Kaphaja unmada kc014hyd

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A clinical study on the efficacy of brahmyadi varti nasya and lasunadi ghrita pana in the management of kaphaja unmada with special reference to depressive disorders, t.sundara raj perumall, 2007, post graduate department of kayachikitsa, dr. B.R.K.R. govt. Ayurvedic college / hospital, hyderabad, affiliated to n.t.r. university of health sciences vijayawada, A.P.

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Kaphaja unmada kc014hyd

  1. 1. A CLINICAL STUDY ON THE EFFICACY OF BRAHMYADI VARTINASYA AND LASUNADI GHRITA PANA IN THE MANAGEMENT OF KAPHAJA UNMADA WITH SPECIAL REFERENCE TO DEPRESSIVE DISORDERS.THESIS SUBMITTED IN PARTIAL FULFILLMENT FOR THE DEGREE OF DOCTOR OF MEDICINE (AYURVEDA) IN KAYA CHIKITSA By DR. T.SUNDARA RAJ PERUMALL GUIDE DR. M.L. NAIDU. MD (AYU) READER DEPT. OF KAYACHIKITSA, P.G. UNIT POST GRADUATE DEPARTMENT OF KAYACHIKITSA Dr. B.R.K.R. GOVT. AYURVEDIC COLLEGE / HOSPITAL HYDERABAD AFFILIATED TO N.T.R. UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA, A.P. 2007
  2. 2. Dr.N.T.R UNIVERSITY OF HEALTH SCIENCES, VIJAYAWADA POST GRADUATE DEPARTMENT OF KAYACHIKITSA Dr.B.R.K.R. GOVERNMENT AYURVEDIC COLLEGE HYDERABAD. CERTIFICATEThis is to certify that Dr.T.Sundara Raj Perumall is a bonafide final year P.G. scholarof M.D.(Ayurveda) in the specialty of Kayachikitsa of this institute. He has worked forhis thesis on the topic titled “A Clinical Study On The Efficacy Of Brahmyadi VartiNasya And Lasunadi Ghrita Pana In The Management Of Kaphaja Unmada WithSpecial Reference To Depressive Disorders” as per the requirements laid down byDr.N.T.R UNIVERSITY OF HEALTH SCIENCES Vijayawada, for the purpose. Thehypothesis submitted by him in the first year of M.D.(Ayu) is one and the same tothat of the dissertation submitted. I am fully satisfied with his work and herebyforward this dissertation for the evaluation of adjudicators.Date: Dr. PRAKASH CHANDERPlace: Hyderabad. MD (Ayu) Professor& HOD, Post graduate Department of Kayachikitsa Dr. BRKR Govt. Ayurvedic Medical College, Hyderabad.
  3. 3. Dr.N.T.R UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA POST GRADUATE DEPARTMENT OF KAYACHIKITSA Dr.B.R.K.R. GOVERNMENT AYURVEDIC COLLEGE HYDERABAD. CERTIFICATEThis is to certify that the present dissertation embodies the outcome of originalobservations made by Dr.T.Sundara Raj Perumall on “A Clinical Study On TheEfficacy Of Brahmyadi Varti Nasya And Lasunadi Ghrita Pana In TheManagement Of Kaphaja Unmada With Special Reference To DepressiveDisorders” in partial fulfillment for the degree of Doctor of Medicine. This work hasbeen completed under my direct supervision after a series of scientific discussions.This scholar has put in commendable efforts for designing and executing themethods and plan for the study. Hence I recommend this dissertation to besubmitted for adjudication.Hyderabad, Dr.M.L. Naidu M.D.(Ayurveda)Date: Guide Reader, Department of Kayachikitsa, Dr.B.R.K.R. Government Ayurvedic College, Hyderabad, Andhra Pradesh.
  4. 4. ABBREVIATIONSAh. - Ashţanga HridayaAk. - Amara KosaAs. - Ashţanga SamgrahaB.G. - Bhagavat GitaBs. - Bhela SamhitaBp. - BhavaprakasaCa - Charaka SamhitaChakra - ChakrapaniCi - Chikitsa SthanaDal - DalhanaHs. - Harita SamhitaI - Indriya SthanaKs. - Kasyapa SamhitaMadhu - MadhukosaMn. - Madhava NidanaNi - Nidana SthanaS - Susruta SamhitaSa - Sarira SthanaSi - Siddhi SthanaSu - Sutra SthanaU - Uttara SthanaVi - Vimana Sthana
  5. 5. ACKNOWLEDGEMENTSMy salutations to Lord Vighneshwara, Goddess Gayatri Mata and Bhagavan Dhanvantari.I pay sincere tributes to my parents Sri T.Murali Krishna and Smt. T.Varalakshmi whose love,support and encouragement were the initiating sources, which directed me towards progress andsuccess in each and every step of my life.With heartful gratitude, I acknowledge the invaluable guidance bestowed on me by honorableguide Dr. M.L.Naidu, M.D. [Ay], Reader, Post graduate department of Kaya chikitsa.I express my profound sense of gratitude to honorable Dr.Prakash chandar M.D. [Ayu],ProffesorHead of the department of Kayachikitsa for guiding me in every stage of my work.I convey my gratitude to the honorable Principal Dr.M.Sadasiva Rao and honorable Dr.L.RadhaKrishna Murthy, superintendent of Dr.B.R.K.R. Government Ayurvedic Hospital for providingnecessary facilities for the study.I am also thankful to teaching staff, Post graduate department of Kaya chikitsa especiallyDr.Vasudevarao garu Dr.RamalingeswaraRao garu and Dr Vijayalakshmi garu for their precioussuggestions and help throughout the study.I express my special thanks to all my classmates specially Dr.Sirisha, Dr.Prasuna,Dr.Priyadarshini, Dr.Jaganmohanbabu, Dr.Venkata Ramana, Dr.Raju for their loving co-operation in completing the work.I thank my friends Dr.Srinivas, Dr.Prasad, Dr.Nagarjuna, Prasanthi and her family members fortheir valuable support which made this work possible.I thank Dr. Raghupati gowd garu, Dr.chari sir RMO, Dr.murali mohan garu, Dr.vasanta lakshmigaru for referring their cases in sufficient number.I thank Advocate Prasad garu, Kowtilya and Prasanna for their love and support.I thank my loving sister T.V.L.Suseela and my dearest wife Dr.T.Kavita whose moral support hasboosted my spirits in difficult situations..I thank my Brothers-in-law S.D.Prasad and S.venkatesh, my Brother K.Ravi ganesh for theirloving support in my work .I thank Dr.Shiva Rama Prasad for his valuable suggestions and support.I pay my tributes to honorable Dr.B.Vijayababu, Reader, Post graduate department of Kayachikitsa. His invaluable guidance, continuous support gave a true sense to this work. His paternalaffection and vigilant care have always encouraged me to pursue right path in my work. I will beindebted to him for ever.Last but not least I express my gratitude to each and every person who has made this taskpossible. Dr.Sundara Raj Perumall.
  6. 6. CONTENTS CHAPTER Page no’sPART-IINTRODUCTION. 1HISTORY OF MANAS ROGAS 5CONCEPT OF MANAS. 17PART-IIREVIEW OF LITERATURE ON UNMADA 44NIDANA 48SAMPRAPTI 53PURVARUPA 60RUPA 61DIFFERENTIAL DIAGNOSIS 80SADHYAASAADHYATA 91GENERAL METHODS OF TREATMENT 94UNMADA CHIKITSA 99PART-IIIDRUG STUDY 117CONCEPT OF NASYA 127CONCEPT OF SAMANA SNEHA 132PART-IVCLINICAL STUDY 142OBSERVATIONS AND RESULTS 147PART-VDISCUSSION 170SUMMARY AND CONCLUSION 195ANNEXURE 200BIBLIOGRAPHY 207CASE SHEET 213KAPHAJA UNMADA RATING SCALE 215HAMILTONS RATING SCALE FOR DEPRESSION
  7. 7. 1INTRODUCTION INTRODUCTION INTRODUCTION In the present age of astonishing scientific advancements in almost every aspect of human life, one faculty upon which man is still unable to gain authority is human mind. Obviously the most threatening problem which is shaking the foundations of human existence is man’s inability to control mind. This ignorance of modern man in understanding and using the strengths of mind makes him misuse this powerful instrument gifted to him by the almighty. Man is unaware of the drastic damage mind can cause, if used improperly. Lord Krishna warns us in Bhagavadgeeta saying “AÉiqÉæuÉ AÉiqÉlÉÉå oÉlkÉÑÈ AÉiqÉæuÉ ËUmÉÑUÉiqÉlÉÈ” i.e. self is the friend of man but self can also become greatest enemy to him. Mismanagement of mind is causing a variety of psychiatric diseases. These ailments are playing a significant role in influencing the growth and development of any country. Modern lifestyle forces people to neglect the harmful changes in their mind which gradually affects their body, leaving them fit for nothing, turning them into dependants and burden to others. This is high time to understand the dynamics of mind to learn the art of living. Ayurveda the majestic legacy of our rich Indian heritage has provided an ocean of knowledge regarding mind and its management. In almost all samhitas we find detailed description of psychological disorders. Charaka Samhita more aptly uses the word ‘Vibhramsa’ to denote the disordered state of the individual suffering from mental illness. By enlisting eight factors, which are said to be the underlined entities for the development of various abnormalities, it provides essential insight into the psychopathology of mental disorders. Of these factors, some are innately related to the individual [mana, buddhi, etc] while some are acquired or developed by constant interaction with the environment or society [achara]. So it is the vibhramsa condition of these factors in different KAPHAJA UNMADA 1
  8. 8. 1INTRODUCTION permutations and combinations that leads to various psychiatric disorders with much-varied psychopathology and phenomenology. Hence the word ‘Unmada’, which is the vibhramsa condition of these factors, has to be perceived as a broad term that describes all mental abnormalities. Kaphaja unmada the third variety produces a group of symptoms similar to that of depressive disorders. Depression is a major psychiatric ailment affecting 9.5% of world population. It affects the body moods and thoughts, which finally creates suicidal tendencies in patients, forcing them to do so. NEED AND SIGNIFICANCE OF THE STUDY Very few studies were conducted on this topic till now. Lot of exploration is needed in understanding and treating kaphaja unmada. Number of formulations were mentioned in every classic to treat unmada. But specific medicines which act effectively in kaphaja unmada which is being compared with depression are to be studied. Treating depression is the need of this era as it is converting major number of people into mentally weak and inactive personalities with suicidal tendencies, which in turn is harming the whole humanity. According to Indian Journal of Community Medicine 2001 Oct-Dec; 26(4): 198-200; prevalence rate for all mental disorders was observed to be 65.4 per 1000 population. Prevalence rates for schizophrenia, affective disorders (depression), anxiety neurosis, hysteria and mental retardation were 2.3, 31.2, 18.5, 4.1 and 4.2 per 1000 population respectively. 15 percent of people diagnosed with depression are commiting suicide. It is also observed that available modern medicines create much more physical and psychological complications. This is an alarming note to the physicians of all systems of medicine. Extensive studies to treat this disease and save human community are very essential. Ayurveda provides rational means for the treatment of many physical and mental disorders, which are considered to be incurable in other systems of medicine. Sodhana and samana are required to treat any problem at gross root KAPHAJA UNMADA 2
