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YASYA SHYAVA NIMITTEEYAM OF CHARAKA INDRIYA STHANA - AN EXPLORATIVE STUDY

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  • R. B. Ayurvedic Medical College & Hospital
  • R. B. AYURVEDIC MEDICAL COLLEGE & HOSPITAL
Article

YASYA SHYAVA NIMITTEEYAM OF CHARAKA INDRIYA STHANA - AN EXPLORATIVE STUDY

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Bi-Monthly Peer Reviewed Indexed International Journal
Vol - 7 / Issue - 6 / Nov - Dec - 2019
SPECIAL THEME ON CHARAKA SAMHITA - INDRIYA STHANA
(Part - 2)
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INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE
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Mamidi P. et.al., Yasya Shyava Nimitteeyam of Charaka Indriya Sthana - An Explorative Study, Int. J. Ayu. Alt. Med., 2019; 7(6): 252-263
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REVIEW ARTICLE
DOI: https://doi.org/10.36672/ijaam.2019.v07i06.003
Prasad Mamidi1*, Kshama Gupta2
1. Professor, Dept of Kayachikitsa, SKS Ayurvedic Medical College & Hospital, Mathura, Uttar Pradesh,
India, Contact No. +91 7567222856, E-mail- drprasadmamidi@gmail.com
2. Professor, Dept of Kayachikitsa, SKS Ayurvedic Medical College & Hospital, Mathura, Uttar Pradesh,
India, Contact No. +91 7567222309, E-mail: drkshamagupta@gmail.com
Article Received on
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04th May 2020
Article Revised on
-
29th May 2020
Article Accepted on
-
30th May 2020
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VOL 7
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INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE
eISSN-2348-0173
pISSN-2395-3985
Mamidi P. et.al., Yasya Shyava Nimitteeyam of Charaka Indriya Sthana - An Explorative Study, Int. J. Ayu. Alt. Med., 2019; 7(6): 252-263
Page253
REVIEW ARTICLE
Abstract:
Charaka Samhita’ is the most revered and followed classical text of Ayurveda (an ancient Indian traditional system of medicine
has been in practice since ages) considered as the treasure trove of the basic principles of Ayurveda and a rich literary source for
academic, clinical and research activities. To estimate the prognosis of diseases Ayurveda has described ‘Arishta lakshanas’ (fatal
signs and symptoms which denotes imminent death). Indriya sthana’ (one among the 8 sections of Charaka samhtia) deals with
prognostication of life expectancy or estimating survival time frames and alerts the physician towards early identification of fatal
conditions based onArishta lakshanas’. Indriya sthana consists 12 chapters and ‘Yasya shyava nimitteeyam indriyam’ is the 9th
chapter of Indriya sthana. The present study is aimed to explore the various concepts mentioned in this chapter and also their
prognostic significance in present era. Clinical examination of the sputum, faeces and semen are the unique features of this chapter.
Assessing prognosis by giving meat soup (trial and error method), and arishta lakshna’s related to various diseases like Vatavyadhi
(neurological conditions), Apasmara (Epilepsy), Kushtha (skin diseases), Rajayakshma (tuberculosis / chronic debilitating
respiratory tract disorders), Gulma (neoplastic conditions / acute abdomen), Shopha (oedema), Udara (ascites) and Madhumeha
(diabetes) etc are mentioned in this chapter. Most of the conditions mentioned in this chapter are related to ‘Cancer induced
cachexia’ (CIC), ‘Shock’, ‘Delirium’, ‘Advanced stages of dementia’ and other ‘Chronic, debilitating conditions’ commonly seen at
the end stages of life. Further research works are required to substantiate the clinical findings quoted in this chapter.
Key Words: Cancer induced cachexia, Dementia, Delirium, Epilepsy, Neurological conditions, Shock
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*Corresponding Author
Prasad Mamidi,
Professor, Dept of Kayachikitsa,
SKS Ayurvedic Medical College & Hospital, Mathura, Uttar Pradesh, India,
Contact No. +91 7567222856,
E-mail- drprasadmamidi@gmail.com
DOI: https://doi.org/10.36672/ijaam.2019.v07i06.003
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INTRODUCTION:
Charaka Samhita’ is the most revered and followed
classical text of Ayurveda (an ancient Indian traditional
system of medicine has been in practice since ages)
considered as the treasure trove of the basic principles
of Ayurveda and a rich literary source for academic,
clinical and research activities. Charaka Samhitais
divided into eight sections (sthana) which are again
divided into specific number of Adhyaya’ (chapters).[1]
‘Indriya sthana’ of Charaka samhita’ deals with the
prognostic aspects and it consists 12 chapters. Yasya
shyava nimitteeyam indriyam is the name of the 9th
chapter of ‘Indriya sthana’ of ‘Charaka samhita’. The
present chapter deals with various ‘Arishta lakshanas
(fatal signs and symptoms commonly seen in dying
patients and they denote imminent death) which leads
to death. Clinical examination of the sputum, faeces
and semen are the unique features of this chapter.
Assessing prognosis by giving meat soup (trial and
error method), and arishta lakshna’s related to various
diseases like Vatavyadhi (neurological diseases),
Apasmara (Epilepsy), Kushtha (skin diseases),
Rajayakshma (tuberculosis / chronic debilitating
respiratory tract disorders), Gulma (neoplastic
conditions / acute abdomen), Shopha (oedema), Udara
(ascites) and Madhumeha (diabetes) etc are mentioned
in this chapter. Most of the conditions mentioned in this
chapter are related to CIC (cancer induced cachexia),
shock, delirium, advanced stages of dementia and other
chronic debilitating conditions commonly seen at the
end stages of life. The present study is aimed to explore
the various concepts mentioned in this chapter and also
their prognostic significance in present era. [2]
MAIN CONTENTS (Table 1&2):
ySy Zyave pirXvSte hirte caip dzRne, AapÚe VyaixrNtay }eyStSy iv}anta.
Yasya shyaave --- vignaanataa [Verse 3] [2]
Alkaptonuria is an autosomal recessively inherited
metabolic disorder (AapÚe Vyaix) due to a deficiency in the
enzyme homogentisic acid oxidase which results in the
accumulation of homogentisic acid. Patient’s wtih
Alkaptonuria may present with arthritis (AapÚe Vyaix) and
a brownish black discoloration (Zyave) in both eyes.
Brownish black pigmented lesions can be seen in both
nasal and temporal aspects of the sclera in inter
palpebral region of both eyes. The scleral discoloration
is referred to as Osler's sign, which usually starts
around the third decade. [3] ‘Nevus of Ota’ is a dermal
melanocytosis (light brown or deep slate gray or deep
blue to brown pigmentation of eyes or skin) (Zyave) may
have delayed-onset and acquired. Nevus of Ota often
occurs in association (AapÚe Vyaix) with nevus of Ito and
other cutaneous disorders and ocular diseases. Benign
cutaneous and leptomeningeal conditions associated
with nevus of Ota are phakomatosis pigmento-
vasculari, nevus flammeus, Sturge-Weber syndrome,
Takayasu disease, Klippel-Trenaunay syndrome, and
YASYA SHYAVA NIMITTEEYAM OF CHARAKA INDRIYA STHANA - AN EXPLORATIVE STUDY
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neurofibromatosis. The ocular complications
associated with nevus of Ota are increased intraocular
pressure and glaucoma. [4] Jaundice, also known as
hyperbilirubinemia, is a yellow discoloration of the
body tissue resulting from the accumulation of an
excess of bilirubin. Sclerae have a high affinity for
bilirubin due to their high elastin content. With further
increase in serum bilirubin levels, the skin will
progressively discolour ranging from lemon yellow to
apple green (hirte), especially if the process is long-
standing and the green colour (hirte) is due to biliverdin.
[5] Various inflammations, infections, neoplasms
(benign and carcinomatous) (intra orbital tumours),
trauma, refractive errors, endocrinal pathologies
(Grave’s ophtahlmopathy), autoimmune diseases and
neurological conditions (AapÚe Vyaix) may distort (pirXvSte)
the shape, size and alignment of eye balls in orbits.
in>s<}> pirzu:kaSy> sm&Xdae Vyaixi-í y>, %péXdayu;< }aTva t< xIr>
pirvjRyet!.
Nissangna --- parivarjayet [Verse 4] [2]
Delirium, stupor, and coma represent a broad spectrum
of acute brain dysfunction and are associated with an
impairment of consciousness (in>s<}>). ‘Stupor’ is a
condition of deep sleep or similar behavioural
unresponsiveness from which the patient can be
aroused only with vigorous and continuous stimulation
whereas ‘Coma’ is a state of unresponsiveness (in>s<}>)
in which the patient cannot be aroused with any stimuli.
Patients with severe dementia, poor functional status
and having multiple comorbidities are highly
vulnerable (sm&Xdae Vyaixi-í y>). Various precipitating
factors (sm&Xdae Vyaixi-í y>) for Acute brain dysfunction are
electrolyte abnormalities (hyponatremia,
hypernatremia, hypercalcemia, and hypocalcemia),
organ failure, Wernicke’s encephalopathy, thyroid
dysfunction, central nervous system insults
(cerebrovascular accidents, intracerebral hemorrhage,
epidural and subdural hematomas and subarachnoid
hemorrhage), ethanol and benzodiazepine
withdrawal, dehydration (pirzu:kaSy>) and cardiovascular
illnesses (congestive heart failure and acute myocardial
infarction). [6]
hirtaí isra ySy laemkUpaí s<v&ta>, sae=Mlai-la;I pué;> ipTtaNmr[mîute.
Haritashcha --- maranamashnute [Verse 5] [2]
Distended and engorged, green coloured veins (hirtaí
isra ySy) can be seen all over the enlarged abdomen
(caput medusae) as a consequence of portal
hypertension due to liver cirrhosis. [7] The systemic and
splanchnic vasodilation seen in cirrhotic patients leads
to reduced systemic vascular resistance, decreased
effective blood volume (central hypovolemia), and
hence decreased arterial blood pressure. In order to
maintain blood pressure during systemic vasodilation,
activation of effective sodium retention and
vasoconstricting systems (laemkUpaí s<v&ta>) (which may
also leads to reduced sweating) [RAAS (renin
angiotensinaldosterone system) and SNS
(sympathetic nervous system)] are initiated in portal
hypertension. [8] Liver is said to be the seat of Pitta’.
All the functions of Pitta’, especially Ranjaka Pitta’
are attributed to liver. Liver and spleen are considered
as, the root of Raktavahasrotas’. Liver is very much
important in all diseases concerned with Raktavaha
and Pittavaha Srotas’. [9] The above verse denotes
‘Cirrhosis of liver’ (Yakruddalyudara), [10] with poor
prognosis (ipTtaNmr[mîute).
zrIraNtaí zae-Nte zrIr< caepzu:yit, bl< c ÿIyte ySy rajyúma ihniSt
tm!.
Shareeraanta --- hinasti tam [Verse 6] [2]
Secondary palmar hyperhidrosis (zrIraNtaí zae-Nte ?) can be
seen in Tuberculosis. [11] The skin of the extremity can
be cool, smooth, and shiny (zrIraNtaí zae-Nte) with hair
loss, and nails can be thickened in severe PAD
(peripheral artery disease). [12] Patients with TB have a
significantly higher risk of developing PAD than
patients without TB. [13] The traditional symptoms and
signs of pulmonary tuberculosis are cough, sputum,
haemoptysis, breathlessness, weight loss (bl< c ÿIyte),
anorexia, fever, malaise, wasting (zrIr< caepzu:yit), and
terminal cachexia (zrIr< caepzu:yit). [14] The word zrIraNtaí
zae-Nte’ denotes shiny or glossy extremities due to an
underlying PAD in the patients of Tuberculosis.
A<sai-tapae ihKka c DdRn< zaei[tSy c, Aanah> paZvRzUl< c -vTyNtay
zaei;[>.
Amsaabhitaapo --- shoshina [Verse 7] [2]
The traditional symptoms and signs of pulmonary
tuberculosis are cough, sputum, haemoptysis (DdRn<
zaei[tSy c), breathlessness, weight loss, anorexia, fever,
malaise, wasting, and terminal cachexia. [14] Persistent
hiccup (ihKka) can be seen in cavitating pulmonary
tuberculosis patients. [15] Lower lung field tuberculosis
affects the right lung more often and it is associating
with pleuritic chest pain (paZvRzUlm!), haemoptysis (DdRn<
zaei[tSy c), early cavitation and hilar lymphadeonpathy.
[16] "Rheumatism of the shoulder" (A<sai-tapae) has been
found associated with pulmonary tuberculosis of the
corresponding lung in many cases. [17] Cavitation or
abscesses at the lower lobes of the lungs (atypical
presentation of pulmonary tuberculosis) may irritate
the diaphragm which can cause referral pain or burning
sensation at shoulder region along with hiccoughs in
the patients of pulmonary tuberculosis. The above
verse may also indicate various other conditions like
pleuritis, subphrenic abscesses, abdominal or extra
pulmonary tuberculosis, secondary infection or
opportunistic infections of lungs in an immune-
compromised patient, perforation of peptic ulcer,
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carcinomas of chest or abdomen and acute myocardial
infarction in tuberculosis patients.
vatVyaixrpSmarI kuóI zae)I twaedrI, guLmI c mxumehI c rajyúmI c yae
nr>.
AicikTSya -vNTyete blma<s]ye sit, ANye:vip ivkare;u tan! i-;k!
pirvjRytet.
Vatavyadhi --- parivarjayet [Verse 8-9] [2]
Sarcopenia and cachexia are muscle wasting
syndromes (blma<s]ye) associated with aging and with
many chronic diseases such as congestive heart failure
(CHF), diabetes, cancer, chronic obstructive
pulmonary disease (COPD) and chronic kidney disease
(CKD). [18] Cachexia is a complicated metabolic
syndrome related to underlying illness and
characterized by muscle mass loss with or without fat
mass loss that is often associated with anorexia,
an inflammatory process, insulin resistance, and
increased protein turnover. Cachexia is seen in various
chronic diseases, chronic infections and inflammatory
diseases including AIDS. Significantly shorter survival
in advanced cancer patients with cachexia (tan! i-;k!
pirvjRytet!) has been identified relative to those without
cachexia. [19] Cachexia is usually reported as a
complication of chronic diseases (AicikTSya -vNTyete),
rheumatoid arthritis, chronic hepatitis & cirrhosis
and diabetes mellitus. A hypothesis has been proposed
that independent of the individual chronic disease
(vatVyaix, ApSmar, kuó, zae), %dr, guLm, mxumeh and rajyúm), the
wasting process follows a common (ANye:vip ivkare;u) final
metabolic pattern. This metabolic pattern usually
relates to an advanced stage of the underlying disease
and can best be summarized as an increased catabolic
turnover and anabolic blunting. [20] Various descriptive
terms used such as “cachexia”, “anorexia”,
“sarcopenia”, “malnutrition” and even
“hypercatabolism” as synonyms by researchers and
clinicians. [21] The above verse indicates the condition
of Cachexia due to various underlying diseases.
ivrecnÿutanahae ySt&:[anugtae nr>, ivirKt> punraXmait ywa àetStwEv s>.
