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AYURVEDIC MANAGEMENT OF YOSHAAPASMARA

(HYSTERICAL NEUROSIS/CONVERSION DISORDER) –A
CASE REPORT
Kumar Dileep1*.,K. H. H. V. S. S. Narasimha Murthy2.,Tripathi J.S3
1-Senior Resident, Division of Manas Raga (Psychiatry and Psychosomatics),
2-Associate Professor , Division of Manas Raga (Psychiatry and Psychosomatics),
3-Professor, Division of Manas Raga (Psychiatry and Psychosomatics), Head
Department of Kayachikitsa, Faculty ofAyurveda, Institute of Medical Sciences,
Banaras Hindu University, Varanasi, India

ABSTRACT
The disease Yoshaapasmara is frequently found in females described in MadhavaNidanaParishista,
BhaishjyaRatnawali etc. In modern psychiatry it is known as hysterical neurosis and now it is classified
under “conversion and dissociative disorder.” Due to less awareness about this disorder and its clinical
presentation, it seems to very emergent condition for a general people. The term conversion disorder
reflects the hypothesis that an unconscious psychological conflict is converted in to symbolic symptoms,
thereby reducing anxiety and shielding the conscious self from a painful emotion and can be defined as
disturbance of bodily functioning that does not conform to current concepts of the anatomy and physiology
of the central or the peripheral nervous system.Continuously changing lifestyle along with ever-riding
stressful psychological conditions contributes to most of the psychosomatic and psychiatric diseases. In
BhaisajyaRatnavaliParishista this disorder is described as Yoshaaptantrak, and principles of management
in very detailed. Dhatupustikara Anna-pana and Aushadha, KosthaShuddhikara Anna-pana and Aushadha,
showering of cold water on head, eyes, and face along with head evacuation e.g.nasal insufflations etc. at
the time fainting, use of apsmarahara medicine, proper consolation,vata-kaphadoshanashakachikitsa,
sttvavajayachikitsa and various drugs and other treatment modality as per clinical situation can be use for
the management of the same.Ayurveda has clinically proven drugs like sarpagandhachurnayoga,
mansyadikashaya, medhyarasayana and other drug along with non-pharmacological (Sattvavajaya
chikitsa) methods for very effective management of the Yoshaapasmara.
Key word- Yoshaapasmara, stress, sapagandhachurna yoga, conversion disorder

INTRODUCTION
Yoshaapasmara is one such ailment commonly found generally in females described in
MadhavaNidanaParishista, BhaishjyaRatnawali and SharngadharaSamhitaParishista etc. Basing on
resemblance in clinical features, many Ayurvedic scholars equated the Yoshaapasmara with
Apatantraka which is described in all major Ayurvedic texts. Dissociation of Gatikakshetra (motor
area) and Sanvedanikakshetra (sensory area) from Manasikakshetra (association area of brain)
manifest as various somatic symptoms, sensory disturbances and emotional instability. Word
“Yosha” refers to female, due to more prevalence in female, it is called as Yoshaapasmara, but it

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may occur in males of who had soft temperament or man who cannot able to bear the any hard
situation or events. In modern psychiatry this condition is known as Hysterical Neurosis, but this
term also not using today. Hysteria is a mental disorder arising from extreme anxiety. It is
characterized by lack of control over acts and emotions, and by sudden seizures of unconsciousness
with emotional outbursts. It is often the result of repressed conflicts within the person. The term
conversion disorder reflects the hypothesis that an unconscious psychological conflict is converted
in to symbolic symptoms, thereby reducing anxiety and shielding the conscious self from a painful
emotion and these symptoms does not conform to current concepts of the anatomy and physiology
of the central or the peripheral nervous system. It is named because it is believed that repressed
sexual/aggressive energy is converted into physical symptoms. Conversion disorder is most
frequent in younger (12-35 years) females (female: male ratio = 2:1 to 10:1), mainly of rural areas
and less educated group. It constitute about 6-15% of all outpatient diagnosis and 14-20% of all
neurotic disorders. Approximately 5%-24% of psychiatric outpatients, 5%-14% of general hospital
patients and 1%-3% of outpatients of psychiatric referrals have a history of conversion symptom.
Dissociation is an altered state of consciousness characterized by partial or complete disruption of
the normal integration of a person’s normal conscious or psychological functioning. Dissociation is
a psychological process commonly found in persons seeking mental health treatment. Out of
different dissociative disorders, dissociative convulsion (most common in India), which was earlier
known as hysterical fits or pseudo seizures and characterized by presence of convulsive movement
and partial loss of consciousness
As per Ayurvedic scholarsexcess blood loss/excess menstrual bloods loss, indigestion, anxiety,
constipation, grief, hopelessness, placental abnormalities, unfair behavior by family members, soft
temperament, unloving / uncaring husband, young widower and excess grief etc and etiological
factors of vatavyadhi are the main causative factors. This disease may occur in any time of
reproductive age. In modern psychiatry Sexual and physical abuse (incest, childhood abuse etc.),
stressful negative life events, marital conflicts, childhood trauma, maladaptive personality,
genetically determined hysterical psychopathy and some neurotransmitters were consider as
etiological factors.Various etiological factors cause dissociation of Gatikakshetra (motor area) and
Sanvedanikakshetra (sensory area) from Manasikakshetra (association area of brain) and manifest
as various somatic symptoms, sensory disturbances and emotional instability. An unacceptable
sexual or aggressive drive is denied expression and repressed and thus becomes unconscious. The
mental energy associated with the drive, which would normally push the drive into conscious
experience, is converted into a somatic symptom. The immediate cause of conversion disorder is a
stressful event or situation that leads the patient to develop bodily symptoms as symbolic
expressions of a long standing psychological conflict or problem.
Prodromal symptoms include pain in heart / chest pain, yawning and continuous letharginess and
disorder is manifest as vauge and diffirent types of signs and symptoms.After removal of
etiological factor, disease spontaneously disappears or after menopause. Its prognosity depends on
and family environment and social environment around the patient.
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In BhaisajyaRatnavaliParishista this disorder is described as Yoshaaptantrak, and principles of

