Unmada Chikitsa – Charaka 9th Chapter

9th chapter of Charaka Samhita Chikitsa Sthana deals with Unmada – symptoms, types, treatment, therapies and medicines for insanity or psychosis. It also explains importance of old ghee – Purana ghritham in the treatment of neurological and psychiatric disorders.

Click to learn about understanding of Unmada in simple terms

Chapter 9
Unmada Chikitsa – Treatment of psychosis, insanity
We shall now expound the chapter on the treatment of Unmada (insanity).
Thus, said Lord Atreya. [1-2]
Punarvasu, the abode of intellect, memory, knowledge and penance and the protector (Sharanya) of living beings while replying to questions, explained to Agnivesha the etiology, signs, symptoms, and treatment of Unmada [3]

Causes

Causes – Unmad Nidana:
The causative factors of Unmada (insanity) are as follows:
1) Intake of Viruddha (mutually contradictory), Dushta (polluted) and Ashuchi (impure) foods and drinks
2) Pradharsana (insult) to the gods, Guru and Dvijas (people belonging to the families of Brahmanas, Ksatriyas and Vaishyas)
3) Affliction of the mind because of fear and sudden happiness and
4) Unwholesome physical and mental activities.[4]

Pathogenesis

Unmada Samprapti – Pathogenesis:
The causative factors described above vitiate the Doshas which afflict Hrudaya (heart), which is the abode of intellect of a person having less of Satva (intellect), and while being located in the Manovaha srotas (Channels carrying Psychic impulses), they afflict the mind. [5]

Signs and symptoms

Unmada Lakshana – Signs and Symptoms
General signs and symptoms of Unmada:
Dhee Vibhrama – Intellectual confusion,
Satva pariplava – Fickleness of mind,
Paryakula – impatience,
Drushti adhirta – unsteadiness of eyes
Abaddha vaktavam – irrelevant speech and
Hrudaya Shunya – a sensation of vacuum in the heart (Vacant mindedness)

other symptoms include:
He will have bewildered mind becomes incapable of experiencing pleasure and sorrow.
He becomes incapable of conducting himself appropriately.
Therefore, he loses peace of the mind altogether and becomes devoid of memory, intellect and recognition.
His mind wavers here and there. [6-7]

Unmada definition

Unmada – definition:
The term Unmada stands for Samudbhrama i.e perversion. Because, in this ailment, the intellect, mind and memory get perverted.
It is of 2 types, viz,
Agantu (exogenous) and
Nija (Endogenous) [8]

Types

Unmada Bheda – types:
Now, the signs, symptoms and treatment of the 5 varieties of Unmada will be described separately. [1/2]
Vataja,
Pittaja
Kaphaja
Sannipatika – combined vitiation of all the three Doshas
Agantuja – due to exogenous causes

Vataja unmada

Causes, signs and Symptoms of Vatika Unmada:
Nidana: Vata gets exceedingly aggravated by
Ruksha ahara – The intake of dry food,
Alpa ahara and Shithanna – less of food and cold food,
Dhatu vireka – excessive elimination of Doshas by excess Panchakarma treatment
Dhatu kshaya – depletion of tissue elements and
Upavasa – fasting.

The aggravated Vata adversely affects the heart afflicted with mental agony (including worry, passion and anger) and instantaneously afflicts intellect and memory.

Signs and symptoms of Vatika Unmada:
1. Laughing, smiling, dancing, singer, speaking, moving limbs of the body and weeping in inappropriate place and
2. Parushya, Karshya and Aruna Varna skin – Roughness of skin, emaciation and reddish coloration of the skin
These signs and symptoms become more conspicuous after the suggestion of food (when normally Vayu gets aggravated). [9-10]

Pittaja unmada

Pittaja Unmada Nidana, Lakshana
The pitta gets aggravated by
Ajirna – indigestion,
Katu, amla ahara – intake of pungent, sour,
Vidahi (which causes burning sensation) and hot food
This aggravated Pitta afflicts the heart of a patient devoid of self-control and leads to serious type of Unmada.

