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Sushruta SamhitaUnmada Pratisedha - Treatment of Insanity - Sushrutasamhita Uttaratantra Chapter 62

Unmada Pratisedha – Treatment of Insanity – Sushrutasamhita Uttaratantra Chapter 62

द्विषष्टितमोऽध्यायः अथात यथोवाच धन्वन्तरिः ॥ १ ॥ भगवान्

उन्मादप्रतिषेधमध्यायं व्याख्यास्यामः

Now we shall discourse on the chapter which deals with the Symptoms and medical treatment of Insanity (Unmada-Pratisedha).1

Derivation of Insanity

मदयन्त्युद्धता दोषा यस्मादुन्मार्गमाश्रिताः । मानसोऽयमतो व्याधिरुन्माद इति कीर्तितः ॥ २ ॥

Derivation— In as much as (in this disease) the deranged bodily Dosas traversing the upper part of the body affect the up-coursing nerves and produce there by a distracting state of the mind, it is called Unmada (Insanity), and it is deisease of the Manas (mind ). 2

Classification of Insanity

एकैकशः समस्तैश्च दोषैरत्यर्थमूर्च्छितैः । मानसेन च दुःखेन स पञ्चविध उच्यते ॥ ३ ॥

विषाद् भवति षष्ठश्च यथास्वं तत्र भेषजम् । स चाप्रवृद्धस्तरुणो मदसंज्ञां विभर्ति च ॥ ४॥

Classification – This disease is divided into five different types according to the nature of their origin-viz. the three types due to the several actions of the three deranged and aggravated Dosas, the one due to their concerted actions and the one due to grief, etc.(real or imaginary). There is a sixth kind also, viz., that due to the effects of poison, whch should be treated according to the nature and intensity of the deranged Dosa or Dosas lying at the root and which in its early stage, if not abnormally aggravated, goes by the name of Mada. 3-4.

Premonitory Symptoms of Insanity / Unmada

मोहोद्वेगौ स्वनः श्रोत्रे गात्राणामपकर्षणम् । अत्युत्साहोऽरुचिश्चान्ने स्वप्ने कलुषभोजनम् ॥ ५॥

वायुनोन्मथनञ्चापि भ्रमश्चक्रगतस्य वा । यस्य स्यादचिरेणैव उन्मादं सोऽधिगच्छति ॥ ६ ॥

Premonitory Symptoms – Fits of unconsciousness, agitated state of the mind, ringing of the ears, emaciation of the body, excessive energy in action, aversion to food, eating filthy things in dreams, churning like sensation feeling in the body due to Vayu and vertigo or giddiness like lying on moving wheel are the symptoms in a patient which forebode a speedy and impending attack of insanity. 5-6.

Specific Symptoms of Vataja, Pittaja and Kaphaja Unmada

रुक्षच्छवि: परुषवाग्धमनीततो वा शीतातुरः कृशतनुः स्फुरिताङ्गसन्धिः । आस्फोटयत्यटति गायति नृत्यशीलो विक्रोशति भ्रमति चाप्यनिलप्रकोपात् ॥ ७ ॥ तृद्स्वेददाहबहुलो बहुभुग्विनिद्रश्छायाहिमानिलजलान्तविहारसेवी । तीक्ष्णो हिमाम्बुनिचयेऽपि स वह्निशङ्की पित्ताद्दिवा नभसि पश्यति तारकाश्च ॥ ८ ॥ छर्द्यग्निसादसदनारुचिकासयुक्तो योषिद्विविक्तरतिरल्पमतिप्रचारः । निद्रापरोऽल्पकथनोऽल्पभुगुष्णसेवी रात्रौ भृशं भवति चापि कफप्रकोपात् ॥ ९ ॥

Specific Symptoms of Vataja, Pittaja and Kaphaja types – Shaggy appearance, use of harsh language, appearance of a number of Dhamanis (nerves) over the body, laboured breathing (D.R. experience of excessive coldness), emaciation of the body and throbbing of the joints of the limbs are the specific features of a case of the Vataja type (of Unmada) and the patient in such a case produces sound by clapping his hands, or sings while dancing, or shouts or wanders about. Excessive thirst, perspiration, burning sensation, voracious eating, insomnia, desire for shade, cold, wind and walks on the banks (of rivers or tanks), fits of anger, fancying fire in cold water and fancied sight of stars in the sky in the day are the symptoms which characterise a case of the Pittaja type. Vomiting, dulness of appetite, lassitude or gone-feeling in the limbs, aversion to food, fondness for sexual propulsion and loneliness, stupidity, somnolence, reservedness in speech, eating little, fondness for warm things and aggravation of the disease in the night mark a case of the Kaphaja type of insanity.7-9.

Tridoshaja Unmada

सर्वात्मके पवनपित्तकफा यथास्वं संहर्षिता इव च लिङ्गमुदीरयन्ति ॥ १० ॥

Tri-dosaja Type — A case of Sannipatika insanity exhibts all the symptoms belonging to the three aforesaid types origined from the three Dosas, viz., Vata, Pitta and Kapha. A case in which the specific symptoms of the disease are manifiested in full should be deemed as incurable. Several authorities, however, hold the Sannipatika type to be sometimes curable. 10.

Sokaja and Vishaja Unmada

चौरैर्नरेन्द्रपुरुषैररिभिस्तथाऽन्यैर्वित्रासितस्य धनबान्धवसंक्षयाद् वा । गाढं क्षते मनसि च प्रियया रिरंसोर्जायेत चोत्कटतरो मनसो विकारः ॥ ११ ॥ चित्रं स जल्पति मनोऽनुगतं विसंज्ञो गायत्यथो हसति रोदिति मूढसंज्ञः ॥ १२॥ रक्तेक्षणो हतबलेन्द्रियभाः सुदीनः श्यावाननो विषकृतेऽथ भवेत् परासुः ॥ १३ ॥

Sokaja and Vishaja types— A person frightened by thieves, king’s officers or his own enemies or any such person, or suffering from any distracted state of the mind owing to a loss of wealth or from any grief (Soka) or bereavement or from any disappointed love would likely to have an attack of mental distraction (insanity). In such cases the patient would unconsciously talk incoherently about subjects uppermost in his mind or would sing in a stupid fashion or laugh or weep. (These are the symptoms of Sokaja insanity). Redness of the eyes, dulness of complexion and of the perceptive faculties, diminution of bodily strength, extreme dejection, blush on face and loss of consciousness are the symptoms which mark a case of insanity and may be fatal due to the effects of poisoning. 11-13.

General Treatment of Unmada

स्निग्धं स्विन्नन्तु मनुजमुन्मादार्त विशोधयेत् । तीक्ष्णैरुभयतोभागैः शिरसश्च विरेचनैः । विविधैरवपीडैश्च सर्षपस्नेहसंयुतैः । योजयित्वा तु तच्चूर्णं घ्राणे तस्य प्रयोजयेत् ॥ १४॥ सततं धूपयेच्चैनं श्वगोमांसैः सुपूतिभिः । सर्षपानाञ्च तैलेन नस्याभ्यङ्गौ हितौ सदा ॥ १५ ॥ दर्शयेदद्भुतान्यस्य वदेन्नाशं प्रियस्य च । भीमाकारैर्नरैर्नागैर्दान्तैर्व्यालैश्च निर्विषैः । भीषयेत् संयतं पाशैः कशाभिर्वाऽथ ताडयेत् ॥ १६ ॥ यंत्रयित्वा सुगुप्तं वा त्रासयेत् तं तृणाग्निना ॥ १७ ॥ प्रतुदेदारया चैनं मर्माघातं विवर्जयेत् । वेश्मनोऽन्तः प्रवेश्यैनं रक्षंस्तद्वेश्म दीपयेत् । सापिधाने जरत्कूपे सततं वा निवासयेत् ॥ १८ ॥ जलेन तर्जयेद् वाऽपि रज्जुघातैर्विभावयेत् । बलवांश्चापि संरक्षेत् जलेऽन्तः परिवासयेत् ॥ १९ ॥ त्र्यहात् त्र्यहाद् यवागूञ्च तर्पणान् वा प्रदापयेत् । केवलानम्बुयुक्तान् वा कुल्माषान् वा बहुश्रुतः ॥ २० ॥ हृद्यं यद्दीपनीयञ्च तत् पथ्यं तस्य योजयेत् ॥ २१ ॥

