Introduction

In Ayurveda, the terms Koshtha and Koshthanga hold significant importance in understanding the physiological and pathological aspects of the human body. Sushruta, the renowned ancient surgeon, has elaborated on these concepts in the Sushruta Samhita, providing insights into their anatomical and functional relevance. This article examines the concepts of Koshtha and Koshthanga described by Sushruta and relates them to current medical knowledge.

Definition of Koshtha according to Sushruta

स्थानान्यामाग्निपक्वानांमूत्रस्यरुधिरस्यच||
हृदुण्डुकःफुप्फुसश्चकोष्ठइत्यभिधीयते”||(सु.चि.2/12)

Acharya Sushruta describes the Koshtha as a cavity or region that contains the following organs:-

Amasaya, Agnyaashaya, Pakvasaya, Mutrashaya, Rudhirashaya, Hridaya, Unduka, Phuphusa.^[2]

The term Koshtha refers to the body cavity that houses vital organs responsible for digestion, metabolism, and other essential bodily functions.

Sushruta defines Koshtha as the region that contains the primary structures involved in nourishment and elimination, broadly including the gastrointestinal tract and associated organs.

Types of Koshtha

तत्रमृदुः, क्रूरो, मध्यमइतित्रिविधःकोष्ठोभवति|
तत्रबहुपित्तोमृदुः, बहुवातश्लेष्माक्रूरः, समदोषोमध्यमः”||(सु.-चि.33/21)

According to Acharya Sushruta, Koshtha is classified based on the predominance of Doshas:

1. Mridu Koshtha (Soft Bowel) - Pitta dominance, resulting in frequent and loose bowel movements.

2. Krura Koshtha (Hard Bowel) - Dominated by Vata & Kapha, leading to dryness, hard stools, and constipation.

3. Madhya Koshtha (Balanced Bowel) - Tridosha balance (Sama Doshas), leading to normal digestion and bowel habits.^[3]

This classification has clinical relevance in predicting a person’s response to medications, dietary habits, and disease susceptibility.

Hrudaya and Phuphusa - the heart and lungs - are among the organs mentioned, and they are the principal structures located within the Uro-guha, or chest cavity. Sushruta also identifies structures such as Agnyashaya, Amashaya, Pakwashaya, Rudhirashaya, Mutrashaya, Hrudaya, and Unduka.

Clinical Correlation with Modern Medicine

From a modern anatomical perspective, Koshtha represents the abdominal and thoracic cavities housing the digestive, respiratory, circulatory, and excretory organs. The functional attributes described in Ayurveda closely correlate with modern physiological concepts:-

Amasaya and Pakvasaya correspond to the stomach and intestines, respectively, where digestion and nutrient absorption occur.

Agnyashaya - Stomach, Small intestine, Pancreas, Liver etc., we should mainly consider Pancreas as the site of Agni.

Mutrashaya - the urinary bladder, crucial for waste elimination.

Rudhirashaya - Yakrit and Pleeha are the liver and spleen, vital for detoxification and hematological functions.

Hridaya - aligns with the heart, responsible for pumping blood throughout the body.

Unduka - The organ then receives the digested food and starts forming the stools, the Cecum or the beginning part of the large intestine should be considered as Unduka.

Phuphusa - matches the lungs, facilitating gas exchange.

Discussion

Concept of Koshtha & Koshthanga in Ayurveda, as elaborated by Sushruta, plays crucial role in unders-tanding the anatomy, physiology, and pathology of the human body. This discussion aims to explore the significance of these concepts in Ayurveda and their relevance in modern medical science.

Koshtha - Its Functional and Anatomical Importance

Sushruta describes Koshtha as abdominal & thoracic cavities, which house vital organs responsible for digestion, metabolism, circulation, and elimination.

Ayurveda’s emphasis on digestion (Agni) and waste elimination (Mala Nirgamana) is supported by contemporary research on gut health, microbiome balance, and metabolic syndromes.

Clinical Implications

• Personalized Medicine: The Ayurvedic classification of Koshtha helps in predicting a patient's response to food, medications, and therapies, much like modern pharmacogenomics.
• Preventive Health: The understanding of Koshthanga aids in the early diagnosis and prevention of diseases like liver disorders, cardiovascular diseases, and metabolic imbalances.
• Approach Holistic: Ayurveda’s emphasis on diet, lifestyle, and detoxification (Panchakarma) can be integrated with modern medical practices for comprehensive patient care.

Conclusion

शरीरचैव शास्त्रे च दृष्टार्थ: स्यादद्विशारद:।
दृष्टशृताभयाां सन्देहमवापोह्य चरेत् क्रिया: ॥ (सु.शा.5/63)

The physician will become greatly learned only after observing the body carefully, study of the science, getting rid of doubts by personal observation and study of texts, he should carry on his activities.^[13]

Rachna Sharir or Human Anatomy is the basis for any medical science. Understanding the construction of the human body requires knowledge of its fundamental components: cells, tissues, organs, and organ systems. In Ayurvedic anatomy, the concept of Koshta offers a detailed understanding of the body’s internal cavities and the visceral organs within them. The three Doshas - Vata, Pitta, and Kapha - are dynamic forces that move throughout the body. Each Dosha is associated with specific tissues and organs where it predominantly resides and governs physiological functions. For instance, organs like the lungs (Phuphusa) and stomach (Amashaya) serve as principal sites for Kapha; the large intestine (Pakwashaya) is the primary seat of Vata; and organs such as the navel (Nabhi), stomach (Amashaya), pancreas (Agnyashaya), and heart (Hrudaya) are key locations for Pitta. A thorough understanding of Koshta is essential for comprehending the physiological roles and interactions of these doshas within the body.