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<div style="text-align:justify;">As the name suggests, the chapter provides a brief description of the ten vital sites of life forces. The characteristics to define and distinguish between the qualified physician and the quack are detailed further. The qualified physician is said to be a “companion of the life forces” (pranabhisara) that dwell in the body, especially in the ten seats specified above. On the other hand, the quack is said to be a companion of diseases (roganamabhisara). In the process of enumerating the characteristics of the qualified physician, this chapter also gives a succinct summary of the entire Sutra Sthana, implying that it represents the core subjects and skills a physician needs to acquire. The behavior of the quack is then portrayed vividly, and the chapter concludes with an express warning to the patients to never fall prey to the quack. It is also made clear that the responsibility of licensing the qualified physicians and censuring the quacks rests with the King and the State. </div>

<div style="text-align:justify;">As the name suggests, the chapter provides a brief description of the ten vital sites of life forces. The characteristics to define and distinguish between the qualified physician and the quack are detailed further. The qualified physician is said to be a “companion of the life forces” (pranabhisara) that dwell in the body, especially in the ten seats specified above. On the other hand, the quack is said to be a companion of diseases (roganamabhisara). In the process of enumerating the characteristics of the qualified physician, this chapter also gives a succinct summary of the entire Sutra Sthana, implying that it represents the core subjects and skills a physician needs to acquire. The behavior of the quack is then portrayed vividly, and the chapter concludes with an express warning to the patients to never fall prey to the quack. It is also made clear that the responsibility of licensing the qualified physicians and censuring the quacks rests with the King and the State. </div>

'''Keywords''': Ten seats of life forces, ''pranayatana'', vital centers, qualities of ''pranabhisara'' (life saver) physician, characteristics of ''rogabhisara''(life destroyer), medical ethics, quack.

'''Keywords''': Ten seats of life forces, [[pranayatana]], vital centers, qualities of [[pranabhisara]], life saver physician, characteristics of ''rogabhisara''(life destroyer), medical ethics, quack.

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There are surely ten principal seats in which the life forces are established. The two temples, the three vital organs, the throat, blood, ''shukra'' (reproductive fluid), ''oja'' (the vital fluid) and the anus. The learned person who knows these as well as the sensory and motor organs, intelligence, the cause of consciousness as well as diseases is known as the companion of the life forces. [3-4]

There are surely ten principal seats in which the life forces are established. The two temples, the three vital organs, the throat, [[rakta dhatu]] (blood), [[shukra dhatu]] (reproductive fluid), [[oja]] (the vital fluid) and the anus. The learned person who knows these as well as the sensory and motor organs, intelligence, the cause of consciousness as well as diseases is known as the companion of the life forces. [3-4]

'''Cross-reference:''' In [[Sankhya Sharira]], Shankha (the temples) are replaced by nabhi and mamsa in the list of pranayatana.[Cha.Sa.[[Sharira Sthana]] 7/9]

'''Cross-reference:''' In [[Sankhya Sharira]], Shankha (the temples) are replaced by nabhi and mamsa in the list of pranayatana.[Cha.Sa.[[Sharira Sthana]] 7/9]

Eternal salutations to those physicians who are well versed in the texts, who are adept, pure and well versed in practice, who have complete control over their hands in performing skilled treatments and those who have self-control. [10-13]

Eternal salutations to those physicians who are well versed in the texts, who are adept, pure and well versed in practice, who have complete control over their hands in performing skilled treatments and those who have self-control. [10-13]

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== Tattva Vimarsha (Fundamental Principles) ==

== Tattva Vimarsha (Fundamental Principles) ==

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*The ten principal seats of life forces are the two temples, the three vital organs (heart, brain and urinary bladder including urinary system), the throat, blood, ''Shukra'' (reproductive fluid), ''Oja'' (the vital fluid) and the anus.  

*The ten principal seats of life forces are the two temples, the three vital organs (heart, brain and urinary bladder including urinary system), the throat, [[rakta dhatu]] (blood), [[Shukra dhatu]] (reproductive fluid), [[Oja]] (the vital fluid) and the anus.  

*The physician who is the companion of life forces shall know these as well as the sensory and motor organs, intelligence, the cause of consciousness as well as diseases.

*The physician who is the companion of life forces shall know these as well as the sensory and motor organs, intelligence, the cause of consciousness as well as diseases.

*''Pranabhisara vaidya'' having the enlisted qualities is the best physician who can protect the life forces. On the contrary, ''Rogabhisara'' destroys the life forces.

*''Pranabhisara vaidya'' having the enlisted qualities is the best physician who can protect the life forces. On the contrary, ''Rogabhisara'' destroys the life forces.

