Lecture Note: Ayurvedic Management of Psychiatric Disorders (Part-3)

Ayurvedic Management of Psychiatric Disorders
Part-3

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

Now coming to the practical issues. When we go into the clinical practice, the majority of the disease that you will deal with would be anxiety disorders. Anxiety disorders are not related to exclusively psychiatric conditions. Almost every patient having some disease would have some sought of anxiety. And it is established now that more than 95% of the total population would experience an anxiety disorder or depression disorder in their life. The causes of anxiety could be many. The common conditions that you would see would be every disease person have same sought of the anxiety disorder as such. From the psychiatric classical point of view anxiety disorders can be classified as (depending upon the causes)

1. Separation anxiety disorders – Separation from any person who is close with you. It could be about the pet animals.
2. Specific phobia – Fear of any specific issues. Like a person may have fear of going into the certain places or so on.
3. Social anxiety disorders (Social phobia) – Fear about the social activities. And they try to keep themselves separately.
4. Agoraphobia – A fear of going out. Always limiting yourself to the limited areas.

These are presented as a group of anxiety disorders. Based upon on these clinical presentations I consider them as the Raja-dosha. This is how I deal them in my clinical practice.

Another group of anxiety disorders are

1. Panic disorders – where a person is confused totally and he will not be having perception of the situation. Quite severe presentations
2. Obsessive- compulsive disorders – It is placed in both anxiety disorders as well as a separate disease as such
3. Selective mutism – Person would be just keeping silent and avoiding the issues

I consider above three as Tama- dosha.

Then another group of anxiety disorder we deal very commonly in clinical practices

1. Medication/ substance induced anxiety disorder – Like alcohol or other drug as such
2. Anxiety disorder due to another medical condition – This is more common. Like a person is having any other disease like any chronic disease a person would have anxiety as a component and every practioner in daily clinical practice would be prescribing some anxiolytc drugs regularly.

So in general in the present classification of the acute stress disorders, post- traumatic stress disorders are no longer considered as anxiety disorders in present classification. We will have good number of patients with anxiety after  trauma particularly in surgical practice either prior to surgery or later to surgery.

This group of classification is according to DSM classification. I have sub classified them based on Raja- and Tama-dosha. So instead targeting single disorder we will target them as Raja dosha and Tama dosha janya disorders.

Anxiety in febrile diseases

 The incidence of anxiety disorders is quite common. Depending upon the incidences like panic disorders are more common in females whereas the social phobia is more among the males. Anxiety as a disorder is mentioned in the name of Dainya or udvega. Udvega is the specific word that has been used for anxiety. This is related to many of the physical disorders. To list all the disorders is not practically possible. But the anxiety related disease is mentioned in a large condition. And in many conditions, there is no specific need for the treatment of anxiety. If you deal with the primary cause of the underlying disease like dainya and udvega in rasa dhatugata jwara are very classical clinical presentations, there is no need of any specificanti-anxiety or anxiolytic drug from Ayurvedic point of view. If you treat the jwara naturally the anxiety component will be reduced. So there is no need of medical intervention as such. So is the case of any other jwara.

गुरुत्वं दैन्यमुद्वेगः सदनं छर्द्यरोचकौ|
रसस्थिते बहिस्तापः साङ्गमर्दो विजृम्भणम्||
Cha Chi 3/76

For example udvega is also produced due to vata prakopa

कषायकटुतिक्तरूक्षलघुशीतव्यवायव्यायामवमनविरेचनास्थापन-शिरोविरेचनातियोगसन्धारणानशनाभिघातातपोद्वेगशोकशोणितातिषेक- जागरणविषमशरीरन्यासानुपसेवमानस्य तथाविधशरीरस्यैव क्षिप्रं वातः प्रकोपमापद्यते||
Cha Ni 4/36

The conditions for managing Udvega is on the line of managing Vata prakopa i.e. any Vata Shamak treatment can be used for anxiety.

The anxiety or udvega is also mentioned in case of Atisara like both Atisara and anxiety are inter-related.

