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Apasmara Nidana (view source)

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{{#seo:

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|title=Apasmara Nidana

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|titlemode=append

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|keywords=Apasmara, transient loss of memory, seizure disorders, epilepsy, mind-heart connection, mind-brain connection

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|description=Nidana Sthana Chapter 8. Diagnosis and etiopathogenesis of seizure disorders

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}}

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<big>'''Nidana Sthana Chapter 8. Diagnosis and etiopathogenesis of seizure disorders'''</big>

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===Sanskrit Text, Transliteration and English Translation===

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अथातोऽपस्मारनिदानं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः ||२||

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athātō'pasmāranidānaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

“Now we shall discuss the diagnosis of ''Apasmara''”, said Lord Atreya [1-2]

==== Four types of ''apasmara'' ====

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इह खलु चत्वारोऽपस्मारा भवन्ति वातपित्तकफसन्निपातनिमित्ताः ||३||

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iha khalu catvārō'pasmārā bhavanti vātapittakaphasannipātanimittāḥ||3||

iha khalu catvAro~apasmArA bhavanti vAtapittakaphasannipAtanimittAH||3||

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</div></div>

There are four types of ''apasmara'' caused by ''vata, pitta, kapha'' and ''sannipatika'' (combination of all the three ''doshas'').[3]

==== Persons prone to ''apasmara'' ====

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त एवंविधानां प्राणभृतां क्षिप्रमभिनिर्वर्तन्ते; तद्यथा- रजस्तमोभ्यामुपहतचेतसामुद्भ्रान्तविषमबहुदोषाणां समलविकृतोपहितान्यशुचीन्यभ्यवहारजातानि वैषम्ययुक्तेनोपयोगविधिनोपयुञ्जानानां

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विषमाः समाचरतामत्युपक्षयाद्वा दोषाः प्रकुपिता: रजस्तमोभ्यामुपहतचेतसामन्तरात्मनः श्रेष्ठतममायतनं हृदयमुपसृत्योपरि तिष्ठन्ते,

तथेन्द्रियायतनानि च | तत्र चावस्थिताः सन्तो यदा हृदयमिन्द्रियायतनानि चेरिताः कामक्रोधभयलोभमोहहर्षशोकचिन्तोद्वेगादिभिः सहसाऽभिपूरयन्ति, तदा जन्तुरपस्मरति ||४||

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ta ēvaṁvidhānāṁ prāṇabhr̥tāṁ kṣipramabhinirvartantē; tadyathā- Rajas tamōbhyāmupahatacētasāmudbhrāntaviṣamabahudōṣāṇāṁ samalavikr̥tōpahitānyaśucīnyabhyavahārajātāni vaiṣamyayuktēnōpayōgavidhinōpayuñjānānāṁ tantraprayōgamapi

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ca viShamamAcaratAmanyAshca sharIraceShTA viShamAHsamAcaratAmatyupakShayAdvA doShAH prakupitA rajastamobhyAmupahatacetasAmantarAtmanaHshreShThatamamAyatanaM hRudayamupasRutyopari tiShThante, tathendriyAyatanAni ca|

tatra cAvasthitAH santo yadA hRudayamindriyAyatanAni ceritAHkAmakrodhabhayalobhamohaharShashokacintodvegAdibhiH sahasA~abhipUrayanti, tadAjanturapasmarati||4||

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</div></div>

Individuals get quickly afflicted with ''apasmara'' if:

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</div>

==== Characteristic features of ''apasmara'' ====

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अपस्मारं पुनः स्मृतिबुद्धिसत्त्वसम्प्लवाद्बीभत्सचेष्टमावस्थिकं तमः प्रवेशमाचक्षते ||५||

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apasmāraṁ punaḥ smr̥ti buddhi sattva samplavādbībhatsacēṣṭamāvasthikaṁ tamaḥ pravēśamācakṣatē||5||

apasmAraM punaH smRutibuddhisattvasamplavAdbIbhatsaceShTamAvasthikaM tamaHpraveshamAcakShate||5||

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</div></div>

''Apasmara'' is characterized by occasional loss of consciousness associated with aberrant activities (like vomiting of froth and abnormal postures of the body) and behavior, due to perversion of memory, intellect and other psychic faculties. [5]

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तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- भ्रूव्युदासः सततमक्ष्णोर्वैकृतमशब्दश्रवणंलालासिङ्घाणप्रस्रवणमनन्नाभिलषणमरोचकाविपाकौ हृदयग्रहः कुक्षेराटोपो दौर्बल्यमस्थिभेदोऽङ्गमर्दो मोहस्तमसो दर्शनंमूर्च्छा भ्रमश्चाभीक्ष्णं स्वप्ने च मदनर्तनव्यधनव्यथनवेपनपतनादीनीति ||६||

ततोऽनन्तरमपस्माराभिनिर्वृत्तिरेव ||७||

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tasyēmāni pūrvarūpāṇi bhavanti; tadyathā- bhrūvyudāsaḥ satatamakṣṇōrvaikr̥tamaśabdaśravaṇaṁ

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tato~anantaramapasmArAbhinirvRuttireva||7||

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</div></div>

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Premonitory symptoms of ''apasmara'' include contraction of eyebrows, erratic and constant movement of eyes, auditory hallucinations, excessive salivation, and nasal discharge. There is frequent accompaniment of anorexia, indigestion, and general disinclination towards food, chest congestion, distension of the lower abdomen accompanied with gurgling sound, weakness, cracking pain in bones and malaise, unconsciousness, a feeling of despondency or depression, fainting and giddiness, and frequent dreams of scenes of intoxication, dancing, murdering, aching, shivering and falling. [6]

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===== ''Vata dosha'' dominant ''apasmara'' =====

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तत्रेदमपस्मारविशेषविज्ञानं भवति; तद्यथा-

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अभीक्ष्णमपस्मरन्तं, क्षणेन सञ्ज्ञां प्रतिलभमानम्, उत्पिण्डिताक्षम्, असाम्नाविलपन्तम्,

उद्वमन्तं फेनम्, अतीवाध्मातग्रीवम्, आविद्धशिरस्कं, विषमविनताङ्गुलिम्, अनवस्थितपाणिपादम्, अरुणपरुषश्यावनखनयनवदनत्वचम्, अनवस्थितचपलपरुषरूक्षरूपदर्शिनं, वातलानुपशयं, विपरीतोपशयं च वातेनापस्मरन्तं विद्यात् ||८||

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tatrēdamapasmāraviśēṣavijñānaṁ bhavati;

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abhIkShNamapasmarantaM, kShaNena sa~jj~jAM pratilabhamAnam, utpiNDitAkSham, asAmnA vilapantam, udvamantaM phenam,atIvAdhmAtagrIvam, AviddhashiraskaM, viShamavinatA~ggulim, anavasthitapANipAdam,aruNaparuShashyAvanakhanayanavadanatvacam, anavasthitacapalaparuSharUkSharUpadarshinaM,vAtalAnupashayaM, viparItopashayaM ca vAtenApasmarantaM vidyAt (1)||8||

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</div></div>

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More frequent episodes of ''apasmara'', episodes of instant loss of consciousness and regain it quickly, bulging or rolling up of eyes, incoherent speech, frothy vomit, excessive stiffness of neck, drooping of the head to one side, irregular contraction of fingers, unstable upper and lower limbs, redness, dryness and grayish tint in the nails, eyes, face and skin, apparent vision or perception of unstable, fickle, coarse and dry objects, conditions associated with consuming ''vata''-aggravating diets and alleviation of ailments when subjected to ''vata''-pacifying diets.[8-1]

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===== ''Pitta''-dominant ''apasmara'' =====

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अभीक्ष्णमपस्मरन्तं क्षणेन सञ्ज्ञां प्रतिलभमानम्, अवकूजन्तम्, आस्फालयन्तं भूमिं, हरितहारिद्रताम्रनखनयनवदनत्वचं,रुधिरोक्षितोग्रभैरवादीप्तरुषितरूपदर्शिनं, पित्तलानुपशयं,विपरीतोपशयं च पित्तेनापस्मरन्तं विद्यात् ||८||

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abhīkṣṇamapasmarantaṁ kṣaṇēna sañjñāṁ pratilabhamānam, avakūjantam, āsphālayantaṁ bhūmiṁ, haritahāridratāmranakhanayanavadanatvacaṁ, rudhirōkṣitōgrabhairavādīptaruṣitarūpadarśinaṁ, pittalānupaśayaṁ,viparītōpaśayaṁ ca pittēnāpasmarantaṁ vidyāt (2)||8||

abhIkShNamapasmarantaM kShaNena sa~jj~jAM pratilabhamAnam, avakUjantam, AsphAlayantaMbhUmiM, haritahAridratAmranakhanayanavadanatvacaM,rudhirokShitograbhairavAdIptaruShitarUpadarshinaM, pittalAnupashayaM,viparItopashayaM capittenApasmarantaM vidyAt (2)||8||

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</div></div>

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Frequent episodes of ''apasmara'', instant loss of consciousness and regaining it quickly, stertorous breathing, abnormal, dragging-like movement, green, yellow or coppery tint of nails, eyes, face and skin, apparent vision or perception of bleeding, terrifying, horrible, burning and angry looking objects, conditions associated with ''pitta''-aggravating diets and alleviation of ailments when subjected to ''pitta''-pacifying diets [8-2]

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===== ''Kapha''-dominant ''apasmara'' =====

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चिरादपस्मरन्तं, चिराच्च सञ्ज्ञां प्रतिलभमानं, पतन्तम्, अनतिविकृतचेष्टं, लालामुद्वमन्तं, शुक्लनखनयनवदनत्वचं,शुक्लगुरुस्निग्धरूपदर्शिनं, श्लेष्मलानुपशयं, विपरीतोपशयं च श्लेष्मणाऽपस्मर-न्तं विद्यात् ||८||

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cirādapasmarantaṁ, cirācca sañjñāṁ pratilabhamānaṁ, patantam, anativikr̥tacēṣṭaṁ, lālāmudvamantaṁ, śuklanakhanayanavadanatvacaṁ, śuklagurusnigdharūpadarśinaṁ, ślēṣmalānupaśayaṁ, viparītōpaśayaṁ ca ślēṣmaṇā'pasmarantaṁ vidyāt (3)||8||

cirAdapasmarantaM, cirAcca sa~jj~jAM pratilabhamAnaM, patantam, anativikRutaceShTaM,lAlAmudvamantaM, shuklanakhanayanavadanatvacaM, shuklagurusnigdharUpadarshinaM,shleShmalAnupashayaM, viparItopashayaM ca shleShmaNA~apasmarantaM vidyAt (3)||8||

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</div></div>

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Less frequent episodes of ''apasmara'', gradual loss and regain of consciousness, frequently falling down, less pronounced abnormalities in movement, dribbling of saliva, whitish discoloration of nails, eyes, face, and skin, apparent vision or perception of white, heavy and unctuous objects, and conditions associated with consuming ''kapha''-aggravating diets and alleviation of ailments when subjected to ''kapha''-pacifying diets [8-3]

</div>

===== ''Sannipatika apasmara'' with dominance of all ''dosha'' =====

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समवेतसर्वलिङ्गमपस्मारं सान्निपातिकं विद्यात्, तमसाध्यमाचक्षते

इति चत्वारोऽपस्मारा व्याख्याताः ||८||

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samavētasarvaliṅgamapasmāraṁ sānnipātikaṁ vidyāt, Tamasādhyamācakṣatē ||

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iti catvAro~apasmArA vyAkhyAtAH||8||

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</div></div>

''Sannipatika apasmara'' (caused by the simultaneous vitiation of all the three ''doshas'') shares the symptoms of all the three ''doshas'' (described above). This condition is incurable.

