Assessment of Shatkriyakaal in ref

erence to diagnosis of diseases

Dr.B.K.Sevatkar
lecturer, Rog & Vikriti
vigyan, NIA, Jaipur
Aims & Objectives:-

 To know the basic concept of disease produc

tion .
 To develop an assessment criteria to determi
ne the disease at every level.
Importance

ज्ञानबुद्धिप्रदीपेन यो नाविशति तत्त्ववित्

आतुरस्यान्तरात्मानं न स रोगांश्चिकित्सति||१२||
 RUDRA

BRAHMA VISHNU
 MOON

SUN
AIR
 Homology of doshas

 :—पर् कुपितस्य खल्वस्य लोकेष ु चरतः कर्माणीमानि भवन्ति; तद्यथा- शिखरिशिखरावमथ

नम्, उन्मथनमनोकहानाम्, उत्पीडनं सागराणाम्, उद्वर्तनं सरसां, प्रतिसरणमापगानाम्,
आकम्पनं च भमू ःे , आधमनमम्बुदानां[७] नीहारनिर्ह्रादपांशसि
ु कतामत्स्यभेकोरगक्षाररुधिराश्मा
ृ न
शनिविसर्गः, व्यापादनं च षण्णामत ू ां, शस्यानामसङ्घातः, भत
ू ानां चोपसर्गः, भावानां चाभा
ू नलानिलानां विसर्गः; स हि भगवान् प्रभवश्चाव्ययश्च,
वकरणं, चतुर्युगान्तकराणां मेघसर्या
ू ानां भावाभावकरः, सुखासुखयोर्विधाता, मत्ृ युः, यमः, नियन्ता, प्रजापतिः, अदितिः, विश्
भत
वकर्मा, विश्वरूपः, सर्वगः, सर्वतन्त्राणां विधाता, भावानामणुः, विभुः, विष्णुः, क्रान्ता लोका
नां, वायुरेव भगवानिति||८||
 Importance of doshas

Hence it may be safely asserted that no disea

se can occur without the direct mediation or interventio
n of the deranged bodily humours. Yet the connection(r
elation) which exists between the two is neither consta
nt nor separable. As the physical phenomena of lightnin
g, storm, thunder and rain can not happen independentl
y of the sky (cloud) ; and yet they sometimes do or do n
ot occur with the presence of a cloud ; again as bubbles
^ though in reality but the modifications of the underlyin
g water, do not swellup on its surface at all times, so th
e connection between a disease and the bodily humour
s is neither universally separable or inseparable.
 Chronobiology of doshas
 . Concept of Vata is also a great menace of mankind,
as classics stated that the main property of Vata is G
ati or movement & the chala guna of Vata is very imp
ortant. To understand the patho physiology of vata it i
s necessary to know about the chaltwa guna of vata.
In the chapter of nanaatmaja vataj vyadhi 80 types of
diseases has been described among them, in most o
f the diseases the chaltwa guna of vata is depleted o
r inclined. So it is very necessary for we people of Ay
urveda, to develop some parameters or interpret this
gunas with existing tools of modern medicine. ECG c
an be very helpful to assess this chaltwa gunas.
 Shadkriyakala 6 stages to identify
& treat the disease process

 Sanchaya (accumulation)
 prakopa (aggravation)
 Prasara (expansion)
 Sthaana-Samshrayam (ensconce)
 Vyakta ( manifestation)
 Bheda (complication)
 Sanchayavastha or accumulati
ons of doshas

The deranged humours exhibit such symptoms as, full

ness and stuffedness of the abdomen,or of any of the viscera
(due to the action of the deranged Vayu ; yellowness of the af
fected part (due to the action of the deranged Pittam , and di
minution of the bodily heat, heaviness of the limbs, and a sen
se of languor . due to the action of the diseased Kapham),an
d a natural repugnance for causes (factors) which lead to the
ir respective aggravations or accumulations.The medical trea
tment should be commenced as soon as the symptoms, pec
uliar to their accumulation, would become manifest.
 Prakopavastha or aggravatio
n of doshas

 Humours and their aggravations :—

we shall enumerate the causes which a
gitate and (aggravate) the deranged humours
. The bodily Vayu is aggravated by such facto
rs (conduct, practices and diet, etc.) as, wrest
ling with a wrestler of superior strength, viole
nt gymnastic exercises, sexual excesses,exc
essive study, a headlong plunge into water or
a leapfrom an inordinate height, running, a vi
olent pressing blow, leaping over a ditch,
 Prakopavastha or a
ggravation of doshas

a bounding gait, swimming,keeping of late hours, car

rying of heavy loads, excessive riding, walking a long
distance and the partaking of a food into the composi
tion of which pungent, astringent, bitter, light or parch
ifying articles, or substances of cool potency, largely
enter. Diets consisting of dried pot-herbs, Vallura, Va
raka, Uddalaka, Karadusha,Shyamaka, nivara, Mudg
a, Masura, Adhaki,Harenu, Kalaya, and Nishpava ten
d to aggravate the bodily vayu.
 Prakopavastha or ag
gravation of doshas

Fasting, unequal or irregular meals, over-eating,

voluntary suppression of urine, semen, and tears, o
r of the mucous secretions from the nose as in a flu
ent coryza, a forced stoppage of defecation, eructat
ionor sneezing are the factors, which may be set do
wnas the aggravating causes of the bodily Vayu.
The bodily Vayu is naturally aggravated in a col
d, cloudy or windy day, in winter,during the rains, in
the morning and evening and especially at the clos
e of digestion.
 Prakopavastha or aggrav
ation of doshas
 Symptoms of aggravated Pittam :—
The Pittam is aggravated by anger, grief, fe
ar, fatigue,fasting, acid transformation (reaction) of the a
ssimilated food, or deficient gastric digestion, unnatural
sexual indulgence, partaking of a food consisting of pun
gent,acid or saline, keen, heat making or light substanc
es, as well as of those whose digestion is followed by a
reactionary acidity. It is aggravated by the use of sesam
um oil, or of sesamum paste. Kulattha, Sarshapa, Atashi
, the pot-herbs known as Haritaka, fish, the flesh of a G
odha or a goat or mutton may lead to its aggravation, if t
aken iniudiciously.
 Prakopavastha or agg
ravation of doshas

 Similarly, the use of curd, whey, Kurchika, (inspissat

ed milk), Sauviraka, different kinds of wine, Amla-ph
ala (sour fruits), or Katvara (curd mixed with oil) and
excessive exposure to the sun, may be followed by t
he same consequences.
In addition to all these,the Pittam is spontaneo
usly and abnormally aggravated in summer, in autu
mn, at noon, at mid-night and during the process of
digestion, as well as by the partaking of hot or warm
substances.
 Prakopavastha or agg
ravation of doshas

 Symptoms of the deranged Kapham

The deranged Kapham is aggravated b
y sleep in the day time, or by the following of lazy
or sedentary habits. The partaking of food, comp
osed of substances which are heavy, slimy, swee
t, acid or saline in their taste, or of one consisting
of substances which increase the mucous secreti
ons from the fissures of the body may' be likewis
e set down as aggravating factors.
 contd

The use of food grains, which are called the Ha

yanaka, the Yavaka, the Naishadha, the Itcata, the M
asha, the Mahamasha, the Godhuma, the Tilam, or o
f rice cakes may lead to its aggravation. Curd, milk, t
he Krishara, the Payasha (sweetened rice porridge t
he various preparations of cane-sugar are things whi
ch produce the same result. The flesh of beasts and
birds that are aquatic in their habits or live in swampy
lands, as well as lard, have the same effect, if used a
s food.
 Prakopavastha or aggrava
tion of doshas

The use of bulbs and lotus stems or of Kasher

uka, Shringataka, Madhura-phala, Valliphala as well a
s eating before digestion or the partaking of food cons
isting of both wholesome and unwholesome substanc
es may aggravate this bodily humour.
The Kapham is naturally and spontaneoush' agg
ravated in the morning and evening, in Hemanta, and
specially in Spring, and just after a meal. Likewise, it i
s aggravated by the use of cold food or drink, etc.
 Prasaravastha or
expansion of doshas

 Expansion of the deranged humours

Now we shall describe the expansion (Prasaram) of the der
anged humours. The deranged humours, aggravated by the above
mentioned causes, expand and overflow the limits of their respecti
ve localities in the same manner as, cakes, soaked in any ferment
or enzyme and kept standing over night, ferment and rise through t
he acquisition of new and unseen attributes. The Vayu, which is po
ssessed of locomotion or extreme mobility, should be looked upon
as the cause of their expansion or over-flowing. The Vayu, though
an inanimate thing, in reality is possessed of the quality of "Rajas“
(creative or cohesive energy), and the quality of the Rajas is the o
nly essential or motive principle in the universe.
 Prasaravastha or
expansion of doshas

As a vast and mighty expanse of water, w

hich has been divided into two expanses by a da
m or barrier, will sweep away the latter and unite
again to form one sheet of water ; so the derange
d humours, sometimes singly, sometimes in com
bination with two or all of their species, or in unis
on with blood, expand and over-run the organism
in all directions.
 contd

The aggravated, or the abnormally irritated deranged

humours, whether permeating the whole or half of th
e system or restricted to any particular part or memb
er of the body, give rise to disease in the place of the
ir incarceration, like rain clouds pouring down in the
quarter of the sky where they are formed. The deran
ged humours, not excessively slightly; aggravated, li
e inoperative coating the internal passages (Margas)
of the body and thus bring about a fresh disease, if s
ubsequently agitated by any disturbing causes.
 Prasaravastha or ex
pansion of doshas

 The deranged and aggravated Vayu, having moved into

any specific seat of Pittam, should be medicinally treate
d as a case of Pittaja aggravation. Similarly,- the derang
ed and aggravated Pittam, or Kapham, changing their re
spective places with. each other, should be medicinally t
reated as the humour in whose location it is lound. The
Vayu, thus aggravated and expanded, tends to deviate f
rom its right passage and gives rise to a swelling or dist
ention of the abdomen, accompanied by a rumbling sou
nd in the intestines.
 contd

 The Pittam, under the similar condition, gives rise to

heat, and a sort of sucking, burning pain in the affect
ed part, together with a sensation of radiation or eva
poration of heat from its surface. The Kapham, under
the circumstance, would usher in a complete aversio
n to food, inertness of the limbs, vomiting and impair
ed digestion. The preceding symptoms, caused by th
e aggravation and expansion of the bodily humours,
should be the third occasion for medical treatment.
 Sthaana-Samshrayam (ensconce)

Sthaana-Samshrayam :—
Now we shall enumerate the names of the peculiar diseases,
which are originated by the deranged and expanded humours, incarc
erated in the different parts of the body.These humours, confined in th
e abdomen, give rise to Gulma abdominal glands) tumours, internal a
bscesses (Vidradhi), abdominal dropsy, impaired digestion in the bow
els, constipation (Anaha', cholera Visuchikai and dysentery.

The aggravated and expanded humours, thus firmly ensconce

d in the different parts of the body, exhibit the premonitory symptoms
of diseases which will be fully dealt with under their respective heads.
The manifestation of these premonitory symptoms should be consider
ed as the fourth occasion for medical treatment.
 Vyaktavastha or
manifestation of disease

Disease- Its Development :—

Now we shall deal with the full developmen
t or manifestation of a disease.The full manifest
ation of a disease, such as a swelling, tumour, a
neurism (Granthi), Vidradhi (abscess) and erysi
pelas (Visarpa) etc., fever or dysentery, signifies
the complete development of the characteristic
symptoms, which should be regarded as the fift
h occasion for medical treatment.
 Bhedavastha or
complication

The sixth occasion for the calling in of medical aid s

hould be considered to have arisen when a swelling (ab
scess, tumour, etc.) would burst and exhibit the charact
eristic symptoms of an open ulcer. A persistent lingering
or continuance of a fever or dysentery, etc., should be c
onsidered as marking, or forming one of its particular st
ages, and which may run into one of an incurable type,
if neglected or not sufficiently cared for at the outset.
 conclusion

The physician, who fully knows about the accumulat

ion (Sanchaya), disturbance or aggravation (Prakopa), ex
pansion ( Prasaram), and differentiating traits of the dera
nged humours (Bheda), and is well conversant with the s
pecific localities in which they are respectively confined in
the course of their expansion (Sthanasamshrayam), and
with the symptoms which they respectively exhibit in conn
ection with the incidental disease (Vyakti), is alone worthy
of that epithet.
 Contd.

The deranged humours, checked or subdued in

their accumulating stage, fail to exhibit any further or
subsequentdevelopment, but, if left unremedied, the
y gain in strength and intensity in the course of their f
urther development. The humours, deranged either s
ingly, or in couples, or in a triple combination as rega
rds one or two of their virtues, push on, follow and bl
end with humours similarly deranged as regards their
qualities and combinative numbers.
 Contd.

The medical treatment in a case, where two

or all (three) of the deranged humours are involved, consi
sts in conquering the strongest one in the combination, b
ut so as not to enrage or aggravate the minor or the weak
er humours in the group and specially so in a case of San
nipata.".

A concourse of deranged humours, affecting and ap

pearing in a particular part of the body, is called a boil or
an ulcer (Vrana) which "is derived from the root "Vri" to co
ver and is so called from the fact of its covering a particul
ar part of the body or from its leaving a cicatrix which rem
ains the whole life-time of the patient.
Kasa Shatkriyakala
 Hetu (Causes)

 Causes:- Exposure to smoke as well as to dust p

articles, excessive bodily exercise, intake of dry
((non fatty) food, entry of food into wrong pathwa
y and suppression of natural urges like sneezing
are the main causative factors for Kasa (Cough).
 This vitiates the Prana vayu along with Udana va
yu, that produces a loud noise as from a cracked
Bell metal (vessel) come out of the mouth sudde
nly with expectoration the condition is called as K
asa.
 Sanchaya Kala

 It is the first step towards disease

 Due to causative agents as described earlier.
It aggravates prana vayu & Udana vayu that
causes fullness of stomach and patient likes t
o adopt things that are exact opposite of dise
ase producing factors.
 Prokopa Kala

 It is the second step of disease.

 In this kala vitiated doshas increased in their
ashaya, of particular doshas, and they try to
expel out.
 In kasa as the main vitiated dosha is Vata, sy
mptoms of cutting pain in abdomen, sensatio
n of something revolving in stomach are obse
rved, further symptoms of vata vridhi are obs
erved
 Prasara

 In this kriya kala, vitiated and increased dosh

as expels out of their ashayas due to persiste
nt intake of disease causing factors.
 These increased and vitiated doshas goes in
three dimensions viz, urdhva, adhah, tiryaka
and produces symptoms as, increase bowl m
ovement (Atopa).
 Sthana samshraya

 In this kala, vitiated and increased doshas get se

ated in body where Sthan Vaigunya i.e weak tisu
es.
 In kasa main seat is pranvaha srotasa. In this kal
a prodromal symptoms of disease are observed
as
During their prodromal stage, one feels as if his o
ropharyngeal region is full of bristles.
There is itching sensation in throat as well as diff
iculty in swallowing food.
 Vyakti

 In this kala, prodromal symptoms of the disea

se are observed more clinically significant.
 As early mentioned symptoms of grittiness, it
ching occur more prominently.
 Bheda Avastha

 During prasara avastha vitiated vayu, someti

mes get collaborated with other doshas as pit
ta, kapha or both of them producing 5 types o
f kasa as Vataja, Pitaja, kaphaja, khshataja, k
shayaja
 Symptoms of kasa in bheda avastha
Vataja kasa:-
There is pain in the precordial & temporal regio
n, head, abdomen & flanks. The face shows
anxious appearance and there is loss of stren
gth, voice & vitality.
Bouts of cough are continuous and voice hoars
e and the cough is dry.
 contd

Pittaja kasa
Patient has complains of burning sensation in c
hest, fever, dryness of mouth and bitter taste.
He feels thirsty and brings out yellow and acrid
(Bilious) vomitus.
There is a pallor & burning sensation all over th
e body.
 contd

 Kaphaja kasa:-
In kaphaja kasa, there is stickiness in oral cavit
y, headache, excess of kapha in the body.
Loss of appetite, feeling of heaviness as well a
s itching sensation.
Gets severe bouts of cough producing a thick e
xpectoration.
 contd

 Ksahtaja kasa:-
 During initial stage, he has unproductive cough, f
ollowed by haemoptysis associated with a sever
e pain in throat & chest.
 He suffers from pricking pain as if being pierced
by sharp needles, hyperesthesia due to pain, a f
eeling of dismemberment, burning sensation, pai
n in joints, fever.
 Dyspnoea, thirst and hoarsness of voice and pro
duces a sound likecoing of pigeons during attack
s of Kshataja kasa.
 contd

 Kshayaja kasa:-
 Body ache, fever, burning sensation, attacks
of fainting and loss of vitality.
 Gradually gets emaciated, becomes weaker
& weaker along with wasting of muscles.
 Expectorates blood with pus, has features of
vitiation of all the three doshas and is certainl
y very difficult to manage by treatment.
 Ques.

 A male patient aged 30 years has come in October at

your clinic with complaint of excessive thirst, burning s
ensation in whole body and sour blenching; diagnose t
he state of disease process…….
 A male child aged 5 years has come with his guardian
at your clinic in August month with complaint of exces
sive blenching with foul smell and distended abdomen
; diagnose the state of disease process …….
 A female patient aged 39 years has come in August a
t your clinic with complaint of minor yellowish discolor
ation only present in her skin; diagnose the state of di
sease process …….
 Ques.

 A female patient aged 48 years has come in April at you

r clinic with complaint of vomiting, indigestion, heavines
s in whole body and altered taste; diagnose the state of
disease process …….
 A male patient aged 13 years has come in December in
your clinic with complaint of heaviness, lethargy and lo
w temperature of the body; diagnose the state of diseas
e process …….
 A female patient aged 57 years has come in May in you
r clinic with complaint of discomfort to watch food (som
etimes nausea after looking food) and heaviness in hea
rt ;diagnose the state of disease process …….
Thank you for your attention!