Unmāda (insanity) according to Caraka

The symptoms of insanity are -the vitiated doṣa move to the mind or Mastiṣka, vitiate it and produces insanity (Unmāda). In this ailment, the intellect, mind and memory get perverted. This is called insanity.

The general symptoms of Unmāda are as follows: delirium, vacant mindedness, intellectual confusion, the fickleness of mind, restless eyes, and impatience. The premonitory symptoms of Unmāda are as follows: emptiness of the head, anxiety of the eyes, noise of the ears, excess of exhalation, discharge from the mouth, anorexia, loss of appetite, indigestion, pain in the heart, meditation, diligence, hypnosis and anxiety, persistent heartburn, fever, fickle mindedness, pain in the upper part of the body, manifestation of symptoms of facial paralysis resulting in movement in one half of the face, frequent appearances 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 forceful whirls-pools, and retraction of eyes.

The causes of insanity are—unhealthy, unhygienic, unclean food habits; curse of devas, gurus and Brāhmaṇas; all the futile attempts of the mind to control fear and humour, etc. For all these reasons, the faults of the less fortunate person become polluted; the abode of the intellect contaminates the heart, and seduces the human heart by occupying the mind.

Causes of Unmāda roga are of two types—innate and exogenous. Unmāda roga according to dosas are of five types—

1. Vāta,
2. Pitta,
3. Kapha,
4. Sannipātaja and
5. Āgantuja (exogenous).

The causes of Vātaja Unmāda are—rough, scanty, cold food, hyperactivity, loss of dhatu and fasting etc. The following symptoms seen in this insanity are as follows, namely, laughter, smile, dance, song, meaningless babbles, gestures, crying, constipation, emaciation, reddish coloration of the skin, and increase in the force of the disease after eating. In modern medicine Vātaja Unmāda is called mania. It is of different types. E.g., A cute mania, A kinetic mania, A’potu mania, Acute delirious mania, Chronic mania, Epileptic mania, Delirious mania, Hysterical mania, Periodical mania, Puerperal mania, persecution mania, transitory mania, Unproductive mania.

The cause of bile insanity is indigestible food, bitter, acid, vidāhi, hot food. Symptoms of this disease are immortality, contagion, nudity, suffocation, flight, warmth, anger, shadow, desire for cold food and water, yellow complexion, etc.

The causes of coughing insanity are overeating and laziness. The following signs and symptoms can be seen the Kaphaja Unmāda, namely, inertia of words and endeavours, distaste, femininity and solitary love, insomnia, vomiting, salivation, increase in disease immediately after taking food and there is dryness of nails, urine, testicles etc.

Sannipātaja insanity is very terrible. When the symptoms of tridoṣa are combined, it is called Sannipātaja insanity.

The reasons for the Āgantu Unmāda are -gods, sages, Gandharvas, vampires, yakṣas, demons, insulting the ancestors, lying to the rules and deeds and pre-born deeds. The insanity which is identified by supernatural words are, valour, semen, effort, knowledge, intellectual excellence as well as strength, and the insanity, which is not fixed is called Bhūtonmāda or exogenous. There are eight types of Bhūtonmāda.

The demonic shots mentioned in the Suśruta Saṃhitā are–Devatā, Daitya, Gandharva, Yakṣa, Rākṣasa, Piśāca. The demons mentioned in the Aṣṭāṅga Hṛdaya of Vāgbhaṭṭa are -Dev, Asura, Gandharva, Uraga, Yakṣa, Brahmarākṣas, Rākṣas, Piśāca, Preta, Ukiraṇa, Kuṣmāṇḍaka, Kālādi, Vetāla, Pitṛ, Ṛṣi, Guru, Vṛddha or Siddha.

Table 4: Describes of various types of Unmādaroga^[1]

Sl. No.	Name	Causes	Symptoms
1	Deva-unmāda	Due to Gods	Devonmatta-puruṣa-saumyadṛṣṭi, reserved, insomnia, lack of appetite, less urination, etc.
2	Śāpa-unmāda	Due to curse	Imitation of the postures of Guru etc.
3	Pitṛgṛha-unmāda	Due to forefathers	Foul way of seeing, sleepiness, lack of appetite etc.
4	Gandharva-unmāda	Due to Gandharva	Furious temper, courageous, composed, hunger for food, desire to bath, dance and sing, etc.
5	Yakṣa-unmāda	Due to Yakṣa	Dance, singing, music, storytelling, hunger for food, bathing, sleepiness and crying and laughter, cursing of Brahmanas and Vaidyas, and disclosing of confidential matters, etc.
6	Rākṣa-unmāda	Due to devils	Insomnia, lack of appetite, very powerful, etc.
7	Brahmarāksa-unmāda	Due to Brahmarākṣasa	Always indulging in dancing and singing, cursing of Devas, Brahmanas and Vaidyas, chanting of mantras with disrespect, etc.
8	Piśāca-unmāda	Due to ghosts	The patient’s mind becomes restless and ill, indulges in dancing, singing, laughter, irrelevant talking, harsh voice, nudity, etc.

