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Unmada Nidana (view source)

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<big>'''Nidana Sthana Chapter 7. Diagnosis and etiopathogenesis of psychosis disorders '''</big>

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<big>'''Abstract'''</big>

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<div style="text-align:justify;">This chapter describes the detailed etiopathogenesis and types of a large class of major mental disorders or psychoses named as Unmada. The word Unmada, literally means frenzy, madness or mental derangement. Unmada is characterized by a disordered mental state in the faculties of mind and intellect. This leads to perverted presentation of thought processes, decision making, intellectual functioning, orientation and responsiveness, memory, desires, habits, character, psychomotor activity, conduct and behaviour. The clinical diagnosis of unmada, its etiology, psychopathogenesis, and prodromal features have been elaborately described in this chapter. </div>

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'''Keywords''': ''Unmada, Sanjna Jnana, Amarsha, himsa, Prajnaparadha'', Psychosis, insanity, mental factors examination, perversion, impairment of decision making, intellectual functions.

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</div>

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{{Infobox

|title = Unmada Nidana

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|data1 = [[Nidana Sthana]] Chapter 7

|label2 = Preceding Chapter

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|data2 = [[~~Sosha~~ Nidana]]

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|data2 = [[Shosha Nidana]]

|label3 = Succeeding Chapter

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}}

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~~==([[Nidana Sthana]] Chapter 7, Chapter on Major Mental Disorders)==~~

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~~=== Abstract ===~~

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The seventh chapter of [[Nidana Sthana]], titled [[Unmada Nidana]], describes the detailed etiopathogenesis and types of ''unmada roga'' a large class of major mental disorders or psychoses. ''Unmada'', in Sanskrit, literally means frenzy, madness or mental derangement. Thus, ''unmada'' is characterized by a disordered mental state in the faculties of ''manas'' (thought processes), ''buddhi'' (decision making and intelligence), ''sanjna jnana'' (orientation and responsiveness/ consciousness), ''smriti'' (memory), ''bhakti'' (desire), ''sheela'' (habits and character), ''cheshta'' (psychomotor activity ) and ''achara'' (conduct and behaviour). For the clinical diagnosis of ''unmada'', its etiology, psychopathogenesis, and prodromal features have been elaborately described in this chapter.

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~~'''Keywords''': ''Unmada, Sanjna Jnana, Amarsha, himsa, Prajnaparadha'', Psychosis, insanity, mental factors examination.~~

=== Introduction ===

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''Unmada'', a major mental disorder, has been known to Ayurvedic practitioners since ancient times in India. In the Vedic period, the disease was thought to be caused due to ''grahas'' or demons, but in [~~https://en.wikipedia.org/wiki/Ayurveda~~ Ayurveda], it is considered a major mental illness. ''Unmada'' as such does not describe a lone clinical entity comparable to a modern diagnostic category, rather it is a group of psychotic disorders. As the psychotic disorders cover almost all the major mental illnesses, the different types and subtypes 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, and depressive disorders.

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''Unmada'', a major mental disorder, has been known to Ayurvedic practitioners since ancient times in India. In the Vedic period, the disease was thought to be caused due to ''grahas'' or demons, but in [[Ayurveda]], it is considered a major mental illness. ''Unmada'' as such does not describe a lone clinical entity comparable to a modern diagnostic category, rather it is a group of psychotic disorders. As the psychotic disorders cover almost all the major mental illnesses, the different types and subtypes 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, and depressive disorders.

Thus, ''unmada'' covers a wide range of major mental disorders and is considered synonymous with madness and mental derangement, in which a person loses contact with reality and loses the ability to regulate his actions & conduct according to the norms of the society. When ''doshas'' move upwards in the body into the head, they could cause aberrations in the functioning of ''manas''(mind) while producing ''mada'' (delusional/ intoxicated state) in an individual. The mental status of psychotic patients is vividly described while explaining the clinical aspect of the disease. The description suggests that a patient of ''unmada'' develops derangement of all the activities of ''manas''(mind), ''buddhi''(intellect), ''ahamkara''(ego) and ''indriyas'' (sense organs). The patient develops thought disturbances in the form of abnormalities of ''chintana''(thinking), ''vichara''(discriminating) and ''uha''(analyzing), derangement of memory in the form of ''smriti nasa'' (memory loss.) and ''smriti bhramsha'' (memory impairment), behavioral, social and emotional disturbances in the form of abnormalities of ''achara, dharma'' and ''bhavas'' along with functional derangement of ''indriyas'' which is manifested clinically as disturbed speech and other variants such as incoherence (''abaddha vakyam''), thought blocking (''hridaya shunyata''), loosening of associations, neologism, echolalia etc. and various psychomotor disturbances.

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''Unmada'' is classified into two broad categories: ''nija''(endogenous), or those caused by internal imbalance of ''dosha'' i.e. ''vata'', ''pitta, kapha'' and ''sannipataja'', and ''agantu nimitta'', i.e., those caused by exogenous factors. Sushruta (S. ut.62/4-5) and Vagbhatta - both are of the opinion that ''unmada'' is of six types, of which four are due to ''doshas'', the fifth is ''madyaja'' (like intoxications) and sixth is ''vishaja'' (poison-based or poison-like). Both have described the ''agantuja unmada'' separately as the condition of ''amanushopasarga'' (due to affliction of supra-human power) and ''bhuta badha'' (due to affliction of demons), under the heading ''amanusopasarga pratishedha'' (treatment of affliction of supra-human power) and ''bhuta badha pratisedha'' (treatment of affliction of demons) respectively. The body of knowledge within [~~https://en.wikipedia.org/wiki/Ayurveda~~ Ayurveda] dedicated to psychiatry underscores the advancement in scientific knowledge on this subject that existed thousands of years ago.

