Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs...

[Full title: Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs - A Review]

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[Find the meaning and references behind the names: Buddhi, Shri, Manas, Prasanna, Sheela, Mana, Divya]

REVIEW ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 279 Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs - A Review Dr. Divya Khare 1 , Dr. Prasanna Savanur 2 1 Assistant Professor, 2 Professor & Head, Dept. of Dravyaguna Vijnana, KAHER’s Shri B M Kankanwadi Ayurveda Mahavidyalaya, Shahapur, Belagavi, Karnataka, INDIA. I NTRODUCTION Unmada is a group of Psychological disorders described in Ayurveda under a single heading. The pathological changes involve vitiation of Tridoshas in a person having Alpasatva (can be interpreted as lessened will power), affecting Hridaya which is the seat of Buddhi . This inturn affects the Manovaha Srotas , ultimately presenting with the derangement of various components such as Mana (Psyche), Buddhi Address for correspondence: Dr. Divya Khare Assistant Professor, Dept. of Dravyaguna Vijnana, KAHER’s Shri B M Kankanwadi Ayurveda Mahavidyalaya, Shahapur, Belagavi, Karnataka, INDIA. E-mail: divyakhare 2008@gmail.com Submission Date: 05/07/2019 Accepted Date: 13/08/2019 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA (Intellect), Sanjna (Consciousness), Jnana (Knowledge component), Smriti (Memory), Bhakti (Likes and Dislikes), Sheela (Mood), Cheshta (Physical activity) and Achara (Habits) [1] The various components involved in Unmada can be broadly divided into three headings. 1 Mana (Psychological component) which includes Bhakti, Sheela and Achara . 2 Buddhi which includes Jnana and Smriti . 3 Cheshta and Sanjna depicting the physical component. Manas is said to be Chanchala . We come across two theories describing the nature of Manas in Ayurvedic literature namely “ Deerghashashkuli Bhakshana Nyaya ” and “ Shatapatra Suchibheda Nyaya ” [2] These theories say that even though it appears that our mind gets associated with multiple senses at a time, it actually happens that the mind gets associated with only one sensory faculty at a single point of time. But it shifts its association from one sensory faculty to A B S T R A C T Unmada depicts a range of different psychological conditions described under a single heading. The various components affected can be broadly classified under Mana (psyche), Buddhi (Intellect) and physical components. And depending on these different entities involved in the presentation of Unmada , the drugs are to be selected and treatment should be planned. With this idea, the classical texts and Nighantus were searched and the mode of action of drugs was analysed depending on their properties. Their possible role in different types of Unmada depending on Dosha predominance was assessed. The possible clinical application of these drugs in different Psychiatric conditions was supported with evidences from recent researches. It was found that among various drugs used in Unmada , some act by their nootropic property and the others by their high anti-oxidant activity. Some drugs help in repairing the damaged neurons. Some act directly on the neuro-humoral mechanisms (Glutaminergic, Dopaminergic). Some are found to have a potent anxiolytic effect. Some drugs have a depressant effect on CNS whereas others act as stimulants. Thus with this analysis, selection of drugs becomes easier in a given condition of Psychosis. Key words: Unmada, Nootropics, Anti-oxidant, Anxiolytic, Depressant, Stimulant.

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[Find the meaning and references behind the names: Man, Raja, Guna, Mano, Rajo, Tamas, Rasa]

