The Compendium of Caraka 6.9: navamo 'adhyāyaḥ/

Now hereafter we shall explain the treatment of insanity.

Thus spoke the venerable Ātreya:

Punarvasu, the abode of intellect, memory, knowledge, and austerity, the refuge of living beings, / when questioned at the proper time, declared to Agniveśa the causes, forms, and medicines of insanity:

Incompatible, corrupted, and impure foods, insults to gods, teachers, and twice-born, / mental trauma preceded by fear or extreme joy, and erratic activities are the causes of insanity.

By these, in a person of feeble mind, the corrupted doṣas derange the heart, the seat of intellect, / and lodging in the mind-carrying channels, quickly confound the person’s consciousness.

Derangement of intellect, wavering of the mind, agitated gaze, absence of courage, / incoherent speech, and an empty heart are the general symptoms of the disease of insanity.

Confused in mind, he experiences neither happiness nor suffering, neither proper conduct nor virtue, much less peace; / deprived of memory, intellect, and awareness, this one wanders here and there in mind.

They declare insanity to be a wandering of intellect, mind, and memory, arising from extrinsic causes or intrinsic ones; / its fivefold origin, its symptoms separately, and its treatment I will declare.

By dry, scanty, and cold food, purgations, depletion of tissues, and fasting, the excessively aggravated wind, / corrupting the heart burdened with anxiety and other feelings, quickly ruins intellect and memory.

Inappropriate laughing, smiling, dancing, singing, speaking, tossing of limbs, and weeping, / harshness, emaciation, reddish complexion, and increased strength after food is digested are the symptoms of that born of wind.

Accumulated through foods causing indigestion, pungent, sour, burning, and hot, pitta, its surge aroused, / lodging in the heart of one lacking self-control, quickly produces terrible insanity as described before.

Intolerance, agitation, nudity, intimidation, excessive running, heat, anger, / craving for deep shade, cold food, and water, and a yellow luster are the signs of that caused by pitta.

In one of sluggish activity due to excessive filling, heated kapha greatly increased in the vital center, / impairing intellect and memory and confounding the mind, generates the disorder.

Sluggish speech and action, loss of appetite, fondness for women and solitude, excessive sleep, / vomiting, salivation, strength when eating, and whiteness of the nails and other parts belong to that caused by kapha.

That which arises from all three doṣas combined is most dreadful and arises from all the causes combined; / it manifests all the symptoms and, having conflicting medical treatments, should be abandoned.

Attacks by gods, sages, gandharvas, piśācas, yakṣas, rakṣases, and ancestors, / rules and vows improperly performed, and action done in a past life are the extrinsic causes.

One whose speech, valour, strength, and actions are superhuman, who possesses [supernatural] knowledge and the like, understanding, power and the like, / and whose onset of madness is irregular—that should be declared as madness arising from spirits.

Without corrupting the man's body, gods and the others, by the power of their own qualities, / enter him unseen and swiftly, just as shadow and sunlight [enter] a mirror and a sun-gem.

For that time of affliction has been declared in the Nidāna[sthāna] as the prodrome; now learn individually from gods and the others / the symptoms of madness, the time [of attack], and the persons vulnerable to them.

Namely: one should recognize one maddened by a god as having a gentle gaze, solemn, invincible, slow to anger, desiring little sleep and food, with scanty sweat, urine, stool, and flatus, possessing a fragrant smell, and with a face like a blooming lotus; one should recognize one maddened by elders, aged persons, accomplished adepts, and sages as having actions, food, and speech conforming to their curses, spells, and ill-will; one should recognize one maddened by ancestors as having a dull gaze, unseeing, drowsy, with obstructed speech, without desire for food, and beset by anorexia and indigestion; one should recognize one maddened by a gandharva as fierce, reckless, sharp, solemn, invincible, delighting in instrumental music, dancing, singing, food and drink, bathing, garlands, incense, and perfumes, fond of red garments, oblations, jesting, conversation, and interrogation, and possessing a pleasant scent; one should recognize one maddened by a yakṣa as repeatedly sleeping, weeping, and laughing, delighting in dance, song, instrumental music, recitation, story-telling, food and drink, bathing, garlands, incense, and perfumes, with eyes bloodshot, reviling twice-born men and physicians, and speaking secrets; one should recognize one maddened by a rākṣasa as having lost sleep, hating food and drink, yet very strong even without food, desiring weapons, blood, meat, and red garlands, and intimidating others; one should recognize one maddened by a brahmarākṣasa as predominantly laughing and dancing, exhibiting hatred and disdain toward gods, brāhmaṇas, and physicians, quoting praises, Vedic mantras, and scriptures, and tormenting himself with wood and the like; one should recognize one maddened by a piśāca as having an unsteady mind, finding no resting place, dancing, singing, and laughing, babbling connected and disconnected words, delighting in ascending heaps of refuse, filthy streets, rags, straw, stones, and wood, with a broken and hoarse voice, running around naked, staying nowhere in one place, proclaiming his miseries, and having lost his memory.

There, the gods, looking for an opportunity, attack a man of pure conduct skilled in austerities and self-study, mostly on the first and thirteenth days of the waxing moon; sages [attack] one devoted to bathing, purity, and solitude, proficient in statements of the Dharmaśāstras and Vedas, mostly on the sixth and ninth days; ancestors [attack] one devoted to serving mother, father, elders, the aged, accomplished adepts, and teachers, mostly on the tenth day and the new moon; gandharvas [attack] one who delights in praises, song, and music, is fond of other men's wives, fragrances, and garlands, and of clean conduct, mostly on the twelfth and fourteenth days; yakṣas [attack] one endowed with mental fortitude, strength, beauty, pride, and valor, fond of garlands, ointments, and jesting, and excessively talkative, mostly on the eleventh and seventh days of the waxing moon; brahmarākṣasas [attack] one who dislikes self-study, austerity, observances, fasting, celibacy, and worship of gods, ascetics, and elders, whose purity has lapsed, whether a brāhmaṇa or a non-brāhmaṇa claiming to be a brāhmaṇa, who imagines himself a hero, and who delights in playing in temples and water, mostly on the fifth day of the waxing moon and on seeing the full moon; but rakṣases and piśācas [attack] one of weak fortitude, malicious, womanizing, greedy, and deceitful, mostly on the second, third, and eighth days; thus these eight most manifest afflictors out of countless numbers have been explained.

In all these [types of affliction], however, one who raises his hands in violent fury and unhesitatingly strikes them against others or himself should be known as incurable; likewise, one whose eyes are filled with tears, whose urine flows with blood, whose tongue is lacerated, whose nose is running, whose skin is tearing away, whose speech is unrestrained, who constantly groans, is discolored, afflicted with thirst, and has a putrid smell—he should be known as maddened [by a spirit] seeking to kill; him one should avoid.

Those, however, who are maddened [by spirits] desiring pleasure or worship, the physician, having recognized them through their intention and behavior, with an offering and sacrifice suitable for that [spirit] combined,

should treat by means of mantras and medicines.

There, we shall explain in brief and in detail the medicinal treatment for both types of madness, innate and extrinsic.

In madness born of vāta, the expert should first administer the drinking of unctuous substances; / but if the channels are obstructed, he should perform mild evacuation accompanied by unctuous substances.

In that arising from kapha and pitta, vomiting along with purgation should first be performed / after the patient is oleated and fomented; when he is purified, the restorative regimen of diet [should be followed].

Then one should administer non-unctuous enemas, unctuous enemas, and errhines, / according to the doṣa; he should practice an excess of these.

When the heart, sense organs, head, and gastrointestinal tract are thoroughly cleansed by emesis and the like, / the mind attains clarity, and he recovers memory and consciousness.

For a purified patient, when there is a lapse of conduct, sharp errhines, collyria, / and beating, which agitate the mind, intellect, and body, are beneficial.

One who is prone to indiscipline should be restrained with very firm, comfortable cloth bands, / and confined in a dark room free from iron, wood, and the like.

Threatening, terrorizing, giving gifts, gladdening, consoling, fear, / and wonderment, being causes of forgetting, restore the mind to its natural state.

Poultices, unguents, massages, fumigations, and the drinking of ghee / that awaken the mind, intellect, memory, and consciousness should be applied.

For an extrinsic [madness], procedures such as drinking ghee, mantras, and the like are desired. / Hereafter, listen to the most accomplished formulations that destroy madness:

One āḍhaka of ghee cooked with hiṅgu, sauvarcala salt, and tryūṣaṇa, two palas each, / in four times as much cow's urine, destroys madness.

Viśālā, triphalā, kauntī, devadāru, elavāluka, / sthirā, nata, the two rajanīs, the two sārivās, priyaṅgu,

blue lotus, cardamom, mañjiṣṭhā, dantī, pomegranate seeds, keśara, / tālīśapatra, bṛhatī, fresh flower of mālatī,

viḍaṅga, pṛśniparṇī, kuṣṭha, candana, and padmaka— / with these twenty-eight pastes, taken one akṣa each,

one should properly cook one prastha of ghee in four times as much water. / In apasmāra, fever, cough, consumption, weak digestive fire, wasting,

vātarakta, catarrh, tertian and quartan fevers, / vomiting, piles, dysuria, and in those afflicted with erysipelas,

in itching, anemia, madness, toxic conditions, and urinary disorders, / for those whose minds are afflicted by spirits, who stammer, and who are dumb [it is praised].

