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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 3-12

Bhutonmada's of harita samhita: An explorative study


Department of Kaya Chikitsa, SKS Ayurvedic Medical College and Hospital, SKS Group of Institutions, Mathura, Uttar Pradesh, India

Date of Submission16-Aug-2019
Date of Acceptance13-Oct-2019
Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. Kshama Gupta
Department of Kayachikitsa, SKS Ayurvedic Medical College and Hospital, Mathura, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijny.ijoyppp_13_19

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  Abstract 


“Harita” was a sage of great antiquity, and he was contemporary of “Agnivesha.” “Harita” has composed a treatise named “Harita samhita” based on the teachings of his preceptor “Punarvasu Atreya.” “Bhoota vidya” (demonology/psychiatry) is explained in 55th chapter of the third sthana (section) of “Harita samhita.” The etiology, number of graha's (demons), their description, and treatment aspects are explained differently in “Harita samhita” from other texts. Previous works have demonstrated that various bhutonmadas or grahonmadas have shown similarity with different psychiatric or neuropsychiatric conditions. The present article explores different “bhutonmada's” /“grahonmada's” (disease caused by the possession of demons) explained in “Harita samhita” along with their clinical significance in the present dayAyurvedic psychiatry practice. Bhutonmada/grahonmada is a psychiatric condition characterized by abnormal behavior in terms of exhibition of strength, energy, valour and enthusiasm, defects in perception, retention and memory, abnormality of speech, and abnormality in perceiving self and environment. Ten grahas (aindra, agneya, yama, nairruta, varuna, maaruta/vaayu, kubera/yaksha, sira, grahaka and pishacha ) and clinical features due to their affliction are described in “Harita samhita.” Grahonmadas explained in Harita samhita have shown similarity with various psychiatric and/or neuropsychiatric conditions.

Keywords: Ayurveda, bhutonmada, grahonmada, harita samhita, neuropsychiatry, psychiatry


How to cite this article:
Gupta K, Mamidi P. Bhutonmada's of harita samhita: An explorative study. Int J Yoga - Philosop Psychol Parapsychol 2020;8:3-12

How to cite this URL:
Gupta K, Mamidi P. Bhutonmada's of harita samhita: An explorative study. Int J Yoga - Philosop Psychol Parapsychol [serial online] 2020 [cited 2020 Feb 24];8:3-12. Available from: http://www.ijoyppp.org/text.asp?2020/8/1/3/277009




  Introduction Top


Acharya Atreya” is one of the oldest authorities of Indian medicine, and several later writers have based their treatises on his work. “Atreya” has imparted his knowledge to his six disciples, “Agnivesha,” “Bhela,” “Jatukarna,” “Parashara,” “Ksharapani” and “Harita,” all of whom have distinguished themselves as authors of medical works that have been handed down to posterity. “Harita” was a sage of great antiquity and he was contemporary of “Agnivesha,” the original author of “Charaka samhita.” “Harita” has composed a treatise named “Harita samhita” based on the teachings of his preceptor “Punarvasu Atreya.” “Harita samhita” is a standard book, which appears to have been dictated by “Atreya” in reply to Harita's questions; for each chapter ends with the words, “said by Atreya in answer to Harita.”[1] The available text of “Harita samhita” appears to be a much anterior work and the authorship of this work does not appear to have any relationship with “Harita,” the disciple of “Punarvasu Atreya.”[2] According to some authors, “Harita samhita,” which is now in print, appears to be the work of a later author who was also known as “Harita.”[3] The time of “Harita” is between 10th and 12th century but before Sharangadhara (13th century).[4]

The available “Harita samhita” contains six sthanas (sections) dealing with annapana (food), arishta (complications), chikitsa (treatment), kalpa (formulations), sutra (basics), and shareera (anatomy). Total 102 chapters are divided among six sthanas, 23, 9, 58, 6, 5, and 1 chapter, respectively, and one extra chapter, “parisishta adhyaya” at the end of the text (total 103 chapters). “Bhoota vidya” (demonology/psychiatry) is explained in 55th chapter of the third sthana of “Harita samhita.” The etiology, number of graha's (demons), and their description and treatment aspects are explained differently in “Harita samhita” from other texts.[5] The present article explores different graha roga's (disease caused by the possession of demons) explained in “Harita samhita” along with their clinical significance in present day Ayurvedic psychiatry practice.

Bhoota vidya describes demoniacal diseases. Bhoota vidya deals with the possession of demons or evil spirits and their management.[1]Bhutonmada/grahonmada is a psychiatric condition characterized by abnormal behavior in terms of exhibition of strength, energy, valour and enthusiasm, defects in perception, retention and memory, abnormality of speech, and abnormality in perceiving self and environment. “Acharya Sushruta” has described 8 types of bhutonmada deva, asura, gandharva, yaksha, pitru, naga, rakshasa, and pishacha. According to “Acharya Charaka, 11 types of bhutonmada can be found. They are deva, rushi, guru, vruddha, siddha, pitru, gandharva, yaksha, rakshasa, brahma rakshasa, and pishacha. In “Ashtanga hridaya,” description of 18 types of graha roga's is available. They are deva, asura, rushi, guru, vruddha, siddha, pitru, gandharva, yaksha, rakshasa, sarpa, brahma rakshasa, pishacha, kushmanda, nishada, preta, maukirana, and vetala.[6]

The cause is untraceable in grahonmada and pragnaparadha (intellectual blasphemy), or karma (misdeeds of previous life or idiopathic factors) plays an important role in the pathogenesis of grahonmada. In grahonmada, symptoms occur suddenly without any reason or triggering factor. Chidra kaalas (vulnerable times when demonic possession takes place) are explained, and the course of illness is unpredictable. The prognosis is also unpredictable. The purpose of grahavesha (demonic possession) may be himsa (violence/aggression) or rati (attachment/desire) or abhyarchanam (for worship). Himsatmaka (demonic possession with violent or aggressive intentions) is untreatable, and remaining two (demonic possession with the intention of desire or worship) are treatable. Daiva vyapashraya (spiritual practices), Sattvavajaya (psychotherapy) and Yukti vypashraya chikitsa (treatment with medicines and panchakarma procedures) have been mentioned in the management of grahonmadas.[6] According to previous works, various bhutonmadas or grahonmadas have shown similarity with different psychiatric or neuropsychiatric conditions.[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19]

According to “Harita samhita,” grahavesha (demonic possession) occurs at deserted temples, burial grounds, deserted highways or roads, and other such type of isolated or deserted places. The persons who got frightened at such type of places are prone to suffer from grahavesha. Ten grahas (aindra, agneya, yama, nairruta, varuna, maaruta/vaayu, kubera/yaksha, sira, grahaka and pishacha) and clinical features due to their affliction are described in “Harita samhita.” Various dhoopas (fumigations), medications, mantra's (hymns), pooja (prayers), and other spiritual methods have been described briefly in the management of graha rogas.[5] The description of ten grahas mentioned in “Harita samhita” and their similarity with contemporary psychiatric conditions has been explored in the following sections.


  Aindra Graha Top


Aindra grahonmada” is characterized by the features like “harshati” (elated mood), “gaayati” (singing), sadarpashcha and asadarpashcha (grandiosity and depression), and unmaadagrasta eva (insane behavior) (verse 6).[5]Harshati” indicates an elated, overactive or euphoric mood and “gaayati” represents singing. “Sadarpa” and “asadarpa” both indicates grandiosity/euphoria and depression. “Unmadagrasta” indicates insane or disorganized behavior. Overactive, aggressive behavior, elevated mood, thought disturbance, irritability, disorganization etc., are features seen in “Psychotic mania.” Psychomotor retardation, depressive mood, euphoric mood, and hostility-destructive behavior are seen in “Mixed mania.”[20]Aindra grahonmada” shows similarity with the conditions like “Psychotic mania” or “bipolar disorder with psychotic features” or “Mixed mania.”


  Agneya Graha Top


Agneya grahonmada” is characterized by the features like “rodati atyartham” (excessive weeping) and “pashyati sarvato bhayam” (distressed with fear)(verse 7).[5] Anxiety is an emotional state that is often considered analogous to fear. Anxiety is synonymous with fear, nervousness, distress, uncertainty, apprehension, and being scared or worried. Anxiety is a general sense of worry or fear which can in turn lead to panic or a sense of feeling trapped, uneasy, or unsafe. Abnormal worrying leads to exhaustion and even depression. Clinical presentation of anxiety consist physiological symptoms such as tears, shakes, tension, crying, feeling sick, and wanting to escape. Excessively crying, trembling, fearfulness, frozen & worried look etc., physical manifestations are also seen in anxiety.[21] Specific phobia is a marked and persistent fear of circumscribed objects or situations (phobic stimuli), such as animals, blood, closed spaces, heights, or flying. The fear is excessive and unreasonable. Panic disorder is characterized by recurrent, unexpected panic attacks, which are discrete periods of intense fear or discomfort accompanied by specific somatic symptoms.[22]

It was found that individuals with higher anxiety cry frequently and excessively. The proneness to crying observed in highly anxious individuals may be due to them perceiving threats more readily and experiencing negative emotions more keenly, leading these individuals to intensify their emotions. This intensification also accounts for the longer duration of crying episodes, as they struggle to regulate and alleviate negative affect.[23] Considering these facts, features such as excessive crying and fear found in “Agneya grahonmada” have shown similarity with anxiety disorder or phobia.


