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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 10-16

Assessment of dreams in context to health and disease: Traditional Indian understanding


1 Consultant in Ayurveda, Govt. of Maharashtra, Nagpur, Maharashtra, India
2 Department of Psychiatry, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
3 Department of Siddhant Darshan, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India

Date of Web Publication28-Mar-2019

Correspondence Address:
Dr. Mona Srivastava
36/2 HIG, Kabir Nagar Colony, Durgakund, Varanasi - 221 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijny.ijoyppp_3_18

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  Abstract 


Background and Aims: Ayurveda is one of the most ancient prevailing medical sciences. The interpretation of dreams to understand one's mind is a valid concept in modern literature and has been extensively mentioned in treatises of Ayurveda. Study of Swapna (dream) in Ayurveda can be helpful for understanding prakriti (personality) and prognosticating an illness. We aim to study swapna on healthy volunteers to identify prakriti and to see if there is any relation between prakriti and dreams; also, to understand the auspicious and inauspicious Swapna in persons suffering from the psychiatric disorder for the assessment of prognosis. Methodology: Two study groups, Group 1 comprising of 100 healthy volunteers assessed using questionnaires based on dreams for the assessment of prakriti (QBD-AP) and self-report questionnaire to assess prakriti (SQ-AP), as defined in Ayurveda; and Group 2 comprised 60 patients diagnosed with a psychiatric disorder. QBD for A-auspicious dreams and B-inauspicious dreams (QBD-A and B) was administered. The cases were given clinical prognosis (CP) as good, fair, and bad based on the experience of the treating psychiatrist. The data were analyzed using appropriate statistical tool. Results: No statistical significance was seen on prakriti assessment by both methods, QBD-AP and SQ-AP (χ2 = 2.81, P = 0.093). No statistical significance was seen on two methods of disease prognosis based on QBD-A and B and CP (χ2 = 0.667, P = 0.414), suggesting convergence of two assessment methods. Conclusion: Prakriti assessment based on dream analysis and traditional ayurvedic methods converge and prakriti assessment can be done by observing dreams in healthy persons. Furthermore, auspicious and inauspicious dreams can be used as a prognostic marker for psychiatric disorders.

Keywords: Ayurveda, dreams, prakriti


How to cite this article:
Munishwar DS, Pandey A, Srivastava M, Singh R. Assessment of dreams in context to health and disease: Traditional Indian understanding. Int J Yoga - Philosop Psychol Parapsychol 2019;7:10-6

How to cite this URL:
Munishwar DS, Pandey A, Srivastava M, Singh R. Assessment of dreams in context to health and disease: Traditional Indian understanding. Int J Yoga - Philosop Psychol Parapsychol [serial online] 2019 [cited 2019 Jun 26];7:10-6. Available from: http://www.ijoyppp.org/text.asp?2019/7/1/10/255079




  Introduction Top


Ayurveda is one of the most ancient, prevailing medical sciences. It is based on laws of nature and deals with maintaining health through holistic approach of not only prescribing medications but procedures which could lead to the emancipation of soul, i.e., achievement of ultimate state of spirituality. Many theories and concepts were propounded by ancient scholars after their prolonged observation and in-depth knowledge.[1] Interpretation of dreams (swapna), is one such concept. The ancient Indian scholars have used assessment of dreams as a tool to understand one's mind, diagnosing and prognosticating an illness, for assessment of personality, pregnancy and to know life expectancy. Some of these concepts have been validated in modern literature also.[2] To understand and review the available literature from the traditional ancient works and to assess whether the personality (prakriti) assessment and disease prognostication on the basis of dreams can be a valid method, the present study was planned. For a better organization, the introduction part is subdivided into literature review of traditional scriptures, and modern knowledge.

Overview

After a thorough research on the traditional and modern literature, we have comprehensively organized the knowledge in the following two parts, i.e., Ancient and Ayurvedic literature.

