Ayurveda based advocacy for mental health

To promote mental health and prevent illness, there is a need to create such living conditions and environment that support mental health and allow people to adopt and maintain healthy lifestyle. The intake of healthy ‘Ahara’ as per the rules prescribed and adhering to the principles of ‘Dinacharya’, ‘Ritucharya’ , ‘Sadvritta’ & ‘Achara Rasayana’ are the fundamental entities which play a pivotal role in attaining positive mental health. Ayurveda has description of many single drugs and formulations for Psychiatric illnesses like Brahma Rasayanam, Brahmi Ghrita, Kalyankaghritam, Mahakalyanaghirtam, Maha Panchgavya Ghrita, Sarasvata Churna etc

The concept of Dhatusamyata, is also relevant here. It is a state of equilibrium of dhatus, where the word Dhatu stands for Dosha, Dhatu and Mala. It is also the main objective of Ayurveda. The characteristics enumerated under Dhatusamyata encompass the equilibrium state of physical and mental wellbeing and may be considered as the subjective markers for ‘Vikaropashamana’ (alleviation of disease) is as follows

• Alleviation of pain
• Appearance of normal voice and complexion
• Nourishment of the body
• Increase in the strength
• Appetite during the meal time
• Proper digestion of the food taken
• Getting sleep at appropriate time and waking up without fatigue
• Absence of morbid dreams
• Proper elimination of flatus, urine, stool, and semen
• Unimpaired state of the mind, intellect, and senses
• Absence of any type of diseases

General line of treatment of Unmada in Ayurveda

Ayurveda approach Unmada in a holistic approach with due importance to the logic based pharmacotherapy, Panchakarma interventions and psychotherapy in the form of spiritual and psychological interventions.

Daiva –vyapashraya Chikitsa ( Spiritual therapy):

Ayurveda considers individuals as part of the supreme conscience and the role of spirituality has been explained in detail in various contexts. Logical use of Mantra, Aushadhi, Mani (wearing gems), Bali (auspicious offerings), Upahara (gifts to deserving people), Homa( oblations), Niyama (observance of scriptural rules), Prayashchitta (atonement), Upavasa (fasting), Svastyayana (chanting of auspicious hymns), Pranipatagamana (obeisance to the Gods, going to pilgrimage),etc are aimed at boosting the self confidence and mental strength to the individuals.

Satvavajaya Chikitsa:

Satvavajaya Chikitsa literally means controlling the mind, in such a way that it is not acted upon by various stressors making it prone to Prajnaparadha. Acharya Charaka, defines Satvavajaya as withdrawal of mind from unwholesome objects. It includes

• Mano nigraha: regulating mind/subjugating mind from unwholesome interactions
• Dhee-dhairyaatmadi vijnanam: It is providing a deeper level of understanding which helps ultimately in better control of mind.

Charaka also explains the utility of replacing negative emotions with that of positive emotions that is beneficial to psyche. Thus Satvavajaya encompasses various aspects that deal with mind – its physiology, morphology, morbidity and also management of Psychological as well as Psychosomatic diseases.

Yuktivyapashraya Chikitsa :

This includes treatment through logical use of medicines and modification of Ahara and Vihara to suit the needs of the person. The patient should be encouraged to follow proper dietary regimen, follow rules of Sadvrita, to use Medhya Rasayana (medicines that boost psyche) and Doshahara Ousadha (medicines) to control the imbalanced mind.

Medicines usually prescribed for Unmada.

Single drugs:

• Brahmi(Bacopa monnieri)
• Sankhapushpi(Convolvulus pluricalis)
• Yastimadhu(Glycyrrhyza glabra)
• Jyotishmati(Celastrus paniculatus)
• Kushmanda(Benincasa hispida)
• Vacha(Acorus calamus)
• Rasona(Allium sativum)
• Shatavari (Asparagus racemosus)

Other preparations

• Ashwagandharishta
• Saraswatharishta
• Saraswatha churna
• Manasamitra gutika
• Dhanvantara Ghrita
• Panchgavya Ghrita
• Brahmi Ghrita
• Mahakalyanaka Ghrita
• Chetasa Ghrita
• Mahapaishachika Ghrita
• Lashunadya Ghrita
• Mahachetasa Ghrita etc

Panchakarma sodhana procedures are also mentioned to be done, as per the Dosha vitiation. 

