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==== ''Skanda graha'' and ''Skandapasmara'' ====

==== ''Skanda graha'' and ''Skandapasmara'' ====

Per [[Ayurveda]], children get afflicted by apasmara due to the effects of any of ''grahas'' (Sanskrit, means seizing) such as ''skandapasmara'' (due to the effects of ''graha''<ref> Sushruta, ‘Sushruta Samhita’, edited by Vaidya Jadavaji Trikamaji Acharya and Sharma PV, Eighth edition, Chaukhamba Orientalia, Varanasi; 2005 Uttara tantra 27/ 8-9.pg.659 </ref>  <ref>Vagbhata, Ashtanga Hridayam, with the commentaries, ‘Sarvangasundara’ of Arunadatta and ‘[[Ayurveda]]rasayana’ of Hemadri collated by Dr.Anna Moreshvara Kunte, and Krishna Ramachandra  Shastri Navre, edited by Pt. Harishastri Paradakar Vaidya, Krishanadas Academy, Varanasi. Reprint 2000.3/6-11.pg.786-7  </ref>.), ''skanda'', etc. knowledge of features of nine evil spirits which seize children is described, ''skanda'' and ''skandapasmara'' are the first two evil spirits which when affect a child, the clinical presentation is similar to that of epilepsy as narrated below.  

Per [[Ayurveda]], children get afflicted by apasmara due to the effects of any of ''grahas'' (Sanskrit, means seizing) such as ''skandapasmara'' (due to the effects of ''graha''. [Su.Sa.Uttara Tantra 27/8-9] [A.H Uttara Sthana 3/6-11]  ''skanda'', etc. knowledge of features of nine evil spirits which seize children is described, ''skanda'' and ''skandapasmara'' are the first two evil spirits which when affect a child, the clinical presentation is similar to that of epilepsy as narrated below.  

A child seized by ''skanda graha'' has swelling of the eyes, smells like blood, has aversion to the breasts, distorted face, and eyelids or one eye having either loss of movement or more movements. The child could also be restless or irritable, have closed eyes, cry very little, hold its fists tight, and have hard bowel movement.  

A child seized by ''skanda graha'' has swelling of the eyes, smells like blood, has aversion to the breasts, distorted face, and eyelids or one eye having either loss of movement or more movements. The child could also be restless or irritable, have closed eyes, cry very little, hold its fists tight, and have hard bowel movement.  

When the child is seized by ''skandapasmara'', it loses and regains consciousness, is irritable, makes dancing like movements with arms and legs, eliminates stools and passes urine accompanied with sound (crying), yawns more and emits froth from the mouth. These are the features of a child seized by the “friend of skanda graham”, i.e., ''skandapasmara''.

When the child is seized by ''skandapasmara'', it loses and regains consciousness, is irritable, makes dancing like movements with arms and legs, eliminates stools and passes urine accompanied with sound (crying), yawns more and emits froth from the mouth. These are the features of a child seized by the “friend of skanda graham”, i.e., ''skandapasmara''.

Similar to this, Vagbhata in Ashtanga Hridayam, has described the variants of the disease caused due to demons/evil spirits possessing the children. The cardinal signs of ''graha'' possession (or affliction) include continuous fever and crying. The general features are fear, too much yawning, movement of eyebrows, timidity, discharge of froth from mouth, upward gaze, biting of lips and teeth (grinding), wakefulness (absence of sleep), crying, moaning, aversion for the breast, change of voice, and scratching its own body or that of the mother by nails without any reason.<ref> Ibid Ashtanga Hrudayam Uttar Sthana.3/3-5. pp.786 </ref>

Similar to this, Vagbhata in Ashtanga Hridayam, has described the variants of the disease caused due to demons/evil spirits possessing the children. The cardinal signs of ''graha'' possession (or affliction) include continuous fever and crying. The general features are fear, too much yawning, movement of eyebrows, timidity, discharge of froth from mouth, upward gaze, biting of lips and teeth (grinding), wakefulness (absence of sleep), crying, moaning, aversion for the breast, change of voice, and scratching its own body or that of the mother by nails without any reason. [A.H Uttara Sthana 3/3-5]

In conventional medicine, epilepsy in children is described in detail. However, the etiology of some variants of epilepsy is mentioned to be idiopathic. As described in context of ''skanda'' and ''skandapasmara'', the involvement of supernatural powers in causing apasmara is a matter of debate and falls in the purview of theology. Considering its importance and prevalence, apasmara of unknown etiology can be categorized as of the fifth type i.e. ''agantu apasmara''. Sushruta and his commentator Dallhana support this view that any variant of the disease which occurs without any reason, acutely and without any rational pathology shall be considered as ''agantu''. Per Charak [Chikitsa 10/53], the etiopathology, clinical features and management of this fifth type are on the lines of ''agantu unmada''. As commented by Chakrapani, in case of ''agantu'' or ''bhutapasmara'', the etiology of being seized by some external factors is considered primary and the involvement (''anubabdha'') of ''dosha'' as secondary. It is important to note here that since clinical patho-physiology cannot take place without the involvement of ''doshas'', therefore ''agantu'' should technically be considered as one of the four doshic variants of apasmara mentioned earlier, in order to follow the ''sankhya niyam''a i.e. rules of numeral classification.

In conventional medicine, epilepsy in children is described in detail. However, the etiology of some variants of epilepsy is mentioned to be idiopathic. As described in context of ''skanda'' and ''skandapasmara'', the involvement of supernatural powers in causing apasmara is a matter of debate and falls in the purview of theology. Considering its importance and prevalence, apasmara of unknown etiology can be categorized as of the fifth type i.e. ''agantu apasmara''. Sushruta and his commentator Dallhana support this view that any variant of the disease which occurs without any reason, acutely and without any rational pathology shall be considered as ''agantu''. Per Charak [Chikitsa 10/53], the etiopathology, clinical features and management of this fifth type are on the lines of ''agantu unmada''. As commented by Chakrapani, in case of ''agantu'' or ''bhutapasmara'', the etiology of being seized by some external factors is considered primary and the involvement (''anubabdha'') of ''dosha'' as secondary. It is important to note here that since clinical patho-physiology cannot take place without the involvement of ''doshas'', therefore ''agantu'' should technically be considered as one of the four doshic variants of apasmara mentioned earlier, in order to follow the ''sankhya niyam''a i.e. rules of numeral classification.

=== Reasons behind aggressive and dormant stages of apasmara ===

=== Reasons behind aggressive and dormant stages of apasmara ===

   

   

From the above sections, it is clear that apasmara occurs in episodes. The patient after seizure regains consciousness like waking up from sleep (''suptavat pratibuddhyate''). Therefore, there are two stages of disease : one is aggressive stage of ''doshas'' and the second is dormant stage of ''doshas''. Sushruta describes that there are two forms of pathogenesis: One form follows the six stages viz. ''sanchaya'' etc.(''kramopayogad'') of the disease in sequence and takes considerable time to manifest disease with gradual onset. The other form manifests acutely in a short time (''kshanikatwat''). The first form is seen in ''nija'' (endogenous) pathologies of disease. The other form is seen in ''agantu'' (exogenous) apasmara. Sushruta gives examples of a seed in the ground that sprouts only during ''sharad ritu'' (autumn) though it rains at other times. Analogous to this example, the virulent form of the disease develops due to a ''dosha'' getting aggravated in very short time and manifesting its different symptoms due to some factors catalyzing the accelerated aggravation. It is quite clear from the detailed descriptions in this chapter, though, that all forms of apasmara are caused by ''dosha'' only.<ref> Ibid Sushruta Samhita Uttar Tantra 61/18-21.pp.800-801. </ref>

From the above sections, it is clear that apasmara occurs in episodes. The patient after seizure regains consciousness like waking up from sleep (''suptavat pratibuddhyate''). Therefore, there are two stages of disease : one is aggressive stage of ''doshas'' and the second is dormant stage of ''doshas''. Sushruta describes that there are two forms of pathogenesis: One form follows the six stages viz. ''sanchaya'' etc.(''kramopayogad'') of the disease in sequence and takes considerable time to manifest disease with gradual onset. The other form manifests acutely in a short time (''kshanikatwat''). The first form is seen in ''nija'' (endogenous) pathologies of disease. The other form is seen in ''agantu'' (exogenous) apasmara. Sushruta gives examples of a seed in the ground that sprouts only during ''sharad ritu'' (autumn) though it rains at other times. Analogous to this example, the virulent form of the disease develops due to a ''dosha'' getting aggravated in very short time and manifesting its different symptoms due to some factors catalyzing the accelerated aggravation. It is quite clear from the detailed descriptions in this chapter, though, that all forms of apasmara are caused by ''dosha'' only. [Su.Sa.Uttara Tantra 61/1821]

   

   

The example states the fact that favorable environment for precipitating factors plays major role in disease episodes. Depending upon the defense system of the body – its natural and acquired immunity -  as the background for disease and factors aggravating the ''dosha'' as offending agents, the interaction between the two defines severity, intensity and frequency of occurrence of episodes of disease as shown in chart. [ Fig.4: Manifestation of episodes ]

The example states the fact that favorable environment for precipitating factors plays major role in disease episodes. Depending upon the defense system of the body – its natural and acquired immunity -  as the background for disease and factors aggravating the ''dosha'' as offending agents, the interaction between the two defines severity, intensity and frequency of occurrence of episodes of disease as shown in chart. [ Fig.4: Manifestation of episodes ]