Changes

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 ''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 [[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 k''apha, 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 ''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 [[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 k''apha, 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.

===Sanskrit text, transliteration and english translation===

===Sanskrit Text, Transliteration and English Translation===

१७. कियन्तःशिरसीयोऽध्यायः

१७. कियन्तःशिरसीयोऽध्यायः

17th Chapter ' kiyantaḥ-śirasīyam-adhyāyaṁ’ (How many are the diseases of head?)'

 

17th Chapter ' kiyantaḥ-śirasīyam-adhyāyaṁ’ (literally, How many are the diseases of the head?)'

 

अथातः कियन्तःशिरसीयमध्यायं व्याख्यास्यामः||१||  

अथातः कियन्तःशिरसीयमध्यायं व्याख्यास्यामः||१||  

इति ह स्माह भगवानात्रेयः||२||  

इति ह स्माह भगवानात्रेयः||२||  

Athātaḥ kiyantaḥśirasīyamadhyāyaṁ vyākhyāsyāmaḥ||1||  

Athātaḥ kiyantaḥśirasīyamadhyāyaṁ vyākhyāsyāmaḥ||1||  

iti ha smāha bhagavānātrēyaḥ||2||  

iti ha smāha bhagavānātrēyaḥ||2||  

athAtaH kiyantaHshirasIyamadhyAyaM vyAkhyAsyAmaH||1||  

athAtaH kiyantaHshirasIyamadhyAyaM vyAkhyAsyAmaH||1||  

iti ha smAha bhagavAnAtreyaH||2||  

iti ha smAha bhagavAnAtreyaH||2||  

Now we will expond the chapter on 'How many diseases are of the head?’ Lord Atreya has described it as follow:  (1-2)

 

Queries by Agnivesha:

Now we will expound the chapter on 'How many diseases are of the head?’ Thus said Lord Atreya.  [1-2]

 

==== Queries by Agnivesha ====

 

कियन्तः शिरसि प्रोक्ता रोगा हृदि च देहिनाम्|  

कियन्तः शिरसि प्रोक्ता रोगा हृदि च देहिनाम्|  

कति चाप्यनिलादीनां रोगा मानविकल्पजाः||३||  

कति चाप्यनिलादीनां रोगा मानविकल्पजाः||३||  

क्षयाः कति समाख्याताः पिडकाः कति चानघ!|  

क्षयाः कति समाख्याताः पिडकाः कति चानघ!|  

गतिः कतिविधा चोक्ता दोषाणां दोषसूदन!||४||  

गतिः कतिविधा चोक्ता दोषाणां दोषसूदन!||४||  

kiyantaḥ śirasi prōktā rōgā hr̥di ca dēhinām|  

kiyantaḥ śirasi prōktā rōgā hr̥di ca dēhinām|  

kati cāpyanilādīnāṁ rōgā mānavikalpajāḥ||3||  

kati cāpyanilādīnāṁ rōgā mānavikalpajāḥ||3||  

kṣayāḥ kati samākhyātāḥ piḍakāḥ kati cānagha!|  

kṣayāḥ kati samākhyātāḥ piḍakāḥ kati cānagha!|  

gatiḥ katividhā cōktā dōṣāṇāṁ dōṣasūdana!||4||  

gatiḥ katividhā cōktā dōṣāṇāṁ dōṣasūdana!||4||  

kiyantaH shirasi proktA rogA hRudi ca dehinAm|  

kiyantaH shirasi proktA rogA hRudi ca dehinAm|  

kati cApyanilAdInAM rogA mAnavikalpajAH||3||  

kati cApyanilAdInAM rogA mAnavikalpajAH||3||  

kShayAH kati samAkhyAtAH piDakAH kati cAnagha!|  

kShayAH kati samAkhyAtAH piDakAH kati cAnagha!|  

gatiH katividhA coktA doShANAM doShasUdana!||4||  

gatiH katividhA coktA doShANAM doShasUdana!||4||  

(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)      

(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 ''doshas''? 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]

Answers by Atreya:

      

