Changes

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' ===

Indriya Buddhi (centres of senses in the brain): While describing pancha-panchaka principle of perception by five jnanaindriya [Cha. Su. 8/3], Charaka mentions five indriya (senses), five indriya adhisthana (sense organs), five indriya dravya (specific matter which enable the senses to perceive), five artha (specific objects to be perceived by sense) and five indriya-buddhi (final sensation). The five indriya are the five senses and the five indriya adhisthāana are the five external sites of senses for example eyes for vision and ears for hearing, but site of  the indriya-buddhi is not mentioned. In this regard, the following observations may be taken into consideration:

==== ''Indriya Buddhi'' (centres of senses in the brain) ====

Charaka mentions that prānavāhi srotāmsi of indriya are situated in the head and are connected with the body as sun is connected with its rays. Therefore, diseases such as ardita (facial paralysis), ceshtā nāsha (paralysis) and disorders of eye movement etc are due to trauma to the head [Ca Sii 9/4]. In this chapter, the physical location of all the indriya has been mentioned to be the head, hence on the basis of these observations, it can be concluded that the indrya-buddhi are also situated in head. Indriya buddhi is that vital part of a sense that decides the final knowledge of the perceived object. Hence sense centres situated in the cortex region of the brain represent the indriya buddhi (12).

 

Classification of shiroroga: Generally, shiroroga implies any type of disease afflicting the head. Therefore, Charaka enlisted diseases such as hemicrania (ardhavabhedaka), headache (sarvam va rujyati shirah), coryza (pratishyaya), diseases of mouth, nose, eyes and ears which cause headache (mukha-nasa-akshi-karna-roga), giddiness/vertigo (sirobhramah), facial paralysis (ardita), tremors of the head (shirasah kampa) and stiffness of the neck, nape and jaw (gala-manya-hanu-grahah) as shiroroga. Hence, in general, shiroroga includes diseases occurring in the skull, its orifices and the structure related to it. As per this classification shiroroga includes vatika, paittika, kaphaja, sannipataja and krimija shiroroga.   

While describing ''pancha-panchaka'' principle of perception by five ''jnanaindriya'' [Cha. Su. 8/3], Charaka mentions five ''indriya'' (senses), five ''indriya adhisthana'' (sense organs), five ''indriya dravya'' (specific matter which enable the senses to perceive), five ''artha'' (specific objects to be perceived by sense) and five ''indriya-buddhi'' (final sensation). The five ''indriya'' are the five senses and the five ''indriya adhisthāana'' are the five external sites of senses for example eyes for vision and ears for hearing, but site of  the ''indriya-buddhi'' is not mentioned. In this regard, the following observations may be taken into consideration:

In addition, in Siddhi Sthana, four more diseases occurring in the head have been described in detail viz. shankhaka, ardhavabhedaka, suryavarta, and anantavata [Ca Si 9/71-87]. In these shiroroga, nasya(nasal errhines) has been indicated [Ca Si 9/88]. In all nine shiroroga (five in this chapter, and four in Siddhi Sthana) that mention headache as a key symptom. Other varieties of shiroroga mentioned in other texts are raktaja and kshayaja [Sushruta Uttara 25/3] and shirah-kampa [As Hr.Uttara 23/9].(Verse 6)

 

The five types of hridroga described in this chapter are also caused by vitiated dosha and krimi. In all these conditions pain in the chest is a common feature, the intensity of which varies according to the involved dosha. For example in vata, pain is accompanied by extra systole/ fibrillation (vepathu), sense of emptiness in the heart region (shunyata), and hyperkinetic heart and thrill (dara). A pittaja type hridroga is indicated by a burning sensation in the precordial region with fainting, giddiness and perspiration. In kaphaja type hridroga, there is heaviness in the precordial area, suptam (bradycardia or decreased diastolic stretching) and a stony sensation (pericardial calcification as in constrictive pericarditis) in heart region.

Charaka mentions that ''prānavāhi srotāmsi'' of ''indriya'' are situated in the head and are connected with the body as sun is connected with its rays. Therefore, diseases such as ''ardita'' (facial paralysis), ''ceshtā nāsha'' (paralysis) and disorders of eye movement etc. are due to trauma to the head [Ca Sii 9/4]. In this chapter, the physical location of all the ''indriya'' has been mentioned to be the head, hence on the basis of these observations, it can be concluded that the ''indriya-buddhi'' are also situated in head. ''Indriya buddhi'' is that vital part of a sense that decides the final knowledge of the perceived object. Hence sense centres situated in the cortex region of the brain represent the ''indriya buddhi'' [12]

Description of krimija hridroga indicates a very serious condition. As mentioned earlier, infeststion starts with one chamber of the heart and then spreads and consumes (bhakshyanti) tissues across the entire heart.The patient of krimija hridroga feels severe pain in the precordial region, as if heart is being pricked/pierced by needles or cut by weapons and is a very grave heart condition that may lead to immediate death. Therefore it is a severe condition and should be promptly diagnosed and managed. It may manifest as chest pain, arrhythmia, heart failure, acute myocardial infarction-like syndrome with normal coronary arteries, ventricular arrhythmia, and loss of right ventricular function leading to sudden death. (Verse 36-40).

