Charaka Apasmara Nidana: 8th chapter

The 8th chapter of Charaka Samhitha Nidana Sthana is called Apasmara Nidana. It deals with the causes, pathology,types and symptoms of Apasmara –  Epilepsy, as per Ayurveda.

अथातोऽपस्मार निदानं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athāto’pasmāra nidānaṃ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātreyaḥ||2||
We shall now explore the chapter on the Apasmara – Diagnosis of Epilepsy. Thus said Lord Atreya [1-2]

Types of Apasmara (epilepsy):
इह खलु चत्वारोऽपस्मारा भवन्ति वात पित्त कफ सन्निपात निमित्ताः||३||
iha khalu catvāro’pasmārā bhavanti vāta pitta kapha sannipāta nimittāḥ||3||
There are 4 types of epilepsy, viz,
Vataja
Pittaja
Kaphaja and
Sannipataja [3]

Subjects of epilepsy:
त एवंविधानां प्राणभृतां क्षिप्रमभिनिर्वर्तन्ते; तद्यथा- रजस्तमोभ्यामुपहतचेतसामुद्भ्रान्त विषम बहु दोषाणां स मल विकृतोपहितान्यशुचीन्यभ्यवहारजातानि वैषम्य युक्तेनोपयोग विधिनोपयुञ्जानानां तन्त्र प्रयोगमपि च विषममाचरतामन्याश्च शरीरचेष्टा विषमाः समाचरतामत्युपक्षयाद्वा दोषाः प्रकुपिता रजस्तमोभ्यामुपहतचेतसामन्तरात्मनः श्रेष्ठ तममायतनं हृदयमुपसृत्योपरि तिष्ठन्ते, तथेन्द्रियायतनानि च|
तत्र चावस्थिताः सन्तो यदा हृदयमिन्द्रियायतनानि चेरिताः काम क्रोध भय लोभ मोह हर्ष शोक चिन्तोद्वेगादिभिः सहसाऽभिपूरयन्ति, तदा जन्तुरपस्मरति||४||
ta evaṃvidhānāṃ prāṇabhṛtāṃ kṣipramabhinirvartante; tadyathā- rajastamobhyāmupahata cetasāmudbhrānta viṣama bahu doṣāṇāṃ sa mala vikṛtopahitānyaśucīnyabhyavahārajātāni vaiṣamya yuktenopayoga vidhinopayuñjānānāṃ tantra prayogamapi ca viṣamamācaratāmanyāśca śarīraceṣṭā viṣamāḥ samācaratāmatyupakṣayādvā doṣāḥ prakupitā rajastamobhyāmupahatacetasāmantarātmanaḥ śreṣṭha tamamāyatanaṃ hṛdayamupasṛtyopari tiṣṭhante, tathendriyāyatanāni ca|
tatra cāvasthitāḥ santo yadā hṛdayamindriyāyatanāni ceritāḥ kāma krodha bhaya lobha moha harṣa śoka cintodvegādibhiḥ sahasā’bhipūrayanti, tadā janturapasmarati||4||

Epilepsy manifests itself quickly in the following types of individuals:
Rajastamobhyāmupahata – When the mind of an individual is overshadowed by Rajas and Tamas
Chetasāmudbhrānta viṣama bahu doṣāṇāṃ – When the Doshas get exceedingly aggravated and their equilibrium is disturbed
Mala vikṛtopahitānyaśucīnyabhyavahārajātāni vaiṣamya yuktenopayoga vidhinopayuñjānānāṃ – When an individual takes food consisting of unclean and unwholesome ingredients possessing mutually contradictory (or touched by the unclean hands of persons suffering from contagious diseases like Leprosy), neglecting the prescribed deictic rules;
When he resorts to unhealthy regimens and behavior and
When he suffers from excessive debility.

In the situations mentioned above, the Doshas get aggravated and attach the persons whose minds are overshadowed by Rajas and Tamas. The Doshas (so aggravated) permeate the heart, organs. While staying there, the Doshas aggravated by force of etc, perturbation etc. all of a sudden, spread throughout the heart and the sense organs. Then an individual fall a victim to epilepsy. [4]

Epilepsy EEG

Definition of Epilepsy:
अपस्मारं पुनः स्मृति बुद्धि सत्त्व सम्प्लवाद्बीभत्सचेष्टमावस्थिकं तमः प्रवेशमाचक्षते||५||
apasmāraṃ punaḥ smṛti buddhi sattva samplavādbībhatsaceṣṭamāvasthikaṃ tamaḥ praveśamācakṣate||5||
Epilepsy is characterized by occasional unconsciousness associated with loathsome activities (like vomiting of froth and abnormal postures of the body), due to the perversion of memory, intellect and other psychic faculties. [5]

