Ayurvedic treatment modalities for depresssion and mental disorders


Ayurveda defines health (Swasthya) as “Samadosha samagni samdhatu malakriya......prasannatmendriya manaha swasthaittyabhidiyate”  which roughly translates to  “balanced doshas, or harmony in mind, body and spirit”. Ayurveda focuses on the promotion of health, and prevention and cure of diseases through the concepts of positive physical and mental health. Definition of ‘Ayu’ clarifies promptly that ‘life is the combined state of body, senses, mind and soul.’

The World Health Organization defines depression as a common mental disorder, with clinical features as depressed mood, loss of interest or pleasure, feeling of guilt or low self-worth, disturbed sleep or appetite, low energy and power of concentration. According to WHO, depression is expected to account for more lost years of healthy life than other disease by 2030 (except for HIV/AIDS). 

According to Acharya Charaka, ‘the entity which is responsible for thinking is manas’ (the mind) which is connected to both jnanendriya (sensory centers) and karmendriya (motor centers), hence called as Ubhayatmaka (combined psychomotor entity).

  Manas (the mind) has following actions:

Indriyabhigraha (sensory and motor perceptions and control)

Svasyanigraha (self-control)

Uha (speculation)

Vicarya (thinking) 

Manas has two basic qualities: anutva (atomic nature) and ekatva (unitary nature).

Manas influences the prakriti (constitution) even at the embryonic stage; Ayurveda states that ‘the feutus grows steadily with the help of the reproductive element and the panchmahabhutas (five basic elements) namely, Prithvi (earth), Aap (water), Teja (fire), Vayu (air), and Akash (space) .

Learn more for Ayurvedic Treatment for Depression.

CLASSIFICATION OF MANASVIKARA (mental disorders):

Three Doshas: Vata, Pitta and Kapha are the three functions which regulate all of the physiological, emotional and spiritual aspects of a person's life. They all have five subdivisions, delicately intertwined. Ayurveda describes in excellent detail about how they work and how to keep them in balance as well as how to bring them into balance when they're out of balance.

a) Digestive fire: This is named Agni. Agni can be equated to the word metabolism. Including the digestion, absorption, assimilation. Conversion of the assimilated food to different Dhatus, such as Plasma, blood, bone, muscle, fat, seminal fluid in males and Artava in girls  and ultimately Ojas or the critical force of the body. In medical term this really is the last responsible tissue to the secretion of Serotonin and Dopamine.

b) Excretory functions: Ayurveda puts great emphasis for the excretory functions to be in excellent order to be in excellent health. This would prevent ailments. Keeps one in good health, soul and provides long life. Ayurveda elaborately explains how one ought to keep one's lifestyle.

c) Pleasantly disposed contented spirit, mind and perceptions: Ayurveda's definition of health is all encompassing. Social wellbeing may only be possible when all these standards are met.


Ayurveda has the following classifications of Manasvikara and provides mapping guidelines of the cause and resultant disease.

1. Nija : Diseases caused by external trauma, due to involvement of vitiated Doshas.

Due to the Dushti / vitiation of Raja and Tama.

Due to the Dushti / vitiation of the Raja, Tama and the Sharir Dosha i.e. vata/pitta/kapha.

Manodehik roga: Which originate on mental level but they mostly show their symptoms on the physical level.

Akshma vyaktitya janya manas roga/ Personality disorder 

2. Aagantuja: As pathogenesis of Nija Vyadhi progresses then they mimic as Agantuja Vyadhi.

Bhutabadhajanya (Bhutonmada)

Grahabadhajanya (Grahonmada)


Manasa Vikara (Mental disorders) is mentioned in Ayuveda classics


Nanatmaja manasa vikara

(due to vitiation of manas quality viz raja and tamas)

 

 

1.Asabda sravana (auditory hallucinations)

2.  Tama (withdrawal)

3.  Ati-pralepa (prating)

4. Aswapna (insomnia)

5. Tandra (stupor)

6. Atinidra (excessive sleep)

7. Bhrama (confusion)

 

Ubhayatmaka manasa vikara

(due to vitiation of raja, tama and shareer dosha)

 

 

