Changes

   

   

=== Abstract ===

=== Abstract ===

 

The eighth chapter of [[Nidana Sthana]] describes causative factors, predisposing conditions, pathogenesis, signs, types, and prognosis of ''apasmara''. The clinical presentation of this disease simulates the seizure disorders described in modern medical literature. ''Apasmara'' is a common neuropsychiatric disorder characterized by intermittent loss of memory, abnormal movements and blackouts. This chapter explores the basic principles of psychiatric disorders involving memory, mind, consciousness and intellect. These disorders are marked by major pathological obstacles in perception, impaired intellectual functioning, orientation, co-ordination and consciousness. Their management includes avoidance of etiological factors  as well as pharmacological and non-pharmacological treatment  (including psychological and spiritual therapies). The basic principles described in the present chapter can be helpful in preventing and managing neuro-psychiatric disorders like ''apasmara'' in a better way. This chapter also deals with some important aspects of diagnosis. It explains how one disease can trigger another disease i.e. ''Nidanarthakara roga'', leading to the presence of two or more diseases at the same time. This chapter lays down some principles of diagnosis to manage such conditions as well.  

The eighth chapter of [[Nidana Sthana]] describes causative factors, predisposing conditions, pathogenesis, signs, types, and prognosis of ''apasmara''. The clinical presentation of this disease simulates the seizure disorders described in modern medical literature. ''Apasmara'' is a common neuropsychiatric disorder characterized by intermittent loss of memory, abnormal movements and blackouts. This chapter explores the basic principles of psychiatric disorders involving memory, mind, consciousness and intellect. These disorders are marked by major pathological obstacles in perception, impaired intellectual functioning, orientation, co-ordination and consciousness. Their management includes avoidance of etiological factors  as well as pharmacological and non-pharmacological treatment  (including psychological and spiritual therapies). The basic principles described in the present chapter can be helpful in preventing and managing neuro-psychiatric disorders like ''apasmara'' in a better way. This chapter also deals with some important aspects of diagnosis. It explains how one disease can trigger another disease i.e. ''Nidanarthakara roga'', leading to the presence of two or more diseases at the same time. This chapter lays down some principles of diagnosis to manage such conditions as well.  

'''Keywords''': ''Apasmara'', transient loss of memory, seizure disorders, epilepsy, mind-heart connection, mind-brain connection.

'''Keywords''': ''Apasmara'', transient loss of memory, seizure disorders, epilepsy, mind-heart connection, mind-brain connection.

 

=== Introduction ===

=== Introduction ===

 

In this important section dealing with the diagnoses of some common disorders of the body and the mind, the [[Nidana Sthana]], this eighth and concluding chapter deals with apasmara, a disorder afflicting the mind and sharing similar etiological and pathological factors as ''unmada'' (the subject of the preceding chapter). ''Apasmara'' (Sanskrit for ''apa'' (to lose) or leave, and ''smara'' (memory)) is a psychosomatic disorder involving memory, intellect and mind and present with cardinal features such as transient loss of memory, abnormal movements of body and blackouts. ''Apasmara'' is counted, in Ayurvedic texts, among the eight ''mahagada'' (most dreadful diseases). The extent of knowledge on the disease indicates that it must have been quite prevalent in antiquity. Ayurvedic scholars have observed that ''apasmara'' simulates epilepsy in its features. Epilepsy is a common neuropsychiatric condition involving mainly the brain, nervous system and the psyche. However, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] emphasizes heart, the abode of consciousness and mind, as its core pathological site while covering diseases of memory, intellect as well as psyche under the umbrella of ''apasmara''.  

In this important section dealing with the diagnoses of some common disorders of the body and the mind, the [[Nidana Sthana]], this eighth and concluding chapter deals with apasmara, a disorder afflicting the mind and sharing similar etiological and pathological factors as ''unmada'' (the subject of the preceding chapter). ''Apasmara'' (Sanskrit for ''apa'' (to lose) or leave, and ''smara'' (memory)) is a psychosomatic disorder involving memory, intellect and mind and present with cardinal features such as transient loss of memory, abnormal movements of body and blackouts. ''Apasmara'' is counted, in Ayurvedic texts, among the eight ''mahagada'' (most dreadful diseases). The extent of knowledge on the disease indicates that it must have been quite prevalent in antiquity. Ayurvedic scholars have observed that ''apasmara'' simulates epilepsy in its features. Epilepsy is a common neuropsychiatric condition involving mainly the brain, nervous system and the psyche. However, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] emphasizes heart, the abode of consciousness and mind, as its core pathological site while covering diseases of memory, intellect as well as psyche under the umbrella of ''apasmara''.  