  Yama Graha Top


Yama grahonmada” is characterized by the features such as “vihvala” (agitation/distress), “deenata” (depression/sadness), and “pretavat cheshta” (behaving like a dead person) (verse 8).[5]“Vihavalata” refers to purposeless activities or mannerisms or stereotypies or increased motor activity or agitation found in catatonia. One of the main symptoms of catatonia are “a change in motor activity” (reduced or less often increased motor activity) and unusual movements (stereotypies, grimacing, infrequent blinking, motor/vocal tics, and posturing). Patients of catatonia with schizophrenia have shown disorganized activity. Purposeless behaviour, Awkward, bizarre types of movements which are excessive in nature are seen in 'excited type of catatonia'. Periods of agitation in catatonia are characterized by extreme hyperactivity with constant motor unrest and purposeless motor activity, and the patient may collapse eventually from exhaustion. Catatonic excitement refers to extreme hyperactivity with constant motor restlessness which is apparently nonpurposeful. Vast majority of persons experiencing catatonic stupor report feeling “frozen” or “petrified” and experience “extreme fear” during the episode. Severe anxiety has been reported in psychiatric, iatrogenic, and medical catatonias.[17] Stereotypy, mannerisms, agitation, and anxiety seen in catatonia denote “Vihavalata” of “Yama grahonmada.”

Catatonia is characterized by features such as hypoactive behavior, decreased response to external stimuli, akinetic behavior, mutism (verbally unresponsive or refusal to speak), posturing, staring, rigidity, negativism, and catalepsy.[24] Catatonia is a state in which the patient remains completely mute and immobile, with staring expression, gaze fixed into space, with an apparent complete loss of will, no reaction to sensory stimuli, waxy flexibility, and catalepsy. Catatonia associated with mood disorder was found to be increasing over the years.[25] These all features of catatonia seem to be similar with “Deenata” of “Yama grahonmada.”

“Pretavat cheshta” of “Yama grahonmada” denotes behavior like a dead body. “Waxy flexibility,” “posturing,” and “catalepsy” are among the well-recognized motor abnormalities seen in catatonia. “Mutism” is manifested by minimal or no verbal communication and “Catatonic stupor” is manifested by patient's absence of movement or other reaction to any stimulus while awake. The patient is extremely hypoactive, immobile, and minimally responsive to stimuli including pain. “Waxy flexibility” and “Catalepsy” positions assumed by the patient in catatonia are unusual and appear uncomfortable to the observer. The patients can adopt statuesque postures with minimal movement lasting for several hours without any apparent fatigue or discomfort. “Rigidity” consists of a stiff position which the patient attempts to maintain despite efforts to be moved. The state of withdrawal, also interpreted as “social negativism,” is a condition manifested by the patient's refusal to eat, drink, or make eye contact.[17] Various features such as mutism, catatonic stupor, waxy flexibility, catalepsy, and rigidity of catatonia are similar to “Pretavat cheshta.” By considering all these facts, the condition of “Yama grahonmada” has shown similarity with catatonia.


  Nairruti Graha Top


“Nairruti grahonmada” is characterized by the features such as “dveshti” (hatred/hostility), “dhaavati” (agitation/running/purposeless movements/restlessness), and “maarayati” (aggressiveness/killing others/violence) (verse 9).[5] Aggressiveness, impulsivity, irritability, violence, anger etc., features which are commonly seen in “antisocial personality disorder” (ASPD), “Conduct disorder” (CD), “Attention-deficit hyperactivity disorder” (ADHD), mania, and psychosis. Aggressiveness can be defined as “the generation of a behavior that aims at causing physical or psychological harm to somebody else.” Aggressiveness is an important issue commonly seen in personality disorders, particularly in ASPD. Individuals with ASPD display a low frustration tolerance. In ASPD, a pervasive pattern of disregard for and violation of the rights of others, a failure to conform social norms, irresponsibility, deceitfulness, indifference to the welfare of others, recklessness, irritability, a failure to plan ahead, and aggressiveness can be seen. ASPD patients show traits of impulsivity, high negative emotionality, low conscientiousness, and wide range of interpersonal as well as social disturbances. Irritability and disruptive aggressive behavior are the characteristic features of “irritable mania.” Violent behavior is relatively common in bipolar disorder and usually occurs during acute manic episodes. It has been observed that manic patients with incongruent psychotic symptoms have showed agitated, aggressive behavior. The tendency to engage in risky and aggressive behaviors is a core feature of the manic episodes of bipolar disorder.[13] By considering all these facts, the condition of “Nairruta grahonmada” has shown similarity with various psychiatric disorders such as irritable mania, ASPD, ADHD, and CD.


