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<big>'''Abstract'''</big>
<big>'''Abstract'''</big>
<div style="text-align:justify;">In this chapter, two subjects are described viz. 1. Two types of patients, based on the psychological types and physical strength are seen; 2. Knowledge of micro and macro organisms that affect human body is given. These two topics seem different, however are connected in view of varied response of humans to exogenous causative factors of disease. The first type of responding individual exaggerates their symptoms (guruvyadhita) and other type understate their symptoms (laghuvyadhita). It is important to make correct assessment of their condition to know the prognosis for proper treatment. Knowledge of micro and macro organisms affecting the body, their etiological factors, site (location), classification, morphology, pathology, nomenclature and treatment is described. These organisms termed as ‘krimi’ have both internal and external manifestations. Three internal types explained on the basis of their origin are raktaja (originating in blood), shleshmika (originating due to kapha predominant factors), and purishaja (originating in feces). Three step treatment protocol has been mentioned i.e., nidana parivarjana (giving up etiological factors), apakarshana (extraction) and prakriti vighata (creating unsuitable environment for parasites). Thus the chapter narrates in detail about the methodology of analysis of krimi, their origin and ill effects and also the modes and medicaments to treat them. </div>
<div style="text-align:justify;">In this chapter, two subjects are described viz. 1. Two types of patients, based on the psychological types and physical strength are seen; 2. Knowledge of micro and macro organisms that affect human body is given. These two topics seem different, however are connected in view of varied response of humans to exogenous causative factors of disease. The first type of responding individual exaggerates their symptoms (guruvyadhita) and other type understate their symptoms (laghuvyadhita). It is important to make correct assessment of their condition to know the prognosis for proper treatment. Knowledge of micro and macro organisms affecting the body, their etiological factors, site (location), classification, morphology, pathology, nomenclature and treatment is described. These organisms termed as ‘krimi’ have both internal and external manifestations. Three internal types explained on the basis of their origin are [[rakta]]ja (originating in blood), shleshmika (originating due to [[kapha]] predominant factors), and [[purisha]]ja (originating in feces). Three step treatment protocol has been mentioned i.e., nidana parivarjana (giving up etiological factors), apakarshana (extraction) and Prakritivighata (creating unsuitable environment for parasites). Thus the chapter narrates in detail about the methodology of analysis of krimi, their origin and ill effects and also the modes and medicaments to treat them. </div>
'''Keywords''': ''Vyadhita Roopiya, Guru Vyadhita, Sattvabala, Laghu Vyadhita, Krimi, Shleshmika, Purishaja, Raktaja, Nidana Parivarjan, Apakarshan, Prakritivighta'', Parasites, worms, response of patient to disease, micro-organisms.
'''Keywords''': ''Vyadhita Roopiya, Guru Vyadhita, Sattvabala, Laghu Vyadhita, Krimi, Shleshmika, [[Purisha]]ja, [[Rakta]]ja, Nidana Parivarjan, Apakarshan, Prakritivighta'', Parasites, worms, response of patient to disease, micro-organisms.
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*Parasitology and Bacteriolgy in [[Ayurveda]] –Oldest recording of classification and treatment of ''krimi'' (parasites and microbes) is found in [[Charak Samhita]]. It is obvious that they had knowledge of parasites and invisible microorganisms and their role in pathogenesis and symbiosis. Details of ''krimis'' is described under seven subheadings i.e., aetiology, nomenclature, site, morphology, colour, pathogenesis and treatment, in the text total number of ''krimi'' is mentioned as twenty.
*Parasitology and Bacteriolgy in [[Ayurveda]] –Oldest recording of classification and treatment of ''krimi'' (parasites and microbes) is found in [[Charak Samhita]]. It is obvious that they had knowledge of parasites and invisible microorganisms and their role in pathogenesis and symbiosis. Details of ''krimis'' is described under seven subheadings i.e., aetiology, nomenclature, site, morphology, colour, pathogenesis and treatment, in the text total number of ''krimi'' is mentioned as twenty.
*Classification – The ''krimis'' are classified as external and internal. Internal type has been further classified under three subtypes i.e. ''raktaja'' (originating in blood), ''shleshmika'' (originating due to ''kapha'' predominant factors), and ''purishaja'' (originating in feces).
*Classification – The ''krimis'' are classified as external and internal. Internal type has been further classified under three subtypes i.e. [[rakta]]ja (originating in blood), ''shleshmika'' (originating due to [[kapha]] predominant factors), and [[purisha]]ja (originating in feces).
