Charak Samhita

Apasmara Nidana: Difference between revisions

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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.   


Table 1: Premonitory signs of apasmara and interpretation of mechanism 
 
Pūrvarūpā Translation Dosha Dushya System involved  
{| class="wikitable"
Bhrūvyudāsa abnormal /  twitching of eyebrows vata – rajas majja nervous system [NS]
! rowspan="1"| Pūrvarūpā
Satatam akshi vaikrutam constant abnormal/ irregular movements of eyes vata – rajas majja NS
! rowspan="1"| Translation  
Ashabda shravanam auditory hallucinations vata –rajas manas NS, psychiatric disorder  
! rowspan="1"| Dosha
Lala prastrava excess secretion of saliva kapha rasa NS, digestive system[DS]
! rowspan="1"| Dushya
Singhanaka prastrava excess nasal mucus discharge   kapha rasa NS, respiratory system
! rowspan="1"| System involved
Anannabhilashanam lack of appetite kapha- Pitta rasa DS, NS  
|-
Arochaka aversion to food and drinks [anorexia] Kapha –pitta –vata rasa DS, Psychiatric disorder  
| Bhrūvyudāsa || abnormal /  twitching of eyebrows || vata – rajas   || majja || nervous system [NS]
Avipaka indigestion pitta rasa DS, NS
|-
Hridaya graham heavyness of precordium/ congestion/ constriction in cardiac region kapha, vata mamsa,majja NS, musculo skeletal system,  
| Satatam akshi vaikrutam || constant abnormal/ irregular movements of eyes || vata – rajas || majja || NS  
Kukshe aatopa puffiness/ swelling in the hypogastric region vata, kapha rasa, purisha, mutra DS, urinary system  
|-
Daurbalyam debility, loss of strength kapha, vata rasa, mamsa, majja NS, musculoskeletal system  
| Ashabda shravanam || auditory hallucinations || vata –rajas   || manas ||  NS, psychiatric disorder  
Asthibheda splitting / breaking [pain] sensation in bones vata asthi, majja skeletal system  
|-
Angamarda generalized bodyache/ twisting/churning pain in body vata mamsa, majja musculo-skeletal system, NS
| Lala prastrava || excess secretion of saliva || kapha || rasa || NS, digestive system[DS]  
Moha confused state of mind [leading to lack of knowledge] vata, kapha, Tama rasa, majja NS, psychiatric disorder  
|-
Tamas darshanam black outs / temporary loss of vision without alteration in consciousness pitta, vata rasa- rakta-majja cardio-vascular/ cerebro vascular  system, NS
| Singhanaka prastrava || excess nasal mucus discharge || kapha || rasa ||NS, respiratory system  
Murchcha syncope / a fatal condition characterized by loss of consciousness and postural tone due to vitiation of blood pitta, kapha rasa, rakta, majja cardio-vascular/ cerebro vascular  system, NS
|-
Abhikshnam Bhrama frequent vertigo/ dizziness pitta, vata, rajas rasa, rakta, rajas cardio-vascular/ cerebro vascular  system, NS, psychiatric disorder  
| Anannabhilashanam || lack of appetite || kapha- Pitta || rasa || DS, NS  
Swapne cha In dreams  
|-
Mada slight intoxication, becoming out of senses showing uncanny or abnormal behaviour     vata, rajas, kapha rasa, rakta, manas Cardio-vascular/ Cerebro vascular  system, NS, psychiatric disorder
| Arochaka || aversion to food and drinks [anorexia] || Kapha –pitta –vata || rasa ||  DS, Psychiatric disorder  
Nartana dancing majja
|-
Vyadhana needling like sensation majja
| Avipaka || indigestion || pitta || rasa || DS, NS  
Vyathana pain majja
|-
Vepana tremors majja
| Hridaya graham || heavyness of precordium/ congestion/ constriction in cardiac region || kapha, vata   || mamsa,majja || NS, musculo skeletal system,
Patanadini falling etc. rasa-rakta,
|-
majja
| Kukshe aatopa || puffiness/ swelling in the hypogastric region || vata, kapha || rasa, purisha, mutra || DS, urinary system
|-
| Daurbalyam || debility, loss of strength || kapha, vata || rasa, mamsa, majja ||  NS, musculoskeletal system  
|-
| Asthibheda || splitting / breaking [pain] sensation in bones || vata || asthi, majja || skeletal system
|-
| Angamarda || generalized bodyache/ twisting/churning pain in body   || vata || mamsa, majja || musculo-skeletal system, NS  
|-
| Moha || confused state of mind [leading to lack of knowledge] || vata, kapha, Tama || rasa, majja ||  NS, psychiatric disorder  
|-
| Tamas darshanam || black outs / temporary loss of vision without alteration in consciousness   || pitta, vata || rasa- rakta-majja ||  cardio-vascular/ cerebro vascular  system, NS
|-
| Murchcha || syncope / a fatal condition characterized by loss of consciousness and postural tone due to vitiation of blood || pitta, kapha || rasa, rakta, majja || cardio-vascular/ cerebro vascular  system, NS  
|-
| Abhikshnam Bhrama || frequent vertigo/ dizziness || pitta, vata, rajas || rasa, rakta, rajas || cardio-vascular/ cerebro vascular  system, NS, psychiatric disorder
|-
! Swapne cha || ! colspan="4" | In dreams  
|-
| Mada ||  slight intoxication, becoming out of senses showing uncanny or abnormal behaviour || rowspan="6" | vata, rajas, kapha || rasa, rakta, manas || rowspan="6" | Cardio-vascular/ Cerebro vascular  system, NS, psychiatric disorder
|-
| Nartana || dancing || majja    
|-
| Vyadhana || needling like sensation ||  majja  
|-
| Vyathana || pain || majja    
|-
| Vepana || tremors ||  majja  
|-
| Patanadini || falling etc. || rasa-rakta,
majja  
|-
|}


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  
Characteristic feature Vataja Apasmara Pittaja Apasmara Kaphaja Apasmara  
 
Frequency of attacks Maximum [Twelve days] More [Fifteen days] Less [One Month]
{| class="wikitable"
Time required to lose consciousness Minimal Less More  
! rowspan="1"| Characteristic feature  
Time required to regain consciousness Minimal Less More  
! rowspan="1"| Vataja Apasmara
Duration of attack Minimal Less More  
! rowspan="1"| Pittaja Apasmara  
Clinical appearance of nails, eyes [sclera],face and skin Aruna[ downy red], Shayva[gray] , parusha [rough] Peeta [yellowish], harita [Greenish], Haridra [ turmeric yellow], Tamra [ coppery]   Shukla [whitish/ pallor]  
! rowspan="1"| Kaphaja Apasmara  
Patient experiences aura of / vision of / views of Anavasthita [unstable], Chapal [Moving/fickle] parusha [rough], Ruksha [Dry] Rupa [  looking objects] Vikrutananam [abnormal faces] [AH] Rudhirokshita [ blood], bleeding, terrifying (which is also injurious) Bhairava [frightful], Aadipta [burning] and Rushita [angry] looking objects Shukla[ white], Guru [ heavy / large in size], Snigdha [ unctuous]  
|-
| Frequency of attacks || Maximum [Twelve days]   ||  More [Fifteen days] ||  Less [One Month]
|-
| Time required to lose consciousness ||  Minimal || Less ||  More
|-
| Time required to regain consciousness || Minimal ||  Less || More
|-
| Duration of attack || Minimal || Less ||  More  
|-
| Clinical appearance of nails, eyes [sclera],face and skin   ||  Aruna[ downy red], Shayva[gray] , parusha [rough] || Peeta [yellowish], harita [Greenish], Haridra [ turmeric yellow], Tamra [ coppery] || Shukla [whitish/ pallor]
|-
| Patient experiences aura of / vision of / views of   || Anavasthita [unstable], Chapal [Moving/fickle] parusha [rough], Ruksha [Dry] Rupa [  looking objects] Vikrutananam [abnormal faces] [AH] || Rudhirokshita [ blood], bleeding, terrifying (which is also injurious) Bhairava [frightful], Aadipta [burning] and Rushita [angry] looking objects ||  Shukla[ white], Guru [ heavy / large in size], Snigdha [ unctuous]  
looking objects  
looking objects  
Clinical picture of abnormal movements Vishama Vinata Angulim  [irregularly contracted fingers] Not given specifically Anati cheshtam [ not more movements/ less movements]  
|-
Anati Vikruta cheshtam [not more abnormal movements i.e. less abnormal movements]
| rowspan="3" | Clinical picture of abnormal movements || Vishama Vinata Angulim  [irregularly contracted fingers || rowspan="3" | Not given specifically || Anati cheshtam [ not more movements/ less movements]
Anavasthita pani Padam [ instable or continuous shaking of upper and lower limbs] Alpa Cheshtam [less abnormal movements ] [AH]
|-
Parito Vikshipati Angam [ places body parts here and there irregularly/ involuntary movements] [AH]
| Anavasthita pani Padam [ instable or continuous shaking of upper and lower limbs] || rowspan="2" |Alpa Cheshtam [less abnormal movements ] [AH]
Character of discharge from mouth Phenam [froth] Not mentioned specific Lalam Bhuyasi [excess saliva discharge]  
|-
Temperature of body Not specific Tapa [rise in temperature/ hyperthermia] [Su] Sheeta Anga [cold body/hypothermia] [Su]
| Parito Vikshipati Angam [ places body parts here and there irregularly/ involuntary movements] [AH]
Other Specific features Utpinditaksham [ bulging of eyes/ upside rolling of eyes] Avakujantam [epileptic cry] Patantam [falling down]  
|-
Asamna Vilapantam [incoherent speech] Aasphalayantam Bhumim [rubbing earth] Hrullas [nausea] [Su]
|  Character of discharge from mouth || Phenam [froth]   || Not mentioned specific   || Lalam Bhuyasi [excess saliva discharge]
Trushna [excess thirst] Nidrarta [excess sleep] [Su]
|-
Ateeva aadhmat greevam [excess heaviness and rigidity in neck region] Sweda [excess perspiration] [Su]
| Temperature of body ||  Not specific || Tapa [rise in temperature/ hyperthermia] [Su] || Sheeta Anga [cold body/hypothermia] [Su]  
Aavidhdha Shiraskam [bending of head towards one side] Murchcha [ syncope] [Su]
|-
Kampate [ trembling/convulsions] Dhunvan Angani [shakes all body parts] [Su]
| rowspan="12" | Other Specific features || Utpinditaksham [ bulging of eyes/ upside rolling of eyes] || Avakujantam [epileptic cry] || Patantam [falling down]
Vepamano [ tremors] Vivhala [agitated] [Su]
|-
Dantan pradashet [grinding of teeth]
|rowspan="2" |Asamna Vilapantam [incoherent speech]   ||  Aasphalayantam Bhumim [rubbing earth] || Hrullas [nausea] [Su]  
Shwasiti [increased respiration/ dyspnea]
|-
Sakthi Sphurana [contraction like sensation in thigh region]
| Trushna [excess thirst] || Nidrarta [excess sleep] [Su]
Viswaram [epileptic cry] [AH]
|-
Virupam [AH]
| Ateeva aadhmatgreevam [excess heaviness and rigidity in neck region]   ||  Sweda [excess perspiration] [Su] ||   
|-
| Aavidhdha Shiraskam [bending of head towards one side]   ||  Murchcha [ syncope] [Su] ||   
|-
| Kampate [ trembling/convulsions] ||  Dhunvan Angani [shakes all body parts] [Su] ||   
|-
| Vepamano [ tremors] || Vivhala [agitated] [Su] ||   
|-
| Dantan pradashet [grinding of teeth] ||  ||   
|-
| Shwasiti [increased respiration/ dyspnea] ||  ||   
|-
| Sakthi Sphurana [contraction like sensation in thigh region]   ||  ||   
|-
| Viswaram [epileptic cry] [AH] ||  ||   
|-
| Virupam [AH] ||  ||   
|-
|}
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   
        
        
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