Paittika Unmada lakshana – symptoms:
1. Intolerance, over daring, nakedness, intimidation, running about, excessive heat in the body and anger,
2. Desire for shady place, cold food and cold water and anger
3. Yellow complexion. [11-12]

Kaphaja unmada

Kaphaja Unmada Nidana Lakshana:
Kapha, along with Ushma (Pitta) gets aggravated because of Sampurna (over nourishment) and lethargy.
This aggravated Kapha afflicts the vital organ (heart), adversely affects intellect and memory, and vitiates mind leading to morbidity (Kaphaja Unmada).

Signs and symptoms of Kaphaja Unmada
1. Manda vak chestitam – Sluggishness in speech and activities
2. Aruchi – Anorexia
3. Nari vivikta priyata – Liking for women and lonely places
4. Ati nidra – Excessive sleep
5. Chardi – vomiting and
6. Lala srava – excessive salivation
7. Aggravation of the condition immediately after taking food (when Kapha gets normally aggravated) and
8. Nakhadi shauklam – Whitening of nails etc. [ 13-14]

Sannipataja unmada

Sannipatika Type of Unmada – Schizophrenia:
Sannipatika type of Unmada (where all the 3 Doshas, Viz. Vata, Pitta and Kapha get simultaneously aggravated) is a serious ailment.
It is caused by the (simultaneous) vitiation of all the 3 Doshas by their (respective) causative factors (as listed above)

In this condition, signs and symptoms of all 3 Doshas are manifested. Such a condition needs the therapeutic measures which are mutually contradictory; therefore, the physician should not attend to such a patient. [15]

Agantuja unmada

Agantuja Unmada – due to exogenous causes:
Exogenous types of Unmada are caused by improper observance of Niyama (spiritual disciplines) in the present life and improper conduct of the past life which leads to seizures by the Gods, Rishis (Sages), Gandharvas, Pisachas, Yakshas, Rakshas (demons) and Pitrus (manes) [16]

Agantu Unmada Lakshana:
Bhutonmada (Seizures by supernatural being), in general is characterised by the following
1. Supernatural speech, valour, potency and activities manifested as a result of Supernatural knowledge (Jnana) and intellectual excellence (Vijnana) as well as strength etc, and
2. Indeterminably of the time of occurrence. [17]

Modes of Seizure
The Gods, etc, because of their own qualities and powers, cause seizures of the individual without afflicting his physique
Like one can see his reflection instantaneously in Suryakanta mani (a gem), these supernatural beings are invisible and they afflict the human being instantaneously.[18]

The time of seizure, premonitory signs and actual signs and symptoms of Bhutonmada are already described, in general, in Nidana Sthana. Now, the signs and symptoms of seizures by the gods etc are being specially described in respect of each of these varieties. [19]

Specific Signs and Symptoms of Agantuja Unmada
Devonmada – Insanity Caused by the Gods:
The patient is of gentle look, earnest, invincible, free from anger, sleep and desire for food, having less of sweat, urine, stool and flatus. He emits good aroma from the body and having the face like a blooming lotus.

Guru unmada

A person having the activities and speech as ordained by the Abhishapa (cure), Abhichara (spell) and Abhidhyana (desire to transform on the basis of will- power) of preceptors, senior persons, Siddhas (those who have obtain spiritual perfection) and Rshis (Sages) is to be diagnosed as suffering from Unmada (insanity) caused by the seizure of preceptors. Etc.

Pitru Unmada

Caused by Manes:
characterized by unhappy look, inability to see, sleepiness, interrupted speech, lack of desire for food, anorexia and indigestion.

Gandharva Unmada

Caused by Gandharva (celestial musicians)
Characterized by violent acts, over bravery, sharpness, seriousness, invincibility and liking for Mukhavadya (Vocal music or musical instruments played with mouth), dancing, singing, good food, good drinks, Garlands, incense, perfume, red apparel, Bali (offering of Sacrifices), laughing and talking (engagement in humorous talks). Pleasuring aroma comes out from his body.