Ancient scriptures

Considered as the oldest source of wisdom, Vedic literature considers swapna in two senses – both sleeping and dreaming. Rigveda considers swapna as a state of insomnia, where eyes are half closed, which occurs due to ignorance (tamas or moha) about oneself. Bad dreams have been described as “duhaswapna[3] and are considered as manifestation of evil spirits, from which by praying to Lord Varuna, a person can protect himself. On similar lines, Yajurveda also mentions about inter-relationship of swapna and manas (psyche),[4] and that sinful dreams are because of the abnormal state of manas. Apamarga has been prescribed for the removal of dreadful dreams. Atharvaveda has extensive mention of methods to cure bad dreams, for example, prayers, yoga exercises, and practices such as yama (ethical rules), niyama (observances), healthy diet, lifestyle, and discipline.[3],[4],[5] In the Purana (mythology) many references of dream can be found. In Bramhavaivarta Purana, time of dream with respect to periods of the night has been described to carry special significance. Dreams seen in worry and diseased states are meaningless, sleeping after seeing a dream leads to sorrow.[5] In Agni Purana, the description of shubha swapna, ashubha sawpna is given. Some examples of bad dreams are dreams of marriage, singing, and killing snake. Good dreams are bushes sprouting from navel, riding on horse, and white flowers. Remedies have also been described such as praying to Brahmanas, Vishnu, Siva, Brahma, Ganesha, and Yajnas. Shiv Mahapurana describes dreams seen by Parvati regarding Lord Shiva, her spouse. In Markandeya Purana, inauspicious dreams have been described while Garuda Purana states that chanting of Lord Vishnu's name can absolve individuals from all the sins. Shrimad Bhagwat Purana discusses bad dreams which indicate death.

Upanishads are holy scriptures[3] which talk about reaching ultimate reality by inward journey, and four steps for inner peace have been described as waking, dreaming, dreamless sleep, and supernatural transcendent. The individual Upanishads talk about different aspects of dream. In Brihadaranyaka Upanisada,[3] the description of dream state has been given as junction of this and the next world. As per the scripture, when a person dreams, the impression of the world having all elements is taken, destroyed, and built again. Diseases can occur if a person is woken up in the middle of dreams. Prasana Upanisada[3] on the other hand talks about the mind being in unison at the time of sleep and deva (mind) enjoys its greatness in dreams by recreating day time experiences, the same way as the early morning unison of sun rays. The Mandukya Upanisada describes three stages of sleep. Katha Upanisada tells about the end of dream occurs at the end of waking, and it ceases from grieving.[3],[4]

Darsana (Indian philosophy)

The study of the Indian philosophy reveals multiple views to understand the complexities of dreams. As per the Yoga-darsana[5] mind can become steady (tranquil) by meditating on the content of dreams. It recommends that the mind should be concentrated on the condition of deep sleep. Sankhya darsana,[5] talks about mayika (false or illusionary) and amayika (true) as two states denoting dreams and jagrita (awakened) states, respectively. Vedanta darsana,[6] says that sleep, dream, and wakefulness are three states and objective world is also a dream. To the empirical self, visva (the phenomenal world) is real, but to the Atman (soul), the witness of the three states, the phenomenal world is unreal. Vaisesika darsana,[5],[6] describes that the cognition in dreaming is due to samskara patavata or previous experiences; dhatudosata (elements) partly arises from derangement of the wind, bile, and phlegm; adristata means dreams also appear under the influence of the invisible after-effects of the past acts.[5],[6] Nyaya Sutra writes about the concept of objects in a dream which passes away as soon as one is awake, in the same way as the false apprehensions of objects disappear as soon as true knowledge of the object is attained. Buddha Dharma talks in Mahayana sutra about samgraha relation between parts of the night and describes the dosas in four parts as yama; being kapha pradhan, pitta pradhan, vatta pradhan, sattva pradhan.[7]

Jyotish shastra (astrology)

Swapnasastra is a Samhita dealing with the meaning of dreams, describes four types of swapna-daivika (divine), future indicating dreams; shubha (auspicious); ashubha (inauspicious). As per astrology nine factors influence dreams, i.e., what we listen, what we see, what we do, what we experience, physical condition, nature (sattva, raja, tama, grace of God, auspicious and inauspicious karma in day-to-day activities) and samskara.[6] Remedies for bad dreams are also described as the individual should share it with another individual or with a Tulsi plant (Ocimum sanctum) and sleep again. Thinking about Deva, Hanumanachalisa, Siva Stotra (religious scriptures) is also described as a remedy. There are some specific mantras also to neutralize the effect of bad dream and dreams should be shared with guru or knowledgeable person for its correct analysis.[6]

Review of ayurvedic literature

Ayurvedic literature is replete with the analysis of dreams. The dream has been described from physiological, pathological, diagnostic, prognostic, and therapeutic point of view.[7] The dream or sawpna is defined as an illusionary experience in semi-awakened state, and the process of its manifestation is said to be the loss of conscious activity from its semiconscious when the manas (mind) is still active.[7] The ayurvedic literature classifies the dream on the basis of external and internal impact on manas and body in the forms like-drista (seen), sruta (heard), anubhuta (experienced), prarthita (desired through prayers), kalpita (imaginary), bhavika (feelings), and dosaja (due to imbalances). It is hypothesized that dreams are due to vitiated dosas. Good or bad dreams indicate good or bad for other persons as per Astanga Samgraha.[8]

Another way to classify dreams is on the basis of their result, i.e., adrista (unseen individuals), asruta (unheard), anukta (untold), akalpitam (unimagined), abhasitam (unuttered), and karyamatram (dreams without any reason). On the basis of intensity, dreams are classified as-alpaphala (less meaningful) which is seen during the first part of night and mahaphala (highly meaningful) which is seen later on. Aphala dreams are those that are seen during day time and may be too long or short or are forgotten dreams.[8],[9] Looking at the contents of swapna they include atman (soul), manas (mind), and indriyas (senses). Atman (soul) types of dreams are a characteristic of soul present in all living beings. Manas (mind) characteristics are the perception of knowledge, and the dreams are characterized by being subtle, single and perceive one stimulus at a time and further control the senses and synthesize the meaning of all experiences. The swapna is related to ojas as being the first dhatu, giving strength to body and controlling manas by properties of kapha and sukra. A decrease in ojas affects dreams. Swapna and vata are related by means of three main bodily dosas of the body known as vata, pitta and kapha. Vata functions to restrain mental activity, coordinate all sense faculties, and create gross and subtle channels. Five types of vata (vayu) are namely prana (sustains all organs), udana (controls courage, memory), samana, vyana, and apana.[7]

Looking at the concept of prakrti we find that prakrti implies to the physical constitution. There are three types of it, namely vatika, pattika, and kaphaja which are formed at the time of the union of sukra and sonata based on the predominant dosa. Some of the prakriti and predominant dreams related to them are elaborated as follows: Vata prakriti signified by dwelling on trees, travelling on mountains; pitta prakriti by means of gold, blazing sun, fire, flames; kapha prakriti by ponds, clouds, water; vatika dreams by sexual themes, swimming, movement on vehicles, songs; paittika dreams by quarrels, anger, heat, black, red and yellow colour; kaphaja dreams by sleep, laziness, water, and sweet taste. The various prakritis are the manas prakriti (psychic constitution); pasavakaya (animal psyche), matsyakaya (fish psyche), vanaspatya (plants psyche), and the prakriti also determines the dreams.[8] The dreams are also classified as per the state of the pregnancy and are related to the gender of the child. In case of a male child masculine objects are seen or lotus, water lily, mango, etc., If the child is female then feminine objects are seen. In case of a false pregnancy, there are dreams of copulation after menstrual periods.

Swapna in purvarupa (prodromal signs) are described in the literature as raktapitta (vision of shinning objects), rajyaksma (defeated by snake, chameleons, monkey, etc., fall of planets), sosa (empty reservoirs, vacant villages, falling mountains, riding over dog, camels, and trees without leaves), unmada (riding on beam of oil, drowning in cyclones, drowning in polluted water), apasmara (dreams of intoxication, dancing, singing, and drinking wine).[8] Swapna in rupa (clinical signs) are as garavisa laksana (seeing cat, jackal, dried rivers and trees, fair complexion for self), madatyaya laksana (terrifying and inauspicious objects). Seeing dreadful or inauspicious dreams is when manas itself or the channels carrying the mental perception (manovahi srotas) are filled with aggravated dosas. The methods for pacification of bad dreams are called samsodhana chikitsa (purification therapy) and samsamana chikitsa. It has been described as dravyabhuta chikitsa (drug therapy) or mritsanjivanagad. Adravyabhuta chikitsa (nonpharmacological) includes advices such as lifestyle changes, donation of black grams, iron, and gold to brahmans, reciting of vedas, thinking auspicious things during sleep, celibacy, not revealing inauspicious dreams, and taking bath before dawn.[9]

