अथातोऽपस्मारप्रतिषेधं व्याख्यास्यामः ।
इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter Apasmara pratisedha-treatment of epilepsy, thus said Atreya and other great sages.
Apasmara samprapti – definition and pathogenesis
स्मृत्यपायो ह्यपस्मारः स धीसत्त्वाभिसंप्लवात् । जायतेऽभिहते चित्ते चिन्ताशोकभयादिभिः ॥ १ ॥
उन्मादवत्प्रकुपितैश्चित्तदेहगतैर्मलैः हते सत्त्वे हृदि व्याप्ते संज्ञावाहिषु खेषु च ॥ २ ॥
तमो विशन् मूढमतिर्बीभत्सा: कुरुते क्रियाः । दन्तान् खादन् वमन् फेनं हस्तौ पादौ च विक्षिपन् ॥ ३
पश्यन्नसन्ति रूपाणि प्रस्खलन् पतति क्षितौ । विजिह्याक्षिभ्रुवो दोषवेगेऽतीते कालान्तरेण स पुनश्चैवमेव विबुध्यते ॥ ४ ॥ विचेष्टते ।
Aapasmara is apaya (going away, loss, destruction) of smrti ( memory, knowledge of the surrounding, of past events) and results from loss of dhi ( understanding, wisdom) and satva (consciousness, mind) when the citta (mind, thinking) gets deranged by (the effect of) worry, grief, fear etc. by the dosas getting increased in the same way as in unmada ( insanity) localised in the heart (mind) and deha (body); when the mind gets deranged by the obstructions of the samjnavaha channels (pathways of consciousness) the person enters into darkness (loss of consciousness) with his mind becoming inactive, performs terryfying actions such as grinding the teeth, emitting froth from the mouth, shaking the hands and feet voilently (convulsions), seeing non-existing things, loses balance and falls on the ground, with irregular eyes (movements) and eyebrows, gets up regaining conscious after the expiry of bouts of the dosas. After sometime (days or months) he acts similarly, performing such abnormal activities. 1-5a.
Apasmara Bheda – types of epilepsy
अपस्मारश्चतुर्भेदो वाताद्यैर्निचयेन च॥५॥
Apasmara (epilepsy ) is of four kinds; by vata etc. (vata, pitta and kapha) seperately and by their combination ( sannipata ), 5b.
Purva rupa – prodromal symptoms
रूपमुत्पत्स्यमानेऽस्मिन् हृत्कम्पः शून्यताभ्रमः । तमसो दर्शनं ध्यानं भ्रूव्युदासोऽक्षिवैकृतम् ॥ ६॥
अशब्दश्रवणं स्वेदो लालासिङ्घाणकस्स्रुतिः । अविपाकोऽरुचिर्मूर्च्छा कुक्ष्याटोपो बलक्षयः ॥ ७ ॥
निद्रानाशोऽङ्गमर्दस्तृट् स्वप्ने गानं सनर्तनम् । पानं तैलस्य मद्यस्य तयोरेव च मेहनम् ॥ ८ ॥
The features of the following disease are-tremors and feeling of the emptiness of the heart, dizziness, seeing darkness before the eyes (loss of consciousness), worry, drooping of the brows, abnormal movements of the eyes, hearing non existing sounds, sweating, flowing out of saliva, and nasal secretion, indigestion, loss of appetite, fainting, gurgling noise in the abdomen, loss of strength, loss of sleep, bodyache, thirst, dreams of singing, dancing, drinking, oil and wine and urinating the same ( all these in dreams ). 6-8.
Vataja apamsara – epilepsy of vata origin
तत्र वातात्स्फुरत्सक्थिः प्रपतंश्च मुहुर्मुहुः । अपस्मरति संज्ञां च लभते विस्वरं रुदन् ॥ ९ ॥
उत्पिण्डिताक्षः श्वसिति फेनं वमति कम्पते । आविध्यति शिरो दन्तान् दशत्याध्मातकन्धरः ॥ १०॥
परितो विक्षिपत्यङ्गं विषमं विनताङ्गुलिः | रूक्षश्यावारुणाक्षित्वड्नखास्यः कृष्णमीक्षते ॥ ११ ॥
चपलं परुषं रूपं विरूपं विकृताननम् ।
In that kind caused by vata, the patient has tremors in the thighs, falls on the ground again and again, losing memory (consciousness) and gets it back soon; cries in a bad voice, eyes bulged out, has dyspnoea, vomits froth; shivers, strikes his head (to things nearby) grinds the teeth, shoulders are bulged, places the body parts (arms, legs) here and there irregularly (convulsions), fingers are bent inward, dryness and blueish-red colour in the eyes, skin, nails and face; sees things which are black, unsteady and rough in shape or things which have no shape and abnormal faces. 9-12a.
Pittaja apamsara – epilepsy of pitta origin
अपस्मरति पित्तेन मुहुः संज्ञां च विन्दति ॥ १२ ॥
पीतफेनाक्षिवक्त्रत्वगास्फालयति मेदिनीम् । भैरवादीप्तरुषितरूपदर्शी तृषान्वितः ॥ १३ ॥
In that caused by pitta, the person loses consciousness and quickly regains it, emits yellow froth from the mouth; eyes, face, skin are yellowish, scratches the ground (during convulsions) sees terryfying, burning/bright red coloured objects and suffers from thirst. 12b-
Kaphaja apamsara – epilepsy of kapha origin
कफाच्चिरेण ग्रहणं चिरेणैव विबोधनम् । चेष्टाऽल्पा भूयसी लाला शुक्लनेत्रनखास्यता ॥ १४ ॥ शुक्लाभरूपदर्शित्वं
In that due to kapha, seizures are slow with long intervals, so also the awakening (regaining consciousness) actions (convulsions) are few and mild, there is more flow of saliva, eyes, nails and face are white, sees objects which are white in colour. 14-15a.
Sannipataja apamsara
सर्वलिङ्गं तु वर्जयेत् ।
That due to all the dosas has all the features appearing together; it should be rejected. 15a.
Apasmara Chikitsa – treatment of epilepsy
अथाऽऽवृतानां धीचित्तहत्खानां प्राक्प्रबोधनम् ॥ १५ ॥ तीक्ष्णैः कुर्यादपस्मारे कर्मभिर्वमनादिभिः ।
In apasmara (epilepsy ) The channels of dhi, citta and hrt (mind) which have become covered / obstructed ( by the dosas) should be cleared first by therapies such as strong emesis etc. 15b-16a.
वातिकं बस्तिभूयिष्ठैः, पैत्तं प्रायो विरेचनैः ॥ १६ ॥ श्लैष्मिकं वमनप्रायैरपस्मारमुपाचरेत् । सर्वतः सुविशुद्धस्य सम्यगाश्वासितस्य च ॥ १७ ॥ अपस्मारविमोक्षार्थं योगान् संशमनान् शृणु ।
That caused by vata should be treated/especially with enema therapy, that caused by pitta especially by purgation therapy and that caused by kapha, especially with emesis therapy. Listen now, for the medicinal recipes for the cure of epilepsy which are to be administered to the patient after doing purificatory thearapies and assuring him of cure.
Panchagavya ghrita
गोमयस्वरसक्षीरदधिमूत्रैः शृतं अपस्मारज्वरोन्मादकामलान्तकरं पिबेत् । हविः ॥ १८ ॥
Medicated ghee prepared by boiling ghee added with juice of fresh cowdung, cow’s milk, curd and cow’s urine cures epilepsy, fever, insanity and jaundice. 18b-19a.
Maha panchagavya ghrita
द्विपञ्चमूलत्रिफलाद्विनिशाकुटजत्वचः सप्तपर्णमपामार्गं नीलिनीं कटुरोहिणीम् । ॥१९॥ ॥२०॥
शम्याकपुष्करजटाफल्गुमूलदुरालभाः द्विपला: सलिलद्रोणे पक्त्वा पादावशेषिते ।
भार्गीपाठाढकीकुम्भनिकुम्भव्योषरोहिषैः ॥ २१ ॥
मूर्वाभूतीक भूनिम्बश्रेयसीसारिवाद्वयैः मदयन्त्यग्निनिचुलैरक्षांशैः सर्पिषः पचेत् ॥ २२ ॥
प्रस्थं तद्वद् द्रवैः पूर्वैः पञ्चगव्यमिदं महत् । ज्वरापस्मारजठरभगन्दरहरं ।
शोफार्श: कामलापाण्डुगुल्मकासग्रहापहम् परम् ॥ २३ ॥ ।
Two pala each of the two pancamulas, triphala, the two nisa, bark of kutaja, saptaparna, apamarga, nilini, katurohini, samyaka, puskarajata, root of phalgu and duralabha -are boiled in one drona of water and decoction reduced to one fourth. To this are added the paste of one aksa each of bharngi, patha; adhaki, kumbha, nikumbha, vyosa, rohisa, murva, bhutika, bhunimba, sreyasi, the two sariva, madayanti, agni, and nicula; one prastha of ghee, and liquids mentioned earlier (juice of fresh dung, milk, curds and urine of the cow) and medicated ghee prepared. Known as Mahapancagavya ghrta, it is best to cure fever, epilepsy enlargement of the abdomen, fistula-in-ano, oedema, haemorrhoids, jaundice, anaemia, abdominal tumour, caugh and diseases caused by evil spirits. 19b-24a.
ब्राह्मीरसवचाकुष्ठशङ्खपुष्पीभृतं घृतम् ॥ २४ ॥ मेध्यमुन्मादालक्ष्म्यपस्मारपाप्मजित् । पुराणं
Old ghee boiled with the fresh juice of brahmi, vaca, kustha and sankhapuspi-improves intellegence and cures insanity, sorcery, epilepsy and diseases caused by sins. 24b-25a.
