Nardostachys jatamansi (Indian Spikenard / Jatamansi)
1. Identity and Botanical Profile
Nomenclature and Taxonomy
Nardostachys jatamansi is a member of the Valerianaceae family and is the smallest, most primitive, perennial, dwarf, hairy, rhizomatous, herbaceous species in its genus. Its accepted scientific binomial is Nardostachys jatamansi (D.Don) DC., with historical synonyms including Nardostachys grandiflora DC. and Valeriana jatamansi Auct. In China, classical records in the Flora of China and the Chinese Pharmacopoeia once accepted N. chinensis and N. jatamansi as two separate species and botanical sources of the Chinese medicine "Nardostachyos radix et rhizoma," but by the early 21st century, N. chinensis was reclassified as a variety or form of the only accepted species, N. jatamansi (D.Don) DC.
The plant is commonly known under several names: scientific name Nardostachys jatamansi DC.; common names include Balchar, Indian spikenard, Jatamansi, Muskroot, Nardostachyos Radix et Rhizoma, Sambul lateeb, Spikenard, and Sumbul-ut-teeb. The taxonomic order is Dipsacales; kingdom Plantae, division Magnoliophyta, class Magnoliopsida, order Dipsacales, family Valerianaceae, genus Nardostachys, species jatamansi; the principal plant parts used are the rhizomes and rhizome oil.
A longstanding and practically significant taxonomic confusion exists in the literature. In many findings that used dried samples, there was an uncanny resemblance between the phytochemical profiles and biological activities of N. jatamansi and Valeriana jatamansi Jones ex Roxb. (another genus of Caprifoliaceae), and since both species share identical vernacular names, it is possible that samples may not have always been of two separate species. Other limitations of various studies include the use of outdated techniques for phytochemical profiling, absence of toxicology studies using animal models, and clinical trials using human subjects; analysis revealed a confusion about botanical nomenclature and geographical distributions.
Botanical Description and Habitat
Nardostachys jatamansi is a critically endangered, perennial medicinal herb restricted to the alpine Himalayas at altitudes of 3,000 m to 5,000 m above sea level; as an adaptation to the high-altitude cold region, the species primarily propagates through underground rhizomes and has a 3–4 year juvenile phase followed by a short reproductive stage and poor seed germination rate.
N. jatamansi is found throughout the Himalayas, from Pakistan to India (Jammu and Kashmir, Himachal Pradesh, Uttarakhand, Sikkim), Nepal, Tibet, and China. Information on its occurrence in Myanmar, Afghanistan, and Pakistan is inconclusive. Flowers with a tinge of blue or pink grow in thick cymes; the short, thick, dark grey rhizomes are covered in reddish-brown tufts of fibrous radical leaf remains.
Parts Used and Common Preparations
The root of this taxon consists of short, thick, dark grey rhizomes crowned with reddish-brown tufted fibrous remains of the petioles of the radical leaves; these rhizomes are used in traditional medicines across different medicinal systems. Preparations derived from the plant include:
- Powdered rhizome (churna): used as a dry powder (churna) administered in milk, as studied in clinical trials.
- Decoction: A decoction of the drug is used in neurological disorders, insomnia, and disorders of the cardiovascular system.
- Hydroalcoholic extract: used extensively in modern pharmacological research and some clinical formulations.
- Essential oil: The essential oil obtained from the roots shows various pharmacological activities including antimicrobial, antifungal, hypotensive, anti-arrhythmic, and anticonvulsant activity.
- Capsule form: In a small clinical study, an N. jatamansi dosage of 3 g/day (one 1 g capsule three times a day) was used.
2. Conservation Status
N. jatamansi is critically endangered due to overexploitation; conservation strategies are essential. The ethanolic extract shows significant antioxidant effects with low IC50 values and neuroprotective potential; however, the species has become critically endangered and requires various conservation strategies. Critically endangered due to overharvesting and habitat degradation, efforts are urgently needed to develop sustainable harvesting and cultivation practices.
3. Traditional and Historical Use
Ancient Civilizations
Nardostachys jatamansi from India was known to Mesopotamia, one of the earliest civilizations of the world; its name was found in their cuneiform script. It was exported to Assyria, to Arabian countries, and to Egypt, where it was known as Sumbul-e-Hind, and in Greece under the name Nardus. The plant is also mentioned in the Bible as Spikenard. It was reputed as a costly incense-herb and perfume, and was used as a nerve tonic in hysteria, epileptic fits, and palpitations of the heart in Middle Eastern countries since time immemorial.