The author makes it clear at the beginning of each chapter that it is not essentially his views that are being codified but rather the views of the preceptor Atreya. The teaching becomes credible when it comes from an authentic source. When codified knowledge is transmitted, it is mandatory to reveal the source of information and also to confirm its authenticity. [2]

The author makes it clear at the beginning of each chapter that it is not essentially his views that are being codified but rather the views of the preceptor Atreya. The teaching becomes credible when it comes from an authentic source. When codified knowledge is transmitted, it is mandatory to reveal the source of information and also to confirm its authenticity. [2]

=== Concept snf importance of prana ===

=== Concepts of importance of prana ===

It is a fundamental principle in [[Ayurveda]] that any medical intervention should not work against the ''prana'' of the individual as it can lead to a decrease in the quality of life, new diseases, reduction in life span or even death. When depletive therapies are done, it has been specified that it should not be antagonistic to the factors that support life - ''pranavirodhina chainam langhanenopapadayet''. Thus, the knowledge of the seats of ''prana'' and the impact of treatments, injuries and other stresses on them is of utmost practical relevance to the physician. Any affliction to the seats of the life forces needs to be attended to promptly. Treatments succeed only when two factors are managed in the background. One is ''prana'', and the other is ''bala''. The text says that life is dependent on ''prana'' and strength is dependent on ''udana'' - ''visheshat jivitam prane udano balamuchyate'' (the life is seated in ''prana'', while the strength in ''udana'').  

It is a fundamental principle in [[Ayurveda]] that any medical intervention should not work against the ''prana'' of the individual as it can lead to a decrease in the quality of life, new diseases, reduction in life span or even death. When depletive therapies are done, it has been specified that it should not be antagonistic to the factors that support life - ''pranavirodhina chainam langhanenopapadayet''. Thus, the knowledge of the seats of ''prana'' and the impact of treatments, injuries and other stresses on them is of utmost practical relevance to the physician. Any affliction to the seats of the life forces needs to be attended to promptly. Treatments succeed only when two factors are managed in the background. One is ''prana'', and the other is ''bala''. The text says that life is dependent on ''prana'' and strength is dependent on ''udana'' - ''visheshat jivitam prane udano balamuchyate'' (the life is seated in ''prana'', while the strength in ''udana'').  

Epidural space, the outermost part of the spinal canal, houses the middle meningeal artery that serves to provide steady blood supply to the meninges. This region is covered by a very thin layer of skull which is also very weak in comparison to the rest of the skull. Any laceration of the middle meningeal artery – due to a trauma or blow to this region – could lead to blood pooling in the epidural space, and consequently, building up of pressure on brain tissues, causing an eventual death of brain cells due to oxygen deprivation.  

Epidural space, the outermost part of the spinal canal, houses the middle meningeal artery that serves to provide steady blood supply to the meninges. This region is covered by a very thin layer of skull which is also very weak in comparison to the rest of the skull. Any laceration of the middle meningeal artery – due to a trauma or blow to this region – could lead to blood pooling in the epidural space, and consequently, building up of pressure on brain tissues, causing an eventual death of brain cells due to oxygen deprivation.  

=== Three marma ===

=== Three [[marma]] ===

The depiction of the three vital organs viz., brain, heart, and bladder as the seats of the life force do not need much explanation. These organs are known as the ''trimarmas'', and entire chapters have been devoted to these three vital ''marmas'' in the section on treatments ([[Chikitsa Sthana]]) and clinical success ([[Siddhi Sthana]]) explaining the various diseases that afflict these organs and how to manage them. ''Trimarma'' corresponds to the biomedical concept of the tripods of life, which are the brain, heart, and lungs. In [[Ayurveda]], instead of lungs, the bladder including the kidneys constitutes one of the three vital organs that sustain life.

The depiction of the three vital organs viz., brain, heart, and bladder as the seats of the life force do not need much explanation. These organs are known as the ''trimarmas'', and entire chapters have been devoted to these three vital ''marmas'' in the section on treatments ([[Chikitsa Sthana]]) and clinical success ([[Siddhi Sthana]]) explaining the various diseases that afflict these organs and how to manage them. ''Trimarma'' corresponds to the biomedical concept of the tripods of life, which are the brain, heart, and lungs. In [[Ayurveda]], instead of lungs, the bladder including the kidneys constitutes one of the three vital organs that sustain life.

The word ''kantha'' means throat and also the neck. The throat is important because it is the common passage for food and air and choking can lead to asphyxiation and death. Apart from that, it is also the location of the voice box. If we extend the meaning to include the neck, then there are important blood vessels that connect to the head. The external carotid artery, the jugular vein, and vertebral arteries can suffer injuries leading to life-threatening situations. Injuries to the thoracic inlet are associated with high mortality.   

The word ''kantha'' means throat and also the neck. The throat is important because it is the common passage for food and air and choking can lead to asphyxiation and death. Apart from that, it is also the location of the voice box. If we extend the meaning to include the neck, then there are important blood vessels that connect to the head. The external carotid artery, the jugular vein, and vertebral arteries can suffer injuries leading to life-threatening situations. Injuries to the thoracic inlet are associated with high mortality.   

=== Rakta (blood) ===

=== [[Rakta]] (blood) ===

The blood is no doubt synonymous with life itself. So much so that [[Ayurveda]] refers to bleeding as ''jivadana'' or taking away life. It is mentioned in the chapter called [[Vidhishonitiya]] that the life forces follow the blood. Qualitative and quantitative parameters of blood need to be maintained for life to be sustained.   

The blood is no doubt synonymous with life itself. So much so that [[Ayurveda]] refers to bleeding as ''jivadana'' or taking away life. It is mentioned in the chapter called [[Vidhishonitiya]] that the life forces follow the blood. Qualitative and quantitative parameters of blood need to be maintained for life to be sustained.   

=== Shukra (reproductive potency) ===

=== [[Shukra]] (reproductive potency) ===

''Shukra'', which is loosely translated as the semen, actually represents the potency of reproduction and renewal. It is concerned with the ability of life to renew itself, which is a challenge at the cellular level as well as the level of the organism. Life ceases to continue if it cannot renew itself. For this reason, the ''shukra'' is considered to be the seat of the life force.  

[[Shukra]], which is loosely translated as the semen, actually represents the potency of reproduction and renewal. It is concerned with the ability of life to renew itself, which is a challenge at the cellular level as well as the level of the organism. Life ceases to continue if it cannot renew itself. For this reason, the [[shukra]] is considered to be the seat of the life force.  

=== Ojas (essence) ===

=== [[Ojas]] (essence) ===

''Ojas'' is related to immunity and is a function that manifests when all the tissues and elements of the body are optimized for structural and functional integrity. ''Ojas'' is not one substance but a network of substances and functions that expresses as the innate immunity of the organism. It goes without words that an immune system is an essential tool for survival and adaptation. Coping with stress and life-threatening situations require a robust immune system, and therefore ''ojas'' is one of the prominent seats of the life forces.

[[Ojas]] is related to immunity and is a function that manifests when all the tissues and elements of the body are optimized for structural and functional integrity. [[Ojas]] is not one substance but a network of substances and functions that expresses as the innate immunity of the organism. It goes without words that an immune system is an essential tool for survival and adaptation. Coping with stress and life-threatening situations require a robust immune system, and therefore [[ojas]] is one of the prominent seats of the life forces.

=== Guda (anus) ===

=== Guda (anus) ===

''Guda'' denotes the anus and also the rectum as such. Rectal injuries result from a variety of insults and cause a heterogeneous spectrum of injuries to patients. Historically, many of these injuries were devastating, with high morbidity and mortality. They often required an aggressive approach to treatment including fecal stream diversion, distal rectal washout, and presacral drainage. Contemporary surgical care and a better understanding of the management of these injuries have dramatically improved outcomes. Even a digital rectal examination can sometimes induce fainting by activating the vasovagal reflex.  

[[Guda]] denotes the anus and also the rectum as such. Rectal injuries result from a variety of insults and cause a heterogeneous spectrum of injuries to patients. Historically, many of these injuries were devastating, with high morbidity and mortality. They often required an aggressive approach to treatment including fecal stream diversion, distal rectal washout, and presacral drainage. Contemporary surgical care and a better understanding of the management of these injuries have dramatically improved outcomes. Even a digital rectal examination can sometimes induce fainting by activating the vasovagal reflex.  

=== Indriya ===

=== [[Indriya]] ===

After listing the ten seats of the life force, the text enumerates the sensory and motor organs which are the primary tools with which the body becomes aware of the external environment and makes adaptive responses. These are called as the ''indriyas'' and much of their activities to ensure survival are autonomous. ''Vijnana'' represents the higher awareness which leads the individual to respond and adapt voluntarily to external stimuli. ''Atman'' is the experiencing self that witnesses the changing self and non-self that is experienced. The disease manifests when the organism fails to adapt to situations in the effort to preserve the life process. The genuine physician is one who has a deep insight into this process. [3-4]   

After listing the ten seats of the life force, the text enumerates the sensory and motor organs which are the primary tools with which the body becomes aware of the external environment and makes adaptive responses. These are called as the [[indriya]] and much of their activities to ensure survival are autonomous. [[Vijnana]] represents the higher awareness which leads the individual to respond and adapt voluntarily to external stimuli. [[Atman]] is the experiencing self that witnesses the changing self and non-self that is experienced. The disease manifests when the organism fails to adapt to situations in the effort to preserve the life process. The genuine physician is one who has a deep insight into this process. [3-4]   

=== Types of vaidya and medical ethics ===

=== Types of [[vaidya]] and medical ethics ===

Two types of ''vaidyas'' (doctors) viz. one who preserves and protects life forces and destroyer of diseases, and the other who produces diseases and destroyer of the life process are observed in the society. [5]

Two types of [[vaidya]] (doctors) viz. one who preserves and protects life forces and destroyer of diseases, and the other who produces diseases and destroyer of the life process are observed in the society. [5]

Characteristics and medical ethics for a doctor to protect the health of patients are described in details. The principles of good clinical practices are observed in this description. [6-7]

Characteristics and medical ethics for a doctor to protect the health of patients are described in details. The principles of good clinical practices are observed in this description. [6-7]