonstrated that 1 year of

chronic untreated insomnia leads to depression in up to 50% of people. Adequate

treatment with antidepressants and psychotherapy will usually ameliorate the insomnia as

the depression improves. Most effective antidepressants significantly suppress REM

sleep. Partial sleep deprivation, another effective treatment for depression, reduces REM

by keeping the patient awake when REM sleep predominates (3–7 a.m.)

Electroconvulsive therapy (ECT) also reduces REM time and normalizes REM– NREM

cyclists.


80


In general, it has been shown that the amount of REM sleep suppression produced

by an antidepressant correlates with its efficacy. Reduced REM latency is a consistent

biological marker of depression. Patients who have REM latency less than 60 minutes

respond dramatically to fluoxetine, while patients with REM latency longer than 65

minutes respond the same as placebo subjects.

Anxiety Disorders:

Chronic anxiety usually produces sleep onset insomnia. Panic attacks can occur at

the onset of sleep or during stage 2 – stage 3 transition. Those occurring during REM

sleep are called REM anxiety attacks. The differential diagnosis must include nocturnal

seizures and night terrors. Anxiety disorders do not appear to produce the typical

abnormalities seen in major depression such as shortened REM latency. In fact, there are

no consistent specific differences between the sleep parameters of patients with anxiety

disorders.

Alcohol and Drug Abuse:

About 10–15% of patients with chronic insomnia abuse substances, especially

alcohol and other sedatives. Although alcohol in low to moderate doses initially promotes

sleep, it disrupts and fragments sleep later in the night. Alcohol may exacerbate

sleeprelated breathing disorders in some patients. A persistent sleep disturbance has been

emonstrated in chronically abstinent alcoholics. However, it is unwise to treat abstinent

alcoholics with benzodiazepines or barbiturates since they are cross-tolerant with alcohol

and patients can quickly become addicted to these drugs. People who are alcoholic or

addicted to sedative-hypnotics have severe insomnia during acute withdrawal.

Hospitalization may be required for such patients for supervised gradual withdrawal.


81


Insomnia may persist for months following withdrawal. Sleep hygiene techniques must

be taught and the underlying psychiatric syndromes should be treated.

Sleep Talking:

Sleep talking is quite common among adults and children. Most of the noises that

come out are actually gibberish, although one might be able to make out individual

words. I have not heard of people blurting out secrets during sleep talking episodes. This

might be considered an embarrassing condition, but it is not one that requires treatment.

Sleep Terrors:

This disorder, which can occur in children and in adults is also called “night

terrors.” Sufferers get out of bed abruptly, sometimes screaming with their eyes wide

open, and sometimes sweating. They appear to be terrified; sometimes they seem as

though they are about to commit a violent act. The person may let out a bloodcurdling

scream and display other bizarre behavior. Although it would seem that the person might

be reacting to a dream.

Sleep terrors are a form of sleepwalking and the treatment is the same. There is no

need to awaken people who are having these episodes; it is best to calmly walk them back

to bed. The following morning, they have no recollection of the distress that they caused

for the other people in the house or of the actual event. Sleep terrors can be bizarre, but

are not usually dangerous enough to require further treatment.

Dreaming While Not Quite Asleep

Some people, in the minutes before falling asleep and sometimes in the minutes

directly after falling asleep, may sometimes have very frightening dreams that include

sounds, visually rich images, and even sometimes sensations in various parts of the body.


82


These dreams are called hypnagogic hallucinations. They are not normal. People don’t

normally dream unless they have been asleep for about ninety minutes. However, a sleep-

deprived person may have hypnagogic hallucinations, and they are quite common in

people who have narcolepsy.

Teeth Grinding, or Bruxism:

Bruxism is an increase in the activity of the jaw muscles while sleeping. This

condition occurs in children and adults and is equally common in females and males. We

don’t know much about it except that it is more common in people under stress and can

occur as a reaction to certain drugs. The grinding can be extremely disruptive, and it can

literally wear down a person’s teeth. In some people, stress reduction alone is an effective

treatment for bruxism. If the teeth are wearing down or if there is pain in the jaw, this

should be checked out with a dentist, who may recommend a mouth guard to be

worn at night.

Head Banging and Body Rolling:

One of the most unusual problems we see in the sleep clinic is a disorder in

which a person repeatedly bangs her head against a mattress, a crib, or a wall. Some

people rock their bodies the entire night and move around a great deal. As painful as it is

to watch these patients, it turns out that this is not a serious problem. They are quite

normal in the daytime. Though it is scary for parents, most children who have this

disorder grow out of it, although sometimes it continues into adulthood. The disorder is

found in about 8 percent of four-year-olds, and the number decreases even further with

older children. For reasons that are not known, this condition is four times more common


83


in males than in females. Some people with neurological problems might display similar

movements. This is a disorder that we do not normally treat unless the person is injuring

himself.

Urinating in Bed:

Enuresis, or urinating in bed, occurs because the mechanisms that normally

keep the sphincters of the urinary system working are not effective. This is a problem in

children and the elderly. In children, the problem is caused by slow development of

bladder control. In the elderly, it is generally related to changes in anatomy brought on by

the aging process. Childhood enuresis can be very troubling for both the child and the

parents. This problem is twice as common in boys. Children might develop a fear of

going to sleep because they are afraid that they will wet the bed. They become afraid to

sleep over at a friend’s house. To make sure that there is no medical reason for this

symptom, children who have this problem should be evaluated by their pediatrician.

There are alarm systems available that are triggered when the bed has been

dampened. Such an alarm awakens the child, who eventually gains bladder control during

sleep. If this treatment is not effective, the doctor might recommend one of several

medications. Desmopressin acetate (DDAVP) is a medication that imitates the effect of a

chemical produced by the pituitary gland that reduces the amount of urine. This drug,

which is immediately effective, can be taken just before bedtime either in a nose spray or

in pill form. A low dose of the antidepressant imipramine taken one to two hours before

bedtime can been used for many years to treat children who wet the bed. It is successful

in less than half the time. These treatments do not cure the problem, though. Nearly all

children eventually gain bladder control.


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Snoring:

All of us think we know what snoring is and most of us have observed it firsthand

or in people we know. Snoring is the loud noise people make while they are breathing in

during sleep. Although the butt of jokes and countless cartoons, snoring usually signifies

that the person’s upper breathing passage is obstructed. Snoring represents vibration in

tissues as the person is trying to suck air in. It can be so loud and disruptive that couples

may start to sleep in different rooms or on different floors of the house.

Treatments:

Pharmacology of Sleep Hypnotics: 152 b

Despite the recent progress in the use of non-benzodiazepines, physicians remain

reluctant to prescribe drugs with sedative properties, i.e. hypnotics, because the risks are

perceived to be too high. Many physicians have the impression that onerous side-effect

are inevitable. In general, physicians should favor short-acting hypnotics over long-acting

drugs in primary insomnia when short-term use is anticipated. Chronic insomnia

associated with the anxiety disorders respond better to hypnotics with longer half-lives to

reduce daytime anxiety.

Some sleep hypnotics like Benzodiazepine hypnotics, Non – Benzodiazepine,

Bright lights, Pharmacotherapy, Melatonin, Chronotherapy, Shift-work consultation /

planning, etc.


85

Drug Review

DRUG REVIEW

Introduction:

“The Drugs is as old as Disease”.

Illness has been man’s heritage from the beginning of his existence, and the

search for remedies to combat, is perhaps equally old. Now a days self administration of

a drug for non – medical reasons in quantities is common and frequencies which may

impair an individual’s ability to function effectively and which results in social, physical

or emotional harm.

Ayurveda – an eternal source of knowledge, has a multi angled textual material

including pharmaceutical knowledge. Drug is a part of quadruped of the treatment, which

has the potential to bring about reversal in the process of pathogenesis and eradication of

the signs and symptoms.

The efforts of the physician who has the sound knowledge of pathology and

pharmacology with due consideration of place, time and quantum, will never be fruitless.

Further, a great deal of vitalistic approach has been given to the complete knowledge of

the drug, right from procurement, identification to processing and application. The

comprehensive knowledge of the drug is very important to physician because without

knowledge of drug the patient cannot be treated properly.

Drugs used:

For Group – A

Murchitha Tila Taila &

Murchitha Gritha


86

Drug Review

Tila Taila153

Acharya charaka mentioned that Tilataila is best among the taila vargas. The word

“Taila” is derived from Sanskrit - “Tilodbhavam” means, one which is derived from Tila-

sesamum. But in general, ‘Taila’ is considered for all oils. It is vata shamaka

From therapeutic point of view, when taila is subjected (samskara) with other

dugs it takes the property of that drug. Vagbhata explains the importance of Tilataila as, it

does Brhmana Karya for Krisha persons and does Karshana for Sthula persons.

Composition:

Palmitic acid (9.1%), stearic acid (4.3%), arachidic acid (0.8%), oleic acid

(45.4%), linoleic acid (40.4%).

Drugs used for taila murchana are given along with the properties of each drug as

Manjistha, Haritaki, Amalaki, Vibhitaki, Mustha, Haridra, Lodra, Vatankura, Hrivera,

Nalika, Ketakipushpa.

Importance of murchana of Tila taila:154

By doing murchana the Amadosha in the taila is removed, also durgandhata &

ugrata are removed. After doing Murchana Samskara, taila gets good smell and colour.

By doing Taila paka and Murchana the veerya of the Sneha is enhanced.

Mahisha Ghrita: (Sneha):155 a, b, c

Sanskrit name : Sarpi

English name : Ghee

Gana : Madhura Skanda (Cha.)

Guna : Snigha, Guru


87

Drug Review

Virya : Sheeta

Vipaka : Madhura

Dosha Karma : Tridosha Shamaka

Source : Animal fat, Jangama Sneha

Action : Rasayana, Vajikarana, Rasavardhaka, Svarya, Varnya, beneficial for Bala,

Vriddha, Abala (Stri), Kshata and Kshina, increases Oja, Medha, Smriti, Agni and

Indriyabala.

Drugs used for Ghrita murchana are given below, along with the properties of each drug

Table no.10 showing the Drugs used for Ghrita murchana No Drugs Rasa Guna Virya Vipaka Doshaghnata Parts used

1.

Pathya

Except lavana

Laghu, ruksha, ushna

Ushna Madhura Tridoshagna Phala, twak

2.

Dhatri

Except lavana

Guru, snigdha, sara

Sheeta Madhura Tridoshagna Phala

3. Vibhitaki

Kashaya, tikta Laghu, ruksha, ushna

Ushna Madhura Kapha and Pitta shamana

Phala

4. Musta

Katu, tikta, kashaya

Laghu, Ruksha

Sheeta Katu Kapha and Pitta shamana

Kanda

5. Rajani Tikta, Katu

Ruksha, Laghu

Ushna Katu Tridoshagna Moola

6. Matulunga Amla Tikshna Anushna Amla Kaphavata Shamaka

Phala

Ghrita possesses a Yogavahi property. Ghrita is one among Mahasneha.

According to Vagbhata Mahisha Ghrita is having the property of Nidrajanaka and also

best Rasayana effect. It improves Smriti, Medha, Buddhi, Varna, Swara, Saukumaryata

and Ojas in the body; it strengthens sensory organs and softens the body. Ghrita is

recommended as main pathya in Vatavyadhis. In Vata disorders Sneha instantaneously

provides nourishment to Ksheena Dhatus, it promotes Bala, Agni and longevity of life.


88

Drug Review

Chemical Contents:

Tryglycerides, Diglycerides, Monoglycerides, Keto acid glyceride,

Glycerylesters, free fatty acids, phospholipids sterols, Vitamin A, D, E & K.

Vitamin - A & K are antioxidant helpful in preventing oxidative injury to the

body. No other edible oil contains vitamin-A except fish oil. Vitamin A keeps epithelial

tissue of the body intact, keeps the outer lining of the eyeball moist and prevents

blindness.

Ghrita also contains 4-5% Linoleic acid & essential fatty acid, which promotes

proper growth of human body. Ghrita resists spoilage by microorganisms or chemical

action.

Digestion, absorption and delivery to a target organ are facilitated by Ghrita,

which is crucial in obtaining the maximum benefit from any formulation. Since active

ingredients one mixed with ghrita, they are easily digested and absorbed - Lipophilic

action of ghrita facilitates transportation to a target organ and final delivery inside the

cell, because cell membrane also contains Lipid. The modern Lipophilic nature can be

compared with the "yogavahi" Guna of Ghrita according to Ayurveda. This Lipophilic

nature of ghrita facilitates entry of the formulation in to the cell and its delivery to the

mitochondria, microsomes and nuclear membrane.

For Group – B

Murchitha Tila Taila,

Yastimadhu and

Mahisha ksheera


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Drug Review

Murchitha Tila Taila:

Already explained in the above review

Yastimadhu: 156 a, b

Latin name : Glucyrrhiza glabra

Family : Leguminoseae (Papillionate)

Vernacular names:-

English : Sweet wood, Liquorice

Hindi : Mithi Lakadi-Mulethee

Synonyms:

Madhuka, Klitaka, Madhulika, Jalaja

Gana:

According to Charaka: Rasayan, Jivaniya, Varnya Sandhaniya, Kandughna,

Kanthya Dahaprashamana, Angamarda Prashamana, Shonita Sthapana, Mutravirajaniya,

Shnehopaga, Vamanopaga, Asthapanopaga Chardinigrahana

According to Sushrutha: Stanyajanan, Kakalyadi, Sarivadi, Anjanadi

Part used : Moola (root)

Table no.11 showing the Properties of Yastimadhu

Drug Rasa Guna Virya Vipaka Prabhava Doshaghnata Yastimadhu Madhura

Tikta Guru Snigdha Sheeta

Sheeta Madhura Kanthya, Varnya

Vata Pitta Shamak


90

Drug Review

Table no.12 Showing the Therapeutic Actions of Yastimadhu In term of Ayurveda In term of Pharmacology Drug General Specific General Specific

Yastimadhu Rasayana, balya, Vrishya, Kanthya, Nadibalya, Medhya, Mridu rechana Mutral, Varnya, Jivaniya, Sandhaniya, Chakshushya, Dahashamaka, Keshya

Daurbalya, Swarabheda, Koos, Vibandha, Smritihrasa, Vrana, Mutrakriccha, Tvakvikar, Rakta pitta, Daha, Jirna Jvara, Trishna, Glani

Tonic, Restorative, anti ulcerative, Demulcent, Refrigerant, Estrogenic, Anti-inflammatory

Gastric ulcer, General Debility, Seminal Weakness

Mahisha ksheera: 157 a, b, c, d, e

According to Vagbhata directly indicated the mahisha kseera in Nidranasha.

Acharya Charaka has mentioned regarding milk that it has Madhura, Snigdha, Shita etc.

properties and it can be used for various Panchakarma’s. Moreover, milk has same

properties like Oja, therefore prompts the Oja also.

Table no.13 showing the ksheera having the properties as follows,

Rasa Guna Virya Vipaka Doshaghnata Mahisha Ksheera

Madhura

Guru, Pichhila, Bahala, Shlakshana,Snigdha, Sheeta, Manda, Mridu, Prasanna

Sheeta

Madhura

Vata Pitta Shamak

Composition of Ksheera:

58% more calcium than cow’s milk,

40% more protein than cow’s milk


91

Drug Review

It is significantly lower in cholesterol and higher in calcium than cows, sheep’s or

goats milks. And unlike the array of industrially produced soya and other cereal milks it

is totally free of additives and chemical formulations.

Table no.14 Showing the Milk Composition Analysis

Milk Composition Analysis

Constituents Buffalo

Protein 4.5 grm

Fat 8.0 grm

Carbohydrate 4.9 grm

Energy 110 K cal 463 K J

Sugars (Lactose) 4.9 grm

Fatty Acids- Saturated Monounsaturated Polyunsaturated

4.2 grm 1.7 grm 0.2 grm

Cholesterol 8 mg

Calcium 195 iu

In addition to the significant cholesterol and calcium benefits Buffalo Milk is also

a rich source of iron, phosphorus, vitamin A and of course protein.

Buffalo Milk also contains high levels of the natural antioxidant tocopherol. Peroxidate

activity is normally 2-4 times that of cow’s milk. An unfortunate sign of the times is the

growing number of people who suffer from cow’s milk allergy.


92

Materials

MATERIALS USED FOR THE STUDY

For Sarpi Nasya

Murchitha tila taila &

Murchitha Gritha

Preparation of Tila taila murchana: 158

For the taila Murchana 1/16 parts of Manjistha,

Haritaki

Vibhitaki

Amalaki

Mustha

1/64 parts of Haridra

Lodra

Vatankura

Hrivera

Nalika

Ketakipushpa

1 part of Tila taila, and

4 parts of jala was taken and reduced for taila avasesha.

Preparation of Ghrita murchana: 159

One prastha of Mahisha Sarpi

Kalka of drugs -

Pathya

Dhatri

Each taken one pala of Vibhitaki

Musta

Rajani

One pala of Matulunga swarasa and four prastha of Jala.

“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 93

Materials

Prepared by heating the Sarpi on mandagni till it stops foaming (i.e., till all the

water content evaporates) and attaining the Ghrita siddha lakshana. Sarpi was allowed

to cool down and filtered. This will be free from Amadosa and becomes more potent.

Materials or Tools for therapeutic intervention:

To administer Nasya - Nasya peeta or Nasya asana, Droni or Pathy, Sthanika

Abhyanga aushada (murchitha tila taila), Nasya Aushadha (Murchitha ghrita), Cotton

or Dropper for instillation, Cotton Swab, Kidney tray, and Cloth was used.

For Nadi Sweda - 6 litres of pressure cooker, 2 meters rubber tube and gas stove.

For Yastiksheera Dhara

Murchitha Tila taila

Yastimadhu &

Mahisha Ksheera

Preparation of Yastiksheera: 161

Prepared with One part of Yastimadhu drug,

Eight parts of Mahisha ksheera,

Thirty two parts of Water, i.e. (1:8:32).

Boiled in moderate heat and reduced to the quantity equivalent of milk i.e. (1/8th).

After cooling the yastiksheera is used for the Dharakarma.

Materials or tools for therapeutic intervention:

Dhara table – specially prepared table having round and concave extra

projection with central hole to keep the head over it and also to collect the pouring

medicine, for rerouting,


Materials & Methods

Dhara patra - It is a shallow, about 5 or 6 inches in depth, wide-mouthed and

curved bottomed vessel of the capacity of not less than 2 prasthas, which is having hole

in the centre of the vessel.

Small vessel with water and Gas stove is used for heating yastiksheera indirectly.

