Unit 30. Enumeration, Nidāna Pañcaka and Sādhya-asādhya-tā of Śiroroga

Unit 30. Enumeration, Nidāna Pañcaka and Sādhya–Asādhyata of Śiroroga

A) Śiroroga: Enumeration, Sāmānya Nidāna, Saṃprāpti, Sāmānya Lakṣaṇas, Sādhya–Asādhyata

1) Paribhāṣā and Enumeration (Types)

Śiroroga—diseases of the head (śiras—chief seat of indriyas) comprise doṣaja and viśeṣa types. Ācārya Vāgbhaṭa enumerates the head-diseases discussed in the adhyāya and concludes:

श्लोक:
“सूर्यावर्तः स इत्युक्ता दश रोगाः शिरोगताः॥” (Aṣṭāṅgahṛdaya, Uttarasthāna 23/20)

Implied list from the same adhyāya:

1. Vātaja śirastāpa (vāta-dominant)
2. Pittaja śirastāpa
3. Kaphaja śirastāpa
4. Raktaja śirastāpa
5. Sannipātaja śirastāpa
6. Kṛmija śiroroga
7. Ardhāvabhedaka
8. Śaṅkhaka
9. Sūryāvarta
10. (Anantavāta is described elsewhere in Śālākya, yet many syllabi include it in the global list of śiras-vyādhis.)

Note: In Suśruta’s Śālākya (Uttara-tantra), the classical listing often cited for exam answers includes 11: Vātaja, Pittaja, Kaphaja, Sannipātaja, Raktaja, Kṣayaja, Kṛmija, Ardhāvabhedaka, Sūryāvarta, Śaṅkhaka, Anantavāta. For this unit we will anchor shlokas from Aṣṭāṅgahṛdaya Uttarasthāna 23 for nidāna–lakṣaṇa and viśeṣa rūpas, as below.

2) Sāmānya Nidāna (Common Etiology)

Aṣṭāṅgahṛdaya provides a compact nidāna for śiro-roga:

श्लोकाः:
“धूमातपतुषाराम्बु-क्रिडातिस्वप्नजागरैः ॥१॥
उत्स्वेदाधिपुरोवात-बाष्पनिग्रह-रोदनैः ॥१॥
अत्यम्बुमद्यपानेन कृमिभिर्वेगधारणैः ॥२॥
उपधानमृजाभ्यङ्ग-द्वेषादः-प्रततेक्षणैः ॥२॥
असात्म्यगन्ध-दुष्टामभाष्याद्यैश्च शिरोगताः ॥३॥
जनयन्त्यामयान् दोषाः ॥३॥” (A.H. Uttara 23/1–3)

Vārtā (meaning for study): Smoking/soot (dhūma), sun-exposure (ātapa), cold/frost (tuṣāra), excessive water sports, over-sleeping/keeping awake, profuse sweating, against-wind exposure, suppression of tears, ati-water & alcohol intake, worms, suppression of natural urges, aversion to pillow/oiling, constant downward gaze, asātmyagandha and duṣṭa-bhojya—all vitiate doṣas in śiras and produce disease.

3) Saṃprāpti (Pathogenesis)

• Doṣa–duṣya sammūrcchanā occurs in śiras owing to repeated nidānas causing vāta prakope (main driver), with pitta and kapha joining variably.
• Srotas: Manovaha, Prāṇavaha and Raktavaha srotas in the ūrdhvajatrugata sphere get involved; sirā-jāla sphuraṇa (pulsation/spasm) and śira–sandhi vedanā evolve.
• Adhīṣṭhāna: Śiras (uttamāṅga)—rich in indriya–marma; small doṣa shifts yield large symptom load (śabda/āloka intolerance, bhrama etc.).
• Kriyākāla: With continued nidāna, sthāna-saṃśraya in śiras → vyakti as śirastāpa/śirahśūla with doṣa-specific bhāvas; upadrava like nausea, netra–karṇa involvement ensue.

Diagnostic tip: Mark the guṇa profile: rūkṣa–śīta–laghu (vāta), uṣṇa–tīkṣṇa (pitta), guru–śīta–snigdha (kapha), along with raktadūṣṭi signs.

