Lecture Note: Ayurvedic Management of Psychiatric Disorders (Part-2)

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Ayurvedic Management of Psychiatric Disorders
Part-2

Prof. Muralidhara Sharma

Transcript by
Dr. Swati Sharma
Senior resident, Dept of Kriya Sharir, IMS BHU
and Dr. Varsha More

based on the lecture available at-Ayurvedic Management of Psychiatric Disorders

Diagnostic and Statistical Manual of Mental disorders

 Earlier the classification of psychiatric disorders was quite simple. They were categorized into two categories. Neurosis and psycho. Neurosis is generally considered as minor illness where a person is aware that he has an illness, whereas psychosis is that conditions where the person doesn’t know that he has an illness but has the illness. And then we have the sub categories like anxiety disorder and so on.  But the present-day method of diagnosis is depending upon the DSM model. The DSM is Diagnostic Statistical Manual of Mental Disorders, published by Americans Psychiatric Association and under this, the psychiatric conditions are grouped or categorized under these headings’ neurodevelopmental disorders, Schizophrenia and so on. The whole detail is not an important issue, but we have to be aware that the method of the diagnosis of grouping these disorders are these categories.  For the present regular clinical practice, it’s not necessary that we will be seeing all these varieties of the cases. But we will be seeing a majority of these conditions in the clinical practice and how we can plan and how you just deal with these issues in the clinical practice.

Of course, the diagnosis or the standard protocol for diagnosing of psychiatric disorders is also given in ICD classification. But ICD coding classification in significantly different from DSM classification. So, when it comes to the question of legal issues, we will be having many confusing areas or grey areas whether it has the DSM to be followed or ICD. But popular in psychiatric disorders DSM is generally followed as such.

Ayurvedic approach on the mental illness

Now coming to the Ayurvedic point of view, how the mental illness is assessed from Ayurvedic point of view. Ayurvedic approach on the mental illness is based upon the doshas. Rajas and Tamas are considered to be the doshas which are affect the mind or manas as we have Vata Pitta Kapha are related to the body. General rule for managing manas roga is a person is made to be aware.

वायुः पित्तं कफश्चोक्तः शारीरो दोषसङ्ग्रहः|
मानसः पुनरुद्दिष्टो रजश्च तम एव च||
Ch.Su 1/ 57||

प्रशाम्यत्यौषधैः पूर्वो दैवयुक्तिव्यपाश्रयैः|
मानसो ज्ञानविज्ञानधैर्यस्मृतिसमाधिभिः||
Ch.Su1/58

In case of mental illness Ayurveda does not mention about the pharmacological or drug intervention in general. Rather non- pharmacological treatment that the person is made aware of surroundings Gyana (knowledge has to be given) Dhairya (Consolation or counseling) or Samadhi (meditation) can be given. This should not be confused with Daiv-vyapasharya chikitsa. Daiv-vyapasharya chikitsa is a part of treatment for the sharir vyadhi. There is a confusion that Daiv-vyapasharya chikitsa (practicing devotion worship and similar other practices) they are considered as a sort of psychiatric treatment generally. But Ayurveda doesn’t accept that as a psychiatric treatment but the basic issue of psychiatric treatment is about counselling, where you are making two approaches philosophical approach as well as personal approach. In general what we have to do for having a healthy mind is “veganam aavidharnam……” Su. Chi. 28.   i.e. the vega dharana or voluntary controlling certain reflexes has to be avoided for both healthy mind and body.

आयुष्यं भोजनं जीर्णे वेगानां चाविधारणम् |
ब्रह्मचर्यमहिंसा च साहसानां च वर्जनम् ||
Su Chi 28/28

The food should be of good quality. There is a direct relationship between the food and mind. Rajas and Tamas are for classification of Ahara. So, if you take Rajas and Tamas Ahara, it will directly affect your mind. So mental health is directly related to the food and is also related to lifestyle where Vega Vidharana also have impact upon the mind.Brahamcharya is perceiving the knowledge. Ahimsa is not hurting others. Sahasanaam cha vardhanam…….never go beyond your capacity. These are the basic essential to maintain the mental health asset.

The mental causes of mental disorders as mentioned in Charak is

भयशोकक्रोधलोभमोहमानेर्ष्यामिथ्यादर्शनादिर्मानसो मिथ्यायोगः||
Ch . Su 11/39

अभिद्रोहानृतवचनम्, अनृतवचनात् कामक्रोधमानद्वेषपारुष्याभिघातभयतापशोकचिन्तोद्वेगादयः प्रवृत्ताः|
Cha Vi. 3/24

“Bhayashokalobhmaanmohairshaya…………… Different sorts of strong emotions are the causes of Manas roga and they are the mithya yoga for the manas. Or it could be Abhidhroha anritvachanam…………..it may be just harming others or lying.  These also are the causes of mansik vyadhi like chintna udvega aadi pravrittah…….

Somatization of psychiatric illness or otherwise?

