E-ISSN:2456-3110

Review Article

Sattwavajay Chikitsa

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 12 December
Publisherwww.maharshicharaka.in

Role of Sattwavajay Chikitsa in the management of stress disorders with special reference to Unmada

Suna J1*, Naik PK2, Swain D3
DOI:10.21760/jaims.8.12.33

1* Janhabi Suna, Final Year Post Graduate Scholar, Pg Dept of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.

2 Prakash Kumar Naik, First Year Post Graduate Scholar, Dept of Kayachiktsa, Institute of Post Graduate Ayurvedic Education Research, Kolkata, West Bengal, India.

3 Dipak Swain, Professor, PG Dept of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.

Stress disorder are due to both stress and strain. Stress can be defined as a state of worry or mental tension caused by a difficult situation. Stress is a natural human response that prompts us to address challenges and threats in our lives. Everyone experiences stress to some degree. The prevalence of stress in the general population is 29.6%. Sattwavajaya Chikitsa described by Acharya Charaka is nothing but withdrawal of mind from unwholesome objects. It also includes methods mentioned under Adravyabhuta Chikitsa.

Keywords: Stress, Strain, Sattwavajaya Chikitsa, Adravyabhuta Chikitsa

Corresponding Author How to Cite this Article To Browse
Janhabi Suna, Final Year Post Graduate Scholar, Pg Dept of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.
Email: 		Suna J, Naik PK, Swain D, Role of Sattwavajay Chikitsa in the management of stress disorders with special reference to Unmada. J Ayu Int Med Sci. 2023;8(12):222-229.
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https://jaims.in/jaims/article/view/2966

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-10-13 2023-10-23 2023-11-03 2023-11-13 2023-11-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 23.96

© 2023by Suna J, Naik PK, Swain Dand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

The term Unmada stands for Samudbhrama i.e., perversion. Because, in this ailment, the (intellect) Buddhi, mind and Smriti (memory) get perverted, this is called Unmada (Insanity).[1] Acharya Charaka has included Sattvavajaya & Daivavyapasraya Chikitsa under the category of Adravyabhuta Chikitsa. Sattavavajaya Chikitsa is a therapeutic technique described specifically for the management of mental disorder.[2]

Tension: Mental or emotional strain where mind is affected and can’t think properly.

Stress: A state of mental or emotional strain or tension resulting from adverse or demanding circumstances.

Anxiety: A feeling of worry, nervousness or unease about something with an uncertain outcome.

Psychiatry: a nervous disorder marked by excessive uneasiness and apprehension, typically with compulsive behaviour or panic attacks.

Anxiety Disorders:

Anxiety disorders are of 5 types[3]

1) Generalized anxiety disorder (GAD)

2) Obsessive compulsive disorder (OCD)

3) Panic disorder

4) Post traumatic stress disorder (PTSD)

5) Social phobia

Generalized Anxiety Disorder:

It is characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.

Obsessive Compulsive Disorder (OCD):

  • Characterized by recurrent unwanted thoughts (obsession) and/or repetitive behaviors (compulsion).
  • Repetitive behaviors such as hand writing, counting, checking or cleaning are often performed with the hope of preventing obsessive thoughts making them go away.
  • Performing these so-called rituals however provides only temporary relief and not performing them markedly increases anxiety.

Panic Disorder:

Characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include

  • Chest pain
  • Heart palpitations
  • Shortness of breath
  • Dizziness
  • Abdominal distress

Post Traumatic Stress Disorder (PTSD):

It is an anxiety disorder that can develop after exposure to a terrifying event or deal in which grave physical harm occurred or was threatened .

Traumatic events that may trigger PTSD include

  • Violent personal assaults
  • Natural or human caused disasters
  • Accidents
  • Military combat

Social Phobia (Social Anxiety Disorder):

  • Characterized by overwhelming anxiety and excessive self consciousness in everyday social situations.
  • Social phobia can be limited to one type of situation such as a fear of speaking in formal or informal situations, or eating or drinking in front of others or its more severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.

