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Pankaj dissertation - final

  1. 1.  Concept of Nidana and its Assessment in Kitibha Kushta1INTRODUCTIONOne of the fundamental truths of the Ayurvedic philosophy isproclaimed in the classical idea of loka-purusha samya. This very importantconcept teaches that the universe (loka) and the individual human being(purusha) are under the same laws and in fact exist on a continuum whichreaches from the realm of the universal to that of the smallest form of creation.The individual living being, whether it is a man or an ant, is a miniature replicaof the universe. This concept is beautifully and succinctly captured in thefamous sutra "as above, so below". It is important to reflect on the fullimplications of this universal truth and to realize that the microcosm (man) andmacrocosm (universe) are in a never-ending interaction with each other. Thisinteraction operates under the law of samanya-vishesa or like-increases-like.The constantly changing conditions both in Nature and in the individual createa dynamic harmony between the two--a state which we recognize as health.When there is more deviation that can be tolerated between the individual andNature (the universe) that harmony is lost and a disease state can arise. Nidanabeing the foremost and definite cause for the manifestation of disease need togive utmost importance. The knowledge of nidana is useful in five differentways; (1) for maintaining the health of a healthy individual. (2) Diagnosis ofthe disease. (3) for differential diagnosis. (4) Prognosis of the disease. (5) fortreatment of the disease. So, nidana is prerequisite for chikitsa. References ofnidana have been scattered in Ayurvedic texts. So, here an attempt has beenmade to systematically compile the literature on nidana.Human beings have been modifying and altering their environment,sometimes resulting in air, water and soil pollution. In addition, problemscreated worldwide by the population explosion, urban migration, overcrowdedsettlements, literacy, poverty, starvation, deforestation, etc., have all resulted inconditions deleterious to human health.
  2. 2.  Concept of Nidana and its Assessment in Kitibha Kushta2Skin is a barrier protecting the underlying tissue from physical, chemicaland biological toxic agents. It helps in the maintenance of body temperature. Itexcretes some of the wastes of body metabolism, besides having its own activecellular activity. In this process it is exposed to and influenced by bothendogenous and exogenous factors. It is the interaction of the skin withexternal influences such as the climate, physical, chemical and biologicalagents, which determines the manifestation of various skin diseases.Skin disorders constitute one of the largest groups of health problems ingeneral practice and hospital reporting patients. Over the years, the number ofpatients opting for Ayurvedic treatment has also increased dramatically due toadverse less and permanent curative methods.The pattern of skin diseases seen in most parts of India is a consequenceof an underdeveloped economy, illiteracy, and social backwardness. More than50% of a general hospital’s skin out-patient attendance consists of infectionswhich are acute and usually recurrent-scabies, pyodermas, pediculosis,parasitic and viral infections-and have been classified as diseases of a pooreconomy. The role of poverty, overcrowding, under nutrition and consequentpoor immunity are emphasized by these diseases. Fungal infections, leprosyand skin tuberculosis constitute chronic infections which are also influenced toa great extent by socioeconomic factors.Ayurvedic Literature has provided substantial information regarding thediagnosis and management of skin disorders. The term “Kushta” mentioned inAyurvedic Literature represents variety of skin manifestations ranging from acomplex leprosy to a simple eczema.According to samhitas the factors which influence the production of skindisease were diet and habits of the individual, for which he is habituated for a
  3. 3.  Concept of Nidana and its Assessment in Kitibha Kushta3long time. Intolerance to food is mentioned as one of the important cause forvarious skin manifestations in the contemporary medicine also. A study isrequired to observe the role of different causative factors for skin disorderswith respect to food habits and Personal hygiene. It is essential to studyweather the Diet and Personal Habits of the individual influence the causationas explained in samhitas.Since it is highly difficult to observe and interpret all skin diseasesmentioned in our science in a short period of time only one skin diseases whichis most commonly reported at our Hospital i.e. Kitibha Kushta was selected forthis observational study.
  4. 4.  Concept of Nidana and its Assessment in Kitibha Kushta4OBJECTIVES To review and systematically compile the literature on nidana. To review and systematically compile the literature on nidana of Kushta. To observe and analyze the etiological factors of Kitibha Kushta To study and understand the etiological factors of Psoriasis fromAyurvedic perspective.
  5. 5.  Concept of Nidana and its Assessment in Kitibha Kushta5HISTORICAL REVIEW OF NIDANA A) Veda kalaRogotpadaka karanas are shareeragata mala roopavisha, krimi, vata, pitta andkapha given in Atharva veda 11/1/22.B) MahabharataSheeta, Ushna, and Vayu are the cause for shareerika vyadhis is found inShantiparva 16thadhyaya.C) Samhita kalaA. Brihat Trayee1. Charaka Samhita: Acharya Charaka has explained nidana in sutra sthana1st, 11th, 25th, and 28thchapter. In nidana sthana 1stchapter and inshareera sthana1st& 2ndchapter and in Vimana sthana 6thchapter.2. Sushruta Samhita: Acharya Sushruta has explained nidana insutrasthana 3rdchapter, explained it as an ‘upaya’ and karaka hetu.3. Asthanga Hrudaya: Acharya Vagbhata has explained nidana insutrasrhana 1stchapter and also under nidanapanchaka in nidanasthana1stchapter.b. Laghu Trayee1. Madhava Nidana explained in 1stchapter about nidana.2. Bhavaprakasha: Bhavamishra mentioned and described nidana inRogaprateekara prakarana the 7thchapter of poorvakhanda.c. Other classical texts1. Ashtanga Sangraha: Acharya Vagbhata described nidana in sutrasthana1st, 22ndchapter and under nidana panchaka in nidana sthana 1stchapter.
  6. 6.  Concept of Nidana and its Assessment in Kitibha Kushta62. Yogaratnakara: Has explained that kupita malas are the nidana for allthe diseases. Kupitamala here means vata, pitta and kapha.3. Gadanigraha: Gadanigrahakara explained nidana under rogagnanasadhana in jwaradhikara.d. Recent Ayurvedic literature1. Nidanachikitsa hastamalaka: Vd Ranajit Rai Desai explained nidanaunder nidana panchaka.2. Doctrines of pathology in Ayurveda: Dr K.R.Srikantha Murthydescribed nidana in 9thchapter3. Ayurveda Vikriti Vignaan: Vd Vidyadhar shukla explained nidana in20thchapter under nidana panchaka.DerivationNi + Da + karne dhatu + Lyut Pratyaya (SKD)i.e to produce or to causeIt is the primary cause, the first or essential factor. (V.S.Apte)1DefinitionsThe word nidana used in two different contexts i.e. etiological factors anddiagnosis of diseases1.Etiological factors:1. Word nidana relates to etiology (vyadhi janakam) 2.2. Nidana is the causative factor of disease and its aim is to producedisease.33. The one which explains about hetu as well as lakshana is called asnidana.44. Nidana refers to karaka hetvah i.e. causative factors and lakshana refersto jnayapak hetavah i.e.diagnosis of disease.55. Bahya nimiita i.e. external factors are called as nidana.6
  7. 7.  Concept of Nidana and its Assessment in Kitibha Kushta76. The causative (etiological) factors are the efficient cause (NimittaKarana) of disease.77. A Particular factor can be called as nidana only when it will develop acomplete disease process (iti kartavyata) in the body either immediatelyor after a certain period.8Diagnosis of diseases :1. Nidana helps to know about etiology, symptomatology andpathogenesis.92. Which gives complete knowledge about the vyadhi is called as nidana.93. Nidana means arriving at a definite diagnosis of a disease.94. Nidana means arriving at a conclusive diagnosis of a disease afterconsidering and correlating several factors like etiology,symptamatology, pathology and investigations.105. Roga should be examined by nidana (etiology), pragrupa (prodermalsymptoms), lakshana (symtomatology), upshaya (trialand errortherapeutics), apti (pathogenesis).116. One which produces pain is called as roga. This can be examined bynidana, poorvarupa, rupa, upshaya and samprapti.127. The word nidana in respect to diagnosis includes nidana, poorvarupa,rupa, upashaya and samprapti.138. Five means of diagnosis (nidana panchaka) helps for the diagnosis ofdisease.14
  8. 8.  Concept of Nidana and its Assessment in Kitibha Kushta8SynonymsTable No.1 Synonyms of Nidana as per Ayurvedic CS AS AH MN BP Ckp1 Hetu      2 Nimitta      3 Aayatana      4 Karta   - - - 5 Karana      6 Pratyaya      7 Samutthana   - - - 8 Utthana -  - - - -9 Nidana  - - -  10 Yoni -  - - - 11 Mukha - - - - - 12 Mula -  - -  13 Karaka -  - - - -14 Prerana - - - - - 15 Prakruthi - - - - - 16 Nibandha - - - -  -1. Nimitta – the factor which initiates the disease process2. Hetu – etiology3. Ayatana – path of disease4. Pratyaya – cause which shows relation to the effect5. Utthana & Samutthana – stimulation of dormant or inactive doshas,making them active & vitiated6. Karana – cause7. Kartha & karaka – the creator of disease8. Moola – root of disease9. Yoni – site of origin or creation of disease
  9. 9.  Concept of Nidana and its Assessment in Kitibha Kushta910. Prerana – which excels the disease11. Prakruthi – which determines the nature of disease12. Nibandha – which has close association with vyadhiTypes15:According to Madhukosha tika, the nidana are broadly classifiedaccording to their role in causation of a disease.1. Asatmendriyartha Samyoga, Prajnaparadha and Parinama.2. Sannikrishta, Viprakrushta, Vyabhichari and Pradhanika3. Dosha hetu, Vyadhi hetu, Ubhaya hetu.4. Bahya and Abhyantara5. Utapadaka and Vyanjaka6. Dosha gati: a) Prakruth, Vaikruth; b) Vridhi, Kshaya and Sama7. Ashayapkarsha8. a) Anubandha b) Anubandhya1. a) Asatmendriyartha Samyoga b) Prajnaparadha c) Parinama.The universe and the individual being interact through the eternally shiftinginterplay of three factors which exist in both realm and form a bridge betweenloka and purusha. These three factors are: Buddhi (intellect) Indriyartha (sense objects) Kala (natural rhythms)The healthy state of all three of these factors is called samayoga(balanced). However buddhi, indriyartha, and kala can also become imbalancedas atiyoga (excessive), ayoga (deficient), or mithyayoga (distorted). Thesedeviations of buddhi, indriyartha, and kala from their normal balanced stateare considered in Ayurveda to be the fundamental cause of disease. It is thesedisharmonies which lead to the vitiation of the doshas, accumulation of ama,
  10. 10.  Concept of Nidana and its Assessment in Kitibha Kushta10weakening of agni, and the entire cascade of the Kriyakala. We give specificnames to each of these fundamental causes of disease.a) Asatmyendriyartha samyogab) Prajnaparadhac) ParinamaAcharya Charaka has given importance to each of the nidana at differentplaces in sutra, nidana and sharira sthana of Charaka Samhita.1. The causes of diseases relating to both (mind and body) are three foldi.e. ayoga, mithya yoga and ati yoga of Kala, budhhi and indriyartha.162. Trividh Ayatanani are ayoga, mithya yoga and ati yoga of artha, buddhiand kala.173. Asatmendriyartha Samyoga, Prajnaparadha and Parinama are thecausative factors of diseases.184. “Causes of miseries” (dukha hetavah). These are impairment of dhi,dhriti and smriti; advent of the maturity of the results of time and action(Samprapti kala karmanam) and Asatmendriyartha samyoga are causesof dukha.19Ashtanga Sangraha and Hridaya opines the same i.e. “hina, mithya andatiyoga of kala, artha and karma are the chief cause of diseases; whereas theirsamyak yoga is the chief cause for health.20a) Asatmendriyartha Samyoga :Introduction: The human sense organs, viz. shrotra, chakshu, sparsha, rasaand ghrana, being the organs of hearing, vision, tactile sensation, taste andsmell respectively, keep regular contact with outside world so as to perceivesensation relating to arthas or vishayas like shabda, sparsha, roopa, rasa andgandha. This contact is expected to be conducive to the maintenance ofswasthya. Such a contact or yoga is called as Samyak yoga. When the contact
