Abstract Insomnia is clinically defined as the inability to sleep or difficulty in sleep. Due to urbanization and industrialization, there has been a drastic change in our day to day activities including lifestyle, food habits, sexual life. Nowadays; due to increased stress due to competitive life also hampers our physical and mental health.
In this case study, a male patient of age 35 years with the loss of sleep, difficulty in falling asleep, and other associated symptoms of weakness was selected. Insomnia resembles Anidra in Ayurveda in which Nidra is inadequate and not proper. The patient was managed with ayurvedic treatment with medhya rasayana and Trailokya Vijaya Vati. Results are assessed by patient perspective and improvement in the overall duration of sleep quality. Trailokya Vijaya Vati gave a satisfactory improvement in insomnia symptoms in this case.
Introduction
Sleep is one of the important parts of life that why in Ayurveda, it’s included in one out of three tripods of life. Sleep in a relaxing state of body and mind. It acts as a rejuvenator of body tissues which use during the daytime. It’s the best elixir and tonic for the mind too. It’s also helpful in consolidation for memory. As per different theories of sleep, it removes the toxin accumulated during day activity in the brain. It also repairs the wear and tear of the body tissues. Any variation in terms of quality and quantity of sleep leads to the origination of various. Sleep loss or insomnia is not only a disease but it’s a symptom of other physical and psychological diseases. Approx. 30% of the adult population is suffered from any of the symptoms of insomnia. The urban population of India also reported a higher prevalence of sleep disorders among which insomnia prevalence is greater.
In Ayurveda, Sleep or Nidra have been explained as the essential factor for life. The imbalance of normal physiology of nidra leads to anidra or nidranash. In classics, the etiological factor behind nidranash is elevated Vata and Pitta in association with depletion of kapha. Normal hemostasis of tridosha leads to normal nidra and the condition of swastha. For normal regulation of sleep, the proper function of mana is also an essential factor. Any vitiation of vata and pitta due to dietary, lifestyle, and environmental factors leads to nidranasha or anidra or insomnia.
Case Report
Patient description
Presenting Concern: A 35-year male presented in OPD of my clinic with a complaint of loss of sleep for 2 years, mild headache for 6 months. Associated Complaints of general weakness, sexual weakness, and early ejaculation were also presented. Refer to Table 01
Table 01: Timeline of the case
| S.No | Complaints | Duration |
| 01 | Loss of sleep | 2 year |
| 02 | Difficulty in falling asleep | 1.5 year |
| 03 | Decease duration of sleep | 1.5 year |
| 04 | General weakness | 1 year |
| 05 | Sexual weakness | 6 month |
| 06 | Headache | 6 month |
Past H/o: He had no history of diabetes/bronchial asthma/T. B and hypertension
Family H/o: No family history of diabetes/hypertension/Bronchial asthma/T.B
Addiction H/o: He had no addiction history of smoking, tobacco, and alcohol
Clinical Finding
General Examination and Personal history: General Condition of the patient was good. No deviation in vital signs. He is a Muslim of Indian ethnicity. He had a good appetite, Normal bladder, bowel habit, and regular sleep pattern. He had a sedentary lifestyle, well-built and well-nourished. He had BMI of 24.5 and a waist circumference of 94 cm. His prakruti was pitta Dominant and sarata was meda sarata. He had avara satva.
Clinical Investigation: Investigation was carried out before treatment like routine haematological test complete blood count (CBC), liver function test(LFT), Kidney function test(KFT), lipid profile, blood sugar fasting, and Postprandial, urine routine and microscopic. All investigation was under normal range except blood sugar which was borderline.
Treatment plan (Table 02):
| Date | Treatment Given | Dose | Time |
| 10.11.2020 | 01. Brahmi Vati 02. Sarswatarishta |
1 tab Twice daily 20ml twice daily | After food After food |
| 17.11.2020 – 27.11.2020 | Continue all 04. Trailokya Vijaya Vati 05. bala ashwagandhadi oil padaabhyanga | 1 Tab twice daily |
After food |
| 28.11.2020 – 08.12.2020 | Continue all |
Table 03: Drug properties
| Name of drug | Herbs present | Rasa | Guna | Virya | Vipaka | Karma |
| Brahmi Vati | Brahmi | Tikta Kashya | Laghu | Shita | Madhura | Vata-pitta shamaka |
| Sankhpushpi |
Tikta rasa | Snigdha, picchila | Shita | Madhura | Vata-pitta shamaka | |
| Marich | Katu | Laghu | Tikshna | Ush | Vata-kapha shamka | |
| Vacha | Katu Tikta | Laghu Tikshna | Ushna | Katu | Vata-kapha shamaka | |
| Gohjihwa | Madhura Tikta |
Laghu Snigdha |
Madhura | Shita | Vata-pitta shamaka | |
| Suvarna makshika | Madhura Tikta kashya |
Laghu | Ushna | katu | Pitta-kapha shamaka | |
| Rasasindoor | Tridosha-shamaka | |||||
| Sarswata-rishta Main ingredients |
Brahmi | Tikta Kashya |
Laghu | Shita | Madhura | Vata-pitta shamaka |
| Shatavari | Madhura Tikta |
Guru, snigdha | Shita | Madhura | Vata-pitta shamaka | |
| Vidarikand | Madhura | Guru snigdha | Shita | Madhura | Vata-pitta shamaka | |
| Haritaki | Kashya pradhana | Laghu | Ushna | Madhura | Tridoshas-hamka | |
| Ushira | Madhura Tikta | Laghu Ruksha |
Shita | Katu | Vata-pitta shamaka | |
| Trilokya vijya vati | Bhanga | Tikta | Laghu, tikshna | Ushna | Katu vipaka | Vata shamaka |
| Vanshlochana | Madhura, kashaya | Laghu, Tikshan, Ruksha | Shita | Madhura | Pitta shamaka |
Observation
The patient was advised Ayurveda medication along with dietary and lifestyle. Modification especially vata and pitta shamak ahara vihara. The patient told Improvement in the duration of sleep but still quality as well as difficulty in falling asleep not improved so much. After adding Trailokya Vijaya Vati, quality, quantity, as well as difficulty, also improved. The patient also told improvement in sexual health and weakness after the addition of Trilokya Vijya Vati.
Patient Perspective
During the treatment, he felt very relaxed and felt improvement in the symptoms of headache as well as insomnia. After 20 days of treatment, he felt a marked improvement in quality & quantity of sleep, sexual weakness as well as in sexual performance.
Discussion
Anidra called insomnia in modern terms is vataja natatmaj vikara as per the classical text. Due to the vitiation of vata and pitta, the Normal physiology of sleep (nidra) turns into the pathological state called anidra. All vata and pitta vardhaka ahara or rasa as well as a lifestyle that enhance the vata and pitta play a vital role in the pathogenesis of anidra. So along with medication, the other factor also must be controlled for significant relief.
Brahmi Vati is a herbal formulation containing the ingredient having acted on the central nervous system as well as the cardiovascular system. The main ingredient Brahmi has anxiolytic effects, anti-stress, sleep producing an effect, anticonvulsive action, antioxidant activity as well as a good mental tonic. Vacha and sankhpushpi are medhya rasayana that enhance mental functioning, remove the toxic from the brain and help in memory improvement. Sankhpushpi is the best medhya rasayana as per acharya charaka.
Another herbo-mineral formulation is “Saraswatarishta”. Ingredients having maximum quantity are vidarikand, Brahmi, and Shatavari. Vidarikand is one of rasayanas that help in the improvement of overall health. Satavari is balya, poshaka and dhatu vardhaka and uses in treating various physical and mental issues. The overall formulation of saraswatarishta is used to improve memory consolidation, conative as well as cognitive issues. Saraswatarishta is to be useful to treat acute anxiety, weakness, fatigue, and insomnia, partial loss of memory, low grasping power, slurred speech, and stress and tissue rejuvenator.
Trailokya Vijaya Vati, the herbal formulation containing the Vijya and Vanshlochana. Vijya(Cannabis sativus) is vata shamaka, dipana, pachana, ruchya, madkari and vyavayi. It is also medhya and rasayana properties as per classical literature. Cannabidiol one of the ingredient found in cannabis is useful in some neuropsychiatric disorders, including epilepsy, anxiety, and schizophrenia as per various scientific literature. It’s also has a calming effect on the central nervous system. Vijaya also has an anti-inflammatory property.
In the classical text, cannabis is indicated in many diseases after proper purification or shodhana karma. Vanshalochana the other ingredient present in Trailokya Vijaya Vati is useful as an aphrodisiac, acts as a cooling agent for the mind, rejuvenating effect as well as liver and cardiac tonic. So Trailokya Vijaya Vati having vata-pitta shamaka properties which help in balancing the dosha of andira and act as the herbal formulation useful in sleep deprivation as well as for general and sexual weakness.
Conclusion
Ayurvedic treatment protocol for insomnia could be safe and cost-effective without producing any side effects. The case study shows that insomnia can be successfully managed with certain Ayurvedic formulations.
Case Study shared by: Dr. Ankur Kumar Tanwar, MD(Ayurveda) Published by: HempStreet