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Purvarupa (Premonitory symptoms) of Apasmara:
तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- भ्रूव्युदासः सततमक्ष्णोर्वैकृतम शब्द श्रवणं लाला सिङ्घाण प्रस्रवणमनन्नाभिलषणमरोचकाविपाकौ हृदयग्रहः कुक्षेराटोपो दौर्बल्यमस्थिभेदोऽङ्गमर्दो मोहस्तमसो दर्शनं मूर्च्छा भ्रमश्चाभीक्ष्णं स्वप्ने च मदनर्तनव्यधनव्यथन वेपन पतनादीनीति||६||
ततोऽनन्तरमपस्माराभिनिर्वृत्तिरेव||७||
tasyemāni pūrvarūpāṇi bhavanti; tadyathā- bhrūvyudāsaḥ satatamakṣṇorvaikṛtama śabda śravaṇaṃ lālā siṅghāṇa prasravaṇamanannābhilaṣaṇamarocakāvipākau hṛdayagrahaḥ kukṣerāṭopo daurbalyam asthibhedo’ṅgamardo mohas tamaso darśanaṃ mūrcchā bhramaścābhīkṣṇaṃ svapne ca madanartanavyadhanavyathana vepana patanādīnīti||6||
tato’nantaramapasmārābhinirvṛttireva||7||

Purvarupa (Premonitory symptoms) of Apasmara:
The following are its Purvarupa (premonitory symptoms):-
Bhrūvyudāsaḥ – Contraction of eye- brows
Satatamakṣṇorvaikṛtama – Irregular movement of eyes constantly
Shabda śravaṇaṃ – Hearing of such sounds as are non- existent
Lālā siṅghāṇa prasravaṇaman – Excessive discharge of saliva and nasal- excreta
Annābhilaṣaṇamarocakāvipākau hṛdayagrahaḥ – Disinclination for food, anorexia and indigestion cardiac spasm
Kukṣerāṭopo – Distension of the lower abdomen with gurgling sound
Daurbalyam asthibhedo’ṅgamardo – Weakness, cracking pain in bones and malaise
Mohas tamaso darśanaṃ mūrcchā bhrama – Unconsciousness, entering into darkness, fainting and giddiness and
Abhīkṣṇaṃ svapne ca madanartanavyadhanavyathana vepana patanādīnīti – Frequent appearance of scenes of intoxication, dancing, murdering, aching, shivering and falling in the dreams
Thereafter the epilepsy is manifested. [6-7]

Visesha rupa – Characteristic features of Apasmara (epilepsy):
तत्रेदमपस्मारविशेषविज्ञानं भवति; तद्यथा- अभीक्ष्णमपस्मरन्तं, क्षणेन सञ्ज्ञां प्रतिलभमानम्, उत्पिण्डिताक्षम्, असाम्ना विलपन्तम्, उद्वमन्तं फेनम्, अतीवाध्मातग्रीवम्, आविद्धशिरस्कं, विषमविनताङ्गुलिम्, अनवस्थित पाणि पादम्, अरुण परुष श्याव नख नयन वदन त्वचम्, अनवस्थित चपल परुष रूक्ष रूप दर्शिनं, वातलानुपशयं, विपरीतोपशयं च वातेनापस्मरन्तं विद्यात् (१)||८||
अभीक्ष्णमपस्मरन्तं क्षणेन सञ्ज्ञां प्रतिलभमानम्, अवकूजन्तम्, आस्फालयन्तं भूमिं, हरित हारिद्र ताम्र नख नयन वदन त्वचं, रुधिरोक्षितोग्रभैरवादीप्तरुषितरूप दर्शिनं, पित्तलानुपशयं,विपरीतोपशयं च पित्तेनापस्मरन्तं विद्यात् (२)||८||
चिरादपस्मरन्तं, चिराच्च सञ्ज्ञां प्रतिलभमानं, पतन्तम्, अनतिविकृतचेष्टं, लालामुद्वमन्तं, शुक्ल नख नयन वदन त्वचं, शुक्ल गुरु स्निग्ध रूप दर्शिनं, श्लेष्मलानुपशयं, विपरीतोपशयं च श्लेष्मणाऽपस्मरन्तं विद्यात् (३)||८||
समवेत सर्वलिङ्गमपस्मारं सान्निपातिकं विद्यात्, तमसाध्यमाचक्षते (४)||८||
इति चत्वारोऽपस्मारा व्याख्याताः||८||
tatredamapasmāraviśeṣavijñānaṃ bhavati; tadyathā- abhīkṣṇamapasmarantaṃ, kṣaṇena sañjñāṃ pratilabhamānam, utpiṇḍitākṣam, asāmnā vilapantam, udvamantaṃ phenam, atīvādhmātagrīvam, āviddhaśiraskaṃ, viṣamavinatāṅgulim, anavasthita pāṇi pādam, aruṇa paruṣa śyāva nakha nayana vadana tvacam, anavasthita capala paruṣa rūkṣa rūpa darśinaṃ, vātalānupaśayaṃ, viparītopaśayaṃ ca vātenāpasmarantaṃ vidyāt (1)||8||
abhīkṣṇamapasmarantaṃ kṣaṇena sañjñāṃ pratilabhamānam, avakūjantam, āsphālayantaṃ bhūmiṃ, harita hāridra tāmra nakha nayana vadana tvacaṃ, rudhirokṣitograbhairavādīptaruṣitarūpa darśinaṃ, pittalānupaśayaṃ,viparītopaśayaṃ ca pittenāpasmarantaṃ vidyāt (2)||8||
cirādapasmarantaṃ, cirācca sañjñāṃ pratilabhamānaṃ, patantam, anativikṛtaceṣṭaṃ, lālāmudvamantaṃ, śukla nakha nayana vadana tvacaṃ, śukla guru snigdha rūpa darśinaṃ, śleṣmalānupaśayaṃ, viparītopaśayaṃ ca śleṣmaṇā’pasmarantaṃ vidyāt (3)||8||
samaveta sarvaliṅgamapasmāraṃ sānnipātikaṃ vidyāt, tamasādhyamācakṣate (4)||8||
iti catvāro’pasmārā vyākhyātāḥ||8||

