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Sushruta SamhitaApasmara Pratisedha - Treatment of Apasmara - Sushrutasamhita Uttaratantra Chapter 61

Apasmara Pratisedha – Treatment of Apasmara – Sushrutasamhita Uttaratantra Chapter 61

एकषष्टितमोऽध्यायः अथातोऽपस्मारप्रतिषेधमध्यायं व्याख्यास्यामः , धन्वन्तरिः ॥ १ ॥ यथोवाच भगवान्

Now we shall discourse on the chapter which deals with the symptoms and medical treatment of Apasmara (Apasmara Pratisedha ). 1

स्मृतिर्भूतार्थविज्ञानमपश्च परिवर्जने। अपस्मार इति प्रोक्तस्ततोऽयं व्याधिरन्तकृत् ॥ २ ॥

Derivative Significance – The word “Smrti” signifies the faculty of past sense-perceptions and (the prefix ) “Apa” denotes the privation (of any object or attribute ). Hence, this disease (in which an individual loses the faculty of past cognitions) is termed Apasmara (Epilepsy) and it turns fatal. 2

॥३॥ । मिथ्यातियोगेन्द्रियार्थ-कर्मणामतिसेवनात् । विरुद्धमलिनाहार-विहारकुपितैर्मलैः वेगनिग्रहशीलानामहिताशुचिभोजिनाम् रजस्तमोऽभिभूतानां गच्छताञ्च रजस्वलाम् ॥ ४॥ तथा कामभयोद्वेग-क्रोधशोकादिभिर्भृशम् । चेतस्यभिहते पुंसामपस्मारोऽभिजायते ॥ ५ ॥

Causes- Excessive, inadequate and improper contact to the objects of the senses as well as to their actions, partaking of filthy, impure, incompatible and uncongenial articles of fare and regimen of conduct, repression of any natural urging of the body or aggravation of the Rajas and Tamas (nescience), or going to a woman for intercourse in her menses, or indulgence in amorous fancies, fright, anxiety, anger, or grief, etc., leads to an aggravation of the bodily Dosas which in their turn affect the mind (Cetas) very greatly and give rise to Apasmara. 3-5.

Premonitory Symptoms of Apasmara

हृत्कम्पः शून्यता स्वेदो ध्यानं मूर्च्छा प्रमूढता । निद्रानाशश्च तस्मिंस्तु भविष्यति भवन्त्यथ ॥ ६ ॥ संज्ञावहेषु स्त्रोत:सु दोषव्याप्तेषु मानवः । रजस्तमः परीतेषु मूढो मूढो विक्षिपन् हस्तपादञ्च भ्रान्तेन चेतसा ॥७॥ विजिह्मभूर्विलोचनः । दन्तान् खादन् वमन् फेनं विवृताक्षः पतेत् क्षितौ ॥ ८ ॥ अल्पकालान्तरञ्चापि पुनः संज्ञां लभेत सः । सोऽपस्मार इति प्रोक्तः स च दृष्टश्चतुर्विधः । वातपित्तकफैर्नृणां चतुर्थः सन्निपाततः ॥ ९ ॥

The sense-carrying Srotas (channels) of the body overwhelmed by the concerted action of the deranged Dosas bring in a predominance of Rajas and Tamas (Nescience) causing the patient unconscious and forgetful of all past memories. He writhes in agony and throws his hands and legs in convulsive jerk with contracted eyes (D.R. tongue) and eye-brows. he gnashes his teeth, with foams at the mouth etc. and falls to the ground with open eyes, the consciousness returning a short while after. The disease in called Apasmara which is classified into four distinct types— viz, Vataja, Pittaja, Kaphaja and Sannipataja.

Premonitory Symptoms – The throbbing of the heart, emptiness or lightness (of the chest i.e. a sense as if the external world is vanishing away fastly), perspiration, attentiveness, fainting, stupid appearance and sleeplessness are the symptoms, which are usually found to usher in an attack ( of Apasmara). 6-9.

Symptoms of Vataja and Pittaja Apasmara

वेपमानो दशन् दन्तान् श्वसन् फेनं वमन्नपि । यो ब्रूयाद् विकृतं सत्त्वं कृष्णं मामनुधावति ॥ १० ॥ ततो मे चित्तनाशः स्यात् सोऽपस्मारोऽनिलात्मकः ॥ ११ ॥ तृद्तापस्वेदमूर्च्छार्त्तो धुन्वन्नङ्गानि विह्वलः । यो ब्रूयाद् विकृतं सत्त्वं पीतं मामनुधावति । ततो मे चित्तनाश: स्यात् स पित्तभव उच्यते ॥ १२ ॥

Symptoms of Vataja and Pittaja types – In the Vaataja type of Apasmara the patient fancies that a dark supernatural being is coming after him to seize his person and is frightened and faints in consequence with shivering grinding of the teeth i.e. lock-jaw, laboured breathing and foaming at the mouth. Fainting is excited by a terror of being seized by a yellow and fierce-looking being in the Pittaja type which is further marked by thirst, increased heat of the body, perspiration, fainting,mild tremor of the limbs and restlessness. 10-12.

Kaphaja and Sannipataja Apasmara

शीतहल्लासनिद्रार्तः पतन् भूमौ वमन् कफम् । यो ब्रूयाद् विकृतं सत्त्वं शुक्लं मामनुधावति । ततो मे चित्तनाशः स्यात् सोऽपस्मारः कफात्मकः ॥ १३ ॥ हृदि तोदस्तृड्डुत्क्लेशस्त्रिष्वप्येतेषु संख्यया । प्रलापः कूजनं क्लेश: प्रत्येकन्तु भवेदिह ॥ १४ ॥ सर्वलिङ्गसमवायः सर्वदोषप्रकोपजे ॥ १५ ॥

Kaphaja and Sannipataja Types- Where the patient is excited by a fancied dread as if a supernatural being of white colour is coming to apprehend him, it is case of the Kaphaja type which is moreover characterised by the exhibition of such symptoms as shivering, nausea, sleepiness, falling prostrate on the ground and vomiting of mucus. Pain in the heart, thirst and nausea are the specific characteristics of the three types respectively. But delirious talk and the making of indistinct and moaning sounds are present in all the types. The specific features of all the three foregoing types manifest themselves in concert in a case of Sannipatika type. 13-15.

अनिमित्तागमाद् व्याधेर्गमनादकृतेऽपि च । आगमाच्चाप्यपस्मारं वदन्त्यन्ये न दोषजम् ॥ १६ ॥ क्रमोपयोगाद्दोषाणां क्षणिकत्वात् तथैव च । आगमाद् वैश्वरूप्याच्च स तु निर्वर्ण्यते बुधैः ॥ १७॥ वर्षात्यपि यथा देवे भूमौ बीजानि कानिचित् । शरदि प्रतिरोहन्ति तथा व्याधिसमुद्भवः ॥ १८ ॥ स्थायिनः केचिदल्पेन कालेनाभिप्रवर्धिताः । दर्शयन्ति विकारांस्तु विश्वरूपान् निसर्गतः ॥ १९ ॥ अपस्मारो महाव्याधिस्तस्माद्दोषज एव तु ॥ २० ॥

Discussion on its cause – The sudden appearance of the disease without any apparent cause and also its sudden and spontaneous disappearance after a short while without any apparent treatment, have induced several medical authorities to hold that Apasmara is not due to any (aggravation of the ) Dosa. Several authorities, on the contrary, have described, on the authority of other works on the subject, the gradual aggravation of the (suddenly) deranged Dosas as well as the concomitant symptoms of the disease in its various phases with the spontaneous and speedy nature of its abatement (though only temporary). Hence it may be presumed that as seeds sprout in autumn only, when the rains make the ground ready to receive them, the shortness of time being counted as no factor potent enough to obstruct the process (of sprouting), so the deranged Dosas of the body though gradually aggravated bring on, as a matter of fact, an attack of Apasmara with all its concomitant symptoms, only under conditions favourable to its appearance which may, however, be short and transitory in its duration. Hence this dreadful Apasmara is certainly a disease of Dosic origin. 16-20.

