Shaddhatu Purusha Treatment- A Holistic Approach to Mental Health Care

. The Shaddhatu Purusha treatment is undertaken for a human being to regain the harmonious balance within the system, the sum total of body, mind and soul is considered and taken as a unit. It is the study to analyse where the root of the disease lies; which can be in the body ( Shareera ), the mind ( Manas ) or the soul ( Karana Shareera ). For the study and analysis, the literature related to the Chikitsa (treatment)Bheda (types of treatment), Chikitsa (treatment)Vyakhya (explanation of treatment), TriGuna’s (the three fundamental features of na-ture), Nityas , concept of microcosm-macrocosm relation are being taken from various classical Ayurvedic texts. The Shaddhatu Purush Chikitsa (treatment) is kind of spiritual treatment, where the doctor is campable of alteration in the subtle and super-conscious body of patient along with the physical body. In Shaddhatu Purush Chikitsa (treatment) it is believed that the disease is the resultant of some Past Karma which can be balanced by balancing the Panch-Bhuta’s and Tri-Guna’s .


Introduction
Ayurveda goes with the holistic approach in its modalities. Considering a human as Shaddhatu Purusha is the basis of it [1] and attaining Purusharthas (Ayurveda's Four Aims of Life) (Dharmaa (duty), Arth (wealth), Kama (pleasure), Moksha (liberation)) is the ultimate [2]. When treatment is undertaken for a human being to regain the harmonious balance within the system, the sum total of body, mind and soul is considered and taken as a unit [3]. This Shastra has been conceptualised by our Acharyas (Masters) by doing trial and error methods, with keen observations, discussions and conclusions. The ancient seers based this Shastra (treatment technique) on causeand-effect theory i.e., Karya-Karana Siddhanta (theory) whereas the Karya is actions or phenomena while the Karana is responsible factor [4]. Karana means Hetu-causative factors and Karyameans the Linga -the signs and symptoms or revealing factors, and the solution to the above is Aushadha (medicines) which culminates as Trisutra (Three formula's)-Hetu, Linga, Aushadha (medicines) [5]. The Chikitsa (treatment) according to Ayurveda is classified on various basis. The subject Daiva-Vyapashraya comes under Trividha (features of three folds) treatment where Satva vajaya treatment and Yukti-Vyapashraya Treatment are also told [6].

Methodology
The literature related to the Chikitsa (treatment) Bheda (types of treatment), Chikitsa (treatment) Vyakhya (explanation of treatment), Tri-Guna's (the three fundamental features of nature), Nitya's (eternal), concept of microcosm-macrocosm relation are being taken from Ayurvedic classical texts i.e., Ashtanga Hridaya, Charaka Samhita; Yogic texts like Raja Yoga by Swami Vivekananda; Textbooks on Tantra by Prof. S. K. Ramachandra Rao, S. Shankarnarayana; Bhagwad gita, Upanishads, Darshanas. An attempt is being made to adapt the principles of philosophical aspects into practicality.

Satva-vajaya Chikitsa
As far as any disease is concerned; as mentioned in Ayushkameeya [7] and Jwara PraKarana [8] in Ashtanga Hridaya, Manas appears to hold a prime position, and the treatment is called Satva vajaya Chikitsa, where Manas is called as Satva. Acharya Charaka has stated about Satva vajaya treatment and coined this termed too which means 'victory or control over the mind by the conscious'. It restrains the mind from desires of unwholesome as well as wholesome subjective and objective things, which will not go well with the human system as a whole. Here the concept is to exercising the will or Satva to subdue the other two Guna's of the Manas (Rajas and Tamas) [9]. The Karma's of mind are Chintya (To be considered or thought over), Vicharam (thought), Uhyam(such meaning which are to be reasoned out or guessed from the statement by one's own intelligence), Dhyeyam (one who is meditated upon), and Sankalpam (to become one with the time and subconscious mind) [10]. If the Karma's happen in Hina, Mithya and Ati yoga with unwholesome or wholesome object, it leads to the improper bondage between the Indriya (senses) and its Arthas (subject) which is asatmya (not accustomed food) to the Manas and Atma leading to Manasik and daiva kritvyadhis. The above statement says how asatmendriya-artha samyoga leads to psychiatric disorders of highest order. Satva vajaya Chikitsa acts as promotion of jnanam, vijnanam, dhairya, smriti, harshana etc., leading to improvement in dhi, dhriti and smriti, culminating in a balanced and harmonious state of mind. When considering the importance of chatushpada [11] i.e., Vaidya, Rogi (patient), paricharaka and Aushadha (medicines), it is the cordial and healthy relationship between Vaidya (doctor) and Rogi (patient) which holds the prime importance in treatment. In Satva vajaya Chikitsa, psycho supportive methods are also used accordingly like mental, physical, emotional, verbal as well as spiritual shock. Substitution of emotions, recreational therapy along with enduring the mind with positivity and assurance, is an excellent and one of a kind of treatments. Vedic counselling also holds an important aspect in this Chikitsa .

