When Vital Essence Meets Neuroendocrinology: Ojas Depletion, HPA Axis Dysfunction, and the Therapeutic Role of Ayurvedic Restorative Therapies

Lisa Strylowski
California College of Ayurveda
March 4, 2026

Chronic fatigue and burnout have achieved the status of a global health crisis in contemporary society. Burnout — most commonly defined as a state of work-related exhaustion, cynicism, and reduced efficacy; has been estimated to cost the European Union alone approximately twenty billion Euros annually in lost productivity and healthcare expenditure.¹ Chronic fatigue and burnout share overlapping features such as immune dysfunction, disrupted sleep, and profound physical and mental depletion that Western medicine has struggled to adequately address. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is a feature of both chronic fatigue and burnout which results in a gradual inability of the body to regulate its stress response to maintain the physiological resilience necessary for daily life.

Ayurvedic medicine, despite being more than 5,000 years old – long before chronic stress, burnout, or chronic fatigue were common experiences – understood this pattern of symptoms. Ojas is the force of stability in the mind and body. It gives every cell, tissue, and organ the ability to do its job and keep the body in homeostasis. The strength of ojas is directly proportional to a person’s ability to endure stress and mitigate dysfunction and disease.³ The Caraka Samhita describes the reduction of ojas, the vital essence distilled from all seven bodily tissues, as causing fear, constant weakness, worry, affliction of the sense organs, loss of complexion, and emaciation.⁴ This depiction of ojas in its diminished state bears a remarkable resemblance to the clinical picture of disease processes that result from HPA axis dysregulation.

This literature review explores the relationship between ojas depletion and HPA axis dysregulation through the classical Ayurvedic and modern Western/allopathic lenses and their comparative standards of treatment. This paper asserts that ojas depletion and HPA axis dysregulation are not merely analogous concepts, but represent the same underlying 2 physiological reality – and that Ayurvedic restorative therapies offer an evidence-supported pathway toward recovery, and prevention that is much-needed in response to the pandemic of stress-related diseases.

Western Physiology: The HPA Axis and Chronic Stress

The hypothalamic-pituitary-adrenal axis is the body’s neuroendocrine system for regulating the stress response and circadian rhythms. When there is a perceived threat or stressor in the body, the hypothalamus releases corticotropin-releasing hormone (CRH), which stimulates the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH). ACTH, in turn signals the adrenal cortex to produce glucocorticoids that have roles in regulating stress, cardiovascular, metabolic, immune, and behavioral responses.⁵ Cortisol is the body’s primary glucocorticoid stress hormone, and is the primary biomarker through which clinicians assess HPA axis function. In cases of acute stress, cortisol mobilizes energy reserves, modulates immune function, sharpens cognition, and prepares the body for effective response to the stressor.⁶ Once the stressor passes, a negative feedback loop restores the system to baseline. When stress becomes chronic, however, this intelligent system begins to malfunction. Prolonged activation of the HPA axis impairs the negative feedback loop, causing glucocorticoid (stress hormone) levels to remain elevated – leading to a wide range of systemic problems. Elevated cortisol disrupts sleep-wake cycles, contributing to insomnia and non-restorative sleep. It also suppresses immune function, increasing susceptibility to inflammation and infections. Over time behavioral changes such as cognitive difficulties, memory impairment, anxiety and depression can occur.⁷ The adrenal system eventually ceases being able to keep up with the cortisol demands and the body shifts into a state of hypocortisolism. This is the pattern associated with chronic fatigue syndrome and late-stage burnout.

Burnout, while not formally classified as a medical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is included in the ICD-10 – a standardized medical coding system developed by the World Health Organization (WHO) to classify symptoms, diseases, and procedure. There it is identified as a state of vital exhaustion, and is most commonly defined by emotional exhaustion, depersonalization, and reduced interpersonal accomplishment.⁸ These defining characteristics correlate with those of HPA axis dysregulation; depletion of energy reserves, the emotional fatigue that accompanies prolonged stress, and the decline of cognitive and motivational capacity. Clinical presentations of burnout consistently show elevated levels of perceived stress, reduced mental health, poor sleep quality, and increased anxiety and depression – all reflecting the ripple effect of consequences of a compromised stress response system. The Profile of Mood States (POMS) questionnaire provides a validated instrument for capturing the subjective experience of stress-related mood disturbance; assessing tension, depression, anger fatigue, and confusion. Quantitatively, serum cortisol and DHEA levels can be evaluated to determine the state of HPA axis activity and the measure of physiologic effects of interventions. In a balanced state, cortisol levels begin to rise early in the morning, peaking midday, and subsequently fall in the evening – governing our circadian rhythms. DHEA is an adrenal androgen and complementary biomarker with neuroprotective and anti-glucocorticoid properties.⁹ In chronic stress states the ratio of cortisol to DHEA tends to shift, reflecting HPA axis dysregulation.

