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|title=Shirodhara

|titlemode=append

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|keywords=Shirodhara, Shirodhara meaning, Shirodhara in ayurveda, charak samhita, caraka samhita online, Adarsh P. M., Deole Y.S., Basisht G., Shirodhara Classification, shirodhara Types, Indications of shirodhara, Contra indications of shirodhara,

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|keywords=Shirodhara, Shirodhara meaning, Shirodhara in ayurveda, charak samhita, caraka samhita online, Adarsh P. M., Deole Y.S., Basisht G., Shirodhara Classification, shirodhara Types, Indications of shirodhara, Contra indications of shirodhara, treatment of psychosomatic diseases, treatment of psychiatric diseases, anxiety neurosis, anxiety treatment, stress treatment

|description=Shirodhara (also known as shiraseka or shiraparisheka) literally means therapeutic streaming overhead.

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|type=article

}}

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Shira means head and dhara means to stream or to pour. Thus, shirodhara (also known as shiraseka or shiraparisheka) literally means therapeutic streaming overhead. It is the procedure of pouring a suitable liquid on the forehead in a synchronized and rhythmic manner for a stipulated period. The reference from [[Samhita|samhita]] for shirodhara is available under [[Murdhni taila|murdhni taila]] (oil applications to head). Various decoctions, milk, butter milk, sugarcane juice, [[Ghee|ghee]], oil etc. are used for shirodhara either in medicated or unprocessed forms. Conceptually shirodhara is indicated for eruptions on head having multiple openings/furunculosis, pricking type of pain in head (shirasthoda), burning sensation (daha), suppuration (paka) and wounds (vranas). [A. Hri. [[Sutra Sthana~~|Sutra Sthana]]~~ 22/24]. In all these conditions there is association of pitha dosha. So, it can be assumed that the procedure of shirodhara is mainly pacifying the [[Pitta dosha|pitta dosha]]. The medicines are chosen based on associated [[Dosha|doshas]]. For example the group of four unctuous substances or sesame oil alone in [[Vata dosha|vata]], [[Ghee|ghee]] and milk in pitha and decoction, sesame oil ,and butter milk in [[Kapha dosha|kapha]]. Shirodhara is said to have greater effect than head massage (shirobhyanga) and lesser effect than therapeutic procedure of placing tampon with oil over head region (shiropichu).[A.Hri [[Sutra Sthana~~|Sutra Sthana]]~~ 22/23] This is based on the pacification of [[Vata dosha|vata dosha]] (vata shamana) property of the procedure as the session deals with the various oil applications of head where shirobasti is considered the supreme. This article deals with conceptual understanding and practical application of shirodhara.

+

Shira means head and dhara means to stream or to pour. Thus, shirodhara (also known as shiraseka or shiraparisheka) literally means therapeutic streaming overhead. It is the procedure of pouring a suitable liquid on the forehead in a synchronized and rhythmic manner for a stipulated period. The reference from [[Samhita|samhita]] for shirodhara is available under [[Murdhni taila|murdhni taila]] (oil applications to head). Various decoctions, milk, butter milk, sugarcane juice, [[Ghee|ghee]], oil etc. are used for shirodhara either in medicated or unprocessed forms. Conceptually shirodhara is indicated for eruptions on head having multiple openings/furunculosis, pricking type of pain in head (shirasthoda), burning sensation (daha), suppuration (paka) and wounds (vranas). [A. Hri. Sutra Sthana 22/24]. In all these conditions there is association of pitha dosha. So, it can be assumed that the procedure of shirodhara is mainly pacifying the [[Pitta dosha|pitta dosha]]. The medicines are chosen based on associated [[Dosha|doshas]]. For example the group of four unctuous substances or sesame oil alone in [[Vata dosha|vata]], [[Ghee|ghee]] and milk in pitha and decoction, sesame oil ,and butter milk in [[Kapha dosha|kapha]]. Shirodhara is said to have greater effect than head massage (shirobhyanga) and lesser effect than therapeutic procedure of placing tampon with oil over head region (shiropichu).[A.Hri Sutra Sthana 22/23] This is based on the pacification of [[Vata dosha|vata dosha]] (vata shamana) property of the procedure as the session deals with the various oil applications of head where shirobasti is considered the supreme. This article deals with conceptual understanding and practical application of shirodhara.

{{Infobox

|title = Contributors

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|data1 = Concepts/[[Panchakarma]]/[[Shirodhara]]

|label2 = Authors

−

|data2 = Adarsh P. M. 1, Deole Y.S. 2

+

|data2 = Adarsh P. M. 1, [[Yogesh Deole|Deole Y.S.]]2

|label3 = Reviewer & Editor

−

|data3 = Basisht G.3

+

|data3 = [[Gopal Basisht|Basisht G.]]3

|label4 = Affiliations

|data4 = 1 [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India 2 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India 3 Rheumatologist, Orlando, Florida, U.S.A.

