Charaka Unmada Nidana: 7th Chapter

The 7th chapter of Charaka Samhitha Nidana Sthana is called Unmada Nidana. It deals with causes, pathology,types and symptoms of Unmada – Insanity, as per Ayurveda. 

अथात उन्माद निदानं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athāta unmāda nidānaṃ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātreyaḥ||2||
We shall now explore the chapter on the “Diagnosis of Insanity”. Thus said Lord Atreya [1-2]

Vidha (Types) of Unmada – Insanity:
इह खलु पञ्चोन्मादा भवन्ति; तद्यथा- वात पित्त कफ सन्निपातागन्तु निमित्ताः||३||
तत्र दोष निमित्ताश्चत्वारः पुरुषाणामेवंविधानां क्षिप्रमभिनिर्वर्तन्ते; तद्यथा- भीरूणामुपक्लिष्टसत्त्वानामुत्सन्न दोषाणां स मल विकृतोपहितान्यनुचितान्याहारजातानि वैषम्ययुक्तेनोपयोगविधिनोपयुञ्जानानां तन्त्रप्रयोगमपि विषममाचरतामन्याश्च शरीरचेष्टा विषमाः समाचरतामत्युपक्षीण देहानां व्याधि वेग समुद्भ्रमितानामुपहतमनसां वा काम क्रोध लोभ हर्ष भय मोहायास शोक चिन्तोद्वेगादिभिर्भूयोऽभिघाताभ्याहतानां वा मनस्युपहते बुद्धौ च प्रचलितायामभ्युदीर्णा दोषाः प्रकुपिता हृदयमुपसृत्य मनोवहानि स्रोतांस्यावृत्य जनयन्त्युन्मादम्||४||
iha khalu pañconmādā bhavanti; tadyathā- vāta pitta kapha sannipātāgantu nimittāḥ||3||
tatra doṣa nimittāścatvāraḥ puruṣāṇāmevaṃvidhānāṃ kṣipramabhinirvartante; tadyathā- bhīrūṇāmupakliṣṭa sattvānāmutsanna doṣāṇāṃ sa mala vikṛtopahitānyanucitānyāhārajātāni vaiṣamyayuktenopayogavidhinopayuñjānānāṃ tantraprayogamapi viṣamamācaratāmanyāśca śarīraceṣṭā viṣamāḥ samācaratāmatyupakṣīṇa dehānāṃ vyādhi vega samudbhramitānāmupahatamanasāṃ vā kāma krodha lobha harṣa bhaya mohāyāsa śoka cintodvegādibhirbhūyo’bhighātābhyāhatānāṃ vā manasyupahate buddhau ca pracalitāyāmabhyudīrṇā doṣāḥ prakupitā hṛdayamupasṛtya manovahāni srotāṃsyāvṛtya janayantyunmādam||4||

schizophrenia

Unmada (insanity) is of 5 types. They are due to:
Vata
Pitta
Kapha and
Sannipata (combined vitiation of all the 3 Doshas) and
Aagantuja – exogenous.

The 4 types of Unmada caused by the vitiation of Doshas manifest themselves quickly in the following circumstances:
Bhīrūṇāmupakliṣṭa – When an individual is timid
Sattvānāmutsanna doṣāṇāṃ – When is mind is afflicted by the predominance of Rajas and Tamas
Mala vikṛtopahitānyanucitānyāhārajātāni- When Doshas in his body are aggravated and Vitiated
Vaiṣamyayuktenopayogavidhinopayuñjānānāṃ – When he takes food consisting of unwholesome and unclean ingredients possessing mutually contradictory properties or touched by unclean hands of persons suffering from contagious disease like leprosy, neglecting the prescribed deitic rules, (viz. conformity with nature etc. of the ingredients)
Samācaratāmatyupakṣīṇa dehānāṃ – When his body is exceedingly depleted
If he is not proper state of health due to other diseases
When his body is exceedingly depleted
If he is not in proper state of health due to other diseases
Vyādhi vega samudbhramitānāmupahatamanasāṃ vā kāma krodha lobha harṣa bhaya mohāyāsa śoka Chintodvegādibhirbhūyo’bhighātābhyāhatānāṃ – When his mind is afflicted over and over again by passion, anger, greed, excitement, fear, attachment, exertion, anxiety and grief and
Abhighātābhyāhatānāṃ – When he is subjected to excessive physical assault

In the circumstances to enumerated above the mind gets seriously affected and the intellect losses its balance. So the Doshas aggravated and vitiated enter the cardiac region and obstruct the channels of the mind resulting in Insanity. [ 3-4]

Definition of insanity:
उन्मादं पुनर्मनोबुद्धिसञ्ज्ञाज्ञान स्मृति भक्ति शील चेष्टाचार विभ्रमं विद्यात्||५||
unmādaṃ punarmanobuddhisañjñājñāna smṛti bhakti śīla ceṣṭācāra vibhramaṃ vidyāt||5||
Insanity is characterized by the:
Punar mano – pervasion of mind
Buddhi – intellect
Sanjna – consciousness
Jnana – knowledge
Smrti – memory
Sheela – desire
Chesta – manners
Achara – behavior and
Vibhrama – contact [5]

