E-ISSN:2456-3110

Case Report

Hamilton’s Anxiety Scale

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 8 August
Publisherwww.maharshicharaka.in

Combined effect of Virechana and Rose Water Shirodhara on Hamilton’s Anxiety Scale

Shetty L1*, Shameembhanu2, Ashvini Kumar M3, Pavan HR4
DOI:10.21760/jaims.10.8.61

1* Lavanyalaxmi Shetty, Post Graduate Scholar, Department of Panchakarma, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Shameembhanu, Assistant Professor, Department of Panchakarma, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 Ashvini Kumar M, Professor and HOD, Department of Panchakarma, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

4 Pavan HR, Post Graduate Scholar, Department of Panchakarma, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

Generalized Anxiety Disorder (GAD) is a common and disabling condition characterized by ongoing worry, anxiety, and tension about various daily concerns, persisting for at least six months.[1] The symptoms of GAD bear resemblance to Chittodwega, an excited state of mind described in the classical Ayurvedic text, the Charaka Samhita, under the category of Manovikara (mental disorders). This study aimed to evaluate the effectiveness of two Ayurvedic therapies - Virechana and Rose Water Shirodhara - in treating anxiety disorders. A 23-year-old female patient presented with symptoms of anxiety, including difficulty breathing, chest heaviness, stress, irritability, concentration issues, sleep deprivation, and constipation, which had persisted for a year. She underwent Panchakarma therapy, incorporating Udwarthana, Parisheka, Rose Water Shirodhara, and Virechana. The patient’s symptoms were assessed using the Hamilton Anxiety Rating Scale before and after treatment. Results indicated a significant reduction in anxiety symptoms, suggesting that both Virechana and Rose Water Shirodhara were effective in alleviating the symptoms of anxiety. The findings support the use of these Ayurvedic treatments for managing anxiety.

Keywords: Anxiety, Chittodwega, Shirodhara, Virechana, Hamilton’s anxiety scale

Corresponding Author How to Cite this Article To Browse
Lavanyalaxmi Shetty, Post Graduate Scholar, Department of Panchakarma, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Shetty L, Shameembhanu, Ashvini Kumar M, Pavan HR, Combined effect of Virechana and Rose Water Shirodhara on Hamilton’s Anxiety Scale. J Ayu Int Med Sci. 2025;10(8):365-369.
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https://jaims.in/jaims/article/view/4294/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-06-14 2025-06-28 2025-07-08 2025-07-18 2025-07-28
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© 2025 by Shetty L, Shameembhanu, Ashvini Kumar M, Pavan HR and 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].

J Ayu Int Med Sci 2025;10(8)365
Download PDFBack To ArticleIntroductionCase ReportDiscussionConclusionReferences
Lavanyalaxmi S et al. Effect of Virechana and Rose Water Shirodhara

Introduction

Anxiety is a natural and adaptive reaction to perceived threats, helping the body prepare for a fight-or-flight response. However, some individuals experience anxiety about almost everything, which can lead to a diagnosis of generalized anxiety disorder (GAD). GAD is characterized by excessive and uncontrollable worry about various events or activities, occurring on most days for a minimum of six months.[2,3] The prevalence of GAD is approximately twice as high in women as in men. The anxiety and anxiety-related disorders are the most common mental disturbances worldwide, with a 12-month prevalence of 14% among persons aged 14 to 65.[4] Due to their high prevalence, chronic nature, and comorbidity, the World Health Organization (WHO) ranks anxiety disorders as the ninth leading cause of health-related disability. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), provides detailed criteria for diagnosing generalized anxiety disorder. The exact cause is unknown but it is believed that noradrenergic, serotonergic, and other neurotransmitter systems appear to play a role in the body's response to stress. This condition can be correlated to Chittodvega.[5] Chittodvega can be defined as a state of anxiety in the mind, where "Chitta" refers to the mind and "Udvega" means anxiety. It is a form of mental disorder (Manasroga) that arises due to an imbalance in the qualities of Rajas and Tamas, along with the Doshas of Vata and Pitta. Symptoms of Chittodvega include feelings of emptiness in the head (Shirah Shoonyata), anxiety, disturbed thoughts (Dhyana), chest tightness (Hridgraha), fatigue (Ayasa), mental agitation (Unmattchittatvam), and other signs similar to excessive worry, restlessness, fatigue, difficulty concentrating, irritability, and sleep disturbances.[6,7] Imbalance in Manasika Doshas i.e., Raja and Tama.[8] The case presented here is managed by Virechana[9] who acted upon the Vikruta Doshas and relieved symptoms and also rose water Shirodhara used to treat variety of condition related to cognition, sleep and anxiety. Continuous pouring of rose water on fore head for a specific period has tranquilizing effect and regulates rhythm Mana and Prana Vayu it induces sleep and relaxes the mind. The present case study is aimed to see positive effects of Virechana and rose water Shirodhara in an anxiety diagnosed patient.

Case Report

Chief Complaints

C\O Difficulty in breathing with heaviness of chest since one year.

Associated Complaints

C\O Stress, not able to concentrate on work, irritability, sleep deprivation since one year.

Case History

The patient is a 23-year-old female who was apparently healthy until one year ago, when her father had an accident. This event caused her significant stress, and since then, she has experienced ongoing difficulty breathing, along with a sensation of chest heaviness. She also reported constant conflicts between her parents, which further affected her mood. The patient noted increased irritability, even over minor issues, and a decreased ability to concentrate on her work. Additionally, she experienced a continuous, racing thought process and an inability to calm her mind, which disrupted her sleep schedule. She also complained of constipation. Due to these issues, she sought further management at SDMCAH, Hassan.

Treatment History: Nothing significant

Surgical History: Nothing significant

Genetic Information: Nothing relevant

Personal History

Appetite - Reduced
Bowel - Altered (constipated) once in 2 or 3 days
Micturition - Unaltered 3-4 times/day
Sleep - Disturbed

Systemic Examination

Respiratory system - NVBS Heard
Cardiovascular system - S1 and S2 heard, no murmurs
Gastrointestinal system - NAD
Central nervous system - Conscious, well oriented to place and person.

Higher Mental Functions

General Appearance and Behaviour

General Appearance - Healthy looking, Grooming Well-groomed, Dressing - Adequate


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Lavanyalaxmi S et al. Effect of Virechana and Rose Water Shirodhara

  • Attitude towards Examiner - Cooperative attitude.
  • Comprehension - Intact
  • Gait and Posture - Normal
  • Motor Activity - No Abnormal Involuntary Movement (AIM), Reaction time Increases occasionally
  • Social Manner - Normal,
  • Eye contact - Normal
  • Rapport - Good
  • Hallucinatory Behaviour - Absent

Speech

  • Rate and Quality - Appropriate rate of speech, sometimes slow.
  • Volume and Tone - Normal
  • Flow and Rhythm - Smooth Mood and Affect: Anxious mood. Anhedonia - Present

Thought

  • Flight of Ideas - Absent
  • Blocking of Thoughts - Absent
  • Thought Broadcasting - Absent
  • Thought Control by Others - Absent
  • Obsession and Fixed Ideas - Present
  • Sudden strange ideas/ Pseudo religious Ideas - Absent

Perception and Motor Control

  • Perception of Time - Intact
  • Hallucination - Absent
  • Illusion - Absent

Cognition

  • Consciousness - Conscious
  • Orientation - Well oriented to Time, Place, Person
  • Attention - Attentive
  • Concentration - Appropriate
  • Memory: Immediate - Intact
  • Intelligence - Normal
  • Abstract thinking - Present
  • Insight - Present

  • Judgement - Not impaired

Intervention

The principles of management of Chittodvega are by doing Samprapti Vighatana of Vata and Rajas.

This can be achieved by alleviating Vata Dosha and maintaining the Rajas. In this patient Shodana by doing Virechana and rose water Shirodhara.

Table 1: Panachakarma Procedures

ProcedureDrug UsedDurationDay/ Date
Sarvanga UdwarthanaUdwarthana Churna20 minutes one dayFirst day - 8/8/24
SnehapanaPanchagavya GrithaFirst day - 50ml9/8/24
Second day - 70ml10/8/24
Third day - 130 ml11/8/24
Fourth day - 180ml12/8/24
ShirodharaWarm water mixed with rose water and rose petals20 minutes for six daysProcedure done on evening from 9/8/24 to 14/8/24
Sarvanga AbhyangaKsheerabala Taila20 minutes for two daysFifth and sixth day 13/8/24 to 14/8/24
Bashpa SwedaErandamoola Kashaya15 minutesFifth and sixth day 13/8/24 to 14/8/24
VirechanaTrivrut Leha 60 gram followed by Triphala Kashaya 100mlLast day15/8/24
12 Vegas

Assessment Criteria

Table 2: Ashta Vibhrama Assessment

VibhramaBTATFollow-Up
Manas VibramaFrequency421
Severity421
Buddhi VibhramaFrequency321
Severity321
Sanjnajyana VibhramaFrequencyAbsent--
Severity---
Smriti VibhramaFrequencyAbsent-- 
Severity-- - 
Bhakthi VibhramaFrequencyAbsent--
Severity---
Sheela VubhramaFrequencyAbsent--
Severity---
Chesta VibhramaFrequencyAbsent--
Severity---
Achara VibhramaFrequencyAbsent--
Severity---

0 - Not Present, 1 - Mild, 2 - Moderate, 3 - Severe, 4 - Very Severe


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Lavanyalaxmi S et al. Effect of Virechana and Rose Water Shirodhara

Table 3: Hamilton’s Anxiety Scale (HAM –A)

CriteriaBefore TreatmentAfter TreatmentFollow-Up
1.  Anxious mood421
2.  Tension311
3.  Fear420
4.  Insomnia321
5.  Intellectual110
6.  Depressed mood321
7.  Somatic muscular310
8.  Somatic sensory000
9.  Cardiovascular symptoms211
10. Respiratory symptoms200
11. Gastrointestinal symptoms210
12. Genito urinary symptoms000
13. Autonomic symptoms000
14. Behaviour at interview100

0 - Not Present, 1 - Mild, 2 - Moderate, 3 - Severe, 4 - Very Severe

Discussion

The treatment plan aims to reduce her anxiety levels and calm her mind. While her anxiety was manageable during childhood, it resurfaced due to challenging life situations. Initially, the symptoms were mild, but after her father's accident, they worsened significantly, leading to more severe symptoms, including difficulty breathing and a feeling of heaviness in the chest.

Vata Dosha governs and regulates the functions of the manas (mind). It supports the mind in carrying out its normal activities, including the ability to discern between good and bad. Vata Dosha also ensures the proper functioning of the Indriyas (senses). By understanding the Karmukata (functional actions) of Vata, we can better appreciate its role in maintaining the normal functioning of the Manas.[10]

Virechana Karma is performed in two primary ways. The first is its systemic action, where it gathers and transports the morbid Doshas from the peripheral regions of the body (Shakha) to the central area (Koshta). The second is its local action, which involves the evacuation of these Doshas in the form of waste (Mala) from the gastrointestinal tract, facilitated by its Adhobhagahara property. Together, these actions help in the purification and balance of the body’s Doshas.[11]

The absorption of the substances used in Virechana Karma occurs through their Veerya, allowing them to travel to the Hrudaya (heart). From there, they reach the Dasha Dhamani (ten main channels) and continue to circulate through both the micro and macro channels within the body, including the Sukshma and Sukshmati Srotas. The properties of Ushna (heat), Teekshna (sharpness), Vyavayee (penetrative), and Vikasi (spreading) drive the morbid Doshas from the peripheral regions (Shakha) towards the central area (Koshta). Finally, due to its Adhobhagahara property, Virechana facilitates the expulsion of these Doshas from the body, flushing them out through the Koshta.[12]

Shirodhara is known to lower stress levels and enhance mood. Its effects are similar to those seen after deep meditation and profound relaxation, as shown in previous EEG studies, which reveal an increase in alpha waves and a reduction in beta activity.[13] Rose is a popular ornamental plant that can also be used as a natural remedy for various health concerns. Its accessibility, feasibility, versatility, and cost-effectiveness make it an ideal option. The Hridya property of rose further enhances its ability to help manage stress, making it a highly beneficial solution.[14] Key Actions of Rosewater are Anti-depressant, Anti-spasmodic, Aphrodisiac, Anti-bacterial, Anti-viral, Antiseptic, Anti-inflammatory, Blood tonic, Digestive stimulant, Expectorant Increases bile production, Menstrual regulator. Recent research work related to Rose water. Rose water has physiological and psychological relaxation, analgesic and anti-anxiety effects on humans.[15] Thus it calms the mind.

Conclusion

The combination of Virechana Karma and Shirodhara, tailored to address the specific Dosha imbalances observed in the condition of Chittodvega, has proven to be highly effective. These treatments have successfully alleviated the signs and symptoms experienced by the patient, demonstrating significant therapeutic benefits and improving overall well-being.

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J Ayu Int Med Sci 2025;10(8)369