Vaidya Pawankumar Godatwar

National Institute of Āyurveda

Jaipur
What do you see?
 Adults who are aware of love and
intimacy see the couple embracing
 Young children only see the 9 dolphins
 Our previous learning changes the way
we view the world
Re-learning the Ancient Perspective:

Āyurvedically
Speaking- the glass
is always full!
½ filled with Air

½ filled with Water

 Unity of Man and Universe

Panchamahabhuta Biological
applications of
AKASHA Panchamahabhuta

VATA
VAYU (Motional energy)

TEJA PITTA
(Chemical activities)

JALA
KAPHA
(Solid substratum)
PRITHVI
 BASIC CAUSE OF DISEASE

Art work by Dr. LACK OF HARMONY

D’Lynn Waldron.
Between
ENVIRONMENT (Loka) & MAN (Purusha)
Due to Ayoga (Absence), Atiyoga (Excess) or Mithyayoga (Abuse) Kaala
(Time factor and its chronological influence), Buddhi (Intellect of
man is the major source of thought information and its
consequences) & Indriyartha(Objects of the Senses are the major
hubs of information exchanges)
Vikriti – the reason for Āyurvedāvatarana
(Origin of Āyurveda):
 Vikriti (disease) as
opposed to Prakriti
(health) led to the first
international conference
in history of mankind
 Great sages from all over
the extant ancient world
got together to find cure
for the newly evolving
diseases.
 If there was no
ill-health, there
would have been no
need for the pursuit
of Āyurveda.
 ‘Arogya’ (health) implies ‘till not afflicted by disease’
 ‘Swastha’ (healthy) is etymologically derived from the
term ‘niroga’ which also means ‘not afflicted by disease’.

- Chakrapani on Charaka Su.1/67

Concept of Vikriti:
 Indian thought
contemplates “Vikriti” in
various ways-
 Sanskrit - Change,
alteration, modification,
illness, indisposition as
well as changed condition
of mind and body.
Āyurveda defines Vikriti as-
 The Derangement of Dhatus or body elements
(whereas the equipoise of dhatus is health)
 At metaphysical level, Health is Sukha (pleasure)
while Vikara or disease is Duhkha (sorrow) (Ca. Su. 9/4).
 At more practical levels-
 Vikriti is defined as a Morbid State of Doshas.
 Avikriti and Vikriti are the two states of Doshas in
our body
(Hemadri on Ashtanga Hridaya Su. 1/7)
 Avikriti is the equipoise of doshas
manifesting as normal functioning of the
mind – body complex
 Vikriti is the
imbalance of
these factors
which causes
disturbance in
normal
functioning
resulting in
disease
 According to Arunadatta- the normal functioning of Doshas is lost in
Vikriti
 Daspandita states that vikriti is a deviation from the normal to
abnormal state.
 Chakrapani defines Vikara as an imbalance of DHĀTUS (the Doshas,
Saptadhatus and Upadhatus)

 Any deviation from equipoise, be it deficiency or excess or vitiation is

deemed as Vikara.
Scope and Clinical Applications:
 Understanding the basic concept of “Vikriti” as
various Imbalances of DHATUS leads to further
clinically significant aspects.
 “A wise physician should clearly observe the subtleties of
aggravated, normal and diminished states of the doshas and
disease along with the conditions of Bala (immune profile),
Agni (Digestion and metabolism) and Sattva (mental
status)and only after a thorough understanding of these
subtle states should a good physician set up a treatment
protocol”
 Aahaara (Diet),
 Nidra (Sleep)
 Brahmacharya
(Regulated
Sexual Activity)
 Are the 3 pillars of
Health
 if any of the pillar
crumbles
Diseases are
caused…..
Shat Kriyākāla: (Six stages of aggravation /
vitiation of Doshas and diseases meriting intervention)
1. Sanchaya (Accumulation of Doshas in own abode)
2. Prakopa (Aggravation of Doshas but contained in
own abode)
3. Prasara (spread of the Aggravated Doshas to other
areas)
4. Sthana Sanshraya (Localization of Doshas in
conducive places- Dosha Dushya Sammurchana
~amalgamation of Dosha and Dushya)
5. Vyakti (Manifestation of disease)
6. Bheda (Complications of disease)
Shishira Vasanta Grishma Varsha Sharad Hemanta

Vâta Pitta Kapha

Sanchaya (Accumulation of Doshas in own abode)

 The doshas tend to collect

locally depending on the
aetiological factors-
 For example:
 Dietetic indiscretion,
 Excessive activity and
 Breathing moist air
 result in accumulation of
doshas in gastro-intestinal
tract, muscles and lungs
respectively.
Clinical Manifestations :
 Fullness of stomach in Vata chaya,
 Yellowish discoloration of skin in Pitta chaya and
 Weak digestive power, heaviness of body and
laziness in Kapha chaya.

