Changes

}}

}}

==[[Indriya Sthana]] Chapter 3, Chapter on the Signs and Symptoms of Imminent Death ==

==[[Indriya Sthana]] Chapter 3, Chapter on the palpable signs of Imminent Death ==

=== Abstract ===

=== Abstract ===

=== Introduction ===

=== Introduction ===

<div style="text-align:justify;">

<div style="text-align:justify;">

[[Parimarshaneeyamindriyam Adhyaya]] is the third amongst the twelve chapters that make up the [[Indriya Sthana]] and mainly deals with the moribund symptoms based on palpating various regions of the body. It follows [[Pushpitakamindriyam Adhyaya]], the second chapter in [[Indriya Sthana]] that deals with the prognosis based on observing the changes in the odour or tastes in the body. The reason for this sequence can be understood as the changes in the odor or taste can be felt easily and from far whereas to palpate proximity to the patient is a must. The chapter also precedes [[Indriyaneeka]], which is the fourth chapter of the [[Indriya Sthana]] that deals with the prognosis based on observing the functioning of the sensory organs of the body.

[[Parimarshaneeyamindriyam Adhyaya]] mainly deals with the moribund symptoms based on palpating various regions of the body. It follows [[Pushpitakamindriyam Adhyaya]] that deals with the prognosis based on observing the changes in the odour or taste in the body. The reason for this sequence can be understood as the changes in the odor or taste can be felt easily and from far whereas to palpate the patient is a must. The chapter also precedes [[Indriyaneeka]], which deals with the prognosis based on observing the functioning of the sensory organs of the body.

</div>

</div>

Lord Atreya said,, now we shall explain all tangible observations related to palpation in relation with imminent death. [1-2]  

Lord Atreya said,, now we shall explain all tangible observations related to palpation in relation with imminent death. [1-2]  

The person who is about to die manifests various signs in terms of colour, voice, odour, taste (sense by person) which are described separately. Now we will learn about the signs of imminent death pertaining to touch. [3]

The person who is about to die manifests various signs in terms of colour, voice, odour, taste (sense by person)????? which are described separately. Now we will learn about the signs of imminent death pertaining to touch. [3]

==== Assessment factors by palpation ====

==== Assessment factors by palpation ====

The physician who wants to use the method of palpation for measuring the remaining lifespan of a patient, should palpate his (patient’s) entire body with his hands, the hands being in normal condition. If the hands of the physician are not in normal condition, he should do so by using another person as a substitute for palpating the patient’s body.

The physician who wants to use the method of palpation for measuring the remaining lifespan of a patient, should palpate his (patient’s) entire body with his hands, the hands being in normal condition. If the hands of the physician are not in normal condition, he should do so by using another person as a substitute for palpating the patient’s body.

While palpating patient’s body; following deviations should be studied keeping normal anatomy and physiology of the body in mind; one should examine the person with palpation technique. Extreme deviations from normalcy in the body like the absence of pulsation in the pulsatile areas of the body, absence of warmth from warm regions of the body or the presence of hardness or rigidity in softer body structures can give important information in regards to the life span of the person. Similarly the presence of the signs like dislocation or displacement of joints, extreme alteration in perspiration, extreme emaciation or bulkiness of muscle etc. which are found without any apparent cause are to be studied to assess the span of life or the signs of death. [4]  

While palpating patient’s body; following deviations should be studied keeping normal anatomy and physiology of the body in mind. Extreme deviations from normalcy in the body like the absence of pulsation in the pulsatile areas of the body, absence of warmth from warm regions of the body or the presence of hardness or rigidity in softer body structures can give important information in regards to the life span of the person. Similarly the presence of the signs like dislocation or displacement of joints, extreme alteration in perspiration, extreme emaciation or bulkiness of muscle etc. which are found without any apparent cause are to be studied to assess the span of life or the signs of death. [4]  

</div>

</div>

तद्व्यासतोऽनुव्याख्यास्यामः- तस्य चेत् परिमृश्यमानं पृथक्त्वेनपादजङ्घोरुस्फिगुदरपार्श्वपृष्ठेषिकापाणिग्रीवाताल्वोष्ठललाटं स्विन्नं शीतं स्तब्धं  दारुणं वीतमांसशोणितं वा स्यात्,परासुरयं पुरुषो न चिरात् कालं  मरिष्यतीति विद्यात्|  

तद्व्यासतोऽनुव्याख्यास्यामः- तस्य चेत् परिमृश्यमानं पृथक्त्वेनपादजङ्घोरुस्फिगुदरपार्श्वपृष्ठेषिकापाणिग्रीवाताल्वोष्ठललाटं स्विन्नं शीतं स्तब्धं  दारुणं वीतमांसशोणितं वा स्यात्,परासुरयं पुरुषो न चिरात् कालं  मरिष्यतीति विद्यात्|  

The physician should similarly examine the patient’s respiration, two sides of the neck, teeth, eye-lashes, eyes, hair covering the head as well as body hair, abdomen, nails and fingers.  

The physician should similarly examine the patient’s respiration, two sides of the neck, teeth, eye-lashes, eyes, hair covering the head as well as body hair, abdomen, nails and fingers.  

If patient breaths either too long or too short of a breath, then it is to be considered that he is nearing to death. While palpating both sides of the neck (''Manya'') of a patient, if absence of pulsation is noted then the person is considered to be closer to death. If his teeth are coated, abnormally white and have sugar/crystal like deposits on it, then the person is considered nearer to death. If his eye-lashes are matted together, he is considered closer to death. If his eyes have lost physiological characteristics or are seen abnormal in any manner like- too bulging, too retracted, too oblique or squinted, too distorted, too loosened within their structure, having too much watery discharge, are either continuously open or closed, continuously blinking, with unstable vision, abnormal vision, deficient vision, have lost their keenness of vision (or color blindness), night blind, sees everything complete white or black, or red like hot coals, if the vision is covered over much with an unhealthy ring of any of colors like- black, yellow, blue, blackish, coppery, green, turmeric, white or any other abnormal color then the person is considered to be standing on death door. Now physician should try to pluck a few hair from scalp and body of the patient, the absence of pain while plucking the hair denotes that the patient is closer to death. If the veins on abdominal region become visible and appear to have various colors like-black, copper, blue, turmeric-like or white, the patient should be considered to be ready to depart from his life. If the nails are drained of blood and flesh, they look dark purple in color, it is to be considered that the patient is not going to survive. Lastly physician should examine the patient’s finger. If while stretching or pulling they do not get cracked, it should be known that the person will not survive. [6]

Following are considered arisht lakshana if patient breaths either too long or too short of a breath. Absence of pulsation in vessels of neck. Teeth are coated, abnormally white and have sugar/crystal like deposits on it,. Eye-lashes are matted together. Eyes have lost physiological characteristics or are seen abnormal in any manner like- too bulging, too retracted, too oblique or squinted, too distorted, too loosened within their structure, having too much watery discharge, are either continuously open or closed, continuously blinking, with unstable vision, abnormal vision, deficient vision, have lost their keenness of vision (or color blindness), night blind, sees everything complete white or black, or red. If, patient sees halo of different colors like- black, yellow, blue, blackish, coppery, green, turmeric, white or any other abnormal color. Absence of pain on plucking hair from any part of his body. Visibly prominent veins on abdominal region and appear to have various colors like-black, copper, blue, turmeric-like or white. If the nails are drained of blood and flesh, they look dark purple in color. Lastly physician should examine the patient’s finger. If while stretching or pulling they do not get cracked, it should be known that the person will not survive. ??? this last sign is very questionable and should be worded properly[6]

</div>

</div>

[[Parimarshaneeyamindriyam Adhyaya]] deals with signs and symptoms of imminent death or moribund symptoms; specifically those are elicited by touch or palpation. The chapter commences with the importance of palpation as a modality for diagnosis and any changes in the body indicative of imminent death. The signs of imminent death are seen as abnormal manifestations which cannot be explained as they appear without any reason. These can be seen as absence of pulsation in the areas of the body that are pulsatile, coldness in the warm areas of the body, rigidity in softer body parts, roughness in the body parts that are slimy in nature, the inexplicable absence of body parts; laxity, bowing or displacement of joints, excessive deficiency of flesh or blood, solidity of flesh or blood, excessive perspiration or stiffness, and/or whatever other similar symptoms that can be demonstrated by palpation. The important point to note here is that all the signs and symptoms seen here as well as other chapters of [[Indriya Sthana]] are seen without any causative factors. The rest of the [[Charak Samhita]] excluding the [[Indriya Sthana]] comprises of various signs and symptoms due to ''dosha dushti'' or vitiation of ''doshas''. (Ch.In.3/4)

[[Parimarshaneeyamindriyam Adhyaya]] deals with signs and symptoms of imminent death or moribund symptoms; specifically those are elicited by touch or palpation. The chapter commences with the importance of palpation as a modality for diagnosis and any changes in the body indicative of imminent death. The signs of imminent death are seen as abnormal manifestations which cannot be explained as they appear without any reason. These can be seen as absence of pulsation in the areas of the body that are pulsatile, coldness in the warm areas of the body, rigidity in softer body parts, roughness in the body parts that are slimy in nature, the inexplicable absence of body parts; laxity, bowing or displacement of joints, excessive deficiency of flesh or blood, solidity of flesh or blood, excessive perspiration or stiffness, and/or whatever other similar symptoms that can be demonstrated by palpation. The important point to note here is that all the signs and symptoms seen here as well as other chapters of [[Indriya Sthana]] are seen without any causative factors. The rest of the [[Charak Samhita]] excluding the [[Indriya Sthana]] comprises of various signs and symptoms due to ''dosha dushti'' or vitiation of ''doshas''. (Ch.In.3/4)

==== Some examples of palpation ====

==== Some examples of palpation ====.

 

 

Arterial pulse can be felt physiologically in various areas as radial pulse, brachial pulse, carotid pulse, femoral pulse, popliteal pulse, posterior tibial pulse and dorsalis pedis pulse. Absence of pulsation in these areas indicates occlusion of the specific artery or aorta from where the pulse wave originates.

The carotid artery is palpated with the thumb or finger tips placed at the upper end of the thyroid cartilage along the medial border of the sternocleidomastoid muscle.<ref> Vakil RJ, Golwalla AF. Physical Diagnosis. 9th ed. Media Promoters & Publishers Pvt. Ltd. MumbaiJal pg231 </ref> The absence of pulsation in carotid artery usually results from atherosclerosis or carotid artery stenosis.

The carotid artery is palpated with the thumb or finger tips placed at the upper end of the thyroid cartilage along the medial border of the sternocleidomastoid muscle.<ref> Vakil RJ, Golwalla AF. Physical Diagnosis. 9th ed. Media Promoters & Publishers Pvt. Ltd. MumbaiJal pg231 </ref> The absence of pulsation in carotid artery usually results from atherosclerosis or carotid artery stenosis.