Changes

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, [[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.

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 dhatu]], 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 dhatu]] 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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