Unmada Chikitsa

Unmada Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 9
Preceding Chapter	Rajayakshma Chikitsa
Succeeding Chapter	Apasmara Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

(Chikitsa Sthana Chapter 9, Chapter on the Management of Mental Disorders)

Abstract

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.

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

Introduction

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.

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.

Sanskrit text, Transliteration and English Translation

अथात उन्मादचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athāta unmādacikitsitaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAta unmAdacikitsitaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now (I) shall expound the chapter on the treatment of unmada. Thus said Lord Atreya. [1-2]

बुद्धिस्मृतिज्ञानतपोनिवासः पुनर्वसुः प्राणभृतां शरण्यः| उन्मादहेत्वाकृतिभेषजानि कालेऽग्निवेशाय शशंस पृष्टः||३||

buddhismr̥tijñānatapōnivāsaḥ punarvasuḥ prāṇabhr̥tāṁ śaraṇyaḥ| unmādahētvākr̥tibhēṣajāni kālē'gnivēśāya śaśaṁsa pr̥ṣṭaḥ||3||

buddhismRutij~jAnataponivAsaH punarvasuH prANabhRutAM sharaNyaH| unmAdahetvAkRutibheShajAni kAle~agniveshAya shashaMsa pRuShTaH||3||

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]

Causes of unmada

विरुद्धदुष्टाशुचिभोजनानि प्रधर्षणं देवगुरुद्विजानाम्| उन्मादहेतुर्भयहर्षपूर्वो मनोऽभिघातो विषमाश्च चेष्टाः||४||

viruddhaduṣṭāśucibhōjanāni pradharṣaṇaṁ dēvagurudvijānām| unmādahēturbhayaharṣapūrvō manō'bhighātō viṣamāśca cēṣṭāḥ||4||

viruddhaduShTAshucibhojanAni pradharShaNaM devagurudvijAnAm| unmAdaheturbhayaharShapUrvo mano~abhighAto viShamAshca ceShTAH||4||

Food with incompatible, contaminated and unclean properties; possession by spirits like gods, teachers and brahmanas; mental trauma due to recurrent exposure to fear or exhilaration and adopting difficult posture are the general causes of unmada.[4]

Pathogenesis of unmada

तैरल्पसत्त्वस्य मलाः प्रदुष्टा बुद्धेर्निवासं हृदयं प्रदूष्य| स्रोतांस्यधिष्ठाय मनोवहानि प्रमोहयन्त्याशु नरस्य चेतः||५||

tairalpasattvasya malāḥ praduṣṭā buddhērnivāsaṁ hr̥dayaṁ pradūṣya| srōtāṁsyadhiṣṭhāya manōvahāni pramōhayantyāśu narasya cētaḥ||5||

tairalpasattvasya malAH praduShTA buddhernivAsaM hRudayaM pradUShya| srotAMsyadhiShThAya manovahAni pramohayantyAshu narasya cetaH||5||

By the above causative factors, the doshas get vitiated in the person possessing low level of sattva guna (weak minded people) in turn vitiate hridaya (mind), which is the seat of intellect. There from the channels carrying mental factors (mano-vaha srotasas), quickly delude the mind of the person. [5]

Clinical features

धीविभ्रमः सत्त्वपरिप्लवश्च पर्याकुला दृष्टिरधीरता च| अबद्धवाक्त्वं हृदयं च शून्यं सामान्यमुन्मादगदस्य लिङ्गम्||६||

स मूढचेता न सुखं न दुःखं नाचारधर्मौ कुत एव शान्तिम्| विन्दत्यपास्तस्मृतिबुद्धिसञ्ज्ञो भ्रमत्ययं चेत इतस्ततश्च||७||

dhīvibhramaḥ sattvapariplavaśca paryākulā dr̥ṣṭiradhīratā ca| abaddhavāktvaṁ hr̥dayaṁ ca śūnyaṁ sāmānyamunmādagadasya liṅgam||6||

sa mūḍhacētā na sukhaṁ na duḥkhaṁ nācāradharmau kuta ēva śāntim| vindatyapāstasmr̥tibuddhisañjñō bhramatyayaṁ cēta itastataśca||7||

dhIvibhramaH sattvapariplavashca paryAkulA dRuShTiradhIratA ca| abaddhavAktvaM hRudayaM ca shUnyaM sAmAnyamunmAdagadasya li~ggam||6||

sa mUDhacetA na sukhaM na duHkhaM nAcAradharmau kuta eva shAntim| vindatyapAstasmRutibuddhisa~jj~jo bhramatyayaM ceta itastatashca||7||

Perverted intellect, psychic agitation, restlessness in eyes, impatience, incoherent speech and feeling of emptiness in hridaya (mind), these are the general features of unmada.

Thus, the person with deranged mind does not know pleasures, pain, ethics and eternal duties and does not get peace anywhere. Therefore, he lets the mind wander here and there due to loss of memory, intellect and perceptions. [6-7]

Types of unmada

समुद्भ्रमं बुद्धिमनःस्मृतीनामुन्मादमागन्तुनिजोत्थमाहुः| तस्योद्भवं पञ्चविधं पृथक् तु वक्ष्यामि लिङ्गानि चिकित्सितं च||८||

samudbhramaṁ buddhimanaḥsmr̥tīnāmunmādamāgantunijōtthamāhuḥ| tasyōdbhavaṁ pañcavidhaṁ pr̥thak tu vakṣyāmi liṅgāni cikitsitaṁ ca||8||

samudbhramaM buddhimanaHsmRutInAmunmAdamAgantunijotthamAhuH| tasyodbhavaM pa~jcavidhaM pRuthak tu vakShyAmi li~ggAni cikitsitaM ca||8||

Unmada refers to excessive affliction of intellect, mind and memory. This is of two types – nija (endogenous) and agantuja (exogenous). According to origin, it is of five types.(I) will describe their symptoms and treatment separately.[8]

Vata dominant unmada

रूक्षाल्पशीतान्नविरेकधातुक्षयोपवासैरनिलोऽतिवृद्धः| चिन्तादिजुष्टं हृदयं प्रदूष्य बुद्धिं स्मृतिं चाप्युपहन्ति शीघ्रम्||९||

अस्थानहासस्मितनृत्यगीतवागङ्गविक्षेपणरोदनानि| पारुष्यकार्श्यारुणवर्णताश्च जीर्णे बलं चानिलजस्य रूपम्||१०||

rūkṣālpaśītānnavirēkadhātukṣayōpavāsairanilō'tivr̥ddhaḥ| cintādijuṣṭaṁ hr̥dayaṁ pradūṣya buddhiṁ smr̥tiṁ cāpyupahanti śīghram||9||

asthānahāsasmitanr̥tyagītavāgaṅgavikṣēpaṇarōdanāni| pāruṣyakārśyāruṇavarṇatāśca jīrṇē balaṁ cānilajasya rūpam||10||

rUkShAlpashItAnnavirekadhAtukShayopavAsairanilo~ativRuddhaH| cintAdijuShTaM [1] hRudayaM pradUShya buddhiM smRutiM cApyupahanti shIghram||9||

asthAnahAsasmitanRutyagItavAga~ggavikShepaNarodanAni| pAruShyakArshyAruNavarNatAshca jIrNe balaM cAnilajasya rUpam||10||

Vayu gets aggravated by the intake of rough, deficient in quantity and cold in property food, excessive evacuation of doshas, depletion of body tissues and fasting. This aggravated vayu affects the hridaya (site of mind), which is already afflicted with anxiety etc. and thus quickly deranges intellect and memory.

Laughing, smiling, dancing, singing, speaking, abnormal movement of body parts, weeping at improper places and improper time, roughness, emaciation, reddish discoloration of body parts and aggravation of the disease after digestion of food; are the clinical features of the vata dominant unmada .[9-10]

Pitta dominant unmada

अजीर्णकट्वम्लविदाह्यशीतैर्भोज्यैश्चितं पित्तमुदीर्णवेगम्| उन्मादमत्युग्रमनात्मकस्य हृदि श्रितं पूर्ववदाशु कुर्यात्||११||

अमर्षसंरम्भविनग्नभावाः सन्तर्जनातिद्रवणौष्ण्यरोषाः | प्रच्छायशीतान्नजलाभिलाषाः पीता च भाः पित्तकृतस्य लिङ्गम्||१२||

ajīrṇakaṭvamlavidāhyaśītairbhōjyaiścitaṁ pittamudīrṇavēgam| unmādamatyugramanātmakasya hr̥di śritaṁ pūrvavadāśu kuryāt||11||

amarṣasaṁrambhavinagnabhāvāḥ santarjanātidravaṇauṣṇyarōṣāḥ | pracchāyaśītānnajalābhilāṣāḥ pītā ca bhāḥ pittakr̥tasya liṅgam||12||

ajIrNakaTvamlavidAhyashItairbhojyaishcitaM pittamudIrNavegam| unmAdamatyugramanAtmakasya hRudi shritaM pUrvavadAshu kuryAt||11||

amarShasaMrambhavinagnabhAvAH santarjanAtidravaNauShNyaroShAH | pracchAyashItAnnajalAbhilAShAH pItA ca bhAH pittakRutasya li~ggam||12||

The already accumulated pitta gets aggravated due to indigestion, by the intake of pungent, sour food, those articles causing burning sensation, and hot in potency. It takes shelter in the hridaya (site of mind) in the person without self restraint and thus suddenly gives rise to severe episode of unmada as per the above mentioned pathogenesis.

Intolerance, agitation, nakedness, terrorizing, excessive movements, (running), heat, wrath (anger), yellowish luster and desire for dense shady places, cold food - are the clinical features of pitta dominant unmada. [11-12]

Kapha dominant unmada

सम्पूरणैर्मन्दविचेष्टितस्य सोष्मा कफो मर्मणि सम्प्रवृद्धः| बुद्धिं स्मृतिं चाप्युपहत्य चित्तं प्रमोहयन् सञ्जनयेद्विकारम्||१३||

वाक्चेष्टितं मन्दमरोचकश्च नारीविविक्तप्रियताऽतिनिद्रा| छर्दिश्च लाला च बलं च भुङ्क्ते नखादिशौक्ल्यं च कफात्मकस्य||१४||

sampūraṇairmandavicēṣṭitasya sōṣmā kaphō marmaṇi sampravr̥ddhaḥ| buddhiṁ smr̥tiṁ cāpyupahatya cittaṁ pramōhayan sañjanayēdvikāram||13||

vākcēṣṭitaṁ mandamarōcakaśca nārīviviktapriyatā'tinidrā| chardiśca lālā ca balaṁ ca bhuṅktē nakhādiśauklyaṁ ca kaphātmakasya||14||

sampUraNairmandaviceShTitasya soShmA kapho marmaNi sampravRuddhaH| buddhiM smRutiM cApyupahatya cittaM pramohayan sa~jjanayedvikAram||13||

vAkceShTitaM mandamarocakashca nArIviviktapriyatA~atinidrA| chardishca lAlA ca balaM ca bhu~gkte nakhAdishauklyaM ca kaphAtmakasya||14||

In the persons taking excessive food and doing slow activities (having sedentary habits), kapha along with heat (pitta) increases in their vital organ (hridaya), impairing intellect and memory and thereby deranging their mind produces insanity. Slow speech and movements, anorexia, and liking for women and loneliness, excessive sleep, vomiting, salivation, aggravation of the disease after taking meals and whiteness of nails etc.– these are the clinical features of the kapha dominant unmada. [13-14]

Sannipata unmada (due to vitiation of all doshas)

यः सन्निपातप्रभवोऽतिघोरः सर्वैः समस्तैः स च हेतुभिः स्यात्| सर्वाणि रूपाणि बिभर्ति तादृग्विरुद्घभैषज्यविधिर्विवर्ज्यः||१५||

yaḥ sannipātaprabhavō'tighōraḥ sarvaiḥ samastaiḥ sa ca hētubhiḥ syāt| sarvāṇi rūpāṇi bibharti tādr̥gvirudghabhaiṣajyavidhirvivarjyaḥ||15||

yaH sannipAtaprabhavo~atighoraH sarvaiH samastaiH sa ca hetubhiH syAt| sarvANi rUpANi bibharti tAdRugvirudghabhaiShajyavidhirvivarjyaH||15||

The severe type of unmada arising from sannipata (aggravation of all three doshas) is caused by all the above etiological factors. It presents with all the above characters in mixed form and because of antagonistic therapeutic principles, it is difficult to treat and therefore should be rejected. [15]

Agantu unmada (exogenous type)

देवर्षिगन्धर्वपिशाचयक्षरक्षःपितॄणामभिधर्षणानि| आगन्तुहेतुर्नियमव्रतादि मिथ्याकृतं कर्म च पूर्वदेहे||१६||

dēvarṣigandharvapiśācayakṣarakṣaḥpitr̥̄ṇāmabhidharṣaṇāni| āgantuhēturniyamavratādi mithyākr̥taṁ karma ca pūrvadēhē||16||

devarShigandharvapishAcayakSharakShaHpitRUNAmabhidharShaNAni| AgantuheturniyamavratAdi mithyAkRutaM karma ca pUrvadehe||16||

