The commentary explains that after the management of apasmāra, the management of unmāda begins because of the similarity of the two in involving the mind and their similar treatment. 'Now, thereafter' and the rest are to be explained as before.
Key terms
unmāda
A classical category of disorder of the mind marked by disturbed thought and behaviour; not equated here with any modern diagnosis.
Because the aggravated doshas, having taken a wrong course, intoxicate (bewilder), this disorder is called unmāda and is described as a disorder of the mind.
The commentary defines unmāda. 'Madayanti' means they cause the mind to whirl. 'Uddhatā' means accumulated; others read 'udgatā', which is explained as risen up, gone astray and reaching the channels that carry the mind. What another text says (that it afflicts the heart and confuses the mind) is said to be included here by 'gone astray' and 'intoxicate'. Jejjaṭa is cited as saying the causes of provocation described for apasmāra should also be understood as present in unmāda. Causes from another text are quoted: incompatible, spoiled and unclean foods, disrespect to gods, teachers and the twice-born, and mental shock preceded by fear or joy, and irregular actions. The connection is that the advanced doshas, reaching the mind-carrying channels, make the mind whirl, so this is a mental disorder.
एकैकशः समस्तैश्च दोषैरत्यर्थमूर्च्छितैः |
मानसेना च दुःखेन स पञ्चविध उच्यते ||४||
विषाद्भवति षष्ठश्च यथास्वं तत्र भेषजम् |
स चाप्रवृद्धस्तरुणो मदसञ्ज्ञां बिभर्ति च ||५||
Meaning of the śloka
Caused by each dosha singly, by all together when greatly aggravated, and by mental distress, it is said to be of five kinds. A sixth arises from poison, and its treatment is according to its own. When not advanced and recent, it bears the name 'mada'.
The commentary explains that the five kinds are three from the single doshas, one from all together, and one from mental distress. An objection is raised: there is also a sixth from poison, so why is it not included in the five? The answer is that it is named separately because its treatment differs, hence 'its treatment is according to its own'. 'Not advanced' means having few signs; 'recent' means slight in degree. Some take 'mada' to mean the first stage of intoxication by liquor, but they regard it as the disease itself or its cause. Here, the name mada is given to a newly arisen unmāda with few signs.
Bewilderment and agitation, a sound in the ears, wasting of the limbs, excessive enthusiasm, distaste for food, unclean food in dreams, the heart being churned by vāyu, and a feeling of whirling as if on a wheel: one in whom these appear soon comes to unmāda.
The commentary says this gives the premonitory signs. Moha is mental unsteadiness; svana is sound in the two ears; gātrāṇām apakarṣaṇa is becoming weak; kaluṣa bhojana is unclean food; 'churning by vāyu' means agitation, with 'of the heart' to be supplied. 'Or of one on a wheel' uses 'or' in the sense of 'like', meaning whirling like a person standing on a potter's wheel. One who has moha, agitation and the rest soon attains unmāda. The irregular grammatical form in 'acireṇaiva unmādam' is due to fear of breaking the metre.
With rough skin and harsh speech, or with prominent veins, affected by cold, thin in body, twitching in limbs and joints, he claps, wanders, sings, is inclined to dance, cries out and whirls, through aggravation of vāta.
The commentary says that after the premonitory signs the vāta type of unmāda is described. Paruṣavāk is harsh speech; dhamanītata is veins spread over the body; śītāturaḥ is troubled by cold, while others read 'troubled by breathlessness'. Vikrośati is cries or weeps; bhramati is trembles, because wandering has already been mentioned by 'aṭati'. Some do not read this half-verse. Jejjaṭa reads it, explaining that 'aggravation' in 'anilaprakopāt' includes roughness, harshness, a reddish-dark colour and strength in digestion.
Marked by much thirst, sweating and burning, eating much, without sleep, liking shade, cold, wind and the neighbourhood of water; sharp-tempered, he is afraid of a fire even in cold water, and by day sees stars in the sky: this is from pitta.
