Clinical Importance of the knowledge of Ṣadkriyākāla w.s.r. to Kuṣṭha Samprāpti

Shivaranjani J Kantharia; SN Gupta N Gupta; K. B. Patel

Clinical Importance of the knowledge of Ṣadkriyākāla w.s.r. to Kuṣṭha Samprāpti

J Kantharia S.^1*, N Gupta S.², B. Patel K.³

DOI:

^1* Shivaranjani J Kantharia, Assistant Professor, Department of Roga Nidan, J S Ayurveda College, Nadiad, Gujarat, India.

² SN Gupta N Gupta, Director of International Activities, J S Ayurveda College & P.D. Patel Ayurveda College, Nadiad, Gujarat, India.

³ K. B. Patel, Principal and Superintendent, J S Ayurveda College & P.D. Patel Ayurveda College, Nadiad, Gujarat, India.

Ayurveda believes that healthy person stay healthy by equalizing the Doṣas, Dhātus and Malas. The concept of Kriyākāla advocated by Suśruta Samhitā. Kriyākāla refers to the recognition of the stage of a disease's progression. It is also referred as Cikitsā Avasara (opportunity to treat). Kriyā means Cikitsā (treatment) and Kāla refers to the stage of progression of a disease. The knowledge of Kriyākāla helps to determine appropriate therapy to correct the imbalance in Doṣas in early stage. In Ayurveda, most of the skin diseases have been described under the broad heading of Kuṣṭha. In the present study, concept of Kriyākāla is tried to elaborate with the special reference of Kuṣṭha Samprāpti. Aim & Objective: To study the samprāpti of Kuṣṭha in accordance to concept of Kriyākāla. Material & Methods: Material has been collected from Suśruta Saṁhitā with various commentaries, Research articles, and electronic databases. Discussion: Early detection of diseases and its progress will help to cure the Disease with minute efforts. However if the Disease will progress it might be difficult to treat. And later on it become incurable. In the same way on young plant can be uprooted completely whereas the same plant is allowed to grow as a big tree cannot uproot easily. Kuṣṭha is Cirakālīna (chronic) Tridoṣaja Vyādhi manifested on Tvak (skin) if untreated later on it intrude to all Dhātus. Conclusion: This article will help in to understand the journey of Kuṣṭha Vyādhi from its Nidānasevan to Samprāpti in accordance with the stage of Ṣadvidh Kriyākāla.

Keywords: Kriyākāla, Importance, Kuṣṭha, Nidāna, Samprāpti

Corresponding Author	How to Cite this Article	To Browse
Shivaranjani J Kantharia, Assistant Professor, Department of Roga Nidan, J S Ayurveda College, Nadiad, Gujarat, India. Email:	Shivaranjani J Kantharia, SN Gupta N Gupta, K. B. Patel, Clinical Importance of the knowledge of Ṣadkriyākāla w.s.r. to Kuṣṭha Samprāpti. J Ayu Int Med Sci. 2022;7(10):186-191. Available From https://www.jaims.in/jaims/article/view/1987

Introduction

Kriyākāla refers to the recognition of the stage of a disease's progression, the knowledge helps to determine appropriate measure to correct the imbalance of Doṣas in early stage. "Kriyā" means Cikitsā (treatment) in terms of Nidāna Parivarjana, Pathya Āhara Vihāra, Saṁśodhanakarma, Auṣadhiseven etc. and "Kāla" (time) refers to the opportunities to initiate the treatment or it could also be said that the stage of progression of the Disease. There are six stages mentioned by Ācārya Suśruta to give an idea regarding the state of the Disease Ṣaḍkriyākāla explains the pathogenesis of Disease in the stages from incubation period to the complete manifestation and later complications of the Disease.^[1] Understanding of Kriyākāla is crucial for early diagnosis, with the help one get an idea about Disease whether it is preventive or curative or incurable. The primary objective of this study is to describe the importance of Kriyākāla in prognosis and diagnosis of the Disease with special reference to Kuṣṭha Vyādhi. Here, there is an attempt to understand the concept of Kriyākāla in accordance to Kuṣṭha Samprāpti. All the skin diseases come under the broad heading of Kuṣṭha. Kuṣṭha is chronic Tridoṣaja Vyādhi. This article will help to understand the journey of Kuṣṭha manifestation from Nidāna to its Samprāpti in accordance with Ṣaḍkriyākāla.

Aim and Objective

1. To study the concept of Ṣaḍ Kriyākāla.

2. To study the samprāpti of Kuṣṭha in accordance to concept of Kriyākāla.

Materials and Methods

Material has been collected from Suśruta Saṁhitā with various commentaries, Research articles, and electronic databases. Collected materials were critically analyzed for understanding, discussion, and conclusion.