Causative factors of ''apasmara'' can be categorized under dietary, lifestyle, psychological and iatrogenic factors. Vitiated ''doshas'' get through the vessels of the heart and when exposed to predisposing psychological factors like excess worry, grief, anger, and fear, move upwards from the heart, the abode of all consciousness, to the brain, afflicting the senses while altering memory. This eventually leads to ''apasmara''. The etiology of the disease and specific features of the dominant ''doshas'' involved, and ''nidanarthakara roga'' (one disease causing other disease) and its importance in diagnosis and treatment have been described in detail in this chapter, with some important aspects of diagnosis addressed. In some cases, both diseases (the causative and the secondary ones) coexist while in other cases, the causative disease disappears and the new disease remains present. Thus, this chapter, while focusing on ''apasmara'', also talks of complications that lead to secondary conditions and their treatment.

Causative factors of ''apasmara'' can be categorized under dietary, lifestyle, psychological and iatrogenic factors. Vitiated ''doshas'' get through the vessels of the heart and when exposed to predisposing psychological factors like excess worry, grief, anger, and fear, move upwards from the heart, the abode of all consciousness, to the brain, afflicting the senses while altering memory. This eventually leads to ''apasmara''. The etiology of the disease and specific features of the dominant ''doshas'' involved, and ''nidanarthakara roga'' (one disease causing other disease) and its importance in diagnosis and treatment have been described in detail in this chapter, with some important aspects of diagnosis addressed. In some cases, both diseases (the causative and the secondary ones) coexist while in other cases, the causative disease disappears and the new disease remains present. Thus, this chapter, while focusing on ''apasmara'', also talks of complications that lead to secondary conditions and their treatment.

 

===Sanskrit Text, Transliteration and English Translation===

===Sanskrit Text, Transliteration and English Translation===

Individuals get quickly afflicted with ''apasmara'' if:  

Individuals get quickly afflicted with ''apasmara'' if:  

 

*the mind of an individual is afflicted by ''rajas'' (mental ''dosha'' associated with hyperactivity) and ''tamas'' (mental ''dosha'' associated with hypoactivity);  

*the mind of an individual is afflicted by ''rajas'' (mental ''dosha'' associated with hyperactivity) and ''tamas'' (mental ''dosha'' associated with hypoactivity);  

*the three ''sharira doshas'' are imbalanced and excessively aggravated;  

*the three ''sharira doshas'' are imbalanced and excessively aggravated;  

In the situations mentioned above, the ''doshas'' get aggravated and affect individuals whose minds are already afflicted by ''rajas'' and ''tamas''. The ''doshas'' (so aggravated) pervade the heart which is, as mentioned earlier, the abode of consciousness, as well as the sense organs. While there, the ''doshas'' get further aggravated by emotions such as passion, anger, fear, greed, attachment, excitement, grief, anxiety, perturbation etc., consequently spreading throughout the heart and the sense organs. The individual is then said to have been afflicted with ''apasmara''. [4]

In the situations mentioned above, the ''doshas'' get aggravated and affect individuals whose minds are already afflicted by ''rajas'' and ''tamas''. The ''doshas'' (so aggravated) pervade the heart which is, as mentioned earlier, the abode of consciousness, as well as the sense organs. While there, the ''doshas'' get further aggravated by emotions such as passion, anger, fear, greed, attachment, excitement, grief, anxiety, perturbation etc., consequently spreading throughout the heart and the sense organs. The individual is then said to have been afflicted with ''apasmara''. [4]

 

==== Characteristic features of ''apasmara'' ====

==== Characteristic features of ''apasmara'' ====

tato~anantaramapasmArAbhinirvRuttireva||7||  

tato~anantaramapasmArAbhinirvRuttireva||7||  

 

