Changes

=== Introduction ===

=== Introduction ===

 

After describing the guidelines for clinical [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] practice in tetrad of previous chapters of ''Nirdesha Chatushka'', information about priniciples of basic Ayurvedic pathology in causing disease is detailed in ''Roga Chatushka'' (tetrad on disease information).   

After describing the guidelines for clinical [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] practice in tetrad of previous chapters of ''Nirdesha Chatushka'', information about priniciples of basic Ayurvedic pathology in causing disease is detailed in ''Roga Chatushka'' (tetrad on disease information).   

   

   

Various permutations and combinations of ''dosha'' have been analysed that help in understanding the pathogenesis of a disease. It is always a matter of debate as to why there are so many diseases and why does a disease have so many different manifestations or forms, depending upon an individual. One answer is that the ''dosha'' involved in pathogenesis varies in the forms of either ''vriddhi'' (increase) or ''kshaya'' (decrease), and that a typical permutation or combination of such ''doshas'' can manifest the disease in a different way. The verses 45, 46, and 47 deal with ''ashayapkarsha'' (pulling ''dosha'' from its location) in which a dominant or increased ''vata'' pulls the normal ''pitta'' and ''kapha'' away from their “seats” and manifests its own features there. Therefore, confusion can occur in the diagnosis and management of the disease. In addition, the concept of ''vikalpa samprapti'' (variable pathogenesis) can be a reason for such varied presentations of the disease, since per ''vikalpa samprapti'', the involvement of various properties of ''dosha'' may differ depending upon the etiological factors. Eighteen types of ''kshaya'' (decreased state) of ''dosha, dhatu,'' ''mala'' and ''ojas'' that may play a significant role in disease pathogenesis are also considered in this chapter. ''Madhumeha'' (Diabetes mellitus) which is also termed as ''ojomeha'' in other texts is one of the ''prameha'' where excessive ''kshaya'' of ''ojas'' takes place. One of its presentations (or forms) is caused due to ''avaranajanya samprāpti'' (obstructive pathogenesis), as explained in this chapter. ''Madhumeha'' is one among twenty types of ''prameha'' characterised by excessive frequency and quantity of urination. The primary ''dosha'' associated with ''madhumeha'' is ''vata'' and two types of pathogenesis of ''madhumeha'' have been discussed in [[Charaka Samhita]]. In the first type, ''dhātukshaya'' (decreased state of body tissue) causes ''vata'' provocation and all the clinical features of a vitiated ''vata'' are present in the patient of ''kshayaja madhumeha'' (Diabetes mellitus type 1) (Charaka Nidana 4/36-44). In the second type, there is an initial involvement of ''kapha, pitta, mamsa'' and ''medas dhātu'', that in turn make ''avarana'' (to get covered or overlapped) of ''vata'' leading to manifestation of ''madhumeha'' (diabetes mellitus type 2) where features of k''apha, pitta, medas'' and ''mamsa dushti'' are also observed. Here, therefore, the main line of treatment (i.e., for Type 2) involves pacifying  ''kapha, pitta,'' ''medas'' and ''mamsa''. Various ''gati'' of ''dosha'' that are responsible for healthy and diseased states are dealt at the end of the chapter. Charaka has also stressed upon the significance of a regular healthy diet. It can be said that in the 17th chapter, a multi-faceted approach to understanding various presentations of diseases has been mentioned, aided with examples.

Various permutations and combinations of ''dosha'' have been analysed that help in understanding the pathogenesis of a disease. It is always a matter of debate as to why there are so many diseases and why does a disease have so many different manifestations or forms, depending upon an individual. One answer is that the ''dosha'' involved in pathogenesis varies in the forms of either ''vriddhi'' (increase) or ''kshaya'' (decrease), and that a typical permutation or combination of such ''doshas'' can manifest the disease in a different way. The verses 45, 46, and 47 deal with ''ashayapkarsha'' (pulling ''dosha'' from its location) in which a dominant or increased ''vata'' pulls the normal ''pitta'' and ''kapha'' away from their “seats” and manifests its own features there. Therefore, confusion can occur in the diagnosis and management of the disease. In addition, the concept of ''vikalpa samprapti'' (variable pathogenesis) can be a reason for such varied presentations of the disease, since per ''vikalpa samprapti'', the involvement of various properties of ''dosha'' may differ depending upon the etiological factors. Eighteen types of ''kshaya'' (decreased state) of ''dosha, dhatu,'' ''mala'' and ''ojas'' that may play a significant role in disease pathogenesis are also considered in this chapter. ''Madhumeha'' (Diabetes mellitus) which is also termed as ''ojomeha'' in other texts is one of the ''prameha'' where excessive ''kshaya'' of ''ojas'' takes place. One of its presentations (or forms) is caused due to ''avaranajanya samprāpti'' (obstructive pathogenesis), as explained in this chapter. ''Madhumeha'' is one among twenty types of ''prameha'' characterised by excessive frequency and quantity of urination. The primary ''dosha'' associated with ''madhumeha'' is ''vata'' and two types of pathogenesis of ''madhumeha'' have been discussed in [[Charaka Samhita]]. In the first type, ''dhātukshaya'' (decreased state of body tissue) causes ''vata'' provocation and all the clinical features of a vitiated ''vata'' are present in the patient of ''kshayaja madhumeha'' (Diabetes mellitus type 1) (Charaka Nidana 4/36-44). In the second type, there is an initial involvement of ''kapha, pitta, mamsa'' and ''medas dhātu'', that in turn make ''avarana'' (to get covered or overlapped) of ''vata'' leading to manifestation of ''madhumeha'' (diabetes mellitus type 2) where features of k''apha, pitta, medas'' and ''mamsa dushti'' are also observed. Here, therefore, the main line of treatment (i.e., for Type 2) involves pacifying  ''kapha, pitta,'' ''medas'' and ''mamsa''. Various ''gati'' of ''dosha'' that are responsible for healthy and diseased states are dealt at the end of the chapter. Charaka has also stressed upon the significance of a regular healthy diet. It can be said that in the 17th chapter, a multi-faceted approach to understanding various presentations of diseases has been mentioned, aided with examples.

===Sanskrit Text, Transliteration and English Translation===

===Sanskrit Text, Transliteration and English Translation===