Unmada Purvarupa – Premonitory symptoms 
तस्येमानि पूर्वरूपाणि; तद्यथा- शिरसः शून्यता, चक्षुषोराकुलता, स्वनः कर्णयोः, उच्छ्वासस्याधिक्यम्, आस्य संस्रवणम्, अनन्नाभिलाषारोचकाविपाकाः, हृद्ग्रहः, ध्यानायास सम्मोहोद्वेगाश्चास्थाने, सततं लोमहर्षः, ज्वरश्चाभीक्ष्णम्, उन्मत्त चित्तत्वम्, उदर्दित्वम्, अर्दिताकृतिकरणं च व्याधेः, स्वप्ने चाभीक्ष्णं दर्शनं भ्रान्तचलितानवस्थितानां रूपाणामप्रशस्तानां च तिलपीडकचक्राधिरोहणं वातकुण्डलिकाभिश्चोन्मथनं निमज्जनं च कलुषाणामम्भसामावर्ते चक्षुषोश्चापसर्पणमिति (दोषनिमित्तानामुन्मादानां पूर्वरूपाणि भवन्ति)||६||
tasyemāni pūrvarūpāṇi; tadyathā- śirasaḥ śūnyatā, cakṣuṣorākulatā, svanaḥ karṇayoḥ, ucchvāsasyādhikyam, āsya saṃsravaṇam, anannābhilāṣārocakāvipākāḥ, hṛdgrahaḥ, dhyānāyāsa sammohodvegāścāsthāne, satataṃ lomaharṣaḥ, jvaraścābhīkṣṇam, unmatta cittatvam, udarditvam, arditākṛtikaraṇaṃ ca vyādheḥ, svapne cābhīkṣṇaṃ darśanaṃ bhrāntacalitānavasthitānāṃ rūpāṇāmapraśastānāṃ ca tilapīḍakacakrādhirohaṇaṃ vātakuṇḍalikābhiśconmathanaṃ nimajjanaṃ ca kaluṣāṇāmambhasāmāvarte cakṣuṣoścāpasarpaṇamiti (doṣanimittānāmunmādānāṃ pūrvarūpāṇi bhavanti)||6||

Premonitory symptoms of insanity caused by the vitiation of Doshas:
Shirasaḥ śūnyatā – Emptiness in head
Chakṣuṣorākulatā – Congestion in eyes
Svanaḥ karṇayoḥ – Noises in ears
Ucchvāsasyādhikyam – Hard breathing in excess
Aasya saṃsravaṇam – Excessive salivation in the mouth
Anannābhilāṣārocakāvipākāḥ – Absence of inclination for food, anorexia and indigestion
Hṛdgrahaḥ – Spasm in cardiac region
Dhyānāyāsa sammohodvegāścāsthāne – Meditation, fatigue, unconsciousness and anxiety in improper situations
Satataṃ lomaharṣaḥ – Continuous horripilation
Jvaraścābhīkṣṇam – Frequent pyrexia
Unmatta cittatvam – Fickle mindedness
Udarditvam – Pain in the upper part of the body
Arditākṛtikaraṇaṃ ca vyādheḥ – Manifestation of symptoms of facial paralysis resulting in movement in one half of the face
Svapne cābhīkṣṇaṃ darśanaṃ – Frequent appearance of the following in dreams
Bhrāntacalitānavasthitānāṃ rūpāṇāmapraśastānāṃ ca tilapīḍakacakrādhirohaṇaṃ vātakuṇḍalikābhiśconmathanaṃ – Inauspicious objects that are wandering, moving and unstable
Nimajjanaṃ – Riding over the wheel of an oil press
Kaluṣāṇāmambhasāmāvarte – Being churned by whirl- winds
Sinking in fearful whirl pools and
Chakṣuṣoścāpasarpaṇamiti – Retraction of eyes.[6]

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Distinctive features of insanity:
ततोऽनन्तरमेवमुन्मादाभिनिर्वृत्तिरेव|
तत्रेदमुन्मादविशेषविज्ञानं भवति; तद्यथा- परिसरणमजस्रम्, अक्षि भ्रुवौष्ठांसहन्वग्रहस्तपादाङ्ग विक्षेपणमकस्मात्, सततमनियतानां च गिरामुत्सर्गः, फेनागमनमास्यात्, अभीक्ष्णं स्मितहसितनृत्यगीतवादित्रसम्प्रयोगाश्चास्थाने, वीणावंश शङ्ख शम्या तालशब्दानुकरणमसाम्ना, यानमयानैः, अलङ्करणमनलङ्कारिकैर्द्रव्यैः, लोभश्चाभ्यवहार्येष्वलब्धेषु, लब्धेषु चावमानस्तीव्रमात्सर्यं च, कार्श्यं, पारुष्यम्, उत्पिण्डितारुणाक्षता, वातोपशयविपर्यासादनुपशयता च; इति वातोन्मादलिङ्गानि भवन्ति(१);
अमर्षः, क्रोधः, संरम्भश्चास्थाने, शस्त्रलोष्ट्रकशाकाष्ठमुष्टिभिरभिहननं स्वेषां परेषां वा, अभिद्रवणं, प्रच्छायशीतोदकान्नाभिलाषः, सन्तापश्चातिवेलं, ताम्रहरितहारिद्रसंरब्धाक्षता, पित्तोपशयविपर्यासादनुपशयता च; इति पित्तोन्मादलिङ्गानि भवन्ति(२);
स्थानमेकदेशे, तूष्णीम्भावः, अल्पशश्चङ्क्रमणं, लालाशिङ्घाणकस्रवणम्, अनन्नाभिलाषः, रहस्कामता, बीभत्सत्वं, शौचद्वेषः, स्वप्ननित्यता, श्वयथुरानने, शुक्ल स्तिमितमलोपदिग्धाक्षत्वं, श्लेष्मोपशयविपर्यासादनुपशयता च; इति श्लेष्मोन्मादलिङ्गानि भवन्ति(३);
त्रिदोषलिङ्गसन्निपाते तु सान्निपातिकं विद्यात्; तमसाध्यमाचक्षते कुशलाः||७||
tato’nantaramevamunmādābhinirvṛttireva|
tatredamunmādaviśeṣavijñānaṃ bhavati; tadyathā- parisaraṇamajasram, akṣi bhruvauṣṭhāṃsahanvagrahastapādāṅga vikṣepaṇamakasmāt, satatamaniyatānāṃ ca girāmutsargaḥ, phenāgamanamāsyāt, abhīkṣṇaṃ smitahasitanṛtyagītavāditrasamprayogāścāsthāne, vīṇāvaṃśa śaṅkha śamyā tālaśabdānukaraṇamasāmnā, yānamayānaiḥ, alaṅkaraṇamanalaṅkārikairdravyaiḥ, lobhaścābhyavahāryeṣvalabdheṣu, labdheṣu cāvamānastīvramātsaryaṃ ca, kārśyaṃ, pāruṣyam, utpiṇḍitāruṇākṣatā, vātopaśayaviparyāsādanupaśayatā ca; iti vātonmādaliṅgāni bhavanti(1);
amarṣaḥ, krodhaḥ, saṃrambhaścāsthāne, śastraloṣṭrakaśākāṣṭhamuṣṭibhirabhihananaṃ sveṣāṃ pareṣāṃ vā, abhidravaṇaṃ, pracchāyaśītodakānnābhilāṣaḥ, santāpaścātivelaṃ, tāmraharitahāridrasaṃrabdhākṣatā, pittopaśayaviparyāsādanupaśayatā ca; iti pittonmādaliṅgāni bhavanti(2);
sthānamekadeśe, tūṣṇīmbhāvaḥ, alpaśaścaṅkramaṇaṃ, lālāśiṅghāṇakasravaṇam, anannābhilāṣaḥ, rahaskāmatā, bībhatsatvaṃ, śaucadveṣaḥ, svapnanityatā, śvayathurānane, śukla stimitamalopadigdhākṣatvaṃ, śleṣmopaśayaviparyāsādanupaśayatā ca; iti śleṣmonmādaliṅgāni bhavanti(3);
tridoṣaliṅgasannipāte tu sānnipātikaṃ vidyāt; tamasādhyamācakṣate kuśalāḥ||7||

Clinical features of Unmada: 
A) Vataja Unmad:
Parisaraṇamajasram – constant wandering
Akṣi bhruvauṣṭhāṃsahanvagrahastapādāṅga vikṣepaṇamakasmāt – sudden spasm of eyes, eyebrows, lips, shoulder, jaws, fore-arms, and legs
Satatamaniyatānāṃ ca girāmutsargaḥ – constant and incoherent speech
Phenāgamanamāsyāt – coming out of froth from the mouth
Abhīkṣṇaṃ smitahasitanṛtyagītavāditrasamprayogāścāsthāne – Always smiling, laughing, dancing, singing and playing with musical instruments in inappropriate situations
Vīṇāvaṃśa śaṅkha śamyā tālaśabdānukaraṇamasāmnā – Loudly imitating the sounds of flute, conch, Samya (cymbal played by right hand) and Tala (cymbal played by left hand)
Yānamayānaiḥ – Riding undesirable vehicles
Alaṅkaraṇamanalaṅkārikairdravyaiḥ – Duration by such things as are not needed for ornaments
Lobhaścābhyavahāryeṣvalabdheṣu – Longing for eatables not available
Labdheṣu cāvamānastīvramātsaryaṃ ca – Digest for food articles and also a strong desire not to part with the eatables available
Kārśyaṃ, pāruṣyam – Emaciation and roughness
Utpiṇḍitāruṇākṣatā – Projected and reddish eyes and
Vātopaśayaviparyāsādanupaśayatā ca – Aggravation of the condition by such of the regimens as are not wholesome for Vata.
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(B) Paittika Unmada: 
Amarṣaḥ, krodhaḥ – Irritation and anger
Saṃrambhaścāsthāne – Excitement on inappropriate occasions
Shastraloṣṭrakaśākāṣṭhamuṣṭibhirabhihananaṃ sveṣāṃ pareṣāṃ vā abhidravaṇaṃ – Inflicting injury on own people or on others by weapons, brick bats, whips, sticks and fist.
Pracchāyaśītodakānnābhilāṣaḥ – fleeing and desire for shade, cold water and food having cooling effect.
Santāpaścātivelaṃ – Continuous state of anguish
Tāmraharitahāridrasaṃrabdhākṣatā – having ferocious eyes of coppery, green or yellow color and
Pittopaśayaviparyāsādanupaśayatā ca – aggravation of the condition by such regimens as are not wholesome for Pitta.

