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|title=Koshtha

|title=Koshtha

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|description= Koshtha used to denote the gut. It has been comprehended as an organ, a collection of organs or a system, a channel, a disease pathway, and a therapeutic target.

|description= Koshtha used to denote the gut. It has been comprehended as an organ, a collection of organs or a system, a channel, a disease pathway, and a therapeutic target.

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<p style="text-align:justify;">The word ‘koshtha’ literally means enclosure or gut. Over the past decade, the concept of gut has revolutionized the health and wellness industry. The state of gut and its flora in every aspect of life, their impact on health and disease, interaction with the other parts of the body and external stimuli have been areas of interest in current research. [[Ayurveda]] has appreciated the role of gut in all the domains; conceptual, diagnostical and therapeutical. The multidimensional term ‘Koshtha’ has been used to denote the gut in [[Ayurveda]]. It has been comprehended as an organ, a collection of organs or a system, a channel, a disease pathway, and a therapeutic target. In the present article, the contributions of [[Ayurveda]] in each of these realms have been explored.

The word ‘koshtha’ literally means enclosure or gut. Over the past decade, the concept of gut has revolutionized the health and wellness industry. The state of gut and its flora in every aspect of life, their impact on health and disease, interaction with the other parts of the body and external stimuli have been areas of interest in current research. [[Ayurveda]] has appreciated the role of gut in all the domains; conceptual, diagnostical and therapeutical. The multidimensional term ‘Koshtha’ has been used to denote the gut in [[Ayurveda]]. It has been comprehended as an organ, a collection of organs or a system, a channel, a disease pathway, and a therapeutic target. In the present article, the contributions of [[Ayurveda]] in each of these realms have been explored.

 

{{Infobox

{{Infobox

|data1 = [[Sharira]] / Koshtha (The concept of gut in [[Ayurveda]])

|data1 = [[Sharira]] / Koshtha (The concept of gut in [[Ayurveda]])

|label2 = Authors

|label2 = Author

|data2 = Karthik K.P.¹

|data2 = Karthik K.P.¹

|label3 = Reviewers

|label3 = Reviewer

|data3 = Basisht G.²

|data3 = [[Gopal Basisht|Basisht G.]]²

|label4 = Editor

|label4 = Editor

|data4 = Deole Y.S. ³

|data4 = [[Yogesh Deole|Deole Y.S.]]³

|label5 = Affiliations

|label5 = Affiliations

|data6 = kpkarthik131@gmail.com, carakasamhita@gmail.com

|data6 = kpkarthik131@gmail.com, carakasamhita@gmail.com

|label7 = Date of first publication:

|label7 = Publisher

|data7 = May 08, 2022

 

|label8 = Date of first publication:

|data8 = May 08, 2022

|label8 = DOI

|label9 = DOI

|data8 = under process

|data9 = 10.47468/CSNE.2022.e01.s09.097

}}

}}

 

==The anatomical and physiological extent==

==The anatomical and physiological perspective==

   

   

===Anatomy of koshtha===

===Anatomy of koshtha===

iii. Prognosis and assessment of therapeutic response

iii. Prognosis and assessment of therapeutic response

===Diagnosis of stage of diseases===

'''Diagnosis of stage of diseases'''

The stages of the diseases are based on multiple parameters. One of them is either the state of saama (associated with [[ama]]) or niraama (not associated with [[ama]]). Obstruction of channels, diminution of [[bala]], heaviness, improper activity of [[vata]], languor, indigestion, expectoration, difficulty in expelling waste matter, anorexia and tiredness are the cardinal features of saama state. The opposite features indicate niraama state.

The stages of the diseases are based on multiple parameters. One of them is either the state of saama (associated with [[ama]]) or niraama (not associated with [[ama]]). Obstruction of channels, diminution of [[bala]], heaviness, improper activity of [[vata]], languor, indigestion, expectoration, difficulty in expelling waste matter, anorexia and tiredness are the cardinal features of saama state. The opposite features indicate niraama state.

! Status of [[agni]]  !! Status of koshtha !! Associated features !! Line of management

! Status of [[agni]]  !! Status of koshtha !! Associated features !! Line of management

|-

|-

| |Strong (dipta) || hard bowels (krura) || Stiffness of upper and lower back, sacral region [Cha.Sa.[[Cikitsa Sthana]] 3/172] ||unctuous enema ([[anuvasana]])

| |Strong (dipta) || hard bowels (krura) || Stiffness of upper and lower back, sacral region [Cha.Sa.[[Chikitsa Sthana]] 3/172] ||unctuous enema ([[anuvasana]])

|-

|-

| | Strong (dipta)|| hard bowels (krura) || Obstruction of flatus [Cha.Sa.[[Cikitsa Sthana]] 5/25] || Nourishing foods and drinks that are unctuous and warm in properties

| | Strong (dipta)|| hard bowels (krura) || Obstruction of flatus [Cha.Sa.[[Chikitsa Sthana]] 5/25] || Nourishing foods and drinks that are unctuous and warm in properties

|-

|-

| | Strong (dipta)|| hard bowels (krura) || Dryness, habituated to exercise, excess of [[Vata]] [A.Hr.Sutra Sthana 18/53-55]<ref name=Hridaya/> ||Therapeutic enema or pungent rectal suppositories followed by unctuous purgation

| | Strong (dipta)|| hard bowels (krura) || Dryness, habituated to exercise, excess of [[Vata]] [A.Hr.Sutra Sthana 18/53-55]<ref name=Hridaya/> ||Therapeutic enema or pungent rectal suppositories followed by unctuous purgation

|-

|-

| | Weak (manda) || mildly unctuous || Abdominal pain, abdominal distension in abdominal lumps caused by [[vata]] (vatika gulma) [A.Hr.Cikitsa Sthana 14/29]<ref name=Hridaya/> ||Decoctions, powders, and tablets in medicated ghee

| | Weak (manda) || mildly unctuous || Abdominal pain, abdominal distension in abdominal lumps caused by [[vata]] (vatika gulma) [A.Hr.Chikitsa Sthana 14/29]<ref name=Hridaya/> ||Decoctions, powders, and tablets in medicated ghee

|-

|-

| | Weak (manda)|| mildly unctuous || Abdominal pain, abdominal distension in abdominal lumps caused by [[kapha]] (kaphaja gulma) [Cha.Sa. [[Cikitsa Sthana]] 5/54] || Decoctions, powders, and tablets

| | Weak (manda)|| mildly unctuous || Abdominal pain, abdominal distension in abdominal lumps caused by [[kapha]] (kaphaja gulma) [Cha.Sa. [[Chikitsa Sthana]] 5/54] || Decoctions, powders, and tablets

|-

|-

| | Weak (manda)|| mildly unctuous || Kaphaja gulma, habituated to alcohol [Cha.Sa.[[Cikitsa Sthana]] 5/60] ||Medicated alcohol preparations (arishta)

| | Weak (manda)|| mildly unctuous || Kaphaja gulma, habituated to alcohol [Cha.Sa.[[Chikitsa Sthana]] 5/60] ||Medicated alcohol preparations (arishta)

|-

|-

| |Weak (manda) || Heavy and sluggish bowels || Kaphaja gulma, very mild pain, tendency to expel [[dosha]]s, anorexia [Cha.Sa.[[Cikitsa Sthana]] 5/49] ||Therapeutic emesis ([[Vamana]])

| |Weak (manda) || Heavy and sluggish bowels || Kaphaja gulma, very mild pain, tendency to expel [[dosha]]s, anorexia [Cha.Sa.[[Chikitsa Sthana]] 5/49] ||Therapeutic emesis ([[Vamana]])

|-

|-

| |Weak (manda) || hard bowels (krura) || - ||Alkali (Kshara), salt (lavana) based preparations along with ghee followed by purgation [A.Hr. Sutra Sthana 18/52-53]<ref name=Hridaya/>

| |Weak (manda) || hard bowels (krura) || - ||Alkali (Kshara), salt (lavana) based preparations along with ghee followed by purgation [A.Hr. Sutra Sthana 18/52-53]<ref name=Hridaya/>

The interactions between gut flora and herbs are also emerging areas of research. It was observed that the microbiota metabolized the components of herbs to produce metabolites that significantly influence physiology. The herbs in turn modulated the composition of gut microbiota that in turn regulated their functioning.<ref>An X, Bao Q, Di S, Zhao Y, Zhao S, Zhang H, et al. The interaction between the gut Microbiota and herbal medicines. Biomedicine & Pharmacotherapy. 2019 Oct 1;118:109252.</ref> The common Ayurvedic formulation Triphala was found to promote the growth of healthy bacteria, i.e., Bifidobacteria and Lactobacilli, and inhibit the growth of pathogenic bacteria like Escherichia coli. The active compounds in Triphala were metabolized by the gut microbiome to generate antioxidant compounds.<ref>Peterson CT, Denniston K, Chopra D. Therapeutic Uses of Triphala in Ayurvedic Medicine. Journal of Alternative and Complementary Medicine (New York, NY) [Internet]. 2017;23(8):607–14. Available from: files/1341/Peterson et al. - 2017 - Therapeutic Uses of Triphala in Ayurvedic Medicine.pdf</ref> Ginger juice taken in a concentration 1.5 g/mL, for 7 days in a dose of 500 mg/kg/day increased the diversity of intestinal flora in young healthy individuals. Reduction was observed in Prevotella-to-Bacteroides ratio and pro-inflammatory microbes, and the juice also elevated the Firmicutes-to-Bacteroids ratio, Proteobacteria (anaerobic, antioxidant) and Faecalibacterium (anti-inflammatory).<ref>Wang X, Zhang D, Jiang H, Zhang S, Pang X, Gao S, et al. Gut Microbiota Variation With Short-Term Intake of Ginger Juice on Human Health. Frontiers in Microbiology. 2021 Feb 23;11:2453.</ref> Curcumin-supplemented diet was found to dose-dependently increase the survival rate and eradicate the tumor burden (at 0.5% concentration) in colitis-induced colon cancer models of IL-10 deficient mice. This action probably attributed to the increase in gut flora diversity and prevention of age-related dysbiosis.<ref>Mcfadden RMT, Larmonier CB, Shehab KW, Midura-Kiela M, Ramalingam R, Harrison CA, et al. The Role of Curcumin in Modulating Colonic Microbiota During Colitis and Colon Cancer Prevention. Inflamm Bowel Dis [Internet]. 2015 Jul 25 [cited 2022 Apr 1];21(11):2483. Available from: /pmc/articles/PMC4615313/</ref> Bio-purificatory procedures like bowel cleansing were also found to decrease the total intestinal microbial load by 31-fold and restore it within 14 to 28 days.<ref>Jalanka J, Salonen A, Salojärvi J, Ritari J, Immonen O, Marciani L, et al. Effects of bowel cleansing on the intestinal microbiota. Gut [Internet]. 2015 Oct 1 [cited 2022 Apr 6];64(10):1562–8. Available from: https://pubmed.ncbi.nlm.nih.gov/25527456/</ref> Rectal administration of buttermilk processed with Acorus calamus, Piper longum, Cyperus rotundus, Aegle marmelos, Anethum sowa, Randia spinosa, Trachyspermum ammi and Saussurea lappa for 15 days increased the abundances of Firmicutes, Proteobacteria and Deinococcus-Thermus in obese patients. Bacteroides abundance decreased, and the ratio of Firmicutes to Bacteroides increased from day 0 and 16 and then was back to baseline by day 45.<ref>Mane S, Dixit KK, Lathwal N, Dhotre D, Kadus P, Shouche YS, et al. Rectal administration of buttermilk processed with medicinal plants alters gut microbiome in obese individuals. J Diabetes Metab Disord [Internet]. 2021 Dec 1 [cited 2022 Mar 19];20(2):1415–27. Available from: http://www.ncbi.nlm.nih.gov/pubmed/34900793</ref>

