E-ISSN:2456-3110

Case Report

Chittodvega

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 3 MARCH
Publisherwww.maharshicharaka.in

Understanding the treatment modalities of Generalized Anxiety Disorder (Chittodvega) - A Single Case Study

Manral S1*, Verma P2, Mishra P3, KK Sharma4
DOI:10.21760/jaims.10.3.61

1* Shiwani Manral, Post Graduate Scholar, Rishikul Campus, Haridwar, Uttarakhand Ayurved University, Dehradun, Uttarakhand, India.

2 Princi Verma, Post Graduate Scholar, Rishikul Campus, Haridwar, Uttarakhand Ayurved University, Dehradun, Uttarakhand, India.

3 Pankaj Mishra, Post Graduate Scholar, Rishikul Campus, Haridwar, Uttarakhand Ayurved University, Dehradun, Uttarakhand, India.

4 KK Sharma, Professor and HOD, Rishikul Campus, Haridwar, Uttarakhand Ayurved University, Dehradun, Uttarakhand, India.

Generalized anxiety disorder is a mental health disorder that produces fear worry and a constant feeling of being overwhelmed. It is characterized by excessive, persistent and unrealistic worry about everyday things. This worry could be multifocal such as finance, family, health and future. It is excessive, difficult to control, and is often accompanied by many non-specific psychological and physical symptoms. Excessive worry is the central feature of GAD. It is evident from textual references that the Acharyas knew different forms of mental status. Among all those terms, Chittakshobha, Asvastha Chitta, Anavasthita Chitta, Chittodvega are indirectly towards the meaning of anxious status. However, Chittodvega is more applicable term to illustrate whole anxious status. A case report of 28year old female patient with chief complaints of Unexplained Stress, Overthinking, Headache followed by increased irritability and Anger issues, palpitations on and off received medication in modern medicine which caused adverse effects and dependency. Panchakarma therapies coupled with Samshamana medication and Yoga module has been proved effective in Manas Roga. Hence in this study, Shirodhara for 14 days and Nasya in two sittings for 7 days each was given along with Samshaman Ausadhi for 1 month. The subjective parameters scale i.e., Hamilton anxiety scale, were compared before and after treatment.

Keywords: Chittodvega, Generalized anxiety disorder, Nasya, Yoga, Shirodhara

Corresponding Author How to Cite this Article To Browse
Shiwani Manral, Post Graduate Scholar, Rishikul Campus, Haridwar, Uttarakhand Ayurved University, Dehradun, Uttarakhand, India.
Email: 		Manral S, Verma P, Mishra P, KK Sharma, Understanding the treatment modalities of Generalized Anxiety Disorder (Chittodvega) - A Single Case Study. J Ayu Int Med Sci. 2025;10(3):398-402.
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https://jaims.in/jaims/article/view/4156/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-02-14 2025-02-27 2025-03-07 2025-03-17 2025-03-27
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© 2025 by Manral S, Verma P, Mishra P, KK Sharma and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Download PDFBack To ArticleIntroductionCase ReportResultDiscussionConclusionReferences
Shiwani M et al. Treatment modalities of Generalized Anxiety Disorder

Introduction

Anxiety disorders, as defined by Harrison’s principles of internal medicine is “a subjective sense of unease, dread, or foreboding, can indicate a primary psychiatric condition or can be a component of, or reaction to, a primary medical disease”.[1] Chittodvega is mentioned by Acharya Charaka in the Vimana Sthana, in the context of physical and psychic Doshas and their vitiators. But the detailed description of the disease is not available in the classics. The term Chittodvega comprises of two words i.e., Chitta + Udvega (i.e., Anxious state of mind).

Anxiety disorder, as defined by Harrison’s principles of internal medicine is “a subjective sense of unease, dread, or foreboding, can indicate a primary psychiatric condition or can be a component of, or reaction to, a primary medical disease”.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) specifically describes GAD as excessive worry and apprehensive expectations, occurring more days than not for atleast 6 months, about a number of events or activities, such as work or school performance etc.[2]

Global Burden-GAD a common variant of anxiety disorders has 5-6% prevalence in general population.[3]

The anxiety and worry are associated with three (or more) of the following six symptoms (with atleast some symptoms having been present for more days than not for the past 6 months)[4]:

  • Restlessness or feeling keyed up or on edge.
  • Being easily fatigued
  • Difficulty concentrating or mind going blank.
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty in falling or staying sleep or restless, unsatisfying)

Patient’s Demographic Profile

Name: xxxx
Age/Sex: 28yr/F
OPD No.: Py -6241/30100
Occupation: Housewife
Religion: Christian
Address: Haridwar

Case Report

According to patient, she was apparently well 7months back. Then she gradually started worrying unnecessarily in her routine work, overthinking about small things ending up with headache since last 7months, since 5months she has complaint of aggravated anger issues, & palpitations in on-off pattern. She took allopathic treatment from AIIMS Rishikesh for 2months & got temporarily relief but she used to feel dizzy whole day while taking those medicines so she left them & her symptoms got more pron. after withdrawal of her medications. With these complaints patient came to Rishikul Campus on 26/09/2024 for further management.