It is commended for barren women; it brings good fortune, life, and strength, / destroys misfortune, sins, and rākṣasas, and eradicates all evil spirits.

This Kalyāṇaka ghee is preeminent also in rituals for obtaining male offspring. / Thus [ends] Kalyāṇaka Ghṛta. / Boiling these twenty-one [ingredients] beginning with sthirā in water,

in that decoction one should cook ghee with four times as much milk from a cow with a single calf, / along with equal pastes of vīrā, raw māṣa, kākolī, svayaṃguptā, ṛṣabhaka, ṛddhi,

and medā; that is the Mahākalyāṇaka [ghee]. / It is particularly nourishing and supremely destructive of sannipāta. / Thus [ends] Mahākalyāṇaka Ghṛta. / Jaṭilā, pūtanā, keśī, cāraṭī, markaṭī, vacā, / trāyamāṇā, jayā, vīrā, coraka, kaṭurohiṇī,

vayaḥsthā, śūkarī, chatrā, aticchatrā, palaṅkaṣā, / mahāpuruṣadantā, kāyasthā, the two nākulīs,

kaṭambharā, vṛścikālī, and sthirā: taking these, the ghee / prepared with them destroys quartan fevers, madness, possession by spirits, and apasmāra.

This ghee named Mahāpaiśācika is like ambrosia; / it confers intellect and memory, and develops the limbs of children. / Thus [ends] Mahāpaiśācika Ghṛta. / One hundred [bulbs] of garlic, thirty abhayās, one pala of the three pungents, / a prastha of ash of cow's hide, two āḍhakas each of milk and urine,

and a prastha of aged ghee: prepared with these, one should employ it. / Adding one pala of hiṅgu powder and a māṇikā of honey when it has cooled,

it quickly overcomes madness arising from doṣas or exogenous causes, irregular fevers, / and apasmāra, through drinking, massage, and errhines. / Thus [ends] the first Laśunādya Ghṛta. / Half a tulā of undamaged garlic, husked, / and half that amount of daśamūla one should cook in two āḍhakas of water.

When a quarter remains, one prastha of ghee and garlic juice, / along with the juices of kola, radish, vṛkṣāmla, citron, and fresh ginger,

pomegranate juice, surā, mastu, and sour kāñjika—half as much of each— / one should prepare with paste of triphalā, devadāru, salt, the three pungents, dīpyaka,

yavānī, cavya, hiṅgu, and amlavetasa, half a pala each. / Prepared thus, one should drink it: it removes colic, gulma, piles, and abdominal diseases;

it alleviates bradhna, anemia, spleen disease, vaginal disorders, fever, worms, / all diseases of vāta and śleṣman, and cases of madness. / Thus [ends] the other Laśunādya Ghṛta. / Ghee prepared with hiṅgu and hiṅguparṇī, along with kāyasthā and vayaḥsthā, / is likewise beneficial, as is that prepared with vayaḥsthā, hiṅgu, and coraka.

Or one should administer aged ghee alone, cooked with these [drugs]; / after having him drink the maximum dose, one should confine him in a pit or inside a room.

And the physician should especially administer aged ghee; / it destroys the three doṣas because of its sacred purity, and specifically destroys evil spirits.

Having greater medicinal properties and actions when drunk, and being pungent-bitter to taste, / with a pungent odor, ghee that has been kept for ten years is aged.

Resembling lac-dye and cold, it destroys all evil spirits; / it improves intellect and is foremost among purgatives. Ancient ghee is older than this:

there is indeed nothing incurable for that which has been kept for a hundred years; / seen, touched, or smelled, it destroys all evil spirits.

It is commended especially for those suffering from apasmāra, spirit possession, and madness. / Or if he does not submit to compliance, these medicinal formulations

one should employ in collyria, massages, unguents, errhines, and the like: / śirīṣa, madhuka, hiṅgu, garlic, tagara, vacā,

and kuṣṭha ground with goat's urine serves as an errhine and collyrium. / Likewise, the three pungents, the two haridrās, mañjiṣṭhā, hiṅgu, mustard seeds,

and seeds of śirīṣa destroy madness, evil spirits, and apasmāra. / Having ground equal parts of apāmārga, hiṅgu, realgar, and hiṅgupatrikā,

a wick should be made with half a part of black pepper and the bile of a cow and a jackal; / with it one should apply collyrium to those afflicted with apasmāra, possession by spirits, madness, and fever,

those afflicted by spirits or gods, and men in eye diseases. / Black pepper and meat, kept in the sun with bile, is a collyrium

to be applied for one who sees hallucinations, whose memory is destroyed by doṣas and spirits. / Siddhārthaka, vacā, hiṅgu, karañja, and devadāru,

mañjiṣṭhā, triphalā, śvetā, bark of kaṭanbhī, the three pungents, / equal parts of priyaṅgu, śirīṣa, and the two rajanīs,

ground with goat's urine, this antidote is [used as] a potion, collyrium, / errhine, salve, bath, and powder massage.

