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AIAPGET POINTS

–        Pana and Abhyanga of Purana Sarpi and Yogas described in the treatment of Graha Roga are also prescribed in the treatment of Apasmara.

–        Godha-Nakuladhya Taila is used in the treatment of Apasmara.

–        Rudra and Rudra Ganas should be worshipped every day by patients suffering from Apasmara.

–        Panchagavya Ghrta described in Apasmara Pratisedha is also used in the treatment of Chaturthaka Jwara.

–        Siddharthaka Ghrta described in Apasmara Pratisedha is also used in the treatment of Vishama Jwara

–        In Apasmara, the person loses Smriti and Bhutartha Vijnana.

–        Sanjnavaha Srotas are affected by doshas, rajas and tamas in Apasmara.

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The 61st chapter of Uttaratantra of Sushruta Samhita is named as Apasmāra Pratiședha. This chapter deals with Treatment of Epilepsy.

अथातोऽपस्मारप्रतिषेधमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Apasmāra pratişedha – treatment of Epilepsy; as revealed by the venerable Dhanvantari.

Nirukti – definition

स्मृतिर्भूतार्थविज्ञानमपश्च परिवर्जने |
अपस्मार इति प्रोक्तस्ततोऽयं व्याधिरन्तकृत् ||३||

Apasmara is the name of a disease in which the memory and knowledge of nature (of the things) are lost. It eventually causes the death of the person.

Nidāna – causes

मिथ्यातियोगेन्द्रियार्थकर्मणामभिसेवनात् |
विरुद्धमलिनाहारविहारकुपितैर्मलैः ||४||
वेगनिग्रहशीलानामहिताशुचिभोजिनाम् |
रजस्तमोभिभूतानां गच्छतां च रजस्वलाम् ||५||
तथा कामभयोद्वेगक्रोधशोकादिभिर्भृशम् |
चेतस्यभिहते पुंसामपस्मारोऽभिजायते ||६||

Below mentioned are the causes of Apasmara –

–        improper and excess association of sense organs with their objects and

–        improper and excess activities of the body, mind and speech,

–        excessive indulgence in incompatible and contaminated foods and improper activities leading to aggravation of the doshas,

–        suppression of the urges of the body and

–        habitual consumption of dirty or polluted foods,

–        being greatly engrossed with rajas and tamas qualities,

–        copulation with woman during her menstrual periods,

–        being greatly afflicted with lust, fear, agitation, anger, sorrow and such other emotions

Due to these causes, the mind of the person gets disordered. As a result, Apasmara develops.

Pūrvarūpa – premonitory symptoms

हृत्कम्पः शून्यता स्वेदो ध्यानं मूर्च्छा प्रमूढता |
निद्रानाशश्च तस्मिंस्तु भविष्यति भवन्त्यथ ||७||

Below mentioned are the premonitory symptoms of Apasmara –

–        tremor,

–        feeling of emptiness of the heart (mind),

–        sweating,

–        worry,

–        fainting,

–        unconsciousness and

–        loss of sleep

These symptoms appear before the manifestation of the disease (apasmara).

Samprāpti – pathogenesis

सञ्ज्ञावहेषु स्रोतःसु दोषव्याप्तेषु मानवः |
रजस्तमःपरीतेषु मूढो भ्रान्तेन चेतसा ||८||
विक्षिपन् हस्तपादं च विजिह्मभ्रूर्विलोचनः |
दन्तान् खादन् वमन् फेनं विवृताक्षः पतेत् क्षितौ ||९||
अल्पकालान्तरं चापि पुनः सञ्ज्ञां लभेत सः |
सोऽपस्मार इति प्रोक्तः… |१०|

Below mentioned events (signs and symptoms) occur when the samjnavaha srotas i.e. channels carrying sensation become filled with vitiated by doshas, rajas and tamas also –

–        the person becomes senseless due to disordered mind,

–        makes violent movements of the arms, legs, eyebrows and eyes,

–        grinds the teeth,

–        emits froth from the mouth,

–        falls on the ground with eyes open and regains consciousness after short time

The disease presenting with the above said features is called Apasmara.