Treatment History - The patient took some Ayurvedic medicines on & off Allopathic medications

1. Tab Clonazepam 0.5mg
2. Tab Alprazolam 0.5mg

Family History - Patient’s elder sister has same kind of same complaints.

No. of siblings - None of the parent has same kind of symptoms

  • one elder sister (affected)
  • one younger brother (healthy)

Patient did not have any kind of psychiatric illness history in the family

Personal History

Appetite: Reduced
Thirst: Normal
Bowel: Occasionally loose stools
Micturition: Normal
Sleep: Disturbed x 5months
Diet: Mixed

General Examination

Pallor: Not Present
Icterus: Not Present
Clubbing: Not Present
Cyanosis: Not Present
Lymphadenopathy: Not Present
Edema: Present

Vital Examination

Blood Pressure: 128/80mmHg
Pulse rate: 88/min
Respiratory rate: 18/min


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Shiwani M et al. Treatment modalities of Generalized Anxiety Disorder

Weight: 58kg
Temperature: 98.6°F

Ashtavidha Pariksha

1. Nadi - Vata Pradhan Pitta Anubandhi
2. Mala - Aniyamit, Avbadhha
3. Mutra - Samanya (4-5 Times a day, No burning sensation)
4. Jivha - Nirlepit (white coated)
5. Shabda - Bahuvaak
6. Sparsha- Khara (dry), Alpa Ushna (warm)
7. Drika - Pittabh Shweta (yellowish white)
8. Aakriti- Madhyam

Dashvidha Pariksha

1. Prakriti-Vata Pitta
2. Vikriti- Vata Rajah
3. Sara- Mamsa Sara
4. Samhanana- Madhyam
5. Pramana - Madhyam
6. Satva -Avar
7. Satmya- Sarvarasa Satmya
8. Ahara Shakti - Alpa
9. Vyayama Shakti- Avara
10. Vaya- Yuva

Systemic Examination

Gastro-intestinal system: Soft, Non- tender
Respiratory system: Bilateral chest clear
Cardiovascular system: S1 and S2 heard normal
Central nervous system: Conscious, well oriented to time and place and person.

Samprapti Ghataka

Nidana - Vishama Ahara, Ruksha Sheeta Ahara-Vihara, Diwaswapna, Ratrijagran, Ati Chintan, Katu Tikta Rasa Atisevana, Krodha
Dosha - Manas- Rajah, Tamah (predominantly Rajah)

  •   Sharirik- Vata, Pitta (predominantly Vata )

Dushya - Manas, Sarvadhatu Prakopanam
Srotas - Rasavaha, Sangyavaha Srotas
Adhisthana - Mana (Hrudaya)
Rogamarga - Madhyama-Marga
Sadhyasadhyata - Kriccha Sadhya
Updrava - Sarvadosha Prakopnam, Unmadadi Manovikara

Vyadhi Vinishchay (Provisional Diagnosis) - Chittodvega, Poorvarupa of Unmada, Attatvabhinivesh

Treatment

1. Samshamana Chiktisa
2. Panchakarma Therapies
3. Yoga

Table 1: Treatment Plan

Samshamana Chiktisa

  • Jatamansi Phanta 50ml (empty stomach in morning)
  • Tab. Chintamani Chaturmukh Ras 1BD
  • Tab. Brahmi Vati 1HS
  • Tab. Bravobol Forte 1BD

Shodhana Chiktisa

  • Shirodhara with Brahmi Taila - 14days
  • Nasya with Brahmi Taila -7 days
  • Yoga (15min daily) - Anuloma Viloma Pranayama, Nadi Suddhi pranayama, Yoga Nidra, Om chanting and Sukshma Vyayama

Table 2: Treatment protocol

DateChikitsa
26/09/2024
  • Jatamansi Phanta 50ml (empty stomach in morning)
  • Tab.Chintamani Chaturmukh Ras 1BD
  • Tab.Brahmi Vati 1HS
  • Shirodhara with Brahmi Taila - 14days
  • Nasya with Brahmi Taila - 7 days
  • Yoga (15min daily) - Anuloma Viloma Pranayama, Nadi Suddhi Pranayama, Yoga Nidra, Om Chanting and Sukshma Vyayama
05/10/2024
  • Jatamansi Phanta 50ml (empty stomach in morning)
  • Tab.Chintamani Chaturmukh Ras 1BD
  • Tab.Brahmi Vati 1HS
  • Yoga (15min daily) - Anuloma Viloma Pranayama, Nadi Suddhi Pranayama, Yoga Nidra, Om Chanting and Sukshma Vyayama
15/10/2024
  • Smritisagar Rasa 1BD
  • Tab. Brahmi Vati 1HS
  • Nasya with Brahmi Taila - 7 days
  • Yoga (15min daily) - Anuloma Viloma Pranayama, Nadi Suddhi Pranayama, Yoga Nidra, Om chanting and Sukshma Vyayama
22/10/2024
  • Tab. Bravobol Forte 1BD
  • Yoga (15min daily) - Anuloma Viloma Pranayama, Nadi Suddhi Pranayama, Yoga Nidra, Om chanting and Sukshma Vyayama

