INTRODUCTION- disturbances predicted in three consecutive stages viz. Chaya,

INTRODUCTION-

                                            Sanchayansh, prakopansh, prasaram,
sthansansrayam

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                                            Vyakti, bhedash yo vetti
doshanam sa bhavedbhishag

                                                                                                                           
(Su.Su.21/36)

 

The
word kriya means action and kala means time. Therefore, the literal
meaning of the word kriyakala is
treatment time. The concept of kriya
kala is introduced in Varna prashna
adhyaya of “Susruta Samhita”. “Charaka” & “Vagbhata” give a version
of evaluation of doshic disturbances predicted in three consecutive stages viz.
Chaya, Prakopa & Prasama.
Susruta version does not include the prasama
stage. In short, sad kriya kala
is a complex process taking place in the body from the initiation of
accumulation to manifestation of disease. This leads to structural &
functional derangement of the body elements. Disease formation
is not immediate process, it occurred through the different stages. The
formation of the disease through the six different stages is called as
Shatkriyakala. If first understand these stages ‘physician’ prevent the
formation of disease & avoid the further complication. In the process of disease
manifestation, the movement of morbid dosha
into the next stage depends upon the nidana
.If three Doshas, Seven Dhatus &
three Malas are in normal state there
is no disease occurs. The etiological factors disturb this normal functioning
& manifest as a disease. A disease begins when the provoked doshas get settled
at the defective site.

Stages of sad kriya kal-  

1)   
Sanchaya- 
(Stage of accumulation or
increased level): –   This stage represents the beginning phase of
disease characterised by indefinite & illdefined symptoms. This is the
accumulation of doshas in their principle
place. The accumulation
of dosha due to various nidana factors. It is seen as the
opportunity to perform the action or the time for the initial treatment. It is
the initial phase where is a requirement of active intervention of the
physician. At this stage, the doshas accumulate and flow in their own
places and do not circulate freely. 

v  In
Vata sanchaya – Stabdhapurnakoshthata,

v  in Pitta sanchaya- Mandoshmata,
Pita-avabhasata

v  in Kapha sanchaya -– Gaurava,
Alasya  lakshana are observed.

1)     Prakopa- 

Prakopa is defind as the
movement of Doshas away from their
principal location. It is graded as achaya
purvaka prakopa & chaya purvaka
prakopa. When the doshas are in sanchaya condition, if nidana intake persists, dosha prakopa stage follows. Dosha increases in quantity and is
ready to move. Specific symptoms and signs are seen in this stage such as-

v
Vata prakopa
-Koshtha- toda, Sancharana of vayu in koshtha

v Pitta prakopa- Amlika, Pipasa, Paridah        

v
Kapha prakopa
-Annadvesha, Hridayotklesh .

Vilayan- rupa
vriddhi of doshas is observed in prakopa stage said by “Acharya Dalhana”. “Acharya Chakrapani” have described two types
of Prakopa (Vriddhi) in their own
words-

a) Chayapurvaka
(with accumulation): with successive accumulation, stage by stage or insidious
increase. In the next stage of increase, it spreads to its other seats and in
further stages it spreads to the Dhatus
(tissues) and produces a disease after a reasonable time.

b) Achayapurvaka
(without accumu- lation): without successive accumulation or quickly. This kind
of sudden increase is also in many stages but the stages develop so quickly
that it is not clearly recognizable.

 3). Prasara- (Spread of the excited Dosha):

 Prasara
means diffusion or expansion from their usual place into other places’.In this
stage, Dosha which had been provoked,
overflow and spread over in body. Vata,
Pitta and Kapha which have their
usual situations leave their places and extend abnormally.

In the Vata
prasaravastha – Vimargagamana, Atopa ,

In Pitta
prasaravastha- Osha, Chosha, Paridah, Dhumayan and

In Kapha
prasaravastha- Arochaka, Avipaka, Angasada, Chardi are observed.

Hetu, linga
chikitsa of dosha is advised up to prasaraavastha , after which vyadhichikitsa is followed.  Fifteen kinds or varieties of Prasara are described as:- 3- Simple Prasara of only Vata, Pitta and kapha types, 1- Caused by vitiation of Rakta only 6- Prasara by vitiation of either of two Doshas and Rakta 4-
Caused by vitiation of triple interaction 1- Caused by vitiation of all the
four i.e. Vata, Pitta, Kapha and Rakta Total = 15  Acharya
Sushruta himself says Rakta (blood).

 

4)   
Sthanasamshraya-(Stage of Localization):

This stage
represents the prodrome state of the disease that is yet to be menifested. It
is defined as the localization of all persistent doshas of prasara stage
to a specific locus. This is the stage in which the disturbed morbid factors
extended to parts other then their principal seats, localizes due to srotovaigunya ( derangement of channels)
leading to unwholesome interaction between dosha
& dushya.22 During the first
three stages, the Dosha were moving
from place to place along with the Rasa
Dhatu. Ahitahara-Vihara Sevana
(Indulence in unhealthy diet and lifestyle) produces their further increase (Vriddhi Karanas), which bring about
abnormalities in the Srotas of the Dhatus (Sroto Dushti), all these factors make way for the development of
this fourth stage. The Dosha undergo
further increase and get mixed with the Dushyas,
while circulating in its channels finds itself incapable of entering into the
minute Srotas (cell pores) in such
places where Srotodushti has also
taken place. The Dosha being present
in the Rasadhatu also get settled in
those places. This activity is known as Sthanasamshraya
of the Dosha (localization). These two Vikrita (abnormal) Dosha and Dushya give rise to development of symptoms of distress to the
body. Such symptoms are actually the Purvarupa
of specific diseases. Thus the fourth Kriyakala
is a very important stage during which abnormalities are found at the level of Dosha, Dushyas, Srotas and Agni. Purvarupa (prodromal symptoms) is de- fined as those symptoms,
produced by the Dosha which have
become localized in specific places and which indicate the approaching disease.Purvarupa is of two kinds viz. a) Samanya (general) and b) Vishishta (specific). Laskshanas (symptoms) produced due to Sammurchhana of Dosha and Dushya indicating
the Vyadhi without pointing  towards the involved Dosha, means by Samanya
Purvarupa the generating Vyadhi can
be identified. These kind of prodromal symptoms have been specifically mentioned
in the texts while describing the disease. For ex.-Shrama, Arati, Vivarnata such Lakshanas
indicates that Utpadyamana Vyadhi is Jwara, but here knowledge of Prakupita
Dosha can’t be gained.Vishishta Purvarupa is defined as the appearance of the specific symptoms of
the future disease itself. For ex.- Jrimbha
(yawning) as Purvarupa of Vataja Jwara, Nayana Daha (burning of
the eyes) of Pittaja Jwara and Aruchi (dislike of food) of Kaphaja
Jwara.26 By recognizing the
prodromal symptoms the onset of the future disease can be prevented.

5)    Vyakti Avastha- (Full manifestation of a disease)-

 The manifestation of disease in its
fully recognizable form is vyakti. It is defind as vyakta lingata i.e.the symptoms are recognisable. The abnormalities
get aggravated further and suppose the intense form known as disease (the
result of Dosha- Dushya Sammurchhana),
manifesting clearly with all its characteristic features These features also
called by several synonyms such as Rupa,
Samsthana, Vyanjana, Linga, Lakshana, Chinha and Akriti. The signs and
symptoms appearing in this Vyakti
stage are broadly classified into two kinds:

 a) Samanya Lakshanas:
general signs and symptoms produced by the increased Dosha which may be seen in
all disease commonly.  

b) Pratyatma Lakshanas: specific or peculiar signs and
symptoms which are seen in any one disease characteristically. 

6). Bhedavastha-
(Final stage of Disease)-

The distinctive change that occurs to a disease after its
fully manifested stage i.e vyaktaavastha
is Bheda  which is an indication of bad prognosis . The
difference between previous kriya kala
& bheda is that the physician
cannot neglect this stage, if he fails to intervene at this stage the disease
will become incurable.

Importance of stages of Sad kriya kala-

v The knowledge about the stages of Sad kriya kal is useful in differential
diagnosis, knowing the prognosis & deciding the line of treatment of a
disease.

v On the cause & effect basis , the
careful observation of symptoms can help in finding the cause of that diasease.
The disease can be prevented by avoiding the cause.

v The sad kriya kala gives knowledge about provocated Doshas, route of disease & system or
organ affected. This is useful in deciding the treatment.

v The differential diagnosis of a
disease is possible by the knowledge of Sad
kriya kala.

v By giving early treatment, the
disease process can be arrested at accumulation or provocation or spread of doshas. The actual stage of Sad kriya kal ( Dosha-dushya-
sammurchchhana) can be prevented.

OBESITY-    obesity is defined
as an excess of adipose tissue that imparts health risk, a body weight of 20%
excess over ideal weight for age, sex & height is considered a health risk.
Obesity is a serious socio economic & also increasingly clinical problem.
Obesity can be considered to result from an imbalance between the amount of
energy consumed in the diet & the amount of energy expended through
exercise & bodily functions. Other factors of energy imbalance may include
(1) Decreased sleep (2) Ingestion of Trans fat (3) Perinatal exposures (4)
Differences in macronutrient quality.  Obesity is not a disease but it postures a
serious risk for the development of type 2 diabetes mellitus, cardiovascular
disease, non-alcoholic fatty liver disease, endocrine problems & certain
forms of cancer. Adipocyte insulin resistance, production of adipokines, free
fatty acids, inflammatory mediators & elevation of systemic dysfunction
that leads to clinical manifestations & sequel of obesity. Chronic
imbalance of calories consumed vs used causes increased storage of the excess
energy in the form of adipocyte intracellular tryglycerides stores. In adults-

·       
BMI
above 30-40 kg/m2 is defind as obesity

·       
BMI
above 40 kg/m2is severe obesity.

Synthesis
of triglycerides-

                                              
Liver & adipose tissue are the major sites of triacylglycerol (TAG)
synthesis. The TAG is synthesized by esterification of fatty acyl coA with
either glycerol -3-phosphate or dihydroxy acetone phosphate ( DHAP). The
glycerol part of the fat is derived from the metabolism of glucose. DHAP is an
intermediate of glycolysis. Liver produces fatty acid & TAG which is
transported as VLDL( very low density lipoprotein) in the blood.

 

Etiology
of obesity-   
 major etiological factors for
development of obesity

 

1)   
Sedentary lifestyle

2)   
Food intake more( meals outside the
home, sugar sweetened beverages, refined corbohydrates)

3)   
Less exercise

4)   
Genetic factor

5)   
Environmental factors

Secondary obesity may
result following a number of underlying diseases such as hypothyroidism, Cushing’s
diseases, insulinoma & hypo thalamic disorders & leptin deficiency.  

Pathogenesis  of
obesity-

Although it is known that
a disturbance of the homeostatic mechanisms controlling energy balance causes
obesity, it is less clear how the balance is disturbed, since the mechanism are
very complex & involve numerous systems in the body, but other places &
in some books described as When fat droplets are overloaded the nucleus of adipose
tissue cells degraded, cell is destroyed & TAG becomes extracellular. The
fatty acid from VLDL are taken up bound to adipose tissue with the help of
lipoprotein lipase & stored as TAG. TAG cannot metabolically reutilize
& forms the dead bulk of obese individuals.

 

 

 

       Sanchaya stage                   

not doing any exercise,

Indulging
in day sleep,

Consuming foods that promote sleshma

 

                                                         
Increase the fat

 

 

 

2)Prakopa stage         Due to the obstruction of the passage
by the fat

 

                       The movement of vata is specially confined to
kostha

 

3) Prasara stage         Stimulation of digestive power &
absorption of food.

 

                 
                   Patients digest
food quickly & become an insatiable eater.

 

                                               
    Accumulation of fat

4) Sthan sanshraya

         
Stage                    Dyspnea,
thrist,delusion, excessive sleep,&

Stinking
of the body

 

5)Vyatka stage              Smell from body, excessive hunger &

Excessive
sweating present

 

6)Bheda stage           
Owing of an excessive increase of fat & muscle tissue,

                     The buttock, breast& abdomen
become pendulous &

 His strength is
reduced.

 

                                                              
     Obesity

 

Complication of obesity-                                                 

 

·       
Metabolic syndrome

·       
Coronary artery disease

·       
Dyspnea

·       
Asthma

·       
Nonalcoholic fatty liver disease

·       
Low back pain

·       
Depression

·       
Stroke

·       
Obesity related glomeroneuropathy

·       
osteoarthritis                                   

               

                        

 

 

 

 

 

 

 

 

CONCLUSION

From above literature & discussion it is concluded that
Shatkriyakala is unique concept of Ayurveda & can be explain in modern
science perspective especially in terms of usual history of disease. By knowing
the concept of Shatkriyakala the disease process can be capture at initial
stage & avoid the probabilities of complications.  The treatment of a disease should be started
at the proper time. Sushruta’s six stages are
included in these two stages. First two stages of Shatkriyakala according to
Ayurveda can be comparing with stage of pre pathogenesis stage of modern
science. Obesity is a well-established metabolic & cardiovascular risk
factor. 

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