Shira (शिरस् or शिरः)

Shira (शिरस्/शिरः) in Samskrt denotes head. In Ayurveda Shira is known as one of the 3 extremely significant marmas (मर्माणि ॥ seats of prana or life energy). A lot of discussion about anatomy and physiology of shiras along with various diseases, pathological processes related to it can be found in Ayurveda literature. While describing all these aspects, the viewpoint of Ayurveda of looking at it is quite different from that of modern/western medicine. The same has been described here.

आयुर्वेदे शिरः तस्य संकल्पनां च ॥ What is Shira according to Ayurveda

Shiras is also called as uttamanga (उत्तमाङ्गम्) 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 (उत्तमम्) means best or of topmost quality/significance etc. Thus shiras is also known as that body part which is of topmost significance. The reason to call it of topmost significance is as follows,

प्राणाः प्राणभृतां यत्र श्रिताः सर्वेन्द्रियाणि च| यदुत्तमाङ्गमाङ्गानां शिरस्तदभिधीयते||१२|| (Char. Samh. Su 17.12) prāṇāḥ prāṇabhr̥tāṁ yatra śritāḥ sarvendriyāṇi ca| yaduttamāṅgamāṅgānāṁ śirastadabhidhīyate||12|| (Char. Samh. Su 17.12)

Meaning: Shiras (head) is foremost among all organs as it is the 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. (Thus) It is vital (uttama) amongst all the other organs of the body.

Therefore it is clear that Shiras is the seat of all the sensory and motor organs according to Ayurveda. Also being one of the marmas, the life energy is also concentrated at this place. It indicates that, any injury to this part of the body will certainly affect indriyas (इन्द्रियाणि), pranas and thus the entire life. It is also clear from the above discussion that, ancient Ayurveda scholars very well knew the level of seriousness of neurological disorders, the center of all of which is situated in brain and nerves that are situated inside head.

शिरःशारीरम् ॥ Anatomy related Shiras

षडङ्गानि॥ Shadangas

Ayurveda acharyas have counted Shiras in one of the 6 angas knows as Shadangas in Human.

तच्च षडङ्गं- शाखाश्चतस्रो, मध्यं पञ्चमं, षष्ठं शिर इति ||३|| (Sush. Samh. 5.3) tacca ṣaḍaṅgaṁ- śākhāścatasro, madhyaṁ pañcamaṁ, ṣaṣṭhaṁ śira iti ||3|| (Sush. Samh. 5.3)

शिरसो द्वारम् ॥ Entrance or Gateway

It is also described that Nose is the entry point of shiras. It has been described like follows,

द्वारं हि शिरसो नासा तेन तद् व्याप्य हन्ति तान्||८८|| (Cha. Sidd. 9.88) dvāraṁ hi śiraso nāsā tena tad vyāpya hanti tān||88|| (Cha. Sidd. 9.88)

बहिर्मुखस्रोतसानि॥ Bahirmukha strotas

Nose is counted as one of the bahirmukha strotasa (channel of passage for various body elements having opening on outer surface of body) along with 5 other such openings situated in head. The other 5 openings are 2 eyes, 2 ears and 1 oral cavity.

मर्माणि॥ Marma

Shiras is known as one of the vital points or marmas.

सप्तोत्तरं मर्मशतं यदुक्तं शरीरसङ्ख्यामधिकृत्य तेभ्यः| मर्माणि बस्तिं हृदयं शिरश्च प्रधानभूतानि वदन्ति तज्ज्ञाः||३||

प्राणाश्रयात्, तानि हि पीडयन्तो वातादयोऽसूनपि पीडयन्ति| (Char. Samh. 26.3-4)

saptottaraṁ marmaśataṁ yaduktaṁ śarīrasaṅkhyāmadhikr̥tya tebhyaḥ| marmāṇi bastiṁ hr̥dayaṁ śiraśca pradhānabhūtāni vadanti tajjñāḥ||3||

prāṇāśrayāt, tāni hi pīḍayanto vātādayo'sūnapi pīḍayanti| (Char. Samh. 26.3-4)

Total 107 marmas have been listed by Ayurveda scholars. Among them 3 are extremely significant and vital. Shiras is one of these 3 vital marmas. Since this is the seat of life energy any disturbance in this point will lead to disturbance in life in total.

Bones, Joints, muscles and other structures related to shiras have been discussed in Ayurveda literature at relevant places. Apart from the shiras being a marma itself, simanta, the fine lines of joint between skull bones known as Simantas have also been counted in marmas and effect of injury to them is also described.