Possession by the gods, sages, gandharvas (celestial choristers), pishachas (devils), yakshas (living supernatural being/spiritual apparition), rakshasas (demons) and pitru(forefathers/ancestors spirits); unmethodical performance of spiritual rituals and vows etc. and the deeds of past life are the causes of the exogenous type of unmada. [16]

Signs of bhutonmada (affliction of evil spirits)

अमर्त्यवाग्विक्रमवीर्यचेष्टो ज्ञानादिविज्ञानबलादिभिर्यः| उन्मादकालोऽनियतश्च यस्य भूतोत्थमुन्मादमुदाहरेत्तम्||१७|| amartyavāgvikramavīryacēṣṭō jñānādivijñānabalādibhiryaḥ| unmādakālō'niyataśca yasya bhūtōtthamunmādamudāharēttam||17|| amartyavAgvikramavIryaceShTo j~jAnAdivij~jAnabalAdibhiryaH| unmAdakAlo~aniyatashca yasya bhUtotthamunmAdamudAharettam||17||

Persons presenting with superhuman speech, valour, power and activities alongwith superhuman knowledge, understanding, strength etc. and having irregular time of aggravation of the disease, are the clinical features of unmada caused by exogenous causes (evil spirits). (17)

अदूषयन्तः पुरुषस्य देहं देवादयः स्वैस्तु गुणप्रभावैः| विशन्त्यदृश्यास्तरसा यथैव च्छायातपौ दर्पणसूर्यकान्तौ||१८|| आघातकालो हि स पूर्वरूपः प्रोक्तो निदानेऽथ सुरादिभिश्च| उन्मादरूपाणि पृथङ्निबोध कालं च गम्यान् पुरुषांश्च तेषाम्||१९|| adūṣayantaḥ puruṣasya dēhaṁ dēvādayaḥ svaistu guṇaprabhāvaiḥ| viśantyadr̥śyāstarasā yathaiva cchāyātapau darpaṇasūryakāntau||18|| āghātakālō hi sa pūrvarūpaḥ prōktō nidānē'tha surādibhiśca| unmādarūpāṇi pr̥thaṅnibōdha kālaṁ ca gamyān puruṣāṁśca tēṣām||19||

adUShayantaH puruShasya dehaM devAdayaH svaistu guNaprabhAvaiH| vishantyadRushyAstarasA yathaiva cchAyAtapau darpaNasUryakAntau||18|| AghAtakAlo hi sa pUrvarUpaH prokto nidAne~atha surAdibhishca| unmAdarUpANi pRutha~gnibodha kAlaM ca gamyAn puruShAMshca teShAm||19|| Gods etc. invisibly & swiftly enter into the body of a person by their own supernatural effect without affecting the body of the individual. This simulates with as image enter the mirror and sunlight enters the sunstone. (18) As said earlier in the diagnosis -section, prodromal features coincide with the entry of gods etc. Now listen about the symptoms of various types separately, time of affliction and susceptible person. (19)

Various types of agantu unmada

Affliction by God

तद्यथा- सौम्यदृष्टिं गम्भीरमधृष्यमकोपनमस्वप्नभोजनाभिलाषिणमल्पस्वेदमूत्रपुरीषवातं शुभगन्धंफुल्लपद्मवदनमिति देवोन्मत्तं विद्यात्; tadyathā- saumyadr̥ṣṭiṁgambhīramadhr̥ṣyamakōpanamasvapnabhōjanābhilāṣiṇamalpasvēdamūtrapurīṣavātaṁ śubhagandhaṁphullapadmavadanamiti dēvōnmattaṁ vidyāt; tadyathA- saumyadRuShTiMgambhIramadhRuShyamakopanamasvapnabhojanAbhilAShiNamalpasvedamUtrapurIShavAtaM shubhagandhaM phullapadmavadanamiti devonmattaM vidyAt; 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.

Affliction by Unmada due to affliction of guru etc.

गुरुवृद्धसिद्धर्षीणामभिशापाभिचाराभिध्यानानुरूपचेष्टाहारव्याहारं तैरुन्मत्तंविद्यात्; guruvr̥ddhasiddharṣīṇāmabhiśāpābhicārābhidhyānānurūpacēṣṭāhāravyāhāraṁ tairunmattaṁ vidyāt; guruvRuddhasiddharShINAmabhishApAbhicArAbhidhyAnAnurUpaceShTAhAravyAhAraM tairunmattaMvidyAt; 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.

Unmada due to affliction of ancestors or forefathers

अप्रसन्नदृष्टिमपश्यन्तं निद्रालुं प्रतिहतवाचमनन्नाभिलाषमरोचकाविपाकपरीतं च पितृभिरुन्मत्तं विद्यात्; aprasannadr̥ṣṭimapaśyantaṁ nidrāluṁ pratihatavācamanannābhilāṣamarōcakāvipākaparītaṁ capitr̥bhirunmattaṁ vidyāt; aprasannadRuShTimapashyantaM nidrAluMpratihatavAcamanannAbhilAShamarocakAvipAkaparItaM ca pitRubhirunmattaM vidyAt; Unhappy look, inability to see, drowsiness, interrupted speech, lack of desire for food, anorexia & indigestion are the characteristics of the person suffering from unmada caused due to affliction by pitris(manes).

Unmada due to affliction of gandharva (celestial musicians)

(चण्डं साहसिकं तीक्ष्णं गम्भीरमधृष्यं) मुखवाद्यनृत्यगीतान्नपानस्नानमाल्यधूपगन्धरतिं रक्तवस्त्रबलिकर्महास्यकथानुयोगप्रियंशुभगन्धं च गन्धर्वोन्मत्तं विद्यात्; (caṇḍaṁ sāhasikaṁ tīkṣṇaṁ gambhīramadhr̥ṣyaṁ)mukhavādyanr̥tyagītānnapānasnānamālyadhūpagandharatiṁraktavastrabalikarmahāsyakathānuyōgapriyaṁ śubhagandhaṁ ca gandharvōnmattaṁ vidyāt; (caNDaM sAhasikaM tIkShNaM gambhIramadhRuShyaM)mukhavAdyanRutyagItAnnapAnasnAnamAlyadhUpagandharatiMraktavastrabalikarmahAsyakathAnuyogapriyaM shubhagandhaM ca gandharvonmattaM vidyAt; Violent acts, over courageousness, sharpness, seriousness, invincibility, liking for vocal music, instrumental music played by mouth, dancing, singing, good food & drinks, garlands, incense, perfume, red apparels, bali (offerings of sacrifices), laughing, humourous talks & pleasant aroma from the body are the features of the patients suffering from unmada caused due to affliction by gandharvas (celestial musicians).

Unmada due to affliction of yaksha

असकृत्स्वप्नरोदनहास्यं नृत्यगीतवाद्यपाठकथान्नपानस्नानमाल्यधूपगन्धरतिंरक्तविप्लुताक्षं द्विजातिवैद्यपरिवादिनं रहस्यभाषिणं च यक्षोन्मत्तं विद्यात्; asakr̥tsvapnarōdanahāsyaṁ nr̥tyagītavādyapāṭhakathānnapānasnānamālyadhūpagandharatiṁraktaviplutākṣaṁ dvijātivaidyaparivādinaṁ rahasyabhāṣiṇaṁ ca yakṣōnmattaṁ vidyāt; asakRutsvapnarodanahAsyaM nRutyagItavAdyapAThakathAnnapAnasnAnamAlyadhUpagandharatiMraktaviplutAkShaM dvijAtivaidyaparivAdinaM rahasyabhAShiNaM ca yakShonmattaM vidyAt;

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

Unmada due to affliction of rakshasa (demons)

नष्टनिद्रमन्नपानद्वेषिणमनाहारमप्यतिबलिनं शस्त्रशोणितमांसरक्तमाल्याभिलाषिणं सन्तर्जकं च राक्षसोन्मत्तं विद्यात्; naṣṭanidramannapānadvēṣiṇamanāhāramapyatibalinaṁ śastraśōṇitamāṁsaraktamālyābhilāṣiṇaṁsantarjakaṁ ca rākṣasōnmattaṁ vidyāt; naShTanidramannapAnadveShiNamanAhAramapyatibalinaMshastrashoNitamAMsaraktamAlyAbhilAShiNaM santarjakaM ca rAkShasonmattaM vidyAt; Sleeplessness, hatred for food & drinks, and excessive strength inspite of aversion for food, liking for weapons, blood, meat & red garlands and ferociousness are the features of the patients suffering from unmada caused due to affliction by rakshasas (demons).

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

प्रहासनृत्यप्रधानं देवविप्रवैद्यद्वेषावज्ञाभिः स्तुतिवेदमन्त्रशास्त्रोदाहरणैः काष्ठादिभिरात्मपीडनेन च ब्रह्मराक्षसोन्मत्तंविद्यात्; prahāsanr̥tyapradhānaṁ dēvavipravaidyadvēṣāvajñābhiḥstutivēdamantraśāstrōdāharaṇaiḥ kāṣṭhādibhirātmapīḍanēna ca brahmarākṣasōnmattaṁ vidyāt; prahAsanRutyapradhAnaM devavipravaidyadveShAvaj~jAbhiH stutivedamantrashAstrodAharaNaiHkAShThAdibhirAtmapIDanena ca brahmarAkShasonmattaM vidyAt; Excessive laughter, dance, hatred & disobedience to Gods, brahmins & physicians, reciting sacred scriptures & illustrations from hymns, the Vedas & 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).

Unmada due to affliction of pishacha

अस्वस्थचित्तं स्थानमलभमानं नृत्यगीतहासिनं बद्धाबद्धप्रलापिनंसङ्करकूटमलिनरथ्याचेलतृणाश्मकाष्ठाधिरोहणरतिं भिन्नरूक्षस्वरं नग्नं विधावन्तं नैकत्र तिष्ठन्तं दुःखान्यावेदयन्तंनष्टस्मृतिं च पिशाचोन्मत्तं विद्यात्||२०|| asvasthacittaṁ sthānamalabhamānaṁ nr̥tyagītahāsinaṁ baddhābaddhapralāpinaṁsaṅkarakūṭamalinarathyācēlatr̥ṇāśmakāṣṭhādhirōhaṇaratiṁ bhinnarūkṣasvaraṁ nagnaṁ vidhāvantaṁnaikatra tiṣṭhantaṁ duḥkhānyāvēdayantaṁ naṣṭasmr̥tiṁ ca piśācōnmattaṁ vidyāt||20|| asvasthacittaM sthAnamalabhamAnaMnRutyagItahAsinaM baddhAbaddhapralApinaMsa~gkarakUTamalinarathyAcelatRuNAshmakAShThAdhirohaNaratiM bhinnarUkShasvaraM nagnaMvidhAvantaM naikatra tiShThantaM duHkhAnyAvedayantaM naShTasmRutiM ca pishAconmattaMvidyAt||20||

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 & not standing at a place, always complaining of his miseries & sorrows before others and has lost his memory should be known as unmada caused due to affliction by pishacha (a class of demons). (20)

Days, time and susceptible persons for affliction

तत्र चौक्षाचारं तपःस्वाध्यायकोविदं नरं प्रायः शुक्लप्रतिपदि त्रयोदश्यां च छिद्रमवेक्ष्याभिधर्षयन्ति देवाः,स्नानशुचिविविक्तसेविनं धर्मशास्त्रश्रुतिवाक्यकुशलं प्रायः षष्ठ्यां नवम्यां चर्षयः, मातृपितृगुरुवृद्धसिद्धाचार्योपसेविनं प्रायोदशम्याममावस्यायां च पितरः, गन्धर्वाः स्तुतिगीतवादित्ररतिं परदारगन्धमाल्यप्रियं चौक्षाचारं प्रायो द्वादश्यां चतुर्दश्यां च,सत्त्वबलरूपगर्वशौर्ययुक्तं माल्यानुलेपनहास्यप्रियमतिवाक्करणं प्रायः शुक्लैकादश्यां सप्तम्यां च यक्षाः,स्वाध्यायतपोनियमोपवासब्रह्मचर्यदेवयतिगुरुपूजाऽरतिं भ्रष्टशौचं ब्राह्मणमब्राह्मणं वा ब्राह्म्णवादिनं शूरमानिनंदेवागारसलिलक्रीडनरतिं प्रायः शुक्लपञ्चम्यां पूर्णचन्द्रदर्शने च ब्रह्मराक्षसाः, रक्षःपिशाचास्तु हीनसत्त्वं पिशुनं स्त्रैणं लुब्धंशठं प्रायो द्वितीयातृतीयाष्टमीषु; इत्यपरिसङ्ख्येयानां ग्रहाणामाविष्कृततमा ह्यष्टावेते व्याख्याताः||२१||

tatra caukṣācāraṁ tapaḥsvādhyāyakōvidaṁ naraṁ prāyaḥ śuklapratipadi trayōdaśyāṁ cachidramavēkṣyābhidharṣayanti [1] dēvāḥ, snānaśuciviviktasēvinaṁ dharmaśāstraśrutivākyakuśalaṁ prāyaḥṣaṣṭhyāṁ navamyāṁ carṣayaḥ, mātr̥pitr̥guruvr̥ddhasiddhācāryōpasēvinaṁ prāyō daśamyāmamāvasyāyāṁca pitaraḥ, gandharvāḥ stutigītavāditraratiṁ paradāragandhamālyapriyaṁ caukṣācāraṁ prāyō dvādaśyāṁcaturdaśyāṁ ca, sattvabalarūpagarvaśauryayuktaṁ mālyānulēpanahāsyapriyamativākkaraṇaṁ [2] prāyaḥśuklaikādaśyāṁ saptamyāṁ ca yakṣāḥ, svādhyāyatapōniyamōpavāsabrahmacaryadēvayatigurupūjā'ratiṁbhraṣṭaśaucaṁ brāhmaṇamabrāhmaṇaṁ vā brāhmṇavādinaṁ śūramāninaṁ dēvāgārasalilakrīḍanaratiṁprāyaḥ śuklapañcamyāṁ pūrṇacandradarśanē ca brahmarākṣasāḥ, rakṣaḥpiśācāstu hīnasattvaṁ piśunaṁstraiṇaṁ [3] lubdhaṁ śaṭhaṁ prāyō [4] dvitīyātr̥tīyāṣṭamīṣu; ityaparisaṅkhyēyānāṁ grahāṇāmāviṣkr̥tatamāhyaṣṭāvētē vyākhyātāḥ||21||

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||

The Gods (deva) attack the person with purity & 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. The Sages (rishis) posess the person who is fond of bath, purity and loneliness and is conversant with religious scriptures and vedic sentences often on sixth or ninth day of fortnight by finding an opportunity to afflict. . The forefathers (pitris) enter into the person who is engaged in the service of mother, father, and teacher, elders, siddhas (who have accomplished spiritual perfection) and preceptors often on tenth day of the dark fortnight or new moon by finding an opportunity to afflict. The gandharvas (celestial musicians) enter into person who is fond of hymns (praising verses), vocal and instrumental music; has liking for others wife, perfume and garland, and has purity & good conduct often on twelfth and fourteenth day of the fortnight (by finding an opportunity to afflict in them). Yakshas (semidivine Celestial being/ attendants of Kubera) possess a person endowed with mental & physical strength, good complexion, ego & valour, who are fond of garlands, unctuous substances and laughter, who is talkative generally during the seventh & twelth day of bright fortnight (by finding an opportunity to afflict in them). Brahma-rakshasa (a class of evil demons) enters into the person who has disliking for study, austerity, religious practices & rules, fasting celibacy and worship of god, ascetics and preceptors(gurus); lost interest in cleanliness, whether brahmana or not but says himself as brahmana, regards himself as brave, has fondness for playing in temples and water tanks often on the fifth day of the bright fortnight (shukla paksha) or full moon day . 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)

Untreatable unmada

सर्वेष्वपि तु खल्वेषु यो हस्तावुद्यम्य रोषसंरम्भान्निःशङ्कमन्येष्वात्मनि वा निपातयेत् स ह्यसाध्यो ज्ञेयः; तथा यः साश्रुनेत्रोमेढ्रप्रवृत्तरक्तः क्षतजिह्वः प्रस्रुतनासिकश्छिद्यमानचर्माऽप्रतिहन्यमानवाणिः सततं विकूजन् दुर्वर्णस्तृषार्तः पूतिगन्धश्च सहिंसार्थिनोन्मत्तो ज्ञेयः; तं परिवर्जयेत्||२२||

sarvēṣvapi tu khalvēṣu yō hastāvudyamya rōṣasaṁrambhānniḥśaṅkamanyēṣvātmani vā nipātayēt sahyasādhyō jñēyaḥ; tathā yaḥ sāśrunētrō mēḍhrapravr̥ttaraktaḥ kṣatajihvaḥprasrutanāsikaśchidyamānacarmā'pratihanyamānavāṇiḥ satataṁ vikūjan durvarṇastr̥ṣārtaḥ [1]pūtigandhaśca sa hiṁsārthinōnmattō jñēyaḥ; taṁ parivarjayēt||22||

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|| 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, haemorrhage from penis, wounded tongue, running nose, a bruised skin, uncounteractable 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)

Management principles

रत्यर्चनाकामोन्मादिनौ तु भिषगभिप्रायाचाराभ्यां बुद्ध्वा तदङ्गोपहारबलिमिश्रेण| मन्त्रभैषज्यविधिनोपक्रमेत्||२३|| 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 (inchantations/hymns) and drugs mixed with the respective gifts and offerings. (23)

तत्र द्वयोरपि निजागन्तुनिमित्तयोरुन्मादयोः समासविस्तराभ्यां भेषजविधिमनुव्याख्यास्यामः||२४|| उन्मादे वातजे पूर्वं स्नेहपानं विशेषवित्| कुर्यादावृतमार्गे तु सस्नेहं मृदु शोधनम्||२५|| कफपित्तोद्भवेऽप्यादौ वमनं सविरेचनम्| स्निग्धस्विन्नस्य कर्तव्यं शुद्धे संसर्जनक्रमः||२६|| निरूहं स्नेहबस्तिं च शिरसश्च विरेचनम्| ततः कुर्याद्यथादोषं तेषां भूयस्त्वमाचरेत्||२७|| हृदिन्द्रियशिरःकोष्ठे संशुद्धे वमनादिभिः| मनःप्रसादमाप्नोति स्मृतिं सञ्ज्ञां च विन्दति||२८|| शुद्धस्याचारविभ्रंशे तीक्ष्णं नावनमञ्जनम्| ताडनं च मनोबुद्धिदेहसंवेजनं हितम्||२९|| यः सक्तोऽविनये पट्टैः संयम्य सुदृढैः सुखैः| अपेतलोहकाष्ठाद्ये संरोध्यश्च तमोगृहे||३०|| तर्जनं त्रासनं दानं हर्षणं सान्त्वनं भयम्| विस्मयो विस्मृतेर्हेतोर्नयन्ति प्रकृतिं मनः||३१|| प्रदेहोत्सादनाभ्यङ्गधूमाः पानं च सर्पिषः| प्रयोक्तव्यं मनोबुद्धिस्मृतिसञ्ज्ञाप्रबोधनम्||३२|| सर्पिःपानादिरागन्तोर्मन्त्रादिश्चेष्यते विधिः|३३| ratyarcanākāmōnmādinau tu bhiṣagabhiprāyācārābhyāṁ buddhvā tadaṅgōpahārabalimiśrēṇa| mantrabhaiṣajyavidhinōpakramēt||23|| tatra dvayōrapi nijāgantunimittayōrunmādayōḥ samāsavistarābhyāṁbhēṣajavidhimanuvyākhyāsyāmaḥ||24|| unmādē vātajē pūrvaṁ snēhapānaṁ viśēṣavit| kuryādāvr̥tamārgē tu sasnēhaṁ mr̥du śōdhanam||25|| kaphapittōdbhavē'pyādau vamanaṁ savirēcanam| snigdhasvinnasya kartavyaṁ śuddhē saṁsarjanakramaḥ||26|| nirūhaṁ snēhabastiṁ ca śirasaśca virēcanam| tataḥ kuryādyathādōṣaṁ tēṣāṁ bhūyastvamācarēt||27|| hr̥dindriyaśiraḥkōṣṭhē saṁśuddhē vamanādibhiḥ| manaḥprasādamāpnōti smr̥tiṁ sañjñāṁ ca vindati||28|| śuddhasyācāravibhraṁśē tīkṣṇaṁ nāvanamañjanam| tāḍanaṁ ca manōbuddhidēhasaṁvējanaṁ [3] hitam||29|| yaḥ saktō'vinayē [4] paṭṭaiḥ saṁyamya sudr̥ḍhaiḥ sukhaiḥ| apētalōhakāṣṭhādyē saṁrōdhyaśca tamōgr̥hē||30|| tarjanaṁ trāsanaṁ dānaṁ harṣaṇaṁ sāntvanaṁ bhayam| vismayō vismr̥tērhētōrnayanti prakr̥tiṁ manaḥ||31|| pradēhōtsādanābhyaṅgadhūmāḥ pānaṁ ca sarpiṣaḥ| prayōktavyaṁ manōbuddhismr̥tisañjñāprabōdhanam||32||

mantrabhaiShajyavidhinopakramet||23|| tatra dvayorapi nijAgantunimittayorunmAdayoH samAsavistarAbhyAMbheShajavidhimanuvyAkhyAsyAmaH||24|| unmAde vAtaje pUrvaM snehapAnaM visheShavit| kuryAdAvRutamArge tu sasnehaM mRudu shodhanam||25|| kaphapittodbhave~apyAdau vamanaM savirecanam| snigdhasvinnasya kartavyaM shuddhe saMsarjanakramaH||26|| nirUhaM snehabastiM ca shirasashca virecanam| tataH kuryAdyathAdoShaM teShAM bhUyastvamAcaret||27|| hRudindriyashiraHkoShThe saMshuddhe vamanAdibhiH| manaHprasAdamApnoti smRutiM sa~jj~jAM ca vindati||28|| shuddhasyAcAravibhraMshe tIkShNaM nAvanama~jjanam| tADanaM ca manobuddhidehasaMvejanaM [3] hitam||29|| yaH sakto~avinaye [4] paTTaiH saMyamya sudRuDhaiH sukhaiH| apetalohakAShThAdye saMrodhyashca tamogRuhe||30|| tarjanaM trAsanaM dAnaM harShaNaM sAntvanaM bhayam| vismayo vismRuterhetornayanti prakRutiM manaH||31|| pradehotsAdanAbhya~ggadhUmAH pAnaM ca sarpiShaH| prayoktavyaM manobuddhismRutisa~jj~jAprabodhanam||32|| sarpiHpAnAdirAgantormantrAdishceShyate vidhiH|33| Now (I)‘ll describe in brief and detail the treatment of both the endogenous and exogenous types of unmada.

In vata dominant type, first of all one should prescribe intake of oils & ghritas (sneha) substance but if there is obstruction in channels, mild unctuous evacuatives in small quantities should be administrated. If the insanity is caused by kapha and pitta, emesis and purgation should be given after unction and sudation. Post- evacuation dietetic regimen should be prescribed (gradually from lighter to heaviour diet as per prescribed procedure). Thereafter non-unctuous (niruha) and unctuous (anuvasana) enema and nasal errhines (shiro-virechana) should be administrated. Depending upon the predominance of doshas, one or the other of the above measures should be repeatedly applied. By the administration of these therapeutic measures, heart, sense organs, head and bowels (koshtha) get cleansed as a result of which the mind gets refreshed and the patient regains memory as well as consciousness. Even after the completion of above cleansing procedure, if the abnormal behaviour persists, the application of irritant snuffing, collyrium and beating should be done, which are useful for stimulating his mind, intellect and body. One who is non- submissive & strong in physique, should be bound with firm and soft cotton bandage and should be confined in a dark room free from irons rods, wooden pieces etc. Verbal teasing or threatening/shouting with anger (tarjana), terrorizing (trasanam), gifts /donations(danam), gladdening & exhilaration(hanshanam), consolation (santwanam), frightening(bhayam) and astonishing/exhibition of surprising acts (vismaya) restore the mind to normalcy by diverting it & counteracting the causes of loss of memory. The patients suffering from unmada should be administered thick ointment (pradeha), anointing (utsadana), massage (abhyanga), fumigation (dhuma) and intake of ghee to arouse mind, intellect, memory and consciousness. 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)

Various formulations

Hingvadi ghee

अतः सिद्धतमान्योगाञ्छृणून्मादविनाशनान्||३३|| हिङ्गुसौवर्चलव्योषैर्द्विपलांशैर्घृताढकम्| चतुर्गुणे गवां मूत्रे सिद्धमुन्मादनाशनम्||३४|| ataH siddhatamAnyogA~jchRuNUnmAdavinAshanAn||33|| hi~ggusauvarcalavyoShairdvipalAMshairghRutADhakam| caturguNe gavAM mUtre siddhamunmAdanAshanam||34|| sarpiḥpānādirāgantōrmantrādiścēṣyatē vidhiḥ|33| ataḥ siddhatamānyōgāñchr̥ṇūnmādavināśanān||33|| hiṅgusauvarcalavyōṣairdvipalāṁśairghr̥tāḍhakam| caturguṇē gavāṁ mūtrē siddhamunmādanāśanam||34|| Now listen, some of the most efficacious formulations for alleviating the unmada. Hingu, sauvarcala & trikatu (shunthi , marich & pippali ) each 80 gm (02 palas) should be made to paste and cooked with one adhak of ghee (2.56 kg ) and four times cow’s urine is a tested destroyer of unmada.(33-34)