Premonitory symptoms of ''apasmara'' include contraction of eyebrows, erratic and constant movement of eyes, auditory hallucinations, excessive salivation, and nasal discharge. There is frequent accompaniment of anorexia, indigestion, and general disinclination towards food, chest congestion, distension of the lower abdomen accompanied with gurgling sound, weakness, cracking pain in bones and malaise, unconsciousness, a feeling of despondency or depression, fainting and giddiness, and frequent dreams of scenes of intoxication, dancing, murdering, aching, shivering and falling. [6]

Premonitory symptoms of ''apasmara'' include contraction of eyebrows, erratic and constant movement of eyes, auditory hallucinations, excessive salivation, and nasal discharge. There is frequent accompaniment of anorexia, indigestion, and general disinclination towards food, chest congestion, distension of the lower abdomen accompanied with gurgling sound, weakness, cracking pain in bones and malaise, unconsciousness, a feeling of despondency or depression, fainting and giddiness, and frequent dreams of scenes of intoxication, dancing, murdering, aching, shivering and falling. [6]

 

These are some common premonitory symptoms of ''apasmara''. [7]

These are some common premonitory symptoms of ''apasmara''. [7]

tatredamapasmAravisheShavij~jAnaM bhavati; tadyathA- abhIkShNamapasmarantaM, kShaNena sa~jj~jAM pratilabhamAnam, utpiNDitAkSham, asAmnA vilapantam, udvamantaM phenam,atIvAdhmAtagrIvam, AviddhashiraskaM, viShamavinatA~ggulim, anavasthitapANipAdam,aruNaparuShashyAvanakhanayanavadanatvacam, anavasthitacapalaparuSharUkSharUpadarshinaM,vAtalAnupashayaM, viparItopashayaM ca vAtenApasmarantaM  vidyAt (1)||8||   

tatredamapasmAravisheShavij~jAnaM bhavati; tadyathA- abhIkShNamapasmarantaM, kShaNena sa~jj~jAM pratilabhamAnam, utpiNDitAkSham, asAmnA vilapantam, udvamantaM phenam,atIvAdhmAtagrIvam, AviddhashiraskaM, viShamavinatA~ggulim, anavasthitapANipAdam,aruNaparuShashyAvanakhanayanavadanatvacam, anavasthitacapalaparuSharUkSharUpadarshinaM,vAtalAnupashayaM, viparItopashayaM ca vAtenApasmarantaM  vidyAt (1)||8||   

 

More frequent episodes of ''apasmara'', episodes of instant loss of consciousness and regain it quickly, bulging or rolling up of eyes, incoherent speech, frothy vomit, excessive stiffness of neck, drooping of the head to one side, irregular contraction of fingers, unstable upper and lower limbs, redness, dryness and grayish tint in the nails, eyes, face and skin, apparent vision or perception of unstable, fickle, coarse and dry objects, conditions associated with consuming ''vata''-aggravating diets and alleviation of ailments when subjected to ''vata''-pacifying diets.[8-1]

More frequent episodes of ''apasmara'', episodes of instant loss of consciousness and regain it quickly, bulging or rolling up of eyes, incoherent speech, frothy vomit, excessive stiffness of neck, drooping of the head to one side, irregular contraction of fingers, unstable upper and lower limbs, redness, dryness and grayish tint in the nails, eyes, face and skin, apparent vision or perception of unstable, fickle, coarse and dry objects, conditions associated with consuming ''vata''-aggravating diets and alleviation of ailments when subjected to ''vata''-pacifying diets.[8-1]

 

===== ''Pitta''-dominant ''apasmara'' =====

===== ''Pitta''-dominant ''apasmara'' =====

abhIkShNamapasmarantaM kShaNena sa~jj~jAM pratilabhamAnam, avakUjantam, AsphAlayantaMbhUmiM, haritahAridratAmranakhanayanavadanatvacaM,rudhirokShitograbhairavAdIptaruShitarUpadarshinaM, pittalAnupashayaM,viparItopashayaM capittenApasmarantaM vidyAt (2)||8||  

abhIkShNamapasmarantaM kShaNena sa~jj~jAM pratilabhamAnam, avakUjantam, AsphAlayantaMbhUmiM, haritahAridratAmranakhanayanavadanatvacaM,rudhirokShitograbhairavAdIptaruShitarUpadarshinaM, pittalAnupashayaM,viparItopashayaM capittenApasmarantaM vidyAt (2)||8||  

 

