Management of Symptoms Associated with Obsessive-Compulsive Disorder (OCD) and PolyCystic Ovarian Disease (PCOD) through an Integrated Approach including Yagya Therapy

. Background: Obsessive-Compulsive Disorder (OCD) is a disabling mental disorder, characterized by continous flow of unwanted mental events (thoughts, urges, etc.), accompanied by repetitive physical or mental acts to allay the fear caused by those events. Poly Cystic Ovarian Disease (PCOD) is a common endocrine disorder, characterized by various symptoms such as irregular menses, hyperinsulinemia, obesity, infertility, hirsutism, etc. Although treatment methodologies of these disorders, side-effect free, long-term, and simultaneous management of these diseases is challenge. Purpose: As the classical of Ayurveda, the disease that resembles the symptoms associated with OCD, is Atatvaabhinivesha; It is caused by Dhi Vibhransh, i.e. vitiation of the Dhi element of Buddhi (intellect), and is characterized by the vitiation of one or more of the three Doshas, i.e. well as other associated ailments.


Introduction
Obsessive-Compulsive Disorder (OCD) is a disabling mental disorder, characterized by continous flow of unwanted mental events (thoughts, urges, etc.), accompanied by repetitive physical or mental acts to allay the fear caused by those events (1). Poly Cystic Ovarian Disease (PCOD) is a common endocrine disorder, characterized by various symptoms such as irregular menses, hyperinsulinemia, obesity, infertility, hirsutism, etc.
(2) Although several treatment methodologies have been employed for the treatment of OCD and PCOD (1,2), side-effect free, long-term management of these diseases is still a challenge. Also, simultaneous management of these disorders, further enhances the difficulty. Hence, there is a definite need to look for effective therapies for patients suffering from OCD and PCOD, as well as other associated ailments.
According to Ayurveda, a healthy human body is supposed to have a relatively stable equilibrium (congenial homeostasis) of Dosha (psychobiological rhythm -Vata, Pitta, Kapha), Dhatu (body tissues) and Mala (excreta) (3)(4)(5)(6); Acharya Sushruta defines health as an equilibrium of Dosha (psychobiological rhythm), Agni (digestion and metabolism), Dhatu (body tissues), Malakriya (excretory function), as well as the well being of soul, senses and mind (3,6). Imbalance in this equilibrium leads to disease, and the aim of the therapy is to restore this balance. Treatment of disease involves procedures for purifying the biological system by removing the vitiated elements from the entire body, and thus causing disease prevention, as well as health promotion (3)(4)(5)(6)(7).
As per the classical texts of Ayurveda, the disease that resembles the symptoms associated with OCD, is Atatvaabhinivesha (Ch. Sh. 1/99) (Ch. Su. 19/8) (Ch. Chi. 10/60) (4,5,8), wherein, a person thinks what should not be thought, as well as assumes useful things to be harmful, and vice versa; thus, the basic symptom of this disease is doing Hatha (obsession) for Atatva (non-existant). It is caused by Dhi Vibhransh, i.e. vitiation of the Dhi element of Buddhi (intellect) (Ch. Sh. 1/99) (4,5), and is characterized by the vitiation of one or more of the three Doshas, i.e. Vata, Pitta and Kapha; hence, treatments that balance these Doshas, as well as have Rasayan (provide rejuvenation and nourishment to the body tissues) properties, are recommended for the management of the symptoms associated with this disease (4,5). As per the classical texts of Ayurveda, the disease that resembles the symptoms associated with PCOD, is characterized by the vitiation of Kapha Dosha, along with Vata Dushti (vitiation), which in turn causes Avarodha (blockage) or Avarana (masking) in the Artavavaha Srotas (2,3); hence, treatments that balance these Doshas, are recommended for the management of the symptoms associated with this disease.
Vedas recommend performing of Hawan (Yagya) every day, morning and evening, to attain spiritual refinement, mental peace, purification of the mind and environment, as well as treatment of various diseases (22).
The Vedic hymns (Mantras) chanted during Yagya are intense spiritual prayers to the Almighty for the well being of both the self, as well as the entire cosmos. During the chanting of these Mantras, the participants are supposed to continuously meditate on their meaning; thus, this chanting creates a continuous process of meditation and contemplation, which contributes to the positive restructuring of the psyche of the participants (22,29,30).
Since past several years, the Department of Ayurveda and Holistic Health (DAHH) at Dev Sanskriti Vishwavidyalaya, Haridwar, Uttarakhand has been practicing Yagyopathy, wherein different herbal preparations of Ayurvedic plant medicines (hawan samagri) have been made for various diseases such as those of digestive system (cholera, dysentery, etc.), fevers (malaria, viral, etc.), respiratory system (cold/cough, asthma, tuberculosis, etc.), diabetes, obesity, joint pain, insomnia, cancer, etc., as well as various psychological ailments (21,24). A large number of patients suffering from these diseases have either taken Yagya Therapy at this Department, or taken the disease specific hawan samagri to their home and conducted yagya themselves. Pre and Post Clinical, Pathological and Biochemistry investigations, as well as verbal and written testimonials from these patients indicate encouraging outcomes of Yagyopathy with regards to the treatment of these diseases.  (27) showed that Yagya Therapy, as supportive care, improved quality of life in cancer patients.
Looking at the multiple advantages of Yagya Therapy, which include positive restructuring of the psyche of the participants by the chanting of Vedic hymns (Mantras) and meditating on their meaning, exposure to medicinal-fumes of multiple herbs, as well as their efficient pulmonary administration, Yagya Therapy can be an effective treatment methodology for the management of symptoms associated with OCD and PCOD.
A case report about a female patient, who was suffering from the symptoms associated with both OCD and PCOD, as well as other associated ailments including hyperinsulinemia, hirsutism, hypertension, is being presented here. She visited the Out Patient Section of the Department of Ayurveda and Holistic Health at Dev Sanskriti Vishwavidyalaya, Haridwar for consultancy. In view of the above discussion about the management of symptoms associated with OCD and PCOD, and other associated ailments, an integrated approach including Yagya Therapy (using an appropriate herbal formulation -hawan samagri), and some other Ayurvedic treatments like decoction of medicinal herbs, Ayurvedic medicines, dietary recommendations, etc. was prescribed to the patient, and the effectiveness of the same is being presented in this article.

