Manas
The Sanskrit word ‘manas’ or ‘mana’ means mind. Ayurvedic texts are rich with the knowledge of multi-dimensional aspects of the mind. ‘Life’ (ayu) is defined as the continuum of the combination of body (sharira), sense organs (indriya), mind, and soul. [Cha.Sa.Sutra Sthana1/42] The mind is included in the three fundamental pillars of the holistic human being (purusha) with body and soul. [Cha.Sa. Sutra Sthana1/46]
Psychological well-being with a blissful state of mind, soul and sense organs is an essential component of health. [Su.Sa. Sutra Sthana 15/41] Ayurveda rishis do not consider the mind a separate entity. Instead, the mind is always combined with the ‘Whole’ well in coordination with body and soul. Thus, the mind can influence gross physiological and sensory functions and spiritual wellbeing as well. Overall personality is identified based on mental attitude. Mental health is important for interpersonal relationships, social and economic aspects of life. It decides the overall productivity of a person.
| Chapter/topic | Health / Mana (mind and mental health) |
|---|---|
| Author | Deole Y.S. |
| Reviewed by | Basisht G. |
| Affiliations | Charak Samhita Research, Training and Development Centre, I.P.G.T.& R.A., Jamnagar |
| Correspondence email: | carakasamhita@gmail.com |
| Date of first publication: | June 06, 2021 |
| DOI | Awaited |
Mental health
As per the World Health Organization, mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and can contribute to his or her community. Mental health is an integral part of health; indeed, there is no health without mental health. Mental health is determined by a range of socioeconomic, biological and environmental factors. It leads to psychological well-being and is an integral part of good quality of life.
Importance of mental tranquility in the preservation of health:
The mind plays a vital role in digestion and metabolism (agni). A positive mental attitude and concentration of the mind on food are crucial for proper digestion. [Cha. Sa. Vimana Sthana 1/25] The negative mental attitude adversely affects digestive health and leads to the production of toxic metabolites (ama), even though the meals are of proper quality and quantity. [Cha.Sa.Vimana Sthana 2/8-9] Research suggests that mental health is closely linked with gastrointestinal health. Emotions like stress, anxiety, mood swings may trigger stomach problems, and gastrointestinal disturbances affect mental health.
The tranquility of mind is essential for proper nourishment of body. A calm mental state and happiness are important factors for gaining weight in asthenic individuals (karshya). [Cha. Sa. Sutra Sthana 21/29]
Mind plays an important role in natural sleep (nidra). Fatigue after involvement in proper mental activities and temporary cessation from involvement in all sensory activities are important for natural sleep. Detachment of mind from senses and feeling of comfort causes sleep. [Cha. Sa. Sutra Sthana] 21/35,52,53]
The reproductive health and sexual pleasure depend upon state of mind. Happy state of mind has an aphrodisiac effect. [Cha.Sa.Chikitsa Sthana 2/4/36-45] Tranquilized and happy state of mind is the first and foremost factor for conception. [Cha. Sa. Sutra Sthana 25/40] Recent research suggests that psychological interventions in lowering psychological distress significantly increase pregnancy rates.
Positive mental health can prevent diseases. A depressed mental state increases the susceptibility and severity of diseases. [Cha. Sa. Sutra Sthana 25/40] The psychological state can directly influence immunity through neuro-endocrine axis. Mental trauma can affect recovery from existing diseases. The persons suffering from cardiac diseases [Cha.Sa.Chiktisa Sthana 26, Sutra Sthana 30/13-14] and cerebro-vascular diseases like coma [Cha. Sa. Sutra Sthana 24/53] should be protected from any kind of mental trauma. Death may occur due to depletion of mental strength in case of severe disease. [Cha.Sa.Indriya Sthana 11/23-24]
It is observed that depression is common among people who have chronic illnesses. These include Alzheimer's disease, autoimmune diseases (including systemic lupus erythematosus, rheumatoid arthritis, and psoriasis), cancer, coronary heart disease, diabetes, epilepsy, HIV/AIDS, hypothyroidism, multiple sclerosis, Parkinson’s disease and stroke. The depressed state of mind can influence the convalescence in these illnesses. It is essential to treat depression in such conditions. It is vital to understand the mind and its mechanisms related to health and disease. Positive Mental health can be achieved and preserved through knowledge of self- somatic constitution and psychological constitution, following a proper diet, taking herbs that promote intellect and memory (medhya rasayanas). Ayurvedic therapies like therapeutic massage (abhyanga), oil dripping method on head (shirodhara) and purification therapies (panchakarma) are effective in the prevention and management of psychiatric diseases. Daily routine (dinacharya) including exercise, meditation, proper sleep habits, seasonal adaptations, and restraints of negative psychological emotion, is helpful. These are the critical factors for a healthy mind and preservation of mental health. This article describes the concept of mind in Ayurveda and its role in the healthcare. Etymology and definition: The word ‘manas’ is derived from the Sanskrit root ‘mana’, meaning to know or understand. (‘Jnane Bodhane va’). The word ‘jnane’ denotes knowing, conscience, awareness, engaging in, or being acquainted with something. The word ‘bodhane’ refers to waking, understanding, signifying, awakening, enlightening, informing. These two words indicate mana functions and their role in daily living to maintain equilibrium in cognitive faculties. Synonyms: The Sanskrit words Sattva, [Cha.Vi.8/119] chitta, chetas are synonyms for mana (mind). Sattva means the essence, quality of purity, self-command, existence, reality, truth, excellence, proper, nobleness. Sattva is applied to denote mental strength. Chitta denotes reflecting, thought, intention, thinking over, pondering, attending, observing, reasoning, and discovering. Chitta is applied to denote the thinking, contemplating, or introspecting capacity of mana. The word Chetas denotes consciousness, insight, intelligence, splendor. It is applied to denote the union of mind with consciousness. An awakened state of mind, united with consciousness, can be named as ‘chetas’. These three words are applied to indicate various psychological functions. It also indicates the affection of mental faculty in the pathogenesis of the disease. For example, the diseases like epilepsy (apasmara) and insanity (unmada) occur in persons with weak mental strength (alpa sattva). [Cha. Sa. Nidana Sthana 7 and 8]