Dr. Divya Khare et al. Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 280 another so instantaneously that we do not understand the time gap in-between. Manas is said to be controlled by Vayu ( Vayuh Tantra Yantra Dharah, Niyanta Praneta Cha Manasah ) [3] So whenever Manas is deranged, Vata is invariably involved. There is another term ‘ Chetah / Chitta ’ being described. Ayurveda considers this as a synonym of Manas [2] But some books of Philosophy consider Chitta as the component which is responsible for maintaining continuity of an action [4] while Manas is known for its flickering nature. There is a class of disorders called Obsessive Compulsive Psychosis where in the affected person keeps on doing a particular act repeatedly. The ‘ Chitta ’ component might be affected in such a condition. The Yogic science describes Chittavrittis [5] - Kshipta, Mudha and Vikshipta - predominated by Raja , Tama and Satva Guna respectively, indicating the possible role of Satva Guna in causing some pathology. And the Ashtanga Yoga [6] described in the classics aims at controlling the Chitta Vrittis . The second component Buddhi is described as ‘ Uhapohayoh Kaaranam - the component responsible for discrimination and analysis’ [7] On the other hand Sarva Darshana Sangraha describes Buddhi as fixed and something which can’t become the site of discriminative perception [8] If we see the Srushti Utpatti Krama (Theory of evolution) [9] explained in Ayurveda, Mahat / Buddhi Tattva is the first component which came into existence from Avyakta (the unmanifest). Then came the Ahankara which gave rise to Trigunas (3 qualities) of mind - Satva, Rajas and Tamas , each quality being responsible for specific traits or behaviors in man. Later came the Pancha Tanmatras and then the Panchamahabhutas which subsequently gave rise to the physical existence. In fact Buddhi is the metaphysical component which forms a link between the psyche and the physic. Buddhi Vibhrama leads to loss of “touch with reality” which is the important sign in Psychosis. The recent classification of Psychosis as per DSM-5 mentions five domains: hallucinations, delusions, disorganized thought (speech), disorganized or abnormal motor behavior (including catatonia), and negative symptoms for the diagnosis of the condition [10] Schizophrenia is one condition characterized by both positive and negative symptoms. During positive symptoms like hallucinations and delusions, Rajoguna appears to predominate. And during negative symptoms like emotional blunting and apathy, Tamoguna appears to predominate. Even in affective disorders like bipolar depression which is characterised by alternating phases of mania and depression, Rajo and Tamo Gunas appear to be alternating. Whereas if we consider Obsessive compulsive psychosis, S atvaguna appears to predominate, thus confirming the role of Satvaguna also as a cause for pathology. Basis for selection of treatment/ drugs in Unmada On the basis of different entities involved in the presentation of Unmada , the treatment modalities can be classified under the following headings: 1 For Mano Vibhrama - Adravya Chikitsa namely Jnana, Vijnana, Dhairya, Smruti, Samadhi as indicated by Acharya Charaka [11] This mainly includes counselling and meditation techniques. 2 For Buddhi Vibhrama - Medhya Dravyas 3 For Sanjna Vibhrama - Sanjna Sthapana Dravyas 4 Respective Dosha Shamaka Dravyas 5 Hridya - Amla Rasa Dravyas Acharya Charaka has described a class of drugs called Sanjna Sthapaka Dashemani (ten drugs having the action of bringing back the consciousness) [12] The author clearly mentions that these drugs subside the Doshas involved and act by virtue of their Prabhava . Sanjnasthapanani Sanjnam Jnanam Doshenanyathabhutam Yadaa Bhuvitumatankate Tadaa Aa Samyak Sanjnadushaka Doshamupahatya Prakrutau Sthapayanti Prabhavat . Hingu Kaidarya Arimeda Vacha Choraka Vayastha Golomi Jatila Palankasha Ashokarohinyeti Dashemani Sanjnaasthaapakaani Bhavanti.

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[Find the meaning and references behind the names: Gangadhar, Aya, Angelica, Mukul]

Dr. Divya Khare et al. Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 281 The identity of these drugs has been depicted in the table no. 1 [12-14] Table 1: Sanjna Sthapaka Dashemani Drug As per Acharya Chakrapani As per Acharya Gangadhar Hingu Hingu - Ferula foetida, Apiaceae - Kaitarya Parvatanimba - Murayya koenigi, Rutaceae Katphalam - (Myrica esculenta, Myricaceae Arimeda - Vitkhadira - Acacia farnesiana, Mimosoideae Vacha Vacha - Acorus calamus, Acoraceae - Choraka - Chorapushpi - Angelica glauca, Apiaceae Vayastha Brahmi - Bacopa monnieri, Scrophullariaceae Brahmi Shakam Golomi Bhutakeshaha - Elaeodendron glaucum, Celastraceae Bhutakeshi Jatila - Jatamamsi - Nardostachys jatamamsi, Valerianaceae Palankasha Guggulu Jatamamsi va – Commiphora mukul, Burceraceae OR Nardostachys jatamamsi, Valerianaceae Guggulu Gokshurako Va - Commiphora mukul, Burceraceae Or Tribulus terrestris, Zygophyllaceae Ashokarohini - Katukaa - Picrorrhiza kurroa, Scrophullariaceae The properties of these drugs have been depicted in the table no. 2 [13,14] Table 2: Properties of Sanjna Sthapaka Dashemani Drug Part used Rasa Vee rya Vipa ka Gun a Propert ies Hingu Oleogumresin Katu, Tikta Ush na Katu Tiksh na Vata- Kaphah ara, Krimigh na Kaitary a - Parvata nimba Root ---- ---- ---- ---- Vishaha ra, Krimigh na Kaitary a - Katphal am Bark Kash aya, Tikta, Katu Ush na Katu ---- Vata- Kaphah ara Arimed a Bark Kash aya Ush na Katu ---- Kaphah ara, Vishagh na Vacha Rhizo me Katu, Tikta Ush na Katu Tiksh na Apasma ra, Kaphon mada, Bhuta- Jantu- Anilaha ra Choraka Root Mad hura, Tikta, Katu Him a Katu Lagh u, Tiksh na Kaphavatahar a, Vishagh na Vayasth a - Brahmi Panch anga Tikta, Kash aya, Him a Mad hura Lagh u Tridosh ahara, Medhya

