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=== Abstract ===

=== Abstract ===

 

The seventh chapter of [[Nidana Sthana]], titled [[Unmada Nidana]], describes the detailed etiopathogenesis  and types of ''unmada roga'' a large class of major mental disorders or psychoses. ''Unmada'', in Sanskrit, literally means frenzy, madness or mental derangement. Thus, ''unmada'' is characterized by a disordered mental state in the faculties of ''manas'' (thought processes), ''buddhi'' (decision making and intelligence), ''sanjna jnana'' (orientation and responsiveness/ consciousness), ''smriti'' (memory), ''bhakti'' (desire), ''sheela'' (habits and character), ''cheshta'' (psychomotor activity ) and ''achara'' (conduct and behaviour). For the clinical diagnosis of ''unmada'', its etiology, psychopathogenesis, and prodromal features have been elaborately described in this chapter.  

The seventh chapter of [[Nidana Sthana]], titled [[Unmada Nidana]], describes the detailed etiopathogenesis  and types of ''unmada roga'' a large class of major mental disorders or psychoses. ''Unmada'', in Sanskrit, literally means frenzy, madness or mental derangement. Thus, ''unmada'' is characterized by a disordered mental state in the faculties of ''manas'' (thought processes), ''buddhi'' (decision making and intelligence), ''sanjna jnana'' (orientation and responsiveness/ consciousness), ''smriti'' (memory), ''bhakti'' (desire), ''sheela'' (habits and character), ''cheshta'' (psychomotor activity ) and ''achara'' (conduct and behaviour). For the clinical diagnosis of ''unmada'', its etiology, psychopathogenesis, and prodromal features have been elaborately described in this chapter.  

'''Keywords''': ''Unmada, Sanjna Jnana, Amarsha, himsa, Prajnaparadha'', Psychosis, insanity, mental factors examination.

'''Keywords''': ''Unmada, Sanjna Jnana, Amarsha, himsa, Prajnaparadha'', Psychosis, insanity, mental factors examination.

 

=== Introduction ===

=== Introduction ===

 

''Unmada'', a major mental disorder, has been known to Ayurvedic practitioners since ancient times in India. In the Vedic period, the disease was thought to be caused due to ''grahas'' or demons, but in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], it is considered a major mental illness. ''Unmada'' as such does not describe a lone clinical entity comparable to a modern diagnostic category, rather it is a group of psychotic disorders. As the psychotic disorders cover almost all the major mental illnesses, the different types and subtypes of ''unmada'' can be separately correlated with different psychotic disorders. The clinical features of the different types of ''unmada'' resemble various types of schizophrenia, manic psychosis, psychotic depression, and depressive disorders.

''Unmada'', a major mental disorder, has been known to Ayurvedic practitioners since ancient times in India. In the Vedic period, the disease was thought to be caused due to ''grahas'' or demons, but in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], it is considered a major mental illness. ''Unmada'' as such does not describe a lone clinical entity comparable to a modern diagnostic category, rather it is a group of psychotic disorders. As the psychotic disorders cover almost all the major mental illnesses, the different types and subtypes of ''unmada'' can be separately correlated with different psychotic disorders. The clinical features of the different types of ''unmada'' resemble various types of schizophrenia, manic psychosis, psychotic depression, and depressive disorders.

''Unmada'' is classified into two broad categories: ''nija''(endogenous), or those caused by internal imbalance of ''dosha'' i.e. ''vata'', ''pitta, kapha'' and ''sannipataja'', and ''agantu nimitta'', i.e., those caused by exogenous factors. Sushruta (S. ut.62/4-5) and Vagbhatta - both are of the opinion that ''unmada'' is of six types, of which four are due to ''doshas'', the fifth is ''madyaja'' (like intoxications) and sixth is ''vishaja'' (poison-based or poison-like). Both have described the ''agantuja unmada'' separately as the condition of ''amanushopasarga'' (due to affliction of supra-human power) and ''bhuta badha'' (due to affliction of demons), under the heading ''amanusopasarga pratishedha'' (treatment of affliction of supra-human power) and ''bhuta badha pratisedha'' (treatment of affliction of demons) respectively. The body of knowledge within [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] dedicated to psychiatry underscores the advancement in scientific knowledge on this subject that existed thousands of years ago.

''Unmada'' is classified into two broad categories: ''nija''(endogenous), or those caused by internal imbalance of ''dosha'' i.e. ''vata'', ''pitta, kapha'' and ''sannipataja'', and ''agantu nimitta'', i.e., those caused by exogenous factors. Sushruta (S. ut.62/4-5) and Vagbhatta - both are of the opinion that ''unmada'' is of six types, of which four are due to ''doshas'', the fifth is ''madyaja'' (like intoxications) and sixth is ''vishaja'' (poison-based or poison-like). Both have described the ''agantuja unmada'' separately as the condition of ''amanushopasarga'' (due to affliction of supra-human power) and ''bhuta badha'' (due to affliction of demons), under the heading ''amanusopasarga pratishedha'' (treatment of affliction of supra-human power) and ''bhuta badha pratisedha'' (treatment of affliction of demons) respectively. The body of knowledge within [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] dedicated to psychiatry underscores the advancement in scientific knowledge on this subject that existed thousands of years ago.

 

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

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

manovahAni  srotAMsyAvRutya  janayantyUnmadaam||4||

manovahAni  srotAMsyAvRutya  janayantyUnmadaam||4||

tatra  doShanimittAshcatvAraH

tatra  doShanimittAshcatvAraH

 

This verse describes the qualities of a person prone to getting afflicted with ''unmada'', as well as the conditions that are conducive to the affliction of the disease:

This verse describes the qualities of a person prone to getting afflicted with ''unmada'', as well as the conditions that are conducive to the affliction of the disease:

Such individuals often get afflicted with subclinical mental disorders, leading to unstable intellect because of volatile ''doshas''. When the seat of consciousness, wisdom, and the system that regulates mental activities are badly affected, then all these factors lead to the manifestation of ''unmada''. [4]

Such individuals often get afflicted with subclinical mental disorders, leading to unstable intellect because of volatile ''doshas''. When the seat of consciousness, wisdom, and the system that regulates mental activities are badly affected, then all these factors lead to the manifestation of ''unmada''. [4]

 

==== Types of cognitive distortions ====

==== Types of cognitive distortions ====

vAtopashayaviparyAsAdanupashayatA ca;

vAtopashayaviparyAsAdanupashayatA ca;

iti vAtonmAdali~ggAni bhavanti(1);

iti vAtonmAdali~ggAni bhavanti(1);

 

After the above stage, ''unmada'' manifests. The distinctive features of ''vatika'' type of ''unmada'' are as follows:

After the above stage, ''unmada'' manifests. The distinctive features of ''vatika'' type of ''unmada'' are as follows:

*Constant wandering

*Constant wandering

*Aggravation by ''vata''-provoking factors; and  

*Aggravation by ''vata''-provoking factors; and  

*Pacification by factors which are opposite to ''vata''

*Pacification by factors which are opposite to ''vata''

 

These are the features of ''vatika'' type of ''unmada''. [7-1]

These are the features of ''vatika'' type of ''unmada''. [7-1]

vitrAsanavismApanavismAraNApatarpaNasirAvyadhanAni,ca yathAsvaM

vitrAsanavismApanavismAraNApatarpaNasirAvyadhanAni,ca yathAsvaM

yuktyA, yaccAnyadapi ki~jcinnidAnaviparItamauShadhaM tadapi kAryaM syAditi||8||

yuktyA, yaccAnyadapi ki~jcinnidAnaviparItamauShadhaM tadapi kAryaM syAditi||8||

 

Modalities of treatment of the three types of curable ''unmada'' are:

Modalities of treatment of the three types of curable ''unmada'' are:

Suitable diets should be given according to the requirement of the patient. Such other therapies as would work against the causative factors of the disease should also be given. [8]

Suitable diets should be given according to the requirement of the patient. Such other therapies as would work against the causative factors of the disease should also be given. [8]

 

भवति चात्र-  

भवति चात्र-  

उन्मादान् दोषजान् साध्यान्  साधयेद्भिषगुत्तमः|   

उन्मादान् दोषजान् साध्यान्  साधयेद्भिषगुत्तमः|   

ki~jcidevaMvidhaM karmAprashastamArabhate; tamAtmanAhatamupaghnanto

ki~jcidevaMvidhaM karmAprashastamArabhate; tamAtmanAhatamupaghnanto

devAdayaH kurvantyunmattam||10||

devAdayaH kurvantyunmattam||10||

 

The type of ''unmada'' having etiology, premonitory symptoms, signs and symptoms, pain and favorable therapeutics (''upashaya'') different from those of the types of ''unmada'' caused by the vitiation of ''doshas'' are known to be of exogenous type. Some scholars hold the view that this type of ''unmada'' is caused by the effect of the activities of the past life. Lord Atreya considers intellectual errors as the causative factor of this condition. Due to intellectual errors, the patient disregards the Gods, ascetics, ancestors, ''gandharvas, yakshas,'' ''rakshasas, pishachas,'' preceptors, elders, teachers and the other respectable ones. He also resorts to undesirable and inauspicious (or blasphemous) activities. The gods etc. cause ''unmada'' in him because of his own inauspicious activities. [10]

The type of ''unmada'' having etiology, premonitory symptoms, signs and symptoms, pain and favorable therapeutics (''upashaya'') different from those of the types of ''unmada'' caused by the vitiation of ''doshas'' are known to be of exogenous type. Some scholars hold the view that this type of ''unmada'' is caused by the effect of the activities of the past life. Lord Atreya considers intellectual errors as the causative factor of this condition. Due to intellectual errors, the patient disregards the Gods, ascetics, ancestors, ''gandharvas, yakshas,'' ''rakshasas, pishachas,'' preceptors, elders, teachers and the other respectable ones. He also resorts to undesirable and inauspicious (or blasphemous) activities. The gods etc. cause ''unmada'' in him because of his own inauspicious activities. [10]

 

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

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

Unmadayisyatamapi khalu devarShipitRugandharvayakSharAkShasapishAcAnAM  guruvRuddhasiddhAnAM vA eShvantareShvabhigamanIyAH puruShA bhavanti;tadyathA- pApasyam,karmaNaH  samArambhe, pUrvakRutasya vA NaH pariNAmakAle,ekasya vA shUnyagRuhavAse catuShpathAdhiShThAne  vA,sandhyAvelAyAmaprayatabhAvevA parvasandhiShu vA  mithunIbhAve, rajasvalAbhigamane vA, viguNe  vA~adhyayanabalima~ggalahomaprayoge, niyamavratabrahmacaryabha~ggevA,mahAhave vA,deshakulapuravinAshe vA, mahAgrahopagamane vA, striyA vA  prajananakAle,  vividhabhUtAshubhAshucisparshanevA,vamanavirecanarudhirasrAve,ashuceraprayatasyavAcaityadevAyatanAbhigamanevA,

Unmadayisyatamapi khalu devarShipitRugandharvayakSharAkShasapishAcAnAM  guruvRuddhasiddhAnAM vA eShvantareShvabhigamanIyAH puruShA bhavanti;tadyathA- pApasyam,karmaNaH  samArambhe, pUrvakRutasya vA NaH pariNAmakAle,ekasya vA shUnyagRuhavAse catuShpathAdhiShThAne  vA,sandhyAvelAyAmaprayatabhAvevA parvasandhiShu vA  mithunIbhAve, rajasvalAbhigamane vA, viguNe  vA~adhyayanabalima~ggalahomaprayoge, niyamavratabrahmacaryabha~ggevA,mahAhave vA,deshakulapuravinAshe vA, mahAgrahopagamane vA, striyA vA  prajananakAle,  vividhabhUtAshubhAshucisparshanevA,vamanavirecanarudhirasrAve,ashuceraprayatasyavAcaityadevAyatanAbhigamanevA,

mAMsamadhutilaguDamadyocchiShTevA,digvAsasi vA,nishi nagaranigama  catuShpathopavana shmashAnAghAtanAbhigamane  vA,dvijagurusurayatipUjyAbhidharShaNe vA, dharmAkhyAnavyatikrame vA, anyasya vA karma No~aprashastasyArambhe, tyabhighAtakAlA  vyAkhyAtA  bhavanti||14||

mAMsamadhutilaguDamadyocchiShTevA,digvAsasi vA,nishi nagaranigama  catuShpathopavana shmashAnAghAtanAbhigamane  vA,dvijagurusurayatipUjyAbhidharShaNe vA, dharmAkhyAnavyatikrame vA, anyasya vA karma No~aprashastasyArambhe, tyabhighAtakAlA  vyAkhyAtA  bhavanti||14||

 

Persons get afflicted by ''unmada'' caused by godly spirits, ascetics, ancestors, ''gandharvas, yakshas, rakshasas, pishachas,'' preceptors, elders and adepts in the following circumstances, places and time:

Persons get afflicted by ''unmada'' caused by godly spirits, ascetics, ancestors, ''gandharvas, yakshas, rakshasas, pishachas,'' preceptors, elders and adepts in the following circumstances, places and time:

Thus, described were some circumstances in which a person attracts the wrath of gods, divinities, and the sages and gets afflicted with ''unmada''. [14]

Thus, described were some circumstances in which a person attracts the wrath of gods, divinities, and the sages and gets afflicted with ''unmada''. [14]

 

त्रिविधं तु खलु उन्मादकराणां  भूतानामुन्मादने प्रयोजनं भवति; तद्यथा-  हिंसा, रतिः, अभ्यर्चनं चेति तेषां  तं  प्रयोजनविशेषमुन्मत्ताचार विशेषलक्षणैर्विद्यात्| हिंसा, अप्सु वा स्थलाच्छ्वभ्रे निमज्जति, पतति, शस्त्रकशाकाष्ठलोष्टमुष्टिभिर्हन्त्यात्मानम्,  अन्यच्च प्राणवधार्थमारभते किञ्चित्, विद्यात्; तमसाध्यं साध्यौ  पुनर्द्वावितरौ||१५||

त्रिविधं तु खलु उन्मादकराणां  भूतानामुन्मादने प्रयोजनं भवति; तद्यथा-  हिंसा, रतिः, अभ्यर्चनं चेति तेषां  तं  प्रयोजनविशेषमुन्मत्ताचार विशेषलक्षणैर्विद्यात्| हिंसा, अप्सु वा स्थलाच्छ्वभ्रे निमज्जति, पतति, शस्त्रकशाकाष्ठलोष्टमुष्टिभिर्हन्त्यात्मानम्,  अन्यच्च प्राणवधार्थमारभते किञ्चित्, विद्यात्; तमसाध्यं साध्यौ  पुनर्द्वावितरौ||१५||

#affection/love/pleasure and  

#affection/love/pleasure and  

#to make the individual pay obeisance to Gods

#to make the individual pay obeisance to Gods

 

The prognosis of ''unmada'' can be judged from the characteristic features of the patient. When the intention of the afflicted agents is to inflict injury, then the patient enters into fire, sinks into water, falls into a pit, provokes others to hurt him, strikes himself with weapons, whips, sticks, brick bats, his own fist etc. He may also adopt to such other means of killing himself. This type of ''unmada'' is incurable.  

The prognosis of ''unmada'' can be judged from the characteristic features of the patient. When the intention of the afflicted agents is to inflict injury, then the patient enters into fire, sinks into water, falls into a pit, provokes others to hurt him, strikes himself with weapons, whips, sticks, brick bats, his own fist etc. He may also adopt to such other means of killing himself. This type of ''unmada'' is incurable.  

The other two types of intentions i.e. for affection/love/pleasure or to offer prayer give rise to variants of ''unmada'' that are curable. [15]

The other two types of intentions i.e. for affection/love/pleasure or to offer prayer give rise to variants of ''unmada'' that are curable. [15]

 

==== Treatment of exogenous ''unmada'' ====

==== Treatment of exogenous ''unmada'' ====

pa~jca  santo  dvAveva bhavataH  |tau ca  parasparamanubadhnItaH kadAcidyathoktahetusaMsargAt |  tayoH saMsRuShTameva  pUrvarUpaM  bhavati,saMsRuShTameva  ca li~ggam|  tatrAsAdhyasaMyogaM  sAdhyAsAdhyasaMyogaM

pa~jca  santo  dvAveva bhavataH  |tau ca  parasparamanubadhnItaH kadAcidyathoktahetusaMsargAt |  tayoH saMsRuShTameva  pUrvarUpaM  bhavati,saMsRuShTameva  ca li~ggam|  tatrAsAdhyasaMyogaM  sAdhyAsAdhyasaMyogaM

cAsAdhyaM  vidyAt,  sAdhyaM tu  sAdhyasaMyogam| tasya  sAdhanaM sAdhanasaMyogameva  vidyAditi||18||

cAsAdhyaM  vidyAt,  sAdhyaM tu  sAdhyasaMyogam| tasya  sAdhanaM sAdhanasaMyogameva  vidyAditi||18||

 

The ''unmada'' of five types can be further classified as endogenous or exogenous or as curable or incurable. At times, due to the combination of etiological factors (of endogenous and exogenous types), these could also manifest in hybrid forms. Such forms would exhibit a combination of both the types of ''unmada'' in their premonitory as well as actual symptoms. However, it is important to note that:

The ''unmada'' of five types can be further classified as endogenous or exogenous or as curable or incurable. At times, due to the combination of etiological factors (of endogenous and exogenous types), these could also manifest in hybrid forms. Such forms would exhibit a combination of both the types of ''unmada'' in their premonitory as well as actual symptoms. However, it is important to note that:

*Combination of the incurable types or of the curable and incurable types result in an incurable condition.  

*Combination of the incurable types or of the curable and incurable types result in an incurable condition.  

*Combination of curable types results in curable conditions that should be treated using a combination of therapies. [18]

*Combination of curable types results in curable conditions that should be treated using a combination of therapies. [18]

 

भवन्ति चात्र-  

भवन्ति चात्र-  

नैव देवा  न गन्धर्वा न पिशाचा न राक्षसाः|

नैव देवा  न गन्धर्वा न पिशाचा न राक्षसाः|

sa~gkhyA  nimittaM  prAgrUpaM  lakShaNaM  sAdhyatA na  ca|

sa~gkhyA  nimittaM  prAgrUpaM  lakShaNaM  sAdhyatA na  ca|

UnmadaAnAM  nidAne~asmin  kriyAsUtraM  ca  bhAShitam||24||

UnmadaAnAM  nidAne~asmin  kriyAsUtraM  ca  bhAShitam||24||

 

In summary, types of ''unmada'' and their etiology, premonitory symptoms, symptoms, curability or otherwise, and their modes of treatment have been described in this chapter. [ 24]  

In summary, types of ''unmada'' and their etiology, premonitory symptoms, symptoms, curability or otherwise, and their modes of treatment have been described in this chapter. [ 24]  

Thus ends the seventh chapter on diagnosis of ''unmada'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charaka . [24]

Thus ends the seventh chapter on diagnosis of ''unmada'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charaka . [24]

Last but not the least, there is a clear message in the chapter that every individual is himself responsible for his wellbeing, happiness and miseries. The behavioral tendencies and lifestyles adopted by the individual are based on his own choices and all types of ''unmada'' are the result of intellectual blasphemy by the individual himself – be it endogenous or exogenous.

Last but not the least, there is a clear message in the chapter that every individual is himself responsible for his wellbeing, happiness and miseries. The behavioral tendencies and lifestyles adopted by the individual are based on his own choices and all types of ''unmada'' are the result of intellectual blasphemy by the individual himself – be it endogenous or exogenous.

 

==== Table 1: Behavioral and psychological manifestation of triguna ====

==== Table 1: Behavioral and psychological manifestation of triguna ====

=== Case Paper Format Points ===

=== Case Paper Format Points ===

 

The format for the clinical assessment of manovahasrotas or The psychiatric assessment.

The format for the clinical assessment of manovahasrotas or The psychiatric assessment.

Every psychiatric history should cover the following points:

Every psychiatric history should cover the following points:

f) Right to Left differentiation

f) Right to Left differentiation

g) Judgment regarding common sense problems

g) Judgment regarding common sense problems