Review of Krimi with contemporary understanding

EK Aiswarya; Mahesh Hirulal; Gopi Krishna

Review of Krimi with contemporary understanding

Aiswarya E.¹, Hirulal M.², Krishna G.³

DOI:

¹ EK Aiswarya, Post Graduate Scholar, Department of Roganidana Evum Vikiriti Vigyana, Sri Dharmasthala Manjunatheshwara College of Ayurveda Hospital, Hassan, Karnataka, India.

² Mahesh Hirulal, Associate Professor, Department of Roganidana Evum Vikiriti Vigyana, Sri Dharmasthala Manjunatheshwara College of Ayurveda Hospital, Hassan, Karnataka, India.

³ Gopi Krishna, Professor, Department of Roganidana Evum Vikiriti Vigyana, Sri Dharmasthala Manjunatheshwara College of Ayurveda Hospital, Hassan, Karnataka, India.

Krimi is used as broad sense for all worms and micro-organisms perspective of modern science. In Samhita Period there is ample description regarding Nidana, Bheda, Lakshana and Chikitsa of Krimi. In present day science, microbiology and helminthology are the separate branches including all the worms and microbe. Classification of Krimi has been mentioned by different authors with its site, etiology, symptoms and treatment. Krimi can be correlated with parasites and microorganisms mentioned in modern science. The disease associated with Krimi also discussed in this article.

Keywords: Krimi, Samhita period, microbiology, helminthology

Corresponding Author	How to Cite this Article	To Browse
	EK Aiswarya, Mahesh Hirulal, Gopi Krishna, Review of Krimi with contemporary understanding. J Ayu Int Med Sci. 2022;7(7):95-100. Available From https://jaims.in/jaims/article/view/1991

Introduction

In Ayurveda the word Krimi is used as broad sense for all worms and microorganisms’ perspective of modern science. Concept of Krimi is not new its description is found since Vedic period. The visible or invisible i.e., macro or micro-organisms that affect the living & non-living things of biosphere are described in Ayurvedic literature.^[1]

In Shabdakalpadruma Krimi is derived as “Bhrame Samprasarane Cha” means which moves with Pada or legs (podia).^[2] According to Veda Krimi originate in different areas like Parvata, Vana, Oushadhi, Pashu, Apshu etc.^[3]Krimi derived from Dhatu “Kunja Himsayam” which literary means either to produce fatal effects or to destroy. Charaka informed Kleda in the body is one of the factors for Krimi production.^[4] In Samhita Period there is ample description regarding Nidana, Bheda, Lakshana and Chikitsa of Krimi. In present day science, microbiology and helminthology are the separate branches including all the worms and microbes. In this article an attempt was made to analyze the Krimi with contemporary understanding.

Classification of Krimi: The following table shows the total number and divisions of Krimi according to different Acharyas. [Table 1]^[5]

Table 1: Number of Krimi according different authors

Name of Acharya	Bahya Krimi	Abhyantara Krimi			Total Abhyantara Krimi	Total Krimi
Name of Acharya	Bahya Krimi	Kaphaja	Purishaja	Raktaja	Total Abhyantara Krimi	Total Krimi
Charaka[6]	2	7	5	6	18	20
Susruta[7]		6	7	7	20	20
Vagbhat[8]	2	7	5	6	18	20
Madhavakara[9]	2	7	5	6	18	20
Sarangadhara[10]	2	7	5	6	18	20
Bhavaprakash[11]	2	7	5	6	18	20

Causative factors of Krimi in general

The Bahya or external Krimi are produced due to “Mrija Barjana” means unhygienic and dirty habits.^[13] Regarding Abhyantar Krimi some general and some specific etiological factors mentioned. The common causative factors include Ajeernabhojana, regular intake of Madhura and Amla Rasa, consumption of Drava substances, Guda, Virudhha Bhojana etc.

Some physical factors are also mentioned in common Nidana like Divaswapna and Avyayama.

