Shira

The word ‘Shiras’ (also spelled as Shirah) means head region. The body parts in supraclavicular region are described as ‘urdhvajatrugata’. Head is a seat of prana [life force] and indriyas [sensory and motor organs]. [Cha.Sa.Sutra Sthana.17/12] A vital part (marma), shiras play a significant role in overall well-being, functioning as an origin for all sensory- motor organs and ten life forces. [Cha.Sa.Sutra Sthana.29/3] The classical texts of Ayurveda, including Charak Samhita, Ashtanga Hridaya and Sushrut Samhita, quoted the significance of shiras, associating it with prana, cognitive functions, and the intricate network of doshas. This article deals with comprehensive information about anatomy, physiology, diagnostic and therapeutic aspects of head from Ayurveda perspectives.

Contributors

Section/Chapter/topic	Concepts/Sharira/Marma/Shira
Authors	Bhojani M. K. 1, Garg Nisha 1
Reviewers & Editors	Basisht G.2, Deole Y.S.3
Affiliations	1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India 2 Rheumatologist, Orlando, Florida, U.S.A. 3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails	meera.samhita@aiia.gov.in carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India & Symbiohealth Foundation, India
Date of publication:	May 17, 2024
DOI	10.47468/CSNE.2024.e01.s09.164

Etymology and derivation

Etymologically, "shira" embodies the essence of being the topmost and most significant part of the body. Shira means head including the neck; also spelled as "Sira.”

Synonyms in Ayurveda

Uttamanga (best part or uppermost part), shirasa (head), shirsha (head), murdha (head), mastaka (head).

Shira in Ayurveda

Shiras is also called as uttamanga in Ayurveda. Uttara means top or above and anga means a body part. Thus, the part of body located in the topmost position is called as uttamanga. Also, uttama means best or of topmost quality/significance etc. Shiras [head] is foremost among all organs as it is part of the body where the life energy and all the vital centers of sensory and motor organs [indriyas] of a living being are located. [Cha. Sa. Sutra Sthana 17/12] It indicates that any injury to this part of the body will certainly affect indriya, prana, and thus the entire life. It is also clear from the above discussion that, ancient Ayurveda scholars emphasized on significance of head and the seriousness of neurological disorders, the center of all of which is situated in brain and nerves that are situated inside the head.

Shadangas (Six main parts)

Ayurveda scholars consider ‘Shiras’ as one of the six main parts of body known as ‘Shadangas’ in Human. [Su. Sa. Sutra Sthana 5/3] Contemporary anatomy also lists ‘Head, Neck and Brain’ as vital parts in medical studies.

Site of external orifices (bahirmukha srotas)

In head region, there are external orifices like nostrils, two eyes, two ears and one oral cavity. These are termed as bahirmukha strotasa that means channels of passage for various body elements having opening on outer surface of body. [Cha. Sa. Sharira Sthana.7/12-13]. Nose is the entry point of shiras. One can administer medicines in nose to attain health benefits in head region. [Cha. Sa. Siddhi Sthana 9/88]

Importance of shirasa as marma

Shiras is recognized as one of the crucial points or marmas. Ayurveda texts enumerate 107 marmas, three of which are most significant. Shiras is included among these three vital marmas, serving as the locus of life energy. Any disruption here can lead to disturbance in overall life. [Cha. Sa. Chikitsa Sthana 26/3-4]
Ayurveda literature extensively discusses the bones, joints, muscles, and related structures associated with shiras. Additionally, the fine lines of joints between skull bones, known as ‘Simantas’, are considered marmas. The effect of injuries to these are also elaborately described. The internal structure of pathways for various sensory and motor organs, along with the seat of prana [life energy], is said to be present in a specific arrangement in 'shiras’. Ayurveda acharyas simplify the explanation of this structure using a simile. The structure of head and its associated indriya are like the radiating spicules of sunlight that appear to be distant from the sun, but originate from a single centre, i.e., the Sun. Similarly, all these sensory organs [indriyas] and life energy [prana] are situated in shiras, but can manifest anywhere else in the body. [Cha. Sa. Siddhi Sthana 9/4]
Shiras is one of the three highly crucial marma in the body. Injury to any of these three marmas, including shiras, can result in sudden pain throughout the body. The destruction of the substance (ashraya) leads to the destruction of the substrate [ashrita]. Severe disease manifestations occur due to injury, emphasizing the need to protect shiras, especially from external injuries and vata dosha. [Cha. Sa. Siddhi Sthana 9/5]
Vagbhatta explains the importance of shiras as, it is essential because all indriya are situated in shiras and it should be protected. He compared shiras with a tree (vruksha) with upward roots (urdhwamoola) and downward branches (adhoshakha). Damage to moola [shiras] results in the damage to shakha [body] [A. Hr. Uttara Tantra 24] Sushruta opines prana is the combination of agni, soma, vayu, pancha indriyas and panchamahabhootas. Such pranas are located in shiras. [Su.Sa. Uttar Tantra 25/1-2]
Specifically, due to head injury, certain signs and symptoms may arise, including neck stiffness, facial paralysis, eye disorders, mental confusion, loss of body movements, cough, breathlessness, stiffness of the jaw, excessive yawning, and more. [Cha. Sa. Siddhi Sthana 9/6]

