Monovikara(Mental Disorders) Health & Ayurveda

Introduction: Ayurveda aims at preservation and promotion of health, and prevention and cure of diseases through the concepts of positive physical and mental health. Ayurveda treatises are rich useful in understanding disorders. National Institute of Mental Health and Neuro Sciences, Banglore, has been studying since 1971.

Ayurveda and Psychosomatics:

.Ayurveda has duly recognized the individuality of manas (Psyche) and sarira (body) and their inseparable and independent relationship in a living body.

. The statement that ‘manifestation of manas occurs during the month of pregnancy in the fetal body’ indicates the coexistent nature of mind and body. Ayurveda advises that food should be consumed with rapt attention. Defying this is liable to allow the food to go the wrong way or injure the health food is not properly placed in the stomach and there is no appreciation of either the good or bad qualities of food taken.

.Vayu which is one of the tridoshas (the three bioentities viz., Vata, Pitta, and Kapha which are generally more related to shareera) is said to be the controller and prompter of manas. It is also said that the excited vayu depresses mind, gives rise to fear,grief,stupefaction,feeling of helpness,delirium etc,

Manah Swaroopa (Concept of mind):                 

According to caraka, that entity which is responsible for thinking is known as manas. It is said to have been inherited from the previous birth and evolved from the combination of vaikarika and tejasa ahankara.it is acetana (inactive) by itself but gets cetana (activeness) from atma (soul).it is called a dravya (substance).Although beyond sensory perceptions,it is connected to both jnanendriya (sensory centres)and karmendriya (motor centres).That is why it is called Ubhayatmaka (combined psychomotor entity).

Manovijnana (understanding of mind):

Manas is understood by its actions which are, indriyabhigraha (sensory and motor perceptions and control), svasyanigraha (self-control), uha (speculation), and vicarya (thinking)Its objects are those, which are chintya (thought about), vicarya (discriminated from), uhya (speculated upon), dhyeya (aimed at), and sankalpya (decided upon).

Manoguna (qualities of mind):

Manas have two basic qualities viz., anutva atomic nature) and ekatva (unitary nature) .But it is difficult to understand these qualities directly and clearly.  Therefore, manas is said to be confused of 3 more operational qualities viz., stave, rajas, and tamas. There are understood by the role the play in the emergence of three different mental response patterns. For example, satwa or kalyana bhaga is understood by self control, knowledge discriminative ability, power of exposition, etc.Rajas or rosabhaga is understood by violence, despotic envy, authoritativeness, self adoration, etc.tamas or moha bhaga is understood by dullness,non-action,sleep etc.

Manasthana (location of mind):

Manas is said to be active throughout body except nail ends, hairs, and such other structures. Its seat of control is said to be between siras (head) and talu (hard palate).  Also it is said that siras is the seat of all senses. Since the senses are controlled bymanas, it is necessary to consider siras in understanding manas. Similarly Hrdaya (heart) is also said to the seat of cetana or atma. Since manas is always associated with atma an different emotions generally influence blood circulation, consideration of Hrdaya will also be important while studying manas.

Jnanotpatti (mechanism of knowledge):

Manas indicate both presence and absence of cognition. Knowledge occurs when the sequential relationship in the order of indriyartha (sensory objectives), indriya(sense organ)and        manas with atma (soul) is established subject

Manasroga Samprapti (pathogenesis of mental disorders):

Generally for all types of mental disorders, alpasatwa (weak mind), manovahasrota (channels conveying manas/conveyers of manas), manasadosha viz., Rajas and Tamas and tridoshas viz., Vata, Pitta and Kapha are said to be responsible , according to Ayurveda. Alpasatwa which is the most important component is indicative of premorbid personality. Involvement of satirical dosa is mo prominent in Ubhayantmaka vikara like unmade apasmara etc., than in Manasavikara viz., Kama, krodha, abhyasuya etc.similarly manadosa will be more vitiated in the latter group than in the former.

Manasroga Nidana (Aetiology of mental disorders):

Emotional disturbances, volitional transgression, unwholesome food are said to be the causes of mental disorders, in general. Lakshana of Manasroga (Symptoms of mental disorders):-

For Ubhayatmaka vikara like unmade, apasmara, mada, murcha etc. symptoms and signs have been described in detail, in the texts. But for nanatmaja Manasavikara and Manasavikara or kevalamansa vikara, no descriptive details are available regarding their symptoms. This may be because of the e conditions are well he terms used to describe ple, Krodha, soka, Udvega

it would be a rewarding of these conditions is taken d studied.  Then it would  to understand and record psycho-physical signs/ re related to each of these conditions

Manasavikara Vargeekarana (Classification of mental disorders):

The different types of disease classification found in the classics mainly pertain to the physical illnesses, no description on classification of manasroga are readily available in the Ayurveda works.  Still, by studying the diseases wherein the manasa dosa viz., rajas (passion) and tamas (inertness) are involved, it is possible to classify and enumerate the mental disorders described in Ayurveda.

Diseases have been broadly classified into 3 broad categories viz., sarira vikara (physical diseases) like jvara (fever), atisara (diarrhea), etc., Manasavikara (mental disorders) like Kama (desire), soka (grief), abhyasuya (jealousy) an others and Ubhayatmaka vikara (diseases wherein bothbody and mind are affected) like, unmade (psychosis),apasmara (epilepsy) and the like.

However, these arbitrary demarcations are made only for the clinical advantages.  It into possible to strictly categories the diseases as physical, mental etc., since the diseases effect the living body which is combination of sarira (body ), indriya(senses), satwa (mind) and atma (soul),wherein even if one of the is deranged, the remaining three are also affected.

MANAH PARIKSA (Mental examination):

As mentioned already, manas are a very subtle entity beyond sensory perceptions whereas the tools of clinical examinations are limited to sensory transactions only. Secondly, it is only the manas (with atma) which are the ‘Knower’ and there is no other entity to ‘know’ this ‘knower’. This situation makes the understanding and examination of manas very difficult.

The various clinical examination schemes like trividha pariksa, dasevidha pariksha and astasthana pariksha (threefold, tenfold and eight fold clinical examinations),and the nidanapancaka (the aetiodiagnostic factors) described in the classics do not apply with the same force while examining manasavikara as they do while examining physical diseases.

Sin view of this situation this unit has prepared a detailed scheme of examination based on the Ayurveda basic concepts and Caraka’s definition of Unmade, which is diagrammatically depicted in this scheme. The Ayurveda meaning of each of the eight factors are laid down, and simple questions/tasks to be given to the patients considering their socio-economic, and cultural background, are suggested in order to elicit the state of these eight aspects, with provisions for suitable modifications.

MANASAVIKARA CHIKITSA(Treatment of mental disorders):

Yet another group of diseases like sokaja atisara (diarrhea caused by grief), bhayaja atisara (diarrheas caused y fear) kamaja jvara (fever caused by lust), krodhaja jvara (fever caused by lust), krodhaja jawaa (fever caused by anger) and sokaja udavata and others, which are also Ubhayatmaka vikara, are founding classics, these are caused due tothe initial impairment of rajas and tamas although clinically they are present as physical illnesses.  They are relieved only when the manodosa are treated.  Therefore, these diseases which refer to some of the somatised neurotic refer to some of the somatised neurotic conditions can also be considered under manovikara.

Ayurveda Treatment:-

Ayurveda treatment for the mitigation of the diseases has always been through ‘holistic approach” while it has only recently ushered in the west as big movement in the field of treatment. Ayurveda recommends three types of chikitsa viz., daivavyapashraya chikitsa (divine or spiritual/therapy), yuktivyapashraya chikitsa (logical therapy), and satwavajaya chikitsa (psycho therapy), for treating mental illnesses as well. Let us examine them in brief.

1.Daivavyapasraya chikitsa: This refers to measure like mantra, (incantation), Ausadhi wearing scared herbs), mani (wearing precious gems), mangala (propitiatory rites), bali (oblations), home (sacrifice), upahara (offerings), niyama (vows), prauascitta (ceremonial penitence), udavata (fasts), swastyayana (prostrations), pranipata (surrender), gamana (pilgrimage), etc.These measures are recommended in mental disorders caused by agnate(extraneous) factors and administered judiciously after considering the nature, faith, religiosity, culture and educational level, of the patient.  .  These may be useful in all types of manasavikara, i.e. both psychosis and neurosis.

2. Yuktivyapashraya chikitsa:

 This refers to the use of ahara (diet) and oushadha (drugs).Under ahara, it is interesting to note that different food articles like ksira (milk), ghrta(ghee), draksa (grapes), panasa (jack fruit Brahmi (Centella Asiatic-plant), mahishamamsa (buffalo meat), sarpamamsa (snake meat), kurmamamsa (tortoise meat),  vastuka (goose foot, kakamaci (solanum nigirum), barhimamsa (cuckoo meat),mahakusmanda ash gourd) ka pittha (wood apple) matulunga and others are recommended as beneficial in various mental disorders Citrus medical).

Medicines                                                  Tonics

1. Brahmi ghrta                                        1.Aswagandha
2. Kalyanakaghrta                                    2.Kusmandarasayana
3. Pancagavya ghrta                                 3.  Jyotismati       

1. Sarasvatarista                                      4. Brahmi Rasayana
2. Asvagandharista                                  5. Asvagandhavaleha
3. Sarasvata curna                                   6. Satavari lea
4. Smritisagara rasa
5. Caturmukha rasa
6. Manasamitra vataka
7. Brahmyadiyoga     
8. Ksirabala taila
9. Dhanvantara taila
10. Asanabilvadi taila
11. Brahmi
12. Tagara
13. Vaca
14. Sarpagandha
15. Jatamamsi
16. Bala

Speaking on the role of the therapist, it is stated that, the therapist should be ‘suhrt’implaying that he should be compassionate to the patient and involve himself in solving the problems of the patient.  This clearly indicates the importance of the therapist if the therapy administered has to be beneficial to the patient.  The best approach to achieve the goal of satwajaya chikitsa as mentioned earlier is through jnanam (knowledge), vijnanam (analytical thinking), dhairya, (courage), smrti (memory), and Samadhi (concentration), according to Caraka.