|Section/Chapter||Indriya Sthana Chapter 8|
|Other Sections||Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana|
- 1 Indriya Sthana Chapter 8, Avakshiraseeya (Chapter on fatal signs like inverted shadow of dying person)
- 1.1 Abstract
- 1.2 Introduction
- 1.3 Sanskrit text, Transliteration and English Translation
- 1.3.1 Moribund feature of shadow
- 1.3.2 Moribund feature on eyelids
- 1.3.3 Moribund feature on eyebrows and forehead
- 1.3.4 Moribund feature of hairs
- 1.3.5 Moribund feature of nose
- 1.3.6 Incurable signs on face, ear and lips
- 1.3.7 Incurable signs on teeth
- 1.3.8 Fatal signs on tongue
- 1.3.9 Fatal sign of respiration
- 1.3.10 Fatal sign of extremities and neck
- 1.3.11 Fatal signs of abnormal movements
- 1.3.12 Summary
- 1.4 Tattva Vimarsha
- 1.5 Vidhi Vimarsha
- 1.6 Similar references in other texts
- 1.7 References
Indriya Sthana Chapter 8, Avakshiraseeya (Chapter on fatal signs like inverted shadow of dying person)
In this chapter Avakshiraseeya thirty six moribund signs starting with avakshira, i.e. inverted shadow of the dying person are described. These moribund signs mentioned in this chapter can be classified into:
- lakshananimitta (whose causative factors are pre-determined by destiny),
- lakshyanimitta (based on etio-pathological factors) and
- nimittaanurupa (resembling with etiological factors).
The changes in eyelids, eyebrows, face, scalp, nose, tongue, ears, and in abnormal movements of body are described to indicate declining lifespan and death. An individual is a union of five elements and consciousness. The union is by no means permanent with the possibility of dissolution (i.e. death) lingers on throughout life. Even though all symptoms mentioned in this chapter cannot be explained by rational scientific parameters, some particular symptoms are experienced and documented by people worldwide. At the end of the chapter the physicians are advised to carefully look for the moribund signs so the therapeutic treatment is stopped at appropriate time. Note: Thirty six moribund signs are mentioned in section of Sanskrit shloka and their translation in English and are not repeated here.
Keywords: avakshira, Avakshiraseeyamindriyam, inverted shadow of the dying person, moribund signs, dissolution.
The name given to this chapter, Avakshiraseeyamindriyam (or Avakshirsheeya) may be because of the significance of the particular symptom, avakshira, which means inverted shadow of the dying person.
These moribund signs mentioned in this chapter can be classified into following types: Table No.1: Classification of features:
|Two fold||Featuring in Healthy||Appearing on unhealthy person.|
When a person enters the final stage of the dying process, two different dynamics are at work and are closely interrelated and interdependent. On the physical plane, the body begins the final process of shutting down, which will end when all the physical systems cease to function. Usually this is an orderly and undramatic progressive series of physical changes which are not medical emergencies requiring invasive interventions. These physical changes are a normal, natural way in which the body prepares itself for death.
The other dynamic of the dying process at work is on the emotional-spiritual psychological plane, and is a different kind of process. The spirit of the dying person begins the final process of release from the body, its immediate environment, and all attachments. This release also tends to follow its own priorities, which may include the resolution of whatever is unfinished of a practical nature and reception of permission to “let go” from family members. These events are the normal, natural way in which the spirit prepares to move from this existence into the next dimension of life. The most appropriate kinds of responses to the emotional-spiritual-psychological changes are those which support and encourage this release and transition. Some specific symptoms mentioned in this chapter are experienced and documented by people worldwide. The physician is advised to assess the moribund signs in order to stop treatment.
Sanskrit text, Transliteration and English Translation
इति ह स्माह भगवानात्रेयः||२||
iti ha smāha bhagavānātrēyaḥ||2||
iti ha smAha bhagavAnAtreyaH||2||
We shall now expound the chapter on moribund signs like inverted physical shadow (of a being). Thus said Lord Atreya. [1-2]
Moribund feature of shadow
अवाक्शिरा वा जिह्मा वा यस्य वा विशिरा भवेत्| जन्तो रूपप्रतिच्छाया नैनमिच्छेच्चिकित्सितुम्||३||
avākśirā vā jihmā vā yasya vā viśirā bhavēt| jantō rūpapraticchāyā nainamicchēccikitsitum||3||
avAkshirA vA jihmA vA yasya vA vishirA bhavet| janto rUpapraticchAyA nainamiccheccikitsitum||3||
If the physical shadow of the individual is found to be inverted (head downwards and legs upwards), irregular or without the head, he must not be treated. 
Moribund feature on eyelids
जटीभूतानि पक्ष्माणि दृष्टिश्चापि निगृह्यते | यस्य जन्तोर्न तं धीरो भेषजेनोपपादयेत्||४||
jaṭībhūtāni pakṣmāṇi dr̥ṣṭiścāpi nigr̥hyatē | yasya jantōrna taṁ dhīrō bhēṣajēnōpapādayēt||4||
jaTIbhUtAni pakShmANi dRuShTishcApi nigRuhyate  yasya jantorna taM dhIro bheShajenopapAdayet||4||
A person, having complete matting of eye-lashes resulting in absence of vision should not be treated.
यस्य शूनानि वर्त्मानि न समायान्ति शुष्यतः| चक्षुषी चोपदिह्येते यथा प्रेतस्तथैव सः||५||
yasya śūnāni vartmāni na samāyānti śuṣyataḥ| cakṣuṣī cōpadihyētē yathā prētastathaiva saḥ||5||
yasya shUnAni vartmAni na samAyAnti shuShyataH| cakShuShI copadihyete  yathA pretastathaiva saH||5||
An emaciated person who is unable to close his eyes due to swollen eyelids and also accompanied by burning eyes should be considered as good as departed. 
Moribund feature on eyebrows and forehead
भ्रुवोर्वा यदि वा मूर्ध्नि सीमन्तावर्तकान् बहून्| अपूर्वानकृतान् व्यक्तान् दृष्ट्वा मरणमादिशेत्||६||
bhruvōrvā yadi vā mūrdhni sīmantāvartakān bahūn| apūrvānakr̥tān vyaktān dr̥ṣṭvā maraṇamādiśēt||6||
bhruvorvA yadi vA mUrdhni sImantAvartakAn bahUn| apUrvAnakRutAn vyaktAn dRuShTvA maraNamAdishet||6||
A person having appearance of bare lines over the scalp, whirls over eye eyebrows or over scalp which were not present before, will die certainly. 
त्र्यहमेतेन जीवन्ति लक्षणेनातुरा नराः| अरोगाणां पुनस्त्वेतत् षड्रात्रं परमुच्यते ||७||
tryahamētēna jīvanti lakṣaṇēnāturā narāḥ| arōgāṇāṁ punastvētat ṣaḍrātraṁ paramucyatē ||7||
tryahametena jIvanti lakShaNenAturA narAH| arogANAM punastvetat ShaDrAtraM paramucyate ||7||
These patients (having above mentioned signs), will survive for three days, and healthy individuals (having above mentioned signs) will survive maximum for 6 nights. 
Moribund feature of hairs
आयम्योत्पाटितान् केशान् यो नरो नावबुध्यते| अनातुरो वा रोगी वा षड्रात्रं नातिवर्तते||८||
āyamyōtpāṭitān kēśān yō narō nāvabudhyatē| anāturō vā rōgī vā ṣaḍrātraṁ nātivartatē||8||
AyamyotpATitAn keshAn yo naro nAvabudhyate| anAturo vA rogI vA ShaDrAtraM nAtivartate||8||
An ill or healthy individual, who does not respond to pulling or uprooting of hairs, does not survive for more than six nights. 
यस्य केशा निरभ्यङ्गा दृश्यन्तेऽभ्यक्तसन्निभाः| उपरुद्धायुषं ज्ञात्वा तं धीरः परिवर्जयेत्||९||
yasya kēśā nirabhyaṅgā dr̥śyantē'bhyaktasannibhāḥ| uparuddhāyuṣaṁ jñātvā taṁ dhīraḥ parivarjayēt||9||
yasya keshA nirabhya~ggA dRushyante~abhyaktasannibhAH| uparuddhAyuShaM j~jAtvA taM dhIraH parivarjayet||9||
If the hair of the individual appears to be unreasonably greasy then he should be considered as at the fag-end of his life and should not be treated.
Moribund feature of nose
ग्लायते नासिकावंशः पृथुत्वं यस्य गच्छति| अशूनः शूनसङ्काशः प्रत्याख्येयः स जानता||१०||
glāyatē nāsikāvaṁśaḥ pr̥thutvaṁ yasya gacchati| aśūnaḥ śūnasaṅkāśaḥ pratyākhyēyaḥ sa jānatā||10||
glAyate nAsikAvaMshaH pRuthutvaM yasya gacchati| ashUnaH shUnasa~gkAshaH pratyAkhyeyaH sa jAnatA||10||
A wise (physician) should consider (the patient) with depressed and thickened bridge? of the nose along with its pseudo – swollen appearance as incurable 
अत्यर्थविवृता यस्य यस्य चात्यर्थसंवृता| जिह्मा वा परिशुष्का वा नासिका न स जीवति||११||
atyarthavivr̥tā yasya yasya cātyarthasaṁvr̥tā| jihmā vā pariśuṣkā vā nāsikā na sa jīvati||11||
atyarthavivRutA yasya yasya cAtyarthasaMvRutA| jihmA vA parishuShkA vA nAsikA na sa jIvati||11||
Excessive nasal flaring or constriction, distortion in shape and extreme dryness of the nose indicate that the individual will not survive. 
Incurable signs on face, ear and lips
मुखं शब्दश्रवावोष्ठौ शुक्लश्यावातिलोहितौ| विकृत्या यस्य वा नीलौ न स रोगाद्विमुच्यते||१२||
mukhaṁ śabdaśravāvōṣṭhau śuklaśyāvātilōhitau| vikr̥tyā yasya vā nīlau na sa rōgādvimucyatē||12||
mukhaM shabdashravAvoShThau  shuklashyAvAtilohitau| vikRutyA yasya vA nIlau na sa rogAdvimucyate||12||
If the face, ears and lips become abnormally (without any visible cause) white, brown, excessively red or blue, then such a patient seldom recovers from the disease. 
Incurable signs on teeth
अस्थिश्वेता द्विजा यस्य पुष्पिताः पङ्कसंवृताः| विकृत्या न स रोगं तं विहायारोग्यमश्नुते||१३||
asthiśvētā dvijā yasya puṣpitāḥ paṅkasaṁvr̥tāḥ| vikr̥tyā na sa rōgaṁ taṁ vihāyārōgyamaśnutē||13||
asthishvetA dvijA yasya puShpitAH pa~gkasaMvRutAH| vikRutyA na sa rogaM taM vihAyArogyamashnute||13||
A patient having morbid conditions like appearance of bony white teeth, white flower shaped spots and mud like appearance over teeth cannot recover from the disease. 
Fatal signs on tongue
स्तब्धा निश्चेतना गुर्वी कण्टकोपचिता भृशम्| श्यावा शुष्काऽथवा शूना प्रेतजिह्वा विसर्पिणी||१४||
stabdhā niścētanā gurvī kaṇṭakōpacitā bhr̥śam| śyāvā śuṣkā'thavā śūnā prētajihvā visarpiṇī||14||
stabdhA nishcetanA gurvI kaNTakopacitA bhRusham| shyAvA shuShkA~athavA shUnA pretajihvA visarpiNI||14||
If the tongue becomes rigid, senseless, heavy, excessively coated with a thorn like fur, brown in color, dry or swollen and constantly mobile, then the patient having such signs should be considered as good as dead. 
Fatal sign of respiration
दीर्घमुच्छ्वस्य यो ह्रस्वं नरो निःश्वस्य ताम्यति| उपरुद्धायुषं ज्ञात्वा तं धीरः परिवर्जयेत्||१५||
dīrghamucchvasya yō hrasvaṁ narō niḥśvasya tāmyati| uparuddhāyuṣaṁ jñātvā taṁ dhīraḥ parivarjayēt||15||
dIrghamucchvasya yo hrasvaM naro niHshvasya tAmyati| uparuddhAyuShaM j~jAtvA taM dhIraH parivarjayet||15||
If a person faints after a short expiration followed by a long inspiration, then he should be considered as nearing his end and must not be treated. 
Fatal sign of extremities and neck
हस्तौ पादौ च मन्ये च तालु चैवातिशीतलम्| भवत्यायुःक्षये क्रूरमथवाऽपि भवेन्मृदु||१६||
hastau pādau ca manyē ca tālu caivātiśītalam| bhavatyāyuḥkṣayē krūramathavā'pi bhavēnmr̥du||16||
hastau pAdau ca manye ca tAlu caivAtishItalam| bhavatyAyuHkShaye krUramathavA~api bhavenmRudu||16||
Excessive coldness, roughness and softness in hands, legs and neck indicate the end of the life of the person. 
Fatal signs of abnormal movements
घट्टयञ्जानुना जानु पादावुद्यम्य पातयन्| योऽपास्यति मुहुर्वक्रमातुरो न स जीवति||१७||
ghaṭṭayañjānunā jānu pādāvudyamya pātayan| yō'pāsyati muhurvakramāturō na sa jīvati||17||
ghaTTaya~jjAnunA jAnu pAdAvudyamya pAtayan| yo~apAsyati muhurvakramAturo na sa jIvati||17||
The person who strikes one knee with the other, throws down legs after lifting them up and frequently turns the face to one or the other side, does not survive. 
दन्तैश्छिन्दन्नखाग्राणि नखैच्छिन्दञ्छिरोरुहान्| काष्ठेन भूमिं विलिखन्न रोगात् परिमुच्यते||१८||
dantaiśchindannakhāgrāṇi nakhaicchindañchirōruhān| kāṣṭhēna bhūmiṁ vilikhanna rōgāt parimucyatē||18||
dantaishchindannakhAgrANi nakhaicchinda~jchiroruhAn| kAShThena bhUmiM vilikhanna rogAt parimucyate||18||
The patient, who cuts tips of his nail by biting, clips hair by nail and writes on the ground with the help of a stick, succumbs to the disease. 
दन्तान् खादति यो जाग्रदसाम्ना विरुदन् हसन्| विजानाति न चेद्दुःखं न स रोगाद्विमुच्यते||१९||
dantān khādati yō jāgra dasāmnā virudan hasan| vijānāti na cēdduḥkhaṁ na sa rōgādvimucyatē||19||
dantAn khAdati yo jAgradasAmnA virudan hasan| vijAnAti na cedduHkhaM na sa rogAdvimucyate||19||
The patient who gnashes teeth while awake, cries and laughs loudly and does not have the pain sensation, does not recover from the disease. 
मुहुर्हसन् मुहुः क्ष्वेडन् शय्यां पादेन हन्ति यः| उच्चैश्छिद्राणि विमृशन्नातुरो न स जीवति||२०||
muhurhasan muhuḥ kṣvēḍan śayyāṁ pādēna hanti yaḥ| uccaiśchidrāṇi vimr̥śannāturō na sa jīvati||20||
muhurhasan muhuH kShveDan shayyAM pAdena hanti yaH| uccaishchidrANi  vimRushannAturo na sa jIvati||20||
The patient, who frequently laughs and shouts, strikes the bed by feet and puts finger into the nostrils, ears and eyes does not survive. 
यैर्विन्दति पुरा भावैः समेतैः परमां रतिम्| तैरेवारममाणस्य ग्लास्नोर्मरणमादिशेत्||२१||
yairvindati purā bhāvaiḥ samētaiḥ paramāṁ ratim| tairēvāramamāṇasya glāsnōrmaraṇamādiśēt||21||
yairvindati purA bhAvaiH sametaiH paramAM ratim| tairevAramamANasya glAsnormaraNamAdishet||21||
If a debilitated patient develops disliking for such factors which, in the past, made him extremely happy, his death is imminent. 
न बिभर्ति शिरो ग्रीवा न पृष्ठं भारमात्मनः| न हनू पिण्डमास्यस्थमातुरस्य मुमूर्षतः||२२||
na bibharti śirō grīvā na pr̥ṣṭhaṁ bhāramātmanaḥ| na hanū piṇḍamāsyasthamāturasya mumūrṣataḥ||22||
na bibharti shiro grIvA na pRuShThaM bhAramAtmanaH| na hanU piNDamAsyasthamAturasya mumUrShataH||22||
If the neck of the patient is unable to support the weight of the head, the back, that of the body, the jaw bones, morsel of food in the mouth, this indicates his imminent death. 
सहसा ज्वरसन्तापस्तृष्णा मूर्च्छा बलक्षयः| विश्लेषणं च सन्धीनां मुमूर्षोरुपजायते||२३||
sahasā jvarasantāpastr̥ṣṇā mūrcchā balakṣayaḥ| viślēṣaṇaṁ ca sandhīnāṁ mumūrṣōrupajāyatē||23||
sahasA jvarasantApastRuShNA mUrcchA balakShayaH| vishleShaNaM ca sandhInAM mumUrShorupajAyate||23||
Sudden fever, thirst, fainting, debility and looseness of joints points to death. 
गोसर्गे वदनाद्यस्य स्वेदः प्रच्यवते भृशम्| लेपज्वरोपतप्तस्य दुर्लभं तस्य जीवितम्||२४||
gōsargē vadanādyasya svēdaḥ pracyavatē bhr̥śam| lēpajvarōpataptasya durlabhaṁ tasya jīvitam||24||
gosarge vadanAdyasya svedaH pracyavate bhRusham| lepajvaropataptasya durlabhaM tasya jIvitam||24||
If a patient suffering from lepajwara i.e. a type of fever patient gets profuse perspiration in the face, there is little chance of his survival. 
नोपैति कण्ठमाहारो जिह्वा कण्ठमुपैति च| आयुष्यन्तं गते जन्तोर्बलं च परिहीयते||२५||
nōpaiti kaṇṭhamāhārō jihvā kaṇṭhamupaiti ca| āyuṣyantaṁ gatē jantōrbalaṁ ca parihīyatē||25||
nopaiti kaNThamAhAro jihvA kaNThamupaiti ca| AyuShyantaM gate jantorbalaM ca parihIyate||25||
If the ingested food does not reach the throat, or the tongue falls back over the throat (thereby causing obstruction ) and there is diminution of strength, then the death of the person is imminent. 
शिरो विक्षिपते कृच्छ्रान्मुञ्चयित्वा प्रपाणिकौ| ललाटस्रुप्रतस्वेदो मुमूर्षुश्च्युतबन्धनः ||२६||
śirō vikṣipatē kr̥cchrānmuñcayitvā prapāṇikau| lalāṭasrupratasvēdō mumūrṣuścyutabandhanaḥ ||26||
shiro vikShipate kRucchrAnmu~jcayitvA prapANikau| lalATasrupratasvedo mumUrShushcyutabandhanaH  ||26||
If the person moves his head with difficulty with the help of the fore-arms and if there is sweating in the forehead and is a sign of detachment from life, he is moribund. 
तत्र श्लोकः- इमानि लिङ्गानि नरेषु बुद्धिमान् विभावयेतावहितो मुमूर्षुषु| क्षणेन भूत्वा ह्युपयान्ति कानिचिन्नचाफलं लिङ्गमिहास्ति किञ्चन||२७||
tatra ślōkaḥ- imāni liṅgāni narēṣu buddhimān vibhāvayētāvahitō mumūrṣuṣu| kṣaṇēna bhūtvā hyupayānti kānicinnacāphalaṁ liṅgamihāsti kiñcana||27||
tatra shlokaH- imAni li~ggAni nareShu buddhimAn vibhAvayetAvahito mumUrShuShu| kShaNena bhUtvA hyupayAnti kAnicinnacAphalaM li~ggamihAsti ki~jcana||27||
Here is the re-capitulatory verse: The wise physician should closely search for these signs repeatedly because some of them disappear in a short moment after their manifestation.
None of these signs remain without leading to the consequences already described i.e. all of them certainly indicate imminent death. [27 ]
- The fatal signs can be observed on eyelids, eyebrows, scalp, nose, face, tongue, teeth, ears, and in abnormal movements of body parts. These signs indicate declining vitality of body.
