View source for Kiyanta Shiraseeya Adhyaya

{{#seo:
|title=Kiyanta Shiraseeya Adhyaya
|titlemode=append
|keywords=Shiroroga (diseases of head), hridaya roga(diseases of heart), imbalances in [[dosha]], [[dhatu]]-kshaya, [[mala]]-kshaya, pidaka, madhumeha, [[dosha]]-gati, sannipata, samsarga, ojokshaya, [[ojas]], signs of depletion of [[dosha]], [[dhatu]] and [[mala]], disorders of [[ojas]], movement of [[dosha]], [[Ayurveda]], Indian system of medicine, charak samhita. 
|description=Sutra Sthana Chapter 17. Diseases of three vital organs including Head and other conditions
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|type=article
}}

<big>'''Sutra Sthana Chapter 17. Diseases of three vital organs including Head and other conditions'''</big>

{{Infobox
|title =  Kiyanta Shiraseeya Adhyaya
|label1 = Section/Chapter
|data1 = [[Sutra Sthana]] Chapter 17
|label2 = Tetrad/Sub-section
|data2 = ''Roga Chatushka''
|label3 = Preceding Chapter
|data3 = [[Chikitsaprabhritiya Adhyaya]]

|label4 = Succeeding Chapter
|data4 = [[Trishothiya Adhyaya]] 

|label5 = Other Sections
|data5 = [[Nidana Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label6 = Translator and commentator
|data6 = Goyal M.,Singh G.
|label7 = Reviewer 
|data7  = Pol A.
|label8 = Editors
|data8  = Kar A., Rai S., Deole Y.S., Basisht G.
|label9 = Year of publication 
|data9 =  2020
|label10 = Publisher 
|data10 =  [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI 
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s01.019 10.47468/CSNE.2020.e01.s01.019]
}}

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

<div style="text-align:justify;">This is the first chapter of Roga Chatushka (tetrad on classification of diseases) dealing with description of diseases of the vital organs, the head and the heart. Diseases are caused by disequilibrium of [[dosha]] in body. The signs and symptoms of various permutations and combinations of [[dosha]] imbalances are enlisted in this chapter. It also enlists and describes signs of depletion of [[dhatu]] and [[mala]]. The disorders of [[ojas]] are narrated, which continues with description of madhumeha (diabetes mellitus), and carbuncles produced as its complications. Various types of [[dosha]] gati (movements) are mentioned. The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter. </div>

'''Keywords''': Shiroroga(diseases of head), hridaya roga(diseases of heart), imbalances in [[dosha]], [[dhatu]]-kshaya, [[mala]]-kshaya, pidaka, madhumeha, [[dosha]]-gati, sannipata, samsarga, ojokshaya, [[ojas]], signs of depletion of [[dosha]], [[dhatu]] and [[mala]], disorders of [[ojas]], movement of [[dosha]].





== Introduction ==
<div style="text-align:justify;">
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 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 [[dosha]]) and samsarga(involvement of two [[dosha]]), based on variations in quantum of increased or decreased state of involved [[dosha]], 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 [[dosha]], [[dhatu]], [[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 [[meda dhatu]]. 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 ''shiroroga'', or the disease(s) of the head, have various clinical manifestations of headache and vary depending upon [[dosha]]-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''shiroroga'', different manifestations of headache can give an idea of the predominant [[dosha]] which may further decide the course of treatment. Similarly ''hridroga'' (heart diseases) and diseases associated with the urinary bladder mentioned in this chapter are also due to [[dosha]] predominance and ''krimi'' infestation. 

Various permutations and combinations of [[dosha]] have been analyzed that help in understanding the pathogenesis of a disease. It is always a matter of debate as to why there are so many diseases and why does a disease have so many different manifestations or forms, depending upon an individual. One answer is that the [[dosha]] involved in pathogenesis varies in the forms of either vriddhi (increase) or kshaya(decrease), and that a typical permutation or combination of such [[doshas]] can manifest the disease in a different way. The verses 45, 46, and 47 deal with ''ashayapkarsha'' (pulling [[dosha]] from its location) in which a dominant or increased [[vata]] pulls the normal [[pitta]] and [[kapha]] away from their “seats” and manifests its own features there. Therefore, confusion can occur in the diagnosis and management of the disease. In addition, the concept of ''vikalpa samprapti'' (variable pathogenesis) can be a reason for such varied presentations of the disease, since per ''vikalpa samprapti'', the involvement of various properties of [[dosha]] may differ depending upon the etiological factors. Eighteen types of ''kshaya'' (decreased state) of [[dosha], [[dhatu]], [[mala]] and [[ojas]] that may play a significant role in disease pathogenesis are also considered in this chapter. ''Madhumeha'' (Diabetes mellitus) which is also termed as ''ojomeha'' in other texts is one of the ''prameha'' where excessive ''kshaya'' of [[ojas]] takes place. One of its presentations (or forms) is caused due to ''avaranajanya samprāpti'' (obstructive pathogenesis), as explained in this chapter. ''Madhumeha'' is one among twenty types of ''prameha'' characterised by excessive frequency and quantity of urination. The primary [[dosha]] associated with ''madhumeha'' is [[vata]] and two types of pathogenesis of ''madhumeha'' have been discussed in [[Charak Samhita]]. In the first type, [[dhatu]] kshaya(decreased state of body tissue) causes [[vata]] provocation and all the clinical features of a vitiated [[vata]] are present in the patient of ''kshayaja madhumeha'' (Diabetes mellitus type 1) [Cha.Sa. [[Nidana Sthana]] 4/36-44]. In the second type, there is an initial involvement of [[kapha]], [[pitta]], [[mamsa dhatu]] and [[meda dhatu]], that in turn make ''avarana'' (to get covered or overlapped) of [[vata]] leading to manifestation of ''madhumeha'' (diabetes mellitus type 2) where features of [[kapha]], [[pitta]], [[meda dhatu]] and [[mamsa]] dushti are also observed. Here, therefore, the main line of treatment (i.e., for Type 2) involves pacifying  [[kapha]], [[pitta]], [[meda dhatu]] and [[mamsa dhatu]]. Various gati of [[dosha]] that are responsible for healthy and diseased states are dealt at the end of the chapter. Charak has also stressed upon the significance of a regular healthy diet. It can be said that in the 17th chapter, a multi-faceted approach to understanding various presentations of diseases has been mentioned, aided with examples.
</div>

==Sanskrit Text, Transliteration and English Translation==
<div class="mw-collapsible mw-collapsed">

अथातः कियन्तःशिरसीयमध्यायं व्याख्यास्यामः||१|| 

इति ह स्माह भगवानात्रेयः||२|| 
<div class="mw-collapsible-content">

Athātaḥ kiyantaḥśirasīyamadhyāyaṁ vyākhyāsyāmaḥ||1|| 

iti ha smāha bhagavānātrēyaḥ||2|| 

athAtaH kiyantaHshirasIyamadhyAyaM vyAkhyAsyAmaH||1|| 

iti ha smAha bhagavAnAtreyaH||2|| 
</div></div>

Now we shall expound the chapter "Kiyanta Shiraseeya" (Diseases of three vital organs including Head and other conditions). Thus said Lord Atreya.  [1-2]

=== Questions by Agnivesha ===
<div class="mw-collapsible mw-collapsed">

कियन्तः शिरसि प्रोक्ता रोगा हृदि च देहिनाम्| 
कति चाप्यनिलादीनां रोगा मानविकल्पजाः||३|| 

क्षयाः कति समाख्याताः पिडकाः कति चानघ!| 
गतिः कतिविधा चोक्ता दोषाणां दोषसूदन!||४|| 
<div class="mw-collapsible-content">

kiyantaḥ śirasi prōktā rōgā hr̥di ca dēhinām| 
kati cāpyanilādīnāṁ rōgā mānavikalpajāḥ||3|| 

kṣayāḥ kati samākhyātāḥ piḍakāḥ kati cānagha!| 
gatiḥ katividhā cōktā dōṣāṇāṁ dōṣasūdana!||4|| 

kiyantaH shirasi proktA rogA hRudi ca dehinAm| 
kati cApyanilAdInAM rogA mAnavikalpajAH||3|| 

kShayAH kati samAkhyAtAH piDakAH kati cAnagha!| 
gatiH katividhA coktA doShANAM doShasUdana!||4|| 
</div></div>

<div style="text-align:justify;">
(Agnivesha asked the questions) “Oh God! How many are the diseases of head and heart of human beings? How many are the disorders caused by the varied combinations of discordant [[vata]] and other [[dosha]]? How many are the disorders caused by kshaya? How many are the papules (pidika)? O Holy One and Dispeller of [[Dosha]]! How many types of gati of [[dosha]] are there? [3-4]
</div>

=== Explanation by Atreya ===
<div class="mw-collapsible mw-collapsed">

हुताशवेशस्य वचस्तच्छ्रुत्वा  गुरुरब्रवीत्| 
पृष्टवानसि यत् सौम्य! तन्मे शृणु सविस्तरम्||५|| 
<div class="mw-collapsible-content">

hutāśavēśasya vacastacchrutvā  gururabravīt| 
pr̥ṣṭavānasi yat saumya! tanmē śr̥ṇu savistaram||5|| 

hutAshaveshasya vacastacchrutvA [1] gururabravIt| 
pRuShTavAnasi yat saumya! tanme shRuNu savistaram||5|| 
</div></div>

On hearing the above questions of Agnivesha, Guru Atreya said “O gentle one! Hear me for the detailed description” [5]
 
=== Number of diseases ===
<div class="mw-collapsible mw-collapsed">

दृष्टाः पञ्च शिरोरोगाः पञ्चैव हृदयामयाः| 
व्याधीनां ह्यधिका षष्टिर्दोषमानविकल्पजा||६|| 
<div class="mw-collapsible-content">

dr̥ṣṭāḥ pañca śirōrōgāḥ pañcaiva hr̥dayāmayāḥ| 
vyādhīnāṁ hyadhikā ṣaṣṭirdōṣamānavikalpajā||6|| 

dRuShTAH pa~jca shirorogAH pa~jcaiva hRudayAmayAH| 
vyAdhInAM hyadhikA ShaShTirdoShamAnavikalpajA||6|| 
</div></div>

“There are five ''shiroroga'' (diseases of head) and five ''hridroga'' (diseases of heart). On the basis of permutations and combinations of [[dosha]], there are sixty-two disorders” [6]  
<div class="mw-collapsible mw-collapsed">

दशाष्टौ च क्षयाः सप्त पिडका माधुमेहिकाः| 
दोषाणां त्रिविधा चोक्ता गतिर्विस्तरतः  शृणु||७||
<div class="mw-collapsible-content">

daśāṣṭau ca kṣayāḥ sapta piḍakā mādhumēhikāḥ| 
dōṣāṇāṁ trividhā cōktā gatirvistarataḥ  śr̥ṇu||7|| 

dashAShTau ca kShayAH sapta piDakA mAdhumehikAH| 
doShANAM trividhA coktA gatirvistarataH [2] shRuNu||7|| 
</div></div>

“There are eighteen varieties of ''kshaya'', seven varieties of ''pidika'' (pustule/carbuncles) caused due to ''madhumeha'' and three courses (''gati'') of [[dosha]]. These are being described in detail henceforth” [7]

=== Causes of diseases of head ===
<div class="mw-collapsible mw-collapsed">

सन्धारणाद्दिवास्वप्नाद्रात्रौ जागरणान्मदात्| 
उच्चैर्भाष्यादवश्यायात् प्राग्वातादतिमैथुनात्||८|| 

गन्धादसात्म्यादाघ्राताद्रजोधूमहिमातपात्| 
गुर्वम्लहरितादानादति शीताम्बुसेवनात्||९|| 

शिरोऽभिघाताद्दुष्टामाद्रोदनाद्बाष्पनिग्रहात्  | 
मेघागमान्मनस्तापाद्देशकालविपर्ययात्||१०|| 

वातादयः प्रकुप्यन्ति शिरस्यस्रं च दुष्यति| 
ततः शिरसि जायन्ते रोगा विविधलक्षणाः||११||
<div class="mw-collapsible-content">

sandhāraṇāddivāsvapnādrātrau jāgaraṇānmadāt| 
uccairbhāṣyādavaśyāyāt prāgvātādatimaithunāt||8|| 

gandhādasātmyādāghrātādrajōdhūmahimātapāt| 
gurvamlaharitādānādati śītāmbusēvanāt||9|| 

śirō'bhighātādduṣṭāmādrōdanādbāṣpanigrahāt  | 
mēghāgamānmanastāpāddēśakālaviparyayāt||10|| 

vātādayaḥ prakupyanti śirasyasraṁ ca duṣyati| 
tataḥ śirasi jāyantē rōgā vividhalakṣaṇāḥ||11|| 

sandhAraNAddivAsvapnAdrAtrau jAgaraNAnmadAt| 
uccairbhAShyAdavashyAyAt prAgvAtAdatimaithunAt||8|| 

gandhAdasAtmyAdAghrAtAdrajodhUmahimAtapAt| 
gurvamlaharitAdAnAdati shItAmbusevanAt||9|| 
shiro~abhighAtAdduShTAmAdrodanAdbAShpanigrahAt [1] | 

meghAgamAnmanastApAddeshakAlaviparyayAt||10|| 
vAtAdayaH prakupyanti shirasyasraM ca duShyati| 
tataH shirasi jAyante rogA vividhalakShaNAH||11|| 
</div></div>

<div style="text-align:justify;">
Suppression of natural urges, day-sleep, insomnia, intoxication, talking too loudly, exposure to frost, exposure to wind from the front, excessive sex, inhalation of unwholesome (or toxic) smell, exposure to dust, smoke, cold and sun, over eating of heavy, sour and green food,  use of very cold water, trauma to the head, formation of products of improper digestion and metabolism in the body (i.e., ama), excessive weeping or suppression of tears, cloudy weather, irritation of mind/anxiety (manastapa), and anomalous climate/season are the general causative factors of shiroroga. The above factors provoke or vitiate [[vata]],  affecting [[rakta]] (blood circulation) in the head leading to shiroroga with various symptoms [8-11]
</div>

=== Importance of the Head ===
<div class="mw-collapsible mw-collapsed">

प्राणाः प्राणभृतां यत्र श्रिताः सर्वेन्द्रियाणि च| 
यदुत्तमाङ्गमाङ्गानां शिरस्तदभिधीयते||१२|| 
<div class="mw-collapsible-content">

prāṇāḥ prāṇabhr̥tāṁ yatra śritāḥ sarvēndriyāṇi ca| 
yaduttamāṅgamāṅgānāṁ śirastadabhidhīyatē||12|| 

prANAH prANabhRutAM yatra shritAH sarvendriyANi ca| 
yaduttamA~ggamA~ggAnAM shirastadabhidhIyate||12||
</div></div>

''Shira'' (head) is foremost among all organs as it is the region of the body where the vital centres and all the senses (''indriya'') of a living-being are located It is vital (''uttama'') amongst all the other organs of the body [12]
  
=== Diseases of the Head ===
<div class="mw-collapsible mw-collapsed">

अर्धावभेदको वा स्यात् सर्वं वा रुज्यते शिरः| 
प्रतिश्यामुखनासाक्षिकर्णरोगशिरोभ्रमाः||१३|| 

अर्दितं शिरसः कम्पो गलमन्याहनुग्रहः| 
विविधाश्चापरे रोगा वातादिक्रिमिसम्भवाः||१४|| 
<div class="mw-collapsible-content">

ardhāvabhēdakō vā syāt sarvaṁ vā rujyatē śiraḥ| 
pratiśyāmukhanāsākṣikarṇarōgaśirōbhramāḥ||13|| 

arditaṁ śirasaḥ kampō galamanyāhanugrahaḥ| 
vividhāścāparē rōgā vātādikrimisambhavāḥ||14||

ardhAvabhedako vA syAt sarvaM vA rujyate shiraH| 
pratishyAmukhanAsAkShikarNarogashirobhramAH||13|| 

arditaM shirasaH kampo galamanyAhanugrahaH| 
vividhAshcApare rogA vAtAdikrimisambhavAH||14|| 
</div></div>

<div style="text-align:justify;">
Hemicrania (''ardhavabhedaka''), headache (''sarvam va rujyate shiraḥ'') (i.e., that which may involve whole of head), coryza (''pratishyaya''), disorders  of mouth, nose, eyes, and ears (''mukhanasakshikarṇaroga''), giddiness/vertigo (''shirobhramaḥ''), facial paralysis (''ardita''), tremors of the head (''shirasaḥ kampa''), stiffness of the neck, nape and jaw  (''galamanyāhanugrahah'')  and other such diseases of the head are caused by [[dosha]] and micro-organisms/worms (''krimi''). [13-14]
</div>

=== Types of Diseases of Head ===
<div class="mw-collapsible mw-collapsed">

पृथग्दिष्टास्तु ये पञ्च सङ्ग्रहे परमर्षिभिः| 
शिरोगदांस्ताञ्छृणु मे यथास्वैर्हेतुलक्षणैः||१५|| 
<div class="mw-collapsible-content">

pr̥thagdiṣṭāstu yē pañca saṅgrahē paramarṣibhiḥ| 
śirōgadāṁstāñchr̥ṇu mē yathāsvairhētulakṣaṇaiḥ||15|| 

pRuthagdiShTAstu ye pa~jca sa~ggrahe paramarShibhiH| 
shirogadAMstA~jchRuNu me yathAsvairhetulakShaNaiH||15|| 
</div></div>

As mentioned in [[Ashtodariya Adhyaya]], there are five types of ''shiroroga'' that are described here with their etiological factors , signs and symptoms [15]