General Treatment – A patient suffering from insanity should be first treated with Sneha and Sveda and then subjected to a course of emetics, purgatives and head-purgatives (Siro-Virecana). powders of various sorts of (drugs used in) Avapida snuffing should be mixed with mustard oil and employed for the purpose of snuffing). Fumigation with burnt beef of dog’s and cow’s flesh should be constantly employed. Snutfing and unguents of mustard oil are also efficacious in all cases. The patient should be made surprised with wonderful sights and the news of the death of any of his dear ones related to him. He should be constantly frightened with sights of fierce-looking men, well-trained elephants or non-venomous snakes. The patient should be threatened with being fastened with ropes or being flogged, or frightened with bundles of blazing hay, after being fastened, while asleep. He should also be pierced in his body with pointed instruments, avoiding, however, the vulnerable parts’, or he should be made to reside constantly in a dry well with a cover over it. Barley gruel, powders of parched barley mixed with water alone should be given to him on every third day by an intelligent physician. The diet of the patient should consist also of palatable and appetising articles. 14-21.

(विडङ्गत्रिफलामुस्त-मञ्जिष्ठादाडिमोत्पलैः । श्यामैलवालुकैलाभिश्चन्दनामरदारुभिः बर्हिष्ठरजनीकुष्ठ-पर्णिनीसारिवाद्वयैः हरेणुकात्रिवृद्दन्ती-वचातालीशकेशरैः ॥२२॥ । ॥ २३ ॥

1. Additional Text- The patient should likewise be threatened with being forced into a burning hut. He should be also kept immersed in water or threalened with the fall of a thunder bolt.

Maha Kalyana Ghrita

द्विक्षीरं साधितं सर्पिर्मालतीकुसुमैः सह गुल्मकासज्वरश्वास-क्षयोन्मादनिवारणम् एतदेव हि सम्पक्कं जीवनीयोपसम्भृतम् । चतुर्गुणेन दुग्धेन महाकल्याणमुच्यते ॥ २५ ॥ अपस्मारं ग्रहं शोषं क्लैव्यं कार्यमबीजताम् । घृतमेतन्निहन्त्याशु ये चादौ गदिता गदाः ॥ २६॥ ॥२४॥

Maha Kalyana Ghrita – Clarified butter duly cooked with twice as much of milk and with Vidanga, Tri-phala, Musta, Manjistha, Dadima, Utpala, Syama, Ela-valuka, Ela, (red) Candana, Deva-daru, Barhistha (Balaka), Haridra, Kustha, Parnini Salaparni), Sariva, Harenuka, Trivrit, Danti, Vaca, Talisa patra, Naga kesara and Malati flowers Kalka (is called Kalyana Ghrita¹ and) proves curative in cases of Gulma, cough, fever, asthma, phthisis and insanity. Clarified butter duly cooked with four times as much of milk and with the aforesaid drugs as Kalka and with the drugs of the Kakolyadi group added to it by way of an after-throw is called Maha-kalyana Ghrita. The range of its therapeutic application includes (such ailments as) Apasmara (attack by) Graha, consumption, impotency, emaciation and sterility as well as the diseases mentioned above. 22-26.