  Varuna Graha Top


Varuna grahonmada” is characterized by the features such as “gupta netra” (deep set eyes), “vivarnasya” (discoloration or pallor of face), “balishtha” (aggressiveness/stubborn/obese/excessive energy levels), “dushta cheatas” (abnormal or psychotic behaviour), “nadee tadaaga teere chalati” (roaming near ponds and river banks/hyperactivity/compulsive traits/due to excessive thirst), “laala sravati aasyaat” (drooling of saliva due to dental caries or poor oral hygiene), “bhrusham mutrayati” (frequent or excessive urination/polyuria/diabetes), “netra plaavashcha” (cataract/eyes looks like floating), and “mookavat pravilokyate” (speech deficits/due to deafness/mutism) (verse 10 & 11).[5] All these features can be found in various neuropsychiatric syndromes [Table 1].
Table 1: Similarity of “Varuna grahonmada” with various neuropsychiatric syndromes

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Wolfram syndrome (WS), also known as DIDMOAD (diabetes insipidus [DI], diabetes mellitus [DM], optic atrophy [OA], and deafness) is a rare autosomal recessive disorder. Polyuria (bhrusham mutrayati), polydipsia (nadee tadaaga teere chalati?) and dysarthria (mookavat pravilokyate?) are seen in WS. Anxiety, depression, abnormal behavior (compulsive aggression, eating disorders), or psychosis (balishtha and dushta chetasa?) can also be seen in WS (EURO-WABB). The common manifestations of WS include DM, optic nerve atrophy, central DI, sensorineural deafness (mookavat pravilokyate), urinary tract problems, and progressive neurologic difficulties. Optic nerve atrophy which is seen in WS is characterized by loss of colour and peripheral vision. Urinary tract problems in WS include obstruction of the ducts between the kidneys and bladder, high-capacity atonal bladder, disrupted urination, bladder sphincter dyssynergia, and difficulty in controlling urine flow. A large atonic bladder, a low capacity and high-pressure bladder with sphincteric dyssynergia associated with hydroureteronephrosis are common urinary tract manifestations in WS. Retinal thinning has been shown to be a reliable marker for the disease progression of WS. Some patients develop cataracts (netra plaavata) in childhood. Dysarthria is commonly seen in WS. Oral hygiene and dental care are important because dysphagia in WS may lead to the impaired clearance of organisms and pathogenic colonization. Anxiety, depression and psychosis are seen in some patients of WS.[26],[27]Nadee tadaaga teere chalati” may indicate that the patient is thirsty and always roaming nearer to the water resources (polydipsia) due to underlying DM or insipidus or polyuria (excessive and frequent urination). “Laala sravati aasyaat” may be due to poor oral hygiene or dental care.

Bardet–Biedl syndrome (BBS) is an autosomal recessive condition with a wide spectrum of clinical features. The principal manifestations are rod cone dystrophy (atypical retinitis pigmentosa), postaxial polydactyly, central obesity (balishtha), mental retardation (dushta cheatas), hypogonadism, and renal dysfunction. Other features include hepatic fibrosis, DM (bhursham mutrayati and nadee tadaaga teere chalati), reproductive abnormalities, endocrinological disturbances, short stature, developmental delay (dushta cheatas), and speech deficits (mookavat pravilokyate). Ocular abnormalities such as astigmatism, strabismus, cataracts, color blindness, macular edema and degeneration and OA are also seen in BBS (gupta netra and netra plaavata). Developmentally delay, late in reaching milestones, and delay of speech are found in BBS. Psychiatric complaints such as emotional immaturity, frequent volatile outbursts, poor reasoning, inappropriate affect, disinhibition, obsessive-compulsive behavior, panic attacks, depression, and schizophrenia (balishtha and dushta cheatas) can also be seen in BBS. Patients with BBS often report behavioral difficulties with labile emotional outbursts, frustration, and inflexibility. Children had a tendency to avoid direct gaze, and many had difficulty in appreciating abstract thought. Language and comprehension difficulties are also apparent. BBS children were unable to repeat sentences accurately and had difficulty interpreting language subtleties correctly (mookavat pravilokyate). Dental anomalies in BBS such as hypodontia, small teeth, enamel hypoplasia, short roots (these anomalies can cause laala sravati aasyaat), a thickened mandibular body etc., were found.[28]