Murchita tila taila and Murchita Gritha:

A total 10 litre of Murchitha tila taila and 2 litre of Murchitha mahisha - ghrita

was prepared in the department of Rasashastra and Bhaishajya kalpana, D.G.M.A.M.C.

and H. Gadag.

METHODS

Clinical study:

Research Approach:

In the present study, the main objective is “The Effect of Yasti Ksheera Dhara

and Sarpi Nasya in Nidranasha” - A Comparative Clinical Study”. The efficacy was

determined by finding out the difference between the baseline data of the parameters to

the after pariharakala data.

Study Design:

The study design set for the present study is ‘Prospective clinical trial (A

Comparative Clinical Observational Study)’.

Reasons for selection of the study design:

The results and conclusions of a clinical trial depend on the study design. The aim

of this study was to find out the “The Effect of Yasti Ksheera Dhara and Sarpi Nasya in

Nidranasha” - A Comparative Clinical Study”.


Materials & Methods

Source of Data:

Patient suffering from Nidranasha were selected from O.P.D and I.P.D. of

D.G.M.A.M.C & H., Gadag after following the Inclusion and Exclusion criteria.

Sample Size & Group:

A total number of 30 Patients suffering from Nidranasha were selected and assigned into

a two group (from OPD & IPD).

Group A: 15 patients for Nasya theraphy with Sarpi.

Group B: 15 patients for Dhara procedure with Yastiksheera

Diagnostic criteria:

The clinical features of Nidranasha or Insomnia as mentioned in texts.

Inclusion Criteria:

1. Patients complaining of reduction in sleep time,

2. Difficulty in Initiating Sleep,

3. Wakefulness during Normal Sleep,

4. Any of the above (or) all of the above will be included.

Exclusion Criteria:

1. Nidranasha due to other conditions like Madatyaya,

2. Nidranasha due to Abhigata,

3. Pregnant Woman,

4. Lactating Mothers,

5. Associated with any other systemic and metabolic disorder,

6. Severe Psychic disorder

7. Kaphaja vikaras

(f) Posology:

Nasyakarma: 8 drops in each nostril will be used.

Dharakarma: Total 1 litre to 1.2 litre of yasti ksheera is used.


Materials & Methods

(g) Study Duration:

Group A: Nasya karma for 7days,

Follow-Up Period: for 15days.

Group B: Dhara karma for 7days,

Follow-Up Period: for 15days.

(h) Total Study Duration:

Twenty two days for both Groups A & B respectively.

Procedures:

Nasyakarma:

Purvakarma:

All the patients were asked to be in the hospital with in 4pm to 6pm. Each patient

was made to lie down on the Table or Droni or Pathy. Each patient was given Sthanika

mukha abhyanga with Murchitha Tila taila on head (lalata), face (kapaala), nose and

neck, followed with Mrudu Nadi swedana. While doing nadi sweda the eyes are covered

with wet cotton swab for the protection from the swedana. The swedana is adopted to

produce vilayana of doshas.

Pradhanakarma:

The method of administration of Nasyakarma was strictly followed as told by the

Acharyas. The patient who was undergone purvakarma is made to lie down on the

droni/table and the pillow is kept under the neck in order to facilitate easy administration

of nasya through the nose. The head and legs are in extended position.

The Murchitha ghrita is made luke warm indirectly, by keeping on the warm

water. With the left hand thumb finger the tip of the nose is wide opened and left side of


Materials & Methods

the nose is closed with index finger and the ghrita is administered in right nostril, vise

versa. Murchitha ghrita was administered to all patients using plastic dropper. A quantity

of 8 bindus of Murchitha Ghrita was administered to each Nostril.

Paschatkarma:

The patient was made to inhale the ghrita through each nostril i.e., patient

was asked to take slow deep breath through nose and exhale through mouth, till the ghrita

comes to the throat. The pani and pada is rubbed vigorously for short time. Slight

massage was done over urdwajatrugata pradesha after Nasya pranidhana. The head is

lowered suitably, because the Nasya will move to Shringataka marma and thereby to

mastulunga, which causes complication. The patient was made to spit the medicament,

which comes through the throat, to the kidney tray which is kept near to the patient.

Patient was made to spit, till feels comfort. Patient was made to relax for five

minutes160. Then patient was made kavalagraha with luke warm salt water and followed

with Dhumapana was administered. Purpose is to make the kapha to dissolve (vilayana of

kapha dosha). The patient is advised to take complete rest

The same procedure was repeated for 7days. The time of administration and

complication were noticed if any. The patient was asked to follow a pariharakala of 14

days and was asked to report on 22nd day counting from the day the treatment schedule

started, for follow up and observation. And on 22nd day is taken for assessing the

parameters.


Materials & Methods

Dharakarma:

Purvakarma:

All the patients were asked to be in the hospital with in 4pm to 6pm.Each patient

was given Sthanika shiro abhyanga with Murchitha Tila taila in sitting posture. The thick

thread of gauze and it is tied on forehead above the eyebrows.

Patient made to lie down on the Dhara table in comfort position. Before doing

Dharakarma the eyes are covered with wet cotton swab, so that liquid may not enter into

the eyes. The height of flow of the Dhara patra was adjusted about four finger space i.e.,

about 3 inches above the forehead, if it is too high or too low leads to complications like

headache, burning sensation on eyes, etc.

Pradhanakarma:

The Yastiksheera was prepared daily around 1000ml to 1200ml and used for the

Dhara purpose. The treatment room was noiseless. The cooled yastiksheera was poured in

the Dhara patra and be poured continuously and slowly on the upper part of the forehead

of the patient i.e., above the tied thread like gauze. A mild oscillation was given, because

to maintain the flow to all over the forehead.

The vessel is kept refilled with the drippings collected from the sink in the

wooden basin in which the patient lies down. The collected ksheera was made Sukoshna

indirectly and was poured continuously. The thickness of the stream and the flow of the

stream were maintained till completion of treatment.


Materials & Methods

The treatment schedule was 1st day 30min,

2nd day 35min,

3rd day 40min,

4th day 45min,

5th day 40min,

6th day 35min and

7th day 30min. is maintained to all patients.

Paschakarma:

After completion of the Dhara, the cotton swab and the tied thread are removed

slowly. Then patient was made to wipe the head with the towel and advised to take Luke

warm water bath after 30 min. After bath patient was made to wipe the head without

delay. It is done carefully so that no moisture was retained. After wiping, rubbed the

medicated powder like Rasnadi choorna on the murdha to prevent the occurrence of Cold,

fever, etc. Then patient is advised not to exposed to the sun or wind directly and cotton is

given to keep in both the ears, to prevent from any other complications (i.e., from any

cold breeze).

The same procedure was repeated for 7days162. The time of administration and the

time of completion, along with complication were noticed if any. The patient was asked

to follow a pariharakala of 14 days and was asked to report on 22nd day counting from the

day the treatment schedule started, for follow up and observation. And on 22nd day is

taken for assessing the parameters.

Assessment of Results:163

Subjective and Objective Parameters Pre Medication to Post Medication

Data is used for Clinical Assessment of Results are as follows.


Materials & Methods

(a) Subjective Parameters:

• Angamarda

• Jrumbha

• Shirogaurava

• Sleeplessness

• Difficulty in initiation sleep

• Sleep Quality

• Performance of daily activities

• Vitality after morning awakening

(b) Objective Parameters:

• Total Sleep Time (hrs)

• Wakefulness during sleep (in number)

Examination for Nidranasha:

Sleep History Questionnaire:

Patients are diagnosed according to diagnostic criteria given for insomnia in

DSM – IV. Patients may be asked to complete a questionnaire to determine Sleep - wake

schedule

The Sleep - wake schedule disturbance involves the displacement of sleep from its

desired circadian period. Patients commonly cannot sleep when they wish to sleep,

although they are able to sleep at other times. Correspondingly, they cannot be fully

awake when they want to be fully awake, but they are able to be awake at other times.


Materials & Methods

The disturbance does not precisely produce Insomnia, although the initial

complaint is often insomnia or somnolence, the inabilities to sleep and be awake are

elicited only on careful questioning. Sleep - wake pattern disturbance can be considered a

misalignment between sleep and wake behaviors. This Sleep history Questioner is helpful

in diagnosing a patient’s sleep disorder, which is given along with Grading.

Table No.15 showing the Sleep history Questioner

S.No. Questions Grading

1 Do you nap during the day?

2 Do you have trouble concentrating during the day?

3 Do you trouble falling asleep when you first go to bed?

4 Do you awaken during the night?

5 Do you awaken more than once?

6 Do you awaken too early in the morning?

7 Are you regularly awakened at night by pain or the need to use the bathroom?

8 Does your job require shift changes?

9 Do you drink caffeinated beverages (coffee, tea, or soft drinks)?

10 Have you ever suffered from depression, anxiety or similar problem?

Grade 0 – 01 to 20%

Grade 1 – 21 to 40%

Grade 2 – 41 to 60%

Grade 3 – 61 to 80%

Grade 4 – 81 to 100%

Calculation:

Total number of counted is divided by 10 *100 for each patient

Methods of Assessment of Clinical Response:

Assessment of Clinical Response was based on DSM – IV criteria Subjective

parameters and objective parameters were made out to assess the Clinical response. A

special proforma was prepared with gradation of symptoms and scoring was done

according to severity.


Materials & Methods

Subjective parameters:

Angamarda: Body ache is common symptom of the Anidra patients as they are

subjected for increased muscle tone with enhanced sympathetic activity.It may or may

not present in all patients. Thus the Angamarda is observed in the study with the grades

as follows.

Shirogaurava: is also common symptom of the Anidra, patient gets severe unilateral

headache with heaviness that often appears during sleep and also is more frequent in

every day. Thus the grades are given below for the study.

Jrumba: Yawning is the expression of the sleep and lack of sleep, seen in Anidra. It may

or may not be present in all patients. The intensity of the yawning is necessary to measure

to evaluate the sleep patterns. Thus the following grades are inducted.

Angamarda Shirogaurava Jrumbha

Grade 0 – Absent Grade 1 - Present

Sleeplessness:

Sleeplessness can have a serious impact upon one’s ability to perform at work and

maintain healthy social relationships, and it can be the source of, or contribute to, a

variety of psychological disturbances, including major mood.Almost every system in the

body undergoes changes during sleep. The Patho - psychological changes associated with

many medical disorders causes changes in both sleeping and waking states. Thus the

grades are given below for the study of Sleeplessness.


Materials & Methods

No complaint Grade 0

Patient gets sleep at night (or) Awakens early in the morning

Grade 1

Disturbed Sleep during night Grade 2 Gets Sleep after taking sedatives Grade 3 Doesn’t get Sleep at all Grade 4 Difficulty in initiating sleep

Difficulty falling asleep and staying asleep, although they are usually considered

separately, but belong to the same group of symptoms. Difficulty in initiating sleep is a

gradual process which changes from person to person and time to time. For proper

assessment of the sleep, the following grading are given below,

Sleep immediately after go to bed Grade 0

Less than One hour late sleep (or) One hour late Sleep after go to bed

Grade 1

Two hours late sleep after go to bed Grade 2

More than Two hours late after go to bed Grade 3

Sleep Quality

Variation of physiological functions in normal sleep may be exaggerated in cases

of sleep disorders to a degree that sets a condition for development of emotional,

behavior and cognitive pathology, such as depression, confusion, or impulsive behavior.

Thus the following grades are inducted for the study of Sleep quality.

Enjoyable sleep Grade 0

Anxious or agitated before and during sleep Grade 1 Feeling unfreshed and unrest after sleep Grade 2 Sleep experience negative and not enjoyable Grade 3


Materials & Methods

Performance of daily activities

The behavior of an active and alert person demands fast, precise, highly

specialized and differentiated reactions with concentrated attention and a variety of

modulations. Thus the performance of daily activities are graded as below,

No Disturbance Grade 0 Slightly Disturbed Grade 1 Moderately Disturbed Grade 2 Highly Disturbed Grade 3 Vitality after morning awakening

Especially in adults - decreased sleep duration caused by the increased sleep

latency, awakenings during the night sleep and early morning awakenings, are changes

from person to person. The vitality after morning awakening thus graded as below,

Feeling Freshness Grade 0

Sleepy or fatigued Grade 1 Poor concentration Grade 2 Irritating mind Grade 3 Objective Parameter:

Total Sleep Time (hrs)

When we sleep, and how much deep sleep and dreaming sleep we need varies

with age. Each person needs his or her own unique amount of sleep. The amount of sleep

needed is that which makes wide awake and alert. Thus the grades are given below for

the study.

Normal sleep (8hrs) Grade 0

Adequate sleep (6 - 8hrs) Grade 1 Inadequate sleep (4 - 6hrs) Grade 2 Sleep 4hrs (or) less than 4hrs Grade 3 No sleep at night Grade 4


Materials & Methods

Wakefulness during sleep (In number)

The roots of adaptive human behavior are based on productive wakefulness.

Productive wakefulness (meaning sustained alertness and focused attention) is an

intrinsic part of the sleep - wake cycle. Some changes in the sleep-wake cycle are

nonspecific. Thus the following grades are inducted below.

No wakefulness Grade 0 One to two times wakefulness Grade 1 3 to 4 times wakefulness Grade 2 More than 4 times wakefulness Grade 3 Overall Assessment of Clinical Response:

Good Response : >75% improvement in clinical parameters

Moderate Response : 50-75% improvement in clinical parameters

Poor Response : up to 50% improvement in clinical parameters

No Response : 0 % or No improvement in clinical parameters


Photo


Observation & Results

OBSERVATION & RESULTS

The observation of the patients and the disease was done by providing the

questionnaire to those patients who can fill the case sheet and from those who can’t

fill; the information was collected by translating the questions in the local language.

The case sheet is attached in the appendix. All the patients were examined thoroughly

before their inclusion in the study. The observation was done by considering the

subjective and objective parameters strictly.

The observations were done in the following heading and are depicted in form and

graphs are used where ever necessary;

1. Observation of demographic data.

2. Observation of the patient.

3. Observation of the disease.

4. Observation of the data related to the response of the patient.

5. Observation of the statistical out comes of the study.

Observation of demographic data:

Table16 showing the distribution of patient’s age group

No of patients and percentage Group A Group B Total

Age group

No. of patients

% No. of patients

% No. of patients %

20 – 35 9 60.00 9 60.00 18 60.0036 – 50 6 40.00 4 26.66 10 33.3351 - 65 0 00.00 2 13.33 2 6.66

Group A: Out of fifteen patients 09(60%) were belonging to 20 - 35 age group,

06(40%) was from 36 - 50 age group, No patients in 51 - 65 age group.



Group B: Out of fifteen patients 09(60%) fell under 20 - 35 age group, 04(26.66%)

were from 36 - 50 age group, 02(13.33%) were from 51-60 age group and 07

(46.66%) were from 61-70 age group.

Overall: Out of thirty patients 18 (60%) were from 20 - 35 age group, 10 (33.33%)

from 36 - 50 age group, 02 (6.66%) from 51-60 group and 13 (43.33%) were from 61-

70 age group.

Fig No 02 showing the distribution of patient’s age group:

9

6

0

9

4

2

18

10

2

0

2

4

6

8

10

12

14

16

18

Group A Group B Total

20-3536-5050-65

Table no. 17 showing the distribution of patients according to sex

Sex Group A no. and %

Group B no. and %

Group A and B no. and %

Male 09 (60.00%) 11 (73.33%) 20 (66.66%) Female 06 (40.00%) 04 (26.66%) 10 (33.33%)

Group A: Among 15 numbers of patients 09 (60.00%) were males and 06 (40.00%)

were females.

Group B: Among 15 numbers of patients 11 (73.33%) were males and 04 (26.66%)

were females.

Overall: Distribution of sex was; male were 20 (66.66%) and females were 10 (33.33%) in 30 patients.



Fig No 03: showing the distribution of patient’s sex group:

9

6

11

4

20

10

0

2

4

6

8

10

12

14

16

18

20


MaleFemale

Table no. 18 showing the distribution of patients by Occupation Occupation

Group A no. and

% Group B no. and

% Group A and B

no. and % Student 03 (20.00%) 04 (26.66%) 07 (23.33%) Labor 04 (26.66%) 05 (33.33%) 09 (30.00%)

Executive 02 (13.33%) 01 (6.66%) 03 (10.00 %) Sedentary 06 (40.00%) 05 (33.33%) 11 (36.66%)

Group A: Out of fifteen patients 3 (20.00%) were students, 04 (26.66%) were labors,

02 (13.33%) was executive and 06 (40.00%) were sedentary by occupation.

Group B: Out of fifteen patients 04 (26.66%) were students, 05 (33.33%) were labors,

01 (6.66%) was executive and 05 (33.33%) was of sedentary by occupation.

Overall: Out of thirty patients 07 (23.33%) were students, 09 (30.00%) were labors,

03 (10.00 %) was executive and 11 (36.66%) were belonging to sedentary category.

Figure 04 showing distribution of patients by occupation

34

2

6

45

1

5

7

9

3

11

0

2

4

6

8

10

12


StudentslaborsExecutivesSedentary



Table 19 showing distribution of patients by Economical status Economical status Group A no. and

% Group B no. and

% Group A and B

no. and % Poor 05 (33.33%) 05 (33.33%) 10 (33.33%)

Middle class 06 (40.00%) 05 (33.33%) 11 (36.66%) Higher class 04 (26.66%) 05 (33.33%) 09 (30.00%)

Group A: Out of fifteen patients 05 (33.33%) were belonging to poor status, 06

(40.00%) were of middle class, 4 (26.66%) were of Higher class.

Group B: Out of fifteen patients 05 (33.33%) were belonging to poor status, 05


Overall: Out of thirty patients 10 (33.33%) were belonging to poor status, 11


Figure 05 showing distribution of patients by Economical status

5

6

4 55 5

10

11

9

0

2

4

6

8

10

12

Gro up A Gro up B T o t al

Poor

Middle class

Higher class

Table No. 20. Showing distribution of patients by Marital Status

Married Un Married Group A 10 (66.66%) 05 (33.33%) Group B 09 (60.00%) 06 (40.00%) Overall 19 (63.33%) 11 (36.66%)

Group A: Out of fifteen, 10 (66.66%) were married and 05 (33.33%) were Unmarried.

Group B: Out of fifteen, 09 (60.00%) were married and 06 (40.00%) were Unmarried.

