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Dr K K Aggarwal

The best description of the causes and treatment of insomnia comes from Vidura Niti a dialogue between Vidura and Dhritasashtra.

In the text, King Dhritarashtra said: “O Vidura, Sanjaya has come back. He has gone away after rebuking me. Tomorrow he will deliver, in the midst of the court, Ajatashatru’s message. I have not been able today to ascertain what the message is of the Kuru hero. Therefore, my body is burning, and that has produced sleeplessness. Tell us what may be good for a person that is sleepless and burning.

“My body is burning, and that has produced sleeplessness” is a typical description of anxiety and related sleeplessness, true even today.

Vidura said: “Sleeplessness overtakes thief, a lustful person, him that has lost all his wealth, him that has failed to achieve success, and him also that is weak and has been attacked by a strong person”.

He therefore described five basic reasons for insomnia and even in today’s science they are true. No new cause has been added in this list of stress induced insomnia.
The situations are:
1. A thief
2. A lustful person
3. A person who has lost all his wealth
4. A person who has failed to achieve success
5. A person who is weak and has been attacked by a strong person.

Ayurveda describes sleep as an aggravation of Vata & Pitta dosha. The number one cause of the same is mental tension; suppressed feelings & acute bitterness. The above five situations again hold true to this effect.

Apart in Allopathy other causes of insomnia mentioned are constipation; dyspepsia; excessive intake of tea, coffee & alcohol and environment Factors-excessive cold, heat or change of environment. They are in most of the situations the effect and not the cause of insomnia.

The treatment of insomnia involves either suppressing the emotions with drugs or root level eradication of stress with proper counseling.
Bhagavad Gita, Chanakya Niti and Vidur Niti are high level counseling books of ancient era and provide texts and sutras even true today.
Bhagavad Gita was a counseling when Arjuna went in an acute anxiety state and was not being able to decide whether or not he should fight with his near ones. He said: my legs are trembling, my bows are leaving me, by body is shaking, what should I do”. The principles of Gita today are incorporated as the principles of any counseling.

Chanakya gave principles of how to manage conflicts and win over others. One of his main teachings was that money earned by unfair means can only last for eight years.

Another answer to insomnia is learning meditation as described in Patanjali Yoga Sutra or Yoga Vashistha. It is based on the principle of concentrating on the present, which shifts the inner environment from sympathetic to para sympathetic mode. 20 minutes of meditation morning and evening provides the same biochemical benefit as gathered from 7 hours of deep sleep.

Here are some other sutras of Vidura Niti
• Do not inhabit a country where you are not respected, cannot earn your livelihood, have no friends, or cannot acquire knowledge. (1.8)
• Do not reveal what you have thought upon doing, but by wise counsel keep it secret, being determined to carry it into execution. (2.7)
• Consider again and again the following: the right time, the right friends, the right place, the right means of income, the right ways of spending, and from whom you derive your power. (4.18)
• A wise man should not reveal his loss of wealth, the vexation of his mind, the misconduct of his own wife, base words spoken by others, and disgrace that has befallen him. (7.1)

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People who develop chronic cough and phlegm (sputum production) are at significantly high risk of developing Chronic Obstructive Artery Disease (COAD).

COAD also called as Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death. It is a combination of chronic bronchitis and emphysema where the lungs get enlarged and weak. The main cause of COAD is smoking.

Presence of chronic cough and phlegm in smokers is not an innocent symptom but is an early marker of airflow obstruction.

People who develop chronic cough and phlegm have a four fold higher risk of developing COAD.

Until now it was thought that only 15% of smokers develop COAD but the current literature suggests that the lifetime risk of COAD in smokers is upto 50%.

If not managed properly COAD leads to heart involvement resulting into right heart failure with increased morbidity and mortality.

Quitting smoking can reverse the process in the early stages. In late stages, quitting will stop further progression of the disease.

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One more four and a world record of hundred centuries. Oops….. he is out and no record. This is what Sachin Tendulkar is facing.

This is what is called as ‘Performance Anxiety’ in medical language and in cricket words the term is often used as ‘nervous 90’.

In cricket performance anxiety is also seen when you are facing the first ball. Many players get out on the very first ball.

The physiology is at the sub-conscious level. There is a sudden rush of sympathetic over activity with influx of chemicals like adrenaline or non-adrenaline, which increases pulse rate, blood pressure, increased sweating and leads to impairment in the fine skills and judgment.

A person in acute anxiety cannot thread a needle, as the fineness required for the same will not be there. Medically one can find presence of fine tremors on the fingers.

Many marital disharmonies are also the result of first night nervousness. One of the commonest causes of erectile dysfunction in males is performance anxiety. Such people may have erectile dysfunction with a particular partner and not with the other. Extra marital affairs are also associated with performance anxiety in many cases.

Facing an interview, an adolescent on his first date, appearing in an exam or viva, are also common situations affected by performance anxiety. Quite often one may find that a student who has been doing well throughout the year fails to score good marks in the final exam. That is one reason why the western schools do not believe in the final exam results but on the overall performance of the year.

People who have marfanoid features, where the out-stretch arm length is more than the height, are especially prone to get episodes of anxiety. Seven percent of normal population may have these features.

Performance anxiety also increases in people who regularly smoke, consume tobacco or take alcohol more than permissible limits. Many herbs, which have actions like ephedrine and amphetamine, can also precipitate it. Tea, coffee and cola in excess can have cardiac stimulatory action and precipitate anxiety.

Fight and flight reactions are the most primitive reactions of the body. Performance anxiety belongs to one such reaction. Learning primordial sound meditation and done for 20 minutes twice daily regularly can shift one from sympathetic to para sympathetic mode and develop resistance towards this condition.

Yoga nidra, yoga shavasana, progressive muscular relaxation, mind-body relaxation, alternative nostril pranayama, regular walking, etc. are other exercises described in Vedic literature which helps stabilization of sympathetic nervous system in the body.

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Just because there are few studies indicating that moderate alcohol consumption is good for heart it should not be a reason for non drinkers to start drinking.

Indulging into alcohol for the first time is common during New Year’s Eve. Once started it invariably leads to a habit. Along with that, during New Year people also indulge into smoking and drugs as experimentation.

Consuming four drinks in one sitting in men (180 ml of 80 proof whisky) and in women (90 ml of 80 proof whisky) is considered health hazard and can precipitate dangerous rise in blood pressure, uncontrolled diabetes leading to sudden cardiac death in susceptible individuals. For those who drink, the safest limit of alcohol is 6 gm per day. However, the current recommendation is, in the absence of contraindication, is that one can take 10 gm of alcohol in one hour, 20 gm in a day and 70 gm in a week.

10 gm of alcohol is present in 30 ml of whisky, 50 ml of wine and one bottle of beer. One peg stays in the body for one hour, therefore, it is safe to drive only one hour after taking a peg. The rough formula is number of pegs taken should be equal to number of hours after which a person can drive. Alcohol and smoking together is more harmful.

Women should beware of rape date drugs which can be given to them in the drinks. Nobody should take any drinks offered by strangers. Date rape drugs are odorless and colorless drugs which if added to drinks can cause a state of mind where the person cooperates for everything but develops complete amnesia after the effect of the drug has gone for the period the person was drunk.

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1) What is counseling?
A: The mental process involves generation of a thought or idea which is analysed and then acted upon. Thought, analysis and action therefore are the primary three process of human mind. Counseling involves action at all three levels.

2) What are different types of counseling?
A: Counseling involves basically two principles – Cognitive counseling and behavioral counseling. Behavioral when the concentration is only on the actions, and cognitive when the concentration is on the changes, in either the thought process or in the interpretation of the thought process.

3) What is cognitive behavior therapy?
A: As against a pure behavior therapy where a person is counseled to do pre-defined things on regular intervals, cognitive behavior therapy involves changing the actions by changing observations of the interpretation of a particular situation.

4) What is the origin of counseling in India?
A: The origin of counseling goes back to Vedic era. Upanishads were basically text books on counseling based on the original knowledge of Rigveda, Yajurveda, Samveda and Atharvaveda.

5) Is there a relationship of Bhagavad Gita with Counseling?
A: Bhagavad Gita was the counseling done by Krishna to Arjuna on the conflict on Arjuna’s mind whether to fight or not. At that time there were no doctors and hence counseling was given by the elders in the family.

6) Are Bhagavad Gita principles followed today?
A: All the principles of cognitive behavior therapy today are basically principles originated from Bhagavad Gita

7) What is the first principle?
A: The first principle is “counseling cannot be done in one or two sessions. It requires up to 18 sessions which is what Krishna did in Bhagavad Gita. Bhagavad Gita contains 702 dialogues in the form of Shlokas therefore a proper counseling involves in-depth conversation between the counselor and the patient.

8) What is the second principle of counseling?
A: The second principle of counseling is to listen to the patient in the first session in great detail and that is what Krishna did in Bhagavad Gita. In Chapter 1 only Arjuna speaks and Krishna does not utter a word. Patient listening is 50% healing done.

9) What is the third principle?
A: As per the third principle the second (first interactive) session between counselor and the patient should be the longest one. Chapter 2 of Bhagavad Gita is the gist of Krishna’s counseling

10) What is the fourth principle?
A: The fourth principle is that after giving a detailed counseling in the second session one should expect the patient to get confused. This is what happens in start of Chapter 3 where Arjuna says to Krishna “I am confused. Sometimes you are talking about one path and other time you are talking about another path. Guide me again. The third counseling session therefore, is the most important where one has to counsel slowly and in great detail.

11) What is the fifth principle?
A: The next principle is to give reasoning to the counseling. One should not take patient for granted. Krishna discusses each and every aspect of life with Arjuna in great detail giving scientific reasoning at every stage.

12) What is the sixth principle?
A: Re-assure the patient again & again. During counseling Krishna assures Arjuna on multiple occasions that you did your job and do not worry. I am with you.

13) What is the seventh principle?
A: The seventh principle involves creating some fear in the patient’s mind. This is what Krishna does while showing his virat swaroop. This especially works in addiction patient. Some degree of fear with re-assurance from the counselor always works.

14) What are the eight principles?
A: The sum up counseling session should be as big as the second session. Chapter 18 of Bhagavad Gita is as big as Chapter 2 where the whole Bhagavad Gita is summarized again.

15 What are the ingredients of counseling?
A: Counseling basically involves in-depth knowledge of dharma, artha, kama, moksha. They are greatly described in Dharmashastra, Arthashastra, Kamasutra and Upanishads through various Vedas.

16) What is stress?
A: Stress is the reaction of the body or the mind to the interpretation of any situation.

17) How to manage stress?
A: Either change the response of the body through yogic living, or change the interpretation by understanding the principles of counseling or change the reaction by willful actions.

18) Are different nitis of our scriptures based on counseling?
A: Yes. Vidur Niti was the counseling given by Vidur to Dhritarashtra when he was not sleeping and Chanakya Niti was based on how to rule a country. Yoga Vashistha was the counseling given by Vashistha to Rama to acquire higher levels of spiritual knowledge.

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Health is not mere absence of disease but a state of physical, mental, social, spiritual, environmental and financial well being. Children should be given exposure to all aspects of health including financial health and spiritual health.

Internationally it has been shown that seven to nine hours of sleep is necessary to achieve optimal health. Taking into consideration the New Year parties, which the children attend, he appealed to the students to take at least seven to nine hours of sleep which can be remembered by the formula: 8 hours for oneself (sleep and hygiene), 8 hours of studies and 8 hours for the social life and family.

Childhood obesity is the new epidemic of the society and can only be controlled by the right education in school children.

Children should refrain from fast food as it is not good for health and have such food provided that it is natural during the New Year party time. It’s unnatural fast food which is called junk food which is a combination of maida and cheese, with or without sugar, which is harmful.

Teachers, parents and doctors should be the role model to the society and should do what they preach.

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Any campaigning involves principles of advertising mainly the principle of collective consciousness which is based on the critical mass above, which the generated message spreads like fire.

The recent Anna movement with mass hysteria can be explained by this critical mass  phenomenon.

It is scientifically proved that rumors spread like wild fire once the critical mass of 1% in the general population is achieved. All political or non political waves (including Anna wave) is based on this principle.

Advertisements in newsprints and in electronic media also work on the same principle. In campaigning, if 1% of your voters feel that you should win, the chances are that you will win.

This observation is based on famous 100th-monkey phenomenon. “Long time back there was a monkey called EMO in a far off village in Japan. Monkeys at that time used to eat apples lying in the gardens full of dust. One day EMO by mistake washed the apple in the pond before eating. Why from next time onwards he washed every apple he ate. From one monkey the message went to the second monkey and then to the third and so on. Many monkeys started washing apples before eating. After sometime some neighbouring monkeys from other villages also started washing apples before eating. The day 100th monkey washed the apple and ate, a strange phenomenon was observed all over the country. Monkeys all over the country started washing apples before eating. The critical mass in that area therefore was 100. Once the critical mass was achieved, the information spread like wild fire to each and every monkey and everybody started washing apples before eating.”

In campaigning also the politicians make use of this principle and make sure that the critical mass is achieved to start with. In local political meetings also, the same principle of 1% critical mass is used. For a gathering of 1000 people, politicians make sure that they have minimum 10 of their own people are sitting in the audience to initiate clapping. When 10 people clap, the rest 990 will also follow and clap. Similarly, for a gathering of 2000 they will need 20 people and for 10,000 they will need 100 people.

Rumors are also used as one of the main weapon in political campaigning. They also work on the same principle of 1% or critical mass. You can plant your people in other’s political meetings and start spreading rumors or hood their meeting. The only precaution that you should take is to cross1% of the number.

When you want to pass on a message to the audience, it has to be flashed for atleast 10 seconds. The mind cannot remember what it had seen or heard for less than 10 seconds. The politicians will highlight what they want to say and pass on hurriedly what they do not want the people to remember.

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Keeping in view the Christmas and New Year celebrations no level of alcohol consumption is safe for some people.

Alcohol should not be taken during pregnancy or by people who have strong family history of alcoholism, previous brain hemorrhage, liver or pancreatic disease, and while operating potentially dangerous equipment or machinery.

Alcohol use should also be limited in patients with active gastritis, esophagitis, premalignant GI lesions such as Barrett’s esophagus, or a strong family history of breast cancer.

For people without these conditions, the social limit has been defined.

1. Men can tolerate more alcohol than women.

2. The ideal dose of alcohol is 5-7 grams per day (about one drink every other day). In women, the dose is 4 g/day. (About one drink every third day).

3. 10 to 15 grams of ethanol is found in one glass of wine, one can or bottle of beer, or one mixed drink.

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