Conceptual Study

Kriyākāla: There are two types of Kriyākāla has described by Ācārya Suśruta.^[2]

1. Ṛtu Kriyākāla: Normal physiological variations of doṣas in the particular season has been deliberated

and according certain measures are described in Ṛtucaryā to overcome the adverse effect.^[3]

2. Vyādhi Kriyākāla:

संचयं च प्रकोपं च प्रसरं च स्थानसंश्रयं।

व्यक्तिं भेदं च यो वेति दोषाणां स भवेत् भिषक्।। (Su. Su.21/

Six stages of Kriyākāla

1. Sancaya (Phase of Accumulation)

2. Prakopa (Phase of Provocation)

3. Prasara (Phase of Propagation)

4. Sthānsamśraya (Phase of Localization)

5. Vyakti (Phase of Manifestation)

6. Bheda (Phase of Complication)

1. Prathama Kriyākāla (1^st stage)

एतानि खलु दोषस्थानानि; एषु सञ्चॆयन्ते दोषा :। तत्र सन्चितानां खलु दोषाणां स्तब्धपूर्णकोष्ठता पीतवभासता मन्दोष्मता च अङ्गानां गौरवमालस्यम्

चयकारण विद्वेष श्चेति लिङ्गानि भवन्ति। तत्र प्रथम: क्रियाकाल:।। (Su.Su. 21/18)

संहतिरुपा वृद्धि: चय:। (Su.Su. 21/18- Dalhana)

1^st stage- Sancaya avasthā, the doṣa will gradually accumulated in their own sites as a result of Nidāna Sevan (Svadoṣa Samāna Āhāra Vihāra Sevan or favorable Ṛtu or Kāla) and manifested minor symptoms such as Stabdhapūrṇa Koṣṭhatā (absence of movement in abdomen); Pītāvabhāsatā (yellowish discoloration on skin); Mandoṣmatā (mild increase in temperature); Aṅga Gaurava (feeling heaviness in the body); Ālāsya( lazyness).

Shows Nidāna of Kuṣṭha

Nidāna of Kuṣṭha (Su.Ni.5/9)

Mithyāhārācāra- Specific Guru, Viruddha, Asātmaya, Ajīrṇa (Faulty diet and conduct particularly eating heavy, incompatible, unwholesome, and also during indigestion);
Ahita Aśina (unhealthy diet);
Snehapāna Evum Vamana Paścāta Vyāyāma Grāmyadharma sevan (indulging in physical exercise and sexual intercourse after intake of snehana (ghṛta/ oil) or emesis);
Payasā Saha Grāmya Ānup Udaka Māṁsa Sevana (Frequently eating meats of domestic, marshy and aquatic animal with milk);

Sahasā Pratihanti Chardi; (suppressing vomiting suddenly)
Majjati Apsū Uṣmāabhitapta (taking dip in to water after having been heated by fire or the sun)
Brahmastrīsajjanavadha (killing of priests, women and priests);
Parasvaharaṇa (stealing other’s properties)
Pāpakarma (sinful act)

If these mentioned Nidānas will be admitted by person, Sancaya of Tridoṣa will get started in their own sites.

2. Dvitiya Kriyākāla

कोपस्तु उन्मार्ग गामिता। विलयनरुपि वृद्धि प्रकोप :।

तेषां प्रकोपात। कोष्ठतोदसञ्चरण अम्लिकापिपासापरिदाह अन्नद्वेष ह्रदयोउत्क्लेदात् च जायन्ते। तत्र: द्वितीय: क्रियाकाल:।

2^nd stage - In Prakopa Avasthā, due to continuing the nidan sevan and not initiating treatment, the accumulated Vātādi Doṣa start moving to the other sites from their own but don't spread all over the body.^[4] And manifested some primary symptoms e.g. Koṣṭha Toda (pricking pain in abdomen), Sancaraṇa (movement in abodomen); Amlikā (sour eructations), Pipāsā (excessive thirst), Paridāha (burning sensation in side the body); Annadveṣa (aversion towards food), Hṛdayotkeda (feeling of heaviness in heart).

Continue to taking the Kuṣṭha Janya Nidānas, Tridoṣas are move from their sites but not spread all over the body. There will be no any sign manifested on the skin.

3. Tṛtiya Kriyākāla

एवं प्रकुपितानां प्रसरतां। वायोविमार्गगमनाआटोपौ, ओषचोष परिदाह धूमायनानि पित्तस्य, अरोचक अविपाक अङ्गसाद छर्दि च इति श्लेष्मणो लिङ्गानि भवन्ति; तत्र तृतीय क्रियाकाल।। (Su.Su.21/32)

If person still pursuing the Nidānas, Diseases will be promoted in the 3^rd stage of the Kriyākāla called Prasaravsthā. In this stage, Dosha will spread all over the body and manifested more advance symptoms than 2^nd stage but not show complete picture of particular Disease. e.g. Vimārga Gamana (movement in wrong direction) and Āṭopa (gargling sound in abdomen) manifested by Vāta Doṣa; Oṣa (feeling of burning sensation ), Coṣa (pain like sucking), Paridāha (feeling of burning

sensation all over the body), Dhūmāyana (feeling of foam inside the throght) produce by Pitta Doṣa; Arocaka (anorexia) , Aṅgasāda (weakness) , Chardi (vomiting), Avipāka (indigestion) emerged by Kapha. All the above said symptoms are dosha specific.

4. Caturtha Kriyākāla

स एव कुपितो दोषः समुत्थानाविशेषत:। स्थानान्तराणि च प्राप्य विकारान् कुरुते बहून।।

एव प्रकुपितानां तान। तान् शरीराप्रदेषान आगम्य तान् तान् व्याधीन जनयन्ति।

……त्वक् मांसशोणितस्था: क्षुद्ररोगान् कुष्ठानि विसर्प च;………..

तेषां एव अभिसन्नि विष्टानां पूर्वरुप प्रादुर्भाव: तं प्रतिरोगं वक्ष्याम।। तत्र पूर्वरुपगतेषु चतुर्थः क्रियाकाल:।। (Su.Su.21/33)

while circulating, when those prakupita Doṣa get Kha - Vaiguṇya / Sroto Vaiguṇya (space in the Srotas or in Dhatu), they embedded in there and will started to Doṣa- Dūṣya Sammurchanā. This will be resulting in producing the Purvarūpa of diseases. If Doṣa lodged in Tvacā, it will be manifested as Kuṣṭha Roga.

पित्तश्लेष्माणौ प्रकुपितौ परिगृह्य अनिल: प्रवृद्ध: तिर्यगा: सिरा:

संप्रपध्य समुद्धुय बाह्यं मार्गं प्रति समन्ताद्विक्षिपति, यत्र यत्र दोषो विक्षिप्तो निश्चरति तत्र तत्र मण्डलानि प्रादुर्भवन्ति। (Su. Su. Ni. 5/3)

Regarding Kuṣṭha, if the treatment is not initiated and nidanas continued yet, the increased Vāta Doṣa carrying aggravated Pitta and Kapha Doṣa, and reaches to Tiryagagāmī Sirā (obliquely moving channels). Furthermore, Vāta exacerbates and scatters to Pitta and Kapha Doṣa in all around towards the Bāhya Rogamārga (Śākhā- Tvak -Rakta… etc). Wherever this Doṣa moves, the Maṇdala (skin lesions) will develop on Bāhyamārga (Tvak).

Shows Pūrvarupa of Kuṣṭha (Su.Ni.5/5)

Tvaka pāruṣya (roughness of skin)
Roma harṣa (horripilation)
Kaṅdū (itching)
Svedabāhulya (excessive sweat)
Asvedana (absence of sweat)
Añgapradeśānām Svāpa (numbess in body part)
Kṣata Visarpaṇa (spreading of a wound)
Asṛja Kṛṣṇatā (blackness of blood

5. Pañcam Kriyākāla

अत ऊर्ध्व व्याधेदर्शन:……..प्रव्यक्त लक्षणतां……। तत्र पञ्चम क्रियाकाल।। (Su.Su.21/34)

In this 5^th stage of Kriyākāla, Disease will appear in fully fledged form. All the clinical features of the diseases will appear. Kuṣṭha will manifested completely. There are two types of Kuṣṭha. Māhākuṣṭha and Kṣudra Kuṣṭha; their Bheda (classification) and Mahatva (importance) are based on their difficult management and incurability due to entry into successive Dhatus. In this stage, we should adopt Vyādhi Pratyanika Cikitsā rather then Doṣa Pratyanika Cikitsā.

Shows classification of Kuṣṭha.

Mahā Kuṣṭha
Aruṇa Kuṣṭha
Udumbara Kuṣṭha
Ṛṣyajihva Kuṣṭha
Kapāla Kuṣṭha
Kākaṇaka Kuṣṭha
Puṇḍarīka Kuṣṭha
Dadru Kuṣṭha

Kṣudra Kuṣṭha
Sthūlāruṣka
Mahākuṣṭha
Ekkuṣṭha
Carmadala
Visarpa
Parisarpa
Sidhma
Vicarcikā
Kiṭibha
Pāmā Rakasā

Shows Symptoms of Kuṣṭha according to Doṣa prominences.