Overall: Out of thirty patients, 19 (63.33%) were married and 11 (36.66%) were

Unmarried



Figure 06 showing distribution of patients by Marital Status

10

5

9

6

19

11

0

2

4

6

8

10

12

14

16

18

20


Married

Un Married

Table 21 showing distribution of patients by Pradhana Vedana

Pradhana Vedana Group A no. and %

Group B no. and %


Reduction in sleep time

11 (73.33%) 09 (60.00%) 20 (66.66%)

Difficulty in initiating sleep

10 (66.66%) 12 (80.00%) 22 (73.33%)

Wakefulness during sleep

12 (80.00%) 12 (80.00%) 24 (80.00%)

Group A: Out of fifteen patients 11 (73.33%) were belonging to Reduction in sleep

time, 10 (66.66%) were of Difficulty in initiating sleep, 12 (80.00%) were of

Wakefulness during sleep.

Group B: Out of fifteen patients 09 (60.00%) were belonging to Reduction in sleep

time, 12 (80.00%) were of Difficulty in initiating sleep, 12 (80.00%) were of

Wakefulness during sleep.

Overall: Out of thirty patients 20 (66.66%) were belonging to Reduction in sleep time,

22 (73.33%) were of Difficulty in initiating sleep, 24 (80.00%) were of Wakefulness

during sleep.



Figure 07 showing distribution of patients by Pradhana Vedana

11 1012

9

12 12

2 0

2 224

0

5

10

15

20

25


Reduction insleep timeDifficulty ininitiating sleepWakefulnessduring sleep

Table 22. Showing distribution of patients by Anubanda vedana Anubanda vedana Group A no. and

% Group B no. and

% Group A and B

no. and % Jrumbha 07 (46.66%) 06 (40.00%) 11 (36.66%)

Shirogaurava 13 (86.66%) 12 (80.00%) 25 (83.33%) Angamarda 11 (73.33%) 09 (60.00%) 20 (66.66%)

Bhrama 07 (46.66%) 04 (26.66%) 11 (36.66%) Apakti 08 (53.33%) 07 (46.66%) 15 (50.00%)

Shirashoola 10 (66.66%) 08 (53.33%) 18 (60.00%) Group A: Out of fifteen patients 07 (46.66%) were had Jrumbha, 13 (86.66%) were

had Shirogaurava, 11 (73.33%) were had Angamarda, 07 (46.66%) were had Bhrama,

08 (53.33%) were had Apakti and 10 (66.66%) were had Shirashoola.

Group B: Out of fifteen patients 06 (40.00%) were had Jrumbha, 12 (80.00%) were

had Shirogaurava, 09 (60.00%) were had Angamarda, 04 (26.66%) were had Bhrama,

07 (46.66%) were had Apakti and 08 (53.33%) were had Shirashoola.

Overall: Out of thirty patients 11 (36.66%) were had Jrumbha, 25 (83.33%) were had

Shirogaurava, 20 (66.66%) were had Angamarda, 11 (36.66%) were had Bhrama, 15

(50.00%) were had Apakti and 18 (60.00%) were had Shirashoola.



Figure 08 showing distribution of patients by Anubanda vedana

7

13

11

7 810

6

12

9

4

78

11

25

20

11

15

18

0

5

10

15

20

25


JrumbhaShirogauravaAngamardaBhramaApaktiShirashoola

Table 23. Showing distribution of patients by Mode of Onset Mode of Onset

Group A no. and

% Group B no. and

% Group A and B

no. and % Chronic 01 (6.66%) 02 (13.33%) 03 (10.00 %) Acute 14 (93.33%) 13 (86.66%) 27 (90.00%)

Group A: Out of fifteen patients 01 (6.66%) were had Chronic onset and 14 (93.33%)

were had Acute onset

Group B: Out of fifteen patients 02 (13.33%) were had Chronic onset and 13

(86.66%) were had Acute onset

Overall: Out of thirty patients 03 (10.00 %) were had Chronic onset and 27 (90.00%)

were had Acute onset

Figure 09 showing distribution of patients by Mode of Onset

1

14

2

13

3

2 7

0

5

10

15

20

25

30


Chronic

Acute



Table 24. Showing distribution of patients by Kula vruttanta Kula vruttanta Group A no. and

% Group B no. and

% Group A and B

no. and % Joint Family 07 (46.66%) 08 (53.33%) 15 (50.00%)

Nuclear Family 07 (46.66%) 07 (46.66%) 14 (46.66%) Staying away from

Home 04 (26.66%) 05 (33.33%) 09 (30.00%)

Physical disturbances in the

family

04 (26.66%)

08 (53.33%)

12 (40.00%)

Psychological disturbances in the

family

06 (40.00%)

09 (60.00%)

15 (50.00%)

Group A: Out of fifteen patients 07 (46.66%) were had Joint Family, 07 (46.66%)

were had Nuclear Family, 04 (26.66%) were had Staying away from Home, 04

(26.66%) were had Physical disturbances in the family, and 06 (40.00%) were had

Psychological disturbances in the family.

Group B: Out of fifteen patients 08 (53.33%) were had Joint Family, 07 (46.66%)

were had Nuclear Family, 05 (33.33%) were had Staying away from Home, 08

(53.33%) were had Physical disturbances in the family, and 09 (60.00%)were had


Overall: Out of thirty patients 15 (50.00%) were had Joint Family, 14 (46.66%) were

had Nuclear Family, 09 (30.00%) were had Staying away from Home, 12 (40.00%)

were had Physical disturbances in the family, and 15 (50.00%) were had


Figure 10 showing distribution of patients by Kula vruttanta

7 7

4 4

6

8 7

5

89

15 14

9

12

15

0

2

4

6

8

10

12

14

16


Joint Family

Nuclear Family

Staying away from home

Physical disturbances in thefamilyPsychological disturbancesin the family



Table 25 Showing distribution of patients by Occupational History Occupational

History Group A no. and

% Group B no. and

% Group A and B

no. and % Physical stress 08 (53.33%) 08 (53.33%) 16 (53.33%)

Psychological stress 06 (40.00%) 09 (60.00%) 15 (50.00%) Social stress 08 (53.33%) 07 (46.66%) 15 (50.00%)

Economical stress 07 (46.66%) 06 (40.00%) 13 (43.33%) Group A: Out of fifteen patients 08 (53.33%) were Physical stress, 06 (40.00%) were

Psychological stress, 08 (53.33%) was Social stress and 07 (46.66%) were

Economical stress

Group B: Out of fifteen patients 08 (53.33%) were Physical stress, 09 (60.00%) were


Economical stress

Overall: Out of thirty patients 16 (53.33%) were Physical stress, 15 (50.00%) were


Economical stress.

Figure 11 showing distribution of patients by Occupational History

86

87

8

9

7 6

16 1515

13

0

2

4

6

8

10

12

14

16


Physical stress

PsychologicalstressSocial stress

Table 26. Showing distribution of patients by Vihara Vihara

Group A no. and

% Group B no. and

% Group A and B

no. and % Hard 04 (26.66%) 05 (33.33%) 09 (30.00%)

Moderate 02 (13.33%) 01 (6.66%) 03 (10.00%) Sedentary 06 (40.00%) 05 (33.33%) 11 (36.66%)

Group A: Out of fifteen patients 04 (26.66%) were hard workers, 02 (13.33%) were

moderate, 06 (40.00%) were Sedentary.



Group B: Out of fifteen patients 05 (33.33%) were hard workers, 01 (6.66%) were

moderate and 05 (33.33%) sedentary.

Overall: Out of thirty patients 09 (30.00%) were hard workers, 03 (10.00%) were

moderate and 11 (36.66%) sedentary worker.

Figure 12. Showing distribution of patients by Vihara

4

2

65

1

5

16

13

11

0

2

4

6

8

10

12

Group A Gro up B T o t al

Hard

Moderate

Sedentary

Table 27. Showing distribution of patients by Vyasana

Vyasana Group A no. and %

Group B no. and %


Tea 07 (46.66%) 10 (66.66%) 17 (56.66%) Coffee 08 (53.33%) 05 (33.33%) 13 (43.33%) Alcohal 05 (33.33%) 07 (46.66%) 12 (40.00%) Smoking 05 (33.33%) 05 (33.33%) 10 (33.33%) Tobacco 12 (80.00%) 07 (46.66%) 19 (63.33%)

Group A: Out of fifteen patients, 07 (46.66%) were had Tea, 08 (53.33%) were had

the Coffee, 05 (33.33%) were had the habit of Alcohol, 05 (33.33%) were had habit of

Smoking and 12 (80.00%) were had tobacco chewing.

Group B: Out of fifteen patients, 10 (66.66%) were had Tea, 05 (33.33%) were had

the Coffee, 07 (46.66%) were had the habit of Alcohol, 05 (33.33%) were had habit of


Overall: Out of thirty patients, 17 (56.66%) were had Tea, 13 (43.33%) were had the

Coffee, 12 (40.00%) were had the habit of Alcohol, 10 (33.33%) were had habit of




Figure 13 showing distribution of patients by Vyasana

7

8

5 5

12

10

5 7

57

17

1312

10

19

0

2

4

6

8

10

12

14

16

18

20


TeaCoffeeAlcoholSmokingTobacco

Table 28 Showing distribution of patients by Satva Satva Group A no. and

% Group B no. and

% Group A and B

no. and % Pravara 00 00 00

Madyama 06 (40.00%) 05 (33.33%) 11 (36.66%) Avara 09 (60.00%) 10 (66.66%) 19 (63.33%)

Group A: Out of fifteen patients none were had Pravara, 06 (40.00%) were had

Madyama and 09 (60.00%) were had Avara.

Group B: Out of fifteen patients none were had Pravara, 05 (33.33%) were had


Overall: Out of thirty patients none were had Pravara, 11 (36.66%) were had


Figure 14 showing distribution of patients by Satva

4

8

3 3

6 616

13

9

0

2

4

6

8

10

12

14


Pravara

MadyamaSamhita Avara

Table 29 Showing distribution of patients by Vyayama Shakti

Vyayama Shakti

Group A no. and %

Group B no. and %


Pravara 04 (26.66%) 04 (26.66%) 08 (26.66%) Madyama 11 (73.33%) 08 (53.33%) 19 (63.33%)

Avara 00 04 (26.66%) 04 (13.33%) Group A: Out of fifteen patients, 04 (26.66%) had Pravara Vyayama Shakti, 11

(73.33%) had Madyama Vyayama Shakti and none were had Avara Vyayama Shakti.



Group B: Out of fifteen patients, 04 (26.66%) had Pravara Vyayama Shakti, 08

(53.33%) had Madyama Vyayama Shakti and 04 (26.66%) were had Avara Vyayama

Shakti.

Overall: Out of thirty patients, 08 (26.66%) had Pravara Vyayama Shakti, 19

(63.33%) had Madyama Vyayama Shakti and 04 (13.33%) were had Avara Vyayama

Shakti.

Figure 15 showing distribution of patients by Vyayama Shakti

4

11

0

4

8

4

0

2

4

0

2

4

6

8

10

12

14

16

18

20


PravaraVyayama ShaktiMadyamaVyayama ShaktiAvara VyayamaShakti

Table 30 Showing distribution of patients by Vaya Vaya

Group A no. and

% Group B no. and

% Group A and B

no. and % Balya 00 00 00

Madyama 15 (100%) 13 (86.66%) 28 (93.33%) Vrudda 00 02 (13.33%) 02 (6.66%)

Group A: Out of fifteen patients, none (00%) were of Balya Vaya, 15 (100%) were

had Madyama Vaya and none were Vrudda.

Group B: Out of fifteen patients, none (00%) were of Balya Vaya, 13 (86.66%) were

had Madyama Vaya and 02 (13.33%) were Vrudda.

Overall: Out of thirty patients, none (00%) were of Balya Vaya, 28 (93.33%) were

had Madyama Vaya and 02 (6.66%) were Vrudda.



Figure 16 showing distribution of patients by Vaya

0

15

0 0

13

20

17

2

0

5

10

15

20

25

30


BalyaMadyamaVrudda

Table 31 Showing distribution of patients by Aharaja hetu

Aharaja hetu Group A no. and %

Group B no. and %


Rukshanna 07 (46.66%) 10 (66.66%) 17 (56.66%) Laghu 11 (73.33%) 07 (46.66%) 18 (60.00%) Sheeta 05 (33.33%) 07 (46.66%) 12 (40.00%) Katu 03 (20.00%) 09 (60.00%) 12 (40.00%)

Alpa/ Pramitha 06 (40.00%) 06 (40.00%) 12 (40.00%)

Group A: Out of fifteen patients, 07 (46.66%) were of Rukshanna, 11 (73.33%) were

had Laghu, 05 (33.33%) were Sheeta, 03 (20.00%) were Katu and 06 (40.00%) were

Alpa/Pramitha.

Group B: Out of fifteen patients, 10 (66.66%) were of Rukshanna, 07 (46.66%) were


Alpa/Pramitha.

Overall: Out of thirty patients, 17 (56.66%) were of Rukshanna, 18 (60.00%) were


Alpa/Pramitha.



Figure 17 showing distribution of patients by Aharaja Hetu

7

11

5

3

6

10

7 7

9

6

0 17

12 12 12

0

2

4

6

8

10

12

14

16

18


Rukshanna

Laghu

Sheeta

Alpa/Pramitha

Table 32 Showing distribution of patients by Viharaja hetu

Viharaja hetu Group A no. and %

Group B no. and %


Divaswapnam 08 (53.33%) 09 (60.00%) 17 (56.66%) Ati-Vyayama 04 (26.66%) 05 (33.33%) 09 (30.00%)

Upavasa/ Langanam

02 (13.33%) 06 (40.00%) 08 (26.66%)

Asukhashayya 07 (46.66%) 10 (66.66%) 17 (56.66%) Vishamaupachara 07 (46.66%) 09 (60.00%) 16 (53.33%)

Ati-vyavaya 04 (26.66%) 05 (33.33%) 09 (30.00%) Vegadharana 09 (60.00%) 07 (46.66%) 16 (53.33%)

Group A: Out of fifteen patients, 08 (53.33%) were of Divaswapnam, 04

(26.66%)were had Ati-Vyayama, 02 (13.33%) were Upavasa/ Langanam, 07

(46.66%) were Asukhashayya, 07 (46.66%) were Vishamaupachara, 04 (26.66%)

were Ati-vyavaya and 09 (60.00%) were Vegadharana.

Group B: Out of fifteen patients, 09 (60.00%) were of Divaswapnam, 05 (33.33%)

were had Ati-Vyayama, 06 (40.00%) were Upavasa/ Langanam, 10 (66.66%) were

Asukhashayya, 09 (60.00%) were Vishamaupachara, 05 (33.33%) were Ati-vyavaya

and 07 (46.66%) were Vegadharana.

Overall: Out of thirty patients, 17 (56.66%) were of Divaswapnam, 09 (30.00%) were

had Ati-Vyayama, 08 (26.66%) were Upavasa/ Langanam, 17 (56.66%) were

Asukhashayya, 16 (53.33%) were Vishamaupachara, 09 (30.00%) were Ati-vyavaya

and 16 (53.33%) were Vegadharana.



Figure 18 showing distribution of patients by Viharaja hetu

8

4

2

7 7

4

9 9

56

109

5

7

0

178

1716

9

16

0

2

4

6

8

10

12

14

16

18


Divaswapna

Ati-vyayama

Upavasa/Langana

Vishamaupachara

Ati-vyavaya

Vegadharana

Table 33 Showing distribution of patients by Manasika Hetu

Manasika Hetu Group A no. and %

Group B no. and %


Bhaya 06 (40.00%) 08 (53.33%) 14 (46.66%) Chinta 09 (60.00%) 09 (60.00%) 18 (60.00%) Krodha 06 (40.00%) 08 (53.33%) 14 (46.66%)

Manasthapa 09 (60.00%) 08 (53.33%) 17 (56.66%) Vyatha 10 (66.66%) 09 (60.00%) 19 (63.33%)

Group A: Out of fifteen patients, 06 (40.00%) were of Bhaya, 09 (60.00%) were had

Chinta, 06 (40.00%) were Krodha, 09 (60.00%) were Manasthapa and 10 (66.66%)

were Vyatha.

Group B: Out of fifteen patients, 08 (53.33%) were of Bhaya, 09 (60.00%) were had


were Vyatha.

Overall: Out of thirty patients, 14 (46.66%) were of Bhaya, 18 (60.00%) were had


were Vyatha.



