Charak Samhita – Sutrasthana – Chapter 17 (Kiyanta Shiraseeya Adhyaya)

Abstract

The description of disorders affecting the brain, heart, and other critical organs is covered in the first section of Roga Chatushka, a tetrad on the classification of diseases. Disequilibrium of the body’s doshas is the root cause of disease. This chapter lists symptoms and signs of the many combinations and permutations of dosha disturbances. Additionally, it describes and addresses mala and dhatu depletion symptoms. Ojas diseases are described, followed by a description of diabetes mellitus (Madhumeha) and the complications that result from it, carbuncles. There are several different dosha gati (Movements) stated. The chapter contains thorough information on the fundamental concepts of Ayurvedic pathology. So today we will discuss the Charaka Samhita Sutra sthana chapter seventeen Kiyanta shiraseeya adhyaya in detail.

Introduction

After outlining the standards for clinical Ayurveda practice in the first four tetrads, Roga Chatushka goes into detail regarding the fundamentals of Ayurvedic pathology that lead to disease. The current chapter opens with a list of diseases that affect the head and an explanation of the importance of the head, then proceeds to descriptions of five distinct forms of head disorders having headache as the primary symptom and five different kinds of heart problems with various clinical manifestations. The pathophysiology of a disease has been understood through the analysis of several dosha combinations and permutations. At the conclusion of the chapter, many movements of dosha which are in charge of both healthy and ill states are discussed. Charaka has also emphasised the value of a consistent, healthy diet. It can be claimed that the seventeenth chapter discussed, with examples to support it, offers multiple approaches to understanding different disease presentations.

Questions From Agnivesha

Agnivesha asked – How many diseases are pertaining to the head and heart? How many disorders are due to proportional variations of vata etc.? How many problems are brought on by kshaya (Wasting)? And how many boils? What are the types of movement of doshas? O alleviator of doshas!

Atreya’s Explanation

Agnivesha asked the questions above, and Guru Atreya responded, “O kind one! Let me give you a thorough explanation.

Number Of Diseases

Five heart disorders and five head disorders exist. There are 62 illnesses based on the combinations and permutations of dosha. There are three movements (gati) of dosha, seven forms of pidika (Carbuncles/pustules generated by madhumeha), and eighteen different types of kshaya. Henceforth, a detailed description of these is provided.

Causes Of Head Disorders

Day sleep, intoxication, suppression of urges, insomnia, excessive sex, exposure to frost, loud talking, exposure to easterly wind, inhalation of unsuitable odour, exposure to snow, smoke, dust and the sun, intake of sour, heavy and salads, drinking of too much cold water, vitiated ama (Toxins), head injury, suppression of tears, weeping, cloudy whether, mental abnormality, use of those unsuitable for time and place-these factors vitiate vata etc. and also blood in the head which produce various types of diseases in head.

Significance Of The Head

Shira (Head) is the most important organ because it houses the body’s vital centres and all of a living thing’s senses (Indriya). Among all the body’s organs, it is the most important (Uttama).

Head-Related Diseases

Coryza, headache, disorders of nose, ear, eyes and mouth, facial paralysis, giddiness, tremors in head, hemicrania, stiffness in jaws and back neck and other various disorders due to vata etc. and organisms (Krimis).

Types Of Head Diseases

There are five different varieties of shiroroga, which are listed here along with their etiological elements, symptoms and signs as specified in Ashtodariya Adhyaya.

Head Illnesses Caused By The Vata Dosha

Due to loud and too much speech, sharp drinks, contact with cold wind, night awake, sexual intercourse, fasting, suppression of urges, injury, excessive purgation and vomiting, grief, anxiety, fear and tears, excessive exhaustion due to weight carrying and travelling on foot, Vata is aggravated by extreme emaciation, which affects the vessels in the brain and causes further Vata to be aggravated, resulting in excruciating headache pain.

Symptoms Of Head Diseases With A Vata Predominance

There is intense pain due to vata particularly in temporal regions and nape, middle of the eyebrows and forehead have burning sensation and excessive pain. There is dizziness and pain in ears, eyes seem to be coming out due to pain, feeling of separation in each joint and the venous plexuses have excessive throbbing and neck becomes stiff. The patient gets relief from unctuous and hot applications. This is about head diseases caused by Vata.

Head Illnesses Caused By The Pitta Dosha

Excessive use of sour, alkali, pungent, wines, salt, by anger and over exposure to the fire and sun, pitta gets vitiated and being located in the head produces head diseases.

Symptoms Of Head Diseases With A Pitta Predominance

The signs of pitta-dominant disorders of the head include pain and burning sensation in the head and is pacified by cold. The eyes have a burning sensation, and there is giddiness, thirst and perspiration.

Head Illnesses Caused By The Kapha Dosha

Due to sedentary habits, too much sleep, over intake of an unctuous and heavy diet, kapha is vitiated and causes head diseases.

Symptoms Of Head Diseases With A Kapha Predominance

The symptoms of kapha-dominant disorders of the head include dull headaches, stiffness, numbness, laziness, heaviness in head, drowsiness and anorexia.

Head Illnesses Caused By The Tridosha Dosha

In head diseases caused by all the three doshas, there are giddiness, tremors and pain due to Vata, narcosis, thirst and burning sensation due to pitta and heaviness and drowsiness due to kapha.

Krimija Shiroroga’s Etiological Factors And Pathogenesis

Excessive intake of milk, sesame, eating during indigestion, jaggery, putrefied and mixed up food in those having abundance of doshas, excessive moisture arise in blood, muscles and kapha. Then due to increase of moisture in the head the trouble creating organisms cause head disease with dreadful signs and symptoms.

Krimija Shiroroga Symptoms

One should diagnose the case of worm affection by the symptoms-cutting and piercing pain, itching, functional disorders, difficulty in movement, swelling and by observing the worms.

Heart Disease With A Vata-Dominant Etiology And Pathophysiology

Due to physical exercise, fasting, grief, intake of dry, rough and a little food the aggravated vayu entering into the heart produces severe disorders.

Heart Disease With A Vata-Dominant Symptoms

In vatika heart disease, the symptoms are cramps, fainting, trembling, tearing pain, stiffness, feeling of emptiness in the cardiac, and aggravation of pain when the food is digested.

Pitta-Dominant Heart Disorders’ Etiology And Pathophysiology

Sour, alkaline, pungent, salty and hot food, wines, eating during indigestion, the sun and anger vitiate the pitta in the heart.

Pitta-Dominant Heart Disease Symptoms

In this pittaja heart disease, these symptoms appear-bitterness in mouth, sour and bitter eructation, burning sensation in cardiac region, thirst, giddiness, perspiration, exhaustion and fainting.

Kapha-Dominant Heart Disorders’ Etiology And Pathophysiology

Kaphaja heart disease is caused by use of unctuous and heavy substances, over eating, sedentary lifestyle, stress free and indulgence in sleep.

Kapha-Dominant Heart Disease Symptoms

The patient suffers from anorexia and drowsiness and feeling of stiffness, heaviness and numbness in the cardiac region in the case of kapha dominant heart disease.

Three Dosha-Dominant Heart Disorders’ Etiological Factors And Pathophysiology

When causative factors and symptoms of all the doshas are combined together it is Sannipatika. Tridosha heart disease is troublesome and hardly curable as said by the great sages.

Krimija Hridroga Etiological Factors And Pathophysiology

A person who consumes milk, sesamum, jaggery, etc. in the heart disease caused by all three doshas, suffers from a swelling appearing in a portion of the heart. Moreover, his rasa dhatu attains moisture due to which organisms develop, spread in the region and lead to decay of the heart.

Krimija Hridroga Signs And Symptoms

The patient feels pain as if the heart is pierced by needles or cut by weapons, itching and intense pain. Diagnosing the case as krimija hridroga on the basis of the above symptoms one should take immediate steps to overcome the disorder which is emergent as well as severe.

Sixty-Two Samsarga And Tridosha Permutations And Combinations

Thirteen Types Of Sannipata

Combination of all the three aggravated doshas is of thirteen types-three conditions arises with two doshas dominating, three conditions arise with one dosa dominating, six conditions arise with doshas in diminished, moderate and dominant conditions and one condition arises with equal aggravation of all doshas.

Nine Types Of Samsarga

Combination of two aggravated doshas is of nine types-six conditions arise with dominant aggravation of one dosha and three conditions arise with aggravation of both the doshas equally. Three conditions arise with aggravation of single doshas.

Twenty-Five Kshina (Decreased) Dosha Conditions

Thus the state of aggravation is of twenty five types. Likewise, the diminution of doshas is also of twenty five types making the number as fifty.

Twelve Sannipata Of Normal, Elevated And Diminished Dosha

Another sort of Sannipata exists where the doshas are present in normal, diminished, or elevated combinations; there are 12 different varieties of such situations. Six conditions arise with one dosha aggravated, one normal and one diminished. Three conditions arise with two dosha aggravated and one diminished and three conditions arise with one dosha aggravated and two diminished. Thus doshas can combine together in various proportions which come to the total number of sixty two as explained above.

Twelve Types Of Irregular Sannipata

1. Normal Pitta, decreased Kapha and increased Vata Sannipata

When in the state of diminution of kapha, vata carries away the normal pitta from its location, it produces unstable tearing pain, burning sensation in those organs wherever it spreads along with fatigue and debility.

2. Normal Kapha, Increased Vata and decreased Pitta Sannipata

When in the state of diminution of pitta, the dominant vata drags on kapha, it causes cold sensation, heaviness, stiffness and pain.

3. Normal Vata, Decreased Kapha, and increased Pitta Sannipata

When excessive pitta blocks the route of regular vata in a condition of substantially diminished kapha, it produces a colicky pain and burning sensation.

4. Normal Kapha, Decreased Vata, and increased Pitta Sannipata

Increased pitta blocks the normal kapha in cases of severely diminished vata, resulting in fever and other symptoms including feeling drowsiness and heaviness.

5. Normal Vata, Decreased Pitta, And Increased Kapha Sannipata

If excessive kapha interferes with the normal vata in the event of diminished pitta, the result is a heaviness, pain and cold sensation.

6. Increased Kapha, Normal Pitta, And Decreased Vata Sannipata

If elevated kapha interferes with normal pitta in a case of diminished vata, it can lead to stiffness in the head, heaviness in the body, cardiac conditions, drowsiness, excessive sleep, delayed digestion, delirium, yellowing of the nails, etc., as well as excessive kapha-pitta discharge.

7. Decreased Vata, Increased Kapha, And Pitta Sannipata

Pitta spreads throughout the body when vata decreases and kapha is elevated, resulting in nausea, anaemia, anorexia, salivation, indigestion, asthenia, indigestion, intoxication, heaviness, sensation of fumes on the palate, mouth, and throat, and irregular digestion and bowel movements.

8. Decreased Pitta, Increased Kapha, And Vata Sannipata

When pitta is reduced, the elevated kapha and vata join together, resulting in unpredictable pricking pain, coldness, tremors, stiffness, poor digestion, heaviness, aversion to eating, pallor of the nails, etc., and dryness of the bodily parts.

9. Decreased Kapha, Increased Vata And Pitta Sannipata

Giddiness, prickling pain, dehydration, tremors, cramps, disruption, burning sensation, bodily discomfort, burning of the palate, mouth, and throat, as well as smoke from the mouth, might result from a combination of diminished kapha and elevated vata and pitta.

10. Decreased Vata And Pitta And Increased Kapha Sannipata

The obstruction of the srotas results in total lack of movement, fainting and loss of speech in a state of diminished vata, pitta and an elevated kapha.

11. Decreased Vata And Kapha And Increased Pitta Sannipata

When vata and kapha are reduced and pitta is raised, the ojas is impacted, which results in malaise, sensory asthenia, thirst, dizziness, and diminished physiological functions.

12. Decreased Pitta And Kapha And Increased Vata Sannipata

When pitta and kapha are depleted, an elevated vata compresses the vital centres, impairs consciousness, or causes violent trembling throughout the entire body.

13. General Concept Of Symptoms Of An Increased Or Diminished Dosha

The provocation of a disease symptom is consequently triggered by an elevation in dosha in the same level as the increase. However, a drop in dosha results in a decline or reduction in functions. When everything is in order, the doshas are in balance.

Types of Kshaya (Decrease)

Now the symptoms of diminution of vata etc. (Doshas), rasa etc. (Dhatus), malas and ojas will be described. The symptoms of diminished vata etc. have already been mentioned.

Decrease Of Rasa Dhatu

Reduced rasa dhatu is characterized by restlessness, does not tolerate loud sound, even on slight exertion his heart palpitates, aches and fails.

Decrease Of Rakta Dhatu

The diminution of rakta dhatu results in skin becoming cracked, coarse and lustreless.

Decrease Of Mamsa Dhatu

The diminution of mamsa dhatu results in emaciation of abdomen, buttocks, and neck.

Decrease Of Meda Dhatu

The diminution of meda dhatu results in cracking of joints, exhaustion, anxious expression and thin abdomen.

Decrease Of Asthi Dhatu

The diminution of asthi dhatu results in falling of nails, teeth, moustaches, hairs and beards, fatigue and laxity of joints.

Decrease Of Majja Dhatu

The diminution of majja dhatu results in the bones being weakened and light as if decaying. They are also always affected with vatika disorders.

Decrease Of Shukra Dhatu

The diminution of shukra dhatu results in the dryness of mouth, malaise, debility, paleness, fatigue, impotence and non-ejaculation of semen.

Decrease In Purisha

The diminution of purisha results in vata as if pressing the intestines and lifting the belly upwards moves obliquely and upwards.

Decrease Of Mutra

The diminution of urine results in abnormal colours in urine, dysuria, dryness of mouth and thirst.

Decrease Of Malayana

The diminution of other malas results in the respective excretory passages becoming vacant, over dried up and light.

Decrease Of Ojas

When the ojas is diminished, the person is weak, fearful, always worried, having disorders in sense organs, deranged mental ability and lustre, emaciated and rough.

Ojas Description

The substance of white or red, slightly yellowish colour which resides in the heart is known as ojas. The person dies if it is destroyed. In the body of living beings the ojas is produced first. This has the colour of ghee, taste of honey and smell of fried paddy. As the bees collect honey from the fruits and flowers, organs of the persons constitute the ojas with their activities.

Causes Of Ojas Kshaya

Excessive exercise, anxiety, measured, rough and little diet, fasting, exposure to sun and wind, grief, fear, vigil, unctuous drinks, excessive discharge of blood, mucus, semen and other excreta, time factor (Old age and adverse season) and injury by organisms-these are the causes of diminution of ojas.

Causes Of Diabetes Due To Obstructive Pathogenesis

Consume unctuous, heavy, saline and sour substances in excessive quantity and also the fresh drinks and new grains, having over sleep and sedentary habit, having abstained from physical and mental work and also neglecting evacuation, pitta, kapha, mamsa (Flesh) and medas (Fat) aggravate excessively and they all obstruct the path of vata which carries the ojas to basti (Urinary passage) and thus the obstinate madhumeha (Diabetes mellitus) arises.

Symptoms Of Obstructive (Avrita) Madhumeha

The vata, pitta, and kapha signs are usually seen in this kind of madhumeha. For a while, the symptoms go away, but they later return.

Sapta Pidika (Seven Pustules/Papules/Carbuncles)

Seven different varieties of pidika (Pustules) are generated if diabetes is not treated. Joints, muscular areas and marma (Vital parts) areas all contain these pidika.

These pidikas (Boils) are seven- Sharavika, Kacchapika, Jalini, Sarshapi, Alaji, Vinata, and Vidradhi.

1. Sharavika

The sharavika type of boils is raised at margina, depressed in centre, blackish in colour, has moisture and pain and looks like an earthen saucer.

2. Kacchapika

The kacchapika type has deeper pain particularly of piercing nature, covers a wide area, is smooth and similar to the back of tortoise.

3. Jalini

The jalini type of boil is stiff, has venous network, unctuous discharge, big base, excessive pain particularly of piercing nature and minute openings.

4. Sarshapi

The sarshapi type is not very big, quickly suppurating, very painful and having mustard like small boils.

5. Alaji

The alaji type of boil, causes burning sensation in skin, thirst, fainting and fever, spreads over and constantly produces terrible burning pain like fire.

6. Vinata

The vinata type of boil has deep pain and thick discharge, appears in back or abdomen, is big, depressed and blue.

7. Vidradhi

There are two forms of vidradhis (abscesses), internal and exterior. On skin and muscle, external abscesses can develop. It resembles a tendon and can be extremely painful.

Internal Abscess’s Etiology And Pathophysiology

By intake of cold, hot, burning, dry and rough food, taking antagonistic, spoiled foods, during indigestion, irregularly and unwholesome diet, excessive wine and imbibing spoiled, suppression of urges, complicated exercise, fatigue, excessive sleep, excessive weight carrying, sexual intercourse and excessive wayfaring.

When doshas in the body affect the muscle and blood, deep seated, painful and severe gland-like nodes appear in the cardiac region, pharynx, spleen, liver, lumbar region, navel, kidneys, urinary bladder or groins.

Definition Of Vidradhi

Because of having impure blood in abundance it gets quickly inflamed and that is why it is called vidradhi that causes vidaha-inflammation.

Three Types Of Vidradhi

All abscesses are extremely painful. The following symptoms, which depend on the dosha, may also manifest in addition to pain.

1. Vataja Vidradhi

An abscess of the vata type is characterized by a cutting or piercing pain. It can affect any part of the body and manifests a number of additional symptoms, including giddiness, abdominal distension, throbbing and gurgling sound.

2. Pittaja Vidradhi

The symptoms are burning sensation, intoxication, fever, fainting and thirst.

3. Kaphaja Vidradhi

The symptoms are nausea, stiffness, shivering, anorexia and yawning.

Symptoms Of Ripened Abscess

The patient experiences pain when the abscess ripens, similar to being cut by the weapon, burned by coal, or stung by the bite of a scorpion.

Pus Discharge Based On The Type Of Abscess

• In vatika vidradhi, discharge is rough, thin, blackish or reddish and foamy.
• In paittika vidradhi, discharge is resembling the soup of black gram, horse gram and sesamum.
• In kaphaja vidradhi, discharge is slimy, white, profuse and thick.
• In sannipatika vidradhi, discharge has got all the above symptoms.

Symptoms Of Vidradhi Based On The Affected Organ

The symptoms and prognosis of abscesses in particular bodily organs are now characterized as follows:-

• In heart – Palpitation, cough, feeling of darkness before eyes and dyspnea.
• In kloma – Dryness of mouth, sore throat and thirst.
• In the liver – Dyspnea.
• In spleen – Breathing obstruction.
• In stomach – Pain in sides of abdomen, chest and scapular region.
• In kidney – Stiffness in waist and back.
• In umbilical – Hiccup.
• In groin – Weakness in legs.
• In urinary bladder – Difficulty and foul odour in faeces and urine.

Passage Of Discharge

In abscesses located in upper parts, when they ripen and burst the discharge comes out of the mouth. In those located in lower parts comes out from anus and in those located in the navel the discharge comes out of both ends.

Prognosis Of Abscesses

If they suppurate, abscesses that develop in the umbilicus, heart, urinary bladder, and caused by all the three doshas have a poor prognosis and can be fatal. The remaining abscess types can be cured if they are treated right away by a qualified doctor. Therefore, as soon as an internal abscess appears, it needs to be treated right away with quick-acting, efficient procedures. Otherwise, it could hurt similarly to an injury from a weapon, a snake bite, or being burned by lightning or fire. All the gulma procedures as well as the oleation and purgation therapies can be used to treat these abscesses.

Possibility Of Pidika Without Prameha

These boils arise even without prameha (Diabetes) in persons with deranged medas (Fat), they do not come to notice till they acquire a large area.

Prognosis Of Pidika

Kachhapika, jalini and sharavika types of boils are hardly tolerable and severe and arise in person having an abundance of medas and kapha. On the other hand, alaji, vidradhi, vinata and sarshapi are curable ones. They are dominant in pitta and occur in persons with little medas.

Bad Prognostic Pidika

If a diabetic develops pidika in his joints, feet, hands, breast, shoulders, and anus, he will not survive.

Miscellaneous Pidika

There are other types of boils such as those having red, black, pale, yellow, reddish, yellowish, deep black and ash like colour. Some are soft while others are hard, some are big while some are small, some of them are slow growing while others are fast growing, some are mildly painful while others are intensely painful. After observing them, one should diagnose according to the respective causes and symptoms of vata etc. and treat them immediately before complications develop.

Complications Of Pidika

Thirst, gangrene, hiccup, fever, intoxication, metastasis, dyspnea, fainting, and obstruction in vital organs-these are the complications of boils.

Gati (States) Of Dosha

Diminution, normalcy and aggravation are three types of movement of doshas. The other threefold movement is upward, downward and oblique and the other three types are movement in belly, extremities and marmasthi-sandhi (Vital organs and bone joints). Thus threefold movement of doshas is said.

Seasonal Course Of Dosha

Accumulation, vitiation, and pacification of pitta, kapha and vata occurs in seasons of rains etc. respectively. Thus conditioning is natural by the effect of seasonal changes.

Dosha’s Physiological And Pathological Progression

Again, movement of doshas is of two types-normal and abnormal. For instance, pitta, having the nature of heat, is responsible for digestion in living beings but when vitiated it causes many disorders. Kapha, in normal state, is responsible for strength but when abnormal becomes excretion. In other words, the normal kapha is said as ojas while the abnormal leads to various disorders. Likewise, all the movements are due to normal vata and it is taken as the life breath of the living beings but in abnormal state it produces disorders even obstructing the life breath. The self-controlled person, observing himself as always surrounded by enemies, should always cautiously manage himself with a desire to have a long life.

Conclusion

In this chapter we read about head diseases along with heart diseases, diseases arisen due to proportional variations, diminutions, boils, movements of doshas-all this has been explained by the seer of realities and wishing welfare of the people in this chapter on the number of head diseases for the knowledge of physicians.