Madonmada of Bhela samhita: Trauma- and stressor-related disorders?

Kshama Gupta; Prasad Mamidi

doi:10.4103/ijoyppp.ijoyppp_16_21

REVIEW ARTICLE

Year : 2022 | Volume : 10 | Issue : 1 | Page : 42-49

Madonmada of Bhela samhita: Trauma- and stressor-related disorders?

Kshama Gupta, Prasad Mamidi
Department of Kaya Chikitsa, R. B. Ayurvedic Medical College and Hospital, Agra, Uttar Pradesh, India

Date of Submission	18-Jun-2021
Date of Acceptance	05-Feb-2022
Date of Web Publication	26-Apr-2022

Correspondence Address:
Dr. Kshama Gupta
Department of Kaya Chikitsa, R. B. Ayurvedic Medical College and Hospital, Agra, Uttar Pradesh
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijoyppp.ijoyppp_16_21

Abstract

A unique condition called “Mada” or “Madonmada” is available in Bhela samhita. Mada is considered as a prodromal phase of Unamada, or it can occur as an independent disease condition also. Mada/Madonmada is caused by various traumatic events or extreme stressors, and it is characterized by various features such as pradhyayati (immersed in thoughts/flashbacks/recurrent or persistent distressing thoughts), praswapati (excessive sleep), animittitam rodati (crying without any reason/pervasive negative emotions/depressed mood), akasmaat hasati (laughing inappropriately or without any reason/disorganized behavior), nidraalu (hypersomnia/excessive sleep), alpa vaak (diminished speech or poverty of speech/social withdrawal), nityam utsuka (hypervigilant/restlessness), trasta shareeri (tiredness/weakness), deenaaksha (depression/pervasive negative emotions), krodhana (angry outbursts/irritable behavior), nirapatrapa (self-destructive behavior/recklessness), purastaat avalokee (exaggerated startle response), na yathavritta eva (disorganized or abnormal behavior), parushatva of roma (roughness or dryness of skin and hair), and aavilam chakshusha (confused/teary eyes). Mada/Madonmada has shown similarity with various psychiatric conditions such as “acute stress disorder,” “posttraumatic stress disorder,” “brief psychotic disorder,” and “adjustment disorder.” The present study provides insights for clinical implementation of “Mada/Madonmada” in the diagnosis and management of “trauma- and stressor-related disorders” in terms of Ayurveda. It is astonishing that thousands of years before, “Acharya Bhela” has documented the conditions such as trauma- and stressor-related disorders in the form of Mada or Madonmada.

Keywords: Acute stress disorder, adjustment disorder, brief psychotic disorder, Madonmada, posttraumatic stress disorder, Unamada

How to cite this article:
Gupta K, Mamidi P. Madonmada of Bhela samhita: Trauma- and stressor-related disorders?. J Appl Conscious Stud 2022;10:42-9

How to cite this URL:
Gupta K, Mamidi P. Madonmada of Bhela samhita: Trauma- and stressor-related disorders?. J Appl Conscious Stud [serial online] 2022 [cited 2023 May 28];10:42-9. Available from: http://www.jacsonline.in/text.asp?2022/10/1/42/343850

Introduction

Ayurveda is an ancient Indian system of medicine which has been in practice since thousands of years. The “Bhela samhita” is one of the prominent treatises of the Samhita period of Ayurveda (Post-Vedic period 100–400 BC). “Bhela Acharya” (author of Bhela samhita) was one of the six outstanding disciples of “Punarvasu Atreya” and contemporary of Agnivesha (author of the popular text Charaka samhita). Bhela samhita has got an equal approval and recognition of Atreya; however, this treatise lost its popularity at later stages. Bhela samhita was available in its original form till the recent years as it was not exposed to the commentators and redactors. Bhela samhita is one among the unique ancient classics of Ayurveda, which is unexplored. Critical study of Bhela samhita has become an important tool for interdisciplinary research to explore new facts and figures (Ratha & Meher, 2018).

