INTRODUCTION  Overwhelming stress can produce psychological problems in anyone. Even stable,  well adjusted person may bre...
According to the recent National Comorbidity Survey, anxiety disorders as a group are  the most common kind of disorders f...
Statement of the problem:  A clinical study on the effect of Aparajita churna and Jyotishmati taila on  Chittodvegam (w.s....
HISTORICAL ASPECT OF MANASA ROGAS  Historical review denotes the roots of the topic in the old classics and methodical rec...
3. Atharvaveda:  Atharvaveda has maximum number of references related with manas and manasarogas.                         ...
Post- vedic period:  This period comprises of Puranas and Itihaas.        In Vayupurana sensory and motor organs are desc...
Samhita period (1000 B.C. to 600 A.D.):  In this period ancient seers like Charaka, Sushruta and Vagbhata contributed abou...
Asthanga sangraha or hridaya:  a. Introduced Dhi, Dhairya and Atmadi vijnana as the best treatment of manasa roga.33  b. B...
Historical aspect of Anxiety neurosis:  1600   In the 16th century, the term hysteria is applied to anxiety and related di...
1960    Patients who had unexpected anxiety attacks were deferrentiated from patients         with other anxiety disorders...
STATE AYURVEDIC COLLEGE, LUCKNOW:  1. A clinical study of Shankapushpi medhya rasayana on patients of Chittodvega     (anx...
SHRI AYURVEDA MAHAVIDYALAYA, NAGPUR:  Chittodvega ka manovaigyanika vivechana evam us mein Medhya rasayana  (yashtimadhu) ...
15. Vi.Pu.1/2/46-49     16. Vi.Pu.6/5/2-6     17. Na.Pu.2/3/47-48     18. Ag.Pu.25/24     19. Ga.Pu.1/114/75     20. Ca.Sa...
CONCEPT OF MANAS  Ayurveda deals mainly with Ayu, which is life. According to Charaka Samhita, Ayu is  a complex union of ...
3) Sattva: The word is derived from ‘Sat’ root by adding ‘Kvta’ which gives meaning  of :- Existance9 ; Mind, Intellect, N...
Sthana of Manas:-  The location of Manas in the body is a disputed question in Ayurveda. According to its  functional aspe...
Sajnavahasrotas are mentioned by Charaka (Ca.Su.24/25, Ca.Ni.7/3) and Sushruta  (Su.Ut. 46/67) and Su.Sa 4/26). The word “...
    Tarkasangraham        has    stated    Manas      as    Indriya   by     quoting   -       “Sukhadyupalabhisadhanam I...
According to Charaka Samhita Manas have five objects. They are: 41  1. Cintya – Thinking  2. Vicarya – Investigation/Inque...
Charaka has stated that thinking, imagining, concentration and determination are the  objects of Manas (Ca. Sa.1/21, 22). ...
Genesis of Knowledge                                     Buddhi                              Dhi, Dhriti, Smriti          ...
Following are the references about doshas and dhatus in relation to sthana and karmas  of Manas:  Dosha:  Vayu : ‘Niyanta ...
Satta                                                 Buddhi         Rajas                       Atma                (Dhi,...
interindividual as well as intra-individual psychic behaviour are due to the relative  expression at a given moment, of th...
By critical study of the above-described qualities we can conclude that among the three  Gunas, Sattva is the equilibrium ...
Functional Neuroanatomy of Brain  Neurons and Neuroglia: 68  Neurons or nerve cells are specialized for electrical and che...
2. Primary sensory cortex – receives input from the peripheral sense organs. (i)           Somatosensory Cortex – located ...
Other structures often included in the definition of limbic system include: Septum,  Olfactory bulbs, Uncus, Entorhinal co...
connections with the pituitary through the hypothalamohypophyseal tract and the     pituitary portal system.  Hypothalamus...
The autonomic Nevous system (ANS):-  The ANS (autonomic nervous system) is a motor system controlling involuntary activity...
REFERENCES    1. Ca.Su. 1/42    2. Chakrapani commentary on Ca.Su.1/42    3. Ca.Sa.3/13    4. Shabdakalpadrumam    5. Amar...
30. Ca.Vi.5/7    31. Cakrapani Commentary on Ca.In.5/41    32. Esentials of Basic Ayurvedic concepts – 8th chapter, 197-19...
60. Patanjali yoga sutras    61. Ca.Su. 11/46    62. Ca.Su.8/5, Su.Sa.4/57    63. Gita 14/5,6,7,8    64. Su.Sa. 1/32    65...
CHITTODVEGA  Etymology And Definition:  The term chittodvega comprises of two words i.e. chitta and udvega.  Chitta:  It i...
Udvega:  It is derived from root “ud” which has following meanings:          Superiority in place, rank or power, up, upw...
Acharya Charaka has quoted (Ca.Ni.8/27) that a single clinical feature can be considered  - as a common symptom in many di...
Andhaputana graha                           As.Hr.Ut. 3/25  Bala graha                                  Su.Sa. 10/51, Ma.N...
NIDANA  Multifactorial origin of psychiatric illness has been stated in modern psychology. In  Ayurvedic classics also man...
 Features of dhriti bhramsa (derangement of the will) -            the mind is always         reaching out for its object...
Advent of maturity of results of kala and karma is also considered as the cause of  Manasarogas.     Results of all misdee...
13. Manoabhighata occurring due to bereavements like loss of wealth, loss of     employment, death of partner etc results ...
23. Ca.Vi. 8/98,99,100    24. Ca.Sa.4/35    25. Ca.Sa. 4/37,38,39,40 & Su.Sa.4/81-98    26. Ca .Vi.8/119    27. Ma.Ni.20/5...
SAMPRAPTI  Chittodvega has been stated as one of the purvarupa of unmada by Charaka & Sushruta  (Ca.Ni.7/6 & Su.Ut.62/6-7)...
(i) Vata: The normal functions of vata are stated as `Niyanta praneta cha manasah,       tantrayantradhara, pravartakaches...
Dosha vaishamyam leads to dhatuvaishamyam due to the ashraya – ashrayee bhava.20 As  the etiological factors vitate tridos...
So the etiological factors of chittodvega vitiate Agni and produce Ama which will further  lead to dosha-dhatu vaishamyata...
Samprapti of chittodvega               Asamndriyaarthasamyoga       pragnyaparadha        parinama                        ...
From the above description the samprapti ghatakas of chittodvega can be stated as:  Dosha :        Manasika:   Rajas, Tama...
exaggerated response to emotional disturbance. This is the sanchayavastha of  chittodvega.  If chayavastha is not encounte...
krichrasadhya leading to major psychiatric illness like unmada. This is the bhedavastha  of chittodvega.                  ...
28. Ca .Vi .5/19      29. Bha .pra. Mad 1/59      30. Arunadatta commentary on As.Hr. Su.13/27      31 As. Hr. Su 13/27   ...
RUPA  Poorvarupa:  The poorvarupa or prodromal stage comprises of appearance of some of the symptoms, in  a sense it is th...
14.   Arocaka (Anorexia)                               Ca. Ni. 7/5  15.   Avipaka (Indigestion)                           ...
CLINICAL CORRELATION OF CHITTODVEGA  It is very difficult to compare neurotic disorders with any disease described in Ayur...
Ojokshaya is noticed in a variety of disorders like Madhumeha (Ca.Ni.4/37), Panduroga  (Ca.Ci.6/5), Raktarsas (Ma.Ni.5/27)...
CLASSIFICATION OF PSYCHIATRIC DISORDERS  Multi Axial System  The DSM-IV organizes each psychiatric diagnosis into give lev...
   Somatoform disorders       Factitious disorders       Dissociative disorders       Sexual and gender identity disor...
ANXIETY NEUROSIS  Anxiety:  The word anxiety is derived from the Latin word ‘Anxitas’ meaning ‘troubled in  mind’.1Anxiety...
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A clinical study on the effect of Aparajita churna and Jyotishmati taila on Chittodvegam (w.s.r.to Anxiety neurosis), JAYA LAXMI.V, Department of Kayachikitsa, PG unit Dr.BRKR Govt. Ayurvedic College, HYDERABAD

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Chittodwega kc013 hyd

  1. 1. INTRODUCTION Overwhelming stress can produce psychological problems in anyone. Even stable, well adjusted person may breakdown if forced to face extensive psychological, physical, environmental or social stressors. In present conditions, human beings are living in the perpetual state of ever increasing stressful situations arising from the current lifestyle, environmental pollution highly ambitious and competitive lifestyle, over population, monotony and boredom of complex interpersonal relationships, job responsibilities and many other associated mental and emotional causes. The ever growing stress and strain in life lead to deterioration in various mental and physiological functions of body, causing psychological disorders like anxiety neurosis. Neurosis or neurotic disorder is the traditional term for those symptoms that are associated with emotional, cognitive, behavioural, and somatic symptoms, and are not due to a medical disorder or to a personality disorder. Anxiety is the primary emotion present in these disorders. Anxiety has been defined as an unpleasant emotion that is characterized by feelings of dread, worry, nervousness, or fear. The stressful life has been the major cause of prevalence of anxiety neurosis in the general population. Studies from different parts of world have found the Community Prevalence rates of neurotic symptoms, between 7and 26 per month. The most frequently reported neurotic symptoms are fatigue (27%), sleep problems (25%), irritability (22%), worry (20%), depression (10%) and anxiety (10%). The National comorbidity Survey from United States reported that almost 1 in 5 adults between 15 and 54 years suffer an anxiety disorder in a year and this rose to 1 in 4 when lifetime diagnosis was considered. On the basis of the Epidemiologic Catchment Area Survey, the prevalence of anxiety disorders in United States is 4% (Barlow, 1988), representing the single largest mental health problem in America. Chittodvega==================================================1created by technoayurveda.wordpress.com of Dr.KSRPrasad
  2. 2. According to the recent National Comorbidity Survey, anxiety disorders as a group are the most common kind of disorders for women, affecting approximately 30 percent of the female population at some point in their lives, and the second most common kind of disorders for men, affecting approximately 19 percent of the male population at some point (Kessler et al., 1994). The twelve month prevalence rates of anxiety for women were 23 percent and for men were 12 percent. It is very common for a person diagnosed with one anxiety disorder to be diagnosed with one or more additional anxiety disorders as well as with a mood disorder. A study appearing in the Journal of the American Medical Association (JAMA), 2004, Jan 2, indicates that anxiety disorders are the most common of mental conditions in many countries and the treatment or support is often inadequate or poorly advocated. The western medicine has not been able to crytalize its approach in the prevention and treatment of such disorders. Therefore, attempts are being made to explore the herbal resources of Ayurvedic medicine to develop suitable remedies for the management of anxiety neurosis. In the present study anxiety neurosis has been considered as the manovikara, Chittodvega, stated by Acharya Charaka. A detailed description of chittodvega is not available in classics. Though a lot of exploration is needed in understanding and in treatment of chittodvega, very few studies were conducted on this topic till now. Numbers of formulations were mentioned in classics for treatment of manasa rogas but specific medicines which are effective in chittodvega are to be evolved. In this context the present study is conducted with the objective of correlating the symptoms of Chittodvega with anxiety neurosis and an effort is made to evolve an effective treatment in the form of Aparajitha and Jyotishmati with special reference to their medhya property. Chittodvega==================================================2created by technoayurveda.wordpress.com of Dr.KSRPrasad