Laurence-Moon-Biedl (LMB) syndrome is a rare familial disorder, inherited by autosomal recessive characteristic with variable penetrance and expressivity. This syndrome is characterized by 5 cardinal features - obesity (balishtha), mental retardation (dushta cheatas and mookavat pravilokyate), retinal degeneration (netra plaavata), hypogonadism, and polydactyly. Glucose intolerance is reported (bhursham mutrayati - polyuria and nadee tadaaga teere chalati - polydipsia). Nystagmus, OA, bilateral keratoconus, internal and external ophthalmoplegia, telecanthus, epicanthal fold, and bilateral ptosis have also been reported (gupta netra and netra plaavata).[29] Obesity, mental deficits, genital dystrophy, nerve deafness, and short stature characterize Weiss syndrome.[30]

Prader–Willi Syndrome (PWS) is a highly variable genetic disorder affecting multiple body systems. It is a sporadic disorder with a recognizable pattern of dysmorphic features and major neurologic, cognitive, endocrine, and behavioral/psychotic disturbances (balishtha, dushta cheatas, and mookavat pravilokyate). Major characteristics of PWS include lethargy, hypotonia, developmental/intellectual disabilities, mental retardation, temper tantrums, stubbornness, controlling and manipulative behavior, psychosis (balishtha, dushta cheatas and mookavat pravilokyate), depression, compulsive traits (nadee tadaaga teere chalati), characteristic facial appearance (vivarnaasya), almond-shaped palpebral fissures (gupta netra), hyperphagia, obesity (balishtha), type II DM (NIDDM) (bhursham mutrayati - polyuria and nadee tadaaga teere chalati - polydipsia), thick and viscous saliva, dental caries (may lead to laala sravati aasyaat), articulation problems (mookavat pravilokyate) and hypogonadism.[31] Ophthalmological conditions like myopia, hypermetropia, and strabismus can be seen PWS.[32]

Alström syndrome (AS) is a rare autosomal recessive genetic disorder characterized by cone-rod dystrophy (gupta netra and netra plaavata), hearing loss (mookavat pravilokyate), childhood truncal obesity (balishtha), insulin resistance and hyperinsulinemia, type II diabetes (bhursham mutrayati - polyuria and nadee tadaaga teere chalati - polydipsia), hypertriglyceridemia, short stature in adulthood, cardiomyopathy, and progressive pulmonary, hepatic, and renal dysfunction. Slowly progressive bilateral sensorineural hearing loss (mookavat pravilokyate), obesity (balishtha), polyuria (bhursham mutrayati), and polydipsia (nadee tadaaga teere chalati) are found in AS. Mild to moderate delay in reaching major developmental milestones including gross motor and fine motor skills and intellectual development has been reported. Autistic spectrum behaviors (dushta cheatas) and seizure activity have been reported. Some individuals lack facial movement sometimes associated with speech difficulty (mookavat pravilokkyate). Major depression, obsessive-compulsive behavior, and psychotic behavior have been noted (dushta cheatas). Distinctive facial characteristics are reported in AS such as deep-set eyes (gupta netra) with a rounded face, hyperostosis frontalis interna, thick ears, premature frontal balding, and thin hair. Dental anomalies such as absent, mislocated, or extra teeth are reported and can include gingivitis (these anomalies may lead to laala sravati aasyaat).[33] Based on these facts, it seems that there is a similarity between “Varuna grahonmada” and various syndromes such as WS, BBS, LMB, PWS, and AS.


