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.
We shall now explore the chapter on the “Diagnosis of Insanity”. Thus said Lord Atreya [1-2
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:
When an individual is timid
When is mind is afflicted by the predominance of Rajas and Tamas
When Doshas in his body are aggravated and Vitiated
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)
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
When his mind is afflicted over and over again by passion, anger, greed, excitement, fear, attachment, exertion, anxiety and grief and
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:
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
Emptiness in head
Congestion in eyes
Noises in ears
Hard breathing in excess
Excessive salivation in the mouth
Absence of inclination for food, anorexia and indigestion
Spasm in cardiac region
Meditation, fatigue, unconsciousness and anxiety in improper situations
Continuous horripilation
Frequent pyrexia
Unmatta cittatvam – Fickle mindedness
Udarditvam – Pain in the upper part of the body
Manifestation of symptoms of facial paralysis resulting in movement in one half of the face
Frequent appearance of the following in dreams
Inauspicious objects that are wandering, moving and unstable
Riding over the wheel of an oil press
Being churned by whirl- winds
Sinking in fearful whirl pools and
Retraction of eyes.[6]

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Distinctive features of insanity: Clinical features of Unmada:
A) Vataja Unmad:
constant wandering
sudden spasm of eyes, eyebrows, lips, shoulder, jaws, fore-arms, and legs
constant and incoherent speech
coming out of froth from the mouth
Always smiling, laughing, dancing, singing and playing with musical instruments in inappropriate situations
Loudly imitating the sounds of flute, conch, Samya (cymbal played by right hand) and Tala (cymbal played by left hand)
Riding undesirable vehicles
Duration by such things as are not needed for ornaments
Longing for eatables not available
Digest for food articles and also a strong desire not to part with the eatables available
Emaciation and roughness
Projected and reddish eyes and
Aggravation of the condition by such of the regimens as are not wholesome for Vata.
Disease- Treatment Of Charaka Samhita Made Easy
(B) Paittika Unmada:
Irritation and anger
Excitement on inappropriate occasions
Inflicting injury on own people or on others by weapons, brick bats, whips, sticks and fist.
fleeing and desire for shade, cold water and food having cooling effect.
Continuous state of anguish
having ferocious eyes of coppery, green or yellow color and
aggravation of the condition by such regimens as are not wholesome for Pitta.

(C) Slaismika Unmada:
Staying in one place and observance of silence
Discharge of saliva and nasal excretions
disinclination for food and love for solitude
Frightening appearance
Aversion for cleanliness
Remaining always sleepy
oedema in the face
White and timid eyes with excreta adhered to them
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:
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):
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
The premonitory symptoms of the exogenous type of insanity:
Desire for inflicting injury upon the gods, cows, Brahmins and ascetics’
Anger and liking for mischievous work
Disliking attitude and impairment of Ojas Color complexion and physical strength and
Abuse and incitement by the gods etc.
Insanity manifests itself immediately after the occurrence of these premonitory symptoms. [11]

Agantuja Unmada Nidana – causative factors:
The causative agents of the exogenous type of insanity insanity their action as follows:-
The gods produce insanity by their vision
Preceptors, elders, adepts and ascetics by their cures
Ancestors by exhibiting themselves
Gandharvas by their touch
Yakshas by seizure
Raksasas by making the patient to smell the odor of their body and
Pishacas by riding and driving their victims. [12]

Rupa – Symptoms of manifestations of disease:
Symptoms of this condition are the manifestations of:
superhuman strength
energy
manliness
enthusiasm
power of understanding and retention
memory
spiritual as well as artistic knowledge and
Power of speech in the patient himself.
There is no fixed time for manifestation of this insanity. [13]

Circumstances of victimization of the subject:
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:
In the beginning of sinful acts.
When the (sinful) acts of the past life are matured enough to produce their effects
Residing in a deserted house or going to cross roads alone.
Sexual intercourse during the junctures of day and night or during the new moon and full moon days
Sexual intercourse with a lady during her menses
Recitation of scriptures, religious offerings, auspicious rites and sacrifices in improper manner
Dishonoring a vow and discontinuing a religious duty or observance of celibacy
Forceful battles
Destruction of countries, communities and towns
Onset of inauspicious planets in the sky
During the time of child- delivery of ladies
Coming in contact with different types of inauspicious and unclean creatures
Emesis, purgation and bleeding
Visiting a Caitya (scared tree) or temple when unclean and not following the prescribed rules
Resorting to the remnants of meat, honey , till sugar candy and alcohol
While naked
Visiting cities, towns, cross roads, gardens, cremation grounds, slaughter houses at night
Insulting Dvija (twice born), preceptors, the Gods, ascetics and others who are respected.
Misinterpretation of religious scriptures and
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:
Insanity is caused by these agents with 3 objectives,
To inflict injury
To play and
To offer prayer
Their intentions can be judged from the characteristic features of the patient:
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.
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:
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:
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:
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:
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:-
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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