CHINTA ROGA (GENERAL ANXIETY DISORDER)

CHINTA ROGA (GENERAL ANXIETY DISORDER) 

• Chinta Roga is a Manovikara (psychological disorder) primarily resulting from Ati-Chinta (excessive worry).

• It correlates with Generalized Anxiety Disorder (GAD) in modern psychiatry.

• Characterized by persistent, excessive, and uncontrollable worry about various aspects of life, lasting for 6 months or more.

NIDANA (ETIOLOGY)

AYURVEDIC ETIOLOGY

• Ati-Chinta (excessive worry)

• Shoka (grief), Bhaya (fear), Krodha (anger)

• Prajnaparadha (intellectual blasphemy)

• Asatmya indriyartha samyoga (unwholesome contact of senses)

• Rajas-Tamas predominance

• Manasika and Sharirika Dosha vitiation (especially Vata)

SANSKRIT REFERENCE

“Chinta Shoka Bhaya Krodha Vega Dharanam Ativyayama Atapasevanaat cha Manaso vikaro Bhavati”
— Charaka Samhita, Sutrasthana 1/57

MODERN ETIOLOGY

• Genetic predisposition

• Chronic stress and trauma

• Imbalance in neurotransmitters (e.g., serotonin, norepinephrine)

• Substance abuse or withdrawal

• Personality traits (neuroticism)

SAMPRAPTI (PATHOGENESIS)

AYURVEDIC PATHOGENESIS

• Manasika Dosha (Rajas & Tamas) get aggravated due to Nidana Sevana.

• This leads to Vata vitiation, especially Prana Vata affecting Manovaha Srotas.

• Vitiated Vata causes imbalance in Buddhi (intellect), Sankalpa (will), Smriti (memory) and Chetnya (consciousness).

SANSKRIT REFERENCE

“Vataat mano vikaraah syuh sankalpa smriti bhranśhaah”
— Charaka Samhita, Chikitsa Sthana 10/4

MODERN PATHOGENESIS

• Dysfunctional prefrontal cortex, amygdala, and hippocampus.

• Altered HPA (hypothalamic-pituitary-adrenal) axis function.

• Increased sympathetic nervous system activity.

• Neurochemical imbalance, especially in GABA, serotonin, and norepinephrine pathways.

LAKSHANA (CLINICAL FEATURES)

AYURVEDIC CLINICAL FEATURES

• Chinta (excessive worry)

• Anidra (insomnia)

• Hriddrava (palpitations)

• Shwasa (breathlessness)

• Bhrama (giddiness)

• Shoola (body ache, headache)

• Dourbalya (weakness)

• Manovyatha (mental suffering)

MODERN CLINICAL FEATURES

• Persistent, uncontrollable worry about multiple domains

• Restlessness, fatigue

• Difficulty concentrating

• Irritability

• Muscle tension

• Sleep disturbance

• Palpitations, trembling, sweating (somatic symptoms)

SAMPRAPTI GHATAKA (AYURVEDIC COMPONENTS OF PATHOGENESIS)

• Dosha – Mainly Vata (Prana Vata), involvement of Rajas & Tamas

• Dushya – Manas, Rasa Dhatu

• Srotas – Manovaha Srotas

• Udbhava Sthana – Manas

• Vyaktasthana – Manovaha Srotas

• Rogamarga – Abhyantara

• Adhisthana – Mana

DIAGNOSTIC CRITERIA (MODERN)

As per DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition):

• Excessive anxiety and worry for ≥6 months.

• Difficult to control the worry.

• At least 3 of 6 symptoms present most days:

  • Restlessness or feeling keyed up

  • Fatigability

  • Difficulty concentrating

  • Irritability

  • Muscle tension

  • Sleep disturbance

• Causes significant distress or impairment in daily functioning.

• Not attributable to substance or another medical condition.

CHIKITSA SIDDHANTA (PRINCIPLES OF MANAGEMENT)

• Nidana Parivarjana – Avoidance of causative factors

• Vatahara & Medhya Chikitsa

• Manonukoolata – Creating a pleasant mental environment

• Daivavyapashraya Chikitsa – Mantra, Japa, Homa, etc.

• Satvavajaya Chikitsa – Psychotherapy

• Yuktivyapashraya Chikitsa – Rational therapy (medications, Panchakarma)

SANSKRIT REFERENCE

“Satvavajaya chikitsa nama mano nigrahaḥ”
— Charaka Samhita, Sutrasthana 11/54

AYURVEDIC MANAGEMENT

SHODHANA THERAPY

• Snehan & Swedan – to calm Vata

• Nasya – with Brahmi Taila or Ksheerbala Taila

• Shirodhara – with Ksheerbala Taila or Brahmi Taila

• Vasti – Medicated oil enema (Matra Vasti with Ashwagandha Taila or Ksheerbala Taila)

SHAMANA YOGA (ORAL MEDICATIONS)

• Medhya Rasayana:

  • Brahmi (Bacopa monnieri)

  • Mandukaparni (Centella asiatica)

  • Shankhpushpi

  • Ashwagandha (Withania somnifera)

  • Vacha (Acorus calamus)

• Formulations:

  • Saraswatarishta

  • Brahmi Vati

  • Manasmitra Vatakam

  • Smritisagara Rasa

SATVAVAJAYA CHIKITSA (AYURVEDIC PSYCHOTHERAPY)

• Reassurance

• Meditation

• Yoga and Pranayama

• Counseling

• Cognitive-behavioral techniques

MODERN MANAGEMENT

PHARMACOLOGICAL MANAGEMENT

• First-line Drugs:

  • SSRIs (Selective Serotonin Reuptake Inhibitors): Paroxetine, Escitalopram

  • SNRIs: Venlafaxine, Duloxetine

• Others:

  • Benzodiazepines (for short-term): Lorazepam, Clonazepam

  • Buspirone

  • Beta-blockers for somatic symptoms

NON-PHARMACOLOGICAL MANAGEMENT

• Cognitive Behavioral Therapy (CBT)

• Relaxation therapy

• Mindfulness-based stress reduction (MBSR)

• Yoga and meditation

• Lifestyle modifications: regular sleep, avoiding caffeine, healthy diet

YOGA & PRANAYAMA

• Anulom Vilom, Bhramari, Nadi Shodhana

• Shavasana, Yoga Nidra

• Asanas: Vajrasana, Padmasana, Sukhasana

RASAYANA THERAPY

• Brahmi Ghrita

• Ashwagandha Rasayana

• Vacha Rasayana

PROGNOSIS

• Sadhya if treated in early stages with proper support

• Kashtasadhya or Yapya in chronic cases with deep-rooted psychological trauma