  9. 9. 1INTRODUCTION level. Hence nasya karma with Bramhyadi varti and samana snehapana of Lasunadi ghrita are selected to treat Kaphaja unmada. STATEMENT OF THE PROBLEM A Clinical study to assess the efficacy of trial drug in the management of Kaphaja Unmada. OBJECTIVES OF THE STUDY To study kaphaja unmada in comparision with depressive disorders. To assess the efficacy of trial drugs, Bramhyadi varti & Lasunadi ghrita in decreasing the signs and symptoms of Kaphaja unmada and decreasing the score of Hamiltons Rating Scale for Depression and Kaphaja unmada rating scale. ASSUMPTIONS KaphajaUnmada can be compared with depressive disorders of modern psychiatry. Trial drug helps in decreasing the signs and symptoms of KaphajaUnmada. Trial drugs help in decreasing the score of Hamiltons Rating Scale for Depression and Kaphaja unmada rating scale HYPOTHESIS Null hypothesis The trial drug doesn’t significantly decrease the signs and symptoms of Kaphaja unmada and the scores of Hamiltons Rating Scale for Depression and Kaphaja unmada rating scale Alternate hypothesis The trial drug lasunadi ghritam significantly decreases the signs and symptoms of Kaphaja unmada and the scores of Hamiltons Rating Scale for Depression and Kaphaja unmada rating scale. KAPHAJA UNMADA 3
  10. 10. 1INTRODUCTION Nasya karma with Brahmyadi varti significantly decreases the signs and symptoms of Kaphaja unmada and the scores of Hamiltons Rating Scale for Depression and Kaphaja unmada rating scale Scientific hypothesis: Nasya karma with Brahmyadi varti along with lasunadi ghritam is more effective in improving the condition of Kaphaja Unmada (Depression) patient and in decreasing the scores of Hamiltons Rating Scale for Depression and Kaphaja unmada rating scale. Design of thesis: This thesis is divided into6 parts in the following order. PART-I INTRODUCTION. HISTORY OF MANASA ROGAS CONCEPT OF MANAS. PART-II REVIEW OF LITERATURE ON UNMADA PART-III DRUG STUDY PART-IV CLINICAL STUDY PART-V DISCUSSION,SUMMARY AND CONCLUSION PART-VI ANNEXURE ***** KAPHAJA UNMADA 4
  11. 11. 2HISTORY OF MANASAROGAS HISTORY OF MANASA ROGAS Knowledge of history is utmost essential for a researcher to understand the depth of that particular science, its origin and its development. Indian sciences were believed to be the first to explore mind and its mechanisms in an elaborate and practical way. Following is the division of our history into Vedic, Samhita, Medieval, & Modern periods. VEDIC PERIOD (6000 B.C TO 1000 B.C.) It is well known that the ancient Indian thought is not only rich in metaphysical approach but in the psychological approach also. Vedic era is said to be the earliest of the ages or recorded history. Four Vedas with their Bramhana, Aranyaka, Samhita and Upanishad parts comprise the Vedic scriptures. Many descriptions about mental disorders and their treatment are available in our sacred texts. RIGVEDA: Rigveda, an oldest classic of human civilization has many references about mental disorders, regarding the psychological derangements, the methods of treatment and the means to prevent the psychiatric entities which are as follows: Manas acts as a tool between Atma and Indriyas in the origin of knowledge.1 The Atma is supreme and the Manas as well as Indriyas surrender to it2 Pishacas are blamable for mental disorganization and Agni has been worshiped for the cure of the same.3 Conjugation of Atma and Manas leads to Moksa.4KAPHAJA UNMADA 5
  12. 12. 2HISTORY OF MANASAROGAS YAJURVEDA: Manas is the supreme power.5 Astanga Yoga is a key factor to reach super consciousness.6 Siva Samkalpa Sukta deals with psychological health.7 ATHARVAVEDA: Atharvaveda has maximum references related with Manas, Manasarogas and Bhutavidya. The main forms of treaties mentioned in Atharvaveda are: 1. Atharvani i.e. psychotherapy 2. Daivya i.e. naturopathy 3. Manusyaja i.e. herbal medicines prepared by human beings.8 Atharvani relates with the psychological aspects and includes: Mantra – chanting Sankalpa – decisiveness by repeated self-suggestions Vasikarana – control over self by mesmerism or hypnosis.9 Most of the hymns of Atharvaveda are directly concerned with the Atharvani or psychotherapy and thus have influenced the majority of Indians to believe in ‘Mantras’ for the cure of the mental disorders.9 The causes of Mental disorders given are Daivakritapapa, Jvara, Krimi, Abhichara, Rakshasa, Gandharva and Apsara, etc. The seat of Manas is heart. Some Manasa Bhavas like Irsha, Krodha etc. are calmed down through special treatments like Irsha Bhesaja.10 Atharvani therapy comprises of Mantras, which are useful in cure of mental disorders.KAPHAJA UNMADA 6
  13. 13. 2HISTORY OF MANASAROGAS Whitney in 1962 tried to interpret and classify the Manas rogas in Atharvaveda, which are presented as below: GLIMPSES OF MENTAL DISORDERS IN ATHARVAVEDA Vedic term Subjects covered Reference of Atharvaveda 1.Unmada Insanity 8/3/3, 6/3/1-2 2. Apasmara Epilepsy 8/1/16,8/1/3 3. Bibheeti Fear 2/15/1, 6/40/1, 7/3/22 4. Dusvapna Evil Dream 6/46/1-3, 6/100/1, 16/7/8 5. Enas, Aparadha, Guilt 6/117/1, 6/118/12, 6/119/1-3 Duritani 6. Gandharva, Idiopathic causes 2/2/5, 6/130/4, 6/130/1 Apsara for psychosexual Disorders 7. Grahi Hysteria 2/9/1, 8/2/12, 13/3/18 8. Irsha Jealous 6/18/1-3, 7/74/3 9. Krodha Aggression 6/42/1-3, 6/43/1 10.Manasa Papa Schizo- Paranoid 6/45/1-3 11. Manya Fuzzy 6/42 12. Moha Eroticism 3/21/4, 3/25/6 13. Raksasagraha Possession 8/3/19, 8/3/15 14. Srapa Curse 6/37/59, 6/67 15. Ahimsa Non violence 6/96/12-13 16. Uttaram Superiority 6/45/1 17. Yatudhana Sorcery & Witches 8/2/8, 8/3, 1/7KAPHAJA UNMADA 7
  14. 14. 2HISTORY OF MANASAROGAS GLIMPSES OF PSYCHOLOGY IN ANCIENT SCRIPTURES In Mahabharatha – Santhiparva swarupa of manas and satvika gunas were described In Bhagavadgita - Motivating talk of Krishna to treat the depression of Arjuna is a great example of psychological counselling. In Yogavasista - attempts of Vasista, Viswamithra and Dasaratha to elevate the depressed mood of Rama are good examples of psychotherapy. In Bhagavata, 11th skanda satvika guna vrittis were mentioned. In Brahma vaivarta purana and Manusmriti, method of psychological examination was explained . A good description of psychological techniques, which can be applied in one’s life can be seen in different stories described in Panchatantra. Different concepts of mind are described in Upanishads like Chandokya, Khatopanishat etc. SAMHITA PERIOD (1000 B.C. TO 600 A.D.) In this period ancient seers like Charaka, Susruta, and Vagbhata contributed about Manas, Manas-roga and its management nicely. Being Upaveda of Atharvaveda, Ayurveda traditionally contains Atharvani type of the treatment in the form of Daivavyapasraya Cikitsa. Out of the eight specialties of Ayurveda Bhutavidya, represents psychology and psychiatry in ancient times. On the basis of classical references we can interpret and correlate most of the psychiatric disorders with the entities described under Bhutonmada and Doshonmada.KAPHAJA UNMADA 8
  15. 15. 2HISTORY OF MANASAROGAS CHARAKA SAMHITA: 1. A complete and detailed definition, properties, function etc. of Manas were described.11 2. It has also mentioned Cittodvega as one of the Vikaras of Manodosha.12 3. Examination and determination of Manasa Bhavas have been described.13 4. Effects of emotional factors like Kama, Krodha, Vishada, Harsha on the body were clearly mentioned.14 5. For examination of mental status, Sattva Pariksa was told.15 6. According to Charaka, Treatment of Manasaroga is Satvaavajaya, which includes Jnana, Vijnana, Dhairya, Smriti & Samadhi.16 7. Complete description about Unmada, Apasmara and Atattvabhinivesha was done.17 8. 16 types of Manasa Prakriti (mental constitution) were mentioned in detail.18 SUSRUTA SAMHITA: 1. Most of the Manasa Bhavas like Krodha (anger), Soka (grief), Bhaya (fear), Kama (passion) etc. were told as either part of Iccha (desire) or Dvesha (aversion).19 2. 16 types of ManasaPrakriti were told in Sarirasthana.20 3. Detailed description about Unmada and Apasmara was given.21 4. Balagraha (child psychiatric disorders) were clearly described by Susruta Samhita.22KAPHAJA UNMADA 9
  16. 16. 2HISTORY OF MANASAROGAS ASTANGA SAMGRAHA /HRIDAYA: Both the texts follow Charaka and Susruta in the sphere of psychiatric disorders, but have given prime importance to Manasa vikaras by describing them, in the first venture of their texts. Astanga Hridaya introduced Dhee, Dhairya, and Atmadi Vijnana as the best treatment of mental disorders.23 Bhootavidya, Unmada, Apasmara and Balagraha etc. were very nicely discussed in both of these texts.24 Medieval Period (600 A.D. to 1600 A.D.) This period is described as a Samgrahakala. Madhava Nidana, an eminent book for diagnosis in this period, incorporates literature about mental disorders based on Samhita. Later on, Sharangadhara, Bhavamishra and all the other commentators of Samhitas have described mental disorders but were mainly based on Samhitas. MODERN PERIOD (1600 A.D. ONWARDS) In the early 20th century, Yogendranath Sen, a renowned pupil of Gangadhar and Commentator of Charaka Samhita, tried to elaborate some terms like Mudha, Alpachetas, Vyakula, etc. Dr. Balkrishna Pathak, Dr. Ayodhyaprasad Achal and Dr. Rajendraprasad Bhatnagar have endeavored well to interpret Ayurvedic description of psychiatry with Modern literature. REFERENCES FROM BIBLE Psychological disorders were thought to represent the punishment of God. Mosses quoted in Bible saying “The Lord shall smite thee with madness”. Jesus reportedly cured a man with an unclean spirit by transferring the devils that plagued him to a herd of swine.25KAPHAJA UNMADA 10
