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. 

???? ?????? ?????? ??????????????||?||
??? ? ????? ????????????||?||
ath?ta unm?da nid?na? vy?khy?sy?ma?||1||
iti ha sm?ha bhagav?n?treya?||2||
We shall now explore the chapter on the “Diagnosis of Insanity”. Thus said Lord Atreya [1-2]

Vidha (Types) of Unmada – Insanity:
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???? ??? ????????????????? ??????????????????? ??????????????????????; ??????- ????????????????????????????????? ??????? ? ?? ????????????????????????????????? ???????????????????????????????????? ??????????????? ?????????????????? ?????????? ?????? ?????????????????? ??????? ?????? ??? ???????????????????????? ?? ??? ????? ??? ???? ?? ??????? ??? ??????????????????????????????????????? ?? ?????????? ?????? ? ????????????????????? ????? ????????? ???????????? ???????? ???????????????? ????????????????||?||
iha khalu pañconm?d? bhavanti; tadyath?- v?ta pitta kapha sannip?t?gantu nimitt??||3||
tatra do?a nimitt??catv?ra? puru????meva?vidh?n?? k?ipramabhinirvartante; tadyath?- bh?r???mupakli??a sattv?n?mutsanna do????? sa mala vik?topahit?nyanucit?ny?h?raj?t?ni vai?amyayuktenopayogavidhinopayuñj?n?n?? tantraprayogamapi vi?amam?carat?many??ca ?ar?race??? vi?am?? sam?carat?matyupak???a deh?n?? vy?dhi vega samudbhramit?n?mupahatamanas?? v? k?ma krodha lobha har?a bhaya moh?y?sa ?oka cintodveg?dibhirbh?yo’bhigh?t?bhy?hat?n?? v? manasyupahate buddhau ca pracalit?y?mabhyud?r?? do??? prakupit? h?dayamupas?tya manovah?ni srot??sy?v?tya janayantyunm?dam||4||

schizophreniaUnmada (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:
Bh?r???mupakli??a – When an individual is timid
Sattv?n?mutsanna do????? – When is mind is afflicted by the predominance of Rajas and Tamas
Mala vik?topahit?nyanucit?ny?h?raj?t?ni- When Doshas in his body are aggravated and Vitiated
Vai?amyayuktenopayogavidhinopayuñj?n?n?? – 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)
Sam?carat?matyupak???a deh?n?? – 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
Vy?dhi vega samudbhramit?n?mupahatamanas?? v? k?ma krodha lobha har?a bhaya moh?y?sa ?oka Chintodveg?dibhirbh?yo’bhigh?t?bhy?hat?n?? – When his mind is afflicted over and over again by passion, anger, greed, excitement, fear, attachment, exertion, anxiety and grief and
Abhigh?t?bhy?hat?n?? – 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:
??????? ?????????????????????????? ?????? ????? ??? ????????? ??????? ????????||?||
unm?da? punarmanobuddhisañjñ?jñ?na sm?ti bhakti ??la ce???c?ra vibhrama? vidy?t||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 
????????? ???????????; ??????- ????? ???????, ??????????????, ????? ???????, ???????????????????, ???? ?????????, ????????????????????????, ?????????, ????????? ???????????????????????, ???? ????????, ?????????????????, ??????? ??????????, ???????????, ??????????????? ? ???????, ??????? ?????????? ?????? ??????????????????????? ?????????????????? ? ??????????????????? ???????????????????????? ???????? ? ???????????????????? ????????????????????? (???????????????????????? ??????????? ??????)||?||
tasyem?ni p?rvar?p??i; tadyath?- ?irasa? ??nyat?, cak?u?or?kulat?, svana? kar?ayo?, ucchv?sasy?dhikyam, ?sya sa?srava?am, anann?bhil???rocak?vip?k??, h?dgraha?, dhy?n?y?sa sammohodveg??c?sth?ne, satata? lomahar?a?, jvara?c?bh?k??am, unmatta cittatvam, udarditvam, ardit?k?tikara?a? ca vy?dhe?, svapne c?bh?k??a? dar?ana? bhr?ntacalit?navasthit?n?? r?p???mapra?ast?n?? ca tilap??akacakr?dhiroha?a? v?taku??alik?bhi?conmathana? nimajjana? ca kalu????mambhas?m?varte cak?u?o?c?pasarpa?amiti (do?animitt?n?munm?d?n?? p?rvar?p??i bhavanti)||6||

Premonitory symptoms of insanity caused by the vitiation of Doshas:
Shirasa? ??nyat? – Emptiness in head
Chak?u?or?kulat? – Congestion in eyes
Svana? kar?ayo? – Noises in ears
Ucchv?sasy?dhikyam – Hard breathing in excess
Aasya sa?srava?am – Excessive salivation in the mouth
Anann?bhil???rocak?vip?k?? – Absence of inclination for food, anorexia and indigestion
H?dgraha? – Spasm in cardiac region
Dhy?n?y?sa sammohodveg??c?sth?ne – Meditation, fatigue, unconsciousness and anxiety in improper situations
Satata? lomahar?a? – Continuous horripilation
Jvara?c?bh?k??am – Frequent pyrexia
Unmatta cittatvam – Fickle mindedness
Udarditvam – Pain in the upper part of the body
Ardit?k?tikara?a? ca vy?dhe? – Manifestation of symptoms of facial paralysis resulting in movement in one half of the face
Svapne c?bh?k??a? dar?ana? – Frequent appearance of the following in dreams
Bhr?ntacalit?navasthit?n?? r?p???mapra?ast?n?? ca tilap??akacakr?dhiroha?a? v?taku??alik?bhi?conmathana? – Inauspicious objects that are wandering, moving and unstable
Nimajjana? – Riding over the wheel of an oil press
Kalu????mambhas?m?varte – Being churned by whirl- winds
Sinking in fearful whirl pools and
Chak?u?o?c?pasarpa?amiti – Retraction of eyes.[6]

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Distinctive features of insanity:
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?????????????????????????? ????; ??????- ?????????????, ????? ?????????????????????????????? ????????????????, ???????????? ? ?????????????, ???????????????, ????????? ????????????????????????????????????????????, ??????? ???? ????? ????????????????????, ?????????, ????????????????????????????, ???????????????????????????, ??????? ?????????????????????? ?, ????????, ?????????, ????????????????????, ???????????????????????? ?; ??? ????????????????? ??????(?);
??????, ??????, ????????????????, ???????????????????????????????????? ??????? ?????? ??, ?????????, ?????????????????????????, ????????????????, ????????????????????????????, ?????????????????????????? ?; ??? ??????????????????? ??????(?);
????????????, ????????????, ????????????????, ???????????????????, ????????????, ?????????, ??????????, ?????????, ?????????????, ???????????, ????? ????????????????????????, ???????????????????????????? ?; ??? ????????????????????? ??????(?);
????????????????????? ?? ???????????? ????????; ??????????????? ??????||?||
tato’nantaramevamunm?d?bhinirv?ttireva|
tatredamunm?davi?e?avijñ?na? bhavati; tadyath?- parisara?amajasram, ak?i bhruvau??h??sahanvagrahastap?d??ga vik?epa?amakasm?t, satatamaniyat?n?? ca gir?mutsarga?, phen?gamanam?sy?t, abh?k??a? smitahasitan?tyag?tav?ditrasamprayog??c?sth?ne, v???va??a ?a?kha ?amy? t?la?abd?nukara?amas?mn?, y?namay?nai?, ala?kara?amanala?k?rikairdravyai?, lobha?c?bhyavah?rye?valabdhe?u, labdhe?u c?vam?nast?vram?tsarya? ca, k?r?ya?, p?ru?yam, utpi??it?ru??k?at?, v?topa?ayavipary?s?danupa?ayat? ca; iti v?tonm?dali?g?ni bhavanti(1);
amar?a?, krodha?, sa?rambha?c?sth?ne, ?astralo??raka??k???hamu??ibhirabhihanana? sve??? pare??? v?, abhidrava?a?, pracch?ya??todak?nn?bhil??a?, sant?pa?c?tivela?, t?mraharitah?ridrasa?rabdh?k?at?, pittopa?ayavipary?s?danupa?ayat? ca; iti pittonm?dali?g?ni bhavanti(2);
sth?namekade?e, t????mbh?va?, alpa?a?ca?krama?a?, l?l??i?gh??akasrava?am, anann?bhil??a?, rahask?mat?, b?bhatsatva?, ?aucadve?a?, svapnanityat?, ?vayathur?nane, ?ukla stimitamalopadigdh?k?atva?, ?le?mopa?ayavipary?s?danupa?ayat? ca; iti ?le?monm?dali?g?ni bhavanti(3);
trido?ali?gasannip?te tu s?nnip?tika? vidy?t; tamas?dhyam?cak?ate ku?al??||7||

