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[[Sutra Sthana]] 19. Ashtodariya Adhyaya

==([[Sutra Sthana]] Chapter 19, Chapter on the Numerical Classification of Diseases)==

[Chapter on numerical classification of diseases]

 

Abstract

=== Abstract ===

 

In continuation of the previous chapter, this chapter delves into classifications of various diseases. Diseases have been broadly classified here into two groups – one comprising of diseases manifesting as a result of involvement of two or more doshas (“Samanyaja Vyadhi”), while the other focusing on diseases caused due to a single dosha (“Nanatmaja Vyadhi”). Forty eight diseases have been enlisted with their types from diagnostic perspective in this chapter.  The role of doshas in etiopathogenesis of the diseases, difference between the exogenous and endogenous diseases and their coexistence has also been described. In modern medicine, classification and knowledge of these diseases differs.  Some diseases described in this chapter can be exactly correlated with diseases of modern medicine whereas some cannot be.

In continuation of the previous chapter, this chapter delves into classifications of various diseases. Diseases have been broadly classified here into two groups – one comprising of diseases manifesting as a result of involvement of two or more doshas (“Samanyaja Vyadhi”), while the other focusing on diseases caused due to a single dosha (“Nanatmaja Vyadhi”). Forty eight diseases have been enlisted with their types from diagnostic perspective in this chapter.  The role of doshas in etiopathogenesis of the diseases, difference between the exogenous and endogenous diseases and their coexistence has also been described. In modern medicine, classification and knowledge of these diseases differs.  Some diseases described in this chapter can be exactly correlated with diseases of modern medicine whereas some cannot be.

Key words: kapha, nija, pitta, sannipattika, vikara, vata, numerical classification of diseases.  

 

Introduction

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

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 Charaka 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.  

=== Introduction ===

 

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 Charaka 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 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.  

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 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.

 

 

अथातोऽष्टोदरीयमध्यायं व्याख्यास्यामः||१||  

अथातोऽष्टोदरीयमध्यायं व्याख्यास्यामः||१||  

इति ह स्माह भगवानात्रेयः||२||  

इति ह स्माह भगवानात्रेयः||२||