=== [[Vata]] - dominant diseases of the Head ===
<div class="mw-collapsible mw-collapsed">

उच्चैर्भाष्यातिभाष्याभ्यां तीक्ष्णपानात्  प्रजागरात्| 
शीतमारुतसंस्पर्शाद्व्यवायाद्वेगनिग्रहात्||१६|| 

उपवासादभीघाताद्विरेकाद्वमनादति| 
बाष्पशोकभयत्रासाद्भारमार्गातिकर्शनात्||१७|| 

शिरोगताः  सिरा वृद्धो वायुराविश्य कुप्यति| 
ततः शूलं महत्तस्य वातात् समुपजायते||१८|| 
<div class="mw-collapsible-content">

uccairbhāṣyātibhāṣyābhyāṁ tīkṣṇapānāt  prajāgarāt| 
śītamārutasaṁsparśādvyavāyādvēganigrahāt||16|| 

upavāsādabhīghātādvirēkādvamanādati| 
bāṣpaśōkabhayatrāsādbhāramārgātikarśanāt||17|| 

śirōgatāḥ  sirā vr̥ddhō vāyurāviśya kupyati| 
tataḥ śūlaṁ mahattasya vātāt samupajāyatē||18|| 

uccairbhAShyAtibhAShyAbhyAM tIkShNapAnAt [1] prajAgarAt| 
shItamArutasaMsparshAdvyavAyAdveganigrahAt||16|| 

upavAsAdabhIghAtAdvirekAdvamanAdati| 
bAShpashokabhayatrAsAdbhAramArgAtikarshanAt||17|| 

shirogatAH [2] sirA vRuddho vAyurAvishya kupyati| 
tataH shUlaM mahattasya vAtAt samupajAyate||18|| 
</div></div>

<div style="text-align:justify;">
Indulgence in loud speech, excessive talk, strong drinks, awaking till late night, exposure to cold wind, excessive sexual act, suppression of natural physical urges, fasting, trauma, excessive/strong [[vamana]] or [[virechana]], excessive weeping, grief, fear, terror, excessive-load carrying, way-faring, severe emaciation leads to provocation of [[vata]] which by affecting the vessels of the head gets further provoked and produces severe pain in head [16-18]
</div>

=== Symptoms of [[vata]]- dominant diseases of head ===
<div class="mw-collapsible mw-collapsed">

निस्तुद्येते भृशं शङ्कौ घाटा  सम्भिद्यते तथा| 
सभ्रूमध्यं  ललाटं च तपतीवातिवेदनम्||१९|| 

वध्येते  स्वनतः श्रोत्रे निष्कृष्येते इवाक्षिणी| 
घूर्णतीव शिरः सर्वं सन्धिभ्य इव मुच्यते||२०|| 

स्फुरत्यति सिराजालं स्तभ्यते च शिरोधरा| 
स्निग्धोष्णमुपशेते च शिरोरोगेऽनिलात्मके||२१||
<div class="mw-collapsible-content">

nistudyētē bhr̥śaṁ śaṅkau ghāṭā  sambhidyatē tathā| 
sabhrūmadhyaṁ  lalāṭaṁ ca tapatīvātivēdanam||19|| 

vadhyētē  svanataḥ śrōtrē niṣkr̥ṣyētē ivākṣiṇī| 
ghūrṇatīva śiraḥ sarvaṁ sandhibhya iva mucyatē||20|| 

sphuratyati sirājālaṁ stabhyatē ca śirōdharā| 
snigdhōṣṇamupaśētē ca śirōrōgē'nilātmakē||21||

nistudyete bhRushaM sha~gkau ghATA [3] sambhidyate tathA| 
sabhrUmadhyaM [4] lalATaM ca tapatIvAtivedanam||19|| 

vadhyete [5] svanataH shrotre niShkRuShyete ivAkShiNI| 
ghUrNatIva shiraH sarvaM sandhibhya iva mucyate||20|| 

sphuratyati sirAjAlaM stabhyate ca shirodharA| 
snigdhoShNamupashete ca shiroroge~anilAtmake||21|| 
</div></div>

<div style="text-align:justify;">
Intense pain in both the temples, splitting sensation in the nape, excessive heat and pain in forehead and between the eyebrows region, severe cutting pain and dissonances in ear, feeling as if the eyes are being gouged out, dizziness, sense of separateness in all the joints, excessive throbs in blood vasculature, stiffness of neck are the symptoms of vataja shiroroga. Use of hot and unctuous things provides relief in [[vata]] type of headache [19-21]
</div>

=== [[Pitta]]- dominant diseases of the Head ===
<div class="mw-collapsible mw-collapsed">

कट्वम्ललवणक्षारमद्यक्रोधातपानलैः| 
पित्तं शिरसि सन्दुष्टं शिरोरोगाय कल्पते||२२||   
<div class="mw-collapsible-content">
                 
kaṭvamlalavaṇakṣāramadyakrōdhātapānalaiḥ| 
pittaṁ śirasi sanduṣṭaṁ śirōrōgāya kalpatē||22|| 

kaTvamlalavaNakShAramadyakrodhAtapAnalaiH| 
pittaM shirasi sanduShTaM shirorogAya kalpate||22|| 
</div></div>

Excessive use of pungent, sour, salty and alkali substances and wine, exposure to sun (or heat) and anger leads to provocation of [[pitta]], which by lodging in the head produces [[pitta]] dominant diseases of head [22]

=== Symptoms of [[pitta]] dominant diseases of head===
<div class="mw-collapsible mw-collapsed">

दह्यते रुज्यते तेन शिरः शीतं सुषूयते  | 
दह्येते चक्षुषी तृष्णा भ्रमः स्वेदश्च जायते||२३||                                 
<div class="mw-collapsible-content">

dahyatē rujyatē tēna śiraḥ śītaṁ suṣūyatē  | 
dahyētē cakṣuṣī tr̥ṣṇā bhramaḥ svēdaśca jāyatē||23|| 

dahyate rujyate tena shiraH shItaM suShUyate [1] | 
dahyete cakShuShI tRuShNA bhramaH svedashca jAyate||23||
</div></div>

Burning sensation and pain in the head, desire for cold things, burning sensation in the eyes, thirst, giddiness and perspiration are the symptoms of [[pitta]] dominant diseases of head [23]

=== [[Kapha]]-dominant diseases of head ===
<div class="mw-collapsible mw-collapsed">

आस्यासुखैः स्वप्नसुखैर्गुरुस्निग्धातिभोजनैः| 
श्लेष्मा शिरसि सन्दुष्टः शिरोरोगाय कल्पते||२४||
<div class="mw-collapsible-content">
                                                                              
āsyāsukhaiḥ svapnasukhairgurusnigdhātibhōjanaiḥ| 
ślēṣmā śirasi sanduṣṭaḥ śirōrōgāya kalpatē||24|| 

AsyAsukhaiH svapnasukhairgurusnigdhAtibhojanaiH| 
shleShmA shirasi sanduShTaH shirorogAya kalpate||24|| 
</div></div>

Due to sedentary life-style, excessive sleep, indulgence in intake of heavy and unctuous meals or excessive food intake, [[kapha]] gets provoked in the head and produces [[kapha]] dominant diseases of head. [24]

=== Symptoms of [[kapha]] dominant diseases of head ===
<div class="mw-collapsible mw-collapsed">

शिरो मन्दरुजं तेन सुप्तं स्तिमितभारिकम्| 
भवत्युत्पद्यते तन्द्रा तथाऽऽलस्यमरोचकः||२५||  
<div class="mw-collapsible-content">
                                                                             
śirō mandarujaṁ tēna suptaṁ stimitabhārikam| 
bhavatyutpadyatē tandrā tathā''lasyamarōcakaḥ||25|| 

shiro mandarujaM tena suptaM stimitabhArikam| 
bhavatyutpadyate tandrA tathA~a~alasyamarocakaH||25|| 
</div></div>

Dull headache, numbness, stiffness and heaviness in head, drowsiness, laziness and anorexia are the symptoms of [[kapha]] doinant  diseases of head [25]

=== Three [[dosha]]-dominant disease of head ===
<div class="mw-collapsible mw-collapsed">

वाताच्छूलं भ्रमः कम्पः पिताद्दाहो मदस्तृषा| 
कफाद्गुरुत्वं तन्द्रा च शिरोरोगे त्रिदोषजे||२६||    
<div class="mw-collapsible-content">
               
vātācchūlaṁ bhramaḥ kampaḥ pitāddāhō madastr̥ṣā| 
kaphādgurutvaṁ tandrā ca śirōrōgē tridōṣajē||26|| 

vAtAcchUlaM bhramaH kampaH pitAddAho madastRuShA| 
kaphAdgurutvaM tandrA ca shiroroge tridoShaje||26|| 
</div></div>

In ''tridoshaja shiroroga'' aching pain, giddiness and tremors occur due to [[vata]], burning sensation, intoxication and thirst occur due to [[pitta']], and heaviness and drowsiness occur due to [[kapha]] [26]

=== Etiological factors and pathogenesis of ''krimija shiroroga'' (disease of head due to parasites/micro-organisms) ===
<div class="mw-collapsible mw-collapsed">

तिलक्षीरगुडाजीर्णपूतिसङ्कीर्णभोजनात्| 
क्लेदोऽसृक्कफमांसानां दोषलस्योपजायते||२७|| 
                                                                              
ततः शिरसि सङ्क्लेदात् क्रिमयः पापकर्मणः|   
जनयन्ति शिरोरोगं जाता बीभत्सलक्षणम्||२८|| 
<div class="mw-collapsible-content">

tilakṣīraguḍājīrṇapūtisaṅkīrṇabhōjanāt| 
klēdō'sr̥kkaphamāṁsānāṁ dōṣalasyōpajāyatē||27|| 

tataḥ śirasi saṅklēdāt krimayaḥ pāpakarmaṇaḥ| 
janayanti śirōrōgaṁ jātā bībhatsalakṣaṇam||28|| 

tilakShIraguDAjIrNapUtisa~gkIrNabhojanAt| 
kledo~asRukkaphamAMsAnAM doShalasyopajAyate||27|| 

tataH shirasi sa~gkledAt krimayaH pApakarmaNaH| 
janayanti shirorogaM jAtA bIbhatsalakShaNam||28|| 
</div></div>

<div style="text-align:justify;">
When a person with provoked [[dosha]] indulges in excessive intake of sesame, milk, molasses,takes meals even when previous meal has not properly digested, eats putrefied or promiscuous food, and/or takes incompatible diet - it causes pathological discharges of [[rakta]], [[kapha]] and [[mamsa]], wherein parasites are produced, leading to ''krimija shiroroga'' with dreadful symptoms [27-28]
</div>

=== Symptoms of ''krimaja shiroroga'' ===
<div class="mw-collapsible mw-collapsed">

व्यधच्छेदरुजाकण्डूशोफदौर्गत्यदुःखितम्  | 
क्रिमिरोगातुरं विद्यात् क्रिमीणां दर्शनेन  च||२९|| 
<div class="mw-collapsible-content">

vyadhacchēdarujākaṇḍūśōphadaurgatyaduḥkhitam  | 
krimirōgāturaṁ vidyāt krimīṇāṁ darśanēna  ca||29|| 

vyadhacchedarujAkaNDUshophadaurgatyaduHkhitam [1] | 
krimirogAturaM vidyAt krimINAM darshanena [2] ca||29|| 
</div></div>

The patient of ''krimija shiroroga'' suffers from piercing, cutting or aching pains in the head with itching, swelling and foul smelling and detectable parasites [29]

=== Etiological factors and pathogenesis of [[vata]]-dominant disease of heart ([[vata]]ja hridroga) ===
<div class="mw-collapsible mw-collapsed">

शोकोपवासव्यायामरूक्षशुष्काल्पभोजनैः  |  
वायुराविश्य हृदयं जनयत्युत्तमां रुजम्||३०||    
<div class="mw-collapsible-content">
                                                                                 
śōkōpavāsavyāyāmarūkṣaśuṣkālpabhōjanaiḥ  | 
vāyurāviśya hr̥dayaṁ janayatyuttamāṁ rujam||30|| 

shokopavAsavyAyAmarUkShashuShkAlpabhojanaiH [1] | 
vAyurAvishya hRudayaM janayatyuttamAM rujam||30|| 
</div></div>

Grief, fasting, over-exercise, intake of rough (non oily or ununctuous) or dry food articles, or food items of low nutritional value are the key etiological factors of [[vata]] dominant dseases of heart. Provoked [[vata]] , due to these causes, produces severe chest pain by affecting the heart [30]

=== Symptoms of [[vata]]-dominant disease of heart  ===
<div class="mw-collapsible mw-collapsed">

वेपथुर्वेष्टनं स्तम्भः प्रमोहः शून्यता दरः  | 
हृदि वातातुरे रूपं जीर्णे चात्यर्थवेदना||३१||  
 <div class="mw-collapsible-content">
                                                                                     
vēpathurvēṣṭanaṁ stambhaḥ pramōhaḥ śūnyatā daraḥ  | 
hr̥di vātāturē rūpaṁ jīrṇē cātyarthavēdanā||31|| 

vepathurveShTanaM stambhaH pramohaH shUnyatA daraH [2] | 
hRudi vAtAture rUpaM jIrNe cAtyarthavedanA||31|| 
</div></div>

<div style="text-align:justify;">
The symptoms of [[vata]]-dominant disease of heart are extra systole/ fibrillation, cardiac cramps, pauses in cardiac beats, stupor, sensation of emptiness in the cardiac region, and murmur (''dara''). The patient suffers from severe chest pain at the time of completion of digestion of the meal [31]
</div>

=== Etiological factors and pathogenesis of [[pitta]]-dominant heart diseases ([[pitta]]ja hridroga) ===
<div class="mw-collapsible mw-collapsed">

उष्णाम्ललवणक्षारकटुकाजीर्णभोजनैः| 
मद्यक्रोधातपैश्चाशु हृदि पित्तं प्रकुप्यति||३२|| 
<div class="mw-collapsible-content">

uṣṇāmlalavaṇakṣārakaṭukājīrṇabhōjanaiḥ| 
madyakrōdhātapaiścāśu hr̥di pittṁ prakupyati||32|| 

uShNAmlalavaNakShArakaTukAjIrNabhojanaiH| 
madyakrodhAtapaishcAshu hRudi pittM prakupyati||32|| 
</div></div>

Excessive intake of hot, sour, pungent, salty and alkaline food articles, alcohol, exposure to sun, and anger are the etiological factors of [[pitta]]-dominant heart diseases  [32]

=== Symptoms of [[pitta]]-dominant heart diseases ===
<div class="mw-collapsible mw-collapsed">

हृद्दाहस्तिक्तता वक्रे तिक्ताम्लोद्गिरणं क्लमः| 
तृष्णा मूर्च्छा भ्रमः स्वेदः पित्तहृद्रोगलक्षणम्||३३|| 
<div class="mw-collapsible-content">
                                                                            
hr̥ddāhastiktatā vakrē tiktāmlōdgiraṇaṁ klamaḥ| 
tr̥ṣṇā mūrcchā bhramaḥ svēdaḥ pittahr̥drōgalakṣaṇam||33|| 

hRuddAhastiktatA vakre tiktAmlodgiraNaM klamaH| 
tRuShNA mUrcchA bhramaH svedaH pittahRudrogalakShaNam||33|| 
</div></div>

Burning sensation in the precordial region, bitter taste in mouth, sour eructation, exhaustion, thirst, fainting, giddiness and perspiration are the symptoms of [[pitta]]-dominant heart diseases [33]

=== Etiological factors and pathogenesis of [[kapha]]-dominant heart diseases ([[kapha]]ja hridroga) ===
<div class="mw-collapsible mw-collapsed">

अत्यादानं गुरुस्निग्धमचिन्तनमचेष्टनम्| 
निद्रासुखं चाभ्यधिकं कफहृद्रोगकारणम्||३४||    
 <div class="mw-collapsible-content">
                                                                              
atyādānaṁ gurusnigdhamacintanamacēṣṭanam| 
nidrāsukhaṁ cābhyadhikaṁ kaphahr̥drōgakāraṇam||34|| 

atyAdAnaM gurusnigdhamacintanamaceShTanam| 
nidrAsukhaM cAbhyadhikaM kaphahRudrogakAraNam||34|| 
</div></div>

Over-eating, intake of heavy and fatty food substances, worry-free and sedentary lifestyle, excessive sleep are the etiological factors of [[kapha]]-dominant heart diseases[34]

=== Symptoms of [[kapha]]-dominant heart diseases ===
<div class="mw-collapsible mw-collapsed">

हृदयं कफहृद्रोगे सुप्तं स्तिमितभारिकम्| 
तन्द्रारुचिपरीतस्य भवत्यश्मावृतं यथा||३५||   
<div class="mw-collapsible-content">
                                                                                   
hr̥dayaṁ kaphahr̥drōgē suptaṁ stimitabhārikam| 
tandrāruciparītasya bhavatyaśmāvr̥taṁ yathā||35|| 

hRudayaM kaphahRudroge suptaM stimitabhArikam| 
tandrAruciparItasya bhavatyashmAvRutaM yathA||35|| 
</div></div>

Numbness, stiffness and heaviness in the precordial area, a stony sensation in the heart region, drowsiness and anorexia are the symptoms of '[[kapha]]-dominant heart diseases [35]

=== Etiological factors and pathogenesis of three [[dosha]]-dominant heart diseases (''tridoshaja hridroga'') ===
<div class="mw-collapsible mw-collapsed">

हेतुलक्षणसंसर्गादुच्यते सान्निपातिकः| 
(हृद्रोगः कष्टदः कष्टसाध्य उक्तो महर्षिभिः) 
<div class="mw-collapsible-content">

hētulakṣaṇasaṁsargāducyatē sānnipātikaḥ| 
(hr̥drōgaḥ kaṣṭadaḥ kaṣṭasādhya uktō maharṣibhiḥ) 

hetulakShaNasaMsargAducyate sAnnipAtikaH| 
(hRudrogaH kaShTadaH kaShTasAdhya ukto maharShibhiH) 
</div></div>

In ''tridoshaja hridroga'', the etiological factors and symptoms of all the three [[dosha]] dominant types of the heart diseases are present. (''tridoshaja hridroga'' is considered a most troublesome disease by great sages)[35½]

=== Etiological factors and pathogenesis of ''krimija hridroga'' ===
<div class="mw-collapsible mw-collapsed">

त्रिदोषजे तु हृद्रोगे यो दुरात्मा निषेवते||३६|| 

तिलक्षीरगुडादीनि ग्रन्थिस्तस्योपजायते| 
मर्मैकदेशे सङ्क्लेदं रसश्चास्योपगच्छति||३७|| 

सङ्क्लेदात् क्रिमयश्चास्य भवन्त्युपहतात्मनः| 
मर्मैकदेशे ते जाताः सर्पन्तो भक्षयन्ति च||३८|| 
<div class="mw-collapsible-content">

tridōṣajē tu hr̥drōgē yō durātmā niṣēvatē||36|| 

tilakṣīraguḍādīni granthistasyōpajāyatē| 
marmaikadēśē saṅklēdaṁ rasaścāsyōpagacchati||37|| 

saṅklēdāt krimayaścāsya bhavantyupahatātmanaḥ| 
marmaikadēśē tē jātāḥ sarpantō bhakṣayanti ca||38|| 

tridoShaje tu hRudroge yo durAtmA niShevate||36|| 

tilakShIraguDAdIni granthistasyopajAyate| 
marmaikadeshe sa~gkledaM rasashcAsyopagacchati||37|| 

sa~gkledAt krimayashcAsya bhavantyupahatAtmanaH| 
marmaikadeshe te jAtAH sarpanto bhakShayanti ca||38|| 
</div></div>

<div style="text-align:justify;">
An unfortunate person already suffering from ''tridoshaja hridroga'', if further indulges in excessive intake of sesame, milk, and molasses, then he develops thrombosis (''granthi'') in  the ''rasavaha srotas'' of the heart, leading to softening of the affected area and making it vulnerable to worm infestations. This infestation then spreads and consumes (''bhakṣyanti'') the heart tissues. It is ''krimija hridroga'' [36-38]
</div>
=== Symptoms of ''krimija hridroga'' ===
<div class="mw-collapsible mw-collapsed">

तुद्यमानं स हृदयं सूचीभिरिव मन्यते| 
छिद्यमानं यथा शस्त्रैर्जातकण्डूं महारुजम्||३९|| 

हृद्रोगं क्रिमिजं त्वेतैर्लिङ्गैर्बुद्ध्वा सुदारुणम्| 
त्वरेत जेतुं तं विद्वान् विकारं शीघ्रकारिणम्||४०||   
<div class="mw-collapsible-content">
                  
tudyamānaṁ sa hr̥dayaṁ sūcībhiriva manyatē| 
chidyamānaṁ yathā śastrairjātakaṇḍūṁ mahārujam||39|| 

hr̥drōgaṁ krimijaṁ tvētairliṅgairbuddhvā sudāruṇam| 
tvarēta jētuṁ taṁ vidvān vikāraṁ śīghrakāriṇam||40||

tudyamAnaM sa hRudayaM sUcIbhiriva manyate| 
chidyamAnaM yathA shastrairjAtakaNDUM mahArujam||39|| 

hRudrogaM krimijaM tvetairli~ggairbuddhvA sudAruNam| 
tvareta jetuM taM vidvAn vikAraM shIghrakAriNam||40|| 
</div></div>

<div style="text-align:justify;">
The patient of ''krimija hridroga'' feels severe pain in the precordial region and complains of itching, as if the heart is being pricked and pierced with needles or cut open by weapons. ''Krimija hridroga'' is a very grave heart condition and may lead to immediate death. Therefore it should be promptly diagnosed and managed [39-40]
</div>
=== Sixty two permutations and combinations of ''samsarga'' and ''tridosha'' ===

==== (I). Thirteen types of ''sannipata'' ====
<div class="mw-collapsible mw-collapsed">

द्व्युल्बणैकोल्बणैः षट् स्युर्हीनमध्याधिकैश्च षट्| 
समैश्चैको विकारास्ते सन्निपातास्त्रयोदश||४१|| 
<div class="mw-collapsible-content">

dvyulbaṇaikōlbaṇaiḥ ṣaṭ syurhīnamadhyādhikaiśca ṣaṭ| 
samaiścaikō vikārāstē sannipātāstrayōdaśa||41|| 

dvyulbaNaikolbaNaiH ShaT syurhInamadhyAdhikaishca ShaT| 
samaishcaiko vikArAste sannipAtAstrayodasha||41|| 
</div></div>

<div style="text-align:justify;">
There are 13 conditions of ''sannipata'' of [[dosha]] (combination of all three [[dosha]]), out of these, three conditions are with a dominance of two [[dosha]] (other one [[dosha]] comparatively less increased), three conditions are with dominance of only one [[dosha]] (others two [[dosha]] comparatively less increased), six conditions with diminished, moderate and dominant [[dosha]], and one condition with equal aggravation of all three [[dosha]] [41]
</div>

==== (II). Nine types of ''samsarga'' ====
<div class="mw-collapsible mw-collapsed">

संसर्गे नव षट् तेभ्य एकवृद्ध्या समैस्त्रयः| 
पृथक् त्रयश्च तैर्वृद्धैर्व्याधयः पञ्चविंशतिः||४२|| 
<div class="mw-collapsible-content">

saṁsargē nava ṣaṭ tēbhya  ēkavr̥ddhyā samaistrayaḥ| 
pr̥thak trayaśca tairvr̥ddhairvyādhayaḥ pañcaviṁśatiḥ||42|| 

saMsarge nava ShaT tebhya [1] ekavRuddhyA samaistrayaH| 
pRuthak trayashca tairvRuddhairvyAdhayaH pa~jcaviMshatiH||42|| 
</div></div>

''Samsarga'' means a combination of two provoked [[dosha]] and there are nine such combinations or ''samsargas''. Of these, six ''samsargas'' have one [[dosha]] more provoked than the other. In the remaining three cases, both [[dosha]] are equally increased [42]

==== (III). Twenty-five conditions of kshina [[dosha]] ====
<div class="mw-collapsible mw-collapsed">

यथा वृद्धैस्तथा क्षीणैर्दोषेः स्युः पञ्चविंशतिः| 
<div class="mw-collapsible-content">

yathā vr̥ddhaistathā kṣīṇairdōṣēḥ syuḥ pañcaviṁśatiḥ| 

yathA vRuddhaistathA kShINairdoSheH syuH pa~jcaviMshatiH| 
</div></div>

Similar to the combinations of increased [[dosha]] mentioned above, there are 25 conditions of kshina (decreased) [[dosha]] [42½]

==== (IV). Twelve ''sannipata'' of normal, increased and decreased [[dosha]] ====
<div class="mw-collapsible mw-collapsed">

वृद्धिक्षयकृतश्चान्यो विकल्प उपदेक्ष्यते||४३||  
                                                                                 
वृद्धिरेकस्य समता चैकस्यैकस्य सङ्क्षयः| 
द्वन्द्ववृद्धिः क्षयश्चैकस्यैकवृद्धिर्द्वयोः क्षयः  ||४४|| 
<div class="mw-collapsible-content">

vr̥ddhikṣayakr̥taścānyō vikalpa upadēkṣyatē||43|| 

vr̥ddhirēkasya samatā caikasyaikasya saṅkṣayaḥ| 
dvandvavr̥ddhiḥ kṣayaścaikasyaikavr̥ddhirdvayōḥ kṣayaḥ ||44|| 

vRuddhikShayakRutashcAnyo vikalpa upadekShyate||43|| 

vRuddhirekasya samatA caikasyaikasya sa~gkShayaH| 
dvandvavRuddhiH kShayashcaikasyaikavRuddhirdvayoH kShayaH [2] ||44||
</div></div>

<div style="text-align:justify;">
There is another form of sannipata where the [[dosha]] are present in normal, decreased or increased combinations, and such cases are of 12 types there. Out of these, six conditions are where one [[dosha]] is increased, the second is normal and the third is decreased. In three types of combinations, two [[dosha]] are increased and the third decreased. Finally, there are three types of combinations where one [[dosha]] is increased and the other two are decreased. [43-44]  
</div>

=== Twelve types of irregular (vishama) sannipata(combination of [[dosha]]) ===

==== 1. Normal [[pitta]], decreased [[kapha]] and increased [[vata]] sannipata ====
<div class="mw-collapsible mw-collapsed">

प्रकृतिस्थं यदा पित्तं मारुतः श्लेष्मणः क्षये| 
स्थानादादाय गात्रेषु यत्र यत्र विसर्पति||४५||
 
तदा भेदश्च दाहश्च तत्र तत्रानवस्थितः| 
गात्रदेशे भवत्यस्य श्रमो दौर्बल्यमेव च||४६|| 
<div class="mw-collapsible-content">

prakr̥tisthaṁ yadā pittaṁ mārutaḥ ślēṣmaṇaḥ kṣayē| 
sthānādādāya gātrēṣu yatra yatra visarpati||45|| 

tadā bhēdaśca dāhaśca tatra tatrānavasthitaḥ| 
gātradēśē bhavatyasya śramō daurbalyamēva ca||46|| 

prakRutisthaM yadA pittaM mArutaH shleShmaNaH kShaye| 
sthAnAdAdAya gAtreShu yatra yatra visarpati||45|| 

tadA bhedashca dAhashca tatra tatrAnavasthitaH| 
gAtradeshe bhavatyasya shramo daurbalyameva ca||46|| 
</div></div>

In a condition where [[kapha]] is decreased, [[vata]] that takes out normal [[pitta]] from its site and spreads it within the body. Wherever this [[pitta]] is placed, there is intermittent breaking pain and burning sensation as well as fatigue and weakness [46]

==== 2.Normal [[kapha]], increased [[vata]] and decreased [[pitta]] sannipata ====
<div class="mw-collapsible mw-collapsed">

प्रकृतिस्थं  कफं वायुः क्षीणे पित्ते यदा बली| 
कर्षेत् कुर्यात्तदा शूलं सशैत्यस्तम्भगौरवम्||४७||  
<div class="mw-collapsible-content">
                                                                             
prakr̥tisthaṁ  kaphaṁ vāyuḥ kṣīṇē pittē yadā balī| 
karṣēt kuryāttadā śūlaṁ saśaityastambhagauravam||47||

prakRutisthaM [1] kaphaM vAyuH kShINe pitte yadA balI| 
karShet kuryAttadA shUlaM sashaityastambhagauravam||47|| 
</div></div>

In a condition of decreased [[pitta]], the increased [[vata]] that takes out normal [[kapha]] from its site and spreads it within the body. Wherever this [[kapha]] is placed, there is coliky pain, coldness, stiffness and heaviness [47]

==== 3. Normal [[vata]], decreased [[kapha]], and increased [[pitta]] sannipata ====
<div class="mw-collapsible mw-collapsed">

यदाऽनिलं  प्रकृतिगं पित्तं कफपरिक्षये|                                                                                            
संरुणद्धि तदा दाहः शूलं चास्योपजायते||४८|| 
<div class="mw-collapsible-content">

yadā'nilaṁ  prakr̥tigaṁ pittaṁ kaphaparikṣayē| 
saṁruṇaddhi tadā dāhaḥ śūlaṁ cāsyōpajāyatē||48|| 

yadA~anilaM [2] prakRutigaM pittaM kaphaparikShaye| 
saMruNaddhi tadA dAhaH shUlaM cAsyopajAyate||48|| 
</div></div>

In a condition of grossly decreased [[kapha]], when increased [[pitta]] obstructs the pathway of normal [[vata]], causing burning sensation and coliky pain (shula) [48]

==== 4. Normal [[kapha]], decreased [[vata]], and increased [[pitta]] sannipata====
<div class="mw-collapsible mw-collapsed">

श्लेष्माणं  हि समं पित्तं यदा वातपरिक्षये| 
सन्निरुन्ध्यात्तदा कुर्यात् सतन्द्रागौरवं ज्वरम्||४९|| 
<div class="mw-collapsible-content">

ślēṣmāṇaṁ  hi samaṁ pittaṁ yadā vātaparikṣayē| 
sannirundhyāttadā kuryāt satandrāgauravaṁ jvaram||49|| 

shleShmANaM [3] hi samaM pittaM yadA vAtaparikShaye| 
sannirundhyAttadA kuryAt satandrAgauravaM jvaram||49|| 
</div></div>

In case of  a grossly decreased [[vata]], increased [[pitta]] obstructs the normal [[kapha]], causing fever accompanied with a feeling of heaviness and drowsiness [49]

==== 5. Normal [[vata]], decreased [[pitta]], and increased [[kapha]] sannipata====
<div class="mw-collapsible mw-collapsed">

प्रवृद्धो हि यदा श्लेष्मा पित्ते क्षीणे समीरणम्| 
रुन्ध्यात्तदा प्रकुर्वीत शीतकं गौरवं रुजम्  ||५०|| 
<div class="mw-collapsible-content">

pravr̥ddhō hi yadā ślēṣmā pittē kṣīṇē samīraṇam| 
rundhyāttadā prakurvīta śītakaṁ gauravaṁ rujam  ||50|| 

pravRuddho hi yadA shleShmA pitte kShINe samIraNam| 
rundhyAttadA prakurvIta shItakaM gauravaM rujam [4] ||50|| 
</div></div>

In the case of decreased [[pitta]], if increased [[kapha]] obstructs the normal [[vata]] leading to a sensation of cold, heaviness and pain [50]

==== 6. Increased [[kapha]], normal [[pitta]], and decreased [[vata]] sannipata ====
<div class="mw-collapsible mw-collapsed">

समीरणे परिक्षीणे कफः पित्तं समत्वगम्| 
कुर्वीत सन्निरुन्धानो मृद्वग्नित्वं शिरोग्रहम्  ||५१|| 

निद्रां तन्द्रां प्रलापं च हृद्रोगं गात्रगौरवम्| 
नखादीनां च पीतत्वं ष्ठीवनं कफपित्तयोः||५२|| 
<div class="mw-collapsible-content">

samīraṇē parikṣīṇē kaphaḥ pittaṁ samatvagam| 
kurvīta sannirundhānō mr̥dvagnitvaṁ śirōgraham  ||51|| 

nidrāṁ tandrāṁ pralāpaṁ ca hr̥drōgaṁ gātragauravam| 
nakhādīnāṁ ca pītatvaṁ ṣṭhīvanaṁ kaphapittayōḥ||52|| 

samIraNe parikShINe kaphaH pittaM samatvagam| 
kurvIta sannirundhAno mRudvagnitvaM shirograham [5] ||51|| 

nidrAM tandrAM pralApaM ca hRudrogaM gAtragauravam| 
nakhAdInAM ca pItatvaM ShThIvanaM kaphapittayoH||52|| 
</div></div>

<div style="text-align:justify;">
In case of decreased [[vata]], if increased [[kapha]] obstructs the normal [[pitta]] then it causes slow digestion,stiffness of head, excessive sleep, drowsiness, delirium, cardiac diseases, heaviness in the body, yellowness in nails etc and excess discharge of [[kapha]]-[[pitta]][51-52]
</div>
==== 7. Decreased [[vata]],increased [[kapha]], and [[pitta]] sannipata====
<div class="mw-collapsible mw-collapsed">

हीनवातस्य तु श्लेष्मा पित्तेन सहितश्चरन्| 
करोत्यरोचकापाकौ सदनं गौरवं तथा||५३|| 

हृल्लासमास्यस्रवणं पाण्डुतां दूयनं मदम्| 
विरेकस्य च वैषम्यं वैषम्यमनलस्य च||५४|| 
<div class="mw-collapsible-content">

hīnavātasya tu ślēṣmā pittēna sahitaścaran| 
karōtyarōcakāpākau sadanaṁ gauravaṁ tathā||53|| 

hr̥llāsamāsyasravaṇaṁ pāṇḍutāṁ dūyanaṁ madam| 
virēkasya ca vaiṣamyaṁ vaiṣamyamanalasya ca||54|| 

hInavAtasya tu shleShmA pittena sahitashcaran| 
karotyarocakApAkau sadanaM gauravaM tathA||53|| 

hRullAsamAsyasravaNaM pANDutAM dUyanaM madam| 
virekasya ca vaiShamyaM vaiShamyamanalasya ca||54|| 
</div></div>

In case of decreased [[vata]] when increased [[kapha]], [[pitta]] spreads in the body causing anorexia, indigestion, asthenia, heaviness, nausea, salivation, anaemia, fumes sensation of mouth, throat and palate (''dūyana''), intoxication and irregularity of bowels and digestion [53-54]

==== 8. Decreased [[pitta]], increased [[kapha]], and [[vata]] sannipata====
<div class="mw-collapsible mw-collapsed">

हीनपित्तस्य तु श्लेष्मा मारुतेनोपसंहितः| 
स्तम्भं शैत्यं च तोदं च जनयत्यनवस्थितम्||५५|| 

