Pankaj   dissertation - final
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

Pankaj dissertation - final

on

  • 2,626 views

Pankaj, Concept of Nidana and its Assessment in Kitibha Kushta, DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA, GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. 2009

Pankaj, Concept of Nidana and its Assessment in Kitibha Kushta, DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA, GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. 2009

Statistics

Views

Total Views
2,626
Views on SlideShare
2,626
Embed Views
0

Actions

Likes
1
Downloads
25
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Pankaj dissertation - final Document Transcript

  • 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.  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.  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.  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.  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.  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.  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.  Concept of Nidana and its Assessment in Kitibha Kushta8SynonymsTable No.1 Synonyms of Nidana as per Ayurvedic textsSl.no 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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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, e.g.travel 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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  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 
  • 71.  Concept of Nidana and its Assessment in Kitibha Kushta71Stree ksheeraTable No.28. Properties of Stree ksheeraProperties Charaka Sushruta VagbhataJeevaniya Pathya  Guru Kashya Sheeta Snigdha  Satmaya Avi ksheeraTable No.29. Properties of Avi ksheeraProperties Charaka Sushruta VagbhataUshna   Guru  Madhura Snigdha Eka Shafa ksheeraTable No.30. Properties of Eka Shafa ksheeraProperties Charaka Sushruta VagbhataUshna   Laghu   Amla   Lavana   Ruksha  
  • 72.  Concept of Nidana and its Assessment in Kitibha Kushta72Hasti ksheeraTable No.31. Properties of Hasti ksheeraProperties Charaka Sushruta VagbhataMadhura Kashaya Guru  Snigdha Sheeta Sthira  9. ATYAMBU SEVANAChakrapani in Dravya sangraha says that patients of aruchi, pratishaya,udara, madhu meha and kushta should drink very minimum quantity of jala. Excess water produces klinnata and later produces mandagni,amajeerna.72Vagbhata has advised to alpa matra jala in all ritus exceptsharad and greeshma. Jala advised at the time of food: Before bhojana: agni mandyata In between food: Dhatu samyata After food: Sthoulyata74 Drinking of excess water leads to vitiation of mandagnai. (B.P) Qualities of Nadi jala as per Brihat trayiTable No.32. Qualities of Nadi jala as per Brihat trayiOrigin of river Charaka Sushruta VagvahattaHimvat prabhava Pathya PathyaPrachya, Avanti,AprantArsha ArshaSahaya, vindhyaprabhvaKushta, Hridroga,ShlipadaKushta Kushta, Pandu,Shiro rogaPaariyatra Shiroroga,Hridroga, Kushta,ShlipadaPathya, nirogta Tridosha shamak,Balya
  • 73.  Concept of Nidana and its Assessment in Kitibha Kushta73Samudra jala Tridosha karaka Tridosha karaka Tridosha karakaMahendraprabhavaUdara, Shlipada Udara, ShlipadaMalaya udbhava Krimi jananaTable No.33. Types of jala as per Desha as per Bhava PrakashJangala Anoopa SadharanaRuksha Abhishyandi LaghuLaghu Madhura SheetaPitta, kapha shamak Snigdha Tri dosha shamakaPathya Guru MadhuraVikara shamaka Mandagni krita Agni deepakaVikara shamakaTable No. 34. Qualities of Jala as per source of collectionSource of jala A.S B.PKoupya Agni deepaka, PittavardhakAgni deepaka, Vatakapha shamakSaaras Agni deepaka, Laghhu Kashaya, Madhura,Laghu, BalyaTadaak Guru, Vata vardhak Kashaya, Madhura, Katuvipaka, Vata karakaChoundya Pitta vardhak Madhura, Agni deepakaPrasravana Tridosha shamak Laghu, agni deepaka,PathyaAoudbhida Madhura, Pitta shamak Madhura, sheeta, avidahiVapi Madhura, Laghu Madhura, LaghuNadeya Laghu, Pathya Laghu, Agni deepakaPaalava Guru, Abhishyandi,Tridosha kopakaKedar Guru, Abhishyandi,Tridosha kopakaSamudra Lavana rasa, durgandhiNarikelodaka Madhura, guru, HridyaTaalambu Guru. Pitta shamak,VrishyaVaikir Laghu, Pitta shamak
  • 74.  Concept of Nidana and its Assessment in Kitibha Kushta74Jala Guna as per ritu :Table No. 35. Qualities of Jala as per Ritu :Varsha Sharad Hemant Shishira Vasantha GreeshmaMadhura Laghu Snigdha Laghu Kashaya AnabhishyandiGuru Anabhishyandi Guru Kapha,VataShamakMadhuraAbhishyandi Nirdosha Balya RookkshaPrashasta Vrishaya10. Hayanak, Chinaka, Uddalaka, Kordusha should not be taken withKsheer, Dadhi, Kola, Takra, Kulatha, Masha, atasi and kusumbhataila7411. KARMA AS NIDANA OF KUSHTAContribution of Vedas in understanding etiology and treatments ofvarious ailments:In the Vedic references we can trace out unbroken continuity of medicaltradition including karmaj vyadhi.Importance of Graha highlighted in Vedas Sangraha karta of Rigveda jyotishi Lagadh Rishi, it contains 36 karikas. Yajurveda jyotish has 49 karikas Atherva veda jyotish has 162 karikas, it contains 162 mantrasAtherva vedaThe nirukti of Atharva veda says: Atha + arvan i.e. which gives theknowledge of Atmik and sharirik tatvas. The Atherva veda is by all accounts acurious compendium of medicine in its various stages of evolution and containsthe most primitive as well as some of most highly developed stages of therapyfor the karmaj vyadhi
  • 75.  Concept of Nidana and its Assessment in Kitibha Kushta75Papa janita karmaj vyadhi :Atharvaveda, kanda 8, Su 7, richa 7/19/9 and 13 says Vachika, Manasikand Baudhik papa vriti are only are the causes of Roga, Dukha, mrityu andNasha.Atharvaveda, kanda 8, Su 3 explains Dushta lakshanas, some of them are :Bhanguravat - Person who thinks of nashas of othersVadha karta – who kills cowsDusha karmi – who does bad deedsAsatyachara – who says lieAsteya – who steal god idolsAchit – who has bad thoughts in mindRisha - DestroyerHimsra – who kills othersDruha – vishwasghatiDurvakta – who speaks rashly Likewise 50 papa karmas has been explained which leads variousailemnts including skin disorders. Kaushika sutra 37-1/25 there is reference of Grahabhichara Kaushika sutra 32/26, 27, two types of Vyadhis has been explained i.e.Ahara nimitaja and Papa nimitaja. Kaushik Sutra Atharva Veda has 731 suktas and divided into 14 vargas,out of which 9this Prayaschit. It is says mode of treatment for papakarmaj vyadhi. Kautilya Arthasahstra contains Brihatparashar hora shastra whichcontains 97 chapters; there is detailed explanation of graham, rashiswaroopa, lagna, arishta adhyaya etc in the context of karmaj vyadhi In Markandeya Purana (16/17/18/19), the main cause of roga is papa,which in turn caused by manas, budhi and antah karana. Papa karmasubsides after sufferings (Chapter 2/100).
  • 76.  Concept of Nidana and its Assessment in Kitibha Kushta76Karma as nidana in Ayurvedic lexicons:Ashtanga Sangraha (A.S. Su 9/107) in Viruddha anna vignyaniya adhyaya saysthere are two types of karma75i.e.1. Eha janam krita i.e. Pourusha karma2. Anya janama krita i.e. Daiva karma Eha janam krita: Dashavidha Papa karama Kayaik: Himsa, steya, anyatha kamam Vachik: paishunyam, parusham, anrutam, Sabhinna alapam Manasik: Vyapad, abihdya, drik viparyaya Anya janama krita: Poorva janam kritam papam Balawan Pourush karma overpowers hina Daiva karma and vice versa76. Same explanation has been given by Charakachrya inJanapadodhwamsiye adhyaya77.As per Acharya Charaka “There is no major action (performed inprevious life) which does not lead to the corresponding results. Diseases arisesout of such actions are not amenable to any therapeutic measures. They arecured only after the results of past actions are exhausted”.78Vriddha Vagbhata in Shishyopanayaniye adhyaya says, “Any diseasecan be transformed from one stage to the other if there is defect in any of thechikitsa chatushpada and if a person has done poorva janma krita papa karma.(A.S Su 2/37)Importance of graham in Ayurveda:Sukha sadhya vyadhisWhen grahas will be at their respective favuorable positions, then the vyadhiwill be sukha sadhyaPumsavan vidhi
  • 77.  Concept of Nidana and its Assessment in Kitibha Kushta77The procedure known as pumsavan vidhi says the importance of nakshatra.During conjunction of Pushaya nakshatra, the woman should be made to drinkcurd added with shweta sarshapa.RasayanaA person should enter in the kuti when sun is in Uttarayana, shukla paksha andwhen the nakshatra, mahurata are shubha (auspicious).Upanayana samskaraUpanayana samskara to be done in shubha nakshatra, mahurata, tithi.Charakacharya has explained in Unmada Chikitsa (Ch.Ch 9/21) about prakopakala of different grahas in their kalas. It is as follows:Table No. 36. Prakopa kala of different grahas79S.No Graha Kala1 Deva Shukla paksha2 Pitru Dashmi / Amavasya3 Rishi Sashti / Navmi4 Gandharva Dvadashi/ Chaturdashi5 Yaksah Ekadashi/ Saptami6 Bramha rakshasa Panchma / Poornima7 Pishacha Dwitiya / tritiya/AshtamiGraha roga in Kaumara BrihtyaGraha as niadana attributed as complete chapter in Kaumara brithyaTable No. 37. Bala grahas as per different acharyasS.No Author Graha1 Sushruta 92 Vagvhbhata 123 Bhavaprakasha 9
  • 78.  Concept of Nidana and its Assessment in Kitibha Kushta784 Yoga Ratnakara 125 Harit 86 Kashyapa 20Medical Astrology80The 12thraashis is in the Zodiac represent certain part of the body.Similarly the 12thbhavas also represent certain parts of the body. Each planetis responsible for the particular disease. The 6thhouse in a horoscope is in thehouse of disease. The 8thhouse is the house which causes mental worries and isalso responsible for the accidents or surgery. 12th house indicateshospitalization. Taking all the above factors into consideration it is possible tofind out that, when a person is likely to fall sick, which part of the body that isgoing to be affected and the cause for the disease and prescribe remedialmeasures.The following are the part of the body rereoresented by different rashisin the zodiac 1stMesha – Head. This is ruled by Mars. Hence the natures of thedisease represented by Mesha are headache, burns and the problemsrelated with brain. 2nd– Vrishabha – This rules over neck, ear, eyes, nose, throat and voicebox. Therefore, Ent problems are indicated by this house. 3rd– Mithuna – This rules over shoulders and arms. It has links with theENT. So cough, cold, nose problems, bronchitis etc. are the diseases thatcould be expected from this house. As mercury rules over this house,problems connected with the functioning of the nervous system couldalso be predicted from this house. 4th- Makara – This rules over the chest. So it can result in problemsrelated with heart, lungs etc . As this is ruled by moon problems such as
  • 79.  Concept of Nidana and its Assessment in Kitibha Kushta79cold, cough, water borne diseases, mental problems can also bepredicted. 5th– Simha – This rules over portions below chest and the abdomen. Asthis is ruled by sun, which in turn rules over heart and liver. The spinalcord, vertebral column are also ruled by this house. 6th– Kanya – This rules over abdomen. Diseases pertaining to gaster,small intestine and bowels are to be found out from this sign. Asmercury rules over this house nervous diseases are also to be found outfrom this house. 7th– Tula – Urinary tract infections, kidneys and uterus are ruled by thishouse. Sexual disorders, urinary tract infections, menrtual cycleproblems are to be ascertained by this house. 8 – Vrishchik – Reproductive organs, prostrate glands and urinarybladder are the organs represented by this house. As Mars rules over thishouse excessive bleeding disorders, BPH, Sexual disorders, UTI etc. areto be found out by this house. 9 – Dhanu – This rules over hips and thighs. Lumbago, back ache arethe diseases that could be found out from this house. 10 – Makara - Knees are represented by this house. As Saturn rules overthis house. Problems connected in the bones could be resulted out bythis house. 11 – Kumbha – Legs, ankles are represented by this house. As Saturnrules over this house, problems connected with bones like arthritis maybe found. 12 – Meena – Feet, leg are ruled by this house. Varicose veins problemsare to be found out from this house.
  • 80.  Concept of Nidana and its Assessment in Kitibha Kushta80Table No. 38. Rashi in relation to organs and diseasesS.No Rashi Organs Diseases1 Mesha Head Headache, tumours2 Vrishabha neck, ear, eyes, nose,throat and voice boxENT problems3 Mithuna shoulders and arms Nervous disorders4 Cancer Thorax cold ,cough, water bornediseases, mental problems5 Leo Thorax and theabdomenAsthama, gastritis, cardiacailements6 Virgo Brain, abdomen Nervous diseases,boweldisorders7 Libra Kidneys and uterus Sexual disorders, urinarytract infections, menstrualcycle problems8 Scorpio Reproductive organs,prostrate glands andurinary bladderBleeding disorders, BPH,Sexual disorders,UTI9 Dhanu Hips and thighs. Lumbago, back ache10 Makara Knees Osteo arthritis, Rheumatoidathritis11 Kumbha Legs, ankles Arthrithis12 Meena Feet, leg Varicose veins As per Veer Simhavalokah81:1. If Rahu and soorya are in the 8thplace leads to Kushta.2. If Rahu and soorya are in the 8thplace along with Mangala graham then,it leads to Maha Kushta3. If Shukra, Soorya and Shani are residing in same house then it leads toKushta and the person will be of bad character.4. If shani resides in 8thhouse leads to Kushdra Kushta.5. If shukra resides in Simha rashi with soorya dirshti over it.6. If soorya is nichastha, if there is antardasha of Buddha during mahadasha of soorya.7. If Chandra mahadasha coincides with anterdasha of Buddha.  
  • 81.  Concept of Nidana and its Assessment in Kitibha Kushta81Table No. 39. Pratikar for Vikrit GrahasS.No Position of Graha Pratikar1 If Rahu and soorya are in the 8thplaceSoorya aradhana2 If Rahu and soorya are in the 8thplace along with Mangalagraham then, it leads to MahakushtaSoorya and Mangal aradhana3 If Shukra, Soorya and Shani areresiding in same houseAll grahas should be worshiped4 If shani resides in 8thhouse Black gram should be offered tocow to pacify Shani kopa.5 If shukra resides in Simha rashiwith soorya dirshti over itDaily morning Soorya should beworshiped along with chantingAditya Hridaya Stotra6 If soorya is nichastha, if there isantardasha of Buddha duringmaha dasha of sooryaDaily morning Soorya should beworshiped along with chantingAditya hridaya stotra As per Panchanga, it shows the places of mitra (favourable) and shatru graham(unfavourable) grahas82Table No. 40. Places of mitra and shatru graham83Shri Sun Moon Mars Mercury Jupiter Venus Saturn Rahu KetuMitragrahaMoonMarsMercuryMercuryRahuMoonRahuJupiterMoonSun RahuVenusRahuMoonMarsMercuryRahuSaturnMercuryRahuVenusMercuryVenusSaturnMercuryVenusSaturnShatrugrahamSaturnRahuVenusRahu MercuRahuMoon MercuVenusSunMoonSunMoonMarsSunMoonMarsSunMoonMarsSamagrahamMercury MarsVenusJupiterSaturnVenusSaturnMars VenusSaturnSaturnRahuMarsJupiterRahuJupiter Jupiter JupiterSvaksetraniLeo Cancer AriesScorpiGeminiVergoSagitarPiscesTaurusLibraCapricoAcquarVirgo PiscesUchakshetraniAries/10 Taurus/3 Capro/28Vergo /15 Cancer/5 Pisces/27Libra /20 Gemini/15Sagitar/15NeechakshetraniLibra /10 Scorpi/3 Cancer/28Pisces /15 Cancer/5 Virgo /27 Aries /20 Sagitar/15Gemini/15
  • 82.  Concept of Nidana and its Assessment in Kitibha Kushta82PsoriasisThe skin is not only the largest organ of the body, it also forms a livingbiological barrier and is the aspect of ourselves we present to the world. It istherefore not surprising that there is great interest in “skin care”, with theassociated vast cosmetic industry. The impairment of the normal functions ofthe skin can lead to acute and chronic illness with considerable disability.Psoriasis is one among most comman dermatologic disease affecting up to 1-2% of world’s population The familiar pink or red lesions with a scaling surfaceand welldefined edge are easily recognised. These changes can berelated to thehistological appearance84Historical back ground :Psoriasis is probably one of the longest known illnesses of humans andsimultaneously one of the most misunderstood. Some scholars believe psoriasisto have been included among the skin conditions called tzaraat in the Bible.The earliest description what appears to represent psoriasis are given at thebeginning of medicine, in Corpus Hipporaticum, a work named afterHippocrates. This work used the term psora and lepra for conditions that can brrecognised as psoriasis. The Greeks used the term lepra (λεπρα) for scaly skinconditions. They used the term psora to describe itchy skin conditions. Itbecame known as Willans lepra in the late 18th century when Englishdermatologists Robert Willan and Thomas Bateman differentiated it from otherskin diseases.Origin of word “Psoriasis”:First this word used in1675–85. It came from the Greek word “psora”which means “to itch”Definition:          As per Dorlands Medical Dictionary it is defined as “a comman chronic,squamatous dermatosis with polygenic inheritance and a fluctuating course”85.
  • 83.  Concept of Nidana and its Assessment in Kitibha Kushta83Robins pathologic basis of disease describes it as “Psoriaisis is mostcomman chronic inflammatory dermatosis affecting 1-2% of world’spopulation and characterized by a typical skin lesion which is well demarcated,pin to salmon coloured plaque covered be loosely adherent scales that arecharacteristically silver white in colour86.Harrison’s Principles of Internal Medicine says “It is a chronicinflammatory skin disorder clinically clinically characterized by erythematous,sharply demarcated papules and rouned plaques, covered by silvery micaceousscale87. (311)Etiology of psoriasis88:The cause is unknown but there is an inherited predisposition. Thestrong genetic influence may result from a single dominant gene with poorpenetrance or a number of genetic influences. Other factors such as localtrauma, general illness and stress are also involved, so the cause of psoriasis isbest regarded as being multifactorial. HLA-Cw6 is the phenotype most stronglyassociated with psoriasis, particularly the early onset variety in whichhereditary factors seem to play the greatest part. Haemolytic streptococcalthroat infection is a common precipitating factor in guttate psoriasis.Antimalarial drugs, lithium, and beta blockers can make psoriasis worse. Thereis evidence that psoriasis occurs more readily and is more intractable in patientswith a high intake of alcohol. Smoking is associated with palmo-plantarpustulosis.The causes can be summarised as follows:1. Stress: Psoriais is more stress sensitive than any other skin disorder.Many stressful events of daily life may exacerbate psoriaisis. Thedisease itself can cause a reactive depression in the patient which couldfurther exacerbate his psoriasis.
  • 84.  Concept of Nidana and its Assessment in Kitibha Kushta842. Infection: Upper respiratory infections and tonsillitis, especially whencaused by streptococci may cause a flare up of exixting psoriasis or mayprecipitate an attack of acute guttate psoriasis. This is common inchildren and is usually associated with an elevated antistrptolysin “O”titer. Infections from other bacteria and viruses may also exacerbatepsoriasis.3. Local trauma: Psoriatic lesions tend to develop at sites of injury to theskin, “Koebner phenomenon” also known as the isomorphic response,refers to the induction of the lesion by cutaneous trauma. Epidermaltrauma alone will not alone induce the lesions. It should also involve thepapillary dermis. The trauma may be of any kind- physical. Chemical,mechanical, allergic or of any other nature.4. Seasonal variations: Most patients experience worsening of their skinlesions during winter, 89% of the patients studied by Farber and Nall(1978) had worsening of their disease duing cold weather. Highhumidity usually beneficial.5. Drugs: Many drugs are known either precipitate or to exacerbatepsoriasis. A number of bet adreno receptor blocking drugs like propanol,paracetamol, metaprolol and oxyprenolol etc. have been reported toinduce psoriasis.Non steroidal anti inflammatory drugs (NSAIDs) such as indomethacin,salicyclates, maclofenamate, phenylbutazone, oxyphenylbutazone andibrufen, which are commonly used, have been reported to eitherprecipitate or to exacerbate psoriasis. Chloroquine is another drug thathas been known for years to precipitate psoriasis.6. Genetic predisposition: HLA-Cw6 is the phenotype most stronglyassociated with psoriasis, particularly the early onset variety in whichhereditary factors seem to play the greatest part. 
  • 85.  Concept of Nidana and its Assessment in Kitibha Kushta85Clinical presentation89Patients usually present with lesions on the elbows, knees, and scalp.The trunk may have plaques of variable size and which are sometimes annular.Patients with psoriasis show Koebner’s phenomenon with lesions developing inareas of skin trauma such as scars or minor scratches. Normal everyday traumasuch as handling heavy machinery may produce hyperkeratotic lesions on thepalms. In the scalp there is a scaling, sometimes producing very thickaccretion. Erythema often extends beyond the hair margin. The nails show“pits” and also thickening with separation of the nail from the nail bed(oncholysis). Psoriasis is characterized by the development of erythematous, welldefined, dry, scaly papules and plaques of sizes ranging from a pin headto larger lesions. A common genetically determined diseases of the skin consisting ofwell defined pink or dull read lesions surmounted by a characteristicsilvery scaling. A chronic disease characterized by sharply defined patches of erythemacovered by silvery scales. It is a common chronic and non-infectious skion diseases characterizedby well defined, slightly raised dry erythematous macules with silveryscales and typical extensor distribution.Clinical appearance: The main characteristics of psoriatic lesions, which reflect thepathological processes listed above, follow. Plaques consisting of well defined raised areas of psoriasis. These maybe few or numerous, covering large areas of the trunk and limbs.Sometimes there are large confluent lesions. Scaling may predominate, giving a thick plaque, which is sometimeslikened to limpets on the sea shore, hence the name
  • 86.  Concept of Nidana and its Assessment in Kitibha Kushta86 “rupioid”. Scratching the surface produces a waxy appearance—the“tache de bougie” (literally “a line of candle wax”). Erythema may be conspicuous, especially in lesions on the trunk andflexures. Pustules are rare on the trunk and limbs, but deep seated pustules on thepalms and soles are fairly common. In the form of palmo-plantarpustulosis they may occur without psoriasiatic lesions elsewhere. The size of the lesions varies from a few millimetresto very extensive plaques.The typical patient of psoriasis:Psoriasis usually occurs in early adult life, but the onset can be at anytime from infancy to old age, when the appearance is often atypical. Thefollowing factors in the history may help in making a diagnosis: There may be a family history—if one parent has psoriasis 16% of thechildren will have it, if both parents, the figure are 50%. The onset can occur after any type of stress, including infection, trauma,or childbirth. The lesions may first appear at sites of minor trauma— Koebner’sphenomenon. The lesions usually clear on exposure to the sun. Typically, psoriasis does not itch. There may be associated arthropathy—affecting either the fingers andtoes or a single large joint.ETIOLOGY OF PSORIASIS FROM AYURVEDIC PERSPECTIVE :As per recent studies Stress is one among the most important factor incausation of Psoriais. It is more stress sensitive than any other skin disorder.Many stressful events of daily life may exacerbate psoriaisis. The disease itselfcan cause a reactive depression in the patient which could further exacerbate
  • 87.  Concept of Nidana and its Assessment in Kitibha Kushta87his psoriasis. In Ayurvesic terms stress can be understood as mano vikara.Sharirika Prakrities Paittika and Vatika Prakriti are more prone topsychosomatic disorders as their Manas is easily affected by Krodha, Kshobhaetc. in comparison to Kaphaja Prakriti whose Manas is not affected or affectedminimally or after a long duration by these Bhavas90. Chinta(anxiety), Krodha(anger), Shoka (grief), Bhaya (fear), Harsha (happiness), Vishada(depression),Irshya (hate), Kama (lust), Lobha (greed) etc. are described as Manas Bhava byAcharya Bharata in ‘Natya Shastra’ . These Bhavas are also known as‘Sthayi Bhava’ there. With these Bhavas other short term Bhavas also originateand they are known as ‘Vyabhichari Bhava’. They affect our body and producesome changes, which are called as ‘Anu Bhava’. These emotional feelings /Bhavas when become prominent then are known as Vegas (urges). It is said byCharaka in ‘Na Vegandharaniya Adhyaya’ that these natural urges should becontrolled91. They are also called as Manasika Vikaras of two Manas Doshas.The Prajnaparadha is the cause of above-mentioned emotional disorders. Theyare the symptoms of so many diseases, cause of so many diseases and also thediseases themselves.Emotions and their bodily expressions:As a science psychosomatic medicine aims at discovering the precisenature of the relationship of the emotions and bodily functions. To a certaindegree every emotion finds some bodily expressions. The individual will showhis emotions in some visible form, perhaps in his posture and attitude, perhapsin his face, perhaps in the trembling of his legs and knees. Similar changescould be found in the organ themselves, e.g. if he flushes or turns pale,circulation of the blood is affected. In anger, anxiety, sorrow or any otheremotion, the body always speaks, and each individual’s body speaks in alanguage of its own. A few emotions are described as follows
  • 88.  Concept of Nidana and its Assessment in Kitibha Kushta881. Krodha (anger):According to Ayurveda, the degree of anger can be measured on thebasis of intensity of ‘Droha’ found in a person92. In this emotional disorder thevictim can go up to the extent of physical attack and even murder also.2. Shoka (grief):Shoka is characterized by depressive nature with sorrowful attitude. Itmay be originated from bad experiences of the past, insult, personnel loss,death of relatives etc. The degree of Shoka can be measured on the basis ofintensity of ‘Dainya’93. The victim of Shoka can suffer from atisara, nidranashaand jwara etc.3. Bhaya (fear):Intensity of Bhaya is examined by ‘Vishada’94. This is a specificemotion by which so many diseases are caused. It is well said by Charaka“Vishado roga vardhananam sreshta”. Fear is caused due to injuries of physicaland social environment, when one is threatened by some social foe or by somephysical threat from the environment, one may attempt to flee from it withaccompanying feelings of fear.Chinta (anxiety):Sometimes individual suffer from an emotional disorder, which ispsychologically just as disabling as the more extreme forms of fear but inwhich the individual really does not know, of what he is afraid, this is knownas Chinta. Neurotic anxiety is perhaps the most important of all the symptomsin the sphere of emotions of psychopatholgy. The physiological concomitantsof tachycardia, of increased respiration, and of sweating of skin surface, whichoccurs in real fear likewise characterize this anxiety. By the above emotionaldisorders and the other than them viz. Lobha (greed), Moha (narcosis), Irshya(jealousy) etc, many diseases are seen. Thus the great importance is given to
  • 89.  Concept of Nidana and its Assessment in Kitibha Kushta89theses psychic factors in respect of their knowledge and necessity ofdescription. Kushta, jwara, atisara and so many other diseases are foundoriginated by these emotional factors.Role of psychological factor in the etiopathogenesis of psoriasis –Modernview :In recent years there has been an increasing awareness on the part ofphysicians about the close relationship between “Psyche” (mind) &“Soma”(body), and in every branch of medicine including dermatology a largegroup of chronic illnesses are being designated as “Psychosomatic” (Behl,1998), Psoriasis is one of them. Psychosomatic disorder like psoriasis areassociated with skin problems that are not directly connected to the mind butthat react to emotional states, such as stress (Koo & Lebwohl, 2001). Psoriasisis a chronic disease that can have substantial psychological and social impacton a patient’s life. For the patient, psoriasis can be far more than “Just a skindisease”. However, close family members or patient’s friends may notunderstand the disease. The psychological impacts are likely to be heightenedwhen the onset of disease was early in life – when the patient was mostvulnerable to psychosocial trauma.Psychological problems can arise from the feelings of the patient abouthis/her appearance, social rejections, guilt, embarrassment for self and family,and emptiness. Patients may also deny themselves enjoyment of leisureactivities because of embarrassment and fear of rejection, and the disease oftenmakes patients feel unattractive to the opposite sex. Number of studies hasshown that psychological stress is often caused by psoriasis, and can be a factorin “flares” of psoriasis. Conversely, psychological stress can affect the courseof the disease as well as contribute to psychological problems such asdepression, anxiety and unfocused anger. The way stress affects the patientvaries from individual to individual; the most common manifestations are
  • 90.  Concept of Nidana and its Assessment in Kitibha Kushta90psychological depression, anxiety, and obsessional behaviors95. The way inwhich stress, depression and anxiety influence the course of psoriasis is notknown. Some studies suggest that the influence may be through an effect on theimmune system.
  • 91.  Concept of Nidana and its Assessment in Kitibha Kushta91MATERIALS AND METHODSPresent study has been carried out under two sections.1. Literary study2. Observational studyMATERIALS1. Literary studyCollection of MaterialsThe Literary source for the present study was obtained from, Vedicscriptures, classical texts of Ayurveda, Sanskrit dictionaries, Western medicaltexts, published articles in reputed journals and also from various media likeinternet etc, followed by retrospective study of related research work.2. Observational studya. Diagnosed patients of Kitibha Kushtab. InstrumentsCollection of MaterialsA) Source of patients - Patients from OPD, IPD, other referrals and specialcamps conducted in GAMC and hospital Mysore were selected for the study,appropriately satisfying the selection criteria.B) Instruments:1. Stethoscope2. SphygmomanometerMETHODS1. Aim : Present work was undertaken to assess the nidana of KitibhaKushta (Psoriasis) as per available Ayurvedic literature
  • 92.  Concept of Nidana and its Assessment in Kitibha Kushta922. Objectives : 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.3. Study designA. Literary Study - Literary study of Ayurvedic literature had been carriedout on nidana of Kushta. This study was based on samuchaya vidhi(collecting of scattered matter) and nirdesh vidhi (detailed explanation).B. Observational study – The nidana of Kitibha Kushta were assessedbased on detailed questionnaire. A set of questionnaire was framedincorporating common Ahara and Vihara which have been mentioned asNidanas to Kushta. Every selected patient was thoroughly assessed fornidana as per the prepared Chart.The discussion was done with the help of Hamsaksheera Nyaya(selecting important matters from the literature).METHOD OF COLLECTION OF DATAPatients were selected with respect to age and irrespective of sex,socioeconomic status, caste, religion with signs and symptoms of KitibhaKushta.INCLUSION CRITERIA1) Patients of either sex were selected.2) Patients between age groups of 17-60 years were selected.3) Patients coming under diagnostic criteria were selected.
  • 93.  Concept of Nidana and its Assessment in Kitibha Kushta93EXCLUSION CRITERIA1) Patients with other systemic disorders were excluded.2) Patients with other skin disorders were excluded.DIAGNOSTIC CRITERIA1. 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 lesionsSAMPLING METHODTotal 45 patients of Kitibha Kushta (Psoriasis) were randomly selected andmade in to a single group.ASSESSMENTAssessment of the patients was made based on the nidana of Kushta explainedin Ayurvedic classics. Statistical interpretation was based on Chi-square test Frequencies / Descriptive Contingency Co efficient testAnalysis was done through SPSS for Window (Statistical PresentationSystem Software), version 14.0, evaluation version (SPSS, 2005, SPSS Inc.New York).
  • 94.  Concept of Nidana and its Assessment in Kitibha Kushta94OBSERVATIONSTotal 45 patients were taken for the study and observations for thepresent study were done in three stages.1. General observations2. Specific observations3. Observations on nidana of KushtaGENERAL OBSERVATIONSAGEIn present study there was limitation for age. The patients of the agebetween 17-60 yrs were selected. It was found that the patients of age groupbetween 17-30 yrs are 20 (44.44%), 31-40 years are 10 (22.22%) 41-50 yrs are8 (17.7%), 51-60 are 07 (15.55 %).Table No.41. Distribution of Patients According To AgeAge in years No. of patients Percentage (%)17-30 yrs 20 44.44 %31-40 yrs 10 22.22 %41-50 yrs 08 17.7 %51-60 yrs 07 15.55 %Total No. of patients 45
  • 95.  Concept of Nidana and its Assessment in Kitibha Kushta95SEXIn the present study it was observed that more number of patients weremales i.e., 30 (66.66%) and female patients were 15 (33.33%).Table No.42. Distribution of patients based upon sexSex group No. of patients Percentage (%)Male 30 66.6 %Female 15 33.33 %Total No. of patients 45RELIGIONIn the present study it was observed that majority of the patients were HinduI.e. 35 (77.77 %) and 10 (22.22 %) were Muslims.Table no 43. Distributionof patients based upon religionRelogion No. of patients Percentage (%)Hindu 35 77.77 %Muslim 10 22.22 %Total No. of patients 45
  • 96.  Concept of Nidana and its Assessment in Kitibha Kushta96MARITAL STATUSIn the present study it was observed that majority of patients weremarried .i.e. 38 (84.44 %) and unmarried were i.e., 07 (15.55%).Table No.44. Marital status wise distribution of 45 patientsMarital Status No. of patients Percentage (%)Unmarried 38 84.44 %Married 7 15.55%
  • 97.  Concept of Nidana and its Assessment in Kitibha Kushta97OccupationIn this study it was observed that majority of the patients were farmersi.e. 25 (55.5 %), students 10 (22.22%), office workers 7 (15.5 %), andBusinessmen 3 (6.6 %).Table No. 45. Occupation wise distribution of 45 patientsOccupation No. of patients Percentage (%)Students 10 22.22 %Office workers 7 15.5 %Businessmen 3 6.6 %Farmers 25 55.5 %Total No. of patients 45SOCIO ECONOMIC STATUSIn the present study it was found that majority of the patients belong tolower Class i.e., 38 (77.77%), middle class were 5 (11.11 %) and Uppermiddle class were 2 (4.44%).
  • 98.  Concept of Nidana and its Assessment in Kitibha Kushta98Table No.46. Socio economic status wise distribution of 45 patientsSocio economic status No. of patients Percentage (%)Lower class 38 77.77 %middle class 5 11.11 %Upper middle class 2 4.44 %EducationIn the present study it was found that the majority of patients wereilliterate i.e., 29(64.44%), School going 6 (13.33 %), graduates 7 (15.55 %)and Post graduates were 3 (6.66%).Table No.47. Education wise distribution of 45 patientsEducation No. of patients Percentage (%)School going 6 13.33 %Ggraduates 7 15.55 %Post graduates 3 6.66 %Illiterates 29 64.44 %Total No. of patients 45
  • 99.  Concept of Nidana and its Assessment in Kitibha Kushta99ADDICTIONIn the present study it was found that the patients having the habit ofdrinking tea were 10 (22.22%), habit of smoking were 4 (8.88%), drinkingalcohol were 3 (6.66%), drinking coffee were 4 (8.88%) and tobacco chewingwere 4 (8.88%) and taking milk were only 20 (44.44%) respectively.Table No.48. Addiction wise distribution of 45 patientsAddiction No. of Patients PercentageMilk 20 44.44%Tea 10 22.22%Coffee 4 8.88%Smoking 4 8.88%Alcohol 3 6.66%Tobacco chewing 4 8.88%
  • 100.  Concept of Nidana and its Assessment in Kitibha Kushta100AGNIAmong 45 patents, 25 patients (45.44%) had mandagni, 15 patients hadvishamagni (33.33%), 5 patients (11.11%) had teekshna agni.Table No. 49. Agni wise distribution of 45 patientsAgni No. of patients Percentage (%)Manda 25 45.55%Vishama 15 33.33%Teekshna 5 11.11%Sama 0 0%DIETIn the present study it was found that the patients with vegetarian dietwere 10 (22.22%) and mixed diet were 35 (77.77%).Table No. 50. Diet wise distribution of 45 patientsDiet Pattern No. of patients PercentageVegetarian 10 22.22%Mixed 35 77.77%
  • 101.  Concept of Nidana and its Assessment in Kitibha Kushta101PRAKRUTHIIn the present study among 45 patients 15 patients (33.33%) had Vata pittaprakruthi, 25 patients (55.55%) had Vata kapha prakruthi and 5 patients(11.11%) belong to kapha pitta prakruthi.Table No.51. Prakruthi wise distribution of 45 patientsPrakruthi No. of patients Percentage (%)Vata pitta 15 33.33%Vata kapha 25 55.55%Kapha pitta 5 11.11%SARAIn the present study 6 patients (13.33%) were having a Avara sara, 35patients (77.77%) and 4 patients (13.33%) were having Pravara sara.Table No.52. Sara wise distribution of 45 patientsSara No. of patients Percentage (%)Avara 6 13.33%Madhyama 35 77.77%Pravara 4 8.88%SAMHANANAAmong 45 patents 43 patients (95.55%) had madhyama samhanana, 2patients (4.44%) has avara samhanana.Table No.53. Samhanana wise distribution of 45 patientsSamhanana No. of patients Percentage (%)Avara 2 4.44 %Madhyama 43 95.55%Pravara 0 0%
  • 102.  Concept of Nidana and its Assessment in Kitibha Kushta102PRAMANAAmong 45 patents 43 patients (95.55%) had madhyama samhanana; 2 patients(4.44%) has avara samhanana.Table No. 54. Pramana wise distribution of 45 patientsPramana No. of patients Percentage (%)Avara 2 4.44%Madhyama 43 95.55%Pravara 0 0%SATMYAAmong 45 patients 41 patients (91.11%) had madhyama satmya and 4patients (8.88%) had avara satmya.Table No.55. Satmya wise distribution of 45 patientsSatmya No. of patients Percentage (%)Avara 4 8.88%Madhyama 41 91.11%Pravara 0 0%SATWAAmong 45 patients, 43 patients (95.55%) had madhyama satwa and 2patients (4.44%) had avara satwa.Table No. 56 Satwa wise distribution of 45 patientsSatwa No. of patients Percentage (%)Avara 2 4.44 %Madhyama 43 95.55 %Pravara 0 0%
  • 103.  Concept of Nidana and its Assessment in Kitibha Kushta103VYAYAMA SHAKTIAmong 45 patents, 43 patients (95.55%) had madhyama vyayama shakti, and 2patients (4.44%) were having avara vyayama shakti.Table No.57. Vyayama Shakti wise distribution of 45 patientsVyayama Shakti No. of patients Percentage (%)Avara 2 4.44 %Madhyama 43 95.55 %Pravara 0 0%DESHAIt was observed that 38 (80.00 %) patients were belong to anoopa desha,2 patients (4.44 %) were belong to Jangala desha and 5 (11.11 %) patients werebelong to Sadharana desha.Table No.58. Desha wise distribution of 45 patientsDesha No. of patients Percentage (%)Anoopa 38 80.0%Jangala 2 44.44%Sadharana 5 11.11%
  • 104.  Concept of Nidana and its Assessment in Kitibha Kushta104Table No 59. Distribution of patients with Chief ComplaintsLakshanas No. of patients PercentageShyava 42 93.33 %Kina sparsha 36 80 %khara sparsha 36 80 %Parusha 38 84.44 %Sravi 2 4.44 %Kandu 6 13.33 %Vardhate cha samutpannam 43 95.55 %Snigdham 2 4.44 %Krishnasm 3 6.66 %Observations on nidana of Kushta:Patients eating fish with milk or curdsIn this study it was observed that 15 (75 %) patients were eating fish with milkand curds.Table No 60. Distribution of patients eating fish with milk or curdsPatients eating fishwith milk or curdsNo. of patients Percentage (%)Yes 15 75 %No 5 25 %Total non-veg pts 20
  • 105.  Concept of Nidana and its Assessment in Kitibha Kushta105CurdsIn this study it was observed that 25 patients (55.55 %) were eating curdat night and 15 (33.33 %) were eating curds in day time and 5 patients(11.11%) were not consuming curd.Table No. 61. Distribution of 45 patients who eats curdsCurds consumption No. of patients Percentage (%)During day time 15 33.33 %During night time 25 55.55 %Not eating curds 5 11.11 %AmlatisevanaIn this study it was observed that 14 patients (31.11 %) were consuming moreamla padartha.Table No.62. Distribution of patients doing AmlatisevanaAmlatisevana No. of patients Percentage (%)Yes 14 31.1 %No 31 68.88 %Aggravation of symptomsIt was observed that aggravation of symptoms observed more in visarga kalai.e. in 33 (73.33 %) patients.
  • 106.  Concept of Nidana and its Assessment in Kitibha Kushta106Table No.63. Distribution of patients based uponaggravation of symptoms:Aggravation ofsymptomsNo. of patients Percentage (%)Adana kala 12 26.66 %Visarga kala 33 73.33 %EATING HABITSExcessive eating habitsIn this study it was observed that 35 patients (77.77 %) were having excessiveeating habitsTable No. 64. Distribution of patients based excessive eating habitsExcessive eating habits No. of patients Percentage (%)Yes 35 77.77 %No 10 22.22 %
  • 107.  Concept of Nidana and its Assessment in Kitibha Kushta107Patients who eats without digestion of previous foodIt was observed that 11 patients (24.44 %) were eating without digestion ofprevious foodTable No. 65. Distribution of patients who eats without digestion ofprevious foodEats without digestionof previous foodNo. of patients Percentage (%)Yes 11 24.44 %No 34 75.55 %Patients who eats improper timeIt was observed that 28 patients (62.22 %) were eating at improper time.Table No. 66. Distribution of patients who eats at improper timeEats at improper time No. of patients Percentage (%)Yes 28 62.22 %No5. 17 37.77%
  • 108.  Concept of Nidana and its Assessment in Kitibha Kushta108Patients who frequently eats green leafy vegetables with milkIn present study it was observed that 12 patients were eating green leafyvegetables with milk.Table No. 67. Distribution of patients who frequently eats green leafyvegetables with milkfrequently eats greenleafy vegetablesNo. of patients Percentage (%)Yes 12 26.6 %No 33 73.33%Day Time SleepingIt was found that 16 (35.5 %) patients were doing day time sleepingTable No. 68. Distribution of patients who does day time sleepingpatients do day timesleepingNo. of patients Percentage (%)Yes 16 35.5 %No 29 64.44 %
  • 109.  Concept of Nidana and its Assessment in Kitibha Kushta109Suppression of VegasIt was observed that (73.33 %) patients were doing suppression of vegas.Table No. 69. Distribution of patients who do suppression of vegas:Patients who dosuppression of vegasNo. of patients Percentage (%)Yes 33 73.33 %No 12 26.6 %Kula VrittantaIt was observes that only 7 patients had maternal/paternal history.Table No. 70. Distribution of patients according to Kula Vrittanta:Kula Vrittanta No. of patients Percentage (%)Pitruja 4 8.88 %Matruja 3 6.66 %Nil 38 84.44 %
  • 110.  Concept of Nidana and its Assessment in Kitibha Kushta110Mental StatusIt was observed that 2 patients (4.44 %) were Anxious, 14 (31.11 %) werenormal, 1 (2.22 %) was fearful and 28 (62.22 %) were depressed.Table No.71. Distribution of patients according to Mental StatusMental Status No. of patients Percentage (%)Normal 14 31.11 %Anxious 02 4.44 %Depressed 28 62.22 %Fearful 1 2.22 %Vyadhi AdhishthanaIn 14 patients (31.11 %) the adhishthana of vyadhi was shareera and in 31patients (68.88 %) it was both shareera and manas.Table No.72. Distribution of patients according to Vyadhi AdhishthanaVyadhi Adhishthana No. of patients Percentage (%)Shareera 14 31.11 %Shareera and Manas 31 68.88 %
  • 111.  Concept of Nidana and its Assessment in Kitibha Kushta111Bathing HabitsIt was observed that 32 patients (71.11 %) were taking bath normally, 3patients after getting frightened (6.66 %), 6 patients after exposing to sun(13.33 %) and 4 patients (8.88 %) after exercise.Table No. 73 Distribution of patients based on bathing habitsBathing habits No. of patients Percentage (%)Normal 32 71.11 %Frightened 3 6.66 %After exposing to sun 6 13.33 %After exercise 4 8.88 %Total No. of patients 45
  • 112.  Concept of Nidana and its Assessment in Kitibha Kushta112Graha vikrutiIt was observed that 24 patients (53.33%) had graha vikrutiTable No. 74 Distribution of patients based on Graha vikrutiGraha vikruti No. of patients PercentageYes 24 53.33%No 21 46.66%RESULTS:1. Based on age shows, between 17-30 years had a greater risk of acquiringKitibha Kushta 44.44 % when compared to the age group of 31-40 years22.22%, and 41-50 years 17.7% and 51-60 years 15.55%.2. Based on religion it was observed that Hindu’s had a higher incidence77.77% when compared to other religion like Muslims 22.22%.3. It was observed that farmers had a greater risk of acquiring KitibhaKushta 55.55%, when compared to office workers 15.55%,students22.22% and business men were at the lowest risk with 6.66.4. Based on Kala, occurrence was more in Visarga Kala i.e. 73.33% than inAdana Kala 26.66%.5. It was found that Anoopa desha people were more prone to get KitibhaKushta i.e. 80.00%.
  • 113.  Concept of Nidana and its Assessment in Kitibha Kushta1136. It was observed that compared to vegetarians in people with mixed diethabit are more prone for Kitibha Kushta i.e. 77.77%.7. Only in 15.44% people Anuvamshata is found as causative factor forKitibha Kushta.8. It was observed that patients eating fish with milk or curds are mostlikely to get Kitibha Kushta i.e. 75% in mixed diet group.9. Patients who were eating curd at night were more prone to get KitibhaKushta i.e. 55.55%.10. It was observed that 68.88% patients had mano-shareera vyadhiadhishthana while only 31.11% patients had shareera as vyadhiadhishthana.11. Only in 73.33% people suppression of vegas is found as causative factorfor Kitibha Kushta.12. It was observed that Depressed patients had a greater risk of acquiringKitibha Kushta i.e. 62.22%.13. It was observed that 26.66 % patients were eating green leafyvegetables with milk14. Graha vikruti is found in 53.33% patients.
  • 114.  Concept of Nidana and its Assessment in Kitibha Kushta114DISCUSSIONAny research work without being discussed about its nature, utility andimportance is said to be incomplete. Vitarka (ability of discussing on the basisof Shastras) is one of the six features to be present in a good Scholar (Ch. Su.9/27). Any hypothesis /principle, if to be proved, must be discussed thoroughlyfrom all angles. This has been clearly told by Acarya Caraka long back (Ca. Vi.8/37). After the formation of a hypothesis, it has to be tested and observed byvarious methods and eventually the results are obtained. All these should bewell supported by proper reasoning or logic and finally concluded., Ahypothesis gets established as a principle if the reasoning given is satisfactory,otherwise, it remains as it is. Acharya Charaka has very precisely said that,even the truth may not accepted, as it is without the logical interpretation.Charaka has clearly stated in Sutra 25th Chapter that,Shastra sahit tarka sadhananam” (Ch. Su. 25/40)Discussion improves the knowledge and discussion with Sastra becomesbase establishment of the concept. Thus discussion is the most essential phaseof any research work. Keeping in this view the facts which have emerged fromthe conceptual, and observational study have been discussed here.DISCUSSION ON REVIEWTITLE OF THE STUDYToday in many ways people have greater opportunities of better life thanever before. Still it is clear that they need to evolve some new strategies or tofollow the golden old rules, which are proved for milleniums, in each and everyfield of life. As Ayurveda aims to protect the health of heathy individual andlater to cure the diseased ones. So, the diet and regimen are such mostimportant field of life. Then also the popularity of fast food, heat of earningmore and more leading the individuals to compromise with their health is
  • 115.  Concept of Nidana and its Assessment in Kitibha Kushta115greater due to the fast life. According to Ayurveda this can be classified as"Prajnaparadha. Due to the demand of time, most of the people are bound to dosuch things, which adversely affect the health. The people who are healthconscious mostly know about "what to eat?", but least about "how to eat?" and“how to live’ . The dietetic code or the rules for diet, code of conduct in thesociety are preserved by our traditions up to some extent, but there is a bigquestion about their awareness in todays society. People basically know verylittle about them and they who know are little bothered to obey such and allsuch summations leads to various ailments. Here, I am dealing with one amongthe such ailment .i.e. kushta which is pervading significantly faster.DISCUSSION ON NIDANADefinitionThe factor which causes rogotpatti by vitiating the dosha is callednidana. All the definitions of nidana in general mean that nidana is anetiological, causative factor for a disease manifestation, gives rise to a diseaseor karana for a vyadhi. Nidana word is also used as synonymous to hetu inmany contexts in the classiscs. definitions on Nidana stated by Madhukoshaseems to be most appropriate i.e. A Particular factor can be called as nidanaonly when it will develop a complete disease process (iti kartavyata) in thebody either immediately or after a certain period. Chakrapani says “nidana”relates to both etiology (vyadhi janakam) as well as diagnosis (vyadhibodhakam) of diseases. So, vyadhi janak nidana refers to “hetu” whereasvyadhi bodhak nidana refers to “nidana panchaka”. The word nidana refers tothe factor which produces vyadhi.SynonymsVarious synonyms of nidana have been used in Ayurvedic lexicons butnidana and hetu used most frequently. Word nidana used for six times inCharaka Sutra sthana and hetu is used for fourty four times while in nidana
  • 116.  Concept of Nidana and its Assessment in Kitibha Kushta116sthana word nidana is used for fifty one time and hetu is used for sixteen times.Word “nidana” seems to be more appropriate.Classification of Hetu1. a) Asatmendriyartha Samyoga b) Prajnaparadha c) Parinaama.a) Asatmendriyartha Samyoga : The five Indriya Buddhi obviouslycorrespond to the area of the cerebral cortex where the five kinds of sensationsare experienced. The events of the external world are intimated to the mind(Manas) through these Indriya Buddhi. Subsequent events leading to Vijnana(knowledge) such as the sorting out of ther sensory data, their interpretation,orientation, integration and ideation are dealt with by the association and silentareas of the cortex which may be considered as mind. The mind enjoys thesupreme place in the body being the coordinator. Every event in the body isdirectly or indirectly, consciously or uncosiously controlled by the mind,through central nervous system, autonomic nervous system or endocrinesystem. Manas are highly inquisitve to know regarding the environment so thatthe body may adapt accordingly. The entire environment is classified into fivesense objects. As long as the external stimuli orginating from five sense objectsare within normal limits the body response is also within physiological limitswhich are Satmya (suitable) for body. But if the stimuli cross the normal rangethey become stressful and as soon as stressful stimuli reach the Manas, theimbalance in Dosa begins which may set in the diseases if the body fails toadopt.Acharya Charaka has given imporantance to each of the nidana atdifferent places in sutra, nidana and sharreara sthana of Charaka samhita. InDheeraganjeevatiye Adhyaya, Charaka says the causes of diseases relating toboth (mind and body) are three fold i.e. ayoga, mithya yoga and ati yoga ofKala, budhhi and indriyartha. In Tisreshniye adhyaya, again Charaka hashighlighted these nidanas in different order. Chakrapani says Kala, Artha and
  • 117.  Concept of Nidana and its Assessment in Kitibha Kushta117Karma are mentioned in the order of their importance. Kala is the mostimportant factor in as much as it is indispensable in character i.e.dushpariharya. Then comes Prajnaparadha. It is the defect in the mentalfaculties that leads to the Asatmendriyartha Samyoga. Even thoughAsatmendriyartha Samyoga arise out of Prajnaparadha only, still owing to itsproximity to the diseases, the former is further categorized separately. On otherhand, Prajnaparadha leads to somatic (Kayaik), oral (Vachik) and psychic(Manasik) ailments. that al though all the three karnas are the important for theproduction of vyadhi but out of all these Asatmendriyartha smyoga deservesthe first place. It is true that prajnaparadha appears to be the original and mostimportant causative factor of all diseases. But at the same timeAsatmendriyartha samyoga being the nearest cause needs special mention.Being unavoidable, kala also constitute its own importance. But then, it issecondary i.e. Apradhan because it can cause disease only in the event ofAtiyoga, ayoga or mithya yoga of indriyas with their respective objects.b) PrajnaparadhaActions have been described to be of three types (i) related with speech(ii) related with mind and (iii) related with body. The excessive use, disuse andmisuse of any of these actions lead to the development of a disease process. Itis supposed that when Raja or / and Tama qualities predominate, there isderangement of the understanding (Dhi), will (Dhrti) and Memory (Smrti).Thus, in short any misconception by the intellect followed by misconduct isknown as volitional transgression. So one should exercise restrain not toindulge in over-use, disuse and mis use of activity related to speech, mind orbody as the result of misconception. This action leads to stress on his body andmind which cause disturbance in the Dosika system of the body following theneurohumoral and endocrinal disturbance. There are Modern evidence whichsupport the fact where the organ response to Emotions are incorporated(Cardiovascular response, Gastro intestinal response, skin response, respiratory
  • 118.  Concept of Nidana and its Assessment in Kitibha Kushta118response, etc are enlisted) John Hunter (1728-1793) had personal experience ofthe effects of mind on body. He had noted how his attacks of angina pectoriswere brought about whenever his mind was agitated. On the other hand, it maybe opined that Prajnaparadha leads to a guilt consious which depresses theimmune system of body rendering it ill. The effect of unhealthy actions of bodyis obviously clear. The above explanations are for the actions of speech andmind.b) Parinaama.If a particular season manifests itself excessively, this should beregarded as excessive utilization of time; if the season manifests itself less thanrequired, it would be non – utilization. If on the other hand, characteristics of aseason are contrary to the normal ones, this would be wrong utilization (forexample, rainfall in winter ,cold in summer etc). In addition to the effect ofabnormal season on human body producing diseases, there is a normal cycle ofDosa in relation to season, day and night, intake of food and age. In relation tothese periods some of the Dosa get excited and the others subsided. So thediseases connected with those Dosa either develop or participate to getexaggerated. The abnormal season as well as the normal season and other timefactors are intimately related with the disease process, one can not escape theireffect on the body; however to minimize them and to adapt accordingly theprinciples of personal hygeine are framed.
  • 119.  Concept of Nidana and its Assessment in Kitibha Kushta119Application of Trividha hetu sangraha in causation of Kushta :Trividha hetu sangrahaPragnyaparadh Kala Asatmendriyartha samyoga(Visarga kala) (Sankramik hetu)Dhi vibhramsha Dhriti vibhramsha Smriti VibhramshaDerangement of Unable to stop the ahita karma To forget theunderstanding knowledgeof Hita karmawhich he does beforeMithya ahara vihara, papa karmaKushtaAsatmendriyartha samyogaShabda Sparsha Rasa Roopa GandhaAyoga Atiyoga Mithyayoga HinayogaAnadana Atyashana Vishmasana AlpadanaMatra viruddha Matra viruddha Intake of incompatible diet Matra viruddhaVidhi viruddha Vidhi viruddha except rashi Vidhi viruddha
  • 120.  Concept of Nidana and its Assessment in Kitibha Kushta1202. Sannikrishta, Viprakrusta, Vyabhichari, PradhanikaSannikrishta: The closest cause of vyadhi is called as Sannikrishta hetu.All the ahara vihara pertaining to nidan of Kushta can be considered asSannikrishta hetu.Viprakrusta: The distant cause of the vyadhi is called as Viprakrishtahetu. Chakrapani says, immediate causes of a disease are the vitiated doshasand distant causes are the unwholesome contacts with the objects of senses.The distant cause of rakta pitta may be ati santapa of jwara. The distant cause iscomman of all the diseases are the previous sinful acts i.e. adharma. Purvajanam krit papa karma can be considered as Viprakrusta nidana for kushta.Vyabhichari: When certain opposing facors are acting against aparticular etiological factor, such a time, dushyabala etc, then under such acondition, that particular cause does not produce a disease. Then it is called avyabhichari hetu. Chakrapani in Prameha nidana says “Specific features ofetiological factors, doshas, and dhatus determine the bodily susceptibility to themanifestation of a disease. When the equilibrium of these three factors isdisturbed or when they do not support each other or when they are weak due totemporal factors, then either the disease does not manifest or the disease is verymild or all its symptoms are not properly manifested. If the situation arecontray to what is mentioned above, the corresponding results will also beotherwise.
  • 121.  Concept of Nidana and its Assessment in Kitibha Kushta121Table No.75 Nidana, Dosha, Dushya relation in causation of disease :Etiological factors+ Dosha + DhatuNo association No diseaseEtiological factors+ Dosha + DhatuLateassociationProlong course ordelay in manifestation(chronic disease)Etiological factors+ Dosha + DhatuWeak or insufficientassociationMild disease orincomplete disease orirregular symptomsEtiological factors+ Dosha + DhatuSudden association Acute diseaseEtiological factors+ Dosha + DhatuPowerfulAssociationFatal (or) threateningdiseaseDosha hetu, Vyadhi hetu and Ubhaya hetu :Dosha hetu : All the Nija Vikara occurs invariably due to the vitiation of Vata,Pitta and Kapha. As the bird can not transgress its own shadow even throughflying throughout the day, so also no endogenous disease caused by thedisturbance of the equilibrium of Dhatus can not occur without the vitiation ofVata, Pitta and Kapha. So, considering the location, signs, symptoms andcauses of vitiation of Tridosa, all the disease caused by them are diagnosed onthe basis of the vitiation of respective Dosas.All the bodily diseases arising outof the disturbance of the equilibrium of Dhatus are ultimately caused bynothing else but by thedisorder of Tridosa. It is only the exogenous diseaseswhich are caused otherwise, the endogenous diseases are at times followed bythe exogenous ones and even the exogenous ones are followed by theendogenous ones of the most vehement type. One should accordingly start thetreatment paying due regard to the secondary development (Anubandha) andthe primary nature of the disease.Vyadhi hetu: So, Vyadhi hetu means those specific etiological factorsresponsible for the particular diseases, irrespective of dosha.Sushrutha haddescribed sankramika nidana which can be incorpaorated in this group.
  • 122.  Concept of Nidana and its Assessment in Kitibha Kushta122Bahaya and Abhyantara hetu :Bahaya hetu : External factors like food, behavior, seasons, poisons etc. arecalled as bahya hetus or external factors. Bhela Samhita has described KushtaRoga in both Nidana & Chikitsa Sthana. Specially indicated, polluted water asa etiological factor of Kushta. So, polluted water can be considered as bahayahetu.Abhyantara hetu : Vitiated doshas are called as intrinsic factors orAbhyantara hetus. Sapta dushya of Kushta i.e tridosha, rakta, twak, mamsa,ambu and lasika can be considered as Abhyantara hetu.Utapadaka and Vyanjaka hetu :Utapadaka hetu : Utpadaka hetu means the real causative factors of theaccumulation of doshas.Virudhahara, Ajeerna, Adhyasana, Matsya (chilchima) with dugdha can beconsidered as Utpadaka hetu.Vyanjaka hetu : It act as a triggering factor. Aggravation of Kushta in winterseason can be considered as Vyanjaka hetu.Dosha Gati :Following questions strikes in mind regading roga marga. “Tatra shakharaktadayo dhatu twak cha sa bahayo roga marga” in this context whether margaword is used for srotas or adhisthana? Why rasa dhatu is not mentioned hereand whether twak can be taken as substitute for rasa dhatu? To me it is marga.So far as Kushta is concerned the layers of skin are far more omportant. It isthe obstruction in the marga which brings about Kushta. Rasa is either plasmaor watery portion of the skin. The skin carries. Rasa is different from rakta.When they intermingle with each other blood is formed. The watery portion ofRasa is located in the layers of skin participates in the formation of Kushta.
  • 123.  Concept of Nidana and its Assessment in Kitibha Kushta123Disscission on anatomy and physiology of SkinThe skin is not simply a barrier separating a body’s internal and externalenvironment, it is also the vehicle for the biological and social communicationto the external world. Any type of change in skin may indicate homeostaticimbalance in the body. Therefore before going to diagnosis and treatment ofskin disease it is essential to know the significant value of skin i.e. RacanaSarira, Kriya Sarira and Bhruna Vijnana (Embryology). Following corelationcan be done. Dr. Ghanekar has written commentary on Sushruta ShariraSthana. He has correlated the layers of skin mentioned by Sushruta with thelatest anatomy of skin as under.S. No Ancient Term Modern Term Types of skin1 Avabhasini Stratum Corneum Epidermis2 Lohita Stratum Lucidum Epidermis3 Shweta Stratum Granulosum Epidermis4 Tamra Malpighian layer Epidermis5 Vedini Papillary Layer Dermis6 Rohini Reticular Layer Dermis7 Mamsadhara Muscular layer DermisKriya Sarira :To understand the Kriya Sharira (physiology) of skin it is essential tocheck its relation with Dosa, Dhatu and Mala like basic structural andfunctional units of the body.(i) Twacha and Tridosha: There are three Dosas in our body. They are situatedin specific places, which have been described in texts. According to thatTwacha has been mentioned as one of the sites of Vata and Pitta Dosa(A.H.12/1, 2)
  • 124.  Concept of Nidana and its Assessment in Kitibha Kushta124(a) Twacha and Vata Dosa: Charakacarya has described Twacha as aSparsanendriya adhisthana (Ch.Su.8/10). Sparsh i.e. Touch sense is the subjectof sparsanendriya which is performed by Vata Dosa.(b) Twacha and Pitta Dosha: Bhrajaka Pitta is one of the types of Pitta which islocated in skin. Bhrajaka Pitta is also called as Bhrajakagni, which is alsosituated in Twacha and forms the lusture of the skin.(c) Twacha and Kapha Dosa : The snigdhata slaksnata, Mrduta, Sitata,prasanata and snighdhavarnata are the attributes to the presence(ii) Twacha and Sapta Dhatu :a) Twacha and Rasa Dhatu : At several places Twacha has been used, as asynonyms of Rasa Dhatu like Twaksara Purusa etc. In context of Kushta Roga,Susruta has mentioned that in early stages Kushta is situated only in theTwacha. Dalhana comments on it and says that Twachasrita i.e. RasasritaKushta (Su.ni. 5/2). Chakrapani has described the six layers of skin firstamongst them is Udakadhara its main work is to maintain the water content ofthe body. Rasa Dhatu is also Jala Mahabhuta Pradhana in Panchabhauticaconstitution. So one can consider the relation between Rasa Dhatu and Twacha.b) Twahca and Rakta Dhatu : Acarya Susruta has described thefunctions ofRakta Dhatu as Varna Prasadana. i.e. It imparts the colour of skin, Mamsa Pustii.e. Nourishes the Mamsa Dhatu in the body. (Su.Su.15/6). Rakta Dhatu is alsoresponsible for the proper conduction of tactile sensation of skin.c) Kwacha and Mamsa Dhatu : Twacha is closely connected with MamsaDhatu because it is a Upadhatu of Mamsa Dhatu (Ca.Ci.15/7). So for thedevelopment and Nourishment of Mamsa Dhatu is concerned Twacha is veryimportant factor.(iii) Twacha and mamsa:Mala (Annamala), Mutra and Sweda are the main three malas in theoutcome of sara kitta vibhajana process during Dhatvagnivyapara. The kitta
  • 125.  Concept of Nidana and its Assessment in Kitibha Kushta125part is excreted out from the body. The Sweda is the mala of Meda Dhatu,which is excrete out from the Svedavahi Srotas of Twacha. Sweda maintainsthe Luster and Humidity of skin (Ca.Su.15/5). According to Ayurveda Nailsand Hairs are the Mala of the Asthidhatu and Tvakgata Sneha is the Mala ofMajjadhatu. (Ca.Su.46/271) From the above facts it is easy to understand therelation between Twacha and Dosa Dhatu and Mala the basic units of the body.Kustha involve morbidity of seven dravyas. They are Tridosa and four Dhatus(Rasa, Rakta, Mamsa and Lasika). So from above description one can easilyunderstand the importance of these units. The Vikrti of these seven essentialslead’s to the occurrence of many skin diseases. i.e. Occurrence of many KusthaRogas.Disscission on Classification of Kushta :The word Kushta is a broad term, which covers almost all the skindiseases. Kustha is produced invariably by the vitiation of the seven factors i.e.3 Dosas and 4 Dusyas. But different types of pain, colour, shape, specificmanifestation etc. are found in Kustha because of Anshanshakalpana of theDosas. Accordingly Charaka Kusthas are in fact of innumerable types, but forsystemic study they are classified into two major groups 7 Maha Kustha & 11Kshudra Kustha.Disscission on Nidana of kushtaThe nidana of Kushta can be classified into sannikrishta andviprakrishta. The Aharajanya, Viharjanya, Chikitsa sambandhi and Sankramikacan be considered as sannikrishta while Daivapacharajanya nidanas can beconsidered as viprakrishta hetu.Disscission on Viruddha Ahara : Whether or not certain foods or food combinations are problematical is avery individual matter, but unless you have an actual allergy, most of the
  • 126.  Concept of Nidana and its Assessment in Kitibha Kushta126symptoms stemming from eating a specific food or food combinationthat disagrees with you are likely to be relatively mild and minor. Ishould note, for the record, that true food allergies are rare, althoughmany people are bothered by intolerances to specific foods that maytrigger physical symptoms Ayurvedic Medicine also has rules about incompatible foodcombinations based on the idea that some foods are toxic whencombined and some - deemed unsuitable to an individuals constitution -may affect the bodys ability to resist disease. You can find any numberof fad diets that make claims that certain combinations of food are eithergood or bad for you.Desha Viruddha:From classical references as dicussed in review of literature, one canconclude that, Desha Dosha dominancy Rasa dominancyAnupa : Kapha - Pitta + MadhuraJangala : Vata - Pitta + KatuAnupa Sadharana : Kapha - Lavana + AmlaJangala Sadharana : Vata - Tikta + KasayaNow, according to Loka-purusa samya theory, the person of Anupadesha has dominancy of Kapha dosa and Madhura rasa. Same way the personof Jangala has dominancy of Vata dosa and Katu rasa. While, Anupa Sadharanaand Jangala Sadharana have dominancy of Kapha and Vata dosa respectivelyand Lavana + Amla and Tikta + Kasaya rasa respectively. Kushta is mostcomman in anupa desha and if a person indulges in Ati amla lavana ahara, itleads to the kushta roga. Ati amla and lavana rasa are one among the nidana ofkushta as mentioned in ayurvedic classics.Viruddhahara causes many diseases. It is not possible to give treatmentof each and every disease separately. So according to Sushruta. Stoppage of
  • 127.  Concept of Nidana and its Assessment in Kitibha Kushta127the intake (consuming) of Viruddhahara is the first principle of treatment.Charaka has stated, by avoiding things (Viruddhahara) that give rise to vitiationand practising those (Hita Ahara) that help in bringing Samavastha of Dhatus,then vitiated elements do not persist and the vitiated element are continuouslybrought into existence. (Ch. Su. 16/36). Charaka has given more weightage forthe avoidance of causative factors. (Ch. Su. 18/46). But, one cannot get healthby only avoiding the causative factors or one cannot get relief from disease byonly avoiding the causative factors.Pathogenesis By Viruddhahara :The body and disease both are product of food. The distinction ofhappiness and sorrow results from the distinction of wholesome (Hita Ahara)and unwholesome diet (Ahita Ahara). in other words, which elements (Bhava)in their wholesome combination give rise to the well being of man, sameelements, in their unwholesome combination produces various kinds ofdiseases. Almost all the classics mentioned Viruddhahara as the causativefactor for Kushta.Discission on “Adhyasana, Visamasana, Samasana, Atyasana ”Agni has an important role to play in the physiological functioning ofbody. Jatharagni has been considered to be prime among all Agnis. Thereforethe functioning of other Agnis, Dhatvagni and Bhutagni are dependant upon thestrength of Jatharagni. If food is not taken in accordance with the four types ofthe thermal intensity then it becomes incompatible. Charaka has rightlymentioned that intensity of Agni depends on Prakrti (habitus) (Ca. Vi.6/12).Discussion on dugdhati seavnam :All the dugdha may not cause kushta rather Apkwa dugdha which hasguru,snigdha and sheeta guna can cause kushta( A.S 6/61). There are eightvarities of ksheera has been told by our acharyas out of which mahisha ksheera
  • 128.  Concept of Nidana and its Assessment in Kitibha Kushta128has gurutara, maha abhisyandi, snigdhatara and sheeta qualities which seems tobe more nearer to be called nidana of kushta.Discussion on dadhi sevana :As per Brihat trayi, Mandak Dadhi does tridosha kopana. It has thequalities like guru, snigdha, maha abhisyandi etc. Hence, we can come outwith conclusion that why dadhi has mentioned in the nidana of kushta Nidanaof Kushta.Discussion on Lakucha sevana :Because of rooksha guna does vata prakopa, amla and ushna guna doesvata pitta kopana,hence, it does tri dosha prakopa. This is the reason charakahas considered it most ahit phala (most unwhole some fruit) Ch.Su 25/39Discussion on atyambu sevana :River water :As per Charaka and Sushrutha rivers from Sahaya, vindhya mountains causesKushta.Types of jala as per Desha :Anoopa desha jala hasAbhishyandi Madhura Snigdha Guru Mandagnikrita properties which resembles the nidana of Kushta.Discussion on stress as causative factor of psoriasis from Ayurvedicperspective :The direct psychological references are available in the etiologicalfactors of Kustha. Blaming of good persons like saint, murder, stealing ofothers properties etc. have also been mentioned as the Nidana of Kustha(A.H.Ni. 14/1,2). Such anti social and misbehaviour and sinful activities makeserious and long standing impact on mind of persons who are indulging in it.
  • 129.  Concept of Nidana and its Assessment in Kitibha Kushta129Bhaya (fear), Krodha (anger), Shoka(grief) etc. are originated by such activitiesleading to vitiation of Dosha which leads to Kushta. Nidanas like Papakarmaseven causes affliction to the second generation (A.H.Ni. 14/2). Thisobservation highlights the seriousness of psychic factors in the etiology ofKushtha.Discussion on Daivapacharajanya nidana of Kushta :1. Papa karma, Vipram gurum garshyatam, Purvakrut karma, Gohatya, Useof money or material acquired through theft, Sadhu ninda, apman and vadha.All these nidanas can be Eha janam krita i.e. Pourusha karma or Anya janamakrita i.e. Daiva karma.2. KarmaDaiva karma Pourusha karmaSheshtha Madhyama AvaraSukha Madhyama sukha Heena sukhaDheerga ayu Madhyama ayu Heena ayuChakrapani says It is only the major actions of the previous life whichleaves their results to be suffered in present life. Minor acts which can becounteracted by acts like atonement do not have that continuity . So, the personhas to suffer till his papa karma gets vanished. Ayurvedic refences whichsuggests importance of graham, rashi, nakshatra etc. in the causation of diseaseIn the context of sukha sadhya vyadhis, acharya Vagbhata used the wordgraheshu. Commenting over this, Arundatta opines that when grahas will be attheir respective favuorable positions, then the vyadhi will be sukha sadhya.
  • 130.  Concept of Nidana and its Assessment in Kitibha Kushta130Discussion on Observations and ResultsTotal number of patients taken for observational study were 45 includedunder one group. Distribution of patients based on age shows that patients ofthe age group of 17-30 had a greater risk of acquiring Kitibha Kushta whencompared to other age groups. This shows that those in the active age group aremore involved.Distribution of patients based on sex shows a general higher incidence inmales i.e., 30 (66.66%) males 55%, than in female 45%. Stress factor in malescannot be ignored in this context.Based on religion it was seen that Hindu’s had a higher incidence 35(77.77 %) wereas 10 (22.22 %) were Muslims. However this can not be takenfor significance since it only justifies the population predominance.In this study it was observed that majority of the patients were farmersi.e. 25 (55.5 %), students 10 (22.22%), office workers 7 (15.5 %), andBusinessmen 3 (6.6 %) may be involvement of frequent exposure to cold dampconditions.Based on Kala, It was observed that aggravation of symptoms observedmore in visarga kala i.e. in 33 (73.33 %) patients. Visarga kala is sheetapradhana kala and also aggravated period for the kapha. Vata kapha doshaswhich are predominant causes aggravation of Kitibha.Discussion on the role of Mithya AharaIt was observed that 20 (44.44%) were taking milk particularly buffalosmilk which is said to be maha abhishyandi.
  • 131.  Concept of Nidana and its Assessment in Kitibha Kushta131In the present study it was found that the patients with vegetarian dietwere 10 (22.22%) and mixed diet were 35 (77.77%). However among the meateaters high incidences of Kushta was noted.It was observed that 38 (80.00 %) patients were belong to anoopa desha,2 patients (4.44 %) were belong to Jangala desha and 5 (11.11 %) patients werebelong to Sadharana desha. Since the study was conducted in anoopa desha thereported cases were naturally higher.In this study it was observed that 15 (75 %) patients were eating fishwith milk and curds. As fish is said to be most abhishyandaOur Acharyas strictly contraindicated consuming curd at night and inthis study it was observed that 25 patients (55.55 %) were eating curd at nightand 15 (33.33 %) were eating curds in day time and 5 patients (11.11 %) werenot consuming curd.In this study it was observed that 14 patients (31.11 %) were consumingmore amla padartha ahra. Amla rasa does pitta and rakta prakopa, mamsavidahana and kapha kopana. All this leads to precipitate Kushta.In this study it was observed that 35 patients (77.77 %) were havingexcessive eating habits which may lead to mandagni and agni dushti is said tobe cause of occurrence of all the disordersGraha vikruti is found in 53.33% patients. It significantly shows thatpapa karma influences the graha gati. The unfavourable grahas leads toproduction of Kushta.
  • 132.  Concept of Nidana and its Assessment in Kitibha Kushta132CONCLUSION Nidana or etiological factors are source to understand a disease, they arealso key to treat the patients. Considering Kitibha, it is one among the main twak vikara hamperingnot only physical, mental but also social status of patients by virtue of itschange in external appearance. As far as knowledge of nidana of specially Kitibha among lay man isvery poor, there is an immediate need to increase awareness aboutimportant contribution of Ayurveda, such viruddha ahara etc. forprevention of diseases. In the changed circumstances and varied life style, as a result ofmodernization and globalization, the core idea of nidana explained byour age old classics, still observed very much resolved. In Kitibha Kushta, graham virtuti, dadhi sevana, adhyashana are foundhighly significant nidana. The disease psoriasis when evaluated on the parameters of nidanapanchaka of Ayurveda stress is found highly significant. Further literary experimental, clinical researchers are essential to knowthe truth in extensive manner.
  • 133.  Concept of Nidana and its Assessment in Kitibha Kushta133SUMMARY“Concept of Nidana and its assessment in Kitibha Kushta (psoriasis)” ispresented in 7 sections. These sections are as follows – Introduction, Review ofliterature, Methodology of research, Observation and results, Discussion,Conclusion and Summary. The introduction gives an overview on importance of nidana, Kushtaand need for selection of the study and objectives. Review of literature comprises of following headings.o Anatomy and Physiology of Skin.o Historical review and classification of Kushtao Lakshana of Kitibha Kushtao Nidana of Kushta and etiology of Psoriasis. Methodology of research explains aims and objectives, source ofpatients, study design, criteria for inclusion and exclusion criteria. The fourth section Observations and the result present relevant tablesand graphs based on the study. The observation percentages werestatistically analyzed and explained. Discussion part deals with salient points on literary aspects,interpretation of observations and results of the study. Conclusion highlights the inferences drawn on the basis of the studyand recommendations for future trials.
  • 134.  Concept of Nidana and its Assessment in Kitibha Kushta134BIBLIOGRAPHY1) Vaman Shivaram Apte Sanskrit English dictionary 2ndedition NewDelhi CSS p 6432) Vangiya Satkarisharma Tarka Samgraha 4thedition VaranasiChaukhambha Sanskrit Samsthan 2003: p363) Acharya Trikamji Yadavaji, Charaka Samhita ChakrapaniCommentary reprint 4thedition, Varanasi Chaukhambha SurabharatiPrakashan 1994:p 934) Shastri,S Upadhyaya Madhava nidana with madhukosha commentaryby Srikanthadutta & Vijayarakshita 30thedition VaranasiChaukhambha Sanskrit Samsthan 2002 p 205) Shastri,S Upadhyaya Madhava nidana with madhukosha commentaryby Srikanthadutta & Vijayarakshita 30thedition VaranasiChaukhambha Sanskrit Samsthan 2002 p 206) Acharya Trikamji Yadavaji, Charaka Samhita ChakrapaniCommentary reprint 4thedition, Varanasi Chaukhambha SurabharatiPrakashan 1994:p 937) Shastri,S Upadhyaya Madhava nidana with madhukosha commentaryby Srikanthadutta & Vijayarakshita 30thedition VaranasiChaukhambha Sanskrit Samsthan 2002 p 208) Shastri, S Upadhyaya Madhava nidana with madhukosha commentaryby Srikanthadutta & Vijayarakshita 30thedition VaranasiChaukhambha Sanskrit Samsthan 2002 p 209) Shastri,S Upadhyaya Madhava nidana with madhukosha commentaryby Srikanthadutta & Vijayarakshita 30thedition VaranasiChaukhambha Sanskrit Samsthan 2002 p 2010) Acharya Trikamji Yadavaji, Charaka Samhita ChakrapaniCommentary reprint 4thedition, Varanasi Chaukhambha SurabharatiPrakashan 1994:p 92
  • 135.  Concept of Nidana and its Assessment in Kitibha Kushta13511) Vagbhata, Ashtanga Hrudaya with Sarvanga Sundari and AyurvedaRasayana commentaries, edited by Harishastri pParadkar, KrishnadasAcademy 2005: p 1412) Dev.R.R.Shabda kalpadruma 2 Edition Delhi Nag Publications 2002p54713) Bhattacharya S.T.Shabdashtoma Mahanidhi; 3rdEdition ChaukhambhaSanskrit Samsthan Varanasi 1967 P51814) Vagbhata, Ashtanga Hrudaya with Sarvanga Sundari and AyurvedaRasayana commentaries, edited by Harishastri Paradkar, KrishnadasAcademy 2005: p 43915) Upadhaya Yadunandana, Madhava Nidana 28thedition VaranasiChaukhambha Sanskrit samsthan1999(I):p 2116) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 1417) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 7418) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 19319) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 29620) Vagbhata, Ashtanga Hrudaya with Sarvanga Sundari and AyurvedaRasayana commentaries, edited by Harishastri pParadkar, KrishnadasAcademy 2005: p 1321) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 7422) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 29723) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 51
  • 136.  Concept of Nidana and its Assessment in Kitibha Kushta13624) Vaman Shivaram Apte Sanskrit English dictionary 2ndedition NewDelhi CSS p 64325) Acharya JT Sushruta Samhita of Sushruta with Nibandha Sangrahacommentary of Dalhana, Varanasi Chaukhambha SurabharatiPrakashan reprint 2003 p 59626) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 29727) Upadhaya Yadunandana, Madhava Nidana 28thedition VaranasiChaukhambha Sanskrit samsthan1999(I):p 1828) Acharya JT Sushruta Samhita of Sushruta with Nibandha Sangrahacommentary of Dalhana, Varanasi Chaukhambha SurabharatiPrakashan reprint 2003 p 629) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 25330) Acharya JT Sushruta Samhita of Sushruta with Nibandha Sangrahacommentary of Dalhana, Varanasi Chaukhambha SurabharatiPrakashan reprint 2003 p 331) Upadhaya Yadunandana, Madhava Nidana 28thedition VaranasiChaukhambha Sanskrit samsthan1999(I):p 2132) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 7733) Upadhaya Yadunandana, Madhava Nidana 28thedition VaranasiChaukhambha Sanskrit samsthan1999(I):p 2134) Upadhaya Yadunandana, Madhava Nidana 28thedition VaranasiChaukhambha Sanskrit samsthan1999(I):p 2135) Upadhaya Yadunandana, Madhava Nidana 28thedition VaranasiChaukhambha Sanskrit samsthan1999(I):p 2136) Upadhaya Yadunandana, Madhava Nidana 28thedition VaranasiChaukhambha Sanskrit samsthan1999(I):p 21
  • 137.  Concept of Nidana and its Assessment in Kitibha Kushta13737) Cortan & Kumar Robins Pathologic Basis Of Disease 6thEdition 2001,Harcort Publications India,New Delhi p138) Marc E Grossman, A Clinical guide To Dermatology; 4thEdition,Informa Health Care 2006, p 2239) Acharya Trikamji Yadavaji, Charaka Samhita ChakrapaniCommentary reprint 4thedition, Varanasi Chaukhambha SurabharatiPrakashana 1994:p 33740) Acharya JT Sushruta Samhita of Sushruta with Nibandha Sangrahacommentary of Dalhana, Varanasi Chaukhambha SurabharatiPrakashan reprint 2003 p 33541) Marc E Grossman, A Clinical guide To Dermatology; 4thEdition,Informa Health Care 2006, p 33442) Dev R R Shabdakalpadruma, 2ndEdition, Delhi Nag Publications2002(III):p 5943) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 45144) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 45145) Vagbhata, Ashtanga Hrudaya with Sarvanga Sundari and AyurvedaRasayana commentaries, edited by Harishastri pParadkar, KrishnadasAcademy 2005: p 52546) Acharya JT Sushruta Samhita of Sushruta with Nibandha Sangrahacommentary of Dalhana, Varanasi Chaukhambha SurabharatiPrakashan reprint 2003 p 27847) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 74448) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 14949) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 149
  • 138.  Concept of Nidana and its Assessment in Kitibha Kushta13850) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 14951) Vagbhata, Ashtanga Hrudaya with Sarvanga Sundari and AyurvedaRasayana commentaries, edited by Harishastri Paradkar, KrishnadasAcademy 2005: p 1552) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 15053) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 4654) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 25455) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 23556) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 15657) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 23558) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 24959) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 14960) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 15261) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 23562) Acharya JT Sushruta Samhita of Sushruta with Nibandha Sangrahacommentary of Dalhana, Varanasi Chaukhambha SurabharatiPrakashan reprint 2003 p 96
  • 139.  Concept of Nidana and its Assessment in Kitibha Kushta13963) Acharya JT Sushruta Samhita of Sushruta with Nibandha Sangrahacommentary of Dalhana, Varanasi Chaukhambha SurabharatiPrakashan reprint 2003 p 24964) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 12665) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 12666) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 13167) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 14468) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 74469) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 47070) Acharya JT Sushruta Samhita of Sushruta with Nibandha Sangrahacommentary of Dalhana, Varanasi Chaukhambha SurabharatiPrakashan reprint 2003 p 20271) Vagbhata, Ashtanga Hrudaya with Sarvanga Sundari and AyurvedaRasayana commentaries, edited by Harishastri Paradkar, KrishnadasAcademy 2005: p 7072) Vagbhata, Ashtanga Hrudaya with Sarvanga Sundari and AyurvedaRasayana commentaries, edited by Harishastri Paradkar, KrishnadasAcademy 2005: p 6173) Vagbhata, Ashtanga Hrudaya with Sarvanga Sundari and AyurvedaRasayana commentaries, edited by Harishastri Paradkar, KrishnadasAcademy 2005: p 6274) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 217
  • 140.  Concept of Nidana and its Assessment in Kitibha Kushta14075) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 10776) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 10877) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 24278) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 29879) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 47080) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 47881) Veer Simhavloka, reprint 5thEdition Varanasi ChaukhambhaSurabharati Prakashana 1994: p 45682) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 40083) Varanasi Chaukhambha Surabharati Prakashana 1994:p 19384) Cortan & Kumar Robins Pathologic Basis Of Disease 6thEdition2001,Harcort Publications India,New Delhi p 119885) Cortan & Kumar Robins Pathologic Basis Of Disease 6thEdition2001,Harcort Publications India,New Delhi p 138186) Cortan & Kumar Robins Pathologic Basis Of Disease 6thEdition2001,Harcort Publications India,New Delhi p 119887) Stedmans Medical Dictionary, 1974, Indian Edition Chand & Co, NewDelhi p 31188) Cortan & Kumar Robins Pathologic Basis Of Disease 6thEdition2001,Harcort Publications India,New Delhi p 119989) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 694
  • 141.  Concept of Nidana and its Assessment in Kitibha Kushta14190) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 27791) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 4092) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 24893) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 24894) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 24895) Marc E Grossman, A Clinical guide To Dermatology; 4thEdition,Informa Health Care 2006, p 49696) P.V.Sharma; Ayurved Ka Vaignanika Itihaas; 7thEdition 2003;Chaukhambha Orientalia, Varanasi; p1997) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi Chaukhambha Pratisthan 2002(I):p 46198) Acharya Trikamji Yadavaji, Charaka Samhita ChakrapaniCommentary reprint 4thedition, Varanasi Chaukhambha SurabharatiPrakashana 1994:p 19399) Trikamji Yadavaji, Chakrapani Commentary Charaka Samhita reprintedition, Varanasi Chaukhambha Surabharati Prakashana 2005:p 193100) Vaidya Hari Shastri Paradakar, Ashtanghridayam 9thedition, VaranasiChaukhambha Orientalia 2002: p 41101) Upadhaya Yadunandana, Madhava Nidana 28thedition VaranasiChaukhambha Sanskrit Samsthan 1999(I):p17102) Bhavamishra. Bhavaprakasha,with vimarhsa By Brahma ShankarMishra, Chaukhamba sanskri series Varanasi p 521103) Upadhaya Yadunandana, Madhava Nidana 28thedition VaranasiChaukhambha Sanskrit samsthan1999(I):p 21
  • 142.  Concept of Nidana and its Assessment in Kitibha Kushta142104) Stedmans Medical Dictionary, 1974, Indian Edition Chand & Co, NewDelhi p 437105) Cortan & Kumar Robins Pathologic Basis Of Disease 6thEdition 2001,Harcort Publications India,New Delhi p1106) Cortan & Kumar Robins Pathologic Basis Of Disease 6thEdition2001,Harcort Publications India,New Delhi p142107) Shukla Vidyadhar and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi Chaukhamba Pratisthan 2002(I):p176,108) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi Chaukhamba Pratisthan 2002(I):p 696109) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi Chaukhamba Pratisthan 2002(I):p 172110) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi Chaukhamba Pratisthan 2002(I):p 26111) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi Chaukhamba pratisthan 2002(I):p 692112) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi Chaukhamba Pratisthan 2002(I):p 26113) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi Chaukhamba Pratisthan 2002(I):p172114) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi Chaukhamba Pratisthan 2002(I):p176115) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi Chaukhamba Pratisthan 2002(I):p 696116) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhitareprintedition, Delhi chaukhamba pratisthan 2002(I):p173117) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p175118) Dev R R Shabdakalpadruma, 2ndEdition, Delhi Nag Publications2002(III):p 59
  • 143.  Concept of Nidana and its Assessment in Kitibha Kushta143119) Trikamaji Yadavaji, Narayana Rama Kavyatirtha 7thedition, Varanasichaukamba Orientalia, 2002:p 23120) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 656121) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 656122) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 26123) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 175124) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 694125) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 694126) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 693127) Dev R R Shabdakalpadruma, 2ndEdition, Delhi Nag Publications2002(III):249128) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 572129) Shukla Vidyadhara and Tripathi Ravidutta, Charaka Samhita reprintedition, Delhi chaukhamba pratisthan 2002(I):p 572130) Sushruta Sushruta Samhita editor Ananta Ram Sharma 1st editionreprint 2006 Varanasi Chowkambha Sansthan Prakashan, p 4131) Dev R.R. shabda kalpa druma 2ndedition Delhi, Nag Publications2002(II) p 415132) Acharya JT Sushruta Samhita of Sushruta with Nibandha Sangrahacommentary of Dalhana, Varanasi Chaukhambha SurabharatiPrakashan reprint 2003 p 596
  • 144.  Concept of Nidana and its Assessment in Kitibha Kushta144133) Acharya JT Sushruta Samhita of Sushruta with Nibandha Sangrahacommentary of Dalhana, Varanasi Chaukhambha SurabharatiPrakashan reprint 2003 p 56134) Acharya JT Sushruta samhita of Sushruta with Nibandha SangrahaCommentary of Dalhanacharya,Varanasi,Chaukambha SurabharatiPrakashan reprint 2003 p 101135) Stephen J.H. Miller, Parsons Diseases of the Eye, EdinburghLondon1990: P 4-14136) Gupta B.R.Ayurved Ka Pramanika Itihas,2ndedition,VaranasiChaukambha Krsihnadas Academy2003: p 85137) Gupta B.R.Ayurved Ka Pramanika Itihas,2ndedition,Varanasi CKrsihnadas Academy2003: p 93138) Sharma U.S.Sarvadarshanasangraha of Madhavacharya,VaranasiChaukambha Vidya Bhavan reprint 2004 p 63139) Srikantha Murthy,Doctrines of Pathology in Ayurveda,Varanasi,Chaukambha Orientalia,1StEdition 1987 p160.140) Acharya JT Sushruta samhita of Sushruta with Nibandha SangrahaCommentary of Dalhanacharya,Varanasi,Chaukambha SurabharatiPrakashan reprint 2003 p 101141) Gupta K.A.Ashtanga Sangraha,Varanasi, Krishnadas Academyreprinted 1993:p 229142) Kunte,Navare, Annonated, Paradkar Shastri H.S. Ashtanga Hrudaya ofVagbhata reprint edition2002, Varanasi,Chaukambha Surabharatiprakashan p 806143) Upadhaya Yadunandana, Madhava Nidana of Madhavakara 30thedition Varanasi Chaukhambha Sanskrit samsthan2002 (II): p 299144) Brahmashankar Shastri, Yogaratnakara of Vaidya LakshmipatiShastri. 5thed. Varanasi; Choukhamba Sanskrit samsthan,1993; p 341145) Mishra S.B, Bhavaprakasha of Bhava Mishra 9thed. Varanasi;Chaukhamba Sanskrit samsthan,1999 (II); p 615
  • 145.  Concept of Nidana and its Assessment in Kitibha Kushta145ANNEXUREQuestionnaire used for the skin disease patients to evaluate habitsand regimenAhara Vishayaka1. Habit of eating Hot or Cold substances without proper order?Ex.Tiffin box food. Yes/NoHot meals-cold drinks or lassi. Yes/NoFast foods + cold drinks or Ice-creams Yes/No2. Habit of eating heavy and light foods without any gap period?Ex. Hostel food or Mess food Yes/NoFestival fasting andNext day consuming the heavy food Yes/NoYesterday prepared food to the next day Yes/No3. Habit of eating or consuming excess Honey or fish combinationYes/No4. Habit of Adhyasana (Bhukthasyopari bhojanam) Yes/No5. Habit of eating fish + milk+curd? Yes/No6. Frequency of consuming guru (high calorie) aharas?7. Indulgence in consuming following Virudha ahara.Desha Viruddha Samakara ViruddhaKaala Viruddha Agni Viruddha,Maatra Viruddha, Dosha viruddhaSaatmya Viruddha, Viirya Viruddha, etc8. Preferred food taste?Sweet/salty/sour/bitter/pungent/astringent9. Changing of food type as per change in seasons? Yes/NoViharaja vishayaka10. Regular or occasional inducing of vomiting?(a) If so is it to get relived from undigested food
  • 146.  Concept of Nidana and its Assessment in Kitibha Kushta146When do you usually do?Morning/Afternoon/evening/night/Midnight(b) Do you consume spicy foods even in conditions of undigested foodOr when not have the interest to consume the food11. Suppressing the urges of vomiting and natural urges? Yes/No12. Habit of over eating and then exposing to sunlight? Yes/No13. Have you undergone panchakarma therapy before? Yes/No14. Habit of sleeping in afternoon?Day: hrs. Occasionally/daily Yes/No15. Respect / disrespect of guru, elders, Gods etc.? Yes/No16. Mentality of harming innocent people? Yes/No17. Exercise habits?If yes only - in relation with food when you will do?Occupation - Driver, agriculture, labourer etc.Atapa sevana - Trafic police / vegetable seller etc.18. Bathing habitsSource of water - E.g. Sump, pump, tap, canal, river, pond etcIn frightened condition. Yes/NoIn tired condition. Yes/NoContinuous exposure to sun, fire, and then taking bath? Yes/NoAfter exercise (ex. Jogging, heavy work etc) Yes/No19. Frequency of undergoing Purgation? Yes/No20. Wearing of other’s cloths? Yes/NoAnya21. Implementation of skin protective treatments like,Lepa, lotions, creams etc. Yes/No22. Frequency of changingCosmetics / Soap / Shampoo etc, Yes/No
  • 147.  Concept of Nidana and its Assessment in Kitibha Kushta147GOVERNMENT AYURVEDA MEDICALCOLLEGE, MYSOREDEPT. OF P.G STUDIES IN AYURVEDA SIDDHANTA“CONCEPT OF NIDANA AND ITS ASSESSMENT IN KITIBHAKUSHTA (PSORIASIS)”PG Scholar: Dr.PANKAJ PATHAK Guide: Dr.N.A.MURTHYCASE PERFORMAPatient Name: Date:Age: Sex:Occupation: Religion:Marital Status:Place: Diagnosed case of Kitibha KushtaAHARASaptha Vidha Ahara VirudhaConsumption form Oca/Daily Remarks1. Swabhava2. Samyoga3. Samskara4. Matra5. Desha6. Kala7. Upayoga samstha
  • 148.  Concept of Nidana and its Assessment in Kitibha Kushta148Types of AharaTypes Oca/Daily Remarks1. Mamsa Verities2. Shaka Verities3. Dhanya verities4. Ksheera veritiesVIHARADuration Rutu Remarks1. Diva swapna2. Vyayama3. Maituna4. Atapa sevanaJalaPond/river/lake/sump/pump/tap/canalAfter the treatments ofVamana / Virechana/ Basti/ Nasya/ RakthamokshanaMano roga janithaKroda / Shoka / Kama / Bhaya / LajaaMiss conduct toGuru / Deva / Vrudha / Lady / BhramanaAnuvamshaContributorMotherFatherGrandfather
  • 149.  Concept of Nidana and its Assessment in Kitibha Kushta149GrandmotherRelativesMiscellaneousJunk foods / Fast food / Road side / Ice creamsShad rasaOca/Daily RemarksMadhurAmlaLavanaKatuTikthaKashayaAhara (guna)Guru – Laghu Sheetha – UshnaSnigdha – Ruksha Manda – TeekshnaSthira – Sara Mrudha – KatinaVishada – Pichilla Shlakshna – KaraSthoola – Sukshma Sandra – Drava