Journal of Ayurveda and Integrated Medical Sciences

Introduction

Kriyakala, a distinctive concept in Ayurveda, offers insights into both diagnosing and foreseeing how a disease might progress. It refers to the treatment methods suitable for different stages of an illness.^[1] In modern science, diseases are typically understood in two stages: first, the detection of the disease itself, and second, the complications that arise from it. However, Ayurveda identifies six distinct stages (Shatkriyakala) in

any disease. Notably, the noticeable symptoms and complications manifest in the last two stages. Fascinatingly, Ayurveda can identify and address the root causes of a disease even before its external symptoms surface. The primary factors influencing disease development in Ayurveda are Ama (self-generated toxins) accumulation and the imbalance or movement of Doshas (biological elements). This ancient approach focuses on understanding and treating the early stages of an ailment, aiming to manage underlying causes before they lead to visible symptoms or complications. By targeting these foundational factors, Ayurveda aims to prevent the disease from progressing to its more severe stages.

Concept of Kriyakala^[2]

Kriya Kala, the stages of activity, can be broadly categorized into two types:
1. Ritu Kriya Kala
2. Vyadhi Kriya Kala

Ritu Kriya Kala relates to the seasonal variations in Dosha activity, where the Doshas manifest according to the changing seasons. Each season brings about specific changes in the Doshas - buildup, aggravation, and subsequent pacification - in a cyclical manner. In the 12^th chapter of the Astanga Sangraha Sutra, Vagbhata delineates the Ritu Kriya Kala into three distinct stages:

Chaya
During this phase, the Dosha accumulates in its natural abode, exhibiting an aversion to substances or activities that contribute to its build-up. There's a preference for elements with properties that counteract this accumulation.

Kopa
Dosha starts spreading to new areas, showing heightened signs of Doshic

Shatkriya Kala^[3]

Acharya Sushruta, an ancient Indian surgeon, introduced the concept of Kriyakala in Varnaprashnadhyaya. This concept combines "Kriya" and "Kala," signifying treatment or action and time, respectively. Kriyakala essentially denotes the timeframe or window of opportunity during the progression of a disease.

Described by Acharya Sushruta, the six stages known as Shat Kriyakala offer a deep understanding of the existing imbalance of biological factors (Doshadushti) and the disease's evolution within the body. These stages not only reveal the present state but also guide on when to initiate treatment and the most suitable course of action.

In modern medicine, maintaining homeostasis is crucial for sustained health. Homeostasis refers to the body's ability to regulate its internal environment, ensuring stability despite external changes or weather variations. Diseases often stem from the body's failure to maintain this balance, disrupting its internal equilibrium and leading to health issues.

Six stages of Shat Kriya Kala
1. Sanchaya (accumulation)
2. Prakopa (aggravation)
3. Prasara (transmigration)
4. Sthan Samshraya (localization)
5. Vyakti (manifestation)
6. Bheda (complication

Stage of Sanchaya^[4]

This is the initial stage of Kriyakala, known as Sanchaya, the accumulation of Doshas occurs without their displacement from their respective sites in the body. This accumulation characteristically involves Vata in the Pakvashaya, Pitta in the Amashaya, and Kapha in the Ura Pradesh.

The etiology or causative factors for Sanchaya can be categorized as either natural (Kala Swabhava) or as Trividha Hetu, consisting of three causative factors:

1. Prajnaparadha (Misleading): Mistakes or errors in judgment and actions that lead to the accumulation of Doshas.

2. Asatmendriyartha Samyoga (Improper use of sensory organs): Incorrect utilization or

These treatments are specifically targeted at the mild stages of Dosha imbalances. Samshana Chikitsa involves therapies appropriate for mild conditions to help restore balance and alleviate symptoms associated with the respective Dosha imbalances.

Stages of Prakopa^[5]

In the second stage of Shatkriya Kala known as Prakopa, the Doshas continue to accumulate at their specific sites in the body. This stage signifies the liquefaction of Doshas. Vagbhat^[6] describes this stage as ‘Unmarga Gamita’ i.e., inclination of Doshas to leave its original site. It resembles the condition of overflow of any liquid material in any utensil.