“Bhuta vidya” or “Graha chikitsa” (Ayurvedic psychiatry) is one among the eight specialties or branches of Ayurveda, which deals with the diagnosis and management of various psychiatric conditions. Unamada is a major psychiatric disease explained in most of the Ayurvedic texts which is characterized by the derangement of various factors such as manas (mind), buddhi (cognitive functions), samgna gnaana (orientation), smriti (memory), bhakti (interests), sheela (character/personality), cheshta (psychomotor activity/behavior), and achaara (conduct) (Gupta & Mamidi, 2015). There are different opinions regarding classification of Unamada; five types according to “Charaka samhita” (Agnivesha, 2014a, 2014b) and six types according to “Sushruta samhita” (Sushruta, 2018), “Ashtanga samgraha” (Vagbhata, 2016), “Ashtanga hridaya” (Vagbhata, 2010), “Madhava nidana” (Madhavakara, 2014), and “Bhava prakasha” (Bhavamishra, 2010).

Two chapters are devoted for the description of Unamada in Bhela samhita, “Unamada nidanam” and “Unamada chikitsitam.” “Unamada nidanam” chapter of Bhela samhita deals with the etiology, pathogenesis, and signs and symptoms of Unamada. Unfortunately, this chapter is incomplete and only some portion of the text is available now. Unamada is classified into five groups (Vataja, Pittaja, Sleshmaja, Sannipataja, and Agantuja); the description of Sleshmaja, Sannipataja, and Agantuja unamada is available completely, whereas the description of Vataja and some portion of Pittaja unamada have been lost or is unavailable (Bhela, 2016b). “Unamada chikitsitam” chapter of Bhela samhita contains the description of treatment principles, various internal medicines, and procedures to manage different types of Unamada. Special description of a condition called “Mada” is available in this chapter which is the unique of Bhela samhita. According to Bhela samhita, Mada is considered as a prodromal phase or period of Unamada or an independent disease condition, and its description is completely different from other texts. Some authors have used the word “Madonmada” for “Mada,” and both the words are considered synonymous (Bhela, 2016a).

Previous studies have compared different types of Unamada and “Grahonmadas” with various psychiatric or neuropsychiatric conditions (Gupta & Mamidi, 2014, 2017, 2018a, 2018b, 2018c, 2018d, 2018e, 2018f, 2020; Mamidi & Gupta, 2015a, 2015b, 2017, 2018a, 2018b, 2018c, 2018d). There are no studies available on “Mada” or “Madonmada” of Bhela samhita till date, and the present study has focused on to explore this condition. Exploration of Madonmada mentioned in Bhela samhita may pave the way for the development of a new diagnostic entity that can be used in Ayurvedic psychiatry clinics for diagnosing psychiatric conditions at prodromal stages and implement the treatment principles mentioned in Madonmada context to treat those prodromal stages and to prevent further worsening of psychiatric conditions. Further understanding of Madonmada may also provide new insights to manage various trauma- and stressor-related disorders in an Ayurvedic way. The present study has explored the similarity (and also dissimilarities) between Mada/Madonmada and various psychiatric conditions such as “acute stress disorder” (ASD), “posttraumatic stress disorder” (PTSD), “brief psychotic disorder” (BPD), and “adjustment disorder” (AdjD).

Methodology

Exploration of physical literature has been done by searching the local library for books (especially Bhela samhita, Charaka samhita with Chakrapani commentary, Sushruta samhita with Dalhana commentary, Ashtanga samgraha with Indu commentary, Ashtanga hridaya with Arunadatta and Hemadri commentaries, Madhava nidana with Madhukosha commentary, and Bhava prakasha) and journals in the print form. Web-based search engines and various electronic databases have been searched to identify materials that were homologues to the present research topic. Various common search terms or keywords and phrases (“trauma- and stressor-related disorders,” “brief psychotic disorder,” “acute stress disorder,” “posttraumatic stress disorder,” “unmade,” “Mada,” “Madonmada,” “Bhela samhita,” etc.) have been used to find out “relevant articles.” Except for “language” and “text availability,” no other filters and Boolean operators were used while searching the literature. Open-access, full-text articles (without keeping restrictions on article types) and abstracts published in English language were only considered in the present work, irrespective of their date of appearance and year of publication.

