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Psychoneuroimmunologic Effects of Ayurvedic Oil-Dripping Treatment

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This study assessed the psychoneuroimmunologic changes achieved by Shirodhara, an Ayurvedic treatment, characterized by dripping oil on the forehead, in a randomized, controlled protocol involving a novel approach using a robotic system. In the first experiment for the determination of the most appropriate conditions of Shirodhara, 16 healthy females (33 +/- 9 years old) underwent a 30-minute treatment. In the second study, another 16 healthy females (39 +/- 9 years old) were assigned to either the Shirodhara treatment or control supine position for 30 minutes, with monitoring of physiologic, biochemical, immunologic, and psychometric parameters including anxiety and altered states of consciousness (ASC). The subjects receiving Shirodhara treatment showed lowered levels of state anxiety and higher levels of ASC than those in the control position. Plasma noradrenaline and urinary serotonin excretion decreased significantly more after Shirodhara treatment than in the control. Plasma levels of thyrotropin-releasing hormone, dopamine, and natural killer (NK) cell activity were different between control and Shirodhara treatment. The correlation between anxiolysis and the depth of ASC was significant in the Shirodhara treatment group (r = 0.52, p < 0.05, N = 16), while in the control no correlation was obtained (r = 0.13, p = 0.64, N = 16). The increase in foot skin temperature after Shirodhara showed a significant correlation with anxiolysis and the depth of Trance of ASC (r = 0.58, p < 0.01, r = 0.43, p < 0.01, respectively). NK cell activity after Shirodhara treatment showed a significant correlation with anxiolysis and the depth of Trance of ASC (r = 0.33, p < 0.05, r = 0.56, p < 0.01, respectively). These results indicate that Shirodhara has anxiolytic and ASC-inducing effects, and it promotes a decrease of noradrenaline and exhibits a sympatholytic effect, resulting in the activation of peripheral foot skin circulation and immunopotentiation.
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THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 14, Number 10, 2008, pp. 1189–1198
© Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2008.0273
Original Papers
Psychoneuroimmunologic Effects of Ayurvedic
Oil-Dripping Treatment
Kazuo Uebaba, M.D., Ph.D.,
1,2
Feng-Hao Xu, M.D.,
1,2
Hiroko Ogawa, M.S.,
1,2
Takashi Tatsuse, B.C.,
3
Bing-Hong Wang, Ph.D.,
4
Tatsuya Hisajima, Ph.D.,
5
and Sonia Venkatraman
6
Abstract
Objective: This study assessed the psychoneuroimmunologic changes achieved by Shirodhara, an Ayurvedic
treatment, characterized by dripping oil on the forehead, in a randomized, controlled protocol involving a novel
approach using a robotic system.
Methods: In the first experiment for the determination of the most appropriate conditions of Shirodhara, 16
healthy females (33 9 years old) underwent a 30-minute treatment. In the second study, another 16 healthy
females (39 9 years old) were assigned to either the Shirodhara treatment or control supine position for 30
minutes, with monitoring of physiologic, biochemical, immunologic, and psychometric parameters including
anxiety and altered states of consciousness (ASC).
Results: The subjects receiving Shirodhara treatment showed lowered levels of state anxiety and higher levels
of ASC than those in the control position. Plasma noradrenaline and urinary serotonin excretion decreased sig-
nificantly more after Shirodhara treatment than in the control. Plasma levels of thyrotropin-releasing hormone,
dopamine, and natural killer (NK) cell activity were different between control and Shirodhara treatment. The
correlation between anxiolysis and the depth of ASC was significant in the Shirodhara treatment group (r
0.52, p0.05, N16), while in the control no correlation was obtained (r0.13, p0.64, N16). The in-
crease in foot skin temperature after Shirodhara showed a significant correlation with anxiolysis and the depth
of Trance of ASC (r0.58, p0.01, r0.43, p0.01, respectively). NK cell activity after Shirodhara treatment
showed a significant correlation with anxiolysis and the depth of Trance of ASC (r0.33, p0.05, r0.56,
p0.01, respectively).
Conclusions: These results indicate that Shirodhara has anxiolytic and ASC-inducing effects, and it promotes a
decrease of noradrenaline and exhibits a sympatholytic effect, resulting in the activation of peripheral foot skin
circulation and immunopotentiation.
1189
Introduction
Shirodhara, one of the healing techniques of Ayurveda, is
characterized by dripping oil on the forehead. Originat-
ing in ancient India, Ayurveda is a science of life that uses
various oil treatments for the proper balance of bioenergies
in the body including oil massage and oil-dripping treatment
such as Shirodhara. In Sanskrit, shiro means “head,” and dhara
means “dripping.” This method was originated from Kerliya
Panchakarma, and is one of the components of the systematic
purification techniques of Panchakarma.
1
Panchakarma is the
most famous purification system in Ayurveda. A.K. Sharma
suggested that Shirodhara may alleviate headache, mental
stress, insomnia, depression, motor neuron diseases, and
several kinds of mental disorders, including schizophrenia.
1
Furthermore, he suggested that it may have an anti-analgesic
1
Department of Presymptomatic Health Promotion, Institute of Natural Medicine, University of Toyama, Toyama, Japan.
2
International Research Center for Traditional Medicine of Toyama Prefecture, Toyama, Japan.
3
Department of Welfare Promotion and Epidemiology, University of Toyama, Toyama, Japan.
4
Department of Public Health, Hiroshima University, Hiroshima, Japan.
5
Faculty of Health Care, Department of Alternative Medicine, Teikyo Heisei University, Tokyo, Japan.
6
Department of Clinical Psychology, University of Oregon, Oregon City, OR.
effect.
1
H.M. Sharma et al. reported the anxiolytic effect of
all treatments comprising Panchakarma.
2
However, there has
been little research on the psychophysiologic or psychoneu-
roimmunologic changes brought about by Shirodhara.
3,4
The
psychologic effects, especially those regarding altered states
of consciousness (ASC), of Shirodhara have not yet been stud-
ied. We have already reported that Shirodhara exhibited an
anxiolytic effect and that it induced ASC, activation of the
peripheral circulation, as well as a sympatholytic effect, in a
noncontrolled study.
3,4
We have also reported that during
Shirodhara, the heart rate and CO
2
excretion decreased, and
an alternative marker of sympathetic tone, the ratio of LF
(low-frequency power)/HF (high-frequency power calcu-
lated from electrogram-R–R wave variability), was sup-
pressed.
3
We have adopted a modern approach employing robotics
to regulate oil dripping on the forehead during Shirodhara.
This robotic system facilitates reproducibility regarding the
oil temperature, oil flow rate, speed of movement of the drip-
ping nozzle, and patterns of oil dripping on the forehead for
30 minutes in Shirodhara. There are several kinds of Dhara
techniques depending on the medium for dripping. Taila
Dhara uses medicated sesame oil mixed with cow’s milk, wa-
ter, and herbs.
1,5,6
We studied the psychoneuroimmunologic
changes during Taila Dhara with plain sesame oil in order to
simplify the study.
To determine the most comfortable and safest condition
of Shirodhara, we compared comfort levels during Shirodhara
conducted using various conditions of oil temperature, oil
flow rate, and duration. The psychoneuroimmunologic
changes brought about by Shirodhara and the control supine
position were measured following a randomly assigned
study design using the most appropriate and safest condi-
tions.
UEBABA ET AL.1190
FIG. 1. Set-up and timetable of the experiment. STAI, State-Trait Anxiety Inventory; ASC, altered states of consciousness.
Oil flow rate: 2.3 L/min; height of the nozzle tip: 20 cm over the forehead; moving speed of the nozzle: 1.5 cm/second
(slowest); oil temperature: 39°C (at nozzle); room temperature: 27 0.5°C. Downward arrows indicate times of checking.
T
ABLE
1. T
HE
10 D
OMAINS OF THE
A
LTERED
S
TATES
OF
C
ONSCIOUSNESS IN
P
SYCHOMETRICS
Loss of space perception (Space): Feeling like floating
Loss of bodily sense (Body sense): Feeling like only mind existing without body
Trance (Trance): Enraptured
Passiveness (Passive): Feeling like being under someone’s control
Loss of knowing difference between subjectivity and objectivity (Sub.–Obj.)
(no separation between oneself and others)
Loss of time perception (Time): No concept of time passing
Loss of speech sense (Speech): No desire to speak
Concentration (Conc.): Do not notice any change in surroundings
Momentariness (Moment.): Feels like only a short time has passed
Cosmic consciousness (C.C.): Experience such as to have seen the truth
Derived from Saito’s papers.
8,9
Methods
Subjects
Sixteen (16) females (21–56 years old; 33 9 years old)
who were physically and psychologically healthy partici-
pated in the first experiment for determining the most ap-
propriate conditions of operating the robotic system, after
giving written informed consent.
Another 16 healthy females (21–60 years old; 39 9
years old) participated in the second experiment investing
the psychoimmunologic changes brought about by Shirod-
hara, after giving informed consent. Because some subjects
were menstruating, two experiments of Shirodhara and con-
trol supine were conducted 1 month later in order to cor-
rect for the hormonal changes owing to their menstrual
rhythm.
EFFECTS OF AYURVEDIC OIL-DRIPPING TREATMENT 1191
T
ABLE
2. C
HARACTERISTICS OF
“T
RANCE
E
XPERIENCE
OF
THE
A
LTERED
S
TATES OF
C
ONSCIOUSNESS
(ASC)
I was so happy and delightful in a trance.
I felt very happy after the states.
I felt as though hovering between dream and awakening.
Other people’s voices and noises reached my ears as pleasant sounds like music.
I was in no mood for doing anything under the states.
I have lost myself in a trance-like state.
In each questionnaire, the following score was selected, and totals of six questions were rec-
ognized as the ASC score:
Yes: 5, So-so: 3, Not at all: 1 (4 and 2 points were between 3 and 5 or 3 and 1, respectively)
Derived from Saito’s papers.
8,9
B
FIG. 2. (A) Oil flow rate and altered state of consciousness (ASC), and anxiolysis and ASC. (B) Oil temperature and com-
fort estimated by visual analogue scale (VAS). (C) Length of Shirodhara and comfort estimated by VAS scale. *p0.05 by
Dunett’s t-test versus 9 minutes
p0.1 by Dunnett’s t-test versus 35°.
A
C
Various conditions of operating the robotic oil drip system
In order to compare the comfort levels during various
conditions of Shirodhara, the robotic oil drip system (Fig.
1) was used to regulate the conditions. Four (4) oil tem-
peratures (35°C, 37°C, 39°C, and 41°C at the nozzle), three
oil flow rates (1.8, 2.3, and 2.8 L/min), and four different
durations (9, 19, 29, and 39 minutes long) were candidate
parameters to achieve the most effective and safest condi-
tion of Shirodhara. Other fixed conditions for operating the
robotics were as follows: The moving speed of the drip-
ping nozzle was 1.5 cm/sec, and the nozzle height (dis-
tance from the forehead to the nozzle) was set at 20 cm.
The patterns of dripping comprised temple, horizontal,
and vertical movements involving two repetitions each of
5-minute movements.
