Exploring Shirodhara and Nasya

[Full title: Exploring Shirodhara and Nasya: A Holistic Ayurvedic strategy for addressing Anovulation-Induced Infertility]

[Find the meaning and references behind the names: Low, Rajib, Gandhi, Preeti, Ritu]

CASE REPORT September 2024 Journal of Ayurveda and Integrated Medical Sciences | September 2024 | Vol. 9 | Issue 9 300 Exploring Shirodhara and Nasya : A Holistic Ayurvedic strategy for addressing Anovulation-Induced Infertility Preeti Garg Assistant Professor, Dept. of Prasuti tantra & Stri Roga, Rajib Gandhi Memorial Ayurvedic College & Hospital, Kolkata, West Bengal, India. I NTRODUCTION Fertility challenges are a significant global issue, with infertility affecting about 17.5% of the adult population - roughly 1 in 6 people worldwide, according to the WHO. In developing countries, infertility impacts up to 25% of couples, making it a prevalent concern. Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse. Primary infertility, as a cause of infertility, is reported to affect approximately 2% of all women worldwide. More women are however affected by secondary infertility, Address for correspondence: Dr. Preeti Garg Assistant Professor, Dept. of Prasuti tantra & Stri Roga, Rajib Gandhi Memorial Ayurvedic College & Hospital, Kolkata, West Bengal, India. E-mail: preety.pg 90@gmail.com Submission Date: 14/08/2024 Accepted Date: 23/09/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.9.48 up to 10.5% in certain regions because couples can find it problematic to conceive after having had one or more previous pregnancies. These notwithstanding, treatments like IVF and other assisted reproductive technologies have given new hope for parenthood to millions of couples [1] Ovarian factor is the 2 nd most common cause of infertility and contributes 25-40 % [2] Ovulatory factors play a crucial role in female infertility, accounting for around 40% of all cases. These issues can arise from various conditions affecting hormone levels, such as polycystic ovary syndrome (PCOS), thyroid disorders, or other hormonal imbalances that disrupt normal ovulation. Addressing these factors is essential for improving chances of conception [3] In Ayurveda , infertility in women is referred to as Vandhya . For successful conception, Ayurveda emphasizes the importance of 4 key factors, known as Garbha- Sambhava Samagri . Ritu (Timing): The right timing, both in terms of a woman’s fertile period and intercourse, is crucial for conception. A B S T R A C T Anovulation and low AMH are common causes of female infertility. Anovulation may be caused due to hormonal disorders, PCOS, thyroid disease, extreme levels of stress, or some other medical disorders. In Ayurveda , four factors are essential for successful conception and pregnancy. These are Ritu (fertile & intercourse time), Kshetra (patent reproductive tract), Ambu (nutrition), and Beeja (healthy sperm & ova). All of these, the most essential factor is said to be Beeja , which actually is the Antahpushpai, or ovum. Conception and successful carrying of a pregnancy depend upon all these factors going along in concordance with each other. According to Ayurveda , Anovulation is a category of Beeja Dushti. Shirodhara & Nasya is one of the most effective Ayurvedic treatments which support ovulation. Case study: This 42 year’s female patient was not getting pregnant since the last 7 years. Her cycles were anovulatory as her ovaries did not show the release of eggs at the proper time. On evaluation through follicular scans revealed the presence of multiple small follicles in left ovary and one dominant follicle (size-14 mm) seen in right ovary even on 15 th day of cycle. The AMH of this patient was also very low i.e., 1.39 ng/dl. The treatment given to this patient was an Ayurvedic therapy Shirodhara and Nasyakarma and Shaman-Aushadi. Result: Over the course of threemonths, she achieved a successful pregnancy. Discussion: Present study illustrates how Ayurvedic practices and treatments can significantly contribute for ovulation and fertility. Key words: Anovulation, Infertility, Shirodhara, Nasya, Shatpushpa-Shatavari oil

[Find the meaning and references behind the names: Karma, Seed, Rasa, Red]