Discussion

The word “Mada” denotes “Harsha” (excitement or euphoria) (Biradar & Ganer, 2019). Description of “Mada” is available in the context of “Madatyaya” (alcohol abuse). Three stages of “Mada” have been described (purva, madhyama, and tritiya) based on the intensity. Acharya Charaka and Sushruta have mentioned three stages of “Mada,” whereas Acharya Madhavakara has mentioned four. “Madakari” is a drug or substance which is predominant of “Tamoguna” (characterized by inhibitory, inactivity, lethargy, and darkness) and causes derangement of the mind. The three stages of “Mada” (purva, madhyama, and tritiya) have been correlated with three stages of acute alcohol intoxication (stages of excitement, in coordination, and narcosis/coma) (Motiram & Nilima, 2016). “Mada” is also explained as an independent disease condition or premonitory condition to “Murcha” and “Sanyasa” (diseases characterized by compromised cerebral blood flow/brain ischemia). “Mada” is considered as “semiconscious stage,” whereas “Murcha” and “Sanyasa” are considered as stage of unconsciousness and coma seen in cerebrovascular accident (CVA) (Sori et al., 2017).

“Mada”/“Madonmada” of “Bhela samhita” is a psychiatric condition, and its description is different from “Mada” explained in other contexts such as “Mada of Madatyaya” (stage of excitement or euphoria seen in acute alcohol intoxication) and “Mada in Mada, Murcha, and Sanyasa” (semiconscious state seen in the early stages of CVA or brain ischemia). “Mada”/“Madonmada” of “Bhela samhita” can be seen as an independent disease or a prodromal stage of psychosis. Untreated or chronic or further aggravated “Mada” can cause “Unamada” (a major psychiatric disease explained in all Ayurvedic classical texts characterized by derangement of various cognitive functions). The word “Madonmada” is used to denote “Mada” as an independent disease, whereas the term “Mada” is used when it is prodromal stage or condition of “Unamada.” Both the terms “Mada” and “Madonmada” are synonymous and used interchangeably to denote the same condition explained in Bhela samhita (Bhela, 2016a, 2016b).

Shoka (excessive grief), kopa (excessive anger or passion), harsha (excessive joy or euphoria or excitement), and vinaasha of dravya (loss of valuable things or possessions) are the causative factors for Mada/Madonmada. These factors cause mental trauma, deviate or disturb the cognitive functions, and lead to the manifestation of Mada. Mada/Madonmada is characterized by various features such as pradhyayati (immersed in thoughts/flashbacks/recurrent or persistent distressing thoughts), praswapati (excessive sleep), animittitam rodati (crying without any reason/pervasive negative emotions/depressed mood), akasmaat hasati (laughing inappropriately or without any reason/disorganized behavior), nidraalu (hypersomnia/excessive sleep), alpa vaak (diminished speech or poverty of speech/social withdrawal), nityam utsuka (hypervigilant/restlessness), trasta shareeri (tiredness/weakness), deenaaksha (depression/pervasive negative emotions), krodhana (angry outbursts/irritable behavior), nirapatrapa (self-destructive behavior/recklessness), purastaat avalokee (exaggerated startle response), na yathavritta eva (disorganized or abnormal behavior), parushatva of roma (roughness or dryness of skin and hair), and aavilam chakshusha (confused/teary eyes). Mada when it becomes exaggerated or becomes chronic or when it gets untreated, it can lead to “Unamada.” There is no specific treatment mentioned for Mada or Madonmada in Bhela samhita. Treatment of Unamada can be implemented to manage “Mada” or “Madonmada” (Bhela 2016a). Mada/Madonmada has shown resemblance with various psychiatric conditions (induced by mental trauma or acute or chronic stress) such as ASD, PTSD, BPD, and AdjD. The similarities and dissimilarities between Madonmada with these contemporary (modern) psychiatric conditions have been explored in the following sections [Table 1], [Table 2], [Table 3].

