Chapter 7 . Unmada Nidana (Chapter on diagnosis of psychosis disorders)

Chapter 7 . Unmada Nidana (Chapter on diagnosis of psychosis disorders)

अथात उन्मादनिदानं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athāta unmādanidānaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||


I shall now describe the chapter on the diagnosis of unmada. Thus said Lord Atreya.[1- 2]

Five types of unmada

इह खलु पञ्चोन्मादा भवन्ति|

तद्यथा- वातपित्तकफसन्निपातागन्तुनिमित्ताः||३||

iha khalu pañcōnmādā bhavanti|

tadyathā- vātapittakaphasannipātāgantunimittāḥ||3||



There are five types of unmada such as 

• those caused due to the three doshas, 

1. vataja
2. pittaja
3. kaphaja

• sannipata (simultaneous vitiation of the three doshas), 

    4. Sannipataja / tridoshaja 

• exogenous causes. [3]

  5. agantu nimitta

Individuals prone to unmada

तत्र दोषनिमित्ताश्चत्वारः पुरुषाणामेवंविधानां क्षिप्रमभिनिर्वर्तन्ते; 
tatra dōṣanimittāścatvāraḥ puruṣāṇāmēvaṁvidhānāṁ kṣipramabhinirvartantē; 


This verse describes 

• the qualities of a person prone to getting afflicted with unmada, 
• as well as the conditions that are conducive to the affliction of the disease:

समलविकृतोपहितान्यनुचितान्याहारजातानि वैषम्ययुक्तेनोपयोगविधिनोपयुञ्जानानां तन्त्रप्रयोगमपि विषममाचरतामन्याश्च शरीरचेष्टा विषमाः समाचरतामत्युपक्षीणदेहानां व्याधिवेगसमुद्भ्रमितानामुपहतमनसां वा 
samalavikr̥tōpahitānyanucitānyāhārajātāni vaiṣamyayuktēnōpayōgavidhinōpayuñjānānāṁ tantraprayōgamapi viṣamamācaratāmanyāśca śarīracēṣṭā viṣamāḥsamācaratāmatyupakṣīṇadēhānāṁ vyādhivēgasamudbhramitānāmupahatamanasāṁ [1] vā

तद्यथा- भीरूणामुपक्लिष्टसत्त्वानामुत्सन्नदोषाणां

tadyathā- bhīrūṇāmupakliṣṭasattvānāmutsannadōṣāṇāṁ

Four types of doshika unmada quickly manifest in individuals 

- who are 

• fearful, 
• confused and 
• complicated, 

 - who 

• do not know societal rules and norms, and 

 - who lead erratic lifestyles and dietary habits (

• unclean, 
• unwholesome, 
• untimely eating habits, as well as 
• neglecting any prescribed dietetic rules). 

Doshas in such individuals 

• are in a volatile state and 
• are prone to getting vitiated.

Resorting to 

• specific lifestyle activities that are not conducive to good health, 
• especially when the body is exceedingly weak & cachexic;
• the person is ailing from various diseases;

कामक्रोधलोभहर्षभयमोहायासशोकचिन्तोद्वेगादिभिर्भूयोऽभिघाताभ्याहतानां वा मनस्युपहते बुद्धौ च प्रचलितायामभ्युदीर्णा दोषाः प्रकुपिता हृदयमुपसृत्य मनोवहानि स्रोतांस्यावृत्य जनयन्त्युन्मादम्||४||

kāmakrōdhalōbhaharṣabhayamōhāyāsaśōkacintōdvēgādibhirbhūyō'bhighātābhyāhatānāṁ vā manasyupahatē buddhau ca pracalitāyāmabhyudīrṇā [2] dōṣāḥprakupitā hr̥dayamupasr̥tya manōvahāni srōtāṁsyāvr̥tya janayantyunmādam||4||

 

- the mind is afflicted repeatedly by 

• desires, 
• anger, 
• greed, 
• excitement, 
• fear, 
• attachment, 
• exertion, 
• anxiety and 
• grief; and

• the person is subjected to excessive mental trauma / physical assault.

 - Such individuals often get afflicted with subclinical mental disorders,

•  leading to unstable intellect because of volatile doshas. 

When 

• the seat of consciousness, 
• wisdom, and 
• the system that regulates mental activities 

 - are badly affected, 

•  then all these factors lead to the manifestation of unmada. [4]

Types of cognitive distortions

उन्मादं पुनर्मनोबुद्धिसञ्ज्ञाज्ञानस्मृतिभक्तिशीलचेष्टाचारविभ्रमंविद्यात्||५||

unmādaṁ punarmanōbuddhisañjñājñānasmr̥tibhaktiśīlacēṣṭācāravibhramaṁ [1] vidyāt||5||



Unmada is again defined as 
- cognitive distortion pertaining to 

• mind, 
• intellect, 
• consciousness, 
• knowledge, 
• memory, 
• desire, 
• attitude, 
• activities and 
• behavior. [5]

Premonitory symptoms

तस्येमानि पूर्वरूपाणि; तद्यथा- शिरसः शून्यता, चक्षुषोराकुलता, स्वनः कर्णयोः, उच्छ्वासस्याधिक्यम्, आस्यसंस्रवणम्, अनन्नाभिलाषारोचकाविपाकाः, हृद्ग्रहः, ध्यानायाससम्मोहोद्वेगाश्चास्थाने, सततं लोमहर्षः, ज्वरश्चाभीक्ष्णम् उन्मत्तचित्तत्वम्, उदर्दित्वम् अर्दिताकृतिकरणं च व्याधेः, स्वप्ने चाभीक्ष्णं दर्शनं भ्रान्तचलितानवस्थितानां रूपाणामप्रशस्तानां च तिलपीडकचक्राधिरोहणं वातकुण्डलिकाभिश्चोन्मथनं निमज्जनं च कलुषाणामम्भसामावर्ते चक्षुषोश्चापसर्पणमिति(दोषनिमित्तानामुन्मादानां पूर्वरूपाणि भवन्ति)||६||

tasyēmāni pūrvarūpāṇi; tadyathā- śirasaḥ śūnyatā, cakṣuṣōrākulatā, svanaḥ karṇayōḥ, ucchvāsasyādhikyam, āsyasaṁsravaṇam, anannābhilāṣārōcakāvipākāḥ,hr̥dgrahaḥ, dhyānāyāsasammōhōdvēgāścāsthānē, satataṁ lōmaharṣaḥ, jvaraścābhīkṣṇam, unmattacittatvam, udarditvam [1] , arditākr̥tikaraṇaṁ ca vyādhēḥ, svapnēcābhīkṣṇaṁ darśanaṁ bhrāntacalitānavasthitānāṁ rūpāṇāmapraśastānāṁ ca tilapīḍakacakrādhirōhaṇaṁ vātakuṇḍalikābhiścōnmathanaṁ nimajjanaṁ cakaluṣāṇāmambhasāmāvartē cakṣuṣōścāpasarpaṇamiti [2] (dōṣanimittānāmunmādānāṁ pūrvarūpāṇi bhavanti)||6||


Following are the premonitory symptoms of unmada:

• Blankness of thought,
• Restless eyes,
• Tinnitus,
• Prolonged exhalation,
• Hyper-salivation,
• Disinclination towards food associated with anorexia and indigestion,
• Feeling of tightness in cardiac region,
• Uncalled for attention, fatigue, confusion and panic,
• Continuous horripilation,
• Frequent fever,
• Insanity,
• Erythematous rashes over the body,
• Distorted faces (as in Bell’s palsy or facial paralysis)
• Dreams with the following recurrent themes--
• Terrifying & inauspicious objects that are wandering, moving and unstable;
• Riding over the wheel of an oil press;
• Being churned by whirl-winds;
• Sinking in dirty whirl-pools; and
• Distortion of eyes.

These are the pre-monitory symptoms of unmada caused by the vitiation of doshas. [6]


Specific features of vatika type unmada

ततोऽनन्तरमेवमुन्मादाभिनिर्वृत्तिरेव| तत्रेदमुन्मादविशेषविज्ञानं भवति; तद्यथा- परिसरणमजस्रम्, अक्षिभ्रुवौष्ठांसहन्वग्रहस्तपादाङ्गविक्षेपणमकस्मात्,सततमनियतानां च गिरामुत्सर्गः, फेनागमनमास्यात्, अभीक्ष्णं स्मितहसितनृत्यगीतवादित्रसम्प्रयोगाश्चास्थाने, वीणावंशशङ्खशम्यातालशब्दानुकरणमसाम्ना, यानमयानैः, अलङ्करणमनलङ्कारिकैर्द्रव्यैः, लोभश्चाभ्यवहार्येष्वलब्धेषु, लब्धेषु चावमानस्तीव्रमात्सर्यं च, कार्श्यं, पारुष्यम्, उत्पिण्डितारुणाक्षता वातोपशयविपर्यासादनुपशयता च; इति वातोन्मादलिङ्गानि भवन्ति(१);