Kalyanaka ghee

विशाला त्रिफला कौन्ती देवदार्वेलवालुकम्| स्थिरा नतं रजन्यौ द्वे सारिवे द्वे प्रियङ्गुका||३५|| नीलोत्पलैलामञ्जिष्ठादन्तीदाडिमकेशरम्| तालीशपत्रं बृहती मालत्याः कुसुमं नवम्||३६|| विडङ्गं पृश्निपर्णी च कुष्ठं चन्दनपद्मकौ| अष्टाविंशतिभिः कल्कैरेतैरक्षसमन्वितैः||३७|| चतुर्गुणे जले सम्यग्घृतप्रस्थं विपाचयेत्| अपस्मारे ज्वरे कासे शोषे मन्देऽनले क्षये||३८|| वातरक्ते प्रतिश्याये तृतीयकचतुर्थके| छर्द्यर्शोमूत्रकृच्छ्रेषु विसर्पोपहतेषु च||३९|| कण्डूपाण्ड्वामयोन्मादविषमेहगदेषु च| भूतोपहतचित्तानां गद्गदानामचेसाम्||४०|| शस्तं स्त्रीणां च वन्ध्यानां धन्यमायुर्बलप्रदम्| अलक्ष्मीपापरक्षोघ्नं सर्वग्रहविनाशनम्||४१|| कल्याणकमिदं सर्पिः श्रेष्ठं पुंसवनेषु चैति कल्याणकं घृतम् vishAlA triphalA kauntI [7] devadArvelavAlukam| sthirA nataM rajanyau dve sArive dve priya~ggukA||35|| nIlotpalailAma~jjiShThAdantIdADimakesharam| tAlIshapatraM bRuhatI mAlatyAH kusumaM navam||36|| viDa~ggaM pRushniparNI ca kuShThaM candanapadmakau| aShTAviMshatibhiH kalkairetairakShasamanvitaiH||37|| caturguNe [8] jale samyagghRutaprasthaM vipAcayet| apasmAre jvare kAse shoShe mande~anale kShaye||38|| vAtarakte pratishyAye tRutIyakacaturthake| chardyarshomUtrakRucchreShu visarpopahateShu ca||39|| kaNDUpANDvAmayonmAdaviShamehagadeShu ca| bhUtopahatacittAnAM gadgadAnAmacesAm||40|| shastaM strINAM ca vandhyAnAM dhanyamAyurbalapradam| alakShmIpAparakShoghnaM sarvagrahavinAshanam||41|| kalyANakamidaM sarpiH shreShThaM puMsavaneShu caiti kalyANakaM ghRutam viśālā triphalā kauntī dēvadārvēlavālukam| sthirā nataṁ rajanyau dvē sārivē dvē priyaṅgukā||35|| nīlōtpalailāmañjiṣṭhādantīdāḍimakēśaram| tālīśapatraṁ br̥hatī mālatyāḥ kusumaṁ navam||36|| viḍaṅgaṁ pr̥śniparṇī ca kuṣṭhaṁ candanapadmakau| aṣṭāviṁśatibhiḥ kalkairētairakṣasamanvitaiḥ||37|| caturguṇē jalē samyagghr̥taprasthaṁ vipācayēt| apasmārē jvarē kāsē śōṣē mandē'nalē kṣayē||38|| vātaraktē pratiśyāyē tr̥tīyakacaturthakē| chardyarśōmūtrakr̥cchrēṣu visarpōpahatēṣu ca||39|| kaṇḍūpāṇḍvāmayōnmādaviṣamēhagadēṣu ca| bhūtōpahatacittānāṁ gadgadānāmacēsām||40|| śastaṁ strīṇāṁ ca vandhyānāṁ dhanyamāyurbalapradam| alakṣmīpāparakṣōghnaṁ sarvagrahavināśanam||41|| kalyāṇakamidaṁ sarpiḥ śrēṣṭhaṁ puṁsavanēṣu caiti kalyāṇakaṁ ghr̥tam

ratyarcanAkAmonmAdinau tu bhiShagabhiprAyAcArAbhyAM buddhvA tada~ggopahArabalimishreNa|

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 padmak, (total 28 drugs) each 10 gm, and ghee 640 gm, should be cooked well with four times water. This ghee is useful in epilepsy, fever, cough, poor digestion, wasting, vatarakta, coryza, tertian and quaternary fever, vomiting, piles, dysuria, erysipelas, itching, anemia, unmada, poisoning, prameha, mental affection by supernatural beings (evil spirits), stammering voice, loss of consciousness and female sterility. It promotes life span, wealth and strength. It alleviates inauspiciousness, sins and micro- organism including all the grahas (seizures). This kalyanaka ghrita is also excellent for punsavana (samskara for formation of fetus). (35-41,1/2)

Mahakalyanaka ghee

एभ्य एव स्थिरादीनि जले पक्त्वैकविंशतिम्||४२|| रसे तस्मिन् पचेत् सर्पिर्गृष्टिक्षीरे चतुर्गुणे| वीरार्द्रमाषकाकोलीस्वयङ्गुप्तर्षभर्धिभिः||४३|| मेदया च समैः कल्कैस्तत् स्यात् कल्याणकं महत्| बृंहणीयं विशेषेण सन्निपातहरं परम्||४४|| इति महाकल्याणकं घृतम्

ēbhya ēva sthirādīni jalē paktvaikaviṁśatim||42|| rasē tasmin pacēt sarpirgr̥ṣṭikṣīrē caturguṇē| vīrārdramāṣakākōlīsvayaṅguptarṣabhardhibhiḥ||43|| mēdayā ca samaiḥ kalkaistat syāt kalyāṇakaṁ mahat| br̥ṁhaṇīyaṁ viśēṣēṇa sannipātaharaṁ param||44|| iti mahākalyāṇakaṁ ghr̥tam

ebhya eva sthirAdIni jale paktvaikaviMshatim||42|| rase tasmin pacet sarpirgRuShTikShIre caturguNe| vIrArdramAShakAkolIsvaya~gguptarShabhardhibhiH||43|| medayA ca samaiH kalkaistat syAt kalyANakaM mahat| bRuMhaNIyaM visheSheNa sannipAtaharaM param||44|| iti mahAkalyANakaM ghRutam In the same way, the twenty one drugs beginning with ‘sthira’ (shalparni) are boiled in water. With this decoction ghee is cooked adding four times milk of primi para cow (milk collected from the cow after its first delivery) and paste of vira, two types of masha (masha and rajmasha) , kakoli, kapikacchu, rishabhaka and riddhi. This Mahakalyanak ghrita is particularly nourishing (bulk promoting) and an excellent alleviator of sannipata (simultaneous vitiation of all three doshas). (42 1/2-44)

Mahapaishachika ghee

जटिलां पूतनां केशीं चारटीं मर्कटीं वचाम्| त्रायमाणां जयां वीरां चोरकं कटुरोहिणीम्||४५|| वयःस्थां शूकरीं छत्रामतिच्छत्रां पलङ्कषाम्| महापुरुषदन्तां च कायस्थां नाकुलीद्वयम्||४६|| कटम्भरां वृश्चिकालीं स्थिरां चाहृत्य तैर्घृतम्| सिद्धं चातुर्थकोन्मादग्रहापस्मारनाशनम्||४७|| महापैशाचिकं नाम घृतमेतद्यथाऽमृतम्| बुद्धिस्मृतिकरं चैव बालानां चाङ्गवर्धनम्||४८|| इति महापैशाचिकं घृतम्

jaṭilāṁ pūtanāṁ kēśīṁ cāraṭīṁ markaṭīṁ vacām| trāyamāṇāṁ jayāṁ vīrāṁ cōrakaṁ kaṭurōhiṇīm||45|| vayaḥsthāṁ śūkarīṁ chatrāmaticchatrāṁ palaṅkaṣām| mahāpuruṣadantāṁ ca kāyasthāṁ nākulīdvayam||46|| kaṭambharāṁ vr̥ścikālīṁ sthirāṁ cāhr̥tya tairghr̥tam| siddhaṁ cāturthakōnmādagrahāpasmāranāśanam||47|| mahāpaiśācikaṁ nāma ghr̥tamētadyathā'mr̥tam| buddhismr̥tikaraṁ caiva bālānāṁ cāṅgavardhanam||48|| iti mahāpaiśācikaṁ ghr̥tam

jaTilAM pUtanAM keshIM cAraTIM markaTIM vacAm| trAyamANAM jayAM vIrAM corakaM kaTurohiNIm||45|| vayaHsthAM shUkarIM chatrAmaticchatrAM pala~gkaShAm| mahApuruShadantAM ca kAyasthAM nAkulIdvayam||46|| kaTambharAM vRushcikAlIM sthirAM cAhRutya tairghRutam| siddhaM cAturthakonmAdagrahApasmAranAshanam||47|| mahApaishAcikaM nAma ghRutametadyathA~amRutam| buddhismRutikaraM caiva bAlAnAM cA~ggavardhanam||48|| iti mahApaishAcikaM ghRutam Ghee processed with drugs like jatamansi, haritaki, bhutkeshi, charati, kapikacchu, vacha, trayamana, jaya (jayanti), vira(kshirakakoli), choraka, katurohini, vayastha, varahi, chhatra, atichhatra, palankasha, shatavari, kayastha, two types of nakuli (nakuli and gandha nakuli), katabhi and shalaparni, is known as mahapaishachika ghrita. It is like ambrosia and alleviates quartan fever, unmada, epilepsy. It also promotes intellect and memory and help in development of children. This is mahapaishachika ghrta. (45-48)

Lashunadya ghee

लशुनानां शतं त्रिंशदभयास्त्र्यूषणात् पलम्| गवां चर्ममसीप्रस्थो द्व्याढकं क्षीरमूत्रयोः||४९|| पुराणसर्पिषः प्रस्थ एभिः सिद्धं प्रयोजयेत्| हिङ्गुचूर्णपलं शीते दत्त्वा च मधुमाणिकाम्||५०|| तद्दोषागन्तुसम्भूतानुन्मादान् विषमज्वरान्| अपस्मारांश्च हन्त्याशु पानाभ्यञ्जननावनैः||५१|| इति लशुनाद्यं घृतम्लशुनस्याविनष्टस्य तुलार्धं निस्तुषीकृतम्| तदर्धं दशमूलस्य द्व्याढकेऽपां विपाचयेत्||५२|| पादशेषे घृतप्रस्थं लशुनस्य रसं तथा| कोलमूलकवृक्षाम्लमातुलुङ्गार्द्रकै रसैः||५३|| दाडिमाम्बुसुरामस्तुकाञ्जिकाम्लैस्तदर्धिकैः| साधयेत्त्रिफलादारुलवणव्योषदीप्यकैः||५४|| यवानीचव्यहिङ्ग्वम्लवेतसैश्च पलार्धिकैः| सिद्धमेतत् पिबेच्छूलगुल्मार्शोजठरापहम्||५५|| ब्रध्नपाण्ड्वामयप्लीहयोनिदोषज्वरकृमीन्| वातश्लेष्मामयान् सर्वानुन्मादांश्चापकर्षति||५६|| इत्यपरं लशुनाद्यं घृतम्

laśunānāṁ śataṁ triṁśadabhayāstryūṣaṇāt palam| gavāṁ carmamasīprasthō dvyāḍhakaṁ kṣīramūtrayōḥ||49|| purāṇasarpiṣaḥ prastha ēbhiḥ siddhaṁ prayōjayēt| hiṅgucūrṇapalaṁ śītē dattvā ca madhumāṇikām||50|| taddōṣāgantusambhūtānunmādān viṣamajvarān| apasmārāṁśca hantyāśu pānābhyañjananāvanaiḥ||51|| iti laśunādyaṁ ghr̥tamlaśunasyāvinaṣṭasya tulārdhaṁ nistuṣīkr̥tam| tadardhaṁ daśamūlasya dvyāḍhakē'pāṁ vipācayēt||52|| pādaśēṣē ghr̥taprasthaṁ laśunasya rasaṁ tathā| kōlamūlakavr̥kṣāmlamātuluṅgārdrakai rasaiḥ||53|| dāḍimāmbusurāmastukāñjikāmlaistadardhikaiḥ| sādhayēttriphalādārulavaṇavyōṣadīpyakaiḥ||54|| yavānīcavyahiṅgvamlavētasaiśca palārdhikaiḥ| siddhamētat pibēcchūlagulmārśōjaṭharāpaham||55|| bradhnapāṇḍvāmayaplīhayōnidōṣajvarakr̥mīn| vātaślēṣmāmayān sarvānunmādāṁścāpakarṣati||56|| ityaparaṁ laśunādyaṁ ghr̥tam

lashunAnAM shataM triMshadabhayAstryUShaNAt palam| gavAM carmamasIprastho dvyADhakaM kShIramUtrayoH||49|| purANasarpiShaH prastha ebhiH siddhaM prayojayet| hi~ggucUrNapalaM shIte dattvA ca madhumANikAm||50|| taddoShAgantusambhUtAnunmAdAn viShamajvarAn| apasmArAMshca hantyAshu pAnAbhya~jjananAvanaiH||51|| iti lashunAdyaM ghRutamlashunasyAvinaShTasya tulArdhaM nistuShIkRutam| tadardhaM dashamUlasya dvyADhake~apAM vipAcayet||52|| pAdasheShe ghRutaprasthaM lashunasya rasaM tathA| kolamUlakavRukShAmlamAtulu~ggArdrakai rasaiH||53|| dADimAmbusurAmastukA~jjikAmlaistadardhikaiH| sAdhayettriphalAdArulavaNavyoShadIpyakaiH||54|| yavAnIcavyahi~ggvamlavetasaishca palArdhikaiH| siddhametat pibecchUlagulmArshojaTharApaham||55|| bradhnapANDvAmayaplIhayonidoShajvarakRumIn| vAtashleShmAmayAn sarvAnunmAdAMshcApakarShati||56|| ityaparaM lashunAdyaM ghRutam

