HOLISTIC APPROACH TO MANASA ROGA
BY Prav
Introduction • Increase incidence of mental diseases. •Ayurveda – Boon to patients of mental disorders.
•By the self must be upheld The self should not be let down The self indeed is its dear relative The self indeed is the enemy of self (Bhagavat Gita)
BODY
MIND
AYURVEDA
SUKHAYU
DUKHAYU
HITHAYU
(PERSONAL LIFE)
AHITHAYU
(SOCIAL LIFE) HEALTH
PHYSICAL
MENTAL
SOCIAL (WHO,1948)
MENTAL ILLNESS It encompasses a broad range of conditions characterised by patterns of abnormal behavioral and psychological signs and symptoms that result in dysfunction. (DSM-IV,1994)
Interrelationship between body and mind • Depends on initial vitiation • Classification of Manasa Roga • For proper diagnosis and management
Classification of Manasa Roga A) Diseases with primary mental origin and predominantly mental symptoms.It is called as Kevala Manasika Rogas. For example- emotional disorders like Lobha (Greed), Moha (infatuation), Kāma (lust), Krodha (anger), Irshyā (competitive tendency), Dvesha(envy), Mātsarya(Jealousy), Rāga( Love, passion), Bhaya(Fear), Śoka(sorrow), Harshya(ecstasy), Vishāda (dejection, Sadness), Asuyā (Jealousy), Dainya(Miserable state) etc. comes under this group.
B) Disease with primary mental origin and predominantly physical Symptoms. 1) Unmāda 2) Apasmāra 3) Apatantraka 4) Bhayaja and Śokaja Atisāra 5) Kāmaja and Śokaja jwara 6) Nidranāśa 7) Shandha In this type due to initiation of Mānasa dosha, Sharira dosha get involved but the symptoms are seen at Sharira level so these may be called as Mano- Sharirika i.e. psychosomatic disorders.
C) Diseases with primary physical origin and predominantly mental symptoms. The etiology and pathogenesis of such diseases are found of somatic nature but symptoms of these diseases are of psychological nature. The following diseases can be included in this category. 1) Atatvābhinivesha 2) Mada In this pathogenesis Sharirika doshas are initially involved which leads to vitiation of Manas doshas, so these diseases can be called as Sharira- Manasika i.e. somato- psychic.
d) Diseases with primarily physical origin and predominantly physical symptoms All somatic diseases can be included in this group but there are some diseases in which they have primarily physical origin and predominantly physical symptoms, showing very similarity to mental diseases. Mūrcchā,Sanyāsa are the diseases included in this category.
E) Diseases with primarily idiopathic origin and predominantly mental and physical symptoms The etiology and pathogenesis of some diseases cannot be found in systemic manner or we are unable to give the scientifically rational logic behind the etiopathogenesis. All type of diseases which are described with the concerns of Āgantuja Unmāda, Grahabādhā & Upagraha, Pisāca, Bhūta etc. can be include in this category.
Definition of mental diseases • Manas as Adhistana of Roga • Vitiation of Manasika Dosha • Disturbance in Buddhi, Sanjna Jnana, Smrti etc.
COMMOM CAUSES OF MENTAL ILLNESS ISTASYA ALABHAT LABHAT ANISTASYA (CA.SU.11)
• ALPA SATVA • TRIVIDA KARANA ASATMYENDRIYARTHA SAMYOGA PRAJNAPARADHA PARINAMA
SOCIAL FACTORS: 1. SEX
CHILDHOOD ADOLESCENCE
2. LIFE EVENTS
ADULTHOOD
3. EXPRESSED EMOTIONS
4. UNEMPLOYMENT
5. WORKING ATMOSPHERE
6. AREA OF RESIDENCE
7. HOMELESSNESS
7. SOCIO-ECONOMIC CLASS
8. SOCIAL ATTITUDE
9. SOCIAL SUPPORT SUPPORT
SOCIAL CONSEQUENCES OF MENTAL DISEASES
DISABILITY STIGMA EFFECTS ON FAMILY
CULTURAL ASPECTS 1.CONCEPT OF AETIOLOGY AND CURE 2.ENVIRONMENTAL SANITATION 3.MOTHER AND CHILD CARE 4.PERSONAL HYGIENE AND CONDUCTS 5.SEX AND MARRIAGE
Common signs and symptoms Unmadam punar Mano buddhi SajnaJnana Smrthi Bhakthi Shila Chesta Achara vibhramam vidyat. (Ch.Ni 7/5) Unmada is vibhrama of Manas,Buddhi, Sanjnajnana, Smruti, Bhakti, Shila, Chesta, and Achara. Here vibhrama means the total disability to perform assigned function or dysfunction of particular entity. Of the eight aspects considered in definition, the first 5 represents different dimension of Manas and latter 3, its reflections.
