By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Apasmara is one of the diseases included under Ayurveda psychiatry. It is considered as one of the mental disorders. Master Charaka has explained the chapter pertaining to diagnosis and treatment of Apasmara immediately after the chapter pertaining to diagnosis and treatment of Unmada.
Unmada is a broad-spectrum mental disorder which includes many mental conditions under its wing. It has often been compared to psychoses, lunacy and many other mental disorders. Master Charaka has also specified that the treatment of unmada and apasmara are alike and shall be handled through similar interventions. Apasmara is compared to epilepsy in Ayurveda clinical practice. But apasmara is more than that. The term Apasmara has embedded in it the word ‘smriti’ which means memory. Apasmara definitely is a condition wherein derangement of memory would be evident. So, is apasmara ‘epilepsy’ or ‘memory disorders’? Let us see what the classics have to tell about it.
Read – Charaka – Apasmara Chikitsa – 10th chapter
Table of Contents
Smrteh apagamanam – ‘Destruction of memory’ is considered as apasmara by experts.
So loss of memory is the predominant characteristic feature and diagnostic point for apasmara. But all cases of ‘memory related disorders’ are not considered as apasmara. The association of other symptoms mentioned below makes the definition of apasmara complete and comprehensive. Apasmara is a condition predominantly marked by loss of memory associated with –
Both tamah pravesha and bibhatsa cheshta are caused due to dhee-sattva samplava.
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Tamah – darkness, Pravesha – entering
Tamah pravesha means feeling like entering a zone of darkness. Entering into the darkness is a term used to explain ‘loss of wisdom or intelligence (temporary)’ which the person experiences during an attack of the disease. Just like we do not understand anything while enveloped by pitch darkness, we cannot understand or access anything when attacked by (surrounded) the disease.
Bhibhatsa – scary; Cheshta – activities
The person does scary or hideous activities due to absence of knowledge / destruction of intelligence and thought process on entering into the zone of darkness. Hideous activities include abnormal jerky movements of the limbs and deviation of eyes, froth appearing from the mouth etc.
What causes ‘doing hideous activities’ and ‘destruction of memory’ in the patient of apasmara?
Dhee-sattva samplava is said to be the cause for doing hideous activities and destruction of memory in the patient of apasmara. Hideous activities are not done intentionally. They appear without the knowledge of the patient on entering the dark zone, losing knowledge / intellect and judgment and being blacked out. Dhee means intellect. Sattva means mind. Samplava means deviation or destruction. So destruction of intellect and mind is the main cause of destruction of memory and hideous activities in apasmaara.
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Note – these events may not follow the chronology and may happen at the same time.
Madhava Nidana treatise defines apasmara and its hallmark features along with the description of the pathogenesis of the disease. The sequence of the disease is as explained below –
The explanation is almost similar to that of Master Charaka. Madhava Nidana has explained the causes and the events following to the causation of apasmara. On the other hand Madhavakara has used the term ‘samrambha’ instead of ‘bhibhatsa chesta (Charaka)’.
Is there only memory loss in apasmara?
Though the main characteristic feature of apasmara is loss of memory along with hideous activities and loss of consciousness, smriti is a term said to be representative of a grosser damage in the disease. Smriti apagamana also includes loss of intellect, wisdom, thought process, higher intellectual functions and knowledge along with memory.
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The word Apasmara is made up of two terms, apa and smara. Apa is used in the meaning of ‘killing, destroying or giving up’. Smara is used to explain smrti i.e. memory. Smrti is also to remember and recollect the past experiences and knowledge of things. When combined together – apa + smara = destruction of memory.
Antakrt – Sushruta tells that this disease would tend to end the life of the patient if not treated properly. Due to destruction of memory, intellect and wisdom, the person would enter water or fire and end life since they cannot remember the consequences during the attack. Smrti should be understood broadly and should include intellect, wisdom and memory. This is because during apasmaara one tends to forget the memories and experiences gained not only from the past but also those of the present time.
Master Dalhana, commentator of Sushruta Samhita also opines that destruction of memory is called as apasmara. Another reference from Master Charaka clarifies the same –
Due to destruction of memory, intellect and mind, the person does many scary activities including appearance of froth from the mouth, cramps and abnormal movements of the limbs and body parts, abnormal movements of eyes, grinding of teeth, throwing of limbs etc while enveloped by darkness and causes loss of consciousness suddenly and repeatedly. This condition is called apasmara.
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Apasmara has been compared to epilepsy. Even in epilepsy we can see that the person will have abnormal movements of the body parts (convulsions, shaking, tremors), froth occurs in the mouth, the person faints and loses consciousness for a short time and when he comes out of the episode of epilepsy he would not remember anything (loss of memory). When the attacks are repeated or are frequent, one’s knowledge, wisdom and analytical skills are also lost. Treatment of apasmara works in providing relief, prolonging the attacks or curing apasmara. Therefore in a way it is correct to compare apasmara with epilepsy.
Apasmara is also a mental disorder. When the mind, memory and intellect are damaged and when the symptoms repeatedly occur and disease becomes chronic, the memory of the person will be severely affected or destroyed. Since loss of memory is the predominant feature of apasmara, it can be considered as ‘memory disorder’ also.
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