Psychiatric diseases

Contributors
Section/Chapter/topic	Concepts and Contemporary Practices -Nidana Chikitsa / Vyadhi / Psychiatric diseases
Author	Dr. Narayan Prakash 1
Reviewer	Basisht G.2
Editors	Deole Y.S.3, Aneesh E. G.2
Affiliations	1 Chief Consultant, Hitayurveda healthcare center, KR Puram, Hasaan, Karnataka, India 2Charak Samhita Research, Training and Development Centre, I.T.& R.A., Jamnagar, Gujarat, India 3 Executive Editor and Professor in Kayachikitsa, G.J.Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails	carakasamhita@gmail.com
Date of first publication:	January 21, 2022
DOI	Under process

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This article is based on a lecture delivered by Dr. Narayana Prakash B, Chief consultant, Hitayurveda Health care, KRPuram, Hassan, Karnataka, India., in Prof. M. S. Baghel Memorial Lecture Series on Sep 09, 2021.

Ayurveda considers body and mind as interconnected entities. It does not separate one from the other in the holistic concept of Purusha. The treatment for body and mind is mentioned by ancient scholars for almost all diseases. Health is the foundation of virtue, wealth, enjoyment, and salvation; diseases are the destroyers of it.

General causes for the diseases of the mind

Any abnormal interactions (excess, absent or erroneous) of mind, time, senses, and sense objects are primary causes of diseases. Rajas (representing activity or passionate involvement) and tamas (representing delusion or inhibition) are the most important pathogenic factors for vitiation of the mind. Abnormal sleep pattern also results in disorders of the mind. The inability to control negative impulses like anger, rash speech etc. may cause diseases of the mind. Severe physical injury may also cause diseases of the mind. Volitional transgression or intellectual errors (prajnaparadha), knowingly indulging in improper food and lifestyle habits, is the root cause for almost all diseases especially that of mind.

Role of intellect (buddhi)

Thoughts are objects of the mind. The mind is continuously involved in process of thinking. The intellect (buddhi) controls the mind and regulates its thinking. It differentiates good and bad thoughts. Continuous indulgence of the mind in harmful thinking and the inability of intellect to control it results in diseases.

Role of sense organs (indriya)

Excessive or improper interaction of objects of senses with sense organs results in vitiation of mind. E.g. excessive usage of mobile phones results in mobile phone addiction, diseases of the eyes and brain, etc. Overuse, disuse, and misuse of sense organs lead to abnormality in rajas and tamas, which ultimately results in diseases. Gain or loss of desirable or undesirable things can cause psychic diseases.

Role of inherent spiritual components (atmaja bhava)

Spiritual (atmaja) and psychological (sattvaja) components present at the time of birth are responsible for the growth and development of each individual. ‘Spiritual (atmaja)’ refers to the genetic or ancestral components. Psychological (sattvaja) includes factors related to the strength of one’s mind.

Importance of food in mental health

The use of incompatible dietetics (viruddhaaahara), can cause psychic disorders. If food is proper, the mind will be healthy. Dietary regulations (aharavidhi) shall be followed while taking food. Then only does it nourish the body and mind. Food plays important role in the manifestation of many psychological diseases.

Mental disorders in children

In the pediatric age group, the mind is seldom afflicted. The psychic abnormalities start by the influence of surroundings as the child grows. The positive or negative inputs from the surroundings lead to nourishment or deprivation of the mind.

Excess food intake in childhood may result in laziness or heaviness of the body. This leads to accumulation and further acquisition and greed which is the cause of all abnormalities. When they reach adolescence, anger, lust, cruelty, aggression, anxiety, distress may also happen.

Diagnosis of mental disorders

All the physical abnormalities must be ruled out before labeling a person as a psychiatric patient. In many physical diseases like hypothyroidism, psychiatric manifestations like depression are present. Careful observation of the patient is needed for proper diagnosis. Tools for a mental examination of a patient are described by ancient scholars. For example, the state of grief should be inferred by despondency, joy by exhilaration, pleasure from a sense of satisfaction, fear from dejection, etc.

Mental strength

The condition of mind (sattva) is also important for mental health. A person with good mental strength (pravara sattva) seldom suffers from any mental disorders. People with medium and low mental strength people suffer from psychic disorders. This influences the prognosis of diseases, too. Diseases occurring in a medium mental strength person can be easily cured, but the treatment is difficult in a person with low mental strength.

Types of mental patterns

Table 1: Types of mental patterns
Sattva	Types
Shuddha (purity)	7
Rajasa (aggression)	6
Tamasa (inhibition)	3

The 7 types of shuddha sattva (pure-minded) people are productive for society. Rajasika and tamasika persons are harmful to society due to their destructive tendencies.