4) Sāmānya Lakṣaṇas (Common Clinical Features)

• Śiraḥ-śūla/śirastāpa, ghūrṇi (giddiness), nidrā–vikāra, karṇa-nāda, āloka-asahatā, bhrūmadhya–lalāṭa pain, sirā-jāla sphuraṇa, kandharā/hanusaṅgraha (neck–jaw stiffness). Many are directly captured in Vāgbhaṭa’s verses for vāta-janya śirovyādhi:

श्लोकाः (Vātaja śirastāpa—core picture):
“तत्र मारुतकोपतः ॥३॥
निस्तुद्येते भृशं शङ्खौ, घाटा संभिद्यते तथा ॥४॥
भ्रुवोर्मध्यं ललाटं च पततीवाति-वेदनम् ॥४॥
बाध्येते स्वनतः श्रोत्रे, निष्कृष्येत इवाक्षिणी ॥५॥
घूर्णतीव शिरः सर्वं, सन्धिभ्य इव मुच्यते ॥५॥
स्फुरत्यति सिराजालं, कन्धरा–हनुसंग्रहः ॥६॥
प्रकाशासहता घ्राण–स्रावोऽकस्माद् यथाशमौ ॥६॥
मार्दवं मर्दन–स्नेह–स्वेद–बन्धैश्च जायते, शिरस्तापोऽयम् ॥७॥” (A.H. Uttara 23/3–7)

5) Nidāna Pañcaka of Śiroroga (Exam-ready)

(i) Nidāna (Hetu): As above (A.H. 23/1–3). Add: vegādhāraṇa, śīrṣa–abhitāpa (sun/heat), atipāna, viṣamāhāra, asātmyendriya-artha-saṃyoga for the head.

(ii) Pūrvarūpa (Prodrome): Dull head heaviness, tandrā, āloka-asahatā, karṇa-nāda, mild ghūrṇi, eye fatigue; with doṣa-hints—

• Vāta: pricking twinges at śaṅkha, intermittent stiffness.
• Pitta: heat, burning, early photophobia.
• Kapha: morning heaviness, nasal ooze, tandrā.

(iii) Rūpa (Vyaktalakṣaṇa): Doṣa-specific lakṣaṇas (below §B); śūla/tāpa pattern (diurnal) and triggers define subtype (e.g., sūryāvarta worsens till mid-day).

(iv) Upadrava: Chardī, mūrcchā, jvara, bhrama, netra/karṇa-vyathā, karṇa-nāda; in kṛmija—kaṇḍū, pūtitā, siṅghāṇaka, foul discharge.

(v) Saṃprāpti: Doṣa prakopa → śiras-sthāna saṃśraya → sira–daurmanasya, sirājāla sphuraṇa (vasospasm/engorgement), indriya-asahatā → vyakti as śirastāpa/śirahśūla with periodicity (e.g., ardhāvabhedaka).

6) Sādhya–Asādhyata (Prognosis)

General principles (exam line):

• Eka–doṣaja (vāta/pitta/kapha) without dīrgha-kāla and bāla–vṛddha–garbha status: Sādhya/Kṛcchra-sādhya.
• Sannipāta, kṛmija, raktadūṣṭa, kṣaya–sahita, śaṅkhaka: Kṛcchra-sādhya to Asādhya depending on bala.

Supportive ślokas on severity:

• Śaṅkhaka—vaidyotsava (emergency):
  “पित्तप्रधनैर्वाताद्यैः शङ्खे शोपः सशोणितैः,
  तीव्रदाह–रुजाराग–प्रलाप–ज्वर–तृड्–भ्रमाः;
  तिक्तास्यः पीतवदनः क्षिप्रकारी स शङ्खकः;
  त्रिरात्राज्जीवितं हन्ति, सिद्ध्यत्यप्याशु साधितः॥” (A.H. Uttara 23/16–17)
• Ardhāvabhedaka—periodic course:
  “अर्धे तु मूर्ध्नः सोऽर्धावभेदकः; पक्षात् कुप्यति, मासाद्वा स्वयमेव च शाम्यति;
  अतिवृद्धस्तु नयनं श्रवणं वा विनाशयेत्” (A.H. Uttara 23/7–8)
• Kṛmija—severe, foul, neuro-sensory involvement:
  “सङ्कीर्णैर् भोजनेर्मूर्ध्नि क्लेदित्ते रुधिरामिषे;
  कोपिते सन्निपाते च जायन्ते मूर्ध्नि जन्तवः;
  शिरसस्ते पिबन्तोऽस्रं घोराः कुर्वन्ति वेदनाः;
  चित्तविभ्रंशजननीर्ज्वरः कासो बलक्षयः;
  रौक्ष्य–शोफ–व्यधन–च्छेद–दाह–स्फुरण–पूतिताः;
  कपाल–तालु–शिरसोः कण्डूः शोषः प्रमीलकः;
  ताम्रच्छ–सिंघाणकता, कर्णनादश्च जंतुजे” (A.H. Uttara 23/12–15)

Clinical take-away for viva: Śaṅkhaka can be prāṇahara if not rapidly addressed; ardhāvabhedaka shows pakṣika/cyclicity with potential sensory loss; kṛmija—chronic, kṛcchra-sādhya.

B) Doṣaja Śirahśūla: Vātaja, Pittaja, Kaphaja, Sannipātaja

1) Vātaja Śirahśūla (Vātaja Śirastāpa)

Key idea: Rūkṣa–śīta–cala guṇas cause pricking, migrating, spasmodic head pain; āloka-asahatā, karṇa-nāda, neck–jaw stiffness; mardana–sveda–bandha give relief.

श्लोकाः: (already quoted under Sāmānya Lakṣaṇa) (A.H. Uttara 23/3–7)

Nidāna highlights: Exposure to cold/dry wind, vegadhāraṇa, anātmya vihāra, fasting, over-exertion.
Upaśaya: Snigdha svedana, gentle bandhana, taila-abhyanga; avoid śīta–vāta provokers.
Sādhya: Generally sādhya/kṛcchra-sādhya if recent, in bala patient.

2) Pittaja Śirahśūla

Clinical picture: Burning, heat, jvara, sveda, akṣi-dāha, worse at night with need for cooling.

श्लोक:
“शोरोभितापे पित्तोत्त्हे शोर–धूमायनं ज्वरः;
स्वेदोऽक्षिदहनं मूर्च्छा, निशि शीतैश्च मार्दवम्” (A.H. Uttara 23/9)

Nidāna: Uṣṇa–tīkṣṇa–amla–lavaṇa āhāra, sun/heat exposure, anger.
Upaśaya: Śītala śirolepa, ghṛta-pāna, virecana where indicated.
Sādhya: Good if promptly treated; raktānvita (raktaja) is more severe.

3) Kaphaja Śirahśūla

Clinical picture: Guru–stimitatā, morning heaviness, tandrā, śūnā’kṣi–kūṭatva (puffiness), karṇa-kaṇḍū, vomiting tendency.

श्लोकाः:
“अरुचिः कफजे मूर्ध्नो गुरु–स्तिमित–शीतता;
शिरानिस्पन्दताऽआलस्यं, रुक्ष्मन्दाऽह्न्यधिकानि” (A.H. Uttara 23/10)
“तन्द्रा, शूनाक्षिकूटत्वं, कर्णकण्डूयनं, वमिः” (A.H. Uttara 23/11)

Nidāna: Guru–snigdha–śīta ahāra, day sleep, sedentary habit, kapha-ṛtu exposure.
Upaśaya: Uṣṇa–tīkṣṇa dīpana–pācana, nasya, śirodhūma, lepa with kaṭu–tikta dravyas.
Sādhya: Sādhya if corrected early.

4) Raktaja & Sannipātaja hints (for viva)

• Raktaja:
  “रक्तात् पित्ताधिक–रुजः, सर्वैः स्यात् सर्वलक्षणः** (sannipāta)**” (A.H. Uttara 23/11) → bleeding tendencies, tāpa, dāha, rāga; treat as rakta-pitta variant with raktamokṣa where proper.
• Sannipātaja: Mixed signs of all doṣas, kṛcchra-sādhya; avoid strong śodhana if bāla is low—prefer mṛdu–tridoṣa–śamana.

5) Viśeṣa Rūpas (you must quote in exam)

(i) Ardhāvabhedaka (classical counterpart of recurrent hemicrania/migraine traits)

श्लोक:
“अर्धे तु मूर्ध्नः सोऽर्धावभेदकः; पक्षात् कुप्यति, मासाद्वा स्वयमेव च शाम्यति;
अतिवृद्धस्तु नयनं श्रवणं वा विनाशयेत्” (A.H. Uttara 23/7–8)
Key points: Unilateral, periodic (pakṣika), photophobia/phonophobia common; may impair eye/ear if severe.

(ii) Śaṅkhaka (temporal fulminant hemicrania)

श्लोक: (as above) (A.H. Uttara 23/16–17)
Key points: Rapidly progressive, prāṇāntika if untreated within 3 nights; urgency emphasized.

(iii) Sūryāvarta (diurnal crescendo with sun-rise)

श्लोक:
“पित्तानुबद्धः शङ्खाक्षि–भ्रूललाटेषु मारुतः,
रुजं सस्पन्दनां कुर्याद् अनुसूर्योदय–उदयाम्;
आ मध्यान्हं विवर्धिष्णुः, क्षुद्वतः सा विशेषतः;
अव्यवस्थित–शीतोष्ण–सुखा, शान्त्यतः परम्;
सूर्यावर्तः स इत्युक्ता…” (A.H. Uttara 23/18–20)
Key points: Pain rises from sunrise to midday; hunger worsens; relief with temperature stability.

(iv) Kṛmija Śiroroga

श्लोकाः: (quoted above, A.H. Uttara 23/12–15)
Key points: Kaṇḍū, foul discharge, karṇa-nāda, citta-vibhrama, severe pain—kṛcchra-sādhya.

C) Classification of Headache as per ICHD-3 (for correlation answers)

Primary headaches

1. Migraine – with/without aura; menstrual migraine; chronic migraine.
2. Tension-type headache (TTH) – infrequent/ frequent episodic; chronic.
3. Trigeminal autonomic cephalalgias (TACs) – cluster headache, paroxysmal hemicrania, SUNCT/SUNA, hemicrania continua.
4. Other primary headaches – cough/exertional/sexual activity related; hypnic; stabbing; external-pressure; cold-stimulus; primary thunderclap, etc.

Secondary headaches

• Trauma/cranial–cervical disorders; vascular (SAH, arterial dissection), non-vascular (IIH); infection; homeostasis disorders; substance/withdrawal; head–neck structures (sinusitis, TMJ); psychiatric causes.

Painful cranial neuropathies and facial pains

• Trigeminal neuralgia, glossopharyngeal neuralgia; persistent idiopathic facial pain; burning mouth syndrome etc.

Exam use: Map Ardhāvabhedaka ↔ Migraine, TTH ↔ Kaphaja/Vātaja śirahśūla with dull band-like pain, TAC traits ↔ Śaṅkhaka/Sūryāvarta red flags (autonomic signs, circadian)—state as correlation only.

Rapid Revision (one-minute points)

• Quote A.H. Uttara 23/1–3 for Nidāna.
• Quote A.H. Uttara 23/3–7 for Vātaja lakṣaṇas.
• Quote A.H. Uttara 23/9–11 for Pittaja/Kaphaja/Raktaja/Sannipāta hints.
• Quote A.H. Uttara 23/7–8 (Ardhāvabhedaka), 16–17 (Śaṅkhaka), 18–20 (Sūryāvarta), 12–15 (Kṛmija).
• Prognosis: Śaṅkhaka—prāṇāntika (3 nights); Ardhāvabhedaka—pakṣika; Kṛmija—kṛcchra-sādhya.

Assessment (Exam-oriented)

A. Long Essay (LAQ) — 10 marks

1. Enumerate Śiroroga. Write the Nidāna Pañcaka and Sādhya–Asādhyata in detail. (Include shlokas: A.H. 23/1–3; 3–7; 9–11; 7–8; 16–17; 18–20; 12–15.)

B. Short Essays (SAQ) — 5 marks each

1. Vātaja Śirahśūla—nidāna, lakṣaṇa, upaśaya with A.H. 23/3–7.
2. Pittaja & Kaphaja Śirastāpa—contrast using A.H. 23/9–11.
3. Ardhāvabhedaka—definition, course, prognosis with A.H. 23/7–8.
4. Śaṅkhaka—red-flags and emergency nature with A.H. 23/16–17.
5. Kṛmija Śiroroga—clinical picture with A.H. 23/12–15.

C. Short Answers (SA) — 2 marks each

1. Write any four nidānas of Śiroroga (quote half-verse).
2. Define Sūryāvarta (one śloka line).
3. Mention two features suggesting raktānubandha in head pain.
4. List two srotases implicated in Śiroroga saṃprāpti.
5. State the ICHD-3 primary headache groups.

D. MCQs — 1 mark each (Answer key below)

1. “…अनुसूर्योदय–उदयाम्; आमध्याह्नं विवर्धिष्णु…” refers to:
   a) Ardhāvabhedaka b) Śaṅkhaka c) Sūryāvarta d) Kṛmija
2. “त्रिरात्राज्जीवितं हन्ति…” is stated for:
   a) Vātaja b) Śaṅkhaka c) Kaphaja d) Raktaja
3. Kaṇḍū, pūtitā, siṅghāṇaka, karṇa-nāda are classical in:
   a) Vātaja b) Pittaja c) Kaphaja d) Kṛmija
4. “स्वेदोऽक्षिदहनं मूर्च्छा…” belongs to:
   a) Pittotthe śirastāpe b) Kaphaja c) Vātaja d) Sannipāta
5. ICHD-3 includes which as a TAC?
   a) Chronic migraine b) Cluster headache c) Hypnic headache d) Medication-overuse headache

Answer key: 1-c, 2-b, 3-d, 4-a, 5-b.

Model Phrasing for Theory Answer Sheets

• Start with definition + enumeration (quote “daśa rogāḥ śirogatāḥ”).
• Write Nidāna Pañcaka with at least two śloka lines from A.H. 23/1–3 and one doṣa-lakṣaṇa śloka.
• Add one viśeṣa (Ardhāvabhedaka/Śaṅkhaka) with exact śloka line.
• Conclude with Sādhya–Asādhyata sentences citing A.H. 23 lines (7–8; 16–17).