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Avakshiraseeyam Indriyam Adhyaya (view source)
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These moribund signs mentioned in this chapter can be classified into following types:
These moribund signs mentioned in this chapter can be classified into following types:
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{| class="wikitable"
|+ Table 1: Classification of features
! colspan="4"| Classifications
! colspan="4"| Classifications
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We shall now expound the chapter "Avakshiraseeyam Indriyam" (Fatal signs like inverted shadow of dying person).Thus said Lord Atreya. [1-2]
We shall now expound the chapter "Avakshiraseeyam Indriyam" (Fatal signs like inverted shadow of dying person).Thus said Lord Atreya. [1-2]
Note: The chapter deals with moribund signs like inverted physical shadow (of a being).
Note: The chapter deals with moribund signs like inverted shadow (of a physical being).
=== Moribund feature of shadow ===
=== Moribund feature of shadow ===
If the tongue becomes rigid, senseless, heavy, excessively coated with a thorn like fur, brown in color, dry or swollen and constantly mobile, then the patient having such signs should be considered as good as dead. [14]
If the tongue becomes rigid, senseless, heavy, excessively coated with a thorn like fur, brown in color, dry or swollen and constantly mobile, then the patient having such signs should be considered as good as dead. [14]
=== Fatal sign of respiration ===
=== Fatal signs of respiration ===
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If the neck of the patient is unable to support the weight of the head, the back, that of the body, the jaw bones, morsel of food in the mouth, this indicates his imminent death. [22]
If the neck of the patient is unable to support the weight of the head, the back, that of the body, the jaw bones, morsel of food in the mouth, this indicates his imminent death. [22]
=== Fatal signs of acute fever ===
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सहसा ज्वरसन्तापस्तृष्णा मूर्च्छा बलक्षयः| <br />
सहसा ज्वरसन्तापस्तृष्णा मूर्च्छा बलक्षयः| <br />
विश्लेषणं च सन्धीनां मुमूर्षोरुपजायते||२३|| <br />
विश्लेषणं च सन्धीनां मुमूर्षोरुपजायते||२३|| <br />
If a patient suffering from ''lepajwara'' i.e. a type of fever patient gets profuse perspiration in the face, there is little chance of his survival. [24]
If a patient suffering from ''lepajwara'' i.e. a type of fever patient gets profuse perspiration in the face, there is little chance of his survival. [24]
=== Fatal signs of throat obstruction ===
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If the ingested food does not reach the throat, or the tongue falls back over the throat (thereby causing obstruction ) and there is diminution of strength, then the death of the person is imminent. [25]
If the ingested food does not reach the throat, or the tongue falls back over the throat (thereby causing obstruction ) and there is diminution of strength, then the death of the person is imminent. [25]
=== Fatal signs of movement of head ===
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The wise physician should closely search for these signs repeatedly because some of them disappear in a short moment after their manifestation.
The wise physician should closely search for these signs repeatedly because some of them disappear in a short moment after their manifestation.
None of these signs remain without leading to the consequences already described i.e. all of them certainly indicate imminent death. [27 ]
None of these signs remain without leading to the consequences already described i.e. all of them certainly indicate imminent death. [27]
== Tattva Vimarsha (Fundamental Principles) ==
== Tattva Vimarsha (Fundamental Principles) ==
== Vidhi Vimarsha (Applied Inferences ) ==
== Vidhi Vimarsha (Applied Inferences ) ==
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The sign of inverted shadow of dying person ''lakshanamitta'', should be understood. It is a classification and a unique sign which is not mentioned in contemporary science or in other alternative medicines. Naming a chapter in the [[Charak Samhita]] after the sign reflects its importance.[3]
=== Importance of moribund signs ===
The sign of inverted shadow of dying person (avakshirasa lakshanamitta) should be understood. It is a classification and a unique sign which is not mentioned in contemporary science or in other alternative medicines. Naming a chapter in the [[Charak Samhita]] after the sign reflects its importance.[verse 3]
=== Signs on eyelids ===
Severe blepharitis comprises of matting of eyelids, swollen eyelids, burning vision and may cause death in patients in following conditions:
Severe blepharitis comprises of matting of eyelids, swollen eyelids, burning vision and may cause death in patients in following conditions:
#or having xerophthalmia at the time of the clinical onset of blepharitis;
#or having xerophthalmia at the time of the clinical onset of blepharitis;
#or having diabetes mellitus at the time of the clinical onset of blepharitis;
#or having diabetes mellitus at the time of the clinical onset of blepharitis;
#or being in an immune-compromised state at the time of the clinical onset of blepharitis; [4]
#or being in an immune-compromised state at the time of the clinical onset of blepharitis; [ verse 4]
=== Signs on hairs ===
A condition of not having pain when uprooting the hairs is found in the end stage of leprosy featuring scalp numbness and alopecia.[ verse 5]
A condition of unctuous hairs without application of oil is found in the incurable signs of [[prameha]].[ verse 9]
=== Signs on nose ===
In the Wegener’s granulomatosis the bridge of the nose can collapse resulting in a “saddle–nose deformity due to cartilage inflammation. Death occurs due to kidney failure in such a case. In traditional Chinese medicine a symptom painting (e.g., nasal flaring) is described as a near death sign.[verse 10]
In the Wegener’s granulomatosis the bridge of the nose can collapse resulting in a “saddle–nose deformity due to cartilage inflammation. Death occurs due to kidney failure in such a case. In traditional Chinese medicine a symptom painting (e.g., nasal flaring) is described as a near death sign.[10]
In Tibetan medicine, dryness of nose has been described as near death sign. <sup>[citation needed]</sup> [verse 11]
In Tibetan medicine, dryness of nose has been described as near death sign.[11]
In contemporary science, extreme pallor of skin and cyanosis is described as a sign for alertness to identify major cause.<sup>[citation needed]</sup>[ verse 12]
=== Signs on respiration ===
When death approaches a person his breathing may sound congested; may change in rate, depth and rhythm; there may be periods of breathlessness for 5-30 seconds resulting in Cheyne Stoke breathing.[15]
When death approaches a person his breathing may sound congested; may change in rate, depth and rhythm; there may be periods of breathlessness for 5-30 seconds resulting in Cheyne Stoke breathing.[verse 15]
=== Signs of abnormal movements ===
The sign of abnormal movements of knees resembles distressed state of the patient suffering from severe pain which is a common near death symptom wherein patient cannot share his experiences with the other people due to widely compromised ability to communicate-a condition resembles Dysdiadokinesia. [verse 17]
At the end of life, multi organ failure is observed, including the brain. Higher-order consciousness tends to change; the chemical balance of the body becomes completely upset leading to altered sensation.
Terminal restlessness is a particularly distressing form of delirium that may occur in dying patients. It is characterized by anguish (spiritual, emotional, or physical), restlessness, anxiety, agitation, and cognitive failure, caused by decrease in oxygen circulation to the brain and by metabolic changes.<ref> Kinzbrunner, BM; Weinreb, NJ; Policzer, JS; 20 Common Problems: End of Life Care, McGraw-Hill Publishing, 2002 </ref> [18-20]
Saavedra-Aguilar and Gomez-Jeria’s (1989) model<sup>[citation needed]</sup> invokes temporal-lobe dysfunction, hypoxia, psychological stress, and neurotransmitter changes to explain the NDE. According to this model, brain stress caused by traumatic events leads to the release of endogenous neuropeptides, neurotransmitters, or both, producing such effects as analgesia, euphoria, and detachment.
Terminal restlessness is a particularly distressing form of delirium that may occur in dying patients. It is characterized by anguish (spiritual, emotional, or physical), restlessness, anxiety, agitation, and cognitive failure, caused by decrease in oxygen circulation to the brain and by metabolic changes.<ref> Kinzbrunner, BM; Weinreb, NJ; Policzer, JS; 20 Common Problems: End of Life Care, McGraw-Hill Publishing, 2002 </ref> [verse 18-20]
Many NDEs share with dissociation or disconnection of perception, cognition, emotion, and identity from the mainstream of the individual’s conscious awareness (Greyson, 1997).<ref> Greyson, B. - The near-death experience as a focus of clinical attention. J Nerv Ment Dis 185:327-334, 1997 </ref>
Many NDEs share with dissociation or disconnection of perception, cognition, emotion, and identity from the mainstream of the individual’s conscious awareness (Greyson, 1997).<ref> Greyson, B. - The near-death experience as a focus of clinical attention. J Nerv Ment Dis 185:327-334, 1997 </ref>
Inability to swallow the oral food contents, leads to choking or enters the trachea causing fatality.[25]
=== Signs of acute fever ===
Hectic fever is a daily recurring fever with profound sweating, chills, and flushed appearance often associated with pulmonary tuberculosis or septic poisoning.<sup>[citation needed]</sup> [verse 24]
=== Signs of deglutition ===
Inability to swallow the oral food contents, leads to choking or enters the trachea causing fatality.[ verse 25]
Chyutabandhanaḥ (Detachment from life) symptom can be interpreted either as release of all bodily sphincters or complete detachment of the bindings of the world, both acknowledged by contemporary science.[26]
Chyutabandhanaḥ (Detachment from life) symptom can be interpreted either as release of all bodily sphincters or complete detachment of the bindings of the world, both acknowledged by contemporary science.<sup>[citation needed]</sup>[ verse 26]
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=== Similar references in other texts ===
=== Similar cross references in other [[Ayurveda]] texts ===
'''Shloka 4 - 7''': Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 10. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1., Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 17. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 4 - 7''': Su.Sa. Sutra Sthana 31/10. <ref name = "Sushruta"> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>, A. H. Sharira Sthana 5/17 <ref name = "Vagbhata"> Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>
'''Shloka-08''': [[Anujyotiyam Indriyam Adhyaya]] verse 17
'''Verse 08''': Cha.Sa. [[Anujyotiyam Indriyam Adhyaya]] verse 17
'''Shloka-09''': Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 16,19. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 09''': A. H. Sharira Sthana 5/16,19. <ref name = "Vagbhata"/>
'''Shloka-10-12''':Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 8. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.
'''Verse 10-12''': Su.Sa. Sutra Sthana 31/8. <ref name = "Sushruta"/>
'''Shloka-13''': Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 6. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1., Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 10. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 13''': Su.Sa. Sutra Sthana 31/6, <ref name = "Sushruta"/>, A. H. Sharira Sthana 5/10. <ref name = "Vagbhata"/>.
'''Shloka-14''': Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 7. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1., Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 10. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 14''': Su.Sa. Sutra Sthana 31/7, <ref name = "Sushruta"/>, A. H. Sharira Sthana 5/10. <ref name = "Vagbhata"/>.
'''Shloka-18-19''': Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 7. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1., Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 10. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 18-19''': Su.Sa. Sutra Sthana 31/7,<ref name = "Sushruta"/>, A. H. Sharira Sthana 5/10. <ref name = "Vagbhata"/>.
'''Shloka-22''': Sushruta. Sutra Sthana, Cha.31 Cchayavipratipatti Adhyaya verse 11. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1., Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 11. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 22''': Su.Sa. Sutra Sthana 31/11, <ref name = "Sushruta"/>, A. H. Sharira Sthana 5/11. <ref name = "Vagbhata"/>.
'''Shloka-23''': Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 109. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 23''': A. H. Sharira Sthana 5/109. <ref name = "Vagbhata"/>.
'''Shloka-24''': Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 110. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 24''': A. H. Sharira Sthana 5/110. <ref name = "Vagbhata"/>.
'''Shloka-26''':Vagbhata. Sharira Sthana, Cha.5 Vikruti vijaniyam Sharira verse 57. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
'''Verse 26''': A. H. Sharira Sthana 5/57. <ref name = "Vagbhata"/>.
Note: Thirty six moribund signs are mentioned in section of Sanskrit ''shloka'' and their translation in English and are not repeated here.
Note: Thirty six moribund signs are mentioned in section of Sanskrit ''shloka'' and their translation in English and are not repeated here.