Changes

}}

}}

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

==([[Sutra Sthana]] Chapter 17, Kiyanta Shiraseeya Adhyaya (Chapter on the Diseases of the Head and others)==

   

   

=== Abstract ===

=== Abstract ===

=== Introduction ===

=== Introduction ===

<div style="text-align:justify;">

<div style="text-align:justify;">

After describing the guidelines for clinical [https://en.wikipedia.org/wiki/Ayurveda 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.

The diseases related to ''trimarma'', or the three vital organs, have also been described in the 26th chapter of [[Chikitsa Sthana]] (titled Trimarmiya Chikitsa adhyaya) and later in 9th chapter of [[Siddhi Sthana]] (titled Trimarmiya Siddhi Adhyaya). While the [[Sutra Sthana]] helps provide the fundamental approaches to treating these diseases, the [[Chikitsa Sthana]] primarily addresses the management aspects and [[Siddhi Sthana]] describes the internal and external traumas of these organs. As per [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], there are 107 marmas that are considered to be points of ''prana'' (vital energy) and are located in various parts of the body. It is accepted that injuries to ''marma'' -external, internal or psychological  - may either cause immediate death or permanent deformities (some of which may cause complications and death at a later stage). Among these 107 ''marmas'', Charaka has given utmost importance to the head, the heart and the urinary bladder. Among these three, the head is foremost as it is central to all senses and is the prime location of ''prana''. This is the reason why other texts have compared human body with an inverted-tree model (with roots at the top and branches at the bottom).

The diseases related to ''trimarma'', or the three vital organs, have also been described in the 26th chapter of [[Chikitsa Sthana]] [[ Trimarmiya Chikitsa adhyaya]] and later in 9th chapter of [[Siddhi Sthana]] [[Trimarmiya Siddhi Adhyaya]]. While the [[Sutra Sthana]] helps provide the fundamental approaches to treating these diseases, the [[Chikitsa Sthana]] primarily addresses the management aspects and [[Siddhi Sthana]] describes the internal and external traumas of these organs. As per Ayurveda, there are 107 marmas that are considered to be points of ''prana'' (vital energy) and are located in various parts of the body. It is accepted that injuries to ''marma'' -external, internal or psychological  - may either cause immediate death or permanent deformities (some of which may cause complications and death at a later stage). Among these 107 ''marmas'', Charaka has given utmost importance to the head, the heart and the urinary bladder. Among these three, the head is foremost as it is central to all senses and is the prime location of ''prana''. This is the reason why other texts have compared human body with an inverted-tree model (with roots at the top and branches at the bottom).

The ''siroroga'', or the disease(s) of the head, are various clinical representations of headache and vary depending upon ''dosha''-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''siroroga'', different manifestations of headache can give an idea of the predominant ''dosha'' which may further decide the course of treatment. Similarly ''hridroga'' (heart diseases) and diseases associated with the urinary bladder mentioned in this chapter are also due to ''dosha'' predominance and ''krimi'' infestation.  

The ''shiroroga'', or the disease(s) of the head, are various clinical representations of headache and vary depending upon ''dosha''-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''siroroga'', different manifestations of headache can give an idea of the predominant ''dosha'' which may further decide the course of treatment. Similarly ''hridroga'' (heart diseases) and diseases associated with the urinary bladder mentioned in this chapter are also due to ''dosha'' predominance and ''krimi'' infestation.  

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

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

|}

|}

'''''Ojas''''': Ojas is well known and defined  in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] in terms of its functions, its importance, its types and its sites of functions within the body. It has been described in this text as a clear and slightly red-yellowish fluid situated in the heart is known as ''ojas'', the destruction of which leads to death. Its colour resembles to that of ''ghee'', taste is like honey and its smell is like that of roasted paddy (Verses 73-75). But its interpretation in modern physiological terms is confusing. In this chapter a hint has been given in this regard that ''ojas'' is a first thing created in the body of all living creatures. The symptoms of diminished ''ojas'' include timidity, debility, constant worry, discomfort of the senses, loss of lustre, neurasthenia, dryness and emaciation.

'''''Ojas''''': Ojas is well known and defined  in Ayurveda in terms of its functions, its importance, its types and its sites of functions within the body. It has been described in this text as a clear and slightly red-yellowish fluid situated in the heart is known as ''ojas'', the destruction of which leads to death. Its colour resembles to that of ''ghee'', taste is like honey and its smell is like that of roasted paddy (Verses 73-75). But its interpretation in modern physiological terms is confusing. In this chapter a hint has been given in this regard that ''ojas'' is a first thing created in the body of all living creatures. The symptoms of diminished ''ojas'' include timidity, debility, constant worry, discomfort of the senses, loss of lustre, neurasthenia, dryness and emaciation.

