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[[Sutra Sthana]] Chapter 17:

==([[Sutra Sthana]] Chapter 17, Chapter on the Diseases of the Head)==

(Chapter on the diseases of the head)

This is the first chapter of Roga Chatushka (tetrad of diseases) dealing with description related to diseases of the trimarma (three vital organs – the head, heart, and the urinary bladder (basti)). The etiopathogenesis of these diseases is detailed.  Various diseases are caused due to permutations and combinations of dosha imbalances. The chapter describes signs of depletion of dhatu and mala. It also highlights the disorders of oja as well as madhumeha (diabetes mellitus, a disease of the basti), and carbuncles produced as its complications. This chapter also describes various types of dosha gati (movements of dosha). The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter.  

This is the first chapter of Roga Chatushka (tetrad of diseases) dealing with description related to diseases of the trimarma (three vital organs – the head, heart, and the urinary bladder (basti)). The etiopathogenesis of these diseases is detailed.  Various diseases are caused due to permutations and combinations of dosha imbalances. The chapter describes signs of depletion of dhatu and mala. It also highlights the disorders of oja as well as madhumeha (diabetes mellitus, a disease of the basti), and carbuncles produced as its complications. This chapter also describes various types of dosha gati (movements of dosha). The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter.  

Key Words: Shiroroga (diseases of head), hrrudroga(diseases of heart), imbalances in dosha, , dhatu-kshaya, mala-kshaya, pidaka, madhumeha, dosha-gati, sannipata, samsarga, ojokshaya, ojas, signs of depletion of dosha, dhatu and mala, disorders of oja. movement of dosha.  

Key Words: Shiroroga (diseases of head), hrrudroga(diseases of heart), imbalances in dosha, , dhatu-kshaya, mala-kshaya, pidaka, madhumeha, dosha-gati, sannipata, samsarga, ojokshaya, ojas, signs of depletion of dosha, dhatu and mala, disorders of oja. movement of dosha.  

Introduction:

 

=== Introduction ===

 

After describing the guidelines for clinical Ayurveda practice in tetrad of previous chapters of Nirdesha chatushka, information about priniciples of basic Ayurvedic pathology in causing disease is detailed in roga chatushka (tetrad on disease information).   

After describing the guidelines for clinical Ayurveda practice in tetrad of previous chapters of Nirdesha chatushka, information about priniciples of basic Ayurvedic pathology in causing disease is detailed in roga chatushka (tetrad on disease information).   

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

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

Various permutations and combinations of dosha have been analysed that help in understanding the pathogenesis of a disease. It is always a matter of debate as to why there are so many diseases and why does a disease have so many different manifestations or forms, depending upon an individual. One answer is that the dosha involved in pathogenesis varies in the forms of either vriddhi (increase) or kshaya (decrease), and that a typical permutation or combination of such doshas can manifest the disease in a different way. The verses 45, 46, and 47 deal with aashayaapkarsha (pulling dosha from its location) in which a dominant or increased vata pulls the normal pitta and kapha away from their “seats” and manifests its own features there. Therefore, confusion can occur in the diagnosis and management of the disease. In addition, the concept of vikalpa samprapti (variable pathogenesis) can be a reason for such varied presentations of the disease, since per vikalpa samprapti, the involvement of various properties of dosha may differ depending upon the etiological factors. Eighteen types of kshaya (decreased state) of dosha, dhatu, mala and ojas that may play a significant role in disease pathogenesis are also considered in this chapter. Madhumeha (Diabetes mellitus) which is also termed as ojomeha in other texts is one of the prameha where excessive kshaya of ojas takes place. One of its presentations (or forms) is caused due to avaranajanya samprāpti (obstructive pathogenesis), as explained in this chapter. Madhumeha is one among twenty types of prameha characterised by excessive frequency and quantity of urination. The primary dosha associated with madhumeha is vata and two types of pathogenesis of madhumeha have been discussed in Charaka Samhita. In the first type, dhātukshaya (decreased state of body tissue) causes vata provocation and all the clinical features of a vitiated vata are present in the patient of kshayaja madhumeha (Diabetes mellitus type 1) (Charaka Nidana 4/36-44). In the second type, there is an initial involvement of kapha, pitta, mamsa and medas dhātu, that in turn make avarana (to get covered or overlapped) of vata leading to manifestation of madhumeha (diabetes mellitus type 2) where features of kapha, pitta, medas and mamsa dushti are also observed. Here, therefore, the main line of treatment (i.e., for Type 2) involves pacifying  kapha, pitta, medas and mamsa. Various gati of dosha that are responsible for healthy and diseased states are dealt at the end of the chapter. Charaka has also stressed upon the significance of a regular healthy diet. It can be said that in the 17th chapter, a multi-faceted approach to understanding various presentations of diseases has been mentioned, aided with examples.

Various permutations and combinations of dosha have been analysed that help in understanding the pathogenesis of a disease. It is always a matter of debate as to why there are so many diseases and why does a disease have so many different manifestations or forms, depending upon an individual. One answer is that the dosha involved in pathogenesis varies in the forms of either vriddhi (increase) or kshaya (decrease), and that a typical permutation or combination of such doshas can manifest the disease in a different way. The verses 45, 46, and 47 deal with aashayaapkarsha (pulling dosha from its location) in which a dominant or increased vata pulls the normal pitta and kapha away from their “seats” and manifests its own features there. Therefore, confusion can occur in the diagnosis and management of the disease. In addition, the concept of vikalpa samprapti (variable pathogenesis) can be a reason for such varied presentations of the disease, since per vikalpa samprapti, the involvement of various properties of dosha may differ depending upon the etiological factors. Eighteen types of kshaya (decreased state) of dosha, dhatu, mala and ojas that may play a significant role in disease pathogenesis are also considered in this chapter. Madhumeha (Diabetes mellitus) which is also termed as ojomeha in other texts is one of the prameha where excessive kshaya of ojas takes place. One of its presentations (or forms) is caused due to avaranajanya samprāpti (obstructive pathogenesis), as explained in this chapter. Madhumeha is one among twenty types of prameha characterised by excessive frequency and quantity of urination. The primary dosha associated with madhumeha is vata and two types of pathogenesis of madhumeha have been discussed in Charaka Samhita. In the first type, dhātukshaya (decreased state of body tissue) causes vata provocation and all the clinical features of a vitiated vata are present in the patient of kshayaja madhumeha (Diabetes mellitus type 1) (Charaka Nidana 4/36-44). In the second type, there is an initial involvement of kapha, pitta, mamsa and medas dhātu, that in turn make avarana (to get covered or overlapped) of vata leading to manifestation of madhumeha (diabetes mellitus type 2) where features of kapha, pitta, medas and mamsa dushti are also observed. Here, therefore, the main line of treatment (i.e., for Type 2) involves pacifying  kapha, pitta, medas and mamsa. Various gati of dosha that are responsible for healthy and diseased states are dealt at the end of the chapter. Charaka has also stressed upon the significance of a regular healthy diet. It can be said that in the 17th chapter, a multi-faceted approach to understanding various presentations of diseases has been mentioned, aided with examples.

 

१७. कियन्तःशिरसीयोऽध्यायः

१७. कियन्तःशिरसीयोऽध्यायः

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

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