Its medicinal use is well recognized in Bhutanese, Chinese, Indian, Japanese, Nepalese, and Tibetan medicine, and its medicinal properties are documented in traditional medicines including Ayurveda, Ben-Cao-Shi-Yi, Homer's Iliad, and the Old Testament.
Ayurvedic Tradition
N. jatamansi has an extensive antiquity of usage in Ayurvedic medicine, homeopathic medicine, ethnomedicine, and the Indian system of medicine, and is now used in the modern medicine industry. Its reference in Ayurveda is found since the times of Charaka and Sushruta. Specifically, its use in Ayurveda dates back to the Charaka Samhita and Sushruta Samhita (1st–2nd century CE), where it is classified as a Medhya Rasayana (intellect rejuvenator) and Sangyasthapaka (consciousness restorer).
In Ayurvedic classical texts, the plant is ascribed multiple therapeutic categories: it is mentioned as Vednasthapan (analgesic), Sangyasthapan (restoring consciousness or alertness of mind), Medhya (brain tonic), Balya (strengthening body), Hrudya (cardioprotective), Jwaraghana (antipyretic), Kusthaghna (preventing skin diseases), and Keshva (promoting hair growth). The rhizome's Ayurvedic actions also include Hrid-balya (supporting heart health), Raktabharaniyamaka (maintaining proper blood circulation), Vajikara (enhancing fertility and vitality), Pittasaraka (managing Pitta dosha), Artavajanana (promoting menstrual health), Swedajanana (inducing sweat), and Kushthaghna (addressing skin conditions).
The roots and the rhizomes of N. jatamansi, as mentioned in Ayurveda, have been used in various herbal formulations including dietary supplements, to treat epilepsy, hysteria, syncope, convulsions, and mental weakness; the decoction is also used in neurological disorders, insomnia, and disorders of the cardiovascular system.
Unani and Greco-Arab Tradition
The term "Valeriana" first appears in ninth- and tenth-century literature, and the plant has long been recognized for its medical properties in Ayurveda in India, Unani medicine in the history of Greek and Arab cultures, and the earliest Egyptian and Roman cultures. N. jatamansi has been used in the traditional Ayurvedic (Indian) and Unani (ancient Greco-Arab) medical systems.
Traditional Chinese Medicine
In particular, the extracts of Nardostachys jatamansi, a species that grows in China, India, and Tibet, have been used to treat mental disorders, hyperlipidemia, hypertension, and convulsions. Nardostachys jatamansi (D.Don) DC. (Valerianaceae), namely Nardostachys chinensis Batalin, is a medicinal plant in traditional and folk medicine in China, India, and Korea, used to treat epilepsy, toothache, indigestion, and heart disease.
4. Phytochemistry: Key Constituents and Active Compounds
Sesquiterpenes (Primary Class)
Sesquiterpene is the major component of N. jatamansi, with jatamansone and nardostachone being particularly notable. Jatamansone, nardostachone, and actinidine are the major secondary metabolites present in the plant. Additional sesquiterpene constituents identified include alpha-patchoulene, beta-eudesmol, beta-patchoulene, calarene, calarenol, elemol, jatamansin, jatamansinol, jatamansone, nardol, nardostachone, norsechelanone, patchouli alcohol, seychelane, seychellene, valeranal, and valeranone.
Lignans and Neolignans
Sesquiterpenes (jatamansic acid, jatamansone), lignans, and neolignans are reported to be present in the roots of this plant. A 2024 study isolated and identified multiple compounds from N. jatamansi, including olivil, cycloolivil, a novel hydroxyphenyl-dihydrobenzofuran compound, teuclatriol, bullatantriol, 1β,4β,7α-trihydroxyeudesmane, nardoeudesmol A, debilon, nardonoxide, nardosinone, a tricyclic compound, jatamanins A, and kanshone M.
Other Classes of Compounds
Flavonoids, terpenoids, saponins, phenolic volatile oils, and alkaloids were discovered in phytochemical screening. Additional identified ingredients include actinidine, aristolene, carotene, coumarin, dihydroazulenes, jatamanshinic acid, nardol, nardostachone, and others. The herb contains a variety of active compounds, including polyphenols and flavonoids, which endow it with antioxidant properties.
