Module on “The Clinical Significance of Takradhara Therapy” Talk By- Dr. Rajkala P. Patil

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“Shirodhara in Clinical Practice:
Diverse Therapeutic Applications”

Dr. Rajkala P. Patil
Head & Associate Professor,
Department of Panchakarma,
Faculty of Ayurveda, IMS, BHU, Varanasi

Introduction:
Shirodhara is a popular Ayurvedic therapy that involves a continuous stream of liquid being poured onto the forehead or the “third eye” region. This therapy is known for its relaxing and rejuvenating effects on the body and mind.  It is a type of bahya Sneha, in which suitable liquid is continuously poured on the forehead and then allowing to flow over the scalp from a specific height in a specific manner. It can also be described as the process of irrigating the head with various liquids, tailored to the patient’s condition, specific diseases, and seasonal considerations. Overall, Shirodhara is a holistic therapy that not only provides physical benefits but also promotes mental and emotional well-being. 

Synonyms for Shirodhara include Shiroparisheka, Shiraseka, Shirasechana, and Prasechana.

The term “Shirodhara” itself is derived from the Sanskrit words ‘Shiro’ (head) and ‘Dhara’ (to flow). This therapy entails the rhythmic and steady flow of lukewarm substances such as oil, milk, or buttermilk onto the forehead.

Classical indication of Shirodhara

अरूंषिकाशिरस्तोददाहपाकव्रणेषुतु|
परिषेकः-

Classical indications involving aggravated Vata Dosha, Arunshika (seborrheic dermatitis), Shirastoda (pricking pain in the head), Daha (burning sensation in the head), Paka (suppuration in the head, inflammation leading to the formation of pus), Apasmar (Epilepsy) Shankhak roga (Headache), Santat Jwara (Stri Dugdha is used for dhara) 

Clinical indications

  • Psychosomatic diseases- Irritable Bowel Syndrome 
  • Neurological disorders-
  • Headache, Epilepsy, Facial palsy, convulsive disorders.
  • Hypertension, Stress 
  • Psychological diseases- Psychosis, Neurosis, insomnia, Anxiety 
  • Skin Diseases- Psoriasis, Eczema 
  • Other Clinical Indications
  • Anxiety disorders 
  • Mental exhaustion 
  • Irritability 
  • Hypertension
  • Insomnia 
  • Phobia,
  • Depression
  • Attention deficit hyperactivity disorder 
  • Other neurobehavioral disorders

Contra-indications of Shirodhara: 

  • Amavastha of any disease indicated for shirodhara
  • Recurrent rhinitis
  • Allergic rhinitis
  • Fever (Pyrexia)
  • Inflamed skin on the forehead  
  • Addiction of Narcotic drugs
  • Alcohol Intoxication
  • Kaphaja Vikara- Shirodhara further increases Kapha, which may make the diseases difficult to cure. 

Various types of Shirodhara: Each using different liquids or substances, and they offer unique therapeutic benefits. Let’s discuss each of these types:

  1. Shirodhara with Oil (Tailadhara): In Tailadhara, warm herbal oil is gently poured in a continuous stream onto the forehead. This type of Shirodhara is particularly effective in calming the nervous system, relieving stress, improving sleep quality, and promoting hair and scalp health.
  2. Takradhara: In Takradhara, buttermilk infused with herbs is used instead of oil. It’s beneficial for treating conditions like insomnia, mental stress, and skin problems. The lactic acid in buttermilk helps exfoliate and cleanse the skin.
  3. Kashayadhara: In Kashayadhara, a decoction of herbal extracts is used. This type of Shirodhara is often recommended for individuals with inflammatory conditions, as it has anti-inflammatory properties. It can also help with pain management.
  4. Dugdhadhara: Dugdhadhara involves the use of warm milk infused with herbs. It is nourishing and soothing, making it an excellent choice for individuals with sensitive skin, insomnia, or anxiety. It can also enhance the complexion.
  5. Jaladhara: Instead of oils or herbal mixtures, Jaladhara uses water. This type of Shirodhara can be cooling and invigorating. It’s often chosen to address excessive heat in the body or as part of detoxification therapies.
  6. Dhanyamladhara: Dhanyamladhara involves pouring a fermented liquid made from cereals and pulses, which is rich in probiotics and enzymes. It’s used to enhance digestion, balance the gut flora, and improve overall health. It’s especially beneficial for digestive disorders and detoxification.

Shirodhara treatments are typically tailored to an individual’s specific dosha (body constitution) and disease. 

Other liquids which can be used- 

Coconut water

Food Vinegar 

Material requirements 

  1. Shirodhara device-1
  2. Varti- 1
  3. Suitable liquid-1.5litres
  4. Gauze- 1
  5. Cotton earplugs-2
  6. Soft pillow covered with rexin-1
  7. Hotwaterbath-1
  8. Vessels -3
  9. Oil for Talam-10ml
  10. Rasnadi choorna- 5g
  11. Soft towels-2
  12. Dhara patra-1
  13. Attendents-2

Pre operative procedure

Abhyanga should be done over the face, neck, shoulder and chest. (Whole body abhyanga can also be done). Gauze is tied around the head above the eyebrows of the patient. After closing the eyes cotton should be kept over the eye lids and it should be tied with proper bandage. Ear plug should be applied.

Selection of medicines 

Vataj disease- Bala taila, prabhanjan Vimardana taila, Mahanarayana Taila, Dashmoola decoction

Pittaja Roga- Chandanadi taila, Ksirabala taila, Himsagar taila, Brahmi taila, Nalpamaradi taila, Chandana, Ushira decoction, coconut water, Milk, Ghrita

Kaphaja- Dhanwantharam taila, Eladi taila, Kottamchukadi taila, Nagar, Musta, Madhuyashti decoction

Procedure of Shirodhara: 

The patient should recline comfortably on their back on a treatment table, with a soft pillow supporting their neck. The Shirodhara apparatus should be positioned close to the patient’s head. To shield the eyes from the flowing oil, a cover made of cotton and gauze should be placed over them.

The Shirodhara device should be adjusted to ensure a continuous, gentle flow of warm oil, falling from a specific height of approximately four fingerbreadths (approximately 3 inches or 7-8 centimeters). Inside the apparatus, a serrated coconut shell should be placed to maintain a consistent and even flow of the oil. The oil used for the treatment should be heated to a temperature slightly above normal body temperature, around 38-40 degrees Celsius (100-104 degrees Fahrenheit). This warmed oil should then be poured into the vessel (dharapatra) of the Shirodhara apparatus. During the Shirodhara treatment, several important considerations should be kept in mind: Ensure that the oil flows consistently and evenly across the entire forehead. This is achieved by gently swaying the vessel known as the dharapatra back and forth while maintaining a continuous stream of oil. Maintain uniform oscillations of the dharapatra to ensure a steady and consistent flow of oil. This uniformity is essential for the effectiveness of the treatment. While performing Shirodhara, use your other hand to simultaneously provide a soothing massage. This additional touch enhances the therapeutic benefits of the treatment and promotes relaxation. Periodically, gather any excess oil that may accumulate in the hollow of the treatment table, also known as the droni. Reheat this collected oil to the appropriate temperature, and then pour it back into the vessel (dharapatra) to maintain an uninterrupted and continuous flow of oil throughout the treatment session. This step is essential to ensure the consistency and effectiveness of the therapy.

Selection of Sneha– according to Dharakalpa

  • Vata Dosha- Tila Taila
  • Pitta Dosha- Ghrita
  • Kapha Dosha- Tila taila
  • Rakta dosha- Ghrita
  • Vata+Pitta +Rakta- Ghrita + Taila in equal part 
  • Vata+Kapha+Rakta- ½ part Ghrita+ 1 part Tila taila 

Techniques of Shirodhara

Various oscillatory procedures can be adopted as per the condition of disease and patient.  

Here’s a description of the post-operative procedure:

Post-operative care:

  1. Gentle Cleansing: Begin by removing any gauze and earplugs that may have been placed during the shirodhara. Then, use a soft towel to gently wipe the head, ensuring cleanliness and comfort.
  2. Application of Rasnadi Choorna: Following the cleansing, Rasnadi choorna, a specific herbal powder or formulation, is applied to the head. This application may have therapeutic or healing purposes.
  3. Hot Water Bath (if prescribed): If the Panchakarma Physician has recommended a hot water bath as part of the recovery process, it can be taken after waiting for at least one hour post-Shirodhara.
  4. Lukewarm Head Bath: For routine cleanliness and comfort, a head bath can be taken with lukewarm water. 

Duration 

45 – 60 minutes for the required number of days. It may be done at 4 – 6 pm or 7-11am. It is believed that by this therapy the effect can be achieved up to the limbs and entire body by 21 days

According to Dharakalpa (Ch.17) 

Patient having dryness and pittayukta vata – the period of Shirodhara should be 2 ½  Muhurta/ 2 Muhurta. In Snigdha Kaphayukta Vata- 1 Muhurta. 

* Muhurta = 987 matra in dhatusthana (Sahastrayogam)  

Period for Changing the liquids 

Milk- Every day

Dhanymla- 3 days 

Oil- 3 days (7th day – both oils first and second half should be mixed and used for dhara)

Precautions:

  1. Vigilance is essential to prevent oil from inadvertently reaching the eyes.
  2. Patients are advised to remain awake and alert throughout the procedure.
  3. It is crucial to maintain a moderate height, viscosity, and controlled flow rate of the liquid.
  4. Minimize hair interference by shaving the patient’s head as much as necessary.
  5. Diligent attention is required to ensure a continuous flow of medicated liquid and to regulate the temperature of the Shirodhara mixture.

Parihara 

The patient is advised to steer clear of the following:

  1. Physical strain and strenuous activities.
  2. Emotional turmoil, including excitement, anger, sorrow, and strong desires.
  3. Exposure to cold weather, direct sunlight, dew, strong winds, smoke, and dust.
  4. Activities involving riding elephants or horses.
  5. Prolonged periods of continuous walking, standing, or sitting.
  6. Excessive or lengthy speaking, especially at high volumes.
  7. Daytime napping.
  8. Using a pillow with either excessive height or low elevation.

Parihara kala 

The patient is advised to adhere to a pathya diet and maintain a state of Jitendriya (control over the senses) throughout the duration of the therapy.

In reference to the Dharakalpa and its specifications:

Dharakalpa Special References:

Dharakalpa provides specific guidelines and references for the construction and use of the Dhara table, including the choice of medicinal woods for its composition.

Dharatable Specifications:

The Dhara table is meticulously crafted from the woods of various medicinal plants, ensuring therapeutic benefits during Dhara treatments. These woods include Plaksha (Ficus Lacor), Udumbar (Ficus glomerata), Chandana (Sandalwood), Varuna (Crataeva nurvala), Devadaru (Cedrus deodara), Ashoka (Saraca Asoka), Amra (Mangifera indica), Nimba (Azadirachta Nimba), Bilwa (Aegale Marmelos), Arjuna (Termainalia Arjuna), Khadira (Asia Catechua), Agnimantha (Clerodendrum phlomidis), and more.

Table Design:

The table features specific design elements: At the foot end, there’s an orifice or tapered opening for pouring liquid onto the patient’s body, which then flows into a collection vessel.  The collected liquid can be reheated and reused for the Dhara therapy throughout the treatment duration.

Head End and Chamber: The head end of the table includes an elevation for a headrest, creating a bridge between the elongated portion of the table meant for the patient’s body and a small chamber behind the head end. This chamber collects the medicinal substances poured on the head during Shirodhara and directs them to an orifice a few inches away from the crown of the head. The collected substances flow into another collection pot, and like the liquid used in Sarvanga Dhara, can also be recycled and reused. 

Dhara Patra and Varti Specifications: The Dhara patra, with a depth of 5-6 inches and a wide open mouth, should be round at the bottom and have a capacity of approximately 2 litres. It includes a hole at the center of the bottom, roughly the size of a little finger.  Three equally spaced holes around the patra’s ridges allow for the attachment of three strings, which are used to hang the patra on a stand.

Dhara Varti: Dhara varti is a wick or a string made of loose cotton threads, with a free end of about 4 inches emerging through the hole of the Dhara vessel. – The threads of the wick should be packed firmly enough to prevent slipping from the hole but remain loose enough to allow a continuous and regular dripping of the liquid poured into the Dhara vessel during the treatment.

These specifications ensure the proper construction and functionality of the Dhara table, Dhara patra, and Dhara varti, all of which play vital roles in traditional therapeutic practices. 

Dhara dosha 

Performing Dhara with varying heights, speeds, or excessive force can potentially lead to adverse effects such as:

  1. Loss of Consciousness (Murccha): Using excessive height or speed during Dhara can cause a loss of consciousness, known as Murccha.
  2. Pain and Discomfort (Shula):  Rapid or forceful Dhara may result in discomfort and pain, referred to as Shula.
  3. Nausea and Vomiting (Chardi): Improper Dhara techniques may induce nausea and vomiting, termed as Chardi.
  4. Bilious Disorders (Raktapitta): Aggressive or incorrectly performed Dhara can trigger bilious disorders, often referred to as Raktapitta.
  5. Fever (Jwara):  Inappropriate Dhara methods may lead to fever or worsen an existing fever, as mentioned in Dharakalpa.

To prevent these adverse effects, it’s crucial to adhere to proper Dhara techniques and guidelines to ensure a safe and effective treatment.

Addressing Dharadosha (Imbalances from Dhara Treatment):

  1. Gandusha: Utilizing the practice of Gandusha, which involves rinsing the mouth with therapeutic substances.
  2. Nasya: Employing Nasya, a technique for administering remedies through the nasal passages.
  3. Shunthi Kashayapana: Incorporating the consumption of an herbal decoction made with ginger (Shunthi) as a part of the management strategy.
  4. Light Evening Meal: Including a light evening meal, complemented by a broth infused with pepper.
  5. Third-Day Basti Treatment: Administering a basti (enema) treatment, combined with the use of Saindhava (rock salt), on the third day as a therapeutic measure to address the imbalances resulting from Dhara.

Modern automated Shirodhara devices offer precise customization of key treatment parameters like temperature, quantity, drip rate, duration, and oscillation, according to each patient’s unique needs and preferences. This advanced technology ensures a patient-centric approach, enhancing the safety and effectiveness of Shirodhara therapy in contemporary healthcare settings.

Question and Answers: 

  1. What is the literal translation of the term “Shirodhara” from Sanskrit?

a) Forehead treatment
b) Head flow
c) Mind Relaxation
d) Scalp therapy

Answer: b) Head flow

  1. Which of the following liquids is NOT commonly used in Shirodhara therapy?

a) Warm herbal oil
b) Buttermilk
c) Decoction of herbal extracts
d) Mamsarasa

Answer: d) Mamsarasa

  1. What is the primary purpose of placing cotton and gauze over the patient’s eyes during Shirodhara?

a) To protect the eyes from oil
b) To enhance visibility for the practitioner
c) To provide a soothing sensation to the eyes
d) To prevent hair from falling into the eyes

Answer: a) To protect the eyes from oil

4. Which dosha imbalance is specifically mentioned as a classical indication for Shirodhara in the provided information?

a) Vata Dosha
b) Pitta Dosha
c) Kapha Dosha
d) Rakta Dosha

Answer: a) Vata Dosha

  1. What is the purpose of applying Rasnadi Choorna to the head in the post-operative procedure?

a) To cleanse the head
b) To enhance the patient’s complexion
c) To promote hair growth
d) To provide therapeutic benefits

Answer: d) To provide therapeutic benefits

  1. Which of the following is NOT listed as a precaution for Shirodhara therapy?

a) Exposure to direct sunlight
b) Emotional turmoil
c) Vigilance to prevent oil from reaching the eyes
d) Prolonged daytime napping

Answer: a) Exposure to direct sunlight

  1. What type of wood is commonly used in the construction of the Dhara table for Shirodhara therapy?

a) Pinewood
b) Oakwood
c) Medicinal plant woods
d) Bamboo

Answer: c) Medicinal plant woods

  1. What is the purpose of using Dhara patra and Dhara varti in Shirodhara therapy?

a) To enhance the fragrance of the oils
b) To collect and reheat excess oil
c) To create an aesthetic ambiance
d) To provide therapeutic massage

Answer: b) To collect and reheat excess oil

  1. Which of the following clinical indications is NOT mentioned in the provided information as a condition that Shirodhara therapy can address?

a) Hypertension
b) Psoriasis
c) Insomnia
d) Ajirna

Answer: d) Ajirna

  1. What is the significance of the term “bahya Sneha” in the description of Shirodhara?

a) External application of oils
b) Internal consumption of oils
c) Balanced dosha levels
d) Continuous oil flow

Answer: a) External application of oils

References: 

1.Agnivesha, Charaka, Charaka Samhita with commentary of Chakrapani Datta, edited by Vaidya Yadavaji Trikamji Acharya, published by Chaukhamba Krishnadas Academy, Varanasi, Reprint 2010

2.Sushruta, Sushruta Samhita with commentary of Sri Dalhanacharya edited by Aryan Ram Acharya “Kavyatirtha”, published by Chaukhamba Orientalia, Varanasi, Reprint 2009

3.Vagbhata, Ashtanga Hridya with the commentaries Sarvangasundara of Arundatta and Ayurveda Rasayana of Hemadri, edited by Pandit Hari Sadasiva Sastri Paradakara Bhisagacarya; Chaukhamba rientalia,Varanasi, Reprint -2011.

4.Dravyaguna Vijnana by Dr. J. L. N Shastri, Vol. 2, 3rd Edition, Chaukhamba Orientalia, Varanasi, 2008

5.KrishnaVaidyan KV, Pillai SG, Editors. Sahastrayogam with Sujanpriya commentary, Chapter 13,Dharakalpa. 26th Edition. Alapuzha; Vidyarambham Publishers, Mullakkal; 2006.pp.472-481

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