1.Mano vibhrama Svanigraha (Self-control) and Indryabhigraha (Control over indriyas) are the functions of Manas. Cintyam, Vicharyam, Ūhyam, Dheyam,and sankalpa are the objectives of Manas. Vibhramsa of Manas would affect both the functional and objectives of Manas. Illusion and hallucination ?
2. Buddhi vibhrama The Karma of Buddhi is to take a decision by which it differentiates right from the wrong one, useful from the harmful ones. (Chakrapani on Cha.Ni.7/3). Naturally when it gets affected, one fails to make a decision or takes wrong decisions due to which he lands in a dilemma. The other aspects of Buddhi, such as intellect, grasping power, and understanding may or may not get affected (Cha.su.1/99).
3. Sanjnajnana vibhrama Loss of orientation towards person, place and time is seen in this condition even though he cannot tell his identity. It may see to such an extent that he cannot feel fire, which burns his body (Chakrapani on Cha.Ni.7/3).
4. Smruthi vibhrama Impairment of memory is seen up to a certain extent in all the individuals. In senility loss of immediate and recent memory is common, but the remote memory may be intact. On the contrary, a psychiatric patient may have all the three types of memory loss or any of them.
5. Bhakti vibhrama Desires, wish, interest etc. are called as Bhakti. When this entity gets impaired, patient shows excessive interest, Withdrawal symptoms or very odd interest (Chakrapani on Cha.Ni.7/3). Withdrawa1 symptoms are like less or not indulging in any talk, not interested in talk, not interested in taking food, not dressing properly etc. He may show intensively withdrawal symptoms also like not interested in his day-today activities, job, diminished pleasure in such things, which he likes previously. He may show interests in strange things or in those things, which are different from his previous interest and looks odd.
6. Shila vibhrama The disturbance in the usual habits and temperament is Shila vibhrama due to which patient shows exaggerated emotions at improper place and time or inappropriate reactions For example - Calm and quiet person may change into a person with an arrogant attitude and also patient may laugh hearing sad news.
7. Chesta vibhrama Chesta is controlled and relevant motor activity which when gets impaired a person does vishama Chesta like Asthane Rodana, Gayana, Nartana, Vadana etc., playing an instrument at improper place and time with abnormal body postures. He may show Atichesta (Hyperactivity) or Achesta (Hypo activity) like excessive wandering, Less activities respectively.
8. Achara vibhrama The person violates all ethics and manners. His behavior and and social attitude would be unfair, improper irrelevant. This is called as Achara vibhrama. Patient may remain undressed, unhygienic or have odd dressing.
• Samanya Unmada lakshana like – • • • • •
Dhi vibhrama - Distortion of Buddhi Satva pariplava- Fluctuation, wavering of mind Paryakula drusti - Anxious look Adheeratha - fear, anxiety Abaddha Vak - Uncontrolled irrelevant, incoherent talk. • Shunya Hridaya - Feeling of hollowness of Manas.