Anatomical perspective of head region

The head region encompasses the cranium, composed of cranial bones that encase and protect the brain, and facial bones that provide support and attachment for facial muscles. The brain, housed within the cranial cavity, orchestrates sensory perception, cognition, and motor coordination. Facial features such as the eyes, nose, mouth, and ears serve essential roles in sensory input, communication, and expression. The eyes capture visual stimuli, the nose detects odors, the mouth facilitates speech and consumption, and the ears enable auditory perception.
Understanding the anatomical relationships within the head region is pivotal in diagnosing and treating a myriad of conditions, from neurological disorders to facial trauma. It aids healthcare professionals in performing surgical procedures, administering treatments, and interpreting diagnostic imaging accurately.

Marma present in head

The areas where muscles, vessels, ligaments, bones and joints meet together are known as the marma (vital points of the body) which by virtue of their nature are specially the seats of life. [Su. Sa. Sharira Sthana 6/15] There are total of one hundred seven marmas. Out of these, there are thirty-seven are jatrurdhvamarma/ siromarma (vital points of the head and neck). Above the clavicles following marmas are found: four dhamani (arteries), eight matrukas (carotid vessels), two krukatikas (atlanto-occipital joint), two phana (olfactory bulb), two apangas, two avartas (junction of frontal, zygomatic and sphenoid bones), two utkshepas (deep temporal vessels and nerve), two shankhas, one sthapani (glabella), five simantas (cranial sutures), four srungataka (junction point of sense organs) and one adhipati (trocula herophilis). Out of these sringataka, adhipati, shankhas, kantha sira marmas are sadyo marma. [Su. Sa. Sharira Sthana 6/9]

Brief description of brain, its main parts and their functions with figures

The brain, the control centre of the nervous system, consists of cerebrum which is the largest part responsible for higher cognitive functions such as thinking, learning, and voluntary movement. It is divided into left and right hemispheres, each controlling the opposite side of the body. The cerebral cortex, the outer layer of the cerebrum, is responsible for higher-level brain functions such as consciousness, perception, and language processing. The cerebellum, located below the cerebrum, coordinates voluntary movements, balance, and maintains posture. The brainstem, situated at the base of the brain, regulates basic life-sustaining functions such as breathing, heart rate, and sleep cycle. It consists of midbrain, pons, and medulla oblongata. The limbic system, found deep within the brain, is involved in emotions, memory, and motivation. It includes structures like the hippocampus, amygdala, and hypothalamus. Understanding the functions of these main parts is crucial for comprehending brain function and pathology.

Dosha physiology in shiras

Dosha seated in shiras are prana vayu, alochaka pitta and tarpaka kapha. Prana vayu is located in the head, chest, throat, tongue, mouth and nose. Its functions are spitting, sneezing, eructation, respiration, deglutition of food etc. [Cha. Sa. Chikitsa Sthana 28/6] The pitta situated in the eyes is known as alochaka agni. It helps in the visualisation of objects. [Su. Sa. Sutra Sthana 21/10] The shleshma situated in the head and by virtue of its greasy and its nutritional properties of its own potency, helps in the proper functioning of sense organs. [Su. Sa. Sutra Sthana 21/14]

General causative factors of diseases of head

The general causative factors of shiroroga are suppression of natural urges, day sleep, insomnia, intoxication, talking too loudly, exposure to frost, exposure to wind from the front, excessive indulgence in sexual activity, inhalation of unwholesome smell, exposure to dust, smoke, cold and sun; over eating of heavy, sour, and green food, use of very cold water, trauma to the head, formation of products of improper digestion and metabolism in the body (i.e. ama), excessive weeping or suppression of tears, cloudy weather, irritation of mind and anomalous climate.. These factors provoke or vitiate vata, affecting rakta in the head leading to shiroroga with various symptoms. [Cha. Sa. Sutra Sthana 17/8-11]

Classification of diseases in shiras (shiro roga)

The diseases in head region are classified based on the dominance of vitiated dosha. Acharya Charak in Sutra Sthana mentioned principally 5 types of shiro roga [Cha. Sa. Sutra Sthana 19/3] and well explained the same in Chikitsa sthana.[Cha. Sa. Chikitsa Sthana 26/118]

