A History of Indian Medical Literature v1.c12: Chapter 5
A History of Indian Medical Literature v1.c12
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Chapter 5
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The Indriyasthāna¹ is concerned with signs foretelling death.²
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Chapter one,³ called varṇasvarīya, begins with enumerating the factors to be taken into consideration by a physician wishing to determine the remaining span of life of a patient.⁴ The list of these factors, comprising forty-seven items, covers all the topics discussed in the Indriyasthāna (1.3).⁵
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Some factors, which do not relate to the patient as a person,⁶ should be judged by means of authoritative statements (upadeśa) and yukti, while the factors relating to the normal condition (prakṛti) of the patient and morbid changes in that condition (vikṛti) should be carefully observed (1.4).
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The normal condition of a patient depends on his birth within a particular social group (jāti), his family lineage (kula), his place of residence (deśa), the period of time (kāla), his age (vayas), and individual characteristics (1.5).
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Morbid changes are of three types: caused by bodily marks (lakṣaṇanimitta), caused by aetiological factors (lakṣyanimitta) and caused by factors resembling aetiological factors (nimittānurūpa) (1.6).
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The first type consists of changes, appearing at their appropriate time, which are the result of bodily marks, acquired by an individual due to fate (daiva);⁷ the second type is caused by factors discussed under the nidāna of the various diseases; the third type consists of changes which appear without any apparent cause (animitta) and are indicative of the remaining measure of the patient’s life span. The changes of the third type will be more elaborately discussed (1.7).⁸
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The normal complexion (varṇa) is of four main types:⁹ kṛṣṇa (black), śyāma (brown),¹⁰ śyāmavadāta, and avadāta (fair);¹¹ other shades should be learnt from the experts (1.8).¹² Abnormal colours of the complexion are: nīla (dark blue), śyāva (grey),¹³ tāmra (coppery red), harita (yellowish green), and śukla (white) (1.9).¹⁴
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A series of premonitory signs (ariṣṭa), relating to a patient’s complexion and indicating a fatal outcome, are described (1.10–13).
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Normal types of voice (svara) are then enumerated, followed by abnormal types and inauspicious signs relating to a patient’s voice (1.14–15).¹⁵ The chapter ends with verses on characteristics of the complexion and the voice which point to a fatal course of the illness (1.17–25).¹⁶
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Chapter two, called puṣpitaka, compares the connection between a fatal sign (ariṣṭa) and death with that between a flower (puṣpa) and the fruit it produces (2.3–5).¹⁷ Patients exhibiting such signs are therefore called prṣpita.¹⁸
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Ariṣṭas relating to the smell emitted by a patient’s body are described (2.8–16),¹⁹ followed by those relating to its taste, as may be deduced from its attractiveness to various kinds of insects (2.17–22).
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Chapter three, called parimārśanīya, is about fatal signs to be ascertained by means of palpation (parimārśana, sparśa), followed by some other categories of ariṣṭas.
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Rules for palpation and inauspicious abnormalities found by means of this procedure are described (3.4–5).²⁰
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The physician should also examine the patient’s way of breathing (ucchvāsa), the region of the carotid arteries (manyā), the teeth, eyelashes, eyes, hair of the head and body, belly, nails and fingers. Fatal signs relating to breathing and signs occurring in the mentioned parts of the body are described (3.6).
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Chapter four, called indriyānīka, ²¹ is concerned with ariṣṭas pertaining to the functions of the senses; this category has to be determined by means of inference (anumāna) (4.3–4).²² Many fatal signs of this type are described.²³
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Chapter five, called pūrvarūpīya, ²⁴ deals with fatal prodromes (pūrvarūpa).²⁵ In general, presence of the complete set of prodromes of a particular disease indicates a fatal outcome (5.3–5). Prodromes, pointing to the severe character of a particular diseases, are described. Dreams (svapna) form a conspicuous element among these fatal signs (5.6–25).²⁶
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Numerous dreams auguring imminent death or great anguish (dāruṇāḥ svapnāḥ) are described (5.27–39).²⁷ Healthy persons, having the same dreams, may sometimes escape this fate (5.40). The dāruṇa dreams are explained as having an organic basis (5.40–41).²⁸
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Seven types of dreams are distinguished: based on visual perceptions (dṛṣṭa), based on auditory perceptions (śruta), perceptions by other senses (anubhūta),²⁹ based on wishes (prārthita), based on imagination (kalpita), pointing to future events (bhāvika), and based on disturbances of the doṣas (doṣaja) (5.43). The first five types have no effects (aphala);³⁰ the same applies to dreams experienced during day-sleep and to those which are very short or very long³¹ (5.44).³² Dreams occurring during the first part of the night have weak results (5.45ab).³³ The effect of a dream becomes operative at once if one does not sleep again after dreaming it (5.45cd).³⁴ The prognostic meaning of an inauspicious dream is annulled when it is followed by one to be regarded as auspicious (5.46).³⁵
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Chapter six, called katamāniśarīrīya, describes signs which should make the physician decide to give up treatment.³⁶
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Chapter seven, called pannarūpīya,³⁷ deals with the prognostic significance of a patient’s chāyā, praticchāyā and prabhā (7.3–17), followed by various ariṣṭas (7.18–31).
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Individuals are of three types according to their measurement: short, medium and tall,³⁸ of two types according to their shape: balanced (susama) and imbalanced (visama) (7.8).
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The praticchāyā (reflected image) is to be assessed according to its measurement (pramāna) and shape (samsthāna), while the chāyā (shadow) depends on a person’s complexion (varna)³⁹ and lustre (prabhā) (7.9).⁴⁰
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Chāyā is of five types, according to the predominance of one of the five mahābhūtas; the chāyā dominated by vāyu is inauspicious, the other four types are auspicious (7.10–13).⁴¹
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Prabhā is fiery (taijasī) in nature and of seven types: red, yellow, white, grey (śyāva), yellowish green (harita), pale (pāndura) and dark (asita); auspicious kinds of prabhā are those which are vikāsin,⁴² snigdha (glossy) and vipula;⁴³ inauspicious are those which are dry (rūksa), dirty (malina) and contracted (samksipta) (7.14–15).
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Chāyā makes varna indistinct (ākrāmati), whereas (pra)bhā enhances (prakāśin) it; chāyā can be observed from nearby, (pra)bhā from a distance (7.16–17).
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Various aristas are described in the second part of the chapter (7.18–31).
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Chapter eight, called avaksirasiya,⁴⁴ is concerned with aristas indicating the advent of death within a few days.⁴⁵
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Chapter nine, called yasyaśyāvanimittīya, describes a number of aristas.⁴⁶
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This chapter contains some verses of particular interest; the survival of a weak patient who gets rid of his disease all of a sudden is doubtful according to Ātreya; if his relations insist on it, a physician may prescribe meat soup to such a patient; his life is in danger if he does not improve after a month on this diet (9.15–17).⁴⁷
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Chapter ten,⁴⁸ called sadyomaranīya, describes signs indicating sudden death.⁴⁹
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Chapter eleven, called anujyotīya,⁵⁰ deals with aristas foreboding death within a year (11.3–6), six months (11.7–9), one month (11.10–12), or an unspecified period of time (11.13–26).
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An arista is defined as a sign produced by dosas which have transcended the range of treatment and pervaded the whole body (11.29).⁵¹
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Chapter twelve, called gomayacūrnīya, begins with a short series of aristas (12.3–8).⁵² It proceeds with omina relating to the messenger (dūta) sent to the physician by the patient or his relatives (12.9–24),⁵³ omina⁵⁴ (autpātika) observed by the physician on his way to the patient (12.25–31)⁵⁵ and in the patient’s domestic surroundings (12.32–39).⁵⁶
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The characteristics of a dying patient are described (12.43–61). The physician should not disclose to a patient or his relatives that he has observed the signs of imminent death without having been requested to do so; he should withhold this information even on request if it is liable to cause harm (12.62–64). A physician who has noticed signs indicative of recovery should certainly announce this (12.65–66).
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Auspicious omina relating to the messenger and to occurrences on the way to the patient and in his house are dealt with in the last part of the chapter (12.67–88).⁵⁷