(C) Slaismika Unmada: 
Sthānamekadeśe tūṣṇīmbhāvaḥ, alpaśaścaṅkramaṇaṃ – Staying in one place and observance of silence
Lālāśiṅghāṇakasravaṇam – Discharge of saliva and nasal excretions
Anannābhilāṣaḥ rahaskamata – disinclination for food and love for solitude
Bībhatsatvaṃ – Frightening appearance
śaucadveṣaḥ – Aversion for cleanliness
Svapnanityatā – Remaining always sleepy
śvayathurānane – oedema in the face
Shukla stimitamalopadigdhākṣatvaṃ – White and timid eyes with excreta adhered to them
Shleṣmopaśayaviparyāsādanupaśayatā ca – Aggravation of the condition by such regimens is not wholesome for Kapha

(D) Sannipatika type: In the insanity caused by the combined vitiation of all the 3 Doshas, all the symptoms mentioned above are simultaneously manifested. This type of Insanity is considered to be incurable. [7]

Therapies as treatment:
साध्यानां तु त्रयाणां साधनानि- स्नेह स्वेद वमन विरेचनास्थापनानुवासनोपशमन नस्तःकर्म धूम धूपनाञ्जनावपीड प्रधमनाभ्यङ्ग प्रदेह परिषेकानुलेपनवधबन्धनावरोधन- वित्रासन विस्मापन विस्मारणापतर्पण सिराव्यधनानि, भोजन विधानं च यथास्वं युक्त्या, यच्चान्यदपि किञ्चिन्निदानविपरीतमौषधं कार्यं तदपि स्यादिति||८||
भवति चात्र- उन्मादान् दोषजान् साध्यान् साधयेद्भिषगुत्तमः|
अनेन विधियुक्तेन कर्मणा यत् प्रकीर्तितम्||९||
sādhyānāṃ tu trayāṇāṃ sādhanāni- sneha sveda vamana virecanāsthāpanānuvāsanopaśamana nastaḥkarma dhūma dhūpanāñjanāvapīḍa pradhamanābhyaṅga pradeha pariṣekānulepanavadhabandhanāvarodhana- vitrāsana vismāpana vismāraṇāpatarpaṇa sirāvyadhanāni, bhojana vidhānaṃ ca yathāsvaṃ yuktyā, yaccānyadapi kiñcinnidānaviparītamauṣadhaṃ kāryaṃ tadapi syāditi||8||
bhavati cātra- unmādān doṣajān sādhyān sādhayedbhiṣaguttamaḥ|
anena vidhiyuktena karmaṇā yat prakīrtitam||9||

Therapies for treatment of the 3 types of insanity which are curable are
Snehana – oleation
Svedana – fomentation
Vamana – emesis
Virechana – purgation
Asthapana basti – type of enema
Anuvasana basti – type of enema
Shamana – alleviation therapies
Nasya karma – ermines
Dhumapana – smoking
Dhupana – fumigation
Anjana – collyrium
Avapida and
Pradhamana types of Snuff
Abhyanga – massage
Pradeha – ointment
Parisheka – effusion
Anulepana – unction
Vadha – assault
Bandhana – tying
Avarodhana – confinement
Vitrasana – frightening
Vismapana – inducing astonishment and forgetfulness,
Vismarana – depletion and
Sira vyadhana – venesection

Suitable diets are given according to the requirements of the patient. Such other therapies as would work against the causative factors of the diseases are also given.
Thus it is said:-Following the principles of treatment (to be detailed in Chikitsa 9) a competent physician should employ the above mentioned therapies to treat the curable types of insanity caused by the vitiation of Doshas. [8-9]

Aagantuja unmada (Exogenous insanity):
यस्तु दोष निमित्तेभ्य उन्मादेभ्यः समुत्थान पूर्वरूप लिङ्ग वेदनोपशय विशेष समन्वितो भवत्युन्मादस्तमागन्तुकमाचक्षते|
केचित् पुनः पूर्वकृतं कर्माप्रशस्तमिच्छन्ति तस्य निमित्तम्|
तस्य च हेतुः प्रज्ञापराध एवेति भगवान् पुनर्वसुरात्रेयः|
प्रज्ञापराधाद्ध्ययं देवर्षिपितृ गन्धर्व यक्ष राक्षस पिशाच गुरुवृद्ध सिद्धाचार्यपूज्यानवमत्याहितान्याचरति, अन्यद्वा किञ्चिदेवंविधं कर्माप्रशस्तमारभते; तमात्मना हतमुपघ्नन्तो देवादयः कुर्वन्त्युन्मत्तम्||१०||
yastu doṣa nimittebhya unmādebhyaḥ samutthāna pūrvarūpa liṅga vedanopaśaya viśeṣa samanvito bhavatyunmādastamāgantukamācakṣate|
kecit punaḥ pūrvakṛtaṃ karmāpraśastamicchanti tasya nimittam|
tasya ca hetuḥ prajñāparādha eveti bhagavān punarvasurātreyaḥ|
prajñāparādhāddhyayaṃ devarṣipitṛ gandharva yakṣa rākṣasa piśāca guruvṛddha siddhācāryapūjyānavamatyāhitānyācarati, anyadvā kiñcidevaṃvidhaṃ karmāpraśastamārabhate; tamātmanā hatamupaghnanto devādayaḥ kurvantyunmattam||10||