  17. 17. 2HISTORY OF MANASAROGAS MENTAL DISORDERS IN ISLAMIC COUNTRIES: In the Islamic tradition, the social attitude towards the mentally ill is based on the sayings of Prophet Mohammad, that the mentally ill are dear to God. In Arabic medicine, the concept of mind and mental illness is roughly comparable to the writings in earlier Greek classics, where the soul is regarded as an entity separate from the body, and many psychological and moral attributes are linked with the soul. The first mental hospital was established in Baghdad in 792 A.D. followed by others in Damascus and Aleppo. The outstanding ‘Prince of physicians’ , Avicenna from Arabia, author of “The canon of medicine”, referred to hysteria, epilepsy, manic reactions and melancholia in his writings. He has cured a prince who was suffering from delusion that he was a cow and had stopped eating, pleading others to kill him. Avicenna came as the butcher and denied to kill him as he was too lean, then the prince ate food, gained strength and got completely cured. PSYCHIATRY IN GREECE In ancient Greece the priests made the patients sleep in temples of the God Asclepies. The dreams they had there would reveal what they needed to do, to get better. EARLY VIEWS OF MENTAL DISORDERS IN CHINA In an ancient Chinese medical text supposedly written by Huang ti 2674 B.C. the symptoms of excited insanity were mentioned. At that time Chinese medicine was based on belief in natural rather than super-natural causes for illnesses. Chung ching (Hippocrates of China) based his views of physical and mental disorders on clinical observations and he implicated organ pathologies as primary causes.KAPHAJA UNMADA 11
  18. 18. 2HISTORY OF MANASAROGAS CULTURE BOUND DISORDERS Socio-cultural factors also appear to influence which disorders develop, the forms that they take and their courses. Kleinman found that in Western societies depression was a frequent reaction to individual stress, but in China he noted a relatively low rate of depression. Instead the effects of stress were more typically manifested in physical problems such as fatigue, weakness and other complaints. Certain culture-bound syndromes were identified with special group of symptoms and a typical nomenclature such as 1. Amok in Malasyia, Phillipines, New Guinea, 2. Koro in South East Asia and China, 3. Latah in Malasyia, Indonesia, Japan & Siberia, 4. Windigo in Algonquin Indian hunters, 5. Kitsunetsuki in Japan, 6. Zar in North Africa & Middle East, 7. Taijin kyofusho in Japan. People exhibit strange symptoms in the above disorders, for example in Koro a man fears that his penis will withdraw into his abdomen and he may die, this condition is treated by having the penis held firmly by the patient or by family members, often the penis is clamped to wooden box. CONTRIBUTION OF SOME EMINENT SCIENTISTS IN THE FIELD OF PSYCHIATRY Thomas Willis (1622-1675)Classified mental disorders into two types: Caused by gross brain disease. Caused by disturbed animal spirits. Johann Christian Heinroth (1773-1843):KAPHAJA UNMADA 12
  19. 19. 2HISTORY OF MANASAROGAS He said that personality is the outcome of an inner struggle between the instinct, the self, and the conscience. James Esdaile (1808-1859): Indian surgeon who performed nearly 300 major operations, using ‘hypnosis’ long before surgical anesthesia was discovered. Sigmund Freud (1856-1939) gave some of the main contributions: Psychoanalysis Psychodynamics Dream analysis Theory of infantile sexuality Libido theory Topographical model of mind (conscious, preconscious, unconscious) Structural model of mind (Id, Ego, Superego). Julius Wagner Von Jauregg (1857-1940): First psychiatrist who received Nobel Prize in 1927, for the first most successful treatment of psychosis. Ugo Cerletti (1877-1963): Explained the mechanism of action of electro convulsive therapy (ECT). HISTORY OF DEPRESSION Much of what is known today about symptoms of depression and related disorders was described by the ancient Greek and Roman physicians who coined terms like ‘melancholia’ and ‘mania’ and noted their relationship. In the fourth century BC, Hippocrates made an early reference to distress and melancholia. He described melancholia (black bile) as a state of "aversion to food, despondency, sleeplessness, irritability and restlessness". Later, Galen (131-201 A.D.) described melancholia manifesting in "fear and depression, discontent with life and hatred of all people". Subsequent Greco-RomanKAPHAJA UNMADA 13
  20. 20. 2HISTORY OF MANASAROGAS medicine not only recognized the symptoms of melancholia in the form of fear, suspicion, aggression and death wishes, but also referred to environmental contributions to melancholia as immoderate consumption of wine, perturbations of the soul due to passion, and disturbed sleep cycle. Many of the original Greek texts on melancholia were transmitted to posterity through medieval Arabic texts in which connections between two major mood states were suggested, and the causes of the disease were speculated to be interactions between temperament, environment and the four humours (i.e. wind, phlegm, yellow bile and black bile). In the modern era, Robert Burton’s text, Anatomy of Melancholy, published in 1621, was entirely devoted to depression. Burton categorized various forms of melancholy and grief, and also described "causeless melancholias". The latter term meant that it was possible to suffer from melancholia without having any apparent cause. Subsequent writers have provided graphic descriptions of the features of melancholia and its long-term outcome and consequences, including "melancholic patient starving himself to death". Towards the nineteenth century, several attempts were made to clarify the concept of melancholia and bring it closer to what would now be equated with depression. Many physicians such as Esquirol (1820), Samuel Tuke (1813) and Henry Maudsley (1868) attempted to define the causation, nature and presentation of melancholia. Towards the later part of the nineteenth century, melancholia began to be viewed as an independent disease. Melancholia was considered to be associated with sadness, suicide, and preoccupation with the past. With the delineation of manic depressive illness as a distinct entity, renewed interest into the phenomenon of depression led to intense studies on various aspects of its clinical features, dynamics, neurobiology, epidemiology, classification and treatment.KAPHAJA UNMADA 14
  21. 21. 2HISTORY OF MANASAROGAS After the Second World War, the World Health Organization commissioned a task force to review the status of classification of psychiatry, and produce a revised edition of the International Classification of Diseases. Its subsequent revisions, along with the revised editions of the Diagnostic and Statistical Manual of the American Psychiatric Association, have revolutionized the approach to the study of mental illnesses. These official nomenclatures have established explicit operational criteria for diagnostic categories, including both inclusion and exclusion requirements which means that more is known on what constitutes depression and what does not. Although such an approach has been applied by the research community for some time, these have only recently been accepted by doctors in general practice. SOME FAMOUS PEOPLE WHO HAD DEPRESSION Abraham Lincoln, Theodore Roosevelt, Robert Schumann, Ludwig von Beethoven, Edgar Allen Poe, Mark Twain, Vincent van Gogh, Georgia O’Keefe. This is a brief history of manasa rogas. REFERENCES 1. Rig-Veda. 4/1/915 2. Rig-Veda. 4/5/917 3. Rig-Veda. 5/29/10 4. Rig-Veda. 2/243/183/1, 8/4/57/4 5. Yajur-Veda. 34/1-6 6. Yajur-Veda. 3/54 7. Yajur-Veda. 34/3 8. Singh 1977 9. Baloddhi & Roychowdhary, 1986 10. Atharvana Veda. 7/46/1, 6/28/1-3, 7/45/1-2 11. Ca. Sa. 1/18-22KAPHAJA UNMADA 15
  22. 22. 2HISTORY OF MANASAROGAS 12. Ca. Vi. 6/5 13. Ca. Vi. 4/8 14. Ca. Su. 25/40 15. Ca.Vi. 8/119 16. Ca.su.1/58, 11/54 17. Ca. Ci. 9-10 and Ni. 7-8 18. Ca. Sa. 4/36-40 19. Su. su. 1/3 20. Su.Sa.4/80,96 21. Su.U.61-62 22. Su. U. 60 23. Ah. Su. 1/26 24. As. U. 6-10 and Ah. U. 2-7 25. Mark:5:1-13 *****KAPHAJA UNMADA 16
  23. 23. 3CONCEPT OFMANAS CONCEPT OF MANASNECESSITY OF MANASA VIGNYANAHealthy life is the common faculty crucial to different people in search ofdifferent aspects of attainment like Dharma Artha, Kaama, & Moksha. Healthymind is utmost important to build a healthy body and a Healthy life. Mind, souland the body – are the three pillars of the tripod of life.2 The world is sustainedby their combination; they constitute the substratum for everything. The mind ismentioned first in the sequential order because it occupies very important placein this trio as the entire activities of the body are controlled by it. In this era ofmedical science utmost importance is being given to understand the complexaspects of mind. It is heartening to know that mind was described elaborately inour samhitas covering all the aspects of physiology and pathology in the contextof manas. It will be very apt to study and interpret the important aspects ofmanas to solve the alarmingly increasing psychiatric problems of modern day.NIRUKTI OF MANAS: ‘qÉlrÉiÉå MüsmrÉiÉå AuÉoÉÑkrÉiÉå AlÉålÉ CÌiÉ qÉlÉÈ’ ‘qÉlrÉiÉå AuÉoÉÑkrÉiÉå ¥ÉÉrÉiÉå AlÉålÉ CÌiÉ qÉlÉÈ’That which analyses the knowledge through perception or cognition. Thatwhich helps in understanding the knowledge.DRAVYATVA OF MANASManas is one of the nine Karana Dravyas.2 The concept of Dravyatwa of Manasindicates that Manas is not simply a theoretical speculation of acharyas .Dravya is defined as “ÄrɧÉÉÍ´ÉiÉÉÈ MüqÉï aÉÑhÉÉÈ MüÉUhÉqÉç xÉqÉuÉÉÌrÉ rÉiÉç iÉiÉç SìurÉqÉç”.Manas is a dravya, with distinctive actions(Indriyaabhigrahaha svasyanigrahaha) and qualities (Anutvam atha ekatvam) . Caraka has included Manasin the classification of Adhyatmika Dravya.KAPHAJA UNMADA 17
