Chapter 8. Apasmara Nidana (Chapter on diagnosis of seizure disorders)

Chapter 8.  Apasmara Nidana (Chapter on diagnosis of seizure disorders)

अथातोऽपस्मारनिदानं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः ||२||

athātō'pasmāranidānaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

“Now we shall discuss the diagnosis of Apasmara”, said Lord Atreya [1-2]

Four types of apasmara

इह खलु चत्वारोऽपस्मारा भवन्ति वातपित्तकफसन्निपातनिमित्ताः ||३||

iha khalu catvārō'pasmārā bhavanti vātapittakaphasannipātanimittāḥ||3||

There are four types of apasmara caused by 

1. vata, 
2. pitta, 
3. kapha and 
4. sannipatika (combination of all the three doshas).[3]

Persons prone to apasmara

त एवंविधानां प्राणभृतां क्षिप्रमभिनिर्वर्तन्ते; तद्यथा- रजस्तमोभ्यामुपहतचेतसामुद्भ्रान्तविषमबहुदोषाणां समलविकृतोपहितान्यशुचीन्यभ्यवहारजातानि वैषम्ययुक्तेनोपयोगविधिनोपयुञ्जानानां तन्त्रप्रयोगमपि च विषममाचरतामन्याश्च शरीरचेष्टा विषमाः समाचरतामत्युपक्षयाद्वा दोषाः प्रकुपिता: रजस्तमोभ्यामुपहतचेतसामन्तरात्मनः श्रेष्ठतममायतनं हृदयमुपसृत्योपरि तिष्ठन्ते, तथेन्द्रियायतनानि च | तत्र चावस्थिताः सन्तो यदा हृदयमिन्द्रियायतनानि चेरिताः कामक्रोधभयलोभमोहहर्षशोकचिन्तोद्वेगादिभिः सहसाऽभिपूरयन्ति, तदा जन्तुरपस्मरति ||४||

ta ēvaṁvidhānāṁ prāṇabhr̥tāṁ kṣipramabhinirvartantē; tadyathā- Rajas tamōbhyāmupahatacētasāmudbhrāntaviṣamabahudōṣāṇāṁ samalavikr̥tōpahitānyaśucīnyabhyavahārajātāni vaiṣamyayuktēnōpayōgavidhinōpayuñjānānāṁ tantraprayōgamapi ca viṣamamācaratāmanyāśca śarīracēṣṭā viṣamāḥ samācaratāmatyupakṣayādvā dōṣāḥ prakupitā Rajas tamōbhyāmupahatacētasāmantarātmanaḥ śrēṣṭhatamamāyatanaṁ hr̥dayamupasr̥tyōpari tiṣṭhantē, tathēndriyāyatanāni ca| tatra cāvasthitāḥ santō yadā hr̥dayamindriyāyatanāni cēritāḥ kāmakrōdhabhayalōbhamōhaharṣaśōkacintōdvēgādibhiḥ sahasā'bhipūrayanti, tadā jantur Apasmarati||4||

Individuals get quickly afflicted with apasmara if:

 - the mind of an individual is afflicted by 

• rajas (mental dosha associated with hyperactivity) and 
• tamas (mental dosha associated with hypoactivity);
• • the three sharira doshas are imbalanced and excessively aggravated;

an individual takes food that is 

• impure, 
• untimely, 
• decomposed, 
• possessing antagonistic properties, or 
• touched/cooked by unclean hands
• an individual follows improper methods (of diet and lifestyle, conduct described in Ayurveda) and 
• neglects prescribed rules;

an individual observes 

• improper techniques (of treatment) and 
• resorts to unhealthy regimen and behavior

an individual practices 

• improper bodily movements and 
• follows improper postures

an individual suffers from 

• excessive degeneration or debility.

In the situations mentioned above, the doshas get aggravated and affect individuals whose minds are already afflicted by rajas and tamas. 

The doshas (so aggravated) pervade the heart which is, as mentioned earlier, the abode of consciousness, as well as the sense organs. 

While there, the doshas get further aggravated by emotions such as 

• passion, 
• anger, 
• fear, 
• greed, 
• attachment, 
• excitement, 
• grief, 
• anxiety, 
• perturbation etc., 

consequently spreading throughout the heart and the sense organs. 

