Charaka – Apasmara Chikitsa – 10th chapter

10th chapter of Charaka Samhita Chikitsa Sthana is Apasmara Chikitsa Adhyaya. Deals with causes, symptoms, types and Ayurvedic treatment of epliepsy.

Treatment of Epilepsy
Let us expound the chapter on the treatment of Apasmara (Epilepsy). Thus said Lord Atreya [1-2]

Related: Ayurvedic treatment for epilepsy

Definition

Definition of Apasmara
According to the experts in the science of medicine, the term “Apasmara” implies ‘loss of memory’, characterised by
Tamah pravesha – loss of consciousness (entering into darkness) and
Beebhasta chestam – fearful – disgusting movements of limbs caused by
Dhi sattva samplavat – derangement of intellect and the mind [3]

Causes

Apasmara Nidana – Causes:
Attacks of epilepsy, in a person, are caused by the upward movement of excessively accumulated Doshas as a result of the following:
1. Habitual intake of unwholesome and unclean food;
2. Suppression of the Sattva (one of the attributes of mind representing purity and consciousness) by Rajas (attribute of the mind representing energy, attraction and dynamism) and Tamas (the third attribute of mind representing passiveness, inaction, darkness and ignorance);
3. Occlusion of the heart by the aggravated Doshas; and
4. Affliction of mind by worry, passion, fear, anger, grief, anxiety etc.[ 4-5]

Pathogenesis, Signs and Symptoms

By the above mentioned factors Doshas located in the Vessels (Dhamani= Artery) afflict the heart and cause disturbances in the functions. The person, thus affected, is afflicted with stupor and malfunctioning of mental activities.

The signs and symptoms:
He visualises non-existent forms, falls down and gets tremors.
Akshi bhru vikshepa – His eyes and eyebrows become distorted
Lala srava – Saliva comes out from his mouth and
Hasta pada vikshepa – His hands and legs become convulsed.
When the fits are over, he regains consciousness as if he were getting up from sleep. [6-8 ½]

Types, signs and symptoms

Apasmara Bheda – Lakshana:
Types of Apasmara, their Signs & Symptoms
Apasmara (epilepsy) is of 4 types, namely
i) Vatika – Due to Vata Dosha
ii) Paittika – Due to Pitta Dosha
iii) Shlaismika – Due to Kapha Dosha
iv) Sannipatika – Due to simultaneous imbalance of all the three Doshas.

Vataja Apasmara

Vataja Apasmara Lakshana:
characterised by-
Kampa – trembling
Pradeshad dantan – Gnashing of teeth,
Phenodvami – vomiting froth
Shvasa – panting, rigorous breathing
The patient gets visual aura of forms which are rough, pink or black in colour

Pittaja Apasmara

Pittaja Apasmara Lakshana:
Paittika type of epilepsy is characterised by-
Yellowness of the form, limbs, face and eyes
He gets visual aura of yellow or blood- red objects.
He suffers from morbid thirst and heat
He visualises the whole world as if set in flames

Kaphaja Apasmara

Kaphaja Apasmara Lakshana:
The Slaishmika type of epilepsy characterised by-
Shukla Phenanga Vaktra Aksha – White colour of the foam from the mouth, body, face and eyes,
Sheeta – feeling of cold,
Hrushtanga – horripilation
Guru – feeling of heaviness
Pashyan Shuklani Roopani – patient visualises the aura of white objects.
Muchyate Chiraat – He recovers from the fit after a long time.

Apasmar Asadhya Lakshana

In the Sannipatika type of epilepsy:
Signs and symptoms of all the above mentioned 3 varieties are manifested. This type of epilepsy is incurable.
Epilepsy, which occurs in emaciated persons or which is of long standing is also incurable.

Apasmara Vega

Frequency of Fits – Apasmara Vega:
The aggravated Doshas cause attacks of epilepsy once in 15 days, 12 days or a month. The attack may, however, takes place even after a shorter period. [13]

Line of treatment

Apasmar Chikitsa Sutra –
Line of Treatment:
The physician should first restore the activities of the heart, channels (vessels) and the mind which are occluded by Doshas by the use of sharp (strong) remedial measures like Vamana (emetic therapy) etc.
The patient suffering from Vatika epilepsy is administered mainly with Basti (medicated enema) therapy;
One suffering from the Paitika type of epilepsy is mainly given Virechana (purgation) therapy and
The one suffering from the Slaismika type of epilepsy is given Vamana (emetic) therapy. [14-15]

