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Line 2: − + + + + − − <big>'''Abstract</big>''' − − The tenth chapter deals with specific features of types of ''apasmara'' and its management. In continuation with the earlier explanation about causative factors, patho-physiology and clinical features have been described in [[Apasmara Nidana]], with another definition provided here in this chapter in greater detail. − − Specific features of dominance of ''vata, pitta'' and ''kapha doshas'' are explained and involvement of exogenous factors is mentioned. Management of ''apasmara'' depending on the predominance of ''doshas'', influence of ''agantu'' (exogenous) factors are explained. Special preparations like ''panchagavya ghrita, mahapanchagavya ghrita, jeevaneeya ghrita,'' various preparations for nasal administrations etc are given. − − Etiological factors, pathogenesis, features and management of an important disease called ''atattvabhinivesha'' (a disease of perversion of intellect) are narrated. Importance of ''rasayana'' (rejuvenation) and protection of patient of ''unmada'' and ''apasmara'' are also emphasized. − − '''Keywords''': ''Apasmara'', memory, consciousness, epilepsy, ''atattvabhinivesha, unmada''. − Line 29:
Line 21: + + + + + + + + + + + + + − |header3 = + + + + + + + − }}+ − === Introduction === + + Line 43:
Line 55: − ===Sanskrit text, Transliteration and English Translation===+ Line 61:
Line 73: − We shall now describe in detail the medical treatment of ''apasmara'' (epilepsy). Thus said Lord Atreya. [1-2]+ − ==== Definition of ''apasmara'' ====+ Line 79:
Line 91: − ==== Etiopathology ====+ Line 108:
Line 120: − ==== Pathogenesis and features of pre-ictal phase ====+ Line 135:
Line 147: − ==== Post-ictal phase of ''apasmara'' ====+ Line 148:
Line 160: − ==== Types of ''apasmara'' ====+ Line 161:
Line 173: − ==== Features (Ictal phase) ====+ − ===== ''Apasmara'' with ''vata'' dominance =====+ Line 178:
Line 190: − ===== ''Apasmara'' with ''pitta'' dominance =====+ Line 194:
Line 206: − ===== ''Apasmara'' with ''kapha'' dominance =====+ Line 210:
Line 222: − ===== ''Apasmara'' with mixed features of all ''dosha'' dominance and prognosis =====+ Line 226:
Line 238: − ==== Diagnosis as per frequency of seizures ====+ Line 242:
Line 254: − ==== Management of ''apasmara'' ====+ Line 258:
Line 270: − ==== Purification based on ''dosha'' dominance ====+ Line 274:
Line 286: − ==== Assurance and counselling therapy ====+ Line 290:
Line 302: − ==== ''Panchagavya ghee'' ====+ Line 310:
Line 322: − ===== Ingredients of ''panchagavya ghee'' =====+ − ===== Indications ===== + − ==== ''Mahapanchagavya ghee'' ====+ Line 392:
Line 404: − ===== Ingredients of ''mahapanchagavya ghee'' =====+ Line 399:
Line 411: − ===== Indications =====+ − ==== ''Brahmi ghee'' ====+ Line 420:
Line 432: − ==== ''Saindhava hingu ghee'' ====+ Line 436:
Line 448: − ==== ''Vacha-shampakadi ghee'' ====+ Line 452:
Line 464: − ==== ''Jivaniya Yamaka Sneha'' ====+ Line 510:
Line 522: − ==== Drugs for external application ====+ Line 607:
Line 619: − ==== Different unction formulations ====+ Line 628:
Line 640: − ==== Drugs for ''nasya'' (nasal errhines) ====+ Line 686:
Line 698: − ==== ''Pradhamana nasya'' formulation ====+ Line 702:
Line 714: − ==== Medicated wicks ====+ Line 782:
Line 794: − ==== Effects of therapy ====+ Line 798:
Line 810: − ==== Treatment of ''Aagantu apasmara'' ====+ Line 814:
Line 826: − ==== ''Mahagada chikitsa'' (management of ''atattvabhinivesha'') ====+ Line 850:
Line 862: − ==== Etiopathology and clinical features of ''atattvabhinivesha'' ====+ Line 893:
Line 905: − ==== Management of ''atattvabhinivesha'' ====+ Line 946:
Line 958: − ==== Prognosis ====+ Line 962:
Line 974: − ==== Protection of patients and precautionary measures ====+ Line 1,013:
Line 1,025: − + Line 1,025:
Line 1,037: − + − ==== Relation between diet, ''dosha'' specificity and ''apasmara'' ====+ Line 1,035:
Line 1,047: − ==== Memory and consciousness ====+ Line 1,041:
Line 1,053: − ==== Brain and heart connection Neurocardiology ==== + − ==== Signs and symptoms of ''apasmara'' ====+ − ==== Gut-brain connection in ''apasmara'' ====+ + + − + − [[File:Bidirectionalgut-brainaxis.png|500px]]+ − − ==== Etio-Pathogenesis of ''Atattvabhinivesha'' ==== − ==== Patho-physiology of ''atattvabhinivesha'' ====+ − ===== Differential diagnosis ===== + Line 1,090:
Line 1,102: − ===== Management of ''apasmara'' =====+ − ====== I. Purification therapies ======+ Line 1,102:
Line 1,114: − ====== II. Assurance and consolation therapies ======+ − ====== III. Pacification (''shamana'') therapy ======+ Line 1,895:
Line 1,907: − ===References ===+ + +
Text replacement - "http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg" to "http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg"
|title=Apasmara Chikitsa
|title=Apasmara Chikitsa
|titlemode=append
|titlemode=append
|keywords=Apasmara, memory, consciousness, epilepsy, atattvabhinivesha, unmada
|keywords=Apasmara, memory, consciousness, epilepsy, atattvabhinivesha, unmada,seizure disorders, ayurveda, psychiatry, Ayurveda, charak samhita, Indian system of medicine.
|description=Chikitsa Sthana Chapter 10. Management of Apasmara (Epilepsy and other disorders)
|description=Chikitsa Sthana Chapter 10. Management of Apasmara (Epilepsy and other disorders)
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=charak samhita
|type=article
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}}
<big>'''[[Chikitsa Sthana]] Chapter 10. Management of Apasmara (Epilepsy and other disorders) </big>'''
<big>'''[[Chikitsa Sthana]] Chapter 10. Management of Apasmara (Epilepsy and other disorders) </big>'''
{{Infobox
{{Infobox
|title = Apasmara Chikitsa
|title = Apasmara Chikitsa
|label5 = Other Sections
|label5 = Other Sections
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label6 = Translator and commentator
|data6 = Deole Y. S.
|label7 = Reviewer
|data7 = Bhagwat M., Tripathi J.S.
|label8 = Editors
|data8 = Baghel M.S., Deole Y.S., Basisht G.
|label9 = Year of publication
|data9 = 2020
|label10 = Publisher
|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.011 10.47468/CSNE.2020.e01.s06.011]
}}
<big>'''Abstract</big>'''
<div style="text-align:justify;">
The tenth chapter deals with specific features of types of ''apasmara'' and its management. In continuation with the earlier explanation about causative factors, patho-physiology and clinical features have been described in [[Apasmara Nidana]], with another definition provided here in this chapter in greater detail.
Specific features of dominance of ''vata, pitta'' and ''kapha doshas'' are explained and involvement of exogenous factors is mentioned. Management of ''apasmara'' depending on the predominance of ''doshas'', influence of ''agantu'' (exogenous) factors are explained. Special preparations like ''panchagavya ghrita, mahapanchagavya ghrita, jeevaneeya ghrita,'' various preparations for nasal administrations etc are given.
Etiological factors, pathogenesis, features and management of an important disease called ''atattvabhinivesha'' (a disease of perversion of intellect) are narrated. Importance of ''rasayana'' (rejuvenation) and protection of patient of ''unmada'' and ''apasmara'' are also emphasized.
'''Keywords''': ''Apasmara'', memory, consciousness, epilepsy, ''atattvabhinivesha, unmada'', seizure disorders. </div>
== Introduction ==
<div style="text-align:justify;">
All psychiatric and psycho-somatic diseases find their roots in the two chapters of ''unmada'' and ''apasmara''. These diseases are caused by similar etiological factors and both manifest as ''manasika vikara'' (psychiatric diseases). Therefore these two chapters are placed in succession. ''Mana'' (mind), ''buddhi'' (intellect), and ''smriti'' (memory) are integral parts combined with ''atma'' (self) in understanding Ayurvedic psychiatry. The series of pathological events that take place to occlude consciousness in heart and loss of memory is distinctive feature of ''apasmara''. As mentioned earlier in [[Apasmara Nidana]], first the aggravation of ''doshas'' at somatic level occurs by improper and impure/foul food and excess affliction of negative emotions like worries, passion, fright, anger, grief etc at psychic level. The disease precipitates in the form of paroxysmal attack, then the negative psychological emotions occlude the consciousness at heart and thereafter leading to loss of memory.
All psychiatric and psycho-somatic diseases find their roots in the two chapters of ''unmada'' and ''apasmara''. These diseases are caused by similar etiological factors and both manifest as ''manasika vikara'' (psychiatric diseases). Therefore these two chapters are placed in succession. ''Mana'' (mind), ''buddhi'' (intellect), and ''smriti'' (memory) are integral parts combined with ''atma'' (self) in understanding Ayurvedic psychiatry. The series of pathological events that take place to occlude consciousness in heart and loss of memory is distinctive feature of ''apasmara''. As mentioned earlier in [[Apasmara Nidana]], first the aggravation of ''doshas'' at somatic level occurs by improper and impure/foul food and excess affliction of negative emotions like worries, passion, fright, anger, grief etc at psychic level. The disease precipitates in the form of paroxysmal attack, then the negative psychological emotions occlude the consciousness at heart and thereafter leading to loss of memory.
''Atattvabhinivesha'' is another disease specially mentioned in this chapter. It is termed as the single major disease ,i.e., ''mahagada,'' leading to affliction of mind and intellect. Its management is also mentioned in this context.
''Atattvabhinivesha'' is another disease specially mentioned in this chapter. It is termed as the single major disease ,i.e., ''mahagada,'' leading to affliction of mind and intellect. Its management is also mentioned in this context.
== Sanskrit text, Transliteration and English Translation ==
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Now we shall expound the chapter "Apasmara Chikitsa"(Management of Epilepsy and other disorders). Thus said Lord Atreya. [1-2]
=== Definition of ''apasmara'' ===
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The expert physicians call ''apasmara'' as 'going away of memory' characterized by black-outs (feeling of entering into darkness) and revolting movements caused by conglomeration of the intellect and the mind. [3]
The expert physicians call ''apasmara'' as 'going away of memory' characterized by black-outs (feeling of entering into darkness) and revolting movements caused by conglomeration of the intellect and the mind. [3]
=== Etiopathology ===
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#Mind is distressed or annihilated by (affliction of negative emotions like) worry, passion, fright, anger, grief, anxiety etc. [4-5]
#Mind is distressed or annihilated by (affliction of negative emotions like) worry, passion, fright, anger, grief, anxiety etc. [4-5]
=== Pathogenesis and features of pre-ictal phase ===
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He visualizes non-existent forms (visual hallucinations), falls down, his tongue, eyes and eyebrows become tremulous, saliva discharges from his mouth, his hands and legs are extended / bent.[7]
He visualizes non-existent forms (visual hallucinations), falls down, his tongue, eyes and eyebrows become tremulous, saliva discharges from his mouth, his hands and legs are extended / bent.[7]
=== Post-ictal phase of ''apasmara'' ===
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When the surge of ''doshas'' is over, he wakes up as if he is getting up from sleep (regains consciousness). [8]
When the surge of ''doshas'' is over, he wakes up as if he is getting up from sleep (regains consciousness). [8]
=== Types of ''apasmara'' ===
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''Apasmara'' is of four types including those due to separate ''doshas'' (''vata, pitta'' and ''kapha'') and due to combination of all (''sannipatika''). [8]
''Apasmara'' is of four types including those due to separate ''doshas'' (''vata, pitta'' and ''kapha'') and due to combination of all (''sannipatika''). [8]
=== Features (Ictal phase) ===
==== ''Apasmara'' with ''vata'' dominance ====
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''Vatika apasmara'' is characterized by trembling, grinding of teeth, frothing from the mouth, and gasping. The patient gets visual hallucinations of objects which are rough, reddish brown or black in color. [9]
''Vatika apasmara'' is characterized by trembling, grinding of teeth, frothing from the mouth, and gasping. The patient gets visual hallucinations of objects which are rough, reddish brown or black in color. [9]
==== ''Apasmara'' with ''pitta'' dominance ====
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''Paittika apasmara'' is characterized by yellowish froth, body, face and eyes. He gets visual hallucinations of yellow or blood-red objects. He has thirst, hot sensation (sensation of heat), and sees fire all over his surroundings. [10]
''Paittika apasmara'' is characterized by yellowish froth, body, face and eyes. He gets visual hallucinations of yellow or blood-red objects. He has thirst, hot sensation (sensation of heat), and sees fire all over his surroundings. [10]
==== ''Apasmara'' with ''kapha'' dominance ====
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The ''shlaishmika apasmara'' is characterized by whitish froth (from the mouth), body, face and eyes, (feeling of) cold, heaviness due to stiff body. The patient gets hallucinations of white objects and recovers late. [11]
The ''shlaishmika apasmara'' is characterized by whitish froth (from the mouth), body, face and eyes, (feeling of) cold, heaviness due to stiff body. The patient gets hallucinations of white objects and recovers late. [11]
==== ''Apasmara'' with mixed features of all ''dosha'' dominance and prognosis ====
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''Tridoshaja apasmara'' is characterized by manifestation of all of above features at the same time. This type of ''apasmara'' is incurable. The ''apasmara'', which occurs in emaciated person and in chronic stage, is also incurable. [12]
''Tridoshaja apasmara'' is characterized by manifestation of all of above features at the same time. This type of ''apasmara'' is incurable. The ''apasmara'', which occurs in emaciated person and in chronic stage, is also incurable. [12]
=== Diagnosis as per frequency of seizures ===
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The vitiated ''doshas'' lead to paroxysms of ''apasmara'' once in fifteen days, twelve days or a month. The paroxysm may occur even after a shorter period.[13]
The vitiated ''doshas'' lead to paroxysms of ''apasmara'' once in fifteen days, twelve days or a month. The paroxysm may occur even after a shorter period.[13]
=== Management of ''apasmara'' ===
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The heart, channels and mind which are obstructed by ''doshas'' shall rouse up or cleared first by strong remedial measures like ''vamana'' (emetic therapy) etc. [14]
The heart, channels and mind which are obstructed by ''doshas'' shall rouse up or cleared first by strong remedial measures like ''vamana'' (emetic therapy) etc. [14]
=== Purification based on ''dosha'' dominance ===
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''Vatika apasmara'' shall be treated mainly with ''basti'' (medicated enema) therapy; ''Paittika apasmara'' shall mainly be treated with ''virechana'' (purgation) therapy and ''shlaishmika apasmara'' shall mainly be treated with ''vamana'' (emesis) therapy.[15]
''Vatika apasmara'' shall be treated mainly with ''basti'' (medicated enema) therapy; ''Paittika apasmara'' shall mainly be treated with ''virechana'' (purgation) therapy and ''shlaishmika apasmara'' shall mainly be treated with ''vamana'' (emesis) therapy.[15]
=== Assurance and counselling therapy ===
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After proper purification is done by all above therapies and well assurance is given, the pacification formulations for relief from ''apasmara'' are described henceforth.[16]
After proper purification is done by all above therapies and well assurance is given, the pacification formulations for relief from ''apasmara'' are described henceforth.[16]
=== ''Panchagavya ghee'' ===
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==== Ingredients of ''panchagavya ghee'' ====
Juice of cow dung, sour curd prepared out of cow's milk, cow's urine in equal quantity and cow’s ghee.
Juice of cow dung, sour curd prepared out of cow's milk, cow's urine in equal quantity and cow’s ghee.
==== Indications ====
The medicated ghee shall be taken for treating ''apasmara, kamala'' (jaundice) and ''jwara''.[17]
The medicated ghee shall be taken for treating ''apasmara, kamala'' (jaundice) and ''jwara''.[17]
=== ''Mahapanchagavya ghee'' ===
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==== Ingredients of ''mahapanchagavya ghee'' ====
Two ''palas'' (80 gms) of each of :
Two ''palas'' (80 gms) of each of :
Shampaka (aragvadha), root of phalgu (kasthodu-mbarika), pushkaramula and duralabha should be added with two dronas (in the recipe actually one drona is described; it has to be taken double in quantity according to definition) of water, boiled and reduced to one fourth. One aksha [12 gm each of]: The paste of bharangi, patha, shunthi, maricha, pippali, trivrita, nichula (hijjala), shreyasi (hastipippali), adhaki, murva, danti, bhunimba; chitraka, shveta sariva, krishna sariva, rohisha, bhutika and madayantika along with prior said decoction, two prasthas [640 ml] of cow's ghee should be cooked by adding two prasthas of each of the juice of cow-dung, sour curd prepared of cow's milk, cow's milk and cow's urine, This medicated ghee, known as mahapancagavya is like ambrosia in the treatment (of following)[18-22]
Shampaka (aragvadha), root of phalgu (kasthodu-mbarika), pushkaramula and duralabha should be added with two dronas (in the recipe actually one drona is described; it has to be taken double in quantity according to definition) of water, boiled and reduced to one fourth. One aksha [12 gm each of]: The paste of bharangi, patha, shunthi, maricha, pippali, trivrita, nichula (hijjala), shreyasi (hastipippali), adhaki, murva, danti, bhunimba; chitraka, shveta sariva, krishna sariva, rohisha, bhutika and madayantika along with prior said decoction, two prasthas [640 ml] of cow's ghee should be cooked by adding two prasthas of each of the juice of cow-dung, sour curd prepared of cow's milk, cow's milk and cow's urine, This medicated ghee, known as mahapancagavya is like ambrosia in the treatment (of following)[18-22]
==== Indications ====
Apasmara (epilepsy), unmada (insanity), shvayathu (edema), udara (obstinate abdominal diseases including ascitis), gulma (abdominal lumps), arshas (piles), pandu (anemia), kamala (jaundice) and halimaka (a serious type of jaundice).
Apasmara (epilepsy), unmada (insanity), shvayathu (edema), udara (obstinate abdominal diseases including ascitis), gulma (abdominal lumps), arshas (piles), pandu (anemia), kamala (jaundice) and halimaka (a serious type of jaundice).
This medicated ghee should be used regularly every day to dispel inauspiciousness and evil effects of bad planets. It also cures chaturthaka (quartan) type of vishama jwara (irregular fever).[23-24]
This medicated ghee should be used regularly every day to dispel inauspiciousness and evil effects of bad planets. It also cures chaturthaka (quartan) type of vishama jwara (irregular fever).[23-24]
=== ''Brahmi ghee'' ===
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Cow's ghee processed with the juice of ''brahmi,vacha, kushtha'' and ''shankhapushpi'' cures ''unmada, alaksmi'' (inauspiciousness), ''apasmara'' and ''papa'' (effects of sins, or evil deeds). [25]
Cow's ghee processed with the juice of ''brahmi,vacha, kushtha'' and ''shankhapushpi'' cures ''unmada, alaksmi'' (inauspiciousness), ''apasmara'' and ''papa'' (effects of sins, or evil deeds). [25]
=== ''Saindhava hingu ghee'' ===
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Cow's ghee (one part) should be cooked by adding (in total) four parts of the urine of bull and goat and the paste of rock salt and asafoetida (l/4th part in total). This medicated ghee cures ''apasmara'' (epilepsy), heart diseases and diseases caused by the evil effects of planetary misalignment.[26]
Cow's ghee (one part) should be cooked by adding (in total) four parts of the urine of bull and goat and the paste of rock salt and asafoetida (l/4th part in total). This medicated ghee cures ''apasmara'' (epilepsy), heart diseases and diseases caused by the evil effects of planetary misalignment.[26]
=== ''Vacha-shampakadi ghee'' ===
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Ghee (one part) should be cooked with the paste of ''vacha, shampaka, kaitarya'' (''parvata nimba''), ''vayastha'' (''guduchi''), ''hingu, choraka'' and ''palankasha'' or ''guggulu'' (1/4th part in total). (Four parts of water should be added according to the general rule, because in present recipe, there is no liquid). This medicated ghee is useful in the treatment of ''vatika'' and ''shlaishmika'' types of epilepsy. [27]
Ghee (one part) should be cooked with the paste of ''vacha, shampaka, kaitarya'' (''parvata nimba''), ''vayastha'' (''guduchi''), ''hingu, choraka'' and ''palankasha'' or ''guggulu'' (1/4th part in total). (Four parts of water should be added according to the general rule, because in present recipe, there is no liquid). This medicated ghee is useful in the treatment of ''vatika'' and ''shlaishmika'' types of epilepsy. [27]
=== ''Jivaniya Yamaka Sneha'' ===
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Two ''prasthas'' of ghee should be cooked by adding two ''dronas'' of juice of ''amalaki'' and two ''palas'' of the paste of ''madhuka''. This medicated ghee instantaneously cures the ''paittika'' type of ''apasmara'' (epilepsy). [31]
Two ''prasthas'' of ghee should be cooked by adding two ''dronas'' of juice of ''amalaki'' and two ''palas'' of the paste of ''madhuka''. This medicated ghee instantaneously cures the ''paittika'' type of ''apasmara'' (epilepsy). [31]
=== Drugs for external application ===
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Juice of ''apetarakshasi'' (''tulasi''), ''kushtha, putanakeshi'' (''jatamansi'') and ''choraka'' should be triturated by adding (cow's or goat's) urine and made to a paste. This should be used as unction (for the treatment of epilepsy). The body of the patient should be sprinkled with the urine (of cow or goat).[39]
Juice of ''apetarakshasi'' (''tulasi''), ''kushtha, putanakeshi'' (''jatamansi'') and ''choraka'' should be triturated by adding (cow's or goat's) urine and made to a paste. This should be used as unction (for the treatment of epilepsy). The body of the patient should be sprinkled with the urine (of cow or goat).[39]
=== Different unction formulations ===
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#ashes of the hair in the tail of the cow. [40]
#ashes of the hair in the tail of the cow. [40]
=== Drugs for ''nasya'' (nasal errhines) ===
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Oil (one part) should be cooked with goat’s urine (four parts) and the paste of ''haritaki, bibhitaki, amalaki, shunthi, pippali, maricha, pitadru'' (''devadaru''), ''yavakshara, phaninjhaka, shyama, apamarga'' and fruits of ''karanja''. (One fourth part in total). Inhalation of this medicated oil cures ''apasmara'' (epilepsy).[43-44]
Oil (one part) should be cooked with goat’s urine (four parts) and the paste of ''haritaki, bibhitaki, amalaki, shunthi, pippali, maricha, pitadru'' (''devadaru''), ''yavakshara, phaninjhaka, shyama, apamarga'' and fruits of ''karanja''. (One fourth part in total). Inhalation of this medicated oil cures ''apasmara'' (epilepsy).[43-44]
=== ''Pradhamana nasya'' formulation ===
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The powder of ''pippali, vrishchikali, kushtha, saindhava, lavana, sauvarchala lavana, samudra lavana, vida lavana, audbhida lavana'' (vide sutra 1:88-89) and ''bhargi'' should be administered in the form of ''pradhamana nasya'' (in which powders of drugs are blown into the nostrils of the patient.) This is an excellent recipe (for curing epilepsy).[45]
The powder of ''pippali, vrishchikali, kushtha, saindhava, lavana, sauvarchala lavana, samudra lavana, vida lavana, audbhida lavana'' (vide sutra 1:88-89) and ''bhargi'' should be administered in the form of ''pradhamana nasya'' (in which powders of drugs are blown into the nostrils of the patient.) This is an excellent recipe (for curing epilepsy).[45]
=== Medicated wicks ===
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(For the treatment of epilepsy), the physician should give fumigation therapy with the help of the beaks, feather and stool of mongoose, owl, cat, vulture, ''kita'' (scorpion etc), snake and crow. [51]
(For the treatment of epilepsy), the physician should give fumigation therapy with the help of the beaks, feather and stool of mongoose, owl, cat, vulture, ''kita'' (scorpion etc), snake and crow. [51]
=== Effects of therapy ===
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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]
=== Treatment of ''Aagantu apasmara'' ===
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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) (refer to Chapter 9 of this section, i.e., [[Unmada Chikitsa]]).[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) (refer to Chapter 9 of this section, i.e., [[Unmada Chikitsa]]).[53].
=== ''Mahagada chikitsa'' (management of ''atattvabhinivesha'') ===
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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'' ===
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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'' ===
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#powder of ''vacha'' with honey.[64]
#powder of ''vacha'' with honey.[64]
=== Prognosis ===
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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 ===
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Thus, ends the tenth Chapter dealing with the treatment of ''apasmara'' in the section on therapeutics of Agnivesha's work as redacted by Charak, 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 Charak, and not being available, restored by Dridhabala. [69]
=== ''Tattva Vimarsha'' / Fundamental Principles===
== Tattva Vimarsha (Fundamental Principles) ==
#''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.
#''Ashwasana'' (assurance therapy) and psychological counseling are advised to remove psychological stressors that provoke ''apasmara vega''(episode).
#''Ashwasana'' (assurance therapy) and psychological counseling are advised to remove psychological stressors that provoke ''apasmara vega''(episode).
=== ''Vidhi Vimarsha'' / Applied Inferences===
== Vidhi Vimarsha (Applied Inferences ) ==
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'' ===
Role of pure diet is important, because it nourishes mind, enriches senses and motor organs. The ''Panchakosha'' theory of Yoga states that the sheath of mind (''manomaya kosha'') is nourished through sheath of food (''annamaya kosha'') only. Therefore, following proper, pure diet and dietary habits is necessary for preventing psychiatric disorders.
Role of pure diet is important, because it nourishes mind, enriches senses and motor organs. The ''Panchakosha'' theory of Yoga states that the sheath of mind (''manomaya kosha'') is nourished through sheath of food (''annamaya kosha'') only. Therefore, following proper, pure diet and dietary habits is necessary for preventing psychiatric disorders.
The physical ''doshas'' like ''vata, pitta'' and ''kapha'' are assigned certain psychological functions also. Their rise and accumulation takes place at different stage after taking food. Therefore, the type of disease depending upon type of dominant ''dosha,'' evoked due to dominant diet specific to a particular ''dosha''. ''Apasmara'' is also caused due to vitiation of ''dosha'' owing to improper diet. This clarifies link between diet, ''dosha,'' mental functions, memory and consciousness.
The physical ''doshas'' like ''vata, pitta'' and ''kapha'' are assigned certain psychological functions also. Their rise and accumulation takes place at different stage after taking food. Therefore, the type of disease depending upon type of dominant ''dosha,'' evoked due to dominant diet specific to a particular ''dosha''. ''Apasmara'' is also caused due to vitiation of ''dosha'' owing to improper diet. This clarifies link between diet, ''dosha,'' mental functions, memory and consciousness.
=== Memory and consciousness ===
The profound relation between memory and consciousness is clearly indicated in ''apasmara''. In [[Ayurveda]], memory is termed as fundamental knowledge based upon experiences acquired through sense and motor organs. In psychology, memory is the mental capacity with which information is encoded, stored, and retrieved. Consciousness is the state of awareness of internal events and external environment.<ref>Available from glossary of psychological terms retrived from http://www.apa.org/research/action/glossary.aspx?tab=3 on August 22, 2017</ref> In ''apasmara'', consciousness is affected leading to transient loss of memory.
The profound relation between memory and consciousness is clearly indicated in ''apasmara''. In [[Ayurveda]], memory is termed as fundamental knowledge based upon experiences acquired through sense and motor organs. In psychology, memory is the mental capacity with which information is encoded, stored, and retrieved. Consciousness is the state of awareness of internal events and external environment.<ref>Available from glossary of psychological terms retrived from http://www.apa.org/research/action/glossary.aspx?tab=3 on August 22, 2017</ref> In ''apasmara'', consciousness is affected leading to transient loss of memory.
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 Neurocardiology ===
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 behavior 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.<ref>Martin A. Samuels, Contemporary Reviews in Cardiovascular Medicine,The Brain–Heart Connection. Circulation.2007; 116: 77-84 doi: 10.1161/CIRCULATIONAHA.106.678995 </ref>
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 behavior 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.<ref>Martin A. Samuels, Contemporary Reviews in Cardiovascular Medicine,The Brain–Heart Connection. Circulation.2007; 116: 77-84 doi: 10.1161/CIRCULATIONAHA.106.678995 </ref>
The theory of heart-brain connection has been well known to [[Ayurveda]] scholars in context of ''apasmara''.
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]].
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'' ===
[[File:Bidirectionalgut-brainaxis.png|500px|thumb]]
Gut-brain dysfunction is proved to play role in many psychiatric disorders like depression, anxiety, autism, schizophrenia.<ref>https://www.psychologytoday.com/blog/evolutionary-psychiatry/201404/the-gut-brain-connection-mental-illness-and-disease accessed on 13/09/2016 </ref>
Gut-brain dysfunction is proved to play role in many psychiatric disorders like depression, anxiety, autism, schizophrenia.<ref>https://www.psychologytoday.com/blog/evolutionary-psychiatry/201404/the-gut-brain-connection-mental-illness-and-disease accessed on 13/09/2016 </ref>
The figure shows physiology of gut-brain connection [fig. ]. As discussed earlier in [[Apasmara Nidana]], many of the somatic symptoms are related with the dysfunction of gastrointestinal tract.Therefore the possibility of gut-brain dysfunction cannot be denied.
The figure shows physiology of gut-brain connection. As discussed earlier in [[Apasmara Nidana]], many of the somatic symptoms are related with the dysfunction of gastrointestinal tract.Therefore the possibility of gut-brain dysfunction cannot 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.
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'' ===
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 the afflicted person is completely lost. This leads to improper judgment regarding eternal and ephemeral events and wholesome and unwholesome objects. Coordination 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 the afflicted person is completely lost. This leads to improper judgment regarding eternal and ephemeral events and wholesome and unwholesome objects. Coordination of mind, intellect, sense-motor organs is disturbed.
=== Patho-physiology of ''atattvabhinivesha'' ===
[[File:dietlifestyle.png|500px]]
[[File:dietlifestyle.png|500px]]
==== Differential diagnosis ====
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'', or 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'', or tremors).
''Apasmara'' is emphasized as ''manasa vikara'' due to loss of ''smriti'' (power of recollection), ''buddhi vyapoha'' (declining of logical and analytical understanding). The person becomes ''moodha'' (stupid). This holds appropriate to say “the loss of logical intelligence in the person”.
''Apasmara'' is emphasized as ''manasa vikara'' due to loss of ''smriti'' (power of recollection), ''buddhi vyapoha'' (declining of logical and analytical understanding). The person becomes ''moodha'' (stupid). This holds appropriate to say “the loss of logical intelligence in the person”.
==== Management of ''apasmara'' ====
The holistic management of ''apasmara'' includes three stages as discussed below:
The holistic management of ''apasmara'' includes three stages as discussed below:
==== I. Purification therapies ====
''Apasmara'' is to be treated with strong elimination therapies like [[Panchakarma]]. The strength here directs towards deeper level of penetrability of the therapies to remove the toxins from micro-channels.
''Apasmara'' is to be treated with strong elimination therapies like [[Panchakarma]]. The strength here directs towards deeper level of penetrability of the therapies to remove the toxins from micro-channels.
Role of these purification treatments like ''vamana'', etc. in normalizing functioning of heart (consciousness mechanism and emotional intelligence), heart-brain connection, and mental functions is important to be studied. This may prove a major breakthrough in prevention and management of psychiatric disorders. The changes in memory/awareness level, mind functioning, emotional quotient, improvement in forbearance power are bio-markers for the assessment.
Role of these purification treatments like ''vamana'', etc. in normalizing functioning of heart (consciousness mechanism and emotional intelligence), heart-brain connection, and mental functions is important to be studied. This may prove a major breakthrough in prevention and management of psychiatric disorders. The changes in memory/awareness level, mind functioning, emotional quotient, improvement in forbearance power are bio-markers for the assessment.
==== II. Assurance and consolation therapies ====
The episodes of ''apasmara'' occur on exposure of distressful events or psychological trauma due to negative emotions like worries, passion, fright, anger, grief, anxieties etc. This indicates poor emotional quotient. Affliction of mental ''dosha'' like ''rajas'' and ''tamas'' also need to be corrected basically. Therefore it is important to improve the emotional intelligence through positive training and programming of mind and brain to cope with the adverse situation. If the mental immunity is good, then ''apasmara'' episode will not occur, even if, the bodily ''doshas'' are aggravated. Cognitive Behaviour Therapy (CBT), REBT (Rational Emotive Behaviour Therapy) can be useful supportive treatments for management of ''apasmara'' to reduce frequency of episodes as well as effective management of disorder.
The episodes of ''apasmara'' occur on exposure of distressful events or psychological trauma due to negative emotions like worries, passion, fright, anger, grief, anxieties etc. This indicates poor emotional quotient. Affliction of mental ''dosha'' like ''rajas'' and ''tamas'' also need to be corrected basically. Therefore it is important to improve the emotional intelligence through positive training and programming of mind and brain to cope with the adverse situation. If the mental immunity is good, then ''apasmara'' episode will not occur, even if, the bodily ''doshas'' are aggravated. Cognitive Behaviour Therapy (CBT), REBT (Rational Emotive Behaviour Therapy) can be useful supportive treatments for management of ''apasmara'' to reduce frequency of episodes as well as effective management of disorder.
==== III. Pacification (''shamana'') therapy ====
After purification and consolation therapies are done, various formulations useful in treatment of ''apasmara'' have been enlisted. If we see the general medicines prescribed by Charak, all of the formulations are either ghee based or oil based formulations. Ghee is considered as best vehicle for management of ''vata-pitta'' dominant disorders. Oil is the best for ''vata-kapha'' dominant disorders. Ghee has been proved to be effective in treatment of many neurological disorders owing to its capacity of maintaining cellular integrity.
After purification and consolation therapies are done, various formulations useful in treatment of ''apasmara'' have been enlisted. If we see the general medicines prescribed by Charak, all of the formulations are either ghee based or oil based formulations. Ghee is considered as best vehicle for management of ''vata-pitta'' dominant disorders. Oil is the best for ''vata-kapha'' dominant disorders. Ghee has been proved to be effective in treatment of many neurological disorders owing to its capacity of maintaining cellular integrity.
* [[Apasmara Nidana]]
* [[Apasmara Nidana]]
== References ==
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