by Shree Gulabkunverba Ayurvedic Society | 1949 | 162,724 words | ISBN-13: 9788176370813
The History of Indian medicine and Ayurveda (i.e., the science of life) represents the introductory pages of the Charaka Samhita composed of six large sections dealing with every facet of Medicine in ancient India in a Socio-Historical context. Caraka is regarded as one of the pioneers in the field of scientific healthcare. As an important final a...
When the imbalance condition of the triumvirate transgresses a particular limit of accumulation there happens disorganization of the triumvirate of organizations.
As a result of rupture of the integrative functions of these, organizations, the circulation and distribution of these dynamic functional principles become irregular and misdirected. If at such unfavourable moment, there occurs the incidence of some exciting factor, the vitium or vitia become upset, provoked and vitiated and assume the vitiating mood. The body as a whole or some part of it may not tolerate the provoked, angry and vitiating character of the vitium and, becomes irritated and thus the organization that was sustaining the very health of the body becomes an irritant and a pathogenic factor at this moment. This stage is called the stage of provocation of the vitia.
Vitiation Process (Dosha-prakopa) or Pathogenesis
This is the real or major pathogenesis. It is quite different from minor pathological condition or imbalance condition brought about by the simple process of increase or decrease which is mere variation in quantity. It is a quintitative change, while the vitiation process (Dosha-prakopa—doṣaprakopa) is the morbid modification of the qualities or functions of the triumvirate of organizations. It is a qualitative change in the functions of the vitia. The vitial pathological process is the drama of action and reaction of the triumvirate or the phenomena manifested in the; body by them when once they are converted into pathological state from their physiological state
The hero who rules and protects the body is encroached upon or assailed by vicious or malevolent exciting factors. These immediate exciting etiological factors may come from endogenous or exogenous sources and the battle-royal issues between the triumvirate and the etiological factors. The hero, the triumvirate, marshals all his forces and equipment and destroys the enemies or nullifies their injurious influences. But if the enemies turn out to he stronger than the hero or the incidence of attack is too sudden, the issue will be otherwise. The triumvirate will be vitiated and it will carry out vitiation all over the body
The intensity and periodicity and results of this vitiation-process depend upon the strength of etiological factors, vital power of triumvirate and of body-elements and the extraneous help each of them receives and the method of fight they adopt.
The following types of disease-conditions may be produced by vitiation pathogenesis.
1. Vitiation process spreads with all intensity and affects the entire body; the body gives no or poor resistance. There will be acute general disease-condition
2. Vitiation process is strong enough to affect the whole body, but the body vitality encounters the incursion with nearly equal force, a prolonged fight ensues with fluctuation on either side; vitiation process waxing and waning according to the extraneous circumstances.
3. Vitiation process does not affect the whole body but becomes located in some system, part, organ or tissues; vitiation process begins to spread, the constitution of the local tissues tries to resist and local inflammatory reaction results. If the fight is acutely carried out there will result acute inflammation of the part.
4. If the local vitiation process is slow in progress there will be chronic inflammation.
This is a brief account of the interplay of triumvirate in the vitiation process that may affect the whole body or part of it and the clinical phenomena of various disease-conditions that may be produced by this vitiation pathogenesis.
Having taken a bird’s eye-view of the significant facts of vitiation pathogenesis and co-related disease conditions produced by them we shall endeavour to study the vitiation pathogenesis, stage by stage, and its intricate details regarding beginning, gradual or sudden evolution, development and final termination so as to have a more intimate understanding of the pathological process which may guide the practical application of therapeutic measures. The importance given by the ancient authors to the complete study of the pathological process in the understanding of disease-condition becomes quite evident in the aphoristic statement of Caraka.
“The knowledge of disease is obtained by the study of (1) Etiology, (2) Premonitory symptoms, (3) Signs and symptoms, (4) Homologatory signs and (5) Pathogenesis”.
Thus it is considered one of the five methods necessary for the diagnosis of disease-condition
Moreover this fifth method is detailed and subdivided in various ways to have a thorough knowledge of pathogenesis.
[Carakasaṃhitā Nidānasthāna 1.12/1]
“Pathogenesis is again classified according to number, predominant morbid humor, mode of classification, minutia and period of exacerbation”
Sushruta divides the vitiation pathogenesis process in six stages they are as follows:—
“He who knows the various stages of pathogenesis viz, stage of accumulation Samcaya (saṃcaya), provocation (prakopa), diffusion (prasara), location Sthanasamshrya (sthānasaṃśrya), manifestation and termination (bheda) is entitled to be a physician”
1. The Stage of Accumulation (saṃcaya)
The first stage of increase or accumulation of quality or quantity has been described fully in the chapter on Imbalance condition Stage of decrease or hypo will only manifest the signs and Symptoms of deficiency either in space or action, but the stage of increase has far-reaching effects Increase shall have to be accommodated somewhere and the body being a limited space for accommodation or to bear the pressure of the extra matter or power, some irregularity or disorder occurs in the body, material increase being a static and localized thing, there may be local increase or growth of the particular tissue, it may disturb the neighbouring tissue and cause Inconvenience by mechanical pressure. But increase and continued accumulation of dynamic force of the triumvirate which are all-pervaisive and whose equilibrium is maintained on a very subtle fulcrum can be tolerated only to a limited stage which does not transgress the threshold of accommodative capacity of pentad of reserve foci. This stage may or may not produce actual disease condition but definitely serves as aid and predisposing condition to trauma or other etiological factors which act as immediate excitant to the triumvirate and heraid the vitiation process, and usher in the incursion of disease condition.
The general postulate of diagnosis of stages of increase and decrease of the function of triumvirate is described as follows—
[Carakasaṃhitā Sūtrasthāna 18.52-53]
“Now the signs of decrease of Vata, Pitta and Kapha are described to be decrease of their respective actions. There may be the loss of their normal functions or even the increase of contrary ones. Increase of natural actions is the position indicated in the increase of humors. The norm, the decrease and increase of humors are thus diagnosed.”
Sushruta describes some more definite premonitory symptoms when triumvirate imbalance is just on the threshold of vitiation. Recognition of these prodromal symptoms is given all importance by the author who considers this stage as the first or earliest therapeutic period.
[Suśrutasaṃhitā Sūtrasthāna 21.18]
“These are the seats of affection. In these the vitia get accumulated. The cause of accumulation has been already stated. The symptoms of accumulated vitia are: stiffness and fullness of abdomen (due to Vāta), yellow tinge of the skin (due to Pitta), low temperature. heaviness of limbs and lethargy (due to Kapha) and instinct of repugnance for the causative factors of accumulation of the respective vitia. This is the first stage for treatment” (Suś. Sūt 21, 18)
Careful personal regimen and simple prophylactic measures will ward off completely or to some extent the incidence of disease condition, if the condition is recognised at this stage and treatment started
2. The Stage of Provocation (prakopa)
This is the provocative reaction of the member of the triumvirate. This is generally subsequent to the triumvirate having reached the maximum point of increase or decrease and being at this moment irritated or provoked by an extraneous excitant etiological factor, endogenous or exogenous. This provocative reaction also may occur without previous imbalance condition if the immediate excitant factor is too strong for the triumvirate for adaptive reaction
Incidence of additional pathogenetic factor to the already over-stressed and imbalanced triumvirate produces baneful poisonous or toxic effects on that body. Triumvirate come easily under the influence of these newly produced toxic effects, imbibe them, and get themselves intoxicated and thus become vitiated Once vitiated, it loses self-control and forgets normal duties and functions. It becomes erratic, irregular, disorganized, abnormal and morbific in function Saviour of the body becomes the sinner of the body.
It becomes a convert and an ally of the enemy. The hero of the physiology begins to play the part of the villain in the drama of pathology. It being itself vitiated, spreads the maleficent effects all over the body and causes vitiation of body-elements or body-channels wherever possible. When fully under intoxication or vitiation effects, it behaves as if possessed by the hostile excitant and does all the harm to its old master, the body.
This tragic conversion of the benevolent triumvirate into malevolent organization is the beginning of real vitiation pathogenesis. This provoked condition is indeed the initiation of disease condition and the stage of diffusion, location, manifestation and termination are the further development of the behaviour of the provoked vitium or villa. If at the termination of this pathological process, vitiation effects are encountered successfully and nullified by the body vitality, the triumvirate is extricated from the pathological stage. Triumvirate then returns as the prodigal son and resumes his benevolent role of supporting the body
Sushruta ascribes definite syndromes to the provocation stage of each of the triumvirate, and considers this stage to be the second in importance for the practical therapeutics. (Sūtrasthāna 21.27)
Vagbhata’s definition of provocation is still more elucidating. He states:—
[Aṣṭāṅgahṛdayasaṃhitā Sūtrasthāna 12.23]
“Provocatian is that stage when a vitium moves in a wrong direction and manifests symptoms of its morbid condition and the feeling of illness denotes the occurrence of disease”.
3. The Stage of Diffusion (prasara) or Pervasion of Vitiation Process:
Sushruta strikes an exceedingly astonishing concept when he tries to explain this process of diffusion (prasara).
[Suśrutasaṃhitā Sūtrasthāna 21.28]
“Now we shall describe the process of diffusion of vitiation process. Triumvirate provoked by the excitant etiological factors begin to increase just as the combination of rice-flour water and yeast give rise to increase (fermentation). And this increase naturally leads to overflow and spreading in the body”.
Sushruta compares this contin nous process of increase to the phenomena of growth in yeast fermentation, thus anticipating by two thousand years the great discoverer of bacterial science, Louis Pasteur, who proved the truth of this concept to the world by physical methods. Equally astonishing is the biological postulate of growth and reproduction which in Caraka’s words runs as follows:—
[Carakasaṃhitā Sūtrasthāna 11.32]
“There is no seedling in the absence of seed”.
Which needed Virchow (1855 A.D.) and Flemming (1882 a.d.) to expound it again in the 19th century as important biological laws “Omnis cellula e cellula” and “omnis nucleus e nucleo” respectively and prove it by modern scientific means.
In this spreading stage, if the vitiating effects are too strong, the whole body may be overpowered and general or constitutional disease condition will result
If the vitiating effects are not so strong as to disable the whole body, it may continue to move in the body, just as clouds do in the sky, till they find sufficient attraction for settling or definite obstruction to proceed further and produce disease condition at that site
Sushruta describes definite syndromes indicative of diffusive stage of each of the triumvirate and considers this stage as the third in importance from the therapeutic point of view (Sūtra. 21, 32)
4. The Stage of Location (sthānasaṃśraya):
This location may occur at any and every place
[Suśrutasaṃhitā Sūtrasthāna 21.29]
“Like the cloud in the sky, the vitium showers disease on the entire body or on a half of it or in whatever part or organ it is greatly provoked”
[Carakasaṃhitā Cikitsāsthāna 21.7]
“Affecting either the entire body, or half the body or only one limb or region of the body”
Why does it get located at a particular place?
Locus minoris resistentiae of the particular system-organ or tissue or obstruction in the bodychannels may determine the location of the vitiating elements. This locus minoris resistentiae may be due to particular constitution of that system, organ, part or cell or it might be due to biological inferiority in growth or it might have been caused by damage to them, by previous trauma, stress, disease or otherwise.
Susruta explains the reason of Location (sthānasaṃśraya) thus—
[Suśrutasaṃhitā Sūtrasthāna 24.10]
“Wherever the all-pervading vitia in their provoked state come into contact with an organ or tissue or part that is already impaired and hence susecptible, there occurs disease-phenomenon”.
Caraka also states in the same way the reason of location in one place.
[Carakasaṃhitā Cikitsāsthāna 15.37]
“The vitium pours down its vitiating element whenever it contacts a susceptible ^spot and causes disease condition there as a cloud pours down rain in a favorable region. This is the mode of local provocation of vitia”.
This stage of location is of great clinical importance for early diagnosis of disease condition.
Vitiation elements having attained foot-hold somewhere get gradually established “therein and produce symptoms which will be indicative not only of the vitiation of the particular vitium or vitia, but also will be indicative of location or site (sthāna) where vitiation process has begun to spread. These combined symptoms help to localize the site of disease-condition. Sushruta, the master clinician, differentiates the symptoms produced during this stage of location of vitiation process as the definite premonitory symptoms (pūrvarūpa—pūrvarūpam)
[Suśrutasaṃhitā Sūtrasthāna 21.33]
“The premonitory symptoms manifest when the vitiation process is located From them the disease is recognised. This is the fourth stage of therapeusis”.
And this stage of location manifested clinically by definite premonitory symptoms is the fourth period of importance for therapeutic purpose
5. The Stage of Manifestation (vyakti):
Vyakti is the stage of manifestation of actual disease condition. Sushruta correlates this pathological stage with the actual appearance of clinical phenomena of the disease.
“We shall hereafter describe the actual manifestation of disease”
This disease condition may be a general disease or a systematic disease, or a disease of one part or limb according to the location of settling and establishing of the vitiation elements. This is the beginning of organic or structural changes in the body.
The disease-condition may be classified in two groups general or local and both these groups, can again be subdivided into acute and chronic types.
1. Acute types (śīghrakārin):
If the vitiation elements are too strong, time and place very favourable to them, and the body constitution very weak or susceptible to disease condition, vitiation or morbific process spreads over the entire body very abruptly and the body is overpowered immediately. The body then succumbs completely and passes in full vitiation stage to be followed generally by dissolution
Such conditions are described by Caraka as follows.
[Carakasaṃhitā Cikitsāsthāna 21.6-7]
“O Worshipful one! I see in the bodies of human beings a fell disease which spreads with the virulence of snake-venom. Those men who are attacked by this fulminating disease succumb to it speedily, unless treated promptly Now concerning this disease, we are in great need of enlightenment”.
If after the immediate stunning, stupefaction and vitiation, the vital power of the body rises to the occasion and rallies all his anti-forces or antibodies (pratyanīka) to save the situation, and extraneous factors of time and environment become helpful to the body, the issue takes the reverse turn and vitiation process becomes lessened and if the counter-action will continue successfully, the body with its triumvirate organization becomes free from vitiation altogether and the man survives. (Carakasaṃhitā Cikitsāsthāna 3.54-56)
2. Chronic types (dīrghakāla-anubandhin):
The general disease condition may have periodical or chrome clinical course if the fighting forces on either side are nearly of equal strength Fighting forces are vitiation elements versus body-constitution and body-elements, season, time and other environmental factors may be helpful to either side. Fluctuation in the strength of either side of the fighting forces or supporting help from extraneous sources may cause abatement or aggravation of the disease condition. Such kind of warfare continues for a long time till one side gets sufficiently powerful to subdue the other Caraka describes such oscillations in disease condition as under:
[Carakasaṃhitā Cikitsāsthāna 3.62]
“The morbid toxic factors having opposition from the anti-bodies, cause remittent fever which periodically rises and remits”.
5-B. Local Disease Condition
If the vitiation process locates and gets established in a localized area, organ or tissue, the same phenomenon of encounter occurs but on a smaller scale and in limited space. Such localized reaction may also occur in the body without the previous internal vitiation process that local part receives a powerful trauma—physical, chemical or biological from external source. These exogenous etiological factor are termed Agantuka (āgantuka) to be differentiated from the endogenous ones which are termed Nija. A long list of such exogenous aud endogenous etiological factors is given in Caraka Samhita. (Carakasaṃhitā Sūtrasthāna 18.4 and 6)
The differential diagnosis between disease conditions produced by endogenous causes (nija) and by exogenous causes (āgantuka) is described by Caraka as under—
[Carakasaṃhitā Sūtrasthāna 20.7]
“The exogenous one begins with pain and later on leads to the discordance of Vata, Pitta and Kapha. But in the endogenous oue, discordance of Vata Pitta and Kapha occurs first and later on gives rise to pain”.
Fight in a localized area of the body has the advantage of receiving great help from the body in general. The entire body concentrates all his fighting forces at the war-site to give a regular pitched battle
The local concentration of warfare phenomena makes the localization of disease area an easy task to the clinician. When the regular pitched battle is decided at the site, all fighting forces and equipment are brought and concentrated at the spot. Thus the part becomes enlarged and appears swollen. There is an acute stage of whole atmosphere. All these signs of local warfare are easily observed by the clinician. It is a happy coincidence to find that the ancient clinicians both of the east and west have grouped these clinical appearances in four groups and described them as the classical signs of such local warfare reaction
Caraka describes as follows—
[Carakasaṃhitā Cikitsāsthāna 25.52]
“The swelling which is characterized by pain, burning, redness and pricking pain should be diagnosed to be a suppurated swelling”.
Similarly Celsus in A.D. 50 described calor, rubor, tumor and dolor as four cardinal signs manifesting the local phenomena of inflammatory reaction.
Caraka considers swelling (tumor) as the pathognomic of such conditions.
[Carakasaṃhitā Cikitsāsthāna 12.8]
“It causes edema with its pathognomic symptoms of swelling”.
[Commentary by Cakrapāni]
“It is marked by steady swelling, so it is edema with swelling”
Sushruta calls this local phenomenon of swelling as (ekadeśotthita śopha) (Suśrutasaṃhitā Sūtrasthāna 17.3)
Clinicians in Greece gave dominance to the other signs viz., redness and heat and called this local phenomenon as inflammatory reaction, redness and heat being the qualities of the ‘flame’.
This difference in dominance of particular signs in two countries may be an interesting subject to the student of ethnology. As race with Kapha constitution will react with swelling as more prominent sign and race with Pitta will have heat and redness as more dominant signs
(1) Acute inflammatory conditions:
The same process as it occurs in general disease condition takes place in localized disease condition but on a smaller scale
It has the advantage of getting help from the body but it may put the whole body to a disadvantage if vitiation or morbific elements get an upper hand and crossing the limit of war-area spread m the neighbouring parts or in the whole body
These are described as complications (upadrava) of local inflammatory reactions. Caraka mentions the following complications:
[Carakasaṃhitā Cikitsāsthāna 25.29-30]
“Acute spreading affection, hemiplegia, vascular thrombosis, convulsions, stupefaction, insanity, acute pain in the wound, fever, thirst, lock-jaw, cough, vomiting, diarrhea, hiccup, dyspnea and tremors are the sixteen complications of wounds, described by the specialists in the subject of wounds”.
The local disease conditions terminate in the same way as the general disease condition. But the results are less serious Resolution and dissolution of the local part indicate the success or failure of the body in the encounter.
(2) Chronic Inflammatory Condition:
When the fighting forces are nearly equi-balanced, Prolonged war with fluctuation on either side continues till some decisive factor comes in aid of either party and concludes the scene of warfare. This is considered the fifth best of the therapeutic period. Though it is late, it is better than too late which is the sixth or last period of treatment as the terminating stage of the disease
We shall now give some of the comparative data of description of such local inflammatory processes found in Ayurveda and modern medical treatise
Inflammation—Variation in Intensity of Classical signs is due to the Domineering Action of Particular Vitium
Celsus in A.D. 50 described the four cardinal signs manifesting the local phenomena of inflammatory reaction. They are calor, rubor, tumor and dolor and they were co-related with the four humors of the microcosm i.e., body-constitution, the four corner stones in the humoral pathology of Hippocrates these were again correlated to the four proto-elements of the macrocosm i.e., the world as described by the philosopher-physician Empedocles who regarded these four proto-elements as the roots of all things.
In India macrocosmic and microcosmic concept was of a triad, but practical surgeons often found blood which is rather a structural system more convenient and useful in diagnosis and treatment specially of local disease-conditions Susruta thus tried to give nearly the same status to blood as to triumvirate and described four categories
[Suśrutasaṃhitā Sūtrasthāna 1.25]
“The diseases pertaining to the body have their origin in food and drink ingested on account of the vitiation and discordance of Vata, Pitta, Kapha and he Blood”
While commenting on this verse, Dalhana gives the following explanation for including Blood in the categories of constitutional classification:
[Suśrutasaṃhitā Sūtrasthāna 1.25, Commentary by Dalhana]
“The Blood is included because in a wound there is the dominance of blood among the vitia”.
Susruta clarified this point by stating that blood is secondary to and dependent upon the primary triumvirate of vitial categories.
[Suśrutasaṃhitā Sūtrasthāna 21.25]
“Because the blood is never provoked without the Vitia”.
Blood (rakta) is included under the Pitta category when the three vitial categories are taken in consideration.
[Suśrutasaṃhitā Sūtrasthāna 17.4]
“That born of Blood is like that of Pitta”.
[Suśrutasaṃhitā Sūtrasthāna 22.11]
“That born of Blood is to be known like that of Pitta”.
It is really interesting to find that equal importance is given to the description of inflammation in Sushruta Samhita, a treatise on Surgery, as is done in the modern surgical text books. In both we find that the description of diseases is initiated with this subject and a large number of chapters is devoted in each to give detailed and exhaustive description of this inflammatory phenomenon in general. Nearly 1/15 of the text in each, deals with this pathological process alone.
Susruta concludes this subject by generalization of the local pathological process in the following words:
[Suśrutasaṃhitā Sūtrasthāna 22.13]
“This summary of the types of pain and color is not limited ouh to wounds but is applicable to all types of inflammation Hence the physician should regard all inflammations like wounds.”
Classification of a subject may be made from various points of view to help the understanding of the subject.
Modern surgical text books classify inflammation generally in the following types:—
- Acute or subacute.
- Acute or Chronic.
- Parenchymatous or Interstitial.
- Serous-Catarrhal-Fibrinous-Hemorrhagic or Suppurative.
These classifications are done either according to the intensity of the process, or to the time it takes to develop, or according to the tissues it attacks or the exudation which it gives rise to.
Ayurveda classifies the inflammation in three groups of constitutional triumvirate.
This triumvirate classification has greater significance in clinical diagnosis and practical therapeutics. It is done from clinical-pathological-cum-physiological point of view.
If the etiological factor is excitant of a particular vitium, or any particular vitium of the constitution is predisposed to disease condition, the signs and symptoms characteristic and pathognomic of that particular vitium will be more dominant than the signs of other two vitia.
If two vitia are dominant and acting in combination, signs of two will be manifested dominantly. If all three, all signs will be aggravated.
The pathognomic signs of each of triumvirate are as follows:—
[Aṣṭāṅgahṛdayasaṃhitā Sūtrasthāna 29.6]
“There is no pain without Vata, and burning without Pitta and no swelling without Kapha, nor is there redness and suppuration without blood. These are the respective signs of the vitia and the blood”.
Pitta and blood—heat and redness (rudor) (calor).
These four signs correspond very closely to the triple response of Thomas Lewis. It is the clinical experience of every physician and surgeon that there is wide variation in intensity and rate of development of these classical signs. This can be well explained if we understand the full concept of Vaso neurotic constitution (vyānavāta).
The phenomenon of inflammatory reaction is the resultant of the action of etiological excitant and reaction of Vaso-neurotic constitution. Threshold of contraction and dilatation of arterioles and capillaries vary in each individual and also the capillary permeability. This is due to Vaso-neurotic individual constitution
Thus Vaso-neurotic constitution of the individual plays an important part in the phenomena of Inflammation, Krogh while describing the Vaso-neurotic constitution declares:—
“I shall say, finally, a few words about the so-called Vaso-neurotic constitution.
It is characterized by the great lability or downright instability of the innervation of the vascular system which manifests itself in the capillaries as well as in the arteries Frequent changes in the innervation occur either spontaneously or from comparatively trivial causes”.
The redness is brought about by opening up and dilatation of capillaries and venules, the heat by the increased flow of blood due to dilatation of arterioles, and the SWELLING by exudation of fluid from vessels due to their increased permeability, and the PAIN finally by the stimulation of nerves.
Though these reactions occur in the interest of the body, it is possible that some of the reaction if occurring in excess may often be harmful, similarly some occurring poorly may not be of effective use. The knowledge of constitutional tendency of the man as a whole as of the Vaso-neurotic constitution of the local organ or part affected and also of the particular exciting action of the etiological factors may help to control or rectify this protective and restorative reaction to the best advantage of the body. Here is the need of the study of the constitutional triumvirate. Triumvirate concept may open up a subtler field of research in the action of etiological factors as well as behaviour of body tissues
6. The Stage of Termination (bheda):
This is the end or termination of the vitiation process. In general disease-condition the person may completely recover if his body vitality can counteract the incursion successfully or may suffer dissolution if the invading forces are too powerful for his body vitality.
If any of them is not able to subdue the other totally and bring about decisive conclusion, the disease condition may persist for a prolonged period
Similarly in local disease condition too, there may occur complete resolution or dissolution or death of the local part (Necrosis, gangrene or ulcer). Local disease condition has one special method of termination and disposal or elimination of waste or morbified matter.
It is the process of suppuration:
[Suśrutasaṃhitā Sūtrasthāna 17.5]
“It tends to suppurate if it is not possible to sedate it bv special external or internal treatment, or if the treatment given is wrong or if the morbidity is in excess”
This will end in producing the condition of (vraṇa) wound.
If the conclusive termination is not brought about by either party being subactive and not able to subdue totally the other, the chronic inflammatory condition or chronic wound condition such as fistula or sinus (nāḍīvraṇa) my continue for a long period.
This is the last or sixth stage of therapeutic period advised by Sushruta
The description of various stages of vitiation pathology ends with a verse that explains the reasons of thorough study and diagnosis of each stage from practical therapeutic point of view. Treatment started in the earlier stage will be easier and simpler than if started late when vitiation process has gained strength and intensified.
[Suśrutasaṃhitā Sūtrasthāna 21.37]
“Vitiation process checked or subdued in the accumulation process, fails to produce any further development, but allowed to progress, it gams in strength and intensity in the course of its further development”.
The principles of treatment during the vitiation process are formulated primarily with a view to eliminate or get rid of the vitiated morbid matter resulting from the pathological processes and accumulated in the body. For the purpose of such elimination, the nearest and simplest outlet or body channel was chosen. Thus came into practice the treatment known as the pentad of eliminatory or purificatory procedures
[Carakasaṃhitā Sūtrasthāna 2.8]
“These drugs should be used as emetics by the physician, in a way not harmful to the body, in gastrogenic disorders characterized by morbid accumulation of Kapha and Pitta”.
[Carakasaṃhitā Sūtrasthāna 2.10]
“Should be prescribed for purgation when the morbid humors have accumulated in the colon”
This purificatory therapy was put into operation in a rather strong degree in order to accomplish the complete elimination of the morbid matter. The procedure required that the body be previously prepared, before undergoing such a strong method of treatment, by oleation (snehana) and sudation (svedana) procedures. These procedures facilitated the easy elimination of morbid matter.
[Carakasaṃhitā Siddhisthāna 1.7]
“Oleation cures the morbidity of Vata, makes the body soft and disintegrates the accumulation of morbid matter, while sudation liquefies the morbid matter which is stuck up in the minute channels of the body of the person who has undergone oleation therapy”.
When the body is found to be not fit and intolerant of such a radical treatment, the line chosen was to bring about the gradual digestion of the morbid matter (doṣapāka[?]) a concept so similar to the detoxication—conjugation concept of modern physiology. The liver is believed to play an important part in protecting the organism from various toxic substances. This detoxifying function is believed to involve the process of oxidation and conjugation into relatively non-toxic substances which are subsequently eliminated in the bile and the urine.
[Carakasaṃhitā Cikitsāsthāna 3.142]
“In the early stage of fever starvation, sudation, time-effect, diet of gruels and articles of bitter taste, digest the imperfectly digested morbid matter in the body”.
After the complete riddance from morbid matter, the treatment consists in supplying the deficit and strengthening the body vitality by drugs as well as dietetic regimen. This process is called rehabilitation (saṃsarjana).—(Carakasaṃhitā Sūtrasthāna 15.16)