Drawing an analogy, in the Chaya Avastha, Doshas are in a solidified form, similar to thick ghee that becomes solid. As the Doshas transition to Prakopa Avastha, they liquefy akin to melted ghee.

When the melted ghee is further heated, it begins to froth and might overflow from the utensil, which parallels the Prasara stage. Similarly, in the Prasara stage of Doshas, they start to move and overflow from their original locations within the body. Prakopa is of two types.

1. Chayapoorvaka Prakopa refers to the transition to the Prakopa stage following the Chaya Avastha, where the Doshas move from a relatively stable or dormant state to an agitated state.

An example of Chayapoorvaka Prakopa is akin to the preparation of Idli, where black gram flour is soaked overnight. The next morning, the paste of black gram flour overflows, signifying the transition from a stable state (Chaya Avastha) to an agitated state (Prakopa Avastha).

2. Achayapoorvaka Prakopa represents the transition to the Prakopa stage without prior accumulation or stability.

An example of Achayapoorvaka Prakopa is observed when boiling milk. If the fire is suddenly increased, the milk may boil over due to the abrupt rise in temperature. Conversely, if the fire is decreased, the milk doesn't overflow as there isn't enough heat to cause agitation or transition to the Prakopa stage. This scenario demonstrates the immediate shift to the agitated state without a preceding stable phase

or spread known as Prasara. Controlling and regulating Vata Dosha becomes crucial at this stage to prevent the progression of Doshas to this level of disorder. Managing Vata can play a key role in averting the Doshas from reaching this critical stage. There are 15 types of Prasara as follows^[8]

1. Vata Prasara

2. Pitta Prasara

3. Kapha Prasara

4. Rakta Prasara

5. Vata Pitta Prasara

6. Vata Kapha Prasara

7. Pitta Kapha Prasara

8. Vata Rakta Prasara

9. Vata Pitta Kapha Prasara

10. Pitta Rakta Prasara

11. Kapha Rakta Prasara  

12. Vata Pitta Rakta Prasara

13. Vata Kapha Rakta Prasara

14. Pitta Kapha Rakta Prasara

15. Vata Pitta Kapha Rakta Prasara

Similarly, when Doshas move from their original sites, they can overflow into new areas either on their own or sometimes in combination with other Doshas. This overflow leads to three distinct directions of movement, known as Gati:

1.Urdhwa Gati: Moving upward can result in manifestations such as vomiting, cough, ailments related to the ear, nose, throat, and eyes.

2. Adho Gati: Progressing downward may cause conditions like diarrhea, hemorrhoids, and issues related to the rectum.

3. Tiryak Gati: Moving horizontally or in a transverse direction can lead to the development of skin diseases and related disorders.

Lakshana

The localization of Doshas at specific sites involves two key preconditions:

(a) Potent Causative Factors (Nidana): The factors responsible for Dosha settlement must be strong enough to cause damage. (b) Depletion or Disturbances in Srotas: The site where Dosha settles should have some form of depletion or disturbance in its normal surface for the Dosha to manifest.

When Doshas cause damage or create Dushti in these weak sites (Khavaigunya), its termed Dosha localization.

Localization of Doshas at specific sites results in various manifestations or diseases, such as:

• Udara (Abdomen): Gulma (abdominal tumors), Vidradhi (abscess), Udara Roga (abdominal disorders), Agni Vikara (digestive issues), Vibandha (constipation), Anaha (bloating), Atisara (diarrhea), etc.
• Basti (Bladder): Prameha (urinary disorders), Asmari (renal calculi), Mutraghata (urinary obstruction), etc.
• Medhra : Nirudhaprakasa( phemosis) , Upadamsa ( gonorhhea ), Suka Dosa (veneral disease).
• Guda (Rectum): Bhagandara (fistula), Arsha (piles).
• Vrana (Wounds): Vrddhi (abnormal growths or swelling).
• Urdhvajatrugata (Upper respiratory tract): Manifestations related to the upper respiratory system.
• Tvak (Skin diseases): Ksudra Roga (minor skin ailments), Kustha (like leprosy), Visarpa (herpes, erysipelas), etc.
• Meda: Granthi (cysts), Apaci (tumors), Arbuda (malignant growths), Galaganda (goiter), Alaji (boils).
• Asthi (Bone tissue): Asthi Vidradi (disorders related to bone destruction or deformity).
• Pada (Foot): Slipada (foot swelling), Vatasonita (gout), Vatakantaka (planter fasciitis).
• Sarvang (Entire body): Jvara (fever), Vatayadhi (nervous disorders due to Vata), Prameha (urinary disorders), Pandu Roga (anemia), Sosha (emaciation), etc.

tissue or Dhatu plays a crucial role in shaping the disease. For example, when Pitta affects blood (Rakta), it might result in specific blood-related disorders.

3. Mixing of Doshas: The extent of combination or mixing of Doshas also influences the disease presentation. Different combinations of Doshas result in varied manifestations, even if the primary dosha imbalance remains the same.

Understanding these factors helps in diagnosing and treating diseases according to their specific characteristics, allowing for a more tailored and effective approach to restoring balance and health.

Diseases exhibit their initial symptoms and indications at this time. Synonyms for these characteristics include Rupa, Samsthana, Vyanjana, Linga, Lakshana, Chinha, and Akriti. Shopha, Arbuda, Granthi, Vidradhi, Visarpa, Jwara, and Atisaradi Vyadhi are a few examples.

According to the diagnosis the treatment is to be planned accordingly.

Stage of Bheda^[11]

Once these sores rupture and ulcers form, it marks the sixth stage in the progression of the condition, where the focus shifts to addressing the imbalance of Doshas. At this point, accompanying symptoms like fever, diarrhoea, and other systemic issues tend to become chronic. If proper intervention and treatment aren't initiated during this stage, the condition can progress to become untreatable. It refers to the chronicity of the disease. Mostly this Kriyakala is concerned with Vidradi leading to Vrana. The Upadrava (complication) of the disease emerges in this stage. Treating the disease in this stage becomes critical because of Dhatukshaya which also occurs at this stage.

Clinical Importance

Understanding the progression of disease through the stages of Kriyakala in Ayurveda is crucial for effective treatment. Early detection in the Sanchaya stage allows for easier intervention and control of Doshas before they escalate and become more entrenched, potentially leading to resistance against treatments. Hence, initiating treatment promptly is key to managing and potentially halting the disease's advancement.

The first two stages, Sanchaya and Prakopa are like the susceptibility stage in modern terms. This is when risk factors and the body need to align for a disease to develop. Then comes Prasara and Sthanasanshraya, where imbalanced elements move and settle in specific body parts. Here, diagnosis becomes tricky as symptoms aren't clear yet, resembling the pre-symptomatic phase in modern medicine.

As the first three stages of Shatkriyakala i.e., Sanchayavastha, Parkopavastha, Prasaravastha are depends on the imbalance Doshas, until the third stage of the Shatkriyakala clear cut diagnosis of a disease cannot be made so the treatment in first three stages are made according to the vitiated Doshas. In the fourth stage of the Shatkriyakala Purvroop (Premonitory symptoms) emerges. Thus, the diagnosis if any disease can be considered and the treatment should also be according to the disease condition after this stage.

When the disease shows clinical signs (Vyakti), it's comparable to the stage of clinical disease, where diagnosis and treatment become critical. Finally, Bheda, the last stage, is akin to the diminished capacity phase, which could lead to recovery, disability, or worse. Emerging of the Upadrava (Complications) of the disease in the Bhedavastha also worsens the disease condition.

Conclusion

Understanding Shatkriyakala is crucial for grasping how diseases develop and for making accurate diagnoses. A doctor who comprehends and distinguishes these six stages of Dosha and can diagnose and treat accordingly becomes a successful practitioner. This knowledge guides which treatments to use at specific Dosha stages and provides a clear idea about the treatability of the disease.

Knowing Shatkriyakala helps determine the chances of successfully treating an ailment. However, Ayurvedic scholars warn against delaying treatment at any stage, as it might render the disease untreatable (Asadhyata) and lead to treatment failure. Therefore, the concept of Shatkriyakala, as detailed in Ayurvedic texts, holds immense importance for effective treatment strategies and avoiding complications due to delays.