Pannarupiyam Indriyam Adhyaya

Indriya Sthana Chapter 7.Fatal signs of changes in shadows, complexion, and luster

Pannarupiyam Indriyam Adhyaya

Section/Chapter	Indriya Sthana Chapter 7
Preceding Chapter	Katamanisharireeyam Indriyam Adhyaya
Succeeding Chapter	Avakshiraseeyam Indriyam Adhyaya
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana
Translator and commentator	Byadgi P.S, Singh A.
Reviewer	Babu S.P.
Editors	Khandel S.K., Babu S.P., Deole Y.S., Basisht G.
Year of publication	2020
Publisher	Charak Samhita Research, Training and Skill Development Centre
DOI	10.47468/CSNE.2020.e01.s05.008

Abstract

The seventh chapter Pannarupiyam Indriyam Adhyaya deals with the loss of shadow image in eyes, changes in complexion and luster indicative of imminent death. Difference between shadow and luster is also explained in this chapter with characteristic features of shadows pertaining to each of pancha mahabhuta. The chapter focuses on fatal prognostic features related to complexion and luster.

Keywords: shadow image, complexion, luster, chhaya, varna, prabha, pupuliary reaction, signs of death.

Introduction

If there is any distortion in the image of the examiner reflected as a shadow in the pupil of the patient, should be considered as a sign of imminent death of the patient. Nimittanurupa vikriti (image pertaining to death) will serve as a yard stick to measure the span of life. The chapter deals with clinical observations of changes in skin complexion, pupillary reactions and their relevant prognosis.

The Sanskrit word "panna" means destruction or deterioration. Hence the chapter deals with the deterioration of complexion due to various disease pathologies leading to bad prognosis and death.

Sanskrit text, Transliteration and English Translation

अथातः पन्नरूपीयमिन्द्रियं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātaḥ pannarūpīyamindriyaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAtaH pannarUpIyamindriyaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter "Pannarupiyam Indriyam " (Fatal signs of changes in shadows, complexion, and luster). Thus said Lord Atreya.[1-2]

Note: The chapter deals with the signs of imminent death as indicated by the distortion of the image reflected in the pupil.

Loss of shadow image in eyes or pupillary reaction

दृष्ट्यां यस्य विजानीयात् पन्नरूपां कुमारिकाम्|
प्रतिच्छायामयीमक्ष्णोर्नैनमिच्छेच्चिकित्सितुम्||३||

dr̥ṣṭyāṁ yasya vijānīyāt pannarūpāṁ kumārikām|
praticchāyāmayīmakṣṇōrnainamicchēccikitsitum||3||

dRuShTyAM yasya vijAnIyAt pannarUpAM kumArikAm|
praticchAyAmayImakShNornainamiccheccikitsitum||3||

The condition in which loss of shadow image is observed in the pupil (eyes) of the patient, should be discarded for treatment.[3]

Features of fatal prognosis based on shadows

ज्योत्स्नायामातपे दीपे सलिलादर्शयोरपि|
अङ्गेषु विकृता यस्य च्छाया प्रेतस्तथैव सः||४||

jyōtsnāyāmātapē dīpē salilādarśayōrapi|
aṅgēṣu vikr̥tā yasya cchāyā prētastathaiva saḥ||4||

jyotsnAyAmAtape dIpe salilAdarshayorapi|
a~ggeShu vikRutA yasya cchAyA pretastathaiva saH||4||

If any sorts of deformity observed in body parts in the shadow of the person in moonlight, sunlight, light of a lamp, water or mirror. He should be considered as dead. [4]

Deformities observed in shadow

छिन्ना भिन्नाऽऽकुला च्छाया हीना वाऽप्यधिकाऽपि वा|
नष्टा तन्वी द्विधा च्छिन्ना विकृता विशिरा च या||५||

एताश्चान्याश्च याः काश्चित् प्रतिच्छाया विगर्हिताः|
सर्वा मुमूर्षतां ज्ञेया न चेल्लक्ष्यनिमित्तजाः||६||

chinnā bhinnākulā cchāyā hīnā vā'pyadhikā'pi vā|
naṣṭā tanvī dvidhā cchinnā vikr̥tā viśirā ca yā||5||