Table 1: Similarity between Madonmada and acute stress disorder and posttraumatic stress disorder

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Table 2: Similarities and dissimilarities between Madonmada and brief psychotic disorder

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Table 3: Similarities and dissimilarities between Madonmada and adjustment disorder

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Similarity of Madonmada with acute stress disorder and posttraumatic stress disorder

ASD occurs within 1 month after exposure to an extreme traumatic stressor, whereas after duration of more than 1 month, the diagnosis of PTSD should be made. The severity, duration, and proximity of an individual's exposure to traumatic event are the factors which determine the likelihood of development of ASD. Stressors such as threatened death, serious injury, threat to one's physical integrity, learning about unexpected or violent death, serious harm, threat of death or injury experienced by a family member, military combat, violent personal assault (sexual assault, robbery, physical attack, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war, natural or artificial disasters, severe automobile accidents, having life-threatening illness, and any other extreme traumatic stressors may cause ASD and PTSD (American Psychiatric Association 2013a, 2013c).

ASD is characterized by features such as anxiety, dissociative symptoms (subjective sense of numbing, detachment, absence of emotional responsiveness, reduction in awareness of his or her surroundings, depersonalization, derealization, dissociative amnesia), persistently re-experiencing the traumatic event (recurrent recollections, images, thoughts, dream, illusions, flashback episodes, and distress on exposure to reminders of the event), increased arousal (difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, and motor restlessness), avoidance (avoiding reminders of the trauma such as places, people, and activities), distress, disturbances in normal functioning, and impairment in the ability to pursue necessary tasks. Decrease in emotional responsiveness, inability to experience pleasure in previously enjoyable activities, feeling guilty, feeling detached from one's body, experiencing world as unreal or dreamlike, symptoms of despair, hopelessness, neglecting personal health and safety needs, impulsiveness and risk-taking behavior, etc., can also be seen in ASD (American Psychiatric Association, 2013a).

PTSD is a potentially debilitating anxiety disorder which affects at least 10% of people who experience traumatic events. It is associated with mental and physical comorbid conditions, diminished quality of life, and economic burden (Bryant et al., 2008). Although traumatic stress has been known by different terms, including “shell shock,” “soldier's heart,” or “battle fatigue.” To diagnose PTSD, people are required to manifest these symptoms for more than 1 month after trauma exposure. PTSD is more likely to occur after prolonged trauma or interpersonal traumatic events. Diagnostic criteria for PTSD includes various factors such as exposure to a major traumatic event, re-experiencing symptoms, intense or persistent psychological distress at exposure to reminders of the trauma, active avoidance of internal and/or external reminders of the trauma, alterations in mood and cognitions, inability to recall an important aspect of the traumatic event, persistent and exaggerated negative thoughts about oneself or the world, pervasive negative emotions, markedly diminished interest, feeling detached or estranged from others, persistent inability to experience positive emotions, irritable behavior, angry outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, concentration problems, and sleep disturbances (American Psychiatric Association 2013c; Bryant, 2019).

Causative factors explained in Madonmada context (shoka, kopa, harsha, and vinaasha of dravya) are similar to the traumatic events mentioned in the context of ASD and PTSD. Clinical features of Madonmada have also shown similarity with the clinical features of ASD and PTSD. “Pradhyayati” of Madonmada denotes re-experiencing the traumatic events such as recurrent recollections, images, thoughts, dream, illusions, flashback episodes, and distress on exposure to reminders of the event, and “Praswapati” and “Nidraalu” denote “staying asleep” mentioned in the diagnostic criteria of PTSD (American Psychiatric Association, 2013c). “Rodati,” “alpa vaak,” “trasta shareeri,” “deenaaksha,” and “aavilam chakshusha” features denote persistent and exaggerated negative thoughts, pervasive negative emotions, markedly diminished interest, feeling detached or estranged from others, persistent inability to experience positive emotions, distress, inability to experience pleasure in previously enjoyable activities, feeling guilty, symptoms of despair, hopelessness, neglecting personal health and safety needs, and alterations in mood and cognitions of ASD and PTSD. “Nityam utsuka” and “purastaat avalokee” denote hypervigilance or exaggerated startle response, whereas “krodhana” and “nirapatrapa” indicate irritability, angry outbursts, reckless behavior, motor restlessness, and self-destructive behaviors seen in ASD and PTSD. “Na yathavritta eva” denotes depersonalization, derealization, dissociative features, disorganized behavior, and changes in mood and cognition, whereas “akasmaat hasati” may indicate hallucinations or disorganized behavior seen in ASD and PTSD. “Parushatva of roma” denotes dehydration or nutritional deficiencies or lack of personal hygiene or care commonly found in ASD and PTSD (American Psychiatric Association, 2013a, 2013c). By considering all these facts, it is evident that Madonmada has shown marked similarity with ASD and PTSD [Table 1].

Similarity of Madonmada with brief psychotic disorder

BPD is characterized by the sudden onset of positive psychotic symptoms such as delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. The duration of episode should be less than a month, and full return to premorbid level of functioning is expected. If the psychotic symptoms develop immediately after and apparently in response to stressful events or any major stress such as the loss of a loved one or the psychological trauma of combat, then it should be termed as “BPD with marked stressors.” Individuals with BPD experience emotional turmoil or overwhelming confusion and rapid shifts from one intense emotion to another. Special attention is required regarding nutritional and hygienic needs of the patient. Poor judgment, cognitive impairment, and acting on the basis of delusions are common findings in BPD cases (American Psychiatric Association, 2013b).

Etiological factors of Madonmada such as shoka, kopa, harsha, and vinaasha of dravya are similar to the major stress or psychological trauma required for the manifestation of BPD. Clinical features of Madonmada also have shown some similarity with the clinical features of BPD. But BPD can occur without having the history of exposure to any significant stressful event (such type of cases it should be termed as “BPD without marked stressors”). Clinical features such as “Akasmaat hasati,” “Rodati animittitam,” “alpa vaak,” “deenaaksha,” “aavilam chakshusha,” “krodhana,” “Praswapati” and “nidraalu” of Madonmada represents emotional turmoil, rapid shifts in mood, delusions, poor judgment, cognitive impairment, and catatonic behaviors of BPD respectively. “Pradhyayati” and “purastaat avalokee” indicate overwhelming confusion, lack of judgment capacity, and catatonic behavior found in BPD. “Nirapatrapa” of Madonmada indicates the behaviors such as “acting on the basis of delusions” or suicidal tendencies observed in BPD. “Na yathavritta eva” and “nityam utsuka” denote grossly disorganized or catatonic behavior seen in BPD. “Parushatva of roma” indicates neglect of nutritional and hygienic requirements or underlying nutritional deficiencies or dehydration in BPD patients. “Rodati animittitam” and “akasmaat hasati” in a same patient denote rapid shifts from one intense affect to another or delusional behavior. “Alpa vaak” denotes diminished speech, which can occur due to the risk factors and/or risk markers, such as “under-developed coping skills” or “isolation” as mentioned in BPD (American Psychiatric Association, 2013b). It seems that Mada or Madonmada has shown some similarity with BPD based on the above facts [Table 2].

Similarity of Madonmada with adjustment disorder

AdjD is characterized by maladaptive emotional and behavioral response to a recognizable psychosocial stressor, capturing those who experience difficulties adjusting after a stressful event at a level disproportionate to the severity or intensity of the stressor. Unlike PTSD or ASD, which have clear criteria for what constitutes a traumatic event, AdjD criteria do not specify any requirements for what can be regarded as a stressor. Traumatic events such as exposure to actual or threatened death, as well as nontraumatic stressful events such as interpersonal conﬀicts, death of a loved one, financial difficulties, unemployment, or illness of a loved one or oneself can cause AdjD. “Failure to adapt” is thought to constitute a response to stress (e.g., sleep disturbances or concentration problems) that results in significant impairment in social, occupational, interpersonal, educational, or other areas of functioning. Two core symptoms (i.e., failure to adapt and preoccupations) and four accessory symptoms (avoidance, depression, impulsivity, and anxiety) have been mentioned in the diagnostic criteria of AdjD in the International Classification of Diseases-11. The Diagnostic and Statistical Manual of Mental Disorders-5 delineates the disorder into a series of six subtypes (depressed mood, anxiety, mixed anxiety and depressed mood, disturbance of conduct, mixed disturbance of emotions, and conduct and unspecified), each signifying the presence of specific symptoms. AdjD symptoms in some people may increase over time marking a trajectory toward a more severe disorder (O'Donnell et al., 2019).

