Preamble of Kalpa Sthana
Vamana and virechana therapies should be administered before administering basti (medicated enema therapy). Therefore, vamana and virechana drugs are first described in Kalpa Sthana before the description of therapy, which is described in detail under Siddhi Sthana. Generally, purgation therapy is administered only after the administration of emetic therapy and keeping this view the first six chapters are allocated for description of emetic drugs.
Six drugs have been described for emesis and nine others are described for purgation. Six hundred recipes prepared from these drugs (Total 15 drugs) are for the use of physician of low caliber and intelligent physician can formulate many other recipes to suit the exact requirement of his patient. The formulations are prescribed according to disease in different dosage forms like kashaya (decoction), svarasa (juice), kalka (paste), churna (powder), peya (drinks), lehya (lickable), and bhojya (foods).
Kalpa Sthana Contents at a glance
| Chapter No. | Chapter Name | No. of Shlokas | Name of the drug | No. of Recipes | Part Used | Botanical identification[1] |
|---|---|---|---|---|---|---|
| 1 | Madanakalpa Adhyaya | 30 | Madanaphala | 133 | Fruit and Flower | Randia dumetorum |
| 2 | Jimutaka Kalpa Adhyaya | 15 | Jimutaka | 39 | Fruit and Flower | Luffa echinata Roxb. |
| 3 | Ikshvaku Kalpa Adhyaya | 23 | Ikshvaku | 45 | Leaf, Fruit, Seed | Lagenaria siceraria Standl. |
| 4 | Dhamargava Kalpa Adhyaya | 20 | Dhamargava | 60 | Fruit, Flower, Tender Leaves | Luffa cylindrica (Linn.) M. Roem. |
| 5 | Vatsaka Kalpa Adhyaya | 12 | Vatsaka | 18 | Fruit | Holarrhena antidysenterica Wall.(male Kutaja)and Wrightia tinctoria R.Br.(or W. tomentosa Roem. & Schult.)(female Kutaja) |
| 6 | Kritavedhana Kalpa Adhyaya | 14 | Kritavedhana | 60 | Flower, Fruit | Luffa acutangula (Linn.) |
| 7 | Shyamatrivrita Kalpa Adhyaya | 80 | Shyama, Trivrita | 110 | Root | Ipomoea petaloidea Chois. |
| 8 | Chaturangula Kalpa Adhyaya | 18 | Araghvadha | 12 | Fruit | Cassia fistula Linn. |
| 9 | Tilvaka Kalpa Adhyaya | 18 | Tilvaka | 16 | Root, Bark | Viburnum nervosum(According to Thakur Balavant Singh) |
| 10 | Sudha Kalpa Adhyaya | 22 | Sudha | 20 | Milky Latex | Euphorbia neriifolia Linn. |
| 11 | Saptalashankhini Kalpa Adhyaya | 19 | Saptala, Shankhini | 36 | Root (of Saptala), Fruit (of Shankhini) | Euphorbia dracunculoides Lam. and Colonyction muricatum G Don. |
| 12 | Dantidravanti Kalpa Adhyaya | 107 | Danti, Dravanti | 49 | Root | Baliospermum montanum Muell.-Arg. |
| Total | 378 | 600 |
Madanakalpa Adhyaya (pharmaceutical preparations)is the very first chapter of Kalpa Sthana of Charak Samhita. In all, there are twelve chapters in this section, of which the first six including Madanakalpa describe the various pharmaceutical formulations for emesis while the remaining six describe various purgative pharmaceutical preparations. Each chapter is named after a plant drug and in every chapter many compound formulations with suitable plant drugs are also given. Grossly, all twelve chapters can be divided into Vamana and Virechana Kalpa. The literal meaning of Vamana is to eliminate the doshas(impurities) from gastro-oral route whereas from lower tract- through anus it is known as purgative. Since impurities are eliminated in both the cases, hence, it is known as Virechana sanjna (evacuative)(Cha.Ka.1/4)
Salient features of Kalpa Sthana
Charak detailed the Pharmacokinetics of drugs, dosage forms and weights and measures in this section. Drugs useful for vamana and virechana are discussed with their synonyms, varieties, pharmacological actions, and various modes of application in different dosage forms.
Factors responsible for therapeutic efficacy
Four important factors for producing maximum therapeutic efficacy of these drugs are identified. Deshasampat (collecting the plant from appropriate habitat), kalasampat (collecting the drugs in the appropriate season), gunasampat (collecting the plants when they are enriched with excellent attributes like rasa, guna, virya, etc.) and bhajanasampat (storage of drugs in appropriate container).
Pharmacokinetics of Drugs
Drugs (used for emesis and purgation) which are ushna (hot), tikshna (sharp), sukshma (subtle), vyavayi (those pervading the entire body before getting digested) and vikasi (those causing looseness of joints), by virtue of their own potency, reach the heart and circulate through the vessels. Because of their agneya nature (predominance of agni mahabhuta, or fire element), they liquefy the compact form of (adhered) doshas (morbid material), and because of their sharpness (tikshna attribute) they separate the adhered doshas located in the gross and subtle channels of the entire body. Like honey kept in the pot smeared with fat, the morbid material, after separation, moves floating without adhesion in the body which has been oleated (by the administration of oleation therapy). Because of its nature to move through subtle channels and to flow (towards the gastrointestinal tract), this morbid material reaches the stomach, and gets propelled by udana vayu. Because of the predominance of agni and vayu mahabhutas in these (emetic) drugs, and because of their specific action (prabhavajanya) to move upwards, the morbid material gets expelled through the upward tract (mouth). On the other hand, purgative drugs, because of the predominance of prithvi and jala mahabhutas, and because of their specific action, (prabhavajanya) move downwards to expel the morbid material through the downward tract (anus). Combination of both these attributes result in the expulsion of the morbid material through both the upward and downward tracts.
Similarities/ Dissimilarities of virya
Sometimes, the drugs of secondary nature (mixed with main drug) have antagonistic property. Even then they do not contradict the effects of the principal drug. If these drugs of secondary nature are similar in potency as that of the principal drugs, then the recipe becomes all the more effective therapeutically. Trituration, boiling etc. are considered samskaras which bring in chemical changes in the chemical structure of the drug which results in the neutralization of the drug activity.
Modification of drug activity
Ingredients of a recipe should be impregnated with the juice or decoction of other ingredients having identical potency. By virtue of appropriate samyoga (addition of ingredients), vishlesha (elimination of ingredients), kala (appropriate time of administration) and samskara (processing) even a small quantity of a drug may produce more powerful effects, and otherwise even a recipe in large quantity may produce very mild effects.
Weight and measures
Two traditions for mana (weight and measures) are mentioned in Kalpa Sthana, namely, Kalinga (part of present Orissa) and Magadha (part of present Bihar). Charak opines that Magadha is better than former. Chakrapani considers this statement as unauthentic. It is also suggested that when weight of ingredients in a recipe is not specified, then all the ingredients are to be taken in equal quantity.
Snehapaka (Dosage form)
Charak Samhita does not specify the liquid medium to be used in formulation of the medications. However, the use of certain liquids has been known through practice and other sources. In the process of snehakalpana, for example, water has to be used invariably. Snehapaka (preparation of medicated oil or ghee) is categorized into three types i.e. mridupaka (mild boiling), madhayamapaka (moderate boiling) and kharapaka (full boiling). Sneha processed by kharapaka is indicated for massage purpose, mridupaka sneha is recommended to be used for nasya (inhalation) and moderately processed oil or ghee for internal use including for basti karma.
Purification of drugs
To reduce the toxicity (vikasi guna) of Danti and Dravanti, Charak evolved a process using Pippali and honey paste which is to be besmeared over the roots and once again to be smeared with mud and fomented with steam after drying up in sun. Chakrapani observes that heat of fire and sunrays makes the root free from adverse effects. This could be quoted as a best example of purification process employed for the removal of toxicity - a novel concept mentioned by Charak. In the medieval ages, Rasashastra texts adopted several purificatory procedures for various herbal and metallic drugs.
Sushruta's perspective of Kalpa sthana
The subject matter of Kalpasthana in Sushruta samhita is entirely different and deals with one of the Ashtangas of Ayurveda known as Damshtrachikitsa (Toxicology). Sushruta furnished the details of vamana and virechana drugs in Sutra sthana (43 and 44th chapter). Among vamana dravyas madanaphala, jimutaka pushpa, kutaja phala, ikshvaku pushpa, kritavedhana beeja and dhamargava phala are enumerated. Sushruta identified best virechaneeya drugs based on part used like, trivrit among root purgatives and amongst bark, fruits, oil, juice and latex, the drugs namely tilvaka, haritaki, erandataila (Castor oil), karavellaka and snuhi are considered as best respectively. Trivrit, danti, dravanti, tilvaka, haritaki, chaturangula, erandataila, snuhiksheera, saptala, and shankhini are enumerated under virechaneeya drugs. There is not much difference among the drugs enumerated in Charak and Sushruta, but Sushruta included triphala, erandataila under virechana drugs.
Charak suggested root bark of tilvaka while Sushruta instructed to use bark of tilvaka. A purgative recipe is suggested for children, old people, delicate and patients suffering from dhatukshaya (weight loss/wasting condition) by Sushruta which includes erandataila (Castor oil) mixed with triphala kwatha and milk or meat soup. He also suggested chaturangula for children up to age 12. It appears that Sushruta suggested easily available purgatives.[2]
Relevance of the concepts of Kalpa Sthana in the current clinical practices
Vamana karma (emesis) and virechana karma (purgation) are mandatory before performing basti karma (enema), in order to promote health (i.e., for the patient to gain mass). Keeping this in view, the details about drugs employed in vamana and virechana karma are described in this section and the details about basti karma in the subsequent section, Siddhi Sthana.