One hundred dehusked bulbs of garlic, 30 fruits of haritaki, trikatu 40 gm ,ash of cow leather 640 gm, cow milk and cow urine 5.12kgshould be well cooked with ten year old cow ghee 640 gm .After it is well cooked and cooled, 40 gms of powder of hingu and honey 320gm should be added .This lashunadya ghrita applied in the form of intake, massage and snuffing alleviates quickly all types of unmada, both endogenous and exogenous, intermittent fever and epilepsy. (49-51) Second formulation of lashunadya ghrita: Undamaged garlic decorticated -200gm, dashamula -100gm should be boiled in 5.12 liters of water and reduced to one fourth. Thereafter ghee -640 gm garlic juice -640 gm along with the juice of kola (jujube), radish, vrikshamla, matulunga and fresh ginger, pomegranate, sura, curd water and sour gruel -each 320 ml and the past of triphala, devadaru, rocksalt, trikatu, ajamoda, yavani, chavya, hingu and amlavetasa -each 20 gm should be cooked. This medicated ghee by intake alleviates colic, gulma, piles, udara, inguinal hernia, anemia, spleen enlargement, female genital disorders, fever, worms, disorder of vata, kapha and all types of unmada. (52-56)

Different useful recipes of medicated ghee

हिङ्गुना हिङ्गुपर्ण्या च सकायस्थवयःस्थया| सिद्धं सर्पिर्हितं तद्वद्वयःस्थाहिङ्गुचोरकैः||५७|| केवलं सिद्धमेभिर्वा पुराणं पाययेद्घृतम्| पाययित्वोत्तमां मात्रां श्वभ्रे रुन्ध्याद्गृहेऽपि वा||५८|| विशेषतः पुराणं च घृतं तं पाययेद्भिषक्| त्रिदोषघ्नं पवित्रत्वाद्विशेषाद्ग्रहनाशनम्||५९|| गुणकर्माधिकं पानादास्वादात् कटुतिक्तकम्| उग्रगन्धं पुराणं स्याद्दशवर्षस्थितं घृतम्||६०|| लाक्षारसनिभं शीतं तद्धि सर्वग्रहापहम्| मेध्यं विरेचनेष्वग्र्यं प्रपुराणमतः परम्||६१|| नासाध्यं नाम तस्यास्ति यत् स्याद्वर्षशतस्थितम्| दृष्टं स्पृष्टमथाघ्रातं तद्धि सर्वग्रहापहम्||६२|| अपस्मारग्रहोन्मादवतां शस्तं विशेषतः|६३|

hiṅgunā hiṅguparṇyā ca sakāyasthavayaḥsthayā| siddhaṁ sarpirhitaṁ tadvadvayaḥsthāhiṅgucōrakaiḥ||57|| kēvalaṁ siddhamēbhirvā purāṇaṁ pāyayēdghr̥tam| pāyayitvōttamāṁ mātrāṁ śvabhrē rundhyādgr̥hē'pi vā||58|| viśēṣataḥ purāṇaṁ ca ghr̥taṁ taṁ pāyayēdbhiṣak| tridōṣaghnaṁ pavitratvādviśēṣādgrahanāśanam||59|| guṇakarmādhikaṁ pānādāsvādāt kaṭutiktakam| ugragandhaṁ purāṇaṁ syāddaśavarṣasthitaṁ ghr̥tam||60|| lākṣārasanibhaṁ śītaṁ taddhi sarvagrahāpaham| mēdhyaṁ virēcanēṣvagryaṁ prapurāṇamataḥ param||61|| nāsādhyaṁ nāma tasyāsti yat syādvarṣaśatasthitam| dr̥ṣṭaṁ spr̥ṣṭamathāghrātaṁ taddhi sarvagrahāpaham||62|| apasmāragrahōnmādavatāṁ śastaṁ viśēṣataḥ|63|

hi~ggunA hi~gguparNyA ca sakAyasthavayaHsthayA| siddhaM sarpirhitaM tadvadvayaHsthAhi~ggucorakaiH||57|| kevalaM siddhamebhirvA purANaM pAyayedghRutam| pAyayitvottamAM mAtrAM shvabhre rundhyAdgRuhe~api vA||58|| visheShataH purANaM ca ghRutaM taM pAyayedbhiShak| tridoShaghnaM pavitratvAdvisheShAdgrahanAshanam||59|| guNakarmAdhikaM pAnAdAsvAdAt kaTutiktakam| ugragandhaM purANaM syAddashavarShasthitaM ghRutam||60|| lAkShArasanibhaM shItaM taddhi sarvagrahApaham| medhyaM virecaneShvagryaM prapurANamataH param||61|| nAsAdhyaM nAma tasyAsti yat syAdvarShashatasthitam| dRuShTaM spRuShTamathAghrAtaM taddhi sarvagrahApaham||62|| apasmAragrahonmAdavatAM shastaM visheShataH|63|

1. Ten year old ghee cooked with hingu, hinguparni, kayastha, vayastha is useful. 2. Similar is the ghee cooked with vayastha, hingu and choraka. The old ghee alone or cooked with the above drugs be administrated.

    After administrating the maximum dose the patient should be kept in isolation in some underground ditch or room. Particularly old ghee should be administrated to the patients of unmada. (57-58) 

Therpeutic utility of old ghee

Old ghee is alleviator of tridosha, particularly destroys demonic seizures because of being pure/sacred nature, by intake is more potent in properties and is pungent- bitter in taste. The ghee stored for ten years is taken as old (puran ghrita). It is irritant in smell. In colour it is like solution of lac in appearance, cold and destroys all grahas. It promotes intellect and is an excellent purgative. Ghee kept beyond ten years is called as ‘pra-puran’ (extremely old). There is no disease, which is incurable for the ghee which is old by one hundred years. It destroys all the grahas by seeing, touching, inhaling and is particularly recommended for those suffering from epilepsy (apasmara), grahas (demonic seizures) and unmada . (59-62)

External applications in vata-kapha dominant unmada

एतानौषधयोगान् वा विधेयत्वमगच्छति||६३|| अञ्जनोत्सादनालेपनावनादिषु योजयेत्| शिरीषो मधुकं हिङ्गु लशुनं तगरं वचा||६४|| कुष्ठं च बस्तमूत्रेण पिष्टं स्यान्नावनाञ्जनम्| तद्वद्व्योषं हरिद्रे द्वे मञ्जिष्ठाहिङ्गुसर्षपाः||६५|| शिरीषबीजं चोन्मादग्रहापस्मारनाशनम्| पिष्ट्वा तुल्यमपामार्गं हिङ्ग्वालं हिङ्गुपत्रिकाम्||६६|| वार्तिः स्यान्मरिचार्धांशा पित्ताभ्यां गोशृगालयोः| तयाऽञ्जयेदपस्मारभूतोन्मादज्वरार्दितान्||६७|| भूतार्तानमरार्तांश्च नरांश्चैव दृगामये| मरिचं चातपे मांसं सपित्तं स्थितमञ्जनम्||६८|| वैकृतं पश्यतः कार्यं दोषभूतहतस्मृतेः| सिद्धार्थको वचा हिङ्गु करञ्जो देवदारु च||६९|| मञ्जिष्ठा त्रिफला श्वेता कटभीत्वक् कटुत्रिकम्| समांशानि प्रियङ्गुश्च शिरीषो रजनीद्वयम्||७०|| बस्तमूत्रेण पिष्टोऽयमगदः पानमञ्जनम्| नस्यमालेपनं चैव स्नानमुद्वर्तनं तथा||७१|| अपस्मारविषोन्मादकृत्यालक्ष्मीज्वरापहः| भूतेभ्यश्च भयं हन्ति राजद्वारे च शस्यते||७२|| सर्पिरेतेन सिद्धं वा सगोमूत्रं तदर्थकृत्| प्रसेके पीनसे गन्धैर्धूमवर्तिं कृतां पिबेत्||७३|| वैरेचनिकधूमोक्तैः श्वेताद्यैर्वा सहिङ्गुभिः| शल्लकोलूकमार्जारजम्बूकवृकबस्तजैः||७४|| मूत्रपित्तशकृल्लोमनखैश्चर्मभिरेव च| सेकाञ्जनं प्रधमनं नस्यं धूमं च कारयेत्||७५|| वातश्लेष्मात्मके प्रायः ...|७६|

ētānauṣadhayōgān vā vidhēyatvamagacchati||63|| añjanōtsādanālēpanāvanādiṣu yōjayēt| śirīṣō madhukaṁ hiṅgu laśunaṁ tagaraṁ vacā||64|| kuṣṭhaṁ ca bastamūtrēṇa piṣṭaṁ syānnāvanāñjanam| tadvadvyōṣaṁ haridrē dvē mañjiṣṭhāhiṅgusarṣapāḥ||65|| śirīṣabījaṁ cōnmādagrahāpasmāranāśanam| piṣṭvā tulyamapāmārgaṁ [1] hiṅgvālaṁ hiṅgupatrikām||66|| vārtiḥ syānmaricārdhāṁśā pittābhyāṁ gōśr̥gālayōḥ| tayā'ñjayēdapasmārabhūtōnmādajvarārditān||67|| bhūtārtānamarārtāṁśca narāṁścaiva dr̥gāmayē| maricaṁ cātapē māṁsaṁ sapittaṁ sthitamañjanam||68|| vaikr̥taṁ paśyataḥ kāryaṁ dōṣabhūtahatasmr̥tēḥ| siddhārthakō vacā hiṅgu karañjō dēvadāru ca||69|| mañjiṣṭhā triphalā śvētā kaṭabhītvak kaṭutrikam| samāṁśāni priyaṅguśca śirīṣō rajanīdvayam||70|| bastamūtrēṇa piṣṭō'yamagadaḥ pānamañjanam| nasyamālēpanaṁ caiva snānamudvartanaṁ tathā||71|| apasmāraviṣōnmādakr̥tyālakṣmījvarāpahaḥ| bhūtēbhyaśca bhayaṁ hanti rājadvārē ca śasyatē||72|| sarpirētēna siddhaṁ vā sagōmūtraṁ tadarthakr̥t| prasēkē pīnasē gandhairdhūmavartiṁ kr̥tāṁ pibēt||73|| vairēcanikadhūmōktaiḥ śvētādyairvā sahiṅgubhiḥ| śallakōlūkamārjārajambūkavr̥kabastajaiḥ||74|| mūtrapittaśakr̥llōmanakhaiścarmabhirēva ca| sēkāñjanaṁ pradhamanaṁ nasyaṁ dhūmaṁ ca kārayēt||75|| vātaślēṣmātmakē prāyaḥ ...|76|

etAnauShadhayogAn vA vidheyatvamagacchati||63|| a~jjanotsAdanAlepanAvanAdiShu yojayet| shirISho madhukaM hi~ggu lashunaM tagaraM vacA||64|| kuShThaM ca bastamUtreNa piShTaM syAnnAvanA~jjanam| tadvadvyoShaM haridre dve ma~jjiShThAhi~ggusarShapAH||65|| shirIShabIjaM conmAdagrahApasmAranAshanam| piShTvA tulyamapAmArgaM [1] hi~ggvAlaM hi~ggupatrikAm||66|| vArtiH syAnmaricArdhAMshA pittAbhyAM goshRugAlayoH| tayA~a~jjayedapasmArabhUtonmAdajvarArditAn||67|| bhUtArtAnamarArtAMshca narAMshcaiva dRugAmaye| maricaM cAtape mAMsaM sapittaM sthitama~jjanam||68|| vaikRutaM pashyataH kAryaM doShabhUtahatasmRuteH| siddhArthako vacA hi~ggu kara~jjo devadAru ca||69|| ma~jjiShThA triphalA shvetA kaTabhItvak kaTutrikam| samAMshAni priya~ggushca shirISho rajanIdvayam||70|| bastamUtreNa piShTo~ayamagadaH pAnama~jjanam| nasyamAlepanaM caiva snAnamudvartanaM tathA||71|| apasmAraviShonmAdakRutyAlakShmIjvarApahaH| bhUtebhyashca bhayaM hanti rAjadvAre ca shasyate||72|| sarpiretena siddhaM vA sagomUtraM tadarthakRut| praseke pInase gandhairdhUmavartiM kRutAM pibet||73|| vairecanikadhUmoktaiH shvetAdyairvA sahi~ggubhiH| shallakolUkamArjArajambUkavRukabastajaiH||74|| mUtrapittashakRullomanakhaishcarmabhireva ca| sekA~jjanaM pradhamanaM nasyaM dhUmaM ca kArayet||75|| vAtashleShmAtmake prAyaH ...|76| If the patient does not come under control, the following formulations should be use as collyrium (anjana), anointing (utsadan), paste (alepa), inhalation therapy (navana) etc. (63 1/2)

