Vipareeta Avipareeta Swapna Nidarshaneeyam (VASN) is the 29^th chapter of Sutra Sthana of Sushruta Samhita. This chapter has 81 verses that deal with various Shakunas (omens), Doota (caregiver) and Swapna (dreams). The aim of the present work is to provide a comprehensive and critical analysis of the contents of VASN chapter with the help of contemporary prognostic and dream literature. Characteristic features of a caregiver and their influence on patient’s clinical outcome, various omens (both good and bad) and dreams (both auspicious and inauspicious) and their positive or negative prognostic consequences are documented in the VASN chapter. Shakunas of the VASN chapter denote the belief systems that were prevalent in ancient India and the prognostic significance needs to be evaluated further. Interpretation of dreams that are documented in VASN chapter seems to be congruent with the findings of contemporary dream research. Interdisciplinary studies among Ayurveda, Jyotishya Shastra (medical astrology) and modern prognostic science are required to authenticate the good and bad omens and their association with the positive or negative clinical outcomes.

Keywords: Ayurveda, caregiver, dream, Doota, Shakuna, Swapna

Maharshi Sushruta has practiced surgery during 5^th century BC in India.¹ He is a great sage surgeon, teacher and renowned all over the world for his contributions to surgery. Sushruta Samhita, the treatise compiled by Maharshi Sushruta had various commentaries.² It was translated into nine foreign languages apart from various Indian languages.¹ Apart from Shalya (Ayurvedic surgery) and Shalakya (Ayurvedic ophthalmology, ENT and dentistry), the Sushruta Samhita encompass other specialities such as medicine (Kayachikitsa), paediatrics (Kaumarabhritya), geriatrics (Rasayana/Jara), toxicology (Agada Tantra), reproductive medicine (Vajikarana) and psychiatry (Graha Chikitsa/Bhuta Vidya). The compendium of Maharshi Sushrutha (Sushruta Samhita) consists of 184 chapters, description of 300 surgical procedures, details of 650 drugs (animal, plant, and mineral origin) and the description of 121 types of surgical instruments. ³ Maharshi Sushruta is recognized today as ‘Father of plastic surgery³ and he was far ahead of his time in the field of surgery.²

Prognostic concepts (Arishta Vijnaana) were documented in the chapters from 28^th to 33^rd of Sutra Sthana (a section that deals with the basic principles of Ayurveda) of Sushruta Samhita. Vipareeta Avipareeta Swapna Nidarshaneeyam (VASN) is the 29^th chapter of Sushruta Sutra Sthana (SSS). Vipareeta Swapna denotes ‘abnormal dreams’ and the word Nidarshaneeyam indicates ‘illustration,’ hence VASN chapter is the documentation of dreams that are having prognostic importance. VASN chapter consists of 81 verses those deal with the description of various good & bad omens (Shakuna) related to Doota (messenger or a caregiver), Bhishak (physician), Swapna (dreams) and other factors along with their prognostic significance.^4,5 Previous studies have explored the prognostic importance of Avaaraneeya,⁶ Swabhava Vipratipatti,⁷ Chaaya Vipratipatti,⁸ and Panchendriyartha Vipratipatti.⁹ chapters of SSS. The contents of VASN chapter also seem to have prognostic potential and further exploration is the need of the hour. The present study aims to analyze and interpret the prognostic importance of the contents of VASN chapter of SSS with the help of contemporary prognostic literature. The hypotheses generated from the present work may pave the way for future research works in the field of an Ayurvedic prognostic science.

Literature search has been carried out to find out relevant articles in databases and search engines including Scopus, Web of science, PubMed, Google Scholar and EMBASE by using different key words pertaining to Ayurveda and contemporary prognostic literature. Open-access, full text articles and abstracts published in English language only were considered. Sushruta Samhita with Nibandha Sangraha and Bhanumati commentary and other Ayurvedic classical texts such as Ashtanga Samgraha, Charaka Samhita, Ashtanga Hrudaya, Bhela Samhita, and Kashyapa Samhita have been referred. Data obtained from these studies is compiled, interpreted and presented as a narrative review.

Arishta denotes fatality and Arishta Lakshanas are the fatal signs and symptoms those indicate an imminent death. Indriya Sthana, a separate section that consists of few chapters describing various Arishta Lakshanas in major Ayurvedic classical texts but Sushruta Samhita has no Indriya Sthana. Maharshi Sushruta has dedicated 6 chapters (28^th to 33^rd chapters) to describe various Arishta Lakshanas in SSS. VASN is the 29^th chapter that deals with the description of Arishta Lakshanas pertaining to Doota (a messenger and/or a caregiver) and dreams (Swapna).^4,5 In ancient India, a Doota from patient’s family used to go to the physician’s home to inform him about the illness of the ailing family member. Doota also would take the physician with him to the patient’s home by carrying his medicinal kit and giving him lift in his cart/carriage and also drop him back. Various auspicious and inauspicious signs pertaining to the personality, appearance (Darshana), attire (Vesha), speech or communication skills (Sambhasha), time of the arrival and other activities (Cheshta) of Doota are documented in various Ayurvedic classical texts along with their prognostic importance.^10-13 Prognosis based on the condition of the physician when Doota arrives, omens occurring on the way to patient’s home, inauspicious events occurring at the patient’s house during physician’s home visit, and various auspicious and inauspicious dreams along with their prognostic significance are described in VASN chapter of SSS. VASN chapter of SSS consists of 81 verses.^4,5 Critical analysis with interpretation of each verse of VASN chapter has been provided in the following sections (Table 1,2 & 3).