  3. 3. Statement of the problem: A clinical study on the effect of Aparajita churna and Jyotishmati taila on Chittodvegam (w.s.r.to Anxiety neurosis). Objectives of the study:  To study Chittodvega in comparision to anxiety neurosis.  To study the efficacy of trial drugs, Aparajitha churnum and Jyotishmati tailam, in decreasing the symptoms of anxiety.  To study the effect of trial drugs on the scores of Hamilton rating scale for anxiety and State Trait Anxiety Inventory. Hypothesis:  Null hypothesis: The trial drug doesn’t significantly decrease the signs and symptoms of chittodvega and the scores of Hamilton rating scale for anxiety and State-Trait Anxiety Inventory.  Alternate hypothesis: The trial drugs Aparajitha churnam and Jyotishmati tailam significantly decrease the signs and symptoms of Chittodvega and scores on Hamilton rating scale for anxiety and State-Trait Anxiety Inventory. Chittodvega==================================================3created by technoayurveda.wordpress.com of Dr.KSRPrasad
  4. 4. HISTORICAL ASPECT OF MANASA ROGAS Historical review denotes the roots of the topic in the old classics and methodical record of important events of past. Here an effort has been made to know the history of manas and manasa rogas in general from Vedic period upto 21st century. Vedic period (6000 B.C. to 1000 B.C.): Vedic era is said to be the earliest of the age or recorded history. Four Vedas with their Brahmana, Aranyaka and Upanishad part comprises the vedic scriptures. Many descriptions about mental disorders and treatments are available in these sacred texts. 1. Rigveda: Rigveda has many references about mental disorders, regarding the psychological derangements, the methods of treatment and means to prevent the psychiatric entities, which are - 1. Manas acts as a tool between Atma and Indriyas in the origin of knowledge.1 2. The Atma is supreme and the Manas as well as Indriyas surrender to it.2 3. Pisachas are blamable for mental disorganization and Agni has been worshipped for the cure of the same.3 4. Conjugation of Atma and Manas lead to Moksha.4 2.Yajurveda: A. Manas is the supreme power, which is associated for all impulses to be carried out, than to interpret it.5 B. In Shivasankalpasutra the sloka dealing with nature of mind (manas) is explained.6 Chittodvega===========================================4created by technoayurveda.wordpress.com of Dr.KSRPrasad
  5. 5. 3. Atharvaveda: Atharvaveda has maximum number of references related with manas and manasarogas. 7 A. Atharvani i.e psychotherapy is one among the main forms of treaties mentioned. B. Atharvani relates with the psychological aspects and includes mantra(chanting), sankalpa(decisiveness by repeated self suggestions) and vasikarana (control over self by mesmerism or hypnosis).8 9 C. Most of the hymns of Atharvaveda are directly concerned with the Atharvani. D. Devakritapapa, jwara, krimi, abhichara, rakshasa, gandharva, apsara etc., were given as the causes of mental disorders. E. Heart is considered as the seat of manas. F. Some manasa bhavas like irshya, krodha, etc., are calmed down through special treatments like Irshya Bheshaja.10 G. References of many manasa rogas like apasmara, duswapna, bibheti are found in Atharvaveda slokas. Data from Brahmanas, Upanishads and kalpasutras:-  In Aitreya brahmana, the sense organs and their functions are defined.11  Satapadha brahmana described about an important centre for dhamanis, nadis [trinabhishchakram] and shironabhi is stated as one among them.  Upanishads explained especially about Atma, Prana, Manas, Buddhi, Vividendriya vyaparas, Manonigraham, Indriyanigraham, Pranayamam, etc.  Manava grihya sutras gives an interesting description, possibly of mental derangement in the context of vinayaka prakarana.12  Taittireeya aranyakam discussed about Sristi vicharana, Pancha bhoutika shareera vicharana, Atma vicharana, Manas, Buddhi, Antahkaranas, Sattvaguna, Rajoguna, Tamoguna, Vividendriya vyaparas and Prana. Chittodvega===========================================5created by technoayurveda.wordpress.com of Dr.KSRPrasad
  6. 6. Post- vedic period: This period comprises of Puranas and Itihaas.  In Vayupurana sensory and motor organs are described.13  In Vishnupurana Indriyas and their functions are described in detail.14 Description about channels carrying consciousness attached to hridaya15 is given. Diseases have been grouped into two i.e.shareera and manasa and the later includes psychic aberrations like passion, wrath, greed etc.16  In Itihaasapurana, Sridhara explains virya, ojus, bala and saha as strength of mind, senses, body and heart respectively.  In Naradiyapurana sattva, rajas and tamas were mentioned as the qualities of mind.17  In Agnipurana senses along with mind were enumerated.18Heart is described like a lotus and seat of consciousness.  In Garudapurana, the role psychic state in metabolism was well emphasized.19  In Mahabharata santhi parva swaroopa of manas and sattvika gunas were described.  In Bhagavad Gita motivating talk of Krishna to treat the depression of Arjuna is a great example of psychological counselling. In eleventh skanda satvika guna vrittis were mentioned. Gnana was said to be residing in hridayam  In Ramayana, disturbed mind is stated to cause vitiation of indriyas. In yoga vashista, attempts of Vasishta, Vishwamitra and Dasaradha to elevate the depressed mood of Rama are good examples of psychotherapy.  In Brahmavaivartapurana and Manusmriti, methodology of psychological examination was explained.  In Panchatantra, a good description of psychological techniques, which can be applied in one’s life, can be seen in different stories. Chittodvega===========================================6created by technoayurveda.wordpress.com of Dr.KSRPrasad
  7. 7. Samhita period (1000 B.C. to 600 A.D.): In this period ancient seers like Charaka, Sushruta and Vagbhata contributed about various aspects of manas, manasa rogas and their management. Ayurveda traditionally contains Atharvani type of treatment in the form of Daiva vyapashraya chikitsa. Out of the eight specialities of Ayurveda, Bhutavidya, illumines, psychology and psychiatry in ancient times. Charaka samhita : a. A complete and detailed definition, properties and functions of manas are described.20 b. Chittodvega is mentioned as one of the vikara of manodosha.21 c. Effects of emotional factors on the body.22 d. Psychosomatic approach towards deha prakriti.23 e. Etiopathogenesis of mental disorders.24 f. Sattva pariksha i.e examination of mental status is described.25 g. Treatment of manas roga includes Gnana, Vijnana, Dhairya, Smirti, Samadhi.26 h. Complete and detailed description of major psychiatric ailments under unmada chapter.27 i. Ayuh is considered as the conjunction of Shareera(body), Indriya(senses), Sattva(mind), and Atma(soul).28 Sushruta samhita: a. Most of the manobhavas like krodha, soka, bhaya, kama are described as a part of either as iccha or dvesha.29 b. Sixteen types of manasa prakritis explained.30 c. In the definition of health, mental health is given due importance.31 d. Trigunas(sattva, rajas, tamas) are included in the Twelve pranas which chiefly regulate and control the biological functions of life.32 Chittodvega===========================================7created by technoayurveda.wordpress.com of Dr.KSRPrasad
  8. 8. Asthanga sangraha or hridaya: a. Introduced Dhi, Dhairya and Atmadi vijnana as the best treatment of manasa roga.33 b. Bhutavidya, unmanda, apasmara and balagraha are thoroughly discussed.34 Bhela samhita: a. Location of manas is given as sirah talvantaram.35 b. Alochaka pitta related to mental vision has been described.36 Samgraha period (600 A.D. to 1600 A.D): Detailed analysis of sattva pareeksha is given. In context of bhutavidya - Mandukaparnighrita, Saraswataghrita are indicated for the first time. Chandrata in his commentary on chikitsa kalika has explained two types of sattva– Bhiruta and Sahishnuta.37 Madhavanidana incorporated literature about mental disorders based on samhitas. Later on Sharagadhara, Bhavamishra and all the other commentators of samhitas have described manasa rogas based on samhitas. Modern period 1600 A.D onwards: In the early twentieth century, Yogendranath Sen, a renowned pupil of Gangadhar tried to elaborate some terms like moodha, alpachetas, vyakulata etc. Dr.BalakrishnaPathak, Dr.AyodhyaprasadAchal and Dr.Rajendraprasad Bhatnagar have endeavored well to interpret Ayurvedic description of psychiatry with modern literature. Chittodvega===========================================8created by technoayurveda.wordpress.com of Dr.KSRPrasad
  9. 9. Historical aspect of Anxiety neurosis: 1600 In the 16th century, the term hysteria is applied to anxiety and related disorders. 1678 An apparent mixture of depression and anxiety known as ‘Nostalgia’ was first described by military physicians among Swiss soldiers. It was termed as ‘Heimweh’ by German doctors. 1733 George Cheyne, in his book ‘English Malady’ and in other works launched the whole notion of ‘nervous illness’ as a malady affecting the nerves. 1751 Robert Whytt (1714-1766) worked with milder mental conditions (in effect the neuroses), categorizing them into the hysteric, the hypochondrial and those characterized by `nervous exhaustion’. 1777 The term neurosis was coined by William Cullen, replacing ‘illness of nerves’ and meaning any disease of nervous system without a known organic basis. 1818 Johann Christian Heinroth (1773-1843) developed a theory of mind involving a ‘Tripartite’ structure. He used the term-` Psychosomatic’. 1850 Heinrich Neumann (1814-1884) spoke of sexual (and other) drives which if not satisfied could generate anxiety. Otto Domrich became the first in the field of Medical Psychology to write about ‘anxiety attacks’, replacing earlier notions of neuro-circulatory neurasthenia. 1869 Chloral became the first rehearsal of the ‘Prozac’ scenario seen with drugs functioning as a hypnotic to relieve insomnia in anxious and depressed patients. 1872 Charles Darwin considered anxiety (fear) and anger (rage) to be adaptive characteristics of both human and non human animals. 1880 Charcot called hysteria as ‘ the Great Neurosis’ 1895 Sigmund Freud’s description of ‘Anxiety neurosis’ in 1895 was a wider concept that covered wilder anxiety states as well as actual panic attacks. 1937 James Papez proposed theory of the emotional brain. He speculated on neural pathways involved with emotional response in two ways- one via sensory stimulation of hypothalamus and the other via cortical stimulation and feed back of hypothalamus. Chittodvega===========================================9created by technoayurveda.wordpress.com of Dr.KSRPrasad
  10. 10. 1960 Patients who had unexpected anxiety attacks were deferrentiated from patients with other anxiety disorders. Chlordiazepoxide (Librium) became the first anti- anxiety medication (first benzodiazepine) to be used in psychiatry. 1980 The diagnostic category of panic disorders was first officially recognized with the publication of the American Psychiatry Association’s Diagnostic and statistical manual of mental disorders, Third edition (DSM III). 1994 DSM IV (Diagnostic and Statistical Manual of Mental disorders fourth edition, published with (listed) 297 disorders. ASAP (alternative support anxiety panic) is created, it is the first public internet forum devoted to anxiety disorders Research scholars in Ayurveda have previously studied about Chittodvega at different institutions. A brief review of the works is given below: B.H.U., VARANASI: 1. Clinical studies on chittodvega vis-à-vis anxiety neurosis and its treatment with rasayana drug Aswagandha (withania somnifera). [Dr.Malaviya P.C; 1977] 2. Role of ayurvedic drug in the management of Anxiety and Depression among elderly in relation to manasa prakriti. [Dr.Singh M.K; 2002] JAMNAGAR: 1. A study on the role of Adambu balli (Ipomea pescaprea Linn.) and Mansyadi quatha in the management of Chittodvega vis-à-vis anxiety disorders (DSM III). [Dr.Bhatt G.J; 1990] 2. Clinical study on the role of Jaladhara and Shankapushpi (Convolvulus) in the management of Chittodvega (Anxiety disorders). [Dr.Parsania Sanjay; 2001] 3. Clinico-experimental study of Kushmandadi Ghrita in GAD w.s.r. to Chittodvega.[Dr.AhirYogita; 2005] Chittodvega===========================================10created by technoayurveda.wordpress.com of Dr.KSRPrasad