UEBABA ET AL.1192
T
ABLE
3. P
ROCESS OF
S
ELECTING OF THE
M
OST
A
PPROPRIATE AND
S
AFEST
C
ONDITIONS OF
S
HIRODHARA
An ASC-
xiolytic inducing VAS for Safety
effect effect comfort Total (complaints and
Conditions rank rank rank rank troubles)
Duration 9 min 4 4 4 12 Not enough
21 min 3 3 3 9
30 min 1 2 1 4
39 min 2 1 1 4 Headache, neck
pain
Temp. 35°C 2 4 4 10 Chill
37°C 3 2 1 6 Slight chill
39°C 4 1 2 7
41°C 1 3 3 7 Too hot
Oil flow 1.8 L/min 3 3 Not 6
rate examined
2.3 L/min 2 2 Not 4
examined
2.8 L/min 1 1 Not 2 Too much
examined pressure
Rank is determined in three or four kinds of experiments, depending on the comfort of the treatments. Total rank is the summed ranks of
each conditions. The lowest total rank indicates the best condition.
ASC, altered states of consciousness; VAS, visual analogue scale.
FIG. 3. Comparison of altered state of consciousness (ASC) by Shirodhara and control supine condition *p0.05, **p
0.01, N16, Wilcoxon signed rank test. Although the values are nonparametric, results are presented as the mean stan-
dard error. ASC scores in the treatment are higher than that of control supine position in all the domains. Space, loss of
space perception; Body sense, loss of bodily sense; Trance, subject is enraptured, Passive, Passiveness, Sub.-Obj., loss of sub-
jectivity and objectivity; Time, loss of time perception; Speech, loss of speech sense; Conc., concentration, Moment, “Mo-
mentariness,”; C.C., cosmic consciousness.
Oil Used for Shirodhara
Although medicated oils are used for Shirodhara in
general, plain sesame oil (Kadoya Oil Co.) was used as
the medium during Shirodhara in this study in order to sim-
plify it.
Randomized, controlled study
The sequence of the experiment with plain sesame oil and
the control supine position was assigned in a random se-
quence. The study started after approval of the Ethical Com-
mittee of International Research Center for Traditional Med-
icine of Toyama Prefecture.
Examinations for the assessment of
psychoneuroimmunologic changes
Evaluation of comfort. An original visual analogue scale
(VAS) for comfort 100 mm long was used. Subjects checked
the initial zero point of the VAS scale when they felt neither
comfort nor discomfort, and the 100-mm point when they
felt the most comfortable.
Psychologic examinations. Anxiety was assessed using
the State–Trait Anxiety Inventory,
7
which is generally con-
sidered the “gold standard” for the evaluation of anxiety.
Anxiolysis was calculated as the percent change between
pre- and post-treatment assessments. The psychometric in-
strument for ASC
8,9
was used. ASC has been commonly mis-
understood as peculiar experiences induced by psy-
chotropic drugs.
10,11
Traditional healing techniques such as
meditation often induce ASC.
8,9
Saito classified ASC into 10
kinds of experiences (10 domains; Table 1), and he created
the ASC questionnaire in Japanese after ascertaining its re-
liability and specificity.
8
We used the ASC questionnaire de-
veloped by Saito,
8
and asked the subjects to answer it im-
mediately after Shirodhara treatment. The questionnaires for
trance experiences and method for calculation are shown in
Table 2.
Physical examinations. Skin temperature of the dorsal side
of the right hand and foot was monitored with thermocou-
EFFECTS OF AYURVEDIC OIL-DRIPPING TREATMENT 1193
FIG. 4. Anxiolytic effect of Shirodhara (**p0.01, N16, Wilcoxon signed rank test) in the treatment and control groups.
Although the values are nonparametric, results are presented as the mean standard error. p0.05 by two-way analysis
of variance in the change in the state anxiety of the two groups, when calculated as parametric values. Shirodhara treatment
induced significant anxiolysis, without any change in the control supine position. Before, before Shirodhara; After, after Shi-
rodhara.
FIG. 5. Elevation in skin temperature of the hand and foot
(†p0.1, N16 mean standard error, paired t-test be-
tween control and treatment group). Hand temperature was
measured at the dorsum of the right hand, and foot tem-
perature was measured at the dorsum of the right foot. Foot
temperature in the treatment is higher than that of the con-
trol supine position from the latter half of Shirodhara treat-
ment.
ple sensors. The skin temperature was measured every 10
seconds and recorded. The changes in temperature were cal-
culated as the average results in three stages of the experi-
ment, for the hand and foot separately: (1) former half: dur-
ing the initial half of Shirodhara treatment, (2) latter half:
during the latter half of Shirodhara, and (3) after: after Shi-
rodhara.
Neuroimmunologic examinations. Serum thyrotropin-re-
leasing hormone (TRH) by radioimmunoassay (RIA), natural
killer (NK) cell activity (chromium uptake method, %),
plasma catecholamine (adrenaline, noradrenaline, and do-
pamine by high-performance liquid chromatography:
HPLC), and urinary serotonin (HPLC) corrected by the uri-
nary creatinine concentration (measured by a calorimetric
study) were examined by Mitsubishi Chemical Co. Ltd. The
ratio of polymorphonuclear neutrophils (PMN) to lympho-
cytes in peripheral blood was calculated according to the
white blood cell classification, as an indicator of autonomic
nervous balance.
12
Statistical analysis. For usual parametric values, one- and
two-way ANOVA, paired t-tests, and Pearson’s correlation
coefficients were calculated. Wilcoxon signed-ranks test and
Spearman’s correlation coefficient tests were performed for
UEBABA ET AL.1194
FIG. 6. Changes in plasma catecholamine (*p0.05, paired
t-test, N16, mean standard error). Changes in plasma
noradrenalin in the treatment subjects is higher than that of
the control subjects in the supine position.
FIG. 7. Changes in the urinary excretion of serotonin (*p
0.05, †p0.1 by paired t-test, N16, mean standard er-
ror). Serotonin concentration was corrected by the urinary
creatinine concentration. Urinary serotonin excretion in the
treatment group is significantly lower than that of the con-
trol subjects in the supine position.
FIG. 8. Changes in the polymorphonuclear neutrophils
(PMN)/lymphocyte ratio and natural killer (NK) cell activ-
ity after Shirodhara (*p0.05, **p0.01, N16, mean
standard deviation, paired t-test). PMN/lymphocyte ratio
decreased significantly in the treatment, without any change
in the control spine position. NK cell activity decreased sig-
nificantly in the control group, without any change in the
Shirodhara treatment group. Before, before Shirodhara; After,
after Shirodhara.
nonparametric values. In some cases, when individual dif-
ferences were large, the changes in the ratios in each study
were compared by parametric tests. For the comparison of
regression coefficients, analysis of covariance (ANCOVA)
was performed. ANCOVA of the regression coefficients be-
tween nonparametric and parametric values was conducted
on the assumption that both are parametric values. Signifi-
cance levels were set as p0.05 by Dunnett’s t-test.
Results
The most appropriate and safest conditions of operating
the robotics of oil dripping.
Figures 2A, 2B, and 2B show changes in comfort levels as-
sessed by the VAS scale or anxiolysis and ASC under the
various conditions of Shirodhara. The safety of the methods
should be taken into account, because, in some extreme con-
ditions, some subjects suffered from headache, chill, slight
chill, or other discomfort, as shown in Table 3. The screen-
ing tests showed us that the most comfortable and safest con-
ditions were a 30-minute duration at 39°C at a oil flow rate
of 2.3 L/min. The diameter of the dripping oil nozzle was
88 mm. Other fixed conditions were the moving speed of
the dripping nozzle, set at 1.5 cm/sec, and the height of the
nozzle, being set at 20 cm above the forehead. The pattern
of dripping comprised temple, horizontal, and vertical
movements, two times of each 5-minute movement. Under
these conditions, we compared the psychoneuroimmuno-
logic changes brought about by Shirodhara and the control
supine condition.
EFFECTS OF AYURVEDIC OIL-DRIPPING TREATMENT 1195
T
ABLE
4. C
OMPARISON OF
R
EGRESSION
C
OEFFICIENTS
B
ETWEEN
A
LTERED
S
TATES OF
C
ONSCIOUSNESS
(ASC)
OR
A
NXIOLYSIS AND
NK (N
ATURAL
K
ILLER
) C
ELL
A
CTIVITY OR
S
KIN
T
EMPERATURE
E
LEVATION
Groups
Control supine
position Treatment
Parameters
Correlationship rp-value Nrp-value Np-value
Anxiolysis: Score of ASC 0.13 0.64 16 0.52 0.05 16 0.05
(Trance)
Elevation of skin temp.: 0.24 0.40 16 0.58 0.01 16 0.05
anxiolysis (%)
Elevation of skin temp.: ASC 0.04 0.45 16 0.43 0.05 16 0.05
(Trance)
NK cell activity (%): Anxiolysis 0.02 0.89 16 0.33 0.05 16 0.05
(%)
NK cell activity (%): Score of 0.20 0.46 16 0.56 0.01 16 0.05
ASC (Trance)
r, regression coefficient; N, cases.
Significant correlations between ASC or anxiolysis and elevation of skin temperature or NK cell activity were obtained only in the treatment
groups. Anxiolysis was determined by the change in state anxiety from before to after Shirodhara. Correlation coefficients were calculated by
Spearman’s method. Regression coefficients between ASC score (Trance) or anxiolysis and elevation of skin temperature or NK cell activity were
significantly different between control and treatment groups on the assumption that ASC scores are parametric values (p0.05, ANCOVA).
ANCOVA, analysis of covariance; NK, natural killer.
ANCOVA
T
ABLE
5. C
OMPARISON OF
C
ORRELATION
C
OEFFICIENTS
B
ETWEEN
A
NXIOLYSIS AND
S
KIN
T
EMPERATURE
E
LEVATION IN
C
ONTROL AND
T
REATMENT
G
ROUPS
Anxiolysis Anxiolysis
(control) (experiment)
Increase of skin temp. (hand: former half) 0.03 0.92 0.26 0.32
Increase of skin temp. (hand: latter half) 0.01 0.97 0.01 0.97
Increase of skin temp. (hand: after Shirodhara) 0.04 0.90 0.07 0.81
Increase of skin temp. (foot: former half) 0.49† 0.08 0.60** 0.01
Increase of skin temp. (foot: latter half) 0.37 0.19 0.59* 0.02
Increase of skin temp. (foot: after Shirodhara) 0.24 0.40 0.58* 0.02
p0.1, *p0.05, **p0.01, N16, Pearson’s correlation coefficient).
No mark means no significant correlation between scores of each domain and the increase in skin temperature. Anxiolysis was determined
by the state anxiety change from before to after Shirodhara. The former half was the 15 minutes after starting Shirodhara, and the later half was
the last 15 minutes.
Comparison between Shirodhara and control. (1) ASC and
State Anxiety. The subjects after Shirodhara treatment showed
decreased levels of state anxiety, and had higher ASC scores
than those in the control supine condition (Figs. 3 and 4). (2)
Changes in the skin temperature. The skin temperature of the
dorsal aspects of the right foot, but not of the right hand, in-
creased more in the Shirodhara treatment than in the control
condition (Fig. 5; p0.1). The changes in foot temperature
on Shirodhara showed a different tendency, while the hand
temperature showed changes similar to those of the control.
(3) Changes of catecholamine. Plasma noradrenaline levels in
the Shirodhara treatment group were decreased significantly
more than in the control (p0.05, N16, paired t-test, Fig.