Clinical features of Unmada: 
A) Vataja Unmad:
Parisara?amajasram – constant wandering
Ak?i bhruvau??h??sahanvagrahastap?d??ga vik?epa?amakasm?t – sudden spasm of eyes, eyebrows, lips, shoulder, jaws, fore-arms, and legs
Satatamaniyat?n?? ca gir?mutsarga? – constant and incoherent speech
Phen?gamanam?sy?t – coming out of froth from the mouth
Abh?k??a? smitahasitan?tyag?tav?ditrasamprayog??c?sth?ne – Always smiling, laughing, dancing, singing and playing with musical instruments in inappropriate situations
V???va??a ?a?kha ?amy? t?la?abd?nukara?amas?mn? – Loudly imitating the sounds of flute, conch, Samya (cymbal played by right hand) and Tala (cymbal played by left hand)
Y?namay?nai? – Riding undesirable vehicles
Ala?kara?amanala?k?rikairdravyai? – Duration by such things as are not needed for ornaments
Lobha?c?bhyavah?rye?valabdhe?u – Longing for eatables not available
Labdhe?u c?vam?nast?vram?tsarya? ca – Digest for food articles and also a strong desire not to part with the eatables available
K?r?ya?, p?ru?yam – Emaciation and roughness
Utpi??it?ru??k?at? – Projected and reddish eyes and
V?topa?ayavipary?s?danupa?ayat? ca – Aggravation of the condition by such of the regimens as are not wholesome for Vata.
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(B) Paittika Unmada: 
Amar?a?, krodha? – Irritation and anger
Sa?rambha?c?sth?ne – Excitement on inappropriate occasions
Shastralo??raka??k???hamu??ibhirabhihanana? sve??? pare??? v? abhidrava?a? – Inflicting injury on own people or on others by weapons, brick bats, whips, sticks and fist.
Pracch?ya??todak?nn?bhil??a? – fleeing and desire for shade, cold water and food having cooling effect.
Sant?pa?c?tivela? – Continuous state of anguish
T?mraharitah?ridrasa?rabdh?k?at? – having ferocious eyes of coppery, green or yellow color and
Pittopa?ayavipary?s?danupa?ayat? ca – aggravation of the condition by such regimens as are not wholesome for Pitta.

