Unmada-Insanity: Ayurvedic Understanding And Management

Article by – Dr. MS Krishnamurthy MD (Ayu), PhD (Ayu).
Ayurvedic understanding of Unmada is too difficult to explain in a single co-related term in modern science as ‘Insanity’. Ayurveda explains the condition of insanity with respect to three important entities like buddhivikara (deformity of will), manovikara (deformity of mind) and atmavikara.(deformity of intellect).

Buddhivikara refers to impairment in will and thinking pattern. Cognition of thinking and paranoid reactions are commonly found in this category of illness.
Mano vikara refers to the impairment of mind. Due to this, inaction and passivity is found.
Atmavikara causes impairment of feelings. Due to this, depressive psychosis is found.
Insanity (unmada) is a condition where according to the Dosha dominance, all the above features are found in gradable variation.

Origin of insanity (Unmada)

Acharya Sushruta explained the origin of insanity as below:
Due to favorable causative factors, the morbidity (vitiated Dosha) ascends upwards to the mind, from the main site of heart. This leads to functional disturbance in its main location (heart) as well as disposed areas like brain and its various relative compartments. Due to this, the individual gets false belief or delusions and person appears as if intoxicated due to the unawareness or the situation. This condition is called Unmad, a kind of psychosis.

Causes

Viruddhahara (incompatible foods)
Dushta ahara (infected/contaminated food)
Ashuchi ahara (polluted food)
Deva-guru-dwija pragharshana (insult towards teachers and elders)
Mano abhighata (mental shock)
Bhaya (fear)
Harsha (unusual/ unnatural pleasure due to accidental happening) etc.

Types

Vataja, Pittaja, Kaphaja, Tridoshaja, Shokaja (Caused due to grief) and Vishaja (originated due to toxicity).

Prodromal symptoms

Moha (delusion)
Udvega (anxiety)
Karna swana (auditory hallucination)
Gatrapakarshana (general debility)
Atyutsaha (occasional unnatural enthusiasm)
Aruchi (tastelessness)
Swapne kalushabhojana (dream of having contaminated food)
Vayunonmathana (sensation of being taken by the wind) etc.

General clinical features

Illusion of intellect (buddhivibrama)
Satwapariplava(dilemma of the mind)
Akuladrishti(biased willing and thinking)
Adheerata (loss of confidence)
Abaddhavak (irrelevant talk)
Hridayashoonyata (emptiness of the mind)
Moodhachetana (disorganized consciousness) etc.

Specific features

Vataja Unmada

Undue laughing, dancing, singing, irrelevant talk, waving the body parts, crying, roughness, emaciation, reddish discolouration of the face, elevated mood, impaired thought etc.

Pittaja Unmad 

Impatience, agitation, naked emotions, excessive actions, hot temperament, desire to have rest under shade, like towards the cold food and drink, yellow lustre etc.

Kaphaja Unmada

Reduced speech and actions, tastelessness, inclination for women, sleepiness, vomiting, excess of salivation,  pallor of the nails etc.

Sannipatic (Tridoshaja) Unmada

Mixed features of all the three doshic factors

Shokaja Unmada

This is usually associated with the history of scaring by the thieves, officials, enemies, animals etc. Or else loss of money or relatives, mental shock due to accidental happenings etc.

Vishaja Unmada

Usually possesses a history of poisoning. It is presented with redness of the eyes, debility, debilitated sense organs, helplessness, smoky appearance of the face etc.

