Changes

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Babu S.P.

|data7  = Babu S.P.

|label8 = Editor

|label8 = Editors

|data8  = Khandel S.K., Babu S.P.

|data8  = Khandel S.K., Babu S.P., Deole Y.S., Basisht G.

|label9 = Date of publication  

|label9 = Date of publication  

|data9 = December 17, 2018

|data9 = December 17, 2018

While palpating patient’s body; following deviations should be studied keeping normal anatomy and physiology of the body in mind. Extreme deviations from normalcy in the body like the absence of pulsation in the pulsatile areas of the body, absence of warmth from warm regions of the body or the presence of hardness or rigidity in softer body structures can give important information in regards to the life span of the person. Similarly the presence of the signs like dislocation or displacement of joints, extreme alteration in perspiration, extreme emaciation or bulkiness of muscle etc. which are found without any apparent cause are to be studied to assess the span of life or the signs of death. [4]  

While palpating patient’s body; following deviations should be studied keeping normal anatomy and physiology of the body in mind. Extreme deviations from normalcy in the body like the absence of pulsation in the pulsatile areas of the body, absence of warmth from warm regions of the body or the presence of hardness or rigidity in softer body structures can give important information in regards to the life span of the person. Similarly the presence of the signs like dislocation or displacement of joints, extreme alteration in perspiration, extreme emaciation or bulkiness of muscle etc. which are found without any apparent cause are to be studied to assess the span of life or the signs of death. [4]  

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तद्व्यासतोऽनुव्याख्यास्यामः- तस्य चेत् परिमृश्यमानं पृथक्त्वेनपादजङ्घोरुस्फिगुदरपार्श्वपृष्ठेषिकापाणिग्रीवाताल्वोष्ठललाटं स्विन्नं शीतं स्तब्धं  दारुणं वीतमांसशोणितं वा स्यात्,परासुरयं पुरुषो न चिरात् कालं  मरिष्यतीति विद्यात्| <br />

तद्व्यासतोऽनुव्याख्यास्यामः-  

तस्य चेत् परिमृश्यमानं पृथक्त्वेनपादजङ्घोरुस्फिगुदरपार्श्वपृष्ठेषिकापाणिग्रीवाताल्वोष्ठललाटं स्विन्नं शीतं स्तब्धं  दारुणं वीतमांसशोणितं वा स्यात्,परासुरयं पुरुषो न चिरात् कालं  मरिष्यतीति विद्यात्| <br />

तस्य चेत् परिमृश्यमानानि पृथक्त्वेनगुल्फजानुवङ्क्षणगुदवृषणमेढ्रनाभ्यंसस्तनमणिकपर्शुकाहनुनासिकाकर्णाक्षिभ्रूशङ्खादीनि स्रस्तानि व्यस्तानि च्युतानिस्थानेभ्यः स्कन्नानि  वा स्युः, परासुरयं पुरुषोऽचिरात् कालं मरिष्यतीति  विद्यात्||५||<br />

तस्य चेत् परिमृश्यमानानि पृथक्त्वेनगुल्फजानुवङ्क्षणगुदवृषणमेढ्रनाभ्यंसस्तनमणिकपर्शुकाहनुनासिकाकर्णाक्षिभ्रूशङ्खादीनि स्रस्तानि व्यस्तानि च्युतानिस्थानेभ्यः स्कन्नानि  वा स्युः, परासुरयं पुरुषोऽचिरात् कालं मरिष्यतीति  विद्यात्||५||<br />

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The physician should similarly palpate separately ankles, knees, pelvis, anus, scrotum, penis, navel, nipples, rib cage, chin, nostrils, ears, eyes, eyebrows, temples to see if these are lax, broken, loosened, displaced from their normal position. If so then the physician should consider that the patient will face death in a short span of time.  [5]

The physician should similarly palpate separately ankles, knees, pelvis, anus, scrotum, penis, navel, nipples, rib cage, chin, nostrils, ears, eyes, eyebrows, temples to see if these are lax, broken, loosened, displaced from their normal position. If so then the physician should consider that the patient will face death in a short span of time.  [5]

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The physician should similarly examine the patient’s respiration, two sides of the neck, teeth, eye-lashes, eyes, hair covering the head as well as body hair, abdomen, nails and fingers.  

