Shira (शिरस् or शिरः)

Shira (शिरस्/शिरः) in Samskrt denotes head. In Ayurveda Shira is known as one of the 3 extremely significant marmas (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.

What is Shira according to 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. 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)

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, 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.

Anatomy related Shiras

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)

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. Si 9.88

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.

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. chi 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)

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. chi 26.3-4) or (Char. Samh. Siddh 9.5) Menaing: 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.

Doshas and shiras

kapha- शिरःस्थः स्नेहसन्तर्पणाधिकृतत्वादिन्द्रियाणामात्मवीर्येणानुग्रहं करोत् (Su su 21.14)

Preventive

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,

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. (Cha . su 5.59-60)

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, (Cha Su. 5 81-83)

• 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.

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. (Char. Samh. Suu 21.46-49)

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 og the causes. Char. Samh. Su 7/8, Char. Samh. Su 7/16, (Char. Samh. Su. 17.8-11), Cha. Si 12.14, Cha. Si 12.14, Cha. Si 12.14, Su su 42.15

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.

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.

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. (Char. Samh. Su. 14.20-21)(char.sut.22.11)

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) (Char. SAmh. su 27.233) (Su su 45.107) (char.sutr.27.231)

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. (Su Su 45.112)

(Su Su 45.112)

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. (asht,hrud.sutr.20.1) (Cha. Si 9.88)

नस्तःकर्म च कुर्वीत शिरोरोगेषु शास्त्रविद्| द्वारं हि शिरसो नासा तेन तद् व्याप्य हन्ति तान्||८८|| Cha. Si 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.

Dhumapana

Dhumapana refers to herbal smoking, primarily indicated in diseases concerning with head and neck and in vata and kapha dosha related diseases. (asht.hrid.sutr.22.1)

Indicated in headaches of various kind, heaviness of head, runny nose, sinuses, cough. (Cha.Chi 18/65)

In which rogas does shira gets affected or headache seen as symptom

V gulma- मन्याशिरःशङ्खशूल (Cha. samh. nidanasthana 3 Sutra 7)

Shirogandha-putita- in Pitta prakrti due to visrata- विस्रत्वात् प्रभूतपूतिकक्षास्यशिरःशरीरगन्धाः; (Charaka samhita vimanasthana Adhyaay 8 Sutra 97)

Ajeerna

तस्य लिङ्गमजीर्णस्य विष्टम्भः सदनं तथा|

शिरसो रुक् च मूर्च्छा च भ्रमः (Cha. Chi 15/45)

Shwasa, kasa, Pinasa

प्रतिलोमं यदा वायुः स्रोतांसि प्रतिपद्यते|

ग्रीवां शिरश्च सङ्गृह्य श्लेष्माणं समुदीर्य च||५५||

करोति पीनसं तेन रुद्धो घुर्घुरुकं तथा|

अतीव तीव्रवेगं च श्वासं (Cha. Chi 17. 56)

अधःप्रतिहतो वायुरूर्ध्वस्रोतःसमाश्रितः|

उदानभावमापन्नः कण्ठे सक्तस्तथोरसि||६||

आविश्य शिरसः खानि सर्वाणि प्रतिपूरयन्|

आभञ्जन्नाक्षिपन् (Cha. Chi 18. 6-7)

Pausing the vitiated blood flow-

स्रवणं चाप्युपेक्षेत लङ्घनैर्वा समाचरेत्||१७६||

प्रवृत्तमादावर्शोभ्यो यो निगृह्णात्यबुद्धिमान्|

शोणितं दोषमनिलं तद्रोगाञ्जनयेद्बहून्||१७७||

रक्तपित्तं ज्वरं तृष्णामग्निसादमरोचकम्| ..........वातमूत्रपुरीषाणां विबन्धं शिरसो रुजम्||१७९||

स्तैमित्यं गुरुगात्रत्वं तथाऽन्यान् रक्तजान् गदान्| (Cha chi 14.179)

V Trushna

निद्रानाशः शिरसो भ्रमस्तथा .... Cha chi 22.12

P trushna

शिरसो दाहः (cha. chi 22.14)

MAdatyaya

मद्योत्क्लिष्टेन दोषेण रुद्धः ^[१] स्रोतःसु मारुतः|

करोति वेदनां तीव्रां शिरस्यस्थिषु सन्धिषु||११७|| Cha. Chi 24.117

Pratishyaya as chief shiroroga

क्रमागतशिरोरोगचिकित्सायां वक्तव्यायां शिरोरोगप्रधानत्वाद्भूरिशिरोरोगहेतुत्वाच्च प्रतिश्यायमेव तावदाह|

संस्त्यानदोषे शिरसि प्रवृद्धो वायुः प्रतिश्यायमुदीरयेत्तु| (Char. Samh. Chi 26.105)

Dushtapratishyaya

दुष्टप्रतिश्याय -

सर्वोऽतिवृद्धोऽहितभोजनात्तु दुष्टप्रतिश्याय उपेक्षितः स्यात्||१०७||

ततस्तु रोगाः क्षवथुश्च .......अरूंषि शीर्षश्रवणाक्षिरोगखालित्यहर्यर्जुनलोमभावाः| (Cha.Chi 26.107-109)

Durvirikte

गलोपलेपः शिरसो गुरुत्वं निष्ठीवनं चाप्यथ दुर्विरिक्ते| (Char. SAMh. SIddhi 1.52)

Migrain / Ardhavabhedaka

केवलः सकफो वाऽर्धं ^[२] गृहीत्वा शिरसस्ततः|

मन्याभ्रूशङ्खकर्णाक्षिललाटार्धेऽतिवेदनाम्||७५||

शस्त्रारणिनिभां कुर्यात्तीव्रां सोऽर्धावभेदकः| Cha. Si 9. 74-76

Ardita

वक्रीभवति वक्त्रार्धं ग्रीवा चाप्यपवर्तते |

शिरश्चलति वाक्सङ्गो नेत्रादीनां च वैकृतम् ||७०||

ग्रीवाचिबुकदन्तानां तस्मिन् पार्श्वे तु वेदना | Su ni 1. 70

Shiro Rogas with reference to certain diseases

Shiroroga is not just a vyadhi or disease in itself but as a symptom in many disorders as well,

In certain diseases like vataja gulma(Char.nida 3.7), ajeerna(indigestion) -(Cha. Chi 15/45, shwasa (breathing disorders) (Cha. Chi 17. 56)

, kasa(different typesof cough), peenasa(types of rhinitis) (Cha. Chi 18. 6-7)

, vataja and pittaja trushna(thirst disorder) (cha. chi 22.12,14)

, madatyaya(alcoholism) (Cha. Chi 24.117)

, shira shola(headache), stiffness over head region, burning sensation of the head region as symptom is observed.

While describing the side effects of virechana karma (purgation therapy), heaviness of head as a symptom is described. (Char. SAMh. SIddhi 1.52)

In pitta prakriti dominant individual, Shirogandha-putita is described which means, unpleasant smell from the head region. (Char.vima 8.97)

During the management of arshas or hemorrhoids of bleeding nature, if the bleeding is controlled or stopped altogether when the doshas are vitiated, severe complications can arise and headache is one among the prime symptoms of it. (Cha chi 14.179)

Fundamental Classification of shiro roga

While describing diseases pertaining to head region or shiras, acharya charaka in sutrasthana mentioned the below disorders as types of Shiro rogas as well,

(char.sutr.kiyantshirasiy 13-14)

Ardhavbhedaka

Commonly co related as migraine, 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) (Cha. Si 9. 74-76)

Shira shula - headaches

Pratishyaya

Although a disease pertaining to nose, acharya charaka also mentions pratishyay() as a chief shiro roga. Commonly co related with allergic rhinitis/common cold. Classified as doshaja and dushtapratishyaya (chronic type of rhinitis), normally characterized with, nasal discharge, suppuration and patient is unable to perceive smell.

(Char. Samh. Chi 26.105)

Dushtapratishyaya

Dryness of nasal mucosa, sneezing, foul smell, excessive nasal discharge, swelling etc are few symptoms of dushtapratishyaya. (Cha.Chi 26.107-109)

Akshi-karna roga

Diseases pertaining to eye and ear.

Shiro bhrama

Dizziness or giddiness.

Ardita

Commonly co related with facial palsy ardita is an isolated concept in Ayurveda which is Characterized with vakrata() over hald side of face and neck, head ache, pain in chin area, neck region and vakrata in eye region.( Su ni 1. 70)

Gala- manya- hanu graha

Stiffness over throat, neck and jaw region.

Vatadi and krimi(meaning caused by vata, pitta, kapha dosha and krimij)

As describes below,

(char.chik trimarmiya. 158-186), (char. Sut. Kiyantshir 19-29)

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

1.     Vataja shiro roga

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

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

2.     Pittaja shiro roga

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.

3.     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(), diet management which reduces kapha dosha, basti karma(), administration of old preserved medicated ghee, agni karma(cauterization method)

4.     Tridoshaja shiro roga

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

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

5.     Krimija shiro roga

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.