Vaidya Pramod Kulkarni
M.D. (Ayurveda)
अपस्मार is a disease in which the patient not only loses consciousness but also suffers from sudden paroxysmal disorderly or uncontrolled movements of the voluntary muscles termed as a convulsion. In addition to the patients pathetic suffering, the sight of the patient writhing or agitating in a fit of convulsion is itself very painful to the healthy persons. Mind and Buddhi are not easily approachable either for investigation or treatment. Hence disease reappears with other difficulties both for the patient and his family.
The disease as such requires a rational approach both for the diagnosis and treatment. APASMAARA–APA S`HABDO GAMANAARTHAM Going away SMARAH —- SMARAN`AM Memory, knowledge of the surrounding, of the past events.
अपस्मार is a disease in which memory (Smriti), intellect (Buddhi) and mind (Sattva) get flowed out all together and there are disgusting movements by the patient. This is a momentary phase (Aavasthika) in which the patient gropes in the dark (Tamah Praves`ha).
This causes results from loss of DHI i.e. understanding or wisdom, Sattva (Consciousness when the mind gets deranged .. worry (CHINTAA), grief (S`HOKA), fears (BHAYA) etc. It happens because of the vitiated Dosha. When the mind gets deranged by the obstruction of the SANDNYAAVAHA channels (loss of consciousness) the person enters darkness with his mind becoming inactive, performs terrifying actions such as grinding the teeth, frothing at mouth, shaking the hands and feet violently (convulsion) seeing non-existing things, loses balance and falls to the ground, with irregular eye movements, gets up regaining conscious after the expiry of bouts of Dosha.
From above definition it can easily understood that the seats of the disease are the Buddhi and Manas including Manovaha channel and the main cause in their deranged functions both in the sensory and motor aspects.
अपस्मार is a disease with the deprivation of SMRITI or memory. According to Sus`hruta, Smriti is the faculty of recalling the past sense perceptions / experience. The sense perceptions constitute the knowledge. Therefore one can come to conclusion of Smriti is the experience associated with knowledge.
Prodromal Symptoms:
The features of the impending disease are tremors and feeling of emptiness of the heart, dizziness, seeing darkness before eyes, worry, abnormal movements of the eyes, sweating, flowing of saliva and nasal secretion, indigestion, loss of appetite, fainting, loss of strength, loss of sleep, body ache, thirst, dreaming of singing etc.
Pathogenesis:
Dooshya: Mind situated at Mastishka
Adhisht`haana: Hridaya & Manovaha channel
Srotas (Channel): Manovaha
Manas is also considered as Indriya and its objects is Chintya or the subject of thought which is independent of the sense organs. Therefore, can get vitiated due to the Ayoga Heenayoga, Atiyoga or Mithyaayoga contact of mind with Chintaa.
Periodicity of the Attack:
The vitiated and provoked tremors precipitate an attack of अपस्मार once every twelve days or every fortnight or every month; depending upon the Doshaanubandha, the paroxysm lasting for a brief period. In other words we can say that Vaataja, Pittaja, Kaphaja अपस्मार are accordingly. This periodicity is considered the nature of the disease.
- Types of अपस्मार:
- Vaataja
- Pittaja
- Kaphaja
- Saannipaatika (all Dosha together)
Symptoms
Vaataja अपस्मार:(During attack)
- Patient has tremors in thighs
- Falls on the ground again and again
- Quick loss of consciousness and revival
- Strangulated cry
- Eyes bulged out
- Dyspnoea
- Vomits froth
- Shivers
- Strikes hard to things nearby
- Grinds teeth
- Places arms and legs here and there irregularly
- Fingers are bent inward.
- Bluish red colour in the eyes, nails, face, skin
Pittaja अपस्मार:(During attack)
- Loses consciousness and quickly regains it
- Emits yellow froth from the mouth
- Yellowish eyes, face and skin
- Scratches the ground during convulsion
- Sees terrifying objects
- Suffers from thirst
Kaphaja अपस्मार: (During attack)
- Seizures are slow with long intervals
- Awaking actions are few and mild
- Regain consciousness slowly
- More flow of saliva
- White eyes, nails and face
Saannipaatika Apasmaara: Due to all Dosha, all the features appearing together as it is incurable hence no treatment is advised.
