Pankaj dissertation - final

Concept of Nidana and its Assessment in Kitibha Kushta

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INTRODUCTION

One of the fundamental truths of the Ayurvedic philosophy is

proclaimed in the classical idea of loka-purusha samya. This very important

concept teaches that the universe (loka) and the individual human being

(purusha) are under the same laws and in fact exist on a continuum which

reaches from the realm of the universal to that of the smallest form of creation.

The individual living being, whether it is a man or an ant, is a miniature replica

of the universe. This concept is beautifully and succinctly captured in the

famous sutra "as above, so below". It is important to reflect on the full

implications of this universal truth and to realize that the microcosm (man) and

macrocosm (universe) are in a never-ending interaction with each other. This

interaction operates under the law of samanya-vishesa or like-increases-like.

The constantly changing conditions both in Nature and in the individual create

a dynamic harmony between the two--a state which we recognize as health.

When there is more deviation that can be tolerated between the individual and

Nature (the universe) that harmony is lost and a disease state can arise. Nidana

being the foremost and definite cause for the manifestation of disease need to

give utmost importance. The knowledge of nidana is useful in five different

ways; (1) for maintaining the health of a healthy individual. (2) Diagnosis of

the disease. (3) for differential diagnosis. (4) Prognosis of the disease. (5) for

treatment of the disease. So, nidana is prerequisite for chikitsa. References of

nidana have been scattered in Ayurvedic texts. So, here an attempt has been

made to systematically compile the literature on nidana.

Human beings have been modifying and altering their environment,

sometimes resulting in air, water and soil pollution. In addition, problems

created worldwide by the population explosion, urban migration, overcrowded

settlements, literacy, poverty, starvation, deforestation, etc., have all resulted in

conditions deleterious to human health.

Ayurmitra

TAyComprehended


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Skin is a barrier protecting the underlying tissue from physical, chemical

and biological toxic agents. It helps in the maintenance of body temperature. It

excretes some of the wastes of body metabolism, besides having its own active

cellular activity. In this process it is exposed to and influenced by both

endogenous and exogenous factors. It is the interaction of the skin with

external influences such as the climate, physical, chemical and biological

agents, which determines the manifestation of various skin diseases.

Skin disorders constitute one of the largest groups of health problems in

general practice and hospital reporting patients. Over the years, the number of

patients opting for Ayurvedic treatment has also increased dramatically due to

adverse less and permanent curative methods.

The pattern of skin diseases seen in most parts of India is a consequence

of an underdeveloped economy, illiteracy, and social backwardness. More than

50% of a general hospital’s skin out-patient attendance consists of infections

which are acute and usually recurrent-scabies, pyodermas, pediculosis,

parasitic and viral infections-and have been classified as diseases of a poor

economy. The role of poverty, overcrowding, under nutrition and consequent

poor immunity are emphasized by these diseases. Fungal infections, leprosy

and skin tuberculosis constitute chronic infections which are also influenced to

a great extent by socioeconomic factors.

Ayurvedic Literature has provided substantial information regarding the

diagnosis and management of skin disorders. The term “Kushta” mentioned in

Ayurvedic Literature represents variety of skin manifestations ranging from a

complex leprosy to a simple eczema.

According to samhitas the factors which influence the production of skin

disease were diet and habits of the individual, for which he is habituated for a


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long time. Intolerance to food is mentioned as one of the important cause for

various skin manifestations in the contemporary medicine also. A study is

required to observe the role of different causative factors for skin disorders

with respect to food habits and Personal hygiene. It is essential to study

weather the Diet and Personal Habits of the individual influence the causation

as explained in samhitas.

Since it is highly difficult to observe and interpret all skin diseases

mentioned in our science in a short period of time only one skin diseases which

is most commonly reported at our Hospital i.e. Kitibha Kushta was selected for

this observational study.


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OBJECTIVES

To review and systematically compile the literature on nidana.

To review and systematically compile the literature on nidana of Kushta.

To observe and analyze the etiological factors of Kitibha Kushta

To study and understand the etiological factors of Psoriasis from

Ayurvedic perspective.


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HISTORICAL REVIEW OF NIDANA

A) Veda kala

Rogotpadaka karanas are shareeragata mala roopavisha, krimi, vata, pitta and

kapha given in Atharva veda 11/1/22.

B) Mahabharata

Sheeta, Ushna, and Vayu are the cause for shareerika vyadhis is found in

Shantiparva 16th adhyaya.

C) Samhita kala

A. Brihat Trayee

1. Charaka Samhita: Acharya Charaka has explained nidana in sutra sthana

1st, 11th, 25th, and 28th chapter. In nidana sthana 1st chapter and in

shareera sthana1st & 2nd chapter and in Vimana sthana 6th chapter.

2. Sushruta Samhita: Acharya Sushruta has explained nidana in

sutrasthana 3rd chapter, explained it as an ‘upaya’ and karaka hetu.

3. Asthanga Hrudaya: Acharya Vagbhata has explained nidana in

sutrasrhana 1st chapter and also under nidanapanchaka in nidanasthana

1st chapter.

b. Laghu Trayee

1. Madhava Nidana explained in 1st chapter about nidana.

2. Bhavaprakasha: Bhavamishra mentioned and described nidana in

Rogaprateekara prakarana the 7th chapter of poorvakhanda.

c. Other classical texts

1. Ashtanga Sangraha: Acharya Vagbhata described nidana in sutrasthana

1st, 22nd chapter and under nidana panchaka in nidana sthana 1st chapter.


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2. Yogaratnakara: Has explained that kupita malas are the nidana for all

the diseases. Kupitamala here means vata, pitta and kapha.

3. Gadanigraha: Gadanigrahakara explained nidana under rogagnana

sadhana in jwaradhikara.

d. Recent Ayurvedic literature

1. Nidanachikitsa hastamalaka: Vd Ranajit Rai Desai explained nidana

under nidana panchaka.

2. Doctrines of pathology in Ayurveda: Dr K.R.Srikantha Murthy

described nidana in 9th chapter

3. Ayurveda Vikriti Vignaan: Vd Vidyadhar shukla explained nidana in

20th chapter under nidana panchaka.

Derivation

Ni + Da + karne dhatu + Lyut Pratyaya (SKD)

i.e to produce or to cause

It is the primary cause, the first or essential factor. (V.S.Apte)1

Definitions

The word nidana used in two different contexts i.e. etiological factors and

diagnosis of diseases1.

Etiological factors:

1. Word nidana relates to etiology (vyadhi janakam) 2.

2. Nidana is the causative factor of disease and its aim is to produce

disease.3

3. The one which explains about hetu as well as lakshana is called as

nidana.4

4. Nidana refers to karaka hetvah i.e. causative factors and lakshana refers

to jnayapak hetavah i.e.diagnosis of disease.5

5. Bahya nimiita i.e. external factors are called as nidana.6


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6. The causative (etiological) factors are the efficient cause (Nimitta

Karana) of disease.7

7. A Particular factor can be called as nidana only when it will develop a

complete disease process (iti kartavyata) in the body either immediately

or after a certain period.8

Diagnosis of diseases :

1. Nidana helps to know about etiology, symptomatology and

pathogenesis.9

2. Which gives complete knowledge about the vyadhi is called as nidana.9

3. Nidana means arriving at a definite diagnosis of a disease.9

4. Nidana means arriving at a conclusive diagnosis of a disease after

considering and correlating several factors like etiology,

symptamatology, pathology and investigations.10

5. Roga should be examined by nidana (etiology), pragrupa (prodermal

symptoms), lakshana (symtomatology), upshaya (trialand error

therapeutics), apti (pathogenesis).11

6. One which produces pain is called as roga. This can be examined by

nidana, poorvarupa, rupa, upshaya and samprapti.12

7. The word nidana in respect to diagnosis includes nidana, poorvarupa,

rupa, upashaya and samprapti.13

8. Five means of diagnosis (nidana panchaka) helps for the diagnosis of

disease.14


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Synonyms

Table No.1 Synonyms of Nidana as per Ayurvedic texts

Sl.no CS AS AH MN BP Ckp

1 Hetu

2 Nimitta

3 Aayatana

4 Karta - - -

5 Karana

6 Pratyaya

7 Samutthana - - -

8 Utthana - - - - -

9 Nidana - - -

10 Yoni - - - -

11 Mukha - - - - -

12 Mula - - -

13 Karaka - - - - -

14 Prerana - - - - -

15 Prakruthi - - - - -

16 Nibandha - - - - -

1. Nimitta – the factor which initiates the disease process

2. Hetu – etiology

3. Ayatana – path of disease

4. Pratyaya – cause which shows relation to the effect

5. Utthana & Samutthana – stimulation of dormant or inactive doshas,

making them active & vitiated

6. Karana – cause

7. Kartha & karaka – the creator of disease

8. Moola – root of disease

9. Yoni – site of origin or creation of disease


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10. Prerana – which excels the disease

11. Prakruthi – which determines the nature of disease

12. Nibandha – which has close association with vyadhi

Types15 :

According to Madhukosha tika, the nidana are broadly classified

according to their role in causation of a disease.

1. Asatmendriyartha Samyoga, Prajnaparadha and Parinama.

2. Sannikrishta, Viprakrushta, Vyabhichari and Pradhanika

3. Dosha hetu, Vyadhi hetu, Ubhaya hetu.

4. Bahya and Abhyantara

5. Utapadaka and Vyanjaka

6. Dosha gati: a) Prakruth, Vaikruth; b) Vridhi, Kshaya and Sama

7. Ashayapkarsha

8. a) Anubandha b) Anubandhya

1. a) Asatmendriyartha Samyoga b) Prajnaparadha c) Parinama.

The universe and the individual being interact through the eternally shifting

interplay of three factors which exist in both realm and form a bridge between

loka and purusha. These three factors are:

Buddhi (intellect)

Indriyartha (sense objects)

Kala (natural rhythms)

The healthy state of all three of these factors is called samayoga

(balanced). However buddhi, indriyartha, and kala can also become imbalanced

as atiyoga (excessive), ayoga (deficient), or mithyayoga (distorted). These

deviations of buddhi, indriyartha, and kala from their normal balanced state

are considered in Ayurveda to be the fundamental cause of disease. It is these

disharmonies which lead to the vitiation of the doshas, accumulation of ama,


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weakening of agni, and the entire cascade of the Kriyakala. We give specific

names to each of these fundamental causes of disease.

a) Asatmyendriyartha samyoga

b) Prajnaparadha

c) Parinama

Acharya Charaka has given importance to each of the nidana at different

places in sutra, nidana and sharira sthana of Charaka Samhita.

1. The causes of diseases relating to both (mind and body) are three fold

i.e. ayoga, mithya yoga and ati yoga of Kala, budhhi and indriyartha.16

2. Trividh Ayatanani are ayoga, mithya yoga and ati yoga of artha, buddhi

and kala.17

3. Asatmendriyartha Samyoga, Prajnaparadha and Parinama are the

causative factors of diseases.18

4. “Causes of miseries” (dukha hetavah). These are impairment of dhi,

dhriti and smriti; advent of the maturity of the results of time and action

(Samprapti kala karmanam) and Asatmendriyartha samyoga are causes

of dukha.19

Ashtanga Sangraha and Hridaya opines the same i.e. “hina, mithya and

atiyoga of kala, artha and karma are the chief cause of diseases; whereas their

samyak yoga is the chief cause for health.20

a) Asatmendriyartha Samyoga :

Introduction: The human sense organs, viz. shrotra, chakshu, sparsha, rasa

and ghrana, being the organs of hearing, vision, tactile sensation, taste and

smell respectively, keep regular contact with outside world so as to perceive

sensation relating to arthas or vishayas like shabda, sparsha, roopa, rasa and

gandha. This contact is expected to be conducive to the maintenance of

swasthya. Such a contact or yoga is called as Samyak yoga. When the contact


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is not proper in the above sense it is called as Asatmendriyartha samyoga or

incompatible correlation of the senses with their objects. There are three types

of improper yoga: (1) hina yoga (2) Mithya yoga (3) Ati yoga i.e. defective,

perverted and excessive contacts. Mere existence of indriyas and vishayas

without any mutual contact does not result in sukha and dukha. Samyak yoga or

proper contact is responsible for sukha while the asamyak yoga is responsible

for dukha or vyadhi. Hina yoga or ayoga means negligible contact or no contact

at all; mithya yoga means contacts of indriyas with vikrita or unnatural vishyas,

means excessive contact. Charaka has elaborately described these three types

of abnormalities in relation to all the five indriyas.

Derivation : Asatmya’ word is derived by adding two upasarga A+SA to

Atma shabda then the word Asatmya is formed. A+sa+atma = asatmya. A thing

which is not conducive to the body is regarded as Asatmya or unwholesome.

Indriya- derived from ‘Ida’ dhatu and ‘gha’ pratyaya meaning it is the ruler of

the body. Prana is termed as Indra and its linga is indriya. So, that which gives

sensory knowledge is called indriya. Vishaya or knowledge attained through a

particular indriya is called artha and samyoga is derived from adding Sama

(upasarga) + yuj (dhatu) + gha (pratyaya). Samyogam means combination of

two or more dravyas. (SKD)

Definition: Excessive utilization, wrong utilization and non utilization of

indriyas is called as asatmendriyartha samyoga.

The objects of sense faculties is of five types and further subdivided into

three, so totally fifteen varieties of unwholesome conjunction of sense organ

observed and it is the root cause for the manifestation of diseases. Depending

upon the indriya, its indriyartha and its hina, ati or mithya yoga the

asatmendriyartha samyoga is classified as follows21:


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1. Shrotendriya : (Sense organs of hearing)

a) Hina yoga : The hearing capacity of human shrotendriya is restricted to

a certain range of the frequency of sound. When a person try to hear a

sound of very low frequency like a manda swara, a whispering sound or

a feeble sound coming from a distance, it causes strain to shrotendriya.

It is called as hina yoga of Shrotendriya.

b) Mithya yoga: Listening to unpleasant sounds or hearing of harsh words,

news about the death of friends, assaulting, insulting and terrifying

sounds constitutes the mithya yoga of Shrotendriya.

c) Ati yoga: Excessive utilization of Shrotendriya would be to hear

unauspicious noise coming out of thunder and kettle drum, loud cries,

etc.

2. Sparshanenriya: (Sense organ of tactile sensation)

a) Atiyoga: Excessive exposure to cold, hot, bath, massage etc. leading to

excessive utilization of tactile sense objects.

b) Mithyayoga: Perverted use of bath, cold and hot substances without

following the prescribed order. For example taking cold bath followed

by hot bath, touching of uneven surface, injury, dirty objects, contact

with evil spirits constitutes wrong utilization of tactile sense objects.

c) Hina yoga : Not at all using tactile sense objects is non utilization i.e.

hinayoga

Importance of Sparshanenriya: The sense of touch alone pervades all the

senses which is firmly associated inherently with mind and mind pervades the

tactile objects along with other sense organs. So the condition of all the sense

organs produced by the over all tactile sensation. So the unfavourable reaction

of all the senses caused by all the pervasive sense of touch is known as the

unwholesome conjuction (sensory stress). This unwholesome conjuction may


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be in the form of non-utilization (ayoga), excessive utilization (ati yoga) and

wrong utilization (mithya yoga) of the objects of senses.

3. Chakshurendriya :

a) Atiyoga: Excessive gazing at the highly luminous objects would

constitute excessive utilization of chakshurendriya.

b) Mithyayoga: To see the things too close or too far away or things that

are awful of terrifying or are surprising, contemptuous, frightful,

deformed and alarming would constitute wrong utilization of

chakshurendriya.

c) Hina yoga: Not looking anything at all would constitute non utilization

of chakshurendriya.

4. Rasanendriya :

a) Atiyoga : Excessive intake of various substances having various tastes

would amount to excessive utilization of rasanendriya.

b) Mithyayoga : Among Ashta vidh ahara visheshyatana except rashi will

constitute mithya yoga of rasnendriya. As regard to mithya yoga relating

to rasanendriya, rashi can be either ati matra or hina matra, but there is

no question of its mithya yoga.

c) Ayoga : Not to use it at all amount to non utilization of rasanendriya

5. Ghranendriya :

a) Atiyoga : Smell of exceedingly sharp, acute and intoxicating odours

constitute excessive utilization of ghranendriya

b) Mithyayoga: The smell of exceedingly putrid, unpleasant, dirty,

putrefied and cadaverous odour is wrong utilization of ghranendriya.

c) Ayoga: Not to use ghranendriya at all is known as its non utilization.

Above explanation can be tabulated as:


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Table No.2 Asatmendriyartha Samyoga of Gnanendriya.

Indriya Indriya Artham

Atiyoga Ayoga Mithyayoga

Karna Shravanam Ati

Shravanam

Ashravanam Uccha,parusha,bhishanadi

shravanam

Twak Sparshanam Ati

Sparshanam

Asparshanam Abhighata,visha,vaatadi

sparshanam

Chakshu Darshanam Ati

Darshanam

Adarshanam Sookshma,atidoora,bhaswa

darshanam

Nasa Ghranam Ati

Ghranam

Aghranam Putya,medhyati,teekshna,ugra,

ghranam

Jihwa Rasanam Ati

Rasanam

Arasanam Apathy,vishama,arasa

grahanam

PRAJNAPARADHA

Introduction

Prajnaparadha literally means a "blasphemy, or mistake, of the

intellect". Improper use of the intellect which results in a wrong understanding

of some kind is an example of prajnaparadha. Another form of this disease

factor is a volitional transgression against what an individual knows to be

correct and true. Whether volitional or non-volitional, prajnaparadha leads to

fallacious information, wrong conclusions, and hazardous actions. It is one of

the important hetu among trividha hetu. Every creation in the world consists of

a combination of these three gunas. Satva represents the qualities of gnana

(knowledge) and joy or happiness; raja manifests the qualities like lust, anger,

action and sorrow. Tama is a guna quite contradictory to satva, evincing

qualities like absence of knowledge (ajnana) and confusion (moha). The

intellect or buddhi also possess the qualities of satva guna to the maximum

extent and they will enable the intellect to realize the truth and interpret the

knowledge properly. This balanced state of the intellect brought about by satva

guna is called as “sama buddhi”. When the qualities of raja and tama mark the


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intellect, various types of defect begin to appear and person indulges himself in

unauspicious and unlawful activities and is termed as pragnyaparadh.

Derivation

It is derived from jna (mulashabda) – jnayate iti shabda, ‘pra’ upasrga, jnayate

iti artha i.e, prajna and its aparadha forming prajnaparadha. (SKD)

Prajna – To know/ understand.

Aparadha – An offence (V.S.Apte)

Definition : The ashubha karma brought about by kaya, vacha and manas in

the disturbed state of dhi, dhriti and smriti is said or defined as prajnaparadha.22

Dhi Vibhramsha: If something is eternal is viewed as ephermal and something

harmful, as useful and vice versa, this is indicative of the impairment of

intellect (Buddhi). For, the intellect normally views things as they are.

Dhrti Vibhramsha: A mind indulging in worldly enjoyments can not be

restrained from harmful objects due to the impairment of dhriti. It is dhriti

which can restrain the mind from its harmful objects.

Smriti Vibhramsha: If smriti is impaired due to a person being overcome by

rajas and tamas, this is known as the impairment of smriti. Normally smriti

contains everything memorable.

The ayoga, atiyoga and mithya yoga of Karma (Prajnaparadha)

The over action of speech, mind and body constitute their atiyoga, an all round

inaction constitute their hina yoga. The mithya yoga of body are suppression of

natural urges, their artificial manifestation, falling from height, excessive

itching, excessive massage, excessive holding of breath and exposing onself to

excessive torture. Mithya yoga of speech are back biting, lying, useless

quarrels, unpleasant utterance, irrelevant unfavourable talks and harsh speech.


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Mithya yoga of mind are fear, anxiety, anger, greed, confusion, vanity, envy

and misconceptions.

In brief, any action relating to speech, mind and body which is not included

either in the categories of atiyoga or ayoga, and which is harmful for the health

in the present life and which is against the religious prescriptions comes under

the category of mithyayoga of speech, mind and body.

Charaka in “Na vegan Dharneya” adhyaya says one desirous of well being

during his life time (Eha loka) and after (Par loka), should suppress the

following urges23.

Manasik vegas to be withhold:

Lobha (greed), Shoka (grief), Bhaya (fear), Krodha (anger), Maan (vanity),

Lajja (shamelessness), Ati raga (too much attachment).

Vachik vegas to be withhold:

Parusha vachana (harsh speech), Suchaka (back biting), Anrita (lying), Akala

vakya (use of untimely words).

Sharirik vegas to be withhold:

Par peedaya (harming others), Anyatha kamam (unlawful sex), Asteya

(stealing), Himsa (causing violence).

Vagbhata has explained the same under the heading of Dash vidh papa

karma.24

Manu smriti 6th chapter has opined the same and called it as “Dashakam

Dharma Lakshanam”


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Prajnaparadha as the nidana for karmaj vyadhi :

Charaka chaturanana while commenting on Charaka Shareera 1st chapter says

that, ailments arises out of results of past actions included under

Pragnyapradha.

Again under the heading of Janpado dhwamsiye, Lord Atreya says “Sins of the

present life or the misdeeds of past life are at the root cause of the vitiation of

vayavadi factors. Prajnaapradha constitutes the origin of both types of papa

karma either eha laukika or par loukika.

In Unmada nidana, Lord Atreya says “The wiseman should not blame the God,

ancestors or rakshasas for diseases caused by his own misdeeds due to

Prajnaparadha. One should hold himself responsible for his happiness and

miseries.33 Surprisingly, Robins Text Book of Pathology says “For the

Arcadians (2500 B.C), if some one became ill, it was the patients own fault (for

having sinned) or the making of outside agents, such as bad smells, cold, evil

spirits, or gods”.

PARINAMA

Introduction

Parinama in general means avastha or parivartana brought by the

influence of kala. Acharya Charaka had used the word ‘kala’ for parinama.

Since ati, hina and mithya yoga of kala brings dosha vitiation in the shareera

and causes vyadhi. Ayurveda treats those factor as an important vyadhi hetu. Its

importance lies in the fact that the effect of two etiological factors cited above

can be avoided by improving our physiological and psychological approaches;

but the effect of time is bound to occur and its unavoidable (Nishpratikriya).

Kala (parinama) is defined as "being out of harmony with the rhythms and

cycles of Nature". Ayurveda recognizes several important cycles on the

macroscopic scale which have corresponding effects on the human being. If an


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individual does not become aware of these cycles and modify his life

accordingly, that discordance will lead to a disease state.

Derivation

It is derived from ‘pari’ upasarga, ‘nama’ shabda and ‘ghama’ pratyaya.

Meaning of which is transformation. (SKD)

Kala : Ka + Aa+ La = Kala; it is derived from kala shabda lee dhatu.

Definition

Acharya Sushruta defines kala as that which does not stay even for the

fraction of second and is gatisheela is called kala.25

Types

Kala or time connates two meanings, viz. the year and the state of the

disease in the patient. Depending upon the necessity, year is variously divided

into two, three, twelve and even more. Six division of the year are envisaged.

Hemanta, grishma and varsha these are the three seasons characterized by cold

weather, hot weather and rains respectively. Flanked by them are the three

other seasons, viz pravrut, sharad and vasanthaha which are of moderate

nature.26

Another connotation of the term kala or time is the state of the patient

which determines the initiation of timely actions and prohibition of untimely

ones. For example, in a particular condition or the state of the patient one

medicine may not be useful. It is the time which determines the manifestation

of the desired effects of a drug administered.


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Kala division

Chart No. 1 - Division of Kala

Kala

Samvatsara

1. Visarga

2. Adana

Trividha Shadvidha Dvadashavidha

1. Sheeta

2. Ushna

3. Varsha

1. Sishira

2. Vasanthaa

3. Grishma

4. Varsha

5. Sharad

6. Hemanta

1. Magha

2. Phalguna

3. Chaitra

4. Vaishakha

5. Jyesta

6. Aashada

7. Shravana

8. Bhadrapada

9. Ashwaija

10. Kartika

11. Margasirsha

12. Pushya

Dvividha


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Atiyoga, ayoga and mithya yoga of kala :

If a particular season manifests itself excessively, this should be

regarded as Atiyoga of kala; if the season manifests itself in lesser measure, it

would be hina yoga of kala. If on other hand, characteristics of a season are

contrary to the normal ones, this would be regarded as mithya yoga of kala (for

example rainfall in winter, cold in summer season etc.).

Chakrapani in Tisreshniya adhyaya says, kala refers to sheeta, ushna, varsha.

Table No.3 Relation between Ritu and Kala

Ritu Kala

Hemant, Shishira Sheeta

Vasanthah, Greeshma Ushna

Varsha, Sharad Varsha

Kala leads to the production of vyadhi in accordance of ritu, vaya, ahani and

ahara by doing respective dosha prakopa of doshas.

Charaka in Kiyantha Shirasiye adhyaya explains how kala leads to dosha

prakopa:

Vagbhata opines the same as like that of Charaka in Ayushkamiye Adhyaya.

Table No.4 Dosha Sanchaya and Prakopa as per Ritu

Dosha Sanchaya Prakopa Prashman

Vata Greeshma Varsha Sharad

Pitta Varsha Sharad Hemant

Kapha Hemant Vasanthah Greeshma

2. Sannikrishta, Viprakrushta, Vyabhichari, Pradhanika

Sannikrishta:

Definition: The closest cause of vyadhi is called as Sannikrishta hetu, like

vatadi. The immediate causative factor of the disease is called as sannikrishta

hetu. Such hetus are responsible for immediate aggravation of doshas. Stages


21

of digestion, seasonal variation of doshas or vihara, and all these factors cause

immediate aggravation of doshas. For example at middle of the day pitta

prakopa and in the morning kapha prakopa. The peculiar thing is that for the

occurrence of this type of aggravation the first stage of accumulation is not

required. It is because the chaya and prakopa stages remain already prepared in

the body and sannikrishta hetus or precipitating causes produce immediate

aggravation of dosha. Hence these causes produce two types of effects. One is

that they become responsible for creation of actual disease symptamatology;

the second is that they produce aggravation of the symptoms of the already

existing disease. For example, a cloudy atmosphere will precipitate the attack

of tamaka shwasa in a susceptible person and increase the severity of the

attack.27

Viprakrushta:

Definition: The distant cause of the vyadhi is called as Viprakrushta hetu, like

Rudra kopa etc.

This type of cause does not produce a disease immediately but their cumulative

or delayed effects produce diseases after a certain period. For example, kapha

accumulated in hemantha ritu produces diseases in vasanthaha ritu. Rudrakopa

is a viprakrishta nidana of jwara.

Arundatta used the word “aasana” for sannikrishta and quoted the following

examples.

Roganaam aasanam: vitiated vatadi doshas

Viprakrushta: Chaya prakopa of vatadi doshas as per ritus.

Vyabhichari:

Definition: It means behavior which deviates from the normal practice is called

as Vyabhichari hetu.


22

Normally, the contact with hetu should produce disease in a body. But in

this case, either the vitiation of dosha is such that it fails to produce disease or

the peculiarities of the dosha and dushya are such that their sammurchana can

not occur.

Pradhanik:

Definition: These are fulminating or very strong hetus like different poisons,

toxins etc. When such etiological factors come in contact with the body, they

produce disease very quickly.

3. Dosha hetu, Vyadhi hetu and Ubhaya hetu:

Dosha hetu:

Definition: The factors responsible for vitiation of dosha are called as dosha

hetu.

For example, Tikta, katu, kashaya does Vata ; Katu, amla, Lavana rasa does

Pitta prakopa ; Madhura, Amla rasa Lavana does Kapha prakopa

Table No.5 Relation between Rasa and Dosha

Rasa Dosha Prakopa

Tikta, katu, kashaya Vata

Katu, amla, Lavana Pitta

Madhura, Amla, Lavana Kapha

General features of vitiated “Doshas”:

Doshas when gets aggravated manifests their signs and symptoms in

accordance with the degree of aggravation; those in the state of diminution give

up their normal signs and symptoms; and those in a state of equilibrium operate

properly. In fact, this is the only way to evaluate the different physiological and

pathological state of the Doshas. Hence, above verse reveals the basic principle

in this regard.


23

Vyadhi hetu:

Definition:

1. Manifestation of discomfort to the body is called as vyadhi.28

2. Group of lakshanas is called as vyadhi29.

3. Dukha is called as Vikara or vyadhi30.

So, Vyadhi hetu means those specific etiological factors responsible for

the particular diseases, irrespective of dosha. For example, mud eating is

specific factor favourable to pandu roga. It is true that mud also vitiates dosha

that in turn produces pandu. In this way mud having kashaya rasa produces

vataj pandu; that of madhura rasa produces kaphaja pandu etc.

but ultimately mud creates the same disease and that is pandu only. Hence it is

a specific cause.

Ubhaya hetu:

Definition: The term “ubhaya” means combined factors. It implies that

these factors are responsible for the vitiation of particular dosha and at the

same time they act as specific etiological causes for particular diseases, e.g.

travel on the animals like camel or elephant vitiates vata, vidahi anna vitiates

pitta and rakta and all these combined factors produces vatarakta.31

4. Bahaya and Abhyantara hetu:

Abhyantara

Bahya: External factors like food, behavior, seasons, poisons etc. are called as

bahya hetus or external factors.

Abhyantara: Vitiated doshas are called as intrinsic factors or Abhyantara hetus.

Really speaking doshas can not be treated as intrinsic factors. Jalpakalpataru,

the commentary of Charaka samhita says “The causative factors of vitiation of

doshas are hetus there is no doubt about it. But that is not the case with the

actually vitiated doshas. They are the part and parcel of the disease pathology.


24

Once we remove vitiation the disease also disappears. The relationship of

dosha with disease is one of uninity or indivisibility (Samvayi). Hence doshas

can not be treated as hetus. Thus whenever doshas are called as etiological

factors, we mean the factors responsible for vitiation of doshas, in an indirect

sense”.

5. Utapadaka and Vyanjaka hetu:

Utapadaka

Utapadaka: Vitiated doshas are the fundamental cause of the diseases. Hence

utpadaka hetu means the real causative factors of the accumulation of doshas,

because unless there is an excessive accumulation (chaya) the precipitating

cause will not produce any effect. For example, the intake of food substances

having madhura rasa and guru and snigdha gunas in hemantha ritu is the factor

really responsible for kaphaja diseases.

Vyanjaka: It acts as a triggering factor. For example accumulated doshas in

hemantha ritu gets aggravated in vasanthaha ritu.

6. Dosha Gati :

Urdhva, Adhoga and Triyak gati of doshas:

In urdhva gati the doshas travel or progress upwards, as in the chardi, kasa etc.

While in adho gati the doshas travel in the downward direction as in atisara,

pravahika, adhoga rakta pitta etc. An important point to be noted that in Urdhva

and adho gatis doshas mostly remain in their koshtas and comes out through

the natural outlets like mukha, guda etc. In triyak gati doshas travel from

koshta towards shakhas, i.e. instead of remaining in koshta they come in direct

contact with different dhatus and get themselves embedded in them.

Koshtha-Shakaha-marmasthisandhi gati: During normal physiological

conditions doshas travel from shakhas to the koshtha and return to shakhas


25

again, this being their normal movement between koshtha and shakha. Even

during the advancement of pathological conditions takes place during the

transit of vitiated doshas from koshtha to shakha, i.e. shakha gati. While the

body recovering from this condition either by treatment or due to the natural

tendency of the body doshas are brought to samyavastha (equilibrium) and this

is done by bringing them back to the koshtha and eliminating them through the

upper or lower orifices. This is koshtha gati. As marma, asthi and sandhi are

included in the passage of doshas into them can only be called shakha gati.

Charaka has explained the causes and effects of the transit of doshas from

shakha to koshtha and vice-versa. He says that knowledge of these paths and

directions of doshas helps in the prevention of diseases and their cure also.

Movement of doshas from koshta to shakha- marmasthisandhi - : Following

factors takes doshas from koshtha to shakha- marmasthisandhi with the help of

vata.

1. Vyayamat

2. Ushna ahara

3. Teekshna ahara

4. Ahita acharna

5. Increased activity of vata (drutatvat)

Effects of the transit of doshas from koshtha to shakha:

Vitiated doshas have always tendency to produce the disease. When

other factors like climate, body resistance etc. are favourable under such

conditions, they result in disease immediately. But when the conditions are not

favourable they remain dormant in shakhas, waiting for the favourable

conditions. The period between the entry of doshas into shakha and the disease

formation also depends on the quantity and strength of vitiated doshas.


26

Movement of doshas from shakha to koshta: Following factors takes doshas

from shakha to Koshtha with the help of vata.

1. Vridhayat : dosha vridhi

2. Abhishyandyat : lubrication of srotas

3. Paakat : Dasha paaka

4. Srotomukha vishodhanat : cleansing the opening of srotas

5. Vayush cha nigrahat : bringing vayu back to koshta

Koshtha-Shakaha-marmasthisandhi gati produce diseases in three different

tracts are called as vyadhi margas. They are Koshtha marga, Shakahamarga and

marmasthisandhi marga. As a particular dosha gati is responsible for a

particular vyadhi marga, in pathological conditions dosha gati can be

considered as the cause and vyadhimarga as its effect. Charaka has described a

group of diseases related to each vyadhi marga.32

Table No.6 Roga marga

Shakha Marmasthisandhi Koshtha

Galganda Pakshavadha Jwara

Pidika Aptanaka Atisara

Alaji Shosha Vamana

Apachi Ardita Alasaka

Charmakeela Rajyakshama Visuchika

Adhi mamsa Asthi shoola Kasa

Mashak Sandhi shoola Shwasa

Kushta Guda bhramsha Hikka

Vyanga Shiro roga Anaha

Shotha Hridaya roga Udara roga

Gulma Basti roga Pleeha vikara

Arsha Visarpa

Vidradhi Shotha

Visarpa Gulma

Arshas

Vidradhi


27

Vriddhi-sthana-kshaya gati of doshas33:

Decrease of doshas, their normal state and their increase constitute this type of

dosha gati. There causes have been described earlier.

Prakruth and Vaikruth34:

Prakruth

Prakruth: Prakruth means vitiation of dosha as per ritu i.e by its swabhava i.e

vitiation of kapha in vasanthah ritu, pitta in sharad ritu, vata in greeshma ritu.

Vaikruth: Contrary to above said, if dosha vitiation occurs irrespective of its

swabhava then it will be called as vaikruth.

7. Ashayapkarsha35:

This peculiar type of dosha gati has been explained by Madhukosha.

Sometimes a resultant effect of the conditions of the three doshas, i.e. a state of

equilibrium, decrease or increase, shows a peculiar type of symptomatology.

The nature of treatment is also peculiar. Therefore this phenomenon deserves

special consideration. This phenomenon occurs in the following manner. :

Kapha and pitta dosha decreases from the normal and vata increases.

Suppose kapha dosha is in equilibrium and pitta is reduced, then the increased

vata will drag out kapha dosha which is in equilibrium and push it towards the

site of pitta, producing the symptoms of kapha prakopa.

In this context one may raise the question why the symptoms of kapha

prakopa appear when there is state of equilibrium. The explanation given by

Madhukosha is as follows: Kapha moves from its original area to that of other

dosha and this quantity of kapha dosha is added to the quantity of its already

present pitta at that place. The line of treatment adopted in this case has

peculiarity. Even though the symptoms are those of kapha prakopa, the


28

treatments are those given for vitiated vata dosha. It is because vata dosha is

the factor responsible for this pathologic development. In short, the treatment

for Ashyapkarsha is nothing but the treatment for vata dosha, irrespective of

the symptoms which are of kapha or pitta.

8. Anubandhya and Anubandha36:

Anubandhya means the one which pradhana (dominating). Anubandha

means the one which apradhana (non dominating). In visarpa chikitsa, Acharya

Charaka has explained that the one in which dosha is independent, lakshna are

clearly manifested, vitiated from its own karanas and which can be treated from

its own chikitsa is called as anubandhya.Opposite to this is apradhana or

anubandha.

Madhukosha comments on this and says, the utility of such

classification helps in the treatment of vyadhis where dosha samsarga is seen.

If there is vitiation of vata and pitta, then pradhana dosha should be treated

first, because by subsiding the pradhana dosha the apradhana dosha will

subside itself .

Some other classification of nidana:

1. Shukra shonit doshaja (Defect in sperm and ovum) : Acharya

Sushruta has kept this nidana under Adibala pravrut vyadhi (Hereditary

anomalies) i.e those which are caused due to defect in the sperm or the

ovum, such as kushta, arshas etc.; even these defects may be transmitted

in two ways-maternal or paternal in origin

2. Sankramik nidana (Contagious causes) : Sushruta He says that certain

diseases spread from a patient to other people by the latters repeated

contact with contaminated objects or with the skin or other organs of the

body of the person such as mouth, sex organs etc. They may also spread


29

through respiration, contaminated food, cloths, flowers etc. Examples of

such disease are kushta, jwara, shosha, netra abhishyanda.

Importance of Nidana:

1. Chikitsa :

Avoidance of the causative factors is of prime importance in the

prevention as well as the cure of diseases. Pro-phylective treatment is based on

this point only. It is usually said that “prevention is better than cure”. While

treating diseases the highest importance should be given to avoidance of causes

responsible for the vitiation of doshas because it will be helpful in breaking the

samprapti of disease. All these things will become possible only if there is a

perfect knowledge about the etiological factors i.e. Nidana.

2. Vyadhi karana:

Hetu is karana for vyadhi. So by knowing the hetu involved the vyadhi Karana

and its severity is known.

3. Vyadhi vinischaya:

If there is any doubt regarding the diagnosis of a disease, observation of the

etiological factors leads to the confirmation of vyadhi.

4. Sadhya asadhyata:

Hetu is very helpful to decide the sadhyasadhyata of a vyadhi. Alpa hetu causes

alpa Lakshana in a vyadhi and its sukhasaadhya lakshana.

5. Upashaya anupashaya:

Upashaya is opposite to hetu and anupashaya is similar to hetu.


30

MODERN REVIEW

Etiology or Cause

Hetu word is synonymous to etiology in modern medical literature.

Derivation

Aitia - a charge, accusation, cause

Logos (logy) – word of speech, treatise, discourse

Aitia + logos = the doctrine of causes,

So the word meaning of etiology can be derived as

The discourse about the cause of a disease

Definition:

The study of causes specifically the cause of disease.37

or

The science dealing with causes of disease

In modern terms there are two major classes of etiological factors.

1. Intrinsic or genetic

2. Acquired (infectious, chemical, nutritional, physical)

Knowledge or discovery of the primary cause remains the backbone on which

the diagnosis can be made, a disease understood or a treatment adopted.

The four aspects of a disease process that forms the core of pathology are.

1) Etiology- cause

2) Pathogenesis- the mechanism of its development.

3) Morphology- the structural alterations/changes induced in cells and

organs of the body.

4) Symptoms/Clinical manifestations-the functional consequences of

morphologic changes.38

In Ayurveda a disease is studied under 5 stages (Nidana panchaka) and

in modern it is studied in 4 stages. In both these medical systems etiology/

nidana is the first and foremost factor which denotes the cause / causative

factor of a disease.


31

Review on Kushta

Twak Shareera

Introduction:

Among all the bodily organs skin is more easily inspected and more

frequently exposed to infection, disease or injury than any other structure.

Because of its visibility, skin reflects our emotions and also features of

physiology or pathology. Changes in skin Colour may indicate homeostatic

imbalances in the body. Many interrelated factors affect both the appearance

and health of the skin, including nutrition, hygiene, circulation, age, immunity,

genetic traits, psychological state, and drugs. So important is the skin to one’s

image that people spend much time and money to restore skin to a more normal

or youthful appearance.

Ayurvedic review:

In Ayurveda the word “twacha or ‘charma’ is used for describing the

skin. Twacha is derived from “Twach-Samvarne” Dhatu meaning ‘the covering

of the body’.

Charka described Twacha as the Matruja Bhava (Maternal factor) which

is one of the six Bhavas essential in the development of fetus

Vagbhata described the formation of Twacha as due to Paka of Rakta

Dhatu by its Dhatvagni in the fetus. After Paka, it dries up to form Twacha, just

like the deposition of cream over the surface of boiled milk. .

Layers of the skin

Regarding the number of layers of skin there is difference of opinion

between the Acharyas

a) Charaka described six layers of skin but while elaborating these layers

he has explained only two layers and the rest of the four layers were

described as terms of the diseases.


32

Table No.7 Layers of Skin according to Charaka39

No Layer Name

1 Prathama It is Udakadhara, which is consider as Bahya-Twak

2 Dvitiya It is Asrigdhara

3 Tritiya It is Sidhma, Kilas Sambhavadhishthana

4 Chaturtha It is Dadru, Kushta Sambhavadhishthana

5 Panchami It is Alaji, Vidradhi Sambhavadhishthana

6 Shashthi If this layer is injured then the individual trembles and

feels as if entering in darkness

b) Sushruta has described seven layers of skin. He has also mentioned the

thickness of each layer along with the diseases which occur in that layer.

Table No.8 Seven layers of skin according to Sushruta40

No Name Thickness Disease

1. Avabhasini 1/18 of Vreehi (0.05 to 0.06 mm) Sidhma, Padmakantaka

2. Lohita 1/16 of Vreehi (0.06 to 0.07 mm) Tilakalaka, Nyachchha, Vyanga

3. Shweta 1/12 of Vreehi(0.08 to 0.09 mm) Charmadala, Mashaka, Ajagallika

4. Tamra 1/8 of Vreehi(0.12 to 0.15 mm) Kilasa, Kushta

5. Vedini 1/5 of Vreehi(0.2 to 0.3 mm) Kushta, Visarpa

6. Rohini 1 Vreehi(1 to 1.1 mm) Granthi, Arbuda, Apachi,

Shleepada, Galaganda

7. Mamsadhara 2 Vreehi(2 to 2.1 mm) Bhagandara, Vidradhi,

Arsha

c) Vagbhata has described seven layers of skin similar to Sushruta. He has

not given any description. Commentator Arunadatta and Hemadri also

named them according to Sushruta’s method.

d) Sharangadhara has also mentioned seven layers of skin along with the

probable onset of diseases. The names of first six layers are same as

Sushruta but the seventh layer is named as “Sthula” which is the site of

Vidradhi.


33

Modern review41:

Skin is one of the largest organs of the body in surface area and weight.

In adults, the skin covers an area of about 2 square meters and weighs 4.5 to 5

kg. It ranges in thickness from 0.5 to 4.0 mm, depending on location.

Layers of skin:

(A) Epidermis

The epidermis is composed of stratified squamous epithelium and

contains four principal types of cells: (i) Keratinocytes (ii) Melanocytes (iii)

Langerhans cell (iv) Marked cell.

The names of the five layers, from the deepest to the most superficial are as

follows:

1) Stratum basal or germinativum:

It forms the lowest layer and consists of single row of columnar cells

and is capable of continued cells division. As these cells multiply, they push up

towards the surface and become part of the upper layers. The stratum basal also

contains tactile (Merkel) discs that are sensitive to touch.

2) Stratum spinosum or Malpighi layer:

This prickle – cell layers lies upon the basal layer and has 8 to 10 rows

of polyhedral cells that fit close together. This layer involves most of the

pathological conditions of the skin.

3) Stratum granulosum:

It consists of about three to five rows of flattened cells that develop

darkly staining granules of a substance called Keratohyalin. Keratin forms a

barrier that protects deeper layers from injury and microbial invasion and

makes the skin waterproof.

4) Stratum Lucidum:

Normally, only the thick skin of the palms and soles has this layer. It

consists of three to five rows of clear, flat, dead cells that contain droplets of an


34

intermediate substance that is formed from keratohyalin and is eventually

transformed to Keratin.

5) Stratum Corneum:

This layer consists of 25 to 30 rows of flat, dead cells completely filled

with keratin. These cells are continuously shed and replaced by cells from

deeper strata. The stratum Corneum serves as an effective barrier against light

and heat waves, bacteria, and many chemicals.

(B) Dermis

The dermis chiefly consists of white fibrous tissue, elastic fibers and

non-stripped muscles and contains blood vessels, nerves, hair, sweat gland and

sebaceous glands and nerve corpuscles. The outer portion of the dermis, about

one fifth of the thickness of the total layer, is named the papillary region. The

deeper portion of the dermis is called the reticular region. It consists of dense

irregular connective tissue containing interlacing bundles of collagen and

coarse elastic fibers.

Keratinization

In the process of Keratinization, cells newly formed in the basal layers

undergo a developmental process as they are pushed to the surface. As the cells

relocate, they accumulate keratin.

Pigmentation of the skin

Three pigments melanin, carotene and hemoglobin – give skin a wide

variety of colors. Melanin is located mostly in the epidermis; carotene is mostly

in the stratum Corneum and dermis; and hemoglobin is in red blood cells

within capillaries in the dermis.

Blood supply of skin

There are two horizontal and parallel systems of plexuses, which supply

the skin. The plexus or network of blood vessels exists between the dermis and

the subcutaneous tissue. Its exact position can never be accurately described.


35

Each arteriole supplies and area of skin and each various plexus associated with

it drains the same area.

Nerve supply

The varied sensations arising from skin are derived from a diverse

population of cutaneous nerve endings or receptors, thus tactile, temperature

and pain sensations are each sub served by different groups of receptors.

Functions of the skin:

The skin is a metabolically active organ with vital functions including

the protection and homeostatic of the body.

[a] Regulation of body temperature

Skin does the evaporation of sweat and convent the high temperature

into lower elevated body temperatures or to the normal. Changes in the flow of

blood to the skin also help the regulation of body temperature.

[b] Protection

The skin is considered under the Integumentory system. It provides a

physical barrier that protects the underlying tissues from physical abrasion,

bacterial invasion, and dehydration and UV radiation.

[c] Sensation

The skin contains abundant nerve endings and receptor that detect

stimuli related to temperatures, touch, pressures and pain.

[d] Immunity

Sweat of the epidermal cells is important components of the skin

immune system, which tends off foreign invaders.

[e] Excretion

Sweat is the vehicle for loss of a small quantity of ions and several

organic compounds along with removal of heat and some part of water.


36

[f] Blood reservoir

The dermis is a house of extensive networks of blood vessels that carry

8 – 10% of the total blood flow in a resting adult. In moderate exercise this

flow increase, which helps to dissipate the heat from the body. While during

the exercise skin’s blood vessels constrict so this allows more blood to circulate

through contracting muscles.


37

HISTORICAL REVIEW OF KUSHTA

VEDIC PERIOD:

Vedas are considered as the oldest and first available literature of the world.

There are four Vedas i.e. Rigveda, Yajurveda, Atharvaveda and Samveda.

Ayurveda is considered to be the Upaveda of Atharvaveda. The history of

Indian medicine start with Veda, so the history of ’Kushta Roga’ begins form

Vedas.

Rigveda:

In Rigveda there is no complete description about the ‘Kushta Roga’. But some

description indicates that Kushta was prevalent during that period also.

The Charmaroga of Apala was cured by Lord Indra.

Ghosa was suffering form ‘Kushta Roga’. She was disliked by her

husband because of her ugly looks due to Kushta Roga. By

administration of proper medication she got cured & ultimately accepted

by her husband.

Yajurveda:

Shukla Yajurveda mentions various medicines having Kushta nashaka

properties.

Atharvaveda:

In Atharvaveda, the various sites for diseases have been described and amongst

them skin has been described as one of the chief sites of the diseases. The

names of various diseases have been illustrated, whereby Kushta has been

described as Kshetriya Roga. There is description of some herbs like Rama,

Nili, Asuri, Shyama etc. for the treatment of Kushta.

PURANA KALA

Mahabharata: It has been mentioned that the person suffering from

‘Twakadosha’ is not fit to be a king. This reference highlights the fact that at


38

that time people suffering from ‘Kushta’ were looked down by the society.

Agnipurana, Kushtaghna preparations are mentioned under the heading of

“Nana Rogahara Aushadhani”.

SAMHITA KALA

Charaka Samhita:

Charaka described it in detail first time, a long range of skin diseases with their

etiology, pathogenesis & specific classification under the heading of Kushta.

Charaka has described 18 types of Kushta. Seven types of Kushta have been

described as a Mahakushta in detail in Nidana Sthana. In the Chikitsa Sthana

eighteen types of Kushta have been classified under 7 Mahakushta & 11

Kshudrakushta. Apart from the description of Kushta in NI. - 5 & Chi. -7, there

are some other references which are related to Kushta, some of them are as

follows:

a) Kushta is described as the Samanya Hetu of Nija Shotha.

b) Kushta is considered as a Santarpanjanya Vyadhi.

c) It is included as one of the disease caused by Rakta.

d) Use of Stambhana Dravyas in the initial stage of Raktapitta, Raktarsha

& Amatisara leads to Kushta.

e) Kushta is noted in Lekhan Yogya & Prachhana Yogya Vyadhi.

f) Agnikarma is contraindicated in Kushtaja Vrana.

Sushruta Samhita:

Aacharya Sushruta first time clearly described the Anuvansika

(Hereditary) & Krimija (Infectious) Nidana as a causative factor of Kushta.

Kushta has also been included in list of Auopasargika Roga, which may spread

from one person to the other. Sushruta has also explained the Dhatugatatva or

Uttarotar Dhatu Pravesha of Kushta Roga. The numbers of Kushta described by

Sushruta are the same as that of Charaka but Dadru has been mentioned under

Mahakushta & Sidhma under Kshudrakushta. There are also some differences


39

of names. Sushruta has described Chikitsa of Kushta in two chapters i.e.

Kushta Chikitsa and MahaKushta Chikitsa. Guggulu, Shilajita, Shveta Bakuchi

etc. Rasayana drugs are mentioned in its Chikitsa.

Ashtanga Hridaya:

Vagbhata has followed Sushruta regarding classification of Mahakushta

& Kshudra kushta (A.H.Ni. 14/6, 20-30). But Ekakushta has been mentioned

under Kshudra kushta with same Lakshanas as described by Charaka

(A.H.NI.14/19, 28).

Bhela Samhita:

Bhela Samhita has described Kushta Roga in both Nidana & Chikitsa

Sthana. Specially indicated, polluted water as a etiological factor of Kushta.

Kashyapa Samhita:

Kashyapa Samhita has described 18 types of Kushta as Charaka, except

that Shvitra, Vishaja Kushta & Sthulruksha instead of CharmKushta, Alasaka

& Visphotaka.Kashyapa has given the classification of Kushta on the basis of

its Sadhya & Asadhyata. Thereby 9 Kushta are described as Sadhya while other

9 are Asadhya.

SANGRAHA KALA

Madhava Nidana:

Madhava has described Nidana Panchaka of Kushta according to the

Charaka & Vagbhata. While Dhatugatatva, Sadhya-Asadhyata & Sankramakata

(contagious) have been described according to Sushruta.

Sharngdhara Samhita:

Classification of Kushta has been described in Purvakhanda. According

to Sharngdhara, Tamra which is the fourth layer of the skin is the site of all

types of Kushta (Sh.Pu. 5/19-22).


40

Vangasena:

Vangasena has mentioned 7 types of special causes of Kushta that is

Tila, Taila, Kulattha, Valmika, Linga Roga, Mahisha Dugdha, and Mathita

Dadhi & Vruntaka.

Vasavarajiyam:

Some other types of Kushta are described like Prasuti Kushta, Galat

Kushta etc.

Bhava Prakasha:

Bhava Prakasha has described a detail description of Kushta Roga. He

has followed Charaka for classification & nomenclature of Kushta. The

Dhatugatatva & Sadhya-Asadhyata are compiled from Sushruta.

Yoga Ratnakara:

Yoga Ratnakara describes the Kushta according to the earlier classics.

Contagious aspect of Kushta is also described in this chapter.

Chikitsa Chandrodaya:

Rajeshwar Dutta Shashtri has tried to correlate the different skin

disorder with different types of Kushta. Photographs of patients are also given

to make the book more practical.

Nirukti

In Sanskrit language, the word ‘Kushta’ means that ‘to destroy’, ‘to

scarp out’ or ‘to deform’. By adding to it the Pratyaya ‘Kta’ which stands for

firmness or certainty, the word Kushta is derived. Thus the word Kushta means

that which destroys with certainty.

In the term Kushta, the word “kush” is added to “hani” to form Kusta,

which gives a meaning as ‘an ugly look’ to the body.


41

“KUSHNAATI ROGAM”. “KUSH + HANI KUSHEETI ITIKTHAN” 42(SKD)

“Kushta”- the word is derived from the root “kush” which means that

which comes out from the inner part.

The word “Kushta” is derived from dhatu “kush”. In this mainly Raktha

is vitiated and drawn towards the region of Twak to cause Kushta.

Paribhasha

1. According to Arunadatta Kushta is defined as that which causes

disfigurement to the body.

2. Todaramalla says it causes contempt.

3. According to Siddhanta Kaumudi, the condition in which different body

organs, Dhatus, Upadhatu are destroyed is known as Kushta.

4. In Shabda Kalpadruma it has been described as the disease which cause

despise or contemptible.

5. In Halayudha Kosha it is mentioned that - Vitiated Rakta leads to

destruction of body and hence called as Kushta’.

6. Commentator Arunadatta mentions Kushta as one which causes vitiation

as well as discoloration of the skin.

7. Acharya Charaka and Sushruta noted saptha dravya Sangraha i.e.

Tridosha, Twacha, Rakta, Mamsa and Lasika which makes the skin

Kutsita (deformed). If it is neglected then normal condition of whole

body may be affected so it is called as Kushta.

Paryaya of Kushta

The Paryaya of the word Kushta can be broadly divided into two groups.

1. Meaning as a disease

2. Clinical presentation of Kushta


42

1) Meaning as a Disease

Vyadi, Aamaya, Gada, Gadaahvam, Gadavayam, Gadakayam.

2) Clinical presentation of Kushta

Aapyam – which consists of water

Utpalam – means to burst open

Jaranam – Delayed or decomposed

Rujaa – Which gives pain

Raaman – which shines with colour

Padmaka – which resembles lotus flower i.e, having red colour

Kauverim – This disease was attached to Kubera

Kutsitam – Contemptible

Basuram – To appear with shining or distinguished by

Nirujam – Without pain.

CLASSIFICATION OF KUSHTA:

The word 'Kushta' is a broad term, which covers almost all the skin

diseases. Kushta is produced invariably by the vitiation of the seven factors i.e.

3 Doshas and 4 Dushyas. But different types of pain, colour, shape, specific

manifestation etc. are found in Kushta because of Anshanshakalpana of the

Doshas. Accordingly Charaka Kushtas are in fact of innumerable types, but for

systemic study they are classified into two major groups 7 Maha Kushta & 11

Kshudra Kushta. There is no difference of opinion between any Acharya about

the total number of Kushta, but difference of opinion in symptoms & names of

some of Kushta exists. Chakrapani has clarified that in Kshudrakushta, the

symptoms of Mahakushta are manifested in milder form.


43

Table No.9 The difference between MahaKushta and Kshudrakushta are

as follows

No. MahaKushta KshudraKustha

1. Bahu Bahul Dosa Arambahta Alpa Dosa Arambhata

2. Bahulakshana Alpalakshana

3. Excessive discomfort Less discomfort

4. Penetrates into deeper Dhatus Less tendency to penetrate

in deeper Dhatu

5. Mahat Cikitsa Alpa Cikitsa

6. Chronic Less Chronic

7. Loss of skin functions like Supti. Less functional skin

deformities.

Table No.10. Classification of Maha Kushta according to various authors

S.No Kushta Cha Su A.Hr M.N B.P B.S Y.R

1 Kapala

2 Audumbara

3 Mandala -

4 Aruna - - - - - -

5 Rishyajiwha

6 Dadru - - - - -

7 Kakanaka

8 Sidhma - -

9 Pundreeka


44

Table No.11 Classification of kshudra Kushta according to various authors

S.No Kushta C.S Su.S A.H M.N B.P B.S Y.R

1 Eka Kushta

2 Charmadala - -

3 Kitibha

4 Dadru -

5 Alasaka - -

6 Vipadika -

7 Charmadala -

8 Visphotaka - -

9 Paama

10 Sataaru

11 Vicharchika

12 Sthularushka

13 Maha Kushta - - - - -

14 Visarpa - - - - - -

15 Parisarpa - - - - - -

16 Sidhma - - - -

17 Rakasaa - - - - - -

18 Kacchu - - - - -

19 Switra - - - - -

20 Vishaja - - - - -

21 Gajacharma - - - - -

KITIBHA KUSHTA

Nirukti and Paribasha

The term kitibha is constituted by the combination of “Kiti” and “Bha”.

The word kiti refers to a variety of insects which is black in colour and stays in

Kesha Pradesha or in hair.


45

This Kiti is also called “Akuna” by Hemadri the commentator of

Vagbhata. This indicates that it is either a lice or some other insect which is

similar to lice.

The term “Bha” refers to the resemblance or similarity. So the term

Kitibha which is constituted by suffixing Bha to Kiti suggests something which

resemblance of a lice.

The similarity that is mentioned is only in colour (Krishnavath) and not

in shape or size.

So the definition of Kitibha is “A pathological skin condition where the

colour of skin is black like Kiti”

Sushruta has also given one more meaning to Kitibha; it is a Upadrava

of the bit of poisonous varieties of insects.

According to William, M.M (1970) Kitibha is a bug, a louse.

Review of Kitibha Kushta

The description of Kitibha Kushta is found in the context of Kushta in

Brihatrayis and Laghutrayis. Symptomatology of Kitibha Kushta described in

the classics has lot of variations causing skepticism among the disciples

following the Ayurvedic principles.

Rigveda has the earliest documentation of Kushta. There is a description

available that “kakshavathi’s” daughter “Gosha” was inflicted by Kushta and

was discarded by her husband because of Kushta. Ashwini Kumaras treated

and cured her disease which mad her to regain her marital status. In the other

context Vaivarnatha and Romasatana are mentioned as Lakshanas of Kushta.

The daughter of Atri-Apala was another victim of Kusta with the above said

Lakshanas and was treated and cured from the disease by Indra.


46

According to Charaka Kitibha Kushta is a variety Kshudra Kushta43.

Madhavakara reproduced the description of Kitibha Kushta as available in

Charaka. He has also accepted it as a variety of Kshudra Kushta.

Chakrapani, and Gangadhara, also described Kitibha Kushta in

Ayurveda Deepika and Jalpa Kalpa Taru respectively. Dalhanacharya and

Gayadasa have also described Kitibha Kushta.

In Hemadri’s “Ayurveda Rasayana” description on Kitibha Kushta is

available.

Recent authors in their works have correlated Kitibha Kushta to

psoriasis which is a Keratinization skin disorder

Lakshana of Kitibha Kushta:

The lakshana of Kitibbha kushta explained by Acharyas has variations

According to Charaka44:

1. Shyava : Bluish black discolouration of the skin

2. Kina sparsha : Rudha vrana sthana, surface of the lesion is rough

resembling healed wound

3. khara sparsha : Lesions are rough or coarse to touch

4. Parusha : Dry lesions (Ch.Ch.7/22)

The similar description is available in Bhava Prakasaha, Madhava

nidana and Yoga Ratnakara. As per Astanga Hridaya has incorporated some

more lakshanas45:

1. Kandu : Itching

2. Ashitam : Shayava varna (A.H.Ni 14/20)

Acharya Sushruta added few more lakshanas46

1. Sravi : Exudating

2. Vritam : Round or coined shaped lesions

3. Ghanam : Well defined borders


47

4. Snigdham : Sticky, unctuous

5. Krishnasm : Black (S.Ni 5/13-14)

In Bhela Samhita following lakshanas explained:

1. Drudham : well defined or firm

2. Punah prasravanti : oozing

3. Roodhanvi tam cha : Separation of lesions

4. Vardhate cha samutpannam : The lesions extend after manifestation

(B.S.Chi 6/25)

Kashyap Samhita says

1. Aruna : Reddish brown

2. Vriddhimanti : Spreading in nature

3. Guruni : Lesions are large

4. Prashantani cha punarutpadyante : Subsides and relapses (K.S.Kustha

chikitsa)

Nidana of kushta47

Specific nidana of kusthaare not described in Ayurvedic classics, as

kitibha is one among the different types of kushta, the samanya nidana

described in the context of kustha holds good for kitibha also. The nidana

mentioned for the causation of kushta can be broadly classified and studied

under the following five headings.

1. Aharajanya

2. Viharjanya

3. Daivaapcharaja

4. Chikitsa sambandhi

5. Sankramika


48

Table No.12 Aharajanya Nidana of Kushta

S.No Nidana C.S Su.S A.H B.S H.S Y.R1 Virudhahara 2 Ajeerna, Adhyasana - -

3 Matsya (chilchima) with dugdha

- -

4 Dugdhati sevana - -

5 Amlati sevana - - -

6 Guru ahara - - -

7 Gramya udaka with anupa mamsa sevana

- - - -

8 Dadhi sevana - - -

9 Sneha - - -

10 Lakucha and kakmachi - - -

11 Matsya with payasa - - -

12 Ahitashana - - - - - -

13 Drava snigdha ahara - - -

14 Uddalka, kusumba - - - -

15 Navanna Yavaka kullatha - - - -

16 Lavana, Hayanaka, Atasi - - - -

17 Mollaka - - - -

18 Satata madhu sevana - - - -

19 Chilmila with milk - - - -

20 Madyaamla with milk - - - - -

21 Guda milk - - - - -

22 Matsya, Nimba with milk - - - - -

23 Mamsa with madhu - -

24 Papodaka - - - - -

25 Pipali, Harit shaka with vidagdha ahara sevana

- - - - -

26 Guda with moolaka - - - - -

27 Haviprasha - - -


49

Table No.13. Viharajanya nidana of Kushta

S.No Nidana Ch.S Su.S Vag B.S Ha.S Y.R 1 Chardinigrahana - - 2 Vegavrodha - - 3 Sheetambu snana

after atapa sevana - -

4 Diva swapna - - 5 Mithya vihara - - - - - 6 Vyayam atisantapa

bhuktopsevana - -

7 Shrama bhayartanam sheetambusevanam

- - -

8 Ratri jagrana - - - - - 9 Ajeerneapi vyayama - - - - 10 Sneha pitasya

vantasys va vyayamam

- - - - -

11 Vyavaya after vidahi ahara sevana

- - - - -

12 Gramya dharma sevana

- - - - -

Table No.14. Daivapacharajanya nidanas mentioned by different acharyas

can be summarized as follows.

S.No Nidana Cha Su Vag B.S Ha.S Y.R

1 Papa karma - -

2 Vipram gurum

garshyatam

- -

3 Purvakrut karma - -

4 Gohatya - - - - -

5 Use of money or material acquired through theft

- - - -

6 Sadhu ninda, apman

and vadha

-

-

-

-


50

The exact role of some of the nidanas mentioned above such as papa

karma, gohatya etc. in the causation of kushta are difficult to analyze. However

these can be taken as vyadhi hetu or vishesha hetu of kushta.

1. Viruddha ahara48 :

Charaka has mentioned “all the food articles, which dislodge the various

doshas do not expel them out of the body, are to be regarded as unwholesome”.

Further he has said “Articles of diet that are inimical to the body-elements tend

to disagree with the system (body).49” Viruddhahara is one potent causative

factor for several diseases. Consumption of Viruddhahara gives rise to various

disturbances of mild to violent nature and disease of acute to chronic nature

including the eight Maharogas. This point towards the potency and lethal effect

of Viruddha Ahara.

Types of viruddhahara : Acharya Charaka has stated eighteen types of

Viruddha i.e. Desha, Kala, Agni, Matra, Satmya, Vatadi, Paka, Samskara,

virya, Samyoga, Kostha, Avastha, Krama, Parihara, Upacara, Hridaya,

Sampada and Vidhi viruddha50.

DESHA VIRUDDHA (CLIMATE INCOMPATIBILITY)

Desha:

There are two types of Desha i.e. Bhumi desha (place), Atura desha

(Patient). Here, regarding this subject, Bhumi desha is important. Acharya

Vagbhata classified desha into three parts. I.e. Jangala, Anupa and Sadharana.

In Jangala, Vata and Pitta dosha are predominant, while Vata and Kapha

Doshas are predominant in Anupadesha. Sadharanadesha has average qualities

of both the above mentioned Desha.51. But, Astangasangraha has more

emphasized the Desha. He has described types of desha according to Sada

Rasotpati, viz. In short, the dominancy of dosa and rasa is as follows:

1. Anupa desha have Kapha, pitta dosa and Madhura rasa dominancy

2. Jangala desha have vata pitta and Katu rasa dominancy


51

3. Sadharana desha have average qualities.

It is further divided in

i) Anupa Sadharana - Lavana + Amla Rasa dominancy

ii) Jangala Sadharana - Tikta + Kasaya Rasa dominancy

Desha Viruddha :

The use of Dry (Ruksa) and Acute (Tiksana) and other food substances

of similar qualities in an arid region (Jangala desha) and the use of unctuous

and cold and other food substances of similar qualities in a wet region (Anupa

Desha) are examples of incompatibility of diet with reference to clime - Desha

Viruddha52. Further according to Astangasamgarha, types of Desha and

regarding Rasa dominancy, the diet incompatibility of desha may be as under.

Table No.15 Types of Desha, Rasa dominancy& diet incompatibility

S.No Desha Dosa

dominancy Rasa

dominancy Incompatibility

1 Anupa Kapha Madhura Madhura and

other Kapha aggravated food substances

2 Jangala Vata pitta Katu Katu and other Vata aggravated food substances

3 Jangala Sadharana

Tikta + Kasaya

Vata

Tikta + Kasaya and other Vata aggravated food substances

4 Anupa Sadharana

Lavana + Amla

Kapha

Lavana + Amla and other Kapha aggravated food substances


52

KALA VIRUDDHA

The use of cold, dry and similar things in winter and the use of pungent,

hot and similar things in summer season are called incompatibility of diet with

reference to season is Kala Viruddha.

Ritu and Virudhha ahara53: (Ch. Su. 6/23)

1. Hemant Ritu and Viruddhahara: In this season Snigdhta (moisture) and

Madhura rasa increase naturally. Therefore Kapha is going to accumulate in the

body. So one should omit Madhura rasa and Snigdha food substances, but here

the Jatharagni also becomes very strong. So if such Jatharagni does not get

sufficient amount of fuel (food substances), then it consumes the body - fluids

and thus the Vata possessed of cold qualities, get provoked in this season. So

one should take the food substances, which are heavy (both as regards measure

and quality), unctuous, amla and salt like juices of the flesh, fatty animals If

one person who don’t take this type of diet regimen, then it is called

Viruddhahara as per the hemanta kala.

2. Shishira and Viruddhahara : Shishira (dewy season) is similar to Hemant

(winter) in nature, therefore the whole regimen prescribed in the hemanta

season as well, viruddha diet regimen are also same in Hemant season. Charaka

has stated that one should avoid those foods substances which are pungent,

bitter, astringent in taste and provocative of vata. These all substances are

Viruddhahara in Shishira Ritu. In Shishira Tikta Rasa and Ruksa Guna

substances are mostly Viruddha than others.

3. Vasantha and Viruddhahara: Kasaya rasa and Ruksa guna became more

dominant in the Spring season (Vasantha). So intake of this type of food

substance is Viruddhahara. Charaka has also stated that one should avoid

heavy, amla, unctuous and sweet food substances, as these are Viruddhahara in

vasantha. 4. Grishma and Viruddhahara: In this season Katu rasa and Ruksa


53

guna become more dominant naturally. Therefore food substances having Katu

and Ruksa quality become Viruddhahara in Grishma season. Lavana, Amla,

Katu, Ushna food substances are also Viruddha as mentioned by Charaka.

5. Varsha and Viruddhahara: In Varsa ritu Amla rasa and Snigdha guna

become dominant naturally. So intake of this type of food substances is

viruddha in this season.

6. Sarada and Viruddhahara: Lavana Rasa and Snigdha Guna become

predominant in this season (The autumn season). So intake of this type of food

substances becomes viruddhahara in this season.

Table No.16 Nidanas as per ritu

Ritu Viruddha Ahara ViruddhaVihara

Shishira Katu,tikta,kashaya rasa; vatala laghu,

sheeta ahara

Pravat

Vasanthaha Amla,snigdha,madhura ahara Divaswapna

Greeshma Katu, amla, lavana, ushna veerya

ahara

Vyayama

Varsha Udmantha, ati drava ahara Atapasevana,vyayama,

vyavaya, diwa swapna

Sharad Vasa, taila, audak anupa mamsa,

kshara, dadhi

Divaswapna,atapasevana,

prag vata

Hemant Vata vardhak, laghu anna

pana,udamantha,pramitahara,teekshna

madya

Pravata


54

AGNI VIRUDDHA

TYPES OF AGNI:

As Acharya Charaka has stated54,

Agni in the bodies is differentiated in to four types according to its intensity

viz.

1. Mandagni - Mild intensity – kapha dominance

2. Tiksnagni - Acute intensity – pitta dominance

3. Vishamagni - Irregular intensity – vata dominance

4. Samagni - Regular intensity – dosha in sama avastha

One should take diet (food - Ahara) after considering four types of agni

respectively. If food has not been taken in accordance to the respective

Jatharagni bala then it will become Agni viruddha.

1. Mandagni - Guru, Snigdha, Madhura, etc. food substances

2. Tiksnagni - Laghu, Tiksana, Suksma, Vidahi, Ushna food substances.

3. Visamagni - Ruksa, Laghu, Sukshma, Guru, food substances

4. Samagni - Excessive quantity of food and taking food substances

irrespective to kala (time).

MATRAVIRUDDHA

Food taken in sufficient quantity is termed as Matravat Ahara. If one

cannot take Matravat Ahara, then it is called Matraviruddhahara. Charaka has

given example of intake same quantity of Madhu and Ghee for explanation of

Matraviruddha. Charaka has described Matra as “Rashi” in Ashtavidha Ahara

Vishesayatana55. At the same time a principle for the Matravat Ahara given by

Charaka is quantity of diet depends upon the digestive power. Matra Viruddha

may be two types viz. (1) Hina (deficient) (2) Adhika Matra (excessive).


55

Table No. 17. Examples of Matraviruddha

S.No Example C.S Su.S A.H A.S.

1 Honey + Ghee in equal quantity

2 Honey + rain water in equal quantity

3 Honey + seed of the east Indian lotus

4 Honey + water in equal quantity

5 Honey + Sneha in equal quantity

6 Water + Sneha in equal quantity

7 Honey + Sneha + rain water

8 Honey + Ghee + Vasa

9 Honey + Vasa

10 Honey + Taila

11 Honey + Taila + Ghee + Vasa

SATMYA VIRUDDHA

Satmya means substances of pleasure to one self.56

A substance conductive to an individual is called “Satmya” and the use

of such substances result in the well being of that individual. In other words,

habituation is that which aggress with one’s system. Thus habitation has the

same connotation as homologation.

Types of Satmya:

Homologation is of three kinds56.

1. Pravara (Superior): Agreeability to all the tastes is the best type of

homologation.

2. Avara (Inferior): Agreeability only to a single taste.

3. Madhya (Mediocre): This agreeability is the mean between the best and

the poorest.


56

Here Charaka has stated that one should develop homologation of the

best type, that is agreeability to all the tastes then the poorest and medium type

of agreeability. But Charaka has pointed out that even after acquiring

homologation to all the tastes (best), yet, one should take wholesome diet /

food substance regarding Ashtaaharavidhi visheshayatana. Factors like Desha

(Habitat), Kala (Time), Jati (Race), Ritu (Season), Roga (Disease), Vyayama

(Exercise). Abhyasa-oka (Continues practice) etc. are such factors which play

an important role in “Satmya”. These all are types of “Satmya”

Intake of sweet and cold food substances or articles by a person to

whom only pungent and hot substances are homologous is an example of

incompatibility of diet with reference to homologation.

VATADI VIRUDDHA

The use of articles of diet (food), drugs and procedures, which are

similar in quality to that of the respective (susceptible) body dosha, is called

(Vatadi Viruddha) humoral incompatibility. Therefore person who suffers from

the preponderance of one or the other dosh should take food substance or diet,

which are opposite or antagonist to respective dosha in Prakrti. But if a person

of the vata prakruti (or any other prakruti), who has indulgence in vata,

provoking things (same quality of Ahara), then the vata get aggravated, and

thus aggravated vata afflicts the victim’s body with various disorders and

impairs his strength, complexion, and span of life. Therefore use of those food

substances / diet which are similar in quality to respective prakruti is called

vatadiviruddha (humoral incompatibility).

PAKA VIRUDDHA

If food substances / diet is prepared with bad and rotten fuel, or is

undercooked or over cooked or burnt, then it is called or Pakaviruddha -

culinary incompatibility. Sushruta has also mentioned them as under.58


57

Repeatedly cooked, over cooked and burnt is Pakaviruddha. Similarly as

mentioned by Charaka Paka (Application of heat) is one type of heat treatment.

If this heat treatment is proper, then one can get that quality which that

individual require, but when improper heat treatment is given, the food

substances may be over cooked, under cooked or burnt. This is called paka

viruddha.

SAMSKARA VIRUDDHA

Samskara is a synonym of Karana. Karana (preparation) is one of eight

factors of dietetics codes known as “Astaaharavidhi visesayatana”. Giving

definition of Karana, Charaka stated “Preparation (Karana) is the process

performed to modify the natural properties of substances. The process is that

which radically modifies the properties of substances”59.

The incompatibility of preparation is that where food/food substance is

converted in to poison during the course of preparation. As for example, in the

case of the peacock’s flesh roasted on a spit made of a stick of the castor plant.

As earlier mentioned various methods of preparation are used for processing of

diet / food substances to get more qualitative properties, but when these

method, are not according to rules and regulations of dietetics, one can not get

more qualitative properties but instead get the harmful effect of food

substances which is just like poisonous effect to the body tissues (Dhatus). So

this type of Samskara (preparation) is called Samskara viruddha due to harmful

effect on the body tissues. Acharya Sushruta has also stated Samskara viruddha

entitled “Krama viruddha” .In same way Astangasamgraha and Astangahrdaya

have also given examples of Samskara viruddha, which are mostly similar to

view of Charaka and Sushruta.


58

Table No. 18 Classical example of Samskara viruddha

No Examples Ca Su. A.H. A.S. Disease

1 The flesh of parakeet bird when it is fried in rape-seed oil becomes incompatible. It provokes pitta.

+ Pittavrddhi

2 Indian Spinach (Yorksaka) prepared with til paste causes diarrhoea

+ + Atisara

3 Peacock’s Flesh roasted on a spit made of the castor plant twigs, or prepared in castor oil, if eaten, will cause immediate death.

+ Sighra Mrtyu

4 The Flesh of the parakeet bird, if eaten, having roasted it on a spit

+ Sighra Maraka

5 Lony pepper (Pippali) and black – night shade (Kakmaci) prepared in fish-oil, causes immediate death

+ + Sighra Maraka

6 Kamala cooked in butter milk + + 7 The flesh of bearded vulture

(Bhusa) roasted on a spit. + + +

8 The flesh of pigeon fried in rapeseed oil.

+

VIRYAVIRUDDHA

Virya is one of the intakes of quality of Dravya. This potency is though

to be of eight kinds by some, while others think it to be of two kinds. In short,

Charaka says in Virya is the power by which an action takes place; nothing can

be done in the absence of virya. Every action is the result of it60. Acharya

Charaka mentioned in Vimana Stana 1st says that, one should take Dravyas in

combinations, which are virya -Aviruddha means having same Virya. When

substance having opposite Viryas are used in combination, that it is known as

Viryaviruddha.


59

SAMYOGA VIRUDDHA:

Combination is the term for the coming together of various substances.

Such combination may be due to the action of both (food substances), all or

one of the constituents and this combination is in every case temporary

(Anitya). In another verse, Charaka has stated that, Combination is the

combining together of two or more (food) substances. This chemical

combination exhibits special properties which none of the constituents ever

possessed. For example – The combination of honey and ghee, the combination

of honey, fish and milk has a toxic effect, not present in any of its constituents

individually61.

That is incompatibility of combination when sour things are taken with

milk. Acharya Sushruta has also pointed Samyoga viruddha viz. “Rasa, Virya,

Vipaka Viruddha”. This type may also be included under Samyoga viruddha61.

Table No. 19 Classical examples of Samyoga Viruddha

S.No Examples C.S Su.S A.H A.S

1 1 Milk + Fish

2 The Flewh of domesticated, wet land or aquatic creatures + honey, til, gur, milk, black gram, garden redish, lotus stralks or sprouted grains

3 Paukana saka, Rohinisaka or the flesh or pigeon fried in rape-seed oil + honey and milk.

4 Milk followed by garden redish, garlic, moringa, large basil, holy basil, surasa.

5 Jatuka – Saka and ripe lakooca + honey or milk

6 Ripe lakooca + black gram soup, gur, ghee + milk

7 Mango, Indian hog-plum, pomelo, lakooca, Bengal current, plantain, lemon, small jujube, Ceylon oak, showy dellenia, jambul, wood apple, tamarind, paravata, walnut, jack-fruit, coconut, pomegranate, emabic myrobalan and such other substances, and all sour things, either liquid or otherwise.


60

8 Kusumbha saka + sugerwine, maireya + honey

9 Crane’s flesh + Varuniwine or Kulmasa pulse

10 Kakamaci (black night shade) + honey 11 Honey + hot water

12 Bhaltataka + hot water

13 Kakamaci + Pippali + Marica

14 Nadisaka + Kukuta flesh + Dadhi

15 Unroasted Meat + Pitta

16 Sura + Khichadi + Khira

17 Gur prepared from Sugarcane + Sugar +

Fish Gur + Black night shade (Kakmaci)

18 Honey + Garden Radish

19 Hog Meat + Gur + Honey

20 Milk takes with Garden radish, Unripe mango, Jambil fruit, meat of Iguana, rabbit & hog.

21 Ripe Lakooca + fruits of Palmyra.

22 Milk + Fruit of Lakooca

Kostha viruddha

In Ayurveda there are two meaning by term “Kostha”

1. Anatomically term of Kostha: This term is mostly related with structure and

anatomy of human being. Here Kostha means Amapakvasaya or Mahasrotas.

Charaka stated 15 of Kosthangas.

2. Therapeutic aspect of Kostha: Here, Kostha means one type of permanent

condition of Pittdharakala or Grahani (Deuodenum) which is affected by any of

one predominant humour (dosa).

Type of kostha :

1. Mridukostha viruddha:

In this type of bowel the assimilative organ (Grahani) is affected by

excessive pitta. As Pitta is having ushna, tiksna, sara qualities, when this type


61

of food substance or drugs are administered then pitta get provoked excessively

and one get disease of pitta dosa. So these types food substances are called

viruddha in Mridu Kostha.

2. Krura Kostha viruddha:

In the same way, Krura kostha person’s assimilative organ (Grahani) is

affected by excessive Vata dosa. Vata is Laghu, Manda, Cala, Ruksa, Sita, and

Khara in nature (quality). Therefore if food substances, having these types of

quality are taken, Vata get aggravated immediately and disease related to vata,

dosa may be produced. So this type of diet / food is called viruddha in krura

kostha.

3. Madhyam Kostha viruddha:

Similar to above in Madhyama kostha where the organ is assimilated by

kapha, in take of food having qualities like kapha will turn out to be viruddha.

AVASTHA VIRUDDHA

Incompatibility with reference to the state of the person is known as

Avastha viruddha, e.g. when a Vata, provoking meal is given to one who is

exhausted on account of Fatigue, sexual act or physical strain then it turns out

to be Avastha viruddha. Similarly, if a Kapha provoking meal is given to one

subject to who is lethargic or sleepy or indolence, then it becomes Avastha

viruddha.

When one person takes food substances similar to his own prakriti

dominant dosa, then it is called. Avastha viruddha viz. in childhood, intake of

Kaphavardhaka Ahara. Similarly, if one person who is suffering from provoked

doshas and he takes food substances having similar quality to provoked dosha,

it is also called Avasthaviruddha.


62

KRAMA VIRUDDHA

This is incompatibility of rules of eating. When person takes his meal

without relieving himself of faeces and urine or eats without the feeling of

hunger or does not eat in spite of severe hunger then it turns out to be Krama

viruddha. Krama is related with general rules and regulations of eating. One

should take his food as per the rules and regulations of eating, if one cannot

obey these rules, his diet may become Krama viruddha. Krama viruddha is

related with Vidhiviruddha.

PARIHARA VIRUDDHA

This is incompatibility of the rules of prohibition, where a person takes

hot (food) substances after a meal varah and similar animals.Parihara means

those food substances which are to be avoided. Acharya has mentioned some

food substances which are to be avoided by person according to his condition

e.g. if any person is suffering from such condition of illness, he should avoid

food substances regarding his condition. This condition may be healthy or

unhealthy. In diseased condition, intake of food substances, which are

mentioned as Apathya - unwholesome in that particular disease is called

Parihara viruddha. Similarly, in healthy conditions, after intake any type of

meal, one should avoid those food substances, which are similar in quality with

previous meal.

UPACHARA VIRUDDHA

Upachara word means practice of medicine, Treatment, Chikitsa (Apte’s

dictionary) According to Charaka, Upachara viruddha is incompatibility of the

rules of ingestion where a person eats cooling things after taking ghee and

similar articles.

Ahara is one major part of Nidanas. So to avoid such type of Ahara

which, causes disease, is also called Upchar - Treatment. Acharya have

mentioned such Ahara as Apathya Ahara. Therefore intake of Apathya Ahara is


63

also called Upachara viruddha. or condition of illness, while Parihara viruddha

is related with both the conditions viz. healthy and unhealthy. So one can

consider Upacara Viruddha as a part of Parihara viruddha.

HRIDAYA VIRUDDHA

This is incompatibility of palatability where an article or substances of

food is unpleasant in taste. As Gangadhara here by term “Hridaya” one should

take “Mana”. Acharya Sushruta has also “Hrdaya viruddha” by avoiding of

Aswadu Anna63.

SAMPADA VIRUDDHA

This is incompatibility with reference to richness of quality where the

juice (Rasa) is taken of unripe, over-ripe or putrefied (food) substances. Intake

of such food articles, which are not having edible qualities, can be considered

as Sampada viruddha.

VIDHI VIRUDDHA

Ahara vidhi:

One should take food substances / diet according to Upayoga Samstha

mentioned in the eight factors of diet and dietetics (Asta aharavidhi

Visheshayatana). i.e.

1. Prakrti : Here Prakrti denotes the natural qualities of the Ahara dravyas i.e.

the inherent attributes like Guru and Laghu etc. of the diets and drugs. For

example masa is Guru in nature. Likewise mudga is Laghu in nature. Similarly

the meat of shukara is Guru and of Yena is Laghu.

2. Karana: Karana means the process or preparation. The mode of preparation

or processing, changes the natural properties of the substances. Thus there is a

change of qualities of the dravyas due to the processing like dilution,

application of heat, cleaning, storing, germination, flavouring, preservation and

the material of the receptacle etc.


64

3. Samyoga : The combination of individual things with two or more things is

known as Samyoga.

4. Rashi: The quantity of food which is to be taken in is known as Rasi.

5. Desha: Desha denotes the habitat. It determines the variations of the

qualities of the substances according to their geographic region, due to different

soil, use and their acclimatization to that particular region.

6. Kala: Time factor is described in dual context, one pertains with daily and

seasonal variations while other deals with individual conditions of age and

disease.

7. Upayoga Samstha: It consists of dietetic rules.

8. Upayokta: It means the person who takes food.

However Astangasamgrahakara Vagbhata has illustrated only seven types of

Ahara Vidhi Visesayatanas.( He has explained upyogasamstha and Upayokta

together and counted them as “Upayogavyavastha. Charaka has also used the

term “ahara vidhividhana” for Upayogasamstha.

Virrudha Ahara can be summarized as :

Milk Is

Incompatible

With

Melons Are

Incompatible

With

Starches Are

Incompatible

With

Honey Is

Incompatible With

Radishes Are

Incompatible

With

Nightshades(Potato, Tomato,

Eggplant, Chilies)

Are Incompatibl

e With Bananas, Fish, Meat, Melons, Curd, Sour Fruits, Kitchari, Bread containing yeast, Cherries.

Grains, Starch, Fried foods, Cheese.

Eggs, Tea, Milk, Bananas, Dates, Persimmons

Ghee (in equal proportions) Heating or cooking with.

Milk, Bananas, Raisins

Yogurt, Milk, Melon, Cucumber


65

Yogurt Is Incompatible

With

Eggs Are Incompatible

With

Mangoes Are Incompatible

With

Corn Is Incompatible

With

Lemon Are Incompatible

With Milk, Sour

Fruits,

Melons,Hot

drinks,

Meat,Fish,

Mangos, Starch,

Cheese.

Milk, Meat,

Yogurt, Melons,

Cheese, Fish,

Bananas.

Yogurt, Cheese,

Cucumbers.

Dates, Raisins,

Bananas.

Yogurt, Milk,

Cucumbers,

Tomatoes.

2. MITHYA AHARA

Mithya Ahara means improper diet. According to Vijayaraksita, the diet

opposite to “Astaaharavidhivisesayatanani” is designated as “Mithya Ahara”.

Charaka has described eight factors determining the utility of food called as

“Astavidha Aharavidhi Visesayatanani”. They are Prakrti, Karana, Samyoga,

Rasi, Desha, Kala, Upayoga Samsthana and Upayokta. These eight factors give

rise to beneficial effects. Of things in proper way may be more useful but in

improper way they are always harmful. So they should be avoided. Following

terms are also under title as Mithya ahara.

Table No.20. Mithya ahara as per Ayurvedic classics

Mithya Ahara

C.S Su.S A.S A.H B.S H.S M.N B.P

Adhyashana

Vishamashana

Atyashana

Asatmya Ahara

Intake of food during Indigestion

Continuous and excessive use of Madhu, Phanita,


66

Matshya, Lakucha, Mulaka, Kaakmachi and intake of above substances while having Ajirna Excessive Snehana Vidahi Ahara without emesis of undigested food

Vidahi Ahara without emesis of undigested food

1. ADHYASHANA

Taking food just after completing a previous meal is called Adhyasana.

If proper time is not given for previous food to get digested and stomach is still

occupied with a previous food and more food is taken in such condition then

there is a disturbance in the rate of production of secretion from the stomach

and other organs related with digestion of food. Further peristalsis movement in

the stomach and intestine get disturbed. Due to decrease in secretion of

digestive enzymes, the food is partially digested thus producing Ama. As the

peristaltic movement is hampered, the food stays in the stomach for longer time

and gets decomposed producing toxins (Amavisa). These factors are the root

cause of several diseases, which are produced due to different permutations and

combinations of Dosa and Dusya involvements.64

2. VISHAMASANA

Taking food at irregular time is called Visama Asana. Visama asana is

best known to produce Visamagni.65


67

In present day life, Hurry, Worry and Curry have become universal

phenomenon; no one has time to even eat properly. Visama Asana is becoming

a common practice now a day.

SAMASHANA

Intake of wholesome diet and unwholesome diet at same time in one

meal is called Samashana.

3. ATYASHANA

Taking excessive amount of diet is known as Atyasana. Atimatra diet is

best known to produce vitiation of Agni and Ama66. Ahita bhojana when taken

in Atimatra at improper time (Akala) leads to Dusti in Annavaha rotasa and

also disturbs the Paka prakriya (process of food digestion).

4. LAVANA ATI SEVANA

Inspite of good qualities, if used in excess causes liquification of kapha,

aggravation of pitta, vitiation of rakata, mamsa vidahana (decomposition of

mamasa), kaya sthilikaroti67. As kapha, rakta, mamsa are among the dushya of

kushta, so excess of Lavaana rasa may precipitate Kushta

5. MOOLAKA

Latin name: Raphanus sativus68

English: Radish

Family: Cruciferae

Types: Bala and vriddha

Out of the above said two types, the pakwa (vriddha) moolaka is nindita and

vitiates tridosha

Bala moolaka is laghu and tridosha hara (B.P)

6. LAKUCHA SEVANA

Latin name: Atrocarpus lakocha69

English: Monkey jack

Family: Moraceae


68

Rasa: Madhua, amla, kashaya

Guna: Guru, ruksha

Veeya: ushna

Vipaka: amla

7. DADHI SEVANA

There are differences in opinion regarding the qualities of curds.

Table No.21 Qualities of curd as per different authors

Qualities C.S Su.S A.H & A.S

Rasa Amla Madhur, amla Amla

Veerya Ushna Ushna Ushna

Guna Guru, snigdha Snigdha Guru, snigdha

Vipaka Amla Amla Amla

Action Rochana,deepana,

vrishya

Vrishya, prana kara,

maangalya

Meda shukra

shleshma krit,

rochana

Types of Dadhi

Table No.22. Types of Dadhi as per Sushruta70

Properties Madura Amla Ati amla

1

2

3

4

Maha abhishyandi

Kleda karaka

Kapha vardhaka

Meda vardhaka

Kapha vardhaka

Pitta vardhaka

Rakta dooshaka

Vidahi

As per Arundatta :

Table No.23. Types of Dadhi as per Arundatta71

Properties Manda jatam Samyak jatam Ati jatam

1 Anbhi vyakta

amlam

Abhi vyakta

amlam

Ati amlam


69

Mandak dadhi :

As per Brihat trayi, Mandak Dadhi does tridosha kopana. Commenting

on Ashtanga hridaya, Arundatta says that it is yugapath dosha kopana i.e it will

vitiate tridosa altogether. Astanga hridaya and sangraha innumerate following g

diseases caused due to the consumption of mandak dadhi.

1. Jwara

2. Rakta pitta

3. Visarpa

4. Kushta

5. Pandu

6. Brahama

8. DUGDHA ATISEVANA

All the Acharyas accepted eight types of ksheera and explained it under

ksheera varga. The qualities of ksheera are listed below:

Table No.24. Types of Gavya ksheera

Properties Charaka Sushruta Vagbhata

Jeevaniya

Rasayana

Sara

Snigdha

Guru

Madhura

Manda

Bahala

Pichila

Mridu

Alpa abhishyandi


70

Mahishi ksheera

Table No.25. Properties of Mahishi ksheera


Guru

Gurutara

Maha abhisyandi

Snigdha

snigdhatara

Sheeta

Aja ksheera

Table No.26. Properties of Aja ksheera

Properties C.S Su.S A.H

Laghu

Kashaya

Madhura

Sheeta

Laghu

Ushtra kseera

Table No.27. Properties of Ushtra kseera ksheera

Properties C.S Su.S A.H

Ruksha

Ushan

Lavana

Laghu

Ishat ushna


71

Stree ksheera

Table No.28. Properties of Stree ksheera


Jeevaniya

Pathya

Guru

Kashya

Sheeta

Snigdha

Satmaya

Avi ksheera

Table No.29. Properties of Avi ksheera


Ushna

Guru

Madhura

Snigdha

Eka Shafa ksheera

Table No.30. Properties of Eka Shafa ksheera


Ushna

Laghu

Amla

Lavana

Ruksha


72

Hasti ksheera

Table No.31. Properties of Hasti ksheera


Madhura

Kashaya

Guru

Snigdha

Sheeta

Sthira

9. ATYAMBU SEVANA

Chakrapani in Dravya sangraha says that patients of aruchi, pratishaya,

udara, madhu meha and kushta should drink very minimum quantity of jala.

Excess water produces klinnata and later produces mandagni,

amajeerna.72 Vagbhata has advised to alpa matra jala in all ritus except

sharad and greeshma. Jala advised at the time of food:

Before bhojana: agni mandyata

In between food: Dhatu samyata

After food: Sthoulyata74

Drinking of excess water leads to vitiation of mandagnai. (B.P)

Qualities of Nadi jala as per Brihat trayi

Table No.32. Qualities of Nadi jala as per Brihat trayi

Origin of river Charaka Sushruta Vagvahatta

Himvat prabhava Pathya Pathya

Prachya, Avanti, Aprant

Arsha Arsha

Sahaya, vindhya prabhva

Kushta, Hridroga, Shlipada

Kushta Kushta, Pandu, Shiro roga

Paariyatra Shiroroga, Hridroga, Kushta, Shlipada

Pathya, nirogta Tridosha shamak, Balya


73

Samudra jala Tridosha karaka Tridosha karaka Tridosha karaka

Mahendra prabhava

Udara, Shlipada Udara, Shlipada

Malaya udbhava Krimi janana

Table No.33. Types of jala as per Desha as per Bhava Prakash

Jangala Anoopa Sadharana

Ruksha Abhishyandi Laghu

Laghu Madhura Sheeta

Pitta, kapha shamak Snigdha Tri dosha shamaka

Pathya Guru Madhura

Vikara shamaka Mandagni krita Agni deepaka

Vikara shamaka

Table No. 34. Qualities of Jala as per source of collection

Source of jala A.S B.P

Koupya Agni deepaka, Pitta vardhak

Agni deepaka, Vata kapha shamak

Saaras Agni deepaka, Laghhu Kashaya, Madhura, Laghu, Balya

Tadaak Guru, Vata vardhak Kashaya, Madhura, Katu vipaka, Vata karaka

Choundya Pitta vardhak Madhura, Agni deepaka Prasravana Tridosha shamak Laghu, agni deepaka,

Pathya Aoudbhida Madhura, Pitta shamak Madhura, sheeta, avidahi Vapi Madhura, Laghu Madhura, Laghu Nadeya Laghu, Pathya Laghu, Agni deepaka Paalava Guru, Abhishyandi,

Tridosha kopaka Kedar Guru, Abhishyandi,

Tridosha kopaka Samudra Lavana rasa, durgandhi Narikelodaka Madhura, guru, Hridya Taalambu Guru. Pitta shamak,

Vrishya Vaikir Laghu, Pitta shamak


74

Jala Guna as per ritu :

Table No. 35. Qualities of Jala as per Ritu :

Varsha Sharad Hemant Shishira Vasantha Greeshma

Madhura Laghu Snigdha Laghu Kashaya Anabhishyandi

Guru Anabhishyandi Guru Kapha, Vata Shamak

Madhura

Abhishyandi Nirdosha Balya Rookksha

Prashasta Vrishaya

10. Hayanak, Chinaka, Uddalaka, Kordusha should not be taken with

Ksheer, Dadhi, Kola, Takra, Kulatha, Masha, atasi and kusumbha

taila74

11. KARMA AS NIDANA OF KUSHTA

Contribution of Vedas in understanding etiology and treatments of

various ailments:

In the Vedic references we can trace out unbroken continuity of medical

tradition including karmaj vyadhi.

Importance of Graha highlighted in Vedas

Sangraha karta of Rigveda jyotishi Lagadh Rishi, it contains 36 karikas.

Yajurveda jyotish has 49 karikas

Atherva veda jyotish has 162 karikas, it contains 162 mantras

Atherva veda

The nirukti of Atharva veda says: Atha + arvan i.e. which gives the

knowledge of Atmik and sharirik tatvas. The Atherva veda is by all accounts a

curious compendium of medicine in its various stages of evolution and contains

the most primitive as well as some of most highly developed stages of therapy

for the karmaj vyadhi


75

Papa janita karmaj vyadhi :

Atharvaveda, kanda 8, Su 7, richa 7/19/9 and 13 says Vachika, Manasik

and Baudhik papa vriti are only are the causes of Roga, Dukha, mrityu and

Nasha.

Atharvaveda, kanda 8, Su 3 explains Dushta lakshanas, some of them are :

Bhanguravat - Person who thinks of nashas of others

Vadha karta – who kills cows

Dusha karmi – who does bad deeds

Asatyachara – who says lie

Asteya – who steal god idols

Achit – who has bad thoughts in mind

Risha - Destroyer

Himsra – who kills others

Druha – vishwasghati

Durvakta – who speaks rashly

Likewise 50 papa karmas has been explained which leads various

ailemnts including skin disorders.

Kaushika sutra 37-1/25 there is reference of Grahabhichara

Kaushika sutra 32/26, 27, two types of Vyadhis has been explained i.e.

Ahara nimitaja and Papa nimitaja.

Kaushik Sutra Atharva Veda has 731 suktas and divided into 14 vargas,

out of which 9th is Prayaschit. It is says mode of treatment for papa

karmaj vyadhi.

Kautilya Arthasahstra contains Brihatparashar hora shastra which

contains 97 chapters; there is detailed explanation of graham, rashi

swaroopa, lagna, arishta adhyaya etc in the context of karmaj vyadhi

In Markandeya Purana (16/17/18/19), the main cause of roga is papa,

which in turn caused by manas, budhi and antah karana. Papa karma

subsides after sufferings (Chapter 2/100).


76

Karma as nidana in Ayurvedic lexicons:

Ashtanga Sangraha (A.S. Su 9/107) in Viruddha anna vignyaniya adhyaya says

there are two types of karma75 i.e.

1. Eha janam krita i.e. Pourusha karma

2. Anya janama krita i.e. Daiva karma

Eha janam krita: Dashavidha Papa karama

Kayaik: Himsa, steya, anyatha kamam

Vachik: paishunyam, parusham, anrutam, Sabhinna alapam

Manasik: Vyapad, abihdya, drik viparyaya

Anya janama krita: Poorva janam kritam papam

Balawan Pourush karma overpowers hina Daiva karma and vice versa76.

Same explanation has been given by Charakachrya in

Janapadodhwamsiye adhyaya77.

As per Acharya Charaka “There is no major action (performed in

previous life) which does not lead to the corresponding results. Diseases arises

out of such actions are not amenable to any therapeutic measures. They are

cured only after the results of past actions are exhausted”.78

Vriddha Vagbhata in Shishyopanayaniye adhyaya says, “Any disease

can be transformed from one stage to the other if there is defect in any of the

chikitsa chatushpada and if a person has done poorva janma krita papa karma.

(A.S Su 2/37)

Importance of graham in Ayurveda:

Sukha sadhya vyadhis

When grahas will be at their respective favuorable positions, then the vyadhi

will be sukha sadhya

Pumsavan vidhi


77

The procedure known as pumsavan vidhi says the importance of nakshatra.

During conjunction of Pushaya nakshatra, the woman should be made to drink

curd added with shweta sarshapa.

Rasayana

A person should enter in the kuti when sun is in Uttarayana, shukla paksha and

when the nakshatra, mahurata are shubha (auspicious).

Upanayana samskara

Upanayana samskara to be done in shubha nakshatra, mahurata, tithi.

Charakacharya has explained in Unmada Chikitsa (Ch.Ch 9/21) about prakopa

kala of different grahas in their kalas. It is as follows:

Table No. 36. Prakopa kala of different grahas79

S.No Graha Kala

1 Deva Shukla paksha

2 Pitru Dashmi / Amavasya

3 Rishi Sashti / Navmi

4 Gandharva Dvadashi/ Chaturdashi

5 Yaksah Ekadashi/ Saptami

6 Bramha rakshasa Panchma / Poornima

7 Pishacha Dwitiya / tritiya/Ashtami

Graha roga in Kaumara Brihtya

Graha as niadana attributed as complete chapter in Kaumara brithya

Table No. 37. Bala grahas as per different acharyas

S.No Author Graha

1 Sushruta 9

2 Vagvhbhata 12

3 Bhavaprakasha 9


78

4 Yoga Ratnakara 12

5 Harit 8

6 Kashyapa 20

Medical Astrology80

The 12th raashis is in the Zodiac represent certain part of the body.

Similarly the 12th bhavas also represent certain parts of the body. Each planet

is responsible for the particular disease. The 6th house in a horoscope is in the

house of disease. The 8th house is the house which causes mental worries and is

also responsible for the accidents or surgery. 12th house indicates

hospitalization. Taking all the above factors into consideration it is possible to

find out that, when a person is likely to fall sick, which part of the body that is

going to be affected and the cause for the disease and prescribe remedial

measures.

The following are the part of the body rereoresented by different rashis

in the zodiac

1st Mesha – Head. This is ruled by Mars. Hence the natures of the

disease represented by Mesha are headache, burns and the problems

related with brain.

2nd – Vrishabha – This rules over neck, ear, eyes, nose, throat and voice

box. Therefore, Ent problems are indicated by this house.

3rd – Mithuna – This rules over shoulders and arms. It has links with the

ENT. So cough, cold, nose problems, bronchitis etc. are the diseases that

could be expected from this house. As mercury rules over this house,

problems connected with the functioning of the nervous system could

also be predicted from this house.

4th- Makara – This rules over the chest. So it can result in problems

related with heart, lungs etc . As this is ruled by moon problems such as


79

cold, cough, water borne diseases, mental problems can also be

predicted.

5th – Simha – This rules over portions below chest and the abdomen. As

this is ruled by sun, which in turn rules over heart and liver. The spinal

cord, vertebral column are also ruled by this house.

6th – Kanya – This rules over abdomen. Diseases pertaining to gaster,

small intestine and bowels are to be found out from this sign. As

mercury rules over this house nervous diseases are also to be found out

from this house.

7th – Tula – Urinary tract infections, kidneys and uterus are ruled by this

house. Sexual disorders, urinary tract infections, menrtual cycle

problems are to be ascertained by this house.

8 – Vrishchik – Reproductive organs, prostrate glands and urinary

bladder are the organs represented by this house. As Mars rules over this

house excessive bleeding disorders, BPH, Sexual disorders, UTI etc. are

to be found out by this house.

9 – Dhanu – This rules over hips and thighs. Lumbago, back ache are

the diseases that could be found out from this house.

10 – Makara - Knees are represented by this house. As Saturn rules over

this house. Problems connected in the bones could be resulted out by

this house.

11 – Kumbha – Legs, ankles are represented by this house. As Saturn

rules over this house, problems connected with bones like arthritis may

be found.

12 – Meena – Feet, leg are ruled by this house. Varicose veins problems

are to be found out from this house.


80

Table No. 38. Rashi in relation to organs and diseases

S.No Rashi Organs Diseases 1 Mesha Head Headache, tumours 2 Vrishabha neck, ear, eyes, nose,

throat and voice box ENT problems

3 Mithuna shoulders and arms Nervous disorders 4 Cancer Thorax cold ,cough, water borne

diseases, mental problems 5 Leo Thorax and the

abdomen Asthama, gastritis, cardiac ailements

6 Virgo Brain, abdomen Nervous diseases,bowel disorders

7 Libra Kidneys and uterus Sexual disorders, urinary tract infections, menstrual cycle problems

8 Scorpio Reproductive organs, prostrate glands and urinary bladder

Bleeding disorders, BPH, Sexual disorders,UTI

9 Dhanu Hips and thighs. Lumbago, back ache 10 Makara Knees Osteo arthritis, Rheumatoid

athritis 11 Kumbha Legs, ankles Arthrithis 12 Meena Feet, leg Varicose veins

As per Veer Simhavalokah81 :

1. If Rahu and soorya are in the 8th place leads to Kushta.

2. If Rahu and soorya are in the 8th place along with Mangala graham then,

it leads to Maha Kushta

3. If Shukra, Soorya and Shani are residing in same house then it leads to

Kushta and the person will be of bad character.

4. If shani resides in 8th house leads to Kushdra Kushta.

5. If shukra resides in Simha rashi with soorya dirshti over it.

6. If soorya is nichastha, if there is antardasha of Buddha during maha

dasha of soorya.

7. If Chandra mahadasha coincides with anterdasha of Buddha.


81

Table No. 39. Pratikar for Vikrit Grahas

S.No Position of Graha Pratikar 1 If Rahu and soorya are in the 8th

place Soorya aradhana

2 If Rahu and soorya are in the 8th place along with Mangala graham then, it leads to Maha kushta

Soorya and Mangal aradhana

3 If Shukra, Soorya and Shani are residing in same house

All grahas should be worshiped

4 If shani resides in 8th house Black gram should be offered to cow to pacify Shani kopa.

5 If shukra resides in Simha rashi with soorya dirshti over it

Daily morning Soorya should be worshiped along with chanting Aditya Hridaya Stotra

6 If soorya is nichastha, if there is antardasha of Buddha during maha dasha of soorya

Daily morning Soorya should be worshiped along with chanting Aditya hridaya stotra

As per Panchanga, it shows the places of mitra (favourable) and shatru graham

(unfavourable) grahas82

Table No. 40. Places of mitra and shatru graham83

Shri Sun Moon Mars Mercury Jupiter Venus Saturn Rahu Ketu Mitra

graha

Moon

Mars

Mercury

Mercury

Rahu

Moon

Rahu

Jupiter

Moon

Sun Rahu

Venus

Rahu

Moon

Mars

Mercury

Rahu

Saturn

Mercury

Rahu

Venus

Mercury

Venus

Saturn

Mercury

Venus

Saturn

Shatru

graham

Saturn

Rahu

Venus

Rahu Mercu

Rahu

Moon Mercu

Venus

Sun

Moon

Sun

Moon

Mars

Sun

Moon

Mars

Sun

Moon

Mars

Sama

graham

Mercury Mars

Venus

Jupiter

Saturn

Venus

Saturn

Mars Venus

Saturn

Saturn

Rahu

Mars

Jupiter

Rahu

Jupiter Jupiter Jupiter

Sva

ksetrani

Leo Cancer Aries

Scorpi

Gemini

Vergo

Sagitar

Pisces

Taurus

Libra

Caprico

Acquar

Virgo Pisces

Ucha

kshetrani

Aries/10 Taurus/3 Capro

/28

Vergo /15 Cancer/5 Pisces

/27

Libra /20 Gemini

/15

Sagitar

/15

Neecha

kshetrani

Libra /10 Scorpi/3 Cancer/

28

Pisces /15 Cancer/5 Virgo /27 Aries /20 Sagitar

/15

Gemini

/15


82

Psoriasis

The skin is not only the largest organ of the body, it also forms a living

biological barrier and is the aspect of ourselves we present to the world. It is

therefore not surprising that there is great interest in “skin care”, with the

associated vast cosmetic industry. The impairment of the normal functions of

the skin can lead to acute and chronic illness with considerable disability.

Psoriasis is one among most comman dermatologic disease affecting up to 1-2

% of world’s population The familiar pink or red lesions with a scaling surface

and welldefined edge are easily recognised. These changes can berelated to the

histological appearance84

Historical back ground :

Psoriasis is probably one of the longest known illnesses of humans and

simultaneously one of the most misunderstood. Some scholars believe psoriasis

to have been included among the skin conditions called tzaraat in the Bible.

The earliest description what appears to represent psoriasis are given at the

beginning of medicine, in Corpus Hipporaticum, a work named after

Hippocrates. This work used the term psora and lepra for conditions that can br

recognised as psoriasis. The Greeks used the term lepra (λεπρα) for scaly skin

conditions. They used the term psora to describe itchy skin conditions. It

became known as Willan's lepra in the late 18th century when English

dermatologists Robert Willan and Thomas Bateman differentiated it from other

skin diseases.

Origin of word “Psoriasis”:

First this word used in1675–85. It came from the Greek word “psora”

which means “to itch”

Definition:

As per Dorlands Medical Dictionary it is defined as “a comman chronic,

squamatous dermatosis with polygenic inheritance and a fluctuating course”85.


83

Robins pathologic basis of disease describes it as “Psoriaisis is most

comman chronic inflammatory dermatosis affecting 1-2% of world’s

population and characterized by a typical skin lesion which is well demarcated,

pin to salmon coloured plaque covered be loosely adherent scales that are

characteristically silver white in colour86.

Harrison’s Principles of Internal Medicine says “It is a chronic

inflammatory skin disorder clinically clinically characterized by erythematous,

sharply demarcated papules and rouned plaques, covered by silvery micaceous

scale87. (311)

Etiology of psoriasis88:

The cause is unknown but there is an inherited predisposition. The

strong genetic influence may result from a single dominant gene with poor

penetrance or a number of genetic influences. Other factors such as local

trauma, general illness and stress are also involved, so the cause of psoriasis is

best regarded as being multifactorial. HLA-Cw6 is the phenotype most strongly

associated with psoriasis, particularly the early onset variety in which

hereditary factors seem to play the greatest part. Haemolytic streptococcal

throat infection is a common precipitating factor in guttate psoriasis.

Antimalarial drugs, lithium, and beta blockers can make psoriasis worse. There

is evidence that psoriasis occurs more readily and is more intractable in patients

with a high intake of alcohol. Smoking is associated with palmo-plantar

pustulosis.

The causes can be summarised as follows:

1. Stress: Psoriais is more stress sensitive than any other skin disorder.

Many stressful events of daily life may exacerbate psoriaisis. The

disease itself can cause a reactive depression in the patient which could

further exacerbate his psoriasis.


84

2. Infection: Upper respiratory infections and tonsillitis, especially when

caused by streptococci may cause a flare up of exixting psoriasis or may

precipitate an attack of acute guttate psoriasis. This is common in

children and is usually associated with an elevated antistrptolysin “O”

titer. Infections from other bacteria and viruses may also exacerbate

psoriasis.

3. Local trauma: Psoriatic lesions tend to develop at sites of injury to the

skin, “Koebner phenomenon” also known as the isomorphic response,

refers to the induction of the lesion by cutaneous trauma. Epidermal

trauma alone will not alone induce the lesions. It should also involve the

papillary dermis. The trauma may be of any kind- physical. Chemical,

mechanical, allergic or of any other nature.

4. Seasonal variations: Most patients experience worsening of their skin

lesions during winter, 89% of the patients studied by Farber and Nall

(1978) had worsening of their disease duing cold weather. High

humidity usually beneficial.

5. Drugs: Many drugs are known either precipitate or to exacerbate

psoriasis. A number of bet adreno receptor blocking drugs like propanol,

paracetamol, metaprolol and oxyprenolol etc. have been reported to

induce psoriasis.

Non steroidal anti inflammatory drugs (NSAIDs) such as indomethacin,

salicyclates, maclofenamate, phenylbutazone, oxyphenylbutazone and

ibrufen, which are commonly used, have been reported to either

precipitate or to exacerbate psoriasis. Chloroquine is another drug that

has been known for years to precipitate psoriasis.

6. Genetic predisposition: HLA-Cw6 is the phenotype most strongly

associated with psoriasis, particularly the early onset variety in which

hereditary factors seem to play the greatest part.


85

Clinical presentation89

Patients usually present with lesions on the elbows, knees, and scalp.

The trunk may have plaques of variable size and which are sometimes annular.

Patients with psoriasis show Koebner’s phenomenon with lesions developing in

areas of skin trauma such as scars or minor scratches. Normal everyday trauma

such as handling heavy machinery may produce hyperkeratotic lesions on the

palms. In the scalp there is a scaling, sometimes producing very thick

accretion. Erythema often extends beyond the hair margin. The nails show

“pits” and also thickening with separation of the nail from the nail bed

(oncholysis).

Psoriasis is characterized by the development of erythematous, well

defined, dry, scaly papules and plaques of sizes ranging from a pin head

to larger lesions.

A common genetically determined diseases of the skin consisting of

well defined pink or dull read lesions surmounted by a characteristic

silvery scaling.

A chronic disease characterized by sharply defined patches of erythema

covered by silvery scales.

It is a common chronic and non-infectious skion diseases characterized

by well defined, slightly raised dry erythematous macules with silvery

scales and typical extensor distribution.

Clinical appearance:

The main characteristics of psoriatic lesions, which reflect the

pathological processes listed above, follow.

Plaques consisting of well defined raised areas of psoriasis. These may

be few or numerous, covering large areas of the trunk and limbs.

Sometimes there are large confluent lesions.

Scaling may predominate, giving a thick plaque, which is sometimes

likened to limpets on the sea shore, hence the name


86

“rupioid”. Scratching the surface produces a waxy appearance—the

“tache de bougie” (literally “a line of candle wax”).

Erythema may be conspicuous, especially in lesions on the trunk and

flexures.

Pustules are rare on the trunk and limbs, but deep seated pustules on the

palms and soles are fairly common. In the form of palmo-plantar

pustulosis they may occur without psoriasiatic

lesions elsewhere. The size of the lesions varies from a few millimetres

to very extensive plaques.

The typical patient of psoriasis:

Psoriasis usually occurs in early adult life, but the onset can be at any

time from infancy to old age, when the appearance is often atypical. The

following factors in the history may help in making a diagnosis:

There may be a family history—if one parent has psoriasis 16% of the

children will have it, if both parents, the figure are 50%.

The onset can occur after any type of stress, including infection, trauma,

or childbirth.

The lesions may first appear at sites of minor trauma— Koebner’s

phenomenon.

The lesions usually clear on exposure to the sun.

Typically, psoriasis does not itch.

There may be associated arthropathy—affecting either the fingers and

toes or a single large joint.

ETIOLOGY OF PSORIASIS FROM AYURVEDIC PERSPECTIVE :

As per recent studies Stress is one among the most important factor in

causation of Psoriais. It is more stress sensitive than any other skin disorder.

Many stressful events of daily life may exacerbate psoriaisis. The disease itself

can cause a reactive depression in the patient which could further exacerbate


87

his psoriasis. In Ayurvesic terms stress can be understood as mano vikara.

Sharirika Prakrities Paittika and Vatika Prakriti are more prone to

psychosomatic disorders as their Manas is easily affected by Krodha, Kshobha

etc. in comparison to Kaphaja Prakriti whose Manas is not affected or affected

minimally or after a long duration by these Bhavas90. Chinta(anxiety), Krodha

(anger), Shoka (grief), Bhaya (fear), Harsha (happiness), Vishada(depression),

Irshya (hate), Kama (lust), Lobha (greed) etc. are described as Manas Bhava by

Acharya Bharata in ‘Natya Shastra’ . These Bhavas are also known as

‘Sthayi Bhava’ there. With these Bhavas other short term Bhavas also originate

and they are known as ‘Vyabhichari Bhava’. They affect our body and produce

some changes, which are called as ‘Anu Bhava’. These emotional feelings /

Bhavas when become prominent then are known as Vegas (urges). It is said by

Charaka in ‘Na Vegandharaniya Adhyaya’ that these natural urges should be

controlled91. They are also called as Manasika Vikaras of two Manas Doshas.

The Prajnaparadha is the cause of above-mentioned emotional disorders. They

are the symptoms of so many diseases, cause of so many diseases and also the

diseases themselves.

Emotions and their bodily expressions:

As a science psychosomatic medicine aims at discovering the precise

nature of the relationship of the emotions and bodily functions. To a certain

degree every emotion finds some bodily expressions. The individual will show

his emotions in some visible form, perhaps in his posture and attitude, perhaps

in his face, perhaps in the trembling of his legs and knees. Similar changes

could be found in the organ themselves, e.g. if he flushes or turns pale,

circulation of the blood is affected. In anger, anxiety, sorrow or any other

emotion, the body always speaks, and each individual’s body speaks in a

language of its own. A few emotions are described as follows


88

1. Krodha (anger):

According to Ayurveda, the degree of anger can be measured on the

basis of intensity of ‘Droha’ found in a person92. In this emotional disorder the

victim can go up to the extent of physical attack and even murder also.

2. Shoka (grief):

Shoka is characterized by depressive nature with sorrowful attitude. It

may be originated from bad experiences of the past, insult, personnel loss,

death of relatives etc. The degree of Shoka can be measured on the basis of

intensity of ‘Dainya’93. The victim of Shoka can suffer from atisara, nidranasha

and jwara etc.

3. Bhaya (fear):

Intensity of Bhaya is examined by ‘Vishada’94. This is a specific

emotion by which so many diseases are caused. It is well said by Charaka

“Vishado roga vardhananam sreshta”. Fear is caused due to injuries of physical

and social environment, when one is threatened by some social foe or by some

physical threat from the environment, one may attempt to flee from it with

accompanying feelings of fear.

Chinta (anxiety):

Sometimes individual suffer from an emotional disorder, which is

psychologically just as disabling as the more extreme forms of fear but in

which the individual really does not know, of what he is afraid, this is known

as Chinta. Neurotic anxiety is perhaps the most important of all the symptoms

in the sphere of emotions of psychopatholgy. The physiological concomitants

of tachycardia, of increased respiration, and of sweating of skin surface, which

occurs in real fear likewise characterize this anxiety. By the above emotional

disorders and the other than them viz. Lobha (greed), Moha (narcosis), Irshya

(jealousy) etc, many diseases are seen. Thus the great importance is given to


89

theses psychic factors in respect of their knowledge and necessity of

description. Kushta, jwara, atisara and so many other diseases are found

originated by these emotional factors.

Role of psychological factor in the etiopathogenesis of psoriasis –Modern

view :

In recent years there has been an increasing awareness on the part of

physicians about the close relationship between “Psyche” (mind) &

“Soma”(body), and in every branch of medicine including dermatology a large

group of chronic illnesses are being designated as “Psychosomatic” (Behl,

1998), Psoriasis is one of them. Psychosomatic disorder like psoriasis are

associated with skin problems that are not directly connected to the mind but

that react to emotional states, such as stress (Koo & Lebwohl, 2001). Psoriasis

is a chronic disease that can have substantial psychological and social impact

on a patient’s life. For the patient, psoriasis can be far more than “Just a skin

disease”. However, close family members or patient’s friends may not

understand the disease. The psychological impacts are likely to be heightened

when the onset of disease was early in life – when the patient was most

vulnerable to psychosocial trauma.

Psychological problems can arise from the feelings of the patient about

his/her appearance, social rejections, guilt, embarrassment for self and family,

and emptiness. Patients may also deny themselves enjoyment of leisure

activities because of embarrassment and fear of rejection, and the disease often

makes patients feel unattractive to the opposite sex. Number of studies has

shown that psychological stress is often caused by psoriasis, and can be a factor

in “flares” of psoriasis. Conversely, psychological stress can affect the course

of the disease as well as contribute to psychological problems such as

depression, anxiety and unfocused anger. The way stress affects the patient

varies from individual to individual; the most common manifestations are


90

psychological depression, anxiety, and obsessional behaviors95. The way in

which stress, depression and anxiety influence the course of psoriasis is not

known. Some studies suggest that the influence may be through an effect on the

immune system.


91

MATERIALS AND METHODS

Present study has been carried out under two sections.

1. Literary study

2. Observational study

MATERIALS

1. Literary study

Collection of Materials

The Literary source for the present study was obtained from, Vedic

scriptures, classical texts of Ayurveda, Sanskrit dictionaries, Western medical

texts, published articles in reputed journals and also from various media like

internet etc, followed by retrospective study of related research work.

2. Observational study

a. Diagnosed patients of Kitibha Kushta

b. Instruments

Collection of Materials

A) Source of patients - Patients from OPD, IPD, other referrals and special

camps conducted in GAMC and hospital Mysore were selected for the study,

appropriately satisfying the selection criteria.

B) Instruments:

1. Stethoscope

2. Sphygmomanometer

METHODS

1. Aim : Present work was undertaken to assess the nidana of Kitibha

Kushta (Psoriasis) as per available Ayurvedic literature


92

2. Objectives :

To review and systematically compile the literature on nidana.

To review and systematically compile the literature on nidana of Kushta.

To observe and analyze the etiological factors of Kitibha Kushta

To study and understand the etiological factors of Psoriasis from

Ayurvedic perspective.

3. Study design

A. Literary Study - Literary study of Ayurvedic literature had been carried

out on nidana of Kushta. This study was based on samuchaya vidhi

(collecting of scattered matter) and nirdesh vidhi (detailed explanation).

B. Observational study – The nidana of Kitibha Kushta were assessed

based on detailed questionnaire. A set of questionnaire was framed

incorporating common Ahara and Vihara which have been mentioned as

Nidanas to Kushta. Every selected patient was thoroughly assessed for

nidana as per the prepared Chart.

The discussion was done with the help of Hamsaksheera Nyaya

(selecting important matters from the literature).

METHOD OF COLLECTION OF DATA

Patients were selected with respect to age and irrespective of sex,

socioeconomic status, caste, religion with signs and symptoms of Kitibha

Kushta.

INCLUSION CRITERIA

1) Patients of either sex were selected.

2) Patients between age groups of 17-60 years were selected.

3) Patients coming under diagnostic criteria were selected.


93

EXCLUSION CRITERIA

1) Patients with other systemic disorders were excluded.

2) Patients with other skin disorders were excluded.

DIAGNOSTIC CRITERIA

1. Shyava : Bluish black discolouration of the skin

2. Kina sparsha : Rudha vrana sthana, surface of the lesion is rough

resembling healed wound

3. khara sparsha : Lesions are rough or coarse to touch

4. Parusha : Dry lesions

SAMPLING METHOD

Total 45 patients of Kitibha Kushta (Psoriasis) were randomly selected and

made in to a single group.

ASSESSMENT

Assessment of the patients was made based on the nidana of Kushta explained

in Ayurvedic classics. Statistical interpretation was based on

Chi-square test

Frequencies / Descriptive

Contingency Co efficient test

Analysis was done through SPSS for Window (Statistical Presentation

System Software), version 14.0, evaluation version (SPSS, 2005, SPSS Inc.

New York).


94

OBSERVATIONS

Total 45 patients were taken for the study and observations for the

present study were done in three stages.

1. General observations

2. Specific observations

3. Observations on nidana of Kushta

GENERAL OBSERVATIONS

AGE

In present study there was limitation for age. The patients of the age

between 17-60 yrs were selected. It was found that the patients of age group

between 17-30 yrs are 20 (44.44%), 31-40 years are 10 (22.22%) 41-50 yrs are

8 (17.7%), 51-60 are 07 (15.55 %).

Table No.41. Distribution of Patients According To Age

Age in years No. of patients Percentage (%)

17-30 yrs 20 44.44 %

31-40 yrs 10 22.22 %

41-50 yrs 08 17.7 %

51-60 yrs 07 15.55 %

Total No. of patients 45


95

SEX

In the present study it was observed that more number of patients were

males i.e., 30 (66.66%) and female patients were 15 (33.33%).

Table No.42. Distribution of patients based upon sex

Sex group No. of patients Percentage (%)

Male 30 66.6 %

Female 15 33.33 %


RELIGION

In the present study it was observed that majority of the patients were Hindu

I.e. 35 (77.77 %) and 10 (22.22 %) were Muslims.

Table no 43. Distributionof patients based upon religion

Relogion No. of patients Percentage (%)

Hindu 35 77.77 %

Muslim 10 22.22 %



96

MARITAL STATUS

In the present study it was observed that majority of patients were

married .i.e. 38 (84.44 %) and unmarried were i.e., 07 (15.55%).

Table No.44. Marital status wise distribution of 45 patients

Marital Status No. of patients Percentage (%)

Unmarried 38 84.44 %

Married 7 15.55%


97

Occupation

In this study it was observed that majority of the patients were farmers

i.e. 25 (55.5 %), students 10 (22.22%), office workers 7 (15.5 %), and

Businessmen 3 (6.6 %).

Table No. 45. Occupation wise distribution of 45 patients

Occupation No. of patients Percentage (%)

Students 10 22.22 %

Office workers 7 15.5 %

Businessmen 3 6.6 %

Farmers 25 55.5 %


SOCIO ECONOMIC STATUS

In the present study it was found that majority of the patients belong to

lower Class i.e., 38 (77.77%), middle class were 5 (11.11 %) and Upper

middle class were 2 (4.44%).


98

Table No.46. Socio economic status wise distribution of 45 patients

Socio economic status No. of patients Percentage (%)

Lower class 38 77.77 %

middle class 5 11.11 %

Upper middle class 2 4.44 %

Education

In the present study it was found that the majority of patients were

illiterate i.e., 29(64.44%), School going 6 (13.33 %), graduates 7 (15.55 %)

and Post graduates were 3 (6.66%).

Table No.47. Education wise distribution of 45 patients

Education No. of patients Percentage (%)

School going 6 13.33 %

Ggraduates 7 15.55 %

Post graduates 3 6.66 %

Illiterates 29 64.44 %



99

ADDICTION

In the present study it was found that the patients having the habit of

drinking tea were 10 (22.22%), habit of smoking were 4 (8.88%), drinking

alcohol were 3 (6.66%), drinking coffee were 4 (8.88%) and tobacco chewing

were 4 (8.88%) and taking milk were only 20 (44.44%) respectively.

Table No.48. Addiction wise distribution of 45 patients

Addiction No. of Patients Percentage

Milk 20 44.44%

Tea 10 22.22%

Coffee 4 8.88%

Smoking 4 8.88%

Alcohol 3 6.66%

Tobacco chewing 4 8.88%


100

AGNI

Among 45 patents, 25 patients (45.44%) had mandagni, 15 patients had

vishamagni (33.33%), 5 patients (11.11%) had teekshna agni.

Table No. 49. Agni wise distribution of 45 patients

Agni No. of patients Percentage (%)

Manda 25 45.55%

Vishama 15 33.33%

Teekshna 5 11.11%

Sama 0 0%

DIET

In the present study it was found that the patients with vegetarian diet

were 10 (22.22%) and mixed diet were 35 (77.77%).

Table No. 50. Diet wise distribution of 45 patients

Diet Pattern No. of patients Percentage

Vegetarian 10 22.22%

Mixed 35 77.77%


101

PRAKRUTHI

In the present study among 45 patients 15 patients (33.33%) had Vata pitta

prakruthi, 25 patients (55.55%) had Vata kapha prakruthi and 5 patients

(11.11%) belong to kapha pitta prakruthi.

Table No.51. Prakruthi wise distribution of 45 patients

Prakruthi No. of patients Percentage (%)

Vata pitta 15 33.33%

Vata kapha 25 55.55%

Kapha pitta 5 11.11%

SARA

In the present study 6 patients (13.33%) were having a Avara sara, 35

patients (77.77%) and 4 patients (13.33%) were having Pravara sara.

Table No.52. Sara wise distribution of 45 patients

Sara No. of patients Percentage (%)

Avara 6 13.33%

Madhyama 35 77.77%

Pravara 4 8.88%

SAMHANANA

Among 45 patents 43 patients (95.55%) had madhyama samhanana, 2

patients (4.44%) has avara samhanana.

Table No.53. Samhanana wise distribution of 45 patients

Samhanana No. of patients Percentage (%)

Avara 2 4.44 %

Madhyama 43 95.55%

Pravara 0 0%


102

PRAMANA

Among 45 patents 43 patients (95.55%) had madhyama samhanana; 2 patients

(4.44%) has avara samhanana.

Table No. 54. Pramana wise distribution of 45 patients

Pramana No. of patients Percentage (%)

Avara 2 4.44%

Madhyama 43 95.55%

Pravara 0 0%

SATMYA

Among 45 patients 41 patients (91.11%) had madhyama satmya and 4

patients (8.88%) had avara satmya.

Table No.55. Satmya wise distribution of 45 patients

Satmya No. of patients Percentage (%)

Avara 4 8.88%

Madhyama 41 91.11%

Pravara 0 0%

SATWA

Among 45 patients, 43 patients (95.55%) had madhyama satwa and 2

patients (4.44%) had avara satwa.

Table No. 56 Satwa wise distribution of 45 patients

Satwa No. of patients Percentage (%)

Avara 2 4.44 %

Madhyama 43 95.55 %

Pravara 0 0%


103

VYAYAMA SHAKTI

Among 45 patents, 43 patients (95.55%) had madhyama vyayama shakti, and 2

patients (4.44%) were having avara vyayama shakti.

Table No.57. Vyayama Shakti wise distribution of 45 patients

Vyayama Shakti No. of patients Percentage (%)

Avara 2 4.44 %

Madhyama 43 95.55 %

Pravara 0 0%

DESHA

It was observed that 38 (80.00 %) patients were belong to anoopa desha,

2 patients (4.44 %) were belong to Jangala desha and 5 (11.11 %) patients were

belong to Sadharana desha.

Table No.58. Desha wise distribution of 45 patients

Desha No. of patients Percentage (%)

Anoopa 38 80.0%

Jangala 2 44.44%

Sadharana 5 11.11%


104

Table No 59. Distribution of patients with Chief Complaints Lakshanas No. of patients Percentage

Shyava 42 93.33 %

Kina sparsha 36 80 %

khara sparsha 36 80 %

Parusha 38 84.44 %

Sravi 2 4.44 %

Kandu 6 13.33 %

Vardhate cha samutpannam 43 95.55 %

Snigdham 2 4.44 %

Krishnasm 3 6.66 %

Observations on nidana of Kushta:

Patients eating fish with milk or curds

In this study it was observed that 15 (75 %) patients were eating fish with milk

and curds.

Table No 60. Distribution of patients eating fish with milk or curds Patients eating fish with milk or curds

No. of patients Percentage (%)

Yes 15 75 %

No 5 25 %

Total non-veg pts 20


105

Curds

In this study it was observed that 25 patients (55.55 %) were eating curd

at night and 15 (33.33 %) were eating curds in day time and 5 patients

(11.11%) were not consuming curd.

Table No. 61. Distribution of 45 patients who eats curds

Curds consumption No. of patients Percentage (%)

During day time 15 33.33 %

During night time 25 55.55 %

Not eating curds 5 11.11 %

Amlatisevana

In this study it was observed that 14 patients (31.11 %) were consuming more

amla padartha.

Table No.62. Distribution of patients doing Amlatisevana

Amlatisevana No. of patients Percentage (%)

Yes 14 31.1 %

No 31 68.88 %

Aggravation of symptoms

It was observed that aggravation of symptoms observed more in visarga kala

i.e. in 33 (73.33 %) patients.


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Table No.63. Distribution of patients based upon aggravation of symptoms:

Aggravation of symptoms


Adana kala 12 26.66 %

Visarga kala 33 73.33 %

EATING HABITS

Excessive eating habits

In this study it was observed that 35 patients (77.77 %) were having excessive

eating habits

Table No. 64. Distribution of patients based excessive eating habits

Excessive eating habits No. of patients Percentage (%)

Yes 35 77.77 %

No 10 22.22 %


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Patients who eats without digestion of previous food

It was observed that 11 patients (24.44 %) were eating without digestion of

previous food

Table No. 65. Distribution of patients who eats without digestion of

previous food

Eats without digestion of previous food


Yes 11 24.44 %

No 34 75.55 %

Patients who eats improper time

It was observed that 28 patients (62.22 %) were eating at improper time.

Table No. 66. Distribution of patients who eats at improper time

Eats at improper time No. of patients Percentage (%)

Yes 28 62.22 %

No5. 17 37.77%


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Patients who frequently eats green leafy vegetables with milk

In present study it was observed that 12 patients were eating green leafy

vegetables with milk.

Table No. 67. Distribution of patients who frequently eats green leafy

vegetables with milk

frequently eats green leafy vegetables


Yes 12 26.6 %

No 33 73.33%

Day Time Sleeping

It was found that 16 (35.5 %) patients were doing day time sleeping

Table No. 68. Distribution of patients who does day time sleeping

patients do day time sleeping


Yes 16 35.5 %

No 29 64.44 %


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Suppression of Vegas

It was observed that (73.33 %) patients were doing suppression of vegas.

Table No. 69. Distribution of patients who do suppression of vegas:

Patients who do suppression of vegas


Yes 33 73.33 %

No 12 26.6 %

Kula Vrittanta

It was observes that only 7 patients had maternal/paternal history.

Table No. 70. Distribution of patients according to Kula Vrittanta:

Kula Vrittanta No. of patients Percentage (%)

Pitruja 4 8.88 %

Matruja 3 6.66 %

Nil 38 84.44 %


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Mental Status

It was observed that 2 patients (4.44 %) were Anxious, 14 (31.11 %) were

normal, 1 (2.22 %) was fearful and 28 (62.22 %) were depressed.

Table No.71. Distribution of patients according to Mental Status

Mental Status No. of patients Percentage (%)

Normal 14 31.11 %

Anxious 02 4.44 %

Depressed 28 62.22 %

Fearful 1 2.22 %

Vyadhi Adhishthana

In 14 patients (31.11 %) the adhishthana of vyadhi was shareera and in 31

patients (68.88 %) it was both shareera and manas.

Table No.72. Distribution of patients according to Vyadhi Adhishthana

Vyadhi Adhishthana No. of patients Percentage (%)

Shareera 14 31.11 %

Shareera and Manas 31 68.88 %


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Bathing Habits

It was observed that 32 patients (71.11 %) were taking bath normally, 3

patients after getting frightened (6.66 %), 6 patients after exposing to sun

(13.33 %) and 4 patients (8.88 %) after exercise.

Table No. 73 Distribution of patients based on bathing habits

Bathing habits No. of patients Percentage (%)

Normal 32 71.11 %

Frightened 3 6.66 %

After exposing to sun 6 13.33 %

After exercise 4 8.88 %



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Graha vikruti

It was observed that 24 patients (53.33%) had graha vikruti

Table No. 74 Distribution of patients based on Graha vikruti

Graha vikruti No. of patients Percentage

Yes 24 53.33%

No 21 46.66%

RESULTS:

1. Based on age shows, between 17-30 years had a greater risk of acquiring

Kitibha Kushta 44.44 % when compared to the age group of 31-40 years

22.22%, and 41-50 years 17.7% and 51-60 years 15.55%.

2. Based on religion it was observed that Hindu’s had a higher incidence

77.77% when compared to other religion like Muslims 22.22%.

3. It was observed that farmers had a greater risk of acquiring Kitibha

Kushta 55.55%, when compared to office workers 15.55%,

students22.22% and business men were at the lowest risk with 6.66.

4. Based on Kala, occurrence was more in Visarga Kala i.e. 73.33% than in

Adana Kala 26.66%.

5. It was found that Anoopa desha people were more prone to get Kitibha

Kushta i.e. 80.00%.


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6. It was observed that compared to vegetarians in people with mixed diet

habit are more prone for Kitibha Kushta i.e. 77.77%.

7. Only in 15.44% people Anuvamshata is found as causative factor for

Kitibha Kushta.

8. It was observed that patients eating fish with milk or curds are most

likely to get Kitibha Kushta i.e. 75% in mixed diet group.

9. Patients who were eating curd at night were more prone to get Kitibha

Kushta i.e. 55.55%.

10. It was observed that 68.88% patients had mano-shareera vyadhi

adhishthana while only 31.11% patients had shareera as vyadhi

adhishthana.

11. Only in 73.33% people suppression of vegas is found as causative factor

for Kitibha Kushta.

12. It was observed that Depressed patients had a greater risk of acquiring

Kitibha Kushta i.e. 62.22%.

13. It was observed that 26.66 % patients were eating green leafy

vegetables with milk

14. Graha vikruti is found in 53.33% patients.


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DISCUSSION

Any research work without being discussed about its nature, utility and

importance is said to be incomplete. Vitarka (ability of discussing on the basis

of Shastras) is one of the six features to be present in a good Scholar (Ch. Su.

9/27). Any hypothesis /principle, if to be proved, must be discussed thoroughly

from all angles. This has been clearly told by Acarya Caraka long back (Ca. Vi.

8/37). After the formation of a hypothesis, it has to be tested and observed by

various methods and eventually the results are obtained. All these should be

well supported by proper reasoning or logic and finally concluded., A

hypothesis gets established as a principle if the reasoning given is satisfactory,

otherwise, it remains as it is. Acharya Charaka has very precisely said that,

even the truth may not accepted, as it is without the logical interpretation.

Charaka has clearly stated in Sutra 25th Chapter that,

''Shastra sahit tarka sadhananam” (Ch. Su. 25/40)

Discussion improves the knowledge and discussion with Sastra becomes

base establishment of the concept. Thus discussion is the most essential phase

of any research work. Keeping in this view the facts which have emerged from

the conceptual, and observational study have been discussed here.

DISCUSSION ON REVIEW

TITLE OF THE STUDY

Today in many ways people have greater opportunities of better life than

ever before. Still it is clear that they need to evolve some new strategies or to

follow the golden old rules, which are proved for milleniums, in each and every

field of life. As Ayurveda aims to protect the health of heathy individual and

later to cure the diseased ones. So, the diet and regimen are such most

important field of life. Then also the popularity of fast food, heat of earning

more and more leading the individuals to compromise with their health is


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greater due to the fast life. According to Ayurveda this can be classified as

"Prajnaparadha'. Due to the demand of time, most of the people are bound to do

such things, which adversely affect the health. The people who are health

conscious mostly know about "what to eat?", but least about "how to eat?" and

“how to live’ . The dietetic code or the rules for diet, code of conduct in the

society are preserved by our traditions up to some extent, but there is a big

question about their awareness in today's society. People basically know very

little about them and they who know are little bothered to obey such and all

such summations leads to various ailments. Here, I am dealing with one among

the such ailment .i.e. kushta which is pervading significantly faster.

DISCUSSION ON NIDANA

Definition

The factor which causes rogotpatti by vitiating the dosha is called

nidana. All the definitions of nidana in general mean that nidana is an

etiological, causative factor for a disease manifestation, gives rise to a disease

or karana for a vyadhi. Nidana word is also used as synonymous to hetu in

many contexts in the classiscs. definitions on Nidana stated by Madhukosha

seems to be most appropriate i.e. A Particular factor can be called as nidana

only when it will develop a complete disease process (iti kartavyata) in the

body either immediately or after a certain period. Chakrapani says “nidana”

relates to both etiology (vyadhi janakam) as well as diagnosis (vyadhi

bodhakam) of diseases. So, vyadhi janak nidana refers to “hetu” whereas

vyadhi bodhak nidana refers to “nidana panchaka”. The word nidana refers to

the factor which produces vyadhi.

Synonyms

Various synonyms of nidana have been used in Ayurvedic lexicons but

nidana and hetu used most frequently. Word nidana used for six times in

Charaka Sutra sthana and hetu is used for fourty four times while in nidana


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sthana word nidana is used for fifty one time and hetu is used for sixteen times.

Word “nidana” seems to be more appropriate.

Classification of Hetu

1. a) Asatmendriyartha Samyoga b) Prajnaparadha c) Parinaama.

a) Asatmendriyartha Samyoga : The five Indriya Buddhi obviously

correspond to the area of the cerebral cortex where the five kinds of sensations

are experienced. The events of the external world are intimated to the mind

(Manas) through these Indriya Buddhi. Subsequent events leading to Vijnana

(knowledge) such as the sorting out of ther sensory data, their interpretation,

orientation, integration and ideation are dealt with by the association and silent

areas of the cortex which may be considered as mind. The mind enjoys the

supreme place in the body being the coordinator. Every event in the body is

directly or indirectly, consciously or uncosiously controlled by the mind,

through central nervous system, autonomic nervous system or endocrine

system. Manas are highly inquisitve to know regarding the environment so that

the body may adapt accordingly. The entire environment is classified into five

sense objects. As long as the external stimuli orginating from five sense objects

are within normal limits the body response is also within physiological limits

which are Satmya (suitable) for body. But if the stimuli cross the normal range

they become stressful and as soon as stressful stimuli reach the Manas, the

imbalance in Dosa begins which may set in the diseases if the body fails to

adopt.

Acharya Charaka has given imporantance to each of the nidana at

different places in sutra, nidana and sharreara sthana of Charaka samhita. In

Dheeraganjeevatiye Adhyaya, Charaka says the causes of diseases relating to

both (mind and body) are three fold i.e. ayoga, mithya yoga and ati yoga of

Kala, budhhi and indriyartha. In Tisreshniye adhyaya, again Charaka has

highlighted these nidanas in different order. Chakrapani says Kala, Artha and


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Karma are mentioned in the order of their importance. Kala is the most

important factor in as much as it is indispensable in character i.e.

dushpariharya. Then comes Prajnaparadha. It is the defect in the mental

faculties that leads to the Asatmendriyartha Samyoga. Even though

Asatmendriyartha Samyoga arise out of Prajnaparadha only, still owing to its

proximity to the diseases, the former is further categorized separately. On other

hand, Prajnaparadha leads to somatic (Kayaik), oral (Vachik) and psychic

(Manasik) ailments. that al though all the three karnas are the important for the

production of vyadhi but out of all these Asatmendriyartha smyoga deserves

the first place. It is true that prajnaparadha appears to be the original and most

important causative factor of all diseases. But at the same time

Asatmendriyartha samyoga being the nearest cause needs special mention.

Being unavoidable, kala also constitute its own importance. But then, it is

secondary i.e. Apradhan because it can cause disease only in the event of

Atiyoga, ayoga or mithya yoga of indriyas with their respective objects.

b) Prajnaparadha

Actions have been described to be of three types (i) related with speech

(ii) related with mind and (iii) related with body. The excessive use, disuse and

misuse of any of these actions lead to the development of a disease process. It

is supposed that when Raja or / and Tama qualities predominate, there is

derangement of the understanding (Dhi), will (Dhrti) and Memory (Smrti).

Thus, in short any misconception by the intellect followed by misconduct is

known as volitional transgression. So one should exercise restrain not to

indulge in over-use, disuse and mis use of activity related to speech, mind or

body as the result of misconception. This action leads to stress on his body and

mind which cause disturbance in the Dosika system of the body following the

neurohumoral and endocrinal disturbance. There are Modern evidence which

support the fact where the organ response to Emotions are incorporated

(Cardiovascular response, Gastro intestinal response, skin response, respiratory


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response, etc are enlisted) John Hunter (1728-1793) had personal experience of

the effects of mind on body. He had noted how his attacks of angina pectoris

were brought about whenever his mind was agitated. On the other hand, it may

be opined that Prajnaparadha leads to a guilt consious which depresses the

immune system of body rendering it ill. The effect of unhealthy actions of body

is obviously clear. The above explanations are for the actions of speech and

mind.

b) Parinaama.

If a particular season manifests itself excessively, this should be

regarded as excessive utilization of time; if the season manifests itself less than

required, it would be non – utilization. If on the other hand, characteristics of a

season are contrary to the normal ones, this would be wrong utilization (for

example, rainfall in winter ,cold in summer etc). In addition to the effect of

abnormal season on human body producing diseases, there is a normal cycle of

Dosa in relation to season, day and night, intake of food and age. In relation to

these periods some of the Dosa get excited and the others subsided. So the

diseases connected with those Dosa either develop or participate to get

exaggerated. The abnormal season as well as the normal season and other time

factors are intimately related with the disease process, one can not escape their

effect on the body; however to minimize them and to adapt accordingly the

principles of personal hygeine are framed.


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Application of Trividha hetu sangraha in causation of Kushta :

Trividha hetu sangraha

Pragnyaparadh Kala Asatmendriyartha samyoga

(Visarga kala) (Sankramik hetu)

Dhi vibhramsha Dhriti vibhramsha Smriti Vibhramsha

Derangement of Unable to stop the ahita karma To forget the

understanding knowledge

of Hita karma

which he does before

Mithya ahara vihara, papa karma

Kushta

Asatmendriyartha samyoga

Shabda Sparsha Rasa Roopa Gandha

Ayoga Atiyoga Mithyayoga Hinayoga

Anadana Atyashana Vishmasana Alpadana

Matra viruddha Matra viruddha Intake of incompatible diet Matra viruddha

Vidhi viruddha Vidhi viruddha except rashi Vidhi viruddha


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2. Sannikrishta, Viprakrusta, Vyabhichari, Pradhanika

Sannikrishta: The closest cause of vyadhi is called as Sannikrishta hetu.

All the ahara vihara pertaining to nidan of Kushta can be considered as

Sannikrishta hetu.

Viprakrusta: The distant cause of the vyadhi is called as Viprakrishta

hetu. Chakrapani says, immediate causes of a disease are the vitiated doshas

and distant causes are the unwholesome contacts with the objects of senses.

The distant cause of rakta pitta may be ati santapa of jwara. The distant cause is

comman of all the diseases are the previous sinful acts i.e. adharma. Purva

janam krit papa karma can be considered as Viprakrusta nidana for kushta.

Vyabhichari: When certain opposing facors are acting against a

particular etiological factor, such a time, dushyabala etc, then under such a

condition, that particular cause does not produce a disease. Then it is called a

vyabhichari hetu. Chakrapani in Prameha nidana says “Specific features of

etiological factors, doshas, and dhatus determine the bodily susceptibility to the

manifestation of a disease. When the equilibrium of these three factors is

disturbed or when they do not support each other or when they are weak due to

temporal factors, then either the disease does not manifest or the disease is very

mild or all its symptoms are not properly manifested. If the situation are

contray to what is mentioned above, the corresponding results will also be

otherwise.


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Table No.75 Nidana, Dosha, Dushya relation in causation of disease :

Etiological factors + Dosha + Dhatu

No association No disease


Late association

Prolong course or delay in manifestation (chronic disease)


Weak or insufficient association

Mild disease or incomplete disease or irregular symptoms


Sudden association Acute disease


Powerful Association

Fatal (or) threatening disease

Dosha hetu, Vyadhi hetu and Ubhaya hetu :

Dosha hetu : All the Nija Vikara occurs invariably due to the vitiation of Vata,

Pitta and Kapha. As the bird can not transgress its own shadow even through

flying throughout the day, so also no endogenous disease caused by the

disturbance of the equilibrium of Dhatus can not occur without the vitiation of

Vata, Pitta and Kapha. So, considering the location, signs, symptoms and

causes of vitiation of Tridosa, all the disease caused by them are diagnosed on

the basis of the vitiation of respective Dosas.All the bodily diseases arising out

of the disturbance of the equilibrium of Dhatus are ultimately caused by

nothing else but by thedisorder of Tridosa. It is only the exogenous diseases

which are caused otherwise, the endogenous diseases are at times followed by

the exogenous ones and even the exogenous ones are followed by the

endogenous ones of the most vehement type. One should accordingly start the

treatment paying due regard to the secondary development (Anubandha) and

the primary nature of the disease.

Vyadhi hetu: So, Vyadhi hetu means those specific etiological factors

responsible for the particular diseases, irrespective of dosha. Sushrutha had

described sankramika nidana which can be incorpaorated in this group.


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Bahaya and Abhyantara hetu :

Bahaya hetu : External factors like food, behavior, seasons, poisons etc. are

called as bahya hetus or external factors. Bhela Samhita has described Kushta

Roga in both Nidana & Chikitsa Sthana. Specially indicated, polluted water as

a etiological factor of Kushta. So, polluted water can be considered as bahaya

hetu.

Abhyantara hetu : Vitiated doshas are called as intrinsic factors or

Abhyantara hetus. Sapta dushya of Kushta i.e tridosha, rakta, twak, mamsa,

ambu and lasika can be considered as Abhyantara hetu.

Utapadaka and Vyanjaka hetu :

Utapadaka hetu : Utpadaka hetu means the real causative factors of the

accumulation of doshas.

Virudhahara, Ajeerna, Adhyasana, Matsya (chilchima) with dugdha can be

considered as Utpadaka hetu.

Vyanjaka hetu : It act as a triggering factor. Aggravation of Kushta in winter

season can be considered as Vyanjaka hetu.

Dosha Gati :

Following questions strikes in mind regading roga marga. “Tatra shakha

raktadayo dhatu twak cha sa bahayo roga marga” in this context whether marga

word is used for srotas or adhisthana? Why rasa dhatu is not mentioned here

and whether twak can be taken as substitute for rasa dhatu? To me it is marga.

So far as Kushta is concerned the layers of skin are far more omportant. It is

the obstruction in the marga which brings about Kushta. Rasa is either plasma

or watery portion of the skin. The skin carries. Rasa is different from rakta.

When they intermingle with each other blood is formed. The watery portion of

Rasa is located in the layers of skin participates in the formation of Kushta.


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Disscission on anatomy and physiology of Skin

The skin is not simply a barrier separating a body’s internal and external

environment, it is also the vehicle for the biological and social communication

to the external world. Any type of change in skin may indicate homeostatic

imbalance in the body. Therefore before going to diagnosis and treatment of

skin disease it is essential to know the significant value of skin i.e. Racana

Sarira, Kriya Sarira and Bhruna Vijnana (Embryology). Following corelation

can be done. Dr. Ghanekar has written commentary on Sushruta Sharira

Sthana. He has correlated the layers of skin mentioned by Sushruta with the

latest anatomy of skin as under.

S. No Ancient Term Modern Term Types of skin

1 Avabhasini Stratum Corneum Epidermis

2 Lohita Stratum Lucidum Epidermis

3 Shweta Stratum Granulosum Epidermis

4 Tamra Malpighian layer Epidermis

5 Vedini Papillary Layer Dermis

6 Rohini Reticular Layer Dermis

7 Mamsadhara Muscular layer

Dermis

Kriya Sarira :

To understand the Kriya Sharira (physiology) of skin it is essential to

check its relation with Dosa, Dhatu and Mala like basic structural and

functional units of the body.

(i) Twacha and Tridosha: There are three Dosas in our body. They are situated

in specific places, which have been described in texts. According to that

Twacha has been mentioned as one of the sites of Vata and Pitta Dosa

(A.H.12/1, 2)


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(a) Twacha and Vata Dosa: Charakacarya has described Twacha as a

Sparsanendriya adhisthana (Ch.Su.8/10). Sparsh i.e. Touch sense is the subject

of sparsanendriya which is performed by Vata Dosa.

(b) Twacha and Pitta Dosha: Bhrajaka Pitta is one of the types of Pitta which is

located in skin. Bhrajaka Pitta is also called as Bhrajakagni, which is also

situated in Twacha and forms the lusture of the skin.

(c) Twacha and Kapha Dosa : The snigdhata slaksnata, Mrduta, Sitata,

prasanata and snighdhavarnata are the attributes to the presence

(ii) Twacha and Sapta Dhatu :

a) Twacha and Rasa Dhatu : At several places Twacha has been used, as a

synonyms of Rasa Dhatu like Twaksara Purusa etc. In context of Kushta Roga,

Susruta has mentioned that in early stages Kushta is situated only in the

Twacha. Dalhana comments on it and says that Twachasrita i.e. Rasasrita

Kushta (Su.ni. 5/2). Chakrapani has described the six layers of skin first

amongst them is Udakadhara its main work is to maintain the water content of

the body. Rasa Dhatu is also Jala Mahabhuta Pradhana in Panchabhautica

constitution. So one can consider the relation between Rasa Dhatu and Twacha.

b) Twahca and Rakta Dhatu : Acarya Susruta has described thefunctions of

Rakta Dhatu as Varna Prasadana. i.e. It imparts the colour of skin, Mamsa Pusti

i.e. Nourishes the Mamsa Dhatu in the body. (Su.Su.15/6). Rakta Dhatu is also

responsible for the proper conduction of tactile sensation of skin.

c) Kwacha and Mamsa Dhatu : Twacha is closely connected with Mamsa

Dhatu because it is a Upadhatu of Mamsa Dhatu (Ca.Ci.15/7). So for the

development and Nourishment of Mamsa Dhatu is concerned Twacha is very

important factor.

(iii) Twacha and mamsa:

Mala (Annamala), Mutra and Sweda are the main three malas in the

outcome of sara kitta vibhajana process during Dhatvagnivyapara. The kitta


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part is excreted out from the body. The Sweda is the mala of Meda Dhatu,

which is excrete out from the Svedavahi Srotas of Twacha. Sweda maintains

the Luster and Humidity of skin (Ca.Su.15/5). According to Ayurveda Nails

and Hairs are the Mala of the Asthidhatu and Tvakgata Sneha is the Mala of

Majjadhatu. (Ca.Su.46/271) From the above facts it is easy to understand the

relation between Twacha and Dosa Dhatu and Mala the basic units of the body.

Kustha involve morbidity of seven dravyas. They are Tridosa and four Dhatus

(Rasa, Rakta, Mamsa and Lasika). So from above description one can easily

understand the importance of these units. The Vikrti of these seven essentials

lead’s to the occurrence of many skin diseases. i.e. Occurrence of many Kustha

Rogas.

Disscission on Classification of Kushta :

The word 'Kushta' is a broad term, which covers almost all the skin

diseases. Kustha is produced invariably by the vitiation of the seven factors i.e.

3 Dosas and 4 Dusyas. But different types of pain, colour, shape, specific

manifestation etc. are found in Kustha because of Anshanshakalpana of the

Dosas. Accordingly Charaka Kusthas are in fact of innumerable types, but for

systemic study they are classified into two major groups 7 Maha Kustha & 11

Kshudra Kustha.

Disscission on Nidana of kushta

The nidana of Kushta can be classified into sannikrishta and

viprakrishta. The Aharajanya, Viharjanya, Chikitsa sambandhi and Sankramika

can be considered as sannikrishta while Daivapacharajanya nidanas can be

considered as viprakrishta hetu.

Disscission on Viruddha Ahara :

Whether or not certain foods or food combinations are problematical is a

very individual matter, but unless you have an actual allergy, most of the


126

symptoms stemming from eating a specific food or food combination

that disagrees with you are likely to be relatively mild and minor. I

should note, for the record, that true food allergies are rare, although

many people are bothered by intolerances to specific foods that may

trigger physical symptoms

Ayurvedic Medicine also has rules about incompatible food

combinations based on the idea that some foods are toxic when

combined and some - deemed unsuitable to an individual's constitution -

may affect the body's ability to resist disease. You can find any number

of fad diets that make claims that certain combinations of food are either

good or bad for you.

Desha Viruddha:

From classical references as dicussed in review of literature, one can

conclude that, Desha Dosha dominancy Rasa dominancy

Anupa : Kapha - Pitta + Madhura

Jangala : Vata - Pitta + Katu

Anupa Sadharana : Kapha - Lavana + Amla

Jangala Sadharana : Vata - Tikta + Kasaya

Now, according to Loka-purusa samya theory, the person of Anupa

desha has dominancy of Kapha dosa and Madhura rasa. Same way the person

of Jangala has dominancy of Vata dosa and Katu rasa. While, Anupa Sadharana

and Jangala Sadharana have dominancy of Kapha and Vata dosa respectively

and Lavana + Amla and Tikta + Kasaya rasa respectively. Kushta is most

comman in anupa desha and if a person indulges in Ati amla lavana ahara, it

leads to the kushta roga. Ati amla and lavana rasa are one among the nidana of

kushta as mentioned in ayurvedic classics.

Viruddhahara causes many diseases. It is not possible to give treatment

of each and every disease separately. So according to Sushruta. Stoppage of


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the intake (consuming) of Viruddhahara is the first principle of treatment.

Charaka has stated, by avoiding things (Viruddhahara) that give rise to vitiation

and practising those (Hita Ahara) that help in bringing Samavastha of Dhatus,

then vitiated elements do not persist and the vitiated element are continuously

brought into existence. (Ch. Su. 16/36). Charaka has given more weightage for

the avoidance of causative factors. (Ch. Su. 18/46). But, one cannot get health

by only avoiding the causative factors or one cannot get relief from disease by

only avoiding the causative factors.

Pathogenesis By Viruddhahara :

The body and disease both are product of food. The distinction of

happiness and sorrow results from the distinction of wholesome (Hita Ahara)

and unwholesome diet (Ahita Ahara). in other words, which elements (Bhava)

in their wholesome combination give rise to the well being of man, same

elements, in their unwholesome combination produces various kinds of

diseases. Almost all the classics mentioned Viruddhahara as the causative

factor for Kushta.

Discission on “Adhyasana, Visamasana, Samasana, Atyasana ”

Agni has an important role to play in the physiological functioning of

body. Jatharagni has been considered to be prime among all Agnis. Therefore

the functioning of other Agnis, Dhatvagni and Bhutagni are dependant upon the

strength of Jatharagni. If food is not taken in accordance with the four types of

the thermal intensity then it becomes incompatible. Charaka has rightly

mentioned that intensity of Agni depends on Prakrti (habitus) (Ca. Vi.6/12).

Discussion on dugdhati seavnam :

All the dugdha may not cause kushta rather Apkwa dugdha which has

guru,snigdha and sheeta guna can cause kushta( A.S 6/61). There are eight

varities of ksheera has been told by our acharyas out of which mahisha ksheera


128

has gurutara, maha abhisyandi, snigdhatara and sheeta qualities which seems to

be more nearer to be called nidana of kushta.

Discussion on dadhi sevana :

As per Brihat trayi, Mandak Dadhi does tridosha kopana. It has the

qualities like guru, snigdha, maha abhisyandi etc. Hence, we can come out

with conclusion that why dadhi has mentioned in the nidana of kushta Nidana

of Kushta.

Discussion on Lakucha sevana :

Because of rooksha guna does vata prakopa, amla and ushna guna does

vata pitta kopana,hence, it does tri dosha prakopa. This is the reason charaka

has considered it most ahit phala (most unwhole some fruit) Ch.Su 25/39

Discussion on atyambu sevana :

River water :

As per Charaka and Sushrutha rivers from Sahaya, vindhya mountains causes

Kushta.

Types of jala as per Desha :

Anoopa desha jala hasAbhishyandi Madhura Snigdha Guru Mandagni

krita properties which resembles the nidana of Kushta.

Discussion on stress as causative factor of psoriasis from Ayurvedic

perspective :

The direct psychological references are available in the etiological

factors of Kustha. Blaming of good persons like saint, murder, stealing of

others properties etc. have also been mentioned as the Nidana of Kustha

(A.H.Ni. 14/1,2). Such anti social and misbehaviour and sinful activities make

serious and long standing impact on mind of persons who are indulging in it.


129

Bhaya (fear), Krodha (anger), Shoka(grief) etc. are originated by such activities

leading to vitiation of Dosha which leads to Kushta. Nidanas like Papakarmas

even causes affliction to the second generation (A.H.Ni. 14/2). This

observation highlights the seriousness of psychic factors in the etiology of

Kushtha.

Discussion on Daivapacharajanya nidana of Kushta :

1. Papa karma, Vipram gurum garshyatam, Purvakrut karma, Gohatya, Use

of money or material acquired through theft, Sadhu ninda, apman and vadha.

All these nidanas can be Eha janam krita i.e. Pourusha karma or Anya janama

krita i.e. Daiva karma.

2. Karma

Daiva karma Pourusha karma

Sheshtha Madhyama Avara

Sukha Madhyama sukha Heena sukha

Dheerga ayu Madhyama ayu Heena ayu

Chakrapani says It is only the major actions of the previous life which

leaves their results to be suffered in present life. Minor acts which can be

counteracted by acts like atonement do not have that continuity . So, the person

has to suffer till his papa karma gets vanished. Ayurvedic refences which

suggests importance of graham, rashi, nakshatra etc. in the causation of disease

In the context of sukha sadhya vyadhis, acharya Vagbhata used the word

graheshu. Commenting over this, Arundatta opines that when grahas will be at

their respective favuorable positions, then the vyadhi will be sukha sadhya.


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Discussion on Observations and Results

Total number of patients taken for observational study were 45 included

under one group. Distribution of patients based on age shows that patients of

the age group of 17-30 had a greater risk of acquiring Kitibha Kushta when

compared to other age groups. This shows that those in the active age group are

more involved.

Distribution of patients based on sex shows a general higher incidence in

males i.e., 30 (66.66%) males 55%, than in female 45%. Stress factor in males

cannot be ignored in this context.

Based on religion it was seen that Hindu’s had a higher incidence 35

(77.77 %) wereas 10 (22.22 %) were Muslims. However this can not be taken

for significance since it only justifies the population predominance.

In this study it was observed that majority of the patients were farmers

i.e. 25 (55.5 %), students 10 (22.22%), office workers 7 (15.5 %), and

Businessmen 3 (6.6 %) may be involvement of frequent exposure to cold damp

conditions.

Based on Kala, It was observed that aggravation of symptoms observed

more in visarga kala i.e. in 33 (73.33 %) patients. Visarga kala is sheeta

pradhana kala and also aggravated period for the kapha. Vata kapha doshas

which are predominant causes aggravation of Kitibha.

Discussion on the role of Mithya Ahara

It was observed that 20 (44.44%) were taking milk particularly buffalos

milk which is said to be maha abhishyandi.


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In the present study it was found that the patients with vegetarian diet

were 10 (22.22%) and mixed diet were 35 (77.77%). However among the meat

eaters high incidences of Kushta was noted.

It was observed that 38 (80.00 %) patients were belong to anoopa desha,

2 patients (4.44 %) were belong to Jangala desha and 5 (11.11 %) patients were

belong to Sadharana desha. Since the study was conducted in anoopa desha the

reported cases were naturally higher.

In this study it was observed that 15 (75 %) patients were eating fish

with milk and curds. As fish is said to be most abhishyanda

Our Acharyas strictly contraindicated consuming curd at night and in

this study it was observed that 25 patients (55.55 %) were eating curd at night

and 15 (33.33 %) were eating curds in day time and 5 patients (11.11 %) were

not consuming curd.

In this study it was observed that 14 patients (31.11 %) were consuming

more amla padartha ahra. Amla rasa does pitta and rakta prakopa, mamsa

vidahana and kapha kopana. All this leads to precipitate Kushta.

In this study it was observed that 35 patients (77.77 %) were having

excessive eating habits which may lead to mandagni and agni dushti is said to

be cause of occurrence of all the disorders

Graha vikruti is found in 53.33% patients. It significantly shows that

papa karma influences the graha gati. The unfavourable grahas leads to

production of Kushta.


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CONCLUSION

Nidana or etiological factors are source to understand a disease, they are

also key to treat the patients.

Considering Kitibha, it is one among the main twak vikara hampering

not only physical, mental but also social status of patients by virtue of its

change in external appearance.

As far as knowledge of nidana of specially Kitibha among lay man is

very poor, there is an immediate need to increase awareness about

important contribution of Ayurveda, such viruddha ahara etc. for

prevention of diseases.

In the changed circumstances and varied life style, as a result of

modernization and globalization, the core idea of nidana explained by

our age old classics, still observed very much resolved.

In Kitibha Kushta, graham virtuti, dadhi sevana, adhyashana are found

highly significant nidana.

The disease psoriasis when evaluated on the parameters of nidana

panchaka of Ayurveda stress is found highly significant.

Further literary experimental, clinical researchers are essential to know

the truth in extensive manner.


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SUMMARY

“Concept of Nidana and its assessment in Kitibha Kushta (psoriasis)” is

presented in 7 sections. These sections are as follows – Introduction, Review of

literature, Methodology of research, Observation and results, Discussion,

Conclusion and Summary.

The introduction gives an overview on importance of nidana, Kushta

and need for selection of the study and objectives.

Review of literature comprises of following headings.

o Anatomy and Physiology of Skin.

o Historical review and classification of Kushta

o Lakshana of Kitibha Kushta

o Nidana of Kushta and etiology of Psoriasis.

Methodology of research explains aims and objectives, source of

patients, study design, criteria for inclusion and exclusion criteria.

The fourth section Observations and the result present relevant tables

and graphs based on the study. The observation percentages were

statistically analyzed and explained.

Discussion part deals with salient points on literary aspects,

interpretation of observations and results of the study.

Conclusion highlights the inferences drawn on the basis of the study

and recommendations for future trials.


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ANNEXURE

Questionnaire used for the skin disease patients to evaluate habits

and regimen

Ahara Vishayaka

1. Habit of eating Hot or Cold substances without proper order?

Ex.Tiffin box food. Yes/No

Hot meals-cold drinks or lassi. Yes/No

Fast foods + cold drinks or Ice-creams Yes/No

2. Habit of eating heavy and light foods without any gap period?

Ex. Hostel food or Mess food Yes/No

Festival fasting and

Next day consuming the heavy food Yes/No

Yesterday prepared food to the next day Yes/No

3. Habit of eating or consuming excess Honey or fish combination

Yes/No

4. Habit of Adhyasana (Bhukthasyopari bhojanam) Yes/No

5. Habit of eating fish + milk+curd? Yes/No

6. Frequency of consuming guru (high calorie) aharas?

7. Indulgence in consuming following Virudha ahara.

Desha Viruddha Samakara Viruddha

Kaala Viruddha Agni Viruddha,

Maatra Viruddha, Dosha viruddha

Saatmya Viruddha, Viirya Viruddha, etc

8. Preferred food taste?

Sweet/salty/sour/bitter/pungent/astringent

9. Changing of food type as per change in seasons? Yes/No

Viharaja vishayaka

10. Regular or occasional inducing of vomiting?

(a) If so is it to get relived from undigested food


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When do you usually do?

Morning/Afternoon/evening/night/Midnight

(b) Do you consume spicy foods even in conditions of undigested food

Or when not have the interest to consume the food

11. Suppressing the urges of vomiting and natural urges? Yes/No

12. Habit of over eating and then exposing to sunlight? Yes/No

13. Have you undergone panchakarma therapy before? Yes/No

14. Habit of sleeping in afternoon?

Day: hrs. Occasionally/daily Yes/No

15. Respect / disrespect of guru, elders, Gods etc.? Yes/No

16. Mentality of harming innocent people? Yes/No

17. Exercise habits?

If yes only - in relation with food when you will do?

Occupation - Driver, agriculture, labourer etc.

Atapa sevana - Trafic police / vegetable seller etc.

18. Bathing habits

Source of water - E.g. Sump, pump, tap, canal, river, pond etc

In frightened condition. Yes/No

In tired condition. Yes/No

Continuous exposure to sun, fire, and then taking bath? Yes/No

After exercise (ex. Jogging, heavy work etc) Yes/No

19. Frequency of undergoing Purgation? Yes/No

20. Wearing of other’s cloths? Yes/No

Anya

21. Implementation of skin protective treatments like,

Lepa, lotions, creams etc. Yes/No

22. Frequency of changing

Cosmetics / Soap / Shampoo etc, Yes/No


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GOVERNMENT AYURVEDA MEDICALCOLLEGE, MYSORE

DEPT. OF P.G STUDIES IN AYURVEDA SIDDHANTA

“CONCEPT OF NIDANA AND ITS ASSESSMENT IN KITIBHA

KUSHTA (PSORIASIS)”

PG Scholar: Dr.PANKAJ PATHAK Guide: Dr.N.A.MURTHY

CASE PERFORMA

Patient Name: Date:

Age: Sex:

Occupation: Religion:

Marital Status:

Place: Diagnosed case of Kitibha Kushta

AHARA

Saptha Vidha Ahara Virudha

Consumption form Oca/Daily Remarks

1. Swabhava

2. Samyoga

3. Samskara

4. Matra

5. Desha

6. Kala

7. Upayoga samstha


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Types of Ahara

Types Oca/Daily Remarks

1. Mamsa Verities

2. Shaka Verities

3. Dhanya verities

4. Ksheera verities

VIHARA

Duration Rutu Remarks

1. Diva swapna

2. Vyayama

3. Maituna

4. Atapa sevana

Jala

Pond/river/lake/sump/pump/tap/canal

After the treatments of

Vamana / Virechana/ Basti/ Nasya/ Rakthamokshana

Mano roga janitha

Kroda / Shoka / Kama / Bhaya / Lajaa

Miss conduct to

Guru / Deva / Vrudha / Lady / Bhramana

Anuvamsha

Contributor

Mother

Father

Grandfather


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Grandmother

Relatives

Miscellaneous

Junk foods / Fast food / Road side / Ice creams

Shad rasa

Oca/Daily Remarks

Madhur

Amla

Lavana

Katu

Tiktha

Kashaya

Ahara (guna)

Guru – Laghu Sheetha – Ushna

Snigdha – Ruksha Manda – Teekshna

Sthira – Sara Mrudha – Katina

Vishada – Pichilla Shlakshna – Kara

Sthoola – Sukshma Sandra – Drava

Pankaj dissertation - final

Health & Medicine

Transcript of Pankaj dissertation - final