Vikriti

Vikriti (Sanskrit: विकृतिः, also spelled as vikruti) means change or alteration of any kind as of purpose, mind, form, and nature. Vikriti is abnormal, differing from the normal state, structure, or condition. In the context of Ayurveda, change from a natural or healthy state to sickness is denoted by the term ‘vikriti’[Cha.Sa.Vimana Sthana 8/101]. Any alteration in prakriti leads to disequilibrium and disease. This article describes the concept and practical application of vikriti in Ayurveda.

Contributors

Section/Chapter/topic	Concepts/Vikriti
Authors	Rai Shalini 1, Manjusha P. 1
Reviewer	Basisht G.2,
Editor	Deole Y.S.3
Affiliations	1 Department of Roga Nidana, All India Institute of Ayurveda, New Delhi, India 2 Rheumatologist, Orlando, Florida, U.S.A. 3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails	vd.shalinirai@gmail.com, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	January 03, 2023
DOI	10.47468/CSNE.2023.e01.s09.125

Etymology and derivation

The term Vikriti is made from adding “Vi” prefix to the word kriti. ‘Vi’ means “change” and “kriti” means “creation”. Thus the word conveys the meaning “change from prakriti [natural or original form][Word route वि + कृ--क्तिन् वा]

Contextual meanings

Vikriti word is applied to denote the following meanings:

• Vikriti as vikara i.e. disease, sickness ^{[Cha. Sa. Vimana Sthana 8/101]}
• Vikriti as dhatuvaishamya [disequilibrium of body components denoting pathological state] ^{[Cha.Sa. Sutra Sthana 9/4]}
• A product that is evolved from prakriti or a prakriti vikriti with different qualities.
• Vikriti as arishta lakshana [signs of impending death] ^{[Cha.Sa. Indriya Sthana 1/6]}

Concept of vikriti

Vikara

Vikriti is a derangement from a natural state. It is also denoted by the term ‘vaishamya’- the body's abnormal unbalanced and pathological state. The manifestation of disease in the form of signs and symptoms also comes under this purview. Vikara ^{[Code:SAT-C.8]} is the condition that causes deviation from an individual's normal physiological state of health. The process of occurrence of disease follows a pathway known as ‘shatkriya kala’ (six pathological stages of treatment). This involves chaya avastha [accumulation of dosha], prakopa avastha [aggravation of dosha], prasara avastha [spread of vitiated dosha to other parts], sthanasamshraya avastha [localisation of dosha to different sites], vyakta avastha[manifestation of the disease] and bheda avastha [chronicity of the disease]. These pathological stages are progressive states of vikriti.
Vikriti pariksha [examination] is done based on specific hetu (etiology), dosha, dhatu (ashraya of dosha like tissues), prakriti (individual constitution), desha (habitat), kala (time) and bala (strength) involved in the samprapti (pathogenesis) of the disease. ^{[Cha. Sa. Vimana Sthana 8/101]}

Vikriti as dhatuvaishamya

The natural physiological state of dhatu is considered as dhatusamya or prakriti. The word dhatu in this context implies dosha, dhatu or mala. Any derangement from this prakriti can be pathological (dhatu vaishamya avastha) which leads to vikara.

Vikriti as product of prakriti

Vikriti is defined as the product, new entity with or without losing the innate nature of its substrata. [nyayakosha]. Any substance produced from substrata is denoted as vikriti or prakriti vikriti. Ksheera (milk) is the prakrit for ksheera vikritis like curd, butter, ghee etc.
According to Sankhya and Yoga darshana, prakriti is the principle of matter responsible for the origin of world, bringing about evolution and changes in the empirical universe. Moola prakriti is considered as prakriti [avikriti, not a by-product of anything]. The products which are derived from prakriti and responsible for further production are called as prakriti vikriti. In Ayurveda, the ashta prakriti constitutes one moola prakriti as prakriti and remaining seven i.e. mahat, ahankara, pancha tanmatra (Susruta samhita) or pancha mahabhuta (Charak Samhita) denoted as ‘prakriti vikriti’. Likewise the sixteen vikaras (indriyadi) derived from prakriti vikriti are considered as vikriti. Thus, vikriti is the finally derived entity in evolution of universe (srishti prakriya).

Vikriti as arishta lakshana

Arishta are the features of impending death, the deviation from natural physiological state (prakriti). Such vikriti can be lakshana nimitta (past deeds of life being the etiology for the symptoms at specific time. e.g. appearance of some bodily marks and specific signs) lakshya nimitha (described and identifiable etiological factors. e.g: features manifesting in a patient due to the specific nidana for vatadi dosha kopa) or nimittanuroopa (the manifestations in a patient which resemble the etiological factors, but in fact, they are not etiological factors in nature. They appear without any apparent cause. E.g. symptoms which indicate death as a result of diminution in life span) ^{[Cha.Sa. Indriya Sthana 1/6]}
All these arishta lakshana are deviation from the normalcy and without the understanding of this vikriti, the physician may lose knowledge, wealth, and success in their career.^{[Cha.Sa. Indriya Sthana 12/90]}

Assessment of vikriti (vikriti pariksha)

