Koshtha
The word ‘koshtha’ literally means enclosure or gut. Over the past decade, the concept of gut has revolutionized the health and wellness industry. The state of gut and its flora in every aspect of life, their impact on health and disease, interaction with the other parts of the body and external stimuli have been areas of interest in current research. Ayurveda has appreciated the role of gut in all the domains; conceptual, diagnostical and therapeutical. The multidimensional term ‘Koshtha’ has been used to denote the gut in Ayurveda. It has been comprehended as an organ, a collection of organs or a system, a channel, a disease pathway, and a therapeutic target. In the present article, the contributions of Ayurveda in each of these realms have been explored.
| Section/Chapter/topic | Sharira / Koshtha (The concept of gut in Ayurveda) |
|---|---|
| Authors | Karthik K.P.1 |
| Reviewers | Basisht G.2 |
| Editor | Deole Y.S. 3 |
| Affiliations |
1 Department of Kaumarabhritya, A.I.I.A., New Delhi, India 2 Rheumatologist, Orlando, Florida, U.S.A. 3 Department of Kayachikitsa, G.J. Patel Institute of Ayurvedic Studies and Research, Anand, India |
| Correspondence email | kpkarthik131@gmail.com, carakasamhita@gmail.com |
| Date of first publication: | May 08, 2022 |
| DOI | under process |
The anatomical and physiological extent
Anatomy of koshtha
The meaning of the word ‘Koshtha’ is ‘enclosure’. In Ayurveda, koshtha denotes the following anatomical ranges:
- Stomach to large intestines (amashaya to pakvashaya).[A.Hr.Sutra Sthana 12/46][1]
- Mouth to rectum (asya to payu).[Gayadasa commentary on Su.Sa.Nidana Sthana 7/6][2]
- Site (sthana) of collection of undigested food (ama), digestive fire (agni), digested food (pakva), urine (mutra), blood (rakta), and the organs, heart (hridaya), caecum (unduka), and lungs (phupphusa).[Su.Sa.Chikitsa Sthana 2/12-13][2]
- The term koshtha is also used to refer to duodenum (grahani), which is the pivot of digestion.[Su.Sa.Nidana Sthana 7/6][2]
- It is considered as a separate pathological terrain (rogamarga), serving as a stratum for its own unique set of diseases.
Fifteen organs have been enunciated as parts of koshtha: umbilicus (nabhi), heart (hridaya), pancreas (kloma), liver (yakrit), spleen (pleeha), kidneys (vrkkau), bladder (vasti), sigmoid colon (purishadhara), stomach (amashaya), cecum (pakvashaya), rectum (uttaraguda), anus (adharaguda), small intestine (kshudrantra), large intestine (sthulantra), and omentum (vapavahana). [Cha.Sa. Sharira Sthana 7/10]
Embryology
Koshtha consists mainly of smooth organs like stomach and intestines that are inherited from mother. [Cha.Sa.Sharira Sthana 3/6] Tilburg et.al., analyzed 308 irritable bowel syndrome (IBS) patients along with 102 healthy controls and 36 inflammatory bowel disease patients of Caucasian traits for maternal inheritance of IBS. 17.5% of the participants had a probable maternal inheritance and the maternal polymorphism 16519T that is seen associated with multiple other functional disorders. This was significantly associated with the maternally inherited IBS.[3] As per Ayurvedic embryology, the precursor of gut is grossly seen in the fetus from the third month [Cha.Sa.Sharira Sthana 4/11] and attains full maturity by the seventh month. [Su.Sa.Sharira Sthana 3/30][2] The development of gut as per the western embryology starts from third week of intrauterine life and attains near-adult level functioning by 32 weeks.[4]
Physiology
Koshtha is the important site for digestion. All the three doshas and their subtypes play pivotal role in maintaining the physiology of koshtha. The prana vayu (a type of vata) propels the timely administered food to the koshtha. The bodhaka kapha (a type of kapha) in oral cavity senses the taste of food. The kledaka kapha moistens the food and subjects it to digestion. Further, pachaka pitta and samana vayu lead the role in division into essence (saara) and waste (kitta). Samana vayu is important in breaking down the moistened food into small particles for easy digestion by pachaka pitta. Further, the wastes of food are expelled by apana vayu. The essence is circulated by vyana vayu. Hence, the proper functioning of all three are necessary to maintain the equilibrium in the koshtha. In the transient stages of digestion (avasthapaka) the dosha are nourished in their respective abodes. Kapha, Pitta, and Vata in amashaya (upper gastrointestinal tract with stomach), pachyamanashaya (small intestine) and pakvashaya (large intestine) respectively. These parts of koshtha are primary seats of the corresponding dosha.
Grahani (lower part of stomach and duodenum) and agni (factors responsible for digestion and metabolism) are the most important structural and functional components of koshtha respectively. Grahani holds undigested food till the completion of digestion. It is the part of koshtha that forms the substratum for agni. The nature of grahani is crucial in deciding the nature of koshtha. When grahani is unable to retain the food till proper digestion or when agni is so weak that it is unable to facilitate proper digestion, the result is improperly formed metabolites or ama.
Types of koshtha
There are basically three types of koshtha:
1. Hard (krura), predominant with vata dosha and in vata prakriti individuals
2. Soft (mridu), predominant with pitta dosha and in pitta prakriti individuals
3. Medium or intermediate (madhya) predominant with kapha dosha and in kapha prakriti individuals. It is also seen in the individuals with equilibrium state of dosha in prakriti.
page under construction
- ↑ Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.
- ↑ 2.0 2.1 2.2 2.3 Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.
- ↑ van Tilburg MAL, Zaki EA, Venkatesan T, Boles RG. Irritable bowel syndrome may be associated with maternal inheritance and mitochondrial DNA control region sequence variants. Digestive Diseases and Sciences. 2014;59(7):1392–7.
- ↑ Bhatia A, Shatanof RA, Bordoni B. Embryology, Gastrointestinal. StatPearls [Internet]. 2021 May 8 [cited 2022 Apr 1]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK537172/