Satvavajaya Chikitsa or Cognitive Behavioral Therapy in Ayurveda (सत्वावजय चिकित्सा)

Satvavajaya Chikitsa (Samskrt: सत्वावजय चिकित्सा) is one of the treatment modalities in Ayurveda (आयुर्वेदः). This type of treatment is focused at controlling the ever wondering mind that has a potential to develop variety of health disorders in a human. There are certain illnesses which are caused by the disturbances in one's manas (मनस् mind) and thus can not be cured until the the causative agent, the mind, is treated or controlled well. In such situations, pharmacological treatments may not work effectively. Thus a treatment modality which can handle the manas (mind) related component in the diseases or which can help to manage psychological disorders was developed and it is known as Satvavajaya chikitsa in Ayurveda.

Introduction

Satvavajaya chikitsa is one of the fundamental treatment modalities among 3 modalities of treatment in Ayurveda ,the others being Daivavyapashraya and Yuktivyapashraya chikitsa. This treatment approach is meant exclusively for the “manas” or mind and its related attributes. The term 'Satvavajaya' is ade up of 2 parts and can be understood by knowing the emaning of these 2 parts as below,

1. Satva: The term “Satva” has been used to refer 2 different things in Ayurveda.
   1. Sattva is one of the trigunas that refer to the qualities of mind.
   2. And also, Satva means manas or mind.
2. Avajaya: The term “Avajaya” means to withdraw or to overcome,

Thus literally, Satvavajaya means, to withdraw the mind from unwholesome objects or to overcome difficulties of mind. It also implies achievement of balance between sattva, rajas and tamas that are the controlling factors of mind. It also works with an objective to increase the satva guna by diminishing the other two doshas of manas.  In comparison with modern sciences, satvavajaya chikitsa is equivalent to cognitive behavior therapy and psychotherapy to some extent. Satva guna can be increased only if the person learns and understands what is right, what is wrong, what is true and what is not, why the certain situation is confronted and why not the other etc. This can be achieved only when he receives the right counselling. Thus Satvavajaya in Ayurveda encompasses CBT and Counselling/ psychotherapy.

Definition

Acharya Charaka in Charaka Samhita describe the term Satvavajaya as follows,

सत्त्वावजयः- पुनरहितेभ्योऽर्थेभ्यो मनोनिग्रहः|| (cha.sut.11.54)

• अहितेभ्यो “ahitebhyo” means harmful, unhealthy.
• अर्थेभ्यो “Artha” means object of sensory organs and mind. (See next section for details)
• मनोनिग्रहः“Mano nigraha” refers to controlling the mind.

Thus, the chikitsa method that restraints the mind from desires for unwholesome objects by increasing the sattva guna (good quality of the mind) is known as the Satvaavajaya chikitsa.

Sattva guna is of illuminating nature. Here illumination refers to the knowledge that help one to know the true and ultimate nature of anything in this world. Therefore empowering the person with knowledge about certain things that are leading to distress and giving knowledge about methods to handle and cope with these events in done in Satvavajaya chikitsa

Functions of mind and its role in health and well being

Manas is considered as the connecting link between Atman and indriyas. It is manas that influences indriyas and initiate them into their activities. Therefore manas also has potential to control these indriyas and restrain their action. Along with that, manas itself performs few actions independently and those are called as karmas of manas or functions of mind. The functions are described as,

इन्द्रियाभिग्रहः कर्म मनसः स्वस्य निग्रहः| ऊहो विचारश्च, ततः परं बुद्धिः प्रवर्तते||२१||

1. इन्द्रियाभिग्रहः Indriyabhighraha – Denotes control over one’s Jnanendriyas / sensory organs (Eyes, nose, ears, tongue, skin), Karmendriyas / motor organs (Hands, legs, speech, anus and reproductive organ).
2. स्वस्य निग्रहः Svasya nigraha – having control over activity of mind itself or being self-restraint means svasya nigraha
3. ऊहो Uhya – the ability to analyze or being able to speculate.
4. विचारश्च Vichara  - Thinking, decision making, or having a controlled thought process means vichara.

It is clear from above that manas has the potential to generate and even control any action, thought, emotion of a person. Therefore when the any of these components ar eresponsible for causing any illness in a person, satvavajaya becomes an important modality of treatment along with other therapeutic aspects.

Manas dosha  treatment aspects

Doshas means defects in something. As there are shareera doshas namely, Vata, pitta and kapha, there are manas doshas which are rajas and tamas. Attaining a balance between rajas, tamas and sattva guna is the target of Satvavajaya chikitsa. Various methods that can help to achieve this balance and specifically increase the sattva guna are employed in Satvavajaya chiktsa. Some of them are listed below as described in Charaka samhita.

with various methods as enlisted below encompasses Savavajaya chikitsa techniques.

मानसो ज्ञानविज्ञानधैर्यस्मृतिसमाधिभिः||(cha.sut.1.58)

ज्ञानम् अध्यात्मज्ञानं, विज्ञानं शास्त्रज्ञानं ^[१] , धैर्यम् अनुन्नतिश्चेतसः, स्मृतिः अनुभूतार्थस्मरणं, समाधिः विषयेभ्यो निवर्त्यात्मनि मनसो नियमनम्||५८||

1. ज्ञानम् Jnana – Here jnana denotes knowledge of self. It includes basic understanding of the concept of self that comprises of knowledge about having 3 different components of life body, mind and energy. It also includes the understanding that a human being is not just a body or mind but something beyond that.
2. विज्ञानं Vijnana – Vijnana denotes knowledge of shastras (doctrines). Shastras refer to the Vedas, Upanishadas and other literature from bharatiya samskrtik parampara that offer knowledge on important aspects about life and nature of self.
3. धैर्यम् Dhairya -  Dhairya means courage/ strength/ steady conduct or patience. It is that quality of a human being which make one strong and persistent despite failures or obstacles in the path of success. The one who possesses this quality can see the light beyond the obstacles in the path and this ultimately takes him to the desired destination, success and all that is wished for.
4. स्मृतिः Smriti – Smrti means memory or capacity to remember. This makes one capable of understanding the association between cause and effect. This aids intellect to decide the right things, actions and thoughts. Ultimately careful decision making and problem solving can be achieved.
5. समाधिः Samadhi – Samadhi denotes meditation. Samadhi is one of the highest order step in Ashtanga yoga. It indicates the state of being in unioson with the parabrahma or paramatman. It is that state in which the being realizes the true nature of life, its separate nature than mind and body and thus the pain disappears.

These methods convey the idea of basic principles of satvaavajaya chikitsa. Various methods of psychotherapy and cognitive behaviour therapy along with these methods can be employed in Satvavajaya chikitsa to achieve these objectives and get cure from disturbing health issues.

Application of Satvaavajaya chikitsa concerning certain diseases

Ayurveda acharyas have given significant importance to the satvavajaya chikitsa in specific diseases and have advised its implementation as and when required to achieve health. Ayurevda scholars very well understood the role of manas (mind), its actions and emotions in the development and progression of certain diseases. Thus Satvavajaya chikitsa had been advised to cure and even to prevent the diseases or their progression. Below are few examples of Satvavajaya chikitsa advised in certain illnesses by Ayurveda achryas.

Jwara

क्रोधप्रवातव्यायामान् कषायांश्च विवर्जयेत्|१३९|(cha.chi.3.139)

Acharya Charaka explained in cases of nava jwara or the initial stages of fever, one must avoid anger or krodha, which is a dosha of manah or the mind. (cha.hi.3.320-324)

There are explanations of jwara caused due to excessive krodha, which is treated with sadvakya(good advise), kamya artha(giving desired object), manodnya artha(giving pleasing object). (cha.hi.3.320-324)

Ashwasana chikitsa or assurance in cases of jwara caused due to bhaya(fear), shoka(grief). (cha.hi.3.320-324)

विचित्रैश्च विषयैर्नाशयेत् स्मृतिम्| (cha.hi.3.324)

When an individual suffers from jwara even by thinking about it, then it is managed by diverting the mind by remembering about different and surprising incidents.

Rajayakshma

हर्षणाश्वासनै..( cha.chi.8.187)

Harshana or inducing happiness and ashwasana (providing assurance) are mentioned as other treatment aspects in rajayakshma chikitsa.

Unmada

(cha.chi.9.79-84)

आश्वासयेत् सुहृद्वा तं वाक्यैर्धर्मार्थसंहितैः|

Ashwasana(providing assurance) chikitsa by a friend is applied again in Unmada disease as well. (this type of treatment method can be associated with modern counseling methods)

Moral speech and virtuous words are used as well. appropriate guidance and suggestions are given.

Measures like inducing fear in the mind, by exhibiting surprising events or showing extraordinary things for distraction are used.

कामशोकभयक्रोधहर्षेर्ष्यालोभसम्भवान्| परस्परप्रतिद्वन्द्वैरेभिरेव शमं नयेत्|| (cha.chi.9.86)

If the cause of the disease is kama(passion). Shoka(grief), bhaya(fear), krodha(anger), etc then replacement by opposite emotions are performed.

Apasmara

सुहृदश्चानुकूलास्तं स्वाप्ता धर्मार्थवादिनः| संयोजयेयुर्विज्ञानधैर्यस्मृतिसमाधिभिः || (cha.chi.10.63)

Vidnyana(wisdom), dhairya(courage), smriti(memory), samadhi(meditative knowledge) are values that are inculcated in apasmara disease by friends, well-wishers, religious sermons, etc.

Hikka

शीताम्बुसेकः सहसा त्रासो विस्मापनं भयम् | क्रोधहर्षप्रियोद्वेगा हिक्काप्रच्यावना मताः ||(cha.chi.17.137)

There are certain measures explained by Acharya Charaka which alleviate Hikka, like the distraction from thoughts, inducing fear, anger, anxiety, and sudden happiness.

Thus, here krodha(anger) and bhaya(fear) are used as treatment methods being dosha(morbidity) of manah or mind.

Visarpa

As there are indications of satvavajaya chikitsa methods in certain diseases there are contraindications as well.

क्रोधव्यायामसूर्याग्निप्रवातांश्च विवर्जयेत् ||(cha.ch.21.115)

In Visarpa krodha(anger) is varja meaning contraindicated along with other lifestyle modulation.

Madatyaya

Harshana chikitsa is mentioned as a treatment method in madatya(alcoholism/intoxication)

वनानि रमणीयानि (roaming around n beautiful gardens), विशदान्यन्नपानानि(decent food and pleasant drinks), माल्यानि गन्धयोगाश्च वासांसि विमलानि (wearing pleasant-smelling flower garlands, perfumes), गान्धर्वशब्दाः(listening to melodious music). These are few examples mentionedas harshna cikitsa(exhilaration method of management).

Madya or liquor cannot intoxicate a person without affecting the mind, thus these methods of management are adopted.