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|title=Ashtodariya Adhyaya

|title=Ashtodariya Adhyaya

|keywords=kapha, nija, pitta, sannipattika, vikara, vata, numerical classification, diseases,Ayurveda, Indian system of medicine, charak samhita.  

|keywords=kapha, nija, pitta, sannipattika, vikara, vata, numerical classification, diseases,Ayurveda, Indian system of medicine, charak samhita.  

|description=Sutra Sthana Chapter 19. Numerical Classification of Diseases

|description=Sutra Sthana Chapter 19. Numerical Classification of Diseases

|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|type=article

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<big>'''Sutra Sthana Chapter 19. Numerical Classification of Diseases '''</big>

<big>'''Sutra Sthana Chapter 19. Numerical Classification of Diseases '''</big>

{{Infobox

{{Infobox

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Pol A.

|data7  = Pol A.

|label8 = Editor

|label8 = Editors

|data8  = Kar A.C., Rai S.

|data8  = Kar A.C., Rai S., Deole Y.S., Basisht G.

|label9 = Date of publication  

|label9 = Year of publication  

|data9 = December 17, 2018

|data9 = 2020

|label10 = DOI

|label10 = Publisher

|data10  = [https://doi.org/10.47468/CSNE.2020.e01.s01.021 10.47468/CSNE.2020.e01.s01.021]

|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s01.021 10.47468/CSNE.2020.e01.s01.021]

}}

}}

<big>'''Abstract'''</big>

<big>'''Abstract'''</big>

'''Keywords''': [[kapha]], nija, [[pitta]], sannipattika, vikara, [[vata]], numerical classification, diseases.

 

'''Keywords''': ''kapha, nija, pitta, sannipattika, vikara, vata,'' numerical classification, diseases.

</div>

</div>

== Introduction ==

== Introduction ==

<div style="text-align:justify;">

<div style="text-align:justify;">

Important principles of diseases in this section of the ''Roga Chatushka'' (tetrad on diseases) have been described. The preceding chapter provided a broader explanation for the cause of innumerable diseases due to ''dosha'' vitiation as well as variations in characteristics like pain, sign, etiology, site of origin, site of manifestation, symptoms and nomenclature. However, only the most important diseases, probably prevalent at that time, have been classified in view of prescribing treatment. Classification of these known diseases, based on characteristics provided above, and coupled with a few more variables such as prognosis, chronicity, treatment etc. have been done at various places within the [[Charak Samhita]]. On critically analyzing, we find that the diseases have been classified into groups having as few as one to as many as eight diseases each.Three disease groups of twenty types each have been classified at the end. It has been observed that the listing of groups by diseases has been done in a descending order - from those having eight diseases to one  - because there are no other groups that have greater than eight types of diseases within them, except for the three groups with twenty types. Hence, these outliers (with twenty types) have been enumerated at the end rather than in the beginning of the chapter. Even though there are eighteen types of obstinate skin diseases, only the seven most obstinate ones have been enumerated here.  

Important principles of diseases in this section of the ''Roga Chatushka'' (tetrad on diseases) have been described. The preceding chapter provided a broader explanation for the cause of innumerable diseases due to [[dosha]] vitiation as well as variations in characteristics like pain, sign, etiology, site of origin, site of manifestation, symptoms and nomenclature. However, only the most important diseases, probably prevalent at that time, have been classified in view of prescribing treatment. Classification of these known diseases, based on characteristics provided above, and coupled with a few more variables such as prognosis, chronicity, treatment etc. have been done at various places within the [[Charak Samhita]]. On critically analyzing, we find that the diseases have been classified into groups having as few as one to as many as eight diseases each.Three disease groups of twenty types each have been classified at the end. It has been observed that the listing of groups by diseases has been done in a descending order - from those having eight diseases to one  - because there are no other groups that have greater than eight types of diseases within them, except for the three groups with twenty types. Hence, these outliers (with twenty types) have been enumerated at the end rather than in the beginning of the chapter. Even though there are eighteen types of obstinate skin diseases, only the seven most obstinate ones have been enumerated here.  

As mentioned above, various modes of classification have been used to classify diseases in the Samhita - some diseases have been classified only according to ''doshas'' involved, such as ''apasmara'' (epilepsy), ''akshi roga'' (eye diseases), ''mukha roga'' (diseases of oral cavity), ''pratishyaya'' (rhinitis) etc. In some cases, apart from ''doshas'', certain etiological factors have also been considered and nomenclature has been done accordingly e.g. in case of ''unmada, pandu roga, hridroga, chhardi, shosha, vrana'' etc. Some diseases have been classified taking into consideration only prominent clinical features, such as in the case of ''kushtha, kilasa, arsha, jwara,'' and ''aayama''.  In some cases, nomenclature is based on the site involved in pathogenesis, as in ''rakta pitta, kamala'' etc, while in some cases, severity has been the basis for classification e.g. ''vatarakta''. We also find groups containing sub-classes or sub-groups of diseases. This hierarchical basis has been used while classifying the three disease families mentioned that have twenty types of diseases. ''Krimi'' are first classified into ''bahya, raktaja, shleshmaja'' and ''purishaja'' which are sub-classified into other diseases. Similarly, twenty types of ''pramehas'' are broadly classified into three groups on the basis of ''doshas'' and then subtypes are mentioned. ''Yoni vyapada'' (gynecological disorders) are broadly classified into diseases caused by ''dosha'' and diseases caused by amalgamation of ''doshas'' and ''dushyas'', with further sub-classifications. Thus, it can be said that classification has not been restricted to a single hierarchic pattern but a hierarchical system for disease classification as well. Still, the classification of all known diseases is not complete using the above mentioned system. Need-based or contextual re-classification of various disease groups can be found in many places within the Samhita.  

