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Line 455: − + − + + + − + + + + + + + − In any manner, hampered blood or oxygen supply to the brain leads to lack of concentration, weakness of mental functions or agitation. Deposition of any toxic substance or progressive degenerative changes of mind also leads to such symptoms. Ageing and death are considered as natural process with passage of time.[ [[Charak Samhita]] [[Sharira Sthana]] 4/36] With declining phase of life, ageing symptoms start to appear, as new cell production is almost stops and older cell destruction continues. With the passage of senescence; weakness, decreasing appetite, muscular wasting, decreased fluid intake, neurological dysfunctions, decreasing level of consciousness etc. are common symptoms manifest and gradually leads to cessation of life. + − Every individual has good appetite and capability of digesting foods he regularly ingests. ''Ksheerada''(only on milk), ''ksheera-anna''(milk and rice products), ''annada'' (staple foods), are three basic stages of life. During ageing process, gradual reduction in both qualitative consumption and digestive abilities are observed. This in turn influences the individual’s physical and mental wellbeing leading to reduction in life span ending in death.[3]+ − As per the principle of ''Yatha Brahmande Tatha Pinde'', whatever is there in the universe, is there in the human body. Hence there should be some connections between human body and the universe. When the soul is preparing for detachment from the body to start its journey to other world, there should be some indications from the universe as indicator of impending death. As per Indian tradition, offerings of food to birds specially to crow and non-acceptance of offering by crow may indicate the preparation of soul for detachment from living body. Inability to see ''Arundhati'' in the sky is another indication of the same. [4 – 5]+ − + − + − + − + − + − + + + − Appearance of blue lines occurs in various conditions. This may be indication of venous congestion due to heart, lungs and liver diseases, requiring attention while scaling the span of life. [13]+ − Immediate disappearance of manifested small pox subsequently develops acute toxemia and hence leads to death. [14]+ − Combined manifestation of stiff neck along with inflamed throat and scrotum and swollen tongue is the condition of tertiary stage of syphilis when the person develops syphilitic meningitis (complication of untreated syphilis), is a life threatening condition. [15]+ − + − + − + − + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Anujyotiyam Indriyam Adhyaya (view source)
Revision as of 07:10, 16 October 2020
, 07:10, 16 October 2020no edit summary
== Introduction ==
== Introduction ==
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The present chapter deals with near death signs that arise due to decrease in digestive capacity of a person i.e. ''jatharagni''. The chapter indicates importance of digestive and metabolic functions of [[agni]]. The ingested food is helpful and nutritive to body only if, it passes through various digestive and metabolic processes successfully. This food nourishes the body at cellular level and it reflects in the form of good complexion, strength, good health, enthusiasm, and nourishment to formation of ''ojas''. Some part of food digested with the help of [[agni]] nourishes sensory organs along with ''mana'' (mind) too. [[Ayurveda]] has emphasized the importance of quality and quantity of Agni for metabolic activity of the body, that if the [[agni]] works well, the person lives long and if it ceases; the person is going to die.[ [[Charak Samhita]] [[Chikitsa Sthana]] 15/4]
The present chapter deals with near death signs that arise due to decrease in digestive capacity of a person i.e. [[agni]]. The chapter indicates importance of digestive and metabolic functions of [[agni]]. The ingested food is helpful and nutritive to body only if, it passes through various digestive and metabolic processes successfully. This food nourishes the body at cellular level and it reflects in the form of good complexion, strength, good health, enthusiasm, and nourishment to formation of [[ojas]]. Some part of food digested with the help of [[agni]] nourishes sensory organs along with [[mana]] (mind) too. [[Ayurveda]] has emphasized the importance of quality and quantity of Agni for metabolic activity of the body, that if the [[agni]] works well, the person lives long and if it ceases; the person is going to die.[ [[Charak Samhita]] [[Chikitsa Sthana]] 15/4]
Some signs seen in diseased or in healthy person, with or without any significant/visible pathology leading to death, are mentioned. These signs occurs due to initiation of some life threatening disease with poor prognosis even in initial stage.
