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Line 35: − + − + − + − + − + − 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.+ − '''Keywords''': ''avakshira, Avakshiraseeyamindriyam,'' inverted shadow of the dying person, moribund signs, dissolution. − </div> Line 51:
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Line 500: − + + + + + + − A condition of not having pain when uprooting the hairs is found in the end stage of leprosy featuring scalp numbness and alopecia.[5]+ − A condition of unctuous hairs without application of oil is found in the ''asadhya lakshanas'' of ''prameha''.[9]+ − + − + − In contemporary science, extreme pallor of skin and cyanosis is described as a sign for alertness to identify major cause.[12]+ − + − 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. [17]+ − 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.+ − + + + − − Hectic fever is a daily recurring fever with profound sweating, chills, and flushed appearance-- often associated with pulmonary tuberculosis or septic poisoning.[24] − Inability to swallow the oral food contents, leads to choking or enters the trachea causing fatality.[25]+ − + + + + + + + − + − + − + − + − + − + − + − + − + − + − + − + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
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{{#seo:
{{#seo:
|title=Avakshiraseeyam Indriyam Adhyaya
|title=Avakshiraseeyam Indriyam Adhyaya
|keywords=avakshira, Avakshiraseeyamindriyam, inverted shadow of the dying person, moribund signs, dissolution, Ayurveda, Indian system of medicine, charak samhita.
|keywords=avakshira, Avakshiraseeyamindriyam, inverted shadow of the dying person, moribund signs, dissolution, Ayurveda, Indian system of medicine, charak samhita.
|description=Indriya Sthana Chapter 8. Fatal signs like inverted shadow of dying person
|description=Indriya Sthana Chapter 8. Fatal signs like inverted shadow of dying person
|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=charak samhita
|image_alt=charak samhita
|type=article
|type=article
}}
}}
<big>'''[[Indriya Sthana]] Chapter 8. Fatal signs like inverted shadow of dying person'''</big>
<big>'''[[Indriya Sthana]] Chapter 8. Fatal signs like inverted shadow of dying person'''</big>
{{Infobox
{{Infobox
|data7 = Babu S.P.
|data7 = Babu S.P.
|label8 = Editors
|label8 = Editors
|data8 = Khandel S.K., Babu S.P., Deole Y.S., Basisht G.
|data8 = Khandel S.K., Babu S.P., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
|label9 = Year of publication
|label9 = Year of publication
|data9 = 2020
|data9 = 2020
}}
}}
<big>'''Abstract '''</big>
<big>'''Abstract '''</big>
<div style="text-align:justify;">
<p style='text-align:justify;'>In this chapter, 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:
In this chapter, 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:
# whose causative factors are pre-determined by destiny(''lakshananimitta''),
#''lakshananimitta'' (whose causative factors are pre-determined by destiny),
# based on etio-pathological factors(''lakshyanimitta'') and
#''lakshyanimitta'' (based on etio-pathological factors) and
# resembling with etiological factors(''nimittaanurupa'').
#''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. </p>
'''Keywords''': ''avakshira, Avakshiraseeyamindriyam,'' inverted shadow of the dying person, moribund signs, dissolution.
== Introduction ==
== Introduction ==
These moribund signs mentioned in this chapter can be classified into following types:
These moribund signs mentioned in this chapter can be classified into following types:
{| class="wikitable"
{| class="wikitable"
|+ Table 1: Classification of features
! colspan="4"| Classifications
! colspan="4"| Classifications
|-
|-
We shall now expound the chapter "Avakshiraseeyam Indriyam" (Fatal signs like inverted shadow of dying person).Thus said Lord Atreya. [1-2]
We shall now expound the chapter "Avakshiraseeyam Indriyam" (Fatal signs like inverted shadow of dying person).Thus said Lord Atreya. [1-2]
Note: The chapter deals with moribund signs like inverted physical shadow (of a being).
Note: The chapter deals with moribund signs like inverted shadow (of a physical being).
