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अपस्मारचिकित्सितोपक्रमः
अपस्मारचिकित्सितोपक्रमः
अथातोऽपस्मारचिकित्सितं व्याख्यास्यामः||१||
अथातोऽपस्मारचिकित्सितं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
इति ह स्माह भगवानात्रेयः||२||
athātō'pasmāracikitsitaṁ vyākhyāsyāmaḥ||1||
athātō'pasmāracikitsitaṁ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātrēyaḥ||2||
iti ha smāha bhagavānātrēyaḥ||2||
athAto~apasmAracikitsitaM vyAkhyAsyAmaH||1||
athAto~apasmAracikitsitaM vyAkhyAsyAmaH||1||
iti ha smAha bhagavAnAtreyaH||2||
iti ha smAha bhagavAnAtreyaH||2||
==== Definition of apasmara ====
We shall now describe in detail the medical treatment of ''apasmara'' (epilepsy). Thus said Lord Atreya. [1-2]
==== Definition of ''apasmara'' ====
स्मृतेरपगमं प्राहुरपस्मारं भिषग्विदः|
स्मृतेरपगमं प्राहुरपस्मारं भिषग्विदः|
तमःप्रवेशं बीभत्सचेष्टं धीसत्त्वसम्प्लवात्||३||
तमःप्रवेशं बीभत्सचेष्टं धीसत्त्वसम्प्लवात्||३||
smr̥tērapagamaṁ prāhurapasmāraṁ bhiṣagvidaḥ|
smr̥tērapagamaṁ prāhurapasmāraṁ bhiṣagvidaḥ|
tamaḥpravēśaṁ bībhatsacēṣṭaṁ dhīsattvasamplavāt||3||
tamaḥpravēśaṁ bībhatsacēṣṭaṁ dhīsattvasamplavāt||3||
smRuterapagamaM prAhurapasmAraM bhiShagvidaH|
smRuterapagamaM prAhurapasmAraM bhiShagvidaH|
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||
चिन्ताकामभयक्रोधशोकोद्वेगादिभिस्तथा|
चिन्ताकामभयक्रोधशोकोद्वेगादिभिस्तथा|
मनस्यभिहते नॄणामपस्मारः प्रवर्तते||५||
मनस्यभिहते नॄणामपस्मारः प्रवर्तते||५||
vibhrāntabahudōṣāṇāmahitāśucibhōjanāt [1] |
vibhrāntabahudōṣāṇāmahitāśucibhōjanāt [1] |
rajastamōbhyāṁ vihatē sattvē dōṣāvr̥tē hr̥di||4||
rajastamōbhyāṁ vihatē sattvē dōṣāvr̥tē hr̥di||4||
cintākāmabhayakrōdhaśōkōdvēgādibhistathā|
cintākāmabhayakrōdhaśōkōdvēgādibhistathā|
manasyabhihatē nr̥̄ṇāmapasmāraḥ pravartatē||5||
manasyabhihatē nr̥̄ṇāmapasmāraḥ pravartatē||5||
vibhrAntabahudoShANAmahitAshucibhojanAt [1] |
vibhrAntabahudoShANAmahitAshucibhojanAt [1] |
rajastamobhyAM vihate sattve doShAvRute hRudi||4||
rajastamobhyAM vihate sattve doShAvRute hRudi||4||
cintAkAmabhayakrodhashokodvegAdibhistathA|
cintAkAmabhayakrodhashokodvegAdibhistathA|
manasyabhihate nRUNAmapasmAraH pravartate||5||
manasyabhihate nRUNAmapasmAraH pravartate||5||
Apasmara occurs in those persons, in whom:
''Apasmara'' occurs in those persons, in whom:
#The ''doshas'' are excessively aggravated and have spread to other sites (''vibhranta'') due to (habitual) intake of improper/harmful and impure/contaminated food.
#In whom, the ''sattva'' (one of the attributes of mind representing purity and consciousness) is suppressed by ''rajas'' (another attribute of the mind representing energy and dynamism) and ''tamas'' (the third attribute of the mind representing passivity and ignorance) ;
#The heart (site of consciousness) is obscured by aggravated ''doshas''; and
#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||
पश्यत्यसन्ति रूपाणि पतति प्रस्फुरत्यपि|
पश्यत्यसन्ति रूपाणि पतति प्रस्फुरत्यपि|
जिह्वाक्षिभ्रूः स्रवल्लालो हस्तौ पादौ च विक्षिपन्||७||
जिह्वाक्षिभ्रूः स्रवल्लालो हस्तौ पादौ च विक्षिपन्||७||
dhamanībhiḥ śritā dōṣā hr̥dayaṁ pīḍayanti hi|
dhamanībhiḥ śritā dōṣā hr̥dayaṁ pīḍayanti hi|
sampīḍyamānō vyathatē mūḍhō bhrāntēna cētasā||6||
sampīḍyamānō vyathatē mūḍhō bhrāntēna cētasā||6||
paśyatyasanti rūpāṇi patati prasphuratyapi|
paśyatyasanti rūpāṇi patati prasphuratyapi|
jihvākṣibhrūḥ sravallālō hastau pādau ca vikṣipan||7||
jihvākṣibhrūḥ sravallālō hastau pādau ca vikṣipan||7||
dhamanIbhiH shritA doShA hRudayaM pIDayanti hi|
dhamanIbhiH shritA doShA hRudayaM pIDayanti hi|
sampIDyamAno vyathate mUDho bhrAntena cetasA||6||
sampIDyamAno vyathate mUDho bhrAntena cetasA||6||
pashyatyasanti rUpANi patati prasphuratyapi|
pashyatyasanti rUpANi patati prasphuratyapi|
jihvAkShibhrUH sravallAlo hastau pAdau ca vikShipan||7||
jihvAkShibhrUH sravallAlo hastau pAdau ca vikShipan||7||
(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 (or ''dhamani'', channels that carry nutrients) afflict the 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|
==== Types of apasmara ====
When the surge of ''doshas'' is over, he wakes up as if he is getting up from sleep (regains consciousness). [8]
==== 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) ====
==== Features (Ictal phase) ====
===== Apasmara with vata dominance =====
===== ''Apasmara'' with ''vata'' dominance =====
कम्पते प्रदशेद्दन्तान् फेनोद्वामी श्वसित्यपि|
कम्पते प्रदशेद्दन्तान् फेनोद्वामी श्वसित्यपि|
परुषारुणकृष्णानि पश्येद्रूपाणि चानिलात्||९||
परुषारुणकृष्णानि पश्येद्रूपाणि चानिलात्||९||
kampatē pradaśēddantān phēnōdvāmī śvasityapi|
kampatē pradaśēddantān phēnōdvāmī śvasityapi|
paruṣāruṇakr̥ṣṇāni paśyēdrūpāṇi cānilāt||9||
paruṣāruṇakr̥ṣṇāni paśyēdrūpāṇi cānilāt||9||
kampate pradasheddantAn phenodvAmI shvasityapi|
kampate pradasheddantAn phenodvAmI shvasityapi|
paruShAruNakRuShNAni pashyedrUpANi cAnilAt||9||
paruShAruNakRuShNAni pashyedrUpANi cAnilAt||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]
''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 =====
===== ''Apasmara'' with ''pitta'' dominance =====
पीतफेनाङ्गवक्त्राक्षः पीतासृग्रूपदर्शनः|
पीतफेनाङ्गवक्त्राक्षः पीतासृग्रूपदर्शनः|