Frequent episodes of ''apasmara'', instant loss of consciousness and regaining it quickly, stertorous breathing, abnormal, dragging-like movement, green, yellow or coppery tint of nails, eyes, face and skin, apparent vision or perception of bleeding, terrifying, horrible, burning and angry looking objects, conditions associated with ''pitta''-aggravating diets and alleviation of ailments when subjected to ''pitta''-pacifying diets [8-2]

Frequent episodes of ''apasmara'', instant loss of consciousness and regaining it quickly, stertorous breathing, abnormal, dragging-like movement, green, yellow or coppery tint of nails, eyes, face and skin, apparent vision or perception of bleeding, terrifying, horrible, burning and angry looking objects, conditions associated with ''pitta''-aggravating diets and alleviation of ailments when subjected to ''pitta''-pacifying diets [8-2]

 

===== ''Kapha''-dominant ''apasmara'' =====

===== ''Kapha''-dominant ''apasmara'' =====

cirAdapasmarantaM, cirAcca sa~jj~jAM pratilabhamAnaM, patantam, anativikRutaceShTaM,lAlAmudvamantaM, shuklanakhanayanavadanatvacaM, shuklagurusnigdharUpadarshinaM,shleShmalAnupashayaM, viparItopashayaM ca shleShmaNA~apasmarantaM vidyAt (3)||8||  

cirAdapasmarantaM, cirAcca sa~jj~jAM pratilabhamAnaM, patantam, anativikRutaceShTaM,lAlAmudvamantaM, shuklanakhanayanavadanatvacaM, shuklagurusnigdharUpadarshinaM,shleShmalAnupashayaM, viparItopashayaM ca shleShmaNA~apasmarantaM vidyAt (3)||8||  

 

Less frequent episodes of ''apasmara'', gradual loss and regain of consciousness, frequently falling down, less pronounced abnormalities in movement, dribbling of saliva, whitish discoloration of nails, eyes, face, and skin, apparent vision or perception of white, heavy and unctuous objects, and conditions associated with consuming ''kapha''-aggravating diets and alleviation of ailments when subjected to ''kapha''-pacifying diets [8-3]

Less frequent episodes of ''apasmara'', gradual loss and regain of consciousness, frequently falling down, less pronounced abnormalities in movement, dribbling of saliva, whitish discoloration of nails, eyes, face, and skin, apparent vision or perception of white, heavy and unctuous objects, and conditions associated with consuming ''kapha''-aggravating diets and alleviation of ailments when subjected to ''kapha''-pacifying diets [8-3]

 

===== ''Sannipatika apasmara'' with dominance of all ''dosha'' =====

===== ''Sannipatika apasmara'' with dominance of all ''dosha'' =====

tasmin hi dakShAdhvaradhvaMse dehinAM nAnAdikShuvidravatAmabhidravaNataraNadhAvanaplavanala~gghanAdyairdehavikShobhaNaiH purAgulmotpattirabhUt, haviShprAshAt pramehakuShThAnAM, bhayatrAsashokairunmAdAnAM,vividhabhUtAshucisaMsparshAdapasmArANAM, jvarastu khalu maheshvaralalATaprabhavaH ,tatsantApAdraktapittam, ativyavAyAt punarnakShatrarAjasya rAjayakShmeti||11||  

tasmin hi dakShAdhvaradhvaMse dehinAM nAnAdikShuvidravatAmabhidravaNataraNadhAvanaplavanala~gghanAdyairdehavikShobhaNaiH purAgulmotpattirabhUt, haviShprAshAt pramehakuShThAnAM, bhayatrAsashokairunmAdAnAM,vividhabhUtAshucisaMsparshAdapasmArANAM, jvarastu khalu maheshvaralalATaprabhavaH ,tatsantApAdraktapittam, ativyavAyAt punarnakShatrarAjasya rAjayakShmeti||11||  

 

As per vedic legends, in the aftermath of destruction of Daksha’s ''yajna'' (holy sacrifice), ''gulma'' (disease similar to lumps in abdomen) was manifested first in human beings due to stress induced as a result of fleeing, swimming, running, flying, etc. in all directions. ''Prameha'' (disease of obstinate urinary disorders) and ''kushtha'' (obstinate skin diseases including leprosy) were manifested due to excess intake of ghee. Various types of ''unmada'' (insanity/psychosis) were manifested due to fear, apprehension and grief. ''Apasmara'' (epilepsy) set in due to coming in contact with various types of unclean objects. ''Jwara'' came out of the forehead of Lord Shiva, and ''raktapitta'' was manifested (a condition characterized by bleeding from different parts of the body) due to ''jwara''’s heat. Moon was afflicted with ''rajayakshma'' due to excessive sexual indulgence. [11]