As mentioned above, various modes of classification have been used to classify diseases in the Samhita - some diseases have been classified only according to [[dosha]] involved, such as ''apasmara'' (epilepsy), ''akshi roga'' (eye diseases), ''mukha roga'' (diseases of oral cavity), ''pratishyaya'' (rhinitis) etc. In some cases, apart from [[dosha]], certain etiological factors have also been considered and nomenclature has been done accordingly e.g. in case of ''unmada, pandu roga, hridroga, chhardi, shosha, vrana'' etc. Some diseases have been classified taking into consideration only prominent clinical features, such as in the case of ''kushtha, kilasa, arsha, jwara,'' and ''aayama''.  In some cases, nomenclature is based on the site involved in pathogenesis, as in ''rakta pitta, kamala'' etc, while in some cases, severity has been the basis for classification e.g. ''vatarakta''. We also find groups containing sub-classes or sub-groups of diseases. This hierarchical basis has been used while classifying the three disease families mentioned that have twenty types of diseases. ''Krimi'' are first classified into ''bahya, raktaja, shleshmaja'' and ''purishaja'' which are sub-classified into other diseases. Similarly, twenty types of ''pramehas'' are broadly classified into three groups on the basis of [[dosha]] and then subtypes are mentioned. ''Yoni vyapada'' (gynecological disorders) are broadly classified into diseases caused by [[dosha]] and diseases caused by amalgamation of [[dosha]] and ''dushyas'', with further sub-classifications. Thus, it can be said that classification has not been restricted to a single hierarchic pattern but a hierarchical system for disease classification as well. Still, the classification of all known diseases is not complete using the above mentioned system. Need-based or contextual re-classification of various disease groups can be found in many places within the Samhita.  

This lack of standardization or disease classification or nomenclature does warrant a need to frame some standards that are unanimously acceptable across the world. In fact, the need for standardizing disease classifications has been strongly aired by experts and this body of classification has been given the name of Ayurvedic Classification of Diseases (ACD). Moreover, considering the importance of traditional medicine, the World Health Organization (WHO) is also incorporating Traditional Medicine (TM) in ICD-11. WHO recently completed a survey among member nations and discovered that 82% of the world's population uses some form of TM.[2]  To bring all countries onto one platform for health management requires the inclusion of TM in ICD.  

This lack of standardization or disease classification or nomenclature does warrant a need to frame some standards that are unanimously acceptable across the world. In fact, the need for standardizing disease classifications has been strongly aired by experts and this body of classification has been given the name of Ayurvedic Classification of Diseases (ACD). Moreover, considering the importance of traditional medicine, the World Health Organization (WHO) is also incorporating Traditional Medicine (TM) in ICD-11. WHO recently completed a survey among member nations and discovered that 82% of the world's population uses some form of TM.[2]  To bring all countries onto one platform for health management requires the inclusion of TM in ICD.  

To make this happen, immense efforts are required to develop adequate nomenclature and classification for Ayurvedic diseases. However, there are practical challenges associated with correlating all these diseases mentioned in [[Ayurveda]] with modern disease families. For example, certain diseases or disorders such as ''kushtha, pandu, prameha, gulma,'' etc. may not have an equivalent in modern medicine. Some do have a direct correlation with those found or classified today, such as ''bhagandara, kamala, baddhodara, chidrodara, tamaka shwasa'' etc.  

To make this happen, immense efforts are required to develop adequate nomenclature and classification for Ayurvedic diseases. However, there are practical challenges associated with correlating all these diseases mentioned in [[Ayurveda]] with modern disease families. For example, certain diseases or disorders such as ''kushtha, pandu, prameha, gulma,'' etc. may not have an equivalent in modern medicine. Some do have a direct correlation with those found or classified today, such as ''bhagandara, kamala, baddhodara, chidrodara, tamaka shwasa'' etc.  

The relationship between the ''doshas'' and endogenous diseases can be explained using the following analogy mentioned in this text:  just as no bird (under the Sun) can fly without casting a shadow, no endogenous disease (caused by the disturbance of the equilibrium of ''dhatus'') can occur without the vitiation of ''vata, pitta'' and ''kapha''. The exogenous diseases may or may not be caused due to a vitiated ''dosha'' but so far as their treatment is concerned, ''doshas'' need not be factored in. There is also a mention of exogenous and endogenous diseases coexisting together. Endogenous diseases are, at times, followed by the exogenous ones and vice-versa. While treating such conditions, one should start treatment on the basis of the secondary development and our understanding of the primary nature of the disease.

The relationship between the [[dosha]] and endogenous diseases can be explained using the following analogy mentioned in this text:  just as no bird (under the Sun) can fly without casting a shadow, no endogenous disease (caused by the disturbance of the equilibrium of [[dhatu]]) can occur without the vitiation of [[vata]], [[pitta]] and [[kapha]]. The exogenous diseases may or may not be caused due to a vitiated [[dosha]] but so far as their treatment is concerned, [[dosha]] need not be factored in. There is also a mention of exogenous and endogenous diseases coexisting together. Endogenous diseases are, at times, followed by the exogenous ones and vice-versa. While treating such conditions, one should start treatment on the basis of the secondary development and our understanding of the primary nature of the disease.

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These diseases will be described in detail in the same order as enumerated earlier.  

These diseases will be described in detail in the same order as enumerated earlier.  

<div style="text-align:justify;">

<div style="text-align:justify;">

*Eight types of ''udara roga'' (abdominal swelling) are ''vataja, pittaja, kaphaja, sannipataja, plihodara'' (due to splenic disorder), ''baddhodara'' (due to intestinal obstruction), ''chidrodara'' (due to intestinal perforation) and ''dakodara'' (ascites).

*Eight types of ''udara roga'' (abdominal swelling) are [[vata]]ja, [[pitta]]ja, [[kapha]]ja, sannipataja, plihodara(due to splenic disorder), ''baddhodara'' (due to intestinal obstruction), ''chidrodara'' (due to intestinal perforation) and ''dakodara'' (ascites).

*Eight types of ''mutraghatas'' (Oliguria/Anuria) are ''vataja, pittaja, kaphaja, sannipatika, ashmarija'' (due to stone in urinary tract), ''sharkaraja'' (due to gravels in urinary tract), ''shukraja'' (due to spermolith) and ''shonitaja'' (due to hematoma).