Figure 19 showing distribution of patients by Manasika Hetu

6

9

6

9 10

8 98 8 9

0

17

14

1719

0

2

4

6

8

10

12

14

16

18

20


Bhaya

Chinta

Krodha

Vyatha

Data Related to Disease

Table No 34: Showing the distribution of patients by different grades of Sleep History Questionaire before treatment

Sleep History Questionaire

Group A no. and %

Group B no. and %


Grade 0 00 00 00 Grade 1 00 00 00 Grade 2 05 (33.33%) 07 (46.66%) 12 (40.00%) Grade 3 10 (66.66%) 08 (53.33%) 18 (60.00%) Grade 4 00 00 00

Group A: Out of fifteen patients, none were complained 01 to 20%, none were

complained 21 to 40%, 05 (33.33%) were complained 41 to 60%, 10 (66.66%) were

complained 61 to 80% and none were had 81 to 100% before treatment

Group B: Out of fifteen patients, none were complained 01 to 20%, none were


complained 61 to 80% and none were had 81 to 100% before treatment

Overall: Out of thirty patients, none were complained 01 to 20%, none were


complained 61 to 80%and none were had 81 to 100% before treatment



Figure 20 showing distribution of patients by different grades of Sleep History Questionaire before treatment

0 0

5

10

0 0 0

78

0 0 0

12

18

00

2

4

6

8

10

12

14

16

18


Grade 0Grade 1Grade 2Grade 3Grade 4

Table No 35: Showing the distribution of patients by different grades of Sleep History Questionaire after treatment

Sleep History Questionaire

Group A no. and %

Group B no. and %


Grade 0 03 (20.00%) 12 (80.00%) 15 (50.00%) Grade 1 02 (13.33%) 00 02 (6.66%) Grade 2 05 (33.33%) 03 (20.00%) 08 (26.66%) Grade 3 05 (33.33%) 00 05 (16.66%) Grade 4 00 00 00

Group A: Out of fifteen patients, 03 (20.00%) were complained 01 to 20%, 02

(13.33%) were complained 21 to 40%, 05 (33.33%) were complained 41 to 60%, 05

(33.33%) were complained 61 to 80% and none were had 81 to 100% after treatment

Group B: Out of fifteen patients, 12 (80.00%) were complained 01 to 20%, none were

complained 21 to 40%, 03 (20.00%) were complained 41 to 60%, none were

complained 61 to 80% and none were had 81 to 100% after treatment

Overall: Out of thirty patients, 15 (50.00%) were complained 01 to 20%, 02 (6.66%)

were complained 21 to 40%, 08 (26.66%) were complained 41 to 60%, 05 (16.66%)

were complained 61 to 80%and none were had 81 to 100% after treatment



Figure 21 showing distribution of patients by different grades of Sleep History Questionaire after treatment

32

5 5

0

12

0

3

0 0

15

2

8

5

00

2

4

6

8

10

12

14

16



Subjective Parameter:

Table No 36: Showing the distribution of patients by different grades of Angamarda before treatment

Angamarda Group A no. and %

Group B no. and %


Grade 0 04 (26.66%) 06 (40.00%) 10 (33.33%) Grade 1 11 (73.33%) 09 (60.00%) 20 (66.66%)

Group A: Out of fifteen patients, 04 (26.66%) were complained Grade 0 and 11

(73.33%) were had Grade 1 before treatment

Group B: Out of fifteen patients, 06 (40.00%) were complained Grade 0 and 09


Overall: Out of thirty patients, 10 (33.33%) were complained Grade 0 and 20


Figure 22 showing distribution of patients by different grades of Angamarda before treatment

4

11

6

910

20

02468

101214

161820


Grade 0Grade 1



Table No 37 Showing the distribution of patients by different grades of Angamarda after treatment

Angamarda Group A no. and %

Group B no. and %


Grade 0 10 (66.66%) 13 (86.66%) 23 (76.66%) Grade 1 05 (33.33%) 02 (13.33%) 07 (23.33%)


(33.33%) were had Grade 1 after treatment





Figure 23 showing distribution of patients by different grades of Angamarda after treatment

10

5

13

2

23

7

0

5

10

15

20

25


Grade 0Grade 1

Table No 38 Showing the distribution of patients by different grades of Shirogaurava before treatment

Shirogaurava Group A no. and %

Group B no. and %


Grade 0 02 (13.33%) 03 (20.00%) 05 (16.66%) Grade 1 13 (86.66%) 12 (80.00%) 25 (83.33%)









Figure 24 showing distribution of patients by different grades of Shirogaurava before treatment

87

15

0

2 3

7

0

5

10

15

2 0

2 5


Grade 0Grade 1

Table No 39 Showing the distribution of patients by different grades of Shirogaurava after treatment

Shirogaurava Group A no. and %

Group B no. and %


Grade 0 08 (53.33%) 15 (100%) 23 (76.66%) Grade 1 07 (46.66%) 00 07 (23.33%)



Group B: Out of fifteen patients, 15 (100%) were complained Grade 0 and none were

had Grade 1 after treatment



Figure 25 showing distribution of patients by different grades of Shirogaurava after treatment

87

15

0

2 3

7

0

5

10

15

2 0

2 5


Grade 0Grade 1



Table No 40 Showing the distribution of patients by different grades of Jrumbha before treatment

Jrumbha Group A no. and %

Group B no. and %


Grade 0 08 (53.33%) 09 (60.00%) 17 (56.66%) Grade 1 07 (46.66%) 06 (40.00%) 13 (43.33%)







Figure 26 showing distribution of patients by different grades of Jrumbha before treatment

87

9

6

1 7

1 3

0

2

4

6

8

1 0

1 2

1 4

1 6

1 8


Grade 0Grade 1

Table No 41 Showing the distribution of patients by different grades of Jrumbha after treatment

Jrumbha Group A no. and %

Group B no. and %


Grade 0 15 (100%) 15 (100%) 30 (100%) Grade 1 00 00 00

Group A: Out of fifteen patients, 15 (100%) were complained Grade 0 and none were


Group B: Out of fifteen patients, 15 (100%) were complained Grade 0 and none were




Overall: Out of thirty patients, 30 (100%) were complained Grade 0 and none were


Figure 27 showing distribution of patients by different grades of Jrumbha after treatment

15

0

15

0

30

0

0

5

10

15

20

25

30


Grade 0Grade 1

Table No 42 Showing the distribution of patients by different grades of Sleeplessness before treatment

Sleeplessness Group A no. and %

Group B no. and %


Grade 0 00 00 00 Grade 1 00 00 00 Grade 2 06 (40.00%) 06 (40.00%) 12 (40.00%) Grade 3 06 (40.00%) 03 (20.00%) 09 (30.00%) Grade 4 03 (20.00%) 06 (40.00%) 09 (30.00%)

Group A: Out of fifteen patients, none were complained Grade 0, none were

complained Grade 1, 06 (40.00%) were complained Grade 2, 06 (40.00%) were

complained Grade 3 and 03 (20.00%) were had Grade 4 before treatment

Group B: Out of fifteen patients, none were complained Grade 0, none were



Overall: Out of thirty patients, none were complained Grade 0, none were complained

Grade 1, 12 (40.00%) were complained Grade 2, 09 (30.00%) were complained Grade

3 and 09 (30.00%) were had Grade 4 before treatment



Figure 28 showing distribution of patients by different grades of Sleeplessness before treatment

0 0

6 6

3

0 0

6

3

6

0 0

12

9 9

0

2

4

6

8

10

12



Table No 43 Showing the distribution of patients by different grades of Sleeplessness after treatment

Sleeplessness Group A no. and %

Group B no. and %


Grade 0 02 (13.33%) 07 (46.66%) 09 (30.00%) Grade 1 05 (33.33%) 08 (53.33%) 13 (43.33%) Grade 2 08 (53.33%) 00 08 (26.66%) Grade 3 00 00 00 Grade 4 00 00 00

Group A: Out of fifteen patients, 02 (13.33%) were complained Grade 0, 05 (33.33%)

were complained Grade 1, 08 (53.33%) were complained Grade 2, none were

complained Grade 3 and none were had Grade 4 after treatment

Group B: Out of fifteen patients, 07 (46.66%) were complained Grade 0, 08 (53.33%)

were complained Grade 1, none were complained Grade 2, none were complained

Grade 3 and none were had Grade 4 after treatment

Overall: Out of thirty patients, 09 (30.00%) were complained Grade 0, 13 (43.33%)

were complained Grade 1, 08 (26.66%) were complained Grade 2, none were

complained Grade 3 and none were had Grade 4 after treatment.



Figure 29 showing distribution of patients by different grades of Sleeplessness after treatment

2

5

8

0 0

78

0 0 0

9

13

8

0 00

2

4

6

8

10

12

14



Table No 44 Showing the distribution of patients by different grades of Difficulty in Initiating Sleep before treatment

Difficulty in Initiating Sleep

Group A no. and %

Group B no. and %


Grade 0 00 00 00 Grade 1 01 (6.66%) 00 01 (3.33%) Grade 2 05 (33.33%) 07 (46.66%) 12 (40.00%) Grade 3 09 (60.00%) 08 (53.33%) 17 (56.66%)

Group A: Out of fifteen patients, none were complained Grade 0, 01 (6.66%) were

complained Grade 1, 05 (33.33%) were complained Grade 2 and 09 (60.00%) were

complained Grade 3 before treatment




Overall: Out of thirty patients, none were complained Grade 0, 01 (3.33%) were





Figure 30 showing distribution of patients by different grades of Difficulty in Initiating Sleep before treatment

01

5

9

0 0

78

01

12

17

0

2

4

6

8

10

12

14

16

18


Grade 0Grade 1Grade 2Grade 3

Table No 45 Showing the distribution of patients by different grades of Difficulty in Initiating Sleep after treatment

Difficulty in Initiating Sleep

Group A no. and %

Group B no. and %


Grade 0 04 (26.66%) 14 (93.33%) 18 (60.00%) Grade 1 09 (60.00%) 01 (6.66%) 10 (33.33%) Grade 2 02 (13.33%) 00 02 (6.66%) Grade 3 00 00 00


were complained Grade 1, 02 (13.33%) were complained Grade 2 and none were

complained Grade 3 after treatment


were complained Grade 1, none were complained Grade 2 and none were complained

Grade 3 after treatment



complained Grade 3 after treatment.



Figure 31 showing distribution of patients by different grades of Difficulty in Initiating Sleep after treatment

4

9

2

0

14

10 0

18

10

2

00

2

4

6

8

10

12

14

16

18



Table No 46 Showing the distribution of patients by different grades of Sleep Quality before treatment

Sleep Quality Group A no. and %

Group B no. and %


Grade 0 00 00 00 Grade 1 00 00 00 Grade 2 06 (40.00%) 03 (20.00%) 09 (30.00%) Grade 3 09 (60.00%) 12 (80.00%) 21 (70.00%)








Grade 1, 09 (30.00%) were complained Grade 2 and 21 (70.00%) were complained

Grade 3 before treatment



Figure 32 showing distribution of patients by different grades of Sleep Quality before treatment

0 0

6

9

0 0

3

12

0 0

9

21

0

5

10

15

20

25



Table No 47 Showing the distribution of patients by different grades of Sleep Quality after treatment

Sleep Quality Group A no. and %

Group B no. and %














Figure 33 showing distribution of patients by different grades of Sleep Quality after treatment

3

9

3

0

12

3

0 0

15

12

3

00

2

4

6

8

10

12

14

16



Table No 48 Showing the distribution of patients by different grades of Performance of daily activities before treatment


Group A no. and %

Group B no. and %














Figure 34 showing distribution of patients by different grades of Performance of daily activities before treatment

0 0

5

10

0 0

5

10

0 0

10

20

02468

101214161820



Table No 49 Showing the distribution of patients by different grades of Performance of daily activities after treatment


Group A no. and %

Group B no. and %


Grade 0 03 (20.00%) 13 (86.66%) 16 (53.33%) Grade 1 10 (66.66%) 01 (6.66%) 11 (36.66%) Grade 2 02 (13.33%) 01 (6.66%) 03 (10.00%) Grade 3 00 00 00












Figure 35 showing distribution of patients by different grades of Performance of daily activities after treatment

3

10

2

0

13

1 10

16

11

3

00

2

4

6

8

10

12

14

16



Table No 50 Showing the distribution of patients by different grades of Vitality after Morning Awakening before treatment

Vitality after Morning

Awakening.

Group A no. and %

Group B no. and %




complained Grade 1, 06 (40.00%)were complained Grade 2 and 09 (60.00%)were










Figure 36 showing distribution of patients by different grades of Vitality after Morning Awakening before treatment

0 0

6

9

0 0

78

0 0

13

17

0

2

4

6

8

10

12

14

16

18



Table No 51 Showing the distribution of patients by different grades of Vitality after Morning Awakening after treatment

Vitality after Morning

Awakening.

Group A no. and %

Group B no. and %














Figure 37 showing distribution of patients by different grades of Vitality after Morning Awakening after treatment

3

9

3

0

12

3

0 0

15

12

3

00

2

4

6

8

10

12

14

16



Objective Parameter:

Table No 52 Showing the distribution of patients by different grades of Total Sleep Time before treatment

Total Sleep Time Group A no. and %

Group B no. and %


Grade 0 00 00 00 Grade 1 01 (6.66%) 00 01 (3.33%) Grade 2 05 (33.33%) 06 (40.00%) 11 (36.66%) Grade 3 06 (40.00%) 03 (20.00%) 09 (30.00%) Grade 4 03 (20.00%) 06 (40.00%) 09 (30.00%)












Figure 38 showing distribution of patients by different grades of Total Sleep Time before treatment

01

56

3

0 0

6

3

6

01

11

9 9

0

2

4

6

8

10

12



Table No 53 Showing the distribution of patients by different grades of Total Sleep Time after treatment

Total Sleep Time Group A no. and %

Group B no. and %


Grade 0 03 (20.00%) 12 (80.00%) 15 (50.00%) Grade 1 06 (40.00%) 03 (20.00%) 09 (30.00%) Grade 2 05 (33.33%) 00 05 (16.66%) Grade 3 01 (6.66%) 00 01 (3.33%) Grade 4 00 00 00


were complained Grade 1, 05 (33.33%) were complained Grade 2, 01 (6.66%) were

complained Grade 3 and none were had Grade 4 after treatment


were complained Grade 1, none were complained Grade 2, none were complained

Grade 3 and none were had Grade 4 after treatment


were complained Grade 1, 05 (16.66%) were complained Grade 2, 01 (3.33%) were

complained Grade 3 and none were had Grade 4 after treatment.



Figure 39 showing distribution of patients by different grades of Total Sleep Time after treatment

3

65

10

12

3

0 0 0

15

9

5

10

0

2

4

6

8

10

12

14

16



Table No 54 Showing the distribution of patients by different grades of Wakefulness During Sleep before treatment

Wakefulness During Sleep

Group A no. and %

Group B no. and %


Grade 0 00 00 00 Grade 1 03 (20.00%) 03 (20.00%) 06 (20.00%) Grade 2 05 (33.33%) 05 (33.33%) 10 (33.33%) Grade 3 07 (46.66%) 07 (46.66%) 14 (46.66%)




Group B: Out of fifteen patients, none were complained Grade 0, 03 (20.00%) were








Figure 40 showing distribution of patients by different grades of Wakefulness During Sleep before treatment

0

3

5

7

0

3

5

7

0

6

10

14

0

2

4

6

8

10

12

14



Table No 55 Showing the distribution of patients by different grades of Wakefulness During Sleep after treatment

Wakefulness During Sleep

Group A no. and %

Group B no. and %














Figure 41 showing distribution of patients by different grades of Wakefulness During Sleep after treatment

3

9

3

0

12

3

0 0

15

12

3

0

0

2

4

6

8

10

12

14

16



Observation of the data related to the response of the patient

Table No 56 Showing the distribution of Overall Response to the treatment

Duration Group A no. and %

Group B no. and %


Good Response 02 (13.33%) 12 (80.00%) 14 (46.66%) Moderate Response 10 (66.66%) 03 (20.00%) 13 (43.33%)

Poor Response 03 (20.00%) 00 03 (10.00%) No Response 00 00 00

Group A: Out of fifteen patients, 02 (13.33%) shown Good response to the treatment.

10 (66.66%) were shown Moderate response, 03 (20.00%) patients shown Poor

response and none were shown No response.

Group B: Out of fifteen patients 12 (80.00%) were shown Good response to the

treatment. 03 (20.00%) were shown Moderate response, none patients shown Poor

response, none were shown No response.

Overall: Out of thirty patients, only 14 (46.66%) patient shown Good response to the

treatment. 13 (43.33%) were shown Moderate response, 03 (10.00%) patients shown

Poor response and none were shown No response.



Figure no. 42 showing the distribution of Overall Response to the treatment

2

10

3

0

12

3

0 0

1413

3

00

2

4

6

8

10

12

14


Good ResponseModerate ResponsePoor ResponseNo Response

Observation of the statistical out comes of the study:

Table no 57 showing the Comparative Study of Group A and Group B after treatment

Parameter Group Mean SD SE PSE T-Value

P-Value

Remarks

A 0.333 0.487 0.126AM B 0.133 0.351 0.090

0.154 1.29 >0.05 NS

A 0.466 0.516 0.133SG B 0.00 0.00 0.00

0.133 3.50 <0.01 HS

A 0.00 0.00 0.00 JB B 0.00 0.00 0.00

- - - -

A 1.4 0.736 0.190SL B 0.533 0.516 0.133

0.231 3.75 <0.001 HS

A 0.866 0.639 0.165DIS B 0.066 0.258 0.066

0.177 4.51 <0.001 HS

A 1.00 0.654 0.169SQ B 0.2 0.414 0.106

0.181 4.41 <0.001 HS

A 0.933 0.593 0.153PDQ B 0.2 0.560 0.144

0.213 3.49 <0.01 HS

A 1.00 0.654 0.169VMA B 0.2 0.414 0.106

0.199 4.02 <0.001 HS

A 1.266 0.883 0.228TST B 0.2 0.414 0.106

0.251 4.24 <0.001 HS

A 1.00 0.654 0.16 WDS B 0.2 0.414 0.106

0.191 4.18 <0.001 HS

A 1.8 1.146 0.296SL Q B 0.4 0.828 0.213

0.364 3.84 <0.001 HS

To know compare the effectiveness of the treatment procedure, the statistical

analysis is done by using Un-paired t-test, by assuming that the mean effect treatment

procedures is same in both the groups after treatment procedure. From the analysis

except the Angamarda all other parameters shows more significant (as P<0.05). i.e.,



the mean effects treatment procedure is not same as in all other parameters. But in

Jrumbha parameter there is no significance difference after the treatment.

Table no 58 showing Individual study of group-A Mean Parameter

BT AT Net

Mean SD SE T-

value P-value Remarks

AM 0.733 0.333 0.4 0.507 0.13 3.07 <0.01 HS SG 0.866 0.466 0.4 0.507 0.13 3.07 <0.01 HS JB 0.466 0.0 0.466 0.516 0.133 3.50 <0.01 HS SL 2.8 1.4 2.533 0.639 0.165 15.35 <0.001* HS DIS 2.533 0.866 1.66 0.487 0.126 13.17 <0.001* HS SQ 2.6 1.0 1.6 0.632 0.163 9.81 <0.001* HS

PDA 2.66 0.933 1.733 0.457 0.118 14.68 <0.001* HS VMA 2.6 1.0 1.6 0.507 0.13 12.30 <0.001* HS TST 2.733 1.266 1.466 0.639 0.165 8.88 <0.001* HS WDS 2.266 1.00 1.266 0.798 0.206 6.14 <0.001* HS SLQ 2.66 1.8 0.866 0.743 0.191 4.53 <0.001* HS

Table no 59 showing Individual study of group-B

Mean Parameter BT AT

Net Mean

SD SE T-value

P-value Remarks

AM 0.6 0.133 0.466 0.516 0.133 3.50 <0.01 HS SG 0.8 0.0 0.8 0.414 0.106 7.54 <0.001* HS JB 0.4 0.0 0.4 0.507 0.13 3.07 <0.01 HS SL 3.0 0.533 2.466 0.639 0.165 14.94 <0.001* HS DIS 2.533 0.066 2.466 0.516 0.133 18.54 <0.001* HS SQ 2.8 0.2 2.6 0.507 0.130 20.00 <0.001* HS

PDA 2.66 0.2 2.466 0.639 0.165 14.94 <0.001* HS VMA 2.533 0.2 2.333 0.617 0.159 14.67 <0.001* HS TST 3.0 0.2 2.8 0.774 0.2 14.00 <0.001* HS WDS 2.2 0.2 2.0 0.654 0.169 11.83 <0.001* HS SLQ 2.533 0.4 2.133 0.915 0.236 9.03 <0.001* HS

To know on which parameters the treatment procedure is more effective, the

statistical analysis is done by using paired t-test, by assuming that the treatment

procedure is same in both groups in all the parameters. From the analysis all

parameters shows highly significant as P<0.05.From the analysis in Group B

(Yastiksheera Dhara) the parameter Angamarda, Shirogaurava, Difficulty in initiating

Sleep, Sleep Quality, Performance of Daily Activity, Vitality after Morning

Awakening, Total Sleep Time, Wakefulness during Sleep and Sleep Question shows




more highly significant than Group A (Sarpi Nasya). In Group A (Sarpi nasya) the

parameter Jrumba and Sleeplessness shows more highly significant than Group B

(Yastiksheera Dhara). But the parameter PDA shows equal effect in Group A and

Group B.

