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→Conclusion
== Preventive measures ==
== Preventive measures ==
Ayurveda advocates several preventive measures to maintain the health of shiras:
Ayurveda advocates several preventive measures to maintain the health of shiras:
<ul style="text-align:justify; list-style-type:none;"><li style="font-weight: bold;">Nasya - <span style="font-weight: normal;">The administration of medicated oil or substances through the nasal passage, is recommended during specific seasons to prevent shiro roga. It helps prevent hair fall, stiffness of the neck, headaches, and facial paralysis. [Cha. Sa. Sutra Sthana 5/60]<br/>Anointing the head with oil is called Murdha taila. It is of four kinds: pouring oil down on the head (parisheka) smearing oil and mild massage (abhyanga), keeping cloth soaked in oil (picu) and basti or sirobasti, each successive type being more effective than the former.
<ul style="text-align:justify;list-style-type:none;"><li style="font-weight: bold;">Nasya - <span style="font-weight: normal;">The administration of medicated oil or substances through the nasal passage, is recommended during specific seasons to prevent shiro roga. It helps prevent hair fall, stiffness of the neck, headaches, and facial paralysis. [Cha. Sa. Sutra Sthana 5/60]<br/>Anointing the head with oil is called Murdha taila. It is of four kinds: pouring oil down on the head (parisheka) smearing oil and mild massage (abhyanga), keeping cloth soaked in oil (picu) and basti or sirobasti, each successive type being more effective than the former.
</span></li>
</span></li>
<li style="font-weight: bold;">Shiro-abhyanga - <span style="font-weight: normal;">Smearing oil and application of mild massage is abhyanga. In cases of dryness, itching and dirtiness can be treated by oil application.</span></li>
<li style="font-weight: bold;">Shiro-abhyanga - <span style="font-weight: normal;">Smearing oil and application of mild massage is abhyanga. In cases of dryness, itching and dirtiness can be treated by oil application.</span></li>
== Standard treatment protocol ==
== Standard treatment protocol ==
As per ministry of Ayush, treatment is at three levels based upon the availability of health facility and clinical condition of the patient:
'''Level 1''' -: At solo ayurveda physician clinic/PHC
In the initial stage when the patient is having signs and symptoms of shirashoola, following drugs may be given:
{| class="wikitable"
|Drugs
|Dose
|-
|Pathyadi Kwatha<ref name="ref5">Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part II (4:15), 2000</ref>
|20ml twice a day with guda
|-
|Gau ghrita
|3 drops in each nostril 4 times a day
|}
Referral criteria: If patient is not responding to above mentioned management within 5 or 7 days and if signs and symptoms indicate need for further investigations.
'''Level 2''': CHC’s or small hospitals with basic facilities,
in addition to the management mentioned in Level 1, few of the following drugs may be added as per the requirement and status of the patient.
{| class="wikitable"
!'''Drugs'''
!'''Dose'''
|-
|Shirahshooladi Vajra Rasa<ref name="ref6">Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part II (16:59), 2000 </ref>
|2 tabs twice a day with normal water
|-
|Shadabindu Taila Nasya<ref name="ref7">Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (8:60), 2000</ref>
|3 drops in each nostril once a day
|-
|Dashamoola Taila<ref name="ref8">Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part II (8:6), 2000</ref> for Abhyanga on scalp
|15 ml once a day
|}
Referral criteria: If patient is not responding to above mentioned management within 10 days or signs and symptoms become more acute, patient should be referred for panchakarma therapy.
'''Level 3''': Ayurveda hospitals at institutional level or district hospital / integrated ayurvedic hospitals.
In addition to the management of Level 1 and Level-2, panchakarma procedures is indicated.
{| class="wikitable"
!S.no.
!Type of Shiroroga
!Treatment
|-
|1.
|Vataja shiroroga
|
* Shirodhara with Luke warm cow milk prepared with Vata pacifying medicines
* Upanaha sweda with krishara
* Marsha nasya with Tila Taila prepared with Vata pacifying medicines
|-
|2.
|Pittaja Shiroroga
|
* Shirodhara with cold milk, sugarcane juice, madhu jala, mastu
* Marsha nasya with Pitta pacifying aushadha sidhdha ghrita i.e. kshira sarpi, jeevaniya ghrita
* Virechana with trivrita avaleha or ghrita
|-
|3.
|Kaphaj Shiroroga
|
* Pradhaman Nasya with Katphala Churna
* Shirolepa with Trivrittadi Lepa
* Fomentation with Water
|-
|4.
|Tridoshaja Shiroroga
|
* Above mentioned treatment as per predominant Dosha
* To drink old Ghrita is especially advocated.
|-
|5.
|Raktaja Shiroroga
|
* As per Pittaja Shiroroga
|-
|6.
|Kshayaja Shiroroga
|
* Ghritapana
* Marsha Nasya with Vataghna Aushadh Siddha Taila
|-
|7.
|Suryavarta
|
* Ghritapana
* Marsh Nasya with Jeevaniya Ghrita
* Shirodhara with lukewarm cow milk prepared with Vataghna medicines
* Shirobasti with Luke warm cow milk
|-
|8.
