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Line 1: + − + + + + − − <big>'''Abstract'''</big> − <div style="text-align:justify;"> − The chapter [[Varnasvariyam Indriyam Adhyaya]] is about [[arishta]] [[lakshana]] (near death signs) perceived by auditory and visual senses. [[Swara]] (Voice) is an audible feature, whereas color and complexion are visual features. Sudden change in frequency, rhythm, resonance, tone, the pitch of voice and complexion of the body is indicative of serious pathology of the body. The characteristic features of [[arishta]] are described in the chapter. − − '''Keywords''': [[arishta]], fatal signs, near death signs, change in voice, change in complexion. − − </div> Line 26:
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Line 399: − इतिवर्णस्वरावुक्तौलक्षणार्थंमुमूर्षताम्|यस्तौसम्यग्विजानाति नायुर्ज्ञाने स मुह्यति||२६|| <br />+ Line 397:
Line 416: − + − *'''Sudden change in following factors indicate near death signs:''' + + + + − *The examination of complexion does not just mean the color only. It also includes objects of visual perception like coarseness, glossiness etc. Abnormal ''swara'' (voice) include fluctuations in the normal quality of sounds produced (hoarseness of voice, dysphonia), absence of the normal physiological sounds like absence of peristalsis in peritonitis, presence of abnormal sounds like crepitus in joints & crepitations, rhonchi etc. in lungs. Abnormalities in touch include tactile perception of abnormal hardness, softness, warmth etc.+ − *The morbid conditions are of three types. Such as those indicated by bodily marks, those caused by etiological factors and those resemble etiological factors.+ − *''Lakshana nimitta'' include visible end stage manifestations.+ − *The abnormal color produced can be considered as ''ojokshaya lakshana'' (depletion of quality of tissue). In ''Raktarshas'' (bleeding piles), when there is excessive bleeding, it may lead to poor complexion, strength, enthusiasm and depleted ''Ojas''. If proper measure is not taken the condition may become fatal. The unnatural color of skin can be compared with the cyanotic conditions, discoloration seen in the fatal hepatic and renal pathologies etc. Appearance of white spots, white nails and loss of pigmentation can be seen in chronic liver failure.+ − *In chronic kidney disease, the conjunctival deposition of calcium leads to redness and gritty feeling in the eye called uremic red eye. Also deposition of calcium as a band in the lamina proprea of cornea leads to band keratopathy.+ − *In chronic hepatic failure, erythematous patches may appear over many parts of the body, especially over the chest wall and supraclavicular regions.+ − *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.''+ − *Abnormal voices:+ − **In ''sannipatha jwara'' - ''swarasada'' (low pitched voice) is a ''lakshana''.+ − **In ''kshathaja kasa'' - ''paravatha ivaakoojan'' (cooing sound like that of a pigeon comes out of the throat)+ − **In ''Apatantraka –kapota iva koojan'' ( make sound like a pigeon).+ − **In Tetanus -sudden death occurs due to laryngeal spasm .+ − **Dysphonia—Disturbance of phonation is due to disturbance in vocal cords. Strained, harsh, low pitched voice, nasal voice.+ − **In laryngeal tumors like supra glottic cancer and glottis cancer hoarseness of voice is a late symptom.+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Varnasvariyam Indriyam Adhyaya (view source)
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|title=Varnasvariyam Indriyam Adhyaya
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|description=Indriya Sthana Chapter 1.Fatal signs in complexion and voice
|description=Indriya Sthana Chapter 1.Fatal signs in complexion and voice
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<big>'''[[Indriya Sthana]] Chapter 1.Fatal signs in complexion and voice'''</big>
<big>'''[[Indriya Sthana]] Chapter 1.Fatal signs in complexion and voice'''</big>
{{Infobox
{{Infobox
|title = Varnasvariyam Indriyam Adhyaya
|title = Varnasvariyam Indriyam Adhyaya
|label5 = Other Sections
|label5 = Other Sections
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label6 = Translator and commentator
|data6 = Gopakumar
|label7 = Reviewer
|data7 = Babu S.P.
