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{{#seo:

|title=Kiyanta Shiraseeya Adhyaya

|titlemode=append

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|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 [[ojas]], movement of [[dosha]], [[Ayurveda]], Indian system of medicine, charak samhita.

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|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 [[ojas]], movement of [[dosha]], [[Ayurveda]], Indian system of medicine, charak samhita,Goyal M.,Singh G.,Pol A.,Kar A., Rai S., Deole Y.S., Basisht G.

|description=Sutra Sthana Chapter 17. Diseases of three vital organs including Head and other conditions

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|type=article

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<big>'''Sutra Sthana Chapter 17. Diseases of three vital organs including Head and other conditions'''</big>

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{{Infobox

|title = Kiyanta Shiraseeya Adhyaya

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|data1 = [[Sutra Sthana]] Chapter 17

|label2 = Tetrad/Sub-section

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|data2 = ''Roga Chatushka''

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|data2 = Roga Chatushka

|label3 = Preceding Chapter

|data3 = [[Chikitsaprabhritiya Adhyaya]]

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|data7 = Pol A.

|label8 = Editors

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|data8 = Kar A., Rai S., Deole Y.S., Basisht G.

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|data8 = Kar A., Rai S., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

|label9 = Year of publication

|data9 = 2020

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s01.019 10.47468/CSNE.2020.e01.s01.019]

}}

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

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<p 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 [[ojas]] 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. </br>

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<~~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 [[ojas]] 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 [[ojas]], movement of [[dosha]].

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</p>

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== Introduction ==

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</div>

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=== Symptoms of ''~~krimaja~~ shiroroga'' ===

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=== Symptoms of ''krimija shiroroga'' ===

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</div></div>

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Grief, fasting, over-exercise, intake of rough (non oily or ununctuous) or dry food articles, or food items of low nutritional value are the key etiological factors of [[vata]] dominant ~~dseases~~ of heart. Provoked [[vata]] , due to these causes, produces severe chest pain by affecting the heart [30]

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Grief, fasting, over-exercise, intake of rough (non oily or ununctuous) or dry food articles, or food items of low nutritional value are the key etiological factors of [[vata]] dominant diseases of heart. Provoked [[vata]] , due to these causes, produces severe chest pain by affecting the heart. [30]

=== Symptoms of [[vata]]-dominant disease of heart ===

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An unfortunate person already suffering from ''tridoshaja hridroga'', if further indulges in excessive intake of sesame, milk, and molasses, then he develops ~~thrombosis~~ (''granthi'') in the ''rasavaha srotas'' of the heart, leading to softening of the affected area and making it vulnerable to worm infestations. This infestation then spreads and consumes (''bhakṣyanti'') the heart tissues. It is ''krimija hridroga'' [36-38]

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An unfortunate person already suffering from ''tridoshaja hridroga'', if further indulges in excessive intake of sesame, milk, and molasses, then he develops swelling (''granthi'') in the channels carrying nutrient fluid (rasavaha srotas) of the heart, leading to softening of the affected area and making it vulnerable to worm infestations. This infestation then spreads and consumes (''bhakṣyanti'') the heart tissues. It is ''krimija hridroga''. [36-38]

</div>

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=== Symptoms of ''krimija hridroga'' ===

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**12 conditions of ''sannipata'' where one [[dosha]] is normal, second is increased and the third is decreased.

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In this way, 62 conditions of various combinations of normal, increased and decreased [[dosha]] have been mentioned in this chapter(verses from 41 to 62), of which only 12 types are described in detail. Chakrapāni mentions that combinations of [[dosha]] may occur in two ways i.e. ''prakriti-sama-samveta'' and ''vikriti-vishama-samveta''. ''Prakriti-sama-samveta'' akin to a sugar and salt solution in water where the tastes of sugar and salt remain intact and in such types of ''samsarga'' or ''sannipata'' of [[dosha]], no specific description is given in the text but simply mentioned that mix features of involved [[dosha]] will present.

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In this way, 62 conditions of various combinations of normal, increased and decreased [[dosha]] have been mentioned in this chapter(verses from 41 to 62), of which only 12 types are described in detail. Chakrapāni mentions that combinations of [[dosha]] may occur in two ways i.e. [[prakriti]]-sama-samveta and [[vikriti]]-vishama-samveta''. [[Prakriti]]-sama-samveta'' akin to a sugar and salt solution in water where the tastes of sugar and salt remain intact and in such types of ''samsarga'' or ''sannipata'' of [[dosha]], no specific description is given in the text but simply mentioned that mix features of involved [[dosha]] will present.

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On the other hand, ''vikriti-vishama-samveta'' a combination of provoked [[dosha]] wherein new symptoms are produced that are neither of any of the [[dosha]] involved. For example, red colour appears on mixing of white lime and yellow turmeric, and in such a case the specific symptoms produced by the combination are described. Here in 17th chapter, specific symptoms of 12 types of ''vikriti-vishama-samveta'' ''sannipata'' are given in detail, but symptoms of ''sama sannipata'' are not given as it is ''prakriti-sama-samveta'' (Verses 41-72).

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On the other hand, [[vikriti]]-vishama-samveta a combination of provoked [[dosha]] wherein new symptoms are produced that are neither of any of the [[dosha]] involved. For example, red colour appears on mixing of white lime and yellow turmeric, and in such a case the specific symptoms produced by the combination are described. Here in 17th chapter, specific symptoms of 12 types of [[vikriti]]-vishama-samveta'' ''sannipata'' are given in detail, but symptoms of ''sama sannipata'' are not given as it is [[prakriti]]-sama-samveta'' (Verses 41-72).

</div>

'''Table 1: Clinical features of different states of [[dosha]] and sannipata:'''

{| class="wikitable"

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! Sr.No. !! ''Vata'' !! ''Pitta'' !! ''Kapha '' !! Signs

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! Sr.No. !! [[Vata]] !! [[Pitta]] !! [[Kapha]] !! Signs

|-

| rowspan="1" style="text-align: left;" | 1

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| rowspan="1" style="text-align: left;" | Increased

| rowspan="1" style="text-align: left;" | Normal

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| rowspan="1" style="text-align: left;" | ''Jwara'' (fever) accompanied with ''Gaurava'' (heaviness) and ''Tandra'' (drowsiness)

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| rowspan="1" style="text-align: left;" | [[Jwara]](fever) accompanied with ''Gaurava'' (heaviness) and ''Tandra'' (drowsiness)

|-

| rowspan="1" style="text-align: left;" | 5

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| rowspan="1" style="text-align: left;" | Normal

| rowspan="1" style="text-align: left;" | Increased

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| rowspan="1" style="text-align: left;" | ''Mruduagni'' (slow digestion), ''Shirograha'' (stiffness of head), ''Nidra'' (excessive sleep), Tandra (drowsiness), Pralap (delirium), Hridroga (heart disorders), Gatragaurava (heaviness in the body), Nakhadi pitatva (yellowness in nails etc) and ''kapha-pitta shthivana'' (spitting of ''kapha –pitta)''

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| rowspan="1" style="text-align: left;" | ''Mruduagni'' (slow digestion), ''Shirograha'' (stiffness of head), [[Nidra]](excessive sleep), Tandra (drowsiness), Pralap (delirium), Hridroga (heart disorders), Gatragaurava (heaviness in the body), Nakhadi pitatva (yellowness in nails etc) and ''kapha-pitta shthivana'' (spitting of ''kapha –pitta)''

|-

| rowspan="1" style="text-align: left;" | 7

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| rowspan="1" style="text-align: left;" | Increased

| rowspan="1" style="text-align: left;" | Decreased

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| rowspan="1" style="text-align: left;" | affecting the [[Ojas]] causes malaise ''(Glāni), ~~indriyadaurbalya~~'' (asthenia of senses), ''Trushna'' (thirst), ''Murchha'' (fainting) and ''Kriyakshayam'' (decreased physiological functions).

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| rowspan="1" style="text-align: left;" | affecting the [[Ojas]] causes malaise ''(Glāni), [[indriya]]daurbalya'' (asthenia of senses), ''Trushna'' (thirst), ''Murchha'' (fainting) and ''Kriyakshayam'' (decreased physiological functions).

|-

| rowspan="1" style="text-align: left;" | 12

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'''''Avarita madhumeha (type 2 Diabetes mellitus)''''':

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Two scenarios that cause provocation of [[vata]] have been mentioned: decrease of [[dhatu]]([[dhatu]] kshaya) and ''avarana''(cover).[Cha.Sa.[[Chikitsa Sthana]] 28/59] The description of ''madhumeha'', provided earlier in this chapter, provides a good example of ''avarana''.That a provoked or vitiated [[vata]] causes ''madhumeha'' has also been reiterated in the [[Nidana Sthana]]. All the factors that cause decrease of body tissues lead to provocation of [[~~vāta~~]]. But even though ''madhumeha'' is caused by a vitiated [[vata]], its etiological factors also cause an increase in [[kapha]] and [[pitta]]. The comparison of ''nidana'' of ''madhumeha'' mentioned in these two different references is tabulated here:

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Two scenarios that cause provocation of [[vata]] have been mentioned: decrease of [[dhatu]]([[dhatu]] kshaya) and ''avarana''(cover).[Cha.Sa.[[Chikitsa Sthana]] 28/59] The description of ''madhumeha'', provided earlier in this chapter, provides a good example of ''avarana''.That a provoked or vitiated [[vata]] causes ''madhumeha'' has also been reiterated in the [[Nidana Sthana]]. All the factors that cause decrease of body tissues lead to provocation of [[vata]]. But even though ''madhumeha'' is caused by a vitiated [[vata]], its etiological factors also cause an increase in [[kapha]] and [[pitta]]. The comparison of ''nidana'' of ''madhumeha'' mentioned in these two different references is tabulated here:

'''Table 2: Difference between two contexts of ''Madhumeha'':'''

{| class="wikitable"

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! Causative Factors !! Causative factors of ''Dhatu kshayaja [[Vata]]ja Madhumeha(Nidana Sthana)'' !! Causative factors of ''Aavaranjanya vataja Madhumeha ( Sutra Sthana)''

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! Causative Factors !! Causative factors of ''[[Dhatu]] kshayaja [[Vata]]ja Madhumeha(Nidana Sthana)'' !! Causative factors of ''Aavaranjanya vataja Madhumeha ( Sutra Sthana)''

|-

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| rowspan="1" style="text-align: left;" | Excessive use of ''Rasa'' (Taste)

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| rowspan="1" style="text-align: left;" | Excessive use of Rasa(Taste)

| rowspan="1" style="text-align: center;" | Indulgence in intake of ''katu, tikta, kashaya rasa'' dominant food articles

| rowspan="1" style="text-align: left;" | Indulgence in intake of, ''lavana'' and ''amla rasa'' dominant food articles

|-

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| rowspan="1" style="text-align: left;" |Excessive use of ''[[Guna]]''

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| rowspan="1" style="text-align: left;" |Excessive use of [[Guna]]

| rowspan="1" style="text-align: left;" | ''ruksha, laghu, shita, ''

| rowspan="1" style="text-align: left;" | ''guru, snigdha, navam-anna-pana''

|-

| rowspan="1" style="text-align: left;" | Food habit

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| rowspan="1" style="text-align: left;" | ''langhana''

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| rowspan="1" style="text-align: left;" | [[langhana]]

| rowspan="1" style="text-align: left;" | ''samashana''

|-

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| rowspan="1" style="text-align: left;" | Excessive sleep, or sedentary life style with no physical activities

|-

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| rowspan="1" style="text-align: left;" | ''Shodhana''

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| rowspan="1" style="text-align: left;" | Shodhana

| rowspan="1" style="text-align: left;" | Excessive ''shodhana''

| rowspan="1" style="text-align: left;" | ''ashodhana''

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As mentioned earlier in the document, the diseases of the head (verses 13-14) include hemicrania, coryza, headache (caused as a side-effect of diseases of the mouth, nose, eyes and ears), giddiness/vertigo, facial paralysis, tremors of the head, and stiffness of the neck, nape and jaw (there are additional varieties of ''shiroroga'' viz. frontal sinusitis, trigeminal neuralgia, and ''shankhaka'' are also described. [Cha.Sa.[[Siddhi Sthana]] 9/70-87]

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In contemporary science, headache is not a disease and can be vascular, myogenic, cervicogenic, and inflammatory in origin. The drug choices also depend upon the causative factors of headache. Similarly in [[Ayurveda]], though headache is a common manifestation of all five types of diseases of the head, different forms of headache can give an idea of ''dosha'' predominance which may further decide the preference of procedures or drug in its treatment.

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In contemporary science, headache is not a disease and can be vascular, myogenic, cervicogenic, and inflammatory in origin. The drug choices also depend upon the causative factors of headache. Similarly in [[Ayurveda]], though headache is a common manifestation of all five types of diseases of the head, different forms of headache can give an idea of [[dosha]] predominance which may further decide the preference of procedures or drug in its treatment.

The term headache implies pain in the region of cranial vault which is one of the most common and difficult clinical problems in medicine and can be due to serious intracranial conditions like raised intracranial pressure or space occupying lesion or various inflammatory changes of brain tissue or meninges. Further, any pain in the head may also be due to lesions in nearby structures such as the eyes and ear causing referred headache.

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Carbuncles are common complications occurring in uncontrolled diabetes patients where the infection spreads extensively in the dermal and underlying soft tissue. This presents itself as a complex localized abscess or as several separate abscesses with multiple discharge sinuses usually caused due to staphylococcus aureus infection.

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Thus, this chapter is very important as it deals with the disorders of three vital parts of the body (''trimarma''). It also describes very important aspects of pathogenesis caused due to combinations of vitiated ''dosha'' viz. ''samsarga'' and ''sannipata''. The description of [[ojas]] is a unique concept of [[Ayurveda]]. The detailed descriptions along with etiological factors of each ''prameha pidika'' are very helpful in planning their prevention and cure.

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Thus, this chapter is very important as it deals with the disorders of three vital parts of the body (''trimarma''). It also describes very important aspects of pathogenesis caused due to combinations of vitiated [[dosha]] viz. ''samsarga'' and ''sannipata''. The description of [[ojas]] is a unique concept of [[Ayurveda]]. The detailed descriptions along with etiological factors of each ''prameha pidika'' are very helpful in planning their prevention and cure.

</div>

====Table 3: Types of Pidika in different classics:====

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|-

| rowspan="1" style="text-align: left;" | ''Pradhanamarma (hr̥daya)''

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| rowspan="1" style="text-align: left;" | ''hriddhaṭṭana'' (Palpitation)<br><hr>''Tamak'' (dyspnoea)<br><hr>''Pramoha''<br><hr>''Kasa'' (cough)<br><hr>''Shvasa'' (breathlessness)

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| rowspan="1" style="text-align: left;" | ''hriddhaṭṭana'' (Palpitation)<br><hr>''Tamak'' (dyspnoea)<br><hr>''Pramoha''<br><hr>Kasa (cough)<br><hr>''Shvasa'' (breathlessness)

|-

| rowspan="1" style="text-align: left;" | ''Kloma''

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|-

|} (Verse 101)

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'''Chart 1 : Different states of dosha'''

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'''Chart 1 : Different states of [[dosha]]'''

[[File:Dōṣāṇāṁ.png]]

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* [[Trimarmiya Chikitsa]]

* [[Trimarmiya Siddhi]]

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