tatō'nantaramēvamunmādābhinirvr̥ttirēva| tatrēdamunmādaviśēṣavijñānaṁ bhavati; tadyathā- parisaraṇamajasram, akṣibhruvauṣṭhāṁsahanvagrahastapādāṅgavikṣēpaṇamakasmāt [1] , satatamaniyatānāṁca girāmutsargaḥ, phēnāgamanamāsyāt, abhīkṣṇaṁ smitahasitanr̥tyagītavāditrasamprayōgāścāsthānē, vīṇāvaṁśaśaṅkhaśamyātālaśabdānukaraṇamasāmnā,yānamayānaiḥ, alaṅkaraṇamanalaṅkārikairdravyaiḥ, lōbhaścābhyavahāryēṣvalabdhēṣu, labdhēṣu [2] cāvamānastīvramātsaryaṁ ca, kārśyaṁ, pāruṣyam,utpiṇḍitāruṇākṣatā, vātōpaśayaviparyāsādanupaśayatā ca; iti vātōnmādaliṅgāni bhavanti(1);


After the above stage, unmada manifests. The distinctive features of vatika type of unmada are as follows:

• Constant wandering
• Sudden spasm of eyes, eyebrows, lips, jaws, and irregular movements of shoulder, fore-arms and legs;
• Continuous, irrelevant and incoherent speech;
• Frothing from the mouth;
• Frequent smiling, laughing, dancing, singing and playing musical instruments in inappropriate situations;
• Loudly imitating the sounds of lute, flute, conch, samya (cymbal played by right hand), and tala (cymbal played by left hand);
• Riding phantom vehicles;
• Adoration of self by false ornaments;
• Craving for food articles that are not available;
• Disgust and hatred for food articles that are readily available.
• Emaciation and roughness;
• Protruding dusky red eyes;
• Aggravation by vata-provoking factors; and
• Pacification by factors which are opposite to vata

These are the features of vatika type of unmada. [7-1]

Features of paittika type unmada

अमर्षः, क्रोधः, संरम्भश्चास्थाने, शस्त्रलोष्ट्रकशाकाष्ठमुष्टिभिरभिहननं स्वेषां परेषां वा, अभिद्रवणं, प्रच्छायशीतोदकान्नाभिलाषः, सन्तापश्चातिवेलं, ताम्रहरितहारिद्रसंरब्धाक्षता, पित्तोपशयविपर्यासादनुपशयता च; इति पित्तोन्मादलिङ्गानि भवन्ति(२) ;

amarṣaḥ, krōdhaḥ, saṁrambhaścāsthānē, śastralōṣṭrakaśākāṣṭhamuṣṭibhirabhihananaṁ svēṣāṁ parēṣāṁ vā, abhidravaṇaṁ, pracchāyaśītōdakānnābhilāṣaḥ,santāpaścātivēlaṁ, tāmraharitahāridrasaṁrabdhākṣatā, pittōpaśayaviparyāsādanupaśayatā ca; iti pittōnmādaliṅgāni bhavanti(2);

• Intolerance, anger and excitement at inappropriate occasions;
• Inflicting injury on self or on others by weapons, brickbats, whips, sticks and fist.
• Running around
• Desire for shade, cold water and food having cooling effect;
• Prolonged anguish;
• Ferocious eyes with coppery, green or yellow color;
• Aggravation of the signs and symptoms by pitta provoking factors
• Pacification by factors which are opposite to pitta

are the features of paittika type of unmada.[7-2]

Features of kaphaja type unmada

स्थानमेकदेशे, तूष्णीम्भावः, अल्पशश्चङ्क्रमणं, लालाशिङ्घाणकस्रवणम्, अनन्नाभिलाषः,रहस्कामता, स्वप्ननित्यता, शौचद्वेषः, बीभत्सत्वं, श्वयथुरानने, शुक्लस्तिमितमलोपदिग्धाक्षत्वं, श्लेष्मोपशयविपर्यासादनुपशयता च; इति श्लेष्मोन्मादलिङ्गानि भवन्ति(३);त्रिदोषलिङ्गसन्निपाते तु सान्निपातिकं विद्यात्; तमसाध्यमाचक्षते कुशलाः||७||

sthānamēkadēśē, tūṣṇīmbhāvaḥ, alpaśaścaṅkramaṇaṁ, lālāśiṅghāṇakasravaṇam, anannābhilāṣaḥ, rahaskāmatā, bībhatsatvaṁ, śaucadvēṣaḥ, svapnanityatā,śvayathurānanē, śuklastimitamalōpadigdhākṣatvaṁ, ślēṣmōpaśayaviparyāsādanupaśayatā ca; iti ślēṣmōnmādaliṅgāni bhavanti(3); tridōṣaliṅgasannipātē tu sānnipātikaṁ vidyāt; tamasādhyamācakṣatē kuśalāḥ||7||

|

• Prefers to live at one place (doesn’t move/ immobility)
• Meek and mum, prefers not to speak;
• Excessive salivation and nasal secretions;
• Disinclination for food
• Prefers loneliness
• Frightening appearance;
• Aversion for cleanliness;
• Always drowsy;
• Edematous face;
• White and timid eyes full of dirt;
• Aggravation of the signs & symptoms by kapha provoking factors
• Pacification by factors which are opposite to kapha

These are the features of kaphaja type of unmada.

