Changes

*In present era we do not predict prognosis by prodromal symptoms except in few cases as prodromal symptoms are not exactly known in most of the diseases. Due to ambiguity, prodromal symptoms are not considered reliable and this might be the reason they are not given importance in disease diagnosis and prognosis. [Verse No.3-5]

*In present era we do not predict prognosis by prodromal symptoms except in few cases as prodromal symptoms are not exactly known in most of the diseases. Due to ambiguity, prodromal symptoms are not considered reliable and this might be the reason they are not given importance in disease diagnosis and prognosis. [Verse No.3-5]

*In the example of tuberculosis, if person is severely debilitated and then consumption is occurring then there are more chances that he will succumb to disease. Persistence of cause like sexual indulgence in such condition will further precipitate the possibility of fatality. Here one point is noticeable that rhinorrhea is not a symptom of tuberculosis. It can occur as complication of extra-pulmonary tuberculosis which may lead to bony erosion, out-pouching of the dura, CSF leak, and subsequent bacterial meningitis which is a fatal condition. This condition suggests that if severe complications are occurring earlier than manifestation of cardinal feature of the disease, it indicates poor prognosis of disease.[10] This rule applies to all other diseases: if prior health status of person is poor, he continues to partake etiological agents and complications are appearing in very early stage then disease produced in future will be fatal in nature.

*In the example of tuberculosis, if person is severely debilitated and then consumption is occurring then there are more chances that he will succumb to disease. Persistence of cause like sexual indulgence in such condition will further precipitate the possibility of fatality. Here one point is noticeable that rhinorrhea is not a symptom of tuberculosis. It can occur as complication of extra-pulmonary tuberculosis which may lead to bony erosion, out-pouching of the dura, CSF leak, and subsequent bacterial meningitis which is a fatal condition. This condition suggests that if severe complications are occurring earlier than manifestation of cardinal feature of the disease, it indicates poor prognosis of disease.<ref>Waqas Wahid Baig et al., Spontaneous Cerebrospinal Fluid Rhinorrhea with Pneumocephalus: An Unusual Manifestation of Nasal Tuberculosis, Korean J Intern Med. 2012 September; 27(3): 350–352 </ref> This rule applies to all other diseases: if prior health status of person is poor, he continues to partake etiological agents and complications are appearing in very early stage then disease produced in future will be fatal in nature.

*Horrible dreams in a person indicate the decreased mental strength of the person. ‘Mind’ is component of health and patient can combat diseases easily with strong mind and will power. Disease is always difficult to cure in a depressed person with low will power. This might be a reason why Charaka has mentioned importance of dreams while predicting prognosis of any disease. Lifestyle has changed since this text was composed, the type of dreams and their interpretation should also be changed, requiring research. We often give importance to ''sharira doshas'' and neglect the importance of ''manasa doshas'' in causation and continuation of disease process. Perhaps this chapter gives us a scope to view things from different dimension. For all dreams the role of ''manasa doshas'' are pivotal. This needs further research [Verse No.6-9]

*Horrible dreams in a person indicate the decreased mental strength of the person. ‘Mind’ is component of health and patient can combat diseases easily with strong mind and will power. Disease is always difficult to cure in a depressed person with low will power. This might be a reason why Charaka has mentioned importance of dreams while predicting prognosis of any disease. Lifestyle has changed since this text was composed, the type of dreams and their interpretation should also be changed, requiring research. We often give importance to ''sharira doshas'' and neglect the importance of ''manasa doshas'' in causation and continuation of disease process. Perhaps this chapter gives us a scope to view things from different dimension. For all dreams the role of ''manasa doshas'' are pivotal. This needs further research [Verse No.6-9]

*From above verse it can be inferred that delirium before bleeding disorders will be fatal for the patient. Important cause of delirium is old age and other risk factors are poor overall health, anemia, malnutrition, underlying medical or neurologic illness etc. [11] If we critically analyze these factors we can infer that each of these will deteriorate general condition  of the patient and so even slight bleeding can produce fatal results in such persons. [Verse No.10-11]