The commentary says the pitta type is described. 'Much' applies to each of thirst, sweating and burning, and 'liking' applies to shade and the rest. Jalāntavihārasevī means one who likes to stay near water. Tīkṣṇa means irritable. The word 'and' indicates that yellow eyes and similar signs should be understood. Divā means by day; nabhasi means in the sky.
With vomiting, weak digestion, heaviness of the limbs and distaste for food and cough, fond of women and of solitude, with little movement of intellect, given to sleep, speaking and eating little, liking cold, and much worse at night: this is from aggravation of kapha.
The commentary says the kapha type is described. Agnisāda is weak digestion; sadana is lack of enthusiasm of the limbs. One who is fond of women and of solitude is 'yoṣidviviktarati'. 'Alpamatipracāra' means little intellect and little movement. 'Much worse at night' is read to mean also after eating at night. The word 'also' indicates whitening of the nails and similar signs.
The commentary says the sannipāta type is described: in the unmāda of all three, the doshas, as though excited (as though competing, all extremely aggravated), show their own signs. This reading was read and explained by the compilers. Others read differently: the three doshas' signs, mixed together, should be known in the unmāda of all; a complete set of signs is called incurable, though some say a sannipāta type may be curable. Jejjaṭa presents this as one school's view without explaining it, so it is connected as that school's view. The word 'even by three' is to show that all three are aggravated by their own causes.
In one terrified by thieves, royal men, enemies or others, or by loss of wealth and relatives, or when the mind is deeply wounded, and in one who desires to enjoy his beloved, a strong disorder of the mind may arise.
The commentary says that, wishing to present the type caused by mental distress, it first gives the causes of mental pain along with the arising of the disorder. 'Enemies' and 'others' includes extremely cruel persons without reason for enmity, or tigers and the like. 'Deeply' means greatly, 'wounded' means afflicted. One who desires to enjoy his beloved needs 'and does not obtain her' supplied. It is to be understood that the mind is deeply wounded. The disorder of the mind is the mental unmāda.
The commentary describes its signs. 'Various' means of many kinds. 'Following the mind' means whatever is in his mind he says without intent, anything at all. Because his memory is disturbed, the 'visañjña' one sings; visañjña here means one with a reversed awareness, not one without awareness, since he speaks and sings. The phrase 'with deluded awareness' should be explained as cause and effect.
The commentary describes the poison type. Bala is strength consisting of enthusiasm and bulk; indriyāṇi are the eyes and other senses; bhā is lustre. Others read 'lost strength, senses and speech', explaining that 'speech' is added to indicate severe damage to speech, otherwise 'senses' alone would suffice. Sudīna is exceedingly weak. Śyāvānana is a face of a mixed white, brown and dark colour. 'He may die' means he dies through neglect. Others read 'through poison he becomes deprived of awareness', where visañjña means reversed awareness, and the poison here is the slow, damaging kind.
A person afflicted by unmāda, once oleated and sweated, should be purified with sharp measures acting in both directions and with head-purging (śirovirecana) measures. Various nasal pressed-juice applications (avapīḍa) combined with mustard oil should be used, and its powder should be applied to his nose.
The commentary says that after stating the causes it gives the treatment. 'Sharp measures acting in both directions' are things like viṣāṇikā, devadālī and vellikā. Head-purging measures are things like viḍaṅga and rice. 'Various' means of many kinds. Avapīḍa are kinds of nasal treatment. 'Measures that calm the disturbed mind' are those from the chapter on non-human afflictions. Avapīḍa combined with mustard oil is meant. 'Having applied' refers to the afflicted person; 'tu' means moreover. The powder is that combined with mustard oil. Because the heart, abdomen, senses and head are cleansed by emesis and other measures, the mind clears, memory and awareness return, and unmāda subsides.
Key terms
śirovirecana
Head-purging, nasal cleansing measure.
avapīḍa
A kind of nasal application by pressing juice or powder.
सततं धूपयेच्चैनं श्वगोमांसैः सुपूतिभिः |
सर्षपानां च तैलेन नस्याभ्यङ्गौ हितौ सदा ||१६||
Meaning of the śloka
One should continually fumigate him with the flesh of dog and cow that is well rotted. Nasal application and massage with mustard oil are always beneficial.
The commentary says fumigation, nasal application and massage are described. 'Him' means the afflicted person. 'Well rotted' means thoroughly decayed. It is said that the mind returns to its natural state by fumigation with decayed flesh, through its special power.
One should show him wonders or announce the loss of something dear to him; frighten him with fearsome-looking men, trained elephants and harmless snakes; frighten him bound with ropes or beat him with whips; or, keeping him well guarded, terrify him with a grass fire; threaten him with water; have him struck with rope blows; a strong man should guard him and make him live inside water; he should prick him with an awl, avoiding the vital points; entering a house, guarding him, he should set the house on fire; or he should keep him constantly in a covered old well.
The commentary explains each measure. Wonders are frightening things never seen before; announcing 'loss of what he values' means telling of the destruction of a dear object. Frightening forms are terrible-looking; nāgas are elephants; 'trained' means schooled; vyālas are snakes, harmless ones such as gonasa. To frighten is to create fear. Pāśa are fetters like chains; kaśā are leather whips. The binding is said to be to stop a confused mind from entering wells or fire and to make the actions comfortable. 'To prick' means to hurt with a sharp-tipped needle. The house is set alight while guarding him. The well is one without water. 'Threaten with water' is to be read as hot water; even hot is described, and another text says he should be touched with hot iron, oil or water.
Every third day one should give barley gruel or nourishing drinks, or plain saktu mixed with water, or kulmāṣa, by a learned physician; whatever is heart-pleasing and digestion-kindling is wholesome and should be given to him. (Bracketed additional verses give ghee medicated with viḍaṅga, triphalā, musta, mañjiṣṭhā, pomegranate, utpala and many other drugs, boiled with two milks, with jasmine flowers, said to remove gulma, cough, fever, breathlessness, wasting and unmāda; the same, cooked with jīvanīya drugs and four times milk, is called Mahākalyāṇa, said to quickly destroy apasmāra, graha, wasting, impotence, thinness and infertility; another ghee with the listed drugs, cooked with four times milk, and a phala ghṛta said to help children afflicted by graha, men with weak semen, and to give conception to barren women.)
The commentary says he describes diet. 'Every third day' means on alternate days. The tarpaṇa (thin liquid) is plain saktu mixed with water; others read 'tarpaṇa' as parched rice. Kulmāṣa means foods made of barley flour. The gruel and the rest are given according to the strength and digestion of the patient. The 'learned' physician is the very skilled one. 'Heart-pleasing' means beneficial to the heart, to be given to clear the channels. Some read 'kalyāṇaka' after this, but that is rejected since it is read in the chapter on fever. Others read the phala ghṛta by extension, but it should not be read, since all the compilers reject it. The bracketed verses 22-29 are thus questioned.
Brāhmī, aindrī, viḍaṅgas, the three pungents (vyoṣa), hiṅgu, surā, jaṭā, viṣaghnī, garlic, rāsnā, viśalyā, surasā, vacā, jyotiṣmatī, nāgara, anantā, abhayā and saurāṣṭrī: in equal parts, one should grind them with elephant urine. Dry them in the shade, and the expert in method should make them into wicks, to be used as nasal pressed-juice, eye application, massage, nasal application, fumigation and paste.