The physician should similarly examine the patient’s respiration, two sides of the neck, teeth, eye-lashes, eyes, hair covering the head as well as body hair, abdomen, nails and fingers.  

Following are considered arisht lakshana if patient breaths either too long or too short of a breath. Absence of pulsation in vessels of neck. Teeth are coated, abnormally white and have sugar/crystal like deposits on it,. Eye-lashes are matted together. Eyes have lost physiological characteristics or are seen abnormal in any manner like- too bulging, too retracted, too oblique or squinted, too distorted, too loosened within their structure, having too much watery discharge, are either continuously open or closed, continuously blinking, with unstable vision, abnormal vision, deficient vision, have lost their keenness of vision (or color blindness), night blind, sees everything complete white or black, or red. If, patient sees halo of different colors like- black, yellow, blue, blackish, coppery, green, turmeric, white or any other abnormal color. Absence of pain on plucking hair from any part of his body. Visibly prominent veins on abdominal region and appear to have various colors like-black, copper, blue, turmeric-like or white. If the nails are drained of blood and flesh, they look dark purple in color. Lastly physician should examine the patient’s finger. If while stretching or pulling they do not get cracked, it should be known that the person will not survive. ??? this last sign is very questionable and should be worded properly[6]

Following are considered bad prognostic features:

*If patient breaths either too long or too short of a breath  

*Absence of pulsation in vessels of neck.  

*Teeth are coated, abnormally white and have sugar/crystal like deposits on it.  

*Eye-lashes are matted together.  

*Eyes have lost physiological characteristics or are seen abnormal in any manner like- too bulging, too retracted, too oblique or squinted, too distorted, too loosened within their structure, having too much watery discharge, are either continuously open or closed, continuously blinking, with unstable vision, abnormal vision, deficient vision, have lost their keenness of vision (or color blindness), night blind, sees everything complete white or black, or red.  

*If, patient sees halo of different colors like- black, yellow, blue, blackish, coppery, green, turmeric, white or any other abnormal color. Absence of pain on plucking hair from any part of his body.  

*Visibly prominent veins on abdominal region and appear to have various colors like-black, copper, blue, turmeric-like or white.  

*If the nails are drained of blood and flesh, they look dark purple in color.  

*Lastly physician should examine the patient’s finger. If there is no cracking sound while stretching or pulling the fingers,it should be known that the person will not survive.[6]

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== Tattva Vimarsha(Fundamental Principles)==

== Tattva Vimarsha(Fundamental Principles)==

Palpation of patient can suggest prognosis of disease.   

Palpation of patient, observation of respiration, eyes can suggest prognosis of disease.   

== Vidhi Vimarsha (Applied Inferences)==

== Vidhi Vimarsha (Applied Inferences)==

The physician who, by palpation ascertains various palpable signs, will never be confused regarding the matter of prognostic knowledge regarding life span of a patient. [7]

The physician who, by palpation ascertains various palpable signs, will never be confused regarding the matter of prognostic knowledge regarding life span of a patient. [7]

[[Parimarshaneeyam Indriyam Adhyaya]] deals with signs and symptoms of imminent death or moribund symptoms; specifically those are elicited by touch or palpation. The chapter commences with the importance of palpation as a modality for diagnosis and any changes in the body indicative of imminent death. The signs of imminent death are seen as abnormal manifestations which cannot be explained as they appear without any reason. These can be seen as absence of pulsation in the areas of the body that are pulsatile, coldness in the warm areas of the body, rigidity in softer body parts, roughness in the body parts that are slimy in nature, the inexplicable absence of body parts; laxity, bowing or displacement of joints, excessive deficiency of flesh or blood, solidity of flesh or blood, excessive perspiration or stiffness, and/or whatever other similar symptoms that can be demonstrated by palpation. The important point to note here is that all the signs and symptoms seen here as well as other chapters of [[Indriya Sthana]] are seen without any causative factors. The rest of the [[Charak Samhita]] excluding the [[Indriya Sthana]] comprises of various signs and symptoms due to ''dosha dushti'' or vitiation of ''doshas''. [Cha.Sa.[[Indriya Sthana]] 3/4]