|label8 = Editors
|data8 = Khandel S.K., Babu S.P., Deole Y.S., Basisht G.
|label9 = Year of publication
|data9 = 2020
|label10 = Publisher
|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s05.002 10.47468/CSNE.2020.e01.s05.002]
}}
<big>'''Abstract'''</big>
<div style="text-align:justify;">
The chapter [[Varnasvariyam Indriyam Adhyaya]] is about [[arishta]] [[lakshana]] (near death signs) perceived by auditory and visual senses. [[Swara]] (Voice) is an audible feature, whereas color and complexion are visual features. Sudden change in frequency, rhythm, resonance, tone, the pitch of voice and complexion of the body is indicative of serious pathology of the body. The characteristic features of [[arishta]] are described in the chapter.
'''Keywords''': [[arishta]], fatal signs, near death signs, change in voice, change in complexion.
</div>
==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 ===
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</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>
*''Nimittanurupa'': This type of pathology is based on signs resembling with etiological factors. [6]
*''Nimittanurupa'': This type of pathology is based on signs resembling with etiological factors. [6]
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==== Symptom based abnormalities ====
तत्र लक्षणनिमित्ता नाम सा यस्याः शरीरे लक्षणान्येव हेतुभूतानि भवन्ति दैवात्; लक्षणानि हि कानिचिच्छरीरोपनिबद्धानि भवन्ति, यानि हि तस्मिंस्तस्मिन् काले तत्राधिष्ठानमासाद्य तां तां विकृतिमुत्पादयन्ति|७|
तत्र लक्षणनिमित्ता नाम सा यस्याः शरीरे लक्षणान्येव हेतुभूतानि भवन्ति दैवात्; लक्षणानि हि कानिचिच्छरीरोपनिबद्धानि भवन्ति, यानि हि तस्मिंस्तस्मिन् काले तत्राधिष्ठानमासाद्य तां तां विकृतिमुत्पादयन्ति|७|
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==== Etiopathogenesis based abnormalities ====
लक्ष्यनिमित्ता तु सा यस्या उपलभ्यते निमित्तं यथोक्तं निदानेषु|७|
लक्ष्यनिमित्ता तु सा यस्या उपलभ्यते निमित्तं यथोक्तं निदानेषु|७|
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निमित्तानुरूपा तु निमित्तार्थानुकारिणी या, तामनिमित्तां निमित्तमायुषः प्रमाणज्ञानस्येच्छन्ति भिषजो भूयश्चायुषः क्षयनिमित्तां प्रेतेलिङ्गानुरूपां, यामायुषोऽन्तर्गतस्य [१] ज्ञानार्थमुपदिशन्ति धीराः| <br />
==== Cause based abnormalities ====
निमित्तानुरूपा तु निमित्तार्थानुकारिणी या, तामनिमित्तां निमित्तमायुषः प्रमाणज्ञानस्येच्छन्ति भिषजो भूयश्चायुषः क्षयनिमित्तां प्रेतेलिङ्गानुरूपां, यामायुषोऽन्तर्गतस्य ज्ञानार्थमुपदिशन्ति धीराः| <br />
यां चाधिकृत्य पुरुषसंश्रयाणि मुमूर्षतां लक्षणान्युपदेक्ष्यामः| <br />
यां चाधिकृत्य पुरुषसंश्रयाणि मुमूर्षतां लक्षणान्युपदेक्ष्यामः| <br />
इत्युद्देशः| <br />
इत्युद्देशः| <br />
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.
तत्रश्लोकः- <br />
तत्रश्लोकः- <br />
इति वर्णस्वरावुक्तौ लक्षणार्थं मुमूर्षताम्| यस्तौ सम्यग्विजानाति नायुर्ज्ञाने स मुह्यति||२६|| <br />
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*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) ==
=== 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.