Aagantuja unmada (Exogenous insanity):
The type of insanity having etiology, premonitory symptoms, actual symptoms, pain and homologation- (Upashaya) different from those of the types of insanity caused by the vitiation of Doshas is known as ‘Exogenous’.

Some scholars hold the view that this type of insanity is caused by the effect of the sinful activities of the past life. Lord Punarvasu Atreya considered intellectual blasphemy as the causative factor of this condition.

Due to intellectual blasphemy the patient disregards the gods, ascetics, ancestors, Gandharvas, Yaksas Raksasas, Pisacas, Preceptors, elders, Adepts, teachers and the other respectable ones. He also resorts to undesirable and such other inauspicious activities. The Gods etc. cause insanity in him because of his own inauspicious activities. [10]

Purvarupa  of Aagantuja Unmada 
तत्र देवादिप्रकोपनिमित्तेनागन्तुकोन्मादेन पुरस्कृतस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- देव गो ब्राह्मण तपस्विनां हिंसारुचित्वं, कोपनत्वं, नृशंसाभिप्रायता, अरतिः, ओजो वर्ण च्छाया बलवपुषामुपतप्तिः, स्वप्ने च देवादिभिरभिभर्त्सनं प्रवर्तनं चेति; ततोऽनन्तरमुन्मादाभिनिर्वृत्तिः||११||
tatra devādiprakopanimittenāgantukonmādena puraskṛtasyemāni pūrvarūpāṇi bhavanti; tadyathā- deva go brāhmaṇa tapasvināṃ hiṃsārucitvaṃ, kopanatvaṃ, nṛśaṃsābhiprāyatā, aratiḥ, ojo varṇa cchāyā balavapuṣāmupataptiḥ, svapne ca devādibhirabhibhartsanaṃ pravartanaṃ ceti; tato’nantaramunmādābhinirvṛttiḥ||11||

The premonitory symptoms of the exogenous type of insanity:
Deva go brāhmaṇa tapasvināṃ hiṃsārucitvaṃ – Desire for inflicting injury upon the gods, cows, Brahmins and ascetics’
Kopanatvaṃ, nṛśaṃsābhiprāyatā – Anger and liking for mischievous work
Aratiḥ, ojo varṇa cchāyā balavapuṣāmupataptiḥ – Disliking attitude and impairment of Ojas Color complexion and physical strength and
Svapne ca devādibhirabhibhartsanaṃ pravartanaṃ – Abuse and incitement by the gods etc.
Insanity manifests itself immediately after the occurrence of these premonitory symptoms. [11]

Agantuja Unmada Nidana – causative factors: 
तत्रायमुन्मादकराणां भूतानामुन्मादयिष्यतामारम्भविशेषो भवति; तद्यथा- अवलोकयन्तो देवा जनयन्त्युन्मादं, गुरु वृद्ध सिद्धमहर्षयोऽभिशपन्तः, पितरो दर्शयन्तः , स्पृशन्तो गन्धर्वाः, समाविशन्तो यक्षाः, राक्षसास्त्वात्मगन्धमाघ्रापयन्तः, पिशाचाः पुनरारुह्य वाहयन्तः||१२||
tatrāyamunmādakarāṇāṃ bhūtānāmunmādayiṣyatāmārambhaviśeṣo bhavati; tadyathā- avalokayanto devā janayantyunmādaṃ, guru vṛddha siddhamaharṣayo’bhiśapantaḥ, pitaro darśayantaḥ , spṛśanto gandharvāḥ, samāviśanto yakṣāḥ, rākṣasāstvātmagandhamāghrāpayantaḥ, piśācāḥ punarāruhya vāhayantaḥ||12||

Agantuja Unmada Nidana – causative factors: 
The causative agents of the exogenous type of insanity insanity their action as follows:-
Avalokayanto devā janayantyunmādaṃ – The gods produce insanity by their vision
Guru vṛddha siddhamaharṣayo’bhiśapantaḥ – Preceptors, elders, adepts and ascetics by their cures
Pitaro darśayantaḥ – Ancestors by exhibiting themselves
Spṛśanto gandharvāḥ – Gandharvas by their touch
Samāviśanto yakṣāḥ – Yakshas by seizure
Rākṣasāstvātmagandhamāghrāpayantaḥ – Raksasas by making the patient to smell the odor of their body and
Piśācāḥ punarāruhya vāhayantaḥ – Pishacas by riding and driving their victims. [12]

Rupa – Symptoms of manifestations of disease:
तस्येमानि रूपाणि भवन्ति; तद्यथा- अत्यात्म बल वीर्य पौरुष पराक्रम ग्रहण धारण स्मरण ज्ञान वचन विज्ञानानि , अनियतश्चोन्मादकालः||१३||
tasyemāni rūpāṇi bhavanti; tadyathā- atyātma bala vīrya pauruṣa parākrama grahaṇa dhāraṇa smaraṇa jñāna vacana vijñānāni , aniyataśconmādakālaḥ||13||
Symptoms of this condition are the manifestations of:
Atyātma bala – superhuman strength
Vīrya – energy
Pauruṣa – manliness
Parākrama – enthusiasm
Grahaṇa dhāraṇa – power of understanding and retention
Smaraṇa – memory
Jñāna vacana vijñānāni – spiritual as well as artistic knowledge and
Aniyataśconmādakālaḥ – Power of speech in the patient himself.
There is no fixed time for manifestation of this insanity. [13]

Circumstances of victimization of the subject:
उन्मादयिष्यतामपि खलु देवर्षि पितृ गन्धर्व यक्ष राक्षस पिशाचानां गुरु वृद्ध सिद्धानां वा एष्वन्तरेष्वभिगमनीयाः पुरुषा भवन्ति; तद्यथा- पापस्य कर्मणः समारम्भे, पूर्वकृतस्य वा कर्मणः परिणामकाले, एकस्य वा शून्यगृहवासे चतुष्पथाधिष्ठाने वा, सन्ध्यावेलायामप्रयतभावे वा पर्वसन्धिषु वा मिथुनीभावे, रजस्वलाभिगमने वा, विगुणे वाऽध्ययन बलि मङ्गल होम प्रयोगे, नियम व्रत ब्रह्मचर्य भङ्गे वा, महाहवे वा, देश कुलपुरविनाशे वा, महाग्रहोपगमने वा, स्त्रिया वा प्रजननकाले, विविध भूताशुभा शुचि स्पर्शने वा, वमन विरेचन रुधिरस्रावे, अशुचेरप्रयतस्य वा चैत्यदेवायतनाभिगमने वा, मांस मधु तिल गुड मद्योच्छिष्टे वा, दिग्वाससि वा, निशि नगर निगम चतुष्पथो पवन श्मशानाघातनाभिगमने वा, द्विज गुरु सुरयतिपूज्याभिधर्षणे वा, धर्माख्यानव्यतिक्रमे वा, अन्यस्य वा कर्मणोऽप्रशस्तस्यारम्भे, इत्यभिघातकाला व्याख्याता भवन्ति||१४||
unmādayiṣyatāmapi khalu devarṣi pitṛ gandharva yakṣa rākṣasa piśācānāṃ guru vṛddha siddhānāṃ vā eṣvantareṣvabhigamanīyāḥ puruṣā bhavanti; tadyathā- pāpasya karmaṇaḥ samārambhe, pūrvakṛtasya vā karmaṇaḥ pariṇāmakāle, ekasya vā śūnyagṛhavāse catuṣpathādhiṣṭhāne vā, sandhyāvelāyāmaprayatabhāve vā parvasandhiṣu vā mithunībhāve, rajasvalābhigamane vā, viguṇe vā’dhyayana bali maṅgala homa prayoge, niyama vrata brahmacarya bhaṅge vā, mahāhave vā, deśa kulapuravināśe vā, mahāgrahopagamane vā, striyā vā prajananakāle, vividha bhūtāśubhā śuci sparśane vā, vamana virecana rudhirasrāve, aśuceraprayatasya vā caityadevāyatanābhigamane vā, māṃsa madhu tila guḍa madyocchiṣṭe vā, digvāsasi vā, niśi nagara nigama catuṣpatho pavana śmaśānāghātanābhigamane vā, dvija guru surayatipūjyābhidharṣaṇe vā, dharmākhyānavyatikrame vā, anyasya vā karmaṇo’praśastasyārambhe, ityabhighātakālā vyākhyātā bhavanti||14||

