We will now expound VIKRUTAVYADHI VIJNANIYA – Fatal signs in diseases – Ashtanga Sangraha Sharira Sthana Chapter 11 thus said Atreya and other great sages. (1).
अथातो विकृतव्याधिविज्ञानीयमध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
Vividha vyadhi Arishta Lakshana – bad prognostic signs in various diseases
सर्वैर्यथास्वं हेतुप्राग्रूपरूपैरतिमात्रैर्यस्य व्याधिरुत्पद्यते । व्याधितस्य वा यस्याशु मुखे पिप्लुव्यङ्गलेखातिलकालकाः । करजरदनेषु वा पुष्पाण्युदरे वा नानावर्णाः सिराः । यस्य शुष्यतो नेत्रोपदेहो वर्त्मनासिकान्यतरश्वयथुर्वर्त्मत्रंसो वा । यस्य क्षीणस्य क्षुत्तृष्णा वा हृद्यैर्बहुभिरप्यन्नपानैर्न शाम्यति । यस्य सफेनमसृक् प्रसिच्यते कुक्षिशूलं च उरसो वा । यस्य श्लेष्मा नीलपीतलोहितो बहुशश्च । यस्य बलवान् ग्रीवावमर्दो जिह्वाशोषः कण्ठास्यगुदपाकश्च । यस्यामाशयोत्था परिकर्तिकातितृष्णा शकृद्भेदश्च । यस्य पक्काशयोत्था परिकर्तिकातितृष्णातिमात्रश्च गुदग्रहः । यस्यामपक्वाशयान्यतरमाश्रित्य संज्ञां च हत्वा वायुः कण्ठे घुघुरकं करोति । यस्य क्षीणस्य तृष्णाभिवृद्धिर्हदि शूलं च । तथा हिध्मारक्तातिसारौ वाध्मानातीसारौ वा भृशं सतृष्णौ सपरासुरिति । भवति चात्र ॥२॥
Patients who are having the following signs and symptoms should be considered as those nearer to death.
Development of the diseases with maximum of causes, premonitory symptoms and characteristic features (signs and symptoms).
Appearance of eruptions, patches of discolouration, ridges (lines, striae) and black moles on the face, flowers (scars, dots of various shapes) on the nails and teeth; and veins of different colours on the abdomen. Dryness of the eyes, swelling of the eyelids,nose and other places or ptosis of the eyelids. Hunger and thirst in an emaciated patient which do not subside even by plenty of pleasant foods and drinks. Discharge of frothy blood associated with pain in the centre of the abdomen or chest, or of large quantity of sputum which is blue, yellow and red in colour. Severe bending of the neck, dryness of the tongue and ulceration in the throat, mouth and anus. Cutting pain in the stomach, severe thirst and diarrhoea.Cutting pain in the colon, severe thirst and diarrhoea. Cutting pain in the colon, severe thirst and obstruction in the anus, Vayu (flatus) getting localised in between the stomach and colon producing unconsciousness and gurgling noise in the throat.
Increase of thirst and pain in the heart in an emaciated patient; likewise increase of hiccup, diarrhoea with svere bleeding or severe flatulence and diarrhoea accompanied with thirst. Further; (2).
ज्वरो निहन्ति बलवान् गम्भीरो दैर्घरात्रिकः । सप्रलापभ्रमश्वासः क्षीणं शूनं हतानलम् ॥३॥ अक्षामं सक्तवचनं रक्ताक्षं हृदि शूलिनम् । सशुष्ककास: पूर्वाह्णे योऽपराह्णेऽपि वा भवेत् ॥४॥ बलमांसविहीनस्य श्लेष्मकाससमन्वितः ।
Jvaras (fevers)-which are very powerful, which are severe internaly, which are long standing, which are associated with delerium, giddiness, and dyspnoea; which are in those who are emaciated, have oedema and loss of digestive activity; of those who are emaciated but having slurred or obstructed speech, reddish eyes, pain in the heart and dry cough either in the forenoon or in the afternoon;of those who are depleted of strength and muscles accompanied with cough with sputum. Such fevers are going to kill the patients. (3-5).