Major psychiatric diseases

Insanity (unmada)

It is an unstable condition of mind, understanding, consciousness, perception, memory, inclination, character, behavior, and conduct. [Cha.Sa. Nidana Sthana 7/5]

Etiopathogenesis of insanity

The weak-minded or timid person is more susceptible to insanity. When his mind is afflicted by raja and tama, dosha vitiation due to unwholesome diet, chronic physical illness, excess passion, anger, greed, excitement, fear, attachment, exertion etc. this condition may result in insanity.

Clinical features

The affliction of mind: Leads to illusions, delusions, and hallucinations.

The affliction of intellect: Leads to poor decision making or failure to decide.

The affliction of consciousness: Loss of orientation towards person, place, and time is lost.

Impairment of memory (smruti vibrama): Loss of immediate, recent, and/or remote memory.

Impairment in desires (bhakti vibhrama): Excessive interest, withdrawal symptoms or very odd interests are observed that are different from past interests.

Impairment of habits (sheela vibhrama): Inappropriate reactions like exaggerated emotions at improper places and times are observed. E.g. Laughing by hearing the sad news. This is seen in general anxiety disorders, stress headaches, etc.

Impairment in body activity (cheshta vibhrama): Controlled and relevant motor activity gets impaired. There might be hyperactivity or hypoactivity.

Impaired social activity (achara vibhrama): The behavior and social attitude of the patient would be unfair, improper, and irrelevant. He may violate all ethics and manners. For eg. the patient may remain undressed, unhygienic, or have odd dressing.

Types and Clinical features

Vata dominant unmada:

Constant wandering; sudden spasm of eyes, eyebrows, lips, shoulder, jaws, forearms, and legs; constant and incoherent speech; patient continuously smiles or laughs or dance; play musical instruments in inappropriate situations; froth comes out of mouth, etc.

Pitta dominant unmada:

Anger and irritation; inflicting injury to themselves and others; ferocious look, desire for shade, cold water, and foods.

Kapha dominant unmada:

Observance of silence; desire for solitude; discharge of saliva and nasal secretions; aversion towards cleanliness; aversion towards food etc.

Sannipatika unmada:

All clinical features are observed in this type.

Agantuja unmada (exogenous type):

Intellectual errors (prajnaparadha) are the root cause of this disease. Sinful activities in a past life are also one of the causes. Various behavior patterns are observed in this type. The person may start behaving like deva (god), rakshasa (demons), etc. The association of a specific dosha cannot be seen in this condition. The person may exhibit superhuman powers like excessive physical strength and energy; unnatural power of retention and memory etc. Certain conditions like devonmada, gandharvonmada, and yakshonmada do not require treatments as they do not cause any harm.

Different disorders in conventional psychiatry like acute mania, bipolar disorders, manic disorders, depression, schizophrenia can be understood under the broad umbrella of unmada.

Atattvabhinivesha

Abnormal thinking pattern is observed in this condition. The impaired intelligence, and abnormal psychic pattern, as in obsessive-compulsive disorders (OCD) is seen.

General principles of treatment

Preventive measures

Proper diet is needed for proper mental health. A wholesome food should be taken as per dietary guidelines (aharavidhi). Re-vitalization through a code of conduct (achara rasayana) is also a preventive measure. This can be considered behavior therapy in Ayurveda. Rejuvenation (rasayana) and aphrodisiac therapy (vajikarana) are very important for the prevention as well as treatment of all sorts of psychic disorders. Brain tonics, memory boosters, nootropics, and vitalizers (medhya rasayana) should be taken daily for the improvement of intellect and prevention of psychic disorders.

Three types of treatments

The three major types of treatment for mental disorders are

Divine/ spiritual therapy (daivavyapashraya)
Rational therapy based on reasoning (yuktivyapashraya)
Psychotherapy (sattvavajaya)

Divine/ spiritual therapy (daivavyapashraya): This includes incantations (mantra), medicine, wearing gems, auspicious offerings, oblations, offerings to the sacred fire, following spiritual rules, fasting, obeisance to gods, etc. The worship of Lord Rudra is specially mentioned and is in practice also.

Rational therapy based on reasoning (yuktivyapashraya): This consists of a proper dietetic regimen and medication. Psychotherapy (sattvavajaya): It includes the restraint of the mind from harmful/unwholesome objects. It is specifically implemented in anxiety and depression.

All these therapies are used in the comprehensive management of psychic disorders.

General treatments for unmada

Panchakarma treatments like oleation (snehana), fomentation (swedana), emesis (vamana), purgation (virechana), enema (basti), venesection (siravyadha) are indicated according to the condition. Some other specific treatment modalities like tying (bandhana), confinement (avarodhana), frightening (vitrasana), forgetfulness (vismapana), etc. are also mentioned to control the violent tendencies of patients.

Treatment of vata dominant unmada

Intake of ghee (snehapana) with purana ghrita, lashunadya ghrita, kalyanaka ghrita, mahakalyanaka ghrita, mahapaishachika ghrita, ashwagandha ghrita etc.
Mild purification
Unctuous enema (sneha basti) preferably with a combination of two unctuous preparations
Oil application on the head: This helps to induce sleep and calms down the patient.
Nasal application with Anu taila or ghee preparations.
Collyrium with Brahmyadi varti
Mineral (rasa) preparations: Manasamitra vati, Unmadagajakesari, Brahmi vati, Bruhatvatachintamani, Vatagajankusha rasa, Mahavatavidwansa rasa, Sameerapannaga rasa.
Fermented preparation (Asava/arishta): Saraswatarishta, ashwagandharishta, balarishta
Decoctions (kashaya): Kalyanaka/ Varavishaladi kashaya, Brahmidrakshadi kashaya, Mamsyadi kashaya
Electuaries (lehya): Ashwagandhadi, Ajashwagandhadi, Ajamamsa rasayana, Brahma rasayana
Powders (churna): Saraswata, Brahmyadi, Sarpagandadi churna, combination of Convolvulus prostrates (shankhapushpi), Bacopa monnieri (brahmi), Tribulus terrestris (gokshura) and Rauvolfia serpentine (sarpagandha).

Treatment of pitta dominant unmada

Purgation (virechana) is the first principle of treatment. For internal oleation Tiktaka ghrita, Brahmi ghrita, Shatavari ghrita, Phalasarpi etc. are used.
Pouring of medicated buttermilk (takradhara) or medicated milk (ksheeradhara)
Anointing head (shirolepa) with Amalakyadi yoga
Expressed nasal medication (avapeedana nasya)
Mineral (rasa) preparations: Kamadugha rasa, pravalapanchamrita rasa, manasamitra vati, brahmi vati, pravalapishti, rajata bhasma.
Fermented preparation (asava/arishta): Chittachandirasava, shrikhandasava.
Decoctions(kashaya): Tiktaka, Brahmidrakshadi, Guduchyadi
Powders (churna): Brahmyadi, chandanadi, avippattikara, shatavaryadi
Electuaries (Lehya): Drakshamalaki, Amalaki rasayana, Drakshadi, Kushmanda rasayana

Treatment of kapha dominant unmada

Emesis (vamana) and purgation (virechana) with purana ghrita, hingwadi ghrita, panchagavya ghrita, mahapanchagavya ghrita, lashunadi ghrita
Powder nasal medication (pradhamana) with shwasakuthara rasa, smritisagara rasa, vachadi churna etc.
Pouring of medicated buttermilk (takradhara) or medicated decoctions (kashayadhara)
Mineral (rasa) preparations: Manasamitra vati, smritisagara rasa, brahmi vati, sameerapannaga rasa.
Fermented preparation (Asava/arishta): Mritasanjeevani sura
Powders (churna): Vachadi churna, kushthadi yoga

Treatment of atattvabhinivesha

Purification through panchakarma procedures is the principal treatment. Nourishment therapy is indicated with brain stimulants. Panchagavya ghrita with juice (swarasa) of Bacopa monnieri (Brahmi) or other rejuvenating preparations are advised. Psychological counseling is also advised.

Some other related conditions and its treatments

Sleep disorders

Insomnia: Oil massage; bath; meat juices of domestic, marshy, and aquatic animals; milk, wine, cheerfulness of mind, perfumes, mild massage, application of medicated paste in head and face, use of comfortable beds are advised in insomnia.

Hypersomnia: Purgation (virechana), emesis (vamana), nasal medication (nasya), venesection (raktamoksha), worries, medicated smoke inhalation, fasting, uncomfortable beds are advised for those who have excessive sleep.

Other psychic disorders mentioned in Ayurveda

Anxiety disorders (chittodvega)
Phobic disorders (bhaya)
Attention disorders (anavasthitachitta)
Hypochondriasis (gadodvega)
Dissociative disorders (smararoga)
Personality disorders (rajasika and tamasika kaya)
Chorea (tandavaroga)
Substance abuse disorders (Madatyaya)
Seizure disorders (Apasmara)
Stress-related disorders (manodukhajonmada)
Perverted sexual disorders (asyeka, kumbika etc.)

Conclusion

In Ayurveda, elaborate descriptions of mental disorders with their management is available. In day to day practice mental disorders are well managed by Ayurvedic interventions. It requires a holistic approach including management with medicines, counseling, and spiritual therapies.

Related Chapters

Indriyopakramaniya Adhyaya, Unmada Nidana Adhyaya, Apasmara Nidana Adhyaya, Katidhapurusha Sharira Adhyaya, Unmada Chikitsa Adhyaya, Apasmara Chikitsa Adhyaya, Tistraishaniya Adhyaya