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=== Introduction ===

=== Introduction ===

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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<ref> Venkataraghvan S., Rajagopalan V, Srinivasan K. Study of doshik involvement in Apasmara (Epilepsy) and its utility. Ancient science of life, Vol.No.VI[3],1987.138-47  </ref> <ref> Murthy ARV, Singh RH.A Critical study on the Ayurvedic concept of the psychopathological basis of Apasmara. Journal of NIMA XXXII [6] 1990.7-11  </ref>. Epilepsy is a common neuropsychiatric condition involving mainly the brain, nervous system and the psyche. However, 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, this 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<ref> Venkataraghvan S., Rajagopalan V, Srinivasan K. Study of doshik involvement in Apasmara (Epilepsy) and its utility. Ancient science of life, Vol.No.VI[3],1987.138-47  </ref> <ref> Murthy ARV, Singh RH.A Critical study on the Ayurvedic concept of the psychopathological basis of Apasmara. Journal of NIMA XXXII [6] 1990.7-11  </ref>. Epilepsy is a common neuropsychiatric condition involving mainly the brain, nervous system and the psyche. However, 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.

Thus, ends the eighth chapter on the ‘diagnosis of ''apasmara''” of the section “Diagnosis of diseases” ([[Nidana Sthana]]) of Agnivesha , as redacted by Charak.

Thus, ends the eighth chapter on the ‘diagnosis of ''apasmara''” of the section “Diagnosis of diseases” ([[Nidana Sthana]]) of Agnivesha , as redacted by Charak.

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

=== ''Tattva Vimarsha'' / Fundamental Principles===

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*''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''.  

*''Psychological'' stressors like excessive passion, anger, fear, greed, attachment, excitement, grief, anxiety, worry, perturbation etc. precipitate episodes of ''apasmara'' in a person afflicted with excessively aggravated ''dosha''.

*''Psychological'' stressors like excessive passion, anger, fear, greed, attachment, excitement, grief, anxiety, worry, perturbation etc. precipitate episodes of ''apasmara'' in a person afflicted with excessively aggravated ''dosha''.

*''Apasmara'', depending upon the predominant ''dosha'', can be diagnosed on the basis of frequency of episodes, duration of loss of consciousness, pattern of abnormal movements, and types of objects perceived (in aura phase) prior to the occurrence of an actual episode.  

*''Apasmara'', depending upon the predominant ''dosha'', can be diagnosed on the basis of frequency of episodes, duration of loss of consciousness, pattern of abnormal movements, and types of objects perceived (in aura phase) prior to the occurrence of an actual episode.  

*Purification therapies using strong medicines, observing a healthy diet and lifestyle are considered the primary forms of treatment of ''apasmara''. Non-pharmacological measures like ''mantra'' (holy chants) and ''sattvavajaya chikitsa'' (mind training for restraint,  such as cognitive behavior therapy) aid in the treatment of ''apasmara''.  

*Purification therapies using strong medicines, observing a healthy diet and lifestyle are considered the primary forms of treatment of ''apasmara''. Non-pharmacological measures like ''mantra'' (holy chants) and ''sattvavajaya chikitsa'' (mind training for restraint,  such as cognitive behavior therapy) aid in the treatment of ''apasmara''.  

*There can be one causative factor for many diseases or multiple causative factors for single disease.  

*There can be one causative factor for many diseases or multiple causative factors for single disease.  

*Similarly one symptom can be common in many diseases and one symptom can be seen in a single disease alone.  

*Similarly one symptom can be common in many diseases and one symptom can be seen in a single disease alone.  

*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'' / Applied Inferences===

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.