Shirisha, madhuka, hingu, lashuna, tagar, vacha and kushtha powdered & triturated with goat’s urine are useful for snuff and collyrium. Likewise, trikatu, two types of haridra, manjishtha, hingu, sarshapa, seeds of shirisha used as snuff and collyrium, alleviate unmada, grahas and epilepsy. (641/2-1/2 66) Apamarga, hingu, haratala, and hingupatrika- in equal quantity, maricha in half quantity are powdered with bile of cow and jackal and made into wick (varties). This stick is applied to eyes in epilepsy, unmada, caused by evil spirits, possession by evil spirits and gods and in eye disease. (661/2-1/2 68) Maricha impregnated with (the above) bile and kept in the sun for a month makes a collyrium which is useful in defects of vision and loss of memory caused by vitiated doshas and demonic seizures. (681/2-1/2 69)

Siddharthakadi Agada : White mustard, vacha, hingu, karanja, devadaru, manjishtha, triphala, shveta, katabhi (bark), trikatu, priyangu, shirisha and two types of haridra – all taken in equal quantity are powederd with goat’s urine. This is an antipoison formulation and used as intake, collyrium, snuff, paste, bath and anointing. It alleviates epilepsy, poisoning, unmada, magical spells, inauspiciousness and fever. It averts fear from the spirits and also protects in royal place. Ghee cooked with these drugs along with cow’s urine serves the same therapeutic purpose. (691/2-1/2 73) -If there is excessive salivation and chronic coryza, the smoking cigar (medicated cigar) made of aromatic substances should be given for smoking. These fragrant & aromatic substances are described under the vairechanika dhuma (medicated smoking (sutra sthana chapter 5) . (731/2-1/2 74) - Similarly, the patient should be given medicated cigar prepared from shweta along with hingu. - In the unmada caused by vata and kapha, sprinkling collyrium(anjana), blowing(pradhamana), snuffing(nasya) and smoking(fumigation) should be done with application of urine, bile, faeces, skin, hairs, nails and hide of porcupine (shallaka), owl (uluka), cat (marjara), jackal (jambuka), wolf (vrika) and goat (basta). (741/2-1/2 76)

Treatment of pitta dominant unmada

... पैत्तिके तु प्रशस्यते| तिक्तकं जीवनीयं च सर्पिः स्नेहश्च मिश्रकः||७६|| शीतानि चान्नपानानि मधुराणि मृदूनि च| शङ्खकेशान्तसन्धौ वा मोक्षयेज्ज्ञो भिषक् सिराम्| उन्मादे विषमे चैव ज्वरेऽपस्मार एव च||७७||

... paittikē tu praśasyatē| tiktakaṁ jīvanīyaṁ ca sarpiḥ snēhaśca miśrakaḥ||76|| śītāni cānnapānāni madhurāṇi mr̥dūni ca| śaṅkhakēśāntasandhau vā mōkṣayējjñō bhiṣak sirām| unmādē viṣamē caiva jvarē'pasmāra ēva ca||77||

... paittike tu prashasyate| tiktakaM jIvanIyaM ca sarpiH snehashca mishrakaH||76|| shItAni cAnnapAnAni madhurANi mRudUni ca| sha~gkhakeshAntasandhau vA mokShayejj~jo bhiShak sirAm| unmAde viShame caiva jvare~apasmAra eva ca||77||

In pitta dominant type of unmada, the patients should be given tikta, and jivaniya ghrita (ghee cooked with bitter and vitallisers e.g. maha tiktaka ghrita (chikitsa sthana chapter 7 ) & jivaniya ghrita (chikitsa sthana chapter 29) and mishrak sneha (chikitsa sthana chapter 5) are efficacious. Moreover, the patient should be given cold, sweet and soft food and drinks or the physician should perform blood-letting vein situated at the joining place of temple and the end of hair line in unmada, irregular fever and epilepsy. (76-77)

Isolation of unmada patients

घृतमांसवितृप्तं वा निवाते स्थापयेत् सुखम्| त्यक्त्वा मतिस्मृतिभ्रंशं सञ्ज्ञां लब्ध्वा प्रमुच्यते ||७८||

ghr̥tamāṁsavitr̥ptaṁ vā nivātē sthāpayēt sukham| tyaktvā matismr̥tibhraṁśaṁ sañjñāṁ labdhvā pramucyatē [1] ||78||

ghRutamAMsavitRuptaM vA nivAte sthApayet sukham| tyaktvA matismRutibhraMshaM sa~jj~jAM labdhvA pramucyate [1] ||78|| The patient should be restricted to wind-free place after taking meat & ghee in his diet to his satisfaction as a result, the patient overcomes the loss of intellect & memory and regains sense and consciousness. Thus, he becomes free from disease. (78)

Psychotherapy and other therapies

आश्वासयेत् सुहृद्वा तं वाक्यैर्धर्मार्थसंहितैः| ब्रूयादिष्टविनाशं वा दर्शयेदद्भुतानि वा||७९|| बद्धं सर्षपतैलाक्तं न्यसेद्वोत्तानमातपे| कपिकच्छ्वाऽथवा तप्तैर्लोहतैलजलैः स्पृशेत्||८०|| कशाभिस्ताडयित्वा वा सुबद्धं विजने गृहे| रुन्ध्याच्चेतो हि विभ्रान्तं व्रजत्यस्य तथा शमम्||८१|| सर्पेणोद्धृतदंष्ट्रेण दान्तैः सिंहैर्गजैश्च तम्| त्रासयेच्छस्त्रहस्तैर्वा तस्करैः शत्रुभिस्तथा||८२|| अथवा राजपुरुषा बहिर्नीत्वा सुसंयतम्| त्रासयेयुर्वधेनैनं तर्जयन्तो नृपाज्ञया||८३|| देहदुःखभयेभ्यो हि परं प्राणभयं स्मृतम्| तेन याति शमं तस्य सर्वतो विप्लुतं मनः||८४||

āśvāsayēt suhr̥dvā taṁ vākyairdharmārthasaṁhitaiḥ| brūyādiṣṭavināśaṁ vā darśayēdadbhutāni vā||79|| baddhaṁ sarṣapatailāktaṁ nyasēdvōttānamātapē| kapikacchvā'thavā taptairlōhatailajalaiḥ spr̥śēt||80|| kaśābhistāḍayitvā vā subaddhaṁ vijanē gr̥hē| rundhyāccētō hi vibhrāntaṁ vrajatyasya tathā śamam||81|| sarpēṇōddhr̥tadaṁṣṭrēṇa dāntaiḥ siṁhairgajaiśca tam| trāsayēcchastrahastairvā taskaraiḥ śatrubhistathā||82|| athavā rājapuruṣā bahirnītvā susaṁyatam| trāsayēyurvadhēnainaṁ tarjayantō nr̥pājñayā||83|| dēhaduḥkhabhayēbhyō hi paraṁ prāṇabhayaṁ smr̥tam| tēna yāti śamaṁ tasya sarvatō viplutaṁ manaḥ||84||

AshvAsayet suhRudvA taM vAkyairdharmArthasaMhitaiH| brUyAdiShTavinAshaM vA darshayedadbhutAni vA||79|| baddhaM sarShapatailAktaM nyasedvottAnamAtape| kapikacchvA~athavA taptairlohatailajalaiH spRushet||80|| kashAbhistADayitvA vA subaddhaM vijane gRuhe| rundhyAcceto hi vibhrAntaM vrajatyasya tathA shamam||81|| sarpeNoddhRutadaMShTreNa dAntaiH siMhairgajaishca tam| trAsayecchastrahastairvA taskaraiH shatrubhistathA||82|| athavA rAjapuruShA bahirnItvA susaMyatam| trAsayeyurvadhenainaM tarjayanto nRupAj~jayA||83|| dehaduHkhabhayebhyo hi paraM prANabhayaM smRutam| tena yAti shamaM tasya sarvato viplutaM manaH||84|| The patients should be assured by a friend and consoled with religious, moral statements and purposeful words. They should tell him the loss of some extremely favourite person or thing or show him some astonishing & surprising things(to subside the episode of insanity). (79) After massaging with mustard oil, the patient should be tied (with ropes) and lay prostrate in the sun, or should touch him with bristles of kapikacchu or heated iron rods or burnt with hot oil or water. (80) Having tied him well, he should be beaten with whips (hunter) and put him in a confined to a lonely room. Thus his perturbed mind gets pacified. (81) He should be terrorized by biting of snakes with their fangs removed or by well- trained lions or elephants. or armed criminals or enemies. (82) Alternatively, he should be terrorized by royal personnel (police) having taken him out side well-tied, arrested and terrorize him intimidating to kill (execution) by the order of king. (83) The danger to the life is above that of the fear of injury to the body. Therefore, the perverted mind of the patient as such gets distracted from all directions and gets pacification & regains normalcy through the above mentioned measures. (84)

Therapies in mental trauma patients

इष्टद्रव्यविनाशात्तु मनो यस्योपहन्यते| तस्य तत्सदृशप्राप्तिसान्त्वाश्वासैः शमं नयेत्||८५|| कामशोकभयक्रोधहर्षेर्ष्यालोभसम्भवान्| परस्परप्रतिद्वन्द्वैरेभिरेव शमं नयेत्||८६||

iṣṭadravyavināśāttu manō yasyōpahanyatē| tasya tatsadr̥śaprāptisāntvāśvāsaiḥ śamaṁ nayēt||85|| kāmaśōkabhayakrōdhaharṣērṣyālōbhasambhavān| parasparapratidvandvairēbhirēva śamaṁ nayēt||86||

iShTadravyavinAshAttu mano yasyopahanyate| tasya tatsadRushaprAptisAntvAshvAsaiH shamaM nayet||85|| kAmashokabhayakrodhaharSherShyAlobhasambhavAn| parasparapratidvandvairebhireva shamaM nayet||86||

If the mental derangement is due to the loss of some dearly loved object, he should be pacified by consoling and assuring him by providing a similar thing. Simultaneously, he should be consoled by pleasant assurances (by family members & friends) as a result of which he recovers from illness. If the mental derangement is due to the passion (kama), grief (shoka), fear (bhaya), anger (krodha), exhilaration (harsha), envy (irshya), and greed (lobha), they should be pacified by their mutually antagonizing & contradictory factors . (85-86)