*Morphology – Charak has described three morphological types of ''shlaishmika krimi'' which is consistent with present day parasitology, three types include platy helminths, large nematodes and small nematodes.
*Morphology – Charak has described three morphological types of ''shlaishmika krimi'' which is consistent with present day parasitology, three types include platy helminths, large nematodes and small nematodes.
*Pathogenesis – ''Raktaja krimi'' are invisible and produce the symptomatology like ''kushtha'' hence they are to be treated like the disease ''kushtha''. However, The ''shleshmika'' and ''purishaja'' variety has more academic importance than therapeutic as their etiological factor and treatment are the same but the presenting symptomatology is different.
*Pathogenesis – [[Rakta]]ja krimi are invisible and produce the symptomatology like ''kushtha'' hence they are to be treated like the disease ''kushtha''. However, The ''shleshmika'' and [[purisha]]ja variety has more academic importance than therapeutic as their etiological factor and treatment is the same but the presenting symptomatology is different.
*Treatment - In this section the management principle has been described which is unique and applicable to the management of most diseases. Treatment is described predominantly for intestinal parasites. Long list of plants is mentioned for the treatment of parasites and their expulsion from the body. Per the advancement in technology and pharmaceuticals, the parasites and micro-organisms are studied in detail in modern medicine. Specific ante-helminthics and anti-microbial drugs with good clinical efficacy are available. The description of methods of removal of parasites in [[Ayurveda]] seems to be inconvenient in today’s era, where convenient therapeutic modalities are developed by modern science. The ayurvedic drugs also need to be used in larger doses. Modern medicine drugs, for removal of common parasites are effective with convenient dosage schedule. However, these drugs are potentially toxic and are to be used with careful watch of physician.
*Treatment - In this section the management principle has been described which is unique and applicable to the management of most diseases. Treatment is described predominantly for intestinal parasites. Long list of plants is mentioned for the treatment of parasites and their expulsion from the body. Per the advancement in technology and pharmaceuticals, the parasites and micro-organisms are studied in detail in modern medicine. Specific ante-helminthics and anti-microbial drugs with good clinical efficacy are available. The description of methods of removal of parasites in [[Ayurveda]] seems to be inconvenient in today’s era, where convenient therapeutic modalities are developed by modern science. The ayurvedic drugs also need to be used in larger doses. Modern medicine drugs, for removal of common parasites are effective with convenient dosage schedule. However, these drugs are potentially toxic and are to be used with careful watch of physician.
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A partial knowledge of any subject does not provide thorough understanding of the entire scientific concept. Those who fail to diagnose a case properly, also fail to prescribe a rational remedy for the same. For instance, when they consider the severely ill person having mild disease and, administer mild evacuative drug which fails to expel (''udeerana'') out ''doshas''. Similarly, when they consider mildly ill patient to have severe disease and administer strong evacuative drug which eliminates the ''doshas'' excessively causing weakness in the body. Thus those who regard the partial knowledge as sufficient to provide complete understanding of the entire object, fail in their pursuit. On the other hand, the physicians who have thorough knowledge from all aspects and take action after examining the entire situation by all means as far as possible they achieve the desired objective.[4]
A partial knowledge of any subject does not provide thorough understanding of the entire scientific concept. Those who fail to diagnose a case properly, also fail to prescribe a rational remedy for the same. For instance, when they consider the severely ill person having mild disease and, administer mild evacuative drug which fails to expel (''udeerana'') out [[dosha]]. Similarly, when they consider mildly ill patient to have severe disease and administer strong evacuative drug which eliminates the [[doshas]] excessively causing weakness in the body. Thus those who regard the partial knowledge as sufficient to provide complete understanding of the entire object, fail in their pursuit. On the other hand, the physicians who have thorough knowledge from all aspects and take action after examining the entire situation by all means as far as possible they achieve the desired objective.[4]
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Excreta are of two types-external and internal. Here the word ''malaja'' means parasites growing due to external excreta. Their etiological factor is lack of cleanliness of the body.
Excreta are of two types-external and internal. Here the word [[mala]]ja means parasites growing due to external excreta. Their etiological factor is lack of cleanliness of the body.
Habitat -hair, beard, moustaches, body hair, eyelashes and clothing.
Habitat -hair, beard, moustaches, body hair, eyelashes and clothing.
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=== ''Purishaja krimi'' (parasites in feces) ===
=== [[Purisha]]ja krimi (parasites in feces) ===
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Their habitat is ''pakwashaya'' (large intestine and rectum); when developed they move downwards or both ways; however if they tend to move (upwards) towards stomach, eructation and breath of the patient may have fecal odor.