Vāta
Tvaksaṅkoca (contraction of skin)
Svāpa (loss of sensation)
Sveda (sweating)
Śopha (swelling)
Bheda (Tearing sensation)
Kauṇya (deformity in hand)
Svaropaghāta (speech disturbance)

Pitta
Pāka (Suppuration)
Avadāraṇa (bursting)
Aṅgulipatana (dropping of the fingers)

Karṇa nāsābhaṅga (breaking off the ear and nose)
Akṣirāga (congestion of eyes)
Satvotpattaya (emergence of organisms)

Kapha
Kaṇdū (itching)
Varṇabheda(discoloration)
Srāva(discharge)
Gaurava (heaviness)

If treatment is still not initiating, Disease will proceed in to advance stage result in manifestion of complications.

एवं समुत्पन्न: त्वचि दोष: च परिवृद्धिं प्राप्य अप्रतिक्रियमाणो अभ्यन्तरं प्रतिपद्धयते धातून्भिदूषयन।। (Su. Su. Ni. 5/3)

6. Ṣaṣtham Kriyākāla

अत ऊर्ध्वं एतेषाम्………. षष्ठ:क्रियाकाल……… :दीर्धकालानुबन्ध:।

तत्रा अप्रतिक्रियमाणड्साध्यतां उपयान्ति।। (Su.Su.21/36)

The the final stage of Kriyākāla, if treatment is not initiated yet, Disease will enter into Bheda Avasthā. In this stage of Kriyākāla, Disease will be associated with a number of consequences and complications. If treatment is not initiated in this stage, the Disease will become Asādhya. Bheda Avasthā is the last stage of Kriyākāla; in other words, it is the last chance to get treated.

Shows Sādhyasādhyatā of Kuṣṭha

Sādhyasādhyatā of Kuṣṭha

Sādhya

Tvak-Rakta-Māṁsagata
Vāta - Śleṣmādhika
Sādhya

Yāpya

Medogata
Dvidoṣaja

Asādhya

Majjā-Asthi
Śukragata
Kṛmiyukta
Dāha- Tṛṣṇayukta
Maṅdagniyukta
Tridoṣaja
Prabhinna Aṅga
Prasrutāṅga

Nāsābhaṅga
Raktanetra, Hatsvara
Pancakarmaguṇātiīa

दम्पत्यो: कुष्ठबाहुल्यात दुष्ट शोणित -शुक्रयो। यद् अपत्ययं तयोर्जातं ज्ञेयं तदपि कुष्ठितं।। (Su. Ni. 5/30)

If vitiated Doṣa reaches the Śukra and Śoṇita Dhātu, they lead to Bīja Dūṣṭī, and Disease become inherited for further progeny; upcoming offspring will also be born with the Kuṣṭha disease.

Discussion

Kriyākāla is the opportunity to treat the vitiation of Doṣa at the early stages before it progresses to a manifested in to the Disease.^[5] In the primary stage of pathogenesis, the disease process just begins with few clinical features and sometimes it doesn't noticeable. It is important to treat the Doṣa in Sancaya Avasthā, as they constitute the seeds of diseases, which should not be allowed to germinate.^[6] The treatment consists of avoiding etiological factors (Nidāna Parivarjana) which would be indicatd by development of natural aversion to them.^[7] If one does not pay attention to natural caution signal, then Sancayāvasthā will quickly leads to further stages.

सञ्चयेड्पह्यता दोषा लभन्ते न उत्तरा गती:। ते तु उत्तराषु गतिषु भवन्ति बलवत्तरा।। (Su.Su.21/ 37)

This is highly meaningful notion given by Ācārya Suśruta in the chapter 21^st of Sutrasthāna to understand all the Disease and their advancement. As per stanza if we cease the Nidāna and admit the treatment in Sancaya Avasthā. Doṣa will stop and not go in further Avasthā instead they will moves to their normal Sthāna.

