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Line 345: + + − *The conditions related with respiratory disease pathologies are pleural effusion, pneumothorax and pleural tumors and secondary to pulmonary diseases like pneumonia, pulmonary infarction and bronchogenic carcinoma. + − *''Anna'' (food) is considered as ''prana'' (vital force). Difficulty to intake the food interferes with nutrition and leads to severe disability. It also interferes with the intake of medicines. Dysphagia may be due to mechanical causes or neurological causes seen associated with other serious pathologies. Lack of digestion indicates impairment of digestive system and thus lack of absorption of nutrients and medicines. ''Prakrita kapha'' imparts ''bala'' (strength) to the body. Sudden depletion of ''bala'' indicates impairment of ''Ojus''. ''Bala'' is essential for both treatment and for prevention of further progression of disease. Severe ''kapha kshaya'' (depletion of ''kapha'') and ''vata-pitta'' vitiation is explained as the cause behind the pathogenesis of ''trishna''. ''Trishna'' indicates not merely thirst, but severe depletion of water and electrolytes from the body which may lead to pathology even at the cellular level. [verse 5-6]+ − *''Gambheera Hikka'' (severe hiccups) is included as one among the terminal illness in [[Ayurveda]]. The word ''gambheera'' indicates either ''hikka'' originating from deep pathology. ''Gambheera hikka'' is mentioned as ''pranantiki'' (Life ending) by Charak in the [[Chikitsa Sthana]]. Persistent hiccups are seen in many pathologies both mechanical and neurological like central nervous system lesions and tumors. Individuals who are very weak due to any illness get afflicted with abdominal distension (''anaha'') and diarrhea simultaneously, it will be very much difficult to prolong his life. Likewise, a debilitated or weak person when afflicted with morbid thirst (''trishna'') and abdominal distension (''anaha'') will soon die. + − *The word ''durbala'' signifies decreased strength in terms of immune deficiency, decreased quality of ''dhatus'', diminished ability to withstand the strength of medicine and disease itself and decreased ability to recover. Such a person, who is weakened by illness when afflicted by any disease or any super imposed infection, there are less chances of survival. + + + + + + + + + + + + + + + + + + + + + + + − *Agni is considered the principal factor responsible for health and disease. When a condition is mentioned as ''nirishmana'' (decrease in temperature/warmth), it ascertains to the fact that the dissociative and associative functions that usually happens physiologically in an individual is subnormal. The physiological levels of ''agni'' in succeeding hierarchy such as the ''dhatwagni'' and ''bhutagni'' will naturally get deranged. Such an individual does not respond to medication and the ''dhatus'' formed will be either ''saama'' or there will be ''dhatu sarahinatha'', which by itself forms abasement for ensuing diseases to be strong and with serious complications. − *The condition presented with edema as feature are Congestive cardiac failure, end stage renal failure, Good Pasteur’s syndrome, Hemolytic uremic syndrome, Cardiomyopathy, Ascites, Thrombophlebitis. − + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Katamanisharireeyam Indriyam Adhyaya (view source)
Revision as of 11:38, 9 October 2020
, 11:38, 9 October 2020→Vidhi Vimarsha (Applied Inferences)
== Vidhi Vimarsha (Applied Inferences) ==
== Vidhi Vimarsha (Applied Inferences) ==
=== Prognosis in respiratory disorders ===
<div style="text-align:justify;">
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The conditions related with respiratory disease pathologies are pleural effusion, pneumothorax and pleural tumors and secondary to pulmonary diseases like pneumonia, pulmonary infarction and bronchogenic carcinoma.
=== Prognosis in digestive disorders ===
[[Anna]] (food) is considered as [[prana]] (vital force). Difficulty to intake the food interferes with nutrition and leads to severe disability. It also interferes with the intake of medicines. Dysphagia may be due to mechanical causes or neurological causes seen associated with other serious pathologies. Lack of digestion indicates impairment of digestive system and thus lack of absorption of nutrients and medicines.