*From above verse it can be inferred that delirium before bleeding disorders will be fatal for the patient. Important cause of delirium is old age and other risk factors are poor overall health, anemia, malnutrition, underlying medical or neurologic illness etc.<ref>Harrison’s-Principles of Internal Medicine-17th edition, The McGraw-Hill Companies, Inc,chapter 26 </ref> If we critically analyze these factors we can infer that each of these will deteriorate general condition  of the patient and so even slight bleeding can produce fatal results in such persons. [Verse No.10-11]

*''Kushta'' literally means discoloration, disgrace, disfiguration of the normal skin texture. From above verse it can be inferred that here ''kushta'' wound refers to non healing ulcers of leprosy. Leprosy is a chronic infectious disease caused by Mycobacterium Leprae, the only pathogenic bacteria able to infect peripheral nerves. About 30% of people with leprosy develop nerve damage. Neural impairment results in a set of sensitive, motor and autonomic disturbances, with ulcers originating primarily on the hands and feet. Neuropathic ulcers are one of the most common squeal of leprosy, but little is known about their clinical and epidemiological aspects. [12] If wounds are occurring before change in normal texture of skin it shows that wounds are occurring in prodromal stage and sensory loss has occurred till this stage and so slight injuries are resulting into wound formation. Such condition will lead to late diagnosis and hence chances of recovery will be minimal. [Verse No.14-15]

*''Kushta'' literally means discoloration, disgrace, disfiguration of the normal skin texture. From above verse it can be inferred that here ''kushta'' wound refers to non healing ulcers of leprosy. Leprosy is a chronic infectious disease caused by Mycobacterium Leprae, the only pathogenic bacteria able to infect peripheral nerves. About 30% of people with leprosy develop nerve damage. Neural impairment results in a set of sensitive, motor and autonomic disturbances, with ulcers originating primarily on the hands and feet. Neuropathic ulcers are one of the most common squeal of leprosy, but little is known about their clinical and epidemiological aspects.<ref>Josafá G Barreto, Claudio G Salgado, Clinic-epidemiological evaluation of ulcers in patients with leprosy sequelae and the effect of low level laser therapy on wound healing: a randomized clinical trial, BMC Infect Dis. 2010; 10: 237 </ref> If wounds are occurring before change in normal texture of skin it shows that wounds are occurring in prodromal stage and sensory loss has occurred till this stage and so slight injuries are resulting into wound formation. Such condition will lead to late diagnosis and hence chances of recovery will be minimal. [Verse No.14-15]

*Symptoms mentioned above in prodromal symptoms of ''unmada'' are negative symptoms and so there are chances of more suicidal tendency which is a major cause of death in ''unmada''. The presence and duration of prodromal symptoms may predict outcome in schizophrenia, that is, long duration of prodromal symptoms may be indicative of poor prognosis. [14]

*Symptoms mentioned above in prodromal symptoms of ''unmada'' are negative symptoms and so there are chances of more suicidal tendency which is a major cause of death in ''unmada''. The presence and duration of prodromal symptoms may predict outcome in schizophrenia, that is, long duration of prodromal symptoms may be indicative of poor prognosis.<ref>Chapman, L.J.; Day, D.; and Burstein, A. The process-reactive distinction and prognosis in schizophrenia. Journal of Nervous and Mental Disease, 133:383-391, 1961. </ref>

*Aura are common in seizures of occipital or temporal lobe origin in patients with focal epileptic seizures. [15] Patients with refractory temporal lobe epilepsy (TLE) have an increased risk of sudden death that is 50 times greater than that in the general population. So if hallucinations are present in epilepsy they indicate grave prognosis. [Verse No.18-23]