Spriritual therapies in exogenous type of unmada

बुद्ध्वा देशं वयः सात्म्यं दोषं कालं बलाबले| चिकित्सितमिदं कुर्यादुन्मादे भूतदोषजे||८७|| देवर्षिपितृगन्धर्वैरुन्मत्तस्य तु बुद्धिमान्| वर्जयेदञ्जनादीनि तीक्ष्णानि क्रूरकर्म च||८८|| सर्पिष्पानादि तस्येह मृदु भैषज्यमाचरेत्| पूजां बल्युपहारांश्च मन्त्राञ्जनविधींस्तथा||८९|| शान्तिकर्मेष्टिहोमांश्च जपस्वस्त्ययनानि च| वेदोक्तान् नियमांश्चापि प्रायश्चित्तानि चाचरेत्||९०|| भूतानामधिपं देवमीश्वरं जगतः प्रभुम्| पूजयन् प्रयतो नित्यं जयत्युन्मादजं भयम्||९१|| रुद्रस्य प्रमथा नाम गणा लोके चरन्ति ये| तेषां पूजां च कुर्वाण उन्मादेभ्यः प्रमुच्यते||९२|| बलिभिर्मङ्गलैर्होमैरोषध्यगदधारणैः| सत्याचारतपोज्ञानप्रदाननियमव्रतैः||९३|| देवगोब्रह्मणानां च गुरूणां पूजनेन च| आगन्तुः प्रशमं याति सिद्धैर्मन्त्रौषधैस्तथा||९४|| यच्चोपदेक्ष्यते किञ्चिदपस्मारचिकित्सिते| उन्मादे तच्च कर्तव्यं सामान्याद्धेतुदूष्ययोः||९५||

buddhvā dēśaṁ vayaḥ sātmyaṁ dōṣaṁ kālaṁ balābalē| cikitsitamidaṁ kuryādunmādē bhūtadōṣajē||87|| dēvarṣipitr̥gandharvairunmattasya tu buddhimān| varjayēdañjanādīni tīkṣṇāni krūrakarma ca||88|| sarpiṣpānādi tasyēha mr̥du bhaiṣajyamācarēt| pūjāṁ balyupahārāṁśca mantrāñjanavidhīṁstathā||89|| śāntikarmēṣṭihōmāṁśca japasvastyayanāni ca| vēdōktān niyamāṁścāpi prāyaścittāni cācarēt||90|| bhūtānāmadhipaṁ dēvamīśvaraṁ jagataḥ prabhum| pūjayan prayatō nityaṁ jayatyunmādajaṁ bhayam||91|| rudrasya pramathā nāma gaṇā lōkē caranti yē| tēṣāṁ pūjāṁ ca kurvāṇa unmādēbhyaḥ pramucyatē||92|| balibhirmaṅgalairhōmairōṣadhyagadadhāraṇaiḥ| satyācāratapōjñānapradānaniyamavrataiḥ||93|| dēvagōbrahmaṇānāṁ ca gurūṇāṁ pūjanēna ca| āgantuḥ praśamaṁ yāti siddhairmantrauṣadhaistathā||94|| yaccōpadēkṣyatē kiñcidapasmāracikitsitē| unmādē tacca kartavyaṁ sāmānyāddhētudūṣyayōḥ||95||

buddhvA deshaM vayaH sAtmyaM doShaM kAlaM balAbale| cikitsitamidaM kuryAdunmAde bhUtadoShaje||87|| devarShipitRugandharvairunmattasya tu buddhimAn| varjayeda~jjanAdIni tIkShNAni krUrakarma ca||88|| sarpiShpAnAdi tasyeha mRudu bhaiShajyamAcaret| pUjAM balyupahArAMshca mantrA~jjanavidhIMstathA||89|| shAntikarmeShTihomAMshca japasvastyayanAni ca| vedoktAn niyamAMshcApi prAyashcittAni cAcaret||90|| bhUtAnAmadhipaM devamIshvaraM jagataH prabhum| pUjayan prayato nityaM jayatyunmAdajaM bhayam||91|| rudrasya pramathA nAma gaNA loke caranti ye| teShAM pUjAM ca kurvANa unmAdebhyaH pramucyate||92|| balibhirma~ggalairhomairoShadhyagadadhAraNaiH| satyAcAratapoj~jAnapradAnaniyamavrataiH||93|| devagobrahmaNAnAM ca gurUNAM pUjanena ca| AgantuH prashamaM yAti siddhairmantrauShadhaistathA||94|| yaccopadekShyate ki~jcidapasmAracikitsite| unmAde tacca kartavyaM sAmAnyAddhetudUShyayoH||95||

Physician should administer the treatment of unmada, caused by spirits or dosha, after examining place, age, suitability, morbidity, time and strength or otherwise. (87)

In the unmada caused by gods, sages, fore- father or gandharvas, the wise physician should avoid irritant collyrium etc. and other harsh measures. Instead he should use intake of ghee and other mild medicaments. Moreover, worship, offering (bali), gifts (upahara), recitation of hymns(mantra), collyrium (anjana), pacificatory rituals (shanti karma) & acts, sacrifices, offering oblation to the fire (homa), repetition of hymns/incantations(japa), auspicious rituals /blessings (swastyayana), vedic rites and expiations (prayaschita) are useful for these patients . (88-90)

If one worships lord shiva daily, the supreme controller of all bhutas (supernatural beings) and lord of the world with sincerity and the all powerful gods with devotion, he overcomes the fear from attack of unmada. (91) Pramathas, attendants of Lord Rudra, move around the world, if worshipped, they help in recovery from unmada. (92)

The exogenous unmada is pacified by offerings (bali), auspicious acts (mangal karma), oblation (homa), wearing herbs roots ( aushadhi -dharana), anti poison drugs (agada- dharana), good conduct (satya-achara), austerity (tapa), knowledge (jnana), gifts (pradan), spiritual duties (niyama), vows (vrata); worship of god, cows, brahmanas & preceptors (guru), by sacred hymns and drugs. (93-94)

Because of similarity in etiology and substratum of morbidity, the remedial measures prescribed for epilepsy (pasmara) should also be adopted for unmada. (95)

निवृत्तामिषमद्यो यो हिताशी प्रयतः शुचिः| निजागन्तुभिरुन्मादैः सत्त्ववान् न स युज्यते||९६||

nivr̥ttāmiṣamadyō yō hitāśī prayataḥ śuciḥ| nijāgantubhirunmādaiḥ sattvavān na sa yujyatē||96||

nivRuttAmiShamadyo yo hitAshI prayataH shuciH| nijAgantubhirunmAdaiH sattvavAn na sa yujyate||96||

The person having preponderance of sattva (strong mental strength), abstaining from meat and wine, taking wholesome diet, sincere & disciplined and observing purity of mind and body is not affected by either endogenous or exogenous type of unmada. (96)

Signs of complete cure of unmada

प्रसादश्चेन्द्रियार्थनां बुद्ध्यात्ममनसां तथा| धातूनां प्रकृतिस्थत्वं विगतोन्मादलक्षणम्||९७|| prasādaścēndriyārthanāṁ buddhyātmamanasāṁ tathā| dhātūnāṁ prakr̥tisthatvaṁ vigatōnmādalakṣaṇam||97||

prasAdashcendriyArthanAM buddhyAtmamanasAM tathA| dhAtUnAM prakRutisthatvaM vigatonmAdalakShaNam||97|| Blissful feeling (in perception) of sense objects and also of intellect, self and mind along with normalcy of tissue elements (dhatus) are the signs of having recovered from unmada. (97)

Summary

तत्र श्लोकः- उन्मादानां समुत्थानं लक्षणं सचिकित्सितम्| निजागन्तुनिमित्तानामुक्तवान् भिषगुत्तमः||९८||

tatra ślōkaḥ- unmādānāṁ samutthānaṁ lakṣaṇaṁ sacikitsitam| nijāgantunimittānāmuktavān bhiṣaguttamaḥ||98||

tatra shlokaH- unmAdAnAM samutthAnaM lakShaNaM sacikitsitam| nijAgantunimittAnAmuktavAn bhiShaguttamaH||98|| Now summing, up verses-

(Punarvasu) the best of physician told about the etiology, symptoms and treatment of the types of unmada caused by endogenous or exogenous factors. (98)

Thus, ends ninth chapter on the treatment of unmada in chikitsa sthana in the treatise composed by Agnivesha, redacted by Charak and reconstructed by Dridhbala as it was unavailable.[9]

Tattva Vimarsha

• The diet poor in qualities, behavioural abnormalities, frequent psychological trauma mainly due to fear or exhilaration and irregular postures play important role in causing unmada. • The individual with low mental strength (level of sattva guna as in weak minded people) are more susceptible for unmada. • Hridaya (seat of mind) also holds the site of intellectual functions and it is vitiated in patho-physiology of unmada. • Unmada involves excessive affliction of intellect, mind and memory. This may be due to either endogenous causes or exogenous causes. • The endogenous causes include vitiation of dosha resulting in variety of unmada with their dominance. Sharira dosha can afflict the psyche, intellect and memory to cause a psycho-somatic disorder. • External social, psychological and spiritual factors can also lead to exogenous unmada in similar way. • Diagnosis of exogenous unmada is based upon the behaviour pattern of afflicted person. The treatment includes assessment of intention of the spirits in terms of pleasure and worship. It 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. This is im-materialistic treatment. • Various purification procedures are administered as per the dosha dominance, strength of the patient. • In order to prevent from getting afflicted by unmada, the person shall have preponderance of sattva (strong mental strength), abstaining from meat and wine, taking wholesome diet, sincere & disciplined and observing purity of mind and body. • The objective of cure in unmada includes blissful feeling (in perception) of sense objects and also of intellect, self and mind along with normalcy of tissue elements (dhatus) are the signs of having recovered from unmada.

Vidhi Vimarsha

Similar conditions observed in contemporary psychiatry: Nija unmada (endogenous psychoses): 1.Vata dominant unmada is similar to excited catatonic type of schizophrenia and is acute form of schizophrenia. These patients present with the symptoms of catatonic excitement with general symptoms of unmada. It is produced due to vitiation of vata along with rajas and tamas doshas. Due to excess of rajas and vata, catatonic exitement occurs. 2. The pitta dominant unmada is similar to maniac psychosis. The patients and mania, show a generalised functional overactivity or increased psychomotor activity, excitability of mood, constant movement, increased talkativeness, aggressive behaviour, irritability as the prominent symptoms. 3. The Features of kaphaja unmada resemble closely with stuporous catatonic schizophrenia and major depressive disorder and thus they can be correlated. 4. There are clinical conditions in which alternating phases of depression and mania, known as bipolar disorders or maniac depressive psychosis. Similarly, there are forms of schizophrenia, in which excited catatonia and stuporous catatonia are alternatively present (periodic catatonia). These conditions, based upon particular doshic combination in the pathogenesis, as indicated by kapha is arrgavated along with pitta. 5. All types of chronic, incapacitating psychotic conditions are included under the category of sannipatik / tridoshaja unmada. Hebephrenic schizophrenia, chronic schizophrenia and residual schizophrenia come under this category, again the difference being predominance of the doshas involved in the psychopathogenesis.

Agantuja unmada (exogenous psychoses): 6. Various psychoses due to possession of grahas & bhutas (supernatural beings) are included under agantuja unmada, which should be regarded as suffering from paranoid schizophrenia, paranoia and various other paranoid states. Paranoid schizophrenia is characterized by predominance of delusions. 7. It is important to mention that grahas have been christened only on the basis of the resemblance of the clinical features of the afflicted individual with the activities of those grahas e.g. gods, gandharvas etc. It is not that these have entered into the boby of the afflicted individual. This is just the way of presentation and the writing style in Ayurveda to personify an event/process. This form of presentation is somewhat similar to syndromic classification in conventional modern medicine. Because of similarity of clinical symptoms, the patients are said to be suffering from so and so grahas. These individual syndromes can also be correlated to a single disease entity from modern perspective. Management of unmada: I. Yuktivyapashraya Chikitsa (rational treatment): The purification procedures prescribed in unmade are :(1) Nasya (2) Vamana (3) Virecana (4) Niruha basti (5) Anuvasana basti. Besides these five chief karmas, two other preparatory and axillary karmas are indicated i.e. snehana karma and swedana karmas. Snehana karmas are also carried out as shamana (pacification) therapy with low dose sneha. Especially in major psychiatric illness it is considered as a separate therapy. The other measures like pradeha, utsadana, abhyanga, dhuma, snehapana, etc. are also administered which stimulates the mind, intellect, memory and consciousness of the patient. Siravedha (venesection): Besides the above methods, surgical techniques like siravedha (venesection) are also advocated in the treatment of mental disorders and hysteria. In vataja unmada, snehapanam has to be done. If the passage of vayu is obstructed laxative along with sneha should be given. In kaphaja unmada, vamana must be done. In pittaja unmada, virechana must be done. After completing purification, samsarjana karma (lighter to heavier diet gradually) must be given. The purification of body also leads to blissful state of mind and sense organs. Even after the body is cleansed, if the patient exhibits perversion of conduct, he should be given strong navanam, anjanam, taadanam. Concept & rationale of ghrita- pana/ shamana sneha pana: Snehapana is specially indicated in unmada. Shamana sneha includes the measures that bring down the increased doshas to normal stage without expelling them out and without disturbing balance of other normal doshas. The properties like sukshma, snigdha, picchila and manda operate pharmacologically to pacify unmada.