 In addition, one develops aversion to the

aetiological factor
ACCUMULATION OF DOSHAS IN
EXCESS (PRAKOPA STAGE)
 Clinical Manifestation : Pain in
abdomen and awareness of
movements of gases in abdomen
occur in Vata prakopa.
 Pitta prakopa gives rise to thirst,
regurgitation with sour taste and
burning sensation.
 Nausea and disgust for food are
the symptoms of Kapha prakopa.
 In addition, one develops a
desire for factors and substances
having properties Opposite to
the causative agents.
 Treatment: consists of administering substances
having properties opposite to those of aetiological
factors.
The dissemination of the doshas
(Prasara stage)
 Prasara is compared to the over flow from a vessel
full of flour (rising of dough), which is undergoing
fermentation.
 Treatment : The treatment consists of neutralising the
increased or vitiated doshas by all possible means.
 Till this stage, the body tissues or organs are not
involved and the treatment is directed towards
normalisation of affected dosha or doshas.
LOCALISATION OF
DOSHAS
(STHANASANSHRAYA
STAGE)
 This is a stage of localisation
of disseminated doshas in a
particular site or stage of
prodromal symptoms.
 The disseminated doshas get
localised in a tissue or organ
whose defence mechanism is
weak.
 The poor local defence
mechanism may be genetic
or acquired.
 The aquired cause may be
dietetic, environmental,
traumatic or sequelae of
previous illness, etc.
 Though in the disseminated stage of prasara, the
doshas are present all over the body, their
concentration in any tissue or organ is not much.
 In addition, the doshas in prasara stage, though in
superficial contact, do not enter or affect the
individual cells of any organ.
 On the other hand, in the stage of
Sthanasanshraya, the concentration of doshas in a
particular organ is much more.
 During this stage, the doshas enter the individual
cells of the tissue or organ and cause their
dysfunction.
Interaction of Dosha & Dushya
 Prakriti Sama Samavaya (Natural & Predictable)

 Vikriti Vishama Samaveta (Unnatural and

unpredictable)
Prakriti Sama Samavaya
(Natural & Predictable)
Vikriti Vishama Samaveta
(Unnatural and unpredictable)

 Hydrogen is highly
combustible in air. It
burned rapidly in  Oxygen is
the Hindenburg disaster essential for
on May 6, 1937. combustion.
Dosha Dushya Sammurchana
 Clinical Manifestation : During the stage of chaya,
prakopa and prasara, the manifestations are non-
specific and are related to the increased or vitiated
dosha.
 In the stage of sthanasanshraya one gets premonitory
or prodromal symptoms of a disease which depend on
affection of the involved organ or tissue as well as
the causative dosha.
Vyakti (Manifestation)
 When the causative doshas
accumulate in excess and cause
significant damage to the tissues
or organ, the disease manifests
 The classical symptoms and
signs of the disease now become
apparent
 The clinical manifestation
depends on the organ involved
as well as the causative dosha
 They are described under
individual diseases
Nidana Panchaka (Five diagnostic criteria
under which a disease ought to be assessed)
1. Nidana (causative factors)
2. Purvarupa (Prodromal Signs and Symptoms)
3. Rupa (Signs and Symptoms)
4. Upashaya (pacifying/aggravating factors)
5. Samprapti (Etio-pathogenesis)
Nidana (causative factors)

 Etiological factors have been classified in different

forms by different Āyurvedic authorities or Acaryas.
 Mainly fourteen types have been described under five
different categories.
 Category I
1. Asatmyendriyartha samyoga
(Abuse of Senses)
2. Prajnyaparadha (Indiscretions)
3. Parinama (Time)
 Category II
4. Sannikrista (Precipitating cause)
5. Viprakrishta (Causes of a longer
duration)
6. Vyabhichari (feeble)
7. Pradhanika (Very strong)
 Category III
8. Doshahetu (Dosha Vitiating)
9. Vyadhihetu (Disease Causing)
10. Ubhayahetu (Both together)
 Category IV
11. Utpadakahetu
12. Vyanjakahetu
 Category V
13. Bahyahetu (External)
14. Abhyanatarahetu (Internal)
Upashaya
(pacifying /
aggravating
factors):
Modalities of
Treatment-
Anna, Vihara,
Aushadha
Roga Bhavas: Management Criteria by which a disease
ought to be classified, studied and therapeutic protocols setup
1. Prakopanam - the primary 9. Upadravam - Complications
reason for ultimate vitiation of 10. Vriddhi - Exacerbating
Doshas. factors
2. Yonim - Dosha profile 11. Sthana - Factors
3. Utthanam - Natural Course of the maintaining Status Quo.
disease 12. Kshaya - Factors reducing
4. Atmanam - Defining Signs and the etiopathology
Symptoms (Definitions) 13. Udarkam- Prognosis
5. Adhishthanam - Main sites for the 14. Namam - Nomenclature
affliction 15. Yogam - Drugs
6. Vedanam - Signs & Symptoms 16. Pratikarartha Pravritti –
7. Samsthanam- Manifestations of Therapeutic measures
Systemic involvement 17. Pratikarartha Nivritti –
8. Shabda, Sparsha, Rupa, Rasa, Contraindications and
Gandham - Signs & Symptoms Acc. Preventive Measures.
to senses
Conclusions:

 The guiding principle behind the understanding and

management of any ‘Vikriti’ be it newly evolved diseases
such as AIDS not mentioned by name in Āyurvedic classics
is the principle of vikriti genesis as Acharyas state:
 “A physician should never feel shy for not knowing the
nomenclature of a particular disease, because it is a certainty
that not each and every disease has a name. The very same
Dosha, depending upon the nature of the causative factors,
travels to various parts of the body and produces various
diseases.” (Ca. Su. 18/46; A. H. Su 12/64-66 ).
 To understand the intricacies
implied in the term ‘Vikriti’ in
context of health and disease, it
will be worthwhile to remember
the paradoxical perspective of
Bhagavan Vyasa when he
equates-
 Prakriti is death
 Vikriti is life
  “We have to take note not only
of the opinions that won – or
allegedly won- in the debates
but also of the other points of
view that were presented and
recorded or remembered.
 An argument that refuses to be
obliterated can remain very
alive”

Nobel laureate Amartya Sen

(in “The Argumentative Indian”, page 6, Penguin books, 2005)