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Unmada Chikitsa (view source)

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

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

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

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

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== Introduction ==

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

Thus, ''unmada'' is not a lone clinical entity comparable to a single modern diagnostic category, rather it is a syndrome describing a group of psychotic disorders. It is a common and broader entity, which provides guidance to the line of management for almost all psychiatric disorders in [[Ayurveda]]. In this ailment, the intellect, mind and memory get perverted. ''Unmada'' can be described as the disordered state of mind, in which an individual loses the ability of regulating his/her actions and conduct according to the rules of society. As the psychotic disorders cover almost all the major mental illnesses, the different types and sub-types of ''unmada'' can be separately correlated with different psychotic disorders. The clinical features of the different types of ''unmada'' resemble various types of schizophrenia, manic psychosis, psychotic depression / major depressive disorder. ''Unmada'' is divided into two broad categories – (1) ''Nija''- those caused by internal imbalance of body humors i.e. ''vata, pitta, kapha'' and the ''sannipataja'' and the (2) ''Agantunimitta''- those caused by exogenous factors.

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

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

== Sanskrit text, Transliteration and English Translation ==

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unmAdahetvAkRutibheShajAni kAle~agniveshAya shashaMsa pRuShTaH||3||

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Punarvasu, the abode of intellect, [[memory]], knowledge, penance and saviour of living beings, timely described the etiology, symptoms and treatment of ''unmada'' to Agnivesha as queried. [3]

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As said earlier in the diagnosis -section, prodromal features coincide with the entry of celestial beings. Now listen about the symptoms of various types separately, time of affliction and susceptible person. [19]

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=== Various types of ''agantu unmada'' ===

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saumyadRuShTiMgambhIramadhRuShyamakopanamasvapnabhojanAbhilAShiNamalpasvedamUtrapurIShavAtaM shubhagandhaM phullapadmavadanamiti devonmattaM vidyAt;

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Gentle look, serious, unassailable, unwrathful, having no desire for sleep and food, with decreased sweat, urine, stool and flatus, auspicious smell and face like blossomed lotus flower- are the characters of unmada caused due to affliction by gods.

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==== Affliction by ''unmada'' due to affliction of guru etc. ====

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guruvRuddhasiddharShINAmabhishApAbhicArAbhidhyAnAnurUpaceShTAhAravyAhAraM tairunmattaMvidyAt;

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One having movements, diet and speech corresponding to type of ''abhishapa'' (curse), ''abhichara'' (magical spell) or ''abhidhyana'' (desire to transform by willpower), meditation of teacher, elders, accomplished person (''siddhas'') and sages should be known as ''unmada'' caused due to affliction by them (''rishis'' etc.) respectively.

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==== ''Unmada'' due to affliction of ancestors or forefathers ====

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aprasannadRuShTimapashyantaM nidrAluMpratihatavAcamanannAbhilAShamarocakAvipAkaparItaM ca pitRubhirunmattaM vidyAt;

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Unhappy look, inability to see, drowsiness, interrupted speech, lack of desire for food, anorexia and indigestion are the characteristics of the person suffering from ''unmada'' caused due to affliction by ''pitris''(manes).

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==== ''Unmada'' due to affliction of ''gandharva'' (celestial musicians) ====

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mukhavAdyanRutyagItAnnapAnasnAnamAlyadhUpagandharatiMraktavastrabalikarmahAsyakathAnuyogapriyaM shubhagandhaM ca gandharvonmattaM vidyAt;

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Violent acts, over courageousness, sharpness, seriousness, invincibility, liking for vocal music, instrumental music played by mouth, dancing, singing, good food and drinks, garlands, incense, perfume, red apparels, ''bali'' (offerings of sacrifices), laughing, humorous talks and pleasant aroma from the body are the features of the patients suffering from ''unmada'' caused due to affliction by ''gandharvas'' (celestial musicians).

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==== ''Unmada'' due to affliction of ''yaksha'' ====

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asakRutsvapnarodanahAsyaM nRutyagItavAdyapAThakathAnnapAnasnAnamAlyadhUpagandharatiMraktaviplutAkShaM dvijAtivaidyaparivAdinaM rahasyabhAShiNaM ca yakShonmattaM vidyAt;

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Frequent sleep, cry and laugh, liking for dancing, singing, playing instruments, reciting sacred scriptures, liking for stories, good food and drinks, garlands, incense, perfume, red & tearful eyes ,despising ''dvijas'' (persons of families of ''brahmana, kshatriya'' and ''vaishyas''.) and physicians, disclosing the secrets are the features of the patients suffering from ''unmada'' caused due to affliction by ''yakshas'' (demigods, semi-divine celestial beings, attendants of ''Kubera'', the celestial physician).

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==== ''Unmada'' due to affliction of ''rakshasa'' (demons) ====

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naShTanidramannapAnadveShiNamanAhAramapyatibalinaMshastrashoNitamAMsaraktamAlyAbhilAShiNaM santarjakaM ca rAkShasonmattaM vidyAt;

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Sleeplessness, hatred for food and drinks, and excessive strength in spite of aversion for food, liking for weapons, blood, meat and red garlands and ferociousness are the features of the patients suffering from ''unmada'' caused due to affliction by ''rakshasas'' (demons).

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==== ''Unmada'' due to affliction of ''brahma-rakshasa'' (a class of evil demons) ====

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prahAsanRutyapradhAnaM devavipravaidyadveShAvaj~jAbhiH stutivedamantrashAstrodAharaNaiHkAShThAdibhirAtmapIDanena ca brahmarAkShasonmattaM vidyAt;

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Excessive laughter, dance, hatred and disobedience to Gods, ''brahmins'' and physicians, reciting sacred scriptures and illustrations from hymns, the ''Vedas'' and ''mantras'' (incantations), injuring himself by pieces of wood etc. are the features of the patients suffering from ''unmada'' caused due to affliction by ''brahma-rakshasas'' (a class of evil demons).

