Introduction

In this era of modernization and busy lifestyle due to excessive work pressure, academic burden, negative impacts of social media, substance abuse, etc. there is rapid progression of mental illness in society. Generalised Anxiety disorder (GAD) is one such mental disorder that is spreading rapidly but is neglected by many people due to social stigma and lack of mental healthcare awareness. Anxiety disorder is the world’s most common mental disorder, affecting almost 301 million people in 2019.^[1]

Women are more likely to experience an anxiety disorder than men. Antidepressant medications in the contemporary medical system, such as selective serotonin reuptake inhibitors (SSRIs) are used for treating adults with anxiety disorders but shows systemic side effects and drug dependency in the long run. Chittodvega, classified as a Mano-Vikara (~psychological disorder) in Ayurveda, can be correlated with generalised anxiety disorder.^[2]

Chitta means Mana or Buddhi and Udvega means Bhaya or Udgamana. So Chittodvega is anxious stage of mind. Asatmya-Indriyartha Sanyoga (~unwholesome contact with the object of senses) and Pragyaparadh (~intellectual blasphemy) are some of the Nidana (~causative factor) of Manovaha Srota Vikara (~mental disorders).^[3] It is described as one of the Vatajananatmaja Vikara.^[4]

The disturbance of Vata Dosha and manas Dosha (Rajas and Tamas) plays a critical role in its manifestation. Herein, a 38-year-old woman was treated with Shirodhara and Pada-Abhyanga for 14 days followed by Shamana Aushadi after discharge. There were significant changes in Hamilton’s Anxiety Rating Scale (HAM-A) along with other symptoms.

Case Report

Chief complaints: A 38-year-old married, working woman had complaints of excessive worry, forgetfulness, lack of concentration and headache since last 8 years. Associated complaints: Disturbed sleep and constipation since last 2 years. History of present illness: The patient started experiencing excessive worry 8 years back which aggravated along with lack of concentration due to excessive work pressure for last 6 years.

Therapeutic Intervention

Table 1: Plan of Panchakarma

Figure 1: Shirodhara

Figure 2: Padabhyanga

Table 2: Shamana Aushadhi after discharge.

Shamana Aushadhis were prescribed on discharge for 15 days. 1^st follow up was done on 30th day after discharge.

Follow-Up and Outcome

The patient got significant relief from symptoms as the treatment progressed. The episodes of headache decreased and the quality of sleep improved after the course of Shirodhara therapy. The bowel became laxed and regular.

Taila Dhara done with lukewarm oil; stimulates the Marma points which helps in vasodilatation thus improving blood circulation of the brain and the Autonomic Nervous System. The Sthapani Marma corresponds anatomically to the level of the hypothalamus, pineal gland, and pituitary gland. Oscillatory movement during the process creates vibrations and pressure over the forehead. The vibrations are amplified by the hollow sinus of the frontal bone which are transmitted inwards via CSF. Vibration along with temperature - activates the function of the thalamus which helps balance the amount of serotonin and catecholamine released and produces a tranquilizing effect. Acharya Caraka has mentioned Shankhapushpi (Convolvulus pluricaulis) a Medhya Rasayana.^[9] It is Katu, Kashaya in Rasa, Guru, Snigdha, Sara, Picchila in Guna, Ushana in Virya and Madhura in Vipaka. Its Karma are Medhakrita, Swarakara, Graha-Bhuta-Doshahara. It balances Tridosha and is Nootrophic. Padabhyanga; According to Acharya Susruta Is Nidrakaraka, Shramahara, Chakshuprasadana etc.^[10] Vata Dosha resides in the Sparshan Indriya, which is located in the Twacha (~skin).^[11] So, Padabhyanga with Taila does Vatashamana. Also, according to Acharya Vagbhata, 4 important sira in the sole of the feet are connected to the head.^[12] Oil massage increases the secretion of dopamine and serum serotonin which relaxes the mind and induces sleep. Also, message stimulates blood circulation and reduces fatigue. Ashwagandha (Whithamnia sominifera) is Tikta, Madhura Rasa, Laghu, Snigdha Guna, Ushna Virya, Madhura Vipaka, Kapha-Vata Shyamak.^[13] Its Karma are Brimghaniya, Sukrakara, Rasayana, Balya etc. Study showed; various properties like anti-inflammatory, hepatoprotective, antibacterial, sedative, anxiolytic, diuretic, aphrodisiac etc. Active principles of Ashwagandha like sitoindosides and Withaferin-A - showed significant anti-stress activity against acute models of experimental stress. Yastimadhu (Glycerriza glabra) has Madhura Rasa, Guru Guna, Shita Virya and Madhura Vipaka and is Vata-Pitta Shamak.^[14] Acharya Caraka has mentioned it under Medhya Rasayana and advised to take in the form of Churna along with milk to get its utmost benefits.^[15] Licorice contains a flavonoid called glabrol, which binds to GABA receptors in the brain, promoting relaxation and potentially aiding sleep. Brahmi Vati has Brahmi, Shankhapushpi, Vacha, Maricha etc.