अत उर्ध्वं विकारा ये त्रिमर्मीये चिकित्सिते| न प्रोक्ता मर्मजास्तेषां कांश्चिद्वक्ष्यामि सौषधान्||११||
Hence forward, will be described some of the diseases related to marma that have not been described in the chapter Trimarmiya Chikitsa, alongwith their treatment.
[Etiopathology of apatantraka (Opisthtomus)] Vata aggaravated by its own causative factors moves upwards from its sthana (site), reaching the hridaya produces pain or discomfort in hridaya (heart) and also in shira (head) and shankha (temporal area).
It causes a bow-like bending of the body, akshipet (involuntary jerks) and mohayet (altered consciousness). (It causes involuntary bending or contractures and jerky movements and also obstruction to breathing).
The person breathes out with difficulty, has spasm of eye movements or drooping, makes cooing sounds like a dove, becomes unconscious. The condition is called apatantraka. Some authors call a variant of this condition as apatanaka, in which there is fixity of eyes (gaze fixed) and grunting sounds from throat.
When hridaya is free of doshas the person becomes healthy and becomes unconscious again when gets afflicted with doshas and is due to severe aggravation of vata.