E-ISSN:2456-3110

Review Article

Sleshmaja Krimi

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 4 May
Publisherwww.maharshicharaka.in

Sleshmaja Krimi vis a vis Helicobacter Pylori: A Literary Review

Murali M.1*, Kumar S.2, Raj N.3, Kumar S.4
DOI:

1* Megha Murali, Final Year Post Graduate Scholar, Department of Kayachikitsa, Government Ayurvedic College, Patna, Bihar, India.

2 Sumit Kumar, Second Year Post Graduate Scholar, Department of Kayachikitsa, Government Ayurvedic College, Patna, Bihar, India.

3 Nitish Raj, Final Year Post Graduate Scholar, Department of Kayachikitsa, Government Ayurvedic College, Patna, Bihar, India.

4 Sujeet Kumar, Assisstant Professor, Department of Kayachikitsa, Government Ayurvedic College, Patna, Bihar, India.

From the Vedic period onwards Krimi is accepted as an etiological factor of various diseases. In Ayurveda, Krimi is widely explained especially by Acharya Charaka who gave full details in Vimanasthana Vyadhitaroopiyam Adhyaya. There is detailed description of Saptaka Gana – Samuthana (Nidana/cause), Sthana (habitat), Samsthana (morphology/ form), Varna (colour), Nama (name), Prabhava (effect) & Chikitsa (treatment). Only a few studies have been carried out in Ayurveda to identify the type of Krimi, infection based on their types, etc. Some researchers tried very well to correlate various Krimi with some microbes. The probable correlation of Krimi with the contemporary infectious microbes may be possible by examining the resemblance of their habitat, morphology and effect on the host. But it is little bit a difficult task to correlate Krimi with the microbes due to lack of sufficient description of individual Krimi. Under the word Krimi, all microorganisms like bacteria, virus, parasites, fungi, etc. can be considered. Here we consider Sleshmaja Krimi w.s.r to Helicobacter pylori and also its habitat mucous layer as Kledaka Kapha. Helicobacter pylori is a gram-negative bacillus, which lives in gastric mucus, some adherent to the mucosa & some enters the cells or penetrates the mucosa; its distribution is not systemic. It is motile in the mucous environment because of its spiral shape & flagella. Colonization of this organism is an important risk factor in causing peptic ulcer, gastritis, gastric adenocarcinoma, etc. In some conditions like gastro-esophageal reflux disease, etc. H.pylori colonization may offer protection against the complications. Through this article, an effort has been made to describe the concept of Sleshmaja Krimi from different Ayurvedic treatises and also to correlate with Helicobacter pylori, based on the habitat and effect on human body.

Keywords: Sleshmaja Krimi, Helicobacter pylori, Amasaya, Stomach, Mucous layer, Kledaka Kapha

Corresponding Author How to Cite this Article To Browse
Megha Murali, Final Year Post Graduate Scholar, Department of Kayachikitsa, Government Ayurvedic College, Patna, Bihar, India.
Email: 		Megha Murali, Sumit Kumar, Nitish Raj, Sujeet Kumar, Sleshmaja Krimi vis a vis Helicobacter Pylori: A Literary Review. J Ayu Int Med Sci. 2022;7(4):40-44.
Available From
https://jaims.in/jaims/article/view/1769

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-04-01 2022-04-02 2022-04-09 2022-04-16 2022-04-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Megha Murali, Sumit Kumar, Nitish Raj, Sujeet Kumarand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

In Ayurveda, the word ‘Krimi’ can be widely used for all worms and microorganisms. But in the modern science, it’s given separate branches for worms and microbes, viz, helminthology and microbiology respectively. The concept of Krimi is available from the Vedic times. Almost all the Acharyas mentioned the term Krimi along with its Nidana (causes), Lakshana (signs & symptoms), Chikitsa (treatment), etc. Acharya Charaka, especially in Vimanasthana Vyadhitaroopiyam Adhyaya, gave details of Krimi elaboratively, in the form of Saptaka Gana of Krimi Chikitsa - Samuthana (Nidana/cause), Sthana (habitat), Samsthana (morphology/ form), Varna (colour), Nama (name), Prabhava (effect) & Chikitsa (treatment). There is description of 20 types of Krimis under four sub-divisions Malaja, Raktaja, Shleshmaja and Purishaja, in which the location of Shleshmaja and Purishaja Krimis are Gastro-intestinal tract.[1] They produce local as well as general symptoms in human body.