Athaato Vipareetaavipareeta – Bhagavaan Dhanwantari (Verse 1-2)

The current chapter (VASN) deals with the bad/inauspicious (Vipareeta) and good/auspicious (Avipareeta) prognostic features pertaining to dreams (Swapna) and Doota (messenger and/or caregiver) as narrated by Lord Dhanwantari. A detailed description is provided in the following sections.^4,5 The current chapter is named as ‘Vipareeta Avipareeta Doota Swapna Nidarshaneeyam’ by Chakrapani (writeen Bhanumati commentory on Sushruta Samhita), ‘Vipareeta Avipareeta Swapna Nidarshaneeyam’ by Dalhana (written Nibandha Samgraha commentary on Sushruta Samhita) and ‘Vipareeta Avipareeta Doota Shakuna Swapna Nidarshaneeyam’ by Harana Chandra.¹⁴

Doota Darshana – Yadi Vaashubham (Verse 3-4)

Appearance (Darshana), mode of conversation (Sambhasha), dressing (Vesha), and behaviour (Cheshta) of a Doota; condition of the stars (Ruksham), time & date (Vela & Tithi), wind direction (Anila) and other omens (Shakuna) at the time of Doota’s arrival at physician’s house; factors related to the physician (Vaidya) such as his place of stay (Desha), manner of speech (Vaak), behaviour (Cheshta), and physical (Deha) & mental state (Manasaam) at the time of Doota’s arrival etc all these denote (Kathayanti) the favourable (Shubham) and unfavourable (Ashubham) clinical patient outcomes (Aaturagatam).^4,5

Paakhanda Aashrama – Yadi Vaashubham (Verse 5-6)

Similarity or equality of (Sapaksha) sociocultural factors such as religion, caste, age etc in between Doota and Bhishak (physician) denote favourable prognosis (Karma Siddhi) whereas dissimilarity (Vipareeta) denote an unfavourable clinical outcome (Karma Vipatti). An eunuch (Napumsaka) or a lady (Stree) Doota or multiple Doota’s (Bahavo) or Doota engaged in multiple tasks (Naikakaarya) or having an aggressive nature (Asuyaka) or Doota arrives on a chariot (Ratha) driven by a donkey (Gaardhabha) or a camel (Aushtra) or arriving in quick succession (Parampara) to meet (Upasarpanti) the physician (Vaidya) denotes an unfavourable prognosis (Garhita).^4,5

Paasha Dandaayudha – Amangalya Abhidhaayina (Verse 7-8)

Having or displaying features such as carrying a rope (Paasha) or a stick (Danda) or a weapon (Aayudha); wearing colourful dresses rather than white (Paanduretara Vaasasa); wearing apparel (Vaasasa) that is drenched (Aardra) or old (Jeerna) or torn (Jeerna) or dirty (Malina); wearing only a single dress or dress made up of a single-piece (Eka); wearing a dress improperly (Apasavya); physically handicapped or disabled (Nyunaanga); having supernumerary digits (Adhikaanga); agitated (Udvigna) or deformed (Vikruta) or fierce-looking (Raudra Rupina); having an unpleasant (Ruksha) or harsh (Nishthura) or inauspicious speech (Amangalya Abhidhaayina) etc of a Doota indicate an imminent death of the concerned patient or an unfavourable prognosis (Garhita).^4,5

Chindanti Trina – Dootaaste Chaapi Garhita (Verse 9-14)

Doing activities such as plucking (Chindanti) grass (Trina) or splitting (Chindanti) a wood (Kaashtha) into pieces; frequently touching (Sprushanti) his nose (Nasika), breasts (Stanam), ring finger (Anamika), nails (Nakha), scalp hair (Kesha), body hair (Roma), teeth (Dashana) and playing with margins of the dress (Vastraanta); closing body orifices with hands (Sroto Avarodha) or putting hands (Paanaya) over his body parts such as cardiac region (Hrut), cheeks (Ganda), head (Moordha), chest (Urah), and abdomen (Kukshi); carrying a skull (Kapaala), stone or cow dung cake (Upala), ash (Bhasma), bones (Asthi), husk (Tusha) and burning charcoal (Angaaraka) in his hands (Karaashcha); scratching (Vilikhanti) the earth (Maheem) with fingers or toes, dropping objects (Munchanti) and breaking (Bhedina) clumps of clay (Loshta); smeared (Digdhaanga) with oil (Taila) or mud (Kardama), wearing a red garland (Rakta) or applied a red paste (Rakta) all over the body (Anulepana); holding (Gruheetva) an over ripened (Pakwam) or juiceless (Asaaram) fruit (Phalam) or any similar such type of useless things (Anyashcha Tadvidham); rubbing the nails together (Nakhairnakhaantaram) or touching feet with his own hands (Karena Charanam); holding or touching shoes (Upaana) or leather (Charma); suffering (Peedita) with a deforming illness (Vikruta Vyadhi) (leprosy?); having an abnormal behaviour (Vamachara), crying (Rudanta), suffering with dyspnoea (Shwasino) and having deformed eyes or cataract (Vikrutekshana); folding his hands together and pointing them towards (Praanjalayo) the south direction (Yaamyaam Dishi); standing (Sthita) in asymmetrical posture (Vishama) or standing on single leg (Eka Paada); Doota approaching (Upasarpanti) a physician (Vaidyam) with displaying or having the above said features should be considered as inauspicious (Garhita) (indicates an unfavourable clinical outcome to the concerned patient).^4,5

Dakshinaabhimukham – Dootaaste Chaapi Garhita (Verse 15-19)

A physician (Vaidyam), who is sitting facing the south direction (Dakshinaabhimukham) or sitting at an unhygienic (Ashuchi) place (Deshe); physician (Vaidyam) kindling fire (Jwalayantam) or cooking (Pachantam) or engaged (Udyatam) in a barbarous activity (Krura Karmaani) or naked (Nagnam) or lying (Shayanam) on the ground (Bhumau) or unhygienic (Ashuchim) after urination or defecation (Vegotsargeshu); physician, whose hair is dishevelled (Prakeerna Kesham) or smeared with oil (Abhyaktam) or sweating (Swinnam) or restless (Viklavam); Doota approaching (Upasarpanti) a physician (Vaidyam) at the above mentioned times should be considered inauspicious (Garhita). Doota approaching a physician (Vaidya) when he is engaged in reverential offerings to the ancestors (Pitru Karya) or while performing sacred ceremonies (Daiva Karya) or during the times of natural calamities (Utpaata Darshana) or approaching at the time of a afternoon (Madhyahna) or midnight (Ardha Ratri) or early morning (Sandhya) or at twilight (Sandhya) or approaching a physician when specific asterisms predominate (Krittika, Aardra, Aaslesha, Maagha, Mula, Purva and Bharani) or approaching during specific days of the month (4^th, 6^th and 9^th) or during a full moon or the new moon days (Sandhi Dineshu) should be considered as inauspicious (Garhita).^4,5