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[Find the meaning and references behind the names: Anjana, Main, Sha]

Dr. Divya Khare et al. Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 282 Mad hura Golomi - Bhutake shi Leaf ---- ---- ---- ---- ---- Jatila - Jatama msi Rhizo me Tikta, Kash aya Him a Mad hura ---- Tridosh ahara, Medhya Palanka sha - Guggul u Gumresin Tikta, Kash aya Ush na Katu Vish ada, Lagh u, Ruks ha, Suks hma Tridosh ahara, Krimigh na Palanka sha - Gokshur a Root Mad hura She eta Mad hura Lagh u Vatahar a Ashokar ohini - Katuka Root, Rhizo me Tikta Him a Katu Ruks ha, Lagh u Krimigh na The drugs for Sanjnasthapana are used in the form of Nasya, Anjana or Dhupana [15],[16] Most of the drugs mentioned in this group are having Tikta-Kashaya- Katu Rasa , Katu Vipaka , Ushna Veerya and Laghu- Ruksha Gunas . Some drugs are also having Tikshna and Sukshma Gunas . Sanjnanasha occurs due to blockage of S ukshma Srotas by Doshas [17] These drugs might help in removing the Srotorodha by their specific Doshaghna action. They might be exerting some irritant effect and thus help in bringing back the consciousness. A wide range of Medhya Dravyas have been described in our classical texts. Few drugs like Brahmi, Vacha, Shankhapushpi, Hingu, Lashuna, Jyotishmati are commonly used in clinical practice to treat different psychological conditions. While there are some drugs like Nirgundi, Bilwa, Eranda, Dhatura which are rarely used and their efficacy in this area is not yet explored. 1. Brahmi - is having Tikta Kashaya Madhura Rasa, Madhura Vipaka, Sheeta Veerya and Tridoshahara action. The mode of action can be explained as follows: ▪ In Unmada – when there is Dhatu Kshaya and Pitta Vriddhi w.r.t Tikshna, Ushna Guna, causing Mano Vikriti, Smritihani and Buddhi Vibhrama , Brahmi in the form of Swarasa or G hrita should be used. It does Pitta Shamana and Dhatu Poshana . Ksheena Manasasya Brimhanam Krutva Swakriyasu Yojayati . ▪ But in case of Kaphapradhana Dosha along with Agnimandya , Brahmi should not be the drug of choice. In such cases drugs like Nirgundi and Vacha should be chosen [18] ▪ Bacopa monnieri has been reported to repair damaged neurons by enhancing kinase activity, restoration of synaptic activity, ultimately enhancing nerve impulse transmission in brain. ▪ It is also found that it decreases stress induced biochemical marker (heat shock proteins and lipid oxides) in all regions of brain. ▪ The nootropic properties of brahmi have been reported to be possibly mediated by its constituents saponins, bacosides A & B through glutaminergic mechanism [19] ▪ Brahmi is found to act in Schizophrenia, possibly through dopaminergic mechanism. The main pathological changes taking place in Schizophrenia include increase in Dopamine level resulting in excess dopamine activity in mesolimbic system of Brain. There is also increase in 5- hydroxytryptamine, the enzyme which is having modulatory effect on dopamine. These changes lead to hallucinations and dramatic psychological effects. The antipsychotic potential of a drug is directly proportional to the dopamine (D 2) blocking and 5 HT 2 receptor blocking potential of

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[Find the meaning and references behind the names: Bala, Ram, Sara, Ayu, Madhu]

Dr. Divya Khare et al. Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 283 the drug [20] Bacopa monnieri might be acting in this way. ▪ Role of herbs in psychosomatic disorders by KVRSS Ramgopal, Insights of Ay 2013 (proceedings) states that the herbs like Brahmi, Shankhapushpi act by their nootropic property and the herbs like Lashuna, Vacha etc., act by their high anti-oxidant activity. 2. Shankhapushpi - has Kashaya Rasa, Madhura Vipaka, Ushnaveerya , Tridoshahara properties. It is mentioned as Medhya, Manasa Rogahrit, Rasayani and Smritikantibalaprada in the classics [13] In Unmada occurring due to Dhatu Kshaya and Vata Vridhi , Shankhapushpi can be used. Due to Madhura Vipaka , it does Brimhana of Dhatus , does Dhatu Vriddhi , Ojo Vriddhi and Bala Vriddhi . It also acts as Vatahara . Thus in Vatottara Manasaroga - Shankhapushpi is said to be the best whereas in Pittottara Manasaroga - Brahmi is best. Different studies on Evolvulus alsinoides have shown that ▪ It has a potent anxiolytic activity in albino rats proved by elevated plus maze test, wherein the time spent in open arms of the maze increased after the administration of Evolvulus alsinoides extract. The open field exploratory behaviour also improved [21] ▪ The neuromuscular coordination decreased, indicating muscle relaxant activity [21] ▪ It was tested in amnestic rats using radial arm maze test (RAM) to find the food hole and by Barne’s maze test to find target hole. In both the tests, the performance improved after the administration of drug extract. Thus the drug has a positive role in improving cognitive functions in Amnesia [22] ▪ It is having higher free radical scavenging activity and cholinesterase enzyme inhibitory activity [23] ▪ It dose dependently prevents STZ induced cognitive impairment by reducing oxidative stress [23] 3. Vacha - has Katu Tikta Rasa, Katu Vipaka, Ushna Veerya, Kapha Vatahara and Pittavardhaka properties. It is said to be the drug of choice in Kaphaja Unmada . It is also described as Ayu- Medha-Smritikari . Apasmara Kaphonmada Bhuta Jantu Anilan Haret [13] Vacha Ayurmedha Smritikari Raksho -Abhirakshini [18] ▪ Vacha , due to Ushna Veerya , acts as Kaphahara and increases Pitta . It probably potentiates Sadhaka Pitta and helps in Medha Vriddhi . It also does Vishodhana of Dhatuposhaka Sara Bhaga and thus helps in Ojo Vriddhi [18] ▪ Dementia - is a psychological condition caused due to decreased cholinergic activity in brain. Acorus calamus has been proved to be a cholinergic drug of plant origin ▪ It acts as a stimulant and nootropic [24] ▪ It has also shown a very high antioxidant activity ▪ Alpha and beta asarones isolated from the drug have been found to posssess sedative, CNS depressant, behaviour modifying, anticonvulsant and memory enhancing abilities [25] 4. Hingu has Katu Rasa, Katu Vipaka, Ushna Veerya and Kapha Vata Shamaka properties. It is the main ingredient in many formulations used in the treatment of Unmada . In Unmada associated with Sanjna Vibhrama, Hingu Churna with Madhu administered internally or as Anjana , removes the Avarana caused by Kapha Dosha on Sanjnavaha Srotas . It does Shodhana of Pranavaha and Sanjnavaha Srotas , resulting in Prana and Udana Vayu Anulomana , thus bringing about the effect of Sanjna Sthapana [18] ▪ Ferula foetida has been recently found to have neuro protective properties. ▪ It acts as a sedative and a stimulant [25] 5. Jatamansi - has Tikta Kashaya Madhura Rasa, Madhura Vipaka, Sheeta Veerya and Tridoshahara properties. It is said to nourish the Manas and increase Satva Guna .

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[Find the meaning and references behind the names: Ama, Good]

Dr. Divya Khare et al. Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 284 Chetah Prinayati . Satvagunasya Vardhanam Karoti. ▪ In Tridoshaja Unmada , Jatamansi Churna acts as Tridoshahara . It removes Sroto Avarana and does Sroto Shuddhi , thus resulting in Dhatu Poshana and Ojo Vriddhi . It also acts as Rakshoghna and Nidrakara [18] ▪ Valeriana wallichii - Causes sedation by increasing Brain’s GABA level. Increase in GABA level promotes a great night’s rest. It calms anxiety ▪ This mode of action is similar to that of Alprazolam and Diazepam. ▪ It can be used as a safe Psychotropic drug [25] 6. Jyotishmati - is having Katu Tikta Rasa, Katu Vipaka, Ushna Veerya and Vata Kaphahara properties. The mode of action is similar to that of Vacha . Due to Ushna Tikshna Guna – does Pitta Vriddhi , potentiates Sadhaka Pitta and results in Medha and S mriti Vriddhi [18] ▪ Celastrus paniculatus - Seed oil reversed scopolamine induced memory impairment (in navigational memory task) in young adult rats [25] ▪ An Ayurvedic proprietary product, MENTAT is proved to act in a similar way [24] 7. Kushmanda - unlike the above mentioned drugs, possesses Madhura Rasa and Vipaka, Naati Sheeta Veerya (Pakva Phala), Laghu, Dipana and specifically mentioned as Chetorogahrit (Unmadahara ) [13] ▪ Benincasa hispida - has been proved to possess Anxiolytic effects by Elevated plus maze test and light dark transition test in mice. ▪ It helps in the reduction of spontaneous motor activity (actophotometer) ▪ It also possesses Anti depressant activity ▪ It has been found to increases Antioxidants in different areas of Brain [26] 8. Sarpagandha - possesses Tikta Katu Rasa, Katu Vipaka, Ushna Veerya and Kapha Vatahara properties. Tikta Rasa does Ama Pachana and Dhatu Poshana , helps in Ojo Vriddhi . Also acts as Nidrakara by Prabhava [13] ▪ Rauwolfia serpentina is said to possess a potent Anxiolytic activity. ▪ It relieves stress, irritability, excitement and aggression. ▪ It is also having antihypertensive properties. ▪ Used in anxiety, schizophrenia and psychosis [25] 9. Nirgundi - mainly acts as Vata Kaphahara and Smritidaa . It helps to resolve Nidranasha . It also acts as Krimighna . It is good in Unmada due to Vataprakopa . [13] 10. Yashtimadhu - has Madhura Rasa, Sheeta Veerya and has been mentioned under Medhya Rasayana [27] 11. Kushta is having Katu Swadu Tikta Rasa, Ushna Veerya [13] It is an important ingredient of different formulations used in Unmada [15,16] ▪ Alzheimer’s disease is a condition characterised by abnormal aggregation of Amyloidal B peptides into insoluble fibrils called Amyloidal plaques. ▪ Glycirrhiza glabra and Saussurea lappa - prevent aggregation of peptides and help in the dissociation of formed plaques. (Aggregation status monitored by thioflavin T fluorescence assay) [28] 12. Katuki - has Tikta Rasa, Katu Vipaka, Sheeta Veerya and Kapha-Pitta Shamaka effects. Tikta Rasa - does Agni Dipana and Ama Pachana . Rasa Dhatu is formed properly, which inturn does Poshana of Hridaya and Ojo Vriddhi . ▪ Picrorhiza kurroa has shown antioxidant and immunomodulatory activities [29] 13. Amalaki is having Alavana Pancharasa, Madhura Vipaka, Sheeta Veerya and acts as Tridoshahara . It is a well known drug possessing Rasayana effect [13] ▪ Emblica officinalis is helpful in anxiety, agitation ▪ Bipolar depression

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[Find the meaning and references behind the names: Chandana, Heart]

Dr. Divya Khare et al. Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 285 ▪ Memory loss and insomnia [25] 14. Ashwagandha - has Tikta Kashaya Rasa, Ushna Veerya, Vatahara, Balya and Rasayana actions [13] ▪ Withania somnifera is useful in neurodegenerative disorders. ▪ It has cognition enhancing properties. ▪ It is very useful in anxiety, depression and Alzheimer's diseases [25] 15. Guduchi - possesses Katu Tikta Kashaya Rasa, Madhura Vipaka, Sheeta Veerya and Tridoshahara properties. It has been described as Rasayani and Medhya [13],[27] ▪ Tinospora cordifolia individually and in combination with Bacopa monnieri and Evolvulus alsinoides , showed improvement in cognitive functions [22] 16. Vatsanabha - Aconitum ferox - Contains alkaloids of fear and panic. It acts as sedative [25] 17. Bilva - Flavanoids present in Aegle marmelos are said to be responsible for anxiolytic effect through benzodiazipine receptors. It is a safe and effective drug [25] 18. Eranda - Ricinine, an alkaloid obtained from the extract of pericarp of castor bean ( Ricinus communis ) has shown memory enhancing properties [25] 19. Kupilu - Strychnos nuxvomica - Strychnine and Brucine alkaloids present in the drug help in depression and stress [25] 20. Dhatura metel - High scopolamine production increases heart rate and induces relaxation in muscles [25] 21. Chandana, Usheera - Due to Sheeta Veerya exert Jeevana effect, do Murcha Apanayana and Prana Dharana . They help to resolve Unmada, Madatyaya and Murcha [18] ▪ Santalum album has been found to possess nootropic effect. The sandalwood oil and alcoholic extracts have been proved to have sedative effect. The oil has a relaxing effect on the nerves and is used in agitated emotional states causing headaches, insomnia and nervous breakdown. The santalols have Central Nervous system depressant effects. Alpha santalol was shown to be a strong antagonist of dopamine D 2 and serotonine 5 HT 2 A receptor binding. The effect of alpha santalol was same as that of chlorpromazine as an antipsychotic agent [30] ▪ Vetiveria zizanoides oil has been proved to be having a potent antioxidant activity [31] 22. Snuhi - is mentioned to be having Katu Rasa, Katu Vipaka, Ushna Veerya, Tikshna, Guruguna, Kapha- Vatahara, Pitta Prakopaka and Unmadahara properties [13] Though S nuhi is not used for the treatment of psychological disorders in clinical practice, it has been found that the plants of euphorbiaceae have CNS depressant action [25] Amla Phala Rasa is an ingredient in some of the formulations like Lashunadi Ghrita [27] used in the treatment of Unmada. Amla Rasa is having the action of Indriya Tarpana, Mano Bodhana and is said to be Hridya . It also has potent Vatahara action. Viguna Vatam Swamargam Anayati. [18] Vitamin C is an anti-oxidant that protects against cellular damage due to inflammation or highly reactive oxygen free radicals. It inhibits peroxidation of Phospholipids [32] Vit C supplement in Schizophrenia - a study reported a decrease in the Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS) scores among patients on antipsychotic treatment after supplementation with Vitamin C, Vitamin E and Omega 3 fatty acids [33] But since the supplement was given in combination, it is difficult to conclude whether the effect is due to Vitamin C alone. Another important thing is to decide whether vitamin supplementation is necessary in all cases of Psychosis. Seeing the prominent Vatahara action of Amla Rasa , we can opt Vitamin C supplementation in Vata predominant conditions of Unmada . 23. Purana Ghrita is mentioned as Tridoshahara, Grahanashaka . The one which is 10 years old has

