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AIAPGET POINTS

1. Mano Dukha Janya Unmada and Vishaja Unmada are the 5th and 6th kinds of Unmada according to Sushruta, apart from 3 kinds of doshaja Unmadas (Vataja, Pittaja and Kaphaja) and Sannipataja (4th type, caused by all three doshas).
2. According to Sushruta, the Apravruddha and Taruna Avastha of Vishaja Unmada are called Mada. (Su.Ut.62/5)
3. Bhrama, mentioned as one of the Purvarupas of Unmada has been described as – Chakragatasya Va – as though spinning on a wheel.
4. When the ingredients of Kalyanaka Ghrta are prepared with herbs belonging to Jivaniya Gana and four parts of milk (instead of two parts), it becomes MAHAKALYANAKA Ghrta.
5. Sira Vimokshana is indicated to be done in uras, apanga and lalata in the treatment of Unmada.
6. Sushruta advises Sneha Basti to be given after the doshas subside, in the treatment of Unmada.
7. Sushruta prescribes treatment principles of Apasmara and Graha to be included in treatment of Unmada also.
8. Sushruta advises removal of Shoka Shalya in Manoja Unmada.

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The 62nd chapter of Uttaratantra of Sushruta Samhita is named as Uñmāda Pratiședha. This chapter deals with Treatment of Insanity.

अथात उन्मादप्रतिषेधमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Uñmäda pratiṣedha – treatment of insanity; as revealed by the venerable Dhanvantari.

Nirukti – definition

मदयन्त्युद्ध(द्ग)ता दोषा यस्मादुन्मार्गमाश्रिताः |
मानसोऽयमतो व्याधिरुन्माद इति कीर्तितः ||३||

A disease in which the greatly aggravated doshas get localized in the upper paths of the body and produce abnormalities (toxicity) in the mind is called Unmada (insanity). Unmada is considered as a disease of the mind.

एकैकशः समस्तैश्च दोषैरत्यर्थमूर्च्छितैः |
मानसेना च दुःखेन स पञ्चविध उच्यते ||४||
विषाद्भवति षष्ठश्च यथास्वं तत्र भेषजम् |
स चाप्रवृद्धस्तरुणो मदसञ्ज्ञां बिभर्ति च ||५||

Unmada is of five kinds –

–        one by each dosha separately – vataja, pittaja and kaphaja,

–        one by all doshas greatly aggravated together – samasta dosha or sannipataja and

–        the fifth type is caused by manasa dukha – misery or disturbance of the mind

The sixth kind of unmada is produced by visa – poison. This condition, when not greatly developed and still young (newly manifested), bears the name Mada (intoxication).

Pūrvarūpa – premonitory symptoms

मोहोद्वेगौ स्वनः श्रोत्रे गात्राणामपकर्षणम् |
अत्युत्साहोऽरुचिश्चान्ने स्वप्ने कलुषभोजनम् ||६||
वायुनोन्मथनं चापि भ्रमश्चक्रगतस्य वा |
यस्य स्यादचिरेणैव उन्मादं सोऽधिगच्छति ||७||

Below mentioned are the premonitory symptoms of Unmada –

–        delusion,

–        emotional bouts,

–        noise in the ears,

–        debility of the body,

–        great enthusiasm,

–        loss of taste or lack of desire for food,

–        dreams as though he is eating dirty foods,

–        experiencing twisting pains in the body,

–        giddiness as though spinning on a wheel

These symptoms would lead to Unmada very soon. 

Laksana – clinical features

रूक्षच्छविः परुषवाग्धमनीततो वा शीतातुरः कृशतनुः स्फुरिताङ्गसन्धिः |
आस्फोटयत्यटति गायति नृत्यशीलो विक्रोशति भ्रमति चाप्यनिलप्रकोपात् ||८||

Vātaja Unmada Symptoms – Below mentioned are the symptoms of Unmada produced by Vata –

–        roughness of the skin and speech (voice),

–        visible prominent blood vessels,

–        desire for cold things,

–        emaciation of the body,

–        throbbing in the body parts and joints,

–        the person breaks things,

–        he wanders, sings, dances, weeps or screams and shivers

तृट्स्वेददाहबहुलो बहुभुग्विनिद्रश्छायाहिमानिलजलान्तविहारसेवी |
तीक्ष्णो हिमाम्बुनिचयेऽपि स वह्निशङ्की पित्ताद्दिवा नभसि पश्यति तारकाश्च ||९||