गौरवं मृदुतामग्नेर्भक्ताश्रद्धां प्रवेपनम्| 
नखादीनां च शुक्लत्वं गात्रपारुष्यमेव च||५६|| 
<div class="mw-collapsible-content">

hīnapittasya tu ślēṣmā mārutēnōpasaṁhitaḥ| 
stambhaṁ śaityaṁ ca tōdaṁ ca janayatyanavasthitam||55|| 

gauravaṁ mr̥dutāmagnērbhaktāśraddhāṁ pravēpanam| 
nakhādīnāṁ ca śuklatvaṁ gātrapāruṣyamēva ca||56|| 

hInapittasya tu shleShmA mArutenopasaMhitaH| 
stambhaM shaityaM ca todaM ca janayatyanavasthitam||55|| 

gauravaM mRudutAmagnerbhaktAshraddhAM pravepanam| 
nakhAdInAM ca shuklatvaM gAtrapAruShyameva ca||56|| 
</div></div>

In case of decreased [[pitta]], the increased [[kapha]] and [[vata]] combine together , causing stiffness, coldness, unstable pricking pain, heaviness, diminution of digestion, disinclination for food, tremors, pallor of nails etc., and roughness of the body parts [53-56]

==== 9. Decreased [[kapha]], increased [[vata]] and [[pitta]] sannipata ====
 <div class="mw-collapsible mw-collapsed">

मारुतस्तु कफे हीने पित्तं च कुपितं द्वयम्| 
करोति यानि लिङ्गानि शृणु तानि समासतः||५७||    
                                                                          
भ्रममुद्वेष्टनं तोदं दाहं स्फुटनवेपने| 
अङ्गमर्दं परीशोषं दूयनं धूपनं तथा||५८|| 
<div class="mw-collapsible-content">

mārutastu kaphē hīnē pittaṁ ca kupitaṁ dvayam| 
karōti yāni liṅgāni śr̥ṇu tāni samāsataḥ||57|| 

bhramamudvēṣṭanaṁ tōdaṁ dāhaṁ sphuṭanavēpanē| 
aṅgamardaṁ parīśōṣṁ dūyanaṁ dhūpanaṁ tathā||58|| 

mArutastu kaphe hIne pittaM ca kupitaM dvayam| 
karoti yAni li~ggAni shRuNu tAni samAsataH||57|| 

bhramamudveShTanaM todaM dAhaM sphuTanavepane| 
a~ggamardaM parIshoShM dUyanaM dhUpanaM tathA||58|| 
</div></div>

In case of decreased [[kapha]] and an increased [[vata]] and [[pitta]] combine together, causing giddiness, cramps, pricking pain, burning sensation, disruption, tremors, body-ache, dehydration, burning of mouth, throat and palate and smoke from mouth [57-58]

==== 10. Decreased [[vata]] and [[pitta]] and increased [[kapha]] sannipata====
<div class="mw-collapsible mw-collapsed">

वातपित्तक्षये श्लेष्मा स्रोतांस्यपिदधद्भृशम्| 
चेष्टाप्रणाशं मूर्च्छां च वाक्सङ्गं च करोति हि||५९|| 
<div class="mw-collapsible-content">

vātapittakṣayē ślēṣmā srōtāṁsyapidadhadbhr̥śam| 
cēṣṭāpraṇāśaṁ mūrcchāṁ ca vāksaṅgaṁ ca karōti hi||59|| 

vAtapittakShaye shleShmA srotAMsyapidadhadbhRusham| 
ceShTApraNAshaM mUrcchAM ca vAksa~ggaM ca karoti hi||59|| 
</div></div>

In case of decreased [[vata]] and [[pitta]] and an increased [[kapha]], obstruction of srotas causes complete loss of movement, loss of speech and fainting (59).

==== 11. Decreased [[vata]] and [[kapha]] and increased [[pitta]] sannipata ====
<div class="mw-collapsible mw-collapsed">

वातश्लेष्मक्षये पित्तं देहौजः स्रंसयच्चरेत्| 
ग्लानिमिन्द्रियदौर्बल्यं तृष्णां मूर्च्छां क्रियाक्षयम्||६०|| 
<div class="mw-collapsible-content">

vātaślēṣmakṣayē pittaṁ dēhaujaḥ sraṁsayaccarēt| 
glānimindriyadaurbalyaṁ tr̥ṣṇāṁ mūrcchāṁ kriyākṣayam||60|| 

vAtashleShmakShaye pittaM dehaujaH sraMsayaccaret| 
glAnimindriyadaurbalyaM tRuShNAM mUrcchAM kriyAkShayam||60|| 
</div></div>

In case of decreased [[vata]] and [[kapha]] with an increased [[pitta]], by affecting the [[ojas]] causes malaise (''glani''), asthenia of senses, thirst, fainting and decreased physiological functions (60).

==== 12. Decreased [[pitta]] and [[kapha]] and increased [[vata]] sannipata ====
<div class="mw-collapsible mw-collapsed">

पित्तश्लेष्मक्षये वायुर्मर्माण्यतिनिपीडयन्| 
प्रणाशयति सञ्ज्ञां च वेपयत्यथवा नरम्||६१||   
<div class="mw-collapsible-content">
                         
pittaślēṣmakṣayē vāyurmarmāṇyatinipīḍayan| 
praṇāśayati sañjñāṁ ca vēpayatyathavā  naram||61||

pittashleShmakShaye vAyurmarmANyatinipIDayan| 
praNAshayati sa~jj~jAM ca vepayatyathavA [6] naram||61|| 
</div></div>

In case of decreased [[pitta]] and [[kapha]], an increased [[vata]] causes compression of the vital centres, adversely impacts consciousness, or leads to severe tremors throughout the whole body [61]

=== General principle of symptoms of increased and decreased [[dosha]] ===
<div class="mw-collapsible mw-collapsed">

दोषाः प्रवृद्धाः स्वं लिङ्गं दर्शयन्ति यथाबलम्| 
क्षीणा जहति लिङ्गं स्वं, समाः स्वं कर्म कुवेते||६२||
<div class="mw-collapsible-content">

dōṣāḥ pravr̥ddhāḥ svaṁ liṅgaṁ darśayanti yathābalam| 
kṣīṇā jahati liṅgaṁ svaṁ, samāḥ svaṁ karma kuvētē||62||

doShAH pravRuddhAH svaM li~ggaM darshayanti yathAbalam| 
kShINA jahati li~ggaM svaM, samAH svaM karma kuvete||62|| 
</div></div>

An increase in [[dosha]] causes a consequent provocation, to the same extent as the increase, of a symptom of a disease. On the other hand a decrease of [[dosha]] leads to decreased or reduced functions. In normal conditions, [[dosha]] are in an equilibrium [62]

=== Types of ''kshaya'' (decrease) ===
<div class="mw-collapsible mw-collapsed">

वातादीनां रसादीनां मलानामोजसस्तथा| 
क्षयास्तत्रानिलादीनामुक्तं सङ्क्षीणलक्षणम्  ||६३|| 
<div class="mw-collapsible-content">

vātādīnāṁ rasādīnāṁ malānāmōjasastathā| 
kṣayāstatrānilādīnāmuktaṁ saṅkṣīṇalakṣaṇam  ||63|| 

vAtAdInAM rasAdInAM malAnAmojasastathA| 
kShayAstatrAnilAdInAmuktaM sa~gkShINalakShaNam [1] ||63|| 
</div></div>

Now the symptoms of decrease of [[dosh]],[[dhatu]], [[mala]](i.e., excreta such as urine, feces,and excreta of nose, ears, eyes  and mouth, as well as body hair) and [[ojas]] will be described. The symptoms of decreased [[dosha]] have already been described. [63]

==== Decrease of [[rasa dhatu]] ====
<div class="mw-collapsible mw-collapsed">

घट्टते सहते शब्दं नोच्चैर्द्रवति  शूल्यते| 
हृदयं ताम्यति स्वल्पचेष्टस्यापि रसक्षये||६४|| 
<div class="mw-collapsible-content">

ghaṭṭatē sahatē śabdaṁ nōccairdravati śūlyatē| 
hr̥dayaṁ tāmyati svalpacēṣṭasyāpi rasakṣayē||64|| 

ghaTTate sahate shabdaM noccairdravati [2] shUlyate| 
hRudayaM tAmyati svalpaceShTasyApi rasakShaye||64|| 
</div></div>

Symptoms of diminution of [[rasa dhatu]] include restlessness (or feeling as if the heart is being churned), intolerance to loud sounds, acceleration of flow (tachycardia), pain and distress even with the slightest exertion [64]

==== Decrease of [[rakta dhatu]] ====
<div class="mw-collapsible mw-collapsed">

परुषा स्फुटिता म्लाना त्वग्रूक्षा रक्तसङ्क्षये| 
<div class="mw-collapsible-content">

paruṣā sphuṭitā mlānā tvagrūkṣā raktasaṅkṣayē| 

paruShA sphuTitA mlAnA tvagrUkShA raktasa~gkShaye| 
</div></div>

Symptoms of decrease of [[rakta dhatu]] include roughness, cracks, withering and dryness of skin.[65]

==== Decrease of [[mamsa dhatu]] ====
<div class="mw-collapsible mw-collapsed">

मांसक्षये विशेषेण स्फिग्ग्रीवोदरशुष्कता||६५|| 
<div class="mw-collapsible-content">

māṁsakṣayē viśēṣēṇa sphiggrīvōdaraśuṣkatā||65|| 

mAMsakShaye visheSheNa sphiggrIvodarashuShkatA||65|| 
</div></div>

Symptoms of decrease in [[mamsa dhatu]] include thinning specially of hips, neck and belly [65]

==== Decrease of [[meda dhatu]] ====
<div class="mw-collapsible mw-collapsed">

सन्धीनां स्फुटनं ग्लानिरक्ष्णोरायास एव च| 
लक्षणं मेदसि क्षीणे तनुत्वं  चोदरस्य च||६६|| 
<div class="mw-collapsible-content">

sandhīnāṁ sphuṭanaṁ glānirakṣṇōrāyāsa ēva ca| 
lakṣaṇaṁ mēdasi kṣīṇē tanutvaṁ  cōdarasya ca||66|| 

sandhInAM sphuTanaM glAnirakShNorAyAsa eva ca| 
lakShaNaM medasi kShINe tanutvaM [3] codarasya ca||66|| 
</div></div>

Symptoms of decrease of [[meda dhatu]] include cracking of the joints, lassitude of eyes, exhaustion and thinning of the abdomen [66]

==== Decrease of [[asthi dhatu]]====
<div class="mw-collapsible mw-collapsed">

केशलोमनखश्मश्रुद्विजप्रपतनं श्रमः| 
ज्ञेयमस्थिक्षये लिङ्गं सन्धिशैथिल्यमेव च||६७|| 
<div class="mw-collapsible-content">

kēśalōmanakhaśmaśrudvijaprapatanaṁ śramaḥ| 
jñēyamasthikṣayē liṅgaṁ sandhiśaithilyamēva ca||67|| 

keshalomanakhashmashrudvijaprapatanaM shramaH| 
j~jeyamasthikShaye li~ggaM sandhishaithilyameva ca||67|| 
</div></div>

Symptoms of decrease of [[asthi dhatu]] are loss of scalp and body-hair, beard, nails and teeth, fatigue and loose joints [67]

==== Decrease of [[majja dhatu]]====
<div class="mw-collapsible mw-collapsed">

शीर्यन्त इव चास्थीनि दुर्बलानि लघूनि च| 
प्रततं  वातरोगीणि क्षीणे मज्जनि देहिनाम्||६८|| 
<div class="mw-collapsible-content">

śīryanta iva cāsthīni durbalāni laghūni ca| 
pratataṁ  vātarōgīṇi kṣīṇē majjani dēhinām||68|| 

shIryanta iva cAsthIni durbalAni laghUni ca| 
pratataM [4] vAtarogINi kShINe majjani dehinAm||68|| 
</div></div>

Symptoms of decrease of [[majja dhatu]] are atrophy of bone tissues, weakness and lightness of bones and the patients suffers frequently from [[vata]] disorders [68]

==== Decrease of [[shukra dhatu]]====
<div class="mw-collapsible mw-collapsed">

दौर्बल्यं मुखशोषश्च पाण्डुत्वं सदनं श्रमः| 
क्लैब्यं शुक्राविसर्गश्च क्षीणशुक्रस्य लक्षणम्||६९|| 
<div class="mw-collapsible-content">

daurbalyaṁ mukhaśōṣaśca pāṇḍutvaṁ sadanaṁ śramaḥ| 
klaibyaṁ śukrāvisargaśca kṣīṇaśukrasya lakṣaṇam||69|| 

daurbalyaM mukhashoShashca pANDutvaM sadanaM shramaH| 
klaibyaM shukrAvisargashca kShINashukrasya lakShaNam||69|| 
</div></div>

Symptoms of decrease in [[shukra dhatu]] include debility, dryness of mouth, pallor, asthenia, fatigue, impotency and absence of ejaculation [69]

==== Decrease in [[purisha]] ====
<div class="mw-collapsible mw-collapsed">

क्षीणे शकृति चान्त्राणि पीडयन्निव मारुतः| 
रूक्षस्योन्नमयन् कुक्षिं तिर्यगूर्ध्वं च गच्छति||७०|| 
<div class="mw-collapsible-content">

kṣīṇē śakr̥ti cāntrāṇi pīḍayanniva mārutaḥ| 
rūkṣasyōnnamayan kukṣiṁ tiryagūrdhvaṁ ca gacchati||70|| 

kShINe shakRuti cAntrANi pIDayanniva mArutaH| 
rUkShasyonnamayan kukShiM tiryagUrdhvaM ca gacchati||70|| 
</div></div>

In decrease of [[purisha]], provoked [[vata]] causes painful peristalsis in the intestine which spreads upwards and oblique, causing distension of belly and dryness [70]

==== Decrease of [[mutra]] ====
<div class="mw-collapsible mw-collapsed">

मूत्रक्षये मूत्रकृच्छ्रं मूत्रवैवर्ण्यमेव च| 
पिपासा बाधते चास्य मुखं च परिशुष्यति||७१|| 
<div class="mw-collapsible-content">

mūtrakṣayē mūtrakr̥cchraṁ mūtravaivarṇyamēva ca| 
pipāsā bādhatē cāsya mukhaṁ ca pariśuṣyati||71|| 

mUtrakShaye mUtrakRucchraM mUtravaivarNyameva ca| 
pipAsA bAdhate cAsya mukhaM ca parishuShyati||71|| 
</div></div>

Symptoms of decrease of [[mutra]] include dysuria, discoloration of urine, excessive thirst and dryness of mouth [71] 

==== Decrease of malayana ====
<div class="mw-collapsible mw-collapsed">

मलायनानि चान्यानि शून्यानि च लघूनि च| 
विशुष्काणि च लक्ष्यन्ते यथास्वं मलसङ्क्षये||७२||  
 <div class="mw-collapsible-content">
                                                                         
malāyanāni cānyāni śūnyāni ca laghūni ca| 
viśuṣkāṇi ca lakṣyantē yathāsvaṁ malasaṅkṣayē||72||

malAyanAni cAnyAni shUnyAni ca laghUni ca| 
vishuShkANi ca lakShyante yathAsvaM malasa~gkShaye||72||
</div></div>

There are five other minor [[mala]](associated with minor orifices) viz. [[mala]] of nose, ears, eyes, mouth and skin. Their deficiencies lead to feeling of emptiness, lightness and dryness of the respective receptacle of that [[mala]] [72]

==== Decrease of [[ojas]] ====
<div class="mw-collapsible mw-collapsed">

बिभेति दुर्बलोऽभीक्ष्णं ध्यायति व्यथितेन्द्रियः| 
दुश्छायो दुर्मना रूक्षः क्षामश्चैवौजसः क्षये||७३|| 
<div class="mw-collapsible-content">

bibhēti durbalō'bhīkṣṇaṁ dhyāyati vyathitēndriyaḥ| 
duśchāyō durmanā rūkṣaḥ kṣāmaścaivaujasaḥ kṣayē||73|| 

bibheti durbalo~abhIkShNaM dhyAyati vyathitendriyaH| 
dushchAyo durmanA rUkShaH kShAmashcaivaujasaH kShaye||73|| 
</div></div>

The symptoms of decrease of [[ojas]] include timidity, debility, constant worry, discomfort of the senses, loss of lustre, neurasthenia, dryness and emaciation [73]

=== Description of [[ojas]] ===
<div class="mw-collapsible mw-collapsed">

हृदि तिष्ठति यच्छुद्धं रक्तमीषत्सपीतकम्| 
ओजः शरीरे सङ्ख्यातं तन्नाशान्ना विनश्यति||७४|| 
<div class="mw-collapsible-content">

hr̥di tiṣṭhati yacchuddhaṁ raktamīṣatsapītakam| 
ōjaḥ śarīrē saṅkhyātaṁ tannāśānnā vinaśyati||74|| 

hRudi tiShThati yacchuddhaM raktamIShatsapItakam| 
ojaH sharIre sa~gkhyAtaM tannAshAnnA vinashyati||74|| 
</div></div>

The clear and slightly red-yellowish substance situated in the heart is known as [[ojas]]. Its destruction leads to death [74]
<div class="mw-collapsible mw-collapsed">

प्रथमं जायते ह्योजः शरीरेऽस्मिञ्छरीरिणाम्| 
सर्पिर्वर्णं मधुरसं लाजगन्धि प्रजायते||७५|| 

(भ्रमरैः फलपुष्पेभ्यो यथा सम्भ्रियते मधु| 
तद्वदोजः स्वकर्मभ्यो गुणैः सम्भ्रियते नृणाम्||१||)   
  <div class="mw-collapsible-content">
                
prathamaṁ jāyatē hyōjaḥ śarīrē'smiñcharīriṇām| 
sarpirvarṇaṁ madhurasaṁ lājagandhi prajāyatē||75|| 

(bhramaraiḥ phalapuṣpēbhyō yathā sambhriyatē madhu| 
tadvadōjaḥ svakarmabhyō guṇaiḥ sambhriyatē nr̥ṇām||1||)

prathamaM jAyate hyojaH sharIre~asmi~jcharIriNAm| 
sarpirvarNaM madhurasaM lAjagandhi prajAyate||75|| 

(bhramaraiH phalapuShpebhyo yathA sambhriyate madhu| 
tadvadojaH svakarmabhyo guNaiH sambhriyate nRuNAm||1||)
</div></div>

[[Ojas]] is the very first substance created in the body of all living beings. Its color resembles that of ghee, tastes like honey and smells like roasted paddy [75]

(As honey is collected by bees from various fruits and flowers, similarly [[ojas]] is collected by the inherent vital qualities of a man from the various physiological processes that take place in the body)(1).