Yakshonmada

semi-divine celestial beings, attendants of Kubera, the god of wealth:
Characterised by frequent sleep, cry and laugh, liking for dancing, singing , playing musical instruments, reciting sacred scriptures, telling stories, good food, drinks, bath, garlands, incense and perfumes. His eyes are red and tearful. He despises dvija (persons belonging to the families of Brahmanas, Kshatriyas and Vaisyas) and Physicians. He discloses the secrets of others.

Rakshasonmada

Caused by Demons
Characterized by sleeplessness, hatred for food and drinks, excessive strength of patient in spite of his a version for food, liking for weapons, blood, meat and red garlands and ferociousness.

Brahma Rakshasa Unmada

Caused by senior devil
Characterized by excessive laughter, dance, hatred and disobedience to the Gods, Vipras (persons belonging to the family of Brahmins) and Physicians. He recites illustrations from hymns, the Vedas, Mantras and other scriptures. He injures himself by pieces of wood etc.

Pishachonmada

Pishachonmada – a type of demons
Characterized by fickle mindedness. He complains of having place to stay. He engages himself in dancing, singing, laughing and incoherent speech. He likes climbing over uneven places, entering into caves, walking in dirty streets and over dirty cloths, and climbing over heaps of grass, stones and woods. His voice is broken and hoarse. He remains naked and runs here and there. He does not stick to one place. He always complains of his miseries before other and he suffers from loss of memory. [20]

Time of affliction of Unmada

Devonmada: The gods possess a person of purity, good conduct, penance and study of religious scriptures, generally on the 1st and 13th days of the bright fortnight (Shukla Paksha) in an opportune moment (at the sight of some off his weak points).

Rushi Unmada: Rushi possesses a person fond of bath, purity and lonely place, and conversant with the sayings of the religious scriptures and the Vedas, generally on the 6th or 9th day of the fortnight (Paksha) in an opportune moment (at the sight of some of his weak points).

Pitru Unmada: Pitrus (manes) possesses a person devoted to the service of his parents, Gurus Vruddhas (senior persons), Siddhas (those who have accomplished spiritual perfection) and Acharyas (spiritual teachers), generally on the tenth day of the fort night (Paksha) or on the new moon day [in an opportune moment, i.e at the sight of some of his weak points].

Gandharva Unmada: Gandharvas (celestial musicians) possess a person fond of Hymns, perfumes, garlands, purify and good conduct, generally on the twelfth or fourteenth day of a fort- night (Paksha) in an opportune moment.

Yaksha Unmada: possess a person endowed with mental strength, physical strength, good complexion, ego and valor, having liking for garlands, unction and laughter and who is talkative, generally during the 7th or 11th day of the bright fort- night (Sukla Paksa) [in an opportune moment, i.e at the sight of some of his weak points]

Brahma rakshasa Unmada:
Brahma rakshasa (a class of evil demons) possess a Brahmin or a non Brahmin claiming to be a Brahmin who has abhorrence for the study of religious scriptures, penance, observance of Scriptural rules, Upavasa( fasting), Brahmacarya (celibacy), respect for the Gods ,Yatis (recluses) and Gurus( preceptors), and purify, who claims to be brave and who likes a temple and aquatic games, generally on the fifth day of the bright fort- night (Sukla paksa) or on the full moon day[ in n opportune moment, i.e. at the sight of some of his weak points]

Raksasa and Pishacha Unmada:
Raksasa and Pishacha (types of evil demons) possess a person who is devoid of will power, who is a backbiter who is fond of women and who is greedy and a cheat, generally on the 2nd, 3rd or 8th day of the fortnight [in an opportunity moment, i.e at the sight of some of his weak points]
These Grahas (celestial begins) are innumerable. The seizures by the 8 most conspicuous ones among them are described above. [21]

Signs of incurability

Asadhya Lakshana- Signs of in-curability:
In the above mentioned varieties of Unmada, if the patient has raised his hand in a fit anger, daringly thrashes others or himself, he is considered as incurable. Similarly, if the patient, with tears in the eyes, passes blood from the genitals, if he has injuries in his tongue, running nostrils, excised skin, uninterrupted (long) speech, constant mumbling, discoloration of body, excessive thirst and putrid smell of body, he is to be considered as suffering from Unmada (insanity) as a result of possession of violent spirit, and hence, he should not be treated. [22]