Some signs seen in diseased or in healthy person, with or without any significant/visible pathology leading to death, are mentioned. These signs occurs due to initiation of some life threatening disease with poor prognosis even in initial stage.
It is emphasized that any extreme alternation in body physiology or psychology, person’s own behavior, mental functions, etc. without any significant reason; is also one of the sign for death.
It is emphasized that any extreme alternation in body physiology or psychology, person’s own behavior, mental functions, etc. without any significant reason; is also one of the sign for death.
Mind supremacy is also highlighted, as the mental strength of a person declines due to advancement of disease; then the person is likely to die. Composition of physical body (''sharira''), sensoria (''indriya''), mind (''sattva'') and soul (''atma'') is called life (''ayu''). With advanced stage of disease, physical body gets damaged, sensoria may also get affected and soul becomes ready to leave the diseased body; in such situation only strong mind power can sustain life as physical body follows mind and vice versa.[ [[Charak Samhita]] [[Sharia Sthana]] 1/155]
Mind supremacy is also highlighted, as the mental strength of a person declines due to advancement of disease; then the person is likely to die. Composition of physical body ([[sharira]]), sensoria ([[indriya]]), mind ([[sattva]]) and soul ([[atma]]) is called life ([[ayu]]). With advanced stage of disease, physical body gets damaged, sensoria may also get affected and soul becomes ready to leave the diseased body; in such situation only strong mind power can sustain life as physical body follows mind and vice versa.[ [[Charak Samhita]] [[Sharia Sthana]] 1/155]
It is elucidated that if person’s life span has ended; even good quality of physician, medicine or care taker are helpless. In a nutshell person’s life span is fixed and when it is gets finished, some signs are manifested called [[arishta]].
It is elucidated that if person’s life span has ended; even good quality of physician, medicine or care taker are helpless. In a nutshell person’s life span is fixed and when it is gets finished, some signs are manifested called [[arishta]].
Further, status of dying person is described briefly that, he may develop aversion to all loving and respectful persons, friends, food (and other basic essentials for surviving) etc. as his soul is almost in position to detach this body and preparing self to travel to other world. The chapter defines ''arishta'' with a new dimension. The concomitant aggravation of [[dosha]] (either qualitative or quantitative) with life-threatening diminution of [[dhatu]] is significant in the prediction of death.
Further, status of dying person is described briefly that, he may develop aversion to all loving and respectful persons, friends, food (and other basic essentials for surviving) etc. as his soul is almost in position to detach this body and preparing self to travel to other world. The chapter defines [[arishta]] with a new dimension. The concomitant aggravation of [[dosha]] (either qualitative or quantitative) with life-threatening diminution of [[dhatu]] is significant in the prediction of death.
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Now we shall expound the chapter "Anujyotiyam Indriyam" (Signs and Symptoms of Imminent Death caused due to diminution of [[Agni]]). Thus said Lord Atreya. [1-2]
Now we shall expound the chapter "Anujyotiyam Indriyam" (Signs and Symptoms of Imminent Death caused due to diminution of [[Agni]]). Thus said Lord Atreya. [1-2]
=== Signs of near-death and declining lifespan ===
=== Prognostic features of impending death and declining lifespan within a year ===
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Sudden gain or loss of luster, body weight, or wealth without any reasons indicates death of the person within one year thereafter. [6]
Sudden gain or loss of luster, body weight, or wealth without any reasons indicates death of the person within one year thereafter. [6]
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=== Prognostic features of impending death and declining lifespan within six months ===
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Sudden appearance of extremely shiny and prominent vasculature on fore head of an individual indicates that maximum life span of less than six month. [8]
Sudden appearance of extremely shiny and prominent vasculature on fore head of an individual indicates that maximum life span of less than six months. [8]
A person, on whose forehead crescent shaped grooves develop, is supposed to die after six months. [9]
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=== Prognostic features of impending death and declining lifespan within one month ===
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रेतोमूत्रपुरीषाणि यस्य मज्जन्ति चाम्भसि| <br />
रेतोमूत्रपुरीषाणि यस्य मज्जन्ति चाम्भसि| <br />
स मासात् स्वजनद्वेष्टा मृत्युवारिणि मज्जति||११||<br />
स मासात् स्वजनद्वेष्टा मृत्युवारिणि मज्जति||११||<br />
हस्तपादं मुखं चोभे विशेषाद्यस्य शुष्यतः| <br />
शूयेते वा विना देहात् स च मासं न जीवति||१२||<br />
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rētōmūtrapurīṣāṇi yasya majjanti cāmbhasi| <br />
rētōmūtrapurīṣāṇi yasya majjanti cāmbhasi| <br />
sa māsāt svajanadvēṣṭā mr̥tyuvāriṇi majjati||11|| <br />
sa māsāt svajanadvēṣṭā mr̥tyuvāriṇi majjati||11|| <br />
hastapādaṁ mukhaṁ cōbhē viśēṣādyasya śuṣyataḥ| <br />
śūyētē vā vinā dēhāt sa ca māsaṁ na jīvati||12|| <br />
sharIrakampaH sammoho gatirvacanameva ca| <br />
sharIrakampaH sammoho gatirvacanameva ca| <br />
retomUtrapurIShANi yasya majjanti cAmbhasi| <br />
retomUtrapurIShANi yasya majjanti cAmbhasi| <br />
sa mAsAt svajanadveShTA mRutyuvAriNi majjati||11|| <br />
sa mAsAt svajanadveShTA mRutyuvAriNi majjati||11|| <br />
hastapAdaM mukhaM cobhe visheShAdyasya shuShyataH| <br />
shUyete vA vinA dehAt sa ca mAsaM na jIvati||12|| <br />
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If semen, urine and feces of an individual sink in water as well as have aversion from own relatives, will sink in the water of death within one month. [11]
If semen, urine and feces of an individual sink in water as well as have aversion from own relatives, will sink in the water of death within one month. [11]
If there is noticeable emaciation or swelling of hands and feet along with face and without body (trunk) involvement, he will not survive for more than a month.[12]
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=== Prognostic features of impending death and declining lifespan ===
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ललाटे मूर्ध्नि बस्तौ वा नीला यस्य प्रकाशते| <br />
ललाटे मूर्ध्नि बस्तौ वा नीला यस्य प्रकाशते| <br />
नरः स्वस्थवदाहारमबलः कालचोदितः||१७||<br />
नरः स्वस्थवदाहारमबलः कालचोदितः||१७||<br />
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lalāṭē mūrdhni bastau vā nīlā yasya prakāśatē| <br />
lalāṭē mūrdhni bastau vā nīlā yasya prakāśatē| <br />
pramuhya luñcayēt kēśān parigr̥hṇātyatīva ca| <br />
pramuhya luñcayēt kēśān parigr̥hṇātyatīva ca| <br />
naraḥ svasthavadāhāramabalaḥ kālacōditaḥ||17|| <br />
naraḥ svasthavadāhāramabalaḥ kālacōditaḥ||17|| <br />
lalATe mUrdhni bastau vA nIlA yasya prakAshate| <br />
lalATe mUrdhni bastau vA nIlA yasya prakAshate| <br />
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Appearance of crescent shaped blue lines on fore head, face and pelvic region indicates that the person will not survive. [13]
Appearance of crescent shaped blue lines on fore head, face and pelvic region indicates that the person will not survive. [13]
If eruption of ''masurika'' (small pox like lesions) on body, having appearance of coral beds (bright red), subsides immediately after its manifestation, the person will die immediately. [14]
If eruption of [[masurika]] (small pox like lesions) on body, having appearance of coral beds (bright red), subsides immediately after its manifestation, the person will die immediately. [14]
A person having acute and severe squeezing type of pain in neck, swelling of tongue along with inflammation of scrotum, throat and mouth should be considered as ripen (for death). [15]
A person having acute and severe squeezing type of pain in neck, swelling of tongue along with inflammation of scrotum, throat and mouth should be considered as ripen (for death). [15]
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The person who searches for his own fingers and hands putting them before his eyes and smiles with upward gaze and unblinking should be considered as blinded by death, [18]
The person who searches for his own fingers and hands putting them before his eyes and smiles with upward gaze and unblinking should be considered as blinded by approaching death. [18]