Samsarga and Sannipata

'''Classification of shiroroga:''' Generally, ''shiroroga'' implies any type of disease afflicting the head. Therefore, Charaka enlisted diseases such as hemicrania (''ardhavabhedaka''), headache (''sarvam va rujyati shirah''), coryza (''pratishyaya''), diseases of mouth, nose, eyes and ears which cause headache (''mukha-nasa-akshi-karna-roga''), giddiness/vertigo (''sirobhramah''), facial paralysis (''ardita''), tremors of the head (''shirasah kampa'') and stiffness of the neck, nape and jaw (''gala-manya-hanu-grahah'') as ''shiroroga''. Hence, in general, shiroroga includes diseases occurring in the skull, its orifices and the structure related to it. As per this classification shiroroga includes ''vatika, paittika, kaphaja, sannipataja'' and ''krimija shiroroga''.   

 

In addition, in [[Siddhi Sthana]], four more diseases occurring in the head have been described in detail viz. ''shankhaka, ardhavabhedaka,'' ''suryavarta,'' and ''anantavata'' [Ca Si 9/71-87]. In these ''shiroroga'', ''nasya''(nasal errhines) has been indicated [Ca Si 9/88]. In all nine ''shiroroga'' (five in this chapter, and four in [[Siddhi Sthana]]) that mention headache as a key symptom. Other varieties of ''shiroroga'' mentioned in other texts are ''raktaja'' and ''kshayaja'' [Sushruta Uttara 25/3] and ''shirah-kampa'' [As Hr.Uttara 23/9].(Verse 6)

 

The five types of ''hridroga'' described in this chapter are also caused by vitiated ''dosha'' and ''krimi''. In all these conditions pain in the chest is a common feature, the intensity of which varies according to the involved ''dosha''. For example in ''vata'', pain is accompanied by extra systole/ fibrillation (''vepathu''), sense of emptiness in the heart region (''shunyata''), and hyperkinetic heart and thrill (''dara''). A ''pittaja'' type ''hridroga'' is indicated by a burning sensation in the precordial region with fainting, giddiness and perspiration. In ''kaphaja'' type ''hridroga'', there is heaviness in the precordial area, ''suptam'' (bradycardia or decreased diastolic stretching) and a stony sensation (pericardial calcification as in constrictive pericarditis) in heart region.

 

Description of ''krimija hridroga'' indicates a very serious condition. As mentioned earlier, infestation starts with one chamber of the heart and then spreads and consumes (''bhakshyanti'') tissues across the entire heart.The patient of ''krimija hridroga'' feels severe pain in the precordial region, as if heart is being pricked/pierced by needles or cut by weapons and is a very grave heart condition that may lead to immediate death. Therefore it is a severe condition and should be promptly diagnosed and managed. It may manifest as chest pain, arrhythmia, heart failure, acute myocardial infarction-like syndrome with normal coronary arteries, ventricular arrhythmia, and loss of right ventricular function leading to sudden death. (Verse 36-40).

 

==== ''Samsarga'' and ''Sannipata'' ====\

 

Combination of two provoked doshas leading to a disease is known as samsarga and when all the three provoked doshas combine then it is known as sannipata. In the combinations , some doshas may be in their normal state, while others may be slightly, moderately or excessively increased or in decrease state. Similarly they may be slightly, moderately or significantly decreased. In this way, on the basis of quantum of increase, decrease etc of the dosha, they can be classified into 62 types (verses from 41 to 62) as follows:

Combination of two provoked doshas leading to a disease is known as samsarga and when all the three provoked doshas combine then it is known as sannipata. In the combinations , some doshas may be in their normal state, while others may be slightly, moderately or excessively increased or in decrease state. Similarly they may be slightly, moderately or significantly decreased. In this way, on the basis of quantum of increase, decrease etc of the dosha, they can be classified into 62 types (verses from 41 to 62) as follows:

• Sixty-two conditions of increased and decreased doshas, including:

• Sixty-two conditions of increased and decreased doshas, including: