Delirium: Ayurveda Understanding

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Delirium is a state of mental imbalance consisting of confusion, disorientation, impairment of ability to concentrate or staying aware and inability to think or remember anything.

It is caused by disturbance in brain functions and predominantly manifests in older persons. The person having delirium can present as a different personality, different from what the people around him know.

In this article we will try to study ‘delirium’ from an Ayurveda perspective.

Delirium: Ayurveda Understanding

Pralapa

Pralapa & Delirium

Pralapa is the Ayurveda name for Delirium. In fact, delirium is a term correlated with ‘pralapa’ mentioned in Ayurveda. There is just a mention of the term and has not been detailed.

Pralapa is one of the symptoms of vata vriddhi – pathological increase of vata.

Pralapa actually means irrelevant, incoherent or delirious speech.

But delirium is more than that and is not limited to irrelevant speech.

Pralapa is one of the presentations or predominant symptoms or reflection of the entire clinical picture of delirium.

The pralapa spectrum

To understand pralapa in terms of delirium, we will also consider the other terms used with it in the context of explanation of ‘vata vriddhi’.

The other words used with pralapa are – ‘…bala nidra indriya bhramsha pralapa bhrama deenata’.

This entire spectrum explains the manifestation of pralapa and pralapa is a part and parcel of this collective manifestation. This spectrum includes –

–        Bala bhramsha – lack of strength, endurance and immunity

–        Nidra bhramsha – sleeplessness, insomnia, sleep deprivation

–        Indriya bhramsha – deficit strength in sense organs, improper perception of sense objects by their respective sense organs

–        Pralapa – delirium, irrelevant talk / speech or excessive talk

–        Bhrama – giddiness, fainting, confusion, dizziness

–        Deenata – helplessness, weakness, tiredness, fatigue, depression

If we carefully observe, the entire spectrum of symptoms explained from bala bhramsha to deenata can be seen in delirium. ‘Talking irrelevantly in a state of confusion’ may be highlighted by Ayurveda Acharyas in the name of Pralapa.

Vata Connection

The Udana Vata connection

Udana Vata, a subtype of Vata is responsible for many important functions in the body, including vak pravritti – production of speech, prayatna – efforts taken to do any activity, urja – energy and drive for any activity, bala – strength, endurance and immunity, varna – expression of colour and complex and smriti – memory.

The pathogenesis of Delirium – Pralapa starts with disturbance of Udana Vata. All the above said udana vata functions are imbalanced to some extent in delirium.

Samanavrita Vyana

Samanavrita Vyana is a type of Vata disorder in which strong Samana Vata would interfere and mask the functions of Vyana Vata. To put it in simple words, it is a condition in which a hyperactive digestive system (monitored by samana vata) masks the functions of the circulatory system (monitored by vyana vata). This may lead to deficit circulation and oxygenation to the brain. This will damage the nervous system in the long run and also will cause affliction of mind, hence causing delirium.

The symptoms of Samanavrita Vyana include –

–        murcha – fainting (loss of consciousness or altered consciousness),
–        tandra – stupor / excessive sleepiness or drowsiness,
–        pralapa – delirium, irrelevant speech,
–        angasada – weaknenss or tiredness in the body parts,
–        agni kshaya – deterioration of digestive fire / strength,
–        ojo kshaya – derioration of ojas (essence of all the tissues),
–        bala kshaya – deterioration of strength (endurance, immunity)

All these symptoms may be a part and parcel of the delirium spectrum. In other words, delirium may be a multi system problem and may be associated with the above said symptoms.

Symptoms worsening at night and Vata link with Pralapa

The symptoms of delirium worsen at night and so do the symptoms of vata. This shows that vata aggravation causes delirium and so do its symptoms.

Vata aggravating causes

Any of the three doshas may affect the mind and cause delirium but it is vata which mainly causes the mentioned disease. Vata aggravating factors including foods, activities, habits, behaviours and seasonal changes might cause or trigger delirium.

Pitta Connection

Pitta and Pralapa

Pitta is responsible for any kind of inflammation or burnouts happening in the body. Inflammation happening at neuron and brain level can cause delirium.

Kapha Connection

Kapha induced Delirium

Though Pralapa is caused predominantly by vata, the condition can also have a kapha variant. This variety is mainly caused by immobility. Prolonged periods of immobility, mainly lying down for a long time can impact the brain functions. This can mask the activity of vata, further reducing the movements. Prolonged immobilization can also cause abnormal increase in kapha and this kapha can block vata and render it inactive. This can be a kaphavrita vata condition i.e. kapha enveloping vata in the head.

It is also said that delirium reduces due to regular indulgence in physical activities and regular movements, which also shortens the duration of the disease. Kapha increase also responds to good exercise habits.

In the kapha variant, pralapa may be an effect of the pathological changes brought about by increased kapha.

Dhatu etc. factors

Dhatu Kshaya & Pralapa

When there is severe dhatukshaya – destruction and diminution of body tissues, it will lead to aggravation of vata. This vata would affect the mind and cause delirium.