=== Moribund feature of shadow ===
=== Moribund feature of shadow ===
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. [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. [14]
=== Fatal sign of respiration ===
=== Fatal signs of respiration ===
<div class="mw-collapsible mw-collapsed">
<div class="mw-collapsible mw-collapsed">
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. [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. [17]
=== Fatal signs of abnormal behvior pattern ===
<div class="mw-collapsible mw-collapsed">
<div class="mw-collapsible mw-collapsed">
The patient, who frequently laughs and shouts, strikes the bed by feet and puts finger into the nostrils, ears and eyes does not survive. [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. [20]
=== Fatal signs of depression ===
<div class="mw-collapsible mw-collapsed">
<div class="mw-collapsible mw-collapsed">
If a debilitated patient develops disliking for such factors which, in the past, made him extremely happy, his death is imminent. [21]
If a debilitated patient develops disliking for such factors which, in the past, made him extremely happy, his death is imminent. [21]
=== Fatal signs of drooping body posture ===
<div class="mw-collapsible mw-collapsed">
<div class="mw-collapsible mw-collapsed">
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. [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. [22]
=== Fatal signs of acute fever ===
<div class="mw-collapsible mw-collapsed">
<div class="mw-collapsible mw-collapsed">
सहसा ज्वरसन्तापस्तृष्णा मूर्च्छा बलक्षयः| <br />
सहसा ज्वरसन्तापस्तृष्णा मूर्च्छा बलक्षयः| <br />
विश्लेषणं च सन्धीनां मुमूर्षोरुपजायते||२३|| <br />
विश्लेषणं च सन्धीनां मुमूर्षोरुपजायते||२३|| <br />
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. [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. [24]
=== Fatal signs of dysphagia ===
<div class="mw-collapsible mw-collapsed">
<div class="mw-collapsible mw-collapsed">
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. [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. [25]
=== Fatal signs of movement of head ===
<div class="mw-collapsible mw-collapsed">
<div class="mw-collapsible mw-collapsed">
The wise physician should closely search for these signs repeatedly because some of them disappear in a short moment after their manifestation.
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 ]
None of these signs remain without leading to the consequences already described i.e. all of them certainly indicate imminent death. [27]
== Tattva Vimarsha (Fundamental Principles) ==
== Tattva Vimarsha (Fundamental Principles) ==
== Vidhi Vimarsha (Applied Inferences ) ==
== Vidhi Vimarsha (Applied Inferences ) ==
<div style="text-align:justify;">
<div style="text-align:justify;">
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 [[Charak Samhita]] after the sign reflects its importance.[3]
=== Importance of moribund signs ===
The sign of inverted shadow of dying person (avakshirasa 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 [[Charak Samhita]] after the sign reflects its importance.[verse 3]
=== Signs on eyelids ===
Severe blepharitis comprises of matting of eyelids, swollen eyelids, burning vision and may cause death in patients in following conditions:
Severe blepharitis comprises of matting of eyelids, swollen eyelids, burning vision and may cause death in patients in following conditions:
#or having xerophthalmia 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 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; [4]
#or being in an immune-compromised state at the time of the clinical onset of blepharitis; [ verse 4]
=== Signs on hairs ===
A condition of not having pain when uprooting the hairs is found in the end stage of leprosy featuring scalp numbness and alopecia.[ verse 5]
A condition of unctuous hairs without application of oil is found in the incurable signs of [[prameha]].[ verse 9]
=== Signs on nose ===
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.[verse 10]
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.[10]
In Tibetan medicine, dryness of nose has been described as near death sign. <sup>[citation needed]</sup> [verse 11]
In Tibetan medicine, dryness of nose has been described as near death sign.[11]
In contemporary science, extreme pallor of skin and cyanosis is described as a sign for alertness to identify major cause.<sup>[citation needed]</sup>[ verse 12]
=== Signs on respiration ===
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.[15]
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.[verse 15]
=== Signs of abnormal movements ===
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. [verse 17]
At the end of life, multi organ failure is observed, including the brain. Higher-order consciousness tends to change; the chemical balance of the body becomes completely upset leading to altered sensation.
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.<ref> Kinzbrunner, BM; Weinreb, NJ; Policzer, JS; 20 Common Problems: End of Life Care, McGraw-Hill Publishing, 2002 </ref> [18-20]
Saavedra-Aguilar and Gomez-Jeria’s (1989) model<sup>[citation needed]</sup> 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.<ref> Kinzbrunner, BM; Weinreb, NJ; Policzer, JS; 20 Common Problems: End of Life Care, McGraw-Hill Publishing, 2002 </ref> [verse 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).<ref> Greyson, B. - The near-death experience as a focus of clinical attention. J Nerv Ment Dis 185:327-334, 1997 </ref>
Many NDEs share with dissociation or disconnection of perception, cognition, emotion, and identity from the mainstream of the individual’s conscious awareness (Greyson, 1997).<ref> Greyson, B. - The near-death experience as a focus of clinical attention. J Nerv Ment Dis 185:327-334, 1997 </ref>
=== Signs of acute fever ===
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.[26]
Hectic fever is a daily recurring fever with profound sweating, chills, and flushed appearance often associated with pulmonary tuberculosis or septic poisoning.<sup>[citation needed]</sup> [verse 24]
=== Signs of deglutition ===
Inability to swallow the oral food contents, leads to choking or enters the trachea causing fatality.[ verse 25]
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.<sup>[citation needed]</sup>[ verse 26]
</div>
</div>
=== Similar references in other texts ===
=== Similar cross references in other [[Ayurveda]] texts ===
'''Shloka 4 - 7''': Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 10. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1., Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 17. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 4 - 7''': Su.Sa. Sutra Sthana 31/10. <ref name = "Sushruta"> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>, A. H. Sharira Sthana 5/17 <ref name = "Vagbhata"> Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>
'''Shloka-08''': [[Anujyotiyam Indriyam Adhyaya]] verse 17
'''Verse 08''': Cha.Sa. [[Anujyotiyam Indriyam Adhyaya]] verse 17
'''Shloka-09''': Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 16,19. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 09''': A. H. Sharira Sthana 5/16,19. <ref name = "Vagbhata"/>
'''Shloka-10-12''':Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 8. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.
'''Verse 10-12''': Su.Sa. Sutra Sthana 31/8. <ref name = "Sushruta"/>
'''Shloka-13''': Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 6. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1., Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 10. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 13''': Su.Sa. Sutra Sthana 31/6, <ref name = "Sushruta"/>, A. H. Sharira Sthana 5/10. <ref name = "Vagbhata"/>.
'''Shloka-14''': Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 7. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1., Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 10. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 14''': Su.Sa. Sutra Sthana 31/7, <ref name = "Sushruta"/>, A. H. Sharira Sthana 5/10. <ref name = "Vagbhata"/>.
'''Shloka-18-19''': Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 7. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1., Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 10. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 18-19''': Su.Sa. Sutra Sthana 31/7,<ref name = "Sushruta"/>, A. H. Sharira Sthana 5/10. <ref name = "Vagbhata"/>.
'''Shloka-22''': Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 11. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1., Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 11. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 22''': Su.Sa. Sutra Sthana 31/11, <ref name = "Sushruta"/>, A. H. Sharira Sthana 5/11. <ref name = "Vagbhata"/>.
'''Shloka-23''': Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 109. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 23''': A. H. Sharira Sthana 5/109. <ref name = "Vagbhata"/>.
'''Shloka-24''': Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 110. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 24''': A. H. Sharira Sthana 5/110. <ref name = "Vagbhata"/>.
'''Shloka-26''':Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 57. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 26''': A. H. Sharira Sthana 5/57. <ref name = "Vagbhata"/>.
Note: Thirty six moribund signs are mentioned in section of Sanskrit ''shloka'' and their translation in English and are not repeated here.
Note: Thirty six moribund signs are mentioned in section of Sanskrit ''shloka'' and their translation in English and are not repeated here.
=== Contemporary views of prognostic features ===
The prognostic features described in the text can be observed in various disease conditions in contemporary clinical practice. The probable relevant conditions are summarized in the table 2.<ref>Gupta K. et.al., Avaakshiraseeyam of Charaka Indriya Sthana- An Explorative Study, Int. J. Ayu. Alt. Med., 2019; 7(6): 236-251</ref>
{| class="wikitable"
|+ Table 2: Contemporary views of prognostic features
|-
! Prognositc feature reference !! Contemporary views and relevant disease condition
|-
| | Inverted Shadow [Cha.Sa.[[Indriya Sthana]] 8/3] || Shadow analysis; similar to radio-diagnosis or imaging studies; shadows represents internal body parts;
|-
| | Signs on eyelashes [Cha.Sa.[[Indriya Sthana]] 8/4] || Blepharitis due to parasitic or fungal eye infections with secondary immunosupression; Automminue disease with ocular manifestations;
|-
| | Signs on eyelids [Cha.Sa.[[Indriya Sthana]] 8/5] || Grave’s ophthalmopathy;
|-
| | Signs on eyebrow [Cha.Sa.[[Indriya Sthana]] 8/6-7] || Seborrhoea in an immunocompromised patients; Carcinomas with an opportunistic scalp fungal infections or autonomic dysfunctions; Skull base tumours or metastatic skull tumours or brain tumours;
|-
| | Signs on hair pulling [Cha.Sa.[[Indriya Sthana]] 8/8] || Syringomyelia; Pure neuritis form of Leprosy (PNL); DSDP (Diabetic symmetric distal polyneuropathy); Acute sensory polyneuritis in GBS (Guillain-Barre syndrome); Sensory neuropathies;
|-
| | Signs on hair unctouness [Cha.Sa.[[Indriya Sthana]] 8/9] || Seborrhoea in an immunocompromised patients; Seborrheic dermatitis in AIDS (Acquired immuno-deficiency syndrome);