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''Unmada'' is classified into two broad categories: ''nija''(endogenous), or those caused by internal imbalance of ''dosha'' i.e. ''vata'', ''pitta, kapha'' and ''sannipataja'', and ''agantu nimitta'', i.e., those caused by exogenous factors. Sushruta (S. ut.62/4-5) and Vagbhatta - both are of the opinion that ''unmada'' is of six types, of which four are due to ''doshas'', the fifth is ''madyaja'' (like intoxications) and sixth is ''vishaja'' (poison-based or poison-like). Both have described the ''agantuja unmada'' separately as the condition of ''amanushopasarga'' (due to affliction of supra-human power) and ''bhuta badha'' (due to affliction of demons), under the heading ''amanusopasarga pratishedha'' (treatment of affliction of supra-human power) and ''bhuta badha pratisedha'' (treatment of affliction of demons) respectively. The body of knowledge within [[Ayurveda]] dedicated to psychiatry underscores the advancement in scientific knowledge on this subject that existed thousands of years ago.

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</div>

===Sanskrit Text, Transliteration and English Translation===

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==== Five types of ''unmada'' ====

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इह खलु पञ्चोन्मादा भवन्ति; तद्यथा- वातपित्तकफसन्निपातागन्तुनिमित्ताः||३||

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इह खलु पञ्चोन्मादा भवन्ति|

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तद्यथा- वातपित्तकफसन्निपातागन्तुनिमित्ताः||३||

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iha khalu pañcōnmādā bhavanti|

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tadyathā- vātapittakaphasannipātāgantunimittāḥ||3||

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~~iha khalu pañcōnmādā~~ bhavanti~~; tadyathā- vātapittakaphasannipātāgantunimittāḥ||3|~~|

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Iha Khalu pa~jconmAdA bhavanti|

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~~Iha Khalu pa~jconmAdA bhavanti;~~ tadyathA- vAtapittakaphasannipAtAgantunimittAH||3||

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tadyathA- vAtapittakaphasannipAtAgantunimittAH||3||

There are five types of ''unmada'' such as those caused due to the three ''doshas, sannipata'' (simultaneous vitiation of the three ''doshas''), and exogenous causes. [3]

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manovahAni srotAMsyAvRutya janayantyUnmadaam||4||

tatra doShanimittAshcatvAraH

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This verse describes the qualities of a person prone to getting afflicted with ''unmada'', as well as the conditions that are conducive to the affliction of the disease:

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Such individuals often get afflicted with subclinical mental disorders, leading to unstable intellect because of volatile ''doshas''. When the seat of consciousness, wisdom, and the system that regulates mental activities are badly affected, then all these factors lead to the manifestation of ''unmada''. [4]

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</div>

==== Types of cognitive distortions ====

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Unmadaam punarmanobuddhisa~jj~jAj~jAnasmRutibhaktishIlaceShTAcAravibhramavidyAt||5||

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Unmada is again defined as cognitive distortion pertaining to mind, intellect, consciousness, knowledge, memory, desire, attitude, activities and behavior. [5]

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''Unmada'' is again defined as cognitive distortion pertaining to mind, intellect, consciousness, knowledge, memory, desire, attitude, activities and behavior. [5]

==== Premonitory symptoms ====

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vAtopashayaviparyAsAdanupashayatA ca;

iti vAtonmAdali~ggAni bhavanti(1);

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After the above stage, ''unmada'' manifests. The distinctive features of ''vatika'' type of ''unmada'' are as follows:

*Constant wandering

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*Aggravation by ''vata''-provoking factors; and

*Pacification by factors which are opposite to ''vata''

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</div>

These are the features of ''vatika'' type of ''unmada''. [7-1]

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vitrAsanavismApanavismAraNApatarpaNasirAvyadhanAni,ca yathAsvaM

yuktyA, yaccAnyadapi ki~jcinnidAnaviparItamauShadhaM tadapi kAryaM syAditi||8||

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Modalities of treatment of the three types of curable ''unmada'' are:

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Suitable diets should be given according to the requirement of the patient. Such other therapies as would work against the causative factors of the disease should also be given. [8]

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</div>

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भवति चात्र-

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उन्मादान् दोषजान् साध्यान् साधयेद्भिषगुत्तमः|

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अनेन विधियुक्तेन कर्मणा यत् प्रकीर्तितम्||९||

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bhavati cātra-

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~~भवति चात्र-~~

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unmādān dōṣajān sādhyān sādhayēdbhiṣaguttamaḥ|

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~~उन्मादान् दोषजान् साध्यान् साधयेद्भिषगुत्तमः|~~

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~~अनेन विधियुक्तेन कर्मणा यत् प्रकीर्तितम्||९|~~|

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~~bhavati cātra- unmādān dōṣajān sādhyān sādhayēdbhiṣaguttamaḥ|~~

anēna vidhiyuktēna karmaṇā yat prakīrtitam||9||

Bhavati cAtra-

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UnmadaAn doShajA sAdhyAn sAdhayedbhiShaguttamaH|

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Anena vidhiyuktena karmaNA yat prakIrtitam||9||

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==== Exogenous ''unmada'' ====

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यस्तु दोषनिमित्तेभ्य उन्मादेभ्यः समुत्थानपूर्वरूपलिङ्गवेदनोपशयविशेषसमन्वितो भवत्युन्मादस्तमागन्तुकमाचक्षते| केचित् पुनः पूर्वकृतं कर्माप्रशस्तमिच्छन्ति तस्य निमित्तम् | तस्य च हेतुः प्रज्ञापराध एवेति भगवान् पुनर्वसुरात्रेयः| प्रज्ञापराधाद्ध्ययं देवर्षिपितृगन्धर्वयक्षराक्षसपिशाच गुरुवृद्धसिद्धाचार्यपूज्यानवमत्याहितान्याचरति, अन्यद्वा किञ्चिदेवंविधं कर्माप्रशस्तमारभते; तमात्मना हतमुपघ्नन्तो देवादयःकुर्वन्त्युन्मत्तम्||१०||

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यस्तु दोषनिमित्तेभ्य उन्मादेभ्यः समुत्थानपूर्वरूपलिङ्गवेदनोपशयविशेषसमन्वितो भवत्युन्मादस्तमागन्तुकमाचक्षते|

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केचित् पुनः पूर्वकृतं कर्माप्रशस्तमिच्छन्ति तस्य निमित्तम् |

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तस्य च हेतुः प्रज्ञापराध एवेति भगवान् पुनर्वसुरात्रेयः|

