Changes

tyaktvA matismRutibhraMshaM sa~jj~jAM labdhvA pramucyate [1] ||78||

tyaktvA matismRutibhraMshaM sa~jj~jAM labdhvA pramucyate [1] ||78||

The patient should be restricted to wind-free place after taking meat & ghee in his diet to his satisfaction as a result, the patient overcomes the loss of intellect & memory and regains sense and consciousness. Thus, he becomes free from disease. (78)

The patient should be restricted to wind-free place after taking meat & ghee in his diet to his satisfaction as a result, the patient overcomes the loss of intellect & memory and regains sense and consciousness. Thus, he becomes free from disease. (78)

Psycho-therapy and other therapies:

 

==== Psychotherapy and other therapies ====

 

आश्वासयेत् सुहृद्वा तं वाक्यैर्धर्मार्थसंहितैः|  

आश्वासयेत् सुहृद्वा तं वाक्यैर्धर्मार्थसंहितैः|  

ब्रूयादिष्टविनाशं वा दर्शयेदद्भुतानि वा||७९||  

ब्रूयादिष्टविनाशं वा दर्शयेदद्भुतानि वा||७९||  

dehaduHkhabhayebhyo hi paraM prANabhayaM smRutam|  

dehaduHkhabhayebhyo hi paraM prANabhayaM smRutam|  

tena yAti shamaM tasya sarvato viplutaM manaH||84||

tena yAti shamaM tasya sarvato viplutaM manaH||84||

The patients should be assured by a friend and consoled with religious, moral statements and purposeful words. They should tell him the loss of some extremely favourite person or thing or show him some astonishing & surprising  things(to subside the  episode of insanity). (79)

The patients should be assured by a friend and consoled with religious, moral statements and purposeful words. They should tell him the loss of some extremely favourite person or thing or show him some astonishing & surprising  things(to subside the  episode of insanity). (79)

After massaging with mustard oil, the patient should be tied (with ropes) and lay prostrate in the sun, or should touch him with bristles of kapikacchu or heated iron rods or burnt with hot oil or water. (80)

After massaging with mustard oil, the patient should be tied (with ropes) and lay prostrate in the sun, or should touch him with bristles of kapikacchu or heated iron rods or burnt with hot oil or water. (80)

Having tied him well, he should be beaten with whips (hunter) and put him in a confined to a lonely room. Thus his perturbed mind gets pacified. (81)

Having tied him well, he should be beaten with whips (hunter) and put him in a confined to a lonely room. Thus his perturbed mind gets pacified. (81)

He should be terrorized by biting of  snakes with their fangs removed  or by well- trained lions or elephants. or armed criminals or enemies. (82)

He should be terrorized by biting of  snakes with their fangs removed  or by well- trained lions or elephants. or armed criminals or enemies. (82)

Alternatively, he should be terrorized by royal personnel (police) having taken him out side well-tied, arrested and terrorize him intimidating to kill (execution) by the order of  king. (83)

Alternatively, he should be terrorized by royal personnel (police) having taken him out side well-tied, arrested and terrorize him intimidating to kill (execution) by the order of  king. (83)

The danger to the life is above that of the fear of injury to the body. Therefore, the perverted mind of the patient as such gets distracted from all directions and gets pacification & regains normalcy through the above mentioned measures. (84)

The danger to the life is above that of the fear of injury to the body. Therefore, the perverted mind of the patient as such gets distracted from all directions and gets pacification & regains normalcy through the above mentioned measures. (84)

 

 

Therapies in mental trauma patients:

==== Therapies in mental trauma patients ====

 

इष्टद्रव्यविनाशात्तु मनो यस्योपहन्यते|  

इष्टद्रव्यविनाशात्तु मनो यस्योपहन्यते|  

तस्य तत्सदृशप्राप्तिसान्त्वाश्वासैः शमं नयेत्||८५||  

तस्य तत्सदृशप्राप्तिसान्त्वाश्वासैः शमं नयेत्||८५||  

kAmashokabhayakrodhaharSherShyAlobhasambhavAn|  

kAmashokabhayakrodhaharSherShyAlobhasambhavAn|  

parasparapratidvandvairebhireva shamaM nayet||86||

parasparapratidvandvairebhireva shamaM nayet||86||

If the mental  derangement is due to the loss of some dearly loved object, he should be pacified by consoling and assuring him by providing a similar thing. Simultaneously, he should be consoled by pleasant assurances (by family members & friends) as a result of which he recovers from illness.

If the mental  derangement is due to the loss of some dearly loved object, he should be pacified by consoling and assuring him by providing a similar thing. Simultaneously, he should be consoled by pleasant assurances (by family members & friends) as a result of which he recovers from illness.

If the mental  derangement  is due to the passion (kama), grief (shoka), fear (bhaya), anger (krodha), exhilaration (harsha),  envy (irshya), and greed (lobha), they should be  pacified by their  mutually antagonizing & contradictory  factors . (85-86)  

If the mental  derangement  is due to the passion (kama), grief (shoka), fear (bhaya), anger (krodha), exhilaration (harsha),  envy (irshya), and greed (lobha), they should be  pacified by their  mutually antagonizing & contradictory  factors . (85-86)  

Spriritual therapies in exogenous type of unmada:

==== Spriritual therapies in exogenous type of unmada ====

 

बुद्ध्वा देशं वयः सात्म्यं दोषं कालं बलाबले|  

बुद्ध्वा देशं वयः सात्म्यं दोषं कालं बलाबले|  

चिकित्सितमिदं कुर्यादुन्मादे भूतदोषजे||८७||  

चिकित्सितमिदं कुर्यादुन्मादे भूतदोषजे||८७||  

Physician should  administer the treatment of unmada, caused by spirits or dosha, after examining place, age, suitability, morbidity, time and strength or otherwise. (87)  

Physician should  administer the treatment of unmada, caused by spirits or dosha, after examining place, age, suitability, morbidity, time and strength or otherwise. (87)  

              In the unmada caused by gods, sages, fore- father or gandharvas, the wise physician should avoid irritant collyrium etc. and other harsh measures. Instead he should use intake of ghee and other mild medicaments. Moreover, worship, offering (bali), gifts (upahara), recitation of hymns(mantra), collyrium (anjana), pacificatory rituals (shanti karma) & acts, sacrifices, offering oblation to the fire (homa), repetition of hymns/incantations(japa), auspicious rituals /blessings (swastyayana), vedic rites and expiations (prayaschita) are useful for these patients .  (88-90)   

 

If one worships lord shiva daily, the supreme controller of all bhutas (supernatural beings) and lord of the world with sincerity and the all powerful gods with devotion, he overcomes the fear from attack of unmada.  (91)

In the unmada caused by gods, sages, fore- father or gandharvas, the wise physician should avoid irritant collyrium etc. and other harsh measures. Instead he should use intake of ghee and other mild medicaments. Moreover, worship, offering (bali), gifts (upahara), recitation of hymns(mantra), collyrium (anjana), pacificatory rituals (shanti karma) & acts, sacrifices, offering oblation to the fire (homa), repetition of hymns/incantations(japa), auspicious rituals /blessings (swastyayana), vedic rites and expiations (prayaschita) are useful for these patients .  (88-90)   

 

If one worships lord shiva daily, the supreme controller of all bhutas (supernatural beings) and lord of the world with sincerity and the all powerful gods with devotion, he overcomes the fear from attack of unmada.  (91)

Pramathas, attendants of Lord Rudra, move around the world, if worshipped, they help in recovery from unmada. (92)

Pramathas, attendants of Lord Rudra, move around the world, if worshipped, they help in recovery from unmada. (92)