|-
| | Signs on nasal ridge [Cha.Sa.[[Indriya Sthana]] 8/10] || Saddle nose deformity in Leprosy, Syphilis, Wegeners granulomatosis; Rhinophyma; Maxillary or occult basal cell carcinomas; Nasal septal deviations;
|-
| | Signs on nostrils [Cha.Sa.[[Indriya Sthana]] 8/11] || SND (saddle nose deformity); Nasal and paranasal carcinomas and benign tumours; Hemangiomas; Lupus vulgaris; Sarcodiosis; Granulomas;
|-
| | Signs on face [Cha.Sa.[[Indriya Sthana]] 8/12] || Anaemia; Hyperpigmentation; Cutaneous flushing in various neuroendocrine diseases; Cyanosis; Acrocyanosis;
|-
| | Signs on teeth [Cha.Sa.[[Indriya Sthana]] 8/13] || Dental fluorosis; Periodontitis in oral, lung and pancreatic carcinomas; Hypomeineralization or demineralization of enamel in carcinomas or metastases;
|-
| | Signs on toungue [Cha.Sa.[[Indriya Sthana]] 8/14] || Pseuobulbar palsy; Myotonia; Progressive bulbar palsy; Pathology of cranial nerves V, VII and IX; DMD (Duchenne muscular dystrophy); ALS (Amyotrophic lateral sclerosis); MG (Myasthenia gravis); Macroglossia; Leukemia; Carcinomas; Inflammations;Fissured tongue in vitamin deficiencies; Black hairy tongue; Pathological pigmentation of tongue seen in Addison’s disease; Neoplastic causes; Atrophy of the tongue in various LMN (lower motor neuron) syndromes; Pathology of cranial nerves VII & XII; LMN syndromes;
|-
| | Signs on pattern of respiration [Cha.Sa.[[Indriya Sthana]] 8/15] || Abnormal breathing patterns like ‘Apenustic’, ‘Cheyne-Stokes’, ‘Kussumaul’ etc seen in cardio-pulmonary conditions, cerebrovascular accidents, metabolic acidosis and diabetic ketoacidiosis etc;
|-
| | Signs of cold extremities [Cha.Sa.[[Indriya Sthana]] 8/16] || Hypovolemic shock;
|-
| | Signs on knee movements [Cha.Sa.[[Indriya Sthana]] 8/17] || Movement disorders seen in brain injuries; Status epilepticus (SE); Hyperactive subtype of Delirium;
|-
| | Signs of abnormal behavior pattern [Cha.Sa.[[Indriya Sthana]] 8/18] || Nail biting, Trichotillomania and stereotypies seen in OCD spectrum disorders; Self injurious behaviours (SIBs) seen in Tourette’s syndrome (TS);
|-
| | Signs of bruxism [Cha.Sa.[[Indriya Sthana]] 8/19] || Awake bruxism seen in various neuropsychiatric conditions; TMDs (Temporomandibular disorders) seen in Schizophrenia;
|-
| | Signs of abnormal behavior [Cha.Sa.[[Indriya Sthana]] 8/20] || Movement disorders or dystonia with ‘gesteantagoniste’ or ‘sensory trick’ or ‘alleviating manoeuvre’; Restless legs syndrome (RLS); Neuropsychiatric Lyme borreliosis; Basal ganglia encephalitis;
|-
| | Signs of depression [Cha.Sa.[[Indriya Sthana]] 8/21] || Major depressive disorder (MDD); Negative symptoms of Schizophrenia; Cotard syndrome (CS); Catatonia; Bipolar mood disorder; Organic mood disorder;
|-
| | Signs of drooping body posture [Cha.Sa.[[Indriya Sthana]] 8/22] || NMDs (Neuromuscular disorders); LMN (lower motor neuron) syndromes;
|-
| | Signs of acute fever [Cha.Sa.[[Indriya Sthana]] 8/23] || Acute septic arthritis; Septic shock; SIRS (Systemic inflammatory response syndrome); MODS (Multi organ dysfunction syndrome);
|-
| | Signs of hectic fever [Cha.Sa.[[Indriya Sthana]] 8/24]|| Fever in neoplastic conditions; Cutaneous flushing in Neuroendocrinal diseases; Pheochromocytoma and Paraganglioma (PPGLs);
|-
| | Signs of dysphagia [Cha.Sa.[[Indriya Sthana]] 8/25] || Neuromuscular disorders (NMDs); ALS (Amyotrophic lateral sclerosis); Oropharyngeal dysphagia;
|-
| | Signs of abnormal head movements [Cha.Sa.[[Indriya Sthana]] 8/26] || Focal hyperhidrosis (acquired); Versive seizures; Frontal and occipital lobe seizures; Spinal cord injury (SCI); Syringomyelia; Intramedullary spinal cord tumours;
|-
|}
'''Acknowledgement:''' The contributors acknowledge support of Dr. M. Prasad and Dr.G.Kshama for providing tables 2,3 and 4 from their published article referred in this chapter.
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== References ==
== References ==