Features of sannipatika type unmada: 

In the unmada caused by the combined vitiation of all the three doshas, 

• all the symptoms mentioned above are simultaneously manifested. 
• This type of unmada is considered to be incurable. [7-3]

Management of unmada

साध्यानां तु त्रयाणां साधनानि- स्नेहस्वेदवमन विरेचनास्थापनानुवासनोपशमन नस्तःकर्मधूमधूपनाञ्जनावपीड प्रधमनाभ्यङ्गप्रदेह परिषेकानुलेपनवधबन्धनावरोधन वित्रासनविस्मापनविस्मारणापतर्पण सिराव्यधनानि, - भोजनविधानं च यथास्वं युक्त्या, यच्चान्यदपि किञ्चिन्निदानविपरीतमौषधं तदपि कार्यं स्यादिति||८||

sādhyānāṁ tu trayāṇāṁ sādhanāni- snēhasvēdavamanavirēcanāsthāpanānuvāsanōpaśamananastaḥkarmadhūmadhūpanāñjanāvapīḍapradhamanābhyaṅgapradēhapariṣēkānulēpanavadhabandhanāvarōdhana-vitrāsanavismāpanavismāraṇāpatarpaṇasirāvyadhanāni, bhōjanavidhānaṁ ca yathāsvaṁ yuktyā, yaccānyadapi kiñcinnidānaviparītamauṣadhaṁ kāryaṁ tadapisyāditi||8||


Modalities of treatment of the three types of curable unmada are:

• Oleation, fomentation, emesis, purgation, asthapana enema, anuvasana enema
• Alleviation therapies
• Nasal medication, smoking, fumigation, collyrium, avapida and pradhamana types of nasal medication
• Massage, ointment, affusion, and unction
• Assaulting at times, tying, solitary confinement, frightening, and inducing shock
• Depleting therapies and venesection.
• Suitable diets should be given according to the requirement of the patient. 

Such other therapies as would work against the causative factors of the disease should also be given. [8]

भवति चात्र-

उन्मादान् दोषजान् साध्यान् साधयेद्भिषगुत्तमः|

अनेन विधियुक्तेन कर्मणा यत् प्रकीर्तितम्||९||

bhavati cātra-

unmādān dōṣajān sādhyān sādhayēdbhiṣaguttamaḥ|

anēna vidhiyuktēna karmaṇā yat prakīrtitam||9||



Thus it is said :

A competent physician should 

• selectively employ the above-mentioned therapies to treat the curable types of unmada 
• caused by the vitiation of doshas 
• as per the fundamental principles of the prescribed therapy. [9]

Exogenous unmada

यस्तु दोषनिमित्तेभ्य उन्मादेभ्यः समुत्थानपूर्वरूपलिङ्गवेदनोपशयविशेषसमन्वितो भवत्युन्मादस्तमागन्तुकमाचक्षते|

केचित् पुनः पूर्वकृतं कर्माप्रशस्तमिच्छन्ति तस्य निमित्तम् |

तस्य च हेतुः प्रज्ञापराध एवेति भगवान् पुनर्वसुरात्रेयः|

प्रज्ञापराधाद्ध्ययं देवर्षिपितृगन्धर्वयक्षराक्षसपिशाच गुरुवृद्धसिद्धाचार्यपूज्यानवमत्याहितान्याचरति, अन्यद्वा किञ्चिदेवंविधं कर्माप्रशस्तमारभते; तमात्मना हतमुपघ्नन्तो देवादयःकुर्वन्त्युन्मत्तम्||१०||

yastu dōṣanimittēbhya unmādēbhyaḥ samutthānapūrvarūpaliṅgavēdanōpaśayaviśēṣasamanvitō bhavatyunmādastamāgantukamācakṣatē|

kēcit punaḥ pūrvakr̥taṁ karmāpraśastamicchanti tasya nimittam|

tasya [1] ca hētuḥ prajñāparādha ēvēti bhagavān punarvasurātrēyaḥ|

prajñāparādhāddhyayaṁ dēvarṣipitr̥gandharvayakṣarākṣasapiśācaguruvr̥ddhasiddhācāryapūjyānavamatyāhitānyācarati, anyadvā kiñcidēvaṁvidhaṁkarmāpraśastamārabhatē; tamātmanā hatamupaghnantō dēvādayaḥ kurvantyunmattam||10||



The type of unmada having 

• etiology, 
• premonitory symptoms, 
• signs and symptoms, 
• pain and 
• favorable therapeutics (upashaya) different from those of the types of unmada caused by the vitiation of doshas 

 - are known to be of exogenous type. 

