Changes

{{#seo:

{{#seo:

|title=Yasyashyavanimittiyam Indriyam Adhyaya

|title=Yasyashyavanimittiyam Indriyam Adhyaya

|keywords=Arishta, Vikara, Bala, Marana, Jivita, change in eye color, grave diseases, death, Ayurveda, Indian system of medicine, charak samhita.  

|keywords=Arishta, Vikara, Bala, Marana, Jivita, change in eye color, grave diseases, death, Ayurveda, Indian system of medicine, charak samhita.  

|description=Indriya Sthana Chapter 9. Signs and Symptoms useful for Palliative Care among Patients approaching Death

|description=Indriya Sthana Chapter 9. Signs and Symptoms useful for Palliative Care among Patients approaching Death

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

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

|image_alt=charak samhita

|image_alt=charak samhita

|type=article

|type=article

}}

}}

<big>'''[[Indriya Sthana]] Chapter 9. Signs and Symptoms useful for Palliative Care among Patients approaching Death '''</big>

<big>'''[[Indriya Sthana]] Chapter 9. Signs and Symptoms useful for Palliative Care among Patients approaching Death '''</big>

{{Infobox

{{Infobox

|data7  = Babu S.P.

|data7  = Babu S.P.

|label8 = Editors

|label8 = Editors

|data8  = Khandel S.K., Babu S.P., Deole Y.S., Basisht G.

|data8  = Khandel S.K., Babu S.P., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

|label9 = Year of publication  

|label9 = Year of publication  

|data9 =  2020

|data9 =  2020

}}

}}

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

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

<div style="text-align:justify;">

<p style='text-align:justify;'>This chapter includes various signs and symptoms related to imminent death that start with changes in color of eyes and identified in a patient as well as in healthy individuals. It has been emphasized that physician should have knowledge of all [[Arishta]] [[Lakshana]] (near death signs) described in this chapter. Clinically only few of them manifest at a stage in an individual and hence the person must be examined properly. Certain features related with imminent death are described which when associated with any disease indicate grave prognosis. Complications which indicate the incurability of a disease are scientific and are seen till date. Description of eight grave diseases and symptoms of approaching death are other two important topics which add value to this chapter. These signs are important in palliative care. Therefore, knowledge of such predictive signs and symptoms is an integral part of medical science.  

This chapter includes various signs and symptoms related to imminent death that start with changes in color of eyes and identified in a patient as well as in healthy individuals. It has been emphasized that physician should have knowledge of all [[Arishta]] [[Lakshana]] (near death signs) described in this chapter. Clinically only few of them manifest at a stage in an individual and hence the person must be examined properly. Certain features related with imminent death are described which when associated with any disease indicate grave prognosis. Complications which indicate the incurability of a disease are scientific and are seen till date. Description of eight grave diseases and symptoms of approaching death are other two important topics which add value to this chapter. These signs are important in palliative care. Therefore, knowledge of such predictive signs and symptoms is an integral part of medical science.  

 

'''Keywords:''' [[Arishta]], Vikara, Bala, Marana, Jivita,'' change in eye color, grave diseases, death.

'''Keywords:''' [[Arishta]], Vikara, Bala, Marana, Jivita,'' change in eye color, grave diseases, death.

</div>

</p>

== Introduction ==

== Introduction ==

<div style="text-align:justify;">

<div style="text-align:justify;">

[[Yasyashyavanimittiyam Indriyam Adhyaya]] refers to color changes in eyes. In the first four chapters of [[Indriya Sthana]], conditions related to [[Indriya]] or five sense organs have been described. In those chapters, derangement in functional aspects of [[indriya]] have been given importance and Atreya told to examine them by the help of logical inference ([[anumana pramana]]). In this chapter certain anatomical changes or changes which can be examined by direct observation([[Pratyaksha Pramana]]) are mentioned which are equally important indicators of life span.  

[[Yasyashyavanimittiyam Indriyam Adhyaya]] refers to color changes in eyes. In the first four chapters of [[Indriya Sthana]], conditions related to [[Indriya]] or five sense organs have been described. In those chapters, derangement in functional aspects of [[indriya]] have been given importance and Atreya told to examine them by the help of logical inference ([[anumana pramana]]). In this chapter certain anatomical changes or changes which can be examined by direct observation([[pratyaksha pramana]]) are mentioned which are equally important indicators of life span.  