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प्रज्ञापराधाद्ध्ययं देवर्षिपितृगन्धर्वयक्षराक्षसपिशाच गुरुवृद्धसिद्धाचार्यपूज्यानवमत्याहितान्याचरति, अन्यद्वा किञ्चिदेवंविधं कर्माप्रशस्तमारभते; तमात्मना हतमुपघ्नन्तो देवादयःकुर्वन्त्युन्मत्तम्||१०||

yastu dōṣanimittēbhya unmādēbhyaḥ samutthānapūrvarūpaliṅgavēdanōpaśayaviśēṣasamanvitō bhavatyunmādastamāgantukamācakṣatē|

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kēcit punaḥ pūrvakr̥taṁ karmāpraśastamicchanti tasya nimittam|

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tasya [1] ca hētuḥ prajñāparādha ēvēti bhagavān punarvasurātrēyaḥ|

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prajñāparādhāddhyayaṁ dēvarṣipitr̥gandharvayakṣarākṣasapiśācaguruvr̥ddhasiddhācāryapūjyānavamatyāhitānyācarati, anyadvā kiñcidēvaṁvidhaṁkarmāpraśastamārabhatē; tamātmanā hatamupaghnantō dēvādayaḥ kurvantyunmattam||10||

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Yastu dosanimittebhyah Unmadaebhyah samutthAn purvarUpa linga vedanopaSaya visesa samanvito bhavatyUnmadaastamAgantukamAcakShate

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Yastu dosanimittebhyah Unmadaebhyah samutthAn purvarUpa linga vedanopaSaya visesa samanvito bhavatyUnmadaastamAgantukamAcakShate

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Kecit punaH pUrvakRutaM karmAprashastamicchanti |tasya nimittam|

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Kecit punaH pUrvakRutaM karmAprashastamicchanti tasya nimittam|

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hetuH ca praj~jAparAdha eveti bhagavAn punarvasurAtreyaH|

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~~praj~jAparAdhAddhyayaM devarShipitRugandharvayakSharAkShasapishA~~

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~~caguruvRuddhasiddhAcAryapUjyAnavamatyAhitAnyAcarati, anyadvA~~

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~~ki~jcidevaMvidhaM karmAprashastamArabhate; tamAtmanAhatamupaghnanto~~

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~~devAdayaH kurvantyunmattam||10||~~

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praj~jAparAdhAddhyayaM devarShipitRugandharvayakSharAkShasapishA caguruvRuddhasiddhAcAryapUjyAnavamatyAhitAnyAcarati, anyadvA

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ki~jcidevaMvidhaM karmAprashastamArabhate; tamAtmanAhatamupaghnanto devAdayaH kurvantyunmattam||10||

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The type of ''unmada'' having etiology, premonitory symptoms, signs and symptoms, pain and favorable therapeutics (''upashaya'') different from those of the types of ''unmada'' caused by the vitiation of ''doshas'' are known to be of exogenous type. Some scholars hold the view that this type of ''unmada'' is caused by the effect of the activities of the past life. Lord Atreya considers intellectual errors as the causative factor of this condition. Due to intellectual errors, the patient disregards the Gods, ascetics, ancestors, ''gandharvas, yakshas,'' ''rakshasas, pishachas,'' preceptors, elders, teachers and the other respectable ones. He also resorts to undesirable and inauspicious (or blasphemous) activities. The gods etc. cause ''unmada'' in him because of his own inauspicious activities. [10]

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</div>

==== Premonitory symptoms of exogenous ''unmada'' ====

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Unmadayisyatamapi khalu devarShipitRugandharvayakSharAkShasapishAcAnAM guruvRuddhasiddhAnAM vA eShvantareShvabhigamanIyAH puruShA bhavanti;tadyathA- pApasyam,karmaNaH samArambhe, pUrvakRutasya vA NaH pariNAmakAle,ekasya vA shUnyagRuhavAse catuShpathAdhiShThAne vA,sandhyAvelAyAmaprayatabhAvevA parvasandhiShu vA mithunIbhAve, rajasvalAbhigamane vA, viguNe vA~adhyayanabalima~ggalahomaprayoge, niyamavratabrahmacaryabha~ggevA,mahAhave vA,deshakulapuravinAshe vA, mahAgrahopagamane vA, striyA vA prajananakAle, vividhabhUtAshubhAshucisparshanevA,vamanavirecanarudhirasrAve,ashuceraprayatasyavAcaityadevAyatanAbhigamanevA,

mAMsamadhutilaguDamadyocchiShTevA,digvAsasi vA,nishi nagaranigama catuShpathopavana shmashAnAghAtanAbhigamane vA,dvijagurusurayatipUjyAbhidharShaNe vA, dharmAkhyAnavyatikrame vA, anyasya vA karma No~aprashastasyArambhe, tyabhighAtakAlA vyAkhyAtA bhavanti||14||

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Persons get afflicted by ''unmada'' caused by godly spirits, ascetics, ancestors, ''gandharvas, yakshas, rakshasas, pishachas,'' preceptors, elders and adepts in the following circumstances, places and time:

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Thus, described were some circumstances in which a person attracts the wrath of gods, divinities, and the sages and gets afflicted with ''unmada''. [14]

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</div>

त्रिविधं तु खलु उन्मादकराणां भूतानामुन्मादने प्रयोजनं भवति; तद्यथा- हिंसा, रतिः, अभ्यर्चनं चेति तेषां तं प्रयोजनविशेषमुन्मत्ताचार विशेषलक्षणैर्विद्यात्| हिंसा, अप्सु वा स्थलाच्छ्वभ्रे निमज्जति, पतति, शस्त्रकशाकाष्ठलोष्टमुष्टिभिर्हन्त्यात्मानम्, अन्यच्च प्राणवधार्थमारभते किञ्चित्, विद्यात्; तमसाध्यं साध्यौ पुनर्द्वावितरौ||१५||

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#affection/love/pleasure and

#to make the individual pay obeisance to Gods

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The prognosis of ''unmada'' can be judged from the characteristic features of the patient. When the intention of the afflicted agents is to inflict injury, then the patient enters into fire, sinks into water, falls into a pit, provokes others to hurt him, strikes himself with weapons, whips, sticks, brick bats, his own fist etc. He may also adopt to such other means of killing himself. This type of ''unmada'' is incurable.

The other two types of intentions i.e. for affection/love/pleasure or to offer prayer give rise to variants of ''unmada'' that are curable. [15]

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</div>

==== Treatment of exogenous ''unmada'' ====

तयोः साधनानि-

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मन्त्रौषधिमणिमङ्गलबल्युपहारहोमनियमव्रतप्रायश्चित्तोपवास स्वस्त्ययनप्रणिपातगमनादीनि||१६||

tayōḥ sādhanāni-

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mantrauṣadhimaṇimaṅgalabalyupahārahōmaniyamavrataprāyaścittōpavāsa svastyayanapraṇipātagamanādīni||16||

tayoh sAdhanAni-

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mantrauShadhimaNi ma~ggala balyupahArahomaniyama vrataprAyashcitopavAsa svastyayana praNipAtagamanAdIni||16||

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*Performance of auspicious and religious rites and sacrifices, oblations

*Taking a vow, performing religious duties, penance, fasting, blessings, obeisance and pilgrimage. [16]

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==== Role of ''dosha'' in causing various types of ''unmada'' ====

एवमेते पञ्चोन्मादा व्याख्याता भवन्ति||१७||

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ते तु खलु निजागन्तुविशेषेण साध्यासाध्यविशेषेण च प्रविभज्यमानाः

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पञ्च सन्तो द्वावेव भवतः| तौ च परस्परमनुबध्नीतः कदाचिद्यथोक्तहेतुसंसर्गात् |

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तयोः संसृष्टमेव पूर्वरूपं भवति, संसृष्टमेव च लिङ्गम्| तत्रासाध्यसंयोगं साध्यासाध्यसंयोगं चासाध्यं विद्यात्, साध्यं तु साध्यसंयोगम् |

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तस्य साधनं साधनसंयोगमेव विद्यादिति||१८||

tē tu khalu nijāgantuviśēṣēṇa sādhyāsādhyaviśēṣēṇa ca pravibhajyamānāḥ pañca santō dvāvēva bhavataḥ|

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tau ca parasparamanubadhnītaḥ kadācidyathōktahētusaṁsargāt|

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tayōḥ saṁsr̥ṣṭamēva pūrvarūpaṁ bhavati, saṁsr̥ṣṭamēva ca liṅgam|

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tatrāsādhyasaṁyōgaṁ sādhyāsādhyasaṁyōgaṁ cāsādhyaṁ vidyāt, sādhyaṁ tu sādhyasaṁyōgam|

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tasya sādhanaṁ sādhanasaṁyōgamēva vidyāditi||18||

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Te khalunijAgantuvisheSheNa sAdhyAsAdhyavisheSheNa capravibhajyamAnAH

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Te khalunijAgantuvisheSheNa sAdhyAsAdhyavisheSheNa capravibhajyamAnAH pa~jca santo dvAveva bhavataH |

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pa~jca santo dvAveva bhavataH ~~|tau ca parasparamanubadhnItaH kadAcidyathoktahetusaMsargAt | tayoH saMsRuShTameva pUrvarUpaM bhavati,saMsRuShTameva ca li~ggam| tatrAsAdhyasaMyogaM sAdhyAsAdhyasaMyogaM~~

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~~cAsAdhyaM vidyAt, sAdhyaM tu sAdhyasaMyogam| tasya sAdhanaM sAdhanasaMyogameva vidyAditi||18|~~|

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tau ca parasparamanubadhnItaH kadAcidyathoktahetusaMsargAt |

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tayoH saMsRuShTameva pUrvarUpaM bhavati,saMsRuShTameva ca li~ggam|

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tatrAsAdhyasaMyogaM sAdhyAsAdhyasaMyogaM cAsAdhyaM vidyAt, sAdhyaM tu sAdhyasaMyogam| tasya sAdhanaM sAdhanasaMyogameva vidyAditi||18||

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The ''unmada'' of five types can be further classified as endogenous or exogenous or as curable or incurable. At times, due to the combination of etiological factors (of endogenous and exogenous types), these could also manifest in hybrid forms. Such forms would exhibit a combination of both the types of ''unmada'' in their premonitory as well as actual symptoms. However, it is important to note that:

*Combination of the incurable types or of the curable and incurable types result in an incurable condition.

*Combination of curable types results in curable conditions that should be treated using a combination of therapies. [18]

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</div>

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==== Responsible factors for ''unmada'' ====

भवन्ति चात्र-

+

नैव देवा न गन्धर्वा न पिशाचा न राक्षसाः|

+

न चान्ये स्वयमक्लिष्टमुपक्लिश्नन्ति मानवम्||१९||

bhavanti cātra-

+

naiva dēvā na gandharvā na piśācā na rākṣasāḥ|

+

na cānyē svayamakliṣṭamupakliśnanti mānavam||19||

cAtra-

−

naiva devA na gandharvA na pishAcA na rAkShasAH|

+

naiva devA na gandharvA na pishAcA na rAkShasAH|

+

na cAnyesvayamakliShTamupaklishnanti mAnavam||19||

Line 445: Line 497:

ये त्वेनमनुवर्तन्ते क्लिश्यमानं स्वकर्मणा |

+

न स तद्धेतुकः क्लेशो न ह्यस्ति कृतकृत्यता||२०||

yē tvēnamanuvartantē kliśyamānaṁ svakarmaṇā|

+

na sa taddhētukaḥ klēśō [1] na hyasti kr̥takr̥tyatā||20||

ye tvenamanuvartante klishyamAnaM svakarmaNA|

−

na sa taddhetukaH klesho na hyasti kRutakRutyatA||20||

+

na sa taddhetukaH klesho na hyasti kRutakRutyatA||20||

If the primary cause of ''unmada'' is misdeeds of the individual, then how could the causation of these exogenous ''unmada'' be attributed to divinities? Misdeeds committed already cannot be undone, but good deeds can pacify or neutralize the effects of these exogenous factors. [20]