न शक्य उन्मूलयितुं वृद्धो वृक्ष एवामय:। अबद्धमूल: क्षुपको यत् उत्पाटने सुख: ।। (Su.Su.23/15-17)

Early detection of diseases and its progress will help to cure the Disease with minute efforts. However if Disease will progress it might be difficult to treat. And later on it become incurable. In the same way on young plant can be uprooted completely whereas the same plant is allowed to grow as a tree cannot uproot easily. (Su.Su.23/15-17)

कुपितानां हि दोषाणां शरीरे परिधावतम्। यत्र सङ्गे खवैगुन्यात् व्याधि : तत्रोपजायते।।

प्रसृतानां पुनः दोषाणां स्रोतोवैगुन्यात् यत्र सङ्ग: स स्थानसन्श्रय।।

Vitiated Doṣa travel in to the body, when they found space in the Srotas or in Dhātu they will lodge in and accomplished Doṣa - Dūṣya Sammurchanā. Here the Doṣa - Dūṣya Sammurchanā will be weak and in the beginning stage. As a result the symptoms will also be weak, manifested as prodromal symptoms (Purvarūpa). Proper diagnosis and treatment given in this stage will cease the further pathogenesis. But if the Doṣa will not treated yet, they will be enter in to successive stage.

In 5^th stage, diseases will manifest with all identified characteristics therefore its called as Vyaktāvasthā. As per involved Dhātu and severity of clinical features, Kuṣṭha is classified in to two group: Mahākuṣṭha and Kṣudrakuṣṭha. With this knowledge we can plan the treatment accordingly. When the Disease is neglected or not treated in this stage, the Doṣa vitiation

will have further progression. The progression of pathogenesis will lead to manifestation of complication in the 6^th stage Bheda Avasthā.

क्रमेण उपचयं प्राप्य धातूननुगत:। (Su.Su.23/16-17)

यथा वनस्पतिर्जात: प्राप्य कालप्रकर्षणम्। अन्तर्भूमिं विगाहेत मूलैवृष्टि विवर्धितै:।।

एवं कुष्ठं समुत्पन्नम् त्वचि कालप्रकर्षत:। क्रमेण धातून् व्याप्नोति नरस्य अप्रतिकारिण:।। (Su.Ni.5/20-21)

As tree grown, it penetrates deep into the earth, in course time, with its roots developed by rains, likewise Kuṣṭha appeared in skin (Tvak/ Rasa), after a long time, gradually permeates the Dhātus Chart No. 01 Shows flow chart of Kriyākāla accordance with Samprāpti of Kuṣṭha.

Conclusion

Ṣaḍkriyākāla gives opportunities to cease the disease at each of its stages. It is important to frame disease control and prevention strategy. Understanding of Kriyākāla is crucial for early diagnosis and getting an idea about whether the disease would be preventive, curative or incurable in nature. When disease proceed, its hard to treat. As above said, if a person omits the Nidānas as in the early stage in Kuṣṭha Vyādhi, or Kṛmi will not be manifested. From the appearance of mandal to Kṛmitpatti, Kriyākāla gives an occasion to treat at each stage, but if it to fail to treat, diasease become incurable.

Reference

1. Malakiya Chintankumar, Naik Nikita, Kanabar Abhay, Bhakkad Bhushan, Patankar Lokesh; Analytical Views on Practical Utility of Kriyakala in Clinical Practice; International Ayurvedic Medical Journal; July 2021; ISSN: 2320-5091

2. Suśruta. Suśruta Saṁhitā, ‘Ayurveda tattva sandīpikā’ hindi commentary by Shastri AD, Part- I (Sutra, Nidāna, Śārira, Cikitsā, Kalpa sthānas), Chaukhambha Sanskrit Sansthan, Varanasi- 221001, 2014

3. Malakiya Chintankumar,Naik Nikita, Kanabar Abhay, Bhakkad Bhushan, Patankar Lokesh; Analytical Views on Practical Utility of Kriyakala in Clinical Practice; International Ayurvedic Medical Journal; July 2021;ISSN: 2320-5091

4. Malakiya Chintankumar,Naik Nikita, Kanabar Abhay, Bhakkad Bhushan, Patankar Lokesh; Analytical Views on Practical Utility of Kriyakala in Clinical Practice; International Ayurvedic Medical Journal; July 2021;ISSN: 2320-5091

5. Divya Naik, Aniruddha; Application of Kriyakala in Kaphaja Vikara – A Review Article; International Journal of Ayurveda and Pharma Chemistry; Volume-15 (Issue- 2) 2021; ISSN 2350-0204

6. Vivekanand B. Mastamardi; Ayurvediya Roga Vigyana evum Vikriti Vigyana Part-1; published by Chaukhambha Vishvabharati, Varanasi 221001

7. Vivekanand B. Mastamardi; Ayurvediya Roga Vigyana evum Vikriti Vigyana Part-1; published by Chaukhambha Vishvabharati, Varanasi 221001

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-08-20	2022-08-22	2022-08-29	2022-09-05	2022-09-12
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Review Article

Kuṣṭha Samprāpti

Journal of Ayurveda and Integrated Medical Sciences