  11. 11. STATE AYURVEDIC COLLEGE, LUCKNOW: 1. A clinical study of Shankapushpi medhya rasayana on patients of Chittodvega (anxiety neurosis).[Dr.Tripathi N.C; 1990] 2. A clinical evaluation of asvagandha choorna on manasaroga (chittodvega- Anxiety neurosis).[Dr.Saxena S.C; 1993] 3. Manasa roga Chittodvega and anxiety neurosis mein vacha choorna ka chikitsakeeya adhyayana.[Dr.Gupta R.K; 1999] GOVT.AYURVEDIC COLLEGE, THIRUVANANTHAPURAM: 1. Study on Chittodvega vis-à-vis anxiety neurosis and its treatment with three rasayana drugs. [Dr.Sarma MPE; 1987] 2. A clinical study on Anxiety neurosis with an ayurvedic compound. [Dr.Sreeja S.; 2002] VPSV AYURVEDA COLLEGE, KOTTAKKAL: 1. Management of Chittodvega (anxiety disorder) with an ayurvedic compound-A double blind study. [Dr.Autade vikas dadaso; 2003] 2. Role of Shankhapushpi (Clitorea ternate) and clinical yoga techniques in the management of general anxiety disorder. [Dr.Chavan Prashanth.J; 2004] SDM COLLEGE OF AYURVEDA, HASSAN: A study on the effect of Shankapushpi compound and Sattvavajaya chikitsa in Chittodvega. [Dr.Karla Sanjeeva; 2003-2004] GOVT.AYURVEDIC MEDICAL COLLEGE, MYSORE: A conceptual analysis of GAD and Chittodvega with a controlled clinical trial on the effect of Ksheera-Dhara. [Dr.Rajendra V; 1997] Chittodvega===========================================11created by technoayurveda.wordpress.com of Dr.KSRPrasad
  12. 12. SHRI AYURVEDA MAHAVIDYALAYA, NAGPUR: Chittodvega ka manovaigyanika vivechana evam us mein Medhya rasayana (yashtimadhu) ka chikitseeya adhyayana. [Dr.Thatte S.M; 1991] TILAK AYURVEDA MAHAVIDYALAYA, PUNE: To study the effect of shirodhara with Balashvagandhadi tailam in the management of anxiety neurosis. [Dr.Raut Raghunath; 2004] GOVT.AYURVEDIC MEDICAL COLLEGE, BANGALORE: Efficacy of Tagara in chittodvega w.s.r. GAD- A clinical study. [Dr.Nagendrachari.M; 2001] A.V.SAMITI’S AYURVED MAHAVIDYALAYA, BIJAPUR: A clinical evaluation of Shiro-dhara and Brahmi vati on anxiety neurosis. [Dr.Harisha.H.M; 2004] REFERENCES 1. Rg 4/1/915 2. Rg.4/5/917 3. Rg.5/29/10 4. Rg.2/243/181/1;8/4/57/1 5. Yaj.34/1-6 6. Yaj.34/3 7. Singh, 1977 8. Baloddhi&Roychoudhary, 1986 9. Baloddhi&Roychoudhary, 1986 10. Ath.veda -7/46/1; 6/28/1-3 11. Ai.Bra.5/22 12. Ma. Grh.Su, 2/14 13. Va. Pu.1/4/56-60 14. Vi.pu.3/37/19 Chittodvega===========================================12created by technoayurveda.wordpress.com of Dr.KSRPrasad
  13. 13. 15. Vi.Pu.1/2/46-49 16. Vi.Pu.6/5/2-6 17. Na.Pu.2/3/47-48 18. Ag.Pu.25/24 19. Ga.Pu.1/114/75 20. Ca.Sa.1/18-22 21. Ca.Vi.6/5 22. Ca Su.25/40 23. Ca.Vi.8/95-98 24. Ca.Sa.1/102,108 25. Ca.Vi.4/8 26. Ca.Su.1/54,58 27. Ca.Ni.7; Ca.Ci.9 28. Ca.Su.1/42 29. Su.Su.1/3 30. Su.Sa.4/80-96 31. Su.Su15/41 32. Su.Sa.4/2 33. As.Hr.Su.1/26 34. As.Sa.Ut.6/10;As.Hr.Ut.2/7 35. Bh.Sam.Ci.8/25 36. Bh.Sam.Sa.4/3-5 37. History of medicine in India 273p, 274p 38. http//anxiety_panic.com/history 39. Oxford handbook of psychiatry – 340p Chittodvega===========================================13created by technoayurveda.wordpress.com of Dr.KSRPrasad
  14. 14. CONCEPT OF MANAS Ayurveda deals mainly with Ayu, which is life. According to Charaka Samhita, Ayu is a complex union of Sarira, Indriya, Sattva and Atma.1 The term Ayu refers to a combination of body, senses, mind and the soul.Sattva is taken as manas i.e.mind.2 The word Sattva is used not only for Manas but is also meant for cetana, citta, hridaya etc. It is called as manas when it is related to intelligence based on reception of senses and voliation.3 Manas is a Sanskrit word and is derived from the Dhatu ‘MAN’ and ‘ASAN’ the suffix following it. Etymology of Manas:- 4 The power or ability or strength that is responsible for experience of agony; Wish and will ; Inclination ; Dislike ; Repugnances ; Effort ; Endeavour ; Knowing ; Investigation ; Discussion ; Nudence. According to Sir Monier Williams Sanskrit – English dictionary: Mind ; Intellect ; Intelligence ; Understanding ; Perception ; Sense ; Conscience ; Will. Synonyms of Manas:- There are seven synonyms of Manas: “Chittam tu ceto Hridayam Swantham Hrinmanasam Manah”!5 According to Charaka Samhita there are three synonyms of Manas: “Atindriya, Sattva and Cetah.”6 Etymology of the Synonyms:- 1) Manas: A Substance that is responsible for the presence or absence of Knowledge is called Manas.7 2) Manasam: A substance which establishes the contact between the Soul and Body and which regulate the function of the Indriyas.8 Chittodvega ==========================================14created by technoayurveda.wordpress.com of Dr.KSRPrasad
  15. 15. 3) Sattva: The word is derived from ‘Sat’ root by adding ‘Kvta’ which gives meaning of :- Existance9 ; Mind, Intellect, Nature, Life, Conciousness10 ; Bright Knowledge, Origin of Comfort.11 4) Chittam, Cetah, Chitta: The word citta is derived from root ‘Cit’ by adding Suffix ` Kta’. It has the following meanings: - Mind12; Internal Instrument13; Awakes Provides Sense14; Thought Process, Intelligence, Heart, Soul, Spirit15 5) Hrit, Hridayam: Derived from the root ‘Hr’ meaning that which Captures or Grasps.16 All the terms represent different functional aspects of the mind. Definition of Manas:- A substance which is responsible for the presence or absence of knowledge is called manas( Ca.Sa.1/18). A substance which establishes the contact between the soul and the body and regulates the function of indriyas is called manas.17 Gunas of Manas:- Anutwam (Atomic dimention) and Ekatwam (oneness) are the basic gunas of manas.18Chakrapani while commenting in this context has given a good example to explain Anutwa and Ekatwa. When one experiences Gyana from more than one Indriya, it appears that the Manas in indulging with both of them simultaneously, it is apparently too. In fact, the Manas in indulging with the Indriyas one after another in a successive manner, the manner which is too subtle to perceive. The same is like, sudden pricking of one hundred tender lotus leaves, which are arranged one over other as a bunch, with a sharp instrument (needle). It appears that all the leaves were picked simultaneously but actually there is a subtle gap of time from one leaf to other while pricking, the subtleness is not perceivable with materialistic eye.19 Chittodvega ==========================================15created by technoayurveda.wordpress.com of Dr.KSRPrasad
  16. 16. Sthana of Manas:- The location of Manas in the body is a disputed question in Ayurveda. According to its functional aspects the seat of Manas has been dealt differently by Acharyas in their respective works. 1. Hridaya:- Both Caraka and Susrutacharyas have mentioned that hridaya is the seat of cetana in the body.20 Hridayam the first organ to form in garbhotpatti 21 have been mentioned by Vagbhata as the location of sattva which lies in the region of sthanayormadhya.22 Taittariyopanisad states that ‘ManomayaPurusa’ resides in Hridayakasa.23 Cakrapani also states that Manas is located in Hridaya.24 2. Sirah :- Charaka has stated that Prana is situated in Siras which is also called as uttamangam due to its control over all the Indriyas.25 3. Between Siras and Talu: - According to Bhela samhita Manas is located between siras and talu.26 4. Sarva Sarira: - Charaka stated that Manas is Atindriyam and the whole body is its adhistanam.27 5. Twak: - Twak is said to be the seat of Manas, as it is considered as the main and only Indriya distributed in all other Indriyas and without which no perception occurs.28 6. Indefinite: - Manas is considered as Achetana. It is under the control of Atma, which has the property of chetanatvam, entering different yonis. As Manas follows Atma, it dosen’t have a definite location.29 Manovaha Srotas:- These Srotas have not been separately mentioned. It is however stated in Charaka 30 samhita that the entire sentient body represents the abode of manas and therefore should be considered as the manovahasrotas.The Manovahasrotas transport either the Manas or the information related to it.31 Chittodvega ==========================================16created by technoayurveda.wordpress.com of Dr.KSRPrasad
  17. 17. Sajnavahasrotas are mentioned by Charaka (Ca.Su.24/25, Ca.Ni.7/3) and Sushruta (Su.Ut. 46/67) and Su.Sa 4/26). The word “Sanjan” indicates knowledge, understanding, hint, sign, mind etc.32 Since the word sajna also means Manas, Chakrapani states that the Sajnavahasrotas are the Manovahasrotas. Chestavahasrotas are not mentioned in Ayurvedic classics. But the two important functions of vata i.e. gati (movement) and gandhana (sensory perception), are conducted by these srotas. Since the direction for requisite action is from the Buddhi and those directions relay in Manas before reaching the target organs, Manas and Buddhi are considered as moolas of the chestavaha srotases. The chestavahasrotas take origin in the Buddhi and pass through the Manas to spread throughout the body. Since all organs function in accordance with the guidance and incitement of the Manas and Buddhi, the manovahasrotas are clearly associated through intercommunication with the Sajnavahasrotas which extend from the sense organs to the manas and Chestavahasrotas which extend from the manas to the motor organs. Therefore, the Manovahasrotas seem to have spread throughout the body, with Manas and Buddhi as the mula. Swarupa of Manas:- It has always been a disputable question in Ayurveda regarding the nature of manas. Theories Supporting Bhautika Nature of Manas:  Vedanta metaphysics leads to the conclusion that Manas is physical because it regards that internal organs (Manas, Buddhi, Ahamkara and Citta) are Bhautika.  In Chandagyopanishad, Manas in described as “annamayam hi saumya manah”.  Few references in Mahabharata infer that Manas may be Panchabhautika.33  Vaiseshika Darshana has accepted the Dravyatva of manas.34  Manas has been quoted as one of the nine karana Dravyas by Charaka.  Manas has been counted as one of the Sixteen Prameyas (categories or objects of right cognition).35 Chittodvega ==========================================17created by technoayurveda.wordpress.com of Dr.KSRPrasad