Nine secondary metabolites have been isolated and identified from a 20% aqueous ethanol extract of N. jatamansi (NJ20), with desoxo-narchinol A identified as the major constituent in that fraction.
5. Mechanisms of Action
GABAergic Pathway
One of the most consistently described neurochemical mechanisms involves the GABAergic system. The effects of N. jatamansi are primarily and plausibly mediated by activating the GABAergic receptor complex. In a preclinical study, the probable mechanism of anxiolytic action of N. jatamansi extract (NJE) was studied using behavioral anxiolytic tests (Elevated plus maze, Open field test, Light dark box test, and Vogel's conflict test) in mice; mice were treated orally with NJE (250 mg/kg) for 3, 7, and 14 days or diazepam (1 mg/kg) followed by behavioral assessment and estimation of monoamine neurotransmitters, GABA, and antioxidant enzymes.
Monoamine and Inhibitory Amino Acid Modulation
A landmark preclinical mechanistic study published in Planta Medica (1994) examined biogenic amines: the effect of acute and subchronic administration of an alcoholic extract of the roots of N. jatamansi on norepinephrine (NE), dopamine (DA), serotonin (5-HT), 5-hydroxyindoleacetic acid (5-HIAA), GABA, and taurine was studied in male albino Wistar rats. Acute oral administration did not change NE and DA levels but resulted in a significant increase in 5-HT and 5-HIAA. A significant increase in GABA and taurine was observed in drug-treated groups; 15-day treatment resulted in a significant increase in levels of NE, DA, 5-HT, 5-HIAA, and GABA, indicating an overall increase in central monoamines and inhibitory amino acids.
Anti-Neuroinflammatory Mechanisms
In LPS-challenged cells, pretreatment with a 20% aqueous ethanol extract of N. jatamansi inhibited LPS-induced excessive production of proinflammatory mediators, such as nitric oxide, prostaglandin E₂, interleukin-1β, IL-6, and tumor necrosis factor-α. A more recent PMC-published study demonstrated that both a N. jatamansi extract fraction (NJ-1A) and nardosinone could significantly suppress LPS-induced production of M1 pro-inflammatory factors or markers in microglia and could inhibit the glycolytic process and promote oxidative phosphorylation via the AKT/mTOR signaling pathway; they also exhibited the capacity to attenuate chemokine release from activated microglia, consequently reducing T cell migration. In vivo experiments revealed that NJ-1A and nardosinone effectively inhibited microglial activation, diminished T cell infiltration, and mitigated the loss of tyrosine hydroxylase (TH)-positive dopaminergic neurons in the substantia nigra of MPTP-induced mice; these neuroprotective effects were concluded to occur through modulation of microglial polarization states, regulation of metabolic reprogramming, and suppression of T cell infiltration.
Antioxidant Mechanisms
N. jatamansi exerts hepatoprotective effects by reducing oxidative stress and stabilizing hepatocyte membranes; its 50% ethanolic extract enhances antioxidant enzyme activity, reducing lipid peroxidation and inflammation. The extract also modulates liver enzymes, lowering elevated transaminases and alkaline phosphatase levels, thus protecting against thioacetamide-induced toxicity.
Enzyme Inhibition (In Vitro)
In vitro profiling has identified inhibitory activities against enzymes linked to multiple disease states. Secondary metabolite profiling demonstrated in vitro inhibitory activities of N. jatamansi on key enzymes linked to hyperglycemia, hypertension, and cognitive disorders.
6. Scientific Evidence by Area of Use
6.1 Central Nervous System: Anxiolytic and Sedative Effects
Nardostachys jatamansi is classified as hypno-sedative in Ayurveda and is used in the treatment of insomnia, hysteria, and depressive illness. The significant effect is on the central nervous system, as diverse pharmacological actions ranging from sedative to nootropic have been reported; animal and clinical research with jatamansone, the active principle of the plant, has justified its hypno-sedative claim in Ayurveda.
One double-blind, randomized, controlled clinical trial compared N. jatamansi to imipramine in generalized anxiety disorder (GAD). The study involved two groups with 38 subjects each. Jatamansi was administered in the dose of 1,000 mg twice daily orally with water. This constitutes one of the few head-to-head comparisons of the herb with a standard pharmaceutical agent for anxiety. However, the full published results of this trial require direct access to the journal for complete outcome data.