The commentary identifies the drugs, noting alternatives. Brāhmī is maṇḍūkaparṇī, though some say lavaṇikā. Aindrī is indravāruṇī, though some say a kind of matsyākṣa. Surā is 'surāhva'; others say indrasurā, i.e. indravāruṇī. Jaṭā is jaṭāmāṃsī. Viṣaghnī is haridrā, though some say nirviṣā. Viśalyā is guḍūcī. Surasā is tulasī. Jyotiṣmatī is kākamardanī. Nāgara is śuṇṭhī. Some read 'nāgavinnā', an indravāruṇī type, or a vṛścikapatrikā. Anantā is utpalasārivā; abhayā is harītakī; saurāṣṭrī is tuvarikā. The 'expert in method' is the physician who knows the procedure.
Key terms
brāhmī
A herb, identified by the commentary as maṇḍūkaparṇī (alternatively lavaṇikā).
hiṅgu
Asafoetida.
gajamūtra
Elephant urine.
vartī
Wick, medicated stick.
Adhikarana ੧੭ (੩੩) · Śloka ੩੩
ਉਰੋਪਾਙ੍ਗਲਲਾਟੇਸੁ ਸਿਰਾਸ਼੍ਚਾਸ੍ਯ ਵਿਮੋਕ੍ਸਯੇਤ੍ |੩੩|
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उरोपाङ्गललाटेषु सिराश्चास्य विमोक्षयेत् |३३|
Meaning of the śloka
One should open his veins at the chest, the outer corners and the forehead.
The commentary says uraḥ is the space between the two breasts. The word 'apāṅga' here refers to the śaṅkha (temple) because of nearness, not the outer corner of the eye at the temple joint, since only one vein to be opened is stated there. 'His' means the afflicted person. From the Bhūtavidyā tradition, opening veins at the chest and other places is stated, and opening veins at the temple joint is by the venesection procedure; so in unmāda both are wanted.
The commentary says this is the treatment by extension. By extension of the apasmāra measures, the treatment for unmāda arising from vāta and the other doshas is reached; therefore the treatments for each dosha are not stated separately here in the treatment section. Other unstated things should likewise be filled in.
Key terms
atideśa
Extension of a rule from one case to another.
graha
A seizing entity in classical belief, treated in the chapter on non-human afflictions.
Adhikarana ੧੯ (੩੪) · Śloka ੩੪
ਸ਼ਾਨ੍ਤਦੋਸਂ ਵਿਸ਼ੁਦ੍ਧਂ ਚ ਸ੍ਨੇਹਬਸ੍ਤਿਭਿਰਾਚਰੇਤ੍ |੩੪|
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शान्तदोषं विशुद्धं च स्नेहबस्तिभिराचरेत् |३४|
Meaning of the śloka
When the doshas are pacified and he has been purified, one should care for him with oleation and enemas.
The commentary says 'with pacified doshas' means with unmāda pacified, and 'purified' means by emesis and the like. Oleation and enemas are given to prevent the return of unmāda.
In all types of unmāda one should calm the mind. In mada also the same course should be gentle at first, and a mild course should be applied. In the fifth type, the physician should remove the thorn of grief. In the poison type, one should carry out a gentle course first and then poison-destroying measures.
The commentary explains that 'gentle at first' means preceded by mild purification, and the mild course means mild oil application and massage and so on; that is, in the previously stated manner. 'Remove the thorn of grief' means by soothing and consoling with desired things, comforting and similar means. The fifth is the one from mental distress. In the poison type, 'gentle first' means preceded by mild purification, and the poison-destroying course is that stated in the section on antidotes.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते भूतविद्यातन्त्रे उन्मादप्रतिषेधो नाम (तृतीयोऽध्यायः, आदितः) द्विषष्टितमोऽध्यायः ||६२||
Meaning of the śloka
Thus ends the sixty-second chapter (the third from the beginning, in the Bhūtavidyā-tantra) named Unmādapratiṣedha, in the Uttaratantra of the Suśruta Saṃhitā.
Having seen all the treatises, the physician Śrī Ḍalhaṇa, son of Bharata, made the ground of Bhūtavidyā clear. Thus ends the sixty-second chapter, named Unmādapratiṣedha, in the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.