Nature: Mana is one of the nine primordial elements (karana dravya). [Cha.Su.1/48] The mind and its objects, intellect and soul, constitute spiritual elements and qualities (adhyatma dravya guna samgraha). [Cha.Su.8/13] It functions as a motor and sensory organ. [ Cha.Sha.1/17 ] It is the sixth sense organ with super sensual power. [Cha.Sha.1/17] Nourishment and development of mind: Mind is nourished from food. Chandogya Upanishada describes that the gross part of the food generates feces. The middle portion develops muscular and other body tissues, while the subtle parts nourish the mind. The quality of food, cooking method, place of eating, and dietary regulations (ahara vidhi) is crucial for proper nourishment of the body and mind. Mind plays an instrumental role in perception and knowledge. It is the mediator between senses (objects) and soul (knower). Therefore, the sensory and motor inputs handled by the mind are essential for developing and nourishing the mind. The kind of sensations like what the person see, listen, touch, taste, and smell are food for the mind. They are processed by mind and intellect together to store it as memory. Better the quality of this food, better is the development. One should always make efforts to maintain the normal state of sense organs with mind and protect them from any trauma. This can be achieved by proper association of sense organs and their objects, the performance of beneficial duties, and following preventive measures opposite to the qualities of residing place (desha), season (kala) and one’s own constitution (prakriti)s. So, all, who are desirous of well-being, should always follow all the codes of conduct. [Cha. Sa. Sutra Sthana 8/17] Moral code of conduct (sadvritta) [Cha. Sa. Sutra Sthana 8/18-28] and behaviour therapy for rejuvenation (achara rasayana) [Cha.Sa. Chikitsa Sthana 1/4/30-35] helps to preserve a normal state of mind and prevent diseases. Test for existence of mind: Knowledge is one and the actual proof of the existence of the mind. The sequential contact of mind with soul, sense organs, and objects leads to understanding and knowing that particular object. [Cha.Sha.1/18-19] Presence of mind can be tested by presence or absence of knowledge. This is one of the signs of active mind. [Cha.Sha.1/18] Mind plays a significant role in the chain of perception to knowledge and memory. Memory works only after proper attention and perception of knowledge. If the mind is absent, the process of perception, knowledge, and memory are blocked. Location: The primary site of mind is the heart. [Cha.Chi.24/34-35 ], [ Su.Sha. 6/26], [A.hr. Sha.4/13 ] Other sites are described as between head (shiras) and palate (talu). [Bhe.Chi.8/2-4] Mind is present all over body through its sensory and motor functions. Contemporary texts describe the site of mind as brain and nervous system. Manovaha srotasa (channels of transportation and transformation of mental factors) The channels that transport and transform mental factors are described. [Chakrapani Cha.Sa. Vimana Sthana 5/3] Mind is connected with the sense and motor organs (indriya). It carries various functions in coordination with soul (atma) and intellect (buddhi). These components are included in manovaha srotasa. It is spread all over the body through ten vessels (manovaha dhamani) originating from heart. [Chakrapani Cha.Sa. Indriya Sthana 5/41] These channels connect the heart to the brain. It is affected in diseases like psychosis (unmada) [Cha.Sa. Chikitsa Sthana 9/5]. If it is vitiated by all three dosha, then the person experiences terrible dreams indicating underlying diseases pathologies. [ Cha.Sa. Indriya Sthana 5/41] The chetanavahi or chetovahi srotasa (channels of consciousness) is obstructed in diseases like intoxication (mada), syncope (murchcha) and coma (sannyasa). [Shivadasa sen commentary on Cha.Sa. Chikitsa Sthana 9/5] The vitiated dosha obstruct these channels and cause diseases like psychosis and epilepsy. [ Bhela Samhita Nidana Sthana 7/2, 8/3, 8/8] The channels can further lead to severe disease called ‘atattvabhinivesha’ (a disease of perversion of intellect). [Cha.Sa. Chikitsa Sthana 10/57-60] Obstruction to channels carrying psychic impulses (sanjnavahi srotasa) by rajas and tamas causes confused state of mind. [Su.Sa. Uttara Tantra 61/8] Accumulation of dosha in heart causes depletion of mental strength and leads to psychosis. [Ashtanga Samgraha Uttara Tantra 10/2, Ashtanga Hridaya Uttara Tantra 7/2] manovaha srotasa is closely connected with rasavaha srotasa. The activities are conducted mainly by vata dosha and regulated by sadhaka pitta and avalambaka kapha. Attributes of mind: The mana is subtle (anu) and unitary (eka). [ Cha.Sha.1/19] Subtleness: The mind is the subtlest organ. Ordinary visual senses cannot observe it. One can perceive the mind through its functions associated with senses. This subtleness might be a reason for the limitation to define and conclude the exact physical structure of mind. Oneness: Mind is only one in an individual. The psyche may appear more than one as it presents multiple roles in an individual. The variation is due to a change in perception as per own suitability (svartha), the capacity of motivation and perception of objects of senses (indriyartha). Similarly, it takes various forms due to its contact with qualities like purity (sattva), activity (rajas), and ignorance (tamas). However, the mind is person-specific and only one. It can unite with only one sense organ at a time to acquire knowledge. [Cha.Su.8/5-6] The other attribute of mana is its fickleness (chanchalatva). Fickle mindedness is one of the significant obstacles in concentration and meditation.
Factors related from mind: Following factors are related to mind (sattvaja) during embryogenesis. These factors develop further to build the psychic constitution based on exposure and experiences in lifetime. Devotion (bhakti), character (sheela), purity (shaucha), hatred (dvesha), memory (smriti), attachment (moha), sacrifice (tyaga), jealousy (matsarya), valor (shaurya), fear (bhaya), anger (krodha), drowsiness (tandra), enthusiasm (utsaha), sharpness (taikshnya), softness (mardava), seriousness (gambhirya), unsteadiness (anavasthitatva). All these are present in the same person, however, do not manifest simultaneously. An individual is said to be of a particular type, based on the predominant type of mind. [ Cha.Sa. Sharira Sthana 3/13] Functions (karma): In addition to the vital role in knowledge and understanding, the mind performs the following four functions. [Cha.Sha.1/21 ] 1. Control of all sensory and motor faculties (indriyabhigraha): The mind is the prime motivator and controller of all sense organs. The sense and motor organs work only in the presence of an active mind. Thus, the mind is the driving force for the perception of the external world through cognitive and conative senses. 2. Self-restraint (swasya nigraha): Mind controls and restrains itself from harmful activities. Mind is regulator and coordinator of its own activities. This function of self-restraint is essential in preservation of health and management of diseases. The wholesome and unwholesome regimen is followed or unfollowed by an individual due to self-restraining capacity of mind. Sattvavajaya therapy [Cha. Su. 11/54 ] (conquest of mind) i.e. restraining mind from harmful objects, is a traditional form of psychotherapy. It includes training of mind to avoid harmful things. Meditation practices involve self-restraint.
3. Hypothesis or logical interpretation (uha):
Mind can postulate a hypothesis and interpret it logically. The strength of mind is applied to innovate, discover, create new things. Mind is logically applied to make a conjuncture about the possible outcome in a given situation. 4. Consideration and thinking (vichara): Mind can think and analyze between right and wrong, correct or incorrect, useful or harmful things. The mind can justify reasons, ascertain possibilities, seek proof or evidence. 5. Attention and meditation (Dhyeya) Attending various sensory objects and processing them to acquire knowledge is an essential function of mind. 6. Resolution or decision (sankalpa): The mind can resolve a situation or take a willful decision based on its capacity. Determination towards a goal is a function of the mind.
The intellect (buddhi) is superior cognitive faculty over the mind. It acts further on the raw data submitted by the mind. [Cha.Sa.Sharira Sthana 1/21-23]
Qualities (guna) and impurities (dosha) of mind: Sattva (purity) is the only quality of mana. Rajas (initiator or activity) and tamas (regulator or ignorance) affect the mind. [ Cha.Sha.1/20] Sattva enlightens the mind with true knowledge. Rajas is the initiator of all activities. Tamas is the regulator or inhibitor of all mental activities. [ Ka.Su.28] These three are fundamental factors responsible for normal or abnormal states of mind. In a normal state, sattva is dominant, and the other two are recessive. Hyperactivity is due to rajas dominance. Hypoactivity is due to the dominancy of tamas. Therefore, the balanced state of all three components is important for normal functions of the mind. Some scholars correlate this ancient theory with modern structural, topographic theories of mind as: Ayurvedic Theory Structural Theory Topographic Theory Sattva Super Ego Conscious Rajas Ego Fore Conscious Tamas Id Unconscious Categories of mental strengths: The mental strength of a person is a crucial factor for health. It is also one of the ten points of clinical examination of the patient. [Cha.Sa. Vimana Sthana 8/119] Depending upon the mental strength, clinical categorization is done in three categories viz. superior, mediocre, and inferior or poor mental strength. [Cha.Vi. 8/119] I. Characteristics of persons with superior mental strength or healthy state of mind: Individuals having superior mental strength have the excellence of psyche or pure quality (sattva sara). The characteristics of these individuals are as follows: [Cha Vi. 8/110] 1. Good memory (smritimanta) 2. Devotion (bhaktimanta) 3. Gratefulness in attitude (kritagya) 4. Wisdom (pragya) 5. Purity and cleanliness (shuchayo) 6. Enthusiasm in all good activities (mahotsaha) 7. Skillfulness and alertness (daksha) 8. Courage and patience (dheera) 9. Valor in fighting for good things (samar vikranta yodhinah) 10. Free from sorrow and depression (tyakta vishadah) 11. Proper gait and movements (suvyavasthita gati) 12. Depth of wisdom (gambhira buddhi) 13. Proper connation (cheshta) 14. Always indulged in welfare activities (kalyanabhiniveshinah)
All the above characteristics indicate a ‘healthy and normal mind.’ Opposite characters indicate an unhealthy and abnormal mind. Persons with superior mental strength can tolerate severe diseases without any difficulties, even if they have a weak physique. II. Mediocre mental strength: The individuals having mediocre mental strength tolerate the pain themselves after realizing the tolerance of other persons towards the same condition. They gain strength from others. III. Weak mental strength: The person with inferior mental strength can’t tolerate even mild pain, even if they have a plump or big physique. They are susceptible to fear, grief, greed, delusion and ego. When they hear stories of wrathful, fearful, hateful, terrifying and ugly situations, or see flesh or blood of animal or man, they fall victims to depression, pallor, fainting, madness, giddiness, falling on the ground, or such events may even lead them to death. [Cha.Sa. Vimana Sthana 8/ 119] All the above types are observed in today’s society. They can be identified by behavior in a crisis. A person with poor mental strength is more susceptible to psychiatric disorders. Therefore, they need careful treatment to improve mental strength. All treatments should be planned according to the strength. This concept of Ayurveda can be widely applied in every preventive as well as curative aspect of psychology and psychiatry. Types of the psychic constitution and their characteristics: Ayurveda presents an elaborative description of psychic traits or personalities. On the basis of the dominancy of sattva, rajas, and tamas, the psychic personalities are classified into three categories. The specific characteristics of each type are given below. [Cha. Sha.4/38-45 ], [Su. Sha. 4/81-87 ] 1. Sattva dominant constitution: A person with the dominance of sattva in the psyche, is kind, benevolent, tolerant, courageous, truthful, religious, intelligent, bold and free. He has a good memory. 2. Rajas dominant constitution: A person with the dominance of rajas in the psyche, is generally impatient, always dis-satisfied, truthless, egoistic, anxious, has excess anger, pride, and other emotions, hyperactive. 3. Tamas dominant constitution: A person with the dominance of tamas in the psyche is characterized by ignorance, poor intelligence, ill-temper, not believing in God, unreligious, hypoactive, and excessive sleep. Types of behavior traits: The dominance of sattva, rajas and tamas leads to variable behavior patterns and temperaments. Based on specific temperamental features and behavior patterns, there are sixteen subtypes of psychic constitutions as follow: I. Satttva (purity of mind) dominant: 1. Brahma sattva (God or knowledgeable teacher like psychic constitution) 2. Arsha sattva (Sage or spiritual saint like psychic constitution) 3. Indra sattva (King of Gods or president like psychic constitution) 4. Yamya sattva (God of death or minister or accountant like psychic constitution) 5. Varuna sattva (God of water or sportsman or athlete like psychic constitution) 6. Kubera sattva (God of wealth or business tycoon like psychic constitution) 7. Gandharva sattva (Celestial musician or artist or entertainer like psychic constitution) II. Rajasa dominant 8. Asura (King of demons or terrorist like psychic constitution) 9. Rakshasa (Demon or criminal like psychic constitution) 10. Paishacha (Ghost like psychic constitution) 11. Sarpa (Snake like psychic constitution) 12. Preta (Dead body or a person without human feelings like psychic constitution) 13. Shakuna (Omen or bird like unstable psychic constitution) III. Tamas dominant 14. Pashava (Animal like psychic constitution) 15. Vanaspatya (Plant like psychic constitution) 16. Matsya (Fish like psychic constitution)
