Changes

shlokAH-prakRutyantarabhedena rogAnIkavikalpanam|parasparAvirodhashca sAmAnyaM rogadoShayoH||20||Doshasa~gkhyA vikArANAmekadeshaH prakopaNam|jaraNaM prati cintA ca kAyAgnerdhukShaNAni ca||21||

shlokAH-prakRutyantarabhedena rogAnIkavikalpanam|parasparAvirodhashca sAmAnyaM rogadoShayoH||20||Doshasa~gkhyA vikArANAmekadeshaH prakopaNam|jaraNaM prati cintA ca kAyAgnerdhukShaNAni ca||21||

narANAM VatalAdInAM prakRutisthApanAni ca| rogAnIke vimAne~asmin vyAhRutAni maharShiNA||22||

narANAM VatalAdInAM prakRutisthApanAni ca| rogAnIke vimAne~asmin vyAhRutAni maharShiNA||22||

To sum up, in this chapter , groups of diseases based upon vata etc. prakriti types, non-contradiction of classified categories of diseases, similarity in dosha and roga, numbers of doshas, diseases with one type, causes of vitiation of dosha, description of agni, and means to stimulate it’s functions, vata etc. dominant types of persons and their management to maintain normalcy of dosha  are described in details by sage Atreya. (20-22)

 

Tattva vimarsha:

To sum up, in this chapter , groups of diseases based upon vata etc. prakriti types, non-contradiction of classified categories of diseases, similarity in dosha and roga, numbers of doshas, diseases with one type, causes of vitiation of dosha, description of agni, and means to stimulate it’s functions, vata etc. dominant types of persons and their management to maintain normalcy of dosha  are described in details by sage Atreya. [20-22]

 

=== Tattva vimarsha ===

 

1. The grouping of diseases, patients and agni is framed for development of common modalities for diagnosis and treatment.

1. The grouping of diseases, patients and agni is framed for development of common modalities for diagnosis and treatment.

2. Understanding the disease, the agni (digestive capacity) and prakriti (constitution) of a person is of prime importance for a physician to provide effective treatment.

2. Understanding the disease, the agni (digestive capacity) and prakriti (constitution) of a person is of prime importance for a physician to provide effective treatment.

8. Rajas is the initiator of all actions. Tamas can’t act without rajas.

8. Rajas is the initiator of all actions. Tamas can’t act without rajas.

9. Agni( digestive processes) of a person shall be diagnosed as tikshna(severe), manda(low), sama(balanced) and vishama(irregular).  The selection of diet and dose of medicine depends upon agni.

9. Agni( digestive processes) of a person shall be diagnosed as tikshna(severe), manda(low), sama(balanced) and vishama(irregular).  The selection of diet and dose of medicine depends upon agni.

Vidhi Vimarsha:

 

=== Vidhi Vimarsha ===

 

Vimana literally means measurement, so this section gives the physical as well pathological parameters for the measurement of various entities like dosha, dhatu, agni, srotasa etc. In the present chapter method of classification of diseases is given on the basis of prognosis, severity, site of origin, cause and location. Physicians are directed to diagnose the disease as primary or secondary one on the basis of vitiated doshas and treatment given. Primary doshas manifest their respective diseases when they are aggravated. On the other hand, the sub-ordinate dosha manifests their respective symptoms only when they are stimulated by the primary dosha. In other words, in view of their un-manifested symptoms, subordinate dosha, do not get aggravated by the factor responsible for their aggravation as mentioned in the texts nor do they get alleviated by the therapy prescribed specially for them. They get alleviated only when the therapy prescribed for primary dosha is administered. That is to say the aggravation and alleviation of subordinate doshas are affected by the causative factors and therapies, other than their own. This is because they share the attributes of the dosha, of primary nature to some extent. For example, in the autumn season pitta is vitiated primarily and kapha secondarily due to sour vipaka of water etc. This is because sour taste is responsible for the vitiation of both. For the treatment of primary doshas, viz. pitta, ghee boiled with bitter drugs is employed; bitter taste, by nature, alleviates the subordinate dosha, viz. kapha also. Anubandhya and, anubandha are the technical terms for primary and secondary diseases respectively known to scholar adapt in the medical science.