Virechana --- preta stathaiva sa [Verse 10] [2]
Gastrointestinal obstructions can occur anywhere
along the gastrointestinal tract, from the esophagus to
the rectum, but are most common in the small bowel.
Bowel obstructions are more frequent in patients with
colon cancer, gynecological cancers, melanoma, lung,
breast, gastric, biliary, and pancreatic cancers. Bowel
obstructions in cancer patients are due to benign causes
also such as adhesions, fibrosis, volvulus, and
intussusception. Malignant causes are secondary to
intra luminal, intramural, or extrinsic tumours causing
mechanical occlusion of the bowel lumen. The
pathophysiology of obstructions involves a vicious
cycle of distension (ivirKt> punraXmait) due to gas and non-
absorbed secretions, followed by more fluid secretion,
causing more distension in the bowel. In large-bowel
obstruction, symptoms appear later with considerable
distension and occasional paradoxical diarrhoea
(ivrecnÿutanahae) owing to bacterial overgrowth. There can
also be functional obstructions causing the peristalsis
of the bowel to malfunction. Diabetic neuropathy,
constipation and medications might also contribute to
bowel obstruction by slowing down intestinal transit or
further blocking a stenosed area. [22] In patients with
advanced cancers, MBO (Malignant bowel
obstruction) is also associated with dehydration
(t&:[anugtae nr>), renal dysfunction and ascites. [23]
Abdominal bloating and distension can also occur in
various “functional” conditions like irritable bowel
syndrome (IBS), functional dyspepsia and
premenstrual syndrome (PMS) etc; but the above verse
denotes MBOs only based on mortality (ywa àetStwEv s>).
pey< patu< n zKnaeit k{QSy c muoSy c, %rsí ivzu:kTva*ae nrae n s
jIvit.
Peyam --- na sa jeevati [Verse 11] [2]
Dysphagia is a disruption in the swallowing process
during the preparatory transport of bolus from the oral
cavity through the pharynx and the oesophagus to the
stomach. Dysphagia can cause significant morbidity
and mortality (nrae n s jIvit). The consequences of
dysphagia include dehydration (ivzu:kTvat!),
malnourishment, starvation, aspiration pneumonia and
airway obstruction. Patients with dysphagia of liquids
(pey< patu< n zKnaeit) often have neuromuscular disorders or
muscular weakness. Dysphagia of both solids and
liquids is typical of oesophageal motility disorders.[24]
Oropharyngeal dysphagia (pey< patu< n zKnaeit) is associated
with numerous pathologies including, cerebrovascular
accident (CVA; stroke), neurodegenerative diseases (e.
g. Alzheimer's disease, Parkinson's disease and
multiple sclerosis), certain advanced cancers,
particularly head and neck, and trauma. A major
complication of dysphagia is aspiration which results
in morbidity (nrae n s jIvit) due to the development of
pneumonia - referred to as aspiration pneumonia.
Patients with dysphagia suffer with dehydration and
excessive thirst (ivzu:kTvat!). [25]
SvrSy dubRlI-av< hain< c blv[Ryae>, raegv&iXdmyuKTya c d&ó!va mr[maidzet!.
Swarasya --- marana maadishet [Verse 12] [2]
The cluster of potential signs and symptoms to be
anticipated in the last days (mr[maidzet!) are pain, dyspnea,
delirium, dysphagia, weakening of voice (SvrSy dubRlI-
avm!), loss of appetite, incontinence (whether due to
decreased ability to move despite support, or loss of
consciousness), dry mouth, weakness, fatigue (hain< c
blm!) and noisy upper airway secretions. [26] Dementia is
a progressive (raegv&iXdm!), incurable illness (mr[maidzet!). In
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patients with advanced dementia, the final year of life
is characterized by a trajectory of persistently severe
disability (hain< c blm!). Stage 7 on the Global
Deterioration Scale (ranging from 1 to 7, with higher
stages indicating worse dementia) provides a useful
description of the features of advanced dementia,
including profound memory deficits (e.g., inability to
recognize family members), minimal verbal abilities
(SvrSy dubRlI-avm!), inability to ambulate independently,
inability to perform any activities of daily living, and
urinary and fecal incontinence. Limited speech (fewer
than 6 intelligible words) is one of the characteristic
features in advanced dementia patients. [27] Delirium is
prevalent at the end of life (mr[maidzet!), particularly
during the final 2448 hours. Delirium at this stage is
not usually reversible (due to multiorgan failure).
Delirium is one of the most common neuropsychiatric
problems in patients with advanced cancer (raegv&iXdm!). [28]
In the last days of life (mr[maidzet!), cancer patients often
experience progressive functional decline and
worsening symptom burden (raegv&iXdm!). Many symptoms
such as anorexia-cachexia, dysphagia and delirium
could impair oral intake. These, coupled with
refractory cachexia, contribute to persistent weight loss
and decreased quality of life (hain< c blv[Ryae>). [29] The
above verse indicates advanced stages of cancers,
dementia, delirium, Motor neuron disease (MND),
Amyotrophic lateral sclerosis (ALS), Lower motor
neuron syndrome (LMNs) and various other
neuromuscular, neurodegenerative and chronic
debilitating disorders.
^XvRñas< gtae:ma[a< zUlaephtv<][m!, zmR canixgCDNt< buiXdman! pirvjRyet!.
Urdhwa shwasam --- parivarjayet [Verse 13] [2]
The signs and symptoms of sepsis are highly variable.
Shortness of breath or tachypnea or hyperventilation
(^XvRñasm!), cold and clammy skin (gtae:ma[am!),
hypothermia (body temperature < 35° C), abdominal
pain or distension or rigidity (surgical abdomen or
gastrointestinal hemorrhage) (zUlaephtv<][m!), agitation or
irritability (zmR canixgCDNtm!) and DIC (disseminated
intravascular coagulation) etc can be seen in sepsis or
SIRS (systemic inflammatory response syndrome). [30]
DIC is an acquired clinic-biological syndrome
characterized by widespread activation of coagulation
leading to fibrin deposition in the vasculature, organ
dysfunction, consumption of clotting factors and
platelets, and life-threatening haemorrhage. DIC is
provoked by several underlying disorders (sepsis,
cancer, trauma, and pregnancy complicated with
eclampsia or other calamities). [31] Haemorrhage is the
commonest presentation of DIC (causing hypothermia
or gtae:ma[am!). Acute renal failure occurs due to
microvascular thrombosis in the kidney and reduced
renal blood flow (zUlaephtv<][m! ?) due to hypotension.
Acute tubular necrosis is common. Disseminated
microvascular thrombosis in the brain leads to
generalised cortical and brain stem dysfunction (brain
hypoxia may cause restlessness or agitation or zmR
canixgCDNtm!) and causes impaired consciousness and
coma. Thrombosis and haemorrhage in the lungs cause
hypoxia and progressive respiratory failure identical to
that seen in patients with the adult respiratory distress
syndrome (^XvRñasm!). [32] The above verse indicates acute
abdomen or sepsis or DIC or intra-abdominal or intra
pelvic haemorrhage due to various underlying
conditions.
ApSvr< -a;ma[< àaPt< mr[maTmn>, ïaetar< capzBdSy dUrt> pirvjRyet!.
Apaswaram --- parivarjayet [Verse 14] [2]
Language difficulties, frank confabulation, misnaming,
word intrusion, repeating previously uttered word and
inability to find a word or pronounce etc are commonly
seen in the patients of Delirium. Disorganized thinking,
manifested by incoherent speech and rambling or
irrelevant conversation, or unclear or illogical flow of
ideas etc (ApSvr< -a;ma[m!) can also be seen in Delirium
patients. [33] Patients with delirium may hear things
which no one else can hear (auditory hallucinations)
(ïaetar< capzBdSy). [34] Auditory hallucinations (ïaetar<
capzBdSy) can also be seen in Alzheimer’s dementia
(AD). [35] Dementia is a set of symptoms that include
memory difficulties, learning difficulties, speech and
language difficulties, disorientation in time and space,
difficulties in understanding and behavioural
changes. People with dementia, among other signs,
show problems of finding words (anomia), lack of
understanding of the sentence and incoherent speech
(ApSvr< -a;ma[m!). [36] The above verse denotes advanced
stages of dementia or delirium or organic psychosis.
y< nr< shsa raegae dubRl< pirmuÂit, s<zyàaPtmaÇeyae jIivt< tSy mNyte.
Yam naram --- tasya manyate [Verse 15] [2]
The common demyelinating diseases are multiple
sclerosis (MS), acute disseminated encephalomyelitis
(ADEM), progressive multifocal leucoencephalopathy
(PML) and extrapontine myelinolysis (EPM).
Demyelinating diseases of the CNS can be classified
into several categories: demyelination due to
inflammatory processes (MS, ADEM and Acute
haemorrhagic leucoencephalitis - AHL), viral
demyelination (PML, HIV infection, Subacute
sclerosing panencephalitis), demyelination caused by
acquired metabolic derangements (central pontine
myelinolysis - CPM, EPM, chronic alcoholism and
MarchiafavaBignami disease), hypoxicischaemic
forms of demyelination and demyelination caused by
focal compression. MS pursues a relapsing and
remitting course from the outset or can become
progressive after initial remissions (pirmuÂit). The interval
between relapses is variable (s<zyàaPtm!). The latent phase
between the first manifestation of MS and the first
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relapse can be many years (pirmuÂit). Approximately 80%
of patients with ADEM make a full recovery. Although
ADEM is classically a monophasic disease, relapses
have been reported (s<zyàaPtm!) in 510% of cases
(multiphasic disseminated encephalomyelitis). The
principal viral demyelinating disease in humans is
PML caused by the papovavirus, JC (John
Cunningham) virus. Reactivation (s<zyàaPtm!) of JC virus
infection occurs under conditions of impaired cell
mediated immunity (dubRlm!) (after organ transplantation,
in leukaemia, lymphoma and in AIDS). [37]
Relapsing polychondritis (RP) is an immune-mediated
systemic disease characterized by auricular chondritis
and polyarthritis, though many organs can be involved.
Its onset is often insidious, with acute painful
inflammatory crisis followed by spontaneous
remission (shsa raegae pirmuÂit) of variable duration
(s<zyàaPtm!). With therapeutic delay RP can leads to an
increased risk of permanent or life-threatening
sequelae (s<zyàaPt< jIivt< tSy). [38] Systemic autoimmune
diseases result from interactions between genes and
environmental triggers that build up overtime until
clinical symptoms appear. A complex interplay
between innate and adaptive immunity lies at the core
of most of these diseases. These diseases can be
heterogeneous regarding the type of organs involved,
clinical course and response to treatment. As many of
these autoimmune diseases (ADs) follow a remitting
(pirmuÂit) and relapsing course. [39] Various ADs are
reported in the literature like Addison's disease,
autoimmune hemolytic anemia, autoimmune vasculitis
(Goodpasture's syndrome), bullous autoimmune
disease (pemphigus), chronic active hepatitis (CAH),
glomerulonephritis, Graves’ disease, idiopathic
thrombocytopenic purpura, multiple sclerosis,
myasthenia gravis, myocarditis, pernicious anemia,
polymyositisdermatomyositis, primary biliary
cirrhosis, relapsing polychondritis, rheumatic fever
heart disease, rheumatoid arthritis, Sjogren's disease,
systemic lupus erythematosus, systemic sclerosis,
thyroiditis, type 1 (insulin-dependent) diabetes
mellitus (DM), uveitis, vitiligo, ankylosing spondylitis,
celiac disease, Guillain-Barré disease (GBS),
idiopathic fibrosing alveolitis (IFA), inflammatory
bowel disease (IBD) (ulcerative colitis and Crohn's
disease), juvenile idiopathic arthritis, polyendocrine
syndrome and psoriasis. [40]
Vitamin B12 deficiency presents with progressive
myelopathy which may sometimes appear to remit
(pirmuÂit) and relapse. Relapses can also be seen in
Transverse myelitis. [41] Persons with HIV associated
secondary psychosis are reported to have a more
variable course, and are more likely to have eventual
remission (pirmuÂit) of their psychosis. Abrupt onset and
relapsing-remitting pattern (pirmuÂit) of symptoms are
found in Pediatric autoimmune neuropsychiatric
disorders associated with streptococcal infections
(PANDAS). [42] Patients with refractory / relapsing
anti-neutrophil cytoplasm antibody-associated
vasculitis (AASV) have shown relapsing-remitting
(pirmuÂit) pattern associated with complications like
death, infection, malignancy and thyroid disorder
(s<zyàaPt< jIivt< tSy). [43] The above verse indicates various
conditions like, demyelinating disease, autoimmune
disease, infectious diseases of CNS (viral),
opportunistic infections in immunocompromised
individuals, malaria, relapsing fevers, leishmaniasis,
tuberculosis and neurocysticercosis etc.
Aw ceJ}atyStSy yacern! ài[patt>, rsena*aidit äUyaÚaSmE d*aiÖzaexnm!.
masen ceÚ d&Zyte ivze;StSy zae-n>, rsEíaNyEbRhuivxEduRlR-< tSy jIivtm!.
Atha chet --- tasya jeevitam [Verse 16-17] [2]
The above verse denotes a cachexia (cancer induced?)
like condition which can’t be reversed with protein
and/or caloric intake and associated with poor
prognosis. Cancer-induced cachexia (CIC) is
commonly seen in advanced stage cancer, particularly
those with gastrointestinal, pancreatic, thoracic and
head and neck cancers. CIC has also been implicated in
up to 20% of cancer-related deaths. Cachexia results
due to an altered metabolic state as the result of
tumour-derived factors, loss of anabolic stimuli, and
due to an increase in catabolic processes. Unlike
starvation, where metabolism slows down to conserve
body mass, CIC cannot be reversed by feeding alone
(ceÚ d&Zyte ivze;StSy zae-n>). There is no accepted therapy
for CIC which has been leading to a feeling of
helplessness by both the patient and treating oncologist
as weight continues to drop. Therapeutic options for
CIC are limited. It is important to understand that
significant increases in caloric intake (rsena*aidit äUyaÚaSmE),
and use of enteral nutrition and parenteral nutrition, are
not always beneficial in CIC patients (rsEíaNyEbRhuivxEduRlR-<
tSy jIivtm!). Often caretakers and patients believe that
increased caloric intake (rsEíaNyEbRhuivxE>) will help the
patient to “fight the cancer”. In reality, the scientific
data behind nutrition support in cancer care remains
conflicting. Short supplementation periods (masen) have
failed to show efficacy in patients who are in advanced
stages of cancer when it is unlikely that any type of
intervention would be of benefit (rsEíaNyEbRhuivxEduRlR-< tSy
jIivtm!). [44]
inó(Ut< c purI;< c retíaM-is mJjit, ySy tSyayu;> àaPtmNtmahumRnIi;[>.
Nishtyutam --- maneeshina [Verse 18] [2]
inó(Ut< AM-is mJjit (Nishtyutam ambhasi majjati):
Chronic airway diseases like cystic fibrosis, chronic
bronchitis, asthma, diffuse panbronchiolitis, and
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bronchiectasis are all associated with chronic
inflammation. The airway mucosa responds to
infection and inflammation in part by surface mucous
(goblet) cell and submucosal gland hyperplasia and
hypertrophy with mucus hypersecretion. Products of
inflammation including neutrophil derived DNA and
filamentous actin, effete cells, bacteria, and cell debris
all contribute to mucus purulence (AM-is mJjit) and,
when this is expectorated it is called sputum
(inó(Utm!). These airway diseases each are associated with
the production of mucus and sputum with characteristic
composition, polymer structure, and biophysical
properties (inó(Ut< c AM-is mJjit). These properties change
with the progress of the disease making it possible to
use sputum analysis to identify the potential cause and
severity of airway diseases (ySy tSyayu;> àaPtmNtmahu). [45]
Carcinomas, tuberculosis, cavitary pulmonary
diseases, lung abscesses and various infectious
diseases can leads to the increased specific gravity of
sputum (due to the presence of pus cells, cell debris,
bacteria and various other abnormal components of
sputum) (inó(Ut< c AM-is mJjit).
purI;< AM-is mJjit (Purisham ambhasi majjati):
Faecal output in healthy individuals was 1.20
defecations per 24 hr period and the main factor
affecting faecal mass was the fiber intake. Faecal wet
mass values were increased (AM-is mJjit) due to high
fiber intakes in comparison to values found in low fiber
intakes. Faeces were composed of 74.6% water.
Bacterial biomass is the major component (2554% of
dry solids) of the organic fraction of the faeces.
Undigested carbohydrate, fiber, protein, and fat
comprise the remainder and the amounts depend on
diet and diarrhoea prevalence in the population. The
inorganic component of the faeces is primarily
undigested dietary elements that also depend on dietary
supply. [46] Stool should also be macroscopically
checked in terms of colour, consistency, quantity,
shape, odour and mucus. The presence of copious
mucus or bloody mucus in stool is abnormal. By using
‘The Modified Bristol visual stool scale’, stool
consistency can be evaluated.[47] Constipation (hard
stool) is a significant problem found in many cancer
patients (ySy tSyayu;> àaPtmNtmahu). [48] Various abnormal
components of stool may increase the specific gravity
or hardness or weight of the stool (AM-is mJjit) in vide
variety of conditions like pancreatic or intestinal
diseases, carcinomas of gastrointestinal tract,
ulcerative colitis and megacolon etc.
rets> AM-is mJjit (Retasa ambhasi majjati):
High white blood cell (WBC) concentrations within
semen are an indicator of infection; this condition,
marked by pus in the semen, is termed pyospermia.[49]
Hematospermia, also known as hemospermia, is a
potentially alarming occurrence. The definition of
hematospermia is presence of blood in the seminal
fluid. Recurring or chronic hematospermia, in
particular, may result from a variety of conditions like
prostatitis, polyps, cysts, stones, telangiectasias,
varices, carcinoma, sarcoma, malacoplakia,
condylomas, hemangiomas, strictures, utricular cysts,
infections, trauma, lymphoma, leukemia, epididymo-
orchitis, testicular tumours and idiopathic.[50] Various
abnormal components of semen like blood and pus
cells etc may increase the specific gravity of semen and
leads to AM-is mJjit’. The above verse indicates various
underlying fatal conditions increasing the specific
gravity of sputum or faeces or semen.
inó(Ute ySy d&ZyNte v[aR bhuivxa p&wk!, sIdTyp> àaPy n s jIivtumhRit.
Nishtyute --- jeevitumarhati [Verse 19] [2]
Yellowish or greenish sputum (inó(Ute ySy d&ZyNte v[aR bhuivxa
p&wk!) may be seen in viral bronchitis. Sputum
production in viral airway infections may be clear,
white, or even tinged with blood. It has been shown that
a yellowish or greenish sputum colour is often related
to the bacterial load of patients suffering from COPD
exacerbation or patients hospitalized due to respiratory
conditions. Bacterial yield from sputum colours green,
yellow-green, yellow, and rust (inó(Ute ySy d&ZyNte v[aR bhuivxa
p&wk!) was higher than the yield from cream, white, or
clear samples. [51] During a lower respiratory tract
infection the sputum is usually discoloured. Typically,
it is a darker green in the early stages and gradually
lightens as the infection improves with time and
treatment. [52] Black-pigmented sputum, also called
“melanoptysis,” is a symptom that may be observed in
certain pathologies such us coal workers’
pneumoconiosis (anthracosis). The cavitation and
liquefaction of a fibrosis mass by an infectious process
(tuberculosis, infections by anaerobes, etc.) or by
ischemic necrosis (n s jIivtumhRit) may cause
expectoration of a blackish secretion. [53] Chronic
expectoration of large amounts of purulent and foul-
smelling sputum is strongly denotes bronchiectasis.
Sudden production sputum in a febrile patient indicates
a lung abscess. Rust-coloured purulent sputum is seen
in pneumococcal pneumonia; currant jelly and sticky
sputum seen in klebsiella pneumonia and blood-tinged
foamy sputum (inó(Ute ySy d&ZyNte v[aR bhuivxa p&wk!) is found in
pulmonary oedema. [54]
ipTtmU:manug< ySy zŒaE àaPy ivmUDRit, s raeg> zŒkae naMna iÇraÇaXdiNt
jIivtm!.
Pittam --- jeevitam [Verse 20] [2]
Inflammatory pseudo tumour (IP) is a clinically
invasive, benign mass lesion of unknown etiology. It
has been recognized by various names like plasma cell
granuloma, inflammatory myofibroblastic tumour,
histiocytoma complex, xanthomatous pseudo tumour,
fibrous xanthoma, and inflammatory
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myofibrohistiocytic proliferation. IP of the temporal
bone (zŒaE àaPy) is uncommon but remains important
given its recurrent and destructive natures. Temporal
pseudo tumour appears to have a more aggressive
(ipTtmU:manugm!) and unpredictable courses than IPs in other
body sites. IPs occurring in the middle ear and mastoid
may erode into the surrounding dura, sigmoid sinus,
tentorium, and even brain parenchyma. Intra temporal
extensions to the otic capsule, facial nerve, petrous
apex, and internal auditory canal are common. [55]
Swelling in the temporal region (zŒaE àaPy) with pain and
shows an increase in size or becomes cosmetically
disfiguring can be seen in a variety of conditions such
as lipoma, schwannoma, dermoid, mesenchymal
angiolipoma, and spindle cell hemangio-endothelioma;
vascular malformations such as cavernous
hemangiomas and arterio-venous malformations
(AVMs); and malignant lesions such as liposarcomas
and angiosarcomas. Occasionally, extracranial
extensions of intracranial meningiomas /
hemangiopericytomas or osteoma of the calvarium can
present in a similar fashion. Enlarged lymph nodes,
myositis ossificans, and temporal arteritis also show
similar features. [56]
Giant cell arteritis (GCA) is the most common systemic
vasculitis (ipTtmU:manugm!) in persons aged 50 and above.
The typical symptoms of new-onset GCA are
bitemporal headaches, jaw claudiacation, scalp
tenderness, visual disturbances, systemic symptoms
such as fever and weight loss, and polymyalgia. GCA,
if untreated, progresses to involve the aorta and its
collateral branches, leading to various complications
(hiNt jIivtm!). Late diagnosis and treatment can have
serious consequences (hiNt jIivtm!), including
irreversible loss of visual function. [57] Patients with
GCA risk a number of disease-related complications
including blindness and aortic aneurysms. GCA
patients have an increased risk of death due (hiNt jIivtm!)
to circulatory diseases and infections, but a decreased
risk of death due to cancer over time. Increased
vascular risk associated with GCA has also been
reported by others and includes cardiovascular disease,
thromboembolic disease, and LV (large vessel)
complications (hiNt jIivtm!). [58]
s)en< éixr< ySy muhuraSyat! àisCyte, zUlEí tu*te kui]> àTyaOyey
Stwaivx>.
Saphenam --- stadha vidhi [Verse 21] [2]
Hemoptysis (s)en< éixrm!) is defined as the expectoration
of blood, alone or mixed with mucus, from the lower
respiratory tract. It occurs in chronic lung disease,
bronchitis, pneumonia, tuberculosis, cystic fibrosis,
pulmonary embolism and bronchial or lung carcinoma.
Hemoptysis is a potentially life-threatening
emergency. True hemoptysis, with the source of
bleeding in the airways or lungs, must be distinguished
from pseudohemoptysis, where the blood originates
from the upper gastrointestinal tract or the upper
respiratory tract (mouth, nose, or throat). Massive
hemoptysis is fatal in 50-100% of cases (àTyaOyey
Stwaivx>). Careful history taking and inspection of the
nasopharynx should determine whether the bleeding is
coming from the respiratory tract (alkaline, bright red,
foamy blood, breathing difficulty, sensation of warmth
in the thorax) or from the gastrointestinal tract
[hematinized blood, acid pH, food particles, abdominal
pain (zUlEí tu*te kui]>) and nausea]. [59] The physician
evaluating hemoptysis must be convinced that the
bleeding is not of gastrointestinal origin. A history of
nausea, vomiting, heartburn, and abdominal pain (zUlEí
tu*te kui]>) may be helpful, but occasionally the
differential diagnosis is difficult and requires either
direct observation of the patient's hemoptysis. The
patient coughs up bright red blood or blood clots (as in
carcinoma of the lung, tuberculosis, pulmonary
embolism); blood-streaked, purulent sputum (as in
bronchitis, bronchiectasis, or pneumonia); blood-
tinged, white, frothy sputum (s)en< éixrm!) (as in
congestive heart failure); and foul-smelling, bloody
sputum (in anaerobic lung abscess). [60] In the above
verse the word s)en< éixrm!’ denotes frothy expectoration
of blood or ‘hemoptysis’ originating from respiratory
tract and in the same verse the word zUlEí tu*te kui]>
denotes abdominal pain along with expectoration of
blood which indicates the source of blood from upper
gastrointestinal tract. The above verse may denote a
condition of hemoptysis with an underlying disease of
respiratory tract and ‘zUlEí tu*te kui]>indicates abdominal
pain due to continuous cough; or it may indicate a
condition of ‘pseudohemoptysis’, where the blood
originates from the upper gastrointestinal tract or the
upper respiratory tract (mouth, nose, or throat)
associated with abdominal pain.
blma<s]yStIìae raegv&iXdrraeck>, ySyaturSy lúyNte ÇIn! p]aÚ s jIvit.
Bala maamsa --- sa jeevati [Verse 22] [2]
Nutritional deficits include weight loss, malnutrition
(blma<s]yStIìae) and anorexia-cachexia are seen in the
patients of lung cancer. Anorexia-Cachexia is a
complex, seen in many solid tumours in late stage
disease. Cachexia related to cancer occurs in most
patients with advanced lung cancer and cancer
anorexia (the loss of appetite) (Araeck>) is a common
symptom of cachexia. Cancer- related anorexia (Araeck>)
and cancer-related cachexia are distinct syndromes but
are often intertwined in progressive disease (raegv&XiXd).
The characteristics of anorexia are common among
many patients with serious illnesses (n s jIvit) such as
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lung cancer, acquired immune deficiency syndrome
(AIDS) and other chronic diseases. [61]
iv}anain mnu:ya[a< mr[e àTyupiSwte, -vNTyetain s<pZyedNyaNyev<ivxain c.
tain svaRi[ lúyNte n tu svaRi[ manvm!, ivziNt ivniz:yNt< tSmaÓaeXyain
svRt>.
Vignaanaani --- sarvata [Verse 23-24] [2]
The above verse denotes the importance of being
vigilant for the physician to detect various arishta
lakshna’s shown by the patient on death bed (mr[e
àTyupiSwte) as explained in this chapter (and those which
are not mentioned in this chapter also). This verse
indicates that arishta lakshana’s are infinite, variable
(qualitatively and quantitatively), and also
individualized or personalized. The arishta lakshana’s
mentioned in this chapter are only for guidance and
physician should improve his/her skills to detect or
identify various other arishta lakshna’s also which are
not mentioned in the text (pZyedNyaNyev<ivxain c) by
observing the patients vigilantly.
CONCLUSION:
Aristhta lakshana’s related to the classical Ayurvedic
diseases like Vatavyadhi’, Apasmara’, ‘Udara’ etc
have been mentioned for the first time in Indriya sthana
in the current chapter. Most of the conditions
mentioned in this chapter are related to CIC (cancer
induced cachexia), shock, delirium, advanced stages of
dementia and other chronic debilitating conditions
commonly seen at the end stages of life. s<zyàaPt< jIivt<
tSyindicates that there may be some conditions which
are having fluctuating or episodic or relapsing-
remitting patterns or latent disease course and cause
great confusion to the physician. This word also
indicates that course of Arishta lakshnas is variable in
nature (they may disappear spontaneously at any time
after their manifestation). Examination of Arishta
lakshanas can be done by using Upashaya and
Anupashaya pariksha (trial and error method) with
Mamsa rasa’ (meat soup) in cachexia patients.
Negative response with ‘Mamsa rasa’ denotes that the
underlying pathology is irreversible and having
progressive nature seen in ‘CIC’. Clinical or
macroscopic examination of sputum, stool and semen
with ‘Float on water test’ is unique contribution of this
chapter in detecting Arishta lakshana’s.
Standardization of Upashaya & Anupashaya
pariksha’ with Mamsa rasa’ and ‘float on water test’
is required. Individual variability of Arishta lakshanas
is also mentioned at the end of the chapter. iÇraÇaXdiNt
jIivtm!and ÇIn! p]aÚ s jIvitetc denotes life expectancy
at the end stages of life based on Arishta lakshanas’.
Now a days to evaluate life expectancy and to predict
prognosis various instruments, scales, calculators,
questionnaires, computer based programmes,
statistical algorithms etc are used such as ‘ePrognosis
calculators’, ‘Questionnaires’, ‘Interactive online
tools’, ‘Risk assessment tools and prognosis scores’,
‘Prognostic scales’, ‘Clinical calculators’, ‘Mortality
indices’, ‘Prognostic scoring algorithms’, ‘Risk score
assessments’, and various other questionnaires or
scales in different diseases or conditions. All these
technological advances and measuring tools should be
implemented and integrated in Ayurvedic research
protocols to standardize ‘Arishta lakshanas’.
Table 1: Vario us Arishta lakshanas (Part-1)
Arishta lakshana
Relevant disease or pathology
ySy Zyave ---- iv}anta
Yasya shyave -- vignaanata (Ch. I. 9 / 3)
Alkaptonuria; Nevus of Ota; Jaundice due to various underlying
pathological conditions;
in>s<}> pirzu:kaSy> ---- xIr> pirvjRyet!
Nissangna -- parivarjayet (Ch. I. 9 / 4)
Acute brain dysfunction; Coma; Delirium; Hypovolemic shock;
hirtaí isra ----- ipTtaNmr[mîute
Haritaashcha -- mashnute (Ch. I. 9 / 5)
Caput medusae in portal hypertension due to cirrhosis of liver;
zrIraNtaí zae-Nte ---- rajyúma ihniSt tm!