Preeti Garg. A Holistic Ayurvedic strategy for addressing Anovulation-Induced Infertility ISSN: 2456-3110 CASE REPORT September 2024 Journal of Ayurveda and Integrated Medical Sciences | September 2024 | Vol. 9 | Issue 9 301 Kshetra (Field): The health of reproductive organs, including the uterus, fallopian tubes, and endometrium, must be optimal. Ambu (Nourishment): The quality of uterine fluid and nourishment of reproductive tissues, particularly Rasa Dhatu , is essential. Beeja (Seed): The vitality and health of both sperm and ovum are critical to reproduction. These factors are interconnected with psychological well-being and balanced Vata Dosha . Imbalances in any of these can lead to Vandhyatva (infertility). Ancient Ayurvedic texts, such as those by Acharya Sushruta, explain Nashtartawa (absence of menstruation or ovulation) as a primary cause of infertility, which can be linked to anovulation, often due to Vata imbalances [4] In this context, Nashtartawa can be likened to anovulation, a condition mainly caused by imbalances in the Vata Dosha , one of the fundamental principles governing the body in Ayurveda . Currently, it is noted that disorders in Artava caused by Vata can lead to a decrease in Artava volume, resulting in weakened Beeja and subsequently no ovulation. Additionally, Pitta plays a crucial role in ovulation by facilitating the transformative changes necessary for follicle maturation. Ayurveda explain wide range of protocols i.e Panchkarma therapies and Shaman Aushad for the management of Beejadushti . Shirodhara & Nasya are Ayurvedic procedure help in getting ovulation. Shridhara , helps soothe the hypothalamus, which activates the regulation of the pituitary gland and regulates the HPO axis by regulation of hormones. It is an external process done by pouring the medicated Kwath or oil on scalp. Nasya Karma , a key component of Ayurveda , involves the therapeutic use of medicated substances administered through the nasal passages. Based on the belief that the nose is a crucial gateway to the head ( Nasa hi Sirsodwaram ), this procedure aims to restore balance among the body's Doshas ( Vata, Pitta, and Kapha ), enhance sensory perception, and alleviate various health issues [5] C ASE S TUDY A 42-year-old female patient sought consultation at Rajib Gandhi Memorial College & Hospital, Kolkata, Gynecology & Obstetrics OPD due to her inability to achieve pregnancy in the last 7 years. Her menstrual cycles were regular, and she had provided her ultrasound (USG) report and several blood test results during her 1 st visit. Upon examination, she was diagnosed with the presence of multiple small follicles in left ovary and one dominant follicle (14 mm) on the 15 th day of cycle. Prior to seeking Ayurvedic treatment, she had already pursued medical advice from an allopathic (conventional) hospital and had undergone a two-month course of letrozole and Injection HCG induction therapy to stimulate ovulation. However, it was not successful. Consequently, she turned to our hospital in search of Ayurvedic management for her fertility concerns. Menstrual History LMP - 21/08/2024 Duration - 3 days Interval - 26-28 days Flow - 2-3 pads per day - fully soaked Clots - Mild, very small size, Pain - absent Color - brownish red Obstetric History - G 1 P 1 A 0 L 1 G 1- FCH X 13 YRS X FTCS Family History - No pertinent family history Past medical history - Patient taking 50 mcg thyroxin since 2011. Past surgical history - FTCS x 13 years back. Personal history Her appetite - Decreased Sleep - disturb (3-4 hours per day) Micturition - clear Bowel - not clear (Constipated)

[Find the meaning and references behind the names: Sara, Mala, Heart, Sheetal, Shakti, Min, Ras, Sama]