management in very detailed. Dhatupustikara Anna-pana and Aushadha (nutritious diet, drink &
medicine), KosthaShuddhikara Anna-pana and Aushadha (diet, drink and medicine causing
cleansing of gastrointestinal tract eg.mild purgation etc.), showering of cold water on head, eyes,
and face along with head evacuation e.g. nasal insufflations etc. at the time fainting, use of
apsmarahara medicine, proper consolation , vata-kaphadoshanashakachikitsa, sttvavajayachikitsa
and various drugs and other treatment modality as per clinical situation can be use for the
management of the same.
CASE STUDY
A 16 year old young hindu unmarried, 10th class girl student (MRD no 2184934) from Vill-
Bedhawan, JamuaMirzapur, belonging with lower middle class combined family having
agriculture as source of income came tokayachikitsamanasroga OPD (Attending consultant – Prof.
J.S. Tripathi) on date 30/06/18 with complaint of episodes of pain abdomen followed by muteness
associated with stiffness in neck with upward bending for 2-5 minutes. Frequency of episodes was
2-3 per month since last 10 month. Other associated symptoms are mild decrease in appetite, and
sometimes mild restlessness. In spite having normal EEG and CT scan brain, in private hospital the
case was diagnosed as seizure disorder and started the treatment by using drugs like valproic acid,
clobazam, levetiracetamlorazepam, mirtazepine, sodium divalproex etc. when patient not get
benefitted symptomatically by treatment than she came to S.S. hospital Indian medicine wing for
the treatment.

On examination – Patient’sgeneral condition was average, PR=80/min, BP= 110/70mmhg, there

was no pallor, icterus, clubbing, cyanosis, or any type of swilling or lymphadenopathy. On the
systemic examination of CNS, CVS, respiratory, gastrointestinal, urogenital and loco-motor no any
clinical finding was noted.
INVESTIGATION
(A) Lab investigation- 15/12.2017-Hb%=11.6mg/dl, WBC=10900, RBC= 376000/mm3, PLT=
130000/mm3, MCV=86.7fl, MCH=30.8pg, MCHC= 35.6g/dl, RBS=92mg/dl, LFT= within normal
limit, Serum Urea= 23 mg/dl, Creatnine= 0.62mg/dl, HIV=negative, HbSag= negative, HCV=
negative,
(B) Radiological investigation- 19/12/17- EEG= normal, CT scan brain= normal, X-ray cervical
spine-AP/LAT = normal, USG abdomen= normal.
TREATMENT GIVEN
After proper history taking and clinical examination along with inspection of lab and radiological
investigation patient was diagnosed as case Yoshaapasmara. Following treatment was given to the

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patient for initially for 15 day thereafter 3 follow ups of 1 month along with SttvavajayaChikitsa
primarily focused on patient and family education about infirmity and its outcome.

1 Name of the Ingredient Dose and Action

medicine Anupana
40ml bid Anticonvulsant, Anti Hypertensive
2 Mansyadikashay jatamansi,
a ashwagandha,
khurasaniajwayana
500mg bid Hypnotic, Antihypertensive, Tranquilizer,
3 Sarpagandhachu sarpagandha churna-
with milk. Anticonvulsant,
rna yoga 475mg, rasa sindura -
25mg

4 Pragyavardhiniv Bala, bilva, vacha, 2 tab bid Anti-anxiety, anti-depressant and brain
ati swarnamakshika, tonic
muktapisti,
rajatabhasma, etc

5 Brainocaresb Brahmi, 2 tsftid Medhyarasayan/ brain

shankhapushpi, tonic,immunomodulator, helps in
ashwagandha, satavari, rejuvenation of neurons
amrita etc

6 Neurokalpa fort Rasna, dashmula, 1cap bid Vata shamaka, anti-arthritic

ekangeera rasa,
vatagajankusha rasa etc

RESULT
After first follow up patient was having complaint of decreased appetite and after three months of
treatment there was no episodes of hysterical fits and any other complaint and she was completely
asymptomatic.

DISCUSSION
The human of present era is living under various adversities, stresses, strains and anxiety. Various
types of stresses like educational, social, official, economical, family and so many others are present
in the today’s life which are responsible for lack of material happiness, comforts and mental peace.
The idleness, sexual repression, perverted thoughts, sexual abuse, fears, worries, depression, mental
trauma, and prolong sickness etc. are the commonly associated with Human life. Physical,
emotional, or sexual abuse can be a contributing cause of conversion disorder in both adults and
children. The term “conversion” was first used by Sigmund Freud (1893). The term conversion
disorder reflects the hypothesis that an unconscious psychological conflict is converted in to
symbolic symptoms, thereby reducing anxiety and shielding the conscious self from a painful

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emotion and can be defined as disturbance of bodily functioning that does not conform to current
concepts of the anatomy and physiology of the central or the peripheral nervous system. It typically
occurs in a setting of stress and produces considerable dysfunction. The proposed etiologies are
suggesting that the symptoms resolve an intrapsychic conflict expressed symbolically through a
somatic symptom. Symptoms may manipulate the behavior of other persons and elicit attention,
sympathy, and nurturance. Current theories about the etiology of conversion emphasize the role of
communication. People, who have difficulty in verbally articulating psychosocial distress for any
reason, may use conversion symptoms as a way of communicating their distress. The principal drug
SarpagandhaChurna Yoga is indicated in the management of insomnia, Apatantraka (hysterical
neurosis), Unmada (psychosis), hypertension and newly diagnosed epileptic disorders. Rasa Sindura
mainly works on KaphaDosa, Rasa-Rakta-MamsaDhatu, Amashaya, Hridaya and Kaphasthana. It
regulates 5 types of Vata and 5 types of pitta. Sarpagandha is Kapha-Vata shamaka,
Mastiskashamak, Nidrajanan (hypnotic), Krimighna, Ampacaka and Hridayavasadak
(cardicdeppressent). It shows Anticholinergic, Hypotensive, Anticontractile, Sedative, Relaxant,
Hyperthermic, Antidiuretic, Hypnotic, Vasodilator, Antiemetic, Nematicidal, and Antifungal
activity. Mansyadikashaya alsohas same properties and indications likesarpagandhachurna yoga.
Neurokalpa fort is a drug combination use for various vatavyadhimanagement. Syrup Brainocareact
as brain tonic,immunomodulator and helps in rejuvenation of neurons.Prgyavardhinivati is also a
combination of various medhyarasayana and other ingredients working on nervous tissue. This drug
has anti-anxiety, antidepressant nootropic properties. Acharya charaka has defined it as a method of
controlling or restraining of the mind from unwholesome Arthas, literally we can say overcoming of
mind or victory over mind or control of mind which can be achieved by increasing Sattva to subdue
the exaggerated Rajas and Tamas. AsatmendriyarthaSamyoga (incompatiable contact of Indriyarths)
has been regarded as one of the principle causes of diseases. So avoidance of excessive, deficient or
erroneous (Atiyoga, Hinayoga and Mithyayoga), use of Manoarthas (Chintya, Vicharya, Uhya,
Dheyaya and Sakalpa along with Sukha, Dukhaetc) as well as Indriyarthas (Sabda, Sparsha, Roopa,
Rasa, Gandha) should serve to cure the mental disorders.

CONCLUSION
Yoshaapasmara commonly found in females is quite difficult to diagnose and treat due to its variable
etiology and clinical manifestation.Dosicinvolment in Yoshaapasmara are Vata and Kaphaand
Sarpagandhachurna yoga containing Rasa Sindura is having the Kaphashamaka, Parada is having
Tridosghna, while Gandhaka and Sarpagandha are having the Vata-Kaphashamaka properties.
Mansyadikashaya, Brainocare, Neurokalpa fort are thevatakaphashamaka and having the properties
like medhyarasayana (nootropic and cognitive enhancer), anti-anxiety, and antidepressant. Along
with above drugs and sattvavajayachikitsa (to correct faulty life style and for patient and family
education about infirmity) can be use to successful management of the same.

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