6.2 Insomnia (Primary)
The most cited human clinical evidence for insomnia is a small comparative trial published in the journal Ayu (2015). A total of 34 patients fulfilling the criteria for primary insomnia were randomly selected and assigned to two groups, wherein 30 patients completed the study (15 in each); Tagara Churna (powder of V. wallichii) and Jatamansi Churna (powder of N. jatamansi) in the dose of 4 g with milk were administered three times a day for a period of 1 month. Jatamansi provided improvement in initiation of sleep (61.34%; P < 0.001), duration of sleep (48.25%; P < 0.001), disturbed sleep (53.08%; P < 0.001), and disturbance in routine works (43.85%; P < 0.001). Both groups showed good results, but the Tagara group showed better results in comparison to the Jatamansi group.
A separate open-label, randomized clinical trial examined a polyherbal formulation: 24 patients with insomnia were given a hydroalcoholic extract derived from the roots of Tagara (Valeriana jatamansi), rhizome of Jatamansi (Nardostachys jatamansi), and rhizome of Vacha (Acorus calamus) in capsule form in the ratio of 2:1:1 for 15 days. The evidence in this area is characterized by very small sample sizes and lack of placebo control in most studies; a small study (N=34) reported positive findings for N. jatamansi in the management of primary insomnia.
6.3 Hypertension
In clinical trials, Jatamansi powder has been demonstrated to be used as an anti-hypertensive drug, with efficacy demonstrated in treating primary insomnia, while jatamansone (or valeranone) from Nardostachys essential oil could alleviate hyperkinetic syndrome of children.
A randomized controlled study published in Complementary Therapies in Medicine (Bhat and Malik, 2020) assessed efficacy in essential hypertension: this single-blind, randomized, placebo-controlled trial was conducted at the Department of Moalajat, National Institute of Unani Medicine Hospital, Bangalore, India, between March 2018 and February 2019. Naik et al. reported significant reduction in systolic and diastolic blood pressure with Jatamansi powder in a study conducted on 20 hypertensive participants. The drug was observed to be safe and well tolerated; however, studies on efficacy of different doses and treatment duration are required to fine-tune these observations.
A separate clinical evaluation of N. jatamansi in essential hypertension enrolled 50 patients of either sex in the age group of 30–70 years with mild to severe primary or essential hypertension, not taking any hypotensive drugs or having agreed to discontinue the regular hypotensive drug, for a period of two weeks prior to enrollment.
Jatamansi contains significant bioactive compounds such as jatamansone, nardostachone, and valeranal, which contribute to its therapeutic effects; the herb exhibits vasodilatory, antioxidant, and anti-inflammatory properties, which are crucial in managing blood pressure. Overall, the human evidence for hypertension is promising but limited: studies are small, some are open-label or single-blind, and the scientific literature contains primarily phytochemical and animal studies of N. jatamansi's activity on the nervous system and the cardiovascular system, and clinical trial data are lacking to recommend use for any indication.
6.4 Neuroprotection and Cognitive Function
Animal studies have investigated neuroprotective effects in models of ischemia and neurodegeneration. A neuroprotective effect of N. jatamansi in rats was observed using the middle cerebral artery (MCA) occlusion model to induce cerebral ischemia; the model caused reduced GSH, thiol group, catalase, and Na-K ATPase activities. All the alterations caused by the MCA model were attenuated by pretreatment with hydroalcoholic extract of N. jatamansi for 15 days, which was also supported by histopathological studies showing decrease in neuronal cell death following MCA and reperfusion.
In a Parkinson's disease model, attenuation by N. jatamansi of 6-hydroxydopamine-induced parkinsonism in rats was assessed through behavioral, neurochemical, and immunohistochemical studies. Stress and memory studies demonstrated that a N. jatamansi extract prevented chronic restraint stress-induced learning and memory deficits in a radial arm maze task. All evidence in this sub-domain is preclinical (animal/in vitro); no human clinical trials on cognitive function or neuroprotection have been published to date.