Some scholars hold the view that 

• this type of unmada is caused by the effect of the activities of the past life. 

Lord Atreya considers 

• intellectual errors as the causative factor of this condition. 

Due to intellectual errors, 
the patient disregards 

• the Gods, 
• ascetics, 
• ancestors, 
• gandharvas, 
• yakshas, 
• rakshasas, 
• pishachas, 
• preceptors, 
• elders, 
• teachers and 
• the other respectable ones. 

He also resorts to 

• undesirable and 
• inauspicious (or blasphemous) activities. 

The gods etc. cause unmada in him 

• because of his own inauspicious activities. [10]

Premonitory symptoms of exogenous unmada

तत्र देवादिप्रकोपनिमित्तेनागन्तुकोन्मादेन पुरस्कृतस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- देवगोब्राह्मणतपस्विनां हिंसारुचित्वं, कोपनत्वं, नृशंसाभिप्रायता,अरतिः ओजोवर्णच्छायाबल वपुषामुपतप्तिः, स्वप्ने च देवादिभिरभिभर्त्सनंप्रवर्तनं चेति; ततोऽनन्तरमुन्मादाभिनिर्वृत्तिः||११||

tatra dēvādiprakōpanimittēnāgantukōnmādēna puraskr̥tasyēmāni pūrvarūpāṇi bhavanti; tadyathā- dēvagōbrāhmaṇatapasvināṁ hiṁsārucitvaṁ, kōpanatvaṁ,nr̥śaṁsābhiprāyatā, aratiḥ, ōjōvarṇacchāyābalavapuṣāmupataptiḥ, svapnē ca dēvādibhirabhibhartsanaṁ pravartanaṁ cēti; tatō'nantaramunmādābhinirvr̥ttiḥ||11||



The premonitory symptoms of exogenous unmada are as follows:

• Desire for inflicting injury upon the gods, cows, brahmins and ascetics;
• Anger;
• Desire for inflicting cruel acts, torture, etc. on living beings
• Restlessness
• Impairment of ojas, colour, complexion and physical strength
• Abuse and incitement of the gods etc. in dreams.

  - Unmada manifests soon after the occurrence of these premonitory symptoms. [11]

तत्रायमुन्मादकराणां भूतानामुन्मादयिष्यतामारम्भविशेषो भवति; तद्यथा- अवलोकयन्तो देवा जनयन्त्युन्मादं,गुरुवृद्धसिद्धमहर्षयोऽभिशपन्तः , पितरो दर्शयन्त: स्पृशन्तो गन्धर्वाः, समाविशन्तो यक्षाः राक्षस्त्वात्मगन्धमाघ्रापयन्तः, पिशाचाः पुनरारुह्य वाहयन्तः||१२||

tatrāyamunmādakarāṇāṁ bhūtānāmunmādayiṣyatāmārambhaviśēṣō bhavati; tadyathā- avalōkayantō dēvā janayantyunmādaṁ,guruvr̥ddhasiddhamaharṣayō'bhiśapantaḥ, pitarō darśayantaḥ [1] , spr̥śantō gandharvāḥ, samāviśantō yakṣāḥ, rākṣasāstvātmagandhamāghrāpayantaḥ, piśācāḥpunarāruhya vāhayantaḥ||12||



The various divine entities unleash their wrath on the individual as follows:

• Godly spirits cause devonmada (divine unmada)
• Preceptors, elders, adepts and ascetics cause unmada by their curse
• Ancestors by manifesting themselves;
• Gandharvas by their touch;
• Yakshas by entering the host;
• Rakshasas by making the person inhale the odor of their bodies,
• Pishachas by seizing and riding the host.[12]

Symptoms of exogenous unmada

तस्येमानि रूपाणि भवन्ति ; तद्यथा- अत्यात्मबलवीर्य पौरुषपराक्रम ग्रहणधारणस्मरणज्ञानवचनविज्ञानानि; अनियतश्चोन्मादकालः||१३||

tasyēmāni rūpāṇi bhavanti; tadyathā- atyātmabalavīryapauruṣaparākramagrahaṇadhāraṇasmaraṇajñānavacanavijñānāni [1] , aniyataścōnmādakālaḥ||13||



Characteristics of a patient afflicted with exogenous unmada are:

• Untimely, uncertain and uncalled for manifestations 
• superhuman strength, 
• valor, 
• manliness, 
• enthusiasm, 
• power of understanding and retention, 
• memory, 
• spirituality, 
• logical and 
• scientific knowledge and 
• power of speech. [13]

उन्मादयिष्यतामपि खलु देवर्षिपितृगन्धर्वयक्षराक्षसपिशाचानां गुरुवृद्धसिद्धानां वा एष्वन्तरेष्वभिगमनीयाः पुरुषा भवन्ति; तद्यथा- पापस्य कर्मणः समारम्भे, पूर्वकृतस्य वा कर्मणः परिणामकाले, एकस्य वा शून्यगृहवासे,चतुष्पथाधिष्ठाने वा, सन्ध्यावेलायामप्रयतभावे वा पर्वसन्धिषु वा मिथुनीभावे, रजस्वलाभिगमने वा विगुणे ,नियमव्रतब्रह्मचर्यभङ्गे वा, महाहवे वा, देशकुलपुरविनाशे वा, महाग्रहोपगमने वा, स्त्रिया वा प्रजननकाले, विविधभूताशुभाशुचिस्पर्शने वा, वमनविरेचनरुधिरस्रावे, अशुचेरप्रयतस्य वा चैत्यदेवायतनाभिगमने वा,मांसमधुतिलगुडमद्योच्छिष्टे वा, दिग्वाससि वा, निशि नगरनिगमचतुष्पथोपवनश्मशानाघातनाभिगमने वा, द्विजगुरुसुरयतिपूज्याभिधर्षणे वा, धर्माख्यानव्यतिक्रमे वा, अन्यस्य वा कर्मणोऽप्रशस्तस्यारम्भे, इत्यभिघातकाला व्याख्याता भवन्ति||१४||

unmādayiṣyatāmapi khalu dēvarṣipitr̥gandharvayakṣarākṣasapiśācānāṁ guruvr̥ddhasiddhānāṁ vā ēṣvantarēṣvabhigamanīyāḥ puruṣā bhavanti; tadyathā-pāpasyakarmaṇaḥ samārambhē, pūrvakr̥tasya vā karmaṇaḥ pariṇāmakālē, ēkasya vā śūnyagr̥havāsē catuṣpathādhiṣṭhānē vā, sandhyāvēlāyāmaprayatabhāvē vāparvasandhiṣu vā mithunībhāvē, rajasvalābhigamanē vā, viguṇē vā'dhyayanabalimaṅgalahōmaprayōgē, niyamavratabrahmacaryabhaṅgē vā, mahāhavē vā,dēśakulapuravināśē vā, mahāgrahōpagamanē vā, striyā vā prajananakālē, vividhabhūtāśubhāśucisparśanē vā, vamanavirēcanarudhirasrāvē, aśucēraprayatasya vācaityadēvāyatanābhigamanē vā, māṁsamadhutilaguḍamadyōcchiṣṭē vā, digvāsasi vā, niśi nagaranigamacatuṣpathōpavanaśmaśānāghātanābhigamanē vā,dvijagurusurayatipūjyābhidharṣaṇē vā, dharmākhyānavyatikramē vā, anyasya vā karmaṇō'praśastasyārambhē, ityabhighātakālā vyākhyātā bhavanti||14||



Persons get afflicted by unmada caused by godly spirits, ascetics, ancestors, gandharvas, yakshas, rakshasas, pishachas, preceptors, elders and adepts in the following circumstances, places and time:

• In the beginning of sinful acts;
• When the consequences of prior (sinful) acts of the person (committed in the present life or the past) manifest their effect (karmic effects);
• (Living) in a deserted house or crossing roads alone;
• Sexual intercourse during the junctures of day and night or during the new moon and full moon nights (considered inappropriate and inauspicious for sex).
• Sexual intercourse with a lady during her menstrual period;
• Recitation of scriptures, religious offerings, auspicious rites and sacrifices in improper manner.
• Dishonoring a vow and discontinuing a religious duty or observance of celibacy
• Fierce battles;
• Destruction of countries, communities and towns;
• Onset of inauspicious planets in the sky;
• Post-partum depression;
• Coming in contact with different types of inauspicious and unclean creatures;
• Emesis, purgation and bleeding;
• Visiting a chaitya (sacred tree) or temple when unclean and not following the prescribed rules;
• Not using mouthwash after eating meat, honey, sesame seeds, sugar candy and alcohol;
• While being naked;
• Visiting cities, towns, crossroads, gardens, cremation grounds, slaughter houses at night;
• Insulting dvija (twice born), preceptors, Gods and divinities, ascetics and the learned;

Thus, described were some circumstances in which 

• a person attracts the wrath of gods, divinities, and the sages and 
• gets afflicted with unmada. [14]

त्रिविधं तु खलु उन्मादकराणां भूतानामुन्मादने प्रयोजनं भवति; तद्यथा- हिंसा, रतिः, अभ्यर्चनं चेति तेषां तं प्रयोजनविशेषमुन्मत्ताचार विशेषलक्षणैर्विद्यात्| हिंसा, अप्सु वा स्थलाच्छ्वभ्रे निमज्जति, पतति, शस्त्रकशाकाष्ठलोष्टमुष्टिभिर्हन्त्यात्मानम्, अन्यच्च प्राणवधार्थमारभते किञ्चित्, विद्यात्; तमसाध्यं साध्यौ पुनर्द्वावितरौ||१५||

trividhaṁ tu khalūnmādakarāṇāṁ bhūtānāmunmādanē prayōjanaṁ bhavati; tadyathā- hiṁsā, ratiḥ, abhyarcanaṁ cēti| tēṣāṁ taṁ prayōjanaviśēṣamunmattācāraviśēṣalakṣaṇairvidyāt| tatra hiṁsārthinōnmādyamānō'gniṁ praviśati, apsu nimajjati, sthalācchvabhrē vā patati, śastrakaśākāṣṭhalōṣṭamuṣṭibhirhantyātmānam, anyaccaprāṇavadhārthamārabhatē kiñcit, tamasādhyaṁ vidyāt; sādhyau punardvāvitarau||15||



Unmada is caused by the above mentioned agents with the following objectives:

• as a consequence of one’s sinful acts
• affection/love/pleasure and
• to make the individual pay obeisance to Gods

The prognosis of unmada can be judged from 

• the characteristic features of the patient. 
• When the intention of the afflicted agents 
• is to inflict injury, 
• then the patient enters into fire, 
• sinks into water, 
• falls into a pit, 
• provokes others to hurt him, 
• strikes himself with weapons, whips, sticks, brick bats, his own fist etc. 
• He may also adopt to such other means of killing himself. 

• This type of unmada is incurable.

The other two types of intentions 
1. i.e. for affection/love/pleasure or 
2. to offer prayer 

• give rise to variants of unmada that are curable. [15]

Treatment of exogenous unmada

तयोः साधनानि-
मन्त्रौषधिमणिमङ्गलबल्युपहारहोमनियमव्रतप्रायश्चित्तोपवास स्वस्त्ययनप्रणिपातगमनादीनि||१६||

tayōḥ sādhanāni-

mantrauṣadhimaṇimaṅgalabalyupahārahōmaniyamavrataprāyaścittōpavāsa svastyayanapraṇipātagamanādīni||16||



For the curable variants of exogenous unmada, the prescribed therapies are:

• Incantation of mantras,
• Wearing of gems and jewels according to astrological indications,
• Performance of auspicious and religious rites and sacrifices, oblations
• Taking a vow, performing religious duties, penance, fasting, blessings, obeisance and pilgrimage. [16]
• Role of dosha in causing various types of unmada

एवमेते पञ्चोन्मादा व्याख्याता भवन्ति||१७||

ēvamētē pañcōnmādā vyākhyātā bhavanti||17||


In the following verses, the five types of unmada have been explained. [17]

ते तु खलु निजागन्तुविशेषेण साध्यासाध्यविशेषेण च प्रविभज्यमानाः

पञ्च सन्तो द्वावेव भवतः| तौ च परस्परमनुबध्नीतः कदाचिद्यथोक्तहेतुसंसर्गात् |

तयोः संसृष्टमेव पूर्वरूपं भवति, संसृष्टमेव च लिङ्गम्| तत्रासाध्यसंयोगं साध्यासाध्यसंयोगं चासाध्यं विद्यात्, साध्यं तु साध्यसंयोगम् |

तस्य साधनं साधनसंयोगमेव विद्यादिति||१८||

tē tu khalu nijāgantuviśēṣēṇa sādhyāsādhyaviśēṣēṇa ca pravibhajyamānāḥ pañca santō dvāvēva bhavataḥ|

tau ca parasparamanubadhnītaḥ kadācidyathōktahētusaṁsargāt|

tayōḥ saṁsr̥ṣṭamēva pūrvarūpaṁ bhavati, saṁsr̥ṣṭamēva ca liṅgam|

tatrāsādhyasaṁyōgaṁ sādhyāsādhyasaṁyōgaṁ cāsādhyaṁ vidyāt, sādhyaṁ tu sādhyasaṁyōgam|

tasya sādhanaṁ sādhanasaṁyōgamēva vidyāditi||18||



The unmada of five types can be further classified as 
1. endogenous or exogenous or 
2. as curable or incurable. 