Etiological factors mentioned in the context of Madonmada such as shoka, kopa, harsha, and vinaasha of dravya are similar to the major traumatic events or nonstressful traumatic events (minor) required for the manifestation of AdjD. Clinical features of Madonmada also have shown some similarity with AdjD. “Rodati animittitam,” “alpa vaak,” “deenaaksha,” “aavilam chakshusha,” and “trasta shareeri” of Madonmada denote “depressed mood” subtype of AdjD. “Pradhyayati,” “nityam utsuka,” and “nirapatrapa” denote “anxiety” subtype of AdjD. “Rodati animittitam,” “akasmaat hasati,” “krodhana,” “praswapati,” “nidraalu,” “alpa vaak,” and “purastaat avalokee” indicate “mixed disturbance of emotions and conduct” subtype of AdjD. “Na yathavritta eva” and “nityam utsuka” denote “disturbance of conduct” subtype of AdjD. “Parushatva of roma” indicates neglect of nutritional and hygienic requirements or significant impairment in different areas of functioning. “Alpa vaak” denotes “avoidance” seen in AdjD patients (O'Donnell et al., 2019). It seems that Mada or Madonmada of Bhela samhita has shown some similarity with AdjD [Table 3].

Prognosis and management of Madonmada

Exaggerated or long-standing Mada/Madonmada can lead to “Unamada.” There is no specific treatment mentioned for Mada/Madonmada in Bhela samhita. Treatment mentioned for specific types of Unamada can be implemented to manage “Mada” or “Madonmada” (Bhela, 2016a). According to “Acharya Charaka,” treatment of mental disorders includes gnaana, vignaana (spiritual and scriptural knowledge), dharya (patience), smriti (memory), and samaadhi (meditation). Only these treatments can reconcile the pathological state of the mind. Main aim of treatment for mental disorders according to Ayurveda is to minimize psychopathology and which can be achieved by implementing sattvaavajaya (Ayurvedic psychotherapy) as well as other treatments such as Daiva vyapashraya chikitsa (traditional or spiritual methods to treat psychiatric conditions in Ayurveda). Virtuous path of living is suggested by Ayurveda to prevent the recurrences or to manage various psychiatric conditions. Achaara Rasayana (a specific code of conduct mentioned in Ayurveda to promote healthy or positive mental state) is also explained to promote and maintain a positive mental state (Mamidi & Gupta, 2015b). Madonmada can be managed by implementing Sattvaavajaya, Daiva vyapashraya chikitsa and Achaara Rasayana methods.

Conclusion

“Acharya Bhela” was one of the six outstanding disciples of “Punarvasu Atreya” and his work “Bhela Samhita” is one of the prominent treatises of Ayurveda. A unique condition called “Mada” or “Madonmada” is available in Bhela samhita. Mada is considered as a prodromal phase of Unamada, or it can occur as an independent disease condition also. Mada/Madonmada has shown similarity with various psychiatric conditions such as ASD, PTSD, BPD, and AdjD. Description of Mada/Madonmada resembles with “trauma- and stressor-related disorders” of contemporary psychiatry. The present study provides insights for clinical implementation of “Mada/Madonmada” for diagnosing and managing of “trauma- and stressor-related disorders.” Further studies should focus on to check the presence of Mada/Madonmada as a prodromal condition in various psychiatric disorders. Clinical implication of Madonmada concept will be beneficial in diagnosing psychiatric disorders at early stages and prevent the full-blown psychosis. It is astonishing to find out that thousands of years before “Acharya Bhela” has documented the conditions like trauma and stressor related disorders in the context of Mada or Madonmada.

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Conflicts of interest

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