तैलप्रस्थं घृतप्रस्थं जीवनीयैः पलोन्मितैः ॥ २५ ॥ क्षीरद्रोणे पचेत्सिद्धमपस्मारविमोक्षणम् ।
One prastha each of oil and ghee, one pala each of drugs of jivaniya gana (vide chapter 15 of sutrasthana) are cooked in one drona of milk; this medicated ghee cures epilepsy. 25b-26a.
कंसे क्षीरेक्षुरसयोः काश्मर्येऽष्टगुणे रसे ॥ २६ ॥
कार्षिकैर्जीवनीयैश्च सर्पिःप्रस्थं विपाचयेत् । वातपित्तोद्भवं क्षिप्रमपस्मारं निहन्ति तत् ॥ २७ ॥
Medicated ghee is prepared with one kamsa (adhaka) each milk and juice of sugarcane, eight parts of juice of kasmarya, one karsa each of the drugs of jivaniya gana and one prastha of ghee. This recipe quickly cures epilepsy caused by vata pitta together. 26b-27.
पयः । तद्वत् काशविदारौक्षुकुशक्काथशृतं कूष्माण्डस्वरसे सर्पिरष्टादशगुणे शृतम् ॥ २८ ॥
यष्टीकल्कमपस्मारहरं धीवाक्स्वरप्रदम् ।
Milk boiled with the decoction of kasa, vidari, iksu and kusa, acts similarly.
Ghee boiled with eighteen times its quantity of juice of kusmanda, added with paste of yasti- cures epilepsy and bestows good intellegence, speech and voice. 28.-29a.
Nasya yoga – nasal drops
कपिलानां गवां पित्तं नावने परमं हितम् ॥ २९ ॥ श्वशृगालबिडालानां सिंहादीनां च पूजितम् ।
Pitta (bile) of the cow which is brown in colour is beneficial as nasal dorps; that (bile) of the dog; jackal, cat, lion etc. is best. 29b-30a.
गोधानकुलनागानां पित्तेषु साधितं तैलं नस्येऽभ्यङ्गे च शस्यते । पृषतर्क्षगवामपि ॥ ३० ॥
Oil boiled with the bile the iguana lizard, mungoose, elephant, spotted deer ( or leopard), bear, or cow, is highly beneficial when used as nasal medication and massage over the body. 30b-31a.
त्रिफलाव्योषपीतद्रुयवक्षारफणिज्जकैः श्रयाह्वापामार्गकारञ्जवीजैस्तैलं विप्रचितम् ।
बस्तमूत्रे हितं नस्यं चूर्णं वा मापयेद्भिषक् ॥ ३२ ॥
Oil should be cooked with triphala, vyosa, pitadru, yavaksara phanijjaka, Sryahva ( bilva), apamarga, seed of karanja, with the addition of goat’s urine-this oil used as nasal drops or the powder of the above blown into the nose is beneficial. 31b-32.
Dhupa – fumigation
नकुलोलूकमार्जारगृध्रकीटाहिकाकजैः
तुण्डै: पक्षैः पुरीषैश्च धूपमस्य प्रयोजयेत् ॥ ३३ ॥
Fumigation should be done with the beak, feathers, and excreta of the mungoose, owl, cat, vulture, insects, snake or crow. 33.
शीलयेत्तैललशुनं पयसा वा शतावरीम् । ब्राह्मीरसं कुष्ठरसं वचां वा मधुसंयुताम् ॥ ३४ ॥ Taila (sesame oil) mixed with lasuna, satavari, mixed with milk, fresh juice of kustha or of vaca may be consumed daily. 34.
समं क्रुद्धैरपस्मारो दोषैः शारीरमानसैः । यज्जायते यतश्चेष महामर्मसमाश्रयः ॥ ३५ ॥
तस्माद्रसायनैरेनं तदार्तं दुश्चिकित्स्यमुपाचरेन् । चाग्नितोयादेर्विषमात्पालयेत्सदा ॥ ३६॥
Since apasmara (epilepsy) arises from the aggravation (increase) of the dosas of the body and mind together and the localised in a mahamarma (important vital organ-the head) so it is diffcult to cure; hence it should be treated with rasayana therapy ( rejuvinatory therapy ). The person suffering from it, should be protected from fire, water and such other hazardeous things always. 35-36.
मुक्तं मनो विकारेण त्वमित्थं कृतवानिति ।
न ब्रूयाद्विषयैरिष्टैः क्लिष्टं चेतोऽस्य बृंहयेत् ॥ ३७॥
After the mind becomes cleared of all disorders, the patient should not be told, “you were doing such and such acts etc.;” his mind ( which is feeble ) should be strengthened by supplying the things desired. 37.
इति श्रीवैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थानेऽपस्मारप्रतिषेधो नाम सप्तमोऽध्यायः ॥ ७ ॥
Thus ends the chapter — Apasmara pratisedha-the seventh in Uttarasthana of Astanga hrdaya samhita-composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
इत्यष्टाङ्गहृदये भूततन्त्रं तृतीयं समाप्तम् ।
Thus ends Bhuta tantra / graha chikitsa— (demonology)—the third branch of ayurveda.
