1. Unmada-insanity (MANOKAYIKA ROGA (Psychosomatic Diseases))

. Unmada

Definition
This has also been called aschittavasada. Chitta means mind orpsyche and avasada means sad or lazy state. In this condition there is disturbance in mind and its various functionslike decisive faculty and intellect, sensation, memory, desires, behaviour,motor activities and conduct.

Hetu

Persons with tendencies of fears andhaving high levels of rajas and tamasare prone to this disease. Consumingimpure, contaminated, unwholesome food in unhealthy atmosphere and unhealthyways and performing unhealthy physical activities and improper social conductare the main causes. Similarly those whoare afflicted with long standing disease and whose mind became weak, whenfrequently struck with emotional shocks of anger, passion, greed, elation,fear, grief, anxiety or worry, can suffer from this disease.

Antagonistic,defective and impure food, incult to Gods, teachers and brahmanas, mental shockdue to fear and difficult posture are the causes. (Ch.Ch. 9/4).

Samprapti

Vitiation of tridoshas and rajas aswell as tamas leads to vitiation of manovaha srotas, which disturbs mentalemotions and produce unmade.

This insanity can be divided intotwo major types; Endogenous, where no apparent cause is found; and Reactive, dueto various external causes.

Bheda

There are five types according toCharaka. Four types are due to doshavitiation and fifth is due to agantuja or bhuttonmada. Manasa and Vishaja are two different typesmentioned by Sushruta and Vagbhata. Including these two types he has classified this disease in 6 types.

SamanyaRupa

The main Symptoms are pervertedintellect, psychic agitation, restless eyes, impatience, incoherent speech andvacant mind. Thus the person withderanged mind does not know pleasure, pain, ethics and religion then how he canget peace? Hence due to loss of memory,intellect and perception he lets the mind loose to wander here and there. (Ch. Chi. 9/6-7)

VisheshaRupa

(1) VatajaUnmada

In this the patients shows followingfeatures like continuously wandering; moving the eyes, eyebrows, lips,shoulders, chin, hands, feet unexpectedly, talking irrelevantly, salivationfrom mouth, frequent smile, laughing, dancing and singing, or other similarmovements in irrelevant situations, imitating loudly musical sounds, imitatingdriving the vehicles, putting any articles on the body, greed for the thingsnot got and rejection when obtained, bulging and reddish brown color of eyes. (Ch.Chi. 9/9-10)

This condition is very similar to schizophrenia.

(2) PittajaUnmada

This shows following features likeaggression, irrelevant agitation, violence to self and others, attackingothers, liking for shadow, cool things, red eyes, burning sensation even ifshowered with icy water, hallucinations of stars in sky during day. (Ch. Chi.9/11-12)

Manic psychosis may be closeequivalent to this condition.

(3) KaphajaUnmada

Patient shows followingfeatures-Staying in unchanged position, silence, least movements, loss ofappetite, liking for loneliness, disliking for cleanliness, excessive sleep,white color and stickiness in eyes, symptoms are much severe in night time(Ch.Chi. 9/13-14)

Catatonic schizophrenia orDepressive psychosis is close equivalent to this condition.

(4)Tridoshaja Unmada

This is mixed type and symptoms ofall the above doshas are found

(5)Manasaja Unmada
Persons whose mind is very week, areaffected more. In this type the personstarts talking, singing and expresses different type of behaviour



(6) VishajaUnmada

When poison affects rajas and tamasthen the individual looses his strength and starts behaving improperly.

SamanyaChikitsa

The etiology and dushya of unmadeand apasmara is similar and hence the samanya chikitsa is also the same. In Vegavastha the physician should givesadhyachikitsa or immediated treatment to the patient. For this mainly pradhamjana nasya of teekshnaand ushna quality-like vacha and stala-teek-shna anjana-applying penetratingtype of collyrium, by giving medicated vapor (dhuma) of subst6ances likemanahshila, hartala or hot and penetrating substances like chilly etc. andrarely tadana and peedana has also to be done.

During theattack, the treatment should aim at establishing senses to its normalfunctioning-sanjna-prabodhana.
In betweenthe attach-Avegavastha:
Herbs ofchoice are brahmi, vacha, shankhapushpi, jatamansi or ashwagandha.

Find outthe cause and eliminate the same. Forincreasing that sattva quality of mind, interaction of the physician with thepatient is very important. The followingmodel has been proved useful; assurance, replacement of emotion, regulation ofthought process, reframing the ideas, channeling of presumptions, correction ofobjectives and ideas, proper guidance, and advice for taking right decision.
The patienthas lost the sense of proper time and place. He should be made aware of the same by proper counseling. If necessary he should be terrorized to theextent that he feels as if his life is finished. This will probably bring his mind back to normalcy.


VisheshaChikitsa

(1) VatajaUnmada

Internal oleation with old ghee orwith medicated ghee is advisable. However if the Kapha or Pitta is associated with Vata then one shoulduse milk laxatives along with ghee.

MedicaredGhee

v Kalyanaka – Prepare paste of vishala, triphala,devadar, two types of haridra, sariva, kamala, ela, danti, nagakeshara,kushtha, chandana, padmakashthya, talispattra, and flowers of malati. Add 64 times ghee and prepare medicatedghee. Most of these are the herbs fromshalparni group.
v Mahakalyanaka- Prepare medicated ghee with the herbsfrom jeevaniya and shalparni group.
v Hingvadi- Prepare paste of asafetida, trikatu andsauvarchala. Add ghee 56 times andmedicated ghee.
v Mahapaishachika – Contains ghee, jatamansi,shankhapushpi, brahmi, shatavari and herbs from jeevaniya group.
v Lashunadi- Prepare decoction of lashuna adddashmula. Then add ghee, lashuna kalka,badara, vrikshmla, trikatu, haritaki, triphala, ajamoda and asafetida. Prepare medicated ghee. The dose of all above is 2 to 5 gm. Two times day.

Swarasa

v Brahmyadi swarasa - Take fresh juice of brahmi, kushmanda and shankhapushpi in equalamount and add honey. Dose of 15 ml. 3times day.

PreparedMedicine

v Chaturbhuja rasa – Prepare mixture of rasaindura,oxide of suvarna, purified manahshila, kasturi and haratala. Triturate the same with the juice ofkumari. Put the whole mixture in crandspatra and give one gajapura. Dose 100 mg. 3 times day.

(2) Kaphajaand Pittaja Unmada

During the attack give penetratingtype of nasya of gudashunthi or juice of shigrupatra or –

Shirishadi yoga- Prepare mixgture of the powders of shigrubeeja,licorice, asafetida, lashuna and vacha.

When the attack is over, give medicared emesis and medicated purgation,after proper oleation and fomentation.

Churna

v Sarasvata churna – Khutha, ashvangandha, rock salt,ajamoda, jeeraka, Krishnajeeraka, trikatu, patha, shankhapushpi, and equal amount of vacha. Triturate the mixture with juice of brahmi. Take this with ghee and honey.; Dose 1gm. Twice day. (BR)

Avalcha

v Shankhapushpi- Contains shankhapushpi, brahmi,kushmanda, vacha and kushtha. Preparedecoction and then add sugar. Thenprepare medicated jam. Dose 3 to 5 gm. Pe day.
v Brahmiprasha – Mix juice or brahmi, sugar and thenprepare avalcha. Dose 3 gm. Per day.

PreparedMedicine

v Unmadagajakeshari – Prepare mixture of kajjali,manahshila and seeds of datura and then triturate the same with the juice ofvacha and decoction of maharasna. Dose150 mg. 3 times day.

MedicatedGhee

v Chaitasa ghrita – Prepare paste from laghu panchamul,kashmari, rasna, erendamula, bala, murva, shatavari, and then and ghee. Prepare medicated ghee as usual. Dose 2 to 5 gm. 2 times day.
v Lashunadaya ghrita – Take lashuna and dashmula, addwater and prepare decoction. Then andghee, juice of lashuna, badara, vrikshmala, matulung, ardraka and dadima. Add to it mastu, triphala, devadar, rocksalt,trikatu, ajamoda, chavya, asafetida and amalvetasa. Prepare medicated ghee Dose 2 to 5 gm. Per day.
v Shiva ghrita – Prepare decoction of fresh meat of foxand dashamula. Add to it milk, ghee andpaste of licorice, manjishtha, vidanga, chandana, triphala, danti, devadar,talisapattra, ela, anantamula, dadima bark, tagara, kantakari, priyangu, medaand prishniparni. Prepare medicated gheeas usual. Dose 2 to 5 gm per day.

(3)Agantuja Unmada

For this usually daiva-vyapashrayatherapies are recommended which include chanting of mantra, wearing preciousstones as per horoscope, offerings, oblations, sacrifices, worshiping to thedeities.
Panchakarma procedure likeshirodhara and shirobasti are useful. Some aphrodisiac preparations help to elevat the mood.

Prof. R.H. Singh and his colleagues in B.H.U haveproved that herbs having vajikarana action are useful in this condition. Tab. Ashwagandha 250mg. 3 times aday or tab Kapikacchu 125 mg. 3 times a dayfor 1 month should be used. Regulatesleeping and eating patterns to establish wholesome rhythms.

The best chikitsa for all psychologicaldisorders is to give proper knowledge of intelligence and the knowledge of selfrealization. To bring the disturbed mindback to normal various methods can be used. The patient should be terrorized. The fear of life is above that of bodily afflication and as such itleads to pacification of the mind which is totally deranged.
If the mind is affected due to lossof some things which the person likes the best, then such person should bepacified by consoling and by assurance or by providing that thing which he haslost.
Clarity of sense objects and also ofintellect, seld and mind along with normalcy of dhartus is the sign of recoveryfrom insanity.

Pathay andApathya
Old wheat, rice, barley, mung bean,old ghee, cow milk, pumpkin, white guard, grapes, pomegranate, coconut andmango, leves of brahmi, old kushmanda, patola, draksha, kapittha should beconsumed regularly.

Snehana, swedana and suitablepanchakarma, application of teekshna anjana, counseling, trasana, handhana,peedana, tedana, exposure to fearful things, sprinkling of water, abhyanga andall the procedures for increasing sattva quality of mind should be undertaken.
Avoid alcohol, contradictory food,do not withhold the urges of hunger, thrist and sleep and do not eat foodshaving bitter and penetrating qualities.