1.Unmade (psychosis)

 2. Apasmara (epilepsy)

 3. Apatanaka, apatantraka (hysteria)

 4. Atatwabhinivesa (obsessive syndrome)

 5. Madatyaya (alcoholic psychosis)

 6. Sanyasa (coma)

 

 

Mano-dehik roga

(disorder having mental level origin but manifest symptoms on physical level also)

 

1.Krodhaja jwara (fever caused by anger)

2. Bhayaja atisara(diarohoea caused by fear)

3.  Shokaja atisara (diarohoea caused by grief)

4. Amavata (rheumatoid arthritis)

5. Tamak shwas (bronchial asthma)

 

Manasa vikara due to vitiation of rajas & tamas (Neurosis)                                    

 

1.Abhyashuya (jealousy)

2.  Bhaya (fear)

3.  Chittodvega (anxiety)

4.  Dainya (meanness of the inferiority complex)

5.  Harsha (hyper-excitement)

6.  Kama(desire)

7.  Krodha  (anger)

8.  Lobha (greed)

9.  Mada (arrogance)

10.  Maana (pride)

11.  Moha (confusion)

12.  Shoka (grief)

 13. Visada (anguish)

14. Irshya (envy).

 

Akshama Vyaktitva Janya Manas Roga (Personality disorders)

 

1. Swa hinata (inadequate personality)

2. Amedhata (mental deficiency)

3. Vikrut Satva (psychopathic personality)



AETIOLOGY (Manner of causation of mental disorders):


According to Ayurveda, the following factors contribute to the causation of depression and mental disorders:

Emotional disturbances, unwholesome diet & lifestyle.

Pragyaparadha is the most important cause for the manifestation of Manas vyadhi (mental disorder). 

Vibhramsha(di of Dhi (learning), Dhriti (retention), Smriti (long term memory).

  Atiyoga, Ayoga and Mitya yoga of Kala.

Chitta vruttis (thoughts that clutter the mind ) like Mada (mental instability), Kshipta, Vikshipta (abnormal projection), Ekagra (concentration) all these because of tama guna bahulya(vitiation of tama guna) leads to Manasaroga.

Shiromarma-bhighata (trauma to energy ponts / marma points present over urdhvajatrugata - head and neck region) may lead to different Manasavyadhi.


SYMPTOMS:

For Ubhayatmaka vikara (due to vitiation of raja, tama and shareer dosha) like unmada (psychosis), apasmara (epilepsy), mada (alcoholic psychosis), sanyasa (coma) etc. 

But for Nanatmaja manas vikara, no descriptive details are available regarding their symptoms. Their names only specify the mental level condition promptly as anger, grief etc.


MANAH PARIKSA (Mental examination)

According to Ayurveda, the mental aspects of the examination are done by inspecting and evaluating the following factors:

Shela (habit, temperament, etc.)

Chesta (psychomotor activity and achara conduct)

Anumana (inference) 

Vijnana (understanding) 

Vyavasaya (purposeful nature of action)

Dhairya (courage) 


PATHOGENESIS: (manner of development of a disease)

From an Ayurvedic perspective, the following three factors are responsible for the all physical and mental diseases:

1. Pragyaparadha : Dhi-vibramsha ( learning disturbance), Dhritivibhramsha (conscious mind indulges in performing harmful things knowingly) and Smriti-vibramsha (memory disturbance) are the main causative factors of the mental disorders, which lead to disease producing karmas (actions/sins of past)

2. Parinama :  Result of all improper deeds (Kukarma) will mature in time and when matures, the person will be afflicted with particular disorder is termed as parinama.

