Concept of Psychosomatic Disorders in Ayurveda

In Ayurveda the evolutionary process of life is a complex phenomenon and according to the concept of disease specially the mental illness is also highly complex. Life is union of sharer, indriya, sattva and atma. Thus mind body and soul influence each other. However grossly there are two types of diseases sharirik and manasika according to the percentage of doshik involvement and their location. Chakrapani interprets and elaborates their context and strongly postulates the psychosomatic concept of Ayurveda.14 Recent scholars of Ayurveda describes this view (based on charaka and chakrapani) in following ways.  Bodily disease affects to the bodily disease.  Mental disease affects to the mental disease  Mental disease affects to the bodily disease.  Bodily disease affects to the mental disease. This concept of psychosomatic interrelationship is described extensively in relation to physiological, psychological and phenomenal aspect of disease. The diseases related with both psych (i.e.mind) and soma (i.e body) are categorized as psychosomatic disorders. It is very clear that these are mental disorders which have a strong relation with the body, in our view disorders having both shariric and sattavaj component in their samprapti process. In Ayurveda thesse have been adequately categorized and classified in details of each disease for ego, unmade, apsamara. Keyword: Psychosomatic disorders, daivyapasraya chikitsa. Introduction: The major disorders and specific mental disease have been adequately categorized with detail in Ayurvedic classic. The production Manasa Vikara considered to be by impairment of general mental functions the presence of weak psyche (alpa stwa), vitiation of sharirik and manas dhosas (raj & Tam) and also by vitiation of manovah srotas this may occur firstly as involvement of mans dhosa while physical involvement is secondary or sometimes the primary involvement is sharirik dhosa and subsequently manas dhosa get involvement. Mans vikara resulting from emotional disturbance due to derangement of rajo and tamo dhosa are treated with psycho behavioural therapy (satvavajay chikitsa) . if the primary involvement is because of sharirik dhosa and for subsequent mental impairment the treatment is mainly with the drugs.in this reference Madhya rasayan an d achar rasayan quoted by Charak is of great value. The measure categories of mental diseases described such as Unmad comparable to dementia and schizophrenia; Apasmara to Epilepsy, atatvaabhinivesh to obssecieve compulsive disorder and mad murcha sanyasa and madatya are comparable to alcoholism. According to charak mansik vikara result due to accrual of undesired objects and loss of desired objects. In this reference shusruta has identified emotions like kroadh, shoak, bhaya, kama, etc as cause of manovikara. The treatment method described in ayurvedic classics include daiva vyapashraya, satwa vajay therapy besides full fledzed yukti vyapashraya chikitsa which include drugs, diet and counseling. Concept of Manasa: In Ayurveda there is two objectives for which this science is evolutioned. First is maintenance of health and second is to cure Indian Journal of Agriculture and Allied Sciences A Refereed Research Journal Received: 20.11.2015, Accepted: 30.11.2015 Concept of Psychosomatic Disorders in Ayurveda 109 the suffering of diseased.According to charaka to achieve the first objective there is requirement of harmonious functioning of four component that include, Sharir (physial body), Indriya (sensory apparatus), Atma (soul) and Satva (manas). The manas (mind) is an important component of life entity classically termed as Ayu. The harmony between these factors leads to happy life and to become a well wisher to the society. In nutshell we can say that the above stage is stage of Arogya, which is mulam (origin) of Purusharth chatustaya . Site and Function of Manasa: Achetana (unconscious), Kriyawan (active), Dravya (substances) , Ekatva (oneness), Anutva (subtle), Pancha Bhautika (material), Ubhayendriya (organ of sensation and action), Trigunatmaka (sattavik, Rajsika, Tamasik), Atindriya (subtle, beyond the perception) , It is Prana. In general the manas pervades all over the sentient parts of the body. A lot of controversy exists about the seat of Manas. Prof. R. H. Singh in Ayurvedic Manas Vigyana wrote that classically Hridya (emotional aspects), Manas (psych), Medha (intellect), sharirasa(skull with brain) and Mastulunga (brain), all these terms refers to brain and its psycho functional aspects in the seat of Manas . Functions: Mana is involved in thinking, discrimination, reasoning, and conclusion. According to Caraka, following are the function of Manas Chintan (thinking)  Vichara (consideration)  Uha (speculation)  Dhyana (concentration)  Indriya nigraha (control of sense)  Sankalpa (determination)  Yat kinchit (miscellaneous)  Kalpana (imagination)  Sva-nigrahaa (self control)  Swapan (dreams) Gunas of Manas: Charaka describes two special characteristic of Manas i.e Anutva (minute) and Akatva (one). ANUTVA: Manas can not be perceived by sences and it is minute subtle hence it is termed as Anutva. EKATVA: Manas performs only one action at one time hence it is said to be characterized by Ekatva guna. Gunas in Reference to Prakriti: Sattva, Rajas and Tamas are three basic Gunas of the Manas(mind) by virtue of which one individual present with Sattvika, Rajsika and Tamasika type of manasik prakriti, according to the predominance of one of the other of the these Gunas. The Trigunas are responsible for each and every psychophysiological event in an individuals. Sattva is responsible for spiritual pleasure, correct knowledge and light (prakash), Raja is responsible for functional entity of an individual and Tama for inertia and darkness.(Gita 14;5:79) General Etiological Factor of Manas Roga: Factors can be classified in to the basic three fold causes-Pragyaparadha i.e unwholesome contact of Kala, Budhi and Artha. Asatmyaendriyarth samyoga and Parinama. Next Sadvritta apalan, Vegavrodha and Vegodirana, Purvajanmakritkarma and Prakriti viparaya. Etiological Factors for the Menifestation of Unmada: Timid person with aggrevation of Rajas and Tamas doshas along with three sharirik doshas. Consumption of unclean, unwholesome and damaged food substances. Person not follow the rules and regulation of dietetics, abnormal posture and extreme emaciation. Whose mind is inflicted by passion, anger, greed,exhilaration,fear, attachment, exertion, grief, enxiety, excitement . Person having chronic disease, frequently subjected to physical assault and insulting God,preceptors and Dvijas. Etiological Factors for the Menifestation of Apasmara: Consumption of unholesomes food,infliction of mind with Raja and Tamas doshas,occlusion of Hridaya with excacerbated doshas . Affliction to mind by excessive anxiety, passion, fear, anger, grief, agitation etc. Improper and exess correlation of the sense organ with their objects and activity. Suppression of the natural urges and sexual intercourse during menstruation. Samprapti of Manasa Roga: Samprapti is a complete phenomenon right from vitiation of dosha till the roga pradurbhava. Manasa vikara usually runs a sequential process from minor unnoticed general behavioral symptoms to the marked alteration of budhi, Dhriti and Smriti. Usually these symptoms acts as Nidanarthakara roga (primary disease acts as etiology of the 110 Indian Journal of Agriculture and Allied Sciences secondry one).Regarding samprapti of Manasa roga our classics hold that the disturbance of equilibrium of Manasa gunas leads to the origin of mental disorders along with disequilibrium of sharirik dosha. There are three qualities of mind viz. Sattva, Rajas and Tamas. When these three remain in equilibrium state leads to mental wellbeing and when this state disturbs i.e. they increases or decreases in their qualities leads to production of Mansik vikara. These are minor but when somatic doshas viz. vata, Pitta and Kapha are involved in the process of pathogenesis, the disease produced as a result of such interaction are considered as major one and at this level there is marked alteration of Dhi, Dhriti and Smriti. Nidana sevan→Vitiation of doshas which leads to Manas+ psychic personality+sharir dosha→Hridaya awasthan (seat of intellect)→manovaha srotodusti→production of Manasik vyadhi. Samprapti Ghataka for Manasik Vyadhis are as Follows A. Dosha  Manasik-Raja and Tama  Sharirik-Tridoshas predominantly vata. B. Dushya: Manas (emotions), Budhi (intellect), Sangya gyana (orientation and responsiveness), Smriti (memory), Bhakti (desire), Sheela (temperament), Chesta (Psychomotor activities), Achara (conducts). C. Adhisthana: Hridaya and Manovahi srotas. D. Srotas  Unmada-Manovaha srotas , Rasavaha srotas.  Apasmara-Samgyavaha srotas and Rasavaha srotas.  Atattvabhinivesha-Manovaha srotas and Budhivaha srotas. Classification of Manasa Roga: Discription of Manasa roga in our Ayurvedic classic are found in very scattered form . Caraka has mentioned Unmada, Apasmara and Atatvabhinivesha in two separate chapters of chikitsa sthana of Caraka samhita as major mental illness. Maharshi Susruta has described Amanushopsarga, apasmara and Unmada in separate chapters of Uttar tantra. Astana samgraha, Astanaga Hridaya, Bhela samhita and Madhava nidana also follow the same pattern. Following is a classification of Manasa roga as depicted in Ayurvedic manasa vigyana. The Disease Primarily Due to Involvement of Rajas and Tamas, Which are considered as True Manasa roga, Manasa vikara Kama (lust)  Krodha (anger)  Lobha (greed)  Moha (delusion)  Irshya (jealousy)  Mana (pride)  Mada (neurosis)  Shoka (grief)  Udvega (anxiety)  Bhaya (fear)  Harsha (euphoria) The Disease Produced Due to the Involvement of Raja, Tamas along with Vata, Pitta and Kapha. These are considered as Major Disoders of Mixed Nature.  Unmade (psychosis)  Apasmara (epilepsy)  Atattvabhinivesh (obsession)  Brama (vertigo)  Tandra (drowsiness)  Klama (neuroasthenia)  Mada (psychoneurosis)  Aptantraka (hysteria)  Murcha (fainting)  Sanyasa (coma)  Madatyaya (alcoholism)  Gadodvega (hypochonriasis)  Psychitric Illness Related wth Personality Disoders  Sattvahinta (inadequate personality)  Amedhta (mental deficiency)  Vikrita Sattva (psychopathic personality) Psychosomatic Illness (Adhi-Vyadhi): these are characterized by psychic and emotional element in the etiology with manifestation of clinical features predominantly at somatic level.  Bhayaja and Shokaj atisara (diarrhea due to fear and grief)  Kamaja and Shokaj jwara (nervous pyrexia)  Amavata (arthopathy)  Tamaka swasa (bronchial asthma) Management of Manasa Roga Pharmacological Management: Out of three therapeutic streams mentioned in Ayurveda (Daivyapashraya, Yuktivyapasraya and Sattvavajaya Chikitsa) only Yuktivyapashraya Concept of Psychosomatic Disorders in Ayurveda 111 chikitsa falls under pharmacological management.Yuktivyapasraya Chikitsa: There is prevalentrational method of treatment is designed to treatmental and physical disease. It deals with properadministration of medicines and prescriptionsuitable diet and other physiological methods. Itconsists of following:A. Antahparimarjana (Internal Purification) Samshodhana (purification) i.e. elimination ofvitiated dosha by Panchakarma therapy.  Samsman (Allevation): It includes differenttypes of drugs, diet and activities used toalleviate the vitiated doshas.B. Bahiparimarjana (External purification): Itincludes purvakarma of Panchkarma i.e. snehana(oleation) and swedana drugs(sudation) andmedicated oils are used for external applicationand heat application apart from this, medicatedcigar effusion, eye ointmens, nasal medicationhave been advised in various types of mentalillness.C. Shastra Pranidhana (Operative Procedures):Bloodlettig has been indicated in different types ofpsychosis. Susruta has mentioned operativecorrection in case of traumatic psychosis and otherorganic cause of mental disorders.Non-pharmacological ManagementDaivyapasraya Chikitsa: It included all thosecircumstances which are beyond the preview ofreasoning. This method creates the confidence andremoves the fear and pessimistic tendencies.Daivyapasraya chikitsa includes mantras,aushadhis, mani, mangala, bali, upahar, homa,niyama, prayaschitta, upvasa, pranipata,yatragamanam.Sattvavajaya Chikitsa: It aimed at control of mindi.e. one should keep himself established in hisoneself after knowing the real nature of the souland attainding the height of spiritual wisdom.Charaka defined it as a method of restraining orwithdraws of the mind from unwholesome arthas.A concise reports was published regardingsattvavajaya, an Ayurvedic psychotherapy by Prof.R.H. Singh and Murthy A.R.V (1987) in whichtherapy is well designed from classics, is as follow: (a) Assurence. (b) Replacement of emotions ( c)Regulation of thought process (d) Retraining ofIdeas (e) Channelisation of Presumption (f)Correlation of objectives and ideals (g) Properguidance and advice for taking decisions (h)Proper control of patience (i) Fear therapy andpsychoshok therapy.Nidanaparivarjana (Avoidence of CausativeFactors): This is very important foremost principleof treatment of any disease. (a) Sadvritta palan (b)Samyaka vegadharana and udirana (c) Wholsomecontact of Kala, Budhi and Indriyarth (d)Following the Ahara visheshayatana.Naishtiki Chikitsa: These terms refers to absoluteeradication of miseries attained by the aliminationof desire which is called as Upadha, which are rootcause of all miseries. Elimination of desires lead toeradication of all miseries.Practice of Yoga: ‘Yogo moksha pravartaka’ inother by practice of yoga one can attain the state ofMoksha (salvation). Process of increasing sattvaand decreasing raja and tama leading to Karmakshaya (loss of deeds) is the way of attaindingMoksha.Relaxation: Relation is the mean s of getting freefrom stress. Stress is supposed to be a majorcausative of mental illness. Various types ofrelaxation procedures have been devised. Clinicalstudy shows that it is an effective way tomanagement of Manasa roga.References1. Sharma, Ram Karan, Das, Vaidya, Bhagwan. (2009). Charaka Samhita of Agnivesha, Vol. I Sutra sthana; Dhirghanjeevitiya Adhyaya: Chapter 1, Verse 42 varanasi: Chaukhambha Krishnadas