Management of unmada

1. Snehapana (internal oleation with medicated ghee)
2. Mridu shodhana (mild body purification by emesis or purgation)
3. Niruha basti (decoction enema)
4. Shirovirechana (medicated errhines) and
5. Sanjna prabodhana (oral medication to stabilize the mind)

Single drugs usage

Single drugs recommended in insanity (unmada)
1. Garlic-  Allium sativa Linn.
2. Asafetida-  Ferula narthex Boiss.
3. Choraka-  Angelica glauca Edgew.
4. Mustard-  Brassica campestris Linn.
5. Brahmi-  Bacopa monnieri (Linn.) Pennell.
6. Jatamamsi–  Nardostachys jatamansi Dc.
7. Jyotishmati-  Celastrus paniculata Linn.
8. Shankhapushpi–  Convolvulus pluricaulis Chosis.
9. Kooshmanda-Ash gourd-  Benincasa hispida (Thunb.) Cogn.
10. Sarpagandha-  Rauwolfia serpentine Benth. Ex Kurz.
11. Rudraksha-  Elaeocarpus ganitrus Roxb.
12. Vacha-  Acorus calamus Linn.
13. Yastimadhu-  Glycyrrhiza glabra Linn.

Ayurvedic formulations

Formulations recommended in insanity (unmada):
1. Kalyanaka ghrita
2. Mahakalyanaka ghrita
3. Mahapaishacha ghrita
4. Lashunadya ghrita
4. Unmade gajanakusha rasa
6. Saraswata choorna
7. Sarsawatarishta
8. Sarpagandha ghanavati
9. Brihatvata chintamani
10. Yogendra rasa etc

Formulations mentioned in Sahasrayoga textbook
1.Rakta pittahara kashaya
2.Tiktaka Ghrita
3 Mahatiktaka Ghrita
4. Dathryadi Ghrita
5. Dhanvantari Ghrita
6. Dhanvantara taila
7.Lakshadi taila
8.Balaswagandhadi taila
9 Mahalakshadi taila
10.Sahacharadi taila
11.Vranabhairava taila
12.Suchimukha rasa
13 Manasamitra vati

Wholesome diet and habits

Light and easily digestible food
All measures which give mental pleasure
Assurance in case of depression
Memory tonics (medhya rasayana)
Cow’s milk, cow’s ghee etc
Good sleep
Red rice, older wheat, green gram, dry grapes, meat of rabbit and koel etc.

According to Yogaratnakara

Wheat, green gram, red rice, milk which is still warm from milking, hundred times washed ghee, old and fresh butter, meat of tortoise, meat soup of animals living in desert like lands, rasala (curd devoid of water content), old pumpkin, pointed gourd, water hyssop leaves, Mexican Tea, Spiny amaranth, grapes, wood apple, jackfruit etc.

Unwholesome diet and habits

Alcohol
Pungent and spicy food
Penetrative and irritant food
Irritating, insulting or provocative incidences and activities
Suppression of natural urges
Incompatible and polluted food
Sleeplessness etc.

According to Yogaratnakara

Alcohol, diet which interrupts the tissue metabolism, hot food, supression of urge of sleep, hunger and thirst, bitter foods, food ith penetrating quality etc.

Panchakarma for Unmada

By Dr Raghuram YS and Dr Manasa

Among Panchakarma detoxification therapies, anuvasana vasti isn’t cleansing in nature. Some types of nasya are also not cleansing in nature. Cleansing errhines are used when there is severe aggravation of doshas in the head in patients of unmadam. All therapies are not needed to be implemented simultaneously in a given patient of unmad or all patients of unmad. They need to be implemented conditionally.
Read – Nasya therapy benefits types indication – Ashtang Hruday Sutrasthan 20

reason for Panchakarma in Unmada

Just before enumerating the utility of panchakarma therapies in the treatment of Unmada, Master Charaka mentions that ‘the treatment of both nija unmada i.e. unmada caused by aggravated doshas and agantuja unmada i.e. unmad caused by external causes shall be explained henceforth’. Immediately after pledging so he first touches upon the administration of panchakarma as the first and foremost approach in the treatment of unmada. Thus, Panchakarma therapies shall be administered in both kinds of unmadam i.e. that caused by doshas and that caused by external causes.

Mental disorders are caused predominantly by the imbalance of the attributes of the mind i.e. sattva, rajas and tamas. There may be increase of rajas or tamas and deterioration or masking of sattva attribute.

