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=== Abstract ===

=== Abstract ===

This is the first chapter of ''Roga Chatushka'' (tetrad of diseases) dealing with description related to diseases of the trimarma (three vital organs – the head, heart, and the urinary bladder (basti)). The etiopathogenesis of these diseases is detailed. Various diseases are caused due to permutations and combinations of dosha imbalances. The chapter describes signs of depletion of dhatu and mala. It also highlights the disorders of oja as well as madhumeha (diabetes mellitus, a disease of the basti), and carbuncles produced as its complications. This chapter also describes various types of dosha gati (movements of dosha). The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter.  

This is the first chapter of ''Roga Chatushka'' (tetrad of diseases) dealing with description related to diseases of the ''trimarma'' (three vital organs – the head, heart, and the urinary bladder (''basti'')). The etiopathogenesis of these diseases is detailed. Various diseases are caused due to permutations and combinations of ''dosha'' imbalances. The chapter describes signs of depletion of ''dhatu'' and ''mala''. It also highlights the disorders of ''oja'' as well as ''madhumeha'' (diabetes mellitus, a disease of the basti), and carbuncles produced as its complications. This chapter also describes various types of ''dosha gati'' (movements of ''dosha''). The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter.  

Key Words: Shiroroga (diseases of head), hrrudroga(diseases of heart), imbalances in dosha, , dhatu-kshaya, mala-kshaya, pidaka, madhumeha, dosha-gati, sannipata, samsarga, ojokshaya, ojas, signs of depletion of dosha, dhatu and mala, disorders of oja. movement of dosha.  

 

'''Keywords''': ''Shiroroga'' (diseases of head), ''hridaya roga''(diseases of heart), imbalances in ''dosha'', ''dhatu-kshaya'', ''mala-kshaya, pidaka, madhumeha, dosha-gati, sannipata, samsarga, ojokshaya, ojas,'' signs of depletion of ''dosha, dhatu'' and ''mala'', disorders of ''oja'', movement of ''dosha''.  

=== Introduction ===

=== Introduction ===

After describing the guidelines for clinical Ayurveda practice in tetrad of previous chapters of Nirdesha chatushka, information about priniciples of basic Ayurvedic pathology in causing disease is detailed in roga chatushka (tetrad on disease information).  

After describing the guidelines for clinical [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] practice in tetrad of previous chapters of ''Nirdesha Chatushka'', information about priniciples of basic Ayurvedic pathology in causing disease is detailed in ''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 the description of five varieties of head diseases 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 provided in brief with a specific variety of avrita Madhumeha (diabetes due to obstructive vata) in which ojas is excreted out 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 the description of five varieties of head diseases 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 provided in brief with a specific variety of ''Avrita Madhumeha'' (diabetes due to obstructive ''vata'') in which ''ojas'' is excreted out 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 diseases related to trimarma, or the three vital organs,  have also been described in the 26th chapter of Chikitsa sthana (titled Trimarmiya Chikitsa adhyaya) and later in 9th chapter of Siddhi sthana (titled Trimarmiya Siddhi Adhyaya). While the Sutrasthana helps provide the fundamental approaches to treating these diseases, the Chikitsa Sthana primarily addresses the management aspects and Siddhisthana 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, Charaka 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 (titled Trimarmiya Chikitsa adhyaya) and later in 9th chapter of Siddhi sthana (titled Trimarmiya Siddhi Adhyaya). While the Sutrasthana helps provide the fundamental approaches to treating these diseases, the Chikitsa Sthana primarily addresses the management aspects and Siddhisthana 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, Charaka 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 ''siroroga'', or the disease(s) of the head, are various clinical representations of headache and vary depending upon ''dosha''-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''siroroga'', 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 doṣha predominance and krimi infestation.  

The ''siroroga'', or the disease(s) of the head, are various clinical representations of headache and vary depending upon ''dosha''-dominance and ''krimi''-infestation. Though headache is a common form of five major types of ''siroroga'', 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 doṣha predominance and krimi infestation.