रक्तपित्तं भृशं रक्तंकृष्णमिन्द्रधनुष्प्रभम् ॥५॥
ताम्रहारिद्रहरितं रूपं रक्तं प्रदर्शयेत् । रोमकूपप्रविसृतं कण्ठास्यहृदये सजत् ॥६॥ वाससोऽरञ्जनं पूति वेगवच्चातिभूरि च । वृद्धं पाण्डुज्वरच्छर्दिकासशोफातिसारिणम् ॥७॥
Raktapitta (haemorrhagic disease)-which discharges copious blood, which is black in colour or thatresemblingarainbow, (different colour) or coppery-red, yellow or green, blood exuding from the hair follicles, blood stagnating in the throat, mouth or (region of ) the heart; blood not staining the cloth, emitting putrid odour, flowing out frequently and in large quantity; seen in aged person associated with pandu (anaemia), fever, vomiting, cough, swelling and diarrhoea (kills them). (6-7).
कासश्वासौ ज्वरच्छर्दितृष्णातीसारशोफिनम् । यक्ष्मा पार्श्वरुजानाहरक्तच्छर्घंसतापिनम् ॥८॥
Kasa (cough)-and svasa ( dyspnoea) – kill those who are having fever, vomiting, thirst, diarrhoea and oedema.
Yaksma (tuberculosis of lungs) kills those who are having fever, distention of the abdomen, vomiting of blood and pain in the shoulders. (8).
छर्दिर्वेगवती मूत्रशकृद्गन्धिः सचन्द्रिका | सास्त्रविट्पूयरुक्कासश्वासवत्यनुषङ्गिणी ॥९॥
Chardi (vomiting) kills when it is very powerful ( too many bouts) brings out materials which smell like urine and faeces, mixed with glistening particles, blood, facces and pus; accompanied with pain, cough, dyspnoea and which persists for long periods. (9).
तृष्णान्यरोगक्षपितं बहिर्जिह्वं विचेतनम् । मदात्ययोऽतिशीतार्तं क्षीणं तैलप्रभाननम् ॥१०॥
Trishna (thirst) kills those who are debilitated by other diseases; those with their tongue protruding out and who are uncouscious.
Madatyaya (intoxication by alcohol) kills those who are troubled with severe cold, debilitated and having face shining like oil (as though smeared with oil). (10)
अर्शांसि पाणिपन्नाभिगुदमुष्कास्यशोफिनम् । हृत्पार्श्वाङ्गरुजाच्छर्दिपायुपाकज्वरातुरम् ॥११॥
Arshas (haemorrhoids) kills those patients having swelling of the hands, feet, umbilicus, anus, scrotum, mouth, pain in the heart and flanks, vomiting, ulcerations of the rectum and fever. (11)
अतीसारो यकृत्पिण्डमांसधावनमेचकैः । तुल्यस्तैलघृतक्षीरदधिमज्जवसासवैः ॥१२॥
मस्तुलुङ्गमषीपूयवेशवाराम्बुमाक्षिकैः । अतिरक्तासितस्निग्धपूत्यच्छघनवेदनः॥१३॥
कर्बुरं प्रस्त्रवन् धातून् निष्पुरीषोऽथवातिविट् । तन्तुमान् मक्षिकाक्रान्तो राजीमांश्चन्द्रकैर्युतः ॥१४॥
शीर्णपायुवलिं मुक्तनालं पर्वास्थिशूलिनम् । स्त्रस्तपायुं बलक्षीणमन्नमेवोपवेशयेत् ॥१५॥
Atisara (diarrhoeas) kills those who eliminates faeces resembling the colour of a peice of liver, mutton-wash or peacocks tail (feather) ( in colour) oil, ghee, milk, curds, marrow, imuscle-fat or fermented decoction, brain matter, soot, pus, minced meat, water or honey; faeces being very red, black, fatty, of putrid odour, clear (at the top) and solid (at the bottom) or karbura (verigated colours); excretions of the tissues without faeces or with large amount of faeces; the faecal matter having-thread-like structures attracting swarms of flies, containing structures which are liner and glistening;with folds of the anus fissured, anal orifice always open, pain in the joints and bones, prolapse of the rectum, loss of strength and food coming out as such ( with out any change). (12-15).
सतृट्कासज्वरच्छर्दिदाहानाहप्रवाहिकः । अश्मरी शूनवृषणं बद्धमूत्रं रुजार्दितम् ॥१६॥
Pravahika (dysentery) kills when associated with thirst, cough, fever vomiting, burning sensation and distention of abdomen.
Ashmari (urinary calculus) kills those having swelling of the testes, obstruction to micturition and severe pain. (16).
मेहस्तृड्दाहपिटकामांसकोथातिसारिणम् । पिटका मर्महत्पृष्ठस्तनांसगुदमूर्द्धगा ॥१७॥
पर्वपादकरस्था वा मन्दोत्साहं प्रमेहिणम् । सर्वं च मांससङ्कोथदाहतृष्णामदज्वरैः ॥१८॥ विसर्पमर्मसंरोधहिध्माश्वास भ्रमक्लमैः ।
Meha (diabetes) kills if associated with thirst, burning sensation, eruptions, putrefaction in the muscles, diarrhoea; pramehaptitaka (diabetic eruptions) appearing on vital spots, heart (region), back, breasts, shoulders, rectum, head, joints, feet and hands; all others having lack of enthusism, gangrene, burning sensation, thirst, toxicity, and fever.
Visarpa (herpes) which has developed on vital spots and associated with hiccup, dyspnoea, giddiness and exhaustion. (17-18).
गुल्मः पृथुपरीणाहो घनः कूर्म इवोन्नतः ॥१९॥
सिरानद्धो ज्वरच्छर्दिहिध्माध्मानरुजान्वितः । कासपीनसहल्लासश्वासातीसारशोफवान् ॥ २० ॥
Gulma (abdominal tumor) which is of big size, hard, bulging out like the shell of the tortoise, with appearance of prominant veins on the abdomen, fever, vomiting, hiccup, flatulence, pain, cough, running in the nose, nausea, dysproea, diarrhoea and oedema. (19-20 ).
विण्मूत्रसंग्रहश्वासशोफहिध्माज्वरभ्रमैः । मूर्च्छाछर्घतिसारैश्च जठरं हन्ति दुर्बलन् ॥ २१ ॥ शूनाक्षं कुटिलोपस्थमुपक्लिन्नतनुत्वचम् । विरेचनहतानाहमानह्यन्तं पुनः पुनः ॥ २२ ॥
Udara (enlargement of the abdomen) kills a weak patient when associated with suppression of urine and faeces, increased respiration, hiccup, fever and giddiness; whose eyes are swollen, the penis has curved, skin is full of fluid and thin, the abdomen becoming enlarged again and again even after purgation. (21-22).
पाण्डुरोग: श्वयथुमान् पीताक्षिनखदर्शनम् । तन्द्रादाहारुचिच्छर्दिमूर्च्छाध्मानातिसारवान् ॥ २३ ॥
Panduroga (anaemia) kills when associated with oedema, yellow colour of the eyes, nails and vision; stupor burning sensation, anorexia, vomiting, fainting, flatulence and diarrhoea (23).
अनेकोपद्रवयुतः पादाभ्यां प्रसृतो नरम् । नारीं शोफो मुखाद्धन्ति कुक्षिगुह्यादुभावपि ॥२४॥
राजीचितः स्त्रवंश्छर्दिज्वरश्वासातिसारिणम् ॥ २५॥
ज्वरातिसारौ शोफान्ते श्वयथुर्वा तयोः क्षये | दुर्बलस्य विशेषेण जायन्तेऽन्ताय देहिनः ॥२६॥
श्वयथुर्यस्य पादस्थः परित्रस्ते च पिण्डिके । सीदतः सक्थिनी चैवं तं भिषक् परिवर्जयेत् ॥२७॥
आननं हस्तपादं च विशेषाद्यस्य शुष्यतः । शूयेते वा विना देहात्स मासाद्याति पञ्चताम् ॥ २८ ॥
Sopha (dropsy/anasarca) kills when associated with many complications, spreading from the leg upwards in men and from the head downwards in women, spreading from the abdomen and genitals in both; the skin studded with striae and exuding water, vomiting, fever, dyspnoea and diarrhoea. Fever and diarrhoea appearing at the terminal stage of oedema or odema appearing at the end of fever and diarrhoea bo are for the end of the patient. The physician should refuse (treatment to) him who has oedema of the legs, very much debilitated calf muscles and the thighs unable to function. He, whose face, hands and feet become swollen especially in a weak person or become swollen without the other parts of the body, also dies within a month. (24-28)
उदरी यश्च शोफी वा स्वं न पश्यति मेहनम् । यस्य वा जठरोन्नामात् परिधानं न तिष्ठति ॥२९॥
A patient of udara (enlargement of abdomen) or sopha (oedema) who is unable to see his own penis, due to enlargement of the abdomen does not survive. (29).
