The Ayurvedic Approach to Anxiety by Dr. Scott Gerson
The Charaka Samhita, the principal medical text of Ayurveda, states: "The body and that which is called the mind are both considered to be abodes of disease, likewise of well-being. The cause of well-being is their harmonious or concordant interaction." 
Ayurveda concerns itself specifically with the relationship between the physiological and the psychological components of health and disease. Regardless of its symptomatic manifestations, almost every disease involves both the body and mind, and these two aspects are inextricably interwoven and cannot be separated. Charaka further states that " everything in the world can have only two conditions, healthy and unhealthy, and both of these have a cause. No thing can exist without a cause."
Ayurveda recognizes that, in many cases, the agent of a disease can be described in terms of a doshic imbalance. The physician can perceive the imbalance sensorily through various means of Ayurvedic diagnosis including visual inspection (darsana), palpation (sparsana) which includes nadivjana or pulse diagnosis, and patient interview (prasna). However, the ancient physicians also appreciated that certain diseases could not be explained by recourse to doshic imbalances alone; these diseases manifested from causes which operated on a more subtle level than the tridosha. These causes are called non-perceivable. Even diseases for which there are perceivable causes have non-perceivable causes operating simultaneously in the subtler realms. In truth, the fundamental cause of all disease, according to Ayurveda, is a non-perceivable yet very real attachment to the material aspect of the creation. This attachment has two major disease-producing consequences in the human mind: fear and desire.
Acute anxiety, borne of fear/desire, falls under the general heading of Unmada ("Insanity") in Ayurvedic medicine. Sushruta describes Unmada as "a derangement of bodily Doshas affecting the upcoursing nerves and thereby producing a distracted state of Manas (mind)." The disease manifests in both physical and mental symptoms which can include:breathlessness, dizziness, faintness, fatigue, palpitations, chest pains, headache, paresthesias, tremors, insomnia, anorexia, nervousness, diarrhea, vomiting, frequent micturition, increased sweating, forgetfulness, amnesia, phobias, incoherent speech, unsteadiness, agitation of the eyes, extreme fickleness of the mind, and mental confusion. The cause of this derangement of the upper-body Doshas is some form of fear/desire which has established itself in the Manas (mind) of the individual. Each person with anxiety has a variety of fear/desire unique to his- or herself. Its remedy lies in recognizing this mental aberration, knowing it to be unreal and insubstantial, and then transcending it.
A second way in which Ayurveda describes acute anxiety is by regarding it as one of the consequences of prajnaparadha (literally, 'transgression against knowledge'). On the simplest level, prajnaparadha is acting without common sense, like lying unprotected on a sunny beach for several hours. At a more universal level such actions are produced by self-centered desires of an individual being who has lost the memory of universal rhythms and universal wisdom. Acting from ignorance, the individual attempts to interpret the universe different than how it is in reality to satisfy particular personal needs. Says Charaka: "An unrighteous act done by one who is ignorant and of impaired memory is to be regarded as a volitional transgression (prajnaparadha)."
Prajnaparadha can be regarded as a channeling of vital energy into unnatural activities. This energy can then take on an enduring form in either the physical or mental body (an electrolyte derangement, a virus, or an acute anxiety neurosis) which fully manifests as a disease if disease-supporting host factors prevail.
A third Ayurvedic description of acute anxiety considers its specific Doshic imbalance. It is always important to identify the Doshas involved in any condition, if possible. This will often indicate the general treatment regimen. Very often in non-corporeal conditions such as acute anxiety, there may be a great number of stress factors operating with no one factor identifiable as the sole cause. In that case we can usually treat the deranged Dosha(s) and, without knowing the specific cause, successfully treat the patient.
Anxiety is a disease of Vata. The primary subdoshas involved are prana and vyana. Anxiety is characterized by an invasion by Vata of manas (mind) and nerves. Prana Vata is what moves prana ("life-force") into the physiology from the air, food, and water we consume. This prana weaves body, mind, and spirit together like beads on a thread. Its impairment in acute anxiety results in a disconnected individual whose mind, senses, and memory function sub optimally. Vyana Vata originates in the heart and pervades the entire body causing energies, including nervous energies, to circulate throughout the organism. A person suffering from aggravated vyana vata might ostensibly seem to be abounding in creative energy but closer observation will reveal only an over-abundance of disorganized, inefficient vata dosha.
