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|keywords=unmada, manas, schizophrenia, manic psychosis, psychotic depression / major depressive disorder, treatment of psychiatric disorders, Ayurveda, charak samhita, Indian system of medicine.

|keywords=unmada, manas, schizophrenia, manic psychosis, psychotic depression / major depressive disorder, treatment of psychiatric disorders, Ayurveda, charak samhita, Indian system of medicine.

|description=Chikitsa Sthana Chapter 9. Management of Unmada (Psychosis Disorders)

|description=Chikitsa Sthana Chapter 9. Management of Unmada (Psychosis Disorders)

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|image_alt=charak samhita

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[[Unmada Chikitsa]] describes the management of ''unmada'' (insanity). The approach to the management of individual types of ''unmada'' have been elaborately described. The uniqueness of the chapter lies in the broad description of all three forms of therapies described in Ayurvedic System  i.e. ''yukti-vyapashraya'' (rational treatment) to ''daiva- vyapashraya'' ( spiritual therapy) and ''sattvavajaya chikitsa'' (psychotherapy) for the management. Apart from these three types, the fourth type of therapy, called ''upayabhipluta'' (consolation, mental support) ''chikitsa'', which incorporates a variety of non–pharmacological methods of treatment has also been described. ''Unmada'' is the only disease entity in the entire classical Ayurvedic literature, which requires such an extensive and broad spectrum of management principles, techniques, drugs, counseling, psychotherapy and therapeutic modalities, which are to be judiciously utilized by the clinicians based on their  specific indications and the state of the disease.

[[Unmada Chikitsa]] describes the management of ''unmada'' (insanity). The approach to the management of individual types of ''unmada'' have been elaborately described. The uniqueness of the chapter lies in the broad description of all three forms of therapies described in Ayurvedic System  i.e. ''yukti-vyapashraya'' (rational treatment) to ''daiva- vyapashraya'' ( spiritual therapy) and ''sattvavajaya chikitsa'' (psychotherapy) for the management. Apart from these three types, the fourth type of therapy, called ''upayabhipluta'' (consolation, mental support) ''chikitsa'', which incorporates a variety of non–pharmacological methods of treatment has also been described. ''Unmada'' is the only disease entity in the entire classical Ayurvedic literature, which requires such an extensive and broad spectrum of management principles, techniques, drugs, counseling, psychotherapy and therapeutic modalities, which are to be judiciously utilized by the clinicians based on their  specific indications and the state of the disease.

'''Keywords''': ''unmada, manas,'' schizophrenia, manic psychosis, psychotic depression / major depressive disorder, treatment of psychiatric disorders </div>

'''Keywords''': ''unmada, [[manas]],'' schizophrenia, manic psychosis, psychotic depression / major depressive disorder, treatment of psychiatric disorders </div>

== Introduction ==

== Introduction ==

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The ''unmada'' covers a wide range of major mental disorders and is considered synonymous with  madness and mental derangement, in which a person loses his/her contact from reality and loses the ability to regulate his/her actions and conduct according to norms of the society. In ''unmada'' there is upward movement of ''doshas'' leading to disturbance in the functions of ''manas'' causing ''mada'' ( delusional/ intoxicated state ) in an individual. The factual clinical picture of the mental status of psychotic patients is vividly described. This description suggests that a patient of ''unmada'' develops derangement of all the activities of ''manas'' (mind), ''buddhi''(intellect), ''ahamkara'' (conceit of self-individuality) and ''indriyas'' (senses). He develops thought disturbances in the form of abnormalities of ''chintana'' (thinking), ''vichara''(discrimination) and ''uhya'' (analysis), derangement of memory in the form of ''smriti nasha'' (loss of memory) and ''smriti bramsha'' (impairment of memory), behavioral, social and emotional disturbances in the form of abnormalities of ''achara'' (behaviour), ''dharma'' (eternal duties) and ''bhavas'' (mental factors) along with functional derangement of ''indriyas'' which is manifested clinically as disturbed speech and its various presentations like incoherence (''abaddha vakyama''), thought blocking (''hridaya shunyata'' ), loosening of associations, neologism, echolalia etc. and various psycho-motor disturbances .

The ''unmada'' covers a wide range of major mental disorders and is considered synonymous with  madness and mental derangement, in which a person loses his/her contact from reality and loses the ability to regulate his/her actions and conduct according to norms of the society. In ''unmada'' there is upward movement of ''[[dosha]]s'' leading to disturbance in the functions of ''[[manas]]'' causing ''mada'' ( delusional/ intoxicated state ) in an individual. The factual clinical picture of the mental status of psychotic patients is vividly described. This description suggests that a patient of ''unmada'' develops derangement of all the activities of ''[[manas]]'' (mind), ''[[buddhi]]''(intellect), ''ahamkara'' (conceit of self-individuality) and ''[[indriya]]s'' (senses). He develops thought disturbances in the form of abnormalities of ''chintana'' (thinking), ''vichara''(discrimination) and ''uhya'' (analysis), derangement of memory in the form of ''smriti nasha'' (loss of memory) and ''smriti bramsha'' (impairment of memory), behavioral, social and emotional disturbances in the form of abnormalities of ''achara'' (behaviour), ''dharma'' (eternal duties) and ''bhavas'' (mental factors) along with functional derangement of ''[[indriya]]s'' which is manifested clinically as disturbed speech and its various presentations like incoherence (''abaddha vakyama''), thought blocking (''hridaya shunyata'' ), loosening of associations, neologism, echolalia etc. and various psycho-motor disturbances .

