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{{#seo:

|title=Kiyanta Shiraseeya Adhyaya

|titlemode=append

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|keywords=Shiroroga (diseases of head), hridaya roga(diseases of heart), imbalances in dosha, dhatu-kshaya, mala-kshaya, pidaka, madhumeha, dosha-gati, sannipata, samsarga, ojokshaya, ojas, signs of depletion of dosha, dhatu and mala, disorders of ~~oja~~, movement of dosha

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|keywords=Shiroroga (diseases of head), hridaya roga(diseases of heart), imbalances in [[dosha]], [[dhatu]]-kshaya, [[mala]]-kshaya, pidaka, madhumeha, [[dosha]]-gati, sannipata, samsarga, ojokshaya, [[ojas]], signs of depletion of [[dosha]], [[dhatu]] and [[mala]], disorders of [[ojas]], movement of [[dosha]], [[Ayurveda]], Indian system of medicine, charak samhita,Goyal M.,Singh G.,Pol A.,Kar A., Rai S., Deole Y.S., Basisht G.

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

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|image=http://www.carakasamhitaonline.com~~/mediawiki-1.32.1~~/resources/assets/ogimgs.jpg

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

|image_alt=carak samhita

|type=article

}}

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

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

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<div style="text-align:justify;">This is the first chapter of Roga Chatushka (tetrad on classification of diseases) dealing with description of diseases of the vital organs, the head and the heart. Diseases are caused by disequilibrium of dosha in body. The signs and symptoms of various permutations and combinations of dosha imbalances are enlisted in this chapter. It also enlists and describes signs of depletion of dhatu and mala. The disorders of oja are narrated, which continues with description of madhumeha (diabetes mellitus), and carbuncles produced as its complications. Various types of dosha gati (movements) are mentioned. The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter. </div>

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'''Keywords''': ''Shiroroga'' (diseases of head), ''hridaya roga''(diseases of heart), imbalances in ''dosha'', ''dhatu-kshaya'', ''mala-kshaya, pidaka, madhumeha, dosha-gati, sannipata, samsarga, ojokshaya, ojas,'' signs of depletion of ''dosha, dhatu'' and ''mala'', disorders of ''oja'', movement of ''dosha''.

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~~</div>~~

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{{Infobox

|title = Kiyanta Shiraseeya Adhyaya

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|data1 = [[Sutra Sthana]] Chapter 17

|label2 = Tetrad/Sub-section

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|data2 = ''Roga Chatushka''

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|data2 = Roga Chatushka

|label3 = Preceding Chapter

|data3 = [[Chikitsaprabhritiya Adhyaya]]

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|label5 = Other Sections

|data5 = [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

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|label6 = Translator and commentator

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|data6 = Goyal M.,Singh G.

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|label7 = Reviewer

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|data7 = Pol A.

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|label8 = Editors

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

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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

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|label11 = DOI

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

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}}

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

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<p style="text-align:justify;">This is the first chapter of Roga Chatushka (tetrad on classification of diseases) dealing with description of diseases of the vital organs, the head and the heart. Diseases are caused by disequilibrium of [[dosha]] in body. The signs and symptoms of various permutations and combinations of [[dosha]] imbalances are enlisted in this chapter. It also enlists and describes signs of depletion of [[dhatu]] and [[mala]]. The disorders of [[ojas]] are narrated, which continues with description of madhumeha (diabetes mellitus), and carbuncles produced as its complications. Various types of [[dosha]] gati (movements) are mentioned. The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter. </br>

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}}

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'''Keywords''': Shiroroga(diseases of head), hridaya roga(diseases of heart), imbalances in [[dosha]], [[dhatu]]-kshaya, [[mala]]-kshaya, pidaka, madhumeha, [[dosha]]-gati, sannipata, samsarga, ojokshaya, [[ojas]], signs of depletion of [[dosha]], [[dhatu]] and [[mala]], disorders of [[ojas]], movement of [[dosha]].

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</p>

== Introduction ==

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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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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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The present chapter begins with an enumeration of diseases afflicting the head and describes the significance of head, followed by description of five varieties of diseases of head with headache as the main symptom and five types of heart diseases with different clinical presentations. Thereafter, sixty two permutations and combinations in the form of ''sannipata'' (involvement of three ~~''doshas''~~) and ''samsarga'' (involvement of two ~~''doshas''~~), based on variations in quantum of increased or decreased state of involved ~~''doshas''~~, along with descriptions of symptoms of twelve varieties of ''sannipata'' have been described in this chapter. Also described are eighteen conditions caused by decrease of ~~''doshas~~, ~~dhatus~~, mala'' and ''ojas'', along with plausible reasons for all the decrease taking place in the body. Further, definition and characteristics of ''ojas'' have been discussed in brief with a specific variety of ''Avrita Madhumeha'' (diabetes due to obstructive ''vata'') in which ''ojas'' is excreted in urine. The description of ''avrita madhumeha'' (resembles diabetes mellitus type II - NIDDM) and seems to represent the disease of third ''marma'' (vital organ) i.e. ''basti''. Skin infection is a common complication of diabetes mellitus. Therefore it is described in detail under the heading of ''prameha pidika'' (carbuncles). Seven types of inflammatory swellings viz. ''sharavika, kacchapika, jalini, sarshapi, alaji, vinata'' and ''vidradhi'' are described in detail with a disclaimer stating that these can also occur independently due to vitiation of ~~''medas''~~. The chapter ends with references to various ''gati'' (states) of ''dosha'' that are related to health as well as disease.

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The present chapter begins with an enumeration of diseases afflicting the head and describes the significance of head, followed by description of five varieties of diseases of head with headache as the main symptom and five types of heart diseases with different clinical presentations. Thereafter, sixty two permutations and combinations in the form of sannipata (involvement of three [[dosha]]) and samsarga(involvement of two [[dosha]]), based on variations in quantum of increased or decreased state of involved [[dosha]], along with descriptions of symptoms of twelve varieties of sannipata have been described in this chapter. Also described are eighteen conditions caused by decrease of [[dosha]], [[dhatu]], [[mala]] and [[ojas]], along with plausible reasons for all the decrease taking place in the body. Further, definition and characteristics of [[ojas]] have been discussed in brief with a specific variety of Avrita Madhumeha (diabetes due to obstructive [[vata]]) in which [[ojas]] is excreted in urine. The description of avrita madhumeha (resembles diabetes mellitus type II - NIDDM) and seems to represent the disease of third marma (vital organ) i.e. basti. Skin infection is a common complication of diabetes mellitus. Therefore it is described in detail under the heading of prameha pidika(carbuncles). Seven types of inflammatory swellings viz. sharavika, kacchapika, jalini, sarshapi, alaji, vinata and vidradhi are described in detail with a disclaimer stating that these can also occur independently due to vitiation of [[meda dhatu]]. The chapter ends with references to various gati (states) of [[dosha]] that are related to health as well as disease.