The internal structure of pathways of various sensory and motor organs along with seat of prana (life energy) is said to be present in a particular manner in Shiras. Ayurveda acharyas have explain this structure in a simplified way with the help of a similie. They say that, like the radiating spicules of the rays of sunlight that seem to be present far away somewhere from the sun but originate from only one center i.e. Sun, all these Indriyas and prana (life energy) are situated in Shiras but could be seen/manifested anywhere else over the body.

शिरसि इन्द्रियाणि इन्द्रियप्राणवहानि च स्रोतांसि सूर्यमिव गभस्तयः संश्रितानि, (Ch siddhi 9.4) śirasi indriyāṇi indriyaprāṇavahāni ca srotāṁsi sūryamiva gabhastayaḥ saṁśritāni, (Ch siddhi 9.4)

शिरोभिघातस्य परिणामाः ॥ Effect of head injury

Shiras is one of the 3 most highly important marmas in the body. It is known that if injury to anyone of these occurs, the person may loose life and can be left severly injured. This has been mentioned by Acharya Charka in the following sutra,

तेषां त्रयाणामन्यतमस्यापि भेदादाश्वेव शरीरभेदः स्यात्, आश्रयनाशादाश्रितस्यापि विनाशः; तदुपघातात्तु घोरतरव्याधिप्रादुर्भावः; तस्मादेतानि विशेषेण रक्ष्याणि बाह्याभिघाद्वातादिभ्यश्च||५|| (Char. Samh. 9.5)

teṣāṁ trayāṇāmanyatamasyāpi bhedādāśveva śarīrabhedaḥ syāt, āśrayanāśādāśritasyāpi vināśaḥ; tadupaghātāttu ghorataravyādhiprādurbhāvaḥ; tasmādetāni viśeṣeṇa rakṣyāṇi bāhyābhighādvātādibhyaśca||5|| (Char. Samh. 9.5)

Meaning: Injury to any of these three vital marma which includes shiras (basti and hriday being other two marma), leads to sudden pain all over body. Destruction of the ashraya(substance) leads to destruction of the ashrita(substrate). Severe disease manifestations occur due to injury, thus shiras must be protected especially from external injury and vata dosha.

Specifically due to head injury certain signs and symptoms can arise and those are as follows,

• Neck stiffness,
• facial paralysis,
• eye disorders,
• mental confusion,
• loss of bodily movements,
• cough,
• breathlessness,
• stiffness of jaw,
• excessive yawning and etc.

शिरसि दोषाः ॥ Doshas and shiras

A subtype of Kapha dosha called as Tarpaka kapha resides in head region and facilitates smooth functioning of organs inside it.

शिरःस्वास्थ्यरक्षणार्थम् उपायाःP reventive

Ayurveda scholars have suggested few regimes into daily routine which have a potential to prevent multiple illnesses including headache and other shirorogas. Few of them are listed below,

शिरोरोगप्रतिबन्धार्थम् नस्यफलम् ॥ Benefits of nasya in preventing shirorogas

Acharya charaka in sutrasthana states, nasya must be practiced as preventive method during, pre-rainy season, autumn and spring when the weather is non-cloudy.

The benefits of Nasya are described as follows which also include its effect on headache and disorders affecting head.

Benefits of nasyam,

• Prevents hairfall and promotes hair growth.
• Prevents, stiffness of neck
• Manages, Headaches
• Facial paralysis
• Stiffness in jaw/ lock jaw
• Rhinitis
• Migraines/hemicrania
• Tremors

Nasya therapy helps in the nourishment of anatomical structures like blood vessels, ligaments and tendons in the head region and provides necessary strength to them.

शिरोभ्यङ्गफलम्॥ Benefits of shiro abhyanga

Applying hair oil or doing head massage with oil is an integral part of ideal daily regime recommended by Ayurveda. It has got multiple health benefits specifically related to head and hair.

Daily head massage with oil helaps in following ways,

• It prevents headaches,
• It prevents hair fall and premature greying of hair.
• It strengthens the bony cavity or cranium overhead.
• It strengthens the roots of hair, promotes hair growth, retains the natural hair color.
• Soothes senses,
• Nourishes the facial skin.
• Improves sleep quality and altogether provides happiness.

दिवास्वापस्य अहितत्वम्॥ Avoid daytime sleep

Ayurveda acharyas always discourage the day time sleep in everyone except certain physiological and medical conditions. It is clearly stated that Daytime sleep can trigger or lead to headache, stiffness and heaviness in body, Therefore it must be avoided to prevent headache or to quickly cure it when one is suffering from it.

शिरोरोगहेतवः ॥ Causes of shiro rogas

Headache and other head related diseases have been counted under Shirorogas by Ayurveda acharyas. Elaborate discussion on causes of these diseases has been found in Ayurveda treatises. Following tbale gives the general idea of causes of headache and head related diseases along with the gross classification of the causes.

Lifestyle related causes	Environmental factors	Vega suppression related	Miscellaneous
Daytime sleep	Exposure to excess cold or wind	Suppression of natural urges like (yawning, micturition etc)	Excessive loud speech (Cha. Si 12.14)
Sleeplessness	Cloudy weather	suppression of tears. (Char. Samh. Su. 17.8-11	Excessively speaking (Cha. Si 12.14)
Excessive indulgence in sexual activity	Excess sun exposure and wind exposure		Excessive crying (Char. Samh. Su. 17.8-11)
Over indulgence in heavy food items, sour tasting food and excessive bitter taste food	Constant exposure to dust, smoke.		Excessive stress.
Intoxication (alcohol or substance abuse)	Irregular climatic conditions.		Inhalation of strong toxic or unpleasant smell.
Usage of cold water for drinking.			Ama formation in the body.
Excessive intake of bitter food items.			Head injury.

शिरोरोग चिकित्सा ॥ Treatment aspects

Headaches even though very commonly observed are one of the primary symptoms in a wide range of diseases from hyperacidity to brain tumor. Ayurveda suggests few general measures descibed below to get relief from symptoms like headache. Apparently trivial looking symptom like headache is related to an important marma(vital point) in the shareera. Thus, consultation with a certified Vaidya or Ayurvedic physician is of importance even while executing the below given general management protocols.

स्वेदनम्॥ Swedana

Swedana is a therapy which means fomentation or sudation or simply steam therapy. There are various methods or types listed in Ayurvedic Samhitas regarding swedana therapy, which differs from disease to disease. Precisely the procedure which relieves stiffness, heaviness, obstruction and cold from body or a specific targeted area is called as swedana and in various Shiroroga(along with many other disorders), Swedana is used as one of the treatment procedure.

जीर्णघृतलाभाः ॥ Jeerna ghruta

Jeerna ghruta means old preserved ghee, this is used orally as one of the treatment methods in shira shula (headache of certain type). Ghee In general has properties which enhances memory, intelligence, balances vata and kapha doshas and also improves digestion and metabolism.the properties of ghee vary based on the source of milk. (cow, buffalo, goat, sheep etc).

तैलस्य महात्म्यम् ॥ Tailam

While describing the properties and benefits of a simple sesame oil used for cooking and external application. Tailam has properties such as nourishing and soothing the micro channels, is flowy in nature and many other properties as well. Application of taila helps improve skin quality, enhances memory functions. Provides stability of muscles. Improves skin complexion, enhances strength. Taila is chakshushya meaning, improves eye sight.

Acharya Sushruta has mentioned its beneficial action on headache. He stated that, the sesame oil helps to relieve headache. Along with that it also has the capacity to relieve earache.

The route of administration of the oil when it is to be used as a medicine could be either external or oral. But the dosage, time of administration, combination or even instruction for external use vary depending on the cause, other symptoms, season, strength of agni and the person.

नस्यलाभाः॥ Nasya

Nasya karma also known as shiro virechana(that therapy which expels doshas situated in shiras) is one of the panchakarma therapy methods which means instillation of medicine (in the form of oil, powder, herbal liquid etc) through nostrils. This is primely indicated for the diseases of head and its associated structures.

नस्तःकर्म च कुर्वीत शिरोरोगेषु शास्त्रविद्| द्वारं हि शिरसो नासा तेन तद् व्याप्य हन्ति तान्||८८|| (Char. Siddh. 9.88) nastaḥkarma ca kurvīta śirorogeṣu śāstravid| dvāraṁ hi śiraso nāsā tena tad vyāpya hanti tān||88|| (Char. Siddh. 9.88)

Meaning: the one who has the knowledge to perform nasya in scientific method should conduct nasya in shirorogas (head related diseases). It is because the nose acts as an entry point to the head and structures inside it so it can cover the entire region and eliminate diseases affecting those.

धूमपानम् ॥ Dhumapana

Dhumapana refers to herbal smoking, primarily indicated in diseases concerning with head and neck and in vata and kapha dosha related diseases.

Indicated in headaches of various kind, heaviness of head, runny nose, sinuses, cough.

विविधानि शिरोरोगलक्षणानि तेषां व्याधिसंबंधः चHeadache and other symptoms associated with various diseases

Ayurveda scholars have mentioned various head related conditions where symptoms arise due to some pathologies occurring in head or other parts of body. Few common symptoms and their understanding as per Ayurveda has been described hereafter.

शिरः पूतिता॥ Stinking scalp or smelly scalp

It mostly happens due to excess Pitta accumulated in scalp or all over the body. This peculiar property of pitta giving specific odor is known as 'Visrata'.

शिरोगौरवम्॥ Heaviness in Head

This symptom is commonly experienced in cold and cough. Kasa (coughing) and shwasa (breathlessness) are the diseases in which heaviness in head is described as one of the symptoms. It is also stated that if bowel cleansing during virechana (therapeutic purgation) has not happened properly it may also lead to heaviness of head.

भ्रमः ॥ Giddiness or dizziness

This can be seen as a symptom in diseases like trushna ( a disease characterized by excessive thirst and dehydration as a predominant symptom). If vata dosha is dominant giddiness and if pitta dosha is dominant burning sensation in and around head can be experienced. Shaking of head - Repeated involuntary shaking of the head can be seen in Ardita (A disease characterized by facial paralysis like features).

शिरःशूलम्॥ Headache and migraine

It is the most commonly encountered symptom related to head. Ayurveda texts describe multiple diseases wherein headache can be found as a symptom. These diseases are as follows, Vata dominant gulma , Ajeerna (Indigestion), alcoholic intoxication or excess alcohol intake known as Madatyaya. Ardhavabhedaka is a condition characterized by pain in half part of the head. Ardhavabhedaka literally means penetration and splitting pain over the half side of the head region. Characterized by severe pain in neck, eyes, eyebrow, fore head region (half side of each) the pain could be severe and recurrent. This condition can be related to the Migrain discussed in western medicine. Thus Ardhavabhedaka is one of the chief cause of headache as per Ayurveda. Also there could be some medicnes whic can lead to the headache. e.g. Ayurveda texts state that if a vitiated impure blood flowing out of the body (which has to get cleared) is stopped unnecessarily with some medicines then it can lead to headache.

प्रतिश्यायम् ॥ Pratishyaya (Sinusitis)

Pratishyaya (a disease characterized by nasal discharge and other nasal symptoms similar to sinusitis) is said to be the chief Shiroroga i.e. disease of head region. It has a potential to give rise to many other head related pathologies and hence its considered chief. The dosha that predominantly causes pratishyaya is vata. It can be associated with other doshas from time to time as per the etiological factors. It can cause headache, heaviness in head, skin lesions over scalp, greying of hair, hairfall, hairloss, disorders of ear and eye.

शिरोरोगभेदाः॥ Fundamental Classification of shiroroga

Shirorogas are separately discussed in a Chikitsasthanam and sutrasthanam of Charaka samhita. The shirorogas have been classified as per the vitiated dosha causing it and other important causative factors like Krumi (worms/microbes/ingections).

Acharya Charaka in Sutrasthana has mentioned principally 5 types of Shiro roga(diseases pertaining to head)

वातज शिरोरोगः ॥ Vataja shiroroga

Characterized by intense pain in temple region, mid of eye brows, pain in fore head, dizziness, stiffness in the neck region.

Primary treatment aspect – Abhyanga (anointing with oil), swedana(steam therapy), nasya(oil instillation through nostrils), diet management, poultice application.

पित्तज शिरोरोगः ॥ Pittaja shiroroga

Characterized with burning sensation over head region, head ache, burning sensation in eyes, excessive perspiration.

Primary treatment aspect – intake of medicated ghee, milk etc. application of poultices, herbal ointments/ pastes, nasya with ghee.

कफज शिरोरोगः ॥ Kaphaja shiro roga

It is characterized with Constant dull head ache, heaviness of the head, stiffness, extreme laziness, loss of appetite.

Primary treatment aspect – Dhumapana (medicated smoke), diet management which reduces kapha dosha, basti karma, administration of old preserved medicated ghee, agni karma (cauterization method)

त्रिदोषज शिरोरोगः ॥ Tridoshaja shiroroga

Characterized by headache, tremors, burning sensation, excessive thirst.

Primary treatment aspect – all the above management principles are applied accordingly.

कृमीज शिरोरोगः ॥ Krimija shiroroga

Characterized with, Piercing and cutting pain through head, itching over head region, swelling, foul smell.

Primary treatment aspect – strong medicated nasya (instillation of oil, liquid, powders etc through nostrils) is administered.