=== Prognosis in [[trishna]]===
Normal [[kapha]] imparts [[bala]] (strength) to the body. Sudden depletion of [[bala]] indicates impairment of [[Ojas]]. [[Bala]] is essential for both treatment and for prevention of further progression of disease. Severe [[kapha]] [[kshaya]] (depletion of [[kapha]]) and [[vata]]-[[pitta]] vitiation is explained as the cause behind the pathogenesis of [[trishna]] (morbid thirst). [[Trishna]] indicates not merely thirst, but severe depletion of water and electrolytes from the body which may lead to pathology even at the cellular level. [verse 5-6]
=== Prognosis in [[hikka]]===
''Gambheera Hikka'' (severe hiccups) is included as one among the terminal illness in [[Ayurveda]]. The word ''gambheera'' indicates either ''hikka'' originating from deep pathology. ''Gambheera hikka'' is mentioned as ''pranantiki'' (Life ending) by Charak in the [[Chikitsa Sthana]]. Persistent hiccups are seen in many pathologies both mechanical and neurological like central nervous system lesions and tumors.
=== Prognosis in diarrhea ===
Individuals who are very weak due to any illness get afflicted with abdominal distension (''anaha'') and diarrhea simultaneously, it will be very much difficult to prolong his life. Likewise, a debilitated or weak person when afflicted with morbid thirst (''trishna'') and abdominal distension (''anaha'') will soon die.
=== Depletion of strength ===
The word ''durbala'' signifies decreased strength in terms of immune deficiency, decreased quality of [[dhatu]], diminished ability to withstand the strength of medicine and disease itself and decreased ability to recover. Such a person, who is weakened by illness when afflicted by any disease or any super imposed infection, there are less chances of survival.
=== Role of [[agni]] ===
[[Agni]] is considered the principal factor responsible for health and disease. When a condition is mentioned as ''nirishmana'' (decrease in temperature/warmth), it ascertains to the fact that the dissociative and associative functions that usually happens physiologically in an individual is subnormal. The physiological levels of [[agni]] in succeeding hierarchy such as the ''dhatwagni'' and ''bhutagni'' will naturally get deranged. Such an individual does not respond to medication and the [[dhatu]] formed will be either ''saama'' or there will be ''dhatu sarahinatha'', which by itself forms abasement for ensuing diseases to be strong and with serious complications.
The conditions related to gastrointestinal pathologies include, E.coli infections, Irritable Bowel Syndrome, colitis, lactose intolerance, intestinal obstructions, cystic fibrosis, colon cancer.
The conditions related to gastrointestinal pathologies include, E.coli infections, Irritable Bowel Syndrome, colitis, lactose intolerance, intestinal obstructions, cystic fibrosis, colon cancer.
Few diseased conditions mentioned here in this chapter may be in quite manageable stage with the present modern management facilities but to the time of Charak those were definitely fatal. For example, many of hypo-volemic and dehydrated conditions are well treated now. But still it is a challenge to save life in toxic dehydrations. Many such clinical challenges are narrated where patient should not be neglected, rather aggressive care should be provided with informed consent to the relatives about possible fatal outcome.
=== Prognosis in edema ===
The condition presented with edema as feature are Congestive cardiac failure, end stage renal failure, Good Pasteur’s syndrome, Hemolytic uremic syndrome, Cardiomyopathy, Ascites, Thrombophlebitis.
=== Contemporary views ===
Few diseased conditions mentioned here in this chapter may be in quite manageable stage with the present modern management facilities but at the time of Charak, those were definitely fatal. For example, many of hypovolemic and dehydrated conditions are well treated now. But still it is a challenge to save life in toxic dehydrations. Many such clinical challenges are narrated where patient should not be neglected, rather aggressive care should be provided with informed consent to the relatives about possible fatal outcome.
=== Comorbid conditions and prognosis ===
Various comorbid conditions can be listed to differentiate as well as severity of a disease. This assessment is important in prognosis of disease. The conditions described in the chapter and probable relevant comorbid conditions in conventional medical terms are summarized in table 1. <ref name= "Mamidi P.1">Gupta K. et.al., Katamani Shaririyam of Charaka Indriya Sthana- An Explorative Study, Int. J. Ayu. Alt. Med., 2019; 7(5): 213-222</ref> These parameters can be applied for further understanding of relevant disease pathology and prognosis.
{| class="wikitable"
|+ Table 1: Comorbid conditions relevant to poor prognosis
|-
! Condition listed in the text !! Relevant comorbid disease or condition
|-
| | Poor prognosis of cardiac pain [Cha.Sa.[[Indriya Sthana]] 6/5-6] || GERD (Gastro esophageal reflux disease); Barrett’s esophagus; Plummer-Vinson syndrome (PVS); Adenocarcinoma of esophagus;
|-
| | Poor prognosis of hiccups [Cha.Sa.[[Indriya Sthana]] 6/7] || Carcinoma of lower gastrointestinal tract; Crohn’s disease; Ulcerative colitis; GERD; Cirrhosis of live;
|-
| | Poor prognosis of diarrhea [Cha.Sa.[[Indriya Sthana]] 6/8]|| Malabsorption syndrome; Tropical sprue; Intestinal tuberculosis; SIBO (small intestinal bacterial overgrowth); Crohn’s disease; Metastatic carcinoid;
|-
| | Poor prognosis with distension of abdomen and morbid thirst [Cha.Sa.[[Indriya Sthana]] 6/9] || Subacute or chronic perforation of peptic ulcer; Internal haemorrhage in gastrointestinal tract; Carcinoma of GI tract; Malabsorption syndrome;
Tuberculous peritonitis;
|-
| | Poor prognosis of fever [Cha.Sa.[[Indriya Sthana]] 6/10] || Pulmonary mucormycosis in immuno-compromised patients; Acute myelocytic leukemia (AML); Adenocarcinoma of lungs; Mediastinal lymphadenopathy;
|-
| | Poor prognosis in abdominal diseases [Cha.Sa.[[Indriya Sthana]] 6/11] || Chronic obstructive pulmonary disease (COPD) with Cardiovascualr disease (CVD); Chronic kidney disease (CKD); Acute glomerulonephritis; ESRD (end stage renal disease);
|-
| | Poor prognosis with ascites [Cha.Sa.[[Indriya Sthana]] 6/12]|| ESLD (end stage live disease); Hepatorenal syndrome (HRS); Cirrhosis of live; Spontaneous bacterial peritonitis;
|-
| | Poor prognosis with pedal edema [Cha.Sa.[[Indriya Sthana]] 6/13] || Peroneal muscular atrophy; Distal myopathies; Charcot-Marie-Tooth disease (CMT);
|-
| | Poor prognosis with genralized swelling [Cha.Sa.[[Indriya Sthana]] 6/14] || Celiac disease; Inflammatory bowel disease; Malabsorption syndrome; Protein losing enteropathy (PLE); Kwashiorker;
|-
| | Poor prognosis with respiratory disorders [Cha.Sa.[[Indriya Sthana]] 6/15] || Opportunistic lung infections in immuno-compromised patients; COPD; Bronchiectasis; Pulmonary mycosis; Pulmonary tuberculosis; Lung abscesses; Empyema; Lung carcinoma;
|-
|}
=== Scope of further research ===
There is a scope for research to study the relation between conditions described in text and relevant disease conditions. Some important points are summarized in table 2.
{| class="wikitable"
|+ Table 2: Text and probable relevant disease conditions
|-
! Verse !! Relevant disease or condition
|-
| | Cha.Sa.[[Indriya Sthana]] 6/16 || Renal tuberculosis; Acute glomerulonephritis; Chronic kidney disease (CKD); ESRD (end stage renal disease); Nephrotic syndrome;
|-
| | Cha.Sa.[[Indriya Sthana]] 6/17 || Delirium; Cardiac or Pulmonary or Cancer Cachexia; Carcinomas; Chronic debilitating conditions;
|-
| | Cha.Sa.[[Indriya Sthana]] 6/18 || Gastroenteritis complications; PLE (Protein losing enteropathy); ESRD; ESLD (end stage liver disease); Immunodeficiency disorders; Carcinomas;
|-
| | Cha.Sa.[[Indriya Sthana]] 6/19 || Hemorrhagic shock; Hypovolemic shock; Internal haemorrhage; Delirium;
|-
| | Cha.Sa.[[Indriya Sthana]] 6/20 || Tetanus;
|-
| | Cha.Sa.[[Indriya Sthana]] 6/21 || Hypoglycaemic shock; Delirium; Status epilepticus;
|-
| | [Cha.Sa.[[Indriya Sthana]] 6/22] || Heterotypic comorbidity; Discordant comorbidity; Antagonistic effect on coexisting disease; Various concepts of comorbdity, multimorbidity, morbidity burden and patient complexity
|-
| | Cha.Sa.[[Indriya Sthana]] 6/23 || Pulmonary or Cardiac or Cancer cachexia; Delirium; Dementia; Carcinomas;
|-
| | Cha.Sa.[[Indriya Sthana]] 6/24 || Dementias; Delirium; Cachexia;
|-
|}
'''Acknowledgement:''' The contributors acknowledge support of Dr. M. Prasad and Dr.G.Kshama for providing tables from their published article referred in this chapter.
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== References ==
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