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The diseases related to ''trimarma'', or the three vital organs, have also been described in the 26th chapter of [[Chikitsa Sthana]] [[ Trimarmiya Chikitsa]] and later in 9th chapter of [[Siddhi Sthana]] [[Trimarmiya Siddhi]]. While the [[Sutra Sthana]] helps provide the fundamental approaches to treating these diseases, the [[Chikitsa Sthana]] primarily addresses the management aspects and [[Siddhi Sthana]] describes the internal and external traumas of these organs. As per [[Ayurveda]], there are 107 marmas that are considered to be points of ''prana'' (vital energy) and are located in various parts of the body. It is accepted that injuries to ''marma'' -external, internal or psychological - may either cause immediate death or permanent deformities (some of which may cause complications and death at a later stage). Among these 107 ''marmas'', Charak has given utmost importance to the head, the heart and the urinary bladder. Among these three, the head is foremost as it is central to all senses and is the prime location of ''prana''. This is the reason why other texts have compared human body with an inverted-tree model (with roots at the top and branches at the bottom).

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The diseases related to trimarma, or the three vital organs, have also been described in the 26th chapter of [[Chikitsa Sthana]] [[ Trimarmiya Chikitsa]] and later in 9th chapter of [[Siddhi Sthana]] [[Trimarmiya Siddhi]]. While the [[Sutra Sthana]] helps provide the fundamental approaches to treating these diseases, the [[Chikitsa Sthana]] primarily addresses the management aspects and [[Siddhi Sthana]] describes the internal and external traumas of these organs. As per [[Ayurveda]], there are 107 marmas that are considered to be points of prana (vital energy) and are located in various parts of the body. It is accepted that injuries to marma -external, internal or psychological - may either cause immediate death or permanent deformities (some of which may cause complications and death at a later stage). Among these 107 ''marmas'', Charak has given utmost importance to the head, the heart and the urinary bladder. Among these three, the head is foremost as it is central to all senses and is the prime location of ''prana''. This is the reason why other texts have compared human body with an inverted-tree model (with roots at the top and branches at the bottom).

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The ''shiroroga'', or the disease(s) of the head, have various clinical manifestations of headache and vary depending upon ''dosha''-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''shiroroga'', different manifestations of headache can give an idea of the predominant ''dosha'' which may further decide the course of treatment. Similarly ''hridroga'' (heart diseases) and diseases associated with the urinary bladder mentioned in this chapter are also due to ''dosha'' predominance and ''krimi'' infestation.

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The ''shiroroga'', or the disease(s) of the head, have various clinical manifestations of headache and vary depending upon [[dosha]]-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''shiroroga'', different manifestations of headache can give an idea of the predominant [[dosha]] which may further decide the course of treatment. Similarly ''hridroga'' (heart diseases) and diseases associated with the urinary bladder mentioned in this chapter are also due to [[dosha]] predominance and ''krimi'' infestation.

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Various permutations and combinations of ''dosha'' have been analyzed that help in understanding the pathogenesis of a disease. It is always a matter of debate as to why there are so many diseases and why does a disease have so many different manifestations or forms, depending upon an individual. One answer is that the ''dosha'' involved in pathogenesis varies in the forms of either ''vriddhi'' (increase) or ''kshaya'' (decrease), and that a typical permutation or combination of such ''doshas'' can manifest the disease in a different way. The verses 45, 46, and 47 deal with ''ashayapkarsha'' (pulling ''dosha'' from its location) in which a dominant or increased ''vata'' pulls the normal ''pitta'' and ''kapha'' away from their “seats” and manifests its own features there. Therefore, confusion can occur in the diagnosis and management of the disease. In addition, the concept of ''vikalpa samprapti'' (variable pathogenesis) can be a reason for such varied presentations of the disease, since per ''vikalpa samprapti'', the involvement of various properties of ''dosha'' may differ depending upon the etiological factors. Eighteen types of ''kshaya'' (decreased state) of ''dosha, dhatu,~~'' ''~~mala'' and ''ojas'' that may play a significant role in disease pathogenesis are also considered in this chapter. ''Madhumeha'' (Diabetes mellitus) which is also termed as ''ojomeha'' in other texts is one of the ''prameha'' where excessive ''kshaya'' of ''ojas'' takes place. One of its presentations (or forms) is caused due to ''avaranajanya samprāpti'' (obstructive pathogenesis), as explained in this chapter. ''Madhumeha'' is one among twenty types of ''prameha'' characterised by excessive frequency and quantity of urination. The primary ''dosha'' associated with ''madhumeha'' is ''vata'' and two types of pathogenesis of ''madhumeha'' have been discussed in [[Charak Samhita]]. In the first type, ~~''dhatukshaya''~~ (decreased state of body tissue) causes ''vata'' provocation and all the clinical features of a vitiated ''vata'' are present in the patient of ''kshayaja madhumeha'' (Diabetes mellitus type 1) ~~(Charak~~ Nidana 4/36-44). In the second type, there is an initial involvement of ''kapha, pitta, mamsa'' and ~~''medas dhātu''~~, that in turn make ''avarana'' (to get covered or overlapped) of ''vata'' leading to manifestation of ''madhumeha'' (diabetes mellitus type 2) where features of ~~k''apha~~, pitta, ~~medas''~~ and ''mamsa dushti'' are also observed. Here, therefore, the main line of treatment (i.e., for Type 2) involves pacifying ''kapha, pitta,~~'' ''medas''~~ and ''mamsa''. Various ''gati'' of ''dosha'' that are responsible for healthy and diseased states are dealt at the end of the chapter. Charak has also stressed upon the significance of a regular healthy diet. It can be said that in the 17th chapter, a multi-faceted approach to understanding various presentations of diseases has been mentioned, aided with examples.

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Various permutations and combinations of [[dosha]] have been analyzed that help in understanding the pathogenesis of a disease. It is always a matter of debate as to why there are so many diseases and why does a disease have so many different manifestations or forms, depending upon an individual. One answer is that the [[dosha]] involved in pathogenesis varies in the forms of either vriddhi (increase) or kshaya(decrease), and that a typical permutation or combination of such [[doshas]] can manifest the disease in a different way. The verses 45, 46, and 47 deal with ''ashayapkarsha'' (pulling [[dosha]] from its location) in which a dominant or increased [[vata]] pulls the normal [[pitta]] and [[kapha]] away from their “seats” and manifests its own features there. Therefore, confusion can occur in the diagnosis and management of the disease. In addition, the concept of ''vikalpa samprapti'' (variable pathogenesis) can be a reason for such varied presentations of the disease, since per ''vikalpa samprapti'', the involvement of various properties of [[dosha]] may differ depending upon the etiological factors. Eighteen types of ''kshaya'' (decreased state) of [[dosha], [[dhatu]], [[mala]] and [[ojas]] that may play a significant role in disease pathogenesis are also considered in this chapter. ''Madhumeha'' (Diabetes mellitus) which is also termed as ''ojomeha'' in other texts is one of the ''prameha'' where excessive ''kshaya'' of [[ojas]] takes place. One of its presentations (or forms) is caused due to ''avaranajanya samprāpti'' (obstructive pathogenesis), as explained in this chapter. ''Madhumeha'' is one among twenty types of ''prameha'' characterised by excessive frequency and quantity of urination. The primary [[dosha]] associated with ''madhumeha'' is [[vata]] and two types of pathogenesis of ''madhumeha'' have been discussed in [[Charak Samhita]]. In the first type, [[dhatu]] kshaya(decreased state of body tissue) causes [[vata]] provocation and all the clinical features of a vitiated [[vata]] are present in the patient of ''kshayaja madhumeha'' (Diabetes mellitus type 1) [Cha.Sa. [[Nidana Sthana]] 4/36-44]. In the second type, there is an initial involvement of [[kapha]], [[pitta]], [[mamsa dhatu]] and [[meda dhatu]], that in turn make ''avarana'' (to get covered or overlapped) of [[vata]] leading to manifestation of ''madhumeha'' (diabetes mellitus type 2) where features of [[kapha]], [[pitta]], [[meda dhatu]] and [[mamsa]] dushti are also observed. Here, therefore, the main line of treatment (i.e., for Type 2) involves pacifying [[kapha]], [[pitta]], [[meda dhatu]] and [[mamsa dhatu]]. Various gati of [[dosha]] that are responsible for healthy and diseased states are dealt at the end of the chapter. Charak has also stressed upon the significance of a regular healthy diet. It can be said that in the 17th chapter, a multi-faceted approach to understanding various presentations of diseases has been mentioned, aided with examples.

</div>

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(Agnivesha asked the questions) “Oh God! How many are the diseases of head and heart of human beings? How many are the disorders caused by the varied combinations of discordant ''vata'' and other ~~''doshas''~~? How many are the disorders caused by ''kshaya''? How many are the papules (''pidika'')? O Holy One and Dispeller of ''Dosha''! How many types of ''gati'' of ''dosha'' are there? [3-4]

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(Agnivesha asked the questions) “Oh God! How many are the diseases of head and heart of human beings? How many are the disorders caused by the varied combinations of discordant [[vata]] and other [[dosha]]? How many are the disorders caused by kshaya? How many are the papules (pidika)? O Holy One and Dispeller of [[Dosha]]! How many types of gati of [[dosha]] are there? [3-4]

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</div>

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</div>

=== Explanation by Atreya ===

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</div></div>

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“There are five ''shiroroga'' (diseases of head) and five ''hridroga'' (diseases of heart). On the basis of permutations and combinations of ''dosha'', there are sixty-two disorders” [6]

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“There are five ''shiroroga'' (diseases of head) and five ''hridroga'' (diseases of heart). On the basis of permutations and combinations of [[dosha]], there are sixty-two disorders” [6]

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</div></div>

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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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“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]

=== 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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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]

</div>

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=== Importance 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]

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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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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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Indulgence in loud speech, excessive talk, strong drinks, awaking till late night, exposure to cold wind, excessive sexual act, suppression of natural physical urges, fasting, trauma, excessive/strong ''vamana'' or ''virechana'', excessive weeping, grief, fear, terror, excessive-load carrying, way-faring, severe emaciation leads to provocation of ''vata'' which by affecting the vessels of the head gets further provoked and produces severe pain in head [16-18]

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Indulgence in loud speech, excessive talk, strong drinks, awaking till late night, exposure to cold wind, excessive sexual act, suppression of natural physical urges, fasting, trauma, excessive/strong [[vamana]] or [[virechana]], excessive weeping, grief, fear, terror, excessive-load carrying, way-faring, severe emaciation leads to provocation of [[vata]] which by affecting the vessels of the head gets further provoked and produces severe pain in head [16-18]

</div>

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

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=== Symptoms of [[vata]]- dominant diseases of head ===

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Intense pain in both the temples, splitting sensation in the nape, excessive heat and pain in forehead and between the eyebrows region, severe cutting pain and dissonances in ear, feeling as if the eyes are being gouged out, dizziness, sense of separateness in all the joints, excessive throbs in blood vasculature, stiffness of neck are the symptoms of vataja shiroroga. Use of hot and unctuous things provides relief in ''vata'' type of headache [19-21]

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Intense pain in both the temples, splitting sensation in the nape, excessive heat and pain in forehead and between the eyebrows region, severe cutting pain and dissonances in ear, feeling as if the eyes are being gouged out, dizziness, sense of separateness in all the joints, excessive throbs in blood vasculature, stiffness of neck are the symptoms of vataja shiroroga. Use of hot and unctuous things provides relief in [[vata]] type of headache [19-21]

</div>

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

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=== [[Pitta]]- dominant diseases of the Head ===

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</div></div>

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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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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 [[pitta]] dominant diseases of head [22]

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

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=== Symptoms of [[pitta]] dominant diseases of head===

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</div></div>

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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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Burning sensation and pain in the head, desire for cold things, burning sensation in the eyes, thirst, giddiness and perspiration are the symptoms of [[pitta]] dominant diseases of head [23]

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

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=== [[Kapha]]-dominant diseases of head ===

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</div></div>

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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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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 [[kapha]] dominant diseases of head. [24]

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

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=== Symptoms of [[kapha]] dominant diseases of head ===

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</div></div>

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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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Dull headache, numbness, stiffness and heaviness in head, drowsiness, laziness and anorexia are the symptoms of [[kapha]] doinant diseases of head [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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</div></div>

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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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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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When a person with provoked ''dosha'' indulges in excessive intake of sesame, milk, molasses,takes meals even when previous meal has not properly digested, eats putrefied or promiscuous food, and/or takes incompatible diet - it causes pathological discharges of ''rakta, kapha'' and ~~''māmsa''~~, wherein parasites are produced, leading to ''krimija shiroroga'' with dreadful symptoms [27-28]

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When a person with provoked [[dosha]] indulges in excessive intake of sesame, milk, molasses,takes meals even when previous meal has not properly digested, eats putrefied or promiscuous food, and/or takes incompatible diet - it causes pathological discharges of [[rakta]], [[kapha]] and [[mamsa]], wherein parasites are produced, leading to ''krimija shiroroga'' with dreadful symptoms [27-28]

</div>

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

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=== Symptoms of ''krimija 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 ([[vata]]ja hridroga) ===

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</div></div>

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

+

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

−

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

+

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

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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]

+

The symptoms of [[vata]]-dominant disease of heart 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]

</div>

−

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

+

−

+

=== Etiological factors and pathogenesis of [[pitta]]-dominant heart diseases ([[pitta]]ja hridroga) ===

+

उष्णाम्ललवणक्षारकटुकाजीर्णभोजनैः|

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</div></div>

−

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]

+

Excessive intake of hot, sour, pungent, salty and alkaline food articles, alcohol, exposure to sun, and anger are the etiological factors of [[pitta]]-dominant heart diseases [32]

−

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

+

=== Symptoms of [[pitta]]-dominant heart diseases ===

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</div></div>

−

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]

+

Burning sensation in the precordial region, bitter taste in mouth, sour eructation, exhaustion, thirst, fainting, giddiness and perspiration are the symptoms of [[pitta]]-dominant heart diseases [33]

−

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

+

=== Etiological factors and pathogenesis of [[kapha]]-dominant heart diseases ([[kapha]]ja hridroga) ===

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</div></div>

−

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

+

Over-eating, intake of heavy and fatty food substances, worry-free and sedentary lifestyle, excessive sleep are the etiological factors of [[kapha]]-dominant heart diseases[34]

−

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

+

=== Symptoms of [[kapha]]-dominant heart diseases ===

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</div></div>

−

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]

+

Numbness, stiffness and heaviness in the precordial area, a stony sensation in the heart region, drowsiness and anorexia are the symptoms of '[[kapha]]-dominant heart diseases [35]