Generalized Anxiety Disorder:

  • Generalized anxiety disorder (GAD) is marked by excessive, exaggerated anxiety and worry about everyday life events for no obvious reason.
  • People with symptoms of GAD tend to always expect disaster and can’t stop worrying about health, money, family, work or school.

Symptoms of GAD:

  • Excessive, ongoing worry and tension
  • Unrealistic view of problems
  • Restlessness or a feeling of being edgy (nervous).
  • Trouble concentrating

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  • Tiring easily or being fatigued
  • Increased crankiness (bad disposition) or irritability
  • Trouble sleeping
  • Muscle tension or muscle aches and soreness
  • Also have phobias, obsessive compulsive disorder, clinical depression.

Causes and risk factors of GAD:

  • Genetics
  • Brain chemistry-nerve cells pathways connect particular brain regions involved in thinking and emotion. The neurotransmitter send information from one nerve cell to the next.
  • If the pathways that connect particular brain regions don’t work well the problems related to mood or anxiety may result.
  • Environmental factors like -death of loved ones, divorce, changing job, withdrawal of addictive substances worsens GAD.

Treatment of GAD:

  • Cognitive behavioral therapy
  • Medications
  • Exercise
  • Yoga
  • A healthy diet
  • Getting enough sleep
  • Avoiding caffeine
  • Avoiding alcohol and other drugs
  • Meditation
  • Relaxation techniques such as deep breathing

Obsessive compulsive disorder:

Obsessive compulsive disorder (OCD) is a mental illness that causes repeated unwanted thoughts or sensations (obsessions) or the urge to do something over and over again. some people can have both obsession and compulsions.

People with OCD have thoughts or actions that,

  • Take up at least an hour a day
  • Are beyond your control
  • Are not enjoyable

Interfere with work, your social life or another part of life.

OCD types and symptoms:

Comes in many form, but most cases fall into at least one of four general categories.

  • Checking
  • Contamination
  • Symmetry and ordering
  • Ruminations (continue thinking) and instructive (disruption thoughts).

Obsession and Compulsion:

Obsessive thoughts include,

  • Worry about yourself or other people getting hurt.
  • Constant awareness of blinking or other body sensation.
  • Suspicion that a partner is unfaithful, with no reason to believe it.

Compulsive habits can include,

  • Doing tasks in a specific order every time or a certain good number of times.
  • Needing to count things, like steps or bottles.
  • Fear of touching doorknobs, using public toilets or shaking hands.

Treatment:

  • Psychotherapy
  • Relaxation
  • Medication
  • Neuromodulation
  • TMS (Transcranial magnetic stimulation)

Panic Attacks:

A panic attacks causes sudden, brief feelings of fear and strong physical reactions in response to ordinary, non-threatening situations. When you are having a panic attack. You may sweat a lot, have difficulty breathing and feel like your heart is racing. It may feel as if you are having a heart attack.

Panic disorder can develop when you worry too much about having another panic attack or change behaviors to avoid having a panic attack.

Management:

  • Psychotherapy
  • Antidepressant

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  • Anti anxiety Medications
  • Cut back caffeine
  • Exercise regularly
  • Eat a healthy diet
  • Manage stress

Post Traumatic Stress Disorder (PTSD):

PTSD is a mental health condition that’s triggered by a terrifying either experiencing it or witnessing it.

Symptoms may include flashbacks, nightmares and severe anxiety as well as uncontrollable thoughts about the event.

Most people go through events may have temporary difficulty adjusting and coping, but with time and good self-care, they usually get better, if the symptoms get worse, last for months or even years, and interfere with your day to day functioning, you may have PTSD.

Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function.

Symptoms:

  • It may start within one month of a traumatic event, but sometimes symptoms may not appear until years after the event.
  • These symptoms cause significant problems in social work situations and in relationships. They can also interfere with your ability to go about your normal daily tasks.

Intrusive Memories:

Symptoms of intrusive memories may include:

  • Recurrent unwanted distressing memories of the traumatic event.
  • Upsetting dreams or nightmares about the traumatic event.
  • Severe emotional distress or physical reactions to something that reminds you of the traumatic event.

Avoidance:

  • Trying to avoid thinking or talking about the traumatic event.
  • Avoiding places, activities or people that reminds you about the traumatic
  • event. You may avoid stimuli that cause you to remember or re-experience the traumatic event, such as people, conversations, places, death etc.

Negative changes in thinking and mood:

It may include

  • Negative thoughts about yourself, other people or the world.
  • Hopelessness about the future
  • Difficulty maintaining close relationships.
  • Feeling detached from family and friends
  • Feeling emotionally numb

Changes in physical and emotional reactions:

May include,

  • Being easily startled or frightened.
  • Always being on guard for danger
  • Self destructive behavior, such as drinking too much or driving too fast
  • Trouble sleeping
  • Trouble concentrating
  • Irritability
  • Overwhelming guilt or shame

Intensity of symptoms:

PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you are stressed in general, or when you come across reminders of what you went through e.g. you may hear a car backfire and relieve combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assaults.

If you have suicidal thoughts:

If you or someone you know has suicidal thoughts, get help right way through one or more of these resources.

Reach out to a close friend or loved one.

Make an appointment with your doctor or a mental health professional.

Causes:

  • You can develop PTSD when you go through, see or learn about an event involving

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  • actual or threatened death, serious injury or sexual violation.
  • Doctors are not sure why some people get PTSD. As with most mental health problems, PTSD is probably caused by a complex mix of;
  • Stressful experiences
  • Inherited mental health risks
  • Inherited features of your personality
  • The way your brain regulates the chemicals and hormones your body releases in response to stress.

Risk Factors:

People of all ages can have PTSD. However, some factors may make you more likely to develop PTSD after a traumatic event, such as;

  • Experiences intense or long lasting trauma.
  • Having experienced other trauma earlier in life, such as childhood abuse
  • Having a job that increases your risk of being exposed to traumatic events such as military personnel and first responders.
  • Having other mental health problems such as anxiety or depression.
  • Having problems with substance misuse such as excess drinking or drug use.
  • Lacking a good support system of family and friends.
  • Having blood relatives with mental health problems, including anxiety or depression.

Complications:

PTSD can disrupt your whole life - your job, your relationship, your health and your enjoyment of everyday activities.

Having PTSD may also increase your risk of other mental health problems, such as

  • Depression and anxiety
  • Issues with drugs or alcohol use
  • Eating disorders
  • Suicidal thoughts and actions

Kinds of traumatic events:

The most common events leading to the development of PTSD include,

  • Combat exposure
  • Childhood physical abuse
  • Sexual violence
  • Physical assaults
  • Being threatened with a weapon
  • An accident

Many other traumatic events also can lead to PTSD such as fire, natural disaster, mugging, robbery, plane crash, torture and other extreme or life-threatening events.

How do people respond to traumatic events:

  • Patient feels numb and detached
  • Repeated memories of the event or flashbacks
  • Nightmares
  • Intense fear that the traumatic event will reoccur, particularly around anniversaries of the event.
  • Withdrawal and isolation from day-to-day activities.
  • Anxiety & nervousness
  • Anger
  • Denial
  • Depression that can commonly occur along with traumatic stress.
  • Difficulty concentrating
  • Insomnia or altered sleeping
  • Worsening of an existing medical condition.

Prevention:

  • After surviving a traumatic event, many people have PTSD like symptoms at first, such as being unable to stop thinking about what’s happened. Fear, anxiety, anger, depression, guilt are all common reactions to trauma. However, the majority of people exposed to trauma do not develop long term PTSD.
  • Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD.
  • This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health professional for a brief course of therapy. Some people may also find it helpful to turn to their faith community.