प्रज्ञापराधात् सम्भूते व्याधौ कर्मज आत्मनः|

+

नाभिशंसेद्बुधो देवान्न पितॄन्नापि राक्षसान्||२१|

prajñāparādhāt sambhūtē vyādhau karmaja ātmanaḥ|

+

nābhiśaṁsēdbudhō dēvānna pitr̥̄nnāpi rākṣasān||21||

pragnAparAdhAt sambhUte vyAdhau karmaja AtmanaH|

+

nAbhishaMsedbudho devAnna pitRUnnApi rAkShasAn||21||

Line 467: Line 525:

आत्मानमेव मन्येत कर्तारं सुखदुःखयोः|

+

तस्माच्छ्रेयस्करं मार्गं प्रतिपद्येत नो त्रसेत्||२२||

ātmānamēva manyēta kartāraṁ sukhaduḥkhayōḥ|

+

tasmācchrēyaskaraṁ mārgaṁ pratipadyēta nō trasēt||22||

−

AtmAnameva manyeta kartAraM sukhaduHkhayoH|

+

AtmAnameva manyeta kartAraM sukhaduHkhayoH|

−

tasmAcchreyaskaraM mArgaM pratipadyeta no traset||22||

+

tasmAcchreyaskaraM mArgaM pratipadyeta no traset||22||

One should hold himself responsible for his happiness and miseries. Therefore, one should follow the path of welfare without apprehensions. [22]

देवादीनामपचितिर्हितानां चोपसेवनम्|

+

ते च तेभ्यो विरोधश्च सर्वमायत्तमात्मनि||२३||

dēvādīnāmapacitirhitānāṁ cōpasēvanam|

+

tē ca [1] tēbhyō virōdhaśca sarvamāyattamātmani||23||

devAnAmapacitirhitAnAM copasevanam|

−

te ca tebhyo virodhashca sarvamAyattamAtmani||23||

+

te ca tebhyo virodhashca sarvamAyattamAtmani||23||

Prayers to the Gods etc. and resorting to wholesome dietary and lifestyle habits act as antidotes to the misdeeds of the individual. Thus, the choice either to avert or get afflicted with ''unmada'' rests with the individual himself. [23]

+

==== Summary ====

तत्र श्लोकः-

+

सङ्ख्या निमित्तं प्राग्रूपं लक्षणं साध्यता न च|

+

उन्मादानां निदानेऽस्मिन् क्रियासूत्रं च भाषितम्||२४||

−

tatra ślōkaḥ- saṅkhyā nimittaṁ prāgrūpaṁ lakṣaṇaṁ sādhyatā na ca|

+

tatra ślōkaḥ-

+

saṅkhyā nimittaṁ prāgrūpaṁ lakṣaṇaṁ sādhyatā na ca|

+

unmādānāṁ nidānē'smin kriyāsūtraṁ ca bhāṣitam||24||

Tatra shloka-

−

~~sa~gkhyA nimittaM prAgrUpaM lakShaNaM sAdhyatA na ca|~~

−

~~UnmadaAnAM nidAne~asmin kriyAsUtraM ca bhAShitam||24||~~

+

sa~gkhyA nimittaM prAgrUpaM lakShaNaM sAdhyatA na ca|

+

UnmadaAnAM nidAne~asmin kriyAsUtraM ca bhAShitam||24||

+

In summary, types of ''unmada'' and their etiology, premonitory symptoms, symptoms, curability or otherwise, and their modes of treatment have been described in this chapter. [ 24]

−

Thus ends the seventh chapter on diagnosis of ''unmada'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by ~~Charaka~~ . [24]

+

Thus ends the seventh chapter on diagnosis of ''unmada'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charak. [24]

−

=== ''Tattva Vimarsha'' ===

+

=== ''Tattva Vimarsha'' / Fundamental Principles===

*The ''unmada'' pathology involves psychic ''dosha'' (''rajas'' and ''tamas'') and body ''doshas'' ( ''vata, pitta'' and ''kapha'').

Line 517: Line 591:

*All the diseases are caused due to intellectual errors. The Gods, ancestors or demons shall not be blamed for any disease. One should hold himself responsible for his happiness and miseries. Therefore, one should follow the path of welfare without apprehensions.

−

=== ''Vidhi Vimarsha'' ===

+

=== ''Vidhi Vimarsha'' / Applied Inferences===

−

As the present chapter deals with the psychopathogenesis and diagnosis of ''unmada'', the fundamental approach of [~~https://en.wikipedia.org/wiki/Ayurveda~~ Ayurveda] in the etiopathogenesis of psychiatric diseases needs to be discussed. ~~Charaka~~ considers violation of dietetic rules as an important causative factor for ''unmada''. Both body and mind are affected by diet. ''Unmada'' occurs in individuals taking diet in manners forbidden by the dietetic rules, consuming improper dietary articles, food articles that are unclean and ill prepared, incompatible and vitiated. According to Chandogya Upanishad, quality of mind depends upon the food taken by the individual. Once digested, the food is divided into three components – gross (''sthula''), medium (''madhyam'') and (''sukshma''). The subtle portion of the food nourishes the mind. Bhagavad Gita also opines that the ''sattvika, rajasika'' and ''tamasika'' types of ''buddhi'' (intellect) is derived from the characteristics associated with the type of diet. Thus, [~~https://en.wikipedia.org/wiki/Ayurveda~~ Ayurveda] considers that incompatible, vitiated food articles affect the physical as well as mental state of an individual, predisposing him to psychiatric illnesses in general, if he is already harboring other causative factors.

+

As the present chapter deals with the psychopathogenesis and diagnosis of ''unmada'', the fundamental approach of [[Ayurveda]] in the etiopathogenesis of psychiatric diseases needs to be discussed. Charak considers violation of dietetic rules as an important causative factor for ''unmada''. Both body and mind are affected by diet. ''Unmada'' occurs in individuals taking diet in manners forbidden by the dietetic rules, consuming improper dietary articles, food articles that are unclean and ill prepared, incompatible and vitiated. According to Chandogya Upanishad, quality of mind depends upon the food taken by the individual. Once digested, the food is divided into three components – gross (''sthula''), medium (''madhyam'') and (''sukshma''). The subtle portion of the food nourishes the mind. Bhagavad Gita also opines that the ''sattvika, rajasika'' and ''tamasika'' types of ''buddhi'' (intellect) is derived from the characteristics associated with the type of diet. Thus, [[Ayurveda]] considers that incompatible, vitiated food articles affect the physical as well as mental state of an individual, predisposing him to psychiatric illnesses in general, if he is already harboring other causative factors.