Pittaja Unmada Symptoms – Below mentioned are the symptoms of Unmada produced by Pitta –

–        excessive thirst, sweating and burning sensation,

–        he eats more food and sleeps less,

–        he resides in shade,

–        has desire for cold breeze and likes to stay in the vicinity of water reservoirs,

–        is violent,

–        suspects the presence of fire even in ice and water and

–        sees stars in the sky even in the day time

छर्द्यग्निसादसदनारुचिकासयुक्तो योषिद्विविक्तरतिरल्पमतिप्रचारः |
निद्रापरोऽल्पकथनोऽल्पभुगुष्णसेवी रात्रौ भृशं भवति चापि कफप्रकोपात् ||१०||

Kaphaja Unmada Symptoms – Below mentioned are the symptoms of Unmada produced by kapha –

–        vomiting,

–        weakness of digestive fire,

–        debility of the body,

–        loss of taste,

–        cough,

–        desire for company of women in solitude,

–        is low (poor) in intelligence,

–        talks less,

–        always sleepy,

–        eats less food,

–        has desire for hot things and

–        symptoms increase after taking the food and at night time

सर्वात्मके पवनपित्तकफा यथास्वं संहर्षिता इव च लिङ्गमुदीरयन्ति ||११||

Sannipātaja Unmada Symptoms – All the symptoms of all the three doshas are greatly exaggerated in Unmada caused by all the three doshas together (combined aggravation). The symptoms behave in a way as if competing with one another.

चौरैर्नरेन्द्रपुरुषैररिभिस्तथाऽन्यैर्वित्रासितस्य धनबान्धवसङ्क्षयाद्वा |
गाढं क्षते मनसि च प्रियया रिरंसोर्जायेत चोत्कटतरो मनसो विकारः ||१२||
चित्रं स जल्पति मनोनुगतं विसञ्ज्ञो गायत्यथो हसति रोदिति मूढसञ्ज्ञः |१३|

Manoja Unmada Symptoms – The mind becomes greatly injured (disturbed) and produces Unmada in the persons –

–        who are threatened by thieves (robbers, murderers etc),

–        who are threatened by officers (security, soldiers, guards etc) of the king,

–        who are threatened by enemies and such other people,

–        who have lost wealth and relatives or

–        who has a strong desire to copulate with his / her beloved (and not being able to do)

This condition is called Manoja Unmada.

A person suffering from such condition –

–        talks differently,

–        reveals the desires of his mind without his knowledge,

–        sings,

–        laughs and

–        weeps

रक्तेक्षणो हतबलेन्द्रियभाः सुदीनः श्यावाननो विषकृतेऽथ भवेत् परासुः ||१३||

Visaja Unmada – Below mentioned are the symptoms of Unmada caused by poisons –

–        reddishness of the eyes,

–        loss of strength,

–        loss of sense of perception,

–        loss of complexion (colour),

–        timidness,

–        bluish coloration of face (mouth) and

–        the person looks like he is going to die soon

Cikitsā – treatment

स्निग्धं स्विन्नं तु मनुजमुन्मादार्तं विशोधयेत् |
तीक्ष्णैरुभयतोभागैः शिरसश्च विरेचनैः ||१४||
विविधैरवपीडैश्च सर्षपस्नेहसंयुतैः |
योजयित्वा तु तच्चूर्णं घ्राणे तस्य प्रयोजयेत् ||१५||
सततं धूपयेच्चैनं श्वगोमांसैः सुपूतिभिः |
सर्षपानां च तैलेन नस्याभ्यङ्गौ हितौ सदा ||१६||

Below mentioned are the general treatment principles of Unmada –

Those suffering from Unmada should be administered with the below mentioned treatments –

–        oleation and sudation therapies to begin with, followed by

–        therapeutic emesis, purgation and purgation to the head (errhines) – with strong herbs and

–        different kinds of avapida (nasal drops) mixed with mustard oil and

–        powder of medicinal herbs (used for nasya) should be blown into the nose of the patient and

–        the patient should be exposed to the fumes of flesh of dog or cow, which are foul smelling and

–        sarsapa taila – mustard oil may be used for administering nasal drops and also for anointing the body

Kşobhotpādana – shock treatment

दर्शयेदद्भुतान्यस्य वदेन्नाशं प्रियस्य वा |
भीमाकारैर्नरैर्नागैर्दान्तैर्व्यालैश्च निर्विषैः ||१७||
भीषयेत् संयतं पाशैः कशाभिर्वाऽथ ताडयेत् |
यन्त्रयित्वा सुगुप्तं वां त्रासयेत्तं तृणाग्निना ||१८||
जलेन तर्जयेद्वाऽपि रज्जुघातैर्विभावयेत् |
बलवांश्चापि संरक्षेत् जलेऽन्तः परिवासयेत् |
प्रतुदेदारया चैनं मर्माघातं विवर्जयेत् |
वेश्मनोऽन्तः प्रविश्यैनं रक्षंस्तद्वेश्म दीपयेत् ||१९||
सापिधाने जरत्कूपे सततं वा निवासयेत् |२०|

The patient of unmada should be put into a zone of shock (which constitutes shock treatment) by doing the below said –

–        he should be shown wonderful or awe inspiring sights,

–        intimated of the death of persons whom he loves the most,

–        be threatened by persons of terrifying shape and size,

–        be threatened by elephants and wild animals which have been tamed and which are also non-poisonous (or whose poison has been removed),

–        be threatened by binding him with ropes or beating him with whips,

–        be tied and hidden in an isolated / solitary place or

–        be threatened with fire of burning hay or burning water or

–        be beaten with whip or

–        a strong patient may be kept immersed in water while protecting his life or

–        be pricked with needles, avoiding injury to marmas – vital spots or

–        be kept inside a house and the house set on fire while taking care to protect him from the fire or getting burnt by fire or

–        kept inside a big pot and cover it with lid 

त्र्यहात्त्र्यहाद्यवागूश्च तर्पणान् वा प्रदापयेत् ||२०||
केवलानम्बुयुक्तान् वा कुल्माषान् वा बहुश्रुतः |
हृद्यं यद्दीपनीयं च तत्पथ्यं तस्य भो(यो)जयेत् |

The intelligent physician should give the below mentioned to the patient suffering from unmada –

–        yavagu i.e. thick gruel or tarpana – flour added with ghee, sugar, honey etc – once in every three days or

–        kulmasa – cooked pulses along with water or

–        foods which are pleasing, likable or good for heart (hrdya) and also

–        foods which are healthy and which increase hunger

Kalyāņaka ghrta

विडङ्गत्रिफलामुस्तमञ्जिष्ठादाडिमोत्पलैः |
श्यामैलवालुकैलाभिश्चन्दनामरदारुभिः ||२२||
बर्हिष्ठरजनीकुष्ठपर्णिनीसारिवाद्वयैः |
हरेणुकात्रिवृद्दन्तीवचातालीसकेशरैः ||२३||
द्विक्षीरं साधितं सर्पिर्मालतीकुसुमैः सह |
गुल्मकासज्वरश्वासक्षयोन्मादनिवारणम् ||२४||
एतदेव हि सम्पक्वं जीवनीयोपसम्भृतम् |
चतुर्गुणेन दुग्धेन महाकल्याणमुच्यते ||२५||
अपस्मारं ग्रहं शोषं क्लैब्यं कार्श्यमबीजताम् |
घृतमेतन्निहन्त्याशु ये चादौ गदिता गदाः ||२६||

Decoction of the below mentioned ingredients should be prepared –

–        vidanga,

–        triphala,

–        musta,

–        manjistha,

–        dadima,

–        utpala,

–        syama,

–        elavaluka,

–        ela,

–        candana,

–        amaradaru,

–        barhistha,

–        rajani,

–        kustha,

–        parnini,

–        two kinds of sariva,

–        harenuka,

–        trivrt,

–        danti,

–        vaca,

–        talisa and

–        malati kusuma

This decoction is added with one part of ghee and two parts of milk (double the quantity of ghee), boiled and processed and medicated ghee is prepared. This ghee is known as Kalyanaka Ghrta.

This medicated ghee cures abdominal tumour, cough, fever, dyspnoea, consumption and insanity.

When the same ghee is cooked with the addition of herbs belonging to the Jivaniya Gana group and four parts of milk, it becomes Mahakalyanaka Ghrta.

Mahakalyanaka Ghrta cures epilepsy, seizure by grahas (demons), consumption, impotence, emaciation, loss or absence of semen and also other diseases named above.

Phala Ghrta

बर्हिष्ठकुष्ठमञ्जिष्ठाकटुकैलानिशाह्वयैः |
तगरत्रिफलाहिङ्गुवाजिगन्धामरद्रुमैः ||२७||
वचाऽजमोदाकाकोलीमेदामधुकपद्मकैः |
सशर्करं हितं सर्पिः पक्वं क्षीरचतुर्गुणम् ||२८||
बालानां ग्रहजुष्टानां पुंसा दुष्टाल्परेतसाम् |
ख्यातं फलघृतं स्त्रीणां वन्ध्यानां चाशु गर्भदम् ||२९||

Decoction of the below mentioned ingredients should be prepared –

–        Barhistha,

–        Kustha,

–        Manjistha,

–        Katuka,

–        Ela,

–        Nisahvaya,

–        Tagara,

–        Triphala,

–        Hingu,

–        Vajigandha,

–        Agara dhuma,

–        Vaca,

–        Ajamoda,

–        Kakoli,

–        Meda,

–        Madhuka and

–        Padmaka

To this decoction, one part of ghee and four parts of milk are added, boiled and processed and medicated ghee is prepared. This ghee is consumed, mixed with sugar.

This medicated ghee is known as Phala Ghrta. It is beneficial for children seized by grahas, for men having vitiated or scanty semen. It also bestows pregnancy to infertile women.

ब्राह्मीमैन्द्रीं विडङ्गानि व्योषं हिङ्गु सुरां जटाम् |
विषघ्नीं लशुनं रास्नां विशल्यां सुरसां वचाम् ||३०||
ज्योतिष्मतीं नागरं च अनन्तामभयां तथा |
सौराष्ट्रीं च समांशानि गजमूत्रेण पेषयेत् ||३१||
छायाविशुष्कास्तद्वर्तीर्योजयेद्विधिकोविदः |
अवपीडेऽञ्जनेऽभ्यङ्गे नस्ये धूमे प्रलेपने ||३२||

Below mentioned ingredients are taken in equal quantities –

–        Brahmi,

–        Aindri,

–        Vidanga,

–        Vyosa,

–        Hingu,

–        Sura (Surahva),

–        Jata,

–        Visaghni (Haridra),

–        Lasuna,

–        Rasna,

–        Visalia,

–        Surasa,

–        Vaca,

–        Jyotismati,

–        Nagara,

–        Ananta (utpala sariva),

–        Anbhaya and

–        Saurastri

They are macerated in the urine of elephants, made into small wicks (draggees) and dried in shade.

This should be used for many purposes like – avapida (nasal drops), anointing the body, nasal medication, inhalation of smoke and application as paste on the body. Only the physicians who are well versed in the techniques of using them should administer them as and when needed.

उरोपाङ्गललाटेषु सिराश्चास्य विमोक्षयेत् |३३|

Venepuncture should be done on the below mentioned sites of the body –

–        chest,

–        outer angle of the eye and

–        forehead

अपस्मारक्रियां चापि ग्रहोद्दिष्टां च कारयेत् ||३३||
शान्तदोषं विशुद्धं च स्नेहबस्तिभिराचरेत् |३४|

In unmada, treatments indicated for apasmara and graha may also be done.

The patient should be treated with sneha basti (oil enema) after the doshas subside.

उन्मादेषु च सर्वेषु कुर्याच्चित्तप्रसादनम् |
मृदुपूर्वां मदेऽप्येवं क्रियां मृद्वीं प्रयोजयेत ||३४||

All methods to purify the mind (which would make the mind calm and free the persons from bad emotions) should be done in all varieties of Unmada. It should be preceded by purificatory therapies which should be administered in mild proportions. These therapies should be administered mildly even in cases of mada (intoxication).

शोकशल्यं व्यपनयेदुन्मादे पञ्चमे भिषक् |
विषजे मृदुपूर्वां च विषघ्नीं कारयेत् क्रियाम् ||३५||

The physician should remove the cause of grief in the fifth kind of unmada (manasika). Anti-poisonous treatments should be adopted after administering mild purificatory therapies in cases of unmada produced by poison.

इति श्री सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते भूतविद्यातन्त्रे उन्मादप्रतिषेधोनाम (तृती-योऽध्यायः, आदितः) द्विषष्टितमोऽध्यायः।।६२।।

Thus ends the sixty-second chapter by name Uñmāda Pratiședha in Uttara Sthana of Suśruta Samhita.