Thus, ''unmada'' is not a lone clinical entity comparable to a single modern diagnostic category, rather it is a syndrome describing a group of psychotic disorders. It is a common and broader entity, which provides guidance to the line of management for almost all psychiatric disorders in [[Ayurveda]]. In this ailment, the intellect, mind and memory get perverted. ''Unmada'' can be described as the disordered state of mind, in which an individual loses the ability of regulating his/her actions and conduct according to the rules of society.  As the psychotic disorders  cover   almost all the major mental illnesses, the different types and sub-types of ''unmada'' can be separately correlated with different psychotic disorders. The clinical features of the different types of ''unmada'' resemble various types of schizophrenia, manic psychosis, psychotic depression / major depressive disorder. ''Unmada'' is divided into two broad categories –  

Thus, ''unmada'' is not a lone clinical entity comparable to a single modern diagnostic category, rather it is a syndrome describing a group of psychotic disorders. It is a common and broader entity, which provides guidance to the line of management for almost all psychiatric disorders in [[Ayurveda]]. In this ailment, the intellect, mind and memory get perverted. ''Unmada'' can be described as the disordered state of mind, in which an individual loses the ability of regulating his/her actions and conduct according to the rules of society.  As the psychotic disorders  cover almost all the major mental illnesses, the different types and sub-types of ''unmada'' can be separately correlated with different psychotic disorders. The clinical features of the different types of ''unmada'' resemble various types of schizophrenia, manic psychosis, psychotic depression / major depressive disorder. ''Unmada'' is divided into two broad categories –  

(1) ''Nija''- those caused by internal imbalance of body humors i.e. ''vata, pitta, kapha'' and the ''sannipataja'' and the  

(1) ''Nija''- those caused by internal imbalance of body humors i.e. ''[[vata]], [[pitta]], [[kapha]]'' and the ''sannipataja'' and the  

(2) ''Agantunimitta''- those caused by exogenous factors.  

(2) ''Agantunimitta''- those caused by exogenous factors.  

The medicated ''ghrita'', the most preferred dosage form for the management, enhances intellect, memory and plays an important role in the treatment of ''unmada''. Hence many ''ghrita'' formulations have been described for the management. ''Anjana'' and ''nasya'' are other treatment modalities indicated in ''unmada''. Vagbhata emphasizes upon their importance by saying that if all medications for ''unmada'' like ''vamana, virechana'' etc. fail, one should do ''teekshna anjana'' and ''nasya karma''. </div>

The medicated ''ghrita'', the most preferred dosage form for the management, enhances intellect, memory and plays an important role in the treatment of ''unmada''. Hence many ''ghrita'' formulations have been described for the management. ''Anjana'' and ''[[nasya]]'' are other treatment modalities indicated in ''unmada''. Vagbhata emphasizes upon their importance by saying that if all medications for ''unmada'' like ''[[vamana]], [[virechana]]'' etc. fail, one should do ''teekshna anjana'' and ''[[nasya]] karma''. </div>

== Sanskrit text, Transliteration and English Translation ==

== Sanskrit text, Transliteration and English Translation ==

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By the above causative factors, the ''doshas'' get vitiated in the person possessing low level of ''sattva guna'' (weak minded people) in turn vitiate ''hridaya'' (mind), which is the seat of intellect. There from the channels carrying mental factors (''mano-vaha srotasas''), quickly delude the mind of the person. [5]

By the above causative factors, the ''[[doshas]]'' get vitiated in the person possessing low level of [[sattva]] guna (weak minded people) in turn vitiate hridaya (mind), which ise seat of intellect. There from the channels carrying mental factors (''mano-vaha srotasas''), quickly delude the mind of the person. [5]

=== Clinical features ===

=== Clinical features ===

''Unmada'' refers to excessive affliction of intellect, mind and memory. This is of two types – ''nija'' (endogenous) and ''agantuja'' (exogenous). According to origin, it is of five types.(I) will describe their symptoms and treatment separately.[8]

''Unmada'' refers to excessive affliction of intellect, mind and memory. This is of two types – ''nija'' (endogenous) and ''agantuja'' (exogenous). According to origin, it is of five types.(I) will describe their symptoms and treatment separately.[8]

=== ''Vata'' dominant ''unmada'' ===

=== ''[[Vata]]'' dominant ''unmada'' ===

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''Vayu'' gets aggravated by the intake of rough, deficient in quantity and cold in property food, excessive evacuation of ''doshas,'' depletion of body tissues and fasting. This aggravated ''vayu'' affects the ''hridaya'' (site of mind), which is already afflicted with anxiety etc. and thus quickly deranges intellect and memory.

''[[Vata]]'' gets aggravated by the intake of rough, deficient in quantity and cold in property food, excessive evacuation of ''[[dosha]]s,'' depletion of body tissues and fasting. This aggravated ''[[vata]]'' affects the ''hridaya'' (site of mind), which is already afflicted with anxiety etc. and thus quickly deranges intellect and memory.