  24. 24. 3CONCEPT OFMANASVYAKHYA OF MANAS A substance, which is responsible for the presence or absence of theknowledge, is called Manas.3An instrument for the perception of happiness or miseries.4A substance which establishes the contact between the soul and body and whichregulates the functions of the Indriyas is defined as Manas.5According to Tarka Samgraha manas is defined as the faculty for the perceptionof feelings like Sukha and Dukha. Manas is accepted as a Dravya, belonging to the AdhyatmikaDravya Guņa Samgraha (non-physical). It is Asaririka but is deeply related withSarira. Acetana, but is essentially related with Atma (consciousness). Abhoutikabut depends reciprocally on pancabhautika sarira in performance of complexand integrated activities of organic life.In short, Manas is at super sensual level6 in the body, an instrument of Atma7,seat of all feelings (pleasures and sorrows)8 and a mediator in the knowledgegaining process activating Indriyas towards the objects.9SYNONYMS OF MANAS:According to seat: Hridayam, Hrnmanasam, HritAccording to function: Prajna(accommodator of super senses) Smriti (restores knowledge) Mahamati (super-most analyzer) Sattvam (Satobhavetva expression of the presence of Atma)According to relation: Swantam (closely related to Atma)According to shape: Anangakam (non-morphological entity)According to action : Citta(CitijnaneThe mediator in the knowledge process) Purvabdhikhyatihi (carrier of previous deeds)KAPHAJA UNMADA 18
  25. 25. 3CONCEPT OFMANASOther Synonyms :Eswaraha(god,owner), Brahma(thesoul) Cetasamavayi(Cetas is Atma.Samavaya is intimate and inseparable relation.One that accompanies Atmathroughout the life and also in further births (Janmas) is Cetasamavayi.)Manas, Manasam(It is derived from root Man which means that which thinks) 10Synonyms of Manas in MahaBharata: Manaha, mahat, matihi, brahma, buddhi, Khyaati, eswaraha, Pragna,Samvitah, Chiti, smriti.11STHANAS OF MANAS:In Ayurvedic literatures, various references are available regarding the seat ofManas which are being discussed hereIndefinite: Mind is continuously active i.e. Cancala12, so it cannot stay at oneparticular place.Hridaya: Many references are available in Caraka and Susruta regarding the seatof Manas in Hridaya. Both Acaryas have mentioned that only Hridaya is the seatof Cetana in the body. It indicates that Hridaya is the actual seat of Manas.13Siras: In Caraka14, it has been explained that Prana and whole Indriyas aresituated in Uttamanga i.e. Sira. Among the whole Indriyas, Manas is supremebecause it is the controller of them. So it illustrates that Manas is situated inUttamanga i.e. Siras.Bhela considers space between Sira and Talu as seat of Manas.15Sarva Sarira: Acarya Charaka states that Sarva Sarira is Adhisthana of Atindriyai.e. mind.16Ojas: Ojas is said to be the seat of Manas.17Tvak: Tvak is considered to be the seat of Manas.18 All the references regardingthe seat of Manas, which are mentioned above indicate various places, butmajority of Acaryas believe that the actual seat of Manas is Hrdaya and itstransportation channel is Sarva Sarira.KAPHAJA UNMADA 19
  26. 26. 3CONCEPT OFMANASGUNAS OF MANAS:Manas has three Mahagunas, namely, Satva, Rajas and Tamas.19 Thepredominance of one or the other determines the instinct nature and qualities ofan individua1.20 In Caraka Samhita, two qualities, namely Anutva and Ekatva of Manaswere described.21. Kasyapa also discusses these two qualities of Manas.Anutva is considered in terms of dimension or the size. There are two types ofsizes; one is the biggest conceivable size, which is called ‘Vibhu Parimana’ orSarvagata Parimana that is all pervading or omnipresent and the other one is thesmallest conceivable size termed as ‘Anu Parimana’.Ekatva is described in terms of numbers of the numerical value and unit is thesmallest number. Singularity has been fixed for Manas which means that in eachliving organism there is only one Manas.ARTHAS OF MANAS As a sensory faculty object of manas is anything that is thinkable. Herethinking includes all sorts of higher mental activities such as Chintya, Vicarya,Uhya, Dhyeya and Sankalpa.Chintya - Thinking about do’s and don’tsVicharya –It is a distinct analysis, Reasoning, logic and discrimination which isenough to direct the mind to accept or reject a thing.Uhya – It is an expectation, hypothetical self-discussion and logical thinking .Dhyeya– Goals , targets, & attention towards sensitive issues and distinct things.Sankalpa – Determination to achieve goals, targets, ambitions & aims.Yat kinchit manaso jneyam – whatsoever perceived by manas is manoartha.KARMAS OF MANAS:KAPHAJA UNMADA 20
  27. 27. 3CONCEPT OFMANASThe Karmas (functions) of the Manas have been described as Indriyabhigrahaand Svasyanigraha. Manas being Ubhayatmaka (Dual) Indriya, serves both thefunctions i.e.Knowledge (Jnana) and action (Karma), i.e. sensory and motor andtheir coordination.So Acarya Charaka states function of Manas as: -Indriyabhigrahah Karma Manasah Svasya Nigraha Uho Vicharscha.22(i) Indriyabhigraha -Direction to Indriyas(ii) Svasyanigraha - Control of itself(iii) Uho- Reasoning, logical thinking(iv) Vicara- Deliberation(i) Indriyabhigraha — Manas is called as the controller of Indriyas. Manasreceives and sends the impulses and inspirations to the cognitive sensesi.e.maintains connection with Indriyas, so as to facilitate them for perception ofindriyaarthaas.(ii) Svasyanigraha — Another function of Manas is controlling of its ownfunction -self control . Manas has got a speciality which is of controlling nature,though Manas is always active and stated as Chanchala. The wordSvasyanigraha denotes right orientation towards desired objects and retractionfrom those, after the purpose is served. This is normal & regular function carriedout by mental faculty and is termed as Dhruti.23(iii) Uho — Here in the context of Karma Chakrapani states that “Atra UhoAlocana Jnanam Nirvikalpakam”. Which Means the Jnana of Indriyas.(iv) Vicara — Cakrapani states that — “Vicharo Heyopadeyatayaa Vikalpanam.”i.e. thinking upon the perceived object in order to define it in terms of reception(Upadeya) or rejection (Heya). Thus chain of these functions can be representedas Indriyabhigraha then Uha then Vicara while Svasyanigraha is anindependent function of Manas irrespective of senses.CONCEPT OF LIFE:vÉUÏUåÎlSìrÉ xÉiuÉÉiqÉ xÉÇrÉÉåaÉÉå kÉÉËU eÉÏÌuÉiÉqÉç..( cÉ.xÉÔ 1.42)KAPHAJA UNMADA 21
  28. 28. 3CONCEPT OFMANASLife is a complex union of Body, Senses, Mind and soul. The body i.e. sarira isthat which is made up of five mahabhutas and acts as the seat to the soul forhappiness and sorrow . The sense organs like ears, eyes, etc are the seats ofindriyas. Satwa is taken as manas i.e. mind and Atma i.e. soul is theaccomplisher of knowledge. Let us see how these four are inter related to make acomplete life.RELATIONSHIP BETWEEN THE MANAS AND THE BODY:As Manas is originated from Ahamkara due to which it is called Ahamkarika, itsnourishment continues according to the different types of consumable articlesand hence Manas is also said to be Bhautika. On the basis of its Bhautikatva, itcan be said that Manas is related to the body. As far as the knowledgeproduction phenomena is concerned it can be very easily concluded that theManas has got relationship with the living body.On the basis of normalcy some definite idea cannot be presented, but in thepathological condition it is seen that if the mind is affected by some etiologicalfactors the psychological disorders will be produced, which will exhibit somedisturbance in the bodily functions also. Similarly if any bodily disease isproduced, some psychological symptoms will also be produced. Caraka has alsoaccepted this fact, and on the basis of this realization he told that the mindfollows the body and Vice Versa.24RELATIONSHIP BETWEEN THE MIND AND INDRIYAS:As The Manas is related to the body it is also related to the other sense organs.This relationship can be explained by one example regarding the process ofknowledge production. It has been stated that for the production of knowledge,four components are required viz. Atma, Manas, Indriyas and Arthas.25If and only when they are interrelated with one another, the knowledge isproduced. This relation is called ‘Sannikarsa’. First of all, the Atma unites withthe Manas. By the union of Atma, Manas assumes Cetanata and its motility willbe inspired. Then it will unite with the Indriyas, which will get the activation ofManas and Cetanata of the Atma. Finally the Indriyas will be united with theArthas and the knowledge will be produced. Here in this example, though theKAPHAJA UNMADA 22
  29. 29. 3CONCEPT OFMANASdirect contact between the Indriyas and Arthas take place, the contact of Manasand Atma is also necessary though, not apparent.RELATION BETWEEN ATMA AND MANASAccording to charaka atma is nirvikara (Uneffected by physical andpsychological ailments , cause for consciousness, nitya (perpetual and everlasting), Drasta (observer of all activities).26 Though atma is nirvikara, only whenmind comes in contact with atma one can experience pleasure or misery.MANASA PRAKRUTI: Since living being is a subtle representation of the universe, the mindin living organism is also having the three major attributes i.e., Satva, Rajas andTamas. Each individual has different temperament and mental personality basedon the predominance of these universal attributes. Satva is considered as pureand is not the cause of diseases. Rajas and Tamas are the vitiators responsible forthe manifestation of mental illness, along with the body humors Vata, Pitta, andKapha. It is the mental constitution which describes about human nature,temperament or disposition. At the time of conception Kalyanamsa, Roshamsaand Mohamsa of the gunas Satva , Rajas and Tamas27 respectively enter the Bija.The predominance of one or other determines Manasa prakriti namely Satvika,Rajasika and Tamasika. The Gunas are not simply intellectual proclivities oremotional types. They show the sensitivity of mind, its capacity to perceive andto act according to it. The following characteristics could be seen in persons withSatvika, Rajasika and Tamasika Prakrtis respectively.SATVIKA PRAKRITI:AÉlÉÑxÉÇxrÉ xÉÇÌuÉpÉÉaÉÂÍcÉiÉÉ ÌiÉiÉϤÉÉ xÉirÉÇ kÉqÉïÇ AÉÎxiÉYrÉÇ ¥ÉÉlÉqÉç oÉÑÌ®qÉåïkÉÉxqÉëÑÌiÉkÉëÑïÌiÉUlÉÍpÉwÉÇaÉxcÉ(xÉÑ.vÉÉ.18)KAPHAJA UNMADA 23