Conclusion: Over all the Group B (Yastiksheera Dhara) is better than Group A (Sarpi

Nasya) in most parameters. The parameter Jrumba is not significant means this

parameter is not necessary for this study. Further study can be conducted by

considering sample by Age, Sex, and Profession and by extending duration of the

treatment.

Demographic Data

Group – A: Table no 60 Showing Demographical Data

Sex

Religion

Occupation

Economical

status

Marital Status

Response

Sl. no

OPD No.

Age Yrs

M F H M C O St L E S P M H M U G M P N 1 8681 45 - + - - + - - - - + - + - + - - + - - 2 12224 21 - + + - - - + - - - - + - - + - + - - 3 14194 33 + - + - - - - + - - + - - + - - + - - 4 14725 30 + - + - - - - - + - - - + + - - + - - 5 17017 40 + - + - - - - - - + - - + + - - + - - 6 18197 31 + - + - - - - + - - + - - - + - + - - 7 18225 21 + - + - - - + - - - - - + - + + - - - 8 18230 40 - + + - - - - - - + - + - + - - + - - 9 19051 46 - + + - - - - - - + - + - + - - - + - 10 19086 20 - + + - - - + - - - - + - - + + - - - 11 19225 30 - + + - - - - - - + - - + + - - + - - 12 19495 31 + - + - - - - - + - - + - + - - + - - 13 19973 49 + - + - - - - + - - + - - + - - - + - 14 23776 30 + - + - - - - - - + + - - - + - + - - 15 23775 46 + - + - - - - + - - + - - + - - - + - Sex: M – male, F – female. Religion: H- Hindu, M – Muslim, C – Christian, O – others. Occupation: S – student, L – labor, E – executive, S – sedentary. Economical status: P – poor, M– middle class H– higher class. Response: G – Good response, M – Moderate response, P – Poor response, N – No response.

“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 147

Demographic Data

Group – B: Table no 61 Showing Demographical Data

Sex

Religion

Occupation

Economical

status

Marital Status

Response

Sl. no

OPD No.

Age Yrs

M F H M C O St L E S P M H M U G M P N 16 5462 37 + - + - - - - + - - + - - + - + - - - 17 5467 47 - + - - + - - - - + - + - + - + - - - 18 5514 60 - + + - - - - - - + - + - + - - + - - 19 6491 21 + - - - + - + - - - - - + + - + - - - 20 7406 48 - + + - - - - - - + - - + + - + - - - 21 2873 25 + - + - - - + - - - - - + - + + - - - 22 2852 26 + - + - - - + - - - - + - - + + - - - 23 3120 25 + - + - - - - + - - + - - - + + - - - 24 3073 65 + - + - - - - + - - + - - + - - + - - 25 8582 21 + - + - - - + - - - - - + - + + - - - 26 14766 29 - + - + - - - - - + - + - + - + - - - 27 18807 42 + - + - - - - + - - + - - + - - + - - 28 19073 28 + - + - - - - - + - - - + - + + - - - 29 19535 29 + - - + - - - - - + - + - + - + - - - 30 23895 25 + - + - - - - + - - + - - - + + - - - Sex: M – male, F – female. Religion: H- Hindu, M – Muslim, C – Christian, O – others. Occupation: S – student, L – labor, E – executive, S – sedentary. Economical status: P – poor, M– middle class H– higher class. Response: G – Good response, M – Moderate response, P – Poor response, N – No response.


Demographic Data


Pradhana Vedhana Anubanda vedana RS DS WS JB SG AM BR AP SS

Sl. no

OPD No. P A P A P A P A P A P A P A P A P A

1 8681 + - + - + - + - + - + - + - + - + - 2 12224 + - - + + - + - + - - + - + - + + - 3 14194 - + + - + - - + + - + - - + - + - + 4 14725 + - + - - + - + + - - + - + + - + - 5 17017 + - + - + - + - + - + - + - - + - + 6 18197 - + + - + - - + + - + - - + - + + - 7 18225 + - - + + - + - + - - + - + + - + - 8 18230 + - + - + - - + + - + - + - + - + - 9 19051 + - + - + - - + + - + - + - - + - + 10 19086 - + - + + - + - - + + - - + + - - - 11 19225 + - + - + - - + + - + - - + - + + - 12 19495 + - - + + - + - + - - + - + + - + - 13 19973 + - - + - + - + + - + - + - + - + - 14 23776 - + + - - + + - - + + - + - - + - + 15 23775 + - + - + - - + + - + - + - + - + -

Pradhana Vedana: RS - Reduction in sleep time, DS - Difficulty in initiating sleep, WS - Wakefulness during sleep Anubanda vedana: JB – Jrumbha, SG – Shirogaurava, AM – Angamarda, BR – Bhrama, AP – Apakti, SS - Shirashoola P – Present, A - Absent


Demographic Data

Group – B: Table no 63 Showing Demographical Data

Pradhana Vedana Anubanda vedana RS DS WS JB SG AM BR AP SS

Sl. no

OPD No. P A P A P A P A P A P A P A P A P A

16 5462 - + + - + - - + + - + - - + - + + - 17 5467 + - + - + - - + + - + - + - + - + - 18 5514 + - + - + - + - + - + - + - + - + - 19 6491 - + - + + - + - + - - + - + - + - + 20 7406 + - + - + - - + - + + - + - + - + - 21 2873 + - + - - + + - + - - + - + - + - + 22 2852 - + + - + - + - + - - + - + - + - + 23 3120 - + - + + - - + + - + - - + - + - + 24 3073 + - + - + - - + - + + - + - + - + - 25 8582 - + + - + - + - + - - + - + + - - + 26 14766 + - + - - + - + + - + - - + - + + - 27 18807 + - + - + - - + + - + - - + + - + - 28 19073 - + + - + - + - + - - + - + - + - + 29 19535 + - + - - + - + - + + - - + + - + - 30 23895 + - - + + - - + + - - + - + - + - +

Pradhana Vedana: RS - Reduction in sleep time, DS - Difficulty in initiating sleep, WS - Wakefulness during sleep Anubanda vedana: JB – Jrumbha, SG – Shirogaurava, AM – Angamarda, BR – Bhrama, AP – Apakti, SS - Shirashoola P – Present, A - Absent


Demographic Data


Mode of Onset

Purva vyadhi

vruttanta

Kula vruttanta

Occupational History

SH Phy Psy

Sl. no

OPD No.

C

A

Sha

Mana

JF

NF Y N Y N Y N Phy S Psy S SS ES

1 8681 + - + + - + - + + - + - + + + - 2 12224 - + - + + - + - - + + - - + - + 3 14194 - + + - - + - + - + - + + - + + 4 14725 - + + - + - - + - + - + - - + - 5 17017 - + - + - + - + - + - + - + - - 6 18197 - + - + - - - + - + - + - - + + 7 18225 - + - + + - - + - + - + - - + + 8 18230 - + - + + - - + + - + - + + - - 9 19051 - + + + - + - + + - + - + + + - 10 19086 - + - + - + + - - + + - - - - - 11 19225 - + - + - + + - - + - + + - - - 12 19495 - + - - + - + - - + + - - + - - 13 19973 - + + + - + - + + - - + + - + + 14 23776 - + - + + - - + - + - + + - - + 15 23775 - + + - + - - + - + - + + - + +

Mode of Onset: C – Chronic, A – Acute, Purva vyadhi vruttanta: Sha – Shareerika, Mana – Manasika, Kula vruttanta: JF- Joint Family, NF - Nuclear Family, SH - Staying away from Home, Phy - Physical disturbances in the family,

Psy - Psychological disturbances in the family, Occupational History: Phy S - Physical stress, Psy S - Psychological stress, SS - Social stress, ES - Economical stress,

Y – Yes, N - No


Demographic Data

Group - B Table no 65 Showing Demographical Data

Mode of Onset

Purva vyadhi

vruttanta

Kula vruttanta

Occupational History

SH Phy Psy

Sl. no

OPD No.

C

A

Sha

Mana

JF

NF Y N Y N Y N Phy S Psy S SS ES

16 5462 - + - + - + + - + + + - - + - + 17 5467 + - - + + - - + + - + - + + + - 18 5514 + - - + - + - + + - + - + + + - 19 6491 - + + - + - - + - - - + + - - - 20 7406 - + - + + - - + - + + - - + + - 21 2873 - + - + - + + - - + + - - + - - 22 2852 - + + - + - + - + - - + + - - - 23 3120 - + - + + - + - - + + - - + + - 24 3073 - + - + - + - + + - + - + + - + 25 8582 - + - - - + + - - + - + - - + - 26 14766 - + - - - + - + - + - + - - - + 27 18807 - + - + + - - + + - + - + + - + 28 19073 - + + - + - - + + - - + + - - + 29 19535 - + + - + - - + + - - + + - + - 30 23895 - + - + - + - + - + + - - + + +

Mode of Onset: C – Chronic, A – Acute, Purva vyadhi vruttanta: Sha – Shareerika, Mana – Manasika, Kula vruttanta: JF- Joint Family, NF - Nuclear Family, SH - Staying away from Home, Phy - Physical disturbances in the family,

Psy - Psychological disturbances in the family, Occupational History: Phy S - Physical stress, Psy S - Psychological stress, SS - Social stress, ES - Economical stress,

Y – Yes, N - No


Demographic Data

Group –A Table no 66 Showing Demographical Data

Ahara: V –Vegetarian, M –Mixed. Vihara: H- Hard, M – Moderate, S –Sedentary. Agni: S – Sama, M – Manda, T – Teekshna, V – Vishama. Koshta: Mr – Mridu, M– Madhyama, K– Krura. Vysana: T – Tea, C– Coffee, A–Alcohol, S – Smoking, To – Tobacco

Ahara Vihara Agni

Koshta Vysana Sl. no

OPD No.

V M H M S S M T V Mr M K T C A S TO 1 8681 - + - - + + - - - - - + + - - - + 2 12224 - + - - - - + - - - - + - + - - - 3 14194 + - + - - + - - - - + - - + - - + 4 14725 - + - + - - - + - - + - + - + + + 5 17017 + - - - + + - - - - - + + - - - + 6 18197 - + + - - - + - - - + - - + + + + 7 18225 - + - - - - - + - - + - - + + - + 8 18230 + - - - + + - - - - - + - + - - - 9 19051 + - - - + + - - - - - + + - - - + 10 19086 - + - - - - + - - - + + - - - - 11 19225 + - - - + - + - - - - + - + - - + 12 19495 - + - + - - - + - - + - - + - + + 13 19973 + - + - - + - - - - - + + - + - + 14 23776 - + - - + + - - - - - + + - + + + 15 23775 - + + - - + - - - - - + - + - + +


Demographic Data

Group - B Table no 67 Showing Demographical Data

Ahara: V –Vegetarian, M –Mixed. Vihara: H- Hard, M – Moderate, S –Sedentary. Agni: S – Sama, M – Manda, T – Teekshna, V – Vishama. Koshta: Mr – Mridu, M– Madhyama, K– Krura. Vysana: T – Tea, C– Coffee, A–Alcohol, S – Smoking, To – Tobacco

Ahara Vihara Agni

Koshta Vysana Sl. no

OPD No.

V M H M S S M T V Mr M K T C A S TO 16 5462 + - + - - + - - - - + - + - - + + 17 5467 - + - - + + - - - - - + - + - - + 18 5514 + - - - + + - - - - - + - + - - - 19 6491 - + - - - + - - - - + - + - - + + 20 7406 + - - - + + - - - - - + + - - - + 21 2873 - + - - - - - + - - + - + - + - - 22 2852 + - - - - - - + - - + - - + + - - 23 3120 + - + - - + - - - - + - - + + - - 24 3073 + - + - - + - - - - - + + - - - + 25 8582 - + - - - + - - - - + - + - - - - 26 14766 - + - - + - - + - - + - - + + - - 27 18807 - + + - - + - - - - - + + - - + - 28 19073 - + - + - + - - - - + - + - + + + 29 19535 - + - - + - - + - - - + + - + + + 30 23895 + - + - - + - - - - - + + - + - -


Demographic Data


Vaya: B – Bala, M – Madhyama, V – Vruddha

Group – A Table no 68 Showing Demographical Data Prakruti

Sara Samhanana

Satmya Satva Ahara shakti

Vyama shakti

Vaya Sl. no

OPD No.

P M A P M A SA E R S V P M A P M A P M A B M V

1 8681 VP - - + - + - - - + - - - + - - + - - + - - + - 2 12224 VP - + - - - + - - - - + - - + - - + - + - - + - 3 14194 VP - + - + - - - - - - + - - + - + - + - - - + - 4 14725 VK - + - - + - - - + - - - + - + - - - + - - + - 5 17017 VP - - + - + - - - + - - - - + - + - - + - - + - 6 18197 VP - + - + - - - - - - + - - + - - + + - - - + - 7 18225 VK + - - - - + - - + - - - + - + - - - + - - + - 8 18230 VP - - + - + - - - - - + - - + - + - - + - - + - 9 19051 VP - - + - + - - - + - - - - + - + - - + - - + - 10 19086 VK + - - - - + - - - - + - - + - - + - + - - + - 11 19225 VP - + - - + - - - + - - - + - - - + - + - - + - 12 19495 VP - + - - + - - - - - + - + - + - - - + - - + - 13 19973 PK - - + - + - - - + - - - + - - + - + - - - + - 14 23776 VP - + - + - - - - - - + - - + - + - - + - - + - 15 23775 PK - - + + - - - - - - + - - + - + - + - - - + -

Prakruti: V – Vataja, P – Pitta, K – Kapha, VP – Vatapittaja, VK – Vatakaphaja, PK – Pittakaphaja, S - Sama Sara: P – Pravara, M – Madhyama, A – Avara Samhanana: P – Pravara, M – Madhyama, A – Avara. Satmya: SA – Sarvarasa, E – Ekarasa, R – Ruksha, S - Snigda V – Vyamishra. Satwa: P – Pravara, M – Madhyama, A – Avara. Ahara shakti: P – Pravara, M – Madhyama, A – Avara. Vyamashakti: P – Pravara, M – Madhyama, A – Avara.

Demographic Data


Vaya: B – Bala, M – Madhyama, V – Vruddha

Group – B Table no 69 Showing Demographical Data Prakruti

Sara Samhanana

Satmya Satva Ahara shakti

Vyama shakti

Vaya Sl. no

OPD No.

P M A P M A SA E R S V P M A P M A P M A B M V

16 5462 VP - + - - + - - - - - + - - + - + - + - - - + - 17 5467 VP - + - - - + - - + - - - - + - + - - + - - + - 18 5514 VP - - + - - + - - + - - - - + + - - - - + - - + 19 6491 VK + - - + - - - - + - - - + - - + - - + - - + - 20 7406 VK - + - - - + - - - - + - - + - + - - - + - + - 21 2873 VP + - - - + - - - + - - - + - - - + - + - - + - 22 2852 VP - + - - + - - - - - + - - + - - + - + - - + - 23 3120 VP + - - - + - - - - - + - - + - + - + - - - + - 24 3073 PK - - + - - + - - + - - - - + - + - - - + - - + 25 8582 VK + - - + - - - - + - - - + - + - - - + - - + - 26 14766 VK - + - - + - - - + - - - - + - - + - - + - + - 27 18807 VP - + - - - + - - + - - - + - - + - + + - - + - 28 19073 PK - + - - - + - - + - - - + - - + - - + - - + - 29 19535 VK - + - - + - - - + - - - - + - - + - + - - + - 30 23895 VP - + - + - - - - - - + - - + - + - + - - - + -

Prakruti: V – Vataja, P – Pitta, K – Kapha, VP – Vatapittaja, VK – Vatakaphaja, PK – Pittakaphaja, S - Sama Sara: P – Pravara, M – Madhyama, A – Avara Samhanana: P – Pravara, M – Madhyama, A – Avara. Satmya: SA – Sarvarasa, E – Ekarasa, R – Ruksha, S - Snigda V – Vyamishra. Satwa: P – Pravara, M – Madhyama, A – Avara. Ahara shakti: P – Pravara, M – Madhyama, A – Avara. Vyamashakti: P – Pravara, M – Madhyama, A – Avara.