Laughing, smiling, dancing, singing, speaking, abnormal movement of body parts, weeping at improper places and improper time, roughness, emaciation, reddish discoloration of body parts and aggravation of the disease after digestion of food; are the clinical features of the ''vata'' dominant ''unmada'' .[9-10]

Laughing, smiling, dancing, singing, speaking, abnormal movement of body parts, weeping at improper places and improper time, roughness, emaciation, reddish discoloration of body parts and aggravation of the disease after digestion of food; are the clinical features of the ''[[vata]]'' dominant ''unmada'' .[9-10]

    

    

=== ''Pitta'' dominant ''unmada'' ===

=== ''[[Pitta]]'' dominant ''unmada'' ===

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The already accumulated ''pitta'' gets aggravated due to indigestion, by the intake of pungent, sour food, those articles causing burning sensation, and hot in potency. It takes shelter in the ''hridaya'' (site of mind) in the person without self restraint and thus suddenly gives rise to severe episode of ''unmada'' as per the above mentioned pathogenesis.

The already accumulated ''[[pitta]]'' gets aggravated due to indigestion, by the intake of pungent, sour food, those articles causing burning sensation, and hot in potency. It takes shelter in the ''hridaya'' (site of mind) in the person without self restraint and thus suddenly gives rise to severe episode of ''unmada'' as per the above mentioned pathogenesis.

Intolerance, agitation, nakedness, terrorizing, excessive movements, (running), heat, wrath (anger), yellowish luster and desire for dense shady places, cold food - are the clinical features of pitta dominant ''unmada''. [11-12]

Intolerance, agitation, nakedness, terrorizing, excessive movements, (running), heat, wrath (anger), yellowish luster and desire for dense shady places, cold food - are the clinical features of [[pitta]] dominant ''unmada''. [11-12]

=== ''Kapha'' dominant ''unmada'' ===

=== ''[[Kapha]]'' dominant ''unmada'' ===

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In the persons taking excessive food and doing slow activities (having sedentary habits), ''kapha'' along with heat (''pitta'') increases in their vital organ (''hridaya''), impairing intellect and memory and thereby deranging their mind produces insanity.

In the persons taking excessive food and doing slow activities (having sedentary habits), ''[[kapha]]'' along with heat (''[[pitta]]'') increases in their vital organ (''hridaya''), impairing intellect and memory and thereby deranging their mind produces insanity.

Slow speech and movements, anorexia, and liking for women and loneliness, excessive sleep, vomiting, salivation, aggravation of the disease after taking meals and whiteness of nails etc.– these are the clinical features of the ''kapha'' dominant ''unmada''. [13-14]

Slow speech and movements, anorexia, and liking for women and loneliness, excessive sleep, vomiting, salivation, aggravation of the disease after taking meals and whiteness of nails etc.– these are the clinical features of the ''[[kapha]]'' dominant ''unmada''. [13-14]

=== ''Sannipata unmada'' (due to vitiation of all ''doshas'') ===

=== ''Sannipata unmada'' (due to vitiation of all ''[[dosha]]s'') ===

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The severe type of ''unmada'' arising from ''sannipata'' (aggravation of all three ''doshas'') is caused by all the above etiological factors. It presents with all the above characters in mixed form and because of antagonistic therapeutic principles, it is difficult to treat and therefore should be rejected. [15]

The severe type of ''unmada'' arising from ''sannipata'' (aggravation of all three ''[[dosha]]s'') is caused by all the above etiological factors. It presents with all the above characters in mixed form and because of antagonistic therapeutic principles, it is difficult to treat and therefore should be rejected. [15]

=== ''Agantu unmada'' (exogenous type) ===

=== ''Agantu unmada'' (exogenous type) ===

The Gods (''deva'') attack the person with purity and good conduct and engage in austerity and study of religious scriptures by finding an opportunity to afflict often on the first or thirteenth day of the bright fortnight.

The Gods (''deva'') attack the person with purity and good conduct and engage in austerity and study of religious scriptures by finding an opportunity to afflict often on the first or thirteenth day of the bright fortnight.

The Sages (''rishis'') posess the person who is fond of bath, purity and loneliness and is conversant with religious scriptures and ''vedic'' sentences often on sixth or ninth day of fortnight by finding an opportunity to afflict.

The Sages (''rishis'') possess the person who is fond of bath, purity and loneliness and is conversant with religious scriptures and ''vedic'' sentences often on sixth or ninth day of fortnight by finding an opportunity to afflict.

The forefathers (''pitris'') enter into the person who is engaged in the service of mother, father, and teacher, elders, ''siddhas'' (who have accomplished spiritual perfection) and preceptors often on tenth day of the dark fortnight or new moon by finding an opportunity to afflict.

The forefathers (''pitris'') enter into the person who is engaged in the service of mother, father, and teacher, elders, ''siddhas'' (who have accomplished spiritual perfection) and preceptors often on tenth day of the dark fortnight or new moon by finding an opportunity to afflict.