(C) Slaismika Unmada: 
Sth?namekade?e t????mbh?va?, alpa?a?ca?krama?a? – Staying in one place and observance of silence
L?l??i?gh??akasrava?am – Discharge of saliva and nasal excretions
Anann?bhil??a? rahaskamata – disinclination for food and love for solitude
B?bhatsatva? – Frightening appearance
?aucadve?a? – Aversion for cleanliness
Svapnanityat? – Remaining always sleepy
?vayathur?nane – oedema in the face
Shukla stimitamalopadigdh?k?atva? – White and timid eyes with excreta adhered to them
Shle?mopa?ayavipary?s?danupa?ayat? 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:
????????? ?? ???????? ???????- ????? ????? ??? ????????????????????????? ????????? ??? ?????????????? ????????????? ?????? ??????????????????????????- ???????? ???????? ??????????????? ????????????, ???? ?????? ? ??????? ????????, ??????????? ???????????????????????? ?????? ???? ????????||?||
???? ?????- ????????? ??????? ???????? ?????????????????|
???? ??????????? ?????? ??? ????????????||?||
s?dhy?n?? tu tray???? s?dhan?ni- sneha sveda vamana virecan?sth?pan?nuv?sanopa?amana nasta?karma dh?ma dh?pan?ñjan?vap??a pradhaman?bhya?ga pradeha pari?ek?nulepanavadhabandhan?varodhana- vitr?sana vism?pana vism?ra??patarpa?a sir?vyadhan?ni, bhojana vidh?na? ca yath?sva? yukty?, yacc?nyadapi kiñcinnid?navipar?tamau?adha? k?rya? tadapi sy?diti||8||
bhavati c?tra- unm?d?n do?aj?n s?dhy?n s?dhayedbhi?aguttama?|
anena vidhiyuktena karma?? yat prak?rtitam||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):
????? ??? ??????????? ??????????? ???????? ???????? ????? ???????? ????? ???????? ??????????????????????????????|
?????? ???? ????????? ????????????????????? ???? ?????????|
???? ? ????? ??????????? ????? ?????? ????????????????|
??????????????????? ??????????? ??????? ???? ?????? ????? ????????? ????????????????????????????????????, ???????? ?????????????? ??????????????????; ???????? ???????????? ??????? ???????????????????||??||
yastu do?a nimittebhya unm?debhya? samutth?na p?rvar?pa li?ga vedanopa?aya vi?e?a samanvito bhavatyunm?dastam?gantukam?cak?ate|
kecit puna? p?rvak?ta? karm?pra?astamicchanti tasya nimittam|
tasya ca hetu? prajñ?par?dha eveti bhagav?n punarvasur?treya?|
prajñ?par?dh?ddhyaya? devar?ipit? gandharva yak?a r?k?asa pi??ca guruv?ddha siddh?c?ryap?jy?navamaty?hit?ny?carati, anyadv? kiñcideva?vidha? karm?pra?astam?rabhate; tam?tman? hatamupaghnanto dev?daya? 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 
???? ???????????????????????????????????? ???????????????? ??????????? ??????; ??????- ??? ?? ???????? ????????? ?????????????, ????????, ???????????????, ?????, ??? ???? ?????? ????????????????, ??????? ? ??????????????????? ????????? ????; ??????????????????????????????||??||
tatra dev?diprakopanimitten?gantukonm?dena purask?tasyem?ni p?rvar?p??i bhavanti; tadyath?- deva go br?hma?a tapasvin?? hi?s?rucitva?, kopanatva?, n??a?s?bhipr?yat?, arati?, ojo var?a cch?y? balavapu??mupatapti?, svapne ca dev?dibhirabhibhartsana? pravartana? ceti; tato’nantaramunm?d?bhinirv?tti?||11||

The premonitory symptoms of the exogenous type of insanity:
Deva go br?hma?a tapasvin?? hi?s?rucitva? – Desire for inflicting injury upon the gods, cows, Brahmins and ascetics’
Kopanatva?, n??a?s?bhipr?yat? – Anger and liking for mischievous work
Arati?, ojo var?a cch?y? balavapu??mupatapti? – Disliking attitude and impairment of Ojas Color complexion and physical strength and
Svapne ca dev?dibhirabhibhartsana? pravartana? – Abuse and incitement by the gods etc.
Insanity manifests itself immediately after the occurrence of these premonitory symptoms. [11]