The following are the characteristic features of different types of epilepsy:
Vataja Apasmara Vishesha Rupa:
Abhīkṣṇamapasmarantaṃ – Losing and regaining consciousness instantaneously
Kṣaṇena sañjñāṃ pratilabhamānam utpiṇḍitākṣam – Projection of eye balls;
Asāmnā vilapantam – Incoherent speech
Udvamantaṃ phenam – Vomiting of frothy matter
Atīvādhmātagrīvam – Excessive heaviness and rigidity of neck
Aaviddhaśiraskaṃ – Bending of the head to one side
Viṣamavinatāṅgulim – Irregularly contacted fingers
Anavasthita pāṇi pādam – Instability of upper and lower limbs
Aruṇa paruṣa śyāva nakha nayana vadana tvacam – Reddishness, dryness and brownishness of nails, eyes face and skin
Anavasthita capala paruṣa rūkṣa rūpa darśinaṃ – Vision (aura) of unstable, fickle, coarse and dry objects
Vātalānupaśayaṃ – Aggravation of the condition by such regimens as are aggravators of Vata and
Viparītopaśayaṃ ca vātenāpasmarantaṃ vidyāt – Alleviation of the condition by such regimens are alleviations of Vata.
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Pittaja Apasmara Vishesha Rupa:
Abhīkṣṇamapasmarantaṃ kṣaṇena sañjñāṃ pratilabhamānam – Losing and regaining consciousness instantaneously
Avakūjantam – Sertorius breathing
Aasphālayantaṃ bhūmiṃ – Rubbing the earth
Harita hāridra tāmra nakha nayana vadana tvacaṃ – Green, yellow or coppery color of nails, eyes, face and skin
Rudhirokṣitograbhairavādīptaruṣitarūpa darśinaṃ – Vision (Aura) of bleeding, terrifying(which is also injurious), frightful, burning and angry looking objects
Pittalānupaśayaṃ,viparītopaśayaṃ ca pittenāpasmarantaṃ vidyāt – Aggravation of the condition by such regimens as are aggravators of pitta and

Kaphaja Apasmara Vishesha Rupa:
Cirādapasmarantaṃ – Delay in losing and regaining consciousness
Cirācca sañjñāṃ pratilabhamānaṃ, patantam – falling down
Anativikṛtaceṣṭaṃ – Absence of much distortion of activities
Lālāmudvamantaṃ śukla nakha nayana vadana tvacaṃ – Dribbling of saliva white color of nails, eyes, face and skin
Shukla guru snigdha rūpa darśinaṃ – Vision (aura) of white, heavy and unctuous objects
Shleṣmalānupaśayaṃ – Aggravation of the condition by such regimens as are aggravators of kapha and
Viparītopaśayaṃ ca śleṣmaṇā’pasmarantaṃ vidyāt – Alleviation of the condition by such regimens is alleviators of Kapha.

Sannipatika Apasmara Vishesha Rupa:
Epilepsy of Sannipatika type (caused by the simultaneous vitiation of all the 3 Doshas) shares the symptoms of all the 3 Doshas (described above). This condition is incurable.
Thus the 4 types of epilepsy are explained. [8]

Extrinsic causative factors:
तेषामागन्तुरनुबन्धो भवत्येव कदाचित्, तमुत्तरकालमुपदेक्ष्यामः|
तस्य विशेष विज्ञानं यथोक्तलिङ्गैर्लिङ्गाधिक्यमदोषलिङ्गानुरूपं च किञ्चित्||९||
teṣāmāganturanubandho bhavatyeva kadācit, tamuttarakālamupadekṣyāmaḥ|
tasya viśeṣavijñānaṃ yathoktaliṅgairliṅgādhikyamadoṣa liṅgānurūpaṃ ca kiñcit||9||
At times these condition are associated with extrinsic causative factors which will be described later (in Chikitsa 10: 53). Their specific characteristic are the association of additional symptoms which are not manifested due to the various dosha already described. [9]

Types of treatment:
हितान्यपस्मारिभ्यस्तीक्ष्णानि संशोधनान्युपशमनानि च यथास्वं, मन्त्रादीनि चागन्तुसंयोगे||१०||
hitānyapasmāribhyastīkṣṇāni saṃśodhanānyupaśamanāni ca yathāsvaṃ, mantrādīni cāgantusaṃyoge||10||
Strong elimination and alleviation therapies depending upon the specific requirements are useful for patients suffering from epilepsy. When this is associated with extrinsic causative factors, then Mantras etc., will be useful. [10]

Mythological origin of diseases, line of treatment and prognosis of epilepsy:
तस्मिन् हि दक्षाध्वरध्वंसे देहिनां नानादिक्षु विद्रवतामभिद्रवणतरण धावन प्लवन लङ्घनाद्यैर्देहविक्षोभणैः पुरा गुल्मोत्पत्तिरभूत्, हविष्प्राशात् प्रमेहकुष्ठानां, भय त्रास शोकैरुन्मादानां, विविधभूता शुचिसंस्पर्शादपस्माराणां, ज्वरस्तु खलु महेश्वर ललाट प्रभवः , तत्सन्तापाद्रक्तपित्तम्, अतिव्यवायात् पुनर्नक्षत्रराजस्य राजयक्ष्मेति||११||
भवन्ति चात्र- अपस्मारो हि वातेन पित्तेन च कफेन च|
चतुर्थः सन्निपातेन प्रत्याख्येयस्तथाविधः||१२||
साध्यांस्तु भिषजः प्राज्ञाः साधयन्ति समाहिताः|
तीक्ष्णैः संशोधनैश्चैव यथास्वं शमनैरपि||१३||
यदा दोष निमित्तस्य भवत्यागन्तुरन्वयः|
तदा साधारणं कर्म प्रवदन्ति भिषग्विदः||१४||
tasmin hi dakṣādhvaradhvaṃse dehināṃ nānādikṣu vidravatāmabhidravaṇataraṇa dhāvana plavana laṅghanādyairdehavikṣobhaṇaiḥ purā gulmotpattirabhūt, haviṣprāśāt pramehakuṣṭhānāṃ, bhaya trāsa śokairunmādānāṃ, vividhabhūtā śucisaṃsparśādapasmārāṇāṃ, jvarastu khalu maheśvara lalāṭa prabhavaḥ , tatsantāpādraktapittam, ativyavāyāt punarnakṣatrarājasya rājayakṣmeti||11||
bhavanti cātra- apasmāro hi vātena pittena ca kaphena ca|
caturthaḥ sannipātena pratyākhyeyastathāvidhaḥ||12||
sādhyāṃstu bhiṣajaḥ prājñāḥ sādhayanti samāhitāḥ|
tīkṣṇaiḥ saṃśodhanaiścaiva yathāsvaṃ śamanairapi||13||
yadā doṣa nimittasya bhavatyāganturanvayaḥ|
tadā sādhāraṇaṃ karma pravadanti bhiṣagvidaḥ||14||

Mythological origin: 
During the destruction of Dakshas’ sacrifice, Gulma first due to the aggravation in their body because of fleeing, swimming running, flying, jumping etc., Pramehas (obstinacy urinary disorders including diabetes) and Kusthas (obstinate skin diseases including leprosy manifested themselves due to intake of ghee, various types of Unmada (insanity) due to fear, apprehension and grief, and Apasmara (epilepsy) due to coming into contact with various types of unclean objects. Fever came out of the forehead of Lord Shiva. Raktapitta (a condition characterized by bleeding from different parts of the body) due to its heart and Rajayaksma (Tuberculosis) occurred in the moon, the king of stars, due to excessive sexual indulgence.
Thus it is said: – epilepsy manifests itself due to the vitiation of Vata, Pitta and Kapha as well as due to Sannipata (combined vitiation of all the 3 Doshas). The last one is incurable. The curable varieties of epilepsy are carefully treated by the physician with strong elimination and alleviation therapies according to the Doshas vitiated.
When the epilepsy caused by the vitiation of Doshas gets associated with extrinsic causative factors then therapies as would bring the Doshas into normalcy and also correct the affectation of extrinsic causative factors- say the wise physicians. [11-14]

Physician’s merits:
सर्वरोग विशेषज्ञः सर्वौषध विशारदः|
भिषक् सर्वामयान् हन्ति न च मोहं निगच्छति ||१५||
sarvaroga viśeṣajñaḥ sarvauṣadha viśāradaḥ|
bhiṣak sarvāmayān hanti na ca mohaṃ nigacchati ||15||
The physician, well versed in the specific characteristics of all diseases and the properties of all medicine s cures all diseases and do not get confused. [15]

इत्येतदखिलेनोक्तं निदान स्थानमुत्तमम्|१६|
ityetadakhilenoktaṃ nidāna sthānamuttamam|16|
Thus the section par excellence on the “Diagnosis of Diseases ‘ are described in its entirety.

Diseases as causative factors for other diseases:
निदानार्थकरो रोगो रोगस्याप्युपलभ्यते||१६||
तद्यथा- ज्वर सन्तापाद्रक्तपित्तमुदीर्यते|
रक्तपित्ताज्ज्वरस्ताभ्यां शोषश्चाप्युपजायते ||१७||
प्लीहाभिवृद्ध्या जठरं जठराच्छोथ एव च|
अर्शोभ्यो जठरं दुःखं गुल्मश्चाप्युपजायते||१८||
प्रतिश्यायाद्भवेत् कासः कासात् सञ्जायते क्षयः|
क्षयो रोगस्य हेतुत्वे शोषस्याप्युपलभ्यते||१९||
nidānārthakaro rogo rogasyāpyupalabhyate||16||
tadyathā- jvara santāpādraktapittamudīryate|
raktapittājjvarastābhyāṃ śoṣaścāpyupajāyate ||17||
plīhābhivṛddhyā jaṭharaṃ jaṭharācchotha eva ca|
arśobhyo jaṭharaṃ duḥkhaṃ gulmaścāpyupajāyate||18||
pratiśyāyādbhavet kāsaḥ kāsāt sañjāyate kṣayaḥ|
kṣayo rogasya hetutve śoṣasyāpyupalabhyate||19||

Diseases as causative factors for other diseases:
Diseases act as causative factors for other diseases as well; for example,
Raktapitta (the disease characterized by bleeding from different parts of the body) is produced by the heat of the Jvara (fever);
Jvara is also produced by Raktapitta
Ascitis is caused by the enlargement of spleen;
Shotha (General oedema) due to ascites, painful ascitis and Gulma due to piles:
Kasa (coughing) due to Coryza;
Kshaya (Wasting) of tissue elements due to Kasa and
Sosha (Consumption) due to wasting of tissue elements. [16-19]

Causative factors as diseases in stages:
ते पूर्वं केवला रोगाः पश्चाद्धेत्वर्थकारिणः|
उभयार्थकरा दृष्टास्तथैवैकार्थकारिणः ||२०||
te pūrvaṃ kevalā rogāḥ paścāddhetvarthakāriṇaḥ|
ubhayārthakarā dṛṣṭāstathaivaikārthakāriṇaḥ ||20||
These conditions in the primary stage manifest themselves as diseases and subsequently they act as causative factors of other diseases. They are found acting both as the disease and causative factor: some of them act in one way also –either as a disease or as a causative factor: [20]

Nature of disease:
कश्चिद्धि रोगो रोगस्य हेतुर्भूत्वा प्रशाम्यति|
न प्रशाम्यति चाप्यन्यो हेत्वर्थं कुरुतेऽपि च||२१||
kaściddhi rogo rogasya heturbhūtvā praśāmyati|
na praśāmyati cāpyanyo hetvarthaṃ kurute’pi ca||21||
Some disease gets subsided after causing another disease and some others even after causing another disease do not subside.
For example, coryza may continue to exit along with Kasa (coughing) after causing the latter; and at times after causing Kasa, coryza itself may get subsided. In the former case, coryza is considered both as a disease as well as a causative factor, in the latter case it acts only as a causative factor. [21]

Difficulty in cure:
एवं कृच्छ्रतमा नॄणां दृश्यन्ते व्याधि सङ्कराः|
प्रयोगापरिशुद्धत्वात्तथा चान्योन्यसम्भवात्||२२||
evaṃ kṛcchratamā nṝṇāṃ dṛśyante vyādhi saṅkarāḥ|
prayogāpariśuddhatvāttathā cānyonyasambhavāt||22||
Such combination of diseases due to the incorrect administration of therapies or production of one disease out of the other, makes the condition difficult of cure. [22]

Correctness of therapy:
प्रयोगः शमयेद्व्याधिं योऽन्यमन्यमुदीरयेत्|
नासौ विशुद्धः, शुद्धस्तु शमयेद्यो न कोपयेत्||२३||
prayogaḥ śamayedvyādhiṃ yo’nyamanyamudīrayet|
nāsau viśuddhaḥ, śuddhastu śamayedyo na kopayet||23||
The therapy which while curing one disease provokes another is not the correct one, the correct therapy, is the one which while curing a disease does not provoke the manifestation of other diseases. [23]

Productivity of Causative factors:
एको हेतुरनेकस्य तथैकस्यैक एव हि|
व्याधेरेकस्य चानेको बहूनां बहवोऽपि च||२४||
ज्वर भ्रम प्रलापाद्या दृश्यन्ते रूक्ष हेतुजाः|
रूक्षेणैकेन चाप्येको ज्वर एवोपजायते||२५||
हेतुभिर्बहुभिश्चैको ज्वरो रूक्षादिभिर्भवेत्|
रूक्षादिभिर्ज्वराद्याश्च व्याधयः सम्भवन्ति हि||२६||
eko heturanekasya tathaikasyaika eva hi|
vyādherekasya cāneko bahūnāṃ bahavo’pi ca||24||
jvara bhrama pralāpādyā dṛśyante rūkṣa hetujāḥ|
rūkṣeṇaikena cāpyeko jvara evopajāyate||25||
hetubhirbahubhiścaiko jvaro rūkṣādibhirbhavet|
rūkṣādibhirjvarādyāśca vyādhayaḥ sambhavanti hi||26||

One causative factor may produce many disease, e. g due to dry causative factors many diseases like fever, giddiness and delirium are manifested. One causative factor may produce fever alone. Many causative factors may produce only one disease e.g fever alone may be caused by many causative factors may produce many diseases, e.g many diseases, viz ununctouous hot and saline substances. [24-26]

Relation of Symptoms with disease:
लिङ्गं चैकमनेकस्य तथैवैकस्य लक्ष्यते|
बहून्येकस्य च व्याधेर्बहूनां स्युर्बहूनि च||२७||
विषमारम्भमूलानां लिङ्गमेकं ज्वरो मतः|
ज्वरस्यैकस्य चाप्येकः सन्तापो लिङ्गमुच्यते||२८||
विषमारम्भमूलैश्च ज्वर एको निरुच्यते|
लिङ्गैरेतैर्ज्वर श्वास हिक्काद्याः सन्ति चामयाः||२९||
liṅgaṃ caikamanekasya tathaivaikasya lakṣyate|
bahūnyekasya ca vyādherbahūnāṃ syurbahūni ca||27||
viṣamārambhamūlānāṃ liṅgamekaṃ jvaro mataḥ|
jvarasyaikasya cāpyekaḥ santāpo liṅgamucyate||28||
viṣamārambhamūlaiśca jvara eko nirucyate|
liṅgairetairjvara śvāsa hikkādyāḥ santi cāmayāḥ||29||

One symptom may be common to many diseases; e.g fever may be the common symptom of many diseases having irregularity as their onset. One symptom may be related to only one disease. E.g hyperpyrexia is the symptom of fever alone. Many symptoms may be common to many diseases, e.g many symptoms like irregularity in onset may be common to many diseases, like fever, asthma and hiccup. [27-29]