विसर्पः कासवैवर्ण्यज्वरमूर्छाङ्गभङ्गवान् । भ्रमास्यशोफहल्लासदेहसादातिसारवान् ॥३०॥
Visarpa (herpes) kills when accompanied with cough, discolouration, fever, faintings, loss of the body parts (or cutting pain in the body) giddiness, dryness of the mouth, nausea, weakness and diarrhoea. (30).
कुष्ठं विशीर्यमाणाङ्गं रक्तनेत्रं हतस्वरम् । मन्दाग्निं जन्तुर्भिर्जुष्टं हन्ति तृष्णातिसारिणम् ॥३१॥
Kustha (leprosy and other skin diseases) kills when the affected parts fall off, eyes become red, loss of voice, poor digestive activity, development of worms (in the ulcer), thirst and diarrhoea manifest. (31).
वायुः सुप्तत्वचं भुग्नं कम्पशोफरुजातुरम् ॥ ३२॥
Vayu (vatarogas-nervous disorders) kills him who has lost the tactile sensation, who has become bent and has tremors, swelling and pain. (32).
वातास्त्रं मोहमूर्छायमदास्वप्नज्वरान्वितम् । शिरोग्रहारुचिश्वाससङ्कोचस्फोटकोथवत् ॥३३॥
Vatasra (gout) kills when associated with delusions, fainting, toxicity, loss of sleep, fever, stiffness of the head, loss of appetite, dyspnoea, delusion, diarrhoea, thirst, giddiness, loss of voice, contractions, eruptions, and putrefaction of the affected parts. (32).
शिरोरोगारुचिश्वासमोहविड्भेदतृड्भ्रमैः । घ्नन्ति सर्वामयाः क्षीणस्वरधातुबलानलम् ॥३४॥
All diseases accompanied with stiffness of the head, loss of appetite, dyspnoea, delusion, diarrhoea, thirst, giddiness, loss of voice, tissues, strength and digestive activity, kill the patient. (34).
वातव्याधिरपस्मारी कुष्ठी रक्त्युदरी क्षयी । गुल्मी मेही च तान् क्षीणान् विकारेऽल्पेऽपि वर्जयेत् ॥३५॥
Patients of nervous diseases, epilepsy, leprosy, haemorragic disorder, enlargement of abdomen, consumption, abdominal tumor and diabetes – if they are weak, should be refused treatment even if the abnormalities are very little (mild). (35).
बलमांसक्षयस्तीव्रो रोगवृद्धिररोचकः । यस्यातुरस्य लक्ष्यन्ते त्रीन् पक्षान्न स जीवति ॥३६॥
The patient in whom depletion of strength and muscles, aggravation of the disease and loss of appetite are seen happening quickly does not survive for three fortnights. (36).
वाताष्ठीलातिसंवृद्धा तिष्ठन्ती दारुणा हृदि । तृष्णयानुपरीतस्य सद्यो मुष्णाति जीवितम् ॥३७॥
Asthila (prostatic gland) getting enlarged greatly by increased vata, stays inside the abdomen causing severe discomfort in the (region of) the heart associated with thirst, kills the patient quickly. (37).
शैथिल्यं पिण्डिके वायुर्नीत्वा नासां च जिह्यताम् । क्षीणस्यायम्य मन्ये वा सद्यो मुष्णाति जीवितम् ॥३८॥
नाभीगुदान्तरं गत्वा वक्षणौ वा समाश्रयन् । गृहीत्वा पायुहृदये क्षीणदेहस्य वा बली ॥३९॥
मलान् बस्तिशिरोनाभिं विबध्य जनयन् रुजम् । कुर्वन् वङ्क्षणयोः शूलं तृष्णां भिन्नपुरीषताम् ॥४०॥
श्वासं वा जनयन् वायुर्गृहीत्वा गुदवङ्क्षणौ । वितत्य पर्शकाग्राणि गृहीत्वोरश्च मारुतः ॥४१॥
स्तिमितस्यातताक्षस्य सद्यो मुष्णाति जीवितम् ॥ ४२ ॥
Vayu (vata) getting powerful, going inside the umbilicus and the rectum or localised in the groins, causes catching pain in the rectum and heart in a weak person, blocks the baldder (region of ) and umbilicus, causes pain in the groins, thirst and diarrhoea; blocking anus and groin it may produce dyspnoea, stagnating in the ends of the ribs it may cause catching pain in the chest, eyes having a fixed gaze and wide open is going to kill the patient. (38-42).
सहसा ज्वरसन्तापस्तृष्णामूर्छाबलक्षयः । विश्लेषणं च सन्धीनां मुमूर्षोरुपजायते ॥४३॥
Increase of fever (temperature), thirst, fainting, loss of strength, looseness of joints, these developing suddenly in a person is going to die shortly. (43).
गोसर्गे वदनाद्यस्य स्वेदः प्रच्यवते भृशम् । लेपज्वरोपतप्तस्य दुर्लभं तस्य जीवितम् ॥४४॥
Profuse sweating of the face at the time of arrival of cattle (evening), in a person afflicted with mild fever his life is difficult to avail. (44).
प्रवालगुलिकाभासा यस्य गात्रे मसूरिकाः । उत्पद्याशु विनश्यन्ति न चिरात्स विनश्यति ॥ ४५ ॥ G
He, on whose body Masurika (chicken pox) suddenly develops, the eruptions resembling beads of coral and which disappear also suddenly make himself to disappear. (45).
मूसूरविदलप्रख्यास्तथा विद्रुमसन्निभाः । अन्तर्वक्रा: किणाभाश्च विस्फोटा देहनाशनाः ॥ ४६॥
Pox resembling lentils or beads of coral, bent inwards and producting sound, such a Vispota (small pox) is going to cause death. (46).
कामलाक्ष्णोर्मुखं पूर्णं शङ्खयोर्मुक्तमांसता । सन्त्रासश्चोष्णताङ्गे च यस्य तं परिवर्जयेत् ॥४७॥
He whose eyes are yellow due to kamala (jaundice), face full (with oedema), temples without muscles and debilitated by high temperature should be refused ( treatment ). (47).
अकस्मादनुधावच्च विघृष्टं त्वक्समाश्रयम् । चन्दनोशीरमदिराकुणपध्वाङ्क्षगन्धयः ॥४८॥
शैवालकुक्कुटशिखाकुङ्कुमालमषीप्रभाः । अन्तर्दाहा निरूष्माणः प्राणनाशकरा व्रणाः ॥४९॥
Vighrusta kind of vrana (ulcer) of the skin developing without any cause, ulcers emitting smell like that of chandana, usira, madira (wine), kunapa (cadaver) or dhvanksi (crow), having colours, like that of algae, crown of a cock, kumkuma, ala (realgar) or soot, with burning sensation inside and no warmth outside-are all going to kill the patient. (48-49).