Daiva Vyapashraya Chikitsa
The concept of Daiva-Vyapashraya Chikitsa (treatment)is adopted from vedas in specific from Atharva and Riga veda. The word 'Daiva' goes with the many meanings like divine, purvajanma Karma, celestials, auspicious etc. and 'vipashraya' means that which gives Ashraya (which facilitates for). The appropriate word here for the term 'Daiva' is 'KARMA', so it becomes Karma-vyapashraya Chikitsa . The term 'Karma' comes to explain certain diseases which are purva-janma krit (past birth deeds) and are termed as daiva krit vyadhis. Everything related with daiva vyapashraya Chikitsa (treatment) can never be understood with the logic and reasoning, be it the cause of the disease or the effect of the treatment. There is also a ritualistic basis behind this treatment like use of bali, mani, homa, mantra, upasana, pooja etc. The ritual concept is based on panchabhuta tatwa which makes sense in the treatment. In general, Ayurveda Chikitsa (treatment) is based on Agni and in panchabhuta tatwa, Agni can be equated to the Manas. Thus, Chikitsa (treatment) is based on primarily Mana tatwa. The mind has two phases; one phase goes with the Shareera where yukti-vyapashraya and Satva vajaya Chikitsa (conscious -subconscious) acts primarily where as in the other phase of mind (unconscious -super conscious) goes with the Atma where Daiva-Vyapashraya along with yukti-vyapashraya and Satvavajaya Chikitsa comes into play. When Prana leaves the body, Atma also does, thus, Atma is related to Prana which accumulates in Marma. So Marma Chikitsa (treatment)has a dimension which goes with Atma tatwa associated with Daiva-Vyapashraya Chikitsa .
When you differentiate a human system; prithwi-jala tatwa (earth and water element) goes with the Shareera , Agni tatwa with the Manas and Vayu-Akasha tatwa (air and space element) with the Atma (soul).
Here, Daiva-Vyapashraya is taken as Karmavyapashraya where this Chikitsa (treatment) is done to exhaust the Karma carried by the human system. It is stated in the Ashtanga Hridaya commentary by Govind Vaidya that Nadis carry paapa-Karma (unjustified-deeds). Substantiating the above statement goes like Nadis carry Nada -Nadais shabda (sound) equated to -Vayu-Akasha tatwa (air and space element) and is related to the Karana Shareera or Atma . Thus, it makes sense to say that, Atma (soul) carries the purva janma krit Karma's (deeds of the last birth) which forms the daiva krit vyadhis eg. Vandhyatwa, Manasa roga, kushtha, shwitra, arbuda etc. Whether this Chikitsa (treatment) is based on belief, faith or psychological factor or not is a point to ponder upon. It has got very little to do with belief, faith or psychological factor, whether a person believes in this modality or not, it will act irrespectively. There are conditions where the Vaidya (doctor) need not see the patient in person for treatment, this treatment modality surpasses the time and space because Atma tatwa(element of soul) does so. Thus, Daiva-Vyapashraya Chikitsa (treatment) can even go beyond the space -time matrix.

Action potential of TRI-GUNA
The TriGuna's are Satva, Rajas, and Tamasa [12]. The cycle of Tri-Guna's happens in every fourteen-day lunar cycle and it varies from person to person. The number of cycles determine how close a person is with the truth. When it comes to treatment aspect, the increase in frequency of number of tri-Guna cycle determine a maniac-depressive phase related to bipolar spectrum. Here the conscious is immersed in Prana as well as the mind and the Sthula Shareera gets caught in it -COMPLETELY STRANGLED. If frequency of the cycle is less or the longer each cycle is, the more stable will be the person's nature. Regarding treatment aspect, frequency of cycle in a person could be altered by the Vaidya. Satva is the key for this action.

Nitya
Another point to consider here is the correlation of mind with the Nityas [13]. Nityas doi.org/10.36018/dsiij.vi.272 when manifested are a combination of Pancha-Bhuta's with Tri-Guna's along with nada, kaala (sound, time) and bindu(unit of measurement) in Ati-Sukshma bhaava. Here the unmanifested consciousness are nada, kaala (sound, time) and bindu and the manifested Prakriti is Panchabhuta and triGuna. Altogether a total of sixteen Nityas are there. Thus, thirty-one days of treatment is told in relation to Nityas with regards to Manasik rogas (mental disorder). The dimension of Nityas in a person lies in lower plane as well as in the higher plane. The lower plane is in relation with the physical aspect of life (Mooladhara, Swadhishthana and Manipuraka chakras) with respect to conscious and subconscious mind whereas the higher plane is in relation with the spiritual aspect (Agya and Sahasrara Chakras) with respect to unconscious and super-conscious mind.
A psychic issue in a person could be sorted out in relation to one or more Nityas and this could be found out by following the lunar calendar wherein the disease will be precipitated in Rogi (patient) on a particular Tithi (Nitya) in every month. And in relation to treatment aspect, Nityas ' Mantra-Yantra are sorted out by the Vaidya (doctor) with relation to disease and Rogi (patient).

Prana
Prana and Akasha (space) are the two materials in the universe /cite14 where Akasha (space) is the one bhuta (element) and Prana has other four Bhuta's (element) represented in it. In treatment aspect, the four Guna's (Snigdha (unctuousness produced by food or medicines) , sheeta, ushana, ruksha) of each Bhuta (element) are embodied in it, representing as Chikitsa (treatment) Guna's. Akasha (space) is omnipresent and has all penetrating existence. All forms in the universe are the effect of combination evolved out of Akasha (space) which is pancha-panchi Karana. Prana is the infinite omnipresent manifesting power of the universe. The Prana manifests as motion, gravity, electric force, magnetic force and even the nerve current in the body. The thought is also a manifestation of Prana i.e., all forces whether mental or phys-ical are representations of the Prana. The nerve current in the body is the Prana carried by the Nadi. If Nadi's are devoid of negative Karma, the Prana flows freely within. Thus, the Prana is the generalized manifestation of force where 'esoteric dimension' person uses it knowingly or unknowingly to heal people. This Prana could be used at the level of subconscious which is a technique learnt and used by present day professionals like mentalist, hypnotist etc. without a proper understanding of the origin of it [15]. But a Vaidya (doctor) should be using it beyond subconscious level i.e, the unconscious level where virtues in life is a must. It is not a technique to be learnt, rather a transformational evolving process.

Duality
The whole nature is of duality like masculinefeminine represented as Purusha-Prakriti (shivashakti), day-night, sheeta-Ushna (the inherent property of Pitta, symbolizing fire both inside and outside the body) which represents in nature as moon and sun; in human body as Manas and Atma. A human body is a representation of both masculine and feminine energy. And thus, an imbalance in one of the energies will manifest as a disease in the system which has its root in the mind. In Tantra Shastra, a supreme Yantra is designed which gives the connection between the macrocosm and microcosm i.e., the relation of universe and the human body, which shows its holistic nature. It is the 'Sri Yantra' where in the second avarana represents the states of mind, fourth avarana represents the fourteen nadis, fifth avarana represents the dasha Pranas, sixth avarana represents the dasha Agni and the seventh avarana represents the sarvarogahara chakra, where panchaBhuta's and Tri-Guna's are considered [16]. From the nineth avarana, the Yogam with the Shiva-tatva starts which is emphasized by Thirumoolar in his book Thirumanthiram in the siddha tradition. This is where the disease related to Atma tatvam is healed by the Vaidya.

Discussion
The term Satva stands for Manas in relation to a Swasthan as well as Vaidya. Where as in Rogi (patient), it is the predominance of Tamo and Rajo Guna. When the Manas in Ayurveda is concerned; it is in relation to the unconscious part of Manas and it happens to be the Satva aspect. A Vaidya (doctor) to be in that level, or to awaken that aspect of Manas one should have virtues in life like Yama, Niyama etc. Regarding the subconscious aspect of Manas, techniques are used as in present mental health care system like hypnotherapy, mentalism, mesmerism along with counselling, medication and neuro-linguistic programming. Whereas Chikitsa (treatment) told in Ayurveda regarding Manas is far superior. If we consider the properties of Manas i.e, Gunas which are the tools for treatment -Anutwa ( its dimension which is beyond the atom in its manifest aspect) and Ekatwa (oneness); which is equivalent to wave and particle nature. Normally the people or Rogi (patient) have Chitta Vruttiswave nature of Manas. Rogi (patient) cannot attain Ekatwa (oneness) or Anutwa ( its dimension which h is beyond the atom in its manifest aspect), that is for the Vaidya (doctor)to possess to enter the Rogi (patient's) antar-atma. The way to enter the antar-atma is through the unconscious mind and the key is the Satva. Satvavajaya Chikitsa and Daiva-Vyapashraya Chikitsa (treatment) are connected with the Agni and Prana tatwa i.e., Satva vajaya Chikitsa with Agni primarily whereas Daiva-Vyapashraya Chikitsa (treatment)with Prana tatwa. Two Gunas in balance i.e., Ushna (the inherent property of Pitta, symbolizing fire both inside and outside the body) and Snigdha (unctuousness produced by food or medicines) is Agni tatwa and four Guna in balance is Prana tatwa which was elaborated by Acharya Sushruta and Agasthya muni where Rakta is given the Doshik status. Prana Chikitsa (treatment) deals with emergency as well. Prana is carried by Nadi's in the body. The capacity of Prana which is a manifesting force in a person depends on karmic effect in the nadis. When the Prana is able to control the Manas, then the person moves along the as-cending path towards its Atma tatwa (spirituality). One of the methods in which the Vaidya (doctor)transfers his manifesting force i.e., the Prana to the Rogi (patient) is by uzichil (type of marma abhyanga). It is moreover like a Prana Pratishtha, if it's a severe debilitating condition eg. Oncological cases. When it comes to the Tri-Guna's , Tamas always tries to own [17], possess control. It is very much attached and it accumulates for its own self. When Tamas is overwhelming a person, it can be counteracted by applying the effort of Rajas. Immediate results are observed in overcoming Tamas. If tendency is to overeat, person should eat less or eat food of low calories; if tendency is to sleep, then don't let to sleep. The experience of suffering is at the body level and hence one can train the body by forcing it to action. If Rajas is in action, it is concerned with the doing thing. Rebellious nature comes with the dissatisfaction in life. That's why Rajas dominant people move from one person or place to another because of their dissatisfied mentality. One can overcome the Rajo Guna by applying the effort of Satva, but if Rajas is embedded deeply in one's personality, it may take years to gain sufficient mastery over it. Nityas are correlated with Manas at the lower as well as the higher plane. Sri yantra is a miniature of human system. At lower plane when equated with sri yantra, in its second avarana, sixteen petals are related with the sixteen Nityas. Here the lower-level mind conditions are taken care. Use of meditation and mantras are done for healing the condition. In the seventh avarana of sriyantra, called as sarva-rogahara chakra where Panch-Bhuta's and Tri-Guna's are stated at this level. This goes to say that, cure of all diseases pertaining to Shareera and Manas, is done by Daiva-Vyapashraya Chikitsa (treatment)and other modalities by using the principles in it accordingly. Eighth and nineth avarana that carry naada and bindu complete the query regarding Nityas . The Karma causing the disease related to Atma tatwa resulting in psychiatric and other daiva krit vyadhis are completely exhausted and healed by the Vaidya.

Conclusion
The Daiva-Vyapashraya Chikitsa (treatment) has a very little reference in the classical texts. Because the concept is related to the Atma tatwa, the Vaidya (doctor) should immerse deeply in the ocean of ancient Indian literature such as Upanishads, Aagam Shastras etc. This knowledge that is shared with all at this moment of time, might influence and motivate the ability of some among those, to go forward with an opening, in search of something greater than what we are currently aware of. No matter how small the Satva is within a person, that person at a particular time and space happens to realise his dharma (purpose in life) and starts ascending to his righteous path. Each of us have a dharma or purpose which is proportionate with the Tri-Guna's and how they are within our system. If a person can seek out his Guna which is dominant at a particular given time, then that person would be able to appreciate and understand how his actions or deeds have consequences relative to his consciousness.