Characteristic features of each of these types are described separately. They represent lifestyle, behavior, fondness, and thought patterns of respective psychic traits. [Cha. Sa. Sharira Sthana 4/36-39] elaborated. The specific behavior pattern and fondness help find suitable professional options in society. Inter-dependence of body and mind: Body and mind both are interrelated & interdependent. The body follows the mind and vice versa. [Cha.Sha.4/36] These two are sites for happiness and misery. [Cha. Sa. Sutra Sthana 1/55] Any somatic disorder affects the mind, and any mental disorder influences the body. Mind can get afflicted by exogenous diseases too. [Cha.Sa. Sutra Sthana 20/3] Therefore, body and mind cannot be separated from each other. Holistic approach to the preservation of health and management of the disease is essential. The physical (sharira) dosha like vata, pitta and kapha carry various functions related to the psyche. Thus, they directly influence the psyche. Vata is considered as the primary dosha to influence mental activities. It is the controller, motivator, and regulator of all mental activities. [Cha.Su.12/6] The dosha, their normal physiological functioning, and pathological impacts are comprised in the table below: Dosha Subtype Physiological function Gross functions [Cha.Su.18/49-51 ] Pathological impact Vata Prana Sensations Enthusiasm (utsaha), Pleasure (harsha) Fear (bhaya), Depression (vishada), Grief (shoka), Anhedonia (apraharsha), Insomnia (anidra), Stress (aayasa), Anxiety, worries (chinta), Delirium (atipralapa) Udana Memory Vyana Movement Pitta Sadhaka Motivation, determination, and accomplishment Valor (shaurya), Blissful state (prasada), Intelligence (medha) Anger (krodha) Kapha Tarpaka Nourishment Steadiness or stability (sthairya), Knowledge (Jnana), Forgiveness (kshama), Self -control (dhriti), Satisfaction and content or lack of greed (alaulya) Idleness (alasya), Heaviness (gaurava), Ignorance or ack of knowledge (ajnana), Hypersomnolence (atinidra), drowsiness or stupor (tantra)
Psychological urges (manasika vega): An intelligent person should control following psychological urges for preserving mental health. Greed (lobha), grief (shoka), fear (bhaya), anger (krodha, egoism or excess pride (maana), shamelessness or impudence (nairlajjya), jealousy (irshya), excessive affliction (atiraaga), and desire to acquire someone else’s wealth (abhidhya). [Cha. Sa. Sutra Sthana 7/27] If these urges are not controlled, they increase in frequency and intensity. These are converted into psychological disorders. Psycho-somatic and psychiatric disorders: The disorders in which only the mind is involved are as mentioned below: [ Ca. Vi. 6/5], [ Su. su. 1/33] 1. Desires or lust (kama) 2. Anger (krodha) 3. Greed (lobha) 4 Confusion (moha) 5. Envy (irshya) 6. Pride or egoism (maana) 7. Intoxication or substance dependence (mada) 8. Grief (shoka) 9. Anxiety (chittodvega) 10. Fear (bhaya) 11. Exhilaration (harsha) 12. Depression (vishada) 13. Envy or indignation (abhyasuya) 14. Affliction (dainya) 15. Jealousy (matsarya) Cause: All the above psychiatric disorders are caused due to various types of desires (iccha) and hatred (dvesha). Rajas and Tamas are responsible for these mental disorders. Prajnaparadha (intellectual error) is the root cause of all the disorders. [ Cha.Ni. 7/ 21] Dosha specific mental disorders: Total 140 types of disorders due to the involvement of single dosha (nanatmaja vikara) are described. [Cha Su.20 ] Some mental disorders are mentioned among those as follows: 1. Vata dosha vitiation: 1. Auditory hallucination (Ashabda shravana) 2. Fainting (tama darshan) 3. Depression (vishada) 4. Delirium (atipralapa) 5. Insomnia (aswapna) 6. Unstable psyche (anavasthita chittatva) 2. Kapha dosha vitiation: 1. Stupor (tandra) 2. Hypersomnolence (nidradhikya) Some major psychiatric diseases involve both mental and physical dosha in pathogenesis. [Chakrapani] [Cha. Su.1/55] Such psychiatric diseases are as mentioned below: 1. Psychosis (unmada) [ Cha. Ni. 7, Cha. Chi. 9, Su. U. 62] 2. Epilepsy (apasmara) [ Cha. Ni. 8, Cha. Chi. 10, Su. U. 61] 3. Atattvabhinivesha [Cha. Chi. 10] 4. Intoxication (mada) [Cha. Su. 24, Su. U. 47 ] 5. Syncope (murccha) [ Cha. Su. 24, Su. U. 46] 6. Coma (sanyasa) [Cha. Su. 24, Su. U. 46] 7. Alcoholism and substance abuse disorders (madatyaya) [Cha. Su. 24, Su. U. 47 ] 8. Seizure disorder (apatanaka) [Cha. Si. 9, Su. Chi.5 & Ni. 1] 9. Opisthotonos (apatantraka) [ Cha. Si. 9, Su. Chi.5 & Ni. 1] 10. Jwara (fever) [ Cha.Sa. Nidana Sthana 1/35] Diagnosis: Mental disorders can be diagnosed with the help of examinations as given below. • Psychiatric Interview for Mental Status Examination ( darshana & prashna pariksha) • Physical examination to rule our somatic illness • Biological & psychological investigations
The psychiatric interview It differs from a medical interview by many aspects such as: • Presence of disturbances in thinking & behavior, interfering with meaningful communication • Need for information from significant others (informers) • More important to obtain information regarding personal history & premorbid personality • More need for astute observation of the patient • Difficulty in establishing rapport may be encountered often • The patient may lack illness & have poor judgment • More important to elicit information regarding stressors.
Mental status examination:
A comprehensive mental status examination is the key to an accurate diagnosis. The following points should be taken into consideration while examining the mental status. 1. General appearance & behavior • General appearance • Attitude towards examiner • Comprehension • Gait & Posture • Motor Activity • Social Manner • Rapport 2. Speech • Rate & Quantity • Volume & Tone • Flow & Rhythm 3. Mood & Affect • Mood is internal feeling & affect is outward emotional display. 4. Thought • Stream & Form • Content 5. Perception 6. Cognition (Higher Mental Functions) • Consciousness • Orientation • Attention • Concentration • Memory • Intelligence • Abstract thinking
7. Insight
8. Judgement
Inference of mental status (Manasa bhava pariksha): The mental status can be examined and inferred by an assessment of mental factors. (Ch. Vi. 4/8) The 22 mental factors are divided into two groups like positive & negative emotions. This description is as follow: - I. Beneficial or positive factors (manasa bhava) 1) Assessment of functions of mind by concentration and absence of deviation from objects (manasa artheshu avyabhicharanena) 2) Assessment of knowledge by indulgence in productive activities (vijnanam – vyavasayena ) 3) Assessment of happiness by cheerful state or celebrating occasions (harsha amodena) 4) Assessment of love by content state of mind (priti – toshena) 5) Assessment of courage by absence of fear or sorrow (dhairyam-avishadena) 6) Assessment of enthusiasm by initiation of activities (viryam – utthanena) 7) Assessment of mental stability by absence of distractions or perversions (avasthanam avibhramena) 8) Assessment of attitude by interest in activities (shraddha abhiprayena) 9) Assessment of grasping power by grasping capacity (medha – grahanena) 10) Assessment of attention by calling name (samjna – namagrahanena) 11) Assessment of memory by recall and remembrance capacity (smriti – smaranena) 12) Assessment of shyness by withdrawal (hriya – apatrapanena) 13) Assessment of character by behavior and conduct (shila–anushilanena) 14) Assessment of restraining power by absence of greed (dhriti – alaulyena) 15) Assessment of obedience by obeying commands (vashyata – videyataya) II. Non-beneficial or negative factors (manasa bhava) 1) Assessment of affection by indulgence in activities (rajah–sangena) 2) Assessment of confused state by lack of knowledge (moha – avijnanena) 3) Assessment of anger by violent and harmful tendencies to others (krodha – abhidrohena) 4) Assessment of grief by crying and sorrowful spells (shoka dainyena) 5) Assessment of fear by depressed mood (bhayam – vishadena) 6) Assessment of hatred by revenging tendency (dvesha – pratishedhena) 7) Assessment of impact by outcome after doing activity (upadhi – anubandhanena)
Diagnosis of perverted mental state: The perverted states of mind (vibhrama) are observed as clinical features of psychosis. [Cha. Sa. Nidana Sthana 7/5] The features are used to assess the severity of disease and prognosis. These indicate impaired mental status. The symptomatology commented by Chakrapani can be observed in various psychiatric conditions as below:
Sr. No. Perversion
Impairment of mental factor
Clinical condition 1) Mano vibhrama (perversion of mind) Thought form & content Schizophrenia, Delusional disorder, O.C.D. 2) Buddhi vibhrama (perversion of intellect) Thought form & content, Decisive power, Intelligence Schizophrenia, Delusional disorder, Anxiety, O.C.D., M.R. 3) Sajna vibhrama (perversion of attention) Attention, Consciousness, Orientation, Concentration Extreme psychosis, Coma, ADHD 4) Smruti vibhrama (perversion of memory) Memory, recall, registration Dementia, Alzheimer's Disease 5) Bhakti vibhrama (perversion of interest) Desires, Hobbies, Interest, Mood Mood & Affective disorders, Depression 6) Shila vibhrama (perversion of character) Thought form & content, Perception Schizophrenia, Delusional disorder, Anxiety Disorder, Stress disorder 7) Cheshta vibhrama (perversion of motor movements) Motor activity, Behavior Psychosis, Mania, personality disorder 8) Aachara vibhrama(perversion of behavior) Behavior, Mood Dementia, Personality Disorder, Mania
Psychological investigations 1) Objective tests • Objective Personality Test • Intelligence Test 2) Neuro psychological tests • Wechsler Memory Scale • PGI Memory Scale 3) Rating scales • Brief Psychiatry Rating Scale • Hamilton’s Anxiety Rating Scale • Hamilton’s Depression Rating Scale
4) Diagnostic standardized interviews
• PSE (Present State Examination) • SCAN (Schedules for Clinical Assessment in Neuro-Psychiatry) General categories of psychiatric illness:
The psychiatric illness is broadly categorized into
• Mood disorders • Psychotic disorders • Eating disorders • Developmental disorders • Personality disorders • Others
Management of preserving and protecting mental health: This depends upon two things: 1. Growth and development of mind as a whole by proper nutrition of body and mind 2. Preservation of harmony of all factors mentioned in journey of life
These objectives can be achieved by following the principles of prevention and management of mental disorders as below: [ Cha.Su.1/58, Vol.I pg.43], [ A.Hr.Su.1/26] 1. Jnana (spiritual knowledge) 2.Vijnana (scriptural or scientific knowledge) 3.Dhairya (courage or patience) 4.Smriti (memory) 5.Samadhi (meditation). These are various measures for controlling and regulating mental mechanisms. Three types of treatments: In a broad-based classification of ayurvedic treatments, three crucial types of therapies are followed: I. Daivavyapashraya (spiritual therapy): Spiritual therapy comprises nono-pharmacological measures in management of certain conditions. It includes incantation of mantras, aushadhi (talisman) , mani (wearing of gems), bali (auspicious offerings), upahara (gifts), homa (oblations), niyama (observance of scriptural rules), prayaschitta (atonement), upavasa (fasting), svastyayana (chanting of auspicious hymns), obeisance of God, pranipatagamana (pilgrimage) etc. II. Yuktivyapashraya (rational therapy): It includes the rationale of medicines, therapies, and diet protocols. III. Sattvavajaya therapy: It includes therapies to controlling the mind from harmful objects. [ Cha.Su.11/54]
Following measures are followed to prevent diseases and promote mental health. These can be broadly categorized as materialistic (dravyabhuta) and immaterialistic (adravyabhuta) treatment measures.
I. Materialistic measures (dravyabhuta chikitsa)
1. Proper nutrition for growth and development of mind:
Besides providing nutrition to body, diet has a great impact on mind as well. Many recently published research indicate effect of diet on mental health. Most of the research focus upon the antioxidants, nutraceuticals and their effect on functions of brain. Though, this is important at physical plane, nourishment of soul and mind are equally important with body. The effect of diet in nourishing five sheaths/coverings of body is observed in yogic texts. Any food first nourishes the sheath of nutrition, material, physical covering (annamaya kosha). Then it nourishes the sheath of life and energy covering (pranamaya kosha). After that, sheath or covering of mind (manomaya kosha), intellect (vijnanamaya kosha) and bliss (anandamaya kosha) are nourished in sequence resulting in blissful state of atman i.e. spiritual self. A subtler part of food is nourishing subtlest part of mind. Thereafter from that part, thoughts and emotions are evoked at a superficial level presenting behavior of that person. The purest (prasad) part of food nurtures soul finally. If this does not happen, it leads to psychiatric illness.
Diet as etiological factor:
The health and disease originate from diet. [Cha. Sa. Sutra sthana,28/45] Incompatible, unhygienic food, impure, unclean, deformed, contaminated, intoxicated food leads to various psychotic and seizure disorders. [Cha. Sa., Chikitsa Sthana, 9/4, 10/4]
2. Rasayana [rejuvenation medicines]: A group of herbs that promote intellectual functions and memory (medhya rasayana) is used for improving mental health. Juice of Guduchi (Tinospora cordifolia), Powder of yashtimadhu (Glycerrhiza glabra) with milk, paste of shankhapushpi (Convolvulus pluricaulis) and mandukaparni (Centella asiatica) promote intelligence and memory. [Cha.Sa. Chikitsa Sthana 1/3/30-31] These herbs are helpful as stress reliever, memory booster, anxiolytic, antidepressant, anti-aging medications in mental disorders. Ayurveda herbs and formulations are researched for their effects in various aspects. Rasayana Ghana tablet (RGT), an Ayurvedic combination of Guduchi (Tinospora cordifolia Miers.) , dried fruit rind of Aamalaki (Emblica officinalis Garten.) , , and whole part of Gokshura (Tribulus terrestris Linn.) , is indicated for reducing mental stress and premature ageing. This classical formulation is prescribed with unequal quantity of ghee and honey as vehicle for maintenance of sexual vigor (vrishya), stability and steadiness (sthiratva), peacefulness and treatment of diseases (shanta vikara-dukkham), balance in mind and body (samah) and longevity (shatam jeevati) with black hairs (it restricts graying of hairs).[Ashtanga Hridaya, Uttara stana, 39/ 159] In experimental part of study, it showed potent anti-stress, ulcer preventing and adaptogenic activity. It showed good anxiolytic and antidepressant activity as well. In clinical research, the rasayana formulation improved quality of life in stressed individuals. It was effective in decreasing the physical complaints related to quality of life, improving the mental and emotional state, decreasing stress evaluation score in various aspects of life, increasing life enjoyment parameters and thus overall quality of life. It can be easily inferred that as the stress increases, the quality of life decreases to the hazardous physical and psychological impact of stress. Treatment with RGT showed 8.62% increase in the level of DHEAs within a span of two months as compared to 10.93% decrease shown by Placebo drug. This drug attenuated the decrease in anti-ageing hormone DHEAs and also tended to restore its level in the prematurely aged and stressed patients. The example shows effect of Ayurvedic drug on body and mind for positive health. List of commonly used herbs in psychiatric disorders: The common herbs are mentioned in the following table: Sr.No. Herb Name Latin Name Common Name 1. Brahmi Bacopa monnieri Bacopa,Indian pennywort 2. Vacha Acorus calamus Linn. Sweet flag, Acorus 3. Jatamansi Nordostachis jatamansi DC Spikenard 4. Jyotishmati Celastrus panniculatus Willd. Staff tree 5. Ashvagandha Withania somnifera Indian ginseng 6. Kushmanda Benincasa hispida Thunb. White gourd melon 7. Sarpagandha Rauwolfia serpentina Benth 8. Tagar Valeriana wallichii DC Indian Valerian 9. Palandu Alium cepa Linn. Bulb onion 10. Rason Alium sativum Linn. Garlic
Effects of ayurvedic treatments in various neuro-psychiatric diseases: Various research works showed positive effect of ayurvedic treatments in anxiety disorders , , menopausal syndrome , , essential hypertension , , dementia , tension headache , , , migraine , attention deficit hyperactivity disorders , irritable bowel syndrome , stress induced chronic insomnia , insomnia , , depressive Illness , Alzheimer’s dementia , stress and premature ageing. A retrospective analysis of researches on effect of ayurvedic management in psychiatric diseases was done. The data showed that Ayurvedic formulations like aamalakyadi and medhya rasayana ghrita (in Alzheimer’s disease), rasayana ghana tablets (in stress), brahmi ghrita (in depression), shirodhara (in insomnia), saraswatarishta (in perimenopausal syndrome) are moderately effective in treatment of psychiatric diseases. Sattvavajaya therapy and powder of Pippalimula with jaggery are observed effective in patients of insomnia. Sattvavajaya therapy was found more effective in reducing mental symptoms like tension (chinta), fear (bhaya) and anger (krodha). 3. Panchakarma (purification therapies): The purification therapies improve clarity in senses, mind and intellect. [Cha.Sa. Sutra Sthana 16/6] [Cha. Sa. Sutra Sthana 15 /22] They are indicated in management of all psychiatric and psychosomatic disorders based upon state of dosha. [Cha.Sa. Chikitsa Sthana 9, 10] 4. Therapeutic massage (abhyanga): Therapeutic massage (abhyanga) is beneficial in slowing the aging process, pacifying vitiated vata and increasing relaxation of mind, stabilizing mind in order to adopt with stress. [Cha. Sa. Sutra sthana,5/81,85,89] Recent study shows beneficial effects of massage on reducing stress. 5. Oil dripping method (shirodhara): Effects of pouring therapeutic oil on forehead in rhythmic pattern (shirodhara) are studied well. A standardized shirodhara leads to a state of alert calmness similar to the relaxation response observed in meditation. The clinical benefits observed with shirodhara in anxiety neurosis, hypertension, and stress aggravation due to chronic degenerative diseases could be mediated through these adaptive physiological effects. Researchers at University of Toyama, Japan proved that the pharmaco-physio-psychologic action of ayurvedic oil treatment may provide a useful model for future pharmaco-physio-psychotherapy. Thus, Herbs and therapies having rejuvenation properties can be utilized for promotion, preservation and restoration of positive mental health. II. Im-materialistic measures (adravyabhuta chikitsa) The im-materialistic measures focus on improving positive mental health without using any substance. The practices of ideal code of conduct (sadvritta) and achara rasayana are beneficial. Some research studies are mentioned below: 1. Meditation: Meditation is the most powerful therapy for mental health. It is an exercise of consciousness to expand beyond the day-to-day experience of duality. It reduces stress, increases creativity and efficiency of the inner faculty. The process of meditation goes beyond the mind to the deepest level of the inner Self. It connects with the soul (atman). Research has confirmed many health benefits associated with the practice of meditation. These include stress reduction, decreased anxiety, decreased depression, reduction in pain (both physical and psychological), improved memory, and increased efficiency. Meditation increases regional cerebral blood flow in the frontal and anterior cingulate regions of the brain, increases efficiency in the brain's executive attentional network, and increases electroencephalogram (EEG) coherence. A study on the effect of meditation on the executive attentional network found that meditators were faster on all tasks. With aging, the brain cortical thickness (gray matter, which contains neurons) decreases, whereas meditation experience is associated with an increase in gray matter in the brain. The practices of ‘dhyaana’ and ‘samaadhi’ are referred as two indistinct stages of meditation. Samaadhi means the withdrawal of mind from all its objects and its concentration and union with self. ‘Dhyaana’ literally means to think, imagine, contemplate, recollect. ‘Samaadhi’ means intense abstract meditation or fixing of mind or attention. It also means putting together or joining of mind and soul. Dhyaana is referred to both the act of inward contemplation in the broadest sense and more technically to the intermediate state between mere attention to an object (dhaarana) and complete absorption in it (samaadhi). These practices produce ample psychological benefits like control of thoughts, detachment, happiness and peace of mind, concentration, spontaneity and creativity, help in discovering the purpose of life. The spiritual benefits include preservation the harmony of body, mind and soul. It helps in understanding eternity, own spirituality with own faith. Meditation is the most important technique in prevention as well as management of psychiatric disorders.
2. Mantra therapy / music therapy / faith therapy: Mantra [chanting holy hymns] acts through sound vibrations. Sharma H. et. Al, in his research at Ohio state University proved the efficacy of effects of 'primordial sounds' [Sama Veda] on decreasing growth of cancer cell lines as compared to rock music. Pratap G. critically analyzed the effect of mantra on positive mental health. Recently researchers at Massachusetts General Hospital and Beth Israel Deaconess Medical center report that the relaxation response – a state of deep rest attained through breathing, meditation, yoga and other practices. This triggers changes in gene expression that affect the body’s immune system, energy metabolism and insulin secretion. 3. Contemplation or prayer: Contemplation involves stilling one’s material thoughts, focusing on material questions or issues, and listening to intuitive answers. Prayer can offer an individual to express gratitude, share hopes and fears with higher power. This helps in connecting the individual with its higher consciousness. The sound vibrations created by self or musical waves unified with those of cosmos vibrations can have subtle effect on the subconscious mind, leading to healing and strengthening its power. Effect of a scientific prayer and other various techniques on subconscious mind and mental health through law of belief and faith is well studied. 4. Exercise (vyayama): Exercise corrects metabolism, provides physical and mental stability, lightness, strength, endurance and mitigation of dosha (especially kapha). [Cha. Sa. Sutra Sthana, 7/32] Lack of exercise (avyayama) oppositely affects the body and mind, increase kapha dosha, and tamas. In a study, over 90% patients of depression were not following any exercise. Recent research demonstrated that exercise generates new neurons in the hippocampus, the area of the brain responsible for some aspects of memory. It improves learning and memory tasks. Another study reported that regular physical exercise has a variety of benefits that may help promote physiological and psychological wellbeing in adolescent females with depressive symptoms. Exercise has been shown to convey a variety of long and short term benefits to the brain and body. Regular physical exercise increases learning capacity, sharpens memory and boosts overall cognitive functions. Exercise and physical fitness, particularly aerobic fitness, not only improves short term mental processes, but also decrease the long-term risk of stroke, Alzheimer’s disease and other forms of age related cognitive decline. Science has also associated regular exercise with improved sleep, improved self-esteem, mood and relaxation, improved bone density, decreased risk of cardio vascular diseases, diabetes mellitus, hypertension and certain cancers. , , Sengupta P. reviewed the health impacts of yoga and pranayama. Regular physical exercise, pranayama [breathing exercises] showed good results on improving higher intellectual functions and delays brain ageing. A study showed two weeks of Yoga practice potentially reduced anxiety and depression and improved self-esteem of orphanage adolescents and young adults. 5. Sleep (nidra): Sleep is essential for good health and considered as one of the three pillars of life. Sleep depends upon the natural retirement of mind and sense organs owing to fatigue. [Cha. Sa. Sutra Sthana 21/35] Sleep is necessary for proper functions of nervous system. Activity in parts of the brain that controls emotions, decision making processes and social interactions is drastically reduced during deep sleep. This suggests that this type of sleep may help people maintain optimum emotional and social functioning while they are awake. Optimizing one’s sleep has a major impact on one’s resilience, that in turn affects one’s equanimity and coherence. Inadequate sleep can vitiate vata-pitta dosha, disturb kapha at physical level. At mental level, it can disproportionate rajas, tamas and sattva quality.[Cha. Sa. Sutra Sthana 21/50] This endangers the person into disequilibrium state leading to disease. Sleep deprivation leads to drowsiness, inability to concentrate, impaired memory and physical strength. Further it leads to hallucinations and mood swings. Sleep duration changes according to age. The amount of sleep a person needs is the optimum amount that allows the person to function properly without feeling drowsy. Ayurveda advises adaptations in duration and timings of sleep according to season and age as well as bodily conditions. Various studies support the finding that improper sleep can adversely affect the physical and psychological functioning. , It is observed that proper quality and quantity sleep is needed for positive mental health. 6. Control over impulses: The person willing for eternal well-being should control the impulses of motor, mental, and vocal activities speech. Greed, grief, fear, anger, egoism, shamelessness [ impudence], jealousy, excess affliction [in anything] and desire to get other’s wealth are mental activities. Harsh talks, excess talking, that which intends to harm others or backbiting, lying and untimely speech [improper words at improper time] are vocal activities. Physical actions intended to trouble others, stealing, violence [persecution] etc. shall be restrained. These control makes a person virtuous and free from all evil deeds, and happy to enjoy life. [Cha. Sa. Sutra Sthana 7/27-30] 7. Rejuvenation behavior therapy [aachara rasayana]: Ayurveda summarizes good code of conduct and behavior for rejuvenation of physical as well as mental health. This included following practices: • Being truthful, free from anger, nonviolent, abstaining from wine and women, relaxed, calm and soft spoken. • The person is engaged in meditation and cleanliness, perseverant, observing charity, penance, worshipping, loving and compassionate, vigilant and takes proper sleep. He consumes ghee with milk daily, considering the measure of place and time. • He is well behaved, simple, with his senses well concentrated to spirituality. • He keeps company of elders, positivist, self-restrained and devoted to holy books. [Cha. Sa. Chikitsa Sthana 1/4/30-35] Theses works: Theses on concept of mind: At I.P.G.T.