Changes

|keywords=arishta, fatal signs, near death signs, change in voice, change in complexion, Ayurveda, Indian system of medicine, charak samhita.

|keywords=arishta, fatal signs, near death signs, change in voice, change in complexion, Ayurveda, Indian system of medicine, charak samhita.

|description=Indriya Sthana Chapter 1.Fatal signs in complexion and voice

|description=Indriya Sthana Chapter 1.Fatal signs in complexion and voice

|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

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Babu S.P.

|data7  = Babu S.P.

|label8 = Editor

|label8 = Editors

|data8  = Khandel S.K., Babu S.P.

|data8  = Khandel S.K., Babu S.P., Deole Y.S., Basisht G.

|label9 = Date of publication  

|label9 = Year of publication  

|data9 = December 17, 2018

|data9 = 2020

|label10 = DOI

|label10 = Publisher

|data10  =

|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

|header3 =  

|label11 = DOI

|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s05.002 10.47468/CSNE.2020.e01.s05.002]

}}

}}

<big>'''Abstract'''</big>  

<big>'''Abstract'''</big>  

==Introduction ==

==Introduction ==

<div style="text-align:justify;">

<div style="text-align:justify;">

Charak has placed [[Indriya Sthana]] (section about near death signs) before [[Chikitsa Sthana]] (section about the treatment of diseases) possibly, to guide physician when not to treat a patient. In this chapter of [[Indriya Sthana]], [[Varnasvariyam Indriyam Adhyaya]], Charak mentions near death signs and symptoms that can be directly observed by visual and other faculties. This chapter also describes ''prakriti'', the natural disposition of an individual, and ''vikriti'', or abnormalities , since such knowledge helps in discerning any sign of ''vikriti'' in a "healthy" individual. Three types of morbid conditions are observed namely, ''lakshana nimitta'', caused by bodily marks, ''lakshya nimitta'', caused by etiological factors which disturb the health, and ''nimitta anuroopa vikriti'', a break down for no apparent reason resembling etiological factors. The chapter describes various near death signs with changes in color, the complexion of body parts and voice.

Charak has placed [[Indriya Sthana]] (section about near death signs) before [[Chikitsa Sthana]] (section about the treatment of diseases) possibly, to guide physician when not to treat a patient. In this chapter of [[Indriya Sthana]], [[Varnasvariyam Indriyam Adhyaya]], Charak mentions near death signs and symptoms that can be directly observed by visual and other faculties. This chapter also describes ''[[prakriti]]'', the natural disposition of an individual, and ''vikriti'', or abnormalities , since such knowledge helps in discerning any sign of ''vikriti'' in a "healthy" individual. Three types of morbid conditions are observed namely, ''lakshana nimitta'', caused by bodily marks, ''lakshya nimitta'', caused by etiological factors which disturb the health, and ''nimitta anuroopa vikriti'', a break down for no apparent reason resembling etiological factors. The chapter describes various near death signs with changes in color, the complexion of body parts and voice.

</div>

</div>

==Sanskrit text, Transliteration and English Translation==

==Sanskrit text, Transliteration and English Translation==

Now we shall expound the chapter "Varnasvariyam Indriyam" (Fatal signs in complexion and voice). Thus said Lord Atreya.[1-2]   

Now we shall expound the chapter "Varnasvariyam Indriyam" (Fatal signs in complexion and voice). Thus said Lord Atreya.[1-2]   

Note: This chapter deals with normal and abnormal color, complexion and voice in a person which especially relies on two "indriya" –visual and auditory faculty.

Note: This chapter deals with normal and abnormal color, complexion and voice in a person which especially relies on two "[[indriya]]" –visual and auditory faculty.

=== Factors for assessment of residual span of life ===

=== Factors for assessment of residual span of life ===

</div></div>

</div></div>

<div style="text-align:justify;">

<div style="text-align:justify;">

The natural constitution of a person depends upon ''Jati'' (origin as per social structure), ''Kula'' (race), ''Desha'' (place), ''Kala'' (time and season), ''Vaya'' (age), ''Pratyatmaniyata'' (individual habits and habitat). The different variations seen in persons are based upon their origin as per social structure, race, place of living, season, age and individual habits.[5]

The natural constitution of a person depends upon ''Jati'' (origin as per social structure), ''Kula'' (race), ''Desha'' (place), ''[[Kala]]'' (time and season), ''Vaya'' (age), ''Pratyatmaniyata'' (individual habits and habitat). The different variations seen in persons are based upon their origin as per social structure, race, place of living, season, age and individual habits.[5]

</div>

</div>

If half of the face there is blue, blackish, coppery or tawny color and the color of the remaining half is otherwise. Manifestation of unctuousness in one half of the face and roughness in the other half is inauspicious.

