The Role of Ayurveda in the Treatment of Stress and Mental Disorders or Illness

Health is refers to a state of physical, mental, social and spiritual well-being of the individual. Thus, mental health is one of the components of the broad concept of health. It is concerned with an optimum level of emotional and behavioral adjustment of the individual. Devil of mental disorders is gaining its worst shape as seen in various data collected and published by WHO (World Health Organization). Today, depression is estimated to affect 350 million people. The World Mental Health Survey conducted in 17 countries found that on average 1 in 20 people reported having an episode of depression. The demand for curbing depression and other mental health conditions is on the rise globally. Mental health is a state of maintaining liarmony or balance between the needs, desires, aspirations and attitudes of the individual with respect to the prevailing condition in the external environment. For these reasons, depression is the leading cause of disability worldwide in terms of total years lost due to disability. Ayurveda covers not only for strengthening the physical power of the body, blit also principles of spirimal as well as mental development. Ayurveda is inherently a psychological as much as it is a physical system of medicine. Its scope of practice includes both physical (Sharirika) and mental (Manasika) diseases. According to Charaka Saiuhita, Ayu (life) itself is the combination of the body, sense organs, mind and soul. Current scenario of life style suffers various psychological diseases. Ayurveda considered mana important pillar of body along with atma and sharir. The balance condition of these three Mana, atma and sharir resembles complete health as per ayurveda. Ayurveda mentioned sattvavajaya therapy as effective treatment approaches of psychotherapy. Manas (mind) is encompasses three sub-pillar dhi, dhriti and smriti. The tridoshic balance vata, pitta and kapha govern mind functioning of mana. Vata controls movement of nervous system. Pitta regulates metabolism. Kapha provides stability of tissues. Vatadosha results anxiety, restlessness and insomnia. Pitta imbalance causes irritability.

mental illness like; excess of shoka, krodha, chinta, kama, krodha, lobh, moha, irshya and mada. Ayurveda prescribed various treatment approaches of mano-vikara which mainly occurs due to the modern life style and stress, this article summarizes role of such treatment approach like; psychological counseling (satwavajay) in the management of modern day‟smano-vikara. Today, stress has become an inevitable and the most unwanted companion of civilization. In biological terms, stress is defined as anything constituting a threat, real or apparent, which would adversely affect the organism. It can be induced by several factors like environmental changes, extremes of temperature, high altitude, restraints, fear, rage, anxiety, shock, grief, pain and so on. As far as body is able to cope with it, a stress act as a normal stimulus required for our physical and social well-being and is better known as “eustress”. On the other hand, stress becomes “distress” when the individual is unable to cope with it. Thus, eustress helps in improving the performance, whereas, distress is known to induce a number of clinical maladies, like hypertension, coronary artery disease, peptic ulcer, asthma, migraine, ulcerative colitis, irritable bowel syndrome, diabetes mellitus, thyrotoxicosis, behavioral disorders like anxiety and depression and the list is very long. The fact that stress plays an important role in the aetiology of several diseases is well recognized in Ayurveda, where, stress is known as sahasa. Caraka advises to avoid sahasa as it adversely affects the body. Different types of stressors physical, psychological and environmental as they vitiate dosas are implicated in the aetiology of several diseases. Sahasa as it causes ojahksaya- loss of immunity increase the susceptibility of the body to various infectious diseases. Therefore, sahasa should be avoided as far as possible and body should be well protected by talking adequate care of the three sub pillars of life-diet, sleep, and celibacy – traya upastambhaiti – aharah, swapnoh, brahmacaryamiti,, sleep here indicates adequate rest required by the body. Ayurveda, the ancient science of life has been serving the mankind since antiquity. It has a very special approach towards the disease, the patient and the science of medicine itself. One of the most important and highly interesting topic of discussion in Ayurveda, as its approach to psychopathology and psychotherapy (Murthy et al. 1987). The meaning of the word “Ayurveda” is self-explanatory (Ayu = Life, Veda = Science). Life has been described as the complex combination of Body (Sarira), Senses (Indriyas), Mind (Sattva) and Soul (Atma) (Acharya 2008). The term “mental disease” (Manasika Roga) is not restricted to mean insanity and allied conditions of specific mental derangement, but also includes to some extent the emotional disorders. The emotional factors, when cross the state of normalcy and get psychotropic drugs, highlighted as medhya dravyas and medhya rasayanas either as a single drug or in the form of compound formulations, in classical texts of Ayurveda. Humanity is suffering from various psychological disorders in spite of great advances in the field of medical sciences. These disorders includes anxiety, depression, dementia, epilepsy, cognitive disorder, neurodegenerative disease like Alzheimer‟s, schizophrenia etc. WHO preamble states that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, suggesting there is no health without mental health. In spite of this about 60 to 70 million Indians suffer from severe and common mental disorders & receive treatment for their condition. According to an estimate there is a prevalence level of 22% individual developing one or more mental or behavioural disorder in their life time. Psychiatric disorders that by 2025, mental illness will catch up with heart disease or may even overtake it as the biggest global health concern. The use of modern CNS acting drugs in spite of having higher therapeutic ratios and neuroprotection is accompanied by side effects like insomnia, mood change, dizziness, respiratory depression, irritability, nausea, rash, and clumsiness etc. Further these drugs need to be taken regularly and if stopped abruptly has potential danger of triggering the recurrence of the disease. Therefore the whole world is looking towards ancient science of Ayurveda to explore safe, alternative, cost effective treatment as well as reliable cure with no or minimal side effects for psychiatric disorders.

