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<li>Vikriti as arishta lakshana [signs of impending death] <sup>[Cha.Sa. Indriya Sthana 1/6]</sup></li></ul>
<li>Vikriti as arishta lakshana [signs of impending death] <sup>[Cha.Sa. Indriya Sthana 1/6]</sup></li></ul>
== Concept of vikriti ==
=== Vikara ===
<div style='text-align:justify;'>Vikriti is a derangement from a natural state. It is also denoted by the term ‘vaishamya’- the body's abnormal unbalanced and pathological state. The manifestation of disease in the form of signs and symptoms also comes under this purview. Vikara <sup>[Code:SAT-C.8]</sup><ref name="ref5"> </ref> is the condition that causes deviation from an individual's normal physiological state of health.<ref name="ref6">8, 9, Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012</ref> The process of occurrence of disease follows a pathway known as ‘shatkriya kala’ (six pathological stages of treatment).<ref name="ref7">Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005</ref> This involves chaya avastha [accumulation of dosha], prakopa avastha [aggravation of dosha], prasara avastha [spread of vitiated dosha to other parts], sthanasamshraya avastha [localisation of dosha to different sites], vyakta avastha[ manifestation of the disease] and bheda avastha [chronicity of the disease]. These pathological stages are progressive states of vikriti. <br/>Vikriti pariksha [examination] is done based on specific hetu (etiology), dosha, dhatu (ashraya of dosha like tissues), prakriti (individual constitution), desha (habitat), kala (time) and bala (strength) involved in the samprapti (pathogenesis) of the disease. <sup>[Cha. Sa. Vimana Sthana 8/101]</sup></div>
=== Vikriti as dhatuvaishamya ===
<div style='text-align:justify;'>The natural physiological state of dhatu is considered as dhatusamya or prakriti. The word dhatu in this context implies dosha, dhatu or mala. Any derangement from this prakriti can be pathological (dhatu vaishamya avastha) which leads to vikara. </div>
=== Vikriti as product of prakriti ===
<div style='text-align:justify;'>Vikriti is defined as the product, new entity with or without losing the innate nature of its substrata. [nyayakosha]. Any substance produced from substrata is denoted as vikriti or prakriti vikriti. Ksheera (milk) is the prakrit for ksheera vikritis like curd, butter, ghee etc. <br/>According to Sankhya and Yoga darshana, prakriti is the principle of matter responsible for the origin of world, bringing about evolution and changes in the empirical universe. Moola prakriti is considered as prakriti [avikriti, not a by-product of anything].<ref name="ref8">Ishwarkrishna, Sankhyakarika with Gaudapadabhashya, Sanskrit commentary by Guruprasadshashtri and Hindi commentary, First Edition, Chaukhamba Surbharati Prakashana, Varanasi, 2019</ref> The products which are derived from prakriti and responsible for further production are called as prakriti vikriti. In Ayurveda, the ashta prakriti constitutes one moola prakriti as prakriti and remaining seven i.e. mahat, ahankara, pancha tanmatra (Susruta samhita) or pancha mahabhuta (Charak Samhita) denoted as ‘prakriti vikriti’. Likewise the sixteen vikaras (indriyadi) derived from prakriti vikriti are considered as vikriti. Thus, vikriti is the finally derived entity in evolution of universe (srishti prakriya). </div>
=== Vikriti as arishta lakshana ===
<div style='text-align:justify;'>Arishta are the features of impending death, the deviation from natural physiological state (prakriti). Such vikriti can be lakshana nimitta (past deeds of life being the etiology for the symptoms at specific time. e.g. appearance of some bodily marks and specific signs) lakshya nimitha (described and identifiable etiological factors. e.g: features manifesting in a patient due to the specific nidana for vatadi dosha kopa) or nimittanuroopa (the manifestations in a patient which resemble the etiological factors, but in fact, they are not etiological factors in nature. They appear without any apparent cause. E.g. symptoms which indicate death as a result of diminution in life span) <sup>[Cha.Sa. Indriya Sthana1/6]</sup> <br/>All these arishta lakshana are deviation from the normalcy and without the understanding of this vikriti, the physician may lose knowledge, wealth, and success in their career.<ref name="ref9"> </ref></div>