Human beings fall victims to the attack of insanity caused by the Gods, Ascetics, ancestors, Gandharvas, Yaksas, Rakshas, Pisacas, Preceptors, elders and adepts in the following circumstances:
Pāpasya karmaṇaḥ samārambhe – In the beginning of sinful acts.
Pūrvakṛtasya vā karmaṇaḥ pariṇāmakāle – When the (sinful) acts of the past life are matured enough to produce their effects
Ekasya vā śūnyagṛhavāse catuṣpathādhiṣṭhāne vā – Residing in a deserted house or going to cross roads alone.
Sandhyāvelāyāmaprayatabhāve vā parvasandhiṣu vā mithunībhāve – Sexual intercourse during the junctures of day and night or during the new moon and full moon days
Rajasvalābhigamane vā – Sexual intercourse with a lady during her menses
Viguṇe vā’dhyayana bali maṅgala homa prayoge – Recitation of scriptures, religious offerings, auspicious rites and sacrifices in improper manner
Niyama vrata brahmacarya bhaṅge vā – Dishonoring a vow and discontinuing a religious duty or observance of celibacy
Mahāhave vā – Forceful battles
Deśa kulapuravināśe vā – Destruction of countries, communities and towns
Mahāgrahopagamane vā – Onset of inauspicious planets in the sky
Striyā vā prajananakāle – During the time of child- delivery of ladies
Vividha bhūtāśubhā śuci sparśane vā – Coming in contact with different types of inauspicious and unclean creatures
Vamana virecana rudhirasrāve – Emesis, purgation and bleeding
Aśuceraprayatasya vā caityadevāyatanābhigamane vā – Visiting a Caitya (scared tree) or temple when unclean and not following the prescribed rules
Māṃsa madhu tila guḍa madyocchiṣṭe vā – Resorting to the remnants of meat, honey , till sugar candy and alcohol
Digvāsasi vā – While naked
Niśi nagara nigama catuṣpatho pavana śmaśānāghātanābhigamane vā – Visiting cities, towns, cross roads, gardens, cremation grounds, slaughter houses at night
Dvija guru surayatipūjyābhidharṣaṇe vā – Insulting Dvija (twice born), preceptors, the Gods, ascetics and others who are respected.
Dharmākhyānavyatikrame vā – Misinterpretation of religious scriptures and
Anyasya vā karmaṇo’praśastasyārambhe – Initiating such another inauspicious activities
Thus the circumstance in which a person is attached by exogenous type of insanity is explained. [14]

Unmada Karana – 3 main causes: 
त्रिविधं तु खलून्मादकराणां भूतानामुन्मादने प्रयोजनं भवति; तद्यथा- हिंसा, रतिः, अभ्यर्चनं चेति|
तेषां तं प्रयोजन विशेषमुन्मत्ताचार विशेष लक्षणैर्विद्यात्|
तत्र हिंसार्थिनोन्माद्यमानोऽग्निं प्रविशति, अप्सु निमज्जति, स्थलाच्छ्वभ्रे वा पतति, शस्त्रकशाकाष्ठलोष्टमुष्टिभिर्हन्त्यात्मानम्, अन्यच्च प्राणवधार्थमारभते किञ्चित्, तमसाध्यं विद्यात्; साध्यौ पुनर्द्वावितरौ||१५||
trividhaṃ tu khalūnmādakarāṇāṃ bhūtānāmunmādane prayojanaṃ bhavati; tadyathā- hiṃsā, ratiḥ, abhyarcanaṃ ceti|
teṣāṃ taṃ prayojana viśeṣamunmattācāra viśeṣa lakṣaṇairvidyāt|
tatra hiṃsārthinonmādyamāno’gniṃ praviśati, apsu nimajjati, sthalācchvabhre vā patati, śastrakaśākāṣṭhaloṣṭamuṣṭibhirhantyātmānam, anyacca prāṇavadhārthamārabhate kiñcit, tamasādhyaṃ vidyāt; sādhyau punardvāvitarau||15||

Unmada Karana – 3 main causes: 
Insanity is caused by these agents with 3 objectives,
Hiṃsā – To inflict injury
Ratiḥ – To play and
Abhyarcanaṃ – To offer prayer

Their intentions can be judged from the characteristic features of the patient:
Hiṃsārthinonmādyamāno’gniṃ praviśati, apsu nimajjati, sthalācchvabhre vā patati, śastrakaśākāṣṭhaloṣṭamuṣṭibhirhantyātmānam – When the intention of the afflicted agents is to inflict injury, then the patient enters into fire sinks into water, falls into a pit, strikes himself with weapons, whips, sticks, brick bats, his own first etc.
Anyacca prāṇavadhārthamārabhate kiñcit – he may also adopt such other means for killing himself. This type of insanity is incurable, if the intention of the causative agents is the remaining 2 i.e to play or to offer prayer, then this is curable. [15]

Therapies:
तयोः साधनानि- मन्त्रौषधि मणि मङ्गल बल्युपहार होम नियम व्रत प्रायश्चित्तोपवास स्वस्त्ययनप्रणिपातगमनादीनि||१६||
एवमेते पञ्चोन्मादा व्याख्याता भवन्ति||१७||
tayoḥ sādhanāni- mantrauṣadhi maṇi maṅgala balyupahāra homa niyama vrata prāyaścittopavāsa svastyayanapraṇipātagamanādīni||16||
evamete pañconmādā vyākhyātā bhavanti||17||
Therapies for this type of insanity are incantation of Mantras wearing of talisman and jewels, performance of auspicious rites, religious sacrifices, oblations and religious rites, taking a vow, performing religious duty atonements fasting, blessing, obeisance and pilgrimage. Thus the 5 types of insanity are explained. [16-17]