Modern understanding

Recent studies suggest that in most dreams, there are deficits in the capacity to solve complex problems. Recent functional magnetic resonance imaging (fMRI) studies during rapid eye movement (REM) sleep show that there is a decrease in activity of the prefrontal cortex, which would normally be associated with a decrease in complex problem-solving executive functioning. Specifically, it has been found that there is a decrease in activity of the dorsolateral prefrontal cortex during REM sleep. This cortical region of the brain is crucial for tasks that require us to switch from our current line of thinking and stop a task once started.[10] The deactivation of this region during a dream state makes intuitive sense, and in that for most dreams even very bizarre scenarios are normally accepted without question and generally just go with the flow of the dream. Contrarily, there is a consistent increase in activity of the anterior cingulate in REM sleep. The anterior cingulate is a medial frontal region implicated in functions such as decision-making, conflict resolution, social cognition, and social judgment tasks. When it is looked at the plasticity of the brain; with 10–20 min of motor practice a day on a specific task, the motor cortex reshapes itself in a matter of a few weeks; hence, the time spent in our dreams would surely shape our brains to develop,[10] and influence our future behavior. The experiences that one acquires from dreaming across the life span are sure to influence how one interacts with the world and are bound to influence our overall life. During REM sleep, acetylcholine alone is involved in maintaining brain activation, whereas monoaminergic systems are silent, this attributes to an inactive state of body but active state of mind. The various studies done on dreams are fraught with methodological issues since dreams have a subjective nature, there are no tools to measure dreams objectively, inability to validate the content of dreams and the hypothetical nature of the subject (dreams).[11]

After the exhaustive review of the literature it was seen that there was a dearth of an exhaustive understanding between the ancient, philosophical, traditional, and modern concepts of dreams and their relation with the diseases, hence a study was undertaken to address this lacuna and also to see if there was a common thread between various streams of knowledge.


  Methodology Top


The study was undertaken in the Institute of Medical Sciences Ayurveda section. As the first step, various classical texts were extensively reviewed to understand various perspectives of dream, as presented in the ancient texts. The second aim was to see whether there is any relation between prakriti and dreams and for this we conducted a survey on 100 volunteers who were 20–40 years of age mostly students pursuing postgraduate courses at the university, who were healthy and those who remembered their dreams. As the study is an initial attempt at this kind, we were not able to calculate the required sample based on the previous studies. The individuals were informed of the study and volunteers who had given written informed consent were recruited in this group. The tools used were Questionnaire Based on Dreams for Assessment of Prakriti (QBD-AP) and Self-report Questionnaire to Assess Prakriti (SQ-AP), as defined in Ayurveda.[12] This was termed as the first study. The third aim was to study the auspicious and inauspicious swapna in persons suffering from psychiatric disorders so as to predict their prognosis. For this aim, the data were collected from 60 psychiatric disorder patients diagnosed by the psychiatrists (MS and AP) as per the international classification of diseases ICD-10. The individuals were taken from the psychiatry outpatient services of Sir Sunderlal Hospital, IMS BHU. The hospital is a tertiary care center at Varanasi. This was termed as the second study. The patients were asked for a written informed consent and patients were expected to have basic education (to maintain a journal of sleep) plus those who were medically fairly stable to give an interview, were included in the study. Sixty individuals were taken based on the availability and the allowed duration of the study. Moreover, the patient population had to maintain a dream journal and had to be followed up for 3 months. The group was further divided into four subgroups based on the diagnosis of the patient as follows:

  • Group I: Depression and somatization disorder
  • Group II: Anxiety disorders
  • Group III: OCD and hypochondriasis
  • Group IV: Psychotic and bipolar disorder.