CHIKITSA • VIKARA ANUTPATTIKARA CHIKITSA PREVENTIVE MEASURMENTS
• VIKARASYA CHIKITSA CURATIVE MEASUREMENTS
PREVENTIVE ASPECTS • TYAGAHA PRAGNAPARADHASCH • INDRIYOPASHAMANA • SADVRITTA PALANA
CURATIVE ASPECTS 1. DRAVYA BHOOTA CHIKITSA •
Shodhana Chikitsa
• Shamana Chikitsa
2. ADRAVYA BHOOTA CHIKITSA
• • •
Bandhana Tadana Tamograha pravesha. etc
General principles of management • Yukti vyapashraya • Daiva vyapashraya • Satvavajaya
Yukti vyapashraya
•Antah parimarjana – Shodhana and Shamana •Bahi parimarjana – Murdhi Thaila •Shastra pranidhana
Panchakarma •Definition
•Area of utility
According to the Involvement of Dosha. •VATA – BASTHI • PITTA – VIRECHANA • KAPHA – VAMANA
Benefits of Panchakarma in Manasa Roga •Hridya Shuddhi •Indriya Shuddhi •Buddhi Shuddhi •Manah Prasada
Management of Mental Disorders according to the Faculty involved • MANOVIBHRAMSHA - MEDHYA RASAYANAS • BUDHI VIBHRAMSHA - GNANA VIGNANA & MEDHYA RASAYANAS • CHESTA VIBHRAMSHA - BHAYA DARSHANA
GHRITHA ARE VERY IMPORTANT OUSHADHIS IN THE MANAGEMENT OF MENTAL DISORDERS.
MOORDHNI TAILA • SHIRO ABHYANGA • SHIRO PICHU • SHIRODHARA-IN CHITTODWEGA • SHIROBASTI - IN NIDRANASHA
ACHARA RASAYANA PHYSICAL AND MENTAL CONDUCTS NO INVOLVEMENT OF DRUGS MAINTAINS THE TOTAL LIFE PROCESS (Cha. Chi.1/30)
One who speaks truth One who is free from anger One who abstains from alcohol and sexual congress Avoids over strain One who is devoted to repetition of holly chants and cleanliness One who is habituated in taking milk and ghee Regular sleep Wholesome diet Knowing about oneself Control over his sense organs etc The persons who follows the above conducts will not be pray for diseases and good conducts will lead to physical mental and spiritual healthy state
MEDHYA RASAYANA DRAVYAS Mandukaparni Svarasa Yastimadhu Choorna with milk Guduchi Svarasa Shankapuspi Kalka (Cha.chi 1/30-31) Brahmi Jyothishmathi Ashwagandha.
Usage of Rasoushadhis in Manasa Roga Unmadagajakesari Rasa Vatakulantaka Rasa Manasamitra Vati Saraswatharista with Gold etc.
SATWAVAJAYA CHIKITSA Punar Ahithebhyo Arthebhyo Manonigrahaha TECHNIQUES • GNANA - ADHYATMA GNANA • VIGNANA - SHASTRA GNANA • DHAIRYA – ANUNNATI CHETASAM • SMRUTI – ANUBHOOTARTHA SMARANAM • SAMADHI – VISHAYEBYO NIVARTHYATMANI MANASO NIYAMANAM
SCOPE OF SATVAVAJAYA • BY REGULATING THE THOUGHT PROCESS (CHINTYA) • BY REPLACING THE IDEAS(VICHARYA) • BY CHANNELING THE PRESUMPTIONS (UHYA) • BY POLISHING THE OBJECTIVES (DHYEYA) • BY PROPER GUIDANCE & ADVICEFOR TAKING RIGHT DECISION (SANKALPA)
Trivarga Anveshsna - Contemplation of the three objectives of life.(Dharma, Artha, and Kama)
Tadvidyaseva - Service of those who are well versed in the treatment of mental diseases.
Atmajnana - Self-realization. Kula-kala, desha, bala Jnana - The knowledge about ones own self, country, family, age, vitality, and ability.
Opposite therapy Kama Bhaya and Krodha Shoka Harsa Asūya Irshya Lobha
x x x x x x x
Kopa or Bhaya Kama Harsha Shoka Bhaya and Krodha Kama and Bhaya Shoka and Bhaya
DAIVA VYAPASHRITA CHIKITSA •Ayurveda is a spiritual science, having divine roots. As per the Ayurvedic texts Brahma, the Lord of Creation himself first imparted the knowledge of Ayurveda. It was practiced by the Devatas first and then passed down to ‘Bhu-loka’ to relieve mankind of all sufferings. •The term Daiva vyapashraya is concerned with all the unknown circumstances, which are beyond the purview of reasoning. • In Ayurveda, Deva has been used in the various senses like unknown past deeds, etc. The evils of past life karmas cannot be cured by the scientific methods of medicine because the diseases so happened are related to past deeds.