Secondly, psychiatric illnesses with special reference to ''unmada'' are not only associated with the vitiation of ''manas doshas'' but there is vitiation and provocation of ''sharira doshas'' as well. It points to the fact that though psychiatric illnesses are associated with subtle pathological changes at the bio-energetic level, they are also simultaneously accompanied by qualitative as well as quantitative changes/imbalances in the neurotransmitters and other bio-chemicals at the physical level. Thus, the normal psychological processes as well as the psychopathologies, operate simultaneously at multiple levels (biological, bio-energetic) and also at subtler levels where the intangible thought processes start appearing in the relatively tangible field of bio-energy. All this needs extensive exploration using the available scientific tools.

Line 542: Line 616:

#Finally, the term ''achara'' refers to personal and social conduct measured by misbehavior, quarrel, disrespect to elders and other respectable and other similar activities by a psychiatric patient.

−

Some exogenous causative factors of ''unmada'' along with their mode of psychiatric infliction in a person have been enumerated below. However, these details are taken with contemporary assumptions, experiences and clinical practices applicable to a particular disease. Many of these beliefs and practices are still extant in many parts of the world. One of the bodies of practices in this field of study, ''Bhutavidya'', was one of the eight branches of [~~https://en.wikipedia.org/wiki/Ayurveda~~ Ayurveda]. The diagnosis of these exogenous factors is based upon the clinical features, behavior patterns and time of affliction. These factors are being studied well under the purview of demonology, parapsychology. The beliefs regarding ghosts, demons are noted and studied to know exact mechanism behind them. However psychiatrist caution to rule out any other mental disorder first before labeling it as a demon. The negative energies in the cosmos may be regarded in view of exogenous factors causing ''unmada''. ''Rajas'' and ''tamas'' are responsible for negativities, while ''sattva'' for positivity. Therefore these must be considered as psycho-dynamic factors to be treated.

+

Some exogenous causative factors of ''unmada'' along with their mode of psychiatric infliction in a person have been enumerated below. However, these details are taken with contemporary assumptions, experiences and clinical practices applicable to a particular disease. Many of these beliefs and practices are still extant in many parts of the world. One of the bodies of practices in this field of study, ''Bhutavidya'', was one of the eight branches of [[Ayurveda]]. The diagnosis of these exogenous factors is based upon the clinical features, behavior patterns and time of affliction. These factors are being studied well under the purview of demonology, parapsychology. The beliefs regarding ghosts, demons are noted and studied to know exact mechanism behind them. However psychiatrist caution to rule out any other mental disorder first before labeling it as a demon. The negative energies in the cosmos may be regarded in view of exogenous factors causing ''unmada''. ''Rajas'' and ''tamas'' are responsible for negativities, while ''sattva'' for positivity. Therefore these must be considered as psycho-dynamic factors to be treated.

Last but not the least, there is a clear message in the chapter that every individual is himself responsible for his wellbeing, happiness and miseries. The behavioral tendencies and lifestyles adopted by the individual are based on his own choices and all types of ''unmada'' are the result of intellectual blasphemy by the individual himself – be it endogenous or exogenous.

−

+

</div>

−

==== Table 1: Behavioral and psychological manifestation of triguna ====

+

==== Table 1: Behavioral and psychological manifestation of ''triguna'' ====

{| class="wikitable"

−

! rowspan="1"| Sattva

+

! rowspan="1"| ''Sattva''

−

! rowspan="1"| Rajas

+

! rowspan="1"| ''Rajas''

−

! rowspan="1"| Tamas

+

! rowspan="1"| ''Tamas''

|-

| Enlightening || Propulsive & dynamic || Inhibitive

Line 581: Line 655:

|}

−

==== Table 2:Predominance of raja and vata ====

+

==== Table 2:Predominance of ''raja'' and ''vata'' ====

{| class="wikitable"

! rowspan="1"| Disease

! rowspan="1"| Clinical features

−

! rowspan="1"| Predominant dosha

+

! rowspan="1"| Predominant ''dosha''

|-

−

| rowspan="12" | 1. Panic attack

+

| rowspan="12" style="vertical-align: top;" | 1. Panic attack

|-

−

| Palpitation, sweating || raja, pitta

+

| Palpitation, sweating || ''raja, pitta''

|-

−

| Trembling or shaking || ~~Vata~~

+

| Trembling or shaking || ''vata''

|-

−

| Sensation of shortness of breath Feeling of choking|| ~~Vata~~

+

| Sensation of shortness of breath Feeling of choking|| ''vata''

|-

−

| Chest pain or discomfort || ~~Vata~~

+

| Chest pain or discomfort || ''vata''

|-

−

| Nausea or abdomen distress || ~~Vata~~

+

| Nausea or abdomen distress || ''vata''

|-

−

| Feeling dizzy, unsteady lightheaded or Faint || ~~Pitta~~

+

| Feeling dizzy, unsteady lightheaded or Faint || ''pitta''

|-

−

| De-realization or depersonalization || raja, vata ~~andpitta~~

+

| De-realization or depersonalization || ''raja, vata and pitta''

|-

−

| Feeling of losing control or going crazy || ~~Raja~~

+

| Feeling of losing control or going crazy || ''raja''

|-

−

| Fear of dying || raja, vata

+

| Fear of dying || ''raja, vata''

|-

−

| Paraesthesia || raja, vata

+

| Paraesthesia || ''raja, vata''

|-

−

| Chills or hot flushes|| ~~Vata~~<hr>vata-pitta

+

| Chills or hot flushes|| ''vata'' <hr>''vata-pitta''

|-

|}

−

==== Table 3:Predominance of raja and vata ====

+

==== Table 3:Predominance of ''raja'' and ''vata'' ====

{| class="wikitable"

! rowspan="1"| Disorder

! rowspan="1"| Clinical features

−

! rowspan="1"| Predominant dosha

+

! rowspan="1"| Predominant ''dosha''

|-

−

| rowspan="8"| Generalized Anxiety

+

| rowspan="8" style="vertical-align: top;"| Generalized Anxiety

|-

−

| Excessive anxiety & worry (apprehensive expectation) || raja, vata

+

| Excessive anxiety & worry (apprehensive expectation) || ''raja, vata''

|-

−

| The person finds it difficult to control the worry || raja, vata

+

| The person finds it difficult to control the worry || ''raja, vata''

|-

−

| Restlessness || raja, pitta

+

| Restlessness || ''raja, pitta''

|-

−

| Being easily fatigued || raja, vata

+

| Being easily fatigued || ''raja, vata''

|-

−

| Difficulty concentrating or mind going blank || raja, vata

+

| Difficulty concentrating or mind going blank || ''raja, vata''

|-

−

| Irritability || raja, pitta vata

+

| Irritability || ''raja, pitta vata''

|-

−

| Sleep disturbance || ~~Vata~~

+

| Sleep disturbance || ''vata''

|-

|}

−

==== Table 4:Predominance of tamas and kapha dosha ====

+

==== Table 4:Predominance of ''tamas'' and ''kapha dosha'' ====

{| class="wikitable"

! rowspan="1"| Disease

! rowspan="1"| Clinical Features

−

! rowspan="1"| Predominant dosha

+

! rowspan="1"| Predominant ''dosha''

|-

−

| rowspan="14"| Major Depressive Illness

+

| rowspan="14" style="vertical-align: top;"| Major Depressive Illness

|-

−

| Depressed mood most of day || tama, kapha

+

| Depressed mood most of day || ''tama, kapha''

|-

−

| nearly every day as indicated by either subjective report (eg. feels sad or empty) || tama, kapha

+

| nearly every day as indicated by either subjective report (eg. feels sad or empty) || ''tama, kapha''

|-

−

| or observation made by others (eg. appears fearful) || Vata

+

| or observation made by others (eg. appears fearful) || ''Vata''

|-

−

| Markedly diminished interest or || vata, kapha tama, kapha

+

| Markedly diminished interest or || ''vata, kapha tama, kapha''

|-

| pleasure in all or almost all activities most of the day ||

|-

−

| Significant weight loss when not dieting or || ~~Tama~~

+

| Significant weight loss when not dieting or || ''tama''

|-

−

| weight gain or decrease or increase in appetite nearly every day. || kapha tama

+

| weight gain or decrease or increase in appetite nearly every day. || ''kapha tama''

|-

−

| insomnia or hypersomnia nearly everyday || vata kapha tama

+

| insomnia or hypersomnia nearly everyday || ''vata kapha tama''

|-

−

| Psychomotor retardation or agitation || ~~Tama~~

+

| Psychomotor retardation or agitation || ''tama''

|-

−

| fatigue or loss of energy nearly everyday || ~~Tama~~

+

| fatigue or loss of energy nearly everyday || ''tama''

|-

−

| Feeling of worthlessness or excessive or inappropriate guilt || tama kapha

+

| Feeling of worthlessness or excessive or inappropriate guilt || ''tama kapha''

|-

−

| Diminished ability to think or concentrate or indecisiveness || tama kapha

+

| Diminished ability to think or concentrate or indecisiveness || ''tama kapha''

|-

−

| Recurrent thoughts of death,recurrent suicidal ideas || tama, kapha

+

| Recurrent thoughts of death,recurrent suicidal ideas || ''tama, kapha''

|-

|}

−

==== Table 5:Predominance of Raja and Pitta dosha ====

+

==== Table 5:Predominance of ''Raja'' and ''Pitta dosha'' ====

−

Mania A distinct period of abnormality and raja, pitta

+

{| class="wikitable"

−

persistently elevated, expansive or

+

|-

−

irritable mood. raja, pitta

+

| rowspan ="11" style="vertical-align: top;" | Mania

−

Inflated self esteem or grandiosity raja pitta

+

|-

−

Decreased need for sleep vata, raja

+

| A distinct period of abnormality and || ''raja, pitta''

−

More talkative than usual vata

+

|-

−

Flight of ideas raja vata

+

| persistently elevated, expansive or irritable mood.|| ''raja, pitta''

−

increase in goal directed activity raja pitta

+

|-

−

or psychomotor agitation raja pitta

+

| Inflated self esteem or grandiosity || ''raja pitta''

−

Excessive involvement in pleasurable activities that have a high potential for painful consequences raja, pitta, vata

+

|-

−

During the period of mood disturbance any three or more of above Symptoms have persisted

+

| Decreased need for sleep || ''vata, raja''

+

|-

+

| More talkative than usual || ''vata''

+

|-

+

| Flight of ideas || ''raja vata''

+

|-

+

| increase in goal directed activity || ''raja pitta''

+

|-

+

| or psychomotor agitation || ''raja pitta''

+

|-

+

| Excessive involvement in pleasurable activities that have a high potential for painful consequences || ''raja, pitta, vata''

+

|-

+

| During the period of mood disturbance any three or more of above Symptoms have persisted ||

+

|-

+

|}

−

==== Table 6: Predominance of Raja and Vata ====

+

==== Table 6: Predominance of ''Raja'' and ''Vata'' ====

−

Schizophrenia Social withdrawal, often with

+

{| class="wikitable"

−

deterioration in personal care, tama, kapha

+

|-

−

Loss of ego boundaries with inability to perceive onself as Separate Alpasatva with excessive raja and tama

+

| rowspan="12" style="vertical-align: top;"| Schizophrenia

−

Loose thought association, often with slowed thinking or over inclusive raja vata

+

|-

−

and rapid shifting from topic to topic raja, vata

+

| Social withdrawal, often with deterioration in personal care, || ''tama, kapha''

−

Autistic absorption of inner thoughts raja

+

|-

+

| Loss of ego boundaries with inability to perceive onself as Separate || ''Alpasatva'' with excessive ''raja'' and ''tama''

+

|-

+

| Loose thought association, often with slowed thinking or over inclusive || ''raja vata''

+

|-

+

| and rapid shifting from topic to topic || ''raja, vata''

+

|-

+

| Autistic absorption of inner thoughts || ''raja''

+

|-

+

| frequent sexual or religious preoccupation || ''raja tama, kapha''

+

|-

+

| Auditory hallucinations || ''raja, vata''

+

|-

+

| Delusions || ''raja''

+

|-

+

| Flat Affect || ''raja''

+

|-

+

| Hypersensitive to environmental stimuli || ''raja, vata''

+

|-

+

| Impaired concentration Depersonalization wherein one behaves like a detached observer of one's own actions. || ''raja'' and ''vata''

+

|-

+

|}

+

==== Case Paper Format Points ====

+

+

The format for the clinical assessment of ''manovahasrotas'' or The psychiatric assessment:

+

Every psychiatric history should cover the following points:

+

#Complaints

+

#History of present illness

+

#Previous disorders and the nature and extent of treatment.

