Purvarupeeya

Indriya Sthana Chapter 5

Abstract: Purvarupiyamindriyam Adhyaya has been devoted to predict prognosis of diseases by prodromal symptoms. This chapter suggests that knowledge and examination of prodromal symptoms was important in ancient times and emphasis was given that physician should carefully recognize disease in early stage and predict course of disease. With the help of eight diseases of Nidana Sthana important principles related to prognosis have been laid down which are also applicable to all other diseases and are valid till now. Various aspects of dreams including physiology, types, interpretation and prognostic importance have also been described. Various dreams along with physical and mental features have been incorporated in prodromal symptoms which signify that dreams should also be analyzed and properly investigated before predicting prognosis of any disease. Even with restricted technological tools, par excellence observation and principles described regarding Arishta Lakshana are valid till now. Key words: Prodromal symptoms, dream, prognosis, disease, death. Introduction: In this chapter prodromal symptoms and dreams related to poor prognosis of diseases- fatality are described. In the first verse Acharya Charaka has emphasized that he will describe both common and special prodromal symptoms. This indicates that while there may be some prodromata which result out of normal pathogenesis, some are unusual and unexpected. In the next verse it has been said that if all prodromal symptoms are manifesting and are severe in nature then such a condition will be fatal. This principle is applicable to all other diseases also. Prodromal symptoms of Kushta and Prameha suggest that complications manifest before cardinal symptoms of the disease appear. If body metabolism in any disease is altered severely during latent phase of disease and complications are appearing before manifestation of full-fledged disease then such condition will be difficult to cure. Example of Gulma suggests that there are certain diseases which are incurable in nature and prodromal symptoms related to such clinical conditions will always be precursors of imminent death. It is commonly seen that any person who is emaciated and have low immunity and strength, when affected by disease, has fatal consequences due to less resistance. This fact is explained with the example of Shosha. Another important aspect regarding disease prognosis is that, if a person is continuously partaking causative factors or is in constant exposure to the causative factors, body will be unable to fight disease properly and thus there will be less chances of recovery from the disease. This point is also mentioned while describing prognosis of Shosha. From the above discussion it is clear that prodromal symptoms can be useful in predicting diagnosis of any disease. But now question arises whether it is practically possible to predict prognosis with prodromal symptoms? We should admit that it is very difficult and one will need years of experience to attain such competence. Another important fact is that the prediction of prognosis can be done from Purvarupa only after disease manifestation. Acharya states that Purvarupa converting into a particular disease in future can be termed a prognostic sign. This indicates that we cannot predict by only prodromal symptoms. We have to look into whether disease was produced after Purvarupa or not. For example, delirium in Raktapitta is indicator of poor prognosis. If delirium is seen in any patient but he is not developing Raktapitta we cannot predict poor prognosis. In this condition, after manifestation of Raktapitta we need to ask the patient whether he suffered from delirium before disease manifestation or not. It is a retrospective inquiry about Purvarupa based on which a prospective prediction may be made. We will have to follow detailed retro-prospective approach and will need proper patient history comprising of each and every detail from prodromal symptoms to disease manifestation. Thus practically, prodromal symptoms are helpful only after disease manifestation as they are not independent. Since accompanying symptoms may also lead to predictions, they can also be regarded as tools of predictive prognosis. This might be the reason that Acharya Sushruta and Vagbhata have not described dreams in reference of Purvarupa but have described in Rupavastha (stage of disease manifestation) Biomarkers are recent advancements can be the answer to above problem as we do not need to wait for disease manifestation and can predict prognosis by seeing values of biomarkers related to that disease. In 2001, a consensus panel at the National Institutes of Health defined the term biomarker as ‘a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention or other health care intervention’.[1] Biomarker defined as alteration in the constituents of tissues or body fluids provide a powerful approach to understanding the spectrum of chronic disease with application in at least 5 areas like screening, diagnosis, prognostics, prediction of disease recurrence and therapeutic monitoring.[2] The biomarker is either produced by the diseased organ (e.g., tumour) or by the body in response to disease. Before diagnosis, markers could be used for screening and risk assessment. Tumour classification, stage and sometimes grade are generally used to assess prognosis. Researches in the field of biomarkers may give us chance to know prognosis of disease in early stage. Another important aspect mentioned in this chapter is concept of dreams. The descriptions related to dreams are found abundantly in the ancient oriental classics, specifically the Atharvaveda, Upanishadas, Puranas, Darshanas and Ayurveda. The description of the Doshika dreams of the Atharvaveda is similar to that in Ayurveda. Dreams are mentioned while describing Purvarupa, Rupa and Arishta lakshanas.[3] Acharya Sushruta states that sex of the unborn child can be predicted and Acharya Vagbhata says that Doshika Prakriti can be known by the help of dreams. Subject of dreams is dealt in very scientific manner. According to Charaka, dreams occur when person is in relatively wakeful state. This has been proved now by the researches that dreams mainly occur in the rapid-eye movement (REM) stage of sleep—when brain activity is high and resembles that of being awake. In the late 19th century, psychotherapist Sigmund Freud developed a theory that the content of dreams is driven by unconscious wish fulfillment. Freud called dreams the "royal road to the unconscious”. [4] To Freud, no dream was of entertainment value, they all held important meanings. Dreams reflect the dreamer’s mental, emotional, and physical state. This fact is well established in this chapter while describing classification of dreams. Dreams are based on our day to day interactions and so are classified as dreams seen, heard, felt etc. Two of the seven types, one which predict prognosis and one which is due to vitiation of Doshas are said to have fatal consequences. Research studies are needed to prove that dreams can be used as markers of prognosis. Some studies have been conducted in this regard but we cannot make strong conclusion on basis of their results. In a few studies it has been shown that hormone levels affect dreams. One of the studies states that cortisol plays an important role in controlling the state of memory systems during sleep. High levels of cortisol, as are observed late at night and, typically in the context of REM sleep, disrupt normal hippocampal → neocortical communication, thereby interfering with forms of memory consolidation dependent upon this communication. At the same time, the content of dreams is also affected.[5] In neurological and psychological diseases dream disturbances are often seen but few other diseases have also been found to affect dreams. Patients with sleep apnea are reported to have intense nightmares. [6] Abnormal dreams have also been reported in diseases like Relapsing fever,[7] Cardiac ischemia[8] etc. Certain drugs also affect dreams e.g. Anti malarial drug has shown to alter dream types.[9] This proves that at times diseases certainly affect dreams but intense research studies are needed to actually establish this fact on scientific grounds. अथातः पूर्वरूपीयमिन्द्रियं व्याख्यास्यामः||१|| इति ह स्माह भगवानात्रेयः||२|| athātaḥ pūrvarūpīyamindriyaṁ vyākhyāsyāmaḥ||1|| iti ha smāha bhagavānātrēyaḥ||2|| athAtaH pUrvarUpIyamindriyaM vyAkhyAsyAmaH||1|| iti ha smAha bhagavAnAtreyaH||2|| We shall now expound the chapter of premonitory symptoms related to signs of death. Thus spoke lord Atreya. Incurable prodromal signs of Jwara leading to death: पूर्वरूपाण्यसाध्यानां विकाराणां पृथक् पृथक्| भिन्नाभिन्नानि वक्ष्यामो भिषजां ज्ञानवृद्धये||३|| पूर्वरूपाणि सर्वाणि ज्वरोक्तान्यतिमात्रया| यं विशन्ति विशत्येनं मृत्युर्ज्वरपुरःसरः||४|| अन्यस्यापि च रोगस्य पूर्वरूपाणि यं नरम्| विशन्त्यनेन कल्पेन तस्यापि मरणं ध्रुवम्||५|| pūrvarūpāṇyasādhyānāṁ vikārāṇāṁ pr̥thak pr̥thak| bhinnābhinnāni vakṣyāmō bhiṣajāṁ jñānavr̥ddhayē||3|| pūrvarūpāṇi sarvāṇi jvarōktānyatimātrayā| yaṁ viśanti viśatyēnaṁ mr̥tyurjvarapuraḥsaraḥ||4|| anyasyāpi ca rōgasya pūrvarūpāṇi yaṁ naram| viśantyanēna kalpēna tasyāpi maraṇaṁ dhruvam||5|| pUrvarUpANyasAdhyAnAM vikArANAM pRuthak pRuthak| bhinnAbhinnAni vakShyAmo bhiShajAM j~jAnavRuddhaye||3|| pUrvarUpANi sarvANi jvaroktAnyatimAtrayA| yaM vishanti vishatyenaM mRutyurjvarapuraHsaraH||4|| anyasyApi ca rogasya pUrvarUpANi yaM naram| vishantyanena kalpena tasyApi maraNaM dhruvam||5|| For enhancing the knowledge of physicians, we will distinctly explain the general and fatal prodromal symptoms of diseases. If all prodromal symptoms of Jwara manifests in severe degree, the person will die. If prodromal symptoms of any other disease also appear in the same way as described above, death of the patient is certain. [3-5]

Incurable prodromal signs of Rajayakshma leading to death: पूर्वरूपैकदेशांस्तु वक्ष्यामोऽन्यान् सुदारुणान्| ये रोगाननुबध्नन्ति मृत्युर्यैरनुबध्यते [१] ||६|| बलं च हीयते यस्य प्रतिश्यायश्च वर्धते| तस्य नारीप्रसक्तस्य शोषोऽन्तायोपजायते||७|| श्वभिरुष्ट्रैः खरैर्वाऽपि याति यो दक्षिणां दिशम्| स्वप्ने यक्ष्माणमासाद्य जीवितं स विमुञ्चति||८|| प्रेतैः सह पिबेन्मद्यं स्वप्ने यः कृष्यते शुना| सुघोरं ज्वरमासाद्य जीवितं स विमुञ्चति||९|| pūrvarūpaikadēśāṁstu vakṣyāmō'nyān sudāruṇān| yē rōgānanubadhnanti mr̥tyuryairanubadhyatē ||6|| balaṁ ca hīyatē yasya pratiśyāyaśca vardhatē| tasya nārīprasaktasya śōṣō'ntāyōpajāyatē||7|| śvabhiruṣṭraiḥ kharairvā'pi yāti yō dakṣiṇāṁ diśam| svapnē yakṣmāṇamāsādya jīvitaṁ sa vimuñcati||8|| prētaiḥ saha pibēnmadyaṁ svapnē yaḥ kr̥ṣyatē śunā| sughōraṁ jvaramāsādya jīvitaṁ sa vimuñcati||9|| pUrvarUpaikadeshAMstu vakShyAmo~anyAn sudAruNAn| ye rogAnanubadhnanti mRutyuryairanubadhyate ||6|| balaM ca hIyate yasya pratishyAyashca vardhate| tasya nArIprasaktasya shoSho~antAyopajAyate||7|| shvabhiruShTraiH kharairvA~api yAti yo dakShiNAM disham| svapne yakShmANamAsAdya jIvitaM sa vimu~jcati||8|| pretaiH saha pibenmadyaM svapne yaH kRuShyate shunA| sughoraM jvaramAsAdya jIvitaM sa vimu~jcati||9|| Now we shall discuss certain severe premonitory symptoms which are associated with certain diseases. The consumption which is associated with continuously decreasing strength, worsening rhinitis and over indulgence in sex in prodromal stage will turn out to be incurable. A man, who in his dreams, is dragged by dog, camel or a donkey towards south, leaves his life as by consumption. A person who in his dreams takes alcohol with demons and who is dragged by a dog leaves his life getting affected with severe fever. [6-9] Incurable prodromal signs of Raktapitta leading to death: लाक्षारक्ताम्बराभं यः पश्यत्यम्बरमन्तिकात्| स रक्तपित्तमासाद्य तेनैवान्ताय नीयते||१०|| रक्तस्रग्रक्तसर्वाङ्गो रक्तवासा मुहुर्हसन्| यः स्वप्ने ह्रियते नार्या स रक्तं प्राप्य सीदति||११|| lākṣāraktāmbarābhaṁ yaḥ paśyatyambaramantikāt| sa raktapittamāsādya tēnaivāntāya nīyatē||10|| raktasragraktasarvāṅgō raktavāsā muhurhasan| yaḥ svapnē hriyatē nāryā sa raktaṁ prāpya sīdati||11||

