E-ISSN:2456-3110

Review Article

Panchakarma

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 10 November
Publisherwww.maharshicharaka.in

Chikitsa Siddhanta with special reference to Panchakarma

Nilanjan U.1*, Madhushree H.2, Puttur G.3
DOI:

1* Unni Nilanjan, Final Year PG Scholar, Department of Post Graduate Studies in Panchakarma, Sri Sri College of Ayurvedic Science & Research, Bangalore, Karnataka, India.

2 H.S. Madhushree, Professor, Department of Post Graduate Studies in Panchakarma, Sri Sri College of Ayurvedic Science & Research, Bangalore, Karnataka, India.

3 Ganesh Puttur, Principal, Professor & H.O.D., Department of Post Graduate Studies in Panchakarma, Sri Sri College of Ayurvedic Science & Research, Bangalore, Karnataka, India.

Chikitsa Siddhanta or the basic fundamental principles involved in treatment are very vital in any science. Ayurveda is a science known for its principles. It has stood the test of time owing to its treatment principles. It guides a physician to accordingly choose the various aspects of treatment such as methods, drugs, etc. Panchakarma is a very effective tool of Ayurveda to not only combat diseases but also to promote health. Thus, it becomes very important to understand the principles concerned with respect to Panchakarma. This article aims at understanding some of the most important principles that form the base of Panchakarma that shapes its utility in treatment.

Keywords: Panchakarma, Chikitsa, Siddhanta, Principles, Shodhana

Corresponding Author How to Cite this Article To Browse
Unni Nilanjan, Final Year PG Scholar, Department of Post Graduate Studies in Panchakarma, Sri Sri College of Ayurvedic Science & Research, Bangalore, Karnataka, India.
Email: 		Unni Nilanjan, H.S. Madhushree, Ganesh Puttur, Chikitsa Siddhanta with special reference to Panchakarma. J Ayu Int Med Sci. 2022;7(10):175-181.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-10-01 2022-10-03 2022-10-10 2022-10-17 2022-10-23
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© 2022by Unni Nilanjan, H.S. Madhushree, Ganesh Putturand 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

Ayurveda is a medical science known for its principles. Success of treatment in Ayurveda is based upon understanding of the basic principles that govern the body as well as the skill to practically apply such principles while treating. As disease or pathophysiology is understood in different regards, the treatment approach will correspondingly differ. This calls for a need to understand the different principles in treatment which is called as Chikitsa Siddhanta.

The term Chikitsa Siddhanta​ is made up of two words, Chikitsa and Siddhanta​. Chikitsa basically means treatment. Charakacharya says that Chikitsa is the Pravṛtti that aims at bringing the Dhatu from an imbalanced state (which is the root cause for the manifestation of a disease) to their normal state of equilibrium and its success is achieved by the 4 supporting factors or the Chikitsa Catushpada, (i.e.) Bhishak, Dravya, Upasthata and the Rogi.[1]

The word Siddhanta​ means principles. Siddhanta​ is that which is scientifically established after verifying through multiple examinations and assessments.[2] Every science, philosophy or school of thought has respective fundamental principles that form the foundation. For example, Tridosha Siddhanta​ is the fundamental principle of Ayurveda that helps to understand and comprehend health, pathology and treatment in terms of Vata, Pitta​​​ and Kapha.

In Ayurveda, Chikitsa Siddhanta​ are innumerable when it comes to general practice. Most common among them would be Dosha Pratyanīka Siddhanta​, Vyādhi Pratyanīka Siddhanta​, Srotoduṣṭi Siddhanta​, Āvaraṇa Chikitsa Siddhanta​, Pāñcabhautika Siddhanta​, Sāmānya Viśeṣa Siddhanta​, etc. However, in this regard, the basic principles that are essential in clinical practice of Panchakarma are highlighted.

Materials and Methods

Various Siddhanta​ were reviewed in the classical literature of Ayurveda and were compiled as follows.

1. Chikitsa Siddhanta​​ based on the status of Roga and Rogī

Status of the Roga and Rogī is important while planning Shodhana. This is mentioned in plenty of diseases. For example, in Raktapitta​​, Shodhana

Chikitsa is not always done. It is indicated only if the following criterias are met:

1. State of Dosha is Bahu Dosha Avasthā

2. Person is Balavān

3. There is no Bala Kṣaya and Māṃsa Kṣaya observed

4. The nature of origin of the disease is Santarpaṇa Janya

5. The subject is Shodhana Arha

Only if the above criteria are met, then Shodhana is advocated in appropriate Kāla by Vamana in Adhoga Raktapitta and Virecana in Ūrdhvaga Raktapitta. [3]

