Changes

With the help of these therapies, the heart of the patient gets stimulated and the channels get cleansed as a result of which the patient regains consciousness.[52]

With the help of these therapies, the heart of the patient gets stimulated and the channels get cleansed as a result of which the patient regains consciousness.[52]

Aagantu apasmara treatment:

==== Aagantu apasmara treatment ====

 

यस्यानुबन्धस्त्वागन्तुर्दोषलिङ्गाधिकाकृतिः|  

यस्यानुबन्धस्त्वागन्तुर्दोषलिङ्गाधिकाकृतिः|  

दृश्येत तस्य कार्यं स्यादागन्तून्मादभेषजम्||५३||

दृश्येत तस्य कार्यं स्यादागन्तून्मादभेषजम्||५३||

dRushyeta tasya kAryaM syAdAgantUnmAdabheShajam||53||

dRushyeta tasya kAryaM syAdAgantUnmAdabheShajam||53||

In some patients of epilepsy, exogenous factors are secondarily involved and in such cases signs and symptoms are manifested over and above those of the doshas (endogenous factors). Such patients should be treated on the lines suggested for exogenous types of unmada (insanity) -vide Chapter 9.[53].

In some patients of epilepsy, exogenous factors are secondarily involved and in such cases signs and symptoms are manifested over and above those of the doshas (endogenous factors). Such patients should be treated on the lines suggested for exogenous types of unmada (insanity) -vide Chapter 9.[53].

Mahagada chikitsa [management of atattvabhinivesha]:

 

==== Mahagada chikitsa [management of atattvabhinivesha] ====

अनन्तरमुवाचेदमग्निवेशः कृताञ्जलिः|  

अनन्तरमुवाचेदमग्निवेशः कृताञ्जलिः|  

भगवन्! प्राक् समुद्दिष्टः श्लोकस्थाने महागदः||५४||  

भगवन्! प्राक् समुद्दिष्टः श्लोकस्थाने महागदः||५४||  

shushrUShave vacaH shrutvA shiShyAyAha punarvasuH|  

shushrUShave vacaH shrutvA shiShyAyAha punarvasuH|  

mahAgadaM saumya! shRuNu sahetvAkRutibheShajam||56||  

mahAgadaM saumya! shRuNu sahetvAkRutibheShajam||56||  

Thereafter, Agnivesha with folded hands [in salutation] said, "O Lord!  In Sutra section (Sutra 19 : 3) you have mentioned in brief as a mahagada (grave disease), that is atattvabhinivesha (pervaded by false principles ). But its etiology, signs and symptoms and treatment are not described there. I want to hear these descriptions. Kindly narrate them in the present context".[54-55]

Thereafter, Agnivesha with folded hands [in salutation] said, "O Lord!  In Sutra section (Sutra 19 : 3) you have mentioned in brief as a mahagada (grave disease), that is atattvabhinivesha (pervaded by false principles ). But its etiology, signs and symptoms and treatment are not described there. I want to hear these descriptions. Kindly narrate them in the present context".[54-55]

Having heard this, Lord Punarvasu addressed his disciple who was desirous of hearing and said, "My child, hear about this mahagada (grave disease) along with its etiology, signs and symptoms and treatment".  [56]

Having heard this, Lord Punarvasu addressed his disciple who was desirous of hearing and said, "My child, hear about this mahagada (grave disease) along with its etiology, signs and symptoms and treatment".  [56]

Etiopathology and clinical features of atattvabhinivesha:

 

==== Etiopathology and clinical features of atattvabhinivesha ====

 

मलिनाहारशीलस्य वेगान् प्राप्तान्निगृह्णतः|  

मलिनाहारशीलस्य वेगान् प्राप्तान्निगृह्णतः|  

शीतोष्णस्निग्धरूक्षाद्यैर्हेतुभिश्चातिसेवितैः||५७||  

शीतोष्णस्निग्धरूक्षाद्यैर्हेतुभिश्चातिसेवितैः||५७||  

If a person is indulged in habitual intake of impure food, due to suppression of manifested natural urges, excessive intake of cold, hot, unctuous, un-unctuous food [incompatible food with contradictory properties] etc, the [vitiated] doshas afflict channels of mind and intellect and abide into heart. The rajas (one of the attributes of the mind) and moha or tamas (another attribute of mind), occlude the person’s self. Excessively aggravated rajas and tamas cover mind and intellect, disturbing the functions of heart, making the person stupid and mentally weak. This leads to improper judgment regarding eternal and ephemeral events and wholesome and unwholesome objects. The expert physicians call this mahagada (grave disease) as atattvabhinivesha. [57- 60]

If a person is indulged in habitual intake of impure food, due to suppression of manifested natural urges, excessive intake of cold, hot, unctuous, un-unctuous food [incompatible food with contradictory properties] etc, the [vitiated] doshas afflict channels of mind and intellect and abide into heart. The rajas (one of the attributes of the mind) and moha or tamas (another attribute of mind), occlude the person’s self. Excessively aggravated rajas and tamas cover mind and intellect, disturbing the functions of heart, making the person stupid and mentally weak. This leads to improper judgment regarding eternal and ephemeral events and wholesome and unwholesome objects. The expert physicians call this mahagada (grave disease) as atattvabhinivesha. [57- 60]

Management of atattvabhinivesha:

 

==== Management of atattvabhinivesha ====

 

स्नेहस्वेदोपपन्नं तं संशोध्य वमनादिभिः|  

स्नेहस्वेदोपपन्नं तं संशोध्य वमनादिभिः|  

कृतसंसर्जनं मेध्यैरन्नपानैरुपाचरेत्||६१||  

कृतसंसर्जनं मेध्यैरन्नपानैरुपाचरेत्||६१||  

This [disease] shall be treated with oleation and fomentation therapies followed by purification therapies like therapeutic emesis etc. Then after doing samsarjana krama (observing specific dietary regimen after purification], diet and drinks which are promoters of intellect should be administered. Juice of brahmi mixed with panchagavya ghrita described above (vide verses 16-17) should be administered. Similarly, other medhya rasayanas (promoters of intellect) like shankhapushpi should be given.  [61- 62]

This [disease] shall be treated with oleation and fomentation therapies followed by purification therapies like therapeutic emesis etc. Then after doing samsarjana krama (observing specific dietary regimen after purification], diet and drinks which are promoters of intellect should be administered. Juice of brahmi mixed with panchagavya ghrita described above (vide verses 16-17) should be administered. Similarly, other medhya rasayanas (promoters of intellect) like shankhapushpi should be given.  [61- 62]

Friends, sympathizers, preceptors preaching religious sermons, philosophers should inculcate into him knowledge, understanding, patience, memory and the power of meditation. [63]

Friends, sympathizers, preceptors preaching religious sermons, philosophers should inculcate into him knowledge, understanding, patience, memory and the power of meditation. [63]

प्रयुञ्ज्यात्तैललशुनं पयसा वा शतावरीम्|  

प्रयुञ्ज्यात्तैललशुनं पयसा वा शतावरीम्|  

ब्राह्मीरसं कुष्ठरसं वचां वा मधुसंयुताम्||६४||

ब्राह्मीरसं कुष्ठरसं वचां वा मधुसंयुताम्||६४||

i) Garlic with oil; ii) shatavari with milk; iii) juice of brahmi with honey; iv) juice or decoction of kushtha with honey; and v) powder of vacha with honey.[64]

i) Garlic with oil; ii) shatavari with milk; iii) juice of brahmi with honey; iv) juice or decoction of kushtha with honey; and v) powder of vacha with honey.[64]

Prognosis:

 

==== Prognosis ====

 

दुश्चिकित्स्यो ह्यपस्मारश्चिरकारी कृतास्पदः [१] |  

दुश्चिकित्स्यो ह्यपस्मारश्चिरकारी कृतास्पदः [१] |  

तस्माद्रसायनैरेनं प्रायशः समुपाचरेत्||६५||

तस्माद्रसायनैरेनं प्रायशः समुपाचरेत्||६५||

tasmAdrasAyanairenaM prAyashaH samupAcaret||65||

tasmAdrasAyanairenaM prAyashaH samupAcaret||65||

If the disease apasmara is resistant to conventional modes of treatment, if it is chronic and if it has acquired a firm footing, then it should be generally treated with the foregoing recipes of rejuvenating drugs. [65]

If the disease apasmara is resistant to conventional modes of treatment, if it is chronic and if it has acquired a firm footing, then it should be generally treated with the foregoing recipes of rejuvenating drugs. [65]

Protection of patients and precautionary measures:

 

==== Protection of patients and precautionary measures ====

जलाग्निद्रुमशैलेभ्यो विषमेभ्यश्च तं सदा|  

जलाग्निद्रुमशैलेभ्यो विषमेभ्यश्च तं सदा|  

रक्षेदुन्मादिनं चैव सद्यः प्राणहरा हि ते||६६||

रक्षेदुन्मादिनं चैव सद्यः प्राणहरा हि ते||६६||

rakShedunmAdinaM caiva sadyaH prANaharA hi te||66||

rakShedunmAdinaM caiva sadyaH prANaharA hi te||66||

The patient suffering from apasmara  and unmada, should be specially protected from water, fire, trees, mountains and uneven places. These may cause instantaneous death of the patient.[66]

The patient suffering from apasmara  and unmada, should be specially protected from water, fire, trees, mountains and uneven places. These may cause instantaneous death of the patient.[66]

तत्र श्लोकौ-  

तत्र श्लोकौ-  

हेतुं कुर्वन्त्यपस्मारं दोषाः प्रकुपिता यथा|  

हेतुं कुर्वन्त्यपस्मारं दोषाः प्रकुपिता यथा|  

महागदसमुत्थानं लिङ्गं चोवाच सौषधम्|  

महागदसमुत्थानं लिङ्गं चोवाच सौषधम्|  

मुनिर्व्याससमासाभ्यामपस्मारचिकित्सिते [१] ||६८||

मुनिर्व्याससमासाभ्यामपस्मारचिकित्सिते [१] ||६८||

tatra ślōkau-  

tatra ślōkau-  

hētuṁ kurvantyapasmāraṁ dōṣāḥ prakupitā yathā|  

hētuṁ kurvantyapasmāraṁ dōṣāḥ prakupitā yathā|  

mahāgadasamutthānaṁ liṅgaṁ cōvāca sauṣadham|  

mahāgadasamutthānaṁ liṅgaṁ cōvāca sauṣadham|  

munirvyāsasamāsābhyāmapasmāracikitsitē [1] ||68||

munirvyāsasamāsābhyāmapasmāracikitsitē [1] ||68||

tatra shlokau-  

tatra shlokau-  

hetuM kurvantyapasmAraM doShAH prakupitA yathA|  

hetuM kurvantyapasmAraM doShAH prakupitA yathA|  

mahAgadasamutthAnaM li~ggaM covAca sauShadham|  

mahAgadasamutthAnaM li~ggaM covAca sauShadham|  

munirvyAsasamAsAbhyAmapasmAracikitsite [1] ||68||

munirvyAsasamAsAbhyAmapasmAracikitsite [1] ||68||

i) Etiological factors of epilepsy; ii) the mode of vitiation of doshas; iii) signs and symptoms in general and of different varieties of epilepsy;  [ 67]iv) Treatment of different types of epilepsy; and v) Etiology, signs and symptoms of mahagada (grave disease). Thus, in this chapter, the sage has described treatment of apasmara, in brief as well as in detail as above said.[68]

i) Etiological factors of epilepsy; ii) the mode of vitiation of doshas; iii) signs and symptoms in general and of different varieties of epilepsy;  [ 67]iv) Treatment of different types of epilepsy; and v) Etiology, signs and symptoms of mahagada (grave disease). Thus, in this chapter, the sage has described treatment of apasmara, in brief as well as in detail as above said.[68]

Thus, ends the tenth Chapter dealing with the treatment of apasmara in the section on therapeutics of Agnivesha's work as redacted by Charaka, and not being available, restored by Dridhabala.  [69]

Thus, ends the tenth Chapter dealing with the treatment of apasmara in the section on therapeutics of Agnivesha's work as redacted by Charaka, and not being available, restored by Dridhabala.  [69]

Tattva Vimarsha:

 

=== Tattva Vimarsha ===

• Apasmara is a disease in which faculties of mind like memory/consciousness, intellect and purest quality of mind are afflicted.  

• Apasmara is a disease in which faculties of mind like memory/consciousness, intellect and purest quality of mind are afflicted.  

• Diet plays significant role in pathophysiology of psychiatric diseases.  

• Diet plays significant role in pathophysiology of psychiatric diseases.  

• Basti [therapeutic enema] in vata dominant apasmara, virechana [therapeutic purgation] in pitta dominant apasmara and vamana [therapeutic emesis] in kapha dominant apasmara are specific therapies.  

• Basti [therapeutic enema] in vata dominant apasmara, virechana [therapeutic purgation] in pitta dominant apasmara and vamana [therapeutic emesis] in kapha dominant apasmara are specific therapies.  

• Ashwasana [assurance therapy] and psychological counselling are advised to remove psychological stressors that provoke apasmara vega[episode].  

• Ashwasana [assurance therapy] and psychological counselling are advised to remove psychological stressors that provoke apasmara vega[episode].  

Vidhi Vimarsha:

 

=== Vidhi Vimarsha ===

 

The first principle of Ayurveda states that life is continuum of healthy coordination between body, mind, soul and sensory-motor organs. Ayurveda considers the mind and body work in symbiotic relationship with each other. When one is affected, other is also affected. Both are emphasized as abode for sensation of pain. The mind and body can’t be separated in water tight compartment.  

The first principle of Ayurveda states that life is continuum of healthy coordination between body, mind, soul and sensory-motor organs. Ayurveda considers the mind and body work in symbiotic relationship with each other. When one is affected, other is also affected. Both are emphasized as abode for sensation of pain. The mind and body can’t be separated in water tight compartment.  

Relation between diet, dosha specificity and apasmara:

Relation between diet, dosha specificity and apasmara:

The forbearance of mind is based upon intellect [dhi] and pure quality of mind [sattva]. Dhi discriminates between right and wrong things. Sattva is pure quality that might be named as “mental immunity” which protects mind in all adverse conditions. In apasmara, both the intellect and pure quality of mind are afflicted leading to poor forbearance.  

The forbearance of mind is based upon intellect [dhi] and pure quality of mind [sattva]. Dhi discriminates between right and wrong things. Sattva is pure quality that might be named as “mental immunity” which protects mind in all adverse conditions. In apasmara, both the intellect and pure quality of mind are afflicted leading to poor forbearance.  

  Brain and heart connection –Neuro-cardiology:  

  Brain and heart connection –Neuro-cardiology:  

Heart [cardiac region] has been considered as site of consciousness and emotions. The heart in context of apasmara is essentially meant by the abode of consciousness and it doesn’t signify anatomical heart. This is functional heart which is involved in emotions, feelings of the self. Brain [head region] is considered as origin of all sensory and motor organs. The term “Dhamani” has been used to denote abode of aggravated doshas. This literally means the artery, vein, nerves which carry impulses. This is very important as it channelizes consciousness from site of consciousness i.e. heart to site of intelligence i.e. brain. This canal of heart-brain connection is manovaha srotas. The brain and heart work in co-ordination with each other for maintaining equilibrium between logical intelligence and emotional intelligence. If these are hampered, the consciousness, memory, sensory and motor co-ordination as well as emotional behaviour will be affected. This establishes the theory that disturbance in cardiac functions can result into neurological disorders. The heart-brain connection has been authenticated by many researches on neuro-cardiology.  The theory of heart-brain connection has been well known to Ayurveda scholars in context of apasmara.    

Heart [cardiac region] has been considered as site of consciousness and emotions. The heart in context of apasmara is essentially meant by the abode of consciousness and it doesn’t signify anatomical heart. This is functional heart which is involved in emotions, feelings of the self. Brain [head region] is considered as origin of all sensory and motor organs. The term “Dhamani” has been used to denote abode of aggravated doshas. This literally means the artery, vein, nerves which carry impulses. This is very important as it channelizes consciousness from site of consciousness i.e. heart to site of intelligence i.e. brain. This canal of heart-brain connection is manovaha srotas. The brain and heart work in co-ordination with each other for maintaining equilibrium between logical intelligence and emotional intelligence. If these are hampered, the consciousness, memory, sensory and motor co-ordination as well as emotional behaviour will be affected. This establishes the theory that disturbance in cardiac functions can result into neurological disorders. The heart-brain connection has been authenticated by many researches on neuro-cardiology.  The theory of heart-brain connection has been well known to Ayurveda scholars in context of apasmara.

Signs and symptoms of apasmara:

Transient nervous system collapse of a person which leads to various signs and symptoms enlisted in the verses 7 to 13. The cluster describes features of paroxysmal stage of apasmara. The features include somatic as well as psychological subjective symptoms experienced by patients self. The dreams specific to predominance of dosha can be important measures for diagnosis of predominance of dosha. The symptomatology has been described elaborately in context of apasmara nidana.  

==== Signs and symptoms of apasmara ====

Gut-brain connection in apasmara:

 

Transient nervous system collapse of a person which leads to various signs and symptoms enlisted in the verses 7 to 13. The cluster describes features of paroxysmal stage of apasmara. The features include somatic as well as psychological subjective symptoms experienced by patients self. The dreams specific to predominance of dosha can be important measures for diagnosis of predominance of dosha. The symptomatology has been described elaborately in context of apasmara nidana.

==== Gut-brain connection in apasmara ====

 

Gut-brain dysfunction is proved to play role in many psychiatric disorders like depression, anxiety, autism, schizophrenia.  The figure shows physiology of gut-brain connection [fig. ]. As discussed earlier in Apasmara Nidana chapter 8, many of the somatic symptoms are related with the dysfunction of gastro-intestinal tract.Therefore the possibility of gut-brain dysfunction can’t be denied. Similarly, as seen above, many of the animal products like medicines formulated with cow’s urine, cow’s ghee, goat urine that are rich in micro-organisms are enlisted in management of apasmara. The exact pharmaco-dynamic behind action of these medicines in management of apasmara with focus on gut-brain axis needs to be investigated.  

Gut-brain dysfunction is proved to play role in many psychiatric disorders like depression, anxiety, autism, schizophrenia.  The figure shows physiology of gut-brain connection [fig. ]. As discussed earlier in Apasmara Nidana chapter 8, many of the somatic symptoms are related with the dysfunction of gastro-intestinal tract.Therefore the possibility of gut-brain dysfunction can’t be denied. Similarly, as seen above, many of the animal products like medicines formulated with cow’s urine, cow’s ghee, goat urine that are rich in micro-organisms are enlisted in management of apasmara. The exact pharmaco-dynamic behind action of these medicines in management of apasmara with focus on gut-brain axis needs to be investigated.  

Etio-Pathogenesis of Atattvabhinivesha:

==== Etio-Pathogenesis of Atattvabhinivesha ====

 

The grave disease atattvabhinivesha is considered as affliction of discrimination power of intellect leading to severe perversion of mental functions.  The pathophysiology includes affliction of mind and intellect simultaneously. Therefore this disease comprises disturbance of mind and intellectual functioning. Decisive and discriminative power of person is completely lost. This leads to improper judgment regarding eternal and ephemeral events and wholesome and unwholesome objects. Co-ordination of mind, intellect, sense-motor organs is disturbed.  

The grave disease atattvabhinivesha is considered as affliction of discrimination power of intellect leading to severe perversion of mental functions.  The pathophysiology includes affliction of mind and intellect simultaneously. Therefore this disease comprises disturbance of mind and intellectual functioning. Decisive and discriminative power of person is completely lost. This leads to improper judgment regarding eternal and ephemeral events and wholesome and unwholesome objects. Co-ordination of mind, intellect, sense-motor organs is disturbed.  

Patho-physiology of atattvabhinivesha:   

Patho-physiology of atattvabhinivesha:   

   

   

The diseases with convulsive movements of the body and loss of memory can be considered for differential diagnosis for apasmara. Though apasmara is a manasa vikara, the diseases with presentation of kampa[tremors], gatra vikshepa [abnormal body movements], vepathu[trembling], etc in the form of paroxysms can be thought of for discussion under differential diagnosis. They include akshepaka (vata vyadhi), dandaka (stiffness), ardita (facial palsy or hemeparesis), apatanaka (status epilepticus), apatantraka (opisthotomus) and vepathu (kampavata/tremors).

      The diseases with convulsive movements of the body and loss of memory can be considered for differential diagnosis for apasmara. Though apasmara is a manasa vikara, the diseases with presentation of kampa[tremors], gatra vikshepa [abnormal body movements], vepathu[trembling], etc in the form of paroxysms can be thought of for discussion under differential diagnosis. They include akshepaka (vata vyadhi), dandaka (stiffness), ardita (facial palsy or hemeparesis), apatanaka (status epilepticus), apatantraka (opisthotomus) and vepathu (kampavata/tremors).

Akshepaka is explained as a vata vyadhi  in Chikitsa sthana 28th chapter characterised by repeated convulsive movements of body when vitiated vata affects muscles and tendons of hands and legs. (Verses 51, 52)

Akshepaka is explained as a vata vyadhi  in Chikitsa sthana 28th chapter characterised by repeated convulsive movements of body when vitiated vata affects muscles and tendons of hands and legs. (Verses 51, 52)

Dandaka is denoted in the same context as stambha (stiffness) manifested in pani [hands], pada [legs], shira [head], prishtha [back] and shroni [pelvis] making body stiff like wooden log. (verse52)

Dandaka is denoted in the same context as stambha (stiffness) manifested in pani [hands], pada [legs], shira [head], prishtha [back] and shroni [pelvis] making body stiff like wooden log. (verse52)