The sign of inverted shadow of dying person lakshanamitta, should be understood. It is a classification and a unique sign which is not mentioned in contemporary science or in other alternative medicines. Naming a chapter in the Charaka Samhita after the sign reflects its importance.
Severe blepharitis comprises of matting of eyelids, swollen eyelids, burning vision and may cause death in patients in following conditions:
- having a neoplasm affecting the eyelid at the time of the clinical onset of blepharitis;
- or having xerophthalmia at the time of the clinical onset of blepharitis;
- or having diabetes mellitus at the time of the clinical onset of blepharitis;
- or being in an immune-compromised state at the time of the clinical onset of blepharitis; 
A condition of not having pain when uprooting the hairs is found in the end stage of leprosy featuring scalp numbness and alopecia.
A condition of unctuous hairs without application of oil is found in the asadhya lakshanas of prameha.
In the Wegener’s granulomatosis the bridge of the nose can collapse resulting in a “saddle–nose deformity due to cartilage inflammation. Death occurs due to kidney failure in such a case. In traditional Chinese medicine a symptom painting (e.g., nasal flaring) is described as a near death sign.
In Tibetan medicine, dryness of nose has been described as near death sign.
In contemporary science, extreme pallor of skin and cyanosis is described as a sign for alertness to identify major cause.
When death approaches a person his breathing may sound congested; may change in rate, depth and rhythm; there may be periods of breathlessness for 5-30 seconds resulting in Cheyne Stoke breathing.
The sign of abnormal movements of knees resembles distressed state of the patient suffering from severe pain which is a common near death symptom wherein patient cannot share his experiences with the other people due to widely compromised ability to communicate-a condition resembles Dysdiadokinesia. 
At the end of life, Organs begin to fail, including the brain. Higher-order consciousness tends to change; the chemical balance of the body becomes completely upset leading to altered sensation.
Saavedra-Aguilar and Gomez-Jeria’s (1989) model invokes temporal-lobe dysfunction, hypoxia, psychological stress, and neurotransmitter changes to explain the NDE. According to this model, brain stress caused by traumatic events leads to the release of endogenous neuropeptides, neurotransmitters, or both, producing such effects as analgesia, euphoria, and detachment.
Terminal restlessness is a particularly distressing form of delirium that may occur in dying patients. It is characterized by anguish (spiritual, emotional, or physical), restlessness, anxiety, agitation, and cognitive failure, caused by decrease in oxygen circulation to the brain and by metabolic changes. [18-20]
Many NDEs share with dissociation or disconnection of perception, cognition, emotion, and identity from the mainstream of the individual’s conscious awareness (Greyson, 1997).
Hectic fever is a daily recurring fever with profound sweating, chills, and flushed appearance-- often associated with pulmonary tuberculosis or septic poisoning.
Inability to swallow the oral food contents, leads to choking or enters the trachea causing fatality.
Chyutabandhanaḥ (Detachment from life) symptom can be interpreted either as release of all bodily sphincters or complete detachment of the bindings of the world, both acknowledged by contemporary science.
Similar references in other texts
Shloka 4 - 7: Su. Su. 31/10, A.H. Sha. 5/17,
Shlok-08:Ca. I. 11/17
Shlok-09: A.H. Sha. 5/16 & 19,
Shlok-10-12: Su. Su. 31/08,
Shlok-13: Su. Su. 31/06, A.H. Sha. 5/10
Shlok-14: Su. Su. 31/07, A.H. Sha. 5/10,
Shlok-18-19: Su. Su. 31/07, A.H. Sha. 5/10,
Shlok-22: Su. Su. 31/11, A.H. Sha. 5/11
Shlok-23: A.H. Sha. 5/109,
Shlok-24: A.H. Sha. 5/110,
Shlok-26:A.H. Sha. 5/57.
Note: Thirty six moribund signs are mentioned in section of Sanskrit shloka and their translation in English and are not repeated here.
- Kinzbrunner, BM; Weinreb, NJ; Policzer, JS; 20 Common Problems: End of Life Care, McGraw-Hill Publishing, 2002
- Greyson, B. - The near-death experience as a focus of clinical attention. J Nerv Ment Dis 185:327-334, 1997