Diseases Of Head, Heart And Abscess – Charaka Samhita Sutrasthana 17

The diseases of head, heart, carbuncle and abscesses have been explained in great detail in the 17^th chapter of Sutrasthana of Charaka Samhita. This chapter also deals with symptoms of Dosha, Dhatu and Mala Kshaya (depletion of body tissues and excreta), definition of head, different ways in which Doshas move in the body, different combinations of Dosha imbalance and their symptoms, Ojas, its nature, causes of depletion and symptoms, causes for diabetes, causes and types of carbuncle, types, causes, symptoms and prognosis of abscess, etc. The chapter is titled as Kiyanta Shiraseeya Adhyaya.

Question by Sage Agnivesha

1. What is the number of diseases relating to the head and the heart?
2. What are the diseases caused due to permutation and combination of Doshas?
3. What are the signs and symptoms of the decrease of Doshas, Dhatus and Malas?
4. How many and what are the types of  the Pidakas (carbuncles)?
5. What are the types of the courses of Doshas?

Lord Punarvasu replied, “I am answering all  your questions in detail. Listen to me, O noble one! Diseases relating to the head and heart each are five in number; Diseases arising out of the permutation and combination of Vata, etc. are sixty two.

There are eighteen conditions relating to the decrease of Doshas, Dhatus and Mala, carbuncles due to Madhumeha (Diabetes) are of seven types. There are three courses of Doshas. Now I would explain their details”.

Causes of diseases of the head

• By the suppression of natural urges
• Sleeping during day time
• Vigil during the night
• Intoxication
• Speaking aloud
• Exposure to frost and easterly wind
• Excessive sexual indulgence
• Inhalation of undesirable smell
• Exposure to dust, smoke, snowfall and sun
• Intake of heavy and sour food, and rhizomes including tubers, etc. in excessive quantity,
• Excessive intake of cold water
• Injury to the head
• Vitiation of Ama (a product of  improper digestion and metabolism)
• Lamentation
• Suppression of  tears
• Advent of cloud, anxiety and adopting regimen contrary to those prescribed for the locality and season
• Doshas like Vata, etc. get aggravated resulting in the vitiation of Rakta Dhatu (blood tissue) in the head. This causes diseases with various symptoms in the head.

Definition of head

प्राणाःप्राणभृतांयत्राश्रिता: सर्वेन्द्रियाणिच|
यदुत्तमाङ्गमाङ्गानांशिरस्तदभिधीयते||१२||

prāṇāḥprāṇabhṛtāṃyatrāśritā: sarvendriyāṇica|
yaduttamāṅgamāṅgānāṃśirastadabhidhīyate||12||

The head is the substratum for Prana – life. All the sense faculties are situated here. It is called as Uttama Anga best of all body parts. So it occupies the first place amongst the vital organs of the body. [12]

Diseases of the head

Ardhavabhedaka – Hemicrania continua – pain in half side of the head
Shiroruja – headache affecting all parts of head
Pratishyaya – coryza, running nose, diseases of mouth, nose, eyes, and ears
Shiro Bhrama – dizziness, giddiness
Ardita – facial paralysis,
Shiro Kampa – trembling of the  head;
Galagraha, Manyagraha, Hanugraha – stiffness of the throat, neck and jaw
and other diseases of Vata imbalance and due to Krimi (worm / germ infestation) [13-14]

Vata – disease of head

The five head diseases, as envisaged by the sages will be separately enumerated in the chapter on “Eight abdominal Diseases” (Sutrasthana 19th chapter). I shall now explain their causes and symptoms. Listen to me:

Ucchair Bhashya, Ati Bhashya – By loud and excessive speech
Teekshna Paanaat – strong pungent drinks
Prajaagaraat – night Vigil, waking up at night
Sheeta Maruta Samsparshaat – excessive exposure with  cold wind (read how cold wind increases Vata)
Vyavaaya – sexual indulgence,
Vega nigrahaat – suppression of natural urges
Upavasa – excessive fasting
Abhighata – trauma
Ati Vireka and Vamana – excessive purgation and vomiting
Bashpa shoka bhaya trasa – excessive weeping, grief, apprehension, tiredness
Bharat, Margat – carrying heavy load, walking for long distance
Atikarshana – excess treatment to lose weight

By these causes, Vata gets aggravated and enters the channels of the head, it gets further vitiated to cause excruciating pain in the head.

Symptoms of Vata type of headache

Pain in the temporal region and cracking sensation in the nape. The head and the central part of eyebrows also have excessive pain and burning sensation. Pain and noise in the ears, feeling as if eyes are coming out. Dizziness, joints are severed as it were, and excessive throbbing pain in veins. The neck is stiffened. The patient gets relief by unctuous (oily) and warm regimen. [15-21]

Pitta related disease of head

Katu, Amla, Lavana, Kshara – excess intake of pungent, sour, salt and alkalies,
Madya – excess alcohol
Krodha, Atapa, Analaihi – anger, exposure to sun and fire.

The Pitta Dosha in the head gets vitiated and thereby produces head diseases resulting in burning and aching sensation in the head. The patient develops a liking for cold substances.
There is a burning sensation in the eyes and the patient is subjected to thirst, dizziness and perspiration in excess. [22-23]

Kapha related disease of head

Asyasukha – eating as per one’s own will
Swapna Sukha – sedentary habits
Guru, Snigdha, Ati Bhojana – excessive intake of heavy and unctuous food,

By these causative factors, Kapha in the head gets vitiated and causes diseases.
Symptoms – There is dull pain and numbness. The patient feels as if he is wet and is loaded with too heavy a burden; there is drowsiness laziness and anorexia.[24-25]

Clinical features of Tridoshaja disease of head

वाताच्छूलंभ्रमःकम्पःपिताद्दाहोमदस्तृषा|
कफाद्गुरुत्वंतन्द्राचशिरोरोगेत्रिदोषजे||२६||

vātācchūlaṃ bhramaḥ kampaḥ pitāddāho madastṛṣā|
kaphādgurutvaṃ tandrā ca śiroroge tridoṣaje||26||

In the event of head- diseases being caused by all the three Doshas, there is
Shula, Bhrama, Kampa – pain, dizziness, shaking of head due to vitiated Vata Dosha,
Daha, Mada, Trusha – burning sensation, intoxication and thirst due to vitiated Pitta Dosha
Gurutva, Tandra – heaviness and drowsiness due to vitiated Kapha. [26]

Krimija disease of head

Krimi means worm / microbe.
By the intake of

• Tila – Sesame (Sesamum indicum Linn),
• Ksheera – excess milk consumption,
• Guda – jaggery,
• Pooti – impure foods,
• Sankeerna Bhojana – unwholesome food, incompatible foods,  ( food of mutually contradictory qualities – (Read more here) stickiness is produced in the Rakta (blood), Kapha and Mamsa Dhatu due to the excessive vitiation of Doshas. The stickiness in the head of the patients results in the diseases associated with severe symptoms.

Symptoms: 
Vyadha, Cheda Ruja – stabbing and cutting pain,
Kandu – itching,
Shopha – swelling, inflammation,
Daurgandhya – foul smell
Durgati – sense of discomfort and
Krimi Darshana – visible pathogenic organisms. [27-29]

Diseases of Heart

Vata – disease of heart:
Causes:
Shoka – grief,
Upavasa – fasting,
Vyayama – excessive exercise,
Rooksha, Shushka, Alpa Bhojana – intake of unctuous, dry and inadequate quantities of food.
By these causes, Vata gets  vitiated and effects the heart.

Symptoms: 
Ruja – excruciating pain,
Vepathu – trembling,
Veshtana – cramps,
Sthambha – stiffness,
Pramoha – darkness,
Shunyata – feeling of sense of emptiness,
Worsening of pain after the digestion of food. [30-31]

Pitta disease of heart

Causes:
Ushna, Amla, Lavana, Kshara Katu  – By the in take of hot, sour, salty, alkaline (caustic) and pungent foods
Ajeerna Bhojana – taking food during indigestio,
Madya – excess of alcoho,
Krodha – anger
Atapa – exposure to Sun
Because of these causes, Pitta located in the heart gets vitiated.

Symptoms:
Hrit Daha – heartburn
Titkata Vaktre – bitter taste in the mouth
Tikta Amla Udgirana – eruptions with bitter and sour taste
Klama – exhaustion
Trushna – thirst
Murcha – unconsciousness
Bhrama – dizziness
Sweda – perspiration. [32-33]

Kaphaja  diseases of heart

Causes:
Atyadana – Excessive intake of food,
Guru, Snigdha – intake of heavy and unctuous food,
Achintana – inadequate mental exercise,
Acheshtana – sedentary habits,
Nidrasukha – excessive sleep.

Symptoms:
Hrudaya Supti – bradycardia, lesser activities of heart,
Stimita – stiffness and
Bharika – heaviness of the heart,
Tandra – drowsiness and
Aruchi – anorexia.

The patient feels as if he is loaded with stones. [34-35]

Tridoshaja heart disease

Sannipatika type of heart disease is the one caused by the combined vitiation of all the three Doshas. This can be diagnosed by the existence of the various signs and symptoms of all the three types of heart diseases.

This type of heart disease is very painful and difficult to cure.

Krimija disease of the heart

In the event of the heart disease caused by the vitiation of all the three Doshas, if one takes
Tila – Sesame (Sesamum indicum Linn), milk, sugar candy etc. this causes nodules in the heart. Rasa becomes sticky in some parts of the heart. This stickiness produces pathogenic organisms.

Symptoms:
Patient feels as if his heart is being pierced or being cut into pieces by weapons. There is itching and pain in the  heart. By these symptoms a wise physician should diagnose the heart diseases as caused by the presence of pathogenic organisms. Considering the seriousness of this condition, he should expedite the treatment of this acute disease.[36-40]

Sixty two types of Dosha combinations

Simultaneous aggravation of all the three Doshas (Sannipata) is of thirteen types. They are as follows:

(a)  Two Doshas aggravated in excess  and the remaining one aggravated in minor volume:

1. Vata and Pitta aggravated in excess, and Kapha just  aggravated.
2. Pitta and Kapha aggravated in excess, and vata  just aggravated.
3. Kapha and Vata aggravated in excess, and Pitta just aggravated.

(b)One Dosha aggravated in excess and the remaining two just aggravated

4.Vata aggravated in excess, and Pitta and Kapha just aggravated.
5. Pitta aggravated in excess, and Vata and Kapha just aggravated.
6. Kapha aggravated in excess, and Vata and Pitta just aggravated.

(c)  Aggravation of Doshas in progressive order.

7. Vata aggravated, Pitta more aggravated and Kapha most aggravated.
8. Vata aggravated, Kapha more aggravated and Pitta most aggravated.
9. Pitta aggravated, Kapha more aggravated and Vata most aggravated.
10. Kapha aggravated, Vata more aggravated and Pitta most aggravated.
11. Pitta aggravated, Vata more aggravated and Kapha most aggravated.
12. Kapha aggravated, Pitta more aggravated and Vata most aggravated.

(d)Aggravation of all three  Doshas in the same degree.

13. Vata, Pitta and Kapha aggravated in the same degree.

Simultaneous aggravation of any Dosha (Samsarga) is of nine types as follows

(e)  Aggravation of only one Dosha is of  three types.
14. Pitta aggravated and Vata more aggravated.
15. Pitta aggravated and Kapha more aggravated.
16. Vata aggravated and Kapha more aggravated.
17. Vata aggravated and Pitta more aggravated.
18. Kapha aggravated and Pitta more aggravated.
19. Kapha aggravated and Vata more aggravated.

(f) Aggravation of two Doshas in the same degree.

20. Vata and Pitta aggravated to the same degree.
21. Pitta and Kapha aggravated to the same degree.
22. Kapha and Vata aggravated to the same degree.

(g) Aggravation of only one Dosha is oof three types.

23. Vata aggravated.
24. Pitta aggravated.
25. Kapha aggravated

The diminution of Doshas like aggravation is also of twenty five types (aggravation and diminution are in total of fifty types)

The twelve other variable conditions of Doshas occur when aggravation and diminution happen together.

(h)  when one Dosha is aggravated, the second Dosha is in normal condition and the third Dosha is in the state of diminution.

51. Vata aggravated, Pitta in normal condition and Kapha in the state of diminution.
52. Vata aggravated, Kapha in normal condition and Vata in state of diminution.
53. Kapha aggravated, Pitta in normal condition and Vata in the state of diminution.
54. Vata aggravated, Kapha in the normal condition and Pitta in the state of diminution.
55. Pitta aggravated, Vata in the normal condition and Kapha in the state of diminution.
56. Kapha aggravated, Vata in the normal condition and Pitta in the state of diminution.

(i) when two Doshas are aggravated and one Dosha is in the state of diminution.

57. Vata and Pitta aggravated, and Kapha in the state of diminution.
58. Pitta and Kapha aggravated, and vata in the state of diminution.
59. Kapha and Vata aggravated and Pitta in the state of diminution.

(j) when one Dosh is aggravated and two are in a state of diminution.

60. Vata aggravated Pitta and Kapha in the state of diminution.
61. Pitta aggravated Cats and Kapha in the state of diminution.
62. Kapha aggravated, Vata and Pitta in the state of diminution.[41-44]

Clinical features of different combinations of Doshas

When Kapha is in the state of diminution, the aggravated Vata displaces the normal Pitta and carries it to different parts of the body. Wherever this vitiated Vata takes Pitta to all those places, there will be burning sensation (Daha), cracking sensation (Bheda), exhaustion (shrama) and weakness (Daurbalya) all over the body.

When the Pitta is in the state of diminution, the aggravated Vata displaces the normal Kapha, causing colic pain (Shoola), coolness (Shaitya), stiffness (Stambha) and heaviness (Gaurava).

When Kapha is in the state of diminution, the pitta obstructs the path of normal Vata causing thereby burning sensation (Daha) and colic pain (shoola).

When Vata is in the state of diminution and Pitta is normal, then Pitta may block Kapha causing thereby drowsiness (Tandra), heaviness (Gaurava) and fever (Jwara).

When Pitta is in the state of diminution, the aggravated Kapha obstructs the channel of Vata causing thereby coolness (Sheeta), heaviness (Gaurava) and pain (Ruja).

When Vata is in the state of diminution, the Kapha obstructs the path of normal Pitta causing low digestive power (Mridu Agni), stiffness of head (Shiro Graha), sleepiness (Nidra), drowsiness (Tandra), irrelevant talk (Pralapa), heart diseases (Hridroga), heaviness in the body (Gatra gourava), yellowness of the nails, etc. and expectoration of Phlegm and bile.

When Vata is in the state of diminution, the Kapha moving together with Pitta causes anorexia (Aruchi), indigestion (Apaka), tiredness (Sadana), heaviness (Gourava), nausea (Hrillasa), salivation (Asya sravana), anaemia (Pandu), burning sensation (Daha), intoxication (Mada), irregularity in purgation and digestion.

When Pitta is in the state of diminution, the Kapha together with Vata causes an unstable stiffness (Asahmita Stambha), cold (Sheeta), pain (Toda), heaviness (Gaurava), weakness of digestive power (Mrudu Agni), dislike for food (Bhakta Ashraddha), trembling (Pravepana), pallor of nails (Nakha Shuklata) and roughness in the body (Gatra Parushya).

When Kapha is in the state of diminution, the Vata and Pitta aggravated together give rise to giddiness (Bhrama), pain (Toda), cramps (Mrudveshtana), burning (Daha), cracking sensation (Sphutana), trembling (Vepana), bodyache (Angamarda), feeling of dryness (Parishosha),  heating (Duyana) and steaming sensation (Dhupana).

When Vata and Pitta are in the state of diminution, the Kapha obstructs the  channels and causes depression, inability to talk (Vak sangha), fainting (Murcha) and loss of action (Cheshta Pranasha).

When Vata and Kapha are in the state of diminution, Pitta causes vitiation of Ojas, leading to Glani (debility), Indriya Daurbalya (weakness of sense organs), Trushna (excessive thirst), Murcha (fainting), Kriya kshayam – depleted body functions.

When Pitta and Kapha are in the state of diminution, the Vata afflicts the vital organs, does away with consciousness and causes trembling  (Vepathu) in the patient.

General features of Vitiated Doshas

दोषाःप्रवृद्धाःस्वंलिङ्गंदर्शयन्तियथाबलम्|
क्षीणाजहतिलिङ्गंस्वं, समाःस्वंकर्मकुवेते||६२||

doṣāḥ pravṛddhāḥ svaṃ liṅgaṃ darśayanti yathābalam|
kṣīṇā jahati liṅgaṃ svaṃ, samāḥ svaṃ karma kuvete||62||

Doshas when aggravated manifest their signs and symptoms in accordance with the degree of aggravation. Those in the state of diminution give up their normal signs and symptoms; and those in a state of equilibrium operate properly.

Dhatu Kshaya Lakshanas

Signs and symptoms of Vitiation of Dhatus (Tissues) and Malas (Excreta):
Diminution occurs in Doshas (Vata,Pitta and Kapha), Dhatus( Rasa, Rakta, Mamsa, Medas, Asthi, Majja and Sukra), Malas (excreta of seven types) and Ojas.
Out of them signs and symptoms of diminution of Doshas have already been explained.

Rasa Dhatu Kshaya

Rasa Dhatu Kshaya – Depletion of Rasa (end product of digestion)
Ghattate -patient becomes restless
Sahate Shabdam Na – he does not stand loud sounds, becomes intolerant
Hrudrava – palpitation
Hrudayam Tamyati Alpa Cheshtasya Api – cardiac pain, exhaustion even with the slightest exertion.

Rakta Dhatu Kshaya

Rakta Dhatu Kshaya – depletion of Rakta (blood) :
Parusha – Roughness,
Sphutita – cracks,
Mlana– dullness,
Tvak Rukshata – skin dryness.

Mamsa Dhatu Kshaya

Mamsa Dhatu Kshaya – depletion of muscle tissue :
Sphik, Greeva Udara Shushkata – emaciation of the buttocks, neck and abdomen.

Medo Dhatu Kshaya

Medo Dhatu Kshaya – depletion of fat tissue :
Sandhi sphutana – cracking of the joints
Glani – Lassitude
Akshno Ayasa – tired eyes
Udara tanutva – thinness of the abdomen.

Ashti Dhatu Kshaya

Asthi Dhatu Kshaya – Depletion of bone tissue – 
Kesha, Loma, Nakha, Shmashru, Dvija prapatana – falling of hair, nails hair of the beard including mustaches and teeth,
Shrama – tiredness,
Sandhi shaithilya – looseness of joints.

Majja Dhatu Kshaya

Majja Dhatu Kshaya – Depletion of bone marrow:
Asthi Sheeryata – emptiness of bones,
Durbala, Laghu Asthi – thinness, weakness, and lightness of the bones,
Vata Roga – frequent affliction with Vata imbalance disorders.

Shukra Dhatu Kshaya

Shukra Dhatu Kshaya – Depletion of semen / female reproductive tissues:
Daurbalya – weakness,
Mukha Shosha – dryness of mouth,
Pandutva – pallor,
Sadana – lassitude,
Shrama – tiredness,
Klaibya – impotency
Shukra Avisarga – non-ejaculation of semen, non-ovulation.

Mala Kshaya Lakshanas

Pureesha Kshaya Lakshana

Pureesha Kshaya Lakshana – depletion of feces –
Antrani Peedana – Vata afflicts intestines and causes dryness (Rooksha) and pain. The abdomen is swollen, the Vata moves upwards and sideways.

Mutra Kshaya Lakshana

Mutra Kshaya Lakshana – Depletion of urine –
Mutra krichrata – dysuria
Mutra vaivarnya – discoloration of the  urine
Pipasa – thirst
Mukha shosha – dryness in the mouth.

The signs and symptoms of the diminution of other Malas (Dhatu malas) are the feeling of emptiness, lightness and dryness in the excretory organs.

Ojas

Ojas:
Learn what is ojas

Ojo Kshaya Lakshana

Ojo Kshaya Lakshana – symptoms of depleted Ojas (immunity).
Bhaya – fear complex
Durbala – constant weakness
Dhyayati – worry
Vyathita Indriya – affliction of sense organs with pain,
Dushchaya – loss of complexion,
Durmana -cheerless, depressed mood
Rooksha – dryness, roughness
Kshaama – emaciation.

Definition of Ojas

The one which dwells in the heart and is predominantly white, yellowish and reddish in colour is known as Ojas of the body. If the Ojas is destroyed, the human being will also perish. The form in which the Ojas is produced in the body of the human beings for the first time has the color of ghee, taste of honey and smell of fried paddy (Laja).

As the bees collect honey from the fruits and flowers, so the Ojas is collected in the body, by the actions, qualities, habits and diet of human beings.

Causes of Depletion of Dhatu (tissues)

व्यायामोऽनशनंचिन्तारूक्षाल्पप्रमिताशनम्|
वातातपौभयंशोकोरूक्षपानंप्रजागरः||७६||
कफशोणितशुक्राणांमलानांचातिवर्तनम्|
कालोभूतोपघातश्चज्ञातव्याःक्षयहेतवः||७७||

vyāyāmo’naśanaṃ cintā rūkṣālpapramitāśanam|
vātātapau bhayaṃ śoko rūkṣapānaṃ prajāgaraḥ||76||
kaphaśoṇitaśukrāṇāṃ malānāṃ cātivartanam|
kālo bhūtopaghātaśca jñātavyāḥ kṣayahetavaḥ||77||

Vyayama – excessive physical activities
Anashana – fasting
Chinta – anxiety, excessive thinking
Rooksha, Alpa, Pramita Ashana – intake of dry food, food in small quantity or habitual intake of food having one taste only.
Vata, Atapa – exposure to the wind and sun
Bhaya – fear
Shoka – grief
Rooksha pana – intake of dry drinks
Prajagara – night vigil,
excessive elimination of phlegm, blood, semen and other excreta, old age and period of Adana Kala (seasons causing exhaustion) and Bhuta (microbes).

Madhumeha Aetiopathology

Aetiopathology of Diabetes Mellitus (Madhumeha):
Guru, Snigdha, Amla, Lavana – Excess intake of heavy to digest food, unctuous, sour and salt foods.
Nava Annam, Panam cha  – consuming fresh grains (freshly collected rice, wheat etc).
Nidra Sukha, Asya Sukha – eating and sleeping frequently.
Tyakta Vyayama, Chinta – lack of exercise, lack of thinking.

Not undergoing seasonal Panchakarma treatments,
These causes lead to vitiation of Kapha, Pitta, Medas (fat tissue), Mamsa (muscle tissue).
The path of Vata gets obstructed. Vata together with the Ojas comes down to reach the Basti (urinary system), causing Madhumeha (Diabetes mellitus).

In this disease, signs and symptoms pertaining to Vata, Pitta and Kapha are manifested quite frequently- they vanish at times and appear again (in more vehement form). If neglected, this disease causes serious types of carbuncles in subcutaneous and muscular areas, vital parts (Marma) and joints of the body.

Prameha pidaka – Diabetic Carbuncles

Types of Diabetic Carbuncles:
The seven types of Carbuncles are Sharvika, Kacchapika, Jalini, Sarshapi, Alaji, Vinata and Vidradhi.

Sharavika

Sharavika type of carbuncle elevated in the border and depressed in the centre, grey in color and associated with slough and pains. Because of its appearance as a sharava (earthen saucer), it is known as Sharvavika.

Kacchapika

Kacchapika type of carbuncle is deep seated and painful combined with a splitting type of pain. It has very big base, it is smooth and resembling the back of tortoise. (Kacchapa means tortoise).

Jalini

Jalini type of carbuncle is hard. It has a network of vessels in its surface. It is sticky. It has a very big base. It is very painful with splitting type of pain having subtle openings.

Sarshapika

Sarshapika type of carbuncle which is not very big, which suppurates quickly, which is very painful and associated with  carbuncles the size of mustard seeds is known as Sarshapi.

Alaji

Alaji type of carbuncle causes burning  sensation during eruption. When fully manifested, it causes thirst, unconsciousness, fever, it always spreads and is very painful due to burning sensation like fire.

Vinata

The pain in Vinata type of carbuncle is also deep-seated. It is associated with slough. It occurs either in the back or abdomen; it is big in size, blue in color and having depression in the centre.

Vidradhi

Vidradhi – External and Internal abscesses:
Abscess is of two types- the external and the internal. The external one arises out of the skin, ligaments and muscles. In shape and size it resembles tendons and it is exceedingly painful.
Read more about Diabetic carbuncle

Abhyantara Vidradhi

The internal abscess is caused by the excessive intake of food which is staled (Sheeta), irritant (vidaaha), hot, dry, incompatible foods, indigestible, and which is Dosha aggravating and unwholesome.

By taking meals irregularly by taking excessively strong wines, suppression of natural urges, excessive physical exertion, physical exercise and sleep in wrong postures, carrying excessive load, walking long distance and excessive sexual intercourse.

These factors are responsible for the affliction of Mamsa (muscle tissue) and Rakta (blood tissue) of the body by the Doshas, thereby causing deep-seated abscesses which are very painful. This causes excessive pain in heart, liver, spleen, sides of the abdomen kidney navel and sides of the lower abdomen or bladder. Due to excessive vitiation of Rakta, these abscesses get suppressed quickly. This is called Vidradhi because of Vidaha (burning sensation and suppuration).

Dosha types of Vidradhi

Vidradhi (abscess) is of four types, viz. Vataja, Pittaja, Shlaishmika (Kapha) and Sannipatika.
Vataja Vidradhi causes piercing (Vyadha) and cutting pain (Cheda), giddiness (Bhrama), flatulence (Anaha),
Shabda, Sphurana, Sarpana – sounding and throbbing sensation, and spreading tendency;
The discharge is thin, unctuous, reddish, grey and foamy.

Pittaja Vidradhi – thirst, burning sensation, unconsciousness, intoxication and fever. Discharge looks like the decoction of Tila – Sesame (Sesamum indicum), Masha (black gram) and Kulatha (horse gram).

Shlaishmika Vidradhi –  yawning, nausea, stiffness and cold. Discharge is white, slimy, thick and profuse.

Samnipatika type of Vidradhi (influenced by all the three Doshas) is marked by excruciating pain. Discharge will have mixed colour. In the event of the abscess being ripened the patient feels as if being assaulted by weapons, burnt by fire brands and being bitten by scorpions.

Symptoms based on site of Vidradhi

Symptoms based on place of Vidradhi (abscess):
If it is situated in Marma (vital points, like heart, brain etc), there  will be
Hrud Ghattana – palpitation,
Tamaka – darkness in front of eyes,
Pramoha – unconsciousness,
Kasa – coughing  and
Shwasa – dyspnea

• If Vidradhi is in Kloma (inside abdomen), there will be thirst, dryness in mouth and obstruction in throat.
• If it is in the liver, there will be dyspnoea.
• If in spleen, there will be obstruction to expiration.
• If in the sides of the abdomen, there will be pain in the sides and middle of the abdomen and in the shoulder (referred pain).
• If it is in the kidney, there will be stiffness in the back and waist.
• If the abscess is in Nabhi (umbilicus), this causes hiccup (Hikka)
• If in the groin, this will impair the movement of the thighs
• If it occurs in the urinary bladder, urine and stool will pass with difficulty and there will be a bad smell.

When ripened and ruptured, the discharge from the internal abscess in the upper portion of the body comes out through the mouth, whereas from the lower part of the body it comes out through the anus. When the abscess in the Nabhi region raptures, the discharge may come out through both mouth and anus.

This disease is as dangerous as a weapon, snake, lightning and fire. The principle of treatment as mentioned for Gulma (will be dealt with in future) should be adopted here.

Abscesses may occur due to the vitiation of Medas even without the disease Prameha (that is diabetes mellitus). They are, however, not visible until they take a definite shape and size.

Sarvika, Kacchapika and Jalini Types of Carbuncles are intolerably painful and of very serious nature. They occur in patients who have excessive Kapha and Medas.

Prognosis of carbuncles

Sarshapi, Alaji, Vinata and Vidradhi types of carbuncles are on the other hand dominated by Pitta and occur in the case of such patients who have meals in less quantity. These are curable.

A diabetic patient who suffers from abscesses occurring in vital organs, shoulder, anus, hands, breasts, joints and feet seldom survive.

Complications of Carbuncles

There are other varieties of abscesses having red, yellow, black, reddish, grey, yellowish, unctuous black and ash color. Some are of soft, some are hard, some are of big size, some are of small size, some of them develop slowly, some of them develop quickly, some of them have dull pain and  some of them have excruciating pain- they should be diagnosed based on Dosha involved, considering their causative factors, signs and symptoms. It should be treated immediately, based on Dosha, before any complication arises.

The complications of an abscess are –
Trut – thirst
Shwasa – dyspnoea
Mamsa Sankotha – sloughing
Moha – unconsciousness
Hikka – hiccup
Mada – intoxication
Jwara – fever
Visarpa – herpes / cellulites
impediment of the functions of the vital organs. [108-111]

Dosha Gati

Different courses of Doshas in the Pathogenesis of diseases:
1. Diminution, normal state and aggravation these are the three conditions of Doshas.
2. The three more types are upwards , downward and sideway movement  of Doshas.
3. The Doshas have another threefold movement.
a. Movement in Kostha or alimentary tract.
b. Movement in Shakha or exterior Dhatus.
c. Movement in Marma asthi sandhi or vital organs, bones and joints.

Dosha undergo Chaya (increase in their own habitat), Prakopa (flow into other places) and prashama (subside) in different seasons, due to the effect of respective seasons. [112-114]

Prakruta Dosha

Physiological and Pathological concepts of Doshas

There are two aspects of the Doshas, viz natural and morbid. In the natural state, Pitta helps in the digestion and metabolism of living beings. In its morbid state, it causes various diseases.

The Kapha in its natural state promotes strength in the form of Ojas. When in morbid condition, it takes the form of excreta and causes misery.

Similarly Vata in its natural state is responsible for all activities of the body. Vata  in fact constitutes the very life of living beings. When in morbid state, it causes disease and  death.[115-118]

Preservation of health

One desirous of ensured longevity for himself, should always make an attempt for his well being as if surrounded by opponents[119]

Summary

Head diseases, heart diseases, the states of Doshas in different permutations and combinations, diminutions, abscesses, the course of movement of Doshas have been explained by the sage in this chapter on “The Enumeration of Diseases relating to the Head”. The sage has done this with a view to enlightening the physicians about it as well as for the well- being of subjects.[120-121]

Thus ends the Seventeenth chapter on “The Enumeration of diseases relating to the Head” of the Sutra section of Agnivesha’s work as redacted by Charaka.