The examination of complexion does not just mean the color only. It also includes objects of visual perception like coarseness, glossiness etc. Abnormal ''swara'' (voice) include fluctuations in the normal quality of sounds produced (hoarseness of voice, dysphonia), absence of the normal physiological sounds like absence of peristalsis in peritonitis, presence of abnormal sounds like crepitus in joints & crepitation, rhonchi etc. in lungs. Abnormalities in touch include tactile perception of abnormal hardness, softness, warmth etc.
=== Three types of morbid conditions ===
The morbid conditions are of three types. Such as those indicated by bodily marks, those caused by etiological factors and those resemble etiological factors.
=== Visible end stage manifestations ===
''Lakshana nimitta'' include visible end stage manifestations. The abnormal color produced can be considered as ''ojokshaya lakshana'' (depletion of quality of tissue). In ''Raktarshas'' (bleeding piles), when there is excessive bleeding, it may lead to poor complexion, strength, enthusiasm and depleted [[ojas]]. If proper measure is not taken the condition may become fatal. The unnatural color of skin can be compared with the cyanotic conditions, discoloration seen in the fatal hepatic and renal pathologies etc. Appearance of white spots, white nails and loss of pigmentation can be seen in chronic liver failure.
In chronic kidney disease, the conjunctival deposition of calcium leads to redness and gritty feeling in the eye called uremic red eye. Also deposition of calcium as a band in the lamina proprea of cornea leads to band keratopathy.
In chronic hepatic failure, erythematous patches may appear over many parts of the body, especially over the chest wall and supraclavicular regions.
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.''
=== Abnormal voices ===
*In ''sannipatha jwara'' - ''swarasada'' (low pitched voice) is a ''lakshana''.
*In ''kshathaja kasa'' - ''paravatha ivaakoojan'' (cooing sound like that of a pigeon comes out of the throat)
*In ''Apatantraka –kapota iva koojan'' ( make sound like a pigeon).
*In Tetanus -sudden death occurs due to laryngeal spasm .
*Dysphonia—Disturbance of phonation is due to disturbance in vocal cords. Strained, harsh, low pitched voice, nasal voice.
*In laryngeal tumors like supra glottic cancer and glottis cancer hoarseness of voice is a late symptom.
In fact the abnormal changes in color and voice of the patient reflect serious changes in the physiology. Deep seated pathologies of cardio vascular system, Respiratory system, endocrine system often presents with color changes. Similarly lesions in the central nervous system can lead to changes in the voice. Dysarthria, Dysphasia and Dysphonia which may become fatal. In short this chapter highlights the events related with major systems in the body which can cause death.
In fact the abnormal changes in color and voice of the patient reflect serious changes in the physiology. Deep seated pathologies of cardio vascular system, Respiratory system, endocrine system often presents with color changes. Similarly lesions in the central nervous system can lead to changes in the voice. Dysarthria, Dysphasia and Dysphonia which may become fatal. In short this chapter highlights the events related with major systems in the body which can cause death.
=== 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 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"
|+ Table 1: Assessment of prognostic factors
|-
! Sr.no. !! Prognostic factor !! Assessment scales / questionnaires / instruments
|-
| 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;
|-
| 3 || Smell (gandha)|| Odor fingerprints, Odor signatures, E-nose, Byoshu, Gas chromatography, Gas chromatography with mass spectrometry etc;
|-
| 4 || Taste (rasam) || Biomarkers, Measuring various blood components, Breathalyser, VOCs (volatile organic compounds) etc;
|-
| 5 || Touch (sparsha)|| Thermography, Tenderness grading scale, Virtual palpation on 3D computer models, Elastography etc;
|-
| 6 || Sensory organs (jnanendriya) || Sensory over-responsivity scale (sensOR), Multi-Modality unusual sensory experiences questionnaire (MUSEQ), The Launay slade hallucination scale (LSHS), Cardiff anomalous perception scale (CAPS), Osteba critical appraisal cards, Sensory integration and Praxis test, The sensory profile, Perceived stress scale (PSS) etc;
|-
| 7 || Psyche (sattva) || Mental health quality of life, The satisfaction with life scale (SWLS), Scale of self esteem (Rosenberg scale), Quality of life index for mental health, Quality of well being scale, Mini mental status examination (MMSE) etc;
|-
| 8 || Interest (bhakti) || The mood, interest and pleasure questionnaire (MIPQ), Strong interest inventory test 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;
|-
| 11 || Behavioral conduct (achara) || Behavior and symptom identification scale (BASIS), Client adjustment rating scale, Social behavior assessment schedule, Social maladjustment schedule 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;
|-
| 14 || Fundamental constitution ([[prakriti]]) || Prototype Prakriti Analysis tool (PPAT), AyuSoft Prakriti software, Ayurveda child personality inventory (ACPI), Mysore tridosha scale etc;
|-
| 15 || Morbidity ([[vikruti]]) || Computerized adaptive assessment of disease impact (DICAT), Quality of life disease impact scale (QDIS), Multi group confirmatory factor analysis (MGCFA), Item response theory (IRT), Disease specific quality of life scales (QOLs) etc;
|-
| 16 || Strength or energy (bala)|| Modifiable activity questionnaire (MAQ), Previous week modifiable activity questionnaire (PWMAQ), Recent physical activity questionnaire (RPAQ), International physical activity questionnaire (IPAQ), 7 day physical activity recall (PAR) etc;
|-
| 17 || Languor (glani) || Fatigue severity scale, Fatigue questionnaire, Multidimensional fatigue inventory, Fatigue impact scale, Visual analogue scale - Fatigue etc;
|-
| 18 || Intellect (medha) || Classification of intellectual and other psychological impairments functioning, Mental residual functional capacity assessment (MRFC), Wechsler adult intelligence scale (WAIS-IV), Boston naming test, Controlled oral word association, Hopkins verbal learning test - Revisited;
|-
| 19 || Exhilaration (harsh) || Affect balance scale, General well being index, The positive and negative syndrome scale (PANSS), Quality of life enjoyment and satisfaction questionnaire etc;
|-
| 20 || Dryness (raukshya) || Surface characterizing impedance monitor (SCIM), Nova Dermal Phase Meter etc;
|-
| 21 || Unctuousness (sneha) || Moisture Map, Dermaflex, Biospec imager, SkinChip, Skicon, Corneometer, Dermal Torque Meter, Twistometer etc;
|-
| 22 || Drowsiness (tandra) || Pittsburgh sleep quality index (PSQI), Holland sleep disorder questionnaire (HSDQ), Gorningen sleep quality scale (GSQS), Karolinska sleepiness scale (KSS), Expanded consensus sleep diary (CSD-E) etc;
|-
| 23 || Onset (arambha) || Various screening tests like Mini-Cog, 6-CIT, The informant questionnaire on cognitive decline in the elderly (IQCODE), Geriatric depression screening scale, The Hospital anxiety and depression scale etc;
|-
| 24 || Heaviness (gaurava)/ lightness (laghava) || Increased or decreased specific gravity of sputum, semen, urine and faeces etc which can be measured by laboratory investigations like sputum, semen, urine analysis;
|-
| 25 || Quality of diet (ahara guna) || Diet satisfaction questionnaire (DSat-45), RESIDE dietary guideline index (RDGI), Food frequency questionnaire (FFQ), Dietary behavior questions (DBQ) etc;
|-
| 26 || Lifestyle (vihara) || Simple lifestyle indicator questionnaire (SLIQ), The healthy lifestyle and personal control questionnaire (HLPCQ), Lifestyle questionnaire related to cancer, Health protective behaviour scale 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 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;
|-
| 30 || Complications (upadrava) || Patient reported outcome measures (PROM), Patient reported experience measures (PREM), EQ-5D, EQ-VAS etc;
|-
| 31 || Luster (chchaya), shadow (pratichchaya) || Red reflex test, Radio diagnosis & imaging, Kirlian photography, Fitzpatrick skin type scale, C.L.B.T assessment, Computerized analysis of shadows, studies on cast shadows etc;
|-
| 32 || Dreams (swapna darshana) || Nightmare distress questionnaire (NDQ), Beliefs about dream questionnaire (BADQ), Chinese version of Van Dream anxiety scale (CVDAS), Dream survey questionnaire (DSQ) etc;
|-
| 33 || Messenger (doota adhikara) || Caregiver strain index (CSI), Zarit burden interview, Care related quality of life, Burden scale for family caregivers, Care giving knowledge questionnaire (CKQ-My), Caregiver burden scale - Indian population (CBS-IP), Caregiver confidence in sign/symptom management scale (CCSM), Revised scale of care giving self efficacy (RSSE), Self efficacy questionnaire for Chinese family caregivers (SEQCFC) etc;
|}
===Assessment of complexion ===
The normal complexion can be compared and related to different skin types as per [https://en.wikipedia.org/wiki/Fitzpatrick_scale Fitzpatrick skin type]<ref name="Mamidi P."/> given in table 2.