  11. 11.  Concept of Nidana and its Assessment in Kitibha Kushta11is not proper in the above sense it is called as Asatmendriyartha samyoga orincompatible correlation of the senses with their objects. There are three typesof improper yoga: (1) hina yoga (2) Mithya yoga (3) Ati yoga i.e. defective,perverted and excessive contacts. Mere existence of indriyas and vishayaswithout any mutual contact does not result in sukha and dukha. Samyak yoga orproper contact is responsible for sukha while the asamyak yoga is responsiblefor dukha or vyadhi. Hina yoga or ayoga means negligible contact or no contactat all; mithya yoga means contacts of indriyas with vikrita or unnatural vishyas,means excessive contact. Charaka has elaborately described these three typesof abnormalities in relation to all the five indriyas.Derivation : Asatmya’ word is derived by adding two upasarga A+SA toAtma shabda then the word Asatmya is formed. A+sa+atma = asatmya. A thingwhich is not conducive to the body is regarded as Asatmya or unwholesome.Indriya- derived from ‘Ida’ dhatu and ‘gha’ pratyaya meaning it is the ruler ofthe body. Prana is termed as Indra and its linga is indriya. So, that which givessensory knowledge is called indriya. Vishaya or knowledge attained through aparticular indriya is called artha and samyoga is derived from adding Sama(upasarga) + yuj (dhatu) + gha (pratyaya). Samyogam means combination oftwo or more dravyas. (SKD)Definition: Excessive utilization, wrong utilization and non utilization ofindriyas is called as asatmendriyartha samyoga.The objects of sense faculties is of five types and further subdivided intothree, so totally fifteen varieties of unwholesome conjunction of sense organobserved and it is the root cause for the manifestation of diseases. Dependingupon the indriya, its indriyartha and its hina, ati or mithya yoga theasatmendriyartha samyoga is classified as follows21:
  12. 12.  Concept of Nidana and its Assessment in Kitibha Kushta121. Shrotendriya : (Sense organs of hearing)a) Hina yoga : The hearing capacity of human shrotendriya is restricted toa certain range of the frequency of sound. When a person try to hear asound of very low frequency like a manda swara, a whispering sound ora feeble sound coming from a distance, it causes strain to shrotendriya.It is called as hina yoga of Shrotendriya.b) Mithya yoga: Listening to unpleasant sounds or hearing of harsh words,news about the death of friends, assaulting, insulting and terrifyingsounds constitutes the mithya yoga of Shrotendriya.c) Ati yoga: Excessive utilization of Shrotendriya would be to hearunauspicious noise coming out of thunder and kettle drum, loud cries,etc.2. Sparshanenriya: (Sense organ of tactile sensation)a) Atiyoga: Excessive exposure to cold, hot, bath, massage etc. leading toexcessive utilization of tactile sense objects.b) Mithyayoga: Perverted use of bath, cold and hot substances withoutfollowing the prescribed order. For example taking cold bath followedby hot bath, touching of uneven surface, injury, dirty objects, contactwith evil spirits constitutes wrong utilization of tactile sense objects.c) Hina yoga : Not at all using tactile sense objects is non utilization i.e.hinayogaImportance of Sparshanenriya: The sense of touch alone pervades all thesenses which is firmly associated inherently with mind and mind pervades thetactile objects along with other sense organs. So the condition of all the senseorgans produced by the over all tactile sensation. So the unfavourable reactionof all the senses caused by all the pervasive sense of touch is known as theunwholesome conjuction (sensory stress). This unwholesome conjuction may
  13. 13.  Concept of Nidana and its Assessment in Kitibha Kushta13be in the form of non-utilization (ayoga), excessive utilization (ati yoga) andwrong utilization (mithya yoga) of the objects of senses.3. Chakshurendriya :a) Atiyoga: Excessive gazing at the highly luminous objects wouldconstitute excessive utilization of chakshurendriya.b) Mithyayoga: To see the things too close or too far away or things thatare awful of terrifying or are surprising, contemptuous, frightful,deformed and alarming would constitute wrong utilization ofchakshurendriya.c) Hina yoga: Not looking anything at all would constitute non utilizationof chakshurendriya.4. Rasanendriya :a) Atiyoga : Excessive intake of various substances having various tasteswould amount to excessive utilization of rasanendriya.b) Mithyayoga : Among Ashta vidh ahara visheshyatana except rashi willconstitute mithya yoga of rasnendriya. As regard to mithya yoga relatingto rasanendriya, rashi can be either ati matra or hina matra, but there isno question of its mithya yoga.c) Ayoga : Not to use it at all amount to non utilization of rasanendriya5. Ghranendriya :a) Atiyoga : Smell of exceedingly sharp, acute and intoxicating odoursconstitute excessive utilization of ghranendriyab) Mithyayoga: The smell of exceedingly putrid, unpleasant, dirty,putrefied and cadaverous odour is wrong utilization of ghranendriya.c) Ayoga: Not to use ghranendriya at all is known as its non utilization.Above explanation can be tabulated as:
  14. 14.  Concept of Nidana and its Assessment in Kitibha Kushta14Table No.2 Asatmendriyartha Samyoga of Gnanendriya.IndriyaIndriyaArthamAtiyoga Ayoga MithyayogaKarna Shravanam AtiShravanamAshravanam Uccha,parusha,bhishanadishravanamTwak Sparshanam AtiSparshanamAsparshanam Abhighata,visha,vaatadisparshanamChakshu Darshanam AtiDarshanamAdarshanam Sookshma,atidoora,bhaswadarshanamNasa Ghranam AtiGhranamAghranam Putya,medhyati,teekshna,ugra,ghranamJihwa Rasanam AtiRasanamArasanam Apathy,vishama,arasagrahanamPRAJNAPARADHAIntroductionPrajnaparadha literally means a "blasphemy, or mistake, of theintellect". Improper use of the intellect which results in a wrong understandingof some kind is an example of prajnaparadha. Another form of this diseasefactor is a volitional transgression against what an individual knows to becorrect and true. Whether volitional or non-volitional, prajnaparadha leads tofallacious information, wrong conclusions, and hazardous actions. It is one ofthe important hetu among trividha hetu. Every creation in the world consists ofa combination of these three gunas. Satva represents the qualities of gnana(knowledge) and joy or happiness; raja manifests the qualities like lust, anger,action and sorrow. Tama is a guna quite contradictory to satva, evincingqualities like absence of knowledge (ajnana) and confusion (moha). Theintellect or buddhi also possess the qualities of satva guna to the maximumextent and they will enable the intellect to realize the truth and interpret theknowledge properly. This balanced state of the intellect brought about by satvaguna is called as “sama buddhi”. When the qualities of raja and tama mark the
  15. 15.  Concept of Nidana and its Assessment in Kitibha Kushta15intellect, various types of defect begin to appear and person indulges himself inunauspicious and unlawful activities and is termed as pragnyaparadh.DerivationIt is derived from jna (mulashabda) – jnayate iti shabda, ‘pra’ upasrga, jnayateiti artha i.e, prajna and its aparadha forming prajnaparadha. (SKD)Prajna – To know/ understand.Aparadha – An offence (V.S.Apte)Definition : The ashubha karma brought about by kaya, vacha and manas inthe disturbed state of dhi, dhriti and smriti is said or defined as prajnaparadha.22Dhi Vibhramsha: If something is eternal is viewed as ephermal and somethingharmful, as useful and vice versa, this is indicative of the impairment ofintellect (Buddhi). For, the intellect normally views things as they are.Dhrti Vibhramsha: A mind indulging in worldly enjoyments can not berestrained from harmful objects due to the impairment of dhriti. It is dhritiwhich can restrain the mind from its harmful objects.Smriti Vibhramsha: If smriti is impaired due to a person being overcome byrajas and tamas, this is known as the impairment of smriti. Normally smriticontains everything memorable.The ayoga, atiyoga and mithya yoga of Karma (Prajnaparadha)The over action of speech, mind and body constitute their atiyoga, an all roundinaction constitute their hina yoga. The mithya yoga of body are suppression ofnatural urges, their artificial manifestation, falling from height, excessiveitching, excessive massage, excessive holding of breath and exposing onself toexcessive torture. Mithya yoga of speech are back biting, lying, uselessquarrels, unpleasant utterance, irrelevant unfavourable talks and harsh speech.
  16. 16.  Concept of Nidana and its Assessment in Kitibha Kushta16Mithya yoga of mind are fear, anxiety, anger, greed, confusion, vanity, envyand misconceptions.In brief, any action relating to speech, mind and body which is not includedeither in the categories of atiyoga or ayoga, and which is harmful for the healthin the present life and which is against the religious prescriptions comes underthe category of mithyayoga of speech, mind and body.Charaka in “Na vegan Dharneya” adhyaya says one desirous of well beingduring his life time (Eha loka) and after (Par loka), should suppress thefollowing urges23.Manasik vegas to be withhold:Lobha (greed), Shoka (grief), Bhaya (fear), Krodha (anger), Maan (vanity),Lajja (shamelessness), Ati raga (too much attachment).Vachik vegas to be withhold:Parusha vachana (harsh speech), Suchaka (back biting), Anrita (lying), Akalavakya (use of untimely words).Sharirik vegas to be withhold:Par peedaya (harming others), Anyatha kamam (unlawful sex), Asteya(stealing), Himsa (causing violence).Vagbhata has explained the same under the heading of Dash vidh papakarma.24Manu smriti 6thchapter has opined the same and called it as “DashakamDharma Lakshanam”
  17. 17.  Concept of Nidana and its Assessment in Kitibha Kushta17Prajnaparadha as the nidana for karmaj vyadhi :Charaka chaturanana while commenting on Charaka Shareera 1stchapter saysthat, ailments arises out of results of past actions included underPragnyapradha.Again under the heading of Janpado dhwamsiye, Lord Atreya says “Sins of thepresent life or the misdeeds of past life are at the root cause of the vitiation ofvayavadi factors. Prajnaapradha constitutes the origin of both types of papakarma either eha laukika or par loukika.In Unmada nidana, Lord Atreya says “The wiseman should not blame the God,ancestors or rakshasas for diseases caused by his own misdeeds due toPrajnaparadha. One should hold himself responsible for his happiness andmiseries.33Surprisingly, Robins Text Book of Pathology says “For theArcadians (2500 B.C), if some one became ill, it was the patients own fault (forhaving sinned) or the making of outside agents, such as bad smells, cold, evilspirits, or gods”.PARINAMAIntroductionParinama in general means avastha or parivartana brought by theinfluence of kala. Acharya Charaka had used the word ‘kala’ for parinama.Since ati, hina and mithya yoga of kala brings dosha vitiation in the shareeraand causes vyadhi. Ayurveda treats those factor as an important vyadhi hetu. Itsimportance lies in the fact that the effect of two etiological factors cited abovecan be avoided by improving our physiological and psychological approaches;but the effect of time is bound to occur and its unavoidable (Nishpratikriya).Kala (parinama) is defined as "being out of harmony with the rhythms andcycles of Nature". Ayurveda recognizes several important cycles on themacroscopic scale which have corresponding effects on the human being. If an
  18. 18.  Concept of Nidana and its Assessment in Kitibha Kushta18individual does not become aware of these cycles and modify his lifeaccordingly, that discordance will lead to a disease state.DerivationIt is derived from ‘pari’ upasarga, ‘nama’ shabda and ‘ghama’ pratyaya.Meaning of which is transformation. (SKD)Kala : Ka + Aa+ La = Kala; it is derived from kala shabda lee dhatu.DefinitionAcharya Sushruta defines kala as that which does not stay even for thefraction of second and is gatisheela is called kala.25TypesKala or time connates two meanings, viz. the year and the state of thedisease in the patient. Depending upon the necessity, year is variously dividedinto two, three, twelve and even more. Six division of the year are envisaged.Hemanta, grishma and varsha these are the three seasons characterized by coldweather, hot weather and rains respectively. Flanked by them are the threeother seasons, viz pravrut, sharad and vasanthaha which are of moderatenature.26Another connotation of the term kala or time is the state of the patientwhich determines the initiation of timely actions and prohibition of untimelyones. For example, in a particular condition or the state of the patient onemedicine may not be useful. It is the time which determines the manifestationof the desired effects of a drug administered.
  19. 19.  Concept of Nidana and its Assessment in Kitibha Kushta19Kala divisionChart No. 1 - Division of Kala                     KalaSamvatsara 1. Visarga 2. Adana Trividha Shadvidha Dvadashavidha 1. Sheeta2. Ushna 3. Varsha 1. Sishira 2. Vasanthaa 3. Grishma 4. Varsha 5. Sharad 6. Hemanta 1. Magha 2. Phalguna 3. Chaitra 4. Vaishakha 5. Jyesta 6. Aashada 7. Shravana 8. Bhadrapada 9. Ashwaija 10. Kartika 11. Margasirsha 12. Pushya Dvividha
  20. 20.  Concept of Nidana and its Assessment in Kitibha Kushta20Atiyoga, ayoga and mithya yoga of kala :If a particular season manifests itself excessively, this should beregarded as Atiyoga of kala; if the season manifests itself in lesser measure, itwould be hina yoga of kala. If on other hand, characteristics of a season arecontrary to the normal ones, this would be regarded as mithya yoga of kala (forexample rainfall in winter, cold in summer season etc.).Chakrapani in Tisreshniya adhyaya says, kala refers to sheeta, ushna, varsha.Table No.3 Relation between Ritu and KalaRitu KalaHemant, Shishira SheetaVasanthah, Greeshma UshnaVarsha, Sharad VarshaKala leads to the production of vyadhi in accordance of ritu, vaya, ahani andahara by doing respective dosha prakopa of doshas.Charaka in Kiyantha Shirasiye adhyaya explains how kala leads to doshaprakopa:Vagbhata opines the same as like that of Charaka in Ayushkamiye Adhyaya.Table No.4 Dosha Sanchaya and Prakopa as per RituDosha Sanchaya Prakopa PrashmanVata Greeshma Varsha SharadPitta Varsha Sharad HemantKapha Hemant Vasanthah Greeshma2. Sannikrishta, Viprakrushta, Vyabhichari, PradhanikaSannikrishta:Definition: The closest cause of vyadhi is called as Sannikrishta hetu, likevatadi. The immediate causative factor of the disease is called as sannikrishtahetu. Such hetus are responsible for immediate aggravation of doshas. Stages
  21. 21.  Concept of Nidana and its Assessment in Kitibha Kushta21of digestion, seasonal variation of doshas or vihara, and all these factors causeimmediate aggravation of doshas. For example at middle of the day pittaprakopa and in the morning kapha prakopa. The peculiar thing is that for theoccurrence of this type of aggravation the first stage of accumulation is notrequired. It is because the chaya and prakopa stages remain already prepared inthe body and sannikrishta hetus or precipitating causes produce immediateaggravation of dosha. Hence these causes produce two types of effects. One isthat they become responsible for creation of actual disease symptamatology;the second is that they produce aggravation of the symptoms of the alreadyexisting disease. For example, a cloudy atmosphere will precipitate the attackof tamaka shwasa in a susceptible person and increase the severity of theattack.27Viprakrushta:Definition: The distant cause of the vyadhi is called as Viprakrushta hetu, likeRudra kopa etc.This type of cause does not produce a disease immediately but their cumulativeor delayed effects produce diseases after a certain period. For example, kaphaaccumulated in hemantha ritu produces diseases in vasanthaha ritu. Rudrakopais a viprakrishta nidana of jwara.Arundatta used the word “aasana” for sannikrishta and quoted the followingexamples.Roganaam aasanam: vitiated vatadi doshasViprakrushta: Chaya prakopa of vatadi doshas as per ritus.Vyabhichari:Definition: It means behavior which deviates from the normal practice is calledas Vyabhichari hetu.
  22. 22.  Concept of Nidana and its Assessment in Kitibha Kushta22Normally, the contact with hetu should produce disease in a body. But inthis case, either the vitiation of dosha is such that it fails to produce disease orthe peculiarities of the dosha and dushya are such that their sammurchana cannot occur.Pradhanik:Definition: These are fulminating or very strong hetus like different poisons,toxins etc. When such etiological factors come in contact with the body, theyproduce disease very quickly.3. Dosha hetu, Vyadhi hetu and Ubhaya hetu:Dosha hetu:Definition: The factors responsible for vitiation of dosha are called as doshahetu.For example, Tikta, katu, kashaya does Vata ; Katu, amla, Lavana rasa doesPitta prakopa ; Madhura, Amla rasa Lavana does Kapha prakopaTable No.5 Relation between Rasa and DoshaRasa Dosha PrakopaTikta, katu, kashaya VataKatu, amla, Lavana PittaMadhura, Amla, Lavana KaphaGeneral features of vitiated “Doshas”:Doshas when gets aggravated manifests their signs and symptoms inaccordance with the degree of aggravation; those in the state of diminution giveup their normal signs and symptoms; and those in a state of equilibrium operateproperly. In fact, this is the only way to evaluate the different physiological andpathological state of the Doshas. Hence, above verse reveals the basic principlein this regard.
  23. 23.  Concept of Nidana and its Assessment in Kitibha Kushta23Vyadhi hetu:Definition:1. Manifestation of discomfort to the body is called as vyadhi.282. Group of lakshanas is called as vyadhi29.3. Dukha is called as Vikara or vyadhi30.So, Vyadhi hetu means those specific etiological factors responsible forthe particular diseases, irrespective of dosha. For example, mud eating isspecific factor favourable to pandu roga. It is true that mud also vitiates doshathat in turn produces pandu. In this way mud having kashaya rasa producesvataj pandu; that of madhura rasa produces kaphaja pandu etc.but ultimately mud creates the same disease and that is pandu only. Hence it isa specific cause.Ubhaya hetu:Definition: The term “ubhaya” means combined factors. It implies thatthese factors are responsible for the vitiation of particular dosha and at thesame time they act as specific etiological causes for particular diseases, on the animals like camel or elephant vitiates vata, vidahi anna vitiatespitta and rakta and all these combined factors produces vatarakta.314. Bahaya and Abhyantara hetu:AbhyantaraBahya: External factors like food, behavior, seasons, poisons etc. are called asbahya hetus or external factors.Abhyantara: Vitiated doshas are called as intrinsic factors or Abhyantara hetus.Really speaking doshas can not be treated as intrinsic factors. Jalpakalpataru,the commentary of Charaka samhita says “The causative factors of vitiation ofdoshas are hetus there is no doubt about it. But that is not the case with theactually vitiated doshas. They are the part and parcel of the disease pathology.
  24. 24.  Concept of Nidana and its Assessment in Kitibha Kushta24Once we remove vitiation the disease also disappears. The relationship ofdosha with disease is one of uninity or indivisibility (Samvayi). Hence doshascan not be treated as hetus. Thus whenever doshas are called as etiologicalfactors, we mean the factors responsible for vitiation of doshas, in an indirectsense”.5. Utapadaka and Vyanjaka hetu:UtapadakaUtapadaka: Vitiated doshas are the fundamental cause of the diseases. Henceutpadaka hetu means the real causative factors of the accumulation of doshas,because unless there is an excessive accumulation (chaya) the precipitatingcause will not produce any effect. For example, the intake of food substanceshaving madhura rasa and guru and snigdha gunas in hemantha ritu is the factorreally responsible for kaphaja diseases.Vyanjaka: It acts as a triggering factor. For example accumulated doshas inhemantha ritu gets aggravated in vasanthaha ritu.6. Dosha Gati :Urdhva, Adhoga and Triyak gati of doshas:In urdhva gati the doshas travel or progress upwards, as in the chardi, kasa etc.While in adho gati the doshas travel in the downward direction as in atisara,pravahika, adhoga rakta pitta etc. An important point to be noted that in Urdhvaand adho gatis doshas mostly remain in their koshtas and comes out throughthe natural outlets like mukha, guda etc. In triyak gati doshas travel fromkoshta towards shakhas, i.e. instead of remaining in koshta they come in directcontact with different dhatus and get themselves embedded in them.Koshtha-Shakaha-marmasthisandhi gati: During normal physiologicalconditions doshas travel from shakhas to the koshtha and return to shakhas
  25. 25.  Concept of Nidana and its Assessment in Kitibha Kushta25again, this being their normal movement between koshtha and shakha. Evenduring the advancement of pathological conditions takes place during thetransit of vitiated doshas from koshtha to shakha, i.e. shakha gati. While thebody recovering from this condition either by treatment or due to the naturaltendency of the body doshas are brought to samyavastha (equilibrium) and thisis done by bringing them back to the koshtha and eliminating them through theupper or lower orifices. This is koshtha gati. As marma, asthi and sandhi areincluded in the passage of doshas into them can only be called shakha gati.Charaka has explained the causes and effects of the transit of doshas fromshakha to koshtha and vice-versa. He says that knowledge of these paths anddirections of doshas helps in the prevention of diseases and their cure also.Movement of doshas from koshta to shakha- marmasthisandhi - : Followingfactors takes doshas from koshtha to shakha- marmasthisandhi with the help ofvata.1. Vyayamat2. Ushna ahara3. Teekshna ahara4. Ahita acharna5. Increased activity of vata (drutatvat)Effects of the transit of doshas from koshtha to shakha:Vitiated doshas have always tendency to produce the disease. Whenother factors like climate, body resistance etc. are favourable under suchconditions, they result in disease immediately. But when the conditions are notfavourable they remain dormant in shakhas, waiting for the favourableconditions. The period between the entry of doshas into shakha and the diseaseformation also depends on the quantity and strength of vitiated doshas.
  26. 26.  Concept of Nidana and its Assessment in Kitibha Kushta26Movement of doshas from shakha to koshta: Following factors takes doshasfrom shakha to Koshtha with the help of vata.1. Vridhayat : dosha vridhi2. Abhishyandyat : lubrication of srotas3. Paakat : Dasha paaka4. Srotomukha vishodhanat : cleansing the opening of srotas5. Vayush cha nigrahat : bringing vayu back to koshtaKoshtha-Shakaha-marmasthisandhi gati produce diseases in three differenttracts are called as vyadhi margas. They are Koshtha marga, Shakahamarga andmarmasthisandhi marga. As a particular dosha gati is responsible for aparticular vyadhi marga, in pathological conditions dosha gati can beconsidered as the cause and vyadhimarga as its effect. Charaka has described agroup of diseases related to each vyadhi marga.32Table No.6 Roga margaShakha Marmasthisandhi KoshthaGalganda Pakshavadha JwaraPidika Aptanaka AtisaraAlaji Shosha VamanaApachi Ardita AlasakaCharmakeela Rajyakshama VisuchikaAdhi mamsa Asthi shoola KasaMashak Sandhi shoola ShwasaKushta Guda bhramsha HikkaVyanga Shiro roga AnahaShotha Hridaya roga Udara rogaGulma Basti roga Pleeha vikaraArsha VisarpaVidradhi ShothaVisarpa GulmaArshasVidradhi
  27. 27.  Concept of Nidana and its Assessment in Kitibha Kushta27Vriddhi-sthana-kshaya gati of doshas33:Decrease of doshas, their normal state and their increase constitute this type ofdosha gati. There causes have been described earlier.Prakruth and Vaikruth34:PrakruthPrakruth: Prakruth means vitiation of dosha as per ritu i.e by its swabhava i.evitiation of kapha in vasanthah ritu, pitta in sharad ritu, vata in greeshma ritu.Vaikruth: Contrary to above said, if dosha vitiation occurs irrespective of itsswabhava then it will be called as vaikruth.7. Ashayapkarsha35:This peculiar type of dosha gati has been explained by Madhukosha.Sometimes a resultant effect of the conditions of the three doshas, i.e. a state ofequilibrium, decrease or increase, shows a peculiar type of symptomatology.The nature of treatment is also peculiar. Therefore this phenomenon deservesspecial consideration. This phenomenon occurs in the following manner. :Kapha and pitta dosha decreases from the normal and vata increases.Suppose kapha dosha is in equilibrium and pitta is reduced, then the increasedvata will drag out kapha dosha which is in equilibrium and push it towards thesite of pitta, producing the symptoms of kapha prakopa.In this context one may raise the question why the symptoms of kaphaprakopa appear when there is state of equilibrium. The explanation given byMadhukosha is as follows: Kapha moves from its original area to that of otherdosha and this quantity of kapha dosha is added to the quantity of its alreadypresent pitta at that place. The line of treatment adopted in this case haspeculiarity. Even though the symptoms are those of kapha prakopa, the
  28. 28.  Concept of Nidana and its Assessment in Kitibha Kushta28treatments are those given for vitiated vata dosha. It is because vata dosha isthe factor responsible for this pathologic development. In short, the treatmentfor Ashyapkarsha is nothing but the treatment for vata dosha, irrespective ofthe symptoms which are of kapha or pitta.8. Anubandhya and Anubandha36:Anubandhya means the one which pradhana (dominating). Anubandhameans the one which apradhana (non dominating). In visarpa chikitsa, AcharyaCharaka has explained that the one in which dosha is independent, lakshna areclearly manifested, vitiated from its own karanas and which can be treated fromits own chikitsa is called as anubandhya.Opposite to this is apradhana oranubandha.Madhukosha comments on this and says, the utility of suchclassification helps in the treatment of vyadhis where dosha samsarga is seen.If there is vitiation of vata and pitta, then pradhana dosha should be treatedfirst, because by subsiding the pradhana dosha the apradhana dosha willsubside itself .Some other classification of nidana:1. Shukra shonit doshaja (Defect in sperm and ovum) : AcharyaSushruta has kept this nidana under Adibala pravrut vyadhi (Hereditaryanomalies) i.e those which are caused due to defect in the sperm or theovum, such as kushta, arshas etc.; even these defects may be transmittedin two ways-maternal or paternal in origin2. Sankramik nidana (Contagious causes) : Sushruta He says that certaindiseases spread from a patient to other people by the latters repeatedcontact with contaminated objects or with the skin or other organs of thebody of the person such as mouth, sex organs etc. They may also spread
  29. 29.  Concept of Nidana and its Assessment in Kitibha Kushta29through respiration, contaminated food, cloths, flowers etc. Examples ofsuch disease are kushta, jwara, shosha, netra abhishyanda.Importance of Nidana:1. Chikitsa :Avoidance of the causative factors is of prime importance in theprevention as well as the cure of diseases. Pro-phylective treatment is based onthis point only. It is usually said that “prevention is better than cure”. Whiletreating diseases the highest importance should be given to avoidance of causesresponsible for the vitiation of doshas because it will be helpful in breaking thesamprapti of disease. All these things will become possible only if there is aperfect knowledge about the etiological factors i.e. Nidana.2. Vyadhi karana:Hetu is karana for vyadhi. So by knowing the hetu involved the vyadhi Karanaand its severity is known.3. Vyadhi vinischaya:If there is any doubt regarding the diagnosis of a disease, observation of theetiological factors leads to the confirmation of vyadhi.4. Sadhya asadhyata:Hetu is very helpful to decide the sadhyasadhyata of a vyadhi. Alpa hetu causesalpa Lakshana in a vyadhi and its sukhasaadhya lakshana.5. Upashaya anupashaya:Upashaya is opposite to hetu and anupashaya is similar to hetu.
  30. 30.  Concept of Nidana and its Assessment in Kitibha Kushta30MODERN REVIEWEtiology or CauseHetu word is synonymous to etiology in modern medical literature.DerivationAitia - a charge, accusation, causeLogos (logy) – word of speech, treatise, discourseAitia + logos = the doctrine of causes,So the word meaning of etiology can be derived asThe discourse about the cause of a diseaseDefinition:The study of causes specifically the cause of disease.37orThe science dealing with causes of diseaseIn modern terms there are two major classes of etiological factors.1. Intrinsic or genetic2. Acquired (infectious, chemical, nutritional, physical)Knowledge or discovery of the primary cause remains the backbone on whichthe diagnosis can be made, a disease understood or a treatment adopted.The four aspects of a disease process that forms the core of pathology are.1) Etiology- cause2) Pathogenesis- the mechanism of its development.3) Morphology- the structural alterations/changes induced in cells andorgans of the body.4) Symptoms/Clinical manifestations-the functional consequences ofmorphologic changes.38In Ayurveda a disease is studied under 5 stages (Nidana panchaka) andin modern it is studied in 4 stages. In both these medical systems etiology/nidana is the first and foremost factor which denotes the cause / causativefactor of a disease.
  31. 31.  Concept of Nidana and its Assessment in Kitibha Kushta31Review on KushtaTwak ShareeraIntroduction:Among all the bodily organs skin is more easily inspected and morefrequently exposed to infection, disease or injury than any other structure.Because of its visibility, skin reflects our emotions and also features ofphysiology or pathology. Changes in skin Colour may indicate homeostaticimbalances in the body. Many interrelated factors affect both the appearanceand health of the skin, including nutrition, hygiene, circulation, age, immunity,genetic traits, psychological state, and drugs. So important is the skin to one’simage that people spend much time and money to restore skin to a more normalor youthful appearance.Ayurvedic review:In Ayurveda the word “twacha or ‘charma’ is used for describing theskin. Twacha is derived from “Twach-Samvarne” Dhatu meaning ‘the coveringof the body’.Charka described Twacha as the Matruja Bhava (Maternal factor) whichis one of the six Bhavas essential in the development of fetusVagbhata described the formation of Twacha as due to Paka of RaktaDhatu by its Dhatvagni in the fetus. After Paka, it dries up to form Twacha, justlike the deposition of cream over the surface of boiled milk. .Layers of the skinRegarding the number of layers of skin there is difference of opinionbetween the Acharyasa) Charaka described six layers of skin but while elaborating these layershe has explained only two layers and the rest of the four layers weredescribed as terms of the diseases.
  32. 32.  Concept of Nidana and its Assessment in Kitibha Kushta32Table No.7 Layers of Skin according to Charaka39No Layer Name1 Prathama It is Udakadhara, which is consider as Bahya-Twak2 Dvitiya It is Asrigdhara3 Tritiya It is Sidhma, Kilas Sambhavadhishthana4 Chaturtha It is Dadru, Kushta Sambhavadhishthana5 Panchami It is Alaji, Vidradhi Sambhavadhishthana6 Shashthi If this layer is injured then the individual trembles andfeels as if entering in darknessb) Sushruta has described seven layers of skin. He has also mentioned thethickness of each layer along with the diseases which occur in that layer.Table No.8 Seven layers of skin according to Sushruta40No Name Thickness Disease1. Avabhasini 1/18 of Vreehi (0.05 to 0.06 mm) Sidhma, Padmakantaka2. Lohita 1/16 of Vreehi (0.06 to 0.07 mm) Tilakalaka, Nyachchha,Vyanga3. Shweta 1/12 of Vreehi(0.08 to 0.09 mm) Charmadala, Mashaka,Ajagallika4. Tamra 1/8 of Vreehi(0.12 to 0.15 mm) Kilasa, Kushta5. Vedini 1/5 of Vreehi(0.2 to 0.3 mm) Kushta, Visarpa6. Rohini 1 Vreehi(1 to 1.1 mm) Granthi, Arbuda, Apachi,Shleepada, Galaganda7. Mamsadhara 2 Vreehi(2 to 2.1 mm) Bhagandara, Vidradhi,Arsha c) Vagbhata has described seven layers of skin similar to Sushruta. He hasnot given any description. Commentator Arunadatta and Hemadri alsonamed them according to Sushruta’s method.d) Sharangadhara has also mentioned seven layers of skin along with theprobable onset of diseases. The names of first six layers are same asSushruta but the seventh layer is named as “Sthula” which is the site ofVidradhi.
  33. 33.  Concept of Nidana and its Assessment in Kitibha Kushta33Modern review41:Skin is one of the largest organs of the body in surface area and weight.In adults, the skin covers an area of about 2 square meters and weighs 4.5 to 5kg. It ranges in thickness from 0.5 to 4.0 mm, depending on location.Layers of skin:(A) EpidermisThe epidermis is composed of stratified squamous epithelium andcontains four principal types of cells: (i) Keratinocytes (ii) Melanocytes (iii)Langerhans cell (iv) Marked cell.The names of the five layers, from the deepest to the most superficial are asfollows:1) Stratum basal or germinativum:It forms the lowest layer and consists of single row of columnar cellsand is capable of continued cells division. As these cells multiply, they push uptowards the surface and become part of the upper layers. The stratum basal alsocontains tactile (Merkel) discs that are sensitive to touch.2) Stratum spinosum or Malpighi layer:This prickle – cell layers lies upon the basal layer and has 8 to 10 rowsof polyhedral cells that fit close together. This layer involves most of thepathological conditions of the skin.3) Stratum granulosum:It consists of about three to five rows of flattened cells that developdarkly staining granules of a substance called Keratohyalin. Keratin forms abarrier that protects deeper layers from injury and microbial invasion andmakes the skin waterproof.4) Stratum Lucidum:Normally, only the thick skin of the palms and soles has this layer. Itconsists of three to five rows of clear, flat, dead cells that contain droplets of an
  34. 34.  Concept of Nidana and its Assessment in Kitibha Kushta34intermediate substance that is formed from keratohyalin and is eventuallytransformed to Keratin.5) Stratum Corneum:This layer consists of 25 to 30 rows of flat, dead cells completely filledwith keratin. These cells are continuously shed and replaced by cells fromdeeper strata. The stratum Corneum serves as an effective barrier against lightand heat waves, bacteria, and many chemicals.(B) DermisThe dermis chiefly consists of white fibrous tissue, elastic fibers andnon-stripped muscles and contains blood vessels, nerves, hair, sweat gland andsebaceous glands and nerve corpuscles. The outer portion of the dermis, aboutone fifth of the thickness of the total layer, is named the papillary region. Thedeeper portion of the dermis is called the reticular region. It consists of denseirregular connective tissue containing interlacing bundles of collagen andcoarse elastic fibers. KeratinizationIn the process of Keratinization, cells newly formed in the basal layersundergo a developmental process as they are pushed to the surface. As the cellsrelocate, they accumulate keratin.Pigmentation of the skinThree pigments melanin, carotene and hemoglobin – give skin a widevariety of colors. Melanin is located mostly in the epidermis; carotene is mostlyin the stratum Corneum and dermis; and hemoglobin is in red blood cellswithin capillaries in the dermis.Blood supply of skinThere are two horizontal and parallel systems of plexuses, which supplythe skin. The plexus or network of blood vessels exists between the dermis andthe subcutaneous tissue. Its exact position can never be accurately described.
  35. 35.  Concept of Nidana and its Assessment in Kitibha Kushta35Each arteriole supplies and area of skin and each various plexus associated withit drains the same area.Nerve supplyThe varied sensations arising from skin are derived from a diversepopulation of cutaneous nerve endings or receptors, thus tactile, temperatureand pain sensations are each sub served by different groups of receptors.Functions of the skin:The skin is a metabolically active organ with vital functions includingthe protection and homeostatic of the body.[a] Regulation of body temperatureSkin does the evaporation of sweat and convent the high temperatureinto lower elevated body temperatures or to the normal. Changes in the flow ofblood to the skin also help the regulation of body temperature.[b] ProtectionThe skin is considered under the Integumentory system. It provides aphysical barrier that protects the underlying tissues from physical abrasion,bacterial invasion, and dehydration and UV radiation.[c] SensationThe skin contains abundant nerve endings and receptor that detectstimuli related to temperatures, touch, pressures and pain.[d] ImmunitySweat of the epidermal cells is important components of the skinimmune system, which tends off foreign invaders.[e] ExcretionSweat is the vehicle for loss of a small quantity of ions and severalorganic compounds along with removal of heat and some part of water.
  36. 36.  Concept of Nidana and its Assessment in Kitibha Kushta36[f] Blood reservoir  The dermis is a house of extensive networks of blood vessels that carry8 – 10% of the total blood flow in a resting adult. In moderate exercise thisflow increase, which helps to dissipate the heat from the body. While duringthe exercise skin’s blood vessels constrict so this allows more blood to circulatethrough contracting muscles.
  37. 37.  Concept of Nidana and its Assessment in Kitibha Kushta37HISTORICAL REVIEW OF KUSHTAVEDIC PERIOD:Vedas are considered as the oldest and first available literature of the world.There are four Vedas i.e. Rigveda, Yajurveda, Atharvaveda and Samveda.Ayurveda is considered to be the Upaveda of Atharvaveda. The history ofIndian medicine start with Veda, so the history of ’Kushta Roga’ begins formVedas.Rigveda:In Rigveda there is no complete description about the ‘Kushta Roga’. But somedescription indicates that Kushta was prevalent during that period also. The Charmaroga of Apala was cured by Lord Indra. Ghosa was suffering form ‘Kushta Roga’. She was disliked by herhusband because of her ugly looks due to Kushta Roga. Byadministration of proper medication she got cured & ultimately acceptedby her husband.Yajurveda:Shukla Yajurveda mentions various medicines having Kushta nashakaproperties.Atharvaveda:In Atharvaveda, the various sites for diseases have been described and amongstthem skin has been described as one of the chief sites of the diseases. Thenames of various diseases have been illustrated, whereby Kushta has beendescribed as Kshetriya Roga. There is description of some herbs like Rama,Nili, Asuri, Shyama etc. for the treatment of Kushta.PURANA KALAMahabharata: It has been mentioned that the person suffering from‘Twakadosha’ is not fit to be a king. This reference highlights the fact that at
  38. 38.  Concept of Nidana and its Assessment in Kitibha Kushta38that time people suffering from ‘Kushta’ were looked down by the society.Agnipurana, Kushtaghna preparations are mentioned under the heading of“Nana Rogahara Aushadhani”.SAMHITA KALACharaka Samhita:Charaka described it in detail first time, a long range of skin diseases with theiretiology, pathogenesis & specific classification under the heading of Kushta.Charaka has described 18 types of Kushta. Seven types of Kushta have beendescribed as a Mahakushta in detail in Nidana Sthana. In the Chikitsa Sthanaeighteen types of Kushta have been classified under 7 Mahakushta & 11Kshudrakushta. Apart from the description of Kushta in NI. - 5 & Chi. -7, thereare some other references which are related to Kushta, some of them are asfollows:a) Kushta is described as the Samanya Hetu of Nija Shotha.b) Kushta is considered as a Santarpanjanya Vyadhi.c) It is included as one of the disease caused by Rakta.d) Use of Stambhana Dravyas in the initial stage of Raktapitta, Raktarsha& Amatisara leads to Kushta.e) Kushta is noted in Lekhan Yogya & Prachhana Yogya Vyadhi.f) Agnikarma is contraindicated in Kushtaja Vrana.Sushruta Samhita:Aacharya Sushruta first time clearly described the Anuvansika(Hereditary) & Krimija (Infectious) Nidana as a causative factor of Kushta.Kushta has also been included in list of Auopasargika Roga, which may spreadfrom one person to the other. Sushruta has also explained the Dhatugatatva orUttarotar Dhatu Pravesha of Kushta Roga. The numbers of Kushta described bySushruta are the same as that of Charaka but Dadru has been mentioned underMahakushta & Sidhma under Kshudrakushta. There are also some differences
  39. 39.  Concept of Nidana and its Assessment in Kitibha Kushta39of names. Sushruta has described Chikitsa of Kushta in two chapters i.e.Kushta Chikitsa and MahaKushta Chikitsa. Guggulu, Shilajita, Shveta Bakuchietc. Rasayana drugs are mentioned in its Chikitsa.Ashtanga Hridaya:Vagbhata has followed Sushruta regarding classification of Mahakushta& Kshudra kushta (A.H.Ni. 14/6, 20-30). But Ekakushta has been mentionedunder Kshudra kushta with same Lakshanas as described by Charaka(A.H.NI.14/19, 28).Bhela Samhita:Bhela Samhita has described Kushta Roga in both Nidana & ChikitsaSthana. Specially indicated, polluted water as a etiological factor of Kushta.Kashyapa Samhita:Kashyapa Samhita has described 18 types of Kushta as Charaka, exceptthat Shvitra, Vishaja Kushta & Sthulruksha instead of CharmKushta, Alasaka& Visphotaka.Kashyapa has given the classification of Kushta on the basis ofits Sadhya & Asadhyata. Thereby 9 Kushta are described as Sadhya while other9 are Asadhya.SANGRAHA KALAMadhava Nidana:Madhava has described Nidana Panchaka of Kushta according to theCharaka & Vagbhata. While Dhatugatatva, Sadhya-Asadhyata & Sankramakata(contagious) have been described according to Sushruta.Sharngdhara Samhita:Classification of Kushta has been described in Purvakhanda. Accordingto Sharngdhara, Tamra which is the fourth layer of the skin is the site of alltypes of Kushta (Sh.Pu. 5/19-22).
  40. 40.  Concept of Nidana and its Assessment in Kitibha Kushta40Vangasena:Vangasena has mentioned 7 types of special causes of Kushta that isTila, Taila, Kulattha, Valmika, Linga Roga, Mahisha Dugdha, and MathitaDadhi & Vruntaka.Vasavarajiyam:Some other types of Kushta are described like Prasuti Kushta, GalatKushta etc.Bhava Prakasha:Bhava Prakasha has described a detail description of Kushta Roga. Hehas followed Charaka for classification & nomenclature of Kushta. TheDhatugatatva & Sadhya-Asadhyata are compiled from Sushruta.Yoga Ratnakara:Yoga Ratnakara describes the Kushta according to the earlier classics.Contagious aspect of Kushta is also described in this chapter.Chikitsa Chandrodaya:Rajeshwar Dutta Shashtri has tried to correlate the different skindisorder with different types of Kushta. Photographs of patients are also givento make the book more practical.NiruktiIn Sanskrit language, the word ‘Kushta’ means that ‘to destroy’, ‘toscarp out’ or ‘to deform’. By adding to it the Pratyaya ‘Kta’ which stands forfirmness or certainty, the word Kushta is derived. Thus the word Kushta meansthat which destroys with certainty.In the term Kushta, the word “kush” is added to “hani” to form Kusta,which gives a meaning as ‘an ugly look’ to the body.
  41. 41.  Concept of Nidana and its Assessment in Kitibha Kushta41“KUSHNAATI ROGAM”. “KUSH + HANI KUSHEETI ITIKTHAN”42(SKD)“Kushta”- the word is derived from the root “kush” which means thatwhich comes out from the inner part.The word “Kushta” is derived from dhatu “kush”. In this mainly Rakthais vitiated and drawn towards the region of Twak to cause Kushta.Paribhasha1. According to Arunadatta Kushta is defined as that which causesdisfigurement to the body.2. Todaramalla says it causes contempt.3. According to Siddhanta Kaumudi, the condition in which different bodyorgans, Dhatus, Upadhatu are destroyed is known as Kushta.4. In Shabda Kalpadruma it has been described as the disease which causedespise or contemptible.5. In Halayudha Kosha it is mentioned that - Vitiated Rakta leads todestruction of body and hence called as Kushta’.6. Commentator Arunadatta mentions Kushta as one which causes vitiationas well as discoloration of the skin.7. Acharya Charaka and Sushruta noted saptha dravya Sangraha i.e.Tridosha, Twacha, Rakta, Mamsa and Lasika which makes the skinKutsita (deformed). If it is neglected then normal condition of wholebody may be affected so it is called as Kushta.Paryaya of KushtaThe Paryaya of the word Kushta can be broadly divided into two groups.1. Meaning as a disease2. Clinical presentation of Kushta
  42. 42.  Concept of Nidana and its Assessment in Kitibha Kushta421) Meaning as a DiseaseVyadi, Aamaya, Gada, Gadaahvam, Gadavayam, Gadakayam.2) Clinical presentation of Kushta Aapyam – which consists of water Utpalam – means to burst open Jaranam – Delayed or decomposed Rujaa – Which gives pain Raaman – which shines with colour Padmaka – which resembles lotus flower i.e, having red colour Kauverim – This disease was attached to Kubera Kutsitam – Contemptible Basuram – To appear with shining or distinguished by Nirujam – Without pain. CLASSIFICATION OF KUSHTA:The word Kushta is a broad term, which covers almost all the skindiseases. Kushta is produced invariably by the vitiation of the seven factors i.e.3 Doshas and 4 Dushyas. But different types of pain, colour, shape, specificmanifestation etc. are found in Kushta because of Anshanshakalpana of theDoshas. Accordingly Charaka Kushtas are in fact of innumerable types, but forsystemic study they are classified into two major groups 7 Maha Kushta & 11Kshudra Kushta. There is no difference of opinion between any Acharya aboutthe total number of Kushta, but difference of opinion in symptoms & names ofsome of Kushta exists. Chakrapani has clarified that in Kshudrakushta, thesymptoms of Mahakushta are manifested in milder form.
  43. 43.  Concept of Nidana and its Assessment in Kitibha Kushta43Table No.9 The difference between MahaKushta and Kshudrakushta areas followsNo. MahaKushta KshudraKustha1. Bahu Bahul Dosa Arambahta Alpa Dosa Arambhata2. Bahulakshana Alpalakshana3. Excessive discomfort Less discomfort4. Penetrates into deeper Dhatus Less tendency to penetratein deeper Dhatu5. Mahat Cikitsa Alpa Cikitsa6. Chronic Less Chronic7. Loss of skin functions like Supti. Less functional skindeformities.Table No.10. Classification of Maha Kushta according to various authors S.No Kushta Cha Su A.Hr M.N B.P B.S Y.R1 Kapala2 Audumbara3 Mandala -4 Aruna - - - - - -5 Rishyajiwha6 Dadru - - - - -7 Kakanaka8 Sidhma - -9 Pundreeka   
  44. 44.  Concept of Nidana and its Assessment in Kitibha Kushta44Table No.11 Classification of kshudra Kushta according to various authors S.No Kushta C.S Su.S A.H M.N B.P B.S Y.R1 Eka Kushta2 Charmadala - -3 Kitibha4 Dadru -5 Alasaka - -6 Vipadika -7 Charmadala -8 Visphotaka - -9 Paama10 Sataaru11 Vicharchika12 Sthularushka13 Maha Kushta - - - - -14 Visarpa - - - - - -15 Parisarpa - - - - - -16 Sidhma - - - -17 Rakasaa - - - - - -18 Kacchu - - - - -19 Switra - - - - -20 Vishaja - - - - -21 Gajacharma - - - - -KITIBHA KUSHTANirukti and ParibashaThe term kitibha is constituted by the combination of “Kiti” and “Bha”.The word kiti refers to a variety of insects which is black in colour and stays inKesha Pradesha or in hair.
  45. 45.  Concept of Nidana and its Assessment in Kitibha Kushta45This Kiti is also called “Akuna” by Hemadri the commentator ofVagbhata. This indicates that it is either a lice or some other insect which issimilar to lice.The term “Bha” refers to the resemblance or similarity. So the termKitibha which is constituted by suffixing Bha to Kiti suggests something whichresemblance of a lice.The similarity that is mentioned is only in colour (Krishnavath) and notin shape or size.So the definition of Kitibha is “A pathological skin condition where thecolour of skin is black like Kiti”Sushruta has also given one more meaning to Kitibha; it is a Upadravaof the bit of poisonous varieties of insects.According to William, M.M (1970) Kitibha is a bug, a louse. Review of Kitibha KushtaThe description of Kitibha Kushta is found in the context of Kushta inBrihatrayis and Laghutrayis. Symptomatology of Kitibha Kushta described inthe classics has lot of variations causing skepticism among the disciplesfollowing the Ayurvedic principles.Rigveda has the earliest documentation of Kushta. There is a descriptionavailable that “kakshavathi’s” daughter “Gosha” was inflicted by Kushta andwas discarded by her husband because of Kushta. Ashwini Kumaras treatedand cured her disease which mad her to regain her marital status. In the othercontext Vaivarnatha and Romasatana are mentioned as Lakshanas of Kushta.The daughter of Atri-Apala was another victim of Kusta with the above saidLakshanas and was treated and cured from the disease by Indra.
  46. 46.  Concept of Nidana and its Assessment in Kitibha Kushta46According to Charaka Kitibha Kushta is a variety Kshudra Kushta43.Madhavakara reproduced the description of Kitibha Kushta as available inCharaka. He has also accepted it as a variety of Kshudra Kushta.Chakrapani, and Gangadhara, also described Kitibha Kushta inAyurveda Deepika and Jalpa Kalpa Taru respectively. Dalhanacharya andGayadasa have also described Kitibha Kushta.In Hemadri’s “Ayurveda Rasayana” description on Kitibha Kushta isavailable.Recent authors in their works have correlated Kitibha Kushta topsoriasis which is a Keratinization skin disorder Lakshana of Kitibha Kushta:The lakshana of Kitibbha kushta explained by Acharyas has variationsAccording to Charaka44:1. Shyava : Bluish black discolouration of the skin2. Kina sparsha : Rudha vrana sthana, surface of the lesion is roughresembling healed wound3. khara sparsha : Lesions are rough or coarse to touch4. Parusha : Dry lesions (Ch.Ch.7/22)The similar description is available in Bhava Prakasaha, Madhavanidana and Yoga Ratnakara. As per Astanga Hridaya has incorporated somemore lakshanas45:1. Kandu : Itching2. Ashitam : Shayava varna (A.H.Ni 14/20)Acharya Sushruta added few more lakshanas461. Sravi : Exudating2. Vritam : Round or coined shaped lesions3. Ghanam : Well defined borders
  47. 47.  Concept of Nidana and its Assessment in Kitibha Kushta474. Snigdham : Sticky, unctuous5. Krishnasm : Black (S.Ni 5/13-14)In Bhela Samhita following lakshanas explained:1. Drudham : well defined or firm2. Punah prasravanti : oozing3. Roodhanvi tam cha : Separation of lesions4. Vardhate cha samutpannam : The lesions extend after manifestation(B.S.Chi 6/25)Kashyap Samhita says1. Aruna : Reddish brown2. Vriddhimanti : Spreading in nature3. Guruni : Lesions are large4. Prashantani cha punarutpadyante : Subsides and relapses (K.S.Kusthachikitsa)Nidana of kushta47Specific nidana of kusthaare not described in Ayurvedic classics, askitibha is one among the different types of kushta, the samanya nidanadescribed in the context of kustha holds good for kitibha also. The nidanamentioned for the causation of kushta can be broadly classified and studiedunder the following five headings.1. Aharajanya2. Viharjanya3. Daivaapcharaja4. Chikitsa sambandhi5. Sankramika
  48. 48.  Concept of Nidana and its Assessment in Kitibha Kushta48Table No.12 Aharajanya Nidana of KushtaS.No Nidana C.S Su.S A.H B.S H.S Y.R1 Virudhahara2 Ajeerna, Adhyasana - -3 Matsya (chilchima) withdugdha- -4 Dugdhati sevana - -5 Amlati sevana - - -6 Guru ahara - - -7 Gramya udaka with anupamamsa sevana- - - -8 Dadhi sevana - - -9 Sneha - - -10 Lakucha and kakmachi - - -11 Matsya with payasa - - -12 Ahitashana - - - - - -13 Drava snigdha ahara - - -14 Uddalka, kusumba - - - -15 Navanna Yavaka kullatha - - - -16 Lavana, Hayanaka, Atasi - - - -17 Mollaka - - - -18 Satata madhu sevana - - - -19 Chilmila with milk - - - -20 Madyaamla with milk - - - - -21 Guda milk - - - - -22 Matsya, Nimba with milk - - - - -23 Mamsa with madhu - -24 Papodaka - - - - -25 Pipali, Harit shaka withvidagdha ahara sevana- - - - -26 Guda with moolaka - - - - -27 Haviprasha - - -
  49. 49.  Concept of Nidana and its Assessment in Kitibha Kushta49Table No.13. Viharajanya nidana of KushtaS.No Nidana Ch.S Su.S Vag B.S Ha.S Y.R1 Chardinigrahana - -2 Vegavrodha - -3 Sheetambu snanaafter atapa sevana- -4 Diva swapna - -5 Mithya vihara - - - - -6 Vyayam atisantapabhuktopsevana- -7 Shrama bhayartanamsheetambusevanam- - -8 Ratri jagrana - - - - -9 Ajeerneapi vyayama - - - -10 Sneha pitasyavantasys vavyayamam- - - - -11 Vyavaya after vidahiahara sevana- - - - -12 Gramya dharmasevana- - - - -Table No.14. Daivapacharajanya nidanas mentioned by different acharyascan be summarized as follows.S.No Nidana Cha Su Vag B.S Ha.S Y.R1 Papa karma - -2 Vipram gurumgarshyatam- -3 Purvakrut karma - -4 Gohatya - - - - -5 Use of money ormaterial acquiredthrough theft- - - -6 Sadhu ninda, apmanand vadha-- --
  50. 50.  Concept of Nidana and its Assessment in Kitibha Kushta50The exact role of some of the nidanas mentioned above such as papakarma, gohatya etc. in the causation of kushta are difficult to analyze. Howeverthese can be taken as vyadhi hetu or vishesha hetu of kushta.1. Viruddha ahara48:Charaka has mentioned “all the food articles, which dislodge the variousdoshas do not expel them out of the body, are to be regarded as unwholesome”.Further he has said “Articles of diet that are inimical to the body-elements tendto disagree with the system (body).49” Viruddhahara is one potent causativefactor for several diseases. Consumption of Viruddhahara gives rise to variousdisturbances of mild to violent nature and disease of acute to chronic natureincluding the eight Maharogas. This point towards the potency and lethal effectof Viruddha Ahara.Types of viruddhahara : Acharya Charaka has stated eighteen types ofViruddha i.e. Desha, Kala, Agni, Matra, Satmya, Vatadi, Paka, Samskara,virya, Samyoga, Kostha, Avastha, Krama, Parihara, Upacara, Hridaya,Sampada and Vidhi viruddha50. DESHA VIRUDDHA (CLIMATE INCOMPATIBILITY)Desha:There are two types of Desha i.e. Bhumi desha (place), Atura desha(Patient). Here, regarding this subject, Bhumi desha is important. AcharyaVagbhata classified desha into three parts. I.e. Jangala, Anupa and Sadharana.In Jangala, Vata and Pitta dosha are predominant, while Vata and KaphaDoshas are predominant in Anupadesha. Sadharanadesha has average qualitiesof both the above mentioned Desha.51. But, Astangasangraha has moreemphasized the Desha. He has described types of desha according to SadaRasotpati, viz. In short, the dominancy of dosa and rasa is as follows:1. Anupa desha have Kapha, pitta dosa and Madhura rasa dominancy2. Jangala desha have vata pitta and Katu rasa dominancy
  51. 51.  Concept of Nidana and its Assessment in Kitibha Kushta513. Sadharana desha have average qualities.It is further divided ini) Anupa Sadharana - Lavana + Amla Rasa dominancyii) Jangala Sadharana - Tikta + Kasaya Rasa dominancyDesha Viruddha :The use of Dry (Ruksa) and Acute (Tiksana) and other food substancesof similar qualities in an arid region (Jangala desha) and the use of unctuousand cold and other food substances of similar qualities in a wet region (AnupaDesha) are examples of incompatibility of diet with reference to clime - DeshaViruddha52. Further according to Astangasamgarha, types of Desha andregarding Rasa dominancy, the diet incompatibility of desha may be as under.Table No.15 Types of Desha, Rasa dominancy& diet incompatibilityS.No DeshaDosadominancyRasadominancyIncompatibility1 Anupa Kapha Madhura Madhura andother Kaphaaggravated foodsubstances2 Jangala Vata pitta Katu Katu and otherVata aggravatedfood substances3 JangalaSadharanaTikta +KasayaVata Tikta + Kasayaand otherVata aggravatedfoodsubstances4 AnupaSadharanaLavana +AmlaKapha Lavana + Amlaand otherKaphaaggravated foodsubstances
  52. 52.  Concept of Nidana and its Assessment in Kitibha Kushta52 KALA VIRUDDHAThe use of cold, dry and similar things in winter and the use of pungent,hot and similar things in summer season are called incompatibility of diet withreference to season is Kala Viruddha.Ritu and Virudhha ahara53: (Ch. Su. 6/23)1. Hemant Ritu and Viruddhahara: In this season Snigdhta (moisture) andMadhura rasa increase naturally. Therefore Kapha is going to accumulate in thebody. So one should omit Madhura rasa and Snigdha food substances, but herethe Jatharagni also becomes very strong. So if such Jatharagni does not getsufficient amount of fuel (food substances), then it consumes the body - fluidsand thus the Vata possessed of cold qualities, get provoked in this season. Soone should take the food substances, which are heavy (both as regards measureand quality), unctuous, amla and salt like juices of the flesh, fatty animals Ifone person who don’t take this type of diet regimen, then it is calledViruddhahara as per the hemanta kala.2. Shishira and Viruddhahara : Shishira (dewy season) is similar to Hemant(winter) in nature, therefore the whole regimen prescribed in the hemantaseason as well, viruddha diet regimen are also same in Hemant season. Charakahas stated that one should avoid those foods substances which are pungent,bitter, astringent in taste and provocative of vata. These all substances areViruddhahara in Shishira Ritu. In Shishira Tikta Rasa and Ruksa Gunasubstances are mostly Viruddha than others.3. Vasantha and Viruddhahara: Kasaya rasa and Ruksa guna became moredominant in the Spring season (Vasantha). So intake of this type of foodsubstance is Viruddhahara. Charaka has also stated that one should avoidheavy, amla, unctuous and sweet food substances, as these are Viruddhahara invasantha. 4. Grishma and Viruddhahara: In this season Katu rasa and Ruksa
  53. 53.  Concept of Nidana and its Assessment in Kitibha Kushta53guna become more dominant naturally. Therefore food substances having Katuand Ruksa quality become Viruddhahara in Grishma season. Lavana, Amla,Katu, Ushna food substances are also Viruddha as mentioned by Charaka.5. Varsha and Viruddhahara: In Varsa ritu Amla rasa and Snigdha gunabecome dominant naturally. So intake of this type of food substances isviruddha in this season.6. Sarada and Viruddhahara: Lavana Rasa and Snigdha Guna becomepredominant in this season (The autumn season). So intake of this type of foodsubstances becomes viruddhahara in this season.Table No.16 Nidanas as per rituRitu Viruddha Ahara ViruddhaViharaShishira Katu,tikta,kashaya rasa; vatala laghu,sheeta aharaPravatVasanthaha Amla,snigdha,madhura ahara DivaswapnaGreeshma Katu, amla, lavana, ushna veeryaaharaVyayamaVarsha Udmantha, ati drava ahara Atapasevana,vyayama,vyavaya, diwa swapnaSharad Vasa, taila, audak anupa mamsa,kshara, dadhiDivaswapna,atapasevana,prag vataHemant Vata vardhak, laghu annapana,udamantha,pramitahara,teekshnamadyaPravata
  54. 54.  Concept of Nidana and its Assessment in Kitibha Kushta54 AGNI VIRUDDHATYPES OF AGNI:As Acharya Charaka has stated54,Agni in the bodies is differentiated in to four types according to its intensityviz.1. Mandagni - Mild intensity – kapha dominance2. Tiksnagni - Acute intensity – pitta dominance3. Vishamagni - Irregular intensity – vata dominance4. Samagni - Regular intensity – dosha in sama avasthaOne should take diet (food - Ahara) after considering four types of agnirespectively. If food has not been taken in accordance to the respectiveJatharagni bala then it will become Agni viruddha.1. Mandagni - Guru, Snigdha, Madhura, etc. food substances2. Tiksnagni - Laghu, Tiksana, Suksma, Vidahi, Ushna food substances.3. Visamagni - Ruksa, Laghu, Sukshma, Guru, food substances4. Samagni - Excessive quantity of food and taking food substancesirrespective to kala (time). MATRAVIRUDDHAFood taken in sufficient quantity is termed as Matravat Ahara. If onecannot take Matravat Ahara, then it is called Matraviruddhahara. Charaka hasgiven example of intake same quantity of Madhu and Ghee for explanation ofMatraviruddha. Charaka has described Matra as “Rashi” in Ashtavidha AharaVishesayatana55. At the same time a principle for the Matravat Ahara given byCharaka is quantity of diet depends upon the digestive power. Matra Viruddhamay be two types viz. (1) Hina (deficient) (2) Adhika Matra (excessive).
  55. 55.  Concept of Nidana and its Assessment in Kitibha Kushta55Table No. 17. Examples of MatraviruddhaS.No Example C.S Su.S A.H A.S.1 Honey + Ghee in equal quantity    2 Honey + rain water in equalquantity3 Honey + seed of the east Indianlotus4 Honey + water in equal quantity  5 Honey + Sneha in equal quantity  6 Water + Sneha in equal quantity 7 Honey + Sneha + rain water  8 Honey + Ghee + Vasa 9 Honey + Vasa 10 Honey + Taila 11 Honey + Taila + Ghee + Vasa  SATMYA VIRUDDHASatmya means substances of pleasure to one self.56A substance conductive to an individual is called “Satmya” and the useof such substances result in the well being of that individual. In other words,habituation is that which aggress with one’s system. Thus habitation has thesame connotation as homologation.Types of Satmya:Homologation is of three kinds56.1. Pravara (Superior): Agreeability to all the tastes is the best type ofhomologation.2. Avara (Inferior): Agreeability only to a single taste.3. Madhya (Mediocre): This agreeability is the mean between the best andthe poorest.
  56. 56.  Concept of Nidana and its Assessment in Kitibha Kushta56Here Charaka has stated that one should develop homologation of thebest type, that is agreeability to all the tastes then the poorest and medium typeof agreeability. But Charaka has pointed out that even after acquiringhomologation to all the tastes (best), yet, one should take wholesome diet /food substance regarding Ashtaaharavidhi visheshayatana. Factors like Desha(Habitat), Kala (Time), Jati (Race), Ritu (Season), Roga (Disease), Vyayama(Exercise). Abhyasa-oka (Continues practice) etc. are such factors which playan important role in “Satmya”. These all are types of “Satmya”Intake of sweet and cold food substances or articles by a person towhom only pungent and hot substances are homologous is an example ofincompatibility of diet with reference to homologation. VATADI VIRUDDHAThe use of articles of diet (food), drugs and procedures, which aresimilar in quality to that of the respective (susceptible) body dosha, is called(Vatadi Viruddha) humoral incompatibility. Therefore person who suffers fromthe preponderance of one or the other dosh should take food substance or diet,which are opposite or antagonist to respective dosha in Prakrti. But if a personof the vata prakruti (or any other prakruti), who has indulgence in vata,provoking things (same quality of Ahara), then the vata get aggravated, andthus aggravated vata afflicts the victim’s body with various disorders andimpairs his strength, complexion, and span of life. Therefore use of those foodsubstances / diet which are similar in quality to respective prakruti is calledvatadiviruddha (humoral incompatibility). PAKA VIRUDDHAIf food substances / diet is prepared with bad and rotten fuel, or isundercooked or over cooked or burnt, then it is called or Pakaviruddha -culinary incompatibility. Sushruta has also mentioned them as under.58
  57. 57.  Concept of Nidana and its Assessment in Kitibha Kushta57Repeatedly cooked, over cooked and burnt is Pakaviruddha. Similarly asmentioned by Charaka Paka (Application of heat) is one type of heat treatment.If this heat treatment is proper, then one can get that quality which thatindividual require, but when improper heat treatment is given, the foodsubstances may be over cooked, under cooked or burnt. This is called pakaviruddha. SAMSKARA VIRUDDHASamskara is a synonym of Karana. Karana (preparation) is one of eightfactors of dietetics codes known as “Astaaharavidhi visesayatana”. Givingdefinition of Karana, Charaka stated “Preparation (Karana) is the processperformed to modify the natural properties of substances. The process is thatwhich radically modifies the properties of substances”59.The incompatibility of preparation is that where food/food substance isconverted in to poison during the course of preparation. As for example, in thecase of the peacock’s flesh roasted on a spit made of a stick of the castor plant.As earlier mentioned various methods of preparation are used for processing ofdiet / food substances to get more qualitative properties, but when thesemethod, are not according to rules and regulations of dietetics, one can not getmore qualitative properties but instead get the harmful effect of foodsubstances which is just like poisonous effect to the body tissues (Dhatus). Sothis type of Samskara (preparation) is called Samskara viruddha due to harmfuleffect on the body tissues. Acharya Sushruta has also stated Samskara viruddhaentitled “Krama viruddha” .In same way Astangasamgraha and Astangahrdayahave also given examples of Samskara viruddha, which are mostly similar toview of Charaka and Sushruta.
  58. 58.  Concept of Nidana and its Assessment in Kitibha Kushta58Table No. 18 Classical example of Samskara viruddhaNo Examples Ca Su. A.H. A.S. Disease1 The flesh of parakeet birdwhen it is fried in rape-seedoil becomes incompatible. Itprovokes pitta.+ Pittavrddhi2 Indian Spinach (Yorksaka)prepared with til paste causesdiarrhoea+ + Atisara3 Peacock’s Flesh roasted on aspit made of the castor planttwigs, or prepared in castoroil, if eaten, will causeimmediate death.+ SighraMrtyu4 The Flesh of the parakeetbird, if eaten, having roastedit on a spit+ SighraMaraka5 Lony pepper (Pippali) andblack – night shade(Kakmaci) prepared in fish-oil, causes immediate death+ + SighraMaraka6 Kamala cooked in butter milk + +7 The flesh of bearded vulture(Bhusa) roasted on a spit.+ + +8 The flesh of pigeon fried inrapeseed oil.+ VIRYAVIRUDDHAVirya is one of the intakes of quality of Dravya. This potency is thoughto be of eight kinds by some, while others think it to be of two kinds. In short,Charaka says in Virya is the power by which an action takes place; nothing canbe done in the absence of virya. Every action is the result of it60. AcharyaCharaka mentioned in Vimana Stana 1st says that, one should take Dravyas incombinations, which are virya -Aviruddha means having same Virya. Whensubstance having opposite Viryas are used in combination, that it is known asViryaviruddha.
  59. 59.  Concept of Nidana and its Assessment in Kitibha Kushta59 SAMYOGA VIRUDDHA:Combination is the term for the coming together of various substances.Such combination may be due to the action of both (food substances), all orone of the constituents and this combination is in every case temporary(Anitya). In another verse, Charaka has stated that, Combination is thecombining together of two or more (food) substances. This chemicalcombination exhibits special properties which none of the constituents everpossessed. For example – The combination of honey and ghee, the combinationof honey, fish and milk has a toxic effect, not present in any of its constituentsindividually61.That is incompatibility of combination when sour things are taken withmilk. Acharya Sushruta has also pointed Samyoga viruddha viz. “Rasa, Virya,Vipaka Viruddha”. This type may also be included under Samyoga viruddha61.Table No. 19 Classical examples of Samyoga ViruddhaS.No Examples C.S Su.S A.H A.S1  1 Milk + Fish    2  The Flewh of domesticated, wet land oraquatic creatures + honey, til, gur, milk,black gram, garden redish, lotus stralks orsprouted grains   3  Paukana saka, Rohinisaka or the flesh orpigeon fried in rape-seed oil + honey andmilk.   4  Milk followed by garden redish, garlic,moringa, large basil, holy basil, surasa.   5  Jatuka – Saka and ripe lakooca + honey ormilk     6  Ripe lakooca + black gram soup, gur, ghee +milk       7  Mango, Indian hog-plum, pomelo, lakooca,Bengal current, plantain, lemon, smalljujube, Ceylon oak, showy dellenia, jambul,wood apple, tamarind, paravata, walnut,jack-fruit, coconut, pomegranate, emabicmyrobalan and such other substances, andall sour things, either liquid or otherwise.    
  60. 60.  Concept of Nidana and its Assessment in Kitibha Kushta608  Kusumbha saka + sugerwine, maireya +honey     9  Crane’s flesh + Varuniwine or Kulmasapulse     10  Kakamaci (black night shade) + honey     11  Honey + hot water     12  Bhaltataka + hot water     13  Kakamaci + Pippali + Marica     14  Nadisaka + Kukuta flesh + Dadhi     15  Unroasted Meat + Pitta     16  Sura + Khichadi + Khira       17  Gur prepared from Sugarcane + Sugar +Fish Gur + Black night shade (Kakmaci)     18  Honey + Garden Radish       19  Hog Meat + Gur + Honey       20  Milk takes with Garden radish, Unripemango, Jambil fruit, meat of Iguana, rabbit& hog.      21  Ripe Lakooca + fruits of Palmyra.       22  Milk + Fruit of Lakooca      Kostha viruddhaIn Ayurveda there are two meaning by term “Kostha”1. Anatomically term of Kostha: This term is mostly related with structure andanatomy of human being. Here Kostha means Amapakvasaya or Mahasrotas.Charaka stated 15 of Kosthangas.2. Therapeutic aspect of Kostha: Here, Kostha means one type of permanentcondition of Pittdharakala or Grahani (Deuodenum) which is affected by any ofone predominant humour (dosa).Type of kostha :1. Mridukostha viruddha:In this type of bowel the assimilative organ (Grahani) is affected byexcessive pitta. As Pitta is having ushna, tiksna, sara qualities, when this type
  61. 61.  Concept of Nidana and its Assessment in Kitibha Kushta61of food substance or drugs are administered then pitta get provoked excessivelyand one get disease of pitta dosa. So these types food substances are calledviruddha in Mridu Kostha.2. Krura Kostha viruddha:In the same way, Krura kostha person’s assimilative organ (Grahani) isaffected by excessive Vata dosa. Vata is Laghu, Manda, Cala, Ruksa, Sita, andKhara in nature (quality). Therefore if food substances, having these types ofquality are taken, Vata get aggravated immediately and disease related to vata,dosa may be produced. So this type of diet / food is called viruddha in krurakostha.3. Madhyam Kostha viruddha:Similar to above in Madhyama kostha where the organ is assimilated bykapha, in take of food having qualities like kapha will turn out to be viruddha. AVASTHA VIRUDDHAIncompatibility with reference to the state of the person is known asAvastha viruddha, e.g. when a Vata, provoking meal is given to one who isexhausted on account of Fatigue, sexual act or physical strain then it turns outto be Avastha viruddha. Similarly, if a Kapha provoking meal is given to onesubject to who is lethargic or sleepy or indolence, then it becomes Avasthaviruddha.When one person takes food substances similar to his own prakritidominant dosa, then it is called. Avastha viruddha viz. in childhood, intake ofKaphavardhaka Ahara. Similarly, if one person who is suffering from provokeddoshas and he takes food substances having similar quality to provoked dosha,it is also called Avasthaviruddha.
  62. 62.  Concept of Nidana and its Assessment in Kitibha Kushta62 KRAMA VIRUDDHAThis is incompatibility of rules of eating. When person takes his mealwithout relieving himself of faeces and urine or eats without the feeling ofhunger or does not eat in spite of severe hunger then it turns out to be Kramaviruddha. Krama is related with general rules and regulations of eating. Oneshould take his food as per the rules and regulations of eating, if one cannotobey these rules, his diet may become Krama viruddha. Krama viruddha isrelated with Vidhiviruddha. PARIHARA VIRUDDHAThis is incompatibility of the rules of prohibition, where a person takeshot (food) substances after a meal varah and similar animals.Parihara meansthose food substances which are to be avoided. Acharya has mentioned somefood substances which are to be avoided by person according to his conditione.g. if any person is suffering from such condition of illness, he should avoidfood substances regarding his condition. This condition may be healthy orunhealthy. In diseased condition, intake of food substances, which arementioned as Apathya - unwholesome in that particular disease is calledParihara viruddha. Similarly, in healthy conditions, after intake any type ofmeal, one should avoid those food substances, which are similar in quality withprevious meal. UPACHARA VIRUDDHAUpachara word means practice of medicine, Treatment, Chikitsa (Apte’sdictionary) According to Charaka, Upachara viruddha is incompatibility of therules of ingestion where a person eats cooling things after taking ghee andsimilar articles.Ahara is one major part of Nidanas. So to avoid such type of Aharawhich, causes disease, is also called Upchar - Treatment. Acharya havementioned such Ahara as Apathya Ahara. Therefore intake of Apathya Ahara is
  63. 63.  Concept of Nidana and its Assessment in Kitibha Kushta63also called Upachara viruddha. or condition of illness, while Parihara viruddhais related with both the conditions viz. healthy and unhealthy. So one canconsider Upacara Viruddha as a part of Parihara viruddha. HRIDAYA VIRUDDHAThis is incompatibility of palatability where an article or substances offood is unpleasant in taste. As Gangadhara here by term “Hridaya” one shouldtake “Mana”. Acharya Sushruta has also “Hrdaya viruddha” by avoiding ofAswadu Anna63. SAMPADA VIRUDDHAThis is incompatibility with reference to richness of quality where thejuice (Rasa) is taken of unripe, over-ripe or putrefied (food) substances. Intakeof such food articles, which are not having edible qualities, can be consideredas Sampada viruddha. VIDHI VIRUDDHAAhara vidhi:One should take food substances / diet according to Upayoga Samsthamentioned in the eight factors of diet and dietetics (Asta aharavidhiVisheshayatana). i.e.1. Prakrti : Here Prakrti denotes the natural qualities of the Ahara dravyas i.e.the inherent attributes like Guru and Laghu etc. of the diets and drugs. Forexample masa is Guru in nature. Likewise mudga is Laghu in nature. Similarlythe meat of shukara is Guru and of Yena is Laghu.2. Karana: Karana means the process or preparation. The mode of preparationor processing, changes the natural properties of the substances. Thus there is achange of qualities of the dravyas due to the processing like dilution,application of heat, cleaning, storing, germination, flavouring, preservation andthe material of the receptacle etc.
  64. 64.  Concept of Nidana and its Assessment in Kitibha Kushta643. Samyoga : The combination of individual things with two or more things isknown as Samyoga.4. Rashi: The quantity of food which is to be taken in is known as Rasi.5. Desha: Desha denotes the habitat. It determines the variations of thequalities of the substances according to their geographic region, due to differentsoil, use and their acclimatization to that particular region.6. Kala: Time factor is described in dual context, one pertains with daily andseasonal variations while other deals with individual conditions of age anddisease.7. Upayoga Samstha: It consists of dietetic rules.8. Upayokta: It means the person who takes food.However Astangasamgrahakara Vagbhata has illustrated only seven types ofAhara Vidhi Visesayatanas.( He has explained upyogasamstha and Upayoktatogether and counted them as “Upayogavyavastha. Charaka has also used theterm “ahara vidhividhana” for Upayogasamstha.Virrudha Ahara can be summarized as :MilkIsIncompatibleWithMelonsAreIncompatibleWithStarchesAreIncompatibleWithHoneyIsIncompatible WithRadishesAreIncompatibleWithNightshades(Potato,Tomato,Eggplant,Chilies)AreIncompatible WithBananas,Fish, Meat,Melons,Curd, SourFruits,Kitchari,Breadcontainingyeast,Cherries.Grains,Starch,Fried foods,Cheese.Eggs, Tea,Milk,Bananas,Dates,PersimmonsGhee (inequalproportions)Heating orcookingwith.Milk,Bananas,RaisinsYogurt,Milk,Melon,Cucumber
  65. 65.  Concept of Nidana and its Assessment in Kitibha Kushta65Yogurt IsIncompatibleWithEggs AreIncompatibleWithMangoes AreIncompatibleWithCorn IsIncompatibleWithLemon AreIncompatibleWithMilk, SourFruits,Melons,Hotdrinks,Meat,Fish,Mangos, Starch,Cheese.Milk, Meat,Yogurt, Melons,Cheese, Fish,Bananas.Yogurt, Cheese,Cucumbers.Dates, Raisins,Bananas.Yogurt, Milk,Cucumbers,Tomatoes.2. MITHYA AHARAMithya Ahara means improper diet. According to Vijayaraksita, the dietopposite to “Astaaharavidhivisesayatanani” is designated as “Mithya Ahara”.Charaka has described eight factors determining the utility of food called as“Astavidha Aharavidhi Visesayatanani”. They are Prakrti, Karana, Samyoga,Rasi, Desha, Kala, Upayoga Samsthana and Upayokta. These eight factors giverise to beneficial effects. Of things in proper way may be more useful but inimproper way they are always harmful. So they should be avoided. Followingterms are also under title as Mithya ahara.Table No.20. Mithya ahara as per Ayurvedic classicsMithyaAharaC.S Su.S A.S A.H B.S H.S M.N B.PAdhyashana     Vishamashana  Atyashana  AsatmyaAharaIntake of foodduringIndigestion   Continuousand excessiveuse of Madhu,Phanita, 
  66. 66.  Concept of Nidana and its Assessment in Kitibha Kushta66Matshya,Lakucha,Mulaka,Kaakmachiand intake ofabovesubstanceswhilehaving AjirnaExcessiveSnehanaVidahi Aharawithoutemesis ofundigestedfoodVidahi Aharawithoutemesis ofundigestedfood1. ADHYASHANATaking food just after completing a previous meal is called Adhyasana.If proper time is not given for previous food to get digested and stomach is stilloccupied with a previous food and more food is taken in such condition thenthere is a disturbance in the rate of production of secretion from the stomachand other organs related with digestion of food. Further peristalsis movement inthe stomach and intestine get disturbed. Due to decrease in secretion ofdigestive enzymes, the food is partially digested thus producing Ama. As theperistaltic movement is hampered, the food stays in the stomach for longer timeand gets decomposed producing toxins (Amavisa). These factors are the rootcause of several diseases, which are produced due to different permutations andcombinations of Dosa and Dusya involvements.642. VISHAMASANATaking food at irregular time is called Visama Asana. Visama asana isbest known to produce Visamagni.65
  67. 67.  Concept of Nidana and its Assessment in Kitibha Kushta67In present day life, Hurry, Worry and Curry have become universalphenomenon; no one has time to even eat properly. Visama Asana is becominga common practice now a day.SAMASHANAIntake of wholesome diet and unwholesome diet at same time in onemeal is called Samashana.3. ATYASHANATaking excessive amount of diet is known as Atyasana. Atimatra diet isbest known to produce vitiation of Agni and Ama66. Ahita bhojana when takenin Atimatra at improper time (Akala) leads to Dusti in Annavaha rotasa andalso disturbs the Paka prakriya (process of food digestion).4. LAVANA ATI SEVANAInspite of good qualities, if used in excess causes liquification of kapha,aggravation of pitta, vitiation of rakata, mamsa vidahana (decomposition ofmamasa), kaya sthilikaroti67. As kapha, rakta, mamsa are among the dushya ofkushta, so excess of Lavaana rasa may precipitate Kushta5. MOOLAKALatin name: Raphanus sativus68English: RadishFamily: CruciferaeTypes: Bala and vriddhaOut of the above said two types, the pakwa (vriddha) moolaka is nindita andvitiates tridoshaBala moolaka is laghu and tridosha hara (B.P)6. LAKUCHA SEVANALatin name: Atrocarpus lakocha69English: Monkey jackFamily: Moraceae
  68. 68.  Concept of Nidana and its Assessment in Kitibha Kushta68Rasa: Madhua, amla, kashayaGuna: Guru, rukshaVeeya: ushnaVipaka: amla7. DADHI SEVANAThere are differences in opinion regarding the qualities of curds.Table No.21 Qualities of curd as per different authorsQualities C.S Su.S A.H & A.SRasa Amla Madhur, amla AmlaVeerya Ushna Ushna UshnaGuna Guru, snigdha Snigdha Guru, snigdhaVipaka Amla Amla AmlaAction Rochana,deepana,vrishyaVrishya, prana kara,maangalyaMeda shukrashleshma krit,rochanaTypes of DadhiTable No.22. Types of Dadhi as per Sushruta70Properties Madura Amla Ati amla1234Maha abhishyandiKleda karakaKapha vardhakaMeda vardhakaKapha vardhakaPitta vardhakaRakta dooshakaVidahiAs per Arundatta :Table No.23. Types of Dadhi as per Arundatta71Properties Manda jatam Samyak jatam Ati jatam1 Anbhi vyaktaamlamAbhi vyaktaamlamAti amlam
  69. 69.  Concept of Nidana and its Assessment in Kitibha Kushta69Mandak dadhi :As per Brihat trayi, Mandak Dadhi does tridosha kopana. Commentingon Ashtanga hridaya, Arundatta says that it is yugapath dosha kopana i.e it willvitiate tridosa altogether. Astanga hridaya and sangraha innumerate following gdiseases caused due to the consumption of mandak dadhi.1. Jwara2. Rakta pitta3. Visarpa4. Kushta5. Pandu6. Brahama8. DUGDHA ATISEVANAAll the Acharyas accepted eight types of ksheera and explained it underksheera varga. The qualities of ksheera are listed below:Table No.24. Types of Gavya ksheeraProperties Charaka Sushruta VagbhataJeevaniya Rasayana  Sara Snigdha  Guru Madhura Manda Bahala Pichila Mridu Alpa abhishyandi 
  70. 70.  Concept of Nidana and its Assessment in Kitibha Kushta70Mahishi ksheeraTable No.25. Properties of Mahishi ksheeraProperties Charaka Sushruta VagbhataGuru  Gurutara Maha abhisyandi Snigdha snigdhatara  Sheeta   Aja ksheeraTable No.26. Properties of Aja ksheeraProperties C.S Su.S A.HLaghu   Kashaya Madhura Sheeta Laghu Ushtra kseeraTable No.27. Properties of Ushtra kseera ksheeraProperties C.S Su.S A.HRuksha  Ushan  Lavana  Laghu  Ishat ushna 