−

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

+

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

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</div></div>

−

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]

+

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

−

+

=== 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]

+

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

</div>

+

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

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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]

+

There are 13 conditions of ''sannipata'' of [[dosha]] (combination of all three [[dosha]]), out of these, three conditions are with a dominance of two [[dosha]] (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 [[dosha]], and one condition with equal aggravation of all three [[dosha]] [41]

</div>

+

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

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</div></div>

−

''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]

+

''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]

−

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

+

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

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</div></div>

−

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

+

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

−

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

+

==== (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]

+

There is another form of sannipata where the [[dosha]] 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>

−

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

−

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

+

=== Twelve types of irregular (vishama) sannipata(combination of [[dosha]]) ===

+

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

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</div></div>

−

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]

+

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]

−

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

+

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

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</div></div>

−

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]

+

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]

−

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

+

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

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</div></div>

−

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

+

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

−

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

+

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

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</div></div>

−

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

+

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

−

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

+

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

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</div></div>

−

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

+

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

−

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

+

==== 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]

+

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>

−

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

+

==== 7. Decreased [[vata]],increased [[kapha]], and [[pitta]] sannipata====

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</div></div>

−

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]

+

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]

−

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

+

==== 8. Decreased [[pitta]], increased [[kapha]], and [[vata]] sannipata====

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</div></div>

−

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]

+

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]

−

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

+

==== 9. Decreased [[kapha]], increased [[vata]] and [[pitta]] sannipata ====

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</div></div>

−

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]

+

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]

−

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

+

==== 10. Decreased [[vata]] and [[pitta]] and increased [[kapha]] sannipata====

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</div></div>

−

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).

+

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).

−

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

+

==== 11. Decreased [[vata]] and [[kapha]] and increased [[pitta]] sannipata ====

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</div></div>

−

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).

+

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).

−

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

+

==== 12. Decreased [[pitta]] and [[kapha]] and increased [[vata]] sannipata ====

Line 917: Line 930:

</div></div>

−

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]

+

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]

−

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

+

=== General principle of symptoms of increased and decreased [[dosha]] ===

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</div></div>

−

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]

+

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, [[dosha]] are in an equilibrium [62]

−

+

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

Line 949: Line 962:

</div></div>

−

Now the symptoms of decrease of ~~''doshas~~, ~~dhatus~~, mala~~,''~~ (i.e., excreta such as urine, feces,and excreta of nose, ears, eyes and mouth, as well as body hair) and ''ojas'' will be described. The symptoms of decreased ~~''doshas''~~ have already been described. [63]

+

Now the symptoms of decrease of [[dosh]],[[dhatu]], [[mala]](i.e., excreta such as urine, feces,and excreta of nose, ears, eyes and mouth, as well as body hair) and [[ojas]] will be described. The symptoms of decreased [[dosha]] have already been described. [63]

−

==== Decrease of ''rasa'' ====

+

==== Decrease of [[rasa dhatu]] ====

Line 965: Line 978:

</div></div>

−

Symptoms of diminution of ''rasa'' include restlessness (or feeling as if the heart is being churned), intolerance to loud sounds, acceleration of flow (tachycardia), pain and distress even with the slightest exertion [64]

+

Symptoms of diminution of [[rasa dhatu]] include restlessness (or feeling as if the heart is being churned), intolerance to loud sounds, acceleration of flow (tachycardia), pain and distress even with the slightest exertion [64]

−

==== Decrease of rakta ====

+

==== Decrease of [[rakta dhatu]] ====

Line 978: Line 991:

</div></div>

−

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

+

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

−

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

+

==== Decrease of [[mamsa dhatu]] ====

Line 991: Line 1,004:

</div></div>

−

Symptoms of decrease in ''mamsa'' include thinning specially of hips, neck and belly [65]

+

Symptoms of decrease in [[mamsa dhatu]] include thinning specially of hips, neck and belly [65]

−

==== Decrease of ~~''medas''~~ ====

+

==== Decrease of [[meda dhatu]] ====

Line 1,007: Line 1,020:

</div></div>

−

Symptoms of decrease of ~~''medas''~~ include cracking of the joints, lassitude of eyes, exhaustion and thinning of the abdomen [66]

+

Symptoms of decrease of [[meda dhatu]] include cracking of the joints, lassitude of eyes, exhaustion and thinning of the abdomen [66]

−

==== Decrease of ''asthi'' ====

+

==== Decrease of [[asthi dhatu]]====

Line 1,023: Line 1,036:

</div></div>

−

Symptoms of decrease of ''asthi'' are loss of scalp and body-hair, beard, nails and teeth, fatigue and loose joints [67]

+

Symptoms of decrease of [[asthi dhatu]] are loss of scalp and body-hair, beard, nails and teeth, fatigue and loose joints [67]

−

==== Decrease of ''majja'' ====

+

==== Decrease of [[majja dhatu]]====

Line 1,039: Line 1,052:

</div></div>

−

Symptoms of decrease of ''majja'' are atrophy of bone tissues, weakness and lightness of bones and the patients suffers frequently from ''vata'' disorders [68]

+

Symptoms of decrease of [[majja dhatu]] are atrophy of bone tissues, weakness and lightness of bones and the patients suffers frequently from [[vata]] disorders [68]

−

==== Decrease of ''shukra'' ====

+

==== Decrease of [[shukra dhatu]]====

Line 1,055: Line 1,068:

</div></div>

−

Symptoms of decrease in''shukra'' include debility, dryness of mouth, pallor, asthenia, fatigue, impotency and absence of ejaculation [69]

+

Symptoms of decrease in [[shukra dhatu]] include debility, dryness of mouth, pallor, asthenia, fatigue, impotency and absence of ejaculation [69]

−

==== Decrease in ''purisha'' ====

+

==== Decrease in [[purisha]] ====

Line 1,071: Line 1,084:

</div></div>

−

In decrease of ''purisha'', provoked ''vata'' causes painful peristalsis in the intestine which spreads upwards and oblique, causing distension of belly and dryness [70]

+

In decrease of [[purisha]], provoked [[vata]] causes painful peristalsis in the intestine which spreads upwards and oblique, causing distension of belly and dryness [70]

−

==== Decrease of ''mutra'' ====

+

==== Decrease of [[mutra]] ====

Line 1,087: Line 1,100:

</div></div>

−

Symptoms of decrease of ''mutra'' include dysuria, discoloration of urine, excessive thirst and dryness of mouth [71]

+

Symptoms of decrease of [[mutra]] include dysuria, discoloration of urine, excessive thirst and dryness of mouth [71]

−

==== Decrease of ''malayana'' ====

+

==== Decrease of malayana ====

Line 1,103: Line 1,116:

</div></div>

−

There are five other minor ''mala'' (associated with minor orifices) viz. ''mala'' of nose, ears, eyes, mouth and skin. Their deficiencies lead to feeling of emptiness, lightness and dryness of the respective receptacle of that ''mala'' [72]

+

There are five other minor [[mala]](associated with minor orifices) viz. [[mala]] of nose, ears, eyes, mouth and skin. Their deficiencies lead to feeling of emptiness, lightness and dryness of the respective receptacle of that [[mala]] [72]

−

==== Decrease of ''ojas'' ====

+

==== Decrease of [[ojas]] ====

Line 1,119: Line 1,132:

</div></div>

−

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

+

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

−

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

+

=== Description of [[ojas]] ===

Line 1,135: Line 1,148:

</div></div>

−

The clear and slightly red-yellowish substance situated in the heart is known as ''ojas''. Its destruction leads to death [74]

+

The clear and slightly red-yellowish substance situated in the heart is known as [[ojas]]. Its destruction leads to death [74]

Line 1,158: Line 1,171:

</div></div>

−

''Ojas'' is the very first substance created in the body of all living beings. Its color resembles that of ghee, tastes like honey and smells like roasted paddy [75]

+

[[Ojas]] is the very first substance created in the body of all living beings. Its color resembles that of ghee, tastes like honey and smells like roasted paddy [75]

−

(As honey is collected by bees from various fruits and flowers, similarly ''ojas'' is collected by the inherent vital qualities of a man from the various physiological processes that take place in the body)(1).

+

(As honey is collected by bees from various fruits and flowers, similarly [[ojas]] is collected by the inherent vital qualities of a man from the various physiological processes that take place in the body)(1).

−

==== General etiological factors of ''ojas kshaya'' (i.e., depletion of ''ojas'') ====

+

==== General etiological factors of [[ojas]] kshaya(i.e., depletion of [[ojas]]) ====

Line 1,186: Line 1,199:

−

Excessive exercising, fasting, worrying, fear, grief, taking dry, scanty and limited meals, dry beverages, exposure to wind and sun, insomnia, excessive excretion of mucus, blood, semen and excretions, adverse season or old age, major mental illness (''Bhuta-Upaghāta'') are the general causative factors for ''kshaya'' (depletion) of ''ojas'' [76-77]

+

Excessive exercising, fasting, worrying, fear, grief, taking dry, scanty and limited meals, dry beverages, exposure to wind and sun, insomnia, excessive excretion of mucus, blood, semen and excretions, adverse season or old age, major mental illness (''Bhuta-Upaghāta'') are the general causative factors for kshaya(depletion) of [[ojas]] [76-77]

</div>

−

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

−

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

+

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

+

गुरुस्निग्धाम्ललवणान्यतिमात्रं समश्नताम्|

नवमन्नं च पानं च निद्रामास्यासुखानि च||७८||

Line 1,221: Line 1,234:

−

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]

+

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 dhatu]] and [[mamsa dhatu]]. 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>

Line 1,238: Line 1,251:

</div></div>

−

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]

+

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]

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

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Excessive use of cold/stale, irritant, hot, un-unctuous and dry food articles, diet with incompatible or unwholesome articles, indigestion, spoiled foods, irregular eating, imbibing spoiled and excessive wines, suppression of natural urges, fatigue, exercise in distorted postures, excessive sleep, carrying heavy loads, excessive wayfaring and excessive sex-activity are the etiological factors of internal abscess.

−

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]

+

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>

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

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</div></div>

−

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

+

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

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

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−

All types of abscesses are very painful. Besides pain, the following symptoms may occur depending upon the ''dosha''.

+

All types of abscesses are very painful. Besides pain, the following symptoms may occur depending upon the [[dosha]].

−

#~~''Vātaja~~ vidradhi'': A ''vata'' type of an abscess is marked by a sensation of piercing or cutting pain. It can spread all over the body and exhibits various other symptoms such as giddiness, distension of abdomen, gurgling sound and throbbing.

+

#[[Vata]]ja vidradhi: A [[vata]] type of an abscess is marked by a sensation of piercing or cutting pain. It can spread all over the body and exhibits various other symptoms such as giddiness, distension of abdomen, gurgling sound and throbbing.

−

#~~''Pittaja~~ vidradhi'': Thirst, burning pain, stupefaction, intoxication and fever are the symptoms of ~~''pittaja~~ vidradhi''.

+

#[[Pitta]]ja vidradhi: Thirst, burning pain, stupefaction, intoxication and fever are the symptoms of [[pitta]]ja vidradhi.

−

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

+

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

</div>

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

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</div></div>

−

*In ''vata'' type of abscess, the discharge is thin, ununctuous, dusky-red and frothy.

+

*In [[vata]] type of abscess, the discharge is thin, ununctuous, dusky-red and frothy.

−

*In ''pitta'' type of abscess, the discharge resembles decocted water of sesame, black-gram or horse-gram.

+

*In [[pitta]] type of abscess, the discharge resembles decocted water of sesame, black-gram or horse-gram.

−

*In ''kapha'' type of abscess, the colour of the discharge is whitish, slimy, thick and profuse.

+

*In [[kapha]] type of abscess, the colour of the discharge is whitish, slimy, thick and profuse.

−

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

+

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

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

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−

The abscesses occurring in the heart, umbilicus and urinary bladder as well as of ''sannipātika'' type, if suppurated, have bad prognosis and may lead to death. ~~Remaining~~ types of abscess ,if treated immediately by an expert physician, are curable.

+

The abscesses occurring in the heart, umbilicus and urinary bladder as well as of ''sannipātika'' type, if suppurated, have bad prognosis and may lead to death. The remaining types of abscess, if treated immediately by an expert physician, are curable.

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>

+

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

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Here are verses again-

−

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]

+

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

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

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</div></div>

−

''Sharavika, kacchapika'' and ''jalini'' types of ''pidika'' are formed due to excessive ''kapha'' and ~~''medas''~~, and therefore can become very severe and cause unbearable pain [105]

+

''Sharavika, kacchapika'' and ''jalini'' types of ''pidika'' are formed due to excessive [[kapha]] and [[meda dhatu]], and therefore can become very severe and cause unbearable pain [105]

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</div></div>

−

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

+

''Sarshapi, alaji , vinata'' and ''vidradhi'' occur due to dominance of [[pitta]] in a person having less quantity of [[meda dhatu]] and are curable [106]

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

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</div></div>

−

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]

+

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]

−

+

=== 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]

−

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

+

=== 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]

+

Decrease, normalcy and increase are the three states of [[dosha]]. Other three courses of [[dosha]] 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 [[dhatu]] except [[rasa dhatu]]) and vital-organs, bones and joints. Thus are described various states of [[dosha]] [112-113]

</div>

−

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

+

=== Seasonal course of [[dosha]] ===

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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]

+

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 [[dosha]].[114]

</div>

−

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

+

=== Physiological and pathological course of [[dosha]] ===

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−

Another set of courses of ''dosha'' are physiological and pathological. Normally, heat generated by ''pitta'' digests the food but when the same ''pitta'' is in a provoked state, it causes various disorders. Similarly, normal ''kapha'' contributes to body-strength but when vitiated, it becomes waste material (''mala''). Normal ''kapha'' is also responsible for ''ojas'', however on provocation, it could cause various ailments in the body.

+

Another set of courses of [[dosha]] are physiological and pathological. Normally, heat generated by [[pitta]] digests the food but when the same [[pitta]] is in a provoked state, it causes various disorders. Similarly, normal [[kapha]] contributes to body-strength but when vitiated, it becomes waste material ([[mala]]). Normal [[kapha]] is also responsible for [[ojas]], however on provocation, it could cause various ailments in the body.