Effect of therapy on disease:
एका शान्तिरनेकस्य तथैवैकस्य लक्ष्यते|
व्याधेरेकस्य चानेका बहूनां बह्व्य एव च||३०||
शान्तिरामाशयोत्थानां व्याधीनां लङ्घनक्रिया|
ज्वरस्यैकस्य चाप्येका शान्तिर्लङ्घनमुच्यते||३१||
तथा लघ्वशनाद्याश्च ज्वरस्यैकस्य शान्तयः|
एताश्चैव ज्वर श्वास हिक्कादीनां प्रशान्तयः||३२||
ekā śāntiranekasya tathaivaikasya lakṣyate|
vyādherekasya cānekā bahūnāṃ bahvya eva ca||30||
śāntirāmāśayotthānāṃ vyādhīnāṃ laṅghanakriyā|
jvarasyaikasya cāpyekā śāntirlaṅghanamucyate||31||
tathā laghvaśanādyāśca jvarasyaikasya śāntayaḥ|
etāścaiva jvara śvāsa hikkādīnāṃ praśāntayaḥ||32||

One single therapy may cause many diseases, e.g diseases having their origin from Amashaya (stomach including small intestine) are cured by fasting. There may be one single therapy only for one disease e.g fasting is a therapy for the cure of fever alone. There may be many therapies for one disease, e.g intake of light diet etc., cures only one disease, viz fever. There may be many therapies for many diseases, e.g intake of light diet etc. may cure many diseases viz, fever, asthma, hiccup etc. [30-32]

Definition of curable, Palliable and incurable diseases:
सुखसाध्यः सुखोपायः कालेनाल्पेन साध्यते|
साध्यते कृच्छ्रसाध्यस्तु यत्नेन महता चिरात्||३३||
याति नाशेषतां व्याधिरसाध्यो याप्यसञ्ज्ञितः|
परोऽसाध्यः क्रियाः सर्वाः प्रत्याख्येयोऽतिवर्तते||३४||
नासाध्यः साध्यतां याति साध्यो याति त्वसाध्यताम्|
पादापचाराद्दैवाद्वा यान्ति भावान्तरं गदाः||३५||
sukhasādhyaḥ sukhopāyaḥ kālenālpena sādhyate|
sādhyate kṛcchrasādhyastu yatnena mahatā cirāt||33||
yāti nāśeṣatāṃ vyādhirasādhyo yāpyasañjñitaḥ|
paro’sādhyaḥ kriyāḥ sarvāḥ pratyākhyeyo’tivartate||34||
nāsādhyaḥ sādhyatāṃ yāti sādhyo yāti tvasādhyatām|
pādāpacārāddaivādvā yānti bhāvāntaraṃ gadāḥ||35||

Easily curable diseases are cured by simple measures in a short time. Disease which are difficult of cure involve much of effort and they take a long time for cure. The palliable variety of incurable diseases can never be eradicated from the root. The irremediable variety of an incurable disease is not amenable to any type of treatment.
The incurable varieties never become curable; the curable variety may on the other hand become incurable. Due to the defects in the four agents of therapeutic or due to misfortune, the easily curable variety may become difficult of cure: diseases which are difficult of cure may become palliable and palliable variety may become irremediable. [33-35]

Observation on the states of disease:
वृद्धि स्थान क्षयावस्थां रोगाणामुपलक्षयेत् |
सुसूक्ष्मामपि च प्राज्ञो देहाग्नि बल चेतसाम्||३६||
व्याध्यवस्था विशेषान् हि ज्ञात्वा ज्ञात्वा विचक्षणः|
तस्यां तस्यामवस्थायां चतुःश्रेयः प्रपद्यते||३७||
vṛddhi sthāna kṣayāvasthāṃ rogāṇāmupalakṣayet |
susūkṣmāmapi ca prājño dehāgni bala cetasām||36||
vyādhyavasthā viśeṣān hi jñātvā jñātvā vicakṣaṇaḥ|
tasyāṃ tasyāmavasthāyāṃ catuḥśreyaḥ prapadyate||37||
A wise physician should closely observe the subtleties of aggravated, normal and diminished states of diseases, body, and power of digestion, strength and mental faculties. Having close acquaintance with the various states of the disease, an intelligent physician should prescribe for these difficult states such therapies as would help attainment of the four- fold blessings. [36-37]