  18. 18.  Tarkasangraham has stated Manas as Indriya by quoting - “Sukhadyupalabhisadhanam Indriyam Manah”  In Bhela Samhita Manas is called ‘Sarvendriyapara’36 i.e. Super sensual and controller of all Indriyas and not identical to them. In Ayurveda, Manas and Indriyas are not regarded identical and, therefore in so many references we observe that Manas and Indriyas have been mentioned in the same phrase side by side. Theories Supporting Adhyatmika nature of Manas:-  Charaka has included Manas in the classification of Adhyatmika dravyaguna samgraha.37  In the cosmological description of evolution, Sushruta stated the origin of Manas (along with Indriyas) from Ahamkara.38 Thus Manas is Ahamkarika, and Ahamkarikas are considered as non-bhautika.  Samkhya doctrine of philosophy suggests that Manas in Ahamkarika.  In classics the Bhautikatva of dasha indriyas is stated 39but not of Manas. From these references, it can be concluded that Manas in accepted as a Dravya but belonging to the category of Adhyatmikadravyaguna Samgraha. It is Asaririka but deeply related to Sarira, Acetana but essentially related with Atma, Abhutika but depending reciprocally on the Panchabhautika Sarira in the performance of complex and integrated activities of the organic life.40 Arthas of Manas:- Whatever can be known by Manas are considered as the Mano Ardhas or Manovisayas. They do not require contact of any object, but incessantly continue to function and ultimately arrive at decision. Chittodvega ==========================================18created by technoayurveda.wordpress.com of Dr.KSRPrasad
  19. 19. According to Charaka Samhita Manas have five objects. They are: 41 1. Cintya – Thinking 2. Vicarya – Investigation/Inquest 3. Uhya – Imagination 4. Dhyeya – Concentration 5. Samkalpa – Intention/ Aiming While commenting in this context Chakrapani, has defined the above five objects as: 42 1) Cintya is the thing that can make a critical thinking process regarding a subject or an object. 2) Vicara is that knowledge, which directs the Manas to enquire the pros and cons of an incident or of an action. 3) Uhya is the knowledge imagining the outcome of a work (with having a high opinion). 4) Dhyeya is that knowledge which is acquired through concentration or meditation. 5) Samkalpya is that knowledge which determinesthe direction of action. All these objects of Manas are having central theme of thinking with different views. Mano karma:- The chief functions of Manas are assimilation and discrimination. According to Chakrapani the chief functions of Manas are Iccha (desire), Dvesa (hatred), Sukha (pleasure), Dukha (pain) and Prayatna (effort).43 Charaka described the Manokarmas into four categories 44 , they are: 1. Indriyabhigraha means regulation and guiding of Indriyas through supervision. 2. Controlling of one self for not indulging in noxious and hostile activities is called Swayamnigraha. 3. Grasping of knowledge through conjecture is called Uha. 4. Pondering over all facts is called Vicaraha. Chittodvega ==========================================19created by technoayurveda.wordpress.com of Dr.KSRPrasad
  20. 20. Charaka has stated that thinking, imagining, concentration and determination are the objects of Manas (Ca. Sa.1/21, 22). The modern Psychology also agrees about the function of mind, as the aggregate of thinking, judgement and conclusion. It directs and controls the senses to control one-self when one is getting away from right thinking, imagination and ideation. [Shukla J.P. (1966); The nature of mind] Gyanothpathi Prakriya ; Physiologial functions of Manas can be divided into three Stages: 1. Perception (cognitive or sensory) 2. Discussion and Determination 3. Stimulation or Initiation (Conative or Motor) 1. Perception: `Indriyeneindriyartho hi samanaskena grihyate!’(Ca.Sa.1/22) In this stage, Indriya receives its Artha on stimulation by Manas. Manas acts as a keyfactor in stimulation of indriyas. For the perception to occur the connection between Atma, Indriya, Manas and Arthas is essential. (Ca.Su.8/7). 2. Discussion and Determination: `Kalpayate manasa turdhvam gunato desatothva! jayate visaye tatra ya buddhi nischayatmika!!’(Ca.Sa.1/22-23) After the perception, the procedure of actual analysis starts. The Processes like Cintya, Vicharya, Uhya, Dhyeya, Samkalpa takes place. According to its capacity, it gives the determination to the perception. 3. Stimulation or Initiation (Conative/Motor): `Vyavasyati taya vaktum kartum va buddhi purvakam!’(Ca.Sa.1/23) After the determination of knowledge perceived by Gyanendriya, Buddhi takes the decision and initiates the karmendriya for desired action. Manas is called ubhayendriya because it connects Gyanendriya and Karmendriya. From the above discussion, it can be understood that Manas plays a vital role from cognition to conation. Chittodvega ==========================================20created by technoayurveda.wordpress.com of Dr.KSRPrasad
  21. 21. Genesis of Knowledge Buddhi Dhi, Dhriti, Smriti Uha Vichara Indriyanigraha Swanigraha MANAS Indriya Figure 1 Object Factors influencing physiology of Manas:- At Metaphysical level: Atma – gives cetanatva to the Manas At Intellectual level: The characteristics of Atma, influences Manas through its three dimensions i.e. Dhi– Proper judgment, Dhriti – contolling power; Smriti – Recall or memory. The three functional dimensions of Manas at intellectual level are – Sattva – Knowledge; Rajas- action; Tamas-Regulation At Physical level: The karmas of Manas in gross body occur through the functional faculty of body i.e. Doshas, Dhatus and Ojus. Manas activate bodily functions through the’Chala’ guna of vata; Arthagrahana, Medha and Buddhi through ‘Tikshna’ guna of pitta and stability of bodily functions through`sthira’ guna of kapha. Chittodvega ==========================================21created by technoayurveda.wordpress.com of Dr.KSRPrasad
  22. 22. Following are the references about doshas and dhatus in relation to sthana and karmas of Manas: Dosha: Vayu : ‘Niyanta Praneta Cha Manasah’ 46(Vayu is said to be the controller and stimulator for Manas. Prana vata: `Buddhi Hridayendriya chitta dhrik.’47Prana Vayu is present in Hridaya, Buddhi, Indriya and Chitta where its influence can be felt. Udana 48 vata:`………Smriti Kriya’ – Udana vayu is responsible for Memory. vyana vata 49 :…… `Prayah Sarvah kriyah’ – All physical and mental activities are controlled by vyanavata. Pitta : Sadhaka pitta is present in Hridayam and has functions like Buddhi, Medha Abhimanadya, intellect, liking, etc.50 Kapha : Normal mental functions like concentration, tolerance, endurance is under the control of normal function of kapha.51Avalambaka and Tarpaka kapha are very much related with Manas. Dhatus: Rasa : Rasa dhatu gets vitiated due to excessive thinking of unnecessary things.52 Rakta : Rakta dhatu heps in normal mental functions. Rakta dhatu also helps in distinct knowledge, perception and action stimulation.53 Mamsa : In Mamsakshaya,Akshaglani i.e. affliction of sense organs is observed.54 Medas : Medo dhatu causes comfort, laziness, courage.55 Asthi : Causes attachment and enthusiasm Majja : Gives strength. On vitiation causes confusion and fainting.56 Sukra : Causes happiness, courage, liking, bliss, interest.57 Ojas: It is the essence of all dhatus through which mind and body are related. Ojas and manas are seated in Hridayam. And Ojas is depleted by mental emotions such as anger, grief.58 When Ojas is depleted, the person becomes fearful, worried and his faculties will not be functioning properly. He will lack enthusiasm.59On the contrary increase of Ojas is conducive to the proper functioning of Manas.60 Chittodvega ==========================================22created by technoayurveda.wordpress.com of Dr.KSRPrasad
  23. 23. Satta Buddhi Rajas Atma (Dhi, dhriti, smriti) Tamas MANAS Twak (sparshanendriya Vata, adhisthana pitta, Kapha Sapta dhatu, ojas Figure 2 Significance and Importance of Manas:-  Manas is said to be the cause for binding of life or for moksha.61  Life is dependent upon the combination of Manas, Atma and Shareera.62  Manas acts as the connecting tool between Atma and Shareera which is called as the `Anusandhana kriya.’  Manas is the substratum for the diseases. (Ca.Su. 1/55)  Gyana, Buddhi and Smriti are the outcome of mental activity.  Manas is conjugated with Atma and moves from one body to another and leads to Punarjanma which is called as `aupapadika guna’.  Manas is Trigunatmaka with three types of Psychological traits or temperament formation. Trigunas (Mahagunas) of Manas: There are three major Universal attributes (Mahagunas) of Manas namely Sattva, Rajas and Tamas. The three terms can be translated as Cognition, Action and Inertia. Trigunas are the essential part of the “Samkhya” conception of Personality. Trigunas are the three potentialities which express themselves only when disturbed. The variations in the Chittodvega ==========================================23created by technoayurveda.wordpress.com of Dr.KSRPrasad
  24. 24. interindividual as well as intra-individual psychic behaviour are due to the relative expression at a given moment, of the above-mentioned potentialities.63 In Bhagavad Gita human beings have been classified into three types of personalities namely Satvika, Rajasika and Tamasika.64 Charaka has described three types of Sattva(manas). They are : 1. Sattvika manas 2. Rajasika manas 3. Tamasika manas Manas environd with Sattvaguna possess qualities like – Anrusahamsyam (absense of all killing or hostile propensities), Samvibhagaruchita( a judicious regimen of diet), Titikshna(forbearance), Satyam(truthfulness), Dharma(piety), Astikyam(belief in God), Jnanam( spiritual knowledge), Buddhi, Medha(intellect), smriti(a good retentive memory), Dhriti (comprehension) and Anabhishangam(performance of good deeds irrespective of consequences).65 Rajoguna yukta Manas has the qualities of Dukhabahulyam(feeling much pain and misery), Atanasheelata(a roving spirit), Adhruthi(non-comprehension), Ahamkara(vanity), Anruthikatwam(untruthfulness), Akarunyam(non clemency), Dambham(pride), Maanam(an over winning confidence in one’s own excellence), kama(lust), krodah(anger) and Harsha(hilarity).66 Tamogunayukta Manas has qualities such as Vishadam(despondency), Nastikyam(disbelief in the existence of God), Adarmasheelata(imparity), Buddhinirodham and Ajnanam, Durmedhastwam(stupification and perversity of intellect), Akarmasheelata( lethargy in action) and Nidralutwam( sleepiness).67 Chittodvega ==========================================24created by technoayurveda.wordpress.com of Dr.KSRPrasad
  25. 25. By critical study of the above-described qualities we can conclude that among the three Gunas, Sattva is the equilibrium state of Manas and also a state devoid of pathogencity. The chief qualities of Rajas are two – ‘Kriyasilatva’ (activeness) and ‘Uttejana’ (instigation). Due to these qualities it induces in all kinds of desires and ambitions. Tamas possess two major qualities i.e. ‘Guru’ and ‘Sthira”. The Tama because of which one can get Asatyajnana, Alasya and Nidra cause Acetana, Nishkriya and Jadata. In the process of evolution of Mind with sensory and motor faculties, the expression of ‘Sattva’ and ‘Raja’ is dominant and that of `Tamas’ is latent. From the above conceptual study of Manas we can come to the conclusion that Manas is the controller of Indriyas and the activities of Manas are the direct outcome of cerebral functions. In dictionaries, the meaning of Manas has been given as Mind. The term Mind has been used to imply the brain, especially, the cerebral cortex and cerebral processes. The cerebral cortex is, for all intents and purposes, the seat of conscious, sub-conscious and unconscious activities, usually ascribed to the different stages of the functioning of the Manas. A synonym of Manas is Buddhi. Ayurveda speaks of five Indirya Buddhis, which correspond to the areas in the cerebral cortex. Subsequent events leading to Vigyana, such as sorting out of the sensory data, their interpretation, orientation, integration and ideation are dealt with the association and silent areas of the cortex. A school of Modern Psychology makes use of the term near Mind to designate the Brain. Chittodvega ==========================================25created by technoayurveda.wordpress.com of Dr.KSRPrasad