Table 2: Nomenclature and site of Krimi according to Acharya Charaka^[12]

SN	Type of Krimi	Name of the Krimi	Site of the Krimi
1.	Bahya	Yuka, Pipilika	Hair, Eyelashes, Skin, Clothing
2.	Kaphaja	Antrada, Udarada, Hrudayacara, Curu, Darbhapuspa, Saugandhika, Mahaguda	Amasaya, from Amasaya spread up and down
3.	Purishaja	Kakeruka, Makeruka, Sausurada, Sasulaka, Leliha	Pakvashaya, spread towards anus and also towards Amasaya
4.	Raktaja	Kesada, Lomada, Lomodvipa, Saurasa, Audumbara, Jantumatarah.	Raktavahini, Dhamani

Table 3: Samprapti Ghataka of Krimi Roga

Dosha	Tridosha mainly Kapha Pittaja
Dushya	Datu: Rasa, Raktha,Mamsa
Dushya	Mala: Purishya later on Mamsa, Sira, Snayu
Srotas	Rasa, Rakta, Annavaha, Raktavaha, Purishavaha
Sroto Dushti Lakshana	Sanga, Vimarga Gamana, Atipravrtti, Granthi
Agni	Jatharagni and Dhatwagni Mandya
Sthana	Amasaya, Pakvashaya, Rakta or Sarva Sharira
Vyatka	Krimi Prabhava

Description of Krimi and its correlation with parasites and microorganisms

Bahya Krimi : Yuka

Yuka can be correlated to with the sucking lice (Pediculus humanus species). It is wingless with distinct head, thorax (bearing three pairs of clawed legs) and abdomen (seven segments). It has multiple legs and it is blood sucking species.

Mainly 3 types

The body louse (Pediculus humanus capitis)
Head louse (Pediculus H corporis)
Pubic louse (Phthirus pubis)

Mode of infection: Personal contact and exchange of clothing’s etc.

Effect: Inject salivary fluids to wound during ingestion, causes intense itching (constant scratching - bacterial infection of wounds), inflammatory papules, pigmentations in the skin.

Pipilika: Corresponds to a very tender insect. Appearance may be like ants but it corresponds to liksha.

Mites: Mites may cause an intense dermatitis

Itch mites (Sarcoptes scabiei)
Black head mites (Demodex folliculorum).

Ticks: Ticks are obligate blood feeders

Hard (ixodid) ticks (chitinuous shield)
Soft (argasid) ticks

Abhyantara Krimi : Kaphaja Krimi

Antrada : Hook worm - Ankylostoma duodenale

Adult worm lives in the small intestine of man, particularly jejunum, less often in duodenum. It is small, greyish white cylindrical worm. Bend dorsally, hence the name hookworm. Freshly passed worm is reddish-brown because of ingested blood in its intestine.

Udarada : Tape worm (T. solium and T. saginata)

The adult worm lives in small intestine & upper jejunum of man and lies in several folds in the lumen. This move against the peristaltic movement in the host’s intestine. It is opalescent white in colour, 2-10 meters in length. Proglottids (Segments) - 800-1000 in no.

Mahaguda : Round worm (Ascaris lumbricoides)

Habitat - small intestine (jejunum) it is cylindrical with tapering ends up to 40cm in length. Freshly passed worms will be light brown or pink in colour that changes gradually to white.

Life cycle

Definitive host - Human beings
Intermediate host - not required
Infective form - embrocated eggs
Source - contaminated food, drinking or raw vegetables

Mode of infection- ingestion, inhalation of polluted dust particles containing embrocated eggs

Hridayachara : Trichinella spiralis

Morphology: Smallest nematode infecting man, just visible to naked eye, white in colour. Anterior half of body is thin and pointed. Posterior end of male has a pair of pear shaped clasping papillae on either side.

Life cycle

Definitive host - pigs/rats and human beings.
Intermediate host - not required.
Infective form - encysted larvae.
Source - improperly cooked pork

Mode of infection: Ingestion.

Raktaja Krimi

Keshada, Lomada, Lomadvipa : Tinea capitis

It is infected to shaft of scalp hair. Infected hair is dull-gray, which break to form patches of alopecia.

Types

1. Keroin - It is painful, inflammatory lesion; form mass on scalp, suppurate, form sinus and discharge pus; caused by verrucosum and T. mentagrophytes.

2. Favus - Waxy honeycomb-like crusts are formed around hair follicles and cause patchy alopecia and scarring; caused by schoenleinii, T. violaceum.

Udumbara: Tinea corporis

It is infection of no hairy skin of the body. It results from extension of infection from groin, scalp or beard area and shows single or multiple confluent erythematous, scaly, annular, sharply marginated lesions. Fungal metabolites may diffuse to deeper layers and cause erythema, vesicle or pustule along with pruritus caused by T. rubrum, T.mentagrophytes.

