PARIMARSHANEEYAM OF CHRAKA INDRIYA STHANA - AN EXPLORATIVE STUDY

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SPECIAL THEME ON CHARAKA SAMHITA - INDRIYA STHANA
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REVIEW ARTICLE
DOI: https://doi.org/10.36672/ijaam.2019.v07i05.003
PARIMARSHANEEYAM OF CHARAKA INDRIYA STHANA
– AN EXPLORATIVE STUDY
Prasad Mamidi1*
, Kshama Gupta2
1. Professor, Dept of Kayachikitsa, SKS Ayurvedic Medical College & Hospital, Mathura, Uttar Pradesh,
India, Contact No. +91 7567222856, E-mail- drprasadmamidi@gmail.com
2. Professor, Dept of Kayachikitsa, SKS Ayurvedic Medical College & Hospital, Mathura, Uttar Pradesh,
India, Contact No. +91 7567222309, E-mail: drkshamagupta@gmail.com
Article Received on - 30th Apr 2020
Article Revised on - 18th
May 2020
Article Accepted on - 20th
May 2020
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REVIEW ARTICLE
Abstract:
Samhitas are considered as highly codified store houses of ancient wisdom. The Charaka samhita (an ancient Indian textbook of
medicine written thousands of years before), as available in its present form consists 8 ‘Sthanas’ (sections) and ‘Indriya sthana’
(section which deals with prognosis) is one among them. Indriya sthana deals with various fatal signs and symptoms which denote
imminent death and prognostication of life expectancy in the patients who are at end-of-life stages. Indriya sthana of Charaka
samhita contain 12 chapters and ‘Parimarshaneeyam indriyam’ is the 3rd chapter of Indriya sthana. ‘Parimarshaneeyam indriyam’
chapter contains various arishta lakshanas (fatal signs and symptoms which indicates imminent death) which can be elicited by
touch or palpation. Various clinical conditions (surgical and ophthalmological) and methods of diagnosing them by using palpation
were described in this chapter. The present study is aimed to explore the contents of this chapter and to analyse their role and
potential in clinical prognostication. Concepts such as medical ethics & etiquette regarding palpation are mentioned in this
chapter. Various pathological technical terms like ‘Aspandanm’ (absence of pulsations), ‘Darunatvam’ (stony hardness or
induration), ‘ Kharatvam’ (sclerosis or licehnification or scaling), ‘Asat bhava’ (atrophy), ‘Sramsa’ (subluxations), ‘Bhramsha’
(dislocations), ‘Swedanubandha’ (hyperhidrosis), ‘Sweda stambha’ (anhidrosis), ‘Mamsa shonita veeti bhava’ (cachexia/ sarcopenia
/atrophy), ‘ Sheetam’ (hypothermia), ‘Stabdham’ (rigidity / spasticity), ‘Chyuta’ (prolapse), and ‘Skanna’ (clotting) etc are
mentioned in this chapter along with arishta lakshanas related to eyes which are having profound clinical importance. The
concepts mentioned in this chapter needs to be standardized. Further research works are required to substantiate the opinions
or claims mentioned in this chapter.
Key Words: Atrophy, Hypothermia, Induration, Rigidity, Sclerosis, Spasticity
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*Corresponding Author
Prasad Mamidi,
Professor, Dept of Kayachikitsa,
SKS Ayurvedic Medical College & Hospital, Mathura, Uttar Pradesh, India,
Contact No. +91 7567222856,
E-mail- drprasadmamidi@gmail.com
DOI: https://doi.org/10.36672/ijaam.2019.v07i05.003
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others
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For reprints contact: editorijaam@gmail.com
INTRODUCTION:
Samhitas are considered as highly codified store
houses of ancient wisdom. [1]
Agnivesha has composed
‘Agnivesha samhita’ based on the teaching of his
preceptor ‘Acharya Punarvasu Atreya’. Later,
Agnivesha samhita was elaborated, edited and redacted
by Acharya Charaka and Dridhabala, since then
‘Agnivesha samhita’ got popularized as ‘Charaka
samhita’. The Charaka samhita (an ancient Indian
textbook of medicine written thousands of years
before), as available in its present form consists 8
‘Sthanas’ (sections) and ‘Indriya sthana’ (section
which deals with prognosis) is one among them. [2]
Indriya sthana of Charaka samhita contain 12 chapters
and ‘Parimarshaneeyam indriyam’ is the 3rd
chapter of
Indriya sthana. ‘Parimarshaneeyam indriyam’ chapter
contains various arishta lakshanas (fatal signs and
symptoms which indicates imminent death) which can
be elicited by touch or palpation. The word
‘Parimarshana’ denotes touch or palpation; hence the
chapter is named as ‘Parimarshaneeyam indriyam’. In
this chapter various clinical conditions (surgical and
ophthalmological) and methods of diagnosing them by
using palpation were described. [3]
The present study is
aimed to explore the contents of this chapter and to
analyse their role and potential in clinical
prognostication.