Management of Ratyarthi Unmada

If the Unmada (insanity) is cured by the possession of evil spirits desirous of pleasure or worship, the physician should ascertain the nature of possession through the intentions and behaviour of the patient, and treat him by the administration of appropriate Mantras and medicines along with the requisite presents and sacrifices. [23]
Now we shall expound therapeutic measures for both endogenous (nija) and exogenous (Agantuja) types of Unmada in brief as well as in detail [24]

Line of treatment

Unmada Chikitsa Sutra – Line of Treatment
In Vataja Unmada, the physician should first of all ascertain in the nature of Vata, and in the beginning, administer Sneha (oil, Ghee, etc).
If the passage of Vata is obstructed, (Avruta Marga), then the patient is given laxative along with Sneha (oil, ghee etc) only in small quantities. – Sasneha Mrudu Shodhana.

If caused by Kapha or Pitta, Vamana and Virechana treatments are given, after Snehana and Swedana. These therapies are followed up with Samsarjana Krama (from lighter to heavier diet gradually according to the prescribed procedure).

Thereafter, he is given Niruha (decoction enema), Sneha Basti (oil / fat enema) and Nasya therapy (therapies for the elimination of Doshas from the head).
Depending upon the predominance of Doshas, these elimination therapies are required to be administered repeatedly.

Benefits of Panchakarma treatment:
By the administration of Vamana etc therapies, the heart, sense organs, head and Koshta (Gastro- intestinal tract) gets cleaned as a result of which, the mind gets refreshed and the patient gains memory as well as consciousness.
If, even after the body is cleansed, the patient exhibits perversion of conduct, then he is given Teekhsna navana Nasya – strong inhalation therapy,
Teekshna Anjana – collieries and even beatings which are useful for stimulating his mind, intellect and the body.

If the patient has a strong physique, and he is disobedient, then he is tied tightly without hurting his body, with pieces of cloth, and kept confined to a dark room devoid of iron (rods) and wooden pieces.
Shouting with anger, terrorizing (with the help of police men), and donation (presents), exhilaration, consolation, fear and exhibition of surprising acts bring back the natural state of the mind by counteracting the causes of his loss of memory.

The patient suffering from Unmada is administered Pradeha (application of thick ointments), Utsadana (unction), Abhyanga (massage), Dhuma (fumigation) and ghee for taking internally to stimulate his mind, intellect, memory and consciousness.

The patient suffering from Agantuja Unmada (insanity) is given Pana (to be taken internally) etc,and Mantras etc is recited for his benefit. [25-33 1/3]
Now, we shall described the most efficacious recipes for the cure of Unmada (insanity) [33 ½ ]

Kalyanaka ghrita

Kalyanaka Ghruta:
2 Palas (96 g) of each of
Hingu – Asa foetida,
Sauvarchala – Sochal salt
Shunthi – Ginger,
Maricha – Black pepper fruit – piper nigrum and
Pippali – Long pepper fruit – Piper longum is made to a paste and cooked with
1 Adhaka of ghee by adding 4 times (adhakas) of cow’s urine. This medicated ghee is efficacious in curing Unmada (insanity) [34]

1 Aksha of each of the 28 herbs, namely
Vishala – Citrullus colocynthis
Haritaki – Terminalia chebula
Bibhitaki – Terminalia bellerica
Amalaki – Phyllanthus emblica
Kaunti
Devadaru -Cedrus deodara
Elavaluka -Prunus cerasus
Sthira – Desmodium gangeticum
Ela – Cardamom
Manjistha – Rubia cordifolia
Danti – Baliospermum montanum
Dadima – Pomegranate – Punica granatum
Keshara – Mesua ferrea
Talisapatra – Taxus baccata
Brihati – Solanum indicum
Fresh Malati flower – Aganosma heynei
Vidanga – Embelia ribes
Prishnaparni – Uraria picta,
Kushta – Saussurea lappa
Chandana – Sandalwood – Santalum album and
Padmaka – Prunus cerasoides is made to a paste.
This paste is added to 1 Prastha of ghee and cooked by adding 4 times (Prasthas) of water.
Indications:
Apasmara – epilepsy
Jwara – fever
Kasa – cough
Sosha – consumption
Suppression of the power of digestion
Phthisis
Vata Rakta – gout
Pratisyaya – coryza
Trtiyaka and Caturthaka types of Visama Jvara (irregular fever)
Chardi – vomiting
Arsha – piles
Mutra krcchra – Dysuria
Visarpa – Erysipelas
Kandu – itching
Pandu- Anaemia
Unmada – insanity
poisoning
Meha (obstinate urinary disorders including diabetes),
Seizures by supernatural beings (Bhutas)
Gadgada (lulling speech)
Achetas – unconsciousness and
Female infertility
It endows the individual with wealth, longevity and strength
It removes inauspiciousness, sins, demoniac seizures and afflictions by evil spirits.
It is most useful in Pumsavana (the second sacramental ritual or Samskara for getting a child of desired sex) this recipe is called Kalyanaka Sarphi [35-41 ½ ]

Read more about Kalyanaka ghrita – current available product

Mahakalyanaka Ghurta

A decoction is prepared of the 21 herbs beginning with Sthira – Desmodium gangeticum, described in the earlier recipe (viz,
Sthira – Desmodium gangeticum
Nata (Valeriana wallicii),
Haridra (turmeric – Curcuma longa),
Daru Haridra – Tree Turmeric (stem) – Berberis aristata,
Sariva – Indian Sarsaparilla – Hemidesmus indicus,
Krsna Sariva – Indian Sarsaparilla – Hemidesmus indicus,
Priyangu (Callicara macrophylla),
Nilotpala,
Ela (Elettaria cardamomum Maton),
Manjistha – Rubia cordifolia
Danti – Baliospermum montanum
Dadima – Pomegranate – Punica granatum,
Kesara,
Talisapatra,
Brihati – Solanum indicum,
fresh flowers of Malati,
Vidanga – Embelia ribes
Prishnaparni – Uraria picta,
Kushta – Saussurea lappa,
Candana (Sandalwood – Santalum album) and
Padmaka – Prunus cerasoides

To this decoction, ghee, 4 times of Grushtiksheera (milk of Vira, green Masa, Rddhi and Meda – Polygonatum cirrhifolium (1/4th in quantity of ghee, all ingredients taken in equal quantities) should be added and cooked.

This is called Mahakalyanaka Ghrta. It is exceedingly nourishing and it cures diseases caused by Sannipata (simultaneous vitiation of all the three Doshas). 42 ½ 44

Mahapaishachika Ghrita

Ghee cooked with [the paste of]
Jatila (Jatamamsi) – Nardostachys jatamamsi
Putanam (Haritaki) – Terminalia chebula
Keshi (Bhutakesi) –
Charati (Kumbhi)
Markati (Sukasimbi),
Vacha – Acorus calamus
Trayamana – Gentiana kurroo
Jaya (Jayanti)
Vira (Ksirakakoli or Salaparni),
Choraka (Candalaka)
Katurohini (Vayahstha( Brahmi or Guduci),
Sukari (Varahikanda),
Chatra (Madhurika),
Aticchatra (Satapuspa),
Palankasa (Guggulu)
Maha purushadanta (Shatavari or Visnukranta)
Kayastha (Suksmaila)
Both the types of Nakuli (Rassna),
Katambhara (Katabhi)
Vrscikali (Vrscikapatri) and
Sthira – Desmodium gangeticum
Indications:
Chaturthaka (a type of Visham Jwara or recurrent fever)
Unmada (insanity, psychosis)
Graha (Seizures by evil spirits) and
Apasmara (epilepsy)
It works like nectar.
It promotes intellect and memory and helps in the development of the physique of children. [45-48]

