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→Sanskrit text, Transliteration and English Translation
iti ha smAha bhagavAnAtreyaH||2||
iti ha smAha bhagavAnAtreyaH||2||
We shall now describe in detail the medical treatment of apasmara (epilepsy). Thus, said Lord Atreya. [1-2]
We shall now describe in detail the medical treatment of apasmara (epilepsy). Thus, said Lord Atreya. [1-2]
Definition of apasmara:
==== Definition of apasmara ====
स्मृतेरपगमं प्राहुरपस्मारं भिषग्विदः|
स्मृतेरपगमं प्राहुरपस्मारं भिषग्विदः|
तमःप्रवेशं बीभत्सचेष्टं धीसत्त्वसम्प्लवात्||३||
तमःप्रवेशं बीभत्सचेष्टं धीसत्त्वसम्प्लवात्||३||
tamaHpraveshaM bIbhatsaceShTaM dhIsattvasamplavAt||3||
tamaHpraveshaM bIbhatsaceShTaM dhIsattvasamplavAt||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]
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:
==== Etiopathology ====
विभ्रान्तबहुदोषाणामहिताशुचिभोजनात् [१] |
विभ्रान्तबहुदोषाणामहिताशुचिभोजनात् [१] |
रजस्तमोभ्यां विहते सत्त्वे दोषावृते हृदि||४||
रजस्तमोभ्यां विहते सत्त्वे दोषावृते हृदि||४||
iii. The heart (site of consciousness) is obscured by aggravated doshas; and
iii. The heart (site of consciousness) is obscured by aggravated doshas; and
iv. Mind is distressed or annihilated by (affliction of negative emotions like) worry, passion, fright, anger, grief, anxiety etc. [4-5]
iv. Mind is distressed or annihilated by (affliction of negative emotions like) worry, passion, fright, anger, grief, anxiety etc. [4-5]
Pathogenesis and pre-ictal features (phase of aura):
==== Pathogenesis and pre-ictal features (phase of aura) ====
धमनीभिः श्रिता दोषा हृदयं पीडयन्ति हि|
धमनीभिः श्रिता दोषा हृदयं पीडयन्ति हि|
सम्पीड्यमानो व्यथते मूढो भ्रान्तेन चेतसा||६||
सम्पीड्यमानो व्यथते मूढो भ्रान्तेन चेतसा||६||
(By the above mentioned factors) doshas located in the vessels (dhamani=which carries nutrients or pulsates) afflict heart. Thus person suffers due to bewildered mind.[6]
(By the above mentioned factors) doshas located in the vessels (dhamani=which carries nutrients or pulsates) afflict heart. Thus person suffers due to bewildered mind.[6]
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:
==== Post ictal phase of apasmara ====
दोषवेगे च विगते सुप्तवत् प्रतिबुद्ध्यते|
दोषवेगे च विगते सुप्तवत् प्रतिबुद्ध्यते|
dōṣavēgē ca vigatē suptavat pratibuddhyatē|
dōṣavēgē ca vigatē suptavat pratibuddhyatē|
doShavege ca vigate suptavat pratibuddhyate|
doShavege ca vigate suptavat pratibuddhyate|
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:
==== Types of apasmara ====
पृथग्दोषैः समस्तैश्च वक्ष्यते स चतुर्विधः||८||
पृथग्दोषैः समस्तैश्च वक्ष्यते स चतुर्विधः||८||
pr̥thagdōṣaiḥ samastaiśca vakṣyatē sa caturvidhaḥ||8||
pr̥thagdōṣaiḥ samastaiśca vakṣyatē sa caturvidhaḥ||8||
pRuthagdoShaiH samastaishca vakShyate sa caturvidhaH||8||
pRuthagdoShaiH samastaishca vakShyate sa caturvidhaH||8||
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:
==== Features (Ictal phase) ====
===== Apasmara with vata dominance =====
कम्पते प्रदशेद्दन्तान् फेनोद्वामी श्वसित्यपि|
कम्पते प्रदशेद्दन्तान् फेनोद्वामी श्वसित्यपि|
Vatika apasmara is characterized by trembling, grinding of teeth, expelling froth [from 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, expelling froth [from mouth] and gasping. The patient gets visual hallucinations of objects which are rough, reddish brown or black in color. [ 9]
Apasmara with pitta dominance:
===== Apasmara with pitta dominance =====
पीतफेनाङ्गवक्त्राक्षः पीतासृग्रूपदर्शनः|
पीतफेनाङ्गवक्त्राक्षः पीतासृग्रूपदर्शनः|
satRuShNoShNAnalavyAptalokadarshI ca paittikaH||10||
satRuShNoShNAnalavyAptalokadarshI ca paittikaH||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]
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:
===== Apasmara with kapha dominance =====
शुक्लफेनाङ्गवक्त्राक्षः शीतो हृष्टाङ्गजो गुरुः|
शुक्लफेनाङ्गवक्त्राक्षः शीतो हृष्टाङ्गजो गुरुः|
पश्यञ्छुक्लानि रूपाणि श्लैष्मिको मुच्यते चिरात्||११||
पश्यञ्छुक्लानि रूपाणि श्लैष्मिको मुच्यते चिरात्||११||
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 visual 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 visual hallucinations of white objects and recovers late. [11]
Apasmara with mixed features of all dosha dominance and prognosis:
===== Apasmara with mixed features of all dosha dominance and prognosis =====
सर्वैरेतैः समस्तैस्तु लिङ्गैर्ज्ञेयस्त्रिदोषजः|
सर्वैरेतैः समस्तैस्तु लिङ्गैर्ज्ञेयस्त्रिदोषजः|
अपस्मारः स चासाध्यो यः क्षीणस्यानवश्च यः||१२||
अपस्मारः स चासाध्यो यः क्षीणस्यानवश्च यः||१२||
apasmAraH sa cAsAdhyo yaH kShINasyAnavashca yaH||12||
apasmAraH sa cAsAdhyo yaH kShINasyAnavashca yaH||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]
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:
==== Diagnosis as per frequency of seizures ====
पक्षाद्वा द्वादशाहाद्वा मासाद्वा कुपिता मलाः|
पक्षाद्वा द्वादशाहाद्वा मासाद्वा कुपिता मलाः|
अपस्माराय कुर्वन्ति वेगं किञ्चिदथान्तरम्||१३||
अपस्माराय कुर्वन्ति वेगं किञ्चिदथान्तरम्||१३||
apasmArAya kurvanti vegaM ki~jcidathAntaram||13||
apasmArAya kurvanti vegaM ki~jcidathAntaram||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]
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:
Management of apasmara:
तैरावृतानां हृत्स्रोतोमनसां सम्प्रबोधनम्|
तैरावृतानां हृत्स्रोतोमनसां सम्प्रबोधनम्|