+

#Family history, important for genetic aspects and family influences, helping in understanding the familial traits.

+

#Personal history: childhood development, adolescent adjustment, level of education and adult coping patterns.

+

#Sexual history

+

#Current life functioning

+

#Current medications, alcohol or drug abuse

+

#Personality: is defined as the sum of those characteristics that make a person into individual he is. These characteristics include behaviour, both actions and reactions; attitude to self; ways of relating to others, both socially and sexually, attitude to authority, level of independence, mood, fantasy life, religious beliefs and moral altitudes and interests and hobbies.

−

~~frequent sexual~~ or ~~religious preoccupation raja tama~~, ~~kapha~~

+

===== The mental status examination =====

−

~~Auditory~~ hallucinations ~~raja~~, ~~vata~~

+

#Appearance: note unusual modes of dress, use of makeup etc. very helpful for evaluation of ''bhootonmada'' and ''vataja unmada''

−

~~Delusions raja~~

+

#Activity and behavior: Gait, gestures, co-ordination of bodily movements. ''akshibhruvaushthamsahanvagrahastapadangavikshepanamakasmat''

−

~~Flat Affect~~

+

#Affect: outward manifestation of emotion such as depression, anger, fear or lack of emotional response eg. ''krodha, sudeen''

−

~~raja~~

+

#Mood: the patients report of feelings and observable emotional manifestations eg. ''rahasyakamata, narivivikta priyata, amarsha''

−

~~Hypersensitiveto environmentalstimuli~~

+

#Speech: coherence, spontaneity, articulation, hesitancy in answering and duration and response. Eg. ''vaka mandam pratihatavacchyam''

−

~~raja~~, ~~vata~~

+

#Content of thought: Association, obsession, depersonalization, delusions, hallucinations, Paranoid, ideation, anger, fear or unusual experiences. Eg. ''amartya vaka vikrama virya cheshta dnyanadi vidnyan baladibhi''

−

~~Impaired concentration~~

+

#Cognition:

−

~~Depersonalization wherein one~~

+

##Orientation to person, place, time and circumstances.

−

~~behaves like a detached observer~~

+

##Remote and recent memory and recall

−

~~of one's own actions. raja and vata~~

+

##Calculation

+

##General knowledge

+

##Ability to identify by naming, reading and writing

+

##Right to Left differentiation

+

##Judgment regarding common sense problems

+

</div>

+

=== Related Chapters ===

−

~~=== Case Paper Format Points ===~~

+

* [[Unmada Chikitsa]]

−

~~The format for the clinical assessment of manovahasrotas or The psychiatric assessment.~~

+

<div id="BackToTop" class="noprint" style="background-color:#DDEFDD; position:fixed;

−

~~Every psychiatric history should cover the following points~~:

+

bottom:32px; left:2%; z-index:9999; padding:0; margin:0;"><span style="color:blue;

−

~~1. Complaints~~

+

font-size:8pt; font-face:verdana,sans-serif; border:0.2em outset #ceebf7;

−

2~~. History of present illness~~

+

padding:0.1em; font-weight:bolder; -moz-border-radius:8px; ">

−

~~3. Previous disorders and the nature and extent of treatment.~~

+

[[#top| Back to the Top ]]</span></div>

−

~~4. Family history, important for genetic aspects and family influences, helping in understanding the familial traits.~~

−

~~5. Personal history~~: ~~childhood development, adolescent adjustment, level of education and adult coping patterns.~~

−

~~6. Sexual history~~

−

~~7. Current life functioning~~

−

~~8. Current medications, alcohol or drug abuse~~

−

~~9. Personality~~: ~~is defined as the sum of those characteristics that make a person into individual he is. These characteristics include behaviour, both actions and reactions~~; ~~attitude to self~~; ~~ways of relating to others, both socially and sexually, attitude to authority, level of independence, mood, fantasy life, religious beliefs and moral altitudes and interests and hobbies.~~

−

~~The mental status examination~~:

−

~~1. Appearance~~: ~~note unusual modes of dress, use of makeup etc. very helpful for evaluation of bhootonmada and vataja unmada~~

−

~~2. Activity and behavior~~: ~~Gait, gestures~~, co-~~ordination of bodily movements. akṣibhruvauṣṭhāṁsahanvagrahastapādāṅgavikṣēpaṇamakasmāt~~

−

~~3. Affect~~: ~~outward manifestation of emotion such as depression, anger, fear or lack of emotional response eg~~. ~~krodha, sudeen~~

−

~~4. Mood~~: ~~the patients report of feelings and observable emotional manifestations eg~~. ~~rahasyakamata, narivivikta priyata, amarsha~~

−

~~5. Speech~~: ~~coherence, spontaneity, articulation, hesitancy in answering and duration and response. Eg. vaka mandam pratihatavacchyam~~

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6. Content of thought: Association, obsession, depersonalization, delusions, hallucinations, Paranoid, ideation, anger, fear or unusual experiences. Eg. amartya vaka vikrama virya cheshta dnyanadi vidnyan baladibhi

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~~7. Cognition~~:

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~~a) Orientation~~ to ~~person, place, time and circumstances.~~

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~~b) remote and recent memory and recall~~

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~~c) Calculation~~

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~~d) General knowledge~~

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~~e) Ability to identify by naming, reading and writing~~

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~~f) Right to Left differentiation~~

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~~g) Judgment regarding common sense problems~~

Agnivesha

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