& R.A.-JĀMNAGAR • Sharma Vadabrata (1963)-Mānas Vijñāna -Jāmnagar • Agrawal P.S (1963)-Mānas Karma Adhyayana (Smṛti Medhā Buddhi Vivechana). • Chacko P.T (1987)-A study on Sattva (mental constitution) in school going children of Jāmnagar. • Chandrakar R.P (1997)-Concept of Manas and its role in psycho pathology w.s.r.to Viṣāda (depression). • Shreevastha (2000)-Concept of Mānas Prakṛti and its role in psychopathology w.s.r to Anavasthita Cittattva (general anxiety disorders) and its management. • Pandya Siddesh (2005)-Ayurvedokta Sattvāvajaya Cikitsā aur self hypnosis ka Smṛti -vardhaka evam Anidra pe Caraka Cikitsā ke pakṣa ka Adhyayana. • Mohanty Bishnupriya K (2001)-Concept of Mano Abhighātkara bhāvas on Āma (free redicles) Utpatti particular to Madhumeha (diabetus melitus). • Neeta Patel (2008)-The conceptual and applied study of Medhā and Manas in Āyurveda. At other places • Chaube Deobrat (1979)-A study on mind-body relationship w.s.r. to Caraka Saṃhitā -B.H.U. • Sharma I.S. (1992)-Mana ka svaroopa evam uska kriyātmaka parigyāna- Jaipur. • Ghosh Tapan(1999)-Studies on the concept of Mana in Saṃhitā w.s.r. to psychological parameters-Kolkata. Theses on Ayurvedic management of psychiatric diseases: 1. Parsania Sanjay C. KC (MR). A Clinical Study on the Role of Jala-Dhara and Sankhapushphi (Convolvulus pluricaulis Chois.) in the Management of Chittodvega (Anxiety Disorders). L-2657. 2001. 2. Pateria M. KC (MR). A Clinical Study of the Manasika Bhavas in Menopausal Syndrome and its Management by Medhya Rasayana and Shiro-Dhara. L-2764. 2002. 3. Shah Tejal. KC (MR). A Clinical Study on Ayurvedic Aspect of Dementia and its Management. 2002. 4. Patel Dhananjay. KC (MR). The Role of Manasika Bhavas in the Aetio-pathogenesis of Uccha-Rakta-Cchapa (Hypertension) and its Management with Medhya Rasayana and Shiro-Dhara. 2003. 5. Patel Ratna. KC (PK). A Comparative Study on the Role of Medhya Ghrita Administered by Nasya and Oral Route in the Management of Vatika Shirah-Shoola (Tension Headache). 2002. 6. Shoor Suraj. KC (MR). Study on the Role of Manasika Bhavas in the Aetiopathogenesis of Shirah-Shoola (Migraine) and its Management. 2003. 7. Jogal Devangi N. (KC). A Comparative Study on the Role of Jala-Dhara and Jatamansi (Nardostachys Jatamansi) in the Management of Vatika Shirah-Shoola (Tension Headache). L-2924. 2004. 8. Nirmal Dhamini A. KC (MR). Role Manasa Bhavas in Anidra and its Management with Certain Indigenous Drugs and Shiro-Dhara. L-2930. 2004. 9. Ahir Yogita U. KC (MR). Clinico-Experimental Study of Kushmandadi Ghrita in Generalized Anxiety Disorder w.s.r. to Chittodvega. 2005. 10. Chetali Bhat. (KB). A Pharmaco-Clinical Study on the Management of Mandukaparni (Centella asiatica) in Attention-Deficit/Hyperactivity Disorder (ADHD). 2006. 11. Hetal Dave. (KC). A Comparative Study on the Role of Medhya Rasayana Yoga and Dashamula Kwathadhara in the Management of Vatika Shirahshula (Tension Headache). 2006. 12. Raksha Mer. (KC). A Clinical Study on Manasikbhava in Irritable Bowel Syndrome and its Management with Kutajadi Avaleha and Medhyarasayana. 2006. 13. Anil Kumar Singh. (MR). A Clinical Study of Manasika Bhavas in Anidra w.s.r to Stress Induced Chronic Insomnia and its Management with Mamsyadi Ghrita and Dashamula Kwatha Shirodhara. 2007. 14. Vansh Bina H. (MR). A Clinical Study on Mansika Bhavas in Anidra w.s.r. to Stress Induced Insomnia and its Management with Tagaradi Kwatha and Mahishi Dugdha Shirodhara. 2008. 15. Deole Yogesh S. (MR). Clinico-Experimental Study on Effect of Brahmi Ghrita on Depressive Illness. 2008. 16. Kundu Chittaranjan. (MR). Role Manasika Bhava in Etiopathogenesis of Essential Hypertension and its Management by Shirodhara and Sarpagandha Vati. 2009 17. Santwani Khyati M. (MR). An Assessment of Mansika Bhavas in Menopausal Syndrome and its Management. 2009. 18. Chaudhury Kundan. A Comparative Study on the Management of Senile Dementia with Polyherbal Medhya Rasayana Ghrita and Aamalakyadi Ghrita. PhD Thesis, Submitted to Gujarat Ayurved University, Jamnagar. 2010. 19. Deole YS. Clinico-Experimental Study on Role of Stress in Premature Ageing and its Management with Rasayana Yoga. PhD Thesis, Submitted to Gujarat Ayurved University, Jamnagar. 2011. Further reading: • Thakar V.J., Jyoti pracheta, Mana ane Manas roga, Vishvabharati Prakashana,Nagpur,India , • Chandrakara R.P.:Concept of Manasa and its role in Psycho pathology with special reference to Vishada (depression),Department of Basic principles, I.P.G.T.R.A., Jamnagar, M.D. Ayu. Thesis (1997) pg. 103 • Bhagvadgita As It Is (Marathi), by A.C. Bhaktivedanta Swami Prabhupada, eigth edition, Bhaktivedanta Book Trust, Juhu, Mumbai – 400 049, 2001 • Gheranda Samhita • Patanjala Yoga Sutra • Yoga and Kriya • Ayurvediya Manas Roga Vijnana by Prof.R.H.Singh • Abhinav Manas Roga Vijnana by Dr. Rajendra Prakash Bhatnagar published by Soorya prakash Sansthan, Udaipur (Rajasthan)
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