lAkShAraktAmbarAbhaM yaH pashyatyambaramantikAt| sa raktapittamAsAdya tenaivAntAya nIyate||10|| raktasragraktasarvA~ggo raktavAsA muhurhasan| yaH svapne hriyate nAryA sa raktaM prApya sIdati||11||

He who sees clothes as if dyed with red lac, leaves his life if he gets affected with severe bleeding disorders. In his dream, the man who sees himself adorned with red garlands, clad in red clothes, anointed with red dye and dragged by a continuously laughing woman will succumb to severe bleeding disorders. [10-11] Incurable prodromal signs of Gulma leading to death:

शूलाटोपान्त्रकूजाश्च दौर्बल्यं चातिमात्रया| नखादिषु च वैवर्ण्यं गुल्मेनान्तकरो ग्रहः||१२|| लता कण्टकिनी यस्य दारुणा हृदि जायते| स्वप्ने गुल्मस्तमन्ताय क्रूरो विशति मानवम्||१३|| śūlāṭōpāntrakūjāśca daurbalyaṁ cātimātrayā| nakhādiṣu ca vaivarṇyaṁ gulmēnāntakarō grahaḥ||12|| latā kaṇṭakinī yasya dāruṇā hr̥di jāyatē| svapnē gulmastamantāya krūrō viśati mānavam||13|| shUlATopAntrakUjAshca daurbalyaM cAtimAtrayA| nakhAdiShu ca vaivarNyaM gulmenAntakaro grahaH||12|| latA kaNTakinI yasya dAruNA hRudi jAyate| svapne gulmastamantAya krUro vishati mAnavam||13||

A man who experiences severe pain, gurgling sounds in abdomen, intestinal peristalsis, excessive debility, discoloration of nails and other body parts is going to die if he is affected with Gulma.

A person, who in his dreams sees hard and thorny creepers grown on his chest and then gets afflicted by Gulma, is surely going to die soon. [12-13] Incurable prodromal signs of Kushtha leading to death:

कायेऽल्पमपि संस्पृष्टं सुभृशं यस्य दीर्यते| क्षतानि च न रोहन्ति कुष्ठैर्मृत्युर्हिनस्ति तम्||१४|| नग्नस्याज्यावसिक्तस्य जुह्वतोऽग्निमनर्चिषम्| पद्मान्युरसि जायन्ते स्वप्ने कुष्ठैर्मरिष्यतः||१५|| kāyē'lpamapi saṁspr̥ṣṭaṁ subhr̥śaṁ yasya dīryatē| kṣatāni ca na rōhanti kuṣṭhairmr̥tyurhinasti tam||14|| nagnasyājyāvasiktasya juhvatō'gnimanarciṣam| padmānyurasi jāyantē svapnē kuṣṭhairmariṣyataḥ||15|| kAye~alpamapi saMspRuShTaM subhRushaM yasya dIryate| kShatAni ca na rohanti kuShThairmRutyurhinasti tam||14|| nagnasyAjyAvasiktasya juhvato~agnimanarciSham| padmAnyurasi jAyante svapne kuShThairmariShyataH||15|| A person whose body even if touched gently leads to deep cuts and whose injuries never heal will be killed by severe skin diseases. In his dream, a man who sees himself naked, anointed with ghee, offering the oblations without the fire being lit, who has lotuses grown on his chest, will be taken away by death as afflicted by skin diseases.[14-15] Incurable prodromal signs of Prameha leading to death: स्नातानुलिप्तगात्रेऽपि यस्मिन् गृध्नन्ति मक्षिकाः| स प्रमेहेण संस्पर्शं प्राप्य तेनैव हन्यते||१६|| स्नेहं बहुविधं स्वप्ने चण्डालैः सह यः पिबेत्| बध्यते स प्रमेहेण स्पृश्यतेऽन्ताय मानवः||१७||

snātānuliptagātrē'pi yasmin gr̥dhnanti makṣikāḥ| sa pramēhēṇa saṁsparśaṁ prāpya tēnaiva hanyatē||16|| snēhaṁ bahuvidhaṁ svapnē caṇḍālaiḥ saha yaḥ pibēt| badhyatē sa pramēhēṇa spr̥śyatē'ntāya mānavaḥ||17|| snAtAnuliptagAtre~api yasmin gRudhnanti makShikAH| sa prameheNa saMsparshaM prApya tenaiva hanyate||16|| snehaM bahuvidhaM svapne caNDAlaiH saha yaH pibet| badhyate sa prameheNa spRushyate~antAya mAnavaH||17||

Even after taking bath and getting anointed with scents, flies are attracted towards person, he will certainly die, if affected with Prameha. One who sees in his dreams, drinking various kinds of oily substances with Chandalas becomes affected by Prameha and will die. [16-17] Incurable prodromal signs of Unmada and Apasmara leading to death: ध्यानायासौ तथोद्वेगौ मोहश्चास्थानसम्भवः| अरतिर्बलहानिश्च मृत्युरुन्मादपूर्वकः||१८|| आहारद्वेषिणं पश्यन् लुप्तचित्तमुदर्दितम्| विद्याद्धीरो मुमूर्षुं तमुन्मादेनातिपातिना||१९|| क्रोधनं त्रासबहुलं सकृत्प्रहसिताननम्| मूर्च्छापिपासाबहुलं हन्त्युन्मादः शरीरिणम्||२०|| नृत्यन् रक्षोगणैः साकं यः स्वप्नेऽम्भसि सीदति | स प्राप्य भृशमुन्मादं याति लोकमतः परम्||२१|| असत्तमः पश्यति यः शृणोत्यप्यसतः स्वनान्| बहून् बहुविधान् जाग्रत् सोऽपस्मारेण बध्यते||२२|| मत्तं नृत्यन्तमाविध्य प्रेतो हरति यं नरम्| स्वप्ने हरति तं मृत्युरपस्मारपुरःसरः||२३|| dhyānāyāsau tathōdvēgau mōhaścāsthānasambhavaḥ| aratirbalahāniśca mr̥tyurunmādapūrvakaḥ||18|| āhāradvēṣiṇaṁ paśyan luptacittamudarditam| vidyāddhīrō mumūrṣuṁ tamunmādēnātipātinā||19|| krōdhanaṁ trāsabahulaṁ sakr̥tprahasitānanam| mūrcchāpipāsābahulaṁ hantyunmādaḥ śarīriṇam||20|| nr̥tyan rakṣōgaṇaiḥ sākaṁ yaḥ svapnē'mbhasi sīdati | sa prāpya bhr̥śamunmādaṁ yāti lōkamataḥ param||21|| asattamaḥ paśyati yaḥ śr̥ṇōtyapyasataḥ svanān| bahūn bahuvidhān jāgrat sō'pasmārēṇa badhyatē||22|| mattaṁ nr̥tyantamāvidhya prētō harati yaṁ naram| svapnē harati taṁ mr̥tyurapasmārapuraḥsaraḥ||23|| dhyAnAyAsau tathodvegau mohashcAsthAnasambhavaH| aratirbalahAnishca mRutyurunmAdapUrvakaH||18|| AhAradveShiNaM pashyan luptacittamudarditam| vidyAddhIro mumUrShuM tamunmAdenAtipAtinA||19|| krodhanaM trAsabahulaM sakRutprahasitAnanam| mUrcchApipAsAbahulaM hantyunmAdaH sharIriNam||20|| nRutyan rakShogaNaiH sAkaM yaH svapne~ambhasi sIdati | sa prApya bhRushamunmAdaM yAti lokamataH param||21|| asattamaH pashyati yaH shRuNotyapyasataH svanAn| bahUn bahuvidhAn jAgrat so~apasmAreNa badhyate||22|| mattaM nRutyantamAvidhya preto harati yaM naram| svapne harati taM mRutyurapasmArapuraHsaraH||23|| He who is affected with disturbing thoughts, anxiety, stupefaction without any specific cause, restlessness, loss of strength will succumb to death as affected with insanity. The person who feels excess anger, fear, always smiles and who is suffering from severe stupor and thirst will be certainly killed by insanity. The man who in his dreams dances with evil spirits and sinks in water leaves the world. He who sees darkness even when he is awake and hears sounds when there is no real sound, will be killed by epilepsy. In dream, a person who sees himself dancing with ghosts while in intoxication with his head upside down, will be taken away by death getting affected with epilepsy. [18-23]

स्तभ्येते प्रतिबुद्धस्य हनू मन्ये तथाऽक्षिणी| यस्य तं बहिरायामो गृहीत्वा हन्त्यसंशयम्||२४|| शष्कुलीर्वाऽप्यपूपान् वा स्वप्ने खादति यो नरः| स चेत्तादृक् छर्दयति प्रतिबुद्धो न जीवति||२५|| stabhyētē pratibuddhasya hanū manyē tathā'kṣiṇī| yasya taṁ bahirāyāmō gr̥hītvā hantyasaṁśayam||24|| śaṣkulīrvā'pyapūpān vā svapnē khādati yō naraḥ| sa cēttādr̥k chardayati pratibuddhō na jīvati||25|| stabhyete pratibuddhasya hanU manye tathA~akShiNI| yasya taM bahirAyAmo gRuhItvA hantyasaMshayam||24|| shaShkulIrvA~apyapUpAn vA svapne khAdati yo naraH| sa cettAdRuk chardayati pratibuddho na jIvati||25|| If individual is found with bahirayama ( a disease with feature of opistho-tonus or bending of body backwards) soon after awaking from sleep along with lock Jaw, neck stiffness, stale eyes and paralysis is going to lose life soon. Such an individual in his dream sees himself taking cakes of sesame seeds and Apupa ( a dietary item) and vomits the same when he is awake.[24-25] एतानि पूर्वरूपाणि यः सम्यगवबुध्यते| स एषामनुबन्धं च फलं च ज्ञातुमर्हति||२६|| ētāni pūrvarūpāṇi yaḥ samyagavabudhyatē| sa ēṣāmanubandhaṁ ca phalaṁ ca jñātumarhati||26|| etAni pUrvarUpANi yaH samyagavabudhyate| sa eShAmanubandhaM ca phalaM ca j~jAtumarhati||26||

One who (physician ) understands these premonitory symptoms thoroughly, also deserves the knowledge of associated diseases and their result i.e. death.[26] इमांश्चाप्यपरान् स्वप्नान् दारुणानुपलक्षयेत्| व्याधितानां विनाशाय क्लेशाय महतेऽपि वा||२७|| यस्योत्तमाङ्गे जायन्ते वंशगुल्मलतादयः| वयांसि च विलीयन्ते स्वप्ने मौण्ड्यमियाच्च यः||२८|| गृध्रोलूकश्वकाकाद्यैः स्वप्ने यः परिवार्यते| रक्षःप्रेतपिशाचस्त्रीचण्डालद्रविडान्ध्रकैः ||२९|| वंशवेत्रलतापाशतृणकण्टकसङ्कटे| संसज्जति हि यः स्वप्ने यो गच्छन् प्रपतत्यपि||३०|| भूमौ पांशूपधानायां वल्मीके वाऽथ भस्मनि| श्मशानायतने श्वभ्रे स्वप्ने यः प्रपतत्यपि ||३१|| कलुषेऽम्भसि पङ्के वा कूपे वा तमसाऽऽवृते| स्वप्ने मज्जति शीघ्रेण स्रोतसा ह्रियते च यः||३२|| स्नेहपानं तथाऽभ्यङ्गः प्रच्छर्दनविरेचने| हिरण्यलाभः कलहः स्वप्ने बन्धपराजयौ||३३|| उपानद्युगनाशश्च प्रपातः पादचर्मणोः| हर्षः स्वप्ने प्रकुपितैः पितृभिश्चावभर्त्सनम्||३४|| दन्तचन्द्रार्कनक्षत्रदेवतादीपचक्षुषाम् | पतनं वा विनाशो वा स्वप्ने भेदो नगस्य वा||३५|| रक्तपुष्पं वनं भूमिं पापकर्मालयं चिताम्| गुहान्धकारसम्बाधं स्वप्ने यः प्रविशत्यपि||३६|| रक्तमाली हसन्नुच्चैर्दिग्वासा दक्षिणां दिशम्| दारुणामटवीं स्वप्ने कपियुक्तेन याति वा||३७|| काषायिणामसौम्यानां नग्नानां दण्डधारिणाम्| कृष्णानां रक्तनेत्राणां स्वप्ने नेच्छन्ति दर्शनम्||३८|| कृष्णा पापा निराचारा दीर्घकेशनखस्तनी| विरागमाल्यवसना स्वप्ने कालनिशा मता||३९|| इत्येते दारुणाः स्वप्ना रोगी यैर्याति पञ्चताम्| अरोगः संशयं गत्वा कश्चिदेव प्रमुच्यते||४०|| imāṁścāpyaparān svapnān dāruṇānupalakṣayēt| vyādhitānāṁ vināśāya klēśāya mahatē'pi vā||27|| yasyōttamāṅgē jāyantē vaṁśagulmalatādayaḥ| vayāṁsi ca vilīyantē svapnē mauṇḍyamiyācca yaḥ||28|| gr̥dhrōlūkaśvakākādyaiḥ svapnē yaḥ parivāryatē| rakṣaḥprētapiśācastrīcaṇḍāladraviḍāndhrakaiḥ ||29|| vaṁśavētralatāpāśatr̥ṇakaṇṭakasaṅkaṭē| saṁsajjati hi yaḥ svapnē yō gacchan prapatatyapi||30|| bhūmau pāṁśūpadhānāyāṁ valmīkē vā'tha bhasmani| śmaśānāyatanē śvabhrē svapnē yaḥ prapatatyapi ||31|| kaluṣē'mbhasi paṅkē vā kūpē vā tamasāvr̥tē| svapnē majjati śīghrēṇa srōtasā hriyatē ca yaḥ||32|| snēhapānaṁ tathā'bhyaṅgaḥ pracchardanavirēcanē| hiraṇyalābhaḥ kalahaḥ svapnē bandhaparājayau||33|| upānadyuganāśaśca prapātaḥ pādacarmaṇōḥ| harṣaḥ svapnē prakupitaiḥ pitr̥bhiścāvabhartsanam||34|| dantacandrārkanakṣatradēvatādīpacakṣuṣām | patanaṁ vā vināśō vā svapnē bhēdō nagasya vā||35|| raktapuṣpaṁ vanaṁ bhūmiṁ pāpakarmālayaṁ citām| guhāndhakārasambādhaṁ svapnē yaḥ praviśatyapi||36|| raktamālī hasannuccairdigvāsā dakṣiṇāṁ diśam| dāruṇāmaṭavīṁ svapnē kapiyuktēna yāti vā||37|| kāṣāyiṇāmasaumyānāṁ nagnānāṁ daṇḍadhāriṇām| kr̥ṣṇānāṁ raktanētrāṇāṁ svapnē nēcchanti darśanam||38|| kr̥ṣṇā pāpā nirācārā dīrghakēśanakhastanī| virāgamālyavasanā svapnē kālaniśā matā||39|| ityētē dāruṇāḥ svapnā rōgī yairyāti pañcatām| arōgaḥ saṁśayaṁ gatvā kaścidēva pramucyatē||40|| imAMshcApyaparAn svapnAn dAruNAnupalakShayet| vyAdhitAnAM vinAshAya kleshAya mahate~api vA||27|| yasyottamA~gge jAyante vaMshagulmalatAdayaH| vayAMsi ca vilIyante svapne mauNDyamiyAcca yaH||28|| gRudhrolUkashvakAkAdyaiH svapne yaH parivAryate| rakShaHpretapishAcastrIcaNDAladraviDAndhrakaiH ||29|| vaMshavetralatApAshatRuNakaNTakasa~gkaTe| saMsajjati hi yaH svapne yo gacchan prapatatyapi||30|| bhUmau pAMshUpadhAnAyAM valmIke vA~atha bhasmani| shmashAnAyatane shvabhre svapne yaH prapatatyapi ||31|| kaluShe~ambhasi pa~gke vA kUpe vA tamasA~a~avRute| svapne majjati shIghreNa srotasA hriyate ca yaH||32|| snehapAnaM tathA~abhya~ggaH pracchardanavirecane| hiraNyalAbhaH kalahaH svapne bandhaparAjayau||33|| upAnadyuganAshashca prapAtaH pAdacarmaNoH| harShaH svapne prakupitaiH pitRubhishcAvabhartsanam||34|| dantacandrArkanakShatradevatAdIpacakShuShAm | patanaM vA vinAsho vA svapne bhedo nagasya vA||35|| raktapuShpaM vanaM bhUmiM pApakarmAlayaM citAm| guhAndhakArasambAdhaM svapne yaH pravishatyapi||36|| raktamAlI hasannuccairdigvAsA dakShiNAM disham| dAruNAmaTavIM svapne kapiyuktena yAti vA||37|| kAShAyiNAmasaumyAnAM nagnAnAM daNDadhAriNAm| kRuShNAnAM raktanetrANAM svapnenecchanti darshanam||38| kRuShNA pApA nirAcArA dIrghakeshanakhastanI| virAgamAlyavasanA svapne kAlanishA matA||39|| ityete dAruNAH svapnA rogI yairyAti pa~jcatAm| arogaH saMshayaM gatvA kashcideva pramucyate||40|| Certain other dreams which are fierce should also be analyzed as they indicate the approaching death of the diseased and grave sufferings for those who are going to be affected. He, who in his dreams sees bamboos, shrubs and creepers etc. growing in his head, birds coming to them and his scalp been shaved. Or who in his dreams sees himself surrounded by vultures, owls, dogs, crows and other birds or by Rakshasa, dead men, Pishachas, women, Chandalas, and inhabitants of Dravida and Andhra regions. Or who in his dreams finds himself surrounded by pathless forests of bamboo, canes, creepers, grass and prickly plants and finds himself lost in the midst and falling down while trying to come out. Or who in his dreams, falls down on the bare ground covered with dust or upon an anthill or upon ashes, or upon a crematorium or in to a hole. Or who sinks in a ditch or pond of dirty water or into mire or in a dark well or who is carried away by a rapid current. Or who in his dreams drinks oily substances or anoints his body with oil, vomits, defecates, or gets gold, engages in quarrel, gets defeated and captured. Or who lose his sandals, has skin of feet peeling off or feels excited or who is rebuked by his angry ancestors. Or who sees in his dreams the fall or destruction of his own tooth or the moon or the sun or the stars or the burning lamps or his own eyes or the cracking of a mountain. Or who in his dreams, enters a forest of trees with red flowers or a place where sinful activities are done or a funeral place (crematorium), a dark cave. Or who in his dreams sees himself proceeding towards south, finds himself adorned with garlands of red flowers, laughing aloud and naked. The sight of a woman who is dark in complexion, who is sinful, who has long hair and nails, hanging breasts, or who is clad in garlands of red flowers and red garments is regarded to be as fatal as a fatal night. These are severe dreams which indicate death of a patient. If a healthy man sees such dreams, his life becomes doubtful, rarely does he escape. [27-40] Dreams: मनोवहानां पूर्णत्वाद्दोषैरतिबलैस्त्रिभिः| स्रोतसां दारुणान् स्वप्नान् काले पश्यति दारुणे||४१|| नातिप्रसुप्तः पुरुषः सफलानफलांस्तथा| इन्द्रियेशेन मनसा स्वप्नान् पश्यत्यनेकधा||४२|| manōvahānāṁ pūrṇatvāddōṣairatibalaistribhiḥ| srōtasāṁ dāruṇān svapnān kālē paśyati dāruṇē||41|| nātiprasuptaḥ puruṣaḥ saphalānaphalāṁstathā| indriyēśēna manasā svapnān paśyatyanēkadhā||42|| manovahAnAM pUrNatvAddoShairatibalaistribhiH| srotasAM dAruNAn svapnAn kAle pashyati dAruNe||41|| nAtiprasuptaH puruShaH saphalAnaphalAMstathA| indriyeshena manasA svapnAn pashyatyanekadhA||42||

When the channels associated with the mind are saturated by the excessively vitiated Doshas, such terrible dreams appear in his sleep. The person who is not in deep sleep (subconscious state), sees various fruitful (meaningful) or fruitless (meaningless) dreams in association with sense organs. [41-42]

दृष्टं श्रुतानुभूतं च प्रार्थितं कल्पितं तथा| भाविकं दोषजं चैव स्वप्नं सप्तविधं विदुः||४३|| dr̥ṣṭaṁ śrutānubhūtaṁ ca prārthitaṁ kalpitaṁ tathā| bhāvikaṁ dōṣajaṁ caiva svapnaṁ saptavidhaṁ viduḥ||43|| dRuShTaM shrutAnubhUtaM ca prArthitaM kalpitaM tathA| bhAvikaM doShajaM caiva svapnaM saptavidhaM viduH||43|| It is known that there are seven kinds of dreams: Seen, heard, felt, desired, imagined, prognosticating and faulty by nature. [43]

तत्र पञ्चविधं पूर्वमफलं भिषगादिशेत्| दिवास्वप्नमतिह्रस्वमतिदीर्घं च बुद्धिमान्||४४|| दृष्टः प्रथमरात्रे यः स्वप्नः सोऽल्पफलो भवेत्| न स्वपेद्यं पुनर्दृष्ट्वा स सद्यः स्यान्महाफलः||४५|| अकल्याणमपि स्वप्नं दृष्ट्वा तत्रैव यः पुनः| पश्येत् सौम्यं शुभाकारं तस्य विद्याच्छुभं फलम्||४६|| tatra pañcavidhaṁ pūrvamaphalaṁ bhiṣagādiśēt| divāsvapnamatihrasvamatidīrghaṁ ca buddhimān||44|| dr̥ṣṭaḥ prathamarātrē yaḥ svapnaḥ sō'lpaphalō bhavēt| na svapēdyaṁ punardr̥ṣṭvā sa sadyaḥ syānmahāphalaḥ||45|| akalyāṇamapi svapnaṁ dr̥ṣṭvā tatraiva yaḥ punaḥ| paśyēt saumyaṁ śubhākāraṁ tasya vidyācchubhaṁphalam|46|| tatra pa~jcavidhaM pUrvamaphalaM bhiShagAdishet| divAsvapnamatihrasvamatidIrghaM ca buddhimAn||44|| dRuShTaH prathamarAtre yaH svapnaH so~alpaphalo bhavet| na svapedyaM punardRuShTvA sa sadyaH syAnmahAphalaH||45|| akalyANamapi svapnaM dRuShTvA tatraiva yaH punaH| pashyet saumyaM shubhAkAraM tasya vidyAcchubhaM phalam||46||

