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===Abstract ===

===Abstract ===

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The chapter [[Varnasvariyamindriyam Adhyaya]] is about ''arishta lakshana'' (fatal/near death signs) perceived by auditory and visual senses. ''Swara'' (Voice) is an audible feature, whereas color and complexion are visual features. Sudden change in frequency, rhythm, resonance, tone, the pitch of voice and complexion of the body is indicative of serious pathology of the body. The characteristic features of ''arishtas'' are described in the chapter.

The chapter [[Varnasvariyamindriyam Adhyaya]] is about ''arishta lakshana'' (near death signs) perceived by auditory and visual senses. ''Swara'' (Voice) is an audible feature, whereas color and complexion are visual features. Sudden change in frequency, rhythm, resonance, tone, the pitch of voice and complexion of the body is indicative of serious pathology of the body. The characteristic features of ''arishtas'' are described in the chapter.

'''Keywords''': Near death signs, change in voice, change in complexion.

'''Keywords''': Near death signs, change in voice, change in complexion.

===Introduction ===

===Introduction ===

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Charak has placed [[Indriya Sthana]] (section about near death signs) before [[Chikitsa Sthana]] (section about the treatment of diseases) possibly, to guide physician when not to treat a patient. In this first chapter of [[Indriya Sthana]], [[Varnasvariyamindriyam Adhyaya]], Charak mentions near death signs and symptoms that can be directly observed by visual and other faculties. This chapter also describes ''prakriti'', the natural disposition of an individual, and ''vikriti'', or abnormalities , since such knowledge helps in discerning any sign of ''vikriti'' in a "healthy" individual. Three types of morbid conditions are observed namely, ''lakshana nimitta'', caused by bodily marks, ''lakshya nimitta'', caused by etiological factors which disturb the health, and ''nimitta anuroopa vikriti'', a break down for no apparent reason resembling with etiological factors. The chapter describes various near death signs with changes in color, the complexion of body parts and voice.

Charak has placed [[Indriya Sthana]] (section about near death signs) before [[Chikitsa Sthana]] (section about the treatment of diseases) possibly, to guide physician when not to treat a patient. In this chapter of [[Indriya Sthana]], [[Varnasvariyamindriyam Adhyaya]], Charak mentions near death signs and symptoms that can be directly observed by visual and other faculties. This chapter also describes ''prakriti'', the natural disposition of an individual, and ''vikriti'', or abnormalities , since such knowledge helps in discerning any sign of ''vikriti'' in a "healthy" individual. Three types of morbid conditions are observed namely, ''lakshana nimitta'', caused by bodily marks, ''lakshya nimitta'', caused by etiological factors which disturb the health, and ''nimitta anuroopa vikriti'', a break down for no apparent reason resembling etiological factors. The chapter describes various near death signs with changes in color, the complexion of body parts and voice.

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

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

tatra yAni puruShamanAshritAni tAnyupadeshato yuktitashca parIkSheta, puruShasaMshrayANi punaHprakRutito vikRutitashca||4||

tatra yAni puruShamanAshritAni tAnyupadeshato yuktitashca parIkSheta, puruShasaMshrayANi punaHprakRutito vikRutitashca||4||

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Out of these entities, some are not seated in a patient but are about patients. Those who are not seated in patients are required to be examined with logic based on scriptural instructions and inference. Those which can be seen in patients are examined by observing their constitution and morbid conditions. The factors not seated in patients are often circumstantial like an informer who comes with news of patient and the good/bad omens seen by the physician. But all these factors should be assessed wisely in the quest for the life of the patient. [4]

Some of the signs and symptoms are not apparent in a patient but can be observed in the surrounding of the patient. These are evaluated by logic based on scriptural instructions and inference. The factors not observed in patients are often circumstantial like an informer who comes with news of patient and the good/bad omens seen by the physician. Those which can be seen in patients are examined by observing their constitution and morbid conditions. But all these factors should be assessed wisely in the quest for the life of the patient. [4]

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==== Factors responsible for natural constitution ====  

==== Factors responsible for natural constitution ====  

*'''Sudden change in following factors indicate near death signs:'''  

*'''Sudden change in following factors indicate near death signs:'''  

Complexion, voice, smell, taste, touch, eyes, ears, nose, tongue, skin, psyche, desire, cleanliness, conduct, behavior, memory, shape, nature, morbidity, strength, malaise, intellect, exhilaration, dryness, unctuousness, drowsiness, initiation, heaviness, lightness, qualities, diet, regimens, digestion of food, manifestation of disease, disappearance of disease, characters of disease, premonitory signs of the disease, symptoms, complications, administration of proper medicine, and effect of medicine on disease, luster, shadow, dream, state of informer about the patient. Bad omens perceived by the physician on his way to patient’s house, changed conditions of the patient’s residence, signs and symptoms indicating the residual span of life may be evident in these factors. Hence physician should pay careful attention to each one of them and interpretation should be made based on his observations, knowledge and scriptural advice.

Complexion, voice, smell, taste, touch, eyes, ears, nose, tongue, skin, psyche, desire, cleanliness, conduct, behavior, memory, shape, nature, strength, malaise, intellect, exhilaration, dryness, unctuousness, drowsiness, heaviness, lightness, qualities, diet, regimens, digestion of food, manifestation of disease, disappearance of disease, characters of disease, premonitory signs of the disease, symptoms, complications, administration of proper medicine, and effect of medicine on disease, luster, shadow, dream, state of informer about the patient. Bad omens perceived by the physician on his way to patient’s house, changed conditions of the patient’s residence, signs and symptoms indicating the residual span of life may be evident in these factors. Hence physician should pay careful attention to each one of them and interpretation should be made based on his observations, knowledge and scriptural advice.

*The examination of complexion does not just mean the color only. It also includes objects of visual perception like coarseness, glossiness etc. Abnormal ''swara'' (voice) include fluctuations in the normal quality of sounds produced (hoarseness of voice, dysphonia), absence of the normal physiological sounds like absence of peristalsis in peritonitis, presence of abnormal sounds like crepitus in joints & crepitations, rhonchi etc. in lungs. Abnormalities in touch include tactile perception of abnormal hardness, softness, warmth etc.

*The examination of complexion does not just mean the color only. It also includes objects of visual perception like coarseness, glossiness etc. Abnormal ''swara'' (voice) include fluctuations in the normal quality of sounds produced (hoarseness of voice, dysphonia), absence of the normal physiological sounds like absence of peristalsis in peritonitis, presence of abnormal sounds like crepitus in joints & crepitations, rhonchi etc. in lungs. Abnormalities in touch include tactile perception of abnormal hardness, softness, warmth etc.

*The morbid conditions are of three types. Such as those indicated by bodily marks, those caused by etiological factors and those resemble etiological factors.

*The morbid conditions are of three types. Such as those indicated by bodily marks, those caused by etiological factors and those resemble etiological factors.

*''Lakshana nimitta'' include visible end stage manifestations.

*''Lakshana nimitta'' include visible end stage manifestations.

*The abnormal color produced can be considered as ''ojokshaya lakshana'' (depletion of quality of tissue). In ''Raktarshas'' (bleeding piles), when there is excessive bleeding, it may lead to poor complexion, strength, enthusiasm and depleted ''Ojas''. If proper measure is not taken the condition may become fatal. The unnatural colors formed can be compared with the cyanotic conditions, discoloration seen in the fatal hepatic and renal pathologies etc. Appearance of white spots, white nails and loss of pigmentation can be seen in chronic liver failure.