  26. 26. Functional Neuroanatomy of Brain Neurons and Neuroglia: 68 Neurons or nerve cells are specialized for electrical and chemical transmission of information. Each neuron consists of a cell body with several branching dendrites and a single axon. Axons terminate in the form of branching processes, each ending with a terminal button. A synapse (gap or cleft between neurons) is formed by a terminal button presynaptically and either a dendritic spine or an area of the neuron cell body membrane post synaptically. Telencephalon (cerebral hemispheres, cerebrum): The cerebral hemispheres are composed of an outer layer of grey matter (the cerebral cortex) and inner core of white matter (the centrum semiovale) and discrete masses of subcortical grey matter or nuclei which form the basal ganglia and the amygdala. The undulating surface is made up of convulsions/gyri, grooves/sulci and deeper infoldings or fissures. The telencephalon is separated into right and left hemispheres by the longitudinal fissue. Fibre bridges or commissures, the largest of which is the corpus callosum, afford communicatin between the hemispheres. Each hemisphere is composed of four lobes: Frontal lobe, Parietal lobe, Temporal lobe and Occipital lobe. The Cortex: - There are two phylogentically distinct types of cortex: Allocortex and Neocortex. Neocortex: Is differentiated into 6 layers and is further classified into (a) Primary cortex (b) Association cortex. (a) Primary cortex is concerned with either the execution of voluntary movement or the analysis of sensory information. 1. Primary motor cortex – Located as a coronal strip anterior to the central sulcus. Parts of body represented somatotopically to form the motor homunculus. Chittodvega ==========================================26created by technoayurveda.wordpress.com of Dr.KSRPrasad
  27. 27. 2. Primary sensory cortex – receives input from the peripheral sense organs. (i) Somatosensory Cortex – located in the postcentral gurus of the Parietal lobe subserves touch, Pain, temperature and proprioception. (ii) Visual cortex – located around the calcarine fissure of the occipital lobe. (iii) Auditory Cortex – lies deep within the sylvian fissure in the temporal lob. (iv) Olfactory cortex – subserving taste and smell, found in the uncus and Parahippocampal gyrus of the temporal lobe. (b) Association Cortex - Forms the major portion of the neocortex (75 percent) and is concerned with higher mental function. (i) Parietal lobe association cortex – Concerned with visuospatial and tactile perception. (ii)Temporal lobe association cortex – Concerned with visual perception and memory. (iii)Frontal association cortex – Concerned with executive function. Allocortex: The edge or rim of the cerebral cortex is composed of allocortex, which is poorly differentiated in that it does not have a distinct internal structure. The edge of the cerebal cortex is infolded to form a ring of allocortex on the medial face of the hemisphere i.e. the limbic lobe. The Limbic System:- The limbic system consists of areas of allocortex, discrete subcortical structures within the telencephalon and diencephalon and interconnecting fibre pathways. Neuroanatomical Circuits formed by limbic system subserve emotional behaviour and memory.The exact components of limbic system vary according to different opinions. However, central to the concept is the ‘Papez Circuit’ formed by: Cingulate Cortex, Hippocampal formation (In the telencephalon) ; Mamillary body of the hypothalamus, anterior nucleus of the thalamus ( In the diencephalon ) ; Fornix(connecting hippocampus to mamillary bodies) ; Mamillothalamic tract (connecting mamillary body to anterior nucleus of the thalamus) ; Gyrate fornicatus (connecting anterior nucleus to cingulate gyrus) ; Cingulate fasciculus (connecting cingulate gyrus to Parahippocampal gyrus) . Chittodvega ==========================================27created by technoayurveda.wordpress.com of Dr.KSRPrasad
  28. 28. Other structures often included in the definition of limbic system include: Septum, Olfactory bulbs, Uncus, Entorhinal cortex (In the telencephalon); Hypothalamus, Habenular nucleus (In the diencephalon); Striamedullaris (Connecting Pathways- between several limbic structures & Habenula) Basal ganglia (corpus striatum):- Three masses of grey matter (Caudate, Putamen and Globus pallidus), congregated centrally in the midline of the hemispheres, form the basal ganglia that are concerned with the initation and performance of voluntary movements. Diencephalon: This is a midline forebrain strucuture consisting of : (i) Thalamus (ii) Hypothalamus (iii) Epithalamus (iv) Subthalamus (v) Optic chiasma (i) Thalamus: A large ovoid structure, occupying the upper half of the diencephalon, and composed of many groups if nuclei. (a) The cortical relay nuclei are situated ventrolaterally and receive the terminals of either motor or sensory fibres. The signals they convey undergo complex transformations before being tramsmitted. (b) The association nuclei have reciprocal connections to areas of association cortex, limbic structures and the hypothalamus (c) The non specific nuclei appear to be involved in arousal and form an integral part of the reticular activating system. (ii) Hypothalamus: Below the thalamus is a collection of nuclei collectively known as the hypothalamus. There are three regions – The mamillary region, the Tuberal region and the Suprachiasmatic region.The hypothalamus has two types of anatomical Chittodvega ==========================================28created by technoayurveda.wordpress.com of Dr.KSRPrasad
  29. 29. connections with the pituitary through the hypothalamohypophyseal tract and the pituitary portal system. Hypothalamus is poised to control homeostatic mechanisms in response to received information concerning the internal milieu and emotional state. It can detect certain properties of circulating blood, such as temperature, osmotic pressure and hormonal levels. In turn it influences autonomic nuclei in the brain stem and sends reciprocal connections to the limbic system. The brain stem:- The midbrain, Pons and Medulla oblongate constitute the brain stem. Mid-brain: – The superior part, tectum, from part of visual and auditory pathways. Substantia nigra (in peduncles) is the important source of Dopamine – containing neurons. Have nuclei of two cranial neves – occulomotor (II) and trochlear (IV). Pons and Medulla: - the important structures here are grouped as (i) Motor pathways – Corticospinal tract & the corticobulbar tracts (ii) Sensory pathways – Fibers of dorsal column of the spinal cord synapse. Nuclei of cranial nerves V – VII are in the pons and VIII- XIII are in the medulla. The reticular formation:- Throughout the medulla, pons and midbrain is a central core of group of cell bodies and fibers forming a reticular network. Within this are centres controlling vegetative functions such as the sleep/wake cycle, arousal, respiration, blood pressure and heart rate. The Cerebellum:- Located above the pons and medulla, with four pairs of central nuclei (Fastigial, Globose, Emboliform and dentate) in white matter. The cerebellum is divided into two hemispheres with a central uniting vermis. Each hemisphere has three lobes- flucculonodular, anterior and posterior. The cerebellum is a motor structure concerned with the co-ordination of movement and maintenance of equilibrium. Chittodvega ==========================================29created by technoayurveda.wordpress.com of Dr.KSRPrasad
  30. 30. The autonomic Nevous system (ANS):- The ANS (autonomic nervous system) is a motor system controlling involuntary activity. Its principal neurotransmitters are noradrenaline and acetylcholine. An overview of Neurotramitters:- Name Location Effects Acetylcholine Found throughout the Central nervous Involved in muscle action, system, in the Autonomic nervous learning and memory. system, and at all the neuromuscular junctions Norepinephrine Found in neurous in the Autonomic Primarily involved in nervous system(ANS). control or alertness and wakefulness. Dopamine Produced by neurous in Substantia Involved in movement, nigra attention and learning. Serotonin Found in neurons in the brain and Plays a role in the spinal cord regulation of mood and in the control of eating, sleep and arousal. GABA Found through out the brain and spinal Major inhibitory neuro cord transmitter in the brain. In general, the parasympathetic division is concerned with day-to-day vegetative function such as increased gastric acid secretion, increased intestinal motility etc. Conversely, the sympathetic division is called into action in emergency situations when the body needs to be prepared for `flight, fight or negotiation.’ Chittodvega ==========================================30created by technoayurveda.wordpress.com of Dr.KSRPrasad
  31. 31. REFERENCES 1. Ca.Su. 1/42 2. Chakrapani commentary on Ca.Su.1/42 3. Ca.Sa.3/13 4. Shabdakalpadrumam 5. Amarakosha 1/4/3 6. Ca.Sa. 8/4 7. Ca.Sa.1/18 8. Ca.Sa.3/13 9. Vachaspatyam, Shabdakalpadruma 10. Sir Monier Williams Sanskrit-English Dictionary 11. Vachaspatyam 12. Amarakosa 1/4/31 13. Vacaspatyam 14. Shabdakalpadruma 15. Sir Monier Williams Sanskrit – English Dictionay 16. Shabdakalpadruma 17. Ca.Sa 3/18 18. Ca.Sa.1/19 19. Chakrapani Commentary on Ca.Su.8/5 20. Ca.Su. 30/4 & Su.Sa.4/27 21. Su.Sa. 3/18 22. As.Hr.Sa.4/13 23. Tai. Up. 1/61 24. Cakrapani on Ca.In5/41 25. Ca.Sa 17/12 26. Bhe.Sam.Ci8/2 27. Ca.Vi.5/6 28. Ca.Su.11/28 29. Ca.Sa.1/76,77 Chittodvega ==========================================31created by technoayurveda.wordpress.com of Dr.KSRPrasad
  32. 32. 30. Ca.Vi.5/7 31. Cakrapani Commentary on Ca.In.5/41 32. Esentials of Basic Ayurvedic concepts – 8th chapter, 197-198p 33. Ma.Bha.Shanti Parva 187/12 34. Ca.Su.1/47 35. Nyaya darshana 36. Bhe.Sam.Ci.3/2 & 8/4 37. Ca.Su.8/13 38. Su.Sa.1/26 39. Su.Sa.1/20 40. Psychopathology in Indian Medicine – 2nd chapter – 105p 41. Ca.Sa.1/20 42. Cakrapani Commentary on Ca.Sa.1/20 43. Cakrapani Commentary on Ca.Su.1/49 44. Ca.Sa.1/20 45. Ca.Su.12/8 46. Ah.Su.12/4 47. Ah.Su.12/5 48. Ah.Su.12/6 49. Ah.Su.12/3 50. Ah.Su.11/3 51. Ca.Vi.5/19 52. Ca.Su.24/24 53. Ah.Su.11/18 54. Su.Su.15/5 55. Ca.Su.27/7 56. As.Sa.Su.11/4 57. Su.Su.15/23 58. Ah.Su.11/39 59. Ah.Su.11/41 Chittodvega ==========================================32created by technoayurveda.wordpress.com of Dr.KSRPrasad
  33. 33. 60. Patanjali yoga sutras 61. Ca.Su. 11/46 62. Ca.Su.8/5, Su.Sa.4/57 63. Gita 14/5,6,7,8 64. Su.Sa. 1/32 65. Su.Sa. 1/33 66. Su.Sa. 1/34 67.Postgraduate Psychiatry – Clinical and Scientific Foundations – 83-118p 68.Psychology-48 Chittodvega ==========================================33created by technoayurveda.wordpress.com of Dr.KSRPrasad
  34. 34. CHITTODVEGA Etymology And Definition: The term chittodvega comprises of two words i.e. chitta and udvega. Chitta: It is derived from root `chit’ which has the following meanings: to perceive, fix the mind upon, attend to, be attentive, to observe, take notice of, to aim at, intend, to be anxious about, care for, to resolve, to understand, comprehend, know, make attentive, remind of. (Sanskrit – English dictionary of Sir Monier Williams) Addition of “Kta” pratyaya to chit i.e. chit + kta leads to chitta, which has the following meanings according to the two Sanskrit – English dictionaries. (a) According to dictionary of P.K. Gode & C.G. karve:  Observed, perceived  Considered, reflected or mediated upon  Resolved  Intended, wished, desired  Visible, perceptible (b) According to dictionary of Sir Monier Williams:  Thinking, reflecting, imagining, thought  Intention, aim, wish  Heart, mind  Memory, intelligence, reason Chittodvega ==========================================34created by technoayurveda.wordpress.com of Dr.KSRPrasad