Swinnabhitapta – Budhyeta Pandita (Verse 20-22)

Doota representing a patient, who has been suffering with a Pitta Roga (disease caused by the vitiation of Pitta) and approaches (Upaagata) a physician (Vaidya) with excessive perspiration (Swinna) or having an elevated body temperature (Abhitapta) (either due to exposure of mid-afternoon heat or staying near fire) indicate an imminent death to the concerned patient or it should be considered as inauspicious (Garhita). Doota approaching a physician with the similar situation as mentioned above but representing a patient suffering with Kapha Roga (disease caused by the vitiation of Kapha) instead of Pitta Roga, should be considered auspicious. Doota representing a patient, who has been suffering with Raktapitta (haemorrhagic disease) or Atisara (diarrhoea) or Prameha (diabetes or renal diseases) and approaches or meets physician near water dam (Jala Rodha), should be considered auspicious (Prashasta).  The symbolic description provided here is for example purposes only, all the other such situations (Sesham) should be analysed carefully and interpreted (Budhyeta) accordingly (Evam) by the concerned and skilled physician (Pandita) while prognosticating.^4,5

Shuklavaasaa – Sa Cha Karayakara Smrita (Verse 23-26)

Doota dressed in white clothes (Shukla Vaasa), hygienic (Shuchi), having fair complexion (Gaura), looks handsome (Priya Darshana) though having dark complexion (Shyaama), healthy (Swastha) and belongs to the same caste and/or sub caste (Gotra) as that of the physician (Jaatau Swagotrau Vaa) indicates auspiciousness (Karyakara). Doota, who comes on a bullock cart (Go Yaana) or by walk (Paadaabhyaam) to visit the physician; Doota having contentment (Tushta), good manners or behaviour (Shubha Cheshtita), good memory (Smrutimaan), skilful (Vidhi Kaalajna), independent (Swatantra) and intelligence (Pratipattimaan); Doota, who is adorned (Alankruta) and show good omens (Mangalavaan) should be considered as auspicious (Karyakara). Doota approaches (Upasarpati) a physician (Vaidyam), who is at ease (Swastham), sitting (Aaseenam) towards the east direction (Praagmukham), seated on a plain (Same Deshe) and hygienic ground (Shuchau Deshe) should be considered as auspicious (Karyakara).^4,5

Characteristics of Doota and their impact on patient’s clinical outcome

Doota is either a messenger (who comes to call the physician to the patient’s house) or a caregiver (either a family member or a relative or a friend or a nurse, who provides care to the patient) and the words Doota, caregiver and messenger have been used synonymously throughout the present article. Prognostic assessment of a remote unseen patient could be done by the physician by observing the phenotypic or behavioural characteristics displayed by a Doota. In ancient India, due to the lack of communication media the way of communicating information was manual only. Doota conveys the message regarding patient’s general condition and requests the physician to visit patient’s house.¹¹ Various good and bad omens pertaining to Doota and their influences on patient’s clinical outcome are described in the VASN chapter. (Table 1)

Due to the multiple stressful events and unrelenting stress, caregivers often experience negative health effects. The caregiver stress process generated by the care situation, socio-demographic characteristics (i.e., as age, gender, marital status, educational level, and social class of the caregiver, relationship with and gender of the patient) are related to primary stressors (i.e., the patient’s disease, dependence level of the patient, daily hours and duration of care), and that primary and secondary stressors (i.e., employment, monthly family income and caregivers’ self-esteem) are related to caregivers’ emotional state.¹⁵ Caregiver burden is a multidimensional response to physical, psychological, emotional, financial and social stressors associated with the caregiving. Caregiver burden is more prevalent in caregivers of patients presenting with dementias or with more comorbidities. Most of the caregivers are usually untrained and unable to perform caregiving tasks. Decline in caregiver mental health is a risk factor for patient mortality in several ways. The stresses and burden of caregiving create increased risk for poor caregiver mental health that may leads to greater mortality among patients.¹⁶

Doota context of VASN chapter provides new insights in areas such as the impact of caregiver’s health on the quality of caregiving, caregiver burden and distress (due to care recipients worse health status), caregiver roles & impacts, caregiver-receiver mutuality, religious & cultural diversity between caregiver and care recipient (patient) and its impact on caregiving quality, and impact of various other factors that are related to a caregiver such as physical & mental health, employment and socio-economic status, personality traits, dressing, speech & communication skills, behaviour and nursing skill etc on the quality of caregiving as well as on the patients clinical outcomes. Caregiving burden could have a significant negative impact on the physical and mental health of caregivers that may ultimately leads to negative health outcomes in the care recipient. The complex interrelationships between the caregiver (Doota), care recipient (patient) and physician (Vaidya/Bhishak) are described in this chapter. Some of the omens related to Doota (such as Verse 25 & 26) are not related to caregiving process and their impact on patient’s clinical outcome (either positive or negative) needs to be authenticated by retrospective cohort studies or cross-sectional studies. Various factors impacting the caregiving process and ultimately the clinical outcomes are documented in VASN chapter as Doota related omens in an indirect manner. (Table 1)

Maamsodakumbha – Hrudayangamaa (Verse 27-31)

If (the physician) happens to see (Darshanam) any objects or people such as meat (Maamsa), earthen pot filled with water (Udakumbha), an umbrella (Aatapatra), a Brahmana (a priest or a person, who performs Vedic rituals and sacrifices), an elephant (Vaarana), a cow (Go), a bullock (Vrisha), and objects that are white in colour (Shukla Varna) while departing (Prasthaane) (to visit the patient) should be considered as auspicious omens (Pujyante). If (the physician) happens to see (Darshanam) any objects/people/animals such as a woman with a child (Stree Putreeni), a cow with a calf (Gau Savatsa), a well adorned girl (Vardhamana Alankruta), fish (Matsya), unripe fruit (Phalam Amam), Swastika symbol, sweets (Modaka), yoghurt (Dadhi), gold (Hiranyam), a vessel filled with puffed rice or cereals (Akshata Paatram), jewellery or gem stones (Ratnaani), the king (Nrupa), burning fire (Aprashaanta Anala), a horse (Vaji), a swan (Hamsa), a blue jay (Chaasha), and a peacock (Shikhi) while departing (Prasthaane) (to visit the patient) should be considered as auspicious omens (Pujyante). If (the physician) hears any sounds (Svanaah) such as sounds of Vedic chanting (Brahma) or the drum (Dundubhi) or clouds (Jeemuta) or a conch shell (Shankha) or a flute (Venu) and sounds of the chariot (Ratha); roaring of a lion (Simha Naada), lowing of a cow (Go Naada) or a bullock (Vrisha Naada), neighing of a horse (Vaji Dhwani), roaring of an elephant (Hasti Svana), cackling of a geese (Kaushikam Rutam), hooting of an owl towards left side (Ullukam Rutam Vaamata), and hearing any other such noble (Sreshtha Vaacha) and pleasing conversations (Hrudayangama Vaacha) while departing (Prasthaane) (to visit the patient) should be considered as auspicious omens (Pujyante).^4,5

