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=== Abstract ===

=== Abstract ===

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This is the first chapter of ''Roga Chatushka'' (tetrad of diseases) dealing with description related to diseases of the ''trimarma'' (three vital organs – the head, heart, and the urinary bladder (''basti'')). The etiopathogenesis of these diseases is detailed. Various diseases are caused due to permutations and combinations of ''dosha'' imbalances. The chapter describes signs of depletion of ''dhatu'' and ''mala''. It also highlights the disorders of ''oja'' as well as ''madhumeha'' (diabetes mellitus, a disease of the basti), and carbuncles produced as its complications. This chapter also describes various types of ''dosha gati'' (movements of ''dosha''). The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter.  

This is the first chapter of [[Sutra Sthana#Roga Chatushka (four chapters on disease classification)|''Roga Chatushka''(tetrad on disease information)]] dealing with description related to diseases of the ''trimarma'' (three vital organs – the head, heart, and the urinary bladder (''basti'')). The etiopathogenesis of these diseases is detailed. Various diseases are caused due to permutations and combinations of ''dosha'' imbalances. The chapter describes signs of depletion of ''dhatu'' and ''mala''. It also highlights the disorders of ''oja'' as well as ''madhumeha'' (diabetes mellitus), and carbuncles produced as its complications. This chapter also describes various types of ''dosha gati'' (movements of ''dosha''). The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter.  

'''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''.

'''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''.

=== Introduction ===

=== Introduction ===

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After describing the guidelines for clinical Ayurveda practice in tetrad of previous chapters of ''Nirdesha Chatushka'', information about priniciples of basic Ayurvedic pathology in causing disease is detailed in ''Roga Chatushka'' (tetrad on disease information).   

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)]].   

   

   

The present chapter begins with an enumeration of diseases afflicting the head and describes the significance of head, followed by the description of five varieties of head diseases 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 provided in brief with a specific variety of ''Avrita Madhumeha'' (diabetes due to obstructive ''vata'') in which ''ojas'' is excreted out 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.

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.

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).

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).

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.

'''''Āvarita madhumeha (type 1 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. 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. 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: