Importance of Shirodhara in sleep disorders.

 Ayurveda ennumerates three important aspect of life that’s called as trayopasthambha ( three basic pillars of life ).  It includes Ahara ( food) , Shayana ( sleep ) and brahmacharya ( reduce over indulgence in sex ). Some of the commentators read Brahmacharya with a prefix “aa” that makes the word exactly the opposite of Brahmacharya in sanksrit. Scholars of this opinion says then Trayopasthambas as food, sleep and sex. Taking the sleep in particular,  Ayurveda projects its physiology,  classification and importance in various contexts.  In Charaka samhitha , sleep is classified into six types according to its causative factors. They are , sleep without any external imbalances ( surroundings) , due to depression , due to increased accumulation of Kapha,due to tiredness, due to some chronic debilitating diseases, or due to some external injury or imbalance of doshas.

 

 

Sleep in ayurveda is predominantly an aspect of Kapha. It makes Tamoguna (inertia) of mind. The disturbances in sleep is induced by Vata and Pitta. So.. that which promotes kapha without aggravating the Vata and Pitta will be considered as the stimulant of sleep. With this understanding,  one can examine the Ayurvedic procedure shirodhara and its impact based on modern physiology of sleep.

 

 

Sleep generated and maintained is more of a balance between two systems in the brain. One is the Synergistic effect produced by Hypothalamus to make the body rest, and the other is Circadian rhythm (Biological clock ) coordinated by the Pineal gland with the hormone Melatonin.  The procedure Shirodhara impacts these two system by inducing a cooling effect into the brain.  There are lotsof studies suggest that the temperature in the brain if drops slightly, can stimulate the secretion of Melatonin.  In this way Shirodhara promotes the sleep cycle and thus have a complementary impact to reduce stress.

 

 

During Shirodhara , the oils that are using is of Vatahara property.  These oils are prepared by saturating it with various fats soluble contents from medicinal plants that have combined effect on controlling Vata. As ayurveda considers neurochemical impulses and brain waves as the feature of Vata , controlling such a hyperstimulated impulses will calm the brain and help to get a stable relaxed sleep. Since these oils are also having a muscle relaxant effect , and is poured directly over the head slowly in a slightly warm . It helps to relax the msucles in the scalp and head that will help to reduce the vascular tension and assure proper blood flow to the brain. Once the blood supply is sufficient,  brain will feel more relaxed and the person will be prone to sleep.

 

 

There is another widely  applied phenomenon called ASMR( Autonomous sensory merdian response ).  The exact mechanism behind this phenomenon needs further studies. But the tingling,  pleasurable sensation we feel when there is gentle touch over the head is one of the implication of ASMR. Shirodhara also make use of this mechanism to make the brain more comfortable to fall asleep.

 

 

Shirodhara thus is a combined effect of all these phenomena.  It relaxes the mind-body system and help to get rid off the stress factor there by promises a good stable sleep.

Frozen shoulder, An Ayurvedic perspective .

There are numerous diseases that have its pathology either in neurological or musculoskeletal system, that are grouped in broad term called Vatavyadhi. Since vata dosha is the etiological factor here, the term Vatavyadhi is even extended to psychosomatic and gastrointestinal system. Among this set of diseases mentioned in Ayurvedic texts, the most proximate reference about frozen shoulder (adhesive capsulitis) is the term Apabahuka. Apabahuka can be correlated with other conditions of shoulder joint including periarthritis, Subacromial or subdeltoid bursitis, subcoracoid bursitis, Bicepital tendonitis, Osteoarthritis of shoulder,  Brachial plexes neuropathies etc..

 

When we look at the pathology behind frozen shoulder , it involves degeneration of focal necrosis of supraspinatous tendon. In Ayurveda, this adverse change is viewed in two ways. Firstly the dryness of sleshaka kapha (shoulder tendon and capsule) will happen and lead to the pain. Secondly , Kaphavruthavata ( Entrapment of vata by Kapha ) , will also make the joint inflammed and stiff. It’s the skill of the physician to rule out the kapha component in its pathology otherwise, treatments will be often contradictory even though there is aggravated vata in both the cases.

 

According to Ayurveda, the aetiology of this condition can be many.  It can be directly due to an external trauma, due to heavy exercise that make the shoulder inflamed ,improper posture during sleep, and also due to excessive intake of food that have tastes like katu (acrid), thikta (bitter) , kashaya (astringent) that are laghu (light) ,sukshma(subtle) and Sheetha (cold) . Because of these factors , there will be lack of adequate blood supply in the areas of insertion of tendons (snayu) or can cause degeneration of collagen fibers (upadhatus) . Such a pathology sometimes trigger an autoimmune response and results in abnormalities in tendons and ligaments.  When these supporting structures loss their ability,  It will make the joint less stable and movements of the joints became either painful or restricted.

 

Ayurvedic treatment principles for vatavyadhi can be judiciously applied in the case of frozen shoulder by carefully understanding the kapha component in its pathology.  The protocol involves Snehana (oleation) , swedhana ( sudation) , Vasti ( retention of oil in the affected areas and Nasya ( errhines). Snehana involves oily massages and snehapana (internal unction) to reduce the depleting impact of vata. Various types of deep tissue massages along with sudation can increase the circulation to the affected area and also will make the muscles and associated structures less stiff. It will also help to bring back the range of motions that might have restricted due to stiffness and pain. Various types of Kizhi ( warm medicated bolus ) that are nourishing to the joints can also be applied.

 

 When it comes to the diet, food that pacifies vata and food that assure antiinflammatory actions and nourishment are to be chosen. It is advisable to take easily digestible food that can have faster nourishment.  Intake of Godhuma ( wheat) , masha ( ural dal ) and Kulattha ( horse gram ) are good to curb vata. Intake of Ghrutha (ghee) , cows milk, Goat’s milk, are good. Fruits like Draksha (grapes),  Dadima ( pomegranate ),  Apples, are beneficial.  Since it’s a vata predominant condition,  the food substance has to be always warm and if possible slightly oily and nourishing.  Intake of fish is good if its not along with milk products. Doing mild exercises without causing further damage is always good to regain normal range of motions. Avoid sleeping in abnormal postures, avoid excessive use of sugar, fried /dried food items,  frozen dairy products and the patient should be completely abstain from consumption of alcohol. Yogasanas like shalabhasana ( locust pose),. Suryanamaskara ( salutation to sun ) , Gomukhasana ( cow face pose) are found to be affective in treating frozen shoulder.