ētāścānyāśca yāḥ kāścit praticchāyā vigarhitāḥ|
sarvā mumūrṣatāṁ jñēyā na cēllakṣyanimittajāḥ||6||

chinnA bhinnA~a~akulA cchAyA hInA vA~apyadhikA~api vA|
naShTA tanvI dvidhA cchinnA vikRutA vishirA ca yA||5||

etAshcAnyAshca yAH kAshcit praticchAyA vigarhitAH|
sarvA mumUrShatAM j~jeyA na cellakShyanimittajAH||6||

Observation of shadow of a patient as broken, torn, hazy, devoid of certain organs, seeing excess organs, not conspicuous, bifurcated, deformed and without head, such other similar abnormal shadows if develops without any apparent cause it is considered as severe morbidity.[5-6]

Assessment parameters of shadow

संस्थानेन प्रमाणेन वर्णेन प्रभया तथा|
छाया विवर्तते यस्य स्वस्थोऽपि प्रेत एव सः||७||

saṁsthānēna pramāṇēna varṇēna prabhayā tathā|
chāyā vivartatē yasya svasthō'pi prēta ēva saḥ||7||

saMsthAnena pramANena varNena prabhayA tathA|
chAyA vivartate yasya svastho~api preta eva saH||7||

Distortion of shadow in respect of changes in shape, measurement, colour and lustre should be considered as ominous sign even in healthy individual.[7]

संस्थानमाकृतिर्ज्ञेया सुषमा विषमा च सा|
मध्यमल्पं महच्चोक्तं प्रमाणं त्रिविधं नृणाम्||८||

प्रतिप्रमाणसंस्थाना जलादर्शातपादिषु|
छाया या सा प्रतिच्छाया च्छाया वर्णप्रभाश्रया||९||

saṁsthānamākr̥tirjñēyā suṣamā viṣamā ca sā|
madhyamalpaṁ mahaccōktaṁ pramāṇaṁ trividhaṁ nr̥ṇām||8||

pratipramāṇasaṁsthānā jalādarśātapādiṣu|
chāyā yā sā praticchāyā cchāyā varṇaprabhāśrayā||9||

saMsthAnamAkRutirj~jeyA suShamA viShamA ca sA|
madhyamalpaM mahaccoktaMpramANaM trividhaM nRuNAm||8||

pratipramANasaMsthAnA jalAdarshAtapAdiShu|
chAyA yA sA praticchAyA cchAyA varNaprabhAshrayA||9||

The term sansthana means shape which may be symmetrical or asymmetrical. Measurement is of three kinds namely short, medium, and large The image reflected in water, mirror, etc., corresponding to the measurement and shape of the body of the individual is known as praticchhaya which is nothing but reflected shadow based on the complexion and luster of the individual.[8-9]

Features of Shadow of Pancha Mahabhuta

खादीनां पञ्च पञ्चानां छाया विविधलक्षणाः|
नाभसी निर्मला नीला सस्नेहा सप्रभेव च||१०||

रूक्षा श्यावारुणा या तु वायवी सा हतप्रभा|
विशुद्धरक्ता त्वाग्नेयी दीप्ताभा दर्शनप्रिया||११||

शुद्धवैदूर्यविमला सुस्निग्धा चाम्भसी मता|
स्थिरा स्निग्धा घना श्लक्ष्णा श्यामा श्वेता च पार्थिवी||१२||

वायवी गर्हिता त्वासां चतस्रः स्युः सुखोदयाः |
वायवी तु विनाशाय क्लेशाय महतेऽपि वा||१३||

khādīnāṁ pañca pañcānāṁ chāyā vividhalakṣaṇāḥ|
nābhasī nirmalā nīlā sasnēhā saprabhēva ca||10||

rūkṣā śyāvāruṇā yā tu vāyavī sā hataprabhā|
viśuddharaktā tvāgnēyī dīptābhā darśanapriyā||11||