In pathogenesis of unmada, the initial onset of pathology leading to the manifestation of the disease is initiated by the aggravated doshas i.e. vata, pitta and kapha. The aggravated doshas move upward and contaminate the seat of intellect i.e. hrdaya (brain) and also afflict the channels of mind (nerves) leading to causation of unmada. Therefore the aggravation of physical doshas is mandatory in the causation of nija unmadas. Agantuja Unmadas are manifested by external causes but in later time the doshas are involved. In both these types of unmada the aggravated doshas in turn afflict the mental attributes, brain and nerves and cause unmada. Panchakarma therapies shall be selectively administered to expel the morbid doshas causing unmada.
Read – Manasika Doshas – Satva, Rajas, Tamas As Per Ayurveda

Agantuja Unmada

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Unmada means mental disorders. Agantuja Unmada means mental disorders occurring accidentally, due to some unforeseen causes mainly exogenous – coming from outside, in an unplanned, unintentional or unexpected way’. Agantuja means – accidental / adventitious / incidental.

These types of unmada are not caused by the aggravation of physical doshas as happens in doshaja or nija unmada. But even in agantuja unmada, the doshas might get involved in the later time period along the course and progression of pathogenesis of the disease. In short, agantuja unmada is caused from some external unforeseen or unexpected causes.

When should we consider a given case of unmada as agantuja unmada?
Any case of unmada which has not been caused by the aggravated doshas falls under the umbrella of agantuja unmada.

Putting it the other way –
Any unmada having the etiological factors, premonitory symptoms, symptoms, pain and remedies different from those of doshic unmada should be considered as agantuja unmada. Therefore, agantuja unmada will have the below mentioned aspects ‘quite different’ from that of doshaja unmada –

• vishesha samutthana – causes
• vishesha purvarupa – premonitory symptoms
• vishesha linga – symptoms and signs
• vishesha vedana – pain (mental and physical pain and discomfort)
• vishesha upashaya – remedies, treatment
  Read – Unmada Chikitsa – Charaka 9th Chapter

Specific causes

1. Purvakrta Karma – According to some experts the wrong deeds done in one’s previous birth are the main causes for agantuja unmada.

2. Prajnaparadha – Prajnaparadha means doing mistakes or sins in a state of awareness or consciousness. It is ‘an offense against wisdom’, ‘intellectual error’, ‘defective judgment’ or ‘harmful violent actions committed by body, mind and words’. This, according to Master Atreya is the main cause for agantuja unmada.
Read – Daiva Vyapashraya Chikitsa – Divine Therapies of Ayurveda

Pathogenesis

Ref – Charaka Samhitha Nidana Sthana7/10
Due to prajnaparadha (defective judgment) the person would do intellectual errors and would do violent actions physically, mentally or verbally which includes – Insults Gods, sages, elders, gandharvas, yakshas, rakshasas, pishachas, teachers, aged people, persons in higher positions and status and others who deserved to be respected, does not get involved in improper actions and bad deeds
The Gods etc (mentioned above) would get angry, cause unmada in such a person who has been afflicted by his own karmas. This is called Agantuja Unmada
Read – Sadvritta In Ayurveda – Code Of Conduct For Healthy Life

Purvarupa of Agantuja Unmada

• Desire to hit and injure the Gods, cows, Brahmans, ascetics / sages etc
• Excessive and aggressive anger
• Tendency to impart harm to the others
• Restlessness
• Depletion of ojus, color / complexion, luster, strength and tissues of the body
• Dreams of Gods etc abusing and threatening them and also advising them / instructing them to undertake certain actions

These premonitory symptoms would indicate that agantuja unmada would be manifested very quickly.
Read – Anger: Relation With Body Types, Ways To Control Anger

Mode of attack of Agantuja Unmada

The aggravated Gods etc will have certain influence and mode of causing unmada. They are as follows –

• Gods would cause unmada just by their divine sight
• Teachers, famous persons, aged people and sages would cause unmada by cursing the patient
• The ancestors would cause unmada by making themselves visible / evident
• Gandharvas would cause unmada by their touch
• Yakshas enter the body of the person and cause unmada
• Rakshasas would cause unmada by imparting smell of meat etc
• The pishachas would make the patient their vehicle and cause unmada while riding him / her
  Read – Should You Suppress Your Emotions? Do They Grow on You?