Preeti Garg. A Holistic Ayurvedic strategy for addressing Anovulation-Induced Infertility ISSN: 2456-3110 CASE REPORT September 2024 Journal of Ayurveda and Integrated Medical Sciences | September 2024 | Vol. 9 | Issue 9 302 Clinical Findings General examinations Built - Middle Weight - 56 kg Height - 5’3” Pulse - 82/min B.P. - 110 /70 mm of hg Respiration rate - 16/min Temp. - 98.6°F Per abdomen - No tenderness and no organomegaly was detected. Ashthavidha Pariksha Nadi - Vaatpittaja Shabda - Samyak Mala - Sama Sparsha - Sheetal Mutra Pravriti - Samanya Drika - Samanya Jihwa - Sama Aakriti - Sama Dashvidha Pariksha Prakriti (nature) - Vatapittaj Vikriti - Madhyama Sara - Madhyama Samhanana - Madhyama Pramana - Madhyama Satmya - Madhyama Satva - Madhyama Vaya - Yuvati Vyayamshakti - Madhyama Aharashakti - Abhyavarana Shakti (intake of food) - Madhyama Jarana Shakti (digestion) - Madhyam Systemic Examination CVS: Heart sounds (S 1 S 2): Audible and normal Respiratory system: normal bilateral air entry, no added sounds. No abnormality found on other system Breast Examination Bilateral breastno abnormality detected. Investigations 1 Seminal analysis (10/06/2024) - Asthenozoospermia (2% rapid progressive motility). 2 All the routine investigations were done to female patient - 22/08/2022 Hb % - 11.3 gm % TSH - 0.499 microIU/ml Prolactin - 34.23 ng/ml AMH - 1.39 ng/ml SIS (21/08/2022) - Patent B/L tubes Treatment Schedule The treatment was carried out with the following medicines for three months. Shirodhara with Kwath (Decoction) of Jatamansi, Vacha, Aswagandha, Brahmi, Gokarkhmudi, Sarpunkha for 45 min from 12 th -15 th day of cycling . Nasya with Shatpushpa-Shatavari oil from 8 th day to 14 days of periods Shaman Aushadh 1 Phalaghrita Pana - 10 ml followed with 200 ml of milk at night (15 th -30 th day of cycle) 2 Pushpadhanva Ras - 2 tab bd before food (2 nd – 14 th day of cycle) 3 Chitrakadi Vati - 2 tab bd after food (10 th – 14 th day of cycle) 4 Castor oil - 10 ml with milk (10 th – 14 th day of cycle) After 3 months of this treatment, patient missed her periods. Then we done UPT test at OPD on 21/09/2024, which was positive.

[Find the meaning and references behind the names: Master]

Preeti Garg. A Holistic Ayurvedic strategy for addressing Anovulation-Induced Infertility ISSN: 2456-3110 CASE REPORT September 2024 Journal of Ayurveda and Integrated Medical Sciences | September 2024 | Vol. 9 | Issue 9 303 R ESULT Pic 1: Dated: 09/07/2024- No mature dominant follicle and ovulation occurred even on 15 th day of cycle. Pic 2: Dated: 04/10/2024-6 weeks 2 days pregnancy positive with normal foetal activity (Foetal heart rate normal) DISCUSSION Ovulation is crucial for a woman's reproductive cycle, and disruptions can significantly affect fertility. Identifying causes such as hormonal imbalances, stress, obesity, and medical conditions is essential for addressing conception challenges. Focusing on these factors is vital for reproductive and overall health. In Ayurvedic terms, Stree Beeja refers to the female ovum, while Beejotsarga relates to ovulation. Ayurvedic treatments like Shirodhara and Nasya can help manage infertility related to Abeejotsarg . Mode of action of Nasya In the practice of Nasya Karma , the way drugs work can be understood as follows: they enter the vital Sringaataka Marma and from there, they disperse into various channels known as Srotases . It's noteworthy that Vriddha Vagbhata was the pioneer in explaining how Nasya Karma functions [6] The term Nasya derives from the Sanskrit word Nasa , meaning the nose. Nasya stimulates the olfactory nerves and the limbic system, which in turn activates the hypothalamus, leading to the stimulation of GnRH neurons. This may help regulate the pulsatile secretion of GnRH, subsequently triggering proper gonadotropin release and promoting ovulation [7] This interplay highlights the significant role of olfactory stimuli in modulating brain functions related to behavior and hormonal regulation. Mode of action of Shirodhara Shirodhara targets vital points on the head, improving blood flow and circulation. The gentle head massage allows medicinal oils or herbal liquids ( Kwath ) to seep into the deeper layers of the scalp, creating a deeply relaxing effect that extends to the peripheral nerves around the forehead. This relaxation reaches the hypothalamus, which plays a crucial role in regulating the pituitary gland - the master regulator of hormones. By promoting this hormonal balance, Shirodhara aids in inducing ovulation. Furthermore, it reduces excessive levels of serotonin and stress hormones like noradrenaline and adrenaline, providing effective stress relief. This makes Shirodhara particularly useful in addressing stress-related conditions such as

[Find the meaning and references behind the names: Sita, Hana, Dhana]

Preeti Garg. A Holistic Ayurvedic strategy for addressing Anovulation-Induced Infertility ISSN: 2456-3110 CASE REPORT September 2024 Journal of Ayurveda and Integrated Medical Sciences | September 2024 | Vol. 9 | Issue 9 304 anovulation, a common cause of infertility in women. The treatment, by calming the nervous system, not only alleviates physical stress but also works on emotional tension, creating a holistic approach to managing reproductive and mental health [8] In Ayurveda , the head ( Shirah ) is regarded as the seat of Prana (life force), connecting all sense organs ( Indriyas ) and known as Uttamanga , or the most vital part. Shirodhara enhances the function of Pranadriyas , [9] which are often affected by psychological disorders. A well-functioning sense system promotes mental health, contributing to overall well-being and healthy ovulation. By calming the mind and balancing the senses, Shirodhara supports the body’s reproductive processes and hormonal balance, ensuring both body and mind remain healthy [10] This entire process is believed to have a role in stimulating the (H-P-O) axis, which in turn stimulates hypothalamus leading to stimulation of GnRH neurons. This may regularize GnRH pulsatile secretion which in turn triggers proper gonadotropin secretion leading to Ovulation [11] When the HPO axis is not functioning correctly, it can hinder the release of mature eggs from the ovaries, causing anovulation. Mode of action of drugs used in this case [12] S N Name of the drug Rasa Veerya Vipaka Karma 1 Jatamans i Tikta, Kasaya Sita Katu Medhya, Nidrajanan, Manasrogahar 2 Ashwaga ndha Tikta, Kasaya Ushna Madhura Rasayan, Balya, Vajikarana, Vatahara 3 Vacha Katu, Tikta Ushna Katu Dipani, Medhya 4 Brahmi Madhura, Tikta, Kashyam Sita Madhura Medhya, Rasayan, Vatahara, Prajasthapana, Ayushya 5 Gorakhm undi Madhura, Katu, Tikta, Kashyam Ushna Katu Medhua, Vatashamak, Asradosha 6 Sarpunkh a Tikta, Kasaya Ushna Katu Vatanulomana, Asrajit, Shwasahara, Rasayan 7 Shatpush pa Katu, Tikta Ushna Katu Shothhara, Vatanulomana, Deepan, Rasayan, Artavjanan 8 Shatavari Madhura, Tikta Sita Madhura Medhya, Rasayan, Agnipushtikara , Stanyakara 9 Erand oil Madhur, Katu, Kashyam Usna Madhura Anulomana, Dipana,Srotoso dhana,Amapac hana Mode of action of drugs used in this case SN Name of Preparation Properties 1 Pushpadhanva Ras [13] Tridosha-Shamak, Deepan, Pachan, Beeja Dushtihar, Vatashamak, Correct the Dhatavagni, Helps in follicle maturation and Ovulation 2 Phala Ghritam [14] Yoni-Doshahara, Shukra-Doshahar, Ayusham, Medhya, Promotes fertility, Arrest recurrent abortion 3 Chitrakadi Vati [15] Tridosha-Shamak, Deepan, Pachan, induces ovulation, Helps in ovulation CONCLUSION Ayurveda offers a holistic approach to treating anovulatory infertility, especially when conventional methods like ovulation induction have failed. It focuses on rebalancing the body's natural rhythms and addressing root causes. While there are anecdotal successes, more extensive research is needed to

[Find the meaning and references behind the names: Prakasan, Rajesh, Asokan, Anil, Madrid, Kumar, Ayu, Jun, Ganesh, Ayush, Nil, Med, Prakashan]

Preeti Garg. A Holistic Ayurvedic strategy for addressing Anovulation-Induced Infertility ISSN: 2456-3110 CASE REPORT September 2024 Journal of Ayurveda and Integrated Medical Sciences | September 2024 | Vol. 9 | Issue 9 305 confirm its effectiveness. Therapies like Shirodhara and Nasya , which use herbal treatments, aim to restore hormonal balance. Overall, Ayurveda presents a promising alternative, though further studies are necessary to support its role alongside modern medicine. REFERENCES 1 Katole A, Saoji AV. Prevalence of primary infertility and its associated risk factors in urban population in central India. [IJCM] Indian journal of community medicine[internet].2019. 2 Insler V, Lunenfeld B. Infertility: Male and Female. 2 nd ed. Edinburgh, London, Madrid, Melbourne, New York and Tokyo: Churchill Livingstone; 1999 3 D. C. Dutta; Textbook of Gynaecology, 8 th edition, chapter Amenorrhoea; Pg-412. 4 Sushrut Samhita of maharishi Sushrut edited by ayurveda Tattva sandipika Hindi commentary by Kaviraj Ambikadutta shastri; Sharir sthana 2/35, part 1, pg- 21; Chaukhamba Sanskritsansthan, Varanasi, reprint 2016. 5 Vagbhata kruta Ashtang Hridaya, Sarth Vagbhat, Sutrasthana, 19 th chapter Shasrakarmavidhi Adhya, 29/2, edited by Ganesh Krushna Garde, Rajesh Prakashan, Pune, 2012 pp 111 6 Ashtanga Hrudayam 20/1; Vidyotini Hindi Commentary; Page.no.172; Chaukhambha Prakasan, Varanasi; Edition: 2011 7 Ashtanga Hrudayam 20/1; Vidyotini Hindi Commentary; Page.no.152; Chaukhambha Prakasan, Varanasi; Edition: 2011 8 Anil Kumar, et.al. Stress: Neurobiology, consequences and management; J Pharm Bioallied Sci. 2013 Apr-Jun; 5(2): 91 – 97. 9 Vagbhata. Rasaratna Samuchchaya (Vidyotini Hindi commentary). Kulkarni DA, editor. 4 thed. New Delhi: Meharchand Publication; 1997. Chapter, 2/23-27.pg 23 10 Bramhanand Tripathi, Charak Samhita, Part 1, Sutra- Sthana, Kiyant shirashiyadhyay, 12/17; page no- 335. 11 Hallie Levine – How Stress Can Hurt Your Chances of Having a Baby https://www.webmd.com/baby/features/infertilitystress#1 12 The Ayurvedic Pharmacopeia of India, Government of India, Ministry of health and family welfare, Department of AYUSH, Part-I, Volume-I-IV 13 Asokan V.A. Review on effectiveness of Pushpadhanva rasa in anovulatory factor of infertility, WJPR 2019 14 The Ayurvedic Pharmacopeia of India, Government of India, Ministry of health and family welfare, Department of AYUSH, Part-II, Volume- I, pg- 120-123 15 K Shukla et. Al., Evaluation of the role of Chitrakadi Vati in the management of Bandhyatva w.s.r to anovulation (as a consequence of unruptured follicle), AYU 2009 ******************************* How to cite this article: Preeti Garg. Exploring Shirodhara and Nasya: A Holistic Ayurvedic strategy for addressing Anovulation-Induced Infertility. J Ayurveda Integr Med Sci 2024;9:300-305. http://dx.doi.org/10.21760/jaims.9.9.48 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2024 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

Other Health Sciences Concepts:

[back to top]

Discover the significance of concepts within the article: ‘Exploring Shirodhara and Nasya’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:

Ayurveda, Kshetra, Ambu, Nasya, Shirodhara, Ritu, Nasyakarman, Vatadosha, Mental health, Ayurvedic, Medicated oil, Conception, Sense-organ, Ayurvedic treatment, Menstrual cycle, Internal process, Patient, Emotional tension, Infertility, Reproductive processes, Female infertility, Hormonal imbalance, Acharya Sushruta, Ayurvedic Management, Reproductive health, Ayurvedic Therapy, Shirodhara therapy, Female patient, Ovulation induction, Anovulation, Ovulatory factor, Ayurvedic text, Hormonal regulation, PCOS, Hormonal balance, Beeja, Ayurvedic practice, Stress, Anovulation infertility, Ovulation, Dominant follicle, Stress relief, Health issue, HPO Axis, Ayurvedic procedure, Stress hormone, Ovum, Reproductive tissue, Medical disorder, Reproductive tract, Nasal passage, GnRH Neurons, Key factor.