E-ISSN:2456-3110

Case Report

Shirodhara and Nasya

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 9 SEPTEMBER
Publisherwww.maharshicharaka.in

Exploring Shirodhara and Nasya: A Holistic Ayurvedic strategy for addressing Anovulation-Induced Infertility

Garg P1*
DOI:10.21760/jaims.9.9.48

1* Preeti Garg, Assistant Professor, Dept of Prasuti tantra and Stri Roga, Rajib Gandhi Memorial Ayurvedic College and Hospital, Kolkata, West Bengal, India.

Anovulation and low AMH are common causes of female infertility. Anovulation may be caused due to hormonal disorders, PCOS, thyroid disease, extreme levels of stress, or some other medical disorders. In Ayurveda, four factors are essential for successful conception and pregnancy. These are Ritu (fertile & intercourse time), Kshetra (patent reproductive tract), Ambu (nutrition), and Beeja (healthy sperm & ova). All of these, the most essential factor is said to be Beeja, which actually is the Antahpushpai, or ovum. Conception and successful carrying of a pregnancy depend upon all these factors going along in concordance with each other. According to Ayurveda, Anovulation is a category of Beeja Dushti. Shirodhara & Nasya is one of the most effective Ayurvedic treatments which support ovulation.

Case study: This 42 year’s female patient was not getting pregnant since the last 7 years. Her cycles were anovulatory as her ovaries did not show the release of eggs at the proper time. On evaluation through follicular scans revealed the presence of multiple small follicles in left ovary and one dominant follicle (size-14mm) seen in right ovary even on 15th day of cycle. The AMH of this patient was also very low i.e., 1.39 ng/dl. The treatment given to this patient was an Ayurvedic therapy Shirodhara and Nasyakarma and Shaman-Aushadi.

Result: Over the course of three-months, she achieved a successful pregnancy.

Discussion: Present study illustrates how Ayurvedic practices and treatments can significantly contribute for ovulation and fertility.

Keywords: Anovulation, Infertility, Shirodhara, Nasya, Shatpushpa-Shatavari oil

Corresponding Author How to Cite this Article To Browse
Preeti Garg, Assistant Professor, Dept of Prasuti tantra and Stri Roga, Rajib Gandhi Memorial Ayurvedic College and Hospital, Kolkata, West Bengal, India.
Email: 		Garg P, Exploring Shirodhara and Nasya: A Holistic Ayurvedic strategy for addressing Anovulation-Induced Infertility. J Ayu Int Med Sci. 2024;9(9):300-305.
Available From
https://jaims.in/jaims/article/view/3667

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-08-14 2024-08-24 2024-09-04 2024-09-14 2024-09-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.32

© 2024by Garg Pand 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

Fertility challenges are a significant global issue, with infertility affecting about 17.5% of the adult population - roughly 1 in 6 people worldwide, according to the WHO. In developing countries, infertility impacts up to 25% of couples, making it a prevalent concern. Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse. Primary infertility, as a cause of infertility, is reported to affect approximately 2% of all women worldwide. More women are however affected by secondary infertility, up to 10.5% in certain regions because couples can find it problematic to conceive after having had one or more previous pregnancies. These notwithstanding, treatments like IVF and other assisted reproductive technologies have given new hope for parenthood to millions of couples.[1]

Ovarian factor is the 2nd most common cause of infertility and contributes 25-40 %.[2] Ovulatory factors play a crucial role in female infertility, accounting for around 40% of all cases. These issues can arise from various conditions affecting hormone levels, such as polycystic ovary syndrome (PCOS), thyroid disorders, or other hormonal imbalances that disrupt normal ovulation. Addressing these factors is essential for improving chances of conception.[3]

In Ayurveda, infertility in women is referred to as Vandhya. For successful conception, Ayurveda emphasizes the importance of 4 key factors, known as Garbha-Sambhava Samagri.

Ritu (Timing): The right timing, both in terms of a woman’s fertile period and intercourse, is crucial for conception.

Kshetra (Field): The health of reproductive organs, including the uterus, fallopian tubes, and endometrium, must be optimal.

Ambu (Nourishment): The quality of uterine fluid and nourishment of reproductive tissues, particularly Rasa Dhatu, is essential.

Beeja (Seed): The vitality and health of both sperm and ovum are critical to reproduction.

These factors are interconnected with psychological well-being and balanced Vata Dosha. Imbalances in any of these can lead to Vandhyatva (infertility).

Ancient Ayurvedic texts, such as those by Acharya Sushruta, explain Nashtartawa (absence of menstruation or ovulation) as a primary cause of infertility, which can be linked to anovulation, often due to Vata imbalances.[4]

In this context, Nashtartawa can be likened to anovulation, a condition mainly caused by imbalances in the Vata Dosha, one of the fundamental principles governing the body in Ayurveda. Currently, it is noted that disorders in Artava caused by Vata can lead to a decrease in Artava volume, resulting in weakened Beeja and subsequently no ovulation. Additionally, Pitta plays a crucial role in ovulation by facilitating the transformative changes necessary for follicle maturation. Ayurveda explain wide range of protocols i.e. Panchkarma therapies and Shaman Aushad for the management of Beejadushti. Shirodhara & Nasya are Ayurvedic procedure help in getting ovulation. Shridhara, helps soothe the hypothalamus, which activates the regulation of the pituitary gland and regulates the HPO axis by regulation of hormones. It is an external process done by pouring the medicated Kwath or oil on scalp. Nasya Karma, a key component of Ayurveda, involves the therapeutic use of medicated substances administered through the nasal passages. Based on the belief that the nose is a crucial gateway to the head (Nasa hi Sirsodwaram), this procedure aims to restore balance among the body's Doshas (Vata, Pitta, and Kapha), enhance sensory perception, and alleviate various health issues.[5]

Case Study

A 42-year-old female patient sought consultation at Rajib Gandhi Memorial College & Hospital, Kolkata, Gynecology & Obstetrics OPD due to her inability to achieve pregnancy in the last 7 years. Her menstrual cycles were regular, and she had provided her ultrasound (USG) report and several blood test results during her 1st visit. Upon examination, she was diagnosed with the presence of multiple small follicles in left ovary and one dominant follicle (14mm) on the 15th day of cycle. Prior to seeking Ayurvedic treatment, she had already pursued medical advice from an allopathic (conventional) hospital and had undergone a two-month course of letrozole and Injection HCG induction therapy to stimulate ovulation.


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However, it was not successful. Consequently, she turned to our hospital in search of Ayurvedic management for her fertility concerns.

Menstrual History

LMP: 21/08/2024
Duration: 3 days
Interval: 26-28 days
Flow - 2-3 pads per day - fully soaked
Clots - Mild, very small size, Pain - absent
Color: brownish red

Obstetric History: G1P1A0L1

G1- FCH X 13 YRS X FTCS

Family History: No pertinent family history

Past medical history: Patient taking 50mcg thyroxin since 2011.

Past surgical history - FTCS x 13 years back.

Personal history

Her appetite: Decreased
Sleep: disturb (3-4 hours per day)
Micturition: clear
Bowel: not clear (Constipated)

Clinical Findings

General examinations

Built: Middle
Weight: 56 kg
Height: 5’3”
Pulse: 82/min
B.P.: 110 /70 mm of hg
Respiration rate: 16/min
Temp.: 98.6°F
Per abdomen - No tenderness and no organomegaly was detected.

Ashthavidha Pariksha

Nadi: Vaatpittaja
Shabda: Samyak
Mala: Sama
Sparsha: Sheetal
Mutra Pravriti: Samanya
Drika: Samanya
Jihwa: Sama
Aakriti: Sama

Dashvidha Pariksha

Prakriti (nature): Vatapittaj

Vikriti: Madhyama
Sara:Madhyama
Samhanana:Madhyama
Pramana: Madhyama
Satmya: Madhyama
Satva: Madhyama
Vaya:Yuvati
Vyayamshakti: Madhyama
Aharashakti: Abhyavarana Shakti (intake of food) - Madhyama
Jarana Shakti (digestion): Madhyam

Systemic Examination

CVS: Heart sounds (S1S2): Audible and normal

Respiratory system: normal bilateral air entry, no added sounds.

No abnormality found on other system

Breast Examination

Bilateral breast- no abnormality detected.

Investigations

1. Seminal analysis (10/06/2024) - Asthenozoospermia (2% rapid progressive motility).
2. All the routine investigations were done to female patient - 22/08/2022

Hb % - 11.3gm %
TSH - 0.499 microIU/ml
Prolactin - 34.23 ng/ml
AMH - 1.39 ng/ml
SIS (21/08/2022) - Patent B/L tubes

Treatment Schedule

The treatment was carried out with the following medicines for three months.

Shirodhara with Kwath (Decoction) of Jatamansi, Vacha, Aswagandha, Brahmi, Gokarkhmudi, Sarpunkha for 45 min from 12th -15th day of cycling. Nasya with Shatpushpa-Shatavari oil from 8th day to 14 days of periods

Shaman Aushadh

1. Phalaghrita Pana - 10 ml followed with 200 ml of milk at night (15th -30th day of cycle)
2. Pushpadhanva Ras - 2tab bd before food (2nd – 14th day of cycle)
3. Chitrakadi Vati - 2tab bd after food (10th – 14th day of cycle)
4. Castor oil - 10 ml with milk


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(10th – 14th day of cycle)After 3 months of this treatment, patient missed her periods. Then we done UPT test at OPD on 21/09/2024, which was positive.

Result

jaims_3667_01.JPG
Pic 1: Dated: 09/07/2024- No mature dominant follicle and ovulation occurred even on 15th day of cycle.

jaims_3667_02.JPG
Pic 2: Dated: 04/10/2024-6 weeks 2 days pregnancy positive with normal foetal activity (Foetal heart rate normal)

Discussion

Ovulation is crucial for a woman's reproductive cycle, and disruptions can significantly affect fertility. Identifying causes such as hormonal imbalances, stress, obesity, and medical conditions is essential for addressing conception challenges. Focusing on these factors is vital for reproductive and overall health. In Ayurvedic terms, Stree Beeja refers to the female ovum, while Beejotsarga relates to ovulation. Ayurvedic treatments like Shirodhara and Nasya can help manage infertility related to Abeejotsarg.

Mode of action of Nasya

In the practice of Nasya Karma, the way drugs work can be understood as follows: they enter the vital Sringaataka Marma and from there, they disperse into various channels known as Srotases. It's noteworthy that Vriddha Vagbhata was the pioneer in explaining how Nasya Karma functions.[6] The term Nasya derives from the Sanskrit word Nasa, meaning the nose. Nasya stimulates the olfactory nerves and the limbic system, which in turn activates the hypothalamus, leading to the stimulation of GnRH neurons. This may help regulate the pulsatile secretion of GnRH, subsequently triggering proper gonadotropin release and promoting ovulation.[7] This interplay highlights the significant role of olfactory stimuli in modulating brain functions related to behavior and hormonal regulation.

Mode of action of Shirodhara

Shirodhara targets vital points on the head, improving blood flow and circulation. The gentle head massage allows medicinal oils or herbal liquids (Kwath) to seep into the deeper layers of the scalp, creating a deeply relaxing effect that extends to the peripheral nerves around the forehead.

This relaxation reaches the hypothalamus, which plays a crucial role in regulating the pituitary gland - the master regulator of hormones. By promoting this hormonal balance, Shirodhara aids in inducing ovulation. Furthermore, it reduces excessive levels of serotonin and stress hormones like noradrenaline and adrenaline, providing effective stress relief. This makes Shirodhara particularly useful in addressing stress-related conditions such as anovulation, a common cause of infertility in women.


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The treatment, by calming the nervous system, not only alleviates physical stress but also works on emotional tension, creating a holistic approach to managing reproductive and mental health.[8] In Ayurveda, the head (Shirah) is regarded as the seat of Prana (life force), connecting all sense organs (Indriyas) and known as Uttamanga, or the most vital part. Shirodhara enhances the function of Pranadriyas,[9] which are often affected by psychological disorders. A well-functioning sense system promotes mental health, contributing to overall well-being and healthy ovulation. By calming the mind and balancing the senses, Shirodhara supports the body’s reproductive processes and hormonal balance, ensuring both body and mind remain healthy.[10] This entire process is believed to have a role in stimulating the (H-P-O) axis, which in turn stimulates hypothalamus leading to stimulation of GnRH neurons. This may regularize GnRH pulsatile secretion which in turn triggers proper gonadotropin secretion leading to Ovulation.[11] When the HPO axis is not functioning correctly, it can hinder the release of mature eggs from the ovaries, causing anovulation.