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  • Support from others also may help prevent you from turning to unhealthy copying methods, such as misuse of alcohol or drugs.

Social Anxiety Disorders (SAD):

Also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects of daily life.

Sign & Symptoms:

  • Patient may feel overly self-conscious, pay high self-attention, self-presentation.
  • May have the perception that they performed unsatisfactorily.
  • Behavioral aspects - it exceeds normal shyness as it leads to excessive social avoidance and substantial social or occupational impairment.
  • Physiological aspects - tears as well as excessive sweating, nausea, breathing, shaking and palpitations as a result of the fight or flight response.

What is acute stress disorder?

  • In the weeks after a traumatic event, you may develop an anxiety disorder called acute stress disorder.
  • ASD typically occurs within one month of a traumatic event. It lasts at least three days and can persists for up to one month. People with ASD have symptoms similar to those seen in post-traumatic stress disorder.

What causes acute stress disorder?

  • Experiencing, witnessing or being confronted with one or more traumatic events can cause ASD. The events create intense fear, horror, or helplessness.
  • You will have three or more of the following dissociative symptoms if you have ASD.
  • Feeling numb, detached or being emotionally unresponsive.
  • A reduced awareness of your surroundings.
  • Derealization which occurs when your environment seems strange or unreal to you.
  • Depersonalization, which occurs when your thoughts or emotions don’t seem like they belong to you.
  • Dissociative amnesia, which occurs when you cannot remember or more important aspects of the traumatic event.

What are the symptoms of acute stress disorder?

The symptoms of ASD include:

Dissociative Symptoms:

  • Objects
  • Activities
  • Thoughts
  • Feelings

Anxiety or Increased Arousal

  • The symptoms of ASD may include anxiety and increased arousal. The symptoms of anxiety and increased arousal include.
  • Having trouble sleeping
  • Being irritable
  • Having difficulty concentrating
  • Being unable to stop moving or sit still.
  • Being constantly tense or on guard
  • Becoming startled too easily or at inappropriate times.

Distress

  • The symptoms of ASD may cause you distress or disrupt important aspects of your life, such as your social or work settings .you may have an inability to start or complete necessary tasks or an inability to tell others about the traumatic event.

How is acute stress disorder treated?

Your doctor may use one or more following methods to treat ASD.

  • A psychiatric evaluation to determine your specific needs.
  • Hospitalization if you are at risk of suicide or harming others.
  • Assistance in obtaining shelter, food, clothing and locating family if necessary.
  • Psychiatric education to teach you about your disorder.
  • Medication to relieve symptoms of ASD, such as anti-anxiety medications

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  • Selective serotonin reuptake inhibitors (SSRIs) antidepressants.
  • Cognitive behavioral therapy CBT
  • Which may increase recovery speed and prevent ASD from turning in to PTSD.
  • Exposure based therapies.

Ayurvedic Concept

Unmada

Tairalpasatwasya Malah Pradusta Buddhenivasam Hridayam Pradyushya |

Srotamsyadhisthaya Manovahani Pramohayantyasu Narasya Chetah ||

Which means Vata with other Doshas when gets vitiated due to several reasons the weak Satwa disturbs the Buddhi which is placed in Hrudaya due to which the mind of a person become unstable.[4]

Samanya Lakshana:

Dhi Bibhrama Satwa Pariplabascha Paryakula Drishti Adhirata Cha |

Abaddha Vakyatwam Hridayam Cha Sunyam Samanya Unmada Gadasya Lingam ||

The sign and symptoms are,

  • Dhi Bibhrama (Unstable mind)
  • Satwa Pariplaba (mood swings)
  • Paryakula Drusti (not accommodation in vision)
  • Adhirata (Loss of Patience)
  • Abadhha Vaaktwam (speaking without any reason or non-reliable things).

Vataja Unmada Lakshana:

  • Laughs at the places where should not laugh.
  • Smiles without reason.
  • Dances, sings, speaks without reason
  • Makes improper movement of body
  • Cries in un related things
  • Body becomes hard, lean and dark discoloration
  • Aggravated after digestion of food.

Pittaja Unmada Lakshana:

  • Asamhana Silata (loss of patience)
  • Sarambha (redness in eye)
  • Binagna Bhabah (put off the cloths)
  • Samtarjana (threatening others)
  • Ati Drabana (runs everywhere)
  • Ushnya (warm body)
  • Roshah (gets angry always)
  • Wishes to have cold food and water
  • Yellowish discoloration of body

Kaphaja Unmada Lakshana:

  • Vak Chestita Mandam (speaks and movement less than normal)
  • Arochaka (loss of appetite)
  • Naari Birikta Priyata (likes opposite gender persons and likes solitude)
  • Ati Nidra (excess sleep)
  • Chhardi (vomiting)
  • Excess salivation from mouth
  • Aggravates after intaking food
  • Nails, eyes, skin becomes pale.

Sannipataja Unmada Laksana:

All the symptoms of Vataja, Pittaja and Kaphaja Unmada is seen.

Bhutonmada Laksana:

Speaks, strength, power and movement is not like human or more than human.

Yakshaonmatta Purusha:

Sleeps for a long time Laughs, sings, dances without reason lacrimation and salivation, Tells all the secrets.

Rakshyasonmatta Purusha:

  • Sleeplessness
  • Loss of appetite
  • Strengthens when not taking food
  • Threatens others.

Brahma Rakshyasonmatta Unmada:

  • Poke fun at everybody.
  • Dances without reason
  • Over excitement




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Satwavajaya Chikitsa of Unmada:

The former ones (Sharira Dosha) are pacified by remedial measures of divine and rational qualities while the latter ones (Manas Dosha) can be treated with knowledge of self (jnana), scientific knowledge (Vijnana), restraint/temperance (Dhairya), memory (Smriti) and salvation/concentration (Samadhi).

Those madden by the types of spirits possessing due to longing for pleasure and worship, should be ascertained as such by the liking (intentions) and behavior (conduct) of the patients and should be treated with administration of the mantras (incantations/hymns) and drugs mixed with the respective gifts and offerings.

Verbal teasing or threatening/shouting with anger (Tarjana), terrorizing (Trasanam), gifts/donations (Danam), gladdening and exhilaration (Hanshanam, consolation (Santwanam), frightening (Bhayam) and astonishing/exhibition of surprising acts (Vismaya) restore the mind to normalcy by diverting it and counteracting the causes of loss of memory.

In exogenous type of Unmada, intaking of ghee (Sarpih Pana) etc. along with chanting of hymns (Mantras) is recommended for the benefit of the patient Aswasana (consolation).

The 5 R’s of stress and anxiety reduction:

  • Recognition of the causes and sources of the threat or distress; education and consciousness raising.
  • Relationships identified for support, help, reassurance.
  • Removal from the stress or stressor, managing the stimulus.
  • Relaxation through techniques such as meditation, massage, breathing exercises, or imagery.
  • Re engagement through managed re exposure and desensitization.

References

1. Pedaprolu Srinivasa Rao. Manas: Psychiatry of Ayurveda. 2nd Varanasi: Chowkhamba Sanskrit Series Office. 2014. Page no. 50.

2. Pandit Kasinath Pandey, Gorakhnath Chaturvedi. Charaka Samhita: Savimarsha

Vidyotini Hindi Vyakhyapeto. Part-1. Varanasi; Chaukhambha Bharati Academy: 2018. Page no. 238

3. https://www.clearviewtreatment.com

4. Pandit Kasinath Pandey, Gorakhnath Chaturvedi. Charaka Samhita: savimarsha vidyotini hindivyakhyapeto. Part-2. Varanasi; Chaukhamba Bharati Academy: 2018. Page no. 304-327

5. https://www.helpguide.org/mental /stress signs.html


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