6.5 Hyperkinetic Syndrome (Historic Clinical Data)
Jatamansone (or valeranone) from Nardostachys essential oil demonstrated the ability to alleviate hyperkinetic syndrome of children in a study published as early as 1968 (Gupta and Vermani, 1968). This clinical trial of jatamansone (syn: valeranone) in hyperkinetic behaviour disorders was published in Neurology India in 1968. This early data predates modern clinical trial standards and must be interpreted accordingly.
6.6 Cardiovascular and Cardioprotective Effects
Treatment with N. jatamansi extract at both dose levels exhibited significant reduction of serum CK-MB, LDH, and HMG-CoA levels, and tissue MDA level in a rat model of doxorubicin-induced cardiotoxicity; histopathological evaluation of cardiac tissues of different treatment groups further reinforced the findings of biochemical estimation, and it was concluded that jatamansi can protect cardiac tissues from oxidative stress-induced cell injury and lipid peroxidation as well as against inflammatory and apoptotic effects on cardiac tissues. This is preclinical evidence only; no confirmed human clinical data on cardioprotection exist. The vasodilator, bronchodilator, spasmolytic, and platelet aggregation inhibition activities of the plant have also been reported.
6.7 Antimicrobial and Antifungal Activity
Nardostachys jatamansi's methanolic extract is efficient against the majority of bacteria, supporting its use as an antibiotic and antifungal agent. This evidence is entirely preclinical (in vitro and animal); no human clinical trials exist in this area.
6.8 Anti-inflammatory and Dermatological Effects
A 2024 study published in the International Journal of Molecular Sciences isolated cycloolivil from N. jatamansi and studied it in keratinocytes: the identified compounds included cycloolivil (among many others); notably, cycloolivil and an adjacent compound were reported for the first time from N. jatamansi. Neuroinflammatory research confirmed inhibition of LPS-induced excessive production of proinflammatory mediators, including nitric oxide, prostaglandin E₂, IL-1β, IL-6, and TNF-α. All dermatological and anti-inflammatory evidence is preclinical.
7. Body Systems Associated
- Central Nervous System: The plant shows marked tranquilizing activity and has been used to treat hysteria, syncope, epilepsy, and mental weakness.
- Cardiovascular System: It exhibits cardioprotective activity and is used in the treatment of neural and cardiac diseases.
- Hepatic System: Hepatoprotective properties have been reported.
- Immune/Inflammatory System: Anti-neuroinflammatory effects via modulation of microglial activity and cytokine production have been demonstrated in vitro and in vivo.
- Integumentary System (Skin and Hair): The essential oil extracted from the rhizomes is widely used in the market for hair treatment.
- Reproductive System: Traditional uses include Vajikara effects (enhancing fertility and vitality) and Artavajanana (promoting menstrual health).
8. Dosage Forms and Reported Dosages
The following dosages are those documented in cited sources and do not represent clinical recommendations:
- Powdered rhizome (Churna) for insomnia: Jatamansi Churna (powder of N. jatamansi) in the dose of 4 g with milk was administered three times a day for a period of 1 month.
- Capsule form for hypertension: An N. jatamansi dosage of 3 g/day (one 1 g capsule three times a day) was used in a small 4-week study to evaluate potential blood pressure–lowering effects.
- Anxiolytic dosage in GAD trial: Jatamansi was administered in the dose of 1,000 mg twice daily orally with water.
- Preclinical (animal) anxiolytic dose: Mice were treated orally with NJE (250 mg/kg) for 3, 7, and 14 days.
- Preclinical (animal) antidepressant dose: Nardostachys jatamansi ethanolic root extract at the dose of 200 mg/kg orally was administered in electron beam irradiated mice for screening its antidepressant effect.
- Polyherbal insomnia formulation: An open-label trial used a hydroalcoholic extract of Tagara, Jatamansi, and Vacha in a ratio of 2:1:1 respectively in capsule form for 15 days.
9. Safety Considerations and Interactions
General Safety Profile
In a randomized controlled study for hypertension, the drug was observed to be safe and well tolerated. Limitations of available studies include the absence of toxicology studies using animal models and clinical trials using human subjects.
Taxonomic Adulteration Risk
A factual and practically important safety concern relates to species identity. Jatamansi and its common substitute Bhootkeshi (Selinum vaginatum) are used in various traditional herbal formulations and nutraceuticals for neurological disorders; they resemble each other in external morphological characters and characteristic odour, so their roots are often confused with each other. There is also an uncanny resemblance between the phytochemical profiles and biological activities of N. jatamansi and Valeriana jatamansi (another genus from family Caprifoliaceae), and since both species share identical vernacular names, samples used in research or commerce may not always be of two separate species. This raises quality-control and safety concerns for consumers using commercial preparations.