MAIN CONTENTS:
‘àk&itSwen pai[na’
‘Prakrutisthena paaninaa’ [Verse 4] [3]
‘àk&itSweneit naTyu:[zIten’
‘Prakrutistheneti naatyushnasheetena’ [Chakrapani,
Verse 4] [3]
Palpation is an art of touching a patient in a therapeutic
manner to elicit specific information. Prior to palpating
a patient, some medical ethics and etiquette needs to be
observed (bed side manners). Physician should warm
his hands prior to placing them on the patient’s body.
Palpating with cold hands can make a patient’s muscles
tense (which can distort assessment findings) and also
can cause discomfort to the patient. The word ‘àk&itSwen
pai[na’ denotes the same i.e., physicians hands should be
sufficiently warm that they shouldn’t cause discomfort
to the patient while doing palpation.
‘pirmzRyeÖa=Nyen’
‘Parimarshayed vaa anyena’ [Verse 4] [3]
‘guédarade> Svy< SpzaeR yda n yuJyte tda ktRVymah pirmzRyeÖa=Nyeneit’
‘Gurudaaraade ---- anyeneti’ [Chakrapani, Verse 4] [3]
If the physician is not allowed (not in a position) to do
palpation (due to cultural or religious backgrounds or
circumstances which may cause embarrassment or
discomfort to the patient), he can get assistance from
another person. ‘Tacesics’ involves tactile
PARIMARSHANEEYAM OF CHARAKA INDRIYA STHANA – AN EXPLORATIVE STUDY
YAVAGU (GRUEL)

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communication and is the study of touch and of the
characteristics that are involved, including the gender
and age of the communicators (physician and patient),
duration, location, action (speed and manner of
approach that precede the touch), intensity (pressure
exerted), frequency and sensations caused by the touch
(degrees of comfort and discomfort generated in the
communicating agents). Another aspect when studying
tacesics is related to ‘where’ the person is touched (it
influences the degree of embarrassment), context, age,
intention and cultural diversity. When performing
palpation, the physician should remember that,
misinterpretations may occur which may cause
embarrassment and discomfort. Therefore, personal
factors, communication skills, attitudes, beliefs, values
and even technical knowledge must be considered
while doing palpation. [4]
Before doing palpation
physician should be alert regarding various factors like
religious or cultural background, gender and part of the
body, education level and patient’s position in society
etc.
‘stt< SpNdmanana< zrIrdezanamSpNdnm!’
Satatam ---- aspandanam [Verse 4] [3]
Diminished or absent pulses in the various arteries
examined may be indicative of impaired blood flow
due to a variety of conditions. All pulses (brachial,
radial, and ulnar arteries of the upper extremities and
the femoral, popliteal, dorsalis pedis, and posterior
tibial arteries of the lower extremities) should be
palpated bilaterally. The aorta and temporal arteries
also can be palpated. Diminished pulses are ominous in
children and they suggest cardiac failure or shock.
Absent or weak pulses in the arm may result from a
coarctation of the aorta. If the pulse is of low volume
and amplitude (hypokinetic), it suggests low cardiac
output in shock or myocardial infarction. Idiopathic
dilated cardiomyopathy, valvular stenosis, pericardial
tamponade, or constrictive pericarditis can also cause
low cardiac output and small peripheral pulses.
Absence of a pulse could also suggest an occlusion by
thrombus, embolus, or dissection. Unilateral absence
of a pulse can aid in the diagnosis of a dissected aortic
aneurysm. Intermittent loss of pulse can be seen in
cardiac tamponade and cardiac herniation. [5]
‘inTyae:m[a< zItI-av>’
‘Nityoshmaanaam sheeti bhaavaha’ [Verse 4] [3]
Spontaneous temperature fluctuations occur
commonly in neurological patients. Thermo-
dysregulation after spinal cord injury causes
dysfunction of the peripheral warm/cold receptors,
autonomic control, and sweating mechanisms.
Hypothermia can be caused by cold exposure, severe
infection, and endocrine abnormalities. Paroxysmal
hypothermia with hyperhidrosis (PHH), multiple
sclerosis (MS), and Wernicke encephalopathy (WE)
are associated with spontaneous episodic hypothermia.
Lower body temperatures in patients with infections
are associated with an extremely high mortality rate.
Hypothermia is one of the most important prognostic
factors for poor outcome in trauma patients. Old age,
comorbid conditions, and comatose state are associated
with an increased incidence of spontaneous
hypothermia in patients with brain injury. [6]
Two
important cutaneous microvascular disorders that may
be related to altered reflex or local thermoregulation
are ‘Raynaud phenomenon’ and ‘Erythromelalgia’.
Reduced vascular density, impaired local vasodilator
responsiveness, and reflex sympathetic dysfunction are
responsible for above two conditions. [7]
Decreased
local temperature also suggests ischemia or reduced
blood flow to that part.
‘m&dUna< daé[Tvm!’
‘Mrudunaam darunatvam’ [Verse 4] [3]
Those structures or body parts which are soft in nature
becoming hard or firm on palpation (hard or firm
consistency) is considered as arishta. For example, on
palpation, hard consistency of liver denotes primary or
secondary malignancy of liver. On palpation, ‘hard but
yielding consistency’ is found in chondroma, ‘bony
hard yielding consistency’ denotes osteoma, ‘stony
hard consistency’ denotes carcinoma and ‘variable
consistency’ denotes malignancy either carcinoma or
sarcoma.
‘ðú[ana< orTvm!’
‘Slakshnaanaam kharatvam’ [Verse 4] [3]
The word ‘Kharatva’ denotes various pathological
conditions like fibrosis or sclerosis or hyperplasia or
patches or lichenification or scaling etc. Fibrosis is the
formation of excess fibrous connective tissue in an
organ or tissue. Sclerosis is the stiffening of a tissue or
anatomical structure, caused by a replacement of the
normal organ-specific tissue with connective tissue.
Hyperplasia is enlargement of an organ or tissue caused
by an increase in the reproduction rate of its cells,
generally seen in the initial stages of cancer. Rough or
scaly or patchy skin is observed in various skin
conditions like chronic eczema, secondary syphilis,
leishmaniasis, onchodermatitis, icthyosis and
tuberculoid leprosy etc. Rough skin is also seen in
hypothyroidism (myxoedema). ‘Kharatva’ also
denotes hyperplasia of skin.
‘stamsÑav>’
‘Sataam asadbhaavaha’ [Verse 4] [3]
Atrophy is a process of waste away of body tissue or
an organ, due to degeneration. For example, in
testicular atrophy the testes shrink due to loss of some
germ and leydig cells. Secondary testicular atrophy
may occur due to ischemia, carcinoma, mumps orchitis
and acquired cryptorchidism. Atrophy of various body
parts or organs denotes underlying carcinoma or
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‘SvedanubNx> StM-ae va’
‘Swedaanubandhaha stambho vaa’ [Verse 4] [3]
The word ‘SvedanubNx>’ denotes excessive sweating
(generalized or regional) hyperhydrosis (secondary in
the arishta lakshana’s context). Secondary
hyperhydrosis is seen in various conditions like
carcinoid, lymphoma, various malignancies, Frey’s
syndrome, insulinoma, pheochromocytoma,
hyperthyroidism, diabetes (due to neuropathy or
hypoglycaemia), various infectious diseases,
endocarditis, chronic malaria, brucellosis, HIV,
vascular deformities and idiopathic unilateral focal
hyperhydrosis etc. Horner’s syndrome with loss of
sweating from one side of the face can cause
compensatory hyperhidrosis from the contra lateral
side. [8]
The word ‘Sved StM->’ denotes absence of
sweating or anhidrosis in which the body does not
respond appropriately to thermal stimuli by sweating.
Anhidrosis (secondary) can be seen in various
conditions like ‘Multiple system atrophy’ (MSA),
Parkinson’s disease (PD), Dementia with Lewy bodies
(BLD), stroke, Multiple sclerosis (MS), tumours and
infections etc which involves autonomic pathways.
Anhidrosis is also observed in other conditions such as
‘Pure autonomic failure’ (PAF), sensory motor
polyneuropathy in diabetes, Guillain-Barre’s syndrome
(GBS), Autoimmune autonomic gangliopathy (AAG),
amyloidosis, alcoholic neuropathy, Fabry disease,
Ross syndrome, systemic sclerosis, and Acquired
idiopathic generalized anhidrosis (AIGA). [9]
‘ma<szaei[tyaevIRtI-av>’
‘Maamsa sonithayo veetee bhavaha’ [Verse 4] [3]
‘vItI-av> Ait]I[Tvm!’
‘Veetee bhavaha ati ksheenatvam’[Chakrapani, Verse 4]
[3]
The above condition denotes ‘Cachexia’. Cachexia is
described as a wasting syndrome involving loss of
muscle and fat directly caused by tumour factors, or
indirectly caused by an aberrant host response to
tumour presence. The etymology of the word cachexia
points to its association with poor prognosis and it has
long been recognised as a key sign in many cancers. It
is a multi-factorial condition which comprises skeletal
muscle and adipose tissue loss. Cachexia correlates
with poor performance status and quality of life with a
high mortality rate in cancer patients. [10]
According to
a study ‘refractory cachexia’ develops approximately
90 days before death in cancer patients. Various terms
are prevalent related to cachexia like ‘cancer cachexia’,
‘cardiac cachexia’, ‘pulmonary cachexia’, and so on,
are generally accepted. Progressive deterioration of
nutritional status is frequently observed in patients
suffering from acute and chronic diseases. Cachexia
also known as disease-associated malnutrition is
associated with negative effects on patients’ morbidity,
mortality and quality of life (QoL). [11]
Chronic heart
failure (CHF) patients develop a generalized wasting
syndrome with extremely poor prognosis termed as
‘cardiac cachexia’. Cardiac cachexia in CHF patients is
associated with weight loss, loss of lean tissue, gross
reduction in fat tissue mass (i.e. energy reserves),
reduced bone mineral density (osteoporosis), reduction
in total body fat and impaired peripheral blood flow.
[12]
‘%CD!vasae=itdI"aeR=itÿSvae va’
‘Ucchwaaso ati deergho ati hrasvo vaa’ [Verse 6] [3]
There are multiple types of abnormal respiration. They
include apnea, orthopnea, dyspnea, hyperpnea,
hyperventilation, hypoventilation, tachypnea,
Kussmaul respiration, Cheyne-Stokes respiration,
sighing respiration, Biot respiration, apneustic
breathing, central neurogenic hyperventilation, and
central neurogenic hypoventilation etc. Apneustic
breathing is is characterized by regular deep
inspirations with an inspiratory pause followed by
inadequate expiration. This respiratory pattern is often
associated with severe brain injury and carries a poor
prognosis. [13]
Prolonged exhalation (‘pursed-lip’ in
severe cases) caused by chronic intra thoracic
obstruction is seen in patients with chronic obstructive
pulmonary disease (COPD) (which includes
emphysema and chronic bronchitis). Obstructive lung
diseases (such as asthma, COPD, cystic fibrosis,
bronchiectasis) cause more difficulty with exhaling air.
Various abnormal breathing patterns occur due to an
underlying cardiac, respiratory or central nervous
system pathology.
‘mNye pirm&Zymane n SpNdyatam!’
‘Manye parimrushyamaane na spandayaataam’
[Verse 6] [3]
‘Manya’ denotes carotid arteries. Palpation of the
carotid arterial pulse provides a clue to the LV (left
ventricle) stroke volume; a small pulse suggests a
reduced stroke volume, whereas a sharp brief upstroke
is often observed in patients with mitral regurgitation
(MR) or ruptured ventricular septum with a left-to-
right shunt. [5]
A weak or impalpable carotid pulse is
indicative of severe aortic stenosis. [14]
The hypokinetic
carotid artery pulse is found in patients with a reduced
stroke volume. This group includes patients with
hypovolemia, left ventricular failure, and mitral
stenosis. [15]
‘dNta> pirkI[aR> ñeta jatzkRra>’
‘Dantaaha --- jaatasharkaraaha’ [Verse 6] [3]
‘pirkI[aR #it mlilPta’
‘Parikeernaa iti malaliptaa’ [Chakrapani, Verse 6] [3]
The word ‘pirkI[aR’ indicates dental plaque, ‘ñeta’ indicates
chalky white discoloration of teeth and ‘jatzkRra’
indicates dental calculus. The presence of clinically
detectable, localized areas of enamel demineralization,
observed as white spot lesions of different opacity, is a
sign that the caries process has begun. The subsurface

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porosity caused by demineralization gives the lesion a
milky appearance which can be found on the smooth
surfaces of teeth. White spot lesions are also seen in
fluorosis, hypomineralization, hypomaturation and
hypoplasia. [16]
Chronic periodontitis is an infectious
inflammatory disease caused by the bacteria of the
dental plaque, resulting in the progressive destruction
of the tissues that support the teeth. Plaque
accumulation (pirkI[aR #it mlilPta), calculus formation
(jatzkRra), gingival redness and swelling, gingival
bleeding and suppuration may occur spontaneously in
periodontitis. Chronic periodontitis is associated with
coronary heart disease (CHD), atherosclerotic
cardiovascular disease or its sequelae, COPD, bacterial
pneumonia, and rheumatoid arthritis. Chronic
periodontitis is associated with head and neck
squamous cell carcinoma (HNSCC), especially in the
oral cavity, followed by the oropharynx and larynx. A
significant association was found between the history
of periodontitis and risk of developing lung, kidney,
pancreas, and hematological cancers. However, the
most consistent increased risk was noted in the studies
of oral and esophageal cancers and periodontal disease.
Gastric and pancreatic cancers had an association with
periodontitis in most of the studies. Patients with
periodontal disease were more likely to have poorly
differentiated oral cavity squamous cell carcinoma
(SCC). [17]
‘púmai[ jqabXdain’
‘Pakshmaani jataabaddhaani’ [Verse 6] [3]
Matted eyelashes can be seen in ‘Blepharitis’. Matted
eyelashes may also denote ‘Seborrheic deramtitis’
(SD). SD often presents as well-defined erythematous
plaques with greasy-looking, yellowish scales of
varying extents in regions rich in sebaceous glands,
such as the scalp, the retro-auricular area, face
(nasolabial folds, upper lip, eyelids and eyebrows), and
the upper chest. SD is more prevalent in immune-
compromised patients such as HIV/AIDS patients and
patients with lymphoma. SD is also associated with
neurological disorders and psychiatric diseases, such as
Parkinson’s disease (PD), neuroleptic induced
parkinsonism, tardive dyskinesia, traumatic brain
injury, epilepsy, facial nerve palsy, spinal cord injury,
depression, chronic alcoholic pancreatitis, hepatitis C
virus and in patients with congenital disorders such as
Down syndrome. [18]
‘kezlaemaNyayMymanain àluCyern! n ceÖedyeyu>’
‘Keshaloma ---- vedayeyuhu’ [Verse 6] [3]
‘Hypoesthesia’ is decreased sensitivity to stimulation
whereas ‘Hypoalgesia’ denotes decreased sensitivity to
painful stimuli. [19]
Lack of pain sensation while
plucking hair denotes various underlying conditions
like neuropathies or neuronopathies. Neuropathic
disorders encompass those that affect the neuron’s cell
body or neuronopathies, those affecting the peripheral
process, or peripheral neuropathies. The peripheral
neuropathies can be broadly subdivided into the
myelinopathies and axonopathies. Sensory
neuronopathy (ganglionopathy) is seen in cancer
(paraneoplastic), idiopathic sensory neuropathy and
HIV related neuropathy. Most of the patients with
sensory loss associated with peripheral neuropathy
(e.g., cryptogenic sensory polyneuropathy or CSPN
and diabetes) clinically show diminished light touch,
pin, and vibration sensation. [20]
Hypoesthesia is also
seen in tabes dorsalis, parietal lobe lesions, Brown-
sequard syndrome (BSS) and leprosy.
‘%dre isra> àkazer|! ZyavtaènIlhirÔzuKla va’
‘Udare siraaha ---- shuklaa vaa’ [Verse 6] [3]
Enlarged tortuous superficial abdominal veins are seen
in various conditions like IVCS (inferior vena cava
syndrome), hepatic sarcoidosis, portal hypertension,
cirrhosis of liver with caput medusae, alcoholic liver
disease, Budd chiari syndrome, and spider nevi in
hepatitis C etc.
‘noa> vItma<szaei[ta> pKvjaMbvv[aR>’
‘Nakhaa --- varnaaha’ [Verse 6] [3]
Discoloration of nails (purple or blue or black) along
with atrophy denotes various underlying systemic
diseases. Cyanosis may manifest as blue or purple
discoloration of the nail bed and digits due to lower
oxygen saturation causing accumulation of
deoxyhemoglobin in the small blood vessels of the
extremities. Central cyanosis is caused by congenital
heart diseases whereas peripheral cyanosis is caused by
vasoconstriction and diminished peripheral blood flow
due to exposure to cold, shock, congestive cardiac
failure, and peripheral vascular disease. Melanonychia
(brown or black lines on nails) may be due to an
underlying melanocytic nevus or malignant melanoma,
hemochromatosis, malnutrition, thyroid disease,
smoking, HIV infection, and Addison's disease. [21]
Vasoreactive individuals often have a perniotic
circulation, especially at the hands and feet
(acroperniosis). At rest, a perniotic circulation is
characterized by a cold purplish (pKvjaMbvv[R) periphery.
In perniosis, cold can cause vasoconstriction severe
enough to induce temporary distal ischaemia. This
prolonged vasoconstriction would be able to cause
prolonged relative hypoxia at the periphery which may
cause pulp atrophy (vItma<szaei[t) and secondary
curvature and hyperplasia of finger nails. [22]
The
purplish discoloration along with atrophy of nails
denotes ischemia or gangrene.
‘A<¼uly AayMymana n S)uqeyu>’
‘Angulaya ---- na sphuteyu’ [Verse 6] [3]
Loss of ability to crack one’s knuckles is one of the
manifestations of hyperparathyroidism. Soft tissue
calcification in secondary hyperparathyroidism
reduces tendon elasticity and restricts finger joint
motion. This limitation reduces the vacuum and

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cavitation caused by phalanx flexion, and thereby
attenuates or eliminates the audible ‘pop’ or cracking
of the knuckles. Articular and other musculoskeletal
manifestations of secondary hyperparathyroidism have
been a longstanding concern for patients with chronic
kidney disease. [23]
Benign joint hypermobility
syndrome (BJHS) is characterized by generalized joint
laxity and hypermobility. Hypermobility may occur in
several different connective tissue disorders including
Marfan syndrome, Ehlers–Danlos syndrome (EDS),
and osteogenesis imperfecta, Down syndrome,
metabolic disorders (homocystinuria and
hyperlysinemia) and Juvenile rheumatoid arthritis. [24]
‘sNxIna< ö<sæ<zCyvnain’
‘Sandheenaam --- chyavanaani’ [Verse 4] [3]
ö<s> mnaGgmnm! , æ<zStu sudUraxaegmnm!, xavn< tu paZvRtae gmnm!.
