Changes

<big>'''Abstract'''</big>

<big>'''Abstract'''</big>

<div style="text-align:justify;">This is the first chapter of Roga Chatushka (tetrad on classification of diseases) dealing with description of diseases of the vital organs the head and the heart. Diseases are caused due to disequilibrium of dosha in body. The signs and symptoms of various permutations and combinations of dosha imbalances are enlisted in this chapter. It also enlists and describes signs of depletion of dhatu and mala. The disorders of oja are narrated, which continues with description of madhumeha (diabetes mellitus), and carbuncles produced as its complications. Various types of dosha gati (movements) are mentioned in this chapter. The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter. </div>

<div style="text-align:justify;">This is the first chapter of Roga Chatushka (tetrad on classification of diseases) dealing with description of diseases of the vital organs, the head and the heart. Diseases are caused by disequilibrium of dosha in body. The signs and symptoms of various permutations and combinations of dosha imbalances are enlisted in this chapter. It also enlists and describes signs of depletion of dhatu and mala. The disorders of oja are narrated, which continues with description of madhumeha (diabetes mellitus), and carbuncles produced as its complications. Various types of dosha gati (movements) are mentioned. The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter. </div>

'''Keywords''': ''Shiroroga'' (diseases of head), ''hridaya roga''(diseases of heart), imbalances in ''dosha'', ''dhatu-kshaya'', ''mala-kshaya, pidaka, madhumeha, dosha-gati, sannipata, samsarga, ojokshaya, ojas,'' signs of depletion of ''dosha, dhatu'' and ''mala'', disorders of ''oja'', movement of ''dosha''.

'''Keywords''': ''Shiroroga'' (diseases of head), ''hridaya roga''(diseases of heart), imbalances in ''dosha'', ''dhatu-kshaya'', ''mala-kshaya, pidaka, madhumeha, dosha-gati, sannipata, samsarga, ojokshaya, ojas,'' signs of depletion of ''dosha, dhatu'' and ''mala'', disorders of ''oja'', movement of ''dosha''.

The diseases related to ''trimarma'', or the three vital organs, have also been described in the 26th chapter of [[Chikitsa Sthana]] [[ Trimarmiya Chikitsa]] and later in 9th chapter of [[Siddhi Sthana]] [[Trimarmiya Siddhi]]. While the [[Sutra Sthana]] helps provide the fundamental approaches to treating these diseases, the [[Chikitsa Sthana]] primarily addresses the management aspects and [[Siddhi Sthana]] describes the internal and external traumas of these organs. As per  Ayurveda, there are 107 marmas that are considered to be points of ''prana'' (vital energy) and are located in various parts of the body. It is accepted that injuries to ''marma'' -external, internal or psychological  - may either cause immediate death or permanent deformities (some of which may cause complications and death at a later stage). Among these 107 ''marmas'', Charak has given utmost importance to the head, the heart and the urinary bladder. Among these three, the head is foremost as it is central to all senses and is the prime location of ''prana''. This is the reason why other texts have compared human body with an inverted-tree model (with roots at the top and branches at the bottom).

The diseases related to ''trimarma'', or the three vital organs, have also been described in the 26th chapter of [[Chikitsa Sthana]] [[ Trimarmiya Chikitsa]] and later in 9th chapter of [[Siddhi Sthana]] [[Trimarmiya Siddhi]]. While the [[Sutra Sthana]] helps provide the fundamental approaches to treating these diseases, the [[Chikitsa Sthana]] primarily addresses the management aspects and [[Siddhi Sthana]] describes the internal and external traumas of these organs. As per  Ayurveda, there are 107 marmas that are considered to be points of ''prana'' (vital energy) and are located in various parts of the body. It is accepted that injuries to ''marma'' -external, internal or psychological  - may either cause immediate death or permanent deformities (some of which may cause complications and death at a later stage). Among these 107 ''marmas'', Charak has given utmost importance to the head, the heart and the urinary bladder. Among these three, the head is foremost as it is central to all senses and is the prime location of ''prana''. This is the reason why other texts have compared human body with an inverted-tree model (with roots at the top and branches at the bottom).

The ''shiroroga'', or the disease(s) of the head, are various clinical representations of headache and vary depending upon ''dosha''-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''shiroroga'', different manifestations of headache can give an idea of the predominant ''dosha'' which may further decide the course of treatment. Similarly ''hridroga'' (heart diseases) and diseases associated with the urinary bladder mentioned in this chapter are also due to ''dosha'' predominance and ''krimi'' infestation.  

The ''shiroroga'', or the disease(s) of the head, have various clinical manifestations of headache and vary depending upon ''dosha''-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''shiroroga'', different manifestations of headache can give an idea of the predominant ''dosha'' which may further decide the course of treatment. Similarly ''hridroga'' (heart diseases) and diseases associated with the urinary bladder mentioned in this chapter are also due to ''dosha'' predominance and ''krimi'' infestation.  

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 [[Charak Samhita]]. In the first type, ''dhatukshaya'' (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) (Charak 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. Charak 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 analyzed 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 [[Charak Samhita]]. In the first type, ''dhatukshaya'' (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) (Charak 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. Charak 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.

</div>

</div>

Thus seventeenth chapter of [[Sutra Sthana]] compiled by Agnivesha and revised by Charak entitled [[Kiyanta Shiraseeya Adhyaya]] is completed (17).

Thus seventeenth chapter of [[Sutra Sthana]] compiled by Agnivesha and revised by Charak entitled [[Kiyanta Shiraseeya Adhyaya]] is completed (17).

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' / Fundamental Principles ===

*There are 107 ''marmas'' which are points of ''prana'' (vital energy) and are located in various parts of body. Three of these ''marmas'' - the head, the heart and the urinary bladder - are the most important.  

*There are 107 ''marmas'' which are points of ''prana'' (vital energy) and are located in various parts of body. Three of these ''marmas'' - the head, the heart and the urinary bladder - are the most important.  

*Diseases of the head and the heart can be identified according to the dominance of a ''dosha'' (or multiple ''doshas'') and diagnosed as per their etiology and symptomatology.  

*Diseases of the head and the heart can be identified according to the dominance of a ''dosha'' (or multiple ''doshas'') and diagnosed as per their etiology and symptomatology.  

*Various permutation and combinations of increase and decrease of ''dosha'' can occur inside the body affecting the physiological functions.  

*Various permutation and combinations of increase and decrease of ''dosha'' can occur inside the body affecting the physiological functions.  

*''Tridoshika'' disequlibrium is a precursor to diseases and their pathogenesis varies with level of ''vriddhi'' (increase) or ''kshaya'' (decrease) and a typical permutation or combination of such ''doshas'' can lead to different manifestations of the disease.

*''Tridoshika'' disequilibrium is a precursor to diseases and their pathogenesis varies with level of ''vriddhi'' (increase) or ''kshaya'' (decrease) and a typical permutation or combination of such ''doshas'' can lead to different manifestations of the disease.

*Increased and decreased states of ''dosha'' and vitiation of a particular ''dosha'' depends upon the exposure to causative factors in diet and lifestyle.  

*Increased and decreased states of ''dosha'' and vitiation of a particular ''dosha'' depends upon the exposure to causative factors in diet and lifestyle.  

*The increased or decreased ''dosha'' state can be identified by clinical appearance of their increased or decreased functions. Thus clinical diagnosis based on observations is more important than pathological or radiological investigations.  

*The increased or decreased ''dosha'' state can be identified by clinical appearance of their increased or decreased functions. Thus clinical diagnosis based on observations is more important than pathological or radiological investigations.  

*Digestion, temperature  and heat in the body is mainly controlled by ''pitta''. Strength of body depends upon ''kapha''. Whereas ''vata'' is responsible for all movements and and vitality.

*Digestion, temperature  and heat in the body is mainly controlled by ''pitta''. Strength of body depends upon ''kapha''. Whereas ''vata'' is responsible for all movements and and vitality.

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' / Applied Inferences ===

==== ''Indriya Buddhi'' (centres of senses in the brain) ====

==== ''Indriya Buddhi'' (centres of senses in the brain) ====