Demographic Data

Group – A Table no 70 Showing Demographical Data

Aharaja Hetu Viharaja Hetu Manasika Hetu Sl. no

OPD No. R L S K A/P D A U/L AS V AV VD B C Kr M Vy

1 8681 + + - - - - - + + - - + + - + - + 2 12224 - + - + + + - - - + - + - + - + - 3 14194 - - + - - + + - + - + - - + - + + 4 14725 + + - + - + - - + - - - + - + - + 5 17017 + + - - + - - - - + - + - + + + - 6 18197 - + - - + + + - - + + - - + - + + 7 18225 + + + + - - - - - + - - + - - - + 8 18230 - - + - - + - + + - - + + + - + + 9 19051 + + - - - - - - + - - + + + + + - 10 19086 - + + - - + - - - + - - + - - + 11 19225 + - - - - - - - + + - + - - - + + 12 19495 - + - - + + - - - - - - - - - - - 13 19973 + + + - - - + - - + + + + - + - + 14 23776 - - - - + - - - - - - + - + - + - 15 23775 - + - - + + + - + - + + - + + + +

Aharaja Hetu: R – Rukshanna, L – Laghu, S – Sheeta, K – Katu, A/P - Alpa/ Pramitha Viharaja Hetu: D – Divaswapnam, A - Ati-Vyayama, U/L - Upavasa/ Langanam, AS – Asukhashayya, V – Vishamaupachara,

AV - Ati-vyavaya, VD – Vegadharana Manasika Hetu: B – Bhaya, C – Chinta, Kr – Krodha, M – Manasthapa, Vy – Vyatha


Demographic Data

Group – B Table no 71 Showing Demographical Data

Aharaja Hetu Viharaja Hetu Manasika Hetu Sl. no

OPD No. R L S K A/P D A U/L AS V AV VD B C Kr M Vy

16 5462 - + - + - + + - - - + - - + - + + 17 5467 + - - - + - - + + + - + + + + + + 18 5514 + + - - + + - + + + - + + + + + + 19 6491 + - + + - + - - + - - - - - + - + 20 7406 - + - - + - - + - + - + + + - + - 21 2873 + - + - - + - - - + - - - - + - + 22 2852 - + + + - + - - + - - - - + - - - 23 3120 - + + + - + + - + + + - + - + - - 24 3073 + + - - + + + + - + + + + + - + + 25 8582 + - + + - - - - + - - - - - + - - 26 14766 + - - + + + - + + + - - + + - - + 27 18807 + - - - + - + + - - + + - - + + - 28 19073 + - + + - - - - + + - - - - - + - 29 19535 + - - + - + - - + + - + + + + + + 30 23895 - + + + - - + - + - + + + + - - +

Aharaja Hetu: R – Rukshanna, L – Laghu, S – Sheeta, K – Katu, A/P - Alpa/ Pramitha Viharaja Hetu: D – Divaswapnam, A - Ati-Vyayama, U/L - Upavasa/ Langanam, AS – Asukhashayya, V – Vishamaupachara,

AV - Ati-vyavaya, VD – Vegadharana Manasika Hetu: B – Bhaya, C – Chinta, Kr – Krodha, M – Manasthapa, Vy – Vyatha


Subjective Parameter

Group – A (Sarpi Nasya)

Table no 72 Showing Subjective Parameter Statistical Data of Group A AM SG JB SL DIS SQ PDA VMA Number of

Patients BT AF BT AF BT AF BT AF BT AF BT AF BT AF BT AF 01 1 1 1 0 1 0 3 2 3 1 2 1 3 1 3 1 02 0 0 1 0 1 0 2 1 2 0 2 0 2 0 2 0

03 1 0 1 1 0 0 3 2 3 1 3 1 3 1 3 1 04 0 0 1 1 0 0 3 1 3 1 3 1 3 2 3 1 05 1 0 1 0 1 0 2 2 3 2 3 1 2 1 2 1 06 1 1 1 0 0 0 3 1 2 1 2 1 3 1 3 2 07 0 0 1 0 1 0 2 0 2 0 3 0 2 0 2 0 08 1 0 1 1 0 0 3 2 3 1 3 1 3 1 3 2 09 1 1 1 1 0 0 4 2 3 1 3 2 3 1 3 1 10 1 0 0 0 1 0 2 0 1 0 2 0 2 0 2 0 11 1 0 1 1 0 0 3 2 3 1 2 1 3 2 3 1 12 0 0 1 0 1 0 2 1 2 1 2 1 3 1 2 1 13 1 1 1 1 0 0 4 2 3 1 3 2 3 1 3 1 14 1 0 0 0 1 0 2 1 2 0 3 1 2 1 2 1

15 1 1 1 1 0 0 4 2 3 2 3 2 3 1 3 2

AM – Angamarda, SG – Shirogaurava, JB – Jrumbha, SL – Sleeplessness, DIS - Difficulty in Initiating Sleep, SQ - Sleep Quality, PDA - Performance of Daily Activities, VMA - Vitality after Morning Awakening. BT – Before treatment, AF – After Follow-up


Subjective Parameter


Group – B (Yastiksheera Dhara)

Table no 73 Showing Subjective Parameter Statistical Data of Group B AM SG JB SL DIS SQ PDA VMA

AM – AngamSQ - Sleep Quality, PDA - Performance of Daily AcBT – Bef

Number of Patients BT AF BT AF BT AF BT AF BT AF BT AF BT AF BT AF

01 1 0 1 0 0 0 4 1 3 0 3 0 3 0 3 0 02 1 0 1 0 0 0 4 0 3 0 3 0 3 0 3 0

03 1 0 1 0 1 0 4 1 3 1 3 1 3 2 3 1 04 0 0 1 0 1 0 2 0 2 0 2 0 3 0 2 0 05 1 0 0 0 0 0 3 1 3 0 3 0 2 0 3 0 06 0 0 1 0 1 0 2 0 2 0 3 0 2 0 2 0 07 0 0 1 0 1 0 3 1 3 0 3 0 3 0 3 0 08 1 0 1 0 0 0 2 0 2 0 3 0 3 0 2 0 09 1 1 0 0 0 0 4 1 3 0 3 1 2 0 2 1 10 0 0 1 0 1 0 2 0 2 0 3 0 2 0 2 0 11 1 0 1 0 0 0 2 0 2 0 2 0 3 0 3 0 12 1 1 1 0 0 0 4 1 3 0 3 1 3 1 3 1 13 0 0 1 0 1 0 2 0 2 0 3 0 2 0 3 0 14 1 0 0 0 0 0 3 1 2 0 3 0 3 0 2 0

15 0 0 1 0 0 0 4 1 3 0 2 0 3 0 2 0

arda, SG – Shirogaurava, JB – Jrumbha, SL – Sleeplessness, DIS - Difficulty in Initiating Sleep, tivities, VMA - Vitality after Morning Awakening.,

ore treatment, AF – After Follow-up

Objective Parameter


Table no 74 Showing Objective parameter Statistical Data of Group – A Total Sleep Time Wakefulness During Sleep Number of

Patients BT AF BT AF

01 3 1 3 1

02 2 0 1 0

03 3 1 3 1 04 3 1 3 1

05 2 2 3 1

06 3 1 2 1 07 2 0 2 0

08 3 2 3 1

09 4 2 2 2

10 1 0 1 0 11 3 2 3 1

12 2 1 2 1

13 4 2 3 2 14 2 1 1 1

15 4 3 2 2

BT – Before treatment, AF – After Follow-up


Objective Parameter


Table no 75 Showing Objective parameter Statistical Data of Group – B

Total Sleep Time Wakefulness During Sleep Number of Patients

BT AF BT AF 01 4 0 3 0 02 4 0 2 0

03 4 1 3 1

04 2 0 2 0 05 3 0 2 0

06 2 0 2 0

07 3 0 1 0 08 2 0 1 0

09 4 1 3 1

10 2 0 1 0

11 2 0 2 0 12 4 1 3 1

13 2 0 3 0

14 3 0 2 0 15 4 0 3 0



Sleep Questions


Table no 76 Showing Sleep Questioners Statistical Data of Group A

Questioner Number of Patients BT AF

01 3 2

02 2 0

03 3 2

04 3 2

05 2 1

06 3 3

07 2 0

08 3 2

09 3 3

10 2 0

11 3 2

12 3 3

13 3 3

14 2 1

15 3 3



Sleep Questions


Table no 77 Showing Sleep Questioners Statistical Data of Group B

Questioner Number of Patients BT AF

01 3 0

02 3 0

03 3 2

04 3 0

05 2 0

06 2 0

07 3 0

08 2 0

09 2 2

10 2 0

11 3 0

12 3 2

13 2 0

14 3 0

15 2 0



Discussion

DISCUSSION

Discussions on this study are made under the following headings:

1. Discussion on the disease Nidranasha vis-à-vis Insomnia.

2. Discussions on the materials and methods.

3. Discussion on clinical study.

4. Discussions on the patients of Nidranasha who underwent the trial.

5. Discussions on observations made on results.

6. Probable mode of action of the Nasya and Ksheera dhara.

1. Discussion on the disease Nidranasha vis-à-vis Insomnia

Nidra – an essential phenomenon for maintenance and restoration of the life,

which is considered under Trayopastambha. Charaka included the Asvapna in 80

Nanatmaja Vata Vikaras. Acharya Sushruta explained this under the chapter Garbha

Vyakarana Shariram, might be because of Nidra plays a role of nutrition and

development of the body. He also explained the Vaikariki Nidra in the same chapter,

which can be correlated to sleep disorders. Nidranasha can be correlated to Insomnia.

Insomnia is defined as repeated difficulty with the initiation, duration, maintenance,

or quality of sleep that occurs despite adequate time and opportunity for sleep that

results in some form of daytime

The treatments which are described for Anidras according to various classics can be

classified as

♦ Bahya upachara

♦ Ahara upachara

♦ Manasika upachara

♦ Anya upachara


Discussion

Charaka mentioned Abhyanga, Utsadana, Samvahana, Akshitarpana, Shiro

Lepa, Karna Purana, Shiro Basti, Shirodhara, Moordhni Taila as bahya upacharas.

Manonukula vishaya grahana,Manonukula sabda granaha,Manonukula gandha

granaha as manasika upacharas and Gramya mamsa rasa,Anupa mamsa rasa,Jaleeya

mamsa rasa,Mahisha ksheera,Peeyusha,Morata as manasika upacharas. Despite the

recent progress in the use of non-benzodiazepines, physicians remain reluctant to

prescribe drugs with sedative properties, i.e. hypnotics, because the risks are

perceived to be too high. Many physicians have the impression that onerous side-

effect are inevitable. In general, physicians should favor short-acting hypnotics over

long-acting drugs in primary insomnia when short-term use is anticipated. Chronic

insomnia associated with the anxiety disorders respond better to hypnotics with longer

half-lives to reduce daytime anxiety.

2. Discussions on the materials and methods.

A. Drugs used in the trial work:

Mahisha sarpi:

According to Vagbhata Mahisha Ghrita is having the property of Nidrajanaka

and also best Rasayana effect. Also Mahisha ksheera indicated in Nidranasha by

Kaiyyadeva nigandu / Gritha varga / 273 It improves Smriti, Medha, Buddhi, Varna,

Swara, Saukumaryata and Ojas in the body; it strengthens sensory organs and softens

the body. Ghrita is recommended as main pathya in Vatavyadhis. In Vata disorders

Sneha instantaneously provides nourishment to Ksheena Dhatus, it promotes Bala,

Agni and longevity of life.

The Sarpi was used for the Nasya karma after murchana. The Mahisha sarpi

murchana is done according to the Ghrita murchana procedure explained in

Bhaishajya Ratnavali, Jwara prakarana.


Discussion

Murchita Tila Taila:

The Murchita Tila Taila is used for the sthanika abhyanga in urdwajatrugata

pradesha, as explained in clasics that Nasya should be administered after Snehana and

Swedana. Murchitha tila taila is also used for shiro abhyanga prior to Shirodhara. This

Sthanika Abhyanga may help in absorption of medicaments used for dhara, as

explained in Pharmocology that hydrated skin is more permeable than dry skin.

Yastimadhu sidda Mahisha Ksheera:

Acharya Vagbhata directly indicated the mahisha kseera in Nidranasha. Also

Mahisha ksheera indicated in Nidranasha by (Haritha Samhitha 8/21). Yastimadhu

having the properties like Madhura rasa, Guru-snigda-sheeta guna, sheeta veerya,

Madhura vipaka, Vata pitta shamaka. So this drug may precipitate the Nidra. As there

is involvement of psychological factor in Anidra, Shirodhara is a choice of treatment.

For this Shirodhara, yastimadhu is processed in Mahisha ksheera according to

Ksheerapaka vidhi is used.

B. Posology:

Sarpi Nasya- 8 drops of Sarpi nasya is administered to each nostril for 7 days. 8

drops was fixed on the basis of dose of Nasya explained by acharya Charaka. This is

the Madhyama matra of Marsha nasya. Duration of treatment was fixed for 7 days on

the basis of Acharya Vagbhatas opinion.

Yasti ksheera Dhara – Dhara was performed for 7 days as explained in Ayurvedic

treatment by Dr. Moss. Dhara karma is done in Arohana karma for first 4 days and

Avarohana from 5th to 7th day i.e. 30 min on first day, daily increased 5 min till 4th

day(45min) then decreased 5 min each day so that on 7th day it was again 30 min.


Discussion

3. Discussion on Clinical Study:

The Patients were selected from OPD and IPD of D.G.M. Ayurvedic Medical

College & Hospital, Gadag after applying the Inclusion & Exclusion criteria. Then

they are randomly distributed into two groups- Group A and Group B and treatment

was administered. Totally 32 patients got registered out of which 2 discontinued the

trial because of their personal problems.

After scrutinizing the Ayurvedic literature and literatures of contemporary

science, Angamarda, Jrumbha, Shirogaurava, Sleeplessness, Difficulty in initiation

sleep, Sleep Quality, Performance of daily activities, Vitality after morning

awakening, Total Sleep Time (hrs) and Wakefulness during sleep (in number), Sleep

History Questionnaire were fixed as the parameters for clinical assessment.

In Group A - Nasya was administered in evening hours in between 4pm to

6pm after stanika abhyanga with Murchitha taila and swedana with Mrudu nadi

sweda. The Nasya was administered in the evening hours as there is involvement of

Vatadosha in the Samprapthi of Nidranasha, and it is explained in the classics that in

Vataroga Nasya should be administered in “Aparahna”. (A.H.Su.19/37). Nasya was

administered in lying supine position over Massage table with a pillow below the

neck region, so that there is slight elevation of head which helps in administration of

Nasya dravya. After Nasya pranidhana, patient was asked to take slow deep breath

through nose and exhale through mouth. The pani and pada is rubbed vigorously for

short time.

Slight massage was done over urdwajatrugata pradesha after nasya

pranidhana. A comfortable massage on the above regions may help to subside the

irritation of the somatic constriction due to heat stimulation and may also help in

removing the slush created in these regions. Manipulation over carotid sinus of neck


Discussion

present on the bifurcation of common carotid artery which has the receptors called

baroreceptors may have a buffering action on cerebral arterial pressure. (Best and

Taylor, 1988). Pressure applied on the baroreceptors is also found to normalize the

deranged cerebral arterial pressure.(Hejmadi S. 1985)

Then patient was asked to lie over massage table for another 10 minutes. The

medicament from mouth was asked to spit in kidney tray. After 10 minutes asked to

do gargling with luke warm salt water and then Dhumapana was administered to

remove the shesha kapha dosha from srotasas.

In Group B, Yasti ksheera dhara was carried out in evening hours 4 pm-6 pm after

shiro abhyanga with murchita tila taila, as there is predominance of Vata dosha during

these hours (A.H.Su.1).

Patient was asked to lie down in Dhara table after shiro abhyanga. Then thick

gauze was tied around the head above the eye brow to avoid flow of medicine in to

eyes. The eyes are also covered with a piece of cotton to avoid any splash of

medicines into eyes. During the Dhara process, absolute calm surrounding was

maintained. After Dhara, head of patient was cleaned with a dried cloth and asked to

take rest for half hour. Afterward asked to take luke warm water head bath. Rasnadi

churna was rubbed to head after proper drying the head with dry towel.

Assesment results:

The efficacy of Sarpi nasya and Yasti ksheera dhara in nidra nasha was

accessed by setting of criteria as discussed in materials and methods section earlier.

Here the base line data was compared with the data taken after 14 days of therapy;

this is because the parihara kala for Panchakarma procedure is told as double the days

of administration of karma. Hence it is postulated that the result of Nasya and Dhara

can be best seen after parihara kala. In this study the course of therapy was 7 days and


Discussion

hence the results were accessed 14 days after the therapy i.e. on 22nd day of the first

day of treatment initiation.

4. Discussions on the patients of Nidranasha who underwent the trial:

Age: Out of 30 patients of Nidranasha studied in this series, maximum i.e.

60.00% of patients were in the age group of 20 – 35 yrs followed by 33.33% patients

in the age group of 36 - 50 yrs. In the age of 20 – 35yrs, chinta may be prime factor

which in turn influences the vata to aggravate resulting in nidranasha.

Sex: The number of male patients 66.66% was more in this series in

comparison to female 33.33%. The prevalence made by earlier researchers that this

disease is more in women than men. Though the females might suffer more from the

Nidranasha complaint, here they did not turn up for the treatment.

Religion: Religion wise distribution showed maximum patients 83.33% were

Hindus, whereas only 10.00% patients were christian and. whereas only 6.66%

patients were muslims. Here hindus are more in geographical proportions.

Occupation: where 36.66% were sedentary, whereas 30.00% were labor,

23.33% of patients in this study were belonging to students and whereas 10.00% were

executives. In this study the more peoples are belonged to sedentary group may be

due to their business.

Economical Status: The present series of study showed maximum number is

36.66% were middle class, whereas 33.33% of patients were belongs to poor class and

30.00% were higher class.

Marital status: In this study 63.33% patients were married and whereas

36.66% patients were unmarried. Here maximum number of patient belongs to

married group, because of chinta and manasthapa.


Discussion

Addiction: An investigation to the addiction of patients showed the maximum

number of patients were addicted to Tea 56.66%, Coffee 43.33%, followed by

40.00% to alcohol, 33.33% to Alcohol and whereas 63.33% patients were having

tobacco addiction.

It has been reported that caffeine, nicotine, alcohol all can alter sleep patterns.

Though they provide sleep initially but fall in blood concentration leads increased

arousal due to sympathetic stimulation.

Koshta: In the present study maximum number of patients 46.66% belonged

to madyama and 53.33% belongs to Krura koshta which highlights the predisposing

factors for vata.

Satva: In this series maximum number of patients were avara satva 63.33%

and 36.66% were belongs to the madyama satva. Avara Satva persons have unsteady

mind for which they have no control over Krodha, Chinta, etc. which leads to

Nidranasha condition.

Vyayama shakti: Majority of patients in this series were of madyama vyayama shakti

is 63.33%, whereas 26.66% were pravara group and avara vyayama shakti 13.33%.

Hetus:

Aharaja hetu: In this study 56.66% patients were taken the Rukshanna,

60.00% patients were taken the Laghu ahara, 40.00% patients were taken the Sheeta

ahara,40.00% patients were taken the katu ahara and 40.00% patients were taken the

Alpa/Pramitha.

Viharaja Hetu: In this study 56.66% were of Divaswapnam, 30.00% were

had Ati-Vyayama, 26.66% were Upavasa/ Langanam, 56.66% were Asukhashayya,

53.33% were Vishamaupachara, 09 (30.00%) were Ati-vyavaya and 16 (53.33%)

were Vegadharana.


Discussion

Manasika Hetu 46.66% were of Bhaya, 60.00% were had Chinta, 46.66%

were Krodha, 56.66% were Manasthapa and 63.33% were Vyatha. All these are said

to be the direct cause for Nidranasha as they provokes Raja, Vata, Pitta and decreases

Satva, Tama and Kapha. These causative factors independently or in conjugation

cause Nidranasha.

Present complaint: The patients in this study showed Out of thirty patients

66.66% were belonging to Reduction in sleep time, 73.33% were of Difficulty in

initiating sleep, 80.00% were of Wakefulness during sleep.

Associated symptoms: Associated symptoms complained by the patients

36.66% were had Jrumbha, 83.33% were had Shirogaurava, 66.66% were had

Angamarda, 36.66%, were had Bhrama, 50.00%, were had Apakti and 60.00% were

had Shirashoola.

Comparison of effect of both therapies:

Sarpi Nasya – Sarpi Nasya shown better relief in complaints Jrumba and

Sleeplessness.

Yastiksheera dhara: Provided better relief in Angamarda, Shirogaurava, Difficulty

in initiating Sleep, Sleep Quality, Performance of Daily Activity, Vitality after

Morning Awakening, Total Sleep Time, Wakefulness during Sleep

It shows that Sarpi Nasya done with Sarpi as well as Yastiksheera dhara

provided significant relief in all the signs and symptoms, improved the quality and

quantity of sleep in the patients of Nidranasha. However comparison showed that the

effects of Yastiksheera dhara were better in comparison to be Sarpi nasya.


Discussion

5. Discussions on observations made on results:

Assessment of the results was done by considering the subjective parameters

and objective. Totally 8 criteria were taken with different grading as explained. The

statistical result showing the significance has already been discussed in the

observation part.

For this purpose the values were observed numerically which are given the –

Now the % of the condition after the treatment is calculated by dividing this number

with the base line data obtained by the step 1. This should then multiply by 100 to get

the % after the treatment.

Step 1 – All the values of before treatment of subjective and objective parameters

were added to get the sum. Now this is the condition in which the patient had

approached us, so it becomes the base line data. This is taken as 100%.

Step 2 – The readings of after treatment was then added to get the sum, which is the

status of the patient after the treatment.

Step 3 – Now the % of the condition after the treatment is calculated by dividing this

number with the base line data obtained by the step 1. This should then multiply by

100 to get the % after the treatment.

Step 4 – The % of improvement is calculated by subtracting the value got by step 3

by 100 will yield the net improvement in the disease.

Step 5 – This value was referred for the table postulated to declare the results and the

table is gradings.


Discussion

Table Showing the Percentage Improvement of Parameters in each patient.

Group A – Sarpi Nasya Group B – Yastiksheera Dhara

SI No OPD No % improvement

1 8681 60.8% 2 12224 66.6% 3 14194 62.5% 4 14725 59.0% 5 17017 50.0% 6 18197 55.0% 7 18225 100.0% 8 18230 52.0% 9 19051 46.0% 10 19086 100.0% 11 19225 50.0% 12 19495 58.0% 13 19973 48.0% 14 23776 62.5% 15 23775 33.0%

Overall Assessment of Clinical Response:

Good Response : >75% improvement in clinical parameters

Moderate Response : 50-75% improvement in clinical parameters

Poor Response : up to 50% improvement in clinical parameters

No Response : 0 % or No improvement in clinical parameters

Group A Response No of Patients Group A no. and

% Good Response 02 13.33% Moderate Response 10 66.66% Poor Response 03 20.00% No Response 00 00

In this group, the chief complaint and Associated complaint was reduced up

to 50% in most of the patients on 5th or 6th day. The other complaint, like

sleeplessness not shown any changes during the period of treatment, the recurrences

of the complaints were not observed during the period of follow up.

SI No OPD No % improvement

16 5462 96.0% 17 5467 100.0% 18 5514 69.0% 19 6491 100.0% 20 7406 95.0% 21 2873 100.0% 22 2852 95.0% 23 3120 100.0% 24 3073 72.0% 25 8582 100.0% 26 14766 100.0% 27 18807 72.0% 28 19073 100.0% 29 19535 94.7% 30 23895 95.4%


Discussion


Group B

In this group, all the chief complaint and associated complaint was reduced up

to 80% in most of the patients on 5th or 6th day. The recurrences of the complaints

were not observed during the period of follow up.

There was no much difference in response was noted during the treatment

period in both group. But much difference in response was noted after the follow up

period in both groups. Only the Parameter Jrumbha not had shown much difference in

patients even after follow up.

Mean Percentage improvement in each Parameter:

The mean percentage of improvement in each parameter was calculated to

know the effect of treatment on individual parameters. These was calculated by using

the following formula

Response No of Patients Group B no. and %

Good Response 12 80.00% Moderate Response 03 20.00% Poor Response 00 00 No Response 00 00

(Before Treatment Mean)–(After treatment Mean)X100 Mean % Improvement =

(Before Treatment Mean)

Discussion

Table Showing the obtained values are as follows

SI No Parameter Group A Group B Overall

01 Angamarda 54.5% 77.7% 66.1%

02 Shirogaurava 46.0% 100.0% 73.0%

03 Jrumbha 100.0% 100.0% 100.0%

04 Sleeplessness 50.0% 82.2% 66.1%

05 Difficulty in Initiating Sleep 65.7% 97.3% 81.5%

06 Sleep Quality 61.5% 92.8% 77.15%

07 Performance of Daily Activities 65.0% 92.5% 78.5%

08 Vitality After Morning Awakening 61.5% 92.1% 76.8%

09 Total Sleep time 53.6% 93.3% 73.4%

10 Wakefulness during Sleep 55.8% 90.6% 73.2%

11 Sleep History Question 32.5 85.0 58.75%

Among all parameter the Difficulty in Initiating Sleep had shown the highest

percentage (65.7%) improvement in Group A (Sarpi Nasya) and in Group B

(Yastiksheera Dhara) the Shirogaurava (100.0%), Difficulty in Initiating Sleep

(97.3%) had shown highest percentage (73.4 %) of improvement. The Parameter

Jrumbha had shown the 100% improvement in both groups.

Overall response of patients: In Group – A: Out of fifteen patients, 02 (13.33%) shown Good response

(>75% improvement in clinical parameters) to the treatment. 10 (66.66%) were shown

Moderate response (50-75% improvement in clinical parameters), 03 (20.00%)

patients shown Poor response(up to 50% improvement in clinical parameters) and

none were shown No response.


Discussion

Group B: Out of fifteen patients 12 (80.00%) were shown Good response (>75%

improvement in clinical parameters) to the treatment. 03 (20.00%) were shown

Moderate response (50-75% improvement in clinical parameters), none patients

shown Poor response (up to 50% improvement in clinical parameters), none were

shown No response.

In total thirty patients, only 14 (46.66%) patient shown Good response (>75%

improvement in clinical parameters) to the treatment. 13 (43.33%) were shown

Moderate response (50-75% improvement in clinical parameters), 03 (10.00%)

patients shown Poor response (up to 50% improvement in clinical parameters) and

none were shown No response.

To know compare the effectiveness of the treatment procedure, the statistical analysis

is done by using Un-paired t-test, by assuming that the mean effect treatment




Jrumba parameter there is no significance difference after the treatment.



procedure is same in both groups in all the parameters.

From the analysis all parameters shows highly significant as P<0.05. From the

analysis in Group B the parameter Angamarda, Shirogaurava, Difficulty in Initiating

Sleep, Sleep Quality, Vitality after Morning Awakening, Total Sleep Time,

Wakefulness During Sleep and Sleep Quality shows more highly significant than

Group A. In Group A the parameter Jrumba and Sleeplessness shows more highly


Discussion

significant than Group B. But the parameter Performance of Daily Activities shows

equal effect in Group A and Group B.

Statistical Conclusion: Over all the Group B(Yastiksheera Dhara) is better than Group

A (Sarpi Nasya) in most parameters. The parameter Jrumba is not significant means

this parameter is not necessary for this study. Further study can be conducted by

considering sample by Age, Sex, and Profession and by extending duration of the

treatment.

6. Probable mode of action of the Nasya and Ksheera dhara:

Probable Mode of action of Nasya Karma:

The Mahisha Sarpi was used for Nasya karma in this study. The clear

description regarding the mode of action of the Nasya Karma is not available in

Ayurvedic classics. According to Charaka, Nasa is the gate way of Shirah (Cha. Si.

2/22). The drug administered through nose as Nasya reaches to the brain and iminates

only the morbid Doshas responsible for producing the disease.

The sarpi administered through the Nasa may reach up to the Shringataka

Marma present inside the Nasa srotas and from there it may spread all over the Shiras

as it is the meeting place of siras related to Nasa, Shrota, Akshi, Kanta.

The head in lowering position may help in the retention of medicine in

Nasopharynx, which may help in providing sufficient time for local drug absorption

and lipid soluble substance has great chance for passive absorption through the cell of

lining membrane. In this present study, Mahisha sarpi was used and as it was a lipid

substance, may get absorbed through cell membranes of Nasal lining. The

enhancement in absorption may expect by Pre and Post facial massage and sudation

as it is explained that it increases the local blood circulation. The efferent vasodilator

nerves, which are spread out on the superficial surface of face, receive stimulation by


Discussion


fomentation and may increase the blood flow to the brain i.e. momentary hyperemia.

So, it can be stated that the modus operandi of nasya karmas has a definite impact on

central neurovascular system and likely to lower the blood brain barrier, which makes

possible the absorption of Mahisha sarpi in the brain tissue.

Probable Mode of Action of Shirodhara:

The mode of action of Yasti Ksheera Shirodhara may be understood in the

following lines:

♦ Effect through Relaxation

♦ Effect through the drugs used for Shirodhara

Effect through Relaxation:

Forehead is the area where Sthapani Marma is situated. Stimulation through

Shirodhara to Marma may exert action over pituitary gland which is the master gland

of endocrine system. Apart from this Ajna Chakra is also situated in the forehead.

When the medicine poured from particular height the relaxation of frontalis muscle

tends to normalize the body mechanism. This results in decrease in the activity of

sympathetic nervous system with lowering heart rate, respiration, blood pressure,

muscle tension, brain cortisone and adrenalin level.

Shirodhara makes the patient to concentrate over this area by which patient

may get stability of mental functions and provides relaxation. It is well evident that

the Shirodhara provides relaxation to the persons subjected to it.

When the medicine is poured from a particular height certain amount of

pressure is exerted over the area. Also some amount of Kinetic energy may be

produced. This may stimulate the nerves, tactile and thermo receptors.

Discussion

Effects of the drugs used for the Shirodhara

Bhrajaka Pitta situated in Avabhasini (Stratum Conium) layer of skin utilizes

and enables the digestion of medicines used for the Shirodhara. Thus the veerya of the

medicine absorbed by stratum conium goes through the hair follicles and spreads all

over the body through Tiryak gami Dhamani. This will result in the Samprapti

Vighatana of the disease.

Certain amount of drug absorption is possible by the topical applications when

they are in lipid media. There are few possible routes for absorption. Route of

penetration is through the follicular pores to the follicles and then to dermis via

sebaceous glands. The permeability of sebaceous gland is greater than that of granular

layer of epidermis.

In Yasti siddha Ksheera Dhara, the medicine is suspended in the lipid media,

which enhances the drug absorption. When it poured to the forehead there will be

maximum absorption of the drug. In this way the veerya of the Yastimadhu along

with Ksheera, which are used for the Shirodhara may absorbed and enter in the blood

and may do the Samprapti vighatana.

The results obtained in Nasya therapy group were maintained with slight

improvement in the values during treatment. But in the Yastiksheera dhara group

there was high improvement seen during follow-up period, remained just as before the

start of the treatment. Hence, Yastiksheera dhara was better than Nasya in providing

overall improvement in Nidranasha.


Conclusion

CONCLUSION

• Sarpi Nasya and Yasti ksheera Dhara can be practiced safely without any

adverse effect.

• Overall the group B is more effective clinically and statistically than group A

in almost all the parameters.

• Sarpi Nasya can be done on large samples, so that definite conclusions can be

drawn as the present study is limited to small sample of 30 patients.


Summary

SUMMARY

The thesis entitled “The Effect of Sarpi Nasya and Yastiksheera Dhara in

Nidranasha – A Comparative Clinical study” comprises following parts.

1. Introduction

2. Objectives of the study

3. Review of literature

4. Methodology

5. Observation and results

6. Discussion

7. Conclusion

Introduction:

In this part includes importance of Sarpi Nasya and Yastiksheera dhara in Nidranasha and about the disease entity Nidranasha and its prevalance and regarding Insomnia.

Objectives of the study:

(1) To evaluate the efficacy of Nasya karma in Nidranasha. (2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha. (3)To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya in

Nidranasha

It includes need for the study, objectives of the study, previous research works

on Nidranasha, conclusions of previous works on Nidranasha and reasons behind

selection of specific therapy for this disease with Sarpi Nasya and Yastiksheera dhara.

Review of literature:

This part includes mainly historical review of Sarpi Nasya, Yastiksheera dhara

and Nidranasha. Description regarding nirukti and paribhasha of Nasya and

Dharakarma, various Nasya bhedas, yogya-ayogya, procedure to perform Nasya and


Summary

Dhara along with Pariharakala. Review of Nidranasha includes disease etymology,

nirukti, classifications, nidana, purvaroopa, rupa, samprapti, upashaya-anupashaya,

pathya-apathya etc. Description regarding the Insomnia, its disorder and different

treatments.

In the drug review description concerning about properties and preparation of

Murchita ghrita, Yastimadhu ksheera paka and Murchita tila taila.

Study Design: The study design set for the present study is ‘A Comparative Clinical

Study’.

Sample size and Grouping: The sample size for the present study was 30 patients

suffering from Nidranasha as per the selection criteria and was randomly distributed

to both the groups of equal size. In Group A, 15 patients received Sarpi Nasya and in

Group B, 15 patients received Yastiksheera Dhara.

Inclusion criteria: Patients suffering from classical signs and symptoms as

complaining of reduction in sleep time, Difficulty in Initiating Sleep, Wakefulness

during Normal Sleep, Any of the above (or) all of the above will be included.

Exclusion criteria: Nidranasha due to other conditions like Madatyaya, Nidranasha

due to Abhigata, Pregnant Woman, Lactating Mothers, Associated with any other

systemic and metabolic disorder, Severe Psychic disorder and with Kaphaja Vikaras

were excluded.

Study duration: In Group A, Sarpi Nasya was administered for 7 days and follow up

period was 14 days. Total study duration was 21 days.

In Group B, Yastiksheera Dhara was administered for 7 days and follow up

period was 14 days. Total study duration was 21 days.

Posology:


Summary

Nasyakarma: 8 drops in each nostril as Marsha Nasya – madhyama

matra.was done

Dharakarma: Total 1 to 11/2 litres of Yasti ksheera was done.

Methods of Assessment of Clinical Response: Subjective parameters and objective

parameters were made out to assess the Clinical response.

Subjective Parameters: Anganmarda, Shirogaurava, Jrumbha, Sleeplessness,

Difficulty in Initiating Sleep, Sleep Quality, Performance of Daily Activities, Vitality

After Morning Awakening,

Objective parameters: Total Sleep time, Wakefulness during Sleep, Sleep History

Question

Result: All these parameters of baseline data to post-medication data (22nd day) were

compared for clinical assessment of the results.

In this study, in Group A two patient (13.33%) shown Good response (> 75%

improvement in subjective and objective parameters) where 10 patients (66.66 %)

were shown Moderate response (50-75% improvement in subjective and objective

parameters) and 03 (20.00 %) were shown Poor response (<50% improvement in

subjective and objective parameters).

In Group B, 12 patients (80.00 %) were shown Good response (> 75% improvement

in subjective and objective parameters) and 03 patients (20.00 %) were shown

Moderate response (50-75% improvement in subjective and objective parameters).

Among all parameter the Difficulty in Initiating Sleep had shown the highest

percentage (65.7%) improvement in group A and in Group B the Shirogaurava

(100.0%), Difficulty in Initiating Sleep (97.3%) had shown highest percentage (73.4

%) of improvement. The Parameter Jrumbha had shown the 100% improvement in

both groups.


Summary

Statistical Analysis:

To know compare the effectiveness of the treatment procedure, the statistical

analysis is done by using Un-paired t-test, by assuming that the mean effect treatment




Jrumbha parameter there is no significance difference after the treatment.



procedure is same in both groups in all the parameters. From the analysis all

parameters shows highly significant as P<0.05. From the analysis in Group B the

parameter Angamarda, Shirogaurava, Difficulty in initiating Sleep, Sleep Quality,

Performance of Daily Activity, Vitality after Morning Awakening, Total Sleep Time,

Wakefulness during Sleep and Sleep Question shows more highly significant than

Group A. In Group A the parameter Jrumbha and Sleeplessness shows more highly

significant than Group B. But the parameter PDA shows equal effect in Group A and

Group B.

Conclusion: Over all the Group B is better than group A in most parameters. The

parameter Jrumbha is not significant means this parameter is not necessary for this

study. Further study can be conducted by considering sample by Age, Sex, and

Profession and by extending duration of the treatment.

Methodology:


Summary

This possesses about the selection criteria, study design, plan of the study,

posology, subjective and objective parameters and grading for assessment criteria’s.

Observation and result:

It includes observation on all demographic data’s with their percentage and

graphical representation about the same, regarding the observation nidanas,

purvaroopas, lakshanas and results of individual symptoms followed overall response

of the treatment.

Discussion:

Nidranasha vis-à-vis Insomnia, Discussions on the materials and methods,

Discussion on clinical study, Discussions on the patients of Nidranasha, who

undergone the trial, Mode of Action of Sarpi Nasya and Yastiksheera Dhara,

Discussion on Sarpi Nasya and Yastiksheera Dhara.

Conclusion:

This is the last part of the present study. This section comprises of the

Conclusion on the whole study.


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50. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 20th, shloka no.7, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.288. 51. (a) Prof P.V.Tewari edited Kasyapa Samhita, Siddhisthana, Chapter 2nd, Sloka.no.17 – 19, Reprint 2002, Pub: Chaukhambha Visvabharati, Varanasi, Page no 269. (b) Prof P.V.Tewari edited Kasyapa Samhita, Siddhisthana, Chapter 4th, Sloka no.3 Reprint 2002, Pub: Chaukhambha Visvabharati, Varanasi, Page no 287. 52. Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter 8th, Sloka.no.2, 11 & 24, fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no. 222, 224 & 225. 53. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita (Dalhana), Chikitsasthana, Chapter 40th, Sloka no.44 - 45, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556. 54. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shloka no.22, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.227. 55. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 2nd, shloka no.23, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.690. 56. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.24, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.555. (b) Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter 8th, Sloka.no.3, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no.222. 57. (a) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana (Indu), Chapter 29th, shloka no.16, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.225. 58. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.36, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana (Arunadhatta), chapter 20th, shloka no.16, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.290. (c) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shloka no.18, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.226.


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59. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 9th, shloka no.93, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.722. 60. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 2nd, Sloka no.22, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.690. 61. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.54 - 55, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.557. (b) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 2nd, shloka no.20, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.689. (c) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 20th, shloka no.11 - 13, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.289. 62. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 9th, shloka no.98, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.723. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.25 - 55, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.555. (c) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shloka no.15, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.225. (d) Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter 8th, Sloka.no.47, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no. 228. 63. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.25, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.555. 64. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 9th, shloka no.101 - 102, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.723. (b) Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter 8th, Sloka.no.47 - 53, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no. 228. 65. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 9th, shloka no.102, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.723.


