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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 327:
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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 ==
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 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 throat obstruction ===
=== Fatal signs of dysphagia ===
<div class="mw-collapsible mw-collapsed">
<div class="mw-collapsible mw-collapsed">
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 ==