Charaka Indriya Sthana 8th Chapter Avaakshirasiya Indriyam

8th chapter of Charaka Indriya sthana deals about the signs of imminent death as indicated by the distortion of the shadow of the individual. The chapter name is Avaakshirasiya Indriyam.

We shall now expound the chapter on imminent death as indicated by signs like distortion of the shadow of the individual viz. the inversion of the shadow of the head. Thus said Lord Atreya[1-2]
Read – Arishta Lakshanas – Ominous Signs And Symptoms Indicating Bad Prognosis

Signs of Imminent death

Read – Bad Prognosis Of Diseases Based On Dreams and Shadows

• In the shadow of an individual if the head is found to be inverted (head pointing downwards and legs pointing upwards), is irregular or without the head, that individual should not be treated.
• A person should also not be treated if in a person there is matting of eyelashes or absence of vision (because of the matting of eye-lashes of both lids together).
• If in an emaciated person, there is swelling of the eyelids, if both the eyelids do not meet each other (due to swelling), if there is accumulation of dirt in the eyes and also if there is burning sensation in the eyes he is considered as equal to being dead. 
• If in a person, there are many well manifested simantas ( lines formed by the parting of hair to each side) without them being made and Avartakas ( whirls of hairs) in the eyebrows or in the hairs of the head which were neither found earlier nor made artificially, he is sure to die soon.
• If the above mentioned signs appear in individuals suffering from diseases, they survive for three days only. If they appear in persons who are not suffering from any diseases, such individuals may live for a maximum duration of six days. [3-7]
  Read – Bad Prognosis Based On Smell, Touch, Taste, Colour And Voice

• If a person with or without a disease does not survive for more than six nights if he does not have any sensation when his hairs are pulled out and uprooted.
• If the hairs of the individual appears to be greasy even when no unctuous substances (like oil) has been applied, he is considered to be at the end point of his life and hence should not be treated. [8-9]
• If there is depression and thickening / separation of the ridge of the nose, if the nose appears swollen in spite of it not being swollen up, the patient having these signs should not be treated by the wise physician.
• Excessive enlargement or constriction of the nasal orifices, distortion in shape and extreme dryness of the nose indicate that the individual will not survive.
• If the face, ears and lips become abnormally white, brown, excessively red or blue without any obvious cause, then such a patient seldom recovers from the disease. [10-12]
  Read – Prognosis Signs Based On The Messenger – Doota Adhishtita Arishta

A patient having morbid conditions like –

• Teeth getting white like the colour of the bone, appearance of white spots (Puspa-lit, meaning flower) over teeth and adhesion of slush / dirt / muddy substance (material) over them cannot recover from the disease.
• If the tongue becomes rigid, senseless, heavy, excessively coated with a thorn like fur, brown in colour, dry or swollen and constantly mobile, then the patient having such signs is considered as good as dead.
• If a person faints after a short expiration followed by a long inspiration, then considering that his end is near he should not be treated.
• Excessive coldness, roughness and softness in hands, legs and nape of the neck indicate the end of life span of that person.
• A person, who strikes one knee with the other, throws down legs after lifting them up and frequently turns the face to one or the other side, does not survive.
• The patient who gnashes teeth while awake, cries and laughs loudly and does not have pain sensation, does not recover from the disease.
• The patient, who frequently laughs, cries and shouts, keeps hitting the bed with his feet and puts finger into the nostrils, ears and eyes does not survive for long. [13-20]
  Read – Charaka Grahani Dosha Chikitsa 15th Chapter

Need for immediate observation

• If a debilitated patient develops disliking for the same factors (and things) by getting which he used to get extremely happy in the past, his death should be considered imminent.
• If the neck of the patient is unable to support the weight of his head, the head gets tilted to one side, the back doesn’t tolerate the weight of the body and the patient feels difficult / impossible to sit, and when his jaws cannot hold / support the morsel of food in the mouth – this indicates his imminent death.
• If in a patient signs like fever, thirst, fainting, diminution of strength perspiration occur in the face, there is little chance of his survival.
• If the ingested food does not reach the throat, or the tongue falls back over the throat (thereby causing obstruction) and there is diminution of strength, then the death of the person is imminent.
• If the person moves his head with difficulty by the help of the fore-arms and if there is sweating in the forehead and looseness of joints, he is moribund. [21-26]
  Read – How To Make Prognosis Of Disease According To Ayurveda?

To sum up:
The wise physician should closely search for these signs repeatedly because some of them disappear in a short moment after their manifestation.
None of these signs remain without leading to the consequences already described i.e. all of them indicate imminent death. [27]
Thus ends the ‘eight chapter’ on imminent death as indicated by signs like the distortion of shadow of the individual, viz, the inversion of the shadow of the head, of the Indriya section of Agnivesha’s work as redacted by Charaka.