  30. 30. 3CONCEPT OFMANASKindness, Discretion in the use of articles, Forgiveness, Truthfulness,Righteousness, Faith in god, Knowledge, Wisdom, Intelligence, Memory,Firmness Non-attachment.SATVIKA GUNAS IN SRIMADBHAGAVATAM:Samam ( controlling Internal senses), Damam(controlling External senses),Titiksha( patience), Iksha( analysis of truth), Tapas( penance), Satyam(truthfulness), Daya(kindness), Smriti( memory power), Tusti ( happiness),Tyagam, Aspruha(renunciation), Sraddha(interest), Hree( shyness towardswrong actions), Svanivritti( comfort& happiness because of self experience). 28RAJASIKA PRAKRITI:SÒÈZÉoÉWÒûsÉiÉÉ AOûlÉvÉÏsÉiÉÉ AkÉëÑÌiÉUWûÇMüÉU AÉlÉëÑÌiÉMüiuÉqÉMüÉÂhrÉqÉç SqoÉÉå qÉÉlÉÈ WûwÉïÈ MüÉqÉ ¢üÉåkɶÉExcessive miseries, Roaming spirit, Unsteady nature, Pride, Falseness,Unkindness, Haughtiness, Vanity, Pleasure, Lust.TAMASIKA PRAKRITI:ÌuÉwÉÉÌSiuÉÇ lÉÉÎxiÉYrÉqÉç AkÉqÉïvÉÏsÉiÉÉ oÉÑ®åÌlÉïUÉåkÉÉå A¥ÉÉlÉqÉç SÒqÉåïkÉxiuÉqÉç AMüqÉïvÉÏsÉiÉÉ ÌlÉSìÉsÉÑiuÉÇ cÉåÌiÉDispodency or sorrowfulness, Atheism, Unrighteousness, Perverted intelligence,Ignorance, Lethargy, sleepyness.This concept gives broader idea for disease prevention, health maintenance andlongevity enhancement as well as treatment of disease. It is a unique concept ofAyurveda, which cannot be neglected.29These three main prakritis are suibdivided into 16 kaayas or satvas both bycharaka and susruta. The following are their characteristics.KAPHAJA UNMADA 24
  31. 31. 3CONCEPT OFMANASSATVIKA KAYAS Caraka Susruta1. Brahma Sattva: Purity, love for truth, Brahma-Kaya : Cleanliness of person self controlled; Power of discrimination, and conduct, belief in existence of God, material and spiritual knowledge, a constant reader of Vedas a worship power of exposition, reply and memory, and reverence of elders and preceptors, freedom from passion, anger, greed, hospitality and celebration of religious ignorance, Jealousy, dejection and sacrifice. intolerance; and Favourable disposition equally for all creatures.2. Arsa Sattva: Devotion to sacred rituals , Rishi-Kaya: Divine contemplation, sacred vows oblations, hospitable observance of vows, complete sexual disposition, freedom from pride, ego, abstinence, performance of Homas attachment, greed and anger, celebration of divine of spiritual science. intellectual excellence and eloquence and power of understanding and retention3. Aindra Sattva: Lord-ship and Mahendra-Kaya: Valour, command authoritative speech, performance of constant discussion of sastra, sacred rituals, Bravery, strength, maintenance of servants and freedom from means acts, for sighted- dependents and magnanimity. ness and devotion to virtuous acts, earning for wealth and proper satisfaction of desire.KAPHAJA UNMADA 25
  32. 32. 3CONCEPT OFMANAS4. Yamya sattva: Observance of Yamya- Kaya: Sense of duty. correctness in actions, initiation of Promptness, firmness of action courage, action, non-violability, readiness for purity and absence of anger, illusion, initiating action, memory and lordship, fear and malice. freedom from attachment, envy, hatred and ignorance.5. Varuna Sattva; Bravery, patience, purity Varuna- Kaya: Liking for exposure to and dislike for impurity: observance of cold, forbearance, a brown hue of religious rites fondness for aquatic pupils, golden color of the hair and sports, a version for mean-acts, and sweet speech. exhibition of anger and pleasure in proper place.6. Kaubera Sattva: possession of station, Kaubera-kaya : Arbitration of disputes, honors, luxuries and attendant, constant capacity of bearing hardships, earning liking of virtuous acts, wealth and and accumulation propagation of satisfaction of desire, purity and liking fertility. for pleasure of recreation.7. Gandharva Sattva: Fondness for Gandharva – Kaya: Love for garlands dancing, Singing, music and praise, and perfumes, fondness for songs and expertness in poetry, singing, stories , music and rover. historic narration and epics, constant fondness, for scents, garlands, unguents appares, association of women and men and passion.RAJASA KAYAS1 Asura satva : bravery, cruelty, envy, Asura kaaya: Affluent in circumstances, lordship, movement in disguise, dreadful, fearless, jealous of others terrifying appearance, excellence, greedy , hot-tempered , fond truthlessness,indulge in self praise. of eating, eats without sharing.2 Rakshsa satva: Intolerance constant Rakshasa kaaya: solitary in his habits, anger, violence at weak points, cruelty, fierce, jealous of others excellence, greedy , fond ness for non vegetarian externally pious, extremely ignorant. food, excessive sleep and laziness, envious disposition.KAPHAJA UNMADA 26
  33. 33. 3CONCEPT OFMANAS3 Paisacha satva : Greedy, fondness for Paisacha kaya: eats food left by others, women, liking for staying with women in irritable temper, rashness lonely place, unclean habbits, disliking shamelessness, materialism, liking for cleanliness, cowardice and terrifying towards women. disposition,resorting to abnormal diet and regimens.4 Sarpa satva: bravery in furious mental Sarpa kaya: Irritable, laborious, state, cowardice when he is not angry. cowardly, angry, double dealing, hasty Sharp reaction, excessive lethargy, in eating, unsteadyness. experiencing fear while walking, taking food and other vihaaraas.5 Preta satva: Excessive desire for food, Preta kaya: will not share his things excessively sorrowful nature(aachaara, with others, lazyness miserableness, upachaara), enviousness, actions without jealous, greedy, never gives daana. discrimination, excessive greediness and inactivity.6 Sakuna satva: attachment with passion, Sakuna kaya: excessive indulgence in excessive food and regimens, sexual act, eats incessantly, intolerance, unsteadiness, ruthlessness, un unsteady mind. acquisitiveness.TAAMASA KAYAS1 Pasu satva: unable to solve his problems, Pasu kaya: perversion of intellect, lack of intelligence, embarrassing food tightfistedness, frequent sexual dreams, intake and life style, always indulges in indecisive. sex , excessive sleep.2 Matsya satva : cowardice, lack of Matsya kaya: unsteadyness stupidity, intelligence greediness for food, cowardice, fond of quarrel, liking unsteadyness, excessive kaama krodha, towards water. always moves from here to there, liking towards water.KAPHAJA UNMADA 27
  34. 34. 3CONCEPT OFMANAS3 Vanaspatya satva: lazyness, indulgence Matsya kaya: fondness towards staying in food, deficiency of all intellectual at a same place, constant eating absence faculties. of dharma artha kaama.This concept of classifying people into number of groups and sub groups is veryunique in nature. Lot of study is required in this field for understanding thedepth of manasa vignyana in Ayurveda.FACULTIES RELATED TO MANASDhi, Dhrti and Smrti are the three main faculties which are closely related toManas. A brief description about these three is given below:1.Dhi (Buddhi): oÉÑÌ®ÌlÉï¶ÉrÉÉÎiqÉMüÉ.30Dhi or Buddhi which is synonymous to Prajna and Mahat, is an Atmaguna. Itpersists beyond the Manas-level. Like Manas, the seat of Buddhi is alsodescribed as hridaya.31The function of Buddhi is decision-making or determination of what Manasplaces before either arthas or knowledge perceived through Indriya. Inconsequence of variety of actions and sensuous objects, Buddhi has beenregarded as of various kinds eg:- Panchendriya Buddhi.322.Dhruti: kÉëÑÌiÉÌWïû ÌlÉrÉqÉÉÎiqÉMüÉ 33Dhruti is the power of will, which controls Manas from the various vikaras ortemptation of the harmful objects.3. Smruti: xqÉUhÉÉiÉç xqÉëÑÌiÉÈ34The recollection of past is called as Smruti. There are three types of Smruti asdrushta (seen) Sruta (heard) and Anubhuta (felt, experienced). This getsregistered in memory and could be recalled due to the following eight factors:KAPHAJA UNMADA 28
  35. 35. 3CONCEPT OFMANASNimitta (Causative factors)Rupa (Size and shape)Sadrusya (Similarity)Viparyaya (Contrariety, difference)Satvanubandha (quality of Satvaguna, concentration)Abhyasa (frequent Recapitulation)Jnanayoga (Acquisition of knowledge or inborn capacity)Punasruta (Rehearing)The person having Uttama satva or Satvika prakriti possesses good memorypower. Thus these faculties along with the Manas form the psychic sphere of thehuman being and control the mental life of a person. GENESIS OF KNOWLEDGE BUDDHI (INTELLECT) DHEE DHRITI SMRITI III UHA VICARA INDRIYANIGRAHA I SWANIGRAHA II MANAS INDRIYA OBJECTFig.1-Phenomenon Of Knowledge ProductionIndriyabhigrahah Karma Manasah SvasyanigrahahUho Vicarasca Tatah param Buddhi pravartateKAPHAJA UNMADA 29
  36. 36. 3CONCEPT OFMANASCONCEPT OF SATVASatva has genetic endowment as it is inherited at the time of conception and thispart of the nature gets nurtured in the womb especially by the influence of ‘satvavaiseshikakara bhavas’ and also by the influence of ‘dharma’ & ‘achara’ duringinfancy, childhood and adolescence and based on their characteristics they areclassified into about 16 types. Though these classifications help to understandthe mental disposition better, Caraka has utilized the concept of ‘Satva bala‘ indetermining the predisposition to develop mental illness. So understanding theconcept of satva bala provides useful insight into the details of predisposingpersonality and also into the normal and abnormal patterns of behavior.SATVA BALAMental strength is graded into three viz., superior, medium and inferior. Thosewith superior mental strength can well withstand mental trauma. Those withinferior mental strength are incapable to suffer even trivial trauma and pain.And those with medium strength can afford to take hardships if consoled to doso.35SATVA SARA PURUSHA LAKSHANAS :Individuals having the excellence of all the mental faculties are said to be satvasara purushas. They are endowed with good memory, devotion greatfullness,wisdom, purity, excessive enthusiasm, skill, courage, valour in fighting, absenceof sorrow, proper gait, depth of wisdom, sincerity in actions and virtous acts.36CHARACTERISTIC FEATURES OF NORMAL PERSONALITIESThe word ‘normal’ comes from the Latin ‘norma’ which means a carpenter’ssquare. In other words normal person is he who does his daily routinenormally, activities in a normal manner, takes decisions thoughtfully and obeysKAPHAJA UNMADA 30
  37. 37. 3CONCEPT OFMANASsocial rules and norms at a limit. They are the madhyama satva individuals withnormal state of rajas and tamas. The characteristic features are as follows:Jnanam, Buddhi - having knowledge of right and wrong.Medha, Smŗti - having good cognitive functions.Satya, Dharma, Astikyam - sociable i.e., possessing the characteristics ofprotecting law and respecting as well as accepting the social norms.Titiksha, Dhŗti, Anabhishanga - adjustable with situations in life.Dukha, Vishada, Kama, Krodha, Dambha, Ahamkara, Mana, Harsha-adequateemotionality , expressing emotions according to the need of situation to anextent and in accordance to the majority of people of his society.FACTORS INFLUENCING PHYSIOLOGY OF MANAS:AT METAPHYSICAL LEVEL:ATMA- It is Atma, which gives Cetanatva to the Manas, by which Manas canattain its Kartritva.AT INTELLECTUAL LEVEL:BUDDHI- The characteristic of Atma, influences Manas through its threedimensions viz.,Dhee: Proper judgmentDhriti: Controlling powerSmriti: Recall or Memory.37Functional dimensions of Manas:Sattva: KnowledgeRajas: ActionTamas: RegulationThese factors also influence the physiology of the mind at Intellectual level.AT PHYSICAL LEVELKAPHAJA UNMADA 31
  38. 38. 3CONCEPT OFMANAS The Karmas of Manas in gross body occur through the functional faculty ofbody i.e. Tridosa. Manas activates bodily functions through the ‘ Cala’ guna ofvata, Artha Grahana, Medha, and Buddhi all these activities of manas occurthrough ‘Tikshna’ guna of pitta. Manas influence the stability of bodily functionsthrough ‘Sthira’ guna of kapha.TRIDOSHAS & MANAS- Following are the references where doshas arerelated to manas , its sthanas , & its karmas.VAYU:ÌlÉrÉliÉÉ cÉ qÉlÉxÉÈ 38Vaayu is said to be the Controller and stimulator for Manas.Prana: oÉÑÌ®È ¾ÒûSrÉåÎlSìrÉ ÍcɨÉkÉëÑMç 39Prana vaayu is present in hridaya indriya, budhi & citta where its influence can be felt.Udana: ….xqÉëÑÌiÉ Ì¢ürÉÉ 40 udaana vata is responsible for memory and action.Vyana: mÉëÉrÉÈ xÉuÉÉïÈ Ì¢ürÉÉÈ 41 All physical and mental activities are controlled byVyanavata.PITTA:Sadhaka: xÉÉkÉMüÇ ¾ÒûªiÉqÉç ÌmɨÉqÉç Sadhaka pittam is present in hridayaoÉÑÌ® qÉåkÉÉ AÍpÉqÉÉlɱæ 42 intellect, likings are controlled by sadhaka pittamKAPHA: Normal mental functions like, concentration, tolerance, endurance isunder the control of Normal functions of Kapha43SAPTADHATUS & MANAS-Many Dhatus have functions related to Manas and also some mental factorsdirectly vitiate some Dhatus.RASA: ÍcÉlirÉÉlÉÇ cÉ AÌiÉÍcÉliÉlÉÉiÉç 44 Rasa dhatu gets vitiated due to excessive thinkingof unnecessary things.RAKTA: Ì¢ürÉÉlÉÉqÉç AmÉëÌiÉbÉÉiÉqÉç Rakta dhatu helps in normal mental functions,KAPHAJA UNMADA 32
  39. 39. 3CONCEPT OFMANASAmoham Buddhi karmanam Rakta dhatu also helps in distinct knowledge,perception, and action stimulation.MAMSA: A¤ÉasÉÉÌlÉ 45MEDAS: xÉÑZÉÉÍpÉwÉÇaÉ, AÉsÉxrÉ, kÉÏUiÉÉ 46 Medo dhatu causes comfort, laziness, courage.ASTHI: Srama47, Toda 48 Vitiation of Asthi dhatu causes tiredness. Mohotsaha,Asthi dhatu causes attachment and enthusiasm.MAJJA: Bala 49 Majja dhatugives strength,Bhrama, Murcha. Vitiation of Majja dhatu causes confusion and fainting)Tamodarshana 50SHUKRA: Harsha, Dhairya, Preeti, Ananda, Kama. Sukra dhatu causeshappiness, courage, liking, bliss, interest.OJAS AND MANAS. It is the essence of all Dhatus through which mind and body are related.Both mind and ojas are seated in Heart. Ojas is depleted by mental emotionssuch as Anger, Grief 51When Ojas is depleted, the person becomes fearful, worried, and his facultieswill not be functioning properly. He will lack enthusiasm52. On the contrary,increase of Ojas is conducive to the proper functioning of mind 53The description of the influencing factors on the physiology of Manas andparticularly influence between Manas and Sharira can be easily understoodthrough this shloka:“ zÉËUUqÉç ÌWû AÌmÉ xɨuÉqÉlÉÑÌuÉkÉÏrÉiÉå, xɨuÉqÉç cÉ zÉËUUqÉç ” 54Caraka gives much importance to Sparsanendriya; according to him, “The senseof touch alone pervades all the senses. It is permanently associated with mind.The mind again pervades the sense of touch. The latter, in turn pervades all thesenses55. This clearly indicates the importance of sparsanendriya. No sensationoccurs without the sense of touch. For perception of their artha all IndriyasKAPHAJA UNMADA 33
  40. 40. 3CONCEPT OFMANASrequire the sense of touch. Hence, the relation of Manas with twak, theadhisthana of Sparsanendriya is explained in scientific manner, by Caraka. ATMA VATA PITTA KAPHA BUDDHI DHEE MANAS DHRITI TWAK SMRITI (SPARSANENDRIYA ADHISTHANA) RASADI SATTVA DHATUs RAJAS OJAS TAMASFig.2-Factors Influencing Physiology of ManasMANOVAHA SROTAS The detailed description of Manovahasrotas is not seen in the‘Srotovimana’, i.e., along with other srotases, even though 13 cannels areenumerated for humors . It is however said that vata, pitta and Sleshma traversethe entire body through kinds of Srotamsi along with the Manasika doşas, whichare beyond sense perception. Hence the entire sentient body is their vehicle andfield of the operation. Classical literature regarding the channels does not directly enumerate thechannels of mind In the context of Unmada and Apasmara, Caraka hasmentioned about Manovaha Srotas, but also in other contexts like Mada,Murccha, and Sanyasa different other terms like “Cetanavahi Srotas,”“Samjnavahi Srotas” are used. These terms can be taken as synonyms forManovaha Srotas.56KAPHAJA UNMADA 34
  41. 41. 3CONCEPT OFMANAS UNDERSTANDING HUMAN BRAINTo interpret the manasa vignyana to this modern era we need a detailedknowledge of brain , its functions and the factors that influence brain.Neuroanatomy is the branch of anatomy that studies the anatomicalorganization of the nervous system. In vertebrate animals, the routes that themyriad nerves take from the brain to the rest of the body (or "periphery"), andthe internal structure of the brain in particular, are both extremely elaborate. Asa result, the study of neuroanatomy has developed into a discipline in itself,although it also represents a specialization within neuroscience. The delineationof distinct structures and regions of the brain has figured centrally ininvestigating how it works. The human nervous system is divided into thecentral and peripheral nervous systems. The central nervous system consists ofthe brain and spinal cord, and plays a key role in controlling behavior.The peripheral nervous system is made up of all the neurons in the body outsideof the central nervous system, and is further subdivided into the somatic andautonomic nervous systems. The somatic nervous system is made up of afferentneurons that convey sensory information from the sense organs to the brain andspinal cord, and efferent neurons that carry motor instructions to the muscles.The autonomic nervous system also has two subdivisions. The sympatheticnervous system is a set of nerves that activate what has been called the "fight-or-flight" response that prepares the body for action. The parasympathetic nervoussystem instead prepares the body to rest and conserve energy.Following are the parts of brain and their functions.Brain FunctionStructureCerebral The outermost layer of the cerebral hemisphere which isCortex composed of gray matter. Cortices are asymmetrical. Both hemispheres are able to analyze sensory data, perform memory functions, learn new information, form thoughts and make decisions.Left Sequential Analysis: systematic, logical interpretation ofKAPHAJA UNMADA 35
  42. 42. 3CONCEPT OFMANASHemisphere information. Interpretation and production of symbolic information:language, mathematics, abstraction and reasoning. Memory stored in a language formatRight Holistic Functioning: processing multi-sensory inputHemisphere simultaneously to provide "holistic" picture of ones environment. Visual spatial skills. Holistic functions such as dancing and gymnastics are coordinated by the right hemisphere. Memory is stored in auditory, visual and spatial modalities.Corpus Connects right and left hemisphere to allow for communicationCallosum between the hemispheres. Forms roof of the lateral and third ventricles.Frontal Lobe Front part of the brain; involved in planning, organizing, problem solving, selective attention, personality and a variety of "higher cognitive functions" including behavior and emotions. The anterior (front) portion of the frontal lobe is called the prefrontal cortex. It is very important for the "higher cognitive functions" and the determination of the personality. The posterior (back) of the frontal lobe consists of the premotor and motor areas. Nerve cells that produce movement are located in the motor areas. The premotor areas serve to modify movements. The frontal lobe is divided from the parietal lobe by the central culcus.Parietal Lobe One of the two parietal lobes of the brain located behind the frontal lobe at thetop of the brain. Parietal Lobe, Right - Damage to this area can cause visuo-spatial deficits (e.g.the patient may have difficulty finding their way around new, or even familiarplaces). Parietal Lobe, Left - Damage to this area may disrupt a patientsKAPHAJA UNMADA 36
  43. 43. 3CONCEPT OFMANAS ability to understand spoken and/or written language. The parietal lobes contain the primary sensory cortex which controls sensation (touch, pressure). Behind the primary sensory cortex is a large association area that controls fine sensation (judgment of texture, weight, size, shape).Occipital Region in the back of the brain which processes visualLobe information. Not only is the occipital lobe mainly responsible for visual reception, it also contains association areas that help in the visual recognition of shapes and colors. Damage to this lobe can cause visual deficitsTemporal There are two temporal lobes, one on each side of the brainLobe located at about the level of the ears. These lobes allow a person to tell one smell from another and one sound from another. They also help in sorting new information and are believed to be responsible for short-term memory. Right Lobe - Mainly involved in visual memory (i.e., memory for pictures and faces). Left Lobe - Mainly involved in verbal memory (i.e., memory for words and names).KAPHAJA UNMADA 37
  44. 44. 3CONCEPT OFMANASLimbic The limbic system includes the structures in the human brainSystem involved in emotion, motivation, and emotional association with memory. The limbic system influences the formation of memory by integrating emotional states with stored memories of physical sensations The limbic system includes many different cortical and subcortical brain structures Amygdala: Involved in signaling the cortex of motivationally significant stimuli such as those that are reward and fear related; Hippocampus: Required for the formation of long-term memories Cingulate gyrus: Autonomic functions regulating heart rate and blood pressure as well as cognitive and attentional processing; Fornicate gyrus: Region encompassing the cingulate , hippocampus , and parahippocampal gyrus; Hypothalamus: Regulates the autonomic nervous system via hormone production and release. Affects and regulates blood pressure, heart rate, hunger, thirst, sexual arousal, and the sleep/wake cycle; Mammillary body: Important for the formation of memory; Nucleus accumbens: Involved in reward, pleasure, and addictio; Orbitofrontal cortex: Required for decision making; Parahippocampal gyrus: Plays a role in the formation of spatial memory and is part of the hippocampus;Basal Ganglia Subcortical gray matter nuclei. Processing link between thalamus and motor cortex. Initiation and direction of voluntary movement. Balance (inhibitory), Postural reflexes. Part of extrapyramidal system: regulation of automatic movement.KAPHAJA UNMADA 38
  45. 45. 3CONCEPT OFMANASSTRUCTURES OF DIENCEPHALON (with in the cerebrum & continues withthe midbrain).Brain FunctionStructureThalamus Processing center of the cerebral cortex. Coordinates and regulates all functional activity of the cortex via the integration of the afferent input to the cortex (except olfaction). Contributes to affectual expression.Hypo Integration center of Autonomic Nervous System (ANS): Regulation ofthalamus body temperature and endocrine function. Anterior Hypothalamus: parasympathetic activity (maintenance function). Posterior Hypothalamus: sympathetic activity ("Fight" or "Flight", stress response. Behavioral patterns: Physical expression of behavior. Appestat: Feeding center. Pleasure center.Internal Motor tracts.CapsuleReticular Responsible for arousal from sleep, wakefulness, attention.ActivatingSystemTHE CEREBELLUM AND THE BRAIN STEMBrainStructure FunctionCerebellum The portion of the brain (located at the back) which helps coordinate movement (balance and muscle coordination). Damage may result in ataxia which is a problem of muscle coordination. This can interfere with a persons ability to walk, talk, eat, and toKAPHAJA UNMADA 39
  46. 46. 3CONCEPT OFMANAS perform other self care tasks.Brain Stem:Midbrain Nerve pathway of cerebral hemispheres. Auditory and Visual reflex centers. Cranial Nerves: CN III - Oculomotor (Related to eye movement), [motor]. CN IV - Trochlear (Superior oblique muscle of the eye which rotates the eye down and out), [motor].Pons Respiratory Center. Cranial Nerves: CN V - Trigeminal (Skin of face, tongue, teeth; muscle of mastication), [motor and sensory]. CN VI - Abducens (Lateral rectus muscle of eye which rotates eye outward), [motor]. CN VII - Facial (Muscles of expression), [motor and sensory]. CN VIII - Acoustic (Internal auditory passage), [sensory].Medulla Crossing of motor tracts takes place hereOblongata Cardiac Center.Respiratory Center. Vasomotor (nerves having muscular control of the blood vessel walls) Center Centers for cough, gag, swallow, and vomit. Cranial Nerves: CN IX - Glossopharyneal (Muscles and mucous membranes of pharynx, the constricted openings from the mouth and the oral pharynx and the posterior third of tongue.), [mixed]. CN X - Vagus (Pharynx, larynx, heart, lungs, stomach), [mixed]. CN XI - Accessory (Rotation of the head and shoulder), [motor]. CN XII - Hypoglossal (Intrinsic muscles of the tongue), [motor].KAPHAJA UNMADA 40
  47. 47. 3CONCEPT OFMANASNEUROENDOCRINOLOGY:It is the study of the interactions between the nervous system and the endocrinesystem. The concept arose from the recognition that the secretion of hormonesfrom the pituitary gland was closely controlled by the brain, and especially bythe hypothalamus Neuroendocrine neurones control the gonads – and gonadalsteroids in turn influence the brain; and so do corticosteroids secreted from theadrenal gland under the influence of ACTH. The peptides secreted byhypothalamic neuroendocrine neurons into the blood proved to be released alsointo the brain, and the central actions often appeared to complement theperipheral actions. Neuroendocrine systems regulate things that matter to mostof us. They control reproduction in all its aspects, from bonding to sexualbehavior, they control spermatogenesis and the ovarian cycle, parturition,lactation and maternal behaviour. They control the way we respond to stressand infection. They regulate our metabolism – they influence our eating anddrinking behaviour, and influence how the energy intake is utilised – i.e. how fatwe become. They influence our mood. They regulate body fluid and electrolytehomeostasis, and blood pressure. In other words, these are systems of centralimportance to many problems that are major health concerns, as well assometimes of intimate personal interest.ENDOCRINE PATHOLOGY AND DEPRESSION. About half of patients with Cushing’s syndromes suffer from majordepression, which usually remits when the cortisol hypersecretion is corrected.Depression also occurs in Addison’s disease, hypothyroidism andhyperparathyroidism. Endocrine changes may account for depressive disorders occuringpremenstruallly, during the menopause, and after childbirth.Hypothalamic pituitary –adrenal (HPA) axis. In about half of patients whose depressive disorder is at least moderatelysevere, plasma cortisol secretion is increased throughout the 24-hour cycle.KAPHAJA UNMADA 41
  48. 48. 3CONCEPT OFMANASDexamethasone non suppression is more common in depressed patients withmelancholia. The cause of cortisol hyper secretion in depressed patients is not clearlyestablished. There seem to be abnormalities at various points in the HPA axis,including:· Increased cortical response of the adrenal gland to ACTH.· Increase number of ACTH secretary episodes.· Blunted ACTH response to pharmacological challenge with corticotropin-releasing hormone (CRH). The blunted ACTH response to CRH challenge isproposed to result from a down regulation of CRH receptors as a consequence ofincreased endogenous CRH release.Thus we can understand the importance of nervous system and endocrinalsystem in controlling the psychological behavior of a person.REFERENCES 1. Ca.Su.1/42 2. Ca.su.1.48 3. Ca. Sa. 1/18 4. Ca. Sa. 1/18 5. Ca. Sa. 3/13 6. Ca.Su.8/4 7. Ca.Sh.1/56 8. Ca.Sh.1/136 9. Ca.Sh.1/21-22 10. Ca. Su.8/4, As. Sa.5/22, Shabda Ratnavali, Amarkosa 1/4/3 11. Mahabharata santi parva. 12. Ca.S. 3/21 13. Ca.S.7/8,Su.S.4/34,Ah. S.4/21 14. Su.17/12 15. Bhe.Ci 8/25 16. Ca. Vi. 5/7KAPHAJA UNMADA 42
  49. 49. 3CONCEPT OFMANAS 17. Ca.Ci. 24/34 18. C.Su.8/5 19. C.Su. 11/38, C.S. 1/133-135 20. Ca.S.4/36 21. Ca.S.1/19 22. Ca.S.1/21 23. Chakra. C.Sa.1/100 24. Ca.S.4/36 25. Ca.S.1/32-34 26. Ca. Su.1.56 27. Ca.Sh.4/36 28. Bha,11. 75 29. Ca.Sh.4/37-39 30. Ca.S.1 31. Ca.Su.30/4 32. Ca.Su.8/3 33. Ca.S.1/100 34. Ca.S.1/101 35. Ca.Vi. 8/119 36. Ca.Vi. 8/110 37. Ca. Sa. 1 38. Ca.Su. 12/8 39. Ah.Su.12/4 40. Ah. Su. 12/5 41. Ah. Su. 12/6 42. Ah.Su.12/3 43. Ah. Su. 11/3 44. Ca. Vi. 5 45. Ah.Su. 11 46. Su. Su. 15/5 47. Ca. Su. 17/67KAPHAJA UNMADA 43
  50. 50. 3CONCEPT OFMANAS 48. Su. Su. 17/9 49. Ca. Su. 13/17 50. Ca. Su. 27/7 51. Su. Su. 15/23 52. Ah. Su. 11/39 53. Ah.Su. 11/41. 54. Ca. Sa. 3/19 55. Ca.Su. 11/38. 56. Ca.su.24/25, Ca. Ni. 7/4, and Ca. Ci. 9/5, Su. U. 61/10. ******KAPHAJA UNMADA 44
  51. 51. 4REVIEW OF LITERATURE ONUNMADA REVIEW OF LITERATURE ON UNMADAUnmada is the most elaborately dealt with manoyadhi in Ayureda. Charakathe celebrated authority on internal medicines considers it under the eightmahagadas. He deals with this subject in the section on nidana and chikitsain his treatise, charakaamhita. Vagbhata, following sushruta describesunmada in uttarasthana of his treatise Ashtangasangraha andAshtangahridaya after the chapter on graha and bhuta chikitsa like jwara,prameha, kushta and others. Unmada is caused on account ofmityaharavihara (unwholesome food and improper psycho behaviouralactivities) which impairs the three doshas viz, Vata, Pitta, Kapha. In unmadamanas or manasdoshas viz Rajas & Tamas are also affected to such an extentthat the treatment administrated to restore the imbalance of Tridoshas alonewill not be sufficient. Certain measures to correct the manasdoshas involvedwill also be essential to bring the patient back to normalcy. Therefore unmadaassumes a place of greater importance.NIRUKTI (ETYMOLOGY) –ElqÉÉS- ElÉç/ ESè + qÉS ElÉç/ ESè- FkuÉïi.e. upward direction qÉS- qɱiÉå, qɱÌiÉ CÌiÉ qÉS i.e.that which causes intoxication, excitement or that which is an uncontrolled force. Though the prefix ‘ud’ means upward direction in this context the ‘overflow’ or ‘beyond the limit would be an appropriate meaning. Hence from Nirukti it can be comprehended that Unmada is a disease related to the uncontrolled or excited mental state.KAPHAJA UNMADA 44
  52. 52. 4REVIEW OF LITERATURE ONUNMADACharaka defines Unmada as,"FlqÉÉSÇ mÉÑlÉÈ qÉlÉÉåoÉÑή xÉÇ¥ÉÉ¥ÉÉlÉ xqÉëÑÌiÉpÉÌ£ü zÉÏsÉ cÉååû¹ÉcÉÉU ÌuÉpÉëqÉqÉç ÌuɱÉiÉç " 1 Unmada is Impairment or perversion in the mental functions and aspects of mind like Intellect, Orientation, Knowledge, Memory, Desire, Conduct, Behavior and Psychomotor activity According to Susruta, Unmada is a distraction of mind due to the upward movement of doshas. 2 Vagbhata’s opinion is also in a similar manner and he has given more emphasis on the involvement of both Sarira and Manas doshas.3 Harita says that in Unmada doshas get deviated from their pathway to go in upward direction for the manifestation of disease. 4 Bhela describes that doshas get aggravated and vitiate Manas, which goes to siras and causes dysfunction of indriyas. Simultaneously they cause vitiation of Citta and Buddhi to produce Unmada.5 Madhavanidana6 has accepted Susruta’s opinion. Among all above definitions, definition by Charaka could be termed as complete as it gives a clear introduction of disease. Of the eight aspects considered in definition, the first five represents different dimension of Manas and latter three, its reflections.1.MANOVIBHRAMA:ÍcÉlirÉÉlÉjÉÉïlÉç lÉ ÍcÉlirÉiÉå, AÍcÉlirÉÉxcÉ ÍcÉliÉrÉiÉå 7As the Main object of the mind is thinking, in Manovibhrama thinking abilityis impaired e.g. Pressure of thoughts, thought block, etc. Things on whichthought process is required will be neglected, thinking about unnecessaryissues will be seen.KAPHAJA UNMADA 45
  53. 53. 4REVIEW OF LITERATURE ONUNMADA2.BUDDHIVIBHRAMA:oÉÑήÌuÉpÉëqÉÉiÉç iÉÑ ÌlÉirÉqÉç AÌlÉirÉÍqÉÌiÉ,ÌmÉërÉqÉç cÉ AÌmÉërÉÍqÉÌiÉ 7In Buddhi vibhrama, the patient looses the ability of ‘Guna-dosa vivecana’and hence, will not have proper intelligence, decision, and understanding ofany sort of things and perceives ever lasting things as temporary things, goodas bad and wants as don’ts, etc.3.SAMJNAJNANA VIBHRAMA:…AalrÉÉÌS SÉWûqÉç lÉ oÉÑSèkrÉiÉå, ÌMüqÉç uÉÉ zÉÇ¥ÉÉ lÉÉqÉÉåssÉåZÉlÉ ¥ÉÉlÉqÉç 7Cakrapani interprets that, in Samjnajnana Vibhrama, a person does not feelthe hotness of fire, or he will loose the power of denomination (Naming,Identifying ability).4.SMRITI VIBHRAMA:...lÉ xqÉUÌiÉ, ArÉjÉÉuÉiÉç uÉÉ xqÉUÌiÉ 7In Smriti Vibhrama, the patient completely looses memory or recollectsincorrectly.5.BHAKTI VIBHRAMA:...rɧÉåcNûÉ TÔüuÉïqÉÎxiÉ iɧÉÉÌlÉcNûÉ pÉuÉÌiÉ 7Here, the patient loses desires and needs like, food, dress, sleep, which weredearer to him previously.6.SHEELA VIBHRAMA:………… A¢üÉåkÉlÉÈ ¢üÉåkÉlÉÉå pÉuÉÌiÉ 7KAPHAJA UNMADA 46
  54. 54. 4REVIEW OF LITERATURE ONUNMADAHabits are totally impaired in Unmada. Sometimes mood swings may changehabits of a person. A person with out anger exhibits fury.7.CESTA VIBHRAMA:……… cÉåxOûÉ ÌuÉpÉëqÉÉiÉç AlÉÑÍcÉiÉ cÉåxOûÉ pÉuÉÌiÉ 7Psychomotor activities are totally inappropriate, along with speech, and facialexpressions rendering him to behave irrelevantly.8.ACHARA VIBHRAMA:……… AÉcÉÉU ÌuÉpÉëqÉÉiÉç AzÉÉæcÉÉÌS AÉcÉUÌiÉ 7Conduct of Unmada patient becomes totally incongruent to the situation &place.Nidana, Samprapti, purvarupa, rupa, differential diagnosis,saadhyaasaadhyata, general treatments of manasa rogas, unmada chikitsa willbe described under this section in the following chapters.KAPHAJA UNMADA 47
  55. 55. 5NIDANA NIDANAThe knowledge of Ayurvedic Cikitsa is based on Trisutram i.e. Hetu (Causativefactors), Linga (Signs and Symptoms) and Aushadhi (Therapeutics).8 Amongthem, Hetu plays an important role both in the Samprapti (etiopathogenesis) andCikitsa (Therapeutic aspect). Every Hetu can produce its separate Samprapti(Pathogenesis) and hence Nidana Parivarjana(avoiding the causes of diseases) ishalf of Cikitsa as it breaks the continuity of Pathogenesis. Madhavakara states thatthere may be only one causative factor for many diseases, many causes for onedisease or only one cause for one disease and many causes for many diseases.9Manasa vyadhis come under the second category, i.e. many causes for onedisease. Modern psychiatry also opines that causes of mental illness are alwaysmultifactorial. NIDANA OF UNMADA ACCORDING TO VARIOUS CLASSICS Nidana Carakasamhita Bhava prakasha Madhavanidana 1. Viruddha bhojanam + + + 2. Dusta Bhojanam + + + 3. Asuchi Bhojanam + + + 4. Deva Pragharshanam + + + 5. Guru Pragharshnam + + + 6. Dwija Pragharshnam + + + 7. Vishama Chesta + + + 8. Bhaya + + + 9. Harsha + + + 10. Manobhighata + + + Unmada Hetu can be classified into three groupsKAPHAJA UNMADA 48
  56. 56. 5NIDANA1.Abhyantara and Bahya2.Prajnaparadha, Asatmyendriyarthasamyoga and Parinama3.Nija and Agantu1.Abhyantara and Bahya:a)Abhyantara hetu:‘Abhyantara’ means causes present within the body. It includes Sarira dosa,Manasa doshas, Satvaguna and also Manasaprakrti. The condition of Dhi, Dhrtiand Smrti, Vyadhikshamatva and Dehabala are also contributory factors.Manasa prakrti determines Manobala of a person, i.e. capacity to withstand stress.If this capacity is less, a person is prone to get disease. Hence it is a majorpredisposing factor. Persons with Rajasa or Tamasa prakrti and with less Satvaguna (Alpasatva), Vibhramsa of Dhi, Dhrti and Smrti (imbalanced state), with lowphysical strength due to various diseases, are more prone to Unmada.10b)Bahya hetu:Bahyahetus are external environmental factors, which include Ahara, Vihara, andManoabhighata.11i. Ahara:ii. Vihara:iii. Manoabhighata:2. Prajnaparadha, Asatmyendriyarthasmyoga and Parinamaa) Prajnaparadha:It is vibhramsa of Dhi, Dhrti and Smrti which results in failure of decision makingand controlling mind from harmful objects.12 This may be the cause of allMithyaharavihara.b) Asatmyendriyarthasamyoga:It is the excessive or deficient contactof the senses with their objects or theperversion of the perception13 which results in Indriyadushti, Pranadushti,provocation of Rajas - Tamas and thereby Unmada.KAPHAJA UNMADA 49
  57. 57. 5NIDANAc) Parinama:The parinama term literally means effect. The other meaning of parinama is Kala(time). Kala carries effect of good or bad deeds done in the past. It is as aKarmavipaka, one of the main causes of Unmada.3) Nija and Agantuja:The classification of hetu in Nija and Agantu types is another way ofcategorization but it expresses the same meaning as Abhyantara and Bahya hetu.For example, Nija hetu comprehends all the intrinsic factors as Manasa and Sariradoshas, Krodhadi all vikaras, Satva of a person etc.Agantu hetu include all the extrinsic or exogenous factors like traumas, stressors,poisons and so on.Thus every causative factor is capable of leading a separate Samprapti(pathogenesis) to produce the vyadhi.EFFECT OF ABOVE FACTORS ON MIND1.Viruddha,Dusta and Asuchi Bhojanam: Viruddha Ahara is a unique concept ofAyurveda which means combination of different kinds of eatables having contrastqualities such as Rasa, Guna, Virya, Vipaka, etc. e.g. milk and fish. Suchcombinations after digestion provoke doshas (Utklesha), vitiate Hridaya,Majjavaha and Rasavaha srotasas and produce poisonous effects in the body.Dushta, Asuci Ahara means unhygienic, stale, poisonous food. Intake of food byviolating dietary regimen also produces similar effect as viruddhahara afterdigestion. These incompatible poisonous and unhygienic foods directly decreasethe satwikata of mind, which increases rajo tamogunas leading to unmada.2. Deva ,Guru and Dwija Pragharshnam: Insulting teachers, dwijas and gods is asinful act which creates Karmavibhramsa. Their curse is powerful enough tocause vitiation in the mind resulting in unmada.KAPHAJA UNMADA 50
  58. 58. 5NIDANA3.Bhaya Harsha purva mano abhighata: Too much of happiness and too much ofsorrow makes the mind susceptible to desire, anger, jealousy, greed, pride andprejudice etc which in turn cause unmada. The Alpasatva person cannot bearvarious sorrowful or stressful events in day-to-day life which leads to suddenshocks, like death of partner or loss of wealth, loss of employment, divorce. Hencethey result in the distortion of mind resulting in unmada unmada.4.Vishama chesta: Abnormal motor activities such as abnormal postures, postureson uneven surface, beating, excessive exercise and Violation of Sadvritta orbehavioral regimen are the major causative factors coming under this group.Vishamacesta and Sadvritta aparipalana both can cause physica1 and mentalexertion, which is conducive to Unmada. Disagreeable behavior such as misusageor excessive usage of the senses, or the perversion of the perception14 results inIndriyadushti, Pranadushti, provocation of Rajas – Tamas, which leads tovitiation of manas causing unmada.SPECIFIC DOSHAJA NIDANAI) Vataja nidana: Intake of Rooksha bhojana, Sheeta, Alpa bhojana, Excess use ofVamana Virechana, excess dhatu kshaya, Prolonged fasting, exceess grief. Thesefactors aggravate Vata dosha along with vitiation of mind causing Vatajaunmada.KAPHAJA UNMADA 51
  59. 59. 5NIDANA2) Pittaja Nidana: Ajeerna, Intake of atikatubhojana, Atiamlabhojana vidahibhojana, sheeta bhojana. These factors aggravate Pitta dosha along with vitiationof mind causing Pittaja unmada3) Kaphaja nidana: Mandacheshta, Adhika santarpana, leading a sedentory lifeaggravates Kapha dosha along with vitiation of mind causing Kaphaja unmada.4) Sannipataja nidana: Intake of all such above mentioned nidanas of tridoshascauses sannipataja unmada.5) Manasa unmada: Adhika shoka, Adhika bhaya, Adhika kamavasana, Adhikaharsha causes specific manasa unmada.6) Vishaja: Intoxication due to poisonous things also disturbs the manovahasrotas causing vishaja unmada.By understanding the specific causative factors of unmada one can treat thedisease by performing nidana parivarjana.KAPHAJA UNMADA 52

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