Principles of treatment:
प्रायस्तिर्यग्गता दोषाः क्लेशयन्त्यातुरांश्चिरम्|
तेषु न त्वरया कुर्याद्देहाग्निबलवित् क्रियाम्||३८||
प्रयोगैः क्षपयेद्वा तान् सुखं वा कोष्ठमानयेत्|
ज्ञात्वा कोष्ठ प्रपन्नांस्तान् यथासन्नं हरेद्बुधः||३९||
prāyastiryaggatā doṣāḥ kleśayantyāturāṃściram|
teṣu na tvarayā kuryāddehāgnibalavit kriyām||38||
prayogaiḥ kṣapayedvā tān sukhaṃ vā koṣṭhamānayet|
jñātvā koṣṭhaprapannāṃstān yathāsannaṃ haredbudhaḥ||39||
If the aggravated Doshas spread sideward’s then the patient continues to be afflicted with the disease foe a longtime. One acquainted with nature of the body, power of digestion and strength of the individual should not administer strong therapies for the treatment of this condition.
By administering slow acting therapies in small Doshas, such diseases should either be suppressed or brought to the Kostha (alimentary tract) with ease. Having known of their arrival in the Kostha, the wise Physician should eliminate these Doshas from their respective abodes by the administration of appropriate therapies. [38-39]

Difference between symptoms and disease:
ज्ञानार्थं यानि चोक्तानि व्याधि लिङ्गानि सङ्ग्रहे|
व्याधयस्ते तदात्वे तु लिङ्गानीष्टानि नामयाः||४०||
jñānārthaṃ yāni coktāni vyādhi liṅgāni saṅgrahe|
vyādhayaste tadātve tu liṅgānīṣṭāni nāmayāḥ||40||
In this section on the “Diagnosis of Diseases” Jvara (fever) etc., are described to have some symptoms, viz Aruchi (anorexia) etc. these symptoms in themselves also constitute diseases. But here, because of their subordinate nature, they are only symptoms and not diseases. [40]

Dependence of causes:
विकारः प्रकृतिश्चैव द्वयं सर्वं समासतः|
तद्धेतुवशगं हेतोरभावान्नानुवर्तते||४१||
vikāraḥ prakṛtiścaiva dvayaṃ sarvaṃ samāsataḥ|
taddhetuvaśagaṃ hetorabhāvānnānuvartate||41||
All manifestations relating to the body and soul can briefly be categorized into two, viz. normal and abnormal, and both of them are dependent upon causative agents- none of these manifestations can continue in the absence of these causative agents. [41]

Conclusion:
तत्र श्लोकाः- हेतवः पूर्वरूपाणि रूपाण्युपशयस्तथा|
सम्प्राप्तिः पूर्वमुत्पत्तिः सूत्रमात्रं चिकित्सितात्||४२||
ज्वरादीनां विकाराणामष्टानां साध्यता न च|
पृथगेकैकशश्चोक्ता हेतु लिङ्गोपशान्तयः||४३||
हेतु पर्याय नामानि व्याधीनां लक्षणस्य च|
निदान स्थानमेतावत् सङ्ग्रहेणोपदिश्यते||४४||
tatra ślokāḥ- hetavaḥ pūrvarūpāṇi rūpāṇyupaśayastathā|
samprāptiḥ pūrvamutpattiḥ sūtramātraṃ cikitsitāt||42||
jvarādīnāṃ vikārāṇāmaṣṭānāṃ sādhyatā na ca|
pṛthagekaikaśaścoktā hetu liṅgopaśāntayaḥ||43||
hetu paryāya nāmāni vyādhīnāṃ lakṣaṇasya ca|
nidāna sthānametāvat saṅgraheṇopadiśyate||44||

To sum up: Causes, premonitory, symptoms, actual symptoms, homologation, pathogenesis, first origin (mythological) and the brief line of treatment of epilepsy are described in this chapter.
Curability or otherwise of the 8 diseases, viz fever etc., description of etiology, symptomatology including premonitory symptoms and treatment including homologation of all diseases in common and individually, symptoms of etiology, disease and symptoms- these are described in brief in this section on the Diagnosis of Diseases. [42-44]

इत्यग्निवेशकृते तन्त्रे चरक प्रति संस्कृते निदान स्थाने अपस्मार निदानं नामाष्टमोऽध्यायः||८||
इति चरकसंहितायां द्वितीयं निदानस्थानं समाप्तम्|
ityagniveśakṛte tantre caraka prati saṃskṛte nidāna sthāne apasmāra nidānaṃ nāmāṣṭamo’dhyāyaḥ||8||
iti carakasaṃhitāyāṃ dvitīyaṃ nidānasthānaṃ samāptam|
Thus ends the 8th chapter on the “diagnosis of Epilepsy “of the section on “Diagnosis of Diseases” (Nidana sthana) of Agnivesha’ work as redacted by Charaka. Thus ends the “section on Diagnosis of Diseases”.

Read related:
Epilepsy – Ayurvedic Understanding And Its Treatment
Charaka – Apasmara Chikitsa – 10th chapter


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