Vimana literally means measurement, so this section gives the physical as well pathological parameters for the measurement of various entities like dosha, dhatu, agni, srotasa etc. In the present chapter method of classification of diseases is given on the basis of prognosis, severity, site of origin, cause and location. Physicians are directed to diagnose the disease as primary or secondary one on the basis of vitiated doshas and treatment given. Primary doshas manifest their respective diseases when they are aggravated. On the other hand, the sub-ordinate dosha manifests their respective symptoms only when they are stimulated by the primary dosha. In other words, in view of their un-manifested symptoms, subordinate dosha, do not get aggravated by the factor responsible for their aggravation as mentioned in the texts nor do they get alleviated by the therapy prescribed specially for them. They get alleviated only when the therapy prescribed for primary dosha is administered. That is to say the aggravation and alleviation of subordinate doshas are affected by the causative factors and therapies, other than their own. This is because they share the attributes of the dosha, of primary nature to some extent. For example, in the autumn season pitta is vitiated primarily and kapha secondarily due to sour vipaka of water etc. This is because sour taste is responsible for the vitiation of both. For the treatment of primary doshas, viz. pitta, ghee boiled with bitter drugs is employed; bitter taste, by nature, alleviates the subordinate dosha, viz. kapha also. Anubandhya and, anubandha are the technical terms for primary and secondary diseases respectively known to scholar adapt in the medical science.

After the description of the classification of diseases,  agni is described which is essential for the maintenance of the body. The term “sharireshu” indicates that agni (factors or enzymes responsible for digestion and metabolism) residing all over the body. However, in subsequent elaboration, agni residing in the gastrointestinal tract is described because this agni regulates the aggravation or abatement of all the other agnis (Chikitsa 15:39). Agnis belonging to regular or balanced category are the most beneficial for a healthy living; still agnis belonging to the sharp category are given priority in the order of description because of their importance in as much as they are capable of tolerating all types of irregularities. Balanced (sama) condition of vata, pitta, and kapha during their natural states and when they are aggravated, accompanies regular or balanced agnis. The term ‘prakriti’ (meaning natural state) has different other meaning as well. Because of these two factors and with a view to specifying the intention, Acharya has used the term “prakritisthanam” along with “vatapittashleshmana”.  In the case of an individual having the dominance of vata in his constitution, agni becomes irregular only when the sites of agnis in his body are afflicted by vata and not otherwise. Similar is the explanation for the changes in the agnis in individuals having the dominance of pitta and kapha in their constitution. The concept of prakriti is also described in the chapter in the context of disease. It is worth mentioning that the prakriti described in this chapter is in reference to disease state i.e. vikrita avastha. [1-2]

After the description of the classification of diseases,  agni is described which is essential for the maintenance of the body. The term “sharireshu” indicates that agni (factors or enzymes responsible for digestion and metabolism) residing all over the body. However, in subsequent elaboration, agni residing in the gastrointestinal tract is described because this agni regulates the aggravation or abatement of all the other agnis (Chikitsa 15:39). Agnis belonging to regular or balanced category are the most beneficial for a healthy living; still agnis belonging to the sharp category are given priority in the order of description because of their importance in as much as they are capable of tolerating all types of irregularities. Balanced (sama) condition of vata, pitta, and kapha during their natural states and when they are aggravated, accompanies regular or balanced agnis. The term ‘prakriti’ (meaning natural state) has different other meaning as well. Because of these two factors and with a view to specifying the intention, Acharya has used the term “prakritisthanam” along with “vatapittashleshmana”.  In the case of an individual having the dominance of vata in his constitution, agni becomes irregular only when the sites of agnis in his body are afflicted by vata and not otherwise. Similar is the explanation for the changes in the agnis in individuals having the dominance of pitta and kapha in their constitution. The concept of prakriti is also described in the chapter in the context of disease. It is worth mentioning that the prakriti described in this chapter is in reference to disease state i.e. vikrita avastha. [1-2]

Doshas pertaining to mind are given priority in the order of their description because they are comparatively smaller in number. [5-6]  

Doshas pertaining to mind are given priority in the order of their description because they are comparatively smaller in number. [5-6]  

Classification of various diseases on five parameters is described and then gives a generalized method for classification of disease on the basis of grief as a universal symptom. Here it is important to note that he uses the term grief instead of pain to identify the disease. The word grief (dukha) signifies both mental as well as physical trouble. Thus more emphasis is given on the fact that both the component of a disease i.e. somatic and psychic should be equally treated for successful management. Description of the causative doshas for mental diseases and their relation with physical doshas is given. In the same context the psychosomatic diseases are described. Chronic somatic diseases cause psychological diseases and chronic psychological diseases leads to somatic diseases i.e. both are intermingled and have cause and effect relationship.  

Classification of various diseases on five parameters is described and then gives a generalized method for classification of disease on the basis of grief as a universal symptom. Here it is important to note that he uses the term grief instead of pain to identify the disease. The word grief (dukha) signifies both mental as well as physical trouble. Thus more emphasis is given on the fact that both the component of a disease i.e. somatic and psychic should be equally treated for successful management. Description of the causative doshas for mental diseases and their relation with physical doshas is given. In the same context the psychosomatic diseases are described. Chronic somatic diseases cause psychological diseases and chronic psychological diseases leads to somatic diseases i.e. both are intermingled and have cause and effect relationship.  