Their habitat is ''pakwashaya'' (large intestine and rectum); when developed they move downwards or both ways; however if they tend to move (upwards) towards stomach, eructation and breath of the patient may have fecal odor.
Their morphology and color- these ''purishaja krimi'' are morphologically of two types :
Their morphology and color- these [[purisha]]ja krimi are morphologically of two types :
#some are minute round in circumference white in color and like hair of goat (wool);
#some are minute round in circumference white in color and like hair of goat (wool);
They may produce symptoms like- diarrhea, emaciation, roughness, and horripilation; on reaching the anus, they produce piercing pain and itching there; when they are exhilarated, they come out of anus frequently.
They may produce symptoms like- diarrhea, emaciation, roughness, and horripilation; on reaching the anus, they produce piercing pain and itching there; when they are exhilarated, they come out of anus frequently.
Thus these are the characteristics of the worms grown due to the vitiation of ''shleshma'' and ''purisha''. [13]
Thus these are the characteristics of the worms grown due to the vitiation of ''shleshma'' and [[purisha]]. [13]
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'''''Apakarshana''''': Extraction (removal) can be done by hands with or without the help of instruments as may be the requirement.
'''''Apakarshana''''': Extraction (removal) can be done by hands with or without the help of instruments as may be the requirement.
*Parasites located inside the organs are extricated, as a rule, by the (eliminative) therapy. These are of four types such as nasal errhines - ''nasya'', emesis, purgation and non-unctuous enema.
*Parasites located inside the organs are extricated, as a rule, by the (eliminative) therapy. These are of four types such as nasal errhines - [[nasya]], emesis, purgation and non-unctuous enema.
'''''Prakritivighata''''': Destruction of the source of their origin and development consists of the use of pungent, bitter, astringent, alkaline and hot drugs, and other measures which are contrary to ''kapha'' and feces.
'''''Prakritivighata''''': Destruction of the source of their origin and development consists of the use of pungent, bitter, astringent, alkaline and hot drugs, and other measures which are contrary to [[kapha]] and feces.
'''''Nidanaparivarjana''''': Thereafter abstinence from the etiological factors-whatever is mentioned as causative factor and similar other substances should be avoided. Thus the principle of treatment is said, which will be further described in detail. [15]
'''''Nidanaparivarjana''''': Thereafter abstinence from the etiological factors-whatever is mentioned as causative factor and similar other substances should be avoided. Thus the principle of treatment is said, which will be further described in detail. [15]
#''Krimis'' are classified as external and internal variety mainly. They are further sub classified based upon etiology, habitat, morphology, color, nomenclature, pathogenesis and treatment.
#''Krimis'' are classified as external and internal variety mainly. They are further sub classified based upon etiology, habitat, morphology, color, nomenclature, pathogenesis and treatment.
#The four categories based on their habitat are: ''purishaja'' (origin in fecal matter), ''shleshmaja'' (origin in ''shleshma'' including body fluids, mucosal layers), ''raktaja'' (origin in blood), ''malaja'' (origin in body impurities).
#The four categories based on their habitat are: [[purisha]]ja (origin in fecal matter), ''shleshmaja'' (origin in ''shleshma'' including body fluids, mucosal layers), [[rakta]]ja (origin in blood), [[mala]]ja'' (origin in body impurities).
#Management principles given for ''krimi'' are ''nidana parivarjana'' (removal of causative factor), ''apakarshana'' (removal of ''krimi'') and ''prakritivighata'' (eradicating favorable environment for growth of ''krimi''). This is collectively a complete management principle (''Chikitsa Sutra'') in [[Charak Samhita]] in all aspects, as all other principles are ''ekangika'' (pertaining only to one or two components of disease process).
#Management principles given for ''krimi'' are ''nidana parivarjana'' (removal of causative factor), ''apakarshana'' (removal of ''krimi'') and ''prakritivighata'' (eradicating favorable environment for growth of ''krimi''). This is collectively a complete management principle (''Chikitsa Sutra'') in [[Charak Samhita]] in all aspects, as all other principles are ''ekangika'' (pertaining only to one or two components of disease process).
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In comparison to modern medicine, the removal of parasites in [[Ayurveda]] seems to be inconvenient to the patient. The drugs are to be used in larger doses with limited efficacy. Modern medicine drugs, for removal of common parasites are effective with convenient dosage schedule. However, these drugs are potentially toxic and are to be used with careful watch of physician.