Agantuja Unmada Nidana – causative factors: 
??????????????????? ???????????????????????????????? ????; ??????- ?????????? ???? ???????????????, ???? ????? ?????????????????????, ????? ????????? , ????????? ?????????, ?????????? ??????, ????????????????????????????????, ??????? ?????????? ????????||??||
tatr?yamunm?dakar???? bh?t?n?munm?dayi?yat?m?rambhavi?e?o bhavati; tadyath?- avalokayanto dev? janayantyunm?da?, guru v?ddha siddhamahar?ayo’bhi?apanta?, pitaro dar?ayanta? , sp??anto gandharv??, sam?vi?anto yak???, r?k?as?stv?tmagandham?ghr?payanta?, pi??c?? punar?ruhya v?hayanta?||12||

Agantuja Unmada Nidana – causative factors: 
The causative agents of the exogenous type of insanity insanity their action as follows:-
Avalokayanto dev? janayantyunm?da? – The gods produce insanity by their vision
Guru v?ddha siddhamahar?ayo’bhi?apanta? – Preceptors, elders, adepts and ascetics by their cures
Pitaro dar?ayanta? – Ancestors by exhibiting themselves
Sp??anto gandharv?? – Gandharvas by their touch
Sam?vi?anto yak??? – Yakshas by seizure
R?k?as?stv?tmagandham?ghr?payanta? – Raksasas by making the patient to smell the odor of their body and
Pi??c?? punar?ruhya v?hayanta? – Pishacas by riding and driving their victims. [12]

Rupa – Symptoms of manifestations of disease:
????????? ?????? ??????; ??????- ???????? ?? ????? ????? ??????? ????? ???? ????? ????? ??? ?????????? , ??????????????????||??||
tasyem?ni r?p??i bhavanti; tadyath?- aty?tma bala v?rya pauru?a par?krama graha?a dh?ra?a smara?a jñ?na vacana vijñ?n?ni , aniyata?conm?dak?la?||13||
Symptoms of this condition are the manifestations of:
Aty?tma bala – superhuman strength
V?rya – energy
Pauru?a – manliness
Par?krama – enthusiasm
Graha?a dh?ra?a – power of understanding and retention
Smara?a – memory
Jñ?na vacana vijñ?n?ni – spiritual as well as artistic knowledge and
Aniyata?conm?dak?la? – Power of speech in the patient himself.
There is no fixed time for manifestation of this insanity. [13]