The individual is then said to have been afflicted with apasmara. [4]

Characteristic features of apasmara

अपस्मारं पुनः स्मृतिबुद्धिसत्त्वसम्प्लवाद्बीभत्सचेष्टमावस्थिकं तमः प्रवेशमाचक्षते ||५||

apasmāraṁ punaḥ smr̥ti buddhi sattva samplavādbībhatsacēṣṭamāvasthikaṁ tamaḥ pravēśamācakṣatē||5||

Apasmara is characterized by 

occasional loss of consciousness 

• associated with aberrant activities (like vomiting of froth and abnormal postures of the body) and 
• behavior, 

due to perversion of 

• memory, 
• intellect and 
• other psychic faculties. [5]

तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- भ्रूव्युदासः सततमक्ष्णोर्वैकृतमशब्दश्रवणंलालासिङ्घाणप्रस्रवणमनन्नाभिलषणमरोचकाविपाकौ हृदयग्रहः कुक्षेराटोपो दौर्बल्यमस्थिभेदोऽङ्गमर्दो मोहस्तमसो दर्शनंमूर्च्छा भ्रमश्चाभीक्ष्णं स्वप्ने च मदनर्तनव्यधनव्यथनवेपनपतनादीनीति ||६||

ततोऽनन्तरमपस्माराभिनिर्वृत्तिरेव ||७||

tasyēmāni pūrvarūpāṇi bhavanti; tadyathā- bhrūvyudāsaḥ satatamakṣṇōrvaikr̥tamaśabdaśravaṇaṁ lālāsiṅghāṇaprasravaṇamanannābhilaṣaṇamarōcakāvipākau hr̥dayagrahaḥ kukṣērāṭōpō daurbalyamasthibhēdō'ṅgamardō mōhasTamasō darśanaṁ mūrcchā bhramaścābhīkṣṇaṁ svapnē ca madanartanavyadhanavyathanavēpanapatanādīnīti||6||

Premonitory symptoms of apasmara include 

• contraction of eyebrows, 
• erratic and constant movement of eyes, 
• auditory hallucinations,
• excessive salivation, and 
• nasal discharge. 

There is frequent accompaniment of 

• anorexia, 
• indigestion, and 
• general disinclination towards food, 
• chest congestion, 
• distension of the lower abdomen accompanied with gurgling sound, 
• weakness, 
• cracking pain in bones and 
• malaise, 
• unconsciousness, 
• a feeling of despondency or depression, 
• fainting and 
• giddiness, and 

frequent dreams of scenes of 

• intoxication, 
• dancing, 
• murdering, 
• aching, 
• shivering and 
• falling. [6]

These are some common premonitory symptoms of apasmara. [7]

Specific types and features of apasmara

Vata dosha dominant apasmara

तत्रेदमपस्मारविशेषविज्ञानं भवति; तद्यथा-

अभीक्ष्णमपस्मरन्तं, क्षणेन सञ्ज्ञां प्रतिलभमानम्, उत्पिण्डिताक्षम्, असाम्नाविलपन्तम्, उद्वमन्तं फेनम्, अतीवाध्मातग्रीवम्, आविद्धशिरस्कं, विषमविनताङ्गुलिम्, अनवस्थितपाणिपादम्, अरुणपरुषश्यावनखनयनवदनत्वचम्, अनवस्थितचपलपरुषरूक्षरूपदर्शिनं, वातलानुपशयं, विपरीतोपशयं च वातेनापस्मरन्तं विद्यात् ||८||

tatrēdamapasmāraviśēṣavijñānaṁ bhavati; tadyathā-

abhīkṣṇamApasmarantaṁ, kṣaṇēna sañjñāṁ pratilabhamānam, utpiṇḍitākṣam, asāmnā vilapantam, udvamantaṁ phēnam, atīvādhmātagrīvam, āviddhaśiraskaṁ, viṣamavinatāṅgulim, anavasthitapāṇipādam, aruṇaparuṣaśyāvanakhanayanavadanatvacam, anavasthitacapalaparuṣarūkṣarūpadarśinaṁ, vātalānupaśayaṁ, viparītōpaśayaṁ ca vātēnāpasmarantaṁ vidyāt (1)||8||

• More frequent episodes of apasmara, 
• episodes of instant loss of consciousness and regain it quickly, 
• bulging or rolling up of eyes, 
• incoherent speech, 
• frothy vomit, 
• excessive stiffness of neck, 
• drooping of the head to one side, 
• irregular contraction of fingers, 
• unstable upper and lower limbs, 
• redness, 
• dryness and grayish tint in the nails, eyes, face and skin, 
• apparent vision or perception of unstable, fickle, coarse and dry objects, 
• conditions associated with consuming vata-aggravating diets and alleviation of ailments when subjected to vata-pacifying diets.[8-1]