Symptoms of agantuja unmadam

The below mentioned factors get enhanced beyond proportions and normal limits in the patient, in comparison to what they were before manifestation of the disease –

• Bala – strength
• Virya – potency
• Paurusha – valor
• Parakrama – valor
• Grahana shakti – grasping power
• Dharana shakti – retention power
• Smarana shakti – memory power
• Jnana – spiritual knowledge
• Vachana – capability to speak
• Vijnana – scientific knowledge

Apart from these, the time of manifestation of agantuja unmada will be non-specific.
Read – Skanda Graha and Skandapasmara Graha Afflicting Children

Time and place of attack

Gods and other forces, when disturbed or angry, would produce unmada but their time of attack are different. At the beginning of sinful acts or when the sins done previously / previous birth are at the point of maturation (to yield results), the grahas attack in the below mentioned circumstances –

• when one lives alone in a deserted house
• when one stands at the junction of four roads / pathways (crossroads)
• when one doesn’t follow rules and regulations and lives in an undisciplined way during evening time (junction of two time periods)
• getting sexually indulged with women on full or new moon days or during menstruation
• reading, performing sacrifices, auspicious rituals and fire sacrifices in an un-procedural and un-ritualistic way
• breaking the rules and laws of practices of self restrain / observance (niyama), holy practices or religious vow (vrata) and celibacy (brahmacharya)
• being unclean or undisciplined during great wars, destruction of countries, villages or clans, solar or lunar eclipse, delivery of child in women, while touching or coming in contact with various kinds of animals and inauspicious and untidy things, after emesis, purgation or bleeding (bloodletting therapy), and while visiting graveyard or temples (places of worship)
• not cleansing the mouth after consumption of meat, honey, sesame, jaggery or wine / alcohol
• being naked
• visiting cities, crossroads, gardens, graveyard or sacrificial places during evenings / night
• rejecting / insulting Brahmans, teachers, Gods, sages and respectable people
• not doing the righteous deeds in a proper way
• beginning of any other untoward or improper activities
  Read – Achara Rasayana – Behavioral Therapy For Calm Mind And Long Life

Reasons for attack by the Grahas

The bhutas which produce unmada will have three reasons for attacking a susceptible individual –

1. himsa – to harm the person
2. rati – sexual satisfaction
3. abhyarchana – to be worshipped

The reason of attack of grahas may be different in different people as said above. The reason of attack shall be inferred seeing the activities of the person afflicted by the graha.

When the bhuta or graha attack a person with the aim of afflicting harm, the person would do some extraordinary adventurous activities and cause harm to himself. But it is actually the bhuta which will be making him or her do that. Such a person will –

• enter the fire
• drown in water
• will jump down from a cliff or roof and
• will afflict harm by beating self with a weapon, whip, hook or thorn, fist etc

He will get involved in many other activities which might cause harm to self or would pose threat to life. Bhuta Unmada presenting with such features should be considered to be incurable. The other two types of bhuta unmada occurring when the bhutas afflict with the purpose of getting sexual satisfaction and be worshipped/to get attention and respect are said to be curable in nature. They should be treated in accordance to the nature of bhuta afflicting these persons, promptly in proper time.
Read – Intermittent Explosive Disorder Symptoms, Causes, Ayurvedic Treatment

Treatment principles of Agantuj Unmad

2 types of agantuja unmada which are said to be curable are mainly treated with ‘daivavyapashraya chikitsa’ i.e. divine therapies. They are also non-pharmacological therapies (adravyabhuta chikitsa). They are as below enlisted –