Role of Diet in Mental Health and Illness

Diet is said to be basis of life, strength, complexion, Ojas, growth and development, perspicuity of Indriyas, happiness, clarity of voice, lustre, pleasure, increase of Dhatus, intellect, health etc. According to Chhandogya Upanishad, the food inside the body is divided into 3 parts: Sthoola, Madhyama & Anu bhaga which nourish Purisha, Mamsa & Mana respectively, which means the subtle and abstract part of the Anna is Mana. “Annamayam hi soumya manah” is a popular quote from Chandogyopanishad, which means the mind is the essence of food we take. Just as when curd is churned up, the butter which is the finest part gather up, the finest part of food rise up and nourishes Manas.

Since Vedic era, food has been given the prime importance. Three categories of Ahara are described in Bhagvad Geeta (17/8, 9, 10) are Sattvika, Rajasika & Tamasika.

Sattvika persons prefers food which increases life span, nourishes Satva, keeps body healthy, increases happiness and prosperity, which are pleasing and full of nutrients, unctuous in nature, providing stability and conducive for the heart and soul. Those persons who take foods which are very pungent, sour, salty, very hot, very sharp in taste, excessively dry, which causes burning sensation, and foods which causes sadness, depression and various diseases are Rajasika persons and thus such foods can be categorized as Rajasika. Food that is not freshly cooked, unhygienic food or food which is devoid of nutrients, foul smelling, stale, mixed with pollutants, dust etc. and left over food comes under the Tamasika food and which is appreciated and practiced by Tamasika persons.

Habit of taking Ahara which is non-Satvika i.e. Rajasika or Tamasika (continuously for a long time) causes some sort of mental disturbances and later on causes serious mental illnesses like Unmada and Apasmara. Satvika ahara not only consists of food with proper nutrition but also it indicates the rules of taking food should be followed. for eg. Ashtaaharavidhi Visheshayatana (Charaka), Dwadashashan Pravicharana (Susruta).

In the treatment aspect also, specific food along with health-conducive routines/regimens plays an important role along with medicines. Somatic or psychic food plays an important role as a preventive factor, causative factor and as a curative factor. Proper diet helps a healthy person to stay healthy/improve it and prevent illness. In the diseased, it helps in easy recovery, not obstructing the action of medicine and regain lost vigor. The importance of food is studied in all contemporary medical systems but the study regarding the food that influence causation and treatment of psychiatric diseases is comparatively new in modern medicine, called as ‘Nutritional Psychiatry’ and lots of studies are coming in this filed, but Ayurveda owns clear and scientific concepts in this regard. The influence of digestive system on the emotional aspects of human beings is another domain of related study in modern research. Gut is considered as the second brain due to the intrinsic neuronal networks. The age old medical system, Ayurveda elaborated the same concepts eons before.

Importance of Pathya

Pathya Sevana is one of the most important supportive pillars for the successful management of the diseases. The proper use of diet also prevents the diseases and also helps in preventing the recurrence. “Pathyam patho anapetam yadyachoktam manasa priyam ||”

The Ahara and Vihaara which is beneficial and nutritional to the body and also give the happiness to the mind is known as Pathya and opposite to that is known as Apathya. Wholesome food and regimen agreeable to mind and senses promote Tushti (mental satisfaction), Urja (mental strength) and Sukha(happiness) as a result of which disease gets diminished. 

Unwholesome food may not produce disease immediately, but becomes harmful depending on the nature of the locality, time, combination, potency, frequency of intake and quantity. So its effect can be negligible or gruesome depending upon where the person resides, the season prevailing, the associated Doshas and Dhatus, the seat of affliction and the quantity taken. When a person constantly takes unwholesome diet, the body becomes saturated with vitiated Doshas and become susceptible to serious diseases. It is also described that the persons with the habit of taking unwholesome diet and with poor mental strength become susceptible to physical and mental diseases.

These various nidanas described in Ayurvedic texts which are responsible for psychiatric disorders can be grouped under sub categories like Aharaja, Viharaja, Mansika Bhava, Agantuja etc. Though Nidana causing direct harm to mental health are the main etiological agents, beside this Ahara and Vihara also have an equal impact.

Pathya Ahara in Mental Illness

The foods with the qualities like colour, smell, taste and touch can be pleasing to the sense organs and conducive to the health if taken in accordance to the rules is the very life of living beings. If proper, it kindles the digestive fire, promote mental as well as physical strength, complexion, and strength of tissue elements and is pleasing to the senses, otherwise they are harmful.

The Pathyas mentioned in Unmada & Apasmara prakarana of Yoga Ratnakara and Bhaishajya Ratnavali includes: 

• Sakavarga [vegetables], Patola [snake guard], Bramhi [Bacopa monnieri [Linn] Pennell], Shobhanjanam [Moringa olifera], Kakamaci [Solanum nigrum Linn], Vastuka [Chenopodium album Linn.], Tanduliyaka [Amarantlus viridis Linn.].
• Dhanyavarga [cereals/pulses]: Raktha/Aruna-Sali [red rice], Godhuma/Yava [Wheat/barley], Mudga [green gram].
• Phalavarga [fruits]: draksa [grapes], Panasa [jack fruit], Matulunga [Citrus medica Linn], Narikela [coconut], Kapittha [wood apple], Kusmanda [ash gourd], Dhatri [gooseberry], haritaki [terminalia chebula]
• Gorasavarga [Milk and Milk products]: Ksira [Milk], Navanita [Butter], Ghrta [Ghee]
• Paniyavarga [drinks/beverages]: Gangambu [Rain water], Madya [Alcohol], Rasala, Kulmasatarpana [Gruel of Kulmasa].
• Mutravarga* [categories of urine]: Kharamutram [urine of donkey], ashvamutram [urine of horse]
• Mamsa varga [Categories of Meat]: Koorma maamsa [Meat of tortoise]

Nootropics is a newly emerging branch of modern research which study drugs, supplements and other substances that may improve cognitive functions, memory, creativity, motivation etc. Botanical nootropics are described in Ayurveda, which are considered as Medhya, Buddhi vardhaka, Smritikara etc. Some of the fruits and vegetables having these properties are Sesame seeds, Ash gourd, Garlic, Pomegranate, black jeera, coconut etc which can be included in the diet.

Apathya Ahara in Mental Illness

The Apathyas mentioned in Unmada & Apasmara Prakarana of Yoga Ratnakara and Bhaishajya Ratnavali include, over indulgence in meat, fish, alcohol, sex, incompatible, heavy, hot and stale food articles, suppression of sleep, hunger, thirst, and natural urges, excessive exercise, excessive strain, leafy vegetables, bitter food items, bimbi, and rude acts, which are not in accordance with prescribed ethical code of conduct. It is also necessary to consider the different food related aetiological aspects of Unmada before suggesting the diet. In Unmada Prakarana of Charaka Samhita, it is mentioned that a person with a strong mind who does not indulge in meat and wine, who eats only healthy foods, remain clean internally and externally does not affected by either “Nija” or “Agantuja Unmada".

Role of Viharas in mental health and Illness

‘Vihara’ means the activities of daily life in accordance with the societal, economical and cultural norms of any person and Ayurvedic classics have described the healthy routines to be followed in Day time (Dina Charya), in Night time (Ratri Charya), and according to the seasonal variations (Ritu Charya) and codes of conduct (Sadvritha & Achara Rasayana). Resorting to these helps in prevention of diseases of body and mind

Pathya Viharas in Mental Illness

The healthy behavioral patterns to be followed by a person as an individual and a social being include Pathya Vihara, among which Sadvritha and Achara Rasayana that have influence on the mental wellbeing are worth mentioning.

Sadvrittha (Code of conduct)

Sadvritta deals about the positive codes & conducts and morals & values which when followed transform the person belief system, cognitive framework and perceptive ability strengthening his state of positive mental health/ Satva. Following this, helps the person in preventing Prajnaparadha and thereby preventing disease.

Achara Rasayana

Achara Rasayana is a form of Rasayana [means to provide excellence of tissue elements] wherein practices of Sadvritta and habitual intake of natural products [Milk & Ghrita] will bring about excellence of Dhatus/ tissue elements as well as Satva/Positive mental health. It is based on principle of conditioning showing the interrelation & interdependence of mind & body – ‘Psycho-neuro-immunology’. Neurological research has identified over fifty neurotransmitters in the brain, several of which are related to mental health problems – Dopamine, Serotonin, Norepinephrine, and GABA (Gamma Amino Butyric Acid). Too much or too little of these neurotransmitters are now felt to produce psychiatric conditions such as schizophrenia, depression, bipolar disorder, obsessive-compulsive disorder, and ADHD

Achara Rasayana emphasizes the conduct of an individual in social settings. Since, human beings are social animals; definitely their social image and social reputation have an enormous effect on their mental status.

Exercise and the brain

Exercise helps memory and thinking through both direct and indirect means. The benefits of exercise come directly from its ability to reduce insulin resistance, reduce inflammation, and stimulate the release of growth factors—chemicals in the brain that affect the health of brain cells, the growth of new blood vessels in the brain, and even the abundance and survival of new brain cells. Indirectly, exercise improves mood and sleep, and reduces stress and anxiety. Problems in these areas frequently cause or contribute to cognitive impairment.

Many studies have suggested that the parts of the brain that control thinking and memory (the prefrontal cortex and medial temporal cortex) have greater volume in people who exercise versus people who don’t Exercise affects the brain on multiple fronts. It increases heart rate, which pumps more oxygen to the brain. It also aids the bodily release of a plethora of hormones, all of which participate in aiding and providing a nourishing environment for the growth of brain cells.

Exercise stimulates the brain plasticity by stimulating growth of new connections between cells in a wide array of important cortical areas of the brain. From a behavioural perspective, the same antidepressant-like effects associated with “runner’s high” found in humans is associated with a drop in stress hormones

Yoga and Mental Health

The literal meaning of Yoga is ‘to join’, that is joining of Mind and Body. Yoga advocates that every life form is interconnected and united the eight limbed path of yoga includes: Yama (moral codes), niyama (self-discipline), asana (postures), pranyama (breath practices promoting life force), pratyahara (sensory transcendence), dharana (concentration), dhyana (meditation) and samadhi (state of bliss). 

The application of yoga as a therapeutic intervention began early in the twentieth century, taking advantage of the various psycho-physiological benefits of the component practices. The physical exercises (Asanas) may increase patient’s physical flexibility, coordination, and strength, while the breathing practices and meditation may calm and focus the mind to develop greater awareness and diminish anxiety, and thus results in higher quality of life. Other beneficial effects include, a reduction of distress, blood pressure, and improvements in resilience, mood, and metabolic regulation. It has been found in many researches that yoga have positive effects on mild depression and sleep problems, and it improves the symptoms of psychiatric disorders like schizophrenia and ADHD among patients using medication.

Some studies even suggested that yoga might affect the body in ways similar to antidepressants and psychotherapy. For instance, yoga may influence brain chemicals known as neurotransmitters (boosting levels of feel-good agents like serotonin), lower inflammation, reduce oxidative stress and produce a healthier balance of lipids and growth factors — just as other forms of exercise do.

Source : Central Council for Research in Ayurvedic Sciences