==== General etiological factors of [[ojas]] kshaya(i.e., depletion of [[ojas]]) ====
<div class="mw-collapsible mw-collapsed">

व्यायामोऽनशनं चिन्ता रूक्षाल्पप्रमिताशनम्| 
वातातपौ भयं शोको रूक्षपानं प्रजागरः||७६|| 

कफशोणितशुक्राणां मलानां चातिवर्तनम्| 
कालो भूतोपघातश्च ज्ञातव्याः क्षयहेतवः||७७|| 
<div class="mw-collapsible-content">

vyāyāmō'naśanaṁ cintā rūkṣālpapramitāśanam| 
vātātapau bhayaṁ śōkō rūkṣapānaṁ prajāgaraḥ||76|| 

kaphaśōṇitaśukrāṇāṁ malānāṁ cātivartanam| 
kālō bhūtōpaghātaśca jñātavyāḥ kṣayahētavaḥ||77|| 

vyAyAmo~anashanaM cintA rUkShAlpapramitAshanam| 
vAtAtapau bhayaM shoko rUkShapAnaM prajAgaraH||76|| 

kaphashoNitashukrANAM malAnAM cAtivartanam| 
kAlo bhUtopaghAtashca j~jAtavyAH kShayahetavaH||77||
</div></div>

<div style="text-align:justify;">
Excessive exercising, fasting, worrying, fear, grief, taking dry, scanty and limited meals, dry beverages, exposure to wind and sun, insomnia, excessive excretion of mucus, blood, semen and excretions, adverse season or old age, major mental illness (''Bhuta-Upaghāta'') are the general causative factors for kshaya(depletion) of [[ojas]] [76-77]
</div>

===Etiological factors and pathogenesis of avrita madhumeha (diabetes due to obstructive pathogenesis) ===
<div class="mw-collapsible mw-collapsed">
गुरुस्निग्धाम्ललवणान्यतिमात्रं समश्नताम्| 
नवमन्नं च पानं च निद्रामास्यासुखानि च||७८|| 

त्यक्तव्यायामचिन्तानां संशोधनमकुर्वताम्| 
श्लेष्मा पित्तं च मेदश्च मांसं चातिप्रवर्धते||७९|| 

तैरावृतगतिर्वायुरोज  आदाय गच्छति| 
यदा बस्तिं तदा कृच्छ्रो मधुमेहः प्रवर्तते||८०|| 
<div class="mw-collapsible-content">

gurusnigdhāmlalavaṇānyatimātraṁ samaśnatām| 
navamannaṁ ca pānaṁ ca nidrāmāsyāsukhāni ca||78|| 

tyaktavyāyāmacintānāṁ saṁśōdhanamakurvatām| 
ślēṣmā pittaṁ ca mēdaśca māṁsaṁ cātipravardhatē||79|| 
                                                           
tairāvr̥tagatirvāyurōja  ādāya gacchati| 
yadā bastiṁ tadā kr̥cchrō madhumēhaḥ pravartatē||80|| 

gurusnigdhAmlalavaNAnyatimAtraM samashnatAm| 
navamannaM ca pAnaM ca nidrAmAsyAsukhAni ca||78|| 

tyaktavyAyAmacintAnAM saMshodhanamakurvatAm| 
shleShmA pittaM ca medashca mAMsaM cAtipravardhate||79|| 

tairAvRutagatirvAyuroja [1] AdAya gacchati| 
yadA bastiM tadA kRucchro madhumehaH pravartate||80|| 
</div></div>

<div style="text-align:justify;">
Excessive taking of heavy, unctuous, sour, and salty articles, eating of newly harvested cereals and newly prepared wines/drinks, excessive sleep, sedentary habits, avoidance of exercise or thinking/worry and not doing śhodhana(purification) lead to excessive increase in [[kapha]], [[pitta]], [[meda dhatu]] and [[mamsa dhatu]]. These obstruct the pathways of [[vata]] leading to aavrita [[vata]] condition. Thus, provoked [[vata]] takes out [[ojas]] from its sites and brings it to basti causing madhumeha which is difficult to treat [78-80]
</div>

=== Symptoms of ''avrita madhumeha'' ===
<div class="mw-collapsible mw-collapsed">

स मारुतस्य पित्तस्य कफस्य च मुहुर्मुहुः| 
दर्शयत्याकृतिं गत्वा क्षयमाप्यायते पुनः||८१|| 
<div class="mw-collapsible-content">

sa mārutasya pittasya kaphasya ca muhurmuhuḥ| 
darśayatyākr̥tiṁ gatvā kṣayamāpyāyatē punaḥ||81|| 

sa mArutasya pittasya kaphasya ca muhurmuhuH| 
darshayatyAkRutiM gatvA kShayamApyAyate punaH||81|| 
</div></div>

In this condition of ''madhumeha'', the symptoms of [[vata]], [[pitta]] and [[kapha]] are frequently manifested. The symptoms subside for some time, but again reappear later [81]

=== ''Sapta pidika'' (seven papules/pustules/carbuncles) ===
<div class="mw-collapsible mw-collapsed">

उपेक्षयाऽस्य जायन्ते  पिडकाः सप्त दारुणाः| 
मांसलेष्ववकाशेषु मर्मस्वपि च सन्धिषु||८२|| 
                                                                                  
शराविका कच्छपिका जालिनी सर्षपी तथा| 
अलजी विनताख्या च विद्रधी चेति सप्तमी||८३|| 
<div class="mw-collapsible-content">

upēkṣayā'sya jāyantē  piḍakāḥ sapta dāruṇāḥ| 
māṁsalēṣvavakāśēṣu marmasvapi ca sandhiṣu||82|| 

śarāvikā kacchapikā jālinī sarṣapī tathā| 
alajī vinatākhyā ca vidradhī cēti saptamī||83|| 

upekShayA~asya jAyante [2] piDakAH sapta dAruNAH| 
mAMsaleShvavakAsheShu marmasvapi ca sandhiShu||82|| 

sharAvikA kacchapikA jAlinI sarShapI tathA| 
alajI vinatAkhyA ca vidradhI ceti saptamI||83|| 
</div></div>

<div style="text-align:justify;">
If the diabetic condition is neglected, seven types of ''pidika'' (pustules) are produced. These ''pidika'' occur in fleshy spaces, vital parts (''marma'') and joints. The names of these seven ''pidikā'' are ''sharavika, kacchapika, jalini, sarshapi, alaji, vinata'' and ''vidhradi'' [82-83]
</div>
==== 1. ''Sharavika'' ====
<div class="mw-collapsible mw-collapsed">

अन्तोन्नता मध्यनिम्ना श्यावा क्लेदरुगन्विता| 
शराविका स्यात् पिडका शरावाकृतिसंस्थिता||८४|| 
<div class="mw-collapsible-content">

antōnnatā madhyanimnā śyāvā klēdaruganvitā| 
śarāvikā syāt piḍakā śarāvākr̥tisaṁsthitā||84|| 

antonnatA madhyanimnA shyAvA kledaruganvitA| 
sharAvikA syAt piDakA sharAvAkRutisaMsthitA||84|| 
</div></div>

The edges of ''sharavika pidika'' are raised and middle part is depressed, and its colour is dusky-red. It is accompanied by slough (''kleda'') and pain. As its shape is like that of an earthen saucer (''sharavika''), hence its name [84]
 
==== 2. ''Kacchapika'' ====
<div class="mw-collapsible mw-collapsed">

अवगाढार्तिनिस्तोदा महावास्तुपरिग्रहा| 
श्लक्ष्णा कच्छपपृष्ठाभा पिडका कच्छपी मता||८५|| 
<div class="mw-collapsible-content">

avagāḍhārtinistōdā mahāvāstuparigrahā| 
ślakṣṇā kacchapapr̥ṣṭhābhā piḍakā kacchapī matā||85|| 

avagADhArtinistodA mahAvAstuparigrahA| 
shlakShNA kacchapapRuShThAbhA piDakA kacchapI matA||85|| 
</div></div>

''Kacchapika'' (carbuncle) is deeply and extensively infiltrated, with distress and pricking pain. It has a smooth surface like that of tortoise (''Kacchapa''), therefore, its name [85]
 
==== 3. ''Jalini'' ====
<div class="mw-collapsible mw-collapsed">

स्तब्धा सिराजालवती स्निग्धास्रावा महाशया| 
रुजानिस्तोदबहुला सूक्ष्मच्छिद्रा च जालिनी||८६|| 
<div class="mw-collapsible-content">

stabdhā sirājālavatī snigdhāsrāvā mahāśayā| 
rujānistōdabahulā sūkṣmacchidrā ca jālinī||86|| 

stabdhA sirAjAlavatI snigdhAsrAvA mahAshayA| 
rujAnistodabahulA sUkShmacchidrA ca jAlinI||86|| 
</div></div>

''Jalini pidika'' is extensive, hard, covered with a network of vessels with unctous discharge, having severe pricking type pain and having minute openings on the surface. It is called ''jalini'' because it resembles a net or a web [86]

==== 4. ''Sarshapi'' ====
<div class="mw-collapsible mw-collapsed">

पिडका नातिमहती क्षिप्रपाका महारुजा| 
सर्षपी सर्षपाभाभिः पिडकाभिश्चिता भवेत्||८७|| 
<div class="mw-collapsible-content">

piḍakā nātimahatī kṣiprapākā mahārujā| 
sarṣapī sarṣapābhābhiḥ piḍakābhiścitā bhavēt||87|| 

piDakA nAtimahatI kShiprapAkA mahArujA| 
sarShapI sarShapAbhAbhiH piDakAbhishcitA bhavet||87|| 
</div></div>

''Sarshapi pidika'' is not very big but very painful and suppurates quickly and is surrounded by mustard seed-like boils [87]

==== 5. ''Alaji'' ====
<div class="mw-collapsible mw-collapsed">

दहति त्वचमुत्थाने तृष्णामोहज्वरप्रदा| 
विसर्पत्यनिशं दुःखाद्दहत्यग्निरिवालजी||८८|| 
<div class="mw-collapsible-content">

dahati tvacamutthānē tr̥ṣṇāmōhajvarapradā| 
visarpatyaniśaṁ duḥkhāddahatyagnirivālajī||88|| 

dahati tvacamutthAne tRuShNAmohajvarapradA| 
visarpatyanishaM duHkhAddahatyagnirivAlajI||88|| 
</div></div>

''Alaji pidika'' commences with a burning sensation in the skin accompanied by fever and thirst. It steadily spreads all over the body and causes severe distress with a fire-like burning sensation [88]

==== 6. ''Vinata'' ====
<div class="mw-collapsible mw-collapsed">

अवगाढरुजाक्लेदा पृष्ठे वाऽप्युदरेऽपि वा| 
महती विनता नीला पिडका विनता मता||८९|| 
<div class="mw-collapsible-content">

avagāḍharujāklēdā pr̥ṣṭhē vā'pyudarē'pi vā| 
mahatī vinatā nīlā piḍakā vinatā matā||89||

avagADharujAkledA pRuShThe vA~apyudare~api vA| 
mahatI vinatA nIlA piDakA vinatA matA||89||
</div></div>

''Vinatā pidika'' is extremely painful form of pustule. It is soft, situated either on back or abdomen, very extensive and depressed in the middle and bluish in colour. It is known as ''vinata'' because it is depressed or deep [89]

==== 7. ''Vidradhi''-(1) ''bahya vidradhi'' ====
<div class="mw-collapsible mw-collapsed">

विद्रधिं द्विविधामाहुर्बाह्यामाभ्यन्तरीं तथा| 
बाह्या त्वक्स्नायुमांसोत्था कण्डराभा महारुजा||९०|| 
<div class="mw-collapsible-content">

vidradhiṁ dvividhāmāhurbāhyāmābhyantarīṁ tathā| 
bāhyā tvaksnāyumāṁsōtthā kaṇḍarābhā mahārujā||90|| 

vidradhiM dvividhAmAhurbAhyAmAbhyantarIM tathA| 
bAhyA tvaksnAyumAMsotthA kaNDarAbhA mahArujA||90||
</div></div>

''Vidradhi'' (abscess) is of two types viz. external and internal. External abscess occurs on skin and flesh. It looks like tendon and can cause severe pain [90]

=== Etiology and pathogenesis of internal abscess ===
<div class="mw-collapsible mw-collapsed">

शीतकान्नविदाह्युष्णरूक्षशुष्कातिभोजनात्| 
विरुद्धाजीर्णसङ्क्लिष्टविषमासात्म्यभोजनात्||९१|| 

व्यापन्नबहुमद्यत्वाद्वेगसन्धारणाच्छ्रमात्| 
जिह्मव्यायामशयनादतिभाराध्वमैथुनात्||९२|| 

अन्तःशरीरे मांसासृगाविशन्ति  यदा मलाः| 
तदा सञ्जायते ग्रन्थिर्गम्भीरस्थः सुदारुणः||९३|| 

हृदये क्लोम्नि यकृति प्लीह्नि कुक्षौ च वृक्कयोः| 
नाभ्यां वङ्क्षणयोर्वाऽपि बस्तौ वा तीव्रवेदनः||९४|| 
<div class="mw-collapsible-content">

śītakānnavidāhyuṣṇarūkṣaśuṣkātibhōjanāt| 
viruddhājīrṇasaṅkliṣṭaviṣamāsātmyabhōjanāt||91|| 

vyāpannabahumadyatvādvēgasandhāraṇācchramāt| 
jihmavyāyāmaśayanādatibhārādhvamaithunāt||92|| 

antaḥśarīrē māṁsāsr̥gāviśanti  yadā malāḥ| 
tadā sañjāyatē granthirgambhīrasthaḥ sudāruṇaḥ||93|| 

hr̥dayē klōmni yakr̥ti plīhni kukṣau ca vr̥kkayōḥ| 
nābhyāṁ vaṅkṣaṇayōrvā'pi bastau vā tīvravēdanaḥ||94|| 

vidradhiM dvividhAmAhurbAhyAmAbhyantarIM tathA| 
bAhyA tvaksnAyumAMsotthA kaNDarAbhA mahArujA||90|| 

shItakAnnavidAhyuShNarUkShashuShkAtibhojanAt| 
viruddhAjIrNasa~gkliShTaviShamAsAtmyabhojanAt||91|| 

vyApannabahumadyatvAdvegasandhAraNAcchramAt| 
jihmavyAyAmashayanAdatibhArAdhvamaithunAt||92|| 

antaHsharIre mAMsAsRugAvishanti [1] yadA malAH| 
tadA sa~jjAyate granthirgambhIrasthaH sudAruNaH||93|| 

hRudaye klomni yakRuti plIhni kukShau ca vRukkayoH| 
nAbhyAM va~gkShaNayorvA~api bastau vA tIvravedanaH||94|| 
</div></div>

<div style="text-align:justify;">
Excessive use of cold/stale, irritant, hot, un-unctuous and dry food articles, diet with incompatible or unwholesome articles, indigestion, spoiled foods, irregular eating, imbibing spoiled and excessive wines, suppression of natural urges, fatigue, exercise in distorted postures, excessive sleep, carrying heavy loads, excessive wayfaring and excessive sex-activity are the etiological factors of internal abscess. 

The [[dosha]] provoked by the above-mentioned factors, when it enters the flesh and  blood of the internal organs of the body, gives rise to deep-rooted nodule-like swellings with severe pain. It is a severe condition that occurs in the heart, pharynx (''kloma''), liver, spleen, stomach, kidney, navel, groin and bladder [91-94]
</div>
==== Etymology of ''vidradhi'' ====
<div class="mw-collapsible mw-collapsed">

दुष्टरक्तातिमात्रत्वात् स वै शीघ्रं विदह्यते| 
ततः शीघ्रविदाहित्वाद्विद्रधीत्यभिधीयते||९५|| 
<div class="mw-collapsible-content">

duṣṭaraktātimātratvāt sa vai śīghraṁ vidahyatē| 
tataḥ śīghravidāhitvādvidradhītyabhidhīyatē||95|| 

duShTaraktAtimAtratvAt sa vai shIghraM vidahyate| 
tataH shIghravidAhitvAdvidradhItyabhidhIyate||95|| 
</div></div>

Excessively provoked [[rakta]] causes quick softening and formation of pus. Owing to its quickly suppurating (''vidahi'') characteristic, it is called ''vidradhi'' [95]

==== Three types of ''vidradhi'' ====
<div class="mw-collapsible mw-collapsed">

व्यधच्छेदभ्रमानाहशब्दस्फुरणसर्पणैः| 
वातिकीं, पैत्तिकीं तृष्णादाहमोहमदज्वरैः||९६|| 

जृम्भोत्क्लेशारुचिस्तम्भशीतकैः श्लैष्मिकीं विदुः| 
सर्वासु च  महच्छूलं विद्रधीषूपजायते||९७|| 
<div class="mw-collapsible-content">

vyadhacchēdabhramānāhaśabdasphuraṇasarpaṇaiḥ| 
vātikīṁ, paittikīṁ tr̥ṣṇādāhamōhamadajvaraiḥ||96|| 

jr̥mbhōtklēśārucistambhaśītakaiḥ ślaiṣmikīṁ viduḥ| 
sarvāsu ca  mahacchūlaṁ vidradhīṣūpajāyatē||97|| 

vyadhacchedabhramAnAhashabdasphuraNasarpaNaiH| 
vAtikIM, paittikIM tRuShNAdAhamohamadajvaraiH||96|| 

jRumbhotkleshArucistambhashItakaiH shlaiShmikIM viduH| 
sarvAsu ca [2] mahacchUlaM vidradhIShUpajAyate||97|| 
</div></div>

<div style="text-align:justify;">
All types of abscesses are very painful. Besides pain, the following symptoms may occur depending upon the [[dosha]].
#[[Vata]]ja vidradhi: A [[vata]] type of an abscess is marked by a sensation of piercing or cutting pain. It can spread all over the body and exhibits various other symptoms such as giddiness, distension of abdomen, gurgling sound and throbbing.
#[[Pitta]]ja vidradhi: Thirst, burning pain, stupefaction, intoxication and fever are the symptoms of [[pitta]]ja vidradhi.
#[[Kapha]]ja vidradhi: Yawning, retching, anorexia, rigidity and chills are the symptoms of [[kapha]] type of vidradhi [96-97]
</div>
==== Symptoms of ripened abscess ====
<div class="mw-collapsible mw-collapsed">

शस्त्रास्त्रैर्भिद्यत  इव चोल्मुकैरिव दह्यते| 
विद्रधी व्यम्लता याता वृश्चिकैरिव दश्यते||९८|| 
<div class="mw-collapsible-content">

śastrāstrairbhidyata  iva cōlmukairiva dahyatē| 
vidradhī vyamlatā yātā vr̥ścikairiva daśyatē||98|| 

shastrAstrairbhidyata [3] iva colmukairiva dahyate| 
vidradhI vyamlatA yAtA vRushcikairiva dashyate||98|| 
</div></div>

On ripening of the abscess, the patient feels pain as if cut by a weapon or as if burnt by coal or as if stung by a scorpion [98]

==== Pus discharge according to type of abscess ====
<div class="mw-collapsible mw-collapsed">

तनु रूक्षारुणं श्यावं फेनिलं वातविद्रधी| 
तिलमाषकुलत्थोदसन्निभं पित्तविद्रधी||९९|| 

श्लैष्मिकी स्रवति श्वेतं पिच्छिलं बहलं बहु| 
लक्षणं सर्वमेवैतद्भजते सान्निपातिकी||१००|| 
<div class="mw-collapsible-content">

tanu rūkṣāruṇaṁ śyāvaṁ phēnilaṁ vātavidradhī| 
tilamāṣakulatthōdasannibhaṁ pittavidradhī||99|| 

ślaiṣmikī sravati śvētaṁ picchilaṁ bahalaṁ bahu| 
lakṣaṇaṁ sarvamēvaitadbhajatē sānnipātikī||100||

tanu rUkShAruNaM shyAvaM phenilaM vAtavidradhI| 
tilamAShakulatthodasannibhaM pittavidradhI||99|| 

shlaiShmikI sravati shvetaM picchilaM bahalaM bahu| 
lakShaNaM sarvamevaitadbhajate sAnnipAtikI||100||
</div></div>

*In [[vata]] type of abscess, the discharge is thin, ununctuous, dusky-red and frothy.
*In [[pitta]] type of abscess, the discharge resembles decocted water of sesame, black-gram or horse-gram.
*In [[kapha]] type of abscess, the colour of the discharge is whitish, slimy, thick and profuse. 
*In sannipata type of vidradhi , a mix of symptoms of all the three [[dosha]] type can be found in the abscess [99-100]

==== Symptoms of ''vidradhi'' according to organ involved ====
<div class="mw-collapsible mw-collapsed">

अथासां विद्रधीनां साध्यासाध्यत्वविशेषज्ञानार्थं स्थानकृतं लिङ्गविशेषमुपदेक्ष्यामः-तत्र प्रधानमर्मजायां विद्रध्यांहृद्धट्टनतमकप्रमोहकासश्वासाः, क्लोमजायां पिपासामुखशोषगलग्रहाः, यकृज्जायां श्वासः, प्लीहजायामुच्छ्वासोपरोधः,कुक्षिजायां कुक्षिपार्श्वान्तरांसशूलं, वृक्कजायां पृष्ठकटिग्रहः, नाभिजायां हिक्का, वङ्क्षणजायां सक्थिसादः, बस्तिजायांकृच्छ्रपूतिमूत्रवर्चसत्वं  चेति||१०१|| 
<div class="mw-collapsible-content">

athāsāṁ vidradhīnāṁ sādhyāsādhyatvaviśēṣajñānārthaṁ sthānakr̥taṁ liṅgaviśēṣamupadēkṣyāmaḥ- tatrapradhānamarmajāyāṁ vidradhyāṁ hr̥ddhaṭṭanatamakapramōhakāsaśvāsāḥ, klōmajāyāṁpipāsāmukhaśōṣagalagrahāḥ, yakr̥jjāyāṁ śvāsaḥ, plīhajāyāmucchvāsōparōdhaḥ, kukṣijāyāṁkukṣipārśvāntarāṁsaśūlaṁ, vr̥kkajāyāṁ pr̥ṣṭhakaṭigrahaḥ, nābhijāyāṁ hikkā, vaṅkṣaṇajāyāṁsakthisādaḥ, bastijāyāṁ kr̥cchrapūtimūtravarcasatvaṁ  cēti||101|| 

athAsAM vidradhInAM sAdhyAsAdhyatvavisheShaj~jAnArthaM sthAnakRutaM li~ggavisheShamupadekShyAmaH- tatra pradhAnamarmajAyAM vidradhyAMhRuddhaTTanatamakapramohakAsashvAsAH, klomajAyAM pipAsAmukhashoShagalagrahAH, yakRujjAyAM shvAsaH, plIhajAyAmucchvAsoparodhaH, kukShijAyAMkukShipArshvAntarAMsashUlaM, vRukkajAyAM pRuShThakaTigrahaH, nAbhijAyAM hikkA, va~gkShaNajAyAM sakthisAdaH, bastijAyAMkRucchrapUtimUtravarcasatvaM [1] ceti||101|| 
</div></div>

Now the curability-incurability, and the symptoms of abscesses in specific bodily organs are described as follows:
<div style="text-align:justify;">
#Symptoms of ''vidradhi'' in the heart: Cardiac flutter, dyspnoea, stupefaction, cough and breathlessness are the symptoms of abscess in the heart.  
#Symptoms of ''vidradhi'' in the ''kloma'': thirst, dryness of mouth and sore throat are the symptoms of abscess in the ''kloma''.  
#Symptoms of ''vidradhi'' in the liver: Breathlessness is the symptom of abscess in the liver.  
#Symptoms of ''vidradhi'' in the spleen: Impediment of breathing is the symptom of abscess in the spleen.  
#Symptoms of ''vidradhi'' in the stomach (''kukshi''): Pain localized to the region between stomach and a side of the body (extending up to the shoulder) are the symptoms of abscess in in the stomach (''kukshi'').  
#Symptoms of ''vidradhi'' in the kidney: Rigidity of back and waist is the symptom of abscess in the kidney.  
#Symptoms of ''vidradhi'' in the navel (''nabhi''): Hiccups is the symptom of abscess in the umbilical region (''nabhi'').  
#Symptoms of ''vidradhi'' in the groin: Weakness of the thigh is the symptom of abscess in groin.  
#Symptoms of ''vidradhi'' in the urinary bladder: Painful micturition and defecation and putrid urine and faeces are the symptoms of abscess in the urinary bladder [101]
</div>
==== Route of discharge ====
<div class="mw-collapsible mw-collapsed">

पक्वप्रभिन्नासूर्ध्वजासु मुखात् स्रावः स्रवति, अधोजासु गुदात्, उभयतस्तु नाभिजासु||१०२||  
<div class="mw-collapsible-content">
              
pakvaprabhinnāsūrdhvajāsu mukhāt srāvaḥ sravati, adhōjāsu gudāt, ubhayatastu nābhijāsu||102||

pakvaprabhinnAsUrdhvajAsu mukhAt srAvaH sravati, adhojAsu gudAt, ubhayatastu nAbhijAsu||102||  
</div></div>

Suppurated internal abscesses burst and the pus is discharged. The discharge of the abscesses situated in the organs above the navel comes out from mouth, of situated below the umbilicus comes out from anus and of around the navel may come from either of the routes [102]
  
==== Prognosis of abscesses ====
<div class="mw-collapsible mw-collapsed">

आसां हृन्नाभिबस्तिजाः परिपक्वाः सान्निपातिकी च मरणाय; शेषाः पुनः कुशलमाशुप्रतिकारिणंचिकित्सकमासाद्योपशाम्यन्ति| 
तस्मादचिरोत्थितां विद्रधीं शस्त्रसर्पविद्युदग्नितुल्यां स्नेहविरेचनैराश्वेवोपक्रमेत् सर्वशो गुल्मवच्चेति||१०३|| 
<div class="mw-collapsible-content">

āsāṁ hr̥nnābhibastijāḥ paripakvāḥ sānnipātikī ca maraṇāya; śēṣāḥ punaḥ kuśalamāśupratikāriṇaṁcikitsakamāsādyōpaśāmyanti| 
tasmādacirōtthitāṁ vidradhīṁ śastrasarpavidyudagnitulyāṁ snēhavirēcanairāśvēvōpakramēt sarvaśōgulmavaccēti||103|| 

AsAM hRunnAbhibastijAH paripakvAH sAnnipAtikI ca maraNAya; sheShAH punaH kushalamAshupratikAriNaM cikitsakamAsAdyopashAmyanti| 
tasmAdacirotthitAM vidradhIM shastrasarpavidyudagnitulyAM snehavirecanairAshvevopakramet sarvasho gulmavacceti||103|| 
</div></div>

<div style="text-align:justify;">
The abscesses occurring in the heart, umbilicus and urinary bladder as well as of ''sannipātika'' type, if suppurated,  have bad prognosis and may lead to death. The remaining types of abscess, if treated immediately by an expert physician, are curable. 

Therefore immediately on appearance of the internal abscess, it should be managed promptly with effective measures that can act quickly, else it may harm just like an injury caused by a weapon, bite by a snake and burning by lightening or fire. These abscesses may be managed by oleation and purgation therapies as well as all the measures of ''gulma'' [103]
</div>

=== Possibility of ''Pidika'' without prameha ===
  <div class="mw-collapsible mw-collapsed">

भवन्ति चात्र- 
विना प्रमेहमप्येता जायन्ते दुष्टमेदसः| 
तावच्चैता न लक्ष्यन्ते यावद्वास्तुपरिग्रहः||१०४|| 
<div class="mw-collapsible-content">

bhavanti cātra- 
vinā pramēhamapyētā jāyantē duṣṭamēdasaḥ| 
tāvaccaitā na lakṣyantē yāvadvāstuparigrahaḥ||104|| 

bhavanti cAtra- 
vinA pramehamapyetA jAyante duShTamedasaH| 
tAvaccaitA na lakShyante yAvadvAstuparigrahaH||104|| 
</div></div>

Here are verses again-

Pustules (''pidika'') can also occur due to vitiation of [[meda dhatu]] in a person who is not suffering from ''prameha''. Such pustules do not become visible till they become extensive in size [104]

=== Prognosis of ''pidika'' ===
<div class="mw-collapsible mw-collapsed">

शराविका कच्छपिका जालिनी चेति दुःसहाः| 
जायन्ते ता ह्यतिबलाः प्रभूतश्लेष्ममेदसः||१०५|| 
<div class="mw-collapsible-content">

śarāvikā kacchapikā jālinī cēti duḥsahāḥ| 
jāyantē tā hyatibalāḥ prabhūtaślēṣmamēdasaḥ||105|| 

sharAvikA kacchapikA jAlinI ceti duHsahAH| 
jAyante tA hyatibalAH prabhUtashleShmamedasaH||105|| 
</div></div>

''Sharavika, kacchapika'' and ''jalini'' types of ''pidika'' are formed due to excessive [[kapha]] and [[meda dhatu]], and therefore can become very severe and cause unbearable pain [105]
<div class="mw-collapsible mw-collapsed">

सर्षपी चालजी चैव विनता विद्रधी च याः| 
साध्यः पित्तोल्बणास्तास्तु सम्भवन्त्यल्पमेदसः||१०६|| 
<div class="mw-collapsible-content">

sarṣapī cālajī caiva vinatā vidradhī ca yāḥ| 
sādhyaḥ pittōlbaṇāstāstu sambhavantyalpamēdasaḥ||106|| 

sarShapI cAlajI caiva vinatA vidradhI ca yAH| 
sAdhyaH pittolbaNAstAstu sambhavantyalpamedasaH||106|| 
</div></div>

''Sarshapi, alaji , vinata'' and ''vidradhi'' occur due to dominance of [[pitta]] in a person having less quantity of [[meda dhatu]] and are curable [106]

=== Bad prognostic ''pidika'' ===
<div class="mw-collapsible mw-collapsed">

मर्मस्वंसे गुदे पाण्योः स्तने सन्धिषु पादयोः| 
जायन्ते यस्य पिडिकाः स प्रमेही न जीवति||१०७||  
 <div class="mw-collapsible-content">
                                                                         
marmasvaṁsē gudē pāṇyōḥ stanē sandhiṣu pādayōḥ| 
jāyantē yasya piḍikāḥ sa pramēhī na jīvati||107||

marmasvaMse gude pANyoH stane sandhiShu pAdayoH| 
jAyante yasya piDikAH sa pramehI na jIvati||107||
</div></div>

A diabetic person does not survive if he gets ''pidika'' in vital-parts, shoulder, anus, hands, breast, joints, and feet [107]

=== Miscellanous ''pidika'' ===
<div class="mw-collapsible mw-collapsed">

तथाऽन्याः पिडकाः सन्ति रक्तपीतासितारुणाः| 
पाण्डुराः पाण्डुवर्णाश्च भस्माभा मेचकप्रभाः||१०८|| 

मृद्व्यश्च कठिनाश्चान्याः स्थूलाः सूक्ष्मास्तथाऽपराः| 
मन्दवेगा महावेगाः स्वल्पशूला महारुजः||१०९|| 
<div class="mw-collapsible-content">

tathā'nyāḥ piḍakāḥ santi raktapītāsitāruṇāḥ| 
pāṇḍurāḥ pāṇḍuvarṇāśca bhasmābhā mēcakaprabhāḥ||108|| 

mr̥dvyaśca kaṭhināścānyāḥ sthūlāḥ sūkṣmāstathā'parāḥ| 
mandavēgā mahāvēgāḥ svalpaśūlā mahārujaḥ||109|| 

tathA~anyAH piDakAH santi raktapItAsitAruNAH| 
pANDurAH pANDuvarNAshca bhasmAbhA mecakaprabhAH||108|| 

mRudvyashca kaThinAshcAnyAH sthUlAH sUkShmAstathA~aparAH| 
mandavegA mahAvegAH svalpashUlA mahArujaH||109|| 
</div></div>

There are some other types of papules or pustules (''pidika'') with the following characteristics:

'''Colour''': There may be some types of ''pidika'' having red, yellow, dark, dusky-red, grey, yellowish, white, ash-colour and blackish appearance.