== Assessment of vikriti (vikriti pariksha) ==
<div style='text-align:justify;'>Diagnosis and treatment in Ayurveda involves individualisation of the therapy as per the individual. This individualisation is based on the ten factors of examination of a patient (dashavidha rogi pariksha), <sup>[Cha.Sa. Vimana Sthana 8/101]</sup> which comprises of patient examination [rogi pariksha] to determine the patient strength, and disease examination [roga pariksha – vikriti pariksha] to determine the relative disease strength in the patient. Vikriti pariksha involves the examination of morbid manifestation with reference to specific hetu [cause], dosha, dushya [vitiated body elements], prakriti [constitution], desha [habitat], kala [time], bala [strength] and also examination of symptoms. The strength of the disease is examined by assessing the strength of these vikriti factors. If all these vikriti factors are having maximum strength, disease severity will also be more and vice versa. The moderate disease is one having moderate strength of the vikriti factors. Based on the strength of this disease severity, prognosis of the disease is determined. A disease having maximum vikriti bala will be of higher severity and most difficult to cure.</div>
=== Vikriti at the level of dosha, dooshya and srotas ===
<div style='text-align:justify;'>Quantitative or qualitative variation of dosha, dushya or srotas is considered under vikriti lakshana. This variation is termed as vriddhi (excess), kshaya (diminution), dushti and prakopa (variation in the quality). Internal medications and specific treatment procedures are explained to correct vikriti. If vata dosha vikriti has occurred, specific treatment procedures called vata upakramas and medications like taila are used to correct that impairment. If there is variation from prakriti of srotas (specific channels of the body) specific therapeutic managements are explained. E.g. Vitiation of rasavaha srotas (channels of transportation and transformation of rasa dhatu) is treated with depleting therapies like langhana upakrama etc. Vikriti at level of dosha, dushya and srotas leads to vikara like atisthaulya (obesity) and ati karshya (emaciation) which effects samhanana (compactness of the body). Besides, undesirable body variations (ashta nindita) with variation in height, body hair, complexion are explained in Ayurveda. </div>
=== Vikriti at the level of kala (time/season), artha (objects) and karma (actions) ===
<div style='text-align:justify;'>Variations in the characteristics of kala (season), artha (object of sense organ) and karma (actions) comes under this aspect. Visual exposure towards bright light, dim light and improper light exposure can be considered as vikriti factors at the level of darshanendriya (sense of visual perception). Similarly vikriti can also be understood at other indriya levels like that of ears, nose, tongue and skin.<ref name="ref10"> </ref></div>
== Importance of knowledge of vikriti ==
=== In management of disease ===
<div style='text-align:justify;'>The derangement of a healthy state is identified as vikriti. Using the vikriti pariksha, the extent of deviation from healthy state can be determined. The choice of drug and decision of treatment depends on the extent of vikriti. For a balavan rogi (strong patient), the line of treatment for prabhuta doshabala (severely aggravated disease) is shodhana (purificatory measures), madhyama bala dosha is pachana and alpa bala vyadhi is upavasa (restraining from food and drinks).<sup>[Cha.Sa. Sutra Sthana 22/19-24]</sup> </div>
=== Prognosis of disease ===
<div style='text-align:justify;'>By calculating the strength of the vikriti, the strength of disease can be calculated. If vikriti factors are strong enough, then the disease's severity is higher, and it has a poor prognosis. [Cha.Sa. Vimana Sthana 8/101] Contemporary medical sciences use several prognosis tools to determine the patients prognosis like TNM classification for cancer staging and prognosis, Glasgow Coma Scale for comatose patients, Child pugh score for the determination of the liver disease severity. These tools can be utilized to assess vikriti.<br/>By examining the vikriti stage in context to arishta lakshana, the patient's remaining life span can be assessed, which is to be ascertained for before starting a patients treatment. </div>
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