As per vedic legends, in the aftermath of destruction of Daksha’s ''yajna'' (holy sacrifice), ''gulma'' (disease similar to lumps in abdomen) was manifested first in human beings due to stress induced as a result of fleeing, swimming, running, flying, etc. in all directions. ''Prameha'' (disease of obstinate urinary disorders) and ''kushtha'' (obstinate skin diseases including leprosy) were manifested due to excess intake of ghee. Various types of ''unmada'' (insanity/psychosis) were manifested due to fear, apprehension and grief. ''Apasmara'' (epilepsy) set in due to coming in contact with various types of unclean objects. ''Jwara'' came out of the forehead of Lord Shiva, and ''raktapitta'' was manifested (a condition characterized by bleeding from different parts of the body) due to ''jwara''’s heat. Moon was afflicted with ''rajayakshma'' due to excessive sexual indulgence. [11]

 

==== Summary ====

==== Summary ====

yadA doShanimittasya bhavatyAganturanvayaH|  

yadA doShanimittasya bhavatyAganturanvayaH|  

tadA sAdhAraNaM karma pravadanti bhiShagvidaH||14||

tadA sAdhAraNaM karma pravadanti bhiShagvidaH||14||

 

From the preceding verses, it can be said that ''apasmara'' manifests itself due to the vitiation of ''vata, pitta'' and ''kapha'' and ''sannipata'' (combined vitiation of all the three ''doshas''). The ''sannipata'' variation is incurable. [12]

From the preceding verses, it can be said that ''apasmara'' manifests itself due to the vitiation of ''vata, pitta'' and ''kapha'' and ''sannipata'' (combined vitiation of all the three ''doshas''). The ''sannipata'' variation is incurable. [12]

When ''apasmara'' is caused by the vitiation of ''doshas'' associated with extrinsic causative factors, then general therapies addressing both (''doshic'' equilibrium and extrinsic causes) are advised by the best of physicians.  [14]

When ''apasmara'' is caused by the vitiation of ''doshas'' associated with extrinsic causative factors, then general therapies addressing both (''doshic'' equilibrium and extrinsic causes) are advised by the best of physicians.  [14]

 

सर्वरोगविशेषज्ञः सर्वौषधविशारदः| भिषक् सर्वामयान् हन्ति न च मोहं निगच्छति ||१५||

सर्वरोगविशेषज्ञः सर्वौषधविशारदः| भिषक् सर्वामयान् हन्ति न च मोहं निगच्छति ||१५||

te pUrvaM kevalA rogAH pashcAddhetvarthakAriNaH|

te pUrvaM kevalA rogAH pashcAddhetvarthakAriNaH|

ubhayArthakarA dRuShTAstathaivaikArthakAriNaH ||20||

ubhayArthakarA dRuShTAstathaivaikArthakAriNaH ||20||

 

Conditions in their primary stages or forms manifest themselves as diseases and subsequently act as causative factors for other diseases. They thus play a dual role - as a disease and as a causative factor. Some of these play just one role as well– either as a disease or as a causative factor. [20]

Conditions in their primary stages or forms manifest themselves as diseases and subsequently act as causative factors for other diseases. They thus play a dual role - as a disease and as a causative factor. Some of these play just one role as well– either as a disease or as a causative factor. [20]

 

कश्चिद्धि रोगो रोगस्य हेतुर्भूत्वा प्रशाम्यति |  

कश्चिद्धि रोगो रोगस्य हेतुर्भूत्वा प्रशाम्यति |  

न प्रशाम्यति चाप्यन्यो हेत्वर्थं  कुरुतेऽपि च ||२१||  

न प्रशाम्यति चाप्यन्यो हेत्वर्थं  कुरुतेऽपि च ||२१||  

nAsAdhyaH sAdhyatAM yAti sAdhyo yAti tvasAdhyatAm|

nAsAdhyaH sAdhyatAM yAti sAdhyo yAti tvasAdhyatAm|

pAdApacArAddaivAdvA yAnti bhAvAntaraM gadAH||35||

pAdApacArAddaivAdvA yAnti bhAvAntaraM gadAH||35||

 

Easily curable diseases can be managed in a short time by simple measures. Diseases which are difficult to cure may require more effort and time to cure. The palliable variety of incurable diseases can never be cured, but can be alleviated. Incurable diseases are not amenable to any type of treatment.  

