Changes

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

=== ''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 [[dosha]] leading to a disease is known as ''samsarga'' and when all the three provoked [[dosha]] combine then it is known as ''sannipata''. In the combinations , some [[dosha]] 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 [[dosha]], including:

**25 conditions of increased ''doshas'':

**25 conditions of increased [[dosha]]:

***Three conditions of ''sannipata'' where one ''dosha'' is increased but the other two ''doshas'' are excessively increased in comparison.

***Three conditions of ''sannipata'' where one [[dosha]] is increased but the other two [[dosha]] are excessively increased in comparison.

***Three conditions of ''sannipata'' where two ''doshas'' are increased and one excessively increased

***Three conditions of ''sannipata'' where two [[dosha]] are increased and one excessively increased

***Six conditions of ''sannipata'' where one ''dosha'' is excessively increased, the second moderately increased and third slightly increased

***Six conditions of ''sannipata'' where one [[dosha]] is excessively increased, the second moderately increased and third slightly increased

***One condition of ''sannipata'' where all the ''doshas'' are equally increased

***One condition of ''sannipata'' where all the [[dosha]] are equally increased

***Six conditions of ''samsarga'' where one ''dosha'' is increased and the others excessively increased

***Six conditions of ''samsarga'' where one [[dosha]] is increased and the others excessively increased

***Three conditions of ''samsarga'' where both the ''doshas'' are equally increased

***Three conditions of ''samsarga'' where both the [[dosha]] are equally increased

***Three conditions of ''sannipata'' where single ''dosha'' is increased and others are normal

***Three conditions of ''sannipata'' where single [[dosha]] is increased and others are normal

**25 conditions of decreased ''dosha'': Here the ''doshas'' may be slightly decreased, moderately decreased or significantly decreased. The combinations follow the same pattern as above.

**25 conditions of decreased [[dosha]]: Here the [[dosha]] may be slightly decreased, moderately decreased or significantly decreased. The combinations follow the same pattern as above.

**12 conditions of ''sannipata'' where one ''dosha'' is normal, second is increased and the third is decreased.

**12 conditions of ''sannipata'' where one [[dosha]] is normal, second is increased and the third is decreased.

In this way,  62 conditions of various combinations of normal, increased and decreased dosha have been mentioned in this chapter(verses from 41 to 62), of which only 12 types are described in detail. Chakrapāni mentions that combinations of ''dosha'' may occur in two ways i.e. ''prakriti-sama-samveta'' and ''vikriti-vishama-samveta''. ''Prakriti-sama-samveta'' akin to a sugar and salt solution in water where the tastes of sugar and salt remain intact and in such types of ''samsarga'' or ''sannipata'' of ''doshas'', no specific description is given in the text but simply mentioned that mix features of involved ''dosha'' will present.  

In this way,  62 conditions of various combinations of normal, increased and decreased [[dosha]] have been mentioned in this chapter(verses from 41 to 62), of which only 12 types are described in detail. Chakrapāni mentions that combinations of [[dosha]] may occur in two ways i.e. ''prakriti-sama-samveta'' and ''vikriti-vishama-samveta''. ''Prakriti-sama-samveta'' akin to a sugar and salt solution in water where the tastes of sugar and salt remain intact and in such types of ''samsarga'' or ''sannipata'' of [[dosha]], no specific description is given in the text but simply mentioned that mix features of involved [[dosha]] will present.  

On the other hand, ''vikriti-vishama-samveta'' a combination of provoked ''doshas'' wherein new symptoms are produced that are neither of any of the ''doshas'' involved. For example, red colour appears on mixing of white lime and yellow turmeric, and in such a case the specific symptoms produced by the combination are described. Here in 17th chapter, specific symptoms of 12 types of ''vikriti-vishama-samveta'' ''sannipata'' are given in detail, but symptoms of ''sama sannipata'' are not given as it is ''prakriti-sama-samveta'' (Verses 41-72).

On the other hand, ''vikriti-vishama-samveta'' a combination of provoked [[dosha]] wherein new symptoms are produced that are neither of any of the [[dosha]] involved. For example, red colour appears on mixing of white lime and yellow turmeric, and in such a case the specific symptoms produced by the combination are described. Here in 17th chapter, specific symptoms of 12 types of ''vikriti-vishama-samveta'' ''sannipata'' are given in detail, but symptoms of ''sama sannipata'' are not given as it is ''prakriti-sama-samveta'' (Verses 41-72).

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'''Table 1:  Clinical features of different states of ''dosha'' and ''sannipata'':'''  

'''Table 1:  Clinical features of different states of [[dosha]] and sannipata:'''  

{| class="wikitable"

{| class="wikitable"

! Sr.No. !! ''Vata'' !! ''Pitta'' !! ''Kapha '' !! Signs

! Sr.No. !! ''Vata'' !! ''Pitta'' !! ''Kapha '' !! Signs

| rowspan="1" style="text-align: left;" | Increased

| rowspan="1" style="text-align: left;" | Increased

| rowspan="1" style="text-align: left;" | Decreased

| rowspan="1" style="text-align: left;" | Decreased

| rowspan="1" style="text-align: left;" | affecting the ''Ojas'' causes malaise ''(Glāni), indriyadaurbalya'' (asthenia of senses), ''Trushna'' (thirst), ''Murchha'' (fainting) and ''Kriyakshayam'' (decreased physiological functions).

| rowspan="1" style="text-align: left;" | affecting the [[Ojas]] causes malaise ''(Glāni), indriyadaurbalya'' (asthenia of senses), ''Trushna'' (thirst), ''Murchha'' (fainting) and ''Kriyakshayam'' (decreased physiological functions).

|-

|-

| rowspan="1" style="text-align: left;" | 12

| rowspan="1" style="text-align: left;" | 12

|}

|}

'''''Ojas''''':  

'''[[Ojas]]''':  

Ojas is well known and defined  in [[Ayurveda]] in terms of its functions, its importance, its types and its sites of functions within the body. It has been described in this text as a clear and slightly red-yellowish fluid situated in the heart is known as ''ojas'', the destruction of which leads to death. Its colour resembles to that of ''ghee'', taste is like honey and its smell is like that of roasted paddy (Verses 73-75). But its interpretation in modern physiological terms is confusing. In this chapter a hint has been given in this regard that ''ojas'' is a first thing created in the body of all living creatures. The symptoms of diminished ''ojas'' include timidity, debility, constant worry, discomfort of the senses, loss of lustre, neurasthenia, dryness and emaciation.

[[Ojas]] is well known and defined  in [[Ayurveda]] in terms of its functions, its importance, its types and its sites of functions within the body. It has been described in this text as a clear and slightly red-yellowish fluid situated in the heart is known as [[ojas]], the destruction of which leads to death. Its colour resembles to that of ghee, taste is like honey and its smell is like that of roasted paddy (Verses 73-75). But its interpretation in modern physiological terms is confusing. In this chapter a hint has been given in this regard that [[ojas]] is a first thing created in the body of all living creatures. The symptoms of diminished [[ojas]] include timidity, debility, constant worry, discomfort of the senses, loss of lustre, neurasthenia, dryness and emaciation.

'''''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.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:

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'':'''

{| class="wikitable"

{| class="wikitable"

! Causative Factors !! Causative factors of ''Dhatu kshayaja Vataja Madhumeha(Nidana Sthana)'' !! Causative factors of ''Aavaranjanya vataja Madhumeha ( Sutra Sthana)''  