Circumstances of victimization of the subject:
???????????????? ??? ??????? ???? ??????? ???? ?????? ????????? ???? ????? ????????? ?? ????????????????????? ?????? ??????; ??????- ?????? ?????? ????????, ??????????? ?? ?????? ??????????, ????? ?? ???????????? ???????????????? ??, ??????????????????????? ?? ??????????? ?? ??????????, ????????????? ??, ?????? ???????? ??? ????? ??? ???????, ???? ???? ?????????? ????? ??, ?????? ??, ??? ???????????? ??, ????????????? ??, ???????? ?? ??????????, ????? ???????? ???? ???????? ??, ??? ?????? ???????????, ?????????????? ?? ??????????????????? ??, ???? ??? ??? ??? ????????????? ??, ????????? ??, ???? ??? ???? ???????? ??? ?????????????????? ??, ????? ???? ???????????????????? ??, ???????????????????? ??, ??????? ?? ???????????????????????, ????????????? ?????????? ??????||??||
unm?dayi?yat?mapi khalu devar?i pit? gandharva yak?a r?k?asa pi??c?n?? guru v?ddha siddh?n?? v? e?vantare?vabhigaman?y?? puru?? bhavanti; tadyath?- p?pasya karma?a? sam?rambhe, p?rvak?tasya v? karma?a? pari??mak?le, ekasya v? ??nyag?hav?se catu?path?dhi??h?ne v?, sandhy?vel?y?maprayatabh?ve v? parvasandhi?u v? mithun?bh?ve, rajasval?bhigamane v?, vigu?e v?’dhyayana bali ma?gala homa prayoge, niyama vrata brahmacarya bha?ge v?, mah?have v?, de?a kulapuravin??e v?, mah?grahopagamane v?, striy? v? prajananak?le, vividha bh?t??ubh? ?uci spar?ane v?, vamana virecana rudhirasr?ve, a?uceraprayatasya v? caityadev?yatan?bhigamane v?, m??sa madhu tila gu?a madyocchi??e v?, digv?sasi v?, ni?i nagara nigama catu?patho pavana ?ma??n?gh?tan?bhigamane v?, dvija guru surayatip?jy?bhidhar?a?e v?, dharm?khy?navyatikrame v?, anyasya v? karma?o’pra?astasy?rambhe, ityabhigh?tak?l? vy?khy?t? 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:
P?pasya karma?a? sam?rambhe – In the beginning of sinful acts.
P?rvak?tasya v? karma?a? pari??mak?le – When the (sinful) acts of the past life are matured enough to produce their effects
Ekasya v? ??nyag?hav?se catu?path?dhi??h?ne v? – Residing in a deserted house or going to cross roads alone.
Sandhy?vel?y?maprayatabh?ve v? parvasandhi?u v? mithun?bh?ve – Sexual intercourse during the junctures of day and night or during the new moon and full moon days
Rajasval?bhigamane v? – Sexual intercourse with a lady during her menses
Vigu?e v?’dhyayana bali ma?gala homa prayoge – Recitation of scriptures, religious offerings, auspicious rites and sacrifices in improper manner
Niyama vrata brahmacarya bha?ge v? – Dishonoring a vow and discontinuing a religious duty or observance of celibacy
Mah?have v? – Forceful battles
De?a kulapuravin??e v? – Destruction of countries, communities and towns
Mah?grahopagamane v? – Onset of inauspicious planets in the sky
Striy? v? prajananak?le – During the time of child- delivery of ladies
Vividha bh?t??ubh? ?uci spar?ane v? – Coming in contact with different types of inauspicious and unclean creatures
Vamana virecana rudhirasr?ve – Emesis, purgation and bleeding
A?uceraprayatasya v? caityadev?yatan?bhigamane v? – Visiting a Caitya (scared tree) or temple when unclean and not following the prescribed rules
M??sa madhu tila gu?a madyocchi??e v? – Resorting to the remnants of meat, honey , till sugar candy and alcohol
Digv?sasi v? – While naked
Ni?i nagara nigama catu?patho pavana ?ma??n?gh?tan?bhigamane v? – Visiting cities, towns, cross roads, gardens, cremation grounds, slaughter houses at night
Dvija guru surayatip?jy?bhidhar?a?e v? – Insulting Dvija (twice born), preceptors, the Gods, ascetics and others who are respected.
Dharm?khy?navyatikrame v? – Misinterpretation of religious scriptures and
Anyasya v? karma?o’pra?astasy?rambhe – 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: 
???????? ?? ?????????????? ??????????????? ???????? ????; ??????- ?????, ????, ????????? ????|
????? ?? ??????? ????????????????? ????? ????????????????|
???? ???????????????????????????? ????????, ????? ????????, ?????????????? ?? ????, ???????????????????????????????????????????, ??????? ????????????????? ????????, ???????? ????????; ?????? ??????????????||??||
trividha? tu khal?nm?dakar???? bh?t?n?munm?dane prayojana? bhavati; tadyath?- hi?s?, rati?, abhyarcana? ceti|
te??? ta? prayojana vi?e?amunmatt?c?ra vi?e?a lak?a?airvidy?t|
tatra hi?s?rthinonm?dyam?no’gni? pravi?ati, apsu nimajjati, sthal?cchvabhre v? patati, ?astraka??k???halo??amu??ibhirhanty?tm?nam, anyacca pr??avadh?rtham?rabhate kiñcit, tamas?dhya? vidy?t; s?dhyau punardv?vitarau||15||