The tool administered to this study group was the Questionnaire Based on Dreams for A-Auspicious Dreams and B-Inauspicious Dreams (QBD-A and B).[13] The cases were given clinical prognosis (CP) as good, fair, and bad based on the details of the cases and other investigations as per the experience of the treating psychiatrist. All the participants of study 1 and 2 gave a written informed consent for the study. The institute ethical committee gave its approval for the study. The study was done in one academic year starting from November 2016 to October 2017. The data were analyzed using SPSS Statistics for Windows, Version 20. (Armonk, NY: IBM Corp). Chi-square, the nonparametric statistical test was applied. The tools used are validated and standardized on the Indian population.

Assessment tools

  1. QBD-AP[12]


  2. It has a good test re-test reliability and has 200 questions which are simple and available in the regional language (Hindi) of this part of the country. The test takes about half an hour to take, and the responses are recorded as “yes” or “no.”

  3. SQ-AP[12]


  4. This questionnaire is an offshoot of the above questionnaire, and this also has the “yes” or “no” response pattern, and it takes about 20 min to self-administer.

  5. QBD-A and B.[13]


  6. Psychoticism trait and QBD-A and B factors are found to be strongly correlated, particularly with those related to action of (0.43) and inhibition of aggressiveness (0.30), and friendly interactions (−0.24) and positive emotions (−0.24); extraversion correlated with aggressiveness (0.23), sexual interactions (0.24), and archetypal (0.32). Neuroticism correlated with inhibition of aggression (0.43), negative emotions (0.34), and archetypal (0.36). This scale takes about half an hour to administer and is available in Hindi.



  Results Top


Based on the data collected, the results are presented in the following tables.

The sociodemographic characters of the study Group 1 shows that females outnumbered males (73 vs. 27), mean age was about 24 years and mostly unmarried, as there were more undergraduates than the postgraduates (77 vs. 23) [Table 1].
Table 1: Sociodemographic profile of study Group 1

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The AP of study group 1 shows that most of the responders had vatta, pitta, kapha; however, the statistical analysis done to check the difference in number of people in different categories did not reveal any significance [Table 2].
Table 2: Comparison of prakriti assessment based on dream and self-reported questionnaire

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Coming to the study Group 2, the sociodemographic details reveal that most of the individuals were from sub-Group I and the average age was 26–35 years. Females were more than males, and the individuals were unmarried but literate [Table 3]. Taking the sub Group I, it was seen that the maximum number of individuals belonged to this subgroup followed by the sub-Group II, and the good dreams were more in the sub-Group I [Table 4].
Table 3: Sociodemographic profile of study Group 2

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Table 4: Distribution of patients according to disease group and dream prognosis

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Considering the prognosis in terms of the modern and traditional understanding it was seen that the prognosis tallied with that of the prognosis by the understanding of the dream (58% bad and 6% good) as shown in [Table 5].
Table 5: Distribution of patients according to dream prognosis and clinical prognosis

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The study Groups 1 and 2 were more or less identical in terms of sociodemographic parameters. Both groups were literate and married belonging to the young adult age group. The AP of study Group 1 shows that most of the responders had vatta, pitta, kapha. The most common diagnosis was of depressive disorders, but there was marginal difference across the diagnostic groups. Sociodemographic details reveal that most of the individuals were from sub Group I, i.e., anxiety subgroup and the average age was 26–35 years. Females were more than males, and the individuals were unmarried but literate. The good dreams were more in the sub-Group I.

The prognosis was identical in the clinical as well as the ayurvedic concept in the depressive disorder category. No significant differences were seen in Chi-square test on prakriti assessment by both methods, QBD-AP and SQ-AP (χ2 = 2.81, P = 0.093). No statistical significance was seen in the Chi-square test on the two methods of disease prognosis based on QBD-A and B and CP (χ2 = 0.667, P = 0.414).


  Discussion Top


Dream description in ancient Indian literature is related to all aspects of human life-like pregnancy, balgraha, prakriti pariksana (examination of temperament), purvarupa (prodromal signs), rupa (signs), and arista laksana (signs of definite death) of disease.[11] This concept is comprehensively dealt in Ayurveda. It is as old as a creation of the universe, as mentioned in Atharvaveda that Brahma created swapna before the creation of night while creating sristi (universe).[11],[12] All Upanisads speak in unison when they proclaim that the susuptawastha is nothing but the temporary attainment of the state of bliss and pure consciousness.[1],[3] It is attained by the involution of human consciousness within the supreme consciousness, whereas the dream state is a mental projection of previous experiences and internal desires.[11] The importance of mind described in Prasna Upanisad is that it is the mind which enjoys the state of dream. When it is full of light or knowledge then there is no dream meaning; when mind is endowed with sattvik properties of its own, then it is pure because dreams are only observed when mind is attached predominantly to the rajasika property.[12] The uniqueness of Mandukya Upanisada relates three states, i.e., jagrata, swapna, susupti to omkara and the knowledge fruits of three states and the second stage is of dream. Mind creates various kinds of the impression produced in waking stage because of avidya (ignorance), kama (desire), and karma (action).[4]