'''Texture''': Some pustules are soft and others are hard

'''Size''': Some pustules are big and others are minute

'''Time to grow''': Some pustules are slow developing while others develop quickly 

'''Associated pain''': Some pustules are slightly painful while others are very painful. [108-109]
<div class="mw-collapsible mw-collapsed">

ता बुद्ध्वा मारुतादीनां यथास्वैर्हेतुलक्षणैः| 
ब्रूयादुपचरेच्चाशु प्रागुपद्रवदर्शनात्||११०|| 
<div class="mw-collapsible-content">

tā buddhvā mārutādīnāṁ yathāsvairhētulakṣaṇaiḥ| 
brūyādupacarēccāśu prāgupadravadarśanāt||110|| 

tA buddhvA mArutAdInAM yathAsvairhetulakShaNaiH| 
brUyAdupacareccAshu prAgupadravadarshanAt||110|| 
</div></div>

The wise physician should diagnose the above pustules on the basis of the causative factors and characteristics of involved [[dosha]] and treat these appropriately (and quickly) before these advance into complications [110]

=== Complications of pustules (''pidika'') ===
<div class="mw-collapsible mw-collapsed">

तृट्श्वासमांससङ्कोथमोहहिक्कामदज्वराः| 
वीसर्पमर्मसंरोधाः पिडकानामुपद्रवाः||१११||  
  <div class="mw-collapsible-content">
                           
tr̥ṭśvāsamāṁsasaṅkōthamōhahikkāmadajvarāḥ| 
vīsarpamarmasaṁrōdhāḥ piḍakānāmupadravāḥ||111|| 

tRuTshvAsamAMsasa~gkothamohahikkAmadajvarAH| 
vIsarpamarmasaMrodhAH piDakAnAmupadravAH||111||
</div></div>

Thirst, dyspnoea, sloughing of flesh, stupor, hiccup, toxaemia, fever, spreading inflammatory swelling and obstruction in function of the vital organs are the complications of pustules [111]

=== States (gati) of [[dosha]] ===
<div class="mw-collapsible mw-collapsed">

क्षयः स्थानं च वृद्धिश्च दोषाणां त्रिविधा गतिः|                  
ऊर्ध्वं चाधश्च तिर्यक्च विज्ञेया त्रिविधाऽपरा||११२||    
                                                                        
त्रिविधा चापरा कोष्ठशाखामर्मास्थिसन्धिषु| 
इत्युक्ता विधिभेदेन दोषाणां त्रिविधा गतिः||११३|| 
<div class="mw-collapsible-content">

kṣayaḥ sthānaṁ ca vr̥ddhiśca dōṣāṇāṁ trividhā gatiḥ| 
ūrdhvaṁ cādhaśca tiryakca vijñēyā trividhā'parā||112|| 

trividhā cāparā kōṣṭhaśākhāmarmāsthisandhiṣu| 
ityuktā vidhibhēdēna dōṣāṇāṁ trividhā gatiḥ||113||

kShayaH sthAnaM ca vRuddhishca doShANAM trividhA gatiH| 
UrdhvaM cAdhashca tiryakca vij~jeyA trividhA~aparA||112|| 

trividhA cAparA koShThashAkhAmarmAsthisandhiShu| 
ityuktA vidhibhedena doShANAM trividhA gatiH||113||
</div></div>

<div style="text-align:justify;">
Decrease, normalcy and increase are the three states of [[dosha]]. Other three courses of [[dosha]] are upward, downward and oblique/transverse movement. Yet another set of three states of [[dosha]] are by their movement to ''koshtha'' (thoraco-abdominal cavity), ''shakha'' (''tvak'' and [[dhatu]] except [[rasa dhatu]]) and vital-organs, bones and joints. Thus are described various states of [[dosha]] [112-113]
</div>

=== Seasonal course of [[dosha]] ===
<div class="mw-collapsible mw-collapsed">

चयप्रकोपप्रशमाः पित्तादीनां यथाक्रमम्| 
भवन्त्येकैकशः षट्सु कालेष्वभ्रागमादिषु||११४|| 

गतिः कालकृता चैषा चयाद्या पुनरुच्यते|११५| 
<div class="mw-collapsible-content">

cayaprakōpapraśamāḥ pittādīnāṁ yathākramam| 
bhavantyēkaikaśaḥ ṣaṭsu kālēṣvabhrāgamādiṣu||114|| 

gatiḥ kālakr̥tā caiṣā cayādyā punarucyatē|115|

cayaprakopaprashamAH pittAdInAM yathAkramam| 
bhavantyekaikashaH ShaTsu kAleShvabhrAgamAdiShu||114|| 

gatiH kAlakRutA caiShA cayAdyA punarucyate|115| 
</div></div>

<div style="text-align:justify;">
Accumulation, provocation and pacification of [[pitta]],[[vata]] and [[kapha]] respectively occur individually and sequentially in the six seasons beginning with the rainy season (e.g., [[pitta]] accumulation in rainy season, etc). These courses (of accumulation, provocation and/or pacification) of [[dosha]] are known as seasonal courses of [[dosha]].[114]
</div>

=== Physiological and pathological course of [[dosha]] ===
<div class="mw-collapsible mw-collapsed">

गतिश्च द्विविधा दृष्टा प्राकृती वैकृती च या||११५|| 

पित्तादेवोष्मणः पक्तिर्नराणामुपजायते| 
तच्च पित्तं  प्रकुपितं विकारान् कुरुते बहून्||११६|| 

प्राकृतस्तु बलं श्लेष्मा विकृतो मल उच्यते| 
स चैवौजः स्मृतः काये स च पाप्मोपदिश्यते||११७|| 

सर्वा हि चेष्टा वातेन स प्राणः प्राणीनां स्मृतः| 
तेनैव रोगा जायन्ते तेन चैवोपरुध्यते||११८|| 
<div class="mw-collapsible-content">

gatiśca dvividhā dr̥ṣṭā prākr̥tī vaikr̥tī ca yā||115|| 

pittādēvōṣmaṇaḥ paktirnarāṇāmupajāyatē| 
tacca pittaṁ  prakupitaṁ vikārān kurutē bahūn||116|| 

prākr̥tastu balaṁ ślēṣmā vikr̥tō mala ucyatē| 
sa caivaujaḥ smr̥taḥ kāyē sa ca pāpmōpadiśyatē||117|| 

sarvā hi cēṣṭā vātēna sa prāṇaḥ prāṇīnāṁ smr̥taḥ| 
tēnaiva rōgā jāyantē tēna caivōparudhyatē||118|| 

gatishca dvividhA dRuShTA prAkRutI vaikRutI ca yA||115|| 

pittAdevoShmaNaH paktirnarANAmupajAyate| 
tacca pittaM [1] prakupitaM vikArAn kurute bahUn||116|| 

prAkRutastu balaM shleShmA vikRuto mala ucyate| 
sa caivaujaH smRutaH kAye sa ca pApmopadishyate||117|| 

sarvA hi ceShTA vAtena sa prANaH prANInAM smRutaH| 
tenaiva rogA jAyante tena caivoparudhyate||118|| 
</div></div>

<div style="text-align:justify;">
Another set of courses of [[dosha]] are physiological and pathological. Normally, heat generated by [[pitta]] digests the food but when the same [[pitta]] is in a provoked state, it causes various disorders. Similarly, normal [[kapha]] contributes to body-strength but when vitiated, it becomes waste material ([[mala]]). Normal [[kapha]] is also responsible for [[ojas]], however on provocation,  it could cause various ailments in the body. 
</div>
[[Vāta]] is responsible for all types of movements in living beings and represents life of living-beings, but vitiated [[vata]] causes many diseases and is even responsible for causing death [115-118]
<div class="mw-collapsible mw-collapsed">

नित्यं सन्निहितामित्रं समीक्ष्यात्मानमात्मवान्| 
नित्यं युक्तः परिचरेदिच्छन्नायुरनित्वरम्||११९|| 
<div class="mw-collapsible-content">

nityaṁ sannihitāmitraṁ samīkṣyātmānamātmavān| 
nityaṁ yuktaḥ paricarēdicchannāyuranitvaram||119||

nityaM sannihitAmitraM samIkShyAtmAnamAtmavAn| 
nityaM yuktaH paricaredicchannAyuranitvaram||119||
</div></div>

A person desiring to live the full span of life should remain self controlled and live with great caution assuming that he is constantly surrounded by the foes to his health [119]

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

तत्र श्लोकौ- 

शिरोरोगाः सहृद्रोगा रोगा मानविकल्पजाः| 
क्षयाः सपिडकाश्चोक्ता दोषाणां गतिरेव च||१२०|| 

कियन्तःशिरसीयेऽस्मिन्नध्याये तत्त्वदर्शिना| 
ज्ञानार्थं भिषजां चैव प्रजानां च हितैषिणा||१२१||
<div class="mw-collapsible-content">

tatra ślōkau- 

śirōrōgāḥ sahr̥drōgā rōgā mānavikalpajāḥ| 
kṣayāḥ sapiḍakāścōktā dōṣāṇāṁ gatirēva ca||120|| 

kiyantaḥśirasīyē'sminnadhyāyē tattvadarśinā| 
jñānārthaṁ bhiṣajāṁ caiva prajānāṁ ca hitaiṣiṇā||121||

tatra shlokau- 

shirorogAH sahRudrogA rogA mAnavikalpajAH| 
kShayAH sapiDakAshcoktA doShANAM gatireva ca||120|| 

kiyantaHshirasIye~asminnadhyAye tattvadarshinA| 
j~jAnArthaM bhiShajAM caiva prajAnAM ca hitaiShiNA||121||
</div></div>

Here are two recapitulate verses: 
<div style="text-align:justify;">
The diagnosis of diseases of the head, diseases of the heart, diseases caused by minute pathological conditions of the ''doshas'', conditions caused by decreased ''doshas'', inflammatory swellings and various courses of ''doshas'' have been described in this chapter entitled 'how many are the diseases of the head', by the well-wisher of mankind, the great sage Atreya, for the enlightenment of the physicians [120-121]
</div>
<div class="mw-collapsible mw-collapsed">

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते श्लोकस्थाने कियन्तःशिरसीयो नाम सप्तदशोऽध्यायः||१७||
<div class="mw-collapsible-content">

Ityagniveśakr̥te Tantre Carakapratisamskr̥te ślokasthāne kiyantaḥśirasīyo Nāma saptadaśoadhyāyaḥ ||17||
</div></div>

Thus seventeenth chapter of [[Sutra Sthana]] compiled by Agnivesha and revised by Charak entitled [[Kiyanta Shiraseeya Adhyaya]] is completed (17).

== Tattva Vimarsha (Fundamental Principles) ==

*There are 107 ''marmas'' which are points of ''prana'' (vital energy) and are located in various parts of body. Three of these ''marmas'' - the head, the heart and the urinary bladder - are the most important. 
*All the control centers of sense and locomotion, along with that of ''prana'' (vital energy), are located in the head. 
*Clinical pathology involving ''rakta'' (blood), along with analysis of ''dosha'' vitiation, is essential to the diagnosis of diseases of the head.
*Diseases of the head and the heart can be identified according to the dominance of a ''dosha'' (or multiple ''doshas'') and diagnosed as per their etiology and symptomatology. 
*Various permutation and combinations of increase and decrease of ''dosha'' can occur inside the body affecting the physiological functions. 
*''Tridoshika'' disequilibrium is a precursor to diseases and their pathogenesis varies with level of ''vriddhi'' (increase) or ''kshaya'' (decrease) and a typical permutation or combination of such ''doshas'' can lead to different manifestations of the disease.
*Increased and decreased states of ''dosha'' and vitiation of a particular ''dosha'' depends upon the exposure to causative factors in diet and lifestyle. 
*The increased or decreased ''dosha'' state can be identified by clinical appearance of their increased or decreased functions. Thus clinical diagnosis based on observations is more important than pathological or radiological investigations. 
*A normal ''dosha'' can also exhibit some signs. Increased ''vata'' can pull normal ''pitta'' and ''kapha'' away to places other than their normal location to manifest their own features there.
*''Ojas'' is the first substance formed in a living being and the sustenance of life depends upon the quality and quantity of ''ojas''. Death can occur due to destruction of ''ojas''. 
*''Kapha, pitta, meda, mamsa, ojas'' and obstructed ''vata'' are important pathogenic factors in ''madhumeha'' (diabetes).
*Diseases can occur due to different states or movements of ''dosha'' like increased or decreased state, upward or downward movements, or movement from center of body to periphery or to vital centers. This also depends upon the environmental and seasonal changes.
*Digestion, temperature  and heat in the body is mainly controlled by ''pitta''. Strength of body depends upon ''kapha''. Whereas ''vata'' is responsible for all movements and and vitality.

== Vidhi Vimarsha (Applied Inferences) ==

=== Indriya buddhi (centres of senses in the brain) ===
<div style="text-align:justify;">
While describing ''pancha-panchaka'' principle of perception by five ''jnanaindriya'', [Cha.Sa.[[Sutra Sthana]] 8/3] Charak mentions five ''indriya'' (senses), five ''indriya adhisthana'' (sense organs), five ''indriya dravya'' (specific matter which enable the senses to perceive), five ''artha'' (specific objects to be perceived by sense) and five ''indriya-buddhi'' (final sensation). The five ''indriya'' are the five senses and the five ''indriya adhisthana'' are the five external sites of senses for example eyes for vision and ears for hearing, but site of  the ''indriya-buddhi'' is not mentioned. In this regard, the following observations may be taken into consideration:

Charak mentions that ''prānavāhi srotāmsi'' of ''indriya'' are situated in the head and are connected with the body as sun is connected with its rays. Therefore, diseases such as ''ardita'' (facial paralysis), ''cheshta nasha'' (paralysis) and disorders of eye movement etc. are due to trauma to the head [Ca Sii 9/4]. In this chapter, the physical location of all the ''indriya'' has been mentioned to be the head, hence on the basis of these observations, it can be concluded that the ''indriya-buddhi'' are also situated in head. ''Indriya buddhi'' is that vital part of a sense that decides the final knowledge of the perceived object. Hence sense centres situated in the cortex region of the brain represent the ''indriya buddhi'' [12]
 
'''Classification of ''shiroroga'':''' Generally, ''shiroroga'' implies any type of disease afflicting the head. Therefore, Charak enlisted diseases such as hemicrania (''ardhavabhedaka''), headache (''sarvam va rujyati shirah''), coryza (''pratishyaya''), diseases of mouth, nose, eyes and ears which cause headache (''mukha-nasa-akshi-karna-roga''), giddiness/vertigo (''sirobhramah''), facial paralysis (''ardita''), tremors of the head (''shirasah kampa'') and stiffness of the neck, nape and jaw (''gala-manya-hanu-grahah'') as ''shiroroga''. Hence, in general, shiroroga includes diseases occurring in the skull, its orifices and the structure related to it. As per this classification ''shiroroga'' includes ''vatika, paittika, kaphaja, sannipataja'' and ''krimija shiroroga''.  

In addition, in [[Siddhi Sthana]], four more diseases occurring in the head have been described in detail viz. ''shankhaka, ardhavabhedaka,'' ''suryavarta,'' and ''anantavata''. [Cha.Sa.[[Siddhi Sthana]] 9/71-87] In these ''shiroroga'', ''nasya''(nasal errhines) has been indicated. [Cha.Sa.[[Siddhi Sthana]] 9/88] In all nine ''shiroroga'' (five in this chapter, and four in [[Siddhi Sthana]]) that mention headache as a key symptom. Other varieties of ''shiroroga'' mentioned in other texts are ''raktaja'' and ''kshayaja'' <ref>Sushruta. Uttara Tantra, Cha.25 Shirorogavijnaniya Adhyaya verse 3. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref> and ''shirah-kampa''. [A.H.Uttara Sthana 23/9]<ref>Vagbhata. Uttara Sthana, Cha.23 Shororogavijnaniya Adhyaya verse 9. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>(Verse 6)

The five types of ''hridroga'' described in this chapter are also caused by vitiated ''dosha'' and ''krimi''. In all these conditions pain in the chest is a common feature, the intensity of which varies according to the involved ''dosha''. For example in ''vata'', pain is accompanied by extra systole/ fibrillation (''vepathu''), sense of emptiness in the heart region (''shunyata''), and hyperkinetic heart and thrill (''dara''). A ''pittaja'' type ''hridroga'' is indicated by a burning sensation in the precordial region with fainting, giddiness and perspiration. In ''kaphaja'' type ''hridroga'', there is heaviness in the precordial area, ''suptam'' (bradycardia or decreased diastolic stretching) and a stony sensation (pericardial calcification as in constrictive pericarditis) in heart region.

Description of ''krimija hridroga'' indicates a very serious condition. As mentioned earlier, infestation starts with one chamber of the heart and then spreads and consumes (''bhakshyanti'') tissues across the entire heart.The patient of ''krimija hridroga'' feels severe pain in the precordial region, as if heart is being pricked/pierced by needles or cut by weapons and is a very grave heart condition that may lead to immediate death. Therefore it is a severe condition and should be promptly diagnosed and managed. It may manifest as chest pain, arrhythmia, heart failure, acute myocardial infarction-like syndrome with normal coronary arteries, ventricular arrhythmia, and loss of right ventricular function leading to sudden death. (Verse 36-40).

=== ''Samsarga'' and ''Sannipata'' ===

Combination of two provoked ''doshas'' leading to a disease is known as ''samsarga'' and when all the three provoked ''doshas'' combine then it is known as ''sannipata''. In the combinations , some ''doshas'' may be in their normal state, while others may be slightly, moderately or excessively increased or in decrease state. Similarly they may be slightly, moderately or significantly decreased. In this way, on the basis of quantum of increase, decrease etc of the ''dosha'', they can be classified into 62 types (verses from 41 to 62) as follows:

*Sixty-two conditions of increased and decreased ''doshas'', including:
**25 conditions of increased ''doshas'':
***Three conditions of ''sannipata'' where one ''dosha'' is increased but the other two ''doshas'' are excessively increased in comparison.
***Three conditions of ''sannipata'' where two ''doshas'' are increased and one excessively increased
***Six conditions of ''sannipata'' where one ''dosha'' is excessively increased, the second moderately increased and third slightly increased
***One condition of ''sannipata'' where all the ''doshas'' are equally increased
***Six conditions of ''samsarga'' where one ''dosha'' is increased and the others excessively increased
***Three conditions of ''samsarga'' where both the ''doshas'' are equally increased
***Three conditions of ''sannipata'' where single ''dosha'' is increased and others are normal
**25 conditions of decreased ''dosha'': Here the ''doshas'' may be slightly decreased, moderately decreased or significantly decreased. The combinations follow the same pattern as above.
**12 conditions of ''sannipata'' where one ''dosha'' is normal, second is increased and the third is decreased.

In this way,  62 conditions of various combinations of normal, increased and decreased dosha have been mentioned in this chapter(verses from 41 to 62), of which only 12 types are described in detail. Chakrapāni mentions that combinations of ''dosha'' may occur in two ways i.e. ''prakriti-sama-samveta'' and ''vikriti-vishama-samveta''. ''Prakriti-sama-samveta'' akin to a sugar and salt solution in water where the tastes of sugar and salt remain intact and in such types of ''samsarga'' or ''sannipata'' of ''doshas'', no specific description is given in the text but simply mentioned that mix features of involved ''dosha'' will present. 