In comparison to modern medicine, the removal of parasites in [[Ayurveda]] seems to be inconvenient to the patient. The drugs are to be used in larger doses with limited efficacy. Modern medicine drugs, for removal of common parasites are effective with convenient dosage schedule. However, these drugs are potentially toxic and are to be used with careful watch of physician.
''Prakritivighata'' (creation of unfavorable condition preventing recurrence)- ''Prakritvighata'' means to create the environment so that ''dosha'' cannot lodge themselves in the ''dhatus''/''krimi''. This includes measures promoting ''agni'' and nourishing ''dhatus'' with ''rasayana'' therapy. The role of the ''rasayana'' is to create the healthy tissues so that vitiated ''dosha'' cannot lodge (''sthana samshraya''). As per the Ayurvedic concept, increased ''dosha'' circulates in the body and on finding a weak and suitable tissue they lodge there causing the initiation of disease process. Use of certain herbs like ''Shigru, Paribhadra'', etc. may create an environment to prevent growth of parasitic ova/cyst.
''Prakritivighata'' (creation of unfavorable condition preventing recurrence)- ''Prakritvighata'' means to create the environment so that [[dosha]] cannot lodge themselves in the [[dhatu]]/''krimi''. This includes measures promoting [[agni]] and nourishing [[dhatu]] with [[rasayana]] therapy. The role of the [[rasayana]] is to create the healthy tissues so that vitiated [[dosha]] cannot lodge (''sthana samshraya''). As per the Ayurvedic concept, increased [[dosha]] circulates in the body and on finding a weak and suitable tissue they lodge there causing the initiation of disease process. Use of certain herbs like ''Shigru, Paribhadra'', etc. may create an environment to prevent growth of parasitic ova/cyst.
Mass deworming is done by World Health Organization (WHO) in certain areas of the world where helminthiasis is common. Although deworming improves the health of an individual, outcomes from mass deworming campaigns, such as reduced deaths or increases in cognitive ability, nutritional benefits, physical growth, and performance, are uncertain or not apparent.
Mass deworming is done by World Health Organization (WHO) in certain areas of the world where helminthiasis is common. Although deworming improves the health of an individual, outcomes from mass deworming campaigns, such as reduced deaths or increases in cognitive ability, nutritional benefits, physical growth, and performance, are uncertain or not apparent.
In case of recurrent worm infestations, emerging drug resistance to known anti-parasitic agents, together with the inability of these agents to prevent re-infection and relapse, further complicates the disease scenario<ref> Ahmad R, Khan T, Ahmad B, Misra A, Balapure AK. Neurocysticercosis: a review on status in India, management, and current therapeutic interventions. Parasitology Research, Jan;116(1):21-33. Epub 2016 Oct 24. </ref>. In such cases, ''nidana parivarjana'' and ''prakrityvighata'' becomes important to follow for prevention. Drug Resistance is a big problem in the field of infectious diseases.
In case of recurrent worm infestations, emerging drug resistance to known anti-parasitic agents, together with the inability of these agents to prevent re-infection and relapse, further complicates the disease scenario<ref> Ahmad R, Khan T, Ahmad B, Misra A, Balapure AK. Neurocysticercosis: a review on status in India, management, and current therapeutic interventions. Parasitology Research, Jan;116(1):21-33. Epub 2016 Oct 24. </ref>. In such cases, ''nidana parivarjana'' and ''prakrityvighata'' becomes important to follow for prevention. Drug Resistance is a big problem in the field of infectious diseases.
The spread of such diseases can be prevented by observing personal hygiene and promoting ''vyadhiksamatva'' or immunity with the help of leading a healthy lifestyle, following good nutrition and through administration of ''rasayana'' therapy.
The spread of such diseases can be prevented by observing personal hygiene and promoting ''vyadhiksamatva'' or immunity with the help of leading a healthy lifestyle, following good nutrition and through administration of [[rasayana]] therapy.
[[Ayurveda]] recognizes and describes a less-known concept of ''ojas'' (vital essence of the body) which gives biological strength (including immunity). ''Ojas'' is the final product of tissue nourishment and is the final product of all the seven ''dhatus'' namely ''rasa, rakta, mamsa, meda, asthi, majja,'' and ''shukra''. ''Ojas'' is of two types called ''para ojas'' and ''apara ojas''. ''Para ojas'' is subtle and present in very minute quantity in the heart while ''apara ojas'' is gross and amounts to handful in quantity, spread all over the body. ''Para ojas'' is vital to life and any damage or vitiation to it can result in sudden death. ''Apara ojas'' gives gross immune strength to the body and can be compared to immunity described by modern medical science. This immune strength is also called ''ojabala'' and is categorized to be of three kinds: ''sahaja bala'' or primary immunity, ''kalaja bala'' or acquired immunity through environmental factors and ''yuktikrita bala'' or artificially-induced immunity by ''rasayana'', lifestyle and suitable diet. The classics prompt to utilize these three resources to enhance the bala/immunity in order to prevent all ailments especially chronic diseases and contagious diseases.