</div>

−

~~''Vāta''~~ is responsible for all types of movements in living beings and represents life of living-beings, but vitiated ''vata'' causes many diseases and is even responsible for causing death [115-118]

+

[[Vata]] is responsible for all types of movements in living beings and represents life of living-beings, but vitiated [[vata]] causes many diseases and is even responsible for causing death [115-118]

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Here are two recapitulate verses:

−

The diagnosis of diseases of the head, diseases of the heart, diseases caused by minute pathological conditions of the ~~''doshas''~~, conditions caused by decreased ~~''doshas''~~, inflammatory swellings and various courses of ~~''doshas''~~ have been described in this chapter entitled 'how many are the diseases of the head', by the well-wisher of mankind, the great sage Atreya, for the enlightenment of the physicians [120-121]

+

The diagnosis of diseases of the head, diseases of the heart, diseases caused by minute pathological conditions of the [[dosha]], conditions caused by decreased [[dosha]], inflammatory swellings and various courses of [[dosha]] have been described in this chapter entitled 'how many are the diseases of the head', by the well-wisher of mankind, the great sage Atreya, for the enlightenment of the physicians [120-121]

</div>

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*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.

*All the control centers of sense and locomotion, along with that of ''prana'' (vital energy), are located in the head.

−

*Clinical pathology involving ''rakta'' (blood), along with analysis of ''dosha'' vitiation, is essential to the diagnosis of diseases of the head.

+

*Clinical pathology involving [[rakta]] (blood), along with analysis of [[dosha]] vitiation, is essential to the diagnosis of diseases of the head.

−

*Diseases of the head and the heart can be identified according to the dominance of a ''dosha'' (or multiple ~~''doshas''~~) and diagnosed as per their etiology and symptomatology.

+

*Diseases of the head and the heart can be identified according to the dominance of a [[dosha]] (or multiple [[dosha]]) and diagnosed as per their etiology and symptomatology.

−

*Various permutation and combinations of increase and decrease of ''dosha'' can occur inside the body affecting the physiological functions.

+

*Various permutation and combinations of increase and decrease of [[dosha]] can occur inside the body affecting the physiological functions.

−

*''Tridoshika'' disequilibrium is a precursor to diseases and their pathogenesis varies with level of ''vriddhi'' (increase) or ''kshaya'' (decrease) and a typical permutation or combination of such ~~''doshas''~~ can lead to different manifestations of the disease.

+

*''Tridoshika'' disequilibrium is a precursor to diseases and their pathogenesis varies with level of ''vriddhi'' (increase) or ''kshaya'' (decrease) and a typical permutation or combination of such [[dosha]] can lead to different manifestations of the disease.

−

*Increased and decreased states of ''dosha'' and vitiation of a particular ''dosha'' depends upon the exposure to causative factors in diet and lifestyle.

+

*Increased and decreased states of [[dosha]] and vitiation of a particular [[dosha]] depends upon the exposure to causative factors in diet and lifestyle.

−

*The increased or decreased ''dosha'' state can be identified by clinical appearance of their increased or decreased functions. Thus clinical diagnosis based on observations is more important than pathological or radiological investigations.

+

*The increased or decreased [[dosha]] state can be identified by clinical appearance of their increased or decreased functions. Thus clinical diagnosis based on observations is more important than pathological or radiological investigations.

−

*A normal ''dosha'' can also exhibit some signs. Increased ''vata'' can pull normal ''pitta'' and ''kapha'' away to places other than their normal location to manifest their own features there.

+

*A normal [[dosha]] can also exhibit some signs. Increased [[vata]] can pull normal [[pitta]] and [[kapha]] away to places other than their normal location to manifest their own features there.

−

*''Ojas'' is the first substance formed in a living being and the sustenance of life depends upon the quality and quantity of ''ojas''. Death can occur due to destruction of ''ojas''.

+

*[[Ojas]] is the first substance formed in a living being and the sustenance of life depends upon the quality and quantity of [[ojas]]. Death can occur due to destruction of [[ojas]].

−

*''Kapha, pitta, meda, mamsa, ojas'' and obstructed ''vata'' are important pathogenic factors in ''madhumeha'' (diabetes).

+

*[[Kapha]], [[pitta]], [[meda dhatu]], [[mamsa dhatu]], [[ojas]] and obstructed [[vata]] are important pathogenic factors in ''madhumeha'' (diabetes).

−

*Diseases can occur due to different states or movements of ''dosha'' like increased or decreased state, upward or downward movements, or movement from center of body to periphery or to vital centers. This also depends upon the environmental and seasonal changes.

+

*Diseases can occur due to different states or movements of [[dosha]] like increased or decreased state, upward or downward movements, or movement from center of body to periphery or to vital centers. This also depends upon the environmental and seasonal changes.

−

*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.

+

*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.

== Vidhi Vimarsha (Applied Inferences) ==

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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:

+

While describing "pancha-panchaka" principle of perception by five jnanaindriya, [Cha.Sa.[[Sutra Sthana]] 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:

−

Charak mentions that ''prānavāhi srotāmsi'' of ''indriya'' are situated in the head and are connected with the body as sun is connected with its rays. Therefore, diseases such as ''ardita'' (facial paralysis), ''cheshta nasha'' (paralysis) and disorders of eye movement etc. are due to trauma to the head [Ca ~~Sii~~ 9/4]. In this chapter, the physical location of all the ''indriya'' has been mentioned to be the head, hence on the basis of these observations, it can be concluded that the ''indriya-buddhi'' are also situated in head. ''Indriya buddhi'' is that vital part of a sense that decides the final knowledge of the perceived object. Hence sense centres situated in the cortex region of the brain represent the ''indriya buddhi'' [12]

+

Charak mentions that ''prānavāhi srotāmsi'' of [[indriya]] are situated in the head and are connected with the body as sun is connected with its rays. Therefore, diseases such as ardita(facial paralysis), cheshta nasha(paralysis) and disorders of eye movement etc. are due to trauma to the head [Ca. Sa. [[Siddhi Sthana]] 9/4]. In this chapter, the physical location of all the [[indriya]] has been mentioned to be the head, hence on the basis of these observations, it can be concluded that the [[indriya]]-[[buddhi]] are also situated in head.[[Indriya]] [[buddhi] is that vital part of a sense that decides the final knowledge of the perceived object. Hence sense centres situated in the cortex region of the brain represent the [[indriya]] [[buddhi]][12]

−

'''Classification of ''shiroroga'':''' Generally, ''shiroroga'' implies any type of disease afflicting the head. Therefore, Charak enlisted diseases such as hemicrania (''ardhavabhedaka''), headache (''sarvam va rujyati shirah''), coryza (''pratishyaya''), diseases of mouth, nose, eyes and ears which cause headache (''mukha-nasa-akshi-karna-roga''), giddiness/vertigo (''sirobhramah''), facial paralysis (''ardita''), tremors of the head (''shirasah kampa'') and stiffness of the neck, nape and jaw (''gala-manya-hanu-grahah'') as ''shiroroga''. Hence, in general, shiroroga includes diseases occurring in the skull, its orifices and the structure related to it. As per this classification ''shiroroga'' includes ''vatika, paittika, kaphaja, sannipataja'' and ''krimija shiroroga''.