Conventional treatment approaches to all conditions stemming from HPA axis dysregulations such as chronic fatigue and burnout remain limited in scope and efficacy. Pharmacological interventions address symptom management; anti-depressants and anxiolytics for mood disturbances, sleep aids for insomnia, but they fail to actually rebuild HPA axis resilience at the source. Cognitive behavioral therapy and relaxation-based programs have shown modest benefits. However, most studies on burnout interventions show significant reduction in benefit just six months after completion.¹⁰

Ayurvedic Classification: Ojas, the Doshas, and the Dhatus

Ayurvedic medicine understands that human existence is a dynamic interplay of the five great elements – Ether, Air, Fire, Water, and Earth – the building blocks of all of creation. These elements give rise to the doshas – Vata, Pitta, and Kapha – whose balanced expression constitutes homeostasis and health and whose disruption gives rise to imbalance or disease.¹¹ Underlying the doshas are the seven layers of tissue (dhatu) in the body. It’s important to note that Ayurveda recognizes that there is both a physical and subtle body and the use of the term bodies applies to both. The successive order of these dhatus are rasa (plasma & lymph), rakta (blood), mamsa (muscle), medas (adipose), asthi (bone), majja (bone marrow and nervous tissue), and sukra (reproductive), each of which is nourished by and refines the preceding tissue in a nutritive chain.¹² Some state that Ojas, the vital force of our stability mentioned in the introduction, is the eight dhatu. The Caraka Samhita states that Ojas is rather the essence of all the seven dhatus taken together, so there is no point in treating it as the eight dhatu.¹³

The classical texts illustrate the signs of diminished ojas as fear, worry, weakness or feebleness, affliction of the sense organs, pain, loss of luster in complexion, cheerlessness, roughness, and emaciation.¹⁴ The similarities with the constellation of symptoms of burnout and chronic fatigue is strikingly similar – pervasive exhaustion, anxiety, sensory hypersensitivity, loss of vitality, and low motivation. The gradual depletion of ojas through the sustained demands of chronic stress is the root of almost all disease according to Ayurveda, but certainly the causative factors in disease states that are associated with HPA axis dysregulation.

Of the three doshas previously mentioned, Vata plays the most central role in the pathogenesis of ojas depletion. The Charaka Samhita describes Vata’s inherent qualities as roughness, lightness, coldness, instability, coarseness, and non-sliminess.¹⁵ These qualities enable Vata to perform its vital functions; coordination of the sense faculties, stimulating digestive fire, governing communication of all the cells and systems within the body, and the integrity of the channels through which nourishment flows.¹⁶ When Vata become aggravated, however, through factors that increase its qualities such as cold exposure, irregular routines, excess physical or mental exertion – its destabilizing effects can be extremely detrimental to one’s health. Vata afflicts the body with various diseases, weakens one’s strength, loss of vital complexion, depression, reduction of life span, fear, delirium, and addiction.¹⁷ This description closely parallels again, the common presentation of HPA axis dysregulation; cognitive impairment, anxiety and mood disturbance, and the erosion of vitality. Excess Vata produces more dryness and depletions throughout all the dhatus, and in doing so diminishes the state of ojas.

While Vata is the main driver of depletion, Pitta dosha also has a role to play. Made of Fire and Water, Pitta governs all the processes of metabolism and transformation. It has a close relationship with hormone metabolism and thermoregulation. The qualities of Pitta dosha are heat, sharpness and intensity.¹⁸ In the context of chronic stress, Pitta aggravation manifests as increasing internal heat in the body and mind; the stereotypical driven, high-performing, perfectionist tendencies that lead to clinical burnout. Chronically high Pitta generates excess heat throughout the body, also reducing the quality of the dhatus and lowering ojas. Where Vata depletes through excess dryness and movement, Pitta depletes through burning through our vital reserves under chronic intensity and stress states.

The dhatu system provides the structural framework through which Ayurveda understands the progression from minor, acute stressors that are easily recovered from, to the chronic stress that results in vital depletion. To review, each dhatu nourishes the next in sequence whose most refined essence becomes ojas. The integrity of this chain is dependent upon the strength of our digestive fire (agni) at each stage of transformation. When our digestive capacity is weakened, as occurs in chronic stress, the dhatus are improperly nourished and therefore are in poor quality. This creates an accumulation of unmetabolized residue known as ama which obstructs the flow of nourishment, yielding poor quantity and quality of ojas. Through purification and restorative Ayurvedic therapies, ojas can be restored and health brought back into balance. The Astanga Hridayam affirms that purificatory therapies properly performed produce clarity of mental function, keenness of sense organs, stability of tissues, improvement of digestive activities, and a slowing of the aging process.¹⁹

Ayurvedic Pathology: The Progression of Ojas Depletion

The Ayurvedic classification gives a critical understanding of the structural understanding of the doshas, the dhatus, and the nature of ojas. The pathological understanding allows us to understand the how and why the body moves from a state of balance into the progressive depletion that is characteristic of chronic fatigue and burnout. Ayurvedic pathology doesn’t view disease as a singular event, but a gradual process that unfolds through six stages. Understanding this progression helps give context to why most conventional treatments aren’t highly effective, and why prevention, early intervention, and restorative therapies are so central to the Ayurvedic approach.