The exogenous unmada is pacified by offerings (bali), auspicious acts (mangal karma), oblation (homa), wearing herbs roots ( aushadhi -dharana),  anti poison drugs (agada- dharana),  good conduct (satya-achara), austerity (tapa), knowledge (jnana), gifts (pradan), spiritual duties (niyama), vows (vrata); worship of god, cows, brahmanas & preceptors (guru), by sacred hymns and drugs. (93-94)

 

Because of similarity in etiology and substratum of morbidity, the remedial measures prescribed for epilepsy (pasmara) should also be adopted for unmada. (95)

The exogenous unmada is pacified by offerings (bali), auspicious acts (mangal karma), oblation (homa), wearing herbs roots ( aushadhi -dharana),  anti poison drugs (agada- dharana),  good conduct (satya-achara), austerity (tapa), knowledge (jnana), gifts (pradan), spiritual duties (niyama), vows (vrata); worship of god, cows, brahmanas & preceptors (guru), by sacred hymns and drugs. (93-94)

 

Because of similarity in etiology and substratum of morbidity, the remedial measures prescribed for epilepsy (pasmara) should also be adopted for unmada. (95)

 

निवृत्तामिषमद्यो यो हिताशी प्रयतः शुचिः|  

निवृत्तामिषमद्यो यो हिताशी प्रयतः शुचिः|  

निजागन्तुभिरुन्मादैः सत्त्ववान् न स युज्यते||९६||

निजागन्तुभिरुन्मादैः सत्त्ववान् न स युज्यते||९६||

nivRuttAmiShamadyo yo hitAshI prayataH shuciH|  

nivRuttAmiShamadyo yo hitAshI prayataH shuciH|  

nijAgantubhirunmAdaiH sattvavAn na sa yujyate||96||

nijAgantubhirunmAdaiH sattvavAn na sa yujyate||96||

The person having preponderance of sattva (strong mental strength), abstaining from meat and wine, taking wholesome diet, sincere & disciplined and observing purity of mind and body  is not affected by either endogenous or exogenous  type of  unmada. (96)

The person having preponderance of sattva (strong mental strength), abstaining from meat and wine, taking wholesome diet, sincere & disciplined and observing purity of mind and body  is not affected by either endogenous or exogenous  type of  unmada. (96)

 

 

Signs of complete cure of unmada:

==== Signs of complete cure of unmada ====

 

प्रसादश्चेन्द्रियार्थनां बुद्ध्यात्ममनसां तथा|  

प्रसादश्चेन्द्रियार्थनां बुद्ध्यात्ममनसां तथा|  

धातूनां प्रकृतिस्थत्वं विगतोन्मादलक्षणम्||९७||

धातूनां प्रकृतिस्थत्वं विगतोन्मादलक्षणम्||९७||

Blissful feeling (in perception) of sense objects and also of intellect, self and mind along with normalcy of tissue elements (dhatus) are  the signs of having recovered from unmada. (97)

Blissful feeling (in perception) of sense objects and also of intellect, self and mind along with normalcy of tissue elements (dhatus) are  the signs of having recovered from unmada. (97)

 

 

Summary:

==== Summary ====

 

तत्र श्लोकः-  

तत्र श्लोकः-  

उन्मादानां समुत्थानं लक्षणं सचिकित्सितम्|  

उन्मादानां समुत्थानं लक्षणं सचिकित्सितम्|  

nijAgantunimittAnAmuktavAn bhiShaguttamaH||98||

nijAgantunimittAnAmuktavAn bhiShaguttamaH||98||

Now summing, up verses-

Now summing, up verses-

(Punarvasu) the best of physician told about the etiology, symptoms and treatment of the types of unmada caused by endogenous or exogenous factors. (98)

 

Thus, ends ninth chapter on the treatment of unmada in chikitsa sthana in the treatise composed by Agnivesha, redacted by Charak and reconstructed by Dridhbala as it was unavailable.[9]  

(Punarvasu) the best of physician told about the etiology, symptoms and treatment of the types of unmada caused by endogenous or exogenous factors. (98)

Tattva Vimarsha:

 

Thus, ends ninth chapter on the treatment of unmada in chikitsa sthana in the treatise composed by Agnivesha, redacted by Charak and reconstructed by Dridhbala as it was unavailable.[9]  

 

=== Tattva Vimarsha ===

 

• The diet poor in qualities, behavioural abnormalities, frequent psychological trauma mainly due to fear or exhilaration and irregular postures play important role in causing unmada.  

• The diet poor in qualities, behavioural abnormalities, frequent psychological trauma mainly due to fear or exhilaration and irregular postures play important role in causing unmada.  

• The individual with low mental strength (level of sattva guna as in weak minded people)  are more susceptible for unmada.  

• The individual with low mental strength (level of sattva guna as in weak minded people)  are more susceptible for unmada.  

• The objective of cure in unmada includes blissful feeling (in perception) of sense objects and also of intellect, self and mind along with normalcy of tissue elements (dhatus) are  the signs of having recovered from unmada.

• The objective of cure in unmada includes blissful feeling (in perception) of sense objects and also of intellect, self and mind along with normalcy of tissue elements (dhatus) are  the signs of having recovered from unmada.

Vidhi vimarsha:

=== Vidhi Vimarsha ===

 

Similar conditions observed in contemporary psychiatry:  

Similar conditions observed in contemporary psychiatry:  

Nija unmada (endogenous psychoses):

Nija unmada (endogenous psychoses):

5. All types of chronic, incapacitating psychotic conditions are included under the category of sannipatik / tridoshaja unmada. Hebephrenic schizophrenia, chronic schizophrenia and residual schizophrenia come under this category, again the difference being predominance of the doshas involved in the psychopathogenesis.

5. All types of chronic, incapacitating psychotic conditions are included under the category of sannipatik / tridoshaja unmada. Hebephrenic schizophrenia, chronic schizophrenia and residual schizophrenia come under this category, again the difference being predominance of the doshas involved in the psychopathogenesis.

Agantuja unmada (exogenous psychoses):

Agantuja unmada (exogenous psychoses):

6. Various psychoses due to possession of grahas & bhutas (supernatural beings) are included under agantuja unmada, which should be regarded as suffering from paranoid schizophrenia, paranoia and various other paranoid states. Paranoid schizophrenia is characterized by predominance of delusions.

6. Various psychoses due to possession of grahas & bhutas (supernatural beings) are included under agantuja unmada, which should be regarded as suffering from paranoid schizophrenia, paranoia and various other paranoid states. Paranoid schizophrenia is characterized by predominance of delusions.

7. It is important to mention that grahas have been christened only on the basis of the resemblance of the clinical features of the afflicted individual with the activities of those grahas e.g. gods, gandharvas etc. It is not that these have entered into the boby of the afflicted individual. This is just the way of presentation and the writing style in Ayurveda to personify  an event/process. This form of presentation is somewhat similar to syndromic classification in conventional modern medicine. Because of similarity of clinical symptoms, the patients are said to be suffering from so and so grahas. These individual  syndromes can also be correlated to a single disease entity from modern perspective.

7. It is important to mention that grahas have been christened only on the basis of the resemblance of the clinical features of the afflicted individual with the activities of those grahas e.g. gods, gandharvas etc. It is not that these have entered into the boby of the afflicted individual. This is just the way of presentation and the writing style in Ayurveda to personify  an event/process. This form of presentation is somewhat similar to syndromic classification in conventional modern medicine. Because of similarity of clinical symptoms, the patients are said to be suffering from so and so grahas. These individual  syndromes can also be correlated to a single disease entity from modern perspective.

The purification procedures prescribed in unmade are :(1) Nasya (2) Vamana (3) Virecana (4) Niruha basti (5) Anuvasana basti. Besides these five chief karmas, two other preparatory and axillary karmas are indicated i.e. snehana karma and swedana karmas. Snehana karmas are also carried out as shamana (pacification) therapy with low dose sneha. Especially in major psychiatric illness it is considered as a separate therapy. The other measures like pradeha, utsadana, abhyanga, dhuma, snehapana, etc. are also administered which stimulates the mind, intellect, memory and consciousness of the patient.  

The purification procedures prescribed in unmade are :(1) Nasya (2) Vamana (3) Virecana (4) Niruha basti (5) Anuvasana basti. Besides these five chief karmas, two other preparatory and axillary karmas are indicated i.e. snehana karma and swedana karmas. Snehana karmas are also carried out as shamana (pacification) therapy with low dose sneha. Especially in major psychiatric illness it is considered as a separate therapy. The other measures like pradeha, utsadana, abhyanga, dhuma, snehapana, etc. are also administered which stimulates the mind, intellect, memory and consciousness of the patient.  

Siravedha (venesection): Besides the above methods, surgical techniques like siravedha (venesection) are also advocated in the treatment of mental disorders and hysteria.  

Siravedha (venesection): Besides the above methods, surgical techniques like siravedha (venesection) are also advocated in the treatment of mental disorders and hysteria.  

  In vataja unmada, snehapanam has to be done. If the passage of vayu is obstructed laxative along with sneha should be given. In kaphaja unmada, vamana must be done. In pittaja unmada, virechana must be done. After completing purification, samsarjana karma (lighter to heavier diet gradually) must be given. The purification of body also leads to blissful state of mind and sense organs.  

In vataja unmada, snehapanam has to be done. If the passage of vayu is obstructed laxative along with sneha should be given. In kaphaja unmada, vamana must be done. In pittaja unmada, virechana must be done. After completing purification, samsarjana karma (lighter to heavier diet gradually) must be given. The purification of body also leads to blissful state of mind and sense organs.  

Even after the body is cleansed, if the patient exhibits perversion of conduct, he should be given strong navanam, anjanam, taadanam.

Even after the body is cleansed, if the patient exhibits perversion of conduct, he should be given strong navanam, anjanam, taadanam.

Concept & rationale of ghrita- pana/ shamana sneha pana:  

Concept & rationale of ghrita- pana/ shamana sneha pana:  

The nourishing medhya medications described are particularly relevant to our times when we are forced to battle continuously against stress and strain. Need of the hour is to find practically useful formulations and treatment procedures, scrutinize them thoroughly, which would help to effectively treat the psychotic states. It may not be exaggartion to say that unmada is the only disease entity in the entire classical Ayurvedic literature where such a comprehensive management has been described and almost all the prevailing methods & forms of  therapy have been used hand in hand .

The nourishing medhya medications described are particularly relevant to our times when we are forced to battle continuously against stress and strain. Need of the hour is to find practically useful formulations and treatment procedures, scrutinize them thoroughly, which would help to effectively treat the psychotic states. It may not be exaggartion to say that unmada is the only disease entity in the entire classical Ayurvedic literature where such a comprehensive management has been described and almost all the prevailing methods & forms of  therapy have been used hand in hand .

Further reading:

=== Further reading ===

 

1. Agnivesha, Charaka samhita. Hindi commentary by Acharya Vidyadhara shukla and prof.Ravi Dutt Tripathi. Delhi, Chaukambha Sanskrit Pratishatan 2010,. pp 1024., page no.656.

1. Agnivesha, Charaka samhita. Hindi commentary by Acharya Vidyadhara shukla and prof.Ravi Dutt Tripathi. Delhi, Chaukambha Sanskrit Pratishatan 2010,. pp 1024., page no.656.

2. Agnivesha, Charaka samhita. Hindi commentary by Acharya Vidyadhara shukla and prof.Ravi Dutt Tripathi. Chaukambha Sanskrit Pratishatan 2010,Delhi , .pp 999, page no.234.

2. Agnivesha, Charaka samhita. Hindi commentary by Acharya Vidyadhara shukla and prof.Ravi Dutt Tripathi. Chaukambha Sanskrit Pratishatan 2010,Delhi , .pp 999, page no.234.