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Those madden by the types of spirits possessing due to longing for pleasure and worship, should be ascertained as such by the liking (intentions) and behavior (conduct) of the patients and should be treated with administration of the mantras (incantations/hymns) and drugs mixed with the respective gifts and offerings. [23]

Those madden by the types of spirits possessing due to longing for pleasure and worship, should be ascertained as such by the liking (intentions) and behavior (conduct) of the patients and should be treated with administration of the mantras (incantations/hymns) and drugs mixed with the respective gifts and offerings. [23]

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Now I will describe in brief and detail the treatment of both the endogenous and exogenous types of ''unmada''.

Now I will describe in brief and detail the treatment of both the endogenous and exogenous types of ''unmada''.

In ''vata'' dominant type, first of all one should prescribe intake of oils and ''ghritas'' (''sneha'') substance but if there is obstruction in channels, mild unctuous evacuatives in small quantities should be administered.

In ''[[vata]]'' dominant type, first of all one should prescribe intake of oils and ''ghritas'' (''sneha'') substance but if there is obstruction in channels, mild unctuous evacuatives in small quantities should be administered.

If the insanity is caused by ''kapha'' and ''pitta'', emesis and purgation should be given after unction and sudation. Post- evacuation dietetic regimen should be prescribed (gradually from lighter to heavier diet as per prescribed procedure). Thereafter non-unctuous (''niruha'') and unctuous (''anuvasana'') enema and nasal errhines (''shiro-virechana'') should be administrated.  

If the insanity is caused by ''[[kapha]]'' and ''[[pitta]]'', emesis and purgation should be given after unction and sudation. Post- evacuation dietetic regimen should be prescribed (gradually from lighter to heavier diet as per prescribed procedure). Thereafter non-unctuous (''niruha'') and unctuous (''anuvasana'') enema and nasal errhines (''shiro-virechana'') should be administrated.  

Depending upon the predominance of ''doshas'', one or the other of the above measures should be repeatedly applied.

Depending upon the predominance of ''[[dosha]]s'', one or the other of the above measures should be repeatedly applied.

   

   

By the administration of these therapeutic measures, heart, sense organs, head and bowels (''koshtha'') get cleansed as a result of which the mind gets refreshed and the patient regains memory as well as consciousness.

By the administration of these therapeutic measures, heart, sense organs, head and bowels (''koshtha'') get cleansed as a result of which the mind gets refreshed and the patient regains memory as well as consciousness.

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In the same way, the twenty one drugs beginning with ''sthira'' (''shalparni'') are boiled in water. With this decoction ghee is cooked adding four times milk of ''primi para'' cow (milk collected from the cow after its first delivery) and paste of vira, two types of ''masha'' (''masha'' and ''rajmasha'') , ''kakoli, kapikacchu, rishabhaka'' and ''riddhi''. This ''mahakalyanaka ghrita'' is particularly nourishing (bulk promoting) and an excellent alleviator of ''sannipata'' (simultaneous vitiation of all three ''doshas''). [42 1/2-44]

In the same way, the twenty one drugs beginning with ''sthira'' (''shalparni'') are boiled in water. With this decoction ghee is cooked adding four times milk of ''primi para'' cow (milk collected from the cow after its first delivery) and paste of vira, two types of ''masha'' (''masha'' and ''rajmasha'') , ''kakoli, kapikacchu, rishabhaka'' and ''riddhi''. This ''mahakalyanaka ghrita'' is particularly nourishing (bulk promoting) and an excellent alleviator of ''sannipata'' (simultaneous vitiation of all three ''[[dosha]]s''). [42 1/2-44]

==== ''Mahapaishachika ghee'' ====

==== ''Mahapaishachika ghee'' ====

==== Second formulation of ''lashunadya ghrita'' ====

==== Second formulation of ''lashunadya ghrita'' ====

Undamaged garlic decorticated -200gm, ''dashamula'' -100gm should be boiled in 5.12 liters of water and reduced to one fourth. Thereafter ghee -640 gm garlic juice -640 gm along with the juice of ''kola'' (jujube), radish, ''vrikshamla, matulunga'' and fresh ginger, pomegranate, ''sura'', curd water and sour gruel -each 320 ml and the past of ''triphala, devadaru,'' rocksalt, ''trikatu, ajamoda, yavani, chavya, hingu'' and ''amlavetasa'' -each 20 gm should be cooked. This medicated ghee by intake alleviates colic, ''gulma'', piles, ''udara'', inguinal hernia, anemia, spleen enlargement, female genital disorders, fever, worms, disorder of ''vata, kapha'' and all types of ''unmada''. [52-56]

Undamaged garlic decorticated -200gm, ''dashamula'' -100gm should be boiled in 5.12 liters of water and reduced to one fourth. Thereafter ghee -640 gm garlic juice -640 gm along with the juice of ''kola'' (jujube), radish, ''vrikshamla, matulunga'' and fresh ginger, pomegranate, ''sura'', curd water and sour gruel -each 320 ml and the past of ''triphala, devadaru,'' rocksalt, ''trikatu, ajamoda, yavani, chavya, hingu'' and ''amlavetasa'' -each 20 gm should be cooked. This medicated ghee by intake alleviates colic, ''gulma'', piles, ''udara'', inguinal hernia, anemia, spleen enlargement, female genital disorders, fever, worms, disorder of ''[[vata]], [[kapha]]'' and all types of ''unmada''. [52-56]

