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→Vidhi Vimarsha
*The ''doshas'' that spread obliquely (in the transverse direction) afflict patient for a longer time. These ''doshas'' should be managed first, or they should be carefully drawn to ''koshtha'' (bowel) by proper measures. After analyzing them in ''koshtha'', the physician should eliminate them through the nearest route.
*The ''doshas'' that spread obliquely (in the transverse direction) afflict patient for a longer time. These ''doshas'' should be managed first, or they should be carefully drawn to ''koshtha'' (bowel) by proper measures. After analyzing them in ''koshtha'', the physician should eliminate them through the nearest route.
=== Vidhi Vimarsha ===
=== ''Vidhi Vimarsha'' ===
The chapter on apasmara is sequenced after the one on unmada. The sequence is due to similarities of clinical origin as well as causative and pathophysiological factors, since both diseases are psychosomatic in nature.
The chapter on ''apasmara'' is sequenced after the one on ''unmada''. The sequence is due to similarities of clinical origin as well as causative and pathophysiological factors, since both diseases are psychosomatic in nature.
History and origin of the disease in ancient medical literature
==== History and origin of the disease in ancient medical literature ====
The origin of various diseases is narrated in the eleventh verse of the chapter. ''Apasmara'' originates from physical and mental contact with various unclean and unwholesome exogenous factors leading to imbalance at physical and psychological levels. The words ''ashuchi samsparsha'' literally mean direct contact of body and mind with unwholesome things. This is further supported by ''apasmara''’s etiology which points at improper diet and lifestyle as a major causative factor.
Review of ancient medical literature confirms that epilepsy was initially called sacred, because of the belief for its divine origin. A chapter on epilepsy in Babylonian texts on medicine comprising 40 tablets dating as far back as 1067 BC accurately recorded many of the different seizure types recognized today. It emphasizes upon the supernatural nature of epilepsy, with each seizure type associated with a divinity, spirit or deity (usually evil). It was believed, in antiquity, that if a person comes in contact with things that are supernatural and evil, he/she would suffer from epilepsy. This view is consistent with those in ancient Greek, British, and Indian (Vedic) literature as well. The Ayurvedic theory of origin of epilepsy mentions contact with evil, unwholesome and unclean objects or experiences as key causative factors. References of ''grahas'' (celestial bodies) as a causative factor of ''apasmara'', specifically in children, can be found in vedic texts with terms such as ‘skanda’ and ‘skandapasmara. Though there are references of exogenous variants of epilepsy (''agantu apasmara'') in [[Charaka Samhita]], a detailed description of these is not found. This indicates two things:
#Epilepsy originates from exposure to unwholesome, unclean and evil things either at a physical or at a psycho-spiritual plane.
#Management of the disease may include ''adhyatmik chikitsa'' (psycho-spiritual therapy) for better treatment.
==== Definition of ''Apasmara'' ====
''Apasmara'' is defined as the occasional loss of consciousness due to deterioration of ''smriti'' (memory), ''buddhi'' (intellect) and ''sattva'' (mind), characterized by ''tamahpravesha'' (entering darkness/ blackouts) and ''bibhatsa cheshta'' (abnormal movements).
As explained by Sushruta, ''smriti'' in context of apasmara is ''bhutarha vijnana'' i.e. orientation of external world and consciousness. ''Dhi-buddhi'' (intellect) is ''karya-akarya vibhaga karini'' i.e. discriminating power between right and wrong. ''Sattva'' is referred as ''mana'' (mind) and ''dhairya'' (temperance, patience). A patient of ''apasmara'' suffers from deterioration of all these three important mental faculties (''dhi, buddhi'' and ''smriti'').
The first cardinal sign of this deterioration is ''tamapravesha'' , i.e., ''jnana abhava'' or loss of knowledge and the ability to acquire new knowledge. The second cardinal sign, ''bibhatsa cheshta'', indicates involuntary movements of body due to lack of brain’s control or improper coordination. Sushruta narrated that due to these features of ''apasmara'', the disease often leads to death (''antakrita''). Dallhana comments that the dreadfulness of this disease is due to the fact that an afflicted person may fall into water or fire due to lack of orientation.
==== Impairment of knowledge and co-ordination ====
Fig. 2: Faculty involved in attainment of knowledge
Fig. 2: Faculty involved in attainment of knowledge