Marma Upaghata & Pralapa

Injury to the important marmas – vital organs and structures of the body, mainly those of the head, chest and neck will affect the brain, nerves and mind, rajas and tamas and cause pralapa.

Agnimandya, Ama and Amavisha & Pralapa

Agnimandya or Mandagni – sluggishness of digestive fire and impairment of digestive functions leads to production of plenty of ama – intermediate products or immature products of weak digestion. When this ama is not controlled it becomes a systemic toxin and circulates throughout the body. When it reaches the head, it damages the brain and nerves. This leads to delirium.

Manas Connection

The ‘Smriti Bhramsha’ connection

Among many causes, dementia increases the chances of one developing delirium, so these conditions can coexist. Dementia simply means impaired ability to remember, think or make decisions. These events would interfere with doing everyday activities. It mostly affects older adults.

So, the explanation of dementia reflects smriti bhramsha disturbance / destruction of memory along with moderate amounts of dhee bhramsha – destruction of intelligence and dhriti bhramsha – destruction of ability or courage of taking decisions. Majority of these events take place at old age which is favourable age for vata aggravation. This vata aggravation is common for both, manifestation of dementia and delirium.

To put it short – old age causes vata aggravation. This vata causes dementia and dementia in turn becomes cause for delirium.

Indriya Bhramsha and Pralapa

Indriya Bhramsha i.e. weakness of sense organs and deficits in their perceptions can also lead to pralapa. The indriyas are also controlled by vata. Vata aggravation, apart from the body and mind, will also hit the indriyas hard.

Asatmya Indriyartha Sannikarsha – improper coordination between the sense organs and their objects – deficit, excess or perverted – is one of the causes of all diseases. These variants of perception deformities will disturb the physical doshas – mainly vata and also pitta and kapha and also the mental doshas – rajas and tamas.

These events might cause or trigger delirium vis-à-vis pralapa.

Modern medicine says that disruption of natural lighting or sound, lack of sensory input – including hearing and vision impairments increases the likelihood and risk of delirium.

Manasika Doshas & Pralapa

The imbalances of rajas and tamas qualities of the mind will affect the mind and cause many neurological and mental issues, including delirium.

Other Factors

Chronic ailments and Pralapa: Delirium

Chronic diseases which remain unaddressed will get deep seated in the tissues and damage them. Damage of tissues will cause vata aggravation. The aggravated vata will affect the mind and cause delirium. Any chronic disease can cause delirium but vata disorders are majorly responsible for causation of pralapa.

According to modern medicine, Delirium is also a product or effect of long-standing ailments including cancer, stroke or infections and also recent bone fractures.

Very interesting to see is that bone fractures can cause delirium. Bones are an important abode of vata tissue. When bones are injured or damaged, the majja dhatu – bone marrow is depleted which leads to bhrama – giddiness / dizziness and timira darshana – feeling of darkness in front of the eyes or blackouts. Majja is also the name of the brain matrix according to Ayurveda. Neuronal deficits cause delirium.

Pain management and Pralapa

Poor pain management and untreated pain are the main risk factors for delirium.

Vata is the main dosha which would cause extreme pain. If vata is not controlled at the proper time with proper interventions, it can undergo severe aggravation and cause pain. Similarly, if pain is not controlled for a long time duration, the pain would cause an increase in vata.

We have seen a lot of people with pain having delirium. As a remedy, better pain management or vata management helps in getting better of delirium episodes.

Nidra & Pralapa

We have seen that people who have had no good sleep or patients of chronic insomnia or those having sleep deprivation exhibit moderate to severe proportions of delirium. Disruption of the sleep-wake cycle increases the likelihood and risk of delirium.

‘Ajnana’ – ignorance, idiocy or disorientation is said to manifest when a person does not sleep well.

Ageing and Pralapa

With ageing, it is quite natural that vata gets increased in the system. The structures and their functioning start deteriorating with ageing. We all have seen aged people speaking to themselves or speaking something out of context. This is due to aging, feeling of rejection and separation and many times due to chronic illness and feeling of helplessness.

Social isolation and Pralapa

When a person is socially isolated or separated, it may cause or trigger delirium. This would cause ayoga or hinayoga (deficit contact) of indriyas (sense organs) with their respective arthas (sense objects). This would affect the mind. The person feels frustrated since he cannot communicate with anyone. The urge to talk may provoke udana vata and the person starts speaking to self, irrelevantly. This may be a part and parcel of a big spectrum of other symptoms.

Madatyaya & Pralapa

People who consume excessive alcohol too exhibit episodes of delirium. The irrelevant talk of a chronic alcoholic is due to the effect of alcohol on the body and mind.

Symptoms of Delirium & Doshas

Predominant Symptoms of Delirium vs Dosha link

a. Predominant Symptoms

b. Symptoms related to Behaviour and Emotions

c. Other symptoms

Principles of Management of Delirium / Pralapa

Nidana Parivarjana

Keeping away the causative factors is the golden principle of treating delirium, just like in any other disease.

Managing Vata imbalances

We have learnt that the vitiated vata is the main troublemaker in causation of delirium episodes. Effective balancing and maintenance of vata is the key ingredient in management of delirium / pralapa. Vata balancing foods, lifestyle activities, emotions, behaviours, medicines and therapies should be comprehensively planned. Following proper and planned seasonal regimen during vata aggravating seasons will help.

Dealing with Pitta and Kapha

There may be variants of delirium in which symptoms may indicate involvement or association of pitta and kapha. When found, they should be promptly addressed and dealt with.

Dealing with dhatu kshaya

Balance of the tissues of the body is one of the key ingredients of comprehensive health. Dhatu Kshaya not only lowers the immunity and strength of an individual, but also causes vata aggravation. This vata will cause many vata disorders including delirium or delirium could manifest as a symptom of any disorder caused by agitated vata. Any deficits of tissues should be identified and treated accordingly.

Exploring Marma Involvement

Marmas are the vital spots of the body which behold Prana energy. Injury to different marmas can cause different effects at physical, mental or psychosomatic planes. When conventional medicines for vata or disease involved are not working to the best of expectations, it is important to explore if any marma or marmas are involved and address them if it is found that they have been insulted or injured.

Addressing Agni imbalances and Ama

Deepana – for kindling the weak digestive fire and Pachana – to digest the ama should be promptly implemented to correct the imbalances related to fire and to remove the ama and protect the body from its toxicity. Balance of agni is also responsible for production and manifestation of speech, with the help of vayu. Ama visha, while having a systemic impact can affect the brain and cause symptoms of delirium.

Treating the mind & senses

Psychotherapy is very much needed in patients having delirium. Dhee – intellectual training, Dhairya – instilling courage and decision-making power in the mind of the person and Atmadi Vijnana – making the person realize the importance of self are the threefold approaches in any of the mental ailments and also should be considered in patients of delirium. Attempts to reduce the rajasika quality of the mind and to instill positivity through sattvika approach should be made.

Medicines, therapies, diet and lifestyle advice on the lines of treatment principles of Unmada – insanity, psychoses and Apasmara – memory disorders, epilepsy – should be considered in the treatment of delirium.

The person should be kept away from asatmya indriya arthas – incompatible or harmful sense objects. Prajnaparadha – intellectual blasphemy or committing sins and mistakes in the state of consciousness may cause delirium. They shall be avoided. 

Managing chronic ailments and Pain

Any disease which is found to cause delirium / pralapa should be promptly treated and so does any cause of pain. Long standing diseases like jwara, unmada, apasmara, shwasa, hrdroga, marmopaghata, madatyaya, visha etc can cause delirium in the long run. It is important to treat causal disease. Likewise, any pain which has been running long should be treated with effective remedies.

Sleep therapies

Sleep is an important supporting pillar for health. Proper medicine and pampering therapies like abhyanga, shirodhara, shirobasti etc should be administered. Along with proper ahara – dietetic protocol and brahmacharya – celibacy / organized living in the pathway of righteousness – one would get rid of delirium. Better quality and quantity of sleep also helps in prevention of delirium.

Anti-ageing medicines

Rasayana and Vajikarana are the best medicines for maintenance of comprehensive health. They should be implemented in the transitional period between middle and old age i.e. at the onset of old age. They are also best in anti-ageing, help boost immunity, good mind medicines and rejuvenate the entire system. Aged people should be given attention, love, care and affection and should not be isolated. This is the best Rasayana.

Management of Madatyaya

Alcohol deaddiction or avoidance is a must in those suffering from pralapa / delirium. It might be a cause or trigger or both. Alternative medicated madyas – wines shall be advised.

Panchakarma

Vasti and Nasya are the best Panchakarma therapies beneficial for those suffering from pralapa – delirium. Virechana and Vamana can be thought of when pitta and kapha respectively are predominantly involved or associated.

Murdni Taila

Shiro Basti and Shiro Dhara are the best options of oil therapies done on the head, for delirium. Shiro Abhyanga and Shiro Pichu too can be considered.

Rasayana & Vajikarana

Rasayanas and Vajikarana medicines are not only preventive medicines, antiaging and rejuvenation medicines, they are also good brain tonics and nervines. Medhya Rasayanas are exclusively helpful. Ashwagandha, Kapikachchu, Guduchi, Shankapushpa, Mandukaparni, Brahmi, Arjuna are some of the best options in this direction.

Daiva Vyapashraya Chikitsa

Divine therapies should be considered along with conventional therapies especially when delirium is a symptom of a disease like unmada or apasmara. They shall also be considered when the conventional approaches in dealing with delirium / pralapa fail to yield results.

Yoga & Meditation

Yoga and meditation are essential therapies for psychosomatic healing and should be considered and designed in treatment of chronic delirium as and when needed.

Below mentioned are some of the important Yoga postures beneficial for those suffering from delirium –

–        Paschimottanasana – Seated forward bend pose
–        Vajrasana – Thunderbolt pose
–        Shirsasana – Headstand
–        Vrikshasana – Tree pose
–        Siddhasana – Adept’s pose – Accomplished pose
–        Adhomukha Shvanasana – Downward facing dog pose