At times, due to the combination of etiological factors (of endogenous and exogenous types), 

• these could also manifest in hybrid forms. 

Such forms would exhibit 

• a combination of both the types of unmada in their premonitory as well as actual symptoms. 

However, it is important to note that:

• Combination of the incurable types or of the curable and incurable types result in an incurable condition.
• Combination of curable types results in curable conditions that should be treated using a combination of therapies. [18]

Responsible factors for unmada

भवन्ति चात्र-
नैव देवा न गन्धर्वा न पिशाचा न राक्षसाः|

bhavanti cātra-

naiva dēvā na gandharvā na piśācā na rākṣasāḥ|

• Neither gods / देवा, 
• nor gandharvas / गन्धर्वा, 
• nor pishachas / पिशाचा
• nor rakshasas  /राक्षसाः 

- afflict a person who himself is free from misdeeds.

न चान्ये स्वयमक्लिष्टमुपक्लिश्नन्ति मानवम्||१९||

na cānyē svayamakliṣṭamupakliśnanti mānavam||19||

The primary cause of unmada in an individual is 

• the consequences of his own misdeeds स्वयमक्लिष्ट and 
• not other agents like the gods etc.  / न चान्ये [19]

ये त्वेनमनुवर्तन्ते क्लिश्यमानं स्वकर्मणा |

yē tvēnamanuvartantē kliśyamānaṁ svakarmaṇā|


If the primary cause of unmada is 

• misdeeds of the individual / स्वकर्मणा

 - then how could the causation of these exogenous unmada be attributed to divinities? 

न स तद्धेतुकः क्लेशो न ह्यस्ति कृतकृत्यता||२०||

na sa taddhētukaḥ klēśō [1] na hyasti kr̥takr̥tyatā||20||

Misdeeds committed already cannot be undone, 
   
- but good deeds can 

• pacify 
• or neutralize the effects of these exogenous factors. [20]

प्रज्ञापराधात् सम्भूते व्याधौ कर्मज आत्मनः|

prajñāparādhāt sambhūtē vyādhau karmaja ātmanaḥ|



All the diseases whether karmaja (due to misdeeds) or atman (due to one’s self) 

• are caused due to intellectual errors / प्रज्ञापराधात्. 

नाभिशंसेद्बुधो देवान्न पितॄन्नापि राक्षसान्||२१|

nābhiśaṁsēdbudhō dēvānna pitr̥̄nnāpi rākṣasān||21||

• The Gods, ancestors or rakshasas shall not be blamed for any disease. [21]

आत्मानमेव मन्येत कर्तारं सुखदुःखयोः|
तस्माच्छ्रेयस्करं मार्गं प्रतिपद्येत नो त्रसेत्||२२||

ātmānamēva manyēta kartāraṁ sukhaduḥkhayōḥ|
tasmācchrēyaskaraṁ mārgaṁ pratipadyēta nō trasēt||22||



One should hold himself responsible for his happiness and miseries  सुखदुःखयोः . 

• Therefore, one should follow the path of welfare - sreyaskaram margam - without apprehensions. [22]

देवादीनामपचितिर्हितानां चोपसेवनम्|

dēvādīnāmapacitirhitānāṁ cōpasēvanam|

1. Prayers to the Gods etc. and 
2. resorting to wholesome dietary and lifestyle habits act as 

• antidotes to the misdeeds of the individual. 

ते च तेभ्यो विरोधश्च सर्वमायत्तमात्मनि||२३||

tē ca [1] tēbhyō virōdhaśca sarvamāyattamātmani||23||

Thus, the choice either to avert or get afflicted with unmada rests with the individual himself. [23]

Summary

तत्र श्लोकः-
सङ्ख्या निमित्तं प्राग्रूपं लक्षणं साध्यता न च|
उन्मादानां निदानेऽस्मिन् क्रियासूत्रं च भाषितम्||२४||

tatra ślōkaḥ-
saṅkhyā nimittaṁ prāgrūpaṁ lakṣaṇaṁ sādhyatā na ca|
unmādānāṁ nidānē'smin kriyāsūtraṁ ca bhāṣitam||24||



In summary, 

• types of unmada 
  सङ्ख्या 
  and 
• their etiology 
  निमित्तं
  , 
• premonitory symptoms
    प्राग्रूपं  
  , 
• symptoms,
  लक्षणं
   
• curability or otherwise, 
  साध्यता न च|
  and 
• their modes of treatment 
  क्रियासूत्रं

        - have been described in this chapter. [ 24] 

Thus ends the seventh chapter on diagnosis of unmada in Nidana Sthana in the treatise composed by Agnivesha and redacted by Charaka . [24]