 Now there is another controversial issue. In the present day condition, very popular word in use is psychosomatic disorders. So in general there is one view or very popular view that a psychiatric disorder in a due course of time becomes somatic and it then leads to a physical illness. In other way, physical illness leads to psychiatric illness is not established fact in contemporary medicine system. Though, it’s although know that any patient having a physical illness would have some impact on mind and majority of the prescriptions which we see in clinical practice would have either anxiolytic or anti-depressant or a sedative as the prescription. And that becomes one of the issues in the clinical issue in the practical clinical conditions that we deal with. Whereas from Ayurvedic point of view, the basic idea in majority of the conditions, what Charak says is “Shariro jayatepurvam dehe……….”

शारीरो जायते पूर्वं देहे, मनसि मानसः|
वैचित्त्यमरतिर्ग्लानिर्मनसस्तापलक्षणम्||
इन्द्रियाणां च वैकृत्यं ज्ञेयं सन्तापलक्षणम्|
Ch.chi 3/36,37

 So initially it is Sharir vyadhi and then later it may become Manasik vyadhi. i.e. the somatic illness can result in a Mansik illness. Or a physical illness can also be presented as psychiatric symptoms like in case of the Jwara.

ऋत्वहोरात्रदोषाणां  मनसश्च बलाबलात्|
कालमर्थवशाच्चैव ज्वरस्तं तं प्रपद्यते||
Ch. Chi 3/75

The jwara could be present due to Manasashchabalaabalat…….. A weakness of mind can result in jwara in due course of time. There are examples present in the texts which are closely related between the mind and the body.

Somatization

अतीव चिन्तनाच्चैव शोकात्क्रोधाद्भयात्तथा||
Ch. Chi 30/181

Dhatukshaya could take place due to aberrations of mental activities like aativ chintanat chaaevshokkrodha bhayastatha………like too much of worrying, anger, shock etc are certain conditions. A healthy body is dependent on healthy thoughts and attitude along with other physical activity.

Cause of Ama production

न च खलु केवलमतिमात्रमेवाहारराशिमामप्रदोषकरमिच्छन्ति अपि तु खलु गुरुरूक्षशीतशुष्कद्विष्टविष्टम्भिविदाह्यशुचिविरुद्धानामकालेचान्नपानानामुपसेवनं, कामक्रोधलोभमोहेर्ष्याह्रीशोकमानोद्वेगभयोपतप्तमनसा वा यदन्नपानमुपयुज्यते, तदप्याममेव प्रदूषयति||
Ch. Vi 2/8

Like ….kamakrodha………..during food intake can leads to Aama awastha. So the healthy thoughts are considered to be the primary for health asset.

Secret of health

त्यागः प्रज्ञापराधानामिन्द्रियोपशमः स्मृतिः|
देशकालात्मविज्ञानं सद्वृत्तस्यानुवर्तनम्||
आगन्तूनामनुत्पत्तावेष मार्गो निदर्शितः|
प्राज्ञः प्रागेव तत् कुर्याद्धितं विद्याद्यदात्मनः||
Ch. Su.7/53,54

“Pragyaapradha” that is considered to be the most important cause of all the diseases is directly related to mind. And hence to maintain a proper health the clue given in Ayurveda is tyaga pragyaapradah……………………………. i.e. the pragyapradha has to be avoided and you need to regulate sensory organs of the body and control them (indiriyaupshama) ,you have to keep in mind about the whole social conditions (smriti) and be aware of the atma kala desh and sadvritasyaanuvartanam. That is about the basic secret of health. So health is dependent on the status of mind. The relevance of mind is very much highlighted and at times given more importance than body to have a health asset. A strong healthy person should have a strong healthy mind along with strong healthy body.

क्षुत्पिपासायासश्रमशीतोष्णवातवर्षासुखदुःखसंस्पर्शसहत्वं, शोकदैन्यमानोद्वेगमदलोभरागेर्ष्याभयक्रोधादिभिरसञ्चलनम्, अहङ्कारादिषूपसर्गसञ्ज्ञा, लोकपुरुषयोः सर्गादिसामान्यावेक्षणं, कार्यकालात्ययभयं, योगारम्भे सततमनिर्वेदः, सत्त्वोत्साहः, अपवर्गाय धीधृतिस्मृतिबलाधानं; नियमनमिन्द्रियाणां चेतसि, चेतस आत्मनि, आत्मनश्च; धातुभेदेन शरीरावयवसङ्ख्यानमभीक्ष्णं, सर्वं कारणवद्दुःखमस्वमनित्यमित्यभ्युपगमः, सर्वप्रवृत्तिष्वघसञ्ज्ञा  , सर्वसन्न्यासे सुखमित्यभिनिवेशः; एष मार्गोऽपवर्गाय, अतोऽन्यथा बध्यते; इत्युदयनानि व्याख्यातानि||

Cha Sha 5/12

Ability to tolerate all these variation in the surroundings like excess of thirst, hunger etc are related with healthy body. Also healthy mind is the way for attaining salvation. That’s about the theory portion of health and mind in Ayurveda.

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