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66. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 9th, shloka no.108 - 110, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.723. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.32 - 35, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556. (c) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 20th, shloka no.22, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.291. (d) Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter 8th, Sloka.no.47 - 53, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no. 228. 67. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.31, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556. 68. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 9th, shloka no.106, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.723. 69. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.30, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556. 70. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 9th, shloka no.104, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.723. 71. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 20th, shloka no.20 - 24, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.291. 72. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 30th, shloka no.2, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.227. 73. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 30th, shloka no.7, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.228. 74. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.18, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.554.


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(b) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana (Indu), Chapter 30th, shloka no.17, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.230. 75. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 20th, shloka no.22, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.291. 76. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.32 - 36, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556. 77. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.56 - 57, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.557. 78. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasasthana, Chapter 6th, Sloka no.18 - 20, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.372. 79. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 2nd, shloka no.22, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.690. 80. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasasthana, Chapter 6th, Sloka no.28, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.372. 81. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shloka no.3, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.223. 82. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.40, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556. 83. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shloka no.2 - 3, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.223. 84. Ross & Willson (1981): Foundation of Anatomy and Physiology, 5th edition, Pub: ELBS, London 85. Ashtavaidyan Vayaskara N.S.Mooss produced Ayurvedic Treatments of Kerala, Chapter 5th, Second edition 1946, Pub: Vaidya Sarathy, Kottayam, Page.no.35.

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86. P.S.Varier produced Chikitsa Samgraham, Sixth edition 2004, Pub: Arya Vaidya sala, Kottakal, Page.no.137.

87. a, Chapter 2nd, Second edition 2008, Pub: Jaya Publications, Akola (M.S), Page.no.15.

88. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 22nd, Sloka no.11, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.120. 89. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 22nd, Sloka no.23, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.301. 90. Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter 11th, Sloka.no.122, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no. 249. 91. Keraleeya chikitsa samgraham by P.K.Krishna Varier and S.Subrahmanian, Vasudevavilasam publications, Trivandrum. 92. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasasthana, Chapter 9th, Sloka no.9, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.385. 93. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasasthana, Chapter 6th, Sloka no.25, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.373. 94. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 21st, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.118. 95. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sutrasthana, Chapter 24th, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.113. 96. amhita, Sutrasthana, Chapter 25th, Sloka.no.40 – 49, Reprint 2002, Pub: Chaukhambha Visvabharati, Varanasi, Page.no.57.

97. Prof. Priya Vrat Sharma edited Bhela Samhita, Chikitsasthana, Chapter 23rd, Reprint 2005, Pub: Chaukhambha Visvabharati, Varanasi, Page.no.445. 98. Ramavalamba Shastri edited Harita Samhita, Chikitsasthana, Chapter 15th, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.297.

Dr.Polepally Yadaiah edited Clinical Panchakrm

Prof P.V.tewari edited Kasyapa S


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99. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 11th, Sloka.no.35, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.74. 100. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 8th, Sloka.no.3 - 4, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.55. 101. (a) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shloka no.27, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.91. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 7th, shloka no.52, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.140. 102. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sutrasthana, Chapter 24th, Sloka.no.7 Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.114. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasthana, Chapter 24th, Sloka.no.32 Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.358. 103. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 21st, Sloka.no.36, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.118. 104. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 21st, Sloka.no.59, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.119.

105. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.33 Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.358.

106. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 21st, Sloka.no.51, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.119 107. Prof P.V.Tewari edited Kasyapa Samhita, Kilasthana, Chapter 5th, Sloka.no.7, Reprint 2002, Pub: Chaukhambha Visvabharati, Varanasi, Page no 484. 108. Sri Brahmasankara Misra and Sri Rupalalaji Vaisya edited Bhavaprakasha, Prathama bhaga, Chapter 3rd, Sloka no.317, Eleventh edition 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.60.


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109. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 21st, Sloka.no.35, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.118. 110. Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Purvakandha, Chapter 6th, Sloka.no.24 - 25, fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no. 30. 111. Ramavalamba Shastri edited Harita Samhita, Chikitsasthana, Chapter 1st, Sloka.no.53, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.453. 112. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.31 or 34, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.352. 113. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shloka no.49, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.94. 114. Prof P.V.Tewari edited Kasyapa Samhita, Sutrasthana, Chapter 28th, Sloka.no.32, Reprint 2002, Pub: Chaukhambha Visvabharati, Varanasi, Page.no.86. 115. Ramavalamba Shastri edited Harita Samhita, Sharirasthana, Chapter 1st, Sloka.no.54, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.453. 116. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.33, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.358. 117. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.56, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.360. 118. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 8th, Sloka no.28, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.153. 119. Prof. Priya Vrat Sharma edited Bhela Samhita, Chikitsasthana, Chapter 21st, Sloka.no.1 – 6, Reprint 2005, Pub: Chaukhambha Visvabharati, Varanasi, Page.no.431. 120. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shloka no.7, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.87. 121. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 21st, Sloka.no.58, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.119.


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122. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shloka no.49, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.94. 123. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 11th, Sloka.no.35, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.74. 124. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 21st, Sloka.no.36 - 38, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.118. 125. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 20th, Sloka.no.11, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.113. 126. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.33, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.358. 127. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shloka no.27, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.91. 128. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 7th, Sloka no.52, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.140. 129. Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Purvakandha, Chapter 7th, Sloka.no.112, 119 & 122, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no.40, 41 & 41. 130. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 25th, Sloka.no.40, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.132. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Uttarasthana, Chapter 55th, Sloka.no.16, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.777. (c) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shloka no.53 - 56, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.94. (d) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 4th, Sloka no.12, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.55.


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(e) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 7th, Sloka no.62 - 63, Ninth edition, and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.143. (f) Ramavalamba Shastri edited Harita Samhita, Threetiyasthana, Chapter 15th, Sloka.no.4, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.298. 131. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 11th, Sloka.no.45, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.76. 132. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Nidanasthana, chapter 2nd, Sloka no.42, Ninth edition, and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.454. 133. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 21st, Sloka.no.55 - 57, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.119. 134. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.42, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.359. 135. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Nidanasthana, chapter 7th, Sloka no.62 - 63, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.143. 136. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shloka no.41 - 42, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.93. 137. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Chikitsasthana, Chapter 28th, Sloka.no.19, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.617. 138. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 7th, Sloka.no.23, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.50. 139. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Uttarasthana, Chapter 55th, Sloka.no.16, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.779. 140. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 9th, Sloka no.50 - 53, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.95.


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(b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya, Sutrasthana, chapter 7th, Sloka no.64, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.143. 141. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sharirasthana, Chapter 4th, Sloka.no.34, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.323. 142. Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Purvakandha, Chapter 7th, Sloka.no.32, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no.34. 143. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Chikitsasthana, Chapter 24th, Sloka.no.88, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.491. 144. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shloka no.44 - 46, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.93. 145. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 21st, Sloka.no.52 -54, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.119. 146. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 25st, Sloka.no.45, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.132. 147. A.C.Guyton text book of Medical Physiology, 8th edition 1991, Pub: W.B.Saunders Company - USA (Prism Books Pvt, Ltd, Bangalore, India), Page.no.659. 148. C.C.Chatterji – Human Physiology, 11th edition, Indian Allied Medical Agency, Vol – I, Page.no.265 149. Alexander Z.Golbin, Howard M.Kravitz and Louis G.Keith edited Sleep Psychiatry, First edition and imprint 2005, Pub: Taylor & Francis Group, USA. 150. Oxford Dictionary, Produced in Great Brtian in 1998, reprinted in 2007, Pub: dorling Kindersely Limited and Oxford University Press, London, Page.no.780. 151. www.wrongdiagnosis/insomnia.com. 152. (a) Kaplon and Sadock’s Synopsis of Psychiatry, Chapter 24th, Eighth edition 1998, Pub: B.I.Waverly Pvt.Ltd, New Delhi, Page.no.737. (b) R.S.Satoskar edited Pharmacology and Pharmacotherapeutics, Chapter 6th, Sixteenth edition 1999, Pub: Popular Prakashan Private Limited, Mumbai, Page.no.100.


Bibliography

153. (a) Vaidya Jadavji Trikamji Acharya edited, Charaka Samhitha, Sutrasthana, chapter 27th, Sloka.no.286-288, Reprint 2004, Pub: Choukambha Sanskri, Sansthana, Varnasi, Page.no.169-170. (b) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhitha, Sutrasthana, Chapter 45th, Sloka no.112, Reprint 2004, Pub: Choukambha Krishnadas academy Varanasi, Page.no.205. (c) Dr. G.S. Pandey edited Shri. Bhavamishra, Bhavaprakasha Nighantu, Tailavarga, Shloka.no.2-7, 6th Edition, Pub: Chaukhambha Bharati Academy,1982. Varanasi, Page.no.779. 154. Dr.Ramachan Dra Reddy M.D edited Bhaishajya Kalpana Vijnanam, Chapter.5, 1st Edition, Pub: Chaukhambha Sanskrit Bhawana,1998, Varanasi, Page.no.371. 155. (a) Ramavalamba Shastri edited Harita Samhita, Threetiyasthana, Chapter 8th, Sloka.no.75, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.62. (b) Prof.Priyavrata Sharma and Dr.Guru Prasada Sharma edited Kaiyyadeva nigantu, Grita varga, Sloka.no.273, first edition 1979,Pub: Chaukhambha Orientalia, Varanasi, Page.no.369. (c) Dr.Indradev Tripathi and Dr. Daya Shankar Tripathi produced Yogaratnakara, Gritha varga, Sloka.no.1, Pub: Krishnadas Academy, Varanasi, Page.no.83. 156. (a) Prof P.V.Sharma edited Dravya guna Vijnana vol – 2, Pub: Chaukhambha Bharati Academy, Varanasi, Page.no.253. (b) Dr.K.M.Nadkani’s edited Indian Materia Medica, reprint – 1996, Pub: Popular Prakasha Private Limited, Page.no.582.

157. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 27th, Sloka.no.219, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.165. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharya edited Susruta Samhita, Sutrasthana, Chapter 45th, Sloka.no.55 - 56, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.201. (c) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 6th, shloka no.28, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.39. (d) Pt. Bhisagacharya Harishasthri Paradkara Vaidya edited Astanga Hrudaya, Sutrasthana, chapter 5th, Sloka no.23, Ninth edition and reprint 2005, Pub: Chaukhamba Orientalia, Varanasi, Page.no.69. (e) Ramavalamba Shastri edited Harita Samhita, Threetiyasthana, Chapter 8th, Sloka.no.21, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.24. 158. Bhisagratna Shri Brahmashankar Mishra edited Bhaisajyaratnavali, Chapter 5th, Sloka.no.1287, Eighteen Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.185.


Bibliography

159. Bhisagratna Shri Brahmashankar Mishra edited Bhaisajyaratnavali, Chapter 5th, Sloka.no.1285, Eighteen Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.185. 160. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shloka no.18, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi, Page.no.226. 161. Prof.K.S.Srikantha Murthy translated Sarangadara samhitha, Madyama khanda, Chapter 2nd, Sloka 161, first edition (1984), Pub: Chaukhambha Orientalia, Varanasi, Page no- 75. 162. P.S.Varier produced Chikitsa Samgraham, Sixth edition 2004, Pub: Arya Vaidya sala, Kottakal, Page.no.137. 163. Kaplon and Sadock’s Synopsis of Psychiatry, Chapter 24th, Eighth edition 1998, Pub: B.I.Waverly Pvt.Ltd, New Delhi, Page.no.737.


Special case sheet


SPECIAL CASE SHEET FOR NIDRANAHSA Post Graduate studies and research centre, (Panchakarma)

Shri. D.G.M Ayurvedic Medical College, Gadag Guide: Dr.Suresh Babu M.D (Ayu) Scholar: Dr.G.Deepak. Co-Guide: Dr Santhosh.N.Belavadi. M.D (Ayu)

1. Name of the patient _________________________

2. Father’s / Husband’s Name ___________________

3. Age ______ yrs, Place of Birth _______________

4. Sex 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: ______________

D M Y D M Y 10. Date of schedule initiation Completion

11. Treatment:

12. Result

CONSENT

I am fully educated with the disease and treatment there by I got satisfied. I

accept for medical trail on me happily.

Signature of Patient

Group A Group B

Sarpi Nasya Yastiksheera Dhara

Good Response

Moderate Response

Poor Response

No Response

SL. No O.P.D. No I.P.D. No

M F

Special case sheet

Pradhana Vedana with Duration

SI No Pradhana Vedana P A Avadhi

1 Reduction in sleep time

2 Difficulty in initiating sleep

3 Wakefulness during sleep

Anubanda vedana SI No Anubandhi vedhana Present Absent

1 Jrumbha

2 Shirogaurava

3 Angamarda

4 Jadya

5 Glani

6 Bhrama

7 Apakti

8 Shira shoola

Vyadhi vruttanta Mode of onset

Routine activities affected: Purva vyadhi vruttanta

Factors Yes No Details

Shareerika

Manasika

Chronic Acute

Yes No


Special case sheet

Chikitsa vruttanta:

S.No History Yes No Details

01 Allopathic treatment

02 Ayurvedic treatment

03 Other modalities

Kula vruttanta:

.

Staying away from Home Yes No

Physical disturbances in the family

Yes No

Psychological disturbances in the family

Yes No

Occupational History: Yes No Physical stress Psychological stress Social stress Economical stress Any habit before Sleep (going to bed):

Joint Family Nuclear Family


Special case sheet

Vayaktika vruttanta :

1 Ahara Vegetarian ( ) Mixed ( )

2 Vihara Nature of work : Hard ( ) Moderate ( ) Sedentary ( )

3 Agni Samāgni ( ) Mandagni ( ) Teekshāgni ( ) vishamāgni ( )

4 Kostha Mrudu ( ) Madhyama ( ) Krura ( )

5 Vyasana None ( ) Tobacco ( ) Smoking ( ) Alcohol ( )

6 Artava Regular ( ) Irregular ( ) Menopause ( )

Samanya Pareeksha

Vital examination

Ashta sthana Pareeksha:

01 Heart Rate

/min

02 Resp. rate /min

03 Blood Pressure mm of Hg

04 Body Temp / F

05 Body weight Kgs.

01 Nadi /min

02 Mala

03 Mootra

04 Jihwa

05 Shabda

06 Sparsha

07 Druk

08 Akruti


Special case sheet

C. Dasha vidha Pareekshā

01 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Sama ( )

02 SĀRA Pravara. ( ) Madhyama. ( ) Avara ( )

03 Samhanana Pravara ( ) Madhyama. ( ) Avara ( )

04 Pramana Pravara ( ) Madhyama. ( ) Avara ( )

05 Sātmya Ekarasa. ( ) Sarva rasa ( ) Vyamishra ( )

Rooksha satmya ( ) Snigda satmya ( )

06 Satva Pravara ( ) Madhyama ( ) Avara ( )

07 Ahara Shakti a) Abhyavaharana shakti P ( ) M ( ) A ( )

b) Jarana shakti P ( ) M ( ) A ( )

08 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( )

09 Vaya Bala ( ) Yuva ( ) Vrudda ( )

Nidana:

Aharaja Hetu Viharaja Hetu Manasika Hetu Anya

Rukshanna Divaswapnam Bhaya Vamana

Laghu Ati-Vyayama Chinta Virechana

Sheeta Upavasa/ Langanam

Krodha Shirovirechana

Katu Asukhashayya Manasthapa Rakthamokshana

Alpa/ Pramitha

Vishamaupachara Vyatha Dhatu kshaya

Ati-vyavaya Abhigata

Vegadharana

Laboratory Examination (if any)


Special case sheet

Chikitsa for Group A

Sarpi Nasya – 8 drops in each nostril for 7 days Date of Initiation - Date of Completion -

Days Time of Procedure Observation

1

2

3

4

5

6

7

Chikitsa for Group B

Yastiksheera dhara : -1200ml (approx) for 7 days

Date of Initiation - Date of Completion -

Time of Administration

Days

Starting Completion

Duration

Observation

1

2

3

4

5

6

7


Special case sheet

Assessment of Criteria’s Subjective Parameters

Anubandha vedana Before Treatment After Follow-up Angamarda

Shirogaurava

Jrumbha

Sleeplessness BT AF

No complaint

Disturbed Sleep during night

Gets sleep after taking sedatives

Doesn’t get sleep at all

Difficulty in initiating sleep BT AF

Sleep immediately after go to bed

One hour late sleep after go to bed

Two hours late sleep after go to bed

More than Two hours late after go to bed

Sleep Quality BT AF

Enjoyable sleep

Anxious or agitated before and during sleep

Feeling unfreshed and unrest after sleep

Sleep experience negative and not enjoyable


Special case sheet

Performance of daily activities BT AF

No Disturbance

Slightly Disturbed

Moderately Disturbed

Highly Disturbed

Vitality after morning awakening BT AF

Feeling Freshness

Sleepy or fatigued

Poor concentration

Irritating mind

Objective Parameters Total Sleep Time (hrs) BT AF

Normal sleep (8hrs)

Adequate sleep (8-6hrs)

Inadequate sleep (6-4hrs)

Sleep less than 4hrs

No sleep at night

Wakefulness during sleep (In number) BT AF

No wakefulness

One to two times wakefulness

3 to 4 times wakefulness

More than 4 times wakefulness


Special case sheet

Sleep History Questionnaire

S.No. Questions BT AF

1 Do you nap during the day?

2 Do you have trouble concentrating during the day?

3 Do you trouble falling asleep when you first go to bed?

4 Do you awaken during the night?

5 Do you awaken more than once?

6 Do you awaken too early in the morning?

7 Are you regularly awakened at night by pain or the need to use the bathroom?

8 Does your job require shift changes?

9 Do you drink caffeinated beverages (coffee, tea, or soft drinks)?

10 Have you ever suffered from depression, anxiety or similar problem?

Guide- signature Co-guide signature

Investigator’s signature [G.Deepak]


Special case sheet

Total Assessment of Results: Subjective Parameters:

Parameters Before Treatment

After Follow-up

Angamarda

Jrumbha

Shirogaurava

Sleeplessness

Difficulty in initiation sleep

Sleep Quality


Vitality after morning awakening

Objective Parameters:

Parameters Before Treatment

After Follow-up

Total Sleep Time (hrs)

Wakefulness during sleep (in number)


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