Purishaja Krimi

Kakeruka: Trichuris trichiura

It is attached to the wall of caecum and appendix. It is adult worm and it is pinkish-white, resembles a whip. The anterior 3/4^th thin, hair like and coiled. The posterior 2/5^th is thick and stout- whip worm.

Makeruka: Enterobius vermicularis (pin worm, thread worm, seat worm)

It will be seen in caecum, vermiform appendix and adjacent part of ascending colon. After mating, the male usually dies and is passed in faeces. The gravid female migrates down the colon to rectum. At night the worm comes out through anus and crawls about on the perianal and perineal skin to lay its sticky eggs. It is adult worm. It is small, white, spindle-shaped, resembles a piece of white thread.

Sasurada: Balantidium coli

It is largest protozoan and only ciliate that infects human beings. It lives in the large intestine, caecum and terminal ileum. They feed on debris of intestinal wall, starch grains, bacteria and mucus. It is trophozoite and oval, 60-70mm. Motility - motile with the help of cilia covered all over the body. Anterior end is narrow, shows cytostome (mouth) and cytopharynx. Posterior end is broad, shows small pore

Sign and Symptoms

Both general and specific sign and symptoms of Krimi Roga are described in Samhita. The general sign and symptoms include Jvara (fever), Vivarnata (skin discoloration), Sula (acute pain in abdomen), Hrudroga, Bhrama (vertigo), Bhaktadwesa (anorexia), Atisara (diarrhea) Sadana (malaise) and Chardi (vomiting).^[14]

Specific sign and symptoms

Bahya Krimi: Itching and urticaria rashes in the body.^[15]

Kaphaja Krimi: Hrillasa, Asyasamsravana, Avipaka, Arochaka, Jvara, Murchha, Jrimbha, Kshavathu, Anaha, Angamarda, Chhardi, Karshya, Parusya, Kasa, Pinasa, Sula, Svayathu, Hrudroga, Pratisyaya, Siroroga.^[16]

Purishaja Krimi: Purisabheda, Karshya, Parusya, Lomaharsa, Gudaniskramana, Guda Kandu, Sula, Agnimandya, Pandu, Visthambha, Bala Kshaya, Praseka Aruchi, Hridroga.^[17]

Raktaja Krimi: Raktaja Vyadhi, Kesa Samshru Nakha Loma Pakshma Dhwamsa, Harsa, Kandu, Toda, excessively grown Krimi eat away skin, vessels, ligaments, muscles, cartilages and tissues.^[18]

Krimi in relation to other diseases

The growth and effect of Krimi may cause several diseases and some diseases listed here, they are Mritbhakshana Janya Pandu (anemia), Chardi (vomiting), Atisara (diarrhea), Krimija Hridroga, Krimija Shiroroga, Karna Krimi and Nasa Krimi or Raktaja Pratishyaya (nasal myasis).

Mritbhakshana Janya Pandu (Anaemia due to intake of mud)

Habitual intake of clay or mud aggravates one of the three Dosha based on its Rasa like if mud

is of Tikta (astringent), it aggravates Vata Dosha; If mud is of Lavana and Kshara (saline with alkaline), it aggravates Pitta and if it is Sweet (Madhura), it aggravates Kapha Dosha. The sign and symptoms manifested in this type of Pandu are Shuna Ganda Akshi Kuta (oedema in the cheek, eye socket and eye bone), oedema in feet and umbilical region. It also causes Krimi Koshta (Appearance of worms in intestine) and loose stool associated with blood and mucus.

Chardi (Vomiting): Chardi is caused due to excessive intake of liquid food, excessive consumption of unwholesome food, excessive intake of salty food, untimely intake of food, exhaustion, fear, indigestion, Krimi doha (infection), pregnancy, eating food in hurry etc.

Atisara (Diarrhea): Atisara is of various types based on aggravation of Dosha. Sannipataja Atisara is a combined effect of these Dosha. Sannipataja Atisara caused due to intake of excessive cold, unctuous, dry, hot and heavy food, intake of unwholesome food, avoiding food, excess intake of alcohol, Krimi Dosha (infection) etc.

Krimija Hrudroga: It is caused due to intake of sesame and its products, milk, Guda while having Hridroga. It forms a Granthi in a portion of Hridaya Marma. This cyst or Granthi filled with Kleda (vicious fluid). To this Rasa in circulation gets added and increases Kleda. This forms an ideal environment for manifestation of Krimi. These manifested Krimi causes severe pain and discomfort in heart.