A person who is lying on his bed but is searching for his bed continuously, sitting on chair and searching his own seat, searching his own organs, walking with the stick and searching the same, and searching the walls of his own room, or while working with something and searching the same, are the symptoms of the imminent death of that person. [19]
A person who is lying on his bed but is searching for his bed continuously, sitting on chair and searching his own seat, searching his own organs, walking with the stick and searching the same, and searching the walls of his own room, or while working with something and searching the same, are the symptoms of the imminent death of that person. [19]
mahāmōhāvr̥tamanāḥ paśyannapi na paśyati||21|| <br />
mahāmōhāvr̥tamanāḥ paśyannapi na paśyati||21|| <br />
ahAsyahAsI sammuhyan praleDhi [1] dashanacchadau| <br />
ahAsyahAsI sammuhyan praleDhi dashanacchadau| <br />
shItapAdakarocchvAso yo naro na sa jIvati||20|| <br />
shItapAdakarocchvAso yo naro na sa jIvati||20|| <br />
Loud shout to call relatives and other people sitting nearby, severe visual hallucinations for non-existing things, observed in the person whose mind is covered by severe delusion [of death].[21]
Loud shout to call relatives and other people sitting nearby, severe visual hallucinations for non-existing things, observed in the person whose mind is covered by severe delusion [of death].[21]
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=== Physician's ethical code to abstain from prescription ===
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A wise physician should abstain from treating a patient on observing that the patient’s body is simultaneously responding both excessively and deficiently to sensory stimuli. [22]
A wise physician should abstain from treating a patient when he observes that the patient’s body is simultaneously responding both excessively and deficiently to sensory stimuli. [22]
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=== Signs of death ===
=== Near death signs ===
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In case of extreme advancement of the disease and weaker psychological strength, the soul immediately leaves the body. [23]
In case of extreme advancement of the disease and weaker psychological strength, the soul immediately leaves the body. [23]
Near the end of life there is general decline in complexion, voice,''agni'', speech and state of mind, as well as sleep pattern alters. [24]
Near the end of life there is general decline in complexion, voice, [[agni]], speech and state of mind, as well as sleep pattern alters. [24]
=== Features and fate of unfaithful patients ===
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In such people, the disease progress occurs unrestricted and the medicine remains ineffective. The wise physician should not take his offerings in any form, even in form of food and drinks. [26]
In such people, the disease progress occurs unrestricted and the medicine remains ineffective. The wise physician should not take his offerings in any form, even in form of food and drinks. [26]
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=== Limitation of healthcare systems ===
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Availability of all four basic components of treatment i.e. doctor, medicament, care taker and patient with their desirable quality are of no value in regard to the person who is at the end of his life and there is no response to treatment.[27]
Availability of all four basic components of treatment i.e. doctor, medicament, care taker and patient with their desirable quality are of no value in regard to the person who is at the end of his life and there is no response to treatment.[27]
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===Importance of knowledge of prognosis===
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Here is the re capitulatory verse: The signs originated due to extensively vitiated and pervaded ''dosha'' throughout the body, and already transcended the stage of the treatment are called ''arishta'' (signs of death). [29]
Here is the re capitulatory verse: The signs originated due to extensively vitiated and pervaded [[dosha]] throughout the body, and already transcended the stage of the treatment are called [[arishta]] (signs of death). [29]
== Tattva Vimarsha (Fundamental Principles) ==
== Tattva Vimarsha (Fundamental Principles) ==
*Sudden changes in likings, gentleness, memory, sacrifices, intellect and strength in a person are pre-indications of death.