  35. 35. Udvega: It is derived from root “ud” which has following meanings:  Superiority in place, rank or power, up, upwards, upon, on, over, above  Seperation, disjunction, cut off  Motion upwards  Publicity  Wonder, Anxiety  Liberation  Blowing, expanding, opening  Acquisition, gain (Sanskrit – English Dictionary of P.K. Gode & C.G. Karve) Addition of “Vin” pratyaya to “ud” i.e. ud + vin leads to udvega, which has the following meanings.  Going swiftly, an express messenger, a runner, courier  Steady, composed, tranquil  Mounting, going up or upwards  Trembling, waving, shaking  Agitation, Anxiety  Regret, fear, distress  Admiration, astonishment (Sanskrit English Dictionary of Sir Monier Williams) Chittodvega: With the above interpretations chittodvega can be defined as – Chitta (Mind) + udvega (Anxiety) = chittodvega (Anxious state of mind). From this we can conclude that cittodvega in a perfect word for highlight the condition, anxiety neurosis. Chittodvega ==========================================35created by technoayurveda.wordpress.com of Dr.KSRPrasad
  36. 36. Acharya Charaka has quoted (Ca.Ni.8/27) that a single clinical feature can be considered - as a common symptom in many diseases, or as a single disease entity. The anxious state of mind or chittodvega may be considered as a separate disorder or symptom of other medical and psychological disorders. It has been described as the causative factor for apasmara, as poorvarupa of unmada, or many times it has been described as a minor psychological illness. Words related to chitta found is Ayurvedic classics are: TERMS REFERENCES ChittaVibhramsa Su.Ut.39/778,As.S.Ni.5/43, Chittavibhrama As. Ni. 6/15 Chittanasha Su.Ni. 61/3 Chittakshobha As.Hr.Ci. 7/78, As.S.Ni.8/9 Chittaviparyaya Su.Ut. 57/3 Chittavilobhana As.Hr.Ci 7/79 Chittopaplava As.Hr.Ni. 6/2 As.Ni 6/3 Asvastha Chitta Ca. Ci. 9/20, As.Hr.Ut.4/30 Anavasthita chitta Ca. Su 20/11 Tapta chitta Ca. Ni 1/38, As .Ni. 5/31 Unmatta chitta Su. Ut. 61/6, As.Ut. 10/2 Bhranta chitta Su. Ut. 61/6, As.Ut. 10/2 Chittodvega Ca. Ni. 6/5 References about udvega in Ayurvedic classics: TERMS REFERENCES Garbha lakshana Su.Sa. 3/15 Katu Rasatiyoga Su .Su. 42/9 Stambhana Atiyoga Ca.Su. 22/40 Bhutabhishanga jwara Su. Su. 39/80, Ma. Ni. 2/30 Rasagata jwara Ca .Ci. 3/76 Chittodvega ==========================================36created by technoayurveda.wordpress.com of Dr.KSRPrasad
  37. 37. Andhaputana graha As.Hr.Ut. 3/25 Bala graha Su.Sa. 10/51, Ma.Ni. 68/7 Mukhamandika graha Su. Ut. 27/15 Pishaca graha Su.Ut. 60/15 Putana graha Ma. Ni. 68/25 Skanda graha Su.Ut. 27/8, As.Hr.Ut. 3/8 Apasmasa Nidana Ca. Ni.8/5 Unmada purvarupa Ca. Ni. 7/6, Su. Ut. 6/62 Unmada arista lakshanas Ca. In. 5/18 Among all these terms, only chittakshobha, asvastha chitta, anavasthita chitta and chittodvega are indirectly indicating towards the meaning of anxious state of mind. However, chittodvega is more applicable term to illustrate the anxious status of mind. So in this study the term “Chittodvega” has been compared with “Anxiety Neurosis” Chittodvega ==========================================37created by technoayurveda.wordpress.com of Dr.KSRPrasad
  38. 38. NIDANA Multifactorial origin of psychiatric illness has been stated in modern psychology. In Ayurvedic classics also many factors are stated to be the cause of manasaroga in various contexts, which can be correlated to the Nidana aspect of chittodvega. 1. Rajas and Tamas are stated as the manasika doshas, on whose vitiation manasa roga like kama, krodha, chittodvega occur.1 2. All kinds of manasika vikaras occur due to dissociation of mind from what is desired and its association with what is undesired. 2 3. Sushruta stated that manasikavikaras, like krodha, soka, bhaya, harsha, vishada, abhasuya, dainya, matsarya, kama, loba arise due to either iccha (desire) or dvesa (aversion). 3 4. Vagbhata in his opening verse stated reference of Ragadi rogas (i.e. the emotional factors in disturbed state) as giving rise to diseases like moha, arati, autsukya.4 5. The principal cause of all saririka & manasika rogas has been stated to be (a) Prajnaparadha (volitional transgression) (b) Asatmentdriyarthasamyoga (deficient, excersive or perverted use of senses) and (c) Parinama (the deficient, excessive or perverted incidence of seasons.5 6. Prajnaparadha has been stated as the cause of manovikaras like irshya, soka, bhaya, krodha, mana, dwesha etc. 6 Prajnaparadha: In the content of manas rogas prajnaparadha has been stated as he root cause of all diseases.7 Buddhi is called `sad-asad vivekin’. The discrimination and judgement capacity of human being is related to wisdom, intelligence or understanding which is known as Prajna.8 The karma done due to dhibhramsa, dhritibhramsa and smriti bhramsa is termed as Prajnaparadha.9  Features of dhi bhramsa (derangement of understanding) - the eternal and the non- eternal, good and evil are mistaken one for the other.10 Chittodvega ==========================================38created by technoayurveda.wordpress.com of Dr.KSRPrasad
  39. 39.  Features of dhriti bhramsa (derangement of the will) - the mind is always reaching out for its objects, is incapable of being restrained from undesirable objects.11  Features of smriti bhramsa (derangement of memory) – the retention of true knowledge is destroyed on account of mind being clouded by rajas and tamas.12 These derangements will be responsible for atiyoga, ayoga and mithyoyoga of actions (karmas) in relation to kaya, vak and manas.13 Excessive action is the over use of speech, mind or body and their lack of action is disuse.14  Misuse (Mithyayoga) with reference to kaya (body) consists of forced suppression or forced exitation of natural urges, awkward stumbling falling or posturing of limbs, injuring the body, etc and other kinds of self mortification.  Misuse with reference to speech (vak) refers to an indulgence in language that is insulting, untrue, untimely, quarrelsome, unpleasant, harsh etc.  Misuse with reference to mind (manas) consists of giving way to fear, grief, anger, greed, infatuation, self conceit, envy, etc.15 Prajnaparadha has also been cited as the cause of adharma or purvajanmakrta papa karma, which is the ultimate cause of Janapadhodvamsa.16 Charaka, has used the term buddhi and its ayoga, atiyoga, and mithyayoga in the sense of Prajnaparadha.17 When Buddhi is defective it leads to the indulgence of man in the unwholesome qualification of the five senses.18 So Prajnaparadha is responsible for Asatmendriyarthasamyoga. Asatmendriyarthasamyoga: Indriyarthasamyoga are the cognitive processes through which a man becomes aware of both external and internal environment.19 Charaka has described the ayoga, atiyoga and mithyayoga of each indriyartha separately.20 As long as the external stimuli originating from five sense objects are within normal limits the body response is also within physiological limits that is satmya for body. But if the stimuli cross the normal range they become stressful and as soon as stressful stimuli reach the manas the imbalance in the dosas begin which may set in the disease.21 Chittodvega ==========================================39created by technoayurveda.wordpress.com of Dr.KSRPrasad
  40. 40. Advent of maturity of results of kala and karma is also considered as the cause of Manasarogas. Results of all misdeeds done in the past will mature in time and will afflict the persons with particular disorder.22 7. The intrinsic causes of manasaroga are mainly sariradosha and manasadosha. The saririka dosas (vata, pitta and kapha) have been indicated in causation of particular behavioural traits in individuals23 and the vitiation of these dosas cause the physical symptoms of the chittodvega. Therefore one the etiological factors for causation of chittodvega can be considered as the tridoshas. Rajas and Tamas (the two manasika dosas) have been the vitiation factors of manas.24And the rajasika and tamasika sattva subtypes explained by Charaka and Sushruta are suggestive of those prakriti persons to be easily afflicted with manasika vikaras.25 8. Sattva pariksha (mental temperament / psychiatric assessment) stated by Charaka has considered three types of manobala26 and on observing the statements of Charaka and Sushruta it can be understood that avara sattva persons are prone to manasa roga.27 9. Manasarogas mainly occur due to discharge of the controllable vegas (Dharaniya vegas) and controlling the Adharaniya vegas.28 The Adharaniya vegas like kama, krodha, lobha, harsha, bhaya, moha, udvega have been stated as the etiological factors of psychiatric illness like chittodvega and unmada.29 The presence of chronic physical illness may also cause manasa roga. And even one manasaroga may cause another manasa roga in its bhedavastha or chronicity.30 This concept has been stated by Cakrapani in his commentary stating etiology of diseases as` Sareeram manasena’ and ‘Manasam manasena’. 10. Dehabala is also a contributory factor in the manasa vikaras, as ksheenadeha bala persons are prone to psychological illness.31 11. Intake of viruddha, dushta and asuchi ahara is also the causative factor of chittodvega32 as mind is affected by the quality of diet taken by the persons. 12. Disobeying of God, Teachers and Elders also causes manasika vikaras.33 Chittodvega ==========================================40created by technoayurveda.wordpress.com of Dr.KSRPrasad
  41. 41. 13. Manoabhighata occurring due to bereavements like loss of wealth, loss of employment, death of partner etc results in the distortion of Manas34 resulting in chittodvega. 14. Vishamachesta i.e. abnormal motor activites like abnormal posture, excessive exercise and violation of sadvritta can also be considered as the etiological factors of chittodvega.35 The above stated factors can be considered in the nidana aspect of Chittodvega. In them one or more factors may combine and produce the disease. The etiological factors show their influence according to the individuals` personality and the circumstances. All the factors have to be taken into consideration while dealing with the disease Chittodvega. REFERENCES 1. Ca.Su.1/57 & Ca.Vi. 6/5 2. Ca .Su. 11/45 3. Su .Su .1/33 4. As. Hr.Su.1/1 5. Ca. Su.11/37 & Ca .Vi.6/6 6. Ca .Su.7/52 7. Ca .Sa.1/101 8. Psychopathology In Indian Medicine 395p 9. Ca.Sa.1/102 10. Ca.Sa.1/99 11. Ca .Sa.1/100 12. Ca. Sa .1/101 13. Ca .Su.11/38 14. Ca .Su.11/39 15. ca .su. 11/40 16. Ca .Su.3/24 17. Ca .Su.1/54 18. Ca. Ni.7/34 19. Psychopathology In Indian Medicine 393p 20. Ca. Sa.1/127 21. Science & philosophy of Indian Medicine 149,150p 22. Ca. Sa .1/113 Chittodvega ==========================================41created by technoayurveda.wordpress.com of Dr.KSRPrasad
  42. 42. 23. Ca.Vi. 8/98,99,100 24. Ca.Sa.4/35 25. Ca.Sa. 4/37,38,39,40 & Su.Sa.4/81-98 26. Ca .Vi.8/119 27. Ma.Ni.20/5 28. As. Su.5/25 29. Ca.Ni.7/3 30. Ca .Ni.7/3, As.Hr.Ut.6/3 31. Ma. Ni.20/4, As.Hr.Ut.6/3 32. Ma.Ni.20/4;As.Hr.Ut.6/3 33. Ma.Ni.20/4, Ca.Ni 7/3 34. Ma.Ni. 20/4, As.Hr.Ut 6/3, Ca.Ni.7/3 35. Ca.Su.8/18. Chittodvega ==========================================42created by technoayurveda.wordpress.com of Dr.KSRPrasad
  43. 43. SAMPRAPTI Chittodvega has been stated as one of the purvarupa of unmada by Charaka & Sushruta (Ca.Ni.7/6 & Su.Ut.62/6-7). On studying the disease entity unmada, from the classics, it can be understood that the disease indicates and includes all the manasikavyadhis. As description of Chittodvega is not available in classics samprapti of unmada is considered as the samprapti of manovikara-chittodvega. The samprapti of chittodvega can be stated as: – In the Alpa sattva individuals due to etiological factors like kama, krodha, viruddhaharavavihara, etc the doshas (both sareerika and manasika) get vitiated. The vitiated dosas goes to hridayam (the seat of buddhi) and vitiate it and spread through manovahasrotas throughout manas and sareera causing the Purvarupa and Rupa of the disease.1 1. DOSHA: (a) Manasika: Acharya Charaka stated that Rajas and Tamas are the two Manodoshas which cause manovikaras like Chittodvega.2 Rajasika prakriti play an important role in predisposing the person to chittodvega. Pajnaparadha stated as nidana of chittodvega mainly vitiates manodoshas rajas and tamas.3 Manobhighata, disobedience towards God, Teachers and Elders, discharge of dharaniya vegas are some of the causative factors for vitiation of rajas and tamas. The deranged manodoshas play major role in causation of chittodvega. (b) Sharirika: All the disorders or vikaras pertaining to the body occur only due to the tridoshas (vata, pitta and kapha).4The disease may be nija or agantuja in its origin but the involvement of the tridoshas in initial or the later stages is inevitable.5 The three causative factors (i.e. prajnaparadha, asatmendriyartha samyoga and parinama) vitiate the tridoshas and cause the symptoms of chittodvega. Chittodvega ===========================================43created by technoayurveda.wordpress.com of Dr.KSRPrasad
  44. 44. (i) Vata: The normal functions of vata are stated as `Niyanta praneta cha manasah, tantrayantradhara, pravartakachestanam, sarvendriyanam udyojakah’.6 Manas is under the control of vata so when vata is vitiated it leads to derangement in the functions of manas causing manovikaras. In the sub-types mainly three types of vata are concerned with the Manokarmas. They are prana, udana and vyana vayu. The etiological factors stated for chittodvega like vishama cesta, vishamasana, vegavarodha,7emotional factors like kama, bhaya, soka8 aggrevates vata which is mainly rajasika in nature. Hence vata can be considered as the main dosha involved in the pathogenesis of chittodvega. (ii) Pitta: Dalhana in his commentary has stated that sadhaka pitta dispels the kapha and tamas of the hridaya and thus enables the manas to perceive things clearly.9 Pitta is vitiated by emotional factors like krodha10and viruddhara sevana, soka, bhaya.11And this vitiation leads to buddhi & medhanasha causing chittodvega. 12 (iii) Kapha:. Vata prakopa and dhatu kshaya leads to vitiation of kapha which causes malnourishment of indriyas and bala kshaya (the vyadhikshamatvam of body is decreased by kaphakshaya).13 This in turn causes the manovikara like chittodvega. So many of the causative factors of chittodvega directly vitiate the tridoshas that in turn vitiate the dhatus and manifest the symptoms of chittodvega. 2. DUSHYA: As the disease is a manasavikara, 14 manas will be the main dushya. Dukha (also synonym of vyadhi) is stated as dhatu vaishamyam, 15 (dukham is the aspect related to manas). So, dhatus are also vitiated in causation of chittodvega. The etiological factors like krodha, viruddhasana,16madya, dharana of adharaniyavegas like chardi causes rakta dhatudushti.17Atichintana causes rasadhatu dushti.18Sukradhatu is vitiated by viruddhahara, dhatu vaishamya and dosha prakopa.19 It has been stated that basing on the vriddhi or kshaya of purvadhatu the paradhatu either gets vriddhi or kshya. So vitiation of one dhatu leads to vitiation of another and finally all the dhatus get involved in the pathogenesis of chittodvega. Chittodvega ===========================================44created by technoayurveda.wordpress.com of Dr.KSRPrasad
  45. 45. Dosha vaishamyam leads to dhatuvaishamyam due to the ashraya – ashrayee bhava.20 As the etiological factors vitate tridoshas they in turn cause vaishamyam of the dhatus manifesting various symptoms of chittodvega. Ojus is also a main dushya in causation of chittodvega. Ojus, which is the sarvadhatu saram21 is located in hridayam.22 Ojas is the main factor behind the vyadhikshamatva shakti of the shareera.23So any factor causing its depletion (kshaya) makes the body susceptible to diseases. The etiological factors of ojokshaya are stated as kopa, soka, dhyana, srama, dhatukshaya.24 Presence of psychological symptoms and somatic symptoms in ojokshaya25 supports the importance of ojokshaya in samprapti of chittodvega. 3. SROTAS: Manovahasrotas had been described in many classics as the srotas involved in samprapti of manasa rogas.26 Sarvashareeragata srotas are also vitiated and involved in the disease chittodvega because the etiological factors of chittodvega are also indicated as vitiating factors of many srotases. Vitiated dhatus vitiate the srotas carrying them. When the srotas are involved the vyadhi manifests its symptoms.27 Atichintana, viruddharasevana, vegavidharana, vataprakopakara ahara vihara sevana, dhatu kshaya, krisatvam, kopa, dukha, bhaya have been stated as vitiating factors of asthivahasrotas, majjavaha, rasavaha, raktavaha, sukravaha, malavaha, mutravaha and swedavaha srotas.28 4. AGNI: One of the synonyms of vyadhi is `Amaya’29and Ama is stated as the cause of all vyadhis30 due to vitiation of doshas, dushyas31 and also the srotases.32 Dhatu parinama and poshana depends on agni.33 Agni in vitiated by asuchi, viruddha annapanasevana,34 kama, krodha, lobha, moha, soka, mana, udvega leading to formation of Ama.35 Even matrahaara will not be properly digested when the person is disturbed with emotional factors like cinta, soka, bhaya, krodha, dukha.36 Vegavidharana37 and Vyadhikarsana38 also are considered as the causative factors of agnivikruti. Chittodvega ===========================================45created by technoayurveda.wordpress.com of Dr.KSRPrasad
  46. 46. So the etiological factors of chittodvega vitiate Agni and produce Ama which will further lead to dosha-dhatu vaishamyata and the vicious circle continues causing the somatic symptoms of chittodvega. 5. UDBHAVASTHANA: Hridayam has been stated as the udbhavasthana of chittodvega.39 As Chittodvega is a manasika vikara caused by derangement of manodoshas rajas and tamas, manas gets effected and the manifestation of the disease occurs. In the context of chittodvega hridayam indicates manas. 6. VYAKTASTHANA: First the chitta is vitiated causing vitiation of buddhi. It affects the psychological aspects of individual causing manovibhramsa, buddhivibhrama, sanjna, gyana vibhramsa.40 This leads to indulgence of individual to faulty activites (i.e sheela, chesta, achara vibhramsa) pertainignt to social aspects. The vitiation of saririka doshas, dhatus, srotas and agni leads to the manifestation of the psychological and somatic symptoms of chittodvega. So the vyaktasthana of chittodvega can be understood as manas and sarvasareera. 7. ROGAMARGA: As chittodvega is originating in hridaya it can be considered as the madhyamarogamarga janya vyadha.41 8. SADHYASADHYATHA: The samprapti of chittodvega is complicated due to the involvement of saririka-manasika doshas, sarva dhatu-mala-srotas, and presence of agnivikruti. So it is difficuit to cure the disorder. The disease is considered as kricchrasadhya as -it is marmasrita (Siras), curable by any karma, with involvement of only one marga,42 and is in purvarupa state of a major disorder. 9. UPADRAVA: Chittodvega has been stated as manovikara (i.e. minor psychiatric illness). Udvega has been stated as purvarupa of unmada,43 nidana of apasmara44 bhutabhishanga Jwara45 and rasagatajwara.46 So the major psychiatric illness like unmada,apasmara and somatic illness like Jwara can be considered as the upadrava of chittodvega. Chittodvega ===========================================46created by technoayurveda.wordpress.com of Dr.KSRPrasad
  47. 47. Samprapti of chittodvega Asamndriyaarthasamyoga pragnyaparadha parinama Nidana sevana Manasa dosha prakopa sarira dosha prakopa Raja Tama Vata Pitta Kapha Prakopa prakopa prakopa prakopa prakopa prana sadhaka tarpaka Udana Vyana Hridaya dushti Agnivikruit rasadidhatudushi Manodushti Manovaha srotodushti rasadisarvasrotodushti Manasalakshana uthpathi sariralakshana uthpathi Chittodvega Figure:4 Chittodvega ===========================================47created by technoayurveda.wordpress.com of Dr.KSRPrasad
  48. 48. From the above description the samprapti ghatakas of chittodvega can be stated as: Dosha : Manasika: Rajas, Tamas Saririka : vata : Prana, Udana, Vyana Pitta : Sadhakapitta Kapha : Avalambaka, Tarpaka Dushya : Manas, Saptadhatus, Ojas, Srotas : Manovahasrotas and Sarvasareera gata srotas Agni: Manda and Vishama Udbhava Sthana : Hridaya Vyakta Sthana: Manas, Sarvasarira SAMPRAPTI-KRIYAKALA Samprapti is described as the series of events taking place right form the beginning of the accumulation of doshas, due to indulgence in nidana, upto the complete course of the disease.The way in which the doshas are vitiated, the manner in which they spread and produce the disease by involving the dushya and ultimately manifesting the various features of the disease are described under the heading of samprapti. There is no direct description of samprapti of chittodvega in Ayurvedic texts, although it is included under Manovikara. Samprapti of chittodvega may be traced out by considering the general principles and multifactorial nidana described earlier. The positive family history,vataja prakriti,rajasika prakriti and avara sattva play an important role in predisposing the person to chittodvega.An emotion like udvega is a common response in part of life but persons having sattvasara can resist the ill-effects of such emotional disturbance as they are seen unmoved even by severe affection. On the other hand when the person having alpasattva indulges in prajnaparadha or asatmendriarthasamyoga or is under stress, it initiates the disease process by resulting in imbalance of manodoshas-rajas and tamas. At this stage the person exhibits an Chittodvega ===========================================48created by technoayurveda.wordpress.com of Dr.KSRPrasad
  49. 49. exaggerated response to emotional disturbance. This is the sanchayavastha of chittodvega. If chayavastha is not encountered with treatment and nidana is continued the disease lands in the next stage i.e.prakopavastha. When the imbalance of the manodoshas continues for some more time it leads to the prakopavastha of chittodvega. At this stage psychic symptoms like chinta, bhaya and soka develop. When these psychic response continue for a longer period and override the limit they start influencing the bodily doshas.At the biological level ,especially vata gets vitiated(as vata is controller of mind and is having direct relationship with rajas). At this stage bodily symptoms, predominantly of vata dosha prakopa are seen. Tarpakakapha declines resulting in undernourishment of indriyas. Derangement of sadhaka pitta also occurs due to sattvaharasa resulting in the symptoms such as bhaya, moha, krodha, etc. This stage, where both saririka and manasika doshas are involved, can be considered as prasaravastha. The vitiated manodosha and saririka doshas move to hridaya and vitiate it. Due to ashraya-ashrayi bhava manas also gets vitiated. when this vitiation persists for longer duration it results in ojoksaya. Vitiated vaatadi doshas vitiate jatharagni and later the rasadi dhatus. Hridaya, manovahasrotas, vulnerable dhatus and their srotases are vitiated resulting in the psychosomatic presentation of the disease, which is the staanasamshrayavastha of chittodvega. In chittodvega, when multiple srotas are involved with affliction of all dhatus, the full blown phase i.e.vyaktavastha occurs. When the disease is not treated properly or promptly and the nidana continues it becomes chronic and disabling. The manodosha and saririka doshas potentiate each other in a vitiated state resulting in a vicious cycle. The disease attains chronicity, becomes Chittodvega ===========================================49created by technoayurveda.wordpress.com of Dr.KSRPrasad
  50. 50. krichrasadhya leading to major psychiatric illness like unmada. This is the bhedavastha of chittodvega. REFERENCES 1. Ma.Ni.20/5 &Ca.Ci.9/5 2. Ca .Vi.6/5 3. Ca.Sa.1/101 4. Ca.Su.19/5 5. Ca.Su.20/7 6. Ca.Su.12/8 7. Su.Su.21/27 8. Ca.Ci.3/114 9. Dalhana commentary on Su.Su.21/10 10. Ca.Ci.3/114 11. Su.Su.15/7 12. As. Hr.Su 11/26-28 13. Su.Su.15/4 14. Ca.Vi. 6/5 15. Ca.Su.9/4 16. Su.Su. 21/24 17. Ca .Su. 25/6 18. Ca .Vi. 5/13 19. Ca .Ci. 30/135-138 20. As. Hr. Su 11/26-28 21. As. Hr.Su .11/37 22. Su.Su.15/21 23. Su.Su.15/19 24. Su.Su.15/24 25. Ca.Su.17/73 26. Ma Ni 20/5 27. Su.Su.24/10 Chittodvega ===========================================50created by technoayurveda.wordpress.com of Dr.KSRPrasad
  51. 51. 28. Ca .Vi .5/19 29. Bha .pra. Mad 1/59 30. Arunadatta commentary on As.Hr. Su.13/27 31 As. Hr. Su 13/27 32. Ma Ni 25/3 33. Ca.Ci.15/3-5 34. Ca. Vi 2/8 & Ca Ci 15/42, As.Hr.Su 8/31 35. Ca .Vi 2/8 36. Ca.Vi 2/9 37. Su .Su. 46/5 38. Ca .Ci .15/43, 44 39. Ma Ni .20/5;Ca.Ni.7/3 40. Ca Ni 7/4 41. Ca Su 11/49 42. Ca .Su .10/16 43. Ca Ni. 7/6 44. Ca .Ni. 8/4 45. Ma. Ni. 2/30 46. Ca .Ci .3/76 Chittodvega ===========================================51created by technoayurveda.wordpress.com of Dr.KSRPrasad
  52. 52. RUPA Poorvarupa: The poorvarupa or prodromal stage comprises of appearance of some of the symptoms, in a sense it is the alpavyakta stage of chittodvega. Rupa: The clinical features presenting in chittodvega are not mentioned as a separate disease entity in the texts, but basing on the etiopathogenesis, the symptomatology may be traced out in different contexts covering the symptoms of vataprakopa, pittaprakopa, kaphakshaya, ojokshaya, dhatudushti, agnivikriti and unmada purvarupa. Symptoms: Psychological: Reference 1. Udvega (Anxiety) Ca. Ni. 7/5 2. Abheekshnam dhyanam (Worrying thoughts) As .Hr. Su 11/39 3. Sammoha (Bewilderment / Confusion) Ca. Ni. 7/5 4. Bibheti (Fear complex) As.Hr. Su. 11/39 5. Durmana (Cheerlessness) As.Hr.Su.11/391 6. Ghattate (Restlessnes) Ca.Su.17/64 7. Sabda asahishnuta (Intolerance to loud sounds) As.Hr.Su.11/17 8. Svapne ca abhikshnam darshanma (Night terror) Ca. Ni. 7/5 9. Vyathitendriya (Affliction of Indriyas with pain) As .Hr. Su. 11/39 10. Deenatha (Timidity / Pervishness) As. Hr. su. 11/56 Somatic: Reference 11. Bhrama (Dizziness) As. Hr. Su. 11/58 12. Kampa (Tremors) As .Hr.Su .11/5,6 13. Toda/ Satatam lomaharsha(Prickling pain) Ca.Ni.7/5;Su.Su. 15/17 Chittodvega ===========================================52created by technoayurveda.wordpress.com of Dr.KSRPrasad
  53. 53. 14. Arocaka (Anorexia) Ca. Ni. 7/5 15. Avipaka (Indigestion) Ca. Ni. 7/5 16. Sakrit graha (Constipation) As. Hr. Ci. 11/5 17. Trisha (Excessive thirst) As.Hr.Su.11/6 18. Glani (Exhaustion – even without work) As.Hr.SU11/17;Ca.Su.17/66 19. Sandhivedana (Pain in the joints) As. Hr. Su.11/18 20. Bala bhramsa (Loss of strength) As .Hr. Su. 11/51 21. Nidra bhramsa (Loss of Sleep) As Hr. Su 11/51 22. Muhasosha (Dryness of mouth) Ca. Su. 17/69 23. Anaha (Excessive flatulence) As. Hr. Su 11/51 24. Kleebata (Loss of libido) Ca .Su .17/69 25. Udarditatvam (pain in upper half of body) Ca. Ni. 7/5 26. Hrit drava (Palpitations) As.Hr.Su 11/16 27. Ucchvasasadhikya (Over breathing) Ca .Ni. 7/5 28. Hrit graha (Constriction in chest) Ca .Ni. 7/5 29. Syanah Karnayo (Tinnitus) Ca. Ni. 7/5 30. Timira darshanam (Fainting) As. Hr. Su. 11/19 The above 30 symptoms were considered for as the symptoms in chittodvega. The symptoms correlating with the symptoms of anxiety states stated by Hamilton are taken into the account of the study. Chittodvega ===========================================53created by technoayurveda.wordpress.com of Dr.KSRPrasad
  54. 54. CLINICAL CORRELATION OF CHITTODVEGA It is very difficult to compare neurotic disorders with any disease described in Ayurveda, because of the different methods of clinical approach of Indian and Western system of medicine. In Ayurveda, all diseases and their treatments are based on the principle of tridosha, while Modern system of medicine has different etiopathological approach. As a matter of fact, no allopathic disease in its complete form can be precisely compared with any Ayurvedic description. But some practical correlations are possible. The clinical correlations of an Ayurvedic entity with the modern disease can be done on the basis of three main parameters i.e.1.Similarity of symptomatology 2.Similarity of etiopathogenesis 3.Similarity of total clinical presentation of the disease. Basing on the above view the symptoms of anxiety neurosis are correlated with a group of entities and an effort has been done to find out a precisely parallel disease in Ayurveda.They are: (i) Ojo Kshaya: The psychological and somatic symptoms stated in ojokshaya lakshanas by Charaka and Vagbhata (Ca.Su.17/33, As.Hr.Su.11/39-40) correlate with symptoms of anxiety. Psychological Symptoms:  Bibheti – fear complex  Dhyayati – worry  Durmana – restlessness, cheerlessness Somatic Symptoms:  Durbala – weakness  Vyadhitendriya – affliction of Indriyas with pain  Duscchaya – loss of complexion  Ruksha – roughness of body  Kshama – emaciated state. Chittodvega ===========================================54created by technoayurveda.wordpress.com of Dr.KSRPrasad
  55. 55. Ojokshaya is noticed in a variety of disorders like Madhumeha (Ca.Ni.4/37), Panduroga (Ca.Ci.6/5), Raktarsas (Ma.Ni.5/27) etc. So, it is not a single disease but only a condition occurring in samprapti of many diseases. (ii) Anavasthitachittatva: Has been mentioned by Caraka and Sharangadhara (Ca.Su. 20/11) in vataja nanatmaja vikaras. Anavastha indicates unsteady, unsettled, changed or dissoluted condition. And chitta indicates the mind. But for its meaning no other description has been given in classics. (iii) Purvarupa of unmada: In Charaka samhita (Ca.Ni. 7/6), the purvarupa (prodromal features) of unmada were described , which can be correlated with few of anxiety neurosis symptoms. Psychological Symptoms:  Asthana udvega – anxiety out of context  Asthana dhyana – attention towards unimportant objects  Unmattachittatvam – crazy mind  Asthana ayasa – fatigue  Sammoha – confusion. Somatic Symptoms:  Karnasvana – tinnitus  Uchvasasadhikya – hurried breathing  Arocaka – tastelessness  Avipaka – indigestion  Hritgraha – constriction in cardiac region  Satatamlomaharsha – prickling sensation  Udarditatvam – pain in upper part of body. (iv) Manasikadosa Vikara: Charakacharya (Ca.Ni. 6/5) stated Chittodvega as a manovikara occurring due to the vitiation of rajas and tamas. No other description is available in classics about Chittodvega. Chittodvega ===========================================55created by technoayurveda.wordpress.com of Dr.KSRPrasad
  56. 56. CLASSIFICATION OF PSYCHIATRIC DISORDERS Multi Axial System The DSM-IV organizes each psychiatric diagnosis into give levels (axes) relating to different aspects of disorder or disability. Axis I Clinical disorders, including major mental disorders, as well as development and learning disorders (all dental disorder except personality disorder and M.R) Axis II Underlying pervasive or personality conditions, as well as mental retardation. Axis III Acute Medical conditions and Physical disorders (Must be connected to a Mental. Axis IV Psychosocial and environmental factors contributing to the disorder. Axis V Global averment of Functioning. Common Axis I Disorders include depression, anxiety disorders, bipolar disorder, ADHD and Schizophrenia. Common Axis II Disorders include borderline personality disorder, schizotypal Personality disorder, antisocial personality disorder, narcissistic personality disorder, and mild mental retardation. DSM Group  Disorders usually first diagnosed in infancy, childhood or dolesunce. “Disorders such as autism and epilepsy have also been referred to as development disorders and developmental disabilities.  Delirium, dementia and amnesia and other cognitive disorders  Mental disorders due to a general medical condition  Substance related disorders.  Schizophrenia and other psychotic disorders  Mood disorders  Anxiety disorders Chittodvega ===========================================56created by technoayurveda.wordpress.com of Dr.KSRPrasad
  57. 57.  Somatoform disorders  Factitious disorders  Dissociative disorders  Sexual and gender identity disorders  Eating Disorders  Sleep disorders  Impose control disorders not elsewhere clarified  Adjustment disorders  Personality disorders  Other conditions that may be a focus of clinical attention. ICD-10 INTERNATIONAL CLASSIFICATION OF DISEASES–10 ORGANIC DISORDERS FUNCTIONAL DISORDERS 1 Dementia 1 Schizophrenia, schizotypal & delusional disorders 2 Delirium 2 Mood disorders 3 Mental & behavioural disorders due 3 Neurotic, stress-related, somatio to psychoactive substance use form disorders 4 Behavioural syndromes with psychological disturbance & physical factors 5 Disorders of adult personality & behaviour 6 Mental retardation 7 Disorders of psychological development 8 Behavioural & emotional disorders occurring in childhood & adolescence. 9 Unspecified mental disorders Chittodvega ===========================================57created by technoayurveda.wordpress.com of Dr.KSRPrasad
  58. 58. ANXIETY NEUROSIS Anxiety: The word anxiety is derived from the Latin word ‘Anxitas’ meaning ‘troubled in mind’.1Anxiety is a common form of reaction that every person experiences to a greater or lesser extent during his or her life time. The term anxiety is as much a part of the lay person’s vocabulary as it is the clinicians. People may describe themselves as anxious when they are anticipating an important examination, or an important job interview. Those who report an experience of fear when left alone in the dark may also describe themselves as anxious. On the other hand, anxiety may be diagnosed as pathological when general functioning is at a level below usual competence and is accompanied by physical symptoms such as tension headaches. Anxiety, in the simplest sense, is a form of response or reaction. Its existence in the individual does not necessarily denote abnormality. Anxiety can however be much more than a normal, helpful reaction in a challenging situation. Whether it is regarded as a disorder depends on the extent of its negative impact on thinking and behavior and on how much it interferes with the person’s daily life.2 Definition is particularly important with the concept of anxiety as it encompasses a range of reaction and can refer to a range of possible experiences. A precise definition is not universally agreed, presented here are the main elements that may be observed in the clinical cases of the anxiety syndrome. Anxiety may be defined as an unpleasant emotion that is characterized by feeling of dread, worry, nervousness or fear. This emotion may be experienced in response to particular events, situations, people or phenomena; or in anticipation of stimuli. This stimulus may be external (like a storm) or internal (like a negative belief accompanied by Chittodvega ===========================================58created by technoayurveda.wordpress.com of Dr.KSRPrasad

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