śuddhavaidūryavimalā susnigdhā cāmbhasī matā|
sthirā snigdhā ghanā ślakṣṇā śyāmā śvētā ca pārthivī||12||

vāyavī garhitā tvāsāṁ catasraḥ syuḥ sukhōdayāḥ |
vāyavī tu vināśāya klēśāya mahatē'pi vā||13||

khAdInAM pa~jca pa~jcAnAM chAyA vividhalakShaNAH|
nAbhasI nirmalA nIlA sasnehA saprabheva ca||10||

rUkShA shyAvAruNA yA tu vAyavI sA hataprabhA|
vishuddharaktA tvAgneyI dIptAbhA darshanapriyA||11||

shuddhavaidUryavimalA susnigdhA cAmbhasI matA|
sthirA snigdhAghanA shlakShNA shyAmA shvetA ca pArthivI||12||

vAyavI garhitA tvAsAM catasraH syuH sukhodayAH |
vAyavI tu vinAshAya kleshAya mahate~api vA||13||

The following are the distinctive characteristic features of shadows pertaining to each of the five great elements [table 1].

Table 1: Shadows of Pancha Mahabhuta

S.No	Mahabhuta	Distinctive characteristic features of shadows
1	Akasha mahabhuta	Clear , blue, unctuous and lustrous shadow
2.	Vayu mahabhuta	Dry, brown, and reddish
3.	Agni mahabhuta	Bright red, brilliant and pleasing to the eyes
4.	Jala mahabhuta	Clear like cat’s eye, and excessive unctuous
5.	Prithvi mahabhuta	Stable, unctuous, compact, smooth, black and white

The shadow pertaining to vayu mahabhuta is of inferior in nature whereas the remaining four are indicative of pleasure and happiness. Vayu mahabhuta shadows indicative of great calamities and miseries.[10-13]

Types of prabha (luster)

स्यात्तैजसी प्रभा सर्वा सा तु सप्तविधा स्मृता|
रक्ता पीता सिता श्यावा हरिता पाण्डुराऽसिता||१४||

तासां याः स्युर्विकासिन्यः स्निग्धाश्च विपुलाश्च याः|
ताः शुभा रूक्षमलिनाः सङ्क्षिप्ताश्चाशुभोदयाः ||१५||

syāttaijasī prabhā sarvā sā tu saptavidhā smr̥tā|
raktā pītā sitā śyāvā haritā pāṇḍurā'sitā||14||

tāsāṁ yāḥ syurvikāsinyaḥ snigdhāśca vipulāśca yāḥ|
tāḥ śubhā rūkṣamalināḥ saṅkṣiptāścāśubhōdayāḥ ||15||

syAttaijasI prabhA sarvA sA tu saptavidhA smRutA|
raktA pItA sitA shyAvA haritA pANDurA~asitA||14||

tAsAM yAH syurvikAsinyaH snigdhAshca vipulAshca yAH|
tAH shubhA rUkShamalinAH sa~gkShiptAshcAshubhodayAH||15||

All varieties of luster are constituted of tejas mahabhuta. They are classified as seven type’s namely red, yellow, white, brown, green, pale yellowish and black. Of them which are emanative, unctuous, and dense are auspicious and those others which are dry, dirty and thin are inauspicious.[14-15]

Difference between Chhaya (shadow) and Prabha(luster)

वर्णमाक्रामति च्छाया भास्तु वर्णप्रकाशिनी|
आसन्ना लक्ष्यते च्छाया भाः प्रकृष्टा प्रकाशते||१६||

नाच्छायो नाप्रभः कश्चिद्विशेषाश्चिह्नयन्ति तु|
नृणां शुभाशुभोत्पत्तिं काले छायाप्रभाश्रयाः||१७||

varṇamākrāmati cchāyā bhāstu varṇaprakāśinī|
āsannā lakṣyatē cchāyā bhāḥ prakr̥ṣṭā prakāśatē||16||

nācchāyō nāprabhaḥ kaścidviśēṣāścihnayanti tu|
nr̥ṇāṁ śubhāśubhōtpattiṁ kālē chāyāprabhāśrayāḥ||17||

varNamAkrAmati cchAyA bhAstu varNaprakAshinI|
AsannA lakShyate cchAyA bhAH prakRuShTA prakAshate||16||

nAcchAyo nAprabhaH kashcidvisheShAshcihnayanti tu|
nRuNAM shubhAshubhotpattiM kAle chAyAprabhAshrayAH||17||

The shadow decreases the complexion of the body whereas the luster illuminates. The shadow can be observed from nearby whereas luster illuminates from a distance. There is nothing devoid of luster or shadow. Certain distinctive features of the shadow and the luster when mature indicates emergence of inauspicious or auspicious results in relation to human beings. [16-17]

Bad prognositc signs in various diseases

कामलाऽक्ष्णोर्मुखं पूर्णं शङ्खयोर्मुक्तमांसता|
सन्त्रासश्चोष्णगात्रत्वं यस्य तं परिवर्जयेत्||१८||

उत्थाप्यमानः शयनात् प्रमोहं याति यो नरः|
मुहुर्मुहुर्न सप्ताहं स जीवति विकत्थनः ||१९||

संसृष्टा व्याधयो यस्य प्रतिलोमानुलोमगाः|
व्यापन्ना ग्रहणी प्रायः सोऽर्धमासं न जीवति||२०||

kāmalā'kṣṇōrmukhaṁ pūrṇaṁ śaṅkhayōrmuktamāṁsatā|
santrāsaścōṣṇagātratvaṁ yasya taṁ parivarjayēt||18||

utthāpyamānaḥ śayanāt pramōhaṁ yāti yō naraḥ|
muhurmuhurna saptāhaṁ sa jīvati vikatthanaḥ ||19||

saṁsr̥ṣṭā vyādhayō yasya pratilōmānulōmagāḥ|
vyāpannā grahaṇī prāyaḥ sō'rdhamāsaṁ na jīvati||20||

kAmalA~akShNormukhaM pUrNaM sha~gkhayormuktamAMsatA|
santrAsashcoShNagAtratvaM yasya taM parivarjayet||18||

utthApyamAnaH shayanAt pramohaM yAti yo naraH|
muhurmuhurna saptAhaM sa jIvati vikatthanaH ||19||

saMsRuShTA vyAdhayo yasya pratilomAnulomagAH|
vyApannA grahaNI prAyaH so~ardhamAsaM na jIvati||20||

Patient who is suffering from kamala, swelling of face, wasting in temples and terrifying appearance with high fever such patient should be discarded for management.

Patient who faints again and again while being lifted from bed cannot survive for a week. The patient afflicted with multiple doshas having movements in upward, downward both directions along with disordered grahani(Duodenum and Small intestine) cannot survive for longer than for a fortnight.[18-20]

उपरुद्धस्य रोगेण कर्शितस्याल्पमश्नतः|
बहु मूत्रपुरीषं स्याद्यस्य तं परिवर्जयेत्||२१||

दुर्बलो बहु भुङ्क्ते यः प्राग्भुक्तादन्नमातुरः |
अल्पमूत्रपुरीषश्च यथा प्रेतस्तथैव सः||२२||

इष्टं च गुणसम्पन्नमन्नमश्नाति यो नरः|
शश्वच्च बलवर्णाभ्यां हीयते न स जीवति||२३||

प्रकूजति प्रश्वसिति शिथिलं चातिसार्यते|
बलहीनः पिपासार्तः शुष्कास्यो न स जीवति||२४||

ह्रस्वं च यः प्रश्वसिति व्याविद्धं स्पन्दते च यः|
मृतमेव तमात्रेयो व्याचचक्षे पुनर्वसुः||२५||

ऊर्ध्वं च यः प्रश्वसिति श्लेष्मणा चाभिभूयते|
हीनवर्णबलाहारो यो नरो न स जीवति||२६||

uparuddhasya rōgēṇa karśitasyālpamaśnataḥ|
bahu mūtrapurīṣaṁ syādyasya taṁ parivarjayēt||21||

durbalō bahu bhuṅktē yaḥ prāgbhuktādannamāturaḥ |
alpamūtrapurīṣaśca yathā prētastathaiva saḥ||22||

iṣṭaṁ ca guṇasampannamannamaśnāti yō naraḥ|
śaśvacca balavarṇābhyāṁ hīyatē na sa jīvati||23||

prakūjati praśvasiti śithilaṁ cātisāryatē|
balahīnaḥ pipāsārtaḥ śuṣkāsyō na sa jīvati||24||

hrasvaṁ ca yaḥ praśvasiti vyāviddhaṁ spandatē ca yaḥ|
mr̥tamēva tamātrēyō vyācacakṣē punarvasuḥ||25||

ūrdhvaṁ ca yaḥ praśvasiti ślēṣmaṇā cābhibhūyatē|
hīnavarṇabalāhārō yō narō na sa jīvati||26||

uparuddhasya rogeNa karshitasyAlpamashnataH|
bahu mUtrapurIShaM syAdyasya taM parivarjayet||21||

durbalo bahu bhu~gkte yaH prAgbhuktAdannamAturaH |
alpamUtrapurIShashca yathA pretastathaiva saH||22||

iShTaM ca guNasampannamannamashnAti yo naraH|
shashvacca balavarNAbhyAM hIyate na sa jIvati||23||

prakUjati prashvasiti shithilaM cAtisAryate|
balahInaH pipAsArtaH shuShkAsyo na sa jIvati||24||

hrasvaM ca yaH prashvasiti vyAviddhaM spandate ca yaH|
mRutameva tamAtreyo vyAcacakShe punarvasuH||25||

UrdhvaM ca yaH prashvasiti shleShmaNA cAbhibhUyate|
hInavarNabalAhAro yo naro na sa jIvati||26||

Consumption of little quantity of food by emaciated person but excretes large amount of urine and stool should be discarded for management.

Consumption of excess quantity of food by weak patient but passes scanty urine and stool should be considered as ghost or almost dead. In spite of taking suitable diet if person constantly loose strength and complexion indicates bad prognosis. If a person who is weak, thirsty and having dryness of mouth, if suffers from groaning, dyspnea and diarrhea, then it should not be treated because he will not survive.

If patient is suffering from shallow respiration with irregular twitching in the body is said to be severe fatal condition like almost dead. Person who is suffering from respiratory distress with abundance of kapha along with diminution of complexion, strength and less intake of food will not survive for longer.[21-26]

ऊर्ध्वाग्रे नयने यस्य मन्ये चारतकम्पने|
बलहीनः पिपासार्तः शुष्कास्यो न स जीवति||२७||

यस्य गण्डावुपचितौ ज्वरकासौ च दारुणौ|
शूली प्रद्वेष्टि चाप्यन्नं तस्मिन् कर्म न सिध्यति||२८||

व्यावृत्तमूर्धजिह्वास्यो भ्रुवौ यस्य च विच्युते|
कण्टकैश्चाचिता जिह्वा यथा प्रेतस्तथैव सः||२९||

शेफश्चात्यर्थमुत्सिक्तं निःसृतौ वृषणौ भृशम्|
अतश्चैव विपर्यासो विकृत्या प्रेतलक्षणम्||३०||

निचितं यस्य मांसं स्यात्त्वगस्थिष्वेव दृश्यते|
क्षीणस्यानश्नतस्तस्य मासमायुः परं भवेत्||३१||

ūrdhvāgrē nayanē yasya manyē cāratakampanē|
balahīnaḥ pipāsārtaḥ śuṣkāsyō na sa jīvati||27||

yasya gaṇḍāvupacitau jvarakāsau ca dāruṇau|
śūlī pradvēṣṭi cāpyannaṁ tasmin karma na sidhyati||28||

vyāvr̥ttamūrdhajihvāsyō bhruvau yasya ca vicyutē|
kaṇṭakaiścācitā jihvā yathā prētastathaiva saḥ||29||

śēphaścātyarthamutsiktaṁ niḥsr̥tau vr̥ṣaṇau bhr̥śam|
ataścaiva viparyāsō vikr̥tyā prētalakṣaṇam||30||

nicitaṁ yasya māṁsaṁ syāttvagasthiṣvēva dr̥śyatē|
kṣīṇasyānaśnatastasya māsamāyuḥ paraṁ bhavēt||31||