Pitta-dominant apasmara

अभीक्ष्णमपस्मरन्तं क्षणेन सञ्ज्ञां प्रतिलभमानम्, अवकूजन्तम्, आस्फालयन्तं भूमिं, हरितहारिद्रताम्रनखनयनवदनत्वचं,रुधिरोक्षितोग्रभैरवादीप्तरुषितरूपदर्शिनं, पित्तलानुपशयं,विपरीतोपशयं च पित्तेनापस्मरन्तं विद्यात् ||८||

abhīkṣṇamapasmarantaṁ kṣaṇēna sañjñāṁ pratilabhamānam, avakūjantam, āsphālayantaṁ bhūmiṁ, haritahāridratāmranakhanayanavadanatvacaṁ, rudhirōkṣitōgrabhairavādīptaruṣitarūpadarśinaṁ, pittalānupaśayaṁ,viparītōpaśayaṁ ca pittēnāpasmarantaṁ vidyāt (2)||8||

• Frequent episodes of apasmara, 
• instant loss of consciousness and regaining it quickly, 
• stertorous breathing, 
• abnormal, dragging-like movement, 
• green, yellow or coppery tint of nails, eyes, face and skin, 
• apparent vision 
• or perception of bleeding, terrifying, horrible, burning and angry looking objects, 
• conditions associated with pitta-aggravating diets and 
• alleviation of ailments when subjected to pitta-pacifying diets [8-2]

Kapha-dominant apasmara

चिरादपस्मरन्तं, चिराच्च सञ्ज्ञां प्रतिलभमानं, पतन्तम्, अनतिविकृतचेष्टं, लालामुद्वमन्तं, शुक्लनखनयनवदनत्वचं,शुक्लगुरुस्निग्धरूपदर्शिनं, श्लेष्मलानुपशयं, विपरीतोपशयं च श्लेष्मणाऽपस्मर-न्तं विद्यात् ||८||

cirādapasmarantaṁ, cirācca sañjñāṁ pratilabhamānaṁ, patantam, anativikr̥tacēṣṭaṁ, lālāmudvamantaṁ, śuklanakhanayanavadanatvacaṁ, śuklagurusnigdharūpadarśinaṁ, ślēṣmalānupaśayaṁ, viparītōpaśayaṁ ca ślēṣmaṇā'pasmarantaṁ vidyāt (3)||8||

• Less frequent episodes of apasmara, 
• gradual loss and regain of consciousness, 
• frequently falling down, 
• less pronounced abnormalities in movement, 
• dribbling of saliva, 
• whitish discoloration of nails, eyes, face, and skin, 
• apparent vision or perception of white, heavy and unctuous objects, and 
• conditions associated with consuming kapha-aggravating diets and 
• alleviation of ailments when subjected to kapha-pacifying diets [8-3]

Sannipatika apasmara with dominance of all dosha

समवेतसर्वलिङ्गमपस्मारं सान्निपातिकं विद्यात्, तमसाध्यमाचक्षते इति चत्वारोऽपस्मारा व्याख्याताः ||८||

samavētasarvaliṅgamapasmāraṁ sānnipātikaṁ vidyāt, Tamasādhyamācakṣatē ||

iti catvārō'pasmārā vyākhyātāḥ||8||

Sannipatika apasmara (caused by the simultaneous vitiation of all the three doshas) shares the symptoms of all the three doshas (described above). 

• This condition is incurable.

Thus, four types of apasmara are explained. [8-4]

Apasmara with extrinsic factors

तेषामागन्तुरनुबन्धो भवत्येव कदाचित्, तमुत्तरकालमुपदेक्ष्यामः |

तस्य विशेषविज्ञानं यथोक्तलिङ्गैर्लिङ्गाधिक्यमदोषलिङ्गानुरूपं च किञ्चित् ||९||

tēṣāmāganturanubandhō bhavatyēva kadācit, tamuttarakālamupadēkṣyāmaḥ|

tasya viśēṣavijñānaṁ yathōktaliṅgairliṅgādhikyamadōṣaliṅgānurūpaṁ ca kiñcit||9||

Sometimes these conditions are associated with extrinsic causative factors described later (in Cikitsa10:53). 

- The symptoms that manifest in such cases, though, are not the same as those caused by vitiated doshas. [9]

Management of apasmara

हितान्यपस्मारिभ्यस्तीक्ष्णानि संशोधनान्युपशमनानि च यथास्वं, मन्त्रादीनि चागन्तुसंयोगे ||१०||

hitānyapasmāribhyastīkṣṇāni saṁśōdhanānyupaśamanāni ca yathāsvaṁ, mantrādīni cāgantusaṁyōgē||10||

• Strong elimination and 
• alleviation therapies 

- are effective in alleviating and curing apasmara. 

When extrinsic causative factors are involved, 

• then mantras etc., are considered useful. [10]

Manifestation of various diseases

तस्मिन् हि दक्षाध्वरध्वंसे देहिनां नानादिक्षु विद्रवतामभिद्रवणतरणधावनप्लवनलङ्घनाद्यैर्देहविक्षोभणैः पुरागुल्मोत्पत्तिरभूत्, हविष्प्राशात् प्रमेहकुष्ठानां, भयत्रासशोकैरुन्मादानां, विविधभूताशुचिसंस्पर्शादपस्माराणां, ज्वरस्तु खलुमहेश्वरललाटप्रभवः , तत्सन्तापाद्रक्तपित्तम्, अतिव्यवायात् पुनर्नक्षत्रराजस्य राजयक्ष्मेति ||११|| 

tasmin hi dakṣādhvaradhvaṁsē dēhināṁ nānādikṣu vidravatāmabhidravaṇataraṇadhāvanaplavanalaṅghanādyairdēhavikṣōbhaṇaiḥ purā gulmōtpattirabhūt, haviṣprāśāt pramēhakuṣṭhānāṁ, bhayatrāsaśōkairunmādānāṁ, vividhabhūtāśucisaṁsparśādapasmārāṇāṁ, jvarastu khalu mahēśvaralalāṭaprabhavaḥ , tatsantāpādraktapittam, ativyavāyāt punarnakṣatrarājasya rājayakṣmēti||11||

As per vedic legends, 

in the aftermath of destruction of Daksha’s yajna (holy sacrifice), 

1. Gulma (disease similar to lumps in abdomen) was manifested first in human beings due to stress induced as a result of fleeing, swimming, running, flying, etc. in all directions. 

2. Prameha (disease of obstinate urinary disorders) and kushtha (obstinate skin diseases including leprosy) were manifested due to excess intake of ghee. 

3. Various types of unmada (insanity/psychosis) were manifested due to fear, apprehension and grief. 

4. Apasmara (epilepsy) set in due to coming in contact with various types of unclean objects. 

5. Jwara came out of the forehead of Lord Shiva, and 

6. Raktapitta was manifested (a condition characterized by bleeding from different parts of the body) due to jwara’s heat. 

7. Moon was afflicted with rajayakshma due to excessive sexual indulgence. [11]

Summary

भवन्ति चात्र-

अपस्मारो हि वातेन पित्तेन च कफेन च |

चतुर्थः सन्निपातेन प्रत्याख्येयस्तथाविधः ||१२||

साध्यांस्तु भिषजः प्राज्ञाः साधयन्ति समाहिताः |

तीक्ष्णैः संशोधनैश्चैव यथास्वं शमनैरपि ||१३||

यदा दोषनिमित्तस्य भवत्यागन्तुरन्वयः |

तदा साधारणं कर्म प्रवदन्ति भिषग्विदः ||१४||

bhavanti cātra-

apasmārō hi vātēna pittēna ca kaphēna ca|

caturthaḥ sannipātēna pratyākhyēyastathāvidhaḥ||12||

sādhyāṁstu bhiṣajaḥ prājñāḥ sādhayanti samāhitāḥ|

tīkṣṇaiḥ saṁśōdhanaiścaiva yathāsvaṁ śamanairapi||13||

yadā dōṣanimittasya bhavatyāganturanvayaḥ|

tadā sādhāraṇaṁ karma pravadanti bhiṣagvidaḥ||14||

From the preceding verses, it can be said that 

• apasmara manifests itself due to the vitiation of vata, pitta and kapha and sannipata (combined vitiation of all the three doshas). 
• The sannipata variation is incurable. [12]

The curable types of apasmara should be carefully treated by 

a physician possessing 

• extensive knowledge and 
• experience of administering elimination and alleviation therapies associated with the dosha(s) causing the specific variant of apasmara. [13]

When apasmara is caused by 

- the vitiation of doshas associated with extrinsic causative factors, 

• then general therapies addressing both (doshic equilibrium and extrinsic causes) are advised by the best of physicians. [14]

सर्वरोगविशेषज्ञः सर्वौषधविशारदः|

भिषक् सर्वामयान् हन्ति न च मोहं निगच्छति ||१५||

sarvarōgaviśēṣajñaḥ sarvauṣadhaviśāradaḥ|

bhiṣak sarvāmayān hanti na ca mōhaṁ nigacchati ||15||

An able physician, 

• well versed in the specific characteristics of all diseases and 
• the properties of all medicines, 

- cures all (curable) diseases and does not get confused. [15]

इत्येतदखिलेनोक्तं निदानस्थानमुत्तमम् |१६|

ityētadakhilēnōktaṁ nidānasthānamuttamam|16|

This concludes the (excellent section titled) Nidana Sthana. [16]

Diagnostic principles of diseases /  Nidanarthakara roga (disease specific causes)

निदानार्थकरो रोगो रोगस्याप्युपलभ्यते ||१६||

nidānārthakarō rōgō rōgasyāpyupalabhyatē||16||

Diseases can act as causative factors of other diseases as well [16]

तद्यथा-

ज्वरसन्तापाद्रक्तपित्तमुदीर्यते |

रक्तपित्ताज्ज्वरस्ताभ्यां शोषश्चाप्युपजायते ||१७||

tadyathā-

jvarasantāpādraktapittamudīryatē|

raktapittājjvarastābhyāṁ śōṣaścāpyupajāyatē ||17||

For example, 

• elevated temperature in jwara can cause raktapitta and 
• raktapitta can cause jwara. 
• Both the diseases (i.e jwara and raktapitta) may lead to shosha (depletion of dhatus). [17]

प्लीहाभिवृद्ध्या जठरं जठराच्छोथ एव च |

अर्शोभ्यो जठरं दुःखं गुल्मश्चाप्युपजायते ||१८||

plīhābhivr̥ddhyā jaṭharaṁ jaṭharācchōtha ēva ca|

arśōbhyō jaṭharaṁ duḥkhaṁ gulmaścāpyupajāyatē||18||

• Pleeha (enlargement of spleen) causes jathara (abdominal diseases including ascitis), 
• which leads to shotha (generalized edema). 

• Arsha (hemorrhoids) causes jathara (abdominal diseases including ascitis) 
• that leads to gulma (abdominal lumps). [18]

प्रतिश्यायाद्भवेत् कासः कासात् सञ्जायते क्षयः |

क्षयो रोगस्य हेतुत्वे शोषस्याप्युपलभ्यते ||१९||

pratiśyāyādbhavēt kāsaḥ kāsāt sañjāyatē kṣayaḥ|

kṣayō rōgasya hētutvē śōṣasyāpyupalabhyatē||19||

• Pratishyaya (rhinitis) leads to kasa (cough) 
• which further leads to kshaya (depletion of dhatu), 
• consequently resulting in sosha (emaciation). [19]

ते पूर्वं केवला रोगाः पश्चाद्धेत्वर्थकारिणः |

उभयार्थकरा दृष्टास्तथैवैकार्थकारिणः [१] ||२०||

tē pūrvaṁ kēvalā rōgāḥ paścāddhētvarthakāriṇaḥ|

ubhayārthakarā dr̥ṣṭāstathaivaikārthakāriṇaḥ [1] ||20||

Conditions in their primary stages or forms 

• manifest themselves as diseases and 
• subsequently act as causative factors for other diseases. 

They thus play a dual role 

• - as a disease and 
• as a causative factor. 

Some of these play just one role as well– 

• either as a disease 
• or as a causative factor. [20]

कश्चिद्धि रोगो रोगस्य हेतुर्भूत्वा प्रशाम्यति |

न प्रशाम्यति चाप्यन्यो हेत्वर्थं कुरुतेऽपि च ||२१||

kaściddhi rōgō rōgasya hēturbhūtvā praśāmyati|

na praśāmyati cāpyanyō hētvarthaṁ kurutē'pi ca||21||

• Some diseases subside after causing another disease, 
• while some do not subside even after causing another disease. [21]

एवं कृच्छ्रतमा नॄणां दृश्यन्ते व्याधिसङ्कराः |

प्रयोगापरिशुद्धत्वात्तथा चान्योन्यसम्भवात् ||२२||

ēvaṁ kr̥cchratamā nr̥̄ṇāṁ dr̥śyantē vyādhisaṅkarāḥ|

prayōgāpariśuddhatvāttathā cānyōnyasambhavāt||22||

Combinations of diseases in human beings are usually very difficult to treat, 

• owing to the complexity of the line of treatment, and 
• their serving as causative factors of each other. [22]

Ideal therapy without adverse effects

प्रयोगः शमयेद्व्याधिं योऽन्यमन्यमुदीरयेत् |

नासौ विशुद्धः, शुद्धस्तु शमयेद्यो न कोपयेत् ||२३||

prayōgaḥ śamayēdvyādhiṁ yō'nyamanyamudīrayēt|

nāsau viśuddhaḥ, śuddhastu śamayēdyō na kōpayēt||23||

A therapy 

• that alleviates one disease condition 
• but provokes another disease

-  is not shuddha (or is an impure or incorrect therapy). 

The ideal therapy 

• is that which pacifies a disease without provoking any other disease. [23]

Diagnostic aspect of etiological factors

एको हेतुरनेकस्य तथैकस्यैक एव हि |

व्याधेरेकस्य चानेको बहूनां बहवोऽपि च ||२४||

ēkō hēturanēkasya tathaikasyaika ēva hi|

vyādhērēkasya cānēkō bahūnāṁ bahavō'pi ca||24||

• One causative factor may cause one or many diseases. 

Many causative factors 

• may result in a single disease 
• or may cause several diseases. [24]

ज्वरभ्रमप्रलापाद्या दृश्यन्ते रूक्षहेतुजाः |

रूक्षेणैकेन चाप्येको ज्वर एवोपजायते ||२५||

jvarabhramapralāpādyā dr̥śyantē rūkṣahētujāḥ|

rūkṣēṇaikēna cāpyēkō jvara ēvōpajāyatē||25||

It is seen that a single causative factor, ruksha (dry) can cause many diseases such as 

• jwara (fever), 
• bhrama (vertigo) and 
• pralapa (delirium) etc., 

while the same single factor (ruksha) 

• may cause just one disease (jwara) [25]

हेतुभिर्बहुभिश्चैको ज्वरो रूक्षादिभिर्भवेत् |

रूक्षादिभिर्ज्वराद्याश्च व्याधयः सम्भवन्ति हि ||२६||

hētubhirbahubhiścaikō jvarō rūkṣādibhirbhavēt|

rūkṣādibhirjvarādyāśca vyādhayaḥ sambhavanti hi||26||

Jwara alone 

• may be caused by a combination of several causative factors including 
• but not limited to ruksha(dry) etc. and many causes like, ruksha (dry, rough) etc. may lead to several diseases. [26]

Diagnostic aspect of symptoms

लिङ्गं चैकमनेकस्य तथैवैकस्य लक्ष्यते |

बहून्येकस्य च व्याधेर्बहूनां स्युर्बहूनि च ||२७||

liṅgaṁ caikamanēkasya tathaivaikasya lakṣyatē|

bahūnyēkasya ca vyādhērbahūnāṁ syurbahūni ca||27||

Similarly, 

• one symptom may be common to many diseases, 
• one symptom may be related to only one disease, 
• many symptoms may be associated with only one disease, and 
• many symptoms may be common to many diseases. [27]

विषमारम्भमूलानां लिङ्गमेकं ज्वरो मतः |

ज्वरस्यैकस्य चाप्येकः सन्तापो लिङ्गमुच्यते ||२८||

viṣamārambhamūlānāṁ liṅgamēkaṁ jvarō mataḥ|

jvarasyaikasya cāpyēkaḥ santāpō liṅgamucyatē||28||

• One symptom i.e. jwara can be considered common to many diseases that have irregular onset, 
• while santapa (elevated temperature) is considered a symptom of only one disease i.e. jwara.[28]

विषमारम्भमूलैश्च ज्वर एको निरुच्यते |

लिङ्गैरेतैर्ज्वरश्वासहिक्काद्याः सन्ति चामयाः ||२९||

viṣamārambhamūlaiśca jvara ēkō nirucyatē|

liṅgairētairjvaraśvāsahikkādyāḥ santi cāmayāḥ||29||

• Irregular onset (and similar other symptoms) appear in the case of jwara, 
• while similar symptoms also occur in shwasa (dyspnea), hikka (hiccups), and other similar diseases. [29]

Therapeutic considerations

एका शान्तिरनेकस्य तथैवैकस्य लक्ष्यते |

व्याधेरेकस्य चानेका बहूनां बह्व्य एव च ||३०||

ēkā śāntiranēkasya tathaivaikasya lakṣyatē|

vyādhērēkasya cānēkā bahūnāṁ bahvya ēva ca||30||

• A single therapy can subside many diseases as well as a single disease. 
• Multiple therapies may be needed to subside many diseases, 
• whereas one disease could require multiple therapies to cure. [30]

शान्तिरामाशयोत्थानां व्याधीनां लङ्घनक्रिया |

ज्वरस्यैकस्य चाप्येका शान्तिर्लङ्घनमुच्यते ||३१||

śāntirāmāśayōtthānāṁ vyādhīnāṁ laṅghanakriyā|

jvarasyaikasya cāpyēkā śāntirlaṅghanamucyatē||31||

• The diseases originating from amashaya are cured by langhana (fasting), 
• only whereas only a single disease entity jwara also can be treated by the single therapy of langhana (fasting). [31]

तथा लघ्वशनाद्याश्च ज्वरस्यैकस्य शान्तयः |

एताश्चैव ज्वरश्वासहिक्कादीनां प्रशान्तयः ||३२||

tathā laghvaśanādyāśca jvarasyaikasya śāntayaḥ|

ētāścaiva jvaraśvāsahikkādīnāṁ praśāntayaḥ||32||

For treating a single disease like jwara, 

• multiple therapies like light diet, etc. are needed and 

the same multiple therapies like light diet etc. 

• are needed to subside many diseases like jwara(fever), shwasa(dyspnea), hikka(hiccups) etc. [32]

Prognostic aspect in therapy

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 sukhōpāyaḥ kālēnālpēna sādhyatē|

sādhyatē kr̥cchrasādhyastu yatnēna mahatā cirāt||33||

yāti nāśēṣatāṁ vyādhirasādhyō yāpyasañjñitaḥ|

parō'sādhyaḥ kriyāḥ sarvāḥ pratyākhyēyō'tivartatē||34||

nāsādhyaḥ sādhyatāṁ yāti sādhyō yāti tvasādhyatām|

pādāpacārāddaivādvā yānti bhāvāntaraṁ gadāḥ||35||

Easily curable diseases 

• can be managed in a short time by simple measures. 

Diseases which are difficult to cure 

• may require more effort and time to cure. 

The palliable variety of incurable diseases 

• can never be cured, but can be alleviated. 

Incurable diseases 

• are not amenable to any type of treatment.

Conversely, 

incurable diseases never become curable, 

• while the curable varieties may become incurable due to factors like 

 - incompetence of the four components of health management (

 

• the physician, 
• the medicine, 
• the attendant and 
• the patient) and/
• or misfortune. 

• The easily curable kinds may also become difficult to cure, if not incurable, 

• while diseases that are difficult to cure may become palliable and 
• palliable variety may become incurable. [33-35]

Examination of stages of disease

वृद्धिस्थानक्षयावस्थां रोगाणामुपलक्षयेत् |

सुसूक्ष्मामपि च प्राज्ञो देहाग्निबलचेतसाम् ||३६||

vr̥ddhisthānakṣayāvasthāṁ rōgāṇāmupalakṣayēt |

susūkṣmāmapi ca prājñō dēhāgnibalacētasām||36||

A wise physician should carefully observe the subtle changes in the state of diseases (aggravated, normal and diminished) 

- while properly assessing the patient’s 

• body strength, 
• digestive power and 
• mental ability. [36]

व्याध्यवस्थाविशेषान् हि ज्ञात्वा ज्ञात्वा विचक्षणः |

तस्यां तस्यामवस्थायां चतुःश्रेयः प्रपद्यते ||३७||

vyādhyavasthāviśēṣān hi jñātvā jñātvā vicakṣaṇaḥ|

tasyāṁ tasyāmavasthāyāṁ catuḥśrēyaḥ prapadyatē||37||

The physician, who is keenly observing variations in disease stages in the patient, 

• should know it (the disease) well and prescribe such a 
• treatment that would be helpful in attaining the fourfold effect of therapeutics. [37]

प्रायस्तिर्यग्गता दोषाः क्लेशयन्त्यातुरांश्चिरम् |

तेषु न त्वरया कुर्याद्देहाग्निबलवित् क्रियाम् ||३८||

प्रयोगैः क्षपयेद्वा तान् सुखं वा कोष्ठमानयेत् |

ज्ञात्वा कोष्ठप्रपन्नांस्तान् यथासन्नं हरेद्बुधः ||३९||

prāyastiryaggatā dōṣāḥ klēśayantyāturāṁściram|

tēṣu na tvarayā kuryāddēhāgnibalavit kriyām||38||

prayōgaiḥ kṣapayēdvā tān sukhaṁ vā kōṣṭhamānayēt|

jñātvā kōṣṭhaprapannāṁstān yathāsannaṁ harēdbudhaḥ||39||

Generally, 

doshas that are spread over obliquely (in the transverse direction)

•  afflict the patient for a longer time. 

In that condition, 

• treatment should not be initiated in a hurry without proper assessment of body strength and digestive power. 

These doshas 

• should be alleviated first by treatment, or
•  they should be carefully be drawn to the koshtha (bowel). 

After knowing their status in koshtha,

•  the wise physician should eliminate them through the nearest route. [38-39]

ज्ञानार्थं यानि चोक्तानि व्याधिलिङ्गानि सङ्ग्रहे |

व्याधयस्ते तदात्वे तु लिङ्गानीष्टानि नामयाः ||४०||

jñānārthaṁ yāni cōktāni vyādhiliṅgāni saṅgrahē|

vyādhayastē tadātvē tu liṅgānīṣṭāni nāmayāḥ||40||

In the Nidana Sthana, 

• a compendium of symptomatology has been provided as a reckoner for the Ayurveda practitioner to gain adequate knowledge of some of the major classes of diseases and diagnose them effectively. 
• But these symptoms may independently develop into diseases and
•  create emergency situations. [40]

विकारः प्रकृतिश्चैव द्वयं सर्वं समासतः |

तद्धेतुवशगं हेतोरभावान्नानुवर्तते ||४१||

vikāraḥ prakr̥tiścaiva dvayaṁ sarvaṁ samāsataḥ|

taddhētuvaśagaṁ hētōrabhāvānnānuvartatē||41||

Everything can be categorized into being in a normal or an abnormal state. 

• Both of these categories depend upon causes. 
• Nothing can happen without a cause. [41]

Summary

तत्र श्लोकाः-

हेतवः पूर्वरूपाणि रूपाण्युपशयस्तथा |

सम्प्राप्तिः पूर्वमुत्पत्तिः सूत्रमात्रं चिकित्सितात् ||४२||

ज्वरादीनां विकाराणामष्टानां साध्यता न च |

पृथगेकैकशश्चोक्ता हेतुलिङ्गोपशान्तयः ||४३||

हेतुपर्यायनामानि व्याधीनां लक्षणस्य च |

निदानस्थानमेतावत् सङ्ग्रहेणोपदिश्यते ||४४||

tatra ślōkāḥ-

hētavaḥ pūrvarūpāṇi rūpāṇyupaśayastathā|

samprāptiḥ pūrvamutpattiḥ sūtramātraṁ cikitsitāt||42||

jvarādīnāṁ vikārāṇāmaṣṭānāṁ sādhyatā na ca|

pr̥thagēkaikaśaścōktā hētuliṅgōpaśāntayaḥ||43||

hētuparyāyanāmāni vyādhīnāṁ lakṣaṇasya ca|

nidānasthānamētāvat saṅgrahēṇōpadiśyatē||44||

To sum up this chapter, 

• etiological factors, 
• premonitory symptoms, 
• signs and symptoms, 
• therapeutic relief, 
• pathogenesis, 
• historical origins and 
• brief line of treatment of apasmara have been described in this section. 

Since this is the concluding chapter of the Nidana Sthana, a summary to the entire section has also been provided here, 

• stating that starting from jwara all eight diseases have been dealt with separately in eight chapters, 
• each with etiological factors, 
• symptomatology, 
• prognosis and 
• brief line of management.

• A compendium of diseases with etiological factors, 
• their synonyms, 
• symptoms of the diseases

          have been provided as an epilogue to the chapter. [42-44]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने अपस्मारनिदानं नामाष्टमोऽध्यायः |

निदानस्थानं समाप्तम् ||८||

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē

apasmāranidānaṁ nāmāṣṭamō'dhyāyaḥ||8||

Thus, ends the eighth chapter on the ‘diagnosis of apasmara” of the section “Diagnosis of diseases” (Nidana Sthana) of Agnivesha , as redacted by Charaka.