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{{Infobox

{{Infobox

|title = Unmada Nidana

|title = Unmada Nidana

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=== Introduction ===

=== 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 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.

''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.

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.

''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.

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

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

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

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

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||

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||

yastu dōṣanimittēbhya unmādēbhyaḥ samutthānapūrvarūpaliṅgavēdanōpaśayaviśēṣasamanvitō bhavatyunmādastamāgantukamācakṣatē|  

yastu dōṣanimittēbhya unmādēbhyaḥ samutthānapūrvarūpaliṅgavēdanōpaśayaviśēṣasamanvitō bhavatyunmādastamāgantukamācakṣatē|  

kēcit punaḥ pūrvakr̥taṁ karmāpraśastamicchanti tasya nimittam|  

kēcit punaḥ pūrvakr̥taṁ karmāpraśastamicchanti tasya nimittam|  

tasya [1] ca hētuḥ prajñāparādha ēvēti bhagavān punarvasurātrēyaḥ|  

tasya [1] ca hētuḥ prajñāparādha ēvēti bhagavān punarvasurātrēyaḥ|  

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

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

Yastu dosanimittebhyah Unmadaebhyah samutthAn purvarUpa linga vedanopaSaya visesa samanvito   bhavatyUnmadaastamAgantukamAcakShate  

Yastu dosanimittebhyah Unmadaebhyah samutthAn purvarUpa linga vedanopaSaya visesa samanvito bhavatyUnmadaastamAgantukamAcakShate  

Kecit punaH pUrvakRutaM karmAprashastamicchanti |tasya nimittam|

Kecit punaH pUrvakRutaM karmAprashastamicchanti tasya nimittam|

 

hetuH ca praj~jAparAdha eveti bhagavAn  punarvasurAtreyaH|

hetuH ca praj~jAparAdha eveti bhagavAn  punarvasurAtreyaH|

praj~jAparAdhAddhyayaM devarShipitRugandharvayakSharAkShasapishA

 

caguruvRuddhasiddhAcAryapUjyAnavamatyAhitAnyAcarati, anyadvA

praj~jAparAdhAddhyayaM devarShipitRugandharvayakSharAkShasapishA caguruvRuddhasiddhAcAryapUjyAnavamatyAhitAnyAcarati, anyadvA

ki~jcidevaMvidhaM karmAprashastamArabhate; tamAtmanAhatamupaghnanto

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

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]

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

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

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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]  

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'').  

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

*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.

*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 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, 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.

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.

#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.

#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 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.

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.

##Judgment regarding common sense problems

##Judgment regarding common sense problems

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