==== Answers by Atreya ====

 

हुताशवेशस्य वचस्तच्छ्रुत्वा  गुरुरब्रवीत्|  

हुताशवेशस्य वचस्तच्छ्रुत्वा  गुरुरब्रवीत्|  

पृष्टवानसि यत् सौम्य! तन्मे शृणु सविस्तरम्||५||  

पृष्टवानसि यत् सौम्य! तन्मे शृणु सविस्तरम्||५||  

hutāśavēśasya vacastacchrutvā  gururabravīt|  

hutāśavēśasya vacastacchrutvā  gururabravīt|  

pr̥ṣṭavānasi yat saumya! tanmē śr̥ṇu savistaram||5||  

pr̥ṣṭavānasi yat saumya! tanmē śr̥ṇu savistaram||5||  

hutAshaveshasya vacastacchrutvA [1] gururabravIt|  

hutAshaveshasya vacastacchrutvA [1] gururabravIt|  

pRuShTavAnasi yat saumya! tanme shRuNu savistaram||5||  

pRuShTavAnasi yat saumya! tanme shRuNu savistaram||5||  

On hearing the above questions of Agnivesha, Guru Atreya said “O gentle one! Hear me for the detailed description” (5).  

 

Number of diseases:

On hearing the above questions of Agnivesha, Guru Atreya said “O gentle one! Hear me for the detailed description” [5]

   

==== Number of diseases ====

 

दृष्टाः पञ्च शिरोरोगाः पञ्चैव हृदयामयाः|  

दृष्टाः पञ्च शिरोरोगाः पञ्चैव हृदयामयाः|  

व्याधीनां ह्यधिका षष्टिर्दोषमानविकल्पजा||६||  

व्याधीनां ह्यधिका षष्टिर्दोषमानविकल्पजा||६||  

dr̥ṣṭāḥ pañca śirōrōgāḥ pañcaiva hr̥dayāmayāḥ|  

dr̥ṣṭāḥ pañca śirōrōgāḥ pañcaiva hr̥dayāmayāḥ|  

vyādhīnāṁ hyadhikā ṣaṣṭirdōṣamānavikalpajā||6||  

vyādhīnāṁ hyadhikā ṣaṣṭirdōṣamānavikalpajā||6||  

dRuShTAH pa~jca shirorogAH pa~jcaiva hRudayAmayAH|  

dRuShTAH pa~jca shirorogAH pa~jcaiva hRudayAmayAH|  

vyAdhInAM hyadhikA ShaShTirdoShamAnavikalpajA||6||  

vyAdhInAM hyadhikA ShaShTirdoShamAnavikalpajA||6||  

“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).  

“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]  

दशाष्टौ च क्षयाः सप्त पिडका माधुमेहिकाः|  

दशाष्टौ च क्षयाः सप्त पिडका माधुमेहिकाः|  

दोषाणां त्रिविधा चोक्ता गतिर्विस्तरतः  शृणु||७||

दोषाणां त्रिविधा चोक्ता गतिर्विस्तरतः  शृणु||७||

daśāṣṭau ca kṣayāḥ sapta piḍakā mādhumēhikāḥ|  

daśāṣṭau ca kṣayāḥ sapta piḍakā mādhumēhikāḥ|  

dōṣāṇāṁ trividhā cōktā gatirvistarataḥ  śr̥ṇu||7||  

dōṣāṇāṁ trividhā cōktā gatirvistarataḥ  śr̥ṇu||7||  

dashAShTau ca kShayAH sapta piDakA mAdhumehikAH|  

dashAShTau ca kShayAH sapta piDakA mAdhumehikAH|  

doShANAM trividhA coktA gatirvistarataH [2] shRuNu||7||  

doShANAM trividhA coktA gatirvistarataH [2] shRuNu||7||  

“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).

“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:

Causes of diseases of head:

सन्धारणाद्दिवास्वप्नाद्रात्रौ जागरणान्मदात्|  

सन्धारणाद्दिवास्वप्नाद्रात्रौ जागरणान्मदात्|