2. Dosha Pratyanīka Chikitsa Siddhanta​​

Dosha are the first and foremost factors responsible for the manifestation of the disease. Based on factors such as which Dosha is involved, the state of the Dosha, etc., specific lines of treatment are to be employed. Following are aspects of treating the disease with respect to the Dosha involved.

a. Nānātmaja Vyādhi: Nānātmaja Vyādhi are diseases that specifically arise due to one particular Dosha, and accordingly the line of treatment has been mentioned. In general, the 80 Vāta​ja Nānātmaja Vyādhi are best treated by Vasti (Āsthāpana and Anuvāsana), the 40 Pitta​​ja Nānātmaja Vyādhi are best treated by Virecana and the 20 Kaphaja Nānātmaja Vyādhi are best treated by Vamana. Vāgbhaṭācārya also says that the best modes of treatment for Vāta​, Pitta​​ and Kapha Dosha are Vasti, Virecana and Vamana respectively.[4-7]

b. Anukta Vyādhi: In treating a disease that is not mentioned in the classics, the modern Ayurvedic physician would be often in a dilemma. It puts forth an opportunity to venture into a new arena of treatment, but carries with it the risk of not being able to comprehend in its entirity, a condition previously unknown to science. It is not possible to name all the diseases due to the infinite permutations and combinations of the factors involved in disease manifestation such as Dosha, Dhatu, etc. Thus, the assessment of these factors becomes key in understanding and the disease in detail. However, Ācārya Vāgbhaṭa gives assurance that giving due importance to the Samīkṣya Bhāva in assessment of the disease, patient as well as treatment plan ensures that the physician does not fail in his attempt owing to incompetence.[8]


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3. Dosha Avasthā Anusāra Chikitsa Siddhanta​​

a. Sāmānya Chikitsa Siddhanta

The 4 states of the Dosha are enumerated as Ksīṇa (emaciated), Kupita (agitated), Vṛddha (aggravated) and Sama (equilibrium). Based on this the treatment principle differs. Dosha which are Ksīṇa are to be subjected to Bṛṃhaṇa Chikitsa. Praśamana (pacification) is advised for Kupita Dosha, whereas measures of Nirharaṇa (elimination) are advocated if the Dosha are Vṛddha. In Sama Avasthā the principle of Paripālana is ideal.[9]

As per this Siddhanta, Vṛddha Dosha are indicated for Shodhana. Ācārya Ḍalhaṇa clarifies that there are two types of Vṛddhi - Caya and Prakopa. Caya is the Saṃhitā Rūpa Vṛddhi (accumulation of Dosha) whereas Prakopa is the Vilayana Rūpa Vṛddhi (Dosha attaining liquefaction and moving out of its place). Dosha which have attained the latter stage, (i.e., Prakopa) are to be removed from the body by means of Shodhana.

He further adds that the Kopa can be either Caya Pūrvaka (preceded by accumulation of Dosha) or Acaya Pūrvaka (not preceded by accumulation of Dosha). Caya Pūrvaka Prakopa is indicated for Śodhana.[10]

b. Kriyākāla​

Manifestation of disease is understood as a process involving 6 milestones. These milestones, known as Kriyākāla (stages of disease manifestation and its management), not only help in understanding the stage of disease, but also provide opportunities of intervention,[11] As the disease progresses from one stage to the next it becomes more stronger and thus more difficult to treat.[12] Hence, they are also considered as Chikitsa Avasara or opportunities for intervention. Although it is said that Dosha must be attended to at the first stage of Chaya (accumulative stage) itself,[13] Shodhana is ideally done in the stage of Prakopa or thereafter.

c. Naturally occurring Prakopa of Dosha with Ṛtu and and corresponding Ṛtu Shodhana

With the influence of time, specifically the climate, the environment is responsible for variations in the Dosha. The respective seasons responsible for Caya, Prakopa and Praśamana of the Tridoṣa as an effect of climatic changes is depicted in the table below.

Table 1: Season in which Caya, Prakopa and Praśamana of respective Dosha occurs, corresponding season and method for Śodhana[14-16]

Dosha Vāta Pitta Kapha
Caya Grīṣma Varṣa Śiśira
Prakopa Varṣa Śarat Vasanta
Praśamana Śarat Hemanta Grīṣma
Ṛtu for Shodhana Prāvṛṭ Śarat Vasanta
Shodhana Vasti Virecana Vamana

As mentioned above, the Chaya of the Dosha happens in respective season and the Prakopa occurs in the next season. Thus, this can be considered as Caya Pūrvaka, for which Shodhana is mandated. Prakopa of Vāta (in Grīṣma Ṛtu), Pitta (in Śarad Ṛtu) and Kapha (in Vasanta Ṛtu) naturally occurs by the influence of time in various seasons. By the effect of the changes happening in the environment, Considering that this change is inevitable and can occur even if an individual resorts to a healthy seasonal regime, there is a need to accordingly eliminate the respective Dosha that attains Prakopa. In this regard, Ṛtu Shodhana is applicable as a prophylactic practice wherein, respective modes of Shodhana of respective Dosha is done in its respective season of Prakopa, i.e., Vasti is done for Vāta Prakopa in Grīṣma Ṛtu, Virecana is done for Pitta Prakopa in Śarad Ṛtu and Vamana is done for Kapha Prakopa in Vasanta Ṛtu.

4. Dhatu Anusāra Chikitsa Siddhanta​​

a. Āśraya Āśrayī Bhāva: The Dosha and Dhatu are very closely interrelated to one another in Āśraya Āśrayī Bhāva, which also means that they have an effect on each other. The Āśraya Āśrayī Bhāva are as follows:

Table 2: Dhatu or Ashraya of respective Dosha or Ashrayi[17]

Dosha (Ashrayi) Dhatu (Ashraya)
Vata Asthi
Pitta Sveda, Rakta
Kapha all other Dhatu

Thus, an effect on one can lead to the effect on the other. Pitta and Kapha are in direct relation with their respective Āśraya, whereas Vāta is inversely related with Asthi. Thus, the Vṛddhi or Kṣaya of Pitta and Kapha cause a corresponding Vṛddhi or Kṣaya in their respective Āśraya, while Vṛddhi of Vāta causes Kṣaya of Asthi and vice versa.[17]


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This principle is used in the treatment of Dhatu (by treating the Dosha that is associated with the respective Dhatu).

b. Dhatu Pradoṣaja Chikitsa Siddhanta​​: Specific treatment principles are mentioned for diseases pertaining to certain Dhatu. The respective Shodhana methods indicated for pathology in respective Dhatu are as follows:

Table 3: Shodhana methods employed for respective Dhatu Pradoṣa[18]

Dhatu Pradoṣa Chikitsa
Rasa Laṅghana
Rakta Virecana, Raktamokṣaṇa
Māṃsa Saṃśodhana
Asthi Panchakarma, Tiktaka Kṣira Sarpi Vasti

5. Dosha​-Gati-Mārga Anusāra Chikitsa Siddhanta

a. Sāmānya Chikitsa: When the normal Gati of Dosha is affected in its own Sthāna it is corrected by Chikitsa.

For example, Udāvarta is characterised by Vāta being vitiated in its own Sthāna. This is treated by Nirūha Vasti.[19] Here, considering Pakvāśaya as the main Sthāna of Vāta, Guda Mārga is selected for treatment and Vasti is administered.

b. Anya Sthāna​ Gata (Sthānāntārgata) Dosha Chikitsa Siddhanta​

When one Dosha is lodged in the Sthāna​ of another Dosha the former is known as Āgantu Dosha and the latter is known as Sthāyi Dosha. This situation calls for comparing the strength of either Dosha and the decision for order of treatment is made as follows:

  • If Āgantu Dosha is more in Bala, then it is treated first.
  • If Sthāyi Dosha is more in Bala, then that is treated first.
  • If both are equally vitiated, Sthāyi Dosha is given preference.[20]

Management of Tamaka Śvāsa and Amlapitta are examples that highlight this principle. In Tamaka Śvāsa, Kapha Dosha and Vāta Dosha involvement is seen but the Sthāna affected is that of Pitta. Thus, giving due importance to the Sthāna, “Vātaśleṣmaharairyuktaṃ Tamake Tu Virecanam” is said. Here, Virecana (prime treatment line for Pitta

Sthāna) with drugs having Vātahara and Kaphahara property is advocated.[21]

Ūrdhva Deha Sthita Amlapitta is treated by Vamana and Adhaḥ Deha Sthita Amlapitta is treated by Virecana.[22] This highlights the due consideration given to Sthāna, and accordingly choosing the mode of Shodhana.

c. Sāma Dosha Chikitsa Siddhanta​​: If Sāma Dosha is spread all over the body then it must not be removed at once. Once the body is subjected to Pācana, Dīpana, Snehana and Svedana, measures of Shodhana can be employed giving due importance to Kāla (time or season), Āsanna Mārga (nearest natural orifice for elimination) and Bala (strength of the patient).[23]

d. Āsanna Mārga Nirharaṇa of Tiryak‌ Gata Dosha

When the Dosha are located in the diverse channels of the body they cause chronic imbalance in the body. Under this circumstance, immediate Shodhana of these Dosha must not be done. Instead, these Dosha can be treated by Śamana alone or after successfully manoeuvring the Dosha towards the Koṣṭha (using Pācanādi Karma) they should be removed from the nearest route (Āsanna Mārga).[24]

In the attempt to remove the Dosha from the body, the appropriate Mārga or channel must be selected. Table [4] shows the Āsana Mārga, referring to the nearest route selected for elimination of Dosha situated in respective locations.

