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== Vidhi Vimarsha (Applied Inferences) ==
 
== Vidhi Vimarsha (Applied Inferences) ==
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*'''Sudden change in following factors indicate near death signs:'''
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=== Sudden change in following factors indicate near death signs ===
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Complexion, voice, smell, taste, touch, eyes, ears, nose, tongue, skin, psyche, desire, cleanliness, conduct, behavior, memory, shape, nature, strength, malaise, intellect, exhilaration, dryness, unctuousness, drowsiness, heaviness, lightness, qualities, diet, regimens, digestion of food, manifestation of disease, disappearance of disease, characters of disease, premonitory signs of the disease, symptoms, complications, administration of proper medicine, and effect of medicine on disease, luster, shadow, dream, state of informer about the patient. Bad omens perceived by the physician on his way to patient’s house, changed conditions of the patient’s residence, signs and symptoms indicating the residual span of life may be evident in these factors. Hence physician should pay careful attention to each one of them and interpretation should be made based on his observations, knowledge and scriptural advice.
 
Complexion, voice, smell, taste, touch, eyes, ears, nose, tongue, skin, psyche, desire, cleanliness, conduct, behavior, memory, shape, nature, strength, malaise, intellect, exhilaration, dryness, unctuousness, drowsiness, heaviness, lightness, qualities, diet, regimens, digestion of food, manifestation of disease, disappearance of disease, characters of disease, premonitory signs of the disease, symptoms, complications, administration of proper medicine, and effect of medicine on disease, luster, shadow, dream, state of informer about the patient. Bad omens perceived by the physician on his way to patient’s house, changed conditions of the patient’s residence, signs and symptoms indicating the residual span of life may be evident in these factors. Hence physician should pay careful attention to each one of them and interpretation should be made based on his observations, knowledge and scriptural advice.
*The examination of complexion does not just mean the color only. It also includes objects of visual perception like coarseness, glossiness etc. Abnormal ''swara'' (voice) include fluctuations in the normal quality of sounds produced (hoarseness of voice, dysphonia), absence of the normal physiological sounds like absence of peristalsis in peritonitis, presence of abnormal sounds like crepitus in joints & crepitations, rhonchi etc. in lungs. Abnormalities in touch include tactile perception of abnormal hardness, softness, warmth etc.
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*The morbid conditions are of three types. Such as those indicated by bodily marks, those caused by etiological factors and those resemble etiological factors.
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The examination of complexion does not just mean the color only. It also includes objects of visual perception like coarseness, glossiness etc. Abnormal ''swara'' (voice) include fluctuations in the normal quality of sounds produced (hoarseness of voice, dysphonia), absence of the normal physiological sounds like absence of peristalsis in peritonitis, presence of abnormal sounds like crepitus in joints & crepitation, rhonchi etc. in lungs. Abnormalities in touch include tactile perception of abnormal hardness, softness, warmth etc.
*''Lakshana nimitta'' include visible end stage manifestations.
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*The abnormal color produced can be considered as ''ojokshaya lakshana'' (depletion of quality of tissue). In ''Raktarshas'' (bleeding piles), when there is excessive bleeding, it may lead to poor complexion, strength, enthusiasm and depleted ''Ojas''. If proper measure is not taken the condition may become fatal. The unnatural color of skin can be compared with the cyanotic conditions, discoloration seen in the fatal hepatic and renal pathologies etc. Appearance of white spots, white nails and loss of pigmentation can be seen in chronic liver failure.
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=== Three types of morbid conditions ===
*In chronic kidney disease, the conjunctival deposition of calcium leads to redness and gritty feeling in the eye called uremic red eye. Also deposition of calcium as a band in the lamina proprea of cornea leads to band keratopathy.
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*In chronic hepatic failure, erythematous patches may appear over many parts of the body, especially over the chest wall and supraclavicular regions.
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The morbid conditions are of three types. Such as those indicated by bodily marks, those caused by etiological factors and those resemble etiological factors.
*Appearance of abnormal complexion in the entire or half of the body of the individual without any significant reason can be due to abnormal peripheral circulation. Oxygenation can affect the complexion. In deep vein thrombosis (DVT) alteration in pigmentation is well appreciated.
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*When both the lips become bluish like ripe fruits of ''jambu'', this is a clear indication of death. As per modern science this condition is similar to central cyanosis. It is directly due to ''Vata Pratilomata'' (reverse direction of ''Vata'') in different organs. The main ''Srotas'' involved are ''Rasavaha srotas'' and ''Raktavaha Srotas.''
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=== Visible end stage manifestations ===
*Abnormal voices:
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**In ''sannipatha jwara''  - ''swarasada'' (low pitched voice) is a ''lakshana''.
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''Lakshana nimitta'' include visible end stage manifestations. The abnormal color produced can be considered as ''ojokshaya lakshana'' (depletion of quality of tissue). In ''Raktarshas'' (bleeding piles), when there is excessive bleeding, it may lead to poor complexion, strength, enthusiasm and depleted [[ojas]]. If proper measure is not taken the condition may become fatal. The unnatural color of skin can be compared with the cyanotic conditions, discoloration seen in the fatal hepatic and renal pathologies etc. Appearance of white spots, white nails and loss of pigmentation can be seen in chronic liver failure.
**In ''kshathaja kasa''  - ''paravatha ivaakoojan'' (cooing sound like that of a pigeon comes out of  the throat)
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**In  ''Apatantraka –kapota iva koojan'' ( make sound like a pigeon).
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In chronic kidney disease, the conjunctival deposition of calcium leads to redness and gritty feeling in the eye called uremic red eye. Also deposition of calcium as a band in the lamina proprea of cornea leads to band keratopathy.
**In Tetanus  -sudden death occurs due to laryngeal spasm .
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**Dysphonia—Disturbance of phonation is due to disturbance in vocal cords. Strained, harsh, low pitched voice, nasal voice.
+
In chronic hepatic failure, erythematous patches may appear over many parts of the body, especially over the chest wall and supraclavicular regions.
**In laryngeal tumors like supra glottic cancer  and glottis cancer hoarseness of voice is a late symptom.
+
 
 +
Appearance of abnormal complexion in the entire or half of the body of the individual without any significant reason can be due to abnormal peripheral circulation. Oxygenation can affect the complexion. In deep vein thrombosis (DVT) alteration in pigmentation is well appreciated.
 +
 
 +
When both the lips become bluish like ripe fruits of ''jambu'', this is a clear indication of death. As per modern science this condition is similar to central cyanosis. It is directly due to ''Vata Pratilomata'' (reverse direction of ''Vata'') in different organs. The main [[srotas]] involved are ''Rasavaha srotas'' and ''Raktavaha Srotas.''
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=== Abnormal voices ===
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*In ''sannipatha jwara''  - ''swarasada'' (low pitched voice) is a ''lakshana''.
 +
*In ''kshathaja kasa''  - ''paravatha ivaakoojan'' (cooing sound like that of a pigeon comes out of  the throat)
 +
*In  ''Apatantraka –kapota iva koojan'' ( make sound like a pigeon).
 +
*In Tetanus  -sudden death occurs due to laryngeal spasm .
 +
*Dysphonia—Disturbance of phonation is due to disturbance in vocal cords. Strained, harsh, low pitched voice, nasal voice.
 +
*In laryngeal tumors like supra glottic cancer  and glottis cancer hoarseness of voice is a late symptom.
 +
 
 
In fact the abnormal changes in color and voice of the patient reflect serious changes in the physiology. Deep seated pathologies of cardio vascular system, Respiratory system, endocrine system often presents with color changes. Similarly lesions in the central nervous system can lead to changes in the voice. Dysarthria, Dysphasia and Dysphonia which may become fatal. In short this chapter highlights the events related with major systems in the body which can cause death.
 
In fact the abnormal changes in color and voice of the patient reflect serious changes in the physiology. Deep seated pathologies of cardio vascular system, Respiratory system, endocrine system often presents with color changes. Similarly lesions in the central nervous system can lead to changes in the voice. Dysarthria, Dysphasia and Dysphonia which may become fatal. In short this chapter highlights the events related with major systems in the body which can cause death.
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=== Assessment of various prognostic factors ===
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Various assessment scales and tools can be applied for objective assessment of the factors described in the chapter. The following tables depicts probable tools and scales of assessment.<ref>Mamidi P., Gupta K. Varna Swareeyam of Charaka Indriya Sthana - An Explorative Study, Int. J. Ayu. Alt. Med., 2019; 7(5): 152-175</ref>
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==References==
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