Patra Pushpa Phalopetaan – Andha Ripavastathaa (Verse 32-40)

Birds sitting on the trees (Drumaan) those are full of leaves (Patra), flowers (Pushpa), fruits (Phala), latex (Ksheera) and disease-free (Neerujo); birds in the sky (Nabha), on a house (Veshma) or sitting on the flagstaff (Dhwaja) or sitting on the decorated, arched doorways (Torana) or on the rostrum (Vedika); birds those are making melodious sounds (Madhuram) from auspicious directions (east and north) or birds coming from behind (Prushtatoanuga) or from the left (Vama) or right side (Dakshina) denotes auspiciousness or considered as good omens (Shakuna Karmasiddhaye). Birds sitting on the trees (Vriksha) those are dry (Shushka), withered by lightening (Ashani Hate), shorn of their leaves (Apatre), encircled by tendrils (Vallinaddhe) and having thorns (Sa Kantake); birds sitting (Sthita) on slabs of stones (Ashma), ashes (Bhasma), bones (Asthi), faeces (Vit), chaff (Tusha), charcoal (Angaara), dust (Paanshu), over a sacrificial shed (Chaitya), anthill (Valmika) and on uneven places (Vishama); birds those are making loud, harsh noises (Khara Swara) from the inauspicious directions (Aagneya-south-east, Yamya-south and Nairuti-south-west) and flying towards (Purato) should be considered as inauspicious (Naartha Sadhaka). Birds having masculine names (Punnaama) and flying towards the left side (Vama) as well as birds having feminine names (Stree Sanjna) and flying towards right side (Dakshina) of the physician (on the way to the patient’s house) is auspicious (Shubha). Dogs (Shva) and jackals (Shrigaala) crossing (Gamanam) the road from the right (Dakshinaat) to the left side (Vama) in front of the physician are auspicious (Prashastam). Mongoose (Nakula) crossing and the blue jay (Chaasha) birds flying towards the left side (Vama) in front of the physician is auspicious (Prashastam). Passage of rabbits (Shasha) and snakes (Sarpa) and flying of a vulture (Bhaasa) and an owl (Kaushika) in any direction in front of the physician is inauspicious (Na Prashastam). Sight (Darshanam) or sound (Rutam) of an iguana (Godha) and a lizard (Krukalaasa), while the physician is on the way to the patient’s house should be considered inauspicious or indicate unfavourable clinical outcome (Na Prashastam). Seeing of (Darshanam) other people similar (Tulya) to inauspicious Doota (Anishtai) is also considered inauspicious (Ashastam). Sight of Kuluttha (Dolichos biflorus Linn.), sesame seeds (Sesamum indicum), cotton (Karpasa), chaff (Tusha), stone (Paashaana), ash (Bhasma), a pot (Paatram) filled with charcoal (Angaara), oil (Taila), mud (Kardama), utensils filled (Paatram Puritam) with alcoholic beverages (except Prasanna type) (Prasannetara Madyaanaam) or filled (Purnam) with red mustard (Rakta Sarshapa) are inauspicious (on the way to the patient’s house). Seeing (when the physician is on the way to the patient’s house) (Pathi) a corpse (Shava), wood (Kaashta), dry leaves (Palaasham), a wicked or immoral person (Patita), a person of low caste (Antahsthaa), a person having depression or weakness (Deena), a blind person (Andha) and an enemy (Ripava) is inauspicious (Neshyante).^4,5

Mrudu Sheeto – Neshyante Darshanam Gataah (Verse 41-48)

Mild (Mrudu), cool (Sheeta) wind (Anila) blowing at physician’s back (Anukula) having nice fragrance (Sugandhi) is auspicious (Shubha). Strong (Khara), hot (Ushna) wind with bad odour (Anishta Gandha) and blowing towards the physician (Pratiloma) is inauspicious (Garhita). If a patient has been suffering with diseases such as Granthi (benign tumour) and Arbuda (malignant tumour) and the physician arrives at patient’s house for visit, during that time if physician hear sounds such as ‘excision’ that denote favourable outcome or considered to be auspicious. Similarly the word ‘incision’ is auspicious for the conditions like Vidradhi (abscesses) and Gulma (intra-abdominal growths). Words such as ‘checked’ or ‘stopped’ or ‘controlled’ are auspicious for the diseases like Raktapitta and Atisara. In the same way, similar words of omens should be understood of their good or bad prognostic significance in other diseases also. Hearing screaming (Aakrushta), lamentation (Haakashta) and weeping (Aakranda) sounds (Svanaa); vomiting sounds (Chardyaam), sounds of passing flatus (Vata) and cries of (Shabdo) animals like donkey and camel are inauspicious. Things such as dissuasion (Pratishiddham), breakage (Bhagnam), sneezing (Kshutam), slipping (Skhalitam), injury (Aahatam) and psychological stress (Daurmanasyam) are inauspicious (Na Prashasyate) when the physician (Vaidyasya) is on the way (Yaatraayaam) to the patient’s house. All these symbolic omens should only be considered at the time of entering (Praveshe) the patient’s house (main entrance or main door) but need not be taken in to account (Na Ganyate) at every door (Pratidwaaram) of the patient’s house (Aature Gruhe). The following people or things or objects such as hair (Kesha), ash (Bhasma), bones (Asthi), wood (Kashta), stone (Ashma), chaff (Tusha), cotton (Karpasa), thorns (Kantaka), cat with its legs pointing upwards (Katvordhwapaada), wine (Madya), water (Apa), fat (Vasa), oil (Tailam), sesame seeds (Tila) or straw (Trinam), an eunuch (Napumsaka), a person with deformity or broken limbs (Bhagna), a naked person (Nagna), a person with shaved head (Munda) and a person wearing non-white or red clothes (Asitaambara) are inauspicious (Neshyante) while the physician arrives at (Praveshe) patient’s house and while departure (Prasthaane).^4,5      

