Changes

=== Abstract ===

=== Abstract ===

 

This chapter, ([[Yasyashyavanimitta]]), includes various signs and symptoms related to imminent death that start with changes in color of eyes and identified in a patient as well as in healthy individuals. It has been emphasized that physician should have knowledge of all ''Arishta Lakshana'' (near death signs) described in this chapter. Clinically only few of them manifest at a stage in an individual and hence the person must be examined properly. Certain features related with imminent death are described which when associated with any disease indicate grave prognosis. Complications which indicate the incurability of a disease are scientific and are seen till date. Description of eight grave diseases and symptoms of approaching death are other two important topics which add value to this chapter. These signs are important in palliative care. Therefore, knowledge of such predictive signs and symptoms is an integral part of medical science.  

This chapter, ([[Yasyashyavanimitta]]), includes various signs and symptoms related to imminent death that start with changes in color of eyes and identified in a patient as well as in healthy individuals. It has been emphasized that physician should have knowledge of all ''Arishta Lakshana'' (near death signs) described in this chapter. Clinically only few of them manifest at a stage in an individual and hence the person must be examined properly. Certain features related with imminent death are described which when associated with any disease indicate grave prognosis. Complications which indicate the incurability of a disease are scientific and are seen till date. Description of eight grave diseases and symptoms of approaching death are other two important topics which add value to this chapter. These signs are important in palliative care. Therefore, knowledge of such predictive signs and symptoms is an integral part of medical science.  

Keywords: ''Arishta, Vikara, Bala, Marana, Jivita,'' change in eye color, grave diseases, death.

Keywords: ''Arishta, Vikara, Bala, Marana, Jivita,'' change in eye color, grave diseases, death.

 

=== Introduction ===

=== Introduction ===

 

[[Yasyashyavanimitta]] refers to color changes in eyes. In the first four chapters of [[Indriya Sthana]], conditions related to ''Indriya'' or five sense organs have been described. In those chapters, derangements in functional aspects of ''indriyas'' have been given importance and Atreya told to examine them by the help of ''Anumana Pramana''. In this chapter certain anatomical changes or changes which can be examined by ''Pratyaksha Pramana''(direct observation) are mentioned which are equally important indicators of life span.  

[[Yasyashyavanimitta]] refers to color changes in eyes. In the first four chapters of [[Indriya Sthana]], conditions related to ''Indriya'' or five sense organs have been described. In those chapters, derangements in functional aspects of ''indriyas'' have been given importance and Atreya told to examine them by the help of ''Anumana Pramana''. In this chapter certain anatomical changes or changes which can be examined by ''Pratyaksha Pramana''(direct observation) are mentioned which are equally important indicators of life span.  

Nowadays, importance is given to the identification of approaching death. Educational and training programs are organized to educate family members/relatives/attendants so that patient care is not neglected near death and this specialized field is commonly known as Palliative care. The World Health Organization (WHO) defines palliative care as 'an approach that improves the quality of life of individuals and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual'.<ref> Available from: http://www.who.int/hiv/topics/palliative/PalliativeCare/en/ </ref>

Nowadays, importance is given to the identification of approaching death. Educational and training programs are organized to educate family members/relatives/attendants so that patient care is not neglected near death and this specialized field is commonly known as Palliative care. The World Health Organization (WHO) defines palliative care as 'an approach that improves the quality of life of individuals and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual'.<ref> Available from: http://www.who.int/hiv/topics/palliative/PalliativeCare/en/ </ref>

In order to care for dying patients it is essential to “identify dying”. This aim can be attained by applying the knowledge given in this chapter. Presently to predict prognostic value few tools have been designed. Most widely-used prognostic tools is the Palliative Performance Scale (PPS) which has been studied primarily in inpatient settings and in patients with cancer. Few researches are on going to develop tools for prognosis in other diseases also.<ref> Harrold J, Rickerson E, Carroll JT, McGrath J, Morales K, Kapo J, Casarett D., Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population?, J Palliat Med. 2005 Jun;8(3):503-9. </ref> Research can be done to develop a scale based on parameters described in Ayurvedic ''Arishta Vigyana'' and this chapter can also contribute a lot in making such kind of tool.

In order to care for dying patients it is essential to “identify dying”. This aim can be attained by applying the knowledge given in this chapter. Presently to predict prognostic value few tools have been designed. Most widely-used prognostic tools is the Palliative Performance Scale (PPS) which has been studied primarily in inpatient settings and in patients with cancer. Few researches are on going to develop tools for prognosis in other diseases also.<ref> Harrold J, Rickerson E, Carroll JT, McGrath J, Morales K, Kapo J, Casarett D., Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population?, J Palliat Med. 2005 Jun;8(3):503-9. </ref> Research can be done to develop a scale based on parameters described in Ayurvedic ''Arishta Vigyana'' and this chapter can also contribute a lot in making such kind of tool.

 

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

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

   

   

haritAshca  sirA yasya lomakUpAshca saMvRutAH|  

haritAshca  sirA yasya lomakUpAshca saMvRutAH|  

so~amlAbhilAShI puruShaH pittAnmaraNamashnute||5||  

so~amlAbhilAShI puruShaH pittAnmaraNamashnute||5||  

 

If patient eyes are brownish/blackish, distorted or displaced or greenish in color, then such condition indicates impending death.

If patient eyes are brownish/blackish, distorted or displaced or greenish in color, then such condition indicates impending death.

The patient who is unconscious, having dry mouth and is suffering from various diseases should be considered as having short life span and such patient should be discarded by the wise physician.

The patient who is unconscious, having dry mouth and is suffering from various diseases should be considered as having short life span and such patient should be discarded by the wise physician.

The man whose veins are green and whose hair follicles are closed and who craves for sour things succumb to death due to ''pitta'' disorders. [3-5]

The man whose veins are green and whose hair follicles are closed and who craves for sour things succumb to death due to ''pitta'' disorders. [3-5]

 

==== Signs of death due to ''Rajayakshma'' and ''Shosha'' ====

==== Signs of death due to ''Rajayakshma'' and ''Shosha'' ====

acikitsyA bhavantyete balamAMsakShaye sati|  

acikitsyA bhavantyete balamAMsakShaye sati|  

anyeShvapi vikAreShu tAn bhiShak parivarjayet||9||  

anyeShvapi vikAreShu tAn bhiShak parivarjayet||9||  

 

When diseases like ''Vatavyadhi'' (diseases due to ''vata''), ''Apasmara'' (Epilepsy), ''Kushtha'' (Skin diseases), ''Shopha'' (Swellings), ''Udara'' (abdominal diseases including ascitis), ''Gulma'' (lumps and tumors), ''Madhumeha'' (urinary disorders including Diabetes) and ''Rajayakshama'' (Tuberculosis) are associated with loss of strength and muscle wasting then such patient should be discarded by the physician as patient will not recover and will succumb to death.

When diseases like ''Vatavyadhi'' (diseases due to ''vata''), ''Apasmara'' (Epilepsy), ''Kushtha'' (Skin diseases), ''Shopha'' (Swellings), ''Udara'' (abdominal diseases including ascitis), ''Gulma'' (lumps and tumors), ''Madhumeha'' (urinary disorders including Diabetes) and ''Rajayakshama'' (Tuberculosis) are associated with loss of strength and muscle wasting then such patient should be discarded by the physician as patient will not recover and will succumb to death.

Patients suffering from other diseases too having above features should be avoided by the physician. [8-9]

Patients suffering from other diseases too having above features should be avoided by the physician. [8-9]

 

==== Death signs after ''Virechana'' (purgation) ====

==== Death signs after ''Virechana'' (purgation) ====

mAsena cenna dRushyeta visheShastasya shobhanaH|  

mAsena cenna dRushyeta visheShastasya shobhanaH|  

rasaishcAnyairbahuvidhairdurlabhaM tasya jIvitam||17||  

rasaishcAnyairbahuvidhairdurlabhaM tasya jIvitam||17||  

 

The man speaking irrelevantly about death or patient suffering from auditory hallucinations should not be treated.

The man speaking irrelevantly about death or patient suffering from auditory hallucinations should not be treated.

If in any disease, patient deteriorates all of a sudden, his survival is doubtful as told by Atreya. If the relatives of the patient request the physician begging for his life, the physician should prescribe the diet of soup prepared out of meat; but no ''Shodhana'' (purificatory therapy) should be done in such patient as it will further deteriorate the condition.

If in any disease, patient deteriorates all of a sudden, his survival is doubtful as told by Atreya. If the relatives of the patient request the physician begging for his life, the physician should prescribe the diet of soup prepared out of meat; but no ''Shodhana'' (purificatory therapy) should be done in such patient as it will further deteriorate the condition.

If after one month, no signs of improvement as the result of soup prepared out of meat and varied other nutritive agents are seen, then the patient’s survival is rare. [14-17]

If after one month, no signs of improvement as the result of soup prepared out of meat and varied other nutritive agents are seen, then the patient’s survival is rare. [14-17]

 

==== Various assessment parameters for lifespan and death ====

==== Various assessment parameters for lifespan and death ====

balamAMsakShayastIvro rogavRuddhirarocakaH|  

balamAMsakShayastIvro rogavRuddhirarocakaH|  

yasyAturasya lakShyante trIn pakShAnna sa jIvati||22||

yasyAturasya lakShyante trIn pakShAnna sa jIvati||22||

 

If a man’s sputum, feces and semen sink into water, the wise physicians say that he has come to the end of his life.

If a man’s sputum, feces and semen sink into water, the wise physicians say that he has come to the end of his life.

If the sputum has various color and sinks in water, the patient does not survive.

If the sputum has various color and sinks in water, the patient does not survive.

The patient, who suffers from rapid loss of strength and muscle wasting, aggravation of disease symptoms and anorexia, does not survive more than three fortnights. [18-22]

The patient, who suffers from rapid loss of strength and muscle wasting, aggravation of disease symptoms and anorexia, does not survive more than three fortnights. [18-22]

==== Summary ====

==== Summary ====

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

 

Various biomarkers have been developed since the time of Charaka and many diseases which were incurable can be controlled. Patient should be evaluated using these biomarkers, before communicating to the patient and family about remaining lifespan of patient.

Various biomarkers have been developed since the time of Charaka and many diseases which were incurable can be controlled. Patient should be evaluated using these biomarkers, before communicating to the patient and family about remaining lifespan of patient.

#vatavyadhi(vAtavyAdhi, वातव्याधि) – Special category of diseases caused by vitiation of Vata Dosha

#vatavyadhi(vAtavyAdhi, वातव्याधि) – Special category of diseases caused by vitiation of Vata Dosha

#virechana (virecanA- विरेचन) -Therapeutic purgation.

#virechana (virecanA- विरेचन) -Therapeutic purgation.

 

=== References ===

=== References ===

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