Ayurvedic medicines

Ayurvedic medicines for Epilepsy:
After the patient is cleansed of impurities from his body by the administration of emetic therapy, etc and after he is well consoled, he should be given alleviation therapies for the cure of Apasmara (Epilepsy). The recipes for this purpose are furnished in subsequent verses. [16]

Panchagavya Ghruta

Cow ghee is cooked by adding the
Juice of cow dung,
Sour curd prepared out of cow milk and cow urine, each of them taken in equal quantities.
The medicated ghee, thus prepared, cures
Apasmara – epilepsy
Kamala – Jaundice and
Jwara – fever [17]
Read more about side effects, shelf life, manufacturer etc of Panchagavya Ghritam

Maha panchagavya Ghritam

2 Palas of each of
Bilva – Aegle marmelos
Agnimantha – Premna mucronata
Shyonaka – Oroxylum indicum
Gambhari – Gmelina arborea
Patala – Stereospermum suaveolens
Shalaparni – Desmodium gangeticum
Prinshnaparni – Urarica picta
Gokshura – Tribulus terrestris
Brihati – Solanum indicum
Kantakari – Solanum xanthocarpum,
Haritaki – Terminalia chebula
Bibhitaki – Terminalia bellerica
Amalaki – Phyllanthus emblica
Haridra – turmeric – Curcuma longa
Daru Haridra – Tree Turmeric (stem) – Berberis aristata
Bark of kutaja – Holarhena dysentrica
Saptaparna – Alstonia scholaris
Apamarga –Achyranthes aspera
Neelini – Indigofera tinctorea
Katurohini – Picrorhiza kurroa
Shampaka (Aragvadha) – Cassia fistula
Root of Phalgu (Kasthodumbarika) – Phalgumoola – Ficus carica
Puskaramula – Inula racemosa and
Duralabha – should be added with
1 Drona – 12.288 liters of water, boiled and reduced to 1/4th, filtered.
Along with this decoction, 2 Prasthas (1.536 kg) of cow ghee is cooked by adding 2 Prasthas (1.536 liter) of each of the juice of
Cowdung
Sour curd prepared of cow milk, cow milk and cow urine and
The paste of 1 Aksha (12 g) of each of
Bharangi – Clerodendrum serratum
Patha – Cyclea peltata
Shunthi – Zingiber officinale
Maricha – Piper nigrum
Pippali – Long pepper fruit – Piper longum
Trivrta – Operculina turpethum
Nicula [ Hijjala] – Barringtonia acutangula
Shreyasi (Hastipippali) – Scindapsus officinalis
Adhaki – Pigeon Pea – Cajanus indicus / Cajanus cajan
Murva – Marsdenia tenacissima
Danti – Baliospermum montanum
Bhunimba – Phyllanthus niruri
Chitraka – Leadword – Plumbago zeylanica
Sveta Sariva – Indian Sarsaparilla – Hemidesmus indicus,
Krsna Sariva – Indian Sarsaparilla – Hemidesmus indicus
Rohisha – Cymbopogon martinii
Bhutika – Trachyspermum ammi
Madayantika – Lawsonia inermis
Indications:
This medicated ghee, known as Maha panchagavya is like ambrosia in the treatment of
Apasmara – epilepsy
Unmada – insanity
Shvayathu – oedema
Udara – obstinate abnormal diseases including ascites
Gulma – Phantom tumour
Arshas – piles
Pandu – Anaemia
Kamala – Jaundice and
Halimaka – a serious type of Jaundice
This medicated ghee is used regularly every day to dispel inauspiciousness and evil effects of bad planets.
It also cures Chaturthaka (Quartan) type of Vishama Jvara (Irregular fever) [18-24]

Read more about Mahapanchagavya ghrita manufacturer, side effect etc

Brahmi Ghritam

Old cow ghee (1 part) is cooked with
4 parts of Brahmi Juice (Bacopa monnieri) and
The paste of
Vacha – Acorus calamus Linn.),
Kushta – Saussurea lappa and
Shankhapuspi – (1/4th part in total)
This medicated ghee is indicated in –
Unmada – insanity
Alaksmi – inauspiciousness
Apasmara – epilepsy and
Papa – effects of devil deeds [25]

Read more about Brahmi Ghritham

Hingu Saindhava Ghrita

1 part of Cow ghee is cooked by adding [in total] 4 parts of the urine of bull and goat urine and the paste of rock salt and asafoetida (1/4 the part in total).
This medicated ghee cures
Apasmara (epilepsy)
Hrud roga – Heart diseases and
Diseases caused by the evil effects of bad planets. [26]

Vachadi Ghritam

Ghee (1 part) is cooked with the paste of
Vacha – Acoruss calamus
Shampaka – Cassia fistula
Kaitarya – Myrica nagi ( Parvata)
Nimba – Neem (Azadirachta indica),
Vayashtha (Guduchi) – Tinospora cordifolia
Hingu – Asa foetida
Choraka (Angelica glauca) and
Palankasha or Guggulu (Commifora mukul) (1/4th part in total) [4 parts of water is added according to the general rule, because in present recipe, there is no liquid].
This medicate ghee is useful in the treatment of Vatika and Slaismika type of epilepsy. [27]

Jivaniya yamaka

1 Prasthas of each oil and cow ghee is added with the paste of 1 Pala (48 g) of each Jeevaneeya Gana herbs
Jeevaka – Malaxis acuminata
Rishabhaka – Manilkara hexandra
Meda – Polygonatum cirrhifolium
Mahameda – Polygonatum verticillatum
Kakoli – Fritillaria roylei
Kshira Kakoli – Roscoea purpurea / Lilium polyphyllum
Mudgaparni – Phaseolus trilobus,
Mashaparni – Teramnus labialis,
Jivanti – Leptadenia reticulata and
Madhuka– Licorice – Glycyrrhiza glabra
and 1 Drona (12.288 liters) of milk and cooked.
This medicated ghee is an effective recipe for the cure of Apasmara (epilepsy) [28]

Recipes for medicated Ghee

2 Prasthas of ghee is added with
1 Kamsa of each of milk and sugarcane juice,
16 Prasthas of the decoction of Kashmarya (Gmelina arborea) and
1 Karsha of each of the 10 drugs belonging to Jeevaniya Group (vide Sutra 4: 9) and cooked.
This medicated ghee instantaneously cures epilepsy caused by Vata and Pitta.
Similarly, ghee cooked by adding
Decoction of Kasha and Kusa (Desmostachya bipinnata) and
Juice of Vidari (Ipomoea paniculata / Pueraria tuberosa) and
Sugarcane is useful in the treatment of this ailment. [29-30]

Madhukadi Ghrita

2 Prasthas of ghee is cooked by adding
2 Dronas of Juice of Amalaki – Indian gooseberryand
2 palas of the paste of Madhuka– Licorice – Glycyrrhiza glabra
This medicated ghee instantaneously the Paittika type of Apasmara (epilepsy). [31]

Recipe of medicated Oil

Mustard oil cooked with 4 times of goat urine is useful for massage for a patient suffering from epilepsy.
Such a patient should use cow-dung for the purpose of unction and cow urine for the purpose of Snana (bath) [32]

Katabhyadi Taila

Sesame oil (1 part) is cooked with goat’s urine (1 part) and the decoction of the barks of
Katabhi – Celastrus paniculatus
Nimba – Neem (Azadirachta indica)
Katvanga – Oroxylum indicum and
Madhushigru – Acorus calamus (3 parts)
This medicated oil is used for massage, effective in the treatment of epilepsy. [33]

Palankashadi taila

Sesame oil is cooked by adding 4 times of goat’s urine and paste (1/4th of oil) of
Palankasa
Vacha (Acorus calamus Linn.),
Pathya – Haritaki
Vrischikali – Tragia involucrata
Arka – Calotropis gigantea
Sarsapa – Brassica campestris
Jatila (Nardostachys jatamamsi D C.)
Putanakesi (Golomi),
Nakuli
Hingu – Asa foetida,
Coraka (Angelica glauca),
Lasuna – Garlic (Allium sativum Linn.),
Atirasa – Asparagus root – Asparagaus racemosus,
(Jalaja Yastimadh)
Chitra – Baliospermum montanum,
Kustha – Sausserea lappa and
The stool of meat- eating birds according their availability
This medicated oil is very effective curing Apasmara (Epilepsy).
The above mentioned drugs (ingredients prescribed to be used as paste) should also be used for Dhupana (fumigation) and Pralepana (external application in paste form) [for curing patients suffering from epilepsy] [34-36]