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===== ''Apasmara'' with extrinsic factors =====

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तेषामागन्तुरनुबन्धो भवत्येव कदाचित्, तमुत्तरकालमुपदेक्ष्यामः |

तस्य विशेषविज्ञानं यथोक्तलिङ्गैर्लिङ्गाधिक्यमदोषलिङ्गानुरूपं च किञ्चित् ||९||

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tēṣāmāganturanubandhō bhavatyēva kadācit, tamuttarakālamupadēkṣyāmaḥ|

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tasya visheShavij~jAnaM yathoktali~ggairli~ggAdhikyamadoShali~ggAnurUpaM ca ki~jcit||9||

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</div></div>

Sometimes these conditions are associated with extrinsic causative factors described later (in Cikitsa10:53). The symptoms that manifest in such cases, though, are not the same as those caused by vitiated ''doshas''. [9]

==== Management of ''apasmara'' ====

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हितान्यपस्मारिभ्यस्तीक्ष्णानि संशोधनान्युपशमनानि च यथास्वं, मन्त्रादीनि चागन्तुसंयोगे ||१०||

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hitānyapasmāribhyastīkṣṇāni saṁśōdhanānyupaśamanāni ca yathāsvaṁ, mantrādīni cāgantusaṁyōgē||10||

hitAnyapasmAribhyastIkShNAni saMshodhanAnyupashamanAni ca yathAsvaM, mantrAdInicAgantusaMyoge||10||

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</div></div>

Strong elimination and alleviation therapies are effective in alleviating and curing ''apasmara''. When extrinsic causative factors are involved, then ''mantras'' etc., are considered useful. [10]

==== Manifestation of various diseases ====

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तस्मिन् हि दक्षाध्वरध्वंसे देहिनां नानादिक्षु विद्रवतामभिद्रवणतरणधावनप्लवनलङ्घनाद्यैर्देहविक्षोभणैः पुरागुल्मोत्पत्तिरभूत्, हविष्प्राशात् प्रमेहकुष्ठानां, भयत्रासशोकैरुन्मादानां,

विविधभूताशुचिसंस्पर्शादपस्माराणां, ज्वरस्तु खलुमहेश्वरललाटप्रभवः ,

तत्सन्तापाद्रक्तपित्तम्, अतिव्यवायात् पुनर्नक्षत्रराजस्य राजयक्ष्मेति ||११||

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tasmin hi dakṣādhvaradhvaṁsē dēhināṁ nānādikṣu

vidravatāmabhidravaṇataraṇadhāvanaplavanalaṅghanādyairdēhavikṣōbhaṇaiḥ purā gulmōtpattirabhūt, haviṣprāśāt pramēhakuṣṭhānāṁ,

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tasmin hi dakShAdhvaradhvaMse dehinAM nAnAdikShuvidravatAmabhidravaNataraNadhAvanaplavanala~gghanAdyairdehavikShobhaNaiH purAgulmotpattirabhUt, haviShprAshAt pramehakuShThAnAM, bhayatrAsashokairunmAdAnAM,vividhabhUtAshucisaMsparshAdapasmArANAM, jvarastu khalu maheshvaralalATaprabhavaH ,tatsantApAdraktapittam, ativyavAyAt punarnakShatrarAjasya rAjayakShmeti||11||

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</div></div>

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As per vedic legends, in the aftermath of destruction of Daksha’s ''yajna'' (holy sacrifice), ''gulma'' (disease similar to lumps in abdomen) was manifested first in human beings due to stress induced as a result of fleeing, swimming, running, flying, etc. in all directions. ''Prameha'' (disease of obstinate urinary disorders) and ''kushtha'' (obstinate skin diseases including leprosy) were manifested due to excess intake of ghee. Various types of ''unmada'' (insanity/psychosis) were manifested due to fear, apprehension and grief. ''Apasmara'' (epilepsy) set in due to coming in contact with various types of unclean objects. ''Jwara'' came out of the forehead of Lord Shiva, and ''raktapitta'' was manifested (a condition characterized by bleeding from different parts of the body) due to ''jwara''’s heat. Moon was afflicted with ''rajayakshma'' due to excessive sexual indulgence. [11]

</div>

==== Summary ====

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भवन्ति चात्र-

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तदा साधारणं कर्म प्रवदन्ति भिषग्विदः ||१४||

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bhavanti cātra-

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tadA sAdhAraNaM karma pravadanti bhiShagvidaH||14||

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</div></div>

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From the preceding verses, it can be said that ''apasmara'' manifests itself due to the vitiation of ''vata, pitta'' and ''kapha'' and ''sannipata'' (combined vitiation of all the three ''doshas''). The ''sannipata'' variation is incurable. [12]

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When ''apasmara'' is caused by the vitiation of ''doshas'' associated with extrinsic causative factors, then general therapies addressing both (''doshic'' equilibrium and extrinsic causes) are advised by the best of physicians. [14]

</div>

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सर्वरोगविशेषज्ञः सर्वौषधविशारदः|

भिषक् सर्वामयान् हन्ति न च मोहं निगच्छति ||१५||

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sarvarōgaviśēṣajñaḥ sarvauṣadhaviśāradaḥ|

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bhiShak sarvAmayAn hanti na ca mohaM nigacchati ||15||

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</div></div>

An able physician, well versed in the specific characteristics of all diseases and the properties of all medicines, cures all (curable) diseases and does not get confused. [15]

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इत्येतदखिलेनोक्तं निदानस्थानमुत्तमम् |१६|

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ityētadakhilēnōktaṁ nidānasthānamuttamam|16|

ityetadakhilenoktaM nidAnasthAnamuttamam|16|

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</div></div>

This concludes the (excellent section titled) [[Nidana Sthana]]. [16]

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===== ''Nidanarthakara roga'' (disease specific causes) =====

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निदानार्थकरो रोगो रोगस्याप्युपलभ्यते ||१६||

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nidānārthakarō rōgō rōgasyāpyupalabhyatē||16||

nidAnArthakaro rogo rogasyApyupalabhyate||16||

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</div></div>

Diseases can act as causative factors of other diseases as well [16]

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तद्यथा-

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रक्तपित्ताज्ज्वरस्ताभ्यां शोषश्चाप्युपजायते ||१७||

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tadyathā-

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raktapittAjjvarastAbhyAM shoShashcApyupajAyate ||17||

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</div></div>

For example, elevated temperature in ''jwara'' can cause ''raktapitta'' and ''raktapitta'' can cause ''jwara''. Both the diseases (i.e ''jwara'' and ''raktapitta'') may lead to ''shosha'' (depletion of ''dhatus''). [17]

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प्लीहाभिवृद्ध्या जठरं जठराच्छोथ एव च |

अर्शोभ्यो जठरं दुःखं गुल्मश्चाप्युपजायते ||१८||

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plīhābhivr̥ddhyā jaṭharaṁ jaṭharācchōtha ēva ca|

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arshobhyo jaTharaM duHkhaM gulmashcApyupajAyate||18||

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</div></div>

''Pleeha'' (enlargement of spleen) causes ''jathara'' (abdominal diseases including ascitis), which leads to ''shotha'' (generalized edema). ''Arsha'' (hemorrhoids) causes ''jathara'' (abdominal diseases including ascitis) that leads to ''gulma'' (abdominal lumps). [18]

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प्रतिश्यायाद्भवेत् कासः कासात् सञ्जायते क्षयः |

क्षयो रोगस्य हेतुत्वे शोषस्याप्युपलभ्यते ||१९||

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pratiśyāyādbhavēt kāsaḥ kāsāt sañjāyatē kṣayaḥ|

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kShayo rogasya hetutve shoShasyApyupalabhyate||19||

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</div></div>

''Pratishyaya'' (rhinitis) leads to ''kasa'' (cough) which further leads to ''kshaya'' (depletion of ''dhatu''), consequently resulting in ''sosha'' (emaciation). [19]

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ते पूर्वं केवला रोगाः पश्चाद्धेत्वर्थकारिणः |

उभयार्थकरा दृष्टास्तथैवैकार्थकारिणः [१] ||२०||

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tē pūrvaṁ kēvalā rōgāḥ paścāddhētvarthakāriṇaḥ|

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ubhayArthakarA dRuShTAstathaivaikArthakAriNaH ||20||

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</div></div>

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Conditions in their primary stages or forms manifest themselves as diseases and subsequently act as causative factors for other diseases. They thus play a dual role - as a disease and as a causative factor. Some of these play just one role as well– either as a disease or as a causative factor. [20]

</div>

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कश्चिद्धि रोगो रोगस्य हेतुर्भूत्वा प्रशाम्यति |

न प्रशाम्यति चाप्यन्यो हेत्वर्थं कुरुतेऽपि च ||२१||

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kaściddhi rōgō rōgasya hēturbhūtvā praśāmyati|

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na prashAmyati cApyanyo hetvarthaM kurute~api ca ||21||

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</div></div>

Some diseases subside after causing another disease, while some do not subside even after causing another disease. [21]

+

एवं कृच्छ्रतमा नॄणां दृश्यन्ते व्याधिसङ्कराः |

प्रयोगापरिशुद्धत्वात्तथा चान्योन्यसम्भवात् ||२२||

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ēvaṁ kr̥cchratamā nr̥̄ṇāṁ dr̥śyantē vyādhisaṅkarāḥ|

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prayogAparishuddhatvAttathA cAnyonyasambhavAt||22||

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</div></div>

Combinations of diseases in human beings are usually very difficult to treat, owing to the complexity of the line of treatment, and their serving as causative factors of each other. [22]

===== Ideal therapy without adverse effects =====

+

प्रयोगः शमयेद्व्याधिं योऽन्यमन्यमुदीरयेत् |

नासौ विशुद्धः, शुद्धस्तु शमयेद्यो न कोपयेत् ||२३||

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prayōgaḥ śamayēdvyādhiṁ yō'nyamanyamudīrayēt|

Line 403: Line 488:

nAsau vishuddhaH, shuddhastu shamayedyo na kopayet||23||

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</div></div>

A therapy that alleviates one disease condition but provokes another disease is not ''shuddha'' (or is an impure or incorrect therapy). The ideal therapy is that which pacifies a disease without provoking any other disease. [23]

===== Diagnostic aspect of etiological factors =====

+

एको हेतुरनेकस्य तथैकस्यैक एव हि |

व्याधेरेकस्य चानेको बहूनां बहवोऽपि च ||२४||

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ēkō hēturanēkasya tathaikasyaika ēva hi|

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vyAdherekasya cAneko bahUnAM bahavo~api ca||24||

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</div></div>

One causative factor may cause one or many diseases. Many causative factors may result in a single disease or may cause several diseases. [24]

+

ज्वरभ्रमप्रलापाद्या दृश्यन्ते रूक्षहेतुजाः |

रूक्षेणैकेन चाप्येको ज्वर एवोपजायते ||२५||

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jvarabhramapralāpādyā dr̥śyantē rūkṣahētujāḥ|

Line 433: Line 524:

rUkSheNaikena cApyeko jvara evopajAyate||25||

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</div></div>

It is seen that a single causative factor, ruksha (dry) can cause many diseases such as ''jwara'' (fever), ''bhrama'' (vertigo) and ''pralapa'' (delirium) etc., while the same single factor (''ruksha'') may cause just one disease (''jwara'') [25]

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हेतुभिर्बहुभिश्चैको ज्वरो रूक्षादिभिर्भवेत् |

रूक्षादिभिर्ज्वराद्याश्च व्याधयः सम्भवन्ति हि ||२६||

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hētubhirbahubhiścaikō jvarō rūkṣādibhirbhavēt|

Line 447: Line 541:

rUkShAdibhirjvarAdyAshca vyAdhayaH sambhavanti hi||26||

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</div></div>

''Jwara'' alone may be caused by a combination of several causative factors including but not limited to ''ruksha''(dry) etc. and many causes like, ''ruksha'' (dry, rough) etc. may lead to several diseases. [26]

===== Diagnostic aspect of symptoms =====

+

लिङ्गं चैकमनेकस्य तथैवैकस्य लक्ष्यते |

बहून्येकस्य च व्याधेर्बहूनां स्युर्बहूनि च ||२७||

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liṅgaṁ caikamanēkasya tathaivaikasya lakṣyatē|

Line 463: Line 560:

bahUnyekasya ca vyAdherbahUnAM syurbahUni ca||27||

+

</div></div>

Similarly, one symptom may be common to many diseases, one symptom may be related to only one disease, many symptoms may be associated with only one disease, and many symptoms may be common to many diseases. [27]

+

विषमारम्भमूलानां लिङ्गमेकं ज्वरो मतः |

ज्वरस्यैकस्य चाप्येकः सन्तापो लिङ्गमुच्यते ||२८||

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viṣamārambhamūlānāṁ liṅgamēkaṁ jvarō mataḥ|

Line 477: Line 577:

jvarasyaikasya cApyekaH santApo li~ggamucyate||28||

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</div></div>

One symptom i.e. ''jwara'' can be considered common to many diseases that have irregular onset, while ''santapa'' (elevated temperature) is considered a symptom of only one disease i.e. ''jwara''.[28]

+

विषमारम्भमूलैश्च ज्वर एको निरुच्यते |

लिङ्गैरेतैर्ज्वरश्वासहिक्काद्याः सन्ति चामयाः ||२९||

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viṣamārambhamūlaiśca jvara ēkō nirucyatē|

Line 491: Line 594:

li~ggairetairjvarashvAsahikkAdyAH santi cAmayAH||29||

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</div></div>

Irregular onset (and similar other symptoms) appear in the case of ''jwara'', while similar symptoms also occur in ''shwasa'' (dyspnea), ''hikka'' (hiccups), and other similar diseases. [29]

===== Therapeutic considerations =====

+

एका शान्तिरनेकस्य तथैवैकस्य लक्ष्यते |

व्याधेरेकस्य चानेका बहूनां बह्व्य एव च ||३०||

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ēkā śāntiranēkasya tathaivaikasya lakṣyatē|

Line 507: Line 613:

vyAdherekasya cAnekA bahUnAM bahvya eva ca||30||

+

</div></div>

A single therapy can subside many diseases as well as a single disease. Multiple therapies may be needed to subside many diseases, whereas one disease could require multiple therapies to cure. [30]

+

शान्तिरामाशयोत्थानां व्याधीनां लङ्घनक्रिया |

ज्वरस्यैकस्य चाप्येका शान्तिर्लङ्घनमुच्यते ||३१||

+

śāntirāmāśayōtthānāṁ vyādhīnāṁ laṅghanakriyā|

Line 521: Line 630:

jvarasyaikasya cApyekA shAntirla~gghanamucyate||31||

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</div></div>

The diseases originating from ''amashaya'' are cured by ''langhana'' (fasting), only whereas only a single disease entity ''jwara'' also can be treated by the single therapy of ''langhana'' (fasting). [31]

−

+

+

तथा लघ्वशनाद्याश्च ज्वरस्यैकस्य शान्तयः |

एताश्चैव ज्वरश्वासहिक्कादीनां प्रशान्तयः ||३२||

+

tathā laghvaśanādyāśca jvarasyaikasya śāntayaḥ|

Line 535: Line 647:

etAshcaiva jvarashvAsahikkAdInAM prashAntayaH||32||

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</div></div>

For treating a single disease like ''jwara'', multiple therapies like light diet, etc. are needed and the same multiple therapies like light diet etc. are needed to subside many diseases like ''jwara''(fever), ''shwasa''(dyspnea), ''hikka''(hiccups) etc. [32]

===== Prognostic aspect in therapy =====

+

सुखसाध्यः सुखोपायः कालेनाल्पेन साध्यते |

Line 551: Line 665:

पादापचाराद्दैवाद्वा यान्ति भावान्तरं गदाः ||३५||

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sukhasādhyaḥ sukhōpāyaḥ kālēnālpēna sādhyatē|

Line 575: Line 690:

pAdApacArAddaivAdvA yAnti bhAvAntaraM gadAH||35||

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</div></div>

+

Easily curable diseases can be managed in a short time by simple measures. Diseases which are difficult to cure may require more effort and time to cure. The palliable variety of incurable diseases can never be cured, but can be alleviated. Incurable diseases are not amenable to any type of treatment.

Line 582: Line 699:

===== Examination of stages of disease =====

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वृद्धिस्थानक्षयावस्थां रोगाणामुपलक्षयेत् |

सुसूक्ष्मामपि च प्राज्ञो देहाग्निबलचेतसाम् ||३६||

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vr̥ddhisthānakṣayāvasthāṁ rōgāṇāmupalakṣayēt |

Line 594: Line 713:

susUkShmAmapi ca prAj~jo dehAgnibalacetasAm||36||

+

</div></div>

A wise physician should carefully observe the subtle changes in the state of diseases (aggravated, normal and diminished) while properly assessing the patient’s body strength, digestive power and mental ability. [36]

+

व्याध्यवस्थाविशेषान् हि ज्ञात्वा ज्ञात्वा विचक्षणः |

तस्यां तस्यामवस्थायां चतुःश्रेयः प्रपद्यते ||३७||

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vyādhyavasthāviśēṣān hi jñātvā jñātvā vicakṣaṇaḥ|

Line 608: Line 730:

tasyAM tasyAmavasthAyAM catuHshreyaH prapadyate||37||

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</div></div>

The physician, who is keenly observing variations in disease stages in the patient, should know it (the disease) well and prescribe such a treatment that would be helpful in attaining the fourfold effect of therapeutics. [37]

+

प्रायस्तिर्यग्गता दोषाः क्लेशयन्त्यातुरांश्चिरम् |

Line 618: Line 742:

ज्ञात्वा कोष्ठप्रपन्नांस्तान् यथासन्नं हरेद्बुधः ||३९||

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prāyastiryaggatā dōṣāḥ klēśayantyāturāṁściram|

Line 634: Line 759:

j~jAtvA koShThaprapannAMstAn yathAsannaM haredbudhaH||39||

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</div></div>

+

Generally, ''doshas'' that are spread over obliquely (in the transverse direction) afflict the patient for a longer time. In that condition, treatment should not be initiated in a hurry without proper assessment of body strength and digestive power.

These ''doshas'' should be alleviated first by treatment, or they should be carefully be drawn to the ''koshtha'' (bowel). After knowing their status in ''koshtha'', the wise physician should eliminate them through the nearest route. [38-39]

</div>

+

+

ज्ञानार्थं यानि चोक्तानि व्याधिलिङ्गानि सङ्ग्रहे |

व्याधयस्ते तदात्वे तु लिङ्गानीष्टानि नामयाः ||४०||

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jñānārthaṁ yāni cōktāni vyādhiliṅgāni saṅgrahē|

Line 649: Line 779:

vyAdhayaste tadAtve tu li~ggAnIShTAni nAmayAH||40||

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</div></div>

+

In the [[Nidana Sthana]], a compendium of symptomatology has been provided as a reckoner for the [[Ayurveda]] practitioner to gain adequate knowledge of some of the major classes of diseases and diagnose them effectively. But these symptoms may independently develop into diseases and create emergency situations. [40]

</div>

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+

विकारः प्रकृतिश्चैव द्वयं सर्वं समासतः |

तद्धेतुवशगं हेतोरभावान्नानुवर्तते ||४१||

+

vikāraḥ prakr̥tiścaiva dvayaṁ sarvaṁ samāsataḥ|

Line 663: Line 798:

taddhetuvashagaM hetorabhAvAnnAnuvartate||41||

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</div></div>

Everything can be categorized into being in a normal or an abnormal state. Both of these categories depend upon causes. Nothing can happen without a cause. [41]

==== Summary ====

+

तत्र श्लोकाः-

Line 681: Line 818:

निदानस्थानमेतावत् सङ्ग्रहेणोपदिश्यते ||४४||

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tatra ślōkāḥ-

Line 709: Line 847:

nidAnasthAnametAvat sa~ggraheNopadishyate||44||

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</div></div>

+

To sum up this chapter, etiological factors, premonitory symptoms, signs and symptoms, therapeutic relief, pathogenesis, historical origins and brief line of treatment of ''apasmara'' have been described in this section. Since this is the concluding chapter of the [[Nidana Sthana]], a summary to the entire section has also been provided here, stating that starting from ''jwara'' all eight diseases have been dealt with separately in eight chapters, each with etiological factors, symptomatology, prognosis and brief line of management.

Line 714: Line 854:

A compendium of diseases with etiological factors, their synonyms, symptoms of the diseases have been provided as an epilogue to the chapter. [42-44]

</div>

+

+

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने अपस्मारनिदानं नामाष्टमोऽध्यायः |

निदानस्थानं समाप्तम् ||८||

+

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē

Line 723: Line 866:

iti carakasaṁhitāyāṁ dvitīyaṁ nidānasthānaṁ samāptam|

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Thus, ends the eighth chapter on the ‘diagnosis of ''apasmara''” of the section “Diagnosis of diseases” ([[Nidana Sthana]]) of Agnivesha , as redacted by Charak.

Agnivesha

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Apasmara Nidana (view source)

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