[[Parimarshaneeyam Indriyam Adhyaya]] deals with signs and symptoms of imminent death or moribund symptoms; specifically those are elicited by touch or palpation. The chapter commences with the importance of palpation as a modality for diagnosis and any changes in the body indicative of imminent death. The signs of imminent death are seen as abnormal manifestations which cannot be explained as they appear without any reason. These can be seen as absence of pulsation in the areas of the body that are pulsatile, coldness in the warm areas of the body, rigidity in softer body parts, roughness in the body parts that are slimy in nature, the inexplicable absence of body parts; laxity, bowing or displacement of joints, excessive deficiency of flesh or blood, solidity of flesh or blood, excessive perspiration or stiffness, and/or whatever other similar symptoms that can be demonstrated by palpation. The important point to note here is that all the signs and symptoms seen here as well as other chapters of [[Indriya Sthana]] are seen without any causative factors. The rest of the [[Charak Samhita]] excluding the [[Indriya Sthana]] comprises of various signs and symptoms due to vitiation of [[dosha]]. [Cha.Sa.[[Indriya Sthana]] 3/4]

=== Some examples of palpation ===

=== Examples of palpation ===

The carotid artery is palpated with the thumb or finger tips placed at the upper end of the thyroid cartilage along the medial border of the sternocleidomastoid muscle.<ref> Vakil RJ, Golwalla AF. Physical Diagnosis. 9th ed. Media Promoters & Publishers Pvt. Ltd. MumbaiJal pg231 </ref> The absence of pulsation in carotid artery usually results from atherosclerosis or carotid artery stenosis.

The carotid artery is palpated with the thumb or finger tips placed at the upper end of the thyroid cartilage along the medial border of the sternocleidomastoid muscle.<ref> Vakil RJ, Golwalla AF. Physical Diagnosis. 9th ed. Media Promoters & Publishers Pvt. Ltd. MumbaiJal pg231 </ref> The absence of pulsation in carotid artery usually results from atherosclerosis or carotid artery stenosis.

Thermoregulatory center of hypothalamus actively monitors thermostasis. If this gets altered it’s a sign of fatality. Sudden drop of body temperature could be a result of an injury, hemorrhage, acute illness or shock. A persistently low temperature is commonly seen in emaciation or wasting diseases, hypothyroidism or Simmonds diseases (post-partum hypopituitarism).<ref> Vakil RJ, Golwalla AF. Physical Diagnosis. 9th ed. Media Promoters & Publishers Pvt. Ltd. MumbaiJal pg80 </ref>

Thermoregulatory center of hypothalamus actively monitors thermostasis. If this gets altered it’s a sign of fatality. Sudden drop of body temperature could be a result of an injury, hemorrhage, acute illness or shock. A persistently low temperature is commonly seen in emaciation or wasting diseases, hypothyroidism or Simmonds diseases (post-partum hypopituitarism).<ref> Vakil RJ, Golwalla AF. Physical Diagnosis. 9th ed. Media Promoters & Publishers Pvt. Ltd. MumbaiJal pg80 </ref>

Cancer is one of the leading causes of death and disease worldwide today. Various changes like rigidity in soft tissues (e.g. breast cancer) and roughness in mucosal membranes (changes seen in gastric cancer) or extreme wasting are a few changes associated with cancer.

Cancer is one of the leading causes of death and disease worldwide today. Various changes like rigidity in soft tissues (e.g. breast cancer) and roughness in mucosal membranes (changes seen in gastric cancer) or extreme wasting are a few changes associated with cancer. Absence of normally existing body parts can be understood as atrophy of various glands or overall muscle atrophy.

Absence of normally existing body parts can be understood as atrophy of various glands or overall muscle atrophy.

 

 

 

 

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== References ==

== References ==