|Section/Chapter/topic||Concepts and Contemporary Practices-Nidana Chikitsa / Vyadhi / Infectious diseases|
|Authors||Khandel S.K.1, Baghel M. S.1|
|Editor||Deole Y.S.2, Aneesh E.G.2,Basisht G. 2|
1Director, ArogyaLaxmi, Jaipur, India2Charak Samhita Research, Training and Development Centre, I.T.& R.A., Jamnagar, Gujarat, India
|Date of first publication:||March 06, 2021|
Principles of Diagnosis and Management of infectious diseases in Ayurveda
This article is based on lecture delivered by Prof. S. K. Sharma Khandel as a part of Prof. M.S. Baghel Memorial Lecture Series on 09th February 2021.
This lecture is presentation of discussion sessions with my beloved friend, associate and teacher Prof. M. S. Baghel. 41 years ago, when we first met, he asked me the question about management of infectious diseases in Ayurveda. Since then, we had frequent discussions on this topic. I pay homage to my friend through this lecture. Truly this is based on our frequent discussions so that it will be right to add his name as author. Whole concept and management of infectious diseases and their sources are mentioned in Ayurveda is summed up in a chapter in nutshell under the title of Krimi.
Charak or all our ancestors had extra-ordinary capacity of narration in a nutshell. It is like coding. Similar to The Da Vinci code. We need to decode it. As there are many colors but basic colors are 3. All others are a combination of these 3.There are 7 basic tunes from Sa to Ni. All the music arises from it. Only 10 basic numbers from 0 to 9. All numbers come from its permutation & combination. Only 26 alphabets. All the language derived from it.
Importance of unlearning, learning and relearning in ever-dynamic medical system
“The illiterate of the 21st century will not be those, who cannot read and write, but those, who cannot learn, unlearn and relearn.” [Alvin Toffler]
Medicine has a dynamic system, concepts and practices consistently need modifications and reorientations. Many of the scientific concepts have expired or outdated need unlearning. In the present situation of COVID19 pandemic, we gained new knowledge and many existing concepts are disapproved. Re-learning of age-old fundamental concepts in inadequacy of conceptual basis in newer knowledge. Similarly is the case of contagious or infectious diseases. This presentation will also follow the same pattern. First, we should see, what is new to be learned; next what concepts or beliefs we should unlearn, and last how to relearn the real knowledge.
References from ancient wisdom
Ayurveda covers almost aspects of a human life for overall development of a person including health. However the central Health is a central issue. The ancient Indian systems explain everything in concise manner. The case is same when it comes to infectious diseases. In Rigveda, which is considered as the oldest source of knowledge, and in the three major treatise (bruhattrayis), written 2000 – 5000 years back, have some descriptions regarding the microbes. It is an unsolved mystery that how they visualized these invisible microbes or source of infections. In Harita Samhita, there are references regarding invisible microorganisms in blood called "raktaja krimi" which cannot be considered as worms. They are basically bacteria like microorganisms.
Perspective of microorganisms
By the word 'Krimi', generally it is considered as parasites/helminths/nematodes etc. But krimi includes bacteria, parasites, fungus and even the virus. Ayurveda mentions 20 types of krimi and descriptions regarding its color, size, location, modes of infection, modes of prevention and its treatment. But they are never considered as the main source of disease in Ayurveda. The concept of disease manifestation in Ayurveda is totally different from that of infection. However, Sushruta mentioned about aupasargika roga or contagious diseases. Ayurveda, being the science of life, covers every aspect of life. The most useful and beneficial is discussed repeatedly and in detail in Ayurveda. The rest of the concepts, which are not in practice, remain undetailed. Even though there are descriptions of 20 types of krimis in Ayurveda [Cha.Sa. Sutra Sthana Ashtodariya Adhyaya ], they need not be detailed here because of their unpopular names and ambiguous explanations.
Epidemics and pandemics
Descriptions of epidemics and pandemics are available in Ayurveda. Eg. Janapadodhvansaniya Vimana Adhyaya in Charaka Samhita Vimana Sthana. Descriptions of some fungal infections are also mentioned under the term kavaka in Sushruta Samhita. Their specific management is not explained because it comes under the general guidelines for treating toxins in the form of dooshi visha, aamvisha and asatmya. Some community health management modalities like drumming or playing flutes after smearing with specific medicinal pastes were used to prevent the spread of diseases as explained in dundubiswaniya adhyaya of Sushruta Samhita.
What is to be re-learned ?
In Ayurveda there is no direct reference regarding any anti infectious or antibacterial or antiviral drugs. Some pharmacology and microbiology studies have reported such properties of hundreds of Ayurvedic drugs like neem, tulsi, guggulu, vidanga, kampillaka, jati, tikta, katuka, manjistha, panchvalkala, triphala, amrita, sudarshan, vasa etc. and even Ghee oils honey are proven antibiotic properties, but in classics there is no such reference.
Sequence of causes and progression of disease in Ayurveda
Many Fundamental differences are there in Ayurveda and present medical system. Ayurveda is public health centric while modern medicine is diseases centric system. Ayurveda gives prime importance to soil (kshetra), seed (beeja) and season (ritu) theory for the manifestation and progression of diseases. In Ayurveda, dosha is considered as the seed/ pathogen; body is soil; and seasons are the aggravating and pacifying factors. If the body or host is weak to prevent the invasions of morbid factors, the disease process starts, and seasons can modify these in mild, moderate or severe states.
- Food (ahara): It is the primary cause of disease and health. Food includes everything that we consume or take inside our body. In that sense, the food that we eat, the water we drink and the air we inhale. The food of senses includes their objects and perceptions.
- Digestion (Agni): Next step is the digestion of food. If the digestive power is good enough to digest even the bad food, it won’t create problems. But if the digestive power at various levels is weak, that will result in improper digestion and the formation of metabolic toxins (ama).
- Metabolic toxins (ama): This is the first pathogen formed in the sequence of disease manifestation. This itself acts as dosha (ama dosha/ama visha) and has the capacity to vitiate the body constituents.
- Pathological interactions (dosha – dushya samurchana): Dosha is the offender and dhatu or tissue is the defender. If tissue is adequately healthy to withstand the attack of dosha, the disease won’t manifest.
- Body channels (srotas): If the body channels for transport and transformation are patent enough to circulate the food or essential nutrients then even the pathogens won’t cause any disease.
- Defective body channels (Kha vaigunya): This is the most important factor in the pathogenesis of disease. If the channels are defective due to inherited genetic disorders or acquired causes (nidana sevana) or due to other comorbid or previous diseases or iatrogenic causes or even poor mental conditions; disease can manifest. In this stage, the invaded microorganisms, bacteria or viruses, get opportunity to produce the diseases.
If the season (ritu), soil (kshetra), nourishment (ambu) and seeds (beeja) are not favorable for the invaded micro-organisms, the disease won’t manifest. If the season is not favorable, the soil not fertile, there are no nourishing factors for pathogens and the seed not potent, disease won’t occur.
For Example: This concept can be best depicted by an example. Recently, in an interview a professor in medical college said that he was very happy when he found the source of cholera infection in a village. The survey conducted by them identified drinking water as a source of vibrio cholerae. However, among the 1038 villagers, who commonly used the well water for drinking, only 31 persons got infected. The rest 1007 persons were not affected even though they used the same water for drinking. This survey reveal strong host defense of those individuals and unfavorable disease manifesting factors for the bacteria. This shows even the entry of bacteria inside the body won’t essentially cause the disease. If all the above-mentioned six stages of disease manifestation are affected, the disease will manifest. Bacteria are only a feeble (vyabhichari) cause. On the other hand, judicious use of anti-biotics is necessary to protect health of the 31 individuals and save lives if the bacterial load is significantly higher than the host defense. So, clinical application of symbiohealth approach in war against diseases is highly useful. The sword (attack against microbes) and shield (protection and strengthening host defense) are judiciously used to win the war in Symbiohealth.
Principles of treatment of infectious disease
Even though Ayurveda mentions about infectious diseases like jwara, kushtha, shosha, shotha, vrana etc., there is no uniform treatment protocol to identify and manage infections. Ayurveda focuses on health of the host and not the disease. Ayurveda is treating diseases like typhoid, tuberculosis etc. but is not treating the disease-causing microorganisms as such. Ayurveda has its own treatment principles. Infections are considered as one of the causes (nidana) of disease and the management is purely based on dosha, dushya, agni and srotas.
Assessing the pathogenesis and prognosis
Ayurveda considers two ways to assess and manage pathogenesis.
- Separating few grains from sand
- Separating few pebbles from millets
1. Separating few grains from sand
Grains are useful and sand is non-beneficial part. In case the disease is severe, the treatment must focus primarily on the beneficial factors (grains) to protect life. The harmful factors (sand) are secondary objectives to be treated. Hence, the vital organs shall be protected irrespective of pathology. The major three vital organs mentioned in Ayurveda are head, heart and bladder. Ojas (essence of life) is the fuel to these vital organs. So, the ojas must be protected in such a condition.
2. Separating few pebbles from millets
The other case presents with more useful (millets) and less harmful (pebbles) factors. In this case, the disease is new or slow progressing or mild. In this case, the harmful factors can be easily identified and removed to protect health. Purpose of this approach is very clear, “conserve the useful and throw out the waste”. If the infection is severe, save the healthy tissues and in case of lesser infection, remove the infecting agents. If the tissues are intact, pathology will never happen. Here the organ physiology is much stronger and clearer than the disease pathology. If we can protect dhatu or tissue, it itself will repair the organ. Therefore, Ayurveda gives clear directions for what is to be screened out and how to prevent the diseases and what is to be protected.
Relation of tridosha and seed-soil theory
Kapha itself can be considered as the kshetra or soil. It is the supreme source of nutrition. All the formed structures in body are due to kapha. If the nutrition is proper or if the kapha is optimum, the chance of getting disease is rare.
Pitta can be considered as seed (beeja). The body (kaya) is developed and evolved from pitta. Food cannot nurture the body without a metabolic transformation by pitta or agni. Sattva is an essence of digestion metabolism, which nurtures ojas. It acts as a connecting switch between body and mind.
Season or ritu balances the internal environment with cosmic rhythm. Vata is the regulator of seasonal fluctuations in the body and in the cosmos. The role of vata is alike the role of rajas in mind. Rajas is creator of desires, lust, attachments and aversions. It changes the internal atmosphere of the body and mind. For the proper functioning of body, uninterrupted movement of vata throughout the body is required along with its placement at proper locations in the desired quality. Because of this nature of vata, it is considered as the creator as well as terminator of disease.
Thus, the three dosha are related with the soil-seed-season theory. These play significant role in preservation of health in normal state and creation of disease in abnormal state.
Infectious agents should be considered as one of the causes (nidana) only. The treatment of such conditions must be based on Ayurvedic principles of soil-seed-season theory and factors like dosha, dushya, agni, srotas etc. If the tissues are healthy, infectious agents can’t produce the disease. So, our aim must be to attain the optimum qualities of dhatus/tissues and strengthen the host defence.
Q. (Dr.Aneesh) Can you elaborate the concept of asatmya in the context of infectious disease?
A. The concept of satmya and asatmya is important in all diseases. In all the 10 factors like dosha, dushya, bala etc. satmya has to be considered. While using potent antibiotics also, we have to consider the satmya of the patient. If so the efficacy of the antibiotics will also enhance. If the treatment is given after considering the satmya and asatmya, disease can be cured with minimal medications.
Q. (Dr.Ramya Alakkal): Covid has presented with varied clinical symptoms belonging to all systems. What should be given importance while treating, the dosha or dushya or roga-marga. How can we understand the severity according to our perspective?
A. Roga marga or disease pathways are narrated in the light of severity. The disease pathways including vital organs (Marmastasandigata roga marga) are more severe. Uttara dhatu or gambhira dhatu also means severity. Rasa the superficial dhatu is 9 anjali in quantity and the deepest dhatu, shukra is much less in quantity. The rasa which is in more quantity can dilute the pathogen, but the shukra cannot do so. The diseases of gut or superficial body constituents (Koshthagata roga or uttara dhatu gata roga ) are easy to treat, but those of deeper tissue (gambhira dhatu gata roga) are always difficult to treat. What proportion of affection of dosha and how many combinations of dosha and dushya are also important while considering the prognosis and treatment? Kaphaja roga are easily curable, vatika roga are difficult to cure and pittaja roga are dangerous as they can spread fast. So, while treating a disease dosha, dushya and rogamarga are equally important.
Q. (Dr.Yogesh Deole) Vaccination triggers antibody response in body. Can it be considered one among the soil (kshetra) strengthening measure?
A. Suvarnaprashana is being done for ages to strengthen the host defense in childhood. Vaccine includes the same mechanism. Suvarnaprashana shall be propagated more to enhance immunity and strengthen the soil (body).