Nowadays, importance is given to the identification of approaching death. Educational and training programs are organized to educate family members/relatives/attendants so that patient care is not neglected near death and this specialized field is commonly known as Palliative care. The World Health Organization (WHO) defines palliative care as 'an approach that improves the quality of life of individuals and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psycho-social and spiritual'.<ref> Available from: http://www.who.int/hiv/topics/palliative/PalliativeCare/en/ </ref>

Nowadays, importance is given to the identification of approaching death. Educational and training programs are organized to educate family members/relatives/attendants so that patient care is not neglected near death and this specialized field is commonly known as Palliative care. The World Health Organization (WHO) defines palliative care as 'an approach that improves the quality of life of individuals and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psycho-social and spiritual'.<ref> Available from: http://www.who.int/hiv/topics/palliative/PalliativeCare/en/ </ref>

The aging of the population, with the numerous chronic debilitating and malignant conditions associated with growing older, has focused attention on palliative care. The terminal state is an integral process and a time to reconcile differences so that patient and family may accept death with a minimum of physical, spiritual, and psycho-social anguish.<ref> Rousseau P., Hospice and palliative care, Dis Mon. 1995 Dec;41(12):779-842. </ref> Hospice care is a specialized philosophy and system of care for the terminally ill patient that accepts death in an affirmative way and provides palliative care and emotional support to dying patients and their families.<ref> Plumb JD, Ogle KS., Hospice care, Prim Care. 1992 Dec;19(4):807-20. </ref> Hospice and palliative care philosophy lays emphasis on relieving suffering and improving quality of life at the end of life in order to permit experiences that will have positive meaning. The role of the physician is central in providing this care.<ref> Sethi S. Hospice: an underutilized resource, J Okla State Med Assoc. 2001 Mar;94(3):79-84. </ref> When recovery is uncertain it is better to discuss this rather than giving false hope to the patient and family. This is generally perceived as a strength in the doctor-patient relationship and helps to build trust.<ref> John Ellershaw, Care of the dying patient: the last hours or days of life, BMJ. 2003 January 4; 326(7379): 30–34. </ref> Charak also supports this view and states that those near death should not be treated. Thus it becomes important that physician should be well trained in identifying features of impending death.

The aging of the population, with the numerous chronic debilitating and malignant conditions associated with growing older, has focused attention on palliative care. The terminal state is an integral process and a time to reconcile differences so that patient and family may accept death with a minimum of physical, spiritual, and psycho-social anguish.<ref> Rousseau P., Hospice and palliative care, Dis Mon. 1995 Dec;41(12):779-842. </ref> Hospice care is a specialized philosophy and system of care for the terminally ill patient that accepts death in an affirmative way and provides palliative care and emotional support to dying patients and their families.<ref> Plumb JD, Ogle KS., Hospice care, Prim Care. 1992 Dec;19(4):807-20. </ref> Hospice and palliative care philosophy lays emphasis on relieving suffering and improving quality of life at the end of life in order to permit experiences that will have positive meaning. The role of the physician is central in providing this care.<ref> Sethi S. Hospice: an underutilized resource, J Okla State Med Assoc. 2001 Mar;94(3):79-84. </ref> When recovery is uncertain it is better to discuss this rather than giving false hope to the patient and family. This is generally perceived as a strength in the doctor-patient relationship and helps to build trust.<ref> John Ellershaw, Care of the dying patient: the last hours or days of life, BMJ. 2003 January 4; 326(7379): 30–34. </ref> Charak also supports this view and states that those near death should not be treated. Thus it becomes important that physician should be well trained in identifying features of impending death.

In order to care for dying patients it is essential to “identify dying”. This aim can be attained by applying the knowledge given in this chapter. Presently to predict prognostic value few tools have been designed. Most widely-used prognostic tools is the Palliative Performance Scale (PPS) which has been studied primarily in inpatient settings and in patients with cancer. Few researches are on going to develop tools for prognosis in other diseases also.<ref> Harrold J, Rickerson E, Carroll JT, McGrath J, Morales K, Kapo J, Casarett D., Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population?, J Palliat Med. 2005 Jun;8(3):503-9. </ref> Research can be done to develop a scale based on parameters described in Ayurvedic [[Arishta]] [[Vigyana]] and this chapter can also contribute a lot in making such kind of tool.

In order to care for dying patients it is essential to “identify dying”. This aim can be attained by applying the knowledge given in this chapter. Presently to predict prognostic value few tools have been designed. Most widely-used prognostic tools is the Palliative Performance Scale (PPS) which has been studied primarily in inpatient settings and in patients with cancer. Few researches are on going to develop tools for prognosis in other diseases also.<ref> Harrold J, Rickerson E, Carroll JT, McGrath J, Morales K, Kapo J, Casarett D., Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population?, J Palliat Med. 2005 Jun;8(3):503-9. </ref> Research can be done to develop a scale based on parameters described in Ayurvedic [[Arishta]] [[Vigyana]] and this chapter can also contribute a lot in making such kind of tool.

</div>

</div>

== Sanskrit text, Transliteration and English Translation ==

== Sanskrit text, Transliteration and English Translation ==

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

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

The patient who is unconscious, having dry mouth and is suffering from various diseases should be considered as having short life span and such patient should be discarded by the wise physician.

The patient who is unconscious, having dry mouth and is suffering from various diseases should be considered as having short life span and such patient should be discarded by the wise physician.

The man whose veins are green and whose hair follicles are closed and who craves for sour things succumb to death due to ''pitta'' disorders. [3-5]

The man whose veins are green and whose hair follicles are closed and who craves for sour things succumb to death due to [[pitta]] disorders. [3-5]

</div>

</div>

=== Poor prognosis in [[Rajayakshma]] and [[Shosha]] ===

=== Poor prognosis in [[Rajayakshma]] and [[Shosha]] ===

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

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

   

   

<div style="text-align:justify;">

<div style="text-align:justify;">

When diseases like [[Vatavyadhi]] (diseases due to [[vata]]), [[Apasmara]] (Epilepsy), [[Kushtha]] (Skin diseases), [[Shopha]] (Swellings), [[Udara]] (abdominal diseases including ascitis), [[Gulma]] (lumps and tumors), [[Madhumeha]] (urinary disorders including Diabetes) and [[Rajayakshama]] (Tuberculosis) are associated with loss of strength and muscle wasting then such patient should be discarded by the physician as patient will not recover and will succumb to death.

When diseases like [[Vatavyadhi]] (diseases due to [[vata]]), [[Apasmara]] (Epilepsy), [[Kushtha]] (Skin diseases), [[Shopha]] (Swellings), [[Udara]] (abdominal diseases including ascitis), [[Gulma]] (lumps and tumors), [[Madhumeha]] (urinary disorders including Diabetes) and [[Rajayakshma]] (Tuberculosis) are associated with loss of strength and muscle wasting then such patient should be discarded by the physician as patient will not recover and will succumb to death.

Patients suffering from other diseases too having above features should be avoided by the physician. [8-9]

Patients suffering from other diseases too having above features should be avoided by the physician. [8-9]

</div>

</div>

=== Poor prognosis after [[Virechana]] ( therapeutic purgation) ===

 

=== Poor prognosis after [[Virechana]] (therapeutic purgation) ===

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

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

</div>

</div>

=== Various assessment parameters for lifespan and death ===

=== Poor prognosis based on sputum, stool and semen test ===

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

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

निष्ठ्यूतं च पुरीषं च रेतश्चाम्भसि मज्जति| <br />

निष्ठ्यूतं च पुरीषं च रेतश्चाम्भसि मज्जति| <br />

यस्य तस्यायुषः प्राप्तमन्तमाहुर्मनीषिणः||१८|| <br />

यस्य तस्यायुषः प्राप्तमन्तमाहुर्मनीषिणः||१८|| <br />

निष्ठ्यूते यस्य दृश्यन्ते वर्णा बहुविधाः पृथक्| <br />

निष्ठ्यूते यस्य दृश्यन्ते वर्णा बहुविधाः पृथक्| <br />

तच्च सीदत्यपः प्राप्य न स जीवितुमर्हति  ||१९|| <br />

तच्च सीदत्यपः प्राप्य न स जीवितुमर्हति  ||१९|| <br />

पित्तमूष्मानुगं यस्य शङ्खौ प्राप्य विमूर्च्छति  | <br />

niṣṭhyūtē yasya dr̥śyantē varṇā bahuvidhāḥ pr̥thak| <br />

स रोगः शङ्खको नाम्ना त्रिरात्राद्धन्ति जीवितम्||२०|| <br />

tacca sīdatyapaḥ prāpya na sa jīvitumarhati  ||19|| <br />

सफेनं रुधिरं यस्य मुहुरास्यात् प्रसिच्यते| <br />

niShThyUte yasya dRushyante varNA bahuvidhAH pRuthak| <br />

शूलैश्च तुद्यते कुक्षिः प्रत्याख्येयस्तथाविधः||२१|| <br />

tacca sIdatyapaH prApya na sa jIvitumarhati  ||19|| <br />

</div></div>

yasya tasyāyuṣaḥ prāptamantamāhurmanīṣiṇaḥ||18|| <br />

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

niṣṭhyūtē yasya dr̥śyantē varṇā bahuvidhāḥ pr̥thak| <br />

पित्तमूष्मानुगं यस्य शङ्खौ प्राप्य विमूर्च्छति  | <br />

tacca sīdatyapaḥ prāpya na sa jīvitumarhati  ||19|| <br />

स रोगः शङ्खको नाम्ना त्रिरात्राद्धन्ति जीवितम्||२०|| <br />

<div class="mw-collapsible-content">

pittamūṣmānugaṁ yasya śaṅkhau prāpya vimūrcchati  | <br />

pittamūṣmānugaṁ yasya śaṅkhau prāpya vimūrcchati  | <br />

sa rōgaḥ śaṅkhakō nāmnā trirātrāddhanti jīvitam||20|| <br />

sa rōgaḥ śaṅkhakō nāmnā trirātrāddhanti jīvitam||20|| <br />

saphēnaṁ rudhiraṁ yasya muhurāsyāt prasicyatē| <br />

pittamUShmAnugaM yasya sha~gkhau prApya vimUrcchati  | <br />

śūlaiśca tudyatē kukṣiḥ pratyākhyēyastathāvidhaḥ||21|| <br />

sa rogaH sha~gkhako nAmnA trirAtrAddhanti jIvitam||20|| <br />

</div></div>

yasya tasyAyuShaH prAptamantamAhurmanIShiNaH||18|| <br />

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

niShThyUte yasya dRushyante varNA bahuvidhAH pRuthak| <br />

सफेनं रुधिरं यस्य मुहुरास्यात् प्रसिच्यते| <br />

tacca sIdatyapaH prApya na sa jIvitumarhati  ||19|| <br />

शूलैश्च तुद्यते कुक्षिः प्रत्याख्येयस्तथाविधः||२१|| <br />

<div class="mw-collapsible-content">

pittamUShmAnugaM yasya sha~gkhau prApya vimUrcchati  | <br />

saphēnaṁ rudhiraṁ yasya muhurāsyāt prasicyatē| <br />

sa rogaH sha~gkhako nAmnA trirAtrAddhanti jIvitam||20|| <br />

śūlaiśca tudyatē kukṣiḥ pratyākhyēyastathāvidhaḥ||21|| <br />

saphenaM rudhiraM yasya muhurAsyAt prasicyate| <br />

saphenaM rudhiraM yasya muhurAsyAt prasicyate| <br />

shUlaishca tudyate kukShiH pratyAkhyeyastathAvidhaH||21||<br />

shUlaishca tudyate kukShiH pratyAkhyeyastathAvidhaH||21||<br />

</div></div>

</div></div>

<div style="text-align:justify;">

 

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

The patient, who suffers from rapid loss of strength and muscle wasting, aggravation of disease symptoms and anorexia, does not survive more than three fortnights. [18-22]

 

The patient, who suffers from rapid loss of strength and muscle wasting, aggravation of disease symptoms and anorexia, does not survive more than three fortnights. [22]

</div>

</div>

=== Summary ===

=== Summary ===

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

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

If patient suffers from an incurable disease and shows [[arishta]] signs, physician should inform the relatives about the exact condition of the patient and suggest care to keep the patient comfortable. If the legal guardian of the patient requests the physician for treatment then only he should treat the patient. [Verse 14-17]

If patient suffers from an incurable disease and shows [[arishta]] signs, physician should inform the relatives about the exact condition of the patient and suggest care to keep the patient comfortable. If the legal guardian of the patient requests the physician for treatment then only he should treat the patient. [Verse 14-17]

</div>

</div>

== References ==

== References ==