It removes apasmāra, poison, madness, sorcery, misfortune, and fever; / it dispels fear from spirits and is commended in the royal court.

Or ghee cooked with this along with cow's urine achieves the same purpose. / In excessive salivation and chronic rhinitis, one should smoke a wick made of aromatic substances

prescribed for purgative smoking, or with the group beginning with śvetā along with hiṅgu. / From porcupine, owl, cat, jackal, wolf, and goat,

the urine, bile, feces, hair, nails, and hides / one should employ for pouring, collyrium, blowing powder, errhine, and smoke.

[These are] mostly in that caused by vāta and śleṣman; but in that caused by pitta are commended / the Tiktaka and Jīvanīya ghees, and the combined unctuous substance,

and cold, sweet, and mild foods and drinks. / Or at the junction of the temple and hairline, the skilled physician should release a vein / in madness, irregular fever, and apasmāra.

Or he should place him, well-sated with ghee and meat, comfortably in a windless place; / casting off derangement of intellect and memory, having recovered consciousness, he is cured.

Or a friend should console him with words endowed with virtue and purpose; / or report the destruction of what he holds dear, or show him wonders.

Or he may expose him tied up, smeared with mustard oil, face up in the sun; / or touch him with kapikacchu, or with heated iron, oil, and water.

Or having beaten him with whips, he should confine him, securely bound, in a deserted house; / for thus his deranged mind returns to calmness.

He should terrify him with a snake whose fangs have been extracted, or with trained lions and elephants, / or with robbers and enemies wielding weapons in their hands.

Or the king’s officers, having led him outside securely bound, / should terrify him with death, threatening him under the king’s command.

For fear of death is held to be greater than fear of bodily pain; / by that, his mind that is agitated on all sides attains tranquility.

Whose mind is afflicted from the destruction of beloved objects, however, / him one should lead to calm by obtaining similar objects and by comforting reassurances.

Those [afflictions of mind] arising from passion, grief, fear, anger, joy, jealousy, and greed / one should bring to calm by these very [emotions] acting as mutually opposing counterparts.

Having discerned the habitat, age, habituation, doṣa, season, and strength and weakness, / one should perform this treatment in insanity born of spirit-affliction.

In the case of one maddened by gods, seers, ancestors, or gandharvas, however, the wise physician / should avoid collyriums and the like that are sharp, as well as cruel procedures.

One should administer mild medicine for him here, such as the drinking of ghee and the like, / worship, offerings and gifts, as well as mantric collyrium procedures,

Pacification rites, sacrificial offerings and oblations, recitations of mantras, and auspicious rites, / and one should also practice the rules and penances taught in the Vedas.

Constantly worshiping the Lord, the master of spirits, the God, the sovereign of the universe, / with concentrated devotion, one overcomes the fear arising from insanity.

Those hordes belonging to Rudra named the Pramathas who wander in the world— / performing worship to them, one is freed from insanities.

Through offerings, auspicious rites, oblations, the wearing of herbs and antidotes, / truthfulness, good conduct, asceticism, knowledge, charity, observances, and vows,

And through the worship of gods, cows, brāhmaṇas, and elders, / as well as through proven mantras and drugs, extrinsic [insanity] is pacified.

And whatever will be taught in the treatment of epilepsy, / that too should be done in insanity, because of the commonality of the etiology and the dūṣyas.

He who has abstained from meat and wine, eats wholesome food, is self-restrained and clean, / and is endowed with mental strength, is not afflicted by intrinsic or extrinsic insanities.

Clarity of the sense objects, as well as of the intellect, self, and mind, / and the dhātus remaining in their natural state, is the symptom of one whose insanity has departed.

Here is a summary verse:

The etiology, symptoms, along with the treatment of insanities / caused by intrinsic and extrinsic origins, the best of physicians has declared.

Thus, in the treatise composed by Agniveśa, redacted by Caraka, and, being unavailable, completed by Dṛḍhabala, in the Cikitsāsthāna, the ninth chapter, titled 'The Treatment of Insanity.' // 9