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== Introduction ==

== Introduction ==

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After describing the guidelines for health care management in clinical [[Ayurveda]] practice in earlier four tetrads, information about principles of basic Ayurvedic pathology in causing disease is detailed in [[Sutra Sthana#Roga Chatushka (four chapters on disease classification)|''Roga Chatushka'' (tetrad on disease information)]].   

After describing the guidelines for health care management in clinical [[Ayurveda]] practice in earlier four tetrads, information about principles of basic Ayurvedic pathology in causing disease is detailed in [[Sutra Sthana#Roga Chatushka (four chapters on disease classification)|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 description of five varieties of diseases of head 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 discussed in brief with a specific variety of ''Avrita Madhumeha'' (diabetes due to obstructive ''vata'') in which ''ojas'' is excreted 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 description of five varieties of diseases of head 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 [[dosha]]) and samsarga(involvement of two [[dosha]]), based on variations in quantum of increased or decreased state of involved [[dosha]], 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 [[dosha]], [[dhatu]], [[mala]] and [[ojas]], along with plausible reasons for all the decrease taking place in the body. Further, definition and characteristics of [[ojas]] have been discussed in brief with a specific variety of Avrita Madhumeha (diabetes due to obstructive [[vata]]) in which [[ojas]] is excreted 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 [[meda dhatu]]. 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]] [[ Trimarmiya Chikitsa]] and later in 9th chapter of [[Siddhi Sthana]] [[Trimarmiya Siddhi]]. 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'', Charak 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]] and later in 9th chapter of [[Siddhi Sthana]] [[Trimarmiya Siddhi]]. 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'', Charak 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 ''shiroroga'', or the disease(s) of the head, have various clinical manifestations of headache and vary depending upon ''dosha''-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''shiroroga'', 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, have various clinical manifestations of headache and vary depending upon [[dosha]]-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''shiroroga'', 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 analyzed 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 [[Charak Samhita]]. In the first type, ''dhatukshaya'' (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) (Charak 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. Charak 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 analyzed 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 [[Charak Samhita]]. In the first type, [[dhatu]] kshaya(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) [Cha.Sa. [[Nidana Sthana]] 4/36-44]. In the second type, there is an initial involvement of [[kapha, pitta]], [[mamsa dhatu]] and [[meda 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 [[kapha]], [[pitta]], [[meda]] and [[mamsa]] dushti are also observed. Here, therefore, the main line of treatment (i.e., for Type 2) involves pacifying  [[kapha, pitta,]] [[meda dhatu]] and [[mamsa dhatu]]. Various gati of [[dosha]] that are responsible for healthy and diseased states are dealt at the end of the chapter. Charak 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.

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