Methods
In the present study, an integrated approach including Yagya Therapy (using an appropriate herbal formulation), and some other Ayurvedic treatments like decoction of medicinal herbs, Ayurvedic medicines, dietary restrictions, lifestyle modifications, etc., was prescribed to a female patient suffering from symptoms associated with OCD and PCOD, as well as other associated ailments.

Case Report
A 40 year old female patient (height -158.2 cm ; weight -82 kg) came to the Out Patient Section of the Department of Ayurveda and Holistic Health (DAHH) at Dev Sanskriti Vishwavidyalaya, Haridwar, in September 2017 for consultancy. The medical history of the patient based on the details provided by the patient, as well as further discussion with the doctor, is as follows:  Patient had been suffering from OCD since past 19 years.  Patient was also suffering from PCOD Patient was also suffering from several other ailments including: Irregular menses, Hirsutism (facial hair were present), Hypertension, Hyperinsulinemia, High serum testosterone level, Emotional weakness, with feeling of insecurity, Negative thinking, with irritation, with angry nature, with anxiety, Depressive thoughts, Presence of mood swings, Obsessive thoughts, Sleeplessness.
The patient had no past history of Diabetes Mellitus, Asthma, Ischemic Heart Disease, Constipation. She had been taking allopathic medication including Metformin tablet, Calcium tablet, Vitamin-D, etc.
Based on the above mentioned medical history and further discussion with the doctor, the current diagnosis for the patient included symptoms associated with OCD, with PCOD, with Hypertension, with Hirsutism, as well as other associated ailments.

Therapeutic Intervention
As mentioned above, the patient was suffering from symptoms associated with OCD and PCOD, as well as other associated ailments. Hence, an integrated approach including Yagya Therapy (using an appropriate herbal formulation), and some other Ayurvedic treatments like decoction of medicinal herbs, Ayurvedic medicines, dietary recommendations, lifestyle modifications, etc., was prescribed for the patient, with the understanding that the patient had come to the Out Patient Section, and the patient would be taking these treatments at her home.
The prescribed therapeutic interventions were as follows:

Yagya Therapy with Manograsit Badhyata
Nivarak (for treating OCD) and Anidra Nashak (for treating Sleeplessness) hawan samagri (herbal mixture) Patient was advised to follow the standard protocol of Yagya at home. The detailed protocol has been described in earlier publications (24,28,31,32). Briefly, the procedure included (24,31,32): Since past several years, DAHH has been prescribing Yagya Therapy (Yagyopathy), wherein different herbal preparations of Ayurvedic plant medicines (hawan samagri) have been made inhouse for various diseases. With regards to the present study, DAHH prescribed a Manograsit Badhyata Nivarak hawan samagri, which consists of 14 herbs, and Anidra Nashak hawan samagri, which consists of 8 herbs, and are based on the formulations for the same given in reference (24).
No metal was used in the herbal preparation. All ingredients were well identified by taxonomist (33), were non-toxic, and could be useful in the treatment of the symptoms associated with OCD and PCOD, as well as other associated ailments (1,24).
Along with the Manograsit Badhyata Nivarak and Anidra Nashak hawan samagri, patient was also prescribed a common purpose immunity-boosting hawan samagri, based on the formulation for the same given in reference (21,24). For the 24 oblations in the morning, Manograsit Badhyata Nivarak hawan samagri and common purpose hawan samagri had to be mixed in 3:1 ratio (i.e. 30 gm and 10 gm, respectively); 30 gm cow ghee had to be added to this herbal mixture; and then 24 oblations, along with chanting of Chandra Gayatri Mantra, had to be made in the fire with this mixture. For the 24 oblations in the evening, Manograsit Badhyata Nivarak hawan samagri, Anidra Nashak hawan samagri and common purpose hawan samagri had to be mixed in 1.5:1.5:1 ratio (i.e. 15 gm, 15 gm and 10 gm, respectively); 30 gm cow ghee had to be added to this herbal mixture; and then 24 oblations, along with chanting of Chandra Gayatri Mantra, had to be made in the fire with this mixture.
It was advised to do Yagya twice daily at the time of Sunrise and Sunset. The patient was advised to do Yagya Therapy for 3 months.

Drinking decoction of Manograsit Badhyata Nivarak hawan samagri (herbal mixture)
Patient was advised to drink the decoction of Manograsit Badhyata Nivarak hawan samagri, wherein 20 gm of herbal mixture had to be mixed in 4.5 cups of water; kept overnight; boiled the next morning till 1.5 cup of water was remaining; this had to be divided in two equal parts, and taken empty stomach two times during the day, i.e. in morning and evening.

Ayurvedic medicines
 Anidra Nashak Churna (fine ground powder of Anidra Nashak hawan samagri -useful in sleeplessness) -half tablespoon had to be taken with honey, twice daily, i.e. in morning and evening  Medhavardhak Churna (herbal mixture for memory enhancement) -half tablespoon of this herbal mixture had to be taken twice daily, i.e. in morning and evening  Punarnavarishta (Ayurvedic medicine for kidney disorders, etc.) -10 ml had to be take with water, twice daily  Arogyavardhini Vati (polyherbal and herbomineral formulation for liver disorders, etc.) -2 tablets had to be taken after meal, twice daily

Dietary advice
It was advised to keep fast on every Poornima (full moon night) (for mental peace)

Other recommendations
It was advised to write Gayatri Mantra, and do Swadhyay (read and contemplate upon spiritual / motivational literature), Meditation, and Sookshma Vyayam (joint loosening exercise) (for providing peace and tranquility to the mind)