Easily curable diseases can be managed in a short time by simple measures. Diseases which are difficult to cure may require more effort and time to cure. The palliable variety of incurable diseases can never be cured, but can be alleviated. Incurable diseases are not amenable to any type of treatment.  

Conversely, incurable diseases never become curable, while the curable varieties may become incurable due to factors like incompetence of the four components of health management (the physician, the medicine, the attendant and the patient) and/or misfortune. The easily curable kinds may also become difficult to cure, if not incurable, while diseases that are difficult to cure may become palliable and palliable variety may become incurable. [33-35]

Conversely, incurable diseases never become curable, while the curable varieties may become incurable due to factors like incompetence of the four components of health management (the physician, the medicine, the attendant and the patient) and/or misfortune. The easily curable kinds may also become difficult to cure, if not incurable, while diseases that are difficult to cure may become palliable and palliable variety may become incurable. [33-35]

 

===== Examination of stages of disease =====

===== Examination of stages of disease =====

prayogaiH kShapayedvA tAn sukhaM vA koShThamAnayet|

prayogaiH kShapayedvA tAn sukhaM vA koShThamAnayet|

j~jAtvA koShThaprapannAMstAn yathAsannaM haredbudhaH||39||

j~jAtvA koShThaprapannAMstAn yathAsannaM haredbudhaH||39||

 

Generally, ''doshas'' that are spread over obliquely (in the transverse direction) afflict the patient for a longer time. In that condition, treatment should not be initiated in a hurry without proper assessment of body strength and digestive power.  

Generally, ''doshas'' that are spread over obliquely (in the transverse direction) afflict the patient for a longer time. In that condition, treatment should not be initiated in a hurry without proper assessment of body strength and digestive power.  

These ''doshas'' should be alleviated first by treatment, or they should be carefully be drawn to the ''koshtha'' (bowel). After knowing their status in ''koshtha'', the wise physician should eliminate them through the nearest route. [38-39]  

These ''doshas'' should be alleviated first by treatment, or they should be carefully be drawn to the ''koshtha'' (bowel). After knowing their status in ''koshtha'', the wise physician should eliminate them through the nearest route. [38-39]  

 

ज्ञानार्थं यानि चोक्तानि व्याधिलिङ्गानि सङ्ग्रहे |  

ज्ञानार्थं यानि चोक्तानि व्याधिलिङ्गानि सङ्ग्रहे |  

व्याधयस्ते तदात्वे तु लिङ्गानीष्टानि नामयाः ||४०||

व्याधयस्ते तदात्वे तु लिङ्गानीष्टानि नामयाः ||४०||

j~jAnArthaM yAni coktAni vyAdhili~ggAni sa~ggrahe|

j~jAnArthaM yAni coktAni vyAdhili~ggAni sa~ggrahe|

vyAdhayaste tadAtve tu li~ggAnIShTAni nAmayAH||40||

vyAdhayaste tadAtve tu li~ggAnIShTAni nAmayAH||40||

 

In the [[Nidana Sthana]], a compendium of symptomatology has been provided as a reckoner for the [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] practitioner to gain adequate knowledge of some of the major classes of diseases and diagnose them effectively. But these symptoms may independently develop into diseases and create emergency situations. [40]

In the [[Nidana Sthana]], a compendium of symptomatology has been provided as a reckoner for the [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] practitioner to gain adequate knowledge of some of the major classes of diseases and diagnose them effectively. But these symptoms may independently develop into diseases and create emergency situations. [40]

 

विकारः प्रकृतिश्चैव द्वयं सर्वं समासतः |  

विकारः प्रकृतिश्चैव द्वयं सर्वं समासतः |  

तद्धेतुवशगं हेतोरभावान्नानुवर्तते ||४१||  

तद्धेतुवशगं हेतोरभावान्नानुवर्तते ||४१||  

hetuparyAyanAmAni vyAdhInAM lakShaNasya ca|

hetuparyAyanAmAni vyAdhInAM lakShaNasya ca|

nidAnasthAnametAvat sa~ggraheNopadishyate||44||

nidAnasthAnametAvat sa~ggraheNopadishyate||44||

 

To sum up this chapter, etiological factors, premonitory symptoms, signs and symptoms, therapeutic relief, pathogenesis, historical origins and brief line of treatment of ''apasmara'' have been described in this section. Since this is the concluding chapter of the [[Nidana Sthana]], a summary to the entire section has also been provided here, stating that starting from ''jwara'' all eight diseases have been dealt with separately in eight chapters, each with etiological factors, symptomatology, prognosis and brief line of management.  

To sum up this chapter, etiological factors, premonitory symptoms, signs and symptoms, therapeutic relief, pathogenesis, historical origins and brief line of treatment of ''apasmara'' have been described in this section. Since this is the concluding chapter of the [[Nidana Sthana]], a summary to the entire section has also been provided here, stating that starting from ''jwara'' all eight diseases have been dealt with separately in eight chapters, each with etiological factors, symptomatology, prognosis and brief line of management.  

A compendium of diseases with etiological factors, their synonyms, symptoms of the diseases have been provided as an epilogue to the chapter. [42-44]

A compendium of diseases with etiological factors, their synonyms, symptoms of the diseases have been provided as an epilogue to the chapter. [42-44]

 

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने अपस्मारनिदानं नामाष्टमोऽध्यायः |  

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने अपस्मारनिदानं नामाष्टमोऽध्यायः |  

निदानस्थानं समाप्तम् ||८||  

निदानस्थानं समाप्तम् ||८||  

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

*''Apasmara'' is a disease due to vitiation of three ''sharira doshas'' and two ''manas doshas''.  

*''Apasmara'' is a disease due to vitiation of three ''sharira doshas'' and two ''manas doshas''.  

*The causative factors of ''apasmara'' mainly include consuming unhygienic, impure, decomposed food and encountering inauspicious things that are not compatible with one’s sensibilities.  

*The causative factors of ''apasmara'' mainly include consuming unhygienic, impure, decomposed food and encountering inauspicious things that are not compatible with one’s sensibilities.  

The above enlisted etiological factors cause depletion in psychological strength (objectively measured as Intelligence quotient (IQ) and Emotional Quotient (EQ). In the era of distress, it is important to know the etiology of a disease in order to prevent its harmful effects. In order to preserve and increase the psychological strength, one shall avoid the causative factors for ''apasmara''.

The above enlisted etiological factors cause depletion in psychological strength (objectively measured as Intelligence quotient (IQ) and Emotional Quotient (EQ). In the era of distress, it is important to know the etiology of a disease in order to prevent its harmful effects. In order to preserve and increase the psychological strength, one shall avoid the causative factors for ''apasmara''.

 

[[File:psycho-dynamics.png]]<br>

[[File:psycho-dynamics.png]]<br>

   

   

===== ''Sanchaya'' =====

===== ''Sanchaya'' =====

 

The first stage of accumulation of pathogenic factors (vitiated ''doshas'') starts at their own sites. It is initiated right from the first exposure to unclean objects and other etiological factors mentioned earlier. This stage is characterized by mild disturbances in the psyche (''rajas'' and ''tamas'') and soma (''tridosha'').   

The first stage of accumulation of pathogenic factors (vitiated ''doshas'') starts at their own sites. It is initiated right from the first exposure to unclean objects and other etiological factors mentioned earlier. This stage is characterized by mild disturbances in the psyche (''rajas'' and ''tamas'') and soma (''tridosha'').   

The table 1 depicts the premonitory signs of ''apasmara'' described in the Ayurvedic texts. Each sign has a specific patho-physiology in terms of ''dosha'' and ''dushya'' behind its manifestation. The enlisted signs are the alerting signals or premonitory symptoms of ''apasmara'' before the onset of seizures. The probable system involved as per conventional medicine is also enlisted for every sign, so that it would be easier to consider the pathophysiological similarities and differences between the two medical streams.   

The table 1 depicts the premonitory signs of ''apasmara'' described in the Ayurvedic texts. Each sign has a specific patho-physiology in terms of ''dosha'' and ''dushya'' behind its manifestation. The enlisted signs are the alerting signals or premonitory symptoms of ''apasmara'' before the onset of seizures. The probable system involved as per conventional medicine is also enlisted for every sign, so that it would be easier to consider the pathophysiological similarities and differences between the two medical streams.   