6), while neither plasma adrenaline nor plasma dopamine
UEBABA ET AL.1196
T
ABLE
6A. C
ORRELATION
B
ETWEEN
P
SYCHOLOGIC
P
ARAMETERS AND
P
LASMA OR
U
RINARY
C
ATECHOLAMINE
ASC
Control supine position Axiolysis average Space Body sense Trance Passive
Serum TRH after experiment 0.35 0.19 0.34 0.20 0.53* 0.04 0.46 0.08 0.37 0.16 0.31 0.24
Plasma noradrenaline after 0.58* 0.05 0.29 0.35 0.44 0.15 0.34 0.28 0.37 0.23 0.31 0.32
experiment
Plasma dopamine after exp. 0.22 0.50 0.34 0.28 0.35 0.27 0.40 0.20 0.27 0.39 0.43 0.17
Change ratio of serum TRH 0.14 0.74 0.55 0.16 0.55 0.15 0.49 0.22 0.56 0.15 0.50 0.21
Change ratio of PMN/Ly 0.36 0.21 0.30 0.30 0.35 0.21 0.32 0.26 0.23 0.42 0.15 0.62
ratio
ASC
Experiment Axiolysis average Space Body sense Trance Passive
Serum TRH after experiment 0.23 0.39 0.40 0.13 0.47 0.07 0.09 0.75 0.24 0.37 0.12 0.66
Plasma noradrenaline after 0.19 0.48 0.15 0.57 0.12 0.66 0.34 0.19 0.02 0.95 0.28 0.30
experiment
Plasma dopamine after exp. 0.03 0.92 0.53* 0.03 0.35 0.18 0.42 0.11 0.35 0.19 0.44 0.09
Change ratio of serum TRH 0.54 0.27 0.83* 0.04 0.71 0.12 0.32 0.54 0.67 0.15 0.14 0.78
Change ratio of PMN/Ly 0.36 0.17 0.44 0.09 0.34 0.20 0.56* 0.02 0.31 0.24 0.43 0.09
ratio
*p0.05, by Spearman’s correlation coefficient. No mark means no significant correlation between physiologic parameters and plasma or
urinary catecholamine and anxiolysis or scores of altered consciousness (ASC).
TRH, thyrotropin-releasing hormone; Space, loss of space perception; Body sense, loss of body sense; Trance, subject is enraptured; Passive,
passivness; PMN, polymorphonuclear neutrophils; Ly, lymphocytes.
T
ABLE
6B. C
ORRELATION
B
ETWEEN
P
SYCHOLOGIC
P
ARAMETERS AND
P
LASMA OR
U
RINARY
C
ATECHOLAMINE
Control supine position Sub.-Obj. Time Speech Conc. Moment. C.C.
Serum TRH after experiment 0.43 0.09 0.21 0.43 0.21 0.45 0.00 0.99 0.45 0.08 0.50* 0.05
Plasma dopamine after 0.32 0.32 0.14 0.67 0.07 0.83 0.18 0.58 0.20 0.54 0.22 0.49
experiment
Change ratio of serum TRH 0.66 0.08 0.71* 0.05 0.33 0.42 0.52 0.18 0.59 0.13 0.60 0.11
Change ratio of plasma 0.08 0.80 0.18 0.58 0.08 0.79 0.20 0.53 0.10 0.76 0.10 0.77
dopamine
Change ratio of PMN/Ly 0.23 0.42 0.21 0.47 0.09 0.76 0.13 0.65 0.46 0.09 0.20 0.49
ratio
Experiment Sub.-Obj. Time Speech Conc. Moment. C.C.
Serum TRH after experiment 0.29 0.28 0.50* 0.05 0.20 0.46 0.52* 0.04 0.10 0.72 0.06 0.83
Plasma dopamine after 0.36 0.18 0.44 0.09 0.70** 0.00 0.16 0.56 0.39 0.14 0.48 0.06
experiment
Change ratio of serum TRH 0.50 0.31 0.77 0.07 0.93** 0.01 0.90* 0.01 0.35 0.50 0.09 0.87
Change ratio of plasma 0.13 0.63 0.24 0.38 0.50* 0.05 0.01 0.96 0.38 0.15 0.30 0.26
dopamine
Change ratio of PMN/Ly 0.50* 0.05 0.43 0.10 0.44 0.09 0.16 0.54 0.01 0.97 0.28 0.29
ratio
*p0.05, **p0.01 by Spearman’s correlation coefficient (c.c). No mark means no significant correlation between physiologic parameters
and plasma or urinary catecholamine and anxiolysis or scores of altered consciousness (ASC).
Sub.-Obj., subjectivity and objectivity; Time, loss of time perception; Speech, loss of speech sense; Conc., concentration; Moment.,
“Momentariness”; TRH, thyrotropin-releasing hormone; PMN, polymorphonuclear neutrophils; Ly, lymphocytes.
levels showed a significant difference. (4) Changes of urinary
serotonin. Urinary serotonin excretion just after and 1 hour
after finishing Shirodhara was decreased significantly more
than in the control condition (p0.05, N16, paired t-test,
Fig. 7). (5) Changes in NK cell activity and PMN/lymph ratio of
peripheral blood. NK cell activity decreased significantly in the
control condition (p0.05, N16, paired t-test, Fig. 8,
right), while there were no changes in the Shirodhara group.
However, there was no significant difference by two-way
ANOVA. The PMN/lymphocyte ratio maintained the same
levels in the control condition, while it decreased signifi-
cantly on Shirodhara treatment (p0.05, N16, paired t-
test, Fig. 8, left). These changes were not significantly dif-
ferent by two-way ANOVA.
Comparison of the correlation between parameters in Shi-
rodhara and control. (1) Correlation between ASC and anxioly-
sis. The correlations between ASC scores of all 10 domains
and the anxiolytic effect were significantly higher in the
Trance experience of Shirodhara, while there was no signifi-
cant correlation in the control condition (r0.52, p0.05
Spearman’s correlation coefficient, Table 4). Regression co-
efficients of the ASC score (Trance) and anxiolysis were sig-
nificantly different between control and treatment groups on
the assumption that ASC scores are parametric values (p
0.05, ANCOVA, Table 4). (2) Correlation between ASC or anx-
iolysis and skin temperature. Anxiolysis (% reduction of state
anxiety) and the increase of the skin temperature of dorsal
aspect of the foot, not hand, were significantly correlated in
Shirodhara (r0.58–0.60, p0.05, N16, Pearson’s corre-
lation coefficient, Table 5). The correlation between the anx-
iolytic effect and increase in skin temperature was only sig-
nificant in the foot skin. However, the regression coefficient
between anxiolysis and the foot skin temperature increase
was not significantly different (p0.05, ANCOVA, Table 4).
An increase of the mean skin temperature of the foot in the
latter half of Shirodhara, not in the control, was also corre-
lated with the ASC score, especially in the Trance experience
(Table 4). The regression coefficients of the ASC score
(Trance) and foot skin temperature increase were signifi-
cantly different (p0.01, ANCOVA, Table 4). (3) Correlation
between ASC or anxiolysis and NK cell activity after Shirodhara.
Anxiolysis and ASC, especially Trance experience, were well
correlated with NK cell activity after Shirodhara (r0.33,
0.56, p0.05, Table 4). The regression coefficients between
the ASC score (Trance) or anxiolysis and NK cell activity
were significantly different (p0.05 in both, ANCOVA,
Table 4). (4) Correlation between ASC or anxiolysis and cate-
cholamines, TRH, and urinary serotonin. Tables 6a and 6b show
the correlation between psychologic parameters and plasma
catecholamine or urinary serotonin obtained by Spearman’s
method. In the control supine condition, not Shirodhara,
scores of ASC such as Space and Cosmic Consciousness (C.C)
(Table 1) were correlated with the TRH level (r0.53,
0.50, p0.05, respectively). The ASC score (Time) was cor-
related with the TRH level and TRH change (r0.56,
0.71, p0.05, respectively). However, only in the Shirod-
hara treatment was the average score of ASC and score of
Speech negatively correlated with the plasma dopamine
level and change of plasma dopamine (r0.53, 0.70,
0.50, p0.05, respectively). Furthermore, the average ASC
score, and scores of Speech and Concentration (Conc.) were
negatively correlated with the TRH-change ratio (r0.83,
0.93, 0.90, p0.05, respectively). Scores of ASC for Time
and Conc. were also negatively correlated with the TRH level
(r0.50, 0.52, p0.05, respectively). In the control
study, anxiolysis was negatively correlated with the plasma
noradrenaline level (r0.58, p0.05, Pearson’s correla-
tion coefficient). However, this correlation was not obtained
on Shirodhara treatment. Plasma adrenaline level and change
ratio of plasma adrenaline and noradrenaline were not cor-
related with any domains of ASC or anxiolysis either in the
control or Shirodhara treatments.
The regression coefficients between ASC scores or anxiol-
ysis and various parameters were not significantly different
(p0.1 in all, ANCOVA).
Discussion and Conclusions
The robotic oil-drip system in this study facilitated a com-
pletely reproducible method for Shirodhara. The regulated
modes of treatment were maintained for all subjects during
Shirodhara. Differences in effects depending on the oil tem-
perature, oil flow rate, and length of treatment were eluci-
dated with this robotic system. This is the benefit of em-
ploying a robotic Shirodhara regulator compared to the usual
hanging pot with a hole in the bottom, which is unable to
provide the same regulated treatment to all subjects. We
adopted the most comfortable and safest conditions of Shi-
rodhara to study psychoimmunologic effects.
Psychologic changes in this study supported the anxiolytic
and ASC-inducing effects of Shirodhara. The anxiolytic effect
of Panchakarma reported by H.M. Sharma must be explained
partly by this anxiolytic effect of Shirodhara. Anxiolysis in-
duced by Shirodhara was positively correlated with NK cell
activity after Shirohara and elevation of the foot skin tem-
perature. Furthermore, Trance experience induced by Shi-
EFFECTS OF AYURVEDIC OIL-DRIPPING TREATMENT 1197
FIG. 9. Suspended mechanism of the action of Shirodhara-
induced psychologic effects as well as neural, immunologi-
cal, and physical changes. An increase of the foot skin tem-
perature and relative elevation of natural killer (NK) cell
activity by Shirodhara treatment may be related with the au-
tonomic nervous suppression secondarily induced by the
psychologic effects of Shirodhara. ASC, state of consciousness;
PMN, polymorphonuclear neutrophils; TRH, thyrotropin-re-
leasing hormone.
rodhara was positively correlated with anxiolysis, NK cell ac-
tivity, and elevation of the foot skin temperature. These re-
sults supported the psychoneuroimmunologic effects of Shi-
rodhara.
The biochemical changes showed the significant suppres-
sion of noradrenaline not adrenaline, and suppression of uri-
nary serotonin and the decrease of the PMN/lymphocyte ra-
tio only in Shirodhara. These results reflect the sympatholytic
effect of Shirodhara, especially suppression of the -receptor,
which works with noradrenaline. Vaitl et al. reported
that ASC induced a sympathetic suppression rather than
parasympathetic activation.
10
ASC induced by Shirodhara
may cause the same sympathetic nervous suppression. Irwin
et al. reported that the sympathetic nervous system medi-
ates the suppression of NK cytotoxicity.
13
An increase of the
foot skin temperature and relative elevation of NK cell ac-
tivity by Shirodhara treatment may be related with this sym-
pathetic nervous suppression, secondarily induced by the
psychologic effects or somato-autonomic nervous reflex
14
during Shirodhara.
13,15
The negative correlation of the TRH
change or dopamine with some domains of ASC may also
be related to the sympathetic suppression because the auto-
nomic nervous system is linked to the depression of various
neurotransmitter secretions such as TRH and dopamines.
16
In our study, the anxiolysis and the mean skin tempera-
ture of the dorsal aspects of the feet, not hands, were corre-
lated (Table 5). Although the same neural linkage between
the central nervous system and hand or foot skin has been
drawn, innervation by the autonomic nervous system of the
hand may not be the same as in the foot. We obtained re-
sults whereby pressure stimulation of hands and feet for 15
minutes showed the opposite reaction to heart rate variabil-
ity.
17
Further research is needed to elucidate hand–foot dif-
ferences (Fig. 9).
Figure 9 summarizes the psychoneuroimmunologic
changes in this study of Shirodhara. Warm, plain sesame oil
starts the action from the tactile stimulation of the skin in-
nervated by the first branch of the trigeminal nerve. It is pos-
sible that the impulses are transmitted to the thalamus
through the principal nucleus and forwarded to the cerebral
cortex. The impulses from the forehead cause a somato-au-
tonomic reflex,
14
and changes in levels of various neuro-
transmitters including, serotonin, TRH, and catecholamine,
resulting in sympathetic suppression and physioimmuno-
logic changes of peripheral circulation and NK cell activity.
It is worth doing further investigation to elucidate the effects
of Shirodhara or Panchakarma of Ayurveda.
Disclosure Statement
This research did not involve competing financial inter-
ests.
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Address reprint requests to:
Kazuo Uebaba, M.D., Ph.D.
International Research Center for Traditional Medicine
of Toyama Prefecture
151 Tomosugi
Toyama, Toyama Prefecture, 939-8224
Japan
E-mail: uebaba@inm.u-toyama.ac.jp
UEBABA ET AL.1198
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The article reviews the current knowledge regarding altered states of consciousness (ASC) (a) occurring spontaneously, (b) evoked by physical and physiological stimulation, (c) induced by psychological means, and (d) caused by diseases. The emphasis is laid on psychological and neurobiological approaches. The phenomenological analysis of the multiple ASC resulted in 4 dimensions by which they can be characterized: activation, awareness span, self-awareness, and sensory dynamics. The neurophysiological approach revealed that the different states of consciousness are mainly brought about by a compromised brain structure, transient changes in brain dynamics (disconnectivity), and neurochemical and metabolic processes. Besides these severe alterations, environmental stimuli, mental practices, and techniques of self-control can also temporarily alter brain functioning and conscious experience.
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Corticotropin-releasing factor (CRF) acts within the brain to elicit changes in neuroendocrine, autonomic and behavioral activity similar to those observed after stress. A reduction of cellular immune function as measured by splenic natural killer cell activity has also been described following the central administration of CRF. In this study we evaluated the role of the sympathetic nervous system in mediating CRF-induced suppression of natural killer (NK) cytotoxicity. Synthetic rat CRF (1.0 microgram) microinjected into the lateral ventricle increased noradrenergic function and reduced NK activity in the rat spleen. Pretreatment of the animals by chemical sympathectomy (6-hydroxy-dopamine, 100 mg/kg i.p. daily over 10 days) produced a greater than 95% reduction of splenic norepinephrine concentration and abolished completely both the CRF-induced increase in plasma catecholamine levels and the reduction in splenic NK activity. In addition, beta adrenergic receptor blockade (either propranolol, 10 mg/kg i.p., or butoxamine, 25 mg/kg i.p. 30 min before i.c.v. infusion) antagonized the CRF-induced reduction in NK activity. Measurement of circulating levels of adrenocorticotrophic hormone and corticosterone demonstrated that activation of the pituitary adrenal axis by CRF was dissociated from changes in NK activity. These findings suggest that the sympathetic nervous system mediates the suppression of splenic NK cytotoxicity after i.c.v. CRF.
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The aim of the present study was to explore the involvement of the sympathetic nervous system (SNS) in the immunomodulatory effects of morphine in Lewis rats and to assess the effects of alterations in SNS activity on immune status. In the first experiment, sympathetic tone was elevated by administering the ganglionic stimulant 1,1-dimethyl-4-phenylpiperazinium (DMPP) in doses of 0, 0.01, 0.1, and 1.0 mg/kg, sc, 5 min before the sc administration of 15 mg/kg morphine or saline. Animals were sacrificed 1 h after the morphine injection and multiple in vitro immune assays were then conducted. Although DMPP did not significantly enhance morphine's suppressive effects in the spleen and blood mitogen stimulation assays or the splenic natural killer (NK) cell assay, DMPP alone produced effects on immune status in saline-treated animals. Therefore, a second experiment was conducted to examine the immunomodulatory effects of increasing peripheral sympathetic outflow in greater detail. Animals were administered a wider dose range of DMPP (0, 0.005, 0.05, 0.5, and 5.0 mg/kg, sc) 30 min prior to sacrifice and an expanded repertoire of immune assays was conducted. DMPP dose-dependently suppressed the mitogenic responsiveness of splenic T lymphocytes, splenic NK cell activity, and interleukin-2 (IL-2) and gamma-interferon production by stimulated splenocytes. DMPP did not alter the total number of splenic leukocytes or the proliferative response of splenic B lymphocytes. In the mesenteric lymph nodes, DMPP had no effect on mitogenic responsiveness, the production of IL-2 or the total number of leukocytes. In the blood, however, DMPP increased mitogenic responsiveness at intermediate doses and decreased proliferation at higher doses. DMPP also dose-dependently decreased the number of blood leukocytes/ml. Taken together, these results indicate that increasing peripheral sympathetic outflow results in profound effects on immune status that depend upon the degree to which SNS activity is altered, the compartment of the immune system, and the lymphocyte subtype.
The hypothalamic hypophysiotrophic neurones are densely innervated by adrenergic and noradrenergic nerve terminals. Activation of alpha 1-adrenoceptors located in the brain stimulates the secretion of ACTH, prolactin and TSH. The effects of the alpha 1-adrenoceptors seem to be exerted on hypothalamic neurones that secrete vasopressin, CRH-41 and TRH. These mechanisms are important in the physiological control of the secretion of ACTH and TSH in humans. alpha 2-Adrenoceptors are not involved in the control of secretion of these hormones under basal conditions in humans. However, alpha 2-adrenoceptors exert an inhibitory effect that acts as a negative feedback mechanism, limiting excessive secretion of these hormones. There is no convincing evidence for the involvement of beta-adrenoceptors in the control of the secretion of these three hormones in humans. Studies on cultured anterior pituitary cells suggested that adrenaline and noradrenaline may influence the secretion of ACTH, prolactin and TSH directly at the level of the pituitary. However, these effects are not demonstrable in humans, and are likely to be due to alterations in the pituitary adrenoceptors during culture. In the case of growth hormone, activation of alpha 2-adrenoceptors located in the brain stimulates secretion of this hormone both by increasing the secretion of GHRH and by inhibiting the secretion of somatostatin. Activation of beta-adrenoceptors inhibits the secretion of growth hormone via an increase in the secretion of somatostatin. The effects of the central alpha 2- and beta-adrenoceptors are important in the physiological control of growth hormone secretion in humans. A considerable amount of evidence implicates brain alpha 1-adrenoceptors in the control of secretion of the gonadotrophins in experimental animals, but, despite intensive study, no convincing evidence has been found in humans of reproductive age.
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All evidence introduced here indicates that, in anesthetized animals in which emotional factors have been eliminated, somatic afferent nerve stimulation can regulate various visceral functions by responses that are reflex in nature. One conclusion emerging from the evidence presented is that the effects of somatic afferent stimulation are dependent upon the particular organs and on the spinal afferent segments. When the central nervous system is intact, the responses are sometimes general, as seen in cerebral cortical blood flow, heart rate, and adrenal medullary hormonal secretion and splenic immune function, whereas sometimes they have a strong segmental organization, as seen in gastric motility and urinary vesical contractility (Fig. 8). Needless to say, in the spinalized preparation all responses are strongly segmental. The contribution of the sympathetic and parasympathetic efferent nerves to the somato-visceral reflexes depends on the organs. It is difficult for us to state specifically or to generalize upon which autonomic component, the sympathetic or parasympathetic, will dominate as the efferent path in these reflexes, because this depends on the individual organ, the site being stimulated, and the nature or mode of the stimulation. The somatically-induced reflex responses of autonomic, hormonal and immune functions demonstrated in anesthetized animals, as have been discussed herein, appear to function even during conscious states. We need further studies to evaluate the physiological meaning of these somato-autonomic reflex responses. The analysis of neural mechanisms of these reflex responses seems to be very important for clinical application to regulate visceral function by physical treatment.
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There are physiological variations in the levels of leucocytes. Among these, the circadian rhythm is very important in terms of the magnitude. Since newly identified lymphocyte subsets (i.e. extrathymic T cells) have recently been detected, a comprehensive study of the circadian rhythm was conducted. All leucocytes were found to vary in number or proportion with a circadian rhythm and were classified into two groups. One group--granulocytes, macrophages, natural killer (NK) cells, extrathymic T cells, gammadelta T cells, and CD8+ subset--showed an increase in the daytime (i.e. daytime rhythm). The other group--T cells, B cells, alphabeta T cells, and CD4+ subset--showed an increase at night. Humans are active and show sympathetic nerve dominance in the daytime. Interestingly, granulocytes and lymphocyte subsets with the daytime rhythm were found to carry a high density of adrenergic receptors. On the other hand, lymphocyte subsets with the night rhythm carried a high proportion of cholinergic receptors. Reflecting this situation, exercise prominently increased the number of cells with the daytime rhythm. These results suggest that the levels of leucocytes may be under the regulation of the autonomic nervous system.
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One of the critical problems in the study of physiotherapy of Oriental medicine is not being able to use the same reproducible stimulation, especially in Ayurvedic oil treatments. To address this problem, we developed a healing robot which conducts shirodhara (an oil treatment) in a computerized reproducible manner. The physio-psychological changes during taila dhara conducted by the healing robot and an estimated psychological experiences during taila dhara by psychometric studies of anxiety and altered states of consciousness (ASC) were studied. The physiological changes of the practitioners themselves were checked. Sixteen healthy adult females (ages 21-56, 33 ± 9 years) signed informed consent and participated in this study. During shirodhara the monitoring items for the subjects were: blood pressure and intermittent blood pressure, electrocardiogram (ECG) R-R intervals, expired gas analysis, impedance cardiography and electroencephalogram (EEG). The single EEG (C3 lead) of the technician was recorded at the same time, and respiratory movement of the chests of both subject and technician were also recorded. In the active studies, shirodhara was performed by a machine with a pumping and heating system. The subject's feelings during shirodhara showed deep restfulness with less anxiety - as if the subjects were between the sleep and awake states. Shirodhara induced bradycardia and the relative suppression of LF/HF power spectrum density, which indicated lowered sympathetic tone. Expired gas analysis showed a decreased tidal volume and CO<sub>2</sub> excretion. The EEG showed the slowing of the α wave, an increase in α and θ activity and an increase in right-left coherence. These metabolic, ECG, and EEG findings support the reported experiences of relaxed and low metabolic states during shirodhara. Physiological changes during shirodhara were similar to those of meditation, including α-wave dominance in the frontal area and a decrease in heart rate and CO<sub>2</sub> excretion. These findings indicated a change in the function of the frontal lobe, limbic system, brain stem, and autonomic nervous system. On the other hand, the EEGs of the technicians of the manual shirodhara showed an increase in their stressful condit- ion, which may also justify the utility of the healing robot as an assistant for the technicians.