Ayurvedic medicine identifies the root cause of disease, known as the nidanas. Nidanas result from three categories: misuse of the sense organs, mistakes of the intellect/crimes against wisdom (prajnaparadha), and the influence of time and seasonal influences.²⁰ In the context of chronic fatigue and burnout it is prajnaparadha that is most directly implicated. The Caraka Samhita identifies aggravating factors of Vata as those actions and substances that share its qualities: excess movement, remaining awake at night, irregular mealtimes, and the habitual use of cold, rough, or dry foods and behaviors.²¹ These are precisely the lifestyle patterns – chronic overwork, lack of sleep, nutritional neglect, and suppression of the body’s signals for rest that create the environment for burnout to develop. When an individual has consistently engaged in behaviors that aggravate both Vata and Pitta and deplete the dhatus, burnout will set it. It’s important to note that this is often not deliberate on the part of an individual, but likely a result of either ignorance of the long-term effects or through competing with the demands of modernity. This understanding correlates with the Western understanding that chronic physiological stress states generate a neuroendocrine cascade that will sustain elevated levels of cortisol and sympathetic nervous system arousal even in the absence of external stressors.²²

The Ayurvedic model of disease progression begins with the stages of accumulation and aggravation. Here the qualities of the doshas will increase in the digestive system, but will quickly resolve. An example of this is in HPA axis dysregulation is when an individual experiences a severe stressor and loses their appetite, skipping meals for a couple of days. This will result in minor fatigue with weak digestion. It will be quickly alleviated if the individual takes a couple of days to rest well and take nourishing foods at regular intervals. If this alleviation does not occur, the dosha will move from the digestive system into the rasa & rakta dhatus and begin to travel through the channels of the body seeking areas of weakness or vulnerability. Symptoms begin to become noticeable, but are still mild and treatable. If proper rest and rejuvenative care is still not taken at this stage, the aggravated dosha will lodge in specific tissues and begin to produce dysfunction. This is the point where most diseases get a Western name or diagnosis. Treatment is still possible, but will take longer and be more challenging. If rejuvenation and full-spectrum treatment is still not taken, the disease manifests further and the body’s ability to produce ojas is critically compromised.²³ At this stage an individual is no longer merely fatigued, but all their tissues have become depleted results in physical weakness, insomnia, heightened anxiety, emotional instability, and sympathetic freeze or collapse seen in burnout and fatigue. Where Western medicine describes acute stress response giving way to allostatic overload, Ayurveda describes the accumulation and overflow of aggravated doshas leading to the progressive impairment of the dhatu chain. Where Western medicine identify the shift from hypercortisolism to hypocortisolism as a biomarker of advanced burnout, Ayurveda describes the depletion of agni and accumulation of ama as markers of a system that has lost ojas and therefore its capacity for self-regulation and regeneration.

This provides a rationale that because these frameworks are not just similar, but the same underlying reality, then therapies that address ojas depletion- rebuilding the dhatus, restoring agni, balancing Vata and Pitta, and nourishing the channels of the body – can also be expected to produce measurable effects on the biomarkers of HPA axis function. The clinical evidence to follow will demonstrate this.

Ayurvedic Restorative Therapies and Clinical Evidence

The Ayurvedic approach to chronic fatigue and burnout is organized around the fundamental principle that depletion at the level of the dhatus and ojas requires gentle purification, but more importantly – deep nourishment. The classical texts distinguish clearly between two types of therapeutic protocols: Lanhana Chikitsa (lightening and reducing therapies) and Brimhana (nourishing and building therapies). The former is indicated for patients who have ama (metabolic toxins) and have strong enough ojas to undergo purification therapies, while the latter is indicated precisely for conditions of depletion and overexertion. As the Ashtanga Hridayam instructs, Brimhana therapy is indicated for persons who have become emaciated, suffering from diseases of Vata origin, sexual intercourse, and grief; who indulge in heavy work or walk long distances; who are thin, weak, dry, or debilitated.²⁴ In the Caraka Samhita, it is said that Lord Atreyu – considered the greatest scholar of internal medicine in early Ayurveda said to his disciples “One who knows to reduce, to nourish, to dry, to oleate, to fomentate and the astringent therapies, is the real physician”.²⁵ In modern clinical practice, the most researched and accessible of these restorative therapies are Abhyanga (oil massage), Shirodhara (oil head dripping), and Svedana (herbal steam). Each of these address a different piece of the neuroendocrine and tissue-level dysregulation seen in HPA axis dysregulation.

Snehana, or oleation, is the therapeutic use of oils and fats both internally and externally – and is a foundation of Ayurvedic treatment of Vata disorders and tissue depletion. The Caraka Samhita establishes oleation therapy as the most important first step toward alleviating Vata disorders before administering any deeper therapeutic intervention – noting that oil alleviates Vata, promotes bodily strength, benefits the skin, and stabilizes the tissues. ²⁶ The Shushruta Samhita elaborates on this mechanism in stating that oil infused on the human organism imparts a tone and vigor to its root-principles (dhatus), in the same manner as water furnishes the roots of a tree or plant with the necessary nutritive elements, and fosters its growth when poured into the soil where it grows. Sneha (oil) penetrates into the system through the mouths of the veins and the ducts of the body, as also through the roots of the hair, and thus soothes and invigorates the body with its own essence ²⁷