  Maaruta/vaayu Graha Top


Maaruta or vaayu grahonmada” is characterized by the features such as “aasya sosha” (dryness of mouth), “deenata” (depression/sadness), “kampana” (tremors), and “rodana” (crying/weeping) (verse 12).[5] These features resemble with “Pseudo bulbar affect in  Parkinsonism More Details” or “Negative symptoms of schizophrenia” or “major depressive episode.” The typical neurological manifestations of Parkinson's disease (PD) (4–6 Hz rest tremor [kampana], muscular rigidity, hypo and bradykinesia and postural instability) as well as other associated symptoms (festinant gait, marked fatigue, masklike or expressionless face, dementia, monotonous and slightly slurred speech, dysautonomia, etc.,) lead to a serious disability and reduced quality of life (QoL). The most common psychiatric illness associated with PD is depression (deenata and rodana). Major depression associated with PD is quite frequent and affects 17%–40% of the patients and minor depression or dysthymic disorders in PD raises up to 50%. About half of depressed patients with PD meet the criteria for major depressive and another half have minor depressive disorder or its chronic form called dysthymic disorder. Depression associated with PD shows some clinical differences from primary major depressive episode: in the comorbid cases, there are high levels of dysphoria, anxiety, pessimism, irritability and suicidal ideation.[34]Kampana” and “deenata” of “Maaruta grahonmada” denote tremors and depression seen in PD.

Dry mouth (aasya sosha) is rarely mentioned as an autonomic symptom of PD despite evidence that salivary secretion is decreased in these patients. Dry mouth is a frequent and underreported symptom of PD; it may be an early manifestation in some cases and its presence appears unrelated to concomitant dopaminergic therapy. The presence of xerostomia (dry mouth) in PD has been reported previously. Dry mouth could be a pre-motor symptom in the course of PD. Xerostomia could be considered an early manifestation of autonomic involvement in PD.[35] Pseudobulbar affect (PBA) is an “explosive bursts of laughter or weeping.” PBA describes a neurological symptom involving involuntary and sudden laughter or crying (rodana) that is disproportionate to or incongruent with an individual's emotional state. PBA can occur in a variety of neurological conditions, including amyotrophic lateral sclerosis, multiple sclerosis, Alzheimer's disease, stroke, traumatic brain injury, and Parkinsonian disorders.[36] PBA has been associated with depression (deenata and rodana). The episodes of crying (rodana) are perceived by others as being unprovoked and disconnected from the situational context, or as being out of proportion to the mood and feelings of the patient. Crying is often described as occurring in situ ations that are sad or otherwise emotionally touching, but which would not have produced such a striking emotional response from the patient in the past. Crying appears to be a more common manifestation of PBA than laughter.[37] The features like PBA, depression, tremors and xerostomia resembles with the signs and symptoms of “Maaruta grahonmada” [Table 1].


  Kubera/yaksharaat Graha Top


Kubera or yaksharaat grahonmada” is characterized by the features like “vihvala” (distressed/agitation/restlessness), “shraanta netra” (tired eyes), “kshudaatura” (excessive eating/hyperphagia), “harsha” (euphoria), “garva” (pride) and “abhimaana” (grandiosity) (verse 13 & 14).[5] All these features of “Kubera grahonmda” resemble with “Mania.” The main psychiatric causes of agitation (vihvala) include psychotic disorders, mania, agitated depression, and anxiety disorders. In patients with bipolar disorder, agitation is often the main clinical manifestation during manic and mixed states. Agitation is the third most frequent symptom in mania. The first signs of PMA (psychomotor agitation) are motor restlessness, decreased ability to maintain attention, hyper reactivity, irritability, inappropriate verbal and motor activity.[38] Constant activity and a reduced need for sleep prevent proper rest. Although short periods of sleep are possible, some patients may not sleep for several days in a row. This nonstop physical activity and the lack of sleep and food can lead to physical exhaustion.[39] Sleep deprivation affects a number of facial characteristics that observers relate to fatigue. It seems that many of the colloquial cues, such as droopy/hanging eyelids, red eyes, dark circles under the eyes, and pale skin, are indicative of both sleep deprivation and looking fatigued. Eye-related behaviors are indicative of sleepiness and that one looks to the eyes to evaluate fatigue (shraanta netra).[40]

In hypomania, voracious appetites, spending, and activity, even indiscriminate sex is observed.[39] Studies have also suggested that hypersomnia and hyperphagia (kshudaatura) are most common in bipolar depression.[41] The euphoric mood associated with mania is unstable. During euphoria (harsha), the patient experiences an intense feeling of well-being, is “cheerful in a beautiful world,” or is becoming “one with God.” The overly joyous mood may seem out of proportion to what is going on, and cheerfulness may be inappropriate for the circumstances. People experiencing a manic state may laugh, joke, and talk in a continuous stream, with uninhibited familiarity. People in the manic phase are busy during all hours of the day and night, furthering their grandiose plans. To the person experiencing mania, no aspirations are too high, and no distances are too far. No boundaries exist to curtail them. Grandiosity (inflated self-regard) (garva and abhimaana) is apparent in both the ideas expressed and the person's behavior. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. The boast of exceptional powers and status can take delusional proportions during mania. Grandiose persecutory delusions are common.[39] The features like PMA, tired eyes due to reduced sleep, voracious appetite, euphoria and grandiosity of Mania resembles with the signs and symptoms of “Kubera grahonmada” [Table 1].


  Siraa/aishaanya Graha Top


Siraa or aishaanya grahonmada” is characterized by the features like “garvoddhata” (grandiosity), “alankaara priya” (fond of make-up/flamboyant), “bhasmaanga raagam” (applying ash all over the body), “bhramate digambara” (roaming naked/disinhibition), “geeta vaadya priya” (fond of songs and music) and “dhyaana rato” (always indulged in thinking/excessive religiosity) (verse 15 & 16).[5] All these features of “Siraa grahonmada” resemble with “Pyschotic mania” or “Bipolar disorder with psychotic features.” Delusion of grandiosity (garvoddhata) with markedly inflated self esteem is found in mania. The person with mania is unusually alert, trying to do many things at one time. The mood becomes expansive which is unceasing and unselective enthusiasm for interacting with people and surrounding environment.[8] The person suffering with mania usually dressed up in gaudy and flamboyant clothes (alankaara priya).[8] Dress in manic patients may be described as outlandish, bizarre, colorful, and noticeably inappropriate. Makeup may be garish and overdone during manic episodes.[11] Reviews of biographical material have suggested that BD (Bipolar disorder) is significantly over-represented among samples of authors, poets, and visual artists. People in creative professions (including architecture/design, musical composition, musical performance, theatre, expository writing, fiction writing and poetry) appeared to have had experiences of mania. Many people with BD appear to be highly creative. Individuals with Mania become involved in pleasurable activities and experience an intense feeling of well-being. The individual with mania displays unparalleled artistic talents such as writing, painting, and dancing (geeta vaadya priya).[11]

Disinhibition (bhramate digambara) and socially inappropriate behaviors (bhasmaanga raagam and bhramate digambara) commonly present in mania which may be attributable to impaired ventrolateral prefrontal cortex function.[42] Psychosis has been an intrinsic part of manic depression. Symptoms such as delusional grandiosity, persecutory, and religious delusions (bhasmaanga raagam and dhyaana rato), hallucinations of all sorts, and thought disorder are found in psychotic mania. Bizarre delusions can also occur during mania.[43] Hyperreligiosity (bhasmaanga raagam and dhyaana rato) is found in mania.[12] By considering all these facts, it is evident that the clinical features of “Siraa grahonmada” resemble with psychotic mania or bipolar disorder with psychotic features.


  Grahaka Graha Top


Grahaka grahonmada” is characterized by the features like “na kshudha” (loss of appetite/not taking food), “na trishaarta” (not taking water/not feeling thirsty), “na kathayati” (not speaking at all/mutism) and “na shrunoti” (not listening/unable to understand the speech) (verse 17).[5] All these features of “Grahaka grahonmada” resemble with “Catatonia” or “Major depressive episode” or “Negative symptoms of Schizophrenia.” Reduced motor activity, freezing, posturing, reduced meaningful speech (na kathayati), mutism (na kathayati), verbigeration (senseless repetition of words or phrases), reduced appetite (na kshudha), slowing down of food intake, negativism (na kathayati and na shrunoti), and decline in activities of daily living are the features of catatonia.[44] Mutism, manifested by minimal or no verbal communication (na kathayati), is probably the most frequently observed sign of catatonia. Social negativism may include turning away when addressed, refusing to open the eyes and closing the mouth when offered food or liquids (na kshudha and na trushaarta). The state of withdrawal, also interpreted as “social negativism,” is a condition manifested by the patient's refusal to eat, drink or make eye contact in catatonia (na kshudha, na trushaarta and na shrunoti).[45]

The National Institute of Mental Health Measurement and Treatment Research to Improve Cognition in Schizophrenia consensus panel has recently defined five negative symptoms: blunted affect (diminished facial and emotional expression), alogia (decrease in verbal output or verbal expressiveness) (na kathayati), asociality (lack of involvement in social relationships of various kinds) (na shrunoti), avolition (a subjective reduction in interests, desires, and goals and a behavioral reduction of self-initiated and purposeful acts) (na kshudha and na trushaarta), and anhedonia (inability to experience pleasure from positive stimuli).[46] Depressed mood, markedly diminished interest in all activities (na kathayati and na shrunoti), significant weight loss (na kshudha and na trishaarta), insomnia, psychomotor retardation, fatigue, feelings of worthlessness, diminished ability to think or concentrate and suicidal ideations are the clinical features of major depressive episode.[47] All these facts indicate that the clinical features of “Grahaka grahonmada” resemble with catatonia or negative symptoms of schizophrenia or major depressive episode.