Reported Adverse Effects
Serum creatinine and liver function tests in a clinical trial showed that both Tagara and Jatamansi interventions had a good safety profile. Adverse effects noted in various sources are limited; the most commonly noted potential gastrointestinal issues are not consistently verified across high-quality sources and require further systematic evaluation.
Reproductive Cautions (Traditional)
The plant has traditionally been associated with emmenagogue activity (stimulating or increasing menstrual flow), which is relevant to safety considerations in pregnancy. However, formal clinical toxicology data in humans are absent in the peer-reviewed literature reviewed here.
Interaction Potential
Given its documented neurochemical mechanisms — specifically, modulation of GABA, serotonin, dopamine, and norepinephrine — there is a theoretical pharmacodynamic interaction potential with CNS-active drugs including benzodiazepines, antidepressants, anticonvulsants, and antihypertensive agents. The scientific literature contains primarily phytochemical and animal studies of N. jatamansi's activity on the nervous and cardiovascular systems; clinical trial data are lacking to recommend use for any indication. The absence of formal human pharmacokinetic or drug interaction studies means that interaction risks cannot be precisely characterized on current evidence.
Endangered Status as a Supply and Quality Risk
Despite its documented benefits, Nardostachys jatamansi faces significant conservation challenges; critically endangered due to overharvesting and habitat degradation, efforts are urgently needed to develop sustainable harvesting and cultivation practices. The endangered status of the plant means that adulteration of commercial products is a recognized risk, with authentic plant material being scarce and verification of botanical identity important for both safety and efficacy.
10. Evidence Strength Summary
Across all areas reviewed, the overall evidence base for Nardostachys jatamansi is characterized by a large body of preclinical (in vitro and animal model) data and a very limited, methodologically heterogeneous set of human clinical studies. The scientific literature contains primarily phytochemical and animal studies of N. jatamansi's activity on the nervous system and the cardiovascular system, and clinical trial data are lacking to recommend use for any indication. Available human trials are generally small (N=20–76), often single-blind or open-label, and have been conducted predominantly within Ayurvedic institutional settings with limited generalizability. The most replicated human signal is for modest hypnotic/sedative effects and modest antihypertensive effects, each supported by only a handful of small trials. Mechanistic evidence from animal studies — particularly for GABAergic modulation, monoamine regulation, and anti-neuroinflammation — is internally consistent and provides a plausible biological rationale for traditional uses, but cannot substitute for adequately powered, placebo-controlled human trials.
References
- PubMed: Nardostachys jatamansi (D.Don) DC. — Challenges and opportunities of harnessing the untapped medicinal plant from the Himalayas (2019)
- PMC: An Important Indian Traditional Drug of Ayurveda Jatamansi and Its Substitute Bhootkeshi: Chemical Profiling and Antioxidant Activity (2013)
- ScienceDirect: Nardostachys jatamansi: Phytochemistry, ethnomedicinal uses, and pharmacological activities: A comprehensive review — Fitoterapia (2024)
- ScienceDirect Topics: Nardostachys — Overview (Phytochemistry, pharmacology, toxicology)
- PMC: Chemical Analysis of 20% Aqueous Ethanol Extract of Nardostachys jatamansi and Evaluation of Anti-Neuroinflammatory Component (2021)
- PMC: Nardostachys jatamansi Extract and Nardosinone Exert Neuroprotective Effects by Suppressing Glucose Metabolic Reprogramming and Modulating T Cell Infiltration (2025)
- PMC: Cycloolivil Isolated from Nardostachys jatamansi Inhibits TNF-α/IFN-γ-Induced Chemokine Production by Blocking NF-κB and JAK/STAT Activation in HaCaT Keratinocytes (2024)
- PubMed: Effects of Nardostachys jatamansi on biogenic amines and inhibitory amino acids in the rat brain — Planta Med (1994)
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- Journal of Pharmaceutical Research International: Comparative Study of Efficacy of Jatamansi and Imipramine in Generalized Anxiety Disorder — A Randomized Controlled Double Blind Clinical Trial (2021)
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