Abhyanga (full body oil massage) is the primary external application of oleation therapy and one of the most researched Ayurvedic interventions. Specific applications carry targeted effects: anointing the head with oil invigorates the sense organs and removes fatigue from the head region, anointing the feet with oil promotes sleep and removes drowsiness and fatigue, and oil applied to the rest of the body targets nourishment of the skin, muscle, adipose, bone, and nervous system tissues. The Sushruta Samhita further explains that the blessings upon a person who has duly taken Snehana include improved digestive capacity, growth of all the vital tissues of the body, strength and firmness of the organs, improvement of complexion, and delayed again – illustrating a picture of recovery from a depletion state such as burnout and chronic fatigue.²⁸

Clinical evidence for the cortisol-modulating effects of Abhyanga is seen in a fourteen day protocol combining Abhyanga with sesame oil and Shirodhara with herbal milk decoction in a patient with anxiety disorder. At the end of the protocol the patient endorsed significant improvement in the subjective experience of anxiety symptoms. Serum cortisol levels supported the patient’s testimony with a serum level of 13.51 ug/dl prior to treatment which declined to a normal value of 5.85 ug/dl by day 8. ²⁹ Though the sample size was small and limits certainly in replicating results in larger populations, it provides important proof-of-concept evidence that supports the classical therapeutic approach – pacifying Vata through stabilizing the nervous system and reducing the body’s stress burden through therapeutic oleation corresponds with demonstrable change in hormonal biomarkers that show reduction in allostatic load.

Shirodhara is the continuous dripping of warm medicated oil or other therapeutic liquids onto the forehead, and is another one of the most well-researched Ayurvedic therapies. Classically indicated for disorders of Vata origin including migraines, insomnia, anxiety, and neurological dysfunction.³⁰ The Ashtanga Hridayam prescribes nourishing head and nasal oil therapies for conditions involving Vata or Pitta aggravation, loss of sleep, or sensory dysfunction.³¹

The most compelling clinical investigation into Shiroidhara’s physiological mechanisms was a 2008 randomized controlled study in which 16 females experienced 30 minute robotic Shirodhara treatments with sesame oil while the control group of the same size were assigned to either a Shirodhara treatment or a control supine position for 30 minutes. During this time all participants had monitoring of physiologic biochemical, immunologic, and psychometric parameter ³² The participants who received the Shirodhara treatment showed significantly greater reduction in anxiety and higher scores on altered states of consciousness measures than those in the control group.33 On the biochemical level, plasma noradrenaline levels decreased significantly more in the Shirodhara group than in controls. The researches surmise that this reflects a suppression of the noradrenaline-mediated sympathetic receptor system.³⁴ Urinary serotonin excretion was also significantly reduced both immediately after, and one hour following Shirodhara treatments vs the control group. A decrease in the PMN/lymphocyte ratio was also observed in the treatment group – a marker of autonomic nervous system balance, indicating a shift away from the physiologic stress state.³⁵ The most striking marker may be that Shirodhara recipients demonstrated preserved natural killer (NK) cell activity, which declined significantly in the control group over the same period. This finding has direct relevance to the immune dysregulation associated with chronic HPA axis activation. The sympathetic suppression effect mentioned earlier appears to interrupt the pathway by which chronic sympathetic arousal suppresses our innate immune system.³⁶ The researchers propose that the warm sesame oil contacts the skin which is innervated by the trigeminal nerve. This nerve impulse is transmitted to the thalamus and cerebral cortex, initiating an autonomic reflex that had downstream changes in neurotransmitter levels such as serotonin, noradrenaline, and thyrotropin-releasing hormone.³⁷ This is clearly compelling biomedical data to support how this classical Ayurvedic therapy achieves its calming, restorative, Vata pacifying effects.

Rajan et al. (2021) further affirms Shirodhara’s capacity to modulate stress biomarkers in a case study of a thirty-five year old female patient presenting with sleep deprivation, loss of concentration, and irritable mood; symptoms that correspond with both ojas depletion and HPA axis dysregulation. Following fourteen consecutive days of Shirodhara treatment using sesame oil, the patient demonstrated significant improvement in the Profile of Mood Score (POMS), serum cortisol and DHEA levels.³⁸ The authors framed their interpretation of these results through their understanding of the Ayurvedic concepts of Chinta (stress) and how it vitiates Vata and the rasavaha srotas and demonstrating that Shirodhara is the mechanism by which the disturbances in the tissues and channels are resolved.

Svedana, also known as fomentation or herbal steam therapy is an Ayurvedic therapy that typically follows oleation to further soften and mobilize aggravated doshas and open the channels to restore warmth and circulation to depleted tissues. The Ashtanga Hridayam describes Pinda Sweda – a form of Svedana involving heated herbal boluses applied to specific parts of the body – as specifically indicated for diseases of Vata origin to warm and soften the tissues while promoting circulation and the removal of metabolic wastes.³⁹ In the context of ojas depletion and HPA axis dysregulation, Svedana serves a few important functions. By inducing perspiration it facilitated the elimination of ama – accumulated metabolic wastes that obstruct the tissues. This restores the flow of nourishment through the dhatus, and relieves the dryness, stiffness, and circulatory stagnation that excess Vata produces. ⁴⁰ This is helpful since patients with low ojas are not candidates for strong purification therapies. Mild Svedana offers a gentle way to remove ama while providing nourishment to the body. While there aren’t clinical studies to show Svedana’s effect on HPA axis biomarkers, its role as a complementary therapy within the broader restorative Ayurvedic therapeutic protocols is well-established in the classical texts and is consistent with its physiological effects on circulation, tissue permeability, and rejuvenation of the nervous system.