General guidelines for treatment for dosha dominant unmada: 1.Snehana (oleation) 2) swedana (fomentation) 3) vamana (emesis) 4) virechana (purgation) 5) asthapana and anuvasana bastis. 6) upashamana (alleviation therapies)7) nasya (errhines) 8) dhooma (smoking) 9) dhoopana (fumigation)10) anjana (collyrium)11) avapida (a type of nasal errhines with juice of herb) and pradhamana (type of snuff) 12) abhyanga (massage)13) pradeha (Ointment)14) parisheka(affusion)15) anulepana (unction)16) vadha (assault) 17) bandha (tying)18) avarodha (confinement)19) vithrasana (frightening) 20) vismapana and vismarana (inducing astonishment and forgetfulness) 21) apatarpana (depletion)22) sira vedha (venesection) . Specific treatment of the types of unmada : 1.Vata dominance: Snehapana, mrudu shodhana, Samsarjana, swedana, niruha, shirovirechana, dhupana, anjana, dhuma, lepana, snana. Medicines:- Kalyanaghrita, mahakalyanghrita, phalaghrita, hinguvadi ghrita . mahapaishachakaghrita, lasunadighrita, vyosadivarti, sirishadivarti, apamargadi varti, marichadivarti, siddharthakadyagada, shallakyadyagada, srugaladiyoga, brahmyadivarti. 2. Pitta dominance: Snehana, swedana, rechana raktamokshna. samsarjana, sirovirechana, sheeta, madhura, laghu annapana. Medicines: Tiktaghrita, jivanthyadighrita. mishrak sneha. 3.Kapha dominance:- Sneha, sweda, vamana, rechana, sirovirechana, samsarjana. shirobasti, abhyanga, dhupana, anjana, dhuma, parisechana, pradeha, dhmapana. Medicines: Shrgaladiyoga, lasunadighrita, katur taila, brahmyadivarti. Daivavyapashraya Chikitsa: One who worships Lord shiva, the supreme controller of all the bhutas, and the omnipotent master of whole universe regularly with devotion becomes free from attack of unmada. Worshipping pramathas, attendants of rudra also cures unmada. Bali, mangala (recitation of mantras), homa, oushadha agadadhaarana, observing truth fullness, maintaining good conduct, tapas, charity, offering prayers to gods, cows, brahmins, and teachers and by using siddha mantras and oushadhis one can cure unmada. I ) Useful single drugs mentioned in unmada: Shankapushpi, Amalaki, . Mandukaparni , Sarpagandha, . Brahmi ,. Rasona, . Vacha, . Devadaru, . Jyotishmati, . Jatiphala, Jatamansi, Mochaka, Kushtha, Karpura, Tagara ,Haritaki ,Parasikyavani, Vibhitaki, Palandu, Ashwagandha, Hingu, Kushmanda, Shatavari, Hema (gold), Ii) Compound Formulations:- (A) Ghrita- Medicated ghee preparations.1. Kalyanakaghrita 2.Mahakalyanaka ghrita ,3). Panchagavya ghrita 4. Chetasa ghrita 5. Mahapanchagavya ghrita 6. Siva ghrita 7. Nishadi ghrita 8. Lasunadi ghrita.9. Lasunadi ghrita10. Ksheerrkalyana ghrita11. Siddhartaka ghrita 12. Tiktaka ghrita. 13.Phala ghrita 14. Brahmi ghrita 15. Dhatriyadi ghrita 16. Jivantyadi ghrita 17. Vachadi ghrita 18. Hingvadi ghrita 19. Hingvadi ghrita 20. Mishraksneha (B) Churna (Powder) -1. Saraswata churna 2. Drakshadi churna 3. Kalyanachurna (C)Asava/Arishta:1. Sarasvatarishta 2. Bhringarajasava3. Draksharishrta 4. Ashwagandharishta (D) Rasoushadha (Herobomineral compounds)1. Chandabhairasava 2. Chaturnakharasa 3. Unmadagajakesari 4. Unmadabhanjnarasa 5. Unmadaparpatirasa 6. Sarveshvara rasa7. Smritisagara rasa 8. Manasmitra 9. Muktapishti (E) Gutika (pills) 1. Shivagutika (F) Tailas (medicated Oils) 1. Lakshadi taila 2. Nirgundyadi taila 3. Chandanadi taila 4. Shiva taila 5. Tungadrumadi taila 6. Himasagara taila 7. Brihatryadi taila 8. Triphaladi taila 9. Manjishtadi taila 10. Chandanadi taila 11. Bhringamalakadi taila 12. Sahacharadi taila 13. Balashwagandhalaskhadi taila (G) Vartis: 1. Marichadi varti 2. Apamargadi varti 3. Vyoshadi varti 4. Shirishadivarti 5. Brahmyadivarti 6. Kayasthadivarti Others: 1. Pippalyadi pradhamana 2. Brahmi rasnadiyoga 3. Srugalyadiyoga 4. Siddharthakayoga 5. Shallakyadiagada 6. Krishnadyanjana 7. Darvyadianjana 8. Mahadhupa 9. Nimbadhatryadi dhupa 10. Marichadyanjana Pathya Apathya (Dietary Indications & contra indications): Pathya: It is said that he who suffers from unmada should maintain cleanliness and consume food and drink, that are relishing and easily digestible, the following articles have been recommended in unmada. A. Shakavarga (Vegetables)- Patola, brahmi, kakamachi vastuka, tanduliyaka, kushmanda. B. Dhanyavarga (cereals/pulses):- Rakta shali, godhuma, mudga C. Phala varga :- Draksha, panasa, matulunga, narikela, kapittha D. Mamsavarga:- kurmamsa (tortoise meat) E. Gorasvarga - Kshira, navnita (butter) ghrita (ghee) F. Paniyavarga - drink/beverages gangambu (rain water) madya (alcohol) rasala (Sugar cane) Kulmasatarpana (gruel of kulmasa)

Satvavajaya: The methods of yuktivyapasraya treatment have been prescribed in the treatment of mental diseases. But in the derailment of manasika doshas, it is essential that the line of treatment of mental diseases should be specific and based on the theory of balancing the mental doshas (rajas and tamas). Taking into consideration all these factors, most probably in Ayurveda a separate classification of satvavajaya treatment has been specially mentioned. Caraka defines it as a mind control therapy in which stress will be laid on restraining the mind from unwholesome arthas (objects) . Certain techniques have been mentioned for this therapy. The inclusion of satvavajaya chikitsa, within these primary classifications of treatment of diseases, clearly indicates that this therapy of mano-nigraha was adopted in those days as a practical therapy to over come the psychological & psycho- somatic diseases. While describing the principles of treatment, Caraka prescribes the following methods of treatment for mental diseases: 1. Jnana (knowledge of spiritual scriptures) 2. Vijnana (scientific knowledge) 3. Dhairya (sustaining courage in adverse conditions) 4. Smrti (good memories)5. Samadhi (meditation and contemplation). In another reference, Caraka prescribes the following treatment for the mental diseases, which resembles the above lines of treatment Trivarga anveshana: Contemplation of the three objectives of life- dharma, artha, and kama Tadvidyaseva : Service of those who are well versed in the treatment of mental diseases. Atmajnana : Self-realization. 4. Kula-kala, desha, bala jnana: The knowledge about ones own self, country, family, age, vitality and ability. Summary - Manovahasrotas can be understood as the channels conducting various factors that regulate behavior. Vitiation of these srotas at different levels produce abnormal behavioral patterns thereby bringing about the psychological & behavioural symptoms of unmada vis-à-vis psychosis. A number of formulations, treatment modalities, procedures and therapeutic techniques have been described with predominance of lipid predominant dosage forms esp. ghritas & tailas, which seems to be so formulated as to exert maximum effect on neural tissue by increasing bio-availability of formulation by increased ability to cross blood –brain barrier. All the preventive measures mentioned by Acaryas are aimed at bestowing relaxation and mental balance, which are the basic prerequisites of a sound mind. It may be mentioned here that sharira shuddhi is needed before attaining manasika shuddhi. The nourishing medhya medications described are particularly relevant to our times when we are forced to battle continuously against stress and strain. Need of the hour is to find practically useful formulations and treatment procedures, scrutinize them thoroughly, which would help to effectively treat the psychotic states. It may not be exaggartion to say that unmada is the only disease entity in the entire classical Ayurvedic literature where such a comprehensive management has been described and almost all the prevailing methods & forms of therapy have been used hand in hand .

Further reading

1. Agnivesha, Charaka samhita. Hindi commentary by Acharya Vidyadhara shukla and prof.Ravi Dutt Tripathi. Delhi, Chaukambha Sanskrit Pratishatan 2010,. pp 1024., page no.656. 2. Agnivesha, Charaka samhita. Hindi commentary by Acharya Vidyadhara shukla and prof.Ravi Dutt Tripathi. Chaukambha Sanskrit Pratishatan 2010,Delhi , .pp 999, page no.234. 3. Madhav S.M. Epidemiological study of prevalence of mental disorders in India. Indian Journal of Community Medicine. 2001 Oct-Dec; 26(4): 198-200 4. Sushruta ,Sushruta samhita. Hindi commentary by Kaviraj Dr.Ambikadatta Shastri. Varanasi ,Chaukambha sanskrit samstana edition 2011,pp 702,. page no.577 5. Madhava, Madhava nidana. Sanskrit commentary Madhukosha by Vijayarakshita and Shrikantadatta. By Brahmananda Tripathi. Chaukambha Surbharati prakashan 2006.pp 660. page no.478 6. Vagbhata, Astanga hradaya. Hindi commentary by Kaviraj Atrideva Gupta. Chaukambha prakashana 2007, PP 616,page no.129. 7. Agnivesha, Charaka samhita. Hindi commentary by Acharya Vidyadhara shukla and prof.Ravi Dutt Tripathi. Delhi.Chaukambha Sanskrit Pratishatan 2010, .pp 1024. page no.656 8. Agnivesha, Charaka samhita. Hindi commentary by Acharya Vidyadhara shukla and prof.Ravi Dutt Tripathi. Delhi, Chaukambha Sanskrit Pratishatan 2010,.pp 999. page no.238 9. Sushrutha, Sushruta samhita, Hindi commentary by Kaviraj Dr.Ambikadatta Shastri. Chaukambha sanskrit samstana edition 2011, Varanasi. pp 702, page no.587. 10. Bhavamishra, Bhavaprakasha. Hindi commentary by Bhishagratna pandit sir Brahma Shankar Mishra. Chaukambha Sanskrit bhavan edition 2010, madhyama khanda,pp 770 , page no.214 11. Chabanur Sunil kumar. A Clinical Study on Shireeshadi Yoga in the Management of Kaphaja Unmada w.s.r.to Depressive Disorders RGUHS, Karnataka, 2010. 12. Deole Y.S. Chandola H.M. Clinico- experimental study on effect of Brahmi ghrita on depressive illness, M.D. dissertation submitted to Gujarat Ayurveda University Jamnagar-2008 13. The national clinical coding standards ICD-10 4th edition. www.connectingforhealth.nhs.uk/.../icd1... 14. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23:56–62 15. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561–71 16. Ahuja Niraj (2002) 5th Ed- A short text book of Psychiatry, Japee Brothers Publication, New Delhi. 17. Amarkosh with Vyakhasudha or Ramaswami Commentary of Bhanuji Diksita (1987) : Reprint 2nd ed. Chaukhamba Sanskrit Partisthana, Delhi, p. 286. 18. Bloch, S. Supportive Psychotherapy: An introduction to the Psychotherapies. Oxford University Press, Oxford, 1979. 19. Carlo Monosanto: Sattvavajay Chikitsa learning from the soul; 2008; caribbean integral Institute (CII). 20. Chandre Rajni and Tripathi J.S., Satvavajaya : The Ayurvedic Approach To psychotherapy in Aryavaidyan International Journal, Kottakal, Kerela Oct. 2006. 21. Charaka Samhita Vol. 11(1977): Eng. Translation by R. K. Sharma and V. Bhagawan Dash - Chowkhamba Sanskrit series Office, Varanasi. 22. Charaka Samhita Vol. I (1976): Eng. Translation of R. K. Sharma and V. Bhagawan Dash - Chowkhamba Sanskrit Series Office, Varanasi. 23. Charaka Samhita Volume III (1988): Eng. Translation By R. K. Sharma and V. Bhagwan Dash - Chowkhamba Sanskrit Series Office, Varanasi. 24. David Frawley; Ayurveda and the mind; The Healing of Consciousness; Motilal Banarasidas Publishers Private Limited; Delhi. 25. Hearold I. Kaplan, Benjamin J. Sadock, Jack A. Grebb (1994) , Synopsis of Psychiatry Behavioural Sciences Clinical Psychiatry, B.I. Waverly Pvt. Ltd., New Delhi. 26. Murthy A.R.V. & R.H. Singh; Non Pharmachological approach to the management of IBS with special reference to group Sattvavajaya; 1986. 27. Shukla Punam Rani : Supportive Psychotherapy in stress related diseases report submitted to teachers reorientation training programme held at Department of Kayachikitsa, Faculty of Ayurveda, IMS, BHU. 2000. 28. Singh R.H. (1986): Ayurvediya manasa vignana, chaukamba Amarabarati Prakasan. Varanasi. 29. Tripathi J.S.: Dimensions of sattvavajaya chikitsa (Ayurvedic -Psychotherapy) and their clinical applications,Annals of Ayurvedic Medicine,vol. 1 Issue 1&2,Jan-June,2012,ISSN-2277-4092 . 30. Upadhyaya Priyanka, Tripathi JS & RaiNP: A study on Indian Psychotherapy and its evaluation in the management of certain psychosomatic illnesses, Ph.D.Thesis,Deptt. Of Kayachikitsa, IMS, BHU, Varanasi,2010. 31. Verma Vandana, Murthy KN & Tripathi JS: A comparative study of Indian and western approaches to psychotherapy in certain neurotic disorders , Ph.D.Thesis,Deptt. Of Kayachikitsa, IMS, BHU, Varanasi ,Dec. 2010. 32. M.A. Lahankar, A.P. Dwivedi. A handbook On Ayurvedic Intranasal Drug Therapy: Nasya Karma Chikitsa By VRI press, Newyork USA.