With regard to study on Group 1, most volunteers were unmarried, as they were students. Most volunteers belonged to VPK prakrti than VK and KP, supporting the ayurvedic view that vata is the main dosa, which is held responsible for most of the actions of body and mind and this is seen in other studies also.[11],[13] In the ancient times, when no sophisticated tools and technologies were available, the concept of swapna was very popular in clinical practice for the diagnosis and prognosis of diseases as well as for the maintenance of health and cure of diseases.[11] This observation is also highlighted in the present study as the prognosis of modern knowledge concurred to a significant level with that of the traditional understanding. The concept was quite popular in practice during the ancient time, i.e., in vedic, puranic and upanishadic time for maintenance of health and for curing diseases. The methods to eradicate bad dreams and related diseases are prayers, yoga and related drugs especially medhya drugs which have been mentioned in ayurvedic literature.[12]

Persons showing KP prakriti are known to the only dream of kaphaprakriti. The principle of “vyapdeshastubhuyasa” says that dreams occur according to the predominance of particular dosa in prakriti formation.[13],[14] Although every individual has combinations of all dosa in their constitution, our study shows that single dosika prakriti which is found on the basis of dreams in some individual.[15] From the data, it is also observed that single dosika prakriti is not found through questionnaire made for self-AP in general. Maximum number of volunteers were having KP prakriti followed by VK and KVP according to self-assessment performa of prakriti. There is some relationship between two methods of prakriti assessment having mainly VK and KP prakriti. The Chi-square test showed no significant difference between two methods of Prakriti assessment, i.e., prakriti assessment by the questionnaire based on dreams and prakriti assessment by self-assessment in general form. This indicates a convergence between two methods of prakriti assessment and from this we can deduce that dreams can be regarded as one of the criteria for prakriti assessment.[16]

With regard to study Group 2, among the total 60 cases common view was found in 36 patients which showed that there is no significant difference between two methods of disease prognosis, i.e., ayurvedic prognosis based on auspicious and inauspicious dreams and the CP based on signs, symptoms, family history, and duration of illness. A new approach toward disease prognosis can be developed if more research is done on this topic and the other neurophysiological parameters like REM sleep study and fMRI are correlated.[17] It can be inferred that prognosis based on auspicious and inauspicious dream can be used if done with the Ayurvedic approach. The dreams are the ultimate support to get self-direction for soul.[18] It requires the evolution of mind in terms of purity and sacredness to get clear indication. The relationships between personality traits and dreams have been scarcely investigated, and our study is one of the first attempts to apply this kind of questionnaire and to evaluate the relationships between dream contents and personality traits. Most studies analyzed these relationships from a psychoanalytic point of view,[17],[19] reporting that dreams, and particularly nightmares can indicate an area of vulnerability and function as defence and tension discharge.[17],[20]

The study has a couple of strengths, that it is one of the few studies to correlate ancient wisdom with the modern literature, the tools used were previously validated, the study populations varied and the sample size was presumably adequate. There are some limitations of the study that the dream assessment is highly subjective and mostly based on recollection which can lead to bias, further the prognosis is highly subjective, and therefore, scientific validity is limited. In future large scale studies using the polysomnography, fMRI and other scientific tools can be undertaken for better comprehensive results.[19]


  Conclusion Top


Prakriti assessment based on dream analysis and traditional ayurvedic methods converge and prakriti assessment can be done by observing dreams in healthy persons. Furthermore, auspicious and inauspicious dreams can be used as prognostic marker for psychiatric disorders. The state of health can be inferred by the absence of abnormal dreams.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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  In this article
   Abstract
  Introduction
  Methodology
  Results
  Discussion
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