*Aura are common in seizures of occipital or temporal lobe origin in patients with focal epileptic seizures.<ref>Christian G. Bien, Felix O. Benninger, Horst Urbach, Johannes Schramm, Martin Kurthen, Christian E. Elger, Localizing value of epileptic visual auras Brain (2000) 123 (2): 244-253. </ref> Patients with refractory temporal lobe epilepsy (TLE) have an increased risk of sudden death that is 50 times greater than that in the general population. So if hallucinations are present in epilepsy they indicate grave prognosis. [Verse No.18-23]

*As mentioned earlier dreams are replica of mind and such kinds of dream represents weak and feeble mental status which is not strong enough to fight diseases properly. So if such dreams are frequently seen by patients they will have poor rate of recovery as compared to patient with strong mind and will power. [Verse No.27-40]

*As mentioned earlier dreams are replica of mind and such kinds of dream represents weak and feeble mental status which is not strong enough to fight diseases properly. So if such dreams are frequently seen by patients they will have poor rate of recovery as compared to patient with strong mind and will power. [Verse No.27-40]

*In modern era, during late 19th century, psychotherapist Sigmund Freud gave emphasis on dream connection with mind in his famous book ‘The interpretation of dreams’. He developed a theory that the content of dreams is driven by unconscious wish fulfillment. [16] Presently dream is defined as successions of images, ideas, emotions, and sensations that occur involuntarily in the mind during certain stages of sleep. [17] Description of ''manovaha srotas'' in pathogenesis of dream shows that role of mind in producing dreams was known in ancient times.

*In modern era, during late 19th century, psychotherapist Sigmund Freud gave emphasis on dream connection with mind in his famous book ‘The interpretation of dreams’. He developed a theory that the content of dreams is driven by unconscious wish fulfillment.<ref>Stone MH,Dream analysis in the psychodynamic psychotherapy of borderline patients, Psychodyn Psychiatry. 2012 Jun;40(2):287-302. </ref> Presently dream is defined as successions of images, ideas, emotions, and sensations that occur involuntarily in the mind during certain stages of sleep.<ref>Dream, The American Heritage Dictionary of the English Language, Fourth Edition. 2000. Retrieved May 7, 2009.  </ref> Description of ''manovaha srotas'' in pathogenesis of dream shows that role of mind in producing dreams was known in ancient times.

*Various studies have established link between REM sleep and dreaming. [18] Poly somnograms show brainwave patterns in REM to be similar to that recorded during wakefulness. Intense dreaming occurs during REM sleep as a result of heightened brain activity. This proves that observations noted by ancient Ayurvedic seers related to pathogenesis of dream are minute and correct. [Verse No.41-42]

*Various studies have established link between REM sleep and dreaming.<ref>Klemm WR. Why Does Rem Sleep Occur? A Wake-Up Hypothesis. Frontiers in Systems Neuroscience. 2011;5:73. </ref> Poly somnograms show brainwave patterns in REM to be similar to that recorded during wakefulness. Intense dreaming occurs during REM sleep as a result of heightened brain activity. This proves that observations noted by ancient Ayurvedic seers related to pathogenesis of dream are minute and correct. [Verse No.41-42]

*As mentioned above dreams more or less depict unconsciousness state. Freud called dreams the "royal road to the unconscious”. They are related to activities which we have seen, listened, wished, thought etc. Based on this fact seven types of dream have been classified here. Five of them are mild as they are more near to events which we encounter in day to day life. Last two have fatal consequences as they are due to disease or ''dosha'' involvement. [Verse No.43]

*As mentioned above dreams more or less depict unconsciousness state. Freud called dreams the "royal road to the unconscious”. They are related to activities which we have seen, listened, wished, thought etc. Based on this fact seven types of dream have been classified here. Five of them are mild as they are more near to events which we encounter in day to day life. Last two have fatal consequences as they are due to disease or ''dosha'' involvement. [Verse No.43]

*It is difficult to predict dream consequences on the basis of time or order in which they were seen. Researches are needed to scientifically prove the validity of such dream prediction. [Verse No.44-46]

*It is difficult to predict dream consequences on the basis of time or order in which they were seen. Researches are needed to scientifically prove the validity of such dream prediction. [Verse No.44-46]