Results
In the present case study, the outcomes were assessed in a qualitative (subjective) manner based on the patient's experiential feedback. After the initial visit of the patient in September 2017, the patient continued with the prescribed integrated approach including Yagya Therapy at her home. A followup was taken from the patient in March 2019, about the present condition of the patient. The feedback provided by the patient is as follows:  The patient had been doing Yagya once daily in the morning  She had been doing Pranayama for 5 to 10 minutes daily -she used to be in the room, in which Yagya was done, for 35-40 minutes  She had been drinking the decoction of the prescribed hawan samagri once daily, in the morning The patient had experienced notable relief in various symptoms, and associated ailments, as described below:  Before starting the integrated approach including the Yagya Therapy (prescribed in the present study), the patient had complaint of PCOD and irregular menses; however, at the time of followup, PCOD was completely resolved, and the menses had become regular  Earlier, the patient had complaint of Sleeplessness; at the time of followup this complaint was about 75% resolved -she could now sleep for 7 to 8 hours  Earlier, the patient had complaint of Hypertension; at the time of followup, her Blood Pressure remains normal now  Earlier, the patient had complaint of vomiting; at the time of followup this complaint was completely resolved  Earlier, the patient had complaint of loss of appetite; at the time of followup this complaint was about 75% resolved  Earlier, the patient had complaint of weakness; at the time of followup this complaint was about 75% resolved  Earlier, the patient had complaint of stress; at the time of followup this complaint was about 50% resolved  Earlier, the patient had complaint of Hirsutism, facial hair; at the time of followup there was reduction in Hirsutism, facial hair  Other complaints in which the patient experienced relief included less mood swings, less flow of unwanted thoughts, increase in confidence, less feeling of insecurity, has become emotionally strong, anger has been reduced  Earlier, the patient had complaint of depression; at the time of followup this complaint was about 25% resolved -the patient especially felt bad before coming of menses  Overall, there was definite improvement in the condition of the patient

Discussion
The present study illustrates the potential of an integrated approach including Yagya Therapy for the management of symptoms associated with OCD and PCOD, as well as other associated ailments.
According to Ayurveda, a healthy human body is supposed to have a relatively stable equilibrium (congenial homeostasis) of Dosha (psychobiological rhythm -Vata, Pitta, Kapha), Dhatu (body tissues) and Mala (excreta) (3)(4)(5)(6); Acharya Sushruta defines health as an equilibrium of Dosha (psychobiological rhythm), Agni (digestion and metabolism), Dhatu (body tissues), Malakriya (excretory function), as well as the well being of soul, senses and mind (3,6). Imbalance in this equilibrium leads to disease, and the aim of the therapy is to restore this balance. Treatment of disease involves procedures for purifying the biological system by removing the vitiated elements from the entire body, and thus causing disease prevention, as well as health promotion (3)(4)(5)(6)(7).
As per the classical texts of Ayurveda, the disease that resembles the symptoms associated with OCD, is Atatvaabhinivesha (Ch. Sh. 1/99) (4,5), and is characterized by the vitiation of one or more of the three Doshas, i.e. Vata, Pitta and Kapha; hence, treatments that balance these Doshas, as well as have Rasayan (provide rejuvenation and nourishment to the body tissues) properties, are recommended for the management of the symptoms associated with this disease (4,5). As per the classical texts of Ayurveda, the disease that resembles the symptoms associated with PCOD, is characterized by the vitiation of Kapha Dosha, along with Vata Dushti (vitiation), which in turn causes Avarodha (blockage) or Avarana (masking) in the Artavavaha Srotas (2,3); hence, treatments that balance these Doshas, are recommended for the management of the symptoms associated with this disease.
In Yagya Therapy, the hawan samagri (mixture of medicinal herbs) contained herbs, which were chosen based on careful review of Ayurvedic pharmacology, modern pharmacology, and scriptural indications. The beneficial properties of some of the herbs with regards to the management of symptoms associated with OCD and PCOD, as well as other associated ailments, are as follows:  Brahmi (Centella asiatica), Giloy (Tinospora Cordifolia) have Rasayan (provide rejuvenation and nourishment to the body tissues) properties ( (33,34); Deepan Pachan drugs are administered for enhancing the digestive fire (35,36) and digestion of the ama dosha (undigested toxins of the body that are responsible for the blockage of micro-channels).
Thus, the ingredients of hawan samagri have properties of balancing the above mentioned Doshas, as well as Rasayan, Balya and Medhya properties, which help in the management of the symptoms associated with OCD and PCOD, and other associated ailments, as well as provide rejuvenation and nourishment to the body tissues. Their vapors can be useful in the management of symptoms associated with OCD and PCOD, as well as other associated ailments (24,33,34).
In Yagya Therapy, ghee is essentially added to hawan samagri. According to Ayurveda, ghee enhances the digestive fire (agni), and nourishes ojas (the subtle essence of the body tissues -dhatus) (37). It helps in memory enhancement and strengthening of the nervous system (37). It also has Vata and Pitta pacifying properties (37). Because of its yogavahi guna, it has the property that without losing its own qualities, it can incorporate the qualities of the herbal medicines added to it; furthermore, it transports the same to deeper body tissues through its lipophilic action (37,38). According to modern research findings, lipid nanoparticles have been shown to enhance drug delivery through the nasal route (17,39).
In the process of Yagya, hawan samagri made up of dry plant-medicines, as well as selected nutritious and aromatic substances, undergoes transformation into vapor phase, sublimation or decomposition by gradual heating; these phytomedicines spread along with the volatile substances and gases, released by the slow and controlled combustion process in Yagya fire (19). Medicinal phytochemicals, vapors of some essential oils and certain other volatile healthy constituents released in this process impart therapeutic advantage (16,19).
Administration of multi-herbs through oral administration can have limitations such as first-pass metabolism (27). In case of nasal drug administration, absorption takes place from the nasal cavity into the systemic circulation, and the firstpass metabolism is avoided (27,39). Furthermore, the blood-brain barrier is also avoided, and the medicinal drugs can be transported directly from the nasal cavity into the brain (39). Thus, nasal administration of herbal medicines through Yagya Therapy may be considered as an important aspect with regards to the therapeutic advantage observed in the present study.
The process of pulmonary drug administration of plant medicines during Yagya is similar to that during Nasya, which is a common purificatory therapeutic procedure in the Panchakarma Therapy of Ayurveda, wherein herbal medicines are administered through the nasal route, in different forms including oil, powder and vapors (4,5). Nasya primarily affects the urdhvajatrugata pradesha (supra-clavicular region) (40,41). According to Acharya Vagbhatta, nose is one of the most convenient routes to convey medicinal effects to the cranial cavity (40). According to Acharya Charaka, nasya drug usually acts through absorption by the Shringataka marma (a vital spot in the head region situated at the site of the union of the nerves, supplying to the nose, ears, eyes, and tongue); after absorption, the medicine acts on the diseases of the respiratory system, shoulder, neck, etc., and the vitiated Doshas are expelled from the head region (40). Thus, the administered medicine moves up to the Shringataka marma, spreads all over the head, channels of eyes, ears, nose and throat, and removes vitiated Doshas from there (40,41). The ayurvedic medicines prescribed to the patient had various beneficial medicinal properties with regards to sleeplessness, memory enhancement, kidney and liver disorders, etc., which are useful in the management of symptoms associated with OCD and PCOD, as well as other associated ailments.
The dietary recommendations included various things that provide peace and tranquility to the mind, and are useful in the management of symptoms associated with OCD and PCOD, as well as other associated ailments.
It is noteworthy that the present study was done in OPD (Out-Patient Department) setting, wherein the patient was prescribed the therapy, and was required to do Yagya and follow other therapeutic procedures at her home. Such a setting has obvious limitations with regards to following the prescribed procedure and dietary recommendations, as well as taking medications, etc.; however, the patient still reported notable benefit. Thus, the present study shows encouraging results with regards to the effectiveness of the integrated approach including Yagya Therapy in the simultaneous management of symptoms associated with OCD and PCOD, as well as other associated ailments. There is definitely a need for further in-depth quantitative study to establish the mode of operation of this integrated approach in the light of modern scientific understanding.

Conclusion
A case report about a female patient, who was suffering from symptoms associated with both OCD (since past 19 years) and PCOD, as well as other associated ailments, has been presented in this article. The patient was prescribed an integrated approach including Yagya Therapy (using an appropriate herbal formulation -hawan samagri), and some other Ayurvedic treatments like decoction of medicinal herbs, Ayurvedic medicines, dietary recommendations, etc.
Before starting the integrated approach including the Yagya Therapy (prescribed in the present study), the patient had several complaints including irregular menses, hirsutism, hypertension, hyperinsulinemia, high serum testosterone level, sleeplessness, emotional weakness, depressive and obsessive thoughts, mood swings; after taking the integrated approach including Yagya Therapy, the complaint of PCOD was completely resolved, and the menses had become regular; complaint of vomiting was completely resolved, and blood pressure remains normal now; there was about 75% relief in the complaints of sleeplessness, loss of appetite and weakness; and there was notable relief in most of the other complaints as well. Overall, there was definite improvement in the contition of the patient. Thus the present study shows encouraging results with regards to the simultaneous management of the symptoms associated with OCD and PCOD, as well as other associated ailments.