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The present chapter begins with an enumeration of diseases afflicting the head and describes the significance of head, followed by the description of five varieties of head diseases with headache as the main symptom and five types of heart diseases with different clinical presentations. Thereafter, sixty two permutations and combinations in the form of sannipata (involvement of three doshas) and samsarga (involvement of two doshas), based on variations in quantum of increased or decreased state of involved doshas, along with descriptions of symptoms of twelve varieties of sannipata have been described in this chapter. Also described are eighteen conditions caused by decrease of doshas, dhatus, mala and ojas, along with plausible reasons for all the decrease taking place in the body. Further, definition and characteristics of ojas have been provided in brief with a specific variety of avrita Madhumeha (diabetes due to obstructive vata) in which ojas is excreted out in urine. The description of avrita madhumeha resembles diabetes mellitus type II (NIDDM) and seems to represent the disease of third marma (vital organ) i.e. basti. Skin infection is a common complication of diabetes mellitus. Therefore it is described in detail under the heading of prameha pidika (carbuncles). Seven types of inflammatory swellings viz. sharavika, kacchapika, jalini, sarshapi, alaji, vinata and vidradhi are described in detail with a disclaimer stating that these can also occur independently due to vitiation of medas. The chapter ends with references to various gati (states) of dosha that are related to health as well as disease.

The present chapter begins with an enumeration of diseases afflicting the head and describes the significance of head, followed by the description of five varieties of head diseases with headache as the main symptom and five types of heart diseases with different clinical presentations. Thereafter, sixty two permutations and combinations in the form of sannipata (involvement of three doshas) and samsarga (involvement of two doshas), based on variations in quantum of increased or decreased state of involved doshas, along with descriptions of symptoms of twelve varieties of sannipata have been described in this chapter. Also described are eighteen conditions caused by decrease of doshas, dhatus, mala and ojas, along with plausible reasons for all the decrease taking place in the body. Further, definition and characteristics of ojas have been provided in brief with a specific variety of avrita Madhumeha (diabetes due to obstructive vata) in which ojas is excreted out in urine. The description of avrita madhumeha resembles diabetes mellitus type II (NIDDM) and seems to represent the disease of third marma (vital organ) i.e. basti. Skin infection is a common complication of diabetes mellitus. Therefore it is described in detail under the heading of prameha pidika (carbuncles). Seven types of inflammatory swellings viz. sharavika, kacchapika, jalini, sarshapi, alaji, vinata and vidradhi are described in detail with a disclaimer stating that these can also occur independently due to vitiation of medas. The chapter ends with references to various gati (states) of dosha that are related to health as well as disease.

The diseases related to trimarma, or the three vital organs,  have also been described in the 26th chapter of Chikitsa sthana (titled Trimarmiya Chikitsa adhyaya) and later in 9th chapter of Siddhi sthana (titled Trimarmiya Siddhi Adhyaya). While the Sutrasthana helps provide the fundamental approaches to treating these diseases, the Chikitsa Sthana primarily addresses the management aspects and Siddhisthana 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, Charaka has given utmost importance to the head, the heart and the urinary bladder. Among these three, the head is foremost as it is central to all senses and is the prime location of prana. This is the reason why other texts have compared human body with an inverted-tree model (with roots at the top and branches at the bottom).

The diseases related to trimarma, or the three vital organs,  have also been described in the 26th chapter of Chikitsa sthana (titled Trimarmiya Chikitsa adhyaya) and later in 9th chapter of Siddhi sthana (titled Trimarmiya Siddhi Adhyaya). While the Sutrasthana helps provide the fundamental approaches to treating these diseases, the Chikitsa Sthana primarily addresses the management aspects and Siddhisthana 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, Charaka 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 siroroga, or the disease(s) of the head, are various clinical representations of headache and vary depending upon dosha-dominance and krimi-infestation. Though headache is a common form of five major types of siroroga, 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 doṣha predominance and krimi infestation.  

The ''siroroga'', or the disease(s) of the head, are various clinical representations of headache and vary depending upon ''dosha''-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''siroroga'', 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 doṣha predominance and krimi infestation.  

Various permutations and combinations of dosha have been analysed 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 aashayaapkarsha (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 samprāpti (variable pathogenesis) can be a reason for such varied presentations of the disease, since per vikalpa samprāpti, 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 Charaka Samhita. In the first type, dhātukshaya (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) (Charaka Nidana 4/36-44). In the second type, there is an initial involvement of kapha, pitta, mamsa and medas dhātu, 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, medas and mamsa dushti are also observed. Here, therefore, the main line of treatment (i.e., for Type 2) involves pacifying  kapha, pitta, medas and mamsa. Various gati of dosha that are responsible for healthy and diseased states are dealt at the end of the chapter. Charaka 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.

Various permutations and combinations of dosha have been analysed 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 aashayaapkarsha (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 Charaka Samhita. In the first type, dhātukshaya (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) (Charaka Nidana 4/36-44). In the second type, there is an initial involvement of kapha, pitta, mamsa and medas dhātu, 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, medas and mamsa dushti are also observed. Here, therefore, the main line of treatment (i.e., for Type 2) involves pacifying  kapha, pitta, medas and mamsa. Various gati of dosha that are responsible for healthy and diseased states are dealt at the end of the chapter. Charaka 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.

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