Primary psychological conditions caused purely by mental disorders are kama (lust), krodha (anger), lobh (greed), moha (delusion), irshya (jealousy), mana (pride), mada (euphoria), shoka (sorrow, grief), chinta (anxiety), udvega (neurosis), bhaya (fear), harsha (happiness). The psychiatric conditions caused by a combination of physical and mental (psycho-physical) disorders are unmada (psychosis), apasmara (convulsive disorder), apatantraka (hysteria), atattvabhinvesha (obsession), bhrama (illusion, vertigo), tandra (drowsiness), klama (neurasthenia), mada-murchha-sanyasa (loss of sensory perception leading to coma), madatyaya (alcoholism), gadodvega (hypochondriasis), (M.G. Ramu and B.S. Venkataram) Ayurvedic Psychology Charaka in his treatise Charaka Samhita, describes eight essential psychological factors that are negatively affected in various ways in all psychiatric disorders. The psychopathological condition is a function of these factors, which are manas (mind), buddhi, smriti

cheshta (psychomotor activity) and achara (conduct). Compared to other major ayurvedic texts like Sushruta Samhita, and Ashtanga Hrdayam, Charaka Samhita gives more emphasis to the view of life as a self-aware field of pure consciousness and natural intelligence where the knower and the known are one. Ayurveda is very effective for stress management and to encourage body and soul to achieve composure of the mind (Ramesh U and Kurian Joseph) Ayurveda Medicines for Stress - Ayurveda classifies herbs with a stabilizing effect on the mind as 'medhya rasayanas'. These herbs promote the intellect and deeply nourish the neurological tissues). They are nervine tonics These medicines act as specific molecular nutrients for the brain, promoting better mental health that leads to the alleviation of behavioral disorders (I.P.V Sharma) . The medhya rasayanas enhance biological nourishment of the brain, producing tranquility of mind, concentration and improved memory. Ashwagandha & Brahmi and shankha pushpi have a secondary mild sedative effect. Others like calamus have a mild stimulating effect. Stress is relaxation with compound herbal formulation consisting of Tagar (Valeriana wallichi), Shankhapushpi (Convolvulus pluricaulis), Brahmi (Bacopa monnieri), Musta (Cyprus rotundas), Ashwagandha (Withania somnifera), Jatamansi (Nardostachys jatamansi), Munakka (Vitis vinifera), Raktachandana (Pterocarpus santalinus), Parpataka (Fumaria indica), Kutaki (Picrorhiza Kurroa), Dashmula, Amaltas (Cassia fistula). This has been given in the dose of 20 gm twice a day as coarse powder to prepare decoction by ‗Chaturthavashesh„ method mentioned by Sharangadhara. Anti-stress effect against stress related changes in immunoglobulin in the body due to the battery of stresses encountered at Antarctica, Rasayana therapy has an advantage over the conventional Kayachikitsa treatment in such conditions, as it is capable of counteracting the stress, promote the adaptogenic abilities of the body, enhance mental endurance.