On the other hand, ''vikriti-vishama-samveta'' a combination of provoked ''doshas'' wherein new symptoms are produced that are neither of any of the ''doshas'' involved. For example, red colour appears on mixing of white lime and yellow turmeric, and in such a case the specific symptoms produced by the combination are described. Here in 17th chapter, specific symptoms of 12 types of ''vikriti-vishama-samveta'' ''sannipata'' are given in detail, but symptoms of ''sama sannipata'' are not given as it is ''prakriti-sama-samveta'' (Verses 41-72).
</div>
'''Table 1:  Clinical features of different states of ''dosha'' and ''sannipata'':''' 
{| class="wikitable"
! Sr.No. !! ''Vata'' !! ''Pitta'' !! ''Kapha '' !! Signs
|-
| rowspan="1" style="text-align: left;" | 1
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Normal
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | ''Bheda'' (unstable breaking pain) and ''Daha'' (burning sensation),''Shrama''( fatigue) and ''Daurbalya'' (weakness)''
|-
| rowspan="1" style="text-align: left;" | 1
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Normal
| rowspan="1" style="text-align: left;" | ''Shula'' (Colicky pain), ''Shaitya'' (coldness), ''Stambha'' (stiffness) and ''Gaurava'' (heaviness)
|-
| rowspan="1" style="text-align: left;" | 3
| rowspan="1" style="text-align: left;" | Normal
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | ''Daha'' (burning sensation) and colicky pain ''(Shula)''
|-
| rowspan="1" style="text-align: left;" | 4
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Normal
| rowspan="1" style="text-align: left;" | ''Jwara'' (fever) accompanied with ''Gaurava'' (heaviness) and ''Tandra'' (drowsiness)
|-
| rowspan="1" style="text-align: left;" | 5
| rowspan="1" style="text-align: left;" | Normal
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | ''Sheetaka'' (cold), ''Gaurava'' (heaviness) and ''Ruja'' (pain) 
|-
| rowspan="1" style="text-align: left;" | 6
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Normal
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | ''Mruduagni'' (slow digestion), ''Shirograha'' (stiffness of head), ''Nidra'' (excessive sleep), Tandra (drowsiness), Pralap (delirium), Hridroga (heart disorders), Gatragaurava (heaviness in the body), Nakhadi pitatva (yellowness in nails etc) and ''kapha-pitta shthivana'' (spitting of ''kapha –pitta)''
|-
| rowspan="1" style="text-align: left;" | 7
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | ''Arochaka'' (anorexia), ''Avipaka'' (indigestion), ''Sadana'' (asthenia), ''Gaurava'' (heaviness), ''Rhallasa'' (nausea), ''Aasyastrava'' (salivation), ''pandu'' (anaemia), ''Duyata'' (fumy sensation sensation of mouth, throat and palate ''(Dūyana)), Mada'' (intoxication) and ''Virekavaishmya'' (irregularity of bowels) and ''Anala vaishamya'' (irregular digestion)''
|-
| rowspan="1" style="text-align: left;" | 8
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | ''Stambha'' (stiffness), ''Shaitya''(coldness), ''Toda'' (unstable pricking pain), ''Gaurava'' (heaviness), AgniMruduta (slow digestion), Ashraddha (disinclination for food), Pravepana (tremors), Nakha shuklata (pallor of nails etc), and ''Gatraparushya'' (roughness of the body parts)
|-
| rowspan="1" style="text-align: left;" | 9
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | ''Bhrama'' (giddiness),''Udweshtana''( cramps), ''Toda'' (pricking pain), ''Daha'' (burning sensation), ''Sphutana'' ( disruption/cracks),''Vepana'' ( tremors), ''Angamarda'' (body-ache), ''Parishosha''(dehydration/wasting), fumes sensation of mouth, throat and palate and smoke from mouth''
|-
| rowspan="1" style="text-align: left;" | 10
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Obstruction of the ''Srotas,'' complete loss of movement, loss of speech and fainting
|-
| rowspan="1" style="text-align: left;" | 11
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | affecting the ''Ojas'' causes malaise ''(Glāni), indriyadaurbalya'' (asthenia of senses), ''Trushna'' (thirst), ''Murchha'' (fainting) and ''Kriyakshayam'' (decreased physiological functions).
|-
| rowspan="1" style="text-align: left;" | 12
| rowspan="1" style="text-align: left;" | Increased
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Decreased
| rowspan="1" style="text-align: left;" | Compression of the vital centres, destroys consciousness or excessively trembles the whole body
|-
|}

'''''Ojas''''': 
Ojas is well known and defined  in [[Ayurveda]] in terms of its functions, its importance, its types and its sites of functions within the body. It has been described in this text as a clear and slightly red-yellowish fluid situated in the heart is known as ''ojas'', the destruction of which leads to death. Its colour resembles to that of ''ghee'', taste is like honey and its smell is like that of roasted paddy (Verses 73-75). But its interpretation in modern physiological terms is confusing. In this chapter a hint has been given in this regard that ''ojas'' is a first thing created in the body of all living creatures. The symptoms of diminished ''ojas'' include timidity, debility, constant worry, discomfort of the senses, loss of lustre, neurasthenia, dryness and emaciation.

'''''Avarita madhumeha (type 2 Diabetes mellitus)''''': 
Two scenarios that cause  provocation of ''vata'' have been mentioned: decrease of ''dhatu'' (''dhatu kshaya'') and ''avarana''(cover).[Cha.Sa.[[Chikitsa Sthana]] 28/59] The description of ''madhumeha'', provided earlier in this chapter, provides a good example of ''avarana''.That a provoked or vitiated ''vata'' causes ''madhumeha'' has also been reiterated in the [[Nidana Sthana]]. All the factors that cause decrease of body tissues lead to provocation of ''vāta''. But even though ''madhumeha'' is caused by a vitiated ''vata'', its etiological factors also cause an increase in ''kapha'' and ''pitta''. The comparison of ''nidana'' of ''madhumeha'' mentioned in these two different references is tabulated here:

'''Table 2: Difference between two contexts of ''Madhumeha'':'''
{| class="wikitable"
! Causative Factors !! Causative factors of ''Dhatu kshayaja Vataja Madhumeha(Nidana Sthana)'' !! Causative factors of ''Aavaranjanya vataja Madhumeha ( Sutra Sthana)'' 
|-
| rowspan="1" style="text-align: left;" | Excessive use of ''Rasa'' (Taste)
| rowspan="1" style="text-align: center;" | Indulgence in intake of ''katu, tikta, kashaya rasa'' dominant food articles 
| rowspan="1" style="text-align: left;" | Indulgence in intake of, ''lavana'' and ''amla  rasa'' dominant food articles 
|-
| rowspan="1" style="text-align: left;" |Excessive use of ''Guna''
| rowspan="1" style="text-align: left;" | ''ruksha, laghu, shita, ''
| rowspan="1" style="text-align: left;" | ''guru, snigdha, navam-anna-pana''
|-
| rowspan="1" style="text-align: left;" | Food habit
| rowspan="1" style="text-align: left;" | ''langhana''
| rowspan="1" style="text-align: left;" | ''samashana''
|-
| rowspan="1" style="text-align: left;" | Life style
| rowspan="1" style="text-align: left;" | Excessive indulgence in sex, exercise, late night awakening,
| rowspan="1" style="text-align: left;" | Excessive sleep, or sedentary life style with no physical activities 
|-
| rowspan="1" style="text-align: left;" | ''Shodhana''
| rowspan="1" style="text-align: left;" | Excessive ''shodhana''
| rowspan="1" style="text-align: left;" | ''ashodhana''
|-
| rowspan="1" style="text-align: left;" | Mental factors
| rowspan="1" style="text-align: left;" | ''udvega''
| rowspan="1" style="text-align: left;" | ''tyakta-chintaa''
|-
| rowspan="1" style="text-align: left;" | Increase of 
| rowspan="1" style="text-align: left;" | ''vata''
| rowspan="1" style="text-align: left;" | Increase of ''kapha, pitta, medas, mamsa'' and ''aavirita Vata''
|-
|}
<div style="text-align:justify;">
It is obvious from the above table that in case of ''avarita'', ''madhumeha'' initially causes an increase in ''kapha, pitta, meda'' and ''māmsa'' leading to an obstruction of functional pathways of ''vata,'' furthering its provocation, thereby increasing the severity of ''madhumeha''. In such a condition, the treatment is ''apatarpana'' and not of ''vata'' i.e. ''santarpana'' (Verses 78-81). 

''Prameha pidika'' mentioned in this chapter usually occurs as a complication of ''avaranjanaya samprapti'' of ''madhumeha'' as ''medas dushti'' occurs in this type of ''madhumeha'', the factor, a must for pathogenesis of ''prameha pidika''. This resembles with presentation of metabolic syndrome which includes dys-lipidemia (Verse 82-111). 

Charak has mentioned seven varieties of ''prameha pidika'' whereas Sushruta and Vagbhata have added three more to this list that includes ''masoorika, putrini'' and ''vidarika''.

The ''shiroroga'' described in this chapter are various clinical presentations of headache depending upon ''dosha'' dominance and ''krimi'' infestation. ''Krimi'' in [[Ayurveda]] is a generic term for a large number of pathological organisms ranging from microorganisms found in blood (''raktaja krimi'') to intestinal worms as well as external parasites such as lice. [Cha.Sa.[[Vimana Sthana]] 7/11-13]

As mentioned earlier in the document, the diseases of the  head (verses 13-14) include hemicrania, coryza, headache (caused as a side-effect of diseases of the mouth, nose, eyes and ears), giddiness/vertigo, facial paralysis, tremors of the head, and stiffness of the neck, nape and jaw (there are additional varieties of ''shiroroga'' viz. frontal sinusitis, trigeminal neuralgia, and ''shankhaka'' are also described. [Cha.Sa.[[Siddhi Sthana]] 9/70-87]

In contemporary science, headache is not a disease and can be vascular, myogenic, cervicogenic, and inflammatory in origin. The drug choices also depend upon the causative factors of headache. Similarly in [[Ayurveda]], though headache is a common manifestation of all five types of diseases of the head, different forms of headache can give an idea of ''dosha'' predominance which may further decide the preference of procedures or drug in its treatment. 

The term headache implies pain in the region of cranial vault which is one of the most common and difficult clinical problems in medicine and can be due to serious intracranial conditions like raised intracranial pressure or space occupying lesion or various inflammatory changes of brain tissue or meninges. Further, any pain in the head may also be due to lesions in nearby structures such as the eyes and ear causing referred headache. 

The forms or manifestations of headache (and referred headache) associated with a ''shiroroga'' may include migraine, stress induced headache, cluster headache, chronic paroxysmal hemicraina, and  miscellaneous forms not associated with structural lesions or headache associated with vascular disorders.

Similarly the five presentations of heart diseases have also been mentioned in this chapter that resemble different manifestations of chest pain and could be in the form of angina, pain associated with myocardial infarction and dissecting aortic aneurysm, pericarditis, oesophageal spasm, or musculo-skeletal chest pain. The clinical picture of cardiac disorders is quite similar to the features of ''hridroga'' mentioned in [[Charak Samhita]], such as choking or constriction, squeezing, crushing, burning or aching chest pain, or a feeling of sharp, tearing or stabbing chest pain that is usually felt retrosternally and may radiate to the left arm or more rarely to the right arm and then to the throat, jaws and teeth, or through the back. In addition to the individual features of five types of ''hridaroga'', in [[Chikitsa Sthana]], the general sign and symptoms of  ''hridroga'' such as  discolouration, syncope, fever, cough, hiccups, dyspnoea, vomiting, water brash, chest discomfort, indigestion or distaste of mouth are also mentioned. [Cha.Sa.[[Chikitsa Sthana]] 26/78] These are  mentioned as common symptoms of heart disease in medicine books.

Carbuncles are common complications occurring in uncontrolled diabetes patients where the infection spreads extensively in the dermal and underlying soft tissue. This presents itself as a  complex localized abscess or as several separate abscesses with multiple discharge sinuses usually caused due to staphylococcus aureus infection.  

Thus, this chapter is very important as it deals with the disorders of three vital parts of the body (''trimarma''). It also describes very important aspects of pathogenesis caused due to combinations of vitiated ''dosha'' viz. ''samsarga'' and ''sannipata''. The description of ''ojas'' is a unique concept of [[Ayurveda]]. The detailed descriptions along with etiological factors of each ''prameha pidika'' are very helpful in planning their prevention and cure.
</div>
====Table 3: Types of Pidika in different classics:====
{| class="wikitable"
! Sr. No. !! Types of ''Pidikā'' !! ''Charak'' !! ''Sushruta'' !! ''Vagbhata'' !! ''Bhoj'' !! ''Kāshypa''
|-
| rowspan="1" style="text-align: left;" | 1
| rowspan="1" style="text-align: left;" | ''Sharavika''
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
|-
| rowspan="1" style="text-align: left;" | 2
| rowspan="1" style="text-align: left;" | ''Kacchapika''
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | ''Kurmika''
| rowspan="1" style="text-align: left;" | +
|-
| rowspan="1" style="text-align: left;" | 3
| rowspan="1" style="text-align: left;" | ''jalini ''
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
|-
| rowspan="1" style="text-align: left;" | 4
| rowspan="1" style="text-align: left;" | ''sarṣhapi''
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | ''sarṣapikā''
| rowspan="1" style="text-align: left;" | ''sarṣapikā''
| rowspan="1" style="text-align: left;" | ''sarṣapikā''
|-
| rowspan="1" style="text-align: left;" | 5
| rowspan="1" style="text-align: left;" | ''Alaji''
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
|-
| rowspan="1" style="text-align: left;" | 6
| rowspan="1" style="text-align: left;" | ''Vinata''
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | -
| rowspan="1" style="text-align: left;" | +
|-
| rowspan="1" style="text-align: left;" | 7
| rowspan="1" style="text-align: left;" | ''Vidradhi''
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
|-
| rowspan="1" style="text-align: left;" | 8
| rowspan="1" style="text-align: left;" | ''Masurika''
| rowspan="1" style="text-align: left;" | -
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | ''Kullathika''
| rowspan="1" style="text-align: left;" | ''Arunshīka''
|-
| rowspan="1" style="text-align: left;" | 9
| rowspan="1" style="text-align: left;" | ''Putrini''
| rowspan="1" style="text-align: left;" | -
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | ''Putrika''
| rowspan="1" style="text-align: left;" | -
|-
| rowspan="1" style="text-align: left;" | 10
| rowspan="1" style="text-align: left;" | ''Vidarīka''
| rowspan="1" style="text-align: left;" | -
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | +
| rowspan="1" style="text-align: left;" | -
|-
|}
(Verse 82-83)

====Table 4:Types of ''Vidradhi'' :====
{| class="wikitable" 
|-
| rowspan="1" style="text-align: left;" | ''Vidradhi sthana''
| rowspan="1" style="text-align: left;" | Symptom
|-
| rowspan="1" style="text-align: left;" | ''Pradhanamarma (hr̥daya)''
| rowspan="1" style="text-align: left;" | ''hriddhaṭṭana'' (Palpitation)<br><hr>''Tamak'' (dyspnoea)<br><hr>''Pramoha''<br><hr>''Kasa'' (cough)<br><hr>''Shvasa'' (breathlessness)
|-
| rowspan="1" style="text-align: left;" | ''Kloma''
| rowspan="1" style="text-align: left;" | ''Pipasa'' (dipsia)<br><hr>''mukhashosha'' (dryness of mouth)<br><hr>''Galagraha''
|-
| rowspan="1" style="text-align: left;" | ''yakrit''
| rowspan="1" style="text-align: left;" | ''Shvasa'' (Breathlessness)
|-
| rowspan="1" style="text-align: left;" | ''Pliha''
| rowspan="1" style="text-align: left;" | ''Ucchvasoparodha'' (Impediment of breathing)
|-
| rowspan="1" style="text-align: left;" | ''kukshi''
| rowspan="1" style="text-align: left;" | ''kukṣhi parshvantaram sa shulam'' (Pain referred to the region between side of abdomen extending up to flanks)
|-
| rowspan="1" style="text-align: left;" | ''vrukka''
| rowspan="1" style="text-align: left;" | ''prishtha kaṭi graham'' (stiffness of back and waist)
|-
| rowspan="1" style="text-align: left;" | ''Nabhi''
| rowspan="1" style="text-align: left;" | ''Hikka'' (hiccups)
|-
| rowspan="1" style="text-align: left;" | ''vankshana''
| rowspan="1" style="text-align: left;" | ''Sakthisada'' (Weakness of the thigh)
|-
| rowspan="1" style="text-align: left;" | ''Basti''
| rowspan="1" style="text-align: left;" | ''kricchra puti mutra varchasatvam''  (Painful micturition and defecation and putrid urine and faeces)
|- 
|} (Verse 101)
'''Chart 1 : Different states of dosha''' 
[[File:Dōṣāṇāṁ.png]]

== Related Chapters ==
* [[Trimarmiya Chikitsa]] 
* [[Trimarmiya Siddhi]]

==References==
 
<div id="BackToTop"  class="noprint" style="background-color:#DDEFDD; position:fixed;
 bottom:32px; left:2%; z-index:9999; padding:0; margin:0;"><span style="color:blue;
 font-size:8pt; font-face:verdana,sans-serif;  border:0.2em outset #ceebf7;
 padding:0.1em; font-weight:bolder; -moz-border-radius:8px; ">
[[#top| Back to the Top ]]</span></div>