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Line 837: − + − From the above sections, it is clear that apasmara occurs in episodes. The patient after seizure regains consciousness like waking up from sleep (suptavat pratibuddhyate). Therefore, there are two stages of disease : one is aggressive stage of doshas and the second is dormant stage of doshas. Sushruta describes that there are two forms of pathogenesis: One form follows the six stages viz. sanchaya etc.(kramopayogad) of the disease in sequence and takes considerable time to manifest disease with gradual onset. The other form manifests acutely in a short time (kshanikatwat). The first form is seen in nija (endogenous) pathologies of disease. The other form is seen in aagantu (exogenous) apasmara. Sushruta gives examples of a seed in the ground that sprouts only during sharad ritu (autumn) though it rains at other times. Analogous to this example, the virulent form of the disease develops due to a dosha getting aggravated in very short time and manifesting its different symptoms due to some factors catalyzing the accelerated aggravation. It is quite clear from the detailed descriptions in this chapter, though, that all forms of apasmara are caused by dosha only. − The example states the fact that favorable environment for precipitating factors plays major role in diseases episodes. Depending upon the defense system of the body – its natural and acquired immunity - as the background for disease and factors aggravating the dosha as offending agents, the interaction between the two defines severity, intensity and frequency of occurrence of episodes of disease as shown in chart below. − + − + + + + + + +
→Prognosis of apasmara
Bad prognostic signs of ''apasmara'' patients can often turn fatal. If one, in his wakeful state sees darkness where there is no darkness and hears all types of sound even when there is no sound, he succumbs to ''apasmara''. If a patient, while dancing in an intoxicated state is caught by a ''preta'' (soul of a dead person) with his head facing downwards, he is sure to succumb to an attack of ''apasmara''.
Bad prognostic signs of ''apasmara'' patients can often turn fatal. If one, in his wakeful state sees darkness where there is no darkness and hears all types of sound even when there is no sound, he succumbs to ''apasmara''. If a patient, while dancing in an intoxicated state is caught by a ''preta'' (soul of a dead person) with his head facing downwards, he is sure to succumb to an attack of ''apasmara''.
Reasons behind aggressive and dormant stages of apasmara:
==== Reasons behind aggressive and dormant stages of ''apasmara'' ====
Therefore, for prevention and management of a disease, it is important either to build up the strength of defense system i.e. improving the sharira bala (physical strength) and sattva bala (mental strength), or pacify/weaken the aggravating causative factors or both.
From the above sections, it is clear that ''apasmara'' occurs in episodes. The patient after seizure regains consciousness like waking up from sleep (''suptavat pratibuddhyate''). Therefore, there are two stages of disease : one is aggressive stage of ''doshas'' and the second is dormant stage of ''doshas''. Sushruta describes that there are two forms of pathogenesis: One form follows the six stages viz. ''sanchaya'' etc.(''kramopayogad'') of the disease in sequence and takes considerable time to manifest disease with gradual onset. The other form manifests acutely in a short time (''kshanikatwat''). The first form is seen in ''nija'' (endogenous) pathologies of disease. The other form is seen in ''agantu'' (exogenous) ''apasmara''. Sushruta gives examples of a seed in the ground that sprouts only during ''sharad ritu'' (autumn) though it rains at other times. Analogous to this example, the virulent form of the disease develops due to a ''dosha'' getting aggravated in very short time and manifesting its different symptoms due to some factors catalyzing the accelerated aggravation. It is quite clear from the detailed descriptions in this chapter, though, that all forms of ''apasmara'' are caused by ''dosha'' only.
Management of apasmara
The example states the fact that favorable environment for precipitating factors plays major role in diseases episodes. Depending upon the defense system of the body – its natural and acquired immunity - as the background for disease and factors aggravating the ''dosha'' as offending agents, the interaction between the two defines severity, intensity and frequency of occurrence of episodes of disease as shown in chart below.
Therefore, for prevention and management of a disease, it is important either to build up the strength of defense system i.e. improving the ''sharira bala'' (physical strength) and ''sattva bala'' (mental strength), or pacify/weaken the aggravating causative factors or both.
==== Management of ''Apasmara'' ====
Although the management of apasmara is described further in Chikitsa Sthana, principles of management are given in this chapter. The curable types of epilepsy should be carefully treated with strong elimination and alleviation therapies according to the vitiated dosha. Doshas present in the vessels above the heart need to be removed which require strong measures requiring medicines having higher penetrability, higher potency and highest bio-availability. With this objective, tikshna samshodhana [strong elimination] and samshamana [alleviation therapies] are employed. When extrinsic causative factors are involved (aagantu apasmara), then mantras etc., will be useful.
Although the management of apasmara is described further in Chikitsa Sthana, principles of management are given in this chapter. The curable types of epilepsy should be carefully treated with strong elimination and alleviation therapies according to the vitiated dosha. Doshas present in the vessels above the heart need to be removed which require strong measures requiring medicines having higher penetrability, higher potency and highest bio-availability. With this objective, tikshna samshodhana [strong elimination] and samshamana [alleviation therapies] are employed. When extrinsic causative factors are involved (aagantu apasmara), then mantras etc., will be useful.
The rationale behind advocating strong elimination therapies is the deeper location and excess vitiated state of doshas. As described in patho-physiology earlier the dosha are in dormant state in the vessels above heart. Therefore to remove these dosha, strong eliminatory therapies are needed. The strength of the prescribed medicine is decided by their higher penetrability, potency and bio-availability.
The rationale behind advocating strong elimination therapies is the deeper location and excess vitiated state of doshas. As described in patho-physiology earlier the dosha are in dormant state in the vessels above heart. Therefore to remove these dosha, strong eliminatory therapies are needed. The strength of the prescribed medicine is decided by their higher penetrability, potency and bio-availability.