Modern scientific research supports this age-old tenet of medical wisdom. Walter Cannon in 1920, documented the physiological changes in body as a response to stressors through hormones called catecholamines. This was further researched by Hans Selye to pioneer the field of stress research. He described the close relation between body and mind with various articles on stress affecting humans biologically. Biofeedback is found effective in treatment of various psycho-somatic disorders. Dean Ornish and his colleagues also worked upon the concept to integrate yoga, meditation for designing protocol for stress management in a medical centre.   

Modern scientific research supports this age-old tenet of medical wisdom. Walter Cannon in 1920, documented the physiological changes in body as a response to stressors through hormones called catecholamines. This was further researched by Hans Selye to pioneer the field of stress research. He described the close relation between body and mind with various articles on stress affecting humans biologically. Biofeedback is found effective in treatment of various psycho-somatic disorders. Dean Ornish and his colleagues also worked upon the concept to integrate yoga, meditation for designing protocol for stress management in a medical centre.   

The relation between agni and disease process is essential to be undertood. Impairement of agni is a cause of accumulation of various toxic products inside body leading to disease. Agni includes all processes of digestion and metabolism taking at gross level, tissue level, micro-cellular level. Hence it needs a special emphasis while treating a disease. Diagnosis of agni of a person is one of key factor in understanding disease. The following charts 1,2 and 3 shows various types of agni and its related processes in ayurvedic perspective.  

The relation between agni and disease process is essential to be undertood. Impairement of agni is a cause of accumulation of various toxic products inside body leading to disease. Agni includes all processes of digestion and metabolism taking at gross level, tissue level, micro-cellular level. Hence it needs a special emphasis while treating a disease. Diagnosis of agni of a person is one of key factor in understanding disease. The following charts 1,2 and 3 shows various types of agni and its related processes in ayurvedic perspective.  

   

   

 

==== Chart 1:  Different types of Agni1 ====

 

 

                                                        Chart 1:  Different types of Agni1  

                  

                  

Chart 2: Factors involved in agni process

==== Chart 2: Factors involved in agni process ====

   

   

 

==== Chart 3: Diagrammatic representation of importance of Agni2 ====

                              Chart 3: Diagrammatic representation of importance of Agni2

Determination of psychosomatic constitution as well as disease susceptibility of an individual in population through genetic trait is known as prakriti. Prakriti is a broad term encompasses all the three genotype, phenotype as well as endophenotype.  The concept of prakriti in Ayurveda is related to the bio-characteristic of an individual in healthy state and its vulnerability for particular diseases. According to Ayurveda, prakriti of an individual once determined at the time of fertilization remains unchanged throughout life though it is well influenced by environment. Role of environment in determination of prakriti during prenatal period is as important as postnatal period.  Reviewing the human embryology, it can be postulated that the three primitive germinal layers namely ectoderm, mesoderm and endoderm can be correlated with vatika, paittika and kaphaja trait. According to Ayurveda at the time of fertilization the doshika prakriti is determined by the doshika predominance of shukra (sperm) and shonita (ovum) that represent the fastidious genetic alignment of chromosomes in sperm and ovum and decide the genetic trait of zygote. Robust research is being conducted to study the link between prakriti and genes.[ link https://www.researchgate.net/profile/Mitali_Mukerji2/publication/51647769_Ayurgenomics_A_New_Way_of_Threading_Molecular_Variability_for_Stratified_Medicine/links/00b7d5179290650224000000.pdf?origin=publication_detail]   

Determination of psychosomatic constitution as well as disease susceptibility of an individual in population through genetic trait is known as prakriti. Prakriti is a broad term encompasses all the three genotype, phenotype as well as endophenotype.  The concept of prakriti in Ayurveda is related to the bio-characteristic of an individual in healthy state and its vulnerability for particular diseases. According to Ayurveda, prakriti of an individual once determined at the time of fertilization remains unchanged throughout life though it is well influenced by environment. Role of environment in determination of prakriti during prenatal period is as important as postnatal period.  Reviewing the human embryology, it can be postulated that the three primitive germinal layers namely ectoderm, mesoderm and endoderm can be correlated with vatika, paittika and kaphaja trait. According to Ayurveda at the time of fertilization the doshika prakriti is determined by the doshika predominance of shukra (sperm) and shonita (ovum) that represent the fastidious genetic alignment of chromosomes in sperm and ovum and decide the genetic trait of zygote. Robust research is being conducted to study the link between prakriti and genes.[ link https://www.researchgate.net/profile/Mitali_Mukerji2/publication/51647769_Ayurgenomics_A_New_Way_of_Threading_Molecular_Variability_for_Stratified_Medicine/links/00b7d5179290650224000000.pdf?origin=publication_detail]