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→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 ====
Differential diagnosis:
===== 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/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)
Ardita caused when vayu does upashoshana [dries up] of bahu [arm] pada [leg] and janu [knees], is characterised by vakrata [curved] of mukhardha bhaga [half face] and also shareerardha [half body]. The attacks of ardita donot include convulsions as presenting feature. (Verses 38 to 42)
Ardita caused when vayu does upashoshana [dries up] of bahu [arm] pada [leg] and janu [knees], is characterised by vakrata [curved] of mukhardha bhaga [half face] and also shareerardha [half body]. The attacks of ardita donot include convulsions as presenting feature. (Verses 38 to 42)
Apatanaka is also a disease caused by vitiated vata either independently or due to avarana [obstruction] caused by kapha characteristically manifests with frequent unconsciousness, antarayama (forward bending of the body) and bahirayama (backward bending of the body). Because of this bending the disease is otherwise known as dhanustambha. (Verses 43 to 48)
Apatanaka is also a disease caused by vitiated vata either independently or due to avarana [obstruction] caused by kapha characteristically manifests with frequent unconsciousness, antarayama (forward bending of the body) and bahirayama (backward bending of the body). Because of this bending the disease is otherwise known as dhanustambha. (Verses 43 to 48)
Vepathu or kampa vata are characterised by kampa (tremor) of either single part/multiple parts / entire body.
Vepathu or kampa vata are characterised by kampa (tremor) of either single part/multiple parts / entire body.
In any of the above explained conditions either the involvement of hrudaya [heart] or manas[mind] are not specified. Hence they implicate more of neurological pathology rather than psychological disorder.
In any of the above explained conditions either the involvement of hrudaya [heart] or manas[mind] are not specified. Hence they implicate more of neurological pathology rather than psychological disorder.
Apatantraka which is explained in Trimarmeeya siddhi adhyaya of siddhi sthana (9th chapter, verses 12 to 15) is very much similar to that of apasmara in its clinical presentation. Avarana of hridaya by doshas lead to paroxysm of the vyadhi with pain in shira, shankha; body bending like a bow, akshepa (convulsions), dyspnea, hoarse expiratory cry like that of a pigeon, unconsciousness, etc. Once the avarana to hridaya by the doshas is clear the person looks healthy.
Apatantraka which is explained in Trimarmeeya siddhi adhyaya of siddhi sthana (9th chapter, verses 12 to 15) is very much similar to that of apasmara in its clinical presentation. Avarana of hridaya by doshas lead to paroxysm of the vyadhi with pain in shira, shankha; body bending like a bow, akshepa (convulsions), dyspnea, hoarse expiratory cry like that of a pigeon, unconsciousness, etc. Once the avarana to hridaya by the doshas is clear the person looks healthy.
Apatantraka is a hridaya marmashrita vyadhi which indicates variation in emotional intelligence of the person.The theory of neuro-cardiology differentiates apatantraka from apasmara the latter being a disorder of logical intelligence (smriti budhi satwa samplavat- ch. Ni. 8/5)
Apatantraka is a hridaya marmashrita vyadhi which indicates variation in emotional intelligence of the person.The theory of neuro-cardiology differentiates apatantraka from apasmara the latter being a disorder of logical intelligence (smriti budhi satwa samplavat- ch. Ni. 8/5)
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:
===== 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:
I. Purification therapies:
Important pathological milestone is occlusion of consciousness. Therefore to remove obstruction at heart [site of consciousness], channels of heart-brain connection, and mind is the treatment objective. Vata dominant apasmara is to be treated with medicated enema, pitta dominant with purgation therapies and kapha dominant with therapeutic emesis.
Important pathological milestone is occlusion of consciousness. Therefore to remove obstruction at heart [site of consciousness], channels of heart-brain connection, and mind is the treatment objective. Vata dominant apasmara is to be treated with medicated enema, pitta dominant with purgation therapies and kapha dominant with therapeutic emesis.
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 biomarkers 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 biomarkers 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:
III. Pacification [shamana] therapy:
Sugarcane Juice 1 adhaka
Sugarcane Juice 1 adhaka
Aamalki-madhuka ghee [verse 31]:
Aamalki-madhuka ghee [verse 31]:
Sr.No. Ingredients Part proportion Indications
Sr.No. Ingredients Part proportion Indications