*Eight types of ''mutraghatas'' (Oliguria/Anuria) are [[vata]]ja, [[pitta]]ja, [[kapha]]ja, sannipatika, ashmarija(due to stone in urinary tract), ''sharkaraja'' (due to gravels in urinary tract), ''shukraja'' (due to spermolith) and ''shonitaja'' (due to hematoma).

*Eight types of ''ksheera-dosha'' (disorders of breast milk) are ''vaivarnya'' (discoloration), ''vaignadhyam'' (altered smell), ''vairasyam'' (altered taste), ''paichichhilyam'' (sliminess), ''phenasamghata'' (excessive frothiness), ''raukshyam'' (absence of unctuousness), ''gauravam'' (heaviness in digestion/physical character) and ''atisneha'' (excessive unctuousness).

*Eight types of ''ksheera-dosha'' (disorders of breast milk) are ''vaivarnya'' (discoloration), ''vaignadhyam'' (altered smell), ''vairasyam'' (altered taste), ''paichichhilyam'' (sliminess), ''phenasamghata'' (excessive frothiness), ''raukshyam'' (absence of unctuousness), ''gauravam'' (heaviness in digestion/physical character) and ''atisneha'' (excessive unctuousness).

*Eight types of ''reto dosha'' (disorders of semen) are ''tanu'' (increased liquidity/decreased liquefaction time), ''shuskam'' (less viscous/dry), ''phenilam'' (excessive frothiness), ''ashwetam'' (discoloration), ''puti'' (foul smelling), ''atipichichhilam'' (excessive sliminess), ''anyadhatupahitam'' (presence of tissue constituents) and ''avasadi'' (increased specific gravity) (1)

*Eight types of ''reto dosha'' (disorders of semen) are ''tanu'' (increased liquidity/decreased liquefaction time), ''shuskam'' (less viscous/dry), ''phenilam'' (excessive frothiness), ''ashwetam'' (discoloration), ''puti'' (foul smelling), ''atipichichhilam'' (excessive sliminess), ''anyadhatupahitam'' (presence of tissue constituents) and ''avasadi'' (increased specific gravity) (1)

*Seven varieties of ''kushtha'' (obstinate skin diseases) are ''kapala, udumbara, mandala, rishyajihwa, pundarika, sidhma'' and ''kakanaka''.

*Seven varieties of ''kushtha'' (obstinate skin diseases) are ''kapala, udumbara, mandala, rishyajihwa, pundarika, sidhma'' and ''kakanaka''.

*Seven types of ''pidakas'' (inflammatory swellings) are ''sharavika, kachhapika, jalini, sarshapi, alaji, vinata'' and ''vidradhi''.

*Seven types of ''pidakas'' (inflammatory swellings) are ''sharavika, kachhapika, jalini, sarshapi, alaji, vinata'' and ''vidradhi''.

*Seven types of ''visarpa'' (acute spreading inflammatory skin conditions) are vatika, paittika, kaphaja, sannipatika, agni, kardama and granthi. (2)

*Seven types of ''visarpa'' (acute spreading inflammatory skin conditions) are [[vata]]ja, [[pitta]]ja, [kapha]]ja, sannipatika, agni, kardama and granthi. (2)

</div>

</div>

==== Diseases of Six Types ====

==== Diseases of Six Types ====

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<div style="text-align:justify;">

*Six types of ''Atisara'' (diarrhoeal disorders) are ''vatika, paittika, kaphaja, sannipatika, bhayaja'' (caused by fear) and ''shokaja'' (caused by grief.)

*Six types of ''Atisara'' (diarrhoeal disorders) are ''vatika, paittika, [[kapha]]ja, sannipatika, bhayaja'' (caused by fear) and ''shokaja'' (caused by grief.)

*Six types of ''Udavartas'' (abdominal diseases due to suppression of natural urges) are ''vataja'' (due to suppression of flatus), ''mutraja'' (due to suppression of urine), ''purishaja'' (due to suppression of feces), ''shukraja'' (Due to suppression of ejaculation of semen), ''chhardija'' (due to suppression of vomiting) and ''kshavathuja'' (due to suppression of sneezing). (3)

*Six types of ''Udavartas'' (abdominal diseases due to suppression of natural urges) are ''vataja'' (due to suppression of flatus), [[mutra]]ja (due to suppression of urine), ''[[purisha]]ja'' (due to suppression of feces), ''[[shukra]]ja'' (Due to suppression of ejaculation of semen), ''chhardija'' (due to suppression of vomiting) and ''kshavathuja'' (due to suppression of sneezing). (3)

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==== Diseases of Five Types ====

==== Diseases of Five Types ====

<div style="text-align:justify;">

<div style="text-align:justify;">

*Five types of ''gulmas'' (abdominal lump/tumour) are ''vataja, pittaja, kaphaja, sannipataja'' and ''raktaja''.  

*Five types of ''gulmas'' (abdominal lump/tumour) are [[vata]]ja, [[pitta]]ja, [[kapha]]ja, sannipataja and [[rakta]]j.  

*Five types of ''pliha doshas'' (splenic disorders) are of the same type as those of ''gulma''.

*Five types of ''pliha doshas'' (splenic disorders) are of the same type as those of ''gulma''.

*Five types of ''kasa'' (cough) are ''vataja, pittaja, kaphaja, kshataja'' (caused by internal injuries in respiratory tract) and ''kshayaja'' (caused by wasting).

*Five types of ''kasa'' (cough) are ''[[vata]]ja, [[pitta]]ja, [[kapha]]ja, kshataja'' (caused by internal injuries in respiratory tract) and ''kshayaja'' (caused by wasting).

*Five types of ''shwasa'' (dyspnoea) are ''mahashwasa, urdhwashwasa, chhinna shwasa, tamaka shwasa'' and ''kshudra shwasa'' (dyspnoea due to exertion).

*Five types of ''shwasa'' (dyspnoea) are ''mahashwasa, urdhwashwasa, chhinna shwasa, tamaka shwasa'' and ''kshudra shwasa'' (dyspnoea due to exertion).

*Five types of ''hikka'' (hiccup) are ''mahati, gambhira, vyapeta, kshudra'' and ''annaja''.

*Five types of ''hikka'' (hiccup) are ''mahati, gambhira, vyapeta, kshudra'' and ''annaja''.

*Five types of ''trishna'' (thirst) are ''vataja, pittaja, amaja, kshayaja'' (due to wasting) and ''upsargaja'' (secondary to other diseases).

*Five types of ''trishna'' (thirst) are [[vata]]ja,[[pitta]]ja, amaja, kshayaja (due to wasting) and ''upsargaja'' (secondary to other diseases).

*Five types of ''chhardi'' (vomiting) are ''vataja, pittaja, kaphaja, sannipataja'' and ''dwistarthsangyogaja'' (by coming in contact with obnoxious articles).

*Five types of ''chhardi'' (vomiting) are [[vata]]ja, [[pitta]]ja, [[kapha]]ja, sannipataja'' and ''dwistarthsangyogaja'' (by coming in contact with obnoxious articles).

*Five types of ''bhaktasyanasana'' (anorexia) are ''vataja, pittaja, kaphaja, sannipataja'' and ''dweshaja'' (repugnance)

*Five types of ''bhaktasyanasana'' (anorexia) are [[vata]]ja, [[pitta]]ja,[[kapha]]ja, sannipataja'' and ''dweshaja'' (repugnance)

*Five types of ''shiroroga'' (disorders of head) are ''vataja, pittaja, kaphaja, sannipataja'' and ''krimija'' (due to parasitic infection).  

*Five types of ''shiroroga'' (disorders of head) are [[vata]]ja, [[pitta]]ja, [[kapha]]ja, sannipataja and ''krimija'' (due to parasitic infection).  

*Five varieties of ''hridroga'' (cardiac disorders) are same as disorders of head i.e. ''vataja, pittaja, kaphaja, sannipataja'' and ''krimija'' (due to parasitic infection).  

*Five varieties of ''hridroga'' (cardiac disorders) are same as disorders of head i.e. [[vata]]ja,[[pitta]]ja,[[kapha]]ja, sannipataja'' and ''krimija'' (due to parasitic infection).  

*Five types of ''pandu'' (anaemia) are ''vataja, pittaja, kaphaja, sannipataja'' and ''mridbhakshanaja''  (due to intake of clay).

*Five types of ''pandu'' (anaemia) are [[vata]]ja, [[pitta]]ja, [[kapha]]ja, sannipataja and ''mridbhakshanaja''  (due to intake of clay).

*Five types of ''unmada'' (insanity) are ''vataja, pittaja, kaphaja, sannipataja'' and ''aagantuja'' (due to exogenous causes). (4)

*Five types of ''unmada'' (insanity) are [[vata]]ja,[[pitta]]ja,[[kapha]]ja, sannipataja and ''aagantuja'' (due to exogenous causes). (4)

</div>

</div>

==== Diseases of Four Types ====

==== Diseases of Four Types ====

</div></div>

</div></div>

*Four types of ''apasmara'' (epilepsy) are ''vataja, pittaja, kaphaja'' and ''sannipataja''.

*Four types of ''apasmara'' (epilepsy) are [[vata]]ja, [[pitta]]ja, [[kapha]]ja and sannipataja.

*Four types of ''akshiroga'' (diseases of the eye)

*Four types of ''akshiroga'' (diseases of the eye)

*Four types of ''karna roga'' (diseases of the ear)

*Four types of ''karna roga'' (diseases of the ear)

*Four types of ''grahani roga'' (mal-absorption disorders)

*Four types of ''grahani roga'' (mal-absorption disorders)

*Four types of ''mada roga'' (intoxication) and  

*Four types of ''mada roga'' (intoxication) and  

*Four types of ''murchcha'' (fainting) are same as that of ''apasmara'' (epilepsy) i.e. ''vataja, pittaja, kaphaja'' and ''sannipataja.''

*Four types of ''murchcha'' (fainting) are same as that of ''apasmara'' (epilepsy) i.e. [[vata]]ja, [[pitta]]ja, [[kapha]]ja and ''sannipataja.''

*Four varieties of ''shosha'' (consumption/wasting) are ''sahasaja'' (over strain), ''sandharanaja'' (suppression of natural urges), ''kshayaja'' (wasting) and ''vishamashanaja'' (irregularities in diet).

*Four varieties of ''shosha'' (consumption/wasting) are ''sahasaja'' (over strain), ''sandharanaja'' (suppression of natural urges), ''kshayaja'' (wasting) and ''vishamashanaja'' (irregularities in diet).

*Four types of ''klaibya'' (sterility) are ''beejopaghataja'' (affliction of sperm), ''dhwajabhangaja'' (atonia of genital organs/erectile dysfunction), ''jaraaja'' (senility) and ''shukrakshayaja'' (decreased production of sperm) (5)

*Four types of ''klaibya'' (sterility) are ''beejopaghataja'' (affliction of sperm), ''dhwajabhangaja'' (atonia of genital organs/erectile dysfunction), ''jaraaja'' (senility) and ''shukrakshayaja'' (decreased production of sperm) (5)

</div></div>

</div></div>

*Three types of ''shothas'' (swellings) are ''vataja, pittaja'' and ''kaphaja''.

*Three types of ''shothas'' (swellings) are [[vata]]ja, [[pitta]]ja and [[kapha]]ja.

*Three types of ''kilasas'' (vitiligo) are ''rakta'' (red), ''tamra'' (coppery) and ''shukla'' (white) coloured.

*Three types of ''kilasas'' (vitiligo) are "rakta" (red), ''tamra'' (coppery) and ''shukla'' (white) coloured.

*Three types of ''lohitatapittas'' (coagulopathies) are ''urdhabhagam'' (involving upper channels), ''adhobhagam'' (involving lower channels and ''ubhayabhagam'' (involving both channels). (6)

*Three types of ''lohitatapittas'' (coagulopathies) are ''urdhabhagam'' (involving upper channels), ''adhobhagam'' (involving lower channels and ''ubhayabhagam'' (involving both channels). (6)

</div></div>

</div></div>

*There is one ''urustambha'' (spastic paraplegia) which is caused by ''ama'' and all three ''doshas''.

