Changes

== Pradhana karma (therapeutic procedure) ==

== 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 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 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>

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

|72  minutes

|72  minutes

|}

|}

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

== 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.

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"

{| class="wikitable"

!'''Dhara dravya'''

!'''Dhara dravya'''

!'''Period of reusage'''

!'''Period of reusage'''

|-

|-

|Kwatha(decoction)

|Kwatha(decoction)

|1 day

|1 day

|-

|-

|Milk

|Milk

|1 day

|1 day

|-

|-

|Tender coconut water

|Tender coconut water

|1 day

|1 day

|-

|-

|Dhanyamla

|Dhanyamla

|3 days

|3 days

|-

|-

|Sneha

|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.

|}

|}

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

<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>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" /> ==

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

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

<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>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>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>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>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>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>

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

== Importance in preservation of health and prevention ==

== Importance in preservation of health and prevention ==

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

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>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>Gentleness of voice</li>

<li>Softness of skin</li>

<li>Softness of skin</li>

== Importance in management of diseases ==

== Importance in management of diseases ==

<ul style="text-align:justify;"><li>Medicated streaming with unctuous substances (snehadhara) can pacify the [[Vyadhi|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>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, [[Vyadhi|diseases]] involving head, eyes, and ears.<ref name="ref1" /> </li></ul>

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

=== Effect on psoriasis ===

=== Effect on psoriasis ===

<p style="text-align:justify;">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></p>

<p style="text-align:justify;">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></p>

== Effect on insomnia ==

== Effect on insomnia ==

<p style="text-align:justify;">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> <br/><br/>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 m’ment with Tagaradi Kwatha & Mahishi Dugdha Shirodhara, Department of Kayachikitsa,ITRA Jamnagar.</ref></p>

<p style="text-align:justify;">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> <br/><br/>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 m’ment with Tagaradi Kwatha & Mahishi Dugdha Shirodhara, Department of Kayachikitsa,ITRA Jamnagar.</ref></p>

== Effect on chittodvega (anxiety disorders) ==

== Effect on chittodvega (anxiety disorders) ==

== Effect on shukravrita vata ==

== Effect on shukravrita vata ==

<p style="text-align:justify;">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 [[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></p>

<p style="text-align:justify;">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 Ŝirodhāra 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></p>

== Current research ==

== Current research ==

<p style="text-align:justify;">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> <br/><br/>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> <br/><br/>In a study conducted among sixteen healthy volunteers on shirodhara using oil containing <i>Centella asiatica (Brahmi), Nardostachys jatamansi (jatamansi), and Withania somnifera (Ashwagandha)</i> 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> <br/><br/>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> <br/><br/>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> <br/><br/>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></p>

<p style="text-align:justify;">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> <br/><br/>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> <br/><br/>In a study conducted among sixteen healthy volunteers on shirodhara using oil containing <i>Centella asiatica (Brahmi), [[Jatamansi|Nardostachys jatamansi (jatamansi)]], and [[Ashwagandha|Withania somnifera (Ashwagandha)]]</i> 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> <br/><br/>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> <br/><br/>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> <br/><br/>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></p>