An Insight into Preventive Aspects of Manovikara as per Charaka Samhita with Special Reference to the Involvement of Trividha Kaarana at Various Stages – A Conceptual Review

Introduction

Priority is given to both body and mind in Ayurveda, whether in Arogya or Rugnaavastha. Manas is one of the two Adhisthanas for vyadhi, and its role is highly significant even in Shaareerika vyadhi. Specific Nidanas for the causation of Manovikara, for Anutpatti of these Vikara, and Manodoshaushadhas have been discreetly quoted in our texts.

Prakshaalanaaddhi pankasya dooraat asparshanam varam || (Mokshopaya 6/146/29)

The Sanskrit text Mokshopaya Shastra states that it is better to avoid touching quicksand or muddy water in the first place than to wash one’s hands after coming into contact with it. In the context of diseases as well, it is always preferable to focus on preventive aspects rather than attempting treatment later, as managing a disease becomes increasingly difficult once it sets its roots deep. Both the body and the mind are susceptible to vitiation by various internal and external factors. These factors, which are capable of causing such vitiation and thus leading to disease, are termed as Nidaana or Kaarana of these Vikaaras. In the context of Manovikaara too, although the information is scattered across Ayurvedic texts, a concrete understanding of the same can be achieved. This facilitates the application of Nidaana Parivarjana as the initial line of treatment in Manovikaara. To effectively implement this, it becomes essential to understand the scope and limitations of Nidaana Parivarjana based on the type of Nidaana / Kaarana (Samavvayi, Asamavaayi and Nimitta) involved and the stage of the Manovikaara. This article is an effort in that direction.

Aim

To provide an insight into the involvement of Trividha Kaarana at various stages of Manovikara.

Primary Objectives

• To provide an insight into the involvement of Samavaayi, Asamavaayi, and Nimitta Kaarana before and after the manifestation of Manoroga.

Secondary Objectives

• To review the literature related to Trividha Kaarana.

• To briefly review the literature on Manoroga.

Materials and Methods

Materials

This article is a literary review, and therefore the materials include the following literary sources:

• Charaka Samhita of Agnivesha, Tarka Sangraha of Annamabhatta.

• Other texts and dictionaries as per the contextual requirement.

• Relevant articles and information from credible internet sources.

The following methodology has been adopted in sequence:

• A review on Manoroga, the causative factors of Manovikara, and the preventive aspects of Manoroga.

• A brief review of Trividha Kaarana.

• Discussion and analysis of the role of Trividha Kaarana and Nidana Parivarjana as a preventive tool at various levels.

Review of Literature

Manoroga

Shareera and Manas are the Adhisthanas of Vikara.¹ When the Adhisthana of Vyadhi is spoken of, it is understood as mind, body, or both together.² For example, Kushthaadi are Shareerika, Kamaadi are Maanasika, and conditions like Unmaadaadi involve both Shareera and Manas as their Adhisthaana.¹ The Vikaras that afflict only the Manas are categorized under Manovikara. Manovikaras include Kama, Krodha, Lobha, Moha, Irshya, Maana, Mada, Shoka, Chittodwega, Bhaya, Harsha, and others.³

Manovikara - Hetu / Kaarana

The Mahagunas of Manas are Sattva, Raja and Tama. Among these, Sattva is Avikaari (not a causative factor for disorders). It is Rajas and Tamas that cause Manovikaras, and hence they are termed Manodoshas.⁴

The major causes of Manovikara resulting in the vitiation of Rajas and Tamas are -

• Non-indulgence, contrary indulgence, and excessive indulgence in Mano-arthas/Mano- vishayas.⁵

• Engagement in activities that are not conducive, due to Vibhramsha of Dhi, Dhruti and Smriti, प्रज्ञापराध.^6,7

Although no specific classification of Manovikara is explicitly mentioned in the texts, based on the article by Chahar et al., the following classification can be derived.⁸

• Mano Adhishthita Manasika Vikara: Mental disorders where Manodoshas are primarily involved. E.g., Kama, Krodha, etc.

• Nanatmaja Manasa Vikara: Endogenous mental disorders caused by specific types of Shaareerika doshas. E.g., Tandra, Bhrama, etc.

• Shareera Mano Adhishthita Manasika Vikara: Mental disorders in which both Shaareerika as well as Manodoshas are basically involved. E.g., Unmada, Apasmara, etc.

• Mano Shareera Adhishthita Manasa Vikara: Disorders primarily caused by afflictions of Manodoshas, subsequently leading to the involvement of Shaareerika doshas. E.g., Shokaja Jwara, Bhayaja Atisara, etc.

• Behavioural disorders like sexual perversions: E.g. Asekya, Kumbhika, etc.

Thus, this classification describes a broad range of mental disorders, which seem to include all kinds of neurotic, psychotic, convulsive, and personality disorders as understood in contemporary science.

Prevention of Manovikara

Direct and indirect scattered references to the prevention of Manovikaras are found across Ayurvedic literature. They include:

• Nagari Nagarasya - Preventing internal disease-causing factors.

• Rathasya Rathi - Preventing external disease-causing factors.

• Krutyeshu Avahito Bhavet - Attentively performing ‘to do’ activities.⁹

• Jnaana, Vijnaana, Dhairya, Smriti, Samaadhibhihi - Engaging in activities with proper knowledge, understanding, courage, memory, and focus.¹⁰

• Maanasa Vega Vidhaarana - Exercising restraint over mental urges like Kama, Krodha, Lobha, Moha, etc.¹¹

• Swasthavrutta Vidhi - Following a healthy lifestyle.¹²

• Tyaagah Prajnaapadhaanaam - Renouncing Prajnaaparaadha.

• Indriyopashamah - Exercising control over the sensory faculties.

• Desha Kala Aatma Vijnaana - Proper knowledge of place, time, and oneself.

• Sadvruttasya Anuvartana - Following an idealistic lifestyle.

• Praageva Hitam Kuryaat - Making timely efforts toward prevention.¹³

Some measures serve both preventive and curative purposes, such as:

• Aptopadesha Prajnaanam - Proper knowledge of Aptopadesha (instructions by Acharyas regarding the prevention and cure of Manovikara).

• Pratipatti - Knowledge of application.¹⁴

• Tadvidyaa Seva - Serving people in the same field.

• Trivargasya Anvekshanam - Striving to attain Dharma, Artha, and Kama.

• Aatmaadi Vijnaanam - An optimal understanding of the self.¹⁵

• Sattvaavajaya - Punah ahitebhyo arthebhyo mano nigrahah - Restraining the mind from involving in non-conducive objects i.e., Satvaavajaya.¹⁶

Trividha Nidana/Kaarana Kaarana Kaarya

That which possesses the inherent capacity to produce or generate is termed Kaarana. The characteristics of any Kaarana are:¹⁷

• Poorvavruttittva (Antecedence) - The Kaarana must exist prior to the Kaarya.

• Niyatattva (Invariable) - Whenever there exists Kaarya, Kaarana must invariably be present.

• Ananyathaasiddhi (Unconditional relation) - The relation between Kaarana and Kaarya is inseparable.

The Kaarana are three in number.¹⁸ Though each plays an important role in the production of Kaarya, their influence operates at different levels of its manifestation. The three types of Kaarana are:

• Samavaayi Kaarana:¹⁹ That which transforms itself into the Kaarya and is inevitable for the existence of Kaarya is called as Samavaayi Kaarana.

• Asamavaayi Kaarana:²⁰ The cause that, while not being the primary cause, always remains with the primary cause (Samavaayi Kaarana) is called Asamavaayi Kaarana. It is essential for transformation of Samavaayi Kaarana to Kaarya.

• Nimitta Kaarana:²¹ The special cause that is distinct from both Samvaayi and Asamavaayi Kaarana. It refers to the tool, instrument, necessary for the production of Kaarya (Table 1).

• Best applicable for Nimitta Kaarana - Being extrinsic causes, mere avoidance will prevent the occurrence of the disease. Since these Kaaranas are not intrinsically involved in the pathogenesis, their role is limited to the pre-production phase of the Vikaara. Hence, avoiding them can effectively curb the disease even before it begins to manifest.

• Moderately applicable for Samavaayi Kaarana (not applicable once the Kaarana becomes potent enough to bind and potentiate the Asamavaayi Kaarana) - Once the Manodoshas are vitiated, they have the potential to create Manovikara. Prevention through Nidaana Parivarjana helps reverse the Manovikara up to the stage where Asamvaayi Kaarana has not yet been potentiated through its proximity with the Samavaayi Kaarana - that is, till the stage where these vitiated Manodoshas have not formed potential associations/bonds with Manas, Manovaha Srotas, Hrudaya, etc.

• Least applicable for Asamavaayi Kaarana (where Chikitsa must be opted) - Once the bond between the vitiated Manodosha (Samvaayi Kaarana) and Manas, Manovaha Srotas, Hrudaya, etc. is established, Chikitsa becomes essential to break the association/ bond (Sampraapti Vighatana).

From the above analysis, Nidaana Parivarjana is preventive before the production of Manovikara. Once the Vikara is produced, Nidaana Parivarjana helps reduce its severity and progression, acts as a supplementary aid alongside Chikitsa, and synergizes with Chikitsa becoming a part of Pathya.

Conclusion

• Manovikaras may manifest in Kevala Mano Adhishthana, Mano Shareera Adhishthana, or as Mano Anubandha in Shaareerika Vyadhis.

• Nidana Parivarjana and other preventive measures are most applicable for Nimitta Kaarana and moderately applicable in restricting Samavaayi Kaarana before the production of disease.

• Once the Asamaavaayi Kaarana is established, curative procedures becomes essential; Nidaana Parivarjana alone is insufficient.

• Nidaana Parivarjana functions as a preventive measure only before the production of Manovikara; after disease manifestation, its role is primarily to support Chikitsa (curative).

Conflict of Interest

Nil