*There is one ''urustambha'' (spastic paraplegia) which is caused by ''ama'' and all three [[dosha]].

*''Sanyasa'' (coma) is also of one type that is caused by all three ''doshas'' and is psycho-somatic in nature.

*''Sanyasa'' (coma) is also of one type that is caused by all three [[dosha]] and is psycho-somatic in nature.

*''Mahagada'' (major disease) is one and is due to ''atattvabhinivesha'' (mental and moral perversion). (8)

*''Mahagada'' (major disease) is one and is due to ''atattvabhinivesha'' (mental and moral perversion). (8)

*Twenty types of ''pramehas'' (urinary disorders characterized by abnormal and increased frequency of urine) include ''udakameha'' (polyuria), ''ikshuvalikarasameha'' (glycosuria), ''sandrameha, sandraprasadameha, shuklameha, shukrameha, shitameha, shanairmeha, sikatameha'' and ''lalameha'' (ten diseases caused by ''kapha''). ''Ksharameha, kalameha, nilameha, lohitameha, manjisthameha'' and ''haridrameha'' are six types caused by ''pitta''. Finally, ''vasameha, majjameha, hastimeha'' and ''madhumeha'' are four types caused by ''vata''.

*Twenty types of ''pramehas'' (urinary disorders characterized by abnormal and increased frequency of urine) include ''udakameha'' (polyuria), ''ikshuvalikarasameha'' (glycosuria), ''sandrameha, sandraprasadameha, shuklameha, shukrameha, shitameha, shanairmeha, sikatameha'' and ''lalameha'' (ten diseases caused by ''kapha''). ''Ksharameha, kalameha, nilameha, lohitameha, manjisthameha'' and ''haridrameha'' are six types caused by ''pitta''. Finally, ''vasameha, majjameha, hastimeha'' and ''madhumeha'' are four types caused by ''vata''.

*There are twenty types of ''yoni vyapadas'' (gynaecological disorders). Of these, ''vatika, paittika, kaphaja'' and ''sannipataja'' are produced by ''vata, pitta, kapha'' and a combination of all the three ''doshas'' (''tridosha'') respectively. The remaining sixteen are caused through various permutations and combinations of ''dosha, dushya'' and other causative factors. These are ''raktayoni'' (menorrhagia),  ''arajaska'' (amenorroea), ''acharana'' (colpitis mycotica), ''aticharana'' (chronic vaginitis), ''prakcharana'' (deflorative vaginitis), upapluta (secondary dysmenorrhoea), paripluta (acute vaginitis), udavartini (primary dysmenorrhoea), karinini (endo-cervitis), ''putraghini'' (abortive tendency), ''antarmukhi'' (inversion of uterus), ''suchimukhi'' (colpo stenosis), ''sushka'' (culpo xerosis), ''vamini'' (profluvium seminis), ''sandhyayoni'' (undeveloped female sex organs/pseudo-uterus) and ''mahayoni'' (prolapse of the uterus). These are twenty types of gynaecological disorders. (9)

*There are twenty types of ''yoni vyapadas'' (gynaecological disorders). Of these, vatika, paittika and kaphaja and sannipataja are produced by [[vata]], [[pitta]], [[kapha]] and a combination of all the three [[dosha]] (''tridosha'') respectively. The remaining sixteen are caused through various permutations and combinations of [[dosha]], dushya and other causative factors. These are ''raktayoni'' (menorrhagia),  ''arajaska'' (amenorroea), ''acharana'' (colpitis mycotica), ''aticharana'' (chronic vaginitis), ''prakcharana'' (deflorative vaginitis), upapluta (secondary dysmenorrhoea), paripluta (acute vaginitis), udavartini (primary dysmenorrhoea), karinini (endo-cervitis), ''putraghini'' (abortive tendency), ''antarmukhi'' (inversion of uterus), ''suchimukhi'' (colpo stenosis), ''sushka'' (culpo xerosis), ''vamini'' (profluvium seminis), ''sandhyayoni'' (undeveloped female sex organs/pseudo-uterus) and ''mahayoni'' (prolapse of the uterus). These are twenty types of gynaecological disorders. (9)

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All the endogenous diseases occur invariably due to the vitiation of ''vata, pitta'' and ''kapha''. As a bird cannot infringe upon its own shadow even by flying throughout the day, in the same way all the diseases are produced by disturbances in equilibrium in ''dhatu'' and cannot occur without vitiation of ''vata, pitta'' and ''kapha''. By examining location, sign and symptoms, causes of vitiation of ''vata'', ''pitta'' and ''kapha'' in any condition, the intelligent physician diagnose all diseases. (5)

All the endogenous diseases occur invariably due to the vitiation of [[vata]], [[pitta]] and [[kapha]]. As a bird cannot infringe upon its own shadow even by flying throughout the day, in the same way all the diseases are produced by disturbances in equilibrium in [[dhatu]] and cannot occur without vitiation of [[vata]], [[pitta]] and [[kapha]]. By examining location, sign and symptoms, causes of vitiation of [[vata]], [[pitta]] and [[kapha]] in any condition, the intelligent physician diagnose all diseases. (5)

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Disturbance in equilibrium of ''dhatus'' results in number of diseases and these are only due to ''pitta, kapha'' and ''vata'' i.e. they cannot be produced without involvement of these three ''doshas''. Exogenous diseases are exception to this. (6)

Disturbance in equilibrium of [[dhatu]] results in number of diseases and these are only due to [[pitta]], [[kapha]] and [[vata]] i.e. they cannot be produced without involvement of these three [[dosha]]. Exogenous diseases are exception to this. (6)

=== Progression of endogenous and exogenous diseases ===

=== Progression of endogenous and exogenous diseases ===

*Numerical classification of diseases is important in practice for differential diagnosis and planning treatment.  

*Numerical classification of diseases is important in practice for differential diagnosis and planning treatment.  

*The diseases can be classified by ''dosha'' dominance, cardinal signs, clinical presentation, or location of ''dosha''.  