==== Different useful recipes of medicated ghee ====

==== Different useful recipes of medicated ghee ====

Ghee kept beyond ten years is called as ''pra-purana'' (extremely old). There is no disease, which is incurable for the ghee which is old by one hundred years. It destroys all the ''grahas'' by seeing, touching, inhaling and is particularly recommended for those suffering from epilepsy (''apasmara''), ''grahas'' (demonic seizures) and ''unmada'' . [59-62]

Ghee kept beyond ten years is called as ''pra-purana'' (extremely old). There is no disease, which is incurable for the ghee which is old by one hundred years. It destroys all the ''grahas'' by seeing, touching, inhaling and is particularly recommended for those suffering from epilepsy (''apasmara''), ''grahas'' (demonic seizures) and ''unmada'' . [59-62]

=== External applications in ''vata-kapha'' dominant ''unmada'' ===

=== External applications in ''[[vata]]-[[kapha]]'' dominant ''unmada'' ===

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''Apamarga, hingu, haratala,'' and ''hingupatrika''- in equal quantity, ''maricha'' in half quantity are powdered with bile of cow and jackal and made into wick (varieties). This stick is applied to eyes in epilepsy, ''unmada'', caused by evil spirits, possession by evil spirits and gods and in eye disease. [661/2-1/2 68]

''Apamarga, hingu, haratala,'' and ''hingupatrika''- in equal quantity, ''maricha'' in half quantity are powdered with bile of cow and jackal and made into wick (varieties). This stick is applied to eyes in epilepsy, ''unmada'', caused by evil spirits, possession by evil spirits and gods and in eye disease. [661/2-1/2 68]

''Maricha'' impregnated with (the above) bile and kept in the sun for a month makes a collyrium which is useful in defects of vision and loss of memory caused by vitiated ''doshas'' and demonic seizures. [681/2-1/2 69]  

''Maricha'' impregnated with (the above) bile and kept in the sun for a month makes a collyrium which is useful in defects of vision and loss of memory caused by vitiated ''[[dosha]]s'' and demonic seizures. [681/2-1/2 69]  

==== ''Siddharthakadi Agada'' ====

==== ''Siddharthakadi Agada'' ====

*If there is excessive salivation and chronic coryza, the smoking cigar (medicated cigar) made of aromatic substances should be given for smoking. These fragrant and aromatic substances are described under the ''vairechanika dhuma'' (medicated smoking)[Cha.Sa.[[Sutra Sthana]] chapter 5] . [731/2-1/2 74]

*If there is excessive salivation and chronic coryza, the smoking cigar (medicated cigar) made of aromatic substances should be given for smoking. These fragrant and aromatic substances are described under the ''vairechanika dhuma'' (medicated smoking)[Cha.Sa.[[Sutra Sthana]] chapter 5] . [731/2-1/2 74]

*Similarly, the patient should be given medicated cigar prepared from ''shweta'' along with ''hingu''.

*Similarly, the patient should be given medicated cigar prepared from ''shweta'' along with ''hingu''.

*In the ''unmada'' caused by ''vata'' and ''kapha'', sprinkling collyrium(''anjana''), blowing(''pradhamana''), snuffing(''nasya'') and smoking(fumigation) should be done with application of urine, bile, feces, skin, hairs, nails and hide of porcupine (''shallaka''), owl (''uluka''), cat (''marjara''), jackal (''jambuka''), wolf (''vrika'') and goat (''basta''). [741/2-1/2 76]

*In the ''unmada'' caused by ''[[vata]]'' and ''[[kapha]]'', sprinkling collyrium(''anjana''), blowing(''pradhamana''), snuffing(''[[nasya]]'') and smoking(fumigation) should be done with application of urine, bile, feces, skin, hairs, nails and hide of porcupine (''shallaka''), owl (''uluka''), cat (''marjara''), jackal (''jambuka''), wolf (''vrika'') and goat (''basta''). [741/2-1/2 76]

=== Treatment of ''pitta'' dominant ''unmada'' ===

=== Treatment of ''[[pitta]]'' dominant ''unmada'' ===

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In ''pitta'' dominant type of ''unmada'', the patients should be given ''tikta'', and ''jivaniya ghrita'' (ghee cooked with bitter and vitalisers e.g. ''maha tiktaka ghrita'' [Cha. Sa.[[Chikitsa Sthana]]  7 ] and ''jivaniya ghrita'' [Cha. Sa.[[Chikitsa Sthana]]  29] and ''mishraka sneha''[ Cha. Sa.[[Chikitsa Sthana]] 5] are efficacious. Moreover, the patient should be given cold, sweet and soft food and drinks or the physician should perform blood-letting vein situated at the joining place of temple and the end of hair line in ''unmada'', irregular fever and epilepsy. [76-77]

In ''[[pitta]]'' dominant type of ''unmada'', the patients should be given ''tikta'', and ''jivaniya ghrita'' (ghee cooked with bitter and vitalisers e.g. ''maha tiktaka ghrita'' [Cha. Sa.[[Chikitsa Sthana]]  7 ] and ''jivaniya ghrita'' [Cha. Sa.[[Chikitsa Sthana]]  29] and ''mishraka sneha''[ Cha. Sa.[[Chikitsa Sthana]] 5] are efficacious. Moreover, the patient should be given cold, sweet and soft food and drinks or the physician should perform blood-letting vein situated at the joining place of temple and the end of hair line in ''unmada'', irregular fever and epilepsy. [76-77]

