Sunday, March 1, 2009

Ayurvedic Perspective of Psychiatry w.r.t. Stress and Emotions
Dr. R.D. Patil
MD(Ay) MA(San)
Senior Medical Officer (Ayu.)
Central Govt Health Scheme,

Ayurveda, the science of life, has the first and foremost aim to preserve the good health and to prolong the life; and secondly to combat the disease if any occurs. Ayurveda describes health by the term ‘Swastha’ which is a state of physical, mental, sensorial and spiritual well being. According to WHO experts committee, mental health is influenced by both biological as well as social factors. The worldwide prevalence of psychiatric illnesses among around 500 million population includes depression, anxiety neurosis, delinquency, mental retardation, schizophrenia, mood disorders, psychosis etc. After rejecting the concept of demonical influences in regard with mental disorders; which was prevalent in times of Atharvaveda; Ayurveda had come a long way to systemize the concept of mental health and its disorders i.e Psychiatry. But such an independent branch of Ayurveda has now turned into antique because of some socio- cultural circumstances prevalent in medieval India.
The body and the mind are two complimentary constituents of living body. These two elements are considered as the abodes of health as well as disease. Various afflictions of the mind are categorized under Psychiatric illnesses. The description of such disorders are available in Ayurveda in scattered form throughout the texts of Brihat-trayi and Laghu-trayi. The term mental disease is not restricted to merely insanity or allied mental derangement, but also includes stress and emotional disorders. These stress and emotional factors when cross the state of normalcy and get deranged, lead to various mental disorders.

Etio-pathology of mental disorders
The prime causative factors for all diseases are classified into three categories as follows.
2. Asatmendriyartha samyoga (stressful contacts of sense objects).
3. Prajnaparadha (voilational transgression).
4. Parinama (effect of season).
The very same causes are responsible for mental disorders. Again there are some socio-environmental factors also. Along with them; incompatible and vitiated food, perverted sexual activity, alcoholism, mental shock etc. can also be mentioned.
The volitional transgression is the basic cause for all above said factors. Due to this, the manodoshas get vitiated and obstruct the channels of mind (Manovaha srotas). As a result of misconception and error in consciousness; the intelligence, and memory of an individual is distracted. In that state, he performs wrong actions which lead to stress on his body and mind producing various psychic and psycho-somatic diseases.
Classification of mental disorders
While classifying the psychiatric disorders; their etiology, symptoms and psychopathology have to be taken into account.they can be generally classified into four major groups.
1.Emotional disorders : These are the symptoms produced due to primary involvement of Rajas and Tamas such as kama, krodha, lobha, mada, moha,irshya, shoka, bhaya, udvega, harsha etc.
2.Psychiatric disorders: these are major problems caused due to involvement of Rajas and Tamas along with Vata, Pitta and Kapha doshas. It includes Unmada, Apasmara, Apatantraka, Bhrama, Murchha, Sanyasa etc.
3.Psychosomatic disorders: These are also known as Adhi-vyadhis in Ayurveda which include Bhayaja and Shokaja Atisara, Kamaja and Shokaja Jwara,Tamaka Shwasa, Amavata etc.
4.personality defects: Some psychiatric illnesses are related with personality defects just as Heenasatwa, Vikruta satwa, Amedhata and Atattwabhinivesha.
M. G. Ramu et al has accounted emotional disorders in four types of divisions.
1.***********: Kama, Krodha, lobha etc.
2.***********: Illusions.
3. ***********: Unmada, Apasmara etc.
4. *********** : Shokaja jwara and Atisara.

Stress emotions in Ayurveda
Ayurveda regards that all diseases occur due to controlling the dischargable vegas or due to discharging the controllable vegas. The dharneeya vegas like Lobha,Irshya, raga etc. should be controlled to avoid the confrontations.
Also it has highlighted the importance of psychic factors in pathogenesis of various diseases saying that ‘ Vishado Roga Vardhananam’ie. Emotional trauma resulting from the repression of emotions lead to causation or aggrevation of diseases.
Emotion means feeling urge to specific action based on intuitive appraisal of the situation, its efffect on us and the way to cope up with it. Just like the vegas in Ayurveda, these emotions are not only psychological experiences, but they affect body also. Such changes may vary in different situations.
Stress and emotional disorders are also included in mental disorders of human being. K. N. Udupa while describing the stress disorders, has stated the stress reactions and their influences on mental and physical health.
Charaka has correctly concieved the mode of how emotional factors influences bodily phenomena. It is stated that emotions like Kama (lust), Bhaya (fear) and Shoka (grief) aggrevate Vata while Krodha (anger) aggrevates Pitta producing somatic diseases. Simillarly certain stress and emotional factors influence the course of illness as is evident from the following statement made by Charaka.
********** : Disgust and unhappyness causing loss of virility.
********** : Mental depression or emotions causing aggrevation of diseases.
********** : Worry or grief, the top cause of ematiation.
********** : Greed, the cause of troublesome practices.
********** : Wicked words leading to harmful results.
Thus there is ample evidence suggesting possible aggrevation and genesis of somatic disorders by stress and emotional factors and vice-versa.