Prognosis: It is stated by ancient Grantha that for Saannipaatika Apasmaara is incurable. In addition Charakaachaarya states the one which occurs in debilitated persons and which is of long standing are also incurable. Status Epilapticus is also incurable.
Treatment of अपस्मार: In अपस्मार the channels of Dhi, Chitta and Mind which have become obstructed are covered by the Dooshya should be cleaned by पंचकर्म. The treatment is defined in two states,
- Vegaavasthaa (Attack state)-During attacks
- Avegaavasthaa (Normal state)- Between attacks
Treatment during attack period: Since the treatment is the restoration of the activity of Buddhi and it is achieved by the Sams`hodhana treatment, the important purificatory measure of the पंचकर्म to be administered during the attack period is Nasyakarma. The arrhythmic activity of the brain is mainly due to the abnormal stimulation. The activity can only be overcome by a strong a counter stimulation of the brain. The nearest route to the brain is nasal canal so Nasyakarma is most important in attack state.
- Samos`hodhana: According to Dosha सौषधं treatment needs Teekshn`a type of medicines.
- Yuktivyapaas`hraya and Satvaavajaya treatment
- Snehana, Svedana, वमन, Virechana, S`hirovirechana & Basti
Special Instruction
- Attendant should be sufficiently alert conscious to look after the patient because he may go near to fire or window or water in which accidents may occur.
- Always assure the patient to for getting cure counselling.
External treatment:
- नस्य: Vachaa (Acorus calamus) Pradhamana नस्य at the time of attack
- अभ्यंग: Jat`aamaamsee (Nardostachys jatamamsi) and Vachaa (Acorus calamus) medicated seasum oil
- Udvartana (application of powder)
- Hareetakee (Termmanalia chebula)
- Jat`aamaamsee (Nardostachys jatamamsi)
- Vachaa (Acorus calamus)
- S`hankhapushpee (Convolvulus pluricaulis)
Mixed with Gomootra (Cows urine)
पंचकर्म Treatment:
For medicinal recipes for the cure of Apasmaara which are to be administered to the patient after doing purification by पंचकर्म .
Vaataja अपस्मार :
- Basti (Enema): Medicated sesame oil with Nirgund`ee leaves (Vitex negundo) + Das`hamoola
- Quantity = 60 ml
- Duration = 30 days
Pittaja अपस्मार: Virechana (Purgation)
Decoction of following herbs : (250-500ml): Nis`hottara (Operculina turpethum), Aaragvadha (Cassia fistula), Hareetakee(termanalia chebula), Aamalakee (Phyllanthus emblica), Bibheetaka (Termalia belerica)
Mixed with Jyotishmatee (Cellastrus paniculatus) oil (25ml) Duration = 3days
Kaphaja अपस्मार: वमन (Emesis)
- Powder of Madanaphala (Randia dumetorum) (10gms) + hondy (20 gms)
- Decoction Vachaa (acorus calamus)
- Quantity as per patients need
Snehana (External Oleation), Svedana (Steam bath) and Aabhyantara Snehana (Internal Oleation) should be followed by any of this treatment.
Oil for internal oleation:
- Naaraayan`a Taila
- Ghee for internal oleation
- Panchagavya Ghee / Braahmee Ghee
Aabhyantara चिकित्सा: (Oral treatment)
- Morning and evening:
Smritisaagara Rasa 250 mgs
Vaatakulaantaka Rasa 250 mgs
Braahmee Vat`i 250 mgs
With honey (10 gms) - After Lunch and Dinner : Saarasvataarisht`a 20 ml with tap water
- Nasyakarma : Jyotishmatee (Cellastrus paniculatus) oil (4 drops / nostril twice a day).
Vaidya Pramod Kulkarni
M.D. (Ayurveda)
Last updated on February 16th, 2021 at 09:23 am