Chapter LXI - Symptoms and Treatment of Epilepsy (Apasmara)

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

Derivative Significance:—

The word “Smriti” 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.

Causes:—

Excessive, inadequate and improper attention to the objects of the sense 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 in unto a woman in her menses, or indulgence in amorous fancies, fright, anxiety, anger, or grief, etc., leads to an aggravation of the bodily Doshas which in their turn affect the mind (Cetas) very greatly and give rise to Apasmara. 3.

The sense-carrying Srotas (channels) of the body overwhelmed by the concerted action of the deranged Doshas 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 jerks 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 is called Apasmara which is classified into four distinct types—vis., Vataja, Pittaja, Kaphaja and Sannipataja. 4.

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, pensiveness, fainting, stupid appearance and sleeplessness are the symptoms, which are usually found to usher in an attack (of Apasmara). 5.

Symptoms of Vataja and Pittaja types:—

In the Vataja 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. 6–7.

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 a 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. 8—10.

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) Dosha. Several authorities, on the contrary, have described, on the authority of other works on the subject, the gradual aggravation of the (suddenly) deranged Doshas 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 Doshas 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 idiopathic origin. 11.

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 Shigru, Katvanga, (Shyonaka), Kinna (sediment of wine) and with the expressed juice of Nimba -barks and with cow’s urine weiging 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 Prishata class, a bear and a cow, are recommended. Strong medicinal errhines (Shiro-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. 12—15.

Specific Treatment:—

Clarified butter duly cooked with goat’s urine and with the decoction of Kulattha, Yava, Kola, Shana-seeds, Palankasha (Guggulu), Jatamamsi, Dasha-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 Krishna, Vaca and the drugs of the Mustakadi group (as Kalka) and with the decoction of the drugs of the Aragvadhadi group^[1] and with the five officinal kinds of animal urine is recommended in cases of the Kaphaja type of Apasmara. 16—18.

Siddharthaka Ghrita:—

Clarified butter duly cooked with (the Kalka of) Sura-druma, Vaca, Kushtha, Siddhartha, Vyosha, Hingu, Manjishtha, the two kinds of Rajani, Samanga, Tri-phala, Atnbuda (Musta), Karanja-seeds, Shirish? -seeds, Giri-karna (white Aparajita) and Hutashana (Citraka) 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), Kushtha, asthma, derangements of Kapha, Vishama-Jvara, Bhuta-graha, insanity and Apasmara. 19.

Panca-gavya Ghrita:—

Clarified butter duly cooked with the Kalka of Dasha-mula, barks of Indra-vriksha,^[2] Murva, Bhargi^[3], Tri-phala, Sampaka, (Aragvadha), Shreyasi (Gaja-pippali), Sapta-parni, Apamarga and Pilu, and with the decoction of Bhu-nimba, Putika (Karanja), Vyosha, Citraka, Trivrit, Patha, the two kinds of Haridra, the two kinds of Sariva, Push-kara- roots Kaluka, Madayanti (Maliika), 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. 20.

General Treatment:—

Vastis should be applied in the Vataja, purgatives, in the Pittaja and emetics, in the Kaphaja types of Apasmara. 21.

 

Milk should be duly cooked with Bhargi and Payasa (porridge) should be prepared by cooking grains of Shali 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 should 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 (Sharira-sthana, Chap. VIII, 25-26) should be resorted to and prophylactic and auspicious articles should be used (by the patient). 22-23.

 

Thus ends the sixty first chapter in the Uttara Tantra of the Sushruta Samhita which deals with the (symptoms and) treatment of Apasmara.

Footnotes and references:

[1]:

According to Dallana, the Ghrita should be cooked with the decoction of Krishnā and Vaca, while the drugs of the Āragvadhādi group should be used as Kalka.

[2]:

By the term ‘Indra-vriksha-twak’ some mean (barks of) Kutaja and Twak (cinnamon).

[3]:

Bhārgi—Dallana explains it as Goshthodumbara—the wild fig.