Relation of stress and emotions with Prana Vayu and Sadhaka Pitta
The limbic lobe function is intimately associated with the control of mood states. The actual working of the nerves within these is dependent on the mono amines. These mono amines are catacholamines such as noradrenaline, dopamine, serotomine etc. in limbic system, anxiety involvement areas are identified as Amygdaloid nucleus, dorsal and particular areas of hypothalamus.
According to Hathayoga Pradipika, Manas is the master of Indriyas and Vata is the master of Manas. The ultimate cognizance of an object and consequent direction for the requisite action is rested with Buddhi.
Pranavata is located in Siras (head) and maintains the action of Hridaya, Manas, Buddhi and Indriyas and supports Dhamanis. Sadhaka Pitta is responsible for intelligence, memory, enthusiasm and one’s aspirations. The concept of Sadhaka Pitta therefore encompasses psycho-physiological actions.
The concept of these two i.e. Prana vata and Sadhaka Pitta shows that they are having prominent role in emotional factors.

Effects of stress factors
Certain amount of psychic trauma leads to various physiological changes in the behaviour personality of the person. The major effects are suppression of immune response, lowering of antibody levels, heart diseases, skin disorders, tension headache, sexual dysfunction, digestive disorders etc.
Stress researches have established that some stress or stimulation is needed for optimum performance. But this relationship varies from person to person. In initial phase, as stress increases, performance rises and boredom and frustration decreases. However continuous stress impairs judgment and alertness resulting in diminished performance.
The main sub systems of our body are Cognitive, Affective, Physical and Behavioural systems which coordinated by the master system. These sub systems respond according to the demands of a particular time and circumstances. E.g. I here noise which I recognize as that of an exploding bomb (cognitive). I feel frightened (affect), mobilizes the body’s response mechanism (physiological) and I want to take shelter (conation). Hence stress emotions and anxiety have a mental side.

The holistic approach towards treatment of mental disorders are aimed for mitigation of symptoms, eradication of disease and personality development. Ayurvedic mode of treatment includes –
1. Shodhana (Panchakarma) therapy.
2. Shamana therapy.
3. Medhya Rasayanas.
4. Daiva – vyapashraya chikitsa.
5. Satwavajaya chikitsa (Psychotherapy)
Panchakarma forms the major part of this treatment since in most of the conditions, Doshas are vitiayed upto such an extent that they can’t be pacified by Shamana therapy. Here procedures like vamana, Virechana, Tikshna Nasya, Dhoopana etc. play important role. In some irritatable conditions, procedures like Dhara with Taila or Takra are also useful.
Shamana treatment includes medication with some herbal or herbo-mineral preparations. This treatment alleviates the Doshas and helps to bring normalcy in mental functions.most of these drugs produce effects on both the faculties i.e. body and mind.
Medhya Rasayana therapy is one more peculiarity of Ayurvedic treatment. These drugs are targeted for improvement of cognitive, conative and affective systems of the mind. Charaka has described four main drugs like Shankhapushpi, Brahmi, Mandukaparni and Yashti in different forms. But there are many others which can be used for the same purpose. E.g. Jatamansi, Vacha, Bhallataka, kushtha, Ghrita, Suvarnabhasma etc. they improve the Satwa (mental strength) and its functions. They act either through their Shamana (alleviation) effect (e.g.Brahmi, Jatamansi, Ghrita etc.) or through stimulation effect (e.g. Vacha, Kushtha etc.)
Daiva – vyapashraya chikitsa includes the holistic rituals like Bali, Homa, Japa, Tapa, dana etc. the effect of such procedures can be explained through their effect at spiritual level.
Satwavajaya treatment is specifically indicated for trating the psychiatric cases. Control of mind is achieved through by spiritual knowledge, philosophy, remembrance and concentration. Vagbhata also regards them as the best remedies for psychiatric illnesses. Some methods of psychotherapy like counseling and reassurance, sympathy and simple relaxation techniques can help to the patients to a great extent.
Following the methods of Achara Rasayana will maintain the psychosomatic equilibrium which gives intelligence, memory, longevity and immunity. Hence they should also form the part of psychotherapy.
Before concluding, it is necessary to mention that the treatment procedures described in the classical texts alone are not sufficient for treating a psychiatric patient. The drug which are mentioned in later Granthas like Sanjnasthapana and nidrajanaka groups also should be encompassed as and when necessary.
Summary and Conclusion
Thus it can be summarized that Ayurveda maintains a very substantial and authentic Mano – vigyna. Heena satwa (inadequate personality) is the prime cause of mental ailments. Hereditary factors and socio – cultural circumstances also are of paramount importance.
Psychiatric ailments are always recurring in nature, hence according to the Doshas, specific Shodhana therapy, Shamana treatment and Satwavajaya Upayas can be adopted.
Avoidance of Prajnaparadha and applying psychotherapy such as counseling, reassurance, sympathy etc. as well as Sadvrittas and Daiva – vyapashrya methods are helpful for mental disorders. According to present day situation, one has to design his lifestyle, diet and regimen which is essential for mental health.
Thus the Ayurvedic management of mental disorders is aimed for mitigation of symptoms, eradication of disease and personality development. Such a comprehensive ands scientific approach talks in volume about scope of Ayurveda in this field irrespective of time or place.

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