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|titlemode=append
|titlemode=append
|keywords= Shat-kriya Kala, Shat-kriya Kala in Ayurveda, Six progressive stages of disease for treatment interventions, charak samhita, caraka samhita, Indian system of medicine, pathogenesis of disease
|keywords= Shat-kriya Kala, Shat-kriya Kala in Ayurveda, Six progressive stages of disease for treatment interventions, charak samhita, caraka samhita, Indian system of medicine, pathogenesis of disease
|description=Prevention of disease occurrence and recurrence
|description= These are six stages of progression of disease important to prevent disease occurrence and recurrence.
|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|image_alt=carak samhita
|type=article
|type=article
|label1 = Section/Chapter/topic
|label1 = Section/Chapter/topic
|data1 = [[Nidana]] / [[Vyadhi]] / Shatkriyakala
|data1 = Concepts and Contemporary Practices-[[Nidana]] / [[Vyadhi]] / Shatkriyakala
|label2 = Authors
|label2 = Authors
|label7 = Date of first publication:
|label7 = Date of first publication:
|data7 = August 31, 2020
|data7 = August 31, 2020
|label8 = DOI
|data8 = [https://doi.org/10.47468/CSNE.2020.e01.s09.028 10.47468/CSNE.2020.e01.s09.028]
}}
}}
== Six pathological stages of a disease ==
== Six pathological stages of a disease ==
=== Stage of accumulation (Sanchaya) ===
[[File:Shatkriyakala.jpg|500px|'''Figure 1: Six stages of pathogenesis'''|thumb]]
The six stages of pathogenesis of disease are shown in figure 1.
=== I. Stage of accumulation (sanchaya) ===
This is the inceptive phase of a disease when dosha accumulates and stagnate within their natural site of predominance. Vague and non-specific features are diagnosable with minute observations.
This is the inceptive phase of a disease when dosha accumulates and stagnate within their natural site of predominance. Vague and non-specific features are diagnosable with minute observations.
====Identifying features ====
* Dullness or fullness of the abdomen due to sluggish digestion is observed due to the accumulation of vata [[dosha]]
* Dullness or fullness of the abdomen due to sluggish digestion is observed due to the accumulation of vata [[dosha]]
* Lower energy and subnormal temperature due to the accumulation of kapha [[dosha]] iv. An aversion of similar qualities of [[dosha]] and attraction towards opposites
* Lower energy and subnormal temperature due to the accumulation of kapha [[dosha]] iv. An aversion of similar qualities of [[dosha]] and attraction towards opposites
====Principle of management in this stage====
Avoid “similar” diet and lifestyle, Using “opposites” diet and lifestyle
Avoid “similar” diet and lifestyle, Using “opposites” diet and lifestyle
====Example====
Fatigue, distended abdomen, loss of appetite occurs at the very early stage of most of the viral fevers even during the incubation period of infections. Primary features are often ignored by the patients and physicians both. Hence the first opportunity of the treatment is lost. If this stage is observed and proper interventions are done, then the disease progression can be prevented or disease with mild symptoms will occur.
Fatigue, distended abdomen, loss of appetite occurs at the very early stage of most of the viral fevers even during the incubation period of infections. Primary features are often ignored by the patients and physicians both. Hence the first opportunity of the treatment is lost. If this stage is observed and proper interventions are done, then the disease progression can be prevented or disease with mild symptoms will occur.
=== Stage of vitiation (Prakopa)===
=== II.Stage of vitiation (prakopa)===
Previously accumulated and stagnated [[dosha]] within their own site are further aggravated and get ready to spread all over the body with the following symptoms:
Previously accumulated and stagnated [[dosha]] within their own site are further aggravated and get ready to spread all over the body with the following symptoms:
This is the second opportunity of management if diagnosed at this level. These signs may appear due to the micro inflammatory process in the tissues, which forms the backbone for the disease process.
This is the second opportunity of management if diagnosed at this level. These signs may appear due to the micro inflammatory process in the tissues, which forms the backbone for the disease process.
=== Stage of spread or transmission (prasara)===
=== III. Stage of spread or transmission (prasara)===
At this stage there are two possibilities:
At this stage there are two possibilities:
==== 3 (a) Remission or prashama ====
==== III.(a) Remission or prashama ====
The [[dosha] may return back to normalcy and to their normal sites, and stop further progression, if they are vitiated in the first two stages. [[Dosha]] may return to normalcy either naturally (swabhavik) or due to the employment of appropriate therapeutic measures. Thus, leading to the absence of disturbances (vikaras). [A. Hr. Sutra Sthana 12/24]<ref>Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>
The [[dosha] may return back to normalcy and to their normal sites, and stop further progression, if they are vitiated in the first two stages. [[Dosha]] may return to normalcy either naturally (swabhavik) or due to the employment of appropriate therapeutic measures. Thus, leading to the absence of disturbances (vikaras). [A. Hr. Sutra Sthana 12/24]<ref>Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>
* Sensible suitable use of senses ([[satmya]] indriyartha)
* Sensible suitable use of senses ([[satmya]] indriyartha)
* Intact intelligence, patience & memory (pragya)
* Intact intelligence, patience & memory (pragya)
* The empowered state of body mind and digestion (Deha bala, chetas bala & [[agni]] bala)
* The empowered state of body mind and digestion (deha bala, chetas bala & [[agni]] bala)
* Followings expert’s advice (aptopsevi)
* Followings expert’s advice (aptopsevi)
* Charity & truthfulness (data & satyaparata) etc.
* Charity & truthfulness (data & satyaparata) etc.
===(b) Spread or prasara ===
==== III.(b) Spread or prasara ====
* If above said precautions are neglected, following factors lead to spread of vitiated [[dosha]] through the blood circulation.
* If above said precautions are neglected, following factors lead to spread of vitiated [[dosha]] through the blood circulation.
* The pathway of disseminated [[dosha]] is [[srotas]] or microchannels.
* The pathway of disseminated [[dosha]] is [[srotas]] or microchannels.
===Features===
====Features====
The features in [[srotas]] or microchannels are manifested as:
The features in [[srotas]] or microchannels are manifested as:
* Nausea and excess salivation - By kapha
* Nausea and excess salivation - By kapha
====Treatment and precautions at this stage====
# Avoid antagonistic Diet (viruddhahar)
# Avoid antagonistic Diet (viruddhahar)
# Avoid exhaustive activities, stress, sex
# Avoid exhaustive activities, stress, sex
# Avoid adulterants and intoxicants
# Avoid adulterants and intoxicants
# Practice daily and seasonal purification
# Practice daily and seasonal purification
=== Localization stage at other site (sthansamshraya) ===
=== IV. Localization stage at other site (sthansamshraya) ===
* This is a prodromal stage and symptoms of the disease start to appear but these may be specific or non-specific.
* This is a prodromal stage and symptoms of the disease start to appear but these may be specific or non-specific.
# Four features of defects of channels viz. increased flow, obstruction, the formation of nodules, and improper direction of movement
# Four features of defects of channels viz. increased flow, obstruction, the formation of nodules, and improper direction of movement
====Treatment at this stage====
* Practice for the avoidance of impairing factors listed specifically for all the 13 major involved channels
* Practice for the avoidance of impairing factors listed specifically for all the 13 major involved channels
* Rejuvenation and protection of the vital organs
* Rejuvenation and protection of the vital organs
=== Stage of manifestation (vyakti) ===
=== V. Stage of manifestation (vyakti) ===
This is the stage of full manifested disease as a result of invasive interaction of morbid factors into defensive healthy tissues ([[dosha]]-[[dushya]] sammurcchana) with its characteristic symptomatology. At this stage, the disease can be named properly. This stage is comprised of:
This is the stage of full manifested disease as a result of invasive interaction of morbid factors into defensive healthy tissues ([[dosha]]-[[dushya]] sammurcchana) with its characteristic symptomatology. At this stage, the disease can be named properly. This stage is comprised of:
* Impaired micro channels – [[srotas]],
* Impaired micro channels – [[srotas]],
* Debilitating defense mechanism – [[dhatu]],
* Debilitating defense mechanism – [[dhatu]],
* Resulting pathologies in organs – [[Avayava]]
* Resulting pathologies in organs – [[avayava]]
====Treatment suggested at this stage====
Restoration of normalcy or vikriti vighata:
Restoration of normalcy or vikriti vighata:
* Improve digestion
* Improve digestion
* Restore dosha equilibrium
* Restore [[dosha]] equilibrium
* Repair the microchannels and organs
* Repair the microchannels and organs
* Refresh the carrier (blood)
* Refresh the carrier (blood)
* Rehabilitation of body tissues
* Rehabilitation of body tissues
* Non recurrence of disease
* Non recurrence of disease
=== Stage of differentiation/ termination (bheda)===
=== VI. Stage of differentiation/ termination (bheda)===
[[File:Stages of disease progression.jpg|500px|'''Figure 2: Six Stages of disease evolution and management interventions'''|thumb]]
This is the stage of differentiation/ termination/ rehabilitation of symptomatology. In this stage, disease becomes sub-acute, chronic, or incurable. When disease further progresses, it may produce complications becoming incurable or severe complications leading to death or may cause temporary/ permanent disability. Otherwise in self-limiting disorders, the disease may get cured itself by body and rehabilitation will be required. This is the last opportunity of the management, where all the possible management is to be applied.