3. Asatmendriyartha sanyoga : Unwholesome contacts with senses in the form of Atiyoga (excessive utilization), Ayoga (non-utilization) and Mithyayoga (wrong utilization) of sense faculties.Due to nidana sevena / adopting all causative factors - vitiates vatadi shareerika dosha and Raja - tama . Manasa dosha take ashraya (reside) in Hrudaya  heart region) and Mastishka (brain part )- and vitiates Manovahasrotas (channels conveying manas/conveyers of manas) - thus produce Manovyadhi (mental disorder).Generally, for all types of mental disorders, alpasatwa (weak mind), manovahasrota (channels conveying manas/conveyers of manas), manasadosha ( Rajas and Tamas) and tridosha ( Vata, Pitta and Kapha) are said to be responsible.  Some memorable quotes drive home the basic point.  “The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.” In the words of Plato, “mind the science gap” beyond the “pill therapy” prompt us to rethink on the foundations of how positive mental health and interdisciplinary approaches are required in health sector. Ayurvedic medicine highlights the importance of self-care in order to prevent diseases from manifesting. The etiology or causation of many illnesses according to Ayurveda, originate from the improper functioning of the digestive system which alludes to a therapeutic understanding that differs significantly from conventional Western medicine.


Early Diagnosis of Depression

This process is comprised of six key steps i.e. SHAT KRIYA KAAL, for early diagnosis, prognosis and for adopting timely preventive and curative measures.1. Sanchaya  (Natural accumulation of Doshas) – The doshas in these stages increase quantitatively,  their quality remaining normal.2. Prakopa (More aggravation) – stage of excitation of doshas in which the accumulated doshas start getting Prakopa (More accumulation)  3. Prasara (Overflow level) – The imbalanced dosha spreads throughout the body, involving one, two, or all the three doshas together with rakta. 4. Sthanasamsraya (Stage of disease augmentation) – The dosha begins to move into organs and bodily tissues which are susceptible to disturbance and precipipitates dosha-dusyasammurchana (interaction of vitiated doshas with dosyas or local tissues). This is the stage of start of real disease and is associated with appearances of prodromal or early symptoms i.e.purva rupa. 5. Vyakti (Stage of symptom manifestation) – characterizes by full manifestations of signs and symptoms of the dully developed spacific disease. It is acute stage of disease.6. Bheda (Stage of complications) – If the disease is not properly treated at the stage of vyakti, it may become sub-acute, chronic or incurable on account of extensive damage sustained or irreversible structural change having taken place due to neglect of early diagnosis and prompt treatment.


TREATMENT FOR DEPRESSION & MENTAL DISORDERS

 “Trividha aushadhamiti Daivyavyapashraya yuktivuapashraya satvavajyascha”

Ayurveda recommends three types of chikitsa (treatments)  listed below:

DAIVAVYAPASRAYA CHIKITSA  / SPIRITUAL THERAPY : This refers to measures like mantra (incantation), Ausadhi (wearing scared herbs), mani (wearing precious gems), mangala (propitiatory rites), homa (sacrifice), upahara (offerings), niyama (vows), praschitta (ceremonial   penitence), upavasa (fasts), swastyayana (prostrations), pranipata (surrender), gamana (pilgrimage), etc,. Chanting Mantras Boosting Positive waves and energy and removing negative thoughts from the mind. Enhancing Satvaguna and balancing Raja and Tama guna which are causative factors.

YUKTIVYAPASRAYA CHIKITSA / LOGICAL THERAPY: This refers to the use of ahara (diet) and oushadha (drugs).

SATVAVAJAYA CHIKITSA / MENTAL or PSYCHOTHERPAY: The aim of this therapy is to restrain mind from desire for unwholesome objects with occupational, behavioral  and like therapies to restrain mind from unwholesome objects.


Role of Achara Rasayana / NITYA RASAYANA (social and mental code of conduct):

Ayurveda stresses on the holistic concept of health and disease. It does not call health merely as absence of disease but something more positive and integrated. Achara Rasayana described in this respect is very essential for the treatment of Manas Roga having direct effect on the potentiating of Sattva Guna of mind.