  Pishaacha Graha Top


Pishaacha grahonmada” is characterized by the features such as “nrutyati and gaayati” (dancing and singing), “jalpati” (irrelevant speech/excessive speech), “rauti” (crying/weeping), “bhramate mattavat” (agitation/restlessness), “nagno bhramate” (roaming naked), “laalaa sraava” (drooling of saliva), and “kshudhaadhika” (voracious appetite/hyperphagia) (verse 18 & 19).[5] All these features of “Pishaacha grahonmada” resemble with “Fronto-temporal dementia (FTD).” FTD is one of the most common causes of early onset dementia and is characterized by progressive behavioral changes and executive dysfunctions with language difficulties. Clinical features of FTD include personality changes, restlessness (bhramate mattavat), disinhibition (nagno bhramate), apathy, social withdrawal, and impulsiveness. FTD patients display socially inappropriate behaviors (bhramate mattavat and nagno bhramate), pervert sexual behaviours (nagno bhramate), compulsive acts (bhramate mattavat and nagno bhramate), poor insight, hallucinations, and paranoid delusions. Behavioral symptoms such as euphoria (nrutyati, gaayati and jalpati), inappropriate joking, increase in self-confidence, and irritability (bhramate mattavat) may cause misdiagnose as hypomania or mania as well. Due to disinhibition, inappropriate social behaviors, repetitive compulsion like behaviors, and poor insight, FTD cases may be misdiagnosed as late-onset schizophrenia or atypical psychosis.[48]

Emotional blunting, impairment of judgment, lack of insight, decrease in self-hygiene, and impairment of social functions are among negative symptoms of schizophrenia which are also found in FTD. FTD is classified into 3 subtypes; “Behavioral variant (FTD bv),” “Semantic variant (SD),” and “progressive nonfluent aphasia (PNA)”. Socially inappropriate behaviors such as childishness, inappropriate jokes, and sexual statements represent behavioral symptoms. Neglecting self-hygiene (nagno bhramate), collecting weird objects, alterations in eating habits (kshudhaadhika), compulsions, late onset gambling and excessive religiosity can be seen in behavioral variant. In “SD,” there is insidious and slowly progressive language impairment (fluent aphasia) is present. Speech is fluent, empty and spontaneous (jalpati). In “PNA,” Language disorder is predominant and nonfluent speech accompanied by any one of the features such as anomia, agrammatism or paraphasia (jalpati). Alterations in eating habits like addiction to food (kshudhaadhika) with high carbohydrate content can be seen in FTD patients.[48]Laala sraava (drooling of saliva) also denotes poor self/oral hygiene in FTD patients. By considering all these facts it is evident that “Pishaacha grahonmada” resemble with FTD. Based on the above description it is evident that, grahonmadas explained in Harita samhita have shown similarity with various psychiatric conditions [Table 2].
Table 2: Similarity of Grahonmadas of “Harita samhita” with various psychiatric/neuropsychiatric syndromes

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  Conclusion Top


Ten grahonmada's explained in Harita samhita resembles with various psychiatric and/or neuropsychiatric conditions such as Bipolar disorder, Anxiety disorders, Phobia, Conduct disorder, Attention-Deficit / Hyperactivity Disorder, Wolfram syndrome, Bardet-Biedl syndrome, Laurence-Moon-Biedl syndrome,  Prader-Willi syndrome More Details, Alström syndrome, Pseudobulbar effect in Parkinsonism, Negative symptoms of Schizophrenia, Major depressive episode, Catatonia, Frontotemporal dementia, and various other diseases.

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Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

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  In this article
   Abstract
  Introduction
  Aindra Graha
  Agneya Graha
  Yama Graha
  Nairruti Graha
  Varuna Graha
  Maaruta/vaayu Graha
   Kubera/yaksharaa...
   Siraa/aishaanya ...
  Grahaka Graha
  Pishaacha Graha
  Conclusion
   References
   Article Tables

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