Types of Apasmara

… स च दृष्टश्चतुर्विधः ||१०||
वातपित्तकफैर्नॄणां चतुर्थः सन्निपाततः |११|

Apasmara is of four kinds –

–        one each by vata, pitta and kapha and

–        the fourth one by sannipata – combination of all the three doshas

Lakṣaṇa – clinical features

Vataja Apasmara

वेपमानो दशन् दन्तान् श्वसन् फेनं वमन्नपि ||११||
यो ब्रूयाद्विकृतं सत्त्वं कृष्णं मामनुधावति |
ततो मे चित्तनाशः स्यात् सोऽपस्मारोऽनिलात्मकः ||१२||

A person suffering from epilepsy of vata origin has the below mentioned signs and symptoms –

–        the person has trembling, bites his teeth, has dyspnoea and vomiting of froth,

–        he says that abnormal black coloured animals or objects are running after him and that

–        he has lost his mind

Pittaja Apasmara

तृट्तापस्वेदमूर्च्छार्तो धुन्वन्नङ्गानि विह्वलः |
यो ब्रूयाद्विकृतं सत्त्वं पीतं मामनुधावति ||१३||
ततो मे चित्तनाशः स्यात् स पित्तभव उच्यते |१४|

Persons suffering from epilepsy of pitta origin has the below mentioned signs and symptoms –

–        the person suffers from thirst, warmth, sweating and fainting, and shaking of the body parts,

–        he is agitated,

–        he says that abnormal yellow animals or objects are running after him and that

–        his mind has become lost

Kaphaja Apasmara

शीतहृल्लासनिद्रार्तः पतन् भूमौ वमन् कफम् ||१४||
यो ब्रूयाद्विकृतं सत्त्वं शुक्लं मामनुधावति |
ततो मे चित्तनाशः स्यात् सोऽपस्मारः कफात्मकः ||१५||

Signs and symptoms of epilepsy caused by kapha –

–        cold (rigors),

–        nausea,

–        sleep,

–        falling on the ground vomiting kapha,

–        seeing an abnormal animal or object running after him (the patient says so) and

–        the mind being lost (as experienced and said by the patient)

हृदि तोदस्तृडुत्क्लेदस्त्रिष्वप्येतेषु सङ्ख्यया |
प्रलापः कूजनं क्लेशः प्रत्येकं तु भवेदिह ||१६||

In these three kinds, pain in the heart, thirst and nausea are the special symptoms respectively. Irrelevant speech, moaning and debility are also found in these kinds respectively.

Sannipataja Apasmara

सर्वलिङ्गसमवायः सर्वदोषप्रकोपजे |१७|

All the symptoms of all doshas will be present together in apasmara produced by combination of all the doshas.

Añyamata – different opinion

अनिमित्तागमाद्व्याधेर्गमनादकृतेऽपि च ||१७||
आगमाच्चाप्यपस्मारं वदन्त्यन्ये न दोषजम् |१८|

Some scholars are of the opinion that Apasmara is not produced by the doshas. Below mentioned are the reasons –

–        apasmara arises without any apparent cause,

–        apasmara disappears without any treatment and

–        because of scriptures describing the disease differently

 Svamata – personal opinion (of Suśruta) 

क्रमोपयोगाद्दोषाणां क्षणिकत्वात्तथैव च ||१८||
आगमाद्वैश्वरूप्याच्च स तु निर्वर्ण्यते बुधैः |
देवे वर्षत्यपि यथा भूमौ बीजानि कानिचित् ||१९||
शरदि प्रतिरोहन्ति तथा व्याधिसमुद्भवः |
स्थायिनः केचिदल्पेन कालेनाभिप्रवर्धिताः ||२०||
दर्शयन्ति विकारांस्तु विश्वरूपान्निसर्गतः |
अपस्मारो महाव्याधिस्तस्माद्दोषज एव तु ||२१||

Wise persons are of the definitive opinion that the disease is born from doshas only because –

–        doshas become gradually aggravated,

–        the doshas are unstable i.e. changing from one stage to the other,

–        in all the scriptures it has been described that it is caused by the doshas and

–        of having many kinds

In spite of the rains occurring at other times also, the seed in the ground sprouts only during Sarad Rtu (autumn). Similarly, the disease also develops from the doshas which are staying in the body, getting aggravated in a very short time and manifesting its different symptoms by their nature only.

Hence, this dreadful disease – apasmara is produced by doshas only.