‘Sramsaha --- gamanam’ [Chakrapani, Verse 4] [3]
The word ‘ö<s>’ denotes subluxation (subluxation of
temporomandibular joint or TMJ), ‘æ<z>’ denotes
dislocation (shoulder dislocation) and ‘xavn<’ denotes
deviation (ulnar deviation in rheumatoid arthritis) or
varus or valgus deformities (genu valgum & genu
varum) of various joints. Generalized joint laxity is
characterized by increased length and elasticity of
normal joint restraints, resulting in an increased range
of motion and increased distractibility. This
hyperlaxity can be congenital and acquired. Congenital
hyperlaxity is caused by connective tissue disorders,
such as Ehlers-Danlos syndrome, Marphan syndrome,
osteogenesis imperfecta, and benign hypermobility
syndrome. Acquired joint hyperlaxity is seen in
athletes (swimmers, gymnasts, pitchers, etc). The term
“multidirectional instability” (MDI) is defined as
symptomatic involuntary instability of the
glenohumeral joint in more than one direction (anterior
and/or posterior, and inferior). [25]
Hypermobility is
seen in various conditions like ‘Benign joint
hypermobility syndrome’ (BJHS), Marfan syndrome,
‘Ehlers–Danlos syndrome’ (EDS), and osteogenesis
imperfecta, ‘Down syndrome’, metabolic disorders
(homocystinuria and hyperlysinemia) and ‘Juvenile
rheumatoid arthritis’. [24]
‘tSy cet! pirm&Zyman< p&wKTven pad j<"aeé iS)gudr paZvR p&óei;ka pai[ ¢Iva
taLvaeó llaq< iSvÚ< zIt< StBx< daé[< vItma<szaei[t< va Syat!’
‘Tasya chet --- vaa syaat’ [Verse 5] [3]
Various pathological findings like ‘iSvÚm!’ (Secondary
hyperhydrosis either generalized or localized seen in
various conditions like carcinoid, lymphoma,
malignancies, insulinoma, pheochromocytoma,
hyperthyroidism, diabetes, infectious diseases,
endocarditis, brucellosis, HIV, vascular deformities,
idiopathic unilateral focal hyperhydrosis and Horner’s
syndrome etc), [8]
‘zItm!’ (Generalized or localized
hypothermia due to various conditions like ischemia,
erythromelalgia, reflex sympathetic dysfunction,
Raynaud phenomenon, brain injury or severe trauma,
Wernicke encephalopathy, Multiple sclerosis,
paroxysmal hypothermia with hyperhidrosis, severe
infections and endocrinal abnormalities etc), [6&7]
‘StBxm!’ (Hypertonia or rigidity or spasticity etc seen in
diseases of basal ganglia or extrapyramidal system
such as parkinsonism, Huntington’s disease, dystonia,
Tourette syndrome, Wilson’s disease, blepharospasm,
and other conditions like fibromyalgia,
hypothyroidism, tetanus, epilepsy, and frozen shoulder
etc), ‘daé[m!’ (Stony hardness seen in carcinoma or
sarcoma) and ‘vItma<szaei[tm!’ (Pulmonary, cardiac and
cancer cachexia or atrophy seen in carcinoma and
various other chronic debilitating diseases) occurring
spontaneously (without any visible or known reason or
cause) at various parts of the body (feet, legs, thighs,
buttocks, abdomen, spine, ribs, neck, hands, palate, lips
and forehead) denote Arishta lakshana’s.
‘tSy cet! p&wKTven guL) janu v<][ gud v&;[ meF+na_y<sStn mi[k pzuRka hnu
naiska k[aRi] æU zŒadIin öStain VyStain Cyutain Swane_y> SkÚain va
Syu>’
‘Tasya chet --- vaa syuhu’ [Verse 5] [3]
Manifestation of various pathological features
(spontaneously without any known cause) like, ‘öSt’
(subluxation or dislocation or laxity or flaccidity), ‘VySt’
(altered or dispersed or seperated), ‘Cyut’ (prolapsed or
fallen or dropped), and ‘SkÚ’ (trickled down or emitted
or thickening or clotting) at various body parts (ankle,
knee, inguinal, anus, testicles, penis, umbilicus, wrist,
breast, shoulder, ribs, jaw, nose, ears, eyes, eyebrows
and temple region) indicates or denote Arishta (Table
1).
‘tSy ce½]u;I àk&ithIne ivk&ityuKte ATyuiTpi{fte Aitàivòe Aitijüe Aitiv;me
AitmuKtbNxne Aitàs&te sttaeiNmi;te sttinimi;te inim;aeNme;aitàv&Tte
ivæa<td&iòke ivprItd&iòke hInd&iòke VyStd&iòke nkulaNxe kpaetaNxe Alatv[eR
k&:[pItnIlZyavtaèhirthirÔzuKlvEkairka[a< v[aRnamNytmenaitPlute va
Syata< tda prasuirit iv*at!’
‘Tasya chet ---- vidyaat’ [Verse 6] [3]
Various aristha lakshana’s related to netra (eye) are
explained in the above verse (Table 2).
CONCLUSION:
Some medical ethics & etiquette regarding palpation
are mentioned in this chapter. The importance of
proper knowledge or training regarding identification
of Arishta lakshana’s is essential and it makes the
physician confident while prognosticating and
minimizing personal biases. Concepts such as medical
ethics & etiquette regarding palpation are mentioned in
this chapter. Various pathological technical terms like
‘Aspandanm’ (absence of pulsations), ‘Darunatvam’
(stony hardness or induration), ‘ Kharatvam’ (sclerosis
or licehnification or scaling), ‘Asat bhava’ (atrophy),
‘Sramsa’ (subluxations), ‘Bhramsha’ (dislocations),

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‘Swedanubandha’ (hyperhidrosis), ‘Sweda stambha’
(anhidrosis), ‘Mamsa shonita veeti bhava’ (cachexia /
sarcopenia / atrophy), ‘ Sheetam’ (hypothermia),
‘Stabdham’ (rigidity / spasticity), ‘Chyuta’ (prolapse),
and ‘Skanna’ (clotting) etc are mentioned in this
chapter along with arishta lakshanas related to eyes
which are having profound clinical importance. The
concepts mentioned in this chapter needs to be
standardized. Further research works are required to
substantiate the opinions or claims mentioned in this
chapter.
Table 1: Sparshagata Arishta lakshanas
Part of the body Relevant conditions
guL) (Ankle) Foot drop / Functional or chronic ankle instability / Predislocation syndrome / Subluxations and
dislocations of ankle joint / Inflammatory joint disease / Multiple sclerosis / Amyotrophic lateral
sclerosis / Charcot-Marie-Tooth disease etc
janu (Knee) Subluxation & dislocation of patella / Genu valgum & varum / Rickets / Inflammatory joint diseases /
Rupture of quadriceps tendon
v<][
(Inguinal or Hip)
Acetabular rim syndrome / Avascular necrosis / Hip dysplasia / Labral tears / Dislocation of hip /
Femoroacetabular impingement (FAI) / Acetabular dysplasia / Poliomyelitis / Femoral neck fracture
(due to osteoporosis)
Gud (Anus) Rectal prolapse or Procidentia / Adenocarcinoma of rectum or sigmoid colon / Rectosigmoid tumour
/ Ischio rectal abscess etc
v&;[
(Testicle / Scrotum)
Acquired cryptorchidism / Testicular torsion / various tumours of testes / Anteversion and inversion
of testis etc
meF+ (Penis) Peyronie’s disease / Lichen sclerosis / Fournier’s gangrene / Buried penis / Idiopathic partial
thrombosis of corpus cavernosum (IPT) / Ischemic priapism etc
Naai- (Umbilicus) Exomphalos / Umbilical or paraumbilical hernias / Everted umbilicus due to intra abdominal
neoplasms etc
A<s (Shoulder) Subluxation & dislocation of shoulder / winging of the scapula / Sprengel’s deformity / Glenohumeral
joint dysplasia / Rotator cuff disease (RCD) / Adhesive capsulitis (frozen shoulder) / Subacromial
impingement syndrome (SIS) / Labral tears etc
Stn (Breast) Benign tumours and carcinoma of breast / Retracted, deviated, inverted and flattened nipples (due to
abscess or neoplasms)
mi[k (Wrist) Radial or ulnar deviation / Flexion deformity / Rheumatoid hand / Madelung’s deformity / Preiser’s
disease / Kienbock’s disease / Ligament tears / Motor neuron disease (MND) / Wrist drop / Varus and
Valgus deformities of wrist / Rickets / Lunate or perilunate dislocations etc
pzuRk (Rib) Metastatic rib lesions / Gorham disease / Chondrosarcoma / Fibrous dysplasia / Rib fractures / Cervical
rib / Paget disease / Kyphosis / Scoliosis / Rachitic rosary etc
hnu (Jaw) Subluxation or dislocation or ankylosis of TMJ (Temporomandibular joint) / Trismus / Oromandibular
dystonia
Naaisk (Nose) Saddle nose / Septal deviation / Sinonasal tumours / Rhinoscleroma / Leprosy / Nasal polyps etc
k[R (Ear) Protruding or bat ears / Cup shaped or low-set ears in Down syndrome / Cauliflower ears / Mastoid
abscess / Ear tumours