Table 4: Āsanna Mārga for respective Dosha based on their location.

Location of the Dosha Āsanna Mārga
Āmāśaya Vaktra / Oral route
Ūrdhva Jatru Ghrāṇa / Nasal route
Pakvādhāna Guda / Rectal route.[25]

e. Pratimārgaharaṇa Chikitsa Siddhanta​​: The term Pratimārgaharaṇa, implies removal (Haraṇa) of Dosha in the opposite direction (Pratimārga). It is an exception to the above-mentioned rule of Āsanna Mārga Dosha Haraṇa, applicable in certain conditions such as Raktapitta.

As mentioned before, if certain conditions are met in a person suffering with Raktapitta, Pratimārgaharaṇa Chikitsa is advocated in appropriate Kāla by Vamana in Adhoga Raktapitta and Virecana in Ūrdhvaga Raktapitta.


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When Atiyoga is seen as a complication of Virecana, Vamana with Taṇḍulāmbu is mentioned.[26] Vamana induces an upward force to counter the downward movement. Similarly, during the Atiyoga of Vamana, Virecana is mentioned,[27] which will exert a downward force to counter the upward movement. In both of these, the principle of Pratimārgaharaṇa and its utility in Shodhana can be appreciated.

Application in Raktapitta is well known. But the Pratimārgaharaṇa used for treating Vamana and Virecana Vyāpat is the concept relevant to Panchakarma.

Discussion

Diseases are innumerable and ever evolving. There is a constant change in the food and lifestyle of human beings along with change in environmental conditions. For example, with the birth of industrialization and technology, the dynamics of living has entirely changed over the years with change in diet as well as lifestyle of individuals. Pollution in the environment and the cascade of events that follow it such as global warming, has led to a decline in the ability of nature to nurture and safeguard health. Instead, newer diseases are formed due to the harsh polluted environment such as Ischemic Heart Disease, Chronic Obstructive Pulmonary Disorder, etc. These factors give rise to a wide variety of diseases.

This emphasizes that pathology can take multiple forms along the years. Many of the new diseases can be correlated to diseases mentioned in classics (for example, cancer as Arbuda or Gulma) and their respective Chikitsa Sūtra can be used in treating them. Chikitsa Sūtra often indicates the best possible methods to eliminate the pathology with the help of the science available at that particular point of time. Thus, it may be upgraded with time.

Importance of adhering to Chikitsa Siddhanta​​ behind the Chikitsa Sūtra

Chikitsa Siddhanta​​ could be understood as the goal and the journey required in tackling a disease while Chikitsa Sūtra often indicates the methods to achieve (which could be more understood as the road taken).

However, understanding the pathology and correcting it accordingly remains to be the goal of Ayurveda. (to return the Dhatu to equilibrium).[28]

Keeping this as the primary goal, it is paramount that a physician should choose to adhere to the principles (Siddhanta​​) of treatment behind the methods (Sūtra).

There may pose a need to deviate from the said protocol based on the underlying principles. For example, the Sūtra indicates that Vamana must be carried out in Vasanta Ṛtu to eliminate Kapha Dosha but the Siddhanta​​ clarifies that it must be done only if there is Caya Pūrvaka Nidāna of Kapha.

Similarly, Tamaka Śvāsa is indicated for Virecana with Kapha-Vātahara Dravya. The underlying criteria here is that Virecana cannot be employed directly if the patient has Vṛddha Kapha state. In such cases, Vamana has to be done priorly and then Virecana can be employed. Multiple Siddhanta​​ such as Dosha Avasthā Anusāra Chikitsa Siddhanta, Anya Sthāna​ Gata Dosha Chikitsa Siddhanta​, etc. come into play.

Conclusion

Chikitsa Siddhanta​ is the fundamental principle behind the different modalities or approach of treatment. Panchakarma being the crown jewel of Ayurveda promises many things that seem too good to be true like disease-free state of the body, increased longevity, non-recurrence of diseases, etc. But for this to be true the approach needs to be clear and precise. This is where the importance of Chikitsa Siddhanta​ is highlighted. Considering this, Panchakarma which offers the means or the path along with Chikitsa Siddhanta​ which gives direction, makes a physician well equipped to tackle any disease.

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6th Chapter/Sloka No 47, Reprint edition 2015, Varanasi: Chaukambha Prakashan.

28. Agnivesha, Charaka Samhitha, revised by Charaka and Dridabala with Ayurveda Dipika commentary of Chakrapanidatta, edited by Vaidya Jadavji Trikamji Acharya, Sutrasthana, 1st Chapter/Sloka No 53, Reprint edition 2015, Varanasi: Chaukambha Prakashan.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(10)181