As Ayurveda accepts purva janama, it is rational need to device methods, which can effectively deal with Daivakrut diseases. Charaka says Karma that has done in Punarjama is considered as Daiva.The diseases that are caused by such an effect are known as Daivakrta. These Daivavyapashraya methods create confidence and remove the fear and pessimistic tendencies. It may in some way indirectly help the patient in gathering confidence.It works at the level of mind and there by influence the body. Ayurveda explains the spiritual therapy for the mental disease in a unique way.It acts through vibrations which stimulates the cosmic consciousness to heal so its direct effect is invisible.
In Bhagavadgita chapter 2/62-63 says, Attachment desire anger delusion loss of memory destruction of discrimination Death. “While contemplating the objects of the senses, a person develops attachment for them, and from such attachment lust develops and from lust anger arises. From anger complete delusion arises and from delusion bewilderment of memory. When memory is bewildered intelligence is lost, and when intelligence is lost one falls down again into the material pool or he dies.
Employed to detach from desires and thereby attain Moksha (salvation). It mainly includes practices of yoga. It guides an individual on how to gain control over his unstable mind and thereby slowly detach it from sensory objects and culture the emotions.
The following treatment in the shape of good deeds is recommended for diseases caused by Deva (C.Su.11/54). Mantra- Sacred Hymes Aushadha Mani - gems Mangala-auspicious offerings Bali - gift Upahara - oblations Homa Niyama Prayascitta- atonement Upavasa - fasting Svastyayana – chanting mantra Pranipata – worshipping god Yatragamana - pilgrimage
Common Manasa Roga •Unmada •Apasmara •Atatva abhinevesha •Vishada •Chittodvega •Madataya etc.
Unmada •Vataja unmada – Snehapana, Mrudu shodhana •Pittaja unmada – Virechana •Kaphaja unmada – Vamana •Bhutonmada – Teekshna shodhana
Apasmara •Vega kala – Sanjna prabhodhana nasya •Vegantara kala – 1.Vataja apasmara – Basti 2.Pittaja apasmara – Virechana 3.Kaphaja apasmara – Vamana
Atatvabhinevesha • Shodhana – Snehana, svedana, Shodhana
• Shamana – Brahmi, Medhya Rasayana etc.
Vishada • Sarvanaga Abhyanga • Nasya – Panchagavya ghrita, Kalyanaka ghrita etc.
Chittodvega •Shirodhara •Murdhni taila
Madataya •Shodhana •Shirodhara
Probable mode of action •Sarvanga abhyanaga •Murdhni taila •Svedana •Vamana •Virechana •Basti •Nasya •Raktamokshana
Sarvanga abhyanga Relationship between Twacha and Manas Soothing and relaxing
Murdhni taila Actions on marma Vascular effect Nervine effect
Svedana -Along with neurological problems Vamana and Virechana •Guna •Mild Irritation •Removal endogenous toxins ( Ama )
Basti •Vayu and manas • Best for vata dosha
Nasya • Shringataka marma • Vascular and Nervine effect • Cavernous sinus
Raktamokshana •Raktaja vikaras like mada, moorcha etc. • Pittaja manasika vikaras
CONCLUSION 1. Principles of sadvritta and achara rasayana laid down in Ayurveda highlights the importance of socio-cultural factors in the maintenance of mental and social health. 2. A stable and harmonious equilibrium between man and his environment is needed to reduce man’s vulnerability to mental diseases and to permit him to lead a more productive and satisfying life. 3. By Ayurvedic line of treatment with psychotherapy and spiritual therapy one can able to treat mental diseases effectively.
REFERENCES 1. CHARAKA SAMHITA 2. SUSHRUTA SAMHITA 3. ASTANGA SANGRAHA 4. ASTANGA HRIDAYA 5. SYNOPSIS OF PSYCHIATRY - KAPLAN & SADACK 6. POSTGRADUATE PSYCHIATRY - LOUIS APPLEBY 7. OXFORD TEXTBOOK OF PSYCHIATRY 8. PREVENTIVE & SOCIAL MEDICINE - PARK
