Code: Del-302 Title: Art and Science of Yoga in Mental and Neurological Healthcare A Manual Stage: 2nd Proof

Name: Sunil Author: Shivarama Varambally Time/Date: 02:52 PM/21 Nov 20

C H A P T E R
From Many to One to Many: The Wheel
Completes a Cycle for Integrative
Approaches in Mental Health
3
Bharath Holla, Hemant Bhargav, Kishore Kumar Ramakrishna

INTRODUCTION diseases. This made a dramatic change in the

In this chapter, we will introduce the concept health conditions with effective treatment
of Integrative Mental Health and the promise and preventive methods for communicable
it holds for the future of treatment approaches diseases. This eventually led to a paradigm
in psychiatry. Integrative medicine (IM) is shift in the causal thinking of origin of disease
an emerging field of health care that seeks to monocausal theories of etiology (the
to combine the best of evidence-informed doctrine of specific etiology) across all branches
approaches of conventional and traditional of medicine, from the earlier multicausal
systems of medicine, to provide personalized, approaches. In the latter half of the 20th
safe, and cost-effective treatments, while century, however, the deaths due to infectious
taking account of the whole person (body, agents reduced and the world witnessed the
mind, and spirit), including all aspects of emergence of noncommunicable disorders
lifestyle. Thus, IM approaches tend to be (NCDs) in epidemic proportions. With this
grounded in systems medicine, with network re-emergence, western medicine and medical
of interacting components that seek to expand epidemiology completed the full circle by
medical reductionism to holism.1 moving the focus back from a monocausal
infectious diseases model to the multifactorial
CAUSES OF PSYCHIATRIC chronic disease model. It is in this context that
DISORDERS: EVOLUTION the traditional systems of medicine (such as
OF THE UNDERSTANDING Ayurveda and Yoga) which focus on lifestyle
management, can provide an important
Kenneth S Kendler, a pioneer in psychiatric
contribution to health care paving the way for
genetics and nosology, traces the history of the
an IM approach.
search for causes of medical and psychiatric
Integrative medicine practitioners adopt
disorders in a recent article.2 He posits that
a multicausal perspective in clinical work
up until the latter part of the 19th century,
and in explanations of psychiatric disorders
multicausal theories were popular. He cites
to patients. They encourage a “this-and-
examples from Robert Burton’s natural and
that” strategy in place of a “this-or-that”
supernatural causes of depression (listed in
approach, thereby enabling responsible
his magnum opus The Anatomy of Melancholy
medical pluralism.
in 1621) to physical and moral (psychological)
causes of insanity by Thomas Arnold in 1786
and Jean Esquirol in 1838. AYURVEDA AS SYSTEMS MEDICINE
With advances in the microbiological Āyurveda derives its theories of creation and
methods, monocausal origins based on existence from sām͘ khya (one among shad
germ theory were found for many infectious darśanas—ancient Indian philosophical

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 Code: Del-302 Title: Art and Science of Yoga in Mental and Neurological Healthcare A Manual Stage: 2nd Proof
Nov 20 Name: Sunil Author: Shivarama Varambally Time/Date: 02:52 PM/21 Nov 20

CHAPTER 3 | From Many to One to Many: The Wheel Completes a Cycle... 25

traditions).3 Yoga is also considered as a form in the doshas and gunas that become the basis
of sān͘khya darśana.4 Therefore, both share for development of mental disorder. Excessive
common concepts of existence. Prakr̥ ti (the attachment toward thinking process leads
unmanifest) consists all elements of existence to further derangement of the lifestyle (diet,
in the most subtle form and the process of activity, sleep, and recreation) and biorhythms
creation starts when puruṣa (life) comes which cause further disturbances in the mind.
into its contact. During creation, the subtler This vicious cycle becomes a perpetuating
forms of pan͂camahābhūta [five elements that factor for mental health disorders.7
comprise all substances, viz., pr̥ thvī (Earth), In Charaka Sam͘hita, during a scientific
ap (water), tejas (fire), vāyu (air), and ākaśa debate on origin of diseases, an ancient
(ether)] with the help of trigun͘aḥ, viz., rajas scientist Śaraloma presents his view that
(positive formational energy), tamas (negative predominance of rajas and tamas factors
formational energy), and sattva (harmony of in the manas (mind) are the source of all
rajas and tamas) get themselves organized into diseases (of mind and body).8 It is pertinent
the structure of a living organism.5 to understand the contextual dichotomy
Āyurveda, as per the vedic tradition, puts while understanding the terms sattva, rajas,
emphasis on the balance of five basic elements and tamas. These three are known as gun͘as
of nature through prakriti-based classification (primordial energy forms) in the context of
of physiological processes and personality creation.9 Whereas, in the context of manas,
as the basis for health. The prakriti-based rajas, and tamas are called manodoṣas, i.e.,
classification involves three factors (doshas): they are vulnerabilities constantly trying to
vata (air + space), pitta (fire + water), and create disharmony by causing emotional
kapha (water + earth) and their psychological attachment of varied intensities in thought
counterparts, the gunas (sattva, rajas, and and action. 10 To elaborate, any event that
tamas). Table 1 provides the characteristics of induces gratification is sukḥa and this leads to
different Ayurveda-based prakriti types. iccha (liking) and pravr̥ tti (action) in the same
Fundamental concepts of dis eas e direction. Similarly, any event that induces
causation according to Ayurveda focus on duḥkha (agony) leads to dweṣa or dislike and
host vulnerability rather than a single causative causes restraint in progressing toward that
factor. Generally, balance and harmony of the direction (this repulsive action in the opposite
following factors promotes resilience against direction is also known as pravr̥ tti). Pravr̥ tti
any disease according to Ayurveda: doṣhas in both directions results in upadha (drive
(vāta, pitta, and kapha), dhātu (tissues), bala to emotionally involve in events of life) and
(strength to thrive, viz., inherited from birth, by is responsible for all types of duḥkha (agony)
virtue of time like youth, special regimens to including diseases of the body and mind.11,12
strengthen health enhancement), kāla (time, Relieving oneself from upadha is the only and
viz., harmony in biorhythms and age), agni the best way to a healthy state of body and
(digestion and metabolism), prakr̥ iti (inherited mind.12 Appropriate way to get rid of upadha
constitution based on vāta, pitta, and kapha), is to regulate rajas and tamas (mind forces that
sattva (mental strength), sātmya (compatibility drive emotions), i.e., attaining such a balanced
to varied food and environment), and āhara and harmonious state of mind where actions
(food habits).6 are driven by higher goals of universal well-
Mental disorders in particular are being and not by individual—sukḥa, duḥkha,
considered as a result of inability to control iccha or dweṣa. Such state of mind has been
emotions and manage a balanced lifestyle. described as mokṣha (detached state of mind)
This propels the individual toward imbalances or niṣṭha.13 Yoga is an ideal method of reigning

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Code: Del-302 Title: Art and Science of Yoga in Mental and Neurological Healthcare A Manual Stage: 2nd Proof
Name: Sunil Author: Shivarama Varambally Time/Date: 02:52 PM/21 Nov 20

26 SECTION 1 | Yoga in Health Care

TABLE 1: Characteristics of different Ayurveda-based prakriti types.

Aspect of constitution Vata Pitta Kapha
Frame Thin Moderate Thick
Body weight Low Moderate Overweight
Skin Dry, rough, cool, brown Soft, oily, warm, fair, red, Thick, oily, cool pale, white
yellowish
Hair Black, dry, kinky Soft, oily, yellow, early gray, Thick, oily, wavy
red
Teeth Protruded, big and crooked Moderate in size, yellowish Strong, white
gums emaciated soft gums
Eyes Small, dull, dry, brown/black Sharp, penetrating, Big, attractive, blue eyes,
green, gray, yellow thick eyelashes
Appetite Variable, scanty Good, excessive, unbearable Slow and steady
Taste Sweet, saline, sour Sweet, bitter, astringent Pungent, bitter, astringent
Thirst Variable Excessive Scanty
Elimination Dry, hard, constipated Soft, oily, loose Thick, oily, heavy, slow
Physical activity Very active Moderate Lethargic
Mind Restless, active Aggressive, intelligent Calm, slow
Emotional Fearful, insecure, Aggressive, irritable, jealous Calm, greedy, attached
temperament unpredictable
Faith Changeable Fanatic Steady
Memory Recent memory good, Sharp Slow but prolonged
remote memory poor
Dreams Fearful, jumping, flying, Fiery, anger, violence, war Watery, river, ocean, lake,
running swimming, romantic
Sleep Scanty, interrupted Little but sound Heavy, prolonged
Speech Fast Sharp, cutting Slow, monotonous
Financial status Poor, spends money quickly Moderate, spends on Rich, money saver,
on trifles luxuries spends on food
Pulse Thready, feeble, moves like Moderate, jumping like a Broad, slow, moves like a swan
a snake frog

in rajas and tamas. Yogic techniques help modern medicine has led to enhanced
to withdraw mind from focusing on external acceptability of yoga as an adjunct to modern
objects and to redirect itself internally, thus medicine, especially for noncommunicable
giving human beings power to channelize lifestyle-related disorders including mental
their energies toward attainment of mokṣha health disorders.16 Scientific exploration has
state.14 This approach to treatment focusing on also been done to unravel the underlying
promotion of positive health and well-being mechanisms through which yoga may work.
has been mentioned by Charaka as naiṣṭhiki As yoga therapy evolved, for the therapists, the
chikitsa.15 modern scientific mechanisms of yoga became
the base for deciding the therapy. For example,
INTEGRATION OF YOGA WITH the effect of certain practices on the autonomic
BIOMEDICINE AND AYURVEDA nervous system (ANS) became the basis for
In the last two decades, rise in research indication or contraindication of a practice
in the domain of integration of yoga with in a particular condition characterized by

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CHAPTER 3 | From Many to One to Many: The Wheel Completes a Cycle... 27

dominance of a particular limb of ANS. Though to understand guna-based clinical correlates of
application of yoga using such scientific various psychiatric disorders, we applied vedic
rationale is good and should be encouraged, personality inventory (VPI, vedicpersonality.
the traditional holistic vision of seeing an org) on 113 patients (73 males, 40 females)
individual should not be compromised. suffering from various psychiatric disorders
Sankhya school of philosophy says that and 113 age- and gender-matched healthy
whole creation is made up of two components: controls. This study showed that in comparison
(1) matter (prakriti) and (2) consciousness to healthy subjects, patients with psychiatric
(purusha). 4 If we look at the roots, both disorders had lower sattva scores. Patients with
Yoga and Ayurveda emerge from the vedas. psychotic disorders had lowest sattva scores
Ancient texts of yoga actually use prakriti and highest tamas scores among all psychiatric
classification of Ayurveda (doshas) to describe disorders and those with anxiety disorders
the therapeutic effects of the yogic practices on had highest “rajas” scores. This redefining of
the body. For example, Hatha Yoga Pradipika mental health disorders in terms of doshas
(HYP) describes surya bhedana as vata and gunas is particularly important because
reducing practice (vataghna) (HYP 2.53), ancient texts also provide specific lifestyle
similarly, both HYP17 and Gheranda Samhita guidelines on correcting the imbalances in
(GS)18 describe kapalabhati as “kapha-dosha- them.17 For example, texts such as Bhagavad
vinashini” means the destroyer of kapha Gita (BG)19 do mention about the diet that
(phlegm) dosha. Table 2 provides several may be conducive for enhancing specific
other such references from ancient yoga texts gunas and dietary advices for purity of the
where Ayurveda-based prakriti classification mind (Table 3). Thus, it is important that even
has been used for therapeutic applications for diagnosis and management of disorders
of yoga and suggesting various lifestyle an integrative approach is followed for Yoga
corrections. In a research study, which aimed therapy, where modern scientific assessments

TABLE 2: Yoga practices for different Ayurveda-based prakriti types as per ancient yoga texts.

Type of
dosha Vata Pitta Kapha Kapha-pitta Vata-kapha Tridosha

Helpful Surya Śītalī Dhauti karma Dan.d.adhauti Ujjjāyīkumbhakam. Mayurasana

practices bhedana (HYP 2.58) (HYP 2.25) (GS 1.38) (GS 5.71-72) (HYP 1.32)
(HYP 2.50)
Jalabasti Kapalabhati Vamanadhauti Vastikarma
(GS:1.46-47) (HYP 2.35) (GS 1.39) (HYP 2.27)

Ujjāyī Vastradhauti Nauli

(HYP 2.51-52) (GS 1.40-41) (HYP 2.34)

Jihvāmūladhauti Śītalīkumbhakam. Bhastrikā

(GS 1.30) (GS 1.73-74) (HYP 2.62-65)

Kapālarandhra
(GS 1.34)

Netiyogah.
(GS 1.50-51)

Kapālabhāti
(GS 1.55)

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28 SECTION 1 | Yoga in Health Care

TABLE 3: Dietary advices as per ancient yoga texts.

S. No. Dietary aspect Advice Reference
1. Diet for different Sattvic diet: Foods which increase life, purity, strength, health, joy and BG 17.8
gunas cheerfulness, which are juicy and oleaginous, substantial and agreeable,
are dear to sattvic people
Rajasic diet: Foods that are bitter, sour, saline, excessive hot, dry, pungent BG 17.9
and burning, are liked by the rajasic people and are productive of pain,
grief, and disease
Tamasic diet: That which is stale, tasteless, putrid, rotten and impure refuse, BG 17.10
causing dullness of the mind, is the food liked by tamasic people
2. Value of Mitāhārah. is defined as agreeable and sweet food, leaving one-fourth of HYP 1.38
moderation in the stomach free, and eaten (as an offering to please shiva)
eating He who practices yoga without moderation of diet, incurs various diseases, GS 5.16
and obtains no success
3. Conducive food The most conductive foods for the yogis are: good grains, wheat, rice, HYP 1.62
for yogi barley, milk, ghee, brown sugar, sugar candy, honey, dry ginger, patola
fruit, five vegetables, mung and such pulses and pure water
A yogi should eat rice, barley (bread), or wheaten bread. He may eat GS 5.17
mudga, mās. a beans, gram, etc. These should be clean, white and free from
chaff
A yogi may eat patola, jackfruit, mānakachu, kakkola, the jujube, the GS 5.18-19
bonduc nut, cucumber, plantain, the unripe plantain, the small plantain,
the plantain stem, the roots, brinjal, and medicinal roots and fruits
He may eat green, fresh vegetables, black vegetables, the leaves of patola, GS 5.20
the vāstūka-śāka, and himalochikā śāka. These are the five vegetable
leaves praised as fit for yogis
Easily digestible, agreeable and cooling foods which nourish the humors GS 5.29
of the body, a yogi may eat according to his desire
Cardamomum, jaiphal, cloves, aphrodisiacs or stimulants, the rose-apple, GS 5.28
haritaki, and date palms, a yogi may eat while practicing yoga
4. Prohibited food The foods which are prohibited for the yogi are: those which are bitter, HYP 1.59
for yogi sour, pungent, salty, heating, green vegetables, sour gruel, oil, sesame and
mustard, alcohol, fish, flesh foods, curds, buttermilk, horse gram, fruit of
jujube, oil cakes, asafetida and garlic
Unhealthy diet should not be taken, that is reheated after becoming cold, HYP 1.60
which is dry (devoid of natural oil), which is excessively salty or acidic, stale
or has too many (mixed) vegetables
A yogi should avoid hard (not easily digestible), sinful food, or putrid food, GS 5.30
or very hot, or stale food, as well as very cooling or very much exciting
food

are combined with dosha- and guna-based multifactorial model. With the increasing
assessments to determine the appropriate popularity of traditional systems of medicine,
therapy plan for the patients. the emphasis has shifted back toward
personalized holistic aspects in diagnosis
CONCLUSION and treatment of mental health disorders.
Approach to mental health has evolved Integration of biomedicine and traditional
over years from multifactorial causation systems of medicine looks like the way
to monocausal theories and back to a forward in which mental healthcare would

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CHAPTER 3 | From Many to One to Many: The Wheel Completes a Cycle... 29

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