The treatment of acute anxiety is really the treatment of Vata. These treatments always include oleation and heat, both internal and external. External oleation should commence first in the form of daily oil massages for fifteen to sixty minutes for five to seven days; these massages can be given by therapists or be self-administered. The best oils to use for massage are:Bala oil, Dhanvantram oil, or Mahanarayana oil. Internal oleation is next. Depending on the prakriti of the individual and the presence or absence of ama, anxiety-stricken patients will benefit from taking cow's ghee, sesame oil, animal fats, or bone marrow in prescribed dosages for four to seven days (internal oleation). This should be followed by a gentle purgative such as castor oil or triphala. Internal oleation should be reduced to a very small quantity in the presence of ama, abdominal bloating, colic pain, or edema. These symptoms indicate obstruction of the srotas (channels) of Vata and would be further aggravated by extensive internal oleation therapy.
Following oleation therapy, patients with acute anxiety must undergo swedana or sweat therapy. Whereas oleation loosens and separates the doshas from the tissues, sweating liquefies them making their egress from the body easier. The simplest way to induce sweating is to take a hot bath for fifteen to twenty minutes. Other methods include steam baths, hot water bottles, sunbathing, exposure to fire, mustard plasters, and various types of herbal poultices. Patients should continue swedana for three to four days. Heating herbs may be given simultaneously to further promote therapeutic sweating. These include: punarnava (Boerhaavia diffusa), tejpatra (Cinnamomum tamala), jayaphala (Myristica fragrans , madana (Randia dumentorium), and kakamachi (Solanum nigrum). Sweat therapy is contraindicated in pregnancy, anemia, dizziness, bleeding disorders, emaciation, and fever.
Many herbal-based preparations are used in the treatment of acute anxiety. They are most effective when preceded by the above oleation and heating treatments but can also be used as initial therapy. No single herb is regarded as efficacious; in fact, all of the most important medicines are in the form of ghritas, or medicated ghees. These are prepared according to precise instructions using accurate measures and often are fairly complex recipes. However any Ayurvedic physician can provide them. While it is beyond the scope of this article to describe these recipes in detail, the simplest one will be outlined to give the reader some idea of how ghritas are made:
Hingvadya Ghrita. Ninety-six grams each of Hingu (asafoetida), Sauvarcala (rock salt), Sunthi (ginger powder), Marica (black pepper), and Pippali (long pepper) are heated in 384 grams of cow's ghee and 1536 grams of cow's urine. Heating proceeds until a characteristic color and texture are noted.
Mahakalyanaka Ghrita. Recipe includes milk from a cow which has just calved for the first time, jasmine flowers, yellow-berried nightshade, and twenty-one other herbs.
Mahapaisacika Ghrita. Uses brahmi, guduchi, guggul, cardamom, and satapushpa.
Lasunadya Ghrita. Uses 100 cloves of Lasuna (garlic), cow's milk, dasamula ("ten roots", a famous Ayurvedic root mixture), and honey. (The ten roots of dasamoola are: patala, agnimantha, syonaka, bilva, gambari, kantakari, brhati, salaparni, prsniparni, and gokshura)
The dosage for all of the above ghritas is one teaspoon upon arising and before bed until the symptoms resolve.
Saraswatarishta. Another effective herbal-based medicine used to treat acute anxiety is saraswatarishta, in a dosage of 30 ml. three times a day. Arishtas are herbal decoctions which are made to ferment. Fermentation is promoted by the natural fungi found on the flowers of the dhataki plant, which are added to a multi-herb decoction. The alcohol thus naturally produced extracts EtOH-soluble constituents from the herbal materials and makes them available for absorbtion.
Shree Gulabkunverba Ayurvedic Society, Charaka Samhita, Jamnagar, 1949, Sutra I:55
Sharma, R.K., Dash, B., Charaka Samhita, Chowkhamba Sanskrit Series, Varanasi, 1988, Sutra XI:44
Bhishagratna, K.L., Sushruta Samhita, Chowkhamba Sanskrit Series, Varanasi, 1968, LXII:387
Sharma, R.K., Dash, B., Charaka Samhita, Chowkhamba Sanskrit Series, Varanasi, 1985, Sarira II:40-41.
 Sharma, R.K., Dash,B., Charaka Samhita, Chowkambha Sanskrit Series, Varanasi, 1985, Cikitsa IX:34. The three other recipes in this section are also from the same chapter, IX:42-56.