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4th International Conference on
Ayurveda, Unani, Siddha & Traditional Medicine 2016
“Indigenous Knowledge for Health Chall...
AYURVEDIC APPROACH TO CLINICAL
MANAGEMENT OF EPILEPSY
(APASMARA)
 PRESENTOR: Dr PRABHAKAR MANU, PG SCHOLAR
 GUIDED BY : ...
CONTENTS
 INTRODUCTION TO EPILEPSY (APASMARA)
 CAUSATIVE FACTORS
 IMPORTANT FEATURES OF EPILEPSY (APASMARA)
 CLINICAL ...
OVERVIEW OF EPILEPSY (APASMARA)
 Chronic neurological disorder characterized by
episodic unprovoked seizures
 Causes: br...
तमःप्रिेशं
Pre-ictal phase
बीित्सचेष्टं
Ictal phase
धीसत्त्िसम्प्लि
Post-ictal phase
Loss of consciousness
(entering into ...
MANAGEMENT THROUGH AYURVEDA ?????
• Consumption of AED
• Adverse effects
• Chances of relapse
• Shodhana and Shamana
treat...
CAUSATIVE FACTORS
AHARA- DIET VIHARA- LIFESTYLE MANASIKA-
PSYCHOLOGICAL
Heavy for digestion(guru
ahara)
Suppression of thi...
APASMARA
SANNIPATAJ
PITTAJ
KAPHAJ
VAATAJ
8
ASSESSMENT
DIAGNOSIS
TREATMENT
9
FEATURES VAATAJ PITTAJ KAPHAJ SANNIPATAJ
FROTH AND
COLORS
Vomiting froth
Yellowness of
the foam, limbs,
face and eyes
Whit...
FEATURES VAATAJ PITTAJ KAPHAJ SANNIPATAJ
Bibhatsa Chesta +++ ++ + +++
Tama Pravesha +++ ++ ++ +++
Dhee Satva Samplava + + ...
12
SAMPRAPTI
S
T
H
A
Y
I
V
E
G
A
K
A
L
I
N
A
SANCHAYA
VYAKTHA BHEDA
STHANA SAMSRAYA
PRASARA
PRAKOPA
SANCHAYA
PRAKOPA
PRASA...
13
14
VEGA KALINA
SANJNA
PRABODHANA
VEGANTARA
KALINA
PREVENTING
FURTHER
EPISODES
APASMARA
TREATMENT
TREATMENT -BEFORE SEIZURES - 1*
 ON EXPERIENCING AURA, HALLUCINATIONS-
 Get away from water, fire, height, sharp objects...
DURING SEIZURES - 2*
 Prevent injuries by placing the patient on flat surface
 Head in lateral position to prevent obstr...
JUST AFTER SEIZURE - 3*
 Nasya – Pippalyadi nasya, Tulasi swarasa,
Lashuna swarasa, Vacha choorna,
Jyotishmati taila
 Dh...
VEGANTARA KALINA CHIKITSA
 REMOVAL OF ETIOLOGICAL FACTORS
 PRAVARA SNEHAPANA (KETOGENIC DIET)
 Basti (Medicated Enema)–...
SNEHAPANA - HIGH INTAKE
 Brahmi Ghrita-
 Polyherbal formulation ( Bacopa monneri, Evolvulus
alsinoids, Acorus calamus, S...
SNEHAPANA – CONT….
 Panchagavya Ghrita-
 Panchagavya ghrita as Arohana Matra Sneha
followed by Virechana provided signif...
TANTU PASHAN
Sanskrit Name
Botanical
Name
Quantity
Maricha
Piper nigrum
berry
180 mg
Chavya
Piper chabab
stem
80 mg
Tantu ...
SHAMANA MEDICINES
22
 Brahmi ghrita
 Panchagavya Ghrita
 Kalyanaka Ghrita
 Vachadi ghrita
 Mahachaitasa ghrita
 Ashv...
DO’S AND DON’TS
23
AHARA VIHARA MANASIKA
Old rice (purana shali) Rest(vishrama) Avoiding excessive Stress
60 days rice (sh...
SINGLE DRUGS
 Vacha- Acorus calamus Linn.
 Shankhapushpi-Convolvulus
pluricaulis Chosis.
 Kooshmanda- Ash gourd–Beninca...
PRANAYAMA OR DEEP DIAPHRAGMATIC BREATHING
 In this method, as a person slips into a seizure state and is
trained to refle...
DISCUSSION
o Modern antiepileptic drugs suppress the seizure, but do
not cure the disorder from root. The main drawbacks a...
DISCUSSION
 Ketogenic diet (Ghrita) is a safe and effective
treatment for intractable epilepsies; it has been
recommended...
CONCLUSION
 Apasmara is a neuropsychiatric disease & has
episodic manifestation.
 Etiopathogenesis should be properly un...
 Duration of the treatment should be planned
according to chronicity, severity etc. of the
disease & response to the trea...
30
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AYURVEDIC APPROACH TO CLINICAL MANAGEMENT OF EPILEPSY (APASMARA)-ICAUST 2016

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AYURVEDIC APPROACH TO CLINICAL MANAGEMENT OF EPILEPSY (APASMARA)

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AYURVEDIC APPROACH TO CLINICAL MANAGEMENT OF EPILEPSY (APASMARA)-ICAUST 2016

  1. 1. 4th International Conference on Ayurveda, Unani, Siddha & Traditional Medicine 2016 “Indigenous Knowledge for Health Challenges” 08th – 10th December 2016 organized by Institute of Indigenous Medicine University of Colombo Rajagiriya, Sri Lanka 1
  2. 2. AYURVEDIC APPROACH TO CLINICAL MANAGEMENT OF EPILEPSY (APASMARA)  PRESENTOR: Dr PRABHAKAR MANU, PG SCHOLAR  GUIDED BY : Dr SUHAS KUMAR SHETTY & Dr SAVITHA H P DEPARTMENT OF MANO VIJYAN EVAM MANASA ROGA SDM COLLEGE OF AYURVEDA & HOSPITAL HASSAN-573201, KARNATAKA, INDIA 2
  3. 3. CONTENTS  INTRODUCTION TO EPILEPSY (APASMARA)  CAUSATIVE FACTORS  IMPORTANT FEATURES OF EPILEPSY (APASMARA)  CLINICAL APPROACH  VEGA KALINA APPROACH  VEGANTARA KALINA APPROACH  UNDERSTANDING THE SAMPRAPTI  DISCUSSION  CONCLUSION 3
  4. 4. OVERVIEW OF EPILEPSY (APASMARA)  Chronic neurological disorder characterized by episodic unprovoked seizures  Causes: brain injury, stroke, brain tumour, infections of the brain, and birth defects.  Approx. 50 million people worldwide have epilepsy - WHO.  स्मृतेरपगमं प्राहुरपस्मारं भिषग्विदः| तमःप्रिेशं बीित्सचेष्टं धीसत्त्िसम्प्लिात्|| Cha. Chi. 10/3 4
  5. 5. तमःप्रिेशं Pre-ictal phase बीित्सचेष्टं Ictal phase धीसत्त्िसम्प्लि Post-ictal phase Loss of consciousness (entering into darkness) Convulsions with Teeth biting Altered state of consciousness Aura, Deviation of the eyes Dribbling of Frothy saliva Drowsiness Salivation and Nasal discharge Expiratory dyspnoea Confusion Sensation of spasm Involuntary speech or murmuring Nausea Congestion of heart Head retraction To one side Headache Giddiness Constriction of the fingers, unstable movements of the limbs Epilepsy ‘Apasmara’
  6. 6. MANAGEMENT THROUGH AYURVEDA ????? • Consumption of AED • Adverse effects • Chances of relapse • Shodhana and Shamana treatment • Decreased frequency of attack • Less chances of relapse and less side effects 6 MODERN MEDICINE AYURVEDA
  7. 7. CAUSATIVE FACTORS AHARA- DIET VIHARA- LIFESTYLE MANASIKA- PSYCHOLOGICAL Heavy for digestion(guru ahara) Suppression of thirst and appetite (vega- kshutvega dharana) Persistent grief, passion and anger, Mental irritation(chinta) Incompatible food (viruddhahara) Excess work (ativyayama) Timid personality Alcohol (madya), Nicotine Unethical activities (abhichara) Insult of teachers and elders (guru- vriddhapachara) Fish (matsya) Impaired Sleep wake cycle Intellectual blasphemy Tiredness (shrama) Prajnaparaadh 7
  8. 8. APASMARA SANNIPATAJ PITTAJ KAPHAJ VAATAJ 8
  9. 9. ASSESSMENT DIAGNOSIS TREATMENT 9
  10. 10. FEATURES VAATAJ PITTAJ KAPHAJ SANNIPATAJ FROTH AND COLORS Vomiting froth Yellowness of the foam, limbs, face and eyes White colour of the foam from the mouth, body, face and eyes Pain in the heart, thirst and nausea AURA Gets visual aura of forms which are rough, pink or black in color Aura of yellow or blood- red objects Visualizes the whole world as if set in flames Aura of white objects MIXED AURA OTHER FEATURES Rigorous breathing Gnashing of teeth Trembling Morbid thirst and heat Horripilation Feeling of heaviness and cold Delirious talk and the making of indistinct and moaning sounds 10
  11. 11. FEATURES VAATAJ PITTAJ KAPHAJ SANNIPATAJ Bibhatsa Chesta +++ ++ + +++ Tama Pravesha +++ ++ ++ +++ Dhee Satva Samplava + + ++ +++ Inter-Ictal phase + ++ +++ +++ Ictal phase + ++ +++ +++ Horripilation - - +++ +++ Trishna and Daha - +++ - +++ Gnashing of Teeth +++ - - +++ 11
  12. 12. 12 SAMPRAPTI S T H A Y I V E G A K A L I N A SANCHAYA VYAKTHA BHEDA STHANA SAMSRAYA PRASARA PRAKOPA SANCHAYA PRAKOPA PRASARA STHANA SAMSRAYA VYAKTHA BHEDA UPAHATA CHETAS UTPADAKA NIDANA HRIDAYA & INDRIYAYATANA APASMARA ROGA VYANJAKA HETU OCCLUSION OF SANJNAVAHA SROTAS DHI SATVA SAMPLAVA SMRITI APAGAMA APASMARA VEGA
  13. 13. 13
  14. 14. 14 VEGA KALINA SANJNA PRABODHANA VEGANTARA KALINA PREVENTING FURTHER EPISODES APASMARA TREATMENT
  15. 15. TREATMENT -BEFORE SEIZURES - 1*  ON EXPERIENCING AURA, HALLUCINATIONS-  Get away from water, fire, height, sharp objects, climbing trees, riding vehicles  Move towards flat large space area  Inform someone nearby if possible 15
  16. 16. DURING SEIZURES - 2*  Prevent injuries by placing the patient on flat surface  Head in lateral position to prevent obstruction in breathing  Placing mouth gag if possible so as to avoid tongue and cheek bite 16
  17. 17. JUST AFTER SEIZURE - 3*  Nasya – Pippalyadi nasya, Tulasi swarasa, Lashuna swarasa, Vacha choorna, Jyotishmati taila  Dhuma – Pippalyadi dhuma, Palankashadi  Anjana – Marichadi, Manashiladi, Shirisadi 17
  18. 18. VEGANTARA KALINA CHIKITSA  REMOVAL OF ETIOLOGICAL FACTORS  PRAVARA SNEHAPANA (KETOGENIC DIET)  Basti (Medicated Enema)– Vataja  Virechana (Classical Purgation)– Pittaja  Vamana(Classical emesis) - Kaphaj 18
  19. 19. SNEHAPANA - HIGH INTAKE  Brahmi Ghrita-  Polyherbal formulation ( Bacopa monneri, Evolvulus alsinoids, Acorus calamus, Saussurea lappa and Cow’s ghee) – Motor Coordination, Behaviour, Sleep, Convulsions, Locomotion and analgesia was evaluated in mice using standard procedures and results showed that Brahmi Ghrita protected mice from maximum electroshock and pentylenetetrazole induced convulsion.  -Achliya GS, Wadodkar SG, Dorle AK. Evaluation of CNS activity of Brahmi Ghrita. Indian J Pharmacol 2005;37:33-6. http://dx.doi.org/10.4103/0253-7613.13853 19
  20. 20. SNEHAPANA – CONT….  Panchagavya Ghrita-  Panchagavya ghrita as Arohana Matra Sneha followed by Virechana provided significant and better relief in most of the symptoms of epilepsy.  Chitrangana CN et al/ Int. J. Res. Ayurveda Pharm. 5(6), Nov-Dec 2014 20
  21. 21. TANTU PASHAN Sanskrit Name Botanical Name Quantity Maricha Piper nigrum berry 180 mg Chavya Piper chabab stem 80 mg Tantu Pashan Bhasma* Magnesium Silicate 140 mg Sudhakar Pemminati et al. / Journal of Pharmacy Research 2010, 3(5),1178-1180 On chronic administration, the test drug significantly reduced the duration of tonic hind limb extension and also the clonus phase in MES induced seizures. But, in PTZ induced seizures, neither it reduced the duration of clonic convulsion nor protected the animals from death. Results indicates that Tantu Pashan has protective effect against MES, but not against PTZ induced seizures.
  22. 22. SHAMANA MEDICINES 22  Brahmi ghrita  Panchagavya Ghrita  Kalyanaka Ghrita  Vachadi ghrita  Mahachaitasa ghrita  Ashvagandarista  Kooshmandaka ghrita  Saraswatarishta  Smritisagara rasa  Brahma rasayana etc.
  23. 23. DO’S AND DON’TS 23 AHARA VIHARA MANASIKA Old rice (purana shali) Rest(vishrama) Avoiding excessive Stress 60 days rice (shashtika shali) Cold water bath (sheetala jala snana) Family support Wheat (godhuma) Soothening music (manohita karani) Positive reinforcement Green gram soup (mudga yusha) Coping skills for social interaction Drum stick (shigru) and Grapes(draksha) Cow’s milk (goksheera), Cow’s ghee(goghrita) Fig(phalgu) Pomegranate(dadima) Gooseberry(amalaki)
  24. 24. SINGLE DRUGS  Vacha- Acorus calamus Linn.  Shankhapushpi-Convolvulus pluricaulis Chosis.  Kooshmanda- Ash gourd–Benincasa hispida (Thunb.)Cogn.  Jyotishmati- Celastrus paniculata Linn.  Yastimadhu- Glycyrrhiza glabra Linn.  Jatamamsi- Nardostachys jatamansi Dc.  Tagara- Valeriana jatamansi Jones.  Lashuna-Garlic- Allium sativa Linn.  Amalaki-Gooseberry- Emblica officinalis Gaertn.  Rasna- Pluchea lanceolata C. B. Clarke.  Hingu-Asafetida- Ferula narthex Boiss.  Choraka- Angelica glauca Edgew.  Kushta- Saussurea costus (Fale.) Lipsch.  Phalgu-Fig- Ficus carica Linn.  Brahmi- Bacopa monnieri (Linn.) Pennell. 24
  25. 25. PRANAYAMA OR DEEP DIAPHRAGMATIC BREATHING  In this method, as a person slips into a seizure state and is trained to reflexively catch and hold their breath as if startled or frightened. This causes changes in metabolism, blood flow, and oxygen levels in the blood.  The practice of pranayama, i.e., controlled deep diaphragmatic breathing, helps restore normal respiration; this can reduce the chances of going into a seizure or stop the seizure before it becomes full blown. 25
  26. 26. DISCUSSION o Modern antiepileptic drugs suppress the seizure, but do not cure the disorder from root. The main drawbacks are adverse effects , contraindications and sometimes lifetime treatment. o Ayurveda believes in balancing humours (dosha) to remove the root causes of the disorders and normalize the brain activity. o In the context of apasmara, The main aim of treatment is to pacify the doshas and to clear the occlusion of sanjna vaha srothas. 26
  27. 27. DISCUSSION  Ketogenic diet (Ghrita) is a safe and effective treatment for intractable epilepsies; it has been recommended since 1921. The diet induces ketosis, which may control seizures.  Ayurveda includes shamana, tikshna sanshodhan, rasayan chikitsa, sattvavajaya chikitsa. 27
  28. 28. CONCLUSION  Apasmara is a neuropsychiatric disease & has episodic manifestation.  Etiopathogenesis should be properly understood to diagnose & manage the cases of apasmara.  Apasmara has sthayi & vega kalina samprapti.  Management of apasmara is divided into vega kalina & vegantara kalina chikitsa. 28
  29. 29.  Duration of the treatment should be planned according to chronicity, severity etc. of the disease & response to the treatment. 29
  30. 30. 30

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