*Sudden changes in likings, gentleness, memory, sacrifices, intellect and strength in a person are pre-indications of death.
*Altered sensorium and psychological status leading to various delusions and hallucinations are pre-indicators of death.
*Altered sensorium and psychological status leading to various delusions and hallucinations are pre-indicators of death.
*Near the end of life there is general decline in complexion, voice, ''agni'', speech and state of mind, as well as sleep pattern alters.
*Near the end of life there is general decline in complexion, voice, [[agni]], speech and state of mind, as well as sleep pattern alters.
*The prognostic signs of life in diseased as well as in healthy person shall always be assessed. This helps to decide remaining lifespan and planning treatment.
*The prognostic signs of life in diseased as well as in healthy person shall always be assessed. This helps to decide remaining lifespan and planning treatment.
*The signs originated due to extensively vitiated and pervaded ''dosha'' throughout the body, and already transcended the stage of the treatment are called ''arishta'' (signs of death).
*The signs originated due to extensively vitiated and pervaded [[dosha]] throughout the body, and already transcended the stage of the treatment are called [[arishta]] (signs of death).
== Vidhi Vimarsha (Applied Inferences ) ==
== Vidhi Vimarsha (Applied Inferences ) ==
=== Role of [[agni]] in near death signs ===
Metabolic process and thermoregulatory center situated in hypothalamus play key role to generate and maintain body temperature respectively. Reduced temperature shows slow metabolic process and gradually it ceases completely, causing death.
Metabolic process and thermoregulatory center situated in hypothalamus play key role to generate and maintain body temperature respectively. Reduced temperature shows slow metabolic process and gradually it ceases completely, causing death.
With the help of healthy digestive power and proper metabolic activity; food nourishes the body and provide macro and micronutrients to the body.[ [[Charak Samhita]] [[Chikitsa Sthana]] 15/3]
With the help of healthy digestive power and proper metabolic activity; food nourishes the body and provide macro and micronutrients to the body.[ [[Charak Samhita]] [[Chikitsa Sthana]] 15/3] [verse 3]
=== Psychological and age related changes in near death signs ===
In any manner, hampered blood or oxygen supply to the brain leads to lack of concentration, weakness of mental functions or agitation. Deposition of any toxic substance or progressive degenerative changes of mind also leads to such symptoms. Ageing and death are considered as natural process with passage of time.[ [[Charak Samhita]] [[Sharira Sthana]] 4/36] With declining phase of life, ageing symptoms start to appear, as new cell production is almost stops and older cell destruction continues. With the passage of senescence; weakness, decreasing appetite, muscular wasting, decreased fluid intake, neurological dysfunctions, decreasing level of consciousness etc. are common symptoms manifest and gradually leads to cessation of life. [verse 3]
Every individual has good appetite and capability of digesting foods he regularly ingests. ''Ksheerada''(only on milk), ''ksheera-anna''(milk and rice products), ''annada'' (staple foods), are three basic stages of life. During ageing process, gradual reduction in both qualitative consumption and digestive abilities are observed. This in turn influences the individual’s physical and mental wellbeing leading to reduction in life span ending in death.[verse 3]
=== Meta-physical observations near death ===
As per the principle of ''Yatha Brahmande Tatha Pinde'', whatever is present in the universe, that is present in the human body. Hence there should be some connections between human body and the universe. When the soul is preparing for detachment from the body to start its journey to other world, there should be some indications from the universe as indicator of impending death. As per Indian tradition, offerings of food to birds specially to crow and non-acceptance of offering by crow may indicate the preparation of soul for detachment from living body. Inability to see ''Arundhati'' in the sky is another indication of the same. [ verse 4–5]
=== Clinical observations in near death signs ===
Acute loss or gain of luster or body weight can be the result of carcinogenic condition or severe catabolic changes taking place in the body that can be fatal for the person. [6]
Acute loss or gain of luster or body weight can be the result of carcinogenic condition or severe catabolic changes taking place in the body that can be fatal for the person. [ verse 6]
Brain regulates multiple functions related to sensory, motor and autonomous nervous system like emotions, intellect and many other activities. Amygdala, and physiological functioning of limbic system of brain, are responsible for proper emotions and its expression. If these are deviated grossly, it shows involvement of higher center in pathogenesis and poor prognosis.
Brain regulates multiple functions related to sensory, motor and autonomous nervous system like emotions, intellect and many other activities. Amygdala, and physiological functioning of limbic system of brain, are responsible for proper emotions and its expression. If these are deviated grossly, it shows involvement of higher center in pathogenesis and poor prognosis.
Gradual cessation of the functions is a clear indication of either degenerative changes or space occupying lesion (SOL) in the specific area. Acute toxicity of brain also leads to acute degeneration of brain cells or infarction that leads to hampering of function. [7]
Gradual cessation of the functions is a clear indication of either degenerative changes or space occupying lesion (SOL) in the specific area. Acute toxicity of brain also leads to acute degeneration of brain cells or infarction that leads to hampering of function. [verse 7]
Sudden appearance of crescent shaped streaks or blood vessel network on forehead may relate with Amyloidosis. It is a rare disease that occurs when a protein (albumoid) substance gets deposited in person’s organ. This abnormal protein is usually produced in bone marrow and can be deposited in any tissue or organ. The prognosis is poor. [8-9]<ref>the description is based on https://en.wikipedia.org/wiki/Amyloidosis, accessed on 15/10/2015 </ref>
Sudden appearance of crescent shaped streaks or blood vessel network on forehead may relate with Amyloidosis. It is a rare disease that occurs when a protein (albumoid) substance gets deposited in person’s organ. This abnormal protein is usually produced in bone marrow and can be deposited in any tissue or organ. The prognosis is poor. [verse 8-9]<ref>the description is based on https://en.wikipedia.org/wiki/Amyloidosis, accessed on 15/10/2015 </ref>
If person having combination of dual type of activity of mind i.e. exaggerated (in form of tremor), and diminished activity (in form of stupor), simultaneously; is supposed to die within a month. These dual types of signs may indicate increased intracranial pressure (ICP) due to localized mass like hematoma, neoplasm, abscess, edema, infarction, obstruction in CSF circulation, diffuse brain edema (like encephalitis, meningitis, or diffuse head injury), thrombosis, or idiopathic intracranial hypertension.
If person having combination of dual type of activity of mind i.e. exaggerated (in form of tremor), and diminished activity (in form of stupor), simultaneously; is supposed to die within a month. These dual types of signs may indicate increased intracranial pressure (ICP) due to localized mass like hematoma, neoplasm, abscess, edema, infarction, obstruction in CSF circulation, diffuse brain edema (like encephalitis, meningitis, or diffuse head injury), thrombosis, or idiopathic intracranial hypertension.
Symptoms of raised ICP are altered mental state, lethargy, irritability, slow decision making and abnormal social behavior. Ultimate result of the patho-physiology of such condition is stupor, coma and death. Rapidly rising ICP leads to syncope, seizures. These neurologic changes seen in increased ICP are mostly due to hypoxia and hyper apnea. [10]
Symptoms of raised ICP are altered mental state, lethargy, irritability, slow decision making and abnormal social behavior. Ultimate result of the pathophysiology of such condition is stupor, coma and death. Rapidly rising ICP leads to syncope, seizures. These neurologic changes seen in increased ICP are mostly due to hypoxia and hyper apnea. [verse 10]
If fecal matter or other excreta are mixed with ''ama'', it sinks straight in water due to its heaviness. Same concept is applied to other body discharge or ''dhatus'' too. Fecal matter is the end product of digestion. Hence, if it sinks in water it shows incomplete or improper digestion of food. ''Shukra'' is the last ''dhatu'' and hence all ''dhatvagni'' contribute (directly or indirectly) in its formation. To sink ''shukra'' in water is indicative that the ''dhatu'' is in ''sama'' stage. To get dipped all the three i.e. feces, urine and semen shows impairment of ''jatharagni'' along with ''dhatvagni'' functions leading to qualitative mal-formation of all ''dhatus''. Such situation has been considered as fatal. [11]
If fecal matter or other excreta are mixed with [[ama]], it sinks straight in water due to its heaviness. Same concept is applied to other body discharge or [[dhatu]] too. Fecal matter is the end product of digestion. Hence, if it sinks in water it shows incomplete or improper digestion of food. [[Shukra]] is the last [[dhatu]] and hence all subtle tissue metabolic processes (dhatvagni) contribute (directly or indirectly) in its formation. To sink [[shukra]] in water is indicative that the [[ama]] associated state of [[dhatu]]. To get dipped all the three i.e. feces, urine and semen shows impairment of ''jatharagni'' along with ''dhatvagni'' functions leading to qualitative mal-formation of all [[dhatu]]. Such situation has been considered as fatal. [verse 11]
Muscular wasting of hands and feet is a type of neurogenic muscular atrophy with poor prognosis.
Muscular wasting of hands and feet is a type of neurogenic muscular atrophy with poor prognosis.
Swelling over both extremities along with face is an indication of damage of two vital organ simultaneously i.e. heart and kidney and hence survival of patient is difficult.[12]
Swelling over both extremities along with face is an indication of damage of two vital organ simultaneously i.e. heart and kidney and hence survival of patient is difficult.[verse 12]
Appearance of blue lines occurs in various conditions. This may be indication of venous congestion due to heart, lungs and liver diseases, requiring attention while scaling the span of life. [verse 13]
Immediate disappearance of manifested small pox subsequently develops acute toxemia and hence leads to death. [verse 14]
Combined manifestation of stiff neck along with inflamed throat and scrotum and swollen tongue is the condition of tertiary stage of syphilis when the person develops syphilitic meningitis (complication of untreated syphilis), is a life threatening condition. [verse 15]
=== Hallucinations in near death signs ===
Visual (or even other sensorial) hallucinations are often part of the dying experience. Person may unknowingly involve in such activities with such illusions. This is the phase when the soul is getting ready to detach from the body and to travel for another world. The dying may turn their focus to “another world”, and thus may see (or feel other sensorial hallucination of) some unusual things, he may see or talk to such people who are already died. [18-19]
Visual (or even other sensorial) hallucinations are often part of the dying experience. Person may unknowingly involve in such activities with such illusions. This is the phase when the soul is getting ready to detach from the body and to travel for another world. The dying may turn their focus to “another world”, and thus may see (or feel other sensorial hallucination of) some unusual things, he may see or talk to such people who are already died. [verse 18-19]
Various kinds of hallucinations are indications of altered psychological state of dying person, and to have laughter without any specific cause is also result of such hallucinations. To lick own lips is the sign of dehydration and coldness of breath and extremity are the indication of almost reducing function of heart and hence, stoppage of blood flow to concerned area. [20] Delusions along with altered sensorial organ is the sign of death. [21]
Various kinds of hallucinations are indications of altered psychological state of dying person, and to have laughter without any specific cause is also result of such hallucinations. To lick own lips is the sign of dehydration and coldness of breath and extremity are the indication of almost reducing function of heart and hence, stoppage of blood flow to concerned area. [ verse 20] Delusions along with altered sensorial organ is the sign of death. [verse 21]
Days or hours before death, the dying person becomes less and less responsive to voice and touch and may not awaken. (Sometimes, quite unexpectedly, the person may appear well and even look as if he/she is going to recover. The person may be alert and talkative. But it does not mean that he is getting well; of course the time may be used as a “window of opportunity” to say what you need to say and have closure).<ref>Available from https://kokuamau.org/the-last-stages-of-life/ cited on 29/05/2020 </ref> [8] These all of sudden recovery changes are also signs of near death. [25]
Days or hours before death, the dying person becomes less and less responsive to voice and touch and may not awaken. (Sometimes, quite unexpectedly, the person may appear well and even look as if he/she is going to recover. The person may be alert and talkative. But it does not mean that he is getting well; of course the time may be used as a “window of opportunity” to say what you need to say and have closure).<ref>Available from https://kokuamau.org/the-last-stages-of-life/ cited on 29/05/2020 </ref> [verse 8] These all of sudden recovery changes also denote signs of near death. [verse 25]