This is the stage of differentiation/ termination/ rehabilitation of symptomatology. In this stage, disease becomes sub-acute, chronic, or incurable. When disease further progresses, it may produce complications becoming incurable or severe complications leading to death or may cause temporary/ permanent disability. Otherwise in self-limiting disorders, the disease may get cured itself by body and rehabilitation will be required. This is the last opportunity of the management, where all the possible management is to be applied.
* Recognition of this stage is also important to know the predisposition for further new disease (Nidanarthkaratva)
* Recognition of this stage is also important to know the predisposition for further new disease (Nidanarthkaratva)
* In this last stage, disease may lead to temporary/ permanent disability.
* In this last stage, disease may lead to temporary/ permanent disability.
* It may advance to incurability/ complications / death on account of neglect of treatment suggested in earlier stages.
* It may advance to in-curability/ complications / death on account of neglect of treatment suggested in earlier stages.
* With strong therapeutic interventions, the health might be restored without disability.
* With strong therapeutic interventions, the health might be restored without disability.
====Suggested as rehabilitative therapies or prakriti sthapana====
* Prevent/limit the complications
* Prevent/limit the complications
* Prevent genetic transmissions to offspring
* Prevent genetic transmissions to offspring
* Rehabilitation of disabilities
* Rehabilitation of disabilities
* Rejuvenation for nonoccurence of diseases
* Rejuvenation for nonoccurrence of diseases
== Bibliography ==
===Summary===
Thus the clinical observations, pathological events, treatment interventions and intensity of host:antigen interactions can be summarized as shown in figure 2. The Ayurvedic concept of the six stages of disease is one of the most important factors distinguishing Ayurveda from Allopathy. During the first four stages, disease symptoms may be subtle or nonexistent. In Allopathy, in these stages when there is no clear feature of diseases and symptoms are subjective, the patients are usually labeled as "functional," "hypochondriac" or "neurotic" until the full manifestations of the disease develop. However, in Ayurveda, the physician can identify the imbalance at an early stage. These Ayurvedic assumptions are not just baseless ideologies. Modern science bears out the validity of these assumptions.<ref>Basisht GK. Symbiohealth-Need of the hour. AYU [serial online] 2011 [cited 2020 Sep 21];32:6-11. Available from: http://www.ayujournal.org/text.asp?2011/32/1/6/85715</ref> The three body types with dominance of dosha are validated by a biostatistical study of large populations with 90 percent certainty.<ref>Joshi RR. A biostatistical approach to Ayurveda: Quantifying the Tridosha. J Altern Complement Med 2004;10:879-89.</ref> Certain genetic traits are more susceptible for diseases is shown by genome research. This principles applies to suitability of a person to certain drugs, too.<ref>Anne Barton, MRCP, Ph D, E Text book, Available from: http://www.Uptodate.com [Last cited on 2011 Jan 28]</ref> Just as Ayurveda has been able to predict which people are more likely to suffer from a particular disease. Recent research has also shown that lifestyle changes can "turn off" and "turn on" certain genes, and thus, with effort, we can turn off bad genes and turn on the good ones. <ref>Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, et al. Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial. Lancet 1990;336:129-33.</ref> Therefore, understanding concept of shatkriyakala is highly important in clinical practice.
=== Abbreviations ===
=== Abbreviations ===
Cha. = Charak, Su. = Sushruta, Sa. = Samhita, A. = Ashtanga, Hr.= Hridayam
Cha. = Charak, Su. = Sushruta, Sa. = Samhita, A. = Ashtanga, Hr.= Hridayam
=== Related links ===
=== Related articles ===
[[Kha vaigunya]]
[[Kha vaigunya]]
== References ==
== References ==
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