DIET & LIFESTYLE:


 AVOID / APATHYA

WHOLESOME TO ADOPT/ PATHYA

Chinta(anxiety)

 Shoka(grief)

 Bhaya(fear)

 Krodha(anger)

Apavitra padartha( unwholesome acts)

 Madya (alcohol intake)

 

 Viruddha(unwholesome food)

Atyanta teekshna (very spicy)

 Ushna (too hot)

 Guru (too heavy food)

Adhikavyavaya (over-eating)

Ati-vyayama (excessive exercise)

 Ati-nidra (excessive sleeping)

Kshudha (suppression of hunger)

Trishna vegadhrana (suppression of thirst)

Godhuma (wheat)

Mudga (green gram0

Shali (rice variety)

Dharoshnadugdha

 Shatadoutaghrita

Navaneeta

 Puranaghrita

 

Dharaniya vega(urges to be controlled)

Aachar rasayan (code of conduct/ethics)

 

 



EVIDENCE BASED THERAPIES FOR TREATING MANAS VIKARA:

Traditional Ayurvedic text emphasized the importance of purification (shodhana)  in  Chittavasada which involves utilization of PanchaKarma therapy by various means:• Antarparimarjana: It includes the process of internal purification • Samshodhana: Elimination of vitiated Doshas by Panchacarma therapy  • Bahiraparimarjana: It is a process of external purification; purvakarma  of  panchakarma  i.e.  Snehan (oileation) & Swedana (sudation). Medicated oil is used for external application with heat application.


GENERAL PANCHKARMA PROCEDURES TO TREAT MANOVIKARA:

·         Abhyang & swedan (oelation & sudation)

·         Vaman (emesis therapy)

·         Virechan (purgation therapy)

·         Shirodhara

·         Shiro-pichu

·         Shiro-lepa

·         Shiro-basti

PANCHKARMA FOR EPILEPTIC DISORDERS (APASMARA)

 

Apasmara : Convulsive disorder

 

·         Virechana in pittaja apasmara 

·         Vamana in kaphaja apasmara.

PANCHKARMA FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

 

Attention Deficit Hyperactivity  Disorder (ADHD)  is  common  neurological  disorders affects  the  focusing,  behaviour  and  activity controlling  abilities.  As per  ayurveda  disease arises due to the increased vata .

 

·          Relaxation and concentration improving  therapy 

·          vedic  chant recitation (music  therapy) 

·         Shirodhara

·         Abhyang & swedan

·         Shiro pichu

 

PANCHKARMA FOR INSOMNIA

 

 

 Insomnia (anidra)  is  pathological  condition  associated with  loss  of  sleep  due  to  the  stress  and  other mental problem. In anidra  there  is aggravation of  vata  pitta  and  rajasik  guna  vruddhi  with shleshma and tama kshaya.

 

·          Sarvang Snehan with tila taila 

·         Sarvang  Swedan  (bashpa  sweda)  with Dashmula kwath 

·         Shirodhara with tila taila

 


EVIDENCE BASED FORMULATIONS IN TEXTUAL REFERENCES

The Ayurvedic text also specifies the formulations depending on the type of mental disorder. multiple doshas may be concurrently vitiated, and that a patient's experience of depression might be dual-doshic or tridoshic (sannipatika). Traumatic abuse or events may cause depression in all people, although people who have a vata imbalance have less stability and less endurance in the face of injury. In treating depression, it's necessary to think about that doshas are out of balance and design treatment to restore equilibrium.



Smritikshya/ Buddhikshaya

(LOSS OF MEMOERY)

Buddhimandya

(PSYCHOLOGICAL DISORDER)

Unmada, Apasmar

(PSYCHOSIS, EPILEPSY etc.)

Kumaryasava

Sarasvatharishta

Amrita bhallataka ghrita          

Swarnabhasma             

Vasanatakusumakara rasa

Brahmi rasayana

Sarasvathaghrita

Saubhagya vati

Muktabhasma

Gorachanadi vati

Rajatabhasma

Vangabhasma

Swarnasindhuraa

Manikya pishti

Kalyanaka ghrita

Jatamayrka

Shiva gutika

Tiktaka ghrita

Brahmighrita

Mahakalyanaka ghrita

Tungudrumadi taila

Vatakulanatakacrasa

Mritasanjivini gutika

Kayasthyadi vati

Mukta pishti

Saptavimshatika guggulu

An important aspect in treating depression is reestablishing a harmonious connection with the cycles of nature. Healthy patterns include waking in the morning, around the same time as sunlight. Rushing ought to be avoided as this generates stress and disrupts the brain. Food should be fresh, free of chemical residues, and well-prepared, and needs to be consumed mindfully. Sattvic spices like ginger, cardamom and ginger open the brain and the heart. Herbal formulas are instrumental in light the path towards growth and healing. These are listed below:



 AUSHADHAKALPAS USED IN DIFFERENT MANASAVIKARAS:


Benefits of Medhya herbs:   Medhya herbs in particular are quite beneficial and they do not have a broad-spectrum action. As per Acharya Shusruta, the benefits derived from Medhya herbs and their applied aspects are enlisted below.  

