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{{#seo:
{{#seo:
|title=Kiyanta Shiraseeya Adhyaya
|title=Kiyanta Shiraseeya Adhyaya
|titlemode=append
|titlemode=append
|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.
|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
|description=Sutra Sthana Chapter 17. Diseases of three vital organs including Head and other conditions
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|type=article
|type=article
}}
}}
<big>'''Sutra Sthana Chapter 17. Diseases of three vital organs including Head and other conditions'''</big>
<big>'''Sutra Sthana Chapter 17. Diseases of three vital organs including Head and other conditions'''</big>
{{Infobox
{{Infobox
|title = Kiyanta Shiraseeya Adhyaya
|title = Kiyanta Shiraseeya Adhyaya
|data1 = [[Sutra Sthana]] Chapter 17
|data1 = [[Sutra Sthana]] Chapter 17
|label2 = Tetrad/Sub-section
|label2 = Tetrad/Sub-section
|data2 = ''Roga Chatushka''
|data2 = Roga Chatushka
|label3 = Preceding Chapter
|label3 = Preceding Chapter
|data3 = [[Chikitsaprabhritiya Adhyaya]]
|data3 = [[Chikitsaprabhritiya Adhyaya]]
|data7 = Pol A.
|data7 = Pol A.
|label8 = Editors
|label8 = Editors
|data8 = Kar A., Rai S., Deole Y.S., Basisht G.
|data8 = Kar A., Rai S., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
|label9 = Year of publication
|label9 = Year of publication
|data9 = 2020
|data9 = 2020
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s01.019 10.47468/CSNE.2020.e01.s01.019]
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s01.019 10.47468/CSNE.2020.e01.s01.019]
}}
}}
<big>'''Abstract'''</big>
<big>'''Abstract'''</big>
<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>
<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 [[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. </div>
'''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]].
'''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]].
</p>
== Introduction ==
== Introduction ==
</div>
</div>
=== Symptoms of ''krimaja shiroroga'' ===
=== Symptoms of ''krimija shiroroga'' ===
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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 [[vata]] dominant dseases of heart. 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 [[vata]]-dominant disease of heart ===
=== Symptoms of [[vata]]-dominant disease of heart ===
<div style="text-align:justify;">
<div style="text-align:justify;">
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]
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</div>
=== Symptoms of ''krimija hridroga'' ===
=== Symptoms of ''krimija hridroga'' ===
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<div class="mw-collapsible mw-collapsed">
=== Indriya buddhi (centres of senses in the brain) ===
=== Indriya buddhi (centres of senses in the brain) ===
<div style="text-align:justify;">
<div style="text-align:justify;">
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:
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''. [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)
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).
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).
=== ''Samsarga'' and ''Sannipata'' ===
=== ''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>
</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"
{| class="wikitable"
! Sr.No. !! ''Vata'' !! ''Pitta'' !! ''Kapha '' !! Signs
! Sr.No. !! [[Vata]] !! [[Pitta]] !! [[Kapha]] !! Signs
|-
|-
| rowspan="1" style="text-align: left;" | 1
| rowspan="1" style="text-align: left;" | 1
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Normal
| 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
| rowspan="1" style="text-align: left;" | 5
| rowspan="1" style="text-align: left;" | Normal
| rowspan="1" style="text-align: left;" | Normal
| rowspan="1" style="text-align: left;" | Increased
| 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
| rowspan="1" style="text-align: left;" | 7
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Decreased
| 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
| rowspan="1" style="text-align: left;" | 12
|}
|}
'''''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)''''':
'''''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.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 ''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'':'''
'''Table 2: Difference between two contexts of ''Madhumeha'':'''
{| class="wikitable"
{| 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: 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;" | 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;" | ''ruksha, laghu, shita, ''
| rowspan="1" style="text-align: left;" | ''guru, snigdha, navam-anna-pana''
| 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;" | Food habit
| rowspan="1" style="text-align: left;" | ''langhana''
| rowspan="1" style="text-align: left;" | [[langhana]]
| rowspan="1" style="text-align: left;" | ''samashana''
| rowspan="1" style="text-align: left;" | ''samashana''
|-
|-
| rowspan="1" style="text-align: left;" | Excessive sleep, or sedentary life style with no physical activities
| 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;" | Excessive ''shodhana''
| rowspan="1" style="text-align: left;" | ''ashodhana''
| rowspan="1" style="text-align: left;" | ''ashodhana''
|-
|-
| rowspan="1" style="text-align: left;" | Increase of
| 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]]
|-
|-
|}
|}
<div style="text-align:justify;">
<div style="text-align:justify;">
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).
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.Sa.[[Vimana Sthana]] 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.Sa.[[Siddhi Sthana]] 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.
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.
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.
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>
</div>
====Table 3: Types of Pidika in different classics:====
====Table 3: Types of Pidika in different classics:====
|-
|-
| rowspan="1" style="text-align: left;" | ''Pradhanamarma (hr̥daya)''
| 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''
| rowspan="1" style="text-align: left;" | ''Kloma''
|-
|-
|} (Verse 101)
|} (Verse 101)
'''Chart 1 : Different states of dosha'''
'''Chart 1 : Different states of [[dosha]]'''
[[File:Dōṣāṇāṁ.png]]
[[File:Dōṣāṇāṁ.png]]
* [[Trimarmiya Chikitsa]]
* [[Trimarmiya Chikitsa]]
* [[Trimarmiya Siddhi]]
* [[Trimarmiya Siddhi]]
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==References==
==References==