Changes

[[Yasyashyavanimitta]] refers to color changes in eyes. In the first four chapters of [[Indriya Sthana]], conditions related to ''Indriya'' or five sense organs have been described. In those chapters, derangements in functional aspects of ''indriyas'' have been given importance and Atreya told to examine them by the help of ''Anumana Pramana''. In this chapter certain anatomical changes or changes which can be examined by ''Pratyaksha Pramana''(direct observation) are mentioned which are equally important indicators of life span.  

[[Yasyashyavanimitta]] refers to color changes in eyes. In the first four chapters of [[Indriya Sthana]], conditions related to ''Indriya'' or five sense organs have been described. In those chapters, derangements in functional aspects of ''indriyas'' have been given importance and Atreya told to examine them by the help of ''Anumana Pramana''. In this chapter certain anatomical changes or changes which can be examined by ''Pratyaksha Pramana''(direct observation) are mentioned which are equally important indicators of life span.  

Nowadays, importance is given to the identification of approaching death. Educational and training programs are organized to educate family members/relatives/attendants so that patient care is not neglected near death and this specialized field is commonly known as Palliative care. The World Health Organization (WHO) defines palliative care as 'an approach that improves the quality of life of individuals and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual'.<ref> Available from: http://www.who.int/hiv/topics/palliative/PalliativeCare/en/ </ref>

Nowadays, importance is given to the identification of approaching death. Educational and training programs are organized to educate family members/relatives/attendants so that patient care is not neglected near death and this specialized field is commonly known as Palliative care. The World Health Organization (WHO) defines palliative care as 'an approach that improves the quality of life of individuals and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual'.<ref> Available from: http://www.who.int/hiv/topics/palliative/PalliativeCare/en/ </ref>

The aging of the population, with the numerous chronic debilitating and malignant conditions associated with growing older, has focused attention on palliative care. The terminal state is an integral process and a time to reconcile differences so that patient and family may accept death with a minimum of physical, spiritual, and psychosocial anguish.<ref> Rousseau P., Hospice and palliative care, Dis Mon. 1995 Dec;41(12):779-842. </ref> Hospice care is a specialized philosophy and system of care for the terminally ill patient that accepts death in an affirmative way and provides palliative care and emotional support to dying patients and their families.<ref> Plumb JD, Ogle KS., Hospice care, Prim Care. 1992 Dec;19(4):807-20. </ref> Hospice and palliative care philosophy lays emphasis on relieving suffering and improving quality of life at the end of life in order to permit experiences that will have positive meaning. The role of the physician is central in providing this care.<ref> Sethi S. Hospice: an underutilized resource, J Okla State Med Assoc. 2001 Mar;94(3):79-84. </ref> When recovery is uncertain it is better to discuss this rather than giving false hope to the patient and family. This is generally perceived as a strength in the doctor-patient relationship and helps to build trust.<ref> John Ellershaw, Care of the dying patient: the last hours or days of life, BMJ. 2003 January 4; 326(7379): 30–34. </ref> Charaka also supports this view and states that those near death should not be treated. Thus it becomes important that physician should be well trained in identifying features of impending death.

The aging of the population, with the numerous chronic debilitating and malignant conditions associated with growing older, has focused attention on palliative care. The terminal state is an integral process and a time to reconcile differences so that patient and family may accept death with a minimum of physical, spiritual, and psychosocial anguish.<ref> Rousseau P., Hospice and palliative care, Dis Mon. 1995 Dec;41(12):779-842. </ref> Hospice care is a specialized philosophy and system of care for the terminally ill patient that accepts death in an affirmative way and provides palliative care and emotional support to dying patients and their families.<ref> Plumb JD, Ogle KS., Hospice care, Prim Care. 1992 Dec;19(4):807-20. </ref> Hospice and palliative care philosophy lays emphasis on relieving suffering and improving quality of life at the end of life in order to permit experiences that will have positive meaning. The role of the physician is central in providing this care.<ref> Sethi S. Hospice: an underutilized resource, J Okla State Med Assoc. 2001 Mar;94(3):79-84. </ref> When recovery is uncertain it is better to discuss this rather than giving false hope to the patient and family. This is generally perceived as a strength in the doctor-patient relationship and helps to build trust.<ref> John Ellershaw, Care of the dying patient: the last hours or days of life, BMJ. 2003 January 4; 326(7379): 30–34. </ref> Charak also supports this view and states that those near death should not be treated. Thus it becomes important that physician should be well trained in identifying features of impending death.

In order to care for dying patients it is essential to “identify dying”. This aim can be attained by applying the knowledge given in this chapter. Presently to predict prognostic value few tools have been designed. Most widely-used prognostic tools is the Palliative Performance Scale (PPS) which has been studied primarily in inpatient settings and in patients with cancer. Few researches are on going to develop tools for prognosis in other diseases also.<ref> Harrold J, Rickerson E, Carroll JT, McGrath J, Morales K, Kapo J, Casarett D., Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population?, J Palliat Med. 2005 Jun;8(3):503-9. </ref> Research can be done to develop a scale based on parameters described in Ayurvedic ''Arishta Vigyana'' and this chapter can also contribute a lot in making such kind of tool.

In order to care for dying patients it is essential to “identify dying”. This aim can be attained by applying the knowledge given in this chapter. Presently to predict prognostic value few tools have been designed. Most widely-used prognostic tools is the Palliative Performance Scale (PPS) which has been studied primarily in inpatient settings and in patients with cancer. Few researches are on going to develop tools for prognosis in other diseases also.<ref> Harrold J, Rickerson E, Carroll JT, McGrath J, Morales K, Kapo J, Casarett D., Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population?, J Palliat Med. 2005 Jun;8(3):503-9. </ref> Research can be done to develop a scale based on parameters described in Ayurvedic ''Arishta Vigyana'' and this chapter can also contribute a lot in making such kind of tool.

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

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

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Various biomarkers have been developed since the time of Charaka and many diseases which were incurable can be controlled. Patient should be evaluated using these biomarkers, before communicating to the patient and family about remaining lifespan of patient.

Various biomarkers have been developed since the time of Charak and many diseases which were incurable can be controlled. Patient should be evaluated using these biomarkers, before communicating to the patient and family about remaining lifespan of patient.

The ''bala'' (strength and immunity) and ''mamsa'' (muscle mass) are important markers for assessment of health and death. Depletion of these two markers indicates near death signs. [8-9]

The ''bala'' (strength and immunity) and ''mamsa'' (muscle mass) are important markers for assessment of health and death. Depletion of these two markers indicates near death signs. [8-9]