The Avurvedic philosophy explained health is not just an absence of disease; it is achieved when there is perfect balance of all three Doshas, Satva, Atma, Sharira. Satva (mind), Sharira (body) and Atma (soul) are tripod of life2. If one is disturbed; the whole life is in turmoil. When the Satva is in good state, it generates positive feelings but if the mind is not healthy then the body-mind apparatus gets imbalanced. between the materialistic world and spiritual world. Half a century ago the idea that the mind has the power over the functions and diseases of the body was regarded as laughable. Today it is generally accepted as a fact, although its implications are still largely neglected. It is realized that in human beings physical symptoms can be due to a state of mind and that the alterations in the state of a mind may be in itself sufficient to relieve the symptoms. Due to improper diet and actions, the natural state of the mind may disturb and the positive feelings may drive out. As a result negative feelings like anger, jealousy, cruelty, drowsiness can take place and may lead to mental disorders. So it is easily understandable that the entire area of Ayurvedic healing process focuses on psychological health. It is already known that the mind can cause physical diseases as well as various mental illnesses. That's why the emphasis of "mind" in Ayurveda is more practical and realistic in the areas of health and healing and touching the day to day life of people. In Ayurveda classics no special description of depression is given but all type of mental disorders are classified in “Unmada”. As Ayurvedic point of view Raja & Tama vitiates leads to Manasika Vikaras like Vishada, Bhrama, Glani3 etc.

We all experience stress a little differently, according to our constitution and mental tendencies. The Ayurvedic approach always takes into account these and provides guidelines in an individualized and holistic manner. For instance, pitta constitutions, who tend to become angry and act out their stress, or take it out on others, will benefit from certain pitta pacifying herbs and foods, such as pomegranate juice, coconut water and aloe vera, to help decrease excess pitta and prevent it from moving into the nervous tissue. Daily massage with coconut oil and applying oils such as sandalwood, khus, mitti or rose attars to the third eye, temples and crown of the head can dramatically cool and quiet the mind. Pitta herbs include Shatavari, Licorice, Brahmi and Rose petals. Kapha people tend to internalize stress and develop eating disorders or substance abuse problems. Lack of exercise causes the formation of toxins and slows down the metabolism. This can lead to heaviness on the mental and emotional plane giving rise to depression. When kapha types become stressed they can also get irritable because excess pitta becomes trapped in their increased body fat, and they tend to eat too much to relieve tension and try to attain a feeling of satisfaction. In this case, pungent, bitter and astringent foods can help, as well as a kapha digestive stimulants like black pepper and pippali are great to lighten the body and refresh the senses. Vata types are more prone to becoming overly anxious, jumpy, and even panicky. And most people with a chronic illness may find that the symptoms of their illness flare up under an overload of stress. When prana vata gets aggravated in the brain it causes an inability to think clearly or retain information, which is a common symptom in a stressful or traumatic situation. Other symptoms associated with vata may include mental hyperactivity, anxiety, and scattered thoughts. Here the best regime consists in following a vata pacifying diet of primarily warm, cooked foods that have sweet, sour and salty tastes, daily oil massage, meditation, relaxing yoga, and warm milk before sleep. Herbs such as Ashwagandha, Bala, Jatamansi, and Licorice are among the best vata tonic herbs to combat stress as well as to replenish depleted stores of energy and bolstering adrenal energy. Stress from excessive physical or mental work can also exhaust your body and mind, and cause fatigue, which can over time make you lazy, sluggish and mentally dull. So rest, play, and fun are vital ingredients to prevent energy exhaustion. To help your body detox and rejuvenate, get regular Ayurvedic therapies such as shirodhara, abhyanga, herbal steam, netra basti, nabhi basti, marma massage, aromatherapy, and color therapy. Also, incorporating healthy daily routines (dinacharya) is a very good way to counteract daily stress and promote overall balance and vitality.

Stress has been postulated to be involved in the aetiopathogenesis of a variety of diseases ranging from psychiatric disorders like depression, anxiety and cognitive dysfunction, immunosuppression, to endocrine disorders including diabetes mellitus, peptic ulcer, hypertension and ulcerative colitis. Modern life style makes us more prone to stress and in turn to stress induced disorders. The routine of tests and treatments is tedious and combined with the economic burder of the disease, causes more stress to the already stressed person. The poor individual is thus trapped in a vicious cycle resulting in the progression of stress induced diseases. Antistress agents are therefore, required to break this cycle. Modern system of medicine is still in want of an effective antistress agent. Though drugs like diazepam and fluoxetine are claimed to have antistress activity but these drugs do no fulfill the criteria of a true, safe and specific antistress agent. Panax ginseng has been developed as a natural medicine for a variety of clinical disorders in modern medicine and is recognized as an antistress agent. It is, however, now known to induce to have potential as antistress agents and the answer to a safe and effective antistress agents probably lies here. Several rasayana herbs used as antistress agents have shown antioxidant, immunomodulator, hepatoprotective, antidepressant and anxiolytic effects in various experimental and clinical studies. Oxidative free radicals (OFR) are constantly formed in the body and an excessive generation of OFRs or/and defective scavenging mechanisms have been implicated in a diverse range of degenerative disorders. Including rheumatoid arthritis, atherosclerosis, adult respiratory distress syndrome, Parkinson‟s and Alzheimer‟s disease. Chronic stress is known to augment the generation of OFRs in various biological systems and to interfere with the activity of enzymes like superoxide dismutase, catalase and glutathione peroxidase which help in the removal of OFRs. Abnormal accumulation of OFRs leads to cell membrane lipid peroxidation. Toxic peroxide metabolites induce excessive cellular injury. Apart from diseases, free radical induced stress has been implicated in aging and immunosuppression. Several rasaya drugs like Asparagus racemosus, Bacopa monnieri, Boerhavia diffusa, Centella asiatica, Convolvulus pluricaulis, Emblica offcinalis, Piper longum, Tinospora cordifolia, Picrorrhiza kurroa, Curcuma longa, Withania somnifera have been reported to have significant antioxidant action. Since these rasayanas have widespread clinical use, including disease postulated to be induced by OFRs it is possible that, at lease a part of their therapeutic effects are due to reduction of oxidative stress. Likewise, antiaging benefits may be due to a similar mechanisms. Rasayana herbs with predominant hepatoprotective effects, like Picrorrhiza kurroa, Tinospora cordifolia possibly help to xenobiotics. Another important use of rasayana is the modulation of immune response, as choronic stress has an immunosuppressive action which adversely affects the defence mechanisms of the body increasing its susceptibility to various diseases. Few herbs that have been shown to possess a significant immunomodulatory action are Asparagus racemosus, Picrorrhiza kurroa, Curcuma longa, Withania somnifera, Tinospora cordifolia, Piper longus, Azadirachata indica and Holorrhena antidysentrica. The difference between rasayana drugs and classical immunostimulants is that the former appears to optimize the immune system only when it is compromised. They have been shown to influence both cellular and humoral immunity by acting on immune function mediators. Rasayana drugs are, therefore, likely to be of immense value in drug – and radiation – induced immunosuppression

Actually Ayurveda is to control stress. Ayurveda provides a combination of benefits such as Pancha karma and Madya Rasayanas (Medicines) practice and guided Herbal Remidies. That is powerful, Even for people who have fallow Nutrition and Diet , Good Dinacharya and Physical Exercises Just by doing this you can have great benefits with the practice of Stress and Health. So in conclusion yes Ayurveda can be a great remedy for stress and can offer some stress relief. The diseases in which the chronic and oxidative stress are implicated in the aetiopathogenesis, there is a logical place for rasayana in their management. However, appropriate scientific evidence needs to be generated for their widespread acceptance. This, in turn, necessitates concerted efforts to investigate the antistress effects of Ayurvedic herbs and the possible mechanism of their antistress actions. Since the mental illness are diverse and individual patients are biochemically unique, a larger number of drugs will increase the likelihood of finding a beneficial medication. Ayurvedic remedy for brain disorders is much preferred over synthetic drugs because of various side effects of synthetic drugs ranging from sleep disorders to withdrawal syndromes. Ayurvedic treatment not only improves patient compliance but also there are possibilities of enhancing the bioavailability of many drugs. Active constituents extracted from specific parts of various plant origins have proved to be beneficial. This review reveals that number Ayurvedic drugs are available for the treatment of various mental disorders but there is a need to explore efficacy of many of them.

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