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Kiyanta Shiraseeya Adhyaya (view source)

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=== Introduction ===

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== Introduction ==

After describing the guidelines for health care management in clinical [[Ayurveda]] practice in earlier four tetrads, information about principles of basic Ayurvedic pathology in causing disease is detailed in [[Sutra Sthana#Roga Chatushka (four chapters on disease classification)|''Roga Chatushka'' (tetrad on disease information)]].

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</div>

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

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==Sanskrit Text, Transliteration and English Translation==

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Now ~~we shall expound~~ the chapter on '~~How many diseases are~~ of ~~the head?’~~ Thus said Lord Atreya. [1-2]

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Now I will explain the chapter on 'Diseases of three vital organs including Head and other conditions'. Thus said Lord Atreya. [1-2]

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==== Questions by Agnivesha ====

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=== Questions by Agnivesha ===

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==== Explanation by Atreya ====

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=== Explanation by Atreya ===

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On hearing the above questions of Agnivesha, Guru Atreya said “O gentle one! Hear me for the detailed description” [5]

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==== Number of diseases ====

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=== Number of diseases ===

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“There are eighteen varieties of ''kshaya'', seven varieties of ''pidika'' (pustule/carbuncles) caused due to ''madhumeha'' and three courses (''gati'') of ''dosha''. These are being described in detail henceforth” [7]

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==== Causes of diseases of head ====

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=== Causes of diseases of head ===

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Suppression of natural urges, day-sleep, insomnia, intoxication, talking too loudly, exposure to frost, exposure to wind from the front, excessive sex, inhalation of unwholesome (or toxic) smell, exposure to dust, smoke, cold and sun, over eating of heavy, sour and green food, use of very cold water, trauma to the head, formation of products of improper digestion and metabolism in the body (i.e., ama), excessive weeping or suppression of tears, cloudy weather, irritation of mind/anxiety (manastapa), and anomalous climate/season are the general causative factors of shiroroga. The above factors provoke or vitiate vata, affecting rakta (blood circulation) in the head leading to shiroroga with various symptoms [8-11]

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==== Importance of the Head ====

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=== Importance of the Head ===

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''Shira'' (head) is foremost among all organs as it is the region of the body where the vital centres and all the senses (''indriya'') of a living-being are located It is vital (''uttama'') amongst all the other organs of the body [12]

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==== Diseases of the Head ====

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=== Diseases of the Head ===

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Hemicrania (''ardhavabhedaka''), headache (''sarvam va rujyate shiraḥ'') (i.e., that which may involve whole of head), coryza (''pratishyaya''), disorders of mouth, nose, eyes, and ears (''mukhanasakshikarṇaroga''), giddiness/vertigo (''shirobhramaḥ''), facial paralysis (''ardita''), tremors of the head (''shirasaḥ kampa''), stiffness of the neck, nape and jaw (''galamanyāhanugrahah'') and other such diseases of the head are caused by ''dosha'' and micro-organisms/worms (''krimi''). [13-14]

</div>

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==== Types of Diseases of Head ====

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=== Types of Diseases of Head ===

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As mentioned in [[Ashtodariya Adhyaya]], there are five types of ''shiroroga'' that are described here with their etiological factors , signs and symptoms [15]

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==== ''Vata''-dominant diseases of the Head ====

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=== ''Vata''-dominant diseases of the Head ===

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==== Symptoms of ''vataja shiroroga'' ====

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=== Symptoms of ''vataja shiroroga'' ===

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==== ''Pitta''-dominant diseases of the Head ====

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=== ''Pitta''-dominant diseases of the Head ===

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Excessive use of pungent, sour, salty and alkali substances and wine, exposure to sun (or heat) and anger leads to provocation of ''pitta'', which by lodging in the head produces ''paittika shiroroga'' [22]

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==== Symptoms of ''pittaja shiroroga'' ====

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=== Symptoms of ''pittaja shiroroga'' ===

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Burning sensation and pain in the head, desire for cold things, burning sensation in the eyes, thirst, giddiness and perspiration are the symptoms of ''pittaja'' ''shiroroga'' [23]

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==== ''Kapha''-dominant diseases of head ====

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=== ''Kapha''-dominant diseases of head ===

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Due to sedentary life-style, excessive sleep, indulgence in intake of heavy and unctuous meals or excessive food intake, ''kapha'' gets provoked in the head and produces ''kaphaja shiroroga'' [24]

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==== Symptoms of ''kaphaja shiroroga'' ====

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=== Symptoms of ''kaphaja shiroroga'' ===

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Dull headache, numbness, stiffness and heaviness in head, drowsiness, laziness and anorexia are the symptoms of ''kaphaja shiroroga'' [25]

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==== Three ''dosha''-dominant disease of head ====

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=== Three ''dosha''-dominant disease of head ===

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In ''tridoshaja shiroroga'' aching pain, giddiness and tremors occur due to ''vata'', burning sensation, intoxication and thirst occur due to ''pitta'', and heaviness and drowsiness occur due to ''kapha'' [26]

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==== Etiological factors and pathogenesis of ''krimija shiroroga'' (disease of head due to parasites/micro-organisms) ====

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=== Etiological factors and pathogenesis of ''krimija shiroroga'' (disease of head due to parasites/micro-organisms) ===

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

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

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The patient of ''krimija shiroroga'' suffers from piercing, cutting or aching pains in the head with itching, swelling and foul smelling and detectable parasites [29]

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==== Etiological factors and pathogenesis of ''vata''-dominant disease of heart (''vataja hridroga'') ====

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=== Etiological factors and pathogenesis of ''vata''-dominant disease of heart (''vataja hridroga'') ===

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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 ''vatika hridroga''. Provoked ''vata'' , due to these causes, produces severe chest pain by affecting the heart [30]

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==== Symptoms of ''vatika hridroga'' ====

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=== Symptoms of ''vatika hridroga'' ===

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The symptoms of ''vataja hridroga'' are extra systole/ fibrillation, cardiac cramps, pauses in cardiac beats, stupor, sensation of emptiness in the cardiac region, and murmur (''dara''). The patient suffers from severe chest pain at the time of completion of digestion of the meal [31]

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==== Etiological factors and pathogenesis of ''pitta''-dominant heart diseases (pittaja hridroga) ====

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=== Etiological factors and pathogenesis of ''pitta''-dominant heart diseases (pittaja hridroga) ===

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Excessive intake of hot, sour, pungent, salty and alkaline food articles, alcohol, exposure to sun, and anger are the etiological factors of ''paittika hridroga'' [32]

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==== Symptoms of ''pittaja hridroga'' ====

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=== Symptoms of ''pittaja hridroga'' ===

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Burning sensation in the precordial region, bitter taste in mouth, sour eructation, exhaustion, thirst, fainting, giddiness and perspiration are the symptoms of ''pittaja hridroga'' [33]

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==== Etiological factors and pathogenesis of ''kapha''-dominant heart diseases (''kaphaja hridroga'') ====

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=== Etiological factors and pathogenesis of ''kapha''-dominant heart diseases (''kaphaja hridroga'') ===

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Over-eating, intake of heavy and fatty food substances, worry-free and sedentary lifestyle, excessive sleep are the etiological factors of ''kaphaja hridroga'' [34]

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==== Symptoms of ''kaphaja hridroga'' ====

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=== Symptoms of ''kaphaja hridroga'' ===

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Numbness, stiffness and heaviness in the precordial area, a stony sensation in the heart region, drowsiness and anorexia are the symptoms of ''kaphaja hridroga'' [35]

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==== Etiological factors and pathogenesis of three ''dosha''-dominant heart diseases (''tridoshaja hridroga'') ====

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=== Etiological factors and pathogenesis of three ''dosha''-dominant heart diseases (''tridoshaja hridroga'') ===

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In ''tridoshaja hridroga'', the etiological factors and symptoms of all the three ''doshika'' types of ''hridroga'' are present. (''tridoshaja hridroga'' is considered most troublesome disease by great sages)[35½]

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==== Etiological factors and pathogenesis of ''krimija hridroga'' ====

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=== Etiological factors and pathogenesis of ''krimija hridroga'' ===

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

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

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The patient of ''krimija hridroga'' feels severe pain in the precordial region and complains of itching, as if the heart is being pricked and pierced with needles or cut open by weapons. ''Krimija hridroga'' is a very grave heart condition and may lead to immediate death. Therefore it should be promptly diagnosed and managed [39-40]

</div>

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==== Sixty two permutations and combinations of ''samsarga'' and ''tridosha'' ====

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=== Sixty two permutations and combinations of ''samsarga'' and ''tridosha'' ===

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===== (I). Thirteen types of ''sannipata'' =====

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==== (I). Thirteen types of ''sannipata'' ====

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There are 13 conditions of ''sannipata'' of ''dosha'' (combination of all three ''dosha''), out of these, three conditions are with a dominance of two ''doshas'' (other one ''dosha'' comparatively less increased), three conditions are with dominance of only one ''dosha'' (others two ''dosha'' comparatively less increased), six conditions with diminished, moderate and dominant ''doshas'', and one condition with equal aggravation of all three ''doshas'' [41]

</div>

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===== (II). Nine types of ''samsarga'' =====

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==== (II). Nine types of ''samsarga'' ====

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''Samsarga'' means a combination of two provoked ''dosha'' and there are nine such combinations or ''samsargas''. Of these, six ''samsargas'' have one ''dosha'' more provoked than the other. In the remaining three cases, both ''dosha'' are equally increased [42]

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===== (III). Twenty-five conditions of ''kshina dosha'' =====

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==== (III). Twenty-five conditions of ''kshina dosha'' ====

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Similar to the combinations of increased ''dosha'' mentioned above, there are 25 conditions of ''kshina'' (decreased) ''dosha'' [42½]

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===== (IV). Twelve ''sannipata'' of normal, increased and decreased ''dosha'' =====

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==== (IV). Twelve ''sannipata'' of normal, increased and decreased ''dosha'' ====

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There is another form of ''sannipata'' where the ''doshas'' are present in normal, decreased or increased combinations, and such cases are of 12 types there. Out of these, six conditions are where one ''dosha'' is increased, the second is normal and the third is decreased. In three types of combinations, two ''dosha'' are increased and the third decreased. Finally, there are three types of combinations where one ''dosha'' is increased and the other two are decreased. [43-44]

</div>

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==== Twelve types of irregular (''vishama'') ''sannipata'' (combination of dosha) ====

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=== Twelve types of irregular (''vishama'') ''sannipata'' (combination of dosha) ===

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===== 1. Normal ''pitta'', decreased ''kapha'' and increased ''vata sannipata'' =====

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==== 1. Normal ''pitta'', decreased ''kapha'' and increased ''vata sannipata'' ====

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In a condition where ''kapha'' is decreased, ''vata'' that takes out normal ''pitta'' from its site and spreads it within the body. Wherever this ''pitta'' is placed, there is intermittent breaking pain and burning sensation as well as fatigue and weakness [46]

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===== 2.Normal ''kapha'', increased ''vata'' and decreased ''pitta sannipata'' =====

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==== 2.Normal ''kapha'', increased ''vata'' and decreased ''pitta sannipata'' ====

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In a condition of decreased ''pitta'', the increased ''vata'' that takes out normal ''kapha'' from its site and spreads it within the body. Wherever this ''kapha'' is placed, there is coliky pain, coldness, stiffness and heaviness [47]

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===== 3. Normal ''vata'', decreased ''kapha'', and increased ''pitta sannipata'' =====

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==== 3. Normal ''vata'', decreased ''kapha'', and increased ''pitta sannipata'' ====

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In a condition of grossly decreased ''kapha'', when increased ''pitta'' obstructs the pathway of normal ''vata'', causing burning sensation and coliky pain (''shula'') [48]

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===== 4. Normal ''kapha'', decreased ''vata'', and increased ''pitta sannipata'' =====

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==== 4. Normal ''kapha'', decreased ''vata'', and increased ''pitta sannipata'' ====

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In case of a grossly decreased ''vata'', increased ''pitta'' obstructs the normal ''kapha'', causing fever accompanied with a feeling of heaviness and drowsiness [49]

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===== 5. Normal ''vata'', decreased ''pitta'', and increased ''kapha sannipata'' =====

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==== 5. Normal ''vata'', decreased ''pitta'', and increased ''kapha sannipata'' ====

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In the case of decreased ''pitta'', if increased ''kapha'' obstructs the normal ''vata'' leading to a sensation of cold, heaviness and pain [50]

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===== 6. Increased ''kapha'', normal ''pitta'', and decreased ''vata sannipata'' =====

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==== 6. Increased ''kapha'', normal ''pitta'', and decreased ''vata sannipata'' ====

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In case of decreased ''vata'', if increased ''kapha'' obstructs the normal ''pitta'' then it causes slow digestion,stiffness of head, excessive sleep, drowsiness, delirium, cardiac diseases, heaviness in the body, yellowness in nails etc and excess discharge of ''kapha-pitta''[51-52]

</div>

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===== 7. Decreased ''vata'',increased ''kapha'', and ''pitta sannipata'' =====

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==== 7. Decreased ''vata'',increased ''kapha'', and ''pitta sannipata'' ====

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In case of decreased ''vata'' when increased ''kapha, pitta'' spreads in the body causing anorexia, indigestion, asthenia, heaviness, nausea, salivation, anaemia, fumes sensation of mouth, throat and palate (''dūyana''), intoxication and irregularity of bowels and digestion [53-54]

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===== 8. Decreased ''pitta'', increased ''kapha'', and ''vata sannipata'' =====

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==== 8. Decreased ''pitta'', increased ''kapha'', and ''vata sannipata'' ====

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In case of decreased ''pitta'', the increased ''kapha'' and ''vata'' combine together , causing stiffness, coldness, unstable pricking pain, heaviness, diminution of digestion, disinclination for food, tremors, pallor of nails etc., and roughness of the body parts [53-56]

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===== 9. Decreased ''kapha'', increased ''vata'' and ''pitta sannipata'' =====

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==== 9. Decreased ''kapha'', increased ''vata'' and ''pitta sannipata'' ====

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In case of decreased ''kapha'' and an increased ''vata'' and ''pitta'' combine together, causing giddiness, cramps, pricking pain, burning sensation, disruption, tremors, body-ache, dehydration, burning of mouth, throat and palate and smoke from mouth [57-58]

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===== 10. Decreased ''vata'' and ''pitta'' and increased ''kapha sannipata'' =====

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==== 10. Decreased ''vata'' and ''pitta'' and increased ''kapha sannipata'' ====

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In case of decreased vata and pitta and an increased kapha, obstruction of srotas causes complete loss of movement, loss of speech and fainting (59).

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===== 11. Decreased ''vata'' and ''kapha'' and increased ''pitta sannipata'' =====

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==== 11. Decreased ''vata'' and ''kapha'' and increased ''pitta sannipata'' ====

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In case of decreased ''vata'' and ''kapha'' with an increased ''pitta'', by affecting the ''ojas'' causes malaise (''glani''), asthenia of senses, thirst, fainting and decreased physiological functions (60).

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===== 12. Decreased ''pitta'' and ''kapha'' and increased ''vata sannipata'' =====

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==== 12. Decreased ''pitta'' and ''kapha'' and increased ''vata sannipata'' ====

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In case of decreased ''pitta'' and ''kapha'', an increased ''vata'' causes compression of the vital centres, adversely impacts consciousness, or leads to severe tremors throughout the whole body [61]

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==== General principle of symptoms of increased and decreased ''dosha'' ====

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=== General principle of symptoms of increased and decreased ''dosha'' ===

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An increase in ''dosha'' causes a consequent provocation, to the same extent as the increase, of a symptom of a disease. On the other hand a decrease of ''dosha'' leads to decreased or reduced functions. In normal conditions, ''doshas'' are in an equilibrium [62]

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==== Types of ''kshaya'' (decrease) ====

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=== Types of ''kshaya'' (decrease) ===

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Symptoms of decrease of ''rakta'' include roughness, cracks, withering and dryness of skin.[65]

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==== Decrease of ''~~māmsa~~'' ====

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==== Decrease of ''mamsa'' ====

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The symptoms of decrease of ''ojas'' include timidity, debility, constant worry, discomfort of the senses, loss of lustre, neurasthenia, dryness and emaciation [73]

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==== Description of ''ojas'' ====

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=== Description of ''ojas'' ===

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==== Etiological factors and pathogenesis of ''avrita madhumeha'' (diabetes due to obstructive pathogenesis) ====

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<div class="mw-collapsible mw-collapsed">=

गुरुस्निग्धाम्ललवणान्यतिमात्रं समश्नताम्|

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Excessive taking of heavy, unctuous, sour, and salty articles, eating of newly harvested cereals and newly prepared wines/drinks, excessive sleep, sedentary habits, avoidance of exercise or thinking/worry and not doing ''śhodhana'' (purification) lead to excessive increase in ''kapha, pitta, meda'' and ''mamsa''. These obstruct the pathways of ''vata'' leading to ''aavrita vata'' condition. Thus, provoked ''vata'' takes out ''ojas'' from its sites and brings it to ''basti'' causing ''madhumeha'' which is difficult to treat [78-80]

</div>

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==== Symptoms of ''avrita madhumeha'' ====

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=== Symptoms of ''avrita madhumeha'' ===

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In this condition of ''madhumeha'', the symptoms of ''vata, pitta'' and ''kapha'' are frequently manifested. The symptoms subside for some time, but again reappear later [81]

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==== ''Sapta pidika'' (seven papules/pustules/carbuncles) ====

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=== ''Sapta pidika'' (seven papules/pustules/carbuncles) ===

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If the diabetic condition is neglected, seven types of ''pidika'' (pustules) are produced. These ''pidika'' occur in fleshy spaces, vital parts (''marma'') and joints. The names of these seven ''pidikā'' are ''sharavika, kacchapika, jalini, sarshapi, alaji, vinata'' and ''vidhradi'' [82-83]

</div>

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===== 1. ''Sharavika'' =====

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==== 1. ''Sharavika'' ====

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The edges of ''sharavika pidika'' are raised and middle part is depressed, and its colour is dusky-red. It is accompanied by slough (''kleda'') and pain. As its shape is like that of an earthen saucer (''sharavika''), hence its name [84]

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===== 2. ''Kacchapika'' =====

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==== 2. ''Kacchapika'' ====

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''Kacchapika'' (carbuncle) is deeply and extensively infiltrated, with distress and pricking pain. It has a smooth surface like that of tortoise (''Kacchapa''), therefore, its name [85]

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===== 3. ''Jalini'' =====

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==== 3. ''Jalini'' ====

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''Jalini pidika'' is extensive, hard, covered with a network of vessels with unctous discharge, having severe pricking type pain and having minute openings on the surface. It is called ''jalini'' because it resembles a net or a web [86]

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===== 4. ''Sarshapi'' =====

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==== 4. ''Sarshapi'' ====

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''Sarshapi pidika'' is not very big but very painful and suppurates quickly and is surrounded by mustard seed-like boils [87]

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===== 5. ''Alaji'' =====

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==== 5. ''Alaji'' ====

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''Alaji pidika'' commences with a burning sensation in the skin accompanied by fever and thirst. It steadily spreads all over the body and causes severe distress with a fire-like burning sensation [88]

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===== 6. ''Vinata'' =====

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==== 6. ''Vinata'' ====

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''Vinatā pidika'' is extremely painful form of pustule. It is soft, situated either on back or abdomen, very extensive and depressed in the middle and bluish in colour. It is known as ''vinata'' because it is depressed or deep [89]

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===== 7. ''Vidradhi''-(1) ''bahya vidradhi'' =====

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==== 7. ''Vidradhi''-(1) ''bahya vidradhi'' ====

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''Vidradhi'' (abscess) is of two types viz. external and internal. External abscess occurs on skin and flesh. It looks like tendon and can cause severe pain [90]

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==== Etiology and pathogenesis of internal abscess ====

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=== Etiology and pathogenesis of internal abscess ===

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The ''dosha'' provoked by the above mentioned factors, when it enters the flesh and blood of the internal organs of the body, gives rise to deep-rooted nodule-like swellings with severe pain. It is a severe condition that occurs in the heart, pharynx (''kloma''), liver, spleen, stomach, kidney, navel, groin and bladder [91-94]

</div>

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==== Etymology of ''vidradhi'' ====

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=== Etymology of ''vidradhi'' ===

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Excessively provoked ''rakta'' causes quick softening and formation of pus. Owing to its quickly suppurating (''vidahi'') characteristic, it is called ''vidradhi'' [95]

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==== Three types of ''vidradhi'' ====

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=== Three types of ''vidradhi'' ===

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#''Kaphaja vidradhi'': Yawning, retching, anorexia, rigidity and chills are the symptoms of ''kapha'' type of ''vidradhi'' [96-97]

</div>

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==== Symptoms of ripened abscess ====

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=== Symptoms of ripened abscess ===

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On ripening of the abscess, the patient feels pain as if cut by a weapon or as if burnt by coal or as if stung by a scorpion [98]

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==== Pus discharge according to type of abscess ====

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=== Pus discharge according to type of abscess ===

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*In ''sannipata'' type of ''vidradhi'' , a mix of symptoms of all the three ''dosha'' type can be found in the abscess [99-100]

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==== Symptoms of ''vidradhi'' according to organ involved ====

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=== Symptoms of ''vidradhi'' according to organ involved ===

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#Symptoms of ''vidradhi'' in the urinary bladder: Painful micturition and defecation and putrid urine and faeces are the symptoms of abscess in the urinary bladder [101]

</div>

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==== Route of discharge ====

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=== Route of discharge ===

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Suppurated internal abscesses burst and the pus is discharged. The discharge of the abscesses situated in the organs above the navel comes out from mouth, of situated below the umbilicus comes out from anus and of around the navel may come from either of the routes [102]

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==== Prognosis of abscesses ====

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=== Prognosis of abscesses ===

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Therefore immediately on appearance of the internal abscess, it should be managed promptly with effective measures that can act quickly, else it may harm just like an injury caused by a weapon, bite by a snake and burning by lightening or fire. These abscesses may be managed by oleation and purgation therapies as well as all the measures of ''gulma'' [103]

</div>

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==== Possibility of ''Pidika'' without prameha ====

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=== Possibility of ''Pidika'' without prameha ===

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Pustules (''pidika'') can also occur due to vitiation of ''medas'' in a person who is not suffering from ''prameha''. Such pustules do not become visible till they become extensive in size [104]

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==== Prognosis of ''pidika'' ====

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=== Prognosis of ''pidika'' ===

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''Sarshapi, alaji , vinata'' and ''vidradhi'' occur due to dominance of ''pitta'' in a person having low ''medas'' and are curable [106]

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==== Bad prognostic ''pidika'' ====

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=== Bad prognostic ''pidika'' ===

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A diabetic person does not survive if he gets ''pidika'' in vital-parts, shoulder, anus, hands, breast, joints, and feet [107]

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==== Miscellanous ''pidika'' ====

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=== Miscellanous ''pidika'' ===

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The wise physician should diagnose the above pustules on the basis of the causative factors and characteristics of involved ''dosha'' and treat these appropriately (and quickly) before these advance into complications [110]

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==== Complications of pustules (''pidika'') ====

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=== Complications of pustules (''pidika'') ===

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Thirst, dyspnoea, sloughing of flesh, stupor, hiccup, toxaemia, fever, spreading inflammatory swelling and obstruction in function of the vital organs are the complications of pustules [111]

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==== States (''gati'') of ''dosha'' ====

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=== States (''gati'') of ''dosha'' ===

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Decrease, normalcy and increase are the three states of ''doshas''. Other three courses of ''doshas'' are upward, downward and oblique/transverse movement. Yet another set of three states of ''dosha'' are by their movement to ''koshtha'' (thoraco-abdominal cavity), ''shakha'' (''tvak'' and ''dhatus'' except ''rasa'') and vital-organs, bones and joints. Thus are described various states of ''doshas'' [112-113]

</div>

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==== Seasonal course of ''doshas'' ====

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=== Seasonal course of ''doshas'' ===

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Accumulation, provocation and pacification of ''pitta, vata'' and ''kapha'' respectively occur individually and sequentially in the six seasons beginning with the rainy season (e.g., ''pitta'' accumulation in rainy season, etc). These courses (of accumulation, provocation and/or pacification) of ''dosha'' are known as seasonal courses of ''doshas''.[114]

</div>

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==== Physiological and pathological course of ''dosha'' ====

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=== Physiological and pathological course of ''dosha'' ===

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A person desiring to live the full span of life should remain self controlled and live with great caution assuming that he is constantly surrounded by the foes to his health [119]

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==== Summary ====

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=== Summary ===

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

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

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== 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.

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*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.

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

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== Vidhi Vimarsha (Applied Inferences) ==

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

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

While describing ''pancha-panchaka'' principle of perception by five ''jnanaindriya'' [Cha. Su. 8/3], Charak mentions five ''indriya'' (senses), five ''indriya adhisthana'' (sense organs), five ''indriya dravya'' (specific matter which enable the senses to perceive), five ''artha'' (specific objects to be perceived by sense) and five ''indriya-buddhi'' (final sensation). The five ''indriya'' are the five senses and the five ''indriya adhisthana'' are the five external sites of senses for example eyes for vision and ears for hearing, but site of the ''indriya-buddhi'' is not mentioned. In this regard, the following observations may be taken into consideration:

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Description of ''krimija hridroga'' indicates a very serious condition. As mentioned earlier, infestation starts with one chamber of the heart and then spreads and consumes (''bhakshyanti'') tissues across the entire heart.The patient of ''krimija hridroga'' feels severe pain in the precordial region, as if heart is being pricked/pierced by needles or cut by weapons and is a very grave heart condition that may lead to immediate death. Therefore it is a severe condition and should be promptly diagnosed and managed. It may manifest as chest pain, arrhythmia, heart failure, acute myocardial infarction-like syndrome with normal coronary arteries, ventricular arrhythmia, and loss of right ventricular function leading to sudden death. (Verse 36-40).

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==== ''Samsarga'' and ''Sannipata'' ====

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=== ''Samsarga'' and ''Sannipata'' ===

Combination of two provoked ''doshas'' leading to a disease is known as ''samsarga'' and when all the three provoked ''doshas'' combine then it is known as ''sannipata''. In the combinations , some ''doshas'' may be in their normal state, while others may be slightly, moderately or excessively increased or in decrease state. Similarly they may be slightly, moderately or significantly decreased. In this way, on the basis of quantum of increase, decrease etc of the ''dosha'', they can be classified into 62 types (verses from 41 to 62) as follows:

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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>

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

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

{| class="wikitable"

! Sr. No. !! Types of ''Pidikā'' !! ''Charak'' !! ''Sushruta'' !! ''Vagbhata'' !! ''Bhoj'' !! ''Kāshypa''

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(Verse 82-83)

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=====Table 4:Types of ''Vidradhi'' :=====

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====Table 4:Types of ''Vidradhi'' :====

{| class="wikitable"

|-

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[[File:Dōṣāṇāṁ.png]]

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~~=== Glossary ===~~

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*Āvrita Vāta (आवृत वात) : Provoked Vāta due to obstruction to its functional path

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*Caya (चय) : Accumulation

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*Dūyanam (दूयनं) : burning sensation of mouth, throat and palate

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*Hridroga (हृद्रोगः) : Diseases of heart

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*Koṣtha (कोष्ठ) : Thoraco-abdominal cavity

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*Kṣaya (क्षयः) : Decrease

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*Mādhumēh (मधुमेहः) : Diabetes mellitus

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*Marma (मर्म) : Vital parts

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*Piḍakāḥ (पिडकाः) : Papules

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*Prakōpa (प्रकोप) : Provocation

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*Prākr̥ta (प्राकृत) : Normal

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*Pramēha (प्रमेह) : A group of clinical conditions wherein excessive urine occurs

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*Pramitāśanam (प्रमिताशनम्) : Taking limited quantity of food/meals

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*Praśama (प्रशम) : Pacified

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*Sarṣapa (सर्षप) : mustard seeds

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*Shākhā (शाखा) : Extremities, six Dhatu except Rasa and Tvak

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*Sirājāla (सिराजाल) : Network of vessels

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*Śirōrōga (शिरोरोगाः) : Diseases of head

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*Śodhana (शोधन) : Purification, detoxification

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*Sthānaṁ (स्थानं) : Normal, site

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*Ulbaṇa (उल्बण) : Excessive

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*Vaikr̥ta (वैकृत) : Abnormal

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*Vidradhī (विद्रधी) : Abscess

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*Vinatā (विनता) : Depressed or deep

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*Vr̥ddhi (वृद्धि) : Increase

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*Vr̥ścika (वृश्चिक) : scorpion

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=== Related Chapters ===

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== Related Chapters ==

* [[Trimarmiya Chikitsa]]

* [[Trimarmiya Siddhi]]

Agnivesha

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