Conclusion

The evidence reviewed in this paper supports a central claim – that ojas depletion and HPA axis dysregulation are not parallel metaphors but descriptions of the same physiological breakdown. The Western biomedical view illustrates the progression from acute stress to allostatic overload, from hypercortisolism to hypocortisolism, and from sympathetic hyperarousal to immune suppression. The Ayurvedic view illustrates its own view from the acute states of accumulation and aggravation of doshic disturbance as a result of prajnapradha to impairment through the successive chain of dhatu, to the depletion of ojas. Both arrive at the same destination; a state of exhaustion on the deepest physiological levels: physically, cognitively, emotionally, and immunologically. In this state self-regeneration or recovery has been outpaced by the demands it sustained over long periods of time. The clinical studies reviewed here demonstrate that Ayurvedic therapies targeted at restoring depletion produce measurable and reproducible outcomes consistent with improvement in biomarkers that track HPA axis function such as cortisol, DHEA, noradrenaline, and NK cell activity – as well as psychometric markers such as anxiety and mood scales.

Although large size clinical studies are still lacking in the field of Ayurvedic medicine, there is compelling evidence to represent some of its advantages over conventional allopathic approaches. First, Ayurvedic treatment is always individualized and calibrated to the patient’s unique state of balance (prakruti) and current imbalances (vikruti). This contrasts with the one-size-fits-all approach of most Western approaches and aligns with the growing recognition and desire for the superior outcomes that come with personalized treatment. Second, it’s multidimensional: Ayurvedic restorative therapy addresses the body from the outside in and the inside out; from the neuroendocrine level, to the physical to the psychological. FInally, Ayurveda is true root cause medicine; by targeting the depletion at its source and nourishing and rebuilding tissue strength and physiological resiliency rather than symptom management, Ayurvedic therapies target the conditions that produced the burnout state, not just its manifestations.

One final piece of evidence that supports the high-caliber, long-term benefits of Ayurvedic therapy comes from a study on sixty patients that underwent Ayurvedic purification therapy, including Ayurvedic health counseling for chronic skin disorders- which are understood to involve the same pathology as Vata Pitta burnout.41 Statistically significant improvements were noted across all three Skindex-29 quality of life domains: emotional, functional, and symptomatic. Impressively, these improvements sustained and even deepened at follow-up assessment suggesting that Ayurvedic intervention produces sustainable effects rather than transient symptomatic relief.42 These long-term outcomes contrasted with the documented diminishing effects of conventional burnout intervention effects within six month points to the possibility that by addressing the underlying dahtu depletion rather than symptoms alone, Ayurvedic restorative therapies create the conditions for genuine lasting physiological recovery.

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Endnotes

1. Kessler CS, Eisenmann C, Oberzaucher F, Forster M, Steckhan N, Meier L, Stapelfeldt E, Michalsen A, Jeitler M. Ayurvedic versus conventional dietary and lifestyle counseling for mothers with burnout-syndrome: A randomized controlled pilot study including a qualitative evaluation. Complement Ther Med. 2017;34:57-65. doi:10.1016/j.ctim.2017.07.006. p 3.
2. Ibid., 3.
3. Halpern, Marc Dr, Principles of Ayurvedic Medicine, 10th Edition (Nevada City, College of Ayurveda,2015), 112-113.
4. Translated by Kaviraj Kunja Lal Bhishagratna, Sushruta Samhita Vol II (Calcutta, Bharaht Mihir Press, 1911) p 325
5. Rajan S, Shamkuwar MK, Tanwar AK. Impact of Shirodhara on biological markers of stress: A case study. J Ayurveda Integr Med. 2021 Jan-Mar;12(1):178-181. doi: 10.1016/j.jaim.2021.01.008. Epub 2021 Feb 23. PMID: 33637424; PMCID: PMC8039348, p 180.
6. Zhang YD, Wang LN. Research progress in the treatment of chronic fatigue syndrome through interventions targeting the hypothalamus-pituitary-adrenal axis. Front Endocrinol (Lausanne). 2024 Apr 10;15:1373748. doi: 10.3389/fendo.2024.1373748. PMID: 38660512; PMCID: PMC11039924, p 2.
7. Ibid., 2-3.
8. Kessler CS, Eisenmann C, Oberzaucher F, et al. Ayurvedic versus conventional dietary and lifestyle counseling for mothers with burnout-syndrome: A randomized controlled pilot study. Complement Ther Med. 2017;34:57-65.
9. Rajan S, Shamkuwar MK, Tanwar AK. Impact of Shirodhara on biological markers of stress: A case study. J Ayurveda Integr Med. 2021 Jan-Mar;12(1):178-181.
10. Kessler CS, Eisenmann C, Oberzaucher F, et al. Ayurvedic versus conventional dietary and lifestyle counseling for mothers with burnout-syndrome: A randomized controlled pilot study. Complement Ther Med. 2017;34:57-65.
11. Halpern, Marc Dr, Principles of Ayurvedic Medicine, 10th Edition (Nevada City, College of Ayurveda,2015), 71-75.
12. Ibid., 104.
13. Translated by Kaviraj Kunja Lal Bhishagratna, Sushruta Samhita Vol II (Calcutta, Bharaht Mihir Press, 1911) p 326
14. Agnivesha. Charaka Samhita (Sutra Sthana). Translated by P.V. Sharma. Chaukhambha Orientalia, Varanasi, 2001. 325-326
15. Ibid., 325.
16. Ibid., 327
17. Ibid., 328
18. Halpern, Marc Dr, Principles of Ayurvedic Medicine, 10th Edition (Nevada City, College of Ayurveda,2015), 80.
19. Vagbhata. Ashtanga Hrdayam. Translated by K.R. Srikantha Murthy. Krishnadas Academy, Varanasi, 1991. 484.
20. Halpern, Marc Dr, Principles of Ayurvedic Medicine, 10th Edition (Nevada City, College of Ayurveda,2015), 5-7.
21. Agnivesha. Charaka Samhita (Sutra Sthana). Translated by P.V. Sharma. Chaukhambha Orientalia, Varanasi, 2001. 235.
22. Zhang YD, Wang LN. Research progress in the treatment of chronic fatigue syndrome through interventions targeting the hypothalamus-pituitary-adrenal axis. Front Endocrinol (Lausanne). 2024 Apr 10;15:1373748. doi: 10.3389/fendo.2024.1373748. PMID: 38660512; PMCID: PMC11039924. 2-3.
23. Halpern, Marc Dr, Principles of Ayurvedic Medicine, 10th Edition (Nevada City, College of Ayurveda,2015), 191-192
24. Vagbhata. Ashtanga Hrdayam. Translated by K.R. Srikantha Murthy. Krishnadas Academy, Varanasi, 1991. 422.
25. Agnivesha. Charaka Samhita (Sutra Sthana). Translated by P.V. Sharma. Chaukhambha Orientalia, Varanasi, 2001. 387.
26. Ibid.. 244.
27. Translated by Kaviraj Kunja Lal Bhishagratna, Sushruta Samhita Vol II (Calcutta, Bharaht Mihir Press, 1911) 484-485.
28. Ibid., 557
29. Sharma A, Sugandh M, Bhardwaj A, Gupta A. Role of Shirodhara and Abhyanga on serum cortisol in Anxiety – A case report. J Ayurveda Integr Med. 2025 Jan-Feb;16(1):100948. doi: 10.1016/j.jaim.2024.100948. Epub 2025 Jan 11. PMID: 39799837; PMCID: PMC11773008. 2.
30. Halpern, Marc Dr, Principles of Ayurvedic Medicine, 10th Edition (Nevada City, College of Ayurveda,2015), 454.
31. Vagbhata. Ashtanga Hrdayam. Translated by K.R. Srikantha Murthy. Krishnadas Academy, Varanasi, 1991. 513.
32. Uebaba K, Xu FH, Ogawa H, Tatsuse T, Wang BH, Hisajima T, Venkatraman S. Psychoneuroimmunologic effects of Ayurvedic oil-dripping treatment. J Altern Complement Med. 2008 Dec;14(10):1189-98. doi: 10.1089/acm.2008.0273. PMID: 19123874. 1189.
33. Ibid., 1189-1191.
34. Ibid., 1198.
35. Ibid., 1194.
36. Ibid., 1198.
37. Ibid., 1197-1198.
38. Rajan S, Shamkuwar MK, Tanwar AK. Impact of Shirodhara on biological markers of stress: A case study. J Ayurveda Integr Med. 2021 Jan-Mar;12(1):178-181.
39. Vagbhata. Ashtanga Hrdayam. Translated by K.R. Srikantha Murthy. Krishnadas Academy, Varanasi, 1991. 450.
40. Halpern, Marc Dr, Principles of Ayurvedic Medicine, 10th Edition (Nevada City, College of Ayurveda,2015), 456.
41. Deshpande H, Shivakumar, Kavita MB, Tripathy TB, Chaturvedi A. Assessment of Quality of Life in Patients With Skin Disorders Undergoing Ayurvedic Panchakarma (Biopurification) as Management. J Evid Based Complementary Altern Med. 2016 Jul;21(3):215-20. doi: 10.1177/2156587215615026. Epub 2015 Nov 12. PMID: 26567027. 216-217
42. Ibid., 215-220.

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Citations

Deshpande H, Shivakumar, Kavita MB, Tripathy TB, Chaturvedi A. Assessment of Quality of Life in Patients With Skin Disorders Undergoing Ayurvedic Panchakarma (Biopurification) as Management. J Evid Based Complementary Altern Med. 2016 Jul;21(3):215-20. doi: 10.1177/2156587215615026. Epub 2015 Nov 12. PMID: 26567027.

Halpern, Marc Dr, Principles of Ayurvedic Medicine, 10th Edition (Nevada City, College of Ayurveda,2015), 4-5

Halpern, Marc Dr Clinical Ayurvedic Medicine 6th Edition (Nevada City, California College of Ayurveda, 2012) 6-40

Kessler CS, Eisenmann C, Oberzaucher F, Forster M, Steckhan N, Meier L, Stapelfeldt E, Michalsen A, Jeitler M. Ayurvedic versus conventional dietary and lifestyle counseling for mothers with burnout-syndrome: A randomized controlled pilot study including a qualitative evaluation. Complement Ther Med. 2017 Oct;34:57-65. doi: 10.1016/j.ctim.2017.07.005. Epub 2017 Jul 16. PMID: 28917376.

Rajan S, Shamkuwar MK, Tanwar AK. Impact of Shirodhara on biological markers of stress: A case study. J Ayurveda Integr Med. 2021 Jan-Mar;12(1):178-181. doi: 10.1016/j.jaim.2021.01.008. Epub 2021 Feb 23. PMID: 33637424; PMCID: PMC8039348.

Sharma A, Sugandh M, Bhardwaj A, Gupta A. Role of Shirodhara and Abhyanga on serum cortisol in Anxiety – A case report. J Ayurveda Integr Med. 2025 Jan-Feb;16(1):100948. doi: 10.1016/j.jaim.2024.100948. Epub 2025 Jan 11. PMID: 39799837; PMCID: PMC11773008.

Tomas C, Newton J, Watson S. A review of hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. ISRN Neurosci. 2013 Sep 30;2013:784520. doi: 10.1155/2013/784520. PMID: 24959566; PMCID: PMC4045534. Translated by R.K. Sharma and Bhagwan Dash, Caraka Samhita Vol. I (Varanasi: Chowkhamba Sanskrit Series Office, 1992), p. 77

Translated by K.R. Srikantha Murthy, Astanga Hridaya Vol I (Varanasi: Chaukambha Orientalia, 2004) p

Translated by Kaviraj Kunja Lal Bhishagratna, Sushruta Samhita Vol II (Calcutta, Bharaht Mihir Press, 1911) p

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Uebaba K, Xu FH, Ogawa H, Tatsuse T, Wang BH, Hisajima T, Venkatraman S. Psychoneuroimmunologic effects of Ayurvedic oil-dripping treatment. J Altern Complement Med. 2008 Dec;14(10):1189-98. doi: 10.1089/acm.2008.0273. PMID: 19123874.

Zhang YD, Wang LN. Research progress in the treatment of chronic fatigue syndrome through interventions targeting the hypothalamus-pituitary-adrenal axis. Front Endocrinol (Lausanne). 2024 Apr 10;15:1373748. doi: 10.3389/fendo.2024.1373748. PMID: 38660512; PMCID: PMC11039924.

Abstracts

Abstracts for When Vital Essence Meets Neuroendocrinology: Ojas Depletion, HPA Axis Dysfunction, and the Therapeutic Role of Ayurvedic Restorative Therapies

Journal: Frontiers in Endocrinology 2024; 10(15):1373748

Title: Research progress in the treatment of chronic fatigue syndrome through interventions
targeting the hypothalamus-pituitary-adrenal axis

Author: Yi-Dan Zhang , Li-Na Wang

Abstract: Chronic fatigue syndrome (CFS) causes great harm to individuals and society. Elucidating the pathogenesis of CFS and developing safe and effective treatments are urgently needed. This paper reviews the functional changes in the hypothalamus-pituitary-adrenal (HPA) axis in patients with CFS and the associated neuroendocrine mechanisms. Despite some controversy, the current mainstream research evidence indicates that CFS patients have mild hypocortisolism, weakened daily variation in cortisol, a weakened response to the HPA axis, and an increase in negative feedback of the HPA axis. The relationship between dysfunction of the HPA axis and the typical symptoms of CFS are discussed, and the current treatment methods are reviewed.

Journal: Journal of Ayurveda and Integrative Medicine 2021: 12 (1): 178-181

Title: Impact of Shirodhara on biological markers of stress: A case study

Authors: Sujata Rajan, Manoj K. Shamkuwar, Ankur Kumar Tanwar

Abstract: The unforgiving pace and complexity of modern life has greatly challenged our ability to live healthier and fully in the present moment. Industrialization, globalization, and competition in each sector lead to emotional stress and strain in life which is dangerous at the physical and mental levels. As per the classics of Ayurveda, chinta (stress) and atichintan (overthinking) are the causes of Rasavaha srotodushti which lead to many diseases. Shirodhara is an important healing technique of Ayurveda that has neuro-immuno-physio-psychological effects on the human body. Several studies have been carried out to evaluate the efficacy of Shirodhara in many diseases. A 35-year-old female patient with sleep deprivation, loss of concentration, and irritable mood symptoms was admitted to the hospital. She was assessed on the basis of the Profile Of Mood Score (POMS) questionnaire, Serum Cortisol (Sr. Cortisol), Dehydroepiandrosterone (DHEA). The patient was treated by Shirodhara with sesame oil for 14 days continuously. Results were assessed by biomarkers of stress and by POMS score. At the end of Shiroadhara, there was significant improvement found in presenting complaints as well as on the POMS Score and Stress biomarkers. During or after the treatment, no adverse events were observed.

Journal: Journal of Ayurveda and Integrative Medicine; 2025; 16 (1): 100948

Title: Role of Shirodhara and Abhyanga on serum cortisol in Anxiety – A case report

Authors: Ashu Sharma, Megha Sugandh, Atul Bhardwaj, Arun Gupta Abstract: Chittodvega, classified as a Mano-Vikara (psychological disorder) in Ayurveda, can be correlated with general anxiety disorder. The disturbance of Vata Dosha plays a critical role in its manifestation. Ayurvedic treatments such as Abhyanga (oleation) and Shirodhara (dripping of medicated oil or other suitable liquid on forehead) are known to pacify Vata. Abhyanga helps to stabilize the body, while Shirodhara enhances concentration, promoting mental stability. Both procedures synergistically balance Vata Dosha, addressing the physiological and psychological aspects of Chittodvega.A 50-year-old male patient presented with complaints of anxiety at Ch. Brahm Prakash Ayurveda Charak Sansthan, New Delhi. He underwent a 14-day treatment regimen, including 7 days of hospitalization and 7 days of follow-up. The treatment involved Abhyanga(Oleation) with Til Taila (sesame oil) and Shirodhara with Dashmool Siddha Ksheer (herbal milk decoction), aimed at assessing their impact on serum cortisol levels. Both, morning and evening cortisol level of this patient was within the normal range before and after the treatment. This study was done only to check the effectiveness of Abhyanga and Shirodhara on serum cortisol level. Observable changes were found in serum cortisol along with a reduction in the patient’s anxiety symptoms, demonstrating the efficacy of these Ayurvedic interventions in managing Chittodvega.

Journal: The Journal of Alternative and Complementary Medicine; 2008:14 (10): 1189-1198

Title: Psychoneuroimmunologic Effects of Ayurvedic Oil-Dripping Treatment

Authors: Kazuo Uebaba M.D., PhD., Feng-Hao Xu, M.D., Hiroko Ogawa, M.S., Takasji Tatsuse,
B.C., Bing-Hong Wang, PhD., Tatsuya Hisajima, PhD., Sonia Venkatraman

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 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).

Conclusions: These results indicate that Shirodhara has anxiolytic and ASCinducing effects, and it promotes a decrease of noradrenaline and exhibits a sympatholytic effect, resulting in the activation of peripheral foot skin circulation and immunopotentiation.

Journal: Journal of Evidence-Based Complementary & Alternative Medicine 2016; 21 (3): 215- 220

Title: Assessment of Quality of Life in Patients With Skin Disorders Undergoing Ayurvedic Panchakarma (Biopurification) as Management

Authors: Harish Deshpande, Shivakumar, MD, M. B. Kavita, MD, T. B. Tripathy, MD, PhD, and Ashutosh Chaturvedi, BAMS

Abstract: Background. Chronic skin conditions can have a negative impact on one’s quality of life, affecting their physical, functional, and emotional well-being. Whereas biopurifactory measures (panchakarma) of Ayurveda claims to provide better quality of life after treatment. Hence current study is planned to provide evidence in patients with skin disorders, undergoing Ayurvedic treatment. Methodology. Sixty patients with skin disorder, who underwent purification therapies like therapeutic emesis and therapeutic purgation, were randomly placed in 2 groups to assess quality of life. Quality of life assessment was done with the help of Skindex- 29 among the patients before and after Ayurvedic purification therapy. Thereafter, the quality of life assessment was done on the first follow-up. Results. A statistically significant improvement in the quality of life domains—emotions, functioning, and symptoms— after the Ayurvedic management was observed with P value <.001. Conclusion. Study concludes that there is improvement in quality of life among patients with skin disease after undergoing Ayurveda purification therapies.

Journal: Complementary Therapies in Medicine; 2017 34 (1): 57-65

Title: Ayurvedic Versus Conventional Dietary and Lifestyle Counseling for Mothers with Burnout-Syndrome: A Randomized Controlled Pilot Study Including a Qualitative Evaluation

Authors: Christian S. Kessler, Clemens Eisenmann, Frank Oberzaucher, Martin Forster, Nico Steckhan, Larissa Meier, Elmar Stapelfeldt, Andreas Michalsen, Michael Jeitler

Abstract: Objectives: Ayurveda claims to be effective in the treatment of psychosomatic disorders by means of lifestyle and nutritional counseling. Design: In a randomized controlled study mothers with burnout were randomized into two groups: Ayurvedic nutritional counseling (according to tradition), and conventional nutritional counseling (following the recommendations of a family doctor). Patients received five counseling sessions over twelve weeks. Main outcome measures: Outcomes included levels of burnout, quality of life, sleep, stress, depression/anxiety, and spirituality at three and six months. It also included a qualitative evaluation of the communication processes. Results: We randomized thirty four patients; twenty three participants were included in the per protocol analysis. No significant differences were observed between the groups. However, significant and clinically relevant intra-group mean changes for the primary outcome burnout, and secondary outcomes sleep, stress, depression and mental health were only found in the Ayurveda group. The qualitative part of the study identified different conversational styles and counseling techniques between the two study groups. In conventional consultations questions tended to be category bound, while counselingadvice was predominantly admonitory. The Ayurvedic practitioner used open-ended interrogative forms, devices for displaying understanding, and positive re-evaluation more frequently, leading to an overall less asymmetrical interaction. Conclusions: We found positive effects for both groups, which however were more pronounced in the Ayurvedic group. The conversational and counseling techniques in the Ayurvedic group offered more opportunities for problem description by patients as well as patient-centered practice and resource-oriented recommendations by the physician.