अतिशीतस्निग्धरूक्षोष्णगुरुखरकठिनविषमविरुद्धासात्म्यभोजनादभोजनात् कालातीतभोजनाद् यत्किञ्चिदभ्यवहरणात् प्रदुष्टमद्यपानीयपानादतिमद्यपानादसंशोधनात् प्रतिकर्मणां विषमगमनादनुपचाराज्ज्वलनादित्यपवनसलिलातिसेवनादस्वप्ना- दतिस्वप्नाद्वेगविधारणादृतुविपर्ययादयथाबलमारम्भाद्भयशोकचित्तोद्वेगातियोगात् कृमिशोषज्वरार्शोविकारातिकर्षणाद्वा व्यापन्नाग्नेस्त्रयो दोषाः प्रकुपिता भूय एवाग्निमुपहत्य पक्वाशयमनुप्रविश्यातीसारं सर्वदोषलिङ्गं जनयन्ति||
Cha chi 19/8

Or any other gastro-intestinal disorder can be presentation of anxiety or a disease of Atisara can also produce anxiety or Udvega etc.

From the clinical point of view, anxiety should not be diagnosed as a separate entity. The primary target should be dealing with the primary diseases.

So, at the same time counselling makes a huge difference. Just giving an assurance to the patient that anxiety is a common phenomenon it can be managed. Such simple words can help a lot. For counselling there are two categories of counselling.

1. Philosophical counselling
2. Personal counselling

Philosophical counselling is rather the upcoming branch. It is much better than the personal counselling. We can recommend some book for the philosophical counselling like Philosophy practice – An alternative to counselling and psychotherapy by …………………………

In the practice also philosophical counselling is much better than the personal counselling. The difference between the two is that in personal counselling one should go deeper into the personal issue of the patient and should advise personal solution to his/ her issue. It is practically difficult. Though it is not impossible but clinically practically difficult. Philosophical counselling is a general statement like your illness is related something beyond your control. And best philosophical counselling which I would prefer is convincing the patient that there are many others who have either similar or more severe conditions than yours. When person fells his problem is comparatively lesser than the problem of others much of the anxiety related to the disease is reduced. So that’s the one the mode of dealing with patients of any sort of illness in my clinical practice instead of going through that the standard protocol of counselling. Standard protocol of counselling goes step by step. First, take the history and then targeted counselling which is more time consuming and I consider this as more difficult. But it’s equally effective if you give a general counselling as such. In general, I avoid a specific prescription for anxiety symptoms as far as possible. When the symptoms are quite severe or the patient is not manageable with other usual advice then only I prescribe Saraswatarishta and Smritisagara Rasa in the patients of Tama lakshana and Kamadugha Rasa in Raja lakshana. At I don’t consider them as an anxiolytic drugs. I don’t use that word as. In fact, in quite severe anxieties it can help in reducing anxieties but the primary treatment is counselling. But form Ayurvedic point of view, we can help the patients who are already on anxiolytic drugs. The anxiolytic drug prescription is quite common. The patient who comes to us would be on anxiolytic drugs prescribed by others which may be either unnecessary or the patient is taking the drugs from long time and hence most of these patients would have one or other adverse effect of the anxiolytic drugs. Like-

Drowsiness

Sedation

Confusion

Stomach upset

Nausea

Diarrhea

Sexaul dysfunction

Headache

Dry mouth

Blurred vision

Constipation

Orthostatic hypotension

Increased Heart Rate

Abnormal heartbeat

Weight gain

Suicidal thoughts

Hypertension

And the most common is Dependence. The person who is on anxiolytic drugs for long is unable to withdraw. Also sometimes the adverse effect is more serious than the primary issue. Here we the Ayurveda physicians can have significant impact on the outcome.

Other measures that I use in my clinical practice are

• Pranayama and Yoga
• Tailadhara / Rajayapaa basti
• Diet and exercise
• Lifestyle modifications [ TV viewing]

Taildhara / Rajayapaa basti in quite severe cases. When there is a other disease which can be delt with Vata prakopa treatment. And so can help in relieving the anxiety.

Diet and exercise

Katu rasa and Vidahi ahara should be avoided. Spicy or katu food should be avoided as it may trigger the anxiety. Though its not established in the contemporary system but It is a true asset.

Lifestyle modifications – Among lifestyle modifications TV viewing plays an important role are enhancing incidence of anxiety. For example, during COVID-19 pandemic.

So we may not write the name of diagnosis as Anxiety but this way we will treat the anxiety by anyhow.