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This chapter is a random compilation of bad prognostic features of diseases that are mentioned in [[Nidana Sthana]] and [[Chikitsa Sthana]]. An experienced clinician can identify bad prognosis of disease well in time and shall intervene as per the condition of patient.  

This chapter is a random compilation of bad prognostic features of diseases that are mentioned in [[Nidana Sthana]] and [[Chikitsa Sthana]]. An experienced clinician can identify bad prognosis of disease well in time and shall intervene as per the condition of patient.  

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===Sanskrit text, Transliteration and English Translation===

==Sanskrit text, Transliteration and English Translation==

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Lord Atreya said, “Now we shall explain the chapter ''Katmani sharireeyam indriyam''". [1-2]

Now we shall expound the chapter "Katmani sharireeyam indriyam"(Specific fatal clinical features).Thus said Lord Atreya.[1-2]

==== Questions by Agnivesha ====

=== Questions by Agnivesha ===

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One, who has severe pain in the upper part of chest while talking, vomits the ingested food, cannot digest the food ingested; one, whose ''bala'' (strength) is depleting suddenly and who has morbid thirst; one who has pain in the region of ''hridaya'' (heart) are incurable.[3-6]

One, who has severe pain in the upper part of chest while talking, vomits the ingested food, cannot digest the food ingested; one, whose ''bala'' (strength) is depleting suddenly and who has morbid thirst; one who has pain in the region of ''hridaya'' (heart) are incurable.[3-6]

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==== Poor prognosis in ''Hikka, Anaha, Atisara'' and ''Jwara'' ====

=== Poor prognosis in ''Hikka, Anaha, Atisara'' and ''Jwara'' ===

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Again this hiccups associated with ''poorvanhika jwara'' (fever in forenoon) and ''shushka kasa'' (dry cough) in a person with wasting of muscles and depleted strength as like as dead body .[7-10]

Again this hiccups associated with ''poorvanhika jwara'' (fever in forenoon) and ''shushka kasa'' (dry cough) in a person with wasting of muscles and depleted strength as like as dead body .[7-10]

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==== Poor prognosis in ''Shotha'' ====

=== Poor prognosis in ''Shotha'' ===

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A person having edema on hands, feet pelvic region, abdomen and diminution of color complexion, strength, and aversion of food should not be administered medicine [due to poor prognosis, medicines are of no use]. [11-14]

A person having edema on hands, feet pelvic region, abdomen and diminution of color complexion, strength, and aversion of food should not be administered medicine [due to poor prognosis, medicines are of no use]. [11-14]

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==== Poor prognosis in respiratory disorders ====

=== Poor prognosis in respiratory disorders ===

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If a person having lock jaw and rigid neck suffers from thirst, diminished strength, and the signs of life(breath) are only confined to chest, such patient should be discarded for treatment purpose. [20]

If a person having lock jaw and rigid neck suffers from thirst, diminished strength, and the signs of life(breath) are only confined to chest, such patient should be discarded for treatment purpose. [20]

==== Markers of imminent death ====

=== Markers of imminent death ===

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If there is sudden deterioration of health is extended to the change in basic constitution (''prakriti'') of a patient then he succumbs for sudden death. [21-24]

If there is sudden deterioration of health is extended to the change in basic constitution (''prakriti'') of a patient then he succumbs for sudden death. [21-24]

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==== Summary ====

=== Summary ===

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Patients with above mentioned diseases should not be taken for treatment. The wise physician should not anticipate success of his treatment in such cases.[25]

Patients with above mentioned diseases should not be taken for treatment. The wise physician should not anticipate success of his treatment in such cases.[25]

=== Tattva Vimarsha (Fundamental Principles) ===

== Tattva Vimarsha (Fundamental Principles) ==

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*Strength against disease is knowledge of health.  

*Strength against disease is knowledge of health.  

*In a person suffering from more than one disease, and if their etiological factors are mutually contradictory and the line of treatments are also contradictory, the condition worsens with bad prognosis leading to death. If they appear suddenly, the sudden death of the patient is also certain.  [21-24]

*In a person suffering from more than one disease, and if their etiological factors are mutually contradictory and the line of treatments are also contradictory, the condition worsens with bad prognosis leading to death. If they appear suddenly, the sudden death of the patient is also certain.  [21-24]

== Vidhi Vimarsha (Applied Inferences ) ==

== Vidhi Vimarsha (Applied Inferences) ==

 

*The conditions related with respiratory disease pathologies are pleural effusion, pneumothorax and pleural tumors and secondary to pulmonary diseases like pneumonias, pulmonary infarction and bronchogenic carcinoma.  

*The conditions related with respiratory disease pathologies are pleural effusion, pneumothorax and pleural tumors and secondary to pulmonary diseases like pneumonias, pulmonary infarction and bronchogenic carcinoma.  

*''Anna'' (food) is considered as ''prana'' (vital force). Difficulty to intake the food interferes with nutrition and leads to severe disability. It also interferes with the intake of medicines. Dysphagia may be due to mechanical causes or neurological causes seen associated with other serious pathologies. Lack of digestion indicates impairment of digestive system and thus lack of absorption of nutrients and medicines. ''Prakrita kapha'' imparts ''bala'' (strength) to the body. Sudden depletion of ''bala'' indicates impairment of ''Ojus''. ''Bala'' is essential for both treatment and for prevention of further progression of disease. Severe ''kapha kshaya'' (depletion of ''kapha'') and ''vata-pitta'' vitiation is explained as the cause behind the pathogenesis of ''trishna''. ''Trishna'' indicates not merely thirst, but severe depletion of water and electrolytes from the body which may lead to pathology even at the cellular level. [verse 5-6]

*''Anna'' (food) is considered as ''prana'' (vital force). Difficulty to intake the food interferes with nutrition and leads to severe disability. It also interferes with the intake of medicines. Dysphagia may be due to mechanical causes or neurological causes seen associated with other serious pathologies. Lack of digestion indicates impairment of digestive system and thus lack of absorption of nutrients and medicines. ''Prakrita kapha'' imparts ''bala'' (strength) to the body. Sudden depletion of ''bala'' indicates impairment of ''Ojus''. ''Bala'' is essential for both treatment and for prevention of further progression of disease. Severe ''kapha kshaya'' (depletion of ''kapha'') and ''vata-pitta'' vitiation is explained as the cause behind the pathogenesis of ''trishna''. ''Trishna'' indicates not merely thirst, but severe depletion of water and electrolytes from the body which may lead to pathology even at the cellular level. [verse 5-6]