Recipe for ointment and Fumigation

Pippali – piper longum
Lavanam – rock-salt,
Chitra – Baliospermum montanum(danti),
Hingu – Asa foetida,
Hingusivatika(Vamsapatrika),
Kakoli – Fritillaria roylei
Sarshapa – Mustard
Kakanasa
Kaitarya – Myrica nagi
Chandana (Sandalwood – Santalum album) and
Shoulder bones, nails and ribs of the dog is made to a paste by triturating with goat’s urine in the constellation of Pusya (8th naksatra).
Use of this for Pradeha (external application in the form of thick paste) and Dhupana (fumigation) [cures epilepsy]. [37-38]

Recipes for Unction

Apetaraksasi
Kushta – Saussurea lappa
Putanakesii and
Choraka (Angelica glauca) is triturated by adding cow or goat’s urine and made to a paste.
This is used as unction for the treatment of epilepsy
The body of the patient is sprinkled with the urine of cow or goat
Similarly, unction is done with the help of the following recipes:
1. Stool of leech
2. Ashes of the small hair of the goat
3. Ashes of the bone of ass
4. Ashes of the nails of elephant and
5. Ashes of the hair in the tail of the cow. [39-40]

Dhumapana recipe

Dhumapana – Recipe for Inhalation:
Inhalation of the urine of cow having reddish brown (Kapila) colour is exceedingly useful for the cure of epilepsy.
Similarly inhalation of the urine of the dog, jackal, cats etc, is useful in this condition.
Inhalation of 5 or 6 drops of the following 3 recipes is useful in the treatment of epilepsy:
1. Bhargi, Vacha (Acorus calamus Linn.) and Nagadanti ( Kasthapatala) triturated with cow urine
2. Swehta (Sveta Aparajita) and veta Visanika (Satavari) triturated with cow urine
3. Jyotismati ( Celastrus paniculatus) and Nagadanti triturated with cow urine.[41- ½ 43]

Navana nasya

Medicated Oil for Navana Nasya:
1 part Oil is cooked with 4 parts Goat’s urine and the paste of
Haritaki – Terminalia chebula
Bibhitaki –Terminalia bellerica
Amalaki – Phyllanthus emblica
Sunthi – Zingiber officinale
Pippali – Long pepper fruit – Piper longum
Maricha – Black pepper fruit – piper nigrum,
Pitadru (Devadaru (Cedrus deodara)),
Yavaksara
Phanijjhaka
Shyama Trivrit
Apamarga – Achyranthes aspera and
Fruits of Karanja (Pongamia pinnata) (1/4th part in total)
Inhalation of this medicated oil Apasmara (epilepsy) is cured [43 1/3 -44]

Dhuma yoga

Dhuma Yoga – Recipes for inhalation:
The powder of
Pippali – Piper nigrum
Vruschikali
Kushta – Saussurea lappa
Saindhava Lavana
Sauvarcala Lavana
Samudra lavana
Vida Lavana
Audbhida Lavana (vid Sutra 1: 88-89) and
Bharga is administrated and blown into the nostrils of the patient.
This is an excellent recipe for curing epilepsy [45]

Kayasathadya Varti

Kayastha
Sharada
Mudga (Harita Mudga)
Musta (Cyperus rotundus)
Ushira – Vetiver – Vetiveria zizanioides
Yava – Barley (Hordeum vulgare)
Sunthi – Zingiber officinale
Pippali – Long pepper fruit – Piper longum and
Maricha – Black pepper fruit – piper nigrum is made to a paste by triturating with Goat’s urine.
From out of this paste, Vartis (elongated pills) is prepared.
Application of this thin paste prepared by rubbing with water in the eyes [as collyrium] works like ambrosia in curing
Apsmara – epilepsy
Unmada – insanity
Snake bite
Afflictions by poisons
Maladies caused by taking poisons internally (lying unconscious like a dead person). [46-47]

Mustadya Varti

These are made to a paste by triturating with the urine of goat, sheep and bull:
Musta – Cyperus rotundus
Vayastha [Daru Haridra – Tree Turmeric (stem) – Berberis aristata]
Haritaki – Terminalia chebula
Bibhitaki – Terminalia bellerica
Amalaki – Phyllanthus emblica
Kayastha [ela] – Elettaria cardamom
Hingu – Asa foetida
Sadvala [Durva (Cynodon dactylon)]
Sunthi – Zingiber officinale
Pippali – Long pepper fruit – Piper longum
Maricha – Black pepper fruit – piper Nigrum
Musa and
Yava – Barley (Hordeum vulgare)
From this paste, Vartis (elongated pills) is prepared.
These Vartis are rubbed over a stone by adding water, and the thin paste, thus obtained, is used as collyrium.
These cures
Apasmara – epilepsy
Kilasa – a type of leucoderma
Unmada – insanity and
Vishama Jvara – irregular fever [48-49]