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==== ''Unmada'' due to affliction of ''pishacha'' ====

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asvasthacittaM sthAnamalabhamAnaMnRutyagItahAsinaM baddhAbaddhapralApinaMsa~gkarakUTamalinarathyAcelatRuNAshmakAShThAdhirohaNaratiM bhinnarUkShasvaraM nagnaMvidhAvantaM naikatra tiShThantaM duHkhAnyAvedayantaM naShTasmRutiM ca pishAconmattaMvidyAt||20||

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One who has impaired mind (fickle minded), does not find peace anywhere, dances, sings and laughs frequently, delirious with coherent or incoherent speech, fond of climbing on garbage, dirty lanes, cloth, grass, stone and wood, has hoarse and rough voice, remains naked, running and not standing at a place, always complaining of his miseries and sorrows before others and has lost his memory should be known as ''unmada'' caused due to affliction by ''pishacha'' (a class of demons). [20]

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=== Days, time and susceptible persons for affliction ===

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tatra caukShAcAraM tapaHsvAdhyAyakovidaM naraM prAyaH shuklapratipadi trayodashyAM cachidramavekShyAbhidharShayanti [1] devAH, snAnashuciviviktasevinaMdharmashAstrashrutivAkyakushalaM prAyaH ShaShThyAM navamyAM carShayaH,mAtRupitRuguruvRuddhasiddhAcAryopasevinaM prAyo dashamyAmamAvasyAyAM ca pitaraH, gandharvAHstutigItavAditraratiM paradAragandhamAlyapriyaM caukShAcAraM prAyo dvAdashyAM caturdashyAM ca,sattvabalarUpagarvashauryayuktaM mAlyAnulepanahAsyapriyamativAkkaraNaM [2] prAyaHshuklaikAdashyAM saptamyAM ca yakShAH,svAdhyAyataponiyamopavAsabrahmacaryadevayatigurupUjA~aratiM bhraShTashaucaMbrAhmaNamabrAhmaNaM vA brAhmNavAdinaM shUramAninaM devAgArasalilakrIDanaratiM prAyaHshuklapa~jcamyAM pUrNacandradarshane ca brahmarAkShasAH, rakShaHpishAcAstu hInasattvaMpishunaM straiNaM [3] lubdhaM shaThaM prAyo [4] dvitIyAtRutIyAShTamIShu; ityaparisa~gkhyeyAnAMgrahANAmAviShkRutatamA hyaShTAvete vyAkhyAtAH||21||

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

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''Rakshasa'' (demons) and ''pishachas'' (a class of evil demons) attack the person who has inferior psyche (devoid of will power), has back- biting tendency, fond of women, thief, greedy and wicked often on the second, third and eighth day of the fortnight. These are the eight prominent ones among innumerable ''grahas'' (seizures), which are described. [21]

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=== Untreatable ''unmada'' ===

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sarveShvapi tu khalveShu yo hastAvudyamya roShasaMrambhAnniHsha~gkamanyeShvAtmani vAnipAtayet sa hyasAdhyo j~jeyaH; tathA yaH sAshrunetro meDhrapravRuttaraktaH kShatajihvaHprasrutanAsikashchidyamAnacarmA~apratihanyamAnavANiH satataM vikUjan durvarNastRuShArtaH [1]pUtigandhashca sa hiMsArthinonmatto j~jeyaH; taM parivarjayet||22||

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Of the above varieties of ''unmadas,'' he who strikes at others or himself, without hesitation raising his hands with wrath and agitation should be considered as incurable. He who has tearful eyes, hemorrhage from penis, wounded tongue, running nose, a bruised skin, uninteractable hands, constantly groaning, deranged complexion, excessive thirst and foul smell should be known as maddened by a violent type of spirits (grahas) and should not be treated. [22]

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=== Management principles ===

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मन्त्रभैषज्यविधिनोपक्रमेत्||२३||

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

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sarpiHpAnAdirAgantormantrAdishceShyate vidhiH|33|<br />

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

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In exogenous type of ''unmada'', intake of ghee (''sarpih pana'') etc. along with chanting of hymns (mantras) is recommended for the benefit of the patient. [24-32]

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=== Various formulations ===

==== ''Hingvadi ghee'' ====

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caturguṇē gavāṁ mūtrē siddhamunmādanāśanam||34||<br />

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Now listen, some of the most efficacious formulations for alleviating the ''unmada''.

''Hingu, sauvarchala'' and ''trikatu'' (''shunthi , maricha'' and ''pippali'' ) each 80 gm (two ''palas'') should be made to paste and cooked with one ''adhaka'' of ghee (2.56 kg ) and four times cow’s urine is a tested destroyer of ''unmada''.[33-34]

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==== ''Kalyanaka'' ghee ====

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buddhvA tada~ggopahArabalimishreNa| <br />

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''Vishala, triphala, harenuka, devadaru, elevaluka, shalaparni, tagara,'' two types of ''haridra'' (''haridra'' and ''dauharidra''), two types of ''sariva, priyangu, nilotpala, ela, manjishtha,danti,dadima, nagakeshara, talisapatra, brahati,'' fresh flower of ''jati, vidanga, prishnaparni, kushtha, chandana'' and ''padmaka'', (total 28 drugs) each 10 gm, and ghee 640 gm, should be cooked well with four times water.

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* [[ Unmada Nidana ]]

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Unmada Chikitsa (view source)

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