Krimija Shiroroga: It is a kind of disease of head or head ache caused by worm infestation or infection. It is also called as Krimija Shirashula or Krimija Shirobhitapa. In this disease person have headache in which person feel throbbing and pulsating pain within the bones of head, feels as if something is eating off brain or brain membranes and discharges pus mixed fluids from nose.

Krimi Karna: Krimi Karna refers to maggots in ear and it is one of the various disease mentioned in 15^th century in Yogasarasangraha by Acharya Vasudeva.

Nasa Krimi or Raktaja Pratishyaya (nasal myasis)

In this disease causative factors are low digestive power, increase of Kapha

Dosha, allergens, unwholesome food. Pratishyaya is classified based on symptoms they are Vataja, Kaphaja, Vata-Kaphaja, Kapha-Vataja, Raktaja and Kapha-Raktaja.

Table 4: Krimi in relation with other diseases.

SN	Diseases	Relation with Krimi
1.	Mritbhakshana Janya Pandu (anemia)	In this type of Pandu Krimikoshta (worms in intestine) appears as sign and symptoms
2.	Chardi (vomiting)	Krimi Dosha (Infection) is one of the causative factors.
3.	Atisara (diarrhea)	Krimi Dosha is one of the causative factors.
4.	Krimija Hridroga	Manifestation of Krimi is the main cause for this disease
5.	Krimija Shiroroga	Manifestation of Krimi is the main cause for this disease
6.	Karna Krimi	Manifestation of Krimi in ear (maggots in ear)
7.	Nasa Krimi or Raktaja Pratishyaya (nasal myasis)	Krimi Dosha (Infection) is one of the causative factor and symptom.

Treatment for Krimi Roga

Acharya Charaka described three basic methods for the treatment of Koshtagata Krimi such as - Apakarshana (Removed by Vamanadi Panchakarma procedures), Prakritivighata (Breaking the pathogenesis), and Nidana Parivarjana (Absence from cause).

Apakarshana: Apakarsana of Krimi includes the manual and instrumental removal Krimi. Apakarsana or removal of the Bahya Krimi (external) should be done by manual method. Removal of Abhyantara Krimi by Virechana, Vamana, Sirovirechana and Asthapana Basti process.

Prakriti Vighatana: Prakriti Vighatana are inhibiting factors which responsible for the inhibition of growth and production of Krimi by Dravyas having Katu, Tikta, Kashaya and Ushna Guna.

Nidana Parivarjana: It helps to eliminate the causative factors which promote the germinating and growing of the Krimi.

Discussion

The word Krimi has broad meaning in Ayurveda for worms and microorganisms. Since the Vedic period its existence was found but in Samhita period detail study about the type of Krimi, its morphology, pathogenesis, clinical features and management

was found very clearly.^[1] The correlation of the Krimi with microbes and parasites depend upon their habitat, available morphological character along with sign and symptoms they produce in host. Individual probable correlation of all the Krimi with microorganisms is quite difficult but some of the Krimi produce similar features like microbes and parasites.^[5] In this article Bahya Krimi Yuka and Pipilika is correlated sucking lice, mites and ticks and Abhyantara Krimi is correlated with parasites and micro-organisms. Kaphaja Krimi is correlated with hook worm (Ankylostoma duodenale), round worm (Ascaris lumbricoides) and tape worm (T. solium and T. saginata). Purishaja Krimi is correlated with Trichuris trichiura, Enterobius vermicularis (pin worm, thread worm, seat worm), Balantidium coli. Raktaja Krimi can be correlated to Tinea capitis and Tinea corporis. In this article Krimi associated with diseases like Mritbhakshana Janya Pandu, Chardi, Atisara, Krimija Hridroga, Krimija Shiroroga, Krimi Karna and Nasa Krimi mentioned in brief.

Conclusion

Concept of Krimi and Krimi Roga are available since Vedic period, but detailed descriptions are found in Samhita period along with treatment of Krimi Roga. Based on the clinical features and habitat inside host Krimi can be compared with various microorganism and parasites.

The clinical conditions originating from Krimi can be understood with different parasiting infections. There is a further scope to evaluate Krimi Chikitsa explained in Ayurveda in contemporary parasitic diseases.

Reference

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Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-06-29	2022-07-01	2022-07-08	2022-07-15	2022-07-22
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Review Article

Krimi

Journal of Ayurveda and Integrated Medical Sciences