'''''Āvarita madhumeha (type 1 Diabetes mellitus)''''': Two scenarios that cause  provocation of ''vata'' have been mentioned: decrease of ''dhatu'' (''dhatu kshaya'') and ''avarana''(cover)[Cha. Chi. 28/59]. The description of ''madhumeha'', provided earlier in this chapter, provides a good example of ''avarana''.That a provoked or vitiated ''vata'' causes ''madhumeha'' has also been reiterated in the [[Nidana Sthana]]. All the factors that cause decrease of body tissues lead to provocation of ''vāta''. But even though ''madhumeha'' is caused by a vitiated ''vata'', its etiological factors also cause an increase in ''kapha'' and ''pitta''. The comparison of ''nidana'' of ''madhumeha'' mentioned in these two different references is tabulated here:

'''''Āvarita madhumeha (type 1 Diabetes mellitus)''''': Two scenarios that cause  provocation of ''vata'' have been mentioned: decrease of ''dhatu'' (''dhatu kshaya'') and ''avarana''(cover)[Cha. Chi. 28/59]. The description of ''madhumeha'', provided earlier in this chapter, provides a good example of ''avarana''.That a provoked or vitiated ''vata'' causes ''madhumeha'' has also been reiterated in the [[Nidana Sthana]]. All the factors that cause decrease of body tissues lead to provocation of ''vāta''. But even though ''madhumeha'' is caused by a vitiated ''vata'', its etiological factors also cause an increase in ''kapha'' and ''pitta''. The comparison of ''nidana'' of ''madhumeha'' mentioned in these two different references is tabulated here:

Charaka has mentioned seven varieties of ''prameha pidika'' whereas Sushruta and Vagbhata have added three more to this list that includes ''masoorika, putrini'' and ''vidarika''.

Charaka has mentioned seven varieties of ''prameha pidika'' whereas Sushruta and Vagbhata have added three more to this list that includes ''masoorika, putrini'' and ''vidarika''.

The ''shiroroga'' described in this chapter are various clinical presentations of headache depending upon ''dosha'' dominance and ''krimi'' infestation. ''Krimi'' in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] is a generic term for a large number of pathological organisms ranging from microorganisms found in blood (''raktaja krimi'') to intestinal worms as well as external parasites such as lice [Cha. Vi. 7/11-13]

The ''shiroroga'' described in this chapter are various clinical presentations of headache depending upon ''dosha'' dominance and ''krimi'' infestation. ''Krimi'' in Ayurveda is a generic term for a large number of pathological organisms ranging from microorganisms found in blood (''raktaja krimi'') to intestinal worms as well as external parasites such as lice [Cha. Vi. 7/11-13]

As mentioned earlier in the document, the diseases of the  head (verses 13-14) include hemicrania, coryza, headache (caused as a side-effect of diseases of the mouth, nose, eyes and ears), giddiness/vertigo, facial paralysis, tremors of the head, and stiffness of the neck, nape and jaw (there are additional varieties of ''shiroroga'' viz. frontal sinusitis, trigeminal neuralgia, and ''shankhaka'' are also described [Cha. Si. 9/70-87].

As mentioned earlier in the document, the diseases of the  head (verses 13-14) include hemicrania, coryza, headache (caused as a side-effect of diseases of the mouth, nose, eyes and ears), giddiness/vertigo, facial paralysis, tremors of the head, and stiffness of the neck, nape and jaw (there are additional varieties of ''shiroroga'' viz. frontal sinusitis, trigeminal neuralgia, and ''shankhaka'' are also described [Cha. Si. 9/70-87].

In contemporary science, headache is not a disease and can be vascular, myogenic, cervicogenic, and inflammatory in origin. The drug choices also depend upon the causative factors of headache. Similarly in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], though headache is a common manifestation of all five types of diseases of the head, different forms of headache can give an idea of ''dosha'' predominance which may further decide the preference of procedures or drug in its treatment.  

In contemporary science, headache is not a disease and can be vascular, myogenic, cervicogenic, and inflammatory in origin. The drug choices also depend upon the causative factors of headache. Similarly in Ayurveda, though headache is a common manifestation of all five types of diseases of the head, different forms of headache can give an idea of ''dosha'' predominance which may further decide the preference of procedures or drug in its treatment.  

The term headache implies pain in the region of cranial vault which is one of the most common and difficult clinical problems in medicine and can be due to serious intracranial conditions like raised intracranial pressure or space occupying lesion or various inflammatory changes of brain tissue or meninges. Further, any pain in the head may also be due to lesions in nearby structures such as the eyes and ear causing referred headache.  

The term headache implies pain in the region of cranial vault which is one of the most common and difficult clinical problems in medicine and can be due to serious intracranial conditions like raised intracranial pressure or space occupying lesion or various inflammatory changes of brain tissue or meninges. Further, any pain in the head may also be due to lesions in nearby structures such as the eyes and ear causing referred headache.  

Carbuncles are common complications occurring in uncontrolled diabetes patients where the infection spreads extensively in the dermal and underlying soft tissue. This presents itself as a  complex localized abscess or as several separate abscesses with multiple discharge sinuses usually caused due to staphylococcus aureus infection.   

Carbuncles are common complications occurring in uncontrolled diabetes patients where the infection spreads extensively in the dermal and underlying soft tissue. This presents itself as a  complex localized abscess or as several separate abscesses with multiple discharge sinuses usually caused due to staphylococcus aureus infection.   

Thus, this chapter is very important as it deals with the disorders of three vital parts of the body (''trimarma''). It also describes very important aspects of pathogenesis caused due to combinations of vitiated ''dosha'' viz. ''samsarga'' and ''sannipata''. The description of ''ojas'' is a unique concept of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. The detailed descriptions along with etiological factors of each ''prameha pidika'' are very helpful in planning their prevention and cure.

Thus, this chapter is very important as it deals with the disorders of three vital parts of the body (''trimarma''). It also describes very important aspects of pathogenesis caused due to combinations of vitiated ''dosha'' viz. ''samsarga'' and ''sannipata''. The description of ''ojas'' is a unique concept of Ayurveda. The detailed descriptions along with etiological factors of each ''prameha pidika'' are very helpful in planning their prevention and cure.

</div>

</div>

=====Table 2: Types of Pidika in different classics:=====

=====Table 2: Types of Pidika in different classics:=====