Cikitsä – treatment

तस्य कार्यो विधिः सर्वो य उन्मादेषु वक्ष्यते |
पुराणसर्पिषः पानमभ्यङ्गश्चैव पूजितः ||२२||
उपयोगो ग्रहोक्तानां योगानां तु विशेषतः |
ततः सिध्यन्ति ते सर्वे योगैरन्यैश्च साधयेत् |
शिग्रुकट्वङ्गकिण्वाहिनिम्बत्वग्रससाधितम् ||२३||
चतुर्गुणे गवां मूत्रे तैलमभ्यञ्जने हितम् |२४|

All kinds of treatments indicated for Unmada (insanity, psychoses) in the next chapter should be adopted in the treatment of this disease also.

In the previous chapter, drinking of old ghee, anointing the body with old ghee and use of medicinal formulae are mentioned for the treatment of grahas (demons). These treatments should specially be done in this disease also. Any other method or treatments which are beneficial in curing the affliction of grahas should also be adopted in the treatment of this disease.

Oil prepared with decoction of the below mentioned ingredients is beneficial for anointing –

–        bark of sigru,

–        katvanga,

–        kinihi and

–        nimba added with

–        four parts of gomutra

गोधानकुलनागानां पृषतर्क्षगवामपि ||२४||
पित्तेषु सिद्धं तैलं च पानाभ्यङ्गेषु पूजितम् |२५|
तीक्ष्णैरुभयतोभागैः शिरश्चापि विशोधयेत् ||२५||

 Oil prepared with the below mentioned ingredients is especially useful for drinking and anointing –

–        bile of iguana,

–        mongoose,

–        elephant and

–        spotted deer and

–        black deer

Purification of the body in both upper and lower directions i.e. vamana and virechana should be done. Apart from this, purgation of the head should also be done greatly with strong herbs.

पूजांरुद्रस्यकुर्वीततद्गणानांचनित्यशः।।

One should worship Rudra and his Gana (attendants, retinue) every day.

वातिकं बस्तिभिश्चापि पैत्तिकं तु विरेचनैः ||२६||
कफजं वमनैर्धीमानपस्मारमुपाचरेत् |२७|
Apasmara of Vata origin should be

treated by the wise physician by administering enema therapy.

Apasmara of Pitta origin should be treated by administration of purgation therapy.

Apasmara of Kapha origin should be treated by administration of emesis therapy.

कुलत्थयवकोलानि शणबीजं पलङ्कषाम् ||२७||
जटिलां पञ्चमूल्यौ द्वे पथ्यां चोत्क्वाथ्य यत्नतः |
बस्तमूत्रयुतं सर्पिः पचेत्तद्वातिके हितम् ||२८||

Decoction of the below mentioned is prepared –

–        Kulattha,

–        Yava,

–        Kola,

–        Sanabija,

–        Palankasa,

–        Jatila,

–        Herbs comprising of both Pancamula (Dasamula) and

–        Pathya

This decoction is added with goat’s urine and ghee is cooked with it. This ghee is beneficial in treating apasmara produced by vata.

काकोल्यादिप्रतीवापं सिद्धं च प्रथमे गणे |
पयोमधुसितायुक्तं घृतं तत् पैत्तिके हितम् ||२९||

Below mentioned are cooked together and medicated ghee is prepared –

–        ghee,

–        decoction of herbs belonging to the first gana i.e. vidarigandhadi gana group,

–        paste of herbs belonging to kakolyadi gana group

This ghee is consumed, mixed with milk, honey and sugar. It is beneficial in treating apasmara produced by pitta.

कृष्णावचामुस्तकाद्यैर्युक्तमारग्वधादिके |
पक्वं च मूत्रवर्गे तु श्लेष्मापस्मारिणे हितम् ||३०||

Ghee is cooked with –

–        decoction of Aragvadhadi Gana group of herbs along with

–        paste of Krsna, Vaca and Musta and

–        mutra vargas – groups of urine

This medicated ghee is beneficial in treating Apasmara produced by Kapha.