Diagnosis and treatment in Ayurveda involves individualisation of the therapy as per the individual. This individualisation is based on the ten factors of examination of a patient (dashavidha rogi pariksha), ^{[Cha.Sa. Vimana Sthana 8/101]} which comprises of patient examination [rogi pariksha] to determine the patient strength, and disease examination [[[Vyadhi|roga]] pariksha – vikriti pariksha] to determine the relative disease strength in the patient. Vikriti pariksha involves the examination of morbid manifestation with reference to specific hetu [cause], dosha, dushya [vitiated body elements], prakriti [constitution], desha [habitat], kala [time], bala [strength] and also examination of symptoms. The strength of the disease is examined by assessing the strength of these vikriti factors. If all these vikriti factors are having maximum strength, disease severity will also be more and vice versa. The moderate disease is one having moderate strength of the vikriti factors. Based on the strength of this disease severity, prognosis of the disease is determined. A disease having maximum vikriti bala will be of higher severity and most difficult to cure.

Vikriti at the level of dosha, dooshya and srotas

Quantitative or qualitative variation of dosha, dushya or srotas is considered under vikriti lakshana. This variation is termed as vriddhi (excess), kshaya (diminution), dushti and prakopa (variation in the quality). Internal medications and specific treatment procedures are explained to correct vikriti. If vata dosha vikriti has occurred, specific treatment procedures called vata upakramas and medications like taila are used to correct that impairment. If there is variation from prakriti of srotas (specific channels of the body) specific therapeutic managements are explained. E.g. Vitiation of rasavaha srotas (channels of transportation and transformation of rasa dhatu) is treated with depleting therapies like langhana upakrama etc. Vikriti at level of dosha, dushya and srotas leads to vikara like atisthaulya (obesity) and ati karshya (emaciation) which effects samhanana (compactness of the body). Besides, undesirable body variations (ashta nindita) with variation in height, body hair, complexion are explained in Ayurveda.

Vikriti at the level of kala (time/season), artha (objects) and karma (actions)

Variations in the characteristics of kala (season), artha (object of sense organ) and karma (actions) comes under this aspect. Visual exposure towards bright light, dim light and improper light exposure can be considered as vikriti factors at the level of darshanendriya (sense of visual perception). Similarly vikriti can also be understood at other indriya levels like that of ears, nose, tongue and skin.

Importance of knowledge of vikriti

In management of disease

The derangement of a healthy state is identified as vikriti. Using the vikriti pariksha, the extent of deviation from healthy state can be determined. The choice of drug and decision of treatment depends on the extent of vikriti. For a balavan rogi (strong patient), the line of treatment for prabhuta doshabala (severely aggravated disease) is shodhana (purificatory measures), madhyama bala dosha is pachana and alpa bala vyadhi is upavasa (restraining from food and drinks).^{[Cha.Sa. Sutra Sthana 22/19-24]}

Prognosis of disease

By calculating the strength of the vikriti, the strength of disease can be calculated. If vikriti factors are strong enough, then the disease's severity is higher, and it has a poor prognosis. ^{[Cha.Sa. Vimana Sthana 8/101]} Contemporary medical sciences use several prognosis tools to determine the patients prognosis like TNM classification for cancer staging and prognosis, Glasgow Coma Scale for comatose patients, Child pugh score for the determination of the liver disease severity. These tools can be utilized to assess vikriti.
By examining the vikriti stage in context to arishta lakshana, the patient's remaining life span can be assessed, which is to be ascertained for before starting a patients treatment.

Current researches

Baghel Prakash Prognosis Scoring System - Conceptual framework and preliminary psychometric validation

V. Ashwathy kutty and V. Rakesh Narayanan have developed a tool for prognosis scoring system named as Baghel Prakash Prognosis scoring system. It includes a set of early clinical warning signs and a prognosis scoring system of 30 items with a provision for clinical adjustment of scores for selected items. The scoring system was pilot-tested in a sample of 30 patients with various disease conditions. The initial psychometric validation studies of the tool yielded satisfactory results.

Relationships among classifications of ayurvedic medicine diagnostics for imbalances and western measures of psychological states: An exploratory study

Paul J Mill’s et. Al. made an attempt to examine the relationship among imbalances in the dosha (termed Vikriti) reported via questionnaire and Western measures of psychological states. The 60 item vikriti questionnaire assess vikriti of each of the three dosha. The 101 participants were asked to rate the symptoms as “very often”, “sometimes”, or “not often” with a score of 5, 3, and 1, respectively. A higher vikruti score equates to more imbalance, or accumulation, of that respective dosha. PROMIS Anxiety Scale, Centre for Epidemiology Studies-Depression (CES-D), Perceived Stress Scale (PSS), Mindful Attention Awareness Scale (MAAS), Rumination-Reflection Questionnaire (RRQ), Ryff Scale of Wellbeing scales were used as western measures of psychological states. Study concluded that symptoms of mind-body imbalances in Ayurveda are differentially associated with western assessments of psychological states. Ayurvedic dosha assessment may be an effective way to assess physical as well as emotional wellbeing in research and clinical settings.

Development and validation of vikrti measuring scale – A pilot study

Suchitra S Patil et al has developed a tool for assessing pathology of tridosha in a group of diseases using ayurvedic concepts. The 97 item tridosha diagnosis scale was developed and administered in 35 samples. Scale can be used in assessing the pathological state of dosha and aid in decision of appropriate medications.

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