Phala Ghrita

॥२७॥ बर्हिष्ठकुष्ठमञ्जिष्ठा-कटुकैलानिशाह्वयैः । तगरत्रिफलाहिङ्ग-वाजिगन्धामरद्रुमैः वचाऽजमोदाकाकोली- मेदामधुकपद्मकैः । सशर्करं हितं सर्पिः पक्कं क्षीरचतुर्गुणम् ॥ २८ ॥ बालानां ग्रहजुष्टानां पुंसां दुष्टाल्परेतसाम् । ख्यातं फलघृतं स्त्रीणां बन्ध्यानाञ्चाशुगर्भदम् ॥ २९ ॥

Phala Ghrita – Clarified butter duly cooked with Balaka, Kustha, Manjistha, Katuka, Ela, Haridra, Tri-phala, Hingu, Asvagandha, Deva-daru, Vaca, Yamani, Kakoli, Meda, Yasti madhu and Padmaka (:as Kalka), and with four times as much of milk and with sugar as an after-throw would be beneficial. It should also be prescribed for infants struck by malignant stars as well as cures seminal disorders of male adults. This is known as Phala-Ghrita and removes barrenness of women. 27-29.

1. According to Dalhana the mentions of these two recipes (Kalyana Ghrita and Phala Ghrita) are interpolations.

ब्राह्मीमैन्द्रीं विडङ्गानि व्योषं हिङ्गु सुरां जटाम् । विषघ्नीं लशुनं रास्त्रां विशल्यां सुरसां वचाम् ॥ ३० ॥ ज्योतिष्मतीं नागरञ्च अनन्तामभयां तथा । सौराष्ट्रीञ्च समांशानि गजमूत्रेण पेषयेत् । छायाविशुष्कास्तद्वर्त्तीर्योजयेद् विधिकोविदः ॥ ३१ ॥ अवपीडेऽञ्जनेऽभ्यङ्गे नस्ये धूमे प्रलेपने ॥ ३२ ॥

Brahmi (Manduka-parni), Aindri, Vidanga, Tri-katu, Hingu, Sura (Deva-daru), Jata (Jata mamsi), Visaghni (Haridra), Lasuna (garlic), Rasna, Visalya (Guduci), Surasa, Vaca, Jytismati, Naga-vinna (a kind of Indra-varuni), Ananta, Abhaya and Sourastri taken in equal parts should be pounded together and made into a paste with the addition of elephant’s urine. It should then be dried in the shade, and Vartis should be prepared there of. These should be used by an intelligent person as an Anjana, unguent, snuff, fumigation and Avapida. 30-32.

उरोऽपाङ्गललाटेषु सिराश्चास्य विमोक्षयेत् । अपस्मारक्रियाञ्चापि ग्रहोद्दिष्टाञ्च कारयेत् ।

शान्तदोषं विशुद्धञ्च स्नेहबस्तिभिराचरेत् ॥ ३३

Blood-letting from the Ura ( chest), Apanga (outer corner of the eye) and Lalata (forehead) should be resorted to Measures and drugs mentioned in connection with the treatment of Apasmara and Graha-roga may be likewise employed in the present instance. Oily purgatives (Sneha-basti) should be administered after the subsidence of the deranged Dosa. 33.

उन्मादेषु च सर्वेषु कुर्याच्चित्तप्रसादनम् । मृदुपूर्वां मदेऽप्येवं क्रियां मृद्वीं प्रयोजयेत् ॥ ३४ ॥

In all types of Unmada (insanity) patients mind should be made pleasant. Even in mild type of Unmada mild medical measures should be applied. 34.

शोकशल्यं व्यपनयेन्दुन्मादे पञ्चमे भिषक् ॥ ३५ ॥

विषजे मृदुपूर्वाञ्च विषघ्नीं कारयेत् क्रियाम् ॥ ३६॥

In a case of th fifth kind (viz. Sokaja) of insanity the cause of grief should be first removed. In all forms of insanity the restoration of the serenity of mind should be first attempted. Mild and gentle forms of these remedies should be resorted to in a case of Mada (preliminary stage of insanity). Mild anti-venomous (anti-toxin) measures should be resorted to in a case (of insanity) due to the effects of poison. 35-36.

इति सुश्रुत संहितायामुत्तरतन्त्रे उन्मादप्रतिषेधव्याख्यानाम द्विषष्टितमोऽध्यायः ॥ ६२॥

Thus ends the sixty-second chapter in the Uttara-Tantra of the Susruta Samhita which deals with the (symptoms and) treatment of Insanity.

Here ends the Bhuta-vidya-tantra.


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