 

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The abovementioned pre-clinical features are observed in the fourth stage of ''shatkriyakala'' (pathogenesis). These may be considered as aura in ''apasmara'' patients. These are important in view of prevention of ''apasmara'' progression to epileptic seizure. In conventional medicine text books, some of the above signs like auditory and visual hallucinations are referred. These signs need to be searched upon for their prevalence, categorization as per ''dosha'' dominance, involvement of ''dosha'' attributes in order to establish precise guidelines for early prevention and management of disease.     

The abovementioned pre-clinical features are observed in the fourth stage of ''shatkriyakala'' (pathogenesis). These may be considered as aura in ''apasmara'' patients. These are important in view of prevention of ''apasmara'' progression to epileptic seizure. In conventional medicine text books, some of the above signs like auditory and visual hallucinations are referred. These signs need to be searched upon for their prevalence, categorization as per ''dosha'' dominance, involvement of ''dosha'' attributes in order to establish precise guidelines for early prevention and management of disease.     

 

Table 2: Differentiation between types of apasmara  

Table 2: Differentiation between types of apasmara  

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Su: As described by Sushruta in Sushruta Samhita AH: As described in Ashtang Hridaya   

Su: As described by Sushruta in Sushruta Samhita AH: As described in Ashtang Hridaya   

The specific features of all the four types of ''apasmara'' are described in Table 2. ''Vata'' type of ''apasmara'' manifests itself with repeated seizures of short duration and increased frequency of attacks. The speed, severity and abnormality of movements are more in this case. This is due to ''chala'' (movable), ''laghu'' (light), and ''sukshma'' (minute) attributes of ''vata dosha''. ''Vata'' is the initiator of all activities including those of the body and the mind. The regulation and coordination of the sequence of sense and locomotor organs – mind-intellect-soul for attainment of knowledge is performed by ''vata''. ''Prana vata, udana vata'' and ''vyana vata'' are involved in the pathophysiology of ''apasmara''. The clinical manifestation of ''vataja'' ''apasmara'' may be due to repeated, excess, hyposynchronous discharges in neurons of the central nervous system. Transient hypoxia leading to dysregulation of brain functioning, and neurological diseases similar to epilepsy syndromes can be categorized under this type of ''apasmara''.   

The specific features of all the four types of ''apasmara'' are described in Table 2. ''Vata'' type of ''apasmara'' manifests itself with repeated seizures of short duration and increased frequency of attacks. The speed, severity and abnormality of movements are more in this case. This is due to ''chala'' (movable), ''laghu'' (light), and ''sukshma'' (minute) attributes of ''vata dosha''. ''Vata'' is the initiator of all activities including those of the body and the mind. The regulation and coordination of the sequence of sense and locomotor organs – mind-intellect-soul for attainment of knowledge is performed by ''vata''. ''Prana vata, udana vata'' and ''vyana vata'' are involved in the pathophysiology of ''apasmara''. The clinical manifestation of ''vataja'' ''apasmara'' may be due to repeated, excess, hyposynchronous discharges in neurons of the central nervous system. Transient hypoxia leading to dysregulation of brain functioning, and neurological diseases similar to epilepsy syndromes can be categorized under this type of ''apasmara''.   

• M.H. Hakim, M.M.H. Siddiqui. A.B. Khan. Anti-epileptic activity of Ustukhudus (Lavandula stoechas) – In a case of secondary epilepsy (A Case Report). Hamdard Medicus.1991.34[ 3] 33-39.

• M.H. Hakim, M.M.H. Siddiqui. A.B. Khan. Anti-epileptic activity of Ustukhudus (Lavandula stoechas) – In a case of secondary epilepsy (A Case Report). Hamdard Medicus.1991.34[ 3] 33-39.

• Hakim M.H. Siddiqui, M.M.H. Siddiqui, A. Ismail, S.A.H. Jafri. Secondary (Symptomatic) epilepsy, an uncommon presentation. The Antiseptic.May 1991. 88[5].231-233.

• Hakim M.H. Siddiqui, M.M.H. Siddiqui, A. Ismail, S.A.H. Jafri. Secondary (Symptomatic) epilepsy, an uncommon presentation. The Antiseptic.May 1991. 88[5].231-233.

 

References:

References: