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    Charak Samhita Sutrasthan 20: Tridosha Qualities, Diseases, Treatment

    The 20th Chapter of Charaka Samhita Sutrasthana is caled as Maharoga Adhyaya. This is one of the most important chapters. It enlists diseases caused by individual Tridosha ̵ Vata, Pita and Kapha, qualities of Tridosha, how they cause disease, patho-physiology and their line of treatment
    Table of Contents
    General clasifications of diseases
    General causative factors
    Thre basic causative features al diseases
    Role of Doshas in disea se pathogenesis
    Physiological sites of Doshas in the body

    Place of Vata Dosha
    Place of P ita Dosha
    Place of Kapha Dosha
    General functions of balanced Doshas
    Diseases caused by Tridosha imbalance
    Nanatmaja Vyadhi
    Vataja Nanatmaja Vyadhi
    Vata dosha qualities
    Vata dosha symptoms
    Treatment principles of Vata disorders
    Importance of Basti treatment in Vata disorders
    Pitaja Nanatmaja Vyadhi
    Patho- physiology of Pita diseases
    Qualities of Pita
    Pita imbalance symptoms
    General principles of treatment for Pita diseases
    Importance of Virechana in Pita imbalance
    Kaphaja Nanatmaja Vyadhi
    Pathophysiology of kaphaja diseases
    Qualities of Kapha
    General principal of treatment for Kaphaja diseases
    Importance of diagnosis in treatment
    Sumary
    General clasifications of diseases
    There are four types of diseases viz.
    Agantuja ̵ due to exogenous causes such as injury, malevolence etc,
    Vatika ̵ Vata imbalance disorders,
    Paitika ̵ Pita imbalance disorders and
    Shlaishmika ̵ Kapha imbalance disorders.
    Pain being comon to al, diseases are finalyof one type (ruk samanyat).
    Diseasesare again of two types depending on their nature,
    Agantuja ̵ that is exogenous and
    Nija ̵ endogenous.
    They are again of two types
    Share ra Adhishtana ̵ somatic and
    Mano Adhishtana ̵ psychic-depending on the sites of their manifestation viz. body and mind.
    Diseases are in fact inumerable in as much as the imediate causes, (like coarse diet and regimen) Permutation and amalgam of profuse factors of Doshas are inumerable (Aparisankhyeya) . [3]
    General causative factors
    The Agantuja Roga ̵ exogenous diseases are caused by
    Nakha ̵ nails,
    Dashana ̵ teth,
    Patana ̵ fal,
    Abhichara ̵ spel,
    Shapa ̵ curse,
    Abhishanga ̵ psychic aflictions including demoniac seizure,
    Abhighata ̵ injury,
    Vyadha ̵ piercing,
    Bandhana ̵ bandage,
    Veshtana ̵ raping,
    Pedana ̵ aplication of presure,
    Raju ̵ binding by rope,
    Dahana ̵ fire,
    Shastra ̵ weapon,
    Ashani ̵ thunderbolt,
    Bhuta ̵ demoniac seizure,
    Upasarga ̵ natural calamities etc.
    The Nija Rogas ̵ endogenous diseases are caused by the imbalance of Tridosha ̵ Vata, Pita and Kapha. [4]
    Thre basic causative features al diseases
    Asatmya Indriya Artha Samyoga ̵ Unwholesome contacts betwen the sense organs and their objects,
    Prajnaparadha ̵ intelectual blasphemy, acting against one’s conscience
    Parinama ̵ Efects of time constitute the comon causative factors for both the exogenous and endogenous types of diseases.[5]
    Al these four types of disease s when agravated finish share the symptoms of each other. Even then, the distinctive features of each one of them are to clearly manifested avoiding any confusion.[6]
    Role of Doshas in disease pathogenesis
    Role of Doshas in the pathogenesis of exogenous and endogenous diseases:
    The exogenous diseases (Agantu Roga) initiate with hurt and then they bring about the disturbance in the Tridosha balance.
    The endogenous diseases beginwith the disturbance in the Tridosha balance, andthen result inpain.[7]
    So, in both Njia and Agantu diseases, ultimately Tridosha balance is noted.
    Physiological sites of Doshas in the body
    Place of Vata Dosha
    Basti ̵ Urinary blader, urinary system
    Pureshadhana ̵ rectum,
    Sakthi ̵ waist,
    Padau ̵ thighs, legs,
    Asthi ̵ bones and
    Pakvashaya ̵ colon are the sites of Vata
    Among them, Pakvashaya (colon) is the most necesary site.
    Related: How Vata Dosha dominates diferent parts of the body
    Place of Pita Dosha
    The necesary sites of region of these thre Doshas are as below:
    Swedo ̵ Sweat,
    Rasa ̵ Rasa dhatu ̵ finish product of fod digestion, containing al nu trients
    Lasika ̵ Lymph,
    Rudhira ̵ blod,
    Amashaya ̵ smal intestine(lower fraction of Amashaya) are the sites of pita;
    Among them, smal intestine (lower portion of Amashaya) is the most necesary site of Pita Dosha.
    Related: How Pita influences diferent body parts
    Place of Kapha Dosha
    Ura ̵ Chest,
    Shira ̵ head,
    Greva ̵ neck,
    Parva ̵ joint,
    Amashaya ̵ stomach (uper fragment of Amashaya) and
    Meda ̵ fat are the sites of Shleshma (Kapha).
    Among them, chest is the most vital site of Kapha Dosha. [8]
    Related: How Kapha dominates diferent body parts
    General functions of balanced Doshas
    Al the thre Doshas are note in al parts of the body. These Doshas, in normal balanced condition, cause god health and in imbalanced condition, they cause ilnes.
    When they are balanced, they cause
    Upachaya ̵ body nourishment
    Bala ̵ improvement of strength and imunity
    Varna Prasada ̵ improvement of skin health and complexion [9]
    Diseases caused by Tridosha imbalance
    Endogenous diseases (Nija Ro ga) again are two types viz,
    Samanyaja Vyadhi ̵ diseases caused by Vata, Pita and Kapha in diferent combinations and
    Nanatmaja Vyadhi ̵ specific diseases caused by individual Doshas ̵ Vata, Pita and Kapha.
    Samanyaja Vyadhi ̵ Diseases of the combined Doshasareexplained in the preceding chapter and diseases caused byindividual imbalanced Doshas are being explained here.
    Nanatmaja Vyadhi
    Diseases caused by individual Doshas ̵
    Vata when imbalanced alone, causes 80 types of disorders
    Pita when imbalanced alone, causes 40 types of disorders
    Kapha when imbalanced alone, causes 20 types of disorders. [10]
    Vataja Nanatmaja Vyadhi
    Eighty diseases caused by Vata alone ̵ Vataja Nanatmaj a Vyadhi:
    Though Vata imbalance diseases are inumerable,the folowing eighty diseases are the most comonly manifested ones:
    1. Nakhabheda (cracking of nails)
    2. Vipadika (cracking of fet)
    3. Pada shola (pain in fot)
    4. Pada Bhramsha (fot Drop)
    5. Pada Suptata (numbnes of fot)
    6. Vata khudata (club fot)
    7. Gulpha Graha (stif ankle)
    8. Pindikodveshtana (cramps in calf muscle)
    9. Gridhrasi (sciatica)
    10. Janu Bheda (Genu varum)- Bow legednes, bandines
    1. Januvishlesha (Genu valgum) ̵ Knock Kne
    12. Urustambha( stifnes of thigh)
    13. Urusada (pain in the thigh)
    14. Pangulya (paraplegia)
    15. Guda Bhramsa (prolapsed rectum)
    16. Gudarti (Tenasmus)
    17. Vrushanakshepa (pain in scrotum)
    18. Shepha Stambha (stifnes of penis)
    19. Vankshana anaha (tension of groin)
    20. Shroni Bheda (pain around the pelvic girdle)
    21. Vidheda (diarhea)
    2. Udavarta (bloating)
    23. Khanjatva (lamenes)
    24 . Kubjatva (kyphosis)
    25. Vamanatava(dwarfism)
    26. Trikagraha (stifnesof sacro-iliac joint)
    27. Prsistagraha (stifnes of back)
    28. Parshva Marda (pain in chest)
    29. Udaraveshta (Griping hurt in abdomen)
    30. Hrit Moha (braby cardia)
    31. Hrit Drava (tachycardia)
    32. Vaksha- Udgharsha (rubing hurt in chest)
    3. Vaksha- Uparodha (impairment of thoracic movement)
    34. Vakshastoda (stabing distres in chest)
    35. Bahu Shosha (atrophy of arm)
    36. Greva Stambha (stifnes of the neck)
    37. Manyastambha (torticolis)
    38. Kanthodhvamsa(hoarsenes of voice)
    39. Hanu Bheda (pain in jaw)
    40. Ostha Bheda (pain in lips)
    41. Akshi Bheda (pain in eye)
    42. Danta Bheda (tothache)
    43. Danta Shaithilya (losenes of toth)
    4. Mokatva (aphasia / dumbnes)
    45. Vak Sanga(staling spech)
    46. Kashaya asyata (astringent taste in mouth)
    47. Mukha shosha (drynes of mouth)
    48. Arasajnata(ageusia) ̵ los of taste function
    4 9. Ghrana Nasha(anosmia) ̵ los of smel function
    50. Karna Shola (ear ache)
    51. Ashabda Shravana (tinitus)
    52. Uchaih Shruti (hard hearing)
    53. Badhirya (deafnes)
    54. Vartma Stambha (Ptosis of eye lid)
    5. Vartma Samkocha (entropies)
    56. Timira(amaurosis) ̵ a type of vision los
    57. Akshi Shola(pinching damage in eye)
    58. Akshi Vyudasa (Ptosis of eye bal)
    59. Bhru Vyudasa (ptosis of eye brow)
    60. Shankha Bheda (pain in transient region)
    61. Lalata Bheda (pain in frontal region)
    62. Shiro Ruk (headache)
    63. Kesha bhumi sphutana (dandruf)
    64. Ardita(facial paralysis)
    65. Ekanga Roga (monoplegia)
    6. Sarvanga Roga (polyplegia)
    67. Pakshavaha (hemiplegia)
    68. Akshepaka (convulsion)
    69. Dandaka (tonic convulsion)
    70. Tama (fainting)
    71. Bhrama (gidines, dizines)
    72. Vepathu (tremor)
    73. Jrumbha (yawning)
    74. Hika (hicup)
    75. Vishada(asthenia) ̵ weaknes, depresion
    76. Ati Pr alapa (delirium) ̵ excesive irelevant talk
    7. Raukshya (drynes)
    78. Parushya (hardnes)
    79. ShyavaArunava Bhasata (dusky red apearance)
    80. Asvapna (sleplesnes)
    81. Anavasthita chitatva (unstable mind). [9-1]
    Vata dosha qualities
    Qualities of Vata Dosha ̵ how it is exhibited in Vata Nanatmaja diseases ̵
    In al the chaste Vata diseases, enumerated or implied, the inherent natural qualities and actions of Vata are quite obviously manifested wholy or partialy and as such it is not augean for a able physician to corectly diagnose the Vatika type of diseases;
    Raukshya ̵ Rokshata ̵ roughnes,
    Shaitya ̵ Shetata ̵ colnes,
    Laghava ̵ Laghu ̵ lightnes
    Vaishadya ̵ clarity, non-slimines,
    Gati ̵ movement,
    Amortata ̵ shapelesnes,
    Anavastitatva ̵ instability- these are the inherent qualities of Vata.
    Related: How to understand Tridosha by its qualities
    Vata dosha symptoms
    Vata Dosha while moving from one fraction of the body if abnormal, exhibits symptoms admire ̵
    Sramsa ̵ losenes,
    Bhramsa ̵ dislocation,
    Vyasa ̵ expansion,
    Sangha̵ obstruction,
    Bheda ̵ separation,
    Sada ̵ depresion,
    Harsha ̵ excitation,
    Tarsha ̵ thirst,
    Kampa ̵ trembling,
    Varta ̵ circular movement,
    Chala ̵ motion,
    Toda ̵ piercing pain,
    Vyatha ̵ aching pain,
    Cheshta action, etc.
    Khara ̵ coarsenes s,
    Parusha ̵ harshnes,
    Vishada ̵ non-slimines,
    Sushira ̵ porousnes,
    Aruna Varna ̵ redishnes, (colour of sunrise)
    Kashaya ̵ Astringent taste
    Virasa Mukhatva ̵tastelesnes in the mouth,
    Shosha ̵ wasting pain,
    Shola ̵ pain,
    Supti ̵ numbnes,
    Samkocha̵ contraction,
    Sthambhana- rigidity and
    Khanjata ̵lamenes, etc. – these are the actions that aid a able physician to diagnose the chaste Vatik type diseases.[12]
    Treatment principles of Vata disorders
    General principles of treatment of Vata disorders:
    Madhura, Amla Lavana Snigdha Ushna Upakrama ̵ The vitiated Vata should be treated by drugs having swet sour and saline taste and unctuous and hot qualities
    Snehana ̵ oleation,
    Sveda ̵ fomentation, sweating treatment
    Asthapana ̵ decoction enema
    Anuvasana ̵ oil enema
    Nasyakarma ̵ nasal instilation of drops,
    Bhojana ̵ healthy diet,
    Abhyanga ̵ masage,
    Utsadana ̵ unction,
    Parisheka ̵ sprinkling of oil / liquid containing materials having anti-Vata properties.
    This is to be done with due regard to the dosage and the season.
    Importance of Basti treatment in Vata disorders
    Of al the treatments stated above, the Asthapana (decoction enema) and Anuvasana (oil enema) are the treatment par excelence for the cure of Vatik diseases, because imediately after entering the colon, they strike at the very rot of the vitiated Vata and when Vata is overcome in the colon, even the entire vitiated Vata dweling in other parts of the body is automaticaly aleviated.
    Thi s can be likened to the cuting of the rot of a tre which result in the automatic plunge of the trunk, branches, sprouts, flowers, fruits, leaves, etc.[13]
    Related:How to balance Vata Dosha
    Pitaja Nanatmaja Vyadhi
    Forty specific diseases of Pita ̵ Pitaja Nanatmaja Vyadhi ̵
    Now we shal narate the forty varieties of diseases due to the vitiation of Pita. Even though the diseases due to the vitiation of Pita are inumerable, the consequent forty varieties are the most comonly manifested.
    1. Osha (heating)
    2. Plosha (scorching)
    3. Daha (burning sensation)
    4. Davathu (boiling)
    5. Dhomaka (fuming)
    6. Amlaka (acid eructation)
    7. Vidaha (pyrosis ) ̵ (heart burn)
    8. Antar daha (burning sensation inside the body)
    9. Amsa daha ( burning sensation in shoulder)
    10. Ushmadhikya (excesive temperature)
    1. Ati Sveda (excesive sweating)
    12. Anga gandha (badodour of the body)
    13. Angavadarana(cracking damage in the body)
    14. Shonita kleda(sloughing of the blod)
    15. Mamsa kleda (sloughing of the muscle)
    16. Tvak Daha( burning sensation in the skin)
    17. Charma dalana(itching of the skin)
    18. Tvagavadarana (cracking of the skin)
    19. Rakta kotha (urticaria)
    20. Rakta visphota (red vesicle)
    21. Rakta Pita(bleding tendency)
    2. Rakta mandala (red wheals)
    23. Haritatva (grenishnes)
    24. Haridratva (yelowishnes)
    25. Nelika (blue moles)
    26. Kaksha (herpes)
    27. Kamala (jaundice)
    28. Tiktasyata (biter taste in month)
    29. Lohita Gandhasyata (smel of blod from the mouth)
    30. Poti mukhata(foetid odour of mouth)
    31. Trishnadhikya (excesive thirst)
    32. Atrupti (non-satisfaction)
    3. Aasya Vipaka (stomatitis)
    34. Gala paka(pharyngitis)
    35. Akshi paka (conjunctivitis)
    36. Guda paka (proctitis)
    37. Medhra Paka(inflamation of the penis)
    38. Jivadana(hemorhage)
    39. Tamah pravesha (fainting)
    40. Harita haridra netra mutra varchas (grenish and yelowish coloration of eyes, urine faeces)[14]
    Patho- physiology of Pita diseases
    In al the Paitika type of diseases enumerated or implied, the inherent natural qualities and actions of Pita are quite obviously manifested wholy or partialy and as such it is not efortful) for a competent physician to corectly diagnose the Paitika type of diseases.
    Qualities of Pita
    The inherent natural qualiti es of Pita are
    Aushnya ̵ Ushna ̵ heat,
    Taikshnya ̵ Tekshna ̵ sharpnes,
    Dravatva ̵ liquidity,
    Anati Sneha ̵ slight unctuousnes, mild oilines,
    al colors except white and red,
    Visra Gandha ̵ fishy smel,
    Katu, Amla ̵ acrid and sour tastes
    Saratva ̵ fluidity.
    Pita imbalance symptoms
    Daha ̵ burning sensation,
    Aushnya ̵ ushna ̵ heat,
    Paka ̵ supuration,
    Sveda ̵ perspiration,
    Kleda ̵ sloughing,
    Kotha ̵ putrification,
    Kandu ̵ itching,
    Srava ̵ discharge,
    Raga ̵ rednes,
    and exhibition of its inherent smel, colour and taste.
    General principles of treatment for Pita diseases
    Madhura, Tikta Kashaya ̵ Pita is treated with herbs having swet, biter and astringent tastes
    Sheta ̵ coling qualities and
    Snehana ̵ oleation
    Virechana ̵ purgation,
    Pradeha ̵ unction,
    Parisheka ̵ efusion,
    Abhyanga ̵ masage, etc. procedures done with herbs havin anti Pita qualities.
    This is of step to be done with due regard to the dosage and season.
    Importance of Virechana in Pita imbalance
    Of al the devices stated above, the purgation is the treatment par excelence for curing the Paitika diseases because, imediately after it is administered, it eliminates the vitiated Pita from its very rot from the level of intestines. When it is overcome in the Amasaya (smal intestine), it aleviates the entire vitiated Pita dweling in other parts of the body. This can be likened to a hot chamber being coled by removing the fire from inside it.[16]
    Related: How to balance Pita Dosha
    Kaphaja Nanatmaja Vyadhi
    Twenty types of kaphaja diseases ̵ Kaphaja Nanatmaja Vikara
    Now we shal recount the twenty verity of diseases due to the vitiation of Kapha. Even though, the diseases due to the vitiation of Kapha are inumerable; the consequent are the twenty varieties which are most comonly manifested.
    1. Trupti (anorexia nervosa)
    2. Tandra (drowsines)
    3. Nidradhikya(excesive slep)
    4. Staimitya (timidnes)
    5. Guru Gatrata (heavines of the body)
    6. Alasya (lazines)
    7. Mukha Madhurya (swet taste in mout h)
    8. Mukha Srava (salivation)
    9. Shleshmodgirana (mucus expectoration)
    10. Maladhikya (excesive excretion of excreta)
    1. Balasaka (los of strength)
    12. Apakti (indigestion)
    13. Hrudayopalepa (feling as if heart is wraped up with moisture)
    14. Kantopalepa (phlegm adhered to throat)
    15. Dhamani Pratichaya (hardening of vesels)
    16. Galaganda (goiter)
    17. Ati Sthaulya (obesity)
    18. Shetagnita(supresion of digestive powder)
    19. Udarda (urticaria)
    20. Shvetavabhasata (palor),Shveta Mutra Netra Varchastva (whitenes of urine, eye and faces)[17]
    Pathophysiology of kaphaja diseases
    In al the Shlaishmika (Kaphaja) type of diseases enumerated or implied, the inherent natural qualities and actions of Kapha are quite obviously manifested fuly or partly and as such it is not chalenging for a capable p hysician to corectly diagnose the shlaishmika type of diseases.
    Qualities of Kapha
    Sneha ̵ Unctuousnes,
    Shaitya ̵ colnes,
    Shauklya ̵ whitenes,
    Gaurava ̵ heavines,
    Madhurya ̵ swetnes,
    Sthairya ̵ steadines,
    Paichilya ̵ slimines
    Martsnya ̵ viscosity- thre are the inherent qualities of kapha.
    Kapha brings about folowing atributes to the body
    Shvaitya ̵ Shveta ̵ whitenes
    Shaitya ̵ Sheta ̵ colnes
    Kandu ̵ itching
    Sthairya ̵ steadines, stability
    Gaurava ̵ heavines,
    Sneha ̵ unctuousnes, oilines,
    Supti ̵ numbnes,
    Kleda ̵ moistnes, stickines,
    Upadeha ̵ slimines, as if being anointed with oil,
    Bandha ̵ binding, obstruction
    Madhurya ̵ swetnes,
    Chirakaritva ̵ slownes,delay in manifestation- these are the actions that help a able physician to diagnose diseases caused by kapha.[18]
    General principal of treatment for Kaphaja diseases
    They (diseases due to vitiated Kapha) should be treated with
    Katu Tikta Kashaya ̵ herbs having pungent, biter, astringent taste,
    Tekshna Ushna Roksha ̵ treatments and medicines having poignant, hot and drynes qualities
    Sveda ̵ fomentation, sweating
    Vamana ̵ emesis, vomiting therapy,
    Shiro Virechana ̵ elimination of Doshas from the head by Nasya procedure,
    Vyayama ̵ exercise etc, which should al comprise materials having Anti- Slaismika properties.
    This is of lofty to be done with due regard to the dosage and season. Of al the devices stated above, emetic therapy is the treatment par exc elence for the cure of diseases due to Kapha because imediately after entering the Amashaya ̵ stomach, it strikes at the very rot cause of the vitiation of Kapha and when it is overcome in the stomach, even the entire vitiated Kapha dweling in other parts of the body is automaticaly aleviated. This can be likened to the withering away of pady, barley, etc. for want of obstacle of the cornfield (ful of water) being broken.[19]
    Related:How to balance Kapha Dosha
    Importance of diagnosis in treatment
    Thus it is said:
    A physician should first of al diagnose the disease and then he should select proper medicine. Thereafter, he should administer the therapy aplying the knowledge of the science of medicine, he had already gained.
    A physician who initiates treatment without acurate diagnosis of the diseases can acomplish the desired object only by chance (he canot be definite of his suces);
    The fact that he is is wel- acquainted with the knowledge of aplication of medicine does not necesarily guarante his suces. On the other hand, the physician who is wel-versed in diagnosing diseases, who is proficient in the administration of medicines and who knows about the dosage of the therapy that varies from asign to place and season to season, is determined to acomplish the desired objective.[20-2]
    Sumary
    In this chapter ̵ Maha Roga Adhyaya, the enlightened sage has fuly dealt with the consequent subjects: clasification, nature, sites of manifestation, specific and general causative factors, interchangeability and specific identity of disease s, sites of Doshas, enumeration of specific diseases due to Doshas, invariable signs and actions of Doshas separately along with their treatment.[23-25]
    Thus ends the twentieth chapter of Charaka Samihta Sutrasthana, of Agnivesa’s work as redacted by Charaka.[20]
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