E-ISSN:2456-3110

Research Article

Kaphaja Unmada

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 10 November
Publisherwww.maharshicharaka.in

Effect of Siddharthaka Agada Arka Pratimarsha Nasya in Kaphaja Unmada (Depressive Disorders)

Sehra A.1*, Kumar Shetty S.2, Savitha H.3
DOI: http://dx.doi.org/10.21760/jaims.7.10.13

1* Anirudh Sehra, Post Graduate Scholar, Dept. of Manovigyan Evam Manasaroga, Shi Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Suhas Kumar Shetty, Principal and Medical Director, KLE Academy of Higher Education and Research (KAHER), Belagavi, Karnataka, India.

3 HP Savitha, Head of the Department, Dept. of Manovigyan Evam Manasaroga, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

In Ayurveda, the term ‘Unmada’ encompasses a wide spectrum of mental disorders. Unmada means "a state of disrupted mental functioning" in etymological terms. The aggravation of Kapha Dosha causes Kaphaja Unmada, which is one of the five forms of Unmada. The symptomatology and description of Kaphaja Unmada can be found in all major Ayurvedic texts. "Kaphaja Unmada" has been linked to "depressive disorder"/"depression"/"major depressive disorder" in previous studies. In this regard, it was planned to do a clinical study on the effectiveness of Siddharthaka Agada Arka Pratimarsha Nasya in Kaphaja Unmada (depressive disorders). Resulting in a statistically significant improvement in the primary and secondary outcome measures of Kaphaja Unmada (Depressive disorders). Thus, concluding Siddharthaka Agada in the form of Arka, administered as Pratimarsha Nasya for 30 days, with a dosage of two drops per nostril, twice a day, before food, is effective in Kaphaja Unmada (Depressive Disorders).

Keywords: Kaphaja Unmada, Depressive Disorders, Siddharthaka Agada Arka Pratimarsha Nasya

Corresponding Author How to Cite this Article To Browse
Anirudh Sehra, Post Graduate Scholar, Dept. of Manovigyan Evam Manasaroga, Shi Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Anirudh Sehra, Suhas Kumar Shetty, HP Savitha, Effect of Siddharthaka Agada Arka Pratimarsha Nasya in Kaphaja Unmada (Depressive Disorders). J Ayu Int Med Sci. 2022;7(10):104-108.
Available From
https://www.jaims.in/jaims/article/view/2124

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-09-26 2022-09-28 2022-10-05 2022-10-12 2022-10-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Anirudh Sehra, Suhas Kumar Shetty, HP Savithaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Depression is a widespread ailment that affects 3.8 percent of the world's population, with 5.0 percent of adults and 5.7 percent of persons over 60 years old suffering from depression. Around 280 million individuals worldwide suffer from depression.[1] In India, 18 percent of the global estimate suffers from depression.[2]

In terms of misery, dysfunction, morbidity, and economic impact, it remains a sociocultural stigma. If left untreated, it can lead to obesity, diabetes, alcohol or other substance addiction, social phobia, panic disorders, family difficulties, and other problems.

It can make the individual who is affected suffer severely and perform poorly at the job, at school, and in the family. Depression can lead to suicide in the worst-case scenario. Every year, around 700,000 individuals die by suicide, globally. Suicide is the fourth highest cause of mortality among those aged 15 to 29.[3]

In this study, the drug used was a modification of Siddharthaka Agada in Arka form. Siddharthaka Agada is useful in the management of mental diseases, especially Unmada.[4]

The reason of selecting Arka Kalpana is that it is one of the most sought-after formulations in this modern age. Many dosage forms are being converted to Arka due to its reduced dose, patient compliance, and increased potency.

Since Arka is prepared by the combination of Jala and with the help of Agni, therefore they are Laghupaki, Vyavayi, and Vikasi and thus assimilates quickly in the body.[5]

Arka is easy to self-administer in the patients for Pratimarsha Nasya.

According to Vagbhatta, Pratimarsha Nasya is good from birth till death and is well-tolerated, has fewer complications, and is a very much convenient procedure. It can be given to anybody at any time without having any restrictions. The dosage is very less (2 drops) and cannot produce any complication.[5]

Materials and Methods

In an open label single arm clinical study participants attending the out-patient

and in-patient department of Mano Vigyan & Manas Roga, Sri Dharmasthala Manjunatheshwara Ayurveda and Hospital, Hassan, Karnataka were screened for Kaphaja Unmada, A total of 30 participants were included in the study.

Lakshanas of Kaphaja Unmada were assessed as primary outcome measures based on its Lakshanas such as Sthanamekdeshe Tooshnimbhava Alpashchankramana Lala Shinghanaka Sravanam Anannabhilasha Rahaskaamta Svapna Nityata Shauch Dvesha Beebhat Satvam Shvayathu Aanan Shuklastimita Malopdigdha Akshi and Hamilton’s depression scale was assessed as the secondary outcome.

Intervention

Siddharthaka Agada Arka 2 drops to each nostril
Time of administration Early morning, before food and Evening, before food
Duration 30 days

Method of preparation of Siddharthaka Agada Arka

1. Drugs were dried as coarsely powdered

2. Drugs were soaked overnight in water

3. The Kalka was diluted 7 parts, with distilled water

4. The goat urine sample was added

5. The mixture was kept in the distillation flask

6. The distillation apparatus was heated at 40- 50 wt.

7. As the first distilled drop came, it was discarded and reduced the heat to 15 wt.

8. The mixture reduced to 60 %

9. The procedure was repeated 7 times to obtain the desired quantity.

Results

For statistical analysis, subjective parameters were assessed with Friedman’s test, Wilcoxon sign rank test, and Cochran Q test followed by McNemar test. Objective parameters were assessed by Repeated Measures ANOVA and Paired t-Test.

Post hoc with McNemar test showed that there was a statistically significant difference between 1st to 30th day in the following Lakshanas of Kaphaja Unmada, Sthanam Ekadeshe, Tooshnimbhava,


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Alpashchankramana, Annanabhilasha, Rahaskaamta, Savapna Nityata, Shauch Dvesha, Beebhat Satvam, Shvayathu Anan & Shuklastimita Malopdigdha Akshi.

Repeated Measure ANOVA test showed the effectiveness of Siddharthaka Agada Arka pratimarsha Nasya in Hamilton’s depression score from 1st day to 30th day as significant.

Table 1: Repeated Measure ANOVA test showing the effectiveness of Siddharthaka Agada Arka Pratimarsha Nasya on Hamilton’s depression score.

Ham D Score N Mean Greenhouse-Geisser Greenhouse-Geisser error df Remarks
df F P
BT 25 15.560 1.740 321.17 <0.05 41.764 S
15th day 6.160
30th day 2.800

BT = Before treatment, N= Number of participants, df = Degree of freedom, F = frequency, P= value of significance, S= Significant, Ham D = Hamilton’s depression score

Table 2: Pairwise comparison of Hamilton’s depression score

Gross Score I Gross Score J Mean Difference (I- J) Std. error Sig. 95% confidence interval for difference Remarks
Lower Upper
BT 15th day 9.400  0.532 <.016 8.030 10.770 S
15th day 30th day 3.360 0.420 <.016 2.279 4.441 S
BT 30th day 12.760 0.598 <.016 11.221 14.299 S

S = Significant, BT = Before Treatment

Discussion

Probable effect of therapy on Kaphaja Unmada
The classical formulation of Siddharthaka Agada contains nineteen ingredients. Each of these ingredients has a distinct effect and combined effect on Kaphaja Unmada. Arka form of Siddharthaka Agada was used to administer pratimarsha nasya for thirty days.

Drugs in Siddharthaka Agada Arka as per Veerya

  Ushna Veerya Sheeta Veerya
Number of Drugs 16 03
Name of Drugs Siddharthaka, Vacha, Hingu, Karanja, Devadaru, Manjishtha, Haritaki, Vibithaki, Katabhi, Shunthi, Maricha, Pippali, Shirisha, Haridra, Daruharidra, Basta Mutra Shweta, Priyangu, Amalaki

As per the above observations, sixteen out of nineteen ingredients in drug used are of Ushna Veerya. Therefore, they help in maintaining Jatharagni, which might have helped with Annanabhilshasha, Shvayathu Aanan, Svapna Nityata.

Drugs in Siddharthaka Agada Arka as per Karma

  Kapha Pittahara Kapha Vatahara Tridosha Hara
Number of drugs 5 9 5
Name of Drugs Manjishtha Vibhitaki, Priyangu Haridra, Daruharidra Siddharthaka,Vacha, Hingu, Karanja, Devadaru, Shweta, Shunthi, Maricha, Pippali, Haritaki, Amlaki, Katabhi, Shirisha, Basta Mutra

As per the above observations, Nine out of nineteen ingredients in the formulation used are of Kapha Vata Hara, Five are Kapha Pittahara and Five are Tridosha Hara.[6] Due to this, they might have helped in the management of Kaphaja Unmada symptoms like Sthanam Ekadeshe, Tooshnimbhaava, Alpashchankramana, Rahaskaamta, Shauch Dvesha, Beebhat Satvam and Shuklastimita Malopdigdha Akshi.

Discussion on Nasya Karma's possible mode of action

There is contact between the nasal cavity and the cerebral cavity, according to Acharya Sushruta.

In the Ayurvedic texts, there is no clear definition of the Nasya Karma's mechanism of operation. Nasa, according to Charaka, is Shiras' entrance. Nasya is a medicine that is delivered by the nose and enters the brain, eliminating only the morbid doshas that cause sickness. The medicine supplied by the nostrils reaches Shrungataka, spreads in Murdha (opening of the vessels, etc.), scratches the diseased Doshas in the supraclavicular area, and expels them from Uttamanga in Astanga Sangraha.[7] Shrungataka marma is defined by Sushruta as Sira Marma, which is created by the union of Siras (blood vessels).

He goes on to say that any harm to this Marma will be deadly right away.[8]

Indu defined Srungataka as the inner side of the middle section of the head, i.e., Sirasa Antar Madhyam, in his commentary on Astanga Sangraha.[7]

Sushruta remarked that excessive eliminative therapy may cause Masthu Lunga (C.S.F) to leak out of the Nose as a Nasya complication.[9]


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Nasa is regarded to be the Shira doorway by all notable acharyas. It does not imply that any channel links directly to the brain; rather, it is possible that they are linked via blood vessels or the neurological system (olfactory nerve etc.).

The fact that whenever any form of irritation occurs in any region of the body, the local blood circulation is always raised is an empirically proven truth. This is due to the body's inherent defensive mechanism. Because of the irritating impact of the supplied medicine, stimulation of the doshas occurs in Shira, resulting in an increase in cerebral blood circulation. As a result, excess morbid doshas are evacuated through tiny blood vessels.

These morbid doshas are eventually expelled by nasal discharge, tears, and salivation.

All of the above insights allow one to think sensibly about Nasya Karma's Mode of Actions (i.e., at various stages of the operation).

Nasya's mechanism of action may be divided into two categories: stimulant and absorbent.

This is accomplished by the use of certain medications in various forms of Nasya.

For particular forms of Nasya, unique medications have been chosen. Nimba, for example, is utilized exclusively for Shamana Nasya, which should be treated using components that are not lipid-based. Certain medications, such as Pippali, Maricha, and other Tikshna drugs, have also been prescribed for Pradhamana Nasya.

It is believed that certain medications have been suggested for use through the nasal route with particular effects, such as those drugs stimulating nasal mucosa with their irritating activity to bring forth Morbid Doshas. Some are light, medicated, or may be absorbed via some medium. Marsha Nasya can be regarded a stimulant activity that brings forth Morbid Dosha depending on the amount. Because Pratimarsha Nasya is unable to discharge vitiated Doshas, it should be classified as Shamana Nasya.[10]

Ravana's Arkaprakasa depicts a great variety of different Arka (distillates) made from various portions of medicinal plants which are used for Nasya.[11]

Siddharthaka Agada was chosen to be administered in the form of Arka for Pratimarsha Nasya.

Conclusion

Two drops of Siddhartaka Agada Arka as Nasya in bilateral nostrils twice a day before meals for a period of 30 days is effective in the management of Kaphaja Unmada (Depressive Disorders). It showed significant improvement in primary outcome measures such as Sthanam Ekadeshe, Tooshnimbhava, Alpashchankramana, Annanabhilasha, Rahaskaamta, Svapna Nityata, Shauch Dvesha, Beebhat Satvam, Shvayathu Anan, Shuklastimita Malopdigdha Akshi and not significant in Lalashinghanaka Sravanam. There was a significant improvement in the secondary outcome measure of Hamilton’s depression score. No adverse drug reactions were reported during the study.

Reference

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3. https://www.who.int/news-room/fact-sheets/detail/depression

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9. Murthy S, Illustrated Sushruta Samhita, Reprint edition, Chikitsa Stana, Ch. 40, Verse 40, Vol 2, Chaukhamba Orientalia; 2017 p-309

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11. A.M Govindan vaidyar, A.M.Krishnan asan, Arka Prakasa, Redyar Press and book depot, Thiruvanathapuram, p 67


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