For vamana karma, Madanaphala is the main drug employed in the current clinical practice. But the rest of five drugs (i.e., Jimutaka, Ikshvaku, Dhamargava, Vatsaka, and Kritavedhana) are not being prescribed. Charak suggested the period of collection and procedure for extracting seed from the Madanaphala. These procedures are not being followed currently.
In the purgative therapy the drug Trivrita is prescribed currently in the various dosage forms and Aragwadha and Danti are infrequently prescribed. Charak suggested a procedure for extracting the pulp from the fruit of Aragwada. He also described a process to reduce vikasi guna (causes looseness of tissues) of Danti root. Both these procedures are not in vogue. Sushruta suggested Triphala (three fruits, namely Haritaki, Vibitaka, and Amalaki) and Eranda Taila (Castor oil) as purgatives and are prescribed in the current clinical practice.
Tilvaka, Saptala, Sankhini, and Dravanti are the purgative drugs suggested by Charak which are controversial and not being preferred in current practice.
The procedures described by Charak with regard to vamana and virechana karma are being followed religiously by Ayurvedic physicians of current times.
Ayurvedic classics have advocated to collect the medicinal plants according to part used and seasons in order to get desired pharmacological action and therapeutic benefits. Sushruta, Charak and other acharyas advocate the collection of various parts of medicinal plants in different seasons. The logic behind such recommendations has been validated by recent modern scientific research.
In a study the variations in the phytoconstituents of Ashwagandha root was evaluated according to lunar cycles with regard to grishma and shishira ritu (summer and late winter season). In this study, total phenolic, flavonide and carbohydrate content of Ashwagandha root were found more in poornima (full moon day) samples. GAP (Grishma Ashadha Poornima, or the full moon night occurring in the Grishma-Ashadha season) samples showed maximum differentiation from rest of the samples with regards to TCA, TCW, TFW, MEx, WEX, pH etc. parameters. The Grishma-Jyeshtha Poornima (GJP) and GAP samples were found to be superior than Amavasya (new moon day) samples with regard to functional groups and with anoloid content respectively. [3] [4] Such type of studies validate the concept of seasonal collection of drug delineated in Ayurveda classics like Charak Samhita and Sushruta Samhita.
Contemporary perspective
Modern phytochemistry suggests that Saponin containing drugs act like irritants due to their foam producing action. Through this mechanism, drugs like madana, ikshvaku, jimutaka, kritvedhana may produce emesis. Till date there is no research work carried out on biological activity of kurchine regarding emesis. Drugs containing anthroquinone derivatives tend to be good laxatives. Therefore anthraqinone containing drugs like argvadha act as good virechaka drugs. Ayurvedic classical texts atributed anti-diarrhoel activity to kutaja (Stem bark & seeds). Charak included kutaja under emetics. It may be interpreted that kutaja in emetic doses induces vomiting, while in sub-emetic or therapeutic doses controls diarrhea. According to modern pharmacology “the emetic drugs in sub-emetic doses acts as bronchodilators” indicates that alteration of the dose of the drug can produce different pharmacological actions.[5] It can be presumed that kutaja in emetic doses produces vomiting at the level of upper gastrointestinal tract, while the therapeutic dose of the drug controls diarrhea at the level of lower gastrointestinal tract. Vamanopaga drugs (synergistic drugs to vamana karma) like kovidara, karbudara, shanapushpi, pratyakpushpi possess agni and vayu mahabhuta dominance can support main vamana dravya for emetic action, while drugs like draksha, kashmariphala, parushaka, badara, kuvala, peelu, karkandhu are prithvi and ap mahabhuta dominant drugs, which can support the main virechaka drugs for inducing purgative action.
To summarize the content of Kalpa sthana of Charak samhita it appears that the information about most popular emetic and purgative drugs with various dosage forms is furnished. And more research is required to explain modus operandii of emetic and purgative drugs and their therapeutic applicability can be documented by evidence based clinical trials.
References
- ↑ Thakur Balvant Sing and Chunekar K. C., Glossary of Vegetable Drugs in Brihattrayi, Chaukhamba Amarabharati Prakashan, Varanasi, Ed. (2015)
- ↑ Sushruta samhita, Ed. By G. D. Shingal et al., Sutra Sthana 44/72-77.
- ↑ Tavhare SD, Nishteswar K, Shukla VJ. Effect of seasonal variations on the phytoconstituents of Aśvagandhā w.r. to lunar cycles. Ancient Sci Life. 2016;35((3)):150–8 available online https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850775/
- ↑ Tavhare SD, Nishteswar K, Shukla VJ. Influence of lunar cycles on growth of Ashwagandha(Withania somnifera [L.] Dunal). AYU [serial online] 2015 [cited 2019 Jan 22];36:258-64. Available from: http://www.ayujournal.org/text.asp?2015/36/3/258/182763
- ↑ Satoskar RS, Bhandarkar SD, Ainapure SS. Pharmacology and Pharmaco- therapeutics. Revised 16th edn. Popular Prakashan Private Limited. Mumbai; 1999.