Ai] (Eye) Exophthalmos (in Graves’ disease) / Enophthalmos / Squint / Retro orbital or orbital tumours /
Ophthalmoplegia etc
æU (Eyebrow) Madarosis / Facial nerve palsy / Horner syndrome / Myasthenia gravis / Brow tumours like
pleomorphic adenoma etc
zΠ(Temple region) Multiple venous malformations with phleboliths at temples / Giant cell arteritis / Intra cranial abscess
/ Temporal osteitis or myositis / Multiple myeloma / Maxillary carcinoma etc
Table 2: Netragata Arishta lakshanas
Arishta lakshana Relevant conditions
ATyuiTpi{fte
(Exophthalmos)
Graves ophthalmopathy / Retro orbital or orbital tumours / Orbital cellulitis / Severe glaucoma etc
Aitàivòe
(Enophthalmos)
Horner’s syndrome / Marfan syndrome / Duane’s syndrome / Silent sinus syndrome / Phthisis bulbi /
Atrophy etc
Aitijüe
(Crossed eyes)
Squint or Strabismus / Acquired paralytic strabismus in Diabetes / Graves disease / Guilain-Barre
syndrome (GBS) / Stroke / Brain tumours / Hydrocephalus / Cerebral palsy etc
Aitiv;me
(Uneven)
Irregular astigmatism / Keratoconus / Central cornea islands / Map-Dot-Fingerprint dystrophy (MDF) /
Cysts or tumours in one eye etc
AitmuKtbNxne
(Plegia)
Ophthalmoplegia / Myasthenia gravis / GBS / Kearns-Sayre syndrome / Foville’s syndrome / Internuclear
ophthalmoplegia / Multiple sclerosis / Parinaud’s syndrome / Stroke / Wernicke encephalopathy /
Cavernous sinus syndrome / Paralysis of cranial nerves (CN III, IV & VI) etc
Aitàs&te
(Watering eyes)
Epiphora / Allergic or infective conjunctivitis / Trichiasis / Ectropion / Keratitis / Corneal ulcers /
Chalazion / Bell’s palsy / Dacrocystitis / Punctal eversion / Stevens-Johnson syndrome / Neoplasms etc

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sttaeiNmi;te
(Lagophthalmos)
Lagophthalmos / Symblepharon formation / Acquired oculomotor synkinesis / Exophthalmos / Facial palsy
/ Ectropion etc
sttinimi;te
(Drooping / Ptosis)
Ptosis / Ocular myopathies / Horner’s syndrome / Cranial nerve palsy (CN III) / Myasthenia gravis /
Stevens-Johnson syndrome / Atrophy etc
inim;aeNme;aitàv&Tte
(Excessive blinking)
Corneal abrasion / Trichiasis / Inflammatory or allergic conditions of eyes / Benign essential
blepharospasm / Meige syndrome / Tics etc
ivæa<td&iòke
(Dancing eyes)
Nystagmus / Cataracts / Strabismus / Meniere’s disease / Multiple sclerosis / Stroke / B12 or Thiamine
deficiencies / Brain tumours etc
ivprItd&iòke
(Distorted vision)
Metamorphopsia / Age related macular degeneration / Astigmatism / Keratoconus / Glaucoma / Migraine
/ Epiretinal membrane etc
hInd&iòke
(Defective vision)
Central retinal artery or vein occlusion / Ischemic optic neuropathy / Vitreous haemorrhage / Retinal
detachment / Acute glaucoma / Transient ischemic attack / Tumours or infections in brain etc
VyStd&iòke
(Oscillopsia)
Seizures / Multiple sclerosis / Superior oblique myokymia / Stroke / Meningitis / Brain tumours / Meniere’s
disease etc
nkulaNxe
(Nyctalopia)
Congenital high myopia / Tapeto-retinal degeneration / Glaucoma / Cataract / Diabetes / Retinitis
pigmentosa / Vitamin A deficiency etc
kpaetaNxe
(Hamarlopia)
Cone dystrophy / Achromatopsia / Central lenticular opacity / Central cataracts / Cancer associated
retinopathy (CAR) etc
Alatv[eR
(Bloodshot eyes)
Chemosis / Various inflammatory & allergic conditions / Acute conjunctivitis / Sub conjunctival
haemorrhage / Glaucoma etc
ANy vEkairk v[aRin
(Eye discoloration)
Panda eye / Jaundice / Heterochromia iridis / Iris nevi / Pigment dispersion syndrome / Horner’s syndrome
/ Osteogenesis imperfecta / Arcus senilis / Keyser Fleischer ring in Wilson’s disease etc
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CITE THIS ARTICLE AS –
Mamidi P. et.al., Parimarshaneeyam of Charaka Indriya Sthana - An Explorative Study, Int. J. Ayu. Alt. Med., 2019; 7(5): 183-191
(DOI: https://doi.org/10.36672/ijaam.2019.v07i05.003)
Source of Support – Nil Conflict of Interest – None Declared.

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