*The abnormal color produced can be considered as ''ojokshaya lakshana'' (depletion of quality of tissue). In ''Raktarshas'' (bleeding piles), when there is excessive bleeding, it may lead to poor complexion, strength, enthusiasm and depleted ''Ojas''. If proper measure is not taken the condition may become fatal. The unnatural color of skin can be compared with the cyanotic conditions, discoloration seen in the fatal hepatic and renal pathologies etc. Appearance of white spots, white nails and loss of pigmentation can be seen in chronic liver failure.

*In chronic kidney disease, the conjunctival deposition of calcium leads to redness and gritty feeling in the eye called uremic red eye. Also deposition of calcium as a band in the lamina proprea of cornea leads to band keratopathy.

*In chronic kidney disease, the conjunctival deposition of calcium leads to redness and gritty feeling in the eye called uremic red eye. Also deposition of calcium as a band in the lamina proprea of cornea leads to band keratopathy.

*In chronic hepatic failure, erythematous patches may appear over many parts of the body, especially over the chest wall and supraclavicular regions.

*In chronic hepatic failure, erythematous patches may appear over many parts of the body, especially over the chest wall and supraclavicular regions.

*Appearance of abnormal complexion in the entire or half of the body of the individual without any significant reason is due to abnormal peripheral circulation. Oxygenation can affect the complexion. Serious vascular insufficiencies will also result in impaired skin complexion. In deep vein thrombosis DVT alteration in pigmentation is well appreciated.

*Appearance of abnormal complexion in the entire or half of the body of the individual without any significant reason can be due to abnormal peripheral circulation. Oxygenation can affect the complexion. In deep vein thrombosis (DVT) alteration in pigmentation is well appreciated.

*When both the lips become bluish like ripe fruits of ''jambu'', this is a clear indication of death. As per modern science this condition is similar to central cyanosis. It is directly due to ''Vata Pratilomata'' (reverse direction of ''Vata'') in different organs. The main ''Srotas'' involved are ''Rasavaha srotas'' and ''Raktavaha Srotas.''

*When both the lips become bluish like ripe fruits of ''jambu'', this is a clear indication of death. As per modern science this condition is similar to central cyanosis. It is directly due to ''Vata Pratilomata'' (reverse direction of ''Vata'') in different organs. The main ''Srotas'' involved are ''Rasavaha srotas'' and ''Raktavaha Srotas.''

*Abnormal voices:

*Abnormal voices:

**In  ''Apatantraka –kapota iva koojan'' ( make sound like a pigeon).

**In  ''Apatantraka –kapota iva koojan'' ( make sound like a pigeon).

**In Tetanus  -sudden death occurs due to laryngeal spasm .

**In Tetanus  -sudden death occurs due to laryngeal spasm .

**Dysphonia—Disturbance of phonation due to disturbance in vocal cords. Strained, harsh, low pitched voice, nasal voice.

**Dysphonia—Disturbance of phonation is due to disturbance in vocal cords. Strained, harsh, low pitched voice, nasal voice.

**In laryngeal tumors like supra glottic cancer  and glottis cancer hoarseness of voice is a late symptom.

**In laryngeal tumors like supra glottic cancer  and glottis cancer hoarseness of voice is a late symptom.

In fact the abnormal changes in color and voice of the patient reflect serious changes in the physiology. Deep seated pathologies of cardio vascular system, Respiratory system, endocrine system often presents with color changes. Central and peripheral cyanosis represents certain death causing conditions. Similarly lesions in the central nervous system can lead to changes in the voice. Dysarthria, Dysphasia and Dysphonia shows underlining pathologies which may become fatal. In short this chapter highlights the events related with major systems in the body which can cause death.

In fact the abnormal changes in color and voice of the patient reflect serious changes in the physiology. Deep seated pathologies of cardio vascular system, Respiratory system, endocrine system often presents with color changes. Similarly lesions in the central nervous system can lead to changes in the voice. Dysarthria, Dysphasia and Dysphonia which may become fatal. In short this chapter highlights the events related with major systems in the body which can cause death.

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