*The diseases can be classified by [[dosha]] dominance, cardinal signs, clinical presentation, or location of [[dosha]].  

*''Doshas'' are inevitable factors associated with the pathogenesis of every disease. A disease cannot occur without disequilibrium in the ''doshas''.   

*[[Dosha]] are inevitable factors associated with the pathogenesis of every disease. A disease cannot occur without disequilibrium in the [[dosha]].   

*In due course of time, endogenous diseases make the patient vulnerable to exogenous diseases and vice versa.

*In due course of time, endogenous diseases make the patient vulnerable to exogenous diseases and vice versa.

== Vidhi Vimarsha (Applied Inferences) ==

== Vidhi Vimarsha (Applied Inferences) ==

*Classification of diseases, including abdominal ones, have been discussed in this chapter. Since diseases are innumerable, the classification is only restricted to diseases prevalent at that time. [Verse no. 1-2]

*Classification of diseases, including abdominal ones, have been discussed in this chapter. Since diseases are innumerable, the classification is only restricted to diseases prevalent at that time. [Verse no. 1-2]

*In this chapter, diseases have been  classified according to ''sankhya samprapti'' (by the number of variants of the disease), ''vidhi samprapti'' (i.e., by features or symptoms of the disease). [Verse 3, 4(1)]

*In this chapter, diseases have been  classified according to ''sankhya samprapti'' (by the number of variants of the disease), ''vidhi samprapti'' (i.e., by features or symptoms of the disease). [Verse 3, 4(1)]

*The common thing among these three diseases with seven varieties is that their manifestation site is skin but they vary in clinical features, severity, chronicity etc. Nomenclature of ''kushtha'' and ''pidaka'' is based mainly on clinical manifestation and ''visarpa'' subtypes have been mentioned according to ''doshas'' involved. [Verse no. 4(2)]

*The common thing among these three diseases with seven varieties is that their manifestation site is skin but they vary in clinical features, severity, chronicity etc. Nomenclature of ''kushtha'' and ''pidaka'' is based mainly on clinical manifestation and ''visarpa'' subtypes have been mentioned according to [[dosha]] involved. [Verse no. 4(2)]

*Diseases are classified into six types on the basis of their etiological factors involved. During classifying ''atisara'' both physical and mental factors are considered while classification of ''udavarta'' is based on suppression of six important natural urges. [Verse no. 4(3)]

*Diseases are classified into six types on the basis of their etiological factors involved. During classifying ''atisara'' both physical and mental factors are considered while classification of ''udavarta'' is based on suppression of six important natural urges. [Verse no. 4(3)]

*In this verse 12 diseases have been mentioned which have 5 subtypes. If we analyze five subtypes of each disease we will find that in most of the cases four sub-types are ''vataja, pittaja, kaphaja'' and ''sannipataja''. Fifth type varies in many of above mentioned diseases like in ''gulma'' and ''pliha dosha - raktaja'', in ''chhardi- dwistarthsangyogaja'', in ''bhaktasyanasana - dweshaja,'' in ''shiroroga'' and ''hridroga - krimija'', in ''pandu – mridbhakshanaja'' and in ''unmada – agantuja''. Any cause other than ''dosha'' remarkably changes pathogenesis of disease so keeping this fact in mind, last subtypes have been separately mentioned and named. For the same reason in ''kasa'', in place of ''sannipataja, kshataja'' and ''kshayaja kasa'' and in ''trishna'' in place of ''kaphaja - aamaja, trishna'' have been mentioned. In ''shvasa'' division has been done on the basis of prominent symptoms and in ''hikka'' it is based on both symptoms and causative factors. [Verse no. 4(4)]

*In this verse 12 diseases have been mentioned which have 5 subtypes. If we analyze five subtypes of each disease we will find that in most of the cases four sub-types are [[vata]]ja, [[pitta]]ja,[[kapha]]ja and sannipataja. Fifth type varies in many of above mentioned diseases like in ''gulma'' and ''pliha dosha - raktaja'', in ''chhardi- dwistarthsangyogaja'', in ''bhaktasyanasana - dweshaja,'' in ''shiroroga'' and ''hridroga - krimija'', in ''pandu – mridbhakshanaja'' and in ''unmada – agantuja''. Any cause other than [[dosha]] remarkably changes pathogenesis of disease so keeping this fact in mind, last subtypes have been separately mentioned and named. For the same reason in ''kasa'', in place of ''sannipataja, kshataja'' and ''kshayaja kasa'' and in ''trishna'' in place of ''kaphaja - aamaja, trishna'' have been mentioned. In ''shvasa'' division has been done on the basis of prominent symptoms and in ''hikka'' it is based on both symptoms and causative factors. [Verse no. 4(4)]

*In eight out of set of ten diseases mentioned, classification into subtypes has been based on involvement of ''soshas''. ''Sosha and klaibya'' pathogenesis and treatment varies with cause of the disease so they are classified on the basis of causative agent involved. [Verse no. 4(5)]

*In eight out of set of ten diseases mentioned, classification into subtypes has been based on involvement of ''soshas''. ''Sosha and klaibya'' pathogenesis and treatment varies with cause of the disease so they are classified on the basis of causative agent involved. [Verse no. 4(5)]

*The basis of classification is different in all the three above mentioned diseases. The ''shotha'' subtypes are classified on the basis of  ''dosha'', in ''kilasa'' it is based on clinical features and in ''lohitapitta'' it is classified on the basis of site of manifestation. [Verse no. 4(6)]

*The basis of classification is different in all the three above mentioned diseases. The ''shotha'' subtypes are classified on the basis of  ''dosha'', in ''kilasa'' it is based on clinical features and in ''lohitapitta'' it is classified on the basis of site of manifestation. [Verse no. 4(6)]

*Diseases are classified into two types based on etiology, clinical features, severity etc. mainly aimed to properly understand pathogenesis as well as to plan treatment. [Verse no. 4(7)]

*Diseases are classified into two types based on etiology, clinical features, severity etc. mainly aimed to properly understand pathogenesis as well as to plan treatment. [Verse no. 4(7)]

*Diseases with no subtypes have been mentioned. The above set includes possible variation of physical and mental causes. ''Urustambha'' occurs due to three ''doshas'' and ''ama, sanyasa'' is psycho-somatic in nature and in ''mahagada'' there is involvement of mental entities only. [Verse no. 4(8)]

*Diseases with no subtypes have been mentioned. The above set includes possible variation of physical and mental causes. ''Urustambha'' occurs due to three [dosha]] and ''ama, sanyasa'' is psycho-somatic in nature and in ''mahagada'' there is involvement of mental entities only. [Verse no. 4(8)]

*While describing diseases with large number of subtypes separate way of classification was used. All the mentioned diseases are first broadly classified in a group and then sub-types are mentioned. ''Krimi'' are first classified into ''bahya, raktaja, shleshmaja'' and ''purishaja'' and then among these four groups twenty types of ''krimi'' have been mentioned.[Cha.Sa.[[Vimana Sthana]]7] Twenty types of ''prameha'' are broadly classified in three groups on basis of ''doshas'' and then subtypes are mentioned, Similarly, ''yoni vyapada'' are broadly classified as diseases due to ''dosha'' and diseases due to amalgamation of ''dosha'' and ''dushyas'' and under second category 16 types of diseases have been mentioned. [Verse no. 4(9)]

*While describing diseases with large number of subtypes separate way of classification was used. All the mentioned diseases are first broadly classified in a group and then sub-types are mentioned. ''Krimi'' are first classified into ''bahya, raktaja, shleshmaja'' and ''purishaja'' and then among these four groups twenty types of ''krimi'' have been mentioned.[Cha.Sa.[[Vimana Sthana]]7] Twenty types of ''prameha'' are broadly classified in three groups on basis of [[dosha]] and then subtypes are mentioned, Similarly, ''yoni vyapada'' are broadly classified as diseases due to [[dosha]] and diseases due to amalgamation of [[dosha]] and ''dushyas'' and under second category 16 types of diseases have been mentioned. [Verse no. 4(9)]

*Importance of ''dosha'' in disease production has been mentioned. Equilibrium of ''dosha'' is important aspect of ''swasthya'' or health and if ''doshas'' are vitiated they will lead to disease formation. Three important factors by which one can diagnose disease have been mentioned in the above verse. [Verse no. 5]

*Importance of [[dosha]] in disease production has been mentioned. Equilibrium of [[dosha]] is important aspect of ''swasthya'' or health and if [[doshas]] are vitiated they will lead to disease formation. Three important factors by which one can diagnose disease have been mentioned in the above verse. [Verse no. 5]

*It has been emphasized that there is separate category of disease (''agantuja vyadhi'') in which involvement of ''doshas'' may not be necessary. [Verse no. 6]

*It has been emphasized that there is separate category of disease (''agantuja vyadhi'') in which involvement of [[doshas]] may not be necessary. [Verse no. 6]

*It has been clarified that exogenous and endogenous diseases can coexist and at times endogenous diseases are followed by the exogenous ones and even the exogenous ones are followed by the endogenous one. So, while treating such type of conditions secondary development and the primary nature of the disease should be properly analyzed. [Verse no.7]

*It has been clarified that exogenous and endogenous diseases can coexist and at times endogenous diseases are followed by the exogenous ones and even the exogenous ones are followed by the endogenous one. So, while treating such type of conditions secondary development and the primary nature of the disease should be properly analyzed. [Verse no.7]

*With the advancement of scientific knowledge and technology mode of disease classification has changed a lot but the basic principles remain the same. At present, disease classification is based upon etiology, pathogenesis, clinical features etc. So, basis remains the same but due to enhancement in knowledge nomenclature has changed. [Verse no.3]

*With the advancement of scientific knowledge and technology mode of disease classification has changed a lot but the basic principles remain the same. At present, disease classification is based upon etiology, pathogenesis, clinical features etc. So, basis remains the same but due to enhancement in knowledge nomenclature has changed. [Verse no.3]

Cardinal feature of ''udara roga'' is swelling in abdomen so all diseases having presentation with abdominal swelling/distension can be taken under common term ''udara roga''. In general diseases of stomach and bowel can be included in it. <ref>Monier Williams , Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 184 </ref>[Madhukosh on M.Ni.35/1] [Cha.Sa.[[Sutra Sthana 18/31]

Cardinal feature of ''udara roga'' is swelling in abdomen so all diseases having presentation with abdominal swelling/distension can be taken under common term ''udara roga''. In general diseases of stomach and bowel can be included in it. <ref>Monier Williams , Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 184 </ref>[Madhukosh on M.Ni.35/1] [Cha.Sa.[[Sutra Sthana 18/31]

So, ''udara rogas'' described in [[Ayurveda]] can be correlated with different intra-abdominal conditions in which abdominal swelling/distension is the prime feature eg. abdominal tumours, hepato/splenomegaly, intestinal obstruction, perforation, ascites etc. Subtypes of ''udara roga'' are named and described on the cause of swelling/distension. First four types are named after ''dosha'' involved. Description of ''pleehodara'' in [[Chikitsa Sthana]] closely resembles with spleen enlargement. ''Pliha'' refers to spleen so all conditions with predominant splenomegaly which cause visible abdominal swelling/distension can be taken by the term ''pleehodara''. ''Baddha'' means obstruction, and so obstructive conditions leading to abdominal swelling/distension can be clubbed as ''baddhodara''. Cause and symptoms closely resembles with that of intestinal obstruction so intestinal obstruction could be the possible modern correlate. ''Chhidra'' refers to cavity or hole. In description of ''chhidrodara'' it is clearly mentioned that intestine is injured which leads to exudation of material from intestine to abdominal cavity from the injured site. This condition closely resembles intestinal perforation. ''Udaka'' literally refers to water. ''Udakodara'' or ''jalodara'' is a condition in which fluid is accumulated in intestine. Based on resemblance in clinical features it can be correlated with ascites.

So, ''udara rogas'' described in [[Ayurveda]] can be correlated with different intra-abdominal conditions in which abdominal swelling/distension is the prime feature eg. abdominal tumours, hepato/splenomegaly, intestinal obstruction, perforation, ascites etc. Subtypes of ''udara roga'' are named and described on the cause of swelling/distension. First four types are named after [[dosha]] involved. Description of ''pleehodara'' in [[Chikitsa Sthana]] closely resembles with spleen enlargement. ''Pliha'' refers to spleen so all conditions with predominant splenomegaly which cause visible abdominal swelling/distension can be taken by the term ''pleehodara''. ''Baddha'' means obstruction, and so obstructive conditions leading to abdominal swelling/distension can be clubbed as ''baddhodara''. Cause and symptoms closely resembles with that of intestinal obstruction so intestinal obstruction could be the possible modern correlate. ''Chhidra'' refers to cavity or hole. In description of ''chhidrodara'' it is clearly mentioned that intestine is injured which leads to exudation of material from intestine to abdominal cavity from the injured site. This condition closely resembles intestinal perforation. ''Udaka'' literally refers to water. ''Udakodara'' or ''jalodara'' is a condition in which fluid is accumulated in intestine. Based on resemblance in clinical features it can be correlated with ascites.

=== ''Mutraghata'' ===

=== ''Mutraghata'' ===

In ''mutraghata'' main symptom is either oliguria or enuria due to suppression of urine formation and obstructive uropathy.''Vijayarakshita'' has mentioned difference between ''mutrakrichra'' and ''mutraghata''. In ''mutrakrichra'' there is painful and frequent micturition <ref>Monier Williams , Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 825 </ref> so it can be correlated with dysuria as in urinary tract infection. All conditions in which urinary output is low or absent can be interpreted as ''mutraghata''.[ Ma.Ni.31/1] [Dalhana on Su.Sa.Uttara Tantra 58/1]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>, [Chakrapani on Cha.Sa.[[Chikitsa Sthana]] 26/43-44]

In ''mutraghata'' main symptom is either oliguria or enuria due to suppression of urine formation and obstructive uropathy.''Vijayarakshita'' has mentioned difference between ''mutrakrichra'' and ''mutraghata''. In ''mutrakrichra'' there is painful and frequent micturition <ref>Monier Williams , Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 825 </ref> so it can be correlated with dysuria as in urinary tract infection. All conditions in which urinary output is low or absent can be interpreted as ''mutraghata''.[ Ma.Ni.31/1] [Dalhana on Su.Sa.Uttara Tantra 58/1]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>, [Chakrapani on Cha.Sa.[[Chikitsa Sthana]] 26/43-44]

Four types of ''mutraghata'' are classified according to ''dosha'' <ref>Monier Williams , Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 114 </ref>:  

Four types of ''mutraghata'' are classified according to [[dosha]] <ref>Monier Williams , Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 114 </ref>:  

*''Ashmarija mutraghata'' (''Ashmari'' means stone) can be taken as obstruction of urine due to urolithiasis.  

*''Ashmarija mutraghata'' (''Ashmari'' means stone) can be taken as obstruction of urine due to urolithiasis.  

*In the same way based on the nomenclature ''sharkaraja mutraghata'' can be taken as condition with gravels in urinary tract,  

*In the same way based on the nomenclature ''sharkaraja mutraghata'' can be taken as condition with gravels in urinary tract,  

=== ''Udavarta'' ===

=== ''Udavarta'' ===

''Udavarta'' word refers to excretion <ref>Monier Williams , Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 185 </ref> and is caused by suppression of natural urges due to which path of ''vata'' is obstructed resulting in hampering of normal functioning and movement of ''vata''. [Madhukosha Teeka on M.Ni. 27/1] Conditions characterized by retention of feces, urine and flatus, associated with pain and leading to or caused by anti-peristaltic movements in the body.

''Udavarta'' word refers to excretion <ref>Monier Williams , Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 185 </ref> and is caused by suppression of natural urges due to which path of [[vata]] is obstructed resulting in hampering of normal functioning and movement of [[vata]]. [Madhukosha Teeka on M.Ni. 27/1] Conditions characterized by retention of feces, urine and flatus, associated with pain and leading to or caused by anti-peristaltic movements in the body.

=== ''Gulma'' ===

=== ''Gulma'' ===

=== ''Chhardi'' ===

=== ''Chhardi'' ===

In ''chhardi'' (vomiting), food and ''dosha'' are forcefully expelled out through mouth.

In ''chhardi'' (vomiting), food and [[dosha]] are forcefully expelled out through mouth.

=== ''Arochaka'' ===

=== ''Arochaka'' ===

=== ''Unmada'' ===

=== ''Unmada'' ===

''Unmada'' is a syndrome with multiple manifestations and heterogeneous causes, including psychosis and mood disorders. It is characterized by perturbation / confusion (''vibhrama'') of mind (''manas''), intellect (''buddhi''), consciousness (''sangyaa''), knowledge (''jnana''), memory (''smriti''), desire (''bhakti''), manner (''sheela''), behaviour (''cheshta''), conduct (''aachaara''). This is cardinal sign of ''unmada''.  

''Unmada'' is a syndrome with multiple manifestations and heterogeneous causes, including psychosis and mood disorders. It is characterized by perturbation / confusion (''vibhrama'') of mind ([[manas]]), intellect ([[buddhi]]), consciousness (''sangyaa''), knowledge (''jnana''), memory ([[smriti]]), desire (''bhakti''), manner (''sheela''), behaviour (''cheshta''), conduct (''aachaara''). This is cardinal sign of ''unmada''.  

=== ''Apasmara'' ===

=== ''Apasmara'' ===

=== ''Jwara'' ===

=== ''Jwara'' ===

''Jwara'' refers to fever.<ref>Monier Williams , Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 428 </ref>

[[Jwara]] refers to fever.<ref>Monier Williams , Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 428 </ref>

=== ''Vrana'' ===

=== ''Vrana'' ===

[[File:Diseases20types.png]]

[[File:Diseases20types.png]]

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== References ==

== References ==