Shariranta -- hinasti tam (Ch. I. 9 / 6)
Secondary palmar hyperhidrosis in tuberculosis (TB); Peripheral artery
disease (PAD) in TB; Terminal cachexia;
A<sai-tapae ihKka ----- -vTyNtay zaei;[>
Amsaabhitapo -- soshina (Ch. I. 9 / 7)
Cavitating pulmonary TB; Subphrenic abscess; Opportunistic infections in
immunocompromised patients; Perforation of peptic ulcer; Carcinoma of
chest;
vatVyaixrpSmarI ----- pirvjRytet
Vata vyadhi -- parivarjayet
(Ch. I. 9 / 8 & 9)
Cachexia and sarcopenia in chronic debilitating conditions like CHF
(congestive heart failure), COPD (chronic obstructive pulmonary disease),
CKD (chronic kidney disease) and AIDS (acquired immunodeficiency
syndrome)
ivrecnÿutanaha ----- ywa àetStwEv s>
Virechana -- pretastathaiva sa
(Ch. I. 9 / 10)
MBO (malignant bowel obstruction); Functional abdominal bloating and
distension (FABD); Irritable bowel syndrome (IBS);
pey< patu< n zKnaeit ----- nrae n s jIvit
Peyam paatum -- na sa jeevati
(Ch. I. 9 / 11)
Liquid dysphagia or Orophrayngeal dysphagia in various neuromuscular or
neurodegenerative or neuroinflammatory or infectious conditions; Lower
motor neuron syndromes (LMNs); Amyotrophic lateral sclerosis (ALS);
Motor neuron disease (MND); Progressive bulbar palsy (PBP);
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SvrSy dubRlI-av< ----- d&ó!va mr[maidzet!
Swarasya -- marana maadishet
(Ch. I. 9 / 12)
Advanced stages of dementia; Delirium; Lower motor neuron syndromes
(LMNs); Amyotrophic lateral sclerosis (ALS); Motor neuron disease
(MND); Progressive bulbar palsy (PBP);
^XvRñas< gate:ma[a< ----- buiXdman! pirvjRyet!
Urdhwa shwasam -- parivarjayet
(Ch. I. 9 / 13)
Acute abdomen; Intra-abdominal or intra pelvic hemorrhage; DIC
(disseminated intravascular coagulation) in sepsis or septic shock;
ApSvr< -a;ma[< ---- dUrt> pirvjRyet!
Apaswaram -- parivarjayet
(Ch. I. 9 / 14)
Auditory hallucination in Alzheirmer’s dementia or other types of
dementia; Delirium; Organic psychosis etc.
(Ch. I. xx / yy): Ch - Charaka samhita; I - Indriya sthana; xx - Chapter number; yy - Verse number;
Table 2: Vario us Arishta lakshanas (Part-2)
Arishta lakshana
Relevant disease or pathology
y< nr< ----- tSy mNyte
Yam naram -- tasya manyate
(Ch. I. 9 / 15)
Various demyelinating diseases like ‘Multiple sclerosis’ (MS); Various autoimmune
diseases like ‘Relapsing polychondritis’ (RP); Opportunistic infections in
immunocompromised individuals; Relapsing fevers; Malaria; Leishmaniasis; Viral
infections of CNS (central nervous system); Tuberculosis (TB) etc;
Aw ---- tSy jIivtm!
Atha -- tasya jeevitam
(Ch. I. 9 / 16 & 17)
Cancer induced cachexia (CIC);
inó(Ut< AM-is mJjit
Nishtyutam ambhasi majjati
purI;< AM-is mJjit
Purisham ambhasi majjati
rets> AM-is mJjit
Retasa ambhasi majjati
(Ch. I. 9 / 18)
Chronic airway diseases like chronic bronchitis, cystic fibrosis, Asthma,
Bronchiectasis and diffuse panbronchiolitis; Cavitary pulmonary diseases, lung
abscesses, TB, and lungs or bronchial carcinomas etc.
Chronic constipation; Partial intestinal obstruction; Megacolon; Ulcerative colitis;
Carcinoma’s of gastrointestinal tract etc.
Hematospermia; Pyospermia; Prostatitis; Carcinomas; Hemangiomas; varices;
Epididymo-orchitis; Lymphoma; Testicular tumours; Condyloma; Leukemia;
Sarcoma etc.
inó(Ute ySy d&ZyNte -----
s jIivtumhRit
Nishtyute-- jeevitumarhati
(Ch. I. 9 / 19)
Bacterial infections; COPD (chronic obstructive pulmonary disease); Tuberculosis
(TB); Melanoptysis; Carcinoma of lungs or bronchi; Bronchiectasis; Pulmonary
oedema; Pneumonia; Opportunistic lung infections in immunocompromised
individuals such as patients suffering with AIDS (acquired immunodeficiency
syndrome) etc.
ipTtmU:manug< ----- jIivtm!
Pittam -- jeevitam
(Ch. I. 9 / 20)
Inflammatory pseudo tumour of the temporal bone; Giant cell arteritis (GCA);
Cavernous hemangiomas; Cavernous sinus thrombosis; Arterio-venous
malformations (AVMs); Malignant lesions like angiosarcoma or liposarcoma;
s)enm! ----- Stwaivx>
Saphenam -- stathaa vidha
(Ch. I. 9 / 21)
Hemoptysis seen in lungs or bronchial carcinoma’s, bronchitis, pneumonia,
tuberculosis, congestive heart failure and lung abscesses etc.
Pseudo hemoptysis (bleeding originating from upper gastrointestinal tract or upper
respiratory tract pathologies);
blma<s]y ----- jIvit
Bala maamsa -- jeevati
(Ch. I. 9 / 22)
Anorexia-Cachexia in lung cancers or AIDS or in chronic debilitating conditions; CIC
etc.
iv}anain ----- svRt>
Vignaanaani -- sarvata
(Ch. I. 9 / 23-24)
Aristhta lakshana’s are infinite; variable (qualitatively and quantitatively); and
personalized or individualized;
(Ch. I. xx / yy): Ch - Charaka samhita; I - Indriya sthana; xx - Chapter number; yy - Verse number
REFERENCES:
1. Dadu V. Charaka - The Ayurveda encyclopedia. Eur J Pharm
Med Res. 2016; 3 (7): 175-178. Available from:
https://www.ejpmr.com/admin/assets/downloads/1467275632.
pdf
2. Agnivesha. Charaka samhita revised by Charaka &
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CITE THIS ARTICLE AS
Mamidi P. et.al., Yasya Shyava Nimitteeyam of Charaka Indriya Sthana - An Explorative Study, Int. J. Ayu. Alt. Med., 2019; 7(6):
252-263 (DOI: https://doi.org/10.36672/ijaam.2019.v07i06.003 )
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INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE
... Carcinomas, tuberculosis, lung abscesses, various inflammatory and infectious diseases of the respiratory tract, cystic fibrosis, asthma, COPD, and bronchiectasis (Arishtha) may lead to the increased specific gravity of sputum (due to the presence of pus cells, cell debris, bacteria, and various other abnormal components of sputum) (Kapha Apsu Nimajjati). [8] Retaamsi Apsu Nimajjati (sinking of semen in water) denotes various conditions such as pyospermia (pus and high white blood cell concentrations in the semen due to infections) and hemospermia (blood in the semen). Chronic hematospermia can be seen in prostatitis, polyps, cysts, stones, telangiectasias, varices, carcinoma, condylomas, hemangiomas, sarcoma, strictures, infections, leukemia, epididymo-orchitis, lymphoma, and testicular tumors (Arishtha?). ...
... Various abnormal components of semen (Retas) may increase the specific gravity (leads to Apsu Nimajjati). [8] Various abnormal components of stool (Purisha) increase the specific gravity or hardness or weight of the stool (leads to Apsu Nimajjati) in various conditions such as pancreatic or intestinal diseases, carcinomas of gastrointestinal tract, ulcerative colitis, and megacolon (Arishtha?). [10] Drushti Mandale Bhinna Vikruta Rupaani Aalokyante If any abnormal shapes or images or objects (Bhinna Vikruta Rupaani) are noticed, when looking at a person's eye (Drushti Mandale) indicates an imminent death (Arishtha) to that person. ...
... "Bhela indriya sthana." [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Studies on "Pushpeeyam" chapter of "Bhela indriya sthana" are lacking till date. The aim of the present review is to explore and find out the prognostic importance of 20 verses of "Pushpeeyam" chapter with the help of contemporary medical literature. ...
Article
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Bhela samhita is an ancient Indian textbook of medicine composed by Maharshi Bhela. Indriya sthana is one among the eight sections of Bhela samhita, and it consists of 12 chapters deals with prognostic aspects. Pushpeeyam adhyaya is the 11 chapter of Bhela indriya sthana which consists of 20 verses. Previous works have explored the prognostic potential of various chapters of Bhela indriya sthana. No studies have been conducted on “Pushpeeyam adhyaya” till date. The present study aims to explore the contents of “Pushpeeyam adhyaya” with the help of contemporary medical literature and principles of Freud’s interpretation of dreams. Various databases have been searched to identify suitable studies (published in English language) by using appropriate key words. Various conditions such as visual perceptual distortions (erythropsia, photopsia, hyperchromatopsia, achromatopsia, metamorphopsia, etc.), Charles Bonnet syndrome, Anton-Babinski syndrome, retinal and vitreous detachments, end-of-life dreams and visions, hypnagogic visual hallucinations with sleep bruxism, temporal lobe epilepsy, occipital lobe seizures, pilomotor seizures, and psychiatric or neuropsychiatric conditions are documented in “Pushpeeyam adhyaya.” Various dreams such as bad, inauspicious, neutral, wish fulfilling, nightmares, day dreams, lucid dreams, bizarre or absurd dreams and dreams having animal figures, and colors along with their consequences (either death or survival) are documented in “Pushypeeyam adhyaya.” Analysis of dreams with the help of “Freud’s interpretation of dreams” principles has revealed that the dreams documented in “Pushpeeyam adhyaya” seems to be rationale. Prognostic estimation based on odors emitted by patients (pushpeeyam) and analyzing dreams (swapna vignaana) of patients are having paramount importance (due to their cost-effectiveness, noninvasiveness, and feasibility) in resource-poor settings. Various hypotheses generated by the present work may pave the way for future research studies.
... Previous studies have explored various emergency conditions mentioned in 'Charaka indriya sthana' which are fatal and associated with death. [4][5][6][7][8][9][10][11][12][13][14][15][16] No studies have been conducted on 'Bhela indriya sthana' and it is unexplored till date though it contains various unique concepts. The present work is aimed to explore the contents of the 'Sadyo maraneeyam indriyam' of 'Bhela indriya sthana'. ...
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Full-text available
Bhela samhita is an Ayurvedic (Indian system of medicine) treatise written by ‘Maharshi Bhela’ (belongs to 1000-2000 BC). Maharshi Bhela was the student of popular preceptor ‘Acharya Punarvasu Atreya’ and colleague of ‘Agnivesha’ (author of the popular Ayurvedic text ‘Charaka samhita’). Bhela samhita consists of 8 sections and 120 chapters. ‘Indriya sthana’ is one of the eight sections of ‘Bhela samhita’ which comprises 12 chapters. ‘Bhela Indriya sthana’ deals with prognostic aspects. ‘Sadyo maraneeyam indriyam’ is the fourth chapter of ‘Bhela indriya sthana’ which contains the description of various emergency conditions with high mortality rates. The word ‘sadyo maraneeyam’ denotes an immediate death caused by various emergency conditions. Though previous works have explored ‘Charaka indriya sthana’, studies on ‘Bhela indriya sthana’ are lacking. The present work is aimed to explore the contents of ‘Sadyo maraneeyam indriyam’ of ‘Bhela indriya sthana’. Various emergency conditions such as coronary artery disease, cardiovascular disease, acute coronary syndrome, Granulomatosis with polyangiitis, increased intra-cranial pressure, abdominal compartment syndrome, cancer cachexia, increased intra-abdominal or intrapelvic pressure due to benign or malignant tumours, prostate cancer, neurosyphilis with saddle nose and ocular manifestations, gastro-duodenal perforation or ulcer, perforation of peptic ulcer, acute abdomen, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, lower gastrointestinal bleeding, upper gastrointestinal bleeding, colon cancer, proctalgia fugax, disseminated intravascular coagulation, idiopathic thrombocytopenic purpura, Henoch-Schönlein purpura, coagulation disorders, cardiac cachexia, coma, shock, pulmonary cachexia, acute respiratory distress syndrome, and chronic obstructive pulmonary disease etc are documented in this chapter by ‘Maharshi Bhela’. ‘Maharshi Bhela’ has provided a list of signs & symptoms or clinical features of emergency conditions having poor prognosis. Keywords: bhela indriya sthana, bhela samhita, charaka indriya sthana, charaka samhita, indriya sthana, emergency conditions
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Sushruta Samhita is an ancient Ayurvedic text deals mainly with surgical knowledge. Sushruta has documented Arishta Vignaana (prognostic knowledge) in the chapters 28 to 33 of Sutra Sthana. Avaaraneeya Adhyaya is the 33rd chapter of Sushruta Sutra Sthana. The term Avaraneeya denotes various untreatable conditions. Avaaraneeya Adhyaya consists of 26 verses that deal with the description of various poor prgnositc conditions or diseases. The contents of Avaaraneeya Adhyaya chapter are unique and require further exploration. No work has been conducted on Avaaraneeya Adhyaya chapter of Sushruta Sutra Sthana till date. The present study is aimed to evaluate the prognostic importance of the contents of Avaaraneeya Adhyaya chapter with the help of contemporary prognostic literature. Various databases have been searched to collect relevant data by using appropriate keywords. Clinical interpretation of the verses have revealed various fatal conditions with poor prognosis such as end of life stages, multiple chronic conditions and signs & symptoms of terminal illnesses. The contents of Avaaraneeya Adhyaya chapter of Sushruta Samhita Sutra Sthana seem to be having clinical and prognostic significance and clinical applicability. The present study provides inputs for future research works on Ayurvedic prognostic science.
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Background: Our objective was to determine the survival and causes of death in a large and well-characterized cohort of patients with giant cell arteritis (GCA). Methods: This is a hospital-based, retrospective, observational cohort study including patients diagnosed with GCA in Western Norway during 1972-2012. Patients were identified through computerized hospital records using the International Classification of Diseases (ICD)-coding system. Medical records were reviewed. Patients were randomly assigned population controls matched on age, sex, and geography from the Central Population Registry of Norway (CPRN). Date and cause of death were obtained from the Norwegian Cause of Death Registry (NCoDR). The survival was analyzed using Kaplan-Meier methods with the Gehan-Breslow test and the causes of death using cumulative incidence and Cox models for competing risks. Results: We identified 881 cases with a clinical diagnosis of GCA of which 792 fulfilled the American College of Rheumatology (ACR) 1990 classification criteria. Among those fulfilling the ACR criteria, 528 were also biopsy-verified. Cases were matched with 2577 population controls. A total of 490 (56%) GCA patients and 1517 (59%) controls died during the study period. We found no difference in the overall survival of GCA patients compared to controls, p = 0.413. The most frequent underlying causes of death in both groups were diseases of the circulatory system followed by cancer. GCA patients had increased risk of dying of circulatory disease (HR 1.31, 95% CI 1.13-1.51, p < 0.001) but lower risk of dying of cancer (HR 0.56, 95% CI 0.42-0.73, p < 0.001) compared to population controls. Conclusions: We found no difference in the overall survival of GCA patients compared to matched controls, but there were differences in the distribution of underlying death causes.
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