|Ardhavabhedaka
|
* Same as treatment of Suryavarta
* Avapida Nasya with Shirisha Moola/Phala or Vacha & Pippali
|-
|9.
|Anantavata
|
* Same as treatment of Suryavarta
|-
|10.
|Shankhaka
|
* Marsha Nasya with Vataghnaaushadh Sidhdha Ghrita
* Shirolepa Shatavaryadi Churna[Su. Uttartantra 26/39]
|}
== Pathya-Apathya (Diet and life style education) ==
'''Pathya:'''
'''Ahara (food articles):''' Freshly cooked, easily digestible diet i.e. Purana Ghrita, Shali/ Shashtika rice, cow milk, drumstick, grapes, bitter guard, butter milk, coconut water, etc. should be taken
'''Vihara:''' Rest, fomentation, Lepa, Dhumapana, fasting
'''Apathya:'''
'''Ahara:''' Excessive and regular intake of horse gram and black gram pulses, virudha dhanya (sprouts), chillies and spices, sour and fermented foods like pickles, idali, dosa etc, heavy-to-digest foods like cheese, paneer, deep fried items etc., junk foods and fast foods, dadhi (curd), matsya (fish), meat of animals belonging to marshy areas (anupa mamsa), phanita, pinyaka (oil cake) aranala (sour gruel), excess water intake, excess alcohol intake and betel leaf chewing (tambula) should be avoided.
'''Vihara:''' Life style factors like anger, grief, excessive coitus; suppression of natural urges like defecation, micturition, lacrimation, hunger, thirst etc.; looking at minute objects, excessive weeping, excessive vomiting and suppression of vomiting, daytime sleep and awakening at night, shift duties, working on computer for continuous and longer duration and watching television for long time, sudden changes of temperatures, exposure to frequent change of hot and cold temperatures, exposure to dust and fumes, excessive sunlight exposure and smokingshould be avoided.
== Contemporary approach ==
<p style="text-align:justify;">The classical understanding of shiras aligns with the contemporary appreciation of the importance of the head in overall health. The head includes the ears, brain, forehead, cheeks, chin, eyes, nose, and mouth. These aid in various sensory functions such as sight, hearing, smell, and taste. Neurological disorders and conditions related to the head, such as headaches, are prevalent reasons for seeking medical assistance. Understanding shirasa in the modern context involves recognizing the intricate connections between the head and various physiological functions, including sensory perception, cognitive abilities, and vital life forces. The human head is an anatomical unit that consists of the skull, hyoid bone and cervical vertebrae. The term "skull" collectively denotes the mandible [lower jaw bone] and the cranium [upper portion of the skull that houses the brain].<ref name="ref9">Wikipedia Contributors. [2024, March 9]. Head. Retrieved March 11, 2018, from https://en.wikipedia.org/wiki/Head</ref></p>
== Research works done on shiras, physiology, anatomy, shiro-roga ==
Few research works related to shirasa and shiroroga:
<ol><li>A pilot study on clinical efficacy of ''Agnikarma'' and ''Pathyadi'' decoction (an Ayurvedic formulation) in the management of ''Ardhavabhedaka'' (migraine). <br/>This study concluded that Agnikarma along with Pathyadi decoction can be considered as an effective line of treatment to manage Ardhavabhedaka (migraine).</li>
<li>A concept of siravedha in shiroroga by Twinkal zala, hemangi shukla and aarti aghera. <br/>This study concluded that raktamokshana is one of the best treatment for Shiroroga.</li>
<li>Effects of Ayurveda interventions on acute pain and quality of life of a trigeminal neuralgia patient - A case report. <br/>In Ayurveda, TN is generally dealt with as the condition of Anantavata, which is a Vata-dominant Tridosha Shiroroga. The above study concluded that Ayurveda interventions used in the present case were found to be helpful in reducing the acute paroxysms of pain in CTN and improving the quality of life.</li>
<li>Efficacy of Sri Lankan Traditional Decoction of ''Katuwelbatu Deduru Katukadi'' in treatment of ''Kaphaja Shira Shula'' (Chronic Sinusitis).<br/>In this study it is concluded that decoction of Katuwelbatu Deduru Katukadiya, a Sri Lankan traditional decoction, can successfully be used in treatment of Kaphaja Shira Shula</li>
<li> Comprehensive review of shroshula in ayurveda reserve.<br/>This study concluded that Shirahshula is the most common disease, is mainly due to aggravation of vatadosha as well as tridosha. Panchakarma like- BrahanaNasya, Murdhnisneha (Shirodhara, Shiropichu, ShiroAbhyang & Shirobasti) Dhumapana, Kawal, Gandush, Taladharan, NetraTarpana are advised for treatment of shiroshula.</li></ol>
== Conclusion ==
<p style="text-align:justify;">In conclusion, shirasa is not merely a physical entity but a complex amalgamation of vital life forces, sensory organs, and cognitive functions. Ayurveda's classical approach to shirasa provides a holistic understanding that resonates with contemporary perspectives on neurological health. By recognizing the significance of dosha balance, preventive measures, and the intricate connections between the head and the entire body, individuals can strive to maintain the well-being of shiras for a healthier and more fulfilling life.</p>
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