UrdhvAgre nayane yasya manye cAratakampane|
balahInaH pipAsArtaH shuShkAsyo na sa jIvati||27||

yasya gaNDAvupacitau jvarakAsau ca dAruNau|
shUlI pradveShTi cApyannaM tasmin karma na sidhyati||28||

vyAvRuttamUrdhajihvAsyo bhruvau yasya ca vicyute|
kaNTakaishcAcitA jihvA yathA pretastathaiva saH||29||

shephashcAtyarthamutsiktaM niHsRutau vRuShaNau bhRusham|
atashcaiva viparyAso vikRutyA pretalakShaNam||30||

nicitaM yasya mAMsaM syAttvagasthiShveva dRushyate|
kShINasyAnashnatastasya mAsamAyuH paraM bhavet||31||

A weak, thirsty and dryness of mouth suffers from rigid and upward look of the eyes and persistent throbbing of the carotid region of the neck, will not survive for long.

If an emaciated person having prominent cheeks along with high fever, severe cough, colic and dislike for food will not cure from his ailments because no treatment suits him.

If there is a distortion of the head, tongue and face, drooping of eye brows and appearance of thorny coat over tongue, don’t treat such patients due to its ominous nature.

Whose penis is excessively long along with pendulous testicles or vice versa, such signs are indicative of death of a patient immediately. In emaciated individual whose muscles are excessively undergone wasting with remnants of skin and bone does not survive more than one month.[27-31]

Summary

तत्र श्लोकः-
इदं लिङ्गमरिष्टाख्यमनेकमभिजज्ञिवान्|
आयुर्वेदविदित्याख्यां लभते कुशलो जनः||३२||

tatra ślōkaḥ-
idaṁ liṅgamariṣṭākhyamanēkamabhijajñivān|
āyurvēdavidityākhyāṁ labhatē kuśalō janaḥ||32||

tatra shlokaH-
idaM li~ggamariShTAkhyamanekamabhijaj~jivAn|
AyurvedavidityAkhyAM labhate kushalo janaH||32||

To summarize:

Who is well versed with the observation of above signs and symptoms which indicates imminent death, is entitled to be known as intelligent physician. [32]

Tattva Vimarsha (Fundamental Principles)

• Shadow image in pupils, changes in complexion and luster should be examined to assess prognosis.
• Perception of distorted images of body parts or their absence are ominous signs.

Vidhi Vimarsha (Applied Inferences)

The Sanskrit word Pannarupi implies something whose form or aspect has disappeared. Pannarupam , the word, has been derived from apannarupam, implies ill-formed or confused in respect of shape. Any alterations in chhaya (complexion) and prabha (luster) denotes the ominous sign for the patient.

Role of Pancha mahabhuta in complexion and luster

Following cross references are important to be re-visited to assess the role of pancha mahabhuta, especially tejas mahabhuta in complexion and luster.

• Qualities of Pancha mahabhuta are:
  • Qualities of Akasha are sound, auditory organ, all orifices and distinctness.
  • Qualities of Vayu are touch tactile organ, all activities, movements in all body parts and lightness.
  • Qualities of Tejas are vision, visual organ, complexion, heat, splendor, digestion, intolerance, sharpness and valor.
  • Qualities of Apa are taste, gustatory organ, all liquidity, heaviness, coldness, unctuousness and semen and
  • Qualities of Prithvi (i.e., those that have qualities of the prithvi element) are- smell, olfactory organ, hardness and heaviness. [Su. Sa. Sharira Sthana 1/19]

Role of tejas and agni in luster

• Tejas mahabhuta promote luster complexion, strength, energy, power, digestive fire, and vitality. It also alleviates all vata dosha dominant diseases and sustains youthful age. [Su. Sa. Chikitsa Sthana 38/50] The normal rasa dhatu converted to reddish color by pitta is rakta dhatu and its equilibrium brings health. [Su.Sa. Sutra Sthana 14/5]

Tejas element is the causative factor of complexion when at the time of conception, it is predominantly associated with apa element, it makes the fetus fair- complexioned, predominance in prithvi elements causes black one. That in prithvi and akasha elements gives to black- sky complexion while predominance in apa and akasha elements makes fair-sky complexion of fetus. If tejas does not reach the visual organ, it makes the fetus born blind, the same associated with blood makes red eyed, that associated with pitta and kapha makes yellow- eyed and white-eyed respectively, if associated with vata it causes deformity in eyes.