If half of the face there is blue, blackish, coppery or tawny color and the color of the remaining half is otherwise. Manifestation of unctuousness in one half of the face and roughness in the other half is inauspicious.

The appearance of swelling in one-half of the face and emaciation in the other half. Spontaneous appearance of various types of ''tila'' (black mole), ''piplu'' (port wine mark),''vyanga'' (freckles), and ''raji'' (spots like mustard) in the face of the patient.

The appearance of swelling in one-half of the face and emaciation in the other half. Spontaneous appearance of various types of ''tila'' (black mole), ''piplu'' (port wine mark),''vyanga'' (freckles), and ''raji'' (spots like mustard) on the face of the patient.

The appearance of flowers like spots in nails and teeth and sticky and powdery substance over the teeth is an indicator of death. Discoloration of lips, legs, heels, eyes, urine, stool and nails of the patient are indicators of diminished strength.

The appearance of flowers like spots in nails and teeth and sticky and powdery substance over the teeth is an indicator of death. Discoloration of lips, legs, heels, eyes, urine, stool and nails of the patient are indicators of diminished strength.

<div style="text-align:justify;">

<div style="text-align:justify;">

*The prognosis of disease leading to death can be predicted by keen observation of complexion, color of body parts and voice. [3]

*The prognosis of disease leading to death can be predicted by keen observation of complexion, color of body parts and voice. [3]

*The natural constitution of a person depends upon ''Jati'' (caste), ''Kula'' (race), ''Desha'' (place), ''Kala'' (time and season), ''Vaya'' (age), ''Pratyatmaniyata'' (individual habits and habitat). The different variations seen in persons are based upon their caste, race, palce of living, season, age and individual habits. [5]

*The natural constitution of a person depends upon ''Jati'' (caste), ''Kula'' (race), ''Desha'' (place), ''Kala'' (time and season), ''Vaya'' (age), ''Pratyatmaniyata'' (individual habits and habitat). The different variations seen in persons are based upon their caste, race, place of living, season, age and individual habits. [5]

*The complexion is a tool to assess malaise, cheerfulness, dryness and unctuousness in body i.e. the circulatory and metabolic state of body. [9]

*The complexion is a tool to assess malaise, cheerfulness, dryness and unctuousness in body i.e. the circulatory and metabolic state of body. [9]

== Vidhi Vimarsha (Applied Inferences) ==

== Vidhi Vimarsha (Applied Inferences) ==

=== Sudden change in following factors indicate near death signs ===

=== Factors indicating bad prognosis ===

 

Sudden change in following factors indicate bad prognosis or near death signs:

 

Complexion, voice, smell, taste, touch, eyes, ears, nose, tongue, skin, psyche, desire, cleanliness, conduct, behavior, memory, shape, nature, strength, malaise, intellect, exhilaration, dryness, unctuousness, drowsiness, heaviness, lightness, qualities, diet, regimens, digestion of food, manifestation of disease, disappearance of disease, characters of disease, premonitory signs of the disease, symptoms, complications, administration of proper medicine, and effect of medicine on disease, luster, shadow, dream, state of informer about the patient. Bad omens perceived by the physician on his way to patient’s house, changed conditions of the patient’s residence, signs and symptoms indicating the residual span of life may be evident in these factors. Hence physician should pay careful attention to each one of them and interpretation should be made based on his observations, knowledge and scriptural advice.

Complexion, voice, smell, taste, touch, eyes, ears, nose, tongue, skin, psyche, desire, cleanliness, conduct, behavior, memory, shape, nature, strength, malaise, intellect, exhilaration, dryness, unctuousness, drowsiness, heaviness, lightness, qualities, diet, regimens, digestion of food, manifestation of disease, disappearance of disease, characters of disease, premonitory signs of the disease, symptoms, complications, administration of proper medicine, and effect of medicine on disease, luster, shadow, dream, state of informer about the patient. Bad omens perceived by the physician on his way to patient’s house, changed conditions of the patient’s residence, signs and symptoms indicating the residual span of life may be evident in these factors. Hence physician should pay careful attention to each one of them and interpretation should be made based on his observations, knowledge and scriptural advice.

Appearance of abnormal complexion in the entire or half of the body of the individual without any significant reason can be due to abnormal peripheral circulation. Oxygenation can affect the complexion. In deep vein thrombosis (DVT) alteration in pigmentation is well appreciated.

Appearance of abnormal complexion in the entire or half of the body of the individual without any significant reason can be due to abnormal peripheral circulation. Oxygenation can affect the complexion. In deep vein thrombosis (DVT) alteration in pigmentation is well appreciated.

When both the lips become bluish like ripe fruits of ''jambu'', this is a clear indication of death. As per modern science this condition is similar to central cyanosis. It is directly due to ''Vata Pratilomata'' (reverse direction of ''Vata'') in different organs. The main [[srotas]] involved are ''Rasavaha srotas'' and ''Raktavaha Srotas.''

When both the lips become bluish like ripe fruits of ''jambu'', this is a clear indication of death. As per modern science this condition is similar to central cyanosis. It is directly due to ''[[Vata]] Pratilomata'' (reverse direction of ''[[Vata]]'') in different organs. The main [[srotas]] involved are ''Rasavaha srotas'' and ''Raktavaha Srotas.''

=== Abnormal voices ===

=== Abnormal voices ===

=== Assessment of various prognostic factors ===

=== Assessment of various prognostic factors ===

Various assessment scales and tools can be applied for objective assessment of the factors described in the chapter. The following tables depicts probable tools and scales of assessment.<ref>Mamidi P., Gupta K. Varna Swareeyam of Charaka Indriya Sthana - An Explorative Study, Int. J. Ayu. Alt. Med., 2019; 7(5): 152-175</ref> These parameters can be applied for clinical assessment of relevant factor. There is a wide scope for research on implementing these practices to predict prognosis and life span of individual. Furthermore, each of these factor is elaborated in forthcoming chapters of this section ([[Indriya Sthana]]).   

Various assessment scales and tools can be applied for objective assessment of the factors described in the chapter. The following tables depict probable tools and scales of assessment.<ref name= "Mamidi P.">Mamidi P., Gupta K. Varna Swareeyam of Charaka Indriya Sthana - An Explorative Study, Int. J. Ayu. Alt. Med., 2019; 7(5): 152-175</ref> These parameters can be applied for clinical assessment of relevant factors. There is a wide scope for research on implementing these practices to predict prognosis and life span of individual. Furthermore, each of these factors is elaborated in forthcoming chapters of this section ([[Indriya Sthana]]).   

{| class="wikitable"

{| class="wikitable"

|-

|-

! Sr.no. !! Prognostic factor !! Assessment scales / questionnaires / instruments

! Sr.no. !! Prognostic factor !! Assessment scales / questionnaires / instruments

|-

|-

| 1|| Complexion (varna) || Fitzpatrick skin type scale, Reflectance spectroscopy, Minolta chromameter, Mexameter (using erythematic and melanin indices), C.L.B.T assessment;

| 1|| Complexion (varna) || [https://en.wikipedia.org/wiki/Fitzpatrick_scale Fitzpatrick skin type], Reflectance spectroscopy, Minolta chromameter, Mexameter (using erythematic and melanin indices), C.L.B.T assessment;

|-

|-

| 2 || Voice (swara)|| Linear analog scale of assessment - voice quality (LASA-VQ), Vocal performance questionnaire (VPQ), Vocal tract discomfort (VTD), Evaluating voice disability - Quality of life questionnaire (EVD-QOL), Speech disability questionnaire (SDQ), Voice handicap index (VHI), Voice symptom questionnaire (VSQ), Vocal fatigue index (VFI) etc;

| 2 || Voice (swara)|| Linear analog scale of assessment - voice quality (LASA-VQ), Vocal performance questionnaire (VPQ), Vocal tract discomfort (VTD), Evaluating voice disability - Quality of life questionnaire (EVD-QOL), Speech disability questionnaire (SDQ), Voice handicap index (VHI), Voice symptom questionnaire (VSQ), Vocal fatigue index (VFI) etc;