Dhupana – Recipes for Collyrium and Fumigation:
Dog-bile, collected during Pusya constellation, is used as collyrium for the cure of Apasmara (epilepsy).
This bile mixed with ghee is used for fumigation which is excellent for curing epilepsy
For the treatment of epilepsy, the physician gives fumigation therapy with the help of the beaks, feather and stool of mongoose, owl bird, cat, vulture, Kita (scorpion etc) snake and crow.
With the help of these therapies, the heart of the patient gets stimulated and the channels get cleansed as a result of which the patient regains consciousness. [50-52]

Exogenous epilepsy treatment

Treatment of Exogenous Epilepsy:
In some patients of epilepsy, exogenous factors [like seizures by evil spirits] are secondarily involved and in such cases signs and symptoms [of these exogenous factors] are manifested over and above those of the Doshas (endogenous factors).
Treatment of such patients should be on the lines suggested for exogenous types of Unmada (insanity) vide chapter 9. [53]

Atattvabhinivesha

Atattvabhinivesha or Psychic Pervasion:
Thereafter, Agnivesha with folded hands said, ‘O Lord! In Sutra section (Charaka Samhita Sutrathana 19/3) you have mentioned in brief Atatvabhinivesha (physic perversion) as Mahagada (serious disease). But its etiology, signs and symptoms and treatment are not described. I want to hear descriptions. Kindly narrate them in the present context”.

Having heard this Lord Punarvasu addressed his disciple “My child, hear about this Mahagada (serious disease) along with its etiology, signs and symptoms and treatment.”

In a person indulging in habitual intake of impure food, suppression of the manifested natural urges, excessively indulging in diet, which are cold, hot, unctuous etc; and having his soul occluded by Rajas (one of the attributes of the mind) and Moha or Tamas (another attribute of mind), the vitiated Doshas afflict the Manobuddivaha Sira (channels carrying the impulses of the mind and intellect) and get lodged in the heart.

With predominant Rajas and Tamas occluding the intellect and the mind and the aggravated Doshas disturbing the function of the heart, the person who is ignorant and mentally weak, makes perverted judgement regarding eternal and ephemeral events and wholesome and unwholesome objects. This Mahagada (serious disease) according to expert physicians is called Atattvabhinivesha (Perversion of the mind).

Such a patient should be administered with Snehana, Swedana therapies followed by Panchakarma treatments like Vamana and then Samsarjana Krama (gradual administration of lighter to heavier food). Thereafter, diet and drinks which are promoters of intellect should be given to him.

Panchagavya Ghruta and Maha Panchagavya Ghrut described above is given to such a patient along with the juice of Brahmi.
Similarly, other Medhya Rasayanas (promotes of intellect) like Sankhapushpi is given to him
His friends and sympathisers and preceptors preaching religious sermons should instill into him understanding, patience, memory and the power of concentration (Samadhi). [54-63]

Treatment of Chronic Epilepsy

If the disease epilepsy is resistant to conventional modes of treatment, if it is chronic and if it has acquired a firm footing, then it is generally treated with the following recipes of elixirs:
1. Garlic with oil
2. Shatavari (Asparagus racemosus) with milk
3. Juice of Brahmi ( Bacopa monnieri) with Honey
4. Juice of decoction of Kushta – Saussurea lappa with honey and
5. Powder of Vaca (Acorus calamus Linn.) with honey

Precautions

The patient suffering from Apasmara (epilepsy) and unmada (insanity) is specially protected from water, fire, trees, mountains and uneven places. These may cause instantaneous death of the patient. [66]

In this chapter on the treatment of Apasmara (epilepsy), the sage has described in brief as well as in detail the following topics:
1. Etiological factors of epilepsy
2. The ode of vitiation of Doshas
3. Signs and symptoms in general and of different varieties of epilepsy
4. Treatment of different types of epilepsy and.
5. Epilepsy, signs and symptoms of Mahagada (serious Disease or Mental Perversion).

Thus, ends the 10th chapter dealing with the treatment of Apasmara (epilepsy) in the section on therapeutics of Agnivesha’s work as redacted by Charaka, completed by Drudhabala.