Acharya Charaka has described three main treatments of Krimiroga- Apakarshana (extraction), Prakriti-Vighata (destruction of the source of origin) and Nidana-Parivarjana (abstinence from the etiological factors).[2] Apakarshana or extraction is done by means of hand or by instruments as per need. In case of internal Krimi extraction can be done by Sodhana (elimination therapies). These include Sirovirechana (medication through nasal route), Vamana (emesis), Virechana (purgation) and Asthapana (decoction enema). Prakriti-Vighata which is the destruction of susceptible environment of the Krimi, can be achieved by the use of drugs which are Katu (pungent), Tikta (bitter), Kashaya (astringent), Kshara (alkaline substances) and Ushna (hot in potency); and other measures which are contrary to Kapha Dosha mainly and thereby leading to the destruction of the source. Thereafter, Nidana-Parivarjana which means abstinence from the etiological/causative factors.[3]

The Sleshmaja Krimi, which is located in the stomach is correlated here to Helicobacter pylori that resides in the gastric mucous. Also, the gastric mucous can be compared to the Kledaka Kapha (type of Kapha located in the stomach).

Helicobacter pylori is a gram-negative bacillus, that colonizes the stomach in ~50% of the world’s

human population. It lives in gastric mucus, some adherent to the mucosa & some enters the cells or penetrates the mucosa; its distribution is not systemic. It is motile in the mucus environment because of its spiral shape & flagella. It has acid resistant mechanisms, requires low oxygen levels & is slow-growing. Colonization of this organism is an important risk factor in causing peptic ulcer, gastritis, gastric adenocarcinoma, mucosa-associated lymphoid tissue (MALT) lymphoma, etc. Recent researches point out that H.pylori colonization is also a risk factor for some of the extra-gastric diseases. Proper treatment for H.pylori may provide permanent cure. In some conditions like gastro-esophageal reflux disease (GERD), esophageal carcinoma, etc. H.pylori colonization may offer protection against the complications.[4]

Objectives

To establish the correlation between Sleshmaja Krimi & Helicobacter pylori and also between Kledaka Kapha & gastric mucous.

Sleshmaja Krimi Vis-A-Vis Helicobacter Pylori

Etiology: Description of etiological factors for both Bahya and Abhyantara Krimi are there in Samhitas. The Bahya (external) Krimi are produced due to “Mrija Varjana” (lack of cleanliness). Regarding Abhyantara Krimi some general and some specific etiological factors are mentioned. Here we are considering Sleshmaja Krimi only, so the causes include the excess intake of Ksheera (milk), Guda (jaggery), Tila (Sesamum indicum), Matsya (fish), Anupa Mamsa (meat of animals living in marshy area), Pishtanna (pastries), Paramanna (milk preparations like Kheer), Kusumbha Sneha (oil of Carthamus tinctorius), Ajirna-Puti-Klinna (uncooked, putrefied & softened food items), Samkeerna (food mixed with dirt, etc.) & Virudha Asatmya Bhojana (incompatible & unwholesome food).[5]

The risk factors for H.pylori infection are domestic crowding, unsanitary living conditions, unhygienic food or water and exposure to gastric contents of an infected person. Transmission of H.pylori occurs from person to person, following an oral-oral or faecal-oral route.[6]

Habitat: Amasaya (stomach) is considered as the habitat of Sleshmaja Krimi. When grown in excess, they move upwards or downwards.[7]


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Sleshma in Amasaya is considered as the Kledaka Kapha which can be correlated with the mucous present in the gastric mucosa or mucous layer.

The mucosa of the stomach has 2 types of glands- oxyntic (acid forming) glands and pyloric glands, located between mucus secreting cells, called surface mucous cells.

Mucous neck cells, peptic/chief cells and parietal/oxyntic cells constitute the oxyntic glands located inside the body and fundus; besides secreting HCl, pepsinogen and intrinsic factor also secrete mucous.

Located at antrum, the pyloric glands secrete mainly mucus, pepsinogen and gastrin. The mucus produced from these cells, especially from pyloric glands and surface mucous cells helps to lubricate movement of food and helps to protect stomach wall from auto-digestion. Kledaka Kapha should be seen in this point of view.[8]

H.pylori is found most commonly in the deeper portions of the mucous gel coating the gastric mucosa or between the mucous layer and the gastric epithelium. It has been designed accordingly to live in the aggressive atmosphere of the stomach. Initially it resides in the antrum, later migrates toward the more proximal segments of the stomach.[9]

Form & Colour: Some are big & flat (tape-like) in shape & white in colour while some are round in shape similar to earthworm & white colour with coppery tinge. Some others are minute long thread-like in structure & white in colour.[10]

H.pylori is S-shaped (~0.5-3 µm in size) with multiple sheathed flagella.[11]

Types of Sleshmaja Krimi

Antrada, Udarada, Hridayachara, Churava, Darbhapushpa, Saugandhika & Mahaguda are the names of various Sleshmaja Krimi as per Acharya Charaka.[12]

Signs & Symptoms: Jwara (fever), Vivarnata (discoloration), Soola (pain in abdomen), Hridroga (disorders in the region of heart), Bhrama (giddiness), Annadhwesha (aversion to food) & Atisara (diarrhoea) are the symptoms of worms present in the human body. The clinical features due to Sleshmaja Krimi are Hrillasa (nausea), Asyasamsravanam (salivation),

Arochaka (anorexia), Avipaka (indigestion), Jwara (fever), Murcha (fainting), Jrumbha (yawning), Kshavadhu (sneezing), Anaha (constipation), Angamardha (malaise), Chhardi (vomiting), Karshyam (emaciation) & Parushya (dryness).[13]

The ultimate result of H.pylori infection may include gastritis, PUD, gastric MALT lymphoma and gastric cancer, which are determined by the complex interplay between bacterial and host factors.[14] The symptoms of gastritis mainly include nausea, vomiting, loss of appetite, abdominal pain and weight loss and that of gastric cancer include poor appetite, nausea, vomiting, heartburn, abdominal pain, blood in stool, weight loss, etc. Peptic ulcer disease shows symptoms like belching, heartburn, indigestion, nausea, vomiting, abdominal discomfort, etc.[15]

Treatment: All the Krimis (parasites) should be extracted first, then the factors responsible should be counteracted and the causes of production of the parasites should be avoided. Samshodhana (purificatory therapy) is considered as a basic treatment of Krimiroga. When it is done along with Prakriti Vighata and Nidan Parivarjana, it can eradicate Krimiroga from the base.[16] The avoidance of Aharas and those Viharas which are conducive for the formation of Krimi can inhibit the growth of parasites and other micro-organisms and also prevents the secondary infection or re-infestation. Samshodhana is not desirable in Bala (children), Vriddha (elderly people), etc. So, keeping this in mind Samshamana therapy may be selected by the Ayurvedic practitioners with suitable Krimighna drugs which are described in classics such as Krimighna Dashaimani (10 drugs that can cure Krimi) in Charaka Samhita Suthrasthana.

Pathya-Apathyas: The Pathya Aharas to be followed are Rakta Sali, Patola, Vetragra, Rasona, Vastuka, Brihati-Phala, Vidanga, Katu-Tikta Kashaya Bhojana, etc. The Apathays include Vega-Dharana, Virudha-Pana-Ashana, Divaswapna, Pishtanna, Dadhi, Amla-Madhura Rasa.[17]

Discussion

As per Ayurveda, the term Krimi stands for both macro and micro-organisms. The word Krimi can be correlated with microbes and parasites depend upon their habitat, available morphological features along with sign and symptoms they produce in the host.


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Particular correlation of all the Krimis with the microorganisms is not easy but some of them possess similar features and shows similar effects like that of microbes and parasites. Ayurvedic scholars had made some attempts to correlate various types of Krimi with the microorganisms and parasites.

The Sleshmaja Krimi lives in Amasaya (upper part of gut), but when multiplies, they travel through both upward and downward directions of gut. Sleshma in Amasaya is considered as the Kledaka Kapha which can be correlated with the mucous present in the gastric mucosa or mucous layer. These Krimi possess different shapes such as thick, flat, elongated, round, ring-like, etc. and produce symptoms like nausea, vomiting, salivation, anorexia, indigestion, fever, emaciation etc. Helicobacter pylori is most commonly seen in the gastric mucosa or between the mucous layer and the gastric epithelium. It lives in the aggressive atmosphere of the stomach. Initially it resides in the antrum, later migrates toward the more proximal segments of the stomach. The symptoms of infection by H.pylori are like that of gastritis, PUD, gastric MALT lymphoma and gastric cancer, which may include nausea, vomiting, loss of appetite, abdominal pain, heartburn, weight loss, blood in stool, belching, etc. Thus, it is clear that Sleshmaja Krimi can be correlated to H.pylori by considering similar habitat and symptoms produced.

Conclusion

Krimi is a term used broadly for describing all the worms and microorganisms. The existence of Krimi has been described from Vedic period onwards, but detailed description given in Samhita period. In the modern era due to invention of instruments like microscope the study of microbes became easy. In Samhitas, classification, nomenclature, etiology, signs & symptoms, and treatment of various types of Krimi are well described. These microorganisms enter into the human body through contaminated food, water, soil, etc. The general symptoms include diseases of GIT, skin and anaemia, etc. as per contemporary science. From their habitat inside host, clinical features they produce, etc. these Krimi can be compared with various bacteria, viruses, fungi, and parasites described in modern science. Apakarshana, Prakriti Vighatana, and Nidana Parivarjana are the main principles of

treatment applied for Krimi. The Sleshmaja Krimi lives in Amasaya and Helicobacter pylori is seen in the gastric mucosa or between the mucous layer and the gastric epithelium. Sleshma in Amasaya is considered as the Kledaka Kapha which can be correlated with the mucous present in the gastric mucosa or mucous layer.

Reference

1. Prof. P. V. Sharma, Caraka Samhita (Agnivesa’s treatise refined and annotated by Caraka and redacted by Dridhabala), Published by: Chaukhambha Orientalia, Varanasi, Vol. I, Reprint Edition: 2017, Pg.no:341.

2. Prof. P. V. Sharma, Caraka Samhita (Agnivesa’s treatise refined and annotated by Caraka and redacted by Dridhabala), Published by: Chaukhambha Orientalia, Varanasi, Vol. I, Reprint Edition: 2017, Pg.no:343.

3. Prof. P. V. Sharma, Caraka Samhita (Agnivesa’s treatise refined and annotated by Caraka and redacted by Dridhabala), Published by: Chaukhambha Orientalia, Varanasi, Vol. I, Reprint Edition: 2017, Pg.no:344.

4. Dennis L. Kasper, Dan L. Longo, Anthony S. Fauci, J. Larry Jameson, Stephen L. L. Hauser, Joseph Loscalzo, Harrison’s Gastroenterology and Hepatology, Published by: McGraw Hill Education (India) Private Limited, Edition: 3, Pg.no:141.

5. Prof. P. V. Sharma, Caraka Samhita (Agnivesa’s treatise refined and annotated by Caraka and redacted by Dridhabala), Published by: Chaukhambha Orientalia, Varanasi, Vol. I, Reprint Edition: 2017, Pg.no:341.Cvim BD 201

6. Dennis L. Kasper, Dan L. Longo, Anthony S. Fauci, J. Larry Jameson, Stephen L. L. Hauser, Joseph Loscalzo, Harrison’s Gastroenterology and Hepatology, Published by: McGraw Hill Education (India) Private Limited, Edition: 3, Pg.no:140.

7. Prof. K. R. Srikanta Murthy, Madhava Nidanam (Roga Viniscaya) of Madhavakara (A Treatise on Ayurveda- Text with English Translation, Critical Introduction and Appendices), Published by: Chaukhambha Orientalia, Varanasi; Reprint Edition: 2011,

8. T. Sreekumar, MD (Ay), PhD, Ashtangahridaya Vagbhata Sutrasthana -I with English


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Translation & Commentary, Published by: Publication Department, Harisree Hospital, Mannuthy, Thrissur, Kerala; Chapter 12, Page No: 294.

9. Dennis L. Kasper, Dan L. Longo, Anthony S. Fauci, J. Larry Jameson, Stephen L. L. Hauser, Joseph Loscalzo, Harrison’s Gastroenterology and Hepatology, Published by: McGraw Hill Education (India) Private Limited, Edition: 3, Pg.no:140.

10. Prof. K. R. Srikanta Murthy, Madhava Nidanam (Roga Viniscaya) of Madhavakara (A Treatise on Ayurveda- Text with English Translation, Critical Introduction and Appendices), Published by: Chaukhambha Orientalia, Varanasi; Reprint Edition: 2011,

11. Dennis L. Kasper, Dan L. Longo, Anthony S. Fauci, J. Larry Jameson, Stephen L. L. Hauser, Joseph Loscalzo, Harrison’s Gastroenterology and Hepatology, Published by: McGraw Hill Education (India) Private Limited, Edition: 3, Pg.no:139.

12. R. K. Sharma, Bhagwan Dash, Caraka Samhita (Text with English Translation & Critical Exposition based on Cakrapani Datta’s Ayurveda Dipika), Published by: Chowkhambha Sanskrit Series Office, Varanasi, Vol. II, Reprint Edition: 2012, Pg.no:202.

13. R. K. Sharma, Bhagwan Dash, Caraka Samhita (Text with English Translation & Critical Exposition based on Cakrapani Datta’s Ayurveda Dipika), Published by: Chowkhambha Sanskrit Series Office, Varanasi, Vol. II, Reprint Edition: 2012, Pg.no:202.

14. Dennis L. Kasper, Dan L. Longo, Anthony S. Fauci, J. Larry Jameson, Stephen L. L. Hauser, Joseph Loscalzo, Harrison’s Gastroenterology and Hepatology, Published by: McGraw Hill Education (India) Private Limited, Edition: 3, Pg.no:142.

15. https://simple.m.wikipedia.org

16. R. K. Sharma, Bhagwan Dash, Caraka Samhita (Text with English Translation & Critical Exposition based on Cakrapani Datta’s Ayurveda Dipika), Published by: Chowkhambha Sanskrit Series Office, Varanasi, Vol. II, Reprint Edition: 2012, Pg.no:203.

17. Kaviraj Shri Ambikadatta Shastri Ayurvedacharya, Bhaishajya Ratnavali of Shri Govind Das (Vidyotini Hindi Commentary), Chaukhambha Prakashan, Varanasi, Reprint Edition 2013; Ch: 11, Sloka no: 83-90, Pg.no: 371.


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