General Treatment of Apasmara

तस्य कार्यो विधिः सर्वो य उन्मादेषु वक्ष्यते । पुराणसर्पिषः पानमभ्यङ्गश्चैव पूजितः । उपयोगो ग्रहोक्तानां योगानान्तु विशेषतः ॥ २१ ॥ ततः सिध्यन्ति ते सर्वे योगैरन्यैश्च साधयेत् । शिग्रु कट्वङ्गकिणिहीनिम्बत्वग्रससाधितम् । चतुर्गुणे गवां मूत्रे तैलमभ्यञ्जने हितम् ॥ २२ ॥ गोधानकुलनागानां पृषतर्क्षगवामपि । पित्तेषु सिद्धं तैलञ्च पानाभ्यङ्गेषु पूजितम् ॥ २३ ॥ तीक्ष्णैरुभयतोभागैः शिरःश्चापि विशोधयेत् । पूजां रुद्रस्य कुर्वीत तद्गणानाञ्च नित्यशः ॥ २४ ॥

General Treatment – Medicinal agents and remedies to be mentioned in connection with insanity (Unmada) may be as well employed in the present disease. The use of matured clarified butter both internally and as unguents is recommended. Medicinal measures and compounds mentioned under the head of possession by the Grahas are also specially beneficial in the present disease. Oil duly cooked with Sigru, Katvanga (Syonaka), Kinna (sediment of wine) and with the expressed juice of Nimba-barks and with cow’s urine weighing four times as much, should be employed as unguents. Draughts and embrocations of oil duly cooked (separately) with the biles of a lizard, a mongoose, an elephant (or snake), a deer of the Prsata class, a bear and a cow, are recommended. Strong medicinal errhines (Siro-virecana) as well as strong emetics and purgatives should be administered. The divine Rudra god and the host of his followers should be regularly worshipped and propitiated every day. 21-24.

वातिकं बस्तिभिश्चापि पैत्तिकन्तु विरेचनैः । कफजं वमनैर्धीमानपस्मारमुपाचरेत् ॥ २५ ॥

General Treatment – Bastis should be applied in the Vataja, purgatives in the Pittaja and emetics in the Kaphaja types of Apasmara. 25.

Specific Treatment of Apasmara

कुलत्थयवकोलानि शणबीजं पलङ्कषाम् । जटिलां पञ्चमूल्यौ द्वे पथ्याञ्चोत्क्वाथ्य यत्नतः । बस्तमूत्रयुतं सर्पिः पचेत् तद् वातिके हितम् ॥ २६ ॥ काकोल्यादिप्रतीवापं सिद्धञ्च प्रथमे गणे। पयोमधुसितायुक्तं घृतं तत् पैत्तिके हितम् ॥ २७ ॥ कृष्णावचामुस्तकाद्यैर्युक्तमारग्वधादिके । पक्कं तन्मूत्रवर्गे तु श्लेष्मापस्मारिणे हितम् ॥ २८ ॥

Specific Treatment – Clarified butter duly cooked with goat’s urine and with the decoction of Kulattha, Yava, Kola, Sana-seeds, Palankasa (Guggulu-Jatamansi, Dasa-mula and Pathya may be given with advantage in a case of the Vataja type (of Apasmara). Clarified butter duly cooked with the decoction of the drugs of the first (i.e. Vidari-gandhadi ) group and with the drugs of Kakolyadi group (as Kalka) if administered with milk, honey and sugar would be beneficial in a case of the Pittaja type. The use of (the medicated) Ghrita duly cooked with Krsna, Vaca and the drugs of the Mustakadi group (as Kalka) and with the decoction of the drugs of the Aragvadhadi group¹ and with the five officinal kinds of animal urine is recommended in cases of the Kaphaja type of Apasmara.26-28.

Siddharthaka Ghrita

। ॥ २९ ॥ । सुरद्रुमवचाकुष्ठ-सिद्धार्थव्योषहिङ्गुभिः मञ्जिष्ठारजनीयुग्म-समङ्गात्रिफलाम्बुदैः करञ्जबीजशैरीष-गिरिकर्णीहुताशनैः सिद्धं सिद्धार्थकं नाम सर्पिर्मूत्रचतुर्गुणम् ॥ ३० ॥ क्रिमिकुष्ठगरश्वास-बलासविषमज्वरान् । सर्वभूतग्रहोन्मादानपस्मारांश्च नाशयेत् ॥ ३१ ॥

Siddharthaka Ghrita – Clarified butter duly cooked with (the Kalka of) Sura-druma, Vaca, Kustha, Siddhartha, Vyosa, Hingu, Manjistha, the two kinds of Rajani, Samanga, Tri-phala, Ambuda (Musta), Karanja- seeds, Sirisa-seeds, Giri-karna (white Aparajita) and Hutasana (Chitraka) and with four times as much of cow’s urine is called Siddharthaka Ghrita, which proves curative in cases of poisoning, worms (in the intestines ), Kustha, asthma, derangements of Kapha, Visama- Jvara, Bhuta-graha, insanity and Apasmara. 29-31.