Bhaandaanaam – Lakshayet Bhishak (Verse 49-53)

The following are the bad prognostic omens such as movement of the stored utensils (Bhaandaanaam) from one place to another (Sthaanaat Sancharanam) or digging them out (Nikhaata Utpaatanam) or their breakage (Bhanga) or falling (Patanam) or bringing them outside (Nirgama); breakage of (Avasaado) physician’s chair (Vaidyaasana), patient (Rogi) lying on prone position (Adhomukha) or scratching his body parts (Pramrujyaad) to the wall (Kudyam) or bed sheet (Aastarana) during the time of conversation (Sambhaashamaano) with physician (Vaidyam); patient shaking (Dhuneeyaat) his hands (Karau) vigorously or holding the hands (Hastam Aakrushya) of the physician (Vaidyasya) and keeping (Nyaset) them on his chest (Uras) or on head (Shiras) or rubbing of physician’s body (Vaidya) with the patient while the patient (Aatura) looking towards or facing the physician (Unmukha) is inauspicious. Patients won’t get relief (Na Siddhyati) from their illness in such houses (Gruhe) where the physician is not respected (Na Pujyate) and vice versa (Sa Siddhyati). Hence the physician (Bhishak) should consider (Lakshayet) all those auspicious (Shubham) and inauspicious omens (Ashubham) related to Doota and patient (Aatura).^4,5

Shakunas (omens) and their impact on patients’ clinical outcome

Various auspicious and inauspicious signs or omens explained in the VASN chapter (Verse 27 to 53) could be understood by Jyotishya Shastra (astrology) that deals with the influences of planetary positions on human life and their destiny. The word Shakuna denotes a bird and omens related to birds are called as Shakunas. The word Nimitta denotes either a cause or Karma or consequences of past deeds. Shakuna shastra or Nimitta shashtra is part of the Jyotishya Shastra and they predict the future events by observing the changes in the environment carefully. The omens can be classified as good (Shubha) or bad (Ashubha) and based on which predictions can be made. If physician confronts with such type of omens (good or bad) in his clinical practice, he should keep his patient under observation for long time to check for any untoward incidents. All these Shakunas (Verse 27 to 53) gives a clue towards the past deeds of the patient and outcome of patient’s clinical condition, hence physician should keep an eye on those signs.^10,11 There is rich corpus of texts (on omens) incorporating various injunctions, instructions, prescriptions, regulations and even taboos throughout the medieval period of Indian history. In ancient India, omens have guided common people about appropriate ways to live their lives, maximize gains and minimize loses. Omens have enjoyed universal appeal across economic strata’s of society in ancient India and people have used them to make predictions regarding gaining wealth, preserving health, to avoid mishaps or tragedies etc.¹⁷

Varahamihira is a well known scientist of the ancient period in India and he belongs to the Gupta period (505-587 A.D). He has made great contributions in the fields of geology, hydrology and ecology. Jyotishya Shastra is one of the fields where Varahamihira’s contribution is worth mentioning. Jyotishya Shastra is the science of predicting the future.¹⁸

Brihat Samhita, a prodigious creation mainly on Jyotishya Shastra composed by Varahamihira. Ayurveda and Jyotishya are two different sciences indeed share unspoken bond by means of Vedic origin. Inter-relation between Jyotishya Shastra and Ayurveda puts curiosity on how they function together, Varahamihira makes us to rely upon him completely to know the depth at which both are related.¹⁹ Shakunas are classified in to ten types i.e., Kshana Deepta, Tithi Deepta, Nakshatra Deepta, Vayu Deepta, Surya Deepta, Gati Deepta, Sthana Deepta, Bhava Deepta, Swara Deepta and Cheshta Deepta in Brihat Samhita. The first five types (Kshana Deepta, Tithi Deepta, Nakshatra Deepta, Vayu Deepta, and Surya Deepta) comes under the category of Deva Deepta and the later five (Gati Deepta, Sthana Deepta, Bhava Deepta, Swara Deepta and Cheshta Deepta) comes under Kriya Deepta category. Shakunas are also classified in to four types i.e., Graha/Nakshatra (omens related to planetary positions), Pashu/Pakshi (omens related to animals and birds), Shareeraka Lakshana (omens related to physical signs and symptoms) and Swapna (dream related omens) in Brihat Samhita.²⁰ Various good and bad omens explained in the VASN chapter (Verse 27 to 53) come under these ten or four types of Shaukunas of Brihat Samhita. (Table 2)

Swapnaanata Pravakshyaami – Sa Vinashyati (Verse 54-70)

Dreams (Swapnaan) seen (Pashyanti) by the patient (Vyadhito Swayam) or his friends (Suhrudo) that predict death (Maranaaya) or well being (Shubhaaya) are narrated here (Pravakshyami). If a health person sees the following dreams, he would become sick; if he is already sick, he would almost die. The patient, who dreams of being applied oil (Snehabhyakta) all over his body (Shareera) and going (Yaayaat) towards the south direction (Dakshinaamukha) on a camel (Karabha), or any carnivorous animal (Vyaala), or of riding on a boar (Varaha) or on a buffalo (Mahisha), or sees himself carried towards (Aakarshati) the south direction (Dakshinaamukha) by a dark woman (Krishna) with dishevelled hair (Muktamurdhaja) and clad in a red colour dress (Raktambaradhara) with laughing (Hasanti) and dancing (Nrutyanti) or being pulled towards (Aakrushyate) south (Dakshinamukha) by a low caste person (Antaahvasa), is going to die. A dream by a patient that ghosts (Preta) or anchorites (Pravrajita) have embraced (Parishvaja) him, or that savage beasts (Shvaapada) with fierce faces (Vikrutaanana) have smelt (Aaghraayate) his head (Moordha), indicates an imminent death; The patient, who dreams of drinking (Pibet) oil (Tailam) or honey (Madhu), or sinking (Avaseedati) in the mud (Panke) or of laughing (Prahaset) and dancing (Pranrutyeta) or having applied mud (Panka) all over his body (Pradigdha Gaatra), indicate an imminent death. A dream of having entwined a wreath of red flowers (Raktaam Srajam) round one’s head (Shirasaa), or seeing himself as nude (Nirambara), or of seeing reeds (Nala), bamboos (Vamsha), or palm trees (Taala) growing on his chest (Urasi Jaayate), indicate an impending death of a patient. Similar dreams, occurring in a healthy subject, indicate an impending disease. The patient, who dreams of being eaten up (Graset) by a fish (Matsya), or who fancies himself again entering (Pravishet) into the womb of his mother (Jananeem), or thinks he is falling (Patet) from the summit of a mountain (Parvataagraat) or into a dark (Tamasaavrute) and dismal cave (Shvabhre), or as being carried away by (Hriyeta) the current of a river (Srotasaa), or assailed (Badhyeta) and overwhelmed (Paraajeeyate) by a pack of crows (Kaakaadyai), is going to die. The dream of a clean shaved head (Maundyam), or of falling (Patanam) stars (Taaraka), or of a dying lamp (Pranaasham Deepa), or of the extraction of (Pranaasham) one’s own eyes (Chakshusho), or of seeing (Pashyet) divine images (Devataanaam), or of earthquakes (Prakampam Avane), purgings (Vireka), vomitings (Chardi) or falling out (Prapatanti) of one’s own teeth (Dashana), indicate an impending death. The patient, who dreams of climbing (Adhirohanti) a Salmalia malabarica (Shalmali), Butea monosperma (Kimshuka), or Erythrina indica (Paribhadra) or a flowering (Pushpaadhyam) Bauhinia purpurea (Kovidara) tree, or of ascending an ant-hill (Valmika) or a funeral pyre (Chitaam), or of receiving (Labheta) or eating (Ashneeta), cotton (Karpasa), paste made up of sesame seeds (Pinyaka), iron (Loha), salt (Lavana), sesame (Tila), boiled rice (Pakvamannam), or drinking oil (Tailam) or any alcoholic beverage (Sura), should indicate an impending death (Mrutyu) and such dreams in a healthy person (Swastha) indicate an impending disease (Vyadhita). A dream (Swapna) should be regarded as futile (Aphalada) that is quite in conformity with the body constitution type (Yathasvam Prakruti) of the dreamer or the one that has been forgotten (Vismruto) or followed by another of an auspicious dream (Vihata) or is the outcome of premeditated thought (Chintaakruto) like one dreamt in the day time (Diva Drushto). A fever patient (Jwaritanaam) dreaming of friendship (Sakhyam) with a dog (Shunaa), a patient with consumption (Shoshinaam) dreaming of making friendship with a monkey (Kapi); a psychiatric patient (Unmada) who dreams of making friendship with a demon (Rakshasa) and a patient of epilepsy (Apasmara) dreams of making friendship with a ghost (Preta); a patient having diarrhoea (Atisara) and Prameha dreaming of drinking water (Toyapaanam); a leper (Kushtinaam) dreaming of drinking oil (Sneha), or a Gulma patient dreaming of a shrub growing on (Sthavarotpatti) his abdomen (Koshta), and a patient with headache (Shiroruja) dreaming of a tree growing on his head (Moordha), or one suffering from vomiting (Chardyaam) and dreaming of eating (Bakshanam) Shashkuli (a spiral flour recipe with crispiness); or a dyspnoea patient (Shwasa), or a person, afflicted with thirst (Pipaasayo), dreaming of making a journey on foot (Adhwaa); or an anaemic patient (Pandu Rogi) dreaming of eating a food (Bhojanam) prepared with turmeric (Haridram); or a patient having Raktapitta and dreaming of drinking blood (Pibet Shonitam), should be considered as about to depart this life (Sa Vinashyati).^4,5

Swapnaanevamvidhaan – Pravimuchyate (Verse 71-74)

Having seen (Drushtva) the above mentioned (Evam Vidhaan) dreams (Swapnaan), the alert patient should get up in the morning (Praataruthaaya) and offer (Dadyat) Masha (Vigna mungo), Sesame, iron (Loha) and gold (Kanchanam) to the Brahmanas (Vipra). Tripada Gayatri Mantra and other sacred texts need to be recited (Japet). Having dreamt a bad dream (Drushtva) in the first part (Pradhame Yaame) of the night, a person should meditate (Dhyaatva) upon a holy or auspicious subject (Punah Shubham), and then sleep again (Swapyaat) with all his senses fully controlled (Samaahita), and repeat (Japet) the Mantras sacred to any of the gods (Anyatamam Vedam). Inauspicious (Ashobhanam) dream (Swapnam) should not be revealed (Achaksheeta) to anyone. One should reside (Vaset) in a holy temple (Devataayatane) for three consecutive nights (Ratri Trayam), and worship (Pujayet) the deity with the most fervent devotion to nullify (Pravimuchyate) the deleterious effects of inauspicious dreams (Duhswapnaat).^4,5

Ata Urdhwam Pravakshyami – Karma Samaacharet (Verse 75-81)

Auspicious (Prashastam) dreams (Swapnam) are described here. Members of the twice born castes (Dvijaan), gods (Devaan), cows (Go), bullocks (Vrishabhaan), kings (Nrupaan), one’s own living friends and relations (Jeevata Suhrudo), a blazing fire (Samiddham Agnim), a Brahmana, or a sheet of clear water (Nirmalaani Jalaani) seen (Pashyet) in a dream by a healthy person indicate a pecuniary gain (Kalyanalaabha), and such dreams occurring in a diseased person (Vyadhe) indicate a speedy recovery of the disease (Apagamaaya). Similarly, dreams of meat (Maamsa), fish (Matsya), garlands (Sraja) of white flowers (Shweta), cloths (Vaasaamsi) and fruits (Phalaani) predict a gain (Dhana Laabhaaya) or a speedy cure (Vyadherapagamaaya). Dreams of ascending (Aarohet) the terrace of a royal palace (Maha Praasaada), of climbing a tree (Vruksha) or a hill (Parvata), or of riding an elephant (Vaarana) predict similar results (Dravya Laabhaaya) as above. A dream of one’s sailing over a river (Nadee), pool (Nada) or sea (Samudra) of turbid water (Kshubhitaan) predicts a money gain (Kalyanalaabha) or cure (Vyadherapagamaaya). A dream of having been bit or stung (Dashet) by a serpent (Uraga), by leeches (Jaluka), or by a bee (Bhramara), indicates money gain (Dhana Laabham) or cure (Arogyam). The man, who usually gets such auspicious dreams (Evam Shubhaan Swapnaan), should be looked upon as a long-lived man (Deerghaayu), and may be unhesitatingly taken under medical treatment (Karma Samaacharet) by a physician.^4,5

Swapna (dreams) and their prognostic significance

Dreams can be a source of personal insight and the dream content reflects or is relatable to previous waking life experiences.²¹ Dream content analysis includes dream bizarreness/realism (occurrence of two or more fantasy objects, bizarre connections, or actions which are impossible in waking life), dream emotions (positive or negative or neutral/balanced), dream characters (number), interactions (like fighting or caressing), aggression (physical or verbal), health-related themes, temperature perception etc. Spatial distortions and threats (dogs, big spheres, insects, terrorists etc) are the common themes of fever dreams (Verse 68). Fever dreams contain more intense negative emotions that might reflect the negative waking emotions (fever related). There is a link between waking emotional tone and dream emotions and poor health is related to more negatively toned dreams (Verse 54-65). The severity of psychotic symptoms during the day is directly related to dream bizarreness in Schizophrenic patients (Verse 68).²² In dreams, good fortune is defined as when there is an acquisition of goods or something beneficial happens to a character (Verse 75-81). Misfortune is defined as any mishap, adversity, harm, danger, or threat that happens to a character (Verse 54-65). A dream character may succeed or fail in the attainment of a goal and may receive positive outcomes (success and good fortune) (Verse 75-81) or negative outcomes (failure, and misfortune) (Verse 54-70).²³ Individuals whose dream reports contained more positive emotions (friendly interactions, positive words and objects) exhibited life satisfaction and higher well-being (Verse 75-81). There is indeed continuity between what individuals dream and what they experience in real life.²⁴ Rapid eye movement (REM) sleep selectively processes personally-significant material. The extraction of any personally meaningful pattern in past experiences would enable expectations about future events. Anticipatory affect may be an integral aspect of prediction. REM dreams are characterized by anxiety and fear (Verse 54-70).²⁵

Dream content is transparent, readable through direct access and it reflects the dreamer’s vision of the world. The link between physical, mental, and emotional conditions, health, and dream content has always been a topic of interest. The possible role and usefulness of the analysis of dream content in the evaluation of the perception of illness, discomfort, psychological reaction, and general psycho-physical well-being of the dreamer is one of the key areas for future research. Various studies evaluated the impact of diseases on dream content, and reported the presence of issues related to negative emotions, death, pain and illness (Verse 54-70). Dream content of patients include higher presence of negative emotions, low familiar settings and characters and no success involving the dreamer (Verse 54-70).²⁶ Ayurvedic scholars of ancient India have used dreams as a tool for prognostication.  They have interpreted dreams to assess the psyche of an individual, to diagnose a disease, to estimate the prognosis, and to calculate the remaining life expectancy. Dreams of death in men are positively associated with worse clinical outcomes (Verse 54-70). A dream converts the mild sensations perceived in sleep into intense sensations (Verse 64). Dream content of nightmares include themes of physical aggression (Verse 56), being chased, evil forces (Verse 57), and accidents and interpersonal conflicts. Bad dreams are significantly more emotionally intense, more bizarre, and more likely to contain misfortunes (Verse 54-70). The nightmare involves a specific danger such as being chased, teased, scolded, beaten, strangled, or murdered (Verse 55, 56, 57, 61 and 62).¹²

If the animal figure in dreams initiates any response to the dreamer, it is some form of threat or hostility (Verse 55 & 68). Pleasurable activities such as singing and dancing in dreams may neutralize the idea of an impending death (Verse 56). The dream fulfils several wishes and it can be recognized as a wish fulfilment (Verse 65). During waking hours the dreamer may deny or suppress the wish or desire to take alcohol but dreams may reveal his suppressed desire or wish (Verse 65). Swimming against strong currents of a river in dreams may symbolically denote a fatal disease by which the patient struggles and an ultimate death (Verse 61). The same dream in a healthy person may represent the physical fitness or stamina of a dreamer (Verse 78). Lord Yama (god of death) is the owner of south direction (Dakshina Disha) and going towards that direction (Dakshinamukha) indicates an impending death (Verse 55, 56 & 57).¹² Demonic dreaming or appearance of supernatural entities in dreams is the common theme of nightmares or bad dreams (Verse 56, 57 & 63). Perceiving various floral scents or odours in dreams and it has been found that the dreamer’s favourite odour was associated with emotionally negative dreams (Verse 58). Colour elements in dreams are significant and they represent specific affective constellation. The red colour in dreams denotes blood, bleeding injury or pathology to dreamer, war, enemy, defloration, menstrual bleeding, anger etc (Verse 56, 59 & 70).¹³

Impact of dreams seen during early morning hours can only remain for ten days (Aphala). Day dreams are incoherent in nature and they are also futile (Aphala). Dreams mentioned in Verse 67 represent commonplace situations and routine waking life experiences of a dreamer, hence there are more chances of forgetting them easily or the dreamer may provide least importance to them as they lack novel content (Aphala). Homa (a Vedic ritual), Gayatri Mantra, chanting of Vedic hymns, meditation and prayers have shown positive influence on many psychological and physiological functions of the body (Verse 72, 73 & 74).¹³ Dreams of misfortunes and their prognostic significance are highlighted in the VASN chapter.  Dreams with evil presence or supernatural agents, dreams and odours, animal figures in dreams and their prognostic significance, appearance of colours in dreams (especially red and yellow), dream symbolism, various auspicious, inauspicious and bad dreams, various dreams objects, characters, images and situations, Homa and other spiritual protocol to neutralize the negative consequences of inauspicious dreams are documented in VASN chapter. Dreams mentioned in VASN chapter of SSS seems to be having prognostic significance and further research works are required to substantiate these claims (Table 3).^4,5

Vipareeta Avipareeta Swapna Nidarshaneeyam (VASN) is the 29^th chapter of Sushruta Sutra Sthana. This chapter has 81 verses that deal with Shakuna (omens), Doota (caregiver or messenger) and Swapna (dreams). Various omens (both good and bad) related to Doota and Swapna and their prognostic significance is the main theme of the VASN chapter. Though the contents of VASN chapter have shown some similarity with other Ayurvedic classical texts such as Bhela Samhita, Kashyapa Samhita and Charaka Samhita, some unique content is also available. Various Shakunas mentioned in VASN chapter represents the belief systems that were prevalent in ancient India and the prognostic significance of them require further validation. Doota related content seems to be logical and has some relevance in present era if Doota is considered as a caregiver instead of considering him only as a messenger. Interpretation of various auspicious and inauspicious dreams and their prognostic significance as documented in VASN chapter seems to be congruent with the findings of contemporary dream research. Interdisciplinary studies among Ayurveda, Jyotishya Shastra (medical astrology) and modern prognostic science are required to authenticate the good and bad omens and their association with the positive or negative clinical outcomes as explained in the VASN chapter. The present work has provided new insights and better understanding of the existing Ayurvedic dream literature.

None.

Authors declare that there are no conflicts of interest.

1. Sharma HS, Sharma HI, Sharma HA. Sushruta-samhit - A critical Review Part-1: Historical glimpse. Ayu. 2012;33(2):167–173. 
2. Natarajan K. Surgical instruments and endoscopes of susruta, the sage surgeon of ancient india. Indian J Surg. 2008;70(5):219–223. 
3. Bhattacharya S. Sushrutha - our proud heritage. Indian J Plast Surg. 2009;42(2):223–225. 
4. Maharshi Sushruta. Sushruta Samhita with Nibandha Sangraha commentary by Shri Dalhanacharya, 1st ed, 29th chapter, Acharya JT, Acharya NR, editors. Vipareetaavipareeta Swapna Nidarshaneeyam Adhyaya. Verse 1-81. Varanasi: Krishnadas Academy; 1998.p.131–136.
5. Maharshi Sushruta. Sushruta Samhita with Bhanumati commentary by Shri Chakrapani Datta, 1st ed, 29th chapter, Acharya JT, Bhishagacharya NS editors. Vipareetaavipareeta Swapna Nidarshaneeyam Adhyaya. Verse 1-81. Jaipur: Swami Lakshmi Ram Trust; 1939.p.203–212.
6. Mamidi P, Gupta K. Avaaraneeya Adhyaya of Sushruta Sutra Sthana ‑ An Explorative Study. J Integr Health Sci. 2021;9(2):107–121.
7. Mamidi P, Gupta K. Swabhava Vipratipatti Adhyaya of Sushruta Sutra Sthana ‑ An Explorative Study. J Integr Health Sci. 2022;10(1):22–47.
8. Mamidi P, Gupta K. Chaaya vipratipatti chapter of Sushruta sutra sthana - An analysis. Int J Ayurveda Res. 2022;3(2):118–135.
9. Mamidi P, Gupta K. Panchendriyartha Vipratipatti chapter of Sushruta Sutra Sthana ‑ An Explorative Study. J Integr Health Sci; 2022.
10. Gupta K, Mamidi P. Gomaya choorneeyam of Charaka Indriya sthana - An explorative study. Int J Ayu Alt Med. 2019;7(6):288–306.
11. Mamidi P, Gupta K. Doota adhyaya of Bhela indriya sthana - An explorative study. Hos Pal Med Int Jnl. 2020;4(4):88‒96.
12. Gupta K, Mamidi P. Pushpeeyam Adhyaya of Bhela Indriya Sthana: An explorative study. J Integr Health Sci. 2021;9(2):81–93.
13. Gupta K, Mamidi P. Aushadha Bheshajiyam of Kashyapa Indriya Sthana - an explorative study. Int J Complement Alt Med. 2021;14(6):258‒270.
14. Goswami PK. Comparative studies of Bhanumati and Nibandha Samgraha with special reference to Arista vijnana (prognostic science). AYU. 2011;32(2):147–153.
15. Otero P, Torres ÁJ, Vázquez FL, et al. Does the disease of the person receiving care affect the emotional state of non-professional caregivers. Front Psychol. 2019;10:1144. 
16. Lwi SJ, Ford BQ, Casey JJ, et al. Poor caregiver mental health predicts mortality of patients with neurodegenerative disease. Proc Natl Acad Sci USA. 2017;114(28):7319–7324.
17. Gautam R. Bhadli P: a popular and historical source of omens in medieval rajasthan. In proceedings of the Indian History Congress. 2013;74:346–352.
18. Kak SC. Science in ancient India. Ananya: A portrait of India. 1997;399–420.
19. Ananya P, Soumya SM. A review on brihat samhita from ayurveda perspective. Int J Creat Res Thoughts. 2022;10(10):137–141.
20. Varahamihira. Brihat Samhita, translated and notes by Sastri VS. (1st ed). 86th chapter –Shaakunam Adhyaya. Verse 1–80. Bangalore: MBD electric printing works. 1946.p.645–669.
21. Edwards CL, Ruby PM, Malinowski JE, et al. Dreaming and insight. Front Psychol. 2013;4:979.
22. Schredl M, Erlacher D. Fever dreams: an online study. Front Psychol. 2020;11:53.
23. Pesant N, Zadra A. Dream content and psychological well being: a longitudinal study of the continuity hypothesis. J Clin Psychol. 2006;62(1):111–121.
24. Fogli A, Maria AL, Quercia D. Our dreams, our selves: automatic analysis of dream reports. R Soc Open Sci. 2020;7(8):192080. 
25. Llewellyn S. Dream to predict? Rem dreaming as prospective coding. Front Psychol. 2016;6:1961
26. Cicolin A, Boffano M, Beccuti G, et al. End of life in oncologic patients' dream content. Brain Sci. 2020;10(8):505.