Sl No	Treatment	Meaning
1	Mantra	chanting hymns
2	Aushadhi	medicines / special medicines (tying around the wrist, neck etc)
3	Mani	Gem therapy
4	Mangala	auspicious rituals
5	Bali	sacrifices / any offering / something offered in worship
6	Upahara	offering / gifting / religious service / oblation / paying tribute
7	Homa	fire sacrifices / Vedic ritual
8	Niyama	practices of self-restraint
9	Vrata	rituals / holy practices
10	Prayaschita	atonement
11	Upavasa	fasting / therapeutic starvation
12	Svastivachana	pronouncing the word svasti / religious rite preparatory to a sacrifice or any solemn observance
13	Pranipata	respecting / saluting
14	Gamana	abandoning the places which are causal for the diseases

There are conditions wherein the nija and agantuja types of unmada cross over and get mixed up. The clinical picture will follow the vicious amalgamation of these two types of unmada. The treatment for the same should be done by skillfully combining the therapies and measures mentioned for both these type of unmadas. Such unmada formed by the combination of nija and agantuja unmada are special types and are called as ‘samsargaja unmada’.
Read – Analysis Of Effect of Mantras On Health And Nadi

Misdeeds done by self are causal for agantuja unmada, not the Gods and other grahas

If a person is free from his misdeeds no grahas including Gods, Gandharvas or Rakshasas can afflict him or her so as to cause unmada. Therefore ‘the consequences of one’s own misdeeds’ are the primary causes of unmada but not the other agents like Gods etc. How can God and other divine powers cause exogenous unmada which has already been caused by his or her misdeeds? Gods and other agents will trouble the person in accordance to the inauspicious acts done by him or her. Therefore, one should not blame Gods etc for the diseases they acquired due to the sins and misdeeds done by their own intellectual blasphemy (prajnaparadha). Misdeeds done already cannot be undone. But the good deeds done after realization and the methods adopted to correct one’s deeds sincerely act as antidote and can pacify or neutralize the effects of the exogenous factors. Therefore, one should hold self responsible for his miseries as well as happiness. One should therefore follow the pathway of welfare and good deeds without any apprehensions.

Offering prayers to Gods etc and resorting to wholesome dietary and lifestyle habits act as antidotes to the misdeeds committed by the individual. Therefore, getting afflicted or not getting afflicted by external forces rests with the individuals themselves.
Read – Sattva Pariksha Examination Of The Mind, Tolerance

Agantuja unmada and bhutonmada

Agantu unmada and bhutonmada are one and the same. Agantu unmadas are caused by exogenous causes. These exogenous causes are the God etc entities who cause unmada in a person who is already afflicted by the effects of their misdeeds due to intellectual blasphemy. The deva, rshi, pitru, gandharva, yaksha, rakshasa, pishacha etc divine entities are the exogenous causes of this type of unmada. They are also called as grahas or bhutas. Therefore, agantuja unmada can also be called as bhutonmada or grahonmada.

In the 12^th verse of Charaka Nidana we can see that Master Charaka has used the word ‘bhutanam unmadayishyataam…’ while describing the ways in which the Gods etc entities attack a person in agantuja unmada. Here he has used the word ‘bhuta’ for deva, rshi, pitru etc exogenous entities.

Sanskrit Verses

Snehapana and Mrdu Shodhana in Vataja Unmada

In Unmada caused by predominant vitiation of vata, the physician who is well versed with the knowledge of every aspect of unmada shall first administer snehapana – i.e. oral administration of metered and calculated quantity of medicated fats (ghee or oil).

On the other hand if the passages or movement of vayu is obstructed by kapha or pitta, mrdu shodhana i.e. mild systemic cleansing shall be given after having administered medicated fats orally. This means to tell that when kapha is obstructing vayu, snehana should be given followed by mild cleansing in the form of therapeutic emesis. On the other hand when pitta is obstructing vayu, snehana shall be given followed by mild cleansing in the form of therapeutic purgation.
Read – Vamana Virechana – Emesis and Purgation – Ashtanga Hridayam Sutrasthana 18

Vamana and Virechana in Kaphaja and Pittaja Unmada

In Kaphaja and Pittaja Unmada, therapeutic emesis and purgation (respectively) shall be administered initially after having administered with snehana – oleation and swedana – purgation. After expulsion of morbid doshas, samsarjana krama – i.e. graduated dietetic regimen (usually administered as a part of post-treatment procedure of emesis and purgation) shall be administered.
Read – Samsarjana Krama – Graduated Dietetic Protocol After Cleansing Treatments

Administration of Niruha Vasti, Sneha Vasti and Shiro Virechana

Decoction enemas, Oil / ghee (unctuous) enemas and errhines shall be administered repeatedly, in larger dose and in accordance with the predominantly vitiated dosha satisfying the below mentioned conditions –

• after the body has been cleansed with proper and comprehensive administration of therapeutic emesis and purgation  followed by samsarjana krama
• after the strength of the digestive fire and body has been increased and stabilized following proper administration of samsarjana krama.

Raktamokshana in Unmada

Siravedha i.e. venesection is the choice of bloodletting therapy in unmada. The veins of the temple and those around the hair margin of scalp shall be punctured for treating unmada, apasmara and vishama jwara – intermittent / irregular fevers.

Benefits of Panchakarma in Unmada

Panchakarma therapies i.e. emesis, purgation etc when administered in a proper way in unmada, they bring about cleansing of hrdaya (brain), senses, head and gut. Once these are properly cleansed, they would bring about pleasantness of the mind. These events would in turn help the person to regain his memory and consciousness / intelligence. All these collectively help in destroying the unmada disease.

Samsargaja Unmada

In case of unmada, the word samsarga is used to explain the vicious and strange amalgamation / overlap of nija (those caused by doshas) and agantuja (caused by external factors) unmadas. This will also denote the prognosis of the unmada types.

Categorization of 5 types of unmada into two gross types

The above mentioned 5 types of unmada can be grossly put under two types –

1. Nija Unmada (caused by doshas) and Agantuja Unmada (caused due to exogenous factors) –

1. Among the above mentioned 5 types of unmada, the first four types are considered as nija unmada i.e. vataja, pittaja, kaphaja and sannipataja.
2. The 5^th type is agantuja unmada.

2. Sadhya (curable) unmada & Asadhya (incurable) unmada –

1. Sadhya Unmada – include the unmadas which are curable. They include –
2. the nija unmadas caused by individual doshas i.e. vataja unmada, pittaja unmada and kaphaja unmada and
3. agantuja unmada caused by bhutas (external forces) afflicting with the purpose of sexual satisfaction and to be worshipped and
4. Asadhya Unmada – include the unmadas which are incurable. They include –
5. nija unmadas caused by all three doshas i.e. tridoshaja / sannipataja unmada and
6. agantuja unmada caused by bhutas (external forces) afflicting with the purpose of harming the person

Sanskrit Verses

Prognosis of unmada based on the overlap of the above said types of unmada

Why do different types of unmada overlap?

When the etiologies of both Nija Unmada and Agantuja Unmada mix together, these two types of unmada will overlap. The unmada formed in this way will have a different presentation. This type of unmada will have the premonitory symptoms and symptoms of both nija and agantuja unmada.

1. If there is amalgamation of incurable nija unmada and agantuja unmada, the resultant disease (unmada) too will be incurable in nature.
2. If there is amalgamation of nija unmada and agantuja unmada wherein one is curable and another is incurable, the resultant disease (unmada) will also be incurable in nature.
3. If there is amalgamation of curable nija unmada and curable agantuja unmada, the resultant disease (unmada) will also be curable.

These conditions should be handled in an intelligent way. The treatment for such combinations shall also be done by skillfully combining the treatments of both nija and agantuja unmadas.

Need of knowledge of overlap of unmada

The knowledge of overlap of nija and agantuja unmada is very essential for the physician so as to make the prognosis of the unmada, to know the complicated nature of the mentioned disease and to plan the treatment protocol in curable conditions and also to reject the incurable conditions.

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