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[Find the meaning and references behind the names: Long, Swami, Prakashan, Kala]

Dr. Divya Khare et al. Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 286 Katu Tikta Rasa, Ugra Gandha and the one which is 100 yrs old is similar to Laksha Rasa in appearance, Sheeta, Sarvagrahapaha and Medhya . Both the types are good in Unmada and Apasmara [27] ▪ Ghee is rich in antioxidants. ▪ It doesn’t go rancid for a long time ▪ It is rich in CLA - Conjugated linoleic acid which causes lymphocyte proliferation and increases macrophage phagocytosis. These (immunomodulatory) effects of CLA on cellular immunity were reported to persist for some time beyond the period of dietary supplementation [34] 24. Panchagavya - the Ghrita prepared from Gomutra, Gomaya, Godadhi, Goghrita and Godugdha is very commonly used in clinical practice for a wide range of psychological disorders. The combination is having Tridoshahara effect and hence can be used in a wide range of psychiatric conditions. The properties of the ingredients as per the classics is as follows: ▪ Gomutra - Medhya ▪ Godugdha - Jara and Samasta Rogahara ▪ Godadhi - Amla, Hridya ▪ Goghrita - Medha, Ojo Vardhaka [13] ▪ Panchagavya Ghrita has been proved to be having Immuno modulatory effect. It is found to enhance both cellular and humoral immune responses by upregulating the lymphocyte proliferation activity, secretion of cytokines and macrophage activity and reducing apoptosis in lymphocytes. They act as antiaging agents by preventing the free radical formation and efficiently repairing the damaged DNA [35] CONCLUSION Thus the treatment in Unmada should include specific Doshahara Chikitsa and use of Medhya Dravyas along with Adravya Chikitsa in order to effect maximum cure. Not only the Shareerika Doshas like Vata-Pitta- Kapha but also the Manasika Gunas like Satva-Raja and Tama need to be assessed and the treatment should be planned. Among the wide range of Medhya Dravyas mentioned in the classics, depending on the Dosha predominance in a given patient, the most suitable drug can be selected. The Medhya Dravyas can be combined with other Doshghna Dravyas eg., combining with Amla Phala Rasa for the treatment of Vataja Unmada and using Pittahara Dravyas like Chandana, Usheera in case of Pitta predominant conditions. In all the cases, emotional support and counselling is most important to help the patient come out of the clutches of the disease. Balancing the Trigunas by following the rules told under Achara Rasayana and controlling the Tridoshas by appropriate Ahara-Vihara shall help the patient lead a normal life. REFERENCES 1 Agnivesha, Charaka Samhita, Elaborated by Charaka and Dridhabala, with Ayurveda Dipika commentary by Chakrapanidatta, Edited by Vaidya Yadavji Trikamji Acharya, Nidana Sthana, Chapter 7, Unmada Nidana. Chaukhambha Surabharati Prakashan, 2009, 222-223. 2 Agnivesha, Charaka Samhita, Elaborated by Charaka and Dridhabala, with Ayurveda Dipika commentary by Chakrapanidatta, Edited by Vaidya Yadavji Trikamji Acharya, Sutra Sthana, Chapter 8, Indriyopakramaniya Adhyaya. Chaukhambha Surabharati Prakashan, 2009, 55-56. 3 Agnivesha, Charaka Samhita, Elaborated by Charaka and Dridhabala, with Ayurveda Dipika commentary by Chakrapanidatta, Edited by Vaidya Yadavji Trikamji Acharya, Sutra Sthana, Chapter 5, Vatakalakaliya Adhyaya. Chaukhambha Surabharati Prakashan, 2009, 79. 4 Dr.G.R.Paranjape, Sanjeevan Chikitsa, Swastik printing press, Belagavi, 1998,218-223. 5 Sayana Madhava, Sarva Darshana Sangraha, with commentary by Vasudev Shastri Abhyankar, translated by E.B.Cowell and A.E.Gough, Bharatiya Kala Prakashan, Delhi. 2008;559-562. 6 Hatha Yoga Pradipika, Commentary by Swami Muktibodhananda, guidance of Swami Satyananda Saraswati, Yoga Publications Trust, Munger, Bihar. 1998.