Agni is the primary factor for sustenance of life, color, strength, health, enthusiasm, plumpness, complexion, ojas, tejas, and prana.

Assessment of complexion and shadows and their relation with pancha mahabhuta

The changes in complexion and shadows can be assessed upon various parameters. This can indicate the dominance of specific mahabhuta. The characteristics are as shown in table 2 below.

Table 2: Mahabhuta and their characteristics related to chhaya (skin complexions)

Parameter	Akasha mahabhuta	Vayu mahabhuta	Agni mahabhuta	Jala mahabhuta	Prithvi mahabhuta
Color	Neela (blue)	Shyava-aruna (grayish red)	Rakta (red)	Vaidurya(cat’s eye)	Shyama Shweta (Shy colour or white)
Luminosity	Saprabha (lustrous)	Hataprabha(Lustreless)	Diptabha (illuminating)	--	--
Brightness	Pure	--	--	Like pure vaidurya(cat’s eye)	Unctuous
Transparency	--	--	Vishudhdha (purely transparent)	Shuddha(Transparent)	--
Hydration & Elasticity	Slightly unctuous	Dried	--	Good unction	Unctuous
Homogeneity	--	--	Darshanapriya (charming)	--	Shlakshna (smooth)
Firmness	--	--	--	--	Sthira (stable) and ghana(solid)

Difference in Chhaya (complexion) and Prabha (luster)

The following table 3 depicts difference between complexion and luster. This is helpful for assessment of disease pathologies and prognosis.

Table 3: Difference between Chhaya and Prabha

Chhaya	Prabha
Dependent on Varna and Prabha	Illuminates Varna and it is independent
Easily detectable when the person in nearer	Illuminates from a distance
Five types based on mahabhuta	Seven types based upon color
Originates from any mahabhuta	Originates from ‘tejas only
Denotes skin complexion	Denotes skin radiance or luminance or AURA
Can be measured or differentiated by using various scales like ‘Fitzpatrick skin type scale’, ‘Luschan’s chromatic scale’, C.L.B.T (skin colour, luminance, brightness and transparency) etc;	Can be measured by using ‘Optical method having three parameters like Complexion / diffusion’ (Cd), Complexion / reflection (Cr), Complexion / specular position (Csp), and C.L.B.T etc;

Signs of bad prognosis

To see things devoid of their real characteristics - e.g., bright things looking dull and lusterless - indicates impending death of the patient. The process of dying usually begins well before death actually occurs. Death is a personal journey that each individual approaches in their own unique way. Nothing is concrete, nothing is set in stone. There are many paths one can take on this journey but all lead to the same destination. As one comes close to death, a process begins; a journey from the known life of this world to the unknown of what lies ahead. As that process begins, a person starts on a mental path of discovery, comprehending that death will indeed occur and believing in their own mortality. The journey ultimately leads to the physical departure from the body.

Sign of imminent death

1. Patient who is suffering from kamala, swelling in face, wasting in temples, and terrifying appearance with high fever has grave prognosis.
2. Patient who faints again and again while being lifted from bed may not survive for a week. This is the time during the journey that one begins to sleep most of the time. Disorientation is common and altered senses of perception can be expected. One may experience delusions, such as fearing hidden enemies or feeling invincible. The dying person may also experience hallucinations, sometimes seeing or speaking to people that are not there or died in the past. Some may see this as the veil being lifted between this life and the next. The person may pick at their sheets and clothing in a state of agitation. Movements and actions may seem aimless and make no sense to others. They are moving further away from life to this earth.
3. At the end of life, patients often lose interest in eating and drinking because the body is conserving its energy and no longer requires the same level of nourishment. It is important to let each individual decide how much, even if it is little or nothing, that he or she wishes to eat or drink. Family members should not force food or drink, as it will only make their loved one feel uncomfortable or upset. Near the end of life, patients no longer feel hunger pangs and forcing them to eat may actually cause nausea and abdominal pain. Eventually, the patient may become entirely unable to swallow food and fluids. Frequent mouth care will be given to help prevent dry mouth.
4. When the body prepares to die, a decrease in urine production and loss of bladder and bowel control are noted. The urine may appear dark because the patient is not as hydrated and there is less circulation in the kidneys.
5. Fluids may collect in a dying person’s throat and lungs. Because he or she is unable to swallow or cough up this fluid, he or she may make a gurgling noise. The noise may be worrisome to family members, but it is common and rarely uncomfortable for the patient. Elevating and repositioning the head may help to relieve some of the congestion.
6. As cardiac output and intravascular volume decrease at the end of life, there will be evidence of diminished peripheral blood perfusion. Tachycardia, hypotension, peripheral cooling, peripheral and central cyanosis, and mottling of the skin (livedo reticularis) are expected. Venous blood may pool along dependent skin surfaces. Urine output falls as perfusion of the kidneys diminishes.

Poor prognostic features and relevant disease pathologies

The prognostic features described in this chapter can be observed in various disease pathologies as shown in table 4. There is a wide scope of research to study the exact clinical correlation of the features and underlying disease pathologies.

Table 4:Reference verse and probable relevant pathology

Reference verse	Relevant disease or pathology
Cha.Sa.Indriya Sthana 7/18	Hepatic encephalopathy; Cirrhosis of liver; Infective hepatitis; Hepatocellular carcinoma; Hepatoblastoma;
Cha.Sa.Indriya Sthana 7/19	Central vertigo; Vertebro basilar insufficiency; Cerebrovascular accidents; Carotid artery stenosis;
Cha.Sa.Indriya Sthana 7/20	Carcinomas with secondary or distal metastases; Various autoimmune, neuromuscular, muscular dystrophies; Bleeding disorders; Malabsorption syndromes; Small intestinal bacterial overgrowth (SIBO)
Cha.Sa.Indriya Sthana 7/21-22	End stage renal disease (ESRD); Acute kidney injury (AKI); Carcinomas; Malabsorption syndrome; Thyrotoxicosis; Fecal impaction; Intestinal (complete or partial) obstruction; Pelvic neoplasms; End stage liver disease (ESLD); Hypercatabolic syndrome;
Cha.Sa.Indriya Sthana 7/23	Hypercatabolic syndrome; Thyrotoxicosis; Carcinomas; Cachexia; Sarcopenia;
Cha.Sa.Indriya Sthana 7/24	Hypovolemic shock; Metabolic acidosis; Diabetic ketoacidosis; Fluid and electrolyte imbalance in hypovolemia; Cerebral hypoperfusion;
Cha.Sa.Indriya Sthana 7/25	Delirium (increased psychomotor activity subtype or hyperactive); Status epilepticus; Cerebral hypoperfusion;
Cha.Sa.Indriya Sthana 7/26	Pulmonary edema; Lung cancer; Pulmonary embolism; Pulmonary cachexia; Pulmonary tuberculosis;
Cha.Sa.Indriya Sthana 7/27	Cerebral hypo perfusion; Cerebral ischemia; Perinaud’s syndrome; Oculogyric crisis; Stenosis or aneurysm or kinking or atherosclerosis or dissection of carotid artery;
Cha.Sa.Indriya Sthana 7/28	Mumps; Diphtheria; Bilateral parotid tuberculosis; Other neoplastic or infectious diseases of salivary glands;
Cha.Sa.Indriya Sthana 7/29	Idiopathic facial paresis; Bell’s palsy;
Cha.Sa.Indriya Sthana 7/30	Acquired cryptorchidism; Testicular atrophy in carcinoma; Buried penis; Penile carcinoma;
Cha.Sa.Indriya Sthana 7/31	Cancer cachexia; Sarcopenia; Muscular dystrophies or hypertrophies

Parapsycholoigical approach

In parapsychology and many forms of spiritual practice, an aura is a field of subtle, luminous radiation surrounding a person or object (like the halo or aureola in religious art). ,

Acknowledgement: The contributors acknowledge support of Dr. M. Prasad and Dr.G.Kshama for providing tables 2,3 and 4 from their published article referred in this chapter.

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