1.Shruta Nigadi (Power of retention after hearing once)  

2. Smrutiman (Endowed with good memory)   

3. Grantham Ipsitam utpadayati (Develops enthusiasm in reading habit) 

4. Nastam cha Pradurbhavati (Power to recollect the forgotten)  

5. Dvirucchaaritam shatamapi avadharayati (Capable of retaining words spoken only twice)  


Summary:Ayurveda stresses on the holistic concept of health and disease. It does not call health merely as absence of disease but something more positive and integrated. Understanding the root cause and then healing with an integrative approach to address those issues is supported by evidence from research and data from the real world.


REFERENCES:

1.  https://www.researchgate.net/publication/224898710_Manovikara_mental_disorders_in_ayurveda

2. Acharya, Y.T., “Charakasamhita”

3. Shastry Rajeswaredatta, “Bhaishajya ratnavali”, Chowkambha  Sanskrit Series, Varanasi, 368. (1969)

4. http://www.sciencedirect.com/science/article/pii/S0975947617302310, A cross comparison between Ayurvedic etiology of Major Depressive Disorder and bidirectional effect of gut dysregulation, Journal of Ayurveda and Integrative Medicine, Volume 10, Issue 1, 2019, Pages 59-66,

5. V.D. Lad, Textbook of Ayurveda: volume 2-A complete guide to clinical assessment , Ayurvedic Press, Albuquerque, NM (2006)

6. World Health Organization.  The world health report.  2001, Mental  Health:  New Understanding, New Hope. Geneva. 2001.

7. DSM-V: diagnostic and statistical manual of mental disorders (5th ed.), American Psychiatric Association, Washington, D.C. (2013), pp. 161-271

8. https://www.nhp.gov.in/Manovasada(Depression)_mtl

9. https://www.researchgate.net/publication/317014347_DEPRESSION-AN_AYURVEDIC_OUTLOOK_INTRODUCTION

10. Charak samhita with Ayurveda Dipika Commentary of Chakrapni Dutta, Ed. Yadavji Trikarma ji Acharya , Chaukhmba Surbharti Prakashan, Varanasi, Charak Samhita Shareer sthana Chapter 1 Verse 100-103

11. KavirajAmbikadatta Shastry Sushruta, Sushrutasamhita, Ayurveda tatvasandipikavyakhyana, Sutrasthana 15th chapter, 44th verse, edition 1996, Varanasi Chowkambha Sanskrit SansthanVol 1

12. Kashinath Shastry, Vaidya Yadavatrikamaji Achar,  Agnivesha Charakasamhita Chakrapanidattavirachita Ayurvedadipikavyakhyanahindi Sutrasthana 1st chapter, 42nd verse 4th edition 1994. Chowkambha Sanskrit samsthana, Varanasi

13. Sudarshana Shastry, Madhavanidana of Srimadhavakara with Madhukosha Sanskrit commentary by Srivijayarakshita and Srikanttadatta with Vidyotini Hindi commentary 4th chapter 11th verse Part-1, Chawkhamba Sanskrit Bharati, Varanasi. 26th edition 1996.

14. Jain Pankaj, A Physiological Study Of Manas Doshas, Imbalance In Depression And Efficacy Of Kalpit Yog With Psychotherapy, 2010

15. Vd. Kushwah H, Charak Samhita: Ayurved Dipika Ayushi Hindi Commentary, 1st edition, Chaukhamba Orientalia, Varanasi (U.P.) 2005. Cha.Su. 11/

16. Brahmanand Tripathi,Vagbhata, Asthangahridaya Shareerasthana 4th chapter, Dehli: Chaukambha Sanskrit Sansthan Reprint 2003

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