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=== Indriya buddhi (centres of senses in the brain) ===

=== Indriya buddhi (centres of senses in the brain) ===

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While describing ''pancha-panchaka'' principle of perception by five ''jnanaindriya'' [Cha. Su. 8/3], Charak 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 adhisthana'' 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:

While describing ''pancha-panchaka'' principle of perception by five ''jnanaindriya'', [Cha.Sa.[[Sutra Sthana]] 8/3] Charak 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 adhisthana'' 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:

Charak 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), ''cheshta nasha'' (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]

Charak 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), ''cheshta nasha'' (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]

'''Classification of ''shiroroga'':''' Generally, ''shiroroga'' implies any type of disease afflicting the head. Therefore, Charak 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''.   

'''Classification of ''shiroroga'':''' Generally, ''shiroroga'' implies any type of disease afflicting the head. Therefore, Charak 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)

In addition, in [[Siddhi Sthana]], four more diseases occurring in the head have been described in detail viz. ''shankhaka, ardhavabhedaka,'' ''suryavarta,'' and ''anantavata''. [Cha.Sa.[[Siddhi Sthana]] 9/71-87] In these ''shiroroga'', ''nasya''(nasal errhines) has been indicated. [Cha.Sa.[[Siddhi Sthana]] 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'' <ref>Sushruta. Uttara Tantra, Cha.25 Shirorogavijnaniya Adhyaya verse 3. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref> and ''shirah-kampa''. [A.H.Uttara Sthana 23/9]<ref>Vagbhata. Uttara Sthana, Cha.23 Shororogavijnaniya Adhyaya verse 9. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>(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.

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.

'''''Avarita madhumeha (type 2 Diabetes mellitus)''''':  

'''''Avarita madhumeha (type 2 Diabetes mellitus)''''':  

Two scenarios that cause  provocation of ''vata'' have been mentioned: decrease of ''dhatu'' (''dhatu kshaya'') and ''avarana''(cover)[Cha. Chi. 28/59]. The description of ''madhumeha'', provided earlier in this chapter, provides a good example of ''avarana''.That a provoked or vitiated ''vata'' causes ''madhumeha'' has also been reiterated in the [[Nidana Sthana]]. All the factors that cause decrease of body tissues lead to provocation of ''vāta''. But even though ''madhumeha'' is caused by a vitiated ''vata'', its etiological factors also cause an increase in ''kapha'' and ''pitta''. The comparison of ''nidana'' of ''madhumeha'' mentioned in these two different references is tabulated here:

Two scenarios that cause  provocation of ''vata'' have been mentioned: decrease of ''dhatu'' (''dhatu kshaya'') and ''avarana''(cover).[Cha.Sa.[[Chikitsa Sthana]] 28/59] The description of ''madhumeha'', provided earlier in this chapter, provides a good example of ''avarana''.That a provoked or vitiated ''vata'' causes ''madhumeha'' has also been reiterated in the [[Nidana Sthana]]. All the factors that cause decrease of body tissues lead to provocation of ''vāta''. But even though ''madhumeha'' is caused by a vitiated ''vata'', its etiological factors also cause an increase in ''kapha'' and ''pitta''. The comparison of ''nidana'' of ''madhumeha'' mentioned in these two different references is tabulated here:

'''Table 2: Difference between two contexts of ''Madhumeha'':'''

'''Table 2: Difference between two contexts of ''Madhumeha'':'''

Charak has mentioned seven varieties of ''prameha pidika'' whereas Sushruta and Vagbhata have added three more to this list that includes ''masoorika, putrini'' and ''vidarika''.

Charak has mentioned seven varieties of ''prameha pidika'' whereas Sushruta and Vagbhata have added three more to this list that includes ''masoorika, putrini'' and ''vidarika''.

The ''shiroroga'' described in this chapter are various clinical presentations of headache depending upon ''dosha'' dominance and ''krimi'' infestation. ''Krimi'' in [[Ayurveda]] is a generic term for a large number of pathological organisms ranging from microorganisms found in blood (''raktaja krimi'') to intestinal worms as well as external parasites such as lice [Cha. Vi. 7/11-13]

The ''shiroroga'' described in this chapter are various clinical presentations of headache depending upon ''dosha'' dominance and ''krimi'' infestation. ''Krimi'' in [[Ayurveda]] is a generic term for a large number of pathological organisms ranging from microorganisms found in blood (''raktaja krimi'') to intestinal worms as well as external parasites such as lice. [Cha.Sa.[[Vimana Sthana]] 7/11-13]

As mentioned earlier in the document, the diseases of the  head (verses 13-14) include hemicrania, coryza, headache (caused as a side-effect of diseases of the mouth, nose, eyes and ears), giddiness/vertigo, facial paralysis, tremors of the head, and stiffness of the neck, nape and jaw (there are additional varieties of ''shiroroga'' viz. frontal sinusitis, trigeminal neuralgia, and ''shankhaka'' are also described [Cha. Si. 9/70-87].

As mentioned earlier in the document, the diseases of the  head (verses 13-14) include hemicrania, coryza, headache (caused as a side-effect of diseases of the mouth, nose, eyes and ears), giddiness/vertigo, facial paralysis, tremors of the head, and stiffness of the neck, nape and jaw (there are additional varieties of ''shiroroga'' viz. frontal sinusitis, trigeminal neuralgia, and ''shankhaka'' are also described. [Cha.Sa.[[Siddhi Sthana]] 9/70-87]

In contemporary science, headache is not a disease and can be vascular, myogenic, cervicogenic, and inflammatory in origin. The drug choices also depend upon the causative factors of headache. Similarly in [[Ayurveda]], though headache is a common manifestation of all five types of diseases of the head, different forms of headache can give an idea of ''dosha'' predominance which may further decide the preference of procedures or drug in its treatment.  

In contemporary science, headache is not a disease and can be vascular, myogenic, cervicogenic, and inflammatory in origin. The drug choices also depend upon the causative factors of headache. Similarly in [[Ayurveda]], though headache is a common manifestation of all five types of diseases of the head, different forms of headache can give an idea of ''dosha'' predominance which may further decide the preference of procedures or drug in its treatment.  

The forms or manifestations of headache (and referred headache) associated with a ''shiroroga'' may include migraine, stress induced headache, cluster headache, chronic paroxysmal hemicraina, and  miscellaneous forms not associated with structural lesions or headache associated with vascular disorders.

The forms or manifestations of headache (and referred headache) associated with a ''shiroroga'' may include migraine, stress induced headache, cluster headache, chronic paroxysmal hemicraina, and  miscellaneous forms not associated with structural lesions or headache associated with vascular disorders.

Similarly the five presentations of heart diseases have also been mentioned in this chapter that resemble different manifestations of chest pain and could be in the form of angina, pain associated with myocardial infarction and dissecting aortic aneurysm, pericarditis, oesophageal spasm, or musculo-skeletal chest pain. The clinical picture of cardiac disorders is quite similar to the features of ''hridroga'' mentioned in [[Charak Samhita]], such as choking or constriction, squeezing, crushing, burning or aching chest pain, or a feeling of sharp, tearing or stabbing chest pain that is usually felt retrosternally and may radiate to the left arm or more rarely to the right arm and then to the throat, jaws and teeth, or through the back. In addition to the individual features of five types of ''hridaroga'', in [[Chikitsa Sthana]], the general sign and symptoms of  ''hridroga'' such as  discolouration, syncope, fever, cough, hiccups, dyspnoea, vomiting, water brash, chest discomfort, indigestion or distaste of mouth are also mentioned (Ca Ch 26/78). These are  mentioned as common symptoms of heart disease in medicine books.

Similarly the five presentations of heart diseases have also been mentioned in this chapter that resemble different manifestations of chest pain and could be in the form of angina, pain associated with myocardial infarction and dissecting aortic aneurysm, pericarditis, oesophageal spasm, or musculo-skeletal chest pain. The clinical picture of cardiac disorders is quite similar to the features of ''hridroga'' mentioned in [[Charak Samhita]], such as choking or constriction, squeezing, crushing, burning or aching chest pain, or a feeling of sharp, tearing or stabbing chest pain that is usually felt retrosternally and may radiate to the left arm or more rarely to the right arm and then to the throat, jaws and teeth, or through the back. In addition to the individual features of five types of ''hridaroga'', in [[Chikitsa Sthana]], the general sign and symptoms of  ''hridroga'' such as  discolouration, syncope, fever, cough, hiccups, dyspnoea, vomiting, water brash, chest discomfort, indigestion or distaste of mouth are also mentioned. [Cha.Sa.[[Chikitsa Sthana]] 26/78] These are  mentioned as common symptoms of heart disease in medicine books.

Carbuncles are common complications occurring in uncontrolled diabetes patients where the infection spreads extensively in the dermal and underlying soft tissue. This presents itself as a  complex localized abscess or as several separate abscesses with multiple discharge sinuses usually caused due to staphylococcus aureus infection.   

Carbuncles are common complications occurring in uncontrolled diabetes patients where the infection spreads extensively in the dermal and underlying soft tissue. This presents itself as a  complex localized abscess or as several separate abscesses with multiple discharge sinuses usually caused due to staphylococcus aureus infection.   

* [[Trimarmiya Chikitsa]]  

* [[Trimarmiya Chikitsa]]  

* [[Trimarmiya Siddhi]]

* [[Trimarmiya Siddhi]]

   

   

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