+

'''Classification of shiroroga:''' Generally, ''shiroroga'' implies any type of disease afflicting the head. Therefore, Charak enlisted diseases such as hemicrania (''ardhavabhedaka''), headache (''sarvam va rujyati shirah''), coryza (''pratishyaya''), diseases of mouth, nose, eyes and ears which cause headache (''mukha-nasa-akshi-karna-roga''), giddiness/vertigo (''sirobhramah''), facial paralysis (''ardita''), tremors of the head (''shirasah kampa'') and stiffness of the neck, nape and jaw (''gala-manya-hanu-grahah'') as ''shiroroga''. Hence, in general, shiroroga includes diseases occurring in the skull, its orifices and the structure related to it. As per this classification ''shiroroga'' includes ''vatika, paittika, kaphaja, sannipataja'' and ''krimija shiroroga''.

−

In addition, in [[Siddhi Sthana]], four more diseases occurring in the head have been described in detail viz. ''shankhaka, ardhavabhedaka,'' ''suryavarta,'' and ''anantavata'' [~~Ca Si~~ 9/71-87]. In these ''shiroroga'', ''nasya''(nasal errhines) has been indicated [~~Ca Si~~ 9/88]. In all nine ''shiroroga'' (five in this chapter, and four in [[Siddhi Sthana]]) that mention headache as a key symptom. Other varieties of ''shiroroga'' mentioned in other texts are ''raktaja'' and ''kshayaja'' [Sushruta Uttara 25/3] and ''shirah-kampa'' [~~As Hr~~.Uttara 23/9].(Verse 6)

+

In addition, in [[Siddhi Sthana]], four more diseases occurring in the head have been described in detail viz. ''shankhaka, ardhavabhedaka,'' ''suryavarta,'' and ''anantavata''. [Cha.Sa.[[Siddhi Sthana]] 9/71-87] In these ''shiroroga'', [[nasya]](nasal errhines) has been indicated. [Cha.Sa.[[Siddhi Sthana]] 9/88] In all nine ''shiroroga'' (five in this chapter, and four in [[Siddhi Sthana]]) that mention headache as a key symptom. Other varieties of ''shiroroga'' mentioned in other texts are ''raktaja'' and ''kshayaja'' <ref>Sushruta. Uttara Tantra, Cha.25 Shirorogavijnaniya Adhyaya verse 3. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref> and ''shirah-kampa''. [A.H.Uttara Sthana 23/9]<ref>Vagbhata. Uttara Sthana, Cha.23 Shororogavijnaniya Adhyaya verse 9. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>(Verse 6)

−

The five types of ''hridroga'' described in this chapter are also caused by vitiated ''dosha'' and ''krimi''. In all these conditions pain in the chest is a common feature, the intensity of which varies according to the involved ''dosha''. For example in ''vata'', pain is accompanied by extra systole/ fibrillation (''vepathu''), sense of emptiness in the heart region (''shunyata''), and hyperkinetic heart and thrill (''dara''). A ''pittaja'' type ''hridroga'' is indicated by a burning sensation in the precordial region with fainting, giddiness and perspiration. In ''kaphaja'' type ''hridroga'', there is heaviness in the precordial area, ''suptam'' (bradycardia or decreased diastolic stretching) and a stony sensation (pericardial calcification as in constrictive pericarditis) in heart region.

+

The five types of ''hridroga'' described in this chapter are also caused by vitiated [[dosha]] and ''krimi''. In all these conditions pain in the chest is a common feature, the intensity of which varies according to the involved [[dosha]]. For example in [[vata]], pain is accompanied by extra systole/ fibrillation (''vepathu''), sense of emptiness in the heart region (''shunyata''), and hyperkinetic heart and thrill (''dara''). A ''pittaja'' type ''hridroga'' is indicated by a burning sensation in the precordial region with fainting, giddiness and perspiration. In ''kaphaja'' type ''hridroga'', there is heaviness in the precordial area, ''suptam'' (bradycardia or decreased diastolic stretching) and a stony sensation (pericardial calcification as in constrictive pericarditis) in heart region.

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'' ===

−

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:

+

Combination of two provoked [[dosha]] leading to a disease is known as ''samsarga'' and when all the three provoked [[dosha]] combine then it is known as ''sannipata''. In the combinations , some [[dosha]] 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:

−

*Sixty-two conditions of increased and decreased ~~''doshas''~~, including:

+

*Sixty-two conditions of increased and decreased [[dosha]], including:

−

**25 conditions of increased ~~''doshas''~~:

+

**25 conditions of increased [[dosha]]:

−

***Three conditions of ''sannipata'' where one ''dosha'' is increased but the other two ~~''doshas''~~ are excessively increased in comparison.

+

***Three conditions of ''sannipata'' where one [[dosha]] is increased but the other two [[dosha]] are excessively increased in comparison.

−

***Three conditions of ''sannipata'' where two ~~''doshas''~~ are increased and one excessively increased

+

***Three conditions of ''sannipata'' where two [[dosha]] are increased and one excessively increased

−

***Six conditions of ''sannipata'' where one ''dosha'' is excessively increased, the second moderately increased and third slightly increased

+

***Six conditions of ''sannipata'' where one [[dosha]] is excessively increased, the second moderately increased and third slightly increased

−

***One condition of ''sannipata'' where all the ~~''doshas''~~ are equally increased

+

***One condition of ''sannipata'' where all the [[dosha]] are equally increased

−

***Six conditions of ''samsarga'' where one ''dosha'' is increased and the others excessively increased

+

***Six conditions of ''samsarga'' where one [[dosha]] is increased and the others excessively increased

−

***Three conditions of ''samsarga'' where both the ~~''doshas''~~ are equally increased

+

***Three conditions of ''samsarga'' where both the [[dosha]] are equally increased

−

***Three conditions of ''sannipata'' where single ''dosha'' is increased and others are normal

+

***Three conditions of ''sannipata'' where single [[dosha]] is increased and others are normal

−

**25 conditions of decreased ''dosha'': Here the ~~''doshas''~~ may be slightly decreased, moderately decreased or significantly decreased. The combinations follow the same pattern as above.

+

**25 conditions of decreased [[dosha]]: Here the [[dosha]] may be slightly decreased, moderately decreased or significantly decreased. The combinations follow the same pattern as above.

−

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

+

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

−

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

+

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

−

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

+

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

</div>

−

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

+

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

{| class="wikitable"

−

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

+

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

|-

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

Line 1,930: Line 1,946:

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

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

−

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

+

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

|-

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

Line 1,942: Line 1,958:

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

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

−

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

+

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

|-

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

Line 1,972: Line 1,988:

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

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

−

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

+

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

|-

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

Line 1,982: Line 1,998:

|}

−

'''''Ojas''''':

+

'''[[Ojas]]''':

−

Ojas is well known and defined in [[Ayurveda]] in terms of its functions, its importance, its types and its sites of functions within the body. It has been described in this text as a clear and slightly red-yellowish fluid situated in the heart is known as ''ojas'', the destruction of which leads to death. Its colour resembles to that of ''ghee'', taste is like honey and its smell is like that of roasted paddy (Verses 73-75). But its interpretation in modern physiological terms is confusing. In this chapter a hint has been given in this regard that ''ojas'' is a first thing created in the body of all living creatures. The symptoms of diminished ''ojas'' include timidity, debility, constant worry, discomfort of the senses, loss of lustre, neurasthenia, dryness and emaciation.

+

[[Ojas]] is well known and defined in [[Ayurveda]] in terms of its functions, its importance, its types and its sites of functions within the body. It has been described in this text as a clear and slightly red-yellowish fluid situated in the heart is known as [[ojas]], the destruction of which leads to death. Its colour resembles to that of ghee, taste is like honey and its smell is like that of roasted paddy (Verses 73-75). But its interpretation in modern physiological terms is confusing. In this chapter a hint has been given in this regard that [[ojas]] is a first thing created in the body of all living creatures. The symptoms of diminished [[ojas]] include timidity, debility, constant worry, discomfort of the senses, loss of lustre, neurasthenia, dryness and emaciation.

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

−

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

+

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

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

{| class="wikitable"

−

! Causative Factors !! Causative factors of ''Dhatu kshayaja ~~Vataja~~ Madhumeha(Nidana Sthana)'' !! Causative factors of ''Aavaranjanya vataja Madhumeha ( Sutra Sthana)''

+

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

|-

−

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

+

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

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

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

|-

−

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

+

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

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

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

|-

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

−

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

+

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

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

|-

Line 2,008: Line 2,024:

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

|-

−

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

+

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

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

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

Line 2,017: Line 2,033:

|-

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

−

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

+

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

−

| rowspan="1" style="text-align: left;" | Increase of ''kapha, pitta, ~~medas~~, mamsa'' and ''aavirita Vata''

+

| rowspan="1" style="text-align: left;" | Increase of [[kapha]], [[pitta]], [[meda dhatu]], [[mamsa dhatu]] and aavirita [[Vata]]

|-

|}

−

It is obvious from the above table that in case of ''avarita'', ''madhumeha'' initially causes an increase in ''kapha, pitta, meda'' and ~~''māmsa''~~ leading to an obstruction of functional pathways of ''vata,'' furthering its provocation, thereby increasing the severity of ''madhumeha''. In such a condition, the treatment is ''apatarpana'' and not of ''vata'' i.e. ''santarpana'' (Verses 78-81).

+

It is obvious from the above table that in case of ''avarita'', ''madhumeha'' initially causes an increase in [[kapha]], [[pitta]], [[meda dhatu]] and [[mamsa dhatu]] leading to an obstruction of functional pathways of [[vata]], furthering its provocation, thereby increasing the severity of ''madhumeha''. In such a condition, the treatment is ''apatarpana'' and not of [[vata]] i.e. ''santarpana'' (Verses 78-81).

−

''Prameha pidika'' mentioned in this chapter usually occurs as a complication of ''avaranjanaya samprapti'' of ''madhumeha'' as ~~''medas~~ dushti'' occurs in this type of ''madhumeha'', the factor, a must for pathogenesis of ''prameha pidika''. This resembles with presentation of metabolic syndrome which includes dys-lipidemia (Verse 82-111).

+

''Prameha pidika'' mentioned in this chapter usually occurs as a complication of ''avaranjanaya samprapti'' of ''madhumeha'' as [[meda dhatu]] dushti occurs in this type of ''madhumeha'', the factor, a must for pathogenesis of ''prameha pidika''. This resembles with presentation of metabolic syndrome which includes dys-lipidemia (Verse 82-111).

−

~~Charak~~ has mentioned seven varieties of ''prameha pidika'' whereas Sushruta and Vagbhata have added three more to this list that includes ''masoorika, putrini'' and ''vidarika''.

+

Charaka has mentioned seven varieties of ''prameha pidika'' whereas Sushruta and Vagbhata have added three more to this list that includes ''masoorika, putrini'' and ''vidarika''.

−

The ''shiroroga'' described in this chapter are various clinical presentations of headache depending upon ''dosha'' dominance and ''krimi'' infestation. ''Krimi'' in [[Ayurveda]] is a generic term for a large number of pathological organisms ranging from microorganisms found in blood (''raktaja krimi'') to intestinal worms as well as external parasites such as lice [Cha. Vi. 7/11-13]

+

The ''shiroroga'' described in this chapter are various clinical presentations of headache depending upon [[dosha]] dominance and ''krimi'' infestation. ''Krimi'' in [[Ayurveda]] is a generic term for a large number of pathological organisms ranging from microorganisms found in blood (''raktaja krimi'') to intestinal worms as well as external parasites such as lice. [Cha.Sa.[[Vimana Sthana]] 7/11-13]

−

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

+

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

−

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

+

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

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

Line 2,038: Line 2,054:

The forms or manifestations of headache (and referred headache) associated with a ''shiroroga'' may include migraine, stress induced headache, cluster headache, chronic paroxysmal hemicraina, and miscellaneous forms not associated with structural lesions or headache associated with vascular disorders.

−

Similarly the five presentations of heart diseases have also been mentioned in this chapter that resemble different manifestations of chest pain and could be in the form of angina, pain associated with myocardial infarction and dissecting aortic aneurysm, pericarditis, oesophageal spasm, or musculo-skeletal chest pain. The clinical picture of cardiac disorders is quite similar to the features of ''hridroga'' mentioned in [[Charak Samhita]], such as choking or constriction, squeezing, crushing, burning or aching chest pain, or a feeling of sharp, tearing or stabbing chest pain that is usually felt retrosternally and may radiate to the left arm or more rarely to the right arm and then to the throat, jaws and teeth, or through the back. In addition to the individual features of five types of ''hridaroga'', in [[Chikitsa Sthana]], the general sign and symptoms of ''hridroga'' such as discolouration, syncope, fever, cough, hiccups, dyspnoea, vomiting, water brash, chest discomfort, indigestion or distaste of mouth are also mentioned ~~(Ca Ch~~ 26/78). These are mentioned as common symptoms of heart disease in medicine books.

+

Similarly the five presentations of heart diseases have also been mentioned in this chapter that resemble different manifestations of chest pain and could be in the form of angina, pain associated with myocardial infarction and dissecting aortic aneurysm, pericarditis, oesophageal spasm, or musculo-skeletal chest pain. The clinical picture of cardiac disorders is quite similar to the features of ''hridroga'' mentioned in [[Charak Samhita]], such as choking or constriction, squeezing, crushing, burning or aching chest pain, or a feeling of sharp, tearing or stabbing chest pain that is usually felt retrosternally and may radiate to the left arm or more rarely to the right arm and then to the throat, jaws and teeth, or through the back. In addition to the individual features of five types of ''hridaroga'', in [[Chikitsa Sthana]], the general sign and symptoms of ''hridroga'' such as discolouration, syncope, fever, cough, hiccups, dyspnoea, vomiting, water brash, chest discomfort, indigestion or distaste of mouth are also mentioned. [Cha.Sa.[[Chikitsa Sthana]] 26/78] These are mentioned as common symptoms of heart disease in medicine books.

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

−

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.

+

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

</div>

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

Line 2,138: Line 2,154:

|-

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

−

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

+

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

|-

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

Line 2,165: Line 2,181:

|-

|} (Verse 101)

−

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

+

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

[[File:Dōṣāṇāṁ.png]]

Line 2,171: Line 2,187:

* [[Trimarmiya Chikitsa]]

* [[Trimarmiya Siddhi]]

+

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+

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