{| class="wikitable"
|+ Table 2: Assessment of normal complexion (varna)
|-
! Normal complexion (varna) !! Skin colour!! [https://en.wikipedia.org/wiki/Fitzpatrick_scale Fitzpatrick skin type]
|-
| | Krishna || Black || Type VI
|-
| | Shyama || Brown || Type V
|-
| | Shyama-Avadata || Light brown || Type III & Type IV
|-
| | Avadata-Gaura || Fair or White || Type I & Type II
|-
|}
===Observations of abnormal complexion and relevant morbidities ===
Clinical observations in change of complexion can be suggestive of probable underlying morbidities.<ref name="Mamidi P."/> These are summarized in the following table 3.
{| class="wikitable"
|+ Table 3: Bad prognostic factor related to change in complexion
|-
! Observation !! Probable relevant disease or pathology
|-
| |Discoloration of whole body [ Cha.Sa. [[Indriya Sthana]] 1/9]|| Cyanosis; Melasma; Addison’s disease; Post-inflammatory hyper pigmentation; Cutaneous amyloidosis; Acanthosis nigricans; Wilson’s disease; Purpura; Fungal infections in immunocompromised patients; Jaundice; Hepatocellular carcinoma; Pallor; Hypomelanosis or hypopigmentation; Vitiligo;
|-
| |Discoloration of right half of body [Cha.Sa.[[Indriya Sthana]] 1/10]|| Harlequin color change;
|-
| |Discoloration of upper half of body [Cha.Sa.[[Indriya Sthana]] 1/10]|| Differential cyanosis; Reverse differential cyanosis; Spinal cord injury (SCI); Paraplegia;
|-
| |Discoloration of dorsal or posterior surface of the body [Cha.Sa.[[Indriya Sthana]] 1/10]|| Venous stasis in chronic bed ridden patients;
|-
| |Discoloration of internal or external mucosal surfaces [Cha.Sa.[[Indriya Sthana]] 1/10] || Acquired generalized hyper pigmentations due to various underlying conditions; Oral pigmentation; Sino-nasal melanosis; Nevus of Ota;
|-
| |Unilateral facial discoloration [Cha.Sa.[[Indriya Sthana]] 1/10] || Unilateral facial flushing in Harlequin syndrome; Horner’s syndrome; Parry-Romberg syndrome;
|-
| |Unilateral numbness or hyperesthesia in body [Cha.Sa.[[Indriya Sthana]] 1/10] || Hemiplegia or hemiparesis; Paraplegia or paraparesis; Diplegia; HSP (Hereditary spastic paraplegia); CMV (cytomegalovirus) polyradiculopathy; SCI; Myelopathies;
|-
||Unilateral numbness or hyperesthecia on face [Cha.Sa.[[Indriya Sthana]] 1/10] || DAN (Diabetic autonomic neuropathy); Anhidrosis & Hyperhidrosis; SCI; Cervical spine pathology; Unilateral facial seborrhoea in Ramsay-Hunt syndrome & Facial paralysis;
|-
| |Unilateral unctuousness or dryness of body [Cha.Sa.[[Indriya Sthana]] 1/10] || Paraplegia; SCI; Myelopathy;
|-
| |Appearance of moles, freckles, pimples on body [Cha.Sa.[[Indriya Sthana]] 1/11] || Basal cell carcinoma; Squamous cell carcinoma; Scleroderma; SLE (Systemic lupus erythematosus); Inflammatory & Infectious dermatoses; Sturge-Weber syndrome; Fungal & Viral skin infections; Melanocytic nevi; Hyper pigmentations; Carcinoid syndrome;
|-
