Changes

=== Abstract ===

=== Abstract ===

 

This chapter, [[Kathamanasharireeya]], explains some specific clinical features that are different than sensory perceptions and prodromal symptoms. Most of the time they indicate  serious complications  and are indicative of imminent death.

This chapter, [[Kathamanasharireeya]], explains some specific clinical features that are different than sensory perceptions and prodromal symptoms. Most of the time they indicate  serious complications  and are indicative of imminent death.

'''Keywords''': Death features, Bad prognostic features.  

'''Keywords''': Death features, Bad prognostic features.  

 

=== Introduction ===

=== Introduction ===

 

Previous chapter ([[Purvarupeeya]]) dealt with the types of premonitory symptoms which indicate imminent death. The present chapter focuses on the characteristic signs and symptoms of diseases in individuals which results in imminent death. The chapter signifies the importance of observation of patient in assessing prognosis of disease. The word ''kathamani sharireeyam'' implies types of presentations of diseases in body leading to immediate death.

Previous chapter ([[Purvarupeeya]]) dealt with the types of premonitory symptoms which indicate imminent death. The present chapter focuses on the characteristic signs and symptoms of diseases in individuals which results in imminent death. The chapter signifies the importance of observation of patient in assessing prognosis of disease. The word ''kathamani sharireeyam'' implies types of presentations of diseases in body leading to immediate death.

This chapter is a random compilation of bad prognostic features of diseases that are mentioned in [[Nidana Sthana]] and [[Chikitsa Sthana]]. An experienced clinician can identify bad prognosis of disease well in time and shall intervene as per the condition of patient.  

This chapter is a random compilation of bad prognostic features of diseases that are mentioned in [[Nidana Sthana]] and [[Chikitsa Sthana]]. An experienced clinician can identify bad prognosis of disease well in time and shall intervene as per the condition of patient.  

 

===Sanskrit text, Transliteration and English Translation===

===Sanskrit text, Transliteration and English Translation===

balaM ca hIyate shIghraM  tRuShNA cAtipravardhate|  

balaM ca hIyate shIghraM  tRuShNA cAtipravardhate|  

jAyate hRudi shUlaM ca taM bhiShak parivarjayet||6||  

jAyate hRudi shUlaM ca taM bhiShak parivarjayet||6||  

 

Agnivesha asks Atreya that how many such symptoms are seen in a diseased individual for which treatment become ineffective. Hearing this, the great scholar explained him thus:

Agnivesha asks Atreya that how many such symptoms are seen in a diseased individual for which treatment become ineffective. Hearing this, the great scholar explained him thus:

One, who has severe pain in the upper part of chest while talking, vomits the ingested food, cannot digest the food ingested; one, whose ''bala'' (strength) is depleting suddenly and who has morbid thirst; one who has pain in the region of ''hridaya'' (heart) are incurable.[3-6]

One, who has severe pain in the upper part of chest while talking, vomits the ingested food, cannot digest the food ingested; one, whose ''bala'' (strength) is depleting suddenly and who has morbid thirst; one who has pain in the region of ''hridaya'' (heart) are incurable.[3-6]

 

==== Poor prognosis in ''Hikka, Anaha, Atisara'' and ''Jwara'' ====

==== Poor prognosis in ''Hikka, Anaha, Atisara'' and ''Jwara'' ====

jvaraH paurvAhNiko yasya shuShkakAsashca dAruNaH|  

jvaraH paurvAhNiko yasya shuShkakAsashca dAruNaH|  

balamAMsavihInasya yathA pretastathaiva saH||10||

balamAMsavihInasya yathA pretastathaiva saH||10||

 

''Gambheera hikka'', or hiccups with deeper pathology, when accompanied with bleeding diarrhea, is a serious condition. In such a case, medication should not be given since the condition is not manageable by stream of Atreya school of medicine. (Note: It may be managed by Dhanwantari school of surgery).

''Gambheera hikka'', or hiccups with deeper pathology, when accompanied with bleeding diarrhea, is a serious condition. In such a case, medication should not be given since the condition is not manageable by stream of Atreya school of medicine. (Note: It may be managed by Dhanwantari school of surgery).

Again this hiccups associated with ''poorvanhika jwara'' (fever in forenoon) and ''shushka kasa'' (dry cough) in a person with wasting of muscles and depleted strength as like as dead body .[7-10]

Again this hiccups associated with ''poorvanhika jwara'' (fever in forenoon) and ''shushka kasa'' (dry cough) in a person with wasting of muscles and depleted strength as like as dead body .[7-10]

 

==== Poor prognosis in ''Shotha'' ====

==== Poor prognosis in ''Shotha'' ====

shUnahastaM shUnapAdaM shUnaguhyodaraM naram|  

shUnahastaM shUnapAdaM shUnaguhyodaraM naram|  

hInavarNabalAhAramauShadhairnopapAdayet||14||

hInavarNabalAhAramauShadhairnopapAdayet||14||

 

In a person with abdominal disease, who passes hard stool and condensed urine, whose body temperature is subnormal, and has dyspnea, is unable to survive.