Amongst these the first five (viz.seen, heard, felt, desired and imagined) are fruitless [meaningless], and also those seen during daytime, and those which are too short or too long. The dream that is seen during the first part of night is partially fruitful. He, however who having seen a dream does not sleep after it, will be realizing the dream completely. It should be known that if a person having seen an inauspicious dream, sees without waking up another dream that is auspicious and of beneficial form just afterwards, he meets with good results. [44-46] Summary: तत्र श्लोकः- पूर्वरूपाण्यथ स्वप्नान् य इमान् वेत्ति दारुणान्| न स मोहादसाध्येषु कर्माण्यारभते भिषक्||४७|| tatra ślōkaḥ- pūrvarūpāṇyatha svapnān ya imān vētti dāruṇān| na sa mōhādasādhyēṣu karmāṇyārabhatē bhiṣak||47|| tatra shlokaH- pUrvarUpANyatha svapnAn ya imAn vetti dAruNAn| na sa mohAdasAdhyeShu karmANyArabhate bhiShak||47|| A physician who is conversant with those premonitory symptoms which are associated with such terrible dreams never starts the treatment for incurable diseases out of his ignorance.[47] Tattva Vimarsha : • Important principle regarding disease prognosis states that “if all premonitory symptoms of a disease are fully manifested in severe form then it indicates poor prognosis”. [Verse No.3-5] • If any person is continuously exposed to etiological agents and complications appear earlier than such disease is going to have poor prognosis. It is also emphasized that any person who is severely debilitated will not recover from any disease easily. Interpretation based on dreams should also be considered while predicting course of the disease. One special note from this chapter is that they describe symptoms in combination than in solitary appearance which shows the complexity of disease causing and disease prognostic process leading to fatality. Perhaps this needs a specially designed research to study on relation between dreams and Arishtas. [Verse No.6-9] • It has been emphasized that not only clinical presentations but personal experiences of the patient can play role in disease outcome and so should not be neglected. This analogy described here has a striking resemblance with astronomy and understanding of body components. They attribute special colors, precious stones in relation with Dhatus, zodiac signs and body components. Perhaps Jyothisha Shastra (astrology) and gemology can be referred for more explanation. [Verse No.10-11] • It has been emphasized that even minor complaints of the patient should not be ignored as they can be indicator of forthcoming serious and grave conditions. [Verse No.12-13] • Significance of dreams in prodromal symptoms and fatal consequences have been described which need further study and research. All the three Doshas should be excessively vitiated and should involve ‘Manovaha Srotas’ i.e. channels associated with mind for producing such kind of dreams.

Vidhi Vimarsha : - In present era we don’t 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 rhinorrhoea 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. - 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 Acharya 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 Shareera 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] - 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]

- 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] - 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] - 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. - 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] - 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] References: 1. Torres-Bugarín O, Zavala-Cerna MG, Nava A, Flores-García A, Ramos-Ibarra ML. Potential Uses, Limitations, and Basic Procedures of Micronuclei and Nuclear Abnormalities in Buccal Cells. Disease Markers. 2014;2014:956835. 2. Pradeep Sahu et al, Biomarkers: An Emerging Tool for Diagnosis of a Disease and Drug Development, Asian J. Res. Pharm. Sci. 2011; Vol. 1: Issue 1, Pg 09-16 3. Sonali S. Tendulkar and R. R. Dwivedi, ‘Swapna’ in the Indian classics: Mythology or science?,Ayu. 2010 Apr-Jun; 31(2): 170–174. 4. Jeannette Y. Wick; Guido R. Zann, Drugs and Dreams, J Am Pharm Assoc (2003) 2002;42:385-390. 5. Jessica D. Payne, Lynn Nadel, Sleep, dreams, and memory consolidation: The role of the stress hormone cortisol, Learning Memory 2004 November; 11(6): 671–678. 6. J. F. Pagel, Carol Kwiatkowski, The Nightmares of Sleep Apnea: Nightmare Frequency Declines with Increasing Apnea Hypopnea Index, J Clin Sleep Med. 2010 February 15; 6(1): 69–73. 7. Harrison’s-Principles of Internal Medicine-17th edition, The McGraw-Hill Companies, Inc, , Chapter 165. 8. Harrison’s-Principles of Internal Medicine-17th edition, The McGraw-Hill Companies, Inc, , Chapter 28. 9. Harrison’s-Principles of Internal Medicine-17th edition, The McGraw-Hill Companies, Inc, , Chapter 203. 10. 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 11. Harrison’s-Principles of Internal Medicine-17th edition, The McGraw-Hill Companies, Inc,chapter 26 12. 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 13. Harrison’s-Principles of Internal Medicine-17th edition, The McGraw-Hill Companies, Inc, , Diabetes mellitus Chapter 338. 14. 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. 15. 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. 16. Stone MH,Dream analysis in the psychodynamic psychotherapy of borderline patients, Psychodyn Psychiatry. 2012 Jun;40(2):287-302. 17. Dream, The American Heritage Dictionary of the English Language, Fourth Edition. 2000. Retrieved May 7, 2009. 18. Klemm WR. Why Does Rem Sleep Occur? A Wake-Up Hypothesis. Frontiers in Systems Neuroscience. 2011;5:73.