Classification and prognosis:
ते तु खलु निजागन्तुविशेषेण साध्यासाध्य विशेषेण च प्रविभज्यमानाः पञ्च सन्तो द्वावेव भवतः|
तौ च परस्परमनुबध्नीतः कदाचिद्यथोक्तहेतुसंसर्गात्|
तयोः संसृष्टमेव पूर्वरूपं भवति, संसृष्टमेव च लिङ्गम्|
तत्रासाध्य संयोगं साध्यासाध्य संयोगं चासाध्यं विद्यात्, साध्यं तु साध्य संयोगम्|
तस्य साधनं साधनसंयोगमेव विद्यादिति||१८||
te tu khalu nijāgantuviśeṣeṇa sādhyāsādhya viśeṣeṇa ca pravibhajyamānāḥ pañca santo dvāveva bhavataḥ|
tau ca parasparamanubadhnītaḥ kadācidyathoktahetusaṃsargāt|
tayoḥ saṃsṛṣṭameva pūrvarūpaṃ bhavati, saṃsṛṣṭameva ca liṅgam|
tatrāsādhya saṃyogaṃ sādhyāsādhyasaṃyogaṃ cāsādhyaṃ vidyāt, sādhyaṃ tu sādhyasaṃyogam|
tasya sādhanaṃ sādhanasaṃyogameva vidyāditi||18||

Insanity along with its 5 types, classified as endogenous or curable and incurable, are again grouped into 2. At times, due to the combination of etiological factors (of endogenous and exogenous types), they are manifested in a combined form. There is combination in their premonitory as well as actual symptoms.
Combination of the incurable varieties or the curable and incurable varieties results in the incurability of the condition. Combination of the curable varieties, however, results in the curability of the condition. For the treatment of this (last mentioned) condition, there is the combination of therapies. [18]

Misdeeds as causes of insanity:
भवन्ति चात्र-
नैव देवा न गन्धर्वा न पिशाचा न राक्षसाः|
न चान्ये स्वयमक्लिष्टमुपक्लिश्नन्ति मानवम्||१९||
ये त्वेनमनुवर्तन्ते क्लिश्यमानं स्वकर्मणा|
न स तद्धेतुकः क्लेशो न ह्यस्ति कृतकृत्यता||२०||
bhavanti cātra-
naiva devā na gandharvā na piśācā na rākṣasāḥ|
na cānye svayamakliṣṭamupakliśnanti mānavam||19||
ye tvenamanuvartante kliśyamānaṃ svakarmaṇā|
na sa taddhetukaḥ kleśo na hyasti kṛtakṛtyatā||20||
Thus it is said:-
Neither the gods, Nor Gandharvas nor Pisacas nor Rakshas afflict a person who himself is free from misdeeds. The primary causes of insanity in an individual are hi own misdeeds and other agents like the gods etc. act only as the consequence of these misdeeds. There cannot be the manifestation of anything which is already manifested. Thus verily the gods etc., are not causative factors of insanity in human beings. [19-20]

Causes and observance of wholesome regimens:
प्रज्ञापराधात् सम्भूते व्याधौ कर्मज आत्मनः|
नाभिशंसेद्बुधो देवान्न पितॄन्नापि राक्षसान्||२१||
आत्मानमेव मन्येत कर्तारं सुख दुःखयोः|
तस्माच्छ्रेयस्करं मार्गं प्रतिपद्येत नो त्रसेत्||२२||
देवादीनामपचितिर्हितानां चोपसेवनम्|
ते च तेभ्यो विरोधश्च सर्वमायत्तमात्मनि||२३||
तत्र श्लोकः- सङ्ख्या निमित्तं प्राग्रूपं लक्षणं साध्यता न च|
उन्मादानां निदानेऽस्मिन् क्रियासूत्रं च भाषितम्||२४||
prajñāparādhāt sambhūte vyādhau karmaja ātmanaḥ|
nābhiśaṃsedbudho devānna pitṝnnāpi rākṣasān||21||
ātmānameva manyeta kartāraṃ sukha duḥkhayoḥ|
tasmācchreyaskaraṃ mārgaṃ pratipadyeta no traset||22||
devādīnāmapacitirhitānāṃ copasevanam|
te ca tebhyo virodhaśca sarvamāyattamātmani||23||
tatra ślokaḥ- saṅkhyā nimittaṃ prāgrūpaṃ lakṣaṇaṃ sādhyatā na ca|
unmādānāṃ nidāne’smin kriyāsūtraṃ ca bhāṣitam||24||

Causes and observance of wholesome regimens:
The man should not blame the gods, ancestors or Rakshasa for diseases caused by his own misdeeds due to intellectual blasphemy. One should hold himself responsible for his happiness and miseries. Therefore without apprehension one should follow the path of propitiousness.
Prayer to the Gods etc and resorting to wholesome regimens act as antidotes to the misdates to the misdeeds of the individual. Thus the power either to avert or invite the attach of insanity rests with the individual himself [22-23]

Contents:-
इत्यग्निवेशकृते तन्त्रे चरक प्रतिसंस्कृते निदान स्थाने उन्माद निदानं नाम सप्तमोऽध्यायः||७||
ityagniveśakṛte tantre caraka pratisaṃskṛte nidāna sthāne unmāda nidānaṃ nāma saptamo’dhyāyaḥ||7||
Number, etiology, premonitory symptoms, curability or otherwise and the principles of treatment of various types of insanity are described in this chapter. [24]
Thus ends the 7th chapter on the “Unmada Nidana” of section of Nidana Sthana of Agnivesha’s work as redacted by Charaka.

Read related:
Unmada-Insanity: Ayurvedic Understanding And Management
Unmada Chikitsa – Charaka Chikitsa Sthana 9th Chapter


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