Ashtanga Hridayam Uttarasthanam Chapter 7: Apasmara Pratishedham (Treatment of Epilepsy)

The 7th chapter of Uttara Sthanam of Ashtanga Hridayam is named as Apasmara Pratisedha adhyāyaṃ. This chapter deals with the explanation of ‘treatment of epilepsy’.

The topics covered in this chapter include –

• Nirvacana – Samprapti – Definition and Pathogenesis
• Bhedas – kinds
• Purva Rupa – prodromal symptoms
• Vataja Apasmara – Epilepsy of Vata origin
• Pittaja Apasmara – Epilepsy of Pitta origin
• Kaphaja Apasmara – Epilepsy of Kapha origin
• Cikitsa – treatment
• Pancagavya Ghrta
• Maha Pancagavya Ghrta
• Brahmyadi Ghrta
• Jivaniya Gana Siddha Ghrta
• Kashmaryadi Ghrta
• Anya Yoga
• Nasya Yoga – Nasal Drops
• Dhupa – Fumigation

Pledge by the author (s)

अथातोऽपस्मारप्रतिषेधं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘treatment of the epilepsy’. Thus say (pledge) Atreya and other sages.

Nirvachana-Samprapti: Definition and Pathogenesis

स्मृत्यपायो ह्यपस्मारः स धीसत्त्वाभिसंप्लवात् ।
जायतेऽभिहते चित्ते चिन्ताशोकभयादिभिः ॥१॥
उन्मादवत्प्रकुपितैश्चित्तदेहगतैर्मलैः ।
हते सत्त्वे हृदि व्याप्ते सञ्ज्ञावाहिषु खेषु च॥२॥
तमो विशन् मूढमतिर्बीभत्साः कुरुते क्रियाः ।
दन्तान् खादन् वमन् फेनं हस्तौ पादौ च विक्षिपन्॥ ३ ॥
पश्यन्नसन्ति रूपाणि प्रस्खलन् पतति क्षितौ ।
विजिह्माक्षिभ्रुवो दोषवेगेऽतीते विबुध्यते ॥४॥
कालान्तरेण स पुनश्चैवमेव विचेष्टते ।
Apasmara is dangerous and may cause destruction of memory, knowledge of the surroundings, of past events and results from loss of/fluctuation 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 Doshas getting increased in the same way as in unmada (insanity) localized in the heart (mind) and Deha (body), deranges (destroys) the mind, spreads in the heart and Samjnavaha channels (pathways of nerve signals / consciousness). The person enters into darkness (loss of consciousness) with his mind becoming
inactive, performs terrifying actions such as grinding the teeth, emitting froth from the mouth, shaking the hands and feet violently (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 Doshas. After some time (days or months) he performs such abnormal activities in the same way.

Bhedas: Kinds

अपस्मारश्चतुर्भेदो वाताद्यैर्निचयेन च ॥ ५ ॥
Epilepsy is of four kinds; by Vata etc. (Vata, Pitta and Kapha) separately and by the combination of all the three Doshas (Sannipata).

Purva Rupa: Prodromal symptoms

रूपमुत्पत्स्यमानेऽस्मिन् हृत्कम्पः शून्यता भ्रमः।
तमसो दर्शनं ध्यानं भ्रूव्युदासोऽक्षिवैकृतम् ॥६॥
अशब्दश्रवणं स्वेदो लालासिङ्घाणकस्रुतिः ।
अविपाकोऽरुचिर्मूर्छा कुक्ष्याटोपो बलक्षयः ॥७॥
निद्रानाशोऽङ्गमर्दस्तृट् स्वप्ने गानं सनर्तनम् ।
पानं तैलस्य मद्यस्य तयोरेव च मेहनम् ॥८॥
The features of the Apasmara are – tremors of the heart, feeling of the emptiness (of the heart), dizziness, seeing tamas – darkness before the eyes (loss of consciousness) worry, dropping of the brows, abnormal movements of the eye, hears sounds which are not present, sweating, 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 of oil and wine and urinating the same (all these in dreams).

Vataja Apasmara: Epilepsy of Vata origin

तत्र वातात्स्फुरत्सक्थिः प्रपतंश्च मुहुर्मुहुः ।
अपस्मरति सञ्ज्ञां च लभते विस्वरं रुदन् ॥९॥
उत्पिण्डिताक्षः श्वसिति फेनं वमति कम्पते ।
आविध्यति शिरो दन्तान् दशत्याध्मातकन्धरः॥ १०॥
परितो विक्षिपत्यङ्गं विषमं विनताङ्गुलिः ।
रूक्षश्यावारुणाक्षित्वङ्नखास्यः 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 bluish-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.

Pittaja Apasmara: Epilepsy of Pitta origin

अपस्मरति पित्तेन मुहुः सञ्ज्ञां च विन्दति ॥१२
पीतफेनाक्षिवक्त्रत्वगास्फालयति मेदिनीम् ।
भैरवादीप्तरुषितरूपदर्शी तृषान्वितः ॥१३॥
In that caused by Pitta, the person loses consciousness and regains it quickly, emits yellow froth from the mouth; eyes, face, skin are yellowish, scratches the ground (during convulsions) sees terrifying, burning, bright red colored objects and suffers from thirst.

Kaphaja Apasmara: Epilepsy of Kapha origin

कफाच्चिरेण ग्रहणं चिरेणैव विबोधनम् ।
चेष्टाल्पा भूयसी लाला शुक्लनेत्रनखास्यता ॥१४॥
शुक्लाभरूपदर्शित्वं सर्वलिङ्गं तु वर्जयेत् ।
In that due to kapha, seizures are slow with long intervals, so also long time for the awakening (regaining consciousness) actions (convulsions) are few and mild, there is excessive flow of saliva, eyes, nails and face are white, sees objects which are white in color. That due to all the Doshas has all the features appearing together; it should be rejected.

Chikitsa: Treatment

अथावृतानां धीचित्तहृत्खानां प्राक्प्रबोधनम् ॥१५॥
तीक्ष्णैः कुर्यादपस्मारे कर्मभिर्वमनादिभिः ।
In epilepsy the channels of intellect, memory and hrt (mind) which have become covered / obstructed (by the Doshas) should be cleared first by therapies such as strong emesis etc.

Chikitsa: Treatment

वातिकं वस्तिभूयिष्ठैः पैत्तं प्रायो विरेचनैः ॥१६॥
श्लैष्मिकं वमनप्रायैरपस्मारमुपाचरेत् ।
सर्वतः सुविशुद्धस्य सम्यगाश्वासितस्य च॥१७॥
अपस्मारविमोक्षार्थं योगान् संशमनाञ्छृणु ।
The apasmara caused by Vata, should be treated with enema therapy, that caused by Pitta by purgation therapy and that caused by Kapha, especially with emesis therapy. Listen now, medicinal recipes by pacifying action for the cure of epilepsy by all means, after doing proper – purificatory therapies and assurance.

Panchagavya Ghrita

गोमयस्वरसक्षीरदधिमूत्रैः शृतं हविः ॥१८॥
अपस्मारज्वरोन्मादकामलान्तकरं पिबेत् ।
Medicated ghee prepared by boiling ghee added with juice of fresh cow dung, cow milk, curd and cow urine should be consumed to cure epilepsy, fever, insanity jaundice.

Maha Panchagavya Ghrita

द्विपञ्चमूलत्रिफलाद्विनिशाकुटजत्वचः ॥१९॥ सप्तपर्णमपामार्गं नीलिनीं कटुरोहिणीम् ।
शम्याकपुष्करजटाफल्गुमूलदुरालभाः ॥२०॥
द्विपलाः सलिलद्रोणे पक्त्वा पादावशेषिते ।
भार्गीपाठाढकीकुम्भनिकुम्भव्योषरोहिषैः ॥२१॥
मूर्वाभूतिकभूनिम्बश्रेयसीशारिवाद्वयैः ।
मदयन्त्यग्निनिचुलैरक्षांशैः सर्पिषः पचेत् ॥२२॥
प्रस्थं तद्वद्द्रवैः पूर्वैः पञ्चगव्यमिदं महत् ।
ज्वरापस्मारजठरभगन्दरहरं परम् ॥२३॥
शोफार्शःकामलापाण्डुगुल्मकासग्रहापहम् ।
Two pala (96 grams) each of the two Panchamulas –
Bilva – Aegle marmelos
Agnimantha – Premnamucronata
Shyonaka – Oroxylum indicum
Patala – Stereospermumsuaveolens
Gambhari – Gmelina arborea
Shalaparni – Desmodiumgangeticum
Prishniparni – Urariapicta
Brihati – Solanum indicum
Kantakari – Solanum xanthocarpum
Gokshura – Tribulus terrestris,
triphalā – Triphala (Haritaki – Terminalia chebula, Vibhitaki – Terminalia bellerica & Amalaki – Emblica officinalis),
dviniśā – the two Nisa (Haridra – Curcuma longa & Daruharidra -Berberis aristata),
kuṭaja tvacaḥ – bark of Holarrhena antidysenterica,
saptaparṇaṃ – Alstonia scholaris,
apāmārgaṃ – Achyranthes aspera,
nīlinīṃ – Indigofera tinctoria,
kaṭurohiṇīm – Picrorrhiza kurroa,
śamyāka – Oroxylum indicum,
puṣkara jaṭā – Inula racemosa,
phalgumūla – Root of Ficus hispida
durālabhāḥ – Fagonia cretica,
are boiled in one drone (12.228 litres) of water and decoction reduced to one fourth. To this are added the paste of one Aksa (12 grams) each of
bhārgī – Clerodendrum serratum,
pāṭhā – Cissampelos pareira,
aḍhakī – Cajanas cajana,
kumbha – Croton tiglium / Jatropha curcas,
nikumbha – Baliospermum montanum,
vyoṣa – Vyosa (Black pepper – Piper nigrum, Long pepper fruit – Piper longum and Ginger – Zingiber officinale),
rohiṣaiḥ – Cymbopogon martinii,
mūrvā – Marsdenia tenacissima,
bhūtika – Trachyspermum ammi,
bhūnimba – Andrographis paniculata,
śreyasī – Scindapsus officinalis
śārivādvayaiḥ – the two Sariva (Shveta Sariva – white variety – Hemidesmus indicus and Krishna Sariva – Cryptolepis buchanani / Ichnocarpus frutescens),
madayanti – Lawsonia inermis,
agni – Plumbago zeylanica
niculai: – Barringtonia acutangula;
one Prastha (768 gram) of ghee, similarly liquids mentioned earlier (juice of fresh dung, milk, curds, and urine of the cow) and medicated ghee prepared. It is known as Mahapancagavya Ghrta, is best to cure fever, epilepsy, enlargement of the abdomen, fistula-in-ano, edema, hemorrhoids, jaundice, anemia, abdominal tumor, cough and diseases caused by evil spirits.

Brahmi Ghritam

ब्राह्मीरसवचाकुष्ठशङ्खपुष्पीशृतं घृतम् ॥२४॥
पुराणं मेध्यमुन्मादालक्ष्म्यपस्मारपाप्मजित् ।
Old ghee boiled with the fresh juice of Bacopa monnieri,
vacā – Acorus calamus,
kuṣṭha – Saussurea lappa
śaṅkhapuṣpī – Convolvulus pluricaulis
medhyaṃ – improves intelligence
unmāda – and cures insanity,
alakṣmī – sorcery,
apasmāra – epilepsy
pāpmajit – disease caused by sins.

Jivaniya Gana Siddha Yamakam

तैलप्रस्थं घृतप्रस्थं जीवनीयैः पलोन्मितैः ॥२५॥
क्षीरद्रोणे पचेत्सिद्धमपस्मारविमोक्षणम् ।
One prastha (768 ml) of oil and one Prastha (768 ml) of ghee, one pala (48 grams) each of herbs of Jivaniya Gana (vide chapter 15 of Sutrasthana) are cooked in one drona (12.228 litres) of milk. Thus prepared medicine relieves epilepsy.

Kashmaryadi Ghrita

कंसे क्षीरेक्षुरसयोः काश्मर्येऽष्टगुणे रसे ॥२६॥
कार्षिकैर्जीवनीयैश्च सर्पिःप्रस्थं विपाचयेत् ।
वातपित्तोद्भवं क्षिप्रमपस्मारं निहन्ति तत् ॥२७॥
Medicated ghee is prepared with one Kamsa (one adhaka – 3.072 litres) each of milk, and juice of sugarcane, eight parts of juice of kāśmarye – Gmelina arborea, one Karsa (12 grams) each of the herbs of Jivaniya gana and one Prastha (768 grams) of ghee. This quickly cures epilepsy caused by Vata pitta together.

Anya Yoga | Kushmanda Yashtimadhu Ghrita

तद्वत्काशविदारीक्षुकुशक्वाथशृतं पयः ।
कूष्माण्डस्वरसे सर्पिरष्टादशगुणे शृतम् ॥२८॥
यष्टीकल्कमपस्मारहरं धीवाक्स्वरप्रदम् ।
Milk boiled with the decoction of kāśa – Saccharum spontaneum, vidāri – Pueraria tuberosa, ikṣu – Saccharum officinarum, kuśa – Desmostachya bipinnata, acts similar. Ghee boiled with eighteen times its quantity of juice of Benincasa cerifera added with paste of Glycyrrhiza glabra cures epilepsy and bestows good intelligence, speech and voice.

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 drops and is the best; that (bile) of the dog, śṛgāla – jackal, biḍālānāṃ – cat, siṃhādīnāṃ – lion etc is best.

Nasya Yoga: Nasal Drops

गोधानकुलनागानां पृषतर्क्षगवामपि ॥ ३० ॥
पित्तेषु साधितं तैलं नस्येऽभ्यङ्गे च शस्यते ।
Oil boiled with the bile of the iguana lizard, nakula – mongoose, nāgānāṃ – elephant, spotted deer (or leopard), bear, cow, is highly beneficial when used as nasal medication and massage over the body.

Nasya Yoga: Nasal Drops

त्रिफलाव्योषपीतद्रुयवक्षारफणिज्जकैः ॥३१॥
श्र्याह्वापामार्गकारञ्जबीजैस्तैलं विपाचितम् ।
बस्तमूत्रे हितं नस्यं चूर्णं वा ध्मापयेद्भिषक्॥३२॥
Oil should be cooked with triphalā – triphala (Haritaki – Terminalia chebula, Vibhitaki – Terminalia bellerica & Amalaki – Emblica officinalis), vyoṣa – Vyosa (Black pepper – Piper nigrum, Long pepper fruit – Piper longum and Ginger – Zingiber officinale), pītadru – Berberis aristata,
alkali prepared of Hordeum vulgare, phaṇijjakaiḥ – Origanum majorana, śryāhva – Aegle marmelos, apāmārga – Achyranthes aspera, seed of Pongamia pinnata, with the addition of Goat’s urine this oil used as nasal drops or the powder of the above herbs blown into the nose by the physician is beneficial.

Dhupa: Fumigation

नकुलोलूकमार्जारगृध्रकीटाहिकाकजैः ।
तुण्डैः पक्षैः पुरीषैश्च धूपमस्य प्रयोजयेत् ॥३३॥
Fumigation should be done with the beak, feathers and excreta of the mongoose, owl, cat, vulture, insects, snake or crow.

Lashunadi tailam

शीलयेत्तैललशुनं पयसा वा शतावरीम् ।
ब्राह्मीरसं कुष्ठरसं वचां वा मधुसंयुताम् ॥३४॥
Sesame oil mixed with laśunaṃ – Allium sativum, śatāvarīm – Asparagus racemosus, mixed with milk, fresh juice of Bacopa monnieri, or juice of Saussurea lappa or of Acorus calamus may be consumed daily mixed with honey.

Importance of Rasayana therapy

समं क्रुद्धैरपस्मारो दोषैः शारीरमानसैः ।
यज्जायते यतश्चैष महामर्मसमाश्रयः ॥३५॥
तस्माद्रसायनैरेनं दुश्चिकित्स्यमुपाचरेत् ।
तदार्तं चाग्नितोयादेर्विषमात्पालयेत्सदा ॥३६॥
Since epilepsy arises from the aggravation (increase) of the Doshas of the body and mind together and then localized in a Mahamarma (important vital organ, the head) so it is difficult to cure; hence it should be treated with Rasayana therapy (rejuvenator therapy). The person suffering from it should be protected from fire, water and such other hazardous things always.
Strengthening the mind

मुक्तं मनोविकारेण त्वमित्थं कृतवान् इति ।
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 if feeble) troubles should be addressed and should be strengthened by supplying the things desired.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थानेऽपस्मारप्रतिषेधो नाम सप्तमोऽध्याय:॥ ७॥
Thus, ends the chapter Apasmara Pratisedha the seventh in Uttarasthana o Astanga Hrudaya Samhita-composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
Thus, ends Bhuta Tantra/ Graha Cikitsa (demonology), the third branch of Ayurveda.