=== Isolation of ''unmada'' patients ===

=== Isolation of ''unmada'' patients ===

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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, forefather or ''gandharvas'', the wise physician should avoid irritant collyrium etc. and other harsh measures. Instead he should use intake of ghee and other mild medicament. Moreover, worship, offering (''bali''), gifts (''upahara''), recitation of hymns(''mantra''), collyrium (''anjana''), pacificatory rituals (''shanti karma'') and 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]  

In the ''unmada'' caused by gods, sages, forefather or ''gandharvas'', the wise physician should avoid irritant collyrium etc. and other harsh measures. Instead he should use intake of ghee and other mild medicament. Moreover, worship, offering (''bali''), gifts (''upahara''), recitation of hymns(''mantra''), collyrium (''anjana''), pacificatory rituals (''shanti karma'') and 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]  

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The person having preponderance of ''sattva'' (strong mental strength), abstaining from meat and wine, taking wholesome diet, sincere and 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 and 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'' ===

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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 (''[[dhatu]]s'') are  the signs of having recovered from ''unmada''. [97]

=== Summary ===

=== Summary ===

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

*The diet poor in qualities, behavioral 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''.  

*''Hridaya'' (seat of mind) also holds the site of intellectual functions and it is vitiated in patho-physiology of ''unmada''.

*''Hridaya'' (seat of mind) also holds the site of intellectual functions and it is vitiated in patho-physiology of ''unmada''.

*''Unmada'' involves excessive affliction of intellect, mind and memory. This may be due to either endogenous causes or exogenous causes.  

*''Unmada'' involves excessive affliction of intellect, mind and memory. This may be due to either endogenous causes or exogenous causes.  

*The endogenous causes include vitiation of ''dosha'' resulting in variety of ''unmada'' with their dominance. ''Sharira dosha'' can afflict the psyche, intellect and memory to cause a psycho-somatic disorder.   

*The endogenous causes include vitiation of ''[[dosha]]'' resulting in variety of ''unmada'' with their dominance. ''Sharira [[dosha]]'' can afflict the psyche, intellect and memory to cause a psycho-somatic disorder.   

*External social, psychological and spiritual factors can also lead to exogenous ''unmada'' in similar way.  

*External social, psychological and spiritual factors can also lead to exogenous ''unmada'' in similar way.  

*Diagnosis of exogenous ''unmada'' is based upon the behavior pattern of afflicted person. The treatment includes assessment of intention of the spirits in terms of pleasure and worship. It should be ascertained as such by the liking (intentions) and behavior (conduct) of the patients  and should be treated with administration of the ''mantras'' (incantations/hymns) and drugs mixed with the respective gifts and offerings. This is immaterialistic treatment.  

*Diagnosis of exogenous ''unmada'' is based upon the behavior pattern of afflicted person. The treatment includes assessment of intention of the spirits in terms of pleasure and worship. It should be ascertained as such by the liking (intentions) and behavior (conduct) of the patients  and should be treated with administration of the ''mantras'' (incantations/hymns) and drugs mixed with the respective gifts and offerings. This is immaterialistic treatment.  

*Various purification procedures are administered as per the ''dosha'' dominance, strength of the patient.  

*Various purification procedures are administered as per the ''[[dosha]]'' dominance, strength of the patient.  

*In order to prevent from getting afflicted by ''unmada'', the person shall have preponderance of ''sattva'' (strong mental strength), abstaining from meat and wine, taking wholesome diet, sincere and disciplined and observing purity of mind and body.

*In order to prevent from getting afflicted by ''unmada'', the person shall have preponderance of ''[[sattva]]'' (strong mental strength), abstaining from meat and wine, taking wholesome diet, sincere and disciplined and observing purity of mind and body.

*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 (''[[dhatu]]s'') are the signs of having recovered from ''unmada''.

== Vidhi Vimarsha (Applied Inferences ) ==

== Vidhi Vimarsha (Applied Inferences ) ==

==== ''Nija unmada'' (endogenous psychoses) ====

==== ''Nija unmada'' (endogenous psychoses) ====

#''Vata'' dominant ''unmada'' is similar to excited catatonic type of schizophrenia and is acute form of schizophrenia. These patients present with the symptoms of catatonic excitement with general symptoms of ''unmada''. It is produced due to vitiation of ''vata'' along with ''rajas'' and ''tamas doshas''. Due to excess of ''rajas'' and ''vata'', catatonic excitement occurs.

#''[[Vata]]'' dominant ''unmada'' is similar to excited catatonic type of schizophrenia and is acute form of schizophrenia. These patients present with the symptoms of catatonic excitement with general symptoms of ''unmada''. It is produced due to vitiation of ''[[vata]]'' along with ''[[rajas]]'' and ''[[tamas]] doshas''. Due to excess of ''[[rajas]]'' and ''[[vata]]'', catatonic excitement occurs.

#The ''pitta'' dominant ''unmada'' is similar to maniac psychosis. The patients and mania, show a generalised functional overactivity or increased psychomotor activity, excitability of mood, constant movement, increased talkativeness, aggressive behavior, irritability as the prominent symptoms.  

#The ''[[pitta]]'' dominant ''unmada'' is similar to maniac psychosis. The patients and mania, show a generalised functional overactivity or increased psychomotor activity, excitability of mood, constant movement, increased talkativeness, aggressive behavior, irritability as the prominent symptoms.  

#The Features of ''kaphaja unmada'' resemble closely with stuporous catatonic schizophrenia and major depressive disorder and thus they can be correlated.  

#The Features of ''[[kapha]]ja unmada'' resemble closely with stuporous catatonic schizophrenia and major depressive disorder and thus they can be correlated.  

#There are clinical conditions in which alternating phases of depression and mania, known as bipolar disorders or maniac depressive psychosis. Similarly, there are forms of schizophrenia, in which excited catatonia and stuporous catatonia are alternatively present (periodic catatonia). These conditions, based upon particular ''doshic'' combination in the pathogenesis, as indicated by ''kapha'' is aggravated along with ''pitta''.  

#There are clinical conditions in which alternating phases of depression and mania, known as bipolar disorders or maniac depressive psychosis. Similarly, there are forms of schizophrenia, in which excited catatonia and stuporous catatonia are alternatively present (periodic catatonia). These conditions, based upon particular ''doshic'' combination in the pathogenesis, as indicated by ''[[kapha]]'' is aggravated along with ''[[pitta]]''.  

#All types of chronic, incapacitating psychotic conditions are included under the category of ''sannipatika / 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.

#All types of chronic, incapacitating psychotic conditions are included under the category of ''sannipatika / tridoshaja unmada''. Hebephrenic schizophrenia, chronic schizophrenia and residual schizophrenia come under this category, again the difference being predominance of the ''[[dosha]]s'' involved in the psychopathogenesis.

==== ''Agantuja unmada'' (exogenous psychoses)====

==== ''Agantuja unmada'' (exogenous psychoses)====

==== ''Yuktivyapashraya  Chikitsa'' (rational treatment) ====

==== ''Yuktivyapashraya  Chikitsa'' (rational treatment) ====

The purification procedures prescribed in ''unmada'' are :(1) ''Nasya'' (2) ''Vamana'' (3) ''Virechana'' (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 ''unmada'' are :(1) ''[[Nasya]]'' (2) ''[[Vamana]]'' (3) ''[[Virechana]]'' (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, snehapana'' 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 ''[[vata]]ja unmada, snehapana'' has to be done. If the passage of ''[[vayu]]'' is obstructed laxative along with ''sneha'' should be given. In ''[[kapha]]ja unmada, [[vamana]]'' must be done. In ''[[pitta]]ja 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 and rationale of ''ghrita-pana/ shamana sneha pana'' ====

==== Concept and rationale of ''ghrita-pana/ shamana sneha pana'' ====

''Snehapana'' is specially indicated in ''unmada. Shamana sneha'' includes the measures that bring down the increased ''doshas'' to normal stage without expelling them out and without disturbing balance of other normal ''doshas''. The properties like ''sukshma, snigdha, picchila'' and ''manda'' operate pharmacologically to pacify ''unmada''.  

''Snehapana'' is specially indicated in ''unmada. Shamana sneha'' includes the measures that bring down the increased ''[[dosha]]s'' to normal stage without expelling them out and without disturbing balance of other normal ''[[dosha]]s''. The properties like ''sukshma, snigdha, picchila'' and ''manda'' operate pharmacologically to pacify ''unmada''.  

==== Recommended therapies for ''dosha'' dominant ''unmada'' ====

==== Recommended therapies for ''[[dosha]]'' dominant ''unmada'' ====

#''Snehana'' (oleation)  

#''[[Snehana]]'' (oleation)  

#''Swedana'' (fomentation)  

#''[[Swedana]]'' (fomentation)  

#''Vamana'' (emesis)  

#''[[Vamana]]'' (emesis)  

#''Virechana'' (purgation)  

#''[[Virechana]]'' (purgation)  

#''Asthapana'' and anuvasana bastis.  

#''Asthapana'' and anuvasana [[basti]]s.  

#''Upashamana'' (alleviation therapies)

#''Upashamana'' (alleviation therapies)

#''nasya'' (errhines)   

#''[[nasya]]'' (errhines)   

#''dhooma'' (smoking)  

#''dhooma'' (smoking)  

#''dhoopana'' (fumigation)

#''dhoopana'' (fumigation)

#''sira vedha'' (venesection) .

#''sira vedha'' (venesection) .

==== Specific therapies by ''dosha'' dominant ''unmada'' , and prescribed medicines====

==== Specific therapies by ''[[dosha]]'' dominant ''unmada'' , and prescribed medicines====

*'''''Vata'' dominance''': ''Snehapana, mrudu shodhana, Samsarjana, swedana, niruha, shirovirechana, dhupana, anjana, dhuma, lepana, snana.''

*'''''[[Vata]]'' dominance''': ''Snehapana, mrudu [[shodhana]], Samsarjana, [[swedana]], niruha, shirovirechana, dhupana, anjana, dhuma, lepana, snana.''

'''Medicines''': ''Kalyanaghrita, mahakalyanghrita, phalaghrita, hinguvadi ghrita, mahapaishachakaghrita, lasunadighrita, vyosadivarti, sirishadivarti, apamargadi varti, marichadivarti, siddharthakadyagada, shallakyadyagada, srugaladiyoga, brahmyadivarti.''

'''Medicines''': ''Kalyanaghrita, mahakalyanghrita, phalaghrita, hinguvadi ghrita, mahapaishachakaghrita, lasunadighrita, vyosadivarti, sirishadivarti, apamargadi varti, marichadivarti, siddharthakadyagada, shallakyadyagada, srugaladiyoga, brahmyadivarti.''

*'''''Pitta'' dominance''': ''Snehana, swedana, rechana raktamokshna, samsarjana, sirovirechana, sheeta, madhura, laghu annapana''.

*'''''[[Pitta]]'' dominance''': ''[[Snehana]], [[swedana]], rechana, [[raktamokshna]], samsarjana, sirovirechana, sheeta, madhura, laghu annapana''.

'''Medicines''': Tiktaghrita, jivanthyadighrita. mishrak sneha.

'''Medicines''': Tiktaghrita, jivanthyadighrita. mishrak sneha.

*'''''Kapha'' dominance''': ''Sneha, sweda, vamana, rechana, sirovirechana, samsarjana, shirobasti, abhyanga, dhupana, anjana, dhuma, parisechana, pradeha, dhmapana.''

*'''''[[Kapha]]'' dominance''': ''Sneha, sweda, [[vamana]], rechana, sirovirechana, samsarjana, shirobasti, abhyanga, dhupana, anjana, dhuma, parisechana, pradeha, dhmapana.''

'''Medicines''': ''Shrigaladiyoga, lasunadighrita, katur taila, brahmyadivarti''.

'''Medicines''': ''Shrigaladiyoga, lasunadighrita, katur taila, brahmyadivarti''.

==== ''Satvavajaya'' ====

==== ''Satvavajaya'' ====

The methods of yuktivyapasraya treatment have been prescribed in the treatment of mental diseases. But in the derailment of manasika doshas, it is  essential that the line of treatment of mental diseases should be specific and  based on the theory of balancing the mental doshas (rajas and tamas). Taking into consideration all these factors, most probably in [[Ayurveda]] a separate classification of satvavajaya treatment has been specially mentioned. Charak defines it as a mind control therapy in which stress will be laid on restraining the mind from unwholesome arthas (objects). Certain techniques have been mentioned for this therapy.  

The methods of yuktivyapasraya treatment have been prescribed in the treatment of mental diseases. But in the derailment of manasika doshas, it is  essential that the line of treatment of mental diseases should be specific and  based on the theory of balancing the mental doshas ([[rajas]] and [[tamas]]). Taking into consideration all these factors, most probably in [[Ayurveda]] a separate classification of satvavajaya treatment has been specially mentioned. Charak defines it as a mind control therapy in which stress will be laid on restraining the mind from unwholesome arthas (objects). Certain techniques have been mentioned for this therapy.  

The inclusion of satvavajaya chikitsa, within these primary classifications of treatment of diseases, clearly indicates that this therapy of mano-nigraha was adopted in those days as a practical therapy to over come the psychological and psychosomatic diseases. While describing the principles of treatment, Charak prescribes the following methods of treatment for mental diseases:

The inclusion of satvavajaya chikitsa, within these primary classifications of treatment of diseases, clearly indicates that this therapy of mano-nigraha was adopted in those days as a practical therapy to over come the psychological and psychosomatic diseases. While describing the principles of treatment, Charak prescribes the following methods of treatment for mental diseases:

#Vijnana (scientific knowledge)  

#Vijnana (scientific knowledge)  

#Dhairya (sustaining courage in adverse conditions)  

#Dhairya (sustaining courage in adverse conditions)  

#Smrti (good memories)

#[[Smrti]] (good memories)

#Samadhi (meditation and contemplation).

#Samadhi (meditation and contemplation).

Manovahasrotas can be understood as the channels conducting various factors that regulate behavior. Vitiation of these srotas at different levels produce abnormal behavioral patterns thereby bringing about the psychological & behavioural symptoms of unmada vis-à-vis psychosis. A number of formulations, treatment modalities, procedures and therapeutic techniques have been described with predominance of lipid predominant dosage forms esp. ghritas & tailas, which seems to be so formulated as to exert maximum effect on neural tissue by increasing bio-availability of formulation by increased ability to cross blood –brain barrier. All the preventive measures mentioned by Acaryas are aimed at bestowing relaxation and mental balance, which are the basic prerequisites of a sound mind. It may be mentioned here that sharira shuddhi is needed before attaining manasika shuddhi.  

Manovahasrotas can be understood as the channels conducting various factors that regulate behavior. Vitiation of these srotas at different levels produce abnormal behavioral patterns thereby bringing about the psychological & behavioural symptoms of unmada vis-à-vis psychosis. A number of formulations, treatment modalities, procedures and therapeutic techniques have been described with predominance of lipid predominant dosage forms esp. ghritas & tailas, which seems to be so formulated as to exert maximum effect on neural tissue by increasing bio-availability of formulation by increased ability to cross blood –brain barrier. All the preventive measures mentioned by Acaryas are aimed at bestowing relaxation and mental balance, which are the basic prerequisites of a sound mind. It may be mentioned here that sharira shuddhi is needed before attaining manasika shuddhi.  

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 ===

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