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[Find the meaning and references behind the names: Ali, Alok, Esmail, Raj, Anand, Gupta, Jagdeep, Vinod, Joshi, Akshay, Rajiv, Veena, Avinash, Rao, April, Prasad, Neeraj]

Dr. Divya Khare et al. Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 287 7 Agnivesha, Charaka Samhita, Elaborated by Charaka and Dridhabala, with Ayurveda Dipika commentary by Chakrapanidatta, Edited by Vaidya Yadavji Trikamji Acharya, Shareera Sthana, Chapter 1, Kathidapurushiya Shareera, verse 72, Chakrapani commentary. Chaukhambha Surabharati Prakashan, 2009, 294. 8 Sayana Madhava, Sarva Darshana Sangraha, with commentary by Vasudev Shastri Abhyankar, translated by E.B.Cowell and A.E.Gough, Bharatiya Kala Prakashan, Delhi. 2008;559-562. 9 Agnivesha, Charaka Samhita, Elaborated by Charaka and Dridhabala, with Ayurveda Dipika commentary by Chakrapanidatta, Edited by Vaidya Yadavji Trikamji Acharya, Shareera Sthana, Chapter 1, Kathidapurushiya Shareera, verse 66. Chaukhambha Surabharati Prakashan, 2009, 293. 10 Heckers, S., et al., Structure of the psychotic disorders classification in DSM 5, Schizophr. Res. (2013), http://dx.doi.org/ 10.1016/j.schres.2013.04.039 11 Agnivesha, Charaka Samhita, Elaborated by Charaka and Dridhabala, with Ayurveda Dipika commentary by Chakrapanidatta, Edited by Vaidya Yadavji Trikamji Acharya, Sutra Sthana, Chapter 1, Deerghamjeevitiya Adhyaya. Chaukhambha Surabharati Prakashan, 2009, 16. 12 Agnivesha, Charaka Samhita, Elaborated by Charaka and Dridhabala, with Ayurveda Dipika commentary by Chakrapanidatta, Edited by Vaidya Yadavji Trikamji Acharya, Sutra Sthana, Chapter 4, Shadvirechanashatashritiya Adhyaya. Chaukhambha Surabharati Prakashan, 2009, 34. 13 Bhavamishra, Bhavaprakasha Nighantu, Commentary by Prof.K.C.Chunekar, Edited by Dr G.S.Pandey. Chaukhambha Bharati Academy, Varanasi, 2010. 14 Bapalal G Vaidya, Nighantu Adarsha, Part 1 and 2, Chaukhambha Bharati Academy, Varanasi, 2007. 15 Acharya Sharangadhara, Sharangadhara Samhita, with Dipika and Sarvangasundari commentaries, Pandit Parashuram Shastri Vidyasagar (Editor), Uttara Kh, 9/21. Chaukhambha Orientalia, Varanasi; 2005:351. 16 Chakrapanidatta, Chakradatta (Chikitsa Sangraha), Dr G Prabhakara Rao (Translator), chapter 20 Unmada Chikitsa. Chaukhamba Orientalia, Varanasi; 2014:195- 196. 17 Agnivesha, Charaka Samhita, Elaborated by Charaka and Dridhabala, with Ayurveda Dipika commentary by Chakrapanidatta, Edited by Vaidya Yadavji Trikamji Acharya, Sutra Sthana, Chapter 824, Vidhishonitiya Adhyaya. Chaukhambha Surabharati Prakashan, 2009; 125. 18 Vd.G.A.Phadke, Dravyaguna Shaastram, Edited by Vd.N.H.Joshi, Part 1, Shuddhayurveda Pathyakramasamiti, Mumbai. 19 Deepali Mathur, Kritika Goyal, Veena Koul, Akshay Anand, The Molecular Links of Re-Emerging Therapy: A Review of Evidence of Brahmi ( Bacopa monniera ). 2016; 7: 44. 20 KD Tripathi, Essentials of medical Pharmacology, Jaypee Brothers Medical Publishers (P) Ltd, New Delhi. 1999;28/406. 21 Neeraj K Sethiya, Alok Nahata, Vinod K Dixit. Anxiolytic activity of Canscora decussata in albino rats. Journal of Complementary and Integrative Medicine June 2010;7(1):19. 22 Gupta A, Raj H, Karchuli MS, Upmanyu N. Comparative evaluation of ethanolic extracts of Bacopa monnieri, Evolvulus alsinoides, Tinospora cordifolia and their combinations on cognitive functions in rats. Current Aging Science 2013 Dec;6(3):239-43. 23 Mehla J, Pahuja M, Dethe SM, Agarwal A, Gupta YK. Amelioration of intracerebroventricular streptozotocin induced cognitive impairement by Evolvulus alsinoides in rats: invitro and invivo evidence. Neurochemistry International 2012 Dec; 61(7):1052-64. 24 Jagdeep S. Dua, D.N.Prasad, Avinash C. Tripathi, Rajiv Gupta. Role of traditional medicine in Neuropsychopharmacology, Asian journal of pharmaceutical and clinical research. April-June 2009. 2(2):72-76. 25 Susmita Sahoo. A review of some medicinal plants used for Nervous disorders, Journal of medicinal plant studies 2018; 6(1):220-224. 26 Ali Esmail, Al-Snafi, Therapeutic properties of medicinal plants: a review of medicinal plants with central nervous effects (part 1), International Journal of Pharmacology and toxicology, 2015, 5(3), 177-192. 27 Agnivesha, Charaka Samhita, Elaborated by Charaka and Dridhabala, with Ayurveda Dipika commentary by Chakrapanidatta, Edited by Vaidya Yadavji Trikamji

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[Find the meaning and references behind the names: Dharma, Rajesh, Singh, Subramanian, Joshua, Chung, Wang, Maya, Kumar, Rakesh, Brown, Jun, Hannah, Chauhan, Mathew, Kim, Nil, Med, Chen, Anjum]

Dr. Divya Khare et al. Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs ISSN: 2456-3110 REVIEW ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 288 Acharya, Chikitsa sthana, Chaukhambha Surabharati Prakashan, 2009, 385, 472, 473. 28 Maya Mathew, Sarada Subramanian, Evaluation of anti-amyloidogenic potential of nootropic herbal extracts in vitro, International Journal of Pharmaceutical Sciences and Research, 2012; 3(11), 4276. 29 K Kant, M Walia, V K Agnihotri, Vijaylata Pathania and B Singh. Evaluation of Antioxidant activity of Picrorhiza kurroa(leaves) extract, Indian Journal of Pharmaceutical Sciences, 2013 May-Jun; 75(3):324- 329. 30 Rakesh Kumar, Nishat Anjum, Y C Tripathi, phytochemistry and Pharmacology of Santalum Album L.: A review.World Journal of Pharmaceutical Research, 2015; 4(10):1842-1876. 31 Kim HJ, Chen F, Wang X, Chung HY, Jin Z. Evaluation of Anti-oxidant activity of Vetiver ( Vetiveria zizanoides oil) and identification of its antioxidant constituents, J agric Food chem.2005 Oct 5;53(20):7691-5. 32 Hannah E brown, Joshua L Roffman. Vitamin supplementation in the treatment of Schizophrenia.CNS Drugs. 2014 Jul;28(7):611-622. 33 Arvindakshnan M, Ghate M, Ranjekar PK, Evans DR, mahadik SP. Supplementation with a combination of omga-3 fatty acids and antioxidants (vitamin E and C) improves the outcome of Schizophrenia. Schizophrenia research. 2003;62(3):195-204. 34 Kathirvelan Chinnadurai, Amrish Tyagi, Conjugated Linoleic Acid: A Milk Fatty Acid with Unique Health Benefit Properties, Available at: https://www.researchgate.net/publication/221916372 _Conjugated_Linoleic_Acid_A_Milk_Fatty_Acid_with_ Unique_Health_Benefit_Properties 35 Dharma K, Rathore Rajesh, Chauhan R S, Tomar Simmi.Panchagavya (Cowpathy): An overview International Journal of Cow Science , 1(1): 1- 15. ******************************* How to cite this article: Dr. Divya Khare, Dr. Prasanna Savanur. Understanding of Unmada in Ayurveda and Rational Application of Herbal Drugs - A Review. J Ayurveda Integr Med Sci 2019;4:279-288. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2019 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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