The interactions between gut flora and herbs are also emerging areas of research. It was observed that the microbiota metabolized the components of herbs to produce metabolites that significantly influence physiology. The herbs in turn modulated the composition of gut microbiota that in turn regulated their functioning.<ref>An X, Bao Q, Di S, Zhao Y, Zhao S, Zhang H, et al. The interaction between the gut Microbiota and herbal medicines. Biomedicine & Pharmacotherapy. 2019 Oct 1;118:109252.</ref> The common Ayurvedic formulation Triphala was found to promote the growth of healthy bacteria, i.e., Bifidobacteria and Lactobacilli, and inhibit the growth of pathogenic bacteria like Escherichia coli. The active compounds in Triphala were metabolized by the gut microbiome to generate antioxidant compounds.<ref>Peterson CT, Denniston K, Chopra D. Therapeutic Uses of Triphala in Ayurvedic Medicine. Journal of Alternative and Complementary Medicine (New York, NY) [Internet]. 2017;23(8):607–14. Available from: files/1341/Peterson et al. - 2017 - Therapeutic Uses of Triphala in Ayurvedic Medicine.pdf</ref> Ginger juice taken in a concentration 1.5 g/mL, for 7 days in a dose of 500 mg/kg/day increased the diversity of intestinal flora in young healthy individuals. Reduction was observed in Prevotella-to-Bacteroides ratio and pro-inflammatory microbes, and the juice also elevated the Firmicutes-to-Bacteroids ratio, Proteobacteria (anaerobic, antioxidant) and Faecalibacterium (anti-inflammatory).<ref>Wang X, Zhang D, Jiang H, Zhang S, Pang X, Gao S, et al. Gut Microbiota Variation With Short-Term Intake of Ginger Juice on Human Health. Frontiers in Microbiology. 2021 Feb 23;11:2453.</ref> Curcumin-supplemented diet was found to dose-dependently increase the survival rate and eradicate the tumor burden (at 0.5% concentration) in colitis-induced colon cancer models of IL-10 deficient mice. This action probably attributed to the increase in gut flora diversity and prevention of age-related dysbiosis.<ref>Mcfadden RMT, Larmonier CB, Shehab KW, Midura-Kiela M, Ramalingam R, Harrison CA, et al. The Role of Curcumin in Modulating Colonic Microbiota During Colitis and Colon Cancer Prevention. Inflamm Bowel Dis [Internet]. 2015 Jul 25 [cited 2022 Apr 1];21(11):2483. Available from: /pmc/articles/PMC4615313/</ref> Bio-purificatory procedures like bowel cleansing were also found to decrease the total intestinal microbial load by 31-fold and restore it within 14 to 28 days.<ref>Jalanka J, Salonen A, Salojärvi J, Ritari J, Immonen O, Marciani L, et al. Effects of bowel cleansing on the intestinal microbiota. Gut [Internet]. 2015 Oct 1 [cited 2022 Apr 6];64(10):1562–8. Available from: https://pubmed.ncbi.nlm.nih.gov/25527456/</ref> Rectal administration of buttermilk processed with Acorus calamus, Piper longum, Cyperus rotundus, Aegle marmelos, Anethum sowa, Randia spinosa, Trachyspermum ammi and Saussurea lappa for 15 days increased the abundances of Firmicutes, Proteobacteria and Deinococcus-Thermus in obese patients. Bacteroides abundance decreased, and the ratio of Firmicutes to Bacteroides increased from day 0 and 16 and then was back to baseline by day 45.<ref>Mane S, Dixit KK, Lathwal N, Dhotre D, Kadus P, Shouche YS, et al. Rectal administration of buttermilk processed with medicinal plants alters gut microbiome in obese individuals. J Diabetes Metab Disord [Internet]. 2021 Dec 1 [cited 2022 Mar 19];20(2):1415–27. Available from: http://www.ncbi.nlm.nih.gov/pubmed/34900793</ref>

Novel drug delivery mechanisms have also developed targeting the gut and related axes. There is emerging evidence related to skin-gut-brain axis which aims to harness the possibilities of transdermal route medicine administration to influence the gut status. Amla, Neem, Aloe and multiple other drugs have been previously studied in this respect.<ref>Beri K. Perspective: Stabilizing the Microbiome Skin-Gut-Brain Axis with Natural Plant Botanical Ingredients in Cosmetics. Cosmetics [Internet]. 2018;5(2):37. Available from: http://www.mdpi.com/2079-9284/5/2/37</ref> Prebiotic, probiotic and symbiotic foods constitute a fast-growing industry having vast implications. Their enteral administration during pregnancy, lactation, and postnatal life were found to influence the maternal and neonatal gut flora and hence improve maternal and neonatal outcomes.<ref>Sohn K, Underwood MA. Prenatal and postnatal administration of prebiotics and probiotics. Seminars in Fetal and Neonatal Medicine [Internet]. 2017;22(5):284–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1744165X17300677</ref> Ayurvedic herbs have been evaluated in various studies for their prebiotic potential. Herbs like Glycyrrhiza glabra and Triphala have been identified to promote the growth of healthy bacteria and to reduce the pathogenic ones. They also influenced different groups of bacteria. Triphala increased the relative abundance of butyrate-producing bacteria whereas G. glabra increased that of propionate-producing bacteria.<ref>Peterson CT, Sharma V, Uchitel S, Denniston K, Chopra D, Mills PJ, et al. Prebiotic Potential of Herbal Medicines Used in Digestive Health and Disease. J Altern Complement Med [Internet]. 2018 Jul 1 [cited 2022 Mar 19];24(7):656–65. Available from: https://pubmed.ncbi.nlm.nih.gov/29565634/</ref> Advances in rectal drug delivery like hollow, thermos-responsive, liquid, nanoparticle-based suppositories have opened new windows of opportunity, especially in subjects where oral, intravenous, and other drug routes are inaccessible.<ref>Purohit TJ, Hanning SM, Wu Z. Advances in rectal drug delivery systems. Pharmaceutical Development and Technology [Internet]. 2018;23(10):942–52. Available from: https://www.tandfonline.com/doi/full/10.1080/10837450.2018.1484766</ref>

Novel drug delivery mechanisms have also developed targeting the gut and related axes. There is emerging evidence related to skin-gut-brain axis which aims to harness the possibilities of transdermal route medicine administration to influence the gut status. Amla, Neem, Aloe and multiple other drugs have been previously studied in this respect.<ref>Beri K. Perspective: Stabilizing the Microbiome Skin-Gut-Brain Axis with Natural Plant Botanical Ingredients in Cosmetics. Cosmetics [Internet]. 2018;5(2):37. Available from: http://www.mdpi.com/2079-9284/5/2/37</ref> Prebiotic, probiotic and symbiotic foods constitute a fast-growing industry having vast implications. Their interal administration during pregnancy, lactation, and postnatal life were found to influence the maternal and neonatal gut flora and hence improve maternal and neonatal outcomes.<ref>Sohn K, Underwood MA. Prenatal and postnatal administration of prebiotics and probiotics. Seminars in Fetal and Neonatal Medicine [Internet]. 2017;22(5):284–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1744165X17300677</ref> Ayurvedic herbs have been evaluated in various studies for their prebiotic potential. Herbs like Glycyrrhiza glabra and Triphala have been identified to promote the growth of healthy bacteria and to reduce the pathogenic ones. They also influenced different groups of bacteria. Triphala increased the relative abundance of butyrate-producing bacteria whereas G. glabra increased that of propionate-producing bacteria.<ref>Peterson CT, Sharma V, Uchitel S, Denniston K, Chopra D, Mills PJ, et al. Prebiotic Potential of Herbal Medicines Used in Digestive Health and Disease. J Altern Complement Med [Internet]. 2018 Jul 1 [cited 2022 Mar 19];24(7):656–65. Available from: https://pubmed.ncbi.nlm.nih.gov/29565634/</ref> Advances in rectal drug delivery like hollow, thermos-responsive, liquid, nanoparticle-based suppositories have opened new windows of opportunity, especially in subjects where oral, intravenous, and other drug routes are inaccessible.<ref>Purohit TJ, Hanning SM, Wu Z. Advances in rectal drug delivery systems. Pharmaceutical Development and Technology [Internet]. 2018;23(10):942–52. Available from: https://www.tandfonline.com/doi/full/10.1080/10837450.2018.1484766</ref>

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