यो वातजो न शूलाय स्यान्न दाहाय पित्तजः । कफजो न च पूयाय मर्मजश्च रुजे न यः ॥५०॥
अचूर्णश्चूर्णकीर्णाभो यत्राकस्माच्च दृश्यते । रूपं शक्तिध्वजादीनां सर्वांस्तान् वर्जयेद् व्रणान् ॥५१॥
विण्मूत्रमारुतवहं कृमिणं च भगन्दरम् ॥५२॥
Persons, who have Vrana (ulcers) of vata origin but without pain; of pitta origin but without burning sensation; of kapha origin but without pus; those developing on vital spots which do not cause pain; ulcers which were dust free earlier becoming dust laden without any cause (on its own accord), and those resembling a weapon, flag etc, should all be refused (treatment ). Similarly an ulcer of fistula-in-ano which eliminates faeces, urine and flatus and worms through it. ( 50-52)
घट्टयन् जानुना जानु पादावुद्यम्य पातयन् । योऽपास्यति मुहुर्वक्त्रमातुरो न स जीवति ॥५३॥
The patient who strikes his knees with one another, lifts up his legs (or feet) and drops them down; bends his face down often is not going to survive. (53)
दन्तैश्छिन्दन् नखाग्राणि तैश्च केशांस्तृणानि वा । भूमिं काष्ठेन विलिखन् लोष्टं लोष्टेन ताडयन् ॥५४॥
He, who bites the nails with his teeth, pulls out his hairs or the grass by his fingers, scratches the ground with sticks, strikes stones against one another (also does not survive). (54)
हृष्टरोमा सान्द्रमूत्रः शुष्ककासी ज्वरी चयः । मुहुर्हसन् मुहुः क्ष्वेडन् शय्यां पादेन हन्ति यः ॥५५॥
मुहुश्छिद्राणि विमृशन्नातुरो न स जीवति ॥५६॥
A patient of fever who has frequent horripilations, thick urine, dry cough, sometimes laughing and sometimes crying (weeping), beating (kicking) the bed with his legs often; in search of holes in everything (or finding fault in everything) – also does not survive. (55-56)
ऊर्ध्वश्वासं गतोष्माणं शूलोपहतवङ्क्षणम् । शर्म चानधिगच्छन्तं बुद्धिमान् परिवर्जयेत् ॥५७॥
Wise physician should refuse a patient who is having severe expirations, has lost the warmth of the body, has severe pain in the groins and does not find comfort by anything. (57)
विकारा यस्य वर्द्धन्ते प्रकृतिः परिहीयते । सहसा सहसा तस्य मृत्युर्हरति जीवितम् ॥५८ ॥
Death takes away the life of that person, whose diseases (or other abnormalities) become increased and normals (constitutional characteristics) became lost; both or any one occuring suddenly. (58)
यमुद्दिश्यातुरं वैद्यः सम्पादयितुमौषधम् । यतमानो न शक्नोति दुर्लभं तस्य जीवितम् ॥५९॥
The physician, who fails to secure even after a great trial, drugs intended for any patient, the life of such a patient is difficult to be retained. ( 59 )
विज्ञातं बहुश: सिद्धं विधिवच्चावचारितम् । न सिध्यत्यौषधं यस्य नास्ति तस्य चिकित्सितम् ॥६०॥
The medicines which are well known, which have been found efficient many times previously, administered in accordance with procedure but still does not produce any success on a perticular patient, such a patient has no use of any treatment (is going to die). (60)
भवेद्यस्यौषधेऽन्ने वा कल्प्यमाने विपर्ययः । अकस्माद्वर्णगन्धादेः स्वस्थोऽपि न स जीवति ॥६१ ॥
निवाते सेन्धनं यस्य ज्योतिश्चाप्युपशाम्यति ॥ ६२ ॥
If the medicines or foods intended for a person, undergo change in their normal colour, smell and other qualities – such a person does not survive even though he is a healthy one. Similarly, the person in whose house, the fire even though fed with fuel and not troubled by wind, gets extinguished. (61-62}
आतुरस्य गृहे यस्य भिद्यन्ते वा पतन्ति वा । अतिमात्रममत्राणि दुर्लभं तस्य जीवितम् ॥६३॥
The life of that patient is difficult, in whose house the vessels get broken or fall from their places very often. (63)
यं नरं सहसा रोगो दुर्बलं परिमुञ्चति । संशयप्राप्तमात्रेयो जीवितं तस्य मन्यते ॥ ६४ ॥ Atreya considers that the life of that weak patient as doubtful (of continuance) in whom the diseases suddenly disappear. (64)
॥ इति एकादशोऽध्यायः ॥
Thus ends Ashtanga Sangraha Sharira Sthana chapter 11.