1. Vataja shiroroga
   Indulgence in loud speech, excessive talk, strong drinks, keeping awake till late at night, exposure to cold wind, excessive sexual acts, suppression of natural physical urges, fasting, trauma, excessive/strong vamana or virechana, excessive weeping, grief, fear, terror and severe emaciation leads to the provocation of vata which by affecting the vessels of the head gets further provoked and produces severe pain in head. The vata-dominant diseases in the head are characterized by intense pain in the temple region, mid of eyebrows, pain in the forehead, dizziness, and stiffness in the neck region. Use of hot and unctuous things provides relief in vata type of headache. [Cha. Sa. Sutra Sthana 17/19-21]
   Primary treatment includes abhyanga [anointing with oil], swedana [steam therapy], nasya [oil instillation through nostrils], diet management and, poultice application. [Cha. Sa. Chikitsa Sthana 26/158]
2. Pittaja shiroroga
   Excessive use of pungent, sour, salty, and alkali substances and wine, exposure to sun (or heat), and anger lead to the provocation of pitta, which by lodging in the head, produces pitta-dominant diseases of the head. The pitta dominant diseases in the head are characterized by a burning sensation overhead region, headache, burning sensation in the eyes, and excessive perspiration. [Cha. Sa. Sutra Sthana 17/22-23]
   Primary treatment includes aspect – intake of medicated ghee, milk etc. and application of poultices, herbal ointments/ pastes, nasya with ghee. [Cha. Sa. Chikitsa Sthana 26/176]
3. Kaphaja shiro roga
   Due to sedentary lifestyle, excessive sleep, indulgence in heavy and unctuous meals, or excessive food intake, kapha gets provoked in the head and produces kaphaj shiro roga. The kapha-dominant diseases in the head are characterized by constant dull headache, heaviness of the head, stiffness, extreme laziness, and loss of appetite. [Cha. Sa. Sutra Sthana 17/24-25]Primary treatment includes dhumapana [medicated smoke], diet management which reduces kapha dosha, basti karma, administration of old preserved medicated ghee, agni karma [cauterization method].[Cha. Sa. Chikitsa Sthana 26/180]
4. Tridoshaja shiro roga
   The diseases with vitiation of three dosha in head are characterized by headache, tremors, burning sensation, excessive thirst. [Cha. Sa. Sutra Sthana 17/26] Primary treatment includes all the above management principles applied accordingly and intake of purana ghruta. [Su. Sa. Uttartantra 26/24]
5. Krimija shiroroga
   When a person with provoked dosha indulges in excessive intake of sesame, milk, molasses, takes meals even when previous meal has not properly digested, eats putrefied or promiscuous food, and/or takes incompatible diet - it causes pathological discharges of rakta, kapha and mamsa, wherein parasites are produced, leading to krimija shiroroga with dreadful symptoms and feels as if, the patient suffers from piercing, cutting or aching pains in the head with itching, swelling, foul smell and detectable parasites. [Cha. Sa. Sutra Sthana 17/27-29] Primary treatment includes removal of the worms/micro-organisms by strong medicated nasya [instillation of oil, liquid, powders etc through nostrils] and medicines to counteract them.[Su. Sa. Uttartantra 26/28]

Other diseases

Injury to the shiras leads to manyastambha (stiffness of neck), ardita (hemiplegia with facial palsy), chakshuvibhrama (improper movements of eyeball/lesions in sight), moha (a state of confusion), udveshtana (twisting pain in the head), cheshtanasha (loss of body functions), kasa (cough), shwasa (breathlessness), hanugraha (stiffness of jaw), muka (dumbness), gadgada (hoarseness of voice), akshinimilana (ptosis), gandaspandana (twitching in cheek), jrumbhana (excessive yawning), lalasrava (dribbling of saliva), svarahani (aphonia), vadana jihmatva (deviation of face) etc. [Cha. Sa. Siddhi Sthana 9/10]
Acharya Sushruta described eleven types of diseases occurring in head region. [Su. Sa. Uttartantra 25/3-16]

1. Vataja —A headache of non-specific aetiology that is markedly aggravated at night and is relieved by pressure and fomentations.
2. Pittaja—The headache in which the head, eyes, and nose feel burning and fuming and as if they are full of burning charcoal, and which is relieved by cold applications and also at night, is said to originate from vitiated pitta.
3. Kaphaja—A headache in which the head and throat are felt as if filled with kapha and are characterized by heaviness, stiffness, coldness, and swelling of the orbit and the face.
4. Sannipātaja - Arising from the combination of all the three doshas shows mixed features of all above types.
5. Raktaja - Having the characteristics of pittaja headache with hyperaesthesia of the head in addition.
6. Kshayaja - The decrease of unctuous constituents and kapha in the head, as a result of trauma to the head, produces headache arising from depletion of tissues, which is very severe, causing excruciating pain and is increased by sudation, vomiting, fumigation, snuffing and blood-letting therapies.
7. Krumija - A person who suffers from a severe pricking headache with a feeling of being eaten up or of something cracking inside and who also has watery discharge from the nose mixed with blood.
8. Suryavarta - The headache which starts mildly in the regions of the eyes and the eyebrows with the sunrise, gradually gains momentum and increases with the sun (going up) and finally subsides as the sun sets and which is sometimes relieved by cold measures and sometimes by hot measures, is described as suryavarta. It is sannipataja in nature, and is extremely troublesome.
9. Anantavata - When all the three dosas in a vitiated condition affect the manya and produce severe pain in the back of the neck (ghata) which is particularly referred to the region of eyes, the eyebrows and the temples where it is localised, producing twitching on the sides of the cheek, lock jaw and many other diseases of the eye; such a condition is described as anantavāta.
10. Ardhavabhedaka - The person who has a severe headache of bursting, pricking and spinning types confined to half of the head only and the attacks tend to come every fortnight, ten days or suddenly (irregularly), is said to have ardhāvabhedaka. It is supposed to be sannipataja in origin.
11. Shankhaka - The troublesome disease in which exacerbated vata localised to the region of the temples and followed by kapha, pitta and rakta, produces excruciating pain in the head particularly in the temples, is termed shankhaka.

Acharya vagbhatta mentioned about following diseases in shiroroga vigyaniya adhyaya: Shirastapa, ardhavbhedaka (affecting half of the head), krimija shiro roga, shira kampa (predominance of vata produces shaking of the head), shankhaka (predominance of pitta, associated with blood causes swelling in the temples along with other symptoms), suryavarta (vata followed by pitta, causes severe throbbing pain in the temples, eye brows and forehead beginning in the head), upshirshaka (the scalp when in the womb, gets vitiated by vata, develops a swelling of the same colour of the skin and is devoid of pain), pitika, arunshika (eruptions) on the scalp caused due to pitta, blood, kapha and worms, darunaka(caused due to vitiation of kapha and vata produce itching, loss of hair, loss of tactile sensation on the scalp, dryness and causing minute cracks in the skin), indralupta (the pitta present in the hair follicles along with vata makes the hair to fall off while the kapha along with blood blocks the orifices of the hair follicles and there is no growth of new hair), khalita (falling of hair due to vata causes scalp to look as though it has been burnt by fire. These are caused due to vitiation of the pitta studded with a network of veins that are thick and are of the same colour as that of the skin) and palita (the heat of the body provoked by grief, exertion and anger, moving on to the head along with the doshas eliminates the hair color to make them gray). [Ash. hr. Uttar sthana 23/6-29]

Diseases with headache as clinical feature

Shirahshool (Headache) occurs in following conditions also:
Due to suppression of urge of defaecation and sneezing [Cha. Sa. Sutra Sthana 7/8,16]

• Vaataja gulma [Cha. Sa. Nidana Sthana 3/7]
• Vatapitta jwar [Cha. Sa. Chikitsa Sthana 3/85]
• Sannipata jwar [Cha. Sa. Chikitsa Sthana 3/103]
• Ajeerna [Cha. Sa. Chikitsa Sthana 15/45]
• Visuchika [Su. Sa. Uttartantra 56/6]
• Karna pratinaha [Su. Sa. Uttartantra 20/12]

Diagnostic tools and investigations

Following investigations support to diagnose diseases of head region:

1. Complete blood count
2. X-ray skull
3. Electroencephalography (EEG)
4. Computerized tomography (CT) scan of head
5. Magnetic resonance imaging (MRI) scan of brain

Preventive measures

Ayurveda advocates several preventive measures to maintain the health of shiras:

• Nasya - 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]
  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.
• Shiro-abhyanga - Smearing oil and application of mild massage is abhyanga. In cases of dryness, itching and dirtiness can be treated by oil application.
• Parisheka - Pouring of oil is parisheka. In the case of ulcerations of the scalp, headache, burning sensation, wounds, and suppurations of the scalp is helped by oil application.
• Shiropichu - Oil-soaked cloth (Pichu) could be applied to stop falling hair, cracking of the skin and feeling of burning sensation as well as in cases of blocked vision.
• Shiro basti - Oil application on the head is basti. In the case of loss of sensation of the scalp, facial palsy, loss of sleep, dryness of the nose and mouth, blindness and diseases of the head, is helped by basti. [Ash. hr. Sutra sthana 22/23-26]
• Shirodhara - Shirodhara is an ancient healing procedure that incvolves pouring liquid on the forehead from a definite height for a specific period allowing the liquid to run through the scalp and into the hair. This is a subtype of murdhataila along with shiro abhyanga, pichu, and shiro basti.

Standard treatment protocol

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