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Line 706: − + − + − 1. Sanchaya: + − + − 2. Prakopa: + − + − 3. Prasara: + − + − 4. Sthanasamshraya:+ − + − 5. Vyakta : + − + + + + + + + + + + + − + − +
→Six stages of pathogenesis of epilepsy (shatkriyakala for apasmara)
==== Six stages of pathogenesis of epilepsy (''shatkriyakala'' for ''apasmara'') ====
==== Six stages of pathogenesis of epilepsy (''shatkriyakala'' for ''apasmara'') ====
Fig.3: Psycho-dynamics in Apasmara
Fig.3: Psycho-dynamics in ''Apasmara''
Fig.4: Satic presentation of pathogenesis of Apasmara
Fig.4: Satic presentation of pathogenesis of ''Apasmara''
===== ''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 & 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'').
If the individual excessively indulges in observing causative factors for a significant period, then the doshas proceed to the next stage of pathology i.e. prakopa. The doshas are vitiated at their own site. In case of apasmara, the doshas reside at the vessels, above the heart (the site of consciousness) in a leena (dormant) state.
===== ''Prakopa'' =====
Whenever the provocative emotional factors like worries, passion, anger etc. trigger these doshas, the vitiated dosha moves upwards affecting the sense and locomotor organs. This will present the prasara avastha (stage of spread) of the disease.
If the individual excessively indulges in observing causative factors for a significant period, then the ''doshas'' proceed to the next stage of pathology i.e. ''prakopa''. The ''doshas'' are vitiated at their own site. In case of ''apasmara'', the doshas reside at the vessels, above the heart (the site of consciousness) in a leena (dormant) state.
Thereafter in sthanasamshraya avastha of apasmara (change in stage, triggering premonitory signs and symptoms), the stridden doshas take pathways of sense organs and locomotor organs alerting manifestation of the disease. This is called the aura stage of epilepsy.
===== ''Prasara'' =====
Then, the vyakta i.e. manifestation stage of apasmara is apparent due to excessive aggravation of doshas. The severity of paroxysms depends upon sharira bala (physical strength that helps do physical work as well as prevent manifestations of diseases, includes genetic predisposition as well), hetu (strength of causative agents depending upon their exposure) and sattva bala (strength of mind). The clinical manifestation will be a product of interactions between these factors. Common clinical features of the disease will start showing at this stage.
Whenever the provocative emotional factors like worries, passion, anger etc. trigger these ''doshas'', the vitiated ''dosha'' moves upwards affecting the sense and locomotor organs. This will present the ''prasara avastha'' (stage of spread) of the disease.
===== ''Sthanasamshraya'' =====
Thereafter in ''sthanasamshraya avastha'' of ''apasmara'' (change in stage, triggering premonitory signs and symptoms), the stridden ''doshas'' take pathways of sense organs and locomotor organs alerting manifestation of the disease. This is called the aura stage of epilepsy.
===== ''Vyakta'' =====
Then, the ''vyakta'' i.e. manifestation stage of ''apasmara'' is apparent due to excessive aggravation of ''doshas''. The severity of paroxysms depends upon ''sharira bala'' (physical strength that helps do physical work as well as prevent manifestations of diseases, includes genetic predisposition as well), ''hetu'' (strength of causative agents depending upon their exposure) and ''sattva bala'' (strength of mind). The clinical manifestation will be a product of interactions between these factors. Common clinical features of the disease will start showing at this stage.
6. Bheda avastha:
6. Bheda avastha:
Bheda avastha is the stage of differentiation depending upon the dominance of doshas. This will predominantly depend upon the genetic constitution of the person as well as the intake of alleviators and pacifiers of that particular dosha. If there are some pacification factors in between, then the progression of disease stops at that stage only blocking presentation of clinical features.
Bheda avastha is the stage of differentiation depending upon the dominance of doshas. This will predominantly depend upon the genetic constitution of the person as well as the intake of alleviators and pacifiers of that particular dosha. If there are some pacification factors in between, then the progression of disease stops at that stage only blocking presentation of clinical features.
If we critically analyze and compare the pathophysiologies, it can be observed that unlike modern research, the brain did not figure in Caraka’s analysis of disease or their pathologic basis, nor did he emphasize the role of an exogenous or supernatural power (agantuka) factor in the causation of epilepsy. Charaka has clearly mentioned heart, the abode of self and consciousness, as the origin for apasmara. In the seizure state, doshas stride upwards through dhamanis (vessels), affecting the indriyas (sense and locomotor organs) leading to erratic movements and loss of consciousness. Sushruta and Vagbhata have specifically mentioned the samajnavahishu srotasu (channels of consciousness) as the pathway of spread of doshas and as a site for the disease.
If we critically analyze and compare the pathophysiologies, it can be observed that unlike modern research, the brain did not figure in Caraka’s analysis of disease or their pathologic basis, nor did he emphasize the role of an exogenous or supernatural power (agantuka) factor in the causation of epilepsy. Charaka has clearly mentioned heart, the abode of self and consciousness, as the origin for apasmara. In the seizure state, doshas stride upwards through dhamanis (vessels), affecting the indriyas (sense and locomotor organs) leading to erratic movements and loss of consciousness. Sushruta and Vagbhata have specifically mentioned the samajnavahishu srotasu (channels of consciousness) as the pathway of spread of doshas and as a site for the disease.
As per Ayurveda, the heart (and not the brain), is the locus or abode of the mind, consciousness and soul , and emotional factors are considered as some of the root causes for triggering epilepsy. The clinical presentation of epilepsy represents the derangement of functions of neurons of central nervous system, but the origin of this derangement shall have been predisposed much earlier due to psycho-pathological factors enlisted above. The acute onset of seizure can be precipitated due to emotional factors. The mechanism of this phenomenon and exact psycho-neuronal pathways behind this are worthy of study.
As per Ayurveda, the heart (and not the brain), is the locus or abode of the mind, consciousness and soul , and emotional factors are considered as some of the root causes for triggering epilepsy. The clinical presentation of epilepsy represents the derangement of functions of neurons of central nervous system, but the origin of this derangement shall have been predisposed much earlier due to psycho-pathological factors enlisted above. The acute onset of seizure can be precipitated due to emotional factors. The mechanism of this phenomenon and exact psycho-neuronal pathways behind this are worthy of study.
Prana vayu (buddhi-hridaya-indriya-chitta dhruk, i.e., regulation of intellect, heart, senses, mind functions), vyana vayu (seat at hridaya and regulating all types of movements), udana vayu (functions for energy and activities), sadhaka pitta (type of pitta dosha), tarpaka (type of kapha) and avalambaka kapha (type of kapha) are important to be considered as patho-physiological factors in this context.
Prana vayu (buddhi-hridaya-indriya-chitta dhruk, i.e., regulation of intellect, heart, senses, mind functions), vyana vayu (seat at hridaya and regulating all types of movements), udana vayu (functions for energy and activities), sadhaka pitta (type of pitta dosha), tarpaka (type of kapha) and avalambaka kapha (type of kapha) are important to be considered as patho-physiological factors in this context.
==== Types of apasmara ====
==== Types of apasmara ====