Mode of action of drugs used in this case[12]

SNName of the drugRasaVeeryaVipakaKarma
1.  Jatamansi Tikta, KasayaSitaKatuMedhya, Nidrajanan, Manasrogahar
2.  AshwagandhaTikta, KasayaUshnaMadhuraRasayan, Balya, Vajikarana,
Vatahara
3.  VachaKatu, TiktaUshnaKatuDipani, Medhya
4.  Brahmi Madhura, Tikta, KashyamSitaMadhuraMedhya, Rasayan, Vatahara, Prajasthapana, Ayushya
5.  GorakhmundiMadhura, Katu, Tikta, KashyamUshnaKatuMedhua, Vatashamak, Asradosha
6.  SarpunkhaTikta, KasayaUshnaKatuVatanulomana, Asrajit, Shwasahara, Rasayan
7.  Shatpushpa Katu, TiktaUshnaKatuShothhara, Vatanulomana, Deepan, Rasayan, Artavjanan
8.  Shatavari Madhura, TiktaSitaMadhuraMedhya, Rasayan, Agnipushtikara, Stanyakara
9.  Erand oilMadhur, Katu, Kashyam UsnaMadhuraAnulomana, Dipana,Srotosodhana,Amapachana

Mode of action of drugs used in this case

SNName of PreparationProperties
1.  Pushpadhanva Ras[13]Tridosha-Shamak, Deepan, Pachan, Beeja Dushtihar, Vatashamak, Correct the Dhatavagni, Helps in follicle maturation and Ovulation
2.  Phala Ghritam[14]Yoni-Doshahara, Shukra-Doshahar, Ayusham, Medhya, Promotes fertility, Arrest recurrent abortion
3.  Chitrakadi Vati[15]Tridosha-Shamak, Deepan, Pachan, induces ovulation, Helps in ovulation

Conclusion

Ayurveda offers a holistic approach to treating anovulatory infertility, especially when conventional methods like ovulation induction have failed. It focuses on rebalancing the body's natural rhythms and addressing root causes. While there are anecdotal successes, more extensive research is needed to confirm its effectiveness. Therapies like Shirodhara and Nasya, which use herbal treatments, aim to restore hormonal balance. Overall, Ayurveda presents a promising alternative, though further studies are necessary to support its role alongside modern medicine.

References

1. Katole A, Saoji AV. Prevalence of primary infertility and its associated risk factors in urban population in central India. [IJCM] Indian journal of community medicine[internet].2019.
2. Insler V, Lunenfeld B. Infertility: Male and Female. 2nd ed. Edinburgh, London, Madrid, Melbourne, New York and Tokyo: Churchill Livingstone; 1999
3. C. Dutta; Textbook of Gynaecology, 8th edition, chapter Amenorrhoea; Pg-412.
4. Sushrut Samhita of maharishi Sushrut edited by ayurveda Tattva sandipika Hindi commentary by Kaviraj Ambikadutta shastri; Sharir sthana 2/35, part 1, pg- 21; Chaukhamba Sanskritsansthan, Varanasi, reprint 2016.
5. Vagbhata kruta Ashtang Hridaya, Sarth Vagbhat, Sutrasthana, 19th chapter Shasrakarmavidhi Adhya, 29/2, edited by Ganesh Krushna Garde, Rajesh Prakashan, Pune, 2012 pp 111
6. Ashtanga Hrudayam 20/1; Vidyotini Hindi Commentary; Page.no.172; Chaukhambha Prakasan, Varanasi; Edition: 2011
7. Ashtanga Hrudayam 20/1; Vidyotini Hindi Commentary; Page.no.152; Chaukhambha Prakasan, Varanasi; Edition: 2011


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8. Anil Kumar, et.al. Stress: Neurobiology, consequences and management; J Pharm Bioallied Sci. 2013 Apr-Jun; 5(2): 91–97.
9. Rasaratna  Samuchchaya (Vidyotini  Hindi commentary). Kulkarni DA, editor. 4thed. New Delhi: Meharchand Publication; 1997. Chapter, 2/23-27.pg 23
10. Bramhanand Tripathi, Charak Samhita, Part 1, Sutra-Sthana, Kiyant shirashiyadhyay, 12/17; page no- 335.
11. Hallie Levine – How Stress Can Hurt Your Chances of Having a Baby https://www.webmd.com/baby/features/infertility-stress#1
12. The Ayurvedic Pharmacopeia of India, Government of India, Ministry of health and family welfare, Department of AYUSH, Part-I, Volume-I-IV
13. Asokan V.A. Review on effectiveness of Pushpadhanva rasa in anovulatory factor of infertility, WJPR 2019
14. The Ayurvedic Pharmacopeia of India, Government of India, Ministry of health and family welfare, Department of AYUSH, Part-II, Volume- I, pg- 120-123
15. K Shukla et. Al., Evaluation of the role of Chitrakadi Vati in the management of Bandhyatva w.s.r to anovulation (as a consequence of unrupturedfollicle), AYU 2009


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