Siddharthaka ghṛta

सुरद्रुमवचाकुष्ठसिद्धार्थव्योषहिङ्गुभिः |
मञ्जिष्ठारजनीयुग्मसमङ्गात्रिफलाम्बुदैः ||३१||
करञ्जबीजशैरीषगिरिकर्णीहुताशनैः |
सिद्धं सिद्धार्थकं नाम सर्पिर्मूत्रचतुर्गुणम् ||३२||
कृमिकुष्ठगरश्वासबलासविषमज्वरान् |
सर्वभूतग्रहोन्मादानपस्मारांश्च नाशयेत् ||३३||

Decoction of the below mentioned herbs is prepared –

–        Suradruma (Devadaru),

–        Vaca,

–        Kustha,

–        Siddhartha,

–        Vyosa,

–        Hingu,

–        Manjistha,

–        Two kinds of Rajani,

–        Samanga,

–        Triphala,

–        Ambuda,

–        Karanja Bija,

–        Sirisa,

–        Girikarnika and

–        Hutasana (Citraka)

This decoction is boiled and processed with one part of ghee and four parts of gomutra and medicated ghee is prepared.

Benefits – This ghee is known as Siddharthaka Ghrta. When consumed, it cures diseases caused by worms, skin diseases, artificial poisons, dyspnoea, kapha diseases, intermittent fevers, diseases caused by all grahas (demons), insanity and epilepsy.

Pañcagavya ghṛta

दशमूलेन्द्रवृक्षत्वङ्मूर्वाभार्गीफलत्रिकैः |
शम्पाकश्रेयसीसप्तपर्णापामार्गफल्गुभिः ||३४||
शृतैः कल्कैश्च भूनिम्बपूतीकव्योषचित्रकैः |
त्रिवृत्पाठानिशायुग्मसारिवाद्वयपौष्करैः ||३५||
कटुकायासदन्त्युग्रानीलिनीक्रिमिशत्रुभिः [१] |
सर्पिरेभिश्च गोक्षीरदधिमूत्रशकृद्रसैः ||३६||
साधितं पञ्चगव्याख्यं सर्वापस्मारभूतनुत् |
चातुर्थकक्षयश्वासानुन्मादांश्च नियच्छति ||३७||

Ingredients –

–        Decoction of Dasamula, bark of Indravrksa, Murva, Bharngi, Phalatrika, Sampaka, Sreyasi, Saptaparna, Apamarga and Phalgu added with

–        Paste of Bhunimba, Putika, Vyosa, Citraka, Trivrt, Patha, two kinds of Nisa, two kinds of Sariva, Puskaramula, Katuka, Yasa, Danti, Ugra, Nilini and Krimisatru (vidanga), along with

–        Milk, curds, urine and juice of cow dung and ghee, all of cow

All the above said ingredients are boiled and processed together so as to prepare their medicated ghee.

This recipe is known as Pancagavya Ghrta. It cures all kinds of epilepsy, demons, quartan fever, consumption, dyspnoea and insanity.

भार्गीशृते पचेत् क्षीरे शालितण्डुलपायसम् |
त्र्यहं शुद्धाय तं भोक्तुं वराहायोपकल्पयेत् ||३८||
ज्ञात्वा च मधुरीभूतं तं विशस्यान्नमुद्धरेत् |
त्रीन् भागांस्तस्य चूर्णस्य किण्वभागेन संसृजेत् ||३९||
मण्डोदकार्थे देयश्च भार्गीक्वाथः सुशीतलः |
शुद्धे कुम्भे निदध्याच्च सम्भारं तं सुरां ततः ||४०||
जातगन्धां जातरसां पाययेदातुरं भिषक् |४१|

Milk should be boiled and processed with decoction of Bharngi, rice and milk. This recipe should be fed to a boar which has been made to fast for three days. It should be fed for three days. The boar should be killed after confirming that the boar has become sweet after consuming the above mentioned recipe.

Three parts of this meat should be taken and mixed with one part of kinva (yeast). This is now put into the decoction of Bharngi. This liquid is now poured into a clean pot along with adjuvants such as powder of Chaturjata, Pippali, Honey etc. This pot is kept undisturbed for some days. The recipe should be given to the patient for drinking once it has attained good smell and taste.

सिरां विध्येदथ प्राप्तां मङ्गल्यानि च धारयेत् ||४१||

After this, venepuncture may be done at the stipulated site as explained in sarira sthana, chapter 8. Mangalya i.e. amulets made from auspicious herbs etc should also be worn on the body.

इति श्रीसुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते भूतविद्यातन्त्रेऽपस्मारप्रतिषेधो नाम (द्वितीयोऽध्यायः, आदितः) एकषष्टितमोऽध्यायः।।६१।।

Thus ends the sixty-first chapter by name Apasmāra pratisedha in Uttara sthana of Suśruta Samhita.