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== Etymology and derivation ==

−

The word shirodhara comprises two words viz shiras and dhara. ‘Shiras’ means head and ‘dhara’ means pouring liquids on the [[Sharira|body]] (seka). The word dhara comes from the Sanskrit root ‘dhr’ (dhr +nich+ang) which means falling of liquid.<ref name="ref3">Raja Radhakanthadeva Bahadur, Sabdakalpadruma,edited by Varadaprasadavasu.2nd edition. Delhi. Naga publishers. 2003.Volume 2, p-795.</ref> Thus, shirodhara is pouring liquid on the head.

+

The word shirodhara comprises two words viz shiras and dhara. ‘Shiras’ means head and ‘dhara’ means pouring liquids on the [[Sharira|body]] (seka). The word dhara comes from the Sanskrit root ‘dhr’ (dhr + nich + ang) which means falling of liquid.<ref name="ref3">Raja Radhakanthadeva Bahadur, Sabdakalpadruma,edited by Varadaprasadavasu.2nd edition. Delhi. Naga publishers. 2003.Volume 2, p-795.</ref> Thus, shirodhara is pouring liquid on the head.

== Synonyms ==

−

Shiraseka, Parisheka [A. Hr. [[Sutra Sthana~~|Sutra Sthana]]~~ 22/23-26], Murdhaseka, Anusechana [Su. Sa. [[Sharira Sthana|Sarira Sthana]] 10/21], Parishechana [Cha.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 6/105], Avaseka [Cha.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 5/181].

+

Shiraseka, Parisheka [A. Hr. Sutra Sthana 22/23-26], Murdhaseka, Anusechana [Su. Sa. [[Sharira Sthana|Sarira Sthana]] 10/21], Parishechana [Cha.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 6/105], Avaseka [Cha.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 5/181].

== Classification ==

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=== Takra dhara (therapeutic streaming of butter milk) ===

−

Here medicated takra (butter milk) is used for shirodhara. It is indicated in diseases having [[Kapha dosha|kapha]] [[Pitta dosha|pitta]] vitiation. The drugs which are cold in touch/potency are indicated for shirodhara in headache due to vitiated pitta (paittika shirobhitapa)). [A. Hr. Uttara Sthana 24/11]

+

Here medicated takra (butter milk) is used for shirodhara. It is indicated in [[Vyadhi|diseases]] having [[Kapha dosha|kapha]] [[Pitta dosha|pitta]] vitiation. The drugs which are cold in touch/potency are indicated for shirodhara in headache due to vitiated [[Pitta dosha|pitta]] (paittika shirobhitapa)). [A. Hr. Uttara Sthana 24/11]

=== Ksheera dhara (therapeutic streaming of milk) ===

−

As the name suggests, medicated or non-medicated milk is advised for shirodhara in [[Pitta dosha|pitta]] associated diseases of [[Vata dosha|vata]]. The milk processed with dashamula is indicated for therapeutic streaming overhead in headache due to vitiated [[Vata dosha|vata dosha]] (vatika shirobhitapa). [A. Hri. Uttara Sthana 24/3]

+

As the name suggests, medicated or non-medicated milk is advised for shirodhara in [[Pitta dosha|pitta]] associated [[Vyadhi|diseases]] of [[Vata dosha|vata]]. The milk processed with dashamula is indicated for therapeutic streaming overhead in headache due to vitiated [[Vata dosha|vata dosha]] (vatika shirobhitapa). [A. Hri. Uttara Sthana 24/3]

=== Kwathadhara (therapeutic streaming of decoction) ===

−

Here, the liquid used is decoction (kwatha) which pacifies both [[Vata dosha|vata]] and [[Kapha dosha|kapha]] ([[Vata dosha|vata]] [[Kapha dosha|kapha]] shamana). In vatarakta associated with burning sensation, boiled and cooled decoction of jivaniya group of drugs is advised for therapeutic streaming. [Cha.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 29/126]

+

Here, the liquid used is decoction (kwatha) which pacifies both [[Vata dosha|vata]] and [[Kapha dosha|kapha]] ([[Vata dosha|vata]] [[Kapha dosha|kapha]] shamana). In [[Vatarakta Chikitsa|vatarakta]] associated with burning sensation, boiled and cooled decoction of jivaniya group of drugs is advised for therapeutic streaming. [Cha.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 29/126]

=== Jaladhara (therapeutic streaming of water) ===

−

Even the use of mere cold water can give benefits of the shirodhara procedure in the case of paithika rogas (diseases having origin from [[Pitta dosha|pitta dosha]]). Therapeutic streaming of cold water (shita jala) is indicated for bleeding hemorrhoids. [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 14/218]

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Even the use of mere cold water can give benefits of the shirodhara procedure in the case of paithika rogas ([[Vyadhi|diseases]] having origin from [[Pitta dosha|pitta dosha]]). Therapeutic streaming of cold water (shita jala) is indicated for bleeding hemorrhoids. [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 14/218]

== Types of shirodhara based on reusage.<ref name="ref1">Pavana Jayaram, Manoj Sankaranarayana, Dharakalpa, Karaliya cikitsa padhati. Kanyakumari.Ayurvedic Educational &Charitable trust.</ref> ==

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!'''Reusage'''

|-

−

|~~Uthama~~

+

|Uttama

−

|fresh sneha each day

+

|fresh sneha each day

|-

|Madhyama

−

|same sneha for 3 days

+

|same sneha for 3 days

|-

|Adhama

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<li>Suppurations in the scalp</li>

<li>Ulcerations of the scalp</li>

−

<li>Burning sensation [A. Hri. [[Sutra Sthana~~|Sutra Sthana]]~~ 22/25] </li>

+

<li>Burning sensation [A. Hri. Sutra Sthana 22/25] </li>

−

<li>The diseases affecting the upper parts of the [[Sharira|body]] (neurological diseases).</li>

+

<li>The [[Vyadhi|diseases]] affecting the upper parts of the [[Sharira|body]] ([[Neurological diseases|neurological diseases]])</li>

−

<li>stress, psychic and psychosomatic diseases like psychosis, neurosis, epilepsy, irritable bowel syndrome.</li>

+

<li>stress, psychic and psychosomatic diseases like psychosis, neurosis, epilepsy, irritable bowel syndrome</li>

<li>Insomnia </li>

−

<li>Generalized anxiety disorders.</li>

+

<li>Generalized anxiety disorders</li>

−

<li>Addition disorders like alcoholism</li>

+

<li>Addition disorders like [[Madatyaya Chikitsa|alcoholism]]</li>

−

<li>Excess sweating, hypertension.</li>

+

<li>Excess sweating, hypertension</li>

<li>Syncope</li>

−

<li>Exhaustion without exertion.</li>

+

<li>Exhaustion without exertion</li>

−

<li>Loss of consciousness</li>

+

<li>Loss of [[Chetana|consciousness]]</li>

<li>Enlargement of glands</li>

<li>Diabetes</li>

<li>Autoimmune skin diseases like psoriasis, dandruff, and chronic eczema.<ref name="ref4">Dr Vasant C Patil, Principles and Practice of Panchakarma.1st ed. Ilkal,Bagalkot.Atreya Ayurveda publications.2010.p.161</ref></li></ul>

−

== Contra indications of shirodhara<ref name="ref1" /> ==

−

<ul style="text-align:justify;"><li>Shirodhara is not indicated in diseases arising out of dominance of [[Kapha dosha|kapha dosha]].</li>

+

<ul style="text-align:justify;"><li>Shirodhara is not indicated in [[Vyadhi|diseases]] arising out of dominance of [[Kapha dosha|kapha dosha]].</li>

<li>It is not advised during extreme hot and cold seasons.</li>

<li>It is not advised at the time of mild increase of [[Dosha|doshas]].</li>

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!Quantity

|-

−

|Dhara patra (pot)

+

|Dhara patra (pot)

|1

|-

−

|Dhara stand

+

|Dhara stand

|1

|-

−

|Dhara droni (table)

+

|Dhara droni (table)

|1

|-

−

|Suitable liquids like oil, butter milk or milk

+

|Suitable liquids like oil, butter milk or milk

−

|1.5 liter

+

|1.5 liter

|-

|Gauze

|1

|-

−

|Cotton ear plugs

+

|Cotton ear plugs

|2

|-

−

|Soft pillow covered with rexin

+

|Soft pillow covered with rexin

|1

|-

−

|Hot water for bath

+

|Hot water for bath

−

|Q. S

+

|Q. S

|-

|Vessels

|3

|-

−

|Rasnadi churna for tala

+

|Rasnadi churna for tala

|5g

|-

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|2

|}

+

== Dhara dravya according to diseases<ref name="ref2">Puthiyedath Raman Menon, Sirassekadi vidhi. Edited by Dr M Prasad.1st ed. Thrissur: Vaidyabhooshanam Raghavan Thirumulpad Foundation for Ayurvedic Studies,2009.</ref> ==

{| class="wikitable"

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!'''Dharadravya'''

|-

−

|Klama, daha

+

|Klama, daha

−

|Coconut water

+

|Coconut water

|-

−

|Pittaja vikara

+

|Pittaja vikara

−

|Cold water/milk

+

|Cold water/milk

|-

|Vata pittottara

−

|Ghee

+

|[[Ghee|Ghee]]

|-

−

|~~Vathadhika~~, arumshika

+

|Vatadhika, arumshika

−

|Sesame oil

+

|Sesame oil

|}

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|-

|Kevala vata

−

|Chatusneha (oil, [[Ghee|ghee]], muscle fat, bone marrow)

+

|Chatusneha (oil, [[Ghee|ghee]], muscle fat, bone marrow)

|-

−

+

|oil and [[Ghee|ghee]] in equal proportion

|-

−

|[[Kapha dosha|Kapha]] associated with [[Vata dosha|vata]]

+

|[[Kapha dosha|Kapha]] associated with [[Vata dosha|vata]]

−

|Oil (2 parts) + [[Ghee|ghee]] (1 part)

+

|Oil (2 parts) + [[Ghee|ghee]] (1 part)

|-

|[[Pitta dosha|Pitta]]

−

|Different types of milk

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|Different types of milk

|}

== Preparation of butter milk for takra dhara ==

−

Two pala(96g) of Musta (Cyperus rotundus) or Yashtimadhu (Glycyrrhiza glabra) boiled in two prastha (1536ml) of milk and eight prastha(6144ml) of water and reduced up to two prastha(1536ml) by suspending them into liquid in a bag of thin cloth. The bag is also squeezed well at the end of boiling. The medicated milk thus obtained is cooled and fermented overnight. Decoction of four pala(192g) of amalaka (Emblicus officinalis) is prepared by boiling it with four prastha (3072ml) of water and reduced to one prastha(768ml). This decoction is mixed with the curd formed and churned to obtain the butter milk. This takra is used for dhara.

+

Two pala(96g) of [[Musta|Musta (Cyperus rotundus)]] or [[Yashtimadhu|Yashtimadhu (Glycyrrhiza glabra)]] boiled in two prastha (1536ml) of milk and eight prastha(6144ml) of water and reduced up to two prastha(1536ml) by suspending them into liquid in a bag of thin cloth. The bag is also squeezed well at the end of boiling. The medicated milk thus obtained is cooled and fermented overnight. Decoction of four pala(192g) of [[Amalaki|amalaka (Emblicus officinalis)]] is prepared by boiling it with four prastha (3072ml) of water and reduced to one prastha(768ml). This decoction is mixed with the curd formed and churned to obtain the butter milk. This takra is used for dhara.

== Preparation of medicated milk ==

−

2 prastha(1536ml) of cow’s milk along with 8 prastha(6144ml) of water and add 1 pala(48g) each of the roots of bala (Sida cordifolia) and shatavari (Asparagus racemosus) which is tied up in a muslin bag into the mixture and boiled over gentle fire till the total quantity reduced to that of milk. It is then diluted with an equal quantity of fresh tender coconut water after it is completely cooled.

+

2 prastha(1536ml) of cow’s milk along with 8 prastha(6144ml) of water and add 1 pala(48g) each of the roots of bala (Sida cordifolia) and [[Shatavari|shatavari (Asparagus racemosus)]] which is tied up in a muslin bag into the mixture and boiled over gentle fire till the total quantity reduced to that of milk. It is then diluted with an equal quantity of fresh tender coconut water after it is completely cooled.

== Preparation of instrument of shirodhara yantra ==

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== Pradhana karma (therapeutic procedure) ==

−

<ul style="text-align:justify;"><li>The physician/therapist should stand on the right side of the patient.</li>

+

<ul style="text-align:justify;"><li>The [[Vaidya|physician]]/therapist should stand on the right side of the patient.</li>

<li>The liquid used for streaming at the desired temperature should be filled into the pot.</li>

−

<li>The hole of pot should be blocked with the thumb of physician while filling the pot.</li>

+

<li>The hole of pot should be blocked with the thumb of [[Vaidya|physician]] while filling the pot.</li>

<li>The block is released gradually once the pot is positioned.</li>

<li>The lower end of the wick is made to oscillate gently between the either ends of the temples across the forehead.</li>

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!'''Duration'''

|-

−

|Ruksha/[[Pitta dosha|Pitta]] associated [[Vata dosha|vata]] diseases

+

|Ruksha/[[Pitta dosha|Pitta]] associated [[Vata dosha|vata]] [[Vyadhi|diseases]]

|96 minutes

|-

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|72 minutes

|}

+

== Period of reusage of dhara dravya<ref name="ref1" /> ==

The medicated liquids used for dhara can be reused for multiple sessions in the same patient based on their potency and form. The details are given in the following table.

{| class="wikitable"

−

!'''Dhara dravya'''

+

!'''Dhara dravya'''

−

!'''Period of reusage'''

+

!'''Period of reusage'''

|-

|Kwatha(decoction)

−

|1 day

+

|1 day

|-

|Milk

−

|1 day

+

|1 day

|-

−

|Tender coconut water

+

|Tender coconut water

−

|1 day

+

|1 day

|-

|Dhanyamla

−

|3 days

+

|3 days

|-

|Sneha

−

|Sneha should be changed after 3 days, and then fresh sneha must be used for the next 3 days and on the seventh day both can be mixed and used.

+

|Sneha should be changed after 3 days, and then fresh sneha must be used for the next 3 days and on the seventh day both can be mixed and used.

|}

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<li>Hot butter milk processed with spices, [[Ghee|ghee]] and soup of pulses should be given to drink.</li>

<li>Light to digest in restricted quantity is advised.</li>

−

<li>Also, the diet and regimen advised during internal oleation (snehapana) must be followed.</li></ul>

+

<li>Also, the diet and regimen advised during internal [[Snehana (unction therapy)|oleation (snehapana)]] must be followed.</li></ul>

== Possible complications<ref name="ref1" /> ==

<ul style="text-align:justify;"><li>Burning sensation (daha) may be produced due to excess sudation (atisweda).</li>

−

<li>Erysipelas (visarpa). Possible reason may be sweda during impaired metabolism (samavastha)</li>

+

<li>[[Visarpa Chikitsa|Erysipelas (visarpa)]]. Possible reason may be [[Sweda|sweda]] during impaired metabolism (samavastha)</li>

<li>Pain (ruk) may be produced by pouring liquid at low temperature.</li>

<li>Syncope (murchha) may be produced due to excess sudation (atisweda).</li>

<li>Loss of voice (svarasada) may be developed by excess streaming of dry and cold liquids like butter milk.</li>

<li>Joint dislocations (sandhidalana) by excess streaming of unctuous substances.</li>

−

<li>Vomiting (chhardi) may be induced by application of unctuous streaming during impaired digestion.</li>

+

<li>[[Chhardi Chikitsa|Vomiting (chhardi)]] may be induced by application of unctuous streaming during impaired digestion.</li>

<li>Bleeding disorder ([[Raktapitta|raktapitta]]) may be produced by streaming oils having excessive hot and sharp potency and excess sudation.</li>

−

<li>Hyperpyrexia (jwara) by application of unctuous streaming during impaired digestion.</li>

+

<li>[[Jwara Chikitsa|Hyperpyrexia (jwara)]] by application of unctuous streaming during impaired digestion.</li>

<li>Urticaria (kotha) may be produced due to excess sudation (atisweda). </li></ul>

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== Importance in preservation of health and prevention ==

Shirodhara with medicated oil and [[Ghee|ghee]] enhances:<ref name="ref1" />

−

<ul style="text-align:justify;"><li>The stability of mind and speech</li>

+

<ul style="text-align:justify;"><li>The stability of [[Manas|mind]] and speech</li>

<li>Strength of the [[Sharira|body]]</li>

−

<li>Increases retaining power of mind.</li>

+

<li>Increases retaining power of [[Manas|mind]].</li>

<li>Gentleness of voice</li>

<li>Softness of skin</li>

<li>Sharpness of vision</li>

−

<li>Nourishment of shukra</li>

+

<li>Nourishment of [[Shukra dhatu|shukra]]</li>

<li>Reduces excess [[Sharira|body]] warming.</li>

−

<li>Induces good sleep. </li>

+

<li>Induces good sleep </li>

<li>Takradhara can prevent premature greying of hair.</li></ul>

== Importance in management of diseases ==

−

<ul style="text-align:justify;"><li>Medicated streaming with unctuous substances (snehadhara) can pacify the diseases arising out of tridosha.</li>

+

<ul style="text-align:justify;"><li>Medicated streaming with unctuous substances (snehadhara) can pacify the [[Vyadhi|diseases]] arising out of [[Tridosha|tridosha]].</li>

<li>Streaming with milk (ksheeradhara) can cure insanity, epilepsy, sleeplessness, burning sensation of head and tension headache.</li>

−

<li>Takradhara can pacify headache, reverse the ~~ojakshaya~~, pacify pricking pain over palms and feet, urinary tract diseases, diseases involving head, eyes, and ears.<ref name="ref1" /> </li></ul>

+

<li>Takradhara can pacify headache, reverse the [[Ojas|oja]] kshaya, pacify pricking pain over palms and feet, urinary tract diseases, [[Vyadhi|diseases]] involving head, eyes, and ears.<ref name="ref1" /> </li></ul>

== Mode of action of shirodhara ==

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=== Effect on psoriasis ===

−

A comparative clinical trial in which 28 patients who had completed the treatments, 15 were in group A (virechana karma followed by shamana yoga) and 13 were in group B (takradhara in the form of shirodhara followed by shamana yoga). Marked improvement was found in 20% of patients in group A, while it was 23.08% of patients in Group B. Moderate improvement was found in 53.33 % of patients in Group A and 14.39 % of patients in Group B. Mild Improvement was found in 26.67 % of patients in Group A and 14.29 % of patients in Group B.<ref name="ref7">Chetan M Gulhane (2011), A Clinical Study of Virechana Karma, Takradhara and Makandi [Coleus forskohlii (Wild) Briq.] Ghanavati in the Management of Ekakushtha (w.s.r. to Psoriasis). Department of a Panchakarma,ITRA, jamnagar</ref>

+

A comparative clinical trial in which 28 patients who had completed the treatments, 15 were in group A ([[Virechana|virechana]] karma followed by shamana yoga) and 13 were in group B (takradhara in the form of shirodhara followed by shamana yoga). Marked improvement was found in 20% of patients in group A, while it was 23.08% of patients in Group B. Moderate improvement was found in 53.33 % of patients in Group A and 14.39 % of patients in Group B. Mild Improvement was found in 26.67 % of patients in Group A and 14.29 % of patients in Group B.<ref name="ref7">Chetan M Gulhane (2011), A Clinical Study of Virechana Karma, Takradhara and Makandi [Coleus forskohlii (Wild) Briq.] Ghanavati in the Management of Ekakushtha (w.s.r. to Psoriasis). Department of a Panchakarma,ITRA, jamnagar</ref>

== Effect on insomnia ==

−

In a comparative clinical trial on insomnia, out of 27 patients who had completed the trial 13 were in group A (Jatamansi tailadhara) and 14 were in group B (Jaladhara group). Among them complete remission, marked improvement was found in one of the patients of group A, moderate Improvement was found in 76.92% and mild Improvement was observed in 15.38% patients. None of the patients remained unchanged. In Jaladhara group, out of 14 patients, none of the patients had complete remission and marked Improvement, while moderate improvement in 85.71% and mild improvement in 14.29% patients were observed. None of the patient remained unchanged in this group.<ref name="ref8">Chinmay P Joshi (2013), Comparative study on the effect of Sneha Dhara & Jala Dhara in Anidra (Insomnia), Department of Panchakarma, GAAC,Ahmedabad</ref> In another research on stress induced insomnia, there were 27 patients who completed the treatment in two groups of dhara. In first group tagaradi kwatha used for shirodhara, whereas mahishi dugdha used for the same in the second group. In Tagaradi Kwatha group, 17 patients completed the course of therapy. Among them complete remission and marked improvement were found in none of the patients, while moderate improvement was found in 23.53% patients and mild improvement was observed in 76.47% patients. None of the patients remained unchanged. In Mahishi Dugdha Dhara Group, out of 10 patients, none of the patients had complete remission, while marked improvement was found in 20% patients; moderate improvement in 60% and mild improvement was observed in 20% patients.<ref name="ref9">Bina H Vansh (2008), A clinical study on Mansika Bhavas in Anidra w.s.r. to stress induced insomnia & its mÃ¢â‚¬â„¢ment with Tagaradi Kwatha & Mahishi Dugdha Shirodhara, Department of Kayachikitsa,ITRA Jamnagar.</ref>

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In a comparative clinical trial on insomnia, out of 27 patients who had completed the trial 13 were in group A (Jatamansi tailadhara) and 14 were in group B (Jaladhara group). Among them complete remission, marked improvement was found in one of the patients of group A, moderate Improvement was found in 76.92% and mild Improvement was observed in 15.38% patients. None of the patients remained unchanged. In Jaladhara group, out of 14 patients, none of the patients had complete remission and marked Improvement, while moderate improvement in 85.71% and mild improvement in 14.29% patients were observed. None of the patient remained unchanged in this group.<ref name="ref8">Chinmay P Joshi (2013), Comparative study on the effect of Sneha Dhara & Jala Dhara in Anidra (Insomnia), Department of Panchakarma, GAAC,Ahmedabad</ref> In another research on stress induced insomnia, there were 27 patients who completed the treatment in two groups of dhara. In first group tagaradi kwatha used for shirodhara, whereas mahishi dugdha used for the same in the second group. In Tagaradi Kwatha group, 17 patients completed the course of therapy. Among them complete remission and marked improvement were found in none of the patients, while moderate improvement was found in 23.53% patients and mild improvement was observed in 76.47% patients. None of the patients remained unchanged. In Mahishi Dugdha Dhara Group, out of 10 patients, none of the patients had complete remission, while marked improvement was found in 20% patients; moderate improvement in 60% and mild improvement was observed in 20% patients.<ref name="ref9">Bina H Vansh (2008), A clinical study on Mansika Bhavas in Anidra w.s.r. to stress induced insomnia & its mÃ¢â‚¬â„¢ment with Tagaradi Kwatha & Mahishi Dugdha Shirodhara, Department of Kayachikitsa,ITRA Jamnagar.</ref>

== Effect on chittodvega (anxiety disorders) ==

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== Effect on shukravrita vata ==

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There were 48 patients who completed the course of trial with 16 patients in each of the 3 groups. Subjects in Group A were treated with placebo, subjects in Group B were treated with Rasayana Yoga (6 gm/day) and subjects in Group C were treated with shirodhara(7 days) and Rasayana yoga. Psychological counseling was given to subjects in all the 3 groups that underwent treatment for a duration of 4 weeks. From the overall effect of therapy, it was gauged that though all the 3. groups showed improvement the maximum improvement was in group C which has combined shirodhara where 10.5% were cured and 79% markedly improved whereas in the other 2 groups. Nobody was cured and only 56.2% markedly improved in group B and none in group A. Thus, it was concluded that ~~Ŝirodhārawith~~ Rasayana Yoga is most effective in the treatment of shukra avrita vata and could even cure the disease.<ref name="ref11">Basil Cardozo (2006), A Clinical Study On Psycho-Somatic Management Of Shukravrita Vata (Premature Ejaculation) With Rasayana Yoga And Shirodhara.Department of Kayachikitsa, ITRA,Jamnagar</ref>

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There were 48 patients who completed the course of trial with 16 patients in each of the 3 groups. Subjects in Group A were treated with placebo, subjects in Group B were treated with Rasayana Yoga (6 gm/day) and subjects in Group C were treated with shirodhara(7 days) and Rasayana yoga. Psychological counseling was given to subjects in all the 3 groups that underwent treatment for a duration of 4 weeks. From the overall effect of therapy, it was gauged that though all the 3. groups showed improvement the maximum improvement was in group C which has combined shirodhara where 10.5% were cured and 79% markedly improved whereas in the other 2 groups. Nobody was cured and only 56.2% markedly improved in group B and none in group A. Thus, it was concluded that shirodhara with Rasayana Yoga is most effective in the treatment of shukra avrita vata and could even cure the [[Vyadhi|disease]].<ref name="ref11">Basil Cardozo (2006), A Clinical Study On Psycho-Somatic Management Of Shukravrita Vata (Premature Ejaculation) With Rasayana Yoga And Shirodhara.Department of Kayachikitsa, ITRA,Jamnagar</ref>

== Current research ==

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Shirodhara has anxiolytic and ASC-inducing effects, and it promotes a decrease of noradrenaline and exhibits a sympatholytic effect, resulting in the activation of peripheral foot skin circulation and immunopotentiation.<ref name="ref12">Uebaba K, Xu FH, Ogawa H, Tatsuse T et al. Psychoneuroimmunologic effects of Ayurvedic oil-dripping treatment. J Altern Complement Med. 2008 Dec;14(10):1189-98. doi: 10.1089/acm.2008.0273.PMID: 19123874.</ref> A pilot study involving twenty participants concluded that the shirodhara with sesame oil improved the sleep quality measured by PSQI score and the score was lower as compared to the scores of shirodhara with warm water after 2 weeks and 6 weeks follow up. Whereas the shirodhara with sesame oil showed improvement with more score on quality of life as compared with shirodhara with warm water. <ref name="ref13">Akiko Tokinobu, Takashi Yorifuji, Toshihide Tsuda et al. Effects of Ayurvedic Oil-Dripping Treatment with Sesame Oil vs. with Warm Water on Sleep: A Randomized Single-Blinded Crossover Pilot Study. J Altern Complement Med. 2016 Jan 1; 22(1): 52–58.doi: 10.1089/acm.2015.0018 PMID: 26669255</ref> In a study conducted among sixteen healthy volunteers on shirodhara using oil containing Centella asiatica (Brahmi), Nardostachys jatamansi (jatamansi), and Withania somnifera (Ashwagandha) in a proportion of 10 mg of aqueous extract of each/ 100 mL of sesame oil, EEG showed an increase in the alfa rhythm after shirodhara. A decrease of beta activity was observed in two subjects, while one subject showed an increase in the central theta activity. The EEG changes are like those observed after deep meditation and alert relaxation. The V.A.S. score and M.A.S. score for stress and mood changed significantly. <ref name="ref14">Kalpana D. Dhuri, Prashant V. Bodhe, Ashok B. Vaidya. Shirodhara: A psycho-physiological profile in healthy volunteers. J Ayurveda Integr Med. 2013 Jan-Mar; 4(1): 40–44.doi: 10.4103/0975-9476.109550 PMID: 23741161</ref> In a comparative clinical study containing two groups involving forty-seven participants, one group has undergone shirodhara and other group had given sarpagandha vati for the management of hypertension. The results in the shirodhara group were better than those in the sarpagandha group. Although both sarpagandha vati and shirodhara helped in reducing systolic and diastolic pressures, the effect of shirodhara was more marked. <ref name="ref15">Chittaranjan Kundu, V. D. Shukla, M. A. Santwani, M.D.et al. The role of psychic factors in pathogenesis of essential hypertension and its management by Shirodhara and Sarpagandha Vati. Ayu. 2010 Oct-Dec; 31(4): 436–441.doi: 10.4103/0974-8520.82035 PMID: 22048535</ref> The comparative study between jatamansi taila dhara group and jaladhara group among thirty-one participants having insomnia have showed good improvement in both groups whereas a better improvement in jatamansi taila group for the chief complaints.<ref name="ref16">Chinmay P Joshi. Comparative study on the effect of Sneha Dhara & Jala Dhara in Anidra (Insomnia). ijam.co.in</ref> In a similar comparative clinical trial involving 137 participants the comparison between the tailadhara group and jaladhara group also revealed that symptoms like insomnia, anxiety etc. were completely relieved by shirodhara. In brief psychiatric rating scale statistically results of the dhara group are highly significant. Tailadhara provided better relief in all most all the symptoms of stress and in brief psychiatric rating scale compared to jaladhara.<ref name="ref17">Tank, N. G. (2015). A Comparative Clinical Study of Jaladhara and Taildhara in the Management of Stress. International Journal of Ayurvedic Medicine, 6(1). https://doi.org/10.47552/ijam.v6i1.532</ref>

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Shirodhara has anxiolytic and ASC-inducing effects, and it promotes a decrease of noradrenaline and exhibits a sympatholytic effect, resulting in the activation of peripheral foot skin circulation and immunopotentiation.<ref name="ref12">Uebaba K, Xu FH, Ogawa H, Tatsuse T et al. Psychoneuroimmunologic effects of Ayurvedic oil-dripping treatment. J Altern Complement Med. 2008 Dec;14(10):1189-98. doi: 10.1089/acm.2008.0273.PMID: 19123874.</ref> A pilot study involving twenty participants concluded that the shirodhara with sesame oil improved the sleep quality measured by PSQI score and the score was lower as compared to the scores of shirodhara with warm water after 2 weeks and 6 weeks follow up. Whereas the shirodhara with sesame oil showed improvement with more score on quality of life as compared with shirodhara with warm water. <ref name="ref13">Akiko Tokinobu, Takashi Yorifuji, Toshihide Tsuda et al. Effects of Ayurvedic Oil-Dripping Treatment with Sesame Oil vs. with Warm Water on Sleep: A Randomized Single-Blinded Crossover Pilot Study. J Altern Complement Med. 2016 Jan 1; 22(1): 52–58.doi: 10.1089/acm.2015.0018 PMID: 26669255</ref> In a study conducted among sixteen healthy volunteers on shirodhara using oil containing Centella asiatica (Brahmi), [[Jatamansi|Nardostachys jatamansi (jatamansi)]], and [[Ashwagandha|Withania somnifera (Ashwagandha)]] in a proportion of 10 mg of aqueous extract of each/100 mL of sesame oil, EEG showed an increase in the alfa rhythm after shirodhara. A decrease of beta activity was observed in two subjects, while one subject showed an increase in the central theta activity. The EEG changes are like those observed after deep meditation and alert relaxation. The V.A.S. score and M.A.S. score for stress and mood changed significantly.<ref name="ref14">Kalpana D. Dhuri, Prashant V. Bodhe, Ashok B. Vaidya. Shirodhara: A psycho-physiological profile in healthy volunteers. J Ayurveda Integr Med. 2013 Jan-Mar; 4(1): 40–44.doi: 10.4103/0975-9476.109550 PMID: 23741161</ref> In a comparative clinical study containing two groups involving forty-seven participants, one group has undergone shirodhara and other group had given sarpagandha vati for the management of hypertension. The results in the shirodhara group were better than those in the sarpagandha group. Although both sarpagandha vati and shirodhara helped in reducing systolic and diastolic pressures, the effect of shirodhara was more marked. <ref name="ref15">Chittaranjan Kundu, V. D. Shukla, M. A. Santwani, M.D.et al. The role of psychic factors in pathogenesis of essential hypertension and its management by Shirodhara and Sarpagandha Vati. Ayu. 2010 Oct-Dec; 31(4): 436–441.doi: 10.4103/0974-8520.82035 PMID: 22048535</ref> The comparative study between jatamansi taila dhara group and jaladhara group among thirty-one participants having insomnia have showed good improvement in both groups whereas a better improvement in jatamansi taila group for the chief complaints.<ref name="ref16">Chinmay P Joshi. Comparative study on the effect of Sneha Dhara & Jala Dhara in Anidra (Insomnia). ijam.co.in</ref> In a similar comparative clinical trial involving 137 participants the comparison between the tailadhara group and jaladhara group also revealed that symptoms like insomnia, anxiety etc. were completely relieved by shirodhara. In brief psychiatric rating scale statistically results of the dhara group are highly significant. Tailadhara provided better relief in all most all the symptoms of stress and in brief psychiatric rating scale compared to jaladhara.<ref name="ref17">Tank, N. G. (2015). A Comparative Clinical Study of Jaladhara and Taildhara in the Management of Stress. International Journal of Ayurvedic Medicine, 6(1). https://doi.org/10.47552/ijam.v6i1.532</ref>

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== Related chapters ==

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[[Manovaha srotas]], [[Manas]], [[Psychiatric diseases‎‎]], [[Unmada Chikitsa Adhyaya]], [[Apasmara Chikitsa Adhyaya]]

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