| 8 || Interest (bhakti) || The mood, interest and pleasure questionnaire (MIPQ), Strong interest inventory test etc;

| 8 || Interest (bhakti) || The mood, interest and pleasure questionnaire (MIPQ), Strong interest inventory test etc;

|-

|-

| 9 || purity or cleanliness (shaucham) || Hygiene behaviour scale (HBS), Hand washing behaviour scale Terms of planned behaviour model, Yale-Brown obsessive compulsive scale (Y-BOCS), Cleaning and Hygiene scale etc;

| 9 || purity or cleanliness (shaucham) || Hygiene behavior scale (HBS), Hand washing behavior scale Terms of planned behavior model, Yale-Brown obsessive compulsive scale (Y-BOCS), Cleaning and Hygiene scale etc;

|-

|-

| 10 || Modesty (sheelam) || Philadelphia geriatric centre morale scales, The big five personality test (BFPT), The traits personality questionnaire 5 (TPQue5), Rorschach ink blot technique, Minnesota multiphasic personality inventory, Eysenck personality inventory, Maudsley personality questionnaire etc;

| 10 || Modesty (sheelam) || Philadelphia geriatric centre morale scales, The big five personality test (BFPT), The traits personality questionnaire 5 (TPQue5), Rorschach ink blot technique, Minnesota multiphasic personality inventory, Eysenck personality inventory, Maudsley personality questionnaire etc;

|-

|-

| 11 || Behavioral conduct (achara) || Behavior and symptom identification scale (BASIS), Client adjustment rating scale, Social behaviour assessment schedule, Social maladjustment schedule etc;

| 11 || Behavioral conduct (achara) || Behavior and symptom identification scale (BASIS), Client adjustment rating scale, Social behavior assessment schedule, Social maladjustment schedule etc;

|-

|-

| 12 || Memory ([[smruti]]) || Addenbrookes cognitive assessment - Revised (ACE-R), Abbreviated mental test score (AMTS), General practitioner assessment of cognition (GPCOG), Memory impairment screen (MIS), Montreal cognitive assessment (MoCA), PGI memory scale, Test your memory (TYM) etc;

| 12 || Memory ([[smriti]]) || Addenbrookes cognitive assessment - Revised (ACE-R), Abbreviated mental test score (AMTS), General practitioner assessment of cognition (GPCOG), Memory impairment screen (MIS), Montreal cognitive assessment (MoCA), PGI memory scale, Test your memory (TYM) etc;

|-

|-

| 13 || Built (akruti) || Anthropometric measurements like height, weight, circumference, skin fold thickness and several other measurements;

| 13 || Built (akruti) || Anthropometric measurements like height, weight, circumference, skin fold thickness and several other measurements;

| 27 || Post digestion effect (ahara parinama) || Questionnaire to assess digestion and metabolism (jatharagni), Self assessment tool to estimate digestion capacity (Agni bala), VAS scales, Metabolic markers etc;

| 27 || Post digestion effect (ahara parinama) || Questionnaire to assess digestion and metabolism (jatharagni), Self assessment tool to estimate digestion capacity (Agni bala), VAS scales, Metabolic markers etc;

|-

|-

| 28 || Disease and its prediction (vyadhi vyadhi purvarupa) || Severity scales, screening instruments or questionnaires, VAS (visual analogue scales) etc;

| 28 || Disease and its prediction (vyadhi and purvarupa) || Severity scales, screening instruments or questionnaires, VAS (visual analogue scales) etc;

|-

|-

| 29 || Complaints (vedana) || Oswestry disability index (ODI), Roland & Morris disability questionnaire, VAS, Graphic rating scale (GRS), Numerical rating scale (NRS), Verbal rating scale (VRS), McGill pain questionnaire (MPQ), Pain-O-Meter etc;  

| 29 || Complaints (vedana) || Oswestry disability index (ODI), Roland & Morris disability questionnaire, VAS, Graphic rating scale (GRS), Numerical rating scale (NRS), Verbal rating scale (VRS), McGill pain questionnaire (MPQ), Pain-O-Meter etc;  

|}

|}

==References==

 

 

 

 

 

 

 

 

 

 

 

 

== References ==

</div>

</div>