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Assessment Criteria - Hamilton anxiety rating scale (HAM-A)

The Hamilton Anxiety Rating Scale (HAM-A)[5] is a widely used and well-validated tool for measuring the severity of a patient's anxiety. The scale consists of 14 substances; each item is scored on a scale of 0 (not present) to 4 (severe), 14 with a total score range of 0-56, where

  • <17 indicates mild severity,
  • 18–24 mild to moderate severity
  • 25–30 moderate to severe.

Table 3: Hamilton Anxiety Rating Scale

SNHAM-A SubstanceBTAT
1.Anxious Mood32
2.Tension32
3.Fear31
4.Insomnia31
5.Difficulties in concentration and memory31
6.Depressed Mood10
7.General somatic symptoms10
8.General somatic symptoms: sensory10
9.Cardiovascular symptoms10
10.Respiratory symptoms00
11.Gastrointestinal Symptoms10
12.Gastro urinary symptoms00
13.Other autonomic symptoms
Dryness of the mouth, blushing or pallor, sweating and dizziness		00
14.Behaviour during interview20
Total247

Follow-up

The follow-up was carried after 1 month to rule out remission of disease and adverse reaction. No sign of remission were found. She was advised to continue Pranayama in daily routine.

Result

Significant relief has been observed in symptoms.

Discussion

According to a survey done in 2017, around 197.3 million people in India suffered from mental disorders, constituting 14.3% of the total population.[6] Anxiety disorders are most prevalent among all psychiatric condition in the world. Generalized Anxiety disorders (GAD) most common occurring mental illness.

The term Chittodvega has been used by Charaka more classically and listed under Manas Dosha Vikara. Acharya Sushruta has mentioned that, systematically performed Nasya Karma can cause clarity of sense organs, sound sleep, cheerful appearance etc. and give mental and sensorial happiness.[7] In Chittodvega functions of mind are disturbed. As Dravya we used do have Snehana property, when given through nasal route, it pacifies Vata, if Vata is controlled Raja is easily balanced and ultimately leads to balanced state of Manas. Medhya drugs used for Nasya like Brahmi, Shankhapushpi etc. may give synergistic action helping to correct mental and intellectual functions. Brahmi has an action against anxiety. It has an anxiolytic action as well as antidepressant effect.[8] Yoga reduces stress and anxiety by improving autonomic functions via triggering neuro hormonal mechanisms that suppress sympathetic activity through down regulation of hypothalamic-pituitary-adrenal (HPA) axis.[9] Hathyoga Pradipika holds that Manas of Indriyas and Vayu is master of Manas. It is simple, cost effective and easy to manifest. In Dhara therapy, prolonged and intermittent stimulation by dripping oil may provide afferent inputs to cerebral cortex, leading to a tranquilizing effect. The continuous dripping of oil on forhead may induce somato autonomic reflex through thermos sensors and pressure sensors in skin or hair follicles via trigeminal cranial nerve. The effect of Shirodhara on hormone secretion can also be postulated considering effect on hypothalamus as hypothalamus is main controller of endocrine secretions. These later release dopamine, Nor adrenaline and Serotonin.[10]

SNName of the MedicineComponentKarma
1.Chintamani Chaturmukha Rasa[11]Rasa Sindoora, Lauha Bhasma, Abhraka Bhasma Kumari, Eranda, Swarna BhasmaPacify Vata Dosha
Mental and Neurological disorders, cardiotonic, regulate bowel movements
2.Smritisagar Rasa[12]Tamra Bhasma, Suddha Shila, Brahmi Svarasa, Jyotishmati Taila,Balance Tridosha, Manas Roga, Unmada, Smritikshaya
3.Brahmi Vati[13]Svarna Bhasma, Brahmi, Vacha, Shankhapushp, Giloya, JatamansiAnxiolytic, sleep inducing, improve cognitive functions
4.Bravobol ForteJyotishmati, Brahmi, Ashwagandha, Sarpagandha, ShankhpushpiRelieve anxiety and mental fatigue, improves immune function, treats debility and stress
5.Jatamansi PhantaJatamansiBalance Pitta, induces sleep, Medhya, lower blood pressure, treats headache

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Conclusion

The main theory of treating this ailment is to pacify Vata Dosha which subsequently pacify Rajah Dosha. The current case study demonstrates the efficaciousness of Nasya Karma, Shirodhara along with Samshamana Chikitsa work effectively. The case study presented here demonstrates a notable decline in the condition during a brief period of time.

References

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