As per ancient classical texts, life span of everyone is fixed and pre-ordained. No one can add years to the life only quality of life can be improved with medications. The same thing is meant here when it is said that death is the destiny of patient and that desirable quality of medicine, human resource and all other things cannot make the person outlive his destined lifespan.[27]
As per ancient classical texts, life span of everyone is fixed and pre-ordained. No one can add years to the life only quality of life can be improved with medications. The same thing is meant here when it is said that death is the destiny of patient and that desirable quality of medicine, human resource and all other things cannot make the person outlive his destined lifespan.[verse 27]
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=== Bad prognostic features and relevant disease pathologies ===
Prognostic features described in this chapter can be observed in various disease pathologies as shown in table 1. <ref>Mamidi P. et.al., Anu Jyoteeyam of Charaka Indriya Sthana - An Explorative Study, Int. J. Ayu. Alt. Med., 2019; 7(6): 274-287</ref> There is a wide scope of research to study the exact clinical correlation of the features, underlying disease pathologies and prognosis of impending death in prescribed time. This can open a new window in critical care management systems.
{| class="wikitable"
|+ Table 1: Disease or pathologies related to prognostic feature
|-
! Reference verse !! Probable relevant disease condition
|-
| | Cha.Sa.[[Indriya Sthana]] 11/3 || BPSD (behavioural and psychological symptoms of dementia); Delirium;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/7 || Frontotemporal dementia; Vascular dementia; Alzheimer’s dementia; BPSD; Major neurocognitive disorders (NCDs);
|-
| | Cha.Sa.[[Indriya Sthana]] 11/8 || Arterial tortuosity syndrome (ATS); Temporal arteritis; Malignant hypertension; Telangiectasia;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/10 || Wernicke-Korsakoff syndrome; Ataxia; Parkinson disease (PD); Dementia with Lewy bodies (DLB); Demyelinating diseases;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/11 || Various infectious, neoplastic pathologies of male genital, urinary and gastrointestinal tracts;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/12 || Progressive, acquired neuromuscular diseases (NMDs); Myopathies; Neuropathies;
Angioedema; Erythropoeiticprotoporphria (EPP); Hepatic, cardiac and renal edema;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/14 || Petechial or purpuric rash; Viral infections;
|-
|| Cha.Sa.[[Indriya Sthana]] 11/15 || Mumps orchitis; Lymphadenopathy; Epstein-Barr virus (EBV); Autoimmune diseases;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/16 || Delirium; Bone metastasis; Acute myeloid leukemia (AML);
|-
| | Cha.Sa.[[Indriya Sthana]] 11/17 || Trichotillomania; Frontotemporal dementia; Vascular dementia; Lewy body disease; Delirium; Major neurocognitive disorders (NCDs);
|-
| | Cha.Sa.[[Indriya Sthana]] 11/18-19 || Asomatognosia; Autotopagnosia; Motor apraxia; Finger agnosia; Exploratory procedures (EPs); Brain stem vascular lesions; ABS (Anton-Babinski syndrome); Delirium;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/20 || Delirium; Hemorrhagic shock; Cardiogenic shock;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/21 || Prosopagnosia; Visual agnosia; Dementia; Delirium;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/22 || Age related sensory impairment or decline; Hallucinations;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/23 || Delirium; Dementia;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/24 || Delirium; Dementia; End of life stages;
|-
| | Cha.Sa.[[Indriya Sthana]] 11/25 || ‘Anger’ in second stage of a dying process; Projection of anger in a dying patient;
|-
|}
'''Acknowledgement:''' The contributors acknowledge support of Dr. M. Prasad and Dr.G.Kshama for providing table 1 from their published article referred in this chapter.
== References ==
== References ==