Unmada Karana – 3 main causes: 
Insanity is caused by these agents with 3 objectives,
Hi?s? – To inflict injury
Rati? – To play and
Abhyarcana? – To offer prayer

Their intentions can be judged from the characteristic features of the patient:
Hi?s?rthinonm?dyam?no’gni? pravi?ati, apsu nimajjati, sthal?cchvabhre v? patati, ?astraka??k???halo??amu??ibhirhanty?tm?nam – 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 pr??avadh?rtham?rabhate 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:
???? ???????- ?????????? ??? ????? ????????? ??? ???? ???? ????????????????? ??????????????????????????||??||
?????? ??????????? ?????????? ??????||??||
tayo? s?dhan?ni- mantrau?adhi ma?i ma?gala balyupah?ra homa niyama vrata pr?ya?cittopav?sa svastyayanapra?ip?tagaman?d?ni||16||
evamete pañconm?d? vy?khy?t? 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:
?? ?? ??? ???????????????? ??????????? ??????? ? ?????????????? ???? ????? ??????? ????|
?? ? ???????????????? ??????????????????????????|
???? ?????????? ????????? ????, ?????????? ? ???????|
?????????? ?????? ??????????? ?????? ???????? ????????, ?????? ?? ????? ???????|
???? ????? ???????????? ??????????||??||
te tu khalu nij?gantuvi?e?e?a s?dhy?s?dhya vi?e?e?a ca pravibhajyam?n?? pañca santo dv?veva bhavata?|
tau ca parasparamanubadhn?ta? kad?cidyathoktahetusa?sarg?t|
tayo? sa?s???ameva p?rvar?pa? bhavati, sa?s???ameva ca li?gam|
tatr?s?dhya sa?yoga? s?dhy?s?dhyasa?yoga? c?s?dhya? vidy?t, s?dhya? tu s?dhyasa?yogam|
tasya s?dhana? s?dhanasa?yogameva vidy?diti||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:
?????? ?????-
??? ???? ? ???????? ? ?????? ? ????????|
? ?????? ?????????????????????????? ??????||??||
?? ???????????????? ??????????? ?????????|
? ? ????????? ?????? ? ??????? ??????????||??||
bhavanti c?tra-
naiva dev? na gandharv? na pi??c? na r?k?as??|
na c?nye svayamakli??amupakli?nanti m?navam||19||
ye tvenamanuvartante kli?yam?na? svakarma??|
na sa taddhetuka? kle?o na hyasti k?tak?tyat?||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:
?????????????? ??????? ?????? ????? ??????|
?????????????? ??????? ?????????? ?????????||??||
????????? ?????? ??????? ??? ???????|
????????????????? ?????? ??????????? ?? ???????||??||
??????????????????????? ?????????|
?? ? ?????? ???????? ?????????????????||??||
???? ??????- ??????? ???????? ?????????? ?????? ??????? ? ?|
?????????? ????????????? ???????????? ? ???????||??||
prajñ?par?dh?t sambh?te vy?dhau karmaja ?tmana?|
n?bhi?a?sedbudho dev?nna pit?nn?pi r?k?as?n||21||
?tm?nameva manyeta kart?ra? sukha du?khayo?|
tasm?cchreyaskara? m?rga? pratipadyeta no traset||22||
dev?d?n?mapacitirhit?n?? copasevanam|
te ca tebhyo virodha?ca sarvam?yattam?tmani||23||
tatra ?loka?- sa?khy? nimitta? pr?gr?pa? lak?a?a? s?dhyat? na ca|
unm?d?n?? nid?ne’smin kriy?s?tra? ca bh??itam||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:-
??????????????? ??????? ??? ????????????? ????? ?????? ?????? ?????? ??? ?????????????||?||
ityagnive?ak?te tantre caraka pratisa?sk?te nid?na sth?ne unm?da nid?na? n?ma saptamo’dhy?ya?||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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