! Causative Factors !! Causative factors of ''Dhatu kshayaja [[Vata]]ja Madhumeha(Nidana Sthana)'' !! Causative factors of ''Aavaranjanya vataja Madhumeha ( Sutra Sthana)''  

|-

|-

| rowspan="1" style="text-align: left;" | Excessive use of ''Rasa'' (Taste)

| rowspan="1" style="text-align: left;" | Excessive use of ''Rasa'' (Taste)

| rowspan="1" style="text-align: left;" | Indulgence in intake of, ''lavana'' and ''amla  rasa'' dominant food articles  

| rowspan="1" style="text-align: left;" | Indulgence in intake of, ''lavana'' and ''amla  rasa'' dominant food articles  

|-

|-

| rowspan="1" style="text-align: left;" |Excessive use of ''Guna''

| rowspan="1" style="text-align: left;" |Excessive use of ''[[Guna]]''

| rowspan="1" style="text-align: left;" | ''ruksha, laghu, shita, ''

| rowspan="1" style="text-align: left;" | ''ruksha, laghu, shita, ''

| rowspan="1" style="text-align: left;" | ''guru, snigdha, navam-anna-pana''

| rowspan="1" style="text-align: left;" | ''guru, snigdha, navam-anna-pana''

|-

|-

| rowspan="1" style="text-align: left;" | Increase of  

| rowspan="1" style="text-align: left;" | Increase of  

| rowspan="1" style="text-align: left;" | ''vata''

| rowspan="1" style="text-align: left;" | [[vata]]

| rowspan="1" style="text-align: left;" | Increase of ''kapha, pitta, medas, mamsa'' and ''aavirita Vata''

| rowspan="1" style="text-align: left;" | Increase of [[kapha]], [[pitta]], [[meda dhatu]], [[mamsa dhatu]] and aavirita [[Vata]]

|-

|-

|}

|}

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It is obvious from the above table that in case of ''avarita'', ''madhumeha'' initially causes an increase in ''kapha, pitta, meda'' and ''māmsa'' leading to an obstruction of functional pathways of ''vata,'' furthering its provocation, thereby increasing the severity of ''madhumeha''. In such a condition, the treatment is ''apatarpana'' and not of ''vata'' i.e. ''santarpana'' (Verses 78-81).  

It is obvious from the above table that in case of ''avarita'', ''madhumeha'' initially causes an increase in [[kapha]], [[pitta]], [[meda dhatu]] and [[mamsa dhatu]] leading to an obstruction of functional pathways of [[vata]], furthering its provocation, thereby increasing the severity of ''madhumeha''. In such a condition, the treatment is ''apatarpana'' and not of [[vata]] i.e. ''santarpana'' (Verses 78-81).  

''Prameha pidika'' mentioned in this chapter usually occurs as a complication of ''avaranjanaya samprapti'' of ''madhumeha'' as ''medas dushti'' occurs in this type of ''madhumeha'', the factor, a must for pathogenesis of ''prameha pidika''. This resembles with presentation of metabolic syndrome which includes dys-lipidemia (Verse 82-111).  

''Prameha pidika'' mentioned in this chapter usually occurs as a complication of ''avaranjanaya samprapti'' of ''madhumeha'' as [[meda dhatu]] dushti occurs in this type of ''madhumeha'', the factor, a must for pathogenesis of ''prameha pidika''. This resembles with presentation of metabolic syndrome which includes dys-lipidemia (Verse 82-111).  

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''.

Charaka 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.Sa.[[Vimana Sthana]] 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.Sa.[[Siddhi Sthana]] 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]

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.   

Thus, this chapter is very important as it deals with the disorders of three vital parts of the body (''trimarma''). It also describes very important aspects of pathogenesis caused due to combinations of vitiated ''dosha'' viz. ''samsarga'' and ''sannipata''. The description of ''ojas'' is a unique concept of [[Ayurveda]]. The detailed descriptions along with etiological factors of each ''prameha pidika'' are very helpful in planning their prevention and cure.

Thus, this chapter is very important as it deals with the disorders of three vital parts of the body (''trimarma''). It also describes very important aspects of pathogenesis caused due to combinations of vitiated ''dosha'' viz. ''samsarga'' and ''sannipata''. The description of [[ojas]] is a unique concept of [[Ayurveda]]. The detailed descriptions along with etiological factors of each ''prameha pidika'' are very helpful in planning their prevention and cure.

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====Table 3: Types of Pidika in different classics:====

====Table 3: Types of Pidika in different classics:====