In a person with abdominal disease, who passes hard stool and condensed urine, whose body temperature is subnormal, and has dyspnea, is unable to survive.

A person having edema on hands, feet pelvic region, abdomen and diminution of color complexion, strength, and aversion of food should not be administered medicine [due to poor prognosis, medicines are of no use]. [11-14]

A person having edema on hands, feet pelvic region, abdomen and diminution of color complexion, strength, and aversion of food should not be administered medicine [due to poor prognosis, medicines are of no use]. [11-14]

 

==== Poor prognosis in respiratory disorders ====

==== Poor prognosis in respiratory disorders ====

pANDurashca kRusho~atyarthaM tRuShNayA~abhipariplutaH|  

pANDurashca kRusho~atyarthaM tRuShNayA~abhipariplutaH|  

DambarI kupitocchvAsaH pratyAkhyeyo vijAnatA||19||

DambarI kupitocchvAsaH pratyAkhyeyo vijAnatA||19||

 

One whose chest is full of phlegm, and constantly expectorates the blue, yellow, and blood mixed sputum, a wise physician should avoid to treat such patients even from distance.

One whose chest is full of phlegm, and constantly expectorates the blue, yellow, and blood mixed sputum, a wise physician should avoid to treat such patients even from distance.

If, in an emaciated patient with fever and diarrhea as sequel of edema or edema as sequel of these two, dies soon. A patient who is pale, excessively emaciated, having excessive thirst, eyes are fixed on one object, and with painful breath is better to declare untreatable. [15-19]

If, in an emaciated patient with fever and diarrhea as sequel of edema or edema as sequel of these two, dies soon. A patient who is pale, excessively emaciated, having excessive thirst, eyes are fixed on one object, and with painful breath is better to declare untreatable. [15-19]

 

हनुमन्याग्रहस्तृष्णा बलह्रासोऽतिमात्रया| प्राणाश्चोरसि वर्तन्ते यस्य तं परिवर्जयेत्||२०||  

हनुमन्याग्रहस्तृष्णा बलह्रासोऽतिमात्रया| प्राणाश्चोरसि वर्तन्ते यस्य तं परिवर्जयेत्||२०||  

ArogyaM hIyate yasya  prakRutiH parihIyate|  

ArogyaM hIyate yasya  prakRutiH parihIyate|  

sahasA sahasA tasya mRutyurharati jIvitam||24||  

sahasA sahasA tasya mRutyurharati jIvitam||24||  

 

If an emaciated person with diminished strength presenting lack of digestive power, faints repeatedly, with violent movements of the body and restlessness in any situation, he succumbs to death immediately.

If an emaciated person with diminished strength presenting lack of digestive power, faints repeatedly, with violent movements of the body and restlessness in any situation, he succumbs to death immediately.

If there is sudden deterioration of health is extended to the change in basic constitution (''prakriti'') of a patient then he succumbs for sudden death. [21-24]

If there is sudden deterioration of health is extended to the change in basic constitution (''prakriti'') of a patient then he succumbs for sudden death. [21-24]

 

==== Summary ====

==== Summary ====

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

 

*Strength against disease is knowledge of health.  

*Strength against disease is knowledge of health.  

*Health is based on digestive power, power of muscles and purity of blood. Significant decrease of these are the markers of terminal illness.     

*Health is based on digestive power, power of muscles and purity of blood. Significant decrease of these are the markers of terminal illness.     

Few diseased conditions mentioned here in this chapter may be in quite manageable stage with the present modern management facilities but to the time of Charaka those were definitely fatal. For example, many of hypo-volemic and dehydrated conditions are well treated now. But still it is a challenge to save life in toxic dehydrations. Many such clinical challenges are narrated where patient should not be neglected, rather  aggressive care should be provided with informed consent to the relatives about possible fatal outcome.

Few diseased conditions mentioned here in this chapter may be in quite manageable stage with the present modern management facilities but to the time of Charaka those were definitely fatal. For example, many of hypo-volemic and dehydrated conditions are well treated now. But still it is a challenge to save life in toxic dehydrations. Many such clinical challenges are narrated where patient should not be neglected, rather  aggressive care should be provided with informed consent to the relatives about possible fatal outcome.