Lasunadi Ghrta

Ingredients of Lashunadi Ghrita
100 Dehusked cloves of Lasuna – Garlic
30 fruits of Haritaki – Terminalia chebula
1 Pala (48 g) of Tryushana (Ginger, pepper, long pepper)
1 Prastha (768 ml) of the ash of bovine leather, and
2 Adhakas of each of cow’s milk and
Cow’s urine is cooked with 2 Prasthas of cow’s ghee (ten years old), after it is well cooked and cooled,
1 Pala of the powder of Hingu (asafoetida) and 2 Manikas of honey is added.
Use of this medicated ghee internally and for massage as well as inhalation therapy cures endogenous as well as exogenous types of Unmada (insanity) and Vishama Jwara (irregular fever). [49-51]

Lasunadi Ghrta ( Second Recipe)
1/2 Tula (50 Palas) of dehusked and unpolluted cloves of Ganikarika, Salaparni, Prsniparni, Brhati, Kantakari and Goksura) is boiled in 4 Adhakas of water and reduced to ¼ th
To this decoction,
2 Prasthas of ghee,
2 Prasthas of garlic juice,
1 Prastha each of juice of
Kola, Mulaka (radish),
Vrukshamla, Matulunga, Ardraka and Dadima and
1 Prastha of each of Sura, Mastu and sour Kanjika is added.
This is cooked by adding the powder or paste of 1/2 Pala of each of
Triphala (Haritaki, Bibhitaki and Amalaki), Devadaru, Lavana, Amla vetasa
Indicated in:
Shoola – abdominal colic
Gulma – abdominal tumour, distension
Pandu – Anaemia, initial stages of liver disorders
Arsha – Haemorrhoids
Bradhna – Prolapsed rectum
Pandu – Anaemia, initial stages of liver disorders
Yonidosha – Gynaecological disorder
Jwara (fever)
Krumi – worm infestation (in wounds and in intestines)
Diseases caused by Vata and Kapha and all varieties of Unmada [52-56]

Recipes of Medicated Ghee

The patient suffering from Unmada is administered the following recipes of medicated ghee:
1. 10 year old ghee, cooked with Hingu and Hinguparni (according to some : Vamshapatrika)
2. 10 year old ghee cooked with Kayastha(Sukshma Ela – Lesser cardamom) and Vayahstha (Brahmi) and
3. 10 year old ghee cooked with Vayastha, Hingu and to such patients.
4. The patient is made to drink the above mentioned recipes of medicated ghee or the unprocessed ghee in a heavy dose and kept confined to an underground cellar or a house. [57-58]

Old Ghee and Its Therapeutic Utility:
The patient suffering from Unmada is specially given old Ghee by the physician to alleviate all the 3 Doshas, and because of sacred nature, it specially cures demoniac seizures.
When taken internally, it has better properties and therapeutic utilities in comparison to ordinary ghee.
In taste, old ghee is pungent and bitter and it has a sharp pungent smell. Ghee stored for ten years is called Purana (cold in potency and it is like the solution of lac. It is cold in potency and it is this old ghee, which cures all types of demoniac seizures.
It promotes intellect and is excellent as a purgative.
The ghee which is stored for more than ten years, it called Prapurana (exceedingly old) Ghrita. There is no disease which cannot be cured by the ghee which is one hundred years old.
Even the look, touch and smell of this 100 years old ghee is especially useful in curing Apasmara (epilepsy), Graha (demoniac seizures) and Unmada(insanity). [59-63 ½]

Read more about Purana ghrita – old ghee – how to make, how to use

It is not possible to administer the above mentioned recipes orally, then these are to be administered in the form of Anjana (collyrium) , Utsadana (unction), Alepa (external use of ointment) and Navana (inhalation therapy). [63 ½- 64 ½]

Recipes for Inhalation and Collyrium

Shireesha (Albizia lebbeck),
Madhuka (licorice), Asafoetida, garlic,
Tagara – Valeriana wallichii
Vacha – Acorus calamus
Kushta – Saussurea lappa
The powder / paste of above herbs is triturated by adding goat’s urine. This paste is used [after dilution] for inhalation therapy and collyrium.

Similarly, the paste of Vyosha (Sunthi, Pippali and Maricha), Haridra (turmeric), Daruharidra (Berberis aristata), Manjistha (Rubia cordifolia), Hingu (asafoetida), Sarshapa (mustard) and the seeds of Shireesha is used in a paste from for curing Unmada(insanity), Graha (demoniac seizures and apasmara (epilepsy) [64 ½- 66 ½ ]

Anjana Varti

1 Part each of
Apamarga – Achyranthes aspera
Hingu – asafoetida
Ala (Haritala) and
Hingupatrika, and
1/2 part of Maricha (black pepper) is made to a paste by adding the bile of cow and jackal.
Out of this paste, vartis (elongated pills) is prepared.
This is used as Collyrium by the patient suffering from Apasmara (epilepsy), Bhutonmada (insanity caused by demoniac seizures) eye- diseases in the patient suffering from the seizures of demons and the Gods, [66 ½ – 68 ½ ]

Maricha Anjana

Maricha – black pepper is impregnated in the bile of [cow and Jackal] and dried in sun for one month. Application of this as collyrium cures visual perversion. Of a patient whose memory is lot as a result of vitiated Doshas and Bhutonmada [68 ½ -69 ½]

Siddharthaka Snana, Udvartana

These herbs taken in equal quantities are triturated by adding goat’s urine and made to a paste:
Siddharthaka – White mustard seed
Vacha – Acorus calamus
Hingu – Asafoetida
Karanja – Pongamia pinnata
Devadaru – Cedrus deodara
Manjistha – Randia dumetorum
Triphala (Haritaka, Bibhitaka and Amalaki) ,
Shveta,
Bark of Katabhi
Trikatu (Ginger, pepper, black pepper ),
Priyangu – Callicara macrophylla
Shireesha – Albizia lebbeck
Haridra – Turmeric and
Daruharidra – Berberis aristata
Use of this anti toxic recipe, in the form of drink, collyrium, inhalation, Alepana (external application), bath and Udavartana (unction) cures Apasmara (epilepsy), Visha ( Poisoning) unmada (Insanity), Krtya (evil effects of Spells) , alaksmi (inauspiciousness) and fever. It removes the fear of evil spirits. A person using this recipe also earns royal favor.
With the above mentioned herbs, ghee is cooked by adding cow’s urine. This medicated ghee also produces the therapeutic effects described above. [69 ½ – 73 ½]

Dhumapana

Dhumapana – Smoke inhalation:
If there is excessive salivation and Peenasa (chronic rhinitis), the patient is given Dhuma Varti (medicated Cigar) prepared of fragrant herbs for smoking.
These fragrant herbs are described in the recipe dealing with “Vairechanika Dhuma” (eliminative type of smoking) (Charaka Sutra Sthana 5:27). Similarly, he is given cigar prepared of shweta etc. along with Hingu. [73 ½ – 74 ½]

Pradhamana Nasya

If Unmada (insanity) is caused by the predominance of Vata and Kapha, then the patient is given Seka (fomentation), Anjana (Collyrium therapy), Pradhamana (a type of inhalation therapy), Nasya (another type of Inhalation therapy) and Dhuma (fumigation therapy), with the help of urine, bile, faeces, Loma (small hair), nail and skin (as per a availability) of animals and birds like Sallaka, Uluka (owl), Marjara (cat), Jambuka (bear), Vruka and Basta (goat) [74 ½ – 76 ½]

Pittaja unmada treatment

Treatment of Paittika Type of Unmada:
In Paittika type of Unmada the patient is given Tiktaka Ghrta (Maha Tiktaka Ghrta- vide Cikitsa 7: 144-150), vide Cikitsa 5:149 -151) and food as well as drinks which are cooling, sweet and light. [57 ¼ -77 1/3]

Read more about Maha Tiktaka ghrita – uses, dose, side effects

Raktamokshana – Blood letting:
Blood-letting is administered by Venesection – Sira Vyadha, at the joint of the hair-line and temporal region, which is useful in the treatment of Unmada (insanity), Vishama Jvara (irregular fever) and Apasmara (epilepsy) [77 2/3]

Diet:
The patient is made to have ghee and meat till his satisfaction, and thereafter, made to sleep in a house without cross-ventilation. As a result of this, he overcomes perversion of the mind and loss of memory and regains consciousness. Thus, he becomes free from the ailment. [78]

Regimens:
The patient is consoled by friends with religious and moral statements. They should announce the news of loss of something which the patient loves or exhibit surprising events. Having smeared his body with mustard oil and tied [with ropes], he is made to lie flat in the sun and his body is rubbed with Kapikacchu or Branded with hot iron rods or burnt with hot oil or water. Having beaten with a hunter and tied properly, he is kept confined to a lonely house as a result of which the perturbed mind of the patient regains composure.

He is terrorized by the biting of snakes having their fangs removed with lions and elephants well tamed or by criminals as well as enemies with weapons in their hands, alternatively by police(royal personnel) having taken him outside and properly arrested with the threat of execution by the order of the king.

The danger of life is taken more seriously than the fear of injury to the body. Therefore, the weak mind of the patient suffering from Unmada gets distracted from all the sides and regains composure through the above mentioned measures.[ 79- 84]

If mental derangement is caused because of loss of something which the patient loved, then he is made to regain a similar object. Simultaneously, he is consoled with pleasing assurances [of friends] as a result of which he becomes free from the ailment. If Unmada (insanity) is caused by passion, grief, fear, anger, exhilaration, jealousy and greed then the exposure of the patient to mutually contradictory psychic factors will cure the ailment. [85-86]

Keeping in view, Desha (region or physique) wholesomeness, nature of the vitiated Dosha, time of onset and aggravation of the attack and the strength as well as weakness of disease, the physician should apply therapeutic measures described earlier even in case of Unmada caused by Bhutadosha (demoniac seizure). [87]

If the patient is suffering from Devon unmada (caused by Gods), Rishi Unmada (Sages), Pitru Unmada (Manes) and Gandharvas (a group of celestial beings), then a wise physician should avoid Teekshna Anjana (sharp, strong collyrium) etc. and physical violence and torture.

Such a patient is given medicated ghee and other mild remedies. Prayers, sacrifices, presents and application of Collyrium sanctified by the recitation of incantations, propitiating rituals, Ishti Homa (Vedic Sacrifices), Japa (recitation of incantation), Svastyayana (Auspicious rituals), observance of Vedic rules and Prayaschitta (expiation, reconciliation) are useful for such patients. [88-90]

Agantuja unmada prevention

Prevention of Agantuja Unmada – Exogeneous Unmada – Schizophrenia:
If one worships Lord Siva, the supreme controller of all Bhutas (supernatural beings) and all the omnipotent master of the universe regularly with devotion, then he becomes free from the attack of unmade (insanity). [91]

Daiva Vyapashraya Cikitsa

The worship of Pramathas, the attendants of Lord Rudra, who roam about the universe, makes the patient free from Unmada (insanity). Exogenous type of Unmada gets cured by Bali (Sacrifices), Mangala (Recitation of auspicious Mantras), Homa (offering oblations to the fire), wearing talismans containing anti-toxic herbs, observance of truthfulness, maintenance of good conduct, practice of penance, recourse of knowledge, charity, observance of scriptural rules and religious bows, offering prayer to the Gods, cows, Brahmins and by the application of perfected Mantras and medicines [92-94]

Therapeutic Measures:
Therapeutic measures, which are to be described in the next Chapter, should also be applied to a suffering from Unmada (insanity) because both Apasmara (epilepsy) and Unmada (insanity) share the same etiological factors as well as pathological process. i.e affliction of tissues elements. [95]

A person who abstains from eating meat and drinking alcohol, and takes only wholesome food, who is disciplined and pure, and who has strong will power doesn’t get afflicted by either endogenous or exogenous types of Unmada (insanity) [96]

Signs of cure of unmada

Vigata Unmada Lakshana – Signs of Cure:
Clarity of sense faculties in perceiving their objects, clarity of intellect, spirit as well as mind and normalcy of the tissue elements, constitute the signs and the symptoms of the person free from Unmada(insanity) [97]

Summary:
The etiology, signs and symptoms and treatment of endogenous and exogenous varieties of Unmada (insanity) are explained in this chapter. [98]

Thus, ends the ninth chapter dealing with the treatment of Unmada in Chikitsa section of Agnivesha’s work as redacted by Charaka, restored by Dridhabala.