(Source: Caraka-Samhita–Vol. II)

The insane can be treated with mantras, medicine, money, blessings, sacrifices, gifts, home, rules, atonement, fasting, self-realization, humble behaviour, etc. The insanity is incurable when the patient raises his hand in a fit of anger, daringly thrashes others or himself. Again, the insanity should not be treated when the patient with tears in the eyes, passes blood from the pudendum, running nostrils, excised skin, wounds on the tongue, uninterrupted speech, discoloration of the body, weakness and mind will abandon him if he is violent etc.

Ācārya Caraka has described the treatment of both, nija-unmāda and āgantu-unmāda. The general treatment of insanity has been said to be the following-the patient suffering from insanity should be administered five purificatory therapies: in Vātika type insanity he should be given internal oleation. In Pittaja and Kaphaja type insanity he should be given internal oleation, sudation, emesis and purgation, unctuous and non-unctuous enema, śirovirecana therapy. In abnormal behaviour even after evacuation, irritant snuffing, collyrium, and threatening should be done. In exogenous insanity he should be given ghee, chanting of hymns etc.

The Nija and Āgantu types of insanity diseases are cured by applying the following combination of drugs after examining the person's jealousy, age, self-esteem and speech. These are as follows—Mahākalyāṇaka-ghṛta i.e., Viśālā, Triphalā, Kauntī, Devadāru, Elavālukā, Sthirā, Nata, Rajanī, Dāruharidrā, Śāriva, Priyaṅgu, Nīlotpala, Elā, Mañjiṣṭhā, Dantī, Dāḍima, Keśara, Tālīśapatra, Bṛhatī, fresh Mālatī flower, Viḍaṅga, Pṛśniparṇī, Kuṣṭha, Candana and Padmaka which should be made to a paste.

The paste of these twenty-one drugs will be prepared with ghee by boiling together twotola and four-sera of the old ghee and sixteen-sera of the water. To this decoction, ghee, four times of gṛṣṭikṣīra and the paste of Vīra, green māṣa, ṛddhi and meda should be added and cooked. Its name is Mahākalyāṇaka-ghṛta.

Mahāpaiśācika-ghṛta i.e., ghee cooked with the paste of Jaṭāmāṃsī, Harītakī, Keśī, Cāraṭī, Markaṭī, Vacā, Trāyamāṇā, Jayā, Vīrā, Coraka, Kaṭurohinī, Vayaḥṣṭhā, Śūkarī, Madhurikā, Śatapuṣpā, Guggulu, Śatāvarī, Kāyaṣṭhā, both the types of rāsnā, Kaṭambharā, Vṛścikapatrī and Sthirā. It is called Mahāpaiśācika-ghṛta. It is as useful as nectar.

Laśunādya-ghṛta -Garlic one hundred, boneless greens thirty, one pala of Tryūṣaṇa, one prastha of the ash of bovine leather, and two ādhakas of each of cow’s milk and cow’s urine should be cooked with two prasthas of cow’s ghee. After it is well cooked and cooled, one pala of the powder of Hiṅgu and two Māṇikās of honey should be added. Use of this Laśunādya-ghṛta is administered internally and for massage as well as inhalation therapy which cures endogenous as well as exogenous types of Unmāda.

Old ghee (purāṇa ghṛta) is best in insanity and seizures. Ghee kept for ten years is called purana-ghṛta. Ghee kept for 100 years is the best ghee in insanity disease.

Table 5: Treated of Unmādaroga^[2]

Emotions which are the cause for Unmāda	Emotions which have to be used for treatment
Passion	Anger
Anger	Passion
Grief	Exhilaration
Envy	Greed
Fear-grief	Passion-anger/envy-greed.

(Source: Synopsis on Caraka Saṃhitā)

Irritant collyrium, beating etc., should be avoided in insanity by Gods, sage, forefathers or gāndharva; instead, patient is advised-intake of ghee, mild medicaments; worship, offerings, oblations to God Rudra etc.

One who abstains from eating meat and drinking alcohol, and takes only wholesome food, who is disciplined and pure, and who has strong will power doesn’t get afflicted by either endogenous or exogenous type of Unmāda.

Footnotes and references:

[1]:

Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, pp. 452- 453.

[2]:

Rajneesh V. Giri & Smitha Rajneesh, Synopsis on Caraka Saṃhitā, Varanasi, Chaukhambha Orientalia, 2019, p. 137.