| |Abnormal discoloration of nails, eyes, face, urine, stools, hands, legs, lips etc. [Cha.Sa.[[Indriya Sthana]] 1/12] || Cyanosis; Melanonychia; Acroperniosis; Chemosis; Jaundice; Panda eye; Iris nevi; Horner’s syndrome; Melanoma; Alkaptonuria; Black water fever; Biliary obstruction; Upper and lower gastrointestinal bleeding; Peripheral vascular disease (PVD); Acrocyanosis; Raynaud’s phenomenon; Mottling at end-of-life stages;
|-
| | Other sudden changes in complexion [Cha.Sa.[[Indriya Sthana]] 1/13] || Cyanosis, Pallor and Erythrosis seen in ALTE (Apparent Life-Threatening Events) & BRUE (Brief Resolved Unexplained Events);
|-
|}
=== Observations of abnormal voice and relevant morbidities ===
Clinical observations in change of voice can be suggestive of probable underlying morbidities.<ref name="Mamidi P."/> These are summarized in the following table 4.
{| class="wikitable"
|+ Table 4: Bad prognostic factor related to change in voice
|-
! Abnormal voice!! Relevant disease or pathology
|-
| | Hoarseness or raspiness like a sheep [Cha.Sa.[[Indriya Sthana]] 1/14] || Due to structural changes of vocal cords (Acute or chronic laryngitis, Polyps etc);
|-
| | Feeble [Cha.Sa.[[Indriya Sthana]] 1/14] || Aphonic palilalia; Hypophonia; Paresis of vocal cords; LMN (lower motor neuron) lesions;
|-
| | Subdued or Inaudible) [Cha.Sa.[[Indriya Sthana]] 1/14] || Aphonia; Hypophonia; LMN (lower motor neuron) lesions; ALS (Amyotrophic lateral sclerosis); MG (Myasthenia gravis); TIA (Transient ischemic attack) etc;
|-
| | Indistinct or Indistinguishable) [Cha.Sa.[[Indriya Sthana]] 1/14] || Aphonia; Aphonic palilalia; Progressive supranuclear palsy; Bilateral upper brainstem lesions;
|-
| | Chocked or stammering [Cha.Sa.[[Indriya Sthana]] 1/14] || Spastic or Spasmodic dysphonia; Dysarthria (bilateral cerebral lesions, cerebral glioma of parietal origin etc);
|-
| | Hoarse or rough [Cha.Sa.[[Indriya Sthana]] 1/14] || Hyperkinetic dysarthria; Structural lesions and inflammatory conditions of larynx;
|-
| | Faint or painful [Cha.Sa.[[Indriya Sthana]] 1/14] || Dysphasia; Dysphonia; Motor or Broca’s Aphasia; Inflammatory lesions of the pharynx and larynx; Neoplasms of larynx, pharynx, lungs, and thyroid; Lymphoma; Mediastinal metastases pressing laryngeal nerves; Unilateral vocal cord palsy (UVCP) etc;
|-
| | Stuttering or stammering [Cha.Sa.[[Indriya Sthana]] 1/14] || Spastic paralysis; Dysarthria; Rigidity; Spasms of muscles of articulation;
|-
| | Other abnormal voices [Cha.Sa.[[Indriya Sthana]] 1/15] || Migraine Aura; TIA; MG; ALS; LMN lesions; UVCP; Multiple sclerosis (MS); Epilepsy; Carcinomas of larynx, pharynx, lungs, and thyroid; Lymphoma; Mediastinal metastasis; Cancer cachexia etc;
|-
|}
'''Acknowledgement:''' The contributors acknowledge support of Dr. M. Prasad and Dr.G.Kshama for providing tables from their published article referred in this chapter.
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== References ==
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