[[Ayurveda]] recognizes and describes a less-known concept of [[ojas]] (vital essence of the body) which gives biological strength (including immunity).[[Ojas]] is the final product of tissue nourishment and is the final product of all the seven [[dhatu]] namely [[rasa dhatu]], [[rakta dhatu]], [[mamsa dhatu]], [[meda dhatu]], [[asthi dhatu]], [[majja dhatu]], and [[shukra dhatu]]. [[Ojas]] is of two types called para [[ojas]] and apara [[ojas]]. Para [[ojas]] is subtle and present in very minute quantity in the heart while apara [[ojas]] is gross and amounts to handful in quantity, spread all over the body. Para [[ojas]] is vital to life and any damage or vitiation to it can result in sudden death. Apara [[ojas]] gives gross immune strength to the body and can be compared to immunity described by modern medical science. This immune strength is also called [[oja]]bala and is categorized to be of three kinds: ''sahaja bala'' or primary immunity, ''kalaja bala'' or acquired immunity through environmental factors and ''yuktikrita bala'' or artificially-induced immunity by [[rasayana]], lifestyle and suitable diet. The classics prompt to utilize these three resources to enhance the bala/immunity in order to prevent all ailments especially chronic diseases and contagious diseases.
Three categories of ''bala-dosha'' or immune disorders are described in the Ayurvedic texts which are comparable to three categories of immune disorders described in modern medical system:
Three categories of bala-[[dosha]] or immune disorders are described in the Ayurvedic texts which are comparable to three categories of immune disorders described in modern medical system:
#''Oja-vyapat'' (immune-aberrations and allergies),
#[[Oja]]-vyapat (immune-aberrations and allergies),
#''Oja-visransa'' (dislodged immunity and autoimmune disorders) and
#[[Oja]]-visransa(dislodged immunity and autoimmune disorders) and
#''Oja-kshaya'' (immunodeficiency).
#[[Oja]]-kshaya (immunodeficiency).
There are specific methods and approaches to tackle the categories of immune disorders. It is evident from the description of ''ojabala'' and ''bala-dosha'' that immunology was highly advanced in ''samhita'' period of [[Ayurveda]] and the knowledge in this field was comparable to the current knowledge of immunology.
There are specific methods and approaches to tackle the categories of immune disorders. It is evident from the description of [[oja]]bala and bala-[[dosha]] that immunology was highly advanced in ''samhita'' period of [[Ayurveda]] and the knowledge in this field was comparable to the current knowledge of immunology.
=== Microbiology in [[Ayurveda]] ===
=== Microbiology in [[Ayurveda]] ===
Even though microscopy became available in 17th century, microbiology and parasitology was known and described in Ayurvedic classics in the context of immunity and body resistance. For an individual to possess immunity adequate ''ojas, bala'' and ''vyadhiksamatva'' is necessary. Role of microbes in causing disease became known to modern medicine in the last two centuries and since then discovery of antibiotics and vaccination there has been rapid advancements in the field of infectious diseases and saved millions of lives. However, indiscriminate use of antibiotics has caused change in body microbiome with resultant increase in various chronic and autoimmune diseases. Use of vaccination is also under cloud these days. Ayurvedic knowledge of ''yuktikrit bala'' or artificially-induced immunity by ''rasayana'', lifestyle and suitable diet can be very useful in prevention and treatment of microbial diseases.
Even though microscopy became available in 17th century, microbiology and parasitology was known and described in Ayurvedic classics in the context of immunity and body resistance. For an individual to possess immunity adequate [[ojas]], bala and ''vyadhiksamatva'' is necessary. Role of microbes in causing disease became known to modern medicine in the last two centuries and since then discovery of antibiotics and vaccination there has been rapid advancements in the field of infectious diseases and saved millions of lives. However, indiscriminate use of antibiotics has caused change in body microbiome with resultant increase in various chronic and autoimmune diseases. Use of vaccination is also under cloud these days. Ayurvedic knowledge of ''yuktikrit bala'' or artificially-induced immunity by [[rasayana]], lifestyle and suitable diet can be very useful in prevention and treatment of microbial diseases.
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