Pancha gavya Ghrita

। ॥३२॥ दशमूलेन्द्रवृक्षत्वड्मूर्वाभार्गीफलत्रयैः शम्पाकश्रेयसीसप्तपर्णापामार्गफल्गुभिः शृतैः कल्कैश्च भूनिम्ब- पूतीकव्योषचित्रकैः । त्रिवृत्पाठानिशायुग्म – सारिवाद्वयपौष्करैः ॥ ३३॥ कटुकायासदन्त्युग्रा-नीलिनीक्रिमिशत्रुभिः । गोक्षीर-दधिमूत्रशकृद्रसैः ॥ ३४ ॥ सर्पिरेभिश्च साधितं पञ्चगव्याख्यं सर्वापस्मारभूतनुत् । चातुर्थकक्षयश्वासानुन्मादांश्च नियच्छति ॥ ३५ ॥

1. According to Dalhana, the Ghrita should be cooked with the decoction of Krsna and Vaca, while the drugs of the Aragvadhadi group should be used as kalka.

Pancha-gavya Ghrita— Clarified butter duly-cooked with the Kalka of Dasa-mula, barks of Indra-vrksa’, Murva, Bhargi, Tri-phala, Sampaka, (aragvadha), Sreyasi (Gaja-pippali), Sapta-parni, Apamarga and Pilu, and with the decoction of Bhu- nimba, Putika (Karanja), Vyosa, Chitraka, Trivrit, Patha, the two kinds of Haridra the two kinds of Sariva, Puskara-roots, Katuka, Madayanti (Malika), Ugra (Vaca), Nilini and Vidanga and with the milk, curd (Dadhi), urine and the expressed liquid of dung of a cow is called Panca-gavya Ghrita. It proves curative in all forms of Apasmara, Bhuta-graha, Caturthaka (quartian) fever, Phthisis, Asthma and Insanity. 32-35.

भार्गीश्रृते पचेत् क्षीरे शालितण्डुलपायसम् । त्र्यहं शुद्धाय तं भोक्तुं वराहायोपकल्पयेत् ॥ ३६ ॥ ज्ञात्वा च मधुरीभूतं तं विशस्यान्नमुद्धरेत् । त्रीन् भागांस्तस्य चूर्णस्य किण्वभागेन संसृजेत् ॥ ३७ ॥ मण्डोदकार्थे देयश्च भार्गीक्काथः सुशीतलः । शुद्धे कुम्भे निदध्याच्च सम्भारं तं सुरां ततः ॥ ३८ ॥ जातगन्धां जातरसां पाययेदातुरं भिषक् ॥ ३९ ॥ सिरां विध्येदथ प्रोक्तां मङ्गल्यानि च धारयेत् ॥ ४० ॥

Milk should be duly cooked with Bhargi and Payasa (porridge) should be prepared by cooking grains of Sali rice with this milk. This preparation should be given to a boar kept fasting for three days. When it is assured that the food taken has acquired a sweet taste (i.e. that the process of digestion has begun in the stomach of the boar) and when the symptoms of poisoning come to be exhibited in the boar, the contents shuld be taken out (of the boar’s stomach) and ( should be dried and) powdered. Three parts of this powder and one part of Kinva (the sediment of wine) should be mixed together and made to ferment in a cleansed earthen pitcher with the addition of the cooled decoction of Bhargi. The wine (Sura) thus prepared should be given in proper doses to the patient as soon as it would acquire its (particular) taste and aroma. Venesection (in the forehead) as recommended before (Sarira-sthana, Chap. VIII, 25-26) should be resorted to and prophylactic and auspicious articles should be used (by the patient). 36-40.

1. By the term Indra-vrksa-twak’some mean (barks of) Kutaja and Twak (cinnamon). 2. Bhargi— Dulhana explains it as Gosthodumbara – the wild fig.

– इति सुश्रुत संहितायामुत्तरतन्